Reporter: Bryan Dunsmore, University of Aberdeen
Contact at Destination: Denis Fouque, Chef de Service de Néphrologie
Year of Visit: January – February 2019
Region: Lyon, Auvergne-Rhône-Alpes
Institution: Centre Hospitalier Universitaire Lyon-Sud
Work/ Study undertaken: Five-week placement in the hospital’s Nephrology Service
CHU Lyon-Sud is in the south-west of the city, reachable from the city centre by numerous bus links and eventually by metro: construction is currently underway to extend the B-line towards the hospital, which will have its own stop within the next few years. My time there was split in two: shadowing in Nephrology inpatients and doing some qualitative research (assessing patient satisfaction) in the outpatient department, known as the Day Hospital, or Hôpital de Jour.
My goals from the placement were to build on my medical French from last year’s AFMS Course and to immerse myself in French healthcare: I am considering moving to France to work in the next few years. Days began at 9am for the handover and ward round. Much like in the UK, this would guide the work required for the rest of the morning, from requesting investigations to discharge planning. In the afternoon, the staff would clerk-in new elective admissions and prepare their digital paperwork for the admission. Like their British counterparts, the interns spent a lot of time doing administrative tasks. During these periods, I would go downstairs to the Day Hospital to seek eligible participants for my questionnaire.
Occasionally, meetings took place towards the end of the day. Journal clubs were refreshingly simple to follow (the staff were encouraged to discuss in English here) but the students’ nephrology tutorials were very challenging – I quickly gathered their theoretical knowledge was much more profound than my own!
Description of Destination:
Lyon is found in the central-east area of France, with a metropolitan population size similar to that of Glasgow. The capital of the Auvergne-Rhône-Alpes region, it features two hills, Fourvière and Croix-Rousse, and two rivers, the Saône and the Rhône, which form a confluence in the centre. There are nine distinct arrondissements, ranging from the bustling “Lyon 2” to the quaint “Lyon 5”. Culturally, the city is known for its ecclesiastical architecture, its wartime heritage as the centre of the French Resistance, and the annual, unmissable, Festival of Lights. I get the impression it is not a well-known destination to British travellers; my time there left me wondering why.
Were locals friendly? Very much so. All hospital staff were really accommodating and enjoyed the cultural exchange that foreign placements bring. Locals outside the hospital were equally friendly; not once did I feel unwelcome or unwanted in Lyon.
Was it safe? I never feared for my safety during the trip. For instance, walking home from nights out within the city limits always felt safe enough; the streets are well-lit and livelier than you would think at those hours. Nonetheless, I would still take the usual precautions you that would anywhere else.
What did you do in your spare time?
My working hours were 9am to 5/6pm every Monday to Friday, with one final free week before (reluctantly!) going home. This wasn’t a great deal of free time, so I had to make the most of it.
I was very fortunate to arrive in January, when a fresh batch of Erasmus students start their semester abroad. Joining in the many freshers-style Erasmus events in the city, I quickly made friends with people from all around Europe and even further afield, many of whom I stay in touch with today. This brilliant cultural exchange was one of the most rewarding parts of the whole elective: it was so refreshing to spend time with a diversely multinational crowd as the only person from the UK.
Together, we sampled the city’s cafes and nightlife (I highly recommend le Sucre, there are also other clubs within the boats docked at the rivers, equally worth checking out), visited the museums when it rained/ Parc de la Tête d’Or when it was sunny, and one day we went skiing at les Sept Laux, a small resort about two hours’ drive from the city centre.
I’d best mention the Lyonnaise cuisine too: it’s excellent. You must visit at least one bouchon if you’re in town (I had a great saucisson brioché at Le Laurencin in Vieux-Lyon).
To give you an idea how much there is to see and do in Lyon, I spent every day bar one of my elective within the city limits, and by the end, I still hadn’t got near the bottom of the list. I’ll be back!
Time of year and climate? I arrived in the depths of Winter (start of January) and left just as Spring was starting to show (end of February). I’d describe the Lyonnaise winter climate as a slightly better version of the Scottish equivalent!
Accommodation? Lyon is notoriously difficult to find short-term accommodation, even if you plan well in advance. For the first half of the trip I stayed with a host family in Oullins through Airbnb. They were incredibly hospitable, and I enjoyed becoming part of the family unit. But location was a big downside: I was far from the action in Lyon proper and the quickest commute to the hospital was a half hour walk. During the second half, I lived in an international student flat in the city’s second arrondissement. Though this meant speaking English rather than French at home (you’ll find, for better or worse, English is the de facto language amongst foreign students), I was able to do much more with my weeknights and weekends. I organised this accommodation through a company called Chez Nestor. It was on the pricier side but unquestionably worthwhile to open the city up to me.
How did I get there? There are weekly direct flights from Edinburgh to Lyon but these did not fall on the days that suited me best. Instead, I flew from Edinburgh with a quick connection in Brussels both ways. It wasn’t any more expensive. Afterwards, I got the Rhone Express to and from Lyon as there were no BlaBlacars available at the time.
I did not feel ready to finish the placement after only five weeks, but the elective was, as hoped, inimitable in observing French medical practice and above all, the working lives of the staff.
Though healthcare provision seemed quite parallel from a patient perspective, the working atmosphere was more upbeat and the team I worked with was very close-knit. Compared to my experience in UK hospitals, the lunch break felt a much more protected part of the day. Lasting an hour on average, the entire nephrology team would dine together, students included, in the hospital cafe, enjoying fresh hot meals with generous staff discounts. In addition, I was pleasantly surprised that most Consultants encouraged a first-name basis. Coupling the convivial lunch, this broke down traditional hierarchies, making for a more positive working day.
But there were similarities. Much like at home, all doctors worked long days (though many consultants enjoyed a four-day week) and the interns complained of difficulties and delays in getting paid their extra hours.
Witnessing these perks and disadvantages of the working life have been useful as I consider the next steps of my career.
Definitely. I started with a decent level of French (around B2) where individual conversations were rarely an issue but following group discussions was difficult. But as you get more exposed to these situations and pick up the terminology, which doesn’t take too long, you notice this becomes easier. Concentrating on understanding complex cases/discussions was difficult towards the end of the day (it is easy to underestimate how fatiguing spending your days in another language can be) but persevering does pay off. Immersion isn’t painless, but it is the best way to learn.
Though it may go without saying, I cannot recommend highly enough the AFMS Medical French Course. I would have had markedly steeper learning curve without it.
Reporter: Samuel Jay (5th year student at Manchester)
Contact at Destination: Organised through UoM, the international mobility officer at Lyon Est is Solange Brandolese: email@example.com
Year of Visit: February – May 2018
Institution: Universite Claude Bernard Lyon 1
Work/ Study undertaken: Neurogeriatrics, Charpennes:
My first placement consisted of four weeks spent on the neurogeriatrics ward at Charpennes hospital. Charpennes is a specialised geriatrics hospital located towards the north of the city, technically just within the neighbouring municipality of Villeurbanne. Charpennes is well served by public transport, on both the A and B metro lines as well as the T1 tram line, making it easy to get to from the majority of the city.
The neurogeriatrics service itself is an 18 bed unit that accepts patients who have had a stroke in the past few days in order to complete their investigatory ‘bilan’ and to medically optimise them before transfer to a rehab centre. Most patients were more or less medically fit and required a stay of around a week, however there were always a few highly complex patients who required much more involved care.
The working day was very similar to that of a UK medical ward with a ward round in the morning and jobs/clerking of admission in the afternoon. Once we were familiar with the workings of the ward the assistant was happy to let us externs see the simpler patients ourselves on the morning ward round, which allowed me to quickly improve my working French.
Neurology, Hoptial Neurologique :
My second placement was on the neuroinflammatory ward at the neurology hospital, which principally treats multiple sclerosis. The Hopital Neurologique is part of the large Groupement Hospitalier Est complex which to the east of the city, technically in the commune of Bron. It is relatively easy to get to by public transport, but certainly more of a hassle than my previous placement in Charpennes. The hospitals in the Groupement are currently only served by a bus from Grange Blanche, where the medical school is located, but the service is regular and only takes 10 minutes. Construction of a tram line to the hospital is currently underway however, and should be completed by the end of 2018.
The neuroinflammatory service mainly takes admissions for investigation of new symptoms and known MS sufferers for treatment of flares. The patient load is quite varied with patients at all stages of their diseases as well as numerous very rare conditions and diagnostic mysteries.
Paediatric nephrology, Hopital Femme Mere Enfant (HFME):
My final placement was on the paediatric nephrology, rheumatology, and dermatology service at HFME, part of the Groupement Hospitalier Est. I am interested in paediatrics as a future career and chose the placement in order to get more exposure, as well as to see how the system works in France. I put the placement last as I thought it would be the most challenging from a French perspective, which proved to be both true and false. On one hand children use a simpler sentence structure than adults and often speak at a slower pace, making them easier to understand. However, a different vocabulary is needed to seem natural with them and gaining the confidence of a shy toddler can be extremely difficult as a non-native speaker.
Description of Destination: Lyon is located in the central-east part of France not far from the alps, at the confluence of the Rhone and Saone rivers. If you include its large metropolitan area it is France’s second largest city, including a large student population of 150,000 split across three main universities. The city is split into three main areas by the rivers that pass through it. To the west is Vieux Lyon, a district of ancient winding streets filled with traditional Lyonnaise ‘Bouchon’ restaurants and one of the principal tourist hotspots of the city. Within the district are many semi-hidden passageways called ‘traboules’ which generally contain beautiful architecture and were historically used as shortcuts to the river and then, later, resistance smuggling and escape routes during the city’s Nazi occupation. These can be difficult to find but are well worth keeping your eyes peeled for. Between the two rivers is the Presqu’ile area extending from Hotel de Ville in the north to Confluences in the south. The northern part of the area is full of grand architecture, museums, and shops, while the southern Confluences area is a regenerated docklands area. To the east of the Rhone is the main working and residential bulk of the city, including the majority of the hospitals. It is also worth pointing out the bohemian Croix-Rousse area on the hill above Presqu’ile, which is full of independent cafes and bars, traboules, fresques, and many panoramic views of the city.
Were locals friendly? French medical students tend to study much more than we do in the UK and are often unavailable for socialising outside of hospital time. In my experience they were all lovely though, as were all of the other locals I encountered. The city is also home to a large Erasmus population, allowing you to socialise with people from all over europe.
Was it safe? As safe as any other major European city: be careful in certain areas in the small hours of the morning but otherwise expect no trouble.
What did you do in your spare time? In terms of things to do in the city, Lyon has plenty. As I have described above there are several distinct areas of the city to explore, full of great architecture and bars/restaurants. The city is also home to some great museums: the unbelievably cheap Carte Musees (€7) gets you unlimited entry to 6 museums, including the Musee de Beaux Arts which has a great collection. Outside of this card there is also the Musee de Confluence which is huge, free for under-25s, and perfect for a rainy day. The Musee de Cinema is also worth a visit if you like films and is in an amazing old building in Vieux Lyon. Lyon was the birthplace of cinema and there are often interesting films being shown across the city with Q&As afterwards with the directors.
Lyon is widely considered the gastronomical capital of France (some would expand that further afield) and the city is packed with amazing restaurants. The traditional ‘bouchons’ of Vieux Lyon are your best bet for local cuisine, although a bit pricey, alongside the massive Brasserie Georges near Perrache. Away from haute-cuisine, the city is also home to the confusingly named ‘tacos’, which is a local invention somewhat like a cross between greek gyros with a fajita. The city is packed with bars to discover and the nightlife generally has a really friendly atmosphere. Once the weather gets warmer, huge numbers of people flock to the banks of the rivers for a few verres, often accompanied by a makeshift cheese board. Finally, if you are a fan of electronic music the Nuits Sonores festival in May is a must. Aside from the official (and rather expensive) events, there are countless free events across the city in some very picturesque settings with great DJs.
Time of year and climate? From the fierce cold of the worst winter on record (down to –8 some mornings) to a month-long heat wave in April/May (~28 degrees).
Accommodation? I personally decided to opt for CROUS student halls due to their low cost (~€260pcm for an en suite) and ease of organisation. However, the University of Manchester as a relationship with Lyon 1 so I don’t know how easy this would be to organise from other institutions.
How did I get there? Flight from London to Lyon. For getting to and from the airport, I would recommend booking the Rhoneexpress online in advance or get a BlaBlacar for even cheaper.
Medically useful? It was certainly very informative to observe the differences in culture between the NHS and France, as well as slightly different was of organising which will give me a new perspective going into my future career.
The culture and environment on the wards is far better than in the NHS. There is a real team spirit that I have rarely noted in the UK, with better continuity of team members and a much flatter hierarchy. The medical team and medical students all take lunch together for at least half an hour, usually more, in the ‘self’ (canteen) which is a really good way to get to know eachother. The downside to the culture is the complete acceptance of very long working hours, 10-12 hour days are very much the norm in all specialities. This in part seems to be due to an inefficiency that I couldn’t put my finger on for the whole time I was there, for some reason most clerical tasks seem to take twice as they would in the UK. Coupled with frequent 24h on-calls, I am unsure how interns in France are expected to have a social life or interests outside of medicine.
French Improved? Absolutely. I began the placement with a relatively good level of French (C1) but still had difficulty following fast conversation on the wards and asking patients more complex questions. Over the course of the placement my oral comprehension improved massively, allowing me to follow all conversations without too much difficulty. I also was able to confidently clerk patients alone by the end, with only the occasional need to ask clarification.
More importantly I think is the familiar language and sentence structure that you pick up when socialising. You can only really get to know a culture through immersion and appreciation of its jokes, puns, and references.
Reporter: Ruth Dodwell (3rd Year Liverpool Medical Student) firstname.lastname@example.org
Contact at Destination: Professor of Neonatology
Year of Visit: 2007
Region: Lyon, Rhône-Alpes region
Institution: L’hôpital Edouard Herriot
Department: Paediatrics (3 weeks) and Neonates (2 weeks)
Work/ Study undertaken: In Paediatrics I was expected to examine children, read their notes and go on ward rounds. Besides this I found plenty of opportunities to play with the children. In Neonates I did the same as the French medical students and was in charge of 4 babies. Each day I examined the babies and then prescribed their feeds and medication. These were checked on the daily ward round and we were asked many questions. Each afternoon I saw follow-up consultations with a variety of doctors.
Description of Destination: Lyon is the second largest city in France and the capital of the Rhône-Alpes region in the East of France. It is situated where the Rhône and Saône rivers join. Lyon is known as the gastronomic capital of France. My favourite speciality was “Tuiles”. These are an almond biscuit shaped like old tiles (or a large pringle!) These were then coated with a variety of delicious toppings from roasted nuts to dark mint chocolate!
Were locals friendly? Yes; they loved the fact I really made an effort to speak their language.
Was it safe?I never felt threatened. I just needed to take the same precautions as I would in any big city, for example I was always aware of my bag and never went anywhere by myself at night.
What did you do in your spare time? Lyon is a fantastic city to explore. They have a system called “velo-v” which enables you to borrow a bike from a station and drop it off at another within half an hour for only 1 euro a week! This was amazing because I could easily and cheaply visit Lyon. I also enjoyed using Lyons 50 metre outdoor swimming pool besides the river Rhône and running around the “Parc Tête D’Or”. The family I stayed with were very friendly. I spent much time chatting, cooking dinner, going shopping and generally joining in with family life. I particularly enjoyed working with their eldest daughter who was a student midwife. We spent several hours reading English articles that she needed to summarise in French. This was brilliant for both of us as we struggled to understand and explain them across the language barrier. We got on so well that I’ve even been invited to her wedding next summer!
Time of year and climate? June-July. I found it hot and certainly needed a fan in my room at night. The French however were moaning about the bad weather this year. I always needed an umbrella with me.
Accommodation? I stayed with the Professor of Neonatology, his wife, who was also a consultant paediatrician and their 3 children (23, 20 and 17).
How did I get there? I flew from London Stansted to Lyon with Easy-Jet.
Medically useful? I learnt a lot from this elective. For example, in paediatrics I saw several children with liver transplants. Most of them had received part of a liver from a living parent. Several children had rare metabolic diseases. These were mainly due to consanguinity; something I have never really thought about asking in a history! During neonates I was shown how to thoroughly examine a newborn baby. Particular emphasis was placed on the different reflexes present such as the Moro, suckling, rooting and stepping reflexes.
French Improved? I learnt a great deal of medical vocabulary whilst in hospital. By the end I was following the ward round well enough to be able to answer some of the questions and be in charge of noting the changes in feeds. I also became much more confident in conversational French from the many hours I spent talking to the family.
Overall Cost? About £400 for travel and food.
Year of visit: 2003
I worked in the Rheumatology Service of the Hôpital Lyon Sud in the firm of Prof. Vignon, a colleague of Prof. Doherty, professor of Rheumatology in Nottingham.. I had arranged to observe the work in the department which involved sitting in on clinics, watching the osteopath at work, going on ward rounds and learning about treatments such as traction, lumbar punctures and densitometry. I could have done more such as performing lumbar punctures, clerking patients etc. but no-one seemed to mind that I didn’t. French medical students only work in the mornings so I followed suit. I took a fair amount of days off, travelling around and they really didn’t mind that either. It was an entertaining department to be in and I learnt a fair bit of Rheumatology as well as seeing some interesting patients. Perhaps 5 weeks is too long to spend in one department.
Lyon is a beautiful city, well situated for the South and Paris (both 2 hours by TGV) as well as the Alps. You can reach Geneva in less than two hours by train. It also has a reputation for food and you can eat remarkably well for very little. The city centre is crammed full of bars. French medical students like their English counterparts enjoy a good night out: cheap alcohol, pissed dancing and stripping-off. The Lyonnais are friendly: people come up and talk to you in the street. You will get more from the city if you go with someone else – there is only so much you can do on your own.
My French was about A-level standard before I arrived. You can get away with a much lower standard. All doctors, most medical students and some patients speak English and your standard WILL improve.
Plan Ahead. Accommodation is very expensive and difficult to find. There is a youth hostel which is cheap but you’ll be sharing with other people. The centre international de sejour offers cheap rooms (30 € ) and food (evening meal ~6 € ) and is close to the centre of town. Begin by contacing the CROUS, a student accommodation service. Don’t bother writing or emailing but ring them up. They are useless but will send you a list of some contacts. You may want to lodge with a French student – which I did for a fortnight – it’s much much easier to organise this once you’re there as you’ll have an idea of where you want to be and who you want to live with.
Lyon has a small metro system and good bus links. The hospital is served by 2 bus links from the city of town. Buses aren’t too regular (~2 per hour) and most French students use their own cars to get to the hospital.
Lyon was experiencing a heatwave (30°C) with weather that they usually get in the Summer so be prepared to get a suntan. But equally, be prepared to be rained on.