King’s College London allows students to organise their own 3 week placement as part of the paediatric rotation. With a deep interest in Israel I decided to use this opportunity to get a feel for paediatric medicine at the Sheba Medical Centre, Tel Hashomer.
I spent the first week mainly attending paediatric outpatient clinics, mostly in the mornings, which included endocrine, respiratory, neurology, haemato-oncology and dermatology. All the doctors were keen to teach me and patients and their parents were happy to have a foreign student present. Tel Hashomer has developed a special interest in cystic fibrosis, and offers acupuncture as treatment alongside regular physiotherapy.
The afternoons I spent with the Tel Aviv university medical students on their paediatric rotation, joining them for their lectures and small-group teaching sessions about various topics. Most of the lecture slides were in English, only the lecturing was in Hebrew (Ivrit), but both the students and doctors had very good English and were more than happy to translate words I didn’t know.
The second week I spent on the wards. The mornings would begin at 8:00 a.m. with a departmental morning lecture or grand round with all the senior and junior staff, followed by a handover of new inpatients from the previous night and a discussion of the ongoing care of the more challenging cases. The department would then divide up into two teams and each team would review all the inpatients under that team’s care, and discuss their management and jobs that needed doing that day. The patients would then be divided up amongst the team and each junior doctor and registrar would go and see their particular patients. This was then followed by a ward round with the full team led by the consultant.
As a student, as well as joining this whole morning procedure, I was also given patients to clerk myself and then present to one of the doctors later on that morning in a teaching session with the other students.
During the third week I joined one of the student groups in the paediatric A+E department. We each clerked patients as they arrived and then presented to a junior doctor in a teaching session to discuss the cases. Every afternoon the students had lectures and small group teaching usually in the form of case discussions.
The student teaching was at a high level, covered a wide range of topics and was generally, very well organised. The doctors and students were very welcoming, and included me in everything that was going on, and were particularly keen to practise their English! I watched bronchoscopies, attended physiotherapy sessions for cystic fibrosis patients, NICU, joined X-ray meetings and spent some time on-call. Not all the doctors were Israeli Jews, many were Israeli-Arab, and there were Russians as well as Olim (immigrants) from America, South Africa and the UK. As the patient population also encompasses patients from all these nationalities, it was particularly enjoyable to witness how everyone worked together to understand each other and ensure efficient use of resources and optimise patient care. This also helped make me feel comfortable as a foreign English-speaker.
During my placement Operation Amud Anan (Pillar of Defense) against Hamas in the Gaza strip occurred, and thus I had experience of work in the medical profession in war time. Tel Hashomer is located on the outskirts of Tel Aviv and is thus within range of missiles fired from Gaza. This meant that we had a number of siren “red alerts” (“tzav adom”) while in the hospital. The first one occurred while I was in an outpatient clinic and we were all ushered into an “Ezor Mugan” – “safe area”. This is an area surrounded by re-inforced concrete walls which when all the doors are closed becomes a shelter. There are several of these areas located in every part of each floor throughout the hospital. After ten minutes we were all allowed out to resume normal clinic routine. Everyone seemed to take the situation in their stride, though all were glued to the news on their phones to find out where the missile had landed.
Another siren was sounded while I was in the emergency department. The paediatric emergency department in Tel Hashomer was built with reinforced concrete and the whole department is effectively a safe area. So business here continued as normal, with few even stopping for a moment to consider the possible missile target. This was my first experience of war, and was a particularly interesting experience being both a civilian walking around and finding myself in a shopping centre during a siren alert, as well as in a hospital where life has to carry on as normal. Of particular interest given the political situation in Israel, is the prevalence of Palestinian patients in the Israeli hospitals. During Amud Anan, several inpatient Palestinian children and their families found themselves stuck in the hospital and unable to return to their homes. It was interesting to see the more human side of the political situation, albeit a very an unusual situation for a country to be in while at war.
I thoroughly enjoyed my placement in Tel Hashomer. The medical teaching and practice I saw was of a very high standard, with much enthusiasm for the profession. It was a good opportunity for me to speak to doctors who have moved to Israel from the UK in recent years and hear about how they have settled and acclimatised to their new environment. I was able to use my current good Ivrit skills which improved dramatically as a result of my speaking to patients and listening to the doctors.
Thank you to JMA for the support and assistance in enabling me to have this fantastic experience.
Adi Gordon
KCL