Dr Bruna Gonçalves
Since the beginning of my residency in Anaesthesiology, the idea of being abroad was part of my plan to develop myself as a professional and as a person. In these 12 years of medicine studies I always learned that being outside of my comfort zone was the best way to improve some points that in another way would be almost impossible to realize, and therefore was a utopia to change.
Currently a 5th-year resident in Anaesthesiology at Pedro Hispano Hospital in Matosinhos, Portugal, I had the opportunity, with the Trainee Exchange Program scholarship, to embrace the adventure of doing a fellowship in Paediatric Anaesthesia at Amsterdam UMC in Amsterdam, Netherlands. I cannot tell you that everything was perfect and simple but I can assure you that in the end it was worth it.
In the first week I was enrolled in the “Boarding School”. This was a week reserved to the new members (medicine and nursing students, first year residents and fellows) to know better the facilities and the hospital system and to be introduced to some basic subjects of Anaesthesia work. I was surprised with the amount of time they spent talking about safety in general and patient safety, including sessions about ACRM and doing simulation for simple procedures like how to transfer a patient from the bed to the operation table. Here I found a big difference between Amsterdam UMC and my hospital and any hospital where I had the opportunity to work in Portugal. They believe that safety comes first and they invest a lot on this subject starting at the beginning of the contact with Anaesthesia. We should take this as a great example.
In the beginning it was hard to adapt to a new culture, language, and day-to-day life, mostly because people in Amsterdam UMC are very nice, but without a proper onboarding for the Paediatric Anaesthesia fellows you find yourself asking about every little thing. I found it annoying and energy consuming, because despite being a fellow in Paediatric Anaesthesia I still had to ask to be planned in the operating room when children were scheduled. I didn´t expect that. It helped a lot to have another fellow already experienced in the running of the Paediatric Anaesthesia fellowship. Luckily for me, she was a Brazilian girl who explained everything to me and gave me tips to improve my opportunities during my time there. In an effort to feel more integrated I took a course in Dutch, that I should say was more helpful for knowing new people and knowing more about Dutch culture than to actually speak or understand the language.
At the end of my first month, I already knew almost every member of the Paediatric Anaesthesia group and, from that point on, my fellowship evolved more easily, engaging with much more interesting paediatric cases. During these 3 months I had the opportunity to work with different drugs than those from my hospital and other paediatric hospitals where I did my internship in Paediatric Anaesthesia, including clonidine, S-ketamine, and metamizole as a part of a multimodal analgesia. Curiously, I was surprised that an academic centre, with so well-equipped OR rooms, did not have any kind of depth anaesthesia monitor.
One thing that I found interesting was the fact that in Amsterdam UMC they have protocols for almost everything. If on one hand this seems to contribute to the safety of all anaesthesia procedures, on the other hand I heard a lot of “I don´t know why we do that, it is in the protocol”, which for a Resident, always eager to learn more, is a disappointing answer. Despite this I recognize the importance of the protocols in the day-to-day life of an Anaesthesia Department, and specially in paediatric patients it helps a lot to have a protocol to guide our management, playing a role closer to a checklist. This is something that I can bring to my hospital.
At the end, the ESA Trainee Exchange Programme showed me that Portuguese Anaesthesia training is at the same level of most recognized centres in Europe, despite not having so many resources or time spent for the education. It also reinforced the idea that it’s always important to try to improve and learn from skilled and dedicated anaesthesiologists who can inspire the Residents to be better, more complete, and successful during this challenging time.