Salvatore's letter, a "young doctor" that at the
end of the second year of specialization went outside Europe, delivers its
experience and tells us how the training of our specialists is working, as
related by the "emigrants" of the profession, at levels below the
The debate about medical training in Italy, on the
destiny of the young doctors, the scarcity of their training, and on the abysmal
distance between European and our standards, with the the worse previsions
confirmed by parliamentary amendments contained in PA reform on specializations,
has reached a crucial point. While the landscape of the healthcare is definitely
changing, since public hospitals are reducing in number and less and less
prestigious, our specialist training continues to be, even in the experience of
"the emigrants", as one of them tells us here, sorrowfully to substandard
levels. Who will, in this situation, rebuild on the current ruins, and most
importantly, if not now, when everything is speed, when?
send you a reflection through which I try to tell my experience of Italian
physician in training abroad with the purpose of focusing on the professional
component and telling one of the many efforts and sacrifices that take place in
favor of a country and a profession for which we are deeply in love. I want to
point out that what is written in this script doesn't absolutely represent a
controversy with Italy, the country that I love, and I thank for having made me
how I am and that gave me the possibility to chase my dreams.
A day of my
second year of specialization, my Chairman, one of the few animated by
enthusiasm for their profession, has accepted my request to deepen my knowledge
in the field of Obstetrics. After the appropriate bureaucracies and an interview
structured in two days that I had to sustain at the host Institution, I asked
for and got a two-year fellowship in one of the most important Institutions of
the world for Obstetrics, an advanced-level centre with its nearly 16,000
deliveries per year for a population of almost one million people, which refer
all to the same institution.
From July 2013 I am working at Soroka
University Medical Center in Beer Sheva (Israel), and I am involved within the
international programme run by Prof. Offer Erez, my mentor ever since. I left
Italy because I knew it was time for me to go where I could learn things in my
country I wouldn't have been able to learn, for several reasons. The first, and
as far as I'm concerned the most important, is linked to the scarcity of the
numbers reached by training specialists within University Institutions
distributed across the country. From one day to the next I found myself
catapulted into a completely different reality from the one in which I was used
to live. A place of which I did not share the language, the customs and
traditions, the religion and where even taking a bus could be a problem since
Italian and English have little in common with Hebrew. But when I started
working at the hospital, every difference between me and this country seemed
I found a perfectly organized world where everybody knows exactly
what needs to be done, and how to do it. A world in which nobody claims
knowledge a priori but provides all the tools in order to achieve the autonomy
of action and learning, a world in which you are educated to understand your
mistakes and learn from them with the understanding and serenity that haven't
been committed because of negligence. I joined a fantastic team that welcomed me
with great enthusiasm after they tested my genuine desire to give my
contribution working hard, so I started my experience based on clinical work and
From a clinical point of view I am involved in the management of
high-risk pregnancy, obstetric ultrasound, and in the management of
physiological and pathological labor and delivery. I will never forget the day
they put me for the first time the scalpel in my hand and told me "Please, now
it's your turn". A case of severe IUGR with estimated fetal weight 1, 700 g at
37 weeks in a patient of about 40 years old and first pregnancy, after several
attempts of assisted reproduction. Not exactly a case that in Italy all
residents would be allowed to operate.
Not for sure as first operation in
the career. At the same way I will never forget the question at the end of the
operation: "Congratulations, but how many Caesarean sections have you performed
as leading surgeon?" exactly like the colleagues's face when I told him that for
me that was the first. And I must thank Italy for these compliments because, if
on one side it is true that I have never been put the scalpel in my hand, it is
also true that Italy gave me the knowledge in order to know exactly what to do
at the right moment, and gave me the opportunity to show how consistent is the
preparation that our system provides. From that first operation, I run almost
every type of caesarean section in the presence of all types of obstetrical
complication (the post seven Caesarean sections and placental accretism I still
watch as a spectator, but give me some time and maybe the perspective from which
I look at things could even change!).
I run every day, always under the
supervision of a tutor (usually a senior resident or a consultant), each type of
pathology or obstetric emergency, and don't believe that in Israel, even in a so
advanced country, everyone has the answer to everything at all times. There are
many cases in which everyone runs to a different computer to search for
information on a topic to which you must respond as soon as possible, meeting
altogether again one or two minutes later with the responses to the problem.
Responses from which the debate leading to the definition of the management of
the case starts. Every morning from Sunday to Thursday (in Israel the weekend
includes Friday and Saturday, during which I often meet the professor who is
responsible for my program, to work in the drafting of papers of investigation),
we meet in the conference room of the Department where the cases of the previous
day or weekend are discussed.
Twice a week the day starts at 7.30 for a
lesson that is held by a resident, a consultant or an international visitor to
an audience represented by the Chairmen of the two departments, consultants,
residents and medical students. Depending on the topic, sometimes
neonatologists, surgeons, or any other type of specialists involved. I've been
included in this, and believe me, giving a talk to a group of 40 people with
some who gave the name to the obstetric pathologies with which we face each day,
is one thing that scares. But it is a challenge that has to be part of the
baggage of a young scientista title that the resident in Obstetrics and
Gynecology needs to be attributed.
The second part of my fellowship begins
after 3.30 pm, when the workday ends, and is represented by the study protocols
in which I am involved and the production of scientific papers, always tutorized
by people with great experience in clinical research but also in basic science.
I presented the results of my work, performed in the group to which I belong, to
the most important world conventions. In less than a year I've been in three
continents, something I would have never imagined in my entire life.
each time is an opportunity to create new relationships, see new places,
establish international connections that can blossom in collaborations and
personal enrichment, as well as important material for all the scientific world.
Our research group works on different topics, to which several subgroups of
people are assigned, and once a month, at 7 in the morning, before the workday
begins, we meet to do a check of the progress of the different protocols. I
shook hands with people I read the name only on the most prestigious scientific
journals, and I discovered the extraordinary humility and preparation. Impress
you when the world's greatest expert on placenta asks you to call him by name
and discusses with you even the most worthless and unenforceable idea that comes
out of your mouth without making you feel a complete incompetent in this area.
And even asks you to keep in touch to share other points of view in the future.
And believe me, these people really respond when you write them an email.
For the future I have several projects, but there is one that I believe is
absolutely a priority: getting back to my country because I am strongly
convinced it only needs new lymph and enthusiasm to reboot. This attitude is, in
my opinion, the only useful key to clear the road from the redundant criticism
but unfortunately often sadly shareable that leads many, in their freedom to
choose the easiest way, represented by pitiless court that is made us by all the
countries of the world and is difficult not to consider.
I don't feel
acceptable the idea, that I personally do not even take into consideration, that
the country that gave birth to the greatest artists and scientists of history,
now wants to give others an army of young minds, after paying handsomely for
their training, and I will continue to do my best to convey my commitment
towards change and personal and environmental evolution, to anyone who is
animated by passion for our work and is ready to fight until dreams become
Salvatore Andrea Mastrolia Resident at the IV
year, school of Obstetrics and Gynecology, 2nd Department of Obstetrics and
Gynecology, Policlinico of Bari".
Salvatore, a "young doctor" already so
responsible, that at the end of the second year of specialization in obstetrics
and Gynecology went outside Europe, in a country historically not so quiet, with
a precise mission: to bring home the Obstetrics Science that during the decades
we missed out on the street, along with the underestimation of the key
importance of our work, gaining in return only a sad record: the highest number
of cesarean section in the world.
Professor at Università degli Studi di Genova