Paediatric Rotation - UCD Partnership with harvard medical school and the massachusetts general hospital
Nathaniel McHugh UCD School of Medicine and Medical Science, University College Dublin, Belfield, Dublin 4, Ireland
what is the paediatric rotation competition?
Each year UCD School of Medicine award a number of scholarships to Stage 5 medical students to carry out electives abroad. This particular award gave me the opportunity to study the paediatric portion of my degree in Harvard Medical School. Study involved a 6-week rotation in Massachusetts General Hospital (MGH) while attending lectures with Harvard medical students. I then returned to Ireland and sat the UCD paediatric exams with my class.
when does the rotation take place?
To fit in with the Harvard schedule, I had to leave 3 weeks before I was due to start my paediatric rotation at UCD. I went in March, which meant missing the last 2 weeks of internal medicine in Mullingar and the week of exams. Unfortunately, this did mean sitting my missed exams in August. However, do not let this deter you too much. A 6-week 'break' in the middle of the year was very welcome, as the other students had exams and started straight back into placement. Alternatively, two additional students were sent on the rotation in August.
HOW DO I APPLY FOR THE COMPETITION?
Applications opened in late February or early March. The process may vary from year-to-year but we were initially invited to apply via e-mail. We then had our academic record reviewed, underwent interviews, and submitted an essay. It is not necessary to have taken the USMLE Step 1.
what did the rotation cost?
There was a bursary to cover both flights and accommodation. The Harvard fee is also waived, leaving only spending money to be supplied by you.
I would highly recommend applying for some form of an international elective. It was a great experience being immersed in a different healthcare system, not to mention the fact it was great fun and you meet lots of interesting people.
Monday consisted of an induction alongside five Harvard medical students who were also starting their 6-week paediatric placement. This was their last rotation before sub-internship so they were already playing an integral role in the medical team; from admitting/discharging patients to carrying pagers and going on-call. We were soon to discover the same was expected of us which was a bit out of our comfort zone to say the least! I was also given an iPad for the 6 weeks which had a Twitter account already set-up for me. The plan was that every evening a question would be tweeted and we had 24 hours to re-tweet an answer. My first rotation was respiratory medicine or pulmonology as it's called there. The week mainly consisted of outpatient clinics which varied from immunology to sleep disorders. Patients flew from all over America to attend these clinics so I got to see several rare disorders that I probably won't see again soon. The professor of paediatrics, Dr Kinane, is a UCD graduate so he was helpful at easing me into the new system. Teaching sessions took place each day. These included a 'simulation' tutorial where we worked as a team managing emergencies on an eerily realistic doll. The doll had pulses, breath sounds and could even vomit! On Friday, the students on placement in other hospitals came to MGH for lectures. These were pretty interactive which was a bit daunting. As it turned out we were all roughly on the same level. A large portion of the Harvard students final grade rested on the evaluation of their involvement in rotation so they were all very driven and vocal when it came to questions. UCD has a strong emphasis on clinical examinations and OSCEs which stood to us in the practical tutorials.
I spent Monday on pulmonology again, having missed the first Monday for induction. As it was my second week the bar was raised and I was sent to do a consultation on a new-born with a rare interstitial lung disease. It was meant to be an evaluation day but, being near the start, I don't think expectations were too high. For the rest of the week I got to choose a speciality of interest. I chose to attend the Massachusetts Eye and Ear centre on the ENT service. My schedule was busy so while I attended most clinics, I didn't get to scrub into the surgical theatre. However, I got to perform a small part of a bronchoscopy which was a milestone! One of the surgeons mentioned he will soon be pioneering a new surgery involving a hypoglossal nerve transplant. On Friday, it was our turn to move for lectures so we got to finally make the trip out to Harvard Medical School.
This week I was assigned to the paediatric intensive care unit. This was a very different experience to my two outpatient weeks. We were each put in charge of a patient. We were responsible for following up on consults and test results and ultimately formulating a management plan to present to the team. To manage this required leaving the house at 5:30 AM to have the time to check on the patient before rounds. Initially, we felt that the nurses would be better off paging the resident or a 'real doctor' with requests, or that the parent’s questions would be better directed elsewhere. Still, by the end of the week, as we got to know our patients better, we definitely felt more confident. Here I witnessed my first 'code' which ended in an emergency intubation and was a distressing event for the whole team. At the end of the week, it was time to make the journey out to campus again for lectures.
For the second block of three weeks I was assigned to the general paediatric ward. Here I saw patients with a wide variety of conditions. Some patients I had seen in the intensive care unit had been transferred to the general ward and it was a nice continuity-of-care to see them improving. I followed several patients over the week including a teenager with Tourette's syndrome and boy with an invasive cholesteatoma. When the team learned I was interested in surgery they organised for me to attend the removal of the cholesteatoma. Rounds occurred similarly to the intensive care unit but with slight differences. I was a bit rusty at the start accidentally printing a 104-page article out on prescription paper! I was also tasked with researching any questions posed on rounds and then presenting my findings to the team the next day.
I survived my first-night on-call which was actually extremely enjoyable. Without the distraction of tutorials and rounds breaking up the day I was able to keep track of patients in the emergency department that were ready to be admitted and I got to be the first team member to assess several patients. I gained more confidence in presenting on rounds and was more comfortable making a plan on the spot without having it pre-prepared. Towards the end of the week, there was a change-over and I was the only longstanding member on the team so I was asked a lot of questions about the in-patients... no pressure. On Friday, we travelled out to the Brigham and Women’s Hospital instead of attending lectures. Here we did a day of emergency simulation tutorials that were very beneficial. During our stay, we were temporarily assigned to an academic 'house' that met up weekly. We had a final extended meeting at the end of this week which took place in the 'Harvard Gardens' with several lecturers in attendance. I found this to be an interesting tradition.
I spent Saturday on call for the day shift but, being that it was my last week, I got to leave early. We also got half of Monday to attend the Boston marathon, which I did. We had a review session on Wednesday to help the Harvard students prepare for their exam. It was useful for us and I found there was a lot of repetition, suggesting I must have learned something over the course of the rotation! Thursday was our last day and it was business as usual up until mid-day when we had to reluctantly hand back our iPads and not-so-reluctantly our pagers. We then attended a graduation for the other students who were at the end of their clinical training. Afterwards Dr Kinane invited Robbie and I out for dinner. It was an enjoyable evening, hearing all about UCD back in the day when John B. Coakley was an anatomy lecturer and not just the name of a medal. The next day I got a tour of the campus dormitories and then Robbie and I bought the obligatory Harvard sweaters to mark our time there. The rotation was an invaluable experience and I've taken a lot more from it than I ever expected. I would definitely do it again.