• Teh Ying Yi

• A188721

• 9 Aug 2024 (Friday)

  
  

2. What have you done?

• I have observed and assisted the surgeons in several surgeries, including total thyroidectomy, mastectomy, and sentinel lymph node biopsy.

• Additionally, I joined ward rounds with the registrars and participated in multidisciplinary discussions conducted in Dutch. I even presented a case in English!

• I also participated in national social program in centre of Brussels and get to meet medical students from all accross the world!

  
  

3. Points to remember from week 1!

• Sterility is the top priority!!!!!!!!!!!!! Remember this until the day you graduate!

• Greet everyone, whether you know them or not!

• Don’t be afraid to make mistakes! Being a medical student is the best time to make as many as possible.

  
  

4. Your feelings & thoughts

• Honestly, having a month-long holiday before the exchange made it difficult for me to fully immerse myself in the clinical setting. I found myself torn between learning and enjoying my holiday. Fortunately, as the days passed, I slowly adapted!

• I am incredibly grateful for the opportunity to scrub in and assist the surgeons! The experience and practical knowledge gained are worth the long hours spent in the operating theatre.

• Right now, I’m feeling excited to keep learning more and making more friends !

  
  

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

• The language barrier is the main challenge I’m currently facing. Being attached to a Dutch-speaking hospital is tough, and I often feel left out when the surgeons or doctors speak in Dutch. Even though they are kind and welcoming, it’s difficult to ask them to consistently speak in a non-native language. I did learn some Dutch before the exchange, but it’s not enough for daily conversations!

• Luckily, Dutch is similar to English, so I can guess most of the words! To better understand what they’re saying, I’ve been learning Dutch from my supervisors, colleagues, and with the help of Google Translate and Duolingo.

  
  

6. 2 words to describe elective posting progress so far

• Exciting but exhausting

7. Your plan for next week (Week 2)

• Continue learning Dutch

• Observe and assist in at least one surgery per day

• Review patients' information and relevant details before surgery

• Present a case in Dutch

Matric number: A190102

Date: 10^th August 2024

2. What have you done?

a.        I started my professional exchange on the 5^th of August, Monday at University Clinical Center Kragujevac which is located 15 minutes of walking distance from our student dormitories. On the first day, I met with my supervisor, Associate Professor Dr. Mladen Pavlovic, a general surgeon who is very nice in person. He took me on a tour around the hospital introducing me to the urgent care on the ground floor, the operation room on the first floor and the general surgical ward on the fourth floor.

b.       I got the chance to observe surgeries from Tuesday onwards including laparoscopic cholecystectomy, open right hemicolectomy with a 15cm colon tumour and high anterior resection with a 9cm rectal tumour. Different surgeons performed the surgeries and they were so kind to let me stand close observe and explain the procedure throughout the procedure in English to me although they mostly spoke in Serbian.

c.        I also have the chance to observe some minor procedures at the urgent care minor operation room. There are cases like sinus pilonidalis at the intergluteal region, paracentesis to remove ascites fluid, subcutaneous hematoma, and doctor showed me how to put a haemostatic suture in varicose vein patient to stop bleeding from the small wound.

d.       Not only that, I joined the social program organised by the local committees to meet and get to know the international students.  

3. Points to remember from week 1!

a.        Just ask if you have any questions.

                                                                              i.        We Asians tend to keep things to ourselves and shy to ask any due to the hierarchy system but Europeans are very outspoken!

b.       Anatomy of the gastrointestinal system

4.Your feelings & thoughts

a.        I am excited to explore the healthcare system of Serbia but homesick at the same time. I feel welcomed by all the kind-hearted surgeons and nurses in the operation room who will try to best to communicate with me in English. I am also proud to say my country of origin, Malaysia when I introduced myself and their reactions are lovely. However, homesickness is true when family is far away from my side and I have to learn to adapt to new environment.

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

a.        Language barriers with the Serbian. Kragujevac is the fourth largest city in Serbia and according to one of the local mentioned English was officially introduced into their education system two years ago. Hence most of the Serbs do not speak nor understand English. It was a challenge in my daily life when I had to communicate to buy food and, in the hospital, when I had to clerk patients.

Not only that, I am also having difficulties in understanding the alphabet in Serbia as they are using the Serbian Cyrillic alphabet officially. For example, Cyrillic C is read as English S and Cyrillic X is read as English H. Therefore, I make good use of Google Translate to translate when I have to communicate to people and translate using taking picture feature.

6.2 words to describe elective posting progress so far

a.        Fun, Exploring

7.Your plan for next week (Week 2)

a.        I wish to ask supervisor for an opportunity to scrub in and assist surgeons in some simple procedures.

b.       Actively revise back anatomy and knowledge in surgery.

c.        Learn Serbian and try my best to communicate.

3. Points to remember in Week 1 is the power of awareness and health interventions on public health. I learned that most surgical procedures done by the Dermatology team these days are excising or shaving off suspicious tumours and conducting histological tests (called micrographic surgery – MOHS)  on the spot to check if it is a malignancy. These procedures are fairly simple and can be done within 30 minutes, so their procedure rooms are always having new patients every half-hour. This is made possible because the people here are aware of their risks of developing skin cancers, and will come to check any suspicious skin lesions. Hence, any potential malignancies are caught very early, and are easy to remove without requiring more intervention. According to Dr. Ormond, his practice 20 years ago was a lot more chaotic as he had to deal with patients who only come in with late stage malignancies, which are much tougher to treat. Now, as I have observed, the patients are so well-informed that they can have casual conversations with their doctors and nurses on what risk factors they are aware of and are actively avoiding.

   
   

4. I feel absolutely pampered here in the Dermatology team, both the doctors and nurses are friendly and very willing to teach me. While the doctors are often busy, they will take the time to narrate what they are doing for me to catch up. The nurses here are also very knowledgeable and skilled that they will take care of simple procedures such as a shaving excision in the event that all the doctors are busy. I find it very touching too that both doctors and nurses will introduce me to the patients.

   
   

5. The main difficulty I faced was the lack of directions from Trinity College Dublin. I was only told to get my card from the security department and to look for a Professor in the Outpatient Department, nothing more. When I went to the hospital on Tuesday, the department did not seem to know I was coming, and the Professor assigned to me will not be in for the week, so for a good minute I stood there with no idea what to do next. Fortunately for me the head nurse informed another consultant that I will be attaching with the team for 2 weeks and the consultant gladly took me around to observe the procedures. I actually started the attachment by observing the nurses handling the bulk of the surgery while the consultant rotated between rooms. It was eye-opening.

   
   

6.  Two words I would use to describe the elective posting progress so far is “different” and “refreshing”. It is refreshingly different from what I’m used to haha.

   
   

7. My plan for next week (Week 2) is to introduce myself to the consultant I was originally attached to and arranging for a teaching session with her, either in clinic or in surgery.

One interesting thing the nurse, registrar, and consultant took extra time to teach me was how to administer the local anaesthetic painlessly. There are 3 factors they control:

1. Temperature: by gripping onto the syringe before administering, they allow the fluid to be closer to body temperature.

2. Pressure: they administer the medication very carefully and slowly because the needle is very small. Large pressures would mean that the fluid is shot out very fast and painful.

3. pH: the solution is acidic, so some institutions neutralise it with bicarbonate solutions (but they don't do that here haha)

My first day scrubbing in (albeit differently because the surgery is considered minor), I was blur the entire time haha, but on my second day I told the nurses that I want to take pictures for this Padlet report, and they all brainstormed what I could do around there for the pictures and even volunteered to help me record. I got to do a lot more on the second day, kinda touched haha :)

Lim Qi Wei, A187883, 5/8 - 9/8

2. What have you done?

On the first day, we had a hospital tour at 7 am, guided by our contact person, a student at VUB hospital. I registered as a medical student intern and received a personal badge, which I use to obtain freshly washed scrubs, crocs, and pay for meals. Then I found my way to the vascular surgery team. Throughout the week, I was expected to be in the operating theatre by 8 am sharp, observing or assisting in surgeries until 4 pm to 5 pm. It was a long and demanding day.

The surgeries I learned about this week include:

• Dilation and stenting for various issues, including renal artery stenosis

• Angioplasty for the femoropopliteal artery

• Femoral popliteal artery bypass

• Carotid endarterectomy

• Pressure ulcer wound debridement

• Resection of the first rib for thoracic outlet syndrome treatment

• Mesenteric artery stenosis

• Temporal artery biopsy to diagnose giant cell arteritis

• Diabetic foot ulcer

• Embolectomy

  
  

3. Points to remember from Week 1!

1. Independence: I did not expect to receive so little guidance and had to navigate the large hospital on my own. With no one to guide me, I had to constantly ask people questions to find my way or accomplish tasks. It was more challenging as many people here speak Dutch. I had to be brave and proactive to get things done. Do not be afraid to ask questions!

2. Sterility: Keep sterility at the top of my mind in the operation room! Learned that they don't practice scrubbing anymore here, they use the rubbing technique and donning sterile gloves without a table, which I have to practice to perfect.

   
   

4. Your feelings & thoughts

During the first week, I felt both excited and nervous as everything was new. Initially, I felt a bit lost because the doctor I was attached to was busy, leaving me to figure things out on my own. Hearing about my friends' experiences in the thoracic oncology department, where the environment was fun, welcoming, and bright, made me doubt, as my department was more serious, strict, and less friendly. I thought it was because I didn’t socialize well, but I soon learned that the vascular surgery department is the most challenging one in this hospital due to its tense environment and strict doctors. I had to adapt, and after a week, I managed to get closer to the team and learn more from the surgeons. I learned to enjoy solitude and be independent.

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

The difficulty was that my team was stern and not very friendly. To cope, I introduced myself to all the staff in the operating room so they would become familiar with my presence and tried to start conversations with them. Soon, they opened up more to me and started chatting with me about Malaysia, which was interesting.

6. Two words to describe elective posting progress so far

Challenging

Interesting

7. Your plan for next week (Week 2)

I plan to initiate more conversations with the doctors and staff and aim to assist in a surgery. After observing many procedures this week, I hope to be more helpful to the team next time.

A188342

9th August 2024

What have you done?

I have arrived at Kragujevac, Serbia. It is a small town in Serbia which dominated by manufacturing industry. I am appointed to the Cardiology department under supervision of Dr. Ivan Simić, who is an interventional cardiologist. His routine in hospital is to perform angiography with or without stents. During my first week, I have seen multiple PCI procedure. Dr. Simić is very patient to explain the full procedure of PCI to me and my friend. The staffs in the angiogram department is also friendly to us.

Apart from that, we also went to visit the third largest city of Serbia, Nis. At there, I get to bond with the incomings from different country which include from India, Azerbaijan, Czech, Poland, Turkey and so on. We visited the skull tower which is a memorial tower with the skulls of Serbs soldier from 15th century who is killed during the Ottoman invasion to the Balkans. At the evening, we visited the Nis fortress which has been used as an important defence during Byzantine and Ottoman period. It is eye-opening and interesting to understand their history.

Points to remember from week 1

• Private healthcare is a popular alternative for the Serbian due to long waiting time in the state healthcare sector.

• Europeans are really good at drinking liquor and beers, which makes the prevalence of CLD high in Europe

• Radial artery approach in PCI is preferred over femoral artery approach because femoral approach gives higher risk of hematoma

• People are really friendly and nice here

• I’m still struggling to read Cyrillic alphabet

Feelings & thoughts

At first, we felt quite disappointed with the city because It’s a small town even smaller than Seremban. However, after the first week, we are starting to adapt to the lifestyle here. In this city, it is actually more comfortable to live than Kuala Lumpur, because we can get everything by feet and the people is so nice here!

Any difficulties or concerns? How do you cope?

We have language barrier here. The proficiency of English is generally low in this city because they only started to make English education mandatory 5 years ago. To cope this, I need to learn basic phrases to order food, buying things and ordering taxi. Although there is language barrier, but the people here is generally patient and would take some time to understand what I’m trying to say.

2 words to describe elective postings so far

Adapting

Exciting

Your plan for next week

I would follow the other incoming students to Belgrade on next week which is the capital of Serbia. We will introduce Malaysian food at the National Food Party with people from other nations. I am looking forward to that!