Shanghai Jiao Tong Medical School, Shanghai (China)
Impressions of Shanghai Jiao Tong
- Kirby Campbell-Wood - medical student from Sydney Medical School, undertook an ILA with Renji Hospital, Shanghai Jiao Tong University in 201112
- Amy Cui - medical student from Sydney Medical School, undertook an ILA with Renji Hospital, Shanghai Jiao Tong University in 201112
- Johnny Siu – medical student from Sydney Medical School, undertook an ILA at Renji Hospital, Shanghai Jiao Tong University in 201112
- Peter Xie – medical student from Sydney Medical School, undertook an ILA at Renji Hospital, Shanghai Jiao Tong University in 201112
- Derrick Wong – medical student from Sydney Medical School, undertook an elective at Renji Hospital (Shanghai Jiao Tong University School of Medicine) in 200910
- Johnson Zang – medical student from Sydney Medical School undertook a placement at Renji Hospital (Shanghai Jiao Tong University School of Medicine) in 200910
- Nathan Lum - medical student from Sydney Medical School undertook a placement at Renji Hospital (Shanghai Jiao Tong University School of Medicine) in 200910
- Owen Lee – medical student from Sydney Medical School undertook a placement at Renji Hospital (Shanghai Jiao Tong University School of Medicine) in 200910
- Jennifer Li – medical students from Sydney Medical School undertook a placement at Renji Hospital (Shanghai Jiao Tong University School of Medicine) in 20078
- Kevin Wang - medical student from Sydney Medical School undertook a placement at Renji Hospital (Shanghai Jiao Tong University School of Medicine) in 20078
Kirby Campbell-Wood - medical student from Sydney Medical School, undertook an ILA with Renji Hospital, Shanghai Jiao Tong University in 201112
I recently completed my ILA in Shanghai, spending 4 weeks at Renji Hospital where I rotated through cardiology and cardiothoracic surgery. The experience was fantastic – I got to see a number of different procedures in both rotations, sit in on consultations, joined staff for ward rounds and received personal tutorials. While mandarin would have been an advantage, it wasn’t critical for my experience. The patients in the hospital tended to be older and speak mostly Shanghainese in any case and I was still able to learn effectively due to the ability and willingness of the staff to speak English.
China continues to develop at an incredible pace and this transition was very much evident in my experience of the medical system. While discussing Traditional Chinese Medicine with a member of the cardiology team I found that while it is still undertaken in parts of the hospital it was not a part of cardiology at all - contemporary Chinese cardiology had moved on and it seemed to be something they wished to distance themselves from. During other discussions staff also made it clear that they were pushing their training in the same direction as their western counterparts, and that all of their senior team members had undertaken placements in Western hospitals and were collaborating with international partners. On a technical level, MRIs are only just being employed for use in cardiology at Renji Hospital, and some catheter procedures undertaken in Australia are still not approved for use in China, it was clear however that while gaps remain, they are closing fast.
One clear cultural difference that emerged during my time in Renji Hospital was the different attitude to privacy. Curtains between beds in the wards were a rarity, and amongst the wards I visited tended to exist only in surgical wards where men and women were mixed in the same room. During consultations I attended in the Emergency Department and in a private clinic, doors tended to remain open, with patients wandering in and out at will. While rules regarding confidentiality would ensure this would not happen in Australia it was perfectly normal in Renji.
In terms of career benefits from the placement the experience has given me an excellent exposure to cardiology and cardiothoracic surgery early on in my training, and has certainly helped to define the direction in which I would like to head in further years
Lastly, there was the very important after hours component! You don’t need Chinese language skills to move around and enjoy Shanghai or the surrounding cities. There are lots of places to visit and go out and lots of opportunities for tasty and incredibly cheap local food.
Having read the student exchange impressions of earlier years, I came to Shanghai with quite a few preconceptions about what the medical system, the city and its people might be like. However few of these preconceptions matched what I found when I arrived early in December – a keen, green medical student just out of her first year.
Renji hospital, in the Pudong district of Shanghai, is a striking red-brick complex consisting of multi-storey surgical and internal medicine buildings larger and taller than any I’d seen in the Sydney hospital system. On my first foray into this vast complex – and unable to accurately decipher the Chinese signage – I was at a loss as to where our student accommodation might be. However several doors and helpful security guards later, I found the spacious rooms assigned to international students and settled in for the start of four weeks in my chosen specialties of anaesthetics and cardiothoracic surgery.
Anaesthetics at Renji turned out to be a wonderful way of getting a taste for all types of surgeries. My tutor Dr Zhu, who was a native speaker of Mandarin and Shanghainese but also a fluent in French and English (so no major language difficulties for me!), gave me a free run of almost all the surgical theatres over two levels of the surgical building – I was able to watch CABG and valve replacement heart surgeries, a liver transplant, lung resections, caesarean closure, endoscopies and many many other procedures, with occasional impromptu tutorials from the surgeon operating. In cardiothoracics, our tutors were equally generous in giving their time and resources to teach us suturing and knot-tying techniques, even – quite memorably – late on New Year’s Eve.
There were some drawbacks to watching so many surgeries in Renji – one was the relatively little contact with Chinese patients, and the other was the strong emphasis on modern Western surgical techniques with therefore not much chance to see a traditional Chinese practice of medicine. Nonetheless, since I am not in the habit of watching multiple surgeries per day in Sydney, I found more than enough learning opportunities to satisfy the most knowledge-hungry medical student.
Living in Shanghai was also a far more comfortable experience than I’d initially imagined. We had the best of both East and West in the less tourist-ridden district of Pudong. A five-minute walk from the hospital took you up Nanquan Rd with all the strange sights and delicious tastes of bustling Chinese shops and marketplaces, while another short walk in the opposite direction took you to a monolithic Walmart where you could satiate random cravings for peanut butter and baguette loaves.
I would hugely recommend Renji hospital in Shanghai to any medical student thinking of doing their ILA internationally. The doctors there are warm, generous with their time and very interested in speaking with Australian medical students, and I greatly value the experiences – both medical and cultural – that I can take back from my stay in Shanghai.
There is nothing more amazing than to experience the vibe of a developing city. Ten years ago, Shanghai looked like a small town, while today, Shanghai is probably the most quickly developing city in China!
During my time in Renji Hospital, I saw many things that I would not experience in Australia. Most people that come into the hospital is usually in the late stage of their disease, because not everyone can afford such expensive medical treatment in China. I felt that life is very fragile in China. Sometimes at night while sleeping I would hear families weep for their deceased love ones. I also witnessed a death for the first time in my life and remembered vividly that the intern was doing CPR to revive him. When he knew that the patient could not come back, I saw tears in his eyes. However he had to hold his emotions because there were many other people who are very sick and waiting for him to treat them.
All these experiences in Shanghai has definitely contributed to me becoming a better doctor because even with the huge amount of people to treat in Renji, every doctor gave their best to save their lives no matter how tired they are. These experiences will remind me to press on even at difficult and sad times during my life as a doctor.
The main cultural lesson I learned with this placement was that Chinese people take their illness with their whole family. You would see patient families sleeping in the staircase area just to maximise every moment to see their loved ones! I was amazed at how Chinese people took the burden of the patient's disease as a whole family, instead of being more individualised in Australia.
An ILA in the renowned Renji Hospital in Shanghai has broadened my understanding in medicine not only in China, but by way of comparison, our own system in Australia. We were part of the Cardiothoracic surgical team, under close supervision of consultants and were given personal tuition. We gained access to extremely valuable learning opportunities in both developing understanding of the specialty, our own surgical skills, and witnessing pathologies unusual in Australia. Through the OGH we were placed in accommodation within Renji Hospital, and we were also able to intimately observe the Chinese health system and the doctor-patient relationship in China.
With internal migration from the rural areas to metropolitan areas, unprecedented in human history, enormous strain is placed on the resources of Shanghai's healthcare system. To whom subsidised healthcare is available and the extent to which subsidies are given, depends on the patient's registered place of origin and their medical insurance. This has deep implications in the allocation of health resources to different patients, as well as expected outcomes. Appreciating this, as the key difference to our own universal healthcare, was a gradual and poignant process. It was almost surreal to discover, however, how little difference there was once I stepped into the sterile Red Zone, where lifesaving surgery took place. Ultimately, this experience gave me a much better understanding in the allocation of resources in health, which underpins the sustainability of a healthcare system.
Spending a month in Shanghai also allowed me to gain valuable cultural lessons. Despite being of Chinese ethnicity, I was initially in culture shock. Everything, from the pace of life, work ethics, to bedside manner were very different to what I was used to. The greatest cultural lesson was the notion of the Chinese family in the context of illness and hospitals. It was not unusual to find families; from spouses to distant relatives, to surround the bedsides of the sick. Even in the ED, everyday paraphernalia of the relatives adorn the already cluttered wards: many relatives of rural patients stay in the hospital days at a time to provide some of the care to the patient. This highlighted the value of Chinese families and the roles they play in healthcare. It also enforces the human aspect of disease, which we, as future doctors, can sometimes overlook.
Derrick Wong, a medical student from Sydney Medical School, undertook an elective at Renji Hospital (Shanghai Jiao Tong University School of Medicine) in 2009-10
"I spent the better part of two months at Renji Hospital in Shanghai where I rotated through Cardiology, Cardiothoracic Surgery, and Traditional Chinese Medicine (TCM). Having never visited Shanghai before and having never stayed in Mainland China for an extended period, I really didn't know what to expect when my taxi pulled up to the hospital accommodation. From attempting to decipher patient charts and medication lists written in Chinese, to experiencing the sheer volume of patients that pass through the hospital doors each day, I learned quickly how different the medical system in China is compared to what I've been acclimated to in Australia.
One of the most interesting concepts I took out of my placement at Renji Hospital is the complementary role that TCM can play alongside Western Medicine. Both in outpatient clinics and in surgical theatres, I witnessed the benefits of acupuncture as a therapeutic tool and a means for anaesthesia. Because the concepts behind TCM are so different from what I've learned in Western Medicine, I was very impressed with the results that can be achieved from techniques for which I have so little understanding.
Outside of the hospital, I experienced first hand the rapid development of the city in preparation for the 2010 World Expo. Anywhere else, the term ‘development’ would be misused to describe the transformation of a city over a two-month period. In Shanghai, I literally watched train stations constructed from scratch, entire sections of the city repaved, and buildings erected at a pace only US$45 billion can buy.
With all the anticipation of the World Expo officially opening its doors on May 1st, my only regret for my time in Shanghai is that I had to depart before that day arrived. I highly recommend all future medical students to consider Shanghai as a placement destination for both the world class medical training that Renji Hospital has to offer, and the opportunity to experience one of the most vibrant cities in Asia."
Johnson Zang – medical student from Sydney Medical School undertook a placement at Renji Hospital (Shanghai Jiao Tong University School of Medicine) in 2009-10
“Being exposed to Traditional Chinese Medicine in my final week of my elective term provided me with an alternative way of thinking about medicine as a whole. By relating the symptoms and signs of the patient to the concepts of Yin (decreased Qi) and Yang (increased), counter-measures may be utilised to suppress the symptoms and signs without finding the aetiology of the problem. Sometimes this is an efficient approach to treating patients, as aetiology may not always be found in every case.
I learnt that the medical knowledge of the general population was very limited and as a result there could be numerous misunderstandings during any one medical consultation. Adding to this the quality of consultation is sometimes limited due to the number of patients a doctor needs to see in a day further providing confusion for the patients to fully understand their diseases and subsequent management, leading to recurrent illness and medication non-adherence.”
Nathan Lum - medical student from Sydney Medical School undertook a placement at Renji Hospital (Shanghai Jiao Tong University School of Medicine) in 2009-10
“The placement in China opened my mind and eyes to its people, medicine and developing healthcare systems. I learnt from inspiring and committed doctors who work tirelessly to provide their patients with the best possible care (despite limited resources) and who nevertheless endure low social status and financial reward. I could easily observe the fulfilment derived from and contributing to rapid economic development. These major issues play an important role in a competitive society with strong desires for recognition and financial success and can make life for doctors in China difficult.
As China continues to flourish, the society is evolving and it is with a profound sense of hope that the basic, educational and health needs of the people do not get overlooked, so the richness of its history, culture and place on the world stage is nurtured, respected and treasured.”
Owen Lee – medical student from Sydney Medical School undertook a placement at Renji Hospital (Shanghai Jiao Tong University School of Medicine) in 2009-10
“As a well-travelled Canadian I have encountered health care systems from developed countries such as those in Canada, England, Hong Kong and Australia, where the standards of care are amongst the best in the world. With the tremendous development of its economy, I was curious to see how the health care system in China is.
I was lucky enough to be a medical student in the General Surgery, Orthopaedic Surgery, and Gastroenterology departments for a total of 4 weeks. The professors I was assigned with gave me a lot of freedom. The surgeons provided me with opportunities to scrub in to surgery with them. This way I could observe the operations closely. This was the first time I really had a chance to do this and I gained a lot from it. In addition I also had the opportunity to be a part of the orthopaedics team on call in the emergency department.
In Shanghai, all the different medical and surgical specialties put a team in the emergency department, so when a patient has a particular concern the nurse at the reception quickly assesses which specialty will be best suited to the condition and you go directly to that room in the emergency department. Apparently on average, the patient only has to wait for about 10 minutes before they get medical attention - quite different from my experience in Canada and Australia! However, patients also have to pay for most of their treatment and that can be a bit of a problem when an important operation is too expensive.
During my week in gastroenterology, I had the opportunity to examine patients in the ward, help out in the out-patient clinic, and watch doctors perform gastric endoscopies, and colonoscopies. As you can imagine there were many patients and doctors in the hospital. It was so busy!
Living in China was also quite an experience. Once you step out, you can sense how busy the country is. Construction sites everywhere, with busy traffic surrounding each block. Obviously I had a chance to eat a lot of cheap Shanghainese Chinese food, which was great. All in all, I felt lucky to be there, and it was a wonderful learning experience for me both medically, and culturally.”
Jennifer Li – medical students from Sydney Medical School undertook a placement at Renji Hospital (Shanghai Jiao Tong University School of Medicine) in 2007-8
“During the placement two patients stood out. Both were patients who were severely ill and passed away a few days after seeing them. My experience seeing patients is limited but my gut feeling was, ‘this patient looks like their time is near’. As a medical student, it was an experience which was both saddening but memorable. Also, the patient is often the focus, but that's no reason to ignore those affected by the patient as well. As a student seeing their families visit them everyday reinforced the importance of considering the wider picture, especially when death is nigh.
After spending time in the hospital in Shanghai, one of the most populated cities in the world I thought to myself, ‘doctors/interns in Australia have far more resources and support than our Chinese counterparts’. So, as doctors here in Australia, when there isn't enough, the question becomes, ‘how can we make use of what we have to make it enough?’”
Kevin Wang - medical student from Sydney Medical School undertook a placement at Renji Hospital (Shanghai Jiao Tong University School of Medicine) in 2007-8
“On my recent placement to China, I experienced an epiphany while looking down at the Renji Hospital outpatients lounge. (View photograph below.) Seeing the multitude of people who have lined up since the wee hours of the morning, I realized that patients everywhere are seeking something in common. That is, regardless of where people have come from, when they come to see a doctor, they have come to seek that one thing, comfort. Comfort in knowing that there is someone who cares for them, someone who will not forsake them.
This placement has lifted me out of my comfort zone to personally attest to this universal truth of the practice of medicine. In years to come, when I will take care of my own patients on the wards, I shall always reflect on that particular moment of realization. As we say, ‘to cure sometimes, to relieve often, to comfort always.’
One of the key cultural lessons that I learnt from my placement, is the role that alternative medicine plays in certain cultures of the world, especially in a country such as China where traditional medicine has been so ingrained as part of the cultural ideology. I feel that to properly understand and interact with the practice of medicine in a place, it is imperative that one first show respect to the value of the incumbent local practices, before beginning to make an assessment of its scientific worthiness. The cultural value of alternative medicine is deeply relevant to optimal patient care. After all, even in this day and age of evidenced based care, medicine belongs as much to the field of humanities as it does to the sciences."
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