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Summary of my Week 1 Elective Posting at Kaohsiung Chang Gung Memorial Hospital.

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Phase 2: Clinical Elective Posting in Kaohsiung Chang Gung Memorial Hospital (Week 1)

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Phase 2: Clinical Elective Posting in Kaohsiung Chang Gung Memorial Hospital (Week 1)

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1. Name: Chan Huan Shen

Matric No: A188111

Date: 5 August 2024 - 9 August 2024

2. How is your progress?

My elective posting started with the orientation conducted by the monthly HOD of the Department of Family Medicine, Dr. Yan. I was given a small briefing about what I am going to do in these two weeks. He also brought me to familiarise with the several places that I will need to go in the following days. In short, the first week of the elective posting, I will attached to several clinics, such as Cancer Screening Clinic, Physical Examination Clinic, and Teaching Clinic, other than that I will also join the Rural Area Visit to Shanlin District.

In the Cancer Screening Clinic, I was assigned to Dr. Sun. In his clinic, I was able to observe several procedures such as Pap smear for cervival cancer screening and oral examination for oral cancer screening. He taught me on the basics of doing the procedures as stated and explained to me the significance. I was told that the common cancers in Taiwan are cervical cancer, oral cancer, breast cancer, colon cancer and lung cancer. Thus, the role of Family Medicine Department is very important to provide screening services to the high risk community. It is also their government effort to advocate early screening to the elderly and high risk community as to detect early and provide early interventions to them.

In the Physical Examination Clinic, I was able to observe the doctor to perform basic physical examinations, which includes eye and hearing assessments, examinations of the neck, chest, abdomen and legs. They provides this service mainly for the employees of partnered companies, and also students for university enrolment.

Next is the Rural Area Visit, I was assigned to Dr. Wang, together with a pharmacist and a community nurse. I was told that there are many rural areas to cover in Taiwan but the area which is assigned to Kaohsiung Chang Gung Hospital is a district known as Shalin District, which is about 45 minutes drive away from the hospital. In the usual routine, the team will prepare the essentials such as the basic medications, the BP measuring devices, glucometer and so on in prior to the visit. They have a fixed meet up point in the rural area (a common area in front of a temple), whereby annoucement will be made at the community centre in prior to the visit, so that the community will aware and seek for medical treatment if they need on that specific day. Most of the cases which I observed on that day was follow up cases for chronic diseases such as diabetes mellitus, hypertension and dyslipideamia to replenish their medication supplies. There were also acute cases such as cough and common colds. The objective of this visit is to let the underprivileged to have opportunities to access to healthcare as many of them do not have the ability to travel to cities just for medical treatment. This effort has great impacts to the community in the rural area as there are professionals guiding them and if necessary or any emergency cases will also be referred immediately to the nearest hospital.

The last clinic in this week was Teaching Clinic, where I was assigned to Dr. Jiang to attach to her clinic. It is quite similar to how we did in Malaysia, in which the doctor will see the patient, to take history from them,  and identify the chief complaint and perform some physical examinations. After each patient, the doctor will briefly explain to me the patient’s condition and the proper way to manage them. Other than that, I also observed how the doctor suggested the patient on diet modifications for dyslipidemia.

Other than academic progression, I was introduced to a totally new environment. Thus, I started to recognise new faces, to make new friends and to know more doctors as possible as this is the best time for me to build connections in a foreign country as a medical student. This can greatly help me to improve my interpersonal and communication skills.

This is the summary of what I did in the Week 1, it was a fun and fruitful experience and I am looking forward to the following week!

3. Points to remember from Week 1 (Phase 2).

After the experiences in Week 1, I learnt that the role of Family Medicine is very important as the first point of contact for patients, handling a broad spectrum of health issues. They manage acute illnesses, chronic conditions and preventive care, serving as the backbone of the healthcare system. Besides, Family Medicine practitioners often engage in community health efforts to improve the overall health of the community. This applies to both Taiwan and Malaysia as Family Medicine in both countries share the same goal.

4. Your feelings and thoughts?

I felt grateful for the first week being able to carry out elective posting in KCGMH especially in the Family Medicine Department, in terms of what I have learnt, the people I met and the environment. This is because the Family Medicine Posting in UKM is considered as small posting and the period we exposed during the posting is quite short and limited. In fact, we can really learn a lot from this department. The most impressive experience is the Rural Area Visit as I did not have this opportunity back then in Malaysia, in term of how to manage patients outside hospital setting and it was a totally new experience to me. Besides, the nurses and doctors I met here are all nice and willing to help. This serves as a really conducive environment for me to learn as an international student.

5. ONE good thing from what you did that you can practice now!

I believe it is do not shy to ask questions if you have any doubt. This is because I am an introvert and to me, to initiate a conversation to ask questions needs a lot of courages. However, due to I was in a foreign country and a totally new environment, I was forced to initiate any conversation to ease my day such as asking the directions in the hospital from someone I do not know. After that incident, I slowly able to open up myself and I believe this is a good approach for me to improve my communcation skills.

6. Any difficulties/concerns? How did you cope?

The main concern is the language barrier as the local Taiwanese has their unique accent even though I can understand and speak Mandarin. Other than that, they have their own dialect as well which is also very different from what we have in Malaysia. To cope, I will just say that I do not understand and most of the time they will understand and speak slower to ensure I am able to understand.

7. Your plan for next week (Week 2)?

According to the timetable, I will have Home Visit and Inpatient Care for the following week. It is surprising that we have wards in Family Medicine Department in Taiwan in contrast to we only have clinics in Malaysia. I can't wait for the following week!

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Week 2: Clinical Elective Posting of Orthopedic Surgery Department  in Almaty Kazakhstan

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Week 2: Clinical Elective Posting of Orthopedic Surgery Department  in Almaty Kazakhstan

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1.     Your name, matric number, date

Name: Khor Shin Rou

Matric number: A188404

Date: 18/8/2024

2.     How is your progress?

I have been changed to the Orthopedics Surgery department for the second week of my Elective Posting. This was my first time entering and observing orthopedics surgery, the feeling of nervousness, thrill, and fear was mixed up simultaneously.

Our tutor Dr Galym is the head of department of orthopedics department in the hospital, he told us about every operation that would be going on the next day and even let us scrub in to help in the surgery. We observed a few types of surgery such as ACL tear reconstruction, hand surgery, and scarf osteotomy surgery.

There is one of the most interesting surgeries for me was the hip joint replacement surgery. It was my first time to attend and observe at a near distance how they removed the femur head and inserted the prosthetic implantation into the patient’s body. I was excited when I saw they cut the neck of the femur and take it out, however, maybe this was my first time seeing this, I felt nauseous and dizzy after that. But it was a new and amazing experience for me.

Once when I followed Dr Galym for his consultation, there was a 60-year-old woman who had two screws in her medial malleolus one year ago due to the fracture in the medial malleolus. She came this time to remove the screw, and I was asked by Dr Galym to assist him. This was my first time assisting a Dr in doing clinical work, to be honest, I am clumsy and nervous at the moment. Dr Galym knew that I did not have any assisting experience before, and he just patiently waited for me to prepare the things needed.

When he tried to take out the screws, it was a bit cruel for me as is my first time observing how they do so, so he cut the skin based on the X-ray film the patient took back in April and he used the screwdriver find the screw, one thing surprised me is, they did all these in the treatment room and there is no any X-ray equipment with him to confirm the exact location of the screw. The patient was really in pain as they just used localized anesthesia on the patient, and it took around half an hour to find only one screw and end up with the second screw Dr Galym decided to take it out in the operation theatre. The patient was suffering the whole time, but one thing that Dr Galym did well is, he always calmed the patient down and confirmed the patient’s situation. This was a fascinating experience as I can help in assisting the doctor and observing how he took out the screw from the bones.

3.     Points to remember from week 2!

-        I should always show my interest in helping and assisting the doctors to gain more clinical hands-on experience.

-        Always remember to gain consent from the patient to take photos for documentation

-        We shall always remember patient-oriented care rules and apply them in our daily life.

4.     Your feelings & thoughts

Throughout this week, I have experienced a range of emotions, from the feeling of anxiety to excitement made my whole week an amazing experience. I am grateful for this whole week's experience in the Orthopedic Surgery department, the doctors help us a lot in explaining and answering the questions we have.

5.     ONE good thing from what you did that you can practice now!

During this whole week, I learned how to interpret an X-ray, and it is the most valuable skill I practiced. Doing an interpretation of an X-ray helps me identify the abnormalities in the images and I am glad that I have my pre-practicing of Orthopedics in Almaty, as I will enter my Orthopedic posting next semester. This pre-exposing of Orthopedics departments gave me an eye-opening experience and it reminded me, that I should start revising the anatomical structure of the bones, muscles, and tendons in the body. With these experiences, I hope it helped me to my Orthopaedics posting smoothly.

6.     Any difficulties/concerns? How did you cope?

The biggest concern I faced here in Almaty is the language barrier, however, I have tried to apply the Russian words I learned in Duolingo, and it works. Now, I know how to greet good morning to the hospital staff by using the Russian language and I also know some words of the food which helps me a lot when I am going to order food. But communication with others is hard for me as most of the Kazakhstan people here speak in Kazakh. So, most of the time I will just use google translator to translate what I need for them.

7.     Your plan for next week (Week 3)

Next week, I probably will join the Endoscopic Department and do some clinical work, I hope through these, I can strengthen my clinical skills and sharpen my knowledge. In addition, I will engage more actively with the doctors by asking and seeking for further explanations. I hope next week's lesson will be more fun. :3

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SCOPE Elective Posting in Linkou Chang Gung Memorial Hospital (Week 2)

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SCOPE Elective Posting in Linkou Chang Gung Memorial Hospital (Week 2)

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Jocelyn Yeak

A188150

12/8/2024 - 18/8/2024

2. How is your progress?

I started my second week with the Trauma team in the plastic surgery department. I was amazed to learn that this department is like a combination of orthopaedics and emergency surgery because the cases they handle are mostly accident-related. During Week 2, I attended ward rounds with my supervisor early in the morning at 7 a.m. every day. I got to see the progression of the patients I had observed during surgery. Additionally, I had dinner with my friends and two Malaysian seniors who studied and work at the same hospital as us. It felt familiar to meet people from the same country.

3. Points to remember from week 2!

One case involved a 20-year-old boy who had a lower limb degloving injury from a car crash while riding his bicycle. This reminded me that we should be careful on the road because accidents are unpredictable. Therefore, we must be alert when crossing the road or driving. Also, my supervisor was very considerate and took the boy’s mental health into account, which taught me that doctors should address patients' biopsychosocial needs in addition to their physical health.

4. Your feelings & thoughts

I felt quite tired this week due to having to wake up early every day, but the week was fulfilling. I was still amazed by the surgeries in plastic and reconstructive surgery, just as I was in Week 1. It has definitely motivated me to pursue a career in surgery in the future.

5. ONE good thing from what you did that you can practice now!

I managed to analyze some trauma-related X-rays under the supervision of my doctor. I definitely benefited from this experience, and I believe it will be useful for me, especially in my upcoming Year 4 clinical rotations.

6. Any difficulties/concerns? How did you cope?

There was one instance when I was asked by the scrub nurse to open a sterile plaster, and I accidentally used the wrong technique, almost contaminating it. Fortunately, the plaster could still be used. I was so embarrassed and apologized to her for my mistake. I will be more alert and careful in the operating theater, especially when handling sterile items, in the future.

7. Your plan for next week (Week 3)

In the third week, I will be with the trauma team under a different supervisor. I plan to ask for permission to assist in surgeries, as I have not scrubbed in for any procedures yet.

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Week 2 elective posting in geriatic department in Taiwan

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Week 2 elective posting in geriatic department in Taiwan

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Name: Karuna Lim Jing

Matric no:A185596

Date:12/8/2024 - 18/8/2024

2. How is your progress?

- I'm becoming more comfortable navigating the ward rounds and have become more adept at picking up medical terms specific to geriatrics. I’ve started to interpret chest X-rays better, especially in elderly patients. Additionally, I’ve familiarized myself with the Clinical Frailty Scale and how it helps assess the overall health status of geriatric patients.

3. Points to remember from week 2!

- Building rapport with patients is crucial. By treating them like a friend, I gain their trust, which is essential for their care. In the geriatrics department, non-pharmacological management is just as important, particularly rehabilitation, which plays a central role in improving patients' quality of life.

4. Your feelings & thoughts

- I'm feeling more integrated into the ward, and it's fascinating to see the holistic approach taken towards patient care in geriatrics. Sometimes, the emotional aspect of caring for frail patients can be overwhelming, but it also reminds me of the impact that compassionate care can have on their well-being.

Beyond attending clinic classes, I've enjoyed joining gatherings organized by Malaysian students who study and work here as doctors. It's been a great experience hanging out with people who share similar backgrounds and speak Malay. I've also had the opportunity to explore Taipei with Taiwanese friends, visiting places like Dadaocheng. Their hospitality has made me feel right at home.

5. ONE good thing from what you did that you can practice now!

- I’ve learned to listen more intently to patients, particularly when discussing non-medical aspects of their lives. This has not only improved their comfort but also enhanced my ability to tailor individualized care plans that address their unique needs.

6. Any difficulties/concerns? How did you cope?

- One challenge has been adjusting to the slower recovery times and more complex health issues seen in elderly patients. To cope, I’ve made a conscious effort to remain patient and to stay updated with geriatric-specific care strategies, including discussions with senior doctors and utilizing non-pharmacological treatments.

7. Your plan for next week (Week 3)

- Next week, I plan to focus more on learning about palliative care in the geriatrics ward. I aim to deepen my understanding of ethical decision-making in elderly care, particularly when managing end-of-life issues. I also hope to improve my communication skills, especially with family members of patients, who often play a critical role in care decisions.

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1.     Name: Jolin Ooi Min Wei

Matric Number: A187931

Date: 12/8 – 16/8

2.     How is your progress?

My week started with the ward rounds with my supervisor, Dr. Chiang. After the quick rounds, we entered the operation theatre (OT). I first observed an umbilical hernia, which Dr. Chiang was responsible to supervise his resident operate. Then I was brought to the other room and managed to observed a Radical Antegrade Modular Pancreatosplenectomy (RAMP).

On Tuesday, I joined the department meeting, where I learnt about a mortal case that was announce for the past week. My day continued with Dr. Chiang’s outpatient clinic. That morning was less hectic, and I was able to get a 3 hours lunch break. The afternoon session was about Dr. Chiang running me through the updates of the patients on his hand. I have learnt that the overall rough treatment plan of the hospital on appendicitis cases, as well as successfully identified the inflamed appendix on a CT scan that afternoon. The day ended with a complete afternoon round with my doctor.

Wednesday also started with the morning rounds. Dr. Chiang then brought me to the OT to observe more surgeries, including laparoscopic direct inguinal hernia repair, cholecystectomy and Transoral endoscopic thyroidectomy vestibular approach (TOETVA). The TOETVA surgery was really mesmerising. To start with, I will need to wear a 3D spectacle to observe the surgery. Not only that, to witness the process of the “scarless thyroidectomy”, is interesting. The opening scar was in the mouth, and small. They also used multiple machines including the nerve monitor to assist in the surgery.

On Thursday Dr. Chiang had 6 planned surgeries. The day started in OT, with a locally anaesthesia surgery. It was a suspected incisional hernia, with encapsulated ascitic fluid on the abdomen. It was resolved with aspiration and planting of a drainage tube. The day then continued with a complicated cholecystectomy surgery, where the gallbladder was so inflamed that there were bad adhesions that happened. When the gall bladder was resected and removed safely, we only learnt that there was a stone as large as 2x2cm. Dr. Chiang was jumping between 2 rooms that day, with the aid of multiple residents from the department. In the afternoon, I was allowed to scrub in to observe a small intestine tumour resection surgery. It was an open surgery, and it was the first time I had the chance to hold on the real intestines as well as tumour. The tumour the patient had was too big that it ate parts of the neighbouring intestines. There were no other options but to remove them together with the tumour. The most interesting part of the day though, was the earthquake. It happened in the middle of the right hemicolectomy surgery. It was just for several seconds, so fast that I would never ever react to if it wasn’t for Dr. Chiang who mentioned about it. However, it was an interesting experience not only the earthquake, but also to learn how surgeons react to earthquakes during surgery.

On Thursday night, I was being informed that Dr. Chiang was on-call. Hence, I took the opportunity to request to join his force. He agreed, and I was placed under the guidance MO on-call. That night, I learned about the management and treatment of the general surgery (GS) on intestinal obstruction cases, and also did a brief abdomen PE on the patient. Then, I was educated on the treatment options of atrial fibrillation (AF) as there was a patient in the wards that was encountering this problem. The night ended with this as fortunately, it was a peaceful night.

The last day, Friday, was the last day I am in the department. The day started with ward rounds and followed with Dr. Chiang’s outpatient clinic. That morning, I was lucky to have the opportunity to do some stitches removal and also observed how follow-up appointments were conducted in Taiwan. The week ended with a short lecture on hernia from Dr. Chiang that afternoon, along with 3 local students.

3.     Points to remember from week 2!

Academically, I received a lot of input this week. From how to manage a patient with intestinal obstruction and AF, to how to interpret abdomen CT scans. I also had a lot of hands-on experience this week which I was really grateful for. These experience were definitely something I will not want to forget!

Throughout the week, I was also fortunate to observe how Dr. Chiang handled outpatient clinics. It was different from in OTs. I was really inspired by the way Dr. Chiang treated his patients. There were different kinds of patient, new cases, as well as follow-up cases. There were even cases where they look totally out of the responsibility of a GS surgeon. But nonetheless, Dr. Chiang always does his best to help each one of them. He will constantly ask patients “what can I do for you?”, to ensure he will not miss out any important concerns of the patients. Personally, I think this would also be something I would really learn from and remember.

4.     Your feelings & thoughts.

The past week was also a great week. But it was complicated with the fact that I am leaving the department. I am extremely grateful for all the opportunities and knowledge gained from each and everyone in the department. Thinking about leaving the department, was however sad for that I hope to learn so much more from them. The feeling is also complicated with the anxious emotions of stepping into a new department in the upcoming week.

5.     ONE good thing from what you did that you can practice now

There is actually so many lessons I learnt from the past week, that to select only one would be difficult. After a thorough thought about this question, the thing that came immediately out of my mind is actually the ability to interpret CT scans. Back in Malaysia, the chances to learn how to interpret CT scans in the past academic year were really limited as our radiology course actually focus more on X-Rays, which were understandable, for that it was the more basic and important radiological analysis. But with the knowledge from the past 2 weeks, I can now be more confident in interpreting CT scans, which in many cases, I believe will aid much in my studies.

6.     Any difficulties/concerns? How did you overcome?

I was concerned about ward works and basic approach of patients for last week, since I was spending most of the time in the OT. Of course, I was glad to have the opportunities, but to really understand a department, I always thought that I will need to experience all aspects of it. So on the second week of my placement in GS, I took the initiative to request to Dr. Chiang if I could join more ward works and also the outpatient clinic. I was first worried that I was asking too much, but turned out, he was really welcoming for me to join ward rounds and the clinics. In short, I was really glad that I asked!

7.     Your plan for next week (Week 3)

In the next week, I will be moving on into a new department for my placement here in Taiwan. I will be in the anaesthesiology department for the rest of my placement here. I am nervous and anxious about it as I am still a total “blank paper” in the aspect of medicine. But my plans for the upcoming week is to get used to the department and learn as much as possible about the department!

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1, 5: Angiography and PCI; 2: General Internal Medicine ward (my department); 3: Lung Cancer Workshop with Dr Lee at Marriott Hotel; 4: Echocardiography by my supervisor; 6: Morning meeting; 7: Discussion room in the ward; 8: My own student card in Kaohsiung CGMH; 9: The outer view of the main building of Kaohsiung CGMH.

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Phase 2: Clinical Elective Posting in Kaohsiung Chang Gung Memorial Hospital (Week 1)

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Phase 2: Clinical Elective Posting in Kaohsiung Chang Gung Memorial Hospital (Week 1)

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1. Name: Tan Ying Ju

Matric Number: A185599

Date: 29/7/2024 – 2/8/2024

2. How is your progress?

My clinical elective posting began with orientation conducted by Ms Chi, a staff member of Education Department of Kaohsiung Chang Gung Memorial Hospital (CGMH). I was given a tour of the hospital compound and I was introduced to the members of General Internal Medicine department and my supervisor, Dr Chen Tian Yu. Dr Chen made sure I was clear of how things work in the department and I was given access to the electronic health record system as paper-based record was no longer available in CGMH.

In the first week, I had four lectures given by specialists in my department which were on Approach to Joint Pain, Approach to Chest Pain, Approach to Gastrointestinal Bleeding, and Immediate Management of Common Chief Complaints. The lectures were also attended by Postgraduate Years (PGY) doctors (equivalent to houseman in Malaysia).

I got the chance to follow ward rounds every day in the first week, Dr Chen would interweave small teaching sessions in between cases to teach me about the illnesses and management. One of the most memorable and fruitful session would be Dr Chen teaching me about mitral prolapse with him explaining the causes, showing the radiological images of mitral valvular prolapse and illustrating the surgical management of the mitral valve prolapse. Even though he thought that the topic of mitral valve was too deep for undergraduate students, he tried his best to use the simplest language that I could understand to explain to me everything about mitral prolapse.

Moreover, I was lucky enough to be given chance to observe cardiac catherisation, echocardiography and abdomen ultrasound. The doctors gave clear explanations of the procedures, and they explained the possible findings to me as detailed as possible.

I am very grateful that Desmond’s doctor gave me the opportunity to learn about the practice of abdominal ultrasound together with Desmond. We learnt about the steps of abdominal ultrasound, the normal findings and abnormal findings of abdomen which were demonstrated on the doctor’s patients.

The most memorable event of the week would definitely be us being invited by a Malaysian specialist who specialises in respiratory medicine (lung cancer), Dr Lee, to a lung cancer workshop with the theme of ‘The Use of TKI in Lung Cancers’ held on World Lung Cancer Day at Marriot Hotel, Kaohsiung. Despite the use of TKI in lung cancer, we also learnt about the side effects of TKI use and the management of the side effects.

3. Points to remember from week 1 (phase 2)

Rapport

The one thing I have learnt from Dr Chen during ward rounds is building rapport with the patients and the family members. He remembered details of every patient, including their medical history, personal history, concerns, family members who took care of them, and the results of every single test done on the patients. To build a better rapport, he used dialect to communicate with some of the patients so that they can communicate more freely and comfortably.

Patience

As a short-tempered person, I find it very difficult to maintain my patience when things do not go well. I learnt my lessons when all the doctors in my department managed to keep calm and faced the patients with the best attitude no matter what happened.

Holistic

There was a case which the patient presented with only nausea and vomiting turned out to be acute coronary syndrome. I have learnt that whether it is a medical case or any problem in life, I should always take a holistic approach so I can come out with the best solution.

4. Your feelings and thoughts

I was utterly grateful to be given this chance to carry out elective posting in CGMH, Taiwan. I could widen my horizon with the exposure to different healthcare system, culture and practice in Taiwan.

On the other hand, I was really amazed by how detailed the lectures and teachings sessions were, I could really feel the passion in teaching in the doctors here in Kaohsiung CGMH.

Since the arrival at Taipei Taoyuan Airport, the 'cute aggression' in me had been triggered. Taiwanese people sounded like a clinger whenever they talk, whether it was a teenage girl or a middle-aged man, it was too cute for me to handle, like you can't even get mad at them!

5. ONE good thing from what you did that you can practise now!

I have learnt the skills of interpreting chest X-ray, Cardiac CT Scan and coronary angiography from my supervisor, Dr Chen, who specialises in cardiovascular medicine. He taught me about the tricks of identifying positive findings in the radiological reports of his patients every day in the ward. It is something I could practise and further improve in the future.

6. Any difficulties/concerns? How did you cope?

The only difficulty I faced here in CGMH was communication. In Taiwan, they mostly use Chinese to communicate even when it comes to professional terms. As a Chinese, I could understand most of it but I found it hard to understand some the professional terms as I had never learnt it in Chinese. I always caught the chance to search it on the net or ask the doctors whenever I did not understand.

7. Your plan for next week (week 2/phase 3)

My plan for next is to learn from my supervisor about the choice and proper use of beta-blocker, interpretation of ECG, and interpretation of X-ray. I also plan to clerk a case to discuss with my supervisor to polish my history taking and diagnosing skills.

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Summary of my Week 1 Elective Posting at Kaohsiung Chang Gung Memorial Hospital.

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Phase 2: Clinical Elective Posting in Kaohsiung Chang Gung Memorial Hospital (Week 1)

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Phase 2: Clinical Elective Posting in Kaohsiung Chang Gung Memorial Hospital (Week 1)

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1. Name: Chan Huan Shen

Matric No: A188111

Date: 5 August 2024 - 9 August 2024

2. How is your progress?

My elective posting started with the orientation conducted by the monthly HOD of the Department of Family Medicine, Dr. Yan. I was given a small briefing about what I am going to do in these two weeks. He also brought me to familiarise with the several places that I will need to go in the following days. In short, the first week of the elective posting, I will attached to several clinics, such as Cancer Screening Clinic, Physical Examination Clinic, and Teaching Clinic, other than that I will also join the Rural Area Visit to Shanlin District.

In the Cancer Screening Clinic, I was assigned to Dr. Sun. In his clinic, I was able to observe several procedures such as Pap smear for cervival cancer screening and oral examination for oral cancer screening. He taught me on the basics of doing the procedures as stated and explained to me the significance. I was told that the common cancers in Taiwan are cervical cancer, oral cancer, breast cancer, colon cancer and lung cancer. Thus, the role of Family Medicine Department is very important to provide screening services to the high risk community. It is also their government effort to advocate early screening to the elderly and high risk community as to detect early and provide early interventions to them.

In the Physical Examination Clinic, I was able to observe the doctor to perform basic physical examinations, which includes eye and hearing assessments, examinations of the neck, chest, abdomen and legs. They provides this service mainly for the employees of partnered companies, and also students for university enrolment.

Next is the Rural Area Visit, I was assigned to Dr. Wang, together with a pharmacist and a community nurse. I was told that there are many rural areas to cover in Taiwan but the area which is assigned to Kaohsiung Chang Gung Hospital is a district known as Shalin District, which is about 45 minutes drive away from the hospital. In the usual routine, the team will prepare the essentials such as the basic medications, the BP measuring devices, glucometer and so on in prior to the visit. They have a fixed meet up point in the rural area (a common area in front of a temple), whereby annoucement will be made at the community centre in prior to the visit, so that the community will aware and seek for medical treatment if they need on that specific day. Most of the cases which I observed on that day was follow up cases for chronic diseases such as diabetes mellitus, hypertension and dyslipideamia to replenish their medication supplies. There were also acute cases such as cough and common colds. The objective of this visit is to let the underprivileged to have opportunities to access to healthcare as many of them do not have the ability to travel to cities just for medical treatment. This effort has great impacts to the community in the rural area as there are professionals guiding them and if necessary or any emergency cases will also be referred immediately to the nearest hospital.

The last clinic in this week was Teaching Clinic, where I was assigned to Dr. Jiang to attach to her clinic. It is quite similar to how we did in Malaysia, in which the doctor will see the patient, to take history from them,  and identify the chief complaint and perform some physical examinations. After each patient, the doctor will briefly explain to me the patient’s condition and the proper way to manage them. Other than that, I also observed how the doctor suggested the patient on diet modifications for dyslipidemia.

Other than academic progression, I was introduced to a totally new environment. Thus, I started to recognise new faces, to make new friends and to know more doctors as possible as this is the best time for me to build connections in a foreign country as a medical student. This can greatly help me to improve my interpersonal and communication skills.

This is the summary of what I did in the Week 1, it was a fun and fruitful experience and I am looking forward to the following week!

3. Points to remember from Week 1 (Phase 2).

After the experiences in Week 1, I learnt that the role of Family Medicine is very important as the first point of contact for patients, handling a broad spectrum of health issues. They manage acute illnesses, chronic conditions and preventive care, serving as the backbone of the healthcare system. Besides, Family Medicine practitioners often engage in community health efforts to improve the overall health of the community. This applies to both Taiwan and Malaysia as Family Medicine in both countries share the same goal.

4. Your feelings and thoughts?

I felt grateful for the first week being able to carry out elective posting in KCGMH especially in the Family Medicine Department, in terms of what I have learnt, the people I met and the environment. This is because the Family Medicine Posting in UKM is considered as small posting and the period we exposed during the posting is quite short and limited. In fact, we can really learn a lot from this department. The most impressive experience is the Rural Area Visit as I did not have this opportunity back then in Malaysia, in term of how to manage patients outside hospital setting and it was a totally new experience to me. Besides, the nurses and doctors I met here are all nice and willing to help. This serves as a really conducive environment for me to learn as an international student.

5. ONE good thing from what you did that you can practice now!

I believe it is do not shy to ask questions if you have any doubt. This is because I am an introvert and to me, to initiate a conversation to ask questions needs a lot of courages. However, due to I was in a foreign country and a totally new environment, I was forced to initiate any conversation to ease my day such as asking the directions in the hospital from someone I do not know. After that incident, I slowly able to open up myself and I believe this is a good approach for me to improve my communcation skills.

6. Any difficulties/concerns? How did you cope?

The main concern is the language barrier as the local Taiwanese has their unique accent even though I can understand and speak Mandarin. Other than that, they have their own dialect as well which is also very different from what we have in Malaysia. To cope, I will just say that I do not understand and most of the time they will understand and speak slower to ensure I am able to understand.

7. Your plan for next week (Week 2)?

According to the timetable, I will have Home Visit and Inpatient Care for the following week. It is surprising that we have wards in Family Medicine Department in Taiwan in contrast to we only have clinics in Malaysia. I can't wait for the following week!

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My Elective Posting in Linkou Chang Gung Memorial Hospital (Week 1)

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My Elective Posting in Linkou Chang Gung Memorial Hospital (Week 1)

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Week 1 in Linkou Chang Gung Memorial Hospital

1. Your name, matric number, date

Name: Low Yu Sen

Matric Number: A190206

Date: 8 August 2024

2. What have you done?

My elective posting is assigned to the Medical Geriatric department at Linkou Chang Gung Memorial Hospital for two weeks.

This week, I began my elective by familiarising myself with the structure and daily operations of the geriatric department at Linkou Chang Gung Memorial Hospital. As a new member of the team, I was introduced to some of their operation team at Linkou Chang Gung Memorial Hospital during the first two days of my elective.

I met my on-site supervisor, Dr Liao, who is a senior geriatrician, some staff nurses in the geriatric ward, and some of the “postgraduate years” doctors (they call them PGY) who are basically equivalent to our house officers.

I was integrated into the geriatric team and participated in daily rounds, where I observed thorough assessment and management of elderly patients with a variety of health conditions, such as dementia, delirium, and other chronic diseases.

Throughout the week, I shadowed the attending physician closely, learning approaches and complexities of geriatric medicine. I assisted in taking patient histories, particularly focusing on aspects that are crucial in geriatric care, such as cognitive function, mobility, and social support systems.

Besides ward work, I also joined their teaching clinics, led by the geriatric physician together with the PGYs. I was held in a special room where patients were informed that they will be clerked by training doctors and students and it was a good experience where our on-site supervisor observed and commented on our clerking techniques and the focus of the consultation.

In addition to ward rounds, I attended a multidisciplinary team (MDT) meeting, where I observed how various healthcare professionals, including nurses, pharmacists, occupational therapists, and social workers, collaborate to develop comprehensive care plans for patients. Chinese medicine also contributed to the team discussion. This experience highlighted the importance of teamwork and the holistic approach required in managing geriatric patients. And it was eye-opening that Chang Gung Memorial Hospital takes interprofessional approach seriously as we don’t often see it in HCTM.

I also had the opportunity to sit in on a few family conferences, where the medical team discussed prognosis, treatment options, social support and care with the patients' families. These sessions emphasised the significance of clear and compassionate communication, particularly when addressing sensitive topics like palliative care or advanced directives.

Towards the end of the week, I was involved in a case study discussion where we reviewed a complex case of a patient with multiple chronic conditions. The discussion revolved around balancing the risks and benefits of various treatments, particularly polypharmacy with a focus on maintaining the patient's quality of life.

3. Points to remember from week 1!

"Caring elderly, less is more” — The goal in caring for elderly patients is not just to manage their conditions, but to enhance their quality of life. Prioritise what brings joy and comfort over aggressive interventions.

“Small signs, big condition” – In elderly patients, their presenting complaints might not be , the tiniest complaint might signal the onset of a serious infection, for example, generalised weakness.

“Polypharmacy: Friend or Foe?” – Elderly patients always have a lot of diseases and medications. However, they come with a lot side effects and drug interactions, which can lead to new health issues or exacerbate existing ones. Hence, balanced view of polypharmacy is important to optimise patient outcomes.

4. Your feelings & thoughts

Feelings: I experienced a range of emotions, in the geriatric ward, I get to see a wide spectrum of patients. It’s very happy for everyone seeing improvements in patients’ conditions and also happy to learn new things and cultures in other countries. Also, sadness dominates when dealing with end-of-life issues. But anyhow, I developed a deep appreciation in “empathy” for the holistic approach required in geriatric care.

Thoughts: I began to realise the importance of integrating physical, emotional, and social aspects of care in patients. Besides, it is also really eye-opening to explore Taiwan’s healthcare system (they have 4 big biggg blocks in thw hospital compound), I hope my legs will be muscular at the end of the posting.

5. Any difficulties/concerns? How did you cope?

Firstly, approaching elderly patients in the geriatric ward is not a common thing that I did in HCTM, and it is very different compared to the normal population in the medical ward, due to various reasons. And the biggest concern of all, is communication.

Engaging with elderly patients can be difficult due to their declined mental status and functional status. Hence, a lot of compassion and professionalism is needed. Hence, in order to understand patients’ condition, involving caregivers are often the easier approach to ensure all aspects of the patient’s care are addressed.

At the same time, was sometimes emotionally challenging to navigate sensitive conversations, especially those involving end-of-life issues or significant health declines. Hence, clear communication techniques and showing patience and compassion is very crucial to address these issues together.

6. 2 words to describe elective posting progress so far

Interesting and eye-opening

7. Your plan for next week (Week 2)

Continue to observe and participate in patient rounds, focusing on improving my ability to follow and contribute to discussions. Spend time in the outpatient clinic to learn more about managing geriatric patients.

Note: Previous post was posted on 8 Aug at Week 1's Padlet and moved here

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Phase 2- Week 1 of elective posting in Linkou Chang Gung Memorial Hospital, Taiwan

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Phase 2- Week 1 of elective posting in Linkou Chang Gung Memorial Hospital, Taiwan

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1. Your name, matric number, date

Name: Tan Shi Ying

Matric number: A189552

Date: 9/8/2024

2. How is your progress?

My elective posting began with an orientation to help me familiarise myself with the hospital's layout and the various departments. I joined ward rounds daily, which allowed me to observe and learn from the interactions between doctors and patients. One of the highlights was acting as a translator for an Indonesian caretaker of a dementia patient, bridging the communication gap between her and the medical team.

I also had the opportunity to participate in the outpatient department for clinical teaching. Here, I learned techniques for taking patient history and performing physical examinations, including detecting heart murmurs. I observed several procedures, such as echocardiography, electrophysiology studies, cardiac catheterization and continuous Doppler. The chance to observe these procedures was both exciting and educational. Additionally, I attended ECG reading classes, which further enhanced my understanding towards cardiology.

3. Points to remember from week 1!

-The importance of familiarising myself with the hospital’s systems and procedures.

-The value of participating in ward rounds and clinical teaching sessions.

-Gaining hands-on experience by observing various cardiac procedures.

4. Your feelings & thoughts

This week has been a mix of excitement and challenge. The exposure to advanced cardiac procedures and the opportunity to observe and learn from experienced doctors have been incredibly rewarding. I’m grateful for the welcoming atmosphere and the chance to immerse myself in the cardiology department. However, the language barrier posed a significant challenge, especially when trying to understand complex medical terms in Chinese and the slang of Taiwanese English. Despite this, the willingness of the doctors to explain things clearly and answer my questions has been a great source of support.

5. ONE good thing from what you did that you can practice now!

One of the most valuable skills I’ve practiced this week is the interpretation of ECG. Attending the ECG reading classes has significantly improved my ability to recognize different cardiac patterns, which is something I can continue to practice and refine in my clinical year.

6. Any difficulties/concerns? How did you cope?

The primary difficulty I encountered was the language barrier, particularly in understanding some medical terms in Chinese. To cope with this, I made an effort to review the terminology beforehand and used translation tools when necessary. I also took the initiative to ask the doctors for clarification whenever I was unsure about something, which helped bridge the gap in my understanding.

7. Your plan for next week (Week 2 of EP)

I will continue participating in ward rounds and clinical teachings to deepen my understanding. I plan to focus more on improving my understanding of Chinese medical terminology to reduce the language barrier. Moreover, I will engage more actively during procedures by asking questions and seeking further explanations. Additionally, I want to spend more time reviewing ECG to improve my interpretation skills.

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Elective Posting in Chang Gung Memorial Hospital Taiwan (Kaohsiung): Phase 2 - The journey begins !

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Elective Posting in Chang Gung Memorial Hospital Taiwan (Kaohsiung): Phase 2 - The journey begins !

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1. Name: Cheah Chen Thung

Matric No.: A186511

Date: 4th August 2024

2. How is your progress?

The week started off with orientation under the Department of Pulmonary and Critical Care Medicine as I was introduced to the medical team and my supervisor. During the first week of posting, I managed to participate in the pre-round conducted by the nurse practitioner (NP) in the morning before the ward round in the afternoon. This enabled me to familiarize myself with the cases prior to discussion with my supervisor. I was also arranged to observe bronchoscopy performed by one of the consultant pulmonologists under the department. During my attachment there, I managed to observe the procedure of endobronchial ultrasound and transbronchial biopsy. The pulmonologist in charge also explained on the interpretation of HRCT Thorax and method to identify the precise location of a mass based on the radiological findings. He also demonstrated the various types of bronchoscopes available here and shared on the indications for some of them. A short teaching session was conducted by him after the bronchoscopy was done and the topic was on "Microscopic findings of lung adenocarcinoma and squamous cell carcinoma: How to differentiate between them?" Apart from that, I was posted to the Respiratory Therapy unit as well. The technician in explained on the rehabilitative activities that are conducted in the unit and demonstrated some of them on real patients, for example VEST (high frequency chest wall oscillation). Clinic attachment opportunities were made available as my supervisor allowed me to join his clinic session. In conjunction with World Lung Cancer Day which falls on 1st August, I was given the opportunity to attend a Lung Cancer Workshop (Gio Workshop 2024) along with my peer lead by another consultant pulmonologist who turns out to be a Malaysian physician who had been working in Taiwan for almost 2 decades. On one of the mornings, I attended a multidisciplinary meeting on Lung Cancer where experts from different specialty come together to discuss on the cases. I had attended a teaching session on "Common On Call Problem in General Medicine" on Friday morning.

3. Points to remember from week 2.

Multidisciplinary care is important to ensure the comprehensive care of a patient is met. Different specialities are important of patient. Establishing a good rapport with patients help to alleviate their anxiety and facilitates their care and ensuring the psychological aspect of their care is met.

4. Your feelings and thoughts.

The first week of posting was relatively hectic as everything was new to me but it was undeniably a fruitful one. Equipping yourself with the ability to regulate your emotion is important in Pulmonary and Critical Care Medicine as this division has the greatest rate of mortality. Palliative care is therefore an important aspect to master in respiratory medicine and this has been repeatedly emphasized by my supervisor. During my first week here, I was exposed to different branches of respiratory medicine which was an opportunity not readily available during our times in Internal Medicine posting.

5. One good thing from what you did that you can practice now.

Communicating with different members of the healthcare team using language with medical terminologies that I'm not familiar with can be daunting initially. Clarifying any terms or doubts can undeniably improve transfer of information and facilitate understanding between colleagues and patients which will ultimately benefits the patients in terms of their survival. I seek clarification repeatedly throughout my first week of posting with the nurse practitioner as I had difficulty understanding the name of diseases and medical equipment in Chinese.

6. Any difficulties/concerns? How did you cope?

Language barrier was the most prominent obstacle that I faced throughout my first week of posting here in Taiwan as the language used in communicating with patients was a mixture of Chinese and the Fujian dialect. As a result of that, I had some hard time understanding the conversation between my supervisor and the patients especially during his clinic session. Due to that, I had to request the doctor to summarize his conversation with the patient which fortunately enough, the doctor was more than happy to help out. I also used my free time to memorize some common medical terminologies in Chinese.

7. Your plan for next week.

The second week of posting will involve me being posted to the sleep medicine unit where I will be allowed to observe mainly polysomnography and being taught on its interpretation. There shall be more teaching, ward rounds and clinic session with my supervisor next week as well.

*Note: Previous post posted on 4th August 2024 which was deleted due to technical issue

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The picture on the right bottom is me and my supervisor, Dr Chen Chih Hong. I took this photo with him after his clinic session. 

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Phase 2: Clinical Elective Posting in Kaohsiung Chang Gung Memorial Hospital, Taiwan (Week 1: Joining Orientation & Start My Posting)

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Phase 2: Clinical Elective Posting in Kaohsiung Chang Gung Memorial Hospital, Taiwan (Week 1: Joining Orientation & Start My Posting)

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1.⁠ ⁠Your name, matric number, date

Name: Desmond Ching Jin Kang

Matric no: A185589

Date: 3/8/2024

2.⁠ ⁠How is your progress?

On 29th of July 2024 (Monday), I started off my clinical elective posting with an orientation. The person in- charge, Miss Chi and the secretary Miss Yu Lan gave me a warm welcome and introduced me to the departments in the hospital and gave me the tasks that I need to complete within these two weeks. Miss Yu Lan also gave me the time table and introduced my supervisor to me, Dr Chen Chih Hong. I was also brought to the outpatient clinic so that the doctor in the department can evaluate my health report. During my first week, my supervisor, Dr Chen demonstrated to me on how to build a nice rapport with the patients when he was doing his ward round. He usually communicates Mandarin and Taiwanese Hokies with his patients. Fortunately, I was able to understand most of his conversation and he would always explain to me what he explained to his patients. I followed his ward round everyday in the general medical ward at 6.30 a.m. Some of the key points that he always want his students to master are critical thinking, clinical reasoning, taking good history, physical examination, planning investigations and management that suit the patients. He always emphasise holistic clinical approach in order to improve the quality of care of the patients. After the ward round, Dr Chen would give me chances to ask him questions. He would also answer my questions in both Mandarin and English to make sure that I could truly understand. Not only that, my supervisor, Dr Chen also brought me to his clinic. Dr Chen is a gastrointestinal and hepatobiliary specialist. Most of his patients come to his clinic for follow-up and most of his patients in the ward had chief complaints such as gastrointestinal bleeding, abdominal pain, vomiting and so on. During the clinic session, he showed his professionalism when talking to the patients and he would also explain to me the case in detail patiently. I realized that he always smiled while he was talking to the patients hence the patients would tell him more about their problems. Whenever I have any doubt, he would also use his computer to show me the patients' medical record and investigations to clarify my questions. Not only that, Dr Chen also invited me to the ultrasound department to observe him doing abdominal ultrasound on real patients. He explained to me how to interpret and locate the organs by using ultrasound and pointed out the abnormal findings to me. Next, I also had a chance to join the multidisciplinary team meeting on Lung Cancer which is conducted by Chen Thung's supervisor, Dr Lai. We had a chance to observe and see how they interpret brain CT and abdominal CT scan. Furthermore, I was also very happy because I was also invited by Ying Ju's supervisor who is a cardiologist, to observe coronary angiogram procedure and also atrial fibrillation ablation. Last but not least, my friends and I were also invited to attend a Lung Cancer Workshop in a 5- stars hotel (Marriot Hotel) and to have a wonderful dinner there. There was a Malaysian Dr who is working in Kaohsiung Chang Gung Memorial Hospital who brought us to this workshop. The talk and the food served were all fantastic and it was a unforgettable night for us!

3.⁠ ⁠Points to remember from week 2!

Communication skills and patience is a key to take a good history from the patients. Putting a good smile while talking to people can create a harmonious environment and build a nice rapport with the patients. Dr Chen Chih Hongalways emphasize to me about the importance of having a nice interpersonal relationship with the people around me. For example, we should talk nicely and have a nice relationship with other healthcare professionals such as nurses because everyone plays an important role in the hospital. He emphasizes to me that nurses play a very important role in the hospital because they help doctors to take care of the patients and they know patients very well and report to the doctor whenever the patients are unwell. Building a good relationship with nurses also boosts the delivery of good patient care to the patients because nurses carry out order given by the doctors. From here, I gained another important point to remember, which is respecting each other.

4.⁠ ⁠Your feelings & thoughts

I felt quite tired throughout the first few days because my doctor usually did his ward round early in the morning at 6.30am and I was trying my best to adapt to this new environment. Moreover, I usually found it hard to fall asleep when I moved to another place. Hence, it took me sometime to adapt to this new hospital and the hostel. However, I was very happy and excited because I would like to explore the healthcare system in Taiwan. I was glad to have a chance to attend a private ultrasound teaching session with my doctor. I also could adapt to this new environment very quickly because the Taiwanese here were all very friendly and all of them treated me like their own junior. They would spend their time introducing their hospital and job scopes to me. Whenever I asked them any questions, they would also try their best to answer. In conclusion, I think all the healthcare workers here were all friendly to the patients and also to their peers and I believed this could create a harmonious environment for everyone to work effectively.

5.⁠ ⁠ONE good thing from what you did that you can practice now!

The good thing that I did was communicate politely with the people surrounding me and respect people’s culture when we are away from our home.

6.⁠ ⁠Any difficulties/concerns? How did you cope?

The main difficulty that I faced in the first week was to understand some terms and conversation between the doctors and patients, and also between the doctors and other healthcare professionals. This is because the Taiwanese have their own Mandarin and English slang while they are speaking. I was not surprised by their slang because everyone was different and Taiwan's education is different from ours. For example, the Taiwanese pronounce lactate as "Latte". In order to overcome this situation, I would always ask my doctors or seniors here to clarify the term and spell it for me so that I could understand. There were also sometimes the doctors here used Chinese medical terms that I do not understand. The way I overcame this was asking my doctor to translate for me and then I would jot them down to learn new Chinese medical terminologies.

7.⁠ ⁠Your plan for next week (Week 3)

I would like to experience how the doctors here conduct Sleep Study Medicine. Not only that, I would continue to attach to my supervisor's clinic and ward round to see more cases before I finish my clinical elective postings.

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Pre event preparation and welcoming delegates before the event day

1. Name: Madhavan A/L Nagaratanan

Matric number: A189433

Date: 7th July 2024

2. How is your progress?

So the delegates will be coming on 8th of July and committee members were doing the last preparation before the event day on 11th for Academic day, 12th Sociocultural, 13th was home visit and 14th was closing ceremony. I was liaising about the letters with the PIC whether everything is approved or not. Thus so far, Anatomy lab and Dissection hall got approved and it's free of charge so we were very happy about that. Unfortunately, the CSL room expenses were too high for us to rent for few hours which was RM 2000 and our committee didn't have that much of fund plus our main sponsor was only KMUKM and AMSA UKM and we got a sun of RM 2000 for the whole programme so we decided to dodge the CSL idea. Gamma knife centre was fine I met Prof Ramesh himself and we were informed that he will be doing a presentation on the academic event day. UMBI was also fine they approved it and the PIC contacted me time to time to confirm about the dates and event time slot for them. At the same time our programs in collaboration with MAHSA too. So ,from 8th till 10th July ,they will be in MAHSA.on the 10th night, the delegates were here at UKM.

3. Points to remember from week 2!

From week 2 I learned that ever doesn't always go as planned . As we had circumstances to replace the csl slot. After discussing we wanted to approach the HPKK PIC to ask for a visit there but unfortunately the queue was too long for wait and since it's last monite we decided to also dodge it.

4. Your feelings & thoughts

Personally I had mixed feelings about this since from the start we were unsure till things got approved last minute. Also scared we would disappoint Prof Isa if academic day couldn't accomplish the tasks and jobs. But thank god, 4/5 plans got a green light so I was happy about it as an EXCO Akad head.

5. ONE good thing from what you did that you can practice now!

Got thing is I had a plan backup in case if the time slot interferes and also if its not approved, so I understood that always have a plan B in your hand to ensure things will always flow smoothly.

6. Any difficulties/concerns? How did you cope?

The main difficulty was the csl slot getting cancelled for me . So I decided to contact first our Supervisor, Chantel, then we came to a consensus to dodge it and instead we decided to go around roam in the library and HCTM area during that time slot. So definitely talking to the superior committee members was huge relief although I understood it was my responsibility to handle it solely, they all helped a lot.

7. Your plan for next week (Week 3)

Next week is the event week so I am very excited. I am currently planning the tentative for next week for Academic day and ensuring time slot don't clash with each other.