In September 2019 I had the excellent opportunity of participating in a conference exchange programme
in Torino, Italy organized by the Vasco da Gama Movement (VDGM) under the auspice of Movimento
Giotto which consists of a vibrant team of young doctors working in Italy. The experience consisted of
a two day exchange programme followed by a 3 day forum entitled the 6th Vasco da Gama Movement
Forum, with the latter also having significant organisational input from international members of the
VDGM.
On the day of arrival all seventeen exchange participants from across Europe were invited for an
introductory meeting at a local health centre, otherwise known as ‘Casa della Salute’ which is a privately
owned clinic that is funded by the Italian government. A presentation was given by the organising
committee which provided a detailed explanation of the Italian healthcare system and a review of the
upcoming exchange itinerary. A tour of the premises was also given which allowed participants to
appreciate the logistics of the day-to-day running of such a clinic, find out more about the pros and cons
of the government funding system as well as learning about working conditions and the out-of-hour
service in the Italian primary healthcare system.
The next two days consisted of an experience in a similar health centre in Chieri, a town and commune
located 11km southeast of Turin. During this exchange I was attached to a senior general practitioner
who I shadowed during consultations. I was also invited to see a small number of patients on my own
followed by discussion on a mutually agreed management plan with the senior doctor. This exchange
was an important learning experience and an eye-opener on a number of levels such as appreciating the
doctor-patient relationship and learning through observation; discussing management of disease and
appreciating similar and divergent approaches in treatment; learning about different subcultures and
health belief models; learning about the Italian national health formulary and prescribing/dispensing
system; appreciating the benefit of the electronic patient record system used in Italy; gaining insight into
different healthcare services provided on a local and regional level and the logistics of accessing such
care.
The exchange programme was followed by a 3 day forum which saw the arrival of hundreds of young
doctors (mostly in training or within 5 years of finishing specialisation) coming together for a number of
lectures, workshops and tailor made courses. The topics addressed were varied and invited participants
to challenge their thoughts and their day-to-day practice as an opportunity for both individual and
collective growth. Some highlights of the forum included discussions on patient empowerment, raising
awareness on overmedicalisation, delivering bad news, international opinions on euthanasia,
crosscultural family medicine, shared decision making and improving collegiality and work ethic amongst
colleagues. GP trainees also had the opportunity of participating in an interactive pre-conference course
on case-based scenarios using standardised simulated patients and receiving performance feedback from
senior clinical teachers. Last but not least the forum also provided workshops to learn about the special
interest groups working within the VDGM such as those on mental health, domestic violence,
international health medicine, migrant care, research and emergency medicine. Participants of the
exchange programme were also given a platform during a workshop specifically held in order to facilitate
sharing of ideas amongst exchange participants following their experience in Italian practice. This
opportunity allowed for a comparative exercise of different practices across Europe and participants
could appreciate universal challenges faced in primary healthcare across Europe, divergent opinions and
practices, the ever increasing role of information technology in health care service provision and different
financing methods of primary health care.
Another important facet to this experience was the social programme organized by Movimento Giotto
organising committee members who scheduled a number of interesting events such as a city walking
tour, a visit to the Anatomy Museum of Torino as well as a number of get-togethers at local eateries.
Such events helped create room for sharing of ideas in a less formal setting and enabled participants to
establish connections in a broader medical community.
In conclusion I believe that this experience has been highly beneficial for me and I would readily suggest
similar opportunities to fellow trainee doctors. I find myself highly motivated and willing to help out the
local exchange co-ordinator in organising future exchange programmes in Malta. I believe it is worth
investing in trainees to attend such events as this not only helps them for personal growth but also serves
as an energising experience that can be helpful in bringing new ideas for improvement that can be
implemented on a local level.

VIGO Exchange (14th Oct – 20th Oct 2019)
I am happy to have had the opportunity to be part of this exchange program which was a well
integrated exchange for exposure to the health care system in the region of Galicia, Spain.
I am currently practicing as a GP trainee in Malta and am in my final year. During this week I was
exposed to various aspects and ways in which the health care system in primary care function in
Galicia and differ from my own. I had the opportunity to take part in daily clinics and discuss
management of cases with my tutor and look into ways in which cases are managed in Spain
when compared to my country.
One of the things that I was happy to take onboard during this placement was the use of the
electronic system for patient data record keeping. As this is a system which is still at the start of
implementation in my country it was very good to see how this works and get a better
understanding of the benefits of using such a system.
The placement gave me exposure to both acute and chronic disease management and also to
screening programs. There was also the opportunity to meet other trainees from other countries
and discuss our health care systems together.
I also attended the EGPRN Meeting. The main objective was focussed mainly on community
health services and research on how things can be improved in the community together with
training on methods of how there can be improvement in the quality of these services.
I recommend this exchange program as it helped me enrich both my medical knowledge by
working in teams and the importance of communication to improve health care systems in the
community.

Between the 20th and the 26th of October 2019, I participated in a UK exchange programme
together with other fellow GP trainees and First5 GPs. We were a cohort of 10 exchange
trainees, 5 from Europe and another 5 from non- European countries. This exchange was
organised in collaboration with the Young Doctors’ Movements of WONCA (the World
Organisation of Family Doctors).
The Exchange programme consisted of a 2 day exchange in a UK GP practice, a day
sightseeing, followed by the RCGP Annual Conference held in Liverpool.
For the first two days, I was set in ‘The Doc’s Surgery’ set in Oak Street, in Central Manchester.
Since this practice was placed in central Manchester, it catered for a different cohort of patients
than what a typical UK practice would be faced with, in that most of the patients were relatively
young, with the exception of a community of Cantonese elderly who lived in the area. This
practice in particular had a special interest in providing a service for LGBTIQ patients and
providing sexual health screening to patients registered in this practice.
I started my first day of training by shadowing Dr. Joslin, who is one of the main practice
partners of the surgery. During this time, I had the opportunity to see how GPs in the UK work,
especially how they deal with patients within the 10 minute appointment system and what type
of patients they encounter in their day to day practice. What I really looked forward to
especially was how their electronic patient record system worked, and how record keeping in
the NHS was all interlinked, making continuity of care much easier.
What I really found interesting in this particular practice was that telephone consultations and
triaging is reserved solely between 11am and 12pm. This, besides reducing interruption during
physical consultations to a minimum, it also aided so that if there was a particular concern with
certain patients they spoke with on the phone, they could slot them in an urgent appointment

later that afternoon, which they kept especially for such patients. In the afternoon, I then divided
my time with the two practice nurses of the surgery. Both of them had a licence to prescribe. I
got to experience first hand how their job, which ranged from sexual health check ups to chronic
disease management and performing spirometry on patients, aided so that workload was
properly delegated between both nurses and doctors, aiding to deliver a better service to the
patients that are registered in the surgery.
On the second day of my rotation, besides sitting with another GP partner of the practice, I had
the opportunity to see the administration side of things. I got to see the excellent work that
receptionists and the clerical team do, in easing the doctor’s workload, like for example, doing
the referrals themselves, giving appointments for annual check ups and handling complaints.
The remainder of the exchange consisted of attending the Royal College of Family Physicians
(RCGP) Annual Conference, which took place at the ACC Liverpool Conference Centre. The
conference consisted of common lectures in the morning and afternoon, with parallel sessions
occurring in between and after the common lectures. I tried to attend sessions of various
interests, some increasing my clinical knowledge, others helped to raise awareness of self care
within the work environment, and others who gave insight as to the problems GPs are facing at
this day and age with the constant evolution of the society in general and how technology can
help/ hinder the doctor- patient relationship.
All in all, I consider this exchange to have been a very fruitful experience. It has broadened my
mindset as to how Maltese healthcare can improve considerably with more delegation of work
amongst different healthcare professionals and how the use of a goood electronic record keeping
system can facilitate the overall work of the general practitioner.