Experience of Clinical Internship at Hôpital Charles Nicolle in Rouen, France
Dr. Nay Myo Htun, Consultant Anaeshtesiologist, Yangon General Hospital, Myanmar
It was a great opportunity for me that I was allowed to participate in the clinical internship program in September, 2019 at Hopital Charles Nicolle, Rouen, France. The training was coordinated by Dr. Henri Maries and supported by AFRASE . It was intended to observe clinical practice of regional anaesthesia techniques in France through an internship program.
Upon arrival to Rouen, I was warmly welcomed by Prof. Vincent Compere and his lovely family and they helped me to visit around the city during the weekend before training. Dr. Juliette Thill and Dr. Andrea Bailleul arranged to meet me on Sunday evening. They explained about the operation theatres and helped me got my schedule to visit the hospital and operation theatres.
The training started on 9th September, 2019. With the helped of the Dr. Andrea and Dr. Juliette, I was able to visit and observe regional anaesthesia practices in the ambulatory, orthopaedic, emergency and cardio-thoracic operation theaters. During my two weeks program, Dr. Andrea, Dr.Juliette and Dr. Fred co-ordinated my internship. They helped me to get the cases that would undergo surgery with regional anaesthesia and always accompanied me to visit each operation theatre. For the whole internship, I was able to observe 13 cases of axillary brachial plexus block, 1 case of infraclavicular brachial plexus block, 3 cases of thoracic paravertebral block, 1 case of serratus anterior plane block, 1 case of saphenous nerve block, 1 case of fascia iliaca block, 3 cases of popliteal nerve block and 4 cases of retrobulbar block. Moreover, I also had a chance to observe the practice of neuraxial block techniques in the hospital.
As the purpose of the training didn’t limit within the technical aspects of ultrasound guided regional anaesthesia, I had opportunity to observe the preoperative preparation and explanation of the regional anaesthetic technique to the patients, preparation of highly sterile equipments to be used, intraoperative level of monitoring and care of patients at PACU area. It was also a great opportunity for me to observe the doctor-patient communication during and after regional anaesthesia procedures.
During the training period, the use of highly sterile technique for ultrasound guided regional anaesthesia procedure was observed and which is still not a common practice in Myanmar. Moreover, the technical skill of the anaesthesiologist is more advanced and all of them are able to perform the procedures independently. The safety precautions such as avoidance of intravascular or intraneural injection were strictly followed by every anaeshtesiologist. It was also a great opportunity to observe different approaches for axillary brachial plexus blocks which is still not a common technique in Myanmar. Between regional anaesthesia cases, I was able to observe the induction room and techniques.
Through the internship program, the need of highly sterile technique for every regional anaesthesia procedure was highlighted than before. Now we are discussing within our department to make out a plan to use highly sterile technique for every regional anaesthesia cases. Moreover, the experience I have observed in Rouen also pointed that the requirement of highly skillful anaeshtesiologist in ultrasound guided regional anaesthesia and being able to perform the procedure independently should be an integral part of training for residence. Finally, the importance of communication between doctor and patient regarding the regional anaesthesia technique was also acquired in this internship program.
In conclusion, the program provided me with numerous invaluable experiences. It helped me to expose the European standard of regional anaesthesia practices in both technical and non-technical aspects. At the end of training, the required experience to upgrade the regional anaesthesia techniques in both clinical practice and residence training in Yangon General Hospital was obtained. I would like to express my deep gratitude and appreciation to AFRASE and all the people I met in France for helping me to lean and get best experience in Rouen. Merci!