Exchange report - incoming students
Home university: University of Toronto
Study programme: Medicine
Exchange programme: INK
Semester: Spring semester 2015/2016
Name: Graham Lloyd
Email address: graham.lloyd@mail.utoronto.ca

Arrival and registration

Myself and a colleague did not arrive at a time that coincided with the start of a new academic term at KI, however the arrival and registration was very smooth. We were able to meet with the international electives coordinator the day of our arrival and the registration process for KI student access went very quickly and efficiently. They were able to answer any questions we had.

My clinic was very welcoming and, despite not having an international exchange student in the past, was very skilled at allowing me to integrate into the clinic and contribute and learn in their practice. I was treated with respect felt that they did all they could to ensure that I had a good transition to the Swedish system. They were also curious to learn more about my training and the health system in Canada which I was happy to share with them. 

I was able to drop into the student health clinic at Huddinge campus for my MRSA test which also went smoothly.

Contact with Global Friends was an excellent way to make contacts with fellow students in Sweden, ask any questions you had about the city or program and feel welcomed into the student community. 

Acommendation

We applied for housing with KI housing but the capacity was unable to accommodate us in a timely manner. This is understandable however, as it appears to be common knowledge that it is quite difficult to find student housing in Stockholm, particularly for short-term students on exchange. In the end we were offered student housing in Lidingo but the offer came close to our arrival date and we had already made alternate arrangements.

Speaking with some other students through Global Friends etc there appears to be some concern about KI housing as it appears to be smaller than some are used to and not close to amenities. If this is a concern to you as an incoming student I would encourage you to look into areas of the city where you may be placed as some are easier to access with transit than others. It may also be helpful to contact any past students who were placed at these areas. Unfortunately I do not have any helpful information in this regard.

I was fortunate to be travelling with another exchange student from Toronto whom I knew well. We were able to get a reasonably priced and nice apartment in Hornstull on Sodermalm. We secured this privately through AirBnb. It was great to be close to the city centre, both for the commute to the clinic as well as to be able to enjoy the amenities of the city that students should take advantage of while on exchange. Coming from Toronto we were accustomed to high housing costs but are aware that this can be a significant increase for other incoming students from smaller cities. In the end however we agreed that being on a main subway line and close to city amenities was a warranted cost to get the most out of our experience. 

Leisure time and social activities

Global Friends appears to be a very active and well-supported group. We attended one event while here that was great to meet others. I was travelling with a good friend who was also on exchange so we tended to do most social activities together. We also had friends visit from home for a part of the trip. If this were not the case however I could see how Global Friends could easily facilitate the fostering of friendships with other students to explore the city. We did also attend a student sports night hosted by KI where we met some other exchange students. We also played drop-in basketball a few times at the school.

We made a few friends through clinical activities. We were in contact with the partnered exchange student from KI who will be later coming to Toronto. He picked us up at the airport which was very kind of him. We also met him and his fellow med student friend one evening to visit an art gallery and cafe. We went rock climbing with another student and had dinner with a resident while here as well.

There are no shortage of fun activities to participate in in Stockholm. We went rock climbing, to music shows, countless museums (many free), hockey games - the list goes on!

Pre-departure

I was attending my fourth and final year of medical school in Canada at the University of Toronto. After we apply for our residency programs we complete further clinical placements called Selectives prior to writing our licensing exam. Many students use this time to complete international electives, either arranged on their own or with partner schools. This year was the first year that the University of Toronto had partnered with Karolinska Institute to have an exchange student program. I was excited by the possibility of studying at Karolinska as it is a well-known institution. I was particularly keen to study in Sweden as they have a strong primary care system and I myself will be entering family medicine in Canada. I was interested to learn more about the Swedish primary care system and hopefully learn lessons that I could take back to Canada to inform both myself and others about what they are doing well in Sweden. 

The application process was very straightforward. I was helped greatly by facilitators at both universities who maintained good contact and were able to advise me through the application process. I felt very supported through the process. I felt that Karolinska provided an adequate amount of information prior to my arrival such that I felt comfortable and knew reasonably well what to expect during my time in Sweden, and what the expectations of me were. 

Courses during the exchange period

2EE045 : Clinical rotation - Family Medicine (Primary Care)
During the rotation we met with the course supervisor once a week. This was a great opportunity to learn about the Swedish healthcare system through both formal and informal discussion. It also gave an opportunity to educate our supervisor about our healthcare structure and education system at home. During our time we did an evidence-based medicine project. I was able to select a topic of relevance to both systems which allowed for an engaging discussion for all parties. The supervisor leading the course was a specialist in general medicine (family medicine) who was also completing a PhD in clinical research so they were very well qualified to lead the course. They were extremely helpful throughout the course and assisted us with any concerns or difficulties. The final assignment consisted of a video assignment relating to a taped patient interaction. This was a good exercise for me as it is not something we commonly do in Canada. It allowed for an in-depth analysis of my history and physical exam techniques both independently and in a group setting. I learned some valuable things to take away from the exercise.

Summary

In summary, the student exchange process at KI is well established. This was evidenced by the quality and efficiency of the exchange from pre-departure through to completion. Everyone was very welcoming and made accommodations to ensure I got the most out of my experience and achieved my educational goals. 

My advice to incoming students would be to approach an exchange mainly as an opportunity to observe and learn from a different health system from your own. I saw some students who struggled at times and I think this was mainly due to their educational expectations. It is important to remember that the way your home country practices medicine and runs their system is of one but many ways to run a successful education and health system. A successful exchange requires students to be flexible above all else. Qualities of introspection and observation for the purposes of analysis and reflection are further keys that help to ensure a quality exchange experience.

With respect to the above paragraph, I feel that KI was an amazing place to achieve these goals while also experience a global city such as Stockholm and the country as a whole and I wish you all the best should you choose to take on this endeavour.

Language and Culture

I did not participate in any Swedish language courses formally. I was here for only a short period of time and was unsure about the amount of useful knowledge I could acquire whilst here. I would suggest learning basic greetings and departures in Swedish as this can help with establishing rapport with patients at introductions. 

There was ample information provided pre-departure about language courses offered by KI. This was great to see and a valuable resource if one were to take advantage of it. 

Studies in general

Overall I found the Swedish educational environment to be an a very supportive one that is sensitive to balancing both priorities of patients and the clinic with that of the student's learning needs. I felt that I was treated as a colleague here and my consultation was sought with how to best proceed at the clinic in order to get the best educational experience. It was helpful to discover that both the educational structure and the healthcare delivery system of primary care in Sweden and Canada share more similarities than differences. As such, it was fairly easy for me to transition in Sweden. Meeting with my exchange supervisor weekly was helpful to discuss any concerns we were having at our clinical placements. In addition this provided an opportunity for more informal discussion to learn about each others health care and education systems which I found particularly helpful and enjoyable. 

Patients at the clinic I was placed at were very welcoming and accepting of me as a student learner. I believe that being at the end of my training and having a sound educational and clinical background helped instill some confidence in the patients as well. 

It was the first time that my clinic had a senior student learner at the clinic so it was also a learning experience for them. As mentioned before they were very accommodating and made adjustments to optimize the learning environment. At times the scheduling of patients and appointments took priority over learning (ie case discussion and theory) but this is understandable and expected and important to remember that quality patient care must come before education at most times. Also, the main purpose of me being there was to observe the similarities and differences of my home system to Sweden's, not necessarily to practice clinical skills. 

Overall however I felt that the clinic did an excellent job of meeting these expectations of both parties, and most importantly they were very receptive to feedback and made the necessary adjustments or accommodations to optimize my learning environment.