One challenge created by the pandemic has been the need to develop avenues for students to interact with their peers in other countries. In early 2021, six Ugandan senior medical students from Makerere University School of Medicine (MUSM) and five fourth- and fifth-year MD students from Yale School of Medicine (YSM), along with faculty from both schools, participated in a six-week virtual clinical elective. The group explored and provided perspectives on topics including medical education and health care systems in one another’s countries, patient-centered communication, ethical questions in clinical practice, social determinants of health, and current critical global health issues.
For over a decade, students from Makerere and Yale have come together through a bi-directional clinical exchange program. Much of their experience has come from the daily interaction between the students, whether on the wards in Kampala or over a lunch at the carts on Cedar Street in New Haven. As it became clear that in-person exchanges would not be possible during the COVID-19 pandemic, program leadership from both schools worked together during the fall of 2020 to create a virtual elective that would provide the students with many aspects of the exchange experience.
The virtual elective included nine synchronous sessions, as well as asynchronous sessions and designated readings. Additionally, the Makerere students learned effective search techniques from the YSM Cushing/ Whitney Medical Library staff and were provided access to the library’s resources for supporting clinical care.
To provide the patient experience, students worked with Standardized Patients (SP) from the YSM Teaching and Learning Center. The students reviewed the training materials used to teach patient-centered communication as part of the regular YSM curriculum and practiced these techniques by conducting telehealth interviews. Though the Yale students had practiced these steps in their pre-clinical years and used them on the wards, this elective provided them with an opportunity to model the steps for the Makerere students before they took turns interacting with the SPs.
In debriefing this experience, the Makerere students shared that attending to emotions was at the center of their learning. One student reflecting on the SP workshop on Communicating Difficult News expressed:
“In the past, I have handled patient emotion mainly by silence and letting the patient express their emotion. Having learned the Naming, Understanding, Respecting, and Supporting model, I now know other strategies for responding to patients’ emotions apart from silence. On issues of my own emotions, I have oftentimes responded by withdrawing from very emotional situations. But now with this new knowledge, I will try other approaches such as being present, listening actively, and offering support in any way I can.”
Another Makerere student reflected on how, in the future, they will approach their patients holistically:
“I will look beyond the clinical features and address their fears. I will take my time to prepare the patient for any communication without undermining any disease. I have learned that syphilis, which I could think is simpler than cancer, can lead to a marital breakdown, hence emotional depression, which I could have addressed while I communicated to my patient. I will listen carefully without interruption because the patient is the specialist of his illness and I am just a specialist of the disease.”
Fourth-year YSM MD student Amy Thomas expressed her appreciation for the program:
“The MUYU virtual elective was a great way to get to know and develop connections with students from a foreign institution with a lot to teach us about their local medical education and health care system. There was an equitable exchange of information and skills during the sessions, and it was great to get to know each other during the social sessions that took place during the course. As someone who wants to do a clinical rotation abroad, it was a really valuable experience to get to know more about the regions where I might be able to practice and get to know the students and faculty involved in this endeavor."
Students also engaged with each other outside of the scheduled sessions with faculty and created virtual meet-ups on Saturdays where they could talk, join in games, and take virtual tours of each campus. At the conclusion of the six weeks, the students reflected on their overall experience and asked for more time with their counterparts from each country and more synchronous sessions, as well as more journal articles from Uganda. They also hope to be able to travel again, so that they can meet in person and experience culture in Uganda and the United States.
The YSM Office of Global Health Education expressed gratitude to colleagues, Harriet Mayanja-Kizza, MBChB, MMed, MSc and Joseph Baluku, MBChB, MMed at Makerere University and Mulago Hospital, and to Tracy Rabin, MD, SM and Jeremy Schwartz, MD at YSM, for committing the time, energy, and enthusiasm to help create and deliver an elective that opened the world of medicine a little more for all participants.