It hardly feels like 4 years have passed, and I can’t believe that this is my 4th annual post in the ‘Life as a Medical Student’ series, but I’ve almost come to the end of my penultimate year of Med school. :’)
M4 is unique in the sense that it’s our shortest clinical year, with postings starting in July and ending in December. It’s crazy how we were finishing our final M3 rotations in March 2019, and by December of the same year, we had finished all our M4 rotations.
This has been the most enjoyable year of med school in terms of pace, content & work-life balance, and it was a welcome respite before our final year…
Our 4th year consisted of clinical postings, finals (January), followed by 4 weeks of a compulsory public health research project/Community Health Project (February). The remaining 12 weeks of the academic year (March-May) are dedicated to medical electives of our own choice. I’ll be writing about my 12 weeks of local and overseas electives in a separate blog post, so be sure to look out for it!
Our postings this year ranged from 2-6 weeks, totalling 24 weeks, paling in comparison to our insane 40 weeks of postings back in M3, since the school’s aim was just to give us a small taster of each of these 7 fairly niche specialties.
The intensity of the postings and depth of knowledge required were both lower than M3, which meant that we had a lot more leisure time, which I took full advantage of by launching my very own jewellery store, which you can check out here!
We had four 6-week blocks, and this was the order of postings and the hospitals my CG was assigned:
- Obstetrics & Gynaecology (KKH) – 6 weeks
- Small postings
- Eye/Ophthalmology (NUH) – 2 weeks
- Pathology (NUH/HSA) – 2 weeks
- ENT/Otolaryngology (NUH) – 2 weeks
- Acute Care
- Anesthesia (CGH) – 2 weeks
- Emergency Medicine (NUH) – 4 weeks
- Psychiatry (IMH/TTSH) – 6 weeks
Strangely enough, my CG (clinical group) was posted to NUH for the majority of our postings for the second year in a row. This is by no means a common allocation of hospitals – we were very lucky to get NUH, since it’s our university’s hospital & an excellent teaching hospital.
I wrote about my postings when I was going through each of them
and still remembered what I did in each posting, hopefully you’ll find this post useful/interesting!
Obstetrics & Gynaecology (KKH)
O&G/ObGyn is basically a posting that’s all about women’s health and the various stages of pregnancy. I had a pleasant 6 weeks at KKH for my O&G posting, which was my first posting of M4.
The curriculum at KKH was well-structured, with many lectures covering all the topics we needed to learn and a fair number of tutorials, both didactic and bedside. We had opportunities to attend clinics and watch operations as well. I also had the chance to observe and assist in a natural delivery (I’m so grateful to the couple for letting me help)!
There was sufficient wiggle-room in the timetable for each of us to choose a learning style and intensity level that suited us best. The more surgically-inclined ones spent all day in the OTs, others dedicated all their time to ward work or sitting in clinics, while some enjoyed a more leisurely schedule.
Even though I definitely don’t see myself pursuing this specialty, I found the content of this posting pretty useful and practical since it pertains to women’s health.
Those of us posted to KKH or SGH had a relatively chill experience, whereas those at NUH had a much more packed schedule and longer hours, so your O&G posting really depends on your hospital and your supervisor’s intensity.
This was hands-down one of my favourite postings in M4, because of the content and the doctors we met in NUH’s Ophthalmology Dept. I have an insane amount of respect for ophthalmologists and really enjoyed studying the subject because I’ve previously had eye surgery and wanted to learn everything I could about the…eyeball. (sorry if that was an underwhelming way to end the sentence)
To kick off the posting, we had one day of combined lectures at SGH, then full-day clinics at NUH for the remainder of the two weeks, interspersed with lots of didactic tutorials. Other hospitals had more relaxed schedules, but I wouldn’t have wanted to trade my NUH Ophthal experience for any other hospital.
Each day was an 8am-5pm affair (which was tiring) but the content was really enjoyable, and we were given many chances to examine patients and assist our doctors. We were even allowed to observe operations like cataract surgery and laser procedures!
For Ophthalmology gunners (a.k.a those who want a residency), be sure to approach any doctor in NUH Opthal for research projects – each of them has multiple ongoing research projects, as the department is very academically-oriented. But this is a notoriously elusive specialty, with only 1-2 residents accepted each year, so doing lots of research still won’t guarantee you a spot!
Since Pathology is largely a lab-based specialty (with no space for 20-odd students to sit in), our 2-week posting was comprised mainly of lectures. The first week was 5 full days of lectures on everything from chemical pathology to lab tests. It was informative, but there’s not much else for me to say about it – the content in Pathology is slightly dry, and may not be everyone’s cup of tea.
The second week was a lot more interesting and eye-opening. We were posted to HSA (Health Sciences Authority) for 3.5 days, during which we had the chance to gown up and enter the morgue to observe autopsies. Some squeamish friends chose to watch the autopsies through the glass walls of the observation room, because the sights, smells and emotional heaviness inside the morgue can get pretty overwhelming. There were also some lectures on forensic pathology (CSI irl!), a subspecialty that had always fascinated me since I was a teen.
During the 2nd week, we were lucky enough to be allocated a court session. We dressed up in our most lawyer-esque outfits, and paid a visit to the State Court early in the morning. The judge showed us around and allowed us to observe her work: she engaged in conference calls with HSA Pathologists to identify bodies, and would discuss cases with the Investigating Officers/police. We also sat in on a few short court hearings, to learn about court proceedings.
Overall, it was a very chill posting and helped us revise some basic Pathology from M2, and get a small peek into the world of forensic medicine.
Our schedule at NUH ENT consisted of clinics, OTs and tutorials, with most days lasting from 9am to 4pm. We were able to learn about a wide range of ear/nose/throat conditions firsthand, and even examine patients in the clinic. We observed many clinic-based procedures such as flexible nasoendoscopy, cleaning of wounds/stitch removal, as well as a wide range of surgeries (including rhinoplasties) in the OT.
We had 3-4 didactic tutorials each week, and they pretty much covered the full scope of the ENT knowledge expected of students. The doctors were so approachable & friendly, which made it really easy to ask dumb questions without getting judged.
During the posting, some of my friends even had their ears cleaned or nasoendoscopies (nose checkups) done for free, a fun perk of being a medical student!
We spent 3 full days in the first week having combined lectures at NUH and having simulations & hands-on sessions (intubation, airway maintenance, emergencies, etc.) to equip us with the skills required during the clinical part of the posting.
During the clinical part, a few of us were posted to CGH’s Department of Anesthesia, and I was privileged enough to get an excellent teacher & mentor (Dr Patrick) for the 7 short days I was posted there. I was given the opportunity to do so much hands-on work and function like a junior doctor – setting plugs, assisting with pre-operation checkups and intubating patients.
The huge responsibility of keeping the patient alive/breathing (done under full supervision), making sure nothing went wrong throughout the course of the operation, and staying by the patient’s side until they woke up from the operation really made me feel the enormity and importance of a doctor’s job.
This was one of my favourite postings this year, because of the procedural work involved, as well as the more introverted nature of the job. The only downside was the constant chilliness of the 20 degree operating theatre…
Emergency Medicine (NUH)
This was the most fulfilling and eye-opening of all my postings because of the fast pace of work in the Emergency Department, and the constant feeling of being at the frontline, saving lives.
Doctors in the ED work on a shift basis, with 3 shifts everyday: Morning (8am-4pm), Afternoon (4-pm-10pm), Night (10pm-8am). For those of us posted to NUH EMed, each of us was assigned to 3 supervisors and expected to complete a minimum of 10 shifts over our 4 week posting.
I did 2 shifts back to back just for fun, from 4pm to 8am the following morning. The night shift at the ED runs on a skeleton crew, so I was tasked with a fair amount of work during my overnight shift. It was a novel experience and I was brisk-walking around the ED taking blood at 2am and clerking patients all the way through the night.
Throughout this posting, we also had a few full days of combined lectures by doctors from various hospitals’ Emergency Departments, to get us up to speed with the basics of Emergency Medicine like triage, ECG interpretation, emergency management, trauma, etc.
The most emotionally significant moment during this posting was when a man was brought in after a suicide attempt, where he jumped from a building. Watching such a large team of doctors, nurses and paramedics working together and fighting tirelessly to save his life, then seeing the doctor in charge of the trauma team announce the patient’s time of death about 2 hours later felt extremely sobering and made me reflect on the fragility of human lives, and how it’s not possible to save everyone no matter how hard we fight.
On a more positive note, the vast majority of emergency cases had happy endings; patients who were brought in with life-threatening conditions were treated efficiently and effectively by the doctors, and we were able to share the good news with their concerned families.
This was by far my favourite posting of the year, from being able to work in such a hectic ever-changing environment, to seeing lives saved and lost on a daily basis.
Our 6 week posting was divided over 2 institutions: we spent 3 weeks (8 days) in TTSH and 2 weeks (7 days) at IMH. We started the posting with 2 days of full-day lectures that spanned the entire Psychiatry curriculum, covering basic conditions, medications and communication skills.
At TTSH’s Department of Psychological Medicine, we were scheduled to attend various clinics, ward rounds and blue letter/referral rounds, with each day being a 9am-5pm affair. We also had numerous Observed Clinical Interview sessions, where we would take turns speaking to simulated patients (actors paid to play patients with psychiatric conditions) and getting feedback from our tutors.
Over at IMH, our timetable comprised daily ward rounds, tutorials, general & subspecialty clinics. We were exposed to subspecialties such as Addiction, Child Psych and Geriatric Psych, and had the chance to observe Electroconvulsive Therapy. The patients here were more severely afflicted than those at TTSH, and it was an eye-opening experience, though it may not be everyone’s cup of tea.
Our 6th week of the posting was a revision week, with time dedicated to revision lectures and a mock OSCE session to prepare us for the end of posting test.
Overall, the pace of life in Psychiatry is considerably slower, and the doctors are generally calmer/more chill than in other specialties. However, the nature of the work and the types of patients encountered may not be within most people’s comfort zones. My only piece of advice for this posting is to have an open mind, and to be compassionate!
Community Health Project
The Community Health Project (CHP) is a compulsory public health research project where a team of 30+ students conduct a research study and write a paper over the course of a year, under the supervision of a public health researcher.
This massive group project began at the start of our M4 academic year (subsequent batches have CHP in M3 instead); we were given our research topic, split ourselves into subgroups, and had frequent meetings over the course of the year to work on our respective sections. My subgroup was in charge of drafting the survey and editing it till it was approved, an arduous process that spanned a few weekends.
The project culminates in a completed research paper, presentation and a written exam.
Stay tuned for my next post to read about my 12 weeks of M4 & M5 medical electives, including my medical elective experience in Korea University! All our hospital-based electives have been cancelled in view of the COVID-19 situation, so our faculty has come up with alternative plans for all affected students. I’m involved in writing 2 research papers, so I guess that’s how I’ll be spending the next few months! Stay safe everyone 🙂
I’ll be churning out new posts regularly, even as I head into my final (and more intense) year of Med school, so remember to like my FB page or follow my Insta to stay up to date with all my upcoming adventures!
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If you’re interested in exploring my blog, click here for an index of all the posts I’ve ever written (travel, musings, doctoring), or check out my most read series below:
- the Chasing Dreams series: a multi-part series chronicling my thoughts, dreams & changing ideals over the years (since 2018), including burnout, quitting the rat race, migration and trying to find my path in life
- the (not-so-definitive) guide to doctoring: Getting into Med School & FAQs | Surviving your Clinical Years | MBBS Tips | Life as a M1 // M2 // M3 // M4 // M5 during COVID // Life as a Doctor (monthly series) | Chasing Careers series