Outside the walls of the hospital: reflections on doing an MPH during residency

Ameer Farooq is a General Surgery Resident (R3) at the University of Calgary who completed his Master of Public Health at the Harvard T. H. Chan School of Public Health in the Global Health track. He is interested in global surgery, implementation science, and trying to keep up with his two children.

Alastair Fung is a Pediatrics Resident (R3) at the University of Manitoba who completed his Master of Public Health at the Harvard T. H. Chan School of Public Health in the Global Health track. He is interested in early childhood development and pediatric infectious diseases in low-resource countries, as well as Canadian indigenous child health.

 

A child is admitted to the PICU for hemiplegia and diagnosed with a brain abscess. The culture of the abscess fluid grows dental flora; clearly, poor education and access to dental hygiene are the root cause.

A homeless alcoholic presents with an incarcerated umbilical hernia requiring an emergency surgery and bowel resection, but ultimately dies of liver failure.

As residents, we are constantly reminded that our patients’ outcomes are affected by forces that extend beyond the walls of the hospital. We learn about the “social determinants of health” in medical school, we take social histories from patients, and we discuss these factors during patient rounds for discharge planning. Yet it often seems that the problems are simply too large and too complicated for us to make a dent in them.

We are two Canadian residents who decided to take a one-year educational leave of absence from residency to do our Masters of Public Health (MPH). We felt that sharing our experience might be helpful for residents who are thinking about doing their MPH but are unsure of what exactly that might entail (with the caveat that we speak from our own personal experiences and perspectives).

1) An MPH isn’t all about statistics

A common misconception about an MPH is that it is all about epidemiology and statistics. While statistics and epidemiology are important in understanding the health of populations, they are only one part of the puzzle. There are many ways in which one might tackle the gargantuan task of improving the health of populations. Howard Koh, former US Assistant Secretary of Health, is fond of asking incoming Harvard MPH students to try to define public health — there are, inevitably, an enormous number of definitions advanced.

One of the most enriching aspects of completing an MPH is the opportunity to work closely on health-related initiatives with classmates outside of what is traditionally thought of as “medicine.” The range of tools available to tackle public health problems include behavioural economics, cognitive psychology, machine learning, and social entrepreneurship (among many others). For example, Ameer is working on a project that uses Geographic Information Systems to understand how we can better design trauma care in low-income countries. Alastair had the opportunity to work on policy measures with the Zambian Ministry of Health to support a malaria elimination strategy. Our classmates have worked on projects ranging from the impact of music videos on HIV awareness in Zambia to starting a new emergency medicine training program in Pakistan, and still others have examined how racial disparities can affect surgical outcomes in North America. What we’ve realized is that if you have a big idea for how to improve people’s health, there’s probably a venue – as well as a whole cohort of classmates – equally excited to bring that idea to life.

2) Personal development

Our MPH year was an opportunity to develop new skills: policy writing, statistical analysis, and project proposals. Equally importantly, it was an opportunity to reflect on our past residency experiences. On your first day as a senior resident, the expectation is that you can manage a team of junior residents and medical students and ensure that they all learn, achieve their goals, attend to their patients safely, and enjoy their rotation. Our busy clinical duties make it difficult to lift our collective noses from the grindstone and develop the leadership and managerial skills to make us better residents. During our MPHs, we attended a simulated humanitarian disaster response course, attended leadership and management courses, and talked with professionals in the military and government. We hung out with computer scientists at the MIT Grand Hack and will be launching a social enterprise to help children in India improve hand hygiene. We feel strongly that those experiences will not only be helpful for our public health and academic careers, but will also make us better physicians that can better manage our teams.

3) It’s about the people

Perhaps the most rewarding experience we’ve had this year is making friends with an enormously talented and diverse group of people. Our classmates ranged from an experienced physician who worked with Doctors Without Borders in disaster settings to consultants for the WHO and founders of large NGOs. While choosing classes and projects this year has often felt like being a child at a candy store, the real benefit has been the bonds we have made with new friends from Ghana to Japan. These people have taught us that the only limit to our potential is ourselves, and that the key to going far is working together.

4) The challenge is the reward

It’s not easy to take time away from residency. There are many opportunity costs: financially, personally, and potentially clinically (especially for all of the surgical residents out there). To borrow a concept from epidemiology, we will never know the “counterfactual” (what would happen if we had not done our MPH).

While one can make a very reasonable argument that you do not need to have an MPH to make a difference in the world, or even to advance your career in medicine, what we can say from our own experiences is that our MPH year provided us with a dedicated period of time during clinical training to think about the big issues in healthcare across the world. It also provided us with some basic approaches to tackling the big challenges in health. Finally, it gave us the chance to be deliberate about our career choices by exposing us to a breadth of approaches and people, helping to ensure we don’t get “pigeon-holed.”

We are returning to residency rejuvenated and re-inspired. Even if we are not able to “move the needle” on the big issues in healthcare, we know that we need to try: through research, innovation, and collaboration. From Guyana to Nunavut to Zambia, our fellow human beings need us – and we might just learn something in the process.

 

References:

http://www.commonwealthfund.org/interactives/2017/july/mirror-mirror/

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