Name: Lai Kam Hoong

Matric number: A189642

Date: 22 July 2024

2. Your progress so far

Week 3 went exceptionally smoothly as I had already familiarized myself with the department's workflow. On Monday, I followed my supervisor during her clinic hours and encountered more thyroid and pancreatic cases. There were also patients with other surgical conditions, such as anal fistula and epithelioma. I felt more included in the clinic this week, as my supervisor would explain each patient's condition to me right after their consultation. She also let me to perform physical examinations on every patient who came into the consultation room and I would tell my findings to her after the physical examination.

This week, I had the opportunity to observe two complex Whipple surgeries using the Da Vinci robotic system. One of the patients was diagnosed with pancreatic carcinoma and had a previous surgical history of gastrectomy due to gastric cancer. This has made the surgery more complicated, especially when reconstructing the digestive system after the tumor resection. The surgery was successful but took a long 8 hours. I also observed a distal pancreatectomy performed with the robotic system. Although robotic surgery typically requires only one assistant at the operating table, the doctor allowed me to scrub in during the preparation phase and explained the components of each robotic arm and the tools connected to them.

Friday marked my last day in the Department of General Surgery. I was fortunate enough to be given the opportunity to introduce my beloved country, Malaysia, to the professors, doctors, and nurses in the ward during the team handover. During a short 5-minute talk, I introduced Malaysia's background, geography, culture, attractions, and delicacies to them. Afterward, my team celebrated my farewell and I took a group picture with everyone.

3. Your feelings and thoughts

I feel grateful for the opportunity to introduce my country while abroad. I was given this task just a day before. Initially, I felt nervous because I only had a short amount of time to prepare. Fortunately, everything went smoothly. I prepared a simple PowerPoint slide for the talk, and it turned out well.

Some of the doctors had never been to Malaysia and didn't know much about Malaysia. After my presentation, they gained a better understanding of Malaysia, and some of them even expressed their interest in traveling to Malaysia for a vacation! I felt extremely proud to have been able to share my culture and promote Malaysia. This experience was not just about sharing information but it was also a great opportunity to promote cultural exchange among healthcare professionals.

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

Decision-making is a skill that I witnessed daily throughout my attachment. Surgeons often need to be prepared for situations where the initial plan cannot proceed as intended. In such moments, it is crucial for them to make quick and well-considered decisions, as the patient’s life is in their hands.

I learned this during a complex surgery for the patient with pancreatic cancer where the internal structures of the patient’s abdomen were not as expected based on the radiological images. The surgeon quickly decided and changed to plan B to ensure the surgery's success and, most importantly, the patient's safety. This experience taught me that the essence of decision-making in surgery is to prioritize the patient’s well-being and be adaptable to changing circumstances to keep them safe.

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

Life in PUMCH requires a high level of self-discipline. Every day, I need to reach the hospital before 7:45 a.m. as the team handover session will start sharply at that time. Since there was a considerable distance from where I stayed to the hospital, I had to take both a bike and a train to get there. To ensure I was never late, I set an early alarm and prepared for any uncertainties, eg bad weather, by checking the weather forecast every day.

Besides that, I prioritize my hospital work and only plan the sightseeing activities for the weekends. However, if I finished early at the hospital, I would take the opportunity to explore the city.

6. Your plan for next week (Week 4)

Next week would be the last week of my elective posting and I will be placed in another department which is Urology department.

Matrics Number: A188948

Date: 22 July 2024

2. Your progress so far

Continuing my journey from the last post. During the weekends from 12 July to 14 July, we went to the famous "Blue Pearl" of Morocco, the town of Chefchaouen. Being a town sitting in the middle of the mountains, with all of their buildings and infrastructures painted in blue, this town offers a painting-like scenery for all the visitors. I was really mesmerized by the beautiful scenery.

After the trip to Chefchaouen, we went back to Oujda for our clinical attachment. The strike is still going on this week unfortunately thus the main operation room has yet to be opened. This week, I got to observe another surgery to clean a big infection at the thigh that involves the femur bone and the surrounding soft tissue. Since the bone was infected and there are not enough mechanical support for internal fixation, an external fixation was arranged for this patient. Other than surgeries, it was the usual ward rounds, bandage changing and consultations.

Outside of clinical attachment time, the local committees arranged a karting session for us. I got the chance to kart near the Morocco-Algeria border since the karting place (and Oujda) is very very near to the border with Algeria. Also, this is my very first time karting, so I drove like a grandma while the others zoomed past me. According to the local committees, the little kids in Oujda like to come here and kart a lot, I appreciate that I had the chance to experience what they like to do.

During the weekend of third week, we get to go on a trip to Essaouira, a town beside the Atlantic Ocean, as well as the famous cultural center of Morocco --- Marrakech. It was really interesting that I get to see many faces of Morocco in terms of weather and terrain. In Essaouira, the weather was cold, windy and humid with an average of 23 degrees Celcius throughout the day due to it being near the ocean. As for Marrakech, the temperature rises to a whopping 43 degrees Celcius during the day and it was like being in an oven, this is due to Marrakech being located in-land in the middle of the country with no sea or beaches nearby.

Overall it was really a fun week. I felt more and more comfortable interacting with people in the hospital and I've been learning a lot and asking a lot of questions. And with all the trips I've been to, I can say that the diversity of this country really fascinates me.

3. Your feelings and thoughts

• Interested: With the trip to Chefchaouen last weekend and to Essaouira and Marrakech this weekend, I get to experience a lot of different stuff, which made me interested to explore more about this country.

• Grateful: Once again, I felt really grateful to the Professors and doctors in the hospital. One day, I was joining the consultation session and some medical students were there as well. Usually, the Prof will translate everything for me but that day, due to the local medical students being in the consultation session as well, the Professor tend to explain in French and Arabic at first, which I completely understand why he did that, so I tried my hardest to understand through his body language and the X-Ray films he showed us. But to my surprise, after explaining everything in their local language he turned to me and started explaining again in English, which really really touched me.

• Happy: I felt really happy that I am already starting to love this place and a part of me even felt sad having to think about leaving Morocco next week.

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

• Deciding which country to choose: This may be before the elective program started but I consider it as one of the crucial experience I've gained through this elective posting. I had a lost of countries to choose from to do my elective posting, but after a series of listing out the pros and cons, asking for advices and searching online, I decided to go for Morocco. And I can say that this decision may be the best I've made.

• Deciding whether to join the social programs held by the local committees: All the social programs held are not compulsory for us to join, and sometimes (especially the first week homesick phase) I find it especially hard for me to want to join those programs. But I decided to let my brain work on deciding rather than my heart, by prioritizing the amount of experience I wanted to gain here in Morocco rather than the comfort, I chose to join all the programs, never ever regretted it. I would even thank myself for deciding to join everything and socialise with others, if not, I could still be homesick until today.

• Deciding on the treatment for the patients: In the hospital, I get to see our Prof and doctors making decision on what is best for the patient everyday. From arranging surgical procedures for patients to small things like what to use for wound cleaning. And throughout the clinical attachment sessions, even though I do not have the ability to directly decide treatment for patients, the doctors would constantly ask and quiz me on what to ask patients and what to prescribe to patients.

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

It was not really that hard to manage my time during the elective posting, because like I've mentioned above, I wanted to maximize my expeirence here instead of being comfortable in my own bubble. So during the weekdays from 8am to 12pm is the clinical attachment session, and afterwards, I will join any social programs held by the local committees or gathering held by us exchange students. If there are no activities or gatherings, I will spend my free time calling my family members, going through social media, take a walk outside to take pictures around or even sit down to study regarding traumatology (just occasionally haahaha). I would really have to thank the local committees for arranging a flexible schedule with various extra-curricular activities for us to maximize our enjoyment here in Morocco.

6. Your plan for next week (Week 4)

• Complete my handbook

• Buy gifts for my supervisors

• Write postcards (that I've brought here from Malaysia) for the other incoming students and some committees as parting gift next week

• Plan a trip to Tangier (another city in Morocco) with other incoming students.

Koay Hong Xin, A189444, 22 July 2024.

2. Your progress so far.

This week, as usual, I attended ward rounds every day at 8 in the morning. Before the ward round, the superior doctors in our team gave us some teaching on certain topics and cases pertaining to cardiovascular diseases. I managed to shadow a medical officer in my team and I truly appreciate myself for making this decision as I learned a lot by attaching myself to him throughout the week. I had the opportunity to clerk patients, perform ECG on a number of patients, and observe the entire flow of how they manage patients from admission to discharge. I was given the opportunity to type patient's medical records via the hospital's internal system as well. He was so nice that we often had nice talks to learn more about both countries' healthcare systems, had lunch together, and even played badminton together after work. On the last day of my elective posting in the department, I joined a case-based discussion with my doctor and was given a quick but thorough revision and discussion on ECG interpretation, and that is where the knowledge I gained during my internal medicine posting in year 3 was applied.

3. Your feelings and thoughts.

Doctors here are so nice and willing to teach They are so experienced and knowledgeable that they will give you a full thorough explanation whenever you ask one simple question. They buy me beverages almost every day and celebrate my farewell on my last day in the department. I am indeed grateful for the great exposure to cardiology that I have had here as I did not have such big exposure to cardiology back in my internal medicine posting.

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

Decision-making is indeed important, especially when it comes to dealing with difficulties on your own in a totally different environment. For instance, clerking patients in purely Mandarin was a bit challenging for me as I was used to clerking patients in English or Malay over here in Malaysia. It was quite challenging to translate certain terms from English to Mandarin on the spot when talking to patients. Therefore, in order to tackle this issue, I knew I had to do something. I decided to analyse which option would help me the most in this situation and eventually came to a decision that I had to attach to someone in the department for me to familiarise myself with how they clerk and talk to patients here. Thanks to my decision-making skills, by attaching myself to the medical officers, I observed how doctors here in China usually talk to patients, ask questions, and clerk patients. Subsequently, I applied it when I was alone clerking patients, and it indeed smoothened my conversation with patients here.

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

On weekdays, I went to the hospital every day at 8 in the morning to follow ward rounds. After that, I spent the rest of the day on a variety of clinical activities and teachings in the department until late afternoon or evening. I usually had my lunch at the hospital. There were 4 canteens on the campus, and I was truly amazed by the food and prices here. The food was so delicious and cheap, and they even had a device at the counter that would display the amount that you had to pay by just scanning the food that you took. It was so efficient, and I was really surprised by their technologies in China. At night, depending on my availability, I usually spent my time either studying and revising cardiology-related knowledge or visiting some nearby popular tourist spots. On weekends, I took the opportunity to visit several famous and fantastic tourist spots and enjoy the breathtaking views of China.

6. Your plan for next week. (Week 4)

This is the end of my 2-week clinical elective posting in SAHZU, China. I truly appreciate the opportunity, and the fantastic exposure obtained here. Again, deciding to conduct my elective posting in SAHZU is definitely one of the best decisions that I have made in my journey as a medical student! Next week, I am planning to spend my last week traveling to more places and enjoying my time in China.

 Lee Jun Jie

A187968

12.08.2024

2. Your progress so far

On my first day in the Breast/Endocrine department, I met my new supervisor, Dr. Marc Ong Weijie. By 7:30 a.m., I joined the department meeting at the Learning Centre in Tower B and then accompanied my supervisor on the morning ward rounds. Afterward, we took a morning break, and my supervisor brought me to observe his OT sessions.

On the second day, I returned to the Learning Centre in the Cardiovascular Centre to attend the morning meeting with the emergency team, followed by the morning ward rounds. This was because my supervisor is also part of the emergency team. Later, Dr. Janna, a medical officer, brought me to observe an open surgical repair of a bilateral hernia. I was surprised and thrilled when I was offered the opportunity to scrub in and assist with the operation. This was my first hands-on experience in surgery. Although I was performing minor tasks like holding instruments or cutting sutures, I felt incredibly satisfied as I had always dreamed of participating in a surgery during my time as a medical student.

On the third day of the week, I joined my supervisor’s breast clinic at 9 a.m. I noticed that the clinic had fewer doctors because all the appointments were scheduled, which showed a very systematic approach to managing outpatients. Each clinic room had at least one nurse assigned to assist the doctors. During the session, my supervisor taught me by asking questions and even allowed me to palpate the lumps or bumps on patients. In the afternoon, I followed Dr. Janna to the OT to observe a right breast mastectomy. I was fortunate enough to scrub in and assist with the operation again.

On the fourth day, I was unable to join my supervisor’s general surgery clinic as he was accompanied by two medical students from NUS. So, I decided to spend the day with Dr. Janna instead. During her clinic, I observed a patient who became inpatient and frustrated after waiting for about 40 minutes, which surprised me, given that their outpatient system is generally more organized than in Malaysia. Meanwhile, I made a new friend, a Year 5 medical student from Germany. We had lunch together and exchanged information. I was shocked to learn that in Germany, House Officers are not paid until they become Medical Officers.

The fifth day marked the last day of my clinical posting at KTPH. I followed the usual routine by joining the morning meeting and ward rounds. Later, I had the chance to meet some UKM seniors who were working at KTPH. They generously shared their experiences about the differences between the healthcare systems in Singapore and Malaysia, including details about the salary as a House Officer. Afterward, I handed my evaluation and attendance forms to my supervisors for their review and signatures. As a token of appreciation for their guidance during my two-week posting, I bought them some chocolates. Finally, a photo session with the team marked the end of my clinical posting at KTPH.

3. Your feelings and thoughts

I felt sad because that my elective posting was short just about two weeks which I just started to familiarise the working system and environment in KTPH. During this two weeks, I met one Year 4 medical student from University Malaya and one Year 5 medical student from Taiwan. From the conversation, I found out that UM medical students do not have to pay for the elective fee in Singapore as UM has the partnership with NUS. I wished that UKM could have partnership with NUS in the future.

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

The skill of decision-making played a crucial role in my elective posting (EP) journey. Despite having the option to visit many overseas countries with vastly different social demographics compared to Malaysia, I chose Singapore for my EP. I’ve always been intrigued by how Singapore, despite being so close to Malaysia and sharing a similar social demographic, has a markedly different healthcare system.

Considering the exchange rate between the Singapore dollar and the Malaysian Ringgit, it was a tough decision to choose Singapore for my EP. Fortunately, my family was able to support my expenses, and I could stay with relatives to save on accommodation costs.

Additionally, several UKM seniors have chosen to work in Singapore instead of serving in Malaysia. This sparked my interest in exploring Singapore’s healthcare system and working environment. I hope to learn from this experience and bring back insights to improve Malaysia’s healthcare system.

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

During the weekdays of my elective posting, I diligently followed my supervisors through their daily routines, participating in ward rounds, patient consultations, and joining as many OT sessions as possible. These experiences were invaluable in providing hands-on learning and exposure to various medical procedures. In the evenings, I dedicated time to revising and deepening my knowledge, ensuring I was well-prepared for the challenges ahead.

On weekends and holidays, I took the opportunity to explore Singapore with my friends. We traveled around the city, immersing ourselves in its vibrant culture, enjoying the breathtaking scenery, and indulging in the diverse and delicious cuisine that Singapore is renowned for. These outings offered a perfect balance to the intensity of my clinical work, allowing me to appreciate both the professional and cultural aspects of my stay.

6. Your plan for next week (Week 4)

Next week, I’ll be heading back to Malaysia. Once home, I plan to organize and edit the photos and videos I took during my EP journey to create a project video. In addition to that, I’ll take a short break to recharge before diving into my next chapter—Year 4, which promises to be a more complex and demanding phase of my medical education.

• Name: Yong Zong Sheng

• Matric Number: A185595

• Date: 12/8/24

2. Your progress so far

• During the first day of my 2nd week in KTPH, I encountered an old man with a perforated peptic ulcer. This was my first time appreciating the free air under the diaphragm in the X-ray. Due to the perforated condition, his abdomen was full of gastric acid. It was an emergency case. They quickly sent the patient into the operating theatre. They underwent the laparotomy to use the omental to repair the big hole. This was my first time observing such a big hole in the body of the stomach. They also poured the sterile water into the abdomen to wash out the gastric acid. The operation lasted for 3 hours. During the operation, they asked me where the fluid had accumulated in the body. Fortunately, I managed to answer almost all the questions

• The following day I followed my supervisor to his clinic. I spent nearly 4 hours with Dr Anil. While waiting for patients, I took the opportunity to ask him for some opinions regarding my future career planning. At the same time, I could learn more about him. It was undeniable that I had learnt a lot from him. In the clinic I was able to observe how he dealt with the patients, how he advised the patients about the surgery and showed his professionalism throughout the clinic session. Meanwhile, I was also able to appreciate how benefit was the standardised medical system in Singapore. They could easily find the past medical history of the patients. I was amazed by this. After that, I went to observe the hernia mesh repair. Dr Anil showed me where was the inguinal canal and where was the inferior epigastric vessels. In this operation, all the textbook knowledge could be visualised. I got to know more about how they perform the repair of the abdomen wall.

• At the end of the week, I took photos with the team and sent some tokens of appreciation to the doctors who helped me a lot. I also managed to meet up with the houseman there including the senior from UKM. I had lunch with them and sought opinions for my future career planning.

3. Your feelings and thoughts

• I felt upset but it was a very meaningful learning trip in Singapore. Time flew so fast. I was already at the end of my elective posting. I could not forgive the people that I had met in KTPH. They lent their hands when I was lost and led me to the right pathway making me enjoy a lot during the clinical attachment. I never felt that I was the outsider in the team. They always treated me as their team member even though I could not help them much. I also felt proud of my national language, Bahasa Melayu. This was because I was able to help the surgeon translate the information while they clerk a patient who could not speak well in English. It was my honour to become the translator between them. I appreciated that my country, Malaysia had provided a chance for me to learn Bahasa Melayu during my secondary school. After the elective posting, I realised that my medical knowledge had been enhanced. It was undeniable that I had encountered a lot of different procedures, and I could be able to visualise the things that I had learned before. This could increase my experience in my life as a medical student. I felt upset because I just got familiar with the team but suddenly, I needed to leave them and back to my normal routine. For the past 2 weeks in KTPH was just like a dream and now it was time to wake up and move forward to accomplish my tasks. I wished to become as professional as them in the future.

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

• An 89-year-old patient with underlying multiple strokes, hypertension, diabetes and dyslipidaemia. He was sent by ambulance to the emergency department of KTPH due to a perforated peptic ulcer and his abdomen was filled with gastric acid. When he reached the hospital, he was already in a coma state. This was an emergency case, but Dr Anil and Dr Kang could not make up the decision immediately due to his age and past medical history. During the discussion, they said the prognosis of the patient would be very bad and required to stay in ICU for 2 to 3 days for observation. After some time, they came out with the decision that they had to try their best to save this patient even though the prognosis was bad. I could not understand all during the discussion. I tried my best to get the info and puzzled it up to have a better understanding, but I knew that they proceeded to the operation theatre. Through this incident, I had learnt to make the correct decision from Dr Kang and Dr Anil. After the operation, Dr Anil told me that sometimes as a doctor it was hard to decide. Most of the time they had no choice, the only choice was to try their best to save the patient. For example, Dr Anil said that if did not operate on the patient, he would die but if Dr Anil operated on him, he might not be able to wake up again if some complications of surgery occurred. Hence, he advised me that in the future if I became a doctor, I should try my best to save a life even though the prognosis was bad. After listening to his advice, I nodded my head. I could not apply this kind of decision-making during my elective posting but I would apply it in the future.

• During my elective posting, I applied the skill of decision-making to another kind of situation. There were 2 operations which I was interested in came together. I had to choose one of them to observe. After consideration, I chose the one that I never observed before, and I might get more information from the one I chose. Among ERCP and inguinal mesh repair, I chose the 2nd one to observe. Fortunately, I made a correct decision, I got the chance to understand how they repair the abdomen wall. Sometimes, we have to sacrifice something even though both were our favourites. In this situation, I did not choose ERCP because I had observed it before. Hence, before making any decisions, we needed to analyse them first and think of the pros and cons of both things.

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

• The day before I slept, I would list out the tasks that I wanted to achieve for the next day. Then I would prioritize the tasks to make sure that I could complete them within the time limit. Without the to-do list, I might just waste my time in the hospital. Sometimes it was hard to follow the timetable that I had met because there might be some changes or emergency things that would interfere with the schedule, but I had tried my best to follow it. The schedule was just a guide for me to know what I should do for that time. I also take some breaks between the tasks. Rest between the tasks would prevent me from getting fatigued and exhausted at the same time I could gather enough strength for the upcoming tasks.  I would make sure that I have enough time for my meals in KTPH.

• Moreover, the journey from my house to the hospital was around 1 hour. Therefore, when I was on the bus, I would take my iPad and do some revision before I reached the hospital. I would also do the same thing when I took the bus back to my house. In the hospital, I would bring the iPad along with me so that I could refer to my notes anytime I needed it. When I reached home, I would make sure that I had at least 2 hours of revision before I slept. Normally I would sleep around 11 pm so that I could wake up at 5 am. It was a tiring schedule, but it could prevent me from getting tired of not enough sleep and prevent me from getting scolded for not being able to answer the questions. Productivity was never an accident. It was always the result of a commitment to excellence, intelligent planning and focused effort.

6. Your plan for next week (Week 4)

• I planned to spend some time with Jun Jie and Jia Hui to walk around the attractive places in Singapore. I would like to take this opportunity to get rid of the tiredness and stress before I back to Malaysia.

• I planned to finish up my Padlet and poster for the upcoming 2 weeks before my year 4 started.

• I planned to document all my memories on the computer and transfer all the pictures onto the computer. I would also spend some time with my family before my year 4 started.

1. Your name, matric number, date

Name: V N Nuvaira Tasneem

Matric Number: A185408

Date: 8/7/24 - 12/7/24

2. Your progress so far

This week was very interesting as I had the unique opportunity to enter into robotic surgery OT and witness with my own eyes how the surgeon operates with the robotic arms. Before the procedure, I had a read through the patient’s case notes and realized that robotic surgery was indicated in this case mainly because it offered the surgeons a higher precision given the complex nature of the case. The patient was a 76 year old male who had recurrent right incisional hernia, divarication of recti and also denervation of left flank muscles. Due to the recent enlargement of his abdominal swelling, he sought treatment at his local GP clinic and was referred to NUH. At NUH, the surgeons reviewed his case and realized that robotic surgery had to be used in order to reduce the complications of surgery and also increase the chances of proper healing given his old age. Robotic surgery is different from conventional laparoscopy and traditional open surgery as it combines the surgeon’s skills with robotic technology to deliver a surgical procedure with higher degree of precision and improved patient outcomes especially in a case like this one. 

During the procedure, I witnessed how the surgeons had to work as a team to complete the procedure. Even though it was a robotic-assisted procedure, the surgeons had to work together from the initial step of properly setting up the robotic arms and ensuring that the lead surgeon’s maneuvering through the surgical console was synchronized with the actual execution by the arms. I realized that there were multiple times when there were errors in which the input by the lead surgeon was not translated into the correct output by the robotic arms. At this juncture, the surgeons who were stationed at the operating table, quickly stepped in to rectify the issue. This taught me the importance of having proper communication, teamwork and leadership skills in order to complete the procedure. 

This week I also had the chance to suture on a real patient. After observing two endocrine procedures, one total parathyroidectomy and one full thyroidectomy, the next case was a total excision of back lump. This case is a fairly simple procedure and my supervisor had given me the opportunity to close up the surgical site. After showing me the steps of performing a vertical mattress suture, my supervisor passed me the suturing needle for me to place the last few sutures. Before this opportunity, I had practiced at home the steps of performing a vertical mattress suture and also gained exposure to suturing through a university event. However, when in the actual position of placing the sutures on a real patient, it felt scary as one wrong step meant a scar on the patient’s skin. Hence, I realized the importance of practicing the essential skill of suturing and knotting whenever possible as these are important as a junior houseman. 

3. Your feelings and thoughts 

• Happy and grateful: for the learning experiences I got through this last few days of my elective posting

• Inspired: to seize greater opportunities and learn more through future postings

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

Decision making is a skill which I always grapple with as I often find myself in situations where I do not have the confidence to make a decision or take a very long time before I make a decision. Especially in this elective posting, there were several instances where I had to make a decision and realized that this is a skill I need to work on. For example, each day I had to make the decision as to what I wanted to accomplish that day and stick to it regardless of what happened that day. For example, I made the decision to get the chance of being able to suture on a real patient on my last day of posting. Hence, I had made sure I practiced enough using the suturing kit I had at home before I asked my supervisor for the opportunity. I also made sure that I familiarized myself with handling the surgical instruments. On the day itself, I made sure I went through the patient case notes before entering into OT so as to understand the patient’s condition. However, my supervisor had not allowed me to scrub in to suture until the very last case of the day. Hence, I still stuck to my decision of wanting to suture on a real patient and waited till the opportunity was given to me. Though it was tiring as I had to stand for a long time, I still managed to go through it and eventually got the chance to suture. Thus, I am very proud of myself for sticking to my decision and hope that I will be brave enough to pursue such similar opportunities in the future. 

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

Time management is also a very crucial skill and one I also have troubles with. This elective posting, I made sure I was prepared enough before each opportunity presented to me. Each day, I would make a mental checklist of what I wanted to accomplish that day and also the next coming days. After coming back from the hospital, I would reflect on the day’s happenings and prepare for the next day. For example, before I did my case presentation during the ward round in front of my supervisor, I made sure I had selected a good case which I was confident in and fully prepared my case with all relevant positive and negative findings from both history taking and physical examination. This required me to be disciplined in clerking cases and coming back to jot down my findings in a comprehensive manner. During the weekends, apart from spending time with family and hobbies, I also did some reading on my surgical cases so that I could reinforce the knowledge I gained during my time at the wards. In this way, I made sure that I was adequately prepared for each day, managed to learn from my mistakes and deepened my knowledge during this posting.

Name: Seenivasan Aparrna

Matric No.: A185410

Date: 10th August 2024

2. Your progress so far

The second week was a step up from the first week. There were so many interesting cases in the OTs this week. Examples include Bracka repair of hypospadias, a complicated bilateral inguinal herniotomy, emergency laparotomy for multiple bowel adhesions and Kasai procedure for biliary atresia! It was a great experience to scrub in and watch these procedures close up. Furthermore, the consultants involved in the surgery asked me questions on anatomy while dissecting the layers of the anterior abdominal wall. This served as a good refresher.

Furthermore, I was given an opportunity to remove a PICC line from a 12 year old boy. A medical officer taught me and assisted me throughout the process. She explained the uses of PICCs as well as the aftercare following insertion and removal of the PICC. This is when I learnt that after removal of the PICC, the patient has to lie flat for the next 2 to 3 hours! Thus planning the time of removal was crucial.

Apart from the OT sessions, I attended ward rounds as well as clinics just like in the first week.

During the clinic sessions this week, I got the opportunity to meet with medical students from NUS. We had a joyful conversation and got to know more about the curriculum and opportunities in each of our universities. They were fascinated by our opportunity to visit Hospital Teluk Intan (HTI) as part of the Internal Medicine (IM) posting.

Another interesting thing happened this week. I wore my UKM scrubs to the hospital. While I was at the hospital, many people, including patients and canteen vendors noticed the UKM logo on my scrubs and were delighted to know that I study in UKM. Furthermore, some even mentioned that they were alumni of UKM! 

3. Your feelings and thoughts 

This week was a very wholesome week as I got to meet and speak with many people. The meeting with fellow medical students of NUS was pleasing. Furthermore, the mini interactions with passers-by who recognised UKM was refreshing.

The end of this week marks the end of my elective posting at NUH. I am grateful for this wonderful  opportunity. Also, I feel honored for being offered a chance to attach to my field of great fascination. I am taking away an abundance of knowledge from this experience. Since this was the last week with the team, I prepared small gifts for the doctors as a token of appreciation and expressed my gratitude for everything. Their kind words and good wishes were uplifting.

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

Decision making is an integral part of medicine. Doctors make crucial decisions at every stage of management of a patient. I felt that this becomes even more difficult when it comes to pediatric surgeries as the risks and complications associated with every surgery might be greater in a premature infant, when compared to an adult. Such life changing decisions required very careful considerations. I was able to witness in person the process of considering various perspectives and options before arriving at a decision. This helped me broaden my horizon on decision making.

For example, a splenic lump removal surgery was held and it was supposed to be a simple uncomplicated laparoscopic surgery. However, during the procedure, the doctors noticed that the lump was attached to a large portion of the adjacent pancreas. It was then determined that a laparoscopic surgery was risky and was converted to an open surgery. The patient had Prader Willi syndrome and was not the most stable patient. Therefore, before deciding to change to laparotomy, the anesthetist was consulted on the risks associated with the decision. The anesthetist also advised on the time constraint that we might have with this decision. The nurses were also consulted on the availability of certain equipment required for the surgery. The doctors understood the situation and carried on with the decision, as it was the best option that we had. Eventually the surgery was successful as the splenic cyst was completely removed without any injury to the pancreas. Another important takeaway from this is the importance of making immediate decisions. I understood that knowledge and experience will provide us with confidence to make the right impromptu decisions. 

Throughout my EP journey, I had to make many decisions. One of which was deciding which course to choose. There were a myriad of options and choosing one was challenging. I chose my domain of interest as this was a one time opportunity and I decided to explore a new field. 

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

Generally the posting was very tiring as the ward rounds started at 7.30am and the day ended at 5pm. Travelling took approximately an hour and by the time I reached home, I am usually completely exhausted and there would only be time for dinner and rest. Therefore, the only time I had to look through whatever I had learnt on a particular day was the next morning. Therefore, I would wake up at 4am to revisit my takeaways from the previous day, prepare some questions for the next day and revise anatomy. Occasionally, this time was not sufficient. Therefore, I would spend my time during train rides to and fro the hospital as well as spare time before the ward rounds to complete my revision. 

6. Your plan for next week (Week 4)

I want to reflect on my elective posting and revisit all the important lessons I gained from this opportunity. I will also prepare an e-poster, to summarize my entire experience.

Name: WONG JIAN CONG

Matric Number: A188021

Date: 12th August 2024

2) Your progress so far:

Day 12- I joined my supervisor ward round followed by watching 3 back-to-back laparoscopic cholecystectomy, and I had the opportunity to cut open the removed gallbladder from the patient. At 1 pm, I joined the pre-op meeting, which was held every Monday, and throughout the meeting, I had lunch with other HPB surgeons and registrar, followed by a Prof. Shridhar clinic session in the afternoon.

Day 13: As usual, every morning starts with a ward round with my supervisor, and today I had the chance to watch a left lateral sectionectomy and microwave ablation of segment 6 of the liver with cholecystectomy on a patient, which took approximately around 6 hours of surgery.

Day 14: Today was quite special, where after I joined my ward round as usual, I had the opportunity to attach to one of the housemen together with a year 5 medical student from NUH. Throughout the day, I was taught about ordering scans and dealing with patients, and I had the opportunity to go to the emergency department to convince a patient who is an elderly woman who refuses to take IV hydrocortisone before her contrast scan. It was challenging as the patient insisted on not taking the hydrocortisone, and it took me about an hour explaining to the patient about the importance of taking the IV hydrocortisone, and in the end the patient finally agreed to take the medication.

Day 15: Today morning starts with a ward round as usual, and I watch some laparoscopic cholecystectomy, and I was able to help to cut open the gallbladder and insert it into the specimen bottle for a routine histopathological examination.

Day 16: Today was a day that I can describe as a once in a lifetime experience in which, after my usual ward round, I was attached to my supervisor for his private clinic session, where my supervisor had invited me to a liver transplant surgery that will be conducted at Changi Hospital for the donor and followed by the recipient surgery at NUH Hospital. During the clinic session, my supervisor, Prof. Glenn, had enlightened me with the liver transplant approach, in which he mentioned that the liver transplant program was introduced by the Ministry of Health in the chosen hospital.

Throughout the clinic session, we had a chat about the Malaysian medical system and the Singapore medical system, in which my supervisor, Prof. Glenn, was actually from Malaysia and is a friend with YBhg. Prof. Dato’ Dr. Razman Jarmin. We also had a talk on the comparison between laparoscopic and robotic surgery approaches.

After the clinic session, I had a quick meal with Prof. Glenn, and from there we headed to Changi Hospital for the donor surgery. I was fascinated at how Changi Hospital was, even though it was one of the oldest hospitals in Singapore. From there, we waited for another team who was my direct supervisor, Dr. Gao Yujia, and his registrar, and from there, we headed to the OT changing room. It took quite a while to find the changing room; as my supervisor said, even though this is his 3rd time in Changi Hospital, he was still confused at the layout of the hospital. In the operation theater, it was my first time seeing roughly about 26 staff standby for the donor surgery. Before the start of the surgery, my supervisor had instructed everyone for a minute of silence to respect the patient who agreed to donate her organs as the patient was pronounced brain dead.

Throughout the surgery, I had the opportunity to stand behind my supervisor throughout the donor surgery as my supervisor was explaining to me about his approach, and not only that, I was able to watch a kidney transplant surgery from the same donor from a Urosurgeon Associate Prof Lu Jirong from NUH hospital. After the surgery, we headed back to NUH hospital through ambulance, which was fun because I got to watch the ambulance speed its way back to NUH hospital to proceed with the recipient surgery, which was carried out by Prof. Alfred Kow under the supervision of Prof. Shridhar, and overall the total surgery took about 12 hours. To end the day, I did manage to join renal transplant surgery, which was taken place as well.

3) Your feeling and thoughts:

I felt excited because it was an eye-opening to watch a liver transplant surgery that started with the donor surgery at Changi Hospital followed by recipient surgery at NUH Hospital. I do understand and appreciate the donor for the organ donation, and I grasp the concept of timing when it comes to transporting the donor's organ from one hospital to another hospital.

Throughout the second week, I learned that not all conditions require surgery, as curing a patient requires healing as a whole and not just based on a specific disease. As far as the ward round throughout the ward round that I had joined for the past 2 weeks, I realized that each patient is as equally important as others, and having empathy is a skill that is required in medical healthcare services.

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

I would say decision-making plays a role throughout my EP journey, as I am the one that decides if I am to join the ward round, OT session, and so forth. From whatever I had witnessed and joined, it was my own decision because throughout these 2 weeks, I had the freedom to do anything I wanted. Instead, to gain maximum knowledge during the EP journey, I am the one that decides to make use of these 2 weeks to learn everything I can, which may benefit me for the upcoming year 4 postings. For example, instead of just watching the surgery, I have decided that I would love to go hands-on, and hence I took the courage to ask the surgeon to help to cut open the gallbladder and insert them into the specimen bottle, and I am proud to say that throughout about 8 laparoscopic cholecystectomy that I have watched, I was able to help the surgeon in terms of cutting open the gallbladder.

Besides that, I applied decision making in term of finding the best route and mode of transportation back and forth from hospital in which one day before the commencing of my elective posting, I took the time to try several route in which by the end of the day, I decide which route is the easiest and shortest from my apartment.

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

I would say that I have the privilege to live near NUH, and instead of waking up early, I woke up at 7.30 am, and it took me about a 10-minute walk to the hospital. However, it won't be time management without proper planning because from the first day until the last day, I had to plan everything in terms of travel route and mode of travel because managing time is important to me as I would love to benefit most of my time from gaining new knowledge.

6)Your plan for next week:

Go back to Malaysia.

Woong Jia Hui

A190103

26 August 2024

2. Your progress so far

This is my second week with the Paediatrics Haematology-Oncology Department in KK Women’s and Children’s Hospital, Singapore. As usual, I still had to follow the departmental schedule that was given to me on my first week here and join all ward rounds as well as clinics.

This week, I was assigned to join the team of doctors from Ward 76. 

On the 5th of August (Monday), I had the opportunity to join a lecture about childhood brain tumours by Dr. Enrica Tan after the morning ward rounds. I learnt that a greater proportion of pediatric tumours are infratentorial and low grade gliomas as compared to brain tumours in adults. The most common brain tumours in the paediatric population are medulloblastoma, low-grade astrocytomas of the cerebellum, and ependymomas. On the whole, the long term prognosis is better in children than adults. After that, I met Jia Dhong, a NUS medical student who was assigned to Dr. Soh’s clinic. We got along well and exchanged perspectives on medical education in different countries. Dr. Soh treated both of us to lunch after her clinic. After lunch, I joined Dr. Enrica’s clinic and met a patient with diffuse intrinsic pontine glioma (DIPG).

On the 6th of August (Tuesday), I spent most of my day joining Dr. Soh’s outpatient clinics. I got a short refresher course on alpha and beta thalassaemia from my supervisor after seeing two patients with different variants of thalassaemia in her clinic.

On the 7th of August (Wednesday), I joined the Oncology Weekly Grand Round and the house officers are kind enough to email me the patient summaries for the patients under their management so I could keep up with their presentation and discussion with the specialists. Also, my supervisor treated me to dessert because she remembered my birthday!

The 8th of August (Thursday) marked the last day of my clinical elective in this hospital. My supervisor evaluated me by asking me what I have learnt throughout my two weeks here. She also asked me to summarise a case I have seen in the ward so she knows that I am actively participating and learning from the doctors. I also returned my access card to the Education Office before I left. 

The 9th of August was Singapore’s National Day so I was not required to come to the hospital. 

3. Your feelings and thoughts 

I really admire my supervisor - Dr. Soh because she is a kind and patient person. She actually took time to read through the essays I wrote for my application to KKH and I could tell she is genuinely interested to teach me whenever we meet. She is also very down to earth and treats her colleagues with respect. I am grateful that I had the opportunity to encounter such a “mantap” supervisor.

On the other hand, it was bittersweet for me to finally end my EP journey in Singapore. I really enjoyed my time in KKH because these two weeks offered me an early exposure to Paediatrics. I am glad I chose Haematology and Oncology because these are subspecialties I did not get exposed to a lot during my postings back in UKM and I wanted to meet and interact with young patients battling childhood cancer and even haematological disorders and how the doctors manage these cases. It was emotionally challenging to see the patients struggling with such serious disorders but it was so rewarding to see them improve under your care.

My two weeks here were truly enriching and insightful as I built connections with the patients, doctors and even fellow medical students in Singapore. The warmth and appreciation shown by them makes it difficult for me to say goodbye.

This EP deepened my knowledge and sparked my interest in Paediatrics. I genuinely hope that I will be blessed to meet such kind people during my Paediatrics posting in UKM.

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

During ward rounds and clinics, the doctors taught me the importance of weighing different factors such as patient history, signs and symptoms, and lab investigation results before making a clinical diagnosis or decision. As childhood cancers often demonstrate non-specific nature and variable symptoms, my experience here really reminded me of how important it is for a doctor to be constantly updated and competent enough to make complex decisions to come to a correct diagnosis or to save a patient’s life.

Observing childhood cancer cases and haematological disorders also exposed me to the ethical dimensions of decision-making in medicine. I observed how the doctors here make decisions and tailor their management plans with the patient’s long-term quality of life in mind. The medical care team also had to emphatise with the parents or guardians of the patients and involve them in discussions regarding the patient’s condition so they can make an informed decision together. 

During ward rounds and clinic sessions, I had the opportunity to analyse patient cases with the guidance of the medical team. From this, I had to decide which symptoms, lab results and imaging findings were most relevant to the diagnosis and treatment plan for the patient. This taught me how to apply my medical knowledge to real patient scenarios. Also, I had to decide which details were most important to include during my case summary for my final evaluation with Dr. Soh. I learnt how to prioritise the main findings, relevant clinical information and to present my conclusions in a clear and concise manner. All in all, I had to assess my own decision-making processes while reflecting on my experiences during this EP journey and identify areas of improvement for myself.

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

I usually follow the department schedule given to me because it offers a structured blend of ward rounds, clinics, and academic discussions. From this I was exposed to a wide range of cases and had the chance to observe some procedures done on patients. 

My day usually starts at 8:30 a.m. but I have to leave my accommodation before 7:00 a.m. because the train will be really packed if I leave later and I might not make it on time. My morning commute to the hospital usually lasts thirty minutes so I will reach the hospital earlier. I usually use this time to study in the break room before joining ward rounds. I also use the time in between clinic sessions to rest or study in various rooms in the hospital. 

After 5:00 p.m. I will take the train back home. If I’m not too tired I will use this time to explore the shops nearby. The remaining time before I sleep was dedicated to activities such as watching videos, reading non-medical books and studying in my room if I am not outside.

6. Your plan for next week (Week 4)

• Go home and spend time with my family and friends!

• Visit more attractions in Singapore before I leave

1. Your name, matric number, date

NAME: SERENA SEET SU YUIN

MATRICS NO.: A189015

DATE: 12/8/2024- 16/8/2024

2. Your progress so far

MONDAY TO FRIDAY

In phase 3 of my elective posting, I was given more opportunities to observe more surgical procedures! Everyday, my mornings began with morning ward rounds and follow ups on patients. I also attached to the clinics of my department. I made friends with some NUS students who were also posted in the same department. They were incredibly friendly! It was so kind of them to bring me around the campus. We also hung out in the student’s room and had breakfast together with the rest of the HPB team! I was given the opportunity to observe a liver resection of a patient with Hepatocellular Cancer (HCC). The Medical Officer (MO) in the team talked me through the process of how it is done and remarkably, the dye used to indicate perfused sections of the liver.

On most of the days, I observed multiple laparoscopic cholecystectomies (Lap Chole). A  HPB registrar, who was an eye-opener to me, was kind enough to talk me through the steps of how a Lap Chole is done. It was astonishing! I collected the gallstones. The HPB registrar commented on how rarely green the stones were — just like jade and emerald. He said, and I quote, “ These stones can be personal jades.” We then took photos of them for memories!

My supervisor gave me the chance to my very first physical examination encounter on a patient with liver cysts! It was indeed a first! I was also given the chance to remove 2 gallbladders, dissect them, remove its stones and prepare the gallbladders for histopathology review!

I also got observed how an Intraoperative Cholangiogram was done! The MO who was in charge took the time to explain to me how it works and its purpose.

In that week, I also managed to discharge 2 patients under HPB team’s care. The houseman in charged guided me on how should one decide on discharging patients. Blood work was ordered to render the patient dischargeable.

In clinics, I was taught on the criteria to determine if a patient with a pancreatic lesion has to undergo a Whipple’s Procedure or local resection through Endoscopic Ultrasound!

Breaking bad news was also something I’ve learned. As I sat at the back of my supervisor in clinics, I observed and learnt how he broke bad news to patients and their families.

Friday greeted me with a big multidisciplinary team who joined the morning ward round. I was then told that there would be a liver transplant going on in the wee hours! My HPB team was assigned to the recipient’s transplant. The other HPB team was assigned to the donor’s care which was rested in Changi General Hospital.

However, the transplant got cancelled as the donor’s liver was found to be 70% fatty, hence was not ideal to be donated.

I got my evaluation forms signed by my supervisor which marked the end of my clinical electives here. 16/8/2024

3. Your feelings and thoughts

I am ultimately grateful to the people who I’ve met, the virtues they’ve shown and the knowledge shared upon me. The memories made and friendships established will always hold a special place in my heart.

“Don't cry because it's over. Smile because it happened. ”— Dr Seuss

Everything aside, I can’t wait to be back in Malaysia! They say home is where it heart is. Already missing the place I call home. :(

I was a bit blue to find out that the liver transplant surgery was cancelled, only to have an epiphany that the news arrived to the recipient of the liver was much more grievous.

As I stood outside the patient’s room to hear the bad news being delivered, I heard the weeping and the sorrows expressed by the patient. Couldn’t imagine how one is given so much hope only to be let down by the end of the day. My heart goes out to the patient and his family.

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

I learned the skills of decision making through several events in my elective posting:

1. Deciding on my elective of choice. As I had a huge interest in Surgery, I wished to have a good exposure in General Surgery before making it the choice of my specialty.

   
   

2. Discharging patients based on blood work and other several criteria stated.

   
   

3. Deciding between endoscopic ultrasound resection or performing a Whipple’s procedure.

   
   

4. Deciding if a patient is qualified for a liver transplant, be it the donor or the recipient.

   
   

5. Deciding on the size of liver being resected in the case of the HCC patient. It was aided by the use of an injectable fluorescent marker!

I applied the skill of decision making in multitude of ways. Decision making is an aspect I could never escape from and is practiced almost every day during the journey of the elective posting! As we were not given a logbook or a checklist to complete, most of the days I make my own decisions on the activities that I want to do with the team. Time did not go to waste! I decided to go for daily morning rounds with the team. My supervisors were kind enough to be my platform of activities relay. I made a bold decision to go for my very first night shift oncall in the first week! I also decided on which and how many surgeries to observe!

There was a time when I was given a choice to choose between a laparoscopic cholecystectomy and a liver resection. I had to make a decision because both surgeries were occurring concurrently. The liver resection was however conducted by the other HPB team. I had to make a choice to choose the surgery I wish to observe. Taking into account that I’ve watched a liver resection this week, I decided to go for the usual laparoscopic cholecystectomy. I also decided to take this posting one step at a time to master the fundamentals and the routinely done items in HPB before taking the high way to bigger surgeries like the liver resection. I am proud to say that I was very happy with my decision! My HPB registrar who was performing the surgery took the time to explain to me the steps of a Lap Chole. The MO, on the other hand, taught me some tricks on suturing a keyhole wound.

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

Time management is indeed a crucial aspect of my elective posting journey! As I decided to attend daily morning ward rounds with the team, I made my way to the hospital as early as possible to read up on several cases. I snack up before any surgical procedures. Surgeries could last for many hours. They sometimes have different surgeries with no rest in between! I adapted to the team’s daily routine pretty well.

I am also happy to report that I did not neglect my wellbeing during my electives here. I tried to maintain a good 7 hours of sleep. I exercise in the evening or during the weekends.

I was also able to make time with my family and friends for dinner and for several spontaneous excursions!

6. Your plan for next week (phase 4)

No words could describe how much I miss Malaysia and its local delicacies! I plan to make my way back to my home country by car. I may also make some touristy stops along the way! I also plan to complete the tasks assigned to me for my elective posting.

Name: Bhelvinder Singh A/L Surinder Singh

Matric Number: A190104

Date: 18/8/2024

2. Your progress so far

• I was able to visit the operating theatre (OT) and observe various surgeries and invasive procedures being performed by my supervisor and his colleagues. Some of the procedures I was fortunate enough to observe include endoscopic endonasal surgery (usually performed for surgical resection of a Rathke’s cleft cyst or pituitary microadenoma), endoscopic third ventriculostomy, craniotomy and meningeal biopsy (performed for a patient with leptomeningeal carcinomatosis). Endoscopic endonasal surgery and craniotomies were common since I managed to observe those procedures a few times. While I was in the OT, I saw many advanced surgical equipment being utilized such as the surgical telescope which allows neurosurgeons to operate using high-definition endoscopy and neuronavigation system which resembles ‘GPS for the brain’ thereby allowing neurosurgeons to determine and mark important sites on the head before operating.

• I was also invited to attend a dinner at the Palm Beach Seafood Restaurant organized by the Neurosurgery Department to felicitate renowned guests from abroad who were invited to speak at a conference being held at NUH over the next two days.

• The conference which I was lucky enough to attend was the Neurosurgery Pre-ASNO Symposium 2024. At the conference, I listened to presentations from many distinguished neurosurgeons, neurologists and neuroscientists from around the world. One of the presentations was a 3D presentation which required the audience to wear 3D glasses throughout the presentation to better appreciate the 3D model of anatomical structures shown. I also had the honour of meeting one of the Malaysian speakers, Dr. Azmi bin Alias who is currently the Head of Neurosurgery at Hospital Kuala Lumpur. There were also many of the latest, cutting-edge neurosurgical equipment on display at the exhibition booths outside the conference hall.

• Furthermore, I visited tourist attractions such as Gardens by the Bay, Cloud Forest and Flower Dome. I found Gardens by the Bay to be remarkable because of the colourful lights illuminating the towers and the surrounding areas. It was especially spectacular watching the light show which featured the lights switching to various colours accompanied by vibrant music.

• The phase ended with getting my supervisor to complete the posting assessment form and returning my NUH access card to the mailroom.

3. Your feelings and thoughts

• I feel thrilled to get the opportunity to observe first-hand live brain surgery of various types. It was a fascinating and one-of-a-kind experience which I shall cherish and take inspiration from.

• I feel that my elective posting journey has also encouraged me to muster up the courage and take the initiative to reach out to staff for help. I reflected upon this when I realized I needed help with getting directions to the OT and the changing room. Other than that, I also approached the staff for help to locate the schedule listing out the surgeries planned for the day.

• Besides, I am also grateful to be a part of many events organized by the Department of Neurosurgery such as the dinner and the conference. Their gesture of inviting me to these events had made me feel a sense of belonging. It was like I was being included intentionally since I am recognized and accepted as being part of the neurosurgery team.

• It was truly an honour and privilege for me to attend the conference as it has provided me with a vast exposure to the field of neurosurgery, the opportunity to network with renowned neurosurgeons and offering me an overall fruitful and unforgettable experience.

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

• Initially, I did not secure accommodation at the NUS campus hostel. Hence, I had to seek accommodation elsewhere. I read through a list of suitable out-of-campus accommodation suggested by NUH. The list included contact information and links to websites for each accommodation. I visited the websites and studied carefully the information stated. In most cases, the information was incomplete. Thus, I also contacted the person-in-charge via email to enquire further. After considering the information obtained about each accommodation, I shortlisted the entire list to just a few options based on aspects such as cost, facilities provided, distance from public transportation (i.e. MRT or bus station) and distance from NUH. I finally made a decision and emailed the documents required to register and make a booking at the hostel of my choice.

• Another scenario was when my supervisor asked to meet me at the operation theatre (OT) but I was unfamiliar with the location of the OT and the changing room. I was too nervous to ask my supervisor for directions to the OT since he might be busy preparing for surgery. I thought of approaching the staff at the counter instead but they seemed to be busy. After considering the options, I decided that the best course of action was to give the staff at the counter some time and then to approach them for help. Hence, after waiting for a minute or so, when the staff did not seem to occupied, I approached them and politely introduced myself making sure to explain that it was my first time going to the OT and that I was unfamiliar with the layout of the various rooms. Thankfully, the staff was friendly and they kindly gave me directions to the OT and changing rooms. Based on their guidance and relying on the few signboards scattered throughout the place, I managed to find my way to change into scrubs and get to the OT.

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

• I made sure to sleep early to ensure that I get enough rest. Being well-rested for the next day is important since it allows me to be punctual when arriving at NUH and that I am able to actively participate in the clinical activities.

• In addition, I set an alarm in order to wake up early. I also took note of the time taken for me to commute from the hostel to NUH by MRT. I will set the alarm daily while taking into consideration a few factors such as the time taken for me to get ready, the time taken to commute to NUH and the time I have to report at the hospital which usually changes from day to day.

• I also made a simple daily schedule in the form of a to-do list. The schedule included tasks or activities that must be completed throughout the day arranged chronologically and their designated times. Tasks or activities which were important or required urgency were highlighted to catch my attention in case I forgot about it.

• Fortunately for me, there is no time difference between Singapore and Malaysia. Hence, I did not need to make major adjustments to my usual schedule and I did not need to adapt to a new sleep-wake cycle.

6. Your plan for next phase (Phase 4)

• Pack luggage

• Check-out of hostel

• Depart from Singapore