Hey there! I am glad that Jonathan asked me to share my foreign rotation experience with you because it gives me a great opportunity to think thoroughly about it and store the best moments in my memory. Beginning with the story. I am in my 4th and last year of Pharmacy residency and since I began I wanted to go abroad, at some point, and be able to see how pharmacists work in other places. So it was not difficult to be convinced to come to the UMMC (University of Maryland Medical Center) in Baltimore to spend 6 weeks doing an internship with the SICU (Surgical Intensive Care Unit) pharmacist. I must say that I wasn’t the first resident to come here. Last year my co-resident Marta went there and came back so delighted with the experience that I didn´t even doubt it for a second.
I wasn´t afraid of the language barrier because I had been preparing with English courses for 3 years but I was a bit scared about the city because, just in case you are not familiar with the place, Baltimore is known for its high rates of crime and violence, all related with drug dealing and abuse. But, now I have been living here for a while I have to say that it is not that bad. When you know the safe parts of the city and don’t mess with drugs (no meds I mean) it is ok. Also, it´s been the bunch of kind and friendly people I met here who have made me enjoy the city and its outskirts.
Well, about the language though, I should have practiced the oral part side more before coming here. I did take some phone classes but I don’t think it was enough. To be able to understand the conversation and communicate in English seems easy in Mallorca in your English class with other students and your teacher (usually non-native) but real life and particularly, working in a hospital is completely different. How many hours did we spend in school with grammar and letters, articles and other compositions? I didn’t use any of that. It took me a week and a half to be able to follow the whole patients rounds. And I also found myself unable to pronounce the drugs or answer some questions because I lacked the medical vocabulary and fluency, I guess.
The bright side is that you get used to it, so you learn quickly. There are some technological devices that can help you, so as the phone applications about acronyms (key to understand the patient medical history) or brand medicines names (they use them all the time and most of them are different from ours). I had to do some oral case presentations too, and I think it helped me to improve my spoken English. After attending a couple of them by other residents and students I could learn the main structure and some useful sentences and vocabulary to do it myself. The first one was a bit of a disaster, but they didn’t even complain. The following ones went better because it is just about practicing, as everything in language.
About complaints; I could also notice that they are so used to accents that don’t make a face when they hear you. They really try hard to understand and never correct you. They also confessed that they admire us speaking more than one language. It is something that makes me thing about how we mix with foreign people.
I enjoyed being part of an American movie for a while, because it is exactly like that.
Teaching hospitals in USA are organized a bit differently.
At rounds, we were almost 10 people some days. As for physicians, there is the Resident who has the prime responsibility for the patient care at the bedside and has to present the patient history to the rest of group. Depending on the service there are more or less residents; for example, at the SICU there were 3 residents (anaesthesiologists or surgeons).Then, there is the Fellow, who is a resident who has completed residency (5 years) and now is doing 1 or 2 years of fellowship, for example in critical care. So they are doing a subspecialisation. We had 2 fellows at the SICU (day and night shift). And finally, the Attending, who has already completed the fellowship and takes care of the unit for one week, usually. He or she is the one who asks the residents and the Fellows questions and makes sure they are learning at the proper pace and are prepared to take care of the patient. I think that is great because you learn from a different Attending each week.
Apart from physicians there are others health care professionals participating in the rounds. The Nurse practitioner, who could be someone similar to our supervisor but they can prescribe medical orders. Also, there is the Respiratory therapist who takes care of the ventilation parameters of the patients. There are usually 2 of them at the SICU. And finally the pharmacist, who takes care not only of all drug related questions the team asks, but is also responsible for kinetic monitoring, IV to PO conversions and other standards of care of the SICU like DVT (distal venous thrombosis) and SRMD (stress related mucosal disease) prophylaxis, hyperglycemia management, anti-microbial stewardship, drug dosing in renal or hepatic dysfunction and interactions.
And I think that is all I have to say. I strongly recommend everyone who feels like an international rotation like mine. I have been in contact with some professionals that made me wish I had studied and worked in the States because, in terms of Pharmacy they are well ahead of us. But I hope that my experience and others who went before and afterwards will help to advance our clinical role as hospital pharmacists.
To conclude, if you are planning to do some foreign stay like this, remember my advice: prepare yourself! forget the books, find someone to speak to in English, and preferably about medical topics. Maybe that is closer than you thought (let’s say at your hospital library).
Thank you, Jonathan for your support and your dedication!