In Focus: Goodbye student life, hello doctorhood

By Amanda Lee, Senior Assistant Manager (Media), Communications and Outreach

From caring for patients, to doing ward rounds and learning new workflow processes, the LKCMedicine Class of 2019 has been quick to pick up new skills and duties since assuming the role of house officers.

Now a month into their Postgraduate Year 1 (PGY1) posting, they shared that the transition from medical school to the workforce has been challenging, yet fulfilling. 

"As house officers, we are the frontline staff who face calls from patients, family members, and the nurses, constantly needing to make judgment calls on whether a problem can be solved at our level, or require escalation to a more senior doctor," said Dr Lee Cheok Hon, who is currently in the Department of General Medicine at Sengkang General Hospital (SKH).

Echoing his sentiments, Dr Marie Ann Wong Mae En, who is currently on her medicine rotation at the National University Hospital said, "Prioritisation is also an important skill that I am learning. It can be overwhelming to get incessantly called at night for various issues, but (usually) only a few need to be addressed immediately."

The cohort is the latest to join the School's pioneer graduates in the workforce, who have proved their abilities to Singapore's healthcare fraternity. Like their seniors, this cohort has had hands-on experience in hospitals during their clinical years at LKCMedicine.

However, they concurred that nothing has prepared them more than having recognition as a doctor in the wards. The title alone comes with a heavy intangible responsibility, they said.

"Coming out of the protected shell of life as a medical student has exposed me to the realities and demands of working life. With the greater responsibility, comes greater stress and reward. However, I feel privileged to be able to provide healthcare as a service to my patients," said Dr Adam Mohamed Naveeth Bin Adam Rabbani who is currently working in the paediatrics department at KK Women's and Children's Hospital (KKH) for his PGY1.

Likewise, Dr Tan Wei Jie, who is currently posted to the Department of General Surgery at Ng Teng Fong Hospital said, "Receiving calls from nurses who address you as 'Doctor' and seek advice on the care of patients is a big change from being a student without the professional responsibility for the care of a patient."

Facing challenges

As a full-time employee now, the young doctors have to not only know how to adapt to their new working life, but also cope with imperceptible duties beyond the job

Since becoming a working doctor, Dr Lee has received advice that he has to take PGY1 "one day at a time" and find some time to reflect on lessons he has learnt from each day or week. However, he pointed out that it is in fact harder in practice to avoid taking work home. 

"Because of the sheer volume of time and effort one spends in the hospital, and some emotions that I still find somewhat difficult to drop at the door whenever I end the day," he explained.

"For example, there are some patients for whom I do worry about if I know they have been especially ill during my shift, and also there are some patients for whom I feel I could have done a better job in managing if I had more time in thinking through the case," he elaborated.

Though LKCMedicine's curriculum has prepped the young doctors in their practical, theory and communication skills, the vigours of the job require them to think out of the box as well as adapting to ever-changing situations.

Dr Wee Lin, who is currently with the Department of General Medicine at Tan Tock Seng Hospital (TTSH) said she is learning how to prioritise and to know which patients need to be seen first.

"It's something that I am still trying to work on, learn and constantly improve. I'm definitely still finding working life challenging and will strive and work hard to continue improving myself," she said.

Over at the Department of Orthopaedic Surgery in SKH, Dr Sophia Wong said answering examination questions is a "completely different ball game from actually solving medical issues in real life". Oftentimes, patients are not like model textbook examples, she noted. 

"There are gray areas, and even within a medical team, different members may disagree on what treatment is best for the patient. As the most junior member, you sometimes feel at a loss as to how to handle certain issues," said Dr Wong. 

"I used to immediately ask a senior for help and instructions. However, the seniors on my team would ask me what suggestion I would make first. By making a decision and checking it against your seniors', you learn and I intend to continue that even after I move on from my current posting."

Meanwhile, Dr Russell Chuah who is currently on his paediatrics rotation at KKH, shared that he clocks in at least 12 hours of work. Describing being on call to be "really tough", he said, "I would be expected to make decisions on my own, and I would get assigned errands to several wards with patients I am unfamiliar with." 

Nonetheless, Dr Chuah and his batch mates are grateful for having supportive colleagues and seniors to guide them in this new chapter of their medicine journey.

"I have been very fortunate to have helpful and approachable colleagues such as the Medical Officers, nursing staff and my fellow house officers. At the end of the day, I know that I am not alone in this," he added.

Commenting on the challenges they face, LKCMedicine Assistant Dean for Year 5 and Lead for Emergency Medicine Associate Professor Tham Kum Ying said, "As a PGY1, it is the first time they take on responsibilities for patients on top of the anxiety that a new job brings to a young adult entering the workforce for the first time. The realisation that they are now part of the team that makes many decisions affecting patients' health and life, is often a sobering thought."

Bridging the gap

For five years, the cohort attended LKCMedicine's bespoke MBBS programme which is built on Imperial College London's world-renowned medical curriculum. The innovative School curriculum is anchored by a care-centred approach, supported by a team-based pedagogy and the latest digital technology. 

Throughout the programme, the Class of 2019 was given opportunities to work closely with patients. For instance, in their Year 1 and 2, they were part of the Long-term Patient Project, where they learnt how to appreciate illness and healthcare from a patient's perspective.

"The Long-term Patient Project was probably the most powerful way to emphasise the fact that beyond the medical problems that our patients seek help for, the social set-up, background and support network of the patient is something we must consider as a possible underlying or complicating factor to be treated in a patient's holistic plan of care," said Dr Lee.

Back then, they also joined clinical teams in healthcare institutions across Singapore to develop their core clinical skills in Medicine, Surgery, as well as in Short Postings undertaken in a number of specialities.

In the last 10 weeks at LKCMedicine, they were part of the Student Assistantship Programme (SAP), where they joined care teams, and worked in key specialities under the close supervision of senior doctors.

Sharing his SAP experience, Dr Tan said having the programme after the final examinations have been helpful in preparing him for PGY1.

"It gave us the peace of mind to focus on picking up the necessary skill sets required of a PGY1 doctor, instead of preparing for exams concurrently. In terms of medical knowledge, I feel that LKCMedicine's curriculum has taught me sufficiently well to manage patients as expected of a PGY1 doctor," he added.

Agreeing, Dr Wong said, "What definitely helped prepare me for working life was SAP. It was a 10-week glimpse into what my year ahead would be like. It taught me hard skills like knowing how to put up morning entries, allowing me to practise blue-letter referral calls and so on." 

Looking forward

Despite all the challenges the PGY1s may face, they remain positive and cheerful. Patients play a big part in keeping their spirits high. 

"It's also particularly rewarding when patients and their families thank you for what you have done or when you manage a patient right from when they came in till their discharge and follow-through time," said Dr Wee Lin.

Similarly, Dr Chuah added, "I am normally quite drained at the end of each day, but my patients who are young children, keep me going. It is always nice to know that I had a role in their care when they are discharged well and stable."

The LKCMedicine Class of 2019 

LKCMedicine wishes the Class of 2019 all the best in their career and hope that they will be the caring doctors they are trained to be and make a difference in Singapore's healthcare landscape and beyond!