Pediatrics at Otto von guericke Universitätsklinikum vs KU

Magdeburg, 01/28 - 02/22 Shaily Patel, MS4 Intro to country and city

GERMANY ● 7th largest country in Europe ● 64th largest country in the world ● Population: 83million ● Currency: Euro ● Language: German ● 16 states; Capital: Berlin

MAGDEBURG ● Capital city and the second largest city of the state of Saxony-Anhalt ● Population: 238,478 ● Area: 201.01km² (Wichita 423.70km²) ● Popular sites: Magdeburg , Hundertwasser building

Universitätsklinikum

● University Children's Hospital - General Paediatrics, Neonatology and Intensive Care Medicine with special focus on Pediatric Hematology and Oncology - Pediatric Endocrinology and Metabolism - Experimental Pediatrics and Neonatology ● 80 total beds - 8 PICU, 10 NICU ● Clinic = inpatient and outpatient housed in the same building ● NICU/well baby housed in women’s hospital ● Building 10: wards, PICU, heme/onc, emergency, ambulatory (outpatient)

Life in Magdeburg

● Stay: university guesthouse - for visiting students ● Exactly like a dorm room here - bed, desk, closet, washbasin ● Shared restrooms and bathrooms; Community kitchen ● Worked at PICU for 2 weeks and NICU for 2 weeks ● Local travel: public transport - trams ● Clinical sites: 20-30 mins away ● Weather: 30-40F, windy; most students bike around the city even in the cold ● Europe travel: no airport at Magdeburg, take a train/bus to Berlin//Hannover ● Grocery: at supermarkets - Edeka, Alee-Center, Karstadt (closed Sunday) Pediatrics in Germany

● Assistant physician; Additional experience to subspecialize ● A subspecialist works for other specialties too ● For example - a cardiologist I followed had ultrasounds scheduled for the mornings but would work at a rheumatology/asthma clinic in the afternoons. A PICU intensivist would often have GI clinics in the afternoons. ● Noon meeting with all the physicians to go over the patients - PICU, wards, heme/onc, ambulatory ● Magdeburg: Much smaller training hospital; no additional help such as PT, OT, RT, case managers, social workers, pharmacy, lactation specialist, psychiatry. ● Physicians perform most procedures such as IV placements, phlebotomy, ultrasound, etc. There were no respiratory therapists and physicians performed the equivalent job. ● Health insurance in Germany covers everything. Physicians do have to work with insurance for certain medications and procedures. ● No research happens in the University Clinic as the hospital size is smaller and they do not have enough data. They usually follow protocols from studies based in other countries like UK, Australia, and US. PICU

7:30am: checkout 6:00am: checkout 8:00am: table rounds with paper charts lead by assistant 6:30am: pre-round, finish notes physicians with attendings and nurses 8:00am: morning report 10:00am: breakfast – physicians and nurses 9:00am: bedside rounds with whole team 11:00am: procedures Lunch at their own time 12:30pm: meeting with all physicians 12:00pm: afternoon conferences as scheduled Lunch at their own time Finish notes, talk to families New admits (maybe 2 admits a week) New admits Discharges Discharges/Transfers Assistant physician worked on her presentations and Teaching sessions with attendings and students studies in the free time Put in consults, talk to subspecialists Attendings either had office work or afternoon Check on progress, put in and follow up on orders subspecialty clinics 4:30pm: checkout 4:30pm: checkout Typical team: 1 senior resident, 1 nurse practitioner, 1 Typical team: 1 assistant physician, 2 attendings, 5-6 attending, 1-2 third year medical students, 1-2 fourth year nurses, medical student if present medical students on critical care elective NICU

7:30am: checkout 6:30am: checkout 8:00am: table rounds with attendings and nurses 5:30am – 8:30am: pre-round and finish notes 10:00am: breakfast 8:30am: bedside rounds/teaching 12:00pm: afternoon conferences as scheduled 11:00am: physical exam, procedures - draw Lunch at their own time blood, IV placements, central line placements, 1:30pm: checkout rounds ultrasounds, UAC/UVC placements, phlebotomy 2:30pm: stay if on call (24hour calls) Lunch at their own time Attend to deliveries where NICU is called, isolettes Attend to all deliveries, 2 isolettes present next to present in the delivery, baby friendly hospital the delivery rooms where the babies are first Procedures/follow-up on orders and consults stabilized and then transferred to NICU Teaching with attendings and students Research and read papers 3:30pm: checkout to afternoon team Students are allowed to do procedures as they feel 9:30pm: checkout to night team comfortable Life as a medical student in Germany vs US

● 6 years right after high-school ● 6th year = intern year: Required EM, IM, Surgery, OBGYN ● Clinical experiences of 3 weeks each semester in different specialties ● End of the clinical week, students pick an interesting patient and do an oral presentation about the case with other students ● Typical day at clinic: 7:30am to 12:30pm ● Mostly involves shadowing ● Do not examine the patients on their own, do not present them, nor do any procedures during years 1-5 ● Tuition: free; students only pay for personal expenses ● Some students prefer to go work in Switzerland once out of medical school since the pay is higher and later would like to settle back in Germany Most profound clinical/academic experience

● Empathy defined very differently in Germany compared to US ● US focuses a lot on bedside manners, being empathetic, spending time with patients/families ● No bedside rounds like in US; parents were barely present and were not given all the information about the hospital stay of their kids. ● Interested in echos, the PICU intensivist took me to different patients to perform echos even though there were no indications. No permission was obtained. ● No empathy towards kids with chronic disabilities; thought that the resources were not utilized right in treating these kids that they had to be admitted over and over again since their quality of life was very minimal. ● An exchange student from China who was admitted to the PICU was referred to as the Chinese girl instead of her name. Most profound cultural experience

● Language barrier ● Most people in Magdeburg did not understand nor speak English ● All the communication in the hospital happened in German too ● None of the nurses that I worked with spoke English ● Some physicians are more fluent in English than others. Some wanted to practice their English and would be more willing to teach us. Whereas, for some physicians it was too much effort to communicate in English. ● All the table rounds and charting happened in German and it was hard to follow through with patients hospital stay. References

● Dr. Michael Gleissner

● Dr. Sebastian Luiis

● Miss. Stefanie Sasaki-Sellmer

● https://en.wikipedia.org/wiki/Magdeburg

● http://www.uni-magdeburg.de/unimagdeburg/en/

● https://www.researchgate.net/publication/26878047_Medical_Education_in_Germany

● Pictures: Shaily Patel and Nisha Patel, MS4 Budget

Tuition 0.00$

Housing 300$

Flights 800$

Food 300$

Transportation 100$

Misc 50$

Exchange rate 1Euro = 1.12 USD

Visa 0.00$

Total 1550$

IEEE award 750$