INTERDISCIPLINARY SPECIAL PROGRAM : IDSP-800 Approved by:

School of Medicine, University of Kansas Medical Center

CLINICAL EDUCATION ELECTIVE PROPOSAL

Check appropriate proposed site: - KUMC Site [ ]
- Other USA Site [ ]
- International Site [X]
All information is required:

KUMC STUDENT: NAME: Please refer to attached list for information STUDENT KUMC NO.
Home Phone #: Cell Phone #: E-MAIL:
Local Address: Street:: Apt #: City: State: Zip:
Clinical Time: WEEKS doing research: n/a
Credit Hours Proposed: 4 [ ] Full Time 40hr/week, 8 wks; 1 [ X] Part Time 20hr/wk, 8 wks or 40hr/wk, 4 wks).
Permission to see my transcript grades (Min GPA=2.0 to participate): [X] YES [ ] NO
INTERNATIONAL APPLICATIONS:
“I have or will have by the travel leave date…”
[ X ] YES [ ] NO. …an up-to-date, legal USA Passport
[ X ] YES [ ] NO. …health insurance for international travel.
[ X ] YES [ ] NO. …medical evacuation and repatriation insurances.
[ X ] YES [ ] NO. …sufficient funds and be responsible to pay all reasonable expenses for my elective.
CLINICAL MENTOR: Multiple – please see item below
CLINICAL EDUC. TITLE: KUMC International Outreach Belize 2009 Medical Mission
Involves student’s contact with patients - [ X] YES [ ] NO
CLINICAL MENTOR: NAME: Multiple – please see item below [ ] MD [ ] DO
Phone #: FAX: *E-MAIL:
Position Title:
Clinical Site: [ X] KUMC (only Dept & Office needed below)[ ] Other: (Institution Name)
Department: Department:__
Office Location: __ Address:
State: Country: Zip:
Agree to submit Student Performance Evaluation at completion (will be e-mailed to you): [ X ] YES [ ] NO

STUDENTS & MENTORS: EXPAND EACH ITEM IN THE CHECKLIST AS NEEDED ON CONTINUATION PAGES FOR
COMPLETING THE APPLICATION:

1. [ X ] MENTOR & STUDENT: Clinical Proposal - 3 pages maximum, double-spaced, and include:

(A) Educational Objectives;

a) Plan and execute remote clinics in isolated Belician communities
b) Serve each of the clinic divisions (health education, acute care clinic, and pharmacy) over the course of the
week
c) Service and contribution to one of the trip planning committees (fundraising, logistics, education, and
pharmacy)
d) Trip reflection with emphasis on health care access, cultural obstacles to health care, and clinical
exceptionalism

(B) Description of Initiative(s) to achieve each Objective;

a) Each day the group will travel to a new community and spend ½ -1 hour preparing for the clinic of the day.
The clinic will run for 6 hours and will visit approximately 100 patients. At the conclusion of each clinic day,
the group will collect all materials and return to the base site for the evening.
b) Each day, trip participants will participate in different elements of the clinic.
(i) Health education will conduct classes with children and address educational needs for clinical encounters
 (ii) Pharmacy will dispense medications or medical devices to patients recommended by the consult by the
student and licensed health care provider
(iii) The acute care clinic will complete history and physical on all patients seen for each day. An appropriate
assessment and plan will be recorded for each patient.
c) All trip participants will join a committee. All developed materials and correspondence will be organized
into a binder submitted to the clinical mentor and course director one month following the trip.
d) All participants will submit a diary for each clinic. As a group, a presentation will be created and given to the
school of medicine, school of nursing, and school of allied health

(C) Description of special Activities and/or Procedures - MUST indicate what activities & procedures the student will
actually do and skills to be enhanced or learned..

Please see item 1B for details.

2. [ X ] STUDENT: Why are you interested in participating in a clinical educational experience?

Motivations for participating in the Belize Medical Trip vary among students, but may include:
-Interest in international health as a career
-Familiarity with common adjustment to care in settings with limited health care
-Administrative experience in student- driven clinic planning
-Exposure to pathologies less frequent in the United States such as parasital and vector- borne infections
(e.g. pinworms, dengue)
-Opportunity to develop physical exam and history taking skills

3. [ X ] STUDENT: What value/benefit would this clinical experience be to your medical education and career?

Please refer to item 2.

4. [ X ] STUDENT in International Experience:

(A) Why international & Why this particular one?

KUMCIO has organized trips for many years and each year interest in the trip has increased. The trips have
identified priorities that include 1. clinical experience for underclassmen medical students 2. growth in health
education programs 3. provision of health care to communities with limited access. An overwhelming majority of
trip participants have completed international health electives in their fourth year and cite the Belize trip as
influencing their participation in this program

(B) Describe your proficiency of the native language of the country to which you are going.

English is official language of Belize. However, a significant minority of Belicians speak Spanish, Garifuana, or
other language as their primary tongue. Although no students speak Garifuana or indigenous language, 5-6 trip
participants are proficient in Spanish and will be able to practice some of their language skills throughout the trip.

5. [ X ] MENTOR: name(s) /title(s) of the key mentor(s) who will have significant training contact with student, and the
approximate amount of time that will be spent with the student each week?

BELIZE TRIP 1 – Feb 27- March 7th, 2010

Sarah Taylor, MD (hematology/oncology KUMC)
Sharon Lewis, NP (adult/geriatric KUMC)
Bruce Campbell, NP (KUMC/Via Christi)

BELIZE TRIP 2 – March 6-14, 2010

Stephen Williamson, MD (hematology/oncology KUMC)
Shadrach Smith, MD (internal medicine Truman Medical Center)
David Schmeidler, MD (family practice South Central Kansas)

6. [ X ] MENTOR: E-mail completed proposal to Clinical Education Coordinator - pshaw@kumc.edu

Emailed by Phaedra Dowell, 2009-2010 president of KUMC International Outreach, on behalf of all medical student
Belize 2010 medical mission participants.