PJ in Australia – Orthopedics

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PJ in Australia. I will profit from these impressions for a long time! Already at the beginning of my medical studies it was clear to me that I would also like to get insights into the education and health care systems of other countries. After having the chance to study for two semesters in a less developed country in South America, I was eager to use the Practical Year (PJ) to look into an Anglo-American system and also improve my medical English.

Application and Visa

As part of my PhD in sports medicine/pediatric orthopedics, I had come across several interesting studies from the Royal Children's Hospital (RCH) in Melbourne. Since I was very interested in their research in this field and I had also heard a lot of good things about Melbourne, I started approx. 12 months before my PJ with the applications – among others with the help of Mr. Peter Karle (medizinernachwuchs.de).

First, I applied to the University of Melbourne, which accepts and coordinates exchange students. Unfortunately I got a rejection from there relatively soon with the reference to missing vacancies. I then applied directly to the Department of Orthopaedics at the Royal Children's Hospital with reference to my doctoral thesis and my interest in their research interests. I got a positive answer from the secretary of the director of the department and the organizational formalities were done by her.

In advance I had to send the following documents by email:

1. Completed official application form
2. A copy of your Curriculum Vitae
3. A letter of reference from your medical school
4. A document of evidence of cover for Public Liability, Professional Indemnity/Medical and Health Malpractice and Personal Accident Insurance. (Here I have taken a simple professional liability insurance.)
5. Police Check – must be dated no longer than 3 months from your commencement date (Polizeiliches Fuhrungszeugnis)
6. Working With Children Check – equivalent to Enhanced Certificate of Conduct – Federal Office for Justice (You can get an Enhanced Certificate of Conduct or in Australia at the post office, but it costs 100 AUD.)
7. Hand Hygiene Certificate – on line learning package under "Essential Paperwork" section of student orientation: https://www.rch.org.au/studentorientation/placement.cfm?doc_id=15433 (A little look here is worthwhile and the German clinics should take an example there.)

In the last year the visa regulations in Australia have changed. In the meantime one has to apply for an electronic visa. Since you will be working in a hospital, neither tourist nor work visas are sufficient, you have to go to a "panel doctor" for a detailed and expensive examination. This takes for a simple physical examination, an X-ray thorax (TBC) and a HIV/Hepatis serology "sporty" 250€. A reference to my own medical-student existence, a tight budget or examinations already carried out before did not lead to any success with me and I was forced to pay the money.

I received the confirmation of the host university about half a year before the beginning of my stay abroad. The visa has approx. Took 8 weeks for approval.

The financial side of the stay abroad

The journey was relaxed with a stopover in Dubai (Emirates, ca. 1.100€). Melbourne has a good and uncomplicated public transport network. At the airport, I was asked only briefly what I intended to do and was then received in a friendly manner. At the exit there was even a person who greeted every arrival with "Glad you're here". I looked at this for a while and the person actually seemed to have no other job to do.

The tuition fees for this stay were 800 AUD. This sounds a lot, but when you see how much the Australian students have to pay for their education, this is about 30 AUD.000 AUD per year, we in Germany can consider ourselves quite lucky.

From Germany, since I was still enrolled at my university and the practical year was a compulsory internship, I received support in the form of Bafog. In addition, I had always worked in the hospital at night during my studies and had taken out a student loan (KfW) for the time of the PJ.

Living in Melbourne

To save costs, I "couchsurfed" the two months in Melbourne. Without an own real room it is of course not so comfortable, but so I could save some money. The average rents are between 700-1.200 AUD (500-800 €) per month in Melbourne. Unfortunately, there was no free food for PJs in the hospital and in the "food court" of the children's hospital, where there was even a McDonald's – sad, you could rarely find something satisfying under 12 AUD. A cafe, but they are also pretty good, beats again with ca. 4-5 AUD to be paid. However, I was invited more often by the doctors in my ward, which I found very nice and quite appropriate given their earnings.

Other living expenses were significantly higher than in Germany. There are now some Aldi markets in Melbourne and also in Sydney that offer relatively cheap staple foods. There is also a vegan restaurant ("Lentils") where you can eat as much as you want and then pay as much as it is worth to you. Most of the time the food was pretty good, so I was happy to pay around 10 AUD. Alcohol and "partying" are about a factor of 2-3 more expensive than in Germany.

The Royal Children's Hospital in Melbourne

There are two MedSchools in Melbourne – Monash University and the University of Melbourne. My PJ stay was organized through the latter. In the hospital there were also ca. 40 medical students who had just completed their pediatrics classes. But there was no one on my ward. Despite this, I met the other students regularly at class, every Wednesday there was approx. Four lectures and seminars on various topics, met and was able to learn a lot about the similarities and differences in training.

On my first day I was greeted by the organizer of the exchange department and all the bureaucratic stuff was done. Then I got a hospital tour and was introduced to my supervisor. This then introduced me to the team and immediately took me into a longer operation.

The Royal Children's Hospital at the University of Melbourne was completed in 2012, making it by far the most modern hospital I have worked in to date. Since in Australia people like to donate especially to children's hospitals, the equipment of the hospital is quite impressive. In the large and friendly entrance hall, the children are first welcomed by a large aquarium built over three floors, in which, in addition to small and large colorful fish, two sharks are swimming around. These are also fed once a day by a diver and the kids always line up to be amazed then. Furthermore, there are playgrounds everywhere and a large meerkat enclosure in a central courtyard, which amuses the children during their waiting times. There are only single rooms in the entire hospital, which also include a place for parents to sleep. Every room is equipped with a flat screen and the different wards are named after Australian animals – so z.B. Surgery = Platypus, Internal = Kockatoo etc. Everything is really very friendly and especially built in a child-friendly way.

My PJ section in orthopedics

The clinics in Australia are structured differently than in Germany. There is a senior triad: the "head of department", the "associate professor" for teaching, the professor for research, and several "consultants". "Consultants" are not really chief physicians, but self-sufficient doctors who have specialized even further after their residency training. Furthermore, there are so-called "fellows" who are in their post-specialization and the "registrars" who are in their residency training.

Then there were the "residents", kind of younger specialists, and me. My position as a PJ does not exist like this in Australia and came closest to that of an intern. That's how I introduced myself most of the time. Since I was the only one in this position, I had great freedom to cover my areas of focus and interest, so I actually felt very comfortable in the position between medical school and residency training.

The normal day started at 6:45 a.m. on the ward, where the "residents on call" reported from the night duty and were followed by a ward round. At 8:00 a.m. there was always a meeting with the "Allied Health" staff (physio, nurses, occupational therapy, orthosis …) to discuss the plans for the day. After that I had a short coffee break, if you are in Australia, you have to try the "flat white", and at 8:30 a.m. the normal work started.

For me there was the possibility to go to the operating room, to do emergency room, to do ward work or to be present at the "outpatient clinics", corresponding to outpatients. There was also a "Fracture Clinic" where I was also allowed to look after my own patients. Since the different "consultants" specialized in very different things, I had decided to rotate with a different one each week. The various specialties in the orthopedics department were scoliosis and spine surgery, hip dysplasia, infantile cerebral palsy, leg length correction, pediatric sports traumatology, and congenital orthopedic pathologies. The "consultants" working in Melbourne come from all over the world and have had their training in the largest children's hospitals in the world such as z.B. in Boston, Toronto, London, Paris, Sao Paulo, etc. completed. It was really very impressive to get a small taste of this expertise.

The days were very long overall, often lasting until 6:00 pm. But I was always given time in between to look things up and sit in the well-stocked library of the hospital. I was also allowed to give a presentation to the department about my PhD thesis and since there were some parallels to the research areas of the professor there, I was lucky enough to get involved in two research projects. Of course this meant some more work on the already full days, but I am quite confident that we will publish 1-2 papers out of the relatively short time.

Every Wednesday there was a conference where first the operations of the next week were planned and then the operations of the previous week were discussed. Afterwards, there was a kind of specialist examination simulation for the "registrars", where difficult cases were examined and discussed in front of a large auditorium. At noon, there was a "Grand Round" which was a lecture on a wide variety of topics for the entire staff. Afterwards there were good and very structured classes for the regular medical students of the University of Melbourne, which I was also allowed to attend. I had the weekends free and I was able to do night duties on a voluntary basis.

For me it was the first longer stay in an Anglo-American hospital, but the language was no problem for me. To prepare myself for the typical hospital vocabulary, I had watched a few episodes of "Emergency Room" and "Scrubs" in English beforehand. I never had to look into my "Medical English Dictionary" that I brought with me.


Melbourne is the second largest city in Australia and the commutes can be long. The public transport system is well developed and you can get everywhere by streetcar and metro without any problems. I was lucky enough to live not too far from the Royal Children's Hospital, so I was able to get to the hospital every morning by bike, helmet compulsory in Australia, which I think is very commendable, or by jogging. There is a large bicycle cellar and a locker room with several showers and towels, so that one could also go for a long run during the lunch break. The sports self-image is very high and most of the doctors come to work with their racing bikes.

Right at the beginning of my stay I joined the track and field team of the University of Melbourne, so I could quickly find a connection and besides good training I could also participate in some competitions.

With a car you could quickly get to the ocean, where there are some very good surf spots. We were mostly in and around "Torquay", the founding place of "RipCurl" and "QuickSilver", for surfing. But also in Melbourne ("St Kilda") there are good possibilities for kitesurfing. From Melbourne you can also reach the "Great Ocean Road" and the "Grampians" for hiking. For one weekend I also flew to Sydney, because domestic flights are quite cheap and are less than 100€.

My conclusion

Overall, I am highly satisfied with my stay in Australia. Even if it is a bit of extra work at the beginning to organize an internship abroad, and it is also more expensive than doing a PJ in Germany, it is absolutely worth it.

In Australia I was able to get to know a different, very well functioning health care system. I have been offered the chance to see a highly specialized hospital with research at the highest level. I am especially excited about the interconnectedness of practice and clinical practice-oriented research as well as very happy to have been involved in two research projects. In the end, I was even offered to be able to do a "PhD" in the Department of Pediatrics after I finish my studies the next year. Since I liked it very much, I might even take up the offer.

In addition, I was able to learn a lot from the practicing doctors. I was able to get a glimpse of some surgical techniques that are only performed in a few places in the world. In addition to these highly specialized activities, there was also the opportunity to do normal ward work or to be involved in the emergency room in the acute treatment of patients. All in all this was a good and instructive mixture and I think I will profit from these impressions for a long time.