European Option Report Hôpital Pitié-Salpêtrière. Université Pierre et Marie Curie, Paris 6

Transcription

1 European Option Report 2014 Hôpital Pitié-Salpêtrière Université Pierre et Marie Curie, Paris 6

2 Contenu Why I chose the European Studies option... 3 Getting set up in Paris... 3 Finding accommodation... 4 How I funded myself... 4 About the Pitie-Salpetriere... 5 On the ward... 5 Medical education in France... 6 Differences between UK and French healthcare provision... 6 Healthcare culture in France... 7 Speaking French... 7 Life in Paris... 8 Practical advice for future students... 8

3 Why I chose the European Studies option I really enjoyed learning French at school, so when I decided to apply to do medicine at university I was a little sad to be giving up languages. When I found out that Manchester offered the European Option course it felt like the perfect combination. I put Manchester as my first choice for that reason; I don't know of any other universities which offer a similar programme. There are lots of reasons to take European Option. It's nice to keep up language skills, especially at a time when the assumption is often that English speakers don't speak anything else. French lessons provided something different to medicine every week which gave a nice balance to studying. Lessons were often quite relaxed, and an opportunity to meet people with similar interests. I was also tempted by the opportunities to do SSCs abroad. I did one of my third year SSCs in Paris with a community paediatrician, which I loved, and made me more keen to return to Paris in my fifth year. Though I didn't particularly think about it when I applied to do European Option, the qualifications available are hugely valuable. French is spoken widely throughout the world, and an internationally recognised diploma in professional French will be respected by many employers. I don't think the European Option added too great a burden to studying. It involved an extra two hours of classes per week for the first four years of the degree. These were held as evening classes in years three and four. I think the hardest bit for me was preparing for the DALF at the same time as for fourth year exams. The prospect of the four month placement in fifth year was exciting and something to look forward to throughout the degree. More than anything, and despite my complaints at 6pm on Monday nights, studying French is fun. Getting set up in Paris Before arriving here I had read (mosty in previous students' reports) of the "famous French bureaucracy"; I prepared myself for a lot of paperwork. In the end, the Erasmus coordinator at the medical school was on leave during my first week in Paris, and was herself replacing the permanent coordinator who was on maternity leave. The result was that I had not been contacted about my placement before arriving in Paris, and there was nobody there to insist upon all this paperwork when I turned up. This was all sorted out a week later, but the delay wasn't a problem; I started on the ward on the Thursday, with none of the paperwork, but was given a whitecoat nonetheless! The documents you need to bring with you are: your passport, European Health Insurance Card, proof of professional insurance (e.g. from the MDU), proof of civil liability insurance (this is provided by Manchester, but you will need to show a copy of the policy - I found this online), some passport photos, your vaccination history, and a letter stating that you are a currently enrolled student in your final year of medicine.

4 I didn't set up a bank account in France, as my accommodation set up (see below) meant that I couldn't really get proof of my address. If you're going to rely on the buses or metro for more than one or two journeys a day, it is well worth getting a Navigo pass. A monthly pass costs 67, which you load onto a card (something else you need a passport photo for) every month. The passes run from the 1st of each month, so you won't be able to use them at the beginning or the end of the placement. The Navigo is 'dezoned' on weekends, so a pass that covers zones 1 and 2 (all of central Paris) will take you quite a long way on the RER on weekends, e.g. to Versailles, for no extra cost. Finding accommodation This was a challenge! The Erasmus coordinator at UPMC was on maternity leave throughout my fifth year, so I wasn't contacted about the placement or given any advice until very late in the day, when the Manchester Erasmus office chased it up. As a result, I applied for accommodation at the Cite Universitaire very late, and was turned down. Likewise, there were no available rooms in other university halls in Paris. UPMC has an allotted number of rooms in various halls of residence, and it is worth applying reasonably early if you want to get into one of these. I looked with a friend for a flat to rent in the private sector which was also quite difficult; French property websites are mostly unsorted listings, short term lets are rare, and after an advert which offered to "help people into the country quietly" we grew wary. In the end we jointly rented a flat through Airbnb. Paris is a very expensive city to live in, and the flat we shared was lovely but very small - this is an option for good friends only. The flat I lived in was in the 10th arrondissement, on the Bassin de la Villette, near the Canal Saint Martin. We had chosen it as a compromise between price and being wellconnected by metro to some hospitals we thought we might be placed at. Though I knew nothing about the area in advance, I'm really glad it's where I ended up. The canal is a lovely area, with lots of nice (and relatively cheap) bars, a couple of cinemas, and even a theatre on a barge. It's about 30 minutes by metro to the Pitie-Salpetriere. How I funded myself I was very fortunate to be able to rely on my family for support. I didn't qualify for a student loan this year, so had been living off savings from previous summer jobs. The Erasmus grant was about 900 initially, and will be topped up by around 300 later in the summer. The second installment was due in April, but administrative problems at the central office means that it will not be paid until after the placement is over. The grant goes a long way to living costs, but cannot fully cover rent. There are other funding possibilities, including the CAF (caisses d'allocations familiales), a form of benefit, available. The CAF is only available to be paid into a French bank account, so was something I didn't do. It might be worth looking into before heading to France.

5 About the Pitie-Salpetriere The Pitie-Salpetriere has an exciting history (former gunpowder factory, prison for prostitutes, insane asylum, site of a massacre, and home to lots of rats), the majority of which is thankfully no longer readily apparent. It was also the workplace of Charcot, Babinski and Freud. It is a huge teaching hospital with several specialist centres, meaning that it takes some of Paris's most complex patients. On the ward The hierarchy of doctors and students on the ward is different to that in the NHS. Medical students are called externes, and are present on the wards every morning from third year, with some placements earlier in their training. After graduating they become internes, who are roughly the equivalent of junior doctors. Internes specialise immediately after leaving university, and are allocated a location and specialty dependent on their performance in a hugely competitive national 'concours' where they are ranked amongst all other graduates in the country. Externes have more responsibility than the average UK medical student. I did two eight week placements, the first in infectious diseases and the second in cardiology. Infectious Diseases The infectious diseases ward received a range of patients, from relatively well short stay patients with pyrexia of unknown origin, to long term patients with multi- and ultra- drug resistant tuberculosis. I saw a lot of patients with infections on top of HIV. I was given a week to settle into the ward, which I spent seeing patients with another externe and following ward rounds. After that I was given a couple of patients of my own. For each patient I would do the initial entrée clerking, then see them every morning to check on their progress and document any observations. There would then be the opportunity to present the patients on ward rounds. Cardiology My second placement was on cardiology. My arrival here was a little more disorganised; when I turned up on the first day it was obvious that nobody was expecting me. I was passed between a couple of secretaries who both clearly felt it was not their job to deal with students. In the end I was simply asked for my preference of subspecialty, and directed to the ward. I spent my placement on the Unit de Soins Intensifs Cardiaque, where they were all very welcoming. Intensive care does not imply what it does in the NHS, and this was really a ward for patients with exacerbations of existing heart failure, who usually stayed for around four days at a time. Overall On both my placements I was one of at least eight medical students at any given time. This meant that even when the wards were full, I was rarely given more than two patients to look after at the same time. This definitely made the work easier, but often meant there

6 was little to do. In cardiology especially, due to a confusing administrative system where observations are recorded digitally but results arrive on paper; much of my time was spent simply waiting to get onto a computer. Medical education in France The differences between French and British medical students in terms of knowledge and responsibility is easily noticeable. Emphasis for externes is on their role and responsibilities within the ward team. As an externe, I had two or three patients who were considered 'mine' to look after. We all had to see our patients every morning, do an examination, document any findings, and make sure their results were in and filed. Much of the work was administrative: tracking down results, arranging transport home, filling in request forms for various tests, ensuring that each patients folder was in order. Though this seems like a lot of clinical responsibility, it was the norm for students to collect results and even perform tests on patients without knowing how to interpret them. Although I saw several patients a day, I rarely had an opportunity to discuss management plans. Every afternoon French students have teaching at university. This meant that there was little, if any, teaching on the wards, and no particular expectation of it. As an Erasmus student, I was not enrolled in lecture-based teaching, so had afternoons off. Entry to medical school in France is very open, but students must then sit a highly competitive exam at the end of their first year in order to determine who stays on to the next year. Around 80% leave the course after the first year. They sit another competitive exam at the end of their sixth year, the national concours, which determines their future career. Perhaps as a result of these competitive exams, most of the students know a lot of theory which in the UK we might not value so highly. They have less practical experience, and are rarely expected to suggest diagnoses or form management plans. Differences between UK and French healthcare provision I found the differences between healthcare systems very interesting, especially as I know several French people who speak very highly of the French healthcare system. French healthcare is financed through public health insurance contributions linked to employment agreements and ringfenced taxes, and is often supplemented by private health insurance. Non-emergency healthcare is not usually free at the point of access, but the patient will be reimbursed according to their level of health insurance and their income (i.e. a person with a low income will be reimbursed to a greater extent). There is a state funded safety net which ensures that the poorest members of society have access to free healthcare. I had thought that this meant all members of society were adequately covered but, as with most systems, there are some people whose access to healthcare are limited. This was made apparent to me by a patient who came to the infectious diseases ward through A&E. He had primary syphilis which had eventually caused him to go into urinary retention. He did not fall into the category of people who simply had free healthcare, but did not feel that

7 he could afford the upfront costs of visiting a doctor in the community. He presented late in emergency care, rather than pay to see a GP earlier. This is not a problem unique to France, but it was an interesting insight into a system whose overall aim is universal coverage. Healthcare culture in France The healthcare culture in France is starkly different to what I was used to in the NHS, and what I had come to see as the norm. Given how close the countries are both geographically and in terms of economic and social development, I found this surprising. The biggest differences I noticed between French and British healthcare cultures were in terms of investigations, confidentiality, and communication. During my placement on infectious diseases, every patient who had a fever of unknown origin was given a 'porte d'entrée' work up. This was a standard set of investigations which were carried out at the beginning of a patient's stay in hospital, in order to try to find the original site of an infection. The set included a chest X-ray, urine dip, endoscopy, colonoscopy, and transoesophageal echocardiogram. Some of these are invasive and uncomfortable procedures, which I would not expect to be ordered as a standard for every patient. If these tests were all negative on admission, they would often be repeated a week later to confirm the findings. This was a level of overinvestigation which I would not want to experience as a patient. However, many patients seemed reassured at the thorough treatment. Within the NHS, and healthcare in the UK in general, patient confidentiality is of huge importance. In France it is less of an issue. Expect to see students taking patient details home and taking photos of them on their phones (something which is actively encouraged). Communication skills are not considered as important in the French medical system as they are in the UK. They are not included in the medical curriculum. I found that doctors and students alike rarely explained their actions to patients before starting examinations. Speaking French I intercalated between fourth and fifth year, so I hadn't been taking the European Option classes for a while before I went to Paris. During my year out I did do a few evening classes at the Alliance Française in Manchester, but these were in the first half of the year, and, though enjoyable, probably didn't do much to prepare for me going to work in a French hospital. I was also full of ideas of doing some revision of medical vocabulary before coming to Paris, but the reality was that from September to January I focused on very little except finals. I arrived in Paris a little worried that I wouldn't be able to communicate very well. However, although I was a bit rusty ("rouillé", a word worth learning!) it was fine. After the first week I

8 felt happy talking to patients, and have just got more confident since. It has also been a pleasure getting to talk in French about non-medical subjects. My biggest problem was understanding acronyms, of which there are many. I spent a lot of time on the ward just trying to decipher these. As an externe, I have had to write in patients' notes. I was initially hesitant about committing bad writing to paper, but all the externes were very helpful about describing the standard notation used in France. If you want people to actually check your writing it is worth asking directly - nobody bothered to correct me even when I wrote direct translations which don't work in French. Life in Paris I had wanted to come and live in Paris since starting on European Option. It is a beautiful city and being able to explore it properly has been amazing. Having afternoons free gave me a lot of time to walk around and really feel like a local, rather than a tourist. It also leaves a lot of time for cheese, bread, and wine. Paris itself is an expensive place to live. Rent, shopping, and eating out cost more than in Manchester or even London. It's worth seeking out bars that are popular with students, or are just a bit cheaper than the average. That said, France is very kind to youths and students, so take your student card with you wherever you go. Most big museums are free for under 26s, or have discounted prices. Similarly, there are student prices for the cinema, and 10 theatre tickets for youths. There are a few theatres which tickets on the door for 5 if you are willing to queue. Practical advice for future students There are quite a few things to organise before you go to France (accommodation, various documents, packing for four months). It is worth trying to get these things sorted earlier rather than later. I left for Paris a day after finals results were released, and hadn't felt like getting ready to leave before I could be certain I had passed. The result is that I came to Paris missing a couple of documents which I had to get scanned and sent to me, and lacking some fairly basic things (plug adaptors are actually very helpful). If you have not heard from the Parisian Erasmus office reasonably early in the academic year, get in touch with the European Option office in Manchester so they can chase this up. If you want to get accommodation in a halls of residence or in the Cite Universitaire, you should try to organise this early in the year too. I found that applying in November was too late. You will have to get various forms and two UCEXs signed off here. Try to do this earlier rather than later; although doctors are usually very helpful in filling in the paper forms, getting them to complete the process on Medlea can be quite difficult. The European Option is an amazing chance to explore a new city whilst doing a very relaxed hospital placement enjoy it.