Maria Riga | Athens, Greece
I am a 5th year resident from Attikon University Hospital in Athens, Greece. One of my goals since the beginning of my training was to complete part of my training abroad. Unfortunately, I soon realized that this was more difficult than I imagined. I was, therefore, more than thrilled to hear about ESA’s Trainee Exchange Programme. Despite the obvious difficulties of covering the anaesthesia rota in my department, I was encouraged by the help of my colleagues and my educational supervisors to apply for the programme. Being selected out of many other European candidates has been one of my greatest experiences in my training so far.
Among the numerous hospitals – centres of excellence – that ESA proposed in this exchange programme, I chose the University Hospital of Münster in Germany (UKM), and more specifically the Intensive Care Unit, for a number of reasons. First, I have always been particularly interested in critical care and was thrilled to gain more experience and expertise in that field. Moreover, I’ve always wished to get a good overview of Germany’s health system and working conditions for the trainees. It became clear from my first visit in UKM that it was the right choice for me. During these few days my host, Professor Björn Ellger, kindly took me through the various stations of critical care in UKM, as well as their daily routine in the work environment.
My formal training started in June 2014. After an initial meeting with my mentor regarding my goals and expectations of the upcoming three months in Münster, we decided that the most suitable for me would be the surgical intensive care unit, which specializes in cardiothoracic, neuro- and vascular surgery.
A typical day in the ICU would start at 7:00 am with the morning handover, discussing the new patients admitted overnight, as well as updates on the postoperative course of those who had already undergone surgery. The morning handover was followed by a joint bedside ward round by the medical and surgical team of the ICU.
The bedside evaluation of each patient was followed by a sitting ward round, thorough discussion about each case with the participation of the multi-disciplinary team, including consultations by other specialties. During this process the current care of each patient was re-evaluated and the management care plan, both short- and long-term, was redefined. I was given the opportunity to actively participate in the examination and evaluation of the patients, make suggestions, and of course ask questions and gain experience in the management of complicated or quite specific medical or surgical conditions. For example, during these three months I had the chance to medically manage the care of quite a few patients with a left ventricular assistance device, I also saw and learned different types of renal replacement therapies, modes of ventilation, surgical procedures, some as complicated as a lung transplant. I was also given the opportunity to gain experience with the use of the ultrasound scanner as well as the fibre optic bronchoscope, which become more and more valuable in everyday practice, both in and out of the operating theatre; unfortunately my country still offers very little opportunity to practice. The UKM part of my practical skills experience was on the ultrasound guided arterial, peripheral, and central venous catheterization, evaluation of pleural effusion or pneumothorax, and pleural drainage. I have observed and also performed bronchoscopies and been able to participate in dilatation tracheotomies as well.
I attended the seminars organized by the Department of Anaesthesiology, Intensive Care and Pain Management that were held weekly on different topics such as liver transplantation, anticoagulation perioperatively, anaesthesia in obstetrics, post-operative cognitive dysfunction, and deep neuromuscular blockade. Some days, instead of the normal morning shift, I attended the afternoon or night shift. In that way I was able to see the whole range of the on-call commitments/duties of a trainee in Germany and get a more complete overview of how the health and training system runs in this country. Last but not least with the approval of my mentor I was given the opportunity to visit the operating theatres for one week and see how anaesthesia is conducted in cardiothoracic and neurosurgery as well as in the maternity room.
I have to say that this Exchange Programme has been a unique and lifetime experience! I have learned so much not only in terms of building my medical knowledge, but also boosting my managerial skills through insight into a different national health organization, language, culture, and training programme.
At this point I would like to thank all the people who helped me to accomplish this programme. First, I shall always be grateful to European Society of Anaesthesiology for giving me this remarkable opportunity and to the ESA secretariat’s Anny Lam for her help. I could not but express my sincere thanks to my supervisor, Prof. Ellger, for supporting and helping me and doing everything possible to make my stay in Münster memorable. I also need to thank the rest of my colleagues, all the people who work in the ICU for being so friendly, kind, and patient with me, trying to make me feel comfortable. Last but not least I would also like to thank my colleagues in Greece, who, especially in a difficult period of personnel shortage, were more than supportive and willing to cover my on-calls/shift so that I would not miss this unique opportunity to participate into the ESA exchange programme.