We offer a wide range of clinical experiences for medical students and physicians. Many participants come with a specific community/research project they want to undertake, but projects aren't necessary to have a rewarding experience. From our experience, the individuals who seem to have enjoyed the program the most were usually self-starters and had concrete objectives or goals for their experience. Students should know that the primary goal of Cachamsi isn’t to learn what they would otherwise learn in 3rd year clerkships. When shadowing physicians, sometimes students feel frustrated when they don't pick up on all the clinical nuances of a case. This is okay. Rather than diagnosis and management, the main emphasis is on taking a history, doing a physical exam, and giving patient education in Spanish.

Medical Spanish
The medical Spanish curriculum will cover a wide range of topics from anatomical vocabulary, medical terminology, and procedures to doctor-patient relationship and cultural appropriateness. The student will systematically learn the different grammar structures, providing a strong linguistic base knowledge as he / she progresses in the program.

After arrival to Riobamba, the students will take a language skill proficiency evaluation test. The results of this evaluation will provide the instructor with the pertinent information as to how address the learning needs of the student. The instructional objective is to best tailor the program to the student in order to maximize his/her experience in Riobamba. The Medical Spanish lesson curriculum will be similar to the one used in various US medical schools, that is, anatomical vocabulary, medical terminology, procedures, and cultural appropriateness. The curriculum will also include topics on indigenous medicine, complementary/ alternative medicine, comparative international health, and Ecuadorian health care. The Spanish language instructors are professionals graduated from major Ecuadorian universities or selected Spanish professors from private language schools.

Class size is dependant on the number of participants enrolled in the program each month. During the summer months of June, July, August, class size ranges from 5-10 students per instructor. During the rest of the year, each instructor has about 1-4 students. The program has a maximum enrollment of 22 each month. Students will spend approximately 2 hours in Spanish classes each day during the week. There are no classes on the weekend since many students wish to use the time to travel.

Clinical Preceptorship
Students will have the opportunity to shadow various physician preceptors among different hospitals and clinics in Riobamba. Prior to traveling to Ecuador, the student will submit a list of preceptor preferences based on specialty, prior experience, etc. Arrangements will then be made, prior to the student arrival and according to availability. Preceptorship time will vary according to the hospital or clinic schedule, preceptorship time may be in the morning, afternoon, or evening. Preceptorship time will start on or around the third day of the program. On average, students spend about 4 hours each day in preceptorships. All precepting physicians are faculty professionals from the following health centers:

Subcentro de Salud Cacha (Clinic) The opportunity to work in the Andean community of Cacha is a unique aspect of the program and one that participants overwhelmingly enjoy the most. This small clinic serves a vast area of indigenous communities 30 minutes outside of Riobamba. Students may work at the Subcentro, do pediatric checkups at local schools, or put on community programs. Most of the patients are indigenous and don’t have access to a regular physician.

IESS Hospital (Hospital del Instituto Ecuatoriano de Seguro Social) This busy hospital serves the beneficiaries of the Social Secure System in Ecuador. Workers usually contribute to this non-profit national entity. Students have particularly enjoyed working in the ER and going on ambulance rides. Walking distance from Rincon Aleman: approximately 1.5 miles. Easy bus access as well.

Hospital Alternativo / Andino This excellent hospital was started in 2002 with the mission of serving patients of all socioeconomic backgrounds. The hospital consists of three areas: Western, Alternative, and Andean. Students may work in all three areas, assisting and observing. Emphasis is on patient satisfaction, holistic care, and affordability. The busiest time is in the morning hours from 8 – 12. Participants may also work the 7pm – 7am shift. Walking distance from Rincon Aleman: approximately .5 miles. In addition to seeing patients in the clinics and hospitals, we now have standardized patients that participants will be conducting H&P's with in Spanish.