Resident Physician Columnist
Hillsboro Medical Center
Aline went to medical school at the University of Essen in Germany. She started training at the University Hospital Essen in Internal Medicine with the focus on GI/Hepatology. She then followed one of her former supervisors in 2017 to the University Hospital Magdeburg and continued her training for two years. In 2019, she started a two-year research fellowship at Johns Hopkins University with a scholarship by the German Research Foundation. During that time, she decided not to return to Germany and instead attempt to become a physician in the US. She has started her internal medicine residency this year at Hillsboro Medical Center in Oregon.
Surviving IM/G
I am an international medical graduate in internal medicine residency (IM/G), sharing my experiences with all of you. If you are an IMG, hopefully you can relate to some of the stories and feel encouraged, because we are not alone. If you are an American-based resident: I hope these stories help you better understand your IMG colleagues a bit better. And above all, I am hoping to hear from you as well: let's share knowledge, experiences, and pave a path for the many other IMGs seeking to fulfill their dreams in the United States.
Let’s start with a very brief introduction: Hello! My name is Aline, and I am an international medical graduate (IMG) from Germany. I used to work in Germany in internal medicine, where I have completed four out of five years of training. I would like to share my experiences, thoughts, and later also some of the processes and steps that got me here over the course of this new column.
The rapid introduction of revolutionary technologies like minimally invasive robotic-assisted surgeries will exponentially increase complexity in medicine, law, education and ethics. Roboethics deals with the code of conduct that robotic engineers must implement in the artificial intelligence of a robot. Through this kind of ethics, roboticists must guarantee that autonomous systems will exhibit ethically acceptable behavior in situations in which robots interact with patients.
It feels odd to have family members in the hospital regularly again. My patient’s wife approaches cautiously; for a second I pretend not to see her. She looks like she wants to talk and I’m afraid she wants good news I can’t give, promises I can’t make, and time I don’t feel like I have. She wants time to tell me her loved one’s stories.
Her grip on my hand is tight. Almost as tight as the elastic on the oxygen mask stretched across her face, digging furrows into her thin, sallow skin.
“Every one of these patients should terrify you,” the fellow said. I thought he was just being dramatic.
Thinking back to January 2020, I recalled the whispers throughout the hospital of the first confirmed case of COVID-19 in the United States, mere minutes from my home institution. Aside from my perspective as a pediatrician, I was also forced to confront my own anxieties regarding exposure to this virus as an adult living with repaired congenital heart disease.
The novel coronavirus pandemic (COVID-19) has drastically increased the number of critically ill and dying patients presenting for hospitalized management of dyspnea, acute respiratory failure and other serious complications. The emergence and spread of SARS-CoV-2 has created unprecedented demands on all avenues of inpatient hospitalist medicine. One of the many services in high demand includes palliative care, with increased need for complex end of life planning.
On the morning of January 6, I awoke ecstatic to the news of Reverend Raphael Warnock and Jon Ossoff’s predicted wins in the Georgia run-off elections. To be frank, I have become hesitant to hope while inured by the near-daily attacks on civil rights by the Trump administration via executive orders and federal policies. Over the past four years, I witnessed with pride — but also fear — as community activists tirelessly organized to combat racist policies.
Above all else, do no harm. This is a basic tenet of a physician’s oath, but this oath does not always align with the religious and cultural beliefs of each patient. In cases where beliefs of faith, salvation or religion play a major factor in a patient’s desire to commit suicide, it can be difficult to draw the line between the traditional ethical guidelines of patient autonomy and non-maleficence.
In my home city of Washington, D.C., citizens have taken the changes brought on by COVID-19 very seriously; social distancing, masking and frequent hand hygiene are now routine. These days, I am startled when I see the bottom half of someone’s face out in public. Our homes have become our sanctuaries. In the hospital, however, much of our work continues unabated. Orders are written, notes are signed, lab work is drawn, imaging is performed. Housestaff are on the front lines with nurses, respiratory therapists and patient care technicians taking care of the sickest patients day-in, day-out.
Earlier in February of this year, before COVID-19’s onslaught in London, UK, I was covering service on a respiratory ward when a young medical student made herself known to the physician’s office. “Could I borrow your stethoscope? I’m here to practice my respiratory examinations.”
When the pandemic hit, many psychiatry departments across the United States had to rapidly adapt and respond in innovative ways to serve the needs of their patient population. After an initial struggle, many found a platform best-suited for this need and transitioned to telepsychiatry as a way to see and treat patients.
Resident Physician Contributing Writer
Texas Tech University Health Sciences Center
Ashish Sarangi is currently a fourth-year psychiatry resident and chief resident at the Texas Tech University Health Sciences Center in Lubbock, Texas. Having previous completed adult psychiatry residency training in Kingston, Jamaica, he has been fortunate to experience the field of psychiatry from different cultural viewpoints. He has gained experience practicing psychiatry in private practice, corporate hospitals and state psychiatric institutes. After graduating from the University of the West Indies Jamaica where he obtained his MD and residency in psychiatry, he has successfully transitioned to the United States healthcare system to pursue his second residency stint. He has been actively involved in helping reducing the stigma associated with mental illness in Jamaica by contributing to policy decision making by helping to draft the mental health act of Jamaica and also was an avid mental health columnist for the national newspaper during his time there. His work in Jamaica includes identifying human rights abuses in psychiatric practice and tweaking aspects of the assertive community treatment (ACT) in healthcare delivery. He has worked to connect medical students with fellow resident and physician colleagues in the care of patients and takes interest in teaching various aspects of psychiatry to different stakeholders in healthcare.
Dr. Sarangi was born in India and has been actively involved in promoting psychiatry amongst the international medical graduate population in the United States. He actively seeks out mentoring opportunities and guides international medical graduates and students towards developing an academic psychiatric career. He practices virtual interviewing and communication skills with medical graduates around the world which helps them better prepare for a career in psychiatry.
Dr. Sarangi’s research interests include Alzheimer’s dementia and geriatric depression. He plans to pursue a geriatric psychiatry fellowship upon the completion of his current training to be able to enhance his role as a clinical educator.
