Short Summary
This week we started our internship with the medical program
here at UFS. We essentially are shadowing a medical student and doing
everything a medical student at UFS would do. In the mornings, we have clinical
rotations. This week I am in surgery rotation. So far, we’ve spent a day in
gastroscopy and a day in the operating “theater.” In the afternoons, we attend
lectures, which have varied in topics from hematology and cardiovascular
abnormalities to radiology and pediatrics. A few nights we will be on call
overnight at different clinics around Bloemfontein. It’s busy, but I’m learning
so much and making many new friends!
Clinical Rounds
Our first morning of rounds was in gastroscopy. The first
patient we saw had dysphasia and had to have a permanent feeding tube inserted.
We could not understand everything going on because the sisters (nurses) and
the doctor were not speaking English. The medical students tried to tell us
what was going on when they could though, which was nice. I thought it was
interesting that the patient only had local anesthesia, because it looked so
painful. I also noted that the sister touched some materials that had been
autoclaved without gloves.
Next, we watched a colonoscopy. This time, there were two
doctors present, so one was available to focus on explaining things to us and
questioning the medical students about the symptoms, procedure, and possible
treatment options. It is amazing how much these students know since they are
the same age as us. He also gave them
the tip to classify their future patients into the following groups: healthy,
curable, palliative, or about to die. That way, they can determine the best
method of treatment to maximize the comfort of the patient as well as efficient
allocation of resources.
Tuesday, we were in the surgical theater (operating room).
We learned the proper way to scrub in. It was interesting to notice that they
even have a different protocol for washing hands than we use. The scrub sister
was very funny and helpful. Even though we had to watch the operation from the
observation room above, two of the students were able to scrub in and do some
stitches! They were very excited and nervous since it was their first time on
an actual patient! We watched a venisection called a “fem-pop.” It was above my
understanding, honestly, but they removed a large vein running the length of
the leg, attached it to the femoral artery, then to somewhere else to divert
blood away from a clot. Overall, the operating room looked just like on in the
US, and they were very cognizant of sterile technique. The only difference I
noticed was the use of fabric scrub gowns rather than disposable ones.
Lecture
The students have lectures every afternoon, from
approximately 12-5, with a lunch break. However, there is a new lecturer every
1-2 hours, so it really isn’t too bad. A sign-in sheet is passed around at the
beginning of each separate lecture, and the students must attend 80% of
lectures to be eligible to write exams. Most lecturers have a PowerPoint
presentation, and the students have a massive bound book with all of the
printouts of the slides in it. The style of lecture is very different depending
on the professor or doctor speaking.
Our first lecture was on myeloproliferative neoplasias,
which are cancers of the bone marrow. This lecturer was very interactive and
used simple metaphors to clarify the concepts he was teaching. He also found it
very important to relate research to clinical practice. He explained how
research has increased the knowledge about these diseases so much so that
current medical students often understand them much more than the older
generation doctors. He also explained the problem that the drugs to treat this
disease are extremely expensive since it isn’t very common. He then highlighted
a nonprofit organization called Max Foundation, that provides these medications
to anyone in need who cannot afford it. He even had specific numbers regarding
how many people in Bloem benefit from that organization.
The next lecture was on pituitary function. This lecturer
was more formal, and he had each disorder categorized into symptomology,
screening, diagnosis, treatment, and follow-up.
He also included mnemonic devices and tips for the students as they
study for their exams.
The final lecture for Monday was on aortic stenosis, a
cardiovascular condition. This professor reviewed basic anatomy and physiology
of the heart. He also went through a logical progression to help the students
understand how the disorder affects the patient to determine the potential outcomes.
His powerpoint was more of an outline, however, so the students had to pay
close attention to take good notes.
Tuesday, the first lecture was on radiology. She specifically
spoke about efficiency and accuracy. She highlighted the importance of
requesting the correct test and providing the radiology department with ample
and sufficient information to know exactly what is necessary. This protects the
patient from unnecessary radiation, but also saves money (this is especially
important in a public health system). Her advice was to always ask the
question, “Am I going to act upon the results of this test?” If not, the test
is unnecessary and should not be requested. One interesting thing she said was
that they have patients keep their radiology films and bring them back for
follow-up appointments rather than keeping them at the hospital.
The rest of the day was pediatrics lectures. One was on
thermal regulation in neonates, and the other was on fetal development. They
were both very interesting because they deal with such a unique and special
patient population. The first lecturer taught without a PowerPoint by just
asking the students questions and guiding them toward the answers. The second
lecturer was very funny and passionate about the topic. One interesting thing
she pointed out was the difference between the public and private systems. For
example, there is more extensive screening of neonates for medical conditions
in the private sector than the public. She also shared personal experiences,
such as a time when she failed to diagnose hypothyroidism in a baby.
Clinical Education
At UFS, there are two classes for medicine—Afrikaans and
English. Both admit 80 students each year. However, the group of third year
students we are currently shadowing has 50 English and 72 Afrikaans. This is
due to students either failing or dropping out. If the students fail, they are
allowed to repeat twice. The same year cannot be repeated twice though. During
the second year, the students study anatomy, and most perform a clinical
research study. For example, one group of students studied children who were
admitted to hospitals and clinics around Bloem after car accidents to see what
percentage was wearing seatbelts, since it is now a law for children to wear
them. The entire medical education is five years, followed by a two-year
internship and a year of community service. If they want to specialize, it can
take another five years. At this point, they are called registrars.
The past two days, the fifth year students have been taking
their final exams. They have both long and short exams. In the short ones, the
examiner tells the student the patient’s complaint or an area of the body that
has an abnormality. Then, the student must examine the patient and make a
diagnosis in fifteen minutes. For the long exam, they must take a complete
patient history and do a physical exam to make a diagnosis in thirty minutes.
All of the students looked so stressed! The hospital was also very busy as
there were examiners from all over the country there to administer the exams.
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