“Round-the-World” elective
Prem Jesudason shares experiences of working in hospitals in New York and Australia.
Why stick to one hospital on one continent if you have time for more? With ten weeks available to me for an elective I decided to be ambitious, buy a round-the-world plane ticket and organise two hospital placements. I spent four weeks at an intensive care unit in New York City, and four further weeks in the busy emergency department at the Gold Coast Hospital in Australia.
New York city skyline
New York City
New York City is not only one of the world’s biggest and busiest cities - it is an amalgamation of thousands of different peoples and cultures, built upon its long history of immigration. As a result, the New York Downtown Hospital caters to a varied cross-section of patients. The hospital serves nearby Chinatown and the people of numerous ethnicities that populate Manhattan’s Lower East Side. Additionally, it is the closest acute care hospital to Wall Street and the business district: the financial hub of the USA.
The hospital’s intensive care (ICU) unit consists of 18 beds and treats both medical and surgical cases. Prior to my elective I had minimal experience of working on an ICU, therefore this placement was an ideal opportunity to develop both my knowledge and skills in managing severely ill patients. My primary duty in the ICU was to present cases during medical and surgical ward rounds, which required a detailed understanding of patients’ clinical problems. This was not easy at first since the majority of ICU patients have complex illnesses and there was often a lot that I did not understand. However, medical and nursing staff in the unit were both knowledgeable and helpful: soon I felt like part of the team, which allowed me to learn quickly and to really enjoy the placement. Additionally, I spent time shadowing both junior and senior doctors to develop my knowledge in various specialties such as respiratory medicine and gastroenterology.
Typical cases seen on the ICU included bacterial pneumonias, diabetic ketoacidosis, renal failure and heart failure. I became familiar with the management of septic, cardiogenic and hypovolaemic shock. More unusual cases that I had not seen before included aspergilloma, Stevens-Johnson syndrome and ovarian hyperstimulation syndrome.
I did find that life on an ICU is not easy - it can be challenging and exhausting in many ways. There is a physical and emotional demand when providing care for patients who are either very ill or critically ill. Inevitably some of those cases I presented on ward rounds did not have happy endings, therefore it was important to be able to emotionally deal with a patient’s death.
My time in New York was a largely positive experience in a fascinating city. However, the main disadvantage with an elective in the USA is that doctors are sometimes unwilling to allow students to perform procedures, such as cannulation and arterial blood gas sampling, given the increased threat of medico-legal action in the US healthcare system. Despite the lack of opportunity to practice clinical skills the placement was hugely rewarding and it allowed me the valuable experience of working with critically ill patients. As I had a second placement arranged in Australia, what I had missed out on in New York I could make up for on the Gold Coast.
Whitsunday Islands, Australia
Gold Coast Hospital, Australia
The Gold Coast is a 40-mile stretch of coastline in the southeastern corner of Queensland. The Gold Coast Hospital, located in the town of Southport, is publicly funded and is one of the largest teaching hospitals in Queensland. Approximately 500,000 people live along the Gold Coast, however the region is one of the most popular tourist destinations in Australia and the hospital serves both residents and tourists. As such, the emergency department, where I worked, is one of the busiest in the country.
My main duty was to clerk patients arriving at the emergency department, and present my findings to senior members of the team. I also spent time shadowing medical staff when more seriously ill patients presented, for example those with major trauma. Another duty was to perform clinical skills such as obtaining venous blood samples, arterial blood gas sampling and inserting peripheral venous cannulae. I clerked patients with very varied presenting complaints, such as shortness of breath, chest pain, vaginal bleeding and minor trauma.
One interesting case that I was involved with was a 43-year-old man presenting with chest pain and shortness of breath; subsequent investigations confirmed a pulmonary embolus. Another case was that of an 18-year-old man with a 16-hour history of abdominal pain, who was diagnosed with acute appendicitis and referred for surgery. These two cases were especially useful since the conditions are common in the UK, therefore it was a valuable experience to be involved in the diagnosis and initial management of the patients.
Additionally, I was involved in the management of a 46-year-old woman who had been bitten by the venomous common brown snake. This allowed me to become familiar with both first aid of a bite and definitive snakebite management. An important role of an overseas elective placement is to broaden your knowledge and to gain experience of situations that may not be encountered at home. Interestingly, cases of snakebite are occasionally seen in UK emergency departments especially given the increase in tropical snakes in zoos and as household pets; therefore, the skills that I learnt on this placement may one day, however unlikely, prove useful.
I feel that after four weeks in Australia I met my aims for the elective. Not only had my knowledge of emergency medicine developed, I also gained experience in other specialities such as obstetrics, gynaecology and paediatrics. My history taking and examination skills improved as did my practical skills. Furthermore, hospital staff were welcoming, and consultants were keen for elective students to find a balance between work and enjoying the attractions of Australia. I was allowed a number of days off to travel North along Australia’s East Coast, taking in Fraser Island and the Whitsundays - must-see sights for any visitors to Queensland.
Conclusions
My elective placements were both great learning experiences as I developed my knowledge and skills in numerous acute care disciplines. I would recommend an elective placement in Australia as it is a fascinating country and hospitals generally have a laid-back atmosphere. Queensland is one of the most geographically varied areas on the planet, with rainforests, coral reefs, deserts, beaches and much more to keep any elective student occupied. New York City also has much to offer, but if organising an elective placement in the USA, be prepared to work some long days and find out beforehand what you will and will not be able to do (for example, in some hospitals you may not be allowed to take blood or insert cannulae).
My words of advice for those organising electives are that round-the-world plane tickets offer flexibility: other than the placements in New York and Australia I had time to travel through the Canadian Rockies and Hong Kong. Remember to research your destinations well, find a balance between work and holidaying, and above all, have fun.
Prem Jesudason
Final Year Medical Student
University of Leeds
ugm2pjj@leeds.ac.uk
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