Having undertaken the majority of my final year elective at Great Ormond Street Hospital, I was keen to spend some time in Israel. I joined the Hadassah Paediatrics Department on the Ein Kerem campus for a week in October 2012, with the intention of learning more about the Israeli medical system in general and paediatrics in particular, with a view to emigrating to Israel and specialising in paediatrics.

I stepped off the El Al night flight early on Sunday morning, and made my way bleary eyed to Ein Kerem, Jerusalem, where I was welcomed by Ayelet, the elective organiser, a medical student herself. I was immediately struck by the hospital’s pleasant appearance, replete with a shopping mall, which compared starkly with the somewhat dreary-looking NHS hospitals we often find ourselves. The paediatrics inpatient department occupies a floor in the relatively newly built “Mother and Child Pavilion”, a modern building linked to the main hospital, with outpatient clinics, obstetrics, and neonatal and paediatric intensive care on the other floors.

The day began at 8am, when junior and senior staff alike meet to handover patients from the previous night, and to discuss management of the more difficult cases. On several days of the week, this was followed by departmental teaching, either given by one of the trainees or by a clinician from elsewhere. I was very impressed by the standard of material presented, which I felt surpassed that of comparable meetings I have attended in the paediatrics departments of the North Middlesex and UCL Hospitals. Interestingly, Israeli doctors tend to present in Hebrew with a smattering of English phrases, yet their lecture slides are almost entirely in English. Of note, several senior doctors not responsible for ward cover that week also attended these morning meetings to contribute to discussions on patients’ care, something I have not observed in the UK.

The doctors split into their two ‘teams’ to carry out ward work prior to the ward round starting at 11am. It is worth mentioning that senior doctors responsible for patients on the ward are all subspecialists, as the concept of a general hospital paediatrician does not exist in Israel as it does in the UK. The majority of Israeli paediatricians are generalists working in the community, and a minority subspecialise and form the corpus of hospital paediatricians. For example, the consultant I joined is a paediatric neurologist. Nonetheless, all subspecialists must maintain their competence and knowledge of general paediatrics as patients under their care while they are responsible for the ward cover the gamut of general paediatrics.

While the ward round was comprehensive, it reflected a style of practice somewhat outdated (for the better) in the UK. The team would enter a patient’s room and have a discussion about their care without involving the patient or their parents, and without any introductions from the doctors. Questions would be fired at the parent to clarify the history, and often the team would leave the room without providing any update on the patient’s progress. I felt that the communication skills and bedside manner in Israel were somewhat lacking, although my Israeli medical student counterparts assured me that this is starting to change.

I joined the Hebrew University final year medical students on the ward for their teaching. They received consultant teaching most days of the week (UCL take note!), which was to a high standard and was similar in style to what I was used to. I found that my knowledge was generally similar to the Israeli students although they certainly had a better grasp of pharmacology than UCL medical students.

I also had the opportunity to join some clinics, which generally were only scheduled in the morning. I joined Dr David Zangen, a paediatric endocrinologist whom Prof Katz had introduced us to during a Student JMA tour in 2009, and Professor Michael Wilschanski, a British paediatric gastroenterologist who had studied at the Royal Free Medical School.

The working day pleasantly ends at 4pm, after which the night shift team takes over in A & E and on the wards (they do a 26-hour shift), although I had the impression that many doctors work in community clinics afterwards to supplement their modest income.

In terms of patient demographics, the majority were Haredi or Arab, with the remainder being secular and ‘national religious’ Jews, which reflects the current trends in the changing Jerusalem population. It was immensely useful to have Arab and Russian doctors on the team in overcoming language barriers.

Finally, my description would not be complete if I did not describe the unique experience of working in an Israeli hospital environment. Looking out of the windows at the panoramic views of the Jerusalem hills surrounding the hospital (see the image below) was emotionally stirring and made day-to-day life working there feel more meaningful. I felt a bond with staff and patients alike unparalleled during the past few years I have spent in UK hospitals; joining the hospital synagogue services where one would pray alongside all sorts of people from patients and doctors to hospital porters and chefs had a very natural feel to it.

I would like to thank the Jewish Medical Association for their generosity in supporting me to have such an enjoyable and worthwhile week in Hadassah, Ein Kerem.

Leo Arkush
UCL