“Every single practitioner should travel somewhere far afield at some point during their career,” says Justin Morgenstern, an emergency physician based in Ontario who has worked in New Zealand, Australia and St. Lucia.
Medical staff at all levels of training benefit from learning and work experiences in new environments, whether in rural Canada or internationally, Morgenstern says. These experiences bring “tremendous value” to multiple aspects of professional and personal growth.
However, due to health and travel restrictions related to COVID-19 and policies by Canadian medical training programs to suspend or discourage international opportunities at this time, a cohort of medical trainees is at risk of missing out on these valuable experiences.
“I looked forward to travelling to the Philippines with some of my co-residents for a global health elective,” explains Susy Lam, who is chief resident of Family Medicine at Markham Stouffville Hospital. “Unfortunately, this was cancelled, which was disappointing, but necessary to keep us all safe.”
“I wanted to see how medicine is practiced differently … to immerse myself within the local community and to expand my cultural knowledge.”
Working at the intersection of diverse communities in the Greater Toronto Area, Lam says an international elective would have made her a better doctor.
“Through learning about my patients’ backgrounds and cultural and spiritual beliefs … I strongly felt that I would be able to become a better physician for my patients through building good rapport while understanding their individual health needs,” she says. “For example, being able to speak their language, or relate to a particular cultural experience, can mean the world to them.”
Canadian trainees have the privilege of learning in a well-resourced environment, says Melanie Henry, who is director of the Global Health and Health Equity Program for the Family Medicine residency program at Markham Stouffville Hospital. Henry explains that “the training is heavily influenced by our collective Canadian culture and values.” When trainees leave their home healthcare system, Henry says, they can better understand both the advantages and failings of the Canadian system and improve their ability to advocate for change: “As in most contexts, the best way to learn about something is to step outside of that thing.”
Similarly, Morgenstern explains that working outside of the home institution helps to distinguish traditions from best practices and evidence-based medicine.
“How medicine is practiced is completely different a hundred kilometres down the road or when you cross borders,” he says. “Moving to different locations opens your eyes to things that you may have assumed were ingrained medical practices; realizing there are multiple ways of doing things to me is one of the best ways of getting into evidence-based medicine.”
Working away from tertiary and urban centres within Canada can yield significant insights, says Morgenstern. “Go to the far north of Canada (where) to get someone to surgery is a seven-hour plane ride; your thinking about medicine changes dramatically.”
Though language and culture may not be as challenging, an experience in rural Canada comes with its own set of challenges. The “hours can be long, and it is easy to dedicate all waking hours to a town,” says Steven Huynh, a family physician who has worked in the Northwest Territories and northern Ontario. “It is important to set boundaries early.”
Huynh says working in rural areas exposed him to patient populations not often seen during his training and offered potential for professional growth because “you hold responsibilities in areas not generally expected of an urban family physician.”
Rural environments provide a holistic demand on your general skills, says Huynh, who has relied more heavily on his clinical judgment and point-of-care ultrasound. “Rural areas are under-resourced so getting imaging such as a CT or MRI scan is not as straightforward as in an urban area.”
Prioritizing resource management is essential, notes Huynh: “There may be multiple patients who benefit from a CT scan but ORNGE (Ontario’s air ambulance service) may only have one flight available in the next six hours for a ‘treat and return.’ Who really needs the scan done now and who can wait?”
Rural and international postings can offer similar experiences. Research on resident physicians’ international clinical rotations shows that not only is medical knowledge broadened through treating diseases endemic to other regions, but with less imaging and laboratory resources available, medical trainees also have to improve their physical examination skills.
Having grappled with language barriers in my international elective in Japan (prior to the pandemic) during my final year of medical school, I now have greater empathy for patients in Canada who speak English as a second or third language. The experience has taught me that, in my role as a resident physician, when I sense a language barrier, I must take steps such as using simpler words, speaking slowly and providing written handouts – all of which I found helpful when I was struggling to understand the nuances of another language.
Observing the operations of a different hospital – and comparing that with what I have seen in my Canadian training – was fascinating. For example, many emergency rooms in Japan are based on a multi-specialist model rather than having physicians trained solely in emergency medicine and many are staffed by medical specialists such as cardiologists. Furthermore, patients do not have to wait for their family physicians to refer them to a specialist; patients in Japan can decide the type of specialist they would like to see and then pick the hospital where they would like to seek treatment based on the hospital’s reputation.
“Living in different cultures opens your eyes to different takes on the world,” says Morgenstern. “The further abroad, the more likely you are to get very different experiences – you can’t grow unless you have those different experiences.”
And, of course, as well as professional growth, there is the opportunity for personal growth – trying new foods, meeting people, getting lost. Huynh recalls that working in the Northwest Territories and “driving on the ice road to Tuktoyaktuk and diving into the Arctic Ocean in September was unreal!”
Morgenstern emphasizes these benefits to personal wellness: “Not to be overlooked, but medicine is very difficult. We talk a lot about burnout. Moving from Toronto to New Zealand where I can hike in the mountains and walk on the beach after every shift and unwind – I think this can extend your career by decades. The fun of travel is something to be considered!”