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Last moments in the hospital; Trip to Tangier, Morocco with 3 other exchange students; Goodbyes

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Clinical Elective Posting: Professional Exchange Program (SCOPE) at Centre Hospitalier Universitaire Mohammed VI, Oujda, Morocco (Week 4)

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Clinical Elective Posting: Professional Exchange Program (SCOPE) at Centre Hospitalier Universitaire Mohammed VI, Oujda, Morocco (Week 4)

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Name: Teng Zhi Qi

Matrics Number: A188948

Date: 30 July 2024

1. Were the objectives of the project fulfilled?

In short, yes I would definitely consider this as a successful project. I got to understand more about the healthcare system in Morocco as well as the common Orthopedic conditions faced by the patients in Morocco, associating it with their lifestyle as well. Otherwise, I also get a glimpse of some of the "not very good" side of their healthcare system, mainly on the treatment towards healthcare workers and medical students which causes a strike / protest that happened during my time in Morocco, as well as the lack of some medical supplies such as antiseptic soap as well as bandage tape. Despite that, I still get to learn new knowledge due to the friendly Professors and doctors trying their best to teach me. After that, I also got to interact with the medical students from different countries: Morocco, Hungary, Czechia, Greech, Tunisia, Poland and Jordan. Many information and interesting facts regarding the healthcare system, medical education system, and of course the culture of different countries were shared between our daily conversations with each other, and I am proud that I got to share about my own country as well. Personal development wise, this is the first time I've ever joined an exchange program, not to mention travelling to such a far away place, boarding planes after planes by myself and sleeping overnight in different airports. I've definitely gained much independence and discipline throughout this program, taking care of myself and ensuring my own safety.

2. What have you enjoyed or liked the most about the project?

Friendly and enthusiastic local committees of UCEMO Oujda, Morocco: They really pour in their heart and soul in terms of organizing activities and trips for us. Making sure all the exchange students enjoy each second throughout the program.

Made new friends that "clicked" very well with each other: We had deep meaningful conversations and helped each other go through difficult times such as the "homesick phase". I even got to organize a privately trip with 3 other girls to a far away city (even though we missed the flight to the city, we solved it by taking the bus hahahha). I loved their adventurous and mature way of thinking, everyday was filled with fun and I felt like was learning something everyday with such friends. By the end of the exchange, before I could realize, we were all bawling our eyes out and group hugging while saying goodbye to each other. Truly amazing people I've met there.

Professors and Doctors trying their very best to teach me: I really appreciate them for trying to translate information into English for me to understand. Even though there will be inevitable moments where they are unable to translate something, they still try to do their very best for me to understand. One thing I like the most about them is the way they treat medical students there --- as their colleague, as their fellow juniors, they are willing to share whatever they know for the students.

3. What have you found challenging about this project? (any part of the project you found hard to do)

Language barrier: Inevitable considering the fact that I wanted to go to Morocco to experience something different. Was a challenge in the beginning but friendly doctors helped a lot to ease the challenge.

4. What has really worked? (any part in the project that you thought worked well)

Being myself: Being a stranger in a totally different continent, environment and being around other new people made me feel uncomfortable at first, wanting to hide the more introverted side of me and be outgoing all the time. But at one point, it was just exhausting, and I just started to go back to my own personality more, and without a doubt, I still made a lot of new friends without problem and is able to interact with them very naturally.

Being more proactive during clinical sessions: At first I was more passive as I was as a student in Malaysia due to me thinking that doctors are busy all the time and prefer students to not ask that much questions and study by themselves more. But the doctors in Morocco felt strange and asked me why I did not ask much questions, that was when I realize I can ask questions here freely and they are happy to answer them, and so I became more proactive during clinical sessions and I am certainly happy about that.

5. What can be improved in this project?

Language: I could have take some time to learn the basics of the Moroccan Arabic language as well as some French. That would be so much more polite and could help me out a lot throughout this project.

Ongoing strike in Morocco: The strike that has happened among healthcare workers during Week 2 and 3 has certainly affected my experience here in some way. Due to the strike, the main operation theatre was not opened and thus no arranged surgery could be observed during that time, only emergency surgeries are available, which were not that much. I could have asked the committees there first to understand their situation and thus avoiding time periods which such strike.

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Phase 4 - Summary of Clinical Elective Posting at NUH

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Phase 4 - Summary of Clinical Elective Posting at NUH

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Name: Seenivasan Aparrna

Matric No.: A185410

Date: 17th August 2024

1. Were the objectives of the project fulfilled?

Undoubtedly, yes! The objectives were well fulfilled.

I was able to appreciate the differences in the healthcare system between Singapore and Malaysia. I acquired a great deal of knowledge in terms of the general organization, the way clinics are run, medical record keeping, the healthcare hierarchy as well as the career pathways in Singapore! With much support and guidance from the doctors, I was able to deepen my knowledge on general surgery as well as gain significant insights into the field of pediatric surgery. I also understood the various approaches to investigation and management of a patient in Singapore. By shadowing the doctors at all times, I was able to observe very closely the process of clerking and physical examination done by the experts, which served as an enlightening discovery of pediatric clinical examination

2. What have you enjoyed or liked the most about the project?

I enjoyed the OT sessions the most. Since these were pediatric patients, most of the surgeries involved repair of congenital defects. I was taught the principle behind each of the steps and I understood how these repairs restore the quality of life of the children. Most of these surgeries were complicated and involved intricate adjustments, but the eventual success of the surgeries gave a sense of fulfillment.

3. What have you found challenging about this project? (any part of the project you found hard to do)

The only part that was challenging in this project was the inability to keep up with discussions on the possible complications and management plan for each patient. This was because of the lack of in-depth knowledge on pediatrics. Although I read up on the patient’s condition before the discussions, the knowledge that I was able to gather lacked context and was not complete. Thus I found myself being clueless occasionally.

4. What has really worked? (any part in the project that you thought worked well)

In my opinion the entire project was a big hit! Everything was smooth during my time in NUH. The best part was being able to interact with esteemed surgeons from a field of my interest and receive valuable guidance from them. I owe my learnings to the EP module, as it rendered such wonderful opportunities accessible before we enter the working world.

5. What can be improved in this project?

I could have spent more of the time I had before the start of elective posting on improving my knowledge on pediatrics. I focused my time majorly on revising anatomy and general surgery. Although it served very well during the Q&A sessions with the MOs, surgeries and clinics, I feel that I could have gained even more if I had known the basics of pediatrics.

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The picture collage are some places I stopped by before heading back to Malaysia! I hiked Bukit Timah to its summit! Claimed to be the highest point of Singapore. Yay! I also visited Gardens By the Bay and the iconic Impression of Monet: The Garden. Also visited Fort Canning Park and Haji Lane! 

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PHASE 4 of MY ELECTIVE POSTING JOURNEY- THE VERY END OF MY CLINICAL ELECTIVES IN NUH WITH THE HPB TEAM & EN ROUTE TO MALAYSIA! <3

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PHASE 4 of MY ELECTIVE POSTING JOURNEY- THE VERY END OF MY CLINICAL ELECTIVES IN NUH WITH THE HPB TEAM & EN ROUTE TO MALAYSIA! <3

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NAME: SERENA SEET SU YUIN

MATRICS NO.: A189015

DATE: 16 AUGUST 2024- 31 AUGUST 2024

1. Were the objectives of the project fulfilled?

I am happy to report that my project objectives are successfully fulfilled !

My objectives are as followings:

1. To explore the clinical practices, surgical procedures, and technology used in the

hospitals of Singapore under General

Surgery.

• My elective posting project has successfully provided a great insight into the clinical practice and surgical procedures practiced in Singapore. The clinical aspects are more or less very similar compared to HCTM. Clinically, I have perform history taking and physical examination on patients with clinically significant findings, remarkably a patient with a cystic liver and a severely jaundiced patient with no axillary hair. I was glad that I could identify the findings of the patients. A huge shout out to my HPB registrar and the Medical officers involved to talk me through the process a Laparoscopic Cholecystectomy, a Liver Resection, and how an Intraoperative Cholangiogram was done! It was so kind of them to guide me through it whilst performing the surgery.

• The technology used here in NUH is quite similar to the ones used in HCTM. The only difference is almost all patient’s data are stored digitalised. While some nurses' charts in Malaysia are handwritten and kept in a patient’s file, NUH practices a digitalised record-keeping system. This presumably reduces misinterpretation of handwritten notes and saves paper, though, typing errors, and cybercrimes can still occur.

2. To compare and contrast the differences between the healthcare systems in

Malaysia and Singapore.

• As aforementioned, most of the clinical practice aspects practiced in Malaysia and Singapore are very similar. Even in the perspective of medical education, most of the syllabi are very similar. I was able to synthesise this from the conversations I exchanged with my NUS friends. They have mini-CEXs too! My professor mentioned that he would be giving a lecture about the costs of medical services to his NUS students. For example, the cost of an ECG for a patient. He then advised us to be wary of what to order for a patient as we don’t want to inflict a financial burden on them as well!

The difference is as above mentioned. Everything is mostly digitalised. Be it, the patient’s record, nurses' charts, doctor’s orders, and reports. I also found out that HCTM still uses reusable sterilised scrubs, while NUH are using disposable ones.

The scrub nurses in NUH will always read out a checklist of things prior to any surgery.

3. To improve my clinical skills in any way possible.

I was able to practice my history taking and physical examination multilingually (Malay, English and Chinese). This helped me a lot in communication skills.

I am very thankful to my supervisors who gave me the opportunity to practice both aspects. I was very happy that I could identify significant findings in HPB patients.

I was also taught on some tricks in suturing keyhole wounds! I am inspired thanks to the Medical Officer!

I learnt the procedural steps of a Laparoscopic Cholecystectomy thanks to the HPB Registrar!

4. To build and foster good international relationships between the medical students and any other healthcare workers in Singapore as future healthcare colleagues.

I was able to establish a friendship with my NUS friends. We exchanged conversations and shared our medical school culture differences.

I made friends with scrub nurses who were so supportive in my learning process there. They also guided me through the preparation of the gallbladder for histopathology review. They explained to me how to effectively do it too!

Clinic nurses were also one of nicest people! I got to help them with some printings!

I am very thankful to my supervisors, the HPB registrar and the MOs who were very supportive in my project there.

5. To explore different approaches to various illnesses.

• This objective was achieved! I learned the approach to different illnesses, such as the approach to a patient with gallstones (symptomatic or asymptomatic), periampullary tumours and the surgical approach ( choosing between an Endoscopic Resection or performing a Whipple Procedure), an approach to patients with HCC and how it is done.

2. What have you enjoyed or liked the most about the project?

I was captivated by the department's complexity and the way it challenged me to think critically and creatively about how to make the best out of it. The collaborative spirit of the HPB team and my ability to adapt to the team's hectic schedules elevated my experience, making it both intellectually rewarding and personally advancing. As the schedules of the department are quite hectic, I was very impressed with my ability to acculturate into their fast-paced work culture I like how everyone was so kind and friendly there! They were all so supportive in achieving my objectives for the project. I enjoyed the explanations of the HPB registrar. He was so patient with my doubts about performing the laparoscopic cholecystectomy. He provided a complement of theoretical knowledge of surgery and anatomy very well. Exposures like these offered me an invaluable learning experience with the team! Overall, I enjoyed being part of the HPB team though for a short period. There was always something to look forward to each day with the team. I enjoyed observing Lap Choles very much. I must say, the highlight of my very posting was the part where I dissected 2 gallbladders, prepared them for histopathology review, and collected their stones! I always look forward to what type of stones that are collected. The greenish stones that looked like jades were the most impressive of them all!

I also enjoyed my interactions and the bonds established with the people there. The interactions I had were very enriching. It provided a diverse perspective on how different our medical school culture is.

This journey was a rare and exhilarating mixture of both intellect and good interpersonal skills.

3. What have you found challenging about this project? (any part of the project you found hard to do)

I am very happy to say that most things went smoothly. My shoes of choice were the biggest challenge. The challenge of running around the hospital with my formal shoes caused me multiple blisters on both my feet. It was quite painful to walk later on as we had a lot of running and stairs climbing around to do. Physical fitness is definitely required! I spent more time on my feet than sitting. Thankfully, I had myself physically and mentally prepared for the posting!

4. What has really worked? (any part in the project that you thought worked well)

My shoes were the biggest challenge in my project. When I was told that I was allowed to wear sports shoes, I changed my daily shoes to sports shoes. I also went to the pharmacy to get myself some antiseptic cream and 40 skin plasters to which I finished it all. It aided the pain in walking with blisters. I also believe that having good physical fitness is very helpful!

I believe having the ability to properly manage my time is essential to making the best out of my elective journey here. It comes by of how I should critically sort the swirl of surgical choices into your priority list to curate a learning journey that is suited for none other than myself.

What also worked for me was that I also had a good preparation of physicality and mentality. It is very essential for one to get through the day without feeling physically exhausted too easily.

All is well. My objectives were achieved and I had a great time there until I was starting to miss Malaysia.

5. What can be improved in this project?

I believe knowing the dress code suited for the very project is so important! I will improve on choosing the right shoes that are suited for my job and knowing and understanding of work-culture understanding beforehand.

As I was pretty nervous in the first week, I did not have as many conversations with the team except with my supervisors. Looking at it in hindsight, I realise that there was nothing to be afraid of. I wish that I had had more conversations with the team in the first few days. Thankfully, they were very welcoming and supportive in my elective journey. The second week then came by in the blink of an eye only to know it was already time to say goodbye. Nevertheless, Malaysia, I am coming home!

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Phase 4: Clinical Elective Posting at NUH Surgery in a nutshell

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Phase 4: Clinical Elective Posting at NUH Surgery in a nutshell

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V N Nuvaira Tasneem

A185408

1. Were the objectives of the project fulfilled?

Yes, definitely.

My first objective was to learn more about the healthcare system and medical systems used in Singapore. During ward rounds, I was able to observe and learn how the medical doctors documented the patient’s history into the digitalised medical platform used across various Singapore hospitals. I also got to learn about the different healthcare clusters in Singapore during one of my clinic sessions with the medical officers on duty. The healthcare clusters include  National Healthcare Group (NHG), National University Health system (NUHS) and SingHealth with NUH being the flagship hospital under NUHS.

My second and third objective was to hone my history taking and physical examination skills and gain exposure to common medical conditions seen in Singapore. During this posting, I clerked patients and presented my case during the ward round in which my supervisor had corrected my case presentation based on my findings during week 2. I also was able to enter into OT and gain a lot of insight into the common surgical cases seen and the right surgical procedures to treat them. For example, hyperthyroidism is a common presentation in surgical clinics in which surgeons will look through the cases to determine which patients require full, partial or watchful observation as treatment for such cases.

My last objective was to build ties with other medical students and healthcare professionals in Singapore. In this posting, I got to interact with both the year 3 and year 5 medical students from NUS Yong Loo Lin School of Medicine. It was nice to learn how their medical curriculum worked and also managed to network with them. I also interacted with various healthcare professionals from doctors and nurses during rounds and in OT, with allied healthcare professionals such as physiotherapists when clerking patients in the ward. It was gratifying to see how various professionals worked together to uphold the healthcare system in Singapore.

2. What have you enjoyed or liked the most about the project?

I enjoyed my OT experiences the most during this project as it was inspiring to see how surgeons worked tirelessly, standing long hours to treat surgical patients. I also got the chance to scrub into OT and help the surgeons during the procedure such as closing up of surgical wounds by performing a vertical mattress suture and also helping to position surgical instruments such as retractor. I also got the opportunity to observe how a robotic assisted procedure works and how the surgeons worked together as a team to complete the procedure.

3. What have you found challenging about this project? (any part of the project you found hard to do)

The project was a little challenging as most of the time I had to independently work to complete my tasks such as clerking patients and also grabbing opportunities at the OT such as getting the chance to scrub in and assist during procedures. Back in HUKM, I had my friends to rely on for support, however at NUH I had to work independently which was difficult at first. This meant that I had to be more outspoken during rounds as I took the initiative to present my case during rounds and also approach the medical officers at surgical clinics to follow their clinic. However, as time went by, I managed to be more vocal and grab opportunities by asking my doctors in the Endocrine team for a chance to scrub into OT. Hence, I was able to also get the opportunity to suture on a real patient and also enter into robotic surgery OT towards the end of the posting which was a fruitful experience.

4. What has really worked? (any part in the project that you thought worked well)

Determination was what kept me going throughout this posting. Standing for long hours in the OT was tiring; however the opportunities of being able to assist towards the end of the procedure was what kept me going throughout the posting. Being vocal in asking questions and for opportunities also was pivotal in being able to garner opportunities such as being able to suture and assist in procedures.

5. What can be improved in this project?

This project could have been improved with more guidance and support from my supervisor. As an endocrine surgery resident, my supervisor was often busy with her schedule and had not much time for teaching. I still managed to interact and learn from my Dr during the ward rounds as she corrected my case presentation and shared with me insights such as her journey of becoming a endocrine surgeon in NUH during OT sessions. However, with more time with my supervisor, this posting would have been more fruitful.

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Beige Aesthetic Pastel Collage Memories Moodboard Portrait Photo Collage

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some pictures i really liked from this EP journey :p

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Phase 4 - Conclusion of my Clinical Elective Programme in Department of Paediatric Haematology-Oncology, KK Women's and Children's Hospital Singapore! :-)

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Phase 4 - Conclusion of my Clinical Elective Programme in Department of Paediatric Haematology-Oncology, KK Women's and Children's Hospital Singapore! :-)

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Woong Jia Hui

A190103

31 August 2024

1. Were the objectives of the project fulfilled?

Yes! By embarking on this elective journey, I truly stepped out of my comfort zone. Knowing myself, I would have chosen the same hospital as my friends so I would have company, but I am grateful that KKH gave me the opportunity to join a department I am genuinely interested in on my own. I learned to be more outspoken and how to adapt to a team’s culture as a newcomer. By actively participating in rounds and clinics, I was able to connect with more people over time, which showed me that I successfully acclimatized to the new environment and workflow. Additionally, my clinical experiences enhanced my medical knowledge, particularly in the areas of paediatric haematology and oncology.

During these two weeks, I also observed some differences in healthcare practices between Malaysia and Singapore. For example, the medical database at KKH is completely digitalized to improve efficiency in data input. Patient confidentiality is also ensured because records can only be accessed via the organization’s intranet. This differs from most hospitals in Malaysia, where we still rely more on physical, handwritten files. Additionally, the hierarchy in KKH and the time needed to become a house officer are similar to what we have in Malaysia.

2. What have you enjoyed or liked the most about the project?

I enjoyed the opportunity to immerse myself in a new and challenging environment while getting to know new people. I really enjoyed spending time with my supervisor because she is extremely knowledgeable, yet humble and kind to everyone around her. Being able to observe her interaction with patients and observe their treatment journey was incredibly rewarding and deepened my understanding of the complexities involved in caring for children with serious conditions such as cancer. I also appreciate the chance to work alongside experienced registrars, MOs, and HOs who were supportive and willing to teach me along the way. The collaborative atmosphere where I was able to learn from different members of the care team made my experience even more fulfilling because I rarely have such an opportunity back in UKM.

Otherwise, I really enjoyed the staff discount in the hospital canteen because I could try different stalls every day without spending too much. The food variety in Singapore is more or less the same with Malaysia but I still prefer the taste of our food any time. I also liked spending time exploring Singapore with my friends during the weekends. Together we visited many places such as the East Coast Park, Universal Studios Singapore, Orchard Road, NUS, and more.

3. What have you found challenging about this project? (any part of the project you found hard to do)

One of the most challenging aspects of this project was adapting to a new healthcare environment on my own. Being in a different country with unfamiliar practices and without the comfort of having friends or familiar faces around was initially daunting. It required me to quickly learn how to navigate the hospital, understand the workflow, and adapt to the team’s culture—all while trying to make meaningful contributions during ward rounds and clinics. Additionally, keeping up with the fast-paced discussions among the medical team, especially when complex cases were being discussed, was sometimes overwhelming because I have not had any prior experience in Paediatrics.

4. What has really worked? (any part in the project that you thought worked well)

This elective project gave me a clearer picture of what working life in a Singaporean hospital is really like. Since the UKM MD qualification is recognized by the Singapore Medical Council, working in Singapore after graduation is an option for me. Throughout my two weeks here, I interacted with a Malaysian registrar and specialist who were UM graduates, and they kindly clarified my doubts about working life here. These are opportunities I would never have had if it weren't for this elective project. By chatting with actual doctors working in Singapore, I gained a lot of information needed to make an informed decision in the future.

5. What can be improved in this project?

For me, two weeks is too short to fully learn about Paediatrics Haematology and Oncology. There were still many procedures I missed out on due to the lack of patients at the time, and I also did not have the opportunity to clerk and examine many patients. In my opinion, having more time and structured opportunities for hands-on experience, such as shadowing different specialties or participating in minor procedures, could have made my experience in Singapore even better than it already was. Another one of my regrets is that I should have read up more about Paediatrics before coming, so I could have kept up with the doctors’ discussions more easily.

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PHASE 4: Summary of Clinical Elective Posting under Hepatobiliary and Pancreatic Surgery Department in National University Hospital (NUH), Singapore

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PHASE 4: Summary of Clinical Elective Posting under Hepatobiliary and Pancreatic Surgery Department in National University Hospital (NUH), Singapore

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1) Name, Matric, number and date:

WONG JIAN CONG (A188021)

16/08/2024

2) Were the objectives of the project fulfilled?

I would proudly say 100% yes, as during two weeks at NUH, I have learned a lot, and one of my objectives was to gain new knowledge in the hepatobiliary and pancreatic surgery departments, where I was able to learn about a new approach to performing Whipple procedures, which involve robotic surgery as compared to open surgery.

Besides that, I did accomplish certain objectives in the sense that I was able to experience more hands-on, where for the past 2 weeks, I did join a lot of surgery sessions, and I managed to cut open some dissected gallbladder during laparoscopic cholecystectomy, in which I assisted in the obtaining of gallbladder samples for histopathological purposes.

Furthermore, one of the objectives I successfully secured was to understand the Singapore healthcare system as compared to the Malaysia healthcare system, as I mentioned previously, where I was enlightened by one of my supervisors regarding how the Singapore healthcare system works, in which Singapore hospitals do not tolerate any miss-use of patients data in the sense that the Singapore healthcare system has actually invested a lot into a security system to protect patients data, and in which most of the hospitals in Singapore digitalize patient information and have high security protection in which only allocated staff are able to assess that information.

More than that, I was able to learn how the Singapore healthcare system advanced into a modern concept in which Singapore hospitals implemented a way where instead of printing a copy of scan results, patients were given a pen drive that was equipped with a password where doctors were able to view the report via hospital computer as compared to the traditional way of reviewing printed scan reports.

3) What have you enjoyed or liked the most about the project?

Everything from the architecture of the hospital to the foods, the culture (free breakfast after ward round if you know what I mean), and the vibe, but of course I can't miss out on the clinical aspect of my elective posting, as I do enjoy every surgery session that I witness, and once again witnessing a live liver transplant and kidney transplant surgery is just a dream of mine as a medical student.

Besides, I do enjoy learning from all my supervisors, as I was able to learn that being a doctor is not just about curing patients, but at the same time, it's about ensuring patient mental health is well taken care of.

Moreover, I do appreciate all those hospital staffs that helped me a lot especially those who welcomed us and gave us a tour as well as registrars and houseman that I attached to as they taught me a lot in term of planning for patient follow-up, and not to forget patient management in respect to their conditions.

4) What have you found challenging about the project?

I would say the long standing hours in the operation theater, as some surgeries require long hours, and I need to resist the urge to sit down during surgery, as I think it's a courtesy and a sign of respect for those surgeons who manage to stand for long hours during surgery.

Besides that, I find it difficult to understand certain patient's conditions as I was unable to assess the patient's information due to security purposes, which makes it difficult to process the patient's history as well as the diagnosis. Hence I was only able to view the patient information that was given to me on the day the ward round began and not the day before.

Moreover, I found out the navigation around the hospital was confusing, as I did get lost several times due to the fact that the hospital itself is huge in the sense that the hospital itself was divided into multiple blocks for different divisions, in which I wasted quite some time to find my way around, yet in the end I was able to familiarize myself with the hospital.

5) What has really worked?

Overall, I would like to say that from the start of my elective posting until the end, I had successfully created a plan for the past 2 weeks in terms of activities, foods, and bucket goals in order for me to fulfill my objectives, and by the last day of my elective posting, I was proud that my planning worked out even though there were a few obstacles that I had to face.

Besides that, even though it was tiring to stand for a long hour during the OT session, I am glad to say that through my high spirit as well as my high interest in being a surgeon, I was able to stand along with those surgeons that were performing the surgery.

6) What can be improved in this project?

I would say that I was hoping I could engage myself more with hands-on surgery, as I think to be a good and safe surgeon, hands-on experience is important to instill proper technique and ensure zero error during future surgeries because practice makes perfect.

Furthermore, I do believe being in just one department is insufficient because I felt that to be a doctor, I need to expose myself to varieties of departments because, through different exposure, I am able to enhance my clinical skills as well as a proper judgement when it comes to patient diagnosis and management.

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Phase 4 of Clinical Elective Posting with Department of Neurosurgery at National University Hospital (NUH), Singapore

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Phase 4 of Clinical Elective Posting with Department of Neurosurgery at National University Hospital (NUH), Singapore

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1. Were the objectives of the project fulfilled?

Yes! The objectives of the project such as gaining more medical knowledge and further improving clinical skills, learning to communicate effectively with patients from another country, learning about the management and treatment of diseases especially those related to neurosurgery as well as learning about the healthcare system of Singapore were successfully fulfilled.

2. What have you enjoyed or liked the most about the project?

This elective posting journey has provided me with an overall rewarding and memorable experience. The best moments throughout this project would be observing surgeries in the operating theatre, attending clinic sessions and exploring the world-famous landmarks and attractions that Singapore has to offer.

3. What have you found challenging about this project? (any part of the project you found hard to do)

I feel that preparing flight documents were initially difficult for me because I was unsure and unfamiliar about the documents needed and how to obtain them. However, I believe this problem would be common among first-time overseas travelers.

Arranging for accommodation at Singapore was also quite difficult since I mainly relied on securing on-campus accommodation at NUS. After I did not manage to get the accommodation at NUS, I tried looking for suitable accommodation elsewhere but this process took a long time and was quite a hassle. Thankfully, after much perseverance, I was able to get affordable accommodation at a student hostel that is situated not too far from NUH.

4. What has really worked? (any part in the project that you thought worked well)

Firstly, the fact that UKM has supported and endorsed my decision to pursue clinical electives abroad sends a very encouraging message to me. Hence, I applaud and appreciate the efforts undertaken by UKM.

The weekly report being sent via Padlet is also a great way for me to document my journey chronologically and share my experience.

The two-week duration allocated for the elective posting overseas is a sufficient amount of time because it allows us to do various activities, explore the country and better appreciate the local culture without costing an arm and a leg. The duration of 2 weeks is reasonable as an extended stay abroad (e.g. 4 weeks) will incur a larger cost.

The posting assessment form also allows me to get proper feedback from my supervisor based on his evaluation of my performance throughout the elective posting. This allows me to identify areas of improvement and take note of the suggestions highlighted by my supervisor.

5. What can be improved in this project?

Since I was not exposed to much of the neurosurgery subspecialty during my third year surgery posting, I should have read more materials on neurosurgery as it would make it easier to understand various diseases and approaches to management being discussed, especially the more complex ones that were mentioned during the conference.

I should also regularly read up on the basics which include common diseases of neurology as well as the steps of performing neurological examination since I am expected to have mastered these concepts and skills.

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Phase 4: Conclusion of my 2 week NUH journey !!!

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Phase 4: Conclusion of my 2 week NUH journey !!!

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1. Name, Matric. number and date:

Syed Hussein Fathi (A185582), 16/08/2024

2. Were the objectives of the project fulfilled?

Very much so. Safe to say, I have thoroughly enjoyed my time in NUH. Not only did I learn what it took to be a colorectal surgeon in Singapore, but I had so much fun interacting with all the members of the medical faculty. From history taking to suturing, and everything in between, I am grateful to have polished my skills as a medical student to hopefully apply what I have learnt during my EP in my final two clinical years.

3. What have you enjoyed or liked the most about the project?

EVERYTHING (maybe not waking up at 5.30am everyday during my holidays haha). But my favourite part of this EP was making new friends in a medical school outside of my own. The connections I have made, the jokes told, the teaching sessions, and the words of wisdom, all have impacted me in some way. And I hope to work with such people in the near future.

4. What have you found challenging about the project?

Apart from waking up at 5.30am everyday during my holiday, the toughest part was realising that to work in Singapore as a doctor, one has to be well versed in basic Mandarin. All the clinic session that were conducted in Chineses made it impossible for me to understand any of the conversation that took place between doctor and patient. And since learning to speak Chinese wasn't something one did overnight, I succumbed to my fate and accepted that I will have to endure long hours of a clinic not understanding anything.

5. What has really worked?

I think how NUS has structured their EP for overseas students makes it possible for students to gain as much insight from their respective areas of interests as possible. Being assigned to a consultant in the field makes it easy to ask questions, experience hands on tasks, relevant history taking, and just get a general feel of how the department operates. The supervisors were super informative, friendly, and to my pleasant surprise, genuinely concerned about our experience in the hospital. So a big shoutout to NUH for organising such a fruitful EP.

6. What can be improved in this project?

Overall, the only thing I wish was different about my EP was to have more time with my SV. As a consultant colorectal surgeon, my SV was always busy with patients, and being able to ask him questions was based on timing and luck. Although he was super friendly, he was even more busy. But as the job of a doctor entails rushing from point A to point B only to be rushed back to point A, I shouldn't expect to be handheld throughout my entire EP. That being said, more time with my SV would have made my experience in NUH a bit better.

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Phase 4: Summary Phase of Elective Posting in KTPH 

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Phase 4: Summary Phase of Elective Posting in KTPH 

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Your name, matric number, date

Name: Yong Zong Sheng

Matric Number: A185595

Date: 20/8/24

1. Were the objectives of the project fulfilled?

Yes, the objectives of the project were successfully fulfilled. Firstly, I was able to significantly enhance my clinical skills and medical knowledge through direct involvement in patient care, observing various procedures, and participating in discussions with experienced healthcare professionals. This hands-on experience not only deepened my understanding of medical concepts but also improved my ability to apply them in real-world settings.

Secondly, I gained valuable exposure to the healthcare and medical systems in Singapore. Observing how the healthcare infrastructure operates in a different country broadened my understanding of how medical care is delivered in a diverse environment. I was able to compare and contrast the systems in Singapore with those in Malaysia, gaining insights into different approaches to patient care, hospital management, and medical practices.

Finally, the project allowed me to build meaningful connections with other medical students and healthcare professionals from different countries. These interactions provided a platform for exchanging ideas, sharing knowledge, and learning from each other’s experiences. The relationships I developed during this project have expanded my professional network and opened up opportunities for future collaborations and learning.

2. What have you enjoyed or liked the most about the project?

One of the most enjoyable aspects of my elective posting was the hands-on learning experience, particularly the opportunity to assist Dr Kang in a laparoscopic cholecystectomy. I was quite surprised that Dr Kang asked me to wear full PPE, and she required my help to hold the gallbladder of the patient during the operation. I was excited and nervous. The sudden responsibility made me feel anxious, as I feared I might not be able to perform the task correctly or, might make some silly mistakes that could disturb the smoothness of the operation. During that moment I had not much time to consider whether I wanted to assist or not because if I rejected this opportunity, I might not have the chance anymore. Without further hesitation, I nodded and quickly put on the PPE as soon as possible.

During the operation, I carefully held the gallbladder with the instrument and closely watched the procedure on the screen, keen to learn as much as I could. Suddenly, Dr Kang asked me about the Calot’s Triangle of the gallbladder. My mind went blank as I struggled to recall the anatomy. Unfortunately, I only managed to answer 2 borders of the triangle. The situation became more challenging when I was asked about the layers of the abdomen, I could only provide incomplete answers. At that moment, I felt embarrassed and guilty because I thought I had let down both myself and my university by not being able to immediately recall what I had previously learned.

Despite these challenges, the operation lasted for three hours. This was an invaluable learning experience. I paid close attention throughout the operation to absorb as much as possible. When the team conducted the time-out procedure, the team mentioned my name. During that moment, I was filled with a sense of pride and excitement. I felt that I was being recognized as part of the team, even as a medical student. This was an incredible honour. This experience not only increased my eagerness to become a surgeon in the future but also reinforced my commitment to seize every learning opportunity in my journey to becoming a skilled and knowledgeable healthcare professional.

I did not regret accepting the chance given by Dr Kang. Without this opportunity, I was not able to visualise the things that I have learned in the textbook. Dr Kang was the doctor who brought me from the textbook to reality. Through this experience, I could understand more about the anatomy of the gallbladder and understand the importance of learning the anatomy. For example, Calot’s Triangle was very important for the surgeon because they needed to find out the cystic artery and right hepatic artery to clip it before they dissected the gallbladder to prevent massive bleeding. Hereby, I would like to express my gratitude to Dr Kang. I hope in the future I can have a more hands-on learning experience.

3. What have you found challenging about this project? (any part of the project you found hard to do)

During my time at KTPH, I encountered challenges in accessing patient information due to strict data confidentiality policies. Unlike at UKM, where I could review a patient's chief complaint before approaching the. At KTPH I didn’t have a temporary account to access patient details either before or after clerking a case. Even after I had clerked a case, I had no way to verify whether the information I gathered was comprehensive or not and I was not able to know whether my provisional diagnosis was correct or not. For instance, after clerking a patient with rectal bleeding, I suspected diverticular bleeding or colorectal carcinoma as potential diagnoses, but I had no way to confirm if my potential diagnoses were correct. To address this issue, I sought assistance from the nurses in the wards, requesting temporary access to patient information through their accounts. Although I occasionally faced rejection, I usually managed to find a nurse willing to help.

Another challenge I faced was navigating the hospital layout, as I was unfamiliar with the environment and often found myself getting lost. To address this, I took photos and videos of the areas I frequently passed through or referred to the hospital's guidelines when necessary. Most of the time, I would ask the nurses or the staff there. For example, if I was in Tower B and needed to meet my supervisor in Tower C, I would initially head back to the main lobby and then make my way to Tower C. Over time, I discovered there were several link bridges between the towers. Therefore, I would take a photo of the significant landmark and practised the route until I remembered where I could get to the link bridges.

4. What has really worked? (any part in the project that you thought worked well)

During my time at KTPH, I had the opportunity to become a translator between the surgeon and a patient who struggled with English. One day, a patient was brought to the hospital by ambulance due to abdominal pain in the right hypochondrium region. Dr Yi Hui, a medical officer and I were in the emergency ward to clerk the patient. Before clerking the patient, she asked if I could speak Bahasa Melayu. I promptly responded yes, and I was then asked to assist by translating the conversation while she clerked the patient. Then I also conveyed the patient’s concerns to the doctor. After the physical examination, the doctor suspected that there might have been some fluid accumulated around the liver. This was because the patient had surgery a week before. The medical team decided to do the ultrasound and ultrasound-guided drainage if the image showed an accumulation of the fluid. Therefore, I was asked to explain the risks of the procedure to the patient and to obtain consent from the patient. It was an honour to serve as the bridge of communication between the patient and the medical team. At that moment, I felt a deep sense of pride in my national language, Bahasa Melayu, and was grateful for the education I received in Malaysia, which provided me with the ability to help others in such a meaningful way.

5. What can be improved in this project?

While the project was largely successful, there are several areas that could be improved. Firstly, the two-week duration of the project felt too short to fully immerse myself in the learning environment in Singapore and was too short to get closer to the doctors there. Extending the program to four weeks would allow for a deeper understanding of the clinical environment, more time to practice new skills, and a greater opportunity to form meaningful connections with the medical staff. Therefore, I should apply for 4 weeks, not for 2 weeks. I felt a bit regretful because I did not make my elective posting into 4 weeks. I hoped that in the future I could have a chance to meet up again with those nice seniors and doctors there.

Additionally, better preparation could enhance the learning experience in Singapore specifically, by reading more extensively or choosing the emergency department after I have gone through the posting in my university first. This would have allowed me to be better equipped for the diverse cases I encountered.

Lastly, I realized that being more proactive and braver in approaching medical doctors could have enriched my experience even further. During the first week, I was hesitant and shy, which limited my interactions with the houseman in the first team. However, as I grew more comfortable in the following week, I began to engage more openly with the doctors and other healthcare professionals. Building confidence earlier on would have allowed me to enjoy myself more during the project.

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PHASE 4: Summary Phase Of My Two Weeks Elective Posting in the Emergency Surgery Acute Trauma (ESAT) and Breast/ Endocrine Department in KTPH 

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PHASE 4: Summary Phase Of My Two Weeks Elective Posting in the Emergency Surgery Acute Trauma (ESAT) and Breast/ Endocrine Department in KTPH 

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1. Were the objectives of the project fulfilled?

Absolutely! My clinical elective posting at Khoo Teck Puat Hospital (KTPH) in Singapore has deepened my understanding of the differences between healthcare settings in Malaysia and Singapore. In Singapore, most hospitals use digital records for patient data instead of physical hard copies. This ensures that all records are well-organized and easy to read, eliminating issues like deciphering doctors' handwriting. Moreover, the hospital and polyclinic systems are interconnected, allowing for seamless tracking of patient progress across different healthcare settings.

At KTPH, there are clear systems in place to ensure effective communication and patient safety. For instance, each patient's identity and preferred language are displayed on a small signboard beside their bed. Patients also wear coloured tags on their wrists to indicate specific conditions: a green tag signals a high risk of falling, while a red tag alerts staff to medication allergies.

Beyond the clinical experience, I had the opportunity to connect with healthcare professionals from diverse backgrounds. All the surgeons, medical officers, and house officers I met at KTPH were friendly and willing to guide me step by step, which made me feel very welcomed. Additionally, by exploring various fascinating tourist spots in my free time, I enhanced my ability to adapt to new environments and stepped out of my comfort zone to make friends from different countries.

2. What have you enjoyed or liked the most about the project?

The OT sessions were the highlight of my project, as they provided me with my first hands-on surgical experience as a medical student. Even though I was only given minor tasks, this experience greatly sparked my interest in general surgery. The surgeons, medical officers, and house officers were incredibly generous in sharing their knowledge and experiences with me, guiding me step by step through the procedures. What stood out to me most was the camaraderie among the team—they treated each other as equals, fostering a supportive and collaborative environment rather than a strict superior-subordinate relationship. They even had a morning tea break after ward rounds, which helped build strong bonds within the team.

3. What have you found challenging about this project? (any part of the project you found hard to do)

I encountered several challenges during the application process for this project. Initially, I was able to apply to most hospitals in Singapore through the application portal, and I chose Changi General Hospital as my preferred option, selecting four different departments there because it was closer to my relative's house. However, during my posting examination, I received a rejection notice due to a lack of response from Changi General Hospital.

This was particularly frustrating as I had already paid the application fee, and there were no other options available for me to reapply. I had also completed all the necessary vaccinations, mask fittings, and infection control measures according to their requirements. Not wanting my efforts, time, and money to go to waste, I decided to write an email to the person-in-charge about my application, hoping for an alternative solution. Fortunately, they were able to offer me two additional options, and I eventually secured my elective posting in the General Surgery department at Khoo Teck Puat Hospital.

4. What has really worked? (any part in the project that you thought worked well)

My clinical knowledge and skills have seen significant improvement compared to where I was before this experience. This progress is largely due to the unique opportunity to apply both theory and practice simultaneously during my elective posting. The hands-on experience I gained by shadowing surgeons and medical officers allowed me to bridge the gap between what I learned in textbooks and real-world medical practice.

By practicing my clinical skills under their guidance, I was able to refine my techniques and gain confidence in my abilities. Although my skills are still a work in progress and not yet perfect, I can confidently say that I have now mastered about 90% of the essential clinical skills. This has been a tremendous leap forward from where I started, and it has strengthened my foundation as I continue to develop as a medical professional.

5. What can be improved in this project?

In my opinion, I should have revisited my anatomy studies before entering the Emergency Surgery Acute Trauma (ESAT) and Breast/Endocrine departments. Much of the knowledge I had gained during my preclinical years had faded over time, as it had been quite a while since I last engaged with those topics. This became evident during my elective posting, where a strong grasp of anatomy was crucial.

The experience highlighted an important lesson for me: the medical journey is an ongoing process that requires continuous learning and revisiting past knowledge. It’s essential not only to keep up with new developments in the field but also to regularly refresh and strengthen the foundational knowledge acquired earlier in our training.

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[Phase 4: Conclusion] Clinical Elective Posting at the Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), China

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[Phase 4: Conclusion] Clinical Elective Posting at the Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), China

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1. Your name, matric number, date.

Koay Hong Xin, A189444, 29 July 2024.

2. Were the objectives of the project fulfilled?

Yes. Through this attachment to the cardiology department of SAHZU, I had the opportunity to learn and get exposed to different aspects of cardiology, including but not limited to treatments, surgeries, procedures, clinics, ward rounds, and academic discussions. By shadowing medical officers in the department and even becoming friends with them, I also had the chance to learn more in-depth about the hospital setting in China and broaden my view of the healthcare system in China. With that being said, I achieved another objective of building connections with healthcare professionals from different backgrounds. Furthermore, by spending my free time visiting different fascinating tourist spots and experiencing various interesting cultures in China, I was able to boost my adaptation skills in a new environment with diverse cultures and traditions. This was my first time traveling alone and I was glad that I was able to practice the soft skills that I had learned previously in dealing with issues and problems that I faced independently throughout the entire journey in China.

3. What have you enjoyed or liked the most about the project?

Having the opportunity to be attached to a hospital in another country as a medical student was the thing that I enjoyed the most throughout this program. Doctors and people here were so nice that they were very willing to teach and guide me throughout the way in the department. It was an indeed eye-opening experience over here, especially when I was brought to the operating theatre to observe different cardiology-related procedures. That was my first time observing procedures like percutaneous coronary intervention (PCI) and stent placement with guidance and explanation from my experienced doctor. Not to forget that I was also amazed by the hospital settings and technologies here in China that were quite different from Malaysia. I have made a lot of good memories here in SAHZU, China. The medical officer that I shadowed even brought me to play badminton, have lunch and dinner together in malls, and visit another campus during our free time. I couldn’t bear to leave on my last day of elective posting here but I believed that I would meet friends that I met here somewhere in the future!

4. What have you found challenging about this project? (any part of the project you found hard to do)

Being alone in a totally new environment was indeed challenging, especially during the first few days in the department. Doctors here were very busy as they had to deal with a lot of patients every day due to the dense population in China, and sometimes their schedules were too packed to guide me, which was totally understandable. I felt quite lost at the beginning as I did not know where to start off and I was not familiarised with the people and environment over here in China. Fortunately, I was able to practice my soft skills by taking the initiative to keep asking the respective doctors in the department based on the components that I would like to learn every day. Despite being busy, they were so nice that they accepted all my requests and guided me thoroughly along the way, giving me the chance to learn a lot about cardiology and finally find my role in the department.

5. What has really worked? (any part in the project that you thought worked well)

One thing that really worked well in this project was my clinical skills improvement. I realised that the changes in me before and after the attachment were huge. By having the opportunity to keep practicing on real patients after shadowing the medical officer, I was more confident and steady in talking to patients over there, performing procedures like ECG on them, preparing patients’ medical records and documents in the system, understanding medical jargons in Mandarin, dealing with healthcare personnel in the hospital, etc. I looked quite clumsy and foreign on my first day entering the hospital, but eventually, I found myself as if I were part of the team in the department. On certain occasions, I even helped the medical officers translate the names of medications brought by patients from English to Mandarin. These changes and improvements were huge and they really meant a lot, even though they couldn’t be seen physically from outside.

6. What can be improved in this project?

Academic preparation is something that can be improved in this project. The department that I chose to attach in SAHZU was cardiology, and the Internal Medicine (IM) posting was not my last posting in year 3 before my elective attachment. Because of this, I had unintentionally forgotten some cardiac-related knowledge gained during my IM posting, which caused me to have some difficulties in listening to teachings and explanations from the doctors over here. I knew I learned them before but I had to look back at my study materials from IM posting when I did my elective in China to recall back and refresh my memories, which indirectly caused a waste of time. The learning process and discussions would have been more effective should I be more academically prepared prior to my visit to SAHZU. Therefore, prior academic preparation before starting the elective posting is definitely something that can be improved on in the future.

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Clinical Elective at Peking Union Medical College Hospital (PUMCH), Beijing, China

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Clinical Elective at Peking Union Medical College Hospital (PUMCH), Beijing, China

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Name: Lai Kam Hoong

Matric number: A189642

Date: 27 July 2024

1. Were the objectives of the project fulfilled?

Definitely yes.

One of my objectives was to observe common general surgical procedures in China. Throughout my attachment, I was able to observe various surgeries, including thyroid, pancreatic, and urologic procedures. Additionally, I witnessed 3D laparoscopic thyroidectomy, laparoscopic adrenalectomy and complex surgeries like the Whipple procedure using the Da Vinci robotic system—most of which I hadn’t encountered during my third-year postings in Malaysia. What made this experience even more valuable was the opportunity to scrub in and assist during surgeries.

I also gained a deeper understanding of China's healthcare system and the cultural factors influencing surgical decision-making. Beyond clinical observation, I had the chance to engage in cultural exchange with healthcare professionals. During my free time, I chatted with doctors about their culture, work experiences, and history. I was also able to promote Malaysia by giving a presentation to the professors, doctors, and nurses in the ward. Overall, I can say that all my objectives were successfully achieved.

2. What have you enjoyed or liked the most about the project?

The aspect I enjoyed the most during my time at PUMCH is undoubtedly the people I have met. Everyone here is extremely kind and friendly. They guided me along my elective journey and teach me step by step. Their warmth and support have been invaluable in helping me adapt to a new environment. I felt genuinely cared for and appreciated their willingness to share their knowledge and experiences with me.

3. What have you found challenging about this project? (any part of the project you found hard to do)

The main challenge I faced during this project was difficulty in understanding Chinese medical terminology. All the systems, communication, and patient medical histories are in Chinese, while my medical education at UKM has been entirely in English. Although I speak Mandarin well, I was not familiar with the specific medical terms used in Chinese. I find it difficult to adapt initially, and I had to find ways to bridge the gap. To overcome this, I sought help from colleagues for translations, studied common terms from the book provided by the doctor, and used online translation tools.

4. What has really worked? (any part in the project that you thought worked well)

One part in this project that worked well is my presentation to promote Malaysia. To be honest, I did not anticipate giving a presentation and was not prepare for it. It was my first time delivering a short talk in front of foreign professionals, including professors and doctors. With the support and encouragement from them, I managed to introduce Malaysia and share our culture with them. By the end of the presentation, I was proud to have sparked their interest in Malaysia and successfully promoted our culture.

5. What can be improved in this project?

I think one area of improvement for this project would be better preparation before starting the elective. I realized that taking some time to practice basic surgical skills beforehand, such as understanding sterile principles in surgery, suturing, and tying surgical knots, would be beneficial. If I am well-prepared, I could confidently apply these skills when asked or even proactively seek opportunities to perform them on real patients.