Immunocompromised people who are infected by B. microti are at risk of persistent relapsing illness. Such patients generally require antibabesial treatment for >or=6 weeks to achieve cure, including 2 weeks after parasites are no longer detected on blood smear.

Abstract. The purpose of this study was to assess the impact of international health electives on physicians-intraining. A retrospective study was conducted using an anonymous, self-administered mailed survey to internal medicine residents who trained at Yale from 1982 to 1996 based on their experience with our International Health Program (IHP). The response rate was 61%, with 96 completed surveys in the participant group and 96 completed surveys in the nonparticipant group. Participants were more likely than nonparticipants to care for patients on public assistance (77 versus 49; P Ͻ 0.001) and immigrant patients (41 versus 23; P ϭ 0.006). Among residents who changed their career plans, participants (22) were more likely than nonparticipants (14) to switch from subspecialty medicine to general medicine (P ϭ 0.02). Participants were significantly more likely to have a positive view of health care delivery in developing countries. Compared with nonparticipants (64), IHP participants (74) believed that the physical examination is under-used by physicians from the United States as a diagnostic skill (P ϭ 0.03). International health experiences appeared to have an important impact on the decisions and attitudes of residents.International health electives are believed to impact residents in training in 3 ways: professional development, health care resource use, and outlooks and attitudes. 1 In a recent study, participants in an international experience indicated greater interest in areas of public health, working with underserved populations, or in academic general internal medicine upon completion of residency compared with nonparticipants. 2 Rotation in an international health elective has also been suggested as a means to strengthen clinical skills and reduce dependence on both laboratory and other diagnostic tests. 3,4 Finally, international health experiences are believed to affect participants' outlooks and attitudes, especially in the area of cross-cultural understanding. 1 Nevertheless, international health electives require substantial financial commitments from medical institutions facing economic challenges created by the forces of managed care. They are perceived to result in a loss of personnel resources for hospitals struggling to survive. In addition, they potentially expose physicians-in-training to health and safety risks. Although previous investigators have documented anticipated changes in career plans among residents participating in international electives, it is not clear how many of these recent graduates will actually pursue these intended professional changes in their future practice. 2

EXECUTIVE SUMMARYTravel medicine is devoted to the health of travelers who visit foreign countries. It is an interdisciplinary specialty concerned not only with prevention of infectious diseases during travel but also with the personal safety of travelers and the avoidance of environmental risks.The field has evolved as a distinct discipline over the last 2 decades. It is represented by an international

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