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Value of Humanitarian Assistance Missions in Residency

Durning, Steven J. MD; Massine, Russell E. MD; Ender, Peter T. MD


The educational value of participation in humanitarian assistance missions by third-year residents was assessed.

Dr. Durning is assistant professor, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Dr. Massine is assistant professor, Department of Medicine, Wright–Patterson Medical Center, Dayton, Ohio; Dr. Ender is director, HIV Clinic, St. Luke's Hospital, Bethlehem, Pennsylvania.

Correspondence and requests for reprints should be addressed to Dr. Durning, Department of Internal Medicine, USUHS, 4301 Jones Bridge Road, Bethesda, MD 20814.

The opinions expressed herein are those of the authors and do not necessarily reflect the opinions of the Department of Defense, the United States Air Force, or other federal agencies.

Humanitarian assistance missions occur outside one's usual practice setting with a primary purpose of providing health care to underserved individuals. At Wright–Patterson Medical Center, a tertiary care hospital, at least one third-year internal medicine resident has voluntarily deployed on each humanitarian assistance mission for the past three years.

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All third-year internal medicine residents (mission participants and non-participants) were surveyed using both open-ended and Likert-scale questions during the study period (July 1998–June 2001). Many participants also underwent unstructured exit interviews.

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Seven humanitarian assistance missions occurred during the study period. Nine of 23 residents participated, and the survey response rate was 100%. All participants and the majority of non-participants felt missions improved the quality of internal medicine residency training, the ability to practice in impoverished areas, and preparation for deployment to austere environments. Six of the nine participants, but only four of the 14 non-participants, felt they had acquired sufficient clinical knowledge of tropical medicine during residency training. Participants reported greater clinical exposure to malaria, tuberculosis, leprosy, leptospirosis, filariasis, and helminthes (all p < .001, except tuberculosis p > .05).

Several participants noted a greater sense of patriotism and improved skill in international diplomacy. Many had gained a greater appreciation of the need for and value of international collegiality in the practice of medicine. Participants reported learning about medical triage, public health, rationing of scarce medical resources, and medical practice in other countries.

Many residents commented on the power of the physician–patient relationship to break down language, cultural, religious, and economic barriers through empathy and a desire to help. Some stated that these missions had reminded them of why they had entered medicine—to help people in need without paperwork, bureaucracy, and ever-present legal issues. Many plan to use this experience to assist them with future humanitarian activities such as overseas deployments as well as volunteering for inner-city missions, church missions, or the Peace Corps after completing their military careers. Negative comments included difficulty with being away from family, living off the local economy (i.e., local restaurants), and personal safety concerns.

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Participation in humanitarian assistance missions significantly increased residents' direct clinical exposures to tropical diseases. These results were statistically significant despite the two-week duration of our missions. Humanitarian assistance missions appear to provide residents with needed knowledge, clinical skills, and confidence to practice medicine in underserved areas, and our preliminary study suggests that even brief clinical encounters are effective. Program directors should consider incorporating humanitarian assistance missions into their residency curricula.

© 2003 Association of American Medical Colleges