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As per July 2013 Max Kade Clinical Clerkship Program 1. Activities Undertaken:

Briefly summarize your daily activities.

With great appreciation to the AAF, I was given the opportunity to complete two months of Internal Medicine rotation (Endocrinology and Infectious Diseases) at the George Washington University Hospital (GWU). While the Endocrinology rotation was in the outpatient clinic, the Infectious Disease rotation was inpatient, providing me detailed insight to both modalities. On the first day of the clerkship, Rick James, senior education specialist of the GWU, accompanied the medical students to the hospital ward. After being introduced to my supervisors at the Division of Endocrinology, my first day began with a Grand Round in the conference room of the Department of Medicine. (This style of lecture was held every Monday; since the lecture was attended by the entire Endocrinology Team. It was a great place for discussion and acquiring additional knowledge). Afterwards I accompanied my attending to the outpatient clinic to see my first patients. Unlike the situation in the majority of Austrian hospitals, the emphasis in the US is on “learning by doing”. First the attending demonstrated to me several times, how to take a proper history, perform an exact physical exam and how he expected a student to present a patient. Then it was my turn. Under the supervision of the attending I saw my first patients. After getting comfortable with what I was doing, I was allowed to see patients on my own for the remainder of the month. That means after taking the history and performing the physical exam, I presented the patient to my attending. Together we discussed my findings, and then made a diagnostic and therapeutic plan. Afterwards I documented the patient assessment in the computer system; briefly summarizing the history, physical exam, study results, assessment and plan. The way this whole process works is entirely different to what I was used in Austria. However, having read a rotation guide (see book recommendations below) before traveling to the US, made it easier for me to quickly become a functioning team member. In my opinion this active approach to medicine is of much greater teaching value as compared to a pure observer status. After seeing many patients and doing some further reading on the clinical pictures seen, I quickly became familiar with the most common endocrine pathologies such as diabetes, thyroid-, adrenal-, and pituitary disorders. Very interestingly we also took care of many transgender patients. Since I had limited knowledge in this field of medicine it was a unique experience to learn more about it.

Every day at noon there was a so called “noon conference” for students, interns and residents. Major topics of Medicine were presented by recognized clinicians from all the different hospital divisions. The “noon lecture” was always one of the highlights of the day. Not only because of the professional camaraderie, but also the amount of knowledge we could gain. The second month I chose was Infectious Diseases. Here the emphasis was on Infectious disease consult service, which is one of the most busy consult services in the GWU hospital. The average is about 120 consults each month. Due to this I had the possibility to see a wide variety of clinical pictures like patients with end stage HIV with opportunistic infections, PML, endocarditis, severe sepsis and even malaria.

On this service we usually started the morning with checking on our patients and their most recent results. Every student had a couple of patients to follow. For these patients the student was “responsible” and wrote the progress notes as well. I worked together with highly motivated fellows who taught me invaluable approaches in terms of patient care. In the afternoon we rounded together with the whole team and the responsible attending on all of our patients. During rounds we presented our patients to the attending (using the SOAP form: subjective, objective, assessment, plan) and discussed the further diagnostic and therapeutic steps. During this service we also had a daily Microbiology lecture in the Department of Pathology. This way we had the chance to get a glance with the microscope on all the organisms visualized in the different patient specimens, which actually caused the underlying

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As per July 2013 Max Kade Clinical Clerkship Program disease. This was an amazing learning experience. The pathologist was compassionate and tried to show us exactly how the problem presents from a pathologist’s point of view. Therefore we had both, the clinical and the pathological approach to our patients’ problems. At the end of both electives I held a presentation, which was very well received.

2. Problems:

What problems did you encounter during the fellowship and how did they affect your original plans?

Most sincerely, my Max Kade colleague and I did not have to face any problems at all. Thanks to the perfect organization of the American Austrian Foundation and the George Washington University the fellowship was a great experience, from the first to the last minute. At this point I would also like to thank the American Austrian Foundation for giving me this unique possibility to complete part of my medical studies in the USA. Especially I want to thank Mag. Kerstin Wahlmüller for her great support. Not only during the application process but also the fellowship Mag. Wahlmüller was always there for her students. She ensured that everything was perfect. I also want to thank Rick James, senior education specialist of the GWU. He was our mentor during the clerkship and handled all the organization from the US site. Already at the first meet and greet in DC, he welcomed us heartily and ensured, “if you need anything during your stay, no matter what, you can always come to me.”

3. Recommendations:

What suggestions or recommendations do you have to improve the operation or administration of the Max Kade / AAF Clinical Clerkship Program?

To my mind the operation and administration of the Max Kade Clinical Clerkship Program is perfect. I cannot think of any suggestions for improvement.

4. Influence on Thinking:

In what ways, if any, has your thinking been influenced by your experiences during this fellowship? Please explain. Describe any new perspectives you have encountered as a result of the fellowship.

I think that during my fellowship I have learned from probably the best medical doctors in the world. I experienced their dedication and effort for both patients and students. Just to give you one example: One of our attendings took not only the time to teach us during the normal clinic hours (presentations, case discussions...), he also stayed at the hospital to show us hands on how to perform an Ultrasound guided procedure. Instead of going home he just said to us students: "Hey guys, my last patient didn't show up. So I have some time for further teaching. Come with me and I'll show you how to perform a fine needle aspiration of the thyroid..." Dreaming of a career at a university hospital I have learned what great physicians and great teachers can be like. I try hard to become what my mentors in Washington DC are now.

5. Fellowship Experience:

How has this fellowship broadened your knowledge of American medicine and culture? This fellowship provided me with unique insights in the American healthcare system and American medicine in general. With coming to the US I started to see the differences between the health care system in Austria and the US. Besides which living in the nation’s capital for 2 months was a lifetime experience. This means not only working in an unparalleled medical

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As per July 2013 Max Kade Clinical Clerkship Program teaching system but also learning about US culture and history. By spending time with patients, US colleagues and teachers I learned more about the American way of life. Furthermore Washington DC is a multicultural city and the International House DC a great place to meet people from all over the world. Intercultural exchange is one of the major goals in the ISH DC.

How do you think this experience will influence your professional life? This fellowship for sure has major influence on my future professional life:

As I worked together with US students I got familiar with valuable information regarding studying and working as a doctor in the US. Since I am absolutely delighted with the US medical training system, I am thinking about applying for residency in the US. This fellowship provided me with knowledge about the whole application process (e.g. USMLE steps, Letters of Recommendation, Programs and Program Directors…). Additionally, with completing this fellowship I can prove to my future employers that I am able to work successfully in the US health system.

6. Recommendations for future Max Kade students: Please address the following points:

•Housing (Where did you live during your stay? How did you find it? How much was it?) •Recommendations (What suggestions or recommendations do you have for future Max Kade students (hospital, leisure time, etc.)?

•Other (Is there any other vital information you would like to share with future Max Kade students?)

Housing: My Max Kade colleague and I stayed at the International Student House DC (ISH DC). This is an exceptional place to stay. Located near Dupont circle, one of the best areas of Washington DC, the International Student House provides safe housing for about 100 international students from all around the world. All residents of the house are very welcoming and it is very easy to quickly become a part of the community. Together you can spend your spare time in the house (table tennis, piano room, tv lounge, library…) or take part in one of the many activities provided (scavenger hunt in the national mall, excursions to museums, “Oktoberfest” and many more…)

You can choose between single or shared rooms depending on personal preference and the amount of money someone is willing to spend (1200-1400 Dollars). On weekdays breakfast and dinner, on weekends a continental breakfast and a so-called “family dinner” are provided. The George Washington University hospital is quite near and you can walk (20 minutes), ride there by bike or take the metro from Dupont Circle Metrostation.

Books: I would like to recommend a few books which will make it much easier for future Max Kade students to take part in the daily hospital routine in the US.

Every US student and also most of the interns and residents have basically two books in their white coats:

Maxwell Quick Medical References and Pocket Medicine (The Massachusetts General Hospital Handbook of Internal Medicine). Both books are very useful tools and fit perfectly in every white coat.

The Maxwell Quick Medical References provides the essential information (lab values, physical exam, notes…) for the daily clinical practice.

Pocket Medicine is a short and well-structured summary of all fields of Internal Medicine. It is perfect to quickly review the key points of a clinical picture before, during or after rounds.

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As per July 2013 Max Kade Clinical Clerkship Program Especially for Austrian Students I can recommend two very useful books:

Medical English by Peter Gross and Success on the wards by Samir P. Desai.

Medical English is very good language training for all students working the first time in the US. Besides the basic vocabulary, also clinical cases and a guide on how to write notes are included. The included extra booklet containing of commonly used medical abbreviations is very helpful, especially in the first days of clinic service.

Last but not least I want to mention Success on the wards by Samir P. Desai. This book includes 250 rules for clerkships success. To my mind this book is one of the best guides on how to maximize one’s clerkship education. Reading this book before coming to the US provided me with great information and strategies for success at the George Washington University Hospital.

Hospital: For all future Max Kade Students who are not sure where to go: I can totally recommend the George Washington University Hospital, especially the Division of Endocrinology and the Division of Infectious Disease (Department of Medicine). Both fields are unbelievably interesting and you will work and learn from attendings who are not only experts in their respective fields but also highly motivated and impassionate teachers. Not only the attendings, but also the residents and fellows will teach you a lot. Once you are a part of this efficient team you will enjoy your work a lot.

Leisure time:

Washington DC is a great place to live. The nation’s capital provides visiting students with everything they can dream of.

The national mall: This is the place where you can find all the famous sights. You will be astonished seeing them for real. There are also the famous Smithsonian museums. My Max Kade colleague and I especially enjoyed the Air and Space Museum. Amazing.

Mt. Vernon: home of George Washington, first President of the United States.

Sport: We enjoyed playing tennis and soccer in the area of Adams Morgan. Everybody can use the sport facilities there for free. The area of Adams Morgan is also famous for its nightlife.

Weekend trips: New York City (“The City That Never Sleeps”) and Philadelphia (“discussions for the democracy via the Age of Enlightenment”, “Pennsylvania Hospital - the nation's first hospital”…) are not far from Washington DC. Going there by bus or train is not expensive and definitely worth doing. Both cities are wonderful; after returning home from our weekend trip from New York City, Washington DC seemed like a welcoming home city.

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As per July 2011 Max Kade Clinical Clerkship Program

MAX KADE CLINICAL CLERKSHIP IN AMERICA

FINAL REPORT FORM for AUSTRIAN STUDENTS:

Instructions for preparing this report:

Prior to departure from the USA, each fellow is required to send a final report to the Executive Director of the American Austrian Foundationat:

max.kade@Aamericanaustrianfoundation.org (Please delete capital “A” in the email address)  This report should be typed. At least 1,5 pages

PERSONAL DATE:

First / Last Name Stefan Moesselberger

Date & Place of Birth: 23/05/88- Rottenmann Gender: Female Male

Address: (Street, City, Zip

Code, Country) Burggasse 12, Graz, 8010 Graz, Austria Phone: (Mobile): 00436502490228 Fax:

E-mail: stefan.moesselberger@stud.medunigraz.at

PROFESSIONAL DATE:

Dates of stay in the USA: 1st Jan 2013- 26th February 2013

Hospital and Department George Washington University Hospital- Cardiology and Pulmonary Medicine Mentor: Dr. Mercator, Dr. Delaney

On a separate sheet of paper, please address the following questions fully and in the order in which they appear below.

1. Activities Undertaken:

Briefly summarize your daily activities.

2. Problems:

What problems did you encounter during the fellowship and how did they affect your original plans?

3. Recommendations:

What suggestions or recommendations do you have to improve the operation or administration of the Max Kade / AAF Clinial Clerkship Program?

4. Influence on Thinking:

In what ways, if any, has your thinking been influenced by your experiences on this fellowship? Please explain. Describe any new perspectives you have encountered as a result of the fellowship.

5. Fellowship Experience:

How has this fellowship broadened your knowledge of American medicine and culture? How do you think this experience will influence your professional life?

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As per July 2011 Max Kade Clinical Clerkship Program

Max Kade :

Final Report, Austrian Student

George Washington University Hospital

Stefan Mößelberger

1. Daily Activities:

Before starting my rotation with clinical cardiology on 2nd of January there was an IT training course, in which we were taught about the documentation programs in use.

The first two weeks I was in Gold team- the Cardiology team of the Hospital. In those two weeks, Dr. Tracy was the attending in charge.

Usually I started around 7am at the 3rd floor, where I looked for patients, prepared for the

morning round- which included sometimes the presentation of patients.

At 8 am there was a morning conference from Monday to Thursday, which took place two times on the sixth floor of the building and two times in the nearby MFA building.

We were supposed to attend those conferences, except we were busy dealing with patients.

In those conferences we discussed a hugh variety of medical subjects (ECG, MM, new interventions...).

Morning round took place from about 8: 15 to usually 1pm- depending on the issues to talk about +/- 2 hours.

We looked for all patients of Gold team, discussed therapy plans, social care issues, and so on.

At 12 there was usually a class, we attended in case there was time.

We were also lucky to attend an excellent ECG course, taking place at 3pm at the MFA building. We were taught a very practical understanding of an ECG and also took the exam with good success.

The clinical day ended usually around 6pm, we had a short final discussion about the developments during the day.

We also had 3 oral exams, where we could show our knowledge to Dr. Mercator and also got a very good feedback. We also did a presentation of a topic our own choice (Clincal case presentations in my case).

The 3rd week of our rotation we spend at the echocardiography, which was very

interesting. We had the luck of having DR. Louise and Dr. Bazil- who were very interested in teaching us a good understanding of the echo.

The 4th week was in the Cath lab, which was very interesting, but also very theoretical, as

we were not allowed to assist- so it was watching and learning most of the time this week. To sum it up- Clinical Cardiology is quite a challenging rotation, where you learn a lot , it is not so much about practical skills (we hardly did interventions on our own), but more about gaining a big fund of knowledge. So it is perfect when you want to learn ECGs, Echoes, and Cardiology in general.

2nd Rotation: Critical Pulmonary Care:

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As per July 2011 Max Kade Clinical Clerkship Program

I got my own patients, which I took care of. Usually 2 to 4, I took the admission

(+examination of course), looked after them in the morning- wrote sometimes the daily note progress, presented them in the morning rounds, discussed about therapy plans, also suggested further intervention...

I was kind of an AI position, always under supervision ,of course.

I think I made a big step forward in my practical skills doing this program.

I also want to mention that Dr. Delaney was a great help, he took a lot of time explaining everything to me and took a big trust in me. I am very thankful for his excellent

mentorship.

2) Problems:

There were some administration problems:

 The IT training course we were supposed to take online wasn’t working at all- so it was impossible to perform the task.

 I wanted to do Endocrinology for my second subject- but Rick told be just 2 days before my start, that there was no place left.... Finally I was very luck getting into Pulmonary Care.

Also sometimes it can be very challenging spending all day in the hospital...

3) Recommendations:

Reports of other students should be easier available, so that you can choose easier between the different departments with a bigger fund of knowledge...

The applying process is also very complicated and full of bureaucracy... sometimes I had to send my documents three times...

4) Influence of Thinking:

I started to think more about the patient’s social background, and how to manage especially chronically diseases in daily life.

5) Fellowship Experience:

I am not sure how it will influence me exactly. Since I saw the American health care system I am more and more grateful of the Austrian one. So I am definitely sticking to a government based health care system.

There is also an excellent, high performance and high technology kind of medicine. Where I am sure- one can learn a lot.

I also notice, that there is much more competition in the American system. So it is a lot about taking opportunities.

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References

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