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PROGRAMME IHCAI CLINICAL ROTATION FOR SENIOR

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					          Community and primary care based clinical rotation for international residents - Program IHCAI P08 /



                                         PROGRAM IHCAI P08

               COMMUNITY AND PRIMARY CARE BASED CLINICAL ROTATION
                           FOR INTERNATIONAL RESIDENTS

1) Overview:

The goal of the International Health Elective is to offer to Medical Residents an opportunity to learn
about health and healing with a more global perspective by living and working in another country. The
residents will have the opportunity to live and learn in a new and different culture, usually with little of
the technical and medical facilities he or she is accustomed to using. The resident will have the chance
to see a different way of organizing health care to achieve good results and outcomes in the health
situation of the population, in this case Costa Rica. The resources that are taken for granted in the USA
and in other developed countries may be lacking. The resident has an opportunity to be of service to the
community and broaden his or her thinking about future medical research and practice.



2) Rotation Identification:

 This a clinical rotation designed to give the opportunity to practitioners of family medicine, Primary
Care Internal Medicine, Gynecology, Obstetrics, Infectious Disease, and Pediatrics to participate in the
medical and health team activities in the primary care network of Costa Rica which corresponds to the
delivery of first level of health care and services. This rotation is fully community based oriented.

An emphasis is placed on preventative services, including immunizations, maternal child services,
prenatal care, growth and development of children, nutrition, community education, community
sanitation and environment, and the continuity of care in chronic cases.

 In the USA and Canada the Hispanic population represents an important number of people to whom
the health professional must provide appropriate care. To promote competence based medical
education means to prepare the professional to face the reality of working, understanding, and
communicating with this population. This rotation is competence based to expose the resident to work
with the Hispanic population, learn, and accept the culture differences as an important scientific and
ethical principle of the Medical Practice.



3) Who is eligible to participate?

Program IHCAI P08 is for residents in Pediatric, Primary Care Internal Medicine, Gynecology, and Family
Medicine in their second and third year at their home medical school. Residents and curriculum or
students home institutions preceptor must be aware that it is primary care based and community
oriented and a part of the rotations are scheduled in small regional hospitals or in primary care clinics or



                                   IHCAI Foundation is an equal opportunity organization

                                           IHCAI FOUNDATION host and sponsor




                                          The Cochrane Center of Central America
                                       Branch of the Iberoamerican Cochrane Center
          Community and primary care based clinical rotation for international residents - Program IHCAI P08 /


small health post. Costa Rica has an important High Tech Hospital Network. However, the program may
only offer some short visits to these hospitals and the main facilities of the rotation are the regional and
community hospitals as well as the clinics and health post which are the first and second level of the
Health system.

The IHCAI Foundation programs changed to a problem based learning and competence based model
(PBL/PBI/CB).

These approaches place great emphasis on self-directed learning on the residents finding the necessary
information to solve clinical problems with guidance of a system of tutors and to accomplish the
appropriate competences to work with their patients and community according to their necessities and
cultural background. Applicants must have intermediate Spanish proficiency.


4) Duration:
This program may be adjusted to the participant home institution’s requirement. However, the
minimum time to earn three credits is four weeks. The maximum is eight weeks with five credits. The
participant must fulfill all the requirements of the rotation and receive a passing grade in order to obtain
the credits.



5) Format of course or rotation:

 Four or eight weeks clinical work in the Clinics and Hospital regular activities. Residents are oriented
to work with the problem solving method to develop competences in order to work with Spanish
speaking patients in a different culture.
 Weekly Tutorial sessions on Tropical Medicine and Health Care organizations, in this particular case
Costa Rica (Tutorials are in Spanish, handouts are bilingual).

 According to resident’s needs and faculty criteria standardized simulated patient interviews are
available with three different levels of complexity.

 The residents will participate in the every day clinical rounds in the Internal Medicine, Pediatrics
services, and health post or EBAIS ( Spanish acronym for Basic Team for Health Care and they are the
smallest health care unit in the Costa Rica health care system).
 One important component is the Home visits for vaccinations, child growth and development,
prenatal care, and control of chronic diseases. If the student works at the clinic he or she will participate
in these activities for at least one week.



6) Educational Model:
The IHCAI P08 International health Elective for residents has a mixture of teaching models and
techniques since it is necessary to achieve an adequate balance between the Medical Spanish


                                   IHCAI Foundation is an equal opportunity organization

                                           IHCAI FOUNDATION host and sponsor




                                          The Cochrane Center of Central America
                                       Branch of the Iberoamerican Cochrane Center
          Community and primary care based clinical rotation for international residents - Program IHCAI P08 /


understanding and speaking skills and the introduction to a different and new Health care system and.
The epidemiological profile of the area and the ethical situation of working with real patient are also
taken into consideration. The resident must be aware of the fact that the elective is based in the new
model and of the diseases that are common in the area. This rotation is oriented to expose the
professionals to the transcultural medical experience and the cultural differences as well as the new or
resurgent diseases common to the tropical area. However, in the specific case of Costa Rica, the
incidence of some tropical diseases is relatively low given the success of the organization of the Health
System.
The rotation is centered on residents’ needs and there’s an individual approach in order to work out the
differences in language levels and the cultural adaptation to a different medical practice between
students. The rotation will necessarily have a great emphasis on thorough skills to understand, speaking,
writing, and reading Spanish in order to assure an appropriate communication with the patient. It is
important to assure the future’s physician’s competences to work with Hispanic minorities in his or her
home country. It is indispensable that a future physician can understand the inequalities and poverty
that hold a determinant role in the prevalence and the burden of diseases in the developing countries.
The community component as the space-population where the burden of disease has its origin and
solution is an essential component of the rotation.


7) Relationship to Other Courses and previous training required:

 The participant needs, in order to completing a good rotation, to apply all the skills learned in Basic
Primary Care and clinical training as a senior Medical student. It requires intermediate Spanish language
skills (Level 3 of 5).

 Human Behavior/Psychiatry/Transcultural work:

o The participant will build on Spanish communication skills acquired during the rotation, and previous
training in the home institution.

o Will introduce advanced topics such as mental status, sexual history taking, grieving in Spanish
language and Transcultural Medical intervention.

 Physical Diagnosis:

o The participant will build on interview and examination skills in Spanish as a second language.

o Thorough review of physical diagnosis and clinical reasoning using Spanish to speak and write notes,
to present a case and report it in the Medical Charts. The student will learn about the Basic Health Team
(EBAIS) Preventive strategy in the Costa Rica Health System.




                                   IHCAI Foundation is an equal opportunity organization

                                           IHCAI FOUNDATION host and sponsor




                                          The Cochrane Center of Central America
                                       Branch of the Iberoamerican Cochrane Center
          Community and primary care based clinical rotation for international residents - Program IHCAI P08 /


8) Where are the locations? What is their particularity?

The residents will be placed in a primary care clinic. There are several locations to work in:

1. Urban metropolitan areas.
2. Suburban areas.
3. Other cities than the Metropolitan areas.


IHCAI Foundation offer rotations at:

   Clínica Carlos Durán
   Área de Salud Goicoechea I
   Área de Salud Goicoechea II
   Hospital de la Mujer CARIT
   Hospital Nacional de Niños
   Hospital Blanco Cervantes para el adulto mayor
   Hospital Regional de Grecia
   And others.


9) How the time is organized. What are students’ activities during the clerkship?

Students in program IHCAI P08 will attend to and care for patients, who normally attend in the clinic or
hospital. According to Costa Rican regulations, this is only possible the direct supervision of an entitled
physician.

It is necessary to have an intermediate proficiency in the Spanish language and a cultural introduction,
before working with patients (level 3 of 5 minimum).

Students have continuous and schedule assistance to the Costa Rica Health System organization
epidemiological profile and to medical Spanish, cultural issues, the organization of the health-care
system, as well as an introduction to the regional and epidemiological profile of Costa Rica.

Clinical work for senior students is Monday through Friday from 7am to 12 pm and 1pm to 4 pm. This
schedule may vary according to the work at the clinic, depends on IHCAI and agreements with the
students. In general, all the students participate in the Health Team community work such as home
visiting for immunization, children growth and development and chronic disease monitoring and
detection.

Community health activities Monday through Thursday, 1:30 p.m. to 4 pm. Friday afternoon are off, in
order to give the student an opportunity to travel and to undertake other activities.




                                   IHCAI Foundation is an equal opportunity organization

                                           IHCAI FOUNDATION host and sponsor




                                          The Cochrane Center of Central America
                                       Branch of the Iberoamerican Cochrane Center
           Community and primary care based clinical rotation for international residents - Program IHCAI P08 /




10) Tutorial:

Students will have a one-hour medical Spanish tutorial at least once per week this may vary according to
student’s needs. There will also be a one-hour tutorial every week to discuss health problems and the
last week the student will do the case presentation.



11) Case or theme presentation:

The week before the departure, the students will present a case, theme or subject, based on the
interest of the clinic staff and their priorities, as well as the student/resident’s possibilities.



12) Evaluation and Grading:

IHCAI Foundation faculty of the Affiliate Hospital and Clinics will evaluate the student’s work during the
entire rotation as well as during the optional and mandatory activities IHCAI Foundation will add the
IHCAI Foundation seal and the signature of the IHCAI Director’s to all evaluations. An initiative of the
student will be highly appreciate in the final evaluation. IHCAI Foundation may use the Evaluation form
of the student’s home institution or may use the Standard evaluation form of the Tulane School of
Medicine.



13) Application dates and special requirements:

Depending on space availability, the application deadline is minimum 3 months prior to the starting date
of the rotation. The starting date may be anytime during the year with the exception of the time
between December 15th and January 1st, during which IHCAI Foundation is on leave. Given the high
demand between January and April, students are advised to complete their registration at the earliest
possible date. IHCAI Foundation does not guarantee space to those students who did no complete the
registration process even if IHCAI Foundation emailed the application form upon student request.

It is mandatory to complete all the requirements named and any additional ones that IHCAI Foundation
might consider necessary in individual cases.

Recommendation letter: IHCAI Foundation may request a recommendation letter from a faculty
member or advisor at the student’s home institution




                                    IHCAI Foundation is an equal opportunity organization

                                            IHCAI FOUNDATION host and sponsor




                                           The Cochrane Center of Central America
                                        Branch of the Iberoamerican Cochrane Center
             Community and primary care based clinical rotation for international residents - Program IHCAI P08 /




14) Are there any fees, tuition, for this program?

Program IHCAI P08 / Minimum 4 weeks.

The application form can be completed online at:

http://www.ihcai.org/aplicationline.htm

When the student completes the online application, IHCAI Foundation system would send a
confirmation message. Please read this message very carefully because some changes may occur.

Fee = $450 US

Accommodation = $140 US per week.
IHCAI Foundation will arrange the student’s accommodation with a Costa Rican middle class family. The
accommodation includes a single room, breakfast and dinner, laundry service and a moderate amount
of local (Costa Rica or other Country territory) telephone calls (local phone calls are not free like in the
USA), and other miscellaneous services. Airport transportation is provided at arrival and also gives
transportation from the host family to the airport at departure.

Initial deposit is US$ 200.
The remaining of the Fee you paid at arrival in Costa Rica. This deposit is not refundable, unless the student cancels
the rotation at least 2 months prior to arrival. IHCAI Foundation will refund US $ 100. Once the application form is
completed you will need to wire the initial deposit (preferably using Western Union). See instructions below. IHCAI
FOUNDATION will refund 50 % of the delivery cost. The participant must claim the refund while doing the program
and must present the Western Union receipt. Do not send cash or personal checks!

Please wires transfer the initial deposit to Mr. Yuri Baidal, otherwise if there name is given in the
confirmation message. WESTERN UNION is highly recommended and the sender only needs the
following information:

http://www.westernunion.com

Recipient:

FIRST NAME:         Yuri

LAST NAME:          Baidal-Sequeira

(IN SPANISH WE USE TWO LAST NAMES FATHER AND MOTHER FAMILY LAST NAMES PLEASE USE THEM
WHEN COMPLETING THE TRANSFER FORM TO AVOID LEGAL ID PROBLEMS IN COSTA RICA).




                                      IHCAI Foundation is an equal opportunity organization

                                              IHCAI FOUNDATION host and sponsor




                                             The Cochrane Center of Central America
                                          Branch of the Iberoamerican Cochrane Center
           Community and primary care based clinical rotation for international residents - Program IHCAI P08 /



ADDRESS:                              San Jose, Costa Rica.

Reference Telephone Number:           (506) 2227-6564

Once you have wire transferred the deposit via Western Union please email Western Union the
Money Transfer Control Number (MTCN) to ybaidal@ihcai.org copying to info@ihcai.org

PLEASE KEEP THE WESTERN UNION DELIVERY COST RECEIPT AND IHCAI FOUNDATION WILL REFUND 50 % OF THE COST AT YOUR
ARRIVAL. YOU MUST CLAIM THE REFUND TO AN IHCAI FOUNDATION OFFICER WHILE YOU ARE IN THE PROGRAM SITE.



15) Spanish Proficiency:

Students must have intermediate Spanish proficiency (Level 3 of 5). An intermediate level of Spanish is
primordial to guarantee patient respect as well as for ethical reasons. If you do not fulfill this
requirement, please contact the main IHCAI Foundation office for more information. It is essential for all
clinical work to have a moderate level of Spanish necessary for the patient respect and ethical
principles. IHCAI offers other options for students with a low or non-existent Spanish command. During
the rotation, IHCAI offers medical Spanish tutorials with a tutor, assistance, and multimedia support, but
it is not a Spanish course. The tutorials are oriented at improving your skills in medical Spanish. The
IHCAI Program P 010A is an alternative for those students with a very limited or no Spanish Proficiency.
If you need more information, please visit: http://www.ihcai.org/Medical_Spanish_Course.htm

16) Registration:

The application form is available online at our homepage. Please read the information on the form
carefully and make sure you fulfill all the requirements as indicated. Please submit your application
registration form once you are sure that you will be doing the program. If you need more information
please contact us at mailto:info@ihcai.org we will be very please to assist you.

After complete your application you go to be oriented by the IHCAI Foundation Staff about the
documents you need to present before your arrival according to the Costa Rican Health System
regulations, like a copy of your passport, your personal resume, Immunization proof and others.

17) Health advice and insurance:

Students are covered by a basic health insurance while in Costa Rica. If you want a more extensive
coverage you may contact IHCAI Foundation for other health insurance options. The student must
present a reasonable proof that he/she possesses travel health insurance protection.

You can get an online insurance quote for extending your travel health insurance protection. Find an
online quote and information about the IHCAI Foundation insurance company for health insurance at:

https://www.worldtrips.com/quotes/default.asp?referid=99690



                                    IHCAI Foundation is an equal opportunity organization

                                            IHCAI FOUNDATION host and sponsor




                                           The Cochrane Center of Central America
                                        Branch of the Iberoamerican Cochrane Center
             Community and primary care based clinical rotation for international residents - Program IHCAI P08 /




Costa Rica is safe for malaria, yellow fever and other tropical diseases. However, in some areas of the
country the water is not completely safe. IHCAI Foundation advises all participants to take precautions
and to drink bottled water when traveling outside of San José and in most of the other countries. The
water is safe only in San José, but if you have a fragile stomach, you might want to drink bottled water
as well. In other countries in Central America, precautions must be taken according to the IHCAI
Foundation local office. More useful information for your travel at:

http://www.ihcai.org/useful_info.htm


Warmest regards,

Program IHCAI P08 CR
Community and Primary Care Based Clinical Rotation
for International Residents


IHCAI FOUNDATION
info@ihcai.org

International Health Central American Institute Foundation. "Clinica Centroamerica" Regional Evidence Based Practice Training
Centre. Central America Branch of the Iberoamerican Cochrane Centre. COCHRANE DEVELOPING COUNTRIES NETWORK
SECRETARIAT MAIN OFFICE.

Address in Costa Rica:
Calles 35 y 37, Avenida 7. Barrio Escalante. Sector este del centro de San José. Casa 3530.

P.O. Box:
1677-2100 SAN JOSE, COSTA RICA.

Local Costa Rica numbers and faxes:
Telephone: (506) 2234-6354 / (506) 2234-6347 / (506) 2227-6564
Tele- Fax (506) 2226-3047

___________________
Confidentiality Notice: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain
confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended
recipient, please contact the sender by reply e-mail and destroy all copies of the original message.




                                           IHCAI Foundation is an equal opportunity organization

                                                   IHCAI FOUNDATION host and sponsor




                                                   The Cochrane Center of Central America
                                                Branch of the Iberoamerican Cochrane Center

				
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