Before becoming a clinical assistant professor of medicine at Stanford University and a YouTube sensation, Eric Strong, MD practiced on the pacific island of Papua New Guinea. It was a medical aid experience far from the description of “tropical paradise” but one that helped shape his global perspective. In this interview, Dr. Strong and Doximity’s Medical Director, Dr. Alex Blau, discuss medical professionals expanding the reach of their professional knowledge outside the United States—through international aid work and new technology.
Alex Blau, MD: Dr. Strong, you spent 6 months working in Goroka, Papua New Guinea—tell us about your experience in global health.
Eric Strong, MD: My wife and I worked at a government-administered, rural secondary care hospital. We hoped to both provide as much individual care as possible, as well as learn how to diagnose and treat patients in a resource-poor environment. Overall, the hospital was very poorly equipped. There were only a handful of different meds available, inadequate space for TB isolation, and no provided linens for patients. During the dry season, the hospital could go all afternoon without running water.
In addition to the lack of resources, there were major language barriers given Papua New Guinea (PNG)'s phenomenal linguistic diversity—there are approximately 700 distinct languages. This setting made acute medical care and even basic patient education extremely challenging. We also conducted an epidemiological survey and informal anthropological study of intimate partner violence, which is extremely prevalent in PNG.
AB: Was there something that they did well in New Guinea that you wish were more mainstream in US practice today?
ES: The entire care team for the medical ward went on walk rounds together every morning. Doctors, nurses, nursing assistants, and the students were all present for a discussion of the day's plan for each patient, which was done at the bedside. This was in part a matter of necessity as the scant documentation made face-to-face communication critical. But, regardless of the reason, by the end of the morning, everyone was on the same page as to each patient's status and treatment plan. I've never seen such rounds occur in the US, outside of the ICU.
AB: What surprised you about medical care in Papua New Guinea?
ES: I expected that the biggest impediment to adequate care would be lack of resources. While resources were definitely few, the major limiting factor was a lack of accountability of the doctors. Medical errors and iatrogenic complications were described in only the vaguest of terms to the patients. Without formal documentation, there wasn't even a record of what had happened to be reviewed later. In addition, doctors would not show up to work for days at a time, without explanation or consequences. Once we encountered the hospital's on-call doctor joy-riding through town in an ambulance, intoxicated—while on duty. When we discussed the joy-riding incident with staff the following day, they shrugged it off, explaining that it was not an uncommon occurrence. That was by far the most shocking, and disappointing, aspect of our experience.
“We encountered the hospital's on-call doctor joy-riding through town in an ambulance, intoxicated—while on duty” Tweet this
AB: What advice would you offer physicians considering international medical relief work?
ES: Pick a goal for the project that is specific and realistic. If you are completely inexperienced in international health, and lacking a strong infectious disease background, you shouldn’t go over with the primary goal of "making a difference." If you get to perform a critical surgery that could otherwise not have been performed, or complete a sustainable public health project, then of course that's absolutely fantastic. But for an inexperienced physician's first trip, I would recommend making your primary goal about gaining the experience and perspective necessary to make your second trip successful. [Editor’s note: Doximity recently partnered with Doctors Without Borders to assist with their physician recruiting. You can learn more about medical aid opportunities here.]
AB: Now that you're back in the US, you've become an advocate for open online medical education. Your YouTube channel has over 35,000 subscribers. How did you start this campaign? How has it grown?
ES: Our residency program (Stanford University) asks faculty to submit the PowerPoint slides for any presentation given during noon conference, so residents can see what was missed if they were unable to attend in person. I felt that reading slides from home was an inadequate substitute for being physically present, so instead, I began creating videos, narrating over the slides, and posting them to YouTube.
I didn't initially think too much about others outside of our program watching the videos. However, I began to receive emails with amazingly thoughtful questions and comments from all over the world. And requests for specific topics as well. A few schools and training programs now use the channel in a flipped classroom model, in which students watch the didactic videos at home, preserving in-class time for small group discussion. There's no need for every institution to create their own, individual set of videos for their courses, if the medical community can create a shared library of resources.
Probably the most satisfying aspect of my channel has been the ability to reach students in parts of the world where formal medical training is less available or robust. Once my children are a little older, I would love to travel abroad again and meet some of the wonderful people I've spoken with through my channel.
AB: If you could change one thing about medical training in the US, what would it be?
ES: I would love to make the distinction between preclinical and clinical years more fuzzy. All four years of medical school should be considered "clinical." We should get more practicing clinicians teaching in the basic science courses to keep the curriculum clinically relevant, and basic science should be better integrated into clerkships in order to help students retain that knowledge long-term. Related to this, I think medical school curricula should also be more reflective of how medicine is practiced in the 21st century. As just one example, schools could replace teaching obsolete components of physical diagnosis with point-of-care ultrasound.
I would also love to replace scheduled tests with pop quizzes in order to end the ubiquitous cramming/purging studying behavior that is the antithesis of what's needed for true learning, but I suspect this last suggestion would be poorly received by just about everyone.
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All four years of medical school should be considered 'clinical.' @Doximity talks with Dr. Strong from @StanfordMed Tweet this