Medical Electives

After completing my 4th year, I had 7 weeks of semester break before recommencing my final year of medical school in September 2018. During that period, I decided to proceed with a 4-week electives at Department of Anaesthesiology and Critical Care, University of Malaya Medical Centre (UMMC) and then, a short stint at the International Volunteers Headquarters (IVHQ) Medical Volunteer Program at 1A Hospital Orthopaedics & Rehabilitation, Ho Chi Minh City, Vietnam for the next 2 weeks. My experiences of doing attachments in both places were absolutely wonderful - without a doubt. I got to learn a lot of things in the medical field and met some of the most amazing personalities from different parts of the globe. At UMMC, I had the privilege of seeing a wide range of cases from medical, surgery and others along with the experience of managing patients in a way that were very efficient and with minimal risk of infection. On the other hand, the hospital I attached to in Vietnam was an Orthopedics & Rehabilitation centre and most of the patients there suffered from motorcycle accidents, work related injuries, stroke and as well as Agent Orange exposure from the American-Vietnam War.

Agent Orange is an herbicide and defoliant chemical and it is widely known for its use previously by the United States military as part of its herbicidal warfare program; Operation Ranch Hand during the American-Vietnam War from 1961-1971 and over 3 million people in Vietnam were exposed to this agent. Its effects include damaging environment where over 3.1 million hectares of forest in Vietnam were defoliated and the traces of dioxin found in the mixture. It caused major health problems like leukemia, Hodgkin's lymphoma and various kinds of cancer for many individuals who were exposed and the chemical is also capable of damaging genes resulting in deformities among the offspring of exposed victims.

These electives also gave me a perfect opportunity to explore in areas of medicine like Anaesthesiology, Critical Care, Orthopaedics and Rehabilitation Medicine as well as some parts of Surgery in greater depth and I also had the opportunity to find out more about the career opportunities in these fields. It also provided me a good chance to get an insight of what are expected from the doctors in this area of medicine by their patients. The reasons I had chosen Vietnam was because I wanted to experience a new culture, while developing my medical knowledge by gaining an insight into the Vietnamese healthcare system. This was a unique opportunity to gain a greater understanding of differences and and to compare the medical systems between Malaysia and Vietnam, a lower middle-income country (LMIC) along with contributing of what myself can in terms of clinical skills to the Vietnamese. The best part of the both electives placements was actually being able to do procedures and assist the doctors and nurses in their daily activities. The nurses and hospital staffs taught me and other elective students the proper way of doing things; to have an overview of their medical practices and some of their own guidelines. Coming from Malaysia, a better developed middle-income country, there was a huge culture shock when I first entered into the Vietnamese hospital. It was quite an eye-opening experience to see how very little resources could be used efficiently to yield the maximum care for the patients.

At UMMC, I had an opportunity to learn about basic anaesthetic management and skills along with attachment at critical care unit. It gave me a chance to understand infection control, managing high-risk patient and well as importance of mobilization of bed-ridden patient. While monitoring the delivery of anaesthetic drugs during a surgery. I also managed to observe many surgeries such as carpal tunnel surgery, reconstructive urology surgery, transurethral resection of prostate (TURP) for benign prostatic hyperplasia, total abdominal hysterectomy and bilateral salphingo-oophorectomy (TAHBSO) for infected ovarian tumor and many more other interesting surgeries. I also learnt about the importance of reviewing patients in anaesthesia clinic prior to their surgeries, which is very vital in order to reduce the risks and complications of surgeries as well as the importance of post-surgery pain management care for the patients, which is also known as acute pain service (APS).

APS provides timely application of appropriate pain-relieving methods, which improves the overall postoperative pain management and patient's hospital experience. I also learnt the importance of taking relevant investigations for certain cases and not wasting the hospital resources as some investigations can be very expensive and must be done if there are only important indications.

At Vietnam, we would check and change the patients' intravenous lines, change fluids, and administer intravenous tube therapy as a daily routine every morning and afternoon. Then as the day continued, I would help to clean some of the extremely severe wounds in the Trauma Ward. The wounds that we encountered varied from open to close wounds and wounds with internal and external fixations. Subsequently, we would check their blood pressure. It was not unusual if the family of the patients would also ask for their blood pressure to be checked. They would then ask if the results are normal and I would use the Google Translate app to show them the results since most of them cannot understand English. After showing the results, I will say 'good' with a 'okay' hand gesture and eventually they would have a huge smile on their face. On some days, we would assist or observe the doctors in either the occupational therapy room, acupuncture department, wound care clinic, or during surgeries. I also managed to shadow the work of surgeons in the operating room. One on occasion, I witnessed more than three surgeries in a day. The surgeons showed my friend and I the methods of skin grafting, internal fixation of broken bones and proper wound care cleaning during surgery. When compared to the hospitals that I had been attached previously, there were a vast difference with their operation theatre. The Vietnamese's operation theatre was small, some had fans instead of air conditioners and some surgical utensils were re-used without autoclaving but just washing in normal saline fluids. The Vietnamese hospital that I was attached had no house officers or interns because it was operating as a specialized hospital. So, most of the immediate care was done by nurses and then followed by doctors. If it was in Malaysia, the house officers would have done the immediate management with the supervision of a medical officer or senior doctor and the nurses would just aid the junior doctors. It was indeed remarkable to see something different.

To reflect back on my experiences during the whole period of electives, I can conclude that I had learnt much more on how to be more flexible and adaptive to the changing situation as well as to always have a back-up plan as things sometimes could derail from the initial plan at any moment. Additionally, I also had learnt to be more opportunistic (in a good way), to learn as much as possible from the house officers and senior doctors. At UMMC, I was attached with the house officers, I felt that I could roughly know and be aware of on how house officers would work, how to prepare for each patient, ward rounds and proceed in obtaining the necessary investigations. I am sure that I am almost capable to do the task of house officers in the future but more importantly at this moment, I have to be better equipped with the knowledge and experiences so that I can be trained to be a safe doctor in near future. I cherished every minute I spent at both hospitals, soaking up the miles of information that was available out there, even if some were just by merely observation.

Footnote : Many clinical electives were cancelled during this COVID-19 pandemic. But I believe there are other ways medical students can do their electives such as research elective, mobile clinics, refugee medical camps, online conferences, virtual summer school, etc. Get a group of your close friends and approach a lecturer in your medical school. I'm sure someone would be able to help you guys. Stay safe!

*this article was also published in Malaysian Medical Association's Berita - November 2018 Issue

Sooriyapiragasam, L. (2018, November) Elective Experience. Berita MMA. 48: 24-25. Retrieved from: https://mma.org.my/berita-mma-november-2018/

How to apply for electives?

1. Get a supporting letter from your university.
2. Plan according to where do you want to go, what discipline would you like to explore (either your interest or a discipline that is not covered in your medical school).
3. Contact the relevant authorities. If Ministry of Health (MOH/KKM) hospitals, you have to contact the respective Jabatan Kesihatan Negeri.
4. If you're going to overseas, be prepared with medical check-ups and recommendation letters from at least 2 lecturers/professors from your university.

• Below are the contacts of my electives placements;

University of Malaya Medical Centre - Elective Posting Department, Faculty of Medicine, University of Malaya 50603 Kuala Lumpur. 

Tel: +603‐7967 3796/6686/4941   |   Email: fomelective@ummc.edu.my

1A Hospital Orthopaedics & Rehabilitation (website is entirely in Vietnamese)        |  under International Volunteers Headquarters (IVHQ) Program 

1A Số, Lý Thường Kiệt, Phường (District) 7, Tân Bình, Ho Chi Minh City, Vietnam  |  Tel: + 84 28 3971 2960