My Elective in Wales

By Jessica Wilding

Country of Elective: Wales

City/Hospital of Elective: University Hospital Wales UHW

Speciality: Emergency Medicine

Dates: May-July 2022

Throughout my time before university, I always enjoyed working in the acute setting. Whether that is ED or ITU I have always enjoyed sick patients. It is a challenge, always changes, and requires a lot of skills and knowledge.

My elective was my last placement of my penultimate year at Newcastle University, and I knew I

wanted to spend my SSC and/or elective in emergency medicine (EM) and anaesthetics. I enjoy both specialties and since I am an ITU nurse by background, gaining more experience in EM was a priority for me and whether it could be a full-time career even with all the stresses and downsides that go along with it.

I carried out my 7-week elective at University Hospital Wales (UHW) in Cardiff. I wanted to try

emergency medicine at a Major Trauma Centre to experience more trauma but also in a setting I felt comfortable in and therefore in the UK.

My elective was the first elective to take place at my university since the pandemic, and therefore

they were encouraging us to stay in the UK also. I can honestly say this was the best decision, I

absolutely loved my elective at UHW. I learnt so much, the staff were all great and so welcoming,

they taught me so much and let me do a lot too!

During the placement I did a range of various shift patterns which allowed me to get the most out of the experience! I preferred the late shifts - 2pm until 12am, because there was always more going on in the department.

Shifts ranged from 8am until 4pm, 2pm until 12am and nightshift 8pm until 8am and I could do as

little or as much as I wanted. I was encouraged to do all types of shifts, but shifts on late weekends turned out to be my favourites and after every shift, I felt like I had had a good, interesting day, which sometimes as a medical student is not always the case.

I was allocated a mentor for the entire of the 7 weeks and working with the same person was great. As a medical student you often work with different people every day but with continuity of the same mentor, I felt comfortable, and it was an encouraging learning environment. It made me feel more part of the team and that my ideas and thoughts were valued.

Handover would take place from the day staff and then we would head straight off to resus usually. My mentor worked primarily in resus, so I managed to see a lot of cool medical/trauma stuff.

I would help assess major trauma patients by performing the primary survey, taking bloods, or

inserting cannulas. I saw multiple stab wounds - one as young as 13, usually at least one every

weekend, farming accidents, a lot of falls from ladders and other heights, weird ECG stuff, car

crashes and so much more. I often found myself thinking in my head ‘wow this is amazing.’

One of the coolest things I saw, was from a patient who had unfortunately been stabbed. His bowels were hanging out of his abdomen, and you could see the peristalsis of the bowel very clearly as there was a large portion outside of the body. The patient went for emergency surgery, and recovered well.

I was always busy and there was never any hanging around. Once I was in the department for a few weeks and you learn the routine and where items are kept, it is so much easier to do the task you’re wanting to do.

There were a few things I wasn’t used too with the healthcare system in Wales. One of those things is that all notes were on paper. I have worked in the NHS for 8-9 years and only ever used computer systems. But this allowed me to do so many more aspects of the actual job than I could at home. I could practice ordering scans, prescribing, writing histories and examinations which I have been unable to do at home without difficulty due to computer systems.

It was clear I have potentially experienced NHS trusts which have more money than Wales as a

healthcare system. This was seen with extremely long wait times, and it was not unusual to see most of the department waiting for over 10 hours to see staff. This wasn’t necessarily due to staff

shortages but more to do with the size of the department. It wasn’t big enough for the number of

patients to be seen and often struggled with rooms to see patients. Therefore, although I carried out a UK elective, there were many insights to be gained from a slightly different healthcare system.

During my time in Cardiff, I took my husband and I’s Fiat Ducato campervan (Dumbo) which we

converted ourselves. I stayed on a local campsite during the week and ventured into the Brecon

Beacons on days off to get out hiking, which was only a 45-minute drive!

The campsite was really friendly and only a 15-minute cycle to the hospital. A good way to clear your head after an exciting shift in ED.

By taking my own van it gave me the homey-ness of something very familiar, my ability to drive

anywhere, and stay in these amazing places you don’t get too otherwise, which was all important

factors for me since I went to Wales on my own.

I woke up one morning with the van being shuck by multiple sheep rubbing themselves against it. I often had the door open during the day too and sheep would come right up the van which I

absolutely loved.

I often walked into the centre of Cardiff too, which was a 15-minute walk from the campsite. I had

never travelled to Cardiff before and was surprised at how much I enjoyed the city, which had

everything I could have possibly needed.

When trying to arrange my elective there was issues about whether they would go ahead, or travel rules would change. This proved arranging an elective slightly difficult at the time as many places did not want to commit to taking you.

I found when I emailed doctors directly, they were more open and forthcoming than filling out forms online or contacting the local university directly.

I managed to find an email address for one of the clinical leads for ED at UHW and emailed them

first. They agreed to have me and then put me in contact with someone from the medical

undergraduate office which was very helpful

Everything was organised in just a few short weeks after that.

However, during the process, I didn’t get a lot of replies and considering I emailed every major

trauma centre ED in the UK, UHW was the only department to reply, therefore was not too

encouraging.

The best way for hospitals/departments to reply is to dig more on their website for a clinical lead

email address. Not every department will have them on their website but that was much more

helpful when trying to arrange my placement.

The elective is often seen as a chance to go abroad for multiple weeks, do some medicine, but

mostly travel. And a lot of my friends who went abroad did that, but that isn’t what I wanted to do. I had an excellent experience where I improved on my competence as well as confidence and since UHW was a teaching hospital, I got so much teaching from all members of staff. ED, PHEM staff and anaesthetists were all willing to teach me and went out of their way to do so and I don’t feel I would have got a similar experience abroad.

If I was to arrange a placement like this again, I would prioritise why I wanted to carry out that

placement. For me, it was to experience ED in a full-time capacity and whether it could be a suitable career choice for myself which I definitely achieved.

Even if the elective is in the UK, it doesn’t mean it isn’t ‘good’. Outside of the hospital I experienced some amazing weather on some excellent hikes I would not have done otherwise. Peers who travelled abroad often only observed, and due to some language barriers, it was difficult to take histories. I personally feel I achieved so much more with a home elective compared to an abroad elective but still with some experience of a different healthcare system. In hindsight my elective was so much more exciting than I could have imagined, and I got to do a lot more than my peers.

I now have experience in major trauma management, primary surveys, CT scans, suturing wounds, arterial lines and ABGs, cannulation in those peripherally shut down and just so much more.

I enjoyed my elective greatly and was sad to leave. All members of staff made me feel part of the

team and not only was the hospital great, but the surrounding countryside areas were also excellent to enjoy too.

My time there made me thoroughly consider where I want to be and what I want to do in my career and I therefore wouldn’t have had my elective any other way, it was truly amazing.