Name: Lee Rou En

Matric number: A196876

Date: 4/8/2025 - 8/8/2025

2. What have you done?

During the first week of my elective posting in the General Surgery Department at Kaohsiung Chang Gung Memorial Hospital, I was immersed in a structured yet fast-paced clinical environment. The week began with an orientation to the hospital’s surgical units, including the wards, operating theaters, and outpatient clinics, where I was introduced to the team of surgeons, residents, and nursing staff. Each morning, I actively participated in the morning meetings where they discussed about patients’ condition involving multidisciplinary team. After that, I will join ward round led by my supervisor there. During rounds, I observed how the team systematically reviewed each patient’s condition, assessed vital signs, examined wounds and drains, and interpreted lab and imaging results. In the operating room, I observed several laparoscopic and open surgeries, such as liver transplants, GIST tumour resection and HCC tumour resection. I also spent time in outpatient clinics, shadowing consultants during patient evaluations and minor procedures. Additionally, I attended departmental teaching sessions, which covered liver transplants and bariatric surgery. By the end of the week, I had gained a solid foundation in the daily workflow of a general surgery team, from preoperative assessments to postoperative follow-ups and patient examinations. The experience was both challenging and rewarding, providing valuable exposure to a high-volume surgical center.

3. Points to remember from week 1!

• Hospital Workflow & Team Dynamics

  • Understood the hierarchy and roles (attendings, residents, interns, nurses) in a Taiwanese surgical team.

  • Learned the daily schedule form morning meetings to ward rounds and operating rooms

• OR Exposure

  • Observed laparoscopic techniques and open procedures

  • And also how recycling is practiced in the OR where they separate the packaging of surgical instruments into plastic packaging and paper packaging into different recycling bins.

• Ward Rounds

  • Post-op checks: Monitoring vitals, drain output, wound status, and bowel function.

  • Fluid/antibiotic adjustments: When to escalate vs. de-escalate based on clinical/lab trends.

  • Discharge planning: Criteria for safe discharge (e.g., tolerating oral intake, afebrile, ambulating).

    
    

4. Your feelings & thoughts

At first, I felt overwhelmed—adjusting to a fast-paced tertiary hospital, unfamiliar medical terms in Mandarin, and the sheer volume of patients. But with each day, I grew more comfortable. By the end of the week, I could navigate the wards confidently, present cases succinctly during rounds, and anticipate the team’s workflow.

Watching the surgeons operate left me in awe—their technical skill, decision-making under pressure, and teamwork in the OR were inspiring. A laparoscopic tumour resection that seemed effortless to them made me realize how much practice and knowledge goes into "routine" surgeries.

I hadn’t fully appreciated how much vigilance surgical patients require until I joined rounds. A fever or a drop in urine output could signal serious complications. Seeing patients recover well was rewarding, but I also felt the weight of setbacks—like a postoperative infection delaying discharge.

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

Emotionally, I struggled with confronting the reality of surgical complications and terminal cases, particularly when witnessing a young patient's devastating cancer diagnosis. These moments left me questioning my emotional capacity for a surgical career. I found solace in debriefing with sympathetic residents who shared their own experiences, while journaling helped me process these encounters. Knowledge gaps became apparent when I missed subtle clinical signs or hesitated with local treatment protocols, but I turned these into learning opportunities by maintaining a dedicated notebook and spending extra time reviewing surgical anatomy and techniques. Through these challenges, I learned the importance of preparation, the value of vulnerability in asking for help, and the need to celebrate small achievements.

6. 2 words to describe elective posting progress so far

Overwhelming and rewarding

7. Your plan for next week (Week 2)

Recognizing that language barriers significantly impacted my first week, I'm committing to learning few Hokkien medical phrases each day, focusing on essential patient communication like pain assessment and consent explanations. I'll seek opportunities to shadow bilingual colleagues during patient interactions to accelerate this learning. Academically, I'll concentrate on postoperative complications and hospital-specific antibiotic protocols, while preparing to discuss one complex surgical case daily with the team. Beyond clinical competencies, I'm making intentional space for emotional processing through nightly journaling and seeking mentorship on navigating difficult patient encounters, all while ensuring self-care through scheduled breaks and proper rest to maintain sustainable energy throughout this demanding but invaluable rotation. Not forgetting attending Ot session, ward rounds, clinic attachment and morning meetings.

Name: Teoh June Jern

Matric No: A195158

Date: 16/08/2025

2. How is your progress

In my second week, I feel that my progress has been more noticeable compared to the first. I am beginning to follow the pace of the residents during morning case discussions, and I am slowly learning how to connect patient presentations with the underlying principles of management. I notice that I am more attentive to details, especially in cases involving complex comorbidities. While I am still not fully confident in voicing out my thoughts in front of seniors, I do feel that my understanding is improving. I am also building the habit of reading up on topics after cases are presented, which helps to reinforce what I have observed.

3. Points to remember from Week 2

Several key lessons stood out to me this week:

Careful planning before surgery is crucial, especially when patients have multiple comorbidities such as cardiovascular disease and liver tumors.

Next , the involvement of a multidisciplinary team ensures that all aspects of the patient’s condition are considered; no single specialty can manage such cases effectively in isolation.

The case of a patient who had anticoagulant therapy stopped 12 days prior to surgery and unfortunately lost his life emphasized the delicate balance between bleeding and thrombosis risk. It highlighted how even small decisions, if not carefully coordinated, can lead to devastating consequences.

I also developed curiosity about the history of transplantation and how it became established as one of the treatment options for end-stage organ disease. This curiosity motivates me to read beyond the immediate cases and think about the bigger picture of medical progress.

4. Your feelings and thoughts

I felt that this week was very eye-opening. The patient case discussed left a strong impression on me, because it was not just about medical knowledge but also about decision-making, communication, and teamwork. I realized that medicine is not always straightforward; every decision carries risks, and the responsibility is heavy. I also felt inspired to dig deeper into topics like liver transplantation, because I see how much effort and history has gone into making it a viable treatment today. At times I also felt a little overwhelmed when I saw how much knowledge the residents carry with them, but I take it as a motivation to keep learning.

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

One good practice I developed this week was reflection after case discussions. Instead of just listening passively, I tried to write down key learning points and later reviewed them to connect with what I already knew. This way, the lessons stay longer in my memory, and I can build my own notes. I believe this reflective habit is something I can continue to practice, both during my clinical years and later as a doctor.

6. Any difficulties/concerns. How did you cope

The main difficulty I faced this week was understanding the reasoning process behind clinical decisions when multiple specialties are involved. Sometimes the discussion became very technical, and I struggled to keep up. Another concern was my hesitation to ask questions in front of others, fearing that they might be too basic.

In addition to academic challenges, external factors also affected me this week. Typhoon Podul created disruptions, both in the general environment and in my own routine. The weather conditions made me feel unsettled and distracted at times, especially when thinking about safety and possible cancellations. However, I tried to cope by focusing on the tasks I could control, maintaining my study schedule indoors,

To manage these difficulties overall, I wrote down my questions to clarify them later—either through reading or by approaching residents individually—and I stayed flexible with my schedule during the typhoon, making sure I used the time productively.

7. Your plans for Week 3

Looking ahead to Week 3, I want to be more engaged in clinical discussions, even if it means asking simple questions. I plan to continue building my knowledge on transplantation, focusing on the perioperative management of patients, including the use of anticoagulants and antiplatelet agents. I also want to strengthen my understanding of surgical anatomy related to the liver. Another goal is to observe more closely how the team communicates with each other and with patients, since I believe good communication is just as important as medical knowledge. By the end of Week 3, I hope to not only expand my knowledge but also grow in confidence to participate actively.

Name :Yap Sin Yin

Matric number :A195900

Date : 11/8/2025 - 15/8/2025

2. How is your progress?

In my second week, I feel that my progress is clearer compared to the first week. During the first week, I often felt exhausted trying to keep up with everything. Now, I am more accustomed to the routine and can catch up with most of the discussions during conferences, meetings, and ward rounds. I understand more easily and can connect patient presentations with management decisions. I also pay closer attention to details, especially in complex cases

3. Points to remember from week 2!

This week reinforced the importance of individualized patient planning. Every patient presents with unique conditions and comorbidities, and treatment decisions must be tailored accordingly. Reflecting on each case allows me to critically evaluate whether the management plan is truly optimal for the patient, and encourages a thoughtful approach rather than a one-size-fits-all mindset.

I also learned that multidisciplinary teamwork is essential. Complex cases often involve multiple specialties, and coordinated input is required to achieve the best outcomes. Effective collaboration not only improves patient care but also provides an opportunity to observe how professionals communicate, negotiate, and make joint decisions in real time.

Observing liver transplant surgery further highlighted the value of preparation, precision, and teamwork. Even during Typhoon Podul on Wednesday (13 Aug 2025), when classes and meetings were cancelled, the surgical team proceeded with the operation as planned. This demonstrated that patient care must remain the top priority, and that adaptability and focus are essential under challenging conditions

4. Your feelings & thoughts

This week was very insightful. I realized that medicine involves not only knowledge, but also professional responsibility, communication, and teamwork. Observing the team work efficiently under pressure, even during a typhoon, inspired me to improve my attitude, patience, and confidence. Compared to Week 1, I feel less overwhelmed and more capable of catching up with discussions and contributing meaningfully.

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

I started reflecting after each case or meeting, writing down key learning points and evaluating my own performance. This habit helps me reinforce medical knowledge and simultaneously think about how to improve my professionalism, communication, and participation.

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

Some discussions were fast-paced and technical, and I hesitated to ask questions in front of seniors. Another difficulty was the language barrier, as some patients spoke in local dialects that I could not fully understand. I coped by asking friends or colleagues to explain the conversations to me and gradually learning common phrases.

7. Your plan for next week (Week 3)

Next week, I want to actively participate in discussions, ask questions confidently, and continue reflecting on my performance to improve my professional attitude. I plan to deepen my understanding of transplantation, perioperative management, and liver anatomy, while also observing communication and teamwork. I also aim to improve my understanding of patient interactions in different dialects. By the end of Week 3, I hope to grow in both medical knowledge and professional behavior, being more confident and proactive in patient care.

Name: Koh Joshua

Matric No : A196985

Date: 16/8/2025

2. How is your progress?

   
   

Compared to Week 1, I found Week 2 to be much clearer and more comfortable. I have started to become familiar with the hospital’s workflow, including ward routines, case presentations, and procedures, which has helped reduce my initial anxiety. I feel more confident in navigating daily tasks, communicating with seniors, and participating in clinical activities. Below are my daily detailed activities in week 2!

Day 1 – (11/8/2025)

I began the day with a common lecture covering “DNR” and “AKI & its treatment.” Afterward, I continued with my usual tasks, which included admission clerking and writing patient progress notes. Later in the morning, I was assigned to the HPB clinic, where I was fortunate to learn from specialists who were both knowledgeable and kind. I also had the opportunity to observe an arthrocentesis procedure alongside my colleague, Wei Eu.

Day 2 – (12/8/2025)

The day started with a lecture on “Abdominal Ultrasound” and the common diseases that can be diagnosed with this tool. As usual, my senior and I reviewed all the patients in the ward before starting rounds with our doctor. Later, we presented our weekly case summary to our doctor and received valuable and constructive feedback.

Day 3 – (13/8/2025)

Unfortunately, due to a typhoon in Kaohsiung, all hospitals were closed today. Nevertheless, I used the time productively by studying conditions such as AKI and CKD, which several of my patients are currently affected by. This helped me strengthen my understanding of the diseases and how to provide them with the best care possible.

Day 4 – (14/8/2025)

I attended a morbidity and mortality conference, where housemen and medical officers presented cases, reflecting on both their strengths and areas for improvement. Afterward, I joined the ward round with my doctor and senior. I was also involved in a procedure—the removal of a double lumen catheter from the right femoral vein. Later, my supervisor gave us a teaching session on interpreting ECGs using real patient cases, which was very insightful.

Day 5 – (15/8/2025)

Today, I attended a conference titled “Optimizing Health, Respecting Life – The Practice of a Surgeon.” An experienced colorectal surgeon shared his professional journey, insights, and treatment approaches for colorectal cancer. In the evening, my senior invited me for a workout session at the staff gym. We enjoyed exercising together and it was a refreshing way to end the day.

3. Points to remember from week 2!

a. Learning Opportunities

• Morbidity & Mortality (M&M) conferences encourage us to do reflection, self-criticism, and continuous improvement among doctors.

• Specialist sharing (colorectal surgeon) provided inspiration and valuable insights and long-term career development.

  
  

b. Professional Development

• Weekly case presentations help us to improve clinical reasoning and presentation skills while benefiting from seniors’ constructive feedback.

• Importance of using downtime productively such as during typhoon closure to enhance and have self study is a must.

  
  

c. Personal Growth & Well-being

• Balancing clinical work with exercise (staff gym session) highlights the need for maintaining personal health and resilience as a healthcare worker.

4. Your feelings and thoughts

   
   

   This week has been both enriching and inspiring. I feel grateful for the opportunities to attend lectures, conferences, and ward rounds that not only deepened my clinical knowledge but also allowed me to witness the professionalism and compassion of the specialists I worked with. Observing and being involved in procedures such as arthrocentesis and double lumen catheter removal gave me a sense of growth and confidence in my clinical journey.

   
   

   At the same time, I realized that being in the medical field is not only about studying diseases and treating patients but also about maintaining our own well-being. I truly appreciate when my senior invited me to the gym after work. It reminded me of the importance of work–life balance. Taking time to exercise together not only relieved stress but also strengthened the bond between us. It was refreshing to see how small efforts to care for ourselves can help us stay energized, motivated, and more effective in caring for others.

   
   

   Overall, this week has taught me that being a good doctor requires not only knowledge and technical skills but also balance—between learning and resting, between dedication to patients and care for ourselves.

   
   

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

   
   

   This week, I was reminded of the importance of maintaining work–life balance when my senior invited me to the staff gym after work. Exercising together not only helped me relieve stress but also gave me a chance to build stronger relationships with colleagues outside the clinical setting. I realized that in Taiwan, there seems to be more encouragement to take short breaks or engage in physical activity after work, which helps maintain both physical and mental health.

   
   

   In contrast, back in Malaysia, the culture in many hospitals often emphasizes long working hours, where doctors may sacrifice rest and personal time for patient care. While the dedication is admirable, it can sometimes lead to burnout. Experiencing both environments has made me understand that achieving balance is crucial—not only to stay healthy and motivated but also to ensure we can continue giving our best to patients in the long run.

   From now on, I will consciously practice this by setting aside time for exercise, even if it is just a short session after work, and by allowing myself small breaks during busy days to recharge. I will also remind myself that caring for my own health is not a distraction from my duties but an essential part of being a sustainable and effective healthcare provider.

   
   

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

One of the challenges I encountered this week was adapting to the fast-paced environment during ward rounds and presentations. Doctors expect concise and accurate information, and at times I felt anxious that I might overlook important details or fail to answer promptly when questioned. Initially, this made me hesitant to speak up. To cope, I reviewed my patients’ notes more thoroughly each evening, practiced summarizing cases in a structured format, and sought advice from my senior on how to prioritize key points. Over time, I noticed that I became more confident and efficient in my case presentations.

Another concern was managing unexpected disruptions, such as the hospital closure due to the typhoon. At first, I worried about “losing” a valuable clinical day. Instead of feeling discouraged, I decided to make use of the downtime by reading about conditions like AKI and CKD, which were directly relevant to my ward patients. This helped me stay productive and reinforced my understanding of topics that I could immediately apply when the hospital reopened.

Lastly, I was concerned about maintaining my own health and energy amid long hours in the hospital. It is easy to become fully absorbed in clinical work and forget about physical well-being. Joining my senior at the gym after work helped me realize the importance of balancing medical responsibilities with personal care. Exercise not only refreshed my body but also reduced stress, making me more focused during the next day’s duties. I learned that work–life balance is not a luxury but a necessity for sustaining long-term growth in this profession.

7. Your plan for next week ( week 3 )

In Week 3, I aim to build on the knowledge and skills I have gained so far. I plan to actively participate in ward rounds and clinical procedures, ensuring that I gain hands-on experience and improve my practical skills. I will also prepare thoroughly for case presentations by reviewing patient notes and practicing structured summaries, while applying lessons learned from previous lectures, particularly in areas such as ECG interpretation and common ward conditions.

To strengthen my medical knowledge, I intend to continue self-study on conditions frequently seen in the ward, such as AKI, CKD, and colorectal diseases. I will focus on understanding their complications and management strategies to provide more effective patient care.

Maintaining work–life balance will also be a priority. I will allocate time for physical activity and short breaks during long working hours, following the example set by my senior, to stay refreshed and focused. Finally, I will keep a daily reflection log to track my learning, challenges, and personal growth, and actively apply feedback from seniors to improve my clinical reasoning and professional development. By integrating these strategies, I hope to make Week 3 both productive and balanced, enhancing my skills as a future healthcare provider.

NAME: YONG WEI EU

MATRIC NUMBER: A196878

DATE: 17 AUGUST 2025

2. How is your progress?

Compared to Week 1, I feel that I have adapted much better this week. I am becoming more comfortable with the hospital workflow and routines, and I am gradually getting used to the medical terms in Mandarin, which was challenging at first. I also feel more confident during ward rounds and case discussions, as I understand better what is expected and how to present my thoughts clearly. Additionally, I am more aware of how to observe and assist in clinical procedures, and I try to actively engage by asking questions and clarifying points when needed. I feel that my overall confidence and understanding of patient care and hospital operations have improved compared to my first week.

Day 1
I attended a morning meeting about Do Not Resuscitate (DNR) agreements. I learned about the proper protocols, including when and how to initiate such discussions with patients and their families. Later in the day, I had the opportunity to observe a patient with gouty arthritis undergoing ultrasound-guided arthrocentesis. I assisted by preparing instruments and supporting the procedural workflow. The patient had coexisting tuberculosis, and his gouty arthritis was likely a consequence of TB medication side effects. Afterward, my senior provided detailed instruction on the safe use of ultrasound for aspiration, emphasizing the avoidance of injury to adjacent structures and the evaluation of synovial fluid characteristics.

Day 2
The morning began with an abdominal ultrasound tutorial alongside other internal medicine PGY trainees. During the ward round, we reviewed a patient who had undergone arthrocentesis. Although the fluid had been aspirated, he continued to complain of knee pain, and his TB medications had to be adjusted.

Day 3
All clinical activities were cancelled due to Typhoon Podul. This was my first experience of a typhoon. We were restricted to our dormitory and had our meals from the nearest convenience store. My senior explained that no patients were discharged or seen in clinics that day, as the hospital would hold full responsibility if accidents occurred on the way.

Day 4
In the morning, I attended a morbidity and mortality conference on dermatomyositis and peritonitis. During the ward round, I clerked a 60-year-old man with gout and metabolic syndrome. On examination, he had multiple tophi on his hands. He shared that he consumed a lot of seafood and meat, which is common since he lives by the beach. This case reminded me of the importance of diet and geographical factors in epidemiology.

Day 5
We attended a hospital-wide lecture where a senior surgeon presented his research on smoking and colorectal cancer. He also discussed the growing role of robotic surgery in the field. I was fascinated by how artificial intelligence (AI) and robotics are starting to influence surgery, potentially improving precision, reducing complications, and even shifting the surgeon’s role in the future. In the afternoon, I joined the ward round where I witnessed a family signing a DNR for a 97-year-old patient with pneumonia and multiple comorbidities. They felt it was time to let go, as they did not want him to suffer.

3. Points to remember from week 2!

i) Continuous evaluation after procedures 

I realised that carrying out a procedure, such as arthrocentesis, does not mark the end of patient care. Patients still need to be closely monitored for progress, complications, and the effectiveness of the intervention. For instance, even if joint fluid is drained successfully, the underlying cause such as gout or infection still needs further management and follow-up. This reminded me that procedures are never “one-off” solutions.

ii) Epidemiology differs across regions 

During my exposure in Taiwan, I noticed a difference in the prevalence of diseases compared to Malaysia. Here, conditions such as gout and dyslipidaemia appeared to be more common, which could be attributed to higher seafood consumption and local dietary patterns. On the other hand, back in Malaysia, diabetes tends to dominate the clinical landscape due to lifestyle and dietary differences. This observation taught me the importance of targeted medicine in relation to geography, culture, and lifestyle habits.

iii) Medicine is evolving with technology 

Another important insight came from observing discussions about robotic surgery and the integration of artificial intelligence in clinical practice. These advances highlight that medicine is not static but constantly progressing. As a medical student and future doctor, I realised the importance of keeping up with innovations to remain relevant and provide the best patient care.

4. Your feelings & thoughts 

This week was really an eye-opener for me in many ways. The DNR discussions made me stop and think deeply about empathy, death, and how important it is to respect a patient’s dignity. I realised that being a doctor is not just about treating diseases, but also about supporting patients and their families through some of the most difficult decisions in life. It made me reflect on how much emotional understanding and communication matter in healthcare.

Another unforgettable experience this week was going through the typhoon. At first, I felt nervous and unsure, as I had never experienced anything like that before. The wind was strong, trees were falling, and the hospital had to make sure patient safety was maintained while keeping essential services running. It made me think about the legal and ethical aspects of care during emergencies, like how hospitals are responsible if anything happens to patients while trying to reach or leave the hospital.

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

One good thing I learned this week that I can start practicing now is applying medical ethics in real situations. The DNR discussions showed me how important it is to respect patient autonomy and dignity, even when it is uncomfortable to talk about. I realised that being open, honest, and empathetic is part of our duty as future doctors. The typhoon experience also gave me a new perspective on responsibility, how hospitals have to balance patient safety, continuity of care, and even legal issues. I may not be making life-and-death decisions yet, but I can already practice this mindset in my daily life by respecting others’ choices, communicating with honesty, and being responsible in whatever role I take.

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

i) Emotional challenge with DNR cases
Watching families decide to stop resuscitation was very emotional for me. I coped by talking with my supervisor and reminding myself that respecting the patient’s dignity and reducing their suffering is also an important part of being a doctor.

ii) Adjusting to different cultural practices
It was hard to get used to how openly end-of-life care is discussed here, compared to Malaysia where such talks are usually more private. I coped by observing carefully, asking questions to understand why they do it this way, and reminding myself that different cultures have different but valid ways of handling sensitive issues.

iii) Experiencing the typhoon and its effect on hospital care
The typhoon caused sudden disruptions and made me realise how challenging it can be for hospitals during natural disasters. I felt concerned about patient safety and keeping care running smoothly. I coped by staying calm, following the hospital rules, and seeing it as a lesson on how important preparation and teamwork are in healthcare.

7. Your plan for next week (Week 3)

Next week, I want to make the most of my final week in the elective posting by focusing on both scheduled activities and overall learning. My schedule includes bedside teaching, cardiological radiology sessions, and clinical teaching. I plan to prepare by reviewing relevant patient cases, refreshing my knowledge on important cardiology and radiology topics, and observing closely during patient interactions. Besides these scheduled sessions, I also want to follow up on interesting patients I have met, practice presenting cases confidently, and consolidate my clinical skills.

Name: Goh Kai Xin

Matric Number: A196314

Date: 11/08/2025 - 15/08/2025

2. How is your progress?

My second week in the General Surgery department at Kaohsiung Chang Gung Memorial Hospital has been even more immersive than the first. I've really started to feel more comfortable in the clinical setting. The initial nervousness of Week 1 has been replaced with a stronger sense of curiosity and purpose. I've been dedicating more time to my specific area of interest: hepatobiliary surgery. I've spent extra time with the team in this specialty, deepening my understanding of liver and pancreas anatomy, pathology, and surgical techniques. The highlight of this week was definitely observing a few more procedures, including a laparoscopic cholecystectomy and a right posterior sectionectomy. Seeing these procedures performed with such precision was a great way to link my textbook knowledge to real-world application. Each day feels like a step forward in my medical journey.

3. Points to remember from week 2!

• Active Observation: It’s not just about watching, but about actively analyzing what's happening. I’ve learned to pay close attention to the non-verbal cues from patients and the subtle ways that doctors communicate with their team.

• Asking Questions: There’s no such thing as a "silly question." Asking for clarification has not only helped me learn but has also shown my mentors that I am engaged and eager to understand.

• The Patient-Centric Approach: I was reminded this week of the importance of seeing the patient as a whole person, not just a set of symptoms. It's something we learn in lectures, but experiencing it firsthand has been powerful.

4. Your feelings & thoughts

I'm feeling a lot more comfortable and confident now that I've settled into the rhythm of the hospital. The initial feeling of being overwhelmed has lessened, and it's been replaced with a deep sense of purpose and excitement. I'm inspired by the immense dedication and skill of the surgeons and staff. It's a privilege to be learning from them.

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

I've learned to be much more assertive in my learning. Instead of waiting for an opportunity to arise, I've started seeking them out. Whether it's asking a resident or nurse to explain a particular lab result or requesting to observe a specific procedure, I've realized that taking charge of my own learning experience is key to making the most of this elective. I can practice this by setting clear intentions and being vocal about my goals in all future rotations.

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

The language barrier is still a challenge, but I've found a new way to cope. I've focused on non-verbal communication and cultural understanding. I pay close attention to the patient's tone, body language, and facial expressions to grasp their emotional state. I've learned that a caring presence and a reassuring smile can make a patient feel seen and understood, even without a shared language. It's a powerful lesson in the universal language of human connection in medicine.

7. Your plan for next week (Week 3)

My elective has officially come to an end, and I'm so grateful for this entire experience. The past two weeks have taught me more than I could have imagined, both clinically and personally. I am leaving with a renewed sense of purpose and a deeper understanding of what it means to be a compassionate and effective healthcare professional.

2. How is your progress?
This week, I was rotated to the microsurgery division of plastic surgery in Chang Gung Memorial Hospital, which is one of the most internationally recognized centers for this field. From the very beginning, I realized why CGMH’s microsurgery department is held in such high regard: the number of cases they handle is remarkable, their techniques are cutting-edge, and the structured way they involve trainees in every stage of the process makes it an excellent learning environment.

I was fortunate to meet my senior Bryce, who has been very kind in guiding me, and also several fellows who came from diverse backgrounds—specifically the US, Mozambique, and Spain. This multicultural environment gave me a sense of how far CGMH’s reputation reaches and how it attracts surgeons from all over the world. It also made me realize that surgery, while technical, is also a shared language that brings people together from different continents.

My week started with joining a right hemiglossectomy reconstruction surgery. What surprised me most was the way the microsurgery team approached the operation. Before even starting, the whole team—led by Professor Fu-Chan Wei—stood together in the operating room to carefully review and discuss the surgical plan. Professor Wei asked questions not only to test our knowledge but also to encourage us to think critically about each step. This was very different from what I had seen previously, and it gave me a strong impression that good surgery starts with good planning and teamwork, not just technical execution.

Once the ENT team had completed the dissection of the right side of the tongue, our microsurgery team began harvesting the flap. The flap chosen was a left free anterolateral thigh (ALT) flap. Later in the afternoon, the team started reconstructing the right tongue using this flap. The reconstruction was performed under a LEICA F-50 microscope, and it was only at this point that I learned the machine itself costs around USD 250,000, which is nearly 1 million ringgit in Malaysian currency. This fact alone made me appreciate how advanced and resource-intensive microsurgery can be, and how privileged I was to be observing and assisting in such a setting.

The highlight of the week for me was when Eugene, the chief resident of microsurgery, gave me the opportunity to scrub in. Under the supervision of Bryce, I was allowed to suture the donor site (left thigh) where the flap had been harvested. This was a huge milestone for me because it was the first time I performed suturing on a real patient. I felt grateful not just for the trust shown to me but also for the realization that even small steps—like suturing a donor site—are meaningful contributions to the surgical process.

By the time we finished closing the wound, it was already 8:30 pm. I looked around and noticed that our team was the last one left in the operating room, as most other surgeries had already concluded during regular office hours. It struck me then how demanding the life of a microsurgeon truly is. These are individuals who not only possess incredible technical precision but also extraordinary stamina, mental resilience, and dedication to their craft. This experience reshaped my perception of surgery—not just as a profession, but as a lifestyle that requires commitment, perseverance, and passion.

3. Points to remember from Week 2!

• Every surgery begins long before the first incision—discussion, planning, and questioning are critical.

• Microsurgery is as much about patience and teamwork as it is about technical skill.

• Even seemingly “small” tasks like suturing a donor site are important learning opportunities that should be valued.

• Advanced surgical tools like the LEICA F-50 microscope make delicate work possible, but they also remind us of the huge investments required in this field.

• The life of a microsurgeon is demanding, requiring stamina, discipline, and mental toughness in addition to surgical skills.

  
  

4. Feelings and thoughts
I felt excited and grateful for the opportunity to scrub in and perform suturing on a real patient for the first time. At the same time, I was amazed by the scale and complexity of microsurgery at CGMH. I also felt humbled by the dedication of the microsurgery team, who work tirelessly and with great precision even after long hours. This motivated me to improve myself and strive towards their level of professionalism.

5. One good thing from what you did that you can practice now!
The main skill I can continue practicing now is suturing. I understand that suturing is not something one can master overnight—it requires repeated practice, fine motor control, and consistency. Each opportunity I get to suture, whether in simulations, animal models, or real patients in the future, will help me refine my technique. I also learned that being confident and steady during suturing is as important as knowing the technique itself, because surgery often happens under pressure and fatigue.

6. Any difficulties/concerns? How did you cope?
One difficulty I faced was following the flow of such a complex and lengthy surgery. At times, I felt overwhelmed by the technical details and the long hours in the OR. To cope, I stayed focused, asked questions when appropriate, and observed carefully how the seniors managed their workflow. I reminded myself that learning surgery is a gradual process, and persistence is key.

7. Your plan for next week (Week 3)
Next week, I plan to:

• Continue improving my suturing technique during any opportunities given.

• Observe more closely the flap harvesting and anastomosis steps in microsurgery.

• Take detailed notes after each surgery to consolidate my learning.

• Interact more with fellows and residents to learn from their experiences and tips.

3. Points to remember from week 2!

   Geriatric care goes beyond cure – It focuses on long-term management and improving quality of life, addressing not only medical conditions but also psychosocial and spiritual needs.

   Elderly patients present differently – Illnesses in seniors often appear with atypical symptoms, so they cannot be treated like younger adults. This requires careful history-taking, observation, and tailored management.

   Caregivers are key to recovery – The involvement of caregivers greatly influences the patient’s daily functioning and speed of recovery, reminding me that holistic care must include both the patient and their support system.

4. Your feelings & thoughts

   This week, I felt more confident and comfortable compared to Week 1, as I had more opportunities to interact with patients and apply what I have learned. I was especially grateful to practice history-taking and physical examinations, which made me realize how much I can grow through hands-on experience. I also found it meaningful that geriatric medicine emphasizes not only treatment, but also quality of life and holistic care — this gave me a deeper sense of purpose in my clinical attachment.

   I was inspired by my supervisor’s teaching style, especially the way he used real-life scenarios to challenge my thinking. Although some situations were tricky, I enjoyed reflecting on them because they encouraged me to think critically, adapt in resource-limited settings, and prioritize what truly matters in patient care. Overall, I felt motivated and encouraged to keep learning, and I am starting to see how important it is to approach elderly patients with patience, empathy, and respect.

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

   One good thing that I learned and can continue to practice is the ability to estimate blood pressure by palpating the radial pulse. At first, I thought this was just a simple technique, but as I practiced it, I realized how important it can be in situations where a sphygmomanometer is not available. For example, in rural or resource-limited settings, or even in emergency scenarios where immediate assessment is needed, this skill can give a quick idea of a patient’s circulatory status.

   Practicing this method also helped me sharpen my clinical senses and reminded me not to become overly dependent on machines. It encouraged me to trust my hands and observation, which are essential qualities for any doctor. Moreover, it taught me to approach clinical examination with patience and accuracy, because small details in palpation can make a big difference in assessment.

   I feel that this is something I can keep practicing not only during my posting but also in future clinical years. By mastering such simple yet powerful bedside skills, I will be better prepared to adapt in different clinical environments. This experience has shown me that sometimes, the most basic techniques can have great value in real practice.

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

   One difficulty I faced this week was the challenge of recognizing atypical presentations in elderly patients. Unlike younger adults, seniors often present with vague or non-specific symptoms, which sometimes made it harder for me to connect the clinical picture to a possible diagnosis. At first, I felt unsure and worried that I might miss something important.

   To cope with this, I tried to slow down during history-taking and focus on being more detailed and attentive. I also observed how my supervisor approached similar cases and learned to ask more open-ended questions, not just disease-specific ones. I found that this not only helped me gather better information but also built rapport with the patients.

   Another concern I had was about communicating with caregivers, since their perspectives are often different from the patients themselves. I coped by reminding myself to listen actively and show empathy, because understanding the caregiver’s challenges is just as important as managing the patient’s condition. With practice, I felt more confident, and I learned that patience and good communication are key in geriatric care.

7. Your plan for next week ( Week 3 )

   For Week 3, my plan is to continue improving my history-taking and physical examination skills, especially focusing on elderly patients with complex or atypical presentations. I hope to become more systematic and confident in identifying key findings during consultations. I also plan to participate actively in journal readings and discussions so that I can strengthen my understanding of evidence-based management in geriatrics.

   In addition, I want to pay closer attention to how caregivers are involved in the care process, and learn how doctors communicate effectively with both patients and their families. By observing and practicing, I aim to develop better communication skills that can help me build trust with patients and caregivers. Overall, my goal is to gain more confidence, broaden my clinical knowledge, and apply what I learn more effectively in real patient interactions.

   
   

 Name: Michelle Teng Qian Ying

Matric no.: A195548

Date: 21/07/2025 – 25/07/2025

2. How is your progress?

It was the second week of my elective posting, and I finally met my official supervisor, Dr. Huang, along with his team. I joined them for morning ward rounds, clinics, and operating theatre sessions. One of the cases I observed was wound debridement for a young girl with a group A streptococcus infection, followed by a split-thickness skin graft (STSG). I was able to watch the preparation process, including the use of a skin mesher and application of staples. This helped me appreciate how both surgical technique and postoperative care are important for good wound healing.

One of the highlights of the week was observing a bilateral orchidectomy as part of gender-affirming surgery. It was eye-opening to see the surgical team perform this procedure with such precision. I learned about the use of a segment of small intestine to create the neovaginal canal and briefly understood how multiple surgical steps come together to ensure both function and aesthetics for the patient. It was inspiring to see how surgery can transform lives beyond treating disease.

Another new experience this week was attending a postgraduate teaching class led by one of the professors. The topic was burns, and I learned about subtopics including the Parkland formula, escharotomy, the lethal triad, split-thickness versus full-thickness skin grafts, and the use of materials like Surgilon. The professor was very detailed in his teaching, and I found it useful to revise both the basics and the more advanced aspects of burn management.

Apart from that, I continued to join Professor Lin’s clinics and OTs. In his clinic, I was exposed to a variety of conditions such as trigger finger, pincer nail, giant cell tumor of the tendon sheath (GCTTS) and De Quervain’s tenosynovitis. I also learned about angiosarcoma and its poor prognosis due to high metastatic risk to the lungs, as well as cases of tendonitis. A particularly inspiring moment was seeing a patient who had undergone a tibial flap surgery performed by Professor Lin’s teacher, a retired professor from the same hospital, more than 40 years ago. The long-term survival and function of the flap stood as a testament to the extraordinary skill of surgeons at a time when resources and research were limited. It was a reminder of the lasting impact of surgical innovation and dedication.

This week I also met my UKM senior, Bryce, who was under the microsurgery team in the plastic surgery department. Through him, I had the chance to observe microsurgical procedures, which were extraordinary in their precision and complexity. I also joined a preoperative discussion in their department, where surgeons reviewed a patient’s case and debated different treatment plans using published research and articles. It was eye-opening to see how evidence-based decision-making guided their final choice of management. I also had the opportunity to observe an MSAP flap (medial sural artery perforator flap) procedure and learn about other types of flaps such as pedicled and chimeric flaps.

Lastly, I continued to attend the weekly case discussions and the hospital-wide conference. This week’s conference topic was about tips and tricks for writing a good case study, which I found very useful for my own future academic writing.

3. Points to remember from week 2!

 This week reminded me that there is always something new to learn, whether in the operating theatre, the classroom, or during discussions with senior doctors. I saw how evidence-based practice is applied directly to patient care, and how surgical techniques continue to evolve. Another point I will remember is the importance of appreciating long-term outcomes, as shown by the patient with the tibial flap that lasted more than 40 years. It inspired me to think about how the decisions we make today as doctors can impact patients for decades.

4. Your feelings & thoughts

I feel very grateful that I finally met my official supervisor and could properly join his team. At the start, I felt a bit nervous because I wasn’t sure how well I would adapt to a new team, but everyone was welcoming and willing to explain. I am excited and inspired by the variety of cases I observed, from skin grafts to microsurgery. Watching a life-changing transgender surgery also broadened my perspective on the role of medicine in improving quality of life.

One of the most meaningful moments for me this week was seeing the patient who had undergone a tibial flap surgery performed more than 40 years ago by Professor Lin’s teacher. The flap was still intact and functional after four decades, despite being done in a time with fewer resources and limited research compared to today. Listening to Professor Lin explain this case gave me a deep sense of respect for the skill, dedication, and innovation of surgeons from the past. It reminded me that as future doctors, the work we do has a long-lasting impact on patients’ lives, sometimes even beyond what we can imagine. I felt truly inspired and motivated to keep learning so that one day, I too can provide the same kind of meaningful and lasting care to my patients.

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

 One good thing I learned this week is how important it is to be observant and ask questions at the right time. In clinics and OTs, I realized that even small observations—such as how the surgeon handles tissues, or how a professor explains a condition to a patient—can teach me valuable lessons. I can practice this by being more attentive during my own postings back in Malaysia, making the most of every chance to learn.

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

 One difficulty was that some procedures were very detailed, making it hard for me to understand every step. To cope, I took notes, asked doctors or seniors to clarify afterwards, and did extra reading in the evenings. This helped me understand better the next time I observed similar procedures. Another challenge was the language barrier in some discussions, but I managed by focusing on key points, following visual demonstrations, and asking for English explanations when possible.

7. Your plan for next week (Week 3)

For Week 3, I plan to continue following Dr. Huang and his team more closely so I can learn from their surgical and clinical practices. I also hope to observe more microsurgery cases, as this is a rare opportunity to gain exposure in such a specialized field. In addition, I want to strengthen my academic knowledge by reviewing topics I have seen in the OT and clinics, such as flaps, burn management, and hand conditions, so I can understand them more deeply. Finally, I will continue attending weekly discussions and conferences to sharpen my clinical reasoning and presentation skills.

Name: Quek Chew Geok

Matrics number: A196228

Date: 3/8/2025 - 9/8/2025

2. How is your progress?

During my first week of working holiday at Good’s Dive, a diving hostel on Green Island, Taiwan, I experienced a unique balance of work and leisure. My main responsibility was housekeeping, in exchange for free food and accommodation. Each morning from 9:30am to 10:30am, we cleaned the common areas, including the living room, kitchen, and bathrooms, ensuring the hostel remained tidy and welcoming. On days when guests checked in or out, we also prepared their rooms, making sure everything was in perfect condition for their stay.

After our morning tasks, the rest of the day shifted toward meal preparation. Together, we cooked both lunch and dinner for our team. The work schedule was light, giving us ample free time in the afternoons to explore the island’s natural beauty and vibrant spots.

Outside of work, I made the most of my time on Green Island. I went snorkelling in its clear turquoise waters, visited good food spots, swam along scenic coastlines, and hiked through its lush landscapes. I prepared and familiarized myself with the ocean by snorkelling in advanced before i started in diving.

3. Points to remember from week 2!

 i. Cultural differences in food

Meals are less salty, less sweet, and less oily compared to Malaysian food, which feels healthier but took me some time getting used to.

ii. Adapting to their cleaning style

The way they do housekeeping here is a bit different from what I’m used to, so I’ve been learning their methods step by step.

iii. Understanding local communication

I’m also adjusting to the way they talk, both in terms of language and casual island expressions.

iv. Teamwork makes it easier

Sharing tasks like cooking and cleaning with other volunteers like me makes the work feel lighter and more fun.

v. Learning to live simply

With just the basics – a bed, good food, and the ocean, life still feels rich and fulfilling.

4. Your feelings & thoughts 

During my first three days on Green Island, I honestly felt quite unhappy. This was my first time travelling alone, and it wasn’t a pure holiday – it was a working holiday. The cultural differences hit me quickly. The food was less salty, less sweet, and less oily than what I was used to, and the way people spoke and thought felt unfamiliar. On top of that, transportation here mainly depends on scooters, but since I don’t have a license, I could only go out when my teammates were free to bring me along. That made me feel a little uneasy and restricted at first.

However, as the days passed, I began to slowly adapt to the local lifestyle. I’m still adjusting, but I’ve started to feel more comfortable with the pace here and more open to the small differences. It’s not always easy, but I’m learning to embrace this new experience day by day.

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

One good habit I developed this week is learning to stay calm and grounded in unfamiliar or challenging situations. Whether it was adapting to a new living environment, adjusting to the island’s lifestyle or snorkelling in deep open water for the first time, I learned to pause, breathe and approach each moment with patience instead of panic.

This is a skill I can continue practising in my daily life especially when facing stressful tasks, unexpected changes or situations outside my comfort zone. Staying calm allows me to think more clearly, respond more effectively and build confidence gradually. It is a mindset that I can apply not only during my elective posting but also in my studies, clinical work and personal life.

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

One of the biggest challenges I faced this week was my first time snorkelling in the open ocean around 20 metres deep and without a life jacket. At first, it was nerve-wracking . The water felt endless and I had to trust my own ability to stay afloat and stay calm. But once I found my rhythm, the fear slowly turned out and I was able to enjoy the marine life beneath me. It was both a test of courage and a rewarding experience that I’ll never forget.

7. Your plan for next week (Week 3)

My goal for next week is to earn my PADI Open Water Diver certificate. Living and working at a diving hostel gives me the perfect chance to learn from experienced instructors and practice right by the ocean. I’m looking forward to stepping out of my comfort zone, building my confidence in the water and experiencing the beauty of Green Island’s marine life up close.

Name: Ashba Khan
Matric number: A192231
Date: 29th June, 25 - 12th July, 25

2. How is your progress?

This Sunday was my first day working with PUC at their Sai Kung Adoption event. I arrived early and met with my on-site managers, who informed us about the day's tasks, mainly setting up cages, banners, greeting guests, and cleaning up afterward.

I paired with my fellow volunteer, Anne, to set up the banners. Our duty manager, Cindy, guided us in arranging them, as there were three types: event details, PUC cat center information, and objectives. We set up six banners, with Anne helping hold the base while I secured the top.

Afterward, we returned to help guests interact with the cats, playing and feeding them. We also talked to interested adopters about the registration process and safety requirements for adopting cats, guiding them to our duty managers for additional assistance.

Overall, it was a rewarding day, seeing cats move to their new homes, though I felt a pang of sadness for the pairs that were separated. One set of siblings aged 2 months and a couple aged 4 years could not be adopted together due to space and financial constraints, but I believe they will thrive in their new homes.

From Monday to Saturday, I continued at the Cat Adoption Centre in Repulse Bay. On Monday, I was 30 minutes late due to getting lost, but a kind stranger helped me. I met Jayne, who guided me through the shelter and had me sign a waiver acknowledging PUC’s limited responsibility for cat scratches.

She explained that sick cats must be isolated for the safety of others. This included Lemon, with a ringworm infection, and Jasmira, who had been sneezing. Lulu, Lemon's sister, was isolated for monitoring, and Pewter, a feisty cat, hadn’t been neutered yet.

In the cat room, I met many cats: Bingo and Buttons, both adorable sisters; Fossil, an energetic cat; Mindy, who loved to sit in my lap; and Simba, a dominant male. We also saw Usher, a 16-year-old cat rescued when the shelter opened.

I learned my duties included cleaning litter boxes, washing bowls, and mopping the shelter. I started by sanitizing the litter boxes with a bleach solution and an organic antiseptic called Dermo.

We cleaned the cages, removing sheets and trays, and then washed the bowls. After cleaning, we rearranged everything. I mopped the cat room and outside area, using glass cleaner on all glass surfaces.

When it was time to give medication, I applied antifungal cream to Lemon's ear and fiber medication to Lodie and Usher. After completing my tasks, I played with the cats, especially Fossil, who eagerly awaited playtime. We played with a feather toy, and others joined in.

At 2 PM, I left but first collected my log sheet from the neighboring dog shelter and got Jayne's signature. I said goodbye to everyone and left, feeling fulfilled despite the tiring day.

The week followed a similar routine, with cleaning and playing with the cats. Lemon's ear showed signs of healing, and Jasmira looked healthier. Mindy was adopted, which brought mixed feelings of joy and sadness.

3. Points to remember from Week 2:

Week 2 taught me the value of consistency and quiet progress. I began to notice the cats' personalities more, recognizing when Simba was territorial or when Mindy was playful. Cleaning tasks became opportunities for connection, like seeing King and Willow, the shy cats, start to watch me.

I also felt more confident talking to visitors and guiding them through the adoption process. Growth often happens quietly, in the small shifts that occur day by day.

4. Your feelings & thoughts:

Emotionally, Week 2 felt heavier but rewarding. I became genuinely attached to the cats, seeing them as individuals with unique stories. Mindy's adoption brought joy but also sadness, highlighting the emotional risks of this work.

I reflected on trust, especially with the hesitant cats. Gaining small signs of openness felt like victories, showing that compassion isn’t always grand gestures; sometimes, it’s about being present.

5. One good thing to practice now:

I've learned the power of patience. Working with sick or traumatized animals taught me that progress isn’t always immediate. Applying cream to Lemon's ear showed slow improvement, and building rapport with shy cats required a calm presence.

I’ve started applying this mindset outside the shelter when speaking to family or managing my frustrations. Instead of reacting quickly, I pause, breathe, and respond with empathy.

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

This week had challenges, both physical and emotional. Managing exhaustion was tough, especially after Sai Kung events. Traveling nearly two hours each day and cleaning for several hours left me depleted.

To cope, I structured my time better, packed snacks, and took short breaks. Emotionally, I felt helpless seeing cats with ongoing health issues. I reminded myself that I’m part of a team, and small acts, like administering medication, are meaningful contributions.

7. Your plan for next week (Week 3):

In Week 3, I want to take on more responsibility and be proactive. At the next Sai Kung event, I hope to lead setup and mentor new volunteers, sharing my experiences to help them feel included.

At the Repulse Bay shelter, I want to engage more with reserved cats like King and Willow, bringing treats to build trust. I also want to learn more about the medical side of shelter care, assisting with medication administration or feeding routines.

Week 3 is about deepening my engagement and finding new ways to serve.

Name: Naomi Choo Xin Ying

Matric number: A196189

Date:26/7/2025 

2. How is your progress?

Over the course of the week, I was able to observe a wide range of surgical procedures and clinical practices. These included a Crohn’s disease case managed with an ileostomy and stoma bag placement, an intraperitoneal chemotherapy procedure, a gender-affirming (transgender) surgery, and a hernia repair. In addition, I also attended sessions at the surgical clinic, which allowed me to see how patients are managed in an outpatient setting and to appreciate the continuity of care beyond the operating theatre.

3. Points to remember from week 2!

1) Fasting Before Abdominal Ultrasound

• Duration: 6–8 hours

• Reason: To keep the gallbladder distended (since no bile is released during fasting).

• Advantage: Improves visualization of the gallbladder walls and lumen → better detection of:

  • Gallstones

  • Polyps

  • Wall thickening

2) Hernia Repair: TEP vs TAPP

Totally extraperitoneal (TEP) vs transabdominal preperitoneal hernia repair (TAPP)

TEP:

Dissection is done exclusively in the preperitoneal space (the area in front of the peritoneum) and the peritoneal cavity is never entered.

TAPP:

The surgeon first enters the peritoneal cavity , makes an incision in the peritoneal lining and then performs the repair in the preperitoneal space

3) Gallbladder stones 

Symptomatic: requires surgery 

• as it can cause gall bladder cancer and the motility risk is high for gall bladder cancer

Asymptomatic

• Usually incidental, often no symptoms

4) Paraeosophageal hernia (post surgery)

Common cause: postsurgical dysphagia 

Management option: balloon dilatation

5) Intraperitoneal chemotherapy

Procedure: Uses liquid that turns into gas and is sprayed into the intraperitoneal cavity

Indications: Palliative and for peritoneal spread of cancer

4. Your feelings & thoughts 

I felt truly grateful and inspired to have the opportunity to observe such a wide variety of surgeries throughout the week. It was eye-opening to see both young and elderly patients undergoing these procedures, each with their own unique stories and challenges. This reminded me of the immense responsibility carried by surgeons. I was amazed by the dedication of the surgical teams that work tirelessly for long hours to restore health and allow patients to return to their normal lives. These moments deepened my respect for the profession and strengthened my motivation to continue learning and growing as a future doctor.

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

I learned the importance of patience from observing the doctor in Taiwan. He was very patient when communicating with his patients, especially when they had questions about surgery. He took the time to carefully explain the procedure, including the necessary preparations and potential complications, which helped the patients fully understand before giving their consent. From this, I realised how valuable patience is in building trust. I can start practicing this by being patient when talking to patients, taking the time to understand their backgrounds and concerns. This will allow me to build better rapport and strengthen the doctor–patient relationship.

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

I faced some difficulties understanding the Chinese language during my time there. Although I can speak and understand Chinese, the local accent and the use of unfamiliar terms made it challenging for me to fully follow the conversations. To cope with this, I asked the doctor to explain the meanings of words I did not understand, which helped me gradually improve my comprehension and adapt better.

7. Your plan for next week (Week 3)

I plan to follow the doctor for ward rounds to see how they carry out their ward rounds in the morning. I also plan to observe my doctor doing breast ultrasounds.

Name: Grace Liew Min Zi

Matric number: A195123

Date: 21/7/25 - 25/7/25 

2. How is your progress?

In Week 2, I was placed under the Division of Pediatric Gastroenterology, Hepatology & Nutrition, supervised by Dr. Hsieh Hui-Hsiang, a chief resident. My daily schedule was similar to Week 1, starting with morning meetings at 7:30am and ward rounds around 8am. During pre-rounds, consultants, PGYs, and students reviewed lab results, imaging, and scope findings before deciding on management, often with teaching included. The cases I encountered were mostly acute gastroenteritis (AGE), but also more complex cases like lower GI bleed (suspected Meckel’s diverticulum), constipation, vomiting, and diarrhea. I realized how central fluid management is in pediatrics, with precise calculations based on age and weight since both under- and overhydration can be harmful.

One of the most memorable clinical experiences this week was following a patient with ruptured appendicitis and suspected peritonitis to the scan room for abscess drainage. Before the procedure, the patient was given plasma infusion, and during the scan, he suddenly developed acute shortness of breath, a suffocating sensation, and became very anxious. His blood pressure spiked to 176 mmHg, heart rate rose to 117 bpm, and SpO₂ dropped to 92%. His face turned markedly red and rashes appeared over his abdomen. The procedure was immediately stopped, and oxygen was administered. The doctors suspected an anaphylactic reaction to the plasma infusion—a rare but possible complication—although hyperventilation and heightened anxiety during the procedure might have worsened his presentation. The patient was pushed back to the ward for close monitoring, and thankfully, by the same afternoon, his condition stabilized. Later that day, the doctors successfully drained a very turbid abscess from his abdomen, which explained his severe discomfort and persistent fever. Witnessing this case was eye-opening, as I learned how quickly pediatric patients can deteriorate, how important it is to recognize and manage acute infusion reactions, and how perseverance and teamwork eventually led to a good outcome.

I also spent significant time in the ultrasound room, observing scans for conditions like infantile hypertrophic pyloric stenosis (IHPS), fatty liver, and hepatitis (both vertical transmission and viral causes such as EBV, HSV, CMV). In addition, I joined the scope room for OGDS and colonoscopy procedures, and attended afternoon clinics at 2pm, observing how doctors explained findings and plans carefully to parents.

3. Points to remember from Week 2!

This week, I picked up several important learning points. From teaching during ward rounds, I learned how to differentiate bacterial vs viral colitis—bacterial being secretory-based with bloody or mucoid stools and less vomiting, usually food-borne; while viral colitis is inflammatory-based, often with vomiting, shorter fever, and cluster/contact transmission. I also reviewed the classic features of intussusception, a pediatric emergency: intermittent irritable crying, abdominal pain, vomiting, and red currant jelly stool, with radiologic signs like pseudokidney on ultrasound. In ultrasound practice, I learned to recognize IHPS with pyloric wall thickness >0.4 cm, and fatty liver graded I–III depending on echogenicity compared with spleen and clarity of vessels/diaphragm. I was struck by the high number of children presenting with fatty liver, a reminder of how early diet and lifestyle impact long-term health. In endoscopy, I observed cases of gastritis, Crohn’s disease, and ulcerative colitis, noting how sedation is necessary in pediatrics to ensure cooperation. Importantly, I saw how doctors immediately included parents post-procedure, showing them the images and explaining findings in detail, which reassured and engaged families.

4. Your feelings & thoughts

This week felt slightly more relaxed compared to my first week in pediatric allergy, but still very rewarding. I enjoyed the calm, efficient atmosphere of the ultrasound and scope rooms, where doctors and nurses worked together to make young patients feel comfortable. It was meaningful to observe how common GIT complaints like diarrhea or vomiting could reflect such a wide range of possible conditions—from simple viral gastroenteritis to serious diseases like intussusception or IBD. I also appreciated how parents were consistently involved, whether during ward rounds or post-scope discussions, showing the importance of clear doctor–parent communication. Personally, I felt inspired by how patient the doctors were in explaining complex findings to parents in simple terms, something I hope to emulate in the future.

At the same time, I also had my first experience witnessing a true emergency situation during the case of ruptured appendicitis with suspected peritonitis. When the patient suddenly developed acute breathing difficulty, rashes, and instability during plasma infusion, I felt panicked and helpless as a medical student seeing a child in real distress for the first time. What left a deep impression on me, however, was how calm and composed the doctors remained—making instant decisions, stopping the procedure, giving oxygen, and managing the situation appropriately. Their steady approach not only stabilized the patient but also reassured everyone else in the room. This incident showed me the importance of keeping calm in critical moments, something I hope to develop as I continue in my training.

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

One good practice I gained this week was learning how to systematically approach fluid management in pediatric patients. I now appreciate how critical it is to calculate and adjust fluid requirements precisely based on age, weight, and clinical condition. This is a skill I can immediately apply in my ongoing medical training, especially since dehydration and electrolyte imbalance are common pediatric problems. Additionally, from witnessing the emergency situation in the scan room, I realized the value of staying calm under pressure—an important mindset I want to consciously practice moving forward.

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

One challenge I faced this week was keeping up with the breadth of new conditions in pediatric GIT and the technical details of ultrasound and endoscopy findings, which were unfamiliar to me at first. I coped by actively asking questions during pre-rounds and procedures, writing down key points, and reviewing them afterwards. The doctors were very approachable, and my supervisor in particular often paused to explain findings in scans or scopes, which helped me bridge the gap. I also reminded myself not to be overwhelmed, but instead to take each case as a learning opportunity.

7. Your plan for next week (Week 3)

In Week 3, I will rotate to Pediatric Hematology, which will be my final week in CGMH. My plan is to deepen my understanding of common and complex blood disorders in children, such as thalassemia, leukemia, ITP, and hemophilia. I want to focus on how to interpret lab findings, blood smears, and bone marrow studies, and how these guide management decisions. I also hope to observe procedures such as bone marrow aspiration and to learn more about transfusion protocols, chemotherapy regimens, and supportive care. On top of that, I aim to sharpen my clinical reasoning by presenting cases more systematically and to practice linking symptoms with hematological patterns. Beyond academics, I hope to engage more with my supervisors and peers, making the most of my last week to learn from their experiences and insights before completing my elective posting.

Name: Goh Kai Xin

Matric Number: A196314

Date: 04/08/2025 - 08/08/2025

2. What have you done?

My first week in the general surgery department at Kaohsiung Chang Gung Memorial Hospital has been incredibly dynamic and educational. I am particularly honoured to be doing my elective posting under Associate Professor Yong Chee Chien, a distinguished general surgeon specialising in living donor liver transplants. I’ve been a part of the daily ward rounds which provided a comprehensive look into patient management, from postoperative care to diagnostic planning. I also had the opportunity to observe several clinic sessions, where I saw the initial consultation and follow up care for various surgical cases. The meetings that I joined were particularly valuable as they not only involved case presentations and surgical planning but also featured multidisciplinary discussions and approachs to patient care. This gave me an excellent perspective on how different specialities collaborate to create the best treatment plans.

Beyond the ward and clinic, I was fortunate enough to observe a few surgical procedures. The highlight was witnessing a living donor liver transplantation and a L-RAMP (Laparoscopic radical antegrade modular pancreatosplenectomy). This was an incredible opportunity to see the theoretical knowledge of anatomy and surgical principles applied in a live operating theatre setting.

3. Points to remember from week 1!

Teamwork is essential: I’ve seen firsthand how crucial it is for the entire surgical team from surgeons to nurses to administrative staff to work together seamlessly to ensure patient safety and positive outcomes. The multidisciplinary approach I observed in the meetings further reinforced this point.

Precision medicine: The smallest details in a patient’s history or any examination can change the entire course of their treatment. I’ve observed that it is important to choose the correct and suitable treatment according to each patient’s conditions allowing them to have a better outcome and reduce the mortality of surgery.

4. Your feelings & thoughts

 I feel a mixture of excitement and being slightly overwhelmed. The pace is fast and there’s a steep learning curve but I’m absolutely fascinated by the cases I’m seeing. The team here has been very welcoming and their dedication is truly inspiring. I feel grateful for this opportunity to experience a new healthcare system and learn from such experienced professionals.

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

 The primary difficulty has been the language barrier, especially during the patient-doctor interactions. Although I understand both Chinese and English but some of the words pronounced  in their slang is still abit different. Other than Chinese, some of the patients also speak Taiwanese which is also abit difficult to understand. To cope, I’ve been focusing on understanding the medical context and observing non verbal cues. I also make sure to ask the senior students or residents for clarification wherever needed.

6. 2 words to describe elective posting progress so far

 Challenging and fulfilling.

7. Your plan for next week (Week 2)

To become more proactive in the ward rounds and other sessions and ask questions to the doctors. I also want to focus on a specific surgical subspecialty such as hepatobiliary to gain a deeper understanding of the anatomy and common procedures.