TSR Med Students' Society Part III

That's the beauty of SSMs/electives really, it opens your eyes to how medicine is done differently across the world. For good or for bad, it definitely is interesting.

Well after three years, that's it really. Your a consultant in GIM effectively. You can work as you like: set up a clinic, as an internist...work in a hospital as a hospitalist...work part time, do as much or as little as you want, do a fellowship to subspecialise etc.

I think a lot of the reduced training time is based on the structured postgraduate training. It really is excellent in that regard. If you look at foundation years, they are pretty crappy in terms of training. They are essentially service jobs. Yes, we may have useless assessments like CBDs and mini-CEX but they just seem assessments for the sake of doing assessments.

Thinking about elective now - I'm tossing between Australia where it'll be like here but different caseload/patients (i.e. can still do things like cannulating/assisting in surgery etc) or being in the US where it's an observership.

Thanks for your post digitalis - really very interesting and one of the better posts in a while . *reps*

So presumably they're working with a far higher number of doctors per patient if they can offer more training and less pure service provision?

How hard was it to organise? I need to start thinking about elective in the next few months and I'm limiting myself to developed world and English speaking, so it's fairly high on my options list.

Thinking about elective now - I'm tossing between Australia where it'll be like here but different caseload/patients (i.e. can still do things like cannulating/assisting in surgery etc) or being in the US where it's an observership.

Thanks for your post digitalis - really very interesting and one of the better posts in a while . *reps*

What about Canada? Or is that pretty much just like the US? I think Aus is probably top of my list at the moment. Any idea what kind of thing you want to do?

V similar, but lot less unis who are in high demand. U of Toronto has a two week application window per half year per year. Need to apply like 6/12 in advance and pay a like 250 pound private medical to go (put me off going to do mine there)

I've heard of some places charging admin fees and tuition costs - is that a widespread thing or is travel/accom still the overriding cost factor?

Thanks for all this insight, btw, I've still got a while before I need to get things actually planned but it's good to get all this info ahead of time

Yes, it is pretty institution dependant but you generally have to pay some form of fee. I did see places that don't charge though.

How are you finding the lifestyle aspect of living and working in the US? Do you even have time to do anything other than work and sleep?

I had a week off before I started, which was great. Americans are very friendly, I think the accent helps a lot. The whole lifestyle/culture shock was massive at first, I was literally wandering around completely lost. You would think some things are same since we speak the same language etc, but it is really very different. Like even in the supermarkets, I recognise NOTHING. Bizarre! Big car culture, big consumer culture: consumer is king here, they really do hold the power.

I have managed to go out a few times after 'work', went out yesterday with the team which was really fun, really nice rooftop bar. Also made it out to go sightseeing one evening, but bailed at half eight as I was tired. Usually in bed by 10ish. Old man!!

'Doctors are like diamonds. The more you reflect, the more you shine'

Quote from our very first reflective writing lecture hehe.

Digitalis you are making me so tempted to go to America, your experience sounds amazing!!

It's a great experience, but I think I'm getting a lot out of it as I quite want to do a residency, so I am constantly comparing systems and thinking 'is this something I want to do?'

You really have to be on the ball here, medical school is like med school on crack back home. The MS3s are extremely knowledgeable and the MS4s as I have mentioned, are treated as interns.

You do have to assess what you want to get out of your elective too. If you want a beach holiday, that's perfectly acceptable but I think doing a sub-I elective in the US is really not for:
a.) slackers
b.) those who want to sightsee/do beachtime/go in for a wardround and get signed off and go home

Another tip is to make sure you are comfortable doing full admissions at speed, i.e. clerking in fresh admits, ordering investigations etc and presenting patients fluently. Pre rounding (consisting of getting to the patient usually on different floors and wings so factor walk time, talking to the nurse, talking to the pt and examining them, looking up overnight investigations, imaging and consults, making a problem based assessment and plan and writing this up) should take no more than 20 minutes if you value your sleep.

It would also be beneficial in doing telephone referrals a few times. You will of course be helped out if you need it, but you will have an easier time and be more useful if you are comfortable with this before (I learnt the hard way!) Updating lists as well.

Try and understand US units as well, things like creatinine, glucose are different.
Learn shorthand for writing bloods (these are excellent and it would be great if they became common back home, they are known as 'fishbones')

Learn the significance of 'rarer' investigations that are common here, Mg, PO4, Ca,Urine electrolytes, serum and urine osms are ones that I have had to get my head around.

I wish I could rep you again, great advice! I am becoming even more tempted, I really don't want a slacker elective. I want to get as much out of it as possible. I've heard so much about how tough it is in the US I like the idea of trying it out for myself. Hmmm, maybe I could get a loan...

I hope you enjoy the rest of it and it doesn't wear you out too much. Has it changed your thoughts on doing a residency?

Slighty random question but does anyone know anyone who has done/is/considering becoming a ships doctor this is something that has interested me for some time and I think it is time to start looking more into it.

As in a doctor who works on a ship. Those floaty things in the sea

As in the navy - isnt that a submarine?
I had to double read that because I thought you said a floater in the sea!

You know what's easier than medicine?

Sleeping.

You know what I prefer doing than going to medicine lectures?

Sleeping.

You know what kind of learning is not problem-based?

Sleeping.

Thus, I have concluded that I shall now transfer, and take a vocational degree in sleeping. And then become asleep(er).

If only.