Intensive Care Unit and Anaesthetic Department, Royal Melbourne Hospital, Melbourne

I spent my six-week medical elective at the Royal Melbourne Hospital in Australia. My
elective was divided into four weeks within the Intensive Care Unit, and two weeks within
the Anaesthetic Department.

ICU Placement
My previous limited experience of ICU was during Covid-19 pandemic where I was deployed as a Health Care Assistant. Therefore, I was greatly looking forward to this placement to further my knowledge of intensive care medicine. I saw many interesting cases. For example, the management of a patient with refractory status epilepticus, where unusual treatments were implemented including Electro-Convulsive therapy, novel surgical
interventions, and other treatments with limited evidence base. I witnessed challenging
discussions regarding management and saw how compromise is often needed for complex cases. An aspect of ICU care that I found thought-provoking during my placement was the
consideration of ethical dilemmas, such as end of life decisions, family discussions, and
ceilings of care. I was invited to sit in on difficult family meetings and watch consultants lead conversations regarding managing expectations and realistic prognoses.

I attended the twice weekly consultant led teaching sessions for doctors in the department.
Topics varied from managing snake bites to airway management. I participated in these
sessions and enjoyed learning practical skills such as placing central lines on models. The ICU doctors were keen to teach, and I learnt to place cannulas under ultrasound. I was
encouraged to examine patients on the ICU ward round and by the end of the placement I
felt more confident and had a greater grasp of examining patients and assessing GCS. I have an ICU job in my FY2 year, and I look forward to putting these skills into practice again.

Anaesthetics Placement
During my anaesthetics placement I was encouraged to perform practical procedures such
as placing cannulas, pre-oxygenation, and intubation. Through this placement I have a
greater understanding of the medications used in anaesthesia, ventilator settings and feel
more confident performing procedures including airway manoeuvres. A highlight was
watching open heart surgery on my last day. The consultant anaesthetist took time to
explain the procedure, cardiac physiology, and the mechanisms of the complex equipment
used. I felt privileged to see such an interesting aspect of anaesthetics I have not previously
been exposed to.

Australia
Outside of placement, I had a fantastic time in Australia. I was able to visit Sydney, the
Whitsunday islands, and the Great Barrier Reef. I also enjoyed sights more local to
Melbourne such as the Yarra Valley, the Great Ocean Road, and watching Australian
Football League games.

During my time in Melbourne, I reconnected with Australian friends from my gap year in
Israel, one of whom is a medical student in Melbourne. I enjoyed comparing experiences
with her and hearing about the differences between being a Jewish medical student in
Australia to the UK. She invited me to Shabbat and Yom Tov lunches where I met other
young people and learnt more about the young Melbourne Jewish community. I spent
Shabbat and Shavuot with family friends who are a Rabbi and Rebbetzin in Melbourne. I
enjoyed attending the local synagogue with them and spending time within the Melbourne
Jewish community. Everyone was incredibly warm and welcoming, and I look forward to
coming back to Melbourne in the future and strengthening these connections.

Thanks
I would like to thank the Jewish Medical Association for their generous scholarship and for
the student JMA events I have enjoyed throughout medical school. I am very grateful for the JMA’s help towards making my elective possible.

Nicola Bowman (UCL)