The author of this article: Ding Liucheng
From April 2021 to March 2022, I will go to the Affiliated Hospital of the Medical College of the University of Hamburg, Germany, jointly funded by the Jiangsu Provincial Scholarship Committee and the 789 Key Talents of the Second Affiliated Hospital of Southern Medical University. A one-year study visit.
During this period, I participated in 3 clinical research studies on urethral strictures and also participated as a Clinical observer in the clinical practice and teaching of the UKE Urology and Prostate Cancer Centre Martini-Clinic .
A year at the University of Hamburg Medical School, I have been thinking: How can I use other stones to solve my confusion? Now I will share with you my learning experiences and thoughts during this period.
One-Stop Clinic
Physicians can decide when patients are seen
Hamburg has a long history and beautiful environment. It is the center of culture, education and health care in northern Germany, with large areas of green space and countless canals.
Hamburg University Hospital (UKE), located on the Klinikum University campus, is the most modern hospital in Europe with a 120-year-old history and is home to many of Germany’s leading medical departments, such as Martini -clinic prostate cancer center, urology, stem cell transplantation, neurology, etc.
Exterior of Hamburg University Hospital (UKE) (photo by the author)
UKE is located in the green Eppendorf district of Hamburg, opposite the Eppendorf Park, full of green trees and flowers.
Coming here, I can deeply feel the importance and creation of the “cultural concept” by the hospital.
UKE Hospital is fundamentally designed to make patients feel as comfortable and convenient as home, rather than in a place that is stressful due to illness. The entire hospital is open, with old buildings from various periods. The courtyard is very quiet, there is no bustling crowd, and everything is orderly.
Recreation centers for patients to drink coffee and talk can be seen everywhere in the hospital, and the corridors are decorated with various works of art of appreciation. The hospital also provides full translation services for non-English-speaking patients who come to seek treatment. No matter what language the patient speaks, there is no need to worry about language problems when visiting a doctor.
Martini-Clinic, one of the best prostate cancer centers in the world, adheres to the value system of “patient care is the core of everything”, which is also reflected in the hospital’s “one-stop clinic” ” in the treatment process.
Author at Martini-Clinic Prostate Cancer Center
The vast majority of hospitals in Germany adopt the outpatient appointment system. Patients can start outpatient appointments from the homepage of the hospital and medical school. The target doctor can be quickly locked by entering the doctor’s name, specialty or their own symptoms. , usually need to wait about 2 weeks. Doctors can set the average time for each patient according to their specialty characteristics, and the outpatient time will be accurate to the minute, such as 10:20 am or 2:30 pm.
After the appointment is successful, the doctor’s secretary will keep in touch with the patient and will communicate in time if the clinic hours are changed. The patient arrives at the one-stop outpatient unit of the department according to the appointment time, and the nurse at the front desk collects the medical history, distributes the questionnaire and brings the patient to the clinic.
Taking urology as an example, patients can complete routine examinations such as urine routine without leaving the clinic, and the examination results are read by nurses in the clinic.
When the doctor sees that the patient is ready in the office area, the doctor first reads the patient’s medical record through the computer, and then asks the patient about the medical history in a focused manner. If further ultrasound, uroflow, and urodynamic tests are required, they can also be done directly in the outpatient unit.
If a physical examination or cystoscopy is required, the nurse will assist the patient in positioning and changing clothes. The doctor can use this time gap to go to another clinic to ask another patient.
Such a one-stop outpatient setting can basically allow patients to complete most of the necessary examinations in the clinic, eliminating the need for patients to be unfamiliar with the hospital’s institutions, and need to conduct inspections on various floors and departments. , Check the pain of running around indoors. Doctors can also shuttle between several clinics to improve work efficiency.
On the day of the outpatient clinic, the doctor will clearly inform the patient about the current diagnosis, options for treatment, possible effects of surgery and complications, etc. If the patient accepts the operation plan, the secretary will arrange the operation schedule for the doctor according to the doctor’s schedule and the time required for the operation, usually after two weeks.
The doctor decides whether the patient needs surgery, and the patient’s eligibility for surgery requires further anesthesia evaluation. Anesthesia assessments are also conducted through outpatient clinics, also in one-stop anesthesia clinics (CPAP), where anesthesiologists use an evaluation system to assess the patient’s condition, and assess the hand through simple and necessary examinations.surgical risk.
Thorny Talking Trainee
Show me the relationship between authority and students
The University of Hamburg Medical School and UKE are located in the same area, making the combination of clinical and teaching as convenient and efficient as possible.
Germany is currently repositioning professional training from the current checklist model to a competency-based curriculum, introducing new professional training regulations in 2018. There are 10 surgical subspecialties in Germany: general surgery, visceral surgery, cardiac surgery, thoracic surgery, paediatric surgery, orthopaedic and trauma surgery, plastic surgery, vascular surgery, neurosurgery and oral and maxillofacial surgery. The first eight subspecialties of postgraduate surgical training are organized consistently, with separate training structures for neurosurgery and oral and maxillofacial surgery.
Surgical training in Germany takes 6 years, the first 2 years include basic clinical training, including 6 months in the emergency department, 6 months in the ICU and 1 year in the surgical ward, This part of the training can take place in any of the eight subspecialties mentioned above. The next 4 years are structured differently depending on the specialty, but the main part is carried out in the surgical department of the chosen specialty.
In UKE, surgical operations are basically performed by two doctors. The chief surgeon (usually the director level) leads a subordinate doctor. The subordinate doctor is sometimes the main doctor and sometimes the resident doctor.
Each resident physician has a strict standardized rotation training plan, Internships are strictly 1-to-1 tutoring, special personnel are responsible, and there is a lot of interaction between students and teachers . The department has large rounds, case discussions, and business learning every week. At the same time, the discussions are particularly in-depth and never mere formality.
UKE da Vinci robotics are widely used, with over 70% of robotic surgeries at prostate cancer centers. And I have my own training center. I can participate in training and on-board training once a month, which is very rewarding.
Da Vinci Robot-assisted radical prostatectomy (photo by the author)
What impressed me the most were the trainees. Many times their questions seemed to have thorns on their bodies, and sometimes they even asked indifferently, lest the words be surprising.
Professor Fisch is good, every time he listens carefully and carefully and tells the details and opinions of surgical treatment of each disease without reservation; at the same time, he listens humbly to the rebuttals of the students and guides each other. Ask questions. In particular, Professor Fisch was always able to persuade me to guide me into in-depth discussions, and never put on an authoritative posture. Every operation will make me feel the academic rigor and the excellence of surgical skills, and it will also burst out some new ideas or bring new inspiration. I have learned a lot of knowledge in one year.
Here, what impresses me the most is the relationship between authority and students, this kind of completely open and free discussion between students and tutors, Not only a form, but also a character and spirit.
Comparing the Chinese and German training systems and systems, there is currently no specialized training system in my country. The following three points may be worth learning from: increasing financial expenditure, especially the financial appropriation of the State Department of Finance; Specialized management institutions of government departments; strengthen supervision and quality management, especially strengthening and monitoring of training bases.
Photo by the author
Let scientific results serve the clinic
Comparatively speaking, German doctors do not feel so much research pressure. Of course, just like China, if you want to be promoted, you also need a thesis blessing, but it is not a necessary condition.
German doctors have the right to choose whether to do scientific research or not. Under the current German system, doctors who only do clinical work and do not conduct scientific research can still be promoted. Of course, you can also rely on scientific research to get promoted, the two do not conflict.
At UKE, many professors have their own laboratories. For professors who are committed to scientific research, in addition to clinical working hours, the hospital also allocates them a certain amount of research time. For residents who want to do scientific research, in addition to using their spare time, they also have the opportunity to apply for funding support, and they can do basic research full-time. They also regularly hold small academic conferences to exchange their scientific research results.
The research here is mostly focused on clinical prospective and retrospective research, and the center’s research data is obtained through the research results, and the diagnosis and treatment system of diagnosis and treatment behavior and itinerary science are continuously adjusted according to the research results.
Basic scientific research topics mostly come from the clinic, and fully consider the feasibility and practical clinical value. Once the research results are available, the clinical problems can be solved quickly, which is helpful for the establishment of the disease treatment system. and standardization.
For example, Martini-clinic, as the world’s largest prostate cancer center, is also the world’s largest clinical database with more than 30,000 cases. The key factors and design of functional recovery were further studied by prospective RCT.
High self-discipline and clear division of labor
The rules watch everything
A brief introduction to Martini-Clinic’s weekly group meeting schedule.
Academic report on basic scientific research at 7:10 every Monday morning, the entire clinic will report and discuss the basic research field of prostate cancer; every Tuesday morning at 7:30 am, in the ward round, in addition to the lectures given by the professors in the undergraduate room, there will also be Prostate cancer experts from top hospitals in the world gave speeches;
Every Wednesday morning at 7:00 AM, the internal discussion of the Faculty, no matter the weather is good or bad, there are many old professors with gray hair and directors of various centers;
Clinical practice class at 7:30 every Thursday morning, and regular summary, report and discussion on difficult cases and complications in the department; Experts from the whole hospital comment on the cases, and experts and professors from major hospitals in Germany will also be invited to comment on typical cases.
Whether it is a doctor or a medical student, working from 7:00 am to 7:00 pm every day, no break at noon, self-discipline and efficient; whether it is surgery or scientific research, it highlights a strong team Work awareness. During my one-year stay in the Affiliated Hospital of the Hamburg Medical College, I have come into contact with many famous experts and scholars. Their dedication and high self-discipline have always touched and inspired me.
Photo by the author
The biggest impression of Germans in my life is that everyone has their own place, and even everything has its own place. German society abides by the rules very much, and “rules guard everything” is a true portrayal of German people’s daily life.
This clear division of labor is also reflected in the collaboration of various departments in the hospital. For example, in the surgery department of a hospital, a special secretary is responsible for making patient reservations and scheduling operations; if clinical research needs to be done, a special researcher is responsible for it; Even for small daily matters such as doctors need to reserve meeting rooms, there are also special the secretary to coordinate arrangements.
Surgical robotic system introduced by the prostate cancer center (photo by the author)
Contrast & Reflect
This high division of labor in the whole society makes doctors and medical students in a more comfortable and step-by-step state as a whole, and the competition is relatively less intense. This down-to-earth work style also allows doctors to have more energy to do research that they are really interested in.
However, this highly detailed division of labor can also lead to overstaffing, with many arriving on time and leaving work on time, a lack of motivation, and a lack of risk-taking among students.
Compared with domestic doctors, the overall work pressure of German doctors is much less; but if compared with other industries in Germany, the working hours of German doctors are still far far more than other industries.
Also because of this highly precise division of labor and detailed and clear training paths, most German clinicians are currently specialized in a subspecialty, which has a lot to do with my country. different.
Due to the large number of patients in our country, all operations are carried out by the directors. It is definitely impossible to cover so many medical work. Therefore, the subspecialties of our domestic hospitals are actually more like suborganisms. , the doctors in the corresponding specialties cover more sub-specialty directions, and can come into contact with different patients, disease directions, and exercise opportunities.
From the patient’s point of view, compared with domestic patients, the overall consultation period and out-of-hospital waiting time will be longer. Features. A Chinese friend in Germany gave me such an analogy: “In China, you are waiting for the number, but in Germany, you are waiting for the air.” On the other hand, too strong regularity of disease diagnosis and treatment may also limit the subjective initiative of doctors to a certain extent.
In addition, although the German academic community adheres to the pragmatic tradition, does not blindly follow the trend, and does not regard the ranking list as the direction of the university’s development, the brand effect affects the attractiveness of human resources. This is also one of the main reasons why the popularity of German university hospitals lags far behind that of British and American universities.
From my communication with Chinese professors working in Germany, Germany has also made some adjustments in recent years, hoping to make its doctors more international and communicate more with the outside world.
During my stay in Germany, my cooking skills have improved significantly. The picture shows my own 2022 New Year’s Eve dinner (photo by the author)
The one-year study time in Hamburg was short, but I experienced the profound meaning of “reading ten thousand books, traveling ten thousand miles” and “the stone of other mountains can be used to attack jade”. Looking back on this year, I think the biggest “sutra” is to develop good habits: focus on time management; maintain self-discipline and preparation; emphasize teamwork.
I sincerely thank the hospital departments for their strong support in the training of young teachers, and the teachers who gave me caring, loving and selfless help on my overseas study journey,friends, family. Hamburg is worthy of being the door to the world, and now this door is open to me, fulfilling an unforgettable experience in my life.
Author Ding Liucheng, Deputy Chief Physician, Associate Professor, Ph.D. Young member of Jiangsu Urology Society, member of lithology group, young member of neuromodulation group of Jiangsu Medical Doctor Association.
Planning: gyouza｜Source of title map: Photo by the author