Moving to Sweden as a doctor: Practical training

In this post, I am documenting my experiences during the mandatory practical training (PT) that you have to undergo for qualifying for the medical license in Sweden.

Before I passed the practical exam, I thought that it would be a good idea to shadow a doctor at a hospital (called praktik in Swedish) so that it helps me build confidence for the exam. It was September 2020, and one was not allowed to do practical training before one passed the practical part of the medical license exam. So, I wrote to the manager (verksamhetschef) of the Vårdcentral near to my home, explaining my situation, and asking if they will be interested in taking me in for a praktik a few days a week. In the same mail, I expressed interest in continuing in the same Vårdcentral (VC) for my PT once I pass the exam. After a week or so, I was called in for an interview at the Vårdcentral. I explained my situation to them, and they were not only interested in allowing me for the praktik, but also were generous to offer me a place for PT. This was the only Vårdcentral that I applied to, and I was lucky to be chosen to work there. I have heard from many students that they have found it hard to find a hospital which would take them in for PT. Here are some tips for those applying for a PT:

  1. PT is a relatively new service and many managers do not know about it. When you write a mail to the manager asking for PT, you have to also explain what PT is, and if possible, provide relevant links to the website containing descriptions of PT. The hospitals usually do not have the finances to hire you, so you have to tell them clearly that it is the Region (i.e. VG region in my case) or Arbetsförmedlingen that pays your salary and your supervisor’s compensation. This means that the hospital/VC is essentially getting an extra person to work for them without incurring any cost from their side. They are usually happy due to this prospect. If your manager does not know this part, you are unlikely to find a job.
  2. Applying to the VC or hospital near your home versus applying at a faraway place is always beneficial. You can tell in the email to the manager that you live quite close by the VC, and you are open to the possibility of continuing to work for them after the PT is over. There is usually a scarcity of qualified licensed doctors, so smaller hospitals and VCs are interested in keeping you there if you happen to perform well enough during your PT. They know that, if you live near the place of work, chances are that you will stick to it because of easy commuting.
  3. You have to tell about your past experience in the email. In my case, I had a PhD. Many of the doctors who come to Sweden are specialists in their home country. If you are a specialist in, say, family medicine in your home country, chances are that you are preferred for the job in VC. Always attach your CV to the email that you are sending to the manager.
  4. I have found from others’ experience that you are more likely to get a position if you apply to VCs in areas where a lot of immigrants live. Such VCs usually want doctors who cater for multicultural patients, and your Swedish language skills do not matter so much because most of your patients (and sometimes colleagues) will be foreign-born.
  5. Never ever write your email in English. Always write in Swedish, and if possible, get the text of the email verified by a Swedish speaker to avoid embarrassing mistakes.
  6. Make your email easy to read and understand. The managers usually get dozens of mails every day, and they are usually very busy. Your email title and content has to grab their attention. Have good amount of text in the body of the email and attach the CV as a pdf (not zip). The manager might skip reading your mail if you have a lot of downloadable material and unclear text in the body.
  7. I have heard that some doctors visited the VC or the hospital directly and asked for meeting the manager. Doing this is hard because the manager is usually busy with other things, but this is definitely worth trying. If you haven’t got any reply for your email for a month or so, you can also call them via telephone and ask about the status of your application politely.

Most often, you apply by directly writing an email to the manager. If you are in VG Region, you can get the list of all VCs here. Go to each VCs page, find the email of the verksamhetschef and write an email to them. You can also apply to the VG Region web portal here, but it takes time for them to find a place for you and their process is quite slow. Apply to many VCs and hospital wards at the same time – you never know who will call you for an interview first.

My interview for the PT at the VC was approximately an hour long. I and the manager talked for around 30 minutes. I was mostly asked about the reasons for choosing to go to Sweden, details of my PhD project, future career plans, reason for choosing to apply to this particular VC and what I expect to learn from the job. We spent the rest of the 30 minutes going around the VC, meeting people and getting used to the rooms and facilities there. I was impressed by the way the VC worked so efficiently. Even before I cleared the practicals, the manager told me that I can join there as a PT doctor once I pass my exam.

I passed the exam in September 2020. It took a week or so for me to get the approval from Socialstyrelsen to continue with PT. I sent the approval documents to the VC, and the VC did the rest of the work for me, including fixing the finances, getting the necessary approvals required for the workplace to employ me. It took almost one and half months for this process to complete. During this period, I worked on a part time project with Creative Commons to create an educational resource for pathology. I also got to work on a research paper about stroke. Being busy with these prior commitments, I could only start PT by December 1, 2020. I signed a contract with a salary of 30,000 SEK per month (much less than my previous salaries, but PT is mandatory, so I had to take the job regardless of the salary). Some say that you can negotiate your salary, but I didn’t do it because I was thankful that I got a PT at the first place. Secondly, I had no experience whatsoever with the healthcare system in Sweden, so I didn’t see why my employer should give me a higher salary for taking in someone who is a beginner. The Region only gives 30,000 SEK per PT, and any extra money going into your salary has to be put in by your employer. Before signing my contract, I did not discuss about vacation, and it so happened to me that I got no vacation days whatsoever. Before you sign your contract, talk with your manager about the terms regarding number of vacation days (usually it is 14 days). You are also qualified for a fitness allowance of around 600 SEK.

The first two weeks of my PT were actually a training period. I had to learn Asynja Visph, the software used for recording journal notes. There are also other portals and software such as Pascal (for Apodos), Melior (for reading notes from the hospital) and Picsara (for adding pictures of skin lesions etc to the journal), but I found them easy to learn. The tough part for me was to get used to the routines that are practiced in the VC and to counsel the patients regarding their disease condition. I found out early on that you cannot satisfy all your patients. There will invariably be patients who ask for unnecessary medication, unwarranted sick leave or advanced diagnostic tests. If you judge that their request is inappropriate, you have to politely refuse it. Learning to say ‘no’ is a big part of your training. Always remember that your main aim is to have disease-free individuals, not happy customers. It is the managers job to keep the customers happy, and your job as a doctor is to do the optimal thing to ensure the long term well-being of the patient as well as the society in general, and to explain to the patient the reasons for your choice of treatment.

I started seeing patients on my own starting from my third week of PT. I would talk with patients and explain the history and examination findings to another doctor, who will then decide the diagnosis and treatment. After two more weeks of doing this, I started taking patients independently, even though I consulted with a senior most of the times in between or after the patient visit. On an average day, I usually took 5-6 patients, made 2-3 follow up phone calls, and renewed one or two prescriptions. This might sound like an easy job for those of you who used to seeing up to 50 patients a day in your home country, but that is not how things work in Sweden. There is a good deal of documentation to do, and you are supposed to spend quality time with your patient. In my case, time just flied between 8 am to 5 pm, and most of the time, I used to forget about fika breaks.

A good part of the job in Sweden is that you can always look up a variety of web resources in medicine. Here is the list of some of them I know.

  1. REK list: Most important reference book for everything related to patient management in primary care. For any disease, refer REK list first. You can check other resources only when the description in REK list is inadequate. Available in booklet format also.
  2. Äldrekompassen: Guidelines regarding medications for the elderly (available as booklet also).
  3. Medibas : Contains commonly encountered diseases and their management. Paid membership, but you can use Institutional access to get full access.
  4. Internetmedicin: Contains description and management of diseases both at the primary care level as well as the specialist level. Useful when your patients need to know about what could happen next after being referred to a specialist.
  5. UpToDate: Contains newer and updated worldwide guidelines about several diseases.
  6. Krav- och kvalitetsbok Vårdval: If you are interested in management and is looking forward to become the manager of a VC, or if you are just curious about the specifics of how a VC works, this book is for you.
  7. FASS : Contains information regarding all available medicines in Sweden, including its pharmacokinetics, interactions, dosing and contraindications.
  8. Smörjschema: Several patients would need to use cortisone creams, and the scheme for tapering the medicine is quite lengthy. I usually give a print out from this website to ease my job of writing out the instructions in detail.
  9. JanusInfo: Lot of good information about medications, including medications for pregnant and lactating individuals.
  10. STRAMA: Antibiotic prescription has to strictly follow STRAMA guidelines. No exceptions.
  11. 1177: Information about self-medication for minor disease conditions can be found here. I usually encourage my patients to read 1177 for knowing more about their diagnosis and self-help remedies.
  12. Läkemedelsverket: Contains details about why some medicines have been phased out, and which medicines can be used in their stead.

At the end of the practical training, your supervisor and manager fill up a form, which you can send to Socialstyrelsen along with other relevant documents. I sent my documents to Socialstyrelsen in the second week of June 2021 and received my Swedish medical license via e-mail within one week after application.

Earlier posts in this series:

  1. Moving to Sweden as a doctor: PhD admission
  2. Moving to Sweden as a doctor: Learning Swedish
  3. Moving to Sweden as a doctor: Medical license exam
  4. Moving to Sweden as a doctor: Practical exam

The Vaccine Safety Project on Wikipedia

There are numerous sources on the internet, particularly on social media, spreading misinformation related to vaccine safety. It is difficult to control the extent to which such messages circulate on the internet, because most of these posts circulate in closed groups in social media and other online echo chambers. The vaccine debate is stronger now more than ever due to the concerns regarding the safety and efficacy of the prospective COVID-19 vaccines which are under development. In addition, the COVID-19 pandemic has caused disruptions in vaccination services across the globe. All these factors make it important that reliable and updated information regarding vaccine safety is communicated to the public. 

Wikipedia is one of the most popular knowledge platforms in the world. The health information on English Wikipedia receives huge traffic, which makes it one of the most consulted health care resources in the world. The Wikipedia article about the COVID-19 vaccine has gathered over two million views. Therefore, it is important that Wikipedia’s vaccine safety information is updated and reliable. 

The Vaccine Safety Project launched this summer to find and bridge the knowledge gaps related to vaccine safety on English Wikipedia. The pages of the Vaccine Safety Project were designed like a WikiProject, a portal for Wikipedians with similar interests to collaborate with each other. The project created a portal with spaces for general discussion (talk), sharing vaccine-related news (news), listing articles related to vaccine safety (navbox), sharing tips for new editors (tips), listing sources and missing topics related to vaccine safety (sources, sources list, missing topics) and for article suggestions from Wikidata (Wikidata lists).

The Vaccine Safety Project also documented the existing knowledge related to vaccine safety on Wikipedia, which includes over 100 articles. The Sources list contains search strategies for finding relevant resources from medical repositories containing vaccination information. The project also contains links to reference sources that contain relevant images and data which could be used for strengthening the vaccine safety information on Wikipedia. One of the features of the vaccine safety project is the Missing Topics page. Topic areas related to vaccine safety which do not feature on Wikipedia are mapped here. In addition to general topics, organizations related to vaccine safety and country-based vaccination status are listed on this page. The resources listed in this page could be used in future to create the articles related to missing topics from a scratch. 

The Vaccine Safety Project uses data from Wikidata, the sister project of Wikipedia, which is a free structured data repository. The project uses Listeria, an automated script, to create a list of topics surrounding vaccines, journals on vaccines and vaccine related journal articles. This list is updated every 24 hours, ensuring that all changes made on Wikidata are included. The entries present in this list could be used to create new articles related to vaccine safety on Wikipedia. 

As a part of this project, bibliographic information related to vaccination from the National Academy of Sciences was uploaded to Wikidata. This was accomplished with a collaboration from Houcemeddine Turki, a Wikipedian working on bibliographic information on Wikidata and project lead of WikiCred project RefB: Adding Reference Support to Biomedical WikiData Statements.

Information from the Vaccine Safety Project was used to conduct the first Vaccine Safety edit-a-thon, a community event where experts and newcomers came together to edit Wikipedia articles. The edit-a-thon was organized by NewsQ and Wikimedia DC, in partnership with the World Health Organization’s Vaccine Safety Network and the Stanford History Education Group. Approximately twenty-five people participated in this edit-a-thon, including medical doctors, researchers and experienced Wikimedians. This event led to eight article creations and the expansion of 461 articles. Similar events are being planned for bridging the knowledge gaps related to vaccine safety on Wikipedia next year, also in different languages. 

If you are interested in leaving feedback about the Vaccine Safety Project, please do so on the talk page of the project here.

Moving to Sweden as a doctor: Practical exam

This blog post is about my experiences in preparing for the practical part of the medical license exam in Sweden. I have provided relevant links and study tips for the practical exam in this post.

Everyone who passed the theory part of the exam is eligible to appear for the practical part. One is eligible to appear for the exam for a maximum of three times. The exam happens four to five times an year and the exam centres are Umeå and Göteborg (although they say Göteborg for all practical purposes, the exam actually happens in the Mölndals sjukhus, which is located in the Mölndal kommun). You get your turn to participate in the exam based on a priority ordering – those who cleared the theory earlier than you get a higher queuing time and they get prioritised in the waiting list for the practical exam. Thus, it is possible that you will need to wait for around 3-6 months for getting a chance to appear for the practical exam after clearing the theory part. Meanwhile, it is important to not lose patience and study systematically.

When I went through the practical exam questions, I figured out that I could learn easily if I have study partners. The practical exam is all about testing how you approach a patient, and this approach differs from country to country. You’ll need to learn the Swedish way of approaching patients. If you study on your own, chances are that you sometimes reinforce your own mistakes by misinterpreting the answer scheme or by not understanding some subtle aspects of the questions. Having study partners means that they can see the question from a fresh perspective and they can bring new ideas to the table. They can also correct your mistakes and teach you the topics that you are weak at. So, I strongly recommend that you prepare for the practical exam with study partners, at least half of your study time. From my experience, studying as a group online via Zoom also works well. The ideal group size according to me is three. If you are more than 5-6 people, it gets messier, so it is better to split yourselves into two groups of three people.

You can find all previously asked questions here (link requires UmU Moodle access). Ensure that you also go through the latest previous questions asked at Umeå University for their medical students which they update here (Moodle access required). I was late to find out about this and I regret that I did not go through it sooner. There were instances where these questions were repeated at the practical exam. Having contacts with those attending the KUL program at Umeå University is also helpful as they are likely to have access to a lot of reading material for the practical exam. The exit test for KUL program is the Day 1 (6 minute stations) of the practical exam, so the KUL students are essentially preparing for the same exam as you.

Most of the questions and concepts are repeatedly asked, so ensure that you study these repeating questions thoroughly. However, there will be new questions too, so it is important that you have a basic understanding about the commonly found disease conditions in Sweden. Read all the previous questions, and then make a clear plan about how you will approach each of the cases. Chart out a timeline for what topics you will study and when. Find study partners from the facebook or telegram group for foreign doctors in Sweden. There is also a Whatsapp group for Indian doctors in Sweden (contact me for details). It is also possible to go to Moodle>Kunskapsprov för läkare>Deltagare and search for those registered for the exam by using the keyword ‘Anmälda till praktisk prov’ and find those students who will appear for the exam with you. Find the profiles of these people and write direct messages to them.

It is good if you have access to KTC (every University has one, check at the University hospital near you), where you can practice clinical examination on dummies and perform procedures such as catheterising and diluting medication. You can buy suturing set, Peak Expiratory Flow Meter, BP monitor, knee hammer, tuning fork and other common devices online on Amazon.de or Wish.com. I also bought a Mini Anne from HLR-butiken to practice HLR. Buying all these stuff costs a lot of money, but my thought was that it was better to spend money and pass, rather than to save money and fail the exam.

You can email to the head of the departments at hospitals near you and ask if they can allow you to practice with ophthalmoscope, slit lamp and otoscope. This is easily said than done, as hospitals do not want to take the trouble of having a student hanging around. Most people I know accomplished this by working as a nursing assistant or as a researcher at some hospital, building contacts there, and using these contacts to go to the relevant department. With COVID-19 around, it has become harder to get an observership, so try to learn as much as you can from videos online. I sought help from my fellow doctors in India for learning radiology, ophthalmology and ENT. I even visited my medical school in India when I went there for vacation. I met my friends there, and discussed some concepts that I was doubtful about. I practiced HLR, BP monitoring, neurology and orthopedics examination using my colleagues at the research lab as ‘patients’.

There are some training programs for students appearing for the practical exam. Region Uppsala is conducting a training program for two days that covers the important topics for the exam. Lund University is also conducting a training program in Kristianstad for one week. Both these programs prioritise students who live in the same region (Uppsala or Skåne). I applied for both the programs, but got rejected, possibly because I live in a different region. Follow the news on the telegram group for foreign doctors in Sweden to get to know when it is time to apply for these courses. I also applied at the HLR centrum in Götenburg to participate in the A-HLR training, but I was rejected with the reason that they have no obligation to teach those employed outside of VG Region.

I appeared for the practical exam in November 2019 and failed for 2.5 marks (I got 127.5/200). It was a near miss, and I evaluate that the reasons for my failure were as follows:

  1. I studied in a group, but we did not practice the questions by role play. We simply sat down and read the questions and answers. Without role play, it was hard to learn to make quick decisions and to hold an uninterrupted conversation with the patient. I also was poor at time management.
  2. My Swedish wasn’t quite good. I was doing my SAS-G course when I appeared for the practical exam. I could understand what the patient said, but it was hard for me to find the right words to answer them back. The end result was that I spent more time finding the right words than addressing the patient’s concern.
  3. I did not repeat and reinforce many questions and answers. There is not enough time to think and plan while you are at the exam, so you have to have a clear plan about what exactly you will do for each question.
  4. I thought that I will get a clear fail if I give a wrong diagnosis, therefore I talked less and said only differential diagnoses. I always sounded unsure. You should not be afraid to say what exactly you suspect. If you are wrong, it doesn’t matter much unless you make a grave error. It is better to speak more than to speak less because the evaluator is looking for keywords in the conversation. You only get points if you say exactly those points and keywords specified in the answer sheet. Ensure that you speak loudly, because you don’t get marks if the evaluator does not hear you.
  5. I appeared for the exam while I was working full-time and doing part time Swedish course. I worked at the lab until the previous day of the exam. This wasn’t a good idea as it is important to revise all the important topics during the last two weeks before the exam.
  6. Those who appeared for the exam in 2017-18 will tell you that it is a breeze. At that time, some people prepared for less than a month and passed the exam. The exam has become tougher overtime and the situation in 2017 does not hold true now anymore. I would suggest at least three months of preparation, especially if you do not have experience in internal medicine or family medicine. It has become a fashion now to claim that one has finished learning Swedish and cleared both theory and practicals in the shortest possible time (six months or less). I would say that it is nearly impossible. Please don’t plan your career based on such exaggerated claims. I have known people who came to Sweden on visas lasting less than one year, and had to return to their home country after the expiration of the visa without even clearing the theory exam. A reasonable timeframe for the whole process (learning Swedish + clearing kunskapsprov) is two to three years.

After my first failure, my plan was to appear for the practical exam again in April 2020, but the exam got cancelled due to COVID-19. I had to wait until September 2020 to appear for the exam again. I had finished my PhD by then, but my Swedish classes were still ongoing. I also worked on the Författningskunskap course on Swedish law and ethics in the meantime. I studied for the exam with two other students and passed this time with 154/200 marks. The cut-off was 141 marks.

There is no one central place where you can get all materials needed for preparing for the exam. You need to search for them on the internet and ask fellow students to find them. Here are some reading material that turned out to be very useful for me:

  1. 200 sidor : An amateurish study material prepared by students
  2. OSCE by subject : OSCE questions divided up by subject
  3. OSCE material from Sahlgrenska: Material used by students at Sahlgrenska. Many students say that the exam at Göteborg is tougher than the exam at Umeå. I got the same feeling when I compared the past questions from Umeå and Göteborg. Umeå has a long legacy of conducting OSCE type exams, while Göteborg usually conducts oral case discussions for medical students.

Here are the videos that I have used for learning new techniques:

  1. Videos of a mock OSCE exam, Gynecological examination, respiratory system examination, diabetes foot examination, PEF use, rectoscopy and ABI examination are given on Läkareprogrammets filmer section of Moodle via UmUPlay.
  2. Nervous system examination here.
  3. Videos of orthopaedics examination from Lund University here.
  4. Videos of psychiatry examination here.
  5. Catheterisation video here.
  6. ABCDE simulation video here.
  7. Neurology and orthopaedics special tests on Physiopedia here (English).
  8. Ophthalmology tropias and phorias explained in simple language here and here (English).
  9. SBAR method for communication here.
  10. Fracture management here.
  11. HLR here.
  12. Helmich manöver here.
  13. ABG here (English).
  14. Direct ophthalmology here.
  15. Reaction Level Scale here.
  16. Audiogram here.
  17. Cardiac USG interpretation here (English).
  18. Emergency tracheostomy here (English).
  19. Examination of an unconscious patient here (English).
  20. Dix Hallpike’s manöver here.
  21. Epley’s manöver here.
  22. Weber v/s Rinne test here (English).
  23. Slit lamp examination here (English).
  24. HINTS exam here (English).

Here are some websites and books I used for learning concepts:

  1. OSCE Umeå : Question bank of previous questions of students at Umeå University
  2. Internetmedicin for understanding difficult concepts in the answering scheme.
  3. Läkamedelsboken and Hypocampus for verifying the approach to difficult cases
  4. På Klink has detailed descriptions, so it is best to focus on the summary boxes in the book.
  5. Procedurhandboken for knowing which types of procedures they expect you to know. Go to the tab innehållsförtechning in the link to the book given here and try to learn all the procedures listed there. No exam yet had procedures from outside of this book.
  6. Akut Medicin book was useful in thinking systematically around the differential diagnoses.
  7. Radiology Master Class for radiology.
  8. Ophthalmoscopy pictures (enter any random number as patient number and student number)

Other general tips:

  1. The exam consists of two days of hard work, so sleep and eat well. One of the fellow doctors who attended the exam with me fainted towards the end.
  2. All ‘patients’ at the exam are actors. You will not meet a real patient. All actors act extremely well.
  3. All cases you see at the exam are typical ones. The only atypical ones are the Allmänmedicin station for 14 minutes, where the patient has a range of symptoms and concerns.
  4. Follow three Fs whenever possible. Communication with the patient is very important in Sweden. You could fail at professional utvekling station not because you don’t know the concepts, but because you did not communicate well enough.
  5. Most people I know got lower points than expected, or even failed at HLR station. Take it seriously and train with friends many times. Many things can go wrong here, so be sure to know it inside out.
  6. Alcohol history, antibiotic allergy, decreased quality of life and stress are important questions that can cost you points if you miss them.
  7. The evaluator for the most part will be silent. You have to manage the situation on your own and explain your diagnosis to the patient in simple language as if you were a real doctor.

NB: I do not endorse any of the study material given in this post. It is possible that some of these sources contain wrong or outdated information. Please use your discretion to find out the latest and correct examination and management protocols.

Earlier posts in this series:

  1. Moving to Sweden as a doctor: PhD admission
  2. Moving to Sweden as a doctor: Learning Swedish
  3. Moving to Sweden as a doctor: Medical license exam

Later posts in this series:

  1. Moving to Sweden as a doctor: Practical training

Writing about COVID-19 on Wikipedia

Last month was eventful not only in terms of my personal and professional life, but also in terms of my volunteering work. In March-April, I have been regularly writing articles on English Wikipedia about COVID-19, mostly about the medical aspects, issues surrounding the impact of the pandemic and people in leadership in responding to COVID-19.

I am used to doing everything in a structured way on Wikipedia, but COVID-19 changed everything. I usually take days and weeks to think about a new project on Wikipedia, then create a time line and a work plan, and then work systematically on each aspect of the work. But in a crisis situation like a pandemic, this level of structuring is not possible, so I am helping out wherever help is needed. Nowadays, I log in to Wikipedia in the morning, read the updates about the pandemic from there and then go searching for topics that are missing. Given the recentness of the pandemic, there is usually a lot to write about, especially about its socio-economic impact. In addition, the tables about the disease epidemiology need to be updated, new regulations and lockdowns passed in various countries need to be added and the biographies of notable individuals working on COVID-19 need to be created. I work on all these aspects.

I get my references from all kinds of sources, thanks to most journals making their COVID-19 research papers open access. Many magazines and newsletters like The Economist have made their articles related to COVID-19 subscription-free. The WHO, UNPFA, UNICEF, Human Rights Watch, Amnesty International and many other organisations have also created several documents related to COVID-19 and the impact of the pandemic on various spheres of life. I have generously drawn content from all these sources for creating and expanding articles on Wikipedia.

I have mostly been following the World Health Organisation (WHO) for knowing the latest disease updates, so I mostly bring information from the WHO to Wikipedia. As of 9 April 2020, I have written around 25 articles related to COVID-19 on Wikipedia. The most popular one so far is 2020 coronavirus pandemic in Kerala. The article I am most proud of is Gendered Impact of the 2019-20 coronavirus pandemic. The article which I think would be the most useful is List of unproven methods against COVID-19, given the misinformation circulating about the disease. Nearly 700 edits I made on English Wikipedia thus far are on articles related to COVID-19. The articles started by me have been viewed around 35,000 times every day during the last one month.

What am I going to do next? We are still in this pandemic and the situation is rapidly evolving (for better or for worse, we don’t know yet). So, I am going to take everything one day at a time, doing what is important for today, not making any long term plans. I will continue to do what I am doing right now on Wikipedia, until help is no longer needed. As a Wikipedian, doctor and researcher, this is the least I can do to empower people around the world to get open and reliable information about COVID-19.

Stay safe, y’all.

 

How to identify misinformation related to coronavirus?

We live in the era of information overload and misinformation. Ever since coronavirus started being a cause for panic among the public, a lot of misinformation regarding it started circulating in the internet. How to identify if a given information is true or not?

  1. Check the source of the information. If the information you found comes from a website, check the URL to find out if it is a reliable organization. Some of the sources that you can rely on are the governments of your countries, World Health Organization and established newspapers. Even Wikipedia has reliable information related to coronavirus pandemic. This is made possible by thousands of volunteers, including experts, monitoring  pages related to coronavirus and updating the pages for accurate information. There is a Wikipedia page for Misinformation related to the 2019-20 coronavirus pandemic. Several instances of misinformation have been recorded here.
    If the information you got is via a social media platform such as Whatsapp, you should be careful about its authenticity. Always ask the sender for the origin of the message if you are unsure if it is true. Encourage everyone to share trusted information only.
  2. Extraordinary claims need extraordinary evidence : If you find a post that says that the the cure for coronavirus disease is found, or makes similar tall claims, it is likely that they are wrong. If a vaccine or medicine for coronavirus gets indeed made, it will be all over the place, not just in that single forwarded message.
  3. If you find something like “The truth behind coronavirus pandemic” or such that has the word ‘truth’ in it, it is likely that they are sharing an unpopular opinion, and therefore, it is likely to be false. Those saying the truth don’t need to affirm that they are indeed saying the truth, but liars need to do it from time to time to make sure their lies are spreading.
  4. If the coronavirus-related post deals with supporting an ideology or a religion, it may be false. In the zeal of projecting one’s ideology or religion first, people tend to create and spread all kinds of news, including fake ones. Neither capitalism or communism has figured out how to control coronavirus spread. Neither Hinduism nor Islam has solutions for preventing disease transmission.
  5. Take extra care when you SHARE information. Only share the posts that you know are true. Don’t be a part of the fake news chain.

Moving to Sweden as a doctor: Medical license exam

This blog post is about my experiences in appearing for the theory part of the medical license exam in Sweden.

Once you have learnt Swedish upto around SFI-D (between B1 and B2 levels, if you are following CEFR), I would suggest that you start going through the past years’ questions of the theory part of the medical license exam (kunskapsprov för läkare utanför EU). Details about learning Swedish has been explained in detail in my previous post. You can find the past questions here. It is likely that you don’t understand many terms, but you might be able to understand something at least. Medical vocabulary in Swedish is quite similar to that of English, so if you have understanding of Swedish grammar, learning medical terminology in Swedish would not take so much time.

To start with, you can translate the past questions to English in order to understand how tough it is. You can upload the pdf document to Google translate to get an English translation. My experience was that the theory exam in Sweden was easier than the post-graduate admission exam (NEET) in India. It is also less intensive in terms of having to memorize concepts. The medical license exam in Sweden focuses more on the basic concepts and practical applications of fundamental principles. This means that a good number of questions are case discussions, where you are asked to choose the most correct option about the diagnosis or management of a particular patient. Most often, the cases have typical signs and symptoms. Sometimes, the question only gives you hints about the patient’s symptoms, and ask you to choose a suitable treatment. In that case, it is upto you to work out the diagnosis first, consider the situation (if you are in primary care or tertiary care) given in the question and choose a diagnosis that is most appropriate for the situation. For example, the question might be about managing a patient who came with hemiparesis and slurred speech in primary care. First, you need to work out the diagnosis as stroke. Then, you need to consider that you are in primary care, and it is therefore not possible to manage the case in your hospital. The right answer would be to send the patient in an ambulance to the tertiary care hospital immediately. On the other hand, if the questions says that you are in a tertiary care, the option of doing thrombolysis might be the correct answer. In order to confuse you, both the options will be given to you. The key to cracking the exam is to visualize the situation in your mind, and then choose the option that sounds the most reasonable for you. Apply your common sense generously.

The theory exam consists of approximately 180 questions divided into three parts : a general part, a clinical part and interpreting a research article. The weightage of subjects can be found in this document. You can see in the document that medicine is the most important subject with 10% of the questions devoted to it. You will need to study pre-clinical subjects as well. I studied First Aid for the USMLE (Step 1) book for the pre-clinical part. This book is very condensed, so whenever I could not understand some concepts, I would look up my old textbooks to read elaborately about that topic. To some extent, Kaplan lecture notes for microbiology and pathology also helped, but I did not read them completely due to lack of time.

For the clinical part, I studied PLABABLE, the mobile app for preparing for the medical license exam in UK. As I was working full time while preparing for the exam, it was good to have the study material in mobile app format for me to study while I am traveling to work. I took longer to read Swedish text than English text, so PLABABLE was good for me since it was in English. In that way, I could grasp the concepts fast. I also subscribed to Hypocampus, but it had detailed descriptions for every disease, so I could not read much of it. There are differences in the ways by which diseases are managed in India and Sweden. In order to be mindful of these differences, I looked up the website internetmedicin to know the current Swedish guidelines. There is also a book and a mobile app called Läkemedelsboken that you can refer for the latest management protocols for common diseases in Sweden. These two resources are huge, so use them only as references. I also discovered two books from the library : Akut medicin and Akut kirurgi. These two books have condensed descriptions of commonly seen cases in Sweden. I used these two books for learning Swedish terms as well as for quick reference. There are similar ‘Akut’ books for orthopedics, radiology, psychiatry etc., but since these subjects were not as important for the exam as medicine and surgery, I did not read them. Sometimes, it was tiresome for me to study during the evening after a full day’s work, in which case I watched Osmosis videos passively while lying on the sofa.

I did not need to study for the research article part of the exam because my day job as a researcher helped me there. The most important parts of the research article are its aim and results (including tables). Make it a practice to read the questions first, and then read the relevant parts of the research article to find out the answer. If you instead read the article in full first, it is likely that you will not have sufficient time for answering the questions.

I think that the key to cracking the exam is to work out as many previously asked questions as possible. There is a lot of material out to study, and you can’t memorize all of them. You will need to prioritize some topics over the other, and you need to be familiar with past questions in order to know which topics are important. The previously asked questions do not repeat, but some subject areas are more frequently asked than others, so make a note of that by solving past question papers. All past questions can be found here. If you have time, solve past TULE and AT questions too. MCQs from Lund University are also in the same pattern as kunskapsprov, so practice them too. Whenever I solved past question papers, I looked up the concepts that I did not know and noted them in a notebook. I made it a practice to revise the contents of the notebook every three days or so.

Some people who were successful in the exam have watched videos on UmUplay (available on your moodle), participated in study-circles (find out if there is a study circle in your city) and attended the completion program for doctors educated outside of EU. I have not done any of these, and I studied alone. I studied only for two months or so, that too while working full time as a PhD candidate. But I had the habit of reading medical textbooks, popular science books and watching medicine related videos. Although I did this for fun, this habit helped me to keep my knowledge updated. Therefore, I did not need to study much for the exam. But even then, my first reaction after the exam day was that I would definitely fail. Fortunately for me, I passed the exam at the first attempt in May 2019. My score was 65.2%.

Earlier posts in this series:

  1. Moving to Sweden as a doctor: PhD admission
  2. Moving to Sweden as a doctor: Learning Swedish

Later posts in this series: 

  1. Moving to Sweden as a doctor: Practical exam
  2. Moving to Sweden as a doctor: Practical training

Moving to Sweden as a doctor : Learning Swedish

This is the continuation of the post Moving to Sweden as a doctor : PhD admission. In this post, I will discuss my experiences in studying Swedish language.

All people who have a personal number in Sweden have the right to learn Swedish language. If you are a temporary or permanent resident in Sweden, you get a personal number, and that enables you to learn Swedish language free of cost. You can choose to go either to Folksuniversitiet or to SFI for learning Swedish (some courses in Folksuniversitiet are paid courses). Both these institutions teach Swedish, but in different ways. Folksuniversitiet follows the Common European Framework of Reference for Languages and has courses starting from A1 to C2 level. At Folksuniversitiet, you need to have cleared the exam for C1 level to be able to practice as a doctor in Sweden. If you go the SFI route, you do SFI-C and SFI-D courses. SFI-C is roughly equivalent to 5th standard level of Swedish and SFI-D is equivalent to 7th standard. People without secondary education start at SFI-A, but you as a doctor has got University education, and you are therefore eligible to start at SFI-C directly.

Once you finish SFI-D, you can start ‘Svenska som ändraspråk (SAS)’ course. While SFI consists of basic level courses, SAS enables you to learn Swedish as a second language. SAS has various levels : SAS-G, SAS-1, SAS-2 and SAS-3. SAS-G consists of four sub-levels. If you performed well in the final exam of SFI-D, you can go directly to the third or the fourth level, so it is important to prepare well for SFI-D if you would like to finish studying Swedish fast. SAS-3 is equivalent to having learnt Swedish at 12th standard level. To work as a doctor in Sweden, you need to complete SAS-3. Clearing SAS-3 would also mean that you are eligible to take University level courses in Swedish language. When you start practicing as a doctor, you might want to  study short University courses as a part of continued education. Nearly all courses are in Swedish, so it is good for you to clear SAS-3 rather than to clear C1 from Folksuniversitiet. In addition, the completion course for doctors from outside Sweden only accepts SAS-3, and not C1. So, even if SAS-3 seems to take longer time than C1, I would say it is worth the effort. It is likely that you have waiting times between passing one SAS course and joining another. My recommendation is to study Swedish during the waiting time and appear for the SAS exam directly if possible. Most kommuns allow you to appear for the SAS exam without having to go to the course. If you are in Göteborg, you can apply for the SAS exam directly here against a fee of 500 SEK.

It takes around 2 years to learn Swedish if you learn intensively. I studied part time, so it took longer. Starting SAS-1, you have the possibility to do distance course. This was helpful for me because I could now study and do the assignments during weekends. You need to show the proof for Swedish proficiency only when you apply for the medical license, so you are allowed to take the medical license exam (kunskapsprov för läkare utanför EU/EEA) before you have finished studying Swedish. I passed the theory part of the medical license exam while I was still doing SAS-G course, so my advice is to start preparing for the medical license exam as soon as you finish SFI-D. I will write about preparing for the medical license exam in the next post.

Earlier posts in this series:

  1. Moving to Sweden as a doctor: PhD admission

Later posts in this series:

  1. Moving to Sweden as a doctor: Medical license exam
  2. Moving to Sweden as a doctor: Practical exam
  3. Moving to Sweden as a doctor: Practical training

Moving to Sweden as a doctor: PhD admission

I have been receiving several phone calls and messages from doctors who want to move to Sweden. Most of them made the choice because their spouse is already in Sweden, while some others want to move to Sweden in search of good career opportunities, possibility to do research and quality lifestyle. When I started getting two or three queries every week or so, I decided that I write this blog post. If you have been directed to this blog post by me, please read it completely and ask me only follow-up questions. Thank you for understanding.

How and why did I move to Sweden?

I decided to move to Sweden for my then fiancé, who is now my life partner. While we met in 2015, I was doing my house-surgeoncy (internship) in India. My partner was doing his PhD in Sweden at that time. Besides this reason, I knew that post-graduate studies in India would mean 24*7 hardwork, stress, working in resource poor settings and zero fun. I was interested in volunteering for Wikipedia, painting and reading books in general. I knew that I will have to give up all these things I love in order to make my career as a specialist doctor in India.

I was interested in research, but I was good at clinical practice too. I didn’t have any past experience in research, but I had done my mandatory research project for MBBS with enthusiasm. I had assisted Wikipedians and post-graduates to do research. Opportunities for research were sparse in India, and most of them came without any funding or mentorship. While we were discussing career, my partner pointed out that I could try doing research in Sweden. I started gathering information about this possibility, and found that my MBBS from India is considered equivalent to a master’s degree (not specialist degree) in Sweden, because it offers a syllabus similar to the MD program in Sweden. Please note that MD is the basic medical degree in Sweden, equivalent to MBBS in India. When you specialize in a subspeciality in Sweden, you don’t get any extra degree, but you will be called as a specialist doctor in that subspeciality. For example, when you finish medical school in Sweden, you get an MD degree. Suppose you specialize in general medicine later on, your degree becomes MD (General Medicine).

I figured out that PhD admission in Sweden requires 4.5 years of university education in the relevant subject. Some PhD positions had specific requirements such as that the student should know fluent Swedish, that the student should have relevant experience in animal research and so forth. The application can be made free of cost, but please be aware that most PhD positions are highly competitive. The link to the application portal of Gothenburg University can be found here. It is not uncommon that as many as 200 applicants apply for one position. Fortunately for me, there were only around 30 applicants who applied for the PhD position that I later got selected for. Many applicants are likely to have a specialist degree in the subject area, so you have to show in your CV and letter of motivation that you have some unique skills that is useful for that particular PhD project. If you want to see what a CV and letter of motivation (LOM) looks like, please leave a comment in the comment box below with your e-mail ID and I shall send my CV and LOM to you.

If you are a medical doctor, you can choose to study either pre-clinical or clinical subjects. There are usually more research opportunities in pre-clinical subjects than clinical subjects. Some projects require that you have experience working with animals or cell cultures. When you apply for pre-clinical subjects, be aware that you are competing with those who have a masters in that particular topic. For example, an applicant with masters in microbiology is likely to have more knowledge about COVID-19 vaccine than you. Clinical researches usually involve working with patient data. If your project needs that you have patient contact, it is very likely that knowing Swedish is a requirement for application. Some projects might require that you have a Swedish medical license, because you might also have to involve in examining or treating patients. A lot of information about the project will be available on the application page, but you can also e-mail the responsible Professor and ask for more details if something is unclear. Don’t always expect fast replies, though.

It is the Professor’s discretion to choose the person they think is the most suitable for the PhD position. You are more likely to get a position if you know academic English, have published research papers in the past, worked as a research assistant or have any other relevant experience related to the research project. Make sure to write about these in your CV or letter of motivation. Knowing Swedish language is a plus, especially if you are applying for PhDs in clinical sciences. In clinical sciences, you will often need to communicate with patients for data collection, which is why Swedish is usually an important requirement for clinical PhDs. In my case, Swedish was not mandatory because a good part of data collection had already been done. Professors usually take one to two months after the application deadline to find the right candidate. Most PhD vacancies are sent out around January (after Christmas) and September (after summer vacation), but you can always find a few vacancies on the Gothenburg University’s job portal regardless of the time of the year.

I had two rounds of interviews over Skype. In the first interview, I was asked about general things in life, my interests, my future plans, my experiences as a doctor, my reasons for choosing an academic career and so forth. It felt more like a friendly discussion than like an interview. I was asked to read through the thesis of a past student before I appeared for the second round of the interview. I read through the thesis and found it interesting, although many terms and concepts were new to me. I looked up as many unknown concepts as I could. The second round interview was more focused on my knowledge related to medicine and research, although I can’t remember being asked any tough questions. A week after the interview, I was informed that I got the job.

After the successful interview, I was asked to send my original certificates to the University for verification. My partner was returning to Sweden from India at that time, so I sent the certificates with him. It took around a month for them to complete the verification process and I was informed about the PhD admission officially from the University. I had applied for a spouse visa to move to Sweden at that time, so I switched it to PhD visa. I did this so that my visa application would be processed faster, because the waiting time for the PhD visa was shorter than the spouse visa. You can check the present waiting times for all visa categories here.

The duration of the PhD program varies depending on whether you perform lab duties and teaching or not. I got a 4 year program that does not involve teaching or lab work. It is not unusual to have 5 year and 5.5 year programs. It is wise to choose a longer program with teaching included if you are planning to continue in academia, because, with teaching, you can gain the relevant experience needed to get promoted as an assistant professor in future. If you instead plan to go back to the clinic or to the industry, a 4 year program would be more suitable for you.

I applied in November 2015, got interviewed in early February 2016 and got accepted for the position in late February 2016. My certificates got verified in March 2016. I then waited for two more months to get my PhD visa, and started working as a PhD student from June 2016.

Later posts in this series:

  1. Moving to Sweden as a doctor : Learning Swedish
  2. Moving to Sweden as a doctor: Medical license exam
  3. Moving to Sweden as a doctor: Practical exam
  4. Moving to Sweden as a doctor: Practical training