3-month clinical elective at the University of Pennsylvania
January – March 2016
Self-organized clinical elective at a foreign institution
University of Pennsylvania, USA
report by Gregor Mayer (student no. 1033326)
[email protected]
final year’s medical student (O202)
period: January to March 2016 (twelve weeks)
My three-month clinical elective was part of a continuous project created by the organization
Going International which every three months sends three Austrian medical students to the
University of Pennsylvania for clinical rotations through different subspecialties of internal
medicine. Dr Polak and Dr Henry are the respective physicians in Vienna and Philadelphia
who initiated this project some 20 years ago. I contacted Ms Rozsenich, Dr Polak’s secretary,
about 13 months prior to the period I was applying for (January to March 2016). After getting
the confirmation that there was still a spot available I quickly initiated the application process
which comprised of a series of blood tests and legal documents. I sent my entire application to
Going International and they then forwarded them to Dr Henry and his secretary at the
University of Pennsylvania.
Living in Philadelphia
Going International recommends staying at the I-House (International House), which is a
large building in Philadelphia’s University City accommodating students and non-students
from foreign countries who temporarily visit Philadelphia. However, since the I-House
seemed a bit over-priced to me I decided to look for other options of accommodation. The
website Airbnb quickly provided me with a few alternatives. This way I found a young couple
which rented out a relatively inexpensive room in North Philadelphia.
North Philadelphia is not considered the safest area in town, however people in this
neighborhood have never approached me in an unpleasant way and I have not even felt unsafe
when riding home on my bike after midnight. I actually had a really great time there and the
guys I stayed with have become really close friends. So using Airbnb for accommodation
worked really well for me.
Public transportation in Philadelphia is rather expensive. I was lucky that my landlord
provided me with a bike for free. But as part of the city’s attempt to become more ecofriendly they have established a system for public bike renting which I heard works quite
well…
Sights to see in Philadelphia include Independence Hall, Liberty Bell and the National
Constitution Center which definitely give you a nice overview about some important
milestones of US history. There are also great art museums or simply nice streets to take a
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3-month clinical elective at the University of Pennsylvania
January – March 2016
walk on…Nightlife in Philadelphia gives you a wide variety of options including clubs, bars,
theaters, and a lot of parks to hang out at. People in Philadelphia are very open and friendly
which make the city a really nice one to live at.
Clinical rotations and hospital
Generally – and this applies to all of my rotations – everything that I’ve done was doublechecked by experienced attendings, the vast majority of which really seemed to enjoy
teaching. I received a lot of good feedback and I always learned something. Every time that
I’ve seen a patient I had the chance to discuss them in depth with an attending.
As everyone in this program, I started my first month together with two Austrian colleagues
at the Hematology/Oncology (HemOnc) Division. Dr Henry who, again, is the main organizer
of this exchange program at Pennsylvania Hospital was one of the two main attendings we
were assigned to during this rotation. He is used to Austrian students and he is very aware of
the fact that we are just not familiar with the US medical system in general and the way they
like their notes to be written. This gave us an easy first month; we had the chance to slowly
adapt to the system and to develop a routine in examining patients and creating notes. As part
of this team we either followed Dr Henry on his rounds, clerked patients as part of the
Hem/Onc consults team, followed up on those patients we’ve clerked ourselves or shadowed
doctors in the outpatient department (OPD).
For my second rotation with the
Rheumatology Department I had to chance
to the Hospital of the University of
Pennsylvania (HUP) which was situated in
University City in the western part of
Center City. HUP is a much larger hospital
than Pennsylvania Hospital and doctors
there are said to be more competitive;
nevertheless, at the Rheumatology
Division made me feel very welcome from
the first day on. I spent two weeks with the
inpatient division and two weeks at the
OPD. During my inpatient weeks I was
assigned to the consult service, consisting
of one attending, one rheumatology fellow
and one medical resident. My job again
was to clerk patients, summarize their
complaints, create a list of differentials and
think about possible diagnostic steps. I
Rheumatology Consults Team: fellow, me, resident, attending
(from left to right)
then would present these patients to the
rest of the team and we would discuss
them thoroughly. The amount of time the attending and the fellow spent on every patient, to
think about differential diagnoses, treatment approaches and to discuss the pathophysiology
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3-month clinical elective at the University of Pennsylvania
January – March 2016
together with me was the longest I’ve ever experienced in any hospital I have been to. Even at
6:30 pm still with a long list of patients to see the same day they would never cut down on
teaching or time they spent with patients. These two doctors worked with clarity, they had a
strictly scientific and evidence-based approach to every case, were very good with patients
and to me passionate teachers.
During my first week in the OPD I was assigned to different doctors every half a day for. This
way I could get to know different specialists and their individual approach to rheumatologic
conditions. By the end of the first week the secretary of this division who created my schedule
asked me which doctors I wanted to shadow in my second week giving me the chance to
choose those I had learned from the most during my first week. I did not actively do a lot
myself in the OPD but I could learn a lot by observing the physicians and discussing their
patients with them.
My third month I spent – together with another Austrian student – with the Nephrology
Department back at Pennsylvania Hospital. Again, I was assigned to the consults inpatient
team, which only consisted of one attending and us two Austrian medical students. The
patients list we had to see at that time was more than twice as long as it usually was. On the
one hand there was not a lot of time for teaching (still more than on most of the rotations I’ve
done prior to the US), but on the other hand we got in contact with patients a lot.
Apart from the rotations in the different departments there were also lectures every day at
lunch time. This provided us with even more theoretical input and got us in contact with local
students who generally rotated through different departments than we did and young doctors
in a more relaxed setting. This way we had the chance to get to know some locals of the
medical society.
Travelling
I only traveled to Washington DC on a weekend and spent four days in New York City after
having finished my three-month clinical rotation in Philadelphia since I just had a great time
there:
Washington DC with its National
Mall including its monuments and
museums (which for the most part
were for free) is a great city to gain
some insight into US history. At the
same time it’s a fun town to go out
into bars and clubs and just meet new
people.
New York City is simply
breathtaking. There’s a ton of huge
and largely renowned museums such
as the Metropolitan Museum of Art
(the largest and most important art
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Sunset over the skyline of Manhattan; view from Brooklyn
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3-month clinical elective at the University of Pennsylvania
January – March 2016
museum of the Americas), the Museum of Modern Art, the Guggenheim Museum, and many,
many more. At night you can go to the Metropolitan Opera, see a play or a musical on
Broadway, check out one of the many Jazz Clubs or just have some fun with random people
on a rooftop bar. New York is a very diverse city and every neighborhood has its unique
charm. Within just two hours you can see posh brokers on Wall Street, the always crowded
China Town, Little Italy with its many restaurants and Washington Square with all its
different artists. It’s a good idea to go there with an idea of what you want to see and roughly
when you want to see it, but at the same time you should leave some extra time for all the
surprising moments you just cannot plan…
Conclusion
Initially I decided to do a clinical elective in the US because I have repeatedly been told about
how good the US medical education system was and I just wanted to find out myself. During
my medical studies I have done rotations in a series of other countries including Switzerland,
Germany, Scotland, South Africa and New Zealand but I have never seen a system that well
organized and that focused on the education of medical students and young doctors as in the
US. One of the main duties of a senior doctor in teaching hospitals really is education and
everyone simply accepts that. Winding up in a team without a good inner dynamic, that also
does not emphasize teaching seems so much less likely in a US hospital than in one in Central
Europe.
Apart from the education I have learned to love the US people’s attitude in everyday
situations; I have gotten to know the US population as open, friendly and diverse people that
are easy to start a conversation with and generally treat each other with a decent amount of
respect.
Finally, I want to thank Dr Polak, Dr Henry and both their wonderful teams for an
unforgettable experience on many different levels. Furthermore, I would like to thank the
Department for International Cooperation and Advanced Training at the Medical University
of Graz for partly funding my clinical elective as well as Ms Christiane Pliessnig for her very
friendly support.
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