A day in the life

As each week goes by, I feel like the victim of a frontal assault. Yet another different presenter offers wave after inevitable wave of new information. Don’t get me wrong, I am not complaining. This is what I signed up for. They have delivered on all of their promises and then some. My knowledge (I hope) keeps growing.

Taken as a whole, this is an outstanding course. Their evolution seems similar in many ways to what we have tried to do at Wilderness Medical Associates. I have picked up some good ideas from how they do things. Like us, they hand out a printed version of each PPT lecture. Because they use 6 images per page, some of the graphs and charts are nearly impossible to read. 3 per page would make everything more readable but would double the amount of paper. I would have to hire a caravan to get everything home. Fortunately, we have online access to all of the lectures until we leave in April. This is great because you can read the charts and see the color version of all of the picts shown in class. We also have a case study book, much like our SOAP notes book, in which we can record information about all of our patients.  Combined with the photos of x-rays and other clinical findings recorded and shared by one of our group, we will leave here with some wonderful clinical information.  The lab sessions relate directly to things that we have already covered in class – e.g., microscopy of parasites. On some days, instead of a lab, we use case presentations to generate discussions about some important and interesting topics. These discussions can revolve around different clinical manifestations of a disease, differential diagnoses of a a symptom complex or dilemmas in treatment. They are frank and with regard to treatment, don’t always agree with the CDC, WHO or Partners in Health.

The late morning and early afternoon sessions (clinic and lab/discussion) are conducted with small groups. These are the most fun for me. There are 5 – 6 people in the clinical group; 8 in the lab/discussion. Each of the 2 groups is composed of different combinations of people. You stay with each for the full nine weeks. It is obvious that they tried to mix the groups up to reflect the heterogeneity of the class. Personally, I relate most closely to my clinical team because it is smaller and we talk about our patients in a more intimate and interactive way. This group includes two Canadians. One is a family practice physician who has finished an infectious disease fellowship and is now doing one in critical care medicine. The other is a nurse from BC presently doing ED locum work in RI. There is an infectious disease fellow from the Dominican Republic, a family practice physician from VT, and an internal medicine resident from Boston who will ultimately do dermatology. Each is motivated and bright.  I will say more about them later if they give me permission. The other group is equally diverse.  It is a pleasure to be with either group. 

In general, we are given an introduction to a topic and then revisit it in different formats several more times. Malaria is a good example. It has been covered in one form or another each week. After some introductory information we have talked about the 5 different types, their natural history, prevention, diagnostics (high and low tech) and treatment of both routine and life threatening presentations. In the lab we have looked at smears, made them (thick and thin), seen the rapid tests, and then looked at smears again. On Friday, we spent nearly 6 hours looking at pictures and then perused known and unknown slides. We got another chance on Sat including a guided tour on a multiuser scope, driven by an expert from Montreal. Then at the end of the course, we will traveling to Iquitos on the Amazon to visit a malaria research station (think Fitzcaraldo).  Malaria is much more complex than I realized but, with some apprehension, I believe I could approach a potential case with some confidence. That represents a huge amount of progress.

I am working on a couple other dispatches but given my writing skills, they are taking a long time. I hope this will suffice.



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