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January 2014, Volume 64, Issue 1

Student's Corner

Neurology elective at The Royal London Hospital

Ramsha Zaheer  ( Editor, Student's Corner, JPMA. )

Students are often advised to do electives abroad and not just to add the experience on their CV. It is an important experience to observe how the healthcare system and the doctors\' attitudes differ from the ones here in Pakistan. I had applied to Barts and The London School of Medicine and Dentistry in the department of neurology, and got an attachment at The Royal London Hospital. My consultant was extremely welcoming and one could not ask for a better mentor, as not only did he give me an organised schedule that I could follow and would help me make the most out of my electives period, but he also advised me on the places I should visit while I was in the city.
The first three weeks were straightforward, in which I had the opportunity to attend hospital teaching sessions with other students, shadow an on-call registrar (reg) or senior house officer (SHO), attend ward rounds and meetings with plenty of opportunities to clerk patients, watch interventional radiological procedures, and visit clinics of different consultants, who had their own sub-specialty within neurology, such as epilepsy and multiple sclerosis. The teaching sessions, which would be the ratio of three students to one consultant, or sometimes just one for me, would be absolutely brilliant, and that is when I realized that these doctors were in this profession for their absolute love of medicine and nothing else. When taking a bedside class, they would not only correct your history and examination techniques, but also take you down the history lane while discussing the basic pathophysiology of a particular disease and discuss how a particular drug was discovered or how a particular neurological sign was figured out. On the session where the doctor was teaching us how an EMG (electromyography) works, and the physiology behind it, he would do the test on us - that makes it quite difficult to forget the rate of nerve conduction for each muscle! The clinics were also an excellent opportunity to learn and to brush up on your history and examination skills. The consultants were always gracious enough to discuss the case for a few minutes before the next patient, and to answer any questions I would have. It was not only the theoretical part of the clinics that was important, but to observe how the doctor conducted his consultation especially in cases of chronic diseases and on breaking bad news.
Every Thursday, there would be multidisciplinary meetings, which included neuroradiology meetings, case presentations, and neurovascular meetings and audits. These would sometimes also include an outside speaker. I was lucky enough to attend one such lecture by a professor from Cambridge University who spoke on autism and how it is an extreme form of male brain profile, and discussed his researches. What is admirable about these meetings is how doctors can get along and discuss difficult cases with each other - not only does it refresh everyone\'s memory but they get to learn something new every time.
No matter how informative my first three weeks were, the last week was the most exciting as I was rotating in the stroke unit. This meant that I received my own bleep, therefore every time there was an emergency call, I would rush down with other SHOs on-call, and had ample opportunity to see and learn how to manage stroke patients in the emergency. The department was great and they would make sure that I felt like I was a part of their team.
If you want to get into a good elective programme, do the research for it as early as possible. Start planning a year ahead as most electives have deadlines at least six months prior to their beginning. Be warned though that more the competitive programmes will have their deadlines one, or even two years earlier. A wealth of information can be found online; visit the official websites of the hospital or medical school and find and email the elective coordinator or a consultant for more information. Email at least twice before calling them to get a response in case they do not reply the first time. The application process is usually straightforward; again it would vary between colleges and hospitals. After that, one has to play the waiting game; it took a month for them to reply to me with a positive response.
For the visa, it is recommended that you apply as soon as possible, to avoid delays. Check the official visa sites for the application process as they are always updated and reliable. For UK visas, it is best to apply three months in advance. Make the checklist of all the documents required and give yourself at least one month to collect them. After the submission, it took just ten days for the student visa to process. As long as the documents are complete and you have proved to them that you have a strong reason to return, the visa should not be a problem.
As far as the tourism part of the experience is concerned, one can never go wrong with London as a choice. From the usual tourist places like the famous wax museum, to aquarium and zoo, it would be wise not to forget that Britain loves its history and has massive green spaces - try to check out as many parks and museums as you can. They are interesting and with a free entrance. If one can be wise with managing their expenses, it is always possible to get a good place to eat and enjoy a play at the West End on your night off!
An elective abroad is a very enriching experience with a good learning opportunity along with a simultaneous holiday. You have to strike a balance between the two and enjoy both.

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