In May 2019, I left for Boston in the United States and spent more than one year studying in Brigham and Women’s Hospital (BWH), Harvard Medical School (HMS). It’s been a tremendously valuable experience to encourage me to be a better physician, colleague, and researcher in the future. During my stay in BWH, I have learned a lot, both academic knowledge and other practice beyond the research. I would like to share my positive experience of studying as a visiting scholar here and encourage my colleagues, even myself, in future work.

Introduction about BWH

    A high educated city in the U.S., Boston, the capital and most populous city of the Commonwealth of Massachusetts in the U.S., gatherers many well-known institutions, such as Harvard University, MIT, Babson College, Wellesley Women’s College, Boston University, Northeastern University, etc., makes the economics, technology, and healthcare highly developed in this city. HMS, consistently ranked first for research among medical schools by U.S. News & World Report，contributed a lot in the medical field. As the top medical school in the United States, HMS was established in 1782 with 17 affiliated hospitals and research institutions located in the Longwood Medical Area in Boston, precisely the place of BWH, the second affiliated hospital of HMS, locates in, which adjacent to the HMS campus.

    With a deep history and long-term development, BWH has grown to be one of the world-renowned general hospitals due to its advanced diagnosis, treatment technology, and powerful scientific research capabilities. It’s also one of the most famous hospitals in the U.S. that integrates teaching, clinical, and scientific research. In March 1994, BWH and Massachusetts General Hospital worked together to be a partnership medical system named Partners Healthcare. The current healthcare system has become a Massachusetts medical group, including many hospitals. BWH has been ranked in the top ten comprehensively for 11 consecutive years in the national hospital assessment by the U.S. News & World Report, and the department of obstetrics and gynecology ranked the first in the United States. A total of 8 Nobel Prize winners worked here, while the institute’s biomedical research institute owns more than 3,200 scientific researchers. BWH received an annual average of $537 million in scientific research funding from NIH, the top institution in the U.S. to get the national funding.

Introduction about Zhou Lab

    The Lab which I worked was an interdisciplinary clinical research Lab. The principal investigator (PI) was Professor Jie Zhou, the director of Brigham and Women's Hospital's Anesthesia and Pain Innovation Center. As one of the hubs for academic exchanges between China and the U.S., Professor Zhou was dedicated and friendly. He has provided a learning platform for many Chinese scholars and has taken care of them.  With various data resources of the partner system, Zhou Lab is characterized in extensive data analysis based on different clinical research. Professor Zhou paid lots of attention to interdisciplinary and encouraged us to integrate disciplines when working on topics. The protocol I was involved in was “Research of pelvic pain post-egg retrieval in fresh embryo transplantation and IVF pregnancy outcome.” I assisted him with protocol writing, data collection and statistical analysis, etc.

    Moreover, Professor Zhou arranged for me to observe in the operating room and studied at the reproductive center once a week. He invited relevant experts to conduct weekly topic design and statistics training for lab members and encouraged us to participate in various training organized by BWH actively. We had our group meeting once a week to promote disciplinary exchanges and creative ideas. In Zhou lab, I learned diverse knowledge in scientific research, such as research design, ethics application, data analysis, interdisciplinary investigation, scientific innovation, etc. I also joined many academic lectures in my discipline and learned how to conduct scientific research in detail. This experience included many systematic pieces of knowledge that were very useful and meaningful for me because I could learn from the healthcare and research system in the U.S. and make it possible for establishing targets for improvement in my work.

Center for Infertility and Reproductive Surgery (CIRS)

    CIRS was the reproductive center in BWH. It was one of the earliest infertile and reproductive medicine centers in the U.S, which was composed of three departments: clinical, embryo lab, and reproductive surgery. CIRS provided all procedures and services used to treat infertility, including IVF, ICSI, PGT, egg donation, and assisted incubation. Minimally invasive and robot-assisted gynecological surgery for reproductive diseases was conducted regularly, including Hyster myomectomy, endometriosis treatment, fallopian tube ligation reversal, etc. The director of CIRS, female clinical, embryo lab respectively was Professor Mark Donald Hornstein, Professor Elizabeth Sarah Ginsburg, and Professor Catherine Racowsky. All of them have visited China several times for academic exchange. During my stay, these three professors also helped me a lot in my study.

    In CIRS, senior experts paid keen attention to training physicians and fellows. Fellows usually hosted academic meetings with each other. The format was flexible and amazingly diversified, and the seniors provided them comments and guidance. They always held multi-disciplinary meetings concerning reproduction medicine, obstetrics, and gynecology, endocrinology, psychology, etc. All kinds of relevant presentations were welcomed there, questions and discussion were widespread.

    In the department of CIRS, support and service teams for research were common and robust. When clinicians put forward a clinical research plan, they always discuss it together, optimize the protocol, and apply it for ethical approval. The support and service team members often helped clinicians do data retrieval and analysis, which made them a high efficiency. Usually, group meeting was held once a week to keep their research going forward. There was a topic summary meeting each year in the department of CIRS to better support clinicians’ research in the future.

In addition, CIRS owned many advantages that we could learn. For example, the condition in the embryo lab was very stable; regardless of D3 or D5 embryos, they could always get embryos of pretty good quality. In the process of infertility treatment, psychological and antistress interventions were sufficiently provided. Most physicians valued literature studies, used these published studies to conduct their clinical work. Intractable diseases discussion and particular case communication regularly started at 3 pm every Wednesday. However, there were also some shortcomings, such as a relatively fixed ovulation induction protocol and less detailed processing for IVF patients. For example, if serious progesterone was higher than 2 ng/ml, embryo implantation was canceled strictly, which meant these patients would lose some opportunities for fresh embryo transfer.

Experience and Consideration

    Firstly, as one of the best hospitals in the U.S., BWH’s rapid development was inseparable from the mature value system. For example, all faculties treated patients as the core in their daily work. BWH explained a new definition of CARE: Communication and Affection, Respect and Extending. Patients were always paid enough attention, and they were fully respected for their characteristics, privacies, rights, even contributions to the hospital. In addition, excellent and high-quality training was always prepared for their staff. Like in CIRS, the director Professor Mark conducted case quality control, case discussion, academic reports, and literature review every week, which were great opportunities for young physicians to enhance their clinical experience. Among them, the residents’ literature reports impressed me deeply, not only did they have solid basic clinical skills, but also, they were pretty confident in giving a speech.

    Secondly, BWH emphasized the conversion rate between research and products. Research topics are often based on clinical issues, focused on improving diagnosis and treatment for patients, serving the clinic, and finally convert to clinical applications. The annual scientific research conversion rate was as high as 20%. In BWH, there were a lot of attractive opportunities for training the next generation of rising surgeons or physicians in different research and make them passionate about creating change through research. BWH also encouraged medical staff interested in doing scientific research to cooperate, work on scientific issues, and even publish papers. Everyone couldn't be proficient in all fields, so cooperation was crucial.

    Thirdly, a mature management system and humanized culture might benefit the whole hospital. Staff in BWH strictly followed the rules, regulations and showed significant responsibilities in their work. Rules and regulations in BWH were derived from practice and effective. The hospital culture promoted staffs respected each other, advocated science. Patients could get a professional diagnosis and qualified treatment here, followed by field consensus and guidelines for medical workers. It could say that the implementation of the American hospital system and the humanized diagnosis and treatment process for patients have been very well reflected in the handling of details. As an old saying “details determine success or failure,” the overall goal would be easier to reach if we keep improving in detail. For example, there was an announcement in the elevator, “Please do not discuss the patient in public,” which reminded us of protecting pa' privacy. Many places in the hospital, including public restrooms, were equipped with distress calls or emergency buttons in case of patients in emergencies. Hospital employees enjoyed discounted services when buying bus tickets and renting bicycles, which might make employees feel proud and cohesive. BWH regularly organized some lectures and posted them on the homepage of the hospital website, every faculty owned access to sign up. The wards of BWH were decorated warmly, and there were many posts on the wall with inspiring and warm words written on them. When checking the patient, medical staff always greeted with a smile, spoke softly, and was considerate during the diagnosis and treatment. Handling these details increased trust from patients to BWH staff so that they could have good compliance and the doctor-patient relationship. These details reflected the culture of BWH, which were pragmatism, compliance with the system, and humanized management.

My Sincere Appreciation

    This visiting scholar program offered me an opportunity to develop as an excellent physician and broaden my horizon about the medical system in the U.S. I have learned many things in BWH, including exchanged academic knowledge, optimized research design, wrote the scientific paper, improved my oral English, even absorbed the essence of their culture, etc. Without question, the program helped me improve my leadership skills, which are critical as a physician, colleague, and researcher. I was appreciative a lot to my supervisor, co-workers, rigorous academic atmosphere, and people who helped me.

    Dr. Jie Zhou, my supervisor, was the first person I would like to thank. He guided me with how to write a protocol and how to present a poster for a conference. He also helped me use the local medical database, modify interview questions, prepare research ethics documents, and review my thesis. With his supports, I became more and more confident about my English writing and qualitative research. I also appreciate the trust from my leaders in my hospital and department. Moreover, I am grateful for the help of all faculty in the Foreign Exchange and Cooperation Department of Lanzhou University First Hospital, thanks for helping me to get this great opportunity and enabled financial support from Lanzhou University Education Developing Program. I am appreciated all of you for this wonderful opportunity to be a visiting scholar in BWH.

    Besides, I also would like to say “thank you very much” to Prof. Xuehong Zhang, who has set an excellent example for us to be humble and enthusiastic in academics. Furthermore, I am very grateful that I met so many Ph.D. international friends there. We built a community for sharing knowledge and helping one another. These friendships will remain a wonderful memory for me.

    During my study, I experienced the COVID-19 epidemic. The epidemic brought anxiety to my original study. However, it also made me understand that I should be more grateful, cherish life, love my family, and love my career. Thanks to all the colleagues caring about me during my study abroad. Thanks for the support and encouragement from my family. More exchange and cooperation among each other are expected in the future. Let’s work together and make progress together!

By Gao Mingxia / Xiong Yanyan 

Edited by Office of International Cooperation and Communication