Ang Zheng Jiet, A178474, 10th July 2022

Compared to last week, I was able to appreciate life as a clinical student in St. James's Hospital more. For me, last week was the exploring stage, and this week is when the real work begins! Dr. Patricia was the consultant in charge for the second week so I was attached to her team. Because I was able to thoroughly understand the patient's details, I felt less anxious and hesitated while responding to the doctors' queries. While the team was away, I took the initiative to go through the patient details and spend more time interacting with the patients. After a week of adjusting myself to the new environment I became more confident to work independently when the team was occupied with work in the ward. Besides that, I felt more comfortable being involved in the discussion of the medical team, and I had more time to interact with the elective students to exchange ideas on the differences of medical education in both Ireland and Malaysia. 

 

I had the opportunity to take history and perform physical examination on a terminally-ill patient that exhibited the stigmatas of chronic liver disease and ovary malignancy. Not only that, I inspected a patient who had shingles. During my second week I presented my first case to my consultant and received a compliment for the completeness of my patient’s history. 

Since the team typically visits 20 to 30 patients per day during ward rounds, the majority of my learning took place during that time. I was able to appreciate abnormal heart sounds and varied lung findings on multiple patients. The ward round list doubled as we went to the emergency room on Tuesday to admit new patients, most of whom had acute symptoms. 

Following that the ward round was extended to 5-6 hours but it was a fruitful session as I got to observe unique patient cases. 

On Friday, I was able to get in touch with a good number of patients exhibiting signs of hypercholesterolemia such as corneal arcus and xanthomas. Best part of the clinic session was when I decided to clerk my own patient and was allowed to do so in a vacant consultation room. I was given the mandate to jot medical details down directly onto the patient file, so I had to be extremely careful and could not afford to make any careless errors - glad everything worked out well in the end! 

 

It was a tiring week for me because of the lengthened hours in hospital mostly spent on doing ward rounds. Nonetheless I felt more productive as I was able to revisit a lot of my preclinical knowledge and appreciate the discussion among doctors to manage patients. I was delighted when some of my patients were able to identify me as a student doctor since I had been successful in establishing rapport with them. Small incidents like this deepen my enthusiasm for my job as a doctor and strengthen my desire to make patients feel better! 

I also observed that a significant portion of the hospitalized patients are senior citizens. Most of them arrived here as a result of fall, subsequently developed fall-related complications of fall such as loss of mobility and neurological impairments. I find myself wondering how a developed country's greater standard of living will lead to a larger elderly population. It makes me wonder how a developed nation will have a better quality of life, leading to a higher population of elderly people. At the same time, developed nations tend to have lower birth rates as compared to developing or underdeveloped countries, which means most of these elderly people might end up living alone, further precipitating the occurrence of falls. 

I learned to be always open-minded and stay receptive to new ideas. I was rather astounded when I was first introduced to the Electronic Patient Record (EPR) and learned about the systematic health management practiced in St. James’s Hospital. However, I was able to easily adapt to the new work environment and appreciate cultural and religious diversity by maintaining an open mind and a humble heart. Eventually I learnt not to be judgmental and treat every souls with full respect! 

Medical pharmacology is heavily emphasised in the Irish medical education system. The students are expected to be well-versed in the names, types, mechanisms of action, side effects, indications and contraindications of the medications. During ward rounds, doctors would go through all the patients’ medications, and this was when I would receive questions from consultants about medical pharmacology. Back in UKM we often get asked about the diseases, signs and symptoms, pathophysiology of diseases, rarely about drugs. Clinical pharmacology are things we learn during preclinical years but not given much emphasis during our clinical rotations. To overcome this issue, I had to revisit all my pharmacology knowledge and be well prepared before every ward round. Although this entails a greater workload, I believe it is vital to enhance my knowledge of clinical pharmacology since it will enable me to tailor the most efficient and comprehensive treatment plan for various patients.

To deepen my knowledge towards clinical pharmacology and start preparing for my ultimate presentation about non-statins cholesterol-lowering drugs during Journal Club! 

Name         : Tan Zhi Xuan

Matric no  : A173570

Date           : Week 2 (4/7 - 10/7)

2. How is your progress?
As time goes by, I am getting into the environment in the hospital. I feel more comfortable in the team. Together with the medical students’ help, I could communicate with the patients more effectively. Throughout the whole week, I managed to gain more hands-on experience by active participation in the discussion. I also make sure I revise my clinical knowledge after my class.

3. Points to remember from week 2!

Being shy is not a dealbreaker for our social life especially in our medical school. To achieve the learning objectives, I shake off my shyness by asking questions. I become more proactive in the case discussion. I feel more appreciative as the doctors take your questions and answer them seriously. I believe no one is perfect, hence the more questions we ask, the more knowledge we get. 

The condition in hospital is not as good as in Malaysia. There is not enough bed for the patients. The relatives must share a single bed with the patients. Whereas the visiting relatives must sleep all over the corridor ward. Moreover, there is no curtain in between the beds. Hence there is no privacy among the patients. Besides, the hospital is always under unstable electric supply. Therefore, we experienced having no electric in the outpatient clinic for almost 3 hours. With all the poor condition in the hospital, I would say we have to be grateful of what we have now. It is not easy for the patients to stay in the hospital with such poor facilities.

4. Your feelings & thoughts
I feel less anxious during the case discussion. The doctors always make sure I am involved in the discussion. I also feel more confident in performing the hands-on procedures. My supervisor guides me very well. I really appreciate the chances given to me by the patients to perform all sorts of hands-on procedures on them. Besides, I observed how patients and family are being involved in decision making. Since Nepal is known as a religious country, some patients would leave the decision to God. From here, I could witness how simple their life is, with no phones or televisions. The relatives are happily talking to each other, and eating together in the hospital.

5. ONE good thing from what you did that you can practice now!
Be proactive! Since we are used to spoon-feed learning style, it is difficult for me to change my learning style at first. However, I managed to adapt myself to the new environment and cultural differences. I become more proactive since then. Until today, I am still practicing to be more proactive in all environment. 

My last time in Internal Medicine posting was 6 months ago. The memory is not fresh for me during my electives. Hence, when I was questioned by my supervisor, I couldn’t give complete answer. To overcome this, I started to revise and study every day after coming back from ward. I note down the questions asked by the supervisors and study at night. As time goes on, I started to gain my memory back. I feel happy as I could answer the question asked. 

7. Your plan for next week (Week 3)
Study in depth on my clinical knowledge, understand more deeply on Nepal healthcare system and make more friends in Nepal :)

 

Hello everyone ! so for this week, I have started the real posting in SNUH, on the first day, I went to the catheterisation lab where I was introduced to Dr. Hwang Doyeon, a cardiologist, and he went through about our schedule for the next 2 weeks. I started off with joining the cardiology clinic, and I joined Dr. Hwang’s clinic. Just like Malaysia, Acute Coronary Syndrome has high prevalence in South Korea, so during the clinic session, I can appreciate the way they manage the patient. Because of the high number of patient in a day, the doctors need to work really fast, they meet the patient for approximately 2-5 minutes only, because most of the patient are follow up patients. The patient that come to the clinic was not only elderly, but also young patient, at the age of 30s, and because the lifestyle in South Korea where they mostly consume alcohol on daily life, the number of young patient was also high. From the clinic session, I learned that in Korea, for patient suspected with ACS, they will proceed with the CT pulmonary angiogram because it is the most beneficial and accurate procedure to minimize sources. Along the session, Dr. Hwang will tell me the cases that he thinks is special and I was able to ask few question to him about the management of the patient. However, as most of the patient is ACS patient, I wasn’t able to observe any findings for short cases. 

 

Aside from the clinic, I also went to the angiogram lab. Most of the patient here will undergo the coronary angiogram where the catheter will be inserted through the artery to observe any stenosis or occlusion. Primary PCI is also commonly done here for patient diagnosed with ACS.  At first, I only observe the procedure through the monitor, and to be honest, during the first time observing it, I could not appreciate the stenosis or blockage that the patient has. However, after observing few times, I can now understand how to appreciate the stenosis and the occlusion. I can also appreciate the reperfusion once the stent is inserted and ballooning is done for the patient. It was really a fruitful experience as I wasn’t able to observe in back during my internal medicine posting.

 

 

Be confident and believe in yourself ! To be honest, I was intimidated when I first join the clinic, I am scared that my knowledge is still lacking. However, while observing the clinic and discussing about the case and management with Dr. Hwang, I realised that, I am more than I thought I were. I was able to understand what Dr. Hwang was discussing about and I also able to think about the management that will be normally done in Malaysia for such case. 

 

 
4. Your feelings & thoughts 

It was a fulfilling attachment, and I have a sense of satisfactory once my day is done because I believe I have learn something new that I can bring back home. I am also happy with the fact that my knowledge are not limited to something I can do in Malaysia only, and it feels amazing to be able to communicate with people across the country. I really hope I will be able enjoy learning for as long as I can in the future. 

 

Networking. If you ask me a year back, I would say I am not confident enough to join any networking program as I have little confidence in myself but throughout this posting I realised that networking is amazing and not only you will able to communicate with others, you will also be able to test your knowledge, and learn new things.
 
6. Any difficulties/concerns? How did you cope?

Being in a place with different culture is sure difficult. Not only we are dressed differently, finding halal food is difficult, and we also not able to communicate with the natives there. Having a friend with me is my coping mechanism, we will laugh about our day and try to communicate in Korean even though our the words that we know are limited. Without me knowing, it went by real quick. 

 
7. Your plan for next week (Week 3)

It will be our last week in SNUH, and I plan to learn as much as I can, and having the experience during the first week, I realised that we won’t be able clerk the patient and practice our clinical skills, so for the last week, I’m planning to observe procedures and gain experience by learning about it. Oh and our supervisor told us that they will do a procedure call stem cell infusion for myocardial infarction, a procedure that cannot be found in Malaysia, so we are excited to see it. 

Matric Number: A174095

Date: 5^th August 2022

It’s the second week and I officially begun my elective posting at Seoul National University Hospital. On my first day, I got out of home a bit earlier because I was afraid that I would take time to get around the hospital compound and I was so right because it took me a little over half an hour to find my department’s office. Thanks to the help of the workers there I managed to reach at the agreed time. My supervisor was very welcoming and he introduced me to the entire team including the chief, Professor Park, who is a very renowned surgeon in Seoul. Professor Park had offered to take me into his surgeries to observe for the day and I was very excited as he had a lot to offer knowledge-wise. Although I was unable to assist on the first day as I was still adapting to the environment, Professor Park had patiently walked me through each surgical procedure as I observed from outside the sterile area.

 

Starting from the second day onwards, I was expected to also scrub in and assist in the surgeries. I was really nervous at first but the team had warmly taught me from scratch on what I should and should not do in the operation room. It was truly fascinating how much care is put in every surgery done to ensure the patient’s recovery goes smoothly and I respect all the parties involved from working together in such harmony. You can tell that only enough experience will get you that far. I participated in about three surgeries each day and they were mainly colostomy and ileostomy.

 

Chances are there will always be people to help you out in any given situation. You just have to break through your shell and ask for it. 

 

The professors and doctors will never truly know the extent of your knowledge. If there is something that you are unclear on, always ask even if it seems small. They are more than happy to teach you as long as you show effort and eagerness to learn. Even the staff nurses have much to teach you so in a hospital setting, everyone plays a vital role in your growth as a healthcare worker.

 

All in all, it was a nerve wrecking week of adapting but the people around me never failed to make things easier and I am very thankful for that. I felt very much apart of the family in the department as the senior interns, fellow and professors would refer to me as the “maknae” which is this sense is a Korean form of endearment term for the youngest in a group. Its heart-warming to see how much they appreciated my presence. 

 

Always politely greet people even if you don’t know them, because that’s how you make acquaintances! 

 

I have a horrible sense of direction so getting around the hospital was a nightmare with the numerous connecting bridges and basement floors but the seniors are always one text away if I ever get lost so that was a relief. It’s a good thing I already got used to taking the subways while I came to Seoul for a holiday a few years back. 

 

There is a scheduled surgery for pyloric exclusion and jejunostomy that is important on the upcoming week so I will be reading up in detail for that. My friends from other universities like Korea University and Yonsei University will be going back to their respective countries next so I also plan on hanging out with them as much as I can before we have to go separate ways.

MATRIX NUMBER : A177333

DATE: 25/7/2022

2. How is your progress?
 I think I have more confidence now and have adapted better to the workplace! I make friends with the student nurses and they are really friendly and helpful. During their break they taught me some Czech vocabulary and teach me how to scrub correctly step by step. Occasionally, they will translate everything into English and update me on the progress of the operations. 

This week, I was able to take the courage approaching the surgeons and request opportunities to assist with procedures such laparoscopic cholecystectomy, atriovenous fistula, duodenojejunostomy, etc. I realized that the surgeons aren’t scary at all instead they are really angelic and patient. Many of them will teach you as they perform the surgeries and will answer your queries. I really appreciate all the opportunities, and I enhance my learning experience. 

Besides, I was invited to the IFMSA international medical student exchange farewell party, where I met many people from several countries. They taught me their traditional dance and invited me to join them. It was enjoyable session and I like connecting with them as it help me broadening my cultural perspectives. There is so much things that I still do not know and through networking I am able to learn from others and in return exchange information with them

 3. Points to remember from week 2!

Taking part in International exchange programme actually benefits us a lot and I really encourage others to participate if they have chance! I met different people and experience different culture. I realize how fast that I am able to adapt the environment and how tolerant I am and how to communicate with others nicely. 

I also able to appreciate the beauty of a language. In Czech, “ano” means Yes. I remember there is one time when I was ordering food at a restaurant, I don’t want alcohol drinks after they offered and you know being a typical Malaysian , we have a lot “ lah , kan, ke , oh, ah” when we talk so I accidentally said something like “Ahh, No No ” to them. Hence, they misunderstood me and provide me with alcohol drinks. You can see how cool a language is. The same pronunciation could be different meaning in different countries!
 
 4. Your feelings & thoughts 
  I am leaving the next week, so I have a mix of feelings as I become used to the surroundings. Even outside of the operating room, I value the friendship and really enjoyed mixing with the international students; it made my training more exciting and fun.
My medical elective in Czech was a terrific and unforgettable learning experience, I would not regret doing me elective here!

 5. ONE good thing from what you did that you can practice now!
  I become more aware, and my self-confidence has improved and this really helps a lot in my personal development. As I began to step out of my comfort zone, asking more questions and chances to assist, One important lesson I have learned ! Successful only comes from finding the opportunities and don’t be afraid of making mistake! You got to have grab every opportunities that come. 

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

Yes! 
I was fined 700 CZK (127 MYR) by the train inspector for fare evasion while I was travelling from my hostel to my university hospital on a tram. I did not have the intention to evade the fare. I wanted to buy one month student card public transportation pass at Olomouc's main train station but due to language barrier they misunderstood and they provided me a student card IC rather than the pass. I only came to this realisation after I was penalised and my Czech buddy had helped me by showing me where the post office was located.  From here, I can see how important it is to learn their language. I also realized Life is not what you expect: it is made up of the most unexpected twists and turns and you can’t control everything in your life, what we need to do is to go with the flow. 

 7. Your plan for next week (Week 3)
I plan to learn as much as I can and explore more nice places in Olomouc!