Department of Trauma Orthopedics
Zhang Degang
In March of 2016, I was selected by BMUH to go to the Foothills Medical Centre of Canada to study as a visiting scholar. Three months of study and life is hard, but the reward is quite good, and now some of the study is reported as follows:
1. Canadian medical care system
(1) Free medical care system: the country provides health care services, similar to the United Kingdom, each Canadian has a medical card. With this card, all the costs of hospitalization, family doctor’s diagnosis and treatment, laboratory tests, and imaging are free of charge. The doctors will charge the government on your card. But the family doctor’s prescription drugs have to be paid.
(2) Queuing system: If a person got a disease, he first needs to make an appointment to see the family doctor, according to the condition of the family doctor to determine whether he needs to go to a specialist doctor. FMC is not registered. The outpatient department of orthopedics is family doctor referral or the hospital referral of patients. The hospital will treat according to the patient’s condition. Emergency is only first aid.
(3) Function of the hospital: rescue and surgery for hospitalized patients are the main functions of the hospital. Proportion of day surgery is very high. There are a lot of upper limbs closed fractures, admitted in operation day, discharged one or two days after operation. Most of the fracture patients are discharged three or four days after operation.
2. Foothills Medical Centre
Foothills Medical Centre in is the largest hospital in Calgary. It is one of Canada’s most recognized medical facilities as well as one of the leading hospitals in Canada, providing advanced healthcare services to over two million people from Calgary and the surrounding areas. The medical center is affiliated with the Alberta health service center, which includes part of the University of Calgary Medicine Centre. The main building of the hospital was opened in June 1966. It was originally named Foothills Provincial General Hospital and later known simply as Foothills Hospital. With the addition of other medical facilities, it became known by its present name. Foothills Medical Centre is an accredited Level 1 trauma centre by the Trauma Association of Canada and is the largest regional trauma centre in Southern Alberta. FMC works in conjunction with the nearby University of Calgary for the purposes of educating students as well as providing facilities for medical research. FMC boasts the world’s first and most powerful movable MRI machine, which was introduced in January 2009. It has helped patients at the FMC receive the world’s safest, most accurate surgery possible. In addition, the world’s first robotic surgery was also performed on a patient at the FMC for a removal of a brain tumour, which also created a landmark in Canadian medical history.
3. The Canadian practice of Medicine
Medical education in Canada takes a 4 + 4 mode, 4 years undergraduate + 4 years medical school. After graduation one obtains an MD degree, and different undergraduate professional graduates can be admitted to Medical University, with the most excellent undergraduate students going to Medical University. Medical students need residency training after graduating. Residency is 5 years in the department of orthopedic, FMC, with a fellow stage of 1 year, equating to a total of 6 years of residency training. He will become a doctor with independent work ability after residency training. Residency training is only a study program, and the resident is not a formal employee of the hospital. Upon completion of residency training, you can become an attending physician. The doctor’s growth period is very long; the time of universities and medical schools is at least 8 years, plus 4 to 7 years of residency training according to the profession. To become a doctor with independent work, one generally needs 12 to 15 years.
4. Strict training system and case discussion system
In Canada, the residents work very hard in the ward from 6 am. The residents need to complete ward rounds and the orders, then follow the teacher to attend ward rounds, surgery, and outpatient clinic. The position of a resident and fellow are very clear, they are the trainees. Therefore, hospitals must ensure that they have sufficient training and professors to impart knowledge without reservation. My personal experience is, the hospital provides various training opportunities to help resident growth. As residents work there can also be a real sense of learning occurring at the same time. So after five or six years of residency training, their medical basic knowledge is very strong. In Canada, every doctor has been trained in strict standardization. Thus the patient’s access to medical services will not change due to different geographical locations as there are not too many differences. A variety of diseases have the corresponding treatment guides, most of the operations are carried out according to the standard operation process. At the same time they carry out the latest diagnosis and treatment technology, to ensure patients can enjoy the best treatment.
I have to participate in orthopedic case discussion at half past six. Case discussion consists of two parts, the first part, reviewing yesterday surgery, the main details of surgery image data transferred to imaging system, even in the absence of operation. Doctors also can grasp the main process of operation, including fracture reduction difficulties, and internal fixation in detail. The second part, discussion of today’s surgery, first by the responsible doctor simply introducing the condition, each doctor expressed his own views on the discussion, and finally the professors discuss to determine the surgical plan. There are the doctor’s special lectures every Fridays, 8am to 9am. At a seminar, coffee and small desserts are usually prepared. Speakers generally prepare 2-3 cases, combined with the latest literature on a disease to form an in-depth analysis, then doctors discuss. The development of various forms of academic activities, can make the young doctor progress faster, and enriches their study.
5. Outpatient and surgery
My supervisor Richard Buckley is currently Head of Orthopedic Trauma at the Foothills Hospital. He goes to outpatient every Wednesday and sees more than 30 patients. There are 5-6 consulting rooms, nurses responsible for the reception of patients, hospitalization and surgery. The patient waits in the consulting room, the resident first asks the history, which is training the hospital medical interrogation, hospital medical history after the acquisition, reporting to the doctor, and the doctor goes into the consulting room. There are many referral patients at FMC. The doctor decides on the treatment, introduces the patient’s condition, guides the patients to exercise. Canadians are very enthusiastic; doctors and patients address each other, shake hands, like the friend of many years of acquaintance. Patients are very respectful to the doctor, and the relationship of doctor and patient is harmonious.
The layout of operation room is very reasonable, they have adequate staffing. Orthopedic building was built in 2006 equipped with advanced facilities. The overall shape of the operation room is approximately square, operating room peripheral and great instrument and dressing room in the middle. It is very convenient for the nurse to take equipment and dressing. There are more than 10 orthopedic operation rooms, every one is staffed with 1 instrument nurse, 2 visiting nurse, and 1-2 radiologists. Doctors and nurses try to communicate with patients before operation. Patients have a full understanding of their illness and surgery. Once the patient is in the operating room, the nurse first communicates with the patient, trying to make the patient to relax, and then the anesthesiologist and surgeon communicate with patient again.
6. Highly developed of information technology
(1) Powerful software system: we did not see X-ray or CT film in Foothills Medical Center; of course, there are no film viewing lamps in the hospital. They have developed electronic medical record system and imaging system to see the hospital medical records, test results and image results. Nearly 10 years of all cases are available to view; more powerful is the provincial information sharing access to the system. As long as a patient’s ID is inserted, all the information is available at a glance. And the hospital’s computers are everywhere, connected to the Internet, to facilitate access to information.
(2) Pager application: all hospital staff including interns has a pager, to which staff can send a message on any hospital computer, making work flow smoothly, and the efficiency is improved greatly.
In short, the Canadian medical nature is reflected in the following aspects. 1) The training of doctors are standardized and institutionalized so that patients can get the homogenization of services. 2) The personnel allocation is sufficient, the team division of labor is reasonable, and the responsibility is clear. 3) Advanced hardware facilities, software systems. 4) New technology, new theory in a timely manner to update the application. Of course, Canada’s health care system is not perfect. Medical resources waste, low efficiency and patients admitted to hospital waiting for a long time are problems criticized by the people. Meanwhile China and Canada’s national conditions are different, so many of the Canadian system may not be suitable for China. In recent years, the level of medical care in our country has been improved, we feel that the gap between us and the developed countries is getting smaller and smaller, but some concepts need to be updated, and some new technologies and theories need to be put into practice. The experience in Canada will be a valuable memory in my life, and I am grateful to the hospital and department leaders to give me this opportunity for further study. I hope to, with what I learned in Canada, contribute to the development of my hospital back in China.
