Monday, 6 December 2010

UK vs NL med student showdown.

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Have you guys met the blonde Phd yet? Yes, there is a PhD version of the Blonde one. See? Dr. Blondie lives on the interwebs as well and is every bit as fun and brilliant as I am. Except that her job is maybe less... gross? Brilliant Blondes United!
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Time till I never ever have to call myself a medical student again: 18 days.


Went to one of my last lectures as a student today. Radiology. Was interesting, if only because repetition sometimes is key to learning.
OF COURSE there was a few abdominal X-rays showing interesting but misplaced objects in the rectum or lower part of the sigmoid. You know, when patients 'fell on it'. At one image he asked us what this was. I replied 'a vibrator'. He seemed a bit disappointed that one of us knew the answer.
It's only because we have an incredibly brilliant radiologist (Simon Robben) at my faculty who managed to put several 'lost' vibrator radiographs next to each other and compared them in terms of 'durability', 'penetration strength' and 'removal cost'. Removal cost went up with a higher penetration strength.
And because there aren't that many rocket-shaped objects with small motors within a certain size range that you would find in a persons arse. It basically comes down to 'vibrator' or 'toy rocket'. The latter being less likely.
Also, the tip of the day was to make sure that, if you simply MUST insert a bottle into body cavities, you use a bottle with a screw-on cap rather than the click-on type.

I've joined the local final years students (year 5 in the UK) in their Acute Care block for my elective. Our final year is year 6, but that's also a sort of intern year. I was ok with being placed essentially a year lower because I'm stepping over from psych to medicine. I was a psych intern. And I was good at it. I still love psych, but it's just not the thing for me. I don't fully regret doing psych, but I've got a slight bit of catching up to do. With less than 3 weeks of my elective to go, I'm realising that med student clinical practice at year 5 level won't get me where I need to be. Instead of randomly clerking patients, I need to be studying.

One thing I've noticed here is that I'm trained completely differently.

UK medical school: 5-year programme, split up in phase 1 and 2, followed by foundation year 1 on a provisional GMC registration, after which you can fully register and continue with FY2. The 5-year programme is a combined Bachelors of Medicine and Bachelors of Surgery. You can only start specialist training after the foundation programme, regardless of your future career plans.
NL medical school: 6-year programme, now consisting of a 3-year BSc and a 3-year MSc. The BSc allows you to switch to any other health-related masters degree, should you discover that you don't want to be a doctor after all. Not all faculties follow the exact same programme. I'm a Maastricht University medical school graduate, bred on the (in)famous Problem Based Learning system. I could start specialist training next year if I landed myself a spot, else I'd have to do some locum jobs. When I started medical school, Maastricht University was ranked the nr 1 medical school in Holland. Now, not so much anymore I think.

Basically I think the main difference is that we're prepared for early specialisation, starting in final year of medical school. The UK students have a better general medical knowledge, while I'm a bit of a blank canvas doctor. They study to pass exams, I study to gather knowledge. I think I have a better framework, now I just have to hang in the right knowledge. To be honest, I think that's the easy part. And I can out-psych any of these medical students, and probably most of the junior doctors too. It does matter, because communication with your patient is important.

But really, if the Dutch system was so bad, the Dutch health care system would not rank higher than the UK's according to the WHO, or we wouldn't have less preventable deaths, or we wouldn't be higher in this... or we wouldn't be ranked nr 1 in the Euro Health Consumers Index (vs the UK's nr 14)...

Anyway. I think, in general, Dutch students have less knowledge, but do not make worse doctors. There's more to being a good doctor than knowing the exact text of your Oxford Handbook by heart. I also think the Dutch just have themselves to blame for their lack of knowledge (and I have them to blame, I just tried to fit in in a country where I will never fit in, but I didn't realise that then)... they don't have a competitive culture and it's not OK to be proud of your achievements. We are trained to use clinical judgement rather than flowcharts.

I can tell you that I really regret trying to fit in in secondary school and medical school. I would have done much better in a slightly more competitive culture... but I was already sticking out like a sore thumb.

So. Problem based learning, right?

Problem: not enough medical knowledge to my liking. Seem to have forgotten a lot.
Solution: insert nose in book.

1 comment:

  1. Um, yes. I would definitely agree that my job is less gross!

    ReplyDelete