Report on Clinical Electives in Hong Kong and Cambodia

This article has been peer reviewed. International health experiences play an increasingly important role in medical education [1, 2]. Many trainees feel they provide important insight into different cultures and health beliefs [3]. International experience exposes students to barriers to healthcare delivery in the context of local, political, social and economic factors. International experience also offers students to see a wide range of pathologies not commonly encountered at their home institution or country, and broaden their horizon to include global health issues [4, 5]. Perhaps these overseas placements become more important as physicians are increasingly called upon to adopt a more culturally sensitive approach to clinical practice [6, 7]. Additionally, as globalization continues, physicians need practical experience in the recognition and management of diseases previously isolated to specific regions [8]. As a medical student at the University of Nottingham, UK, I undertook my elective during my final year of medical school. This is a period after finals but just before starting work. I spent a month in Hong Kong observing an obstetrician/gynecologist working in the private health sector. Then, I did a clinical clerkship in a pediatric hospital in Cambodia. The obstetrics/gynecology clinic in Hong Kong is situated in the heart of the city. I saw cases ranging from antenatal visits to hysterectomies. It was my first experience in a private practice setting, and I was interested to observe the doctor-patient dynamics in a different environment. Patients in this setting are extremely well-informed and this necessitates altered different approach to consultations [9].

Each appointment lasted 40 minutes allowing a leisurely pace and the opportunity to build an excellent rapport. These consultations provided an excellent stimulus to reflect on ethics surrounding medical practice, as well as factors influencing a good doctor/patient relationship. Through this I will appraise my own practice in order to improve my interactions with patients, and gain a firmer grasp of applied medical ethics. The second part of my clinical rotation was in the Angkor Hospital for Children, which is on the edge of Siem Reap, Cambodia. Common cases included typhoid, dengue and neonatal infections. I saw clinical conditions I had never encountered before such as leprosy and became more confident in managing tropical diseases. Additionally, the non-clinical experiences provided invaluable learning opportunities. Health beliefs in Cambodia are wildly different from those in Nottingham. Appreciating this is important in understanding attitudes towards disease and treatment [10]. I was fascinated by the procedure for gaining consent. Forms were ‘signed’ with a thumb print following verbal explanation. This made me consider aspects of consent, reiterating that a signature on a piece of paper is not informed consent. My attempts to learn Khmer were greeted with kind confusion. I had to focus on ways to improve my communication skills, particularly non-verbal communication. This is an important transferable skill which will serve me well in future practice. My international electives were a wonderful experience. I visited Asia, the largest, most populous continent in the world. I saw a diverse range of clinical signs and learned cutting edge OBGYN management in a private setting. I was exposed to different cultures and gained understanding of some of the advantages or challenges facing healthcare providers in different political and/or socioeconomic conditions. These experiences were a catalyst for critical reflection on ethical principles governing medicine, aspects of successful doctor/patient relationships and my own communication skills. I would urge anyone considering taking an international clinical elective to seize the opportunity. I believe the understanding, knowledge and the skills I gained through these placements will make me a better doctor in my future career.

To apply for my elective in Hong Kong, I found online lists of English speaking doctors in the city (http://hkdoctors.org/ or http://hongkong.angloinfo.com/af/473/hong-kong-doctors-and-medical-practitioners.html). I emailed several practices a copy of my CV. I had a number of replies and was able to select from these. I stayed in a hostel on the island. Accommodation was expensive but the atmosphere was great. Hong Kong boasts a multitude of bars, restaurant and shops and is a good starting point for travel to pretty much every Asian destination. Bus, taxi and rail links are outstanding. At the Angkor Hospital for Children, there is a central coordinator for students applying for electives (https://angkorhospital.org/). They request a copy of your CV, a cover letter and two references. There are multiple affordable guest houses scattered throughout the town. Availability of water and electricity can be variable, but people are generally very welcoming. Transport is on cycles or tuk-tuks and can be an intimidating experience! The temple complex is perhaps one of the most magnificent sites of the world, and should not be missed by anyone travelling to Cambodia.

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