Elective Posting at the Singapore General Hospital By Ng Jia Hui (Doctor of Medicine)
I have always wanted to experience the difference in healthcare systems in other countries. As Singapore is ranked top 10 globally in healthcare performances and a neighbouring country of Malaysia, I decided to pursue my clinical elective there. Through the National University of Singapore (NUS)'s Yong Loo Lin School of Medicine, I was placed in Singapore General Hospital (SGH).
Built in the 19th century, SGH is the first and largest general hospital in Singapore. It currently encompasses 39 clinical specialty departments, 29 specialist centres, and eight allied health departments, all aiming to facilitate multidisciplinary approach in patient management. Besides the seven main hospital blocks where the wards and the specialist centres are located, there are five other national specialist centres co-located in the SGH campus. Along with the latter as well as two other hospitals and nine polyclinics, SGH comes under the management of Singapore Health Services (or SingHealth). These healthcare centres all share a centralised online system into which the patients' information are recorded and can be obtained anytime from any of these centres.
SGH is a well-known teaching hospital for undergraduate and postgraduate medical training, particularly for students from NUS Yong Loo Lin School of Medicine, Duke-NUS Graduate Medical School, and for student nurses, radiographers and therapists from polytechnics and medical institutions in Singapore and the Asia Pacific region.
I spent the four weeks of my clinical elective posting in the department of internal medicine and was placed in the acute medical team. The team consisted of a consultant, a registrar, three medical officers, four house officers, a pharmacist, and a specialist nurse. There were five medical students from NUS Yong Loo Lin and Duke-NUS Graduate Medical School in the team. My supervisor was Dr Than Aung, the consultant of the team, and I tagged along one of the medical officers, Dr Jolene Liu Jiaxuan.
I volunteered to follow the house officers for the pre-round clerking every morning at 7am. During this hour, I was given the opportunity to clerk new cases and to present them to the consultant or registrar during morning rounds. Morning rounds started at 8.15am daily, conducted by the consultant and/or registrar, and lasted about 2 to 2.5 hours. A post-round meeting will be held to discuss each and every patient that had been seen to in the morning, to ensure that their management plans were all updated.
During the other hours, I clerked patients in the ward either individually or with the other NUS students, or followed the specialist nurse to perform simple procedures. With the help of the specialist nurse, I successfully performed a few venepunctures, cannulations and obtain blood cultures. I was also given the opportunity to perform a digital rectal examination under the guidance of Dr Jolene.
Teaching sessions were held during the lunch hour, from 1pm to 2pm, to prepare the doctors for their residency examinations. Medical students were also welcome to join. The sessions were usually conducted by the house officers or medical officers, facilitated by the consultants. The topics discussed include approaches to certain medical conditions and board examination question reviews. The sessions were conducted in an interactive way, encouraging the attendees to engage in the discussions and share their opinions. I found the teaching sessions extremely beneficial.
Due to the fact that most Singaporeans do not speak Bahasa Melayu, and as a Malaysian who could speak the language, I translated for Malay patients who could not speak other languages besides their mother tongue. I learned how the doctors advised the patients and how to ensure that the patients understood the instructions by speaking to them directly.
My day usually ended at 5pm after the exit rounds.
There were a few key differences in the healthcare system that I observed. The first is that a centralised online system is used. This allowed for fast and easy ways to retrieve the patients' old records despite having been treated at other hospitals or polyclinics.
Many of the patients were well read before coming to the hospital, especially for those suffering from chronic conditions. I was so surprised that the patients were actually conversing with me in medical terms and could pronounce the name of the medications so well. However, patients have high expectations for the quality of health care provided. They will make complaints if the care is not up to their mark.
The team is based in in-ward patient care where you will find the same team working together for a month. Every member of the team must know the condition of all the patients admitted under their list. During the rounds, all the members, including the house officers, will discuss best management plans without needing to wholly depend on the consultant's or registrar's decisions.
It was a great experience being at SGH. Not only did I learn from the doctors, but the nurses were also my teachers. Their willingness to clear my doubts were highly appreciated. Last but not least, I would like to express my sincerest gratitude to UCSI University for providing me the opportunity to experience my elective posting in Singapore. This elective had broadened my horizons, making me a more knowledgeable person.
Ng Jia Hui is an alumna of SMJK Katholik, Selangor.