Into the field: A report card on Postgraduate Year 1

By Andy Kwan, Writer, Communications & Outreach

Almost a year has passed since the 52 pioneer graduates of LKCMedicine stepped out of the nurturing arms of their alma mater into various hospitals for real medical battlegrounds to fight disease and save lives. On May 2, 2018, when they transitioned from medical students to house-officers (HO), LKCMedicine’s first cohort has found it challenging, exhausting, nerve-wrecking but nonetheless, rewarding.

Now in their final month of their Postgraduate Year 1 (PGY1), the feedback from the hospitals has been overwhelmingly positive. The newly qualified doctors are proving their mettle with their postings in departments that include Medicine, Orthopaedic, General Surgery, and Paediatrics. Three of them have been offered residency by the hospitals even before they complete their PGY1. 

This cohort might have gone through many practical sessions at these exact same healthcare institutions during their medical school years but nothing beats putting on the metaphorical doctor’s mantle and talking to patients that are now under their direct care. Being the pioneer batch means they have no seniors from the same School to seek advice, or get tips from on how to survive PGY1; survival depends on the skills and knowledge learned in School, and seeking advice from their mentors and supervisors in the wards.

Although it is physically and, at times, mentally challenging, the end result is gratifying, many of them say.

Dr Claudia Tong who is now with Khoo Teck Puat Hospital, said, “PGY1 has been a unique learning experience. It was a steep learning curve at the start and each new posting is a new challenge with new teams, new people, new wards, new speciality and of course, new patients. It can be very demanding physically but at the same time, rewarding as well.”

For Dr Benjamin Siow, who had his first posting at KK Women’s and Children’s Hospital, it has been a good year so far. “It’s definitely a very challenging phase with the long hours and a lot of expectations from the senior doctors. But through it all, I think it’s very satisfying because, instead of just learning from the
books, we are actually practising what we’ve learnt for the past five years. So every day, even though we are exhausted, we are satisfied with our work,” he said.

Over at Tan Tock Seng Hospital (TTSH) where Dr Delwyn Lim is doing his residency in Internal Medicine, he sees PGY1 as a fun learning experience despite it being tough most of the time. "LKCMedicine has acclimatised us well to the real work environment and I believe this is why we can adapt well," he said. 

“The staff expect you to know the workflow on the first day. We already have prior experience during our hospital attachments so it was not too difficult to settle in. Fellow colleagues will help teach the workflow as well,” said Dr Jeremy Soon, who is doing his final posting at Singapore General Hospital (SGH).

Learning system paves a smooth route to work
Team Based Learning (TBL), the hallmark pedagogy of LKCMedicine, and the Student Assistantship Programme (SAP) in Year 5, have been useful in helping them transit into PGY1.

“SAP is a useful experience because we had it right after we took our final exams when we were not stressed out studying. During SAP, we learned how to be functional, so we transited into the workforce more easily,” Dr Toh Ching Han said.

Dr Tong concurred, “I believe SAP has helped us tremendously because it was done after the exams. So when we were shadowing the HOs, we were not interrupted by tutorials. At the same time, the hospital consultants and registrars also expected us to be functional HOs. It was then that we picked up the skills
and knowledge required and this made the transition to HO less of a culture shock.”

Echoing her sentiment is Dr Joel Wong, “The SAP programme has prepared us well, so nothing was a surprise. Even though it was hard work throughout PGY1, it helps to have familiar faces around to work together and support each other.”

Dr Leon Tan, who is also inaugural President of the LKCMedicine Alumni Association, credits the TBL for helping him settle comfortably in the hospital environment where team-based work is a common culture. “In TBL, we work in teams where we would constantly support each other through the weaknesses and 
strengths that we have. Even in the actual practice of medicine, it’s very team-based too. We don’t get to choose which team we go to. TBL has shaped us into being team players and that’s a very big part of what the School has inculcated in me,” said Dr Tan, who is now attached to SGH.

Added Dr Soon, “At the hospitals, we learn to react faster and more efficiently with procedures and coming up with medical decisions, but at the end of it, we still fall back on our core knowledge.”

Coping with stress
How did the pioneer cohort cope with the stressful work environment in the healthcare sector, which is something all health professionals have to contend with? Dr Soon, for example, has experienced overnight calls where he went without sleep for more than 30 hours, and was physically and mentally drained.

Dr Joseph Wong remembered a day when there were a few patients who were really sick and required immediate, urgent attention at the same time for transfers to high-dependency wards or scans. “It’s a real challenge to prioritise which patient to attend to first,” he said.

Those we spoke to agree that all the training that they went through has mentally prepared them quite well in adapting to stress. “I was actually able to cope with the stress that comes with work as there are always challenges in any field of work. It’s just that we are able to cope with it, so it’s a good thing for now,” said
Dr Aishwarya Narayanan.

Good doctors, appreciative patients
If it helps that patients show their appreciation to these young doctors to keep them going, this
is not lacking.

Dr Joseph Wong recalled a pleasant encounter with a family whose grandmother was hospitalised for three months. Upon her discharge, the family bought chicken pies for the entire department. “So shiok, no need to spend time to buy food,” he recalled with a laugh.

It gets exceptionally heart-warming when they get to fulfil LKCMedicine’s mission of “nurturing doctors you and I would like to have caring for us”.

“When the patients are admitted, they are in varying degrees of sickness. When you see them get better throughout the few days that you are with them, and eventually fit enough to be discharged, it’s quite heart-warming to see them walk out of the hospitals. Even if we did not address their medical issues, they were thankful that you tried your best to help them and they appreciate your efforts,” said Dr Lim. 

“When you see your patient who came in bleeding in his bowels and was really sick, pick up his bag and was able to go home – you know your management has made a difference,” said Dr Joseph Wong. 

Communication is key
Breaking bad news, to Dr Tong, is itself an indelible experience. “The interaction with the patients and their family members, especially when it comes to near-death instances, made a huge impression on me. I vividly remember how the senior doctors had to broach the topic as well as witness the good bedside manners that the doctors practise to handle difficult issues like this,” she said.

Agreeing with Dr Tong, Dr Lim added that communication can make or break a patient’s trust. “We can try very hard to treat the patients but their family members may not be appreciative of your help. There are certainly cases of family members who are pushy but these are, fortunately, in the minority. In any case, I feel that if we can communicate properly, especially with empathy, we can usually win their confidence,” he said.

But there are times when communications skills are still inadequate. “In school, the simulated patients and family members are always calm and the situation is resolved when time is almost up. But in real life, it could be a lot more emotional when delivering bad news and we may need to have multiple family conferences. It would be helpful to have more sessions with patients who have been through traumatic situations themselves, for example losing a loved one, rather than simulated patients,” said Dr Joseph Wong.

Small and tight-knit group
For Dr Toh Wen Shien, he is heartened by the new friends he made from his first posting at Changi General Hospital. “Before I started, I thought it might be hard to make friends. But this isn’t true and I’m very thankful for the people that I’ve met and how we’ve supported each other through the tough times,” he said.

Supportive colleagues are also a great motivation. “The nurses at National University Hospital would go beyond their duty to buy me food when I was on call,” said Dr Joseph Wong, appreciatively.

Being a graduate of a young medical school also means you do not have senior alumni to seek advice from, or shoulders to cry on, but there has been a silver lining in this.

Dr Jean Chiew has not seen a lot of her batch mates since they started their PGY1. “We don’t even get to see our families very much, much less each other. Nevertheless, the LKCMedicine community is quite a tight one. There are so few of us and we are close to our professors. So when we see them in the hospitals and get to work with them, it’s rather special. There’s a camaraderie in this small group so when we see each other, it’s like seeing a family member,” she said.

Recalling his first day at work, Dr Lim said it was “a day filled with 40 per cent excitement and 60 per cent of anxiety”. The intensity of both emotions has levelled down gradually as he has gotten used to the environment.

He has this advice for those who are considering a medical profession, “If you really feel that it’s your passion to be a doctor, go ahead and pursue it but keep in mind it is really a tough journey ahead. You must be prepared to work very hard and commit long hours. But at the end of the day, you will definitely feel a sense of satisfaction thinking of what you’ve done for your patients.”

Their days will only become tougher as they face patients on their own. However, this batch is ready to take it in their stride and fulfil the Doctor’s Oath.

The road to residency
Dr Delwyn Lim, Dr Kevin Sim and Dr Eden Tay have accepted their residency offers. Their batch was the last year that residency would be offered to final-year medical students. From 2018, residency would only be offered to those who have completed their PGY1 year.

Residency is a training programme that prepares doctors for a medical specialisation. To qualify for residency, new doctors have to make an application to the programme when the healthcare institutions make an open call annually. Those who are shortlisted have to attend interviews conducted by the sponsoring institutions. Once selected, they would start their residency programme with the hospitals
that offer the specialisation they have selected. With residency, young doctors can choose to
delve into their choice of specialisation after completing a six-year residency programme with the sponsoring hospital. Dr Lim and Dr Sim have started their residency in Internal Medicine with Tan Tock Seng Hospital, while Dr Tay is doing his residency in Family Medicine with Singapore General Hospital.

“I developed an interest in Internal Medicine during medical school because I was quite clear that doing General Practice or Surgery is not my preferred pathway. I would like to specialise in skin diseases and treatments and hope to work with the National Skin Centre in future,” says Dr Lim.

An excellent report card
Dr Joanne Tan, an Associate Consultant in General Medicine at Tan Tock Seng Hospital, supervises the PGY1 doctors on her team. She is full of praise for those she has worked with. 

“The LKCMedicine graduates I have worked with have been very knowledgeable, dependable, and steady house-officers. They have a good knowledge base and clinical reasoning skills. Their communication skills are good too. I remember one of the LKCMedicine graduates patiently building a good rapport with a particularly difficult and depressed patient that nobody else could get through to. It was thanks to this doctor-patient relationship that the patient finally accepted medical treatment and was agreeable to further tests,” said Dr Tan.

Associate Professor Chow Wan Cheng, Chairman, Division of Medicine, Senior Consultant, Department of Gastroenterology & Hepatology at Singapore General Hospital, who worked with the first batch of LKCMedicine graduates, said, “The School has prepared them well in terms of communication skills and
bedside manner, but importantly, that didn’t compromise the acquisition of knowledge and clinical skills.”

The fruits of five years' work
The management and faculty staff in LKCMedicine can now heave a big sigh of relief knowing that their students have done them proud. It also means that the medical curriculum jointly drawn up by the School and Imperial has achieved its objectives.

Dean of LKCMedicine Professor James Best said, “We are very proud of our first group of doctors that we have produced for Singapore. I’m doubly proud because all the reports that we receive are that they are absolutely outstanding. We knew that already, but it’s good to have it confirmed. I’m very confident that the pioneer batch will fulfil the School’s mission by being the doctors that you and I would like to have caring for us.”