The elective posting, which is a part of our year four medical curriculum, allows us to choose the hospital and specialty according to our own preference. It provides us with an opportunity to experience health care in an entirely different setting as well as broaden our knowledge and explore our interests in the future. I chose Queen Elizabeth Hospital (HQE) for my elective posting which is a tertiary teaching hospital in my hometown, Kota Kinabalu, Sabah. It is also a popular destination for medical students from both local and overseas universities. I completed the four weeks of my elective in neurology as I wanted to gain new experience in a subspecialty posting. Moreover, neurology is a field which attracted me since before entering medical school.
The neurology department in HQE is headed by Dr. Chia Yuen Kang, whom I shadowed during my elective posting. The department consists of a neurology clinic and a neurophysiology unit. The clinic officially operates on a daily basis from Monday to Wednesday. Apart from the clinic, botulinum toxin injection services are also provided to scheduled patients. Additionally, the neurophysiology unit is fully-equipped with adequate facilities for various procedures such as electroencephalography (EEG), nerve conduction study (NCS), electromyography (EMG) and visual evoked potential (VEP). Patients who require inpatient treatment will be admitted to the neurology ward which houses four cubicles and an isolated negative pressure room designed for patients diagnosed with highly contagious illnesses.
My elective at the neurology department was a fruitful experience. My supervisor, specialists and medical officers were all very encouraging and helpful in guiding me throughout my posting. The placement was well-organised with regular specialist ward rounds, clinic sessions, neurophysiology study sessions and continuing medical education (CME). I was able to practice on examining patients and present my findings to the specialist during ward rounds. It helped me improve my clinical skills and learn to present cases in a clear and concise manner. I saw a wide range of uncommon neurological disorders like multiple sclerosis, neuromyelitis optica, anti-MUSK myasthenia gravis, amyotrophic lateral sclerosis, Guillain-Barré syndrome, Fahr syndrome, Brown-Sequard syndrome. I was grateful for being able to see all these cases because it motivated me to understand the conditions more thoroughly.
Besides that, I also observed several procedures especially lumbar puncture which is particularly useful in diagnosing many neurological diseases. During the clinic sessions, I saw doctors explaining conditions and offering treatment options to the patient and family members. Moreover, I also learnt the importance of developing interpersonal skills by observing how doctors establish rapport with their patients. In neurophysiology studies sessions, my specialists showed me how to perform nerve conduction study and electromyography as well as their interpretation. Undoubtedly, the most invaluable experience was when my supervisor assigned me to read and present in the neurology CME, a research paper on mitochondrial respiratory chain disorders & MELAS syndrome.
I also had the fortunate opportunity of seeing how my specialists emphatically delivered a bad news to a patient who was newly diagnosed with ALS. After the completion of my elective posting, I learnt that most of the nervous system disorders are chronic debilitating illnesses so patients usually require long-term follow-up services in facilities. Therefore, physicians should expend more patience and compassion towards their patients. Most importantly, this elective posting has given me a clearer picture for my future plan. Lastly, I would like to extend my sincere gratitude to UCSI University, our elective coordinator, Professor Retneswari, and her assistant, Puan Norsiah for their constant support and help throughout my elective posting period.