By Katie Baines, Manager, Communications and Outreach
"Overwhelmed but excited" and "scared but ready for it." That's how LKCMedicine’s new batch of Postgraduate Year 1 (PGY1) junior doctors from the Class of 2021 described their first day after a month on the wards as fully-fledged healthcare professionals amid a world healthcare crisis.
The mixed emotions that come with trepidation for a fresh junior doctor in an ordinary COVID-19-free world would only be natural, but these are extraordinary times, and we are not free of the pandemic. However, the preparation our junior doctors received during their training at LKCMedicine and their Student Assistantship Programme (SAP), coupled with the Singapore healthcare system’s admirable endeavour in containing the virus, meant they were primed for the front line.
“It’s truly quite an experience to graduate into a pandemic! This will go down in memory for a long time; these moments will define us and shape us for years to come,” said Dr Aaron Goh, who began his posting on 26 April this year at Ng Teng Fong General Hospital.
Sharing his experience as a new doctor in the current climate, he said, “I couldn’t be more fortunate to be working in a supportive hospital which continues to prioritise the safety and operational readiness of its healthcare workers.”
As citizens in the throes of the pandemic, we adapted and learned to live with the virus, and our perception of ‘the new norm’ became simply ‘the norm’. Then on 28 April, not two days into the PGY1s postings, the Ministry of Health (MOH) announced that a 46-year-old nurse working at Tan Tock Seng Hospital (TTSH) tested positive for COVID-19. A new cluster of a new variant had formed. This was, indeed, a jolt to the system.
“The predominant emotion that grips us is uncertainty,” said Dr Goh. “Workflows seem to keep changing every day, and change is the only constant.”
A curveball it may have been, but MOH acted swiftly and its healthcare centres with it, and Dr Goh’s outlook is positive. He said, “Under steady leadership and open channels of communication, we are provided with regular updates on the pandemic situation which helps mitigate a lot of the uncertainty.”
Dr Megan Mary John, who began her posting at TTSH at the onset of the new variant, said, “Everyone is tired but working very hard to contain the situation.”
Despite understandably strict restrictions, with the need to wear a N95 mask and goggles throughout the day, however, she said, “It is heartwarming that patients and their families have been understanding of the dynamic situation.”
The ripple effect of the necessary measures that TTSH took in ceasing new admissions was felt in other hospitals, such as Sengkang General Hospital (SKH) where PGY1 Dr Nadia Nasuha Binte Mohammad Nazri was posted, as new wards opened to receive a higher influx of patients.
“On the ground, each ward team has had to manage more patients to cope with the increased bed capacity,” she said. “Managing more patients can be tiring; however, we take it in our stride to do our part in the fight against COVID-19.”
It may have been ‘in at the deep end’ for our newly minted doctors but, regardless, the water wings came off and they have taken to their profession swimmingly.
Speaking about the reality of his first day on the job, as opposed to his expectations, Dr Bryan Seet, also at SKH, reflected, “To be honest, the change wasn’t as big as I thought it would be. For sure, you’re now given the authority to order medications and make clinical decisions, but you would have been doing all these already (under supervision) up to that point because of the SAP.”
While the prospect of making these decisions unsupervised as a fresh doctor may seem at first daunting, Dr Seet continued, “You feel more responsible for your patient, so you get more sense of fulfilment when you see them leave the hospital in a better state than when they entered.”
On considering his initial thoughts of needing to know it all from day one, Dr Goh added, “I’m learning to acknowledge that I’ll never have all the answers, and I don’t have to – what’s more important is that I find those answers so I can do better for the patients I serve.”
With that, our PGY1s acknowledge that behind every great junior doctor is an incredibly supportive team of mentors.
“We work in teams on the ward, and I can consult my colleagues – other HOs and MOs – who are more senior, to clarify any doubts so that I can do my best for my patients,” said Dr Nadia.
She continued, “I was warmly welcomed by my team. Despite being a fresh junior doctor, they were very approachable, and everyone took time to teach me. I felt comfortable learning on the job, though the learning curve was steep.”
This asserted confidence in the new doctors has given rise to triumphs along the way, even in such as short space of time, however large or small.
“Being able to perform new procedures and skills, being positively affirmed by my seniors, being appreciated by my patients and their families for caring for them, and just seeing my patients get better are small wins which do make me feel fulfilled at the end of the day,” said Dr John.
There have been personally touching moments that have made it all worthwhile, too. Dr Seet recalled, “Getting a note and compliment from my patient about his positive experience under my care was really unexpected as I felt like I was just doing my job. But after reflecting, I guess it’s quite personal to the patients.”
Dr Nadia echoed the feeling from reciprocity in showing compassion to her patients, saying, “I was in charge of one particular patient for several days and her daughter was very worried for her mother’s condition. The stress of seeing their loved ones admitted to hospital can be overwhelming for families. At the end of the patient’s stay, she thanked me profusely and complimented my care for her.”
If there has been one thing that has been unanimous from our junior doctors, though, it is that nothing could have prepared them for the fatigue and chasing that ever-elusive work-life balance. “It is not easy when you’re on call at 3am because a patient is refusing blood taking, declining essential medications, or demanding to be discharged when he still needs inpatient management,” said Dr John.
Dr Goh shared, though, that it is through intentionally making time for friends, projects, exercise, and sleep that keeps him in check. He said, “We can only be our best selves when we are well-rested, and our mental well-being is taken care of.”
What was also agreed was the sense of gratitude they feel in the School’s training for their profession. “SAP was the best preparation for clinical practice,” Dr John said. “Many of the teaching faculty at LKCMedicine are nurses, doctors, and staff who have years of experience working on the ground in clinical practice, and my training during these five years of medical school has been focused and effective.”
For Dr Goh, it was honing skills in communication that was key. “LKCMedicine’s strong emphasis on communication has prepared me well to handle conversations with patients and their families,” he said. “Beyond equipping us with both head and heart knowledge, LKCMedicine has helped me nurture an ‘others-centric’ outlook - one which always strives to add value to the people I meet every day.”
As these new doctors put their best foot forward in a career where no two days are the same, they can take heart in that their trepidation has been pushed to the extreme. And they’ve prevailed – at least at this first step of what would be a long journey. Much like their initial conflicted feelings of fear and excitement, they are now fatigued, but content. It is beginning to pay off.
“This is exactly why I have been training for the past five years,” mused Dr Goh. “It is quite a surreal feeling to realise that I’m living out the dreams I had when I was an 18-year-old high school student.”