Grudzen Corita R, Legome Eric
Robert Wood Johnson Clinical Scholars Program, University of California, Los Angeles, Los Angeles, California, USA.
BMC Med Educ. 2007 Nov 28;7:47. doi: 10.1186/1472-6920-7-47.
Despite the great influence International Medical Experiences (IMs) can have on young physicians and their impact on patients and communities, they are not offered in all training programs and are at risk of being reduced in some due to stringent guidelines for funding of graduate medical education.
IMs provide unique experiences in clinical, epidemiologic, cultural, and political arenas. From an educational perspective, they broaden a physician's differential diagnostic skills and introduce clinical entities rarely seen in the U.S. Time spent in developing countries emphasizes the importance of community health and increases cultural and linguistic competence. Experience working with the underserved during an IM has been shown to increase interest in volunteerism, humanitarian efforts, and work with underserved populations both in the US and abroad. IMs also afford physicians the opportunity to learn about the delivery of health care abroad and are associated with an increase in primary care specialty choice.
It is time for the leaders in graduate medical education to prioritize international health opportunities. Leaders in academic medicine can press for changes in reimbursement patterns at the national level or special funds for international electives. Hospitals can set up separate accounts to help finance resident salaries and benefits while abroad. Individual departments must be flexible with resident schedules to allow elective time. Medical students and housestaff can organize and lobby larger organizations such as the American Medical Association (AMA), the American Association of Medical Colleges (AAMC), and specialty groups to make IMs universally accessible.
尽管国际医学经历（IMs）对年轻医生有很大影响，且对患者和社区也有作用，但并非所有培训项目都提供此类经历，并且由于研究生医学教育资金的严格指导方针，一些项目有减少此类经历的风险。
国际医学经历在临床、流行病学、文化和政治领域提供独特的体验。从教育角度看，它们拓宽了医生的鉴别诊断技能，引入了美国罕见的临床病症。在发展中国家度过的时间强调了社区健康的重要性，并提高了文化和语言能力。有研究表明，在国际医学经历中与弱势群体合作的经历会增加对志愿服务、人道主义努力以及在美国国内外与弱势群体合作的兴趣。国际医学经历还使医生有机会了解国外的医疗服务提供情况，并与增加选择初级保健专业相关。
研究生医学教育的领导者们是时候将国际健康机会列为优先事项了。学术医学的领导者们可以敦促在国家层面改变报销模式或设立国际选修特别基金。医院可以设立单独账户，以帮助支付住院医生在国外期间的工资和福利。各个部门必须灵活安排住院医生的日程，以留出选修时间。医学生和住院医生可以组织起来，并游说诸如美国医学协会（AMA）、美国医学院协会（AAMC）和专业团体等更大的组织，以使国际医学经历普遍可及。
