Unethical International Experiences?

[doctorshateher]

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I recently started following UMich's med school admission twitter and the plethora of tweets about not liking international clinical work where students do things they aren't trained for or capable of doing. Like, automatic rejection bad.

Here's what I did:
+ Vital signs and patient registration. We were given good training for taking BP.
+ Home-based care for HIV/AIDS and TB patients where we assisted them with problems like dealing with side effects of medications or took blood pressure, etc.
+ Taught a home-based care class for volunteers that wanted to start their own home-based care program. For this I worked with a public health nurse and used a curriculum provided by the Zambian ministry of health.
+ Taught a first aid course (under the supervision of 2 health professors)

Would this be considered work beyond my training and unethical.

 

[jm192]

I recently started following UMich's med school admission twitter and the plethora of tweets about not liking international clinical work where students do things they aren't trained for or capable of doing. Like, automatic rejection bad.

Here's what I did:
+ Vital signs and patient registration. We were given good training for taking BP.
+ Home-based care for HIV/AIDS and TB patients where we assisted them with problems like dealing with side effects of medications or took blood pressure, etc.
+ Taught a home-based care class for volunteers that wanted to start their own home-based care program. For this I worked with a public health nurse and used a curriculum provided by the Zambian ministry of health.
+ Taught a first aid course (under the supervision of 2 health professors)

Would this be considered work beyond my training and unethical.

None of that sounds too over the top. Some of these people are on here talking about making diagnoses, and being consulted on life saving procedures. I guess the rationale is if you were brought along into medicine this way, you'll be irresponsible in the same way when pre-meds work under you.

I'd say if anyone has an issue with anything you've done though, you could simply leave it off your activities description. You can still say I volunteered in Zambia without saying I cut legs off.

 

[blomar]

A general guideline ( I would assume) is that if it's okay to do in the States, then it's okay to do abroad.

 

[HatWobble]

I'm no expert, but none of that stuff sounds outside the scope of what a volunteer or employee w/o clinical training would do here in the US. I took EKGs in the ER at a hospital (in addition to pt registration and vitals) and I put that on my app. I would imagine doing things like injecting vaccines or suturing would be what these UMich adcoms are griping about, although I can't see their reasoning for thinking such actions are "unethical"... maybe "risky," but "unethical" is a little strong.

Also, while that UMich twitter feed is a good source of info I wouldn't take it to be representative of attitudes of ALL adcoms. UMich admissions seems to be known for being a little eccentric. I would be willing to bet that other adcoms would appreciate the same kind of experience that UMich frowns upon. Maybe someone who is an adcom at another school can corroborate this.

 

[aSagacious]

I can't see their reasoning for thinking such actions are "unethical"... maybe "risky," but "unethical" is a little strong.

Here's the difference:
Risky - messing around with only your own health at risk
Unethical - messing around with another's health at risk

 

[Web MD]

It's unethical to mess around with your own health too since I'll end up paying for part of that bull ****

 

[HatWobble]

Here's the difference:
Risky - messing around with only your own health at risk
Unethical - messing around with another's health at risk

Well, I hope nobody would be "messing around" with anyone's health. I guess it all depends what we're talking about. I would defend that doing things in Haiti that require an RN in the States (like giving vaccinations) is not unethical if you are doing more good than harm. Things that previous posters have mentioned, such as making diagnoses and performing life-critical tasks, could be perceived as unethical if your risk of doing more harm than good is high.

Obviously there is a lots of philosophically-rooted opinions on what is ethical and unethical, depending on whether you take a deontological or utilitarian view of medical care. SDN is one of the last places I'd like to get into such arguments 🙂

 

[venacontracta]

There are people that could turn this topic into a rigorous philosophical discussion. But let's not go there.

If you do significant work abroad, though, you really should think about this and come up with what will the the answer to what you will or will not do. Personally, when it came to hands-on tasks, my view was that it is ethical to do something in a developing setting if I was either formally trained to do it in the US (e.g. an EMT-B course had covered taking vitals) or if I was trained in-country in a way equal to the way other people (not foreign volunteers) were trained to do the same task.

There exist many different viewpoints on work abroad, however, and due to this I would refrain from mentioning any specific procedure you may have done in your primary and probably in your secondaries as well. This way you can bring it up in interviews if you want in a more directed and informed way based on how your interviewer reacts to you discussing international experience.

 

[RNwantDO]

I would suggest dropping the teaching part, when describing your experience. In the nursing field, in my state, you are suppose to at least be an RN when doing patient education. Also first aid teaching is suppose to require the proper certification for said course. Assisting in the clinic and vitals are something that anyone with proper training is permitted to do. Just down-play the education part, and make it sound like you were assisting more. This is the safe way to describe your experience, and it still sounds impressive.

 

[aSagacious]

Well, I hope nobody would be "messing around" with anyone's health. I guess it all depends what we're talking about.

Naturally. If the subject weren't so muddy we wouldn't be having this discussion 😉.

 

[sk8ngli]

I would suggest dropping the teaching part, when describing your experience. In the nursing field, in my state, you are suppose to at least be an RN when doing patient education. Also first aid teaching is suppose to require the proper certification for said course. Assisting in the clinic and vitals are something that anyone with proper training is permitted to do. Just down-play the education part, and make it sound like you were assisting more. This is the safe way to describe your experience, and it still sounds impressive.

Hmm as an AmeriCorps member, I do a lot of health education and it's a legitimate part of my job description. Perhaps some topics are a little dubious, but basic hand washing and encouraging people to see their doctors isn't exactly clinical education.

 

[HatWobble]

Hmm as an AmeriCorps member, I do a lot of health education and it's a legitimate part of my job description. Perhaps some topics are a little dubious, but basic hand washing and encouraging people to see their doctors isn't exactly clinical education.

Yes, I would agree-- I think the previous poster may be conflating his/her state's legal requirements with her particular hospital's desired job applicant qualifications. But, I could be wrong and am happy to be corrected 🙂

 

[RNwantDO]

Yes, I would agree-- I think the previous poster may be conflating his/her state's legal requirements with her particular hospital's desired job applicant qualifications. But, I could be wrong and am happy to be corrected 🙂

Nope, it is the state's requirements. However, washing hands would most likely not be considered patient education. Home based care for HIV/TB would almost assuredly be considered patient education. If someone has certified you as being capable, than I would not worry about it. Overall, nursing is very convoluted as to what is and is not "nursing" related. Just keep in mind you should be certified/authorized/trained to teach by some higher authority, otherwise you may be overstepping your scope of duties.

Added:
Medical schools probably do not care about all of the nuances of other fields. However, providing education on medications and other medical topics may garner questions on your training.

 

[Calvinball]

Looks like this got cleared up:

https://www.aamc.org/download/181690/data/guidelinesforstudentsprovidingpatientcare.pdf

 

[Medicine4Bruhs]

I would keep the information brief to just a sentence or two on what exactly you did down there. Adcoms honestly won't believe you very much anyway. Just make sure you get one or two cool stories from the trip that will allow them to remember you come interview time (think stuff like elephantiasis). It also reassures them that you may have actually gone on the trip in the first place, as they 99.99% of the time will never check up on it.

The most important part of describing these kinds of activities on AMCAS is that you ballpark some range of "shadowing" that you did. What I mean is that adcoms will not choose to infer that a two week medical relief trip to Honduras satisfies some sort of "minimum hours of shadowing" requirement they may secretly have of applicants (which the school chooses not to publicize!). You must literally write that it "allowed you to obtain 60+ hours of primary care shadowing for underserved patients in a rural area". Maximize the impact of your activities! Any other descriptions of the trip on AMCAS are honestly unimportant.

 

[doctorshateher]

Well, I kind of made the teaching aspects the main focus of my personal statement. But after reading the AAMC guidelines for international service, I think I'm A-OK.

I think I will just have to emphasize in my secondaries/interviews that the work was all directly supervised by (1) a public health nurse for the health care class, (2) health science professors for the first aid class, and I was fully trained by local health officials for the vital signs, etc.

For the home-based care, we didn't really do patient education in the sense that it is done in the US. A lot of it was also helping around the house, arranging patient transport to clinics and serving as a DOTS method for TB meds.

Take-home message: I will stress that everything we did as volunteers was highly supervised.

 

[doctorshateher]

Also, I just forwarded that AAMC statement to my study abroad office at school because I have heard a lot of stories of other students who have done stuff that is definitely way questionable on study abroad trips, etc.

Thanks for the input everyone!