Montreal


Report 1

Reporter: Gabriella Bathgate, 5th year medical student, University of Edinburgh

Year of visit: 2014

Country: Canada

Region: Montreal, Quebec

Institution: Royal Victoria Hospital

Contact at destination: Mary Cecere (electives coordinator) electives.med@mcgill.ca, Nadia Marchetti (departmental administrator) nadia.marchetti@muhc.mcgill.ca

Department: Endocrinology & Metabolism

Work / Study undertaken: I was included in the main departmental rota with the residents (foundation/specialty trainee doctors) and worked shifts from 8am to ~6pm daily during the week. The mornings consisted of outpatient clinics (including diabetes, general endocrinology, reproductive endocrinology, neuroendocrine disorders, lipid disorders, metabolic bone disease), while the afternoons consisted of carrying out consults for patients on the wards or in the emergency department. There were numerous additional educational activities during the week including teaching sessions, seminars, lectures and journal clubs.

Description of the service and department: The Endocrinology & Metabolism department is the RVH’s largest outpatient service, with some 20 full- and part-time consultants and a throughput of approximately 18,000 outpatients per annum. A 5-year Adult Endocrinology residency training programme is split between the RVH and two other sites in the city. At any time, the on-call RVH endocrinology team typically consisted of three residents and one or two medical students working with a duty consultant of the week.

Description of the destination: Montreal is a large urban metropolis of some 3 million people and the capital of the province of Quebec, Canada. The city offers an excellent range of cultural activities throughout the year, as well as ample opportunities in the surrounding area for winter sports and a range of outdoor summer activities.

Were the local people friendly? Most were very friendly and helpful.

Did you feel safe and if not why not? Generally speaking yes, certainly compared to large cities in the UK; however, as in most western cities of its size precautions e.g. avoiding walking alone at night would be advisable.

What did you do in your spare time?

  • Museums – Musee des Beaux Arts, Musee d’Art Contemporain, Redpath Museum (Natural History Museum), McCord Museum
  • Other sightseeing – Notre Dame Basilica, Old Town + Port, Downtown + Underground City, Chinatown
  • Several ski trips
  • Long weekend trip to Quebec City
  • Cirque du Soleil show
  • Climbed Mont Royal and enjoyed a Sunday ‘Tam-Tams’ gathering (drumming/music events which typically take place every weekend throughout the Spring and Summer)
  • A lot of culinary indulgence!

Is there anything that you would particularly recommend others to do? All the above are definitely to be recommended – particularly a visit to Quebec City. Other destinations slightly further afield that would also certainly be worth a 3- or 4-day visit include Toronto and New York.

What time of the year were you there? What was the climate like? I was in Montreal from the end of March for 5 weeks. I arrived at the end of a particularly brutal winter, with daytime temperatures still approximately -15°C with a lot of snow in the city. However, by the end of my stay temperatures had risen to almost 20°C – a sudden transition into spring is typical – and in the middle of summer you can expect temperatures around 35°C.

What was your accommodation like? I found a private let in the McGill student area for the month.

Was it provided? No, although I believe there was a limited amount of accommodation on offer through the university.

How much did it cost? Approximately £400 for the month.

Did you enjoy your visit? Absolutely.

Did you find it useful medically? – in what way? Very much so. I was given a great deal of responsibility compared to what I typically experienced during placements in the UK, and found the experience extremely useful in clarifying my career ambitions. I also received a large amount of excellent clinically-oriented small group teaching to complement the clinical experience.

Has it improved your French? Yes, certainly. Although the official professional language was English (in the RVH as well as the other hospitals affiliated with the McGill Faculty of Medicine), I carried out perhaps one-third of consultations in French and not infrequently communicated in French to consultants and other members of staff, which greatly increased my general fluency as well as my medical vocabulary.

How has it increased your knowledge of French culture? During my stay, I learned a lot about the political history of Quebec, and gained much insight into contemporary culture in the province – a unique mix given both European and North American influences.

If you went back would you do anything differently? I would strongly consider taking the opportunity to organise a further 4 weeks in rural Quebec to experience the prevailing culture outside of the city as well as challenges of delivering medical services in such a setting.

How did you get there? What was the approximate total cost? Flight from Edinburgh via Amsterdam (KLM), approx. £550.

Is there any other information that you think may be useful? Get organised early and research the requirements re Canadian immigration medical examinations, which are costly and must be undertaken several months in advance of the placement.

Report 2

Reporter: Gordon McKenzie, Graduate-Entry Course Year 3 Medical Student, University of Birmingham

Year of visit: 2013

Country: Canada

Region: Montreal, Quebec

Institution: Montreal General Hospital (‘MGH’)

Contact at destination:

Visiting student electives are organised through McGill University (http://www.medicine.mcgill.ca/ugme/electives/visiting_interapp_en.htm). Ms. Mary Cecere
is the Student Affairs Coordinator and the contact for the Department of Otorhinolaryngology is Rosa Gasparrini (rosa.gasparrini@muhc.mcgill.ca). My supervisor was Dr. Karen Kost – Assistant Professor of Otorhinolaryngology and Site Director at Montreal General Hospital.

Department: Otorhinolaryngology (‘ENT’)

Work / Study undertaken:

All students attending an elective at one of the McGill University teaching hospitals will be matriculated as a McGill medical student for the elective period. This allows the visiting elective student to become fully involved in the team and obtain as much hands on experience as possible.

Resident led rounds start early, from anywhere between 06:45 to 08:30; however, ENT only ever had 1-3 inpatients whilst I was there! After this, the student will either attend clinics, theatre (‘OR’) or tumour board meetings (equivalent to MDTs). Theatre is excellent as a medical student at McGill, you are nearly always expected to scrub and are fully (often very helpfully) involved. It is very common for a medical student to suture and even learn a variety of techniques to do so at McGill. You will also be permitted to make incisions, blunt dissect, cauterise and clip etc. etc. as required!

Clinics are an excellent way to practice history taking, examination, diagnosis, presenting and formulating management plans. At McGill, students see patients on their own in small consulting rooms and, in the ENT department, are taught how to do flexible nasolaryngoscopy where indicated. Students present patients straight to the attending (‘consultant’), and I found all of them were very friendly and encouraging and teach contemporaneously during the clinic.

There were plenty of other interesting events for me to attend including resident teaching, resident research day and grand rounds. I was even invited to the residents’ research day meal at the McGill Faculty Club, which consisted of a four-course meal, open bar and a very pleasant atmosphere!

 

Description of the service and department:

The ENT department at MGH is a small, friendly department and I found myself actually attending three other hospitals depending on what was going on: the Royal Victoria Hospital, St-Mary’s hospital and the Jewish General Hospital. This made my working week quite interesting and varied. A typical working day starts around 07:00 and finishes around 17:00. Clinics consist of 4-6 small rooms equipped with all necessary ENT equipment. The ENT department shuts down at weekends and after 17:00 on weekdays with only one resident and attending taking on call emergencies. Medical students are not expected to attend on call work for ENT. Clinics get very busy and can be quite chaotic as residents (and students!) ‘fight’ to get their patient reviewed by the attending. OR lists start at about 7:30 and finish early afternoon. On theatre days there are afternoon post-surgical rounds.

Description of the destination:

Montreal is a vibrant city, which reminds me of a smaller London with North American and European (especially French!) influence. If there is one thing that Montreal can offer it is places to eat: there is an amazing diversity of excellent restaurants. You do not need to travel far to find French patisseries or nice places for coffee/drinks. I stayed around a popular street called Monkland where many nice places to eat, drink and snack are all found together, which becomes really busy on a sunny day. Public transport is generally very good and visiting elective students are entitled to get a student card, which saves a lot of money! There is a great mountain for a walk/jog nearby to the MGH called Mont Royal. As could be expected, there are many shops, museums and art galleries to be found to keep visitors and locals busy.

The first language of Montreal is French, but obviously a lot of English is also spoken, making it a ‘bilingual’ city. When you arrive in Montreal the immigration officer will greet you “bonjour-hi” and this theme remains largely throughout the city. However, this creates a fascinating environment where many other languages are also spoken. In fact, sometimes you hear one person speaking French and another speaking English in the same conversation!

Were the local people friendly?

I found the local people to be very friendly and welcoming; the UK accent is an instant give-away! The patients and various service workers that I spoke with instantly heard my accent when I spoke French and lapsed into English. They understood that I am not fluent in French and appreciated my effort. People often wanted to know what brought me to Montreal. Tourism from British and U.S.A citizens has declined over the years of the economic low, so they were pleased to meet someone visiting the city from outside Canada. I found the hospital staff and McGill medical students very approachable and friendly. They were keen to pass on tips about where to go and what to do, which was extremely helpful.

Did you feel safe and if not why not?

I felt very safe. Despite Montreal being a North American city and having its fair share of crime (like anywhere else) it is generally a very safe place to visit and live.

 

What did you do in your spare time?

I stayed with my Aunt and Uncle, so we went out for dinner, musical performances, hiking up Mont Sutton and Mont Royal. One of the local McGill students took me out for breakfast, and then a tour round explaining different places and highlighting good places to go with my girlfriend when she arrived after my elective. I visited Atwater Market which was nice: buy some sorbet it is the best I have ever tried! St. Catherine’s Street has many shops and malls to browse around. The exchange rate was pretty poor when I visited so shopping was not really on my agenda. A visit to Old Montreal, the Biodome and Planetarium was fun. I visited St. Viateur for coffee and bagels and tried poutine (aka chips, cheese and gravy!) – a Quebec specialty. When my girlfriend arrived, we spent most of our time going to different places for lunch (cheaper than evening meals and just as good). We visited Quebec City, which was amazing. Whilst there one can go whale watching, tour the fjords of the Saguenay or visit Montmorency falls (taller than Niagara Falls). Quebec City itself is a really nice place and Le Chateau Frontenac is a spectacular piece of architecture. We stayed in Université Laval accommodation in Quebec City, which was cheap, convenient and reminiscent of my first year university days!

Is there anything that you would particularly recommend others to do?

Ask the McGill medical students where is good to go, they’ll be happy to help and might invite you out to show you around. Go to St. Viateur as it’s where the locals hang out – great coffee and bagels. The Latin Quarter is also a good place to go for drinks. Definitely go to Quebec City – three hours by coach – as it’s a great couple of days. We didn’t get the chance, but try and go to Niagara Falls, it is a long, long journey, but it’s supposed to be amazing from the Canadian side. Walk up Mont Royal for great views of the city. Lastly, try and watch the films Bon Cop, Bad Cop and La grande séduction as they really touch on the spirit of Quebec!

What time of the year were you there? What was the climate like?

I visited during May and early June and was very fortunate to benefit from some really nice weather. There was some rain, but it was never cold. Spring passes very quickly in Montreal. There was still a tiny bit of snow left in the mountains.

What was your accommodation like?

My accommodation was amazing as I stayed with my Aunt and Uncle! They are both expats who have been in Montreal for many years and are bilingual and know the city well. This was a huge bonus and made my stay very easy and relaxing! They also helped me with my French!

Did you enjoy your visit?

I really enjoyed my visit, so much so I was sad to leave and I am considering doing a residency at McGill, although it will be a huge bureaucratic nightmare to do so. Doing an elective in Montreal is ideal if you want hands on experience and to be pushed above and beyond what one might experience in the UK. It also offers the opportunity to work with and learn from world-class doctors and get a fantastic linguistic, cultural and social experience. Moreover, it’s great to learn about and understand a different western healthcare system and it helped me to appreciate why things are done differently in the UK.

Did you find it useful medically? – in what way?

This elective was the most useful part of my medical training. Final year medical students in Quebec are equivalent to FY doctors in the UK; therefore visiting medical students are treated as such and incorporated fully into the team. I was permitted to clerk patients, perform invasive investigations and fully assist with surgery. I was also taught and expected to perform key procedures such as wax removal from ears, nose packing and wound care. Being given this responsibility allowed me to flourish, use my knowledge and learn a lot more about ENT, a career in surgery and myself. I have also prepared a case report from an interesting patient that I encountered and will submit this for peer-review soon.

Has it improved your French?

I studied French at GCSE level (Grade C), so I was never a strong linguist. Unfortunately, the French language course that I wanted to attend before my elective was cancelled. I ‘brushed up’ before I left, mainly on medically relevant French. It took the first few weeks to build my confidence up and work on my accent. Most patients realised immediately that I was not a fluent speaker and many who could speak English better than I could speak French would lapse into English! However, the best linguistic moment came when I was able to take a relatively simple consultation in French with a unilingual patient. Towards the end I found that I could follow medically oriented conversations fully. Overall, I feel it definitely improved my medical French and it has inspired me to take some further lessons.

How has it increased your knowledge of French culture?

It has certainly increased my knowledge of Québécois French culture. French architecture and food is everywhere, and the Anglo-French divide is very evident in Montreal. It is important to note that Montreal is a fusion of French and North American culture and this is fascinating. Interestingly, Quebec French profanity is directed against Catholicism unlike in France!

If you went back would you do anything differently?

I would have stayed longer, learned more French before I visited, attended French classes whilst there and been more proactive in social networking by trying to meet with other visiting elective students. I would have visited Niagara Falls in the first week; instead of waiting until my girlfriend arrived (we didn’t go in the end!).

How did you get there?

Flight from London Heathrow to Montreal Trudeau Airport. From there my Aunt and Uncle picked me up!

 What was the approximate total cost?

£1,500

I must acknowledge, with thanks, the support of the Anglo-French Medical Society and Birmingham University Medical School who helped make this elective much more affordable for me.

Is there any other information that you think may be useful?

New York City is 10 hours away by train – also well worth a visit if you can!

I would be willing to provide a list of hints and tips about where to go for food, drinks etc. (provided to me by a McGill medical student). Please contact me on gordonmckenzie@hotmail.com

Report 3

Reporter: Katarzyna Hunt (kasiahunt@gmail.com)

Contact at destination: Professor Apostolos Papageorgiou

Year of visit: 2011

Country: Canada

Region: Quebec province

Institution: Jewish General Hospital. I applied through McGill University.

Department: Neonatal Intensive Care Unit (NICU)

Work / Study undertaken

I was based on the NICU for four weeks, with opportunities to spend time on the normal neonatal ward. I was working in a team of four other medical students, all at McGill University. We were each allocated between four and six babies at any one time. I was expected to come in an hour before ward rounds every morning in order to examine the babies and to catch up on the events that had happened overnight. Following this, I would present these babies on the ward round and make suggestions for their further management to the senior staff member. Ward rounds were a fantastic opportunity for learning; we would stop at the cot-side of the interesting patients to discuss a whole spectrum of issues ranging from the basic physiology to the management of the cases currently in the unit. After ward rounds, we would be ushered enthusiastically by the professor into the staff room for a quick coffee, following which we would go to teaching sessions. Each student, myself included, had to give a 30-60 minute presentation on a topic of their choice within neonatology. When we had spare time we were encouraged to spend time on the normal neonatal ward examining as many healthy term babies as we could.

Description of the service and department

The NICU is part of the neonatology department, which also includes the normal neonatal ward. Patients were admitted from various clinical areas, most commonly from the delivery room or theatres on the labour ward. Occasionally babies from the normal neonatal ward had to be admitted if they exhibited signs of distress. The NICU also accepted babies from other hospitals, and occasionally had to send its patients to other hospitals if they needed surgery (the Jewish didn’t have facilities for paediatric surgery). The team on NICU always consisted of one consultant (or staff, as they are called in Canada), the junior doctor (resident), and five medical students. The medical students were integral in the babies’ medical care; the resident would read the notes we had written, and sometimes confirm examination findings when we found unusual clinical signs in our patients.

The NICU worked extremely closely with the Obs&Gynae department, and we had inter-disciplinary student meetings in which we would discuss whole cases as they had evolved, from the mother pre-labour, to the labour itself, and then to her baby and how it was medically, currently on the ward. These were chaired by consultants from both specialties, who would ask the presenting students questions about their cases.

Description of the destination

Montreal is the largest city (population ~1.6 million) in Quebec province, situated on an island at the confluence of the St Lawrence and Ottawa rivers. It is a highly mixed community; in my few weeks there, I only met a handful of true French-Canadians in the workplace. Most people had an immigrant background, which is what characterises Montreal. This cultural mix works very well in Montreal; people there were very tolerant of cultural differences, and they appeared to actively mix with people of different origins, unlike in London where I live, where it often seems as if immigrant communities remain insular, and that people are wary of strangers from different places. I was in Montreal during the winter, having arrived in the middle of February, the coldest month of the year. Temperatures at the beginning of my stay were usually below -10̊C, and there were a couple of snowstorms during my time there. Unlike in the UK, however, these did not cause much disruption to people’s daily lives, as snow clearing services were highly efficient.

Were the local people friendly?

Incredibly so.

Did you feel safe and if not why not?

Yes, even when walking around the city after dark.

What did you do in your spare time ?

I visited many museums and art galleries, I explored the underground city (no matter how often you’ve been in it, you still get lost), I walked in the big parks including Mont Royal, explored the food markets which sell Quebec specialities, went to concerts as part of the Montreal winter festival called Montreal en lumiere, and ate foods from many different countries (including typical Quebecois, of course). And I was given the opportunity to go to a cabane à sucre, which I took up with relish!

Is there anything that you would particularly recommend others to do?

If you’re there during maple syrup season, which runs roughly from the beginning/middle of March until the end of winter, go to a cabane à sucre (sugar shack). These are large buildings in the middle of maple forests where they make maple syrup. Quebec province is the world’s largest producer of maple syrup, so this is a truly traditional local experience. Going to a cabane à sucre involves going with a large group of people to one of these houses in the middle of nowhere, surrounded by maples, eating a very large meal consisting of various traditional dishes, and pouring maple syrup on just about everything that you eat. The best part was at the end, when you have ‘tire’, which is where heated maple syrup is poured on to the snow, and after waiting for a few seconds, you take a lolly stick, roll up the syrup on to the stick, and then eat it. Delicious!

What time of the year were you there? What was the climate like?

Mid-February until mid-March. Temperatures did not rise above -5̊C, and there was a thick blanket of snow on the ground throughout my entire stay.

What was your accommodation like?

I stayed in a family-owned house who rented out their rooms to students. It was a great house, with eight other students living in it. We spoke mainly French in the house. There was a great community feel to it, yet the atmosphere was such that there was plenty of privacy and quiet should you want it.

Was it provided? No

If not who arranged it?

I did. As I wanted to have the opportunity of speaking French at home, I found an agency that arranges home-stays in Montreal. They try to put you up somewhere close to where you’ll be working/studying, which was ideal. I was living 15 minutes’ walk away from the hospital. Here’s the website: http://www.lamimo.com/

How much did it cost?

760 CAD (~£505) for 4 weeks, meals not included.

Did you enjoy your visit?

It was absolutely terrific!

Did you find it useful medically? If so, in what way?

Enormously! I learned a huge amount about neonatology, a specialty we do not get much exposure to here in the UK. In addition to this, the responsibility we had there as students was huge, which I think has prepared me perfectly for the duties I will have next year as a junior doctor.

Has it improved your French?

Yes. Even though the Jewish is an English-speaking hospital, many of the patients (or in this case their parents) spoke French only. Medical students in Montreal had the task of speaking to the parents and explaining what is going on with their babies, so I managed to practise my French a lot. By the end of my stay I was also able to finally understand enough Quebecois French to have some conversations.

How has it increased your knowledge of French culture?

I learned a lot about local history, from the first French settlements, through their disputes with the British, to present-day efforts to maintain French language and culture in the province. The most amusing concept I came across in this important endeavour was the ‘language police’, whose task it is to measure the font size on bilingual signs, to ensure that the French language version is always ‘at least as prominent’ as the English language version (amongst other tasks).

How did you get there?

I flew to New York first, to spend a week’s holiday there. I then took the train to Montreal. This took longer than the coach would have taken, but it was the same price, and much more comfortable.

What was the approximate total cost?

Probably around £2500, which includes the fee for medical registration in Quebec province, elective insurance, the McGill elective fee, flights, accommodation, a £200 compulsory medical examination and chest x-ray, and all other food and tourist costs. Canada is expensive, especially in terms of food and buying groceries. In fact, it was often cheaper to go out to buy dinner than to cook for yourself, especially if you wanted to eat fruit and vegetables.

Is there any other information that you think may be useful?

Make friends with the medical students – they are on the whole very friendly and provide excellent tips on where to see, eat and drink the best stuff.

The first day there was a complete shock to the system, realising just how much was expected of me, and having to try to decipher Canadian English abbreviations in the medical notes. So be prepared for hard, but extremely rewarding, work. And a great time out of work, too!

 

Report 4

Reporter: William Davison, 5th year medical student, Peninsula Medical School

Year of visit: 2010

Country: Canada

Region: Montreal, Quebec

Institution: Montreal General Hospital (MGH)

Contact at destination:

The co-ordinator for the visiting electives programme is Mary Cecere. She is extremely helpful and can be reached via email (electives.med@mcgill.ca).

My named supervisor was Dr Eidelman though I never worked directly with him as he was not on service whilst I was there. The co-ordinator for the MGH Respiratory service is Andrea Sanders. She is also extremely helpful and can be reached via email (andrea.sanders@muhc.mcgill.ca).

Department: Respiratory Medicine

Work / Study undertaken:

I was attached to the respiratory service at the Montreal General Hospital. The team consisted of an attending (consultant), a respiratory fellow, three resident doctors doing an “elective” rotation, and myself. The bulk of our work was providing consultations on in-patients for other services. For example, we could be asked to assist in the management of a patient presenting to A&E with haemoptysis or assess a medical patient with new pleural effusions. This would involve taking a history, examining the patient, reviewing the blood work and scans, and proposing a management plan. We also provided outpatient services covering a variety of respiratory conditions. A typical day would begin at 8.00am when we would review the patient list as a team. The rest of the morning would be spent following up our personal patients and taking it in turns to see new consults. In the afternoon we would present our cases to the attending and review new/interesting cases as a team. I would usually finish sometime between 5.30-7.30pm. In addition to the daily workload there were twice weekly radiology conferences, daily lunchtime medical rounds and opportunities to attend pulmonary function testing or bronchoscopy.

Description of the service and department:

The Respiratory service at MGH is a consult service (i.e. there is no dedicated respiratory ward) providing assessment and treatment of in-patients with complex respiratory problems (including multi-system disorders and patients who are immunocompromised). There are also regular clinics, including asthma and COPD clinics, and a pulmonary function testing service. The service operates twice weekly radiology conferences and contributes to the daily medical teaching rounds.

Description of the destination:

MGH is one of the hospitals that makes up the McGill University Health Centre. It is a large hospital with nearly 500 beds providing both medical and surgical care, and is designated a level 1 trauma centre. It is primarily an English speaking hospital.

Montreal is the largest city in the province of Quebec and is the second largest city in Canada. It has a population of nearly 4m people. It is a highly commercial and cultural city built on the St Lawrence River. It is named after the three peaked hill at its centre, “Mont Royal”.

Were the local people friendly?

The locals were very welcoming and were often interested to talk with me as I was a visitor. A couple of my work colleagues took me out on several occasions to experience the Quebecoise delicacies of smoked meat and poutine!

Did you feel safe and if not why not?

I felt very safe even though where I stayed was a slightly run-down area. Montreal is a very accessible city.

What did you do in your spare time?

During my four week rotation there wasn’t a lot of spare time other than weekends! However, I managed to pack a lot of stuff in. I wandered around most areas in the city, including downtown, the old city, and the plateau. There are lots of attractive buildings, parks and statues that you can see for free in these areas. I also visited Mont Royal and the modern art museum. On several weekends I hired a bike to get around, cycling along the Lachine canal, and to Ile Ste-Helene and Ile Notre-Dame. For the evenings there are many great places to go and eat or drink and Montreal has a great live music scene so it is worth looking out for concerts. When I had finished working I spent a few days visiting Quebec City, which was very beautiful (like a piece of France or Belgium in North America!), and I took a day to visit La Ronde amusement park to go on the largest wooden roller coaster in the world! I was also lucky enough to be there at the right time for ice hockey pre-season and the festival of the lights at the botanical gardens.

Is there anything that you would particularly recommend others to do?

The things I most enjoyed were cycling along the Lachine canal and visiting the islands in the St Lawrence River. There is loads to see around there and on the weekends you can cycle/roller blade around the F1 circuit which is cool. For general sights don’t miss the view from the top of Mont Royal and wandering around the old town. If you’re into shopping then get lost in the vast network of the underground city. If you’re a foodie then visit the Atwater market and make sure you try smoked meat (ideally from Schwartz’s) and poutine. I would definitely recommend going to a hockey game if you can as that is a truly Canadian experience, even if like me you don’t understand the rules! Also, keep an eye out for local festivals like the festival of the lights and take advantage of anything special going on.

If you want to get out of Montreal then I would recommend a few days in Quebec City to help enhance your experience of the region. I didn’t have a chance to go myself, but there are several national parks a few hours north of Montreal, and Toronto and Niagara falls are not too far away.

What time of the year were you there? What was the climate like?

I was there for 6 weeks from the end of August to the beginning of October. This covered the end of the summer going into the fall season. When I got there the weather was hot and sunny (temperatures of 30 degrees plus), but it gradually cooled down (when I left temperatures were about 16 degrees) and there was some rain. It was a beautiful time to be there as the leaves on the trees changed from vibrant green to amazing reds, yellows and oranges. I would definitely recommend going at this time of year as long as you don’t mind the weather being a little bit unpredictable!

What was your accommodation like?

I took a short term let on an apartment through a private company (www.mystudiomontreal.com) as I wanted my own space and my girlfriend came to join me for part of the trip. The apartment was a good size, fully furnished and was comfortable. The kitchen could have been better equipped, but there was free Wi-Fi and access to laundry facilities which was very useful. It was in a very convenient location for the MGH and getting around Montreal, but the area itself was not the nicest.

Was it provided?

No, but the university did provide a list of private lets and home-stay options to help me organise things myself.

How much did it cost?

Around $1600 Canadian for the entire stay.

Did you enjoy your visit?

Definitely! It was hard work but I loved my time in Canada and can’t wait to go back and see some more of the country.

Did you find it useful medically? – in what way?

Absolutely. I was treated as an equal member of the team and was expected to do my share of new consults and take responsibility for following up my patients. This was great for improving my decision-making skills and increasing my confidence in caring for patients beyond making an initial assessment. Some of the patients were complex, or had rare conditions so I experienced things that I had not come across before. This made the experience challenging and interesting. Also, due to religious holidays whilst I was there, on a couple of occasions I was the only junior member of the team. As a result I had to carry the bleep for the service. This was a nerve-wracking but great experience! Lots of teaching was provided and I had numerous opportunities to improve my skills of x-ray and CT interpretation.

Has it improved your French?

A little. I spent several months before I went brushing up on my language skills using a free podcast. This was a good thing because even though I was in an “English” hospital there were occasions where the patients only spoke French. This forced me practise and I’m sure that it was helpful. However, often I difficulty understanding the accent (as the locals did with my accent) and so it became my habit to speak in English where possible.

How has it increased your knowledge of French culture?

Yes. Even though I have spent quite a bit of time in France the culture in Quebec is different so I definitely learnt something new.

If you went back would you do anything differently?

Stay longer!

How did you get there?

Flight from London Heathrow to Montreal Trudeau Airport. Montreal airport has good bus links into the downtown area of the city.

What was the approximate total cost?

About £2500-3000 in total. The major costs were flights and accommodation, which I could have got cheaper if I had been more organised or taken alternative options. There were tuition fees of about £200 and additional costs for registration and medical screening of about £200. Cost of living is fairly expensive in Montreal.

Is there any other information that you think may be useful?

 

There is quite a lot of red tape involved in organising an elective at McGill. Start thinking about it early, get organised, apply as soon as you can, and persevere if you run into any problems. The extra effort of sorting it out just makes it feel all the better once you get out there!

If you are considering an elective in Canada then be aware that it is likely to be hard work as the elective over there is more akin to a special study module in the UK. Also, be aware that there probably won’t be many opportunities for doing practical procedures as a student as many things are done by the nursing staff.

 

Report 5

Reporter: Melpomeni Kountouri, 4th yr medical student, Birmingham University Medical School

Year of visit: 2006

Country: Canada

Region: Montreal , Quebec

Institution: Jewish General Hospital (JGH)

Contact at destination: McGill University is the Anglophone university of Montreal and the variety of electives on offer can be found at http://www.medicine.mcgill.ca/undmededuca/ The electives coordinator is Ms Mary Cecere who can be contacted at electives.med@mcgill.ca

Once you know you have been allocated to JGH the elective coordinator for electives there, is Ms Shana Szikman emacademics.jgh@mail.mcgill.ca. Both are very helpful.

Department: Accident and Emergency

Work / Study undertaken:

The “rounds” start at the beginning of new shifts i.e. at 8am , 4pm and 11pm when there is a handover from one team to the next. The attending (Consultant), resident and/or student, nurse in charge, pharmacist, social worker and department coordinator from both teams attend these. The students do not need to be present at the first handover instead they clerk in new patients. On the contrary, at the end of the shift they have to present their patients to the next team. The shifts are invariably the same: clerking patients, formulate a plan and present it to the attending to finalise it. Teaching usually depends on the attending and how busy the shift is. There were occasions when I stayed for almost a 2-hour one to one teaching after my shift (and my attending’s!). In terms of practical procedures nurses did bloods and ECGs however I was offered to do a lumbar puncture (!) and insert an endotracheal tube. Unfortunately, I could only do the latter.

Description of the service and department:

JGH has an extremely busy minors and majors department with trauma being catered by the nearby Montreal General Hospital . My shifts included both minors and majors and they were lasting from 8 to 10 hours varying from morning to afternoon and evening shifts. Teamwork is a key aspect for the efficient running of the department and no day is the same. Surely no one gets bored there!

Description of the destination:

The city of Montreal is based along the sides of the hill that the locals prefer to call the “mountain” Mount Royal . It is a city with a European air and attitude making you feel at home. The transport system is very efficient and there are at least 2 buses from downtown serving the hospital as well as two metro lines. The only downside is the weather. I was there throughout May and it was raining most of the days…

Were the local people friendly?

Montreal is a multicultural city and the locals have blended very well with each other making the city very welcoming to its visitors. Everyone was very helpful and accommodating, although if you don’t realize that tip is not included in bar(!) bills they can, very embarrassingly, let you know.

Did you feel safe and if not why not? I felt safe enough to use the bus at the end of afternoon shifts ( 1 – 2 am ). The bus driver are obliged to stop when requested as long as it is safe to do so, in order to reduce walking distance during night time.

What did you do in your spare time? Spare time was limited. I was working 10 hour shifts for two out of four weekends… However, during the off days (1 in 3 usually) it was nice to go to the waterfront and the Old Montreal, the historic centre of the city. Also, the views of the city from St Joseph ’s Oratory and a walk up the “mountain” are a must. I also went to Quebec City , which is truly breathtaking.

Is there anything that you would particularly recommend others to do? Other than walking up Mont Royal, enjoying the view from there, and strolling along the narrow roads of Old Montreal there is the amusement park “La Ronde” which is very similar to Alton Towers . A great stress reliever. Also, don’t leave without having tried smoked meat and maple flavoured ice cream and biscuits: delicious.

What time of the year were you there? What was the climate like? I was there in May and it was mostly raining and cold. However, I was working most of the time so I didn’t mind! The weekends I had off, somehow the weather changed to being hot-almost 25C, and humid, something like a sauna.

What was your accommodation like? I found my apartment from the University’s accommodation listings on the internet. I had my own room and the girl who was subletting the place was usually offering to cook for me. Internet was provided (I had my laptop) but there was only one phone line which I had to share with the other girl.

Was it provided? No, it was arranged by myself, a month before the rotation started, through the internet.

How much did it cost? $390 (£205) for four weeks.

Did you enjoy your visit? It was a very good educational experience blended with a nice holiday. An excellent combination.

Did you find it useful medically? – in what way? Absolutely. I was responsible for my patients which meant that I had to be knowledgeable. This level of responsibility is lacking over here although we do get more exposure to practical skills, something that the nurses have taken over in Canada

Has it improved your French? Absolutely, especially medical terminology. Almost one in 4 patients would speak only French.

How has it increased your knowledge of French culture? The entire city is bathed in French culture: from its architecture and history to language and music. It is inevitable to escape this especially when you live around the student areas. In addition, the “metro” daily newspaper is in French and two of the free channels on TV are Francophone.

If you went back would you do anything differently? I would have extended my stay for one more rotation as four weeks may not be enough to fully appreciate this rotation. Also, I would choose to go there in June-July if I had the option.

How did you get there? Flight from London Heathrow to Montreal Trudeau Airport.

What was the approximate total cost?

Travel: Flights & Insurance – £599, Transport – £150

Accommodation: £205

Other: Living costs – £200, Study Permit -Medical Examination – £184, Application to McGill Medical School – £230

Total: £1,568

Is there any other information that you think may be useful? I would thoroughly recommend a clinical elective in North America as it prepares students from the UK very well for final year.

Report 6

Reporter: Frances Slatter, 5th Year Student, University of Leeds Medical School

Contact at destination: Electives at Royal Victoria and many of the other anglophone hospitals need to be arranged through McGill University. This is easy to find out about on their website, there’s loads of information although there are also lots of forms to fill out.

Year of visit: 2006

Country: Canada

Region: Montreal, Quebec.

Institution: Hôpital Royal Victoria (RVH)

Department: Emergency Medicine (A&E)

Work / Study undertaken

I spent one month in the emergency department, medical students are basically rostered onto the junior doctor schedule, doing 4-5 8 hour shifts per week, a combination of days, evenings, weekends and night shifts. It seemed like I was there an awful lot! It was great because it means you get to work directly with the attending (consultant) on shift, clerking patients who come in then presenting them and working out a management plan with their supervision, basically getting one-to-one consultant teaching for eight hours. At the RVH they don’t get many medical students so they seemed quite keen to teach, although while I was there, there were 2 McGill students on their elective and one other British student. There was an hour’s teaching every week day for students and junior doctors which you were expected to attend and there was quite a strict system of attendance and feedback on your performance. There was also grand round monthly which was a morning of lectures.

Description of destination

The Royal Victoria Hospital (http://www.muhc.ca/pfv/rvh/) is an English speaking, state-funded hospital affiliated with McGill University. The hospital fairly large; it is one of 4 McGill University hospitals in the city, and the emergency department sees around a hundred patients each day. The trauma centre for the city is located at a different hospital, but the Royal Victoria ED sees a wide mix of cases including more complex cases due to the number of specialties housed within the hospital; patients are frequently transferred to the Royal Victoria from other emergency departments because their consultant is based there. The hospital itself is about 10 minutes walk from McGill university, in what looks like an old castle on the side of Mont Royal, the hill from which Montreal gets its name.

Montreal is a fantastic, unique place to spend 2 months. Imagine French cafés, bars and patisseries on big American style boulevards, where people switch from French to English and back again mid-sentence. It’s unlike anywhere in North America or Europe and has a brilliant relaxed feel. I was there in August and September and there was a heatwave when I arrived, but by the time I was leaving the leaves on the trees were starting to turn. The city feels safe at anytime of the day and the metro system is cheap and easy to use, although you can walk almost anywhere you’d need to go.

Were the locals friendly? Everyone was really friendly and helpful.

Did you feel safe and if not why not? I always felt safe, using the metro and walking around at night. Montreal has very little crime compared to the UK. My flatmate used to go out leaving her windows open and doors unlocked.

What did you do in your spare time?

I went to a French language school which was brilliant as I made loads of friends and got an instant social life! I went to the cinema, out for meals, bars, clubbing, to see the ice hockey (a BIG deal in Canada), and Canadian football, hung out in Mont Royal park. I also hired a car and travelled around Quebec; to Quebec City (the province capital) and north up the St. Lawrence river, seeing some amazing scenery and going whale-watching.

Is there anything that you would particularly recommend others to do?

In the summer, hang out on Sunday afternoons at Piknik Electronique, a weekly dance music festival in the park on Jean-Drapeau island just south of Montreal. Or go to the Tam-Tam in Mont Royal Park where people go every Sunday to play music, relax and dance around.

Climb the steps to the top of Mont Royal for an amazing view over the city.

Get all your food from Jean-Talon Market, a huge Quebec-produce fruit and veg market with its own TV programme.

Go and see a hockey match at the Centre Bell. Montrealers support the Canadiens (the “Habs”). We only saw a pre-season match but the atmosphere was amazing!

Go to Schwartz’s deli for smoked meat and cherry coke – a Montreal touristy must but definitely worth it.

Get a coffee in Old Montreal and pretend you’re back in Europe.

Go whale-watching (and get soaked) in Tadoussac.

You can also visit Toronto, Niagara Falls and New York fairly easily from Montreal.

What was the climate like?I was there August to September and didn’t need to wear a coat until the last 2 weeks of September when we went further north.

What was your accommodation like? Great. The first 2 weeks I lived with a Quebecois girl, arranged through my language school, the rest of the time I lived with a French couple in downtown Montreal.

Was it provided? No.

If not who arranged it?I arranged it all myself. The University and Hospital were not very helpful with arranging accommodation. I found my first two weeks accommodation through my language school as a “homestay” to practice my French and then organised the rest by contacting people of the housing list sent to me by the university.

How much did it cost?The home stay was included in my language school fees; the rest of my accommodation was £50 a week.

Did you enjoy your visit?I loved it, and didn’t want to leave!

Did you find it useful medically?I had plenty of opportunity to practice my history taking, examination and presenting, get experience at suturing and see lots of different cases. Unfortunately the nurses in the emergency department did all the bloods, cannulas and ECGs so I found it difficult to get to practice these.

Has it improved your French?Definitely, I spoke French to the people I lived with, and although the hospital was all English speaking, as it was the emergency department French speakers would come in very often and I got the opportunity to speak French in the hospital. When I ran into language problems almost all the staff is bilingual.

How has it increased your knowledge of French culture?I know a lot more about Quebecois culture and history and the Anglophone/Francophone divide.

If you went back would you do anything differently?I might have gone for a different rotation because my knowledge of general medicine at the end of fourth year was quite good enough to get the most out of the experience, although I did learn things that have helped me in fifth year.

How did you get there?British Airways, London to Montreal.

What was the approximate total cost?

v £400 for flights

v £80 for BMA medical and travel insurance

v £300 for accommodation

v £250 for the immigration medical exam blood tests and chest x-ray

v £230 for McGill application and tuition fees

v £600 for language school 2 week intensive course and accommodation (a lot but this made my trip)

v £400 living and spending money

Total = around £2600

Is there any other information that you think may be useful?

Sorting out the temporary student visa from the Canadian embassy took quite a long time. It needs to be done quite a few months in advance as requires going for a medical examination with an approved GP – there’s only one in Leeds. This was very expensive but I can recommend getting hold of the list of approved GPs from the embassy and phoning those in your area as they charge different amounts and you may be able to get it done cheaper if you are willing to travel.

 

Report 7

Reporter: Alison Munro, 5th Year Medical Student, University of Leeds

Year of visit: 2004

Country: Canada

Region: Montreal, Quebec

Institution: Hôpital Général Juif

Contact at destination: Electives are arranged through McGill University because it is a teaching hospital. Email electives.med@mcgill.ca or visit their electives website at http://www.medicine.mcgill.ca/undmededuca/

Department: Emergency Medicine (A&E)

Work / Study undertaken:

I was included on the doctor’s rota and worked a mixture of earlies, lates and night shifts over six weeks. I was expected to carry a similar workload to a first year resident, which was a lot more responsibility than I am used to in the UK. I would take a history and examine new patients who came to A&E, come up with a differential diagnosis and order any necessary tests. Each patient would then be presented to the Attending (Consultant), who would check over and modify the plan. It was then my responsibility to keep checking on the patients I had seen including blood results, imaging and consults until they were discharged or transferred from the department. At the end of each shift there was a round where patients were handed over to the next team, where a brief summary of each patient would be presented. This did wonders for my confidence and presenting skills, as there was no opportunity to be unprepared or shy.

Description of the service and department: JGH is a non-trauma centre, adult, general hospital in the Jewish area of Montréal. All paperwork is done in English but there is a mixture of French and English speaking patients, along with a bit of Yiddish, Polish, Italian, and many others!

Description of the destination: Montreal is a very European North American city. It is extremely multicultural and thrives on these influences. There are very distinct areas such as the Jewish area, the Italian market, China town which you can hardly believe are all part of the same city.

Were the local people friendly? Very friendly – the Canadians have a more moderate version of the American ‘Have a nice day’ culture.

Did you feel safe and if not why not? Montréal was a very safe city. People still leave their houses and cars unlocked and there is very little crime. I felt safe as a single woman walking around on my own and using public transport, even late at night.

What did you do in your spare time? I visited all the ‘must see’ tourist sites, but also just did regular things to really get a feel of city life. I also visited Quebec City (the capital of the province), Toronto and Niagara Falls.

Is there anything that you would particularly recommend others to do?

In Montréal

Go cycling along the canal and get a picnic from Atwater market

Make the most of any outdoor festivals that are on: for example, the film, comedy, jazz and art festivals.

Walk to the top of Mont Royal – the hill that the city is named after. It’s really not very high, but nothing is allowed to be built higher than it in the city – therefore you get a good view!

Go to the baseball. Even if you don’t like sport, go for the atmosphere. It is very confusing because they try to do all the commentary in English and French, but you will be entertained by the performance from the people selling hotdogs, crackerjack, beers and barbe au papa! Oh, and there’s some people batting a ball around. . . .

Out of town

Visit Quebec City. It is a very quaint walled city where the parliament for the province is held. There are lots of beautiful buildings to see, for example Chateau Frontenac. It is a grand hotel built in the age of the railways and you can have a guided tour with a bellboy from the 1800s, which is well worth it!

Take a trip to Toronto. It is about 4 hours away by train but is definitely worth the journey. The CNN tower is the ‘must see’ attraction, especially if you go right up to the skypod at sunset – it’s beautiful.

What time of the year were you there? What was the climate like? 1st August – 26th September. It was a ‘bad’ summer and the weather was still fantastic – temperatures reached 30 degrees C. However, it can be very humid in the city, which is not very pleasant.

What was your accommodation like? I stayed in an Apartement-hôtel as my elective was during Canadian University term time and there was no space in their halls of residence. It was a 20 min bus ride from the hospital, in the down town area which was perfect for my time off.

Was it provided? No, I had to arrange it myself through the internet. No one at the University or Hospital was able to help.

How much did it cost? £200 per week

Did you enjoy your visit? Very much, I am already considering going back there to work in a few years time.

Did you find it useful medically? – in what way? Yes, I saw a wide variety of patients and practiced all of my history and examination skills. I now feel much more confident about being a house officer next year. On the downside, there was little opportunity to practice practical skills, because the nurses do all the bloods/venflons/nasogastric tubes etc. In the minor injuries unit there was always an opportunity to practice suturing though!

Has it improved your French? Absolutely.

How has it increased your knowledge of French culture? It increased my knowledge of French-Canadian culture. I learned a lot about the history of the area and how people feel about the French/English divide.

If you went back would you do anything differently? I don’t think so. I had a great time – it would just be nice to have been there for longer!

How did you get there? Flew from Manchester to Paris, CDG and then to Montréal

What was the approximate total cost? Around £3000 altogether. It sounds a lot of money, but I was kindly given some money from university trusts and educational charities. The main costs involved were:

Flights

Accommodation

Immigration medical (must be done several months before by a specialist GP) ~ £150 including blood tests and chest x-ray

Fees to the Canadian University ~ £250 to arrange an 8 week elective

Travel insurance

Metro travel passes ~ £25 per month

Spending money

Is there any other information that you think may be useful?

Monthly metro passes are great value and can be used without restriction on the underground and buses. However, you can only buy them in the first few days of each month, so don’t miss out.

You do not need any kind of permit to do an elective in Canada, but you do need to deal with Canadian Immigration. You must do this early as they only correspond in writing, by post. It is impossible to contact them by phone or email or fax! You will require a letter from them that says you are a healthcare student on a temporary visit to the country. Before they give you this, you will have to have a full medical with one of their registered GPs. For more information see Immigration Canada website http://www.cic.gc.ca/english/

Report 8

Reporter: Shazid Karim, 5th Year Medical Student, Guy’s, King’s and St Thomas’s School of Medicine

Year of visit: 2004

Country: Canada

Region: Montreal, Quebec

Institution: Montreal General Hospital

Contact at destination: Electives are arranged through McGill University because it is a teaching hospital. Email electives.med@mcgill.ca or visit their electives website at http://www.medicine.mcgill.ca/undmededuca/. The elective co-ordinator is a very helpful lady called Andrea McDaniel

Department: Trauma Surgery

Work / Study undertaken:

Work begins early at with a 7am ward round which everyone attends. This takes about 1.5 hours at which point the team has breakfast together in the canteen. Then we present to the Staff (Consultant) and he decides what jobs need to be done for the patients on that day. During the day if a trauma occurs everyone in the team is bleeped and there is a mad rush to get to the trauma bay where the patient will have arrived. It can be very exciting and busy or very quiet depending on the time of day and whether it is a weekend or not. I observed the management of traumas at the start but as my confidence grew I was allowed under supervision to be in charge of traumas which was fantastic. There were also daily scenario sessions which were good for learning. In terms of surgery, you can scrub in whenever you like but the mcgill medical students get priority and hence I only got to see basic operations like hernias but I did manage to suture a bit.

Description of the service and department: MGH is a level 1 Trauma Centre near the downtown area. I was attached to the Trauma Team who work in conjunction with the general surgery team and share the same offices and common room. Patients speak French and English and it is only rarely that a non-Enlgish speaking patient presents.

Description of the destination: Montreal is a beautiful city with a good mix of European and North American influences. It is very hilly but the good metro and bus system make it is easy to get around. It is as you would expect cheaper than London.

Were the local people friendly? They were very friendly and as soon as they find out you’re from England they become even more so. My accent was amusing to them and hence I had no problem making friends.

Did you feel safe and if not why not? I felt very safe much more so than I do in some parts of London.

What did you do in your spare time? The only spare time I had was on weekends but there are plenty of things to see and do from the common tourist attractions to some hidden treasures like playing petanque (French for bowls) with the locals in the park. The casino is also amazing!

Is there anything that you would particularly recommend others to do?

Mont Royal is a must as is walking through Vieux (Old) Montreal and sitting down to have a coffee to take in the atmosphere. Montreal also has a great nightlife with many clubs and bars including 737 which is a club that is situated on top of a skyscraper building giving fantastic views of the city.

Out of Montreal there is also lots to do. Cities like Toronto and New York are under 6 hours away and it’s a good idea to take a weekend trip. Toronto has lots to see like the CN Tower and New York is fabulous.

What time of the year were you there? What was the climate like? I was there in August which meant the weather was great- hot and humid- definitely T-shirt and shorts weather.

What was your accommodation like? I stayed in halls accommodation for 2 weeks and then with my aunt for the rest. It was pretty basic but it meant I got to meet other students.

Was it provided? No, I had to arrange it myself through the internet.

How much did it cost? £100 per week

Did you enjoy your visit? I had a great time and hope to return one day

Has it improved your French? Without a doubt

How has it increased your knowledge of French culture? Certainly. Some parts of Montreal are distinctly French and English is barely spoken and it was from these areas where I learn the most.

If you went back would you do anything differently? I would probably prepare myself a bit better as they expect a lot of medical students!

How did you get there? Flight from London to Boston. Coach from Boston to Montreal..

What was the approximate total cost?

· £150 for the medical

· £400 for the elective

· £200 for accommodation

· £400 for flights

· £100 insurance

· £400 living

· Total = £1650

Is there any other information that you think may be useful?

As with any elective in North America, plan early and book early as places get taken quickly. Use the website as it very useful and get the compulsory medical done early and everything will run smoothly.