Rotating in the UK

In response to my last post, AE wrote a compliment and asked a question. I started to answer it in the comments section, but it kept getting longer and longer, so in lieu of a real post, I thought I'd answer it here.

AE,

Thanks for the kind words! I'm not pleased with how my blogging has gone in the last few months, but c'est la vie.

You ask why the UK and not the US. I chose to do my third year in the UK for several reasons:

-I get to live for a year in Europe; travelling to other parts of Europe is easy and generally cheap, and London is one of the most exciting cities of the world to live in. Why not? I'm single and have no dependents. And I am borrowing so much money for med school that the cost of living in the UK really doesn't make that much of a difference.

-The culture of medical education in the UK is different from the US. Much less is required of medical students over here in terms of working hours and the amount of scut work. My job (this is made very clear by the vast majority of docs I work with) while in the hospital is to learn, not to help run the hospital. It's a subtle shift in emphasis, but has huge implications. The downside to this is that no one is checking up to make sure I show up and actually learn, so my own motivation and direction is much more important than it might be in the US. But I haven't found this to be a problem. As medical students, we are basically given the run of the hospital; if we want to head down to A&E and do H&Ps, we can, if we want to wander into theatre and watch surgery, we can, if we want to join a random consultant's clinic, we can, if we want to wander into radiology and review images with the docs there, we can. Basically, if we introduce ourselves to any doctor in the hospital and ask to observe and be taught, they will more often than not be happy to, regardless of whether we are assigned to that doctor or specialty. The choice is actually a bit daunting sometimes. And this is in addition to the schedules we are given for the particular rotations we are on, which always have a fair bit of down time scheduled into them.

-Medical education in the UK seems much more humane than in the US. While docs ask questions and use the Socratic method to teach, I have not come across a single one who was interested in pimping because they have a small penis for humiliation's sake. I haven't seen the sort of bullying and hazing behaviours that my colleagues in the US describe that seem designed to put the medical student in their place. And while I've encountered grumpy docs whose bad moods influenced the clinic or OR they were working in, I can genuinely say that none of their ire was directed at me. Most of the doctors I have worked with, from first year F1s to senior consultants have been pleasant and happy to teach.

-As a Canadian, I was interested in observing how the NHS works, because in general the Canadian system and the British system are more similar than the Canadian and US ones.

These were my reasons in making the decision. I have to say that one reason I chose my particular Caribbean school was because they offered the opportunity to rotate in the UK. It was a decision I was seriously considering before starting school.

Now that I'm here, my decision has been confirmed. I think the UK is an excellent place to be as a med student. There are a few things I wasn't expecting:

-The docs that came over from the UK while we were still on the island to promote their rotations talked a lot about how much med students in the UK get to do. And for the most part that's true, but what med students get to do in the UK is very different from the US. Here, med students get to do a lot of procedures: i.e. taking bloods, inserting IV cannulas, taking ABG's, inserting urinary catheters, etc. We are expected to become proficient at these sorts of tasks (which are done mostly by nurses in the US) by the time we are finished. We also get to scrub in for surgery. I now have several first assists in my log book, which is pretty cool and (in my understanding) not that common in the US.

-One major different from the US is that we are not assigned particular patients to follow while we are with a particular firm. So if we do a H&P on a patient and present them, that does not mean that we have assumed responsibility for that patient.

-There is also a lot of observation. We spend a lot of time observing ward rounds and clinics as opposed to actually doing them, which works for me, because I am a fairly strong visual learner. So while we get to do some things that US students do not, there are some things that we generally observe instead of practice.

-While it is interesting to see how the NHS works (and it generally works quite well for the average patient), there are some deep-seated problems in the administrative culture of the NHS that make it a very unattractive place to work. I would not want to be a doctor here in the UK. Mostly because given the top-down and politically driven way the NHS is run, health care professionals in the UK face an almost daily erosion of their professional autonomy.

I am enjoying this experience, and am grateful for the opportunity to see different health-care systems in action. By the time I graduate, I will have seen how the UK, US, and Canadian systems work. It will be interesting to me to see the strengths and weaknesses of all three, and, IMO, knowing that there are many different ways to arrive at the same result will make me a better, more flexible, and creative physician.

I'm actually not looking forward to heading back to North America for my fourth year. I have enjoyed being treated like a valuable member of the team whose job is to learn why the rest of the team is doing what they are doing. I am not happy about getting back home and being treated like a moron and/or slave labour. Hopefully it won't be as bad as the horror stories I have heard!