Harborview Medical Center

International Health Ambulatory Rotation

Faculty Contact
Annie Chun, MD

325 9th Ave, Box 359780
Seattle, WA 98104
Phone: 206 731-4193, 206 731-3767
Email: anchun@uw.edu

Overall Educational Purpose
· Preparatory clinical experience for those interested in International Health
· 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 medicine/research.
· If scheduling allows, residents will work in the dermatology clinic to improve their physical exam skills in the diagnosis of skin diseases.
· 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 smear review.

Educational Content
Mix of Diseases
Immigrant/refugee health, General Internal Medicine primary care, TB, HIV, STD, General Dermatology, Maternal/Child health

Patient Characteristics
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
Recommended Readings
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 2001;174:433-437.

Kleinman A, Eisenberg L, Good B. Culture, illness, and care: clinical lessons from anthropologic and cross cultural research. Annals of Intern Med. 1978;88:251-258.

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.

W ebsites
http://www.cdc.gov/nchstp/tb/default.htm (CDC Division of Tuberculosis Elimination)
http://www.cdc.gov/travel/ (CDC Travelers health website)
http://www.cdc.gov/node.do?id=0900f3ec80009a98 (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 Program Perfomance
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 competence).

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