2. Were the objectives of the project fulfilled?

   There were 3 objectives planned for this project and all 3 of them were successfully accomplished. The first one would be on understanding the healthcare system and unveiling the differences with the Malaysian system. Through my inquiring directed towards the doctors and the local medical students supplemented by online reading materials, I realized that the Taiwanese government adopts a national health insurance policy where all of their citizens are to subscribe to a monthly health insurance scheme. They would also receive a physical insurance card which would enable them to gain access to quality healthcare services offered in the country. It explains why Chang Gung Memorial Hospital (CGMH) as a private hospital would have such a high patient load compared to the public hospitals in Taiwan. They also have a health clinic of sort in Taiwan but due to the health insurance policy, everyone would seek medical attention directly at the hospital rather than seeing a general practitioner in the government health clinic. Through my ward works and clinic attachment for 2 weeks in the Pulmonary & Critical Care wards in CGMH, I managed to build on my communication skills with the healthcare team as well as the ability to adapt myself working in a healthcare setting with different system. I had to do a pre-round daily with the nurse practitioner and the other nurses in the morning before the ward round with my supervisor in the afternoon, this provided me with an opportunity to understand the cases beforehand and clarifying the patient's progress with the nurses. I would also cleared my doubt with them especially when it comes to chinese medical terminologies that I didn't understand. I also utilized my time to navigate through their hospital information system (HIS) as I needed to read up and interpret the patients' investigation results and their vitals before discussing them with my supervisor during his ward round.

3. What have you enjoyed or liked the most about the project?

   The communication aspect of the project was the one that I enjoyed the most during my posting in CGMH. In CGMH, everyone viewed each other equally and the members of the team addressed each other respectfully. Even medical students were regarded as part of the team as we were addressed "xue-di" which meant junior in chinese rather than calling us by our names or pointing at us and our views were more than welcome to be voiced up to the doctors when they were doing their rounds. They would ask us questions pertaining to the cases but wouldn't get irritated even if we got some of the questions wrong. The doctors there understood that we were here to learn and mistakes are expected but not to be repeated. Their workplace culture definitely deserves an appraisal and we should learn from them.

4. What have you found challenging about this project?

   Language barrier would definitely be the most challenging part of conducting this project as most of the medical terms were recorded in Chinese rather than English. As such, I have to "google" most of the time for the English version of it in order to understand the cases. When the doctors were explaining the cases to me, they would use the Chinese terminology even though they did try their best to provide me with the English translation. Towards the end of the posting however, I managed to equipped myself with the common terminologies and so I was able to understand the cases better even without the English translation during the second week of my posting there. I also found it difficult to communicate with the elderly patients as most of them speak Hokkien rather than Chinese and as someone who doesn't speak that dialect, I couldn't communicate with them at all which necessitated the doctors and nurses around to help out with the translation.

5. What has really worked?

   I was really grateful for the freedom given by my supervisor in arranging my learning here in CGMH. At the beginning of each week, my supervisor would asked me on which aspect of Pulmonary Medicine that I would like to see more and whether I want to observe any specific procedures. He would arranged it for me based on my proposal so that my learning objectives could be met. Due to this, I was able to maximize my time posted there as I was able to observe those that I had never been exposed to or of limited exposure back here in HUKM.

6. What can be improved in this project?

   I should be more proactive in clerking and presenting cases to my supervisor rather than waiting for ward round or clinic attachment so that I could learn more. I should have done more pre-reading prior to discussing cases with my supervisor so that thorough understanding of the cases can be met.

Matrics no: A185589

Date: 21/8/2024

2. Were the objectives of the project fulfilled?

Absolutely yes. Before my clinical elective posting started, I created three (3) objectives for me to achieve which are gaining new experience by learning and working with other healthcare professionals in Taiwan, gaining exposure to a wider variety of illnesses, and grabbing a golden opportunity to learn about different healthcare systems in the world. I had achieved my first objective by joining ward rounds and clinics with the doctors and medical officers in Kaohsiung Chang Gung Memorial Hospital. Observing the procedures that I had never seen before and learning how to communicate with the healthcare professionals in Taiwan had expanded my horizon. Secondly, clerking patients with the doctors in Taiwan made me understand which are the common diseases in Taiwan and what are the rare cases that have in Taiwan. For example, I realized there were a lot of patients suffering from acute pancreatitis which were caused by their diet containing high fats and oily. I also managed to see some complicated cases such as GI bleed with unknown origin in chronic patients. From these cases, my doctor would spend time explaining about how to communicate with the patients’ family, what the criteria are for them to discharge and so on. Thirdly, I had achieved the third objective by talking to the doctors in Taiwan. From there, I learned that, by law, every Taiwanese citizen with official residency or foreign national living in Taiwan with an Alien Resident Certificate (ARC), regardless of age, gender, or employment status, must enroll in the program called Taiwan’s National Health Insurance. Also, this insurance program lasts an entire lifetime. No one may arbitrarily withdraw, except for those who lose their insurance eligibility (such as people who give up their Taiwan citizenship, move abroad, let their Alien Resident Certificate expire, or a person who goes missing). When individuals enroll in the National Health Insurance program, they have to apply for a National Health Insurance Card. The card is proof that a person enrolls in the National Health Insurance program, and it must be presented every time you visit a clinic or hospital. When you visit a doctor, the National Health Insurance Administration will cover most of your examination and medication costs. All you need to pay is a co-payment.

3. What have you enjoyed or liked the most about the project?

The thing that I liked the most about this project was to experience working and studying in a different country temporarily. This is because it has made me become a more independent and extroverted person. I have more courage to talk to strangers now than before after this project. Not only that, working in a different country gave me a golden opportunity to build professional networks with the students and healthcare professionals in Taiwan and make new friends. I was very happy to make new friends in Taiwan because we shared and exchanged a lot of knowledge during the postings. For example, my seniors in Taiwan shared with me the reference books that they usually use during the Internal Medicine posting. They also shared with me the life as a medical student in Taiwan and how to survive in the medical school. Not only that, studying in Taiwan also improved my communication skills and language proficiency, especially Mandarin and Taiwanese Hokkien. 

4. ⁠What have you found challenging about this project? (any part of the project you found hard to do)

The first challenge I found in this project is language barrier. This is because Taiwanese speak English with their Taiwanese slang and it was quite difficult for me to understand at the first moment.  This problem was solved successfully with the help of search engine “Google”. Oftentimes, I also requested the doctors and my seniors to write the words out for me to avoid misunderstanding or miscommunication. Not only that, I personally do not know a lot of Mandarin medical terminologies. Hence, I would also request my doctors and seniors to translate some terminologies into English for me. However, overall the communication between my doctors and I was not very difficult because we could communicate with each other in Mandarin. The problem only occurred when we were discussing medical cases which involved a lot of Mandarin medical terminologies. 

5. What has really worked? (any part in the project that you thought worked well)

The part of the project that I thought worked really well was learning and observing  some procedures such as abdominal ultrasound, sleep study medicine, lung ultrasound, lung aspiration and  coronary angiogram. I was satisfied and happy that my supervisor and the doctors in Kaohsiung Chang Gung Memorial Hospital were all very friendly to bring me to observe the procedures. My supervisor was also very kind to share his experience and knowledge with me. He would also ask me for some feedback and always listen to my questions and requests patiently. My English, Mandarin and Taiwanese Hokkien proficiency level were all good to communicate with the local healthcare professionals. Overall, the project went well and I had achieved my objectives. 

6. What can be improved in this project?

In this project, I think I could have done more activities with my doctors and seniors (houseman)  in Taiwan. For example, I could invite my seniors to have lunch together besides going ward round with them. I think it can enhance our relationship and I can know Taiwan better. Not only that, I think I could spend more time communicating with the nurse to know more about life as a nurse in Taiwan. 

Name: Tan Shi Ying 

Matric number: A189552

Date: 24/8/2024

2. Were the objectives of the project fulfilled?

Yes, the objectives of my elective posting were fully achieved. My objectives were to broaden my horizons by gaining exposure to a different healthcare system and culture, develop invaluable clinical skills that I might not have had access to within my local environment, and enhance my social skills and confidence. Over these two weeks, I was able to immerse myself in the cardiology department at Linkou Chang Gung Memorial Hospital, Taiwan by participating in advanced cardiac procedures and learning from experienced professionals. This experience has given me both a deeper understanding of the medical field and personal growth. Additionally, this elective has helped improve my social skills and boosted my confidence in a foreign medical environment. 

3. What have you enjoyed or liked the most about the project?

I thoroughly enjoyed the learning process, particularly the exposure to advanced cardiac procedures such as echocardiography, electrophysiology studies, cardiac catheterizations, and continuous wave Doppler. Observing these procedures and having the opportunity to learn directly from highly skilled doctors was an incredibly enriching experience. The supportive and educational environment made it easy to ask questions and deepen my understanding of complex cardiology cases.

4. What have you found challenging about this project? (any part of the project you found hard to do)

The most challenging aspect of this elective was the language barrier. Taiwanese and the medical terminology used in Chinese were difficult for me to fully grasp at times. This occasionally made it harder to follow along during discussions and rounds. However, I worked to overcome this by asking for clarification when needed and using translation tools to enhance my understanding.

5. What has really worked? (any part in the project that you thought worked well)

The structure of the program and the supportive teaching environment were the aspects that worked exceptionally well. The regular ward rounds, opportunities to observe a variety of cardiac procedures, and the accessibility of the hospital’s computer system for patient information made it easy to connect theoretical learning with real-world practice. The mentorship from doctors was invaluable, as they were consistently open to explaining complex procedures and addressing any doubts. Their willingness to teach and share insights made the learning process smooth and enriching.

6. What can be improved in this project

While the overall experience was excellent, I believe that I could have benefited from doing more pre-reading prior to starting the elective. This would have improved my understanding of certain advanced procedures and concepts.

Name: Low Yu Sen

Matric Number: A190206

Date: 28 August 2024

1. Were the objectives of the project fulfilled?

Yes, the objectives of the project were fulfilled. One of my goal was to gain clinical experience in geriatric medicine, understand the complexities of caring for elderly patients, and improve my clinical decision-making skills.

Throughout the elective, I engaged in comprehensive geriatric assessments, and teaching clinics, participated in multidisciplinary team meetings, and observed a wide spectrum of patient cases during ward rounds. These experiences have deepened my understanding of geriatric care, from managing polypharmacy to handling end-of-life decisions with compassion. The elective has equipped me with practical skills and knowledge that I will carry forward in my medical career.

Besides, another objective of my elective was to get exposed and enhance my cross-cultural competence in a foreign setting. I achieved this by actively engaging with patients and healthcare professionals from diverse backgrounds. I took the time to learn about the local culture, for example, some family members got talismans and hung them around the ward as a blessing to the patient, which helped me understand how cultural beliefs influence patients' views on illness and treatment. By observing and participating in these interactions, I am able to communicate effectively and respectfully to patients and family members.

Lastly, I also planned to understand the local healthcare system in Taiwan in my learning objectives, by receiving and sharing information at the same time, this was achieved. I saw a lot of differences in terms of Taiwan’s medical education system and how they operate hospitals, and their training systems. Both Malaysia and Taiwan have different ways in achieving these components and both have their advantages. But most importantly, I had observed them and hopefully be able to integrate them into my medical practice in the future.

2. What have you enjoyed or liked the most about the project?

The most enjoyable part of this project has been the opportunity to interact with and learn from elderly patients. Hearing their stories, understanding their needs, and contributing to their care has been a rewarding process. It’s like listening to their life stories and accompanying them at their golden years.

And of course, another highlight has been experiencing the local food! Exploring the local cuisine added an extra layer of enjoyment to my time here, allowing me to connect with the culture in a delicious way.

3. What have you found challenging about this project? (any part of the project you found hard to do)

One of the most challenging aspects of the project was adapting to the complexity of geriatric medicine. Managing multiple comorbidities, balancing the risks and benefits of treatments, and understanding the unique pharmacological considerations in elderly patients require careful thought and consideration. For example initially, when joining ward rounds, there were long long lists of medications in the patient’s EMR charts where I don’t know a lot of their indications and get confused. While another challenge that I encountered was the communication process with elderly patients, as in the geriatric ward, some of them had dementia and delirium, hence, extra patience is needed to address their needs. Sometimes, I couldn’t understand what the patients were trying to express and I let them keep on talking and puzzled up the words. But at the end of the day, what matters is what matters, to the patients themselves. Hence, it was a challenge, but also a part of learning process.

 In addition, there was the challenge of working in a different healthcare system with its own set of protocols and practices. Adjusting to these new procedures while maintaining a high standard of care took some time and effort. Language barriers also posed a challenge at times, as certain medical terms or cultural nuances were difficult to convey or understand, requiring me to be extra mindful in my communication.

4. What Has Really Worked?

One part of the project I felt worked very well is that I was given a chance together with my friend to conduct Comprehensive Geriatric Assessment on a patient and we clerked her too. Since then we followed up the patient everyday during ward rounds and monitored her progress. Her case were discussed later with the residents to recover her function and planned for rehabilitation. This process had allowed me to apply medical knowledge in clinical situation, making the learning process more effective and relevant.

Supportive mentorship also played a crucial role in my success throughout my elective posting. The guidance and feedback from senior physicians and other ward staffs (including friendly PGY, residents and nurses) who guided me were crucial in deepening my understanding of clinical decisions, particularly in challenging areas like polypharmacy management and end-of-life care. Their willingness to discuss complex cases and having teachings provided me with the insights needed to grow both professionally and personally, so called PPA (Personal and Professional Advancement)

5. What can be improved in this project?

While the project was overall a rewarding experience, there are several areas where improvements can be made.

Increasing my knowledge prior to my clinical elective could improve my effectiveness of the project. Before starting the elective, having some pre-elective preparation would have been beneficial. This could include some reading on core principles of geriatric medicine, such as the physiological changes associated with aging, common geriatric syndromes, and the management of chronic conditions prevalent in the elderly population. By having some foundational knowledge beforehand, I would have been better equipped to engage with the elderly patients.

2. Were the objectives of the project fulfilled?

   
   

   I believe that I had achieved all the learning objectives throughout this project. The first objective is to gain new experience by learning with the healthcare professional in another country. This objective is fullfilled by various activities which were conducted throughout my 2 weeks in the Family Medicine Department of KCGMH and I will only provide one most significant example in this reflective writing. This is said so because I have the chance to follow the Rural Area Visit to Shanlin District, where it enables me to expose to rural area medicine and how to manage the patients outside the hospital setting. I also learnt that the common presenting complaint in rural area is muscle pain as most of them are involved in farm work that requires a lot of physical activities. Other than that will be the follow ups for the chronic diseases such as diabetes mellitus, hypertension and dyslipidemia. The Rural Area Visit is the totally new experience to me and it had broaden my view of patient management is not just confined to healthcare facilities only. Other than this, I also had the opportunities such as Home Visit and Cancer Screening Clinic to obeserve Pap smear procedure and oral examination which had further broaden my view and knowledge. 

   
   

   My second objective is to gain exposure to wider variety of illnesses. This objective is also fullfilled by the daily Inpatient Care in the ward of the Family Medicine Department. As I had mentioned in the previous padlet, the ward is also known as Palliative Ward, which indicated to patients who had fullfilled specific criterias only. Thus, the most common disease will be terminal stage cancer, which ranged from cancer of any body parts. Not only that, there are also neurodegenerative diseases, cancer complicated with stroke and so on. From the ward, I learnt mainly on pain control as pain is the most common complaint of the patients and I also noticed that the goal to manage the patients is just to relieve their symptoms and to improve the quality of life only. This is because there is no added value to treat them optimistically anymore, which is sad to say so.

   
   

   My third objective is to learn different culture in Taiwan. This objective is fullfiled by the observation of the living lifestyle of the local Taiwanese during my 2 weeks in Taiwan. I learnt that Oral Cancer is one of the most common cancers in Taiwan and I wondered why. This becomes more clear to me when I am travelling around the city during my several outings. I noticed that there are many betel nut chewing store can be easily seen in the city, indicating that the locals have the habit of betel nut chewing which posseses higher risk to oral cancer. Other than that, I noticed that the doctors during my clinic attachment will usually ask the patient during history taking to know wether the patient has the habit of betel nut chewing, in contrary to us we usually just ask cigarette smoking and alcohol consumption only. Moreover, I also learnt that the differences of the healthcare system between Malaysia and Taiwan. As mentioned before, I was requested to talk about this topic during presentation. In short, the major difference is there is a National Insurance Programme in Taiwan whereby every citizens will need to pay certain amount each month to the government. It is sort of like ‘tax’ and the amount will be depending on the income of the individual. This amount will be contributed to their medical insurance and with that insurance, they are free to seek for medical treatment from government or private sector based on their preference as the fees do not have much difference in governement or private sector. 

3. What have you enjoyed or liked the most about the project?

   
   

   The part that I liked the most will be the people that I met in hospital. This is said so because the people in the hospital (doctors, nurses, cleaners and office staffs) are all so friendly, kind and helpful. Wherever I go, they will just greet you a good morning with a smile on their face, no matter what is their title. They are also ready to help as I was first introduced to this new environment and I often lost of direction in the hospital. There was one cleaner noticed me wandering around and she approached me to ask if I need any help. As a result, she put down her work and brought me to the place without further ado. The second time was a nurse that directed and navigated me to my desired place. Moreover, the doctors that i met in the clinics were all just nice. they are very patience and ready to answer my questions. The way they talked to me is like they are talking to their friend and the whole discussion is comfortable and not stressful. The environment in the hospital at KCGMH is so different and I really have nice experience throughout my days there. 

4. What have you found challenging about this project? (any part of project you found hard to do)

   
   

   The challenging part will be the communication problem part. This is because as I said the patients in the wards are all palliative patients. They are all in terminal stages of life and they are not very conscious anymore, they either are not conscious or they are on devices which cause them unable to talk. Thus, to take history from them can be really hard and I did not really have chance to practise history taking. To know more about the patient’s condition depends solely from the caretaker and the patient information sheet. 

5. What has really worked? (any part in the project that you thought worked well)

   
   

   I believe the decision to come to KCGMH and to Taiwan as the country of choice worked well. This is because I can speak and understand their language and thus basic communication in the hospital or outside the hospital is not a problem to me. As I mentioned in previous padlet that my initial decision is to apply to South Korea. Just imagine that if I were to go to South Korea with zero knowledge on Korean language, I think it will be really hard for me to survive there. I am really fortunate that I know how to speak and understand Mandarin, as I can get involved in many of the discussions, teachings and even to make new friends over there. As we know that English is not their mother tongue, so if you know how to speak English only is also not very useful. However, there were also times where I did not understand when coming to medical terminologies in Mandarin, as what we learnt is in English, but it was not a problem anymore when I use Google or directly raised my problem to the doctors and they are all nice to explain more. 

6. What can be improved in this project?

   
   

   I believe that it will be better if the duration of my elective posting can be extended to 3 or 4 weeks. This is because 2 weeks is definitely not enough to really understand their structure and there are still many learning oppurtunities yet to be explored. Other than that, it will be better if I applied to additional one more department other than Family Medicine. Thus, I can learn more about other department as well. 

Matric number: A189433

1. Were the objectives of the project fulfilled?

Yes absolutely! The programme went very smooth and for the final week we ensured that the Taiwan delegates got everything they wanted and I made sure we sent them off back well and safely without any hesitation to the airport. The closing ceremony was a huge success and everything went very fine.

2. What have you enjoyed or liked the most about the project?

The thing I enjoyed the most about this AMSEP programme was making a lot of friends and having interactive sessions along with teamwork and helping each others back. I'm an extremely introverted person thus it took a lot of challenges for me to come out of my confirm zone to talk and be interactive especially me being the Head for a committee department thought me to be more assertive and act accordingly.

3. What have you found challenging about this project? (any part of the project you found hard to do)

Personally there were a lot of challenges for me especially the letter part and getting approval for it. Iy takes day ans night editing and making huge changes within short period of time given. But still I guess I made through it well and handled it quite precisely by always having a backup plan. Well I wanted to fly to Taiwan but unfortunately the flight got delayed and I couldn't go because I'm kick starting my Year 4 so that made me sad :(

4. What has really worked? (any part in the project that you thought worked well)

Well since I'm in clinical years, I could actually help a lot the Taiwan delegates since my syllabuses are somewhat similar to theirs compared to the preclinicals students. I enjoyed sharing my thoughts and knowledge with them. Besides, me being a Malaysian and sharing a lot of things about Malaysia like explaining monument, food and social culture was a huge win for me.

5. What can be improved in this project?

Overall the project was good and successful. The only issue was timing and execution other than last minute changes. But stay calm and always keep your mind clear so that challenges can be faced easily. Never get distracted and focus. I would only like to manage the time better I this project since it needs a lot of multitasking otherwise everything was well done.

A188150

26/8/2024 - 30/8/2024

1. Were the objectives of the project fulfilled?

Definitely! One of the objectives of the project was to experience healthcare in different settings in a different country, which was definitely fulfilled. I learned that the current healthcare system in Taiwan, known as National Health Insurance (NHI), is a single-payer compulsory social insurance plan that centralizes the disbursement of healthcare funds. The system promises equal access to healthcare for all citizens. Another objective was to expand my network by connecting with medical students from different countries and healthcare professionals. I made friends with medical students from France, Vietnam, the Czech Republic, and others throughout this program, as well as with my supervisors and nurses in my department. Everyone was so friendly and kind, welcoming me with enthusiasm. I was grateful to observe a wide range of medical cases and interesting surgeries there. Since this was my first time living overseas for a month, which is quite a long time, I definitely boosted my adaptability, problem-solving skills, and self-confidence. I feel more open to challenges and know how to deal with different situations by myself.

2. What have you enjoyed or liked the most about the project?

I was particularly attracted to their medical school system, where only one student is assigned to one doctor. This setup enhances the connection between the doctor and the student and allows the doctor to focus on just one student. The doctors were so friendly and open to any questions, with no hierarchical stress, which created a healthy learning environment and enabled me to learn a lot.

3. What have you found challenging about this project? (Any part of the project you found hard to do)

The only challenge I faced was that we don’t have a plastic surgery rotation in Malaysia. Therefore, I initially lacked knowledge about plastic surgery, which made it difficult to catch up with the cases I encountered during the first week. Sometimes, I couldn't ask more questions because I wasn’t sure what I didn’t know.

4. What has really worked? (Any part of the project that you thought worked well)

I was able to participate in their lectures and truly experience life as a clinical medical student there. I was given the same opportunities as the local students to attend lectures and small group discussions, which definitely helped me achieve my objective of gaining medical knowledge through this project.

5. What can be improved in this project?

I hope to have the chance to scrub in, as there were a few foreign doctors who did their training there and were prioritized for these opportunities. However, I still learned a lot by observing cases and procedures, as the details were thoroughly explained to me.

Matric Number: A187931

Date: 26/8 – 30/8

1.     Were the objectives of the project fulfilled?

A big yes! Before the trip abroad, I have listed 6 objectives for the exchange. One of them was to enhance medical knowledge and practical use. Although throughout my time in Taiwan, I did not interact much with the patients, I have gained a lot of experience and knowledge about the surgical aspect. I learned many small hacks as a beginner in the field, including how to scrub in and gown in for surgery. They were beneficial knowledge that was not taught traditionally in schools.

Not only that, I have also set an objective for this exchange to explore and learn about the differences in the healthcare system between Malaysia and Taiwan. I was very fascinated by the fact that there is such a big difference between countries running their healthcare systems! The most astonishing part was the replacement rate in Taipei Veterans General Hospital (TVGH)! Despite being such a busy government hospital, they still have enough manpower and resources to accommodate a huge part of the population in Taipei! I was very surprised when my supervisor agreed to conduct an elective surgery just a week before! In the meantime, I was also very touched by how kind and patient-oriented all the healthcare workers were! It did inspire me to be a better doctor as a whole!

Besides, one of my objectives for this elective posting is to also connect with students from multiple nations. This was in fact the objective that I had accomplished most satisfactorily! It was not easy, given that I am a slow and introverted person. However, I managed to convince myself to step out of my safety zone for the exchange, and I am now gifted with multiple quality friendships with the local Taiwanese students, as well as with my roommates, who were from Czech Republic and Hong Kong!

Overall, I am proud to say that all the listed objectives in my proposal were fully accomplished. I am very satisfied and happy about the exchange, and definitely looking forward to another exchange experience in the future!

2.     What have you enjoyed or liked the most about the project?

There are particularly 2 things that I enjoyed the most about this project. First of all, is to have the opportunity to expose myself to a totally different working atmosphere. The different cultural backgrounds, different working traditions, and systems made the experience really interesting. I am a person who loves to learn new things, and being able to pick up such experiences just by observing how they run their hospitals was absolutely eye-opening.

The second part that I love most about this project is being able to connect with people from different living backgrounds. I was surprised that half of my friends there had been to Malaysia for vacation before. Despite the vacation experience, I was even more surprised that they do not know about Malaysians as much as I know about them. I learned about dual nationalities from my best friend during the exchange, learned about the lifestyles of different nations, and even managed to have a conversation/discussion with my supervisor on the education system between Taiwan and Malaysia! It was just a crazy experience, and I have absorbed so much from all of those that I met on my journey, not only those related to medicine but also as a human being!

3.     What have you found challenging about this project? (any part of the project you found hard to do)

I would say that the biggest challenge was to make full use of my time in Taiwan. Living abroad for a month is almost a “once-in-a-lifetime” experience. Even though I was more convinced that I would visit Taiwan again in the future at the end of the trip, I still wanted to visit as many places as possible when I was there. This was a challenge for me as I had many reportings to do for the exchange, not to mention that my working shifts there were average 8-to-5 daily. I had too many plans in mind, wanting to spend more time in the city as well as with my friends there, but too little time to make it real. It was harder for me as I felt that it should be as it was because I went there for an exchange, not for vacation. This contradicting feeling was torturous. The only thing I wished was that I had more time there.

4.     What has really worked? (any part in the project that you thought worked well)

The thing that really worked was to connect with the country. Not only socially, but intellectually. I felt really satisfied every day after spending so much time in their operation theatres and hospitals. Understanding the culture and adapting to it is also a way for me to brush up on my soft skills. I was able to build my confidence not only academically, but also as an individual. Nonetheless, I have been influenced so much to be a kinder and sweeter person by just communicating with the people there. Not to mention being independent. I had lived my first solo trip abroad and for a month successfully and safely.

5.     What can be improved in this project?

Personally, it was a fruitful journey that I have not once regretted. This project is really an eye-opener for me and a good experience to learn so much more than only medicine. I am glad that I have the opportunity to join this project, and the only thing that I would change is to lengthen the period for this experience. To reflect on myself, the only thing that I would change throughout the experience is to be more courageous to ask questions as well as to connect with the other healthcare workers including the nurses and medical assistants there.

Matric number: A188404

Date: 31/8/2024

1. Were the objectives of the project fulfilled?

Yes definitely! One of my objectives for this elective posting was to experience Kazakhstan’s healthcare system and learn a different culture. I realized that Kazakhstan's current healthcare system have a distinct healthcare system as ours in Malaysia.

The public health care in Malaysia is overseen by the ministry of health which provides subsidized healthcare services to all citizens and legal residents. These public facilities include hospitals and clinics funded by the government. But in Kazakhstan, they has a state-funded healthcare system managed by the Ministry of Healthcare. Public healthcare services are provided through state-owned hospitals and clinics.

The public healthcare system in Malaysia is primarily funded through general taxation and government budget allocations while in Kazakhstan, it has been transitioning towards a more insurance-based system. The government funds basic health services through general taxation, while the Social Health Insurance Fund (SHIF) covers additional services.

Besides that, my objectives in this elective posting are to make connections and interact with international medical students and healthcare professionals. I made friends with medical students from Slovakia, Romania, Morocco, Turkey, Poland and others throughout this program. I have made friends with my supervisors, and nurses in my department too. They were so kind and heartwarming for welcoming me to join in their surgeries and daily rounds. I was grateful to have a chance to rotate to different departments and observe a lot of interesting surgeries that have been done there.

2. What have you enjoyed or liked the most about the project?

What I enjoyed most about this elective posting was making many new friends and having interactive sessions with contact persons from Kazakhstan. We also did a lot of hiking in various beautiful locations around Kazakhstan. As a nature lover, I was excited to accept the offer from IFMSA SCOPE after researching the country's stunning natural landscapes. I managed to go hiking at least once in Kazakhstan, and I’m thrilled to say I achieved that goal! I was captivated by the fresh, breathtaking views and the well-preserved natural environment.

 3. What have you found challenging about this project? (any part of the project you found hard to do)

The most challenging issue during this elective posting was the miscommunication between the contact persons and international students. Recently, we received a notification from the person in charge of the student dorm that we had to move out within 24 hours, with no alternative accommodation arranged for the remaining weeks. We contacted the Kazakhstan IFMSA representative, who instructed us to wait for further updates. However, after a day, we had not received any information about where we would stay, which caused us considerable anxiety and frustration.

After multiple texts and calls, we finally received a response explaining that there had been a miscommunication with the student dorm manager. The dorm needed to be cleaned and disinfected one week before new students arrived, but the IFMSA representative was unaware of this requirement. As a result, they were working to find new accommodation for us, the international students, for the remaining week. Fortunately, they managed to find an apartment that can fit for all of us to stay there for the remaining week and it is well-equipped with a convenient store and bus stations. All of us are happy with it.

4. What has really worked? (any part in the project that you thought worked well)

During this elective posting, I was able to manage my time very effectively. I spent half of each day working in the hospitals, engaging in various clinical activities, while dedicating the other half to exploring and traveling around the city. I thoroughly enjoyed attending classes and observing surgeries in the operating theatre. These experiences not only enriched my medical knowledge but also prompted me to actively engage in differential diagnosis as I observed the procedures. Revisiting anatomical structures and understanding the organs being operated on significantly enhanced my learning process. This approach allowed me to maximize my learning with minimal effort—by integrating observation with active revision, I was able to retain and recall information more effectively. The simultaneous revision and practical experience helped me remember the cases better and deepened my understanding of the surgical procedures.

5. What can be improved in this project?

This journey was incredibly rewarding, and I have no regrets about it. It was an eye-opening experience that allowed me to learn about and explore how healthcare systems operate in different countries. I am deeply grateful for the opportunity to participate in this project and am eager to engage in more exchange programs in the future to broaden my knowledge and global perspective. One area for improvement that I identified from this elective posting is the need to enhance my communication skills and to learn the language of the host country before arriving. Using the native language during interactions can significantly increase approachability and facilitate more effective communication. By addressing these areas, I believe future experiences will be even more enriching and immersive.

2. Were the objectives of the project fulfilled?

   
   

   I believe that I had achieved all the learning objectives throughout this project. The first objective is to gain new experience by learning with the healthcare professional in another country. This objective is fullfilled by various activities which were conducted throughout my 2 weeks in the Family Medicine Department of KCGMH and I will only provide one most significant example in this reflective writing. This is said so because I have the chance to follow the Rural Area Visit to Shanlin District, where it enables me to expose to rural area medicine and how to manage the patients outside the hospital setting. I also learnt that the common presenting complaint in rural area is muscle pain as most of them are involved in farm work that requires a lot of physical activities. Other than that will be the follow ups for the chronic diseases such as diabetes mellitus, hypertension and dyslipidemia. The Rural Area Visit is the totally new experience to me and it had broaden my view of patient management is not just confined to healthcare facilities only. Other than this, I also had the opportunities such as Home Visit and Cancer Screening Clinic to obeserve Pap smear procedure and oral examination which had further broaden my view and knowledge. 

   
   

   My second objective is to gain exposure to wider variety of illnesses. This objective is also fullfilled by the daily Inpatient Care in the ward of the Family Medicine Department. As I had mentioned in the previous padlet, the ward is also known as Palliative Ward, which indicated to patients who had fullfilled specific criterias only. Thus, the most common disease will be terminal stage cancer, which ranged from cancer of any body parts. Not only that, there are also neurodegenerative diseases, cancer complicated with stroke and so on. From the ward, I learnt mainly on pain control as pain is the most common complaint of the patients and I also noticed that the goal to manage the patients is just to relieve their symptoms and to improve the quality of life only. This is because there is no added value to treat them optimistically anymore, which is sad to say so.

   
   

   My third objective is to learn different culture in Taiwan. This objective is fullfiled by the observation of the living lifestyle of the local Taiwanese during my 2 weeks in Taiwan. I learnt that Oral Cancer is one of the most common cancers in Taiwan and I wondered why. This becomes more clear to me when I am travelling around the city during my several outings. I noticed that there are many betel nut chewing store can be easily seen in the city, indicating that the locals have the habit of betel nut chewing which posseses higher risk to oral cancer. Other than that, I noticed that the doctors during my clinic attachment will usually ask the patient during history taking to know wether the patient has the habit of betel nut chewing, in contrary to us we usually just ask cigarette smoking and alcohol consumption only. Moreover, I also learnt that the differences of the healthcare system between Malaysia and Taiwan. As mentioned before, I was requested to talk about this topic during presentation. In short, the major difference is there is a National Insurance Programme in Taiwan whereby every citizens will need to pay certain amount each month to the government. It is sort of like ‘tax’ and the amount will be depending on the income of the individual. This amount will be contributed to their medical insurance and with that insurance, they are free to seek for medical treatment from government or private sector based on their preference as the fees do not have much difference in governement or private sector. 

3. What have you enjoyed or liked the most about the project?

   
   

   The part that I liked the most will be the people that I met in hospital. This is said so because the people in the hospital (doctors, nurses, cleaners and office staffs) are all so friendly, kind and helpful. Wherever I go, they will just greet you a good morning with a smile on their face, no matter what is their title. They are also ready to help as I was first introduced to this new environment and I often lost of direction in the hospital. There was one cleaner noticed me wandering around and she approached me to ask if I need any help. As a result, she put down her work and brought me to the place without further ado. The second time was a nurse that directed and navigated me to my desired place. Moreover, the doctors that i met in the clinics were all just nice. they are very patience and ready to answer my questions. The way they talked to me is like they are talking to their friend and the whole discussion is comfortable and not stressful. The environment in the hospital at KCGMH is so different and I really have nice experience throughout my days there. 

4. What have you found challenging about this project? (any part of project you found hard to do)

   
   

   The challenging part will be the communication problem part. This is because as I said the patients in the wards are all palliative patients. They are all in terminal stages of life and they are not very conscious anymore, they either are not conscious or they are on devices which cause them unable to talk. Thus, to take history from them can be really hard and I did not really have chance to practise history taking. To know more about the patient’s condition depends solely from the caretaker and the patient information sheet. 

5. What has really worked? (any part in the project that you thought worked well)

   
   

   I believe the decision to come to KCGMH and to Taiwan as the country of choice worked well. This is because I can speak and understand their language and thus basic communication in the hospital or outside the hospital is not a problem to me. As I mentioned in previous padlet that my initial decision is to apply to South Korea. Just imagine that if I were to go to South Korea with zero knowledge on Korean language, I think it will be really hard for me to survive there. I am really fortunate that I know how to speak and understand Mandarin, as I can get involved in many of the discussions, teachings and even to make new friends over there. As we know that English is not their mother tongue, so if you know how to speak English only is also not very useful. However, there were also times where I did not understand when coming to medical terminologies in Mandarin, as what we learnt is in English, but it was not a problem anymore when I use Google or directly raised my problem to the doctors and they are all nice to explain more. 

6. What can be improved in this project?

   
   

   I believe that it will be better if the duration of my elective posting can be extended to 3 or 4 weeks. This is because 2 weeks is definitely not enough to really understand their structure and there are still many learning oppurtunities yet to be explored. Other than that, it will be better if I applied to additional one more department other than Family Medicine. Thus, I can learn more about other department as well. 

Before I embarked on this exchange, I had set several objectives for myself:

1. To actively participate in Internal Medicine ward rounds, patient consultations, and medical procedures.

2. To gain hands-on experience in managing common internal medicine conditions under the guidance of experienced healthcare professionals.

3. To develop effective communication and teamwork skills within an Internal Medicine team.

Throughout my posting in Taiwan, I made a conscious effort to fully immerse myself in all activities. I actively participated in ward rounds, patient consultations, and medical procedures such as observing central venous catheterization, CPR, and urinary catheterization. Although I did not have the opportunity to perform any of these procedures myself, I gained invaluable experience conducting Comprehensive Geriatric Assessments (CGA) on two patients. These assessments included functional mobility tests and mini-mental state examinations, which deepened my understanding of geriatric patients and allowed for individualized management based on the results.

Additionally, I participated in multidisciplinary team discussions centered around patient management, using CGA results. These discussions involved various healthcare professionals including pharmacists, who addressed polypharmacy issues; nurses, who assessed patients' quality of life in the hospital; physiotherapists, who introduced rehabilitation programs; and dieticians, who evaluated daily calorie intake to ensure adequate nutrition. I witnessed firsthand the team's coordinated efforts to improve patient outcomes, which was truly inspiring.

2. What have you enjoyed or liked the most about the project?

• Cultural Exchange: One of the key highlights was meeting students from different countries and learning about the medical syllabi and healthcare systems in their respective countries. This exchange of ideas broadened my global perspective on medical education. My mentor even organized a welcoming party for us, which included Japanese and Malaysian students. Although we were in different departments, it gave us a chance to bond and learn more about each other’s experiences.

• Culinary Experiences: I thoroughly enjoyed the famous Taiwanese cuisine, such as bubble milk tea, taro ball tofu, and beef noodle soup. These dishes were unique and introduced me to Taiwan’s rich food culture. Additionally, my contact person in Taiwan organized both a welcoming and farewell party for all incoming students. They took us to local restaurants for authentic food and tourist attractions, making the experience even more memorable.

• Local Convenience: The facilities near the hospital were incredibly convenient. A variety of food stores and a well-stocked convenience store offering a wide selection of food and drinks were just a five-minute walk away. It made day-to-day life much easier and comfortable.

• Living Abroad: Most importantly, this exchange provided me with a rare opportunity to live in a foreign country for a month. It allowed me to fulfill a long-standing personal ambition of studying abroad, even if it was just for a short period. I learned valuable lessons about self-care, both physically and mentally, while adapting to a new and unfamiliar environment.

3.What have you found challenging about this project?

• Hands-On Experience Restrictions: While applying for my visa, I was required to sign a consent form agreeing not to perform any physical examinations on patients. As a result, I wasn’t able to enhance my hands-on skills as much as I would have liked.

• Language Barriers: Most of the elderly patients in the Geriatrics department primarily spoke Taiwanese. While I have a Hokkien background and could understand parts of their conversations, I found it difficult to communicate fluently with those who only spoke Taiwanese. This language barrier presented a challenge when trying to interact with patients more effectively.

  
  

4. What has really worked?

• Mentorship and Guidance: One of the most valuable aspects of my experience was the excellent mentorship I received from the doctors. They took the time to teach me key principles of patient management, including how to interpret chest X-rays (CXR), CT scans, the fundamentals of resuscitation, and drug infusions. Their guidance helped deepen my understanding of internal medicine.

• Senior Support: Another significant highlight was meeting a senior from Chang Gung University in my department. He was incredibly supportive, introducing me to different departments, hospital events, and even showing me the best local food spots. His mentorship helped me immerse myself more fully in the hospital environment and gain exposure to various medical specialties.

• Teamwork and Communication: I was impressed by the strong sense of teamwork between the house officers and doctors. They demonstrated effective communication and treated one another with respect, regardless of position or seniority. Observing this collaborative and non-discriminatory environment was inspiring, and it taught me the importance of fostering a positive working culture in healthcare.

5. What can be improved in this project?

As a first-time exchange student, there were several obstacles I faced, but they also offered valuable learning experiences. Here are some areas for improvement:

• Language Preparation: I believe that providing exchange students with resources or basic language classes before arriving, especially for students going to departments where patients primarily speak a local dialect, would help bridge communication gaps. This would greatly enhance the ability to interact with patients and understand their needs more thoroughly.

• Hands-On Opportunities: While I understand the limitations set by visa regulations, perhaps future programs could consider adjusting the consent forms or providing supervised opportunities for exchange students to perform basic hands-on procedures. This would allow for more practical experience and skill development.