Ready, doc? Students embark on final rehearsal
By Sean Firoz, Senior Executive, Communications & External Relations
Sitting in the consultation room, LKCMedicine Year 5 student Ang Wee Kiat and his supervisor, Family Physician Dr Low Kang Yih, found themselves facing an elderly woman, her daughter and a predicament. Doctor, I want you to tell my mother that she needs to take her insulin injections, pleaded the distraught daughter.
"I remember trying my best to manage their emotions and translating the agitated comments between both parties," said Wee Kiat, who with much persuasion, managed to convince the older woman to agree to injections.
Being in the "hot seat" for the very first time at Ang Mo Kio Polyclinic, Wee Kiat got a taste of what is expected of him when he embarks on his career as a doctor in May. These valuable experiences are gained as part of the Year 5 Student Assistantship Programme (SAP), a 10-week programme that covers three core specialties: Family Medicine, General or Orthopaedic Surgery, and Internal Medicine, preparing the final-year students for life after graduating from medical school.
An experience like no other
The capstone of the MBBS programme, the SAP integrates all that the students have learnt over the past five years and embeds them into medical teams across specialties.
"The SAP allows students to apply their knowledge and skills much like they would in a real-world setting," said LKCMedicine Assistant Dean for Year 5 Associate Professor Tham Kum Ying, who is also a senior consultant with the Emergency Department at Tan Tock Seng Hospital (TTSH).
Unlike other final year attachments, the SAP at LKCMedicine begins after the students have completed their final MBBS exams, allowing them to fully focus on their work in the hospitals and clinics. This is to ensure that the students have proven they are ready to begin their medical career and possess a good baseline of skills, added A/Prof Tham.
Serving much like house officers, but under the tutelage of senior doctors, the students are expected to be quick on their feet, examine patients and propose management plans, among many other responsibilities.
Currently, junior doctors spend most of their first postgraduate year in hospitals, with little or no exposure to family medicine. Most rotate to polyclinics only during their second year, when the learning curve can be too steep for some, said A/Prof Tham. To give its students a wholesome medical education that covers all aspects of care, LKCMedicine decided to include family medicine during the SAP to help students feel more at home in the polyclinic, and learn the skills needed to treat patients on the front lines.
At the end of the SAP, the students have to present a portfolio of their work to the School, comprising a series of reflective essays and case-based studies of the patients they have seen. The portfolio is graded and to graduate, students have to pass.
To prepare them for the SAP, the students went through an orientation week, including an advanced class on clinical communication, focusing on breaking bad news to a simulated patient in a professional and empathetic manner. The students also had the opportunity to participate in a family conference, where the care team and family decide on a treatment decision for an elderly parent.
Another component was the SBAR or Situation, Background, Assessment and Recommendation course. The SBAR teaches students how to communicate effectively with a senior doctor whether it is a request or referral of a patient. Talking to a senior doctor can be a nerve-wracking experience for many students, and to build their confidence, the students were given a mock patient file to internalise before calling an actual senior doctor to refer the patient.
At the end of the orientation week, LKCMedicine invited residents from the National Healthcare Group (NHG) hospitals to share their insights on what to expect on the wards and how to cope with stress in the work place.
"I think our School has prepared us pretty well," said LKCMedicine Year 5 student Jacqueline Chua. "We generally have no problem communicating with patients, and the procedures we’ve learnt in school are like muscle memory at this point."
The life and times of a student doctor
The transition from medical student to junior doctor is no easy feat. Gone are the days when the Class of 2018 spends their time in Team-Based Learning classes and observes patient care from the sidelines during clinical rotations in Years 3 and 4. Now, the students are expected to give inputs on how to manage patients' conditions and perform procedures as part of the medical team.
Year 5 student Toh Ching Han started her SAP at TTSH, joining a large medical team of senior doctors, medical officers, house officers and medical students. Beginning her day as early as 7am, Ching Han shadowed the house officers and performed the same procedures as they did under the supervision of Department of General Medicine Senior Consultant Dr Ashish Anil.
"During the ward rounds, I was assigned a few patients to take care of and look through their notes, speak to them and find out what needs to be highlighted to my seniors," said Ching Han. "An important part of my job is also proper documentation, including any modifications to the management plan made by my seniors."
In the afternoon, Ching Han implemented the changes to the management plans, which included writing referrals to other specialties, ordering investigations and updating the patients and their relatives on the care plan.
Ching Han’s work impressed Dr Ashish, who observed that by "putting in a lot of hard work, she will have good career options that will be available to her in the future."
Over in the north of Singapore, Jacqueline and her classmate Melissa Chia began their family medicine rotation under the same supervisor as Wee Kiat, Dr Low. In the consultation room, Melissa and Jacqueline took turns leading consultations for several patients, formulating management plans and deciding whether they need specialist attention.
"I was impressed that the students were very earnest and keen to learn during their SAP," said Dr Low.
What stood out the most for the two students was the spectrum of cases, from taking care of infants to elderly patients suffering from depression.
"Examining newborns was very interesting, and as they were only five to seven days old, I previously wouldn't have dared to touch them," said Jacqueline. "But now being in a ‘doctor position', the parents entrust me with their child, which was pretty cool."
However, out of the three rotations, the surgery posting proved to be one of the most eye-opening experiences. Melissa recalled being on-call with the general surgery department at TTSH, having to spend long hours following the care team around, communicating and following up with patients alongside the other house officers.
"Going on calls was also a way for us to manage our time properly, and learn more about interpersonal skills," said Melissa.
"It also made you realise that you've graduated from your role as observer in Year 3 to one where your decision can make a difference to the outcome of a patient," added Jacqueline.
A little bit of help goes a long way
Throughout the SAP, the students had nurturing and helpful seniors and inspiring role models to help them adapt and learn from the programme.
In his posting at Ang Mo Kio Polyclinic, Wee Kiat recalled how his supervisor Dr Low addressed patients’ concerns in a warm and empathetic manner. "I've learnt the ideal model of family medicine from Dr Low, which is to be comprehensive in my approach and always be an advocate for the patient," said Wee Kiat.
As for Ching Han, her seniors at TTSH also helped her out when things got unfamiliar, stating that the junior doctors were "always ready to help and took her through their day to day work" in order for them to function as a team in the wards.
Sometimes during ward rounds, the house officers would show them clinical skills, recalled Jacqueline, such as removing surgical drains from patients who just came out of the operation theatre.
"We are not exactly thrown in the deep end, as there is a lot of supervision from our seniors, learning points and debriefs after each session so that we take away something from the whole experience," said their classmate Toh Ying Jie, who started his SAP at Hougang Polyclinic.
Stepping up from student to doctors
With their time at LKCMedicine coming to an end, the Class of 2018 is looking forward to becoming doctors that you and I would like to have caring for us.
From how to be a productive team player, to communicating with patients, and honing practical skills, the students learnt much and found their footing in the hospitals and clinics, preparing them to become junior doctors. And how far they have come from fresh medical students to the doctors they aspire to be tomorrow!
Dr Ashish who supervised Ching Han during her internal medicine rotation said, "She surprised me as she could easily function as a house officer, and a great team player too."
Dr Low added, "I hope that they will maintain their caring attitude towards patients and constant zest for learning from their patient encounters."
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