Life as a 3rd Year NUS Medical Student

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And so my 3rd year is over; it’s been a hectic 11 months of non-stop clinical rotations and exams, but boy does it feel great to be done with what is dubbed as the ‘toughest/most tiring’ year of Med school! We hit the ground running exactly on my 21st birthday in mid-June – what a way to start M3, aka the start of the rest of our adult lives as doctors – and our M3 sprint has finally come to an end as of mid-May.

Clinical Postings

In M3, you’re rotated through five 8-week postings, and the order varies depending on which CG (Clinical Group, a team of 6) you’re in. Subsequent batches won’t have the same experience as my batch did, as the school will be reshuffling some postings between M3 & 4, and altering posting lengths.

This was the order of postings I had:

  1. Orthopaedics (SGH/NUH)
  2. Internal Medicine (NUH)
  3. Paediatrics (NUH/KKH)
  4. Family Medicine
  5. General Surgery (CGH)

A lot of seniors told us stories about how tiring and intense M3 was going to be, and there was a lot of fear-mongering happening in general, so I started M3 wondering if it was really as terrible as they made it sound. The truth is, M3 can be as hardcore or as chill as you want it to be; apart from compulsory ward rounds & tutorials, it’s predominantly self-directed learning, so you have a certain degree of freedom over how you choose to spend your time outside the designated timetable.

Overall, I had a pretty good M3 experience; the clinical years are SO different from the more boring pre-clinical years, and you’ll get to interact with patients and learn so much new stuff on the job.

I wrote about my postings when I was going through each of them, and as you can probably tell, I have some particularly beloved posting (Paeds & Fam Med!) and some not-so-beloved postings.

Ortho

Ever wanted to know the difference between an arthropod and an Orthopod (slang for Ortho surgeons)? This hilarious post that I stumbled upon while procrastinating is definitely worth a read; below is a gem from GomerBlog’s satire website: “An orthopod is a vertebrate animal with an endoskeleton that cares deeply about everyone else’s bones; they show their affection by beating on them with hammers and drills.”

For this posting, you can leave your stethoscope at home cos you won’t use it at all! I’m not even kidding; you won’t see any of the senior doctors carrying stethoscopes around. It’s generally a very chill but interesting posting. I did 4 weeks in SGH and another 4 in NUH, and the posting culminates in an OSCE examination on the last Saturday of the posting.

The Ortho posting is just a taster of what life as an Orthopaedic surgeon will be like, so if you’re a guy and you happen to enjoy the nature of work that they do, then maybe this specialty is for you. If you’re a female and you like Orthopaedics, try Hand Surgery, since the gender ratio for Orthopaedic surgeons is extremely lopsided (and fairly so, since brute strength is required for most of the procedures).

I’ll be the first to confess that my Ortho posting was pretty much an extended vacation for me, and on most days, I left work after morning clinic sessions and/or tutorials were over. Ortho barely had ward rounds (they usually finish by 8am, so we were advised not to attend them), and lurking around in the wards was low-yield, as most of the patients were post-op, so we couldn’t practise our physical examinations on them.

It was very much an own-time-own-target kind of posting, so if you’re interested in it, then by all means spend more time in the OT and getting to know the senior doctors; but if you’re like me and have 0 interest in surgical specialties, just take it slow, learn your Physical Examination steps well and start studying ahead for IM enjoy the 8 weeks! 🙂

The assessment for this posting is an OSCE with 3 short cases and 1 long case. It accounts for 95% of your posting score, but fret not, as pretty much everyone passes. Just use this posting to have fun and relax a bit before starting IM, which is notorious for being the most intense posting.

Internal Medicine (NUH)

I was really lucky to have had my IM posting at NUH, because our schedule wasn’t as terribly exhausting as our friends in other hospitals. We had daily ward rounds that started at 7.30/8am (depending on the team we were assigned to for that week), and we usually had bedside tutorials & some lectures in the afternoon. Most days ended around 3-4pm, which is considered very early by IM standards; I had friends in SGH who ended at 7pm on many days due to poor scheduling of tutorials. Our NUH posting coordinator was really thoughtful, and she scheduled our timetables to end by latest 5pm, so we would have sufficient time to have a life outside Med school.

At NUH, we had the option to do night calls and procedures (blood-taking, ECG, catheterisation, etc), but they were optional. The procedures were optional since the patients in NUH are generally more ill than in other hospitals and were more ‘fragile’, so the posting director didn’t want us causing unnecessary distress to those patients. As far as I know, DOPS (Directly Observed Procedural Skills) are compulsory in all other hospitals, and you’re required to get all of them signed off by doctors, so it’s a fairly time-consuming affair.

IM is a lot more high-yield and fascinating than Ortho (some of my CG mates hated IM and loved Ortho :/), and there’s so much more depth to the content. I would advise buying the Oxford Handbook of Clinical Medicine at the start of the posting, and carrying it around with you to read during ward rounds. Ward rounds are compulsory but not necessarily high yield for M3s, since the doctors normally discuss patient management, so use those precious hours to read your own notes. Nigel Fong’s Approaches is an amazing resource for your clinical years; email me if you’d like his notes!

We had an average of 3-4 bedside tutorials weekly, where we would get to examine patients under a doctor’s supervision; I found these relatively high-yield and interesting, although it was quite physically exhausting to stand for 5+ hours straight (3h of morning rounds followed by a 2h tutorial until lunch time). Oh well, I guess I just need to get stronger legs. NUH also organised a lot of lectures, covering each subspecialty very thoroughly, and I’m really grateful we were posted here, since other hospitals’ IM postings didn’t have such well-organised and structured lectures.

IM has the most assessments of all the postings, with 6 mini-CEXs, 2 Reflective Journals, 1 Case Write-up and the EOPT. If you manage your time properly and start writing your Reflective Journals in the first 3 weeks (I completed both of my RJs by week 4 of the posting), you’ll have a lot of leisure time towards the end of your posting, while your peers are busy doing their assignments last-minute. The EOPT is fairly easy to pass, but hard to excel in (getting >80% is v difficult); don’t be too stressed about it, as it’s just an indicator of how much you’ve learnt within the first 6 weeks of IM, which is really quite a short amount of time to learn a whole new specialty.

I was initially really fearful of this posting, after hearing horror stories from my seniors and peers, but I still managed to get 7-8h of sleep at night (yes, I’m a human sloth) and my sanity was still intact at the end of the posting, and I enjoyed it overall! Your experience will vary greatly according to the hospital you’re posted to, but it ultimately depends on how you manage your own time and extracurricular activities.

Paediatrics (NUH/KKH)

I’m writing this section in the final week of my Paeds posting, and I just wanted to declare that this will probably be my favourite posting in M3.

5 CGs (30 ppl) were posted to NUH for the first 4 weeks of our posting, then KKH for the last 4 weeks; the other 5 CGs started at KKH–>NUH. The first 2 days of the posting were full-day lectures to introduce the basics of Paediatrics to us, since it’s quite different from adult medicine/IM. Thankfully, we had just finished our IM posting, so we were able to build on the basics from IM.

The assessments in Paeds are: 2 Case Analysis reports (1 in each hospital), 2 CEXs (1 in each hospital), tutorial participation (assessed in both NUH & KKH) and the EOPT, which is just 40 MCQs.

NUH only has 2 Paediatric wards, so we were not required to attend ward rounds, cos 30 ppl would have made the wards far too crowded. NUH’s schedule is less densely packed than KKH’s, so we were lucky to have been posted there first, cos it gave us time to study our seniors’ unofficial textbook (Ching Hui & Hamid’s Paediatrics Notes) and cram basic knowledge into our heads.

The structure of my NUH posting was: 1.5 weeks of ward embedding, 1 week of specialist clinics, 1 week of general clinics. For ward embedding, we were assigned a tutor who would take us to see interesting cases and give us daily bedside tutorials for that whole week. The specialist and general clinic weeks were largely free apart from tutorials, since we were not assigned to fixed clinics. I attended 1 general clinic, and spent 3 hours sitting on the floor playing with kids while their parents spoke to the doctor-in-charge; I had so much fun probably cos I’m a kid at heart! Throughout the 4 weeks at NUH, we were assigned 3 core tutors, who would organise tutorials for us; my all-time favourite tutor was Dr Seo, as her tutorials were high-yield but also extremely chill/fun. We also had a half-day session at CCK Polyclinic to observe Paediatrics in a community setting.

KKH organised a lot more tutorials and lectures, so the days were longer and it was more tiring in general. We were also assigned to wards by CG, so ward rounds were a part of our daily schedule (though they were not compulsory). We had 6 core tutors, with an average of 3 tutorials by each tutor. Since the patient load in KKH is far higher, we were able to see a huge variety of patients and more interesting cases.

I absolutely LOVED this posting, and enjoyed it far more than I ever thought I would. It was the perfect mix of being intellectually stimulating and fun; it’s basically Internal Medicine with toys, stickers, happiness and children.

Family Medicine

Some people love Fam Med, while others don’t; but either way, this posting is the most broad-based posting in med school, letting us rotate through different care settings (GP clinics, polyclinics, palliative care, community hospitals). Realistically, majority of the current medical students in Singapore will end up in the primary care sector (due to an excess of doctors), so this posting was highly relevant and gave us the opportunity to explore our future career options outside the hospital.

The first week of our posting comprised lectures from 8 to 5 each day, so it was relaxed but not particularly exciting. Our second week was spent at a community hospital (YCH), where we were able to see stepped-down care and learn more about rehab medicine.

The following 2 weeks were spent at a GP clinic of our choosing, and 2 of us we were lucky enough to be posted to Dr Lim Lean Huat’s clinic at OUE Downtown, so I learnt a lot – he’s been in practice for over 50 years and is the family doctor to multiple generations of families – and had a fabulous ocean view from his 40th floor office during my 2 week stint. During the subsequent 2 weeks at Tampines polyclinic, we interacted with patients at the community level, educated them on preventive health, and observed the in and outs of the life of polyclinic doctors.

My final week was spent in various Palliative Care settings, with one day spent at Dover Hospice, another shadowing a doctor on palliative care home visits, and another at the National Cancer Centre Singapore@SGH. This was possibly the most impactful week of my M3 year, and it was the first time I cried at work (after a palliative patient collapsed). Palliative Care is a very delicate and nuanced specialty, and the doctors there are truly angels and they uphold an extremely high standard of care, both medical and psychosocial, for their patients. It was a short but sobering week, because it makes you confront your own mortality, and reminds you that even as a doctor, you can’t save every life.

The assessments for this posting included: 2 write-ups, 2 CEXs (1 each in the GP clinic & Polyclinic), an OSCE and EOPT (MCQs).

Overall, I found Family Medicine a fulfilling posting, and the level of patient care is so much more holistic in this primary care setting, with a doctor being able to take care of entire families from cradle to grave. And in terms of work-life balance, it was the most relaxed and peaceful posting in M3, and provided an extremely welcome respite from the pace and general vibe of hospital postings; I enjoyed the posting so much and I’m officially sold on the Family Medicine life.

General Surgery (CGH)

GS is generally known (within the med student community) as being one of the tougher postings, due to the amount/depth of content covered, as well as the not-so-nice culture of some hospitals’ GS departments. CGH (Changi General Hospital) has one of the nicest GS departments, and I was so blessed to have been rotated there for my GS posting, although it was really far from my home. They lived up to their reputation; every doctor I met there in my 8 weeks was approachable and very willing to teach dumb students (like us).

Our timetable consisted of daily 7.30am ward rounds, twice-weekly Morbidity and Mortality sessions and a smattering of lectures & bedside tutorials. Our rounds thankfully started a lot later than the 6.30/7am rounds that our fellow friends at other hospitals had to endure, and they were generally quite short compared to IM rounds as the surgeons had to be in the OT by 9am. I was attached to the Colorectal Surgery department for 5 weeks (some of my CG-mates were posted to the Head & Neck and Hepatobiliary departments), spent another week with the Vascular team and had 2 weeks in Urology.

We were lucky enough to be able to accompany our supervisors into OTs and watch various operations and procedures for learning. It was fascinating to observe the huge role technology plays in making surgeries more precise and less invasive, and we had the chance to observe multiple operations performed with the multi-million dollar Da Vinci robot.

The heaviest component in this posting was the Team-Based Assessment (which included participation during rounds, attending OTs and completing 7 CEXs). On top of that, we had 2 write-ups, 1 Direct Observed History Taking and the EOPT (MCQ & MEQs).

The curriculum at CGH was well-structured, with lectures that covered key GS topic. We had approximately 2 afternoons free for self-study every week, which was beneficial especially since our GS posting was right before our finals. We ended around 3-5pm on most days.

While GS is far from my cup of tea (due to insane working hours), it is certainly an interesting and highly technical specialty, and we were very fortunate to have had a great posting to end off the tiring 11-month academic year.

Electives

At the end of both Year 3 & 4, the faculty gives us a few months to do electives. The Year 3 electives (4 weeks) need not be medical-related, but the Year 4 ones (12 weeks) must. It’s a great chance for people like me – a.k.a those who have always been itching to try other careers and hobbies – to explore my non-medical options and just have fun learning new life skills. We’re allowed to do absolutely anything under the sun; some of my batchmates are undertaking electives in exotic safaris, restaurants, veterinary clinics or doing mission work, while others are interning at hospitals overseas.

I’ll be churning out new articles regularly, so remember to follow my Insta or Facebook page to stay up to date with all my upcoming adventures!

xoxo,
Faith

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3 responses to “Life as a 3rd Year NUS Medical Student”

  1. Yay!! You finally posted! I’ve been waiting around so long for this!!! Thank you so much for taking the time and effort to draft this up!😊 Please continue with such posts in the future. I’ll be looking out for them😊

    Like

  2. How time flies, I remember the feeling when I was in third year of medical school. Wish you a brightful, meaningful journey ahead. 🙂

    Like

    1. Thanks Rara, same to you, and may you have a great journey ahead in this profession! 🙂

      Like

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