The pathway to residency in Germany: a survey study to identify factors that impact an international medical graduate from Syria.

BACKGROUND: The German health care system has recently become an attractive destination for international medical graduates, particularly from developing countries such as Syria. However, there are no studies about the factors that influence the successful entry into the German healthcare system at trainee level.  METHOD : An anonymous cross-sectional survey was distributed electronically to Syrian medical graduates who successfully entered residency training in Germany. Collected data included demographics and factors that influence entering the residency, such as proven German proficiency and clinical experience in the home country. Hypothesis testing was used to assess the difference between the variables. RESULTS: A total of 109 participants responded to the survey. Twenty-three (21.1%) subjects completed a medical residency in Syria before moving to Germany, and 46 (42.2%) had no previous clinical experience before moving to Germany. The proven German proficiency of the participants upon arrival in Germany was less than B1 in 39 (35.8%), B1 in 37 (33.9%), and B2 in 33 (30.3%) cases. None of the participants had a language level beyond B2, and 18 (16.5%) had no German knowledge. The median of months spent in Germany till residency for those with B1 or B2 certificates before moving to Germany (10.5 (6.25-16) months and 8 (5-11) months, respectively) differed significantly from those with German-language skills belowB1 ((21 (14-29) months, p < .001). Residency in the home country was not associated with a difference in the median of the months in Germany till entering residency, p = 0.84. CONCLUSION: A crucial factor influencing the successful entry to the German medical system at the trainee level is the ability to speak German, measured in levels based on the Common European Framework of Reference for languages. A high language skill level is a crucial factor associated with a decrease in time in Germany till entering residency for an international medical applicant. In contrast, previous work experience is not influencing the entry into the German labor market.

Internal Jugular Vein Thrombosis: Unusual Diagnosis of a Cervical Mass.

Idiopathic internal jugular vein thrombosis (IJVT) is a rarity that we must quickly identify and manage, as it may have severe consequences such as cerebral venous sinus thrombosis (CVST). CVST might be fatal unless it is managed promptly. However, due to its rarity, clinicians are often unfamiliar with the presentation of this pathology. We report an unusual finding of IJVT in a 53-year-old female patient who presented with a cervical mass on the left side to our otolaryngology outpatient clinic. A cervical ultrasound and computed tomography (CT) confirmed the diagnosis of IJVT. An extensive workout ruled out thrombophilia, CVST, cardiovascular diseases, head and neck cancers, and urinogenital tract neoplasms. The symptoms resolved under treatment with anticoagulation.

The Secondary Manifestation of a Marginal Zone Lymphoma in the Larynx: Lessons From a Misdiagnosis.

The secondary manifestation of a marginal zone lymphoma (MZL), which is a less common type of B-cell non-Hodgkin's Lymphoma (NHL), in the larynx is a rarity. We report a case of the secondary involvement of the larynx following MZL in a 72-year-old woman who presented with the sensation of a foreign body in the throat and history of MZL. A fiberoptic laryngoscopy confirmed the presence of a mass in the supraglottic area. The initial clinical evaluation indicated that the mass was benign. Hence, it was removed surgically. However, the histopathological analysis confirmed the diagnosis of MZL. After a systemic evaluation, the patient was classified as stage IV A according to the Ann Arbor staging system for lymphomas. Treatment was initiated with Ibrutinib 520mg/d and Rituximab 375 mg/m2 every 28 days. When it comes to tumors of the head and neck, including NHL, the larynx should also be considered as a site for a possible secondary as well as primary involvement.