International Member Spotlight:
Oscar Leonel Rueda Ochoa, MD, FACP
Dr. Oscar Leonel Rueda Ochoa, MD, FACP, is Professor of Medicine, Internal Medicine Physician and Director of the Cardiology Research Group at Universidad Industrial de Santander. He has been a Fellow of the American College of Physicians since 2005. He won the International Fellowship Exchange Program (IFEP) Award in 2008, which awarded him the opportunity to pursue a two month observorship in the United States. Here, he shares some of his professional experiences and talks about how ACP has influenced his career.
When and how did you make the decision that you wanted to become a physician?
My first encounter with the medical world was when I was a child. I remember watching the TV program “Quincy, M.E.”, a medical thriller about a criminal pathologist who tried to find the real cause of death in crime victims. I enjoyed the mysteries and the different hypotheses that appeared in each episode. This program ignited my curiosity for medicine. This passion for medicine continued when I took biology class in school. I remember the fascination that I felt when I opened a frog’s chest for the first time and the curiosity to try to understand the mechanism involved in the contraction of the heart.
Describe your job. What do you like about it? What do you enjoy about each role?
I have been fortunate enough to work in three areas: teaching, attending to patients, and research. These three areas have allowed me to grow as a human being and to contribute to the wellbeing of those around me. Teaching is a pillar of my job. Being a teacher is a privilege and a big responsibility – teaching helps form a new generation of doctors while at the same time feeding and maintaining an attitude of continual study and a critical position with respect to knowledge, which helps us discover voids in our knowledge and inspires us to raise many questions, some of which end up being the source of research projects. At the same time, all of this contributes to quality patient care that is both scientific and humane.
What got you interested in teaching? What do you find most rewarding about teaching?
Teaching is also about learning, and knowledge is a work in progress. We have to learn, unlearn, and relearn. Teaching is a unique opportunity in which this process is carried out, which is why I enjoy being a university professor.
What do you enjoy about working with students? What have you learned through working with them?
Students are critical and enthusiastic about knowledge. They question what they are learning and ask questions that beseech answers. Through working with students, I have learned to understand different learning styles and the speed at which they occur, along with different ways that the same problem can be approached. I have also learned how important it is to have clear and concise ideas in order to make complex concepts understandable.
A group of your students participated in the ACP Internal Medicine Poster Competition in 2008 and 2009. How did you coordinate this effort?
Since 1990, I have led an internal medicine and cardiology research group at the Universidad Industrial de Santander in Bucaramanga, Colombia. The group is made up of undergraduate medical and nursing students. This group is a source of research for youngsters that want to be more in touch with clinical research. The group has remained active for a variety of reasons, primarily because of its active areas of research stemming from questions that are increasingly complex and comprehensive which have generated research projects that seek answers to those questions. Students are motivated to link up to these areas after a pre-selection process that puts the student in contact with the problem, gives them basic training to obtain the initial tools to help them develop the research work and then evaluate their performance in the process. All products resulting from this work (like articles, acceptance of abstracts, and presenting them at congresses) form part of the academic productivity of the students who are co-authors of them and recognize and enhance their work, which is also important as achievements for their resumes.
As a result of this work, my students participated as finalists on two occasions in the ACP Medical Student Poster Competition in 2008 and 2009, and had the opportunity to prepare and present their research projects in front of the judges, receiving valuable feedback and suggestions as part of the process of research training.
How did the experience benefit your students?
The experience benefited my students in many ways. First, they had to face the challenge of a new language; communicating their ideas in English is not easy for a Spanish-speaking undergraduate student. They also learned to design and create a poster adhering to all the requirements of scientific rigor that facilitate the communication of research results. Additionally, they came into contact with other medical students from North America and other countries with whom they could share experiences, and this expanded their vision of the world.
What does the future hold for today’s medical students in Colombia, in your opinion? What is their biggest challenge?
In the last decade, a reform of the health care system in Colombia was implemented with the goal of increasing coverage and improving quality of care. This reform necessitated structural changes in health administration on the part of state hospitals and private institutions, many of whom did not adapt to the new model and were closed down, resulting in massive layoffs of healthcare workers. Currently, many of the institutions that were shut down have reopened their doors with new administrators and new methods of hiring by worker cooperatives, which reduces doctors’ incomes and undermines job stability. This poses a big challenge to medical students as they now face this new job market in which quality of care is measured to a great extent by the doctor’s capacity to provide quality care in an efficient way, using the least amount of diagnostic tools and with the least amount of medical expense.
If a medical student asked you which area of medicine they should pursue, would you recommend internal medicine and why?
Without any doubt, I would recommend that my students choose internal medicine as a specialty. I owe this in a large part to the fact that I consider internal medicine to be the basis of clinical medicine and is responsible for treatment of most diseases that afflict the adult population. Furthermore, being an internist requires extensive medical knowledge, a systematic approach to patient problems, and a high level of compassion, which contributes to a comprehensive training.
What has been a particularly rewarding accomplishment for you in your career?
The biggest reward in my career is seeing how an appropriate medical intervention and an accurate and timely diagnosis can improve a patient’s quality of life. Seeing the look on someone’s face change from pain, anguish and desperation to a smile of relief and recuperation is the most gratifying thing about being an internist.
You were an ACP International Fellowship Program (IFEP) Awardee. How did the IFEP award contribute to your work? What were you able to bring back to your country from the experience?
The IFEP scholarship allowed me to do an observership in the Internal Medicine Department at the University of Pennsylvania (UPENN). I had the opportunity to do clinical rotations, discuss clinical cases, present topic reviews and move forward with a project on medical decision making. What really left an impact on me during my experience at UPENN was its philosophy of a constant search for excellence and leadership; the importance given to this philosophy is reflected in all activities, both administrative and academic. This philosophy is framed by teamwork, in broad and open discussions of ideas in a friendly environment, of respectfully listening to the ideas of others and searching for a consensus. This leads to a collective decision making process and a collaborative learning experience. This process motivates everyone to participate and tends to make for a stress free environment, which is considered to promote better learning.
What also left an impact on me was the positive reinforcement that is constantly given by the professors and directors to the subordinates; I frequently heard them say “Good job”, “Great”, and “Excellent”. I was also intrigued by the acceptance of ignorance as an important part of the learning process. There was no fear in saying “I don’t know” – on the contrary, on some occasions I observed teachers accept their ignorance on a topic and, at the same time, immediately motivate the whole team towards finding the correct information
Something else that stood out to me was the enormous respect that exists for the patient and for the decisions that he makes with respect to his illness. The doctor is the adviser and provides diagnostic and therapeutic options to the patient, but the patient is the one to make the final decision. Patients tend to be very informed about their illnesses (based on knowledge acquired from the internet, magazines, patient groups, and medical staff).
Another thing that stood out to me was the advanced technological equipment and diagnostic tools to serve the patient, without disregarding the clinical expertise as it corresponds to the clinical history, physical exam, and evidence-based medicine, all combined with a high level of humanitarianism defined by compassion and “putting yourself in the patient’s shoes” to understand his situation and to give him the appropriate support. In spite of that, on rare occasions, medical errors occur, an appropriate diagnosis cannot be reached, or there are adverse affects to a course of treatment. These difficulties are faced collectively and analyzed in academic meetings so that the necessary corrective measures can be found. This trains doctors to accept errors as part of the learning process and teaches them how to communicate an error to the patient and his family, without hiding it, but to try to make the most out of these errors in order to improve themselves both in a personal and professional way.
Lastly, the academic program is structured in training for patient care and research and guided by clear objectives that are evaluated by the professors and academic directors at the end of the semester in a personal way for every one of the students and medical residents. By doing so, they seek to motivate students towards the search for excellence and make them conscious of the fact that their personal and intellectual growth are the stamp that UPENN imprints on them and is the standard that the university projects in the community and the world. The saying at UPENN “Love for knowledge and social commitment” is not in vain I have shared this experience in my country with colleagues and I hope that it will be a source of motivation to continue doing our jobs better every day for the benefit of our students and patients.
What were the highlights of you experience in the US?
First of all, I want to emphasize the attention and support I received from Eve Swiacki, Wendy Rivera, and Monica Davis, from the ACP International Activities Department, who were in constant contact with me during my stay in Philadelphia and who provided me with all the support I needed to carry out my observership. Additionally, I was received by my UPENN colleagues with friendliness. They always showed an interest in collaborating with me and they allowed me to share my previous experience with them. They included me in their project teams and allowed me to contribute with presentations on select topics. From all accounts, it was a very positive experience in both my academic and personal training.
What current projects or activities are you working on? What are your future plans?
Currently, I continue to lead the research group at the Universidad Industrial de Santander in Bucarmanga, Colombia and to teach medicine as well as provide patient care in internal medicine in my practice. At the moment I am completing the USMLE exams in order to apply for formal training in internal medicine in the United States and I hope to be able to link up with a clinical research group to carry out research projects collaboratively between Colombia and the USA.
You recently won several awards in your country. Can you tell us more about those?
We [the university research group] were fortunate enough to participate as finalists, on two occasions, in the ACP Medical Student Poster Competition in 2008 and 2009. In 2009, we were awarded first place as Colombia’s Best National Research Project by the Colombian Association of Pediatrics for the project: “Electrocardiography Findings in a Sample of Healthy Newborns in Bucaramanga” and third place as Best Research Project in the Congreso Internacional de Investigacón Juan Jacobo Muñoz de la Organización Sanitas Internacional with the project “Heart Rate Variability as a Predictor of Mortality and Morbidity in Acute Myocardial Infarction – Cohort Study”. I also received first place in the Excellence in Internal Medicine contest, as the best Colombian Research Professor in Internal Medicine in 2009, granted by the Colombian Association of Internal Medicine.
What advice would you have for other international mentors in general, and specifically for those who want to get more involved in the ACP?
ACP provides many sources for updating one’s knowledge in internal medicine, and also provides the opportunity to serve as a bridge between colleagues in the United States and other parts of the world. All of ACP’s resources are made to contribute to improving the quality of internists in a comprehensive way. It is worth exploring all the options that ACP offers and also to motivate all undergraduate medical students interested in internal medicine to join early to begin their training as future internists.
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