A clinical rotation in the Division of Pulmonary Medicine at the Thomas Jefferson University in Philadelphia was the last stop for me in my short journey of pursuing electives in the United States. Since I had two months of elective experience behind me, I was not very nervous on starting this final elective. However, little did I know what was in store for me. Every elective presents new challenges and you can never be completely prepared for them all!!

Hospital
Established in 1825, the Thomas Jefferson University Hospital now has 957 licensed acute care beds, with major programs in a wide range of clinical specialties. Thomas Jefferson University Hospitals serves patients in Philadelphia and the surrounding communities in the Delaware Valley Thomas Jefferson University Hospitals among the nation’s top medical centers for a number of specialties including Orthopedics; Rehabilitation Medicine; Cancer; Digestive Diseases; Ear, Nose and Throat; and Respiratory Disorders.

Experience
At Jefferson, I was rotating with the in-patient pulmonary consult team and our duty was to perform the initial evaluation of all the respiratory consults across the hospital and make the appropriate recommendations. As the junior most member of a team, which consisted of a medical student (me), a medical resident, a pulmonary fellow and the attending doctor, I was initially taught the essentials of history taking and physical examination from the respiratory perspective and was then expected to see consults individually. I would then present them in front of the attending doctor at the daily rounds. This provided me with a great opportunity to learn and at the same time, be able to demonstrate my history taking and physical examination skills. With every different elective there is a steep learning curve and initially this experience was no different. However I was fortunate enough to rotate under extremely understanding attendings and fellows who were patient with my mistakes and always encouraged me to learn from them. This really helped build my confidence and I became more thorough in my presentations as the rotation progressed. In addition to the seeing the consults everyday, I was also attending several weekly conferences. These included the Chest conference which was an integrated conference compromising the Divisions of Pulmonary Medicine, Pathology, Radiology as well as Cardio Thoracic surgery, the Journal Club and daily noon conferences. The topics presented here were comprehensive and it was very interesting to see how medical issues could be efficiently resolved using inputs from doctors belonging to different medical specialities.

I rotated with three different attending doctors during the tenure of my four week elective and each one of them offered new perspectives and insight in the field of Pulmonary Medicine. My first attending doctor was Dr Elisabeth Carr who is one of the most thorough physicians I have ever met. Her warm personality coupled with impeccable bedside manners always made patients feel at ease in her presence. There was never a dull moment when Dr Baram, my second attending doctor, was around and his enthusiasm was very contagious. Finally I rotated under Dr Mangione, whose physical examination skills were astounding. A thorough clinical examination is a dying art in today’s world, especially given the rapid advancements in medical technology. His approach was like a breath of fresh air and I learnt several new signs of physical examination, such as the Frank’s Sign. Another plus of rotating with the consult team was the abundance of hands on teaching that I was exposed to. I observed first hand the challenges involved in managing a wide variety of respiratory conditions. Part of this education included the interpretation of Pulmonary Function Tests, understanding the techniques involved in analyzing various radiological imaging modalities such as Chest X Rays and Computerised Tomography of the chest and studying the application of diagnostic tools such as the Ventilation/Perfusion scans in the management of patients. Interventional procedures such as bronchoscopy were routinely performed in the bronchoscopy suite and I had the opportunity to observe procedures such as Bronchoalveolar Lavage (BAL), Brush Biopsy and Transbronchial biopsy. Part of doing an elective in a different country is the exposure to patients with a completely different disease profile. Coming from a country where infectious diseases constitute the crux of the disease burden, I was exposed to diseases of non infectious etiology such as Sarcoidosis and its pulmonary manifestations. Overall It was an extremely informative and enriching four weeks whereby I greatly increased my existing knowledge regarding various lung pathologies such as Chronic Obstructive Pulmonary Disease (COPD), Asthma, Lung Cancer and their respective management.

Throughout the month I had the opportunity to observe a wide range of cases, one of which involved a patient who had suffered from Negative Pressure Pulmonary edema (NPPE). The patient underwent a routine cystoureteroscopy for renal stones and while recovering from anesthesia, bit her endotracheal tube thus leading to acute upper airway obstruction and subsequent NPPE. This was reflected by hypoxia and new onset infiltrates on the chest X-Ray. However prompt management with 100% oxygen in the PACU* lead to a rapid resolution of the situation. This case made me aware of the dangers of NPPE and its deadly consequences unless managed aggressively early on.

In the last week, I was supposed to present in front of the entire Pulmonary Medicine faculty and medical fellows on any interesting topic. Under the guidance of Dr Baram, I presented on NPPE. My presentation went well and I attribute that to my skillful knowledge of Microsoft PowerPoint and my ability to conduct searches of medical databases such as Pubmed and Scopus. The style of teaching and learning in the United States is quite different from that in a country like India. In the United States, rather than going through piles of textbooks, you are encouraged to review electronic databases for the most recent advancements and improvements in medical techniques. Therefore all students interested in pursuing and excelling in medical rotations in the United States require a thorough knowledge of how to use Pubmed and Scopus. New students shouldn’t worry however; to help you gain this familiarity; all libraries have friendly and approachable librarians who will help you conduct a better and detailed search.

Scott Memorial Library

During the course of my elective, I stayed on campus at the Martin Residence Hall Dorms.

Martin Residence Hall on the Right

As the dorms are extremely close to the hospital, I was able to work long hours without worrying about transportation services to go home. Additionally the magnificent Scott Memorial Library is located in the adjoining building and a well equipped gym is also close by in the alumni hall. All of these conveniences made it possible for me to use these facilities on a daily basis during my time there. I was also able to interact with students from different countries such as Brazil and Spain, thereby broadening my exposure through regular discussions on diverse medical topics and obtaining a global health perspective. All in all, I recommend that staying on campus is unique and enjoyable experience and should definitely be the preferred site of lodging whenever possible.

Finally, it was a great experience to live and work in a beautiful city like Philadelphia, which was the capital of the United States before Washington DC. The SEPTA public transport system provides effective transportation services throughout the city and at a reasonable cost. There are a large number of tourist attractions such as the Liberty Bell Pavilion, Independence Hall, Philadelphia City Hall and the National Historical Park, all of which should definitely be visited.

As someone famously said “All good things come to an end” and my four weeks at Jefferson flew by very fast. It was a great learning opportunity and I met some amazing people. I will truly miss and cherish this experience.

Purav Mody is a medical student at the Government Medical College, Surat, India
puravmody(at)gmail.com

Appreciation

I would like to thank the entire Pulmonary Medicine Division for their help and cooperation during my rotation with special gratitude to Dr Baram, Dr Carr, Dr Mangione and Dr Peter

I am a medical student from Rangaraya Medical College, Kakinada, India. Since the beginning of my final year in medical school I started to apply for an elective at a hospital in the US.Finally on the evening of 16th November 2009 I got an acceptance letter from University of North Carolina-School of Medicine. I was extremely happy and and before I knew it I was in the US. I already finished an elective in hematology and oncology in the month of January.

FEBRUARY: CRITICAL CARE MEDICINE, Medicine Intensive Care Unit

I had already completed a rotation in hematology and oncology for the month of January. I was excited and I was waiting for the new rotation to begin.

On the first day I was looking forward to start my rotation on a good note with the experience I got from my rotation earlier in January. I met with the rest of the team at the Medicine ICU in the 4th floor of North Carolina Memorial Hospital. We had two attendings Dr. Shannon Carson and Dr. Robert Aris , two fellows Dr. Kevin Fischer and Dr. William Hall, 4 teams with 2 residents and a medical student. I was a part of Team C with Dr. Lindsay Wilson and Dr. Stephen Telloni as my residents. Each team was on call every 4th night and we would admit patients when we were on call. Our attending Dr. Carson had an inspiring speech for us on the first day about how to utilize time in the ICU.

University of North Carolina memorial hospital

We used to assemble in the conference room by 630AM everyday examine the patients assigned to us and get ready to round on our patients by 8AM. We used to round till noon. The rounds showed me a totally different side of the health system when compared to the way we round in India. We also had nursing staff, Respiratory therapists and pharmacists joining us during rounds and offering suggestions and asking about queries they have regarding patient care. This aspect of including everyone involved inpatient care moved me a lot because this sort of co-operation was totally lacking in teaching hospitals in India.

During rounds we were supposed to present patients assigned to us. We had to start with a brief note about their problem during admission, events which had happened overnight, vitals that morning, Physical exam findings and all relevant laboratory data and our assessment and plan. We made changes in the assessment and plan as suggested by the attending.

After rounding we reassembled in the conference room to look at the X-rays of patients and commenting on their relevant findings. Our attendings, fellows, pharmacists would give lectures on various ICU management topics soon after discussing about X-rays. We would then finish by writing patient progress reports and signing off by explaining things to be monitored in our patients to the on-call team.

Being on call was a totally different experience when compared to on call experience in India. I was assigned a new patient based on the number of admissions. I was also assigned to take care of cross cover stuff about patients being taken care of other teams. It was also our responsibility to attend several Rapid responses and Codes called at various places in the hospital and if necessary we needed to perform CPR and admit the patient to the Medicine ICU under our team. I had a wonderful experience to witness many of these rapid responses and codes because these experiences were not very common back in India.

The sad thing about an ICU is that patients admitted in the ICU have a poor prognosis and it is really depressing to see what the families of the patients feel and go through about their loved ones admitted in the ICU. One particular lady who was admitted with sepsis, she had to be intubated but she go better and was extubated. The family said they didn’t want her to be reintubated. She developed lung collapse shortly after extubation due to formation of a mucus plug, this condition was reversible if she could get intubated again. We had to convince the family about this and reintubated her and she improved so much that I had never seen her as good as she was then. She was still weak but much better than admission. I felt really happy then but she soon started getting worse only this time her family didn’t want her to get intubated at any cost. Eventually she passed away. It was tough and difficult to explain a bad prognosis to the family at various stages of her hospital course. The good thing about this was that the family was supportive of most of our decisions and they greatly appreciated the way we held their hand through out.

The attendings, fellows and residents were nothing but helpful throughout the entire month. They were always helping me gain experience in the ICU by asking me to assist in several procedures and by inviting me to view certain procedures. Not only did they give me continuous feedback throughout the month about the areas I needed to improve but they were also happy to clear any doubts I may be having regarding management of patients in the ICU.

With the resident

Even though the entire month was really tiring because we were on call every 4th night, it was a truly amazing experience to be part of the ICU team with a lot of responsibilities, because every day spent in the ICU helped me learn things which I believe I may not have learnt if I hadn’t chosen this rotation. This month in the ICU has helped me look at life I may experience as a resident in a good hospital in the future.

How to apply:

You need to be in final year medical school for applying for an elective at UNC School of medicine.You also need to have a passing score in USMLE step 1 and TOEFL. Requirements may be revised frequently. Please refer to the Website of UNC School of medicine for latest requirements.

Tuition:

Tuition fee for a rotation is 2000$. Please refer to website for any updates.

Accommodation:

No accommodation is provided. However on acceptance a mail containing list of people who have rented their places to students will be sent. Contact those people for accommodation. Craigslist can also be helpful in finding accommodation.

Getting around in Chapel Hill:

Chapel Hill is a town which is a part of the research triangle park. Franklin Street in Chapel Hill is the heart of the town containing many restaurants and places to hang out.

Chapel Hill and its surrounding areas are served by a bus service called Chapel Hill transit which has regular services to most of chapel hill. All trips in buses of Chapel Hill transit are free of charge.

Hari hara Phani varma Kakarlapudi is a medical student at Rangaraya Medical College,Kakinada.
phanivarma19(at)yahoo.co.uk

I am a medical student from Rangaraya Medical College, Kakinada, India. It is my goal to pursue a residency program in the US. As a part of my journey towards that goal I got a chance to do an elective at the University of North Carolina School of Medicine. Soon I applied for a visa and I got a visa without any difficulty. I soon found myself flying to the US to pursue my dream.

JANUARY: HEMATOLOGY-ONCOLOGY

I soon arrived in Chapel Hill, the home of UNC School of medicine. I found an accommodation south of the campus just over a mile away with wonderful home owners who were willing to help with anything I might need.
On my first day I was standing on the sidewalk of Manning drive, Chapel Hill right in front of the several Hospital buildings wondering where to go. Finally I went to the consult room in the fourth floor of the newly built North Carolina Cancer hospital.

Outside North Carolina Cancer Hospital

There I was welcomed by Dr. Ryan Raddin a first year fellow, Dr. Taylor, two other Internal medicine residents and a fourth year medical student. I was given a workstation and a pager. I was asked to get familiarised with the Web CIS system which gives us access to patient data including history, vitals chart, progress note and all investigations done. Our attendings for the month were Dr. Alice Ma and Dr. Nigel Key.

Work station

Initially I found it difficult to adjust to the system here because it is quite different from the way things are done in India, with the help of the fellows. We used to assemble in the consult room at 830 AM. We would get beeped on our pagers in case there is a new addition to the patient list. We went and saw our assigned patients taking a complete history and performing a physical exam. We then arrived at a management plan for these patients based on the relevant findings in the history, physical exam and laboratory data. We would present these patients to the attending physician and also present our assessment and plan. The attending would then discuss in detail about the patient’s condition and make necessary changes required in the assessment and plan. After discussing all our patients we would start rounding by going first to the Hem-path lab to look at the peripheral blood smears and bone marrow apirates of our patients. Our attending would then explain about the relevance of the microscopic findings in arriving at the diagnosis. After looking at the slides we would go and see our patients along with the rest of the team and if possible talk to the patient and the patient’s family about our assessment and plan for the patient. We would then go back to our work stations and add a note about our assessment and plan which would be verified by our fellow before being added to the patients chart.

We also attended hematology conferences on every Friday and were also given assignments by our attendings to speak about a certain topic the next day. Our attending was kind enough to give us a Hematology-oncology manual which would help us during our elective.

One particular experience which made the team members think I was a capable, trustworthy and responsible person was when we had 4 admissions just as the day was about to end. Normally any late admissions would have been looked after by one of the fellows but on that day there were many late admissions and one of our fellows and both residents were in clinic so our attending was thinking about what to do, I then took the initiative to take up one patient and gather all required information while they go and examine the other admissions. They were impressed by my initiative and even though they were initially doubtful about what I could do, I did a good job and showed them I was a person capable of handling busy situations.

With the team and the rest of the team members in the conference room

Overall my experience for this month was new and initially difficult to adjust but with the help of the rest of the team was able to understand how things are done in the health system here. The department of hematology at UNC School of medicine is a leading institute in the US pioneering research and offering quality care in the field of hematology. Infact hematology is one of my choice when I plan to do my fellowship. The fact that this institute is one of its kind in the entire country made me feel proud to learn from its well experienced faculty and I hope that this experience helps me in achieving my goals.

How to apply:

You need to be in final year medical school for applying for an elective at UNC School of medicine.You also need to have a passing score in USMLE step 1 and TOEFL. Requirements may be revised frequently. Please refer to the website of UNC school of medicine for latest requirements.

Tution:

Tution fee for a rotation is 2000$. Please refer to website for any updates.

Accomodation:

No accommodation is provided. However on acceptance a mail containing list of people who have rented their places to students will be sent. Contact those people for accommodation. Craigslist can also be helpful in finding accommodation.

Getting around in Chapel hill:

Chapel Hill is a town which is a part of the research triangle park. Franklin Street in Chapel Hill is the heart of the town containing many restaurants and places to hang out.
Chapel Hill and its surrounding areas are served by a bus service called Chapel hill transit which has regular services to most of chapel hill. All trips in buses of chapel hill transit are free of charge.

Hari hara Phani varma Kakarlapudi is a medical student at Rangaraya Medical College,Kakinada.
phanivarma19(at)yahoo.co.uk

“If the human brain were so simple that we could understand it, we would be so simple that we couldn’t.” – Emerson M. Pugh

UC Davis Medical Center

The Background
The field of Neurosurgery has somehow always attracted me. The desire to take it up as a profession was further fuelled when I witnessed a brain surgery for the first time during my Anesthesia Rotation at my Medical School. However, having only had an “outside view” of the field so far, I felt it essential for me to get a closer look before I reached a final decision. The two months I spent at the Department of Neurological Surgery at the University of California, Davis Medical Center (U.C.D.M.C.) gave me that, and much more.

The Location
California is the most populous state in the United States, and the third largest in the country by land area. Located on the West Coast, it is home to almost 40 million people. The capital of California was Monterey under Spanish rule, and then San Jose for some time, before the State Legislature moved to Sacramento in 1854. Sacramento was named to be the permanent state capital in the 1879 Constitutional Convention.

The City
Sacramento derives its name from the Sacramento Valley and the Sacramento River, which in turn were christened after the Christian Sacrament of the Holy Eucharist. The city is situated at the confluence of the Sacramento River and the American River. It has a Mediterranean climate that is characterized by cool, wet winters and hot, dry summers. This was different from the subtropical climate of Delhi that I am used to, with brief mild winters and long very hot summers interrupted by the monsoon season starting in late June or early July.

Sacramento is a small city when compared to some of the larger cities of California. I admit, I seriously doubted, at one point, if it was actually the capital of the country’s most populated state. In India, most state capitals are the largest cities in their areas, and also tend to be the most populous. I learnt that this was not the case in this country. This was just one of the many interesting facts that I learned about the U.S.A. and I look forward to learning much more.

The Hospital
Ranked among the top 50 hospitals in the country, the Medical Center is the primary teaching hospital of the UC Davis School of Medicine. This 613-bedded hospital employs researchers and specialists in over 150 areas of specialty. It serves a population of about 6 million people residing in a 65,000 square mile area across Northern and Central California. Although the hospital itself was founded in 1852, it officially became the University of California, Davis Medical Center on July 1, 1978.

Front Entrance of the Main Hospital

The Experience
My elective at the Department of Neurological Surgery started on the 4th of January, 2010. I quickly adjusted to the long working days, with rounds starting at 6 AM. Most of my time was spent in the Operating Room, where I observed and assisted in a large number of neurosurgical cases ranging from ventriculo-peritoneal shunt insertion to intracranial tumor resection. I spent almost all my time with the residents, who taught me many surgical skills including the different suturing techniques, knot-tying etc. One patient that particularly interested me had developed a neuroma in his common peroneal nerve following a football injury, and presented with a foot drop. I had the chance to assist in the surgery to remove the neuroma, and was intrigued to know that many such patients often have a dramatic recovery following surgery.

I also took five 24-hour calls when I shadowed the residents on duty as they paid individual attention to the inpatients and attended to consults from the Emergency Room overnight. It allowed me to learn about the care of neurosurgical patients and to assist in bedside procedures including spinal catheterization and external ventricular drain placement.

I attended clinic once a week with Dr. Muizelaar, the Departmental Chair, at the UC Davis Spine Center. Here I learnt about the different problems that patients commonly present with to a neurosurgeon as an outpatient. Most of the patients I saw had neck and/or back pain caused by intervertebral disc bulge, but I did also come across some patients with intracranial tumors, aneurysms and patients with stroke who came for follow-up care.

Tuesdays were reserved as the Academic Day, when I attended various teaching conferences along with the residents at the Lawrence J. Ellison Ambulatory Care Center, popularly known as the A.C.C. Building. We also had the weekly Pre-Operative conferences, where the patients scheduled for surgery the following week were discussed and their treatment plans agreed upon by everyone as a team.

During my second month, I gave a 45 minute presentation on intraventricular tumors. In the process of preparing for it, I learned a lot about these tumors. I read up on the topic, and searched for online articles about the recent advances in their treatment. It gave me particular joy as this was a new topic for me, and I devoured everything I came to know about it. The presentation went well, and being appreciated for it gave me additional confidence.

Life Outside the Hospital
I didn’t need to look for accommodation in Sacramento, as I stayed with my sister and brother-in-law at their apartment, which was only 10 minutes away from the Med Center. Although I had hardly any time outside the hospital on weekdays during the rotation other than to eat and to sleep (sleep seemed to be a luxury at the time), I did get the chance to visit San Francisco, which is an hour and a half’s drive from Sacramento. After the vast open spaces in Sacramento, San Francisco, with its crowded streets and closely packed buildings, brought back vivid memories of Delhi. We went to Pier 39, which is one of the city’s many tourist attractions, and claimed to be the country’s third most popular. I also spent a weekend at Los Angeles, which is one of the most famous cities of the state, and home to the oldest and largest (revenue – wise) film making industry of the world – Hollywood.

Pier 39 at San Francisco

The People
The thing I like the most about the Medical Profession is that it allows one to meet people from different backgrounds, and with different personalities. My elective experience at UC Davis brought me face-to-face with many people, and I got my first real exposure to a whole new way of life. I am especially thankful to the residents, who were good and helpful all the way. I learned a lot from them, as each one of them patiently cleared my doubts and taught me many new things. The nurse practitioners also went out of their way to make me feel comfortable, and never let me feel like an outsider. Overall, everyone from the attendings to the nurses had their share in making my time at the Department a memory I will cherish for a long time.

The Advice
For students who wish to do an elective here, my advice is to maintain an attitude of sincerity and dedication. If you demonstrate a desire to learn, the residents and the attendings would be more than happy to teach you. Most international students wish to do an away rotation in the United States either to get a good letter of recommendation, or because they want to explore the possibility of taking up a Residency in that particular Program. In both cases, you would additionally need to show yourself in the best possible light. Remember that a clerkship is like an extended interview, which gives both the program and the student a chance to assess their mutual “fit”. Besides that, take the time out to unwind and visit the places nearby, explore the city and its surroundings, and make the most of your visit to this country.

The Conclusion
Looking back, I am glad I had this opportunity to do a rotation in the U.C.D.M.C., where I got a close look at life in Neurosurgery. As a career, this branch demands a lot of time, effort and dedication. And yet it seems, now more than ever, to be just the right choice for me.

Jesna Mathew is a final year medical Student at the University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi University, India
jesnasmathew(at)yahoo.com

Attending an Ivy League college is the dream of every student, and mine came true in January this year. After several emails to Danielle Pokorski-Klette, Director of Continuing Education of the Radiology Department at Harvard Medical School, I was permitted to attend the Continuing Medical Education program (CME) being conducted by the Ultrasound department at Brigham and Women’s Hospital. This was my first-ever international clinical experience.

Harvard Longwood Campus

The Rotation

My first day was pleasant. I reached the Ultrasound unit of Brigham and Women’s hospital on January 4th at 8.10 am. I was introduced to Dr. Mary Frates, the CME program co-director and she gave me a quick orientation of the place, the daily schedule and what I would get to do. It was a warm welcome. Later in the day, I met the program director Dr. Carol Benson. I also got to know the other attending radiologists, fellows, residents and staff technicians.

Initially, I was a little anxious – about the new environment and the senior professors I would be interacting with. All my apprehensions were wiped out of my mind on the first day itself. I was asked what aspects of Ultrasound imaging I was familiar with, what my goals were for this two week period and any specific area I was interested in. The program was going to be tailored to my needs.

My objectives for this program were to understand the practical aspects of ultrasound, observe as many scans as I could and interpret them. In the first week, I saw a wide spectrum of patients coming in for scans – patients from the endocrine clinic for thyroid biopsies, nephrology patients for kidney biopsies, pulmonology patients for a thoracocentesis marking, gastroenterology patients for abdominal scans, gynecology patients for fertility studies and pelvic scans. I really enjoyed observing the antenatal ultrasounds – watching the tiny heartbeat of a 10 week old fetus was truly amazing!

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Mount Sinai Medical Center is among America’s Best Hospitals. My observership was on General Surgery, Surgical Oncology and Endocrine Surgery. It lasted three weeks and took place in Manhattan and Astoria, Queens.

Mount Sinai Hospital

The program included seeing new patients or basic postoperative care at the doctor’s office, morbidity and mortality (M&M) conferences, surgical team lectures, ORs (gastrectomy, thyroidectomy, colectomy, laparoscopic cholecystectomy, laparoscopic appendectomy and so on) and other diagnostic procedures (such as colonoscopy, laparoscopy, ultrasound-guided FNA biopsy of the thyroid, DRE and so forth), therapeutic and research procedures (such as port-catheter placement, sebaceous cyst removal, hidradenitis suppurativa, soft tissue excision, etc). I had to be prepared before the procedures and surgeries so that I could understand them better. Selecting to observe a surgeon gives you the opportunity to develop a more personal approach with the physician and ask directly any question you may have and you will certainly get an answer.

I realized soon enough that the way of work in the United States is different than in my country, Greece. More specifically, doctors use expensive radiologic tests far more often due to the high technologies available. Of course, history taking and physical exam should always accompany labs and radiology films. All the data of the patients are recorded in the computer to facilitate better access to it. However, attention had to be paid in order to practice confidentiality and respect patients’ privacy, as it is explained in the HIPAA agreement.

Despite the good quality of training and medical education that you get, US hospitals are large enterprises having as a main goal the profit and as such, patients may be overshadowed in the game of competition between different institutions or due to the overload a resident endures. Even though personalized medicine is supposed to be the first priority of the healthcare providers, it kind of seemed as if patients were ‘collateral’!

New York, the city that never sleeps

Overall, my experience was quite good. I learnt a lot in medicine along with the way of living in the United States of America. However, you have to carefully choose the program, the hospital, the University, even the state you would like to go to, since there is something for anyone. If you are the kind of medical student who loves to act and make things happen, just like me, think twice before opting for an observership. Instead, go for a hands-on clinical elective, which will provide a more intense experience. Again, it is up to you to decide which program suits you best. Last but not least, bear in mind that you need to be cleared from the registrar’s office before you are ready to enter the hospital. That may take up to two to three days.

This elective report has been written by Gus Gasteratos, a medical student at the Aristotle University of Thessaloniki, Greece.
Kostas_gr_200(at)yahoo.com

Clinical Electives! Nine months ago when I first heard about them and started applying, I did not have the remotest idea of where it was going to lead me. The rush of adrenaline felt while applying, the palpitation experienced while opening the replies to my applications and the joy felt at being accepted, were all truly unbelievable feelings! Being accepted by Tufts University for a rotation in Gastroenterology at St Elizabeth’s, Boston was the start of an amazing journey that began several months ago. Having completed my rotation, I am now able to write a report describing my experiences.

The Hospital

Caritas St. Elizabeth’s Medical Centre is a community-based 317-bed tertiary care hospital located in the Brighton neighbourhood of Boston. St Elizabeth is a thoroughly modern inpatient and outpatient facility that is also a major teaching affiliate of Tufts University School of Medicine.

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Entry Into the USA

You realize how much you love your country when you are off to alien shores; I had the same realization when I landed on the Philadelphia International Airport. I had come for a 4 week elective rotation at the Rehabilitation Medicine department of Thomas Jefferson Medical College, Philadelphia. I was abroad for the first time in my life and was apprehensive about everything – the place I would be living, the hospital, not to mention the American accent. But the welcoming atmosphere at the hospital and the hospitality of the people of Philadelphia helped me feel at home; also it took me no time at all to get hold of the American English.

Another source of concern was the cost of living. As I am from India and that too from a very humble background, everything from food to housing seemed very expensive to me but then everyone seemed to be more than happy to help me find cheaper groceries or other stuff.

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Me and my attending hematologist – Rachel Rosovsky, M.D.

It was the 6th of September 2009 and I can precisely recall the moment of excitement at 9 in the morning when my inbox greeted me with the acceptance letter of Harvard Medical School. I had been scheduled for a one month externship rotation in Hematology department at the Massachusetts General Hospital, Boston under the HMS. The excitement only grew in the next few days with the visa interview, shopping and planning the trip. And I was finally, on the 23rd of September, heading for the US.

As I settled myself in a rented apartment in Boston, it was already time for the beginning of my rotation. My first day at Mass General was full of “Wow”s and “Oh my God”s. I stood there in the pleasant winter morning, looking at the some dozen buildings of MGH wondering which way to go. MGH is huge. After playing the ‘curious pedestrian ‘ for a long time, I finally reached the 7th floor Yawkey building – my abode for the next month. There I met a team of 1st and 2nd year fellows in Hematology. It was a warm welcome and I was given a workstation and an overview of the heme consult service that I was going to work on.

From the next day onwards it was an unbeatable schedule of getting up at 5 in the morning, dressing up and reaching the hospital at 6:50; attending 2 conferences back to back till 9; then shadowing the medicine teams at various floors till 12; attending the noon lunch conference at 12 and finally working on the heme consult patients that were assigned to me, sometimes till 9:30 in the evening. Honestly, it took me a few days to set myself into the system and workstyle at MGH as I was still in the hang of things back at my medical college in India. But even the long hours of work didn’t seem tiring because of the interesting work and amazing environment. Taking a detailed history, doing complete physical examination and then relating it all to the hematology questions required a lot of brainwork. The patient would then be discussed with the hematology attending and resident as a case presentation. It was such a responsible feeling that my note and workup plan would be put up in the patient chart with a small addendum from the attending. My interest in hematology grew several folds during patient discussions and reviewing blood slides and bone marrow aspirates. I also got a chance to observe and assist procedures like bone marrow biopsies.

Days passed by swiftly and I felt more comfortable and satisfied after each days work. There was so much to learn from MGH – the best patient care, the latest treatment protocols, a whole new face of research world, presentations and conferences… I could never learn more in such a short time. My own presentation on Myelodysplastic Syndromes was nerve-wracking but after it went well, I had acquired all the confidence I need for whenever I’ll need to prepare and give a talk.

Overall the entire month was a great experience. It taught me the essentials of the best patient care and the ‘American’ way of working. Apart from the letters of recommendations that one can get, the experience itself is worth having at least once. I shall forever remember and cherish the memories of – as my attending called it – the ‘DREAM HEME TEAM’ at the MGH.

Manav Sharma is an intern post graduate at the Institute of Medical Sciences in Rohtak, India.
manavsewak(at)yahoo.co.in

“I always wondered what place would be feasible (taking the cost of trip in to consideration) for me to do clinical electives in the US”

I am from a middle class family in India, so it was tough for me to decide to go for electives in USA (Being a forerunner in Global Health, I kept it as my top choice) considering the cost of living and the tuition fees for electives in various universities. But by God’s grace I got acceptance from SUNY Downstate Medical Center, New York. This institute doesn’t charge any tuition fee for electives. I got the opportunity to rotate in my dream specialty: Clinical Cardiology at King’s County Hospital Center (KCHC), Brooklyn, New York. This hospital is affiliated to SUNY Downstate Medical Center and provides patient care in all the basic and modern specialties of medicine. It comes under New York City Health and Hospitals Corporation (HHC), the municipal agency which runs New York City’s public hospitals.

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