1. Your name, matric number, date

Teh Ying YI

A188721

25 Aug 2024 (Sunday)

2. Your progress so far

This week, I assisted in consecutive hemithyroidectomy and total thyroidectomy surgeries, working for five hours straight. Additionally, I was involved in the implantation of a port catheter via the Pulmonary Artery Catheterization (PAC) procedure.

One of the most exciting observations of the week was Robotic-Assisted Thoracoscopic Surgery, a procedure I had not previously encountered in Malaysia. I was fortunate to observe from the surgeon's perspective, using the 3D view provided by the robotic control system. I also observed a Latissimus Dorsi Flap (LD) procedure, where the surgery was a collaborative effort between the oncology and plastic surgery teams.

3. Your feelings and thoughts

I am incredibly grateful for the opportunity to assist in most of the surgeries. Reflecting on my journey, I’m proud to see how far I’ve come—from repeatedly breaching sterility and needing to change scrubs or gloves, to now scrubbing in quickly and confidently without supervision. I was especially thrilled when Dr. Manong, the surgeon I assisted, praised me for being a fast learner and adapting well to her pace.

As my exchange nears its end, with only one week remaining, I can’t help but feel a bit down. I truly wish time would slow down so I could spend more time with all the wonderful people I’ve met here.

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

I've learned decision-making skills in various ways, primarily by seeking advice from my supervisors and by directly facing challenges.

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

I manage my time by prioritizing tasks and staying organized. I use tools like Microsoft To Do to create daily task lists, which helps me focus on what needs to be completed each day.

I also set aside specific times for planning, reviewing and working on key tasks. For example, every night before sleep I will plan the day for tomorrow and review the progress of the day.

Additionally, I try to balance my elective posting and social life by scheduling time for both, which really help me stay productive! What I usually do: Attend operation in the morning until afternoon > have my lunch with friends > research on the operation for the next day and study if required > go back to dorm and REST > outing for night!

6. Your plan for next week (Week 4)

• suturing on real patient

• assist in at least one surgery every day

• prepare farewell gifts and letters for my supervisor and exchange students

Hoh Chui Yan, A190102, 24th August 2024

2. Your progress so far

Entering my third week, I’ve been assigned to a new supervisor, Dr Jelena Zicković as my initial supervisor went for his vacations. It was like a new adventure again as I have to get to know the doctor and tagged along with her schedule. It had been a very challenging week for me with the adaptation. This is because the doctor was busy in different departments, made it difficult to find her similar to playing hide-and-seek with her everyday. When I reached the hospital, I had to check her a schedule at the surgery ward nurse station on fourth floor. After that, I need to check for her availability in different emergency departments and rooms until I got to find her. I’ve reflected the issue to the local committees of IFMSA in Serbia but we were still looking for a solution to it hoping to solve the problem. Despite this supervisor issue, I’ve tried my best to join the operation with other surgeons that I knew from the first two weeks but mostly in the emergency operation room. I observed a duodenum perforation lavage and gastrojejunal anastomosis. Some of the nurses and surgeons are kind enough to let me stand closer observe for a girl who dressed like a karate kid with her XXL scrubs. On Thursday, I decided to join the cardiology team students to observe Percutaneous Coronary Intervention. Other than the hospital routine, I hanged out with the other incoming students more often. We will hang out on the benches next to our dorm playing games in team, picnic in the park, and visit the Serbian’s favourite club. It was the moment when I, the introvert started to feel I can get along with the others.

3. Your feelings and thoughts

This week was full of mix emotions like anger, frustration, and happy. I was frustrated with the long hours of waiting and searching for my supervisor in order to get permission to join an operation. After liaising with the committees about my issue was much more devastated as they told me the new supervisor is not working under the faculty so they couldn’t help me to contact the doctor and it was the agreement between the first supervisor with the new supervisor. I felt demotivated to go to the hospital knowing that the language barrier with the nurses will take some time and not knowing the exact location to look for new supervisor. After days drowning myself in the emo period, I talked to my friends about my condition and it helped to ease my emotions. Hanging out with them also make me feel happier and better.

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

In my EP journey, decision making comes in many different ways from deciding what to eat, where to go, take the taxi or walk, speak Serbian or English and many more. I would like to commit I am a person bad in making decision and taking a long time to consider the choices. It’s even more complicated when I have to save money but spend more time walking or save time of walking but spend more money. After a lot of struggling in making a decision, I came to conclusion where I will go with the first thought that comes to my head.

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

On weekdays, I will wake up at 6am and start walking to the hospital that take 15minutes, reaching hospital by 8am. Then, I will spend two or three hours to observe operations and I am free to go back afterwards. I will walk back to the dorm, have a rest in the room waiting for the lunch to be served at student dorm canteen at 1pm. Later it’s time to chill and hangout again with friends at 4pm whether to go swimming pool, taking a stroll at the park, or watching them to play basketball. Dinner will usually at 7pm or later depending on eating in a restaurant or cook my dinner in the dorm with my mini cooker. At 9pm, I will take some time replying to message or emails of events. Lights off around 11pm.

6. Your plan for next week (Week 4)

· For the final week in Serbia, I plan to get signature of my certificate from my supervisor.

· I have to write small notes to every incoming students, total 21 of them.

· I also have to start packing luggage to go back home on Friday.

· Last but not least, need to be mentally prepare to start new semester of year 4. Reach Malaysia on the 31 st of August, fixing the jet lag while I have to pack things to move into dorm on 1st of September and starting semester on 2nd of September.

2. By the second week of my clinical attachment, I finally got familiar with the Dermatology Department’s schedule. On Mondays and Fridays, there will be clinics at the outpatient department, handled by the registras with the consultant rotating between rooms. During clinic days, the procedure rooms are still running, with the specialised nurses handling procedures such as biopsies, dressings, and removal of certain benign lesions seen by the consultant. On Tuesday through Thursday, there will be Micrographic Surgeries (MOHS) conducted by different consultants. I learned that each consultant have an area of interest (as in parts of the body they will focus more on), so on days where certain consultants are in charge of, they will mostly handle cases involving that area specifically. For example, Dr Ormond seems to be more inclined towards MOHS of the nose, and is very experienced in techniques used to suture the gaping hole left behind from excising lesions on the nose. I managed to observe MOHS of various parts of the face, including the nose, chin, eye and forehead, and watch the consultants teach the registras how to sketch out the parts to suture together, which are different on each part of the face because of how it moves around. I also managed to join a Lupus Clinic, which is conducted in conjunction with a nephologist and rheumatologist consultant. While I was hoping to observe the dermatological examination of an SLE patient, there unfortunately were no SLE patients in the clinic until AFTER I retired for the day.

3. I am quite satisfied with how much I managed to observe and learn from the Dermatology Team in the short 2 weeks I was attached with them. However, dermatology in St James Hospital is quite specialised, and Irish people are quite aware of their risk of developing skin cancer, so people who come here are mostly for suspicious skin lesions, and consultations are to rule out malignancy. Perhaps it was my lack of exposure to common dermatological presentations in Ireland, but I was initially hoping to see how the doctors here approach various skin lesions, including infectious or immune-related. Hence, when the majority of the patients I met were there for suspected skin tumours, I could not help but get a little bored. Looking back, of course they would be referred there to see a specialist for a suspected malignancy, they can just go to their General Practitioner nearby if it was just an itchy rash.

4. From observing dozens of MOHS surgeries, I have learned that the doctor (surgeon)’s decision making will heavily impact the patients quality of life. Since MOHS is mostly done on the face, it is a very delicate procedure, any error of judgement will affect the patients’ looks, movement, and daily functions. Hence, the registras will learn by meticulously sketch out the suture plans, and discuss with the consultant about the most appropriate technique to close the wound to ensure the wound closes perfectly with minimal scarring and allow the patients’ face to move as naturally as possible. I agree that it is not a life-or-death matter, but the patient is a person with a life to live, so care should still be given to help them comfortably get back to their life after the procedure.

Personally, the biggest decision to make during my attachment is planning out what to do every day. While I could have skipped going to the hospital for a day or two and no one would notice, I chose to go every day to at least learn something (even from a different department) because the effort it took to go all the way to Ireland was too big to waste lazing around.

5. The Dermatology Department is very specialised, and they don’t have wards, so their schedule is quite easy to get familiar with because it’s either clinic or surgery (MOHS). Hence, I will double confirm with the registras and nurses the day before what is the plan for the next day. Having this information will help me decide if I will stay for the entire day or just half a day. On days where it is just MOHS, I stay in the procedure room until lunch time, and explore other departments after lunch, or go out and explore Dublin city. On days with afternoon clinics, I go to the procedure rooms to observe daily procedures done by the specialised nurses in the morning, and attend the clinic in the afternoon.

6. My plan for the social phase of Week 2 is to go exploring another part of Ireland – Glendalough. I also intend to get souvenirs, pack, and rest up for my trip back to Malaysia.

2. Your progress so far
This week was relatively quiet. I arrived at the Hybrid OT at 8 a.m. sharp on Monday, only to find it empty. Fortunately, one of the doctors had previously given me his contact number, so I called him and met him in the vascular surgery unit. This week offered a different experience compared to the past weeks, as I spent most of my time in the wards rather than the operating rooms.

I accompanied the doctor on ward rounds, visiting the neuro ward, cardiothoracic ward, and abdominal surgery ward. Vascular surgery intersects with many other specialties, as it deals with the vascular system, so the doctor was kind enough to explain the various cases and procedures. He also gave me the opportunity to remove a temporary pacemaker from a patient, which was a new and exciting experience for me.

Additionally, I learned how to use a portable vascular Doppler. The doctor taught me how to locate and assess patients’ peripheral blood flow, including checking the dorsalis pedis and posterior tibialis pulses. It was challenging at first, but after some practice, I got the hang of it.

By now, I feel quite familiar with the operating room environment and can independently scrub in, which I’m proud of! This week, I observed various procedures such as dilatation and stenting, wound debridement, and carotid endarterectomy. However, the highlight for me was definitely the ward rounds, where I gained a deeper understanding of the pathology behind each case.

3. Your feelings and thoughts
I felt very eager to learn and excited to go to the hospital everyday, especially since the doctor was so helpful and willing to teach. I’m incredibly grateful for his kindness and patience. He really seemed to understand what medical students need—good guidance and hands-on opportunities.

Vascular surgery is vast and very interesting, and the experience made me reflect on how I would like to guide junior doctors when I am in his position someday. A supportive and encouraging environment really enhances productivity and helps students grow both academically and in terms of skills.

4. How did you learn and apply the skill of decision-making in your EP journey?
On Monday, when I found out that there were no surgeries scheduled, I was given the option to take the day off. However, I decided to stay because I had come all this way for my elective, and I wanted to make the most of every opportunity.

Although I didn’t understand the consultations and discussions between the doctor and patients, I was fortunate enough to have the doctor explain things to me and allow me to assist. This wouldn’t have happened if I had decided to go home that day. Staying gave me a valuable learning experience.

5. How did you manage your time throughout this EP journey?
I believe I managed my time well during this elective posting. I dedicated weekdays to learning and my hospital attachment, while weekends were for exploring the country and traveling.

I prepared for surgeries by reviewing what was scheduled for the next day, reading up on the relevant procedures in advance, so I could follow along more effectively and ask informed questions.

Since the sun sets at 9 p.m. in Belgium, the days are long, giving me time to relax and explore the city after leaving the hospital at 5 p.m. My time management allowed me to balance both learning and leisure.

6. Your plan for next week (Week 4)
Next week will be my final week, and my plan is simple: I hope to assist and help the surgeons and operating staff as much as possible, while learning as much as I can.

On my last day, I plan to give them some gifts—souvenirs from Malaysia. I’ve brought postcards and local snacks like Milo, teh tarik, and Maggi, which I hope they will enjoy.

1. Your name, matric number, date

Chan Meng Xian, A188342, 24th August 2024

2. Your progress so far

This week will be our final week with Dr. Ivan Simic because he will travel to Romania at the weekend and take a leave. At this week, we followed Dr. Simic to his night shift. We has seen some interesting disease including Lyme disease which is not existed in Malaysia. Apart from that, we also witness a patient went into asystole and eventually died despite Adult BLS performed. It was a strange feeling to witness this to happen as the patient being compressed so violently while there is no sign of her regaining her pulse.

We took our picture with Dr. Simic and said goodbye to him. He is a great teacher and always search for interesting content to teach us during the session. He also shared some insight about his career as an interventional cardiologist to us.

3. Your feelings and thoughts

This week, I has a mixed feeling. I am feeling more comfortable to talk with the other incoming students and we started to build closer bond among us. However, I also feeling sad that our exchange is coming to an end soon. I really like how the people treat each other here. They are friendly with each other, and I can feel that they are genuine to get to know me.

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

For me, I think sometimes we just should not think too much. Sometimes the worst choice might comes out to be good!

While deciding the country for my EP, Serbia is at my very bottom choice as this country is not well-known of its economy nor its technology. However, the interview result from the exchange committee of Malaysia given the seat in Serbia to me. I have very low expectation to the experience here as I thought I would not learn much in a less developed country.

However, I was wrong. I actually gained a lot of knowledge that is not medically related by talking with people from different background coming to here. Like one of my friend says: "Sometimes it's not the place that matters, the people is". I also has a great memorable friendship over here with the incomings.

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

I usually go to the hospital at 9 am and come back to dormitory at 12 pm. After lunch, I would use the afternoon to complete my to-do-list for my commitment in PERSIAP. If not I will just watch some movie. At the evening, I will go out and play basketball or go to the swimming pool with my friends. While at night, usually the other friends will ask to hang out.

6. Your plan for next week (Week 4)

My plan for next week will continue to enjoy my last week in Serbia, visit some of the places before leaving this place and have a good farewell with everyone I know here.

Having finished my two-week length summer course, I'm now setting out to explore the beauty of Medan and North Sumatera, Indonesia. Medan's vibrant culture, bustling streets, and rich history provide an exciting start to my journey. I wander through traditional markets, savour local delicacies like durian, and admire the colonial-era architecture. Beyond the city, North Sumatera reveals breathtaking natural wonders—lush tea plantations, scenic Lake Toba, and the majestic Sipiso-Piso waterfall. I also visit quaint villages where I get to learn about Batak culture and traditions. Each moment is a blend of discovery and wonder, deepening my appreciation for this incredible region.

Your feelings and thoughts

Exploring the culture of Medan and North Sumatera has truly left me impressed. The vibrant mix of ethnic groups—Batak, Malay, Chinese, and Indian—creates a rich tapestry of traditions and customs. I’ve been captivated by the warm hospitality of the people, their unique rituals, and their deeply rooted cultural pride. The Batak dances and traditional music tell fascinating stories of the past, while the beautiful Ulos textiles showcase skilled craftsmanship. Medan’s diverse culinary offerings, from spicy rendang to savoury soto, reflect its multicultural influence. Experiencing the dynamic blend of traditions and modernity here has deepened my appreciation for this remarkable culture.

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

 While learning about global health in local communities in North Sumatera, I applied decision-making skills to address various challenges effectively. I assessed community needs through surveys and interviews, gathering information about common health issues. Analysing the data, I prioritized initiatives like promoting hygiene and vaccination awareness, which would have the most immediate impact. Collaborating with local health workers, I identified feasible solutions and weighed the available resources. During group discussions, I considered different perspectives, ensuring culturally appropriate approaches. By making informed decisions, I aimed to create sustainable interventions that addressed the specific health challenges faced by these communities.

How did you manage your time throughout this EP journey?

During my summer course, effective time management allowed me to balance my studies with exploring Medan. I carefully planned each day, dedicating mornings to attending lectures and completing assignments, ensuring I stayed on top of the course material. Afternoons were reserved for exploring Medan's vibrant culture, visiting iconic sites like Maimun Palace and tasting local cuisine at bustling markets. I set specific study goals for each day, which helped me stay focused and productive. Evenings were a mix of reviewing the day's lessons and reflecting on my experiences, which enriched both my academic understanding and personal appreciation of North Sumatera.

Your plan for next week (Week 4)

As I prepare to leave Medan, I take time to reflect on the summer course experience. The learning, cultural immersion, and personal growth have been transformative. I plan to document these reflections, acknowledging the challenges, insights, and memories that will continue to shape my understanding of global health and diverse cultures.