Moving to Sweden as a doctor: Starting Specialist Training

This is the continuation of my previous posts on starting a career as a medical doctor in Sweden. Today’s post is about my experiences in applying for Specialist Training (ST) in Sweden.

While I was doing my Practical Training (PT), I started applying for jobs. I was interested in continuing to work at the same vårdcentral that I did my PT, but because VG region had temporarily stopped recruiting ST doctors, I was told by my manager that I will not have a chance to continue there as an ST soon after PT. Moreover, Socialstyrelsen (Swedish National Board of Health and Welfare) had decided to roll out an additional requirement called BT for some foreign doctors. Doctors educated outside of Sweden who have not done their 18 months rotating internship (called AT or Allmantjanstgöring) within Sweden would have to undergo a training called Bastjänstgöring (BT). This requirement would apply starting July 2021. BT is a one year long training containing rotating internships in primary care, medicine, surgery, psychiatry and possibly other optional subjects. Since BT would be rolled out for the first time in 2021, there would only be a few positions available all over the country. The present status of BT positions at VG Region can be read here. Most foreign educated doctors will now have to go through the BT channel in order to go on and become a specialist.

It was February 2021. For me, the two possible career pathways were research and medical practice. In my case, if I should continue working as a medical doctor, the best way forward was choose a speciality and join specialist training there. For me to start the specialist training, I have to either get accepted to an ST position before July 2021, or do a BT first and then apply for ST. I heard at that time that it was possible for employers to offer you a ‘combined’ BT + ST, where you have to finish all parts of your BT within two years of joining ST. I investigated about this, but it looked as if no employer was giving such a combined employment at that time. I learnt from my friends that there was some confusion among the authorities regarding how BT should be structured and how often and how many positions should be offered. When I was looking for jobs in February 2021, no job vacancies for BT were advertised (eventually in May 2021, they advertised just 25 positions, and the earliest one could start BT was in November 2021).

It was hard to get an ST position in any speciality without having an experience of working as an underläkare (junior doctor) in the same speciality for a few months. There were very few ST positions opening up in VG region then, partly because of the temporary halt in recruiting ST doctors in family medicine. So, when I saw an advertisement for ST in radiology at Sahlgrenska, I just went in and applied in one go, without thinking too much about it. I also applied for two postdoc positions and I was not called for the interview for one of them, and I got rejected for the other because the position required that I teach in Stockholm. I was not interested in traveling to Stockholm every two weeks, so I gave up that job offer. I also applied for over ten temporary positions as underläkare in primary care (vårdcentral) in and around Gothenburg, but I was not called in for an interview. I was getting slightly frustrated at this point, so I planned that I would take up some volunteering project or simply take rest until I get a suitable job or BT. For those looking for jobs now, all current job vacancies with VG Region as the employer can be found here.

It was March 2021. On a fine Monday, I went through my work email and was surprised to find out that I am called in for an interview for ST in radiology. They had sent me the email a few days ago, but I had failed to see it on time. The interview was scheduled for the next day. With zero time to prepare for the interview, I would now have to get ready without any pre-reading. I had no previous experience working in radiology either. I liked radiology because it is a broad and general subject, it is similar to doing research in terms of having to read and discuss cases and it gives me possibility to work closely with clinicians and patients from all departments. However, I was thinking that, with my present CV, I would not qualify for this competitive position.

The interview happened on Skype, in Swedish, with two interviewers, my boss and study rector. I was told by the interviewer that they wouldn’t ask me any subject specific questions, because they expect me to learn the job on the go, and they do not always expect their specialist trainees to have any previous experience working in radiology. This was comforting for me, because this is not the case in many other specialities, particularly the surgical ones. During the interview, I got to talk about myself, my reasons for choosing radiology, my hobbies, my future plans, areas I am weak at, challenges I faced after coming to Sweden, a person who really influenced me, reasons for volunteering (at Wikipedia), how I cope up with stress, hobbies I enjoy doing, willingness to work during off hours, interesting things I learned at vårdcentral, details about the research I did for my PhD and so forth. I was told that the references I named in my CV will be contacted, and I will get a decision about my selection in one or two weeks.

In around two weeks, my boss rang me up on phone to inform that I have been chosen for ST in radiology. The starting salary was 40,000 SEK before tax. For those like me who have a PhD, the salary is 4000 SEK more, amounting up to 44,000 SEK per month. In addition, one can earn more by encashing the hours spent doing night shifts, weekend shifts and overtime work.

I started at the radiology department in Mölndal on 14th June 2021, just two weeks before rules regarding BT came into effect. Coincidentally, I also received my medical license from Socialstyrelsen on the same day.

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
  5. Moving to Sweden as a doctor: Practical training
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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
  5. Moving to Sweden as a doctor: Starting Specialist Training

Free Medical Images Collection

These days I am illustrating Wikipedia articles with images related to medicine. Sometimes, the existing image(s) on an article are too old, so I would want to add a newer, higher resolution image by replacing the old one. Some articles do not have images at all. A major problem for me was in finding the right image for the given article. Wikipedia accepts images/media that are CC-BY-SA or lower, so I had to go through the existing image repositories to find out those with the right license for Wikipedia. I decided to tabulate some of the image repositories that have medical content, along with the license they are shared under. I hope this would be useful not only for me, but for everyone else who are looking for free images related to medicine. Please note that this is not a comprehensive list, I have only included the repositories that I know of.

Source License Notes
Creative Commons search CC-varied Datasets from these collections are found on CC-search.
All Free Photos Free photos of all kinds
Burst Images Public Domain Free photos of all kinds
Medpix All Rights Reserved Medpix is a repository of medical cases run by the NIH, USA. The images are free for personal use, but need permission from the authors for any use other than personal. Contact the authors directly for permission.
Radiopedia CC-BY-NC-SA Collection of radiology images. Copyright rests with the author of the image.
Flickr Commons CC varied Media from Flickr Commons also shows up on CC search.
British Library Images from British Library, UK
ASH Image bank Fair Use A collection of hematology images. Login needed, free account creation.
Centre for Disease Control and Prevention Mostly Public Domain Images related to healthcare, diseases, health promotion etc.
Brain Biodiversity Bank All rights reserved Altas of human brain. Radiology images and 3D movies available. Free re-use permitted, contact the authors for re-use permissions.
US National Library of Medicine Fair Use Contain images related to. medicine. Obtain permission from the website for re-use. Permission shall be granted on a case-by-case basis. Some images are CC.
National Eye Institute CC varied Some images are CC-BY. Results can be found from CC-search.
Duke University Digital Repository CC-BY-NC-SA Contains advertisements and handouts of medical products
Visible Body All Rights Reserved Some content is available without subscription. Contains 3D anatomy resources.
3D Embryo Atlas CC-BY-NC-ND Media related to embryology
Bio Atlas Use with attribution Contains high resolution histology and histopathology images of humans and animals
CAOM Histopathology slides, pages are slow to load. From Poznan
Brain-Maps Histo- and gross images of brains of humans and animals
Cancer Digital Archive Image repository of oncopathology
Aurora M-scope Most images in Public Domain Contains histopathology slides. Needs a special software for opening the files in high resolution.
Heidelberg University All Rights Reserved Contains educational images related to pathology
Pathobin A platform for uploading pathology slides. Copyright lies with the uploader.
National Institute of Health, USA Public Domain Images are on Flickr, hence available using CC-search.
Europeana CC varied Contains media related to history of medicine and natural history
Fossil Forum Collection of fossils. Individual uploaders hold the copyright. Fair use permitted.
Medillsb Varied Website of the association of medical illustrators. Contact individual authors for re-use.
Medical Graphics DE CC-BY-ND Illustrations related to medicine.
LifeScienceDB CC-BY-SA Create your own photos and videos of human anatomy
Neuroanatomy CC-BY-SA-NC Neuroanatomy media. From University of British Columbia. Contains 360 degree views of the brain, MRIs etc.
Dollar Street CC-BY-SA Collection of everyday objects, people, families showing socioeconomic status of people around the world.
Cell Image Library CC-varied Mostly public domain images of cells.
Heal Collection CC varied Images for medical education.
Stanford Medical Library CC varied Images related to medicine from Stanford.
National Cancer Institute CC-varied Contains media related to cancer.
Histology Atlas CC-BY-NC-ND Histology images
Audilab CC-BY-NC-SA 3D images related to anatomy
Sketchfab CC-BY-NC-SA Illustrations related to human body
Open Access Biomedical Search Engine Can perform advanced search by License type
Science Images of Australia CC-BY Natural history, medicine images
Library of Congress collection Varied History of medicine
The noun project CC-BY Contains icons for general use and those related to medicine
Somersault Images CC-BY-SA-NC Illustrations related to medicine
Smart Servier CC-BY Illustrations related to medicine
Ghorayeb Images CC-BY-NC=ND Collection of images from ENT
Ecure Me All Rights Reserved Illustrations and photos of diseases
University of California All Rights Reserved Images of clinical signs and symptoms
University of Iowa All Rights Reserved Images of dermatological conditions
Internet Pathology Laboratory All Rights Reserved Images related to pathology
Atlas of endoscopy All Rights Reserved Images related to endoscopy/gastroenerology

Gandhian Philosophy and neurorehabilitation

This is the essay and poster on Gandhian Philosophy in Neurorehabilitation prepared for the 10th World Congress in Neurorehabilitation, Mumbai, India.

Gandhian Philosophy and Neurorehabilitation_Sahlgrenska


 

Neurorehabilitation is a complex process that involves minimization of neural damage and compensation of limitation of functions arising from neural disorders. New insights on neurorehabilitation can be gathered when observed from a Gandhian point of view. The perspectives, ideals, and vision of Gandhi are relevant today that one can find many parallels of principles from his life that are now used in medical practice worldwide.

Simplicity is prominently reflected in Gandhi’s ideas and way of living. His affinity to simplicity was evident even during his early days in England, when he cut down all unwanted expenses and chose to live in a modest setting. Gandhi firmly believed that happiness and prosperity are not bound to materialistic things but are derived from internal peace and satisfaction. He was against over-consumption and affinity to material possessions. The Gandhian virtue of simplicity has an important role in neurorehabilitation where the focus is on patient’s personal satisfaction and fulfilment. Oftentimes, the simplest of all interventions might be the most therapeutic to the patient. Some of the most complex life decisions of the patient can be changed simply by offering new perspectives. In neurorehabilitation, some of the most effective interventions such as mirror therapy and physical exercise are cheap, simple and inexpensive.

Gandhi had a holistic approach to his development as a complete social being. He did not divide his personal and private life into watertight compartments and mixed social, political and religious work harmoniously. He also believed that all life goals should be defined in such a way that it should make progress not only to one’s lifestyle, but also to one’s family, nation and the world. This philosophy of holism is one of the pillars of modern neurorehabilitation. A neurorehabilitation professional not only caters for the physical and psychological aspects of the patient, but also for the social and cultural dimensions of his/her personality. Neurorehabilitation involves working with not only the patients, but also their families. It also draws no boundaries between personal needs and social needs. Neurorehabilitation deals with several aspects of the patient’s life including nutrition, mobility, cognition etc. Thus, quality rehabilitation can be administered only by considering the patient as a whole, and not as a sum of organs.

Inclusivity and diversity were Gandhi’s core values. The ‘Hind Swaraj’ of his vision was the one where people thrived and cooperated despite differences in caste, creed, gender or religion. The same vision is applicable to neurorehabilitation in which all medical practitioners, caregivers, the family, and community have to work together with the patient to bring him/her to the fullest possible potential. There cannot be any hierarchy in terms of work division and everyone’s role is crucial in rehabilitating the patient. Gandhi emphasized that one’s action should be directed at the well-being of the poorest and weakest man (woman). This principle is of great importance in neurorehabilitation where the healthcare professional has to deliver the most care to the neediest and weakest patient.

Gandhi warned his followers that ‘healing should be its own reward’. In the present day world, medical care is commercialized and monetary reward is the primary reason for those involved in the healthcare industry. Gandhi had foreseen this problem as early as in 1925 when medical science was in its infancy. In neurorehabilitation where often debilitated patients might need lifelong treatment, it is inhumane to be acutely business-minded. Gandhi had also noted that science without humanity is the root of violence. In neurorehabilitation, the focus of the researcher and practitioner is on being compassionate, empathetic and tolerant. These humane values are emphasized more in neurorehabilitation than in other branches of medicine.

Gandhi had a life-long commitment to his ideals. His lifelong dedication to ahimsa and satyagraha are well-known and are praised by scholars and disciples alike. Similarly, in neurorehabilitation, the patients often need life-long care. Hence, neurorehabilitation becomes an integral part of the lifestyle of the patient. The patient and the healthcare professionals should work hand-in-hand, often throughout the lifetime of the patient to meet the goals of the therapy. Gandhian value of satyagraha encompasses the same philosophy: being patient, working consistently, and not stopping until the goal is reached.

The ideal community as envisioned by Gandhi is a reformed one where each individual works harmoniously to produce a self-sustaining economy. This aspect of community involvement is well-established in neurorehabilitation. The ‘social safety net’ provided by the state, and the ‘social cushion’ provided by the community are very important for patients needing neurorehabilitation. Community support and social awareness regarding neurorehabilitation are essential for enforcing policy change for accessible public spaces, pension plans and return-to-work policies.

It is evident that Gandhian philosophy is closely in alignment with the core principles of rehabilitation. Gandhi’s ideas and practices should continue to inspire healthcare professionals to seek provisions for applying ahimsa in various facets of their work in neurorehabilitation. In current times of intense competition, we, the healthcare professionals, must embrace Gandhi’s integrity and avoid the temptation to forego morality and empathy.