The british training system

I know its halfway through my first week and I haven't written anything about my experience at the hospital yet, but a you can see from my posts I've been a bit busy. I was worried about coming here and not finding anything to do but the exact opposite has been true and I find myself fighting to cut my hours at the hospital so I can just go traipse around the city.

I arrived at the Royal Infirmary on Monday morning to find out that the physician I'm supposed to be working for wasn't even in the country and the ward staff had no idea I was supposed to be there (disorganization here will be a common theme in my posts). It sounds like this happens for a lot of the students here so the staff never knows when they are supposed to have students and when they aren't. I was a bit astounded by this at first because back home the students are expected to carry their own patients and help do a considerable amount of the work and so not knowing when they are to be there would be a bit of a problem. Here however the students responsibilities are minimal, and they spend much of their time on the wards shadowing rounds. It is only in their 5th year (their 3rd doing clinical responsibilities) that they start to be given the task of writing H&P's (called clerking, pronounced in the native accent as "clarking") and still they are not expected to cover the patients in the manner I was expected (i.e. prerounding, presenting on rounds, daily notes etc.) I have not been bothered by these differences though as they have manifested in two very positive ways for me: first, no one really knows when I am to be there and what I am to be doing so I am free to take time to go sightsee or travel when I want to; second, I have just jumped right in and covered patients like I normally would have and since this is not what most students do here, I have been accepted as part of the team and gained respect quickly.

I guess now would be the appropriate time to tell you about the differences in the training in the UK vs the States (please note that these are just my general obs from my already massive ::sarcasm:: one week of experience. I am attempting to describe things only here, without judgement, as I have not come to man conclusions about how I feel about the training scheme). Over here medical school is 5 years and is normally done as the first year out of high school. After medical school there are two general years (called "foundations years", so they are designated FY1 and 2 similiar to our PGY designation) that included a variety of rotations similiar to our 3rd year. Each person completes six 4 month long rotations that cover medicine and surgery, and possibly OB, Psych, Peds, and Neuro. The responsibilities of the foundations years are similar to a 4th year medical student back in the states, except that they have the power to order tests and prescribe. However they are rarely the primary decision maker on the care of a patient and generally have much more supervision and support from upper lever "junior doctors", the equivalent term to resident. After those two years you much choose a specialty go through an application process very similar to our match, and get assigned to a geographic area as a Specialist Trainee, "ST". They spend 3 years as a general ST (essentially the equivalent to our 3 year residencies) and then go on for 4 more years in a sub-specialty. I am not completely sure how they train general practitioners, whether they stop after 3 ST years or whether they do all 7 years, but I plan to find out.

Another huge change? The weekly average hour limit for the junior doctors is FORTY EIGHT!?!

Many of the differences in the training system are due to the students starting 4 years earlier. I can't imagine having to go through boards and do the same patient care things we do back home at the age of 21 or 22. They do 2 years of all class, 2 years of clinical rotations where they do mostly shadowing, and then in their 5th year they begin to do what we do in our 3rd year though it seems with a bit less responsibility. The two foundations years are a brilliant idea, as they are essentially identical to our 3rd and 4th years with a few less rotations and the ability to prescribe. They get to be "residents" in a very real sense but still get to rotate through a variety of positions to figure out what they want to spend the rest of their lives doing. The total amount of years after high school is the same as ours would be to get the whole way through fellowship (non surgical that is) but they don't have to spend 4 years completing a first degree that may have nothing to do with their eventual careers.

So what do I think about the training here? The benefits: more total time on clinical rotations, more real experience before they have to chose a specialty, and are perhaps (though this is speculation) better prepared to become attendings their first year out. The down sides? Not as sure about this one. For me personally I was not ready to choose medicine as a career at 18, and would not have been ready for patient responsibilities at age 22. I loved my experience in undergrad and would not have given it up for the world. For those students who do a first degree and then come to medicine as a grad student it is a much longer road than for us. Largely i believe that it puts them in the same place as we end up in the end, but by a different road, and they do so with more clinical years which is a necessity with a 48 hour work week.

All in all I'm loving my time here. I'll post tomorrow about what I've actually been doing on the wards and what I've noticed about the hospital running a bit differently. I'm hoping to get into an outpatient clinic as well as the emergency room and "combined assessment" (essentially a holding area for patients needing admitted from the ER, a great idea after you've seen our ED) . I think I may also get to spend a day in the NICU and a day on the general peds floor.

Cheers!