I will not forget that rainy afternoon in March of 2015 that I randomly read about the Trainee Exchange Programme organised by ESA. That afternoon I thought: Why not? So, after many, many emails with the super-helpful Anny Lam, at the end of August 2015 I sent the application. And it was beyond my imagination that Saturday morning in November, when I was informed that I was one of the winners!
After even more emails I was accepted at my first choice, Hôpital Jeanne de Flandre, based in Lille, France, for a trimester in paediatric anaesthesia. Due to the fact that I was preparing for the national board exams and the EDAIC Part 2, we decided along with Dr Richart and Dr Laffargue that the optimal period for my first three-day visit would be the end of September 2016.
In this first visit it was decided that Dr Laffargue, head of the paediatric anaesthesia department, and Dr Veyckemans were going to be my mentors. We also decided that the best period for my trimester was from November 2016 to February 2017.
There are big differences in the organisation of anaesthesiology departments in France compared to my home country, Greece: the role of the nurse anaesthetist is much more active and this fact allows the anaesthetist to be occupied with more than one patient at the same time – given that the gravity of both the procedure and the patient permit it. Thus, the daily programme included 7 operating rooms and – depending on the length of each action performed – 15–25 young patients.
Each day there were 3 rooms used for general surgery, 2 rooms used either for orthopaedics or plastic surgery, 1 room for endoscopies or ENT, 1 room for the treatment of burns, and 1 room for the emergencies. Also, an operation could be performed in the neonatal ICU.
As I was in the training regime, it was possible for me to participate in every action performed in the operating room under the surveillance of the responsible anaesthetist. That fact made my training even better than I had imagined it.
In the beginning there were the venous lines (in patients of any age from neonates to adolescents). Then followed the airway management: inhalational induction, bag mask ventilation, jet ventilation, laryngeal mask, classical intubation, intubation with video laryngoscopes. Then the regional anaesthesia followed: blocks either ultrasound guided (TAP, ilioinguinal) or with nerve stimulation (pudendal), caudal block, epidural anaesthesia. And all these performed in a very calm and professional way, even though my French was not the best!
But it was not only the technical knowledge that was offered to me. It was the overall management of difficult cases, such as emergencies in premature infants (such as patent ductus arteriosus), in neonates (such as laparoschisis), management of patients suffering with malignancies, rare syndromes or metabolic diseases, scoliosis surgery, or unexpected massive bleeding.
Every week there was a “forum” where the anaesthetists of the department organised the programme of the following week, emphasizing patients who had many or serious pathologies or difficult operations to go through. These “forums” were of great importance for my training, because I had the chance to approach the way of organising the cases, to realize the importance of an anaesthetic plan that is known to the whole team, and the importance of the point of view of each member of the team, regardless of their age or experience.
One month after my arrival, one of the younger department anaesthetists invited me to participate in one of the “formations” that are organised every 3 months for the trainees. There was a simulation of intubation, difficult intubation (like in Pierre-Robin syndrome), placement of intraosseous access, and 4 clinical case scenarios performed by the trainees. After each scenario there was a discussion of our actions and we were provided with the relevant bibliography. Unfortunately, in my home country formations are not included in our training programme. This deprives us of the opportunity to make mistakes during a scenario and be corrected in a safe and calm way – outside of the operating room and having the time to think of it thoroughly.
But it was not only that! The last month, when my French had significantly progressed, for a week I followed the anaesthetist and the trainee on their rounds at the high dependency unit and the ward.
But after 3 months that training came to its end. I am now returning to my home country having participated in almost 150 paediatric cases, more capable of realizing anaesthetic acts, more informed, but also having worked in a department that functions as a team (from the nurses to the anaesthetists and the surgeons). That team building leads to reflexes that are compact, tranquil, and accurate. During my training, there were many difficult situations, many stressful moments; but what I realized, time after time, was that as long as a team functions well, even the worst can be overcome, the crises can be resolved, and the patients can benefit the most.
In the end, I want to thank my Greek mentors Annie Theodoraki and Anna Malissiova who supported me in trying to accomplish my goal. I cannot put in words the gratitude that I feel for Anny Lam, the patient and positive person responsible for this programme’s organisation. I am grateful to my new mentors Dr Laffargue and Dr. Veyckemans, but also to each and every anaesthetist in Jeanne de Flandre for the things they have taught me. Also, the support that I received from all the nurse anaesthetists of the department made my training even more efficient.
Last but not least, the European Society of Anesthesiology that supports in such a way their younger members and gives them that opportunity to broaden their knowledge – but most importantly to broaden their horizons. The honour was great and I will use everything I learned, in the best way I can in my country.