Medical Elective Report Daniel Atkinson 2014 I did my elective in paediatric intensive care at Boston Children’s Hospital. I chose to do my elective in the USA and in particular Boston, as its one of the most advanced nations in healthcare and research. I was able to arrange this through my former Director of studies and Selwyn alumni Professor Robert Tasker. Boston Children’s Hospital has a 120-bed intensive care unit. This by far the largest PICU I have ever encountered, and it was a great opportunity for me to see a large number and a great variety of patients. This was especially true in at the Boston's children hospital where they get patients from all over the USA and in fact the world. BCH is also a Harvard medical school teaching hospital, which gave me the opportunity to pit my wits against the Harvard students! I attended daily ward rounds, and was an active part of patient discussions. I also assisted residents where possible with practical procedures, and in the day to day running of the ward. I saw many cases of patients on life support, post-op patients and individuals suffering from traumatic brain injury. I also attended residents teaching, and attended conferences happening on the site to broaden my knowledge of paediatrics and anaesthetics in general. Teaching sessions for residents which I attended and occurred daily were helpful in building theoretical foundations for clinical topics that I encountered on the ward. Lectures included topics such as sedation, status epilepticus, head injury, ventilation, airway management, principles of ECMO, shock, TBI. These sessions illustrated many principles in anaesthesia and perioperative medicine, such as airway management, ventilation, perfusion, preoperative evaluation, analgesia, life support, and postoperative care. They often had a clinical vignette attached to them, which made the teaching particularly engaging. A particularly useful experience was attending practical sessions in the ward simulation suite (topics covered included central venous line placement, thoracic ultrasound, defibrillation, ventilation, airway management) as this allowed me to get hands on, and gain confidence by practicing on models. I particularly enjoyed the Friday mornings "mock code� aiming to simulate a medical emergency, and allowing us to rehearse the management of a critically ill child or infant. These felt very realistic with a consultant leading the session changing the vital parameters you were seeing depending on the interventions you implemented. We would then debrief what happened in the code afterwards, and look at what worked and what didn't. The first research project I undertook during the placement was a literature review of outcomes following paediatric severe traumatic brain injury. Traumatic brain injury (TBI) is a significant cause of morbidity and mortality within the United States. With children and adolescents being most likely to sustain a TBI. In the literature review, the quality of studies on outcome from childhood sTBI were assessed and the information from different centres was evaluated. Information on both short-term outcomes (mortality on discharge, PICU length of stay, etc.) and long-term outcomes (Glasgow Outcome Scale scoring) were evaluated and presented. The aim was then to compare the different outcomes between centres across the world, as well as between areas with different structures of paediatric intensive care. A second project that is ongoing is a literature review looking at outcomes that can be used as reliable PICU performance measures, with the aim of improving the accuracy of existing scoring systems which are used. One particularly exciting experience I had was to visit the ether dome at Massachusetts General Hospital. The site of It was the site of the first public demonstration of the use of inhaled ether as a surgical anaesthetic on 16 October 1846!
My elective exceeded all my expectations and I learnt a great deal from it. I'm thankful for the funding I received from the Selwyn Medical Elective Fund for helping make this experience possible.
Image above showing me seated in the ether dome
Daniel Atkinson Selwyn College University of Cambridge