Chloe MacAuley is an intern (junior doctor) at Tallaught Hospital in Ireland who graduated from medical school at Trinity College Dublin in 2017
Armed with an email outlining the ‘Dangerous Abbreviations NOT to Use’, a certificate showing I had passed an online test on how to use the hospital computer system, and a dictation number — what was a dictation number? I wondered — I boarded my plane from Dublin to Vancouver for a medical student summer elective.
Canadian students in my class at Trinity College Dublin had warned me that Canadians expected more of a hands-on approach from their medical students. Navigating the unfamiliar streets to St. Paul’s Hospital on my first day in downtown Vancouver, I was thinking about how much easier it would have been to stick with the familiar commute to St. James’s Hospital in Dublin. I was nervous, but I had resolved to throw myself in the deep end before final year.
When I arrived, I was overwhelmed with information. I was told they were ‘used to’ international students, which I sensed was code for: ‘most international medical students are a bit lost.’ This was not surprising, as there were a number of differences (even down to the hierarchy of training). Canada has Residents, Fellows, and Attendings, whereas Ireland has Interns, Senior House Officers, Registrars, and Consultants. Interns are newly qualified; this year-long post is required in Ireland to complete your degree. Senior House Officers are on a training scheme, be it medicine, surgery, or otherwise. Registrars are in the later years of their training. Consultants are the equivalent of Attendings.
“So, you don't do bloods?” I asked. It seemed strange to me to chase down a phlebotomist to take a particular blood sample when I could have done it myself. But everyone had a specific role here and they were sticking to it. In Ireland, bloods were taken in the morning by phlebotomoists — but aside from this, most bloods were taken by interns.
Ward organization was also quite different. Things seemed to happen by magic in Canada using the ‘Orders’ section of the chart. I learned how to flag orders, which were picked up by nurses and distributed throughout the hospital. This ensured that activities such as IV-line siting, imaging studies, and tests were all done by the right person. In Ireland, tests were ordered using computers on the wards; although this may sound like a more efficient method, people tended to take more responsibility with flagging.
While my team at St. Paul’s wrote clinical notes by hand, they told me this was uncommon and that most Canadian hospitals log all patient data on computers. In Ireland, clinical notes are still largely handwritten. Only test results and imaging are found online.
I was asked if we used the ‘SOAP’ format in Ireland to write our chart notes. I didn't know — I had never actually written a chart note. As an Irish medical student, you were more of an observer; at times questioned and tested, but with very little responsibility and almost never taking on any patient care.
I learnt quickly that this was not the case in Canada. From early on in their training, Canadian medical students were expected to manage patients and order tests, and they had an obligation to remain in the hospital until the rest of the team had also completed their work for the day. The patient list was divided amongst all members of the team equally — including students — and when patients presented to the respirology service, we took it in turn to complete the consult and present before reviewing later as a team. The patient became your responsibility, and you followed them until a summary had to be dictated upon discharge. This was also a new concept, as medical students never dictated in Ireland.
Four weeks in, I started to enjoy the responsibility of seeing patients and ordering tests. I was quick to ask for help and check that I was thinking along the right lines, but it was great completing things myself.
Looking back, the major difference between these settings for a medical student was the level of clinical responsibility. In Canada, students took on much more responsibility and were an integral part of the team. I found this a little overwhelming at first, but soon became accustomed to it. Suddenly finding myself in a different healthcare system was challenging, but I was so impressed by the patient care, the commitment of the staff to teaching, and the enthusiastic help from junior doctors. I can also appreciate the difficulties that Canadian students must face in Ireland: they must miss greater involvement in the team and more directed teaching. The language and medicine may be the same, but the system is vastly different. Medical care in Canada seems very structured with defined roles and working hours; while this has advantages, a little more flexibility may be useful at times.
Despite the organizational differences, patients’ problems are quite similar. St. Paul’s and St. James’s may be in very different cities, thousands of miles from each other, but patients face the same social problems and suffer similar comorbidities. The inner city population in downtown Vancouver was much the same as I had seen in central Dublin.
I loved the city, enjoyed the hospital, and greatly appreciated the support from the doctors at St. Paul’s. It was a great opportunity to learn in a different healthcare system and think more widely about where I would like to work and what type of doctor I would like to be. Furthermore, I can now understand why Canadian medical students might find the Irish system so different. There is a lot to be gained from experiencing a different system, and when I spoke to doctors-in-training at St. Paul’s, the Fellowship system also seemed very attractive. Perhaps one day I will have the opportunity to join them…
Acknowledgment: Thank you to the respiratory/internal medicine team at St. Paul’s, who made me feel so welcome, for all of their help.