What’s New in Internal Medicine?

Sep 12, 2020

Headed by Dr. Kristin Burkhard from Columbia University Medical Center and Dr. Guenter Weiss from the Medical University of Innsbruck, the first OMI Seminar following the COVID-19 shutdown took place from September 6 to 12, 2020 at Schloss Arenberg.

16 fellows from 10 different countries, selected from 375 applicants, were eager to learn from an expert faculty. The six OMI faculty members created an excellent learning environment for the OMI fellows, covering the most up-to-date information in the fields of pulmonology, infectious diseases and endocrinology.

Dr. Gloria Leksic, an OMI fellow from Zagreb, Croatia shared her impressions of the seminar week in Salzburg in a diary. Enjoy reading!

Sunday, September 6, 2020: “Arrival Day – Schloss Arenberg”

I arrived at the train station in the centre of Salzburg at 1:48 pm. With the help of instructions, I easily found the right bus to get to the “Volksgarten” station, which was my destination address. I was pulling my big suitcase as I came across a large set of doors that looked like the entrance to a castle. And indeed, it was a castle, “Schloss Arenberg”. Although I have seen the pictures of the castle online, it was not comparable to seeing it live. To be honest, for a couple of moments I felt really “royal”. My room was on the fourth floor looking to the large garden of the castle with a wonderful view of tall trees and green grass with a peaceful silence all around. At 7 pm, the welcome reception started. Professor Aulitzky gave a speech about the upcoming seminar. He shared with us all the problems they had to deal with to organize a seminar during a pandemic. It was not easy, but with enough persistence and optimism they made it happen. Then, we had an excellent dinner. I was sitting with a family physician from Lithuania who told me about barriers he has to deal with in his everyday practice. For example, they cannot properly and completely diagnose patients because of limited financial resources. Also, patients have become more demanding and opinionated, thinking they have a right to order therapy for themselves. Family physicians, “door-keepers”, are on the first line with this and it is not an easy task.

Monday, September 7, 2020: “Wake-up day”

As every Monday should begin, so begun this one – with an alarm. Breakfast included coffee and everyone walked slowly to the conference room. It was the first morning, so the chatter between the participants was still quite modest and shy; limited to the colleagues with whom you had breakfast. The first thing we did was a pre-seminar test. It was interesting, with a wide range of questions. The first lecture was given by Professor Steininger, who presented the challenging topic of emerging infectious diseases. He was a great speaker, so it was easy to follow his presentations. He gave me (as an internal medicine resident who had little interest in infectious diseases except for COVID-19) a good overview of infectious diseases, which were kind of forgotten in my everyday practice, but that are actually very important and can easily burst again, like measles, zika virus, chikungunya. During the rest of the day, there were lectures on tuberculosis and preoperative risk assessment, and my favourite lecture was about adrenal insufficiency. The most important thing I learned from these presentations (except for new knowledge) is how to think about diagnostics for a patient. That is why learning from books simply cannot replace a good teacher. All the teachers are great speakers and were very well prepared on the topic. After every lesson, we had interesting discussions and each question from the public was thoroughly answered. Doctors from Columbia University were giving lectures over a big screen in the Grand Hall, but such a high-quality technical equipment was used that it seemed like they were there were with us in the room. At the dinner, I had a talk with an internal medicine resident from Czech Republic and he told me about the positive experience in his country regarding the salaries, which significantly increased in the last years, so they do not have a big “exodus” of physicians (like Croatia does). Maybe we should try to follow these politics regarding medical staff.

Tuesday, September 8, 2020: “Do we actually know how to prescribe an antibiotic?”

Tuesday started with a lecture about antimicrobial drug resistance. Professor Graninger gave us one of the most interesting lectures about bacteria I have ever heard. He thaught us that when prescribing antibiotics, we should not be blinded by recommendations and guidelines, but rather to always stay critical and reassess the patient status together with antimicrobial results. The next presentation was a total surprise – it was about malaria, and there were some stunning facts. Although 90% of the cases are in Africa, we should be aware that the climate is changing and mosquitos carrying a parasite have a good chance to spread their geographical area. Nowadays we are all very worried about COVID-19, and regularly counting infected patients. However, the lecture about malaria helped me to widen my point of view because every year there are 2 billion (!!!) people infected with malaria. Why doesn’t that hit the headlines? Afterwards we listened to case presentations of our colleagues, which were all really interesting and very educational for our everyday practice. In the afternoon, Professor Labella had a lecture about life-threatening rashes. It was a great topic because in internal medicine, we rarely receive education on skin changes, often neglecting this biggest human organ that can actually tell us so much about the patient’s health. Then there was my favourite part: an endocrinology session about adrenal incidentalomas. Professor Lonier gave us really clear and simple guidelines about what to do with this nowadays increasing diagnosis due to more frequent radiological work ups. After the lessons, I went to the city which is so enchanting. I just got “lost” between baroque buildings, castles and surrounding mountains. I did not have any specific goal, I was just wandering around, enjoying the sun. I spent a dinner with colleagues from Slovenia, Austria and with Professor Graninger. We had a long chat about the current situation in politics, different health care systems and perspectives for the future. Also, Professor Graninger was explaining the process of the development of antibiotics and how it is actually hard to get new antibiotics and that we should be very careful with the ones we have, because there is no “back-up” when we spend them.

Wednesday, September 9, 2020: “COVID-19 Day”

I had breakfast with a colleague from Germany who shared about his residency experience. They have a very well-structured programme for residents, but in the everyday practice they must “struggle” if they want to learn some new procedures or techniques, for example ultrasound or some puncture. You have to find a senior physician who will show you that and also to find time to do it in the everyday rush and “thousands” of patients you have to examine. I always thought that it was much easier for residents in Germany but now I realize that we all deal with the same issues, no matter which country we are in. Although we have been hearing about COVID every day for the last six months, this COVID talk was different. The lecture was held by Professor Weiss, who is a pulmonologist and specialist for infectious diseases. So, you can imagine how great this synthesis is in the COVID era. Really valuable information about COVID pathogenesis, treatments, and the future. We had so many questions so that when the lecture was over we “attacked” him during lunch and continued with our dilemmas, which he clearly answered. In the afternoon, we learned about sexually transmitted diseases which was a good reminder for internal medicine residents, as we do not deal with them that often. But, I think is important to have that in mind because STDs can come with various systemic symptoms. Then, we listened to Professor Labella and her updates on alcohol withdrawal treatment, which was a great lecture because we often have these kinds of patients and there are no clear guidelines for how to deal with it, so it was very helpful for me. During dinner, I was listening to the experiences of a colleague who was working in Switzerland. They have really different work habits, and a different way of living than Croatians. They work 12 hours per day, and when it is needed, they stay longer to finish the job – it is not paid, which is actually a problem in every other country. I always thought that Croatia is so unfair because extra hours are not paid, but when I heard that it is happening also in Switzerland, I see it as more of a normal thing.

Thursday, September 10, 2020: “No SABA for Asthma”

The morning started with the lecture from Professor Studnicka about lung nodules and masses. It is an emerging diagnosis without clear clinical implications. He presented very simple guidelines on how to treat these patients. “No SABA for asthma” was the next lecture. It was actually one of the most surprising, but also enchanting, conclusions about asthma. The most crucial part was that Professor Idzko brought it from the most recent pneumonology meeting, which had been held only two days ago, so we were informed on the most recent guidelines. I spent lunch with a colleague from Czech Republic and I was convincing her to use ultrasound more often because it is considered the stethoscope of the 21st century. I hope I gave her enough pro arguments to use it more often. The afternoon started with Professor Miko, who gave an excellent lecture on outbreak investigations, which is enormously useful in this era of COVID. Every day we are fighting with new COVID numbers, including incidence, prevalence, rates and so on, and after this lecture I am sure that we can much more easily handle these epidemiological terms. He also told a story about a missionary hospital in Central Africa, which did not have adequate hygiene standards and became a source of a virus spreading. So, when western countries are working to help Africa, especially when offering medical help, there should be some minimum standards with strict control, which were missing in this case. Afterwards, Professor Lonier held a lecture about congenital adrenal hyperplasia. With that lecture, we said farewell to our Columbia University teachers. They taught us a lot; they were patient with each of our questions and I really enjoyed all the lessons even though they were livestreamed. Thank you for your efforts, you were great! Moreover, I must not forget all the case presentations from my colleagues, which were excellent. They presented hard cases, and showed their own way of handling them and that will surely be helpful in my future work. Also, an important thing that we learned from one of our colleagues is that we all should always think about vitamin D when doing work-ups for patients. The late afternoon was reserved for going to the city. I went to the centre, enjoyed a coffee by the riverside, and visited some of the local libraries. In the evening, our Slovenian friends organized a small gathering in the lobby, and it was so nice to sit together talking and laughing, and Professor Aulitzky joined us to tell his experience about past seminars. We had a great evening.

Friday, September 11, 2020: “Farewell”

This was the last day at the seminar. It is hard to believe that the whole week is already behind us. I am really sad. In the morning we had lectures about COPD and bronchoscopy that were really interesting. Afterwards we took a post-seminar test and it showed me how much I have learned during this week. And learning is not only knowledge, I will cite Professor Studnicka here: “This seminar is not only about providing knowledge (you have it in your books), it is about sharing experience.” To conclude this small diary, I must say how flattered I am that I was chosen for this seminar, and I am very thankful for everything that organizers have provided for us.

A big thank you to Professor Aulitzky who made this seminar happen despite all the problems during the COVID-pandemic, a big thank you to Ms. Faschang who was associate director of the seminar, also to all of our American teachers for bringing their lessons to us, and of course a big thank you to all the other people whose names I do not know, but who supported this beautiful event. I am travelling back to Croatia with so many new impressions, and I cannot wait to share this knowledge with my colleagues at home, and especially to tell them “Do not use SABA for asthma!” 😀

P.S. During the seminar, all the participants strictly followed the recommended guidelines on how to behave during the COVID-19 pandemic.

Diary of Gloria Leksic, MD (University Hospital Center Zagreb, Department of Internal Medicine, Zagreb, Croatia)

Click here to read this week’s seminar report!