Columbia University, New York City (USA)
Impressions of Columbia
- Michael Spies – medical student from Sydney Medical School, undertook an Elective with Columbia University in 201213
- Samantha Dingwall – medical student from Sydney Medical School, undertook an Elective with Columbia University in 201112
- Victoria Bond – medical student from Sydney Medical School, undertook an Elective at Columbia University in the USA in 201011
- Chris Dwyer – medical student from Sydney Medical School, undertook an elective at Columbia in 200910
- Daniel Raper – medical student from Sydney Medical School, undertook an elective at Columbia (USA) in 2010
- Georgia Ritchie – medical student from Sydney Medical School, undertook an elective at Columbia (USA) in 2010
- Kirsty Benton – medical student from Sydney Medical School, undertook a placement at Columbia University in 20089.
Michael Spies - medical student from Sydney Medical School, undertook an Elective with Columbia University in 201213
My time at Columbia University Medical Centre was one of the best experiences I have enjoyed during my time at medical school. From day one I was challenged to become a part of the consulting team, and given a far greater level of responsibility and expectation than I was ever allowed in Sydney Medical School affiliated clinical placements. I was challenged to adapt quickly, and to be autonomous in my efforts towards learning and patient care, while receiving feedback at least on a daily basis.
With this level of expectation came respect for the work that a medical student could undertake, and the value of that work to the functioning of a medical team as a whole. I felt accepted, involved and stimulated each day. With this position on the team I gained confidence, a greater sense of what it means to practice medicine, the art of medicine itself, and better framework for approaching learning and problem solving in medicine.
In addition to these factors, I gained an understanding of what makes the health care systems unique, and which factors within these systems are beneficial or undesirable. It was invaluable to have the opportunity to compare the Australian and United States health care systems, and the effect that such a construct has upon individual patient care.
This experience has led me to have higher expectations of myself, while gaining the confidence to approach situations that will allow me to fulfil these goals. I felt a great sense of achievement at the conclusion of this placement. I had learnt an incredible amount, not just academically, but also about the art of medicine. I also made some great friends along the way, who not only taught me, but respected my input and were welcoming when I was assigned to their medical teams. I would like to take this opportunity to thank everyone involved in the organisation of my placement. It truly was a wonderful and invaluable experience which I will always hold as a crucial part of my medical training.
The key cultural lesson I learnt was that the structure of healthcare system in which someone lives can have an enormous impact on their individual patient care. This holds true when comparing the systems of large countries developed countries such as Australia and the United States. I also learnt that grasp of a patient’s first language is very helpful in taking a good clinical history; and that the utilisation of Spanish phone interpreters, while somewhat useful, left a lot to be desired within Manhattan’s Washington Heights Latin American population.
I undertook a split elective in New York. The first was an elective in Emergency Medicine at Harlem Hospital. I had no idea what was in store for me here when I chose ER at Harlem Hospital as my first preference. The hospital setting became one of the most important influences of my time here. Harlem Hospital serves a largely impoverished African American community. Many of the patients I saw lived in shelters and housing commissions. This setting provided me not only with exposure to both acute and chronic medical conditions but also with an insight into the social disparities in USA, and the frustrations of working within the medical system in New York. Some of the most interesting things I learned in this rotation came from listening in to the doctor’s corridor-conversations about the health care system. I also got some great hands on experience particularly in the night shifts, in which I was often able to suture stab wounds and witness the emergency management of gunshot wounds and other trauma cases. Finally I came away with much more confidence in taking histories and performing examinations, as this made up the bulk of my day-to-day work here.
My second elective was in Transplant Surgery at New York Presbyterian Hospital. In this elective, I became very frustrated with the limited involvement I had with the surgical team’s work. I spent most of my time standing and watching surgeries, and was only able to assist a handful of times within the month. However, this is not representative of the other medical students’ experiences. I spoke to others who were attached to other teams who had a much more challenging and hands-on experience. I derived most of my learning from attending all of the lectures and tutorials offered to the Columbia University medical students. These intensive sessions really provided me with a much stronger grasp of concepts in general surgery, which is one of the things I hoped to achieve by the end of the placement. I was also lucky enough to go out on an organ procurement on my last day, which was a real highlight, and gave me a chance to assist much more than I had at any other time in the rotation.
These two electives relied much more on passive learning than I would have liked. However, I still had the opportunity to practice much more clinical medicine than I had had previously in Sydney. The electives also allowed ample time to experience the city, which was, as can be expected, amazing.
Victoria Bond – medical student from Sydney Medical School, undertook an Elective at Columbia University in the USA in 201011
"For my four-week elective at Columbia University I chose to join the Infectious Diseases team at the New York Presbyterian Hospital.
My team has been wonderful and very welcoming. Right away, I was expected to tackle new consults, write notes and recommendations, participate in rounds, interpret lab and investigation results, and follow up on all of my patients. Throughout these exercises however, I was guided and helped by the rest of the team. They also encourage me to participate in all of their conferences and teaching sessions, as well as tailor one-on-one teaching time for me.
In addition to becoming an integral part of an inpatient consultation team at the hospital, the attending physician has took into account my keen interest in HIV/AIDS and referred me to other services, such as the HIV/AIDS rounds, and the outpatient clinic as well.
As for the hospital, it was fascinating to compare the hospital system in Australia as that in America. I am grateful for this opportunity to better understand what is expected of Registrars and Fellows in the United States, as well as see firsthand how the issues of insurance and private health care are dealt with. Once again, the team was very open and forthcoming about any and all questions I had.
As a teaching opportunity, I could not speak more highly of my experience as a visiting student at Columbia University.
And last, but not least: New York City. With over 18 million people, this truly is the city that never sleeps. There is so much to do here, all of the time, that no matter what crazy hours you do at the hospital, there will always be a concert or a play or an art opening or a bar or a museum or something left to explore. Having the chance to truly live in this city for a month or two is well worth it!"
Chris Dwyer - medical student from Sydney Medical School, undertook an elective at Columbia in 200910
"During my time at Columbia I spent one month with the neurosurgery team and one month in the emergency departments of St. Luke's and Roosevelt Hospitals.
From a professional point of view, time spent in the emergency department presented me with the first opportunity to assume a significant degree of responsibility for patient care - at least in a First World setting. I had previously spent a month in South Africa where I was given a great deal of autonomy and responsibility but it wasn't until I went to New York that I was given those same opportunities in a modern, Western teaching hospital.
Indeed, I was quite surprised by the role I was given in the emergency department in New York. Medical students undertaking clinical placements in the US are expected to contribute to the functioning of the team or service that they join. They are not there to get in the way, just observe or make up the numbers. I must say this is in great distinction to my experience in Australian teaching hospitals.
With each emergency shift I was assigned to an ER attending (the equivalent of a Staff Specialist in the Australian system) and I then spent the next 12 hours working for that attending. I was assigned patients by the attending and I was expected to take ownership of each patient’s progress through the department. I was responsible for working up the patient, proposing investigations, ordering them, checking results and requesting consults from specialist teams. Each and every patient was in effect a mini-long case which I presented to the attending once I had formulated a list of differentials and a proposed investigation and management plan. If the plan involved investigations or procedures that could be conducted in the ED I was the one to perform them - suturing, pelvic exams, lumbar punctures - all with supervision as required.
It was a fantastic learning experience and I was lucky enough to see a broad range of pathology during my month in the emergency department in New York. I also learnt some clinical pearls that will stay with me for years to come.
My two months in New York were also very informative from a cultural perspective. Obviously, there are many general similarities between the US and Australia and I lived in New York for 6 years prior to returning to Sydney to start medical school. Accordingly, on certain levels I knew what to expect from a cultural perspective. However, I found the medical culture in the US to differ quite markedly from my experience and expectations in Australia.
Obviously, more is expected of medical students in the US students - we were really treated like junior doctors from day one and we were expected to make a serious and useful contribution. I thought this was fantastic and I will acknowledge that it has been a difficult adjustment returning to Australian clinical placements.
I was less enamoured, however, with the lifestyle of the junior doctor in the US system. Certainly at a centre like Columbia, the junior house staff are expected to make heavy sacrifices for the privilege of holding their positions. They seem to have virtually no time for non-hospital related activities. Their shifts are long, hectic and frequent. I left New York frustrated at the limits typically placed on Australian medical students - how can it be that the world's most litigious medical system affords its medical students more autonomy and clinical experience than in Australia? At the same time, I felt fortunate to be returning to work in a system that seems to treat its staff (and patients) a little more gently than the system that prevails in the US."
Daniel Raper - medical student from Sydney Medical School, undertook an elective at Columbia (USA) in 2010
I spent a busy two months at Columbia in a sub-internship with the Department of Neurosurgery. As a sub-intern with the team, you are thrown fully into the team structure of a US department – attending early morning rounds, drawing blood, transporting patients and taking overnight call. Days were spent entirely in theatre, observing and assisting in every case. There was tremendous opportunity to gain practical skills, from placing spinal drains and lumbar punctures to suturing dura and excising brain tumors. A particular highlight was the opportunity to be assistant for an eminent professor’s microvascular decompression for trigeminal neuralgia that went until the early hours of the morning. The opportunities for research at Columbia are also numerou and I was lucky to be involved in a number of projects that have resulted in an ongoing collaboration between neurosurgeons at Columbia, Cornell and the University of Virginia to write a series of systematic analyses.
Outside of the hospital, New York remains a city of boundless experience. Reunions of old friends in familiar restaurants (Caracas in the East Village, Chinese hot pot downtown, Shake Shack’s unsurpassable burgers), strange exhibits in modern, concerts in cake shops, abandoned warehouses, and bowling alleys. New York is in a state of continual renewal, which means that visiting it, again or for the first time, is revelatory: despite any fathomable difference of culture or background, the city says, our pursuit of new and exciting things lets us call ourselves, even if only for two months, New Yorkers.
Georgia Ritchie - medical student from Sydney Medical School, undertook an elective at Columbia (USA) in 2010
My placement at Columbia University gave me many amazing opportunities and experiences both medically and culturally. In the US medical system students are given ample opportunity to see patients, run consultations and manage patients with guidance from their consultants. My first 4-week placement was in Obstetrics. The highlights for me on this placement were that I was able to deliver babies, attend high-risk pregnancy clinics and learn how to interpret foetal ultrasound. In my second placement I did cardiology and on this rotation I was very impressed by the fact that each week my supervisor would spend time reading ECGs with me. Overall, I found the teaching in the US to be fantastic with all the doctors trying to ensure that you were getting the best medical education possible.
Kirsty Benton – medical student from Sydney Medical School, undertook a placement at Columbia University in 20089
"I spent my time in New York at two different hospitals that displayed two completely different levels of functioning. I was lucky to be a part of the neurology service at Columbia Presbyterian University Medical Centre where I was exposed to truly world class medicine. The clinical skills I learnt whilst on this rotation are still with me, however I was comforted by the fact that the nuts and bolts of medicine are essentially the same between our two countries. I believe the best thing this taught me was the ability to adapt to different surrounds and different communication styles.
My experience at Harlem Hospital was different again. This was a purely publicly funded hospital hence facilities were limited and processes slow. My time in ICU here gave me perspective on what it takes to run an efficient team.
The major lesson I walked away with is health and medicine itself are great equalisers with no political boundaries. I was very interested to see how the practice of medicine in America and Australia compared. The similarities between the two countries medical methods enforced the notion that medicine really is an international language. My time at Harlem meant I was exposed to many different doctors from many countries which further demonstrated this point. So I guess the key cultural lesson I learnt was treat people with respect and humanity.