AFMS Medical Bursary Report – Nantes
Contact at destination:
Hélène Lamy-Billaud (firstname.lastname@example.org), International Exchanges Coordinator
Year of visit: 2018
Institution: Centre Hospitalière Universitaire (CHU) Nantes
Renal (Néphrologie), Emergency (Urgences), Cardiology Intensive Care (Cardiologie soins intensif), Neurology (Neurologie)
Work / Study undertaken:
I undertook a 4-month Erasmus elective placement, enrolled as a medical student at Université de Nantes. I am normally enrolled at the University of Manchester, where I undertake the ‘European Option’ programme. As part of this, we are enrolled in weekly evening classes and sit external certifications in Medical French alongside our medical studies. I went to Nantes during my final semester, as a final-year student prior to qualification.
Description of the service and department:
Your placements are likely to be based at one of two hospitals encompassed within CHU Nantes–Hôtel Dieu or Hôpital Laennec (Nord). Hôtel Dieu is very central, easily accessible and well-located to cafés and restaurants, whilst Laennec requires about an hour of commuting each way. These are old and steeped in history; notably, Laennec was the inventor of the stethoscope. The services at both hospital are tertiary, and therefore receive some very interesting cases.
I began in the renal department. Nantes is a centre for both kidney and pancreatic transplants, and the department had some legendary characters. I was exposed to a range of pathology, found doctors practicing at a high level, and found the placement fascinating. I proofread several academic manuscripts written in English, and interestingly, several consultants wished to improve and practice their English with me. I was able to attend outpatient consultations as well (néphrologie générale, and post-greffe). Some students were even able to observe transplant surgery.
For Neurology, I was based in the East Wing, in which I saw some incredibly interesting and rare neurology. The service accepts both acute and planned admissions, the latter for in-patient infusions or specific investigations. I saw everything autoimmune and inflammatory I had studied about–– multiple sclerosis, myasthenia gravis, motor neuron disease, inflammatory myelitis, inflammatory demyelinating neuropathies, chronic hydrocephalus, and atypical Parkinson’s disease. The service provides opportunities to refine the art of neurological examination, look at MRI scans, and even attempt a lumbar puncture if you dare.
In Cardiology Intensive Care, I witnessed a range: myocardial infarctions, rhythm disorders, and occasionally, cardiomyopathies. The unit sees between 150 and 200 in-patients a month, which is a phenomenal figure. It is an excellent opportunity to revise your cardiology, see countless ECGs and bedside echocardiograms, and develop a systematic clinical approach to the cardiology patient. I particularly appreciated opportunities to watch interventional cardiology procedures on patients on my service, including defibrillator insertion and ablations.
My final placement in Emergency Medicine was a fine one. The service triages patients well, and there was ample opportunity to gain practical experience. I always closely collaborated with a French student; we would clerk new admissions together––documenting history and examination––and then discuss the case and management plan with the intern and Chef. You may also have opportunity to observe how prehospital (SAMU) doctors, operate.
Description of the destination:
Nantes is France’s 6th largest city, located in the Pays de la Loire region in the Northwest of France, only a couple of hours from Paris by train, and an hour from the Atlantic coast.
It is a vibrant, student city, sporting a charming centre with multiple cultural attractions. Based at the confluence of rivers––La Loire and the Erdre––Nantes was once one of France’s largest seaside ports, and historically played an important role in the transatlantic slave trade.
Were the local people friendly?
My French colleagues were incredibly charming and affable, and we had lunch together everyday. People you meet out in Nantes are friendly, helpful and polite.
However, my level of spoken French was relatively basic when I arrived, and few people in Nantes voluntarily speak in English. This made easy socialising difficult, which meant my social entourage mainly consisted of Erasmus students. However, exchange networks where you can meet others are available.
Did you feel safe and if not why not?
I never felt genuinely unsafe in Nantes. There were times I might have felt slightly uneasy taking a tram late at night, but this was never really for good reason. Nantes is a safe city.
What did you do in your spare time? Is there anything that you would particularly recommend others to do?
I made a small group of friends––mainly Erasmus students who also spoke both English and French––and began leading a different life. I initially contacted students via an Erasmus Facebook group. There is also the Exchange Students Network (ESN) that hosts many events.
I explored everything! I visited almost every museum (Arts, History, Jules Verne, Printing). Of course, I admired the walking elephant many times (‘Machines d’île’). I went to café-concerts in Nantes’ many bars. I regularly watched independent international films at Cinéma Katorza. We visited one of France’s largest natural lakes only 20 minutes from the city, Lac de Grand Lieu, and a nearby fishing village, Trentemoult. We had coffee by the riverside Erdre. My life post-finals, free of intensive study commitments, became relaxed and more balanced. However, it was not easy to begin with, particularly after leaving Manchester on a post- finals ‘high’.
After a few weeks, Nantes will seem small, and you will definitely want to see more of France. I went on several trips––to Lyon, to Paris, but above all else, many times to the Atlantic coast, or as the French say, ‘La Bord de La Mer’. The strong maritime influence is what makes placements in Nantes unique. We tried to explore more of Pays de La Loire, and took trains to Pornic, St. Nazaire, and Le Croisic. I also visited La Rochelleand île d’Oléron. We ate mussels and galettes. The coast is an absolute must, and seaside day trips represent a treasure trove of discoveries.
What time of the year were you there? What was the climate like?
I was in Nantes from late January until mid-May. In comparison to Manchester, which is in Northern England, Nantes was equally wet to begin with, with frequent rain until March, whilst a few degrees warmer than in Manchester.
From mid-March onwards, the weather became much dryer, and beautiful. We had several weeks of pure sunshine in April and May, which were absolutely incomparable.
What was your accommodation like?
I decided to live in an AirBnB, and took a room in the household of a Nantaise family. I lived with a working couple who had two young children (aged 2 and 4) and a friendly cat in a district called Longchamps, which is a 15-minute bus ride from the centre. I had a large, comfortable room, and was content with this arrangement as all finances were handled virtually.
As my French improved, we began to have longer and more personal conversations about our respective lives, and they could offer me any practical advice I needed, as well as tell me about Nantes and the surrounding region. They were a superb family.
Was it provided?
No, I self-arranged this. However, it is also possible to obtain accommodation via the university. My friend stayed in CROUS university accommodation, which is altogether cheaper and closer to the centre, but lacks amenities such as bedding and cutlery. If you wish to, you need to indicate this preference to the university.
These are small en-suite units that resemble university accommodation in the U.K. Most Erasmus students will take university accommodation. Bear in mind that rules within the accommodation can be strict, with restrictions on noise and cooking times.
If not, who arranged it?
I arranged it myself via AirBnB.
How much did it cost?
I paid approximately £300 per month (all expenses-included, including AirBnB fees).
Did you enjoy your visit?
I would recommend everyone to visit Nantes, and was grateful to have been placed here for Erasmus.
I derived a great deal of satisfaction, value, and insight from my placements––and in this sense, I enjoyed it.
However, this does not preclude the fact that I found these experiences tested and challenged me.
Did you find the visit useful medically? – in what way?
I learnt a lot in Nantes; the experience was intensive.
As a medical student, you will be expected to adopt the role of an externe. Externes are the first to see new admissions to the ward and write up an initial assessment, which is verified and expounded upon by theinternes. These present strong learning opportunities Each externe is typically attached to an interne, secteur, and chef, and therefore forms part of a clinical team for the duration of their placement.
During my placement in renal medicine, for example, I became well-integrated into the team. I found myself reading patient notes in advance, preparing folders for ward rounds, clerking patients independently, making phone calls, and writing job lists. None of this was easy. Through trial-and-error, copying the French students and interns, and reading how history and examination findings were written, everything became easier.
Has it improved your French?
Gradually and unconsciously, my French improved. The benefit of being in hospital is it provides you a deeply immersive, incomparable, language experience. You have readymade, concrete objectives, and that is to be able to interact and discuss cases in a relevant and practical manner with other healthcare professionals, or elicit specific and pertinent information from patients.
It was my first time in France, and initially, I found it very difficult. Conversations demanded effort. I had to learn how to be flexible in self-expression, follow the ‘gist’ of conversations where I did not understand every word, and to not be embarrassed at making frequent errors with vocabulary and pronunciation. I relied on tone and body language to extract meaning much more than I had ever appreciated. I mimicked the French as much as I could, and every moment was an opportunity to practice. Whilst I had a hodgepodge of vocabulary and an academic understanding, I was really able to polish my everyday use of the language. My medical French became particularly good, but not without deliberate effort.
Real mastery of a language is global––achieving proficiency in speech, writing, listening and reading. My development in France was naturally asymmetric, and my proficiency depended on context and to whom I spoke with. Nevertheless, I was so fortunate to be able to test speaking French in many areas of life, gradually introduce new grammatical constructions, and succeed in small ways–and I consider this to have been my real, most tangible, start in the language. I absolutely intend to continue studying French, and attending language groups as a doctor. How I implement this in a professional sense remains to be seen, but I suspect many doors will have been opened as a result.
How has it increased your knowledge of French culture?
Absolutely–I have never been to France before, and Nantes is incredibly authentic. Living with a French family gave me a particularly good insight into modern culture. The city itself, particularly given its history– which I could trace at the local history museum––provides good insight into French history as a whole.
It is difficult to pin-point one particular cultural aspect, but I learnt about the language, cuisine, and customs. In my work, I found doctor-patient relationships relatively more frank in nature, and certainly appreciated the ready availability of cafés, vin, and of long lunches. Whilst I was there, massive strikes were taking place on the national train network, the SNCF, which follows a long line of the French’s nonexistent fear of expressing their discontentment.
How did you get there?
I booked my flight from Manchester about 3 weeks beforehand, and paid just over £100 for a single 5-hour journey via Belgium, booked directly with Brussel Airlines. There are several possibilities with regards to stop-overs, and this was the most economic option from Manchester at the time.
Is there any other information that you think may be useful?
Nantes is easily commutable, and well-connected by a singular network of trams and buses called the TAN,which radiates out from its centre, Commerce. The ‘Itinéraire’ on its web and mobile applications can help you plan journeys. I like cycling, but preferred taking the TAN on account of its efficiency and weather.
Traveling around France is mainly achieved by train, coach, or car-sharing (‘co-voiturage’). Both train and coach tickets on trains can be bought from Trainline.EU, in advance and inexpensively. LILA buses, which are dirt-cheap, and regularly go to the coast from Nantes, are not listed on Trainline searches, but timetables can be found online. By far the least expensive means of long-distance travel is by co-voiturage, mainly via BlaBlaCar, which is used extensively in France. Journeys in and out of Nantes are available to most conceivable destinations. I booked one journey via BlaBlaCar, and loved it.
Below, I have listed links that may be of use.
Information and Specialties available for Erasmus students – www.medecine.univ-nantes.fr/navigation/ relations-internationales-891703.kjsp
TAN – https://www.tan.fr
Bicloo – www.bicloo.nantesmetropole.fr
TrainLine – https://www.trainline.eu
LILA (Buses in Pay de la Loire) – https://lila.paysdelaloire.fr BlaBlaCar (Covoiturage) – https://www.blablacar.fr
Exchange Students Network – nantes.ixesn.fr
Ville de Nantes Site Officiel (releases a weekly ‘Que à faire ce weekend à Nantes?’) – https:// www.nantes.fr/home.html; Facebook page – https://www.facebook.com/pg/nantes.fr/posts/?ref=notif Nantes Tourism website – https://www.nantes-tourisme.com
Tourisme Loire-Atlantique website – https://tourisme-loireatlantique.com/theme/culture/