My colonial medical elective

Now that I’ve finally completed the Sydney Medical Program, it’s about time that I finally post some long-overdue reflections on my elective terms in London and Hong Kong at the start of the year.

The Royal London Hospital (Barts and The London, QMUL)

The Royal London Hospital

My first elective term was spent at The Royal London Hospital under Barts and The London School of Medicine and Dentistry (Queen Mary, University of London). The Royal London Hospital is a 650-bed tertiary hospital and the principal facility of the Barts and The London NHS Trust. It is particularly known as one of London’s major (level one) trauma centres and the home of the London Air Ambulance (Helicopter Emergency Medical Service), however a full range of medical and surgical specialties are represented.

Drs Po and Preston

I was assigned to the gastroenterology team under consultant gastroenterologist Dr Sean Preston. He was an excellent supervisor and I was lucky to have spent quite a lot of time under his guidance during my elective. Dr Roocroft (the F1 house officer) was also a great mentor, teaching me the ins and outs of being a house officer in the NHS.

Work casual

Work attire in NHS hospitals is very appropriately guided by infection control considerations. In summary:

  • no tie
  • sleeves rolled-up to elbows
  • no watch (most male doctors wear their watch on their belt)

The Royal London Hospital

The logic (and comfort) of this policy was such that I continued with this after returning to Sydney, where it was still convention for male doctors to wear ties.

Speaking English

There were a few differences in the medical vocabulary used in the UK, which took a little while for me to get used to. The most prominent ones during my elective were:

bleeper – pager
phlebotomy – venepuncture
OGD (oesophageogastroduodenoscopy) – endoscopy
TTA (to take away) – discharge summary

EastEnders

I alluded in a previous post that I lived in hospital accommodation. Indeed I found myself living in John Harrison House, The Royal London Hospital, Whitechapel E1 2DR for the duration of my stay in London. Whilst relatively cheap (approx. £100/week), it was rather spartan. One of the other JHH residents described living there as punishment for his sins, whilst more colourful language was employed by one of the senior registrars.

One of the unexpected consequences of living in Whitechapel, with its majority non-white population, was the difficulty I had in trying to find a decent full English breakfast. Despite there being half a dozen (halal) fried chicken shops on Whitechapel Rd alone, there were very few decent cafés in the area. Spotting a modern-looking café on New Rd advertising that they served “English breakfast”, I stepped into Zaza’s Café (E1 1HJ)… only to realise that they served a halal version of English breakfast: smoked turkey, beef sausage, egg, baked beans, mushroom & toast. It wasn’t bad, but it’s just not the same! Thereafter I quickly learnt the Arabic characters for halal (حلا).

Queen Mary Hospital (HKU)

My second elective term was spent at Queen Mary Hospital under the Faculty of Medicine, The University of Hong Kong. Queen Mary Hospital (est. 1937) is a 1400-bed tertiary hospital and the principal facility of the Hong Kong West Cluster, with a catchment area population of over 500,000 people.

Queen Mary Hospital, Hong Kong

I was attached to a final-year group undertaking their Specialty Clerkship rotation. This works rather differently from the way our attachments work during clinical years – instead of being attached to a specific medical/surgical specialty team for the duration of a clinical attachment, each group of HKU students is allocated to one general medical ward where they’re expected to clerk patients (with seemingly little direct role in patient care). They take part in case discussions, PBL tutorials, and clinics with consultants from different specialties over the course of the term. Often ward-based tutorials were quite crowded, particularly with the confined spaces inside most hospital wards in Hong Kong (see pic below – I wasn’t standing at the back).

Ward tutorial, QMH

Masquerade

I was in Hong Kong during the 2009 influenza H1N1 “swine flu” pandemic. Following their experience during the SARS epidemic, all Hong Kong hospitals had activated what they termed “pandemic emergency response level E2”. One of the E2 requirements was that a surgical face mask was required in all clinical areas – effectively meaning that staff/students had to wear surgical masks all day!

Emergency E2 clinical attire

White coat syndrome

In total contrast to NHS policy, Hong Kong clinical attire convention was still very conservative and included the wearing of a “clean, white laboratory coat”. I’d never previously worn a lab coat in the clinical setting, but noticed two advantages: (i) it was handy having large pockets in which to put my stuff (e.g. Oxford Handbook of Clinical Medicine), and (ii) I got my student/staff discount at the hospital cafeteria and Starbucks without having to show any ID. Nevertheless, once I returned to Sydney I greatly appreciated not having to wear a lab coat.

HKU Specialty Clerkship group a/b, 2010 rotation 1

Finally, I’d like to take this opportunity to acknowledge and thank the Specialty Clerkship group to which I was attached – Fifian, Jimi, James, Vincent, Rosemary, Edgar and Sha Sha – for helping me to fit-in and manage the language barrier.

19 thoughts on “My colonial medical elective

  1. Hey Kieran, have been following your blog for quite some time. But this’ll be my first post!

    Out of curiousity, for your HKU student elective, did it take long for them to approve whatever rotation you chose?

    Thanks heaps!
    rex

  2. I don’t remember exactly unfortunately, but it was probably at least a month or two?

  3. Hi Kieren,

    Sounds like a great elective at The London… I’ve actually been accepted there for 2012 myself, doing Neurology. A question if I may, about the accommodation there – was it decent enough for a month-odd stay? I’m thinking of contacting them and seeing myself if it’s available, but am both unsure of whom to speak with (the trust website’s a little spartan!) and just wanted to know what kind of facilities are included in John Harrison house. 🙂

    Cheers!

    -Ben

  4. Yes, it’s decent enough and the price is hard to beat. If it helps, it was comparable to a typical residential college room at USyd, UQ or UTAS. You share a bathroom/toilet with your neighbour (you may need to buy a shower attachment for the bath). There’s a communal kitchen per floor (though there was no cutlery/crockery/cookware supplied when I was there). The nearby Sainsbury’s supermarket will quickly become your friend. In terms of who to speak to, just ask the electives coordinator or the residential manager at the medical school for the details of the residential manager at the hospital/Trust. Good luck!

  5. hi 🙂 I stumbled upon your blog post! Just wondering if you could give me some help. I’m going to HKU to do the same medical elective as you this summer! ( dept of medicine and dept of surgery) I was wondering how many hours you were in per day and also did you find it really difficult with the language barrier? I am fluent in conversational Cantonese but I wouldn’t be comfortable taking a history on my own!

    Ani

  6. Your mileage may vary, but I remember spending between 4-6 hours at QMH most days. The language barrier was only an issue when trying to communicate with patients (teaching/tutorials/professional communication is in English). Fluent conversational Cantonese should suffice most of the time, but if you get stuck the local students are a great help.

  7. hi! jus saw ur blogpost and was wondering how you applied to st barts as well as hong kong and what time period of the year you went! i am an aussie student too and im in abit of conflict wondering if i should go to uk or hong kong. i cant speak any canto at all so its good to hear the tutes are in english. however speaking with patients will definitely be a problem, is that going to affect the elective alot?

    also in terms of which elective u liked better? which one had more hands-on practical stuff and you mentioned dr preston is relly nice and knowledgable. what about the hong kong doctors. also what about the environment in the uk, were the students nice? from your hk pics i gather there are mostly asian students there?

    thanks alot!:D

  8. I applied directly to the respective medical schools (Barts and The London SMD and The University of Hong Kong). I think Barts now requires you to apply at a certain time before your intended elective – best to check their website. I went to Barts over Christmas/New Year, which was perhaps not ideal because there weren’t really any local students around. The students I did meet were nice – much like Australian med students.

    Yes, HKU is pretty much entirely Asian students (including elective students). It’s not impossible as a non-Cantonese speaker (and there was one from the UK when I was there), but it does mean you pretty much won’t be able to speak to patients – not necessarily a bad thing if all you’re after is tutes/teaching (which are good) and clinical signs (more than you’ll find in an Australian tertiary hospital). Senior doctors in Hong Kong will generally be a bit more distant than you might be used to (it’s a more conservative work environment).

    I preferred my elective at Barts because of the hands-on style, but your mileage may vary.

  9. I was wondering where you stayed during the elective in Hong Kong and how much you paid for the accommodation?

  10. I stayed with relatives during my elective. HKU’s medical school has a residential college (Madam SH Ho Residence for Medical Students) but I don’t know how much it costs to stay there.

  11. hello, JK and Kieren, I am a medical student from HKU (when you were in Queen Mary Hospital ,I was in my year 2 haha! but I do recognize some of the students you met)

    JK,
    I lived in the Madam SH Ho residence for Medical Students , well, for local students I know it charges about 40 HKD per day. And I don’t think it would be too much different even if they do really charge exchange students more ( I dont know if they do). Simply I think things in HK don’t charge as much as UK does.( no offence haha!) . If you need , I can just call and check it out for you. Basically I am around there every day.

    But the environment is so-so. You got one small bed ( can have lengthened version of bed if you are tall, but only 2 such beds available in this hall, so you hv to fight if you are this tall.) ,one water tap, also one table with some drawers, and one wardrobe in there. Overall speaking , dont open the window becoz usually variable species of bugs will try to fly in ( becoz some trees are around there). Toilets and 2 bathroom(small) and one pantry each floor.
    Usually the elective students coming to HKu will choose to stay at their relatives( if they have).

    For your language problem , no worry! this year in my class there is one Australian girl who is a native english speaker, dont know chinese at all, she was under our great help and not felt ignored. Generally speaking, we are very friendly towards elective students, at most some of us will be quite shy if your english appears very fluent. The only thing is you will be quite bored in ward round because some of the physicians they tend to add many chinese into the talking between the doctors. So that Australian girl basically learnt nothing in the rounds. But all the stuff is written in English though. Thats really our official language for learning and practice. That’s no worry. And you can clerk patients who can speak English ( well. 1 or 2 patient per ward you can find ). Or you can just follow us. We can translate it for you.

    Kieren,

    it is so nice of you typing the experinece in Barts in such details. Thank you! But then I still got some problems in thinking about doing medical electives in UK ( esp Barts , where I am now seriously considering ), hope you can help me answer them if they dont trouble you much!

    1. I saw on the website of Barts, they say if the applications are so full now , so if i want to apply for elective next year, I may have to wait for July when they re-open the application process , I wonder if it would be too late if I apply at that time?

    2.Did they process your application fast? Because in HKU, they require me to hand in the letter of confirmation in September. Quite rush!

    3.Some UK people just do not reply emails( for example Imperial ..i sent it twice but no reply), I wonder if it is also a problem in Barts?

    4. I am gonna stay for 4 weeks elective,do you know if I can choose 2 weeks in one specialty and another 2 weeks in another sepcialty ?

    5. Probably I will be travelling alone to UK to do this attachment, do you think the safety around the Barts is okay for one-girl travel? Also is the view around the hospitals beautiful? because I probably have 2 aims for this trip- learn and play.

    6. Is the supervisor strict in terms of time that I have to spend in wards and rounds ? I plan to show up 3-4 days per week and the rest of time spent on travelling.. do you think that is possible?

    7. At last , are there chinese / asian students stuyding in Barts?

    Many thanks!!! I desperately need opinion now!

  12. Hi Corrs,

    Things have changed a bit since I did my elective there but I’ll see if I can help:

    1. Yes they have a set application period now, so I’m not sure if you can make a late application (unlikely).

    2. From memory it took Barts about a month to approve my application.

    3. The Barts electives coordinator at the time was quite good at replying to emails. Some of the other staff took a bit longer…

    4. I’m not sure, you’d have to check with Barts.

    5. The Royal London Hospital is in Whitechapel, which is quite a deprived area. It’s fine during the day, but I’d be wary at night. I also wouldn’t describe it as a beautiful area, though the new hospital building and the new medical school buildings have nice designs, and you get a good view of “the Gherkin” building when you’re standing on Whitechapel Rd.

    6. It depends. My supervisor and registrars were very understanding. Most British doctors will be similar, but of course it’s not guaranteed.

    7. There are some east Asian students at Barts, but not as many as you might find at, say, a typical Australian medical school.

  13. I enjoyed reading about your elective I’m a student at Barts. Just to let Corrs know, we have moved into the new Royal London hospital now. Some of the email addresses and phone numbers have not been updated so it may be worth phoning the hospital and checking contact details.
    Electives at the London seem to be greatly enjoyed. Very relaxed as you are left to your own devices a lot of the time to plan your own combinations of clinics/ surgery etc.
    Dawn

  14. Hi Kieren,

    I’m considering HK as an elective option, and I’d really like to know what it’s like from an educational perspective.

    For example, if I chose the Accident & Emergency or Surgery electives, how much hands-on experience do you think I’d get? Is it mostly just observation, or do they let you independently see patients and learn some procedural skills?

    Thanks heaps!

    Jenna

  15. Hi Jenna, I’m not sure as I did a general medicine elective. Given my overall impression of HKU electives, however, I would say that there’s certainly an educational focus but it’s likely to be less hands-on than in an Australian or UK hospital.

  16. Hi Dr. Kieren,

    I’ve just received an offer to do my elective in General Medicine at HKU. Though Psychiatry was my first choice, I’m still glad with this outcome.
    Initially, I was expecting to be accepted into at least 2 departments, can then I split my elective attachments throughout.

    I fathom that your elective experience at HK could be eons ago, but I’ll be very grateful if you could clear some of my doubts.

    1. Did HKU require a Medical Malpractice Insurance during your time there? That was said to be available from our home med school but what can be done if that’s not the case?

    2. For other insurance policies (life,disability,medical) needed, we will have to prepare them ourselves right?

    3. How can we prepare for the electives? (e.g. attire / working and learning culture at HK / anything to read prior etc)

    I’ll appreciate any other advice prior to my elective attachment at HKU.

    Many many thanks Dr!

    Warmest Regards,
    HM

  17. Hi HM, yes it was a while back (4 years ago) but I’ll see if I can answer your questions…

    1. Yes, they did require something of the sort. My medical school had an indemnity policy that covered us, but there were also some cheap (or free) policies available from the main Australian MDOs.

    2. Yes, you’ll have to sort out the other required insurance policies yourself. Travel insurance should suffice (depending on the policy obviously).

    3. Can’t think of much specifically to prepare for an elective there (so long as your have some understanding of the culture). Attire is quite traditional compared to Australia/UK (see photos above). Bring your own (clean) lab coat. Likewise the educational and work cultures are more conservative/heirarchical than in Australia.

    Hope that helps.

  18. Hi Dr Kieren,

    It’s me again. Everything has settled except the student visa.
    Did you apply for a student visa back then for your elective in HK, even though your nationality might not require a visa (which varies from the student visa) to enter HK,

    I’m from Malaysia and since Malaysians do not require any visa to remain in HK up to 3 months, I’m thinking should I just skip the student visa application with the reason of entering HK for leisure purposes instead of education.

    Your advice is appreciated with many thanks. Hope to hear back soon.

    Regards,
    HM

  19. Hi HM, I cannot advise about your exact situation but generally, in most countries, student visas (or similar) are required for overseas elective programs.

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