October 2013|Issue 8
Why Year 1 Clinical Weeks Matter

By Associate Professor Tham Kum Ying

Some six weeks after school began in August, some students (presumably comparing their experience with that of Year 1 medical students elsewhere) asked, “When will we start learning anatomy, physiology, histology etc?”

This question was easy to answer – come mid-October, our students will begin their Cardiorespiratory block and learn the science as well as the application of it in clinical practice. Perhaps the question ought to have been phrased “Why such an extended orientation and introduction?”

Nine weeks might seem long to some, but everything from content to sequencing to delivery of this extended orientation for our Year 1 students was meticulously planned for. The White Coat Ceremony on 15 August, for example, was not just a symbolic welcome of a new cohort of students into the medical profession – it also served as an early reminder to be caring, ethical and responsible, what our students pledged to be when they recited the ‘Declaration of a New Medical Student’ during the Ceremony.

As part of orientation, our students were also introduced to ‘Medicine - Past, Present and Future’, where the contributions (and the wrongdoings) of the medical profession were discussed and the key message about being responsible doctors and maintaining high ethical standards was reinforced. A Team-Based Learning session on ‘Medical Professionalism and the Medical Student’ was also conducted to address the issue of privacy and confidentiality, especially regarding the Internet.

Likewise, the sequencing and delivery of teaching sessions around and during the Polyclinic and Hospital Clinical Weeks also underwent careful planning. To prepare our students, Assistant Dean (Clinical Communication Training and Student Welfare) Dr Tanya Tierney conducted clinical communication sessions where our students learnt how to approach and initiate a conversation with patients, mask fitting, hand hygiene and basic infection control from senior nurses.

From left to right: Students interacting with Simulated Patients, students having lessons.

In between the Clinical Weeks, the students also completed a seminar on ‘Social Determinants of Healthcare’ where access, availability and affordability were discussed interactively with Assistant Dean (Family Medicine) Associate Professor Wong Teck Yee and Dr Ian Leong, Head of Continuing and Community Care at Tan Tock Seng Hospital.

All this helped lay the foundation for our students to accomplish the following learning outcomes:

• Describe the patient’s journey through the clinical setting
• Describe what is meant by ‘ideas, concerns and expectations’ in relation to conversations with patients
• Describe the roles of the doctors, nurses and other members of the healthcare team
• Recognise the importance of good communication between health care professionals

During Hospital Clinical Week, a pair of doctor-nurse or doctor-therapist supervisors mentored each team of students, walking alongside them on the journey a patient will take. Our students were embedded in the daily activities of how patients are cared for, including the backstage areas of the hospital such as the kitchen to understand the complexities involved in the daily running of a hospital. Most importantly, the supervisors were role models for our students, demonstrating empathy, teamwork and professionalism.

Clinical Exposure at TTSH.

Reflecting on the experience, Year 1 student Jacqueline Chua said, “Detractors say that such early clinical exposure can disillusion us with the realities of the hospital, but having gone through it, I beg to differ. This Hospital Week has given me so much food for thought and made me feel that I made the right choice entering medicine and in particular, LKCMedicine.”

LKCMedicine Students Impress During Polyclinic Clinical Week

Dear Students of LKCMedicine,

Thank you for sharing your learning points from your one-week posting to the Family Medicine Academy at Bukit Batok Polyclinic last Friday. It was unfortunate that I could not address you all personally after your presentations as I had another event to attend immediately following that. So while the session is still fresh in my mind, let me share my thoughts with you now.
 
Overall, I am very pleased and impressed with your presentations which were a reflection of your understanding of the importance of effective communication and the various roles of the primary care team in patient care at the polyclinic. You all have done your tutors proud with the amount of work and effort put in for your presentations despite the little time you had. Some of you even showed your artistic talents which bowled us over - you may just get to be invited to showcase them for future events in NHGP!
 
Many of you shared your reflections – both the pitfalls and experiences from your one-week experience of communicating with patients who were strangers. You started initially feeling awkward but became better towards the end of the week.
 
Indeed, communication skills are essential to help us start a conversation, establish rapport with our patients and then develop a doctor-patient relationship. It is an on-going learning journey which involves some self-discovery, identification of our gaps and then learning how to close these gaps. You may improve through feedback by friends and tutors or even by observing yourselves through recordings but one thing for sure – you need to practice in order to improve. Practice makes perfect.

 

Student presenting their reflections about their clinical attachments.

You will be applying these skills from now on and for the rest of your lives as doctors. Having effective communication skills enables you to practice medicine, to care for patients, to empathise with patients and to advise patients on his/her management plan. In fact, you can apply these communication skills in your own personal lives and learn to reduce the chances of miscommunication and improve your relationship with others.
 
Some of you sounded a little disappointed at not being able to speak with a doctor running his/her clinic after having spoken with almost everyone else on the team. The idea here is that you need to start by learning what and how others in the team contribute towards the care of the patient when working alongside the doctor.

In a nutshell, the doctor in a polyclinic plays several roles – as a clinician caring for his/her patient, he/she needs to be a communicator, patient’s advocate and a professional. As one who leads and orchestrates his/her team of healthcare professionals (nurse, dietician, pharmacist, operations staff etc), he/she needs to be a leader and a manager. These are some of the skills he/she will need to continue to hone as a good doctor.
 
You’re now at the early phase of the learning journey of being a doctor and what you’re learning are the fundamentals. These are life skills.  Learn them well and you’ll be laying the foundation for clinical medicine.
 
I certainly look forward to seeing you all again during your Clinical Methods Teaching sessions and I’m sure you will enjoy learning from the patients and tutors as much as you did the last week.
 
Best wishes,

Adjunct Associate Professor Chong Phui-Nah
Family Physician, Senior Consultant
Senior Director
Family Medicine Development Division
National Healthcare Group Polyclinics