June 7, 2019

International EM Resident Rotation: Italy

We are very privileged and thankful to be have been invited by Professor Giovanni Ricevuti to the University of Pavia as visiting professionals. From the moment we arrived and were greeted by Miss Edona Leka at our dormitories at the Collegio Universitario Santa Caterina Da Sienna, we knew that our visit would be filled with warmth, reward, and growth. Meeting with Professor Giovanni Ricevuti, we together planned and orchestrated a series of didactic lectures, small groups, case discussions, and simulations that would both review essential concepts of emergency medicine, but also introduce key differences in American health care practices and systems compared to Italy. We designed over 30 hours of content given to a multidisciplinary group of medical students, residents, and faculty members from specialties such as emergency medicine, cardiology, orthopedics, and traumatology. Provocative topics such as the North American opioid epidemic, gun violence, and out of hospital cardiac arrest management were highlighted. New cases expected to be rare in Italy were presented to medical students and residents and senior faculty were engaged with us in controversial issues of public health, policy, and community leadership.

Although a majority of the elective work was devoted to the conference halls, most of the rewards were realized outside of it. Professor Giovanni Ricevuti unexpectedly and graciously made sure that we had every opportunity to integrate into the culture and lifestyle of Pavia. We toured the University of Pavia where Nobel Prize winners Golgi, Scarpa, and Volta taught centuries ago. In Milan, we took part in an international conference designed to detect patterns of dementia by employing the resources of smart cities and smart phones. We broke bread and grape with medical leaders from England, Ireland, Spain, and of course Italy. Although branded as “non-academic,” it was this cumulative experience that gave us the insight into not only the cultural values of Italian and European people, but also an appreciation for how those values guide the structure and function of their healthcare system.

The last night of the elective could not have been a more proper summary of the give and take of our time with the students, residents, and faculty at the University of Pavia. Professor Ricevuti rented a small farmhouse in the countryside with tables 30 people long. Together we reminisced on our time together and made plans for the future. We debated the overutilization of resources for end of life care in America and conversely, the possible underutilization in Italy. We discussed the curriculum of EKG training and how it can be taught in a dynamic way that really challenges clinical thinking in place of simple memorization which they had been accustomed to. We delved into the drawbacks of government health care in Europe, and the impacts and controversies of the Trump administration in the United States. In the end, we found we all learned something about each other and ourselves, and expressed our gratitude in one of best Italian traditions of all, singing together. I am excited about the prospect of sending residents to Pavia again in the future, and hopefully we can return the favor and accept visiting students from Pavia as well. Sharing our experiences, perspectives, strengths, and weaknesses as people and societies through these ventures has resulted in the greatest impact of this experience. It is truly a most rewarding memory of residency.

Christopher Gruenberg and Carol Shih

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