Karolinska Institute, Stockholm (Sweden)
Impressions of Karolinska
- Costa Boyages - medical student from Sydney Medical School, undertook an Elective with Karolinska Institute in 201213
- Nicholas Cardillo – medical student from Sydney Medical School, undertook an elective at Karolinska Institute – Sweden 2010.
- Monique Menzies – medical student from Sydney Medical School undertook a placement at Karolinska Institute – Sweden 2008-9
- Eddy Tabet – medical student from Sydney Medical School undertook a placement at Karolinska Instittue – Sweden 2008-9
Costa Boyages - medical student from Sydney Medical School, undertook an Elective with Karolinska Institute in 201213
An elective at the Karolinska Institute was a privileged opportunity to witness one of the world’s most progressive healthcare institutions in action. The Swedes justifiably lay claim to having an enviable record in healthcare delivery and an elective term here is a snapshot into why. Day 1 was illustrative. We passed our MRSA screening test, donned our standard-issue hospital whites before navigating our course through the vast network of underground tunnels artfully dodging Swedish surgeons riding their scooters to work. Once at our destination department, we were met with warm Swedish hospitality, the venerable tradition of a morning ‘Fika’ (coffee break) and a program of learning that was both highly structured and incredibly accommodating of our presence. Whole, multi-disciplinary teams were often conducting meetings in English for our benefit and very busy surgeons were highly attentive to our learning needs giving fireside tutorials wherever possible and scheduled teaching. In my time, I rotated through three surgical teams in my four weeks – endocrine, vascular and colorectal which included observing two robotic surgeries on a state-of-the-art Da Vinci system. Of course, an impression wouldn’t be complete without extolling the virtues of Stockholm as a city: teeming with life, food and colour even when blanketed with the thickest snow.
Nicholas Cardillo – medical student from Sydney Medical School, undertook an elective at Karolinska Institute – Sweden in 2010.
“When I left for Sweden I had some clear goals in mind. I wanted to gain more exposure to surgery because during my surgical term in Sydney (in plastics and orthopaedics) I felt that I had not experienced a wide variety. Furthermore, in Sydney, when I attended the operating theatres there was usually a consultant, one or two registrars, and often a resident and intern who were all competing for experience. As a result, opportunities to scrub in were fairly rare and when I did it was usually just to hold a retractor. In contrast, in Sweden students are expected to scrub in. It was extremely rewarding to be actively involved in patient care, rather than to simply be a ‘fly on wall’ as we sometimes are in Sydney.
As a result of my practical experience in Sweden my surgical skills improved out of sight, especially my subcuticular suturing. I became confident in dealing with different tissues and structures, and my surgical anatomy knowledge improved significantly. I also felt that rotating between several departments was a great way to get a broad experience in a relatively short amount of time. I learnt something different from everyone that I worked with different tips, techniques, and anecdotes every day.
In 8 weeks I probably worked with at least 40 different doctors across different departments, all of whom were extremely welcoming. On day one when I met Prof Zedenius for the first time he told me to address him only by his first name, as they are not referred to as ‘doctor’ or ‘professor’. The hospital Swedish system is much less hierarchical than the Australian system, allowing closer working relationships between senior and junior medical staff. For example, most days of the week I had lunch with Professors and senior staff members, which almost never seems to happen in Australia. I thereby came to know them well on personal basis and this translated into trust and responsibility when in the OR and on the wards.
In Sweden, there is a term ‘fike’ which means to take a break for coffee and cake. In all Swedish workplaces fike is almost a religious custom. Everyone would stop what they are doing to sit down together for fike, often several times a day. While it perhaps was not great for productivity, it facilitated communication between all term members (especially between the medical and nursing staff) in an informal setting. To me it seemed that the working conditions in Sweden were better than in Australia, with better doctor to patient ratios and more reasonable working hours for medical staff. If doctors worked overtime in excess of 40 hours, they generally received time off in lieu. They also have around 12 months maternity or paternity leave with full pay. These features of the Swedish system create a less stressful working environment and a better work-life balance.
While Swedes (especially younger ones) generally speak English extremely well, there were times when language was a small issue. The doctors almost always talked to the patients in Swedish, which meant that sometimes ward rounds and clinics were of limited value. The doctors would usually try and translate for me where possible. By the end of the elective I could understand some of the conversations, as many Swedish medical terms are similar to English ones. Having an Australian accent was also a bonus for me and a novelty for the Swedes. There were no other Australians at the hospital, so the doctors generally took an interest in me and this often opened up clinical opportunities.
Overall, my elective in Sweden was a fantastic learning experience. I felt privileged to be able to study under esteemed academics and clinicians at a world-class institution. I gained an appreciation of the merits of pursuing a career which includes both academic research and clinical medicine. I was very pleased to receive offers from two surgical departments to return to Karolinska to undertake research in the future. This experience has had a significant impact on my personal and professional development and will shape the way I practice medicine through the application of concepts and philosophies I learnt from the egalitarian patient-centric Swedish healthcare system.”
Monique Menzies – medical student from Sydney Medical School undertook a placement at Karolinska Institute – Sweden in 2008-9
"During January 2009 I completed a course with European English-speaking students in inflammatory diseases and in February 2009 a clinical rotation in emergency medicine with other Swedish students. My two months at Karolinska Institute were both eye-opening and inspirational. I was fortunate to learn a lot about medicine, first hand, from various researchers and clinicians at Europe's best medical school - home of the Nobel Prize.
It was refreshing to see a public medical system function so well - a medical ‘utopia’, with high doctor-patient ratios, absence of hierarchy, a high standard of health care with little costs to patients delivered in a calm environment and to see the latest research, in particular in immunology be translated from laboratory to patients, all in the one location. I also saw many rare immunological disease presentations, previously only read about.
I am certain that my exposure to these experiences will help me become a better doctor. Perhaps, in the future, some of the aspects of the Swedish medical system could be incorporated into the way I practice medicine in the future."
Eddy Tabet – medical student from Sydney Medical School undertook a placement at Karolinska Instittue – Sweden in 2008-9
"The opportunity to engage in a different health system and appreciate the existing diversity in the nature and style of medical care will make me a more well-rounded doctor. I feel more confident in my own communication skills and more equipped to practice medicine in challenging situations in a culturally appropriate manner. I feel I have also returned with a renewed appreciation for the value of research in medicine, given the emphasis on high quality research at KI.
Overall, the sense of equality that I experienced in the Swedish hospital system, even as a student, has taught me that humility is one of the most valuable traits a doctor can have. I have learned the value of embracing the input of all members of a team and treating everyone as equal, including patients. This placement has taught me the value of patient-centred medicine and I hope to embrace this philosophy in my own practice in the future.
The key lesson I brought home from Sweden is a concept the Swedes identify as lagom, which in essence means ‘balance’. The Swedes pride themselves on an excellent work-life balance - time for respite, good food and deliberation. This balance brings with it an opportunity for adventure. Hence the cultural experience would not be complete without traditional winter activities such as ice-skating on frozen lakes, playing indoor hockey (inne bande), skiing and of course…running from a sauna through the snow and into a freezing pond with only swimmers on!"