Portrait | International

They make the Université de Lyon: Ivan Bittar

On The December 2, 2020

China

Ivan Bittar is a tutor and instructor for the French-speaking section in Shanghai. His one-year tutoring and teaching assignment at the French Medical School is part of the “Filière médicale francophone à Shanghai” project managed by the Université de Lyon and funded by the Région Auvergne-Rhône-Alpes.

How did you find out about this mobility program and what led you to get involved?

The resident who took part in the program the previous year had posted a message about the assignment on the Lyon interns’ Facebook group. So I discussed it at length with my predecessor, who was still in Shanghai at the time, to find out exactly what was expected as part of this assignment and to learn more about his experience in this position. I was particularly interested in taking a break from my residency and going abroad, all while still being paid. I applied because, for several years now, I have wanted to move away from the well-beaten path of traditional medical studies. I also wanted to go to another country, not just as a tourist, but to live there and really experience the culture. When I was in my fifth year, I had already completed a one-month internship in China at the Sino-French Hospital in Suzhou (near Shanghai), which I have very fond memories of. It was during this internship that I was able to learn about hospitals and medical studies in China, and I even had the opportunity to observe some consultations.

How were you selected for this assignment?

I simply contacted the people in charge of the assignment, in particular Prof. Patrick Mertens, with whom I had an interview to discuss my reasons for applying and to learn more about this initiative. He explained the assignment in detail, which involves establishing clinical cases to present during French tutoring of Chinese students, running a French-speaking space focused on non-medical French culture, and preparing for the arrival of Chinese volunteer residents in France for the year 2020-2021. Roughly one month after my interview, I was officially awarded the position for 2019-2020. So there was no real special procedure (such as a competitive examination).

What was your daily routine like during your stay?

I am very pleased with the welcome I received on site and the support I received at each of the necessary stages of my stay. My role was to act as a tutor for the different classes of Chinese students in the French-speaking sector. My main task was to prepare clinical cases in French in order to encourage students to use the medical French vocabulary that they had only learned in theory. I taught them the methods to be used in basic clinical situations, the practical steps to be taken when taking care of the patient (what are the essential signs to look for, what tests to order, etc.). Applying such methods was all the more important for candidates applying for an residency position in France. During exams, I was pleased to see that the sixth year class had applied the advice they had received in class. This was also noticed by the instructors, who seem to have been very satisfied with the overall level. I also spent a lot of time talking with my Chinese colleagues who are in charge of managing the students in this program, and with a few Chinese professors, since the assignment involved preparing exam papers, correcting the papers and sitting in on oral exam juries.

Do you think that France and China have a different approach to medicine and the way it is taught?

The Chinese health care system is very different from the French system. Not so much in terms of techniques, but rather in terms of organization. For example, there aren’t really any private medical practices in China; everything is done in hospitals or clinics of various sizes. Patients simply go there and are examined on the spot. Also, a 15-20 minute doctor’s appointment is difficult to imagine in China. Doctors see more than 100-150 patients each day, often spending only two to three minutes with each patient. So it’s quite perplexing and rather difficult for us to understand how they can practice medicine with such short consultations, but I suppose it’s because we do not have the same number of patients to treat. You look at things a little differently when you come back to France. Also, medicine is taught in a different way: during the internships, the students draw blood, check blood pressure and oxygen levels, have daily academic visits (the professor sees the patients and all the students follow them), and review their courses. As for new residents, they are given fewer responsibilities than in France. They take care of post-surgical dressings, for example, whereas this is more of a nurse’s role in France. They watch their superior when it comes to patient care and prescriptions, but they don't really get involved themselves at the beginning.

How would you sum up this experience?

This assignment involves taking one year off from your residency, which means requesting a two semester break. Since I hadn’t started my thesis at that time, it was quite nice not to have to think about it for a year. That being said, it is possible to continue your thesis while working in this position, which has been the case for a number of my predecessors. This experience is something I will always look back on with great fondness. It allowed me to take a step back from my residency while keeping a foothold in medicine. Explaining things to students, especially non-French students, requires a different approach; it is not enough to understand the subject yourself, you have to make sure that they understand it, too! We had to adapt the vocabulary quite a bit, and even make comparisons that may seem a bit silly. We had to use a lot of gestures, onomatopoeias, pointing to things, and we changed the slideshows to include diagrams, drawings, photos, etc. The French Medical School went to great lengths to adapt the program so that it could continue throughout the pandemic. For example, it has introduced a number of online classes. Without them, most of the training sessions would not have been possible. The sixth-year students could sit their written exams on a computer, so that all documents could be sent to the various examiners by e-mail, and the oral exams were conducted by video link, so the overall exam process was “almost” normal. This rewarding experience makes me want to do something similar in another country, but I’d like to finish my residency first. This will surely influence my career in one way or another; it has made me want to get off the beaten track even more than before!