Medical Elective Report
Reporter: Florence Judge-Clayden
Contact at Destination: Prof Alexandre GHUYSEN – Chef de Service Urgences and Prof MAQUET – Chef de Service Neurologie
Year of visit: 2023
Country: Belgium
Region: Liège, Wallonie
Institution: CHU Liège, site du Sart Tilman, Avenue de l’Hôpital 1, 4000
Department: A&E and Neurology
Work/Study undertaken: 5 days per week 8am -6pm – Two weeks’ placement in A&E and Two weeks’ in Neurology.
In both departments I was able to get fully involved in the placement as I already had a good level of conversational and written French and was granted the same rota and responsibilities as local medical students on that placement.
In A+E, it was the expectation that all patients will be seen and clerked by the students first, so we had our work cut out to see everyone! I would see a patient speaking in French with them, then present an SBAR to the registrar. I had a login to the computer so I could write up my notes too then request any necessary investigations, then move on to the next patient.
In Neurology I joined either the stroke ward round or the general neurology ward round most mornings, which was with the consultant once a week. Other mornings or afternoons I was able to go to Clinics – I went to stroke clinics, epilepsy clinics, sleep clinics, Parkinsons clinics and general neurology. I even was able to see a thrombectomy and join the EEG analysis staff and learn how to interpret polysomnography graphs and analyse a couple myself. I really enjoyed the flexibility of this placement and the variety of learning opportunities.
Description of the service and department: CHU was the main university teaching hospital for Liège and received medical emergencies, GP referrals, and self-presentations. There were three parts to the A&E – Resus, Bed-bound/continuous monitoring bay and ambulatory care. In Neurology there was a stroke unit, general neurology ward and clinics.
Description of the destination: Liège is the third largest French-speaking town in Belgium. It is a vibrant city with a large student community and is well connected by train to other parts of Belgium. Its Erasmus /Exchange office was very welcoming with a Buddy system set up to help integrate foreign students with local students. The hospital was a 30-40 minute bus ride from the centre where I had my accommodation
– and the bus pass for young people was incredibly cheap.
Dress code: I was given white trousers and a short white coat/tunic to wear as a student {and was laundered for me, with fresh set available daily}.
Were the local people friendly: Yes I found the local students from the year below so friendly that I met through the buddy programme. The students that I was on placement with were very busy and stressed so they didn’t tend to want to socialise. I also found the ERASMUS students very friendly from other subjects!
Did you feel safe? Yes I did mostly, although I was warned away from walking along certain central streets after dark.
What did you do in your spare time? I went on the train to Brussels, and to Luxembourg on two of the weekends. Otherwise I explored the town, went to the cinema and theatre, and went to some student parties. Liège is famous for its student nights self-organised by different university societies, as well as their Chapi parties which happen in a massive marquee. A must do if you like unlimited beer!
Is there anything you would particularly recommend others to do? I think going with a good level of French is very helpful as all the consultations were all in French. A lot of the doctors did speak good English and occasionally wanted to practise with me, but you have the independence of practising your medicine and socialising with local students if you have the language skills.
What time of year were you there? What was the climate like? I went in March, and the weather
was quite cold and grey- it even snowed!
What was your accommodation like? I stayed in Xior student accommodation in the centre of town
5 mins away from main shopping streets, supermarkets, bars and clubs. It had a large social area
downstairs and each half floor had a shared kitchen between 12 of us with ensuite bathroom for
each room. I found the accommodation ok, but I was sharing with Erasmus students who were
partying all week, so some nights before placement I didn’t get much sleep. There was no bedding
provided and technically no cooking ware {but there were pans and plates in the kitchen from
previous students}.
Was it provided? No
If not who arranged it? I arranged it from the accommodation links provided by the Erasmus office
How much did it cost? It was 615 euros for the accommodation overall including bills for 1 month.
But I had to put a deposit down of 1000 euros initially.
Did you enjoy your visit? Yes I did by the end as I met some really lovely people, but the first couple
of weeks were quite tough as the learning curve was so steep, the timetable was quite intense and
it took a week or two to make friends.
Did you find it useful medically? If so, in what way? In terms of increasing my medical knowledge, the intense experience in A and E allowed me to see a wide range of patients, from ENT, scabies and Derm, Stroke, MI, PE, Trauma and Rheumatology. This gave me a great opportunity to practice all my exams and gain lots of feedback from either direct observation or from looking at how my notes were added to after the supervising doctor examined the patient.
I found the clinic time with the consultants very valuable, especially with Prof MAQUET himself. He taught me a lot about improving my neurology exam, including getting better at eliciting reflexes and testing sensitivity of the area, as well as knowing when to do extra features of the exam e.g. visuospatial spiral {identifying cause of or monitoring efficacy of treatment for tremor and cerebellar disease} and spirals between two lines (ataxia, vertiges), fine movements (parkinsonism or muscular dystrophy), archaic reflexes (dementia), aphasia rapid test (stroke suspected). I’ve also learnt new standard parts of the exam – Hoffman nail flick, cutaneous hand reflex to chin, serment and mingazzini. I also learnt that we can distinguish Alzheimer’s dementia from other forms of memory loss by asking patients to remember words – if the word comes with prompting, the memory has been made, it’s just the frontal lobe executive function that’s not working, but if the word won’t come at all, it means the memory has not been made, so likely to be a hippocampus problem and therefore Alzheimer’s.
Has it improved your French? Yes! When I went, I was very confident speaking conversational French and found understanding people quite ok most of the time. I prepped how to take a history and instructions for examination before I went, but my medical French improved immensely while I was there – I can now confidently take a history, do an examination in French, and write up my notes in the formal medical French required. I’ve also learnt how to request different investigations and what information needs to be
included in the referral. I really struggled with presenting my patient in a SBAR handover in Medical
French in the first week, as I was either lacking vocabulary or wasn’t concise enough, but I started to
improve by the end of the placement.
How has it increased your knowledge of Belgian culture? I was able to increase my knowledge of waffles, chocolate and beer which was great!
In terms of seeing how the Belgium medical system works, I noted that things happened a lot quicker there than in the UK (investigations, specialist appointments, physio etc.) I think part of this is because it’s a mix of state funded and top up health insurance system which costs around €40-50 per month, but allows maybe more staff to be employed and/ or better working conditions. I also noticed that the doctors coming out of medical school did not have a Foundation Year period, but instead started training in their specialty straight away and were given full responsibility for making specialty decisions more often. For example they were the ones to review a patient and decide on the plan, both on call and on the ward round (for example there was only a consultant ward round once per week). This was a change from the level of responsibility during medical school but perhaps allowed them to learn more quickly about their specialty as they were making decisions independently and were only required to attend to patients in their specialty.
If you went back would you do anything differently? Ideally I would go for longer than one month, as I only just felt like I was settling in and starting to enjoy meeting up with new friends! I also may have done Neurology first as A+E was quite intense so was a lot to cope with in the first two weeks as well as socialising and getting to grips with the French!
I would also aim to get a ‘kot’ or shared flat if I was staying longer or there was an easy way to organise it. I couldn’t find one for just a month so I went with student halls accommodation.
How did you get there? I went by Eurostar train.
Is there any information that you think may be useful? I found organising this placement relatively easy with the help of the Erasmus exchange office {even though I wasn’t with Erasmus}. I think central accommodation vs hospital campus accommodation, allowed easier socialisation so even though there was a daily commute, it was worth it for feeling safer getting home after socials.
