Here - American Austrian Foundation

1. Activities Undertaken:
Briefly summarize your daily activities.
With great appreciation to the AAF, I was given the opportunity to complete two months of
Internal Medicine rotation (Endocrinology and Infectious Diseases) at the George Washington
University Hospital (GWU). While the Endocrinology rotation was in the outpatient clinic,
the Infectious Disease rotation was inpatient, providing me detailed insight to both modalities.
On the first day of the clerkship, Rick James, senior education specialist of the GWU,
accompanied the medical students to the hospital ward. After being introduced to my
supervisors at the Division of Endocrinology, my first day began with a Grand Round in the
conference room of the Department of Medicine. (This style of lecture was held every
Monday; since the lecture was attended by the entire Endocrinology Team. It was a great
place for discussion and acquiring additional knowledge). Afterwards I accompanied my
attending to the outpatient clinic to see my first patients. Unlike the situation in the majority
of Austrian hospitals, the emphasis in the US is on “learning by doing”. First the attending
demonstrated to me several times, how to take a proper history, perform an exact physical
exam and how he expected a student to present a patient. Then it was my turn. Under the
supervision of the attending I saw my first patients. After getting comfortable with what I was
doing, I was allowed to see patients on my own for the remainder of the month. That means
after taking the history and performing the physical exam, I presented the patient to my
attending. Together we discussed my findings, and then made a diagnostic and therapeutic
plan. Afterwards I documented the patient assessment in the computer system; briefly
summarizing the history, physical exam, study results, assessment and plan. The way this
whole process works is entirely different to what I was used in Austria. However, having
read a rotation guide (see book recommendations below) before traveling to the US, made it
easier for me to quickly become a functioning team member. In my opinion this active
approach to medicine is of much greater teaching value as compared to a pure observer status.
After seeing many patients and doing some further reading on the clinical pictures seen, I
quickly became familiar with the most common endocrine pathologies such as diabetes,
thyroid-, adrenal-, and pituitary disorders. Very interestingly we also took care of many
transgender patients. Since I had limited knowledge in this field of medicine it was a unique
experience to learn more about it.
Every day at noon there was a so called “noon conference” for students, interns and residents.
Major topics of Medicine were presented by recognized clinicians from all the different
hospital divisions. The “noon lecture” was always one of the highlights of the day. Not only
because of the professional camaraderie, but also the amount of knowledge we could gain.
The second month I chose was Infectious Diseases. Here the emphasis was on Infectious
disease consult service, which is one of the most busy consult services in the GWU hospital.
The average is about 120 consults each month. Due to this I had the possibility to see a wide
variety of clinical pictures like patients with end stage HIV with opportunistic infections,
PML, endocarditis, severe sepsis and even malaria.
On this service we usually started the morning with checking on our patients and their most
recent results. Every student had a couple of patients to follow. For these patients the student
was “responsible” and wrote the progress notes as well. I worked together with highly
motivated fellows who taught me invaluable approaches in terms of patient care. In the
afternoon we rounded together with the whole team and the responsible attending on all of our
patients. During rounds we presented our patients to the attending (using the SOAP form:
subjective, objective, assessment, plan) and discussed the further diagnostic and therapeutic
steps. During this service we also had a daily Microbiology lecture in the Department of
Pathology. This way we had the chance to get a glance with the microscope on all the
organisms visualized in the different patient specimens, which actually caused the underlying
As per July 2013
Max Kade Clinical Clerkship Program
disease. This was an amazing learning experience. The pathologist was compassionate and
tried to show us exactly how the problem presents from a pathologist’s point of view.
Therefore we had both, the clinical and the pathological approach to our patients’ problems.
At the end of both electives I held a presentation, which was very well received.
2. Problems:
What problems did you encounter during the fellowship and how did they affect your original
plans?
Most sincerely, my Max Kade colleague and I did not have to face any problems at all.
Thanks to the perfect organization of the American Austrian Foundation and the George
Washington University the fellowship was a great experience, from the first to the last minute.
At this point I would also like to thank the American Austrian Foundation for giving me this
unique possibility to complete part of my medical studies in the USA. Especially I want to
thank Mag. Kerstin Wahlmüller for her great support. Not only during the application process
but also the fellowship Mag. Wahlmüller was always there for her students. She ensured that
everything was perfect. I also want to thank Rick James, senior education specialist of the
GWU. He was our mentor during the clerkship and handled all the organization from the US
site. Already at the first meet and greet in DC, he welcomed us heartily and ensured, “if you
need anything during your stay, no matter what, you can always come to me.”
3. Recommendations:
What suggestions or recommendations do you have to improve the operation or
administration of the Max Kade / AAF Clinical Clerkship Program?
To my mind the operation and administration of the Max Kade Clinical Clerkship Program is
perfect. I cannot think of any suggestions for improvement.
4. Influence on Thinking:
In what ways, if any, has your thinking been influenced by your experiences during this
fellowship? Please explain. Describe any new perspectives you have encountered as a result
of the fellowship.
I think that during my fellowship I have learned from probably the best medical doctors in the
world. I experienced their dedication and effort for both patients and students. Just to give you
one example: One of our attendings took not only the time to teach us during the normal
clinic hours (presentations, case discussions...), he also stayed at the hospital to show us hands
on how to perform an Ultrasound guided procedure. Instead of going home he just said to us
students: "Hey guys, my last patient didn't show up. So I have some time for further teaching.
Come with me and I'll show you how to perform a fine needle aspiration of the thyroid..."
Dreaming of a career at a university hospital I have learned what great physicians and great
teachers can be like. I try hard to become what my mentors in Washington DC are now.
5. Fellowship Experience:
How has this fellowship broadened your knowledge of American medicine and culture?
This fellowship provided me with unique insights in the American healthcare system and
American medicine in general. With coming to the US I started to see the differences between
the health care system in Austria and the US. Besides which living in the nation’s capital for 2
months was a lifetime experience. This means not only working in an unparalleled medical
As per July 2013
Max Kade Clinical Clerkship Program
teaching system but also learning about US culture and history. By spending time with
patients, US colleagues and teachers I learned more about the American way of life.
Furthermore Washington DC is a multicultural city and the International House DC a great
place to meet people from all over the world. Intercultural exchange is one of the major goals
in the ISH DC.
How do you think this experience will influence your professional life?
This fellowship for sure has major influence on my future professional life:
As I worked together with US students I got familiar with valuable information regarding
studying and working as a doctor in the US. Since I am absolutely delighted with the US
medical training system, I am thinking about applying for residency in the US. This
fellowship provided me with knowledge about the whole application process (e.g. USMLE
steps, Letters of Recommendation, Programs and Program Directors…). Additionally, with
completing this fellowship I can prove to my future employers that I am able to work
successfully in the US health system.
6. Recommendations for future Max Kade students:
Please address the following points:
•Housing (Where did you live during your stay? How did you find it? How much was it?)
•Recommendations (What suggestions or recommendations do you have for future Max Kade
students (hospital, leisure time, etc.)?
•Other (Is there any other vital information you would like to share with future Max Kade
students?)
Housing: My Max Kade colleague and I stayed at the International Student House DC (ISH
DC). This is an exceptional place to stay. Located near Dupont circle, one of the best areas of
Washington DC, the International Student House provides safe housing for about 100
international students from all around the world. All residents of the house are very
welcoming and it is very easy to quickly become a part of the community. Together you can
spend your spare time in the house (table tennis, piano room, tv lounge, library…) or take part
in one of the many activities provided (scavenger hunt in the national mall, excursions to
museums, “Oktoberfest” and many more…)
You can choose between single or shared rooms depending on personal preference and the
amount of money someone is willing to spend (1200-1400 Dollars). On weekdays breakfast
and dinner, on weekends a continental breakfast and a so-called “family dinner” are provided.
The George Washington University hospital is quite near and you can walk (20 minutes), ride
there by bike or take the metro from Dupont Circle Metrostation.
Books: I would like to recommend a few books which will make it much easier for future
Max Kade students to take part in the daily hospital routine in the US.
Every US student and also most of the interns and residents have basically two books in their
white coats:
Maxwell Quick Medical References and Pocket Medicine (The Massachusetts General
Hospital Handbook of Internal Medicine). Both books are very useful tools and fit perfectly in
every white coat.
The Maxwell Quick Medical References provides the essential information (lab values,
physical exam, notes…) for the daily clinical practice.
Pocket Medicine is a short and well-structured summary of all fields of Internal Medicine. It
is perfect to quickly review the key points of a clinical picture before, during or after rounds.
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Max Kade Clinical Clerkship Program
Especially for Austrian Students I can recommend two very useful books:
Medical English by Peter Gross and Success on the wards by Samir P. Desai.
Medical English is very good language training for all students working the first time in the
US. Besides the basic vocabulary, also clinical cases and a guide on how to write notes are
included. The included extra booklet containing of commonly used medical abbreviations is
very helpful, especially in the first days of clinic service.
Last but not least I want to mention Success on the wards by Samir P. Desai. This book
includes 250 rules for clerkships success. To my mind this book is one of the best guides on
how to maximize one’s clerkship education. Reading this book before coming to the US
provided me with great information and strategies for success at the George Washington
University Hospital.
Hospital: For all future Max Kade Students who are not sure where to go: I can totally
recommend the George Washington University Hospital, especially the Division of
Endocrinology and the Division of Infectious Disease (Department of Medicine). Both fields
are unbelievably interesting and you will work and learn from attendings who are not only
experts in their respective fields but also highly motivated and impassionate teachers. Not
only the attendings, but also the residents and fellows will teach you a lot. Once you are a part
of this efficient team you will enjoy your work a lot.
Leisure time:
Washington DC is a great place to live. The nation’s capital provides visiting students with
everything they can dream of.
The national mall: This is the place where you can find all the famous sights. You will be
astonished seeing them for real. There are also the famous Smithsonian museums. My Max
Kade colleague and I especially enjoyed the Air and Space Museum. Amazing.
Mt. Vernon: home of George Washington, first President of the United States.
Sport: We enjoyed playing tennis and soccer in the area of Adams Morgan. Everybody can
use the sport facilities there for free. The area of Adams Morgan is also famous for its
nightlife.
Weekend trips: New York City (“The City That Never Sleeps”) and Philadelphia
(“discussions for the democracy via the Age of Enlightenment”, “Pennsylvania Hospital - the
nation's first hospital”…) are not far from Washington DC. Going there by bus or train is not
expensive and definitely worth doing. Both cities are wonderful; after returning home from
our weekend trip from New York City, Washington DC seemed like a welcoming home city.
As per July 2013
Max Kade Clinical Clerkship Program
MAX KADE CLINICAL CLERKSHIP IN AMERICA
FINAL REPORT FORM for AUSTRIAN STUDENTS:
Instructions for preparing this report:

Prior to departure from the USA, each fellow is required to send a final report to the
Executive Director of the American Austrian Foundation at:
[email protected] (Please delete capital “A” in the email address)

This report should be typed. At least 1,5 pages
PERSONAL DATE:
First / Last Name
Stefan Moesselberger
Date & Place of Birth:
23/05/88- Rottenmann
Address: (Street, City, Zip
Code, Country)
Burggasse 12, Graz, 8010 Graz, Austria
Phone: (Mobile):
00436502490228
E-mail:
[email protected]
Gender:
Female
Male
Fax:
PROFESSIONAL DATE:
Dates of stay in the USA:
1st Jan 2013- 26th February 2013
Hospital and Department
George Washington University Hospital- Cardiology and Pulmonary
Medicine
Dr. Mercator, Dr. Delaney
Mentor:
On a separate sheet of paper, please address the following questions fully and in the order in
which they appear below.
1. Activities Undertaken:
Briefly summarize your daily activities.
2. Problems:
What problems did you encounter during the fellowship and how did they affect your original
plans?
3. Recommendations:
What suggestions or recommendations do you have to improve the operation or administration of
the Max Kade / AAF Clinial Clerkship Program?
4. Influence on Thinking:
In what ways, if any, has your thinking been influenced by your experiences on this fellowship?
Please explain. Describe any new perspectives you have encountered as a result of the fellowship.
5. Fellowship Experience:
How has this fellowship broadened your knowledge of American medicine and culture?
How do you think this experience will influence your professional life?
Date
As per July 2011
14th March 2013
Signature Stefan Mößelberger
Max Kade Clinical Clerkship Program
Max Kade :
Final Report, Austrian Student
George Washington University Hospital
Stefan Mößelberger
1. Daily Activities:
Before starting my rotation with clinical cardiology on 2nd of January there was an IT
training course, in which we were taught about the documentation programs in use.
The first two weeks I was in Gold team- the Cardiology team of the Hospital. In those two
weeks, Dr. Tracy was the attending in charge.
Usually I started around 7am at the 3rd floor, where I looked for patients, prepared for the
morning round- which included sometimes the presentation of patients.
At 8 am there was a morning conference from Monday to Thursday, which took place two
times on the sixth floor of the building and two times in the nearby MFA building.
We were supposed to attend those conferences, except we were busy dealing with
patients.
In those conferences we discussed a hugh variety of medical subjects (ECG, MM, new
interventions...).
Morning round took place from about 8: 15 to usually 1pm- depending on the issues to
talk about +/- 2 hours.
We looked for all patients of Gold team, discussed therapy plans, social care issues, and
so on.
At 12 there was usually a class, we attended in case there was time.
We were also lucky to attend an excellent ECG course, taking place at 3pm at the MFA
building. We were taught a very practical understanding of an ECG and also took the
exam with good success.
The clinical day ended usually around 6pm, we had a short final discussion about the
developments during the day.
We also had 3 oral exams, where we could show our knowledge to Dr. Mercator and also
got a very good feedback. We also did a presentation of a topic our own choice (Clincal
case presentations in my case).
The 3rd week of our rotation we spend at the echocardiography, which was very
interesting. We had the luck of having DR. Louise and Dr. Bazil- who were very
interested in teaching us a good understanding of the echo.
The 4th week was in the Cath lab, which was very interesting, but also very theoretical, as
we were not allowed to assist- so it was watching and learning most of the time this week.
To sum it up- Clinical Cardiology is quite a challenging rotation, where you learn a lot , it
is not so much about practical skills (we hardly did interventions on our own), but more
about gaining a big fund of knowledge. So it is perfect when you want to learn ECGs,
Echoes, and Cardiology in general.
2nd Rotation: Critical Pulmonary Care:
My second subject was much more practical then my first one:
As per July 2011
Max Kade Clinical Clerkship Program
I got my own patients, which I took care of. Usually 2 to 4, I took the admission
(+examination of course), looked after them in the morning- wrote sometimes the daily
note progress, presented them in the morning rounds, discussed about therapy plans, also
suggested further intervention...
I was kind of an AI position, always under supervision ,of course.
I think I made a big step forward in my practical skills doing this program.
I also want to mention that Dr. Delaney was a great help, he took a lot of time explaining
everything to me and took a big trust in me. I am very thankful for his excellent
mentorship.
2) Problems:
There were some administration problems:
 The IT training course we were supposed to take online wasn’t working at all- so it
was impossible to perform the task.
 I wanted to do Endocrinology for my second subject- but Rick told be just 2 days
before my start, that there was no place left.... Finally I was very luck getting into
Pulmonary Care.
Also sometimes it can be very challenging spending all day in the hospital...
3) Recommendations:
Reports of other students should be easier available, so that you can choose easier between the
different departments with a bigger fund of knowledge...
The applying process is also very complicated and full of bureaucracy... sometimes I had to
send my documents three times...
4) Influence of Thinking:
I started to think more about the patient’s social background, and how to manage especially
chronically diseases in daily life.
5) Fellowship Experience:
I am not sure how it will influence me exactly. Since I saw the American health care system I
am more and more grateful of the Austrian one. So I am definitely sticking to a government
based health care system.
There is also an excellent, high performance and high technology kind of medicine. Where I
am sure- one can learn a lot.
I also notice, that there is much more competition in the American system.
So it is a lot about taking opportunities.
All in all it was a great experience and I am thankful for this clerkship!
As per July 2011
Max Kade Clinical Clerkship Program