Magdeburg, Germany01/28 - 02/22

Shaily Patel, MS4

Pediatrics at Otto von guerickeUniversitätsklinikum vs KU

GERMANY

● 7th largest country in Europe

● 64th largest country in the world

● Population: 83million

● Currency: Euro

● Language: German

● 16 states; Capital: Berlin

MAGDEBURG

● Capital city and the second largest city

of the state of Saxony-Anhalt

● Population: 238,478

● Area: 201.01km² (Wichita 423.70km²)

● Popular sites: Magdeburg cathedral,

Hundertwasser building

Intro to country and city

Universitätsklinikum

● University Children's Hospital - General Paediatrics, Neonatology and Intensive Care Medicine with special focus

on Pediatric Hematology and Oncology - Pediatric Endocrinology and Metabolism - Experimental Pediatrics and

Neonatology

● 80 total beds - 8 PICU, 10 NICU

● Clinic = inpatient and outpatient housed in the same building

● NICU/well baby housed in women’s hospital

● Building 10: wards, PICU, heme/onc, emergency, ambulatory (outpatient)

Life in Magdeburg

● Stay: university guesthouse - for visiting students

● Exactly like a dorm room here - bed, desk, closet, washbasin

● Shared restrooms and bathrooms; Community kitchen

● Worked at PICU for 2 weeks and NICU for 2 weeks

● Local travel: public transport - trams

● Clinical sites: 20-30 mins away

● Weather: 30-40F, windy; most students bike around the city even in the cold

● Europe travel: no airport at Magdeburg, take a train/bus to Berlin/Leipzig/Hannover

● Grocery: at supermarkets - Edeka, Alee-Center, Karstadt (closed Sunday)

Pediatrics in Germany

● Assistant physician; Additional experience to subspecialize

● A subspecialist works for other specialties too

● For example - a cardiologist I followed had ultrasounds scheduled for the mornings but would work at

a rheumatology/asthma clinic in the afternoons. A PICU intensivist would often have GI clinics in the

afternoons.

● Noon meeting with all the physicians to go over the patients - PICU, wards, heme/onc, ambulatory

● Magdeburg: Much smaller training hospital; no additional help such as PT, OT, RT, case managers,

social workers, pharmacy, lactation specialist, psychiatry.

● Physicians perform most procedures such as IV placements, phlebotomy, ultrasound, etc. There were

no respiratory therapists and physicians performed the equivalent job.

● Health insurance in Germany covers everything. Physicians do have to work with insurance for certain

medications and procedures.

● No research happens in the University Clinic as the hospital size is smaller and they do not have

enough data. They usually follow protocols from studies based in other countries like UK, Australia,

and US.

PICU

7:30am: checkout

8:00am: table rounds with paper charts lead by assistant

physicians with attendings and nurses

10:00am: breakfast – physicians and nurses

11:00am: procedures

12:30pm: meeting with all physicians

Lunch at their own time

New admits (maybe 2 admits a week)

Discharges

Assistant physician worked on her presentations and

studies in the free time

Attendings either had office work or afternoon

subspecialty clinics

4:30pm: checkout

Typical team: 1 assistant physician, 2 attendings, 5-6

nurses, medical student if present

6:00am: checkout

6:30am: pre-round, finish notes

8:00am: morning report

9:00am: bedside rounds with whole team

Lunch at their own time

12:00pm: afternoon conferences as scheduled

Finish notes, talk to families

New admits

Discharges/Transfers

Teaching sessions with attendings and students

Put in consults, talk to subspecialists

Check on progress, put in and follow up on orders

4:30pm: checkout

Typical team: 1 senior resident, 1 nurse practitioner, 1

attending, 1-2 third year medical students, 1-2 fourth year

medical students on critical care elective

NICU

7:30am: checkout

8:00am: table rounds with attendings and nurses

10:00am: breakfast

11:00am: physical exam, procedures - draw

blood, IV placements, central line placements,

ultrasounds, UAC/UVC placements, phlebotomy

Lunch at their own time

Attend to all deliveries, 2 isolettes present next to

the delivery rooms where the babies are first

stabilized and then transferred to NICU

3:30pm: checkout to afternoon team

9:30pm: checkout to night team

6:30am: checkout

5:30am – 8:30am: pre-round and finish notes

8:30am: bedside rounds/teaching

12:00pm: afternoon conferences as scheduled

Lunch at their own time

1:30pm: checkout rounds

2:30pm: stay if on call (24hour calls)

Attend to deliveries where NICU is called, isolettes

present in the delivery, baby friendly hospital

Procedures/follow-up on orders and consults

Teaching with attendings and students

Research and read papers

Students are allowed to do procedures as they feel

comfortable

Life as a medical student in Germany vs US

● 6 years right after high-school

● 6th year = intern year: Required EM, IM, Surgery, OBGYN

● Clinical experiences of 3 weeks each semester in different specialties

● End of the clinical week, students pick an interesting patient and do an oral

presentation about the case with other students

● Typical day at clinic: 7:30am to 12:30pm

● Mostly involves shadowing

● Do not examine the patients on their own, do not present them, nor do any

procedures during years 1-5

● Tuition: free; students only pay for personal expenses

● Some students prefer to go work in Switzerland once out of medical school since the

pay is higher and later would like to settle back in Germany

Most profound clinical/academic experience

● Empathy defined very differently in Germany compared to US

● US focuses a lot on bedside manners, being empathetic, spending time with patients/families

● No bedside rounds like in US; parents were barely present and were not given all the information

about the hospital stay of their kids.

● Interested in echos, the PICU intensivist took me to different patients to perform echos even

though there were no indications. No permission was obtained.

● No empathy towards kids with chronic disabilities; thought that the resources were not utilized

right in treating these kids that they had to be admitted over and over again since their quality of

life was very minimal.

● An exchange student from China who was admitted to the PICU was referred to as the Chinese girl

instead of her name.

Most profound cultural experience

● Language barrier

● Most people in Magdeburg did not understand nor speak English

● All the communication in the hospital happened in German too

● None of the nurses that I worked with spoke English

● Some physicians are more fluent in English than others. Some wanted to

practice their English and would be more willing to teach us. Whereas, for

some physicians it was too much effort to communicate in English.

● All the table rounds and charting happened in German and it was hard to

follow through with patients hospital stay.

References

● Dr. Michael Gleissner

● Dr. Sebastian Luiis

● Miss. Stefanie Sasaki-Sellmer

● https://en.wikipedia.org/wiki/Magdeburg

● http://www.uni-magdeburg.de/unimagdeburg/en/

● https://www.researchgate.net/publication/26878047_Medical_Education_in_Germany

● Pictures: Shaily Patel and Nisha Patel, MS4

Budget

Tuition 0.00$

Housing 300$

Flights 800$

Food 300$

Transportation 100$

Misc 50$

Exchange rate 1Euro = 1.12 USD

Visa 0.00$

Total 1550$

IEEE award 750$