Dear friends, below you will find four random reports from participants of the EFPT Exchange Programme from different countries:
Exchange experience from Croatia
Host institution: Psychiatric Clinic Vrapče, Zagreb
Duration: 2 weeks (19th November – 2nd December 2012)
I applied for the exchange program in the Department of Neurophysiology because the content looks interesting and different from what we have in Ireland where I have been in psychiatry training for about 4.5 yrs. My motivation stem primarily from the objectives of the program to expose and acquaint trainees with different mental health system among others.
I spent two weeks as it is called in the Department of Psychophysiology and Organic Mental Disorders in Psychiatric Hospital Vrapce Zagreb, Croatia. The sleep centre was established in 1981 with the aim to diagnose and treat patients that usually fall into a “mixed” category between psychiatry and neurology.
During my 2 week visit in observership capacity, I participated and contributed in diagnostic assessment of hypersomnia and insomnia patients as well as patients suffering with sleep apnoea, narcolepsy, sleep walking and night terror. I also participated in all night polysomnograhic recording and checked polysomnographic findings. I overlooked all night video recordings of specific cases like night frontal lobe epilepsy, incidental parasomnic awakening, RBD (REM Sleep Behaviour Disorder) with sound grasps of the therapeutic approach. I contributed to diagnostic and therapeutic process of in and out patients with organic psychiatric disorders such as Parkinson like disease, organic dissociative disorders and epileptic personality disorders.
The Psychiatric Hospital Vrapce Zagreb is 800 bedded, biggest and oldest psychiatric institutions in Croatia. The hospital environment was welcoming and staffs were genuinely friendly. Treatment is fully hospital based. Work starts 8 o-clocks in the morning. The practice of mental health is different in number of ways but despite this diversity, we still have same language of ICD 10 criteria and pattern of presentations for psychiatric assessment in the emergency appears similar. The hospital holds a ground round every Monday afternoon and I attended one which was a journal presentation and another lecture by the professor. The junior doctors in training spend 4 to 5 years to become specialists. I delivered a presentation as part of the program on my basic Curriculum vitae and Community Model of Mental Health in Ireland to good number of attendees. Overall, three most striking things were;
Firstly, the great hospitality I received from colleagues; all members of staff from the day one I arrived at Zagreb Airport to my emotional departure were remarkable. I enjoyed my stay in the hospital accommodation and the restaurant meal was a delight. Patients and staff were willing to communicate and colleagues are very supportive all the way.
Secondly I counted it a privilege to sit with Dr Hodoba, my mentor whose is an authority with vast experience in this specialised area of organic neuropsychiatric disorders. It is such a great feeling to have an expert to tease out and simplify some complex aspect of epilepsy, sleep related disorders and all the questions I have. It was a good experience for the first time in training to see and read EEG tracing and appreciate diagnostic usefulness of all night video recording and polysomnograhic findings of some interesting cases. Dr Hodoba was very kind to show me some of his prepared power point presentations for teaching and I particularly found some of his publications very useful for personal career development and MRPsch exam written papers.
Thirdly, it was good to note that, EEG Electroencephalograph and polysomnograhic recordings are diagnostic and routine practice and the average waiting period for EEG is very short. Again, the team include a compliment of psychiatrists and neurologists and I met an intern doctor and neurology trainee on rotation during my visit. I enjoyed the daily ward round and it is relaxing to sit for a cuppa- (tea and coffee) after wardround and have brief discussion.
No regret whatsoever though I could only use my annual (holiday) leave to get on this rewarding program. The two weeks appears short but quite content that, I maximise the period effectively. It is very easy to access the city centre from the hospital and extra 4 nights in Zagreb was relaxing and had wished it did not finish. What a wonderful time to see a beautiful country and fashionable people, play football with hospital staff and make new contactable friends. Many thanks to Dr Nikolina Jovanovic and Dr Marina Fistonic, the coordinators of the program in Croatia for their quality time to make it a memorable experience. The initiative behind this program is very good and I suppose a feasible reciprocal arrangement between host and visiting country/ trainee may enable trainees to avail of this program for an appreciable longer duration of up to 4 to 6 weeks intended. I will strongly recommend EFPT Exchange program for colleagues and will grab this opportunity in future if it comes my way. As I return to my routines, I was so refreshed and full of enthusiasms to share my experience and invaluable knowledge gathered locally with colleagues.
Host institution: Psychiatric Clinic Vrapče, Zagreb
Duration: 2 weeks (19th November – 2nd December 2012)
I applied for the exchange program in the Department of Neurophysiology because the content looks interesting and different from what we have in Ireland where I have been in psychiatry training for about 4.5 yrs. My motivation stem primarily from the objectives of the program to expose and acquaint trainees with different mental health system among others.
I spent two weeks as it is called in the Department of Psychophysiology and Organic Mental Disorders in Psychiatric Hospital Vrapce Zagreb, Croatia. The sleep centre was established in 1981 with the aim to diagnose and treat patients that usually fall into a “mixed” category between psychiatry and neurology.
During my 2 week visit in observership capacity, I participated and contributed in diagnostic assessment of hypersomnia and insomnia patients as well as patients suffering with sleep apnoea, narcolepsy, sleep walking and night terror. I also participated in all night polysomnograhic recording and checked polysomnographic findings. I overlooked all night video recordings of specific cases like night frontal lobe epilepsy, incidental parasomnic awakening, RBD (REM Sleep Behaviour Disorder) with sound grasps of the therapeutic approach. I contributed to diagnostic and therapeutic process of in and out patients with organic psychiatric disorders such as Parkinson like disease, organic dissociative disorders and epileptic personality disorders.
The Psychiatric Hospital Vrapce Zagreb is 800 bedded, biggest and oldest psychiatric institutions in Croatia. The hospital environment was welcoming and staffs were genuinely friendly. Treatment is fully hospital based. Work starts 8 o-clocks in the morning. The practice of mental health is different in number of ways but despite this diversity, we still have same language of ICD 10 criteria and pattern of presentations for psychiatric assessment in the emergency appears similar. The hospital holds a ground round every Monday afternoon and I attended one which was a journal presentation and another lecture by the professor. The junior doctors in training spend 4 to 5 years to become specialists. I delivered a presentation as part of the program on my basic Curriculum vitae and Community Model of Mental Health in Ireland to good number of attendees. Overall, three most striking things were;
Firstly, the great hospitality I received from colleagues; all members of staff from the day one I arrived at Zagreb Airport to my emotional departure were remarkable. I enjoyed my stay in the hospital accommodation and the restaurant meal was a delight. Patients and staff were willing to communicate and colleagues are very supportive all the way.
Secondly I counted it a privilege to sit with Dr Hodoba, my mentor whose is an authority with vast experience in this specialised area of organic neuropsychiatric disorders. It is such a great feeling to have an expert to tease out and simplify some complex aspect of epilepsy, sleep related disorders and all the questions I have. It was a good experience for the first time in training to see and read EEG tracing and appreciate diagnostic usefulness of all night video recording and polysomnograhic findings of some interesting cases. Dr Hodoba was very kind to show me some of his prepared power point presentations for teaching and I particularly found some of his publications very useful for personal career development and MRPsch exam written papers.
Thirdly, it was good to note that, EEG Electroencephalograph and polysomnograhic recordings are diagnostic and routine practice and the average waiting period for EEG is very short. Again, the team include a compliment of psychiatrists and neurologists and I met an intern doctor and neurology trainee on rotation during my visit. I enjoyed the daily ward round and it is relaxing to sit for a cuppa- (tea and coffee) after wardround and have brief discussion.
No regret whatsoever though I could only use my annual (holiday) leave to get on this rewarding program. The two weeks appears short but quite content that, I maximise the period effectively. It is very easy to access the city centre from the hospital and extra 4 nights in Zagreb was relaxing and had wished it did not finish. What a wonderful time to see a beautiful country and fashionable people, play football with hospital staff and make new contactable friends. Many thanks to Dr Nikolina Jovanovic and Dr Marina Fistonic, the coordinators of the program in Croatia for their quality time to make it a memorable experience. The initiative behind this program is very good and I suppose a feasible reciprocal arrangement between host and visiting country/ trainee may enable trainees to avail of this program for an appreciable longer duration of up to 4 to 6 weeks intended. I will strongly recommend EFPT Exchange program for colleagues and will grab this opportunity in future if it comes my way. As I return to my routines, I was so refreshed and full of enthusiasms to share my experience and invaluable knowledge gathered locally with colleagues.
Exchange Experience from Romania
Press the link: Exchange in Romania
Exchange experience from Ireland
Host institution:
Daughters of Charity Service for Persons with Intellectual Disability, Dublin, Ireland
As a second year trainee in the field of General Adult Psychiatry, I had the opportunity to attend a 4 week observership position at Daughters of Charity Service for Persons with Intellectual Disability, Dublin, Ireland. Throughout this period, my activity took place in four different locations: St. Vincent’s Centre, St. Joseph’s Centre, St. Louise’s Centre and an outpatient clinic.
In St Vincent’s Centre, I had the chance to work with patients with severe or profound intellectual impairment and different psychiatric comorbidities such as depression, autism, schizoaffective disorder, and dementia. These patients were permanent residents of the center, and lived in bungalows under continuous observation.
My activity in the outpatient clinic took place two times a week. In this setting, I got familiar with mild cognitive disabilities and different psychiatric comorbidities. These patients were living in community based settings and most of them had the opportunity to work (part-time), go on vacations or spend more time with their families. I also took part in a couple of MDT’s or Multidisciplinary Meetings. These meetings were attended by psychiatrists, psychologists, dementia nurses (for people diagnosed with dementia), clinical nurse manager, social workers, occupational therapists, staff working in the house and sometimes speech and language therapists. Their goal was to discuss and find solutions to different aspects related to patient care.
The activity in St Joseph’s Centre was somewhat similar to the one in St. Vincent’s. Patients were permanent residents of the bungalows, most of them with severe intellectual impairment. The difference between the two was that in St Joseph’s I got the chance to see people in convalescence post admission to general hospitals with a range of different medical concerns.
Besides my regular observership activity in these centers, I had the chance to visit a private facility, St Michael’s House established by parents of children with intellectual impairment, and I attended the teaching sessions at St. Patrick University Hospital.
Another important part of the experience was the possibility to visit Ireland. I had the chance to see Dublin and its surroundings: Powerscourt House and Gardens, Ardgillan Castle, the Windmills in Skerries, and I took a one day trip to the Cliffs of Moher.
My observership position at Daughters of Charity Service for Intellectual Disability took place under the supervision of Dr. Niamh Mulryan, consultant in Psychiatry and clinical director who offered me the opportunity to write a scientific article on Mild Cognitive Impairment, and Dr. Fionnuala Kelly, consultant in Psychiatry who supervised my clinical activity. I also had a great collaboration with Dr. Iulia Dud, Registrar in Psychiatry who was kind enough to host me for the 4 week period and became a very good friend. Dr. Elizabeth Barrett, the local programme coordinator, was very supportive throughout the experience and provided me all the information needed. In my opinion, the observership position offered by the EFPT Exchange Programme was excellent for my experience as a psychiatric trainee. I had the chance to get familiar with a different type of management of psychiatric services, to work with great professionals and to visit a new country.
Exchange experience from Spain
Host institution:
Ponzano Day Hospitals , Madrid, Spain
I am an ST6 in General Adult Psychiatry with London Deanery. I came across the European Federation of Psychiatry Trainees’ (EFPT) exchange programme and applied for an exchange in Spain. It was straightforward to arrange thanks to EFPT and in particular to the trainee who is in charge of the organisation in Madrid. I was granted a 2 week programme in one of the Day Hospitals called Ponzano in central Madrid, in the heart of Chamberi district.
Ponzano provides an intensive treatment programme for severe and enduring mental illness, primarily first episode psychosis but not exclusively, as in reality it also caters for individuals with Bipolar Affective Disorder, Drug induced illness, severe OCD, schizotypal/schizoid personality disorders, persistent delusional disorders, and even at times emotionally unstable personality disorders who have had psychotic episodes. Their capacity is somewhere around 25 patients per day; they are usually at full occupancy. Referrals come from community psychiatrists, acute inpatient services, and homeless programme. One of their main objectives is insight building/relapse prevention. The centre is open 9 – 3pm as per Spanish working hours.
The team is multidisciplinary, formed of 2 consultant psychiatrists one of whom is the service director and founder of the project, an extremely experienced psychologist, 2 psychiatric nurses, occupational therapist, a part time social worker, and admin staff, alongside psychology and psychiatry trainees who mainly have an observational role. There is a team meeting every morning, after which some members of the team go to their local cafe for a quick ‘cafe con leche’ and ‘barrita’, a small but terribly tasty fresh bread and tomato breakfast plus or minus jamon serrano, which I still crave after being back home for over a week.
Ponzano adopts a therapeutic community philosophy, with a genuine person centred approach, not limited to a paper-based exercise, where there is a real sense of getting to know the patients and their families.
There is daily group work for patients facilitated by OT and psychiatric nurses, where timekeeping, boundaries, respect for others, self care, healthy living etc is promoted. The patients were involved in the production of a short film (they worked as a group to devise script, props...), indirectly addressing negative symptoms. Every week they agree on a Friday leisure activity (watch a film, play a sport, and when I was there we went to a photo exhibition at a local museum).
There is also a weekly psycho-education group for patients where they learn about mental illness and are encouraged to talk about their symptoms, with a view of building insight, which can be extremely powerful when this awareness arises from interactions with other patients.
Patients also have individual sessions with the psychiatrist and psychologist. The consultant I was with utilised an eclectic approach combining psychodynamic or CBT depending on the situation, as well as centring on Attachment theory and its transgenerational nature. The use of psychotropic medication was minimal; poly-pharmacy was frowned upon. He had an open door policy, and he oozed charisma! The psychologist was amazing, extremely personable, empathic, genuine in her interactions, employing CBT techniques with Bentall as her doctrine.
They also carried out individual systemic family therapy interventions alongside weekly family group work in the form of psychoeducation around high EE (Leff) alternating with Multifamily Group Therapy (Garcia Badaracco), the latter of which I was unfamiliar with. It consists of large family group meetings, where numerous families and patients are present together, in which there is a collective sharing of experiences about living with mental illness. I found a paper from 2006 about MGFT project in the UK (Asen, Schuff), and I was wondering whether trainees had come across this in their training.
I was deeply touched by the impressive work carried out at Ponzano. The patients and their families embraced the recovery work, and there was a sense of hope and happiness in the environment. Prior to the exchange, I think I was feeling slightly
So with that in mind, I humbly advise those of you who can to start polishing up on your Spanish and apply for this particular EFPT programme....
Exchange experience from UK
Host Istitution: Maudsley Hospital, CAMHS , South London , UK
When I received the email with the EFPT programme, I did not have to think twice. Having done all my psychiatry training in Ireland to date, I have always wondered what psychiatry training in other countries is like. It was the perfect opportunity!
For the first week, I was based in the Lewisham Kaleidoscope Centre. It is an outpatient CAMHS service. Keir Jones who kindly helped coordinate my programme with the CAMHS clinical director was welcoming and extremely helpful. He made sure I participated in the SpR teaching and also invited me to the SpR night out to ensure I got the most out of the exchange. I can’t thank him enough for all his help! From the learning perspective, it was helpful to see the multidisciplinary approach being optimised on assessment basis, for eg. The use of the 2 way mirror in complex ADHD assessment cases. The SpR teaching days was great, as it offered a chance to meet other SpRs on the scheme and very relevant clinical teaching.
For my remaining exchange, to optimise the experience, it was decided to gain exposure to the various specialty clinics and the inpatient unit. It was an eye opener to see how Tier 4 specialist services run. The level of expertise of the teams is amazing. I rotated on a daily basis to the following- Snowsfields Adolescent Unit, Eating Disorders Service, Mood Disorder Service, OCD Service and the DBT outpatient service. I had the chance to sit in at CPAs and team meetings, initial assessments etc. I came away with a refreshed view having being exposed to this level of specialisation. This is a major difference with my current training, where the CAMHS practice by far, tends to be more general. I came back and find myself incorporating and sharing some of the things learnt on the exchange in my daily practice.
My only regrets are not having a longer exchange programme to optimise the clinical experience and to set up research opportunities. And of course, due to the time limitation, I felt it was a major regret not being able to socialise more with the local trainees to get the full exchange experience.
Having said that, it was a wonderful experience which I would not change. I would do it all over again if the opportunity arises and definitely encourage my peers to do it. Thank you to all involved in the EFPT for making it possible, especially Marisa who has been helpful and approachable in every step of the exchange process.
EFPT internship. Porto Sao Jao Hospital. Dep. Eatings disorders
Exchange experience from Ireland
Host institution:
Daughters of Charity Service for Persons with Intellectual Disability, Dublin, Ireland
As a second year trainee in the field of General Adult Psychiatry, I had the opportunity to attend a 4 week observership position at Daughters of Charity Service for Persons with Intellectual Disability, Dublin, Ireland. Throughout this period, my activity took place in four different locations: St. Vincent’s Centre, St. Joseph’s Centre, St. Louise’s Centre and an outpatient clinic.
In St Vincent’s Centre, I had the chance to work with patients with severe or profound intellectual impairment and different psychiatric comorbidities such as depression, autism, schizoaffective disorder, and dementia. These patients were permanent residents of the center, and lived in bungalows under continuous observation.
My activity in the outpatient clinic took place two times a week. In this setting, I got familiar with mild cognitive disabilities and different psychiatric comorbidities. These patients were living in community based settings and most of them had the opportunity to work (part-time), go on vacations or spend more time with their families. I also took part in a couple of MDT’s or Multidisciplinary Meetings. These meetings were attended by psychiatrists, psychologists, dementia nurses (for people diagnosed with dementia), clinical nurse manager, social workers, occupational therapists, staff working in the house and sometimes speech and language therapists. Their goal was to discuss and find solutions to different aspects related to patient care.
The activity in St Joseph’s Centre was somewhat similar to the one in St. Vincent’s. Patients were permanent residents of the bungalows, most of them with severe intellectual impairment. The difference between the two was that in St Joseph’s I got the chance to see people in convalescence post admission to general hospitals with a range of different medical concerns.
Besides my regular observership activity in these centers, I had the chance to visit a private facility, St Michael’s House established by parents of children with intellectual impairment, and I attended the teaching sessions at St. Patrick University Hospital.
Another important part of the experience was the possibility to visit Ireland. I had the chance to see Dublin and its surroundings: Powerscourt House and Gardens, Ardgillan Castle, the Windmills in Skerries, and I took a one day trip to the Cliffs of Moher.
My observership position at Daughters of Charity Service for Intellectual Disability took place under the supervision of Dr. Niamh Mulryan, consultant in Psychiatry and clinical director who offered me the opportunity to write a scientific article on Mild Cognitive Impairment, and Dr. Fionnuala Kelly, consultant in Psychiatry who supervised my clinical activity. I also had a great collaboration with Dr. Iulia Dud, Registrar in Psychiatry who was kind enough to host me for the 4 week period and became a very good friend. Dr. Elizabeth Barrett, the local programme coordinator, was very supportive throughout the experience and provided me all the information needed. In my opinion, the observership position offered by the EFPT Exchange Programme was excellent for my experience as a psychiatric trainee. I had the chance to get familiar with a different type of management of psychiatric services, to work with great professionals and to visit a new country.
Exchange experience from Spain
Host institution:
Ponzano Day Hospitals , Madrid, Spain
I am an ST6 in General Adult Psychiatry with London Deanery. I came across the European Federation of Psychiatry Trainees’ (EFPT) exchange programme and applied for an exchange in Spain. It was straightforward to arrange thanks to EFPT and in particular to the trainee who is in charge of the organisation in Madrid. I was granted a 2 week programme in one of the Day Hospitals called Ponzano in central Madrid, in the heart of Chamberi district.
Ponzano provides an intensive treatment programme for severe and enduring mental illness, primarily first episode psychosis but not exclusively, as in reality it also caters for individuals with Bipolar Affective Disorder, Drug induced illness, severe OCD, schizotypal/schizoid personality disorders, persistent delusional disorders, and even at times emotionally unstable personality disorders who have had psychotic episodes. Their capacity is somewhere around 25 patients per day; they are usually at full occupancy. Referrals come from community psychiatrists, acute inpatient services, and homeless programme. One of their main objectives is insight building/relapse prevention. The centre is open 9 – 3pm as per Spanish working hours.
The team is multidisciplinary, formed of 2 consultant psychiatrists one of whom is the service director and founder of the project, an extremely experienced psychologist, 2 psychiatric nurses, occupational therapist, a part time social worker, and admin staff, alongside psychology and psychiatry trainees who mainly have an observational role. There is a team meeting every morning, after which some members of the team go to their local cafe for a quick ‘cafe con leche’ and ‘barrita’, a small but terribly tasty fresh bread and tomato breakfast plus or minus jamon serrano, which I still crave after being back home for over a week.
Ponzano adopts a therapeutic community philosophy, with a genuine person centred approach, not limited to a paper-based exercise, where there is a real sense of getting to know the patients and their families.
There is daily group work for patients facilitated by OT and psychiatric nurses, where timekeeping, boundaries, respect for others, self care, healthy living etc is promoted. The patients were involved in the production of a short film (they worked as a group to devise script, props...), indirectly addressing negative symptoms. Every week they agree on a Friday leisure activity (watch a film, play a sport, and when I was there we went to a photo exhibition at a local museum).
There is also a weekly psycho-education group for patients where they learn about mental illness and are encouraged to talk about their symptoms, with a view of building insight, which can be extremely powerful when this awareness arises from interactions with other patients.
Patients also have individual sessions with the psychiatrist and psychologist. The consultant I was with utilised an eclectic approach combining psychodynamic or CBT depending on the situation, as well as centring on Attachment theory and its transgenerational nature. The use of psychotropic medication was minimal; poly-pharmacy was frowned upon. He had an open door policy, and he oozed charisma! The psychologist was amazing, extremely personable, empathic, genuine in her interactions, employing CBT techniques with Bentall as her doctrine.
They also carried out individual systemic family therapy interventions alongside weekly family group work in the form of psychoeducation around high EE (Leff) alternating with Multifamily Group Therapy (Garcia Badaracco), the latter of which I was unfamiliar with. It consists of large family group meetings, where numerous families and patients are present together, in which there is a collective sharing of experiences about living with mental illness. I found a paper from 2006 about MGFT project in the UK (Asen, Schuff), and I was wondering whether trainees had come across this in their training.
I was deeply touched by the impressive work carried out at Ponzano. The patients and their families embraced the recovery work, and there was a sense of hope and happiness in the environment. Prior to the exchange, I think I was feeling slightly
bogged down by the never-ending culture of paperwork, payment-by-results, resource constraints... I am not advocat
ing for the abolishment of this as it has its place, but I had somehow along the way lost sight of why we, as psychiatrists got into this beautiful profession in the first place. Ponzano reminded me about how it feels to get to know your patients and families and the ‘refreshing warm feeling’ you experience when you have contributed to making someone’s life that little bit better: ‘¡Muchas Gracias Ponzano!’So with that in mind, I humbly advise those of you who can to start polishing up on your Spanish and apply for this particular EFPT programme....
Exchange experience from UK
Host Istitution: Maudsley Hospital, CAMHS , South London , UK
When I received the email with the EFPT programme, I did not have to think twice. Having done all my psychiatry training in Ireland to date, I have always wondered what psychiatry training in other countries is like. It was the perfect opportunity!
For the first week, I was based in the Lewisham Kaleidoscope Centre. It is an outpatient CAMHS service. Keir Jones who kindly helped coordinate my programme with the CAMHS clinical director was welcoming and extremely helpful. He made sure I participated in the SpR teaching and also invited me to the SpR night out to ensure I got the most out of the exchange. I can’t thank him enough for all his help! From the learning perspective, it was helpful to see the multidisciplinary approach being optimised on assessment basis, for eg. The use of the 2 way mirror in complex ADHD assessment cases. The SpR teaching days was great, as it offered a chance to meet other SpRs on the scheme and very relevant clinical teaching.
For my remaining exchange, to optimise the experience, it was decided to gain exposure to the various specialty clinics and the inpatient unit. It was an eye opener to see how Tier 4 specialist services run. The level of expertise of the teams is amazing. I rotated on a daily basis to the following- Snowsfields Adolescent Unit, Eating Disorders Service, Mood Disorder Service, OCD Service and the DBT outpatient service. I had the chance to sit in at CPAs and team meetings, initial assessments etc. I came away with a refreshed view having being exposed to this level of specialisation. This is a major difference with my current training, where the CAMHS practice by far, tends to be more general. I came back and find myself incorporating and sharing some of the things learnt on the exchange in my daily practice.
My only regrets are not having a longer exchange programme to optimise the clinical experience and to set up research opportunities. And of course, due to the time limitation, I felt it was a major regret not being able to socialise more with the local trainees to get the full exchange experience.
Having said that, it was a wonderful experience which I would not change. I would do it all over again if the opportunity arises and definitely encourage my peers to do it. Thank you to all involved in the EFPT for making it possible, especially Marisa who has been helpful and approachable in every step of the exchange process.
Reflection on EFPT exchange in Dublin
I participated in an exchange for psychiatric trainees in St. Vincents University Hospital in Dublin, Ireland. This programme is subsidized by the Life Long Learning programme of the European Union and the Leonardo Da Vinci Programme.
Learning objectives:
The learning objectives my supervising consultant psychiatrist Dr. A. Guerandel and myself agreed on with were to ‘gain knowledge of and experience transcultural psychiatry, to become acquainted with different mental health care systems and a different training programme, to enlarge one’s professional network and to extend my knowledge of adult psychiatry in different types of settings (liaison psychiatry, outpatient and community based psychiatry’.
What I did during my stay:
With Dr. Guerandel, we made every day a plan for the day; varying from taking part in the ward rounds and community based clinics (twice a week in different community hospitals/primary care centre) of her team to engaging with the registrars in the liaison psychiatry and in their teaching programmes. Thursdays there was a teaching programme for the registrars where in the second week I gave a presentation on the differences in the medical and specialist training schemes as well as thfe difference in the organization of care. (see also the added PowerPoint presentation!) In the third and last week of my stay I was invited by one of the colleagues of Dr. A. Guerandel, Dr. A. McCarthy who worked in the maternity hospital in Dublin, to see a bit of the perinatal mental healthcare services. Also in the last week I was invited to take part in the teaching of the medical students, and prepared a lecture and some exercises on the topic of personality disorders, diagnosis and treatment.
What I take home:
At first I was not very aware of the fact that this experience in transcultural psychiatry would help me form an opinion about the possibilities to work abroad as a psychiatrist. This stay in St. Vincents really opened my eyes and my mind to that idea. I worked with a mostly international team; the consultant being from French origin, the two senior registrars being Ethiopian and Malaysian. I really enjoyed and appreciated their openness and welcoming attitude towards me and foreigners in general. It convinced me of the richness of the transcultural dialogue, but also of the great impact of culture and language on social, psychological and biological aspects of psychiatric illnesses (the latter actually being the most similar in Dublin and Amsterdam).
Something else I take home is appreciation of my own training scheme and efficiency in which it is organized and put together. A registration takes 4.5 years full time compared to 7 years in Ireland, and competition is much more severe throughout the whole training.
Last interesting thinking point I want to mention here is a difference in the organisation of care in Ireland. Apart from the fact there exists a private and a public systems, the public system works strictly with ‘catchment areas’. In these areas the consultant psychiatrist is responsible for all patients, be it out-patient clinics or patients submitted under the mental health care act. This provides patients with continuity of care; their consultant is responsible for their care at home as well as in the clinic. I feel that specialized supraregional facilities sometimes suffer from the strict financial boundaries of the catchment areas, but in general patients are better taken care of and followed through the various stages of their illness, by the same healthcare providers. I this viewed as a great strength of the system.
Conclusion:
I had a very nice, enriching stay in Dublin and learned a lot, mostly on transcultural psychiatry and the possibilities of internationalizing my own practice in mental health care.
From Rotterdam to Porto
Host institution: Sao Joao Hospital, Porto, Portugal
Duration: 4 weeks
When I read the email received from the Dutch residency organisation SAP considering the possibility of an EU exchange, I didn’t hesitate for a second and applied right away. I chose for Portugal because I expected more differences in therapeutic approach between western and southern European countries. Another reason was that I wanted to gain experience in liaison psychiatry, since I would start liaison psychiatry after my return. Eventually I’ve been offered to do a combination of my first two choices, namely liaison and eating disorders.
Sao Joao Hospital is an academic hospital. The psychiatry department has its own building next to the main hospital building. The emergency room also has its own psychiatry unit. The liaison department consists of three psychiatrists and two residents. Liaison does not only consist of consultations in several departments in the hospital, but also outpatient consultations such as pain, psychosomatics and assistance in quitting with smoking.
My average weekday started with consultations in the hospital with resident Marko. The case of a 78-year old man with neurosyphilis has been by far the most interesting case we visited. In the afternoon I usually joined one of the psychiatrists or residents in their consultations. The language barreer was a problem, but luckily all of the colleagues were more than willing to translate. A good thing about not speaking the language is that it gave me enough time to focus on the body language which is mostly universal.
The outpatient consultations are about general psychiatry, pain, psychosomatics and smoking. In Porto psychiatrists as well as lungspecialists see people who want to quit smoking. In Holland, those cases are being treated by a general practioner.
I also sat in at the eating disorder consultations. The treatment of eating disorders in Porto is comparable to the treatment in Rotterdam. Mostly psychotherapy is being used.
The biggest difference I noticed is the more paternalistic approach. I believe this is mainly due to the cultural differences. The Portuguese people have a lot of respect for the doctor. He owns a high status in the country. I was surprised how many times they thanked the consulting psychiatrist during one session. Even the long waiting in the waiting room did not make them thank the doctor less.
My overall opinion is very positive. The staff of the Sao Joao Hospital and also residents in other hospitals in Porto have been very nice and helpful to make my stay as convenient and my exchange as interesting and educational as possible. My special thanks go out to the psychiatrists, residents and one GP in trainee Dr. Adelaide, Dr. Constantia, Dr. Isabel, Catia, Mariana, Marko, Catarina, Andre and Oriana for always welcoming me, taking their time to translate and explain. I’ve been very lucky to come across such great doctors.
Croatia: Emergency Psychiatry and Intensive Care
The University Psychiatric Hospital Vrapče is the oldest and largest psychiatric institution in Croatia. Founded in 1879, the hospital was designed for 200 to 250 patients but today, the hospital has a capacity of more than 800 patients[1]. I was familiar with Zagreb from a personal perspective and therefore, to go to Vrapče for my psychiatric exchange experience was an easy decision to make.
I was also lucky enough to be present during an important time of transition for the hospital. Croatia became a member state of the European Union (EU) in July 2013. A directive of the EU; the Working Time Directive meant significant changes to working patterns which were just coming into force for the doctors during my final weekend.
Effectively the first point of contact for emergencies to the hospital; the Intensive Care, Emergency and First Psychosis Units where I was based, received adults presenting with conditions that spanned the breadth of the ICD-10[2] Mental and Behavioural Disorders. I met patients with illnesses ranging from psychosis, affective disorders, post partum illness and anxiety to dementia, learning disability, personality disorder and substance dependence.
In the context of an intercultural professional exchange, observing that the fundamental elements of a psychiatric assessment were the same as well as seeing treatments being used that I had grown familiar with in training, engendered a sense of satisfaction in being able to apply my own knowledge and experience in an unfamiliar setting. Furthermore, it was interesting that despite a background of different cultural influences, some of the psychosocial circumstances of many of the patients and the difficulties expressed closely mirrored those in the patients in my own work setting.
The care pathway revolved around the changing clinical needs of the patient. Depending upon presentation, a patient would initially be admitted either to the intensive care unit if there were particular concerns such as agitation or aggression where duration of stay would be aimed at days rather than weeks or to the emergency unit. Once assessment and treatment were underway and further treatment in hospital was deemed necessary, the patient would then be transferred to the most appropriate ward either within the department (first psychosis unit or emergency unit) or if the patient was already known to a certain team or additional subspecialist input needed, to the relevant department in the hospital.
The multidisciplinary approach to patient care supported central roles for social work and occupational therapy. I had the opportunity to observe a session of occupational therapy where craftwork was taking place. The therapist very kindly also showed me around the occupational therapy and rehabilitation departments with their wide selection of beautiful patient created crafts from vases and cushions to rugs and artistically restored furniture. Furthermore, as part of ongoing rehabilitation and recovery for patients, a hospital Café run by service users became the source of many coffees during my visit. In addition, an on-site museum The Slava Raškaj Gallery housed an archive of artwork by former patients, some pictures as old as sixty years; all thought provoking and reflective of the individuals’ state of mind at the time.
The day’s work started at 8 o’clock. There were daily morning meetings reviewing night staff reports and discussion of new admissions. Ward rounds happened twice daily in the intensive care unit, twice weekly in the first psychosis unit and weekly in the emergency unit. Once a week a therapeutic community meeting also took place. This was unexpected as I had only been familiar with this in a psychological services setting, however the ideas of collective responsibility, a participative approach and flattened hierarchy were the same. Formal educational opportunities included a weekly lunchtime academic meeting and presentation of cases at the forensic unit.
From the outset, I was made to feel a part of the team; observing clinicians on the ward and in outpatient clinic, shadowing those oncall in the assessment unit and contributing to diagnostic and treatment discussions. Having the chance to speak with patients was invaluable not only to get a sense of the range of psychiatric presentations, but importantly to learn about these in the context of a personal story in a different country and culture.
During my visit I also had the fortune to be able to visit a number of the other departments; the addictions unit, forensic unit, dual diagnosis centre, psychogeriatrics and sleep disorders unit. I was deeply touched by the welcome, genuine friendliness and generosity of all the staff in sharing their time, knowledge and experience.
As part of the EFPT ethos, through the contacts I made, I learnt a great deal about the four to five year psychiatry training programme in Croatia which includes a period spent in Neurology. The presentation I gave about my own training and the mental healthcare system in which I work allowed me to take a step back and think about these aspects from a wider perspective. From the questions and feedback received it was a real delight to be able to give this talk.
My initial aims and objectives for this visit were to gain an insight into similarities and differences in the manifestations of acute psychiatric presentations and their treatments, along with the psychosocial factors and intercultural diversities involved. I was also interested in how a different mental health care system works to meets its patient’s needs. Finally, I wanted to meet psychiatrists in a different training system to share experiences. I can certainly say these goals were all met and much more gained over-and-above.
From both a professional but also personal stance I have returned home refreshed and re-inspired. The hospitality of the people I met was humbling and the work done with the patients is truly special.
Zagreb is a beautiful city. I pondered over whether to visit in winter, but I needn’t have; the snow covering made the city magical. Vrapče Hospital is a short and straightforward journey to the city centre and English is a language that is widely understood and spoken by many, so anxieties over language should not be considered a barrier to applying to this programme. I have made contacts I continue to be in touch with. The only regret I have is that I did not have the time to stay longer.
I want to thank Professor Jukić, director of Vrapče Hospital, for being instrumental in enabling this exchange to take place, Dr Ostojić, my mentor and her team for all their time in making it possible to gain the experience I did and Dr Marina Fistonić the EFPT local coordinator, whose organisation and dedication made the process faultless. I would unreservedly recommend this programme.
[2] International Classification of Diseases Version 10
EFPT internship. Porto Sao Jao Hospital. Dep. Eatings disorders
Via the European Federation of Psychiatry trainees I followed stated internship in the city of O Porto in Portugal. It was the last 4 weeks of my psychiatry specialization and it was a month that I still had not filled in with other internships. Some of the factors that made me choose Portugal were: the fact that I speak the Portuguese language, the fact that I might consider working a part of my professional career in Portugal in the future. The raisons that I choose O Porto (eating disorders program) were: easy to arrange housing, city I didn’t know very well yet, my absent experience with the field of eating disorders and my affinity working with adolescents. I followed the Dutch Specialization Registration Committee (RGS) internship registration route in order to fulfill also local (Dutch) requirements for the internship. Apparently that was a novelty. Arranging the internship was easy and the process of being selected went without any problems. On the day of arrival I was pro-actively welcomed and a program was made. There were 4 (including me) interns for the department of eating disorders which resulted in some logistic challenges. All interns were from outside hospitals in Portugal who came specifically to this hospital to learn about eating disorders.
The weekly schedule consisted globally of:
Monday: clinic in the morning, day hospital in the afternoon
Tuesday: outpatient department with head of department
Wednesday: Team meeting with case discussion and journal club, weekly psychiatry department lecture in the morning. Family treatment with one way screen in the afternoon.
Thursday: Family treatment in the morning, outpatient department in the afternoon.
Friday: clinic in the morning, day hospital in the afternoon.
Each intern had his/her own schedule. Sometimes were there was little to do we studied, discussed or left early to enjoy the city.
The team was open to my visit, collaborative and interested in my opinion and experience. During the weeks I built a good relationship with my fellow Portuguese interns that allowed us to extensive reflections on professional and personal issues. I was impressed by the colleague intern’s factual knowledge and dedication to patient care. On numerous occasions I felt uneasy because in many aspects the position of Dutch interns is better than that of the Portuguese. I my 3rd week I presented my lecture in the general department of psychiatry weekly meeting. Apparently I was the first EFPT intern (before me there were 3 I think) to present to that public and the presentation was received well. I approached topics on Dutch psychiatry residency psychiatry program, Psychiatry in the Netherlands, a Dutch article about burn out among residents and approaching sexuality by interns in patient care and supervision. I also presented about my special interest in PTSD.
Psychiatry interns from other hospitals, involved in EFPT, were in contact with me and we set up a social life. They were friendly, honest and curious with exemption. The head of the psychiatry department had set up a movie cycle about “movie and illness” in a local cinema in which the screening was followed by discussion. I went to visit the cycle during my stay.
In 4 weeks I got a good impression about the way eating disorders present clinically and are treated. I was linked to a fixed patient in the clinic who I visited daily. The experience fulfilled my expectations and helped to reflect on my work and other professional and personal issues. I could recommend this internship to any European colleague.
Exchange to Copenhagen, Denmark
June 2012
One morning, sifting through my numerous emails, my attention was
caught by a message from the EFPT, inviting applications for an exchange
programme to several European countries. I instinctively filled out an
application form and chose my preferred options of Portugal, Croatia and
Denmark. Having received multiple invitations, I eagerly
accepted the offer from Copenhagen, a city I had visited multiple
times but was excited to spend more time in.
I successfully negotiated the tricky process of attaining study leave
and my prospective host, Renne, prepared me with information about his hospital
and planned my visit according to my particular interests. As accommodation was
not provided, I arranged to stay with some friends I had in the city; my trip
was thus set to be a busy combination of both work and pleasure.
My first week was spent at Hvidovre Psychiatric Centre, an inpatient,
adult mental health unit, with about 120 patients.The
unit also had a walk-in facility for patients to be seen 24 hours a day.
Instead of all patients being seen at A&E and then being referred to
psychiatry, patients were assessed directly by the on-call psychiatrist, either
arriving independently or after being referred by their GP or by the police.
The psychiatrists appeared comfortable with regards to being able to rule out
non-psychiatric causes for the presentation.
On my first day, Renne met me at the station near the hospital;
I was rather amused to see him wearing bright green
trousers and a t-shirt. I subsequently discarded my
formal attire and quickly got used to wearing trainers, jeans and tshirts to
work. Another visible sign of reduced formality was that doctors introduced themselves
to patients using their first names. A cultural nuance I quickly discovered was
the importance of shaking hands with everyone one meets, not only other
professionals but also patients; whilst in the UK this is usually a matter of
individual choice, in Denmark I was informed that not shaking hands may lead to
a perception of arrogance.
The twenty or so psychiatrists in the unit met every morning
at 8am to discuss various issues; all patients
seen overnight would also be presented. Every Friday, breakfast
would be served by a pharmaceutical
company. After the meeting at 9:30am, all would depart
for ward-work, until midday, at which point
another meeting with all the psychiatrists would take place
for half an hour. The canteen would then be
vacated solely for the doctors, where juniors and seniors
alike would chat together during lunch; the
final part of the day would then be spent on clinical tasks
until 3pm, the end of the working day. I was
highly struck by the amount of time the doctors spent together
each day. This resulted in the psychiatrists
being a particularly cohesive team; comparatively, it
is not uncommon for an SHO in the UK, to have never
spoken to many of the consultants or registrars in
their unit.
I was made to feel welcome by all present at the meetings
I attended; the fact that it was the British
Queen’s Diamond Jubilee, perhaps led to my nationality
being all the more celebrated. I planned
my own day each morning, attending various ward rounds,
new-assessments, and even a tribunal. The
doctors I met spent time talking to me about
psychiatry in Denmark and their own personal experiences. I
gave a presentation about our own British mental health
system, highlighting differences I had noted; this
provoked much interest and ongoing discussions after my
talk.
Whilst in the UK, training is split, in Denmark there
is a continuous period of five years, prior to becoming a
consultant. I was rather surprised when I noticed the consultants
I was shadowing, spending all their clinical
time on the ward, and carrying out various tasks such as
physical examinations and ECGs, requesting (and at
times administering) blood tests, arranging transfers
to medical wards, checking results of investigations and
all such duties that would fall under the remit of an SHO
in Britain. At times there was no junior doctor
present, but when there was, patients would be divided
up, rather than tasks being allocated according to
seniority. This rather flattened hierarchy appeared to
cause not insignificant frustration to the senior
consultants, who were very curious about how different
things are in the UK.
I spent my second week at Hillerod, a large hospital where
a friend of Renne’s, Nanna, was a CAMHS
trainee. I was able to not only explore the inpatient child
and adolescent wards and attend outpatient
follow-ups but was also fortunate to attend several home-visits,
to carry out new assessments in rather
remote areas of the countryside. Shadowing Nanna, I gained
a perspective into the realities of child
psychiatry in Denmark, including the personal experiences
of a trainee in a career parallel to my own.
During meetings, those present would attempt to speak in
English, but during lapses my neighbour would
often translate. When seeing a patient with another doctor,
they would discuss the case with me both
before and after; where the patient felt comfortable, assessments
were carried out in English but even when
this was not possible, I discovered the opportunity to
test my powers of observation of non-verbal
communication.
My time in Copenhagen not only allowed me an insight
into the practice of psychiatry there, but to
consider a wider perspective of what may be gained by such
international collaborations. Presenting my
experiences at the Psychiatric Trainees conference at the
London Deanery, there appeared to be much
interest in the differences I highlighted between our systems.
The EFPT programme does not only
exchange trainees but allows the exchange of ideas and
philosophies; it offers an opportunity to reflect upon
our own practice and to learn from each other and as such
I would emphatically recommend it to all
trainees.
