Name: Dharmithaa Sree A/P M. Ravi Kumar

   Matric Number: A195517

   Date: 11 August 2025 – 16 August 2025

2. How is your progress?

This was my second week in the surgical department at PRS Hospital, where I had the chance to observe and learn under my supervisor, Dr. John, and his postgraduate student, Dr. Yadu. I observed three surgeries this week: disarticulation of the right metatarsophalangeal joint in a diabetic patient, open bilateral inguinal hernia repair with mesh, and a Milligan-Morgan hemorrhoidectomy.

I began the week by joining Dr. John on his morning ward rounds, where we discussed patients’ progress. I also observed wound dressings for post-op patients and learned how to manage them in the ward before discharge. I realized the importance of auscultating patients and inspecting surgical scars to rule out complications like atelectasis, paralytic ileus and bleeding. 

From the surgeries I observed, I learned about skin preparation, surgical draping, and patient positioning. During the open inguinal hernia repair, Dr. John explained the anatomical structures such as the spermatic cord and inguinal ligament, and showed how the mesh was anchored. Because I had prepared by reading the anatomy and steps beforehand, I could follow the surgery better and connect theory with practice.

In the outpatient clinic, I saw a patient with bilateral varicose veins and lipodermatosclerosis. I was excited to examine him because it was such a textbook presentation. I also got to assist in a Zadik procedure for an ingrown toenail which was my first time seeing it. During the procedure, I helped monitor the patient’s blood pressure.

Another highlight was donning a lead apron to watch an ERCP with sphincterotomy up close, which gave me a clearer understanding of the procedure. I also attended a case presentation by a postgraduate student on obstructive jaundice secondary to choledocholithiasis, alongside Dr. John and another general surgeon, Mr. Krishnan Nair. It was a lively discussion, and I actively participated by answering some of their questions.

Compared to last week, I felt more confident in answering questions and presenting myself. I was starting to adapt better, becoming more open-minded and independent in how I approached situations.

Outside the hospital, I explored Thiruvananthapuram by taking a city bus tour. It was a two-hour ride covering many historic and tourist attractions. The streets were beautifully decorated with Indian flags and lights for the 79th Independence Day celebrations on 15 August. I also visited Sri Padmanabhaswamy Temple, India’s richest temple, and was amazed by its historic architecture and sculptures. To top it off, I watched the much hyped Tamil film ‘Coolie’ at the cinema with my  friend. It was surreal watching a Tamil film in India as the locals here celebrate the release of a film like a festival. 

3. Points to remember from Week 2!

1. A mesh is sutured to the inguinal ligament, conjoint tendon, and transversalis fascia.

2. Blood mixed with stool suggests an anal fissure, while drops of blood after passing stool suggest hemorrhoids.

3. Colicky abdominal pain arises from hollow viscera, while continuous pain usually comes from solid organs.

4. Your feelings & thoughts

This week I felt more confident because I revised some topics before my clinical attachments. Still, I sometimes held back from answering even when I knew the answer, just out of hesitation. That’s something I need to work on. I am grateful for Dr. John’s guidance. He always makes the effort to teach during surgeries, especially anatomy, and often asks questions to keep me engaged. His explanations have definitely deepened my understanding. Outside of hospital life, I was genuinely happy to explore so many new places. I rarely go on vacations or tourist visits back in Malaysia, so this was refreshing. Plus, shopping here has been a bonus as clothes are much cheaper!

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

 Asking questions whenever I have doubts. It doesn’t hurt to ask, but it does take courage to start. This is something I’d like to practice everywhere.

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

I sometimes feel underprepared because here the emphasis is heavily on anatomy, while in HUKM the focus was more on clinical features, investigations, and management. To cope, I’ve been revising anatomy every morning before attachments. It’s a lot to take in, but slowly I’m covering more ground. Language is also still a barrier. After almost three weeks here, I can manage basic Malayalam and understand patient complaints, but navigating the city and holding conversations with locals can still be tough. 

7. Your plan for next week (Week 3)

For Week 3, I plan to revise one topic a day so I can answer questions more confidently and improve my participation. I’d also like to observe more surgeries to widen my exposure. I plan to spend some time with another general surgeon, Mr. Krishnan Nair, to learn from his patients as well. Outside the hospital, my plan is to visit Lulu Hypermarket, which is a very popular mall here to pick up some Indian attire and snacks to bring home.

2. How is your progress?

   During the first weekend I visited the Padmanabhaswamy Temple in Trivandrum Kerala. It was a beautiful temple with many police securities around the temple and then I visited the Padmanabhaswamy Street to do some street shopping such as buying accessories. It was very fun because there were plenty of designs at very cheap prices, so I bought a few accessories and ended my day.

   
   

   I started my week by attaching with Dr John's clinic and also joining his ward rounds. There were very few post-op patients in the ward, so the ward round was very relaxed. Dr John will always make sure that I am aware of the case before ward round and he will also ask my opinion towards each case. During the first ward round, the post- op cholecystectomy patient was still in the ward, and she was recovering well. Dr John also asked me a few advice that should be given prior to her discharge such as avoiding oily food because she just removed her gallbladder and her bile will be less concentrated, and she might experience dyspepsia if she consumes oily food. Dr also advised her to avoid lifting anything heavy because it might cause pressure on the suture and leads to bleeding. It was very nice to see a senior consultant surgeon explaining in detail the complications that the patient might encounter due to her actions, and he made it clear to the patient before proceeding with her discharge. He also advised me to make sure patients are clear with the do's and don'ts before discharging them.

   
   

   I also joined Dr John's OT which were Bilateral Hernioplasty and Hemorrhoidectomy. I felt the OT session was very fruitful because he lends me his Atlas Book of General Surgery to read regarding the surgery before he conducts the surgery. Hence, I had some idea on how the surgery will be held. During the Hernioplasty surgery, Dr John showed me the inguinal ligament, spermatic cord, rectus abdominis muscle, hernia sac and conjoint tendon. I felt very fortunate to see those anatomical structure on a real-life patient because I have only seen cadavers during my preclinical session and sometimes, I will not even be able to identify the structures but here the dr shows every structure clearly and explains it. During the surgery, Dr had a difficulty to adjust the mesh, and it was misplaced so he had to remove the mesh and place it again properly and suture it to the conjoint tendon and then neatly suture the muscle to avoid recurrent hernia.

   
   

   Next, I was also taught the Milligan-Morgan Hemorrhoidectomy. During the surgery, Dr John showed me how the hemorrhoid is held, ligated and cut. Then it will produce a flower shaped appearance and then the anal will be sutured carefully to avoid anal stenosis.

   I also saw many Diabetic Foot Ulcer cases in the Outpatient clinic. Mostly the patient came for their wound dressing and for their weekly check-up. There was also a toenail removal procedure because the patient had an ingrown nail with abscess which was causing pain and was not relieved after taking antibiotics and analgesia, so patient insisted on a nail removal.

   
   

   Not to forget, I also had the opportunity to take the city bus that is a double decker bus that brings the passengers around Trivandrum city, and I saw the Trivandrum city and historic places and also the Trivandrum Airport. I felt sad watching a flight take off because I was already missing my country, Malaysia. Next, I also went for "Superstar" Rajinikanth's movie at a nearby cinema to watch the movie Coolie that was released on the 14th of August 2025. It was a dream come true to watch the movie in India because people here celebrate his movie like a festival. Watching Thalaivar on the big screen in India really is a once in a lifetime experience because the energy, the whistles, the claps, the crowd going crazy… it’s not just a movie, it’s a full-on celebration.

3. Points to remember from Week 2!

   • A surgeon can make mistakes during a surgery so always must see and check properly before proceeding to suture the wound.

   • The blood vessels and nerve supplying the anal canal and identifying the type of hemorrhoid that will cause pain. Anal sphincter is also very crucial because damaging the external sphincter can lead to anal stenosis and patient will not be able to pass stool.

   • After removing gallbladder patient will still have bile production that is less concentrated, and it will directly enter the common bile duct from the liver and it will not be stored anywhere, so patient have to give some time to the body to adapt to the new mechanism of fat metabolism.

     
     

4. Your feelings & thoughts

   This week I felt that I manage to balance my activities because I went to the hospital for half day then the other time, I used it to study and also to go around the city and visit places and also spend my time in doing some shopping. I also felt like I have refreshed my anatomy a little and I was able to answer my Dr's question regarding the anatomical structures and events. I notice that India Dr's prefer to learn everything by relating it to the anatomy and Dr John is also slowly teaching us how to not just memorize the anatomy but to understand it and remember it. Hence, I feel very motivated to start my week 3 and to learn more tips on studying anatomy. I am also starting to love Surgery posting.

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

   I learnt how to examine ulcers because I always felt difficult to identify the ulcers, and I did not know how a venous ulcer will differ from arterial ulcer. However, here I am seeing Ulcer patient daily, so I have some idea on how to identify the ulcers. I think if I see a ulcer case I will have the confidence to identify the type of ulcer.

   
   

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

   Currently, I feel language is still a barrier because I could only understand a few terms in Malayalam and people here talk fluent Malayalam, so I learnt a simple phrase in Malayalam to say I do not understand. In addition, I feel here their medical school emphasizes more on the anatomy, so I have difficulties to cope with them because my anatomy knowledge is very limited, so I have to revise entire preclinical anatomy lectures

   
   

7. Your plan for next week (Week 3)

   For the upcoming week, I would like to practice talking in Malayalam with the locals here to improve my language. Next, I would like to visit a few more shopping spots and also Museums here and not forgetting a few more temples here. I also would like to observe a few more surgeries and also, I would like to refresh my anatomy knowledge by reading some flashcards as it will help me recall the lectures that I studied during preclinical.

1.

Name: Nurul Aisyah binti Jalalemping

Matric Number: A195804

Date: 18/8 - 24/8

2. How is your progress?

I feel much more confident navigating inside the hospital now. I had the chance to meet my supervisor, join the clinic, and observe some minor treatments. I’ve also encountered several rare cases and witnessed the collaboration of multidisciplinary teams in surgery, such as neurosurgery and craniofacial surgery, which were handled exceptionally well.

3. Points to remember from Week 2!

• Not every patient has the privilege to seek medical treatment. At the same time, there are people who can afford it and invest significantly in their health.

• Even though some diseases are rare and difficult to detect, patients still live with them. It is our responsibility as future doctors to continue discovering treatments and providing the best possible solutions.

• Patient care is never a one-person effort. A multidisciplinary team is essential—success in treatment comes from teamwork, not from a single doctor.

4. Your feelings & thoughts

I feel happy and excited, especially after meeting my professor. He is very kind and took the time to bring us to the clinic, explaining each case thoroughly after consultations with the patients.

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

I’ve become more open in asking questions to both residents and doctors, which has helped me learn more effectively.

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

The main challenge remains the language barrier, as patient consultations are conducted in Korean. I coped with this by relying on my supervisor, who kindly explained the cases to me in detail.

7. Your plan for next week (Week 3)

Heading back home🥹

Name: Hana Daniya Salsabila

Matric number: A185411

Date: 24-30 August 2025

2. What have you done?

By the second week, I felt much more adjusted to the daily routine in the pesantren. The schedule no longer felt as overwhelming, and I became more familiar with the flow of activities. Every night we continued our sharing sessions, where the students eagerly asked questions not only about medicine but also about life as a university student. It was heartwarming to see how much they looked forward to our presence.

In the mornings, I joined clinical rotations as usual with the bidan and other medical students. Because we were more settled, the teamwork also felt smoother, and we managed the sick students more efficiently. Outside of clinical activities, the interactions with the teachers became more natural. They treated us like part of their community, which made the environment even warmer.

3. Points to remember from Week 2

- Becoming more comfortable with the schedule

- Building stronger connections with teachers and students

- Continuing the nightly sharing sessions

- Participating in clinical rotations

- Enjoying the free Indonesian meals together

- Experiencing the pesantren environment more deeply.

4. Your feelings and thoughts

This week I felt more attached to the people around me. The students and teachers were very welcoming, and over time they started treating us like family. It made me realize how quickly bonds can form when we spend time learning, praying, and sharing together.

Another aspect that stood out to me was the food. Every morning and night we were served meals such as ayam kecap, sayur lodeh, and other comforting Indonesian dishes. I also enjoyed the local snacks like seblak, crispy mushroom, and rujak. Sharing these meals together was not just about eating but also about experiencing the warmth of Indonesian culture within the pesantren.

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

Unlike the first week, the second week was less about difficulties and more about adaptation. I already adjusted to the early mornings, long schedules, and late-night sessions, so the routine felt more manageable. The main challenge was perhaps saying goodbye each day, because the students had become so attached to us and we to them. It was touching to see their excitement whenever we spent time together, and this bond helped me cope with any tiredness.

6. Two words to describe elective posting progress so far

Nostalgic and meaningful.

7. What can be improved from your project?

I hope we can continue the legacy from the 1-2 week of short mini lectures, especially encouraging them to take care of their health and to dream big for their future. Clinically, I plan to keep learning from the bidan and lecturers while practicing the skills I have observed. Most of all, I want to carry the lessons of discipline, spirituality, and togetherness into my own life, even after this elective ends. I want to continue waking up at 4 am to pray and memorize Quran. The things I would like to improve is the lectures that we gave to them could be more varied and the audience could be bigger, we could attend the high schooler and middle schooler outside Pesantren while they were at school. I would love to also collaborate with my friends from the other universities that is currently doing their clinical teaching in Al Masoem to do screening and teaching them medicine related knowledges that would hopefully benefited them.

Name: Nurul Aisyah Binti Jalalemping

No. Matric: A195804

Date : 11/8/25 - 15/8/25

2.How is your progress?

I arrived in Korea on 9/8 (Saturday).

During the weekend, I went out with my friends and we spent our time exploring tourist spots and enjoying the city.

On 11/8, it was orientation day! At first, I thought the program was only for medical students, but it was actually open to fellows and residents too. I got to meet 4 other students, 2 international residents, and 3 doctors who are doing fellowships in Asan. Even though all of us started on the same day, our duration is different. Students like me will be here for 2 weeks, while fellows and residents are staying for up to 3 months.

In the Plastic Surgery Department, I am the only student, together with 2 international residents from UAE.

The hospital is really huge. Judy, our person in charge, welcomed us warmly and showed us around our departments. She was very kind and answered all our questions patiently. Sadly, I haven't met my supervisor yet because he had other appointments the whole week, but I did get to meet his Korean and international residents.

From 12/8 (Tuesday) to 14/8 (Thursday), I observed several surgeries, including:

Scalp reconstruction using DIEP free flap. It amazed me how they used skin from the abdomen to reconstruct the scalp. 

Excision of a tumor in ababy's finger. The surgeon used skin from the sole of the foot to graft on the finger, so the baby wouldn't lose movement from skin retraction.

Eyebrow fixation in a patient with facial palsy. It is to improve facial asymmetry.

Breast reconstruction on patient with Invasive lobular carcinoma of the breast (NASSM, SNB, Rt.)

3. Points to remember from week 1!
   

   • Each surgery is a valuable learning experience.

   • Small details in surgical techniques matter.

   • Communication and teamwork are crucial in healthcare.

   • Always ask questions if unsure,not everything can be solved with Google or Chatgpt

   • People are generally very willing to help if you reach out.
     

4. Your feelings & thoughts
   
     I was a little disappointed that I couldn't meet my supervisor yet, but at the same time I feel very grateful to have met his residents. Overall, the week has been eye-opening and exciting.

5. ONE good thing from what you did that you can practice now!
   
   Discipline and punctuality. Observing how strictly the doctors followed their schedules made me realize that time management is not just important but essential in medicine. This is something I want to carry into my own academic and professional life

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

- Language barrier: I only understand a little Korean, so I relied a lot on Papago and Google Translate.

Halal food: The cafeteria food was tricky since the main dishes were usually pork or non-halal beef. I managed by eating only the side dishes like fishcake and kimchi.

-Hospital size: The hospital is so big that 1 got lost on my second day! It took me nearly 30 minutes to find the operation changing room. I had to ask around using Papago and call Judy for help.

Thankfully, everyone I met was very kind and helpful.

7. Plan for Next Week 2

• Finally meet and get to know my supervisor. Observe more surgeries in the Plastic Surgery Department.

• Learn more actively by asking residents and fellows about techniques and procedures.

.Get more familiar with the hospital layout so I won't get lost again.

• Continue adjusting to the culture and language differences while making the most of this opportunity.

Name: Hana Daniya Salsabila

Matric Number: A185411

Date: 04 – 28 August 2025

2. What have you done?

Every night we had a sharing session in the form of a mini lecture, where I had the chance to speak as a medical student, sharing my experiences and answering the students’ questions. The biggest event was held on Friday night after the Isya prayer, when students from grade 7 to 12, both boys and girls, gathered for our lecture. We spoke about basic sanitary hygiene, which is very important in a boarding school, and also about first aid during accidents, since many of them are active in sports teams.

Every morning I joined the clinical rotation with the bidan and other medical students from Universitas Padjadjaran to help take care of sick students. We originally were asked to just be “Santri” and attend the prayer as well as mini lecture. But the curriculum staff suggest us to help Bidan Susi and the medical student from Unpad. This was a good opportunity to learn and apply what I have studied in a real setting. In the evenings we sometimes joined horse riding, which gave me a unique cultural experience and helped me understand the lifestyle of students in the pesantren. We prayed together, eat together and sleep together with the other Santri from Al Masoem.

3. Points to remember from Week 1

- Sharing sessions every night

- Praying together in the morning and at night

- Memorizing the Qur’an

- Clinical rotations every morning

- Horse riding in the evening

- Experiencing life in Islamic boarding school.

4. Your feelings and thoughts

I felt very excited because this reminded me of my own high school days, when I also felt unsure about the future and received guidance from seniors. Now being in their position, I could see how important it is to share knowledge and give perspective to younger students about university life.

Spiritually, I felt recharged. The environment motivated me to continue memorizing the Qur’an and gave me more discipline in my daily prayers. I was also inspired by the bidan and by my fellow medical students, especially those from outside the country such as Argentina and Portugal, as well as the UNPAD students. Their dedication and diverse backgrounds showed me how medicine is not only about science but also about collaboration and learning from one another. We also come to the school the day after Indonesia Independence Day so we get to see the students celebrate the day with traditional competition and performances.

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

The main difficulty was adjusting to the pesantren lifestyle. We had to wake up at 4 a.m. for morning prayers, followed by a lecture, then clinical rotations from 8 a.m. until lunchtime. In the afternoons there were sometimes sports activities or horse riding, and at night we attended prayers and sharing sessions until about 10 p.m.

At first it was tiring, but I coped by choosing to enjoy every moment and by reminding one another in the group to wake up and join the activities together. My only concern was whether I would be able to connect with the middle and high school students, but this quickly faded when I saw how enthusiastic they were and how warmly they welcomed us. They made us feel like family.

6. Two words to describe elective posting progress so far

Enriching and inspiring.

7. Your plan for next week (Week 2)

Next week I think I will be more used to the schedule. I plan to use my time to learn as much as possible from the lecturers and the bidan while staying consistent with prayer and Qur’an memorization. I also want to try motivating the students more, not only in their studies but also in balancing their health, spirituality, and daily life. I hope to continue learning and growing, both clinically and personally, while also building stronger connections with the students.

Name: Hayqa Afra Zahira

Matric Number: A185415

Date: 4–8 August 2025

2.⁠ ⁠How is your progress?

My first week at RSCM I spent in the paediatrics department.

It was a nice Monday morning; I woke up at 4 to get ready to go to the hospital—only to arrive 2 hours too early. To kill time, I had some bubur ayam somewhere along the way. At 8, Keisha and I went to the International Relations Office to begin our introduction and orientation.

We then went to the RSCM Kiara building, which is the mother and children’s hospital inside the RSCM complex. Since I chose paediatrics, there were clinical students from Universitas Indonesia’s medical faculty who were around the same age as us. It was also their first week of paediatrics posting, and because of that, my supervisor advised me (as I was doing my electives alone) to follow the students for the week.

For my first day, we had a perinatology lecture from Prof. Riri. She covered the basics (since it was the first day): newborn examinations, scoring systems to detect abnormalities right away, hyperbilirubinemia, red flags for jaundice, indications for phototherapy, and what to look for when a baby has sepsis. At 10, it was time for polyclinics. We went to the Child Growth and Development Clinic.

Here, I was attached to 2 residents. The first patient I encountered was a 6-year-old with intellectual disability. She appeared fine at first glance, but she had difficulty speaking and an IQ below 80. It was the first time I had heard about this in detail, and I was quite bewildered. The second patient was a 1-year-old with microcephaly. I could clearly see something was wrong—there was a significant groove on the baby’s head, and during the examination, she still couldn’t hold up her head. She was far behind her developmental milestones. During this clinic, I also had the opportunity to assess a healthy child (who came for her brother’s appointment). I had a great time playing and assessing—it was my first time doing this.

Next, we went to the immunisation and nasogastric tube (NGT) room, where the professor taught us all about vaccines—the types, administration method, and doses. She also allowed us to inject vaccines into a baby. The microcephaly baby I mentioned earlier was due for her vaccinations, which had been delayed due to her condition. She was given 3 injections simultaneously and one oral vaccine. I forgot exactly what they all were, but it was such a valuable experience. We also practiced inserting an NGT into children. After that, we discussed with the professor.

After the clinics, I met with my supervisor and went to the wards, where I was introduced to a child with biliary atresia. She and her family had travelled all the way from Medan for a liver transplantation. She was very jaundiced—almost greenish—with a large, distended abdomen and a very palpable, hard hepatosplenomegaly. While waiting for her liver transplant, she had vomited blood the day before and was admitted. I clerked her as I needed to join her OGDS the next morning for oesophageal varices bleeding. That sums up day 1!

On Tuesday, I went straight to Pusat Endoskopi Saluran Cerna (PESC) for the OGDS. I checked in with Dr. Mega, who was responsible for me for the next 2 hours, and also spoke a bit with the patient’s mother. During the OGDS, it was actually my first time seeing an active bleeding site and multiple esophageal varices. The doctor performed banding, and she was good to go. Then I joined fellow students in the nephrology clinic, where we did history-taking for a case of post-streptococcal glomerulonephritis—he had all the signs. We did examinations and discussed the case with the doctor. I then attached to a different doctor and saw a case I had never heard of before—Bartter syndrome! The doctor explained the condition, and the class ended. I also joined a case discussion on neonatal jaundice, where the doctor explained the red flags, when to be alert, what to check, and when phototherapy is indicated. The students were very active, and the doctor was an excellent moderator. I learned so much.

On Wednesday morning, we had a class in perinatology on the physical examination of neonates. I also went inside the neonatology ward, where the doctor demonstrated the examination on a real baby—they were really cute. Then I went to the general clinic and was attached to a doctor. I saw a case of retinoblastoma and also played with a child who was in for a broken arm follow-up. Later, I went to PESC to observe an OGDS and colonoscopy with Prof. Mita. The patient had GERD, ulcerative colitis, infective colitis, and suspected TB gut—quite serious, but also fascinating. I learned so much from Prof. Mita as she explained the presentations of the case.

On Thursday, I tried taking the bus to the hospital for the first time. It was quite easy as I didn’t have to transit anywhere, but the bus was only available until 6 AM, so once again, I arrived 2 hours early. In perinatology class, we learned about respiratory distress syndrome in preterm babies. I had the chance to see retrosternal collapse in person and auscultate grunting for the first time—it was a bit challenging since their breathing is irregular. Then I went to the gastro clinic, where most cases were GERD. It was fascinating to watch how Prof. Mita explained the condition to parents, both educating them and preventing worsening. This not only helped the parents but also taught me the importance of effective communication in medicine. Later, I went to the transplant clinic, learned a few things from the doctor in charge, and toured the clinic. After lunch, I went back to the wards to follow up on the patient who was about to be discharged—I was so happy for her!

On Friday, my last day in paediatrics, we went to the emergency department and learned how to triage paediatric patients. I clerked a patient with myasthenia gravis—exciting since I had just learned about it in my internal medicine posting. We then presented our findings to the doctor, who also showed us a cyanotic patient we had triaged incorrectly. She gave us examples and tested us on which photos showed cyanosis—it was a bit of a disaster, but a great learning experience. And thus, my week in paediatrics ended.

3.⁠ ⁠Points to remember from week 2!

There’s obviously so much to learn in paediatrics.

• Bring stickers for children to make it easier to lower their guard and clerk them.

• Paediatrics and adults have different cut-off points for diseases—always check the guidelines!

• It’s okay to make mistakes the first time, but always learn from them.

4.⁠ ⁠Your feelings & thoughts

im very happy in this posting, i feel like paediatrics is calling to me now. i want to implement all ive learned here to paedriatics posting in UKM

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

not something i cannot practice before but something that ive gained confidence in, HISTORY TAKING!. ive felt that i lacking in this departement but turns out im not that bad. this increased my confidence by threefold at least.

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

I had very little time to prepare before this and felt that I was behind my peers in terms of knowledge for this posting. As an international student learning in English, I also struggled with the abbreviations used in my own country. Now I know that if I want to survive after this, I need to study in both languages and refer to the guidelines. Thankfully, by following the local students, I received some help.

7.⁠ ⁠Your plan for next week (Week 3)

I’m getting into obstetrics and gynecology, which will involve caring for expecting mothers. I need to be more careful, prepare in advance, and study beforehand so I don’t appear clueless. I will focus on reviewing antenatal care, labour management, and common pregnancy complications, while also honing my communication skills to ensure I can interact sensitively and respectfully with both patients and families.

Name : Intan Ageng Heriani Fakhrunnisa

Matric Number : A185511

Date :Week 2 (18-24 August 2025)

2. How is Your Progress?
   We arrived at Al Masoem in the evening. On that very first night, the staff informed us that starting the next day, we would already be given the opportunity to handle some classes. At the boarding school, the students have regular night study sessions every evening. During these sessions, if any teacher is absent, we were assigned to replace them by either teaching health-related education or simply having a sharing session with the students.

   
   

   The students gave us a very warm welcome. In fact, many of them even requested to the curriculum division that we be assigned to their classes. Every time we entered a classroom, the students showed great enthusiasm by listening attentively and asking many questions. These questions were not only about health but also about university life, which they were curious about.

   
   

   As this is a boarding school, the religious activities (pesantren programs) are held in the evenings, while the formal school (general education) is conducted in the mornings until the afternoon. Therefore, when the students were busy with their general school lessons, we were free to use our time as we wished.

   
   

   In the mornings, around 8 AM, we joined the Al Masoem health team, which consists of one midwife and also clinical year medical students from Universitas Padjadjaran (Unpad) who were stationed there. Every morning, we examined students who were sick and unable to attend classes. On average, there were around 4–8 students who fell sick daily.

   
   

   One special experience was when two exchange students from Brazil came and also joined in examining the sick students. During this activity, we helped them with translation during history taking, since the students could not speak English fluently. After finishing the health checks, we usually had time to relax. Sometimes, we would buy snacks at the school canteen, or simply take some rest in our rooms.

   
   

3. Points to Remember from week 2

   - Strengthening interactions with both students and teaching staff is very important.

   - Listening to feedback and requests helps us adjust our approach to better fit their needs.

   - Maximizing every opportunity to answer students’ questions is valuable, as they are eager to learn and share their thoughts.

   - The provided facilities were enjoyable, especially the two delicious meals each day.

   - The school canteen offered a variety of affordable and tasty snacks.

   - We had the chance to try extracurricular activities, such as horse riding, which made the experience more enjoyable.

   
   

4. Your Feelings and Thoughts

   At first, I was nervous because I had no prior experience teaching junior high or high school students. However, as time went on, I started to enjoy the process. Even though I realized that teaching may not be my true passion, I learned that I am still capable of doing it when required.

   
   

   I also felt happy because I got the chance to practice horse riding again. During my student years at Al Masoem, the sport subject I chose was horse riding. Returning now as an alumna and being able to do it once more brought back many good memories.

   
   

5. One Good Thing From What You Did That You Can Practice Now

   One valuable lesson I gained from this week is that I managed to train myself to step out of my comfort zone. As an introvert, it was not easy for me to stand in front of a class full of students. However, I learned to face this challenge, and it made me grow more confident.

   
   

6. Any Difficulties or concerns? How did you cope?

   The main concern I had during this week was the fear of teaching for the very first time. To cope with this, I tried my best to prepare and practice thoroughly before entering the classroom. Fortunately, I also received support and encouragement from my friends, which helped me to overcome my nervousness.

   
   

7. Your plan for next week? Week 3

   For the upcoming week, we plan to focus more on the female students, since in the boarding school the male and female students are placed in separate buildings. However, we are also planning to organize one big session that combines both male and female students together. During that session, we aim to present health-related education that is relevant to all of them.

Name: Keisha Hanifa Alma Mayra

Matric number: A185507

Date: 4/8/25 - 10/8/25

2. How is your progress

During the second week of my elective posting, I commenced my rotation in Internal Medicine.

On the first day, I was oriented to the hospital by my supervisor, Dr. Anastasia, a consultant specializing in geriatric medicine. She guided me through the various facilities, including the inpatient wards, outpatient clinics, procedure rooms, and the dialysis center, while also explaining the structure of patient care within the department. This provided me with an important overview of the hospital workflow and patient management systems. The daily commute itself was a new experience, as I had to depart at 6 a.m. and take a combination of taxibike and MRT to ensure I arrived before 8 a.m. This was in contrast to my experience at UKM, where the hospital was within walking distance from the student hostel.

On the second day, I joined the nephrology division under the supervision of Dr. Dimas, a resident specializing in nephrology and hypertension. I participated in ward rounds and the general nephrology clinic. One of the notable cases involved a patient with severe hyperkalemia secondary to burn injuries. The management plan included administering salbutamol either intravenously (0.5 mg diluted in 100 ml dextrose 5 percent over 15 minutes) or via inhalation (10 to 20 mg over 10 minutes). This was particularly enlightening, as I had not previously encountered the use of beta-2 agonists as a temporizing measure for hyperkalemia. Another significant case involved a 22 year old male diagnosed with systemic lupus erythematosus (SLE) who developed rapidly progressive glomerulonephritis (RPGN). The consideration for renal replacement therapy highlighted the severity of his condition, and the rarity of SLE in young males made this an uncommon and academically valuable case.

Following ward rounds, I observed the insertion of a tunneled internal jugular venous catheter for dialysis access. In this case, the patient’s vascular anatomy was unsuitable for the creation of an arteriovenous fistula, illustrating the importance of individualized decision-making in vascular access. I also visited the hemodialysis unit, which accommodates 20 patients. I learned how the dialyzer functions as an artificial kidney, removing metabolic waste and fluid from the blood. A key learning point was the limitation imposed by Indonesia’s national health insurance, which only allows patients to undergo dialysis twice weekly, in contrast to international guidelines that recommend thrice-weekly sessions. This has significant implications for patient outcomes. I was given the opportunity to assist with the priming of the dialyzer, which emphasized the technical precision required before initiating hemodialysis.

On the third day, I continued my exposure to nephrology in the peritoneal dialysis (PD) clinic. Under the supervision of Dr. Hendra, another nephrology resident, I clerked and presented three patients. One patient had recently lost vascular access following removal of a tunneled catheter, and thus was initiating continuous ambulatory peritoneal dialysis (CAPD). Prior to commencement, she underwent a Peritoneal Equilibration Test (PET) to evaluate the transport characteristics of her peritoneal membrane, which would guide the prescription of dialysis exchanges. Observing this process allowed me to understand how PD can be an effective alternative to hemodialysis in selected patients, particularly in those with limited vascular access.

Later that day, I observed consultations in the kidney transplant clinic. Here, I gained insights into the multidisciplinary approach required for transplant candidates, including pre-transplant evaluation, donor-recipient matching, and long-term post-transplant care. I also learned about the necessity of lifelong immunosuppressive therapy which is tacrolimus (calcineurine inhibitors) in transplant recipients to prevent rejection, along with the importance of balancing immunosuppression with the risk of infection and malignancy.

On the final day of my nephrology rotation, I concluded with an engaging discussion session with Dr. Hendra. He patiently addressed my numerous questions, covering a broad spectrum of topics ranging from acute kidney injury to long-term dialysis management. This dialogue enhanced my understanding of nephrology as a specialty and highlighted the importance of linking basic pathophysiology with clinical decision-making.

On the fourth and fifth days, I transitioned into the endocrinology division. On the very first morning, I observed ultrasound-guided FNAB (Fine-Needle Aspiration Biopsy)  procedures, including the use of core needle biopsy and blood smear preparation. Although I had previously observed FNAB at UKM, what was new to me was the difference in practice. At UKM, FNAB is performed by the endocrinology and breast surgery team, whereas in Indonesia, endocrinologists from internal medicine are trained to perform it, since there is no dedicated endocrine-breast surgery unit. Dr. Tya explains to me that the patients undergoing FNAB were those with dominant or suspicious nodules on ultrasound, complex cystic nodules with solid components or recurrent cysts after aspiration, and cases with clinical suspicion of malignancy.

Following this, I joined ward rounds in the ophthalmology ward, where patients were admitted due to thyroid eye disease, secondary to Graves’ disease. I clerked three patients, all of whom were unaware of their thyroid condition until they developed prominent eye problems. Their eyes had become enlarged and difficult to close, with some cases complicated by keratitis. This was followed by an enlightening clinic session where I encountered patients with various thyroid conditions—some already in remission post-ablation with normalized TRAb levels and one year of symptom-free follow-up, and others presenting to the emergency department with thyroid crisis.

Beyond thyroid-related cases, I also encountered patients with diabetes presenting with Hyperosmolar Hyperglycemic State (HHS) and Diabetic Ketoacidosis (DKA), as well as cases of adrenal insufficiency, including Addison’s disease. One particularly memorable case involved a patient with a disorder of sex development, later diagnosed as 5α-reductase deficiency. These diverse encounters enriched my exposure to endocrinology and brought my second week of elective posting to a meaningful close.

3. Points to remember from week 2

• Learned hospital workflow and joined nephrology rotation (hyperkalemia, SLE with RPGN, dialysis access, PD, transplant clinic)

• Gained insight into dialysis limitations in Indonesia and assisted with hemodialysis preparation

• Observed ultrasound-guided Fine-Needle Aspiration Biopsy under endocrinology

• Clerked thyroid eye disease patients and saw thyroid crisis, remission post-ablation

• Encountered endocrinology emergencies (HHS, DKA, Addison’s disease) and rare case of 5α-reductase deficiency

4. Your feelings and thoughts

I felt both challenged and inspired during Week 2. Early mornings and a new commute tested my adaptability, while close supervision from consultants and residents strengthened my clinical confidence. Seeing severe and diverse cases, such as acute hyperkalemia, RPGN in a young man with SLE, dialysis access dilemmas, PD initiation, thyroid eye disease, and endocrine emergencies was humbling and highlighted the importance of integrating pathophysiology with bedside decision-making. Overall, the week reinforced my interest in internal medicine and motivated me to deepen my knowledge and technical skills.

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

One good thing I can practice now is systematic clerking and case presentation. For example, during the peritoneal dialysis clinic I clerked three patients and presented them to Dr. Hendra, which trained me to organize history, examination, and management clearly, something I can apply in future postings and bedside teaching.

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

• Difficulty 1: Adjusting to the early commute and long hospital hours was initially exhausting.
  Coping: I managed this by preparing my belongings the night before, setting multiple alarms, and using the commute time to review cases or guidelines, which made the journey more productive.

• Difficulty 2: Encountering many complex endocrinology and nephrology cases at once felt overwhelming.
  Coping: I coped by writing down key learning points after each case and clarifying doubts with residents and consultants, which helped me gradually build confidence and retain the information.

7. Your plan for next week (week 3)
In Week 3, I will be rotating through other divisions under Internal Medicine, including Infectious Disease, Pulmonology, Geriatrics, and Rheumatology. My plan is to actively participate in ward rounds and clinics, observe key procedures, and focus on understanding the clinical approach to common and complex cases in each subspecialty. I also aim to strengthen my skills in clerking and case presentations while noting the differences in practice compared to my previous rotations.

Name: Andi Nadine Saphira Aliyya Natasha Putri

Matric number: A185419

Date: 11th - 15th August 2025

2. How is your progress?

In the second week, we began our elective program. Each morning, after completing the pesantren routine of prayers, du’a, and Qur’an recitation, we went to the curriculum office for basic Arabic lessons. Around 7 a.m., we had breakfast together with the ustadzah and students, followed by a short rest before preparing for the health check.

The health check was provided for students who were unwell, both boys and girls. My friends and I assisted Bu Susi, the midwife, by helping with history taking, physical examinations, and occasionally suggesting appropriate medications based on our knowledge. To our surprise, we met some colleagues from UNPAD who were also doing their clinical attachment at Al Masoem. Along with them, there were two exchange students from Portugal and Brazil currently studying at UNPAD. It was unexpected, but we were happy to reunite with our UNPAD friends and also make new friends with students from another country.

In the evening, we conducted teaching sessions for the students that we have been planning for. After their school hours and pesantren activities, they gathered in a classroom where we delivered interactive lessons using the presentation slides we had prepared. Our day usually ended around 9 p.m., when we returned to our rooms, cleaned up, and rested. By the time the lights went out at 9:35 p.m., we could barely resist sleep and quickly drifted off. This schedule is similar everyday during the weekday and we had our day off on Saturday and Sunday.

On the final day of the second week, we held our main event, where we covered three topics: (1) management of sprains, strains, fractures, and wounds, (2) personal hygiene, and (3) scabies and other common skin diseases. I was assigned to present the topic on personal hygiene.

I call this our “main event” because, unlike our smaller sessions with only the female students, this time the program took place in the main hall, complete with a stage, an MC, and a moderator. Both male and female students attended, along with their ustadz, ustadzah, and even the head of the school. In total, there were about 200 people present, a much larger audience than before, which admittedly felt quite intimidating. Alhamdulillah, everything went smoothly. The students’ enthusiasm and active participation were exactly as we had hoped, making the event a truly rewarding experience.

3. Points to remember from week 2!

 It was finally time to deliver the results of our hard work in preparing the presentation. Creating slides is one thing, but presenting them is another challenge altogether. At first, everything went smoothly the students were enthusiastic, curious, and actively asking questions. However, I soon realized how challenging it can be to keep their attention and maintain engagement throughout the session. Since it was already evening, after a full day of activities, the students were understandably tired and ready to rest, which made it even harder to sustain a conducive learning environment toward the end.

As the days passed, I gradually learned more about the students’ learning styles. This helped me adjust my approach by adopting a lighter, more easygoing presentation style, making it easier for them to stay focused and less likely to feel bored.

In addition, this is from me to myself, by following the pesantren routine alongside the santri, I realized that nothing is ever too difficult, you just have to keep doing it and be accustomed to it. What felt challenging in the first week, especially the early start to the day, became much easier by the second week, once I had grown accustomed to it.

4. Your feelings & thoughts 

As I mentioned earlier, we had our main event at the end of the week, and I felt profoundly relieved once it was over. For an introverted like me, spending two hours with such a large crowd, let alone being the speaker, was truly exhausting. Nevertheless, it turned out to be a very memorable experience. The series of mini lectures we conducted throughout the week had prepared us well and gave us the practice we needed to perform well and confidently during the main event.

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

One significant improvement I can truly feel is in my confidence. This is something valuable that I will carry forward and apply in my journey as a medical student. From now on, I believe I can navigate my studies with greater self-assurance, especially when it comes to speaking up in class or delivering presentations. This experience has shown me that confidence is not built overnight but grows through practice and exposure. Standing in front of a large audience, sharing knowledge, and engaging with students has pushed me out of my comfort zone. It taught me that even as an introvert, I am capable of handling challenges that initially seem intimidating. I hope to continue nurturing this confidence so that it not only benefits me in academic settings but also later on when I will need to communicate effectively with patients, colleagues, and the healthcare team.

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

I can say that I have adapted well to the routine and haven’t faced any major difficulties. However, compared to my two friends, I do feel at a slight disadvantage when it comes to communication. Both of them are able to speak Sundanese—at least basic conversational phrases—which allows them to connect with the students on a different level. Since I cannot converse in Sundanese, the local language, I sometimes miss out on that extra layer of rapport. Still, I don’t see this as a major problem, rather, it makes me realize how much of an important role language can play in building meaningful connections with others.

7. Your plan for next week (Week 3)

I plan to maintain my confidence on our upcoming classes and aim to deliver the teaching sessions more effectively. In addition, I intend to stay consistent with the after-Subuh lessons with the head of curriculum, while also revising our family medicine materials as they are closely related to the students’ common health complaints. This way, we can offer better support and perform our role more effectively for the students. Equally important, I also hope to maintain, or even increase, our acts of worship, reciting and memorizing the Quran verses, as our remaining time as santri in the pesantren is limited.

Name: Keisha Hanifa Alma Mayra

Matric number: A185507

Date: 4/8/25 - 10/8/25

2. How is your progress

During the second week of my elective posting, I commenced my rotation in Internal Medicine.

On the first day, I was oriented to the hospital by my supervisor, Dr. Anastasia, a consultant specializing in geriatric medicine. She guided me through the various facilities, including the inpatient wards, outpatient clinics, procedure rooms, and the dialysis center, while also explaining the structure of patient care within the department. This provided me with an important overview of the hospital workflow and patient management systems. The daily commute itself was a new experience, as I had to depart at 6 a.m. and take a combination of taxibike and MRT to ensure I arrived before 8 a.m. This was in contrast to my experience at UKM, where the hospital was within walking distance from the student hostel.

On the second day, I joined the nephrology division under the supervision of Dr. Dimas, a resident specializing in nephrology and hypertension. I participated in ward rounds and the general nephrology clinic. One of the notable cases involved a patient with severe hyperkalemia secondary to burn injuries. The management plan included administering salbutamol either intravenously (0.5 mg diluted in 100 ml dextrose 5 percent over 15 minutes) or via inhalation (10 to 20 mg over 10 minutes). This was particularly enlightening, as I had not previously encountered the use of beta-2 agonists as a temporizing measure for hyperkalemia. Another significant case involved a 22 year old male diagnosed with systemic lupus erythematosus (SLE) who developed rapidly progressive glomerulonephritis (RPGN). The consideration for renal replacement therapy highlighted the severity of his condition, and the rarity of SLE in young males made this an uncommon and academically valuable case.

Following ward rounds, I observed the insertion of a tunneled internal jugular venous catheter for dialysis access. In this case, the patient’s vascular anatomy was unsuitable for the creation of an arteriovenous fistula, illustrating the importance of individualized decision-making in vascular access. I also visited the hemodialysis unit, which accommodates 20 patients. I learned how the dialyzer functions as an artificial kidney, removing metabolic waste and fluid from the blood. A key learning point was the limitation imposed by Indonesia’s national health insurance, which only allows patients to undergo dialysis twice weekly, in contrast to international guidelines that recommend thrice-weekly sessions. This has significant implications for patient outcomes. I was given the opportunity to assist with the priming of the dialyzer, which emphasized the technical precision required before initiating hemodialysis.

On the third day, I continued my exposure to nephrology in the peritoneal dialysis (PD) clinic. Under the supervision of Dr. Hendra, another nephrology resident, I clerked and presented three patients. One patient had recently lost vascular access following removal of a tunneled catheter, and thus was initiating continuous ambulatory peritoneal dialysis (CAPD). Prior to commencement, she underwent a Peritoneal Equilibration Test (PET) to evaluate the transport characteristics of her peritoneal membrane, which would guide the prescription of dialysis exchanges. Observing this process allowed me to understand how PD can be an effective alternative to hemodialysis in selected patients, particularly in those with limited vascular access.

Later that day, I observed consultations in the kidney transplant clinic. Here, I gained insights into the multidisciplinary approach required for transplant candidates, including pre-transplant evaluation, donor-recipient matching, and long-term post-transplant care. I also learned about the necessity of lifelong immunosuppressive therapy which is tacrolimus (calcineurine inhibitors) in transplant recipients to prevent rejection, along with the importance of balancing immunosuppression with the risk of infection and malignancy.

On the final day of my nephrology rotation, I concluded with an engaging discussion session with Dr. Hendra. He patiently addressed my numerous questions, covering a broad spectrum of topics ranging from acute kidney injury to long-term dialysis management. This dialogue enhanced my understanding of nephrology as a specialty and highlighted the importance of linking basic pathophysiology with clinical decision-making.

On the fourth and fifth days, I transitioned into the endocrinology division. On the very first morning, I observed ultrasound-guided FNAB (Fine-Needle Aspiration Biopsy)  procedures, including the use of core needle biopsy and blood smear preparation. Although I had previously observed FNAB at UKM, what was new to me was the difference in practice. At UKM, FNAB is performed by the endocrinology and breast surgery team, whereas in Indonesia, endocrinologists from internal medicine are trained to perform it, since there is no dedicated endocrine-breast surgery unit. Dr. Tya explains to me that the patients undergoing FNAB were those with dominant or suspicious nodules on ultrasound, complex cystic nodules with solid components or recurrent cysts after aspiration, and cases with clinical suspicion of malignancy.

Following this, I joined ward rounds in the ophthalmology ward, where patients were admitted due to thyroid eye disease, secondary to Graves’ disease. I clerked three patients, all of whom were unaware of their thyroid condition until they developed prominent eye problems. Their eyes had become enlarged and difficult to close, with some cases complicated by keratitis. This was followed by an enlightening clinic session where I encountered patients with various thyroid conditions—some already in remission post-ablation with normalized TRAb levels and one year of symptom-free follow-up, and others presenting to the emergency department with thyroid crisis.

Beyond thyroid-related cases, I also encountered patients with diabetes presenting with Hyperosmolar Hyperglycemic State (HHS) and Diabetic Ketoacidosis (DKA), as well as cases of adrenal insufficiency, including Addison’s disease. One particularly memorable case involved a patient with a disorder of sex development, later diagnosed as 5α-reductase deficiency. These diverse encounters enriched my exposure to endocrinology and brought my second week of elective posting to a meaningful close.

3. Points to remember from week 2

• Learned hospital workflow and joined nephrology rotation (hyperkalemia, SLE with RPGN, dialysis access, PD, transplant clinic)

• Gained insight into dialysis limitations in Indonesia and assisted with hemodialysis preparation

• Observed ultrasound-guided Fine-Needle Aspiration Biopsy under endocrinology

• Clerked thyroid eye disease patients and saw thyroid crisis, remission post-ablation

• Encountered endocrinology emergencies (HHS, DKA, Addison’s disease) and rare case of 5α-reductase deficiency

4. Your feelings and thoughts

I felt both challenged and inspired during Week 2. Early mornings and a new commute tested my adaptability, while close supervision from consultants and residents strengthened my clinical confidence. Seeing severe and diverse cases, such as acute hyperkalemia, RPGN in a young man with SLE, dialysis access dilemmas, PD initiation, thyroid eye disease, and endocrine emergencies was humbling and highlighted the importance of integrating pathophysiology with bedside decision-making. Overall, the week reinforced my interest in internal medicine and motivated me to deepen my knowledge and technical skills.

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

One good thing I can practice now is systematic clerking and case presentation. For example, during the peritoneal dialysis clinic I clerked three patients and presented them to Dr. Hendra, which trained me to organize history, examination, and management clearly, something I can apply in future postings and bedside teaching.

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

• Difficulty 1: Adjusting to the early commute and long hospital hours was initially exhausting.
  Coping: I managed this by preparing my belongings the night before, setting multiple alarms, and using the commute time to review cases or guidelines, which made the journey more productive.

• Difficulty 2: Encountering many complex endocrinology and nephrology cases at once felt overwhelming.
  Coping: I coped by writing down key learning points after each case and clarifying doubts with residents and consultants, which helped me gradually build confidence and retain the information.

7. Your plan for next week (week 3)
In Week 3, I will be rotating through other divisions under Internal Medicine, including Infectious Disease, Pulmonology, Geriatrics, and Rheumatology. My plan is to actively participate in ward rounds and clinics, observe key procedures, and focus on understanding the clinical approach to common and complex cases in each subspecialty. I also aim to strengthen my skills in clerking and case presentations while noting the differences in practice compared to my previous rotations.

Matric : A185416

21/08/2025 - 28/08/2025

What have we done?

Just like I mentioned on the first week, we started our clinic with introduction of the clinic and the doctors also the staff. It is important so we know our environment for the next 2 weeks.

This week we mostly observed how the clinic and the people in it operate, while observing we also participate with taking history of patients guided by the nurses. We also learned how to do ECG on our own directly into the patient. Here in the clinic mostly the patients are patient who need follow up, medical check up with underlying co morbidities and chronic history. By taking HOPI of patient we learned that most of patients have similar complaints and similar backgrounds. Really grateful by doing our own history taking, ECG, and medical recording I felt that we have a broader vision how to manage patient and how to recognize specific medical illness

Things To remember

History taking is even more crucial in cardiovascular system where you can directly know the diagnosis, management and treatment of the patient, patient usually came with similar symptoms, we learned things that need to be focused on at history taking, treadmill test, and echocardiography, patient may have “concerns” about pain on the chest but we have to be careful cause it still open to gastric and pulmonary problem”

Feelings and thoughts

Grateful that finally the things that we learned at pre clinic and clinical years specifically cardiovascular symptoms can be implemented directly into real situations where there many things to learn by making mistakes and experienced it directly

Difficulties

Not many things I struggled with because we had enough preparation for all the activities that we proposed in the proposal but going back to Indonesia maybe changed a bit how I approached patient with all differences in cultures

2 words to describe

Informative and learning

Name: Sashvini Sivarathanam
Matric Number: A194995
Date: 11 August – 17 August 2025

2. how is your progress so far
This week, I observed basic aspects of patient care typically performed by nurses, such as monitoring patients, assisting with daily needs, and providing bedside support. I also had the opportunity to enter the operating theatre (OT) and observe several surgeries, including a laparoscopic cholecystectomy and other general surgical procedures. These experiences provided valuable insights into surgical techniques, teamwork in the OT, and perioperative patient care.

Beyond hospital activities, I continued exploring Plovdiv and its surroundings. I visited the Plovdiv Museum of Archaeology and participated in the National Food & Drinks Party, where delegates shared traditional dishes from their home countries. I also went hiking to watch the sunset and took day trips to Asenovgrad to see Asen’s Fortress, as well as to Bachkovo Monastery, both of which offered fascinating insights into Bulgaria’s history and culture.

3. Points to Remember from Week 2

• Observation of patient care responsibilities and their importance in clinical practice.

• First exposure to surgical procedures such as laparoscopic cholecystectomy.

• Understanding the dynamics of teamwork and communication in the OT.

• Appreciation of cultural diversity through international food sharing and social interactions.

4. Feelings and Thoughts
I felt grateful for the chance to experience both the clinical and cultural aspects of this elective. Being in the OT was inspiring, as it allowed me to witness surgeries firsthand and understand how theoretical knowledge is applied in practice. At the same time, the cultural exchange reinforced how medicine brings people from different backgrounds together, both in the hospital and beyond.

5. One Good Thing I Can Practice Now
I learned how to carry out basic patient care, including blood taking and replacing IV drips. These are practical skills that I can continue to practice and refine throughout my clinical training.

6. Difficulties/Concerns and Coping Strategies
The major difficulty remained the language barrier with doctors and patients. I coped by relying more on non-verbal communication, observing closely, and asking mentors or colleagues for clarification when needed. This helped me to stay engaged and continue learning despite the challenges.

7. Plan for Next Week (Week 3)
In Week 3, I plan to take on a more active role in clinical settings by practicing the skills I have learned, such as blood taking and IV drip replacement, under supervision. I also aim to continue observing surgeries to broaden my surgical exposure and enhance my understanding of patient management in both ward and theatre settings.