University of Leeds medical student, Lubiana Shabeer, is one of four UK students who participated in an exchange to Germany over the summer. In March 2018, we will welcome four German students to the UK in return, as part of the SCOPE exchange program. Read her exchange report to find out what she got up to!
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The day begins at 7:15 with a staff meeting to discuss any important issues regarding patients or information for staff in general. The staff obtain a quick breakfast and begin their tasks at 7:45 with the ward round and bloods needed from patients, completed by 9am. The first half of the day consisted of sitting in with patient consultations of patients having surgery the next day. The purpose of this is for the medical students to do a general examination and ensure the patient is fit for surgery. This also consists of addressing patient concerns and ensuring patients understand what the procedure being done is. All four patients being operated on had some form of skin cancer which required excision. On the second day of my placement this week, I was in theatre and observed these procedures. The first patient had a large melanoma on his back, the second had a melanoma on his ear. Both patients required a lymph node biopsy as well. This process revealed the use of a tracer to detect the location of the lymph nodes with the help of a solution the patient drank prior to surgery. The format of the surgery and health and safety procedures in place mirrored that of the UK healthcare system. One thing which really stood out to me was two connection changing rooms. The first changing is where the staff strip down to the underwear and leave their clothing and belongings and then enter the second changing room through a connecting door to put on scrubs. This is put in place for hygiene and safety and I have not seen this method being done in the UK. On the third day of my placement, I was in theatre again and got to observe a graft being performed using a ‘skin shaver’ type of equipment and another melanoma excision and lymph biopsy.
A particular case which interested me was the presence of multiple melanoma nodules on a patient with skin cancer. This patient who was not treated when in prison and is known to abuse alcohol, neglected a small melanoma which has spread to the rest of his skin and has presented with multiple ‘golfball like’ lumps in the skin. This fortunately for the patient has not spread to other organs and only on the skin, where his prognosis will increase should therapy be successful. However, the doctors predict his prognosis will not be great since a melanoma on his face has already incooperated with the mandible and is likely to need resection to remove this. This malignant skin cancer has been shown to be increasingly worldwide due to increased sun exposure and use of sun beds.
Another patient who has particular resonated with me is a lady in her 40s, due to her incredibly infectious smile, who came in with a legal guardian. I was told by the student that the patient had learning difficulties and required an individual from the government to sign documents on her behalf. This lady presented with ulcers caused by chronic venous insufficiency. However, the following day I noticed how she seemed very upset and was not her usual smiling self. I was told this is because she has been told that her animals (6 cats, 38 guinea pigs) will be taken away as there are too many animals in her house, particularly while she is in hospital. This was upsetting to see but I could also understand that this was in the best interest of the animals she owns and also herself. The patient was given maggot therapy. When I was told this, it sounded like a highly gross procedure. However, when I saw it, it wasn’t as bad as the maggots were placed in a thin bag and were left to eat the dead tissue. In this process there is a secretion of chemicals which aid the healing process.
During my stay, I attended a teaching session on “hauttumore”, also known as skin cancer, given to the medical students. I was really pleased with how much I understood from this lecture. This has revealed that a lot of my German is coming back to me and I am learning more than I think. I learnt about the two difference cancers – squamous cell carcinoma and basal cell carcinoma.
Talking to the medical students this week has revealed great differences in the medical curriculum with their national exams at the end of the third, fifth and sixth year, longer rotations per department and also the compulsory three months spent doing a nursing placement in the summer before starting medical school or during the holidays of the first two years. The purpose of this is to get to grips with the basics and caring aspect on the wards, such as dressings, equipment preparations. To me, this sounds fantastic as it provides further insight into the role of additional healthcare members and also running of the health system whilst gaining basic skills. It was also interesting to hear about the three main pathways by which people get into medicine. The first is by being in the top 20% of applicants to that medical school, where admission is permitted due to top marks in the Abitur (A-levels). The second group consists of those with good grades but must also show additional components such as experience in healthcare, German proficiency for example. The last 20% consist of students who don’t get grades but wait for a space. The waiting process is up to seven years where admission is given conditional to passing an exam. Most students during this time work in a healthcare setting, such as a nurse or assistant. One of the students I have shadowed said she marginally missed the grades so only had to wait three years and during this time, worked in several departments in the hospital. I was amazed by her confidence on the wards and with clinical skills, which is likely to have been amplified through her previous experience.
Besides my clerkship, I have spent time sightseeing Halle and engaging with the locals through cycling everywhere, exploring the park and visiting the beautiful museums the town has to offer. My favourite has been the chocolate museum, where I was able to gain an understanding of the fascinating history of chocolate and the oldest chocolate factory in Germany. There were many opportunities to eat chocolate and see the production of chocolate from start to finish.
During the week I met some of the other exchange students for dinner and learnt about medicine in Lebanon, Tunisia, Hungary, Korea and Germany. There are many similarities in the curriculum with medical school dividing into pre-clinical and clinical stages. However, in many of the other countries, there is a national exam at the end of the pre-clinical stage and clinical stage. This is not present in the UK at the moment, but as far as I am aware, will be implemented in the upcoming years. A common theme was the fact the course is six years across the globe and wearing a white coat on the wards is compulsory, differing from the British system. This trip was followed by relaxing by a lakeside and fruit picking. The first week was ended by a trip to Prague with the other exchange students. Other excursions included a weekend trip to Berlin with other exchange students, karaoke night and attending the Halle lantern festival.