Placements in France
Third Year Teaching and Placements in Paris
Placements for French Students
The French hospital placements are called stages. They last about 3 months each (depending on which year). Each stage is within a particular service (department/speciality). Different years have different obligatory specialities to cover, but within each year there will be one or two free placements where the students have options of where they can work. Placements are normally from 9 am till 1 am every morning, as lectures take place in the afternoons.
The third year of medicine at Bristol corresponds to both DCEM 1 and DCEM 2 of Paris. Therefore, in different placements, you will be considered a different year. In DCEM 1, there is an obligatory stage of cardiology, neurology and ENT, of which you will join them for ENT and cardiology. In DCEM 2, urgences is an obligatory placement.
Within each placement, especially rheumatology and respiratory, there will be a range students from different years. Year matters little within the placement, and the doctors will not know which year anyone is in unless you tell them.
Placements for the Bristol Students
Both the TUBES and MDEMO units studied in Bristol, will be covered while you are in Paris. On the first day in Paris, (or earlier if they are sent to Bristol), you will receive a timetable informing you of which placement you do when. It is unlikely that there will be a block of MDEMO followed by a block of TUBES, (like in Bristol), so you will find that you are studying both units together. This does not matter, but it means your work out of the hospital needs to be structured to prepare you for the OSCEs when you return home.
Also, your placements in France will not be of equal length. In my case, urgences was 6 weeks, rhumato and pneumo 3 weeks, and ORL and cardio 2 weeks. It may be possible to shorten, prolong or change placements, if you feel that the timetable does not cover your Bristol requirements sufficiently. However, more than a couple of weeks in each is long enough to learn relevant clinical skills, and in each placement general clerking of patients can be practised.
Within each department, there are various areas in which the students work. French students doing 3 month stages, may move between areas to gain experience in all. As you may only be there for a few weeks, if you feel that good experience may be gained in another area of the speciality, ask if you can go there for a few days.
The Different Placements
Urgences
La Pitié-Salpêtrière is such a big hospital that many big departments have there own A & E. Therefore, the actual urgences is relatively small. Urgences générales receives patients who do not go immediately to a more specialised department. These are often orthopedic patients, respiratory patients, strokes, overdoses……
The department is split into three sections:
- Médecine- for all medical problems
- Chirurgie- for surgical problems
- La porte- approx. 30 beds for patients who are to be admitted, before it is decided which ward they should go to. They stay in la porte for about 24 hours.
In both Médecine and Chirurgie, students work with the doctors clerking patients, sending them for investigations, doing ECGs…. There is a degree of working alone, seeing patients for the first time. Older students may work completely independently, but obviously a doctor will always need to see the patient at some stage, so the work you do merely makes the whole process quicker. It is a good idea to work alone some of the time, but especially at first, working with the older students means you learn alot and begin to understand how the process works.
In la porte, students attend a handover meeting (le staff) between the doctors and nurses where the details of each patient on the ward are discussed. Students then clerk and write up a patient that interests them. This both helps the junior doctors who are trying to get round all the patients and gives you the opportunity to see interesting cases. Again, there is also an element of helping the doctors fill in forms, do ECGs, and telephoning for results.
Rheumatology
In rheumatology, there are two wards and an hôpital de semaine. Students are attached to a ward, and have a few patients each, to whom they clerk on arrival, check on each day, send off for any investigations, write up any results, keep the dossier in order, and take notes during the ward round. It is a superb way of following cases through from admission to discharge.
Respiratory
The respiratory department again consists of wards, intensive care and an hôpital de jour. Here, there are lots of opportunities to take arterial blood gases, and then learn about all the different results. Hôpital de jour is mainly where people come to try, change and use ventilators eg. patients with COPD or MND.
ENT
ENT is the most similar to Bristol placements. Students are attached to a doctor and attend their clinics, and go to surgery with them. The role of the student is purely observational.
Cardiology
Cardiology is a huge department, where there are many different areas. One of which is rhythmologie, which deals with arrhythmias. Students get to listen to and learn about all different arrhythmias and their ECGs. There is also hôpital de semaine, which deals more with patients having angiograms and other investigations. Here, students follow patients through, noting ECGs, investigations done and the outcome.
Teaching
Within each department, during the mornings, there are lessons given by the doctors to all students in that speciality. This ensures you learn more theory behind that area of medicine. Lessons will include students from all clinical years, and so different levels of knowledge are expected. The lessons may include case presentations given by the students.
During the placements, you are continually learning by seeing patients, looking at radiographs, and interpreting results. However, doctors will often take time to teach you more about a particular condition or to go through the investigations with you. It is important to ask whenever you have questions, as certain doctors will only teach if they are asked!! Students in DCEM 4 are very experienced. They will be in the process of working hard for their final exams, and therefore are a great source of information and knowledge and are normally very willing to teach.
In the afternoons, the different years have teaching. This consists of mainly lectures, but occasionally smaller group teaching with the use of case studies. Lecture series may not correspond with any placement a student does that year eg. a student in DCEM 2 has three weeks of respiratory lectures, but may not do a placement in respiratory until DCEM 4!
