Since it’s inception in 1987, over a million students in 32 countries have taken advantage of the European Union’s Erasmus exchange programme; living and studying at universities in other member states(1). British medical schools are slowly realising the value of time spent abroad as an undergraduate, with several offering short, Erasmus-funded opportunities in Europe, usually as a student selected component (SSC)(2)(3)(4). For most UK medical students, however, the typical “year abroad” available to students in other faculties is simply not on offer, due, in part, to the inflexible and highly structured nature of medical courses in the UK. That said, accounts of such exchanges do appear occasionally in the literature, proving that, with enthusiasm and perseverance, it is possible for students to arrange and participate in highly rewarding programmes abroad(5)(6).

Studying medicine at the University of Tübingen (below left) in southern Germany between my 3rd and 4th years was the highlight of my medical education so far. I returned to Leeds with my ideas about everything from doctors' working hours to abortion challenged by participation in a system that made me think differently. I learned a new language, gained experience in many clinical specialties and broadened my horizons through contact with students and health care staff from Germany and all over the world. My first semester consisted of various language courses and a limited timetable of medical lectures and seminars in neurology, forensic medicine and tropical medical research. By the second semester, I was confident enough to start hospital-based teaching, or Wochenpraktika, in various specialties, roughly comparable to 4th Year clinical medicine in the UK. By the end of the year, I was comfortable assisting in operations, taking histories and examining patients in German. This had all seemed very unlikely eighteen months earlier, as I spent the long, dark winter in Leeds (below right) sifting through conflicting and confusing advice and regulations in a bid to set up the exchange. This article aims to clarify the steps that individual UK medical students wishing to study in Europe need to take in order to set up Erasmus exchanges.

Timing: It is technically possible to study abroad between any two years of your course, but it is the clinical years when the benefits of overseas experience are most obvious – interacting with and learning from health care workers and patients in a different health system.

Study Abroad Office: This is the place to start. The support of your university’s Erasmus co-ordinator is vital, and their level of helpfulness and enthusiasm will be key. They should be able to supply you with contact details of their counterparts at the universities you are interested in and, once you’ve got a positive response from your target university abroad, will process most of the bureaucracy for you.

The Medical School abroad: Many UK universities already have institutional links with European partners in several countries to which they regularly send students from various faculties – it can be a good idea simply to approach their medical school as expanding existing links can be easier than starting a fresh one. Failing that, European medical schools are generally very keen for their students to gain experience in English-speaking countries, so the offer of establishing a new exchange is often met with enthusiasm. In either case, make contact by identifying and sending an email to the Erasmus co-ordinator at the university abroad, who will direct you to the appropriate contact at the medical school. You can decide with them which semester to join and which courses to take. Countries taking part in Erasmus are the 25 member states of the EU, candidate countries Romania, Bulgaria and Turkey, and EFTA members Swizterland, Liechtenstein, Norway and Iceland (see map below.)

Your Medical School: Even the most supportive sub-dean can have reservations about the idea of initiating an exchange with a foreign university, so being clued-up about the technicalities of Erasmus is essential before your first meeting. Most bureaucracy is dealt with by experienced staff at the Study Abroad Office, although some involvement from senior staff will be necessary. Students are exchanged on a one-for-one basis, although many European universities operate a 2-semester year, and may prefer to send 2 students for half a year each. Financially, the medical school does not lose out; it receives the same amount of money as it would do if you stayed. It is standard practice to initially arrange exchanges on a trial basis for one year only, so there is no risky long-term commitment. Also, the quality of students from the partner university is usually extremely high as the premium placed on studying at an English-speaking institution results in competition for places on the exchange. Finally, by hosting a European exchange, your medical school can make itself more attractive to potential students and underlines its international credentials.

Finance: Studying in the EU on Erasmus is free. You pay no tuition fees to your host university and, if you spend the full year away from your home university, you pay none in the UK. Grants are offered to all participating students – in 2004/05 it was in the region of £1500 for the year. Medical students, along with all non-language students, are also eligible for €400 to pay for private language courses in addition to the free Erasmus language courses provided by your host institution. You’ll still be eligible to apply for the full student loan from your local education authority. It has recently been confirmed that a full-year Erasmus exchange is counted as a “year of study” in the same way as an intercalated year with respect to the NHS bursary – a government grant available to UK medical students from their fifth year of study onwards. More information is available at www.erasmus.ac.uk. >>article continues below>>

Erasmus - participating states (2005)

Language: Most medical schools in Europe teach in the local language, although there are exceptions where courses are delivered in English or German. A basic grounding in the local language is essential – opportunities to improve on this, in the form of intensive pre-semester language courses, are easy to find, and are subsidised by Erasmus. A minimum of an A-Level is recommended, but a good GCSE pass and hard work and commitment on the language courses can suffice.

Conclusion: In a recent email, a spokesman for the UK Socrates-Erasmus Council confirmed that "we are keen to see medical Exchanges increase and welcome points in support of what has traditionally been a difficult area. Our position on all Erasmus placements, regardless of subject area, is that they should be encouraged and we actively support Higher Education Institutions to set up and maintain links." For some medical students, studying an additional year of medicine abroad through Erasmus can be a challenging and exciting alternative to intercalating or progressing directly with their medical course in the UK. Living and studying medicine in a new environment exposes students to new clinical methods and thinking as well as equipping them with invaluable linguistic and interpersonal skills. Setting up such an exchange requires initiative and perseverance, but the rewards are immense and life-long. The situation at different medical schools may vary somewhat, but the information in this article should provide a good base from which to start.

Good sources of further information: Talk to your university’s Study Abroad Office. Watch L’Auberge Espagnole – A brilliant film, available on DVD, by Cédric Klapisch about a young Frenchman studying in Barcelona as an Erasmus student. Go on a Night Out with your university’s Erasmus society, many of which organise lots of different events for international and local students to meet each other - great for practicing your language skills and finding out about potential host countries. Look at the Erasmus homepage – www.erasmus.ac.uk. It’s full of information about the scheme and links to other useful sites.

References

1. http://europa.eu.int/comm/education/archive/million/million_en.html

2. http://www.medici.bris.ac.uk/student/exchange.html

3. http://www.liv.ac.uk/FacultyMedicine/handbk/Erasmus.html

4. http://www.qub.ac.uk/fmhs/Electiveshome.htm

5. Desai, M. Du pain, du vin, du fashion. sBMJ 2003;11:340

6. Gray, L D. Erasmus: Alpine retreat. stBMJ 2003;11:338