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SCOPE Exchange Week 1 in the General Surgery Department of 4th City of Hospital in Almaty, Kazakhstan

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SCOPE Exchange Week 1 in the General Surgery Department of 4th City of Hospital in Almaty, Kazakhstan

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1. Name: Khor Shin Rou

Matric number: A188404

Date: 9/8/2024

2. What have you done?

This week we are started with going for another medical checkup in Almaty, Kazakhstan. Due to some different requirement of vaccination and documents needed, my Contact Person (CP) from IFMSA organization were bring me to their clinic for blood taking and get the medical book from their clinics.

As first i thought that, i will get my medical book at the moment after I have done my medical checkup, but after that they told me i had to go the clinic the next day by myself to get my medical book. I was really shocked at the moment as I am not used with their public transport and I don’t even speak their languages. But fortunately, I had successfully made it after I step out my comfort zone by travelling alone with buses in the city and to use the translator to communicate with the clinic lady and got my book.

After getting my medical book, I went to the hospital with my IFMSA colleagues and we met our contact person, Dr Miras, he guided us to out respectives departments and introduced us to Professor Aidar the General Surgeon in the 4th City of Hospital in Almaty city. The Professors and Drs are not that fluent in English, but they are trying their best to talk and explained all the questions we have to us.

Throughout this week, we did manage to observe a few of laparoscopic cholecystectomy and a cystectomy operation. From these, we know that cholangitis and echinococcosis infection are one of their epidemiology diseases that happened in Kazakhstan. This might due to the Republic of Kazakhstan is centrally located in Central Asia, and they have harsh winters so they tend to rely on meats and lack of vegetable intake in their daily life. It is quite surprising for the operation techniques, as they are reusing the needle for suturing, and we are using disposable needles when doing suturing in Malaysia.

There are also a few of the social programs that the SCOPE X SCORA Kazakhstan organization holds, we went to a mountain named as Koktobe and we tried their local cuisine in the restaurant, it is nice and they have some similar Shawarma food in Malaysia. They also brought us to Medeu a mountain valley on the south-eastern outskirts of Almaty, it is good place for those who like hiking and love nature as it has a really good view from the top of the mountain to watch the sunset, and it is really worth to be there even though we need to climb on the killing stairs for 4 km. We also had our National Food Drink Party done on Thursday night, they prepared us a lot of Kazakhstan local cuisine, and we also tasting a lot of other country food such as the dessert from Morocco, the Slovenia homemade Blueberry Liquorice and the Ardei Umpluti from România. It was an amazing experience that we can meet a lot of new friends from all over the world.

3. Points to remember from week 1!

Try to use the Russian words that i have been learned to overcome the language barrier

Have more patience to have a good communication skills with the Drs and patient

Established a good Doctor-Patient relationship and Doctor-Medical Student relationship

Familiarise with the hospitals systems and procedures

4. Your feelings & thoughts

I am really happy that my Doctor and Professors is really kind guy, and they are willing to explained to us of all questions we have. There is also a Doctor who really excited when seeing us, eventhough he can’t talk in English, but he help us a lot during we are lost in the hospitals. I was also glad to have two collegueas with me, which one is Karina from Romania and Amira from Slovakia, they are very friendly and thelped me a lot throughout this week. They were treated me as their little sisters as i am the only Asians girl during this exchange period.

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

The main difficulties that I faced was to understand the conversations and communicate with the Kazakhstan people, it is really hard for me to understand what they are trying to convey to me, as most of them are not speaking English but fortunately the body language helps a lot in the communications. There is once where we are trying to require some kettle and kitchen utensils from the dorm lady and she was not understanding English and we tried to use body language and some google translate to get the things we need.

6. 2 words to describe elective posting progress so far

Grateful

Motivating

7. Your plan for next week (Week 2)

Continue to observe and try to get some chance to assist in the surgery

Learn and revising the anatomical of the human body

Revising the disease of infection and the pathophysiology of the diseases

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This is a compilation of pictures of my arrival on the first day in Kaohsiung Chang Gung Memorial Hospital. 

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Phase 1: Preparation of Elective Posting in Kaohsiung Chang Gung Memorial Hospital 

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Phase 1: Preparation of Elective Posting in Kaohsiung Chang Gung Memorial Hospital 

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1. Name: CHAN HUAN SHEN

Matric No: A188111

Date: 4 August 2024 (Date of Arrival)

2. What have you done?

During the preparation phase, I did survey on a few of institutions which provide clinical attachment opportunities to foreign students. It was back in December 2023. After my considerations, I narrowed down my choices to Seoul National University (SNU) and I started to prepare the required documents, including Curriculum Vitae, Personal Statement, Recommendation Letter and Student Verification Letter. Along the way, I did ask a Y4 senior who was also the applicant to SNU during her time for suggestions and improvements for my Personal Statement. After compiling everything, I submitted my application in January 2024 (which is considered as the early batch to apply for August slot). With that thinking in mind, I believe I have high chance to get accepted and I put my hope solely on SNU without setting any alternative plan if I failed the application.

No one expected in February 2024, which is a month after my application, there are news regarding “South Korea doctors’ strike” circulating around all the social media. During that time, I had a sense of it might affect my application. Thus, I try to contact the person in charge to follow up with my application but I did not get any reply from them, but only computer-generated reply stating that it may take up to 2 months to process my application. At that time, I decided to wait and I just hope for the best outcome.

Until April 2024, the PIC had finally reply to my email but with bad news stating that they are unable to process my application yet due to shortage of manpower in their institution with the ongoing strike issue (If in normal circumstances, my application should be accepted at that time already). I started to feel anxious about that after I received that email, and I suddenly realised that I should immediately find an alternative plan as I have no more time to wait, as I need to submit my iStar application as well in advance. I did survey on Taiwan after that and contacted my batch mate, Ying Ju and consulted her on the institution that she is applying in Taiwan (As I know she and a few of our friends, Desmond and Chen Tung will be going to the same institution). Thus, I took them as my reference and started to apply to Kaohsiung Chang Gung Memorial Hospital (Department of Family Medicine). Fortunately, the process was smooth and fast. It takes only about a month to receive my approval letter. It was June during that time and I immediately prepare and submit my iStar application after I received my approval letter from the institution.

I started to survey on flight ticket, compare prices and decide when to depart. The institution provides accommodation for international students and lucky to say that I do not need to worry about that anymore. In the meantime, I also study about their public transportations and their local culture. As I believe that they have very different systems and cultures as in our country. I did a lot of survey on the travelling tips to Kaohsiung, places to visit and delicious food to eat through a Chinese application, called “RED” or in Chinese it is called “Xiao Hong Shu”. Other than that, I also went for full medical and body check up to ensure good health and fit to enrol for the clinical training in Taiwan.

Time flies and it is finally D-DAY (4 August 2024). As my elective posting period with the other groups is not the same, I’m later than them one week. This means that I need to travel alone to Taiwan. It was my first time taking a long hour flight alone and I am quite nervous. I need to mentally prepare myself to anything that could happened and what should I do if I encountered any problems along the way. Not forget to mention that, my parents were also very worry about me as I’m the yougest child to them. However, everything went very smooth and I successfully touched down safely. I also met up with Ying Ju, Desmond and Chen Tung and had lunch with them while they told me their experiences in the past one week.

3. Points to remember from Phase 1!

The biggest mistake I made is I do not think of alternative plan to my option. I should have think of alternatives so that when my original plan is not working, at least I have alternatives to back me up. This applies to daily life when coming to make a decision, we should have able to predict the consequences and have alternatives to that so that we wouldn’t be panic when bad things happen. Other than that, I learnt that we should have the courage to seek help from friends or any experienced one and don’t be shy to ask as they are ready to help. If I were to do research on my own after knowing my original plan is not working anymore, i wouldn’t be able to find one in that short period of time. I’m thankful to the friends and doctors that helped and guided me along the way.

4. Your feelings and thoughts.

I have mixed feelings and they ranged from nervous to worry and relieved and to excited and looking forward.

Nervous as in when I received the email from SNU stating that my application was not processed yet and I might not be accepted. I felt nervous as I do not have any back ups at that moment.

Worry and relieved as in if I could not find any institutions, then I have no idea what to do for my elective posting as I do not have alternatives for that. Luckily I could find one which is KCGMH at the very last minute and I relieved about that.

Excited  and looking forward as in I’m going to a new place and I wonder what will happen in the next 2 weeks. I excited to meet new people over there!

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

The biggest fear in me was I am travelling there alone and I will be spending the rest of days alone too. Although I still can meet up with Ying Ju, Desmond and Chen Tung, we are still in different departments, in addition to that is they are going to end soon as they came earlier than me a week. Being in a foreign country alone can be quite worrisome as I do not know what will happen next. However, I believe that this is a mission or a challenge to me to face it. It is the time for me to learn how to be independent and to stand up on my own. It is just a mental game and I should just face it bravely. Fortunately, I can still able to speak Chinese and understand the local language, which greatly reduces the fear in me. Moreover, another concern is I am not really familiar to use Google Maps, which is an important application to navigate myself in a foreign country. What I did was I practise using in before my departure in Malaysia together with my friends, which is kind of like a 'rehearsal' for me to familiarise with the application.

6. 2 words to describe elective posting progress so far>

Exciting

Independent

7. Your plan for Phase 2

My plan for Phase 2 is to meet up with the PIC (Ms Chi) on the following day and she shall give me briefing and touring around the hospital. I will be given timetable and assigned to different Doctors to expose to different learning sessions. I plan to make full use of my time here to learn about their healthcare system, the differences of the Family Medicine Department in Malaysia and Taiwan, and to make more new friends as possible!

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1, 2: Taipei Taoyuan International Airport; 3: The first email to Kaohsiung CGMH; 4: My dorm room; 5: Family Medicine department (where our health assessment was done); 6: View of Taiwan from the plane; 7, 8: Taiwan High Speed Rail (Taoyuan station).

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Phase 1: Preparation for Clinical Elective Posting in Kaohsiung Chang Gung Memorial Hospital

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Phase 1: Preparation for Clinical Elective Posting in Kaohsiung Chang Gung Memorial Hospital

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1. Name: Tan Ying Ju

Matric Number: A185599

Date: 27/7/2024

2. What have you done?

The idea of clinical elective posting in Taiwan started with me emailing Kaohsiung Chang Gung Memorial Hospital in February 2024. I successfully received approval letter from Kaohsiung Chang Gung Memorial Hospital with the help of Ms Chi, the staff member of educational department who mainly assists international medical students in applying elective program at the hospital. In order to get the approval letter, I have prepared all the documents needed including curriculum vitae, statement of purpose, recommendation letter, enrolment letter, and non-disclosure agreement. I have also done health checkup as required by the hospital. I am so grateful for Ms Chi’s patience in guiding us with the application and preparation before flying to Taiwan. She made sure we had downloaded Line application and added her contact as communication tool in Taiwan.

My flight to Taipei Taiyuan’s Airport on 28/7/2024 indicated the start of my adventure in Taiwan. Due to delay of the flight, we missed our High Speed Rail to Kaohsiung so we had to wait for the next train, resulting in us reaching the dormitory of the hospital at 10.30pm. Once again I am thankful for the housemaster who waited for us to help with our check-in even it was off-hours. Even though I was exhausted at the time, the dorm room had cheered me up as it is the best dorm room I have ever stayed in!

The next day right before the start of our elective program, we were brought by Ms Chi to undergo health assessment at Family Medicine department in the hospital. I have also received MMR vaccine as recommended by the doctor in the hospital.

3. Points to remember from phase 1!

Always plan ahead!

From the delay of flight flying to Taiwan, I learnt that things may not always go as planned. Thus, we should always plan ahead with consideration of all possibilities that may happen. Most importantly, always have plan b.

Be flexible

As I have mentioned above, things may not always go as planned and we sometimes cannot possibly think of all the possible changes, so it is of utmost importance to be able to adapt to changes and act accordingly.

4. Your feelings & thoughts.

Throughout the whole preparation phase, the major feeling I had was gratitude. I am thankful for Ms Chi who was ready to help whenever we had problems and never get tired of us asking questions. I am thankful for housemaster who remained patient and caring even when we had to delay our check-in at the dormitory. I am thankful for Kaohsiung Chang Gung Memorial Hospital for accepting our application for elective program at the hospital.

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

The only difficulty I faced during the preparation phase was preparing the iStar paperwork. It was my first time doing the paperwork and it was confusing at first. However, Dr Syamsa and my group members were there to help me to solve the problems faced and I successfully completed the paperwork and got approval from my supervisor, Dr Husna.

6. 2 words to describe elective posting progress so far.

Exciting

Inspiring

7. Your plan for next week (week 1/phase 2).

The coming week will be me embarking on my clinical elective program journey in Kaohsiung Chang Gung Memorial Hospital. My plan is getting to get myself familiar with the environment, with my supervisor and with my fellow colleagues. I am also hoping to get to plan my schedule with my supervisor for every day’s teaching sessions and observational learning sessions.

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Phase 1: Clinical Elective Posting in Kaohsiung Chang Gung Memorial Hospital, Taiwan (Preparation of elective posting and arriving Taiwan on 28th of July 2024)

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Phase 1: Clinical Elective Posting in Kaohsiung Chang Gung Memorial Hospital, Taiwan (Preparation of elective posting and arriving Taiwan on 28th of July 2024)

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1.⁠ ⁠Your name, matric number, date

Name: Desmond Ching Jin Kang

Matric no: A185589

Date: 30/7/2024

2.⁠ ⁠What have you done?

During the preparation phase of my outbound elective posting, I contacted the person in charge, Miss Chi from Kaohsiung Chang Gung Memorial Hospital, Taiwan via email. Whenever I had any inquiries, I would email her for clarification. I was accepted to be posted in the Department of Internal Medicine in Kaohsiung Chang Gung Memorial Hospital from 29/9/2024 to 9/8/2024. Not only that, I also did my medical checkup at Institut Jantung Negara (IJN) to make sure that I was in good health before I went to Taiwan. On 28th of July 2024, Chen Thung , Ying Ju and I gathered at KLIA terminal 1 at 6.30 am. Our flight which was previously scheduled to depart at 9.15 am was delayed to 10.20am. At 10.20 am, we boarded the airplane and departed for Taiwan. The estimated duration of the flight was 4 hours and 50 minutes. After that, we touched down at Taoyuan International Airport at around 3.30 pm. Then, we went to collect our baggage and bought a sim card for internet access. After that, we quickly traveled to Taoyuan High Speed Rail station by MRT because we had bought a train ticket online which will depart at 5.10pm. Unfortunately, we were unable to reach the High Speed Rail station before 5.10 pm and we missed our train. However, we were lucky because we still could buy another train ticket to travel to Kaohsiung which will depart at 7.20 pm. After that, we boarded the train and traveled to Kaohsiung. Finally, we reached Kaohsiung at 9.30 pm and we traveled to our Kaohsiung Chang Gung Memorial Hospital by using Uber. Finally, we reached the hospital at 10.30 pm and checked into the hostel.

3.⁠ ⁠Points to remember from phase 1!

The first point I remember was to keep calm in difficult situations. For example, I kept myself calm when we missed the train and discussed with my friends on how to plan our “Plan B”. Secondly, I also learned that teamwork is important when we are away from our home. For example, my friends and I would work together to check the route to our destination by using Google Maps so that we would not get lost.

4.⁠ ⁠Your feelings & thoughts

I felt very excited because it’s been a while since I traveled overseas before COVID-19 pandemic. I also felt very nervous when I took the plane because I am an aerophobic.

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

The first difficulty that I faced was missing the high speed train.This is because we had promised the person in charge of the hostel to reach the hostel before 10pm. Unfortunately, we reached the hostel at 10.30 pm due to the flight delay. The way I coped with this difficulty was to call the person in charge to clarify our situation and apologize to her. I also communicated politely to her so that she could understand our situation. Secondly, I felt nervous and anxious whenever the airplane experienced heavy turbulence. The way I coped with this problem was to listen to the music and watching movies on the aircraft because these could help distract my mind.

6.⁠ ⁠2 words to describe elective posting progress so far

Grateful, Exciting

7.⁠ ⁠Your plan for next week (Phase 2)

I would like to join the orientation guided by secretary of the Internal Medicine Department. I would also like to follow my supervisor, Dr Chen Chih Hong to join his ward round and clinic sessions. I would also like to try my best to adapt to this new environment by getting to know new friends and seniors in the hospital so that they can introduce the healthcare system and the structure of the hospital to me. Last but not least, I would also like to travel around in Kaohsiung with my friends during my leisure time.

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"Gearing Up, Setting Sails" - Preparation of Elective Posting in Linkou Chang Gung Memorial Hospital (Phase 1)

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"Gearing Up, Setting Sails" - Preparation of Elective Posting in Linkou Chang Gung Memorial Hospital (Phase 1)

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Phase 1 - Preparation of Elective Posting in Linkou Chang Gung Memorial Hospital

1. Your name, matric number, date

Name: Low Yu Sen

Matric Number: A190206

Date: 8 August 2024

2. What have you done?

For the preparation phase, I started my medical elective application way back to months ago by surveying over a few medical universities. After considering many factors, I chose Linkou Chang Gung Memorial Hospital, Taiwan as my preferred destination for my medical elective as there will be less language barrier and I am able to communicate easily with patients. I focused in sending application via email and submitted required documents to the hospital and get accepted to the geriatric department.

After settling down with the application, I started to prepare myself for the iStar application. Besides, I started booking my flight tickets to my destination country and prepared my travel insurance.

On the other hand besides paperworks, I prepared myself mentally weeks before departure by doing some cultural research on the local culture and healthcare system of the host country to better understand the environment I’ll be working in later on. For example, Taiwan’s cultural norms & etiquette, I found out that Taiwan has different local customs and societal norms as compared to a multi-racial society in Malaysia. With this, I have prepared beforehand to understand how religion and spirituality influence healthcare in Taiwan.

To prepare academically, I reviewed key concepts and procedures that I would likely encounter during my elective. This included brushing up on clinical skills, reading recent literature in my field, and understanding the local disease burden and prevalent medical conditions in the host country.

3. Points to remember from phase 1!

I realised that application process well in advance. Along surveying, some hospitals require a variety of documents, including immunisation records, letters of recommendation, and proof of insurance. Gathering these can take time, and starting early ensures myself to meet their deadlines without last-minute stress. Important point here is “Start Early and Be Organised”

Besides I create a checklist for tasks I need to complete before departure, and paperworks, including securing a visa, booking flights, and preparing packing lists and many more! More importantly, with this list I can regularly update and review this list to stay on track and ensure nothing is overlooked. Important point here is “Checklist Management”

⁠4. Your feelings & thoughts

It was a mixed feeling of excitement, anxiety. I’m eager to start the elective and gain hands-on experience in a foreign healthcare setting and at the same time I have to adapt to a new environment, especially if it’s my first time working abroad in Taiwan. But overall, the most important thing is that I am grateful and look forward to have this learning opportunity in Taiwan

5. Any difficulties/concerns? How did you cope

I met some difficulties when dealing with paperworks and documentation for my application and iStar. For my early application process, there is quite some extensive paperwork and forms which are complex and require detailed information while at the same time I need to prioritise my own academic responsibilities as they took me a long time to understand what is required, filling out the forms correctly, and ensuring that all information is accurate. Hence I created checklists to allow me to track which documents had been settled and which were still pending, and also follow-up with the coordinator in Chang Gung Memorial Hospital on my application process. As for iStar, I faced similar difficulties as it was my first time accessing the system as it took me some time to familiarise the functions in iStar website. However, I had discussed with my groupmates and get advices from Dr Husna and eventually the iStar proposal was submitted successfully by other groupmate.

⁠6. 2 words to describe elective posting progress so far

Excited

Productive

7.⁠ ⁠Your plan for next week (Week 1 of EP)

My primary focus for the first week is to thoroughly familiarize myself with the hospital environment including the staff, facilities, and places. I will also try my best to be productive and proactive with their departmental activities to maximise my productivity, and to enhance my learning experience, focusing on my clinical skills and gain learning objectives throughout my elective.

I am also excited to explore around the hospital for any interesting places and food, eateries and try local dishes that are popular in the region. Exploring these areas will provide a richer understanding of the local culture and give me a break from hospital works.

Looking forward to Week 1!

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Phase 1- Preparation of elective posting at Linkou Chang Gung Memorial Hospital, Taiwan

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Phase 1- Preparation of elective posting at Linkou Chang Gung Memorial Hospital, Taiwan

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1.⁠ ⁠Your name, matric number, date

Name: Tan Shi Ying

Matric number: A189552

Date: 4/8/2024

2.⁠ ⁠What have you done?

I focused on preparing all the necessary documents required for my elective posting in the division of Cardiology at Linkou Chang Gung Memorial Hospital, Taiwan. I completed the medical checkup required for the hospital application and submitted all the necessary forms. I clarify my doubt with the person in charge through email. Moreover, I also made significant progress on the iStar application. Additionally, I reviewed key topics in cardiology to ensure I am well-prepared for the rotation. I also finalised my travel arrangements, including booking the flight ticket, packing, and securing travel insurance.

3.⁠ ⁠Points to remember from phase 1!

-Submitting the hospital application before the due date and ensuring all documents were in order.

-Navigating the complex iStar application process, which required coordination with other students applying for electives in the same country at the same time period.

-Revising cardiology topics to prepare for the elective posting.

-Finalising travel arrangements, including flight tickets and travel insurance before departure.

4.⁠ ⁠Your feelings & thoughts

I’m feeling a mix of excitement and anticipation as the start of my elective posting approaches. The preparation process has been a bit overwhelming, especially with all the documents and coordination required, but it’s also been a valuable experience in terms of organising and managing tasks. I’m looking forward to the clinical exposure in cardiology, which I believe will be a pivotal part of my medical education.

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

One of the main difficulties I encountered was with the iStar application. It was challenging when they returned my individual iStar application and instructed me to combine all the information into one document with peers that go to the same country at the same time period as we received acceptance letters at different time frames and I’m afraid of the due date of submitting iStar application. Additionally, I experienced some frustration with not receiving email replies regarding the correction process and details from the administration. To cope, I decided to try reaching out by phone to get in touch with the person in charge, Puan Aisyah from HEP UKM which eventually helped move the process forward and completed the correction for the application in the end.

6.⁠ ⁠2 words to describe elective posting progress so far

Challenging

Productive

7.⁠ ⁠Your plan for next week (Week 1 of EP)

In the upcoming week, which will be the first week of my elective posting in Linkou Chang Gung Memorial Hospital, Taiwan, I plan to adapt to the hospital environment and get to know the team I’ll be working with. I would like to participate actively in ward rounds, clinics, and any teaching sessions, by applying the knowledge I’ve revised. I will focus on honing my clinical skills, particularly in cardiology, by taking every opportunity to perform and observe relevant procedures. Furthermore, I would like to build connections with the staff and other students to enhance my learning experience. I will regularly reflect on my experiences to identify areas for improvement and growth throughout the posting.

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1.     Name: Jolin Ooi Min Wei

Matric Number: A187931

Date: 5/8/2024 – 9/8/2024

2.     What have you done?

On Monday (5th of August), which was the first day of my elective posting, I started my day by registering and checking into my dormitory. Then, I was arranged to meet my supervisor, Dr. Chiang Ching-Shu in the ward. Upon meeting, I was given a briefing on the patients my supervisor had been responsible for by the local HO. After lunch, I was summoned to the OT for an emergency re-operation. She was a patient under Dr. Chiang’s care, who had a hernioplasty 5 days ago. However, despite a successful operation, the patient persisted with vomiting and dyspepsia for the past 5 days. After a contrasted abdominal X-ray conducted at noon, my supervisor decided to re-open the patient as there was an obstruction seen in the X-rays. It happened to be an obturator hernia. I managed to observe the surgery thoroughly and was taught how to scrub into the OT that evening. Under supervision, Dr. Chiang also guided me to do some stitching practice during closure.

On the next day (6th of August), I was arranged to observe a laparoscopic Whipple surgery which was conducted with the Da Vinci robotic arm. Although I did not manage to observe the whole surgery, I managed to observe about 90% of it, as it was a long surgery that lasted for more than 9 hours. It was fascinating how the surgeon conducted the surgery from a distance, controlling the robotic arms from a separate machine. The fact that they were so skillful in controlling the robotic arms was mind-blowing.

On August 7th, I was given a chance to accompany my supervisor to a small division of the hospital in Taoyuan. There, I observed 3 surgeries. The first was a laparoscopic cholecystectomy. My supervisor specialized in the hepatobiliary system, hence despite the limited resources available, it was a quick surgery. He was also kind enough to guide me on what he was doing on the table. The second surgery though was a tough one. It was a laparoscopic segmental hepatectomy. Due to limited resources, I was also summoned to scrub in to assist. I was just responsible for holding surgical forceps to ensure a better view for Dr. Chiang to access the liver, but it was a great experience to be up close to a liver resection surgery. Plus, I managed to scrub in independently that day! The last surgery I managed to observe that day was an open hemithyroidectomy. However, due to open surgery, I had a limited view of the operation site. But the surgeon on the table was very friendly! He walked me through what he was performing during the surgery.

On Thursday, 8th August, I spent my day in the OT as well. The day started with an appendectomy surgery, and then another segmental hepatectomy. The appendectomy was a relatively easy and fast surgery. However, the segmental hepatectomy that day took longer than usual, given that the patient was noticed with multiple other complications only on the table. He had severe adhesions from his cholecystectomy a few years back, and he had cirrhotic liver. The surgery was complicated in whole, and my supervisor, Dr. Chiang, had to switch the laparoscopic surgery to one-hand-assisted laparoscopic surgery.

My week ended early, as I will be joining a social program organised in Tainan. My room mate and I took the earliest train in the morning and left for Tainan.

3.     Points to remember from Week 1

Academically, the one thing I would like to remember is the lessons taught by Dr. Chiang and his colleagues. With their generous effort to teach, I am now able to identify and recognise organs. And I absolutely think that this is crucial because it’s the most basic thing to be able to understand surgeries. Hence, I would definitely not want to forget this important knowledge.

Not only that, I was mesmerised by Dr. Chiang’s reaction on Thursday, when he leaded the laparscopic segmental hepatectomy. It was the one where he had to switch in between to the one-hand-assisted laparoscopy surgery. Honestly, it was really a tough scene for me, seeing the patient kept bleeding from the surgery. I could see that Dr. Chiang was also spending extra efforts and caution during the surgery, but despite all the chaos, he was never nervous or panic. That was when I realised how important it is to stay calm at the worst times. It was also inspiring, for that the surgery ended up a success. Witnessing this in my first week of placement here was sufficient for me to learn something from it, not to say I scrubbed in and assisted in this one. And even though I may not be a surgeon in the future, I still aspire to be a great and humble doctor just as Dr. Chiang.

4.     Your feelings and thoughts

I managed to observe and assist relatively lot of surgeries throughout the week, and I am absolutely satisfied with that. Although it’s not the same as what I heard from my roommates had and mine was more intense long hours than them, but I am personally very happy with what I got. The experience and exposure to actual surgeries and being able to involve in them were excellent! It was a tiring week, for that I was literally shadowing my supervisor, Dr. Chiang. It was an average of daily 8-6 posting schedule and I was always exhausted at the end of the day, but I am still happy for that it was actually what I was hoping to gain from my elective posting here.

I am also extremely grateful to have Dr. Chiang as my supervisor. He was constantly checking on me while he was working, just to ensure my experience here in Taiwan is great.

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

Definitely yes, and the biggest problem was to understand what the surgeons were doing on the table. Despite having anatomy classes with specimens back in Malaysia, the organs look absolutely different in a living patient. To understand what the surgeons were doing on the table, I had to first know how to identify the organs. It was not easy given that we had limited opportunity and guidance back in Malaysia. However, I was fortunate to have a supervisor who was very kind to share. In the meantime, I managed to make friends with the local students who were also posting in the General Surgery department for the same period. With the courage to ask, I was given adequate help from the local students, as well as my supervisor, on my journey. Not only that, but I was also resourceful in referring to diagrams and notes online about the system involved in each surgery to identify the organs and progress during the observation.

Another problem that was relatively difficult to manage, was my physical ability. As a surgeon, it is so demanding about physical fitness as they will be standing for a long time with the need of complete focus for a long time. It was already a big challenge for me to pay 100% attention constantly while sitting and observing in the room. The largest challenge was on the Thursday’s segmental hepatectomy. I scrubbed into the OT to assist Dr. Chiang as he requested but I was definitely not expecting the surgery to be on for more than 9 hours. I tried to stand as long as possible since I had to keep hygiene protocols, but luckily there were ready seats for all surgeons and assistants in the room. It was a tough challenge to get through with, but I have been trying to push myself to stand longer than the last time I did. The progress was slow, but fortunately I can see myself improving from beginning of the week.

6.     2 words to describe elective progress so far

Fascinating

Fruitful

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

I have not been given the chance to spend more time on the outpatient part of the department this week, so I am hoping that I could join the clinic in the upcoming week as well as to spend more time in the wards.

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SCOPE Elective Posting in Linkou Chang Gung Memorial Hospital, Taiwan (Week 1)

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SCOPE Elective Posting in Linkou Chang Gung Memorial Hospital, Taiwan (Week 1)

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Name: Jocelyn Yeak

Matric Number: A188150

Date: 5/8/2024 - 11/8/2024

2. What have you done?

The department I am assigned to is Plastic and Reconstructive Surgery (PRS). I was introduced to various areas within PRS, including General Plastic, Microsurgery, Trauma, and Craniofacial departments. I started my first day with General Plastic at 8:30 a.m. at the clinic.

The next day, I attended the department’s morning meeting on the topic of negative pressure pulmonary edema following septoplasty. I then went to the burn ICU and observed burn wound care. Watching the nurses perform wound care felt quite harsh, as I could empathize with the patients' pain, though it is necessary for their recovery.

On Wednesday, I attended the department’s morning meeting on the topic of refinement in flap selection, harvest, design, and insertion for head and neck reconstruction. I was a bit confused because I was not familiar with the content, but I managed to grasp the overall message. Later, I went to the burn operating theater to observe burn debridement and full-thickness skin grafting from the scalp. It was an eye-opening experience for me.

Every Thursday is my supervisor’s operation day. I spent the whole day in the operating room and observed four cases: mole excision, removal of stitches from a full-thickness skin graft with a background of syndactyly, excision of a lipoma, and removal of a sebaceous cyst.

I spent my weekend participating in the United Social Program (USP) organized by SCOPE in Tainan. I managed to make new friends from around the world while exploring the city. It was definitely an unforgettable experience for me because we seldom have the chance to meet new people back in Malaysia, as our students are from the same faculty.

3. Points to remember from week 1.

In summary, I have learned that patient care and critical decision-making are very important. For example, many burn patients require extensive care from healthcare workers to manage their wounds, and the patience and respect shown by doctors and nurses ensure that patients receive the best care possible in the hospital.

4. Your feelings and thoughts.

Although it was my first week in Taiwan, I didn’t feel out of place since this was my third visit. However, this department was entirely new to me, and I found it fascinating to encounter a range of cases, including burn and nasal reconstruction. I was amazed and invigorated by the variety of cases. Additionally, I am thrilled to participate in the USP here.

5. Difficulties/concerns? How did you cope?

The challenge I have faced so far in week 1 is understanding medical terminology. Our syllabus is in English, but communication is often in Chinese, so I frequently need to ask questions or look up medical jargon. Despite this, the doctors and staff have been very friendly and welcoming to me as a new foreign student.

6. 2 words to describe EP so far.

I would describe my elective posting progress as one of adaptation and curiosity.

7. Your plan for next week.

I am excited and looking forward to next week as I will be entering the Trauma sub-department. I hope to gain more experience and learn new knowledge about plastic surgery.

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Elective posting in Linkou Chang Gung Memorial Hospital, Taiwan

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Elective posting in Linkou Chang Gung Memorial Hospital, Taiwan

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Name: Karuna Lim Jing

Matric number: A185596

Week 1: 5/8-9/8

I arrived at the Lin Kou Chang Gung Memorial Hospital hostel a day before my elective posting began. The accommodation is a shared room for four, complete with a built-in bathroom, and I’m grateful for the comfortable stay provided. My roommates are from different countries—Hong Kong, Hungary, and France. On the first night, we had dinner together, and I was amazed by the determination of my friends from Hungary and France, who had learned to use chopsticks before visiting Taiwan. Their respect for the local culture was truly impressive.

On the first day, our contact person guided us to our respective departments. I was assigned to Internal Medicine, specifically in Geriatrics. I attended Dr. Chen’s clinic, where he taught us about various types of hypertension. I had the opportunity to observe him as he interacted with patients in a cheerful manner, which I noticed made the elderly more attentive and receptive to his advice. I learned several key points, one of which is the importance of respecting the human life cycle rather than viewing it as giving up on treatment. For instance, some elderly patients with sepsis at the terminal stage can only receive palliative care. It's crucial to follow nature's course and do our best to treat patients while recognizing the limits of medical intervention.

As healthcare professionals, we must show empathy towards patients and their families. The families, who deeply care about their loved ones, may have many questions and can become emotional if anything happens to them. Besides attending the clinic, I also had the chance to join a grand interdisciplinary meeting, which included doctors, nurses, speech therapists, physiotherapists, nutritionists, traditional medicine doctors, pharmacists, and social workers. They collaboratively planned the care for patients from pre-admission to post-admission, ensuring comprehensive and well-rounded care—a truly impressive approach.

Throughout the week, I realized the importance of patience. Most patients in the geriatric ward are over 90 years old, and many have hearing difficulties or are in a delirious state. We often have to repeat ourselves, and taking a history from them can be challenging. Moreover, some patients only understand Taiwanese, a language I’m not familiar with. Fortunately, the doctors and junior doctors spent time translating for me.

If I had to describe my elective posting so far in two words, it would be “fruitful” and “enjoyable.”

My plan for the next week is to join more ward rounds and clerk more patients as I become more familiar with the system here. I might also explore the hospital food court, which has over 10 restaurants. I am looking forward to next week!

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Elective Posting in Chang Gung Memorial Hospital Taiwan (Kaohsiung): Phase 1

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Elective Posting in Chang Gung Memorial Hospital Taiwan (Kaohsiung): Phase 1

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1. Name: Cheah Chen Thung

Matric No.: A186511

Date: 4th August 2024

2. What have you done?

I submitted my application for elective posting under the Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital Kaohsiung in April where after months of waiting, I finally received an email confirming my place for attachment under the aforementioned department. I prepared all the relevant documents including a basic medical check-up report along with a learning plan for submission to the person in charge, Ms Chi for arrangement of my learning activities by the head of department. I had also visited the Taipei Economic and Cultural Office in Malaysia few weeks before departure for application of a hands-on visa for medical students as required by the Taiwanese government. With all the preparation done, I flew to Taoyuan International Airport in Taipei, Taiwan along with my other two batchmates on 28 July 2024. Upon our arrival in Taipei, we took the high speed rail to Kaohsiung from Taipei. We managed to check in into the hostel on 28 July 2024.

3. Points to remember from week 1.

Planning is an essential skill as my journey to Taiwan on this occasion was a rather rough one as the flight was delayed causing us to miss out the train to Kaohsiung from Taipei. We had difficulty finding our ways to the hostel as well when we arrived in Kaohsiung as we were unfamiliar with the transportation here in Kaohsiung. Preparing alternative plans is vital when it comes to planning as it helps to ensure the smooth execution of a plan when the first plan does not work out as planned. Moreover, teamwork is extremely important as well as it helps to ensure everyone can contribute to the process, thereby overcoming any obstacles. For instance, we figured out the various methods of reaching our hostel despite having difficulties navigating ourselves in a foreign country.

4. Your feelings and thoughts.

This week was rather hectic as I did my final preparation before travelling to Taiwan. However, I felt extremely irritated upon arrival here due to the flight delay causing me to miss out on the train to Kaohsiung. Now thinking back on it, I should arrange flight directly to Kaohsiung instead of Taoyuan, Taipei which would undeniably simplify my trip to the hostel. Still, I am grateful as I was supported by my batchmates as we stayed together to brainstorm on ways to overcome the obstacles.

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

The most prominent obstacle would be navigating myself in a completely unfamiliar environment. As we arrived at Kaohsiung late in the evening, we had significant difficulty navigating around the area and determining ways to travel to our hostel. However, we covered each other by discussing on the available options and the feasibility of each of them whilst not compromising our safety.

6. 2 words to describe elective posting progress so far.

Exciting, unpredictable

7. Your plan for next week.

The posting will officially begin on next week where I will be scheduled for an orientation program by the department followed by briefing by my supervisor regarding the learning and teaching activities throughout my 2 weeks of attachment here.

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

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

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My Elective Posting in Linkou Chang Gung Memorial Hospital

1. Your name, matric number, date

Name: Low Yu Sen

Matric Number: A190206

Date: 8 August 2024

2. What have you done?

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

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

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

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

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

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

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

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

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

3. Points to remember from week 1!

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

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

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

4. Your feelings & thoughts

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

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

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

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

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

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

6. 2 words to describe elective posting progress so far

Interesting and eye-opening

7. Your plan for next week (Week 2)

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

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Nama: Madhavan A/L Nagaratanan

Matrics number: A189433

So as a HOD for EXCO Clinical,I'm currently preparing letters and tentative for the event next week from 11th July 2024 to 14th July 2024. We are planning on to visit and bring the delegates to the UMBI,UKMSC Gamma Knife centre, CSL rooms, the Dissection hall and the anatomy muzium. We are currently working on finalising the tentative and scheduling the events so that everything goes smooth . Attached above is the screenshot of official emails letters sent after getting approval from Dr Isa. Attached below are the examples of formal letters.

https://docs.google.com/document/d/1WoyeDB2rLJFwQVopNQP8uZrud3qoxXrg/edit?usp=drivesdk&ouid=103937440611756580686&rtpof=true&sd=true

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PREPARATION OF LETTERS FOR AMSEP UKM WITH CMU TAIWAN

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PREPARATION OF LETTERS FOR AMSEP UKM WITH CMU TAIWAN

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1. Your name, matric number, date

NAME: Madhavan A/L Nagaratanan

MATRIC NUMBER: A189433

DATE: 28 June 2024

2. What have you done?

I as the EXCO HOD for Academic was asked to prepare for letters to be sent to the specific departments. We were asked to write letters to the UMBI, UKMSC Gamma Knife, HPKK, Anatomy lab and Dissection Hall. Plus, I physically had to go and meet the PIC for each departments to give them heads up about our AMSEP UKM programme.

3. Points to remember from week 1!

I have learn to organise time first because there was a lot of letters to be prepared and getting email confirmations to be sent beforehand was a other headache.

4. Your feelings & thoughts

So far I feel quite happy because our progress was actually good compared to other departments in the committee.

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

6. 2 words to describe elective posting progress so far

Very Exhausting

7. Your plan for next week (Week 2)

Next week I will be sending the letters to the respective departments. On a side note, I would also have to get Prof Isa's approval ahead since he's the AMSA UKM supervising Dr.