I arrived in Lisbon for my ENTOG exchange programme on a bright sunny day, weather that remained all week. I went straight from the airport to the Hospital Santa Maria, a tertiary hospital in north Lisbon. The hospital is about 50 years old and has typical Portuguese touches such as cork flooring and marble clad theatres. The morning theatre session was similar to the UK but I noticed scrupulous attention to changing theatre overshoes and donning masks and gowns as an observer.
The afternoon outpatient clinic was more of a culture shock. Two clinicians each with their own desk were conducting their consultations in the same room. The examination couch was behind a curtain and one patient would be examined with a parallel consultation going on. Patients were often referred following a routine scan or from other specialties the patient had chosen to consult (for example, a lady with dysmenorrhoea who had first consulted a hepatologist). Patients were guardians of their X rays, scans and blood results. Most investigations had been done by external doctors or laboratories.
The weekend was spent between emergency consultations and the delivery suite. With very little triage due to patchy primary care coverage and the patients' wish to see a gynaecologist directly, emergency gynaecology had a free for all approach. My Finnish colleague and I wee surprised that it was expected of senior gynaecologists to see ‘emergency' candida and oligomenorrhoea. This contrasted sharply with the usual goings-on of the labour ward upstairs. There were also a considerable number of consultations about minor ailments of pregnancy which needed reassurance. Some of these consultations were at the weekend to fit with the patient's day off work.
Labour pain is the same the world over, however epidural rates are high in this hospital. The resident doctors often do normal deliveries with 100 a training requirement. Ventouse was the instrument of choice for instrumental deliveries and the residents were all keen to learn forceps deliveries. My Finnish colleague thought this was a very antiquated idea! The caesarean section rate was 18%.
It was really interesting to meet other trainees from all over Europe and discuss training requirements and changes. I had the chance to meet colleagues from Malta, Latvia, Hungary, France, Belgium and Estonia. Many systems, including the Portuguese, rely on a numbers approach for completion of training rather than competency based assessment. Annual examinations weigh heavily on the Portuguese trainee and they then face an exit exam. My impression from the residents I met was that it was a highly competitive specialty.
ENTOG had two sessions within the European Congress of Obstetrics and Gynaecology and I had the chance to do a presentation on the UK training scheme with some discussion about our assessment tools. A long morning session was taken up by different countries' experience of implementing the European Working Time Directive (EWTD) including a well balanced talk from Leonard Harvey and a lively debate between seniors and trainees.
EBCOG itself was very stimulating with the new HPV vaccines generating a huge amount of interest. Hearing Xavier Bosch and Margaret Stanley was the high point of the conference for me. Linda Cardozo gave a robust and highly entertaining lecture on cosmetic genital surgery which other trainees I took to the session applauded with great gusto. It took a while to get used to the incessant photography by some delegates of each and every slide appearing before them.
The exchange experience was fascinating and perhaps its greatest value is allowing a view of one's own system from afar. At the beginning of the exchange I was talking about the virtues of our logbook, training tools and greentop guidelines. By the end I was looking forward to returning home to our system so strongly supported by a good primary care system and reliant on midwives. Privacy and confidentiality within our consultations are taken for granted and are precious. Fine-tuning is great, but only works on solid foundations.
I would encourage any trainee to take the opportunity to do an exchange, it is a challenging and exciting experience. In the future the UK may be able to host an exchange and I would appeal to units to host European trainees. As they say in Portugal: Muito obrigada!
Clare Lipetz