Chasing Faith and Love

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Those of you who’ve been following my blog for the past 4 years know that I’m going to be starting my 5th and final year of medical school next week, amidst the COVID-19 pandemic. With all the chaos and disruption caused by COVID-19 over the past few months, I thought it’d be interesting and informative to write this post to share how this pandemic has affected medical students and our training.

The NUS Med/YLLSoM faculty has been nothing short of amazing in their prompt response to the pandemic – they started to cancel clinical postings, electives, and all other activities that included human contact from as early as end-January. I don’t mean to sound like a propaganda machine for NUS Med, but the doctors and staff running our faculty have been working insanely hard rearranging the schedules for all 5 years of students (imagine how much work that was!), prioritising our welfare & health, and meeting with the Ministry of Health to arrange for the resumption of our clinical training.

These are some of the changes that they’ve made since then:

For my batch (M4s going to M5):

• We had already finished our clinical postings and final exams in late January, so our M4 curriculum wasn’t disrupted or affected.
• As part of the Community Health Project (public health research), we were supposed to conduct face-to-face surveys in various housing estates throughout February, but it was cancelled really early on. I remember getting the good news when I was on vacation with my CG mates! The exam for this module was changed to an open-book, home-based exam instead.
• We were supposed to have 12 weeks of clinical electives running from March to early-June, where we could choose postings based on our own interests (in any hospital or country), but everyone’s electives were cancelled. I was supposed to go to Korea University for 2 weeks (after 10 weeks of Singapore-based electives), so I was kinda bummed, but it was definitely the best decision the school could have made!
• We were given the option to undertake our own research projects or join various ‘Pathway’ courses (new programmes thrown together by the faculty at lightning speed) during those 12 weeks. I participated in and published 2 COVID-19 research papers, while growing my business (shameless plug for GLITTR), so it was a pretty fulfilling use of my time!

For other batches:

• Our graduating seniors (from all 3 medical schools) were the hardest hit of all, with their MBBS (the final exam before graduation) having sudden changes from real patients to simulated patients (paid actors), to minimise contact risk. Their grad trips were cancelled, and they were also ‘conscripted’ to start work 2 weeks earlier than planned, to join the frontline and help ease the workload of existing doctors.
• The 4-week Clinical Skills Foundation Programme (you can read abt it here) was cancelled for our M2 juniors, so they’ll be starting their M3 year with less clinical exposure and practical skills. It’s not a huge issue, since M3 feels like being tossed in the deep end of the pool, with or without this programme.
• Our M3 juniors in both NUS and NTU were in the midst of their clinical rotations when all of this happened, so they switched to home-based learning, with their final exams (before progressing to M4 in mid-2020) being truncated to just theory papers, instead of the regular OSCEs + theory papers.
• The next batch of M4s (their academic year starts in July) will not be able to have their Emergency Department or Anaesthesia postings, since those involve particularly high-risk patient exposure. It’s a real pity that they’re gonna miss it; those were my favourite postings last year!

Changes to our Final-year Training

Our final year was initially supposed to consist of 32 weeks of clinical/ward-based postings, with ~16 of those weeks dedicated to our Student Internship Programme (SIP), where we would intern in various specialties (to better prepare us for Housemanship/PGY1), and the remaining weeks comprised regular ward-based postings.

However, due to the manpower of our doctors being greatly stretched due to COVID-19, as well as safety concerns for students, the school modified our curriculum from almost 100% clinical to 50% theory and 50% clinical.

Originally, the M5 year was split into four 8-week blocks as follows:

• General Surgery
• Internal Medicine
• Orthopaedics (4 weeks) + Dermatology (2 weeks) + Infectious Diseases (2 weeks)
• Paediatrics (3 weeks) + ACLS (2 weeks) + Geriatrics (3 weeks)

Most of these postings included an internship component for 50% of the duration, and ward-based learning for the remaining 50%. The changes made only affect the ward-based component, which has been replaced with campus-based learning; the duration of our internship remains unaffected.

MOH requires medical students to have a ‘washout period’ of at least 2 weeks when switching between hospitals for rotations, so the campus-based learning component of each 8-week block cleverly enables us to continue clinical rotations in the next posting without a break in our curriculum.

Pre-COVID	4 weeks of internship	4 week of ward-based learning
The new arrangement	4 weeks of internship	Campus-based learning (washout phase between hospitals)

On top of many briefings & documents sent by the faculty, we’ve also attended mask fitting sessions, a PPE refresher course, and been trained for taking COVID swabs. In the wards, many precautions have been put in place – we’re restricted from all high-risk areas in hospitals, and are only allowed to attend to or clerk/examine patients within designated ward to prevent cross-transmission; we also have to log the details of patients we’ve examined (for contact tracing). Additionally, we’re not allowed to have in-person interactions with friends posted to different hospitals.

These restrictions may sound excessive and inconvenient, but they’ve been surprisingly easy to comply with so far, and they haven’t negatively impacted my personal learning experience (idk how my fellow batchmates feel about it).

It’s a unique experience to be one of the few batches to have our clinical years during this pandemic, and it’ll make our final year all the more memorable. And of course, massive props to our faculty, MOH, and all the doctors who are tirelessly fighting COVID (while still devoting time to teach us on Zoom & mentor us in the wards), they’re the real MVPs of this whole situation!

With all this extra time for home-based learning, I’ll be able to continue running my handmade accessories & craft store, GLITTR. I’m nervous yet excited to spend my final year of med school juggling being a full-time student and a small business owner, especially during such crazy times…

Anyway, be sure to follow my Insta or Facebook page to stay up to date with my latest posts. I’ll be writing a separate post for my ‘Life as an M5’ series, which I’ll publish after graduation (in slightly under a year’s time). 2020 has been a wild ride for everyone in the world, and let’s hope things start looking up soon. Stay safe and stay sane!

P.S. I don’t make any money from running this blog, so if you’d like to support my writing and help me bring even better content to you, you can buy me a coffee/donate on Ko-fi!

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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