Harborview Medical Center
International Health Ambulatory Rotation
Annie Chun, MD
325 9th Ave, Box 359780
Seattle, WA 98104
Phone: 206 731-4193, 206 731-3767
Overall Educational Purpose
· Preparatory clinical experience for those interested in International
· Residents will be exposed to cross cultural medical care-working
with interpreters, immigrant/refugee screening, cross cultural communication.
· Residents will work in Public Health clinics focused upon the
care of STDs and TB and will gain an appreciation for population based
· If scheduling allows, residents will work in the dermatology
clinic to improve their physical exam skills in the diagnosis of skin
· Residents will work in the Madison HIV clinic to learn the basics
of HIV primary care.
· Residents will have the opportunity to work in the Children’s
clinic and Women’s clinic to familiarize themselves with maternal
and child health care.
Principle Teaching Methods
Case discussion and review
Patient based learning in outpatient clinic setting.
If scheduling allows, residents may participate in weekly TB case management
discussions (currently scheduled for Thursday morning, although this may
change to Weds mornings)
Weekly didactic sessions on lab medicine, basic parisitology and blood
Mix of Diseases
Immigrant/refugee health, General Internal Medicine primary care, TB,
HIV, STD, General Dermatology, Maternal/Child health
Immigrant/refugee patients at Harborview Medical Center. Urban underserved
population served by Harborview and the King County Public health clinics.
Types of Clinical Encounters
Outpatient clinic visits
Rotation Specific Schedule
AM: Dermatology Clinic or Children’s Clinic
PM: International Medicine Clinic or Women’s Clinic
AM: Continuity Clinic or ?Madison Clinic
PM: STD Clinic
AM: TB Conference
PM: Madison Clinic or Children’s Clinic
AM: Conferences at UW
PM: Didactics or International Medicine Clinic
AM: Women’s Clinic or International Medicine Clinic
PM: Women’s Clinic or Continuity Clinic
Call and Weekend Responsibilities
Principle Educational Materials Used
Black RE, Morris SS, Bryce J. Where and why are 10 million children
dying every year? Lancet 2003;361:2226-34.
De Cock KM, Weiss HA. The global epidemiology of HIV/AIDS. Tropical Medicine
and International Health 2000;5(7):A3-A9.
De Cock KM, Mbori-Ngacha D, Marum E. Shadow on the continent: public
health and HIV/AIDS in Africa in the 21st century. Lancet 2002;360:67-72.
Jong, Elaine. Intestinal parasites. Prim Care Clin Office Pract 2002;29:857-877.
Immigrant women’s health: initial clinical assessment West J Med
Kleinman A, Eisenberg L, Good B. Culture, illness, and care: clinical
lessons from anthropologic and cross cultural research. Annals of Intern
Shaywitz DA, Ausiello DA. Global health: a chance for Western physicians
to give—and receive. American Journal of Medicine 2002;113:354-357.
Walker PF, Jaranson J. Refugee and immigrant health care. Medical Clinics
of North America 1999;83(4):1103-1120.
(CDC Division of Tuberculosis Elimination)
Travelers health website)
(CDC site on sexually transmitted diseases)
http://ethnomed.org/ (Website created
at Harborview Medical Center on cross cultural medical care)
Methods used in Evaluating Resident and
At the end of the rotation, the resident is evaluated in writing and their
performance reviewed with them verbally by every attending and fellow
he or she has interacted with for a significant amount of time. The evaluator
rates the resident on a nine-point scale in each component of clinical
competence (i.e. patient care, medical knowledge, practice based learning
improvement, interpersonal and communication skills, professionalism,
system based learning, educational attitudes, leadership, overall clinical
The resident is given the opportunity to evaluate in writing the quality
of the curriculum and the extent to which the educational goals and objectives
of the rotation have been met. The resident also evaluates the teaching
competence of each attending and fellow with whom s/he has interacted
for a significant amount of time.
Explicit Lines of Responsiblity for Care
of Patients on this Service
Attending physicians provide direct supervision of all care provided by
resident physicians and thus bear responsibility for quality of care,
orders, and follow-up. Attending supervision is documented by co-signature
on resident notes.
Last Revised February 19, 2004 by Andrea Chun, MD