October 2015 | Issue 20
Life on a clinical posting

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By Leon Tan Yuan Rui
Class of 2018

For two years, we learnt basic clinical and communication skills and the scientific foundation of medicine in the safety of the Team-Based Learning (TBL) seminar room and with mainly simulated patients. This August, it was time for us to step forth into our clinical years.

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Scrubs and gloves, check!

While it wasn't a total goodbye to what we'd gotten used to (we have pre-rotation weeks of TBLs and content to prepare us for the rest of the weeks in our postings), it was a big transition.

I started my clinical years with a posting in surgery. For that, we were signposted to read a few chapters from Norman Browse's famous
Introduction to the Symptoms and Signs of Surgical Disease and Essential Surgery, which are our key reference books, in preparation for two TBL sessions in Week 2 of School (one week before our eight-week rotation with the department of general surgery at Tan Tock Seng Hospital [TTSH]). The TBLs showcased cases commonly seen in general surgery and covered most of the basics we needed to know before we headed to the wards and helped prepare us.

When it came to more specialised content knowledge such as the breast and vascular system to which we had little exposure in the pre-clinical years, we had additional tutorials every Tuesday and Thursday afternoons. During the tutorials, clinical tutors and Associate Professor Nandini Rao (Lead for Pathology) taught the subject and pathophysiology in more detail. Besides those, we also had tutorials for each component of general surgery too, such as tutorials for hepatopancreatobiliary, upper GI, lower GI etc. Although the amount of content got quite overwhelming for us at times, they served as pit stops for us to gather our thoughts on the review matter and check our knowledge.

Everyone has different styles when it comes to learning in the clinical years. One thing that definitely helped me was the huge amount of patient contact. Every day, students find patients to 'clerk', taking a detailed history from them and performing physical examinations on those who have pathology that we can feel and learn from. We learnt that every patient is unique, and each of them have their own stories to share and tell.

Learning from patients is different from reading off textbooks. When Mr A comes to the hospital with a perforated appendicitis, he may present with classical symptoms, or may present with slightly different symptoms that somewhat resemble what the textbooks say, but with unexplainable differences at times that clinical tutors attribute to 'uniqueness of each individual'. In clinical medicine, we learnt the phrase "never say never to any possibility", which is why clinical experience is so important in making the right diagnosis. No amount of textbook reading could help someone learn better than talking to the patients themselves and learning about their conditions from them.

Learning in the clinical world is extremely self-driven too. We often compare and feel that certain tutors are more willing to teach, and that our colleagues with such tutors are 'luckier'. However, learning isn't just confined to our core tutors assigned to us. Rather, we have to take the initiative to find clinicians who are willing to teach us, and be proactive in asking around for opportunities to perform procedures. Professor Low Cheng Hock (Emeritus Consultant with TTSH's department of general surgery) told us that "we should wake up to each
day because of the many opportunities to learn, and should only leave TTSH each day after learning something". Indeed, that's the mantra many of us have adopted for this phase in our lives.

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My team members and I

Whilst we have our own 'agenda' of learning from patients, we cannot forget the other side of the coin as well. Some patients feel lonely and these are instances when we should put aside our own agenda and give them our fullest attention to show them that someone is there to care for them. The small things that we do for patients can go a long way. During the third week of my surgical posting, I met Mr X who told me about his life for two hours. Although he did not talk to me about his medical condition as much, I learnt from that interaction how to be a better listener and comforter. At the end, he told me that this is the first time he felt cared for in a very long time, and held my hand to thank me. It was a heart-warming moment, and reminded me of why I wanted to do medicine in the first place.

We are not here just to learn how to heal everyone. Whilst that is an ideal goal, clinical medicine has exposed us to the harsh reality that there are certain conditions which are simply untreatable. Instead, what we can do for these patients is to make their time more comfortable. The famous quote "cure sometimes, treat often, comfort always" comes to mind, and this is definitely applicable in the world of clinical medicine.

Learning is a continuum; even a consultant at the age of 40 is still learning every day. Our Wednesday afternoons off provide many of us with the opportunity to recharge midweek, and I am thankful to the school for such a policy.

To the juniors reading this, study your pre-clinical content well as it will definitely serve as a good foundation for the clinical years, and look forward to the exciting world ahead where everything comes to life.

To my class mates, I hope this piece will resonate with many of you, and that we will strive together to redefine medicine, transform healthcare and become the doctors that our patients would like to have caring for them.