Exchange report - incoming students
Home university: Northwestern University Feinberg School of Medicine
Study programme: Medicine
Exchange programme: INK
Semester: Spring semester 2015/2016

Arrival and registration

My rotation was only 1 month and took place in the middle of the semester, so I did not attend the introduction day. I did receive an email from my buddy in advance of my arrival, which was a friendly way of welcoming me to KI! I was able to schedule all my necessary appointments for registration, ID, etc. within the first two days of my rotation. There was a drop-in period at the student health center on my first day, so I didn’t have to schedule my MRSA screening in advance. The appointment was quick and easy.

Acommendation

My fiancé also did exchange rotation at KI, so we wanted to find housing arrangements together. We spoke with the housing coordinator, who told us that it may be difficult to arrange housing for the two of us. We were pleasantly surprised when we heard that there was a private room with two twin beds available for us at Varberg. Unfortunately, we were a bit disappointed in our housing. There was only one set of keys for us when we arrived, which was a problem because you need a key fob to gain access to the elevator and the hallway with the laundry room and kitchen. Our room hadn’t been cleaned when we arrived, and a prior resident’s towels and garbage were left in the room. In addition, it was difficult to sleep because the curtains didn’t block out light, and the door to the room had a window that allowed the hallway light to stream in. We spoke with the housing coordinator to see if we could make alternate arrangements, and she was very understanding.

 

Ultimately, we decided to accommodations on Airbnb, because we preferred to be closer to central Stockholm. We were able to rent a small apartment in Solna, fairly close to the KI campus. Although this option was about twice as expensive as the KI housing, we felt the additional expense was worth it so that we could be closer to the city center and KI’s campus.

Leisure time and social activities

I was impressed by the number of programs and social activities available for exchange students to participate in. Unfortunately, I wasn’t able to make it to any of these events, but I didn’t hear positive things from the other exchange student I met on my family medicine rotation.

Pre-departure

My medical school offers funding for students to participate in a variety of global health rotations and a significant number of students choose to participate in global health experiences towards the end of their fourth (final) year. I wanted to go an exchange in order to gain an appreciation for a health care system different from that in the US. I specifically chose to go on an exchange at KI because I wanted to gain a better understanding of Sweden’s government-funded heath care system. In addition, I was interested in KI because previous students at my school spoke highly of their experiences at KI. I felt that the exchange information given by KI was very informative and comprehensive. The study aboard guide was full of useful information that helped make my pre-arrival preparations much less stressful. I was not required to be vaccinated or bring any certificates.

Courses during the exchange period

2EE045 : Clinical rotation - Family Medicine (Primary Care)
I participated in a clinical rotation in Family Medicine. I spent four days per week at a primary care center and one day per week with the course director for feedback and discussion. I found these Friday sessions to be quite informative and enjoyable, as we were able to discuss similarities and differences between the medical education system in the US, Sweden, and Canada (there was one other exchange student from Canada). We each had to complete an evidence-based medicine report on a clinical question we encountered during clinical service. Evidence-based medicine is strongly emphasized at my home institution, so I was familiar with the process of developing and researching a clinical question. I found the assignment to be useful and enjoyable to complete. During our clinical service, we had to video record several of our patient encounters and choose one to analyze. Because I had limited opportunities to independently interview patients, I only was able to record two patient encounters. I chose one of the two videos and completed a self-assessment on my patient interview techniques. We watched these videos on the last day of class and discussed them as a group. I didn’t realize that a significant portion of my final assessment would be based on the content of this video, specifically whether I asked about “ICE,” or the patient’s ideas, concerns, and expectations about their symptoms. Patient-centered interview techniques, including “ICE,” weren’t discussed during the course prior to this video analysis. I think it would be helpful to introduce these interview skills earlier in the course, especially if students will be assessed on their use during the video analysis.

Summary

I had heard such positive reports from other students at my school who have completed an exchange at KI, so I was really looking forward to my experience. Unfortunately, I was disappointed by my clinical rotation. Honestly, my first two weeks were really difficult. My time was spent observing conversations in Swedish without an interpreter. The second two weeks were better, but I still felt like I was unable to be as actively involved as I would have liked. I definitely understand that due to the language barrier, it’s not always possible for exchange students to be as involved in patient care as they are at their home institution. I think that my view of this rotation would have been positive overall if I had been as involved during the first half of the rotation as I was the second half. I also think that the experience will be much smoother if there are designated clinics who have experience working with English-speaking students.

Language and Culture

Because I had such limited time in Stockholm, I didn’t participate in a language course at KI.

Studies in general

Since my rotation was only one month long, I feel like my impressions of the study environment are somewhat limited. I was placed at 2 different primary care centers and worked primarily with one physician at each site. Due to difficulty finding English-speaking patients, my role was primarily that of observer. The experience differed greatly from that at my home university, where I usually evaluate patients on my own and then present to my supervisor. I didn’t have the opportunity to meet any medical students from KI, so I’m not sure how my experience compares with that of a Swedish-speaking student. I think that language was a significant barrier, because few patients spoke English (particularly at the second primary care clinic).

 

It seemed like both sites had limited experience working with English-speaking exchange students at my stage of medical school (i.e. about to graduate). I heard from various people that they weren’t used to having English-speaking students, and they usually work with younger students. As a result, I felt like I didn’t know what level of involvement I should expect to have at the clinic, and the clinic didn’t seem to know what level of involvement they should expect from me. In the future, I think it would be useful to assign exchange students to designated clinics that have experience working with international students. I also think it would be helpful to have a meeting with the course director at the beginning of the course to talk about expectations and structure for the course. Finally, I think it would be ideal if students could work at the same clinic for the entire month, if possible.