I couldn't have phrased it better than
@DoctorS84.
to be honest.
1. adding to what's been said already.
(elaborating as..I'm now wondering if you were after a more specific response after repeating the question)
worst case scenario, it's very minimal hands-on experience in surgery compared to the states.
I'll be quite frank. there are students who may never get to suture during an entire surgical rotation, let alone close. the retractor was it, or doing the IDCs. yay.
again, if you do your research, you can get some hands-on and learn some surgical skills.
for instance, once you attend a medical school, ask around to find out which of their hospitals (or clinical schools) offers the best surgical experiences. ask other students and upper years, or do shadowing as a first year to find out early. then you can try to be a clinical year student at site with better hands-on. nothing is handed to you in Australia however, you have to earn that trust sometimes and be proactive. versus much more is expected from students in the USA, you're not allowed to be a passenger or observer and expect to pass. In Australia, scrubbing in and closing is not a common expectation of students, depending on hospital, it may not even be expected of interns.
the point to the Australian system in the clinical years is to make you safe to be an intern, looking after patients in clinic or the wards, not performing surgery. it was important to go to theatre as a student, but to get an idea of what surgery was about and what the common surgeries involved so you had the ability to diagnose things. to be able to refer when on a different field and get the ball rolling. or to be able manage common post-operative complications for a particular surgery. surgical skills come later, if you choose that path. (not that this isn't important or taught in the USA system).
reason for this is that there is a general intern year in Australia, where you have to rotate in all the different fields (Emerg, med and surg), that doesn't exist in the USA. Also in Aus, you don't go directly into surgical residency after med school in Australia like the grads would in the USA. so that surgical training as a student in the USA schools is actually critical to selection for residency. selection doesn't come till much later in Australia.
training is much more condensed in the USA. hence the differences.
2. there are massive differences.
(I know some would argue there isn't. but i mean c'mon guys..really? the structure alone..)
looking at surgery. let's say general surgery.
After grad:
USA: match into a surgical program for what, 4-5 years?
It's much more streamlined & straightforward. everyone in the program is generally in it to be surgeons.
intern year is a surgical intern year.
Australia: not streamlined. less obvious to understand. also highly dependent on the state.
universal to all the states: intern year - mixed year of emergency medicine, internal medicine and general surgery and electives.
- after that year - house officer years (you have to reapply each year for a contract with a hospital) - variable
- you could match into years with all surgical rotations if lucky. if not, you can still end up with a mixed year of anything, highly dependent on hospital and state.
- roughly - 2-3 years (or more) of house officer years, with variable hands on that remains hsopital and state dependent.
- then you do surgical anatomy courses and an anatomy exam
- then you get to do what is called registrar training (if you can get into one after applying and interview), which is equivalent to roughly a senior surgical resident in the usA for another 5 years. do extremely hard exams - MCQ & live oral exams. much like how there's surgical board exams in the USA.
- it's also not uncommon for people to be "surgical residents' for 5-6 years before getting registrar training to finish their training.
- so up to 10-12 years to be a surgeon in Australia.
why the difference?
The day to day hours. there's no 24 hr or 30 hr shifts in Australia.
as an Australian intern or resident, most days are 8-10 hrs with a 16-17 hr shift once a week or every two weeks.
among other things. it's two different countries that evolved two very different systems. I could go on.
Would the Aussies like their programs to be shorter? yea to be sure. however, most would prefer the hours they currently have.
The other major contributing factor is that surgery is getting more and more competitive. that's why some are lingering in the house officer years for longer. it didn't always used to be that way. it's becoming more and more required to do research for competitive fields in Australia, which is relatively new for the Aussies. this probably isn't case for Americans, where students are more expected to do research prior to getting into their competitive programs. also trending is that they want you to be highly trained and incredibly sure about the path you're taking before starting vocational training.
"it's a war of attrition", as in, many in australia will decide surgery is not for them 2-3- years into house officer training in surgery and choose a 'lifestyle' field with better hours. it's also to do with the fact that many clinical year students in Australia aren't worked as hard as they are in the USA, so they wouldn't know until they've worked in the system later as interns and house officers.
Basically..cultural norms & values about lifestyle & training are very diverse.
never make the presumption that all Western countries are the same.
there is no better or worse, there's pros and cons to each, and you choose the one that is best suited to your needs.
See the
Royal college of surgeons guide.
See
AMA re: training pathway for any medical field
*Disclaimer! I'm not a surgeon. Just throwing that out there..
3&4 & regrets - what doctors84 said.
Ohio weather? Ha..
if you're an American clinical student or resident, how often do you think you'll be outdoors?
unless weather on the commute that is important to you...
Re; holiday semesters -
similar to Ireland, in Australia, it's encouraged that you use your 'holidays' in the summer off to do shadowing and electives, at least for internationals wishing to go abroad for residency.
however, it is very, very hard to arrange any electives in the USA unless the medical school you attend has partner schools (this means they have arrangements to exchange students and paid good money to the American site, it's all about money). it's increasingly competitive to get electives in the USA, you're also competing with American students trying to try out other schools/hospitals prior to applying for residency. not to mention all the other IMGs trying to get a foot in the door to the USA. expect to drop a few grand too.
As for regrets.
just adding onto what's already been said (my sentiments exactly)
it's also a very individualistic experience.
i've had classmates who were happy with their experiences.
others just made the best of it. they knew they had no other choice.
some hated it and couldn't wait to leave.
(there were even the rare number of people who dropped out - they were that disappointed. they returned to their home countries to try harder to get into medical schools at home. or just did something else).
it's often hard to predict how you'll find it.
you have to remember though, that for many internationals, it was the last resort.
it was either attending schools overseas and signing up to be an IMG or not being a doctor at all.
fairly simple for them. in this scenario, the question is more, would you regret not being a doctor more?
it's also universally said 'don't be a doctor, unless you can't picture doing anything else.'
except that it's even more desperate if you're going abroad to train to be a doctor.
if your aim is to practice surgery in the USA, your chances are far, far better if you were stay in the USA and attend an AMerican MD or DO program than being an IMG. it's far more common for IMGs to match in FM or IM (if they match). However, if you can't get into an American program, you have to make the best with what's left to you.
(how does that song go? "you can't always get what you want, but if you try sometimes, you get what you need")