To Stay, Or Not to Stay…

Joy Wong Lynn, Ho Choong Kai, Xu Yanling, Andrew Lim, Carolyn Chiam

When COVID-19 cases started sprouting up around the world, many aspects of life as we know it were impacted. Students studying overseas were hurriedly recalled upon the Government’s advisory and this included our medical students as well. Below, we hear from five students in various universities around the globe on their decisions and journeys in this tumultuous year.

Joy Wong Lynn

I've been back in Singapore for seven months and counting, and am still unsure of when I'll return to Sydney, Australia for in–person studies. Rewinding to the start of 2020,1 was meant to embark on my clinical transition year at the University of New South Wales as a third-year medical student. Australia was initially blessed with two months of limited COVID-19 cases as they had shut their borders to travellers from China early on in the year, until March 2020 came and cases went on the rise.

March went by in a weird, fuzzy blur marked by confusion and disbelief. Initially, hospital and on-campus classes were still running as per usual, but there were growing concerns among our peers regarding our safety and health as more outbreaks were being reported across the city.

"Should we wear a mask to the hospital?"

"Does our insurance cover us if we get COVID–19?"

"If one person in our apartment gets infected, what are we going to do?"

"Is the faculty going to introduce safety restrictions?"

After several discussions held between the student body and the medicine faculty, the decision was made to convert all on-campus teaching into an online curriculum.This gave us exactly one week to make our decisions, pack, arrange our quarantine and book a flight back to Singapore, before the lockdown began in Australia.

Virtual school felt somewhat surreal but manageable. It required some adapting, as the convenience of interacting and learning with peers in-person got cut off. Without that environment, it also became increasingly difficult to focus on work from the comfort of your home. You would think that online school would be easier, but our class schedule was jam-packed with lectures, tutorials and assignments, forcing us to remain disciplined.

As time went by, we accepted and adjusted to this new norm. Microsoft Teams and Zoom became all-too-familiar platforms to us, with my peers and I forming online study groups and chats where we could discuss difficult topics and message each other questions. Faculty also continued having regular feedback sessions with student representatives and held webinars with the cohort to keep us up-to-date on the latest news.

In a period that has drastically changed the way we work and interact, it was important for me to remain proactive in my learning by reaching out to my peers and tutors, and participating in online classes. It was easy to feel overwhelmed and lost at times, but recognising that everyone else was in the same boat and facing their own struggles made me appreciative of the supportive (albeit virtual) learning environment I had.That being said, in–person teaching is still something that we all hope to return to soon!

Ho Choong Kai

When I flew to Melbourne in February 2020,1 was somewhat excited to meet new people and make newfriends. However, when social distancing restrictions were imposed as the school year started, the faculty at Monash decided to move the syllabus online. In May, when Victoria state lifted COVID-19 restrictions, everyone was hopeful to return to face-to-face lessons for semester two. The faculty even organised a "mock session" to get a feel of how such lessons would run with social distancing measures in place. However, new clusters of cases arose in Melbourne and the government reimposed stricter restrictions, meaning that the mock session was the one and only time I saw my tutorial group offline. Although restrictions in Melbourne have lifted slightly recently, the faculty had already set that no physical classes would occur this year for my batch. It was disappointing just to know that there was really no need to be in Melbourne at all this year.

Studying online for an entire year has had its ups and downs. While I enjoyed being able to sleep in just that little bit longer, I felt that online learning just wasn't as engaging as face-to-face lessons and "Zoom fatigue" was a real issue. While the faculty created an online forum for us to post questions, I personally found it awkward to get questions answered there, especially since tutors could ignore the questions for days or weeks. I also felt that I was not able to socialise with my batchmates as much. Even though the student representatives tried their best to organise online socialising events, my experiences were often filled with awkward silences. I was only able to make friends with a group of Singaporeans also staying on campus, and they are the people I have spent the most time with, both online and offline. However, many of them have decided to fly back to Singapore over the course of the year.

Personally, I made the choice to remain in Australia till the end of the school year. Even though I miss home, the study environment is much better than at home due to the climate and the surroundings. I was also concerned about having to defer my studies if I were unable to return to Australia, but repeated assurances from the faculty has assuaged my worries. Thus, I flew back to Singapore after the year-end examinations, and am hoping to be able to return to Melbourne for face-to-face lessons next year!

Xu Yanling

In the middle of March 2020, COVID-19 cases began to climb in Melbourne, Victoria and alert levels were raised to prepare Victoria for a lockdown. Singapore's Ministry of Foreign Affairs released an advisory for overseas students to return home. Amid toilet paper shortages, border closures and flight cancellations, our families urged us to return home quickly due to the numerous uncertainties ahead. Medical education at Monash University is a five-year programme and this was going to be my first year of hospital placement. Like the rest of my peers, I was deeply concerned about how leaving Australia would affect my learning. However, as clinical sites closed and the medical faculty granted their permission for us to leave, many of us eventually returned home to Singapore.

Thus began our year of remote learning. Having to adjust to remote learning was a predicament not unique to international students, as local students faced similar circumstances. Rather than feeling let down by this situation, we made the most out of every opportunity to learn and remained optimistic during the disappointing moments. I recall receiving encouragement from friends and family when the second wave of COVID-19 in Melbourne prevented our return and we could not acquire local placements due to the ongoing situation.

Thankfully, there were amazing people who reached out to the international medical students to offer academic support. We cannot express enough appreciation for the SingHealth Helping Overseas Medics' Education initiative, its organising team and the participating doctors for bringing us a comprehensive lecture series to help us assimilate into the Singapore medical workforce. We are truly grateful to Adj Asst Prof EndeanTan, who along with National Healthcare Group Education and the Singapore Medical Society of Australia and New Zealand, prepared sessions for us that were invaluable in aiding our clinical learning.

In this time of public health crisis, I feel even more motivated to study hard and become a competent doctor. This year, I have received endless support from my family, friends and the Singapore medical community. COVID-19 has shown me that "home" is an irreplaceable existence. When the time comes to return to Melbourne, I am sure that leaving will be harder than ever before. However, if I have learnt anything in 2020, it is to "just keep swimming", and to work with the changing tides. In the future, I hope to remember 2020 with gratitude, for the people who have been supporting me and my community, in ways big and small.

Andrew Lim

It was in March that COVID-19 was ploughing its way through Ireland from Dublin down south to Cork (where I was studying). Our lecturers knew things were moving quickly and some arranged to have lectures pushed earlier for fear of the college being closed on short notice. Within a few days of cases being reported in Cork, the fateful email announcing the closure of the college arrived, and I found myself stuck at home in the middle of the school term with examinations still scheduled to take place in the coming weeks.

People were rushing to supermarkets to hoard groceries, expecting a nationwide lockdown, while I was constantly updating my family on what was happening. There was a flurry of activity that very weekend as I deliberated with friends and family over whether to fly home and risk coming into contact with other potentially infected travellers, or risk being stuck in Ireland if a lockdown was to be enforced. I finally decided to book a flight for the following Sunday, after most of my peers booked their flights earlier in the week. My heart arrived at some sense of peace knowing that I was headed somewhere I would have the support necessary if anything adverse were to happen.

Thankfully, I arrived back in Singapore without much of a hiccup after the Government introduced stay-home notices for those returning from the UK. It took a week for the remainder of our lessons to be moved online and examinations rescheduled to accommodate students taking papers overseas. Times were certainly very strange as I struggled to adjust to studying from home in isolation in the midst of my normally busy household!

Fast forward to October after the extended summer break. College is back in full swing, consisting mostly of online learning mixed with a handful of hospital placements and minimal contact with anyone else from the course. While online lessons seem to be the norm now, I miss the human contact and learning environment that the university typically provides. Cases are on the rise in Ireland (again) while the situation back home seems to be stabilising, and I'm starting to fear that opportunities for clinical placements and learning will disappear. Any contact time with patients now is treasured, like liquid gold falling through the gaps in my fingers. I wonder… will learning be like what it used to be anytime soon?

Carolyn Chiam

It was surreal when I received an email from the university that they would be cancelling our hospital placements, and moving the rest of the year to online lectures. With all the uncertainty surrounding COVID-19, it was clear to me then that the safest place to be would be home in Singapore. The university tried their best to provide teaching online, but lectures undoubtedly cannot replace learning through clinical placements.

While in Singapore, I was introduced to a job opportunity at the Community Isolation Facility (CIF) at Expo for migrant workers who tested positive for COVID-19. I, like many Singaporeans my age, had never really attempted to interact with the foreign workers working at construction sites or shipping companies. I thought that this job would allow me the opportunity to, in an indirect way, give back to these people and also experience a less medical side of healthcare at the community level. In fact, the job description included looking out for the residents' mental health through organising and executing patient engagement activities. After much discussion with my parents about the risks of the job, they encouraged me to take it on. After all, it was likely that I would be exposed to COVID-19 patients eventually, and early infection control education is never a bad thing. My role at the CIF was a very varied one – from planning and executing morale–boosting activities, to facilitating weekly hair–cutting sessions and helping doctors with clerking patients. The stint at the CIF was only a short three months, but interacting and making friends with the foreign workers, as well as the doctors, nurses and staff there has opened my eyes to a side of medicine that I had not seen before, and will shape the way I develop as a medical student and doctor.

I am now back in the UK and the contrast between the COVID-19 situation here and in Singapore – the infection rates, policies and mindsets of the people – is stark. My hospital placements have resumed, albeit with some restrictions, including not being present at aerosol generating procedures, and increased infection control protocols. I am apprehensive that the virus will eventually find me here, but for now, I am relying on what I have learnt through experiencing Singapore's healthcare policies and the tight infection control within the CIF, and that will hopefully tide me through the worst of this next imminent wave.

COVID-19 threw a huge curveball in my learning as a medical student, but it has also given me the opportunity to experience a different side of community healthcare and helped me to cultivate good infection control techniques early on, which will definitely be useful in years to come.

Joy Wong Lynn is a third-year medical student, from the University of New South Wales in Sydney, Australia. She is currently working on her literature review for her research project that begins next year.

Ho Choong Kai started studying medicine at Monash University in February 2020, and has attended classes online for the entire year from his room in Melbourne.

Xu Yanling is a third-year medical student at Monash University, Melbourne.

Andrew Lim is a third-year undergraduate medical student in University College Cork, Ireland. He enjoys cycling to explore the surrounding hills of the city when he feels adventurous.

Carolyn Chiam is a fourth-year medical student currently studying in the University of Glasgow. She enjoys playing ultimate frisbee, bouldering, baking, playing with dogs and eating good food.