H. would probably be at the top of her class no matter where she went to medical school.  Like most of the Ecuadorian medical students I have had the privilege of working with she is curious, dedicated, and focused.   She attends a prestigious medical school and has had the opportunity to complete clinical rotations at some of the largest hospitals in Cuenca and Quito.  Her dream is to study internal medicine.  Part of her curriculum includes a scholarly work.  This is especially important in Ecuador because the most valuable research to a physician anywhere in the world is that which is conducted on a population similar to her patients.  For example, in Ecuador there is a very high rate of gastric cancer but no one knows why.  This is true of the entire Andean region and it is assumed that it is due to an unknown environmental exposure but more research is necessary.  If an Ecuadorian doctor wants to help her patients prevent and survive this common devastating disease, she needs to know its causes and the efficacy of available treatments within her target population.  However, H.’s attempts to come up with original research were severely hampered by a lack of resources because her school could not afford the expensive institutional subscriptions to databases that we U.S. medical students take for granted.  Her instructors teach with many of the same methods I experienced in the U.S., namely intense questioning and brief lectures.  The difference is that, while I can access the latest in updated medical information with the touch of a keyboard on my smart phone, laptop, or tablet, she purchases photocopied textbooks.  In the U.S. my professors have often commented on how medicine is constantly changing and that the pace of change has accelerated significantly in the last couple of decades.  Instead of memorizing massive textbooks as our predecessors did, we are expected to find our information in constantly updated online resources, review articles, meta-analyses, and medical journals.  H. is lucky because she happens to be fluent in Spanish and English making articles accessible to her, if only she could get a hold of them.  While my interactions with H. and other Ecuadorian medical students greatly enriched all of our education, I think that simply providing them access to online medical resources would do even more.  Access to information is changing our planet but far too much medical research remains locked within electronic libraries with expensive passwords.