Medical Clerkship in a State Registration and Reception Center for Forced Migrants in Germany: Students' Experiences, Teachable Moments, and Psychological Burden.

David Kindermann,Hans-Christoph Friederich,Cassandra Derreza-Greeven,Christoph Nikendei,Carolin Schmid,Florian Junne

doi:10.3390/ijerph16101704

Abstract

Aspects of global health are becoming increasingly relevant for doctors of future generations. However, medical curricula rarely include courses which focus on global health or forced migration. Furthermore, it remains unclear whether students are at risk to develop psychological strain, after being confronted with highly burdened or even traumatized asylum seekers. This is a prospective study using a mixed-methods approach. We included n = 22 medical students performing a medical clerkship in a state registration and reception center for refugees. By applying (1) qualitative interviews, (2) reflective diaries, and (3) psychometric questionnaires, we examined the students’ experiences, teachable moments, and potential psychological burdens. In the interviews, the students emphasized the importance of cultural sensitivity during their clerkship. However, they also reported cognitive changes concerning their views of themselves and the world in general; this could indicate vicarious traumatization. The reflective diaries displayed high learning achievements. According to the psychometric questionnaires, the assignment in the reception center had not caused any significant psychological strain for the students. By completing their medical clerkship in a reception center, students were able to improve their medical, organizational, and interactional knowledge and skills. Furthermore, they reported that they had broadened their personal and cultural horizons.

Highlights

In 2017, nearly 200,000 refugees arrived in Germany and applied for asylum to find protection from prosecution, violence, and war [1]; the most common countries of origin were Syria, Iraq, and Afghanistan
In a recent cross-sectional study which investigated the psychological burden in interpreters at a state registration and reception center, we found that 21% of the participants fulfilled all criteria of secondary traumatization [20]
N = 22 medical students of the University of Heidelberg who did their medical clerkship in the outpatient clinic of the Medical Treatment Center of the Heidelberg–Kirchheim State registration and reception center “Patrick Henry Village” (PHV) participated in the study

Summary

Introduction

In 2017, nearly 200,000 refugees arrived in Germany and applied for asylum to find protection from prosecution, violence, and war [1]; the most common countries of origin were Syria, Iraq, and Afghanistan. Forced migrants have a high prevalence of psychological strain due to the awful experiences in their home countries or during their flight: Manok et al [2] assessed asylum seekers attending a psychosocial outpatient clinic in the state registration and reception center in southwestern Germany, in which the present study was conducted. They found prevalence rates of 38% for post-traumatic stress disorder (PTSD), 27% for depressive disorders, and 17% for substance abuse [2]. Public Health 2019, 16, 1704; doi:10.3390/ijerph16101704 www.mdpi.com/journal/ijerph

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Conclusion