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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In May 2009, I travelled to New York City for my elective placement in maternal-fetal medicine. I chose this subject as in my obstetrics rotation at medical school I found it to be a speciality that was really hands on and extremely diverse. This elective was a chance to experience care in a first world country, where new techniques and procedures that are not yet in current practice in the UK are tested and to see how healthcare systems differ in their patient care. I would also be exposed to issues such as abortion, domestic violence and STI’s, which are all commonly encountered areas of practice in the UK.

My elective was organised as part of an exchange programme with Columbia University, College of Physicians and Surgeons. Columbia is the oldest institution of higher education in the state of New York and is a member of the Ivy League. Its main campus lies in the Morningside Heights neighbourhood of Manhattan.

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As we all know, the United States has been on the forefront of global health, and it was my desire to witness health care in such a setting. So in my final year of medicine I decided to pursue my electives there.

The Hospital

Kings County Hospital Center (KCHC) is located in Brooklyn, New York and was founded 175 years ago. Over the decades, Kings County has claimed many “firsts” in the field of medicine: it was the site of the first open-heart surgery performed in New York State; Kings County physicians invented the world’s first haemodialysis machine, conducted the first studies of HIV infection in women and produced the first human images using magnetic resonance imaging (MRI). In addition, Kings County has the world-renowned first Level 1 Trauma Center in the U.S.

Today, with over 627 beds, the hospital provides a wide range of health services, and specialties are offered in all fields of modern medicine. More than 200 clinics provide a wide array of ambulatory care services. An affiliation between Kings County Hospital Center and SUNY-Downstate Medical School has enhances the clinical, as well as the academic activities of both institutions.

Shaukat (left) outside Kings County Hospital

Speciality: Internal medicine (Gastroenterology)

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I forget exactly when this observership started growing on me. Maybe it was day 1 at the Beth Israel Deaconess Medical Center (BIDMC) or even the days before spent in nervous excitement about what to expect and wondering what would be expected of me.

BIDMC is a world in itself. Rightly known as the “Harvard with a heart”, it stretches across Brookline Avenue in Boston from East to West campuses with satellite buildings dotting the avenue. I took to it immediately on day 1 of my observership in Hematology-Oncology in July 2009. I was scheduled to be with the Consult Service for a month and my mind was already racing with a million things I wanted to do.

Dr. Reed E. Drews, Program Director of Hematology-Oncology, is a very distinguished hematologist-oncologist who is highly acclaimed by students and peers alike. I had googled him before coming to BIDMC and had read his superlative profile and numerous articles he had authored in journals. The prospect of interacting with him and his team was exciting as well as slightly unnerving.

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I was born and brought up in a doctor’s family, so the medical profession has appealed to me the most and I grew up with a staunch desire to become a doctor.Upon entering medical school, regular visits to the wards deepened my interest in the field and I became more inquisitive. Eliciting history, performing physical examination, making a differential diagnosis and recommending treatment options reinforced my conviction. I aimed to learn more and make a difference. The United States has been on the forefront of global health. I desired to witness health care in such a setting. So, during my final year of medicine, I decided to pursue my electives there.

I did a one month rotation in February 2009 at the Neonatal Intensive Care Unit (NICU) in the Brigham’s and Women’s hospital in Boston. It was a very enriching experience. Upon my arrival in Boston, I was welcomed by heavy snowfall. However, once I reached my room, the view from the window looked pristine and captivating, but I went to bed early to kick start my first day at the hospital.

The entrance to the Newborn Medicine Department

I woke up, got ready and reached the hospital at 8 in the morning. What struck me first was its immaculate and uncluttered appearance. On reaching the contact person I was allotted an ID badge and was introduced to the team at NICU. I was not very familiar with the working there as the pattern was little different from that in India, so I decided to observe the work on the first day. The house staff and the nursing staff were very helpful and generous in helping me comprehend the system. As I had studied in an English medium school from the beginning and the medium of instruction in my medical school was also English, language was not a barrier and I got used to the electronic records system pretty easily. I was assigned one patient on the second day. It was a 27 week baby girl admitted to the NICU for prematurity, respiratory distress and feeding immaturity. The baby was intubated to administer surfactant before she was two hours old. It was the first time I witnessed endotracheal intubation on a 27 week baby weighing less than 800 grams. I was mesmerized.

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Institute attended: The Henry I. Goldberg Radiology Learning Center for Advanced Imaging Education, University of California, San Francisco

Visited Hospital / Institution’s Description: UCSF Medical Center is one highest ranked hospitals in USA and a leader in medical innovations which have improved and saved lives. UCSF Children’s Hospital is equipped with more than 150 specialists in more than 40 different areas of medicine. It has programs designed specifically for young patients, including a 50-bed neonatal intensive care nursery, recreational therapy for recovering kids and 60 outreach clinics throughout Northern California.

Specialty Attended: Pediatric Radiology (140.19 Advanced Clinical Clerkship)

Typical Tasks: Students are usually required to reach the school at 9am and then work in the pediatric radiology reading room with the residents, fellows and attending on duty. They are taught how to read X-Rays, CT, MRI and USG using the Picture Archiving and Communications System (PACS). Students also accompany the mentors when they go for fluoroscopy or CT where they are encouraged to assist them. They work till 5pm daily through out the week. Students are to prepare and present presentations to the attending. At times they are also allowed to participate in some ongoing research project depending upon the individual capabilities and rapport with the mentors.

What I learnt from My Experience: The experience I acquired from UCSF was incredible. I was introduced with the latest technology now being used for radiological examinations and briefed on how to use it. One of the attendings (Dr. Charles A. Gooding) taught me how to read X-Rays, CT and MRI while another (Dr. Heike Daldrup – Link) allowed me to participate in the ongoing research project. She also taught me using various presentations of actual radiologic findings using her laptop. In short, it was a wonderful experience that brought about a significant change in my approach towards medical education.

Social Life: Social life in San, Francisco is awesome. I had no problem regarding residence, meals, trips etc. My landlord was a very honest and nice person so I had no problems where I lived. There are many Pakistani restaurants in San, Francisco so I was able to enjoy my favourite meals there. It is a place which is extremely magnetic, especially for tourists, so I spent my weekends visiting the city. Even though I stayed for more than a month I still missed many places worth seeing.

Elective Evaluation: This elective is particularly useful for all those who are interested in choosing radiology as a career but even those who are interested in some other specialty will learn a lot about their specialty and acquire a great deal of experience to further their education and skills.

Advice for Others: I recommend all the international medical graduates to go for this elective. Although the number of seats available is limited and only the radiology department accepts international students, it is one of the best places with best faculty and hospitable staffs as far as IMGs are concerned.

General Comments: Although I went to San Francisco for the purpose of doing elective, this is not all that you should expect because along with an elective in the world’s best ranked medical school, you also get a chance to visit one of the world’s most beautiful cities. San Francisco is adorned with beautiful beaches, the historic Golden Gate Bridge, cable cars, Coit Tower, Lombard Street, Fisherman’s Wharf and Golden Gate Park to name only a few. I would also like to mention the names of the staff that really helped during my elective, particularly Randy E. Ortega, Bernie Baccay and Nina Felizardo.

Mohsin Ullah is a final year MBBS student at Allama Iqbal Medical College in Lahore, Pakistan
mohsinzia16(at)hotmail.com

Country of Exchange: United States

State / City of Exchange: New York / Brooklyn. (Photo 1). New York City is one of the World’s biggest cities. Built upon its long history of immigration, it is an amalgam of thousands of people representing many different nations and cultures.

Photo 1: The Brooklyn Bridge and Manhattan skyline at night

Institution Attended: SUNY Downstate Medical Center, a tertiary care hospital. Opened in 1966, the University Hospital of Brooklyn is an 8 story, 376-bed facility in central Brooklyn. This hospital has 8 intensive care and step-down units, 12 operating rooms, an emergency services department, and a diagnostic and ambulatory surgery facility, an ambulatory care center with some 75 clinics, plus 3 satellite Health Centers and a nearby Dialysis Center. It is probably the only public hospital serving around 5 million people living in Brooklyn. (Photo 2)

Photo 2: The SUNY Downstate Medical Center

Period of Exchange: 1 month (March 30 – April 24, 2009)

Specialty: Internal Medicine (Electrolyte Disorders)

Typical Tasks: This elective was mainly focused on interactive sessions with two most competent faculty members of SUNY Downstate. Daily study period was divided into two interactive sessions. First session from 10:00 – 12:00 and the second session from 13:00 – 15:00. Students were given senarios and encouraged to discuss them among themselves and then come up with solutions. The problems were then discussed in detail with the mentor who provided full background knowledge and made sure that every participant understood the basic mechanisms involved. At times our tutor would play games with us. At the end of rotation, every student was evaluated on the basis of his/her overall performance. (Photo 3)

Photo 3: Mohsin and Doctor Carroll

Language Difficulties: As the medium of instruction in my home school is English, I did not come across any such issue. Although there was some hesitation in the very beginning, within a week everything was on track.

What I Learned from My Experience: I really got to know about the healthcare system in US. The most important factor was my exposure to a variety of advanced techniques used there for the evaluation of patients. I learned and experienced for myself that active learning is the best form of learning, which really boosted my confidence to participate actively in the ongoing discussions. Furthermore, a detailed command on electrolyte disorders and role of making calculations was a valuable addition to my existing knowledge. It really boosted my interest in the field of nephrology.

Social Life: On-campus housing is available in SUNY Downstate so accommodation isn’t a big issue. It’s therefore one of the very few universities which does offer these facilities The transport system of New York has a very well developed network of subway trains. You just don’t need your personal transport., especially since public transport is faster because of the heavy traffic on the roads. The people are very friendly and helpful. Some of the fellow students took me to Atlantic City in the neighboring state of New Jersey. (Photo 4)

Photo 4: A visit to Atlantic City

Advice for Others: Form a rapport with your mentor so that you will be able to secure a good letter of recommendation at the end of your elective because that letter really matters, especially when you are planning your post-graduation from USA. Contact the residential department before your arrival through email to make a reservation for yourself. Come on the registration day to complete your official documentation and OSHA training. Bring your passport with a valid visa because that needs to be copied and placed in university records. As the weather in New York is relatively cold, bring your winter clothes with you, especially the students from south Asia. I strongly recommend the international medical students to go for this elective.

General Comments: I know international students come here for getting US clinical experience but I would advise you to make sure that you spare time to explore New York.

Mohsin Ullah is a final year MBBS student at Allama Iqbal Medical College in Lahore, Pakistan
mohsinzia16@hotmail.com

This is a question that many foreign medical students including myself and my friends, asked ourselves when we were scheduling our electives rotations in US last year. Everyone had different opinions, especially depending upon their specialty of choice, but then we used to think ‘is there any electives rotation which can be declared the “best” and “must” for all the specialties?‘. I found the answer to my question this March when I came to UCSF for my radiology rotation. It was one of the best experiences of my life; I don’t think it could have been better.

First let me tell you about the UCSF Medical Centre, Parnassus Centre. It is a 600 bed tertiary care teaching hospital affiliated with University of California, San Francisco (UCSF), has almost all the specialties of medicine and was declared as 7th best US hospital of 2007 by the US News & World report and the best hospital in bay area. UCSF Medical Centre has been in the top 10 rankings consecutively for the past 8 years. Moreover out of 16 various specialties, UCSF ranked in the top 10 position of the 8 various specialties including endocrinology, neurology and neurosurgery, gynecology, urology, cancer, respiratory disorders, rheumatology and ophthalmology in 2007.

UCSF Medical Center is recognized throughout the world as a leading academic hospital that provides innovative treatments, uses advanced technology, fosters collaboration among clinicians and scientists, and employs a highly compassionate team of doctors, nurses and staff. As far as UCSF medical school is concerned, it is the only US medical school to be ranked in the top 5 positions in both research and primary care rankings in 2008 among all the other US medical schools. According to the official NIH Rankings of 2005, it is the 3rd best medical school in US.

I worked in the Radiology Department of UCSF Medical School which ranked as one of the top 10 US Radiology Departments according to NIH Awards of 2005. I had the 140.03 Diagnostic Radiology Elective; most of our teaching was done in The Henry I. Goldberg Radiology Learning Center for Advanced Imaging Education in UCSF.

Each morning by around 9 am, we had small group lectures, seminars and case demonstrations by the radiology faculty. Over the 4 weeks, we covered the full spectrum of diagnostic radiology, including sessions on nuclear medicine, neuro-radiology, interventional radiology, introduction to body imaging, chest and musculoskeletal radiology and true hands-on ultrasound demonstrations.

This exposure to basic and advanced imaging and image interpretation is supplemented by some wonderful self-instructional cases especially by Dr. McCowin in all the major areas of imaging. These teaching case files are available all days, evenings, and weekends. Radiographs from the PACS are used to practice skills in acute care imaging. Moreover each student rotates on evening “night-call” with radiology residents; I had a wonderful experience on these calls and it is a great experience of learning the true practical aspect of not only imaging and radiology but also many related specialties. Moreover it provides us with a chance to share the responsibilities of residents and then in the morning, we share our call experiences under the supervision of a resident, with the other students using the PACS.

We had small group lectures, seminars and case demonstrations daily by the UCSF radiology faculty on various sections of diagnostic radiology like nuclear medicine, neuron-radiology, interventional radiology, chest and musculoskeletal radiology. Most of them were exceptionally well-oriented lectures and interesting case demonstrations especially those by Dr. Breiman, the course director. The 3D Stereoscopic Imaging demonstration by Dr. Breiman will make you apreciate how far UCSF radiology department has progressed.

There is a also a true hands-on ultrasound and Doppler demonstration where you yourself perform the ultrasounds of other students. Then the self-instructional cases and presentations by Dr. McCowin is a wonderful learning experience. She is the best and most dedicated teacher one could ever come across; she would make you see hundreds of things in the X-Rays, CT- Scans, MRIs and Ultrasounds without even giving any formal lecture. Actually, the interactive and self-instructional modules are so beautifully designed by Dr. McCowin that you don’t even feel like you are learning and she is teaching, but you remember everything. Moreover, handouts are given out as the study material in addition to the extensive online material. In short, the resources and staff create an intense, productive learning environment and the phenomenal lecturers make learning interactive and memorable.

Each student is assigned to make a Powerpoint presentation on the last day of the elective regarding any medical topic of their choice with some interesting pictures of themselves and their area. It is indeed a very pleasant experience. At the end, the students are given a Pass/Fail according to their presentations and their learning experience in the past 4 weeks. There is also a small celebration: a pizza party over lunch on the last day of elective to provide a memorable ending to a beautiful learning experience.

I would give special credit to the course director Dr. Breiman on designing such a wonderful elective course for all the UCSF and visiting medical students. I would call it a “learning treat” as it does not feel like learning; by the end of the electives, you would realize that you had great fun and you also learned a lot. I consider myself incredibly lucky to have been taught by these radiology professors as they have been the finest and most dedicated group I have ever encountered.

As this is a clinical elective in Radiology, there was not much patient interaction. As far as any language difficulties are concerned, if you know English well, you would not have any problem interacting with staff and other students. However, even if you don’t know how to speak good English, you need not worry. I would recommend interacting more and more with the staff and other students, they all are very helpful, co-operative and understanding, you would not feel like being a visiting medical student.

I very strongly believe that you learn a lot during these few weeks in the very intelligently designed 140.03 elective by Dr. Breiman in UCSF/Henry Goldberg Center for Advanced Imaging Education. Irrespective of whatever field you plan to go in, the UCSF people teach you in such a great manner that you acquire a vast knowledge of your specialty, whether it it be medicine, surgery, pediatrics, orthopedics or even anesthesia. It seems that they have something for everyone. The best part is most of the instructors would ask your specialty of choice before your lectures and note it down and then teach and question you accordingly. So at the end, you don’t feel like you have studied only radiology but you feel like you have acquired an immense amount of knowledge in the field of your choice probably because they discuss in detail every aspect of the radiological findings including anatomy, physiology, pharmacology, pathology, medicine and surgery; this way everything is revised in a very systematic manner and much of it is retained, with reference to the radiological image you see. I wish I could have learned what I did here before. I am jealous of the UCSF medical students, because they have always had this quality of instruction.

UCSF staff and students are very nice, helpful, understanding and co-operative; they would do whatever they can to make your stay a memorable experience. So you have a great time in UCSF. Moreover you find a chance to meet new people from various parts of the world, so it’s a rich and interesting cultural exchange program.

The same holds true for San Francisco; you would find people from every part of the world, along with food and grocery stores from all ethnic groups. You would meet many new people and learn many new interesting things. In general, people in San Francisco are very co-operative, helpful and easy-going. Moreover, San Francisco is well known for its awesome weather, beautiful scenery and bay area; it’s a hilly area with steep roads and a beautiful ocean, it’s a great place to be and one of the biggest tourist spots in the world! You would definitely have a great time here! However, as UCSF does not provide any accommodation to visiting medical students itself and San Francisco is somewhat more expensive as compared to other US cities, so you might face some problems in finding accommodation. Traveling is much cheaper in San Francisco than most of the other US cities as they have a really nice public transport system e.g. Judah, MUNI, BART etc.

If you are interested in getting radiology elective in UCSF, then it has the most convenient application process among all the US medical schools. They reserve a spot for you on your request via email and then you have to send the fees with the application form but keep in mind UCSF accepts foreign medical students only in Radiology and Anesthesia departments so you cannot apply for elective in any other UCSF department.

Before starting the elective it is better if you revise some of the basic anatomy, specially the relations of structures in mediastinum and abdomen. Moreover, try to go through the Rad100 Syllabus (accessible on the UCSF Radiology department website after acceptance) before the start of your elective.

UCSF is one of the best medical schools in the US and the Henry I. Goldberg Radiology Learning Center is the best learning center for radiology in the whole world according to me. I would very strongly recommend this elective to everyone irrespective of whatever specialty you plan to go in; you would definitely learn a lot related to your specialty. I had a wonderful experience in UCSF and found an answer for my question, “Which is the best place for electives in US!”… it could not have been better in any way….it was simply the best experience and I very strongly recommend it to everyone.

Umar Tariq is a final year medical student at King Edward Medical University, Lahore, Pakistan.
umartariq58@yahoo.com

Lucia Anthonypillai, a student in London, went to Massachusetts for her elective and shares her experiences here.

Lucia at MGH – photograph courtesy of the author.

Massachusetts General Hospital (MGH) is the largest teaching hospital of Harvard Medical School, located in the heart of Boston. The opportunity to do my elective in such a world renowned hospital was very exciting. Patients traveled from as far as Barbados to attend the clinics, providing me with the experience to see a variety of diseases.

The diseases that I saw frequently in MGH are also the common ones encountered in the UK. These include short stature, pubertal related disorders, diabetes mellitus and obesity/metabolic syndrome. The causes for these various diseases were diverse. For example, the different causes of children with short stature observed in the clinics, included chronic renal disease, Prader-Willi Syndrome, Growth Hormone Deficiency and Noonan Syndrome. The decision to use Growth Hormone to treat the short stature was dependent on the cause, which also dictates the dose of growth hormone used. For example, a higher dose of growth hormone was required for patients with Noonan and Turner Syndrome compared to the amount required for Growth Hormone Deficiency. Children with other causes of short stature, such as, idiopathic, familial or delayed puberty were not in general treated with growth hormone.

While attending the clinics at MGH, I was fortunate enough to encounter a number of syndromes that are related to endocrinology diseases, such as Turner Syndrome, Klinefelter’s Syndrome, Noonan Syndrome, Sotos Syndrome and Prader-Willi Syndrome. The paediatric endocrinologists also played a part in the management of children with non endocrinology related diseases. The family of a child with Duchene Muscular dystrophy required education and follow up about steroids by the endocrinologists. As you can see, within this very specialised rotation I encountered a wide range of diseases.

In the clinics, prior to meeting the patients, I was informed about each of the patients presenting complaint, past medical history and was then able to observe the appropriate management. Each patient’s management plan was tailored according to the condition and their specific needs. I observed the various techniques used to attain the trust of both the children and their parents in order to obtain a detailed history and perform a thorough examination. A number of patients were also seen on the wards, including those with recurrent Cushing’s disease, Diabetes Ketoacidosis, Congenital Adrenal Hyperplasia, Addisons Disease and adrenal insufficiency secondary to steroid treatment in a neonate with Downs Syndrome.

This elective was a great experience as I was able to observe several different diseases and the numerous clinical signs associated with them. Every week ‘Case Studies’ were also presented, all of which were informative and interesting. One of the most fascinating cases concerned a young pregnant woman whom had been shot and then suffered Sheehans Syndrome (infarction of the pituitary). I also had the opportunity to attend the Clinical Endocrinology Conference held by Harvard University, which was attended by Endocrinologists from around the world. This conference discussed the management of various endocrinology diseases, presenting the latest studies and discussing them all in depth.

A factor, which students often forget, that influences the management of patients is how the patients’ medical care is funded. In the United Kingdom, the healthcare is provided by the National Health Service, an organisation that is publicly funded. In the USA, healthcare is covered by several different legal entities. The medical insurance a patient has can affect the choices of investigations and management, which are often limited. The medical insurance can also influence the choice of which hospital the patient is to be followed up in. Some patients may not have any health insurance. In the United Kingdom, the main factors which influence the choice of investigations and treatment given are clinical indication and cost.

In comparison to my experience at St Bart’s; The London University, I discovered the strong emphasis that Harvard Medical School puts on research. The management of all the patients were always influenced by the latest clinical studies. After the consultation with the patient, the doctor would report his findings to the consultant. The management would be discussed in detail, often referring to the new studies. When then explaining the treatment to parents, clinical studies were used as a tool to explain the choice of treatment. This is something that I do not see often and think is very impressive. I hope to take this approach in the management of patients and implement it in the future as a doctor.

Lucia Anthonypillai.
5th year medical student, Barts and The London School of Medicine and Dentistry, UK.
lucia_ant85@hotmail.com