Comparing apples to naranjas

It's interesting to watch the residents work here in Chile. Justin and I have picked up on some interesting similarities and differences between our own UAB program and pediatric residency the program here in Chile at the Universidad de Católica. Starting from the top...
Well, let me back up with an intro about how the medical education system works here. Students come straight out of secondary education to the University to begin medical school. They complete university and medical studies in 7 years. Their 6th & 7th year are clinical years where they are in the hospitals and clinics and referred to as interns. They see patients with the supervision of residents (1st-3rd year) and/or attendings. They are not at this time committed to any particular field of medicine. This seems to be similar to our 3rd & 4th year medical studies, however in some aspects these non-doctors function more as interns than students.

Justin with chief Daniela

So...back to the top...
Their morning report is very similar to our morning report. One major difference is that they begin at 8:30 and this is generally the first thing they do (i.e. no prerounding yet). The post call intern or resident presents a patient and they discuss differentials, etc. Occasionally there is a powerpoint presentation on a special topic instead of a patient presentation. There are generally some faculty present at the morning report to help guide the interns and residents.

Morning Report

 After morning report the interns and residents head upstairs to pre-round. The interns have been responsible for ~3 patients each and scurry around from 9:00-10:30/11:00 gathering data on patients. The difference is that the residents really take a more supervisory role but they're present and around for help during pre-rounds. The attendings are around as well and will see patients along with the interns/residents as they pre-round.

Handwritten SOAP note

Then any time from 10:30-11:30 (depending what service you are on) the rounds begin. Everyone gets a cup of coffee (instant, not starbucks) or tea and there are usually cookies or muffins to go along with the beverages. After the refreshments...the onslaught of rounds begins. Interns (and occasionally residents have to see their own patients and present) present the patients and their plans. This seems pretty similar to our "sit down" rounds, except for there are more people talking at once! At this point most of the patients have already been discussed with attendings so this also functions as sort of a team check-out with education mixed in.

Rounds are usually done by 12-1pm...now it's time for lunch. At Sótero del Río there are 3 different cafeteria options for lunch but the choices are similar at each. Justin and I tried 2 of the three. The residents get menu tickets for lunch which they print using their fingerprint...pretty cool. One group of interns favored the hot lunch in the pediatric cafeteria where we generally ordered the special of the day which came with soup, bread, an entree, a side and usually a piece of fruit. We ate here several times but we typically ended up at the 2nd cafeteria where we grabbed a to go plate (anything from pasta to chicken with rice) and took it back to the resident lounge to microwave and eat. There were no lunch lectures but generally there was a lecture right after lunch. The interns generally had a more formal lecture on powerpoint while the residents discussed different patients and cases.
After this there is time to wrap up notes, etc. and get ready for check out to the on call intern/resident.

Corn is a part of almost every meal...

Their images are electronic...but they use centricity to view images... we like to complicate things with as many different programs as we can.

What is it?

They wear short coats and flip flops...

Jealous? ...yes

They don't print out and obsess over lists...

They also enjoy a nap in a cozy call room...

They can't remember vital sign ranges either...

They love their patients but make babies cry...

Now on to recent events...
For the past 3 days Justin and I have been in the resident clinic at the University Campus at San Joaquin...another short metro ride away. The campus is very beautiful and it seems the bulk of the undergraduate studies are here. We each followed a resident as they saw mostly well children (with the occasional sick complaint...i.e. my first patient had varicella). Some of the patients are their own patients but many of them are patients who just happen to have appointments that day. The residents say by the time they are 3rd year they are seeing more of their own patients. The notes here are all electronic and it appears to be a pretty good system and seems to be a little bit easier to navigate than our own beloved electronic well child checks on centricity. We do win points for our point and click physical exam...which they have to free text. Within this clinic there is a separate clinic and waiting area for sick patients. These patients are seen by the interns first and then checked out to an attending or a resident who is assigned to that clinic for that 1/2 of the day. A resident assigned to clinic at San Joaquin will either be doing sick visits or well child checks, not both on the same day. We also noted that they were not returning phone calls, calling in refills, or filling out disability paperwork (jealous??? yes). The residents here were very friendly and Justin and I enjoyed our time here. Justin wants to give a shout out to this cafeteria, of which he is a huge fan.

Now more about the food... we received a very helpful email from Patricio, who is from Chile and knows Santiago well. He had several recommendations regarding food around the city so we made it a point to try out his suggestions. On Monday we headed via metro to the El Golf section of town. We felt like we were in a different world when we stepped out of the station into the sunlight. It is a very clean, seemingly posh section of town. Each high rise building seemed to have it's own very unique architectural point of view.

We made our way to Tiramisu...as we were hoping to dine on some pizza with sauce and without olives (see earlier post for our first experience with "pizza" in Santiago). Pato did not lie to us as the pizza and calzone were delicious! As were the gelato and tiramisu (because how could you not eat the dessert the place was named for?) we had for dessert! Thank you Pato!

I gave up trying to get Justin to make a normal face...

Tonight we ventured to another Pato recommendation near the Universidad de Católica, Fuente Alemana . Justin aptly described this place as similar to the Golden Rule BBQ inside. This was definitely the place to be...we had to wait for other diners to finish to get a seat at the bar. We were here for the Lomito, a pork sandwich (topped with anything from guacamole, to tomatoes, to enough mayonnaise to make 5 gallons of potato salad). The pork was sliced very thin and piled high on a toasted bun. Our waitress, Eugenia was very friendly and we were served very quickly. The sandwich was great! Another win for Pato! I might also add that we washed the sandwich down with Kunstmann Lager, which was another Pato recommedation and again a very good one!

We opted out of mayo, tomatoes, & avocado

Eugenia

Ciao for now!
j/K