Interest in International Emergency Medicine within residency and fellowship programs in the United States has refused to be limited by barriers of language, geography, or limited resources. We are reminded of this every interview season when one of the most frequently asked questions by applicants concerns the availability of exposure to health care delivery outside our system in this country.
In March of 2009, Dr. Erik Barton and I traveled to New Zealand to establish opportunities for our residents, fellows and attendings to work in a non-third world socialized health care system where technology is rationed and the physical exam is emphasized.
We started in Auckland at Middlemore Hospital, which has the busiest Emergency Department in the country, treating 80,000 patients a year and is home to an emergency medicine residency. Our host was Dr. Lou Fennel and after a tour of their department we spent time with their faculty discussing potential collaborations between our two residencies.
Erik and I then found our way to the South Island and its' largest city, Christchurch. The city was planned as an outpost of the Church of England and has become New Zealand's gateway to outdoor and wilderness adventure. We had productive discussions with Dr. Scott Pearson from the Christchurch Hospital Emergency Department. This is the largest ED on the South Island, seeing 72,000 patients per year. Christchurch Hospital is the major referral center for the South Island and the primary teaching hospital for the University of Otago, Christchurch School of Medicine and Health Sciences. It was obvious that our educational programs had much in common, especially our interest in wilderness medicine.
As planning continues we are hopeful that an elective in Christchurch, New Zealand will be available as early as the fall of 2009. -By Stephen Hartsell, MD
Here at the University of Utah we have begun collaborating with Canterbury Health to send our residents to Christchurch Hospital in the southern island of New Zealand. Our second and third year residents are treated as senior "registrars" there; meaning they are given all the responsibilities of senior emergency medicine physicians.
Christchurch hospital has a bustling ED with around 75,000 patient visits per year and an 80% admission rate. The city itself is the largest in the south island and the only large trauma center. New Zealand's health care system is government run and very similar to the United Kingdom's system.
During my month long rotation, in September of 2009, I was engulfed in a completely different health care system; and in my experience, forced to question our own style of emergency medicine practice. For example, in New Zealand the physical exam is paramount, CT scans are rare, 80% of all ED patients are admitted, and consults are called based on acuity of illness rather than a diagnosis and often within minutes of patients arriving in the ED.
Overall, the experience has afforded me the luxury of analyzing my own practice. I don't think I would have ever been able to do that without this experience of a totally different system. I was the first resident to do this rotation and found it to be invaluable. -By Mike Mallin, MD