Ezekwu Precious Kemakanma from Nigeria traveled to Ukraine in 2015 to pursue his dream of becoming a doctor. Just before his graduation, war broke out and he fled to the Netherlands. Thanks to a new educational pilot program for refugee students, Ezekwu and four other medical students were able to obtain the necessary credits at UMC Utrecht to receive their doctor's degree in Ukraine. "This was a unique opportunity," he said.

"When the war started in Ukraine, I didn't leave right away. I had almost finished my medical training and hoped that the war would end within a week," says Nigerian Ezekwu Precious, who started his medical studies at Kharkiv University in 2015. Ten days later, he left Ukraine hurriedly when his apartment building in Kharkiv was shelled. "After all the experiences, the Netherlands became a safe haven. In an attempt to pick up my life here, I sent emails to several universities requesting placement in a medical institution while waiting for an update from the university in Kharkiv. After a few weeks, I received an email from the UMC Utrecht inviting me to apply for a new observership program for refugees. Thus began my journey to Utrecht."

Pilot new refugee student program

Because Ezekwu Precious and the other students from Ukraine were already in asylum centers in the Netherlands, spoke English well and were highly motivated to complete their medical studies, they were selected for UMC Utrecht's new program. This program had been developed as a pilot in a short time at the initiative of assistant professor of Global Health Joyce Browne and Iris Homan of the International Office, supported by the Medical studies Director of Education Annet van Royen. "There was an international refugee crisis and we all heard the stories of students who suddenly had to interrupt their studies, many of whom were medical students. Many colleagues and students were eager to do 'something' in response. There was a lot of willingness. We harnessed this willingness, joined forces, and developed this project to allow the UMC Utrecht to contribute something positive for these students," says Annet van Royen.

Establishing contacts at lightning speed

Soon the initiators invited clinical educator in gynecology Peter Hoge to think along. "Innovating education appeals to me and I wanted to something for these students," says Peter, who was able to establish contacts within the hospital at lightning speed because, in addition to his clinical work in the delivery rooms, he coordinates education for his department. "In a short time we set up an English education program. This consisted of participation in one of the UMC Utrecht’s annual Summer Schools, followed by six weeks of observership at the clinical departments of surgery, pediatrics and gynecology. The observership in the department was combined with two teaching days each week. In addition, they were also connected to a buddy, a final-year medical student from Utrecht."

Practicing on phantom dolls

By partnering with the Utrecht Summer School, on-campus accommodation was arranged to avoid a daily commute for participants between the UMC Utrecht and their shared rooms in asylum centers throughout the Netherlands. This allowed them to concentrate on their education. Peter: "What was striking was that the curriculum of medical students in Ukraine, partly because of corona, was heavy on theory with less emphasis on practical skills compared to the Dutch curriculum. That is why our program also emphasized the latter: practicing on simulators and manikins, for example how to take blood samples, feel a pregnant abdomen to see if the baby is lying properly or insert a speculum for a vaginal examination. We also wanted the program reflect our vision that medical education should also focus on professional development and the broader perspective on health care. Because of this, we included several guest speakers from other fields such as psychology, ethics and communication."

Watching a cesarean section

During the observership rotation in gynecology/obstetrics, students joined the ward rounds, join the labor rooms to experience childbirth within our hospital, and a cesarean section in the operating room. The students found the interaction between nurses and doctors with the patient particularly special, as it was much more open than the hierarchy they had experienced in Ukrainian hospitals. Ezekwu Precious: "The program lasted about two months and was an excellent exposure to different clinical procedures from different departments. This was important because it was a criterion for completing my medical education at Kharkiv University. The program also created a special WhatsApp group for us to quickly connect with the various faculty members and each other. The program was really educational and informative. Moreover, it was also a way for me to relieve stress and worries about the future."

Learning from the differences

Not only for the students, but also for UMC Utrecht the new educational program was a valuable experience. "This observership program showed that, if we want to, we can get something done in a short time and even in a large hospital. This program started as a pilot, and allowed us to learn about how to implement education for international students here. How to organize it, how to deal with cultural differences.“ Peter shares. "For some cultural differences we were not always well prepared. For example, the amount of interaction between student and doctor and giving feedback to each other is different in the Ukraine, and we needed to think about ways to familiarize students and departments with these difference. As such, this experience has been very instructive for us to improve future internships. We will now include in future editions a training course on 'giving and receiving feedback' in the preparation, pair foreign students more often with Dutch medical interns to show them around, and continue to fine-tune and match the expectations of participants and departments are."

Grateful and emotional at graduation ceremony

On August 26 the time had finally come: the graduation ceremony at UMC Utrecht. After the abrupt interruption of their studies in Ukraine and the uncertainty about whether they would ever complete their medical studies, their final credits had now been earned at UMC Utrecht. The five students received certificates that can be submitted at their Ukrainian universities in to complete their medical degree. The participants look back with appreciation for this opportunity. The ceremony resulted in relief and happiness achieving this milestone. "We were also touched by the experience. In a short time we formed a group and personal connections were built," Peter explains. "I wish these students a bright and wonderful future as doctors and am confident that they will achieve their goals given their determination and positive attitude."

Zinai's experience at UMC Utrecht

Zinai is one of the participants in the observership program. The Utrecht University featured her experience in this video.