Sultan Qaboos University
College of Medicine & Health Sciences
Clinical elective office
Done by:
Khadija Mohsin Al-Hafeedh
Elective experience:
The overseas clinical elective is an integral component of the MD curriculum in our college which
helps us as students to gain wide clinical experience and exposure to various medical systems.
I have chosen to spend my elective period in Canada for various reasons. First of all Canada is one
of the countries well known in the field of medicine. The medical system there is very advanced and
well organized. Second, I had family members studying their which motivated me to join them.
I have spent my elective period in two different specialties in two different hospitals. The first 4
weeks were in pediatrics at McMaster children hospital. The second 4 weeks were in general
internal medicine at St Joseph hospital.
McMaster Children Hospital:
McMaster children hospital is a teaching hospital. In the department of general pediatrics they have
4 working teams. They place elective students in team C. this team deals with premature babies and
neonates who have medical issues that require admission to level II nursery. The nursery there is
divided into three levels; level I is equivalent to neonatal ICU (NICU), level II is the level in which
less critical cases are placed. Level III is the normal nursery for normal newborns or those with
medical issues that does not require admission to level II nursery.
Beside level II nursery the team deals with chronic patients; who are children with complicated
diseases or syndromes which require prolonged hospital stay and integrated special medical
management.
As part of the team, I was given the responsibility to follow up and take care of at least tow babies
at any point of time. So I was responsible for seeing my patients daily to do the physical
examination and check for the progress of their condition & manage any emerging issues. The team
has daily morning rounds in which the issues of the babies are discussed with the attending
physician to agree and decide on the plan of management. I had to take care of my patient right
from their admission to level II nursery until their discharge including doing the dictation/discharge
summery.
During my placement, I had much more exposure to neonatal issues such as feeding issues in
premature babies, respiratory issues such as apnea of prematurity, gastrointestinal conditions such
as necrotizing entercolitis, retinopathy of prematurity, intracranial bleeding and many more
conditions.
Beside patient care I had to attend different teaching sessions and grand rounds in which different
topics are discussed. Each Thursday and Friday, I was placed in the general pediatrics clinics. Part
of those clinics is growth and development clinic. In those clinics I was given the opportunity to see
and examine patients and discuss on the plan of management with the attending physician.
I also was involved in case presentation in cooperation with other members of the team. We
presented a case of necrotizing enterocolitis.
So, during my placement in pediatrics time was allocated for different clinical activities from 7:15
am to 5:00 pm. However, as elective student I was not given any on call duties.
St Joseph hospital:
The second month of my elective period was spent in the department of general internal medicine at
St Joseph hospital. There are 6 working team in the department. Students are placed in any of the 1st
four teams. I was placed with team D. The day starts at 8:00 am with morning report in which
interesting cases are discussed. Another teaching session takes place at 12:00 pm which is driven by
doctors from various specialties including cardiology, respirology, neurology, radiology and
infectious diseases. I also had to attend teaching sessions which were conducted for medical
students who are doing their core medicine rotation. These sessions included clinical skills session
each Wednesday & tutorials each Thursday. Again each Wednesday there are grand rounds with
various topics.
I also had the opportunity to participate in the team presentation. We presented a topic about liver
cirrhosis and we presented in relation to that one of our patients that had Wilson's disease.
Apart from teaching, again I had my own patients to be responsible for their care and management.
I had as many as four patients at any point of time. Everyday after the morning report I see my
patients and follow up their investigations and active issues. Based on that I had to decide on their
plan of management and discuss it with the senior resident and attending physician/staff.
As part of the team I had to do on call duties as per schedule. During the on call, I see patient in the
emergency department who are referred for medicine team consult. So I had to deal with history
taking, physical examination, reaching to provisional diagnosis and doing the admission orders &
investigations for further management. The patients whom I admit become my patients so that I
become responsible for their follow up and management until discharging them and doing their
discharge summery.
I had exposure to different common medical conditions mostly in elderly. I had seen patients with
congestive heart failure, uncontrolled atrial fibrillation,UTIs with sepsis, pneumonias, COPD, lung
Ca, liver cirrhosis and much more. One of the interesting cases that I have seen in my team was a
patient with late presentation of Wilson's disease.
So overall in both departments the clinical experience was divided between patient care and
teaching sessions.
Benefits:
1. Applied the clinical knowledge acquired in the pre-clinical & clinical years of my study.
2. Gained more knowledge and experience about neonatal issues and their management which was
helpful as we didn't have much exposure to neonatology during our pediatrics rotation in 5th year.
3. Getting the chance to have my own patients to be responsible for which motivated me to learn
and know more about their conditions to decide on the right plan of management.
4. Gained more confidence in taking care of patients.
5. Gained more experience in communication skills with both staff & patients.
6. Exposure to a different medical system.
7. Learned more about the practice of evidence based medicine.
8. Travel by itself is a learning experience.
Difficulties:
1. Communication was difficult in the beginning of the elective period.
We study in English and we do practice communication in English language. However,
communication with people whom their mother language is English was difficult. The accent is
different a difficult and the vocabulary is so wide and variable.
2. Their culture is different and their knowledge about our culture and religion is limited which
added to the difficulty in the communication.
3. The medical system is different from our system. I struggled in the beginning to learn about their
system to be able to take care of my patients in the proper way.
4. In the beginning it was a challenge for me to have my own patient to be responsible for and take
the decision making role about their management. However, with time I gained confidence and
found it very useful.
5. During the process of application I faced many obstacles that delayed confirmation of my
placement. One of those is that I had to have malpractice insurance to be accepted for practice their.
It was not covered by McMaster University. It was difficult to find out a company that provides the
insurance for 2 months period so I had to apply for malpractice insurance in Canadian Medical
Protective Association (CMPA) for complete one year just for the sake of 2 months elective
practice.
Another obstacle was application for the visa which was time consuming with many requirements.
Expenses with figures:
Note: some of the figures are approximate
Expenses in Canadian dollars
Expenses in Omani Rials
Application fee
450
145
Malpractice insurance
1250
410
Visa with sending expenses
46
27
30
Health check up
62
Health insurance
49
Ticket
464
Accommodation
1200
400
Transportation
120
40
Food
1200
400
Telecommunication
150
50
Sum
2123 R.O
Suggestions for improvement:
I think the idea of the clinical elective is very useful. The period is reasonable. Students in Canada
appreciated that we have to do overseas elective which they don't have to do. Financial support
provided by the university is very helpful as it would be difficult to do overseas elective for most of
the students if this is not provided.
The only thing that I would think of for further improvement is to request the different universities
that the SQU/college of medicine deal with to provide description about the elective provided by
different departments so the students can be very clear about what exactly they are going to face
and do and hence be able to decide based on their preferences.
Overall I enjoyed my clinical elective period and I spent valuable time in different hospitals. I feel
that I had gained good experience from this placement. I strongly recommend the continuation of
this part of the curriculum in our school of medicine.