After reading a local final year medical student's comments to the original "Residency" post, I think it deserves to be reproduced as a separate entry:
"Hi, i am a final year student at YLLSOM and i have a few comments on this issue.
We have brought up quite a few of the questions that spacefan has mentioned today at a NUHS briefing on the residency program. The answers we were given were rather vague, with the higher powers knowing little/unwilling to commit as they too have no idea what the finalized plans by the DMS are.
This puts us in an extremely tight spot, as we were informed of this new program only 2months ago, and are now given ONE month to decide and make up our mind and subsequently submit a portfolio in October and go for interviews in January, on top of studying for the final MBBS.
The whole process has been rushed through with little thought given to the current batch of graduating students, with the reasoning being that with us being guinea pigs and that the kinks that we encounter will be ironed out in time to come.
However, this is OUR future we are placing on the line, not theirs.
With regards to the trainee not performing up to expectations, the panel of program directors assured us that it will NOT happen, as we will be very closely monitored and supervised every step of the way(hand-holding). I have serious doubts about that, but they declined to elaborate further with a sweeping statement of if we fail, the sponsoring institution will suffer and the program directors face the sack, hence we will NOT fail.
This whole residency thing benefits those who have made up their minds about their future, and in a short 5 years most will become associate consultants equivalents,(attending physicians). In fact, most will hit reg levels in 3years, which is a boon for them.
However, those of us who are still undecided are "forced" to make a less informed decision of signing up with a residency program, or for that matter ANY residency program if we do not want to be left behind. I say this because even though they have repeatedly stressed the option of a transitional year to look around and decide, we will be severely disadvantaged as the number of places allocated for that particular year will have been almost, if not totally filled, hence we might have to start from the postgradyear1 again in that particular residency should we decide AND get accepted.
The process of the interviews is also a hot topic of discussion, primarily because we have very little to present to the interviewers, who will now scrutinize our medical school grades, down to our anatomy grades in year1 and that biochemistry TEST in CA2. Many of us are caught off guard, as we were time and again told by our seniors and many junior doctors to just pass all the tests and exams in med school, even the MBBS. As long as we pass, our application for speciality training will be based on our performance as a HO/MO.
But now it's a whole new ball game, and many of us are on a wrong footing.
Lastly, all three clusters are scrambling to give us talks on the residency program the past few weeks, treating us as hot commodities and trying to sell their department/programme as the better one.
So do we now choose a particular hospital because say, the programme director was extremely charismatic and eloquent? Or that they gave us more freebies, a better tea session and promises to treat us BETTER than the other hospitals?
If, for example i have been posted to the surgery department in SGH surgery for my third year rotations in medical school, i will almost certainly choose it over the TTSH department as i will have no clue on how their department operates. But will i be making an informed decision? I highly doubt so. Of course if SGH rejects me and i put TTSH surgery as my 2nd choice i might not get it compared to someone who placed it as his 1st choice.
Dear seniors, if you were in our shoes, what will you do?"
It is my hope that putting this comment up will spur the powers-that-be to tackle this issue head-on. I wasn't at the abovementioned briefing, so I have no idea whether any MOH official was present, but I do know that Singapore MD is monitored by MOH, so perhaps this poor M5's S.O.S. will filter through to the DMS.
That said, I'd also like to point out that since emergency medicine is one of the disciplines that has been earmarked for this residency programme, patients can look forward to having fresh med school graduates in our ERs. And I don't mean "look forward to" in a good way.
Back in my medical officer days, ERs were staffed with a good number of medical / surgical trainees, and only 2nd-year or more senior medical officers were allowed to rotate through.
Over the past decade, there's been a huge paradigm shift such that 1st year non-trainee MOs ( and 1st posting MOs especially ) now throng ERs all over the country, with a significant portion of these hailing from overseas ( i.e. returning to Singapore after completing their housemanship in Australia / the UK, etc. ).
Even with 12 months of internship behind them, most 1st year MOs are ill-equipped to handle the stress of ER work, which involves constant multi-tasking, rapid and accurate clinical decision-making, and the difficult job of handling anxious / hysterical / violent patients and relatives.
While I make room for the possibility of fresh graduates mastering the art of communication and public relations quickly, clinical skills is an entirely different kettle of fish. We already face problems monitoring our current MOs. Imagine having a group of even more inexperienced junior doctors added to the mix.
Did this new programme get any coverage in the local news? Don't remember reading anything, and was away during the 1st half of September. Is the public aware of any of this?
- Medical students become house officers (or interns, to use the US term) upon graduation. For one year, they will rotate through 2 or 3 rotations in medicine (compulsory), surgery, orthopedics, pediatrics, or obstetrics & gynecology to acquire practical skills in doctoring (and surviving in the public hospital setting).
- Those that pass through housemanship become medical officers, who typically have 6-monthly rotations through postings of their choice. Medical officers (MO’s) can elect to take up basic specialty training (BST, i.e. surgery, medicine, family medicine, pediatrics, etc) which is usually a 3-year process, completion of which is contingent on passing yet another exam as well as jumping through whatever hoops set up by the all-powerful BST committees. Of course, MO’s can also just float through the system for a few years before going out to set up their GP clinics or to join other GP groups.
- Those who complete their BST can then opt to join a relevant clinical subspecialty as a registrar (this can be tougher than it sounds for specialties that are over-subscribed – the wait for a training slot can be up to a year or longer), and the advanced specialty training (AST) is usually 3 years in length (again, it is longer for certain subspecialties such as cardiothoracic or neurosurgery).
- After finishing the AST, doctors become certified specialists and attain the rank of associate consultant in the local hospitals.
Under the new residency system, it will take only 5 years to complete training in most specialties. Medical students can opt to join a hospital residency program upon graduation, if they are certain as to their future career (i.e. specialist) tract. They become 1st-year residents (equivalent to the current internship or housemanship, but with greater educational opportunities and clinical involvement), which is 14 months for the YLLSOM graduates and 12 months for the Duke-NUS graduates. This is so that everyone will be in sync for the second year of residency, since the Duke-NUS students graduate 2 months after the YLLSOM students (a classic case of the tail wagging the dog, since there are about 50 Duke-NUS students and between 260 to 300 YLLSOM students in the coming years). Of course, the YLLSOM students will be compensated by having all the requisite pay raises after the 12th month of work.
From the 2nd to 5th years, the residents will continue to train in the specialty and subspecialty of their choice, and will theoretically become fully-trained specialists after the 5th year of residency – employed in the hospitals as associate consultants.
Not all the details have been worked out, of course. There are some advantages to the residency program – medical education becomes more important for the hospitals, and hopefully residents will get a more structured training program. It will be nice to shorten the time to being a specialist by 2 years (I expect to get some flak for this comment!), but the current batch of house officers and even 1st/2nd year medical officers may be a bit disadvantaged with the rollout of the new system. It will be interesting to see how things will unfold from next year.
This is a pertinent question, because historically, half of the 20th century influenza pandemics have had second waves that were more devastating than the first, and most pandemics had between three to five waves (the later waves were far milder and resulted in fewer people infected). It would make sense to prepare for a next round of heightened clinic attendances, hospital admissions (and potential bed shortfalls), and media interest.
Most of the local influenza experts I have spoken to have privately expressed the opinion that there will either be no real second wave, or that it will be milder than the current outbreak. This is based partly on historical precedent – all 20th century influenza pandemics have had negligible impact in the second year in Singapore, regardless of impact in other countries. Singapore is also a very small country with no seasons, and the first wave has already resulted in an estimated 15% to 20% (this is based on mathematical models, of course, not real data) of the population – mainly schoolchildren – infected. There is thus a bit of herd immunity, or “firewall” if you like, to limit the spread of newly-imported H1N1.
Time will tell if this is borne out.
and so yours truly is on leave, and was casually reading the papers during breakfast this morning, when she came across this article –
Medical dramas give patients false hopeas a doctor who was previously hooked on medical dramas, it does not come as a surprise that half the things mentioned on the telly almost never happen in real life. i remember someone commented about the show House, where the lead character and his team take on cases where the diagnoses have eluded others, saying that House would never have passed the MBBS, because his top differential was way too rare. such things make for exciting television, and even as medical professionals many of us continue to be glued to the screen week after week. deep down inside however, we know otherwise.
Washington: People love watching television doctors working miracles on patients with mystery ailments or devastating injuries but these medi-dramas are feeding patients unrealistic expectations, experts warn.
Viewers glued to weekly installments of fictional doctors ordering batteries of diagnostic tests and unorthodox medical treatments can be forgiven for believing that rafts of examinations and aggressive interventions are the norm.
But US experts said hospitals are unable to provide the cure-all solutions found on programs like the rabidly popular House, starring British actor Hugh Laurie as the maverick medical genius Doctor Gregory House.
Research also suggests aggressively treating some ailments can do more harm than good, they said. “The shows do tend to be very activist, very interventionist, very aggressive with their care…because action is more interesting,” said Andrew Holtz, a medical journalist and author of a book on House. “You get the pressure to have aggressive medical intervention that almost always works and that’s just unrealistic.”
Not only does such treatment often fail to work, Holtz noted, but sometimes it can have side effects that outweigh the benefits.
“People don’t see that on television,” he said, adding that medical dramas contribute to a false conviction that any ailment can be cured.
Medical professionals often provide the background material that television writers use to script the unusual illnesses that afflict their unfortunate characters. Allan Hamilton, a script consultant for the popular medical drama ‘Grey’s Anatomy’, is also the chairman of the surgery department at the University of Arizona Health Services Center. “They’ll say ‘we need a disease that looks like a person’s going to die, but then there’s this one thing that tips them off that they need to do further diagnostic tests.’ Or ‘we want a patient who is doing really well and everyone’s really happy and then something goes dreadfully wrong,’” he said.
“I always joke with the writers, you know, ‘this wouldn’t really happen or that wouldn’t really happen’ and then they turn around to me and say ‘yeah, but this is Hollywood, anything can happen.’”
As a medical professional, Hamilton is wary of the effects that depicting experimental treatments can have on viewers. “Are we going to suddenly raise people’s expectations? You do worry about that. People see this and there’s a question in their mind, ‘well are there people like that that we could find…is there a House that could fix me?’” AFP
hopes are easily raised. i mean, even the BMJ has an article about false hopes raised by tv dramas! i know most doctors are always cautious in outlining treatment and explaining outcomes, but just as dr hamilton says in the article, it is hard sometimes to explain to patients and their relatives the reality of the situation.
but even without hollywood's interference, there will always be people with unrealistic expectations. case in point, yours truly has a patient in her ward with hypoxic encephalopathy, and hence is, well, a vegetable. infection after infection has set in with several close calls, but the family still insists on full resuscitation despite months of hospitalisation. then there was this time when there was a stand off between an a&e registrar and a family hell-bent on micu admission for a relative that had poor pre-morbids and wasn't doing very well. these cases aren't as simple as they sound of course, but you get my point. so no matter how hard you explain and paint the bleakest of pictures if we proceeded according to the family's wishes, some patients are just tossed back and forth.
we of course already have something in place - the DNR order, which some seniors are more enthusiastic to sign about, just so that we can avoid ugly scenes when a patient deteriorates. someone just asked me recently, how do you communicate a decision for DNR to relatives? most times, the truth hurts, but the best thing, in my opinion, is to let a person go peacefully when the time comes. which is what i say, and which is what most relatives accept.
but it is always at this point when dr house steps in, grabs a defib pad, and saves the patient.
