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THE FELLOWS GUIDE TO BALGRIST/ZURICH
Orientation
The first item for orientation is to describe your work environment. When I arrived I had no idea what
to expect. You will be working on the shoulder (shulter) team at Balgrist Universitatsklinik under the
auspicies of Prof Gerber.
The Hospital
Balgrist is a small hospital which is University-based, and is entirely orthopaedic. There is no
emergency department per se on site, although there are some "emergency" cases that get assessed and
admitted by the residents. All such cases will be single-limb trauma, and fairly minor. Most other
admissions are usually patients that are already known to Balgrist. It is not the only orthopaedic
department or hospital in town. Close by are two private orthopaedic clinics and hospitals - Shulthess
and Hirslanden. The trauma is seen at the main University hospital closer to downtown, which also has an
orthopaedic department.
The Team
Most of the orthopaedic surgery performed at Balgrist is non-acute elective stuff. You will quickly
realize there are about 6 different teams - shoulder (and elbow), hand, hip, knee, foot, spine, and
technical orthopaedics. Prof. Gerber is both leader of the shoulder team and also medical director of
the entire hospital/clinic Balgrist. Each team has 1 or 2 Oberartz, or trained orthopaedic surgeons in
the Swiss system who are doing something similar to extra training by means of a fellowship. At any
given time there is usually only 1 on the shoulder team. The team is run by the Assistantartz, or
residents, and the shoulder team usually has 3 or 4 of these. There then is the odd medical student.
Alberto Schneeberger is also an Oberartz, although he is the other "staff" on the shoulder/elbow team
other than Prof. Gerber. He basically does all of the elbow cases at Balgrist, as well as a lot of
shoulder stuff.
Weekly Schedule
Monday
Clinic with Prof. Gerber. Alberto Schneeberger is also in an adjoining clinic.
Tuesday
OR
Wednesday
Prof. Gerber administrative day
Alberto Schneeberger in clinic
Thursday
OR
Friday
OR
Each morning at 7:05 there is morning report, which consists of the assistants (residents) presenting
cases, and the staff discussing them. There is a staff radiologist present. Morning report generally
ends about 7:40 - 7:50. Routine coffee rounds afterwards.
Operating Room
The OR's start at 8am sharp (if not before). If you are the first name on the list of assistants, you
are ultimately responsible for ensuring that the patient gets set up properly. This means that for the
first case you should leave morning report early at about 7:40 to get to the OR. For cases that you are
the primary surgeon, you are responsible for typing the appropriate information into the computer system,
and either dictating or typing an OR note. Otherwise if Prof. Gerber wants you to complete the OR note,
he should generally tell you.
Weekly Conferences
There are preoperative conferences, at 4:30 Monday and Wednesday, during which the cases for the next
days OR are discussed. At these, cases are discussed for OR's for all teams, not just shoulder and
elbow. Tuesday there is generally nothing, except anatomy dissection for the residents, and monthly
trauma conferences at the main University hospital put on by the trauma team. Thursday approx. 2x/month
there are talks given by various guest or local speakers, including the team leaders at Balgrist.
Daily Rounds
At some point each day, the team will round on the inpatients on the service. This is generally mostly
in German, although the fellow is expected to attend these rounds. They are generally performed at the
end of the working day, after other conferences have finished.
The City
I am not an expert on Zurich or the surrounding area, but it is a major city with a small town feel. The
population is approx. 300,000. There is certainly a ton to do, both in and out of the city. The public
transportation system, with trams and trains, is excellent.
The city's transportation system is divided into zones. The center of town is zone 10 - you should
always be aware of which zone you are traveling in, because there is a penalty of approx 60-80 CHF for
not having a ticket when checked. The city transportation system is basically on an honor basis. No
one checks your ticket each time you get on…you just occasionally have ticket agents jump on the tram
and check that you have the right ticket, and that you are in the right zone. Each time you use the
transportation system, you have to buy either a one-way ticket or a 24 hour ticket. A 24 hour ticket in
zone 10, for example, is 7.20 CHF regular price, and 5.20 CHF with a half pass. If you plan to do a lot
of travel within any of the zones, you can buy a monthly pass. A monthly pass for zone 10 travel is 150
CHF, I think (I did not personally need it).
Whether you choose to buy a monthly pass for Zurich city travel depends on how much you plan to travel
and whether you are living in the residence. If you are living in the Balgrist residence, you probably
won't need it. What you will definitely need it to purchase early on in your stay a Half Pass from the
train station. It is available for 1 year for 150 CHF. It is also available for 1 or 3 months, I think,
but the only way to go is to take it for 1 year (it is NOT available for only 6 months). This will get
you half price train tickets all over Switzerland, and discounted intercity travel on trams (sometimes
in town it is not always 50% off, but always some discount). After 2 or 3 longer trips within
Switzerland, the pass will have paid for itself. Warning - they need a passport sized photo to make up
your card, so bring a few extras during your stay.
The closest train station to Balgrist is Stadelhofen. The main train station in town is the Hautbanhof
(HB), which (from Balgrist) you can reach by traveling on the #11 tram to Stadelhofen, then taking a
train (1 stop), or by continuing on the #11 tram directly through town and to the HB station (slower,
more stops). You can purchase your Half Pass at either station.
City Highlights
To get oriented to the city, go to the tourist office at the Hautbanhof (HB) main train station, and ask
for the walking tour maps of the city (3 or 4 available). A few recommendations to consider seeing
include Uetliberg, the Opera House, cruise on Zurichsee or Limmat river, the Orange outdoor movie
festival (summer - movies at edge of Zurichsee), 2 churches (Grossmunster, Fraumunster). If you want to
see a movie, it isn't cheap, but there are discounted prices at the Corso theatre at Bellevue on Mondays. Small town close by which is nice is Rappersweil. Other day trips include Luzern, Shaffhausen (and the Rhein falls), and Bern. The region of Appenzeller (and St. Gallen) is considered one of the most traditional Swiss areas - can check out the cheese factory.
The list is endless…
Monthly Events
There is a small booklet available at the tourist office or train station which outlines the events in
Zurich each month.
The Residence
The single rooms have a single bed, desk, chair, cupboards and wardrobe. The kitchen is small, but has a
small table and 2 chairs, small fridge and 2 burners (no oven). They are small but clean, and the
building is right beside the hospital and has a reasonable view overlooking the lake in the middle of
town. IF you choose to stay in the hospital residence, you will quickly notice that there is nothing
in it (in the way of pots, pans, dishes, etc.) You can get any dishes needed from the hospital cafeteria
(just speak to Beatrice Borgst about you making a list of what you need for the kitchen staff, who will
put it together for you). Pots/pans and cooking utensils we bought - the cheapest place is probably
EPA (at Bellevue), or the large Co-op department store on Banhofstrasse. There are also a couple of
IKEA stores in town, where you can get a lot of this stuff fairly cheap.
What to bring for the residence. My suggestion is to bring one set of your own sheets/pillow cases, and
a duvet cover. You can get the hospital to provide you with new sheets/ etc. weekly, but you will have
to pay approx 50 CHF for this priviledge. Bring your own…there are washers and dryers downstairs. You
can ask for an extra bed to be left in the room, for 80 CHF/month.
Another thing to remember…the hospital does have other rooms in the residence, that people (usually
visiting doctors) can rent out per day. These are small and don't have a kitchen, but if you have any
short term visitors who want cheap accommodation, you can check whether there is a room available as an
option.
Skiing
Obviously great skiing in Switzerland. Watch for deals through the SBB train station…called I think
Snow 'N Rail. You can buy a combination of your train ticket and ski lift pass - at reduced rates. For
day ski trips from Zurich, the closest place is Flumsberg. Next closest (and a little better) is
Flims/Laax. Other great places are Zermatt and Verbier. Of course there is always Davos and St.
Moritz.
Outside of Switzerland, we found GREAT skiing in St. Anton, Austria. Spent an incredible week there.
Approx 3 hours from Zurich…and cheaper than Swiss ski towns, but skiing is just as good!.
From the Airport to Balgrist when you Arrive
There are 2 options for transportation from the airport to Balgrist when you arrive: either taxi (for ~CHF 70), or 1 train and 1 tram for about CHF 5. To buy a ticket for the train and tram…this is all intercity travel, so you have to have some change and use the automated ticket machine. Load all of your bags on a baggage cart…you can take it with you all the way to the train - even up and down the escalators. After collecting your bags and coming out through the greeting area, look for signs and an escalator to your left to "Bahn Railway". Take this escalator up 1 level. Walk straight ahead, take your first right (over a small bridge), then down the escalators directly in front of you. Turn right off these escalators, and take the next set (which is straight ahead of you) down another level…just keep looking for the Bahn Railway You should now be near the ticket purchasing window for SBB trains (this is not where you buy your ticket), and you will see signs numbered 1 to 4 for trains to various locations…look for one that is going to Stadelhofen - you will have to go down one last escalator to get to this train. On the train platform you will see the automated ticket machine. Look for either the name Hautbanhof (HB) or Stadelhofen (which is in zone 10), and punch in the 4 digit number. Press the button with ? symbol to switch from the one-way to the 24 hour ticket price. Select the price which is lower (one way). This ticket will get you from to airport not just to Stadelhofen, but to anywhere in zone 10. Remember you can only use change at these machines.
When you arrive at Stadelhofen, you will be in a central square. You need to get on one of two trams going to your left up the hill - either the #11 or the S18 tram, toward Balgrist. The #11 tram has more regular stops…Balgrist is about the 8th stop from Stadelhofen. The S18 is an express tram…Balgrist is about the 3rd stop.
You will have an incredible time with this fellowship. My best piece of advice is travel a lot, and have an incredible time
Renting a Car
Best way to rent a car in Switzerland is to call Auto Europe, a middle-man in the U.S. who will give you the best rates on cars. Call toll free 00 800 223 5555 5 from Switzerland, to get you to the office in Maine. Word of advice: if you say you are a Canadian and a CAA member (equivalent to AAA membership in the U.S.), they will quote you prices THE SAME as US dollar quotes, only they will be in Canadian dollars. They also never asked for any details of my CAA number, etc.
Michael K. Gilbart, M.D., Canada
2002-2003 Intercontinental Shoulder Fellow Zurich-Harvard
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