Author: Ding Liucheng
From April 2021 to March 2022, with the joint funding of the Jiangsu Scholarship Committee and the 789 key talents of the Second Affiliated Hospital of Southern Medical University, I went to the Affiliated Hospital of the University of Hamburg Medical School in Germany for a one-year study visit.
During this time, I participated in 3 clinical studies on urethral stenosis and also participated as a Clinical observer in the clinical practice and teaching of martini-clinic at the UKE Urology and Prostate Cancer Centre.
During my year at the Faculty of Medicine at the University of Hamburg, I have been thinking: How to use the stone of his mountain to solve my confusion? Now I will share with you my learning experience and impressions during this period.
One-stop clinic
The doctor can decide when the patient will see the doctor
Steeped in history and beautiful surroundings, Hamburg is the cultural, educational and health center of northern Germany, with large green areas and countless canals.
Located on the campus of Klinikum University, the University Hospital Hamburg (UKE) is one of the most modern hospitals in Europe with a history of 120 years and is home to many of Germany's leading medical departments, such as the Martini-clinic Prostate Cancer Centre, Urology, Stem Cell Transplantation, Neurology, etc.
Exterior of the University Hospital hamburg (UKE) (photo by the author)
UKE is located in Hamburg's lush district of Eppendorf, opposite eppendorf Park, full of green trees and flowers.
When I came here, I could deeply feel the hospital's emphasis on and creation of "cultural concepts".
UKE Hospital's design philosophy fundamentally wants patients to feel as comfortable and convenient as home, rather than coming to a place where illness makes people nervous. The entire hospital is open-plan, with old buildings from various periods. The courtyard is very quiet, there are no bustling crowds in sight, and everything is orderly.
The hospital is full of rest centers where patients drink coffee and talk, and both sides of the corridor are decorated with a variety of works of art that are valuable for appreciation. The hospital also provides full translation services for non-English patients who come to seek treatment, no matter what language the patient speaks, there is no need to worry about language problems.
Martini-Clinic, one of the best prostate cancer centers in the world, embraces the value system that "patient care is at the heart of everything", and this culture is reflected in the hospital's "one-stop clinic" process.
The authors are at the Martini-Clinic Prostate Cancer Center
Most hospitals in Germany use the outpatient appointment system, patients can start outpatient appointments from the home page of the hospital and medical school, and quickly target doctors can be locked through the doctor's name, specialty or their own symptom input, usually need to wait about 2 weeks. Doctors can set the average time for each patient according to the characteristics of their specialty, and the outpatient time will be accurate to the minute, such as 10:20 a.m. or 2:30 p.m.
After the appointment is successful, the doctor's secretary will keep in touch with the patient and communicate in time if the outpatient time changes. The patient arrives at the one-stop outpatient unit of the department according to the appointment time, and the nurse at the front desk collects the medical history, distributes the questionnaire and takes the patient to the consultation room.
In urology, for example, patients do not need to leave the clinic to complete routine examinations such as urine routines, and the results are read by nurses in the outpatient clinic.
When the doctor sees that the patient is ready in the office area, he first reads the patient's medical record through the computer, and then asks the patient in person with a focused medical history. Further ultrasound, urine flow rate, and urodynamic tests can also be done directly in the outpatient unit if required.
If a physical examination or cystoscopy is required, the nurse will assist the patient in setting up the position and changing clothes, and the doctor can use this time slot to go to another clinic to ask another patient.
Such a one-stop outpatient setting can basically allow patients to complete most of the necessary examinations in the examination room, eliminating the pain of patients who are not familiar with the hospital's institutions, and also need to run around on various floors, departments, and examination rooms. Doctors can also shuttle between several consultation rooms to improve work efficiency.
On the day of the clinic, the doctor will clearly tell the patient about the current diagnosis, the available treatment methods, the possible effects of the operation and complications. If the patient undergoes the surgical plan, the secretary will schedule the operation according to the doctor's schedule and the time required for the operation, usually after two weeks.
The doctor decides whether the patient needs surgery, and whether the patient can undergo surgery requires further anesthesia evaluation. Anesthesia assessment is also conducted through outpatient clinics, also in the One-Stop Anesthesia Clinic (CPAP), where anesthesiologists assess the patient's condition through an evaluation system and assess the risk of surgery through simple and necessary tests.
Trainees with thorny speech
Let me see the relationship between authority and students
The University of Hamburg Medical School and the UKE are located in the same area, making the combination of clinical and teaching as convenient and efficient as possible.
Germany is currently repositioning professional training from the current checklist model to competency-based courses, proposing a new professional training regulation in 2018. There are 10 subspecialties in Germany: General Surgery, Visceral Surgery, Cardiac Surgery, Thoracic Surgery, Pediatric Surgery, Orthopedics and Trauma Surgery, Plastic Surgery, Vascular Surgery, Neurosurgery and Oral and Maxillofacial Surgery. The first eight subspecialty postgraduate surgical training is organized in a coherent manner, with separate training structures in neurosurgery and oral and maxillofacial surgery.
Surgical training in Germany takes 6 years, the first 2 years include basic clinical training, including 6 months in the emergency department, 6 months in the ICU and 1 year in the surgical ward, which can be carried out in any of the eight subspecialties mentioned above. The next 4 years vary according to the different structure of the specialty, but the main part is carried out in the surgical department of the chosen specialty.
At UKE, surgery is basically performed by two doctors, with the chief surgeon (usually at the chief level) taking a subordinate doctor, who is sometimes the attending physician and sometimes the resident.
Each resident has a strict and standardized rotation training program, internships are strict 1-on-1 tutoring, dedicated responsibility, and there is a lot of interaction and communication between students and teachers. The department has weekly rounds, case discussions, business learning, and at the same time, the discussions are particularly in-depth and never formal.
UKE da Vinci robot application is very popular, prostate cancer center robot surgery rate of more than 70%. And I have my own training center, I can participate in training and computer training once a month, which is very rewarding.
Da Vinci robot-assisted prostatectomy (photo by the author)
What impressed me the most were a few trainees, many times their questions seemed to have thorns on their bodies, and even sometimes they asked incoherently, lest the language was not surprising.
Professor Fisch listened carefully and carefully every time and unreservedly explained the details and insights of the surgical treatment of each disease, while at the same time humbly listening to the students' rebuttals and guiding each other to ask questions. Professor Fisch, in particular, has always been able to follow the rules and induce me to lead to deep discussions, never posing as authoritative. Every operation will make me feel the academic rigor and excellence of surgical skills, but also burst out some new ideas or bring new inspiration, 1 year after I really learned a lot of knowledge.
What I gain the most and are deeply shocked here is the relationship between authority and students, and this completely open and free discussion between students and tutors is not only a form, but also a kind of character and spirit.
Compared with the Sino-German training system and system, the mainland currently does not have a specialized training system, and the following three points may be worth learning: increasing fiscal expenditure, especially the financial allocation of the State Financial Department; establishing a professional management institution for non-governmental departments; strengthening supervision quality management, especially strengthening the monitoring and monitoring of training bases.
Photo by the author
Let the results of scientific research serve the clinic
Relatively speaking, the scientific pressure felt by German doctors will not be so great. Of course, like China, if you want to be promoted, you also need the support of the thesis, but it is not a necessary condition.
In the matter of whether to do scientific research or not, German doctors have a choice. Under the current System in Germany, doctors can still be promoted if they only do clinical work and do not conduct scientific research. Of course, you can also rely on scientific research to get promoted, and the two do not conflict.
At UKE, many professors have their own laboratories, and for professors who are committed to research, in addition to the clinical working hours, the hospital also allocates them with a certain amount of research time. For residents who want to do scientific research, in addition to using their spare time, they also have the opportunity to apply for fund support and can do basic research on a full-time basis. They also hold small academic conferences on a regular basis to exchange their scientific research results.
Most of the research here focuses on clinical prospective and retrospective studies, deriving the research data of the center through the research results, and constantly adjusting the diagnosis and treatment behavior and the scientific diagnosis and treatment system according to the research results.
Most of the basic scientific research topics come from the clinic, and fully consider the feasibility and clinical practical value, once there are research results, it will be able to solve clinical problems quickly, which is conducive to the establishment and standardization of the disease treatment system.
For example, Martini-clinic, as the world's largest prostate cancer center and the world's largest clinical database of more than 30,000 cases, through a large database of forward-looking and retrospective analysis, addresses the key factors of postoperative urinary control and sexual function recovery, and designs and further adopts prospective RCT studies.
High degree of self-discipline and a clear division of labor
Rules guard everything
A brief overview of Martini-Clinic's weekly group meeting schedule.
Every Monday morning at 7:10 a.m. basic scientific research academic report, the entire clinic's basic research field of prostate cancer report discussion; every Tuesday morning at 7:30 rounds, in addition to the lectures of the professors in the department, there will also be speeches by prostate cancer experts from the world's top hospitals;
Every Wednesday morning at 7:00 a.m., the department's faculty discusses, whether the weather is good or bad, the thunder does not move, including many white-haired old professors and directors of various centers;
Every Thursday morning at 7:30 a.m. clinical practice class, at the same time for the department of difficult cases and complications of the regular summary report discussion, every Friday morning at 7:00 a.m. the whole hospital case discussion, not only the hospital experts to comment on the case, but also invite experts and professors from major German hospitals to comment on typical cases.
Whether it is a doctor or a medical student, working from 7 a.m. to 7 p.m. every day, non-stop at noon, self-disciplined and efficient; whether it is surgery or scientific research, it highlights a strong sense of teamwork. During my year at the Hamburg Medical College, I came into contact with many well-known experts and scholars, and their dedication and high self-discipline have always touched and inspired me.
Photo by the author
The biggest impression of Germans in life is that everyone has their own belonging, and even everything has its right place. German society is very obedient to the rules, and "rules guard everything" is a true portrayal of the daily life of Germans.
This clear division of labor is also reflected in the collaboration of various departments of the hospital. For example, in the surgical department of the hospital, there is a special secretary responsible for making appointments for patients and scheduling operations; if clinical research is needed, there are special researchers responsible; and even daily trivia such as doctors need to make an appointment in the conference room, there are also special secretaries to arrange and coordinate.
Surgical robot system introduced by prostate cancer center (photo by the author)
Contrast and reflection
This high division of labor in the whole society has put doctors and medical students in a more comfortable and step-by-step state as a whole, and the competition is relatively less intense. This down-to-earth work style also allows doctors to have more energy to do research that they are really interested in.
However, this highly refined division of labor can also lead to people being overwhelmed, with many people going to work on time and on time, lacking in subjective initiative, and students may lack a sense of adventure.
Compared with domestic doctors, the overall work pressure of German doctors is much less, but if compared with other industries in Germany, German doctors still work far more weekly hours than other industries.
Also because of this highly refined division of labor and meticulous and clear training path, most German clinicians are currently specialized in a sub-specialty, which is very different from the mainland.
Due to the large total number of patients in the mainland, the operation is all carried out by the directors, and there is certainly no way to cover so much medical work, so the sub-specialties of our domestic hospitals are actually more like sub-organ departments, and the doctors in the corresponding specialties cover more sub-specialties, and can contact different patients, disease directions, and exercise opportunities.
From the patient's point of view, compared with China, the overall medical cycle and the waiting time outside the hospital will be longer, and the preoperative pre-hospital examination is completely completed in the out-of-hospital assessment, which has more assembly line characteristics. A Chinese friend in Germany once gave me an analogy like this: "In China it is an equal call, and in Germany it is waiting for the air." On the other hand, too much regularity in the diagnosis and treatment of diseases may also limit the subjective initiative of doctors to a certain extent.
In addition, although the German academic community adheres to the pragmatic tradition, does not blindly follow the trend, and does not regard the ranking list as the direction of university development, the brand effect affects the attractiveness of talent resources, which is one of the main reasons why the popularity of German university hospitals is far behind that of British and American universities.
Judging from my exchanges with Chinese professors working in Germany, Germany has also made some adjustments in recent years, hoping to make its doctors more international and communicate with the outside world.
During his time in Germany, the cooking skills have improved significantly, and the picture is made for yourself in the 2022 Chinese New Year's Eve rice (photo by the author)
Although Hamburg's one-year study time was short, I experienced the deep meaning of "reading thousands of books, walking thousands of miles" and "the stone of his mountain, you can attack jade". Looking back on the year, I think the biggest "lessons" are developing good habits: valuing time management; being self-disciplined and prepared; and emphasizing teamwork.
I sincerely thank the hospital department for their strong support in the training of young teachers, and sincerely thank the teachers, friends and family members who have given me care and selfless help on the road of studying abroad. Hamburg is truly the gateway to the world, and now it is open to me, fulfilling an unforgettable experience in my life.
The author is Ding Liucheng, Deputy Chief Physician, Associate Professor, Ph.D. He is a young member of the Jiangsu Urology Society, a member of the calculus group, and a young member of the neuromodulation group of the Jiangsu Medical Doctor Association.
Curated by: gyouza| Title Image Source: Author Photo