Немецкая врач-резидент начала практику в самой маленькой общине Канады с программой обучения

MOOSOMIN — Lea Britton of Germany is the newest medical grad to start her medical residency in Moosomin as part of the Southeast Family Medicine Residency Program. Moosomin is the smallest community in the country to have a medical residency program. The Southeast progam, based in Moosomin, also has residents completing their training in Weyburn and Humboldt. Britton says she completed her medical school in Latvia before meeting her Canadian husband from Calgary. “I am from Germany. I did my medical school in Riga, Latvia, which is in Eastern Europe, for six years there. I met my husband Jordan. He’s from Calgary. In 2018, I finished my med school in Europe, and then I moved to Calgary five years ago. I lived there with him for four years. We had our kids, and then I went to Germany last year because I couldn’t get into the residency program in Canada, and I wanted to start working. We went to Germany, and then I matched this year to Moosomin. Our kids are four and almost three, dual citizens, and they’re starting preschool and Kids Kollege this fall.” Enjoying Moosomin Britton says Moosomin is a great fit for her family. “I really like it here. It’s exceeding expectations. My husband, he lived in Carbon, Alberta for a bit, which is about 900 people, so he knew what he was getting into, and when we Googled Moosomin, it’s obviously pretty small, with around 3,000 people, but we didn’t realize it’s the hub of everything around it, and people are traveling so much here. It’s also on Highway 1, so that helps too. It doesn’t feel like a town of 3,000.” She says the doctors in Moosomin have been great mentors. “The doctors are all amazing. I’m very lucky to have them as my mentors here. I am really enjoying it, and there’s been something going on every weekend as well for our family, so that’s been really nice to get out together. We went to the rodeo in July. The parade was right by our house, so we saw that.” Coming to Moosomin Britton says she was placed in Moosomin after rating it high on her list. “I matched in my third cycle applying, so I applied twice before and I didn’t match for the international medical graduates (IMGs). There are very limited spots and there are lots of us that are trying to match from outside of Canada because it includes all Canadians that studied abroad as well—they’re not considered Canadian grads, they’re considered international grads, so we have to have our permanent residency or Canadian citizenship before we can apply. Most people would pick everywhere in Canada, and then you send your application, you submit tons of documents, you pay a lot of money, and then you wait to get an interview or not. I got an interview with USask luckily in January, and actually didn’t match then. It was very disheartening for me, but they do a second round for the leftover positions. She explains the steps after the interviewing process. “After the interview, the university ranks their candidates, and then the candidates rank their programs. So for the first cycle, most people that match are Canadians, and then usually in the second round is when the international students match for the positions that are left. There were nine spots left for the second round that I applied to. I did get an interview again, which I was happy about, but I didn’t have high hopes because it was nine positions for hundreds of people. My interview was stressful. Then, I surprisingly matched, and I got the notification at the end of April that I would start here in Moosomin July 1. We were still in Germany at the time, so it was quite stressful with two kids and a dog. My husband was happy for me. He was a little bit concerned about moving from a city in Germany to a small town in Saskatchewan because he’s only ever lived in Alberta.” She explains her husband’s profession. “He is a mental health counsellor. He studied psychology. He worked at a high school until last year working in mental health. He was doing Grade 10 to 12 in Okotoks. He was part of a nonprofit organization called Wood’s Homes for five years before that, and then he started his own business two years ago. Now he’s self-employed working remotely.” Positive feedback about medical residency program in Moosomin Britton says she received lots of positive feedback from medical residents on practicing family medicine in Moosomin. “You have very limited options because you’re an international student so you just apply everywhere. Everywhere I got interviews, I did my interview and then I ranked the places, and I did rank Moosomin pretty high. My husband thought for small kids it would be better in a town, just with crime rates alone compared to in the city. “I just did my boot camp, at the end of June in Saskatoon with all the new residents and they were asking, ‘Where did you match?’ And when I said Moosomin, people were always giving very positive feedback about it.” Interest in medicine Britton says her mother is a veterinarian and sparked her interest in surgeries and procedures at a young age. “My mom is a veterinarian, so I had a little bit of exposure to animal medicine, and I would help her with surgeries when I was a teenager. I’ve always really enjoyed procedures. I’ve always liked it. So that was one of the reasons I pursued medicine. “Then during the end of high school, I was really interested in psychology. I’ve been interested in mental health but also medicine. So I decided I would apply for medicine, and in Germany it’s quite difficult to get in. “I ended up applying to Latvia, where I was able to study in English because I also I did have 12 years of English in school, and I’ve always liked languages. I got in right away after high school. It’s a six-year program in Europe—you don’t do undergrad and med school—it’s six years total. The first two years is pre-clinics, and it’s a lot of physics, chemistry, biology, biochemistry, physiology, and anatomy. The first two years are really stressful because you have to learn so much. Then you go into clinical work. When I started I knew I was in the right spot. I always enjoyed my time.” Loves Canada Britton says she fell in love with Canada the first time visiting the country. “Most Germans would come back to Germany after school. For me, I wasn’t sure about that. I did enjoy living somewhere not in Germany and during med school I never really envisioned myself going back home. I just didn’t enjoy the German mentality as much. People are very direct. They’re not very welcoming, not very open-minded, and they don’t really speak English. “When I would go home and stay for a week or two with my mom, it was good, but I preferred to go back to Riga and to a city and enjoy all the time with my friends because I studied with people from Latvia, Russia, Israel, France, India, some other Germans, from the UK, Sweden and Finland, we had everybody there. So going back to Germany with just Germans just didn’t feel quite enjoyable anymore. “I met my husband when I was on vacation in Southeast Asia, and we stayed in touch. I finished my degree, and I would visit him in Canada a lot, and I loved Canada. The first time I visited Canada, I loved it. People are so friendly. Everyone’s usually in a good mood. The most common interaction is positive, and I like that. Canada is obviously a country of immigrants, so there’s lots of different cultures, and people are open to that.” Benefits to Southeast Residency Program Britton says there are huge benefits to doing her residency in family medicine in Moosomin. “I’m the only new one here this year. I get to work with two second-year residents, so a total of three residents for sometimes eight to 10 doctors, and it is really nice because we get to assist in procedures and see lots of things. Sometimes we are the one person there they might be teaching, so that’s really nice. In a city, you often have to share that with 20 other residents. “Rural medicine is very different from urban, people’s mindset is different, and you don’t have the same investigations—lots of the medicine here is based on talking to the patient. The doctors here are very comfortable diagnosing patients without having fancy techniques because we have to send them to Regina. You get good at filtering when it’s needed or learning other techniques when its needed. Life here feels more relaxed or slower than in a city, too. I think for work-life balance and the cost of living, it is a really big benefit of living and working in a rural community.” Britton explains she will be in Moosomin for the next four years. “I’ll be in Moosomin for two years during my residency, and then I have a return of service contract that I signed—all internationals sign when they match somewhere in Saskatchewan—they have a return of service of the years equivalent to their training, so that would be two years for me after my residency. I definitely have to do it in a small community, and right now my family and I don’t know why we would move to a different small community after those two years, so it’s likely we’re staying for at least four years. I would say I’m open to staying in Moosomin long term, but I can’t really say because it’s so far away.” Practicing medicine in Moosomin First year medical resident, Britton explains her day-to-day schedule doing her first year in medical residency in Moosomin. “I’m learning lots every day. I am in clinic most days of the week, working with different preceptors, and so I can get some advice from them every day. I do see my own patients for the most part, and then I discuss with my preceptors before I send the patients on their way just to get feedback and make sure that patient safety is the top priority before they leave the office. One day a week, I’m at the ER. Most of the time, it’s a 16-hour shift, and we do that with the preceptor, too. We see all the urgent patients there. I’ve been doing some procedures a couple of times a month, outpatient procedures at the hospital too—smaller procedures.” She says she will be doing a rotation in Yorkton at the beginning of next year. “My first six months is in Moosomin, entirely. So until the end of the year, I’m here, which is good I think to just get really familiar and comfortable with what I’m doing here before I have to go somewhere else. In January, I’ll be going to Yorkton for 10 weeks to do obstetrics, psychiatry, surgery, and anesthesia for patients, and then we also do six weeks of electives as well, where we can pick and choose where we want to do that.” Rural care versus urban Britton says she enjoys the connections family doctors in Moosomin have to their patients. “The patients we are admitting to the hospital when we’re on an ER shift, they usually have a family doctor that is in town or a doctor that is responsible for them or for their stay at the hospital, and all the doctors do rounds at the hospital for the patients they admitted. So they’re really familiar with their history. They know why they’re at the hospital. I feel like it’s a different level of comfort if they know that their family doctor is the one that’s checking up on them every day. It’s special for a small town. In cities I don’t think that would ever really be a thing that you see your family doctor at the hospital. So I think that’s really nice for the patient care and for their families— knowing which doctor they can reach out to, and continuity of care that you follow that family, know their daughters and the grandma, and are able to have that communication. It’s very different, and it was quite an adjustment to get used to, because in med school and during the CARMS process, a lot of the focus is on patient confidentiality and conflict of interest where if you know someone is your friend or your acquaintance, you’re not treating them, which all goes out the window when you’re here because everyone knows everybody. “It was definitely an adjustment because I’m working with my family’s family doctor now, so it’s something to get used to, but it’s obviously working here for everyone that lives here and is happy with their care.” Family medicine in Canada versus Germany Britton explains family medicine is very different in Germany compared to Canada. “I worked in Germany for a year, and then moved back here. I like the Canadian healthcare system a lot more than I did my work in Germany. In Germany, I wouldn’t even have picked family medicine because I did not enjoy my day-to-day there as much. Family doctors in Germany are very limited as to what they’re allowed to do. Most of them don’t do procedures, they don’t do prenatal care, they don’t do children. I wasn’t allowed to do obstetrics and gynecology, any women’s health which is one of my main focus points that I enjoy. So, I went into family medicine because I knew in Canada I’m able to do what I wanted to do.” Looks forward to building connections Britton says she enjoys chatting with patients and building a connection with them and their family. “Building that connection with the patients and their families is quite rewarding, which is part of the reason why family medicine is so nice. You get to see them, but also their families and their kids, and in a small town, you might even see them around town. It’s rewarding when you feel you are providing the care, and they feel reassured in their care, and they see you as the provider that’s giving advice, prescribing treatments, and looking after their children. The continuity of care is still something I’m building because I’m a resident, so I don’t get to follow-up with all the patients I see because of scheduling. “I’ve been here six weeks now, so I’m still working toward that, but it is nice seeing the connections that they have with their family doctors that have been here 30 years or longer. They really put their trust in you, and you want to make sure that they’re covered in what they need, and they feel comfortable with you, and even having normal conversations with them that are just a bit outside of medicine is very nice to see what stage in life they’re at, what they need, and whether or not something that you have advised or done has worked for them. When I see patients for the second time, it’s nice to notice they’re more open every time you see them, and more willing to share. The first visit is always a bit difficult in the sense where you don’t know their life story, so the more you get to know them, the more you know what’s going on, and the more effectively you can treat them.”