Careers Symposium 2021: Other Specialties

The Other Specialties talk involved a wide range of specialists.

Paediatrics: Dr Kristy Fu

The talk was kickstarted by Dr Kristy Fu, who is currently a Consultant in the Division of Paediatric Critical Care in the Department of Paediatrics under Khoo Teck Puat - National University Children's Medical Institute, National University Hospital. Dr Fu is also a passionate teacher and contributes to undergraduate and postgraduate education. She was awarded the Best Teacher Award and Best Young Clinician Mentor Award by the National University Hospital and Department of Paediatrics on many occasions.

She shared with us 4 guiding questions on how one should choose one’s residency. 1) What aspect of Medicine did I really enjoy in school and made me really excited to come to work daily? 2) What type of patient contact do I enjoy the most or can embrace the most? 3) What else apart from clinical medicine makes me happy? 4) Which residency programme would suit me? She then ended off by asking us to consider what kind of doctor we hope to become at the end of residency. These questions not only serve as wonderful core questions in the contemplation for the pursuit of residency, but also as essential questions one should ponder in the course of medicine, to determine one’s passions and interests.

Next, she shared a typical day in the life of a paediatric resident, which starts at 7am before formal ward rounds, is dotted with morning departmental teaching, and is followed by ward rounds at 9am. Around lunchtime, there is lunchtime teaching for residents, before clinics around 2pm. This is perhaps a format applicable to most other residency programmes too!

To find out more about the NUHS paediatric residency programme, she made a call for interested applicants to visit the NUHKids Open House which occurs in July annually, and also kindly opened up her mailbox for students to get in touch with her.

Anaesthesiology: Prof Tay Sook Muay

This was followed by a lively engagement by Prof. Tay Sook Muay, a familiar name to many who have walked through the doors of SGH. A Senior Consultant anaesthesiologist, she called on students to give oneself time to find out if one can truly cope with the various difficulties of the speciality. She shared, fittingly, that she had initially wanted to join Paediatrics, but realised that she could not cope with seeing children with cancer, especially back in the 1980s where cancer treatment wasn’t yet so developed.

She eventually decided on anaesthesiology after a posting opportunity opened her eyes to the field, and described anaesthesiology as having a good balance of physiology and pharmacology, alongside an understanding of anatomy.

Students who would enjoy constant contact with the patient and family after the patient moves to the ICU, who have both a steady heart and hand, and who have the ability to think on one’s feet to make quick decisions for therapy, this could be the place for you!

Emergency Medicine: Dr Peng Li Lee

Dr Peng Li Lee, Head and Senior Consultant of the Emergency Medicine Department at NUH, then commenced, with slides interspersed with warnings cautioning students with a faint heart to turn away. She described EMed as an Exciting field of clinical practice which allows integration of medical specialities in one, and described herself as a generalist with focus on acute care and resuscitation.

To her, EMed is a field that spans from cradle to grave, and where patients are more often than not seen once with no follow up. Being the first point of contact for most patients, she suggested the EMed doctors be able to triage, treat and street (discharge), advise or refer where needed. Even in EMed, she shared, there are many subspecialties to consider, including trauma, critical care, and toxicology.

For those interested in learning more about the schedules for a job entailing such high adrenaline, Dr Peng shared that doctors in the ED work in 3 shifts, which leaves some of them reeling from adrenaline late at night if they worked the afternoon shift, or gives them the opportunity to pursue their hobbies after work if they worked the morning shift.

Psychiatry: Dr Cyrus Ho

Next, we had a sharing from Dr Cyrus Ho, consultant psychiatrist at NUH. Speaking with a reassuring tone of voice and displaying a calm demeanour, he emphasised the importance of needing potential residents to be able to manage not only mental illnesses, but also to encourage wellness and resilience in patients.

He highlighted the importance for residents to able to handle ambiguity, to be emotionally stable and resilient, to be able to handle challenging events such as agitation, suicides and most importantly, to enjoy talking and be genuinely interested in lives of others.

He went a step further to share a list of pros and cons with those present at the talk, which has been reproduced here:

Pros

1. Impact life of patient and families in the long term
2. More time to know patients and their lives in depth
3. Huge potential for exploration into neuroscience and neuropsychiatry
4. Good work-life balance
5. Can continue working for a long time

Cons

1. No biomarkers or objective tools for diagnosis/ treatment, symptom-based, heterogenous presentation
2. Can be emotionally draining
3. Some disorders are untreatable
4. Have to manage patient’s psychological issues
5. Confusion with psychologists/ social worker/ counsellors

Our last two speakers, Dr Nga Min En and Dr Low Ying Liang, peppered their talks with jokes and called upon each other’s specialties as being greatly similar in nature.

Pathology: Dr Nga Min En

Dr Nga is an anatomical pathologist in NUH. Her areas of clinical and research interest include Cytopathology, particularly where it intersects with head and neck tumours. She has published in journals such as Cancer Cytopathology, Cell and Nature Communications.

She also has a keen interest in undergraduate, postgraduate and interprofessional teaching, and is the recipient of several NUS teaching awards. She has developed Pathweb, an online pathology resource that has users in over 70 countries. She has also written a Cytopathology textbook, which was published in 2021.

Dr Nga presented a set of slides with the famous dark blue colour as we have come to associate with M2 Pathology slides, and suggested using a set of screening questions to contemplate one’s pre-application suitability:

1. Are your hobbies related to visuals e.g. photography, art
2. Did you enjoy playing where’s wally?
3. Do you enjoy jigsaw puzzles?
4. Are you OK without too much human contact?
5. Do you like working with your hands?
6. Do you enjoy detective stories?
7. Are you reasonably not allergic to studying?

She pointed out the differences between an anatomical pathologist/ histopathologist (who analyses tissue biopsies to provide a tissue diagnosis), a forensic pathologist (who performs forensic post-mortems to ascertain the cause of death) and a clinical/ chemical pathologist (who performs validation, analysis and interpretation of blood/ lab tests).

Radiology: Dr Low Ying Liang

Meanwhile, Dr Low Ying Liang is a Consultant Radiologist in National University Hospital, with subspecialty interests in Neuro, Head and Neck, and Body Imaging. He succinctly described radiologists as being the doctor’s doctor. He then shared a cheeky image published in the BMJ back in 2005, which brought grins to many present.

We would like to thank all speakers who attended this year’s iteration of the Career Symposium for taking time off your busy schedules to share your experiences, and for leaving us with nuggets of wisdom and matters to ponder over. We look forward to the next!

Careers Symposium 2021: More than a Clinician

The second talk of Careers Symposium Day 1 focused on what it takes to become a clinician educator or a clinician scientist.

The first speaker was Assistant Professor Kenneth Ban, who is a medical educator and Assistant Professor at the Department of Biochemistry, and a senior lecturer and Phase 1 director at NUS Yong Loo Lin School of Medicine. Many of us fondly remember his lectures in our pre-clinical years! Assistant Professor Ban also leads the development of a longitudinal Health Informatics track, empowering this generation of medical students with data science competencies.

He started off by sharing his own experience with becoming a medical educator. For him, he was influenced from an early age by family, as his mother was a teacher. Often, he could see the joy she had in sharing her knowledge with students, and during Chinese New Year, students would come over to their house by their own volition. As a result, he started to appreciate the bond between student and teacher.

Also influenced by his own education, he shared that he had a mix of teachers who helped him understand that teaching is a calling. Many of us hold teachers in high regard, particularly those who broke down complex things into something that was understandable. Thus, he started to look into education more seriously as a career.

I’m sure many of us have also been curious why some doctors return to the preclinical sciences to teach us during our preclinical years. Prof. Ban shared that not many doctors do it and those that do have different reasons for doing it. For him, it was because someone had taken faith in him previously, so he was determined to pay it forward. He shared that when he was a medical student, the school offered an intercalated year for students to try out science. He completed the program, and ended up with a science degree. After doing his house officer rotation for a year, the then-head of the Department of Biochemistry called him and asked him if he was interested in pursuing academic medicine. And so, off to Stanford he went for his PhD in cell biology. After returning to Singapore, he was required to work in a research institute, and so he applied back to NUS, doing research and also teaching at the same time. In his early years, he was assigned to teach the Krebs cycle, which he acknowledged was difficult for students to take in. Thus, he strove to teach in the way he wants to be taught, and reviews what he teaches annually.

He ended off by saying that teachers have an enormous responsibility to make learning easier or more fun, and that all of us, as clinicians in the future, will also be educators to our own patients, hence educating is very relevant to us. Furthermore, in academic medical centres, it is also difficult to divorce clinical work from education and research.

The second sharing of the talk was by Dr Raghav Sundar, who is a Consultant in Oncology, specialising in gastrointestinal cancers and practices at the National Cancer Institute, Singapore. He is an alumnus of NUS Medicine. His research interests are developing novel genomic biomarkers and precision oncology, and he is also interested in Med Tech and AI. He shared his journey to becoming a clinician scientist as well as some hacks so that we can do the same!

After finishing med school, Dr Sundar went to do basic training in internal medicine, before subspecialising in medical oncology. In medical school he did UROPS, but he started doing more serious research once he entered medical oncology. As the practice of medical oncology is intertwined with research, there are many clinical trials to give patients new drugs.

He shared that it has taken him 18 years since 2003 to become a clinician scientist. It has involved a fellowship at the Royal Marsden in the United Kingdom, a Masters of Clinical Investigation, and embarking on a part-time PhD. In the process, he came to realise that if we do cutting edge research, we may be able to reach out to a wider range of people other than our own patients.

Why are people pursuing this path even though it is so hard? For him, what is essential is finding your niche, finding your space, and finding what you want to do.

He also shared a few tips to becoming a successful clinician scientist.

Hack 1: Find a good mentor and team, as it takes many people to raise a clinician scientist.

Hack 2: Find an understanding partner, otherwise it would be impossible to find the time to do the things that he needs to do. He also urges us to refrain from thinking that working more means that there will be less life, encouraging us to balance both at the same time.

Hack 3: Find meaning in what you do. If you find meaning in what you do, you won’t consider this as work. He also admitted that spent a lot of time soul searching and thinking about what he wanted to do before going down this path.

Hack 4: Don’t hesitate to grab an opportunity. He shared that in Singapore, we are very fortunate as opportunities are easily available with relatively less competition than in other parts of the world.

Next up, was Associate Professor Suresh Pillai, who is a Senior Consultant in the Emergency Medicine Department of National University Hospital. He is actively involved in the teaching of undergraduates, medical trainees, and nursing students, and has been a strong proponent of medical simulation training. His efforts have been recognised with numerous awards, including the NUS Faculty Teaching Excellence Award, Dean’s Award for Excellence in Undergraduate Teaching and Top Ten Tutors Award in Yong Loo Lin School of Medicine.

He started off by debunking the myth about clinician educators: “Those who can, do; those who can’t, teach”. This is untrue, as many clinician educators feel that there is no better reward than educating. Many clinician educators join due to intrinsic motivation and interest and enjoyment in the task. Not many, however, do it for pay raises or bonuses. For those who want to become clinician educators, it mostly consists of intrinsic rewards, so we need to come in with the right mindset.

Another reason that clinician educators do what they do, is because they want to demonstrate what it really means to be a physician, as what we read in the books do not show the full picture. By the bedside, they are models for students to become knowledgeable healers and do their best for patients with kindness, compassion and a constant search for new knowledge.

So what does a clinician educator actually do? Dr Pillai shared that firstly, they should have a clear set of values. Secondly, they have the ability to overcome obstacles and show to students that despite obstacles, patient care can still be achieved. Thirdly, they should be selfless and accepting of others. Fourthly, they have a commitment to the community. Last but not the least, they have the passion to inspire trainers. Thus, a clinician educator does many things, including lecture, teach and facilitate.

Dr Pillai also shared some tips about how we can prepare to be a clinician educator. We should educate ourselves about educational content and pedagogy by seeking out experts and keeping ourselves up-to-date. We should also keep in mind that practice makes perfect. Through deliberate practice, everyone can be achievers if taught at their own proficiency. Thus, we should challenge ourselves with learners of different levels and vary our teaching strategies. Additionally, we should aim to use multiple different formats in teaching, as well as participate in educational leadership and scholarship.

Why become a clinician educator? Dr Pillai ended the talk by sharing that the job has intangible rewards, and provides us with the ability to inspire students and educate the next generation. Such a job will also give us a valuable opportunity to pay it forward.

Careers Symposium 2021: Introduction to Healthcare Clusters and PGY1/Residency Programs

Kicking off the 2 days of Careers Symposium was the talk “Introduction to Healthcare Clusters and PGY1/Residency Programs”, conducted by the Designated Institutional Officials (DIOs) representing their respective healthcare clusters -- Associate Professor Malcolm Mahadevan from National University Health System (NUHS), Assistant Professor Faith Chia from National Healthcare Group (NHG) and Associate Professor Tan Hak Koon from Singhealth. Through an engaging panel discussion, they shared on the changing landscape of residency programs and answered commonly asked questions about our postgraduate years.

In case you missed it, here are some of the highlights!

Question: Could you introduce your cluster and share how it is different or unique from other clusters?

Associate Professor Malcolm Mahadevan started the ball rolling by sharing that NUHS comprises 3 main hospitals: National University Hospital (NUH), Ng Teng Fong General Hospital (NTFGH) and Alexandra Hospital (AH). For AH, there will be future developments that may impact our choice of residency in the future. Of the three healthcare clusters, NUHS is the smallest, however, it is in an unusual position because NUH is next to the school and many doctors hold appointments in both the school as well as the hospitals.

Next, Assistant Professor Faith Chia shared that NHG takes care of the central and north area of Singapore. It comprises 2 hospitals currently, Tan Tock Seng Hospital (TTSH) and Khoo Teck Puat Hospital (KTPH), with another hospital upcoming in Woodlands.

Last but not the least, Associate Professor Tan Hak Koon shared that Singhealth is responsible for running 4 hospitals, with 1 more upcoming in Bedok. It also comprises the national specialty centres as well. This makes it the largest of the 3 clusters in terms of geography and patient load. He also added that training is standardised now for each speciality, and that all 3 clusters are good clusters, we just need to find which specialty suits us the best. He advised us to take our time, try new things, do postings and find out what we really like.

Question: What is the working culture in each of the clusters and what does it translate into when we are working as HOs and MOs?

Associate Professor Malcolm Mahadevan shared that while there are nuanced differences between the 3 institutions, the exact differences are difficult to explain as they only become apparent once we work as a PGY1. Giving the analogy of a car, he explained that similar to a car, the size, shape, design and number of doors appeal to different people.

Assistant Professor Faith Chia agreed, building upon the car analogy. When she was searching for a new car, she knew the car that she test drove was the one for her. Hence, these differences are hard to explain in words as we would need to experience them ourselves.

Associate Professor Tan Hak Koon further expounded on this, sharing that the culture today and twenty years ago are very different, highlighting that people are responsible for creating and changing the culture at each of the healthcare institutions.

Most importantly, all three of them agreed that across the three healthcare clusters, the framework for training and leave was all the same. Similarly, junior doctors in all three clusters were expected to work hard and learn along the way. In return, the faculty will reciprocate by nurturing them as well.

Question: Will the PGY1 institution we are assigned to influence our future residency selection in the same sponsoring institution?

Assistant Professor Faith Chia reassured us that the PGY1 institution we are assigned to does not affect the residency process, however it is a good opportunity for PGY1s to experience what working in the different hospitals is like. She also encouraged us to cross cluster and experience at least 2 different hospitals.

Associate Professor Malcolm Mahadevan also advised that for M5s, our first focus should be to work hard, follow instructions, be an active learner as well as perform well. Our second focus would be to look around and see what the situation is like in wherever we are training, assessing the speciality we are considering as well as the culture, before deciding where we would like to train.

Associate Professor Tan Hak Koon concurred, emphasising that PGY1 is a very important year where we should learn as much as we can and do our jobs well, while finding our way and working on the ground before we can determine what we like, which specialty we want as well as the institution.

Question: How important is having research experience or publications in the application for residency?

Associate Professor Tan Hak Koon shared that while research is one of the many things they look at, it is not one of the most important. Residency directors are looking at a few basic things, namely, honesty, integrity, commitment to specialty and competency. However, he added that each specialty is different and there may be some which will be more research focused.

Associate Professor Malcolm Mahadevan added that he knew someone who did research to the point of neglecting other areas, and it became detrimental to their growth as a doctor. He advised us that we should not jump the gun and learn how to run before walking.

Assistant Professor Faith Chia also added that when they match residents, they are not looking for a finished product, and emphasised that research is one of the things that they will train. Residency directors do not expect a consultant CV when someone comes in, rather, more importantly, they focus on personality, values and whether someone can be trusted before selecting them.

Question: In recent years there has been increased recognition of burnout and overwork especially in residents. What are some of the things healthcare clusters are doing or looking into to address this?

Associate Professor Malcolm Mahadevan answered that addressing burnout is a shared responsibility between healthcare clusters as well as ourselves when we start working. The hospitals make sure that the junior doctors do not hurt themselves and are able to take care of patients, whereas we also have a responsibility to take care of ourselves. In the workplace, he acknowledges that it is important to ensure that there is psychological safety, and added that there are rules for how faculty and residents should behave, and that the hospitals actually enforce these policies. Furthermore, hospitals also have welfare initiatives such as meditation and yoga sessions, as well as food baskets.

Associate Professor Tan Hak Koon added that medicine is a competitive field and that it will be busy no matter which field we choose to go into, whether we go down a clinical path or a research path. However, he shared that even though doctors are busy, it does not mean all work and nothing else, as many doctors still manage to get married and start families. Most importantly, we should learn how to apportion our time, as it is very possible to do things outside of work. He advised us to go in with the correct mindset, acknowledging that burnout is a big problem among healthcare workers. As for how the hospitals are tackling the issue, he shared that duty hour restrictions have been implemented and that on a ministerial level, policy makers are also looking into the issue. He ended off by reminding us that there is always help available!

Assistant Professor Faith Chia added to the discussion as well, as each of us have different boundaries and that there are some people who would want to work more. She acknowledges that burnout is higher in early career physicians, because as junior doctors, we may meet many hurdles and have very little autonomy over our schedules.