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Devan Dipak Limbachia
St Vincent's Hospital, Melbourne, Melbourne, Australia

Clinical interest: Cardiothoracic Surgery

About Melbourne

Melbourne is the capital city of the Australian state of Victoria and is the second-most populous city in Australia with a population well over 4.5 million. Melbourne rates very highly in education, healthcare, research and development, tourism, sport and entertainment making it the most liveable city in the world, according to the Economist. There is plenty to do in this metropolis including great food and drink, sports, culture and nightlife – so there will never be a dull moment.

St Vincent’s Hospital is one of five large tertiary hospitals in Melbourne. It was established by the Sisters of Charity as a hospital for the sick and poor and now operates as an extensive public teaching hospital. The hospital has particular strengths in Cardiac, Neuroscience, Gastrointestinal, Microsurgery and Plastic Surgery and is well-equipped with a high doctor-to-patient ratio. Due to its high standard of facilities and role as a referral centre, St Vincent’s will expose you to the best variety of conditions and patients which will further aid your elective experience. In addition, St Vincent’s Hospital is home to many medical students and so the opportunity for teaching and learning will be maximised.

Planning

Organising the elective itself was a fairly long process (approximately 12 months), therefore I would definitely advise planning as early as possible.

Ø Time difference – there is a 10 hour difference between the UK and Melbourne and therefore sending email at times appropriate for Australian administration was difficult.
Ø Staff availability – elective staff at St Vincent’s Clinical School only work part-time which again made it more difficult to contact them as sometimes there would be a week delay before replies were sent.
Ø Documentation – you will be required to submit an application and a letter of good standing (provided by your medical school) therefore try and contact your medical school early regarding this because they are likely to get such requests from many other students.
Ø Accommodation – the clinical school provide you with the option of staying within an off-site hospital residence. It is cheap and cheerful with adequate facilities to stay for the 4 weeks so definitely cost-effective if you are on a budget.
Ø Flights – book as early as possible, flights to Australia can be relatively expensive so search for the best deals in advance.

Why I wanted to go there

Following a family holiday in Australia the previous year, I decided that I wanted to organise my elective in Australia. I chose Melbourne because I never had the opportunity to visit the city on my last trip and thought this would be the perfect chance. Additionally, as Melbourne was voted the most liveable city, it was definitely somewhere that I considered working should the opportunity arise in the near future and so this was the best way to explore that possibility.

Also, due to the fact that I was organising my elective well in advance, I knew that I would be travelling to Melbourne alone and this would be the first time doing so. Therefore, considering that there was some transferability from British to Australian culture I felt that it was a safe place to visit.

What I hoped to see and achieve

Within the undergraduate medical curriculum, we are sparsely exposed to the surgical specialties, especially that of cardiothoracic surgery. I hoped that this placement would allow me to gain more exposure, especially because cardiothoracic surgery is a career I wish to pursue in the future.

Professional development aims:

§ Understand how a cardiothoracic surgery theatre functions and operates.
§ Learn how to work and interact with the cardiothoracic surgical team.
§ Explore the different surgical operating techniques unique to the specialty.
§ Learn how to assess patients pre-operatively and develop the ability to identify post-operative complications following cardiothoracic surgery.
§ Develop a surgical case-portfolio for future career prospects.

Personal development aims:

§ Understand the roles and responsibilities of a cardiothoracic surgeon.
§ Explore my attitudes and perceptions towards the speciality.
§ Explore whether I possess the attributes for a career in cardiothoracic surgery.
§ Understand my own strengths, limitations and ways to improve.

I also wanted to experience the Australian lifestyle and explore as much culture whilst there.

Time in hospital

During my placement I was able to work with the cardiothoracic surgery team Monday- Friday. The team was split with multiple consultants, 1 registrar and 1 intern based on thoracics with the remaining consultants, registrars, residents and interns based on cardiac. Consultants were based in theatre, clinic and other administrative tasks whilst also holding their own private practices. The office in which the cardiothoracic team were based was shared with the respiratory team and therefore as an added bonus I was able to spend some time with them for the 4 weeks whilst I was there. This was actually very beneficial as I was able to appreciate the physiological and surgical side of thoracic medicine.

A typical day would consist of:

Ø 7:00/7:30am – (+/- morning conference) ward round
Ø 9:30am – ward-based jobs/ clinic
Ø 12:30 – lunch.
Ø Afternoon – theatres/ ward-based jobs.

There were also teaching sessions and MDT meetings that occurred weekly which were very useful to attend.

Days in hospital were very flexible. You were able to take on as much responsibility as you wanted but at the same time the team gave you freedom to explore the city because they appreciated that you had just finished your exams. The cardiothoracic team at St Vincent’s were fantastic and made me feel very welcome. They allowed me to practice my clinical skills (venepuncture, cannulation, examinations, etc.), allowed me to run my own pre-admission clinic (with supervision), allowed me to scrub into theatre and generally get involved as much as possible. I was also able to join a few on-call shifts which were fantastic because we covered acute emergencies for cardiothoracics, respiratory and CCU and I was able to practice my examination and acute management skills – definitely something I would recommend doing. The interns on-call have a huge workload and you can be an invaluable resource and actually make a difference!

Time outside of hospital

There was plenty of time to explore Melbourne after placement and during the weekends.

Things I would definitely recommend whilst in Melbourne:

Ø Food & Drink: Melbourne is foodie central. There are so many great brunch places, restaurants and wine bars!
Ø Watch an Aussie Rules Football Match – this is a definite if you come to Melbourne. Even if you’re not a sports person you get right into this game and it’s a great atmosphere.
Ø St Kilda’s – Located 20 mins away from Melbourne city-centre is this family friendly beach, with stunning views, a penguin peer and a busy nightlife!
Ø Melbourne Museum – free for students with a great exhibition on aboriginal culture and Melbourne in the past!
Ø Southbank & Yarra at night – there is always some sort of outdoor show and a very lively professional vibe.
Ø Shrine of Remembrance – stunning views of Melbourne’s skyline from the top!
Ø Laneways – make sure you visit all the quirky alleyways in Melbourne, filled with coffee shops, bars, restaurants and the famous street-art Hosier Lane.
Ø Great Ocean Road – again another must do with some stunning scenery. I was lucky that this tour was included in a package tour that I booked beforehand but many choose to visit the Great Ocean Road on 1/2/3 day tours via tour companies or hiring a car.

I was also able to explore further parts of Australia. I joined a 10 day tour from Melbourne to Alice Springs where I witnessed some of the most breath-taking scenery in Australia. Some of the highlights of this tour included The 12 Apostles, Loch Ard Gorge, Coober Pedy, Uluru and Kings Canyon. I 100% recommend this tour as it’s a great way to meet new people and see places you would never normally know to visit. I then headed over to Cairns for a nice relaxing end to the trip where I was able to finish off with a dive in the famous Great Barrier Reef!

What I would do differently

If I was to visit again I would contact the research coordinator at the hospital before my visit. St Vincent’s Hospital and especially the cardiothoracic team at the hospital are very research orientated and support many local final year medical students in completing research projects. If you wish to complete a survey or an audit project then you must have prior ethics approval in place (which is different to the UK where you very rarely need ethics approval for an audit project). They would be very supportive of you carrying out such research whilst there and it would definitely be an opportunity not to miss!

Reflection

I loved my elective in Melbourne and would highly recommend a placement in Cardiothoracic Surgery at St Vincent’s Hospital. I achieved the aims of my elective project plus more, and I was able to fully immerse myself in the experience. The elective placement reinforced my ambition for a career in the specialty and taught me plenty, from surgical technique to acute management of cardiothoracic emergencies. It was an opportunity to develop both professionally and personally and has given me a base level of understanding, regarding cardiothoracic surgery, which I can develop throughout my career. Australia is a beautiful country and whilst you have time on your hands, definitely give it a visit – do not miss this opportunity! Highlight video of my elective coming soon…

Devan Dipak Limbachia

Garden of Eden

Baby Kanagroo

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