Exchange report - incoming students
Home university: Universidad del Azuay
Study programme: Medicine
Exchange programme: INK
Semester: Autumn semester 2016/2017
Name: Maria Jose Jaramillo Torres
Email address: majosejt14@gmail.com

Arrival and registration

Pick up service


One week before arriving to Stockholm, my friend and I contacted the office of pick up service and they told us we should take an airport coach to Stockholm Central. There, we met one masters program student who explained us about the public transportation system of Stockholm (SL) and helped us buying a card and guiding us home. 

Student Health Centre


I wasn't able to book an appointment during the date I specified, and had to go to Huddinge (they changed the name to Fleminberg a few months after) during the drop-in hours. Even though it was far away from my rotation hospital, the nurse was gentle and answered all my questions and explained the importance of the MRSA screening. She also told me about the other services the centre offers. 

Introduction day 


I arrived in late September and didn't attend the introduction day for the international students. I had to book an appointment with my international coordinator before the start of my first rotation. 

Acommendation

Pax


I stayed during my whole exchange program in a student dorm called Pax. I applied to it through the UAC (KI Housing, http://www.kihousing.se/). The process is easy, all the information is available in their website and they always willing to help in case you have any problem or question. 

I had my own room and bathroom and shared the kitchen with the people of my floor and the laundry with the whole building. My kitchen was very equipped compared to other floors, and had my own cabinet, shelf at the fridge and freezer. 

The price is expensive compared to my country, but according to the data I found about Stockholm, it's quite affordable for students. 

Leisure time and social activities

The student organization MF (https://www.medicinskaforeningen.se/) is very active and is always looking for activites for all the students. 

I participated in a party, the dance lessons and a boat trip and I have great memories from all of them. I met new people from all around the world, learned about new cultures and countries and had a lot of fun. 

One of their programs is KI Buddies, in which you are assigned a Swedish student from the school and you become friends. My buddy was really nice, she taught me many things about Stockholm and Sweden and suggested some activities we could do together. 

Pre-departure

Why KI?


My school signed an agreement with Karolinska Institutet last year and since then I had been reading about the school, the associated teaching hospitals and the opportunities of learning about a different culture. I learned it is one best medical schools in the world and one of the most famous (not only because of the Nobel Prize).  I have always thought that studying abroad gives you the opportunity to improve some personal features and your way of learning.

Application


I went through the selection process in my school (with a motivational letter and an interview) and after that I was nominated by the dean. The online application process was explained by my school's dean and I think it was easy to understand and follow. I was able to find the courses I wanted to take, some of the syllabus and the documents I needed to send to KI (like passport, grading records, etc). My international coordinator was really helpful and patient during the whole process, she answered all my questions and helped me to contact my supervisor for my first rotation. 


Extras


I didn't need any vaccine or special test before my departure, but I was aware I needed to be tested for MRSA before the start of my rotation. 
I required a visa to visit Sweden, and applied for it at an agency in the capital of my country. 
I took all the copies and documents suggested by the welcome package I recieved (p.e. ID and copy, original and copy of the acceptance letter, etc). 

Courses during the exchange period

2EE090 : Emergency Medicine
This rotation was at the Emergency Department at Södersjukhuset. I was contacted by my supervisor a week before it started and met him for the general instructions. Before the start of every week, I was assigned to a different supervisor in one of the wards: internal medicine, surgery, "older patient module" orthopedics or cardiology. If it was the morning shift, I had to assist to the meetings in which they discussed the cases they had the day before and sometimes they presented an unusual case they had treated during the ward. I had also a weekly seminar, I studied a common pathology I could encounter in the emergency department and then discussed a clinical case with my classmates, following the anamnesis and physical evaluation as if we were doing it with a real patient. I was impressed of the number of interesting cases I had the chance to study during this period and the approach they have with this patients.
ELAXX6 : Surgery 1
This rotation was at the Surgical Department at Södersjukhuset. My supervisor contacted me a month before it started with general information about the course and its contents. First we went to the clinical training center and we practiced some general procedures like sutures, NG tubes, etc. That afternoon I started my Urology week, in which I had also a lecture and observed several surgeries and procedures. The next week was the General surgery week, with upper gastric ward. The team was really friendly, my supervisor explained to me the surgeries step by step and discussed with me the cases. I really liked the guest wards they arrange for the students, you get the chance to see the patients from other wards and learn from different procedures they do there. At the end of this week I had a vascular surgery and acute care surgery seminar with all the KI students. For the Anesthesia week my supervisor took us to the clinical training center where we practiced intubation, IV lines, etc. After that I was assigned to another supervisor for the week. He was an incredible teacher, he explained everything from the physiologic perspective and let me help him with some small steps while he was working. I learned a lot also from the anesthesia nurses, they were always willing to teach me about the medications, the instruments and the patient monitoring. During the last week I stayed with the breast surgery ward. I really enjoyed this week because it combined both the outpatient clinic and the operating rooms. I met many patients, mostly with breast cancer and learned about its diagnosis and treatment and also about the physical examination for every patient that comes to the clinic. By the end of the week I presented a case to my classmates, explaining why I had chose it and what I learned from it. This was my examination, and I think it is a good way to evaluate the international students as it was difficult to talk to patients directly.
LÄK100 : Plastic surgery
I started my exchange period with this rotation at Karolinksa Universitetssjukhuset in Solna. I contacted my supervisor before the start of my rotation. She introduced me to her team and taught me how to scrub and help in the procedures. During this time I was able to watch and assist on several surgeries like breast reconstructions, skin tumors excisions, cleft palate and lip repair, flaps, etc. They changed the image I had of plastic surgery, in my country people mostly think about it in an esthetic way more than in a reconstructive perspective. My supervisors were very kind and eager to teach me, they encouraged me to ask questions and remember previous knowledge from basic sciences. I always asked if I could scrub with them before the start of every surgery, and most of the times they let me do it so I could stay next to them and watch it closer and help them if it was something simple. I also learned about catheters, suturing techniques, surgical instruments, etc. For the evaluation I had to write an essay about a topic of my interest in this field and after I presented it to my supervisors they sent me their suggestions to improve the structure.

Summary

My exchange period at KI has been one of the best experiences of my career, I would recommend it to any person with a good english level and a will to experience a different health system and culture. During these three months I improved my study techniques and my clinical reasoning and became interested in specialties I had not considered before. 

Language and Culture

I did not participate in any official Swedish language course as I was staying only for three months but I did use some online resources like Learning Swedish (http://learningswedish.se/login/canvas) and Duolingo (https://www.duolingo.com/) to learn some basic words. 

Studies in general

I am impressed of the study environment at KI teaching hospitals, all the staff in the hospitals is kind and eager to teach and learn. They were also interested in my culture, the health care system and some important facts about my country. 

My supervisors were willing to teach me something in spite of the fact that I didn't speak Swedish and it limited part of the interaction with the patients. They presented me as part of their team when we met any patient or any member of the team (doctors, students, nurses or nurse assistants) and translated me what the patient said or if they felt comfortable speaking in English they asked if they could explain it to me. They always encouraged me to do the physical examination simultaneously and to think and discuss of the differential diagnosis, tests or treatments for the patient. 

I didn't have many lectures, but I had some seminars in which several cases were presented and I had to study before the class. I think they were really good to learn about surgical techniques, unusual pathologies or syndromes or to remember common diseases and their clinical presentation. In my home university I have problem based learning (PBL) for two years, and I think this has helped me to learn to study on my own in my country and during my exchange period. These seminars were similar to PBL just shorter. I still feel I learned a lot during them. 
Also, if I was interested in a specific topic I could ask my supervisor for more articles, books or small lectures they could help me to find. 

I felt confident asking questions as they were always checking if I was understanding. This is a big difference with my home university because the teachers tend to send us to read and search all the questions we ask and it is an overload of important information that leads to miss details during the learning process. 
 
I also learned to ask for feedback, liked the suggestion my international coordinator gave me on the day I met her. It was always good to ask if my supervisor considered I could do something better or if there was anything I should study more. It was hard at the beginning as I was used to a different environment but I think I will do it in all my rotations back at home.