June 2020 | Issue 48
“We want to be the best we can”

The Class of 2020’s commitment to their patients and colleagues

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 By Nicole Lim, Science Writer, The LKCMedicine


Excited and scared, but raring to go. This sums up the mood among five newly minted doctors from the Class of 2020 as they were about to start their Postgraduate Year 1 (PGY1) postings in the middle of the ongoing Covid-19 pandemic. Slightly more than half of the group joined institutions under the National Healthcare Group umbrella, while the remainder were posted to the other two clusters, working in hospitals across Singapore.

"It really is exciting, but it is also equally scary because we'd been out of the hospital [for some time] and suddenly we are expected to be quite independent," said Dr Amanda Chia, whose first PGY1 posting is with the department of general surgery at Tan Tock Seng Hospital (TTSH).

Dr Kannan Ramanathan, who is posted to the same department, added, "[But] most of us just want to support the healthcare system in whatever way we can. So, I am just excited to finally do something."

Dr Beverley Lim, who is posted to the Department of Internal Medicine at TTSH, agreed. "This is what we have been training and studying for. We're all excited to be doctors, but at the same time anxious about what lies ahead because we want to be the best we can," she said.

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Dr Lim (centre) at work (Source: Tan Tock Seng Hospital Facebook)

With elective surgeries postponed and some manpower diverted to help manage the growing number of people diagnosed with Covid-19, Dr Kannan and Dr Chia joined surgery during an unusual time. They may be caring for fewer patients, but the team is also leaner. Under these extraordinary circumstances, the assessments and requirements for PGY1 doctors, too, have been modified, which is reassuring to the fledgling doctors.

"Even though there are a lot of things that you cannot change about a whole Covid situation, you know that the system is on your side and everyone wants you to learn how to be a proper doctor and make the process safe," said Dr Ong Kim Yao, who like most his batchmates joined the healthcare workforce on April 27, a full week earlier than originally planned.

But in his eyes, the earlier start to their PGY1 is a win-win. Having missed out on most of their Student Assistantship Programme or SAP, the week-long handover period with a more senior house officer promised to be a great way to get settled faster.

"We really benefitted from having a senior house officer to just tag on to, watch and, at the very least, learn by imitation. At the same time, we also know that as the pandemic draws out, the strain on manpower will get worse. The earlier we get up to speed in our own roles, the more senior clinicians we could free up to deploy out of the hospitals [during the pandemic]," said Dr Ong, who is posted to TTSH's Internal Medicine Department.

And it is not just their seniors who may get redeployed. Dr Ong's batchmate Dr Koo Jian Hui, who'd started his posting at Singapore General Hospital's Department of Internal Medicine even earlier on April 21, was told to be prepared for possible redeployment to suspect Covid-19 wards if necessary.

"We had initially thought that house officers would not be posted to Covid-19 wards but given the significantly increasing numbers, there would have to be a change in deployment strategy. Realising that we may be on the front line before June is something to think about," said Dr Koo.

LKCMedicine's newest group of 90 doctors had passed their final MBBS exams back in January and just embarked on their Student Assistantship Programme or SAP when the outbreak struck. Just a week in, postings were suspended, an interruption that was felt keenly.

"I felt the lack of having SAP very strongly," said Dr Koo.

While they may have felt the lack of a traditional SAP before they embarked on their postings, the initial feedback in May from supervisors at the various hospitals has been positive, according to LKCMedicine Vice-Dean for Education Professor Naomi Low-Beer.

"All 90 of them have transitioned successfully into PGY1 and by all accounts are coping well with the challenges of the healthcare environment which has been transformed by the Covid-19 pandemic. We are very proud of them. The fact that they were so well prepared for this role is a tribute to many people, but in particular Assistant Dean for Year 5 Associate Professor Tham Kum Ying who had to translate the clinic-based student assistantship programme into a campus-based programme," she said.

Simulated ward rounds and simulated consults replaced hospital- and clinic-based patient encounters, giving the Year 5 students a glimpse into the role and responsibility of a working house officer. The e-prescribing module, too, hit the right spot.

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During simulated ward rounds, the students clerked patients who were played by actors and presented their findings to a clinician

"[The School] arranged quite a number of sessions by doctors from Tan Tock Seng [Hospital] to specifically cover what a junior doctor should be able to do when we are called to see a patient," said Dr Chia.

Even if they'd had the benefit of a full SAP, all five agree that transitions inevitably cause some jitters. Changing from a student to a full-fledged member of the medical profession and being addressed as doctor, they said, takes some getting used to.

"The responsibility that you feel as a house officer is different from the responsibility that you feel as an SAP student. There will always be this little feeling that there's something that we need to prepare for," said Dr Kannan.

While business-as-usual would have been preferred by all of them, Dr Lim felt that their medical education didn't just hinge on the SAP. "We have to trust that it's not just about whether we have SAP or not, but about all these five years of what we've been doing all along, which I'm confident has prepared us because I see the fruit of it in our seniors who have been so kind and are very competent at what they do," she said.

The School, too, was confident that its third graduating class more than met the high bar set by Singapore's healthcare system.  

LKCMedicine Dean Professor James Best said, "Our latest cohort of junior doctors is joining the workforce at a most challenging time. But I know they are eager to do their part. They will have their seniors from the School and in the healthcare setting to guide them, and we are confident they will be outstanding in caring for their patients, just like our previous two cohorts."

Starting work during a disease outbreak was not in anyone's career plan, but the young doctors felt ready and well cared for by the system. On April 21, those posted to Tan Tock Seng Hospital underwent a half-day mask fitting to ensure everyone knew what make of N95 mask fitted their face best and how to fit it airtight.

"It's really heartening to see hospitals invest resources to make sure that we're all well-prepared and we know what to do in these circumstances, and how to protect ourselves," said Dr Kannan.

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Dr Kannan while still a Year 4 medical student celebrates his emergency medicine posting (Courtesy of Dr Kannan)

Looking back at their first few weeks on the wards, the junior doctors adjusted quickly to their new responsibilities, which remained largely unchanged despite the turbulence of the Covid-19 pandemic. Dr Koo reflected that it has been "challenging but very meaningful."

"Seeing patients come to us sick and discharging them back well has been a very fulfilling experience," he said.

His colleague Dr Ong agrees. "Work has been tiring but also fulfilling to finally contribute to patient care and put into action what we have been preparing for in the past five years," he said, adding, "What better time to serve than during a pandemic."