A Month in a Colombian Hospital (with the ACR-PANLAR Exchange Program)

Colombia is a beautiful country with a rich cultural history that has made many social advances over the past decades. I was privileged to spend a month rotating with rheumatologists in San Vicente de Paul Hospital in Medellín, the City of Eternal Spring.

As part of the ACR and the Pan American League of Rheuma­tology Associations (PANLAR) international fellowship exchange programs, fellows from each organization can apply to participate in a month-long paid exchange program. For me, it was a fantastic opportunity to hone clinical skills in rheumatology and to experience healthcare delivery and medical education in a unique environment.

The program provided the perfect chance to be immersed in a different cultural environment and observe how rheumatology is practiced in a Latin American setting. Although access to some of the latest and most expensive medications was more limited than in the U.S., I witnessed a strong emphasis on educating physicians to think critically and broadly about rheumatology, and internal medicine in general, often with greater depth than might be found in many U.S. programs. The finer points of a clinical question were examined in an academic spirit, with articles and study details available to back up a viewpoint.

The hospital is a referral center for high-complexity patients, ensuring some of the more complicated rheumatology patients in Colombia are evaluated there. It is a beautiful collection of archaic-style buildings, built in an era before antibiotics were popular and, thus, required quarantine to avoid disease spread.

The average day starts early, with a scholarly session including journal clubs, book sessions or lectures, often drawing from source material published in English language journals. Inpatient rounds focus on deliberating over the clinical scenario, dissecting the details and mulling differential diagnoses. A strong emphasis is placed on ruminating each patient’s case and in teaching the residents and fellows.

The time allotted for evaluating patients, conducting rounds and teaching reflects these ideals, and physicians are never rushed. In fact, during inpatient rounds on Fridays, all attendings and members of the team join rounds to deliberate the different cases and share their viewpoints. As required by a cognitive specialty such as ours, physicians are truly there to think.

The residents and fellows spend their time learning from patients and preparing for rounds by exchanging articles through a mobile group application. Often, interesting tidbits or challenging questions are posed through this forum, stimulating learning throughout the day. Everyone welcomed me to participate, making the experience one to remember.

International Conference

Another highlight of the program for me was the chance to go to PANLAR’s Annual Conference in Quito. It was interesting to see Spanish, Portuguese and English lecturers and attendees communicating among themselves and collaborating to move rheumatology forward.

Of course, I also enjoyed the chance to travel through and experience Colombia and Ecuador, but the opportunity to do a rotation in a foreign medical system is unique. These are also opportunities to build bridges that, in the future, may translate to multi-national research and educational programs.

If you know a fellow with the ability and availability to go abroad for a month, they should be encouraged to apply for the exchange program. If you’re a fellow yourself, learn more about the opportunity.

Nicole Bitencourt, MD, is a rheumatology fellow in adult and pediatric rheumatology at UT Southwestern Medical Center, Dallas.