To Sydney and Back
Steven Naylor shares his “Aussie” experience
Having completed the rather strenuous set of fourth year exams, I was finally able to embark on my elective: the space of ten weeks that had occupied a corner of my mind since the first few weeks of first year. Where would I go? Who with? What would I like to get out of my elective? The elective experience threw up hundreds of questions, uncertainties and anxious waits for emails from the establishment you so desperately want to work in. But one thing is for certain; it is and was a life-changing experience.
The fourth year had confirmed my interest in surgery, but at the same time, I hugely enjoyed paediatrics. I therefore decided that paediatric surgery would be the ideal speciality for me to experience while undertaking my elective. It would combine the opportunity to ‘scrub’ for theatre and hopefully develop some fundamental surgical skills in a paediatric context as well as gaining some experience in a speciality not well covered in the undergraduate course. Paediatric patients are often the most complex, requiring excellent communication skills, well developed clinical acumen and a sense of fun! I was therefore incredibly proud when given the opportunity to join the team at Sydney Children’s Hospital (SCH) for an incredible four weeks!
SCH is situated in Randwick (East Sydney) and serves as the largest paediatric tertiary referral centre in New South Wales. The hospital has a very clear mission statement: “to improve the health and well being of children and their families through promoting wellness and caring for illness efficiently, effectively and compassionately without discrimination.” http://www.sch.edu.au/
SCH has the facilities required of any paediatric-orientated health facility but also has unique, specialist centres to deal with those children with particularly troublesome and life impinging conditions including cancer, trauma, HIV/AIDS, congenital abnormalities, disabilities, heart disease and respiratory disorders.
The hospital also aims to be a centre of excellence for research opportunities. Recent significant research successes have included pioneering new techniques for post -operative paediatric pain control and surgery on the unborn child. When applying for elective posts, the ‘cutting edge’ nature of the medicine/surgery occurring at SCH really confirmed my aspirations to undertake a surgical elective in this wonderful facility. Perhaps the most impressive feature of SCH is that it has been designed and decorated purely for children in mind. As soon as you walk through the doors of the hospital, you are greeted with bright colours and mounds of toys to engage the energetic minds of children. Furthermore, each ward has a specially designed play room for all of the patients and over night rooms for parents anxious about their ill child.
My aims for my elective at Sydney Children’s Hospital
The elective experience is a huge undertaking both financially and emotionally. This period of ten weeks becomes the “light at the end of the tunnel” (the tunnel being fourth year MBChB!) and therefore represents a precious opportunity for an undergraduate to do something that they will talk about for years to come. I therefore thought it was vital to have some clear aims for my time in Australia to allow me to return to the UK with skills that may have not necessarily been as possible to develop in this early stage of my career.
My three main aims included:
- Becoming more knowledgeable about the basic principles of surgery including gowning and basic techniques including surgical knots and wound care.
- Developing a greater ability to clerk and examine a child with a surgical problem and formulating a sensible differential diagnosis.
- Enjoying being in Australia for the first time in my life!
My activities at SCH
In order to achieve the first two aims outlined above, I wanted to maximize my clinical exposure at the SCH. I was fortunate enough to be attached to two surgical paediatric registrars. I attended the morning team meetings prior to the extensive morning ward rounds. When on the ward rounds, I was regularly given the task of writing in the clinical notes summarizing our clinical assessment and management plans; perfect preparation for fifth year and beyond. On operating days, we regularly visited the child and parents to ensure they understood our intentions and that we had left no questions unanswered.
Whilst in theatre, I was regularly able to scrub enabling me to have an optimum view of the surgical field and handle some of the instruments I may use if I am to become a surgeon. I received excellent teaching on basic surgical techniques for common surgical problems including congenital inguinal hernia, pyloric stenosis and hydrocele.
The most beneficial clinical experiences came in the form of “on-call” shifts on the acute admissions unit. SCH is an incredibly busy hospital; hence I was able to see a wide range of clinical conditions. Most interestingly, it was possible to witness the treatment of patients from demographics not present in the UK such as the aboriginal population. The aboriginal children not only present with clinical conditions not commonly seen in the UK but also act incredibly different to non-aboriginal children. Therefore, it was necessary to adapt my communication skills to enable an appropriate and fruitful consultation.
The learning experiences provided by the SCH enabled me to fulfill my educational aims. I now feel much more informed about paediatric surgery and the ramifications such a career has on you in terms of psychological and emotional effects. Furthermore, I feel more competent at communicating with children, putting them at ease and explaining procedures to patients (and parents) in appropriate language.
My reflections on Sydney
It is hard to describe my experience at SCH. Without sounding too cliché, words truly fail me. Never before have I felt so welcome in a clinical team and so touched by the patients I helped care for. Furthermore, I was able to work with doctors from various different backgrounds within a clinical setting I have no previous experience of i.e. a busy surgical admission unit of a tertiary referral centre. I felt that my professional development has benefited directly from my elective experience, as I had to adapt and include myself into a busy, large and unfamiliar team. As well as the clinical aspect of this portion of my elective, I thoroughly loved the city and people of Sydney.
And finally…
My elective was everything I wanted it to be. It had included interesting clinical experiences, wonderful sights and fantastic company. I am so grateful to the medical school for giving us the opportunity to pursue an elective in whatever speciality we desire, wherever we want (within reason!). I believe that my elective has changed me; I am more aware of medical care in an international setting and have ascertained some experience in a speciality I may well pursue. Most importantly, I felt that the elective period was exactly what I needed following the extensive fourth year. On returning to Leeds, I felt refreshed and ready to take on the challenges of phase three MBChB.
A big thank you to everybody involved in organizing the elective process at the University of Leeds.
Steven Naylor
Fifth year medical student
University of Leeds
UK
ugm3s2n@leeds.ac.uk