French connection
Victoria Greeves writes about her experience on Bristol's European credit transfer scheme
Smugness enveloped me as our plane touched down in Strasbourg in January. I and three friends were about to spend three and a half months doing our orthopaedic and care of the elderly attachments in the heart of Europe, through the European credit transfer scheme (ECTS) offered by Bristol University.
A stone's throw from the Vosges mountains and the Black Forest, and steeped in Franco-Germanic history, Strasbourg is situated on the river Il, a tributary of the Rhine. The large Pont de L'Europe provides the quickest escape over the river into Germany though there is no need for such escape. Strasbourg boasts more miles of beautiful waterways than Venice and its beautiful twelfth century cathedral stuns all who stop to admire it.
The European parliament is another central feature of this mid European city. Opinions of it depend largely on your taste in architecture, but I found it stunning on bright days when the sun reflected off the water into its gleaming windows.
Our accommodation was basic; window sills made good fridges in January temperatures although we hadn't accounted for the birds--Strasbourg's indigenous stork population. We fell victims to diving swoops whereby entire milk cartons and yoghurt pots were stolen or knocked to the floor. With no fridge or oven facilities on our arrival, we wondered how we were going to sustain ourselves for three months. Fortunately, the problem was quickly rectified and we enjoyed many a happy meal, fortified by our recommended daily allowances of good French wine.
French patients enjoy greater respect
Spending time in Strasbourg hospitals convinced me that the French really do have their health care and hospitals sussed. Patients have their own room or share with someone of the same sex. Doors are kept shut and even the chef de service (consultant) knocks before entering. Everyone has a phone by the bed, good television access, and greater respect for their dignity than any patient can hope for in Britain. Between midday and 4 00 pm doctors go home for a three course meal and return to finish their working day between 4 00 pm and 7 00 pm.
Of course, all these seemingly superior aspects of French health care do not come free. The system is partially privatised and patients contribute towards their government subsidised treatment. This is a sensible way to run things--the standard of patient care is greater, doctors are not rushed off their feet, and patients can expect a certain level of treatment because they are paying. The only draw back is that there is a high level of unemployment among French doctors.
The route into medicine in France is long and tortuous--anyone can apply and begin the course of basic medical sciences. Thousands of hopefuls begin in the first year and most of them resit it at least twice! Only a minority are accepted into the second year where the same thing happens all over again. If you make it into the third year you have done exceptionally well...and are probably approaching 25.
The clinical years in France are also different from those in Britain. The students choose which specialties they want to do and spend a minimum of four months on a placement. This has its advantages if you particularly enjoy a specialty but if you are late to sign up it can be four months of boredom, doing something you don't like.
Students are part of the team
French medical students are considered part of the care team. They assist the house doctors and it is their responsibility to take the blood pressures and arterial blood gases; they perform venepuncture, order x ray examinations, and chase up blood results from the previous day. Students are paid; it's effectively their job and they quickly become expert in clinical skills and gain a thorough knowledge of the patients. Unfortunately, they do not get as much attention from the consultants as we do, formal teaching sessions on the ward being few and far between. Each hospital does, however, provide their students with two or three seminars a week.
Our time in Strasbourg was an exciting and educational experience that provided a real insight into a different kind of health system and a different culture. We were privileged to spend time in such a beautiful place and to be able to improve our linguistic skills in a professional environment familiar to us. We picked up the French medical terminology quite easily, most of it being very similar. One of the funniest moments on the wards was discovering that the word for a fungal infection in French is "champignons"--yes, the literal translation in English is mushrooms!
ECTS placements are an opportunity that most UK medical schools do not provide. Perhaps British students are deemed too incompetent at foreign languages to be able to cope with such an experience--a fair assumption I admit--but it is an interesting and exciting opportunity for those who take part.
Victoria Greeves, fourth year medical student, Bristol University Medical School
Email: vicgreeves@hotmail.com
studentBMJ 2001;09:443-486 December ISSN 0966-6494
