Sepehr Rajai

UMMS Class of 2013

Why UMMS? During the interview and recruitment at Michigan, I found it to be the most well rounded environment out of all of my options and looking back after four years, I believe I made the right choice.  I also wanted to leave California and experience a different part of the country. 

Residency Match: UCLA for anesthesiology.

M4 clinical elective: Shahid Beheshti Medical University/Loghman Hakim Hospital in Tehran, Iran. Loghman Hospital is a tertiary care referral center in busy area of Tehran. It is known primarily as a toxicology center with many treatment clinics and surgeries addressing the needs of poisoned patients. My rotation was a clinical anesthesia elective and involved participating in cases, learning about the anesthetic management of different patients with varying comorbidities, rotating in the emergency department and intensive care unit.

What were the best aspects of your experience? Some of the best aspects of my experience were learning about the patient population of Tehran with all of its complexities. For example, many patients would present at this particular hospital (which specialized in toxicology) after attempting suicide (one case that comes to mind was a young male patient undergoing a trans-hiatal esophagectomy and extensive small bowel resection after he had swallowed extensive amounts of cleaning fluid). Learning about the anesthetic management of these patients was something I found unique to this hospital. The other high point was getting the opportunity to re-visit my home country and also learn medical Farsi. I knew how to read and write Farsi from living in Iran and going to school there for year, but I never had the opportunity to learn how physicians communicate in the hospital setting. Surprisingly, most of the technical language was straight out of American text books, and spoken in English. I did learn about documenting patient information in Farsi and what an academic hospital in Iran is run in terms of resident/fellow education.

Do you think this experience affected the way that you think of yourself as a physician? If so how? The experience clearly showed me the disparities that exist between practicing first world and third world medicine. For example, the meaning of sterile technique was different in this hospital compared to our hospital here. The operating room doors were open throughout all cases and some of the surgeons would walk into the hallway while scrubbed-in to comment on something in the room next door. It seemed that infection rates were no different, however, mainly due to broad spectrum antibiotic coverage post operatively. Also, some attending physicians spoke of times where they would re-use (after sterilizing) endotracheal tubes or other equipment. Without doubt, it affected my perception of resourcefulness and also how anesthesia can be administered with less monitoring and more reliance on clinical judgment. For example, most rooms did not have capnography equipment available, and the recent sanctions placed on the country had affected the importation of inhaled anesthetics (they were predicting a shortage in the near future, and were planning to use first generation inhaled anesthetics).

Any additional comments other students might find helpful (e.g., state of the facilities, preparation you wish you had done ahead of time)? I think a fourth year clinical elective is extremely valuable mainly because we are at a point in our training that is closest to being an intern. As fourth years we are able to understand clinical decision making and compare/contrast. I would highly recommend it to any student who finds the time and can make arrangements.