Travelling man

Tim Killeen spent a year abroad as part of his medical education. He is now back home and gives some practical advice on setting up your own Erasmus exchange

The hospital must surely be getting close…

Since its inception in 1987, more than a million students in 32 countries have taken advantage of the European Union's Erasmus exchange programme and have lived and studied at universities in other member states (box). ¹ Named after and inspired by the 16th century Dutch theologian and humanist who travelled and studied all over Renaissance Europe, the European Union funded scheme is designed to encourage the mobility of European citizens within the union.

British medical schools are slowly realising the value of time spent abroad as an undergraduate, and several offer short, Erasmus funded opportunities in Europe, usually as a student selected component at an established European partner university.^2–4 For most medical students, however, the typical year abroad available to students in other faculties is simply not on offer, due in part to the inflexible and highly structured nature of medical courses in the United Kingdom. That said, accounts of such exchanges do appear occasionally in the literature, proving that with enthusiasm and perseverance it is possible for students to arrange and participate in highly rewarding programmes abroad. ⁵-⁶

Studying medicine at the University of Tübingen in southern Germany between my third and fourth years has been the highlight of my medical education so far. I returned to Leeds with my ideas about everything from doctor's working hours to abortion having been challenged by participating in a system that made me think differently. I learnt a new language, gained experience in many clinical specialties, and broadened my horizons through contact with students and healthcare staff from Germany and all over the world.

My first semester consisted of various language courses and a limited timetable of medical lectures and seminars in neurology, forensic medicine, and tropical medical research. By the second semester, I was confident enough to start hospital based teaching (Wochenpraktika), in various specialties, roughly comparable to fourth year clinical medicine in the United Kingdom.

By the end of the year, I was comfortable assisting in operations, taking histories, and examining patients in German, although the thick Swabian dialect used by patients from the more rural parts of the region still left me bewildered at times.

This had all seemed very unlikely 18 months earlier, as I spent the long, dark winter in Leeds sifting through conflicting and confusing advice and regulations in a bid to set up the exchange. This article aims to clarify the steps that individual UK medical students wishing to study in Europe need to take in order to set up Erasmus exchanges.

Setting up your exchange

Timing

It is technically possible to study abroad between any two years of your course, but it is the clinical years when the benefits of overseas experience are most obvious—interacting with and learning from healthcare workers and patients in a different health system.

Study abroad office

This is the place to start. The support of your university's Erasmus coordinator is vital, and their level of helpfulness and enthusiasm will be key. They should be able to supply you with contact details of their counterparts at the universities you are interested in, and once you've had a positive response from your target university abroad, will process most of the bureaucracy for you.

The medical school abroad

Many UK universities already have institutional links with European partners in several countries to which they regularly send students from various faculties, and it can be a good idea simply to approach their medical school because expanding existing links can be easier than starting a fresh one. Failing that, European medical schools are generally very keen for their students to gain ex­perience in English speaking countries, so the offer of establishing a new exchange is often met with enthusiasm. In either case, make contact by identifying and sending an email to the Erasmus coordinator at the university abroad, who will direct you to the appropriate contact at the medical school. You can decide with them which semester to join and which courses to take.

Your medical school

Even the most supportive subdean can have reservations about the idea of initiating an exchange with a foreign university, so being clued up about the technicalities of Erasmus is essential before your first meeting. Most bureaucracy is dealt with by experienced staff at the Study Abroad Office, although some involvement from senior staff will be necessary.

Students are exchanged on a one for one basis, although many European universities operate a two semester year, and may prefer to send two students for half a year each. Financially, the medical school does not lose out; it receives the same amount of money as it would do if you stayed in the United Kingdom. It is standard practice to initially arrange exchanges on a trial basis for one year only, so there is no risky long term commitment. Also, the quality of students from the partner university is usually extremely high as the premium placed on studying at an English speaking institution results in competition for places on the exchange. By hosting a European exchange, your medical school can make itself more attractive to potential students and underline its international credentials.

Finances

Studying in the European Union on an Erasmus exchange is free. You pay no tuition fees to your host university, and if you spend the full year away from your home university you pay none in the United Kingdom. Grants are offered to all participating students—in 2004-5 it was about £96 ( a140; $170) a month.⁷ Medical students, along with all non-language students, are also eligible for £275 to pay for private language courses in addition to the free Erasmus language courses provided by your host institution. You'll still be eligible to apply for the full student loan from your local education authority. It has recently been confirmed that a full year Erasmus exchange is counted as a year of study by the NHS bursary in the same way as an intercalated year—a government grant available to UK medical students from their fifth year of study onwards. More information is available at www.erasmus.ac.uk and www.europa.int/comm/education.

Language

Most medical schools in Europe teach in the local language, although there are exceptions where courses are delivered in English or German, the former in Scandinavia and the latter predominantly in eastern Europe. A basic grounding in the local language is essential; opportunities to improve on this, in the form of intensive pre-semester language courses, are easy to find, and are subsidised by Erasmus.⁸  A minimum of an A level is recommended (advanced level UK exams, taken at 18), but a good GCSE (ordinary UK school leavers exams, taken at 16) pass and hard work and commitment on the language courses can suffice.

For some medical students, studying an additional year of medicine abroad through Erasmus can be a challenging and exciting alternative to intercalating or progressing directly with their medical course in the United Kingdom. Living and studying medicine in a new environment exposes students to new clinical methods and ways of thinking as well as equipping them with invaluable linguistic and interpersonal skills. Setting up such an exchange requires initiative and perseverance, but the rewards are immense and lifelong. The situation at different medical schools may vary somewhat, but the information in this article should provide a good base from which to start.

Competing interests: None declared.

Tim Killeen , fourth year medical student, Leeds University
Email: ugm1tjk@leeds.ac.uk  


studentBMJ 2006;14:133 - 176 April ISSN 0966-6494

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