I have taken part in a professional exchange organised by the European Federation of Psychiatric Trainees. The programme offers a two week exchange period, customised to the needs of individual trainee. As a visiting trainee, I had an opportunity to follow the work of fellow psychiatrists in training as well as more senior colleagues and members of the multidisciplinary team. The experience allowed me to learn as much as possible about the Swedish psychiatric health care system as well as immerse myself in a different culture.
The child and adolescent psychiatric university clinic of Gothenburg enrol 4000 new patients each year, mainly from the Gothenburg area and is the only care provider in child and adolescent psychiatry in the city. It has an emergency inpatient unit with 8 hospital beds, a short term inpatient unit with 7 beds for assessment and treatment, five general outpatient units, a specialised outpatient unit for psychosis and OCD, a specialised in- and outpatient unit for eating disorders, a specialised neuropsychiatric unit and a dialectical behaviour therapy (DBT) team.
During my time in Gothenburg, I have been able to visit a number of those units. I have spent my first week with the team on the emergency inpatient ward. The team made every effort to involve me with the activities such as ward rounds and multidisciplinary discussions and planning meetings. They have accommodated my lack of Swedish brilliantly either by simultaneous translation or conducting their meetings in English. It was very inspiring and intellectually stimulating to be able to discuss real clinical cases in a very different clinical environment. I had an opportunity to discuss in detail with the psychologist and social worker as to what their role on the unit is and compare that with the work of MDT in the UK. All members of staff were very friendly and welcoming and made me feel part of their busy team for the short time I was there.
During my second week in Sweden I have visited inpatient assessment Unit where in depth psychological and psychiatric evaluations can be conducted. The Unit also offers support to children with school phobia and allows them to ease themselves gently back into education through a co-located, small teaching unit. I was again welcomed to join in with the ward rounds. I also had an opportunity to speak at length with a young person and his mum, who were both interested to hear about the care offered in the UK and give their valuable insights on the differences between the two systems. During my second week I have also spend a day with Swedish equivalent of Tier 3 CAMHS to explore how care is delivered in the community. My final day was spend in a secure state institution providing accommodation and care to young people at risk of absconding or presenting with challenging behaviours. The staff there were again very welcoming and took time out of their busy schedule to talk to me about the structure and purpose of their service. I had an opportunity to observe ADHD clinic and speaking to young people residing in the Unit.
I have keen interest in medical education and I was very interested to compare UK curriculum with the model adopted in Sweden. I was jealous to hear that psychiatric trainees in Sweden don’t have to face the expense and stress of mandatory college exams and do not maintain a portfolio. The assessment and supervision is more flexible and informal with emphasis on principles of adult learning. There is less enthusiasm for structured, portfolio based activities such as Work Based Assessment. Nevertheless, a lot of learning occurs in the departments with regular departmental teaching sessions and impromptu bedside teaching. I had a privilege of being invited to take part in those teaching sessions by delivering presentations on the UK Mental Health act and a whistle stop tour of our training system. The audience was very welcoming and engaged, keen to ask questions and join in the discussion.
What did I learn
Through the participation in the program I was able to gain first-hand experience of different models of healthcare delivery and I intend to implement some of the positive ideas into the services in the UK. Similarly I hope that the host organisation may benefit from hearing how care is provided in the UK.
It was reassuring to know that our practice in the UK does not differ massively from the interventions delivered by colleagues in Sweden and that we have a common approach to diagnosis and treatment. At the same time the differences in practice were most thought provoking. I was interested to learn about use of mechanical restraints in Sweden and compare them to our practice of patients being held by staff or placed in seclusion. I was initially sceptical if mechanical restraints should have place in practice of child and adolescent psychiatry however I can see that they can be utilised to facilitate medical procedures such as NG feeding in a safe manner, possibly allowing patient more dignity then is afforded to them by being held by multiple staff members. There is also the important advantage of reducing the risk of serious injuries to staff members as well as patients with this restraint method.
During my trip to Sweden it was the first time I had an opportunity to deliver a presentation to an international audience. This highlighted new challenges such as language barrier and lack of familiarity with jargon, systems and practices that we take for granted within the NHS (National Health Service in UK). I have learnt from the experience and I have now a better idea how to improve my presentations in the future. I have gained a lot of confidence in my presentation skills by speaking in front of a large audience of clinicians that I have not met before.
Final words of wisdom
I would encourage any psychiatric trainee thinking about applying to take part in the exchange in Sweden to take the plunge and go for it. Don’t be apprehensive about the language issue if you don’t know Swedish as English is widely spoken. Everyone I met both in the hospitals and in the community was friendly and keen to assist when needed. Gothenburg is a very interesting and vibrant city with plenty to do on your days off. I could not have wished for a better host then Amelie and she went out of her way on every step to make sure that I had enjoyed my experience. I very much appreciated being included by Amelie and her friends in wide range of activities. Between the cinema trips, yoga classes and music concerts I hardly had time to catch my breath, never mind be bored or home sick. It was a fantastic experience both on the professional and personal level and I have left Gothenburg with plenty of new ideas and happy memories.