Reporter: John McManus
Contact at destination:Prof Leyvraz
Year of visit;2006
Country:Switzerland. Switzerland is a very beautiful country and is very tidy and well kept. It is a complete melting pot of cultures and languages as it sits right in the centre of Europe with so many influences from the surrounding countries.
The Centre Hospitalier Universitaire Vaudois is a large university hospital. This is a 20 storey, 1000 bed, 5000 personnel institution; it is one huge central grey concrete building surrounded by ancillary hospitals. 40% of the staff are foreigners, 500 are doctors.
The view from the top floor is absolutely stunning. Lake Geneva with the high Alps on the other side. Lausanne Med School : WWW.UNIL.CH/MEDICINE CHUV : WWW.HOSPVD.CH/ Or email questions to : Lausanne Med Students Rep: AEML@UNIL.CH
Department:Orthopaedics and Trauma (also including A+E)
Work / Study undertaken: I spent six weeks at the Hospital Orthopédique de la Suisse Romande, which is part of the Centre Hospitalier Universitaire Vaudois, in Lausanne Switzerland.
I admit it’s a bizarre choice for an elective destination, but I am thinking of moving out here and wanted to see what I thought of the work. I spent my Erasmus year in Lausanne two years ago and really enjoyed everything about my time here. I chose my elective in Orthopaedics and Trauma to get the experience to pursue that as a career. I have tried to combine as much information from my experiences to write this report.
Any speciality is available ; beware the highly specialised tertiary ‘services’. Medical firms in this category may not have any beds, only day patients, carry out limited variety of highly technical procedures and only deal with ready made diagnoses. ‘Medecine Interne’ is the medical speciality that deals with new patients, makes diagnoses and carries out routine investigations. Surgical firms in the super-specialist category, may not know what to do with a stagaire, Swiss stagiaires tend to steer clear. The general firms allow a lot of scope for involvement and responsibility. Some enthusiastic stagiaires reported they got good teaching on some specialist firms, and there will often be stagiaires around to pass on recent intelligence of each services’ style. If not the hospital SHOs themselves can advise about later attachments. a. Tertiary Services Gastroenterology, respiratory, neurology, nephrology, endocrinology, dermatology, rheumatology, cardiology, ENT, haematology and Infectious diseases. These had stagiaires from time to time. Radiology, psyche, Obs & Gyne also have places. Pneumonologie at mountain hospitals like Montana might be interesting? b. General ‘Exposure’ Medecine interne is highly recommended (and oversubscribed because stagiaires often do 3 months here in order to do the 3rd in A&E), Anaesthetics had lots of Swiss stagiaires who must do an attachement there. c. Good ‘Teaching’ Surgery Firms Trauma/Orthopaedics, thoraco-vascular surgery, general surgery. d. Over-Specialist Surgery firms reconstructive and plastic surgery, paediatric surgery, neurosurgery, cardiac surgery. 1 month attachments are normal, but more for ‘Medecine Interne’. You can do longer but unless really dead set on your future however beware of specialists. Surgery can include a spell of ‘Urgences’ in any attachment, but Medecine Interne only allows students to go to the Urgences, on the 3rd month of ‘Medecine’ placements, and after assessment.
The programme on the 1st day of the month usually starts at 08h00 from the department secretary’s office. Thereafter routine usually starts 07h15(ish) for surgery firms or 08h00(ish) for medical firms, with a ward round and finishes well after 17h30 with another doctors meeting (and usually later, with a post-grad teaching session). On calls are not required for stagaires. A 60 hour week is standard for the full time doctors but 50 for students is about the norm. If working in the ‘Urgences’ (casualty) (part of ‘Chirugie or Medecine General’) the work schedule was a week of 24 on, 24 hours off. If in traumatologie, on-call was as you and the ‘assistants’ agreed. Few other services had stagiaires in the Urgences. Unfortunately, this was not the ideal Elective for sitting on a beach. I had to work.
ORTHOPAEDICS AND TRAUMA
The boss is Prof Leyvraz. The Orthopaedic Hospital is a private institution within the grounds of the CHUV, which only does elective surgery or private patients. Every doctor has his specialist area, but often carry out other operations to keep up to date.
There were three medical students attached to the service at the same time. We were given an excellent welcome and were made to feel completely at home from the outset. We were integrated into the team and given places on the operating rota.
07h05 They start far too early for me, with a ward round
07h45 Ortho – traumatologie meeting on 14th floor
07h30-09h00 On Thursdays there is a large ortho meeting on the 5th floor of the HOSR
08h15 After the meeting, the whole team goes for breakfast and coffee together. This is an excellent way to start the day as there are freshly baked croissants and patisseries in the canteen. It is also a great way to get to know who you are working with.
08h30-13h00 Morning operations, Clinics, Pre-Operative checkups
13h00-14h00 Lunch – this is by no means fixed. Eat if and when you can.
14h00-16h00 Afternoon operations, Clinics
16h30 Ortho-trauma X-Ray meeting
You work with an SHO who generally looks after you very well.
Most surgery (not medicine) placements give out ‘bips’. The system is a bit different from ours: When you bleep someone, don’t hang up: The target will connect direct to you when they dial their own bleep number.
Everything is much more casual than in the UK. Ties are not required and should not be worn. Jeans, T-shirt and trainers are quite acceptable daily wear. You may not wear your own white coat, one is provided. Return it to the laundry weekly for replacement. Hospital ‘whites’ can be provided, but must be asked for (many doctors wear these to speed up transit times into and out of theatre). Surgical scrubs may not be worn outside theatre or Resus (‘Deshoc’).
There is a lot of post-grad teaching conferences. The times vary with each service. There was no bedside teaching (some was available to 4th years), but ample opportunity for clerking and patient management. As with all things your SHO can make or break the teaching value of an attachment. Keep up with the rapid-fire French !
Description of destination: LAUSANNE. Lausanne is amazing. It is a really beautiful city without being too big and having the usual problems. Lausanne is a city of 125,000, in the Swiss canton of Vaud, on the middle of the north shore of Lake Geneva. The city was initially built on the top of a hill. As a result, many of the roads in the city are quite steep, though this does give amazing views of the Alps and the lake. You will need a road map to navigate as the road system is very confusing at first.
Were the locals friendly? The Swiss are fantastic people. Initially they seem cold and stand-offish, but once the ice is broken, you are very well welcomed.
Did you feel safe and if not why not? Perfectly. Switzerland has one of the lowest violent crime rates in the world.
What did you do in your spare time?
Lausanne offers an excellent social life with lots of pubs, clubs, bars and restaurants. Closing time is late (sometimes after 3am) but the drinks can be very expensive. There are lots of things to do here. There is usually a good community feel amongst the foreign students.
Swimming-Hiking-Climbing-Sailing-Skiing-Biking gear is a good idea. There is a very active University sports centre at Dorigny (55+ sports available), beside the lake, about 20 minutes from the hospital. Prices are middling-high for big item sports but many facilities are very cheap. If you want an August holiday, there are a lot of very interesting week long expeditions/ courses going on (Parapent, hangliding, canyoning, climbing). There are many Skiing expeditions (week-end and week long) at affordable prices, especially at the 40 place University chalet at Diablerets. A big swimming pool in the town centre is 2.50Sfr for students. The lakeside has a very pleasant beach and the water can get quite warm at the lakeshore. It isn’t warm if you swim out though!
Is there anything that you would particularly recommend others to do? Work hard, then take time off and enjoy it. To make plans, the AEML are a great help. Association d’Etudiants de Medecine de Lausanne. Go to their website, send them an email and they can help with any questions you might have. AEML@UNIL.CH
What was the climate like? Warm 20-30’C in summer, cold in winter.
What was your accommodation like? I was lucky and rented room in a friends shared apartment.
Was it provided? You will probably be offered hospital accommodation. You may have to ask for this. The accommodation office is in the CHUV. Confirm your home and permanent contact details, sign for your room, sign for your rent and deposit, collect your departure slip (to be returned 30 days before departure).
If not who arranged it? Beware of Madame Sordat; the French lady in charge of accommodation. I have never had to deal with her in an angry mood, but apparently she can be a real bitch. There are several options for accommodation. There are different apartment buildings owned, maintained and rented by the hospital to staff. These are sometimes quite far from the city centre and you need to take the bus to get to work. There is also accommodation for medical students which is just opposite the main building of the CHUV. The Building has just been completely refurbished and renovated. It is definitely your best choice for accommodation. This building is not run by the hospital but instead by student accommodation.
How much did it cost? Other main University accommodation is available, mostly further away. The ground floor CHUV notice boards offer lots of flat shares (especially in August/ September). Rents advertised seemed to be in the 150-600 Sfr/ month range, but I did not explore details! There were some students who self-accommodated.
Did you enjoy your visit? Amazing. What more need I say.
Did you find it useful medically? I was expected to take part as a full member of the team. It was a leap from my previous experiences as a student. This attachment was extremely useful and relevant to my future career plans.
Has it improved your French? You will pick up a lot in a few weeks even if you only have basic French. French was the lingua-franca of all staff and the other exchange students at the accommodation (Spanish and German also a bit, but hardly any English). Hospital teaching is sometimes pretty haphazard and you are often simply expected to keep up with the professor of surgery muttering into his beard or surgical mask (and very rarely, mostly in the ‘Urgences’ (Casualty), some patients in German, Italian, ‘Swiss-German’ and even Portuguese) The Swiss have a reputation in France of speaking slowly ; they are certainly slower than Parisians, but don’t make allowances for a stagiaire’s linguistic ability/inability. Learning and enjoyment of the attachment will be related to your degree of fluency in French. It is also very much up to you how much effort you make. There were many students of all levels of medicine and language ability, the strugglers mostly on preclinical placements. There are French courses available to non-clinical ERASMUS students at the Dorigny campus.
How has it increased your knowledge of French culture? Swiss culture and history are very interesting with many quirks.
If you went back would you do anything differently? No. Perfect combination of interesting work, time off and so much to do; travelling, partying and culture.
How did you get there? Thanks to EasyJet, this is really simple. Lots of cheap flights to Geneva from many UK airports.
What was the approximate total cost? Cheap flights, reasonable accommodation, expensive living costs. £150 + £300 + £500
Is there any other information that you think may be useful?
There is a medical student association, the Association d’Etudiants de Medecine de Lausanne (AEML) who offer social, shop and information services from an office opposite the CHUV library (irregularly 12-14h00 from end October). They organise parties and events throughout the year. It is made up of elected 4th years. They are good at answering specific emailed questions from ERASMUS students or elective students.
There are c.70 overseas medical students who come to Lausanne every year. Most are 4th year (pre-clinical) students, who all start mid-October, and remain various periods, often until May. A significant minority are 5th year (clinical) students (‘Stagiaires’) who work full time with clinical teams as an understudy to an SHO (assistant) and usually for only 4 months. These will be the ones that you will meet if you choose to take your elective at the CHUV.
There is a very good association for foreign students at the university, called Xchange. It is run by a mix of local and foreign students, and organises events, pubnights and trips. Unfortunately it is unlikely to have many events during the summer as the foreign students aren’t there during the summer. http://www2.unil.ch/xchange/index.html
There is a lot of form filling in Switzerland; they almost seem to enjoy it. Before you start work, there are several offices you need to visit, ideally before the first day: Bureau de Gestion de Personnel (BGP) This is beside the CHUV. Here you need to fill in employment, Carte grise (National Insurance Card: You keep this for life if you want to work in Switzerland again) and address details. Have a passport photo ready; though they can digitally photograph you, you can save time because you cannot be photographed until the computer has registered you, and a passport photo can be scanned in without more visits to see if you’re on the system yet. (This can usually be done quite quickly). You collect ID, Cafeteria pass, pay forms, white coat voucher (you must wear the issued short sleeved one) and locker entitlement voucher (Note: Lockers are in short supply, so you’ll have to push to get one). The hospital can issue regulation white T-shirt and trousers (recommended if on a surgery attachment and not to be confused with green scrubs, which are not worn outside theatre).
(Town Centre – Rue de Beau Sejour). You are required within 8 days, to visit the Canton ‘Police des Etrangers’ with passport, a photo, a copy of your health insurance and any of the personalised letters or contracts from the CHUV. They may not need these if the resident permit is ready (for a stay of less than a year), but it will solve any problems. It is a normal condition that you are alone for the period of the attachment, families require a different procedure. You will receive your permis de sejour by post.
There is no National Health Care system! You must have health insurance by law. National health care costs have skyrocketed and it is a BIG topical issue in Switzerland. If you haven’t provided the certificate required, Swiss law requires you to take local cover (A vastly higher premium, (200-300 Sfr /month)!) You can arrange cover by the EHIC (European health insurance card) which you get for free from the post office.