My Fellowship Experience at Massachusetts General Hospital
Ki Chul Park, MD and Mark Vrahas, MD
Massachusetts General Hospital
A life seems to be a unique cloth weaved out of many
threads. Despite encounters with many people and places,
building close and lasting relationships remains the most difficult
thing. It seems to me that a Korean word “In-Yeon” best
describes from casual incidents to inevitable events of relationships
with people. Being accepted as a visiting research fellow
in Orthopaedic Trauma at Massachusetts General Hospital was
a significant “ In-Yeon” of my life.
SMALL YET FAST CHANGING
As you may have read from the news articles, South
Korea is a small country about the size of Indiana. It lies east
of China’s Yellow Sea, west of Japan. Everything seems to be
compact and work is done fast and quick. Your one month old
cell phone will probably be out of fashion in couple of months.
Vast changes in such a short period that it is almost inevitable
for people like me to fall behind some trends, which I do not
mind. As I wanted to take a break from this busy life , coming
here to the secure and stable atmosphere of MGH was perfect
for me.
MEDICAL SCHOOL SYSTEM
The Korean medical system is similar to that of US because
its structure is based on it. But despite many similarities the
steps in school are somewhat different. To become a doctor in
Korea, a high school graduate needs to be accepted to medical
college, which offers a six-year course including two years of
premeds and four years of medical school. Students take basic
science subjects such as physics, biology, chemistry, statistics
and medical ethics in premedical school. The medical school
curriculum includes clinics for three years and polyclinic
rounding for one year. In recent years, the Korean government
has suggested changing medical college to medical graduate
school just like in the US. Some universities have followed the
suggestion with many others are still debating this change.
The main issue is that unlike US, Korea still has a conscription
system that every male is required to perform over two years
of military service, and of course there is no exception for doctors-
to-be. Including these service periods, it takes many years
to become medical doctor. After one year internship course,
medical doctors may for apply to a four-year residency course
in a clinical department.
CONFERENCES CURRICULUM
The orthopaedic conference curriculum in Korean teaching
hospital is similar to that of United States except that it
usually starts at 7:30 am. The daily conference of MGH begins
one hour early compare to Korea. It seems that Americans are
more active in the mornings and Koreans are active at night in
general. Not only the time schedule but also the atmosphere
during the conference is different. In Korea, the attending staff
usually ask questions of the residents after a presentation but
scarcely every the other way around. I was impressed that the
residents were allowed ask for the opinions of the staff. It could
not only induce resident to study harder, but also stimulate the
staff to research more. It is not a common practice in Korea. I
am going to try it out when I go back to my hospital.
There is no individual orthopaedic trauma conference at
each teaching hospital. Orthopaedic traumatologists from eight
university hospitals have organized a special conference, which
meets once a month. We have many interesting cases often
with animated discussions
OUTPATIENT CENTER
The first noticeable difference between MGH and Hanyang
University Hospital(HUH) which caught my eyes was the outpatient
center of MGH. It is crowded in the outpatient center
in HUH and most other teaching hospitals. Over one hundred
and fifty outpatients visit the orthopaedic department everyday.
Outpatients would come for an appointment on their reserved
date. However, patients without a reservation could also visit.
Of course, they would have to wait for hours for their turns.
As a result, doctors have to consult many patients in short
time. Exhausted doctors cannot guarantee the best condition
and service for the patients. When I visited the Yawkey outpatient
building I was surprised to see that only patients with an
appointment could come for examination and that the number
of patients is limited for each day. I wish it could be the same
way in Korea.
To my point of view, the quality of Korean health examination
service is almost as the same level with that of United
States. But the cost for the medical service is only 10% to 20%
of that of United States. Some Koreans living in United States
goes to Korea to have a medical examination for his health
check up. It is cheaper even with airplane fare included.
OPERATIONS
The elective operation schedule is usually done from 8
am to 5 pm just like MGH. But there is less than 30 minutes
interval between operations for cleaning and preparing. At first
I was very surprised that there was about one and half hour
interval at MGH. I think it is due to culture difference. Most
casual restaurants in a busy city like Seoul would serve dishes
within 15 minutes otherwise they would soon probably go out
of business. In my point of view, Korea seems to be enthusiastic
but still impetuous in some ways. Compared to that, US is
stable, calm and yet easy going. Korea is too fast, and United
States is too slow. I think something in between would be more
suitable.
The trauma team of MGH is very active. There are many
emergency operations. They manage trauma patients aggressively.
In Korea, we only do an emergency operation in case
of true emergency. For example, a patient with a closed femur
fracture usually comes to surgery about 5 to 7 days after injury
due to the small number of medical personnel.
The atmosphere of the operating room at MGH is far different
from that of Korean hospitals. In Korea it is quieter, a
little grave and tense during the operation. Most surgeons do
not permit talking about other than operation. The atmosphere
of operation room in MGH is free, active and academic as well.
It was impressive to see how the staff teach the the theory of
surgery together with his own experiences for the benefit of
residents during each operation.
ORTHOPAEDIC TRAUMATOLOGY AND AMBULANCE SYSTEM
I like orthopaedic traumatology since it is dynamic. The
field is in its infancy in Korea, and university hospitals do not
have enough traumatologists to have their own daily conferences.
Orthopaedic traumatology is one of the important
subdivisions of orthopaedics. Until recently in Korea there were
few orthopaedic traumatologists. Managing trauma was left to
the junior surgeons.. That still happens at some hospitals. But
in the case of severe trauma, such as high-energy open fracture,
initial management is very important. If it is done in the
wrong way, the patient may be incapacitated for a for long time
or even lose his job. So there has been an increased interest in
orthopaedic traumatology.
Ambulance service is another important part in managing
trauma patients. In Korea there are two ambulance systems.
One is operated by fire department (119) and private companies
operate the other. Unfortunately Korean ambulances do
not carry sophisticated medical equipment and the ambulance
personnel do not have the same level of emergency medical
training as in the United States. However, ambulances operated
by the fire department respond very quickly and take patients
to the nearest hospital according to the injury severity. If the
status of injury is grave, he will be transported to a level one
trauma center. But sometimes ambulances operated by private
institute transport the patient to a hospital they have connection
with. No matter the severity of the injury they would go
to that “hospital” even if it is not the closest emergency center
around. To preventthis type of corrupt practice, the Department
of Health has recently reinforced qualifications on issuing certificates
to private ambulances.
During an emergency regardless of how badly they are
injured, an increasing number of patients express a strong
preference for the larger hospitals, mostly Level One trauma
centers of university hospitals. As a result these hospitals are
always crowed which leads to poor quality service.
OPPORTUNITY FOR FELLOWSHIP ABROAD
If you are a university hospital professor, you are most
likely to get a chance to visit an advanced hospital system in
other countries. It is the equivalent of a sabbatical leave for the
surgical staff. Most of the professors plan to pursue projects
which would be impossible under their normal schedules, such
as learning new methods orlanguages. This is a valuable opportunity
for professors to improve their knowledge and skills. I
believe that it is what makes professors some privilege towards
individual practice surgeons. In Korea, professors are prohibited
from opening private practices unless they resign.
I have seen many impressive pelvic and acetabular surgery
operation cases performed by the MGH trauma team. These
operations are rare in Korea. As a surgeon, whenever I learn
something new from here, I would like to perform to my
patients in Korea.
As it is rare for professors in teaching hospitals to have a
second chance to apply for a visiting fellowship, I am trying to
make my stay worthwhile for me and my home institution. I
am hoping that with this special “In Yeon” with MGH and Dr.
Vrahas, we will make a fruitful and lasting relationship for the
future.
Ki Chul Park M.D. is a visting research fellow from South Korea.
Dr. Mark Vrahas is Chief of the Partners Orthopedic Service and Assistant Professor of Orthopedic Surgery at Harvard Medical School.
Address correspondence to :
KiChul Park, MD
Research fellow, Orthopaedic Trauma Service
Massachusetts General Hospital
55 Fruit Street
Boston, MA 02114
|
"
authorName = ""
authorTitle = ""
bgTile = ""
volume = "volume8"
%>