June 4, 2024

'This was a highlight of my training': Resident details rotation in India

A dermatology resident recently embarked on an educational journey to India as the department looks to expand international collaborations and exchange opportunities in medical education.

Daniel Nadelman in India
Dr. Nadelman with dermatology colleagues at AIIMS. 

Daniel Nadelman, MD, spent much of January at the All India Institute of Medical Science (AIIMS) Hospital in New Delhi. AIIMS is a Michigan Medicine partner institution with a history of collaborations and exchange, although usually with medical students—not residents—traveling between the two institutions.

“The goal was to experience firsthand a very high-volume healthcare system, as well as to see diseases endemic to India that we seldom see here, if ever,” said Nadelman, MD. “Thanks to the people I met, this was a highlight of my residency training. I would go back to AIIMS in a heartbeat.”

As a large, public referral center in the heart of India’s capital city, AIIMS treats patients from across the country and beyond. Michigan Medicine Associate Professor of Dermatology Trilokraj Tejasvi, MD, MBBS, an AIIMS alumnus, played a crucial role in facilitating the exchange opportunity.

Daniel Nadelman at the AIIMS campus
Dr. Nadelman was the first Michigan Medicine Dermatology resident to visit AIIMS.

“The unique learning opportunities in India, such as the chance to see cases that are rarely seen at Michigan Medicine—or even across much the region—make the exchange program an enriching experience,” said Tejasvi. “Our residents go on to practice anywhere, and for those who end up someplace with increased diaspora in the population, the experience is beneficial.”

Now in the third and final year of his residency, Nadelman presented his experience to a group of Dermatology colleagues in April, including Department Chair Christopher Bichakjian, MD.

“Our hope is to make opportunities like this a lasting part of our curriculum,” Bichakjian said. “Clearly, there is value in seeing illnesses and conditions specific to another part of the world. Aside from that, the chance to see and learn how a different health system works is an important aspect of such experiences.”

Nadelman detailed his rotation, what he learned about the healthcare and medical education systems in India, and some of the cases he saw. These included rare genetic diseases such as epidermolysis bullosa, as well as infectious diseases less common in the US, including tuberculosis and leprosy. India accounts for about 120,000 leprosy cases annually—more than half the global number of new cases. He also encountered cases of vitiligo, which are more prevalent in India than in the US.

While English is the language of medicine in India and the residents Nadelman worked alongside spoke English, most patient interactions occurred in Hindi.

“There were times when I would talk with patients, and a resident would translate,” he said. “They were great about always asking for my input and including me in discussions. If I had a suggestion, they would try it.”

Nadelman told his colleagues that, apart from seeing illnesses and diseases uncommon in the United States, a significant difference was how dermatology is approached as a discipline in India. Dermatologists play a broader role in patient care, performing procedures, managing their patients’ comorbidities, and handling all aspects of care.

“They are the primary care team on the inpatient service wards. It demonstrated to me that dermatology as a discipline could manage a lot more than is typically seen in the United States,” he said.

Nadelman is the first Dermatology resident to travel abroad for a clinical rotation, and the department is working on creating additional exchange opportunities. Two more residents plan to visit AIIMS in 2026, and Tejasvi said the department is exploring similar exchange programs with partner schools in China and Mexico.

“There is a lot of interest among our residents for this type of experience, which can fill a gap in their training,” he said. “The first one took two years to set up and make happen. But now we have a system paving the way for more people who want to do this.”