by Julien Schneider.
Julien Schneider, Medizinische Universität Wien, Österreich
Sweden is a wonderful country with many small islands, pleasant summer days, friendly people, lots of tradition and beautiful cities. In addition, Sweden is highly respected worldwide for its healthcare system and medical education. These were just some of the reasons that made me decide to do a clinical elective in Örebro.
As for my expectations of the clinical elective in Örebro, I wanted to learn more about the Swedish culture and way of life. We have all been on vacation in different countries and learned foreign languages, but usually you don’t get closer to people in their daily lives.
However, the opportunity to work in a hospital provides contact with people in their familiar environment and the chance to participate in their social life. Therefore, I was very curious about the differences in work, leisure activities, family life, and even political views. In addition, I had never been to Sweden or any of the Nordic countries in Europe and wanted to see more of the beautiful cities and landscapes. Of course, I was also looking forward to getting a better insight into the Swedish healthcare system. Over the past few years, I have met a few people in medical school who have done internships in the Nordic countries, and their conclusion made me always curious.
Introduction
If you have never been to Örebro before, I would like to give you some impressions before going into detail about the internship itself. Örebro can be called the heart of Sweden due to its central geographical location between Gothenburg and Stockholm. Although Örebro has only 124,000 inhabitants, it is the sixth largest city in Sweden. The small Svartån River crosses through the city and empties a few kilometers inland into Lake Hjälmaren, which is definitely worth a walk. One of the landmarks of Örebro is the castle in the city center, which is surrounded by water and in combination with the nearby park, a good place to relax. The University Hospital of Örebro is also located near the city center and can be reached in about 15-20 minutes on foot.
In general, I recommend choosing one of the months July or August for a clinical elective due to the Swedish weather. The geographical location leads to very long nights in winter and very long days in summer, and after midsummer (always a Friday, around the 21st – 24th June) the days get shorter faster than you would expect. As far as I am concerned, the temperatures are very pleasant during the summer months. Even in July and August, temperatures don’t usually rise above 30 degrees. I was told that the weather is kind of unpredictable and you should take an umbrella or rain jacket in your luggage. However, I experienced good weather throughout the trip, but in the last two weeks of August the temperatures were colder and I often needed a sweater and a coat.
My application process
After I had considered doing a clerkship in Sweden, my first approach was to find suitable hospitals. I did a lot of research on various websites, but especially the German-language website “famulatur ranking“, which serves the exchange of experiences, helped me a lot. Medical students can write experience reports about hospital wards worldwide and grade them. It is a very useful tool to get an overview of which hospitals and departments offer a good traineeship and which do not. You can also find out how the application process works, what requirements applicants have to meet, and if you must pay a fee. In general, my experience is that you have to write a lot of emails and applications to get a clinical elective. For example, many hospitals require applications through the university, foreign language tests, application fees, just to name a few things. If you are not willing to do this, the number of hospitals where you can take an elective can be quite small. After some research and with the stipulation that I would like to do the elective on a cardiology ward, I came across Örebro University Hospital. Luckily for me, I found an email address of the cardiology chief in a report about this ward where I wanted to apply. From that point on, the application was quite easy. I was referred to the student coordinator of this department and had to send some documents, including a CV, a letter of recommendation and a letter of motivation. The student coordinator gave me all the important information about the clinical elective, and we agreed on a start date. Fortunately, Sweden is part of the European Union, and I did not need any special visa or travel documents to complete the clinical elective.
My experience of the clerkship
After a warm welcome, I was quickly integrated into the ward team and everyone was very friendly. Although the university campus seems quite large, the atmosphere in the hospital is comparable to that of a smaller hospital in the countryside. The number of patients on the cardiology ward ranges from 20 to 25 and are mostly in the late adulthood or older patients. The team of nurses is large and often provides one nurse for two to three patients. The medical team in charge consisted of one or two consultants and the same number of residents and 3 or 4 underläkare. Underläkare are students who have already graduated from medical school but still had to complete two years of training in the hospital to be licensed as physicians. In addition, as far as I could tell, the outpatient clinic treated five to ten patients daily.
Generally, my day began at 8 a.m., where I went to the doctor’s office and caught up on any overnight events or new patients. At 8:30 a.m., the obligatory fika – the morning break – took place. The entire ward team of physicians, nurses and other medical support staff gathered and enjoyed time together with plenty of coffee and cookies. In contrast to Austria and Germany, the hierarchies are very flat, and patients are even addressed by their first names. Morning rounds usually began at 9 am. The teaching depended very much on the physician in charge. I must admit that my knowledge of the Swedish language was very limited. Although a large part of the Swedish population has an excellent skill of the english language, it was a great advantage to have a good proficiency, as it was necessary for independent patient care. Only some senior physicians switched to English during rounds. However, it is not mandatory to speak Swedish well, and the doctors and students are eager to teach you and make it a good experience. But of course, the better your Swedish skills are, the more responsibility you can take on.
The patients were all very friendly and I did not notice any major social differences. Since I was not responsible for the patients, planning the rest of the day was up to me. Sometimes an underläkare had time and gave me a special lesson. They are generally very well trained and have given me exceptionally good teaching. The consultants and attendings were also willing to give one some private training or allowed me to follow them into the cath lab, outpatient clinic, or other procedures. If the weather was nice, it was also possible to leave the hospital at noon to enjoy the rest of the day and go on some outings. If I had to name an average number of hours spent in the hospital, I would suggest 6 hours per day and 30 hours per week. Unfortunately, there were no continuing education opportunities during the time I was there.
My free time and tourist experiences
The relatively pleasant working hours at the hospital, fortunately, allow a lot of time to explore the area and pursue various leisure activities. First and foremost, it is certainly worth exploring the city center and taking a break in the various cafés. If you want to be a bit more sporty, you should take a trip to the southern part of the city, where a large high ropes course Sörbybacken is. Some beautiful hiking trails through the forest can also be found there. A local insider tip is a secluded swimming lake, which must have been a quarry in earlier times. Many years ago, this area was flooded and has now become an idyllic bathing and recreation area. The lake is located about 400 meters from the bus stop Kvinnerstatorp and can be easily reached with the 314 bus from Örebro. One of the highlights of the medical clerkship were the trips to Stockholm and Gothenburg. Stockholm is an incredibly diverse city with lots of beautiful places and museums. An absolute recommendation is the visit to the Vasa Museum, which was founded in 1991 and exhibits a complete warship from the 17th century. For me personally, however, the weekend trip to Gothenburg was my favorite excursion. If you are looking for the swedish charm from various movies and documentaries, this is the place for you. The palm house Trädgårdsföreningen costs no admission and offers a great variety of exotic plants to look at. Also free is a large park a little southwest of downtown with large animal enclosures Djurpark, where you can admire reindeers, mooses, seals, sheeps and ducks. A trip to one of the offshore islands, such as Marstrand, should also be considered if the weather is good.
Insurance
The insurance coverage of the liability insurance and the accident insurance exists for all students at the medical university of Vienna through the Austrian Student Union (ÖH). Furthermore, the Austrian health care insurance was also valid in Sweden. So, I didn’t need to take out any other insurance for the internship in Sweden.
Table of costs
| Flight (both ways) | approx. EUR 300 |
| Accommodation | approx. EUR 500-600 |
| Food and drinks | approx. EUR 500 |
| Public transport | approx. EUR 200 |
| Leisure activities | approx. EUR 200 |
| Total | EUR 1700-1800 |
Interesting websites
- Famulatur ranking: useful website for identifying possible hospitals and wards for clerkships (only in German)
- Swedish railway: useful website for planning arrival, trips, and departure with public transport
- Örebro University Hospital: for important information about the hospital
- Public transport in Örebro: very useful as an app on the smart phone
- Midsummer: Read the Guide about Midsummer in Sweden (Dancing, feasting, drinking and a seemingly endless supply of sunlight)
- Trädgårdsföreningen: website of the palm house in Gothenburg
- Djurpark: animal enclosure in Gothenburg
- Sörbybacken: high ropes course in Örebro
Contact
If you have any questions about Julien Schneider’s elective, or if you have any questions to Julien Schneider personally, please write an e-mail to j.schneider.kn@gmail.com.
Do you have questions regarding the topics working & postgraduate training or finding jobs & career, write an e-mail to Mag. Seitz: office@goinginternational.org
Citation:
Schneider, Julien: Experience report of the medical clerkship in Örebro (Sweden) (In: Polak, G. [Hg.]: GI-Mail 08/22, ISSN: 2312-0819 Going International, Vienna 2023)
Here you can download this publication.
Published in GI-Mail 05/2023 (English edition).
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