Elective in Cambridge, England
Kiran Atmuri* |

*BCom/BSc (Monash), 4th Year Medical Student, The Australian National University

Ihad the privilege of completing my medical elective with the University of Cambridge, England, United Kingdom (UK).

When I commenced medical school I had not planned on completing my elective in a western setting, especially where I would be forgoing the Australian summer for a region of the globe where it would be the peak of winter.  After much thought and advice sought from senior students, I had decided to apply for an elective in Emergency Medicine at the University of Cambridge.  I selected Cambridge as it is known to have a well-structured elective program, and probably more importantly, for its rich history and tradition.  I had never travelled to Europe and it would offer a unique cultural experience. Furthermore, an elective in a western health system would mean that the skills and knowledge learnt would be more readily transferrable to work back in Australia.  Emergency Medicine was my area of choice because of its dynamic nature, general clinical medicine, and importance in medicine regardless of specialty.

I commenced my journey with a pre-elective trip through Dubai, Paris, Marrakech and Barcelona. Paying homage to Paul Broca’s brain in Musée de l'Homme in Paris was interesting as a medical student, but the intensity of its red city and a visit to the mystical Kasbah Ruins sealed the deal for Marrakech as one of the highlights of the trip.  After welcoming the New Year with twelve grapes in Barcelona, I began on the final leg to Cambridge where I would be set for six weeks.

Cambridge is a ‘university town’ (population 130,000) in the countryside county of Cambridgeshire, approximately a one hour train trip north-east from London.  Its ‘skyline’ is supposedly famous for the chimneys of Addenbrooke’s Hospital, the tertiary teaching hospital of the University of Cambridge and where I would be placed for my elective.

Figure: Punting along the River Cam, with King's College in the background. Photo by author

I was fortunate to be part of a larger group of visiting elective students.  Australians dominated this group with the others being from Jordan and the Czech Republic. 

My supervisors in Accident & Emergency (A&E) were Dr Richard Kendall and Dr Vazeer Ahmed, who were very approachable and knowledgeable.  You’ll soon realise that most of the staff are fond of Australians and have been to Australia at some point.  Dr Kendall had himself trained in Adelaide.  Although, with Australia just having lost the Ashes series, my trip wasn’t appropriately timed!

The A&E department is structured into different streams: minors, acute adult care, paediatric and resuscitation.  There are also secondary areas attached for more complex cases, but these seemed to be the byproduct of UK’s dubious ‘four hour rule’.  Teamwork was central to A&E and everyone had a specified role, e.g. nurses solely for procedures.  It was great to see consultants working side-by-side with junior staff, and to witness resuscitation teams working like clockwork to stabilise patients.  Nurse practitioners were highly skilled in the minors area, and makes one wonder why Australia hasn’t embraced the concept more widely. 

There were two elective students in A&E, complemented with two local Cambridge medical students.  As students, we were able to do whatever we felt comfortable with.  The majority of my time was spent taking initial patient histories and devising management plans.  All cases were presented to senior staff, usually consultants.  This was a good test of skills! There was also plenty of opportunity to practice clinical skills, particularly, radiograph interpretation.  You were able to follow patients into surgery if desired.  One day was also spent with the local ambulance service.  The clinical medicine was very similar to that in Australia which is not unexpected.  This provided ample opportunity to consolidate theory and to develop new clinical knowledge.

Tutorials play a key role in Cambridge, which revolves around its pedagogical system of teaching by supervision in small groups.  We were permitted to attend clinical skills and teaching sessions provided to the local students.  Within A&E there were further tutorials.  In my last week, I was offered the opportunity to present a case I had been involved with, on the role of hyperbaric treatment in carbon monoxide poisoning, which appeared to be a significant problem in the UK.  The presentation was well received, and I hope to publish the work this year.

As with any medical elective, it was not all work.  Whether it be wandering through the eerie chapels of the majestic sandstone colleges, or ‘punting’ along the River Cam, there is plenty of sightseeing to be done in the historical town that is Cambridge.  This is what defines 800 year old university.  A taste of college life can be sought by attending a ‘formal dinner’ or an inter-college sporting spectacle.  We had the lucky opportunity to hear the world-renowned Choir of King’s College. Bicycles dominate the transport system, and it is worthwhile hiring one to explore the surrounds.  We peddled to The Orchard in Grantchester which was frequented by the late Virginia Woolf, and Ely Cathedral where the King’s Speech was filmed.  With a little research, you will be able to visit the sites where the great alumni of Cambridge had worked.  We visited the Old Cavendish Laboratory and The Eagle pub where Watson & Crick had announced their discovery of the double helix.  Also, be sure to take part in a walking tour of Cambridge, where you will hear of the many myths, legends and traditions, such as those stories of the Bridge of Sighs or the construction of the Mathematical Bridge by Isaac Newton.  Lastly, a stroll around the cobble-stoned laneways of Cambridge will allow you to discover historic publishing houses and pubs, and a chance to procure some Cambridge attire or maybe even a tweed jacket if you are brave.

Of course, Cambridge is a stone’s throw from London and other European cities.  I met with fellow ANU students and old friends in London, appropriately timed with the Chinese New Year (of the Rat) celebrations.  An evening production of the Lion King at Lyceum Theatre in the West End could not be missed.  If time permits, I’d recommend a visit to the Bath/Windsor Castle/Stonehenge trio, and a trip to Cornwall on the south-west coastline of England which provides sensational views. 

A well-structured program with adequate supervision, impressive teamwork and regular teaching made the Cambridge elective a fantastic one and I highly recommend it.  There is plenty to explore in Cambridge and its surrounds.  Importantly, the cultural and historical awareness and inspiration gained is something that I will carry forward.  In fact, my short stay in Paris inspired me to begin learning French, in the hope that it would be useful in the future when working with aid organisations.

I would like to thank the ANU School of Clinical Medicine staff and my referees for their support with the applications.  Importantly, I would like to acknowledge the generous financial support received from ANU through the Vice-Chancellor’s Travel Grant and the ANU-IARU Travel Grant.