Exchange report - incoming students
Home university: University of Minnesota
Study programme: Medicine
Exchange programme: INK
Semester: Spring semester 2011/2012

Arrival and registration

Before my arrival, I had pondered over the various transportation options offered to get from the Arlanda International Airport to the Stockholm city center. Arlanda is about 40 km to the north of the city, quite a long distance! Needless to say, I was a little anxious about getting my currency exchanged and then navigating through a public transportation system in a foreign language while trying not to blow all my money on transportation. Reading about my options ahead of time, I had decided on taking either the flygbussarna motor coach bus or the express shuttle train for about twice the cost. However, during my flight from Amsterdam to Stockholm, I became acquainted with my aisle seat neighbor. He was a fellow graduate student who had just completed his exchange studies at the University of Illinois and was returning home to Stockholm. After talking for a while on the plane, he learned that I was from Minnesota and studying abroad at the KI. He then told me that he was being picked up from Arlanda and offered me a ride to my place in Stockholm on his way home. I was very appreciative of the generous offer, but also a little apprehensive. He told me his mother and brother were driving, so I figured it would be fairly harmless.

 

To my surprise, as the plane descended through the overcast skies into Arlanda, there was a winter wonderland awaiting us as we touched down. From what I could see through the snowflakes, I immediately noted how the landscape reminded me of northern Minnesota with its plentiful coniferous trees and rocky gravel. At first I found myself a bit regretful that I had left behind the record warmth of the 2012 spring in Minneapolis to come to a place with a snowstorm in progress. However, being a true Minnesotan, I was able to put those feelings aside, comforted by how I knew that such weather in the springtime does not last long, and energized by the excitement I had for my journey ahead in Sweden! I arrived at my housing complex without difficulty, thankful for the graciousness of my acquaintance and his family.

 

Among your first stops in Stockholm should be at the Pressbyrån store, a chain of convenience stores located throughout the city. Here you can buy a 30-day pass that will provide you with unlimited free travel on all of the busses, subways, commuter trains, light-rail, and ferries offered through the state-run public transportation system called “SL.” As mentioned earlier, navigating the public transportation system is difficult while out on the town as the information is all in Swedish. However, the SL website has an English mode that is very helpful and has a great trip planner function. I would suggest using the SL website to plan out your journey before going out while you have computer access. As for communication, international calls on the typical cell phone plan are very expensive, so people in need of a cell phone while abroad usually buy an inexpensive temporary phone with a reloadable SIM card. I chose to go without a cell phone in Sweden as I wanted to stay on a budget and be environmentally conscious by not buying a new phone that I would only use for a month.

Acommendation

The KI offers housing to students through the University Accommodation Center, but it does fill up fast, so it is important to apply for housing as soon as you accept your rotation offer. The housing is very reasonably priced, especially considering the high cost of living in Stockholm. I was assigned to live in the Jägargatan complex, which I later learned was located in the most urban location among the KI housing complexes. However, for better or worse, one should know that this particular complex offered a very college dormitory-like living experience with communal kitchen and bathrooms, but I did have my own private bedroom with a desk. My building was filled with KI exchange students from all over the world, studying various disciplines within health care and the medical sciences. It was fascinating to get to know people of this international community and to learn about the various countries and cultures. People are also of various age (and maturity) levels, so weekend hall parties on some of the floors in this building can last until the wee hours of the morning; perfect if that is your thing. The walls in the building are quite thin, so remember to bring ear plugs if the all-night parties are not always your cup of tea.

Leisure time and social activities

I had a fantastic time in Stockholm! With more free time than I was expecting, I had plentiful opportunities to get together with the other exchange students and to meet up with my Swedish friends. We were able to explore the sites in Stockholm and visit some unique bars and music venues. Stockholm is an amazing city! I found it to be clean, safe-feeling, very compact and walkable, and full of beautiful architecture with all of the usual cosmopolitan attractions in its wide variety of places to eat, drink, shop, and mingle with others. Some of my recommended favorites are Gamla Stan (the vibrant and bustling Old Town area with lots of tourist shops and cafés along narrow cobblestone streets), museums (Fotografiska, Vasa, Nordiska, Skansta), the Royal Palace, Café Opera, and The Gondolen bar. The public transportation is great and can get you everywhere you need to go. Be forewarned, the cost of living in Sweden is quite high, so it can get expensive to eat or go out for drinks. For example, a typical 33 cl/11.2 fl oz bottle of beer costs 60-70 SEK, meaning around $9-10! To save money, I bought groceries and made many of my meals in my communal kitchen, making due with basic ingredients and minimal spices and sauces, meaning I ate bland food for the month. Perhaps someday I will be able to return to Stockholm and more fully indulge in the vast array of expensive culinary delights that the city has to offer. Speaking of meals, one evening after work, our course director and his wife hosted all of us exchange students at his home for a delicious traditional Swedish dinner. They certainly demonstrated the hospitable nature of the Swedish people! I also found time to spend weekends exploring outside of Stockholm. One weekend, I took a train to the southern region of Sweden known as Småland where I met for the first time some of my Swedish relatives. I stayed at their home for the weekend and explored some of the countryside and the famous Swedish glassmaking factories with them. Since I know that I will not have the opportunity to visit Europe in the near future, I made it a priority to travel to another European country. One of my Swedish friends and I found a relatively inexpensive airfare to Warsaw, Poland, so we had an amazing weekend exploring that city. We enjoyed seeing the sites and learning about its World War II history while taking advantage of the comparatively low cost of living to check out a lot of restaurants and bars!

Pre-departure

My elective abroad was a clinical rotation in urology that took place in Stockholm, Sweden at the Karolinska Institutet during April 2012. I was a graduating 4th year student and had already been through the Match, and I wanted to finish medical school with an exciting educational experience. I had traveled internationally once as a young child, but this was my first opportunity to go abroad during my adult life, so I did not know quite what to expect! I chose to go to Sweden because as many Minnesotans, I have a heavy Swedish ancestry and I realized that sadly, most of my knowledge of the Swedish people and their culture had been obtained during affordable furniture acquisitions at IKEA during college and medical school. Also, I had become friends with two Swedish medical students from the KI who had been on rotations with me during their exchange studies at the U of M, so I thought it would be a wonderful experience to reconnect with them on their home turf. Additionally, I wanted to get more of a sense of how Sweden’s “socialized” medical system compares to the system in the U.S. and what lessons I could learn from it as a soon-to-be American health care provider who may very well be playing a role in helping to shape our country’s future health care policies.

 

I had begun planning for this trip about one year ahead of time. As soon as I learned about the opportunity for U of M medical students to rotate in Stockholm, I got in contact with Shannon Benson in the IMER office. She is a superb resource and helped keep me on track for successfully applying to study abroad. The KI has an online application for exchange studies on which the applicant ranks in order of preference the clinical rotations available during the planned time period in Sweden. I learned a few months after applying that I had been accepted at the KI for a clinical rotation in the Department of Urology. Once accepted, it is important to stay in contact with Magdalena Palmqvist, the student coordinator at the KI, and to fill out and return any forms in a timely manner.

 

On a separate note, as with any journey to a foreign country, I would recommend buying a Stockholm travel guide and skimming through it to map out your list of must-see attractions in the city before arriving. Stockholm is loaded with rich history, which is reflected by its copious museum population. As far as packing goes, you should leave at home your white coat, scrubs, and normal work dress attire. Swedish doctors never come to work in dress pants and button-up shirts! The Swedish hospitals are very concerned about keeping infection from outside sources at bay, so all hospital staff is required to wear hospital-issued scrubs at all times. This rule applies whether working in clinic or in the O.R. They are very strict about their protocol with the scrubs, especially in the way that it is forbidden to take the scrubs outside of the hospital. I did not need to bring any books or medical equipment for my urology rotation, but this may be different from rotations in the other specialties. Do remember to pack your laptop and an electrical outlet adapter, and waterproof shoes and a coat if in Sweden during the sometimes slushy spring. Lastly, I have a few thoughts on the Swedish language. It is a beautiful and unique language, with a paucity of English cognates, so it is a bit difficult to learn. Upon arrival, it very much became apparent to me that although a majority of Swedes can speak perfect English when necessary, all of the conversations (including during patient encounters), signs, menus, and recorded messages on public transportation are in Swedish which can make getting around a bit daunting. Therefore, I would recommend studying a little of the language prior to arriving. Of course, it is helpful to know or at least be able to visually recognize a few basic words and phrases. However, most Swedes are quite approachable and willing to translate if asked.

Courses during the exchange period

ELAX22 : Urology
The course director, Dr. Lars Henningsohn, is a very personable and friendly person, and his passion and enthusiasm for teaching is obvious. This helped to make for a great rotation experience. The other faculty members were more variable in their enthusiasm for teaching, but everybody was willing to hold discussions in English when appropriate for the benefit of the exchange students. I did have the opportunity to observe some renowned surgeons operate the DaVinci robot. One memorable operation was a cystectomy and prostatectomy with the creation of a neobladder – all done robotically. I was told that the surgeon performing this operation was the only surgeon in Scandinavia able to do this operation completely by robot, so I found that to be a neat experience. Since Swedish is spoken during patient encounters and among the hospital staff, much of the learning ended up being through observation, which was less than optimal, but still worthwhile. Due to the language barrier, I did not have much opportunity to be directly involved in patient care. However, the culture in the hospitals in Sweden is such that medical students do not usually act as the primary caretakers of patients as they regularly do in the U.S. Swedish medical students do take medical histories, conduct physical exams, and discuss assessments with staff, but from what I observed, they do not generally have much involvement in formulating plans for carrying out patient care.

Summary

As I spent my final evening in Stockholm among thousands of Swedes gathered in front of a giant bonfire for the annual Walpurgisnacht celebration of the spring season at the Skansta outdoor museum, I reflected on my marvelous month in Sweden. Quite simply, my trip to Sweden was among the most gratifying experiences in my life. I learned so much during my time in Sweden, not only about urology, Swedish medical culture, and the socialized Swedish medical system, but I also received important lessons about life in general. My immersion in the Swedish culture, being humbled while learning how to navigate a place where I am the foreigner that does not speak the common language, developing and building upon international relationships, and gaining an understanding and appreciation for the differences and similarities between the U.S. and other countries – all are fond memories and lessons that will serve me well throughout my life. I am very grateful for the opportunity I had to travel to Sweden thanks to the generosity of Curtis L. Carlson and the support of the IMER office.

Language and Culture

Did not take part.

Studies in general

My four week rotation in urology was split up into two weeks each at the southern KI hospital in Huddinge and the northern KI hospital in Solna. I became acquainted with the six other students on my rotation who hailed from Spain, France, and Chile. We were expected to arrive at 8 am everyday and our days consisted of a lot of shadowing and observing surgeries and procedures. We had lectures from the urology faculty for a few hours on three of the days of the rotation. The topics ranged from robotic surgery to nephrolithiasis, and the lectures were of high quality. We had the opportunity to practice suturing and laparoscopic skills in the simulation lab as well. Our days would usually end early in the afternoon around 2-3 pm. We were not expected to work on weekends or take call during the evenings. The combination of short days at the hospital and no weekend or overnight work was something that I was not at all accustomed to as an American medical student, and the Chilean medical exchange students were similarly surprised by this flexible and relaxed work schedule. This was in contrast to the European exchange students, who were quite familiar with such a schedule.