Spreading Medical Knowledge Abroad Is Necessary and Rewarding

PHOENIX-As James D. Smith, MD, took his place behind the lectern to prepare to speak about what America’s role should be in the instruction of physicians in underprivileged and disease-stricken countries, a question was posed on the screen next to him: Do we have a responsibility to help?

But it wasn’t really a question-it was more like a request.

Of course physicians in the United States should do what they can to bring medical education to struggling parts of the globe, said Dr. Smith, who himself has given a lot of time to overseas work.

Both he and Wayne M. Koch, MD, who introduced him, said our advantages in the United States put us in prime position to help.

Why do I think international medical education is important? Dr. Smith said during his John J. Conley Lecture at the 2009 annual meeting of the American Head and Neck Society, held as part of the Combined Otolaryngology Spring Meeting. Why should we even be concerned about helping? I think in North America and most of Europe, we have been blessed with opportunities and resources that most doctors in the world can only dream about. I have been in many countries where there are 400 to 500 medical students in each medical school class, only a few hundred beds to teach clinical medicine, and then only a few faculty to teach them. You can imagine making rounds with 40 or 50 students, one professor, and maybe one or two residents. If you’re student number 50 in the back, you really don’t hear much, let alone get any hands-on experience.

Dr. Koch said, North America has the best teaching and surgery and research in the realm of head and neck cancer in the world, and with that we have both an opportunity and an ethical obligation, I think, as we consider our responsibility as citizens in that world for teaching and reaching out.

Residency Training

Dr. Smith said that North American residency programs, with residents and faculty members working hand in hand, are not found in most other countries. I think one of the places where North America shines is in its postgraduate or residency training programs, he said. The concept of a rigorous, structured training program where the faculty actually assists and teaches a resident is not common in most countries. In most countries, the residents tend to watch, maybe assist, and then after they’ve seen enough cases, they are sent away to do the cases on their own, with little or no supervision.