Grant Gellert, MD
The Kaunas Lithuania Observership is a training and cultural partnership program between the emergency residency programs of the Hospital of Lithuanian University of Health Sciences and the University of Louisville Medical School. Each Observership consists of a two-and-a-half-week cohort visit to each hospital’ s respective emergency department. The Observership cohort traveling to Lithuania in September 2024 was the first for UofL, and included Dr. Luther Daniel and myself, Dr. Grant Gellert.
Our Lithuanian Observership was an immersive program, and included an EMS ride-along, multiple clinical observer shifts, grand round presentations and involvement in various residency activities, including morbidity and mortality conference. Although the exchange program was created to broaden each resident’ s understanding of medical systems in foreign countries, the opportunity for cultural exchange and personal growth cannot be discounted. We were encouraged to become part of the local community. We lived in a Lithuanian apartment. We shopped for fresh food and goods at the local Maxima, and in the process learned to use Lithuanian words and phrases to communicate with our hosts and the community at large. Unique culinary opportunities were the norm as we sampled šaltibarščiai( cold beet soup), kepta duona( dark fried bread with cheese) and especially cepelinai( potato dumplings). We found Lithuania’ s countryside exceptionally beautiful, especially the seascape at Nida, with its rolling sand dunes along the Baltic Sea, as far as one can see. The outdoor sculptures at the Hill of Witches were a highlight, depicting unique hand-carved wooden characters from Lithuanian folklore. Often Dr. Daniel and I were simply content to wander about on the bustling Laisvės alėja( Liberty Street) after a shift in the ED and catch the sun setting behind Kaunas Castle.
The city of Kaunas has multiple hospitals, but one reigns supreme in prestige and size: Kauno Klinikos. It is the largest hospital in the Baltics and opened in 1939. The hospital went without a designated emergency medicine space with emergency trained physicians until the emergency department opened in 2015. Similar to the emergency medicine practice in the U. S. in the 1960s and 1970s, we learned how our Lithuanian colleagues of 2025 were experiencing similar growing pains of their new specialty. The autonomy and trust from other medical specialties was not always forthcoming. Fortunately, our Kaunas emergency colleagues are adept at finding balance between respect and tradition, and have established emergency medicine as a crucial cog in the health care system of Lithuania. According to Dr. Gailė Damulevičiūtė and Dr. Miglė Šteimantaitė, emergency medical care prior to the creation of the specialty of emergency medicine was mostly provided by physicians who completed medical school with no other formalized training. Residency-trained doctors have advocated their belief that formal residency training improves the care of patients, compared to traditional care from physicians without formal residencies, whom they felt lacked diagnostic / therapeutic expertise.
Since the creation of emergency medicine residencies in Lithuania, the situation has improved for patients suffering emergencies. Unfortunately, in many rural areas the standard of emergency care has not improved due to the lack of properly trained doctors. Studies support that having emergency medicine residency trained physicians in the emergency department improves care. As more physicians graduate with an emergency medicine specialty from the residencies in Kaunas and Vilnius, the need for non-residency trained physicians in the emergency department will be eliminated. This difficulty of staffing rural emergency departments is not unique to Lithuania; it plagues Kentucky as well.
While at Kauno Klinikos we were plugged into the EM team and were able to see severely ill cirrhotic patients with hematemesis requiring intubation. As TB is prevalent still in Lithuania, we were also able to witness many different stages of tuberculosis and see the care they provided for these patients. In addition to our time spent in the hospital, we were able to enter Soviet era apartment blocks and transport ill patients with their amazing EMS teams. In our experience, Lithuanian emergency medicine physicians were well trained with the same procedural and diagnostic skills as our colleagues in the U. S.
Despite our similarities, trauma seems to be more sporadic in Kaunas, Lithuania than in Louisville. As part of our trip, we were able to present cases we have experienced in Louisville. Dr. Daniel and I spoke on traumatic injuries including gunshot wounds, severe motor vehicle accidents and stabbings. We also shared various procedures we have been able to perform as a part of our training at UofL, including tube thoracostomies, open cardiac massage and cricothyroidotomies. The information exchanged and the friendships developed between our two programs and cities has created a unique and lasting bond that the UofL Emergency Medicine Department and I cherish.
I cannot believe it has been almost a year since I visited Kaunas. As two more UofL residents prepare for their journey to Lithuania, I am heartened by our continued relationship with Kauno Klinikos. I sincerely believe in the value of this shared experience and look forward to seeing it continue to grow and improve both our programs.
į sveikatą( Cheers)!
Dr. Gellert is an emergency medicine resident at the University of Louisville Hospital.
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