Three-Continent Comparison of Medical Education

By Rebecca DiBiase  

I recently completed my master’s degree in public health at the Bloomberg School of Public Health. Through the help of two projects I worked on during my master’s degree, I rediscovered a niche in the field of global health that I find particularly unique and exciting: international medical education.

I initially became interested in this field during college, when I went on a medical relief trip to a remote part of Guatemala. I was fascinated by the disconnect I noticed between the education provided at medical schools in Guatemala and the traditional medicine many providers practice in the community. I spoke with a number of people who had received very different types of medical education in Guatemala, including formal biomedical training, midwife apprenticeship training and a knowledge of healing acquired through years of serving as the village’s curandera, a social leader who also fills the role of community healer.

I also spoke with a medical anthropologist who taught at one of the universities in Guatemala and had spent his career studying the varying types of medical training provided in that country. He described the need to expose medical students to the different types of healing seen throughout Guatemala, especially in remote indigenous communities, to prepare them to work with other providers and place their own knowledge in the context of the community’s health views and needs. Through this preliminary experience, I began to appreciate the art of designing a medical education curriculum that prepares students to care for patients in diverse environments.

When I started medical school four years ago, I got swept up in the hustle of studying and memorizing vast amounts of new medical knowledge. Toward the end of my second year at Johns Hopkins, I connected with Steve Sozio, a nephrologist who is very involved in medical education both here and abroad. He began telling me about a medical education project he was designing and implementing in Istanbul, Turkey. I was immediately hooked.

Last fall, I was afforded the unique opportunity to travel to Istanbul with a group of students and doctors, including Dr. Sozio, to help teach a class at Bezmialem University and examine whether a research training module could be implemented in a Turkish medical school. We taught the Scholarly Concentrations curriculum, a required class at Johns Hopkins for all first- and second-year medical students.

Through this experience, I recognized the challenges of adapting a portion of the curriculum from a U.S. medical school to fit the needs and goals of an institution in another country, particularly one with some different foundations and values underlying its medical education.

For instance, research is an important component of medicine in the United States, and this passion for academic inquiry extends through all levels of practice and training. In Turkey, medical school and residency admissions almost completely rely on students’ national examination scores, and thus it can be more difficult to inspire students to pursue projects that might detract from their perceived preparation time for these examinations.

Thus, in Turkey, I experienced the challenges of international medical education through a very different lens compared with the one I experienced in college. Nevertheless, I learned it is important in this field to work with a comprehensive knowledge of the environmental nuances that impact how education must be structured.

I recently returned from a trip to China, during which I supported a collaboration between Johns Hopkins and Drum Tower Hospital in Nanjing, China. The two institutions are working together to help establish an innovative medical residency program in China that we hope will be the first training program in the country recognized by the Accreditation Council for Graduate Medical Education. I spoke with and observed a number of teachers and trainees at Drum Tower Hospital to gain a broad sense of the specific nuances and challenges of developing a U.S.-style residency program in China.

Again, I observed the difficulties of transposing a U.S. medical education system to another country and the need to adapt that system to the environment to give it the best chance of thriving. Research is highly valued in China, and medical students can start medical school with a clinical or research background—in essence, the equivalent of either our traditional premedical curriculum or a scientific master’s degree or doctorate. Thus, students approach clinical training from a very different array of experiences, which makes it challenging to standardize education and adequately prepare everyone for independent clinical practice. This was an equally fascinating, yet very different nuance of the medical education system from what I had experienced in Turkey.

My experiences in Guatemala, Turkey and China have demonstrated the diverse challenges that make international medical education interesting. I am excited to continue exploring this field of academic medicine through a global health lens as I continue my own education.

Rebecca DiBiase is an M.D., M.P.H. student planning to become a neurologist. This post originally appeared in Biomedical Odyssey, Adventures from the Johns Hopkins University School of Medicine.