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Week 3: Last week at Juntendo University

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Week 3: Last week at Juntendo University

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1. Your name, matric number, date:

Name: Richard Sim Jian Cheng
Matric number: A179778
Date: 14/08/2023 - 20/08/2023 (Mon - Sun)

2. Your progress so far

14/08/2023 - 18/08/2023 (Mon - Fri):
My schedule was mainly centered around HBP surgeries, which followed a similar routine as last week. During this time, I was able to observe more pancreatic tumor biopsy. As this week was a particularly busy week, my supervisor did not have much time to explain the procedures and I tried to understand it by asking the nurses and junior doctors. Thankfully, they were kind and patiently explained the procedures to me.

During this week, I was lucky enough to be able to use the Medical Technology & Simulation center with some of the clinical observers. There we got to try our hands on laparoscopic surgery and even Da Vinci surgery simulations machines.  The staff there helped us switch on the machine and told us how to use it. Through this simulation, we managed to learn how complex these surgeries are and how skilled a doctor needs to be to carry out these surgeries. It helped us to appreciate the time spent by the surgeons to master these procedures. It also gave us more insight to how laparoscopic and Da Vinci surgery are done.

I also had the opportunity to meet up with my friend, Dr. Will, a gastroenterologist based in the USA. During our dinner, we both exchanged the differences in culture between USA, Japan and Malaysia. He was pretty surprised when he first came to Japan as he did not expect that doctors at Juntendo only go back around 8pm as opposed to 4-5pm in the US. I also learnt from him that Artificial Intelligence (AI) is being used in some parts the US to help radiologist diagnose pathologies. They are also training AI in gastroenterology to help doctors determine whether a lesions is cancerous or benign.  Like everything AI, it is still in the early stages of development but Dr. Will is hopeful that one day AI can help to relieve some of the doctor's work load.

Besides that, I also met some foreign students from China who were studying for their Japanese medical license. I talked with them on the difficulties of practicing medicine as a foreign student in Japan. They mentioned that although it is hard, they will do their best. I wished them the best of luck in obtaining the Japanese medical license

On the last day of my clinical electives, I made my rounds saying goodbye to my supervisors and other doctors. They all encouraged me to work hard and never give up on my dreams. The only regret I had was not taking pictures with them as they looked busy and I do not want to disturb them. I am really grateful for their teachings as they helped to open my eye to the different surgeries done here at Juntendo University.  Throughout my elective here, I was really thankful for their patience and kindness in explaining the procedures, their indication and complication to me in English despite their limited vocabulary. On the way back, I stopped by the Juntendo University International Centre to return my access card and was given a completion certificate by the university.

18/08/2023 - 20/08/2023 (Fri- Sun):
During the weekend, I took the opportunity to go places which are further away from Tokyo. I did a day trip to Nikko where I was able to enjoy the beauty of nature. As I was in Tokyo for quite some time, the change of pace felt very refreshing.

3. Your feelings and thoughts

As it was my last week here, I was feeling a little sad as I know that I am about to leave Juntendo University. At the same time, I felt extremely blessed to have such wonderful supervisors and doctors who helped me a lot while I was here at Juntendo University. Without their help, I would not have enjoyed my time here at Juntendo University. From the bottom of my heart, thank you very much to everyone who helped me during my time at Juntendo University.

4. How did you learn and apply the skill of decision making in your EP journey?

The skill of decision making in my EP journey can be divided into 2 phases, preparation phase and during my elective posting

During the preparation phase, I applied the skill of decision making in many different aspects. These includes selecting which university to apply to, choosing my travel insurance, booking my flights and place to stay while in Japan.

During my elective posting, I also applied the skill of decision making when I am not sure of something in and outside of the hospital. I had to choose between different methods, either asking a doctor or a stranger about it or looking it up using my phone.

I also learn the importance of good decision making skills during my elective posting. I learn how surgeons used their judgements to determine the best procedure for the patients either open surgery, laparoscopic or robotics surgery. The surgeon will always consult with another surgeon to determine if the procedure is the best way to approach the disease that the patient is having. This helped me realize that good opinions can help us to make a better decision  both in our work place and also life.

4. Your plan for next week (Week 4)

- As I am done with my elective posting, my plans are to travel around Japan
- Pack and get ready to return to Malaysia.

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1. Your name, matric number, date

Jeslynn Koh Hui Yi A182066 21/8/2023-25/8/2023

2. Your progress so far

(21/8/2023)

I went early to go through the patients list for ward rounds with the NUS students, at the same time contacted my supervisor of the week Dr Anil Dinkar Rao. Endocrine team ward rounds were divided into a few teams under different Drs which I am quite confused at first. So the ward rounds that I attached to with the NUS student is actually under Dr Lee Jing Wen. In the middle of the ward rounds, I excused myself because my supervisor wanted to meet me at the clinic. I witnessed Dr Anil did an ultrasound guided biopsy of the thyroid during the clinic session. In the afternoon, I attached Dr Anil to the OT and what a lucky week, I got to observe a very rare laparoscopic adrenalectomy surgery and an open hernia repair surgery. The registrar asked me if I wanted to assist in that open hernia repair surgery but I’m not sure why , I rejected her offer due to my lack of confidence in assisting.

I regretted so much for my decision at that time TT.

(22/8/2023)

Never have I ever expect myself to spend the whole week and the entire day in the OT. As usual I went to the hospital early for ward rounds, then they asked me to join the daycare surgery OT. I found Dr Clement , the main surgeon and self introduced to him. The entire day were breast surgery such as breast mastectomy, wide local excision biopsy and axillary lymph node biopsy. During the OT, I met a new friend aka OT observing partner who is a current accounting student but she is taking her postgraduate studies in medicine in DUKE-NUS next year. She is here for a research attachment with Dr Clement. For the last surgery, Dr Clement offered me to scrub in and assist, however after that they realised the patient is a Hep B positive patient, so for safety purpose, I was not allowed to assist.

(23/8/2023)

After ward rounds, forgot to mention that Endocrine Team seems like not having the culture of coffee round. I went over to the Day Surgery OT for another day observing of Breast surgeries. That day, the main surgeon was Dr Jerry, who used to be a Malaysian, studied in Ireland but currently is a Singaporean residence. He is being extra friendly to me when he got to know I’m from Malaysia, and even had a short chit chat session during the surgery with me like talking to a friend. He also offered me to assist in the surgery and I finally had the chance to scrubbed in now. A new interesting thing that I found out that day is they have a portable tablet-like ultrasound device which is looking very cute and I very amazed by that.

(24/8/2023)

Every Thursday, the Endocrine team in KTPH will be travel to Admiralty Medical Centre (two station away from KTPH by MRT) for elective surgery mainly for lumps and bumps such as excision biopsy.

After the mandatory morning rounds, my Supervisor Dr Anil, fetched me to the Admiralty Medical Centre to observe the lumps and bumps surgery. There were in total 8 elective surgeries on that day , and I observed/ assisted about 5 of them and left earlier for the day and had a late lunch.

(25/8/2023)

This is the last day of my 2 weeks journey of electives in Singapore. I attended the last ever ward rounds and gave out some souvenirs to all the doctors and medical students I crossed path with for the past 2 weeks and had group photo with them. I also went to observe Thyroidectomy surgery and eventually the senior consultant of Endocrine department , Dr Reyaz Singaporewalla asked me to scrub in and assist him in his surgery which is a parathyroidectomy. I was so nervous but excited at the same time, for the first time I got the opportunity to observe a neck surgery in such near distance. After that, I express my gratitude and appreciation for their guidance for the past 2 weeks and went back home after returning my access card to the office.

3. Your feelings and thoughts

I found myself experiencing the real life of a surgeon which all the exhaustion, tiredness and satisfaction gained through working. They basically have not much time for themselves neither for their family, fully committed to the career and ambition or dream they are pursuing. Through this elective posting, I reconsidered on my decision of pursuing surgery in the future, as we gets older, priorities shift. One of the registrar told me on my last day of posting, if you would like to be surgeon in the future, you will have to be sure that your family members are healthy. So you can fully commit to this career, because you will never be able to cope both sides. I am really glad I went for this electives and finally realising the reality of pursuing a dream is not as easy as we think which I did fantasize it from the start.

4. How did you learn and apply the skill of decision making in your EP journey?

In this short 2 weeks of posting, I don’t think there’s much of a scenario that I faced needed a decision making other than thinking of what to eat for lunch everyday. Maybe most of the decision I made is to either scrub in to the OT or not to scrub in. I do hesitate to scrub in even when they offer me sometimes because I know I am not quite a helpful person which I am really afraid to cause trouble to them especially in the OT. However, we should aways learn from our mistakes and that is why at the end of the second week, I am more courage and confident then before to enter OT and scrub in to assist doctor.

5. How did you manage your time throughout this EP journey?

I will make sure to know the schedule of the week on the first day of my posting in the team which is Monday, so I can expect what should I do for the day or what I should bring. It is a hassle to carry backpacks along for ward rounds or OT, so I will normally put important stuffs in my pocket to bring along with me and put my bags at the doctors room. This will reduce the time wasted for me to find places to put my bags and going back and forth. I will set a habit to wake up and the same time every morning, to make it as habit.

6. Your plan for next week (Week 4)

My plan next week is to express my appreciation to the Doctors and everyone I met through electives, and depart back to Malaysia.

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Chapter 3: Earning Trust in the Operating Room – My Elective Climax and Farewell

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Chapter 3: Earning Trust in the Operating Room – My Elective Climax and Farewell

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1. Your name, matric number, date

Name: Tan Zi Yee

Matric number: A181429
Date: Week 3 (14.08.2023 - 20.08.2023)

2. Your progress so far

This week has been a remarkable journey of growth, opportunities, trust, and unforgettable experience. It began with a deep sense of gratitude for the chance to actively participate in surgeries, gaining the trust of the medical team as I took on significant roles, including Chief Assistant in a surgery. These experiences not only expanded my knowledge but also boosted my confidence. The pinnacle of the week was the opportunity to present my case in front of esteemed professionals, representing my university in a foreign land. This experience marked a significant milestone in my journey and showcased personal and professional growth.

Beyond the hospital, exploring the cultural wonders of Korea with friends added a beautiful dimension to this incredible experience. It was a week of broadening horizons, boosting confidence, and making lasting memories. As I reflect on the past week, it becomes evident that it was more than just a week of progress. It was a transformative chapter in my journey, leaving an indelible mark on my personal and professional development.

14.08.2023 [Monday]

Starting at 8:00 am, it was another day filled with surgeries, and it proved to be quite fruitful. I had the privilege of assisting in three surgeries, with the highlight being appointed as the Chief Assistant for one of them. During this surgery, I made incisions and handled laparoscopy procedures, even working with the 3D scope.

Throughout the day, I observed and assisted in various surgical procedures, including Hartmann's procedure, perianal biopsy, and total proctocolectomy with J pouch and ileostomy. It was an exhilarating learning experience, and I felt grateful for the trust placed in me. Despite the long hours, which ended at 7:30 pm, the knowledge and experience gained made it all worthwhile.

15.08.2023 [Tuesday]

I had a day off on this occasion, as it was Korea's national day. It provided a much-needed break, which I utilized for rest and exploration of Seoul alongside my friend, Wen Jia. We headed to Sinsa-dong, a vibrant district known for its boutiques and cafes, and visited the famous Starfield Library, a mesmerizing place filled with books and natural light. It was a peaceful escape in the midst of a busy city. Amidst our adventures, I also dedicated some time to work on my presentation, making the most of this elective experience.

16.08.2023 [Wednesday]

Similar to the previous week, my day was dedicated to observing colonoscopy procedures, allowing me to learn valuable techniques from the doctors. What made this day special was my professor's thoughtful gesture to organize a gathering with a few of his colleagues. We enjoyed a dinner together, and it provided a great opportunity for engaging conversations and bonding.

17.08.2023 [Thursday]

On the second-to-last day of my elective posting, my schedule was filled with surgeries. After actively participating in three consecutive surgeries, the clock was inching towards 5:30 pm. I wisely utilized the remaining time within the hospital to finalize my presentation slides. As the evening approached 6:30 pm, I left the hospital, marking the end of a productive day. This day held a special significance as it coincided with the arrival of two more friends, Yi Hui and Kai Xin, who joined us in Korea for the upcoming adventures. On this day, Wen Jia and I also relocated to a new accommodation, sharing it with our two friends. We celebrated with a delightful dinner and brimmed with excitement for the journey that lay ahead.

18.08.2023 [Friday]

My last day at SNUH was a significant one, featuring my case presentation and review on colorectal cancer screening tests in Korea and Malaysia. The 7 am colorectal surgery department meeting provided the platform for my presentation. Facing a room filled with professors, doctors, and fellow students while representing my university in a foreign land, was a significant milestone in my journey.  The nerves were palpable as I fielded questions about colorectal cancer incidence rates, fees for the screening test, any medical insurance in Malaysia and so on. Thankfully, I managed to answer their queries and conclude the presentation to their satisfaction. By 10:30 am, the meeting had wrapped up, I seized the chance to capture memories with the Chief and other respected professionals, marking the end of my elective stint at SNUH. Leaving the hospital behind, I rejoined my friends to explore Seoul and relish the day with them.

19.08.2023 [Saturday]

Our last day in Seoul was filled with memorable experiences and cultural immersion. We kicked off the day with a delectable adventure, patiently waiting in line for over an hour to savor the famous pastries and bread at Onion Café. The exquisite flavours were well worth the wait.

Next, we embarked on a journey through time and tradition as we donned Hanbok, traditional Korean attire and explored the magnificent Gyeongbukgung palace. This historical gem allowed us to step back in time and gain a profound understanding of Korea’s rich heritage and cultural traditions. In the evening, we headed to Banpo Hangang Park, where we were captivated by the mesmerizing bridge fountain display, a perfect way to bid farewell to this vibrant city.

20.08.2023 [Sunday]

On this exciting day, we embarked on a train journey to Busan. Upon our arrival in this bustling coastal city and settling into our accommodations, we set out to explore the charming Gamcheon Cultural Village, a colourful and artistic community built on the slopes of a hill. While strolling through its vibrant streets, we had the pleasure of encountering the Little Prince statue, a whimsical and heart-warming sight that prompted us to capture cherished photos alongside it. We wrapped up our first day in Busan with a visit to the lively BIFF Market, where we delighted in sampling a variety of local dishes and snacks. It was a flavourful journey through Busan's street food scene, allowing us to savour the region's culinary delights.

3. Your feelings and thoughts

This week has been quite a journey for me emotionally and mentally. It all started with a mix of excitement and nervousness as I able to assist in surgeries and prepare for my presentation. As the days went on, I felt a growing sense of gratitude and accomplishment for the opportunities and trust I received.

Of course, there were moments of uncertainty, especially when dealing with language barriers and navigating an unfamiliar healthcare system. However, these challenges also made me more adaptable and resilient. Besides, exploring Korea’s culture and history with friends was a wonderful break from the hospital routine and it added a layer of personal fulfillment to the week.

Looking back, it’s been a week of ups and downs, but it’s left me feeling more prepared and eager to take on whatever comes next in my journey and also in the future.

4. How did you learn and apply the skill of decision making in your EP journey?

Throughout my elective posting journey, I’ve learned to apply decision making skills effectively. Initially, deciding to pursue this overseas opportunity in Korea was a significant choice, considering the language barrier, different medical system, and cultural differences.  Once in Korea, I further honed my decision making skills in several ways. These included making quick decisions while assisting in surgeries, structuring my case presentation efficiently, managing my time effectively and finding ways to overcome language barriers in a foreign medical environment. Each day presented new challenges that required quick and thoughtful decisions. These experiences not only deepened my medical knowledge but also contributed to my overall growth as a healthcare professional, emphasizing the importance of decision making in the field.

5. How did you manage your time throughout this EP journey?

During my elective journey, time management became a fundamental skill. I carefully structured my days to accommodate surgeries, preparation for my case presentation, and leisure activities. Prioritizing my responsibilities allowed me to balance patient care and academic commitments while still enjoying cultural experiences. Being adaptable and flexible in my schedule was vital to handle unexpected challenges efficiently. This experience emphasized the importance of effective time management in the medical field.

6. Your plan for next week (Week 4)

In the upcoming week, I'm excited to explore Busan and Jeju with friends, immersing myself in Korean culture, enjoying the natural beauty, and creating unforgettable memories together with my friends.

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Exploring Nepal's Culture and Making Lasting Impact: The Third Week of Volunteering

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Exploring Nepal's Culture and Making Lasting Impact: The Third Week of Volunteering

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Your name, matric number, date

Sarvisuwaran Ravi, A181777, 14/8/2023 – 19/8/2023

1.     Your progress so far

My First day at Emergency department started off boring as I was clueless and lost. The situation here is completely different compared to my previous posting. Patient comes in and goes out contantly. The nurses were kind enough as some of them directed us on things that we should do such as branula insertion, blood taking, and also ECG reading. Certain days, this department gets extremely busy and certain days, theres very little patients. The drs told us that it depends on the weather as frequent landslides tend to block the main road that joins this hospital with minor cities. Thus, patient can’t get to the hospital leading them to visit some nearby local clinics. My first days completed with briefing from the nurses and Drs, followed some rounds and getting familiar with their management plan.

Upcoming days were quite interesting as I got to do some hands on experience such as branula insertion and blood taking. Initially I was nervous as it is my first time doing such procedures on real patients. The nurses were kind enough as they directed every step and taught us till we grasp the method. The Drs also taught us on how to interpret X-Rays , CT Scan and Principles of management in any case of emergency. He even quizzed us on types of branula, contraindications and method of insertion to make sure we are not puzzled. We were allowed to examine certain patients with obvious findings to allow us to appreciate them.

During the weekend, we went to visit some local sites such as Pumdikot, World Peace Pagoda, Davis Falls and Gupteshwar cave. All this historical and herritage sites gave us some insightful information on whats there to visit in Nepal. Besides that, we also did bungee jumping and solo swing from a height of 225 metres which is considered as the second highest point for bungee jumping in the world. It was definitely a once in a lifetime experience and took all my adrenaline with it during the jump

2.     Feelings and Thoughts

Grateful – Was able to experience some hands on experience for the first time. Gain a lot of medical knowldege from local doctors. Able to get a better understanding on how a medical system works at a third world country.

Proud- Able to overcome my fear and did something that I wanted to do for long

3.     How did you learn and apply skill of decision making in your EP journey.

My EP journey wasn’t long and I don’t have much time to explore other things as i’m bounded with my tight hospitals schedule. Despite having numerous attraction that should be visited, I made a precise list on attractions that I should visit based on my priority. I prioritize them accordingly and made a wise decision to visit only certain places that is coverable by given time. In the end it turns out pretty good and I had no regret.

4.     How did you manage your time throughout this EP Journey

Time is something that was never enough throughout this journey. In order to maximise my time in Nepal. I started waking up as early as 6 am and going to hospital as early as 7.30. I spend my time at hospital till 2 pm and I will leave early to check out on other stuffs. This allows me to have more time for things that I wanted to do.

5.     Plan for week 4

-        Back to Kathmandhu

-        Farewell

-        Local Shopping in Kathmandhu

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Week 3: Last week at SNUH - Endocrine department

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Week 3: Last week at SNUH - Endocrine department

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1. Your name, matric number, date
Ng Wen Jia, A180860, 14/8/2023 - 20/8/2023

2. Your progress so far

14th August 2023 (Monday) - First day in Endocrine department

My day commenced by observing a BABA (bilateral axillo-breast approach) robotic thyroidectomy, a procedure I had never seen before. It involved four incisions, two in each axilla and breasts for the insertion of robotic arms. I pondered the distinctions between traditional open thyroidectomy and robotic surgery and had the pleasure of meeting Dr. Ang Wei Wen, who was an associate consultant under E&B in Singapore and was on a year-long clinical exchange at SNUH. He was exceptionally kind and informative, helping to clarify my doubts. I learned that there weren't significant differences between the two thyroidectomy methods, but the BABA approach was preferred by young female patients due to its better cosmetic results. He also explained the surgical procedures and anatomy to me during the operation. After the thyroid removal, Prof. Kim Woo Chul, the chief surgeon, displayed the specimen and tumor location. I even had the opportunity to touch and examine the nodule myself. This day allowed me to make new friends with medical students from the Europe. It was a rewarding experience, both in terms of learning in the operating room and meeting people from various countries.

15th August 2023 ( Tuesday) - Gwangbokjeol

It was a day off for us, as it was the Independence Day in South Korea. This holiday commemorated the end of the dark period in Korean history when Japan occupied the entire Korean peninsula. Korean flags adorned the country on this day. After a rejuvenating sleep, we decided to explore a new area in this captivating country. We headed to Sinsa-dong for lunch and some sightseeing. This area was known for its unique shops and fashion sense. We also sampled the famous honeycomb makgeolli, which was a delightful surprise for my taste buds. Our next stop was the COEX mall, where we visited the starfield library, famous for its towering 13-meter bookshelves.

16th August 2023 (Wednesday) - First time joining clinic

It was a typical day filled with surgeries where I observed conventional total thyroidectomy, lobectomy, and modified radical neck dissection (MRND) procedures for managing papillary thyroid carcinoma and removing cancerous lymph nodes. These surgeries primarily focused on the neck, with a limited area of involvement so I didn't have many opportunities to assist, but I closely observed. Fortunately, I met a clinical fellow, Dr. Kang, who was incredibly helpful and patient in explaining procedures. Dr. Bae Hae-Rim, another clinical fellow, invited me to assist with suturing wounds, even though my role was mainly limited to cutting. Nevertheless, I cherished the chance to participate in the surgery. In the afternoon, I was guided by Dr. Jung Young Hoon to the clinic, where I joined Prof. Kim Su-Jin's clinic. This was my first and only clinic experience during the two weeks. It was eye-opening to witness Prof. Kim's efficient and effective approach. She saw patients in two connecting rooms, seamlessly transitioning between them while her medical officers and house officers prepared patient information in one room and called in patients from the other. Prof. Kim managed to see over 20 patients in just one hour. Despite her busy schedule, she took the time to answer my questions during brief intervals and clarified my doubts  after the clinic sessions. Afterward, I explored Namsangol Hanok Village, Namsan Park, and Namsan Seoul Tower, where I enjoyed breathtaking views of the city and experienced a magnificent sunset in Itaewon. On my way back, I had a pleasant chat with a local resident in Itaewon. This day was filled with surprises and self-discovery, making it truly satisfying.

17th Aug 2023 (Thu) - Conference Day

As I didn't have surgeries to observe that day, I didn't need to arrive at the hospital very early. The conferences were conducted in Korean, and while I didn't understand most of it, I still paid respectful attention. Lunch was provided, and I enjoyed engaging conversations with the doctors in attendance. Later in the afternoon, I revisited Hong Dae, exploring areas I had not seen before and even getting a haircut.

18th Aug 2023 (Friday) - Last day at SNUH

Despite my reluctance to leave, the day started with a robotic-assisted thyroidectomy, a procedure I actively participated in, learning how to operate the robot under Dr. Jung's guidance. Although I didn't perform any procedures on the patient, the hands-on experience was invaluable. I also met another medical student from SNUH, Shin A-Ra, and we had an engaging conversation throughout the day. After lunch, I observed a major and rare surgery, an adrenalectomy conducted by Prof. Kim. This was my first time witnessing an abdominal operation, and it was a complex procedure that kept the doctors focused. Fortunately, the operation went smoothly and was a success. As it was my last day, I received a gift from Prof. Lee of the Breast team as a souvenir. Although I had initially planned to meet him after the final surgery, it ended quite late, so the gift was passed to a clinical fellow. I was touched by the gesture but regretted not being able to take a photo with Prof. Lee and say a proper goodbye. My two weeks at SNUH had come to an end, marking one of the most memorable experiences in my medical school journey.

19th Aug 2023 (Saturday) - Finally a visit to the Geongbukgong palace

This was my first time wearing a Hanbok, and it made me feel like a princess from ancient times. The palace entrance was complimentary with Hanbok and we even had the opportunity to take photos with other visitors who were fascinated by our attire. It was an unforgettable day immersing ourselves in Korean culture and history. Later, we visited Hangang Park at Banpo, witnessing the captivating Banpo Bridge Rainbow Fountain Show, a relaxing and cozy experience by the riverside.

20th Aug 2023 (Sunday) - Bye Seoul

We left Seoul and headed to Busan for further exploration of South Korea.

3. Your feelings and thoughts
During my two-week experience under the Endocrine team, I found that I enjoyed it more compared to the previous week. One reason for this was that I had become more accustomed to the hospital environment and South Korea in general. This newfound comfort led to increased confidence and calmness. Despite limited opportunities to assist in surgeries, I received more attention and guidance during this week. The doctors were patient in explaining procedures and answering my questions even if there was a language barrier. While I thoroughly enjoyed myself, time flew by and the day to bid farewell to Seoul had arrived. I felt grateful for the successful completion of my visiting clerkship at SNUH and the opportunity to meet incredible people from around the world, an experience I will treasure forever.

4. How did you learn and apply the skill of decision making in your EP journey?
My decision to undertake a visiting clerkship at SNUH in South Korea was undoubtedly the best decision I ever made. It was my first time traveling and studying in a foreign country, far from Malaysia without my parents' company. From the initial application process to planning and managing my finances, I had to rely on myself for everything.

Throughout the journey, I had to make numerous decisions, both big and small, from choosing accommodation and meals to navigating unfamiliar roads and deciding what to purchase. Socializing with people from different backgrounds was also a personal challenge. This experience forced me to step out of my comfort zone, becoming more independent and adaptable to new environments. This freedom and trust in my own judgment allowed me to become more responsible and mature. My hesitation diminished and I gained confidence in making decisions, both quickly and wisely.

5. How did you manage your time throughout this EP journey?
My two-week visiting clerkship at SNUH was a definitely hectic experience as I aimed to explore Seoul while attending the hospital. On weekdays, from Monday to Friday, I typically went to the hospital from 8 am to 5 pm. However, as my focus was on the Breast and Endocrine departments and the surgeries were relatively short, I often left the hospital earlier when there were no scheduled procedures. This extra time allowed me to explore Seoul and visit places on my travel bucket list. I usually explored alone on weekdays because Zi Yee was in the colorectal team, which meant she often finished late. Nevertheless, we would meet for dinner and explore nearby areas if time allowed. Nights were dedicated to reflection, recording experiences in my diary, and planning the following day's activities. We shared our experiences with each other.

On weekends and public holidays, I prioritized rest and extended sleep, exploring Seoul with Zi Yee during the day. Having a companion made the experience more enjoyable, and we managed to cover many places and savor local cuisine together. It was a memorable and fulfilling time.
I believe I had made the most of my trip by balancing learning at the hospital and exploring Seoul.

6. Your plan for next week (Week 4)
I am going to embark on a new journey to discover other cities in Korea other than Seoul which are Busan and Jeju Island with my friends.

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Newborn screening, Laproscopic cholecystectomy, Observing total laproscopic hysterectomy, View of the Anapurna mountain, Sight-seeing at Pokhara at weekend. 

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1. Your name, matric number, date

Nahgeshwarie A/P Ratha Manaalan
A182267
14/08/2023 - 19/08/2023

2. Your progress so far

The second posting that I chose was surgical departments. There was a whiteboard outside the operation theatre telling what are the surgeries will be carried out. Thereby we divided ourselves into pairs to observe the operations. At first we introduced ourselves to the surgeons and started to watch the procedure. I feel very thrilled to observe all these surgeries because in UKM I did not get the opportunity to observe the surgeries. The most heartwrecking surgery that I observed was the emergency ceserian section performing on pregnant mothers.  Before this, I have not fixed my interest to pursue further on any specific departments. But after seeing ceserian section, a interested sparked through to me to pursue my career in Obstetric and Gynaecology. Furthermore when I saw an emergency c-section for the very first time, I teared up. We all have heard that generally mothers need to endure lot of pain to give birth. But seeing that with my eyes felt so different and I have truly very grateful for the oppotunity given. I followed the pediatrician who brought the baby to clean up and to do newborn screening. It left me thinking, most of the emergency c-section babies will be admitted in neonatal intensive care unit (NICU) and devastating will it be for the parents. I have asked a few questions to the medical officer performing newborn screening. I learned what were the normal weight of the newborn and the abnormalities of the head of the baby and many more. The doctors were very kind to answer all our questions which created a pathway for us to learn more. We also got to observe modified electroencephalogram in psychiatric patients. In that operation theatre a psychiatrist and anaesthesiologist was there. We were thrilled we observe that procedure. The psychiatrist was explaining the principles of electroencephalogram and was telling that the patient is having major depressive disorder (MDD). Furthermore, we got observe laproscopic cholecystectomy. Before this I have only read about this in books during my surgical rotation in UKM. But witnessing in real life was so fascinating. It only lasted for a few hours and the nurse assisting the surgery showed us the gallbladder and gallstone which was removed. We got to observe anaethesia via epidural. It was so cool that whatever we learned we got to see in the operation theatre. There was a surgeon who was asking questions about the epidural procedure. I was little dissapointed that I wrongly answered the question but sooner realized that its all part of the learning process. I am the type of student can learn more by seeing and hearing rather than merely reading books. Thereby this gave me a chance to enhance my knowledge more.

The whole week was very hectic with long hours of standing in operation theatres which was both exciting and exhausting. During our weekends we unwind ourselves by exploring the tourist spots in Pokhara which were Pumdikot, World peace pagoda, Davis fall, Guptaswarer cave. While playing tourist we were buying souveniers for our friends and family. The experience could have been better if it was not raining but unfortunately we went during the monsoon seasons. Overall, I feel satisfied for the unique experience.

3. Your feelings and thoughts

The shortage of medical supplies and hygiene standards in the operation theatre during my elective in Nepal evoked a mix of empathy and concern. It was a stark departure from the well-stocked environments in Malaysia I was normalized to. The lack of essential equipment and inadequate sterility controls posed significant obstacles. Yet, amidst these challenges, I witnessed the unwavering dedication of the medical team, who demonstrated remarkable adaptability and resourcefulness. Their commitment to providing quality care under such circumstances left an indelible mark on me. This experience ignited a fervor within me to advocate for improved healthcare infrastructure and accessibility in underserved regions, reinforcing my dedication to global health equity. It emphasized the need for systemic change and increased my desire to help bring about good change in the way healthcare is provided.

Observing a C-section in Nepal was a profound experience that evoked a range of emotions. With few resources, the medical staff and the moms' tenacity in completing the process was obvious. It sparked a mixture of respect for the medical staff's knowledge and sympathy for the mothers, who shown incredible bravery. My dedication to promoting better mother care was strengthened by the stark reality of healthcare inequality. Experiencing these moments in the operating room left a lasting effect and strengthened my desire to support equal healthcare access, especially for women in environments with little resources.

4. How did you learn and apply the skill of decision making in your EP journey?

During my medical elective in Nepal, I embarked on a transformative journey in honing the crucial skill of decision-making. This experience immersed me in a diverse healthcare system, where resources were often limited, demanding precise choices. I learned to navigate complex cases, weighing risks and benefits while considering cultural nuances. Through mentorship from my supervisor and hands-on experience, I gained confidence in diagnosing and treating patients, recognizing when to seek second opinions, and adapting to unforeseen challenges. This elective not only enriched my medical knowledge but also instilled in me the resilience and adaptability required in demanding healthcare environments.

5. How did you manage your time throughout this EP journey?

Our trip so far have no hiccups. I think this is because before coming to Nepal we have an itinerary on how our trip is going to be. Even if we got an itinerary, it was just a guideline and we were not fixed with the scedehule so much. I think the key for effective time management for was the itinerary and the cooperation all 9 of us with each plan. Morever, everyday I had a things-to-do list where I have listed one day before the actual day. This had made me more organized and believe that it helped me more in the time management. I do believe that it was something quite similar on how we manage our time in UKM. But in Nepal we were not in any academic stress so it made me easygoing even my plan for the day did not work. Overall I feel that I managed my time quite effectively.

6. Your plan for next week (Week 4)

My plan for the next week is bid our farewell to our Dr and nurses in Gandaki Medical College, the friends we made in the hospitals and our host family. Depart to Kathmandu to do some sightseeing before coming back to Malaysia.

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My Second Week of Clinical Elective Program

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My Second Week of Clinical Elective Program

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1. Your name, matric number, date

Name: Tan Xin Yee

Matric Number: A182195

Date: 31/7/2023 – 6/8/2023

2. Your progress so far

·         Monday 31.07.2023

After attending the morning conference at 7:30 a.m., which included multiple departments such as the Upper and Lower Gastrointestinal Department, I went to the operation room to observe a patient with cholangiocarcinoma. This patient had a history of oesophagostomy performed four years ago and the upper part of the patient's stomach had been severed, and the esophagus removed in this surgery. To elongate the stomach, a gastric tube was inserted, and the upper part was anastomosed. For today surgery, it was crucial to preserve the gastric duodenum artery, as it was connected to the right gastroepiploic artery, supplying the lower part of the stomach. In cases where preservation of the gastric duodenum artery was not feasible, Prof. Saiura Akio had a backup plan to preserve the right gastroepiploic artery by replacing the gastric duodenum artery with another artery. The use of Indocyanine green (ICG) dye was employed to visualize blood flow during the surgery. This procedure was a Whipple procedure, involving the removal of the head of the pancreas, duodenum, gallbladder, and bile duct.

·         Tuesday 01.08.2023

I attended the morning conference at 8:30 a.m. Following that, I had the privilege to witness a laparoscopic cholecystectomy performed on a patient with cholelithiasis. Dr. Hirata Yoshihiro, an experienced and expert surgeon in this procedure, completed all the necessary steps in just one and a half hours. The procedure was a success, and the swollen gall bladder was removed through four small incisions on the patient.

·         Wednesday 02.08.2023

This day was particularly remarkable for me as I had the opportunity to observe robotic surgery after the morning conference. Robotic surgery was utilized for the removal of a neuroendocrine tumor due to its minimally invasive nature and lower complication rates. Initially, Prof. Saiura Akio made five small incisions on the patient for the insertion of graspers, a camera, and forceps. The DaVinci device was used for the robotic surgery. Spleen-preserving distal pancreatectomy is typically reserved for cases of chronic pancreatitis, proven benign pancreatic lesions and cysts, neuroendocrine tumors, and trauma. In the case of a patient with a neuroendocrine tumor, lesions located in the body and tail of the pancreas become symptomatic as they enlarge and invade surrounding structures. Dr. Mise Yoshihiro explained that spleen preservation was possible for this patient by preserving the splenic artery and splenic vein located behind the pancreas, as the tumor was low-grade malignancy.

·         Thursday 03.08.2023

During the morning conference, I submitted my supervisor evaluation form to Prof. Saiura Akio, who offered the highest praise and commended my excellent attitude throughout the elective posting. Following this, I joined Prof. on his ward rounds as Thursdays were dedicated to ward rounds. After the ward rounds, I observed another robotic surgery, this time for a patient with a 7cm mucinous cyst neoplasm at the tail of the pancreas. Consequently, the patient needed the removal of the pancreatic tail and spleen. Dr. Ito Ryota explained that the pancreatic tail could be removed by dividing the splenic artery, splenic vein, pancreatic vein, and pancreatic parenchyma. I even had the opportunity to feel the pancreas during the surgery. Following the surgery, my friend Josephine and I took photos with Dr. Ito Ryota, Dr. Kawano Fumihiro, and Dr. Mise Yoshihiro as a keepsake.

·         Friday 04.08.2023

Today marked the final day of my elective posting at Juntendo University Hospital. I took a group photo with all the doctors in the Hepatobiliary Pancreatic Surgery Department and handed over postcards to Prof. Saiura Akio, Dr. Ito Ryota, Dr. Kawano Fumihiro, and Dr. Mise Yoshihiro as an expression of our gratitude. They were delighted and expressed their hopes of visiting Malaysia in the future. Later, I entered the operation room to observe the surgery. After enjoying a delicious lunch at the café, I returned my hospital access card and international center access card to the office. Mr. Ken also presented us with certificates of completion and T-shirts as souvenirs for my two-week elective posting program.

3. Your feelings and thoughts

I felt extremely happy and grateful to have had the opportunity to participate in the clinical elective program. Initially, I had concerns about the language barrier, but the doctors in the department consistently made efforts to communicate with us in English, believing that speaking English with us would help improve their language skills. Their dedication and professionalism inspired me to become a future doctor likes them. In Japan, hepatobiliary and pancreatic cancer is prevalent, and Prof. Saiura Akio is a leading expert in this field. Despite his stature, he approaches each patient with great seriousness, even drawing the anatomy of the area to be resected for every surgery. Through this experience, I gained a profound appreciation for the importance of anatomy and expanded my knowledge of hepatobiliary and pancreatic surgery and diseases. In conclusion, I take pride in my accomplishments during this program, and I believe it will be an invaluable experience and an unforgettable memory.

4. How did you learn and apply the skill of decision making in your EP journey?

Decision making skill is the life-long learning skill and essential for establishing a strong doctor-patient relationship. I learned the art of decision-making by observing the surgeons during surgeries. During the morning conferences, they would discuss and finalize the procedures to be performed on each patient. However, in the surgical theater, not everything unfolds as planned. The surgeons must make decisions on the spot to ensure the best possible management for the patient. It's a challenging skill to master, and I learned to apply it in simple ways during my journey in Japan. For instance, when faced with the daily-changing menu in the café, I had to quickly decide on my meal. Additionally, I had the freedom to choose evening destinations during my free time. These small decisions honed my ability to make quick and effective choices.

5. How did you manage your time throughout this EP journey?

I applied effective time management skills throughout my elective posting. Mornings began with an early wake-up, ensuring I had ample time to reach Juntendo Hospital, which was five stops away from my hotel. Following the morning conference, I swiftly changed into scrubs before entering the operation room to ensure I could observe the surgery from start to finish. During the lunch hour, I changed back into my formal attire and headed to the International Centre Café for lunch, which typically took almost an hour. After lunch, I changed back into scrubs for continued observation. My schedule was packed and rigorous, but the experience I gained during the clinical elective program was immensely valuable. Surgery usually ended at the same time as class, so I would explore Japan with my friend and indulge in local cuisine after class.

6. Your plan for next week (Week 4)

·         Travel around Japan

·         Enjoy my Japan Journey

# data[].attributes.headline
Phase 3: My exciting second-week medical elective experience in Taiwan

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Phase 3: My exciting second-week medical elective experience in Taiwan

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1. Your name, matric number, date
Wong Yi Lyn, A179360, 21/8/23-25/8/23

2. Your progress so far

21/8

On the first day of second week posting, I joined the outpatient clinic and observed Doctor Chia to perform physical and health examinations on the patients. The examinations include the weight and height measurement, abdomen, thyroid, lung and heart examination. Doctor Chia was very patient with me as she explained the classification and variations of examinations performed, as well as the need to conduct such exams on healthy employees. Besides, I also attended  Dr. Jiang and Dr. Luo's clinic teaching. Following the lesson, Dr Jiang assigned me to write a case report for recording, while Dr Luo also gave me the task of completing a case presentation in the clinic.

22/8

The journey to rural communities with Dr. Ong, nurse practitioners, and physician assistants to provide healthcare services was the most valuable experience I've had.

In general, the surveys and data analysis were done to identify the prevalent health issues and also understand the specific healthcare needs of the rural populations. Then, we set up our booth at community health centres and we primarily target the needs of low-income and uninsured individuals.

We additionally visit certain homes where patients are confined to bed or unable to get to medical facilities due to transportation issues to offer basic healthcare services such as vaccination, medical consultations and health screenings.

23/8

On Wednesday, I went for a house visit with Dr. Tan and the registered nurse to provide home care services. Home care services in urban regions typically offer a greater range of specialised care, including home physical therapy, speech therapy, family or caregivers education, medication administration, and chronic disease management.

I was able to observe the nurse manage the patients' wounds, administer intravenous therapy, and assess their overall well-being. In the meantime, I also had the chance to gain insight into how Dr. Tan assisted patients with pain management, such as administering pain medications, implementing non-pharmacological pain relief techniques.

In the evening, Dr. Hsiao treated Zhi Xuan and I for dinner together with other senior doctors. He also purchased us mementos to take back to Malaysia. We were appreciative of the warm and kind times we had with them.

24/8

On the last day, I also followed the cancer screening clinic learning with Dr.Lan. I was able to observe the screening procedures such as Pap smears, skin examinations, oral cancer and lung cancer screening. Dr Lan will always educate patients about cancer risk factors, prevention strategies, and the benefits of early detection.

Thanks to Dr Lan teaching, I was able to gain an understanding of the specific screening tests used,  the process of follow-up care for patients with abnormal screening results and also the importance of regular cancer screenings.

3. Feeling and thoughts

I feel tremendously blessed and grateful to have had the chance to get insightful learning from all doctors here. During the observation of all procedures, the doctors did not forget about educating me. Numerous techniques and skills used by the doctors and nurses additionally enabled me realise that hospice care actually places a greater emphasis on the patients' comfort and quality of life.

Besides, I was also especially fascinated by Dr. Tan's introduction of various traditions and cultures upheld in the village during lessons in a rural region. He even requested that the team stop at a lovely countryside spot, where he served me a taste of the local cuisine.

# data[].attributes.headline
Phase 3: My exciting second-week medical elective experience in Taiwan

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Phase 3: My exciting second-week medical elective experience in Taiwan

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Wong Yi Lyn, A179360, 21/8/23-25/8/23
4. How did you learn and apply the skill of decision making in your EP journey?

In the clinical setting,  the most effective way for me to learn decision-making in a clinical setting is by observing experienced healthcare practitioners.

I always pay close attention to how the doctors approach patient assessments, evaluating medical data, and making decisions about diagnosis and treatment.

Besides, as sometimes decision-making in healthcare often involves ethical dilemmas, through observation, it provides me insights into how the doctors navigate these dilemmas while adhering to ethical principles. I still clearly recall the day when a patient's family objected to her having an endoscopy, and I was asked to inform the doctor who hadn't yet arrived at the ward. I made the decision to comfort the patient by stating that we would obtain informed consent before beginning any treatment. Then, I attempted to convey to the family that we should respect and understand what the patient expresses as they may have their own considerations through discussion. Afterwards, I reported the incident happened when Dr came to the ward.

Besides, since this is my first trip abroad, I have always been concerned about the expense. Therefore, I make the decision to estimate my budgets with

thorough planning like considering my travel destinations, the duration of my trip, and the activities I want to engage in. Besides, I also discussed my overall planning with my friend, Ng who will be traveling with me. For example, I had previously planned a trip to the Taiwanese city of Hualien. However, after speaking with Ng, we found out that the transportation was not convenient and also the weather was  unsuitable for outdoor activity.  Therefore, I made decision to cancel the trip to that city at the end.

5. How did you manage your time throughout this EP journey?

Initially, after receiving the timetable for my medicine elective,  I started  creating a weekly schedule that outlines my commitments, including clinical tasks, study time and personal activities. However, there was a time when Dr. requested Ng and me to do a presentation on our Malaysian healthcare system in addition to introducing certain tourism attractions. So, when it came to making preparations, we truly felt rushed. After finishing our elective work each evening, we would take the time to conduct research, make a mental map for better understanding, and add fascinating images to our presentation slides. We also divided the work amongst ourselves; for example, I was in charge of creating the slides that described the KL area, and Ng was in charge of introducing her hometown state of Penang. In the end, we were able to complete our presentations well and earn the doctors’ compliments.

6. Your plan:

- Express gratitude to all healthcare professionals

- Bringing back to travel memories of visiting Taiwan tourism attractions

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1. Your name, matric number, date

Lohith Selan Raja Selan, A182279, 14/8/2023-19/8/2023

2. Your progress so far

We first encountered the emergency department on Monday. A brief description of the patient admittance procedure was given by a staff nurse. The system in Nepal is very different from Malaysia in which the patients family takes full charge of what is to be done before the patient starts his treatment.The family member has to pay the admission costs and purchase the required medical supplies. This process is different from the usual way of how a patient is treated .

The nurses took their time on Tuesday and Wednesday teaching us how to perform ECGs, perform venepuncture, and insert continuous bladder drainage. I volunteered myself and asked if the nurse could teach me how to perform a venipuncture and she patiently guided me to perform it on a female patient who was very accomodating.I was proud of myself as my branular insertion was a success in my first try and the nurse told me that I did a very smooth insertion and that just boosted my confidence level.My friends also assisted me in performing ECG on female patients and it was indeed a challenge getting the cooperation from older ladies who were senile and aggrasive. We also go with the doctors as they examine patient cases and the doctors would explain to us in English and ask us some questions regarding the cases discussed. This offers us insightful information and a broader comprehension of medical practise in various settings.

There were a vast of diseases that I encountered in the emergency department such as heart attacks, dengue fever, food poisoning, bronchial asthma, pulmonary embolism,organophosphate poisoning and many more.All the doctors generously offered us their advice and provided us with in-depth explanations of these cases. They devoted their time to instructing us on topics including calculating fluid requirements for paediatric patients, treating paediatric fractures, managing dengue fever cases, and reading brain CT scans.

Looking at how enthusiastic the doctors were,I became even more keen in learning more and asking the doctors more on diseases similar to in our homeland and asking them how they would manage such cases.There was a doctor who put up and X-ray and helped us interpret it while having a learning session with us on the costophrenic angle, any air bubbles notes, cardiomegaly,any fractured ribs, deviated trachea and many more.Another doctor was Dr Asmita who taught us basic drug doses used on most patients who come in with the most common reasons such as fever.Another father figure we had was Dr Tarun Paddle who was our supervisor and he was looking out for us every time we were lost and needed guidance.He made sure we were always learning and enjoying the learning process.

3. Your feelings and thoughts

Patience is a virtue in the medical field, as everyone is busy helping patients and being there for the patients,especially in the busy environment of a hospital. Particularly the emergency room might be stressful and overwhelming with patients flooding at odd hours of the day. While we all took turns doing procedures on patients, we made exceptions for individuals who were in urgent need of care due to their serious circumstances.

I feel accomplished as I learnt a lot of new knowledge and did a lot of hands on procedure in stressful environments which made me realise how my working life would be in the future.I consider myself lucky for the opportunity to perform procedures on real patients. I had only practised these procedures on mannequins but what an experience it was dealing with real patients.

4. How did you learn and apply the skill of decision making in your EP journey?

Firstly,the decision to embark on this elective in Nepal was a challenge as there were many countries to go to but after various discussion with family and friends I told myself that I wanted tottery a country that was a little backward in order to be able to know their working life and experience there and I think that's the best decision I have made as I have zero regrets.

After enrolling myself in the medical college in Pokhara choosing the departments was another big decision to make and I made myself clear that my intention was to watch surgeries and perform procedures on patients which led me to choose surgical and emergency department as my first two choices.This decision was indeed a good one as it has brought me a step closer to who I want to be in the far future and I got to see myself there.In addition to giving me the chance to do certain procedures, the medical professionals were exceedingly kind and willing to share their time and expertise. Despite their hectic schedules, they made an attempt to inform us about the cases and give us useful insights into how the ED operates. Their commitment to our educational process was genuinely admirable.I was able to take good values from them and would do the same to the my future students when I am a specialist one day.

I'm happy with my decisions because they gave me the opportunity to work with patients, better grasp patient findings, decipher brain CT images, and observe several operations. I made the right choice, and I'm proud of it.

5. How did you manage your time throughout this EP journey?

Time management wasn't really an issue as I had my team and my friends who made sure we went to the hospital on time and leave after our shift was over.They also kept checking on me to see if I was in the Operation Theatre and this made me make sure I was never missing on anything.Normally, the hospital was open from 9 am to 2 pm and we would dedicated reach on time. We would select an appropriate location for lunch and dinner after our attachment. Our pre-planned itinerary turned out to be of great value. We would talk about any schedule modifications as a group to make sure that everyone was aware of them and to help us organise our time properly.

My friend also managed to arranged our tourist agent Mr Krishna who managed all our trips to tourist spots so systematically and safely.We managed to visit a lot of beautiful places in Nepal such as Pumdikot,Phewa Lake,and many more.Our time zone difference was just 2 hrs and 15 minutes which wasn't too bad and we managed to adapt to it over the time.

6. Your plan for next week (Week 4)

-Farewell from the hospital and head back to Kathmandu
-Visit places in Kathmandu and enjoy the city life also the hustle and bustle of the main city
-Explore the local cultures and food in Nepal
-Fly back to our homeland

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Phase 3: A Journey through Rural Mobile Clinics, Home Care, and Hospice in Taiwan

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Phase 3: A Journey through Rural Mobile Clinics, Home Care, and Hospice in Taiwan

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Ng Zhi Xuan, A182906, 17/8/23-25/8/23

21/8 - 25/8
Hospice Inpatient Care

21/8 Monday

Today marked my first day in the hospice ward, and I'll be staying here for the entire week.

The hospice ward consists of a total of 10 beds. Within the ward, there was a multifunctional room that houses a piano along with plants and flowers used for musical therapy and plant therapy to soothe patients. There was also a multifaith prayer room to support patients and their families spiritually.

Every morning 8.00 a.m., there is a meeting held where the night shift nurses provide updates regarding the patients' progression. After meeting, I joined the 9.00 a.m. morning ward round with Dr. Kao and two postgraduate year interns.

During the morning ward rounds, the resident assessed the patients' mental alertness by asking questions such as their names, their current location, whether it's daytime or nighttime, etc. This was followed by a general physical examination.

Each patient has their dedicated caregiver who accompanies them throughout their stay in the ward. They were trained to provide attentive care, which includes assisting with feeding, recording bowel output, urinary frequency, and reporting any new complaints to the medical team.

To my surprise, other than doctors and nurses, a Priestesses was following every morning round. By observing the patients' reactions, behavior, and the dialogue process between doctor and caregivers, she would determine who needs additional care, and then allocate time to offering guidance, spiritual support and companionship.

After the ward round, the resident and interns were busy updating the patients progress in health information system. Knowing that I would be free until 1:00 p.m., I approached one of the interns and kindly requested an ID, so I can briefly review the health records, to gain a better understanding of the diagnoses and the current conditions of the patients.

The afternoon ward round led by the attending physician, Dr Sun closely resembled the morning round. It was followed by a brief discussion among doctors during which they decided on the initiation or discontinuation of specific medications and discuss the reasons.

Family Discussion

In the hospice ward, I witnessed a deeply emotional moment. There was a patient battling terminal cancer and a positive COVID status. She was in isolation room. Her sister and cousin have come to discuss her condition with the attending physician.

The sister expressed a heartfelt request, asking if it would be possible for the patient's son, who has been in prison for 14 years, to visit his mother. He had penned a letter, pleading for permission to temporarily leave prison to be with his mother. However, he needed a doctor's letter to make this happen.

The sister's concern was evident, she feared that her sibling might pass away during her isolation, and she won't have the chance to see her son. Sister even argued that COVID policies have loosened, questioning why the patient can't be moved out of isolation.

The doctor, with empathy and understanding, explains that keeping the patient in isolation wasn't just for her own safety but also to protect other vulnerable patients in the ward. The doctor assured the family that once the patient's COVID status turned negative, she would be transferred to a regular ward. They also promised to assist with the required letter.

The patient's family, though disappointed, understands the doctor's explanation and expresses their feelings. There is a sense of sadness and frustration, with almost tears in their eyes. The sister eventually cried and shared her profound wish that her sibling would pass away sooner to spare her from further suffering.

The doctor counselled the patient, emphasizing that the timing of death is a was beyond human control, a matter of fate and faith. It was a heartfelt message that urged them not to to harbor negative thoughts about her situation but to cherish the time they had together.

22/8 Tuesday

During the morning ward round, I learned about signs of approaching death, which include agitation, loss of appetite, irregular breathing, cool extremities, pale and mottled skin, and so on.

I had the opportunity to observe the eyes of a pre-dying patient. Her eyes appeared half-open, with a thin membrane covering the eyeballs filled with watery and glassy substances, resembling the flesh of a lychee. In Taiwanese clinical terms, they referred to this as '荔枝膜' or 'lychee membrane’.

I also heard a death rattle from another pre-dying patient. It was characterized as a wet, gurgling sound produced by air passing through the accumulated secretions in the airway. The sound of a death rattle is quite startling and distressing for me, especially when I realized that it was a reminder of the impending death.

From Dr Sun, I gained valuable insights regarding the management of dehydration symptoms in terminally ill patient. For example, in cases where a patient complains of thirst, they can suck on ice chips to relieve it. Although drinking fluids can prevent dehydration which could potentially lead to renal failure and subsequent accumulation of opioid metabolites, resulting in symptoms like confusion, restlessness, and seizures. However, it's important to note that as death approaches, aggressive hydration can hasten death by causing issues like pulmonary edema, worsened breathlessness, increased oral and bronchial secretions causing congestion and choking. Therefore, only a small amount of water should be allowed to maximize palliative benefits.

23/8 Wednesday

Withdrawal of life support – Compassionate Extubation

This morning, there was a newly admitted patient who had underlying severe respiratory failure. He was in a comatose state and has been dependent on a ventilator for life support for months. Following a serious family meeting involving the patient's eldest son, other family members, and the attending physician, a shared decision was made to withdraw life support for this patient. The consent letters were signed by the eldest son, who acted as the legitimate surrogate decision-maker. It was a tough decision, as they considered the patient's dignity, comfort, and the inevitability of the situation.

In the afternoon, the endotracheal tube was removed, and ventilator was terminated. About 20 of the patient's relatives gathered in the lounge waiting to witness this significant moment. Their presence showed the strength of family bonds.

When medical treatment can't reverse multiorgan failure in a dying patient, keeping the breathing tube and machine only makes suffering last longer. Not all terminally ill intubated patients can tolerate this. In Taiwan, The Hospice Palliative Care Act (2013) legalizes palliative extubation, also known as Compassionate Extubation (CE). CE is performed to alleviate suffering by termination of mechanical ventilation and withdrawal of the tube. It's not just a medical procedure. It's about respecting the patient's wishes, making them comfortable and allow a natural death when further treatment won't help.

Musical Therapy

In the afternoon, I participated in a musical therapy session. Alongside a skilled musical therapist and two postgraduate year interns, we gathered in multipurpose room to sing some classical songs to an elderly patient.

The therapist conducted the session with gentleness and care. After each song, she would pose thoughtful questions to encourage the patient to reminisce about the cherished moments from her good old days. It was heartwarming to witness how the patient responded with happiness.

Feedback with Elective Supervisor

After lunch, I had a feedback session with supervisor Dr Pan.

24/8 Thursday

Today, I met a hospice chaplain and had the opportunity to gain a better understanding of the roles of a chaplain in hospice. I learnt that some patients have a fear of dying due to a lack of understanding about the process. It is the role of the chaplain to explore their concerns and wishes and to provide spiritual guidance and reassurance.

It is also the responsibility of the chaplain to conduct a 'Hospice Spiritual Needs Assessment' to record information about the patient, such as their religion, the need for religious rituals, the type of spiritual support needed, wishes, or things they would like to accomplish and so on.

25/8 Friday

After the afternoon round, I went to the management department to pay my tutor fee. I met a secretary who invited me to join her for lunch since she knew it was my last day in the hospital.

In the evening, I started packing my luggage, preparing to fly back tomorrow.

# data[].attributes.headline
Phase 3: A Journey through Rural Mobile Clinics, Home Care, and Hospice Care in Taiwan

# data[].attributes.subject
Phase 3: A Journey through Rural Mobile Clinics, Home Care, and Hospice Care in Taiwan

# data[].attributes.body
1. Your name, matric number, date

Ng Zhi Xuan, A182906, 17/8/23 – 25/8/23

2. Your progress so far

17/8
Mobile Health Clinic in Rural Area

Today, I joined a mobile clinic team led by Dr. Huang Kun Siang, the Deputy Chief of the Family Medicine Department, a nurse, a pharmacist and a driver. Our first stop was the Guanshan Community Center in Guanshan Village, Jiaxian District. We departed from hospital at 8:00 a.m., and it took about an hour to reach our destination. Since the village is located on mountain, the journey consisted of rugged and steep terrain.

After setting up, the clinic began at 9:30 a.m. and continued until 11:30 a.m. During this time, a total of five patients visited the mobile clinic, all of whom had chronic conditions such as diabetes, hypertension, hyperlipidemia, chronic back pain, and depression. Most of them came for medication renewals. The doctor's responsibilities primarily included consulting with the patients, explaining their recent lab results, offering medication advice, and recording medical records on a laptop. The nurse assisted by measuring the patients' blood pressure, blood sugar and weight, while the pharmacist distributed medications prescribed by the doctor.

Dr. Huang explained to me that the implementation of Mobile Health Clinics in rural areas are one of the government strategies in tackling national disparities in rural indigenous health care.

Similar to many countries, including Malaysia, Taiwan faces challenges related to the shortage of healthcare resources and manpower in remote regions. Due to the inconvenience of transportation to rural and mountainous areas, these regions often experience a shortage of healthcare providers and nearby medical facilities, making it difficult for people to access the healthcare resources they need.

Therefore, temporary mobile health clinics are set up to dispatch dedicated healthcare personnel to provide healthcare services for rural communities. They visit the same specific locations once a week, ensuring that residents in remote areas have consistent and adequate access to essential medical resources.

After lunch, our next station was Xiaolin Wulipu Community Center in Xiaolin Village, a mere 7-minute drive from Guanshan Village. Xiaolin Village is located at a higher elevation than Guanshan Village, therefore our trip was filled with lush forests, waterfalls, and scenic landscapes.

The number of outpatient visits was even lower than in Guanshan Village. Since there was quite a bit of free time, Dr. Huang suggested that I visit Xiaolin Pingpu Cultural Museum. Originally located within Xiaolin Elementary School, this museum emerged as a replacement after the school and much of Xiaolin Village were wrecked by landslides during Typhoon Morakot in 2009. It serves as a memorial to Xiaolin Village and Pingpu culture preservation, with exhibits like a Siaolin Kuwa shrine and traditional tools for farming, hunting, and fishing. Moreover, it narrates the story of the local community's rebuilding efforts following the 2009 Typhoon Morakot.

Visiting the museum was definitely a valuable experience for me, particularly in witnessing the resilience of local communities as they overcame adversity to rebuild their lives and their village.

18/8
Hospice Home Care

Today, I joined a hospice home care team led by Dr. Lu Gakuon, an attending family physician, and a nurse. Dr. Lu informed me that we would be conducting three home visits in Fengshan District.

We departed from Chang Gung Memorial Hospital at 9:30 a.m. During the journey, Dr. Lu explained that hospice home care is provided to patients with terminal illnesses or life-limiting conditions who are no longer seeking curative treatment. The goal of hospice care is to ensure the patient's comfort and overall quality of life during the final stages of their illness, allowing them to spend their remaining days in the comfort of their own home, surrounded by loved ones and familiar surroundings.

While the hospice home care team typically consists of nurses and physicians, it may also include social workers, religious teachers, and volunteers responsible for counseling and offering support services to patients and their families, addressing the emotional and psychological challenges that arise during this difficult time. Furthermore, Dr. Lu explained that in Taiwan, under the National Health Insurance, patients who qualify for palliative care at home due to severe injuries and illnesses are exempt from copayments for medical visits by the home care team. Patients only need to cover the registration fees, which are charged according to the hospital's rates, and the taxi fare to and from the hospital to the patient's residence.

After a 30-minute ride, we reached our first destination. The first patient was an elderly woman with an irreversible stroke who needed a Foley catheter change, a nasogastric tube change and medication refill. She was paralyzed in bed and had difficulty speaking. Dr. Lu asked me to perform a neurological examination on the patient and rate her Barthel Index.

I was a bit nervous plus hesitant and did not proceed to complete the full examination as the patient seemed unable to understand and follow my instructions. Dr. Lu later explained to me that I could assess the muscle power without giving instructions to the patient. However, my concern was that I didn't dare to touch or apply force to the patient without her consent, as I might elicit unnecessary discomfort or pain for her while she was having difficulty expressing herself.

As for the Barthel Index, I had heard of it before and knew it is used to evaluate the Activities of Daily Living (ADL) of a patient. However, I admitted to him that I couldn't recall the exact items on the Barthel Index. He understood and suggested that I should look it up online.

The second patient was an elderly woman who had undergone head and neck surgery for brain tumor removal and required a tracheostomy tube change. Being on a tracheostomy, she was unable to speak, and she communicated by writing on an iPad. From the nurse, I learned that this patient enjoyed crafting gifts for the home care team during every home visit. This time, she presented us with her handmade bracelets.  Holding the bracelet in my hand, I felt a strong sense of connection with her and a deep appreciation for her kindness.

As I glanced around her living room, my eyes were drawn to several oil paintings adorning the walls, all painted by her. Her ability to find joy in crafting, even in the midst of her health challenges, left a lasting impression on me.

The third patient was an elderly man in a comatose state with underlying end-stage renal failure and a recently diagnosed hepatocellular carcinoma. Upon examination by doctor, it was discovered that he also had pulmonary edema. His prognosis was deemed fatal. He might not have much time left.  Dr. Lu, in his gentle and compassionate manner, sat down and discussed with the patient's wife the option of withdrawing hemodialysis to reduce the risk of infection, which could further contribute to the patient's suffering. He also consulted with the wife about involving other family members in the discussion, allowing them to make informed and shared decisions regarding the withdrawal of other life-sustaining treatments to avoid the prolongation of a "low-quality life extension”.

I learned that in the face of terminal illness, the truth becomes painfully clear: continuing life-sustaining treatments no longer offer any real benefits. Instead, they only add to the heavy burden carried by both the patient and the family. Dr. Lu also offered the possibility of moving the patient to a hospice ward, where he could receive palliative inpatient care.

Today's encounters reminded me of the importance of compassion and thoughtfulness in patient care. At the end of life, the focus should shift towards providing comfort, dignity, and support to both the patient and their family. Helping them navigate this challenging part of life's journey with grace and empathy is the responsibility of every healthcare provider.

19/8

In the morning, Yi Lyn and I went to the hypermarket to buy souvenirs and thank-you cards for the doctors who had taught us. In the evening, I visited Dayi Pier-2 and Love Pier.

20/8

Yi Lyn and I traveled to Ciaotou District to explore its parks, cultural sites, and indulge in the local delicacies.

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Phase 3: A Journey through Rural Mobile Clinics, Home Care, and Hospice in Taiwan

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Phase 3: A Journey through Rural Mobile Clinics, Home Care, and Hospice in Taiwan

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Ng Zhi Xuan, A182906, 17/8/23-25/8/23

3. Your feelings and thoughts

I feel happy and satisfied. My experiences during this elective have been incredibly eye-opening and deeply emotional. Each day, there were new challenges and opportunities for me to learn and reflect.

In the rural mobile health clinic, I witnessed the dedication of healthcare professionals in providing essential medical resources to remote communities. It highlighted the role of family medicine which is to provide easily accessible health services to the community despite challenging geographic locations.

Visiting Xiaolin Pingpu Cultural Museum and reading through the inspiring story of the local community rebuilding their lives after Typhoon Morakot reminded me that we should maintain resilience and perseverance even in the worst scenarios.

My experience in the hospice ward (Family Discussion, 21/8/23) reminded me that healthcare isn't just about treating illnesses, it's also about understanding the deep human aspects of suffering, love, and family bonds. The sister's heartfelt plea for the imprisoned son's visit showed how strong family love can be. While the doctor's compassionate explanation to the sister balanced medical rules with emotional needs.

For that experience, I saw how healthcare providers can make a significant impact, not only on a patient's physical health but also on emotional well-being of their family members. It emphasized the importance of empathy and compassionate in delivering holistic care. This experience truly highlighted that healthcare is more than just medicine; it's about recognizing the human side of healing and offering support in times of great need.

Even though I did not personally witness the compassionate extubation process, however, by listening to the dialogues during the family meeting, observing their reactions, and witnessing their faces blend with sorrow and acceptance as they emerged from the room post-extubation made me feel emotional. The strong bonds within the family during this difficult moment were also heartwarming. It reminded me of the importance of family unity during times of loss.

4. How did you learn and apply the skill of decision making in your EP journey?

When it comes to choosing my elective posting, I know it's time for me to exercise my personal decision-making skills. This decision needs to be made by me, personally, based on my own choices because I will be the one dealing with any consequences that may result from it, so I'm taking it seriously.

Taiwan is the country chosen based on several considerations. Firstly, there is no language barrier for me. Without this barrier, I feel confident and comfortable traveling around alone. I can understand road signs, read menu items, and communicate with the locals, which adds to my sense of security and ease during the trip.

Moreover, I believe that the learning process becomes more effective when there is no language barrier. I can readily follow instructions from doctors, understand most conversations in clinics and wards, and stay aware of my surroundings. While upon arriving in Taiwan, I did face some challenges with speaking and understanding the Minnan dialect, which is commonly spoken by many elderly patients, however, it does not significantly affect my overall learning process.

Affordability was another factor in my decision, as I found the flight ticket prices to Taiwan to be within my budget. Moreover, Taiwan's healthcare system is renowned as one of the best in the world and often serves as a model for other countries. This made me eager to learn about it. Furthermore, I've never been to Taiwan before, so I saw this as an opportunity to travel and learn about its culture.

The decision to choose Kaohsiung Chang Gung Memorial Hospital (CGMH) was based on a recommendation from my friend, Yi Lyn. Her uncle had previously worked at CGMH and highly recommended it because CGMH is well-known as one of the major educational hospitals in Taiwan, recognized for its top-notch medical education and outstanding healthcare services. What's more, CGMH was the only institution that responded to my email inquiry among other renowned medical institutions in Taiwan.

When it came to selecting the department, I opted for something I had studied at my own university. This would allow me to relate to and make comparisons more easily, and probably able to answer questions asked by the supervisor in hospital. During that time, I haven’t gone through surgery posting, so it wasn't on my list. Considering that internal medicine posting could be stressful and tiring, and that I might need to review a vast amount of medical knowledge before joining, I decided against it. This left Family Medicine become the final and only option.

During that time, I wouldn't readily admit that I chose the Family Medicine posting because I had a deep interest in this field. However, I believe it is due to the amount of experience and exposure I gained during my Family Medicine posting back in my university, which was not enough to spark my interest. This was influenced by several factors, such as the schedule timing. For example, most of the time, my posting group was assigned to visit the clinic in the afternoon, where there were fewer patients and fewer procedures to observe. Additionally, personally, there was a mismatch in teaching styles with the supervisor. Therefore, I decided to choose Family Medicine for my elective posting in Taiwan to take the opportunity to learn more and explore this field further.

In the end, I am truly happy with this personal decision because it allowed me to experience many things I had never encountered before, such as mobile clinics, home care, and hospice wards, which used to be only concepts I had learned from lecture slides. Furthermore, this elective posting managed to spark my interest in Family Medicine, particularly in the field of palliative care.

For clinical settings, I learn about informed decision-making and shared decision-making. Informed decision-making skills are essential for patients, especially when it comes to their healthcare choices. Patients in hospice and palliative care often face complex medical decisions, such as whether to continue aggressive treatments, initiate palliative care, or discontinue life-sustaining treatments. By practicing informed decision-making, patients can educate themselves about these options, including the benefits, risks, and potential outcomes of each. This knowledge ensures patients make choices aligning with their values and preferences.

Furthermore, informed decision-making allows patients to participate in shared decision-making with their doctors. In this approach, a doctor must actively listen, provide clear information, open for questions, and respect patient autonomy while the patient's role is conveying their preferences, values, and goals.

In my future practice as a doctor, I will apply these decision-making skills to provide the best possible care for my patients.

5. How did you manage your time throughout this EP journey?

Before going to Taiwan, I created a travel itinerary for the first two weeks, which was before the period of clinical placement. During the first two weeks, I followed the planned schedule to travel around, except for some tourist locations that were canceled due to a typhoon and bad weather.

My classes for the first week of elective placement started at 8:30 am, while the second week's classes began at 7:45 am. I usually woke up at 6:30 am to prepare myself. It was just a 5-minute walk from my dorm to the hospital. However, I had to allow 10 minutes to wait for the elevator and another 10 minutes to arrive earlier, so I made sure to leave my room 30 minutes before the class.

My classes typically ended around 12:00 pm to 2:00 pm. After that, I had the freedom to spend the rest of the day exploring nearby places and checking Google Maps for the best transport options.

Every day, either immediately after class or at night before sleep, I spent some time recalling what I had encountered that day and reflecting on what I could learn from those experiences. I then typed them down on my phone in point-form.

In conclusion, my time management and the flexibility I built into my schedule allowed me to make the most of both my educational and travel experiences throughout this elective posting journey.

6. Your plan for next week (Week 4)

• Distribute farewell gifts and thank-you cards to express my gratitude to the doctors and seniors who have been part of my elective placement journey.

• As my time in Taiwan comes to an end, I'll start packing my luggage and preparing to go back home.

• I'll begin working on a detailed report to share my elective posting experience after returning from Taiwan.

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Second Week : Camouflaging as a Local Medical Student :)

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Second Week : Camouflaging as a Local Medical Student :)

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1. Your name, matric number, date

Noor Halinah Binti Mohamed Ali Jinnah, A181430, 21/9 - 26/9/2023

2. Your progress so far?

For the second week of my posting I was attached to the Internal Medicine Department. I found my way to the office on Monday morning for registration and the secretary assigned me into Medicine Unit II. I met my supervisor, Dr Nicole at the Outpatient Department. After a small introduction, she asked me to join the final year medical students who were now in their medicine rotation. I went to the ward to meet the students who were working up a respiratory case. I am glad that I was well received by the students. I helped them to measure the vital signs while they completed other examinations. We discussed the examination findings before one of the students presented it to the lecturer during the bedside-teaching session. After lunch, there was a lecture on Approach to Stomach Ca.

The next day started with a morning lecture on Seizures and Epilepsy followed by working up cases in the ward and presentation during class. There was another lecture after lunch and an evening class. This is how a typical day looks like as a medical student there. One thing that I find different from here is that the students were given 2 patients based on specific diagnosis early in the morning by the registrar for them to work up for the day. So there will be 2 classes/bedside-teaching sessions - one long case in the morning and one short case in the evening conducted by the appointed lecturers. This means, in a week, the students will be exposed to 10 cases from different systems such as Cardiovascular, Respiratory, CNS and Gastrointestinal. This is really different from Ukm where the students are free to clerk any cases and need to arrange classes with the supervisors themselves.

The remaining days continued with a similar schedule. One of the medical students in my group, Ninglumtur accompanied me to do a physical examination on a patient with rheumatic heart disease. I was thrilled to hear a very loud S2 heart sound for the first time. That's not all, she even taught me how to palpate for hepatosplenomegaly so patiently and willing to go around finding interesting cases to show me. I will be forever grateful to her.

On Thursday, after a morning full of lectures and classes, I got a chance to visit the Ranipet Campus of CMC which is located around 14 km from the main hospital. It is a new hospital opened in June 2022 and provides secondary and tertiary care with many sub speciality units. I was mesmerized by the infrastructure and the environment as it was far more modernized and huge than the main hospital. On the last day, I received the assessment from my supervisor. I was happy to hear constructive feedback from her. Before ending the day, I explored Vellore town and went to Gandhi Road which had the Main bazaar.

3. Your feelings and thoughts

- I felt very gratified to have doctors and medical students who are more than happy to teach me. It was a new experience for me to palpate an enlarged liver and spleen on a patient and to hear abnormal heart sounds. This was definitely an experience worth remembering.

- As I was getting towards the final day in CMC, I had conflicted feelings. I was content that I had finally completed my elective journey which I was anticipating for the past months but at the same time I was sad to leave CMC. I really got used to the warm doctors and staff, amiable medical students and somehow the hustle and bustle of Vellore town.

4. How did you learn and apply the skill of decision making in your EP journey?

Decision making is an important skill that I have practiced since the very beginning of this elective journey. There were many options for us to choose from locally or internationally  such as volunteering, learning skills, entrepreneurship or clinical attachment. I have always wanted to explore the medical and healthcare system abroad, so I weighed my options to apply for clinical attachment abroad. After a lot of research, debating pros and cons and long discussions with my parents, I finally decided to do it at Christian Medical College, Vellore, India. And I can assure that it was one of the best decisions I had ever made because I have gained immense experience both in clinical and interpersonal aspects.

5. How did you manage your time throughout this EP journey?

- It was hard to adapt to the time zone there. The sunrise is at 6 am and by 6.30 am, the environment is similar to how 8 am looks like in Malaysia. I need to wake up as early as 4.50 for Subuh prayers. Apart from that, the buses for students arrive at 7.25 am and leave at 7.28 am although it was supposedly scheduled for 7.35 am. I nearly missed the bus on the first day due to this difference. So, starting the next day, I went earlier to avoid any mishap. And on the days when the schedule starts at 9, I will take an auto (3-wheeled passenger vehicle) since the only bus available for foreign students will be too early.  Managing time in the clinical posting is eased by the schedule given by the team. I will usually follow the schedule and always ask for an update from my supervisor or medical students if there are any changes. A typical day will start at 8 am until lunch break (12 pm). Usually my day in hospital ends around 5 pm except for OT days when it ends by noon.

6. Your plan for next week (Week 4)

- Wrap up this exceptional elective journey

- Bid farewell to CMC and heading back to my homeland, Malaysia

- Update the padlet and finish the report for final submission

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1. Your name, matric number, date

Name               : Oon Men Joo
Matric number: A179804
Date                 : 14/08/23 (Mon) – 20/08/23 (Sun)

2. Your progress so far
14/08/23 – 17/08/23 (Mon – Fri): It was my first week in the Liver Transplantation division. On Monday, I witnessed a complex open Whipple procedure lasting about 6 hours. This involved the removal of the pancreas's head, gallbladder, duodenum, part of the stomach and nearby lymph nodes, with a reconstruction of the digestive system through procedures like HJ, PJ, and GJ. I also observed two laparoscopic distal pancreatectomies, where the spleen was spared due to intact blood vessels. When I have questions, I sought answers through phone or consulting the doctors nearby who were observing the same operation.

I attended a research meeting on Tuesday morning, where the year 6 specialty clerkship students presented a study on the effectiveness of vacuum-assisted breast biopsy through systematic review and meta-analysis. This exposure introduced me to this diagnostic and potentially therapeutic intervention for benign lesions, expanding my knowledge base.

Throughout the week, I continued to participate in LT, HBP, and HCC clinics, where I learned from various doctors. Surprisingly, I found myself comprehending most consultation conversations conducted in Cantonese with relative ease, even without my full attention, indicating significant language improvement.

Besides, I observed how the Indocyanine green (ICG) test was performed. It was a perioperative dynamic assessment of liver function in case of major liver surgery. In addition to the Indocyanine green (ICG) test, several other criteria are considered to assess a patient's suitability for major liver surgery. These criteria include factors such as INR, bilirubin levels, creatinine, and various other medical parameters.

I also participated in a tutorial session alongside fellow year 6 specialty clerkship students on topics like "Gallstones and Cholangitis" and "Hepatocellular Carcinoma (HCC)," with a particular emphasis on real patient cases and their management. During the session, most students actively took notes on their laptops while the lecturer was teaching.

In addition to my medical studies, I seized the opportunity to spend time with a Malaysian friend visiting Hong Kong for a few days and enjoyed a meal with newfound friends from Hong Kong, alongside Yee Xin.

19/08/23 – 20/08/23 (Sat – Sun): Over the weekend, Yee Xin and I embarked on a memorable one-day trip to Macau, where we explored its vibrant culture and unique attractions. Additionally, we ventured to Lantau Island, immersing ourselves in the breathtaking natural beauty of the surroundings, allowing us to appreciate the beautiful landscapes.

3. Your feelings and thoughts

I felt my confidence grew in various aspects within the hospital, including conversing in Cantonese, asking questions, and making new friends. It was encouraging to receive compliments about my Cantonese from other students. I believe my medical knowledge, particularly in the realms of HBP and LT, was significantly improved through my observations and exposure in the hospital during these weeks.

I also noticed that the working environment in Hong Kong is marked by its fast pace and high efficiency. Staff members need to respond promptly to orders, as any delay could lead to scolding. Effective communication is important as well in such an environment, demanding clear, loud, and precise speech to ensure smooth collaboration.

I think that when we're alone without support, we often discover our inner courage and unlock our hidden abilities. Having elective posting overseas definitely trained me to be more independent in completing the tasks.

4. How did you learn and apply the skill of decision making in your EP journey?

In the preparation phase for this elective posting, I actively applied the skill of decision-making in numerous aspects, ranging from selecting the universities to apply to, arranging accommodation, booking flights, and handling various logistical details. This process involved a meticulous evaluation of several critical factors, including personal interests, cultural differences, financial considerations, and the duration of the elective posting.

During the elective posting in hospital, since I had the flexibility to decide which medical activities that I wish to join, decision-making skills are essential as it allowed me to tailor my learning experience to suit my educational objectives and interests.

When faced with doubts or questions, especially during medical procedures and consultations, I had to choose between different strategies, either via asking questions or seek answers via phone. This decision often required assessing the doctor's availability and willingness to assist, as well as their familiarity with the specific topic or procedure in question. Therefore, decision-making skill was important in determining when to rely on digital resources and when to engage with medical professionals directly to optimise the learning experience.

During this elective posting, I came to understand the critical role of decision-making for surgeons. I witnessed how surgeons use their judgment in patient consultations and during surgery. For instance, I observed surgeons switching from laparoscopic to open procedures or even halting surgeries based on their judgment.

5. How did you manage your time throughout this EP journey?

Before heading to Hong Kong, Yee Xin and I meticulously planned our weekend schedule using Google Excel.  Our aim was to ensure that we could make the most of our weekends to explore Hong Kong's beauty and culture while maintaining a balance between learning and leisure during this elective posting. Since we have our early planning, it enabled us to visit most places with reduced expenses and fewer obstacles, allowing us to optimise our time and experiences.

Given the freedom to choose the activities to attend during the week, I had to carefully arrange my daily schedule to maximise exposure to various surgeries and medical procedures. After that, I prioritised the teaching session that would most beneficial for my learning. Thankfully, I had the opportunity to observe a wide range of medical activities in Queen Mary Hospital.

6. Your plan for next week (Week 4)

·       Observe a living donor liver transplantation

·       Submit supervisor report for evaluation

·       Take photos with the people I met in Hong Kong

·       Compile all the knowledge learned in a pdf format note

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1.     Your name, matric number, date

Muhammad Azim Bin Jawhardeen, Al82374,2/8/23-8/8/23

2. Your progress so far

·      Visited Kyoto

·      Had a daytrip to Nagoya for a business meeting and giving out flyers on Jdc which will be held in September

·      Visited a mosque in Nagoya

·      Cleaning of a new house bought by JDC for the interns

·      On Saturday, my supervisor brought me to a mosque in ibaraki which was an hour away to attend a lecture on Islam in Japan given by a Japanese Ustaz

·      On Sunday , we went to Osaka station to give out more flyers for the upcoming event

3. Your feelings and thoughts

·       Distributing flyers presented a unique challenge, as not everyone was interested in taking them. However, I observed an interesting aspect of Japanese culture – even if they declined the flyer, they did so politely by bowing their heads slightly as a sign of respect.

·       Attending the business meeting was a valuable learning experience. I gained insights into various aspects of business, including negotiation techniques and other essential elements.

·       The lecture was very interesting as he had shown the growth of islam and other religions in Japan

4. How did you learn and apply the skill of decision making in your EP journey?

·       Long-Term Planning: I had planned my itinerary a month before my programme

·       Continuous Learning: Throughout my volunteering journey, I remained open to learning from both successes and challenges

·       Prioritizing Tasks: I had to make decisions about which tasks to prioritize based on their importance and urgency to ensure the smooth operation of the centre.

5. How did you manage your time throughout this EP journey?

·       I had planned an itinerary before I went to Osaka and got it supervised by my supervisor

·       On my itinerary I had included the places that I will be visiting so that I could inform my supervisor earlier of my activities during the off days

6. Your plan for next week (Week 4)

·      Since this would be my last week, I’m planning to visit other places in Osaka such as the universal studios, Nara, and some other mosques in Osaka.

·       To visit Tokyo for the last 4 days.

·      I was given a task to pick up and bring the new interns who will be coming next Mondayand brief them on jdc and Osaka.

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1. Your name, matric number, date

LIM YEE XIN, A179999, 12/08/2023-18/08/2023

2. Your progress so far

As I continue to acclimate to this new environment, I've begun to notice the presence of many kind-hearted individuals around me, particularly among the local HKU medical students. Initially, I had the impression that they might not be very friendly, as many of them didn't approach me or initiate conversations. However, during my clinic attachment, I had the opportunity to work alongside a medical student who was more than willing to assist me. I feel fortunate that this week, I met a medical student named Yeung Leung Ching, who not only allowed me to palpate the fundus but also patiently taught me the technique.

Furthermore, during my attachment with Dr. Vivian Ng, I was pleasantly surprised when she encouraged me to palpate the fetal head and determine the presentation of the fetus. I also had the opportunity to observe an intriguing case in the antenatal clinic involving an IVF-pregnant lady. This experience underscored the significance of maintaining patient confidentiality, even when a patient is accompanied by family members during the clinic visit.

I had to attend another clinic known as the combined endocrine clinic. This clinic primarily focuses on reviewing patients who have experienced gestational diabetes, often identified early in pregnancy by OGTT due to various risk factors, such as PCOS. What's particularly fascinating is that I had the opportunity to encounter a patient with Marfan Syndrome who expressed a desire to become pregnant. The doctor had to carefully monitor her underlying condition and provide advice on whether it was suitable for her to proceed with pregnancy.

Additionally, I attended the Gynecology Oncology pre-operation and chemotherapy clinic. This clinic primarily serves chemotherapy patients, conducting regular assessments of their condition, particularly their Full Blood Count (FBC), Liver Function Tests (LFT), and Renal Profile (RP), ensuring that they are in a stable condition before proceeding with subsequent cycles of chemotherapy.

Furthermore, I had the privilege of being able to shadow two house officers who graciously allowed me to observe their daily work. I accompanied them during ward rounds and assisted in documenting patients' progress. I was particularly impressed with the advanced technology they utilized, including the use of an iPad Mini to access patient information and prescribe medications.

During one of these rounds, I found it particularly interesting to review a patient with gestational diabetes. However, that day was marked by a somber incident. Unfortunately, a patient experienced the loss of one of her twins at 18 weeks of gestation due to the early rupture of membranes with an underlying infection. She also had to contend with post-partum hemorrhage and was currently under close monitoring in the ward. It was a heart-wrenching experience to witness the photograph of the deceased twin fetus, which already bore their recognizable features, taken by the hospital for the mother to keep.

3. Your feelings and thoughts

It was genuinely exhilarating to have the opportunity to perform palpations on various patients. I'm truly grateful to the doctors who patiently explained things to me, even when I wasn't quite sure what questions to ask. Additionally, I deeply appreciate the local students who treated me with respect and were willing to share their knowledge.

As I prepare to leave next week, I find myself experiencing a mix of emotions. I've grown accustomed to the surroundings, the warm greetings from the nurses each day, and the guidance provided by the doctors in the clinic. This past week has been a joyful one as I've become more familiar with the hospital staff and local students. In fact, some of the local students even invited me and Men Joo to join them for a "YumCha" session, which involves enjoying dim sum together.

4. How did you learn and apply the skill of decision making in your EP journey?

The skill of decision-making plays a crucial role in my everyday experiences during my elective project journey. Being in a foreign country like Hong Kong, I've realized that expenses are considerably higher compared to Malaysia, especially when it comes to food. Even when I venture outside for weekend excursions, I have to carefully weigh my options to choose routes and activities that are more cost-effective and budget-friendly in terms of transportation and dining. Since I'm traveling with my friend, Men Joo, open discussions and thorough planning become essential in making well-informed decisions.

Moreover, my EP attachment has taught me the significance of making clinical decisions swiftly and accurately, without hesitating. For instance, during the grand rounds I participated in, there was only a limited time of 1 hour and 15 minutes to review over 20 patients, formulate future treatment plans, anticipate patients' progress, and prepare for it. The ability to make the best decisions for these patients requires a wealth of experience and practice.

5. How did you manage your time throughout this EP journey?

Honestly to say, my elective schedule is not too occupied as I do not need to take history taking, perform physical examination for assessment and cover bed. All I needed is observe their system. Typically, I spend my days at the hospital from 8:30 am to 4:30 pm. However, I need to wake up at 7 am to prepare for the day and catch the bus to the hospital. Fortunately, the bus system in Hong Kong is punctual, and I always check my phone for the bus's arrival time in the morning to ensure I arrive at the bus station on time. Since next week is my final week in Hong Kong, I plan to make the most of my free time by exploring different areas of the city. I truly enjoy wandering around and immersing myself in Hong Kong's rich culture and vibrant atmosphere.

6. Your plan for next week (Week 4)

·        To explore more places of Hong Kong!

·        To say thank you and take pictures with the kind souls in hospital

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1. Your name, matric number, date

Prissha Siveraj, A184223, 14/8/2023-19/8/2023

2. Your progress so far

Monday- Wednesday: Marked our introduction to the emergency department. A staff nurse provided a succinct overview of the patient admission process. Notably, in Nepal, treatment initiation is contingent upon the settlement of admission fees and procurement of the necessary medical equipment by a family member. This procedure deviated somewhat from our accustomed admission system.

The nursing staff dedicated their time to instructing us on how to conduct ECGs, perform venepuncture, and insert continuous bladder drainage. With their guidance, we were granted the opportunity to execute these procedures. Additionally, we also accompany the doctors to review patient cases. This provides us with valuable insights and a deeper understanding of medical practice in this new environment.

Generously, all the doctors extended their guidance, offering us comprehensive insights into these cases. They allocated their time to teach us about fluid calculation for pediatric patients, the management of pediatric fractures, handling cases of dengue fever, addressing organophosphate poisoning, antibiotic sensitivity tests, interpreting CT and more.

On Thursday and Friday, I had the privilege of joining the Surgical Department, and it was truly thrilling. I had the opportunity to witness a wide range of interesting surgeries, including hysterectomy, lower segment caesarean section, cholecystectomy, maxillofacial reconstruction, and more. The surgeons were generous with their time and knowledge, taking the time to explain the procedures and the reasons behind each surgery. It was an invaluable learning experience. That marked the end of my elective posting at Gandaki Medical College.

On the weekend, we just strolled around the Lakeside which is a famous tourist spot for restaurants, shopping and a breathtaking lakeside view. We also visited Pumdikot, World Peace Pagoda, Davis Falls and Gupteshwar Mahadev Temple.

3. Your feelings and thoughts

I could feel the adrenaline rush when we were in the Emergency department. It was truly fascinating to observe how swiftly the nurses and doctors sprang into action when a critical patient was brought in.

I consider myself incredibly fortunate and grateful for the opportunity to perform procedures on real patients. Back at UKM, I had only practised these procedures on mannequins. Initially, I was quite nervous about performing them on actual patients, but with the guidance and support of the staff nurses, I successfully executed all those procedures.

In the medical realm, patience is a virtue, particularly within the bustling environment of a hospital. The emergency department, in particular, can be overwhelming. While we all took turns performing procedures on patients, exceptions were made for those in critical conditions, recognizing the urgency of their care.

4. How did you learn and apply the skill of decision making in your EP journey?

Choosing Nepal for my medical electives was one of the best decisions I've ever made. Most of the activities and arrangements were scheduled and prepared by the organizers at IVHQ, so we didn't have many choices to make. However, the one significant decision we did have to make was selecting the department to which we wanted to be attached. We were presented with options such as Internal Medicine, Emergency Department, Surgery, Pediatrics, Obstetrics and Gynecology.

Given my interest in Internal Medicine and my passion for learning new cases and appreciating positive findings in patients, I decided to attach myself to the Internal Medicine department. Additionally, I also chose to spend time in the Emergency Department and the Surgical Department. I found the Emergency Department to be the most enjoyable part of my elective experience. Not only did I have the opportunity to perform procedures, but the doctors and nurses were incredibly generous with their time and knowledge. Despite their busy schedules, they made a concerted effort to educate us about the cases and provide valuable insights into the workings of the ED. Their dedication to our learning experience was truly commendable. I'm delighted with my choices because they allowed me to gain hands-on experience, better understand patient findings, interpret CT scans, and witness numerous surgeries. I have no regrets about my decision; it has been a great experience.

5. How did you manage your time throughout this EP journey?

Time management turned out to be surprisingly smooth for us. Initially, I had concerns about travelling in a large group, but my worries were unfounded, and I'm relieved that everything went well. Regarding our hospital schedule, the organisers provided us with a set schedule. However, we were prepared to be flexible and adapt to changes as needed. Clinical settings can be unpredictable, and we might need to rearrange our plans to accommodate unexpected patient care needs or learning opportunities.

Our typical hospital hours were from 9 a.m. to 2 p.m. After our attachment, we would find a suitable place for both lunch and dinner. The itinerary we had created in advance proved to be incredibly helpful. If there were any changes to the schedule, we would discuss them as a group to ensure everyone was aware of the adjustments, allowing us to plan our time accordingly.

For our travels, we were fortunate to have Mr. Krishna, a tourist agent, who helped us plan our trips and provided transportation. Our time was efficiently managed during our visits to various places.

In terms of the time zone difference in Nepal, it didn't have a significant impact. However, we did need to adjust our schedules to start our day earlier. With the sun rising at 5:30 a.m., we found ourselves waking up earlier in Nepal than we typically would in Malaysia, as it started getting brighter around 6 a.m.

6. Your plan for next week (Week 4)

We bid goodbye to our doctors, nurses and friends and our host family in Nepal

Embark on a journey to explore and discover new places in Kathmandu.

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Dhanyavaad Pokhara , Street 21 , Potato Factory & GMC

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Dhanyavaad Pokhara , Street 21 , Potato Factory & GMC

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1. Your name, matric number, date

Parvin A/P Thirumurugananthajiva
A180823
14/8/2023 -19/8/2023

2. Your progress so far

From Monday to Wednesday, I found myself immersed in the hustle and bustle of the emergency department during my rotation. This department was undoubtedly the busiest, consistently filled with patients seeking immediate care. The medical staff, including doctors and nurses, worked tirelessly, ensuring swift treatment, which not only helped patients but also facilitated their prompt discharge. Admission was reserved for only a few cases, and it was intriguing to note that in Nepal, the system involved patient relatives purchasing the specific medical tools prescribed by the doctors to initiate procedures. This was an entirely novel experience for me.

Throughout this rotation, I shadowed a nurse who patiently taught me fundamental procedures typically performed during triage, such as venipuncture, ECGs, and catheter insertions. The nurse took the time to guide us through these procedures while observing our performance step by step. Initially, I felt a bit nervous, but I wisely seized this opportunity to gain valuable hands-on experience. I also had the privilege of witnessing some unusual cases, including organophosphate poisoning. The doctors were exceptionally kind and dedicated, taking the time to educate us on interpreting CT scans, calculating fluid requirements, administering medications for dengue cases, and conducting antibiotic sensitivity tests.

One particularly gracious doctor even invited me to shadow her, allowing me to observe how patient histories are documented in the emergency department. She went above and beyond, explaining each patient's signs and symptoms and the underlying reasons behind them. She also hosted informative Q&A sessions, enabling me to seek clarification on any uncertainties and witness firsthand the physical examinations conducted by the doctors.

For Thursday and Friday, I transitioned to my final rotation in the surgery department, which I had eagerly anticipated. Initially, I was apprehensive about the stern appearance of the surgeons. The corridors of the operating theaters were constantly bustling, with patients continually arriving, surgeries in progress, and the next patients being prepared. There seemed to be no breaks for the surgeons. I held immense admiration for their dedication. To my pleasant surprise, some of the surgeons were exceptionally kind, taking the time to explain the procedures they were performing and the medications being administered.

My days were spent moving from one surgery to another, each presenting a new learning opportunity. I had the privilege of observing a wide range of procedures, including maxillofacial repairs, laparotomies, cholecystectomies, hysterectomies, ovarian cancer removals, and even cesarean sections. Personally, I cherished my time in the surgery department, especially the moments when a newborn's cries echoed through the halls after delivery. I also witnessed an emergency cesarean section due to fetal bradycardia, which was a race against time. Thankfully, through the grace of providence, the baby survived. It was truly a day filled with gratitude.

As the weekend arrived, we embarked on a short trip before returning to Kathmandu. We explored the picturesque lakeside, Pumdikot, the World Peace Pagoda, Davis Fall, and the Gupteshwar Cave. It was a delightful day, offering us the chance to visit some of Pokhara's renowned attractions before bidding farewell.

3. Your feelings and thoughts

I'm genuinely elated and profoundly grateful for the opportunity I had to witness all the surgeries firsthand. The surgical practices in Nepal were distinct, characterized by a deliberate and unhurried approach to each procedure. While their patient handling might have seemed somewhat robust, it ultimately led to the successful survival of every patient. Moreover, the doctors generously dedicated their time to impart some aspects of the procedures to us. I consider myself fortunate to have participated in performing an ECG on an elderly patient, which proved to be quite challenging. With the unwavering guidance and patience of the nurses, I eventually succeeded. Their commitment to teaching us each step of the process left a lasting impression on me.

4. How did you learn and apply the skill of decision making in your EP journey?

At the outset, I was overcome with fear when it came to interacting with doctors. Even during my internal medicine rotation, the prospect of approaching doctors, nurses, or patients filled me with trepidation. I carried an unwarranted sense of being a burden and hesitated to pose questions. It didn't feel right to disturb them. However, as time went on, I mustered the courage to overcome my reservations. I reminded myself that this was a once-in-a-lifetime opportunity, and I couldn't squander it by remaining silent.

As a result, with each new case, a cascade of questions would arise within me, and I would gather the courage to approach the medical officers for clarification. I look back on my decision to choose Nepal for my elective posting with immense satisfaction, knowing that I seized the opportunity to learn and grow, and I'll forever cherish this experience.

5. How did you manage your time throughout this EP journey?

Before my journey to Nepal, I personally experienced the meticulous planning of our itineraries as a group. We diligently adhered to these schedules throughout our adventure. IVHQ, in collaboration with the hospital, expertly crafted these plans, and we simply followed their guidance, reassured by their continuous monitoring of our well-being. This made our journey remarkably hassle-free. Even when we encountered changes to our plans, we ensured that everyone was promptly informed through the WhatsApp group we had established, ensuring smooth coordination. Each day, we would review our schedule as a group, ensuring that everyone was well-informed about the day's expectations.

Furthermore, we organized and participated in enjoyable activities with our foster family during the evenings. Our "D&D" (DANCE AND DRINK) sessions were particularly memorable, as we all danced and reveled together, brightening our spirits every night.

6. Your plan for next week (Week 4)

- The moment had arrived to bid farewell to our foster family, our newfound friends from Nepal, as well as the doctors and nurses who had welcomed us during our stay.

-We embarked on our journey back to Kathmandu, filled with memories and experiences that would stay with us for a lifetime.

-Once back in Kathmandu, we took the opportunity to explore and visit some of the city's renowned landmarks and attractions.

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Paeds FKUGM: Week 3 (NICU, Hemato Onco Clinic)

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Paeds FKUGM: Week 3 (NICU, Hemato Onco Clinic)

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1. Name, Matricular number, Date

Farah Dina Khansa

A177347

7/8 - 11/8

2. Your progress so far

My third attachment was at the Neonatal Intensive Care Unit (NICU), where I learned with the other clinical students of FKUGM. We learned how to assess Dubowitz score on newborns in which we evaluated both physical and neurological characteristics to determine the gestational age in pregnancies. On the second day of attachment I did learn about neonatal resuscitation together with the clinical students and the specialist in charge. To be honest, I felt sad and also touched throughout the 2 days at NICU since I witnessed all the mothers that were really dedicated to breastfeeding their babies or even just came to see their babies and be there for hours even though they were all still in pain from the labor and could not walk properly. Lastly, my fourth and most favorite of all attachments was at the hemato-onco clinic. I spent my last 3 days here and my registrar at the clinic was the coolest he was very chill but still teached me a lot of things, let me performed abdominal physical examination directly to the patient, let me observed invasive procedure at the clinic together with the specialist and also entertained me with new interesting topics everyday. Very happy and satisfied with my last attachment, especially since I got the opportunity to observe both bone marrow puncture and lumbar puncture in one day in which it was so hard to get this opportunity at HUKM since there were so many students and not many patients. It was very interesting to see almost all the patients that had similar features of moon face due to their long term treatment and the parents that were already very expert with their children's medication schedule. On the very last day I also had the opportunity to get to know the oldest patient that had been a permanent patient for years at the pediatric hemato-onco clinic and needed to move to the adult clinic in a few months. It was very touching to listen to his story on how he managed to get through his day with his disease since he was a kid.

3. Your feelings and thoughts

Leaving my elective posting at the pediatric department made me kinda sad to the point I considered adding a one week attachment at the hemato-onco clinic which shows how much i was really happy with the time i spent at the clinic. But then again my elective posting journey has come to an end. On my way back to the dorm I couldn't help but think about how I got so scared and nervous on the first day but at the end it was all worth it and I felt very grateful that I did give this opportunity a try.

4. How did you learn and apply skill of decision making in your EP journey

Throughout my 2 weeks of clinical clerkship at the pediatric department, the decision making is something the doctors need to do everyday especially regarding dosage of a certain treatment. I witnessed so many things during my time in ICU and the specialists there always emphasized on the importance of dosage for pediatric patients to all the registrar there. This made me realize every count of the dose is important since if it's not correct then it can prolong the patient's time at the hospital and it can also be harmful for the patients.

5. How did you manage your time throughout this EP journey

My activity at the hospital usually started around 8 in the morning until 4, which made me not really have the free time to explore more nearby areas except on weekends. But during my very last attachment at the clinic, it was more chill since the clinic usually started at 8.30 and finished at around 2.30 therefore I really utilized my extra time to explore nearby areas. I went to a few eating places or cafes recommended by my acquaintance who is a clinical student of FKUGM.

6. Your plan for next week (week 4)

Plan to explore more Malioboro streets which Yogyakarta is famous for and also visit the Jogja National Art museum.

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1. Your name, matric number, date

Josephine Tan, A184112, 31 July- 6 July 2023

2. Your progress so far

Monday 31/7

I attended the morning conference of HPB team which comprises of multiple departments such as upper GI and lower GI team. After that, I went to the operation room. Today’s patient underwent pancreaticoduodenectomy, also known as Whipple procedure. Professor explained to us that this patient did oesophagectomy 4 years ago, the upper portion of oesophagus and stomach is connected, so in this case the gastric duodenal artery should be preserved. I also got the opportunity to witness the usage of indocyanine green (ICG) for the visualisation of blood supply when anastomosis is performed. Professor explained to us that the ICG binds to plasma protein & emits fluorescence signals. It has a short half life of 140 signals and it can only be visualised with a special machine.

Tuesday 1/8

After attending the morning conference, as usual, I went to the operation room to observe. Today I had the opportunity to observe laparoscopic cholecystectomy. It was truly and eye-opening experience as the whole procedure was very quick which took less than 1 hour. There was minimal bleeding and the patient’s wound can heal faster.

Wednesday 2/8

I attended the morning conference and after the conference, I went to the operation room. Today I had the opportunity to observe robotic surgery with da Vinci device. it was my first time to have the opportunity to observe robotic surgery, it was definitely an eye-opening experience. Patient has hepatocellular carcinoma and requires to remove tumour at liver head. the da Vinci robotic surgery is a minimally invasive surgery performed by 3 surgeons at the same time. The major benefit of robotic surgery is faster recovery and fewer surgical complications.

Thursday 3/8

After participating morning conference, after that I passed my supervisor evaluation form to one of the professors, Prof Akio. Prof let us evaluate our performance ourselves. I felt that I had room of improvement so I rate myself honestly. Prof Akio said that our attitude was good and we were polite. After that, I followed ward round with the professors. Today’s operation was another da Vinci robotic surgery. Patient had a mucinous cyst neoplasm which was 7cm at the pancreatic tail. Therefore, this patient has to undergo surgery to remove pancreatic tail and the spleen. It was a long surgery & the professor explained the anatomy of the pancreas. After the surgery, we took a group picture with the surgeons which are Dr Mise, Dr Kawano and Dr Ito. Every doctor in the hepatobiliary surgery department had been kind but Dr Mise, Dr Kawano and Dr Ito had helped us a lot by explaining the anatomy and procedure of the surgery.

Friday 4/8

Today is the last day of my elective posting. I arrived the hospital earlier than usual. Before the morning conference started, we passed post cards to Prof Akio, Dr Mise, Dr Kawano, and Dr Ito. After the morning conference, we took a group picture together at the conference room. After that, I went to the operation room as usual to observe my last surgery here as medical observer. after lunch, I went to the international students affair office to return my hospital access card and I received a certificate of completion. It was a meaningful day which marks the end of my elective posting journey in Japan.

3. Your feelings and thoughts

Being able to participate in this program was definitely something huge and meaningful in my life. I felt grateful and privileged to be able to join the hepatobiliary pancreatic surgery team in Juntendo university. I learned a lot from them like their punctuality, preciseness and work ethic. Through this program, I also realised my shortcomings, such as my weakness in anatomy. I used to study anatomy just for the sake of passing exams, but when it comes to real life when I’m in the operation room, I am still “blur” and gets confused on what’s going on. Nevertheless, I am very grateful for the time here in Juntendo university. It was an experience of a lifetime and inspired me to become someone better.

4. How did you learn and apply the skill of decision making in your EP journey?

My elective posting journey in Juntendo university was a transformative experience that enhanced my decision-making ability. Managing a tight budget alone in a foreign country has taught me to be financially savvy. I had to think wisely before I purchase anything. Furthermore, navigating in the city with Tokyo’s bustling public transport was a journey to reinforce my capacity to act responsibly. These lessons taught me to be independent and continue to influence my personal and professional decision, shaping me into a more capable individual.

5. How did you manage your time throughout this EP journey?

The morning conference usually ends at 9.30am and the operation starts roughly around 10.30am. This gives us an hour to quickly get to the changing room to change into student scrubs provided by Juntendo hospital. After carefully sanitise ourselves, we will get into operation room 5 to observe procedures. Around 12pm, the surgeon will tell us to get a rest and have lunch. We will leave & change into our formal attire to get to the student cafe to have lunch. It is located at a different building & it’s a 5 minute walk from the hospital. Even though we tried to hurry, but we will still spent around an hour for lunch time. After lunch, we will get back to the operation room to continue to observe the operation. the operation usually ends at 5pm and that will be time for us to get home. If the operation ends early, we will go to the simulation lab to do some hands on practice and get home at 5pm. After that, it will be our free time to explore around Tokyo. We had been to different parts of Tokyo such as; Shibuya, Shinjuku, Ginza area etc.

6. Your plan for next week (Week 4)

Enjoy our last week in Japan, and visit Osaka city.

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"Take a break from the OT, go explore Poland ;)" -Mr Sebastian

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"Take a break from the OT, go explore Poland ;)" -Mr Sebastian

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1. Your name, matric number, date
Anis Nazira binti Razali, A180856, 7/8/23-13/8/23

2. Your progress so far
Since it has been the second week of elective posting, things have been so much smoother than the previous week. I have mastered the route & public transportation to get from the dorm to the hospital. I have familiarised myself with the canteen food & shops besides going on well with my colleagues too.

In terms of clinical attachments, I have been observing more surgeries which most I havent fully observed before such as laparoscopic cholecystectomy, total thyroidectomy, colostomy removal and many more. My surgeon was generous enough to explain each and every step justifying reasons behind doing them. One thing about one of the surgeries I observed was about a thyroidectomy. Mr. Sebastian, a general surgery resident that was attached with my supervisor explained to us about the procedure on this particular patient. This patient had goiter which caused him to have hypercalcemia. Hence the necessity for surgical intervention. The procedure that day was a 7 out of 8 thyroidectomy. Whereby both left and right thyroid are imaginarily segmented into 4 lobules then divided into another 2. In total there will be 8 lobules, and they removed 7 of the lobules and kept the 8th. Since the thyroid gland has been overactive, the 8th lobule left will be sufficient to meet the patient's needs. Therefore, the patient will have normal blood calcium.

Even though Mr Sebastian told me and my colleagues that we were free to take the entire week off to explore Poland, we insisted and utilised the remaining days of the 2nd week of attachment there to maximise the knowledge and surgical/clinical skills by the surgeons there.

In terms of social activities, the polish students here, Ania, Mela & Aleksandra have been inviting us to do many kinds of activities together after our attachment sessions that ends around 1pm. Our weekdays have always been packed with hospital attachments in the morning & bonding activities in the afternoon onwards

One unforgettable moment throughout this week was on the day when we went out together to the trampoline park after hospital sessions. Unfortunately, I sprained my ankle and it immediately was swelling quite severely. My right ankle was very painful and I could barely walk. All the other incomings were very caring and one of them voluntarily walked to the pharmacy just to buy me a bandage & cooling gel cream to apply on my swelling foot. Due to that reason, I had to stay bed-bound for 2 days before I could finally walk back again. Throughout the 2 days, I practiced the RICE technique and was treated very kindly by all my friends. Some even offered to carry me to places to minimise my right foot movement, my roommate bought food for each of my meals and I just stayed in the dormitory and had adequate sleep to rest before I could continue joining the other programmes.

Ive been joining so many social programmes organised by the local committee. One of the tons of social programmes organised by them is the National Food and Drink Party whereby all incomings from different countries cook or bring food/drink representing their country. I made cucur pisang with sambal kicap dipping sauce (I promise the taste is better than how they look like in picture). It is a combination in my hometown, Johor. It was a varietizing event whereby I had the chance to taste horsemeat from Kazakhstan, polish pierogi, Moroccan tagine and many more! They also exchanged knowledge regarding differences in culture and language. We ended the night with traditional dances from our home countries and I taught them poco-poco. Initially, I was planning to teach them zapin but the steps were too complicated even for me I could barely remember the steps but in the end we all enjoyed our time together.

3. Your feelings and thoughts

Engaging with friends, colleagues, and acquaintances brings joy and enrichment in my day there. The camaraderie and shared experiences create a positive feedback loop that revitalizes me, counteracting the weariness felt after returning from the hospital. Nevertheless, reaching the last few days of the 2nd week, it was well-spent! I gained so much experience, knowledge and networking. It was a core memory indeed as I could vividly remember each and every bits of what happened throughout the week. Not to sound dramatic however, it was kind of early to feel sad but i feel like I would want to be with them forever.

At this point, I am still very impressed with the transportation infrastructures of how practical their strategic located zebra crossings which provides a safe distance for the pedestrians to use ensuring the safety of both drivers and pedestrians which is hard to see in Malaysia. It answered my inquisitiveness of the countless number of uniformed cops which are literally everywhere to give compound to people who do not follow the road’s rules & regulations.

4. How did you learn and apply the skill of decision making in your EP journey?

This skill has been used ever since the beginning of when the application came out whereby I was contemplating of the destination for my EP. It was not an easy choice to make as all application required tedious documentations and such. With adequate knowledge from senior’s sharing, inquiries from relevant parties and endless readings, I was able to weigh the pros and cons after listing out the choices of places I surveyed for. I also watched multiple videos regarding the country that I intended to go to previse my adaptability and resilience capability into venturing in a new country. The location for my EP was fixed for me as I had to undergo several interviews for limited spots.

However, making a decision for the department was genuinely based on my observation of the postings that I have gone thru throughout Year 3 and I was quite hooked up with surgery posting as it gave an impressive first impression from the surgeons to the entire patient’s management, especially the operation theatre. Ever since I reached Poland, all the time I invested to research on Wroclaw and the department that I got into was definitely worth it as from that point onwards, with the help of critical thinking, all my decision makings were easier as sufficient prerequisite has been acquired beforehand by myself and that reassured me throughout my stay there.

5. How did you manage your time throughout this EP journey?

Sometimes I find it hard to make time for myself as I have always been occupied with the activities organised there. I get extremely exhausted at night since there’s not much gap i could use to rest after hospital sessions. Despite the tiredness, I enjoy myself a lot both attachment wise & socialising wise. However, this is where discipline and priority kick in whereby human innate tells us to have fun and enjoy our time but due to responsibilities as a student which I cant neglect, I tend to overdo myself to ensure I could participate in both social activities and hospital sessions causing me to feel extra fatigue. I then prioritised for the first 2 weeks to maximise my time in the hospital every weekday to observe operations and just standby in case I was able to assist and spent the remaining 2 weeks of the exchange in Poland to explore Europe and the cities in Poland with my friends. I made sure I could benefit both academically and personally for my professional and personal advancement from this EP.

6. Your plan for next week (Week 4)

- Buy souvenirs for family, friends & others

- Explore Europe!

- Spend more time, take more pictures & videos together with the other incomings

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1. Your name, matric number, date

Name: Haritha Subba Rau

Matric number: A181806

Date: 14/8/2023-19/8/2023

2. Your progress so far

The following week I was posted to the Emergency Department (ED). I met so many doctors and nurses who were willing to guide me through some procedures in the ED. I was eager to do the branula insertion procedure and I finally had the opportunity to do it on a young lady with the guidance of a nurse and it was successful. I also managed to perform ECGs on several patients and the nurse was also there observing us. I also read through the patients files to know about the more common cases here in Nepal and we also observed the doctors doing physical examination on patients. As I was observing a doctor performing a respiratory physical examination on the patient, the doctor was kind enough to explain to us the significance of each step and the anatomy of respiratory system and the findings of this patient. The doctor then also taught us how to interpret a chest X-ray step by step based on a patients X-ray findings. Dr Asmita who was in the ED also taught us the management and doses of drugs given to patients according to their age and how to calculate the appropriate dose. I also met a medical student Jyothi from Andhra Pradesh, India. She is here for her clinicals posting and she also guided me in the ED and made sure I was not lost or blur. The head of Emergency Department and our supervisor is Prof Dr Tarun Paudel. Prof would come to ED and always check up on the situation in the ED also making sure we learn something everyday. Prof was also kind enough to explain to us what are the findings we can see from the X-ray of kidney ureter and bladder for a patient with kidney stones.

During the weekends we had the opportunity to visit Pumdikot, World Peace Pagoda, Davis Falls and Gupteshwar Mahadev Cave Temple. It was truly refreshing to reconnect with nature after a hectic week in the hospital.

3. Your feelings and thoughts

I felt happy because I got to perform branula insertion on a patient which was successful and I was also very grateful for the doctors and nurses as they were so patient and kind with us throughout the week and explained to us about certain procedures that we were not sure of.

4. How did you learn and apply the skill of decision making in your EP journey?

Initially I was indecisive whether I wanted to be posted to the Surgery department, Medicine, Emergency Medicine, Pediatrics, Maternity or Obstetrics and gynecology. Then I made up my mind that I wanted to start with surgery department first as I was most passionate about it and it interests me so much. I am glad I made that decision. I also feared doing the branula insertion as I was scared I might hurt the patient if it was unsuccessful but I decided to give it a try because every trial has a purpose and it was successful and I am thankful for nurse Prathiba who guided me in the procedure.

5. How did you manage your time throughout this EP journey?

Since we had planned our itinerary few weeks prior coming to Nepal so we pretty much had everything planned. We knew where we were going each day and unless the weather was bad only then we did some minor changes where we had to switch our plans or activities to something indoor. Otherwise everything went great.

6. Your plan for next week (Week 4)

Taking the bus back to Kathmandu, where we will be staying for four more days before departing back to Malaysia.

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Week 3 in China: Transitioned to Respiratory Department, Breathing in New Experiences

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Week 3 in China: Transitioned to Respiratory Department, Breathing in New Experiences

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1. Your name, matric number, date

Goh Xin Qi, A184017, 17/7/2023 – 23/7/2023

2. Your progress so far

[17/7/2023, Monday: Entering Internal Medicine Respiratory Department]

In the early morning, Ms. Shi Beiyi guided me to the Internal Medicine Respiratory Department on the 17th floor of Block 2. This time, I was assigned to join the group under Dr. Bao Zhang 鲍彰 (chief physician).

[18/7/2023, Tuesday: Observing Bronchoscopic Procedures]

After the morning ward round, Dr. Bao Zhang took me to the bronchoscopy centre. During this visit, I had the opportunity to observe various procedures, including bronchoscopic balloon dilatation (BBD), tumour excision, cryotherapy, and laser therapy. Additionally, I was tasked with capturing screenshots of a navigated bronchoscopy, which displayed a 3D visualisation of the surface of bronchial trees of patients which were intended for records purposes.

[19/7/2023, Wednesday: Assist in the Pleural Fluid Drainage]

After watching my groupmates’ demonstration for two days, today was my first attempt to assist in the pleural fluid drainage procedure for a patient. The chest tube had already been inserted into the patient’s lung and my task solely involved connecting the patient’s chest tube to the drainage bag, which would collect the pleural effusion. The drainage bag was set to collect 500ml of fluid each time.

[22/7/2023 – 23/7/2023, Saturday & Sunday]

My friends, GiGi and Jun Kai, arrived in Hangzhou yesterday, and we planned to spend two days and one night in Nanjing, a neighbouring province to Zhejiang. We met at the Hangzhou railway station before departing for Nanjing. It was truly joyful to reunite with people I know after two weeks of being alone in a foreign country.

3. Your feelings and thoughts
Despite entering another department and being in a new environment, I do not feel uneasy. This sense of comfort can be attributed to the teaching style of Dr. Bao Zhang, who conducts discussions in an engaging and relaxed manner. I have noticed a distinctive and harmonious atmosphere within this team, which makes me feel relaxed and comfortable. Additionally, it is worth mentioning that Dr. Bao Zhang had previously studied in Singapore, and he will explain complex medical terms to me using English.

My clinical elective in the respiratory department has heightened my awareness of the critical importance of strictly adhering to infection control measures. In respiratory wards, it is common for us to encounter patients with contagious diseases such as tuberculosis, pneumonia, and COVID-19, which tend to spread easily through the air. On the third day of my stay in the respiratory department, my teammate Chunyi was diagnosed with COVID-19. In China, COVID-19 is already regarded as a common disease, and close contacts are not required to undergo quarantine. However, given that I had been in proximity with Chunyi in the hospital for the previous two days, I found myself increasingly concerned and anxious about the potential for infection. As a result, I always ensure that I am symptom-free and have become more cautious about infection control procedures. I consistently practice rigorous hand hygiene, wear gloves during procedures, and ensure proper disposal of contaminated materials.

The trip to Nanjing with my friends was filled with unexpected surprises right from the beginning. Upon our arrival in Nanjing and while on our way to the resort we had booked earlier, Gigi made a call, and we were suddenly informed that the resort was not open to foreigners. They promptly refunded us the fee. In China, it is not uncommon for certain hotels or accommodations to have restrictions on accepting foreign guests. This unexpected turn of events forced us to find an alternative hotel on the spot. There is not much to fret about when encountering issues with friends, as we can work together to find solutions. Despite the initial hiccup, we were able to make the most of our trip to Nanjing and create lasting memories.

4. How did you learn and apply the skill of decision making in your EP journey?

Adapting to the culture: In China, I chose to approach the new culture with an open mind, embracing the differences without judgement. Throughout my three-weeks stay in the country, I made a conscious effort to observe and understand the cultural norms, customs, and behaviours that shape daily life. Notable instances include the practice of security checks on both passengers and their belongings before boarding trains. I discovered that unlike Malaysia, toilets in China lack washing pipes, and it is customary not to dispose of toilet paper in the bowl. Additionally, while navigating the city streets, I observed that cars consistently give priority to pedestrians. By consciously observing and adapting to these customs, I gained a profound insight into the extensive diversity that characterizes daily routines and interactions within Chinese culture.

Language transition: In China, Mandarin serves as the primary language of communication. During my clinical electives at the hospital, all conversations were conducted in Mandarin, since they know that I am proficient in the language. Although my medical education was conducted in English in Malaysia, I had to fully immerse myself in a Mandarin-speaking environment and adapt to this linguistic shift. Although I could understand their daily conversations, comprehending complex Mandarin medical jargon terms was challenging for me. To overcome this challenge, I paid close attention to ward round discussions, which offered me an opportunity to listen, learn and familiarise myself with medical terminology. During these discussions, I listened carefully, asked questions, and took notes. Whenever I encountered unfamiliar Mandarin terms, I proactively sought clarification from my teammates. Recognising the necessity for improvement, I made the decision to allocate time to language practice, focusing on specific medical terminology commonly used in the field. This not only enhanced my understanding but also allowed me to contribute more effectively to discussion and patient care. This journey highlighted the importance of adaptability and continuous learning within cross-cultural medical experiences.

Handling medical procedures. During my involvement in various medical procedures, such as performing an electrocardiogram and assisting in pleural fluid drainage, I have had to make quick decisions in response to patient’s conditions and safety concerns. Performing an electrocardiogram is a standard practice for incoming patients. However, I encountered a situation where a patient declined the procedure, asserting that he had no heart issues. In response, I offered advice and explained that the procedure typically takes less than 5 minutes. Eventually, the patient agreed to undergo the electrocardiogram. In another instance, while attempting to aspirate pleural fluid from the chest tube for laboratory investigation, I encountered a challenge. Despite my attempts to suction the fluid with a needle, it did not come up as expected. I promptly sought assistance from my senior. The pleural fluid was eventually successfully aspirated after making some adjustments to the chest tube position. This experience highlighted the importance of making timely decisions when conducting medical procedures and seeking assistance when necessary to ensure optimal patient care and outcomes.

Managing unexpected situations: During my sole journey in China, I encountered various unexpected situations that required me to make immediate decisions. I faced an abrupt change in my accommodation plan during my trip to Nanjing and had to quickly find an alternative hotel on the spot. These experiences taught me the value of being prepared for the unexpected and the importance of remaining composed in unfamiliar situations.

5. How did you manage your time throughout this EP journey?

On weekdays, my routine revolves around the hospital, where I am present from 8.00 am to 5.00 pm. Typically, I participate in the morning ward rounds, which wrap up by 10.00 am at the latest. Following the ward round, I am tasked with conducting electrocardiograms or performing pleural fluid drainage on patients. During periods of free time, I actively utilize this opportunity to study and further enhance my medical knowledge.

Once I return from the hospital, I usually embark on an exploration of Hangzhou, strolling through the city to immerse myself in its surroundings.

I utilize weekends to explore neighbouring cities. In the first week, I visited Shaoxing and Jiaxing. The following week, I travelled to Ningbo. In the week after that, I went to Nanjing with my friends. Planning these trips in advance before coming to China has helped me fully enjoy the experiences and make them more comfortable.

6. Your plan for next week (Week 4)

Participating in the morning and evening ward rounds daily.

Making new friends and engaging in meaningful conversations.

Continuing to explore Hangzhou through city walks.

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Week 3: Posting in the respiratory department

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Week 3: Posting in the respiratory department

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Name: Chee Jun Kai

Matric Number: A181855

Date: 07/08/2023-11/08/2023

2. Your progress so far

Monday: Start the next posting at the respiratory department. It was a hectic day in the ward due to COVID-19 disease confirmation on inpatient. The first mission my supervisor assigned to me was to help my colleague separate those who confirmed COVID-19 from the ward. It was quite challenging for me because I was in charge of asking all the patient’s family members to leave the ward. After that, I joined my first-afternoon ward round with my supervisor.

Tuesday: Today I met new friends from Thailand who took a medical course at Zhejiang University. I’m shocked because they are final-year students but can’t even speak Chinese. After ward rounds, we successfully conducted history taking on one patient and presented it on the spot to our supervisor.

Wednesday: A day started with morning ward rounds and ended with afternoon ward rounds. After that, I joined and tried to immerse myself in my colleague’s study group although it was quite difficult to understand.

Thursday: Today, the head of the department - Dr Li had a ward round with us because there was one patient who is a relative of the dean. Dr Li was super nice and she gave oppurtunity to me to do blood taking on the patient. It was an unforgettable experience for me because it was not only my first hands-on experience for me in China but also the artery I took the blood taking was at the femoral artery. Besides that, today I also assisted my supervisor in doing the pleural tapping procedure.

Friday: It was my last day of elective posting at the second affiliated hospital Zhejiang University School of Medicine. After the ward round, I met up with the people in charge of international students. We had a simple feedback session and got my certificate.

3. Your feelings and thoughts

I am happy that finally finished my elective posting in China but at the same time feel unwilling to all the people I met here. Everyone was very enthusiastic to welcome me and take good care of me during this journey. It was an unforgettable life for me and will never forget it. Unfortunately, I didn’t have much exposure to physical examination as well as surgical procedures here but fortunately learnt a lot of knowledge not only related to the medical field but also communication skills. Nevertheless, I am still grateful for the opportunity to meet medical staff and students here.

4. How did you learn and apply the skill of decision-making in your EP journey?

Throughout this clinical training, I realized that good decision-making is very important for patient good and also responsibilities to patients as a healthcare worker. As I started the first day of clinical posting here, I went through a lot of tough decision-making situations. The decision not only affects the patient’s future but also their family's emotions. I can see it every time doctors are confident when making a difficult decision about a patient. Therefore, it is significant for us to be well prepared to face any situation that happens to prevent unwanted consequences.

5. How did you manage your time throughout this EP journey?

On a working day, I’ll sign in to the hospital at 8 a.m. and have a lunch break at 11 a.m. After the lunch break, I’ll sign in back at 2 p.m. for the afternoon ward round. Following, I’ll dismiss myself at around 4 p.m., and for the rest of the time, I will explore Zhejiang City with Yueh Chee. We went to tourist spots and also had food hunting with Yueh Chee’s cousin. We usually travel by public transport and also by bicycle. It is very convenient because everything can be paid through their e-wallet - Alipay. On weekends, we will spend time with Yueh Chee’s cousin's family.

6. Your plan for next week (Week 4)

Back to Malaysia

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1. Your name, matric number, date
Azizah Zafira (A179285), 10th August - 24th August 2023

2. Your progress so far
This week is going to be my last week in this amazing orthopaedics hospital.
It started with an emergency department case where a young boy was referred from other hospital was presented with Left radius and ulnar fracture following a motorcycle accident. It was a complete oblique fracture. They planned to place a plate in both bones and to educate the patients about the pre-operative procedure and its possible complications. I also learned how to refer a case to a specialist, such as the important informations need to be given and what not to be included from the patient's history. And finished my day with reading more MRI cases from not just today, but other months, finding interesting yet common findings, trying to familiarize myself with the radiological vocabulary and how to properly interpret the images.

The rest of the days started with a fruitful discussion with the emergency doctor about the important anatomy in clinical orthopaedics settings. We also had an acute motorcycle accident where a young lady was presented with Right ankle pain with some abscess on the right first distal phalanges.
I was also fortunate enough to be invited to another surgery on arthroscopy diagnostic with debridement in a 16 y/o girl with possible complete right ACL rupture. It was really cool as it was my first time seeing the surgeon use the arthroscopy tools. It was also the day I met the anaesthesiologist I met on the previous operation last week. He still remember the questions he gave me and asked me for my answer. And he applaud my effort and smiled at me. I felt so relieved that my readings were sufficient and met his expectations. Lastly, I ended the day with reading 2 MRI cases as usual

On my last day, I was invited to grab a lunch with the board of directors for the last time, as they asked me how was my experience there and how would they improve for the next time. As a token of gratitude, my family have prepared gifts for everyone who had helped me throughout my postings there. As I was distributing the gift they all wished me luck and pray for the success on my studies.
I am indeed one of the luckiest person to be able to met them.

3. Your feelings and thoughts
I felt happy yet sad at the same time. I was happy because of how much knowledge I have gained, both medical wise and outside of the field. I was also happy as I had the opportunity to meet so many amazing people which are extremely helpful and welcoming my presence. It was such a short and sweet experience I had. I wish I could stay longer, and learn even more from each one of them. Leaving them felt like I just left my family. I am so thankful for this amazing opportunity and promised myself I will make them proud later on my orthopaedics posting and also share my knowledge to my friends.

4. How did you learn and apply the skill of decision-making in your EP journey?
On one of the day I was faced with a choice of clinic attachment with one of my favourite doctor or an operation. I thought that both were a great chance of learning, even though I will definitely learn more cases in the clinic, operation is just a one time case, we cannot repeat the same case, if there was another similar case, it will still be different. So, in the end, I chose to follow the operation and making myself familiarize with the settings and learn how to operate the machine itself. And it was the best decision I have met so far

5. How did you manage your time throughout this EP journey?
I started the day with having a simple breakfast with my aunt and uncle, helping a little bit with the house chores, I only learn based on cases I found, and work backwards. I did this while I have breaks in the hospital. I then jotted down the "learning issues" I had to revise tonight. Once I reached back the house, I spent sometimes to explore the community by having long walk for an hour. I then helped around to cook dinner and I spent about 2-3 hrs of studying at night. To be really honest, I did not study as much as I was back in Malaysia, as I did not want to put too much unnecessary stress and enjoy my time here as much as possible. I tend to spend more time with my family, catching up with what they did when I was away.

6. Your plan for next week (Phase 4)
Spend time with my families to explore Jakarta and its culinary

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1. Your name, matrics number, date

Name : Kaviyarasi A/P Manoharan
Matric Number : A182834
Date : 14/8/2023-19/8/2023

2. Your progress so far

Every day in the ED, I read through the patients’ case files and explore the interesting cases. The documents are not computerised and it was quite hard to access them since the doctors will be using them most of the time for emergency cases. There were few CT scans and X-ray findings I was not sure it and luckily the doctors helped me to interpret it. I learnt a lot about fractures and since I have not gone through the Orthopedics posting yet, it was a good introduction to it.

I was posted in the Surgery department for the next few days. Initially, I was quite confused about how things work there. On the first day, we asked around and doctors there showed us how to get into the operation theatres. I was quite surprised when I saw the condition of the OTs. All the OTs were right next to each other and the doors were left open all the time. You get to enter all the OTs all the time. Anyway, I get to observe so many interesting surgeries here. For the first time, I got to see a Cesarean section. All this while, I was considering surgery as a path of specialisation but at that moment I was not sure anymore. As I watched more of these surgeries, I got my confidence back. Watching a baby being born just felt amazing. Mothers are great indeed. After the baby, it will taken for clean up, and a few other examinations will be done to make sure it is healthy. If there is any abnormality seen, the baby will be kept in the NICU for observation.

Besides, the other surgeries I observed were laparoscopic hysterectomy, laparoscopic cholecystectomy, tubal ligation, hip replacement, and so on. The surgeons there were so nice and explained to us about the surgeries and entertained all the questions we asked. They even shared their experiences of visiting Malaysia while the surgery was going on. On the last day of the posting, we thanked our supervisor, Prof Tarun Padel for giving us this opportunity and bid goodbye.

During the weekend, we visited Pumdikot, World Peace Pagoda, Taar Barahi Temple in Phewa Lake, and Pokhara Lakeside. We did take part in some adventurous activities such as ATV and paragliding.

3. Your feelings and thoughts

I feel contented as I was able to learn a lot during the past two weeks. I am so glad that I got posted to this hospital. The condition in this hospital is kind of different from what I have experienced back in Malaysia and it is totally what I expected to see.

I have always thought that I am not an adventurous person. ATV and paragliding proved I was wrong. Both were fun and scary at the same time. During the ATV, I was riding it with fear of falling the whole time. Paragliding gave me a whole new level of experience. I was surprised by how comfortable I felt in the air and loved feeling “at one” with the skies. Flying in smooth weather was calm and relaxing.

4. How did you learn and apply the skill of decision-making in your EP journey?

Decision-making is the main skill I have been using during the whole journey. From deciding to volunteer in Nepal to leaving after a few days of elective, it played a huge part. In the beginning, we were given few choices of departments to volunteer such as Surgery, Internal Medicine, Emergency Medicine and Obstetrics, and Gynaecology. I have always wanted to work in the ER as it consists of a multidisciplinary approach and need to make immediate decisions to avoid further disability. I really enjoyed the posting as I got to explore so many aspects of medicine and do hands-on activities every day.

Apart from that, I used this skill on a daily basis to decide what to focus on a particular day in the hospital and places I could visit after that. As I had my friends together with me during the whole time, it made my life so much easier. We will always make decisions together and it has been a great decision as all of us will our ideas every time.

5. How did you manage your time throughout this EP journey

My friends and I have already prepared an itinerary before our posting starts. We were aware that we might need to make changes as we were not certain about so many things. Every day during our breakfast, we will discuss as a group current day plans and make changes accordingly. At one point, we were not really following our itinerary as most of the activities we planned were not carried out due to rain. It was quite challenging to carry out our daily plans due to the monsoon weather.

We were also asked opinions from those, who have been already doing electives in the hospital for some time. They recommended us few places to visit, and restaurants that serve good food and shared with us how they manage their time wisely every day. It has helped a lot with the planning.

6. Your plan for next week (Week 4)

I am going to head over to Kathmandu to visit more tourist places and bid goodbye to Nepal.

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inserting cannula, with Dr Asmita, with nurse Pratibha, doing ECG with Shalu, with Jyothi, with nurse, touring in Pumdikot &Gupteshwor Mahadev cave with friends

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1. Your name, matric number, date

Name: Shuithadevi Ganaraj (A184032)
Date: 14.08.23 - 19.08.23

2. Your progress so far

After completing the last week in Surgery department, I was now attached to the Emergency Department (ED). The ED was filled with many patients and also great doctors and nurses that guided me through that week. They were so keen in teaching us which definitely made me very enthusiastic each day. I also remember once I was having some problems putting the ECG leads on the patient and the doctor came to me and explained thoroughly on why this lead is placed here and so forth. He also helped me to interpret a chest X-ray and told me the fundamentals and basics of X-rays when we need to interpret them. There was another doctor, Dr Asmita who taught us the basic management together with the drug doses that is used on mostly all patients who come in for common sickness like fever and diarrhea. She was so kind and would not let us look lost or blur in the ED. Our supervisor there, Dr Tarun Paudel would also check on us from time to time when he was in the ED. He made sure we knew what was happening in their hospital setting.

In the ED, I did some procedures. I got to insert a cannula on a young boy's hand with the help of a nurse. I did not get it on my first try but I guess that is what learning is all about. I also withdrew blood from an elderly person and the nurses there were patient enough to teach and assist me while doing these procedures. After knowing how to put the ECG leads, the nurses would always call me to do the ECG by myself on the patients. I think one day, I did about 5 ECG's on the patients who needed it in the ED.

3. Your feelings and thoughts

I was really amazed and excited to see how the doctors think on their feet when an emergency patient comes in. They act first and do what they can to give the best to their patient. However, I did feel a bit disappointed because some of the nurses and doctors there do not use gloves when putting the cannula and taking the blood. I understand, it could be because they have many patients to attend too in a day but these kind of things shouldn't be ignored in order for their own safety. Some of them wouldn't even change their gloves when moving from one patient to the other.

Nevertheless, I can see that they are really good in what they do and the inspiration just kept building within me when I was in the ED. I was also feeling that slight sense of accomplishment because I got to do certain procedures there. It was my first time trying some of it and I hope I will get more opportunities to try and practise all these once I'm back in HUKM. At first, I was definitely scared but the nurse kept encouraging me and making sure I knew the proper way on doing it. I'm really grateful and thankful for the doctors and nurses there.

We also went for some sight seeing during the evenings that we had a little time off and even during the weekends. We did not want to miss exploring the beauty of Pokhara while we were there. We went to Pumdikot, World Peace Pagoda and Gupteshwor Mahadev Cave. These were some of the known and must visit places here. I got to learn about the history and story of all these places.

4. How did you learn and apply the skill of decision-making in your EP journey?

In choosing Nepal as the country for my EP was indeed something that I wanted. I just wanted to see how patients are and what various diseases I can see from a lesser developed country. Most of the things for my EP was already pre-planned and there wasn't much of a decision making prior to my programme started as the hospitals and homestays were all already decided by IVHQ.

However, a decision that we had to make when we had to start our posting was to choose which department we wanted to attach too in that 2 weeks. I always had interest in surgery ever since year 3 started and I knew surgery would definitely be one of the postings I wanted to attach too and that was an easy decision. I even had a friend from Norway, Marte who helped guide me in surgery because she was in that department for the past one month, also doing her elective. Since I had to choose another department, I thought of going with ED to try something new but what I didn't expect was to actually like ED very much since I got to do lots of hands-on. This was also because of my another new friend Jyothi from India who always used to help me there. All in all, I didn't regret the two departments that I chose to attach too in Gandaki Medical College (GMC).

5. How did you manage your time throughout this EP journey?

Since we had a big group of 10, most of the things for our EP was planned way earlier. Some of us were in charge of the itinerary and the itinerary planning was done early with changes made here and there whenever one of us had a new idea. We roughly knew from what time to what time we would be in the hospital and that slots were just allocated for hospital time. Then, for the evenings that we were free, we would use up that time to eat good food and visit some places. We made it a 2 in 1 combo where we got to do our medical posting as well as not miss the opportunity of visiting some amazing places whenever we had that little time.

Also, one of my friend had someone to help guide us in Nepal; Mr Krishna. He was very helpful in giving us inputs and correcting the itinerary that we did if it did not match. He helped planned our itinerary as well so we don't waste time and make double trips when visiting certain places.

In terms on sleeping schedule and time difference, it wasn't such a big difference compared to Malaysia. I didn't really experience jet lagged but I definitely woke up earlier than I should everyday and this could probably be because their sunrise is very early at 5:30am and it becomes so bright at 6:00am there. I was experiencing lesser sleep everyday but it wasn't such a big issue.

6. Your plan for next week (Phase 4)

- Bidding farewell to GMC, our homestay and definitely Pokhara
- Head back to Kathmandu for a few days of sight seeing before leaving back to Malaysia
- Get some shopping done for family and friends back home

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1(TLH); 2(Burrito baby <3); 3(One with GMC Surgeons); 4(One with Surgery mates); 5 & 6 (Snaps from the C-sec OT)

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NEPAL: Unveiling a Medical Elective Memoir PART 2

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NEPAL: Unveiling a Medical Elective Memoir PART 2

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1. Your name, matric number, date

Name: Keshrina Subramaniam

Matrics number: A182868

Date: 14.8.23-19.8.23

2. Your progress so far

After completing 1 week in the Emergency Room (ER), we proceeded to attach to the Surgery department. There were quite a number of surgeries that we managed to observe throughout the week. We were lucky that we were able to observe a few Cesarean sections, laparoscopic CBD Exploration, and laparoscopic hysterectomy. Although we could not really understand the discussion with the team, the surgeons there were kind enough to explain to us what the procedure was and the indication. They were also very patient with our questions and I really appreciate their kind treatment towards us. Not only that, we also managed to observe the prepping part of the patient. We managed to observe spinal and epidural anaesthesia being administered prior to surgery. It was my first time observing the Anaes site of the procedure and it was pretty cool too! Plus, the Anaesthesiologist was also very extensive in answering our doubts. I really loved my attachment to the Surgery department too.

3. Your feelings and thoughts

I was feeling very intrigued throughout my whole time in Surgery. Since it was my first time observing a C-section, there were so many emotions and thoughts that were running through my mind. One of them had to be the amazement of how a surgeon is capable of doing the steps so quickly and be the first to welcome a newborn into the world. Since C-sections are done in emergency settings, a surgeon has to be really quick and precise with her skills. Everything was done so quickly and the baby was out in no time. We also managed to observe a case of fetal bradycardia and umbilical strangulation which required an emergency C-section. After the baby was delivered, there was also a physical examination made on the newborn. It was also overwhelming to see the babies being examined and then later wrapped in blankets like a burrito baby. I was in awe the whole time!

4. How did you learn and apply the skill of decision-making in your EP journey?

Although most things were pre-planned, there was still some decision that needed to be made when we were in Nepal. First and foremost, we had to choose the department that we would like to attach to. Our organiser gave us a few options namely, ER, Surgery, Internal Medicine, Paeds and Obstetric & Gynaecology. In order to make which two departments that I would like to attach to, I had to get information on what to expect from each department. Thus, I approached a few of my new friends, Marte Aasland from Norway and Jyothi Sri from India to get an idea about each department. Since I wanted to get most hands-on, I chose ER as my first choice and since I was informed that surgeons in Gandaki Medical College are very friendly, I chose this department too. Looking back at my decision, I did not regret it.

Other than that, as a team, we also had to make daily decisions on the agenda after our day in the hospital. This is because our plans are very much influenced by the weather conditions. When it is raining, we had to choose a location indoors and be back early. This is also to avoid scammers if we were to use the cab late at night. All this decision was made by a healthy discussion with the rest of the team. I am very glad that each time, we were able to come up with a consensus.

5. How did you manage your time throughout this EP journey?

Although we had quite a big group going together, we did not have many problems in terms of time management. We began our itinerary planning way before coming to Nepal. In this phase, we constantly reminded ourselves that there might be unexpected alterations to the schedule. Thus, we tried to make it as versatile as possible. Not only that, upon reaching Nepal, we were lucky that we had contact with a local in Nepal, Mr Krishna, who was kind enough to review our itinerary and to give inputs. He was very helpful in part of the planning and as a result, we managed to save a lot as some places were along the same stretch and we could get there by walking.

Since the time zone difference in Nepal and Malaysia is not that big of a difference, it did not affect me that much although it took a few days for me to get used to the early sunrise there. The sunrise time in Nepal is way earlier which is 5.30 am. Apart from being awakened by the Sun, I was also blessed by the sound of ringing bells in the morning. I was already feeling very much into the Nepali culture especially being able to experience the lifestyle.

6. Your plan for next week (Phase 4)

Bid Goodbye to our Drs, host family, friends and of course, our lovely Pokhara

Head back to Kathmandu for a few days of exploring

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1.     Your name, matric number, date

Salinee A/P R Arasu (A184222) >> 06/08/2023 to 22/08/2023

2.     Your progress so far

The third week was a week filled with so many emotions and memories. I was in the surgical posting on Monday and Tuesday where I encountered so many interesting cases. Unfortunately, I was unable to assist the surgeons during the procedure but I’m happy to be able to watch so many surgeries. The operating theatres were completely different from the ones in Malaysia from the aspect of infrastructures and resources. I watched so many different surgeries such as total laparoscopic hysterectomy and orthopaedic surgeries.

The surgery that moved me tremendously was a caesarean section. I was filled with a range of emotions. The surgeon was moving at an extreme speed as it was a category 2 emergency caesarean where the umbilical cord was wrapped around the baby’s neck. In this case, the mother was given general anaesthesia instead of an epidural as there was no time to waste. I was awestruck and emotional as I watched how the mother was being cut open to birthing a baby. I was weeping at the end of the procedure as I was reminded of my own mother and the pain she endured giving birth.

From Wednesday to Friday, I was posted to the emergency department. I had the most fun in the ED. The nurses in the ED were so friendly and helpful. In the ED, we had the most hands-on experiences. We learned how to insert the cannula, perform an ECG and measure blood pressure manually. One of the doctors even taught us how to interpret chest X-rays. Apart from that, our supervisor, Mr. Tarun Padel was the chief professor in the emergency department. Every once in a while, he would quiz us on a random topic. He was a very knowledgeable and kind man. A fun fact about him that he’s very proud of is he used to study at the University of Cyberjaya. In conclusion, I had my best time in the emergency department. On the last day, we thanked all of the people who helped us throughout the whole journey.

Here's a fun fact about me this time: I have acrophobia; a fear of heights. Now you can imagine the horror I felt when my friends said they wanted to try paragliding. Paragliding is one of the things Pokhara is famous for. I was trembling in fear before paragliding but my guide, Mr. Shiva was a kind man. He reassured me everything was going to be fine and it was. I had the best time up in the sky. From Mr. Shiva’s words, I felt like a bird soaring up high. On the weekends, we celebrated our friends’ birthdays again, tried some new cafes with different cuisines and visited some places. We watched the sunrise at Sarangkot, prayed to Lord Shiva at Pumdikot, and visited the World Peace Pagoda, Davis Falls and Mahadev cave. It was an eventful week.

3.     Your feelings and thoughts

Throughout the whole EP journey, I’ve polished my clinical skills thoroughly. I can confidently perform basic procedures such as ECG, inserting a cannula, and interpreting chest X-rays and CT. I find a strong sense of purpose and fulfilment knowing that I’m able to make a positive impact on people’s health and well-being. When I was witnessing the sufferings of the mother giving birth to a child, I felt a deep sense of vulnerability. I hope I can help many mothers to ease their pain in the future.  I am also very thankful and grateful to the doctors, nurses and interns who helped us throughout our whole journey.

4.     How did you learn and apply the skill of decision-making in your EP journey?

When I was posted to the surgical department, I got to observe so many different surgeries. Each surgery required a different intervention. For instance, the surgeon knew what was the immediate treatment that was best for the patient. As I interact with more patients and medical professionals, I learn about various medical conditions and treatments available. I observed how experienced healthcare providers make decisions about patient care. Over time in the emergency department, I developed my decision-making skills by considering various factors such as the severity of the patient’s condition, their medical history, and cultural differences and also by consulting the medical staff. At the end of the day, I believe we must reflect back on the choices and outcomes to refine our decision-making skills.

5.     How did you manage your time throughout this EP journey?

My friends and I have been planning our itinerary carefully. We have a very consistent schedule where we work from 10 a.m.- 4 p.m. every weekday and explore the country on the weekends. We also explored local cafes and food for dinner. At the same time, we spend a fair amount of time with our host family during breakfast and dinner. Our DND session every weekend has been a great activity for us to bond with our host family. In conclusion, I believe staying consistent with your schedule is the best way to fulfil your duty as a volunteer and have fun at the same time.

6.     Your plan for next week (Week 4)

Explore Kathmandu and its tourist attractions

Bidding farewell to Nepal

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1. Your name, matriculation number, date

Farah Alysha binti Mohd Farid Ridzwan Lee, A181270, 1/8/2023-7/8/2023

2. How is your progress?

As per requested last week, our professor gave us an article titled ‘involvement of strawberry notch homologue 1 in neurite outgrowth of cortical neurons’ to help us deepen our understanding towards the experiment they’re working on. I had so many questions while reading through the article and ended up spending so much time surfing the internet to look for answers and asking my superiors for help. They were always so welcoming and answered each of my question earnestly.

This week, our professor agreed on dissecting the mice from theiranimal centre, specifically their brains. We dissected a total of 5 mice in the course of 2 days. After obtaining their brains, we embedded them in paraffin to preserve the tissue morphology. The following day, we sliced the brain tissue to produce histology slides. It was such a tedious procedure and it made me appreciate histology slides more.

Moreover, we had another experiment which involved X-ray treatment. The hypothesis is that when not mutated, SBNO1 gene protects the neurons. Hence, we treated the brain cells with X-ray for half an hour, and performed immunofluorescence to observe the changes.

Putting the academics life aside, our accommodation was attacked by bees this week. Long story short, we lodged a complaint because our toilet’s light bulb went out. The office sent a few of their workers to fix it and while at it, they discovered a bee hive in our kitchen’s ventilation system. We have been seeing insects flying in our house since the very first day. However, after some observation, the insects did not seem to bother us so we let them be. Our concern was also further addressed by the seniors, stating that it’s rather normal to have insects in the house because it’s summer. Little did we know that the insects turned out to be bees and we have been sharing the same habitat for almost two weeks. That same night, a team consisting of exterminators, police officers and staff from the office came to get rid of the bees.

3. Your feelings & thoughts

In the beginning, I had such a hard time understanding the context of the articles that were assigned to me. It was such a humbling experience having to read something over and over again but still failing to capture the essence of it. However, with the encouragement of my senior, I managed to understand bits my bits everyday and I was proud of my improvement. She told me to read the articles multiple times and to make small notes beside the texts so that when I read it again, my level of understanding will be slightly better than before.

I was so excited when our professor agreed to dissect a few mice from the animal centre. The whole procedure from anesthetizing the mice, performing transcardial perfusion to solidify the organs to taking out the brain was very interesting.

We spent nearly 3 hours preparing the brain tissue slides and even then, we only managed to cut half of the brain. I was starting to lose focus after a couple hours because we have been doing the same thing on repeat and the cold laboratory definitely didn’t help. However, we kept making small conversations amongst each other and that helped time to pass quicker.

I found it interesting that the Japanese people usually do not directly ask or request for things. During my encounter with the radiology technician, he told us that he had an exam coming soon and I wished him luck. However, my senior told him that we were capable of managing the X-ray machine ourselves if he was busy. He was so relieved and left the room immediately. I learned that they often ask for things indirectly and if it wasn’t for my senior, the technician would’ve been stuck with us in the room for another awkward hour.

I felt so relieved when they removed the bee hive. Although we weren’t stung, we felt uneasy seeing them flying around everyday. We definitely counted our lucky starts that night, feeling thankful that we weren’t attacked by the bees.

4. How did you learn & apply the skill of decision making in your EP journey?

Decision making came into play even before the elective project started. I had to choose what activity I wanted to be involved in and there were so many to choose from. I made the decision to go abroad because I’ve always wanted to experience learning in a foreign country. I shortlisted a few countries and the reason why I picked Japan was because it’s one of the safest countries in the world. As a female, safety is very important and I made it a priority of mine when making the final decision.

When it comes to decision making, I always weigh out the pros and cons. For example, when we were planning our trip to Osaka, we had the option to make it a day trip or to spend the night there. After listing down the advantages and disadvantages, it was obvious that the pros of staying in Osaka outweighed the cons and that was how we made the decision to overnight. As a result, we saved a lot of time, energy and money commuting back and forth, enabling us to explore more of the beautiful city.

Travelling requires a lot of decision making. I had to decide which public transport to take to the airport, having to catch an early morning flight with a heavy luggage to drag along with. After comparing the schedules of the train and the bus, the comfort and cost of both transportation, I decided that travelling by train was the best choice. I also had to decide which transportation pass to purchase. There was a variety to choose from, so after mapping out the locations I wanted to visit and calculating the cost of each pass, I bought the Kansai thru pass and the Osaka amazing pass. This saved me so much money because transportation is very expensive in Japan.

5. How did you manage your time throughout this EP journey?

My classes in Shiga University were typically from 9am till 5pm. There’ll be multiple experiments throughout the day but the time varied. Every morning, my professor and seniors would inform us the experiments that they have planned for the day and when will they be carrying them out. Lunch was around 11am-12pm and we always ate at the university’s cafeteria as the food was cheap and delicious.

At the beginning of each week, Adliana and I would take the bus to the nearest supermarket to get groceries. We would check the bus schedule before heading over to the bus stop so we can get there just in time. I adore the fact that the Japanese people are very punctual because it allowed me to plan my journey efficiently.

I did laundry once every 3 days. It was my routine and it worked really well for me. I always had clothes ready to wear and no dirty laundry piled up at home. At the beginning of each week, I planned out all my outfits and ironed it altogether. This way, I saved a lot of time getting ready in the morning.

On weekdays, Adliana and I would plan our weekend trips together. We searched up where we’d like to visit and constructed our very own itinerary. Planning the trips was definitely not as easy as it sounds, because there were lesser bus trips during weekends. We would take the earliest bus out to be able to explore more of the city and we were very careful not to miss the last bus back.

6. Your plan for next week

I plan on observing the changes in the brain tissue after being treated with X-ray and to see if SBNO1 gene plays a protective role when it’s not mutated.

Adliana and I brought some souvenirs from Malaysia such as postcards, fridge magnets and pen holder that we’d like to give to our professors and seniors who were so accommodating for the past 3 weeks.

I also plan on visiting more tourist attractions such as Universal Studios Japan, Dotonbori, some shrines in both Kyoto and Osaka. I also plan on going to Nara Park to look at the deers.

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Journey Through Cardiology Department: My SAHZU Elective Posting Diary

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Journey Through Cardiology Department: My SAHZU Elective Posting Diary

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1. Ng Yueh Chee, A182958, 5/8/2023-10/8/2023

2. Your progress so far
Saturday-Sunday 5/8/23-6/8/23
Before I started my second week of posting, I planned to visit to the famous ancient town in Hang Zhou- Wu Zhen to experience the life of the ancient people in China. As I stepped into Wuzhen, I was immediately transported back in time. Cobblestone streets, well-preserved ancient buildings, and traditional wooden architecture lined the pathways. The ancient town was divided into two parts by the gentle flow of the Beijing-Hangzhou Grand Canal. East Wuzhen exuded a vibrant, bustling atmosphere, with lively markets, artisan shops, and the aroma of local delicacies wafting through the air. In contrast, West Wuzhen exuded a serene tranquility, with its narrow canals, stone bridges, and well-manicured gardens. My visit to Wuzhen was a journey of discovery and wonder. This historic water town had welcomed me with open arms, revealing its hidden treasures and providing a unique perspective on Chinese culture and heritage. It was a very great experience which helped me to understand more about the culture of China.

Monday 7/8/2023
I continued my posting in the cardiology department of SAHZU. I Arrived at the Cardiology Department of SAHZU. However, i was not able to find my supervisor: Dr Gao in the ward. So, I contacted him via WeChat and he asked me to follow the ward rounds by another doctor: Dr Jiang as he was busy in the catheterization room. After the ward rounds, Dr asked me to do ECG on 2 patients. I followed a senior from Malaysia who studied medicine in SAHZU to approach the patients.
Met with Dr. Gao, who provided an overview of the department's functions, specialties, and expectations for the elective. I had the opportunity to observe a cardiac catheterization procedure in the Cardiac Catheterization Lab at SAHZU. The catheterization lab, often referred to as the "cath lab," is a specialized environment where minimally invasive procedures are performed to diagnose and treat various cardiovascular conditions, particularly those involving the coronary arteries and the heart's structural components.

Tuesday 8/8/2023
After the morning ward rounds, Dr Jiang bought us coffee! As usual, all doctors in the clinic was very busy. There was a patient with on and off fever for one week. Dr was working very hard to investigate the etiology of the fever but they still could not find it. Most of the patients in the wards were admitted because of atherosclerosis and were waiting for CT angiogram treatment.

Wednesday 9/8/2023
When I was doing ECG to the patients in the ward, one of the family member refused to allow his father to do the test. Luckily, there was a senior together with me, he explained to him the purpose of doing ECG and it is a must to do it.

3. Your feelings and thoughts
- Observing a cardiac catheterization procedure in the catheterization room was an eye-opening experience that deepened my understanding of interventional cardiology. Witnessing the procedure's intricacies, the emphasis on patient care, and the role of cutting-edge technology left a lasting impression on me.

4. How did you learn and apply the skill of decision making in your EP journey?
- The observation brought my academic knowledge to life. Concepts that I had studied in textbooks suddenly had real-world significance. Witnessing the diagnostic process, the importance of imaging, and the decision-making involved in interventions made the theoretical concepts tangible and relatable.
- Engaging in case discussions with the cardiology team allowed me to evaluate different perspectives and treatment approaches. These discussions required me to analyze the available clinical data, consider the potential risks and benefits of each option, and contribute to a consensus decision.

5. How did you manage your time throughout this EP journey?
Everyday, we cycled to the hospital from my cousin's house. It took a round 15 minutes time to reach hospital. So, we usually wake up 6am in the morning to prepare ourself. The night before, we will scheldule our breakfast to be delivered at 6.50am. After our breakfast, we will depart from our house at 7.30am. It usually took 5 minutes to rent a bicycle.

6. Your plan for next week (Week 4)
- prepare souvenirs for my doctors.
- visit the places that I haven't go

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Holy-day in Poland and the National Food and Drinks Party!

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Holy-day in Poland and the National Food and Drinks Party!

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1. Your name, matric number, date
Yasmein binti Yuhaimi, A181933, 12/8/2023-17/8/2023

2. Your progress so far
This week the Polish students reminded us that it would be a "long weekend". Continuous with the actual weekends, people normally take the day off on Monday and Tuesday as well, since it was a religious holiday - thus "Holy" Day. So this week I had executed a very ambitious plan of visiting some Polish cities!

[Saturday-Sunday, 12/8-13/8] My roommate's contact person, Alicjya,  had invited us to visit her hometown in Lublin, Poland. She  had bought train tickets to Lublin for the 3 of us and so we had to purchase our return tickets only! We had planned this a week earlier so we had already bought the return tickets back to Warsaw before the trip. We woke up at 7.00 am and left our dorms for the Warsaw Central Station as early as 7.45 am. We were meeting Alicjya at 8.20 am for our train departs at 8.40 am. We arrived in Lublin roughly around 10.30 am and headed to Alicyja's family home. After settling in, we got ready to head out and explore Lublin. On our first stop, Alicyja brought us to visit Lublin's Village Museum, then we headed out to explore Lublin's old town.  We had some Polish food there as well where Aicyja had treated us the meal! Other than eating a Polish meal, we had to try Jagodzianki - a bun filled with wild Polish berries and Cebularz - a savory bread topped with onions. We stayed over for a night and were fortunate for Alicyja had invited us to visit her famiy lakehouse the next day. Her step father had cooked us a traditional Polish lunch while we headed to the lake for a swim. We had lunch and even exchanged some Malaysian snacks my roommate had brought from Malaysia. After we said our goodbyes, we headed to the train station to catch our train back to Warsaw.

[Monday, 14/8] Anis who was also doing an exchange in Wroclaw had come to visit Warsaw, thus I took the chance to explore the city with her together. In the evening, my roommate joined us for a kayak trip I had always wanted to try. It was free and was held at Fort Bema (Fort P) in Warsaw. Hostorically it was built in the 19th century as a part of the Warsaw fortress, where the surrounding mort had been made into a activity site for kayaking.

[Tuesday, 15/8] I had made a last minute plan for a trip to Wroclaw because I wanted to join Anis' group of the other incomings for a hiking trip to the "Lakes of Color". The train ride took abouut 2 hours where I was able to connect with the exchange students from Wroclaw. They were very different from the exchange students in Warsaw and I felt very welcomed as I joined them along for the trip. We had hiked for a total of approximately 16km including the return. It was such a fun and momentful experience hiking in a foreign country and experiencing a different kind of nature whilst doing so.

[Wednesday, 16/8] I still had a few hours before my bus back to Warsaw, thus I had Anis bring me around her exchange city, Wroclaw. Again, it was definitely much different than in Warsaw - the old town, architecture, city and its overall hostorical background, and I was so grateful to have experienced it.

[Thursday, 17/8] I had arrived in Warsaw at 6am this morning and had left to the hospital at 9 am. After the long holiday, I attended hospital greeted by another tutor, Dr Zuzanna Jakubowska. Dr. Marlena was busy so she had passed on the teachings temporarily to her. She was concurrently doing her PHD and had shared us some details of it. Dr. Zuzanna is younger than Dr. Marlena thus we could relate to her more as a young doctor while she guided us through the day in the wards. She was keen on sharing her research study with us where she had focussed on sample groups of kidney transplants patients with the continuous glucose monitoring devices. She had shared the main aspect of the study in relation to the behavioural responses of this group of study when compared to the hemodialysis patients. Then, we continued the teachings by reviewing tests required by patients who are candidates of kidney tranplants. She briefly explained us through the procedures and laws behind organ transplantations in Poland. It was an insightful sharing as I had not not been intriduced much on organ tranplantations in Malaysia. After hospital I had stopped by the groceries to buy some items to prepare for the National Food and Drinks Party! I had prepared 'cekodok pisang' and 'teh tarik' as the theme for Malaysia was tea time. That evening, I had shared the kitchen with the exchange student from Equador who was also making a banana dish. We exchanged recipes and company while the others had occupied the kitchen downstairs. When it was time, everyone had gathered at the location set for the party and we had laid out the delicacies from each nation. The tables were colourful with national foods from Italy, Greece, Romania, Oman, Jordan, Lebanon, Kenya, Equador and Poland. We had taken turns to introduce our dishes before digging into each others' dishes. Other than eating, we also danced and played some games all night.

3. Your feelings and thoughts
This week was so eventful! I feel happy and more content as I have accomplished more goals for the week. I feel more culturally involved during the exchange in this week as I have learnt more and more from the other exchange students. I was also fortunate enough to explore the other cities of Poland and had a taste of their history along the way. Each of the cities had their own style of architecture, natural surroundings and more importantly very different historic value. Other than that, I felt very proud of the other exchange students who collectively got involved in preparing each of their own national food and drinks. I was very happy when I received cheers after introducing my dish that I had made as well as when I was performing the iconic tea-pull for the 'teh tarik'. We were all also very connected as we feasted together and spent time enjoying the party together.

4. How did you learn and apply the skill of decision making in your EP journey?
Throughout my EP journey, I was basically living alone in a foreign country. I had to get used to deciding how I spend my money and my time as well as the commute around by myself. Firstly, I was given a WISE prepaid card - a multicurrency account for my expenditure in Poland. I also had a credit card where I had only used it in emergency situations. The WISE card works as a normal debit card where I had already converted Malaysian Ringgit into Polish Zloty - an effective tool to optimise the hidden charges of currency exchange. I bought groceries suffice for the week to avoid wastage as well as only deciding to eat out when I am with the other exchange students to further opimise my spendings. In the situations of an emergency was only where I had decided to use the credit card - that is I had only used it three times. I am not much of a shopper thus, I did not really indulge in shopping except for personal souvenirs. Secondly, I had decided to buy all my transportation tickets online at least a week earlier before the planned trip. This was to avoid the long line at the train station and not being able to get a guarenteed seat for the journey. Not only was buying the tickets a crucial decision to make but also deciding the timing for every journey and its drawbacks plays a role into the planning. Lastly, and most importantly I was able to exercise the skill of decision making during my hospital clerkship. My dr would give us tasks of planning the patient management as though we were in a real life situation. I am now more confident in deciding the appropriate fluids for patients with acidosis, alkalosis or even sepsis. As a result I believe this skill will be useful for when I return to my postings in HUKM as well as when I become a doctor in the future.

5. How did you manage your time throughout this EP journey?
I believe time management was the mainstay throughout my whole EP journey. I was commuting via public transportation thus I had to thoroughly plan my journey properly. In the beginning when I was stil getting used to the public transportation systems and schedules, I left at least an hour early from the dorms to ensure my punctuality to the hospital and to my other destinations. Later when I got used to it, I started palnning for future journeys as well by utilising the maps application to the fullest. After hospitals I did not waste my time in the dorms, rather I was constantly planning to explore the city during the day and making the most of time in Warsaw. Since I also mainly cooked my meals in ther dorms, I was able to integrate this into my daily schedule. As a result I effectively spent my time learning in the hospital in the morning till noon, cook and have lunch then spend the rest of the day exploring Warsaw - making everyday in Poland a productive one.

6. Your plan for next week (Week 4)
1. Socialise and make more international friends during the NICE project
2. Plan one more trip to Krakow before returning to Malaysia
3. Prepare gifts for my dr as it is my last week of the exchange
4. Settle all required documents for the EP and completion of the exchange

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Malta Memoirs: Final Week in the Mediterranean

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Malta Memoirs: Final Week in the Mediterranean

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1. Your name, matric number, date
Chia Xin Yi, A181188, 26/6/23-1/7/23

2. Your progress so far
Monday, 26/6
I participated in the daily morning ward round at 7 am, moving quickly as usual because we had to cover approximately 15 beds scattered throughout the hospital within an hour. Following that, I shadowed the houseman during pre-operative consultations. In the afternoon, I decided to wait for Casey in the designated resting area outside the operating room, where I engaged in conversations with several friendly doctors hailing from various parts of the world. I introduced myself and shared information about my homeland and background. Interestingly, one of the Professors mentioned that he had a laboratory in his home and had conducted numerous experiments with his daughter. This led to an extensive conversation, which only ended an hour after Casey finished attending her OT session. I also enjoyed a sandwich offered by one of the resident surgeons from Turkey.

Tuesday, 27/6
Following the usual early ward rounds, I joined my consultant for an operating theater (OT) session. The initial procedure involved a laparoscopic cholecystectomy, followed by a hernia repair surgery. I took a coffee break with my German colleagues, and later, after having lunch, I embarked on an exploration of the University of Malta with Casey. It was noticeably less crowded due to the summer holiday, as most students were away.

Wednesday, 28/6
Today felt more fulfilling as I lent a hand to the two housemen who had been on call last night. It was quite a demanding day for them, as they had a substantial workload, which included the preparation of discharge letters and conducting pre-operative consultations. Due to the lack of an available consultation room, they had to use the doctor's resting area for the pre-operative consultations. I assisted in organizing the necessary documents and also helped with drawing patients' blood. They expressed their gratitude for my assistance, considering they had an exceptionally long and tiring day.

Thursday, 30/6
Public holiday yayyyyy

Friday, 31/6
Today marks my final day at the hospital. I participated in the morning ward round and also visited my consultant's clinic. As a gesture of appreciation, I prepared souvenirs for all the doctors and my German colleagues. We captured some photographs to cherish the memories, and we bid farewell to one another. Following this, I headed to the university's office to return my student card and receive the certificate for my two-week posting at the hospital.

3. Your feelings and thoughts
Definitely a whirlwind of emotions as I've just settled into the hospital environment, and now it's time to bid farewell to Malta. It feels like my time here passed in the blink of an eye. Beyond the breathtaking scenery, what truly captured my heart are the people. Malta's residents are incredibly friendly, to the point where striking up conversations with strangers feels like reconnecting with long-lost friends. This warmth extends to the hospital as well, where the majority of the staff have been remarkably helpful and welcoming, always greeting me with a smile. Perhaps my only regret is that I didn't have the opportunity to cross paths with the local medical students, as they were engrossed in their finals and summer holidays during my stay. Nevertheless, I remain deeply grateful for the chance to meet and connect with medical students from various other countries and for all the valuable experiences I've gained during my time here.

4. How did you learn and apply the skill of decision making in your EP journey?
Throughout my EP journey, I had the privilege of closely observing numerous surgical procedures. This provided me with a unique vantage point to witness the intricate decision-making processes that surgeons engage in during each operation, such as deciding the appropriate surgical approach, intraoperative decisions and postoperative planning. This process is not easy because it requires a culmination of years of medical training, extensive knowledge, and a keen understanding of the patients' unique condition.

When it comes to traveling in Malta, deciding on our destinations has consistently presented a challenge. This challenge arises from the need to take into account both the weather conditions and the routes to our desired locations. Planning in advance, such as before arriving in Malta, can be difficult because plans are often subject to alteration due to numerous unforeseen circumstances. Consequently, I've adopted a "free and easy" approach, opting to plan our itinerary the day before we set off.

The significance of always having a plan B becomes evident in the face of these unpredictable circumstances. Having an alternative plan ensures that we can adapt to changing weather conditions, unexpected closures, or other unforeseen obstacles that might disrupt our original plans. It provides a sense of flexibility and helps to maximize the enjoyment of the trip by offering backup options when the primary plan encounters challenges. In short, a plan B ensures that our travel experiences remain as smooth and enjoyable as possible, even in the face of the unexpected.

5. How did you manage your time throughout this EP journey?
In Malta, medical students enjoyed a significant degree of autonomy in structuring their educational experiences. Most of the attachment sessions with doctors relied on the students' own initiative, placing me in a position where I had to independently determine how to make the most of my time during the attachment period and acquire as much knowledge as possible. For instance, while attending clinics and operating theaters was optional, I made the conscious decision to participate in these activities. This choice was driven by my desire to enrich my learning experience in Malta, reflecting my commitment to effective time management in pursuit of my educational goals.

To ensure that Casey and I could thoroughly explore various places and savor the diverse cuisine in Malta, we consistently seized the chance to embark on adventures after our work commitments were fulfilled. On weekdays, we typically opted for destinations closer to our campus, like the bustling city center of Valetta. However, on weekends, we ventured farther afield, with our most ambitious excursion taking us to the scenic Gozo island, a journey that demanded a longer travel time but promised unique experiences. This approach to our explorations allowed us to strike a balance between our responsibilities and our desire to immerse ourselves in the vibrant culture and landscapes of Malta.

6. Your plan for next week (Week 4)
Regarding my travels in Malta.

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1 (checking our histopathology), 2 (hanabi!), 3 (SUMS map), 4 (dept group photo), 5 (last autopsy), 6 (farewell party)

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1. Your name, matric number, date

Maisarah binti Junaidi, A173345, 7-11/8/2023

2. Your progress so far

Monday - Thursday: We had our routine autopsies in the morning. On Tuesdays we had 2 autopsies back to back. One of the autopsies done on Tuesday was quite interesting as it involved a foreigner that had stab wounds on her body, the cause of death was to be concluded as suicide/homicide. The other cases was related to a drowning case and a decomposed body found in the lakes in the mountains.

Besides that, we also prepared hard for our presentation on Thursday by double checking the glass slides under the microscope and detailing what we would explain for each organ. We also perfected our slides.

Tuesday: After our autopsy was over that day, we went to a summer firework festival that was held at Biwako Lake with our senior, Kak Aslina. The festivals are held as summer festivities in Japan.

Thursday: We had our big presentation regarding the System of Determining Causes of Death in Malaysia and Tuberculosis in Malaysia presented in front of the forensic specialists in SUMS and a few of our fellow Japanese friends. After the presentation, we had a mini Q&A session with the group and had group pictures taken, as it was our last day in SUMS🥲

Afterwards, Hitosugi sensei bought the 3 of us to meet the dean of SUMS at the administration building. There, the dean asked why we chose forensics, how did we like our experience here in SUMS ans Japan, how did we like their culture and many more questions. He was such a nice person and I was honoured we were able to meet and talk to him briefly. Then, our sensei gave us a mini tour around the building and places in SUMS we never got the chance to see yet.

Later that night, we had a farewell party that was hosted by our sensei to give our last goodbyes to the Forensics department. Gifts were exchanged and tears were shed. The food was also nice as they served us sashimi, grilled fish, tamago, warabi mochi, and many more amazing Japanese food! The ride back home in the taxi was filled with tears.

Friday: We bid our last farewell to our precious senior, Kak Aslina in the International House. We then moved to the train station headed to Kyoto Station by our sensei's car. After arriving at Kyoto station, we had an exquisite meal with Beppu sensei and his wife, which was living in Penang with their kids. The food was absolutely mind-blowing and we had a nice conversation regarding the living style here in Japan and back in Malaysia. After that, we headed to our stay in Tokyo with the help of our sensei.

3. Your feelings and thoughts

One of the autopsy cases involving the stab wound victim was most interesting to me, as they were many small points that were noticed throughout the autopsy procedure. I felt like I was at my peak of learning many autopsy cases.

Previously and this week alone, we had performed autopsies on two children (6 & 9 year old boys). During the early stages, before dissection, I couldn't control my sadness and pity towards the child because I had a brother who was about their age. After leaving the autopsy room, we saw the boy's family and it caused me to shed tears. This whole situation taught me to have compassion when dealing with an autopsy case, as there are people who are relying on us to know the cause of death, either for justice or as closure for the family.

Despite having to do 2 autopsies consecutively in one day, I realised I did not feel tired and felt like time passed in a blink of an eye.

I appreciated how everyone paid close attention to our presentation and helped us expand our knowledge in the topic by asking interesting questions. I was also touched at how they wanted to know more about what is happening in Malaysia.

I loved how the summer festivals were held in Japan. How everyone was wearing their traditional Yukatas and Kimonos, and how the firework performance was just spectacular.

At the end of the week, I only felt sadness overcoming my body as we were leaving SUMS already. We all bawled our eyes out on the night of the farewell party, and when parting ways with our sensei at the train station in Tokyo. However, in the sadness I found a sense of joy and gratitude that I have ended up with the nicest people who treat us like actually family. Who would've thought I would be bawling my eyes out after spending only 3 weeks will these people? The old me would've said I'm being weird. I realised how much we all cherished each other and enjoyed each others presence everyday, let it be during autopsies, lectures, lunch or even outside university hours. I am super grateful to have met these amazing individuals.

4. How did you learn and apply the skill of decision making in your EP journey?

Since I was posted to the Forensic Department in SUMS, a lot of decision making needed to be done, especially during autopsies where the cause of death had to be determined. One of our Drs taught us how the final result was concluded on a suspected drowning patient. She made a list on all the possible causes of death, such as drug intoxication, strangulation, drowning, etc and included the signs of each causes. During the autopsy procedure, she crossed out the signs that were included in the body, helping her lead onto a few possible causes of death. This taught me that when making a decision, it is wise to view in a bigger perspective so we can see what possible choices we have. This will help us in making a wise decision instead of a rash one.

5. How did you manage your time throughout this EP journey?

Starting from waking up in the morning, me and friends have practiced to manage our time wisely. As it is widely known that Japanese people are extremely on time, we try not to be tardy as we are bringing the Malaysian name with us. We estimate the time to get ready, have breakfast and the route we take to arrive at the department. By doing that, we can help estimate our arrival on time, not too early and not late.

Our sensei also has a habit of writing down our schedule for the next day at the end of the day on a piece of paper. This helps us keep track on any schedule changes and updates from the tasks given by him so we can prepare in advance.

6. Your plan for next week (Week 4)

A trip to Tokyo, Nagoya and many more.

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To Japan I Hustle: Unexpected House Guests

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To Japan I Hustle: Unexpected House Guests

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1. Your name, matric number, date

Adliana binti Abdul Samad, A181052, 1/8/2023- 10/8/2023

2. Your progress so far

Life in Japan

I quickly adjusted to life in Japan, especially during the summer. I developed the habit of applying sunscreen before leaving the house, which is essential as it helps minimize the penetration of harmful UV rays into the skin.

It was untold from the first week, my roommate and I both noticed there were consistent unknown bugs that kept on flying into our room from the kitchen hood. For some reason, it did not bother us as it was harmless and flew into our room to die. We chose to remain silent about it. However, on the morning of Wednesday (2/8), I noticed that the bathroom light was not functioning, thus we launched a complaint with the staff at international centre. The staff assured us that she would visit our room while we were away. It was during this time that I received an email with the subject line, ‘Bees in the house'. It turns out, the culprits were actually bees all along. To address the issue, the staff promptly arranged for a bug exterminator to visit our place on the very same day. Their goal was to safely eliminate the beehives that were concealed within our kitchen hood.

Besides, we had a wonderful opportunity thanks to our Mongolian friend, who kindly invited us to witness the mesmerizing hanabi event in Shiga. My research partner and I borrowed bicycles from our seniors and rode it to the venue. It was an incredibly enjoyable and memorable experience!

Life in laboratory

i. Dissecting mice brain, get hands on cutting the section of brain

Katsuyama Sensei took my friend and I to the Animal Centre to obtain the mice for the dissection. To preserve the soft brain's shape, we injected Paraformaldehyde (PFA) into the heart using transcardial perfusion. During the dissection, I discovered that knockout Sbno1 mice experience hindleg paralysis, which affects their ability to walk properly. The following day, I had the privilege of performing a paraffin tissue section of a 10-day-old mice brain. Beforehand, I carefully observed Sensei's technique to ensure I could execute it correctly.

ii. Observing the differentiated neuron with dendrites and axon of Sbno1 wild type, floxed (act as control) and point mutation after adding retinol acid. At this point, all of the types above have responded well toward the neuronal differentiation.

iii. Genotyping of mice using the tip of tail. Through this experience, I learned about the different genotypes, including Sbno1 knockout mice, which can be represented by 'Sbno1 f/f, Nex Cre'. The Sbno1 floxed mice, 'Sbno1 f/f', served as the control group, while the Sbno1 wild type mice, 'Sbno1 f/+', indicated the normal condition. Notably, the Sbno1 knockout mice lacked the expression of sbno1 in the brain.

iv. Observing immunocytochemistry of Sbno1 wild type, floxed (act as control) and point mutation towards the reaction of X-ray. I was given the opportunity to observe a cool microscope that cost an arm and a leg (DMi8 Leica).

In this experiment, 3 colour indicators were used (1) DAPI (Blue)- to detect nucleus of cells, (2) H2AX antibody & P53BP1 antibody (Red)- Expressed/ seen when DNA damaged occurs and (3) GFP (Green)- Expression of Sbno1.

Due to the limited duration of the experiment, we were unable to draw a conclusive result regarding the reaction towards X-ray treatment over several weeks. However, based on the current findings, it can be tentatively concluded that not all cells expressing Sbno1 possess a protective mechanism.

3. Your feelings and thoughts

As my time in Japan came to an end, bidding farewell to my colleagues was bittersweet. Reflecting on the experience, I realized that the knowledge I gained during my time here was invaluable. It surpassed even the three years I spent in medical school, highlighting the unique learning opportunities I encountered during my stay. Other than that, during the process of sectioning the mice's brain, I learned the importance of patience and persistence. Through trial and error, I discovered the correct techniques for dissecting and obtaining perfectly sectioned brains. This experience underscored the significance of perseverance and continuous learning in achieving desired outcomes.

Some of the thoughts this week includes:-

i. The Japanese people are widely recognized for their remarkable hospitality and their genuine eagerness to meet your needs. I was so grateful that they go above and beyond to ensure that our experience is pleasurable and that our desires are fulfilled. This became evident during my time in the laboratory when my friend and I expressed interest in observing a mice brain dissection to enhance our laboratory experience. The response from the staff was incredibly prompt, and the very next day, we were given the opportunity to observe the dissection ourselves.

ii. I was truly amazed by the unwavering dedication of Japanese people. I had the privilege of befriending some fellow students who shared the same study room as me, and I couldn't help but be inspired by their commitment. Even during their semester break, they chose to continue conducting research on campus. What struck me even more was the diverse range of backgrounds among my new friends, including individuals with undergraduate degrees like chemistry, pharmacology and even a master's degree in philosophy!

iii. I was surprised by the well-designed bike lanes which were created to ensure the safety and effectiveness of bicycle riders. I did not have to worry about potential accidents while riding. Additionally, the zebra crossings were remarkably efficient and safe. In fact, it's safe to say that I hardly need to glance left and right before crossing because cars in Japan almost always stop to let pedestrians pass.

4. How did you learn and apply the skill of decision making in your EP journey?

During my EP journey, I had the opportunity to closely observe multiple experiments. This experience has been teaching me the importance of evidence-based decision-making. Researchers often gather and analyse data to draw conclusions such as retinol acid helps in neuronal differentiation. By observing research, I have learned the significance of relying on evidence rather than solely depending on intuition or personal bias when making decisions. This approach fosters objectivity and rationality in the decision-making process.

In the laboratory, researchers frequently face challenges, including unexpected results that contradict to their hypotheses and technical issues. For instance, the hypothesis should be the brain that expresses Sbno1 has protective mechanism toward x-ray treatment but the conclusion drawn was opposed. Observing on how they navigate and solve these problems can greatly enhance my problem-solving and decision-making skills. It teaches me on how to think critically, troubleshoot issues, adapt my approach when faced with difficulties and deciding what is my next move.

Additionally, laboratory research also involves the management of various risks such as contamination risk to experiments. By closely observing how researchers assess and effectively mitigate these risks, I can acquire valuable information into the strategies and approaches done for risk management. For instance, to avoid contamination of a medium like DMEM, I learn to make a decision of changing the tip of pipette each time when a different cell is used even it seems like a wastage of resources.

5. How did you manage your time throughout this EP journey?

It was fairly easy to manage my time as I was provided with a daily plan of experiments. After each day's experiments or before going to sleep at night, I would immerse myself in reading the research papers written and given by Katsuyama sensei. This allowed me to fully comprehend the experiment's content. Whenever my friends and I encountered sections of the paper that were difficult to understand, we proactively sought out Katsuyama sensei or the post-graduate students for guidance and clarification.. Most of the time, all the works and readings were completed before we went back to international house, so we had plenty time to cook our dinner and rest. Weekends were reserved in exploring the other parts of Japan like Kyoto, Osaka and Nagoya.

6. Your plan for next week (Week 4)

Exploring Nagoya- Ghibli’s Park in Aichi Prefecture and Kiyosu castle which is an inspiration to the castle in Spirited Away movie.

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1. Your name, matric number, date

Nur Emilia Ellina Binti Mohd Imran A183604 7/8/2023 – 13/8/2023

2. Your progress so far

I've been to 11 autopsies so far during my third week at Shiga University, including ones for murder, suicide, and drowning. Since Shiga Prefecture is home to Japan's largest lake, there are a number of drowning cases every year. There were two child drowning cases and two adult drowning cases during our visit. I'm getting used to the food here, especially the limited options at the university, where we can only eat seafood. I eat the same kind of cuisine almost every day, but it is relatively affordable when compared to places outside the university grounds. Nearly every day, we ate lunch with medical students who were conducting research in the forensic department. They assisted us with language and helped us communicate with the cafeteria staff. I gained a lot of experience during the autopsy and now feel more comfortable removing several organs from the body on my own, such as the kidneys and abdominal aorta. Getting the pieces out without breaking them is the finest sensation.

My supervisor hosted a farewell party for our team on my last day, and he treated us to some delicious Japanese seafood cuisine. In addition, my supervisor gave me some mementos to take home.

Monday to Thursday – attend autopsy in the morning and preparing slides for our presentation.

Thursday – presentation of our slides: “system of determining the cause of death in Malaysia” and “pathology of histology slides of a victim”.

Friday – Farewell party

3. Your feelings and thoughts

During my elective posting, I had the privilege to work with the forensic department. Everyone there is extremely kind, and I learned a lot from them. It's been eye-opening for me to experience another country's medical system. Even though I couldn't communicate well with them throughout the autopsy, they did everything they could to help me understand the procedure. Everyone was very friendly and welcoming, including the police officer who attended the autopsy. He was kind enough to assist us with any questions and explained the scenario around the autopsy to us using Google Translate. Making new acquaintances in Japan is also a lot of fun since we share a lot of cultural information with them, such as details about Malaysia and its healthcare system.

4. How did you learn and apply the skill of decision making in your EP journey?

I realized that doing an autopsy requires a lot of decisions, and that the procedure itself is meant to determine the cause of death. The reason for death, for instance, could have been murder, suicide, drowning, or disease. To determine the cause of death, there are numerous indicators or cues that must be observed. Additionally, after the autopsy is completed, additional confirmation procedures like gram staining, drug testing, or DNA samples must be carried out or requested. In such circumstances, it is necessary to make this kind of decision because, as an operator like my supervisor, other people will follow his request for different additional procedures. I have participated in more autopsy cases now, and I have a better understanding of the techniques requested.

5. How did you manage your time throughout this EP journey?

Our schedule is quite full as there are autopsies in the morning and mini lectures in the evening, however, there are some presentations that my friend and I need to prepare to present on our last day. We can do it at our international house, of course, but access to Wi-Fi is limited as we need to share our Wi-Fi with another house. So, my friend and I really need to maximize our time at the university to do our presentation. Working in a group is a must in order to keep everything on schedule. I am grateful to have had a great teammate all along to finish our presentation on time.

6. Your plan for next week (Week 4)

I'll be in Tokyo for a week to sightsee for my final week, and I'm hoping to visit a lot of lovely sites in Japan and have a lot of positive experiences.

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Egészségére! It’s the National Food and Drinks Party!

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Egészségére! It’s the National Food and Drinks Party!

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Name: Siw Ming Huey

Matric Number: A181220

Date: 3rd July 2023 – 28th July 2023 (Phase 3)

Your progress so far

We had many social programmes planned by the CPs for the month, which included going around Hungary, enjoying local summer activities, bonding/fun activities, trying local food etc. In the third week, we have the National Food and Drinks Party (NFDP) for the whole week. In NFDP, each of us took turns preparing some local food or drinks for everyone, followed by a presentation about our home country.

I prepared the presentation about Malaysia on Canva before I come to Szeged. For the food, I was contemplating what Malaysian food should I make since I am not a good cook, and some ingredients might not be so easy to obtain since I am not in Malaysia. I had many choices in mind since it is no doubt that Malaysia is a food heaven. However, I also had to take into consideration about some friends who are vegetarian and some who could not tolerate spicy food. I wanted to make a food that everyone could enjoy. In the end, I set my mind on making fruit rojak. Although I could not find the shrimp paste for rojak anywhere, I found out that I can make a similar paste using other ingredients such as fish sauce, tamarind paste and sweet soy sauce. For the friends who are vegetarian, I grinded roasted peanuts so that they can also enjoy the rojak with ground peanuts. For snacks, I brought dodol and coconut sweets from Malaysia to share them with everyone.

I also helped my friends from other countries to prepare their food as much as I can. We then enjoyed our food together in a long dining table and shared our culture with each other. From Spain, Türkiye, Brazil, Poland, Latvia, Lithuania, South Korea, Indonesia, Malaysia, Moldova, Czech Republic, Russia, Tunisa to Syria, we learnt about different places people call home. It was a week filled with “saudade”, a Portuguese word that means the feeling of longing, as we were all far away from home.

Your feelings and thoughts

When I presented about Malaysia, my home country, I wore our traditional clothing – baju kurung – that I brought from home. I was so happy that everyone praised my outfit and said that it was pretty, even though it was just a simple design. When talking about our history, all the food and drinks from Malaysia, the tourist spots, the colourful local culture, our multiracial, multiethnicity, multicultural Malaysia, I felt so proud that I introduced our country so confidently.

In my opinion, often when you travel abroad, you see that what is rare in your country can be very common in theirs; but at the same time, what you see everyday might be a rare sight to foreigners. This made me more appreciative and grateful for what I have in my country.

It feels incredible to me that I've been in Hungary for three weeks now, and it pains me to think that I will be leaving soon and saying farewell to my friends here.

How did you learn and apply the skill of decision making in your EP journey?
Throughout my clinical clerkship in the hospital, especially being so much in the operation room, decision making is a skill I see every day. As I have stated in the first week, not everything goes the way we planned it, I think this applies to surgeries as well. Sometimes, surgeons are met with circumstances where they cannot proceed with the initial flow/plan. At that moment, it is important to be good and quick at deciding because the patient’s life is in their hands. Decision making in surgery can sometimes be as heavy as a life-and-death situation. I see this skill being practised when we discussed about patient’s cases with Dr Geczi as well, when he laid out all the treatment alternatives and tried to decide on the best plan. The most important part is to always keep the patient’s best interest in mind because ultimately, we want to save the patient and prevent their further suffering.

How did you manage your time throughout this EP journey?
For the whole month, my time in the hospital starts at 08:00 and ends at 13:00. For the rest of the day, I would spend my time doing activities or exploring around with my friends. There were also a lot of activities planned for us, which helps me to make full use of my time and maximise my experience there. Since I had 4 weeks there, it gave me ample time to do a lot, like exploring the whole city of Szeged, trying their local food or desserts, and experiencing how the youths spend their summer there. When I feel tired or need some time to replenish myself, I also go picnicking, play beach volleyball or rope-climbing with my friends, which fits into a Hungarian’s emphasis on work-life balance. There would be time when I feel I need to be alone. On these days, I usually choose to opt out of the social programme in the afternoon and take a stroll in Széchenyi Square (my favourite place in Szeged). For weekends, we would usually travel to places further away from Szeged, including Budapest and the Balaton Lake, which added so much to my experience in Hungary. In the third week, I even travelled out of the country to Bratislava, Slovakia and Vienna, Austria during the weekend.

Your plan for next week (Week 4)

Enjoy the last week in the hospital and in Hungary with my friends.

Bid farewell to my friends.

Souvenir-shopping and packing my luggage

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1. Your name, matric number, date
Nurul Nabihah bt Zahanordin, A173349, 11/8/23 - 15/8/23

2. Your progress so far

Monday - Thursday (AM):

Hands-on doing autopsy every morning at 9.30am until 12pm

Tuesday (PM):

Observe and try to do the automated slicing of the organs before putting it onto slides and observe it under microscope

Prepare our presentation slides

Wednesday (PM)

Watch the largest fireworks in Shiga Prefecture, which were held at Biwako Lake.

Thursday (PM)

Present two of our presentations in front of our supervisor Hitosugi sensei and the Legal Medicine lecturers and students.

Farewell party with my supervisor, lecturers and my colleagues from Forensic Department. My first time eating sashimi (thank you sensei!) Then we gave our farewell speech, exchanged gifts and bid our last goodbye (full of tears 😭)

Friday (AM)

My kind and caring supervisor sent us to the nearest train station

We had our eight-course lunch with one of our lecturers at Kyoto Station.

I met again with my supervisor, and he sent us to Tokyo station by Shinkansen or bullet train as he was worried about us if we got lost (he was super nice 😭)

3. Your feelings and thoughts
Leaving my elective posting at the forensic department was a whirlwind of emotions. As I packed up my belongings and walked through the familiar hallways one last time, a sense of nostalgia washed over me. I couldn't help but think about all the experiences I had gained, the cases I had witnessed, and the lessons I had learned during my time there.

There was a tinge of sadness in my heart as I realized that this chapter was coming to an end. The camaraderie I had developed with my colleagues, the lecturers who had guided me, and the unique atmosphere of the forensic department had become a significant part of my daily life.

As I said my goodbyes to my colleagues and mentors, a sense of gratitude enveloped me. I was thankful for the opportunities I had been given and for the growth I had experienced. Walking out of the forensic department's doors, I felt a mix of accomplishment, sadness, and hope. The memories and lessons I had gathered during my time there would undoubtedly shape my path ahead, serving as a reminder of where I had been and the potential that lay ahead in my medical career.

4. How did you learn and apply the skill of decision making in your EP journey?
During my elective posting in the Forensic Department, I learned that the consequences of decisions can be profound, impacting legal proceedings and justice outcomes. I learned to assess the potential risks associated with different courses of action, considering the potential benefits and drawbacks before making a choice. For instance, I should be very careful with my actions during the autopsy, as the risks of making mistakes are high, and this can deeply affect the reasoning that will be used to choose the cause of death of the victim.

5. How did you manage your time throughout this EP journey?
It takes me one week to adapt to my time at SUMS. I create a fixed schedule, starting with what time I should wake up, prioritising tasks that should be completed, and creating goals for what tasks should be completed the next day.

6. Your plan for next week (Week 4)

plan on our holiday trip in Tokyo and Nagoya

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2nd week of Elective Posting in Mater Dei Hospital

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2nd week of Elective Posting in Mater Dei Hospital

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Name: Casey Lau

Matrix number: A181338

Date: 14/6/2023-1/7/2023

2. Your progress so far

Monday: Today I arrived at the hospital early, at 7:30am, and joined the ward rounds. It was a great opportunity for me to learn and observe various surgeries such as inguinal hernia repair, hemorrhoidectomy, laparoscopic sigmoid colectomy with bladder repair, and left inguinal hernia repair.

Tuesday: During today's ward rounds, our supervisor assigned my colleague and me to take the medical history of a patient who spoke fluent English. After the rounds, we successfully conducted the history taking and also performed a hernia examination on the patient. After we were dismissed, me and Xinyi managed to walk around the campus of University of Malta.

Wednesday: Another day of following the ward rounds in the morning. In the afternoon, I had the opportunity to present a short case about the patient we had clerked the previous day. Later on, I observed a colonoscopy procedure.

Thursday: Today was a public holiday, so we took the opportunity to visit Valletta again.

Friday: As it was the last day, I joined the ward rounds and also attended an outpatient clinic session in the afternoon. I took some memorable pictures with my supervisor, the house officers, and my colleague to cherish these moments.

Saturday: Although I had to check out of Campus Hub at 10am, I still managed to attend a ward round session before heading to the airport at 3:15pm. Finally, my flight departed at 7pm.

Sunday: I safely arrived back in Malaysia at 4pm, marking the end of my journey.

3. Your thoughts and feeling

To be honest, I am reluctant to believe that this will be my last week here. Malta is truly a beautiful country with welcoming and friendly locals, breathtaking scenery, and a calming environment. The doctors, nurses, and staff at Mater Dei Hospital were also extremely helpful to us medical elective students. Unfortunately, I did not have the opportunity to meet the local medical students as they had just finished their exams and started their summer break, which made me feel like this elective posting journey might be incomplete. Nevertheless, I am still grateful for the chance to meet medical students from other countries.

4. How did you learn and apply the skill of decision making in your EP journey?

As a future healthcare worker, I realize that decision-making is inevitable and important. It involves saving a patient's life, and even a slight delay can have unwanted consequences. Therefore, it is imperative for us to be prepared at all times, ready to face any situation and apply the knowledge we have learned. Additionally, we should learn from our past mistakes and always keep them in mind to avoid making the same errors in the future, especially during decision-making.

5. How did you manage your time throughout this EP journey?

Usually on working days, I am in the hospital from 8am to 2pm. However, there are some days when we might be dismissed earlier, like at 12:30pm. If that happens, Xinyi and I take the opportunity to explore more places in Malta in the afternoon and come back in the evening. We also like to find restaurants to try out the local food. Speaking of local food, we realized that rabbit meat is one of the famous dishes in Malta, but we haven't tried it yet. Normally, when we travel on working days, we choose to explore places that are not too far from campus, like Valletta. On weekends, we go to places that require longer travel time, such as Gozo Island. We usually travel by bus because it's a cheaper option for us.

6. Your plan for next week

In the Week 4 padlet I will share about the places I had visited in Malta throughout this journey.