My University of Michigan Experience

By: Ethel Osei-Tutu, medical student, University of Cape Coast, School of Medical Sciences, Ghana

Editor’s Note: For more information on the Ghana–Michigan medical student exchange program, see “Perceptions of Ghanaian Medical Students Completing a Clinical Elective at the University of Michigan Medical School” by Abedini, Danso-Bamfo, and colleagues, published in the July issue. 

The University of Cape Coast, School of Medical Sciences (UCCSMS) began a yearly exchange program with the University of Michigan (UMich) in 2012. Four final-year students from UCCSMS are selected each year based on merit to participate in the month-long clinical electives program. In 2013, I had the opportunity to spend a month in Ann Arbor, Michigan. I gladly accepted the offer because of my passion for obstetrics and gynecology and my zeal to learn from other cultures. I was hoping to experience firsthand some of the things I learned during my obstetrics and gynecology rotation that remained abstract because they were not practiced in my hospital (Cape Coast Teaching Hospital). My clinical electives program at UMich was in the obstetrics and gynecology department in August 2013. During this period, I did rotations in various subspecialties–labor and delivery, maternal and fetal medicine, and gynecological oncology.

University of Michigan simulation lab session

University of Michigan simulation lab session

Unlike my hospital, most of the surgeries I observed at UMich were laparoscopic. The most exciting one I observed was a total vaginal hysterectomy done with the da Vinci Surgical System. Being my first experience with a robotic surgery, I found the precision of the da Vinci Surgical System to be absolutely astonishing! These minimally invasive surgeries offered patients quicker recovery with minimum tissue injury and scars. It also reduced hospital stay, therefore reducing the risk of some post-op complications, such as deep vein thrombosis. I believe it will be awhile before laparoscopic surgery becomes established in Ghana, especially for obstetrics and gynecology procedures. The developing world has many more problems, and laparoscopic surgery is seen as a luxury.

Aside from the astonishing surgical procedures and equipment, I marveled at the high degree of patient-centered care that UMich offered her clients. As much as patient liberties and dignity was prioritized by the health personnel, patients seemed very proactive in seeking health care. I observed that patients knew their rights and most were well informed about their conditions even before coming to the hospital. They were involved in decision making–from the date for their surgery to little details such as the material for closing up their skin, i.e. staples or sutures. Some patients even declined an epidural because they wanted to experience “natural birthing.” Back in my hospital, there are very few options available and, even when given the options, most patients leave the decision making to the doctors, hoping for the best. Very few women here know about epidural anesthesia and, even if they did, it is hardly ever available.

Also, most of the procedures done at UMich, even the vaginal deliveries, were by an attending, and occasionally a resident under supervision. Some patients did not want even final year residents delivering their babies. In Ghana, there are very few doctors compared to patients so most vaginal deliveries are done by midwives. Sometimes these deliveries are done by medical and nursing students under supervision. This gives medical students here adequate exposure; many of us are able to do deliveries by the end of our training, sometimes to the detriment of patients.

The doctors I worked with at UMich were always ready to teach. My experiences were countless, and I hope to apply them to my future practice. My desire is to be able to offer women pain-free deliveries and minimally invasive surgery in the near future. I really enjoyed my stay at UMich, and I hope the UMich-UCCSMS program will continue so that other students will have the same opportunity my colleagues and I had.

UMich-UCCSMS partnership dinner party

Dinner party at Professor Moyer’s house

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One Comment

  1. Kemi Tomobi
    August 29, 2014 at 9:21 PM

    Great experience! While all medical students get some exposure to OB/GYN, not many U.S medical students have the opportunity to rotate on a gynecology-oncology service (“gyn-onc”). It is usually in residency and fellowship when one gets this exposure, so for an international medical student to have this exposure in the United States is really amazing.

    It is a noble passion to desire pain-free deliveries. OB/GYN analgesia and anesthesia practices vary from country to country, ranging from the 100% natural birthing experiences (without pain medication) to general anesthesia with endotracheal intubation. One thing that could improve is the timing and depth of discussion concerning OB analgesia. Perhaps this approach varies from country to country. How does the obstetrician address pain management at prenatal follow up? Where and when does an OB anesthesiologist counsel the patient about analgesia options? Is it at a time when patients can make well-informed decisions? Also, what is the perception of the anesthesiologist role in labor and delivery? These perceptions can be shaped by pediatricians, obstetricians, anesthesiologists, and even the media. All of these factors play a role in the provider and the patient efforts to promote pain-free delivery. Perhaps health care trainees who become involved in any aspect of the labor and delivery process can also get some exposure to OB anesthesia so they, too, like anesthesiologists, will know how to best advise the OB patient.

    It appears that this partnership between the medical programs allows each side to learn from one another, and hopefully, such a partnership will continue.

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