JoshiUltrasound1I recently traveled to San Salvador to help teach a pediatric and adult ultrasound course. The course was well received and it was wonderful traveling around San Salvador.

I wanted to share some of our experiences, and discuss some challenges to educating internationally. More importantly, I want to engage you, the readers to share some of your experiences when educating internationally as well.

The language

The first challenge and major road block was attempting to lecture in a foreign language. Although I studied Spanish for many years, I was definitely rusty. While I learned the history of the Argentinian Dirty War in school, I never mastered vocabulary sufficient to discuss the physics of ultrasound. We translated the majority of the presentations into Spanish by using the aid of colleagues who were from El Salvador and Google translator. Imagine how difficult this would be for languages that are not based on the Roman alphabet or if there were no native language speaking colleagues to assist. Even with that, there were still some funny hiccups.

Delivering presentations

Creating the presentations is half the battle. Delivering the presentation is even more daunting.

We all know that good lecturers don’t read off of their slides.  They can ad-lib, interact with the crowd, and make adjustments as necessary.  This becomes more difficult in another language.  No one wants to deliver a bad presentation simply because it is in another language.  Or worse, give a bizarre answer to a question because of translation issues.  I definitely practiced my presentations more than I would usually.  The butterflies in my belly before presenting were palpable!

AV equipment

A major challenge was ensuring that the AV equipment worked properly.  Although traveling with 5 other EM physicians in my group, none of us remembered to bring a dongle to connect our laptops with the AV equipment in the hospital.  Luckily, we were able to find a store and could buy the necessary missing equipment.  However, you may not always be so lucky when traveling internationally to be near an urban center.  It is important to be organized to try to limit as much AV malfunction as possible.  Remain flexible and know that there may be some level of malfunction and be prepared to address it.  Having a backup plan such as hard copies of the lecture could be life (and reputation) saving.

Ultrasound equipment

Finally there is the challenge of traveling with the portable ultrasounds internationally.

  • Customs doesn’t always know what a portable ultrasound machine is. Plus, it takes coordination to organize carry-on luggage as the ultrasound, check in your suitcase, and manage your souvenirs– all without incurring additional travels charges.
  • Don’t forget how heavy the ultrasound machines can be on your back!  
  • Ultrasound machines are expensive. We always knew their locations to avoid losing them.

Ethical question

There was the ethical dilemma of using our high tech portable ultrasound donated by companies for international education versus using the machines that the hospitals already had.  Our equipment was definitely more advanced, but what purpose does it serve to not teach familiarity to what is available?  This is a thought that definitely can be pondered upon and argued over.


Lessons I learned

  •  Practice, practice, and practice again when delivering a presentation that is not in your primary language
  •  Think about AV equipment – consider backups
  •  Ultrasound machines are heavy and costly
  •  Always consider sustainability

Please share any lessons you may have learned while traveling and educating internationally!

Nikita Joshi, MD

Nikita Joshi, MD

ALiEM Chief People Officer and Associate Editor
Clinical Instructor
Department of Emergency Medicine
Stanford University
Nikita Joshi, MD


Emergency Medicine Doctor Associate Editor of ALiEM Gun Sense Advocate #FOAMed #Docs4GunSense #MomsDemandAction Tweets represent my own views and opinions