Second Opinion: Clinicians, conductors and a step out of place

Even if summer electives are undertaken in a local hospital, elements of summer holiday, change of routine and freshness suffuse the experience for both student and clinician. Photograph: Thinkstock

This month’s column comes from the Dingle peninsula, relaxing after windsurfing lessons at the Jamie Knox Watersports centre in the Maharees, framed by the magnificent panorama of Brandon Bay.

Summer infuses a special quality into our lives, often spilling into our workplaces. And the public may not be aware of the key role of summer electives in medical education. This is where the student undertakes placements over the course of two summers in a healthcare setting of their own choosing.

They may be in an Irish hospital or clinic, or in a bewildering array of countries across the globe. Whenever an elective student joins our own unit, I get a vivid flashback of my own summer electives.

Educational episodes

No matter how much water has flowed under the bridge, something particularly special endures about these less structured educational episodes. Even if undertaken in a local hospital, elements of summer holiday, change of routine and freshness suffuse the experience for both student and clinician.

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My own electives were a blast. Hamburg in summer is green, leafy and sunny with water a constant presence, from the huge harbour to the Alster lakes in the centre of the city.

The first summer was spent in a large hospital, St Georg, whose Wilhelmine ward blocks radiated the spirit of the great German pioneers of 19th-century medicine. The second was in the racier setting of the small Harbour Hospital beside the red-light district of the Reeperbahn.

The trainee doctors were attached to specific wards, rather than to teams, and nurses, care attendants, doctors and students started the day with a shared breakfast of ham and cheese rolls with coffee.

Marrying my rudimentary German with the local dialect of the patients – Plattdeutsch is an unholy scramble of German, English and Dutch – was all part of the challenge and humour that characterised the elective.

But with the perspective of time, I realise I had a different form of elective during the previous two summers when I worked as a barman in the Royal Albert Hall during the Proms.

Here I was exposed to an extraordinary range of music and ensembles, as well as revealing glimpses into how large teams work together.

The last hour of rehearsal coincided with my lunchbreak, and from various vantage points in this great hall I observed the greats – including Solti, Haitink, Boult, Boulez and Rattle – extract the best from the great orchestras of the world.

The BBC Symphony Orchestra is the workhorse of the Proms, and the difference in how one ensemble responded to a range of conductors was a strikingly insightful workshop into leadership.

Musicians, like the members of our clinical multidisciplinary teams, are highly skilled and independent practitioners, and there are many parallels in the challenges of countering our centrifugal urges and maximising the potential of the group.

The most successful conductors combined deep knowledge and an unerring ear, and demonstrated an amazing range of ways for dealing with both talent and waywardness.

Respect seemed to be a key factor, whether tinged with a disciplinary edge for the stern Georg Solti, or the trusting and deceptively relaxed bonhomie of Gennadi Rozhdestvensky.

Medical humanities

The exposure to the music and the intensity of attachment of the public to these great works also laid a foundation for an interest in the medical humanities, with an emphasis on music and the importance of receptive participation in cultural activities.

The rapt attention of more than 5,000 people to the complex and strange beauty of a long Mahler choral symphony bolsters faith in a widely shared vision of our simultaneously limitless potential and fragile vulnerabilities. It also reassures me that, with the right approach, complexity can be brokered with large groups of people.

So, as I ask our students about what they are planning for electives, sometimes assisting in sourcing attachments or providing a place or involvement in a medical humanities project with us, I get a momentary flash of anxiety that they will not make the most of this wonderful opportunity.

However, I am always reassured when I meet them again and also find that those who, through penury or family circumstances, opt for a local elective are as likely to have an enjoyable, educational and above all memorable time as those who have travelled greater distances. A version of this column originally appeared as a British Medical Journal blog. Prof Des O'Neill is a consultant in geriatric and stroke medicine. His book, Ageing and Caring: A Guide for Later Life, is published by Orpen Press.