Since the inception of Khoo Teck Puat Hospital's (KTPH) Learning Oriented Teaching in Transdisciplinary Education (LOTTE) programme in 2021, many batches of Year 4 medical students from NUS Yong Loo Lin School of Medicine (NUS Medicine) have had great experiences and fond memories of their time in the programme. With the re-opening of international borders in this "post-COVID-19" era, KTPH has once again launched a new initiative, this time offering two NUS Medicine Year 4 students the chance to take a transdisciplinary breast cancer service elective with both KTPH and the Faculty of Medicine Siriraj Hospital, Mahidol University in Bangkok, Thailand.
This transnational initiative was inspired and spearheaded by our mentor, Adj Asst Prof Clement Chia, after he had completed his fellowship in Siriraj Hospital. Having had this unique opportunity to experience firsthand the healthcare systems in both Singapore and Thailand, this article will therefore be our reflections of the experiences we had in this inaugural transnational transdisciplinary elective.
The first half – in KTPH!
We spent the first two weeks of the month-long elective in Singapore, where we rotated between the radiology, breast surgery, plastic surgery, medicine oncology and radiation oncology departments in KTPH. This was a very holistic experience for us as we were able to see a patient with breast cancer's entire journey, from the initial screening all the way to their recovery. The LOTTE programme was very thoroughly planned, incorporating clinic and OT sessions so we could gain both clinical and surgical skills, while at the same time learn more about other departments (eg, oncology and radiology) which we had not rotated through during our clinical postings in medical school. Numerous group teaching sessions were also organised with the other subspecialties in the LOTTE programme (eg, endocrinology, vascular surgery and palliative care), so that students could learn more about the other specialties as well. More than just the exposure that this LOTTE programme offered, it gave us the opportunity to revise our medical and surgical knowledge and refine our clinical skills, which would be essential when we start working shortly after.
The tutors whom we were assigned to across the various departments in this transdisciplinary breast cancer service were extremely nurturing and passionate in their teaching. They took time and went out of their way to show us how their departments worked handin-hand with each other while exposing us to other aspects of their specialties. This was a truly unique experience for us to have such great exposure across a broad spectrum of healthcare, where it allowed us to better appreciate how the Singapore healthcare system works cohesively to look after our patients through the long and painful journey of breast cancer. It was also pleasant to see the collegiality and camaraderie of the doctors across the various teams, and how they often consulted each other personally before deciding on the best course of care for patients.
The second half – in Siriraj Hospital!
After two weeks in KTPH, we set off for the second leg of our elective in Siriraj Hospital. We noticed the jarring difference in environments from the moment we disembarked from the plane. From the surging heatwave to the different language being spoken, and the heavy Bangkok traffic, we had to quickly adjust ourselves to this new place that we would call home for two weeks. That said, the warm smiles of the helpful and courteous Thais made it much easier for us to assimilate into their country.
On our first day at work, we found ourselves lost and stuck amid the heavy vehicular and human traffic at Siriraj Hospital. As one of the top hospitals and medical institutions in Thailand, people flock from all over to seek medical attention there. Coupled with the heat of the weather, it was an eye-opening experience squeezing among the bustling crowd as we searched through the huge compound for our reporting venue. With the help of a few friendly locals, we quickly found our way and became orientated to the place in no time.
Having spent two weeks rotating through their Head, Neck and Breast Surgery Department, there were many valuable lessons that we learnt just by observing how the patients, nurses and doctors interacted with one another. In Thailand, patients demonstrated a high level of respect and regard for their healthcare providers, with everyone bowing and greeting the doctors and nurses at the start of their consultations before thanking them and bowing once more as they take their leave. It is also very apparent that there is a huge amount of trust and rapport that has been established between the patients and their doctors – a lot of the patients seem happy to see their doctors, with many of them bringing food and gifts as a way of expressing their gratitude. The generosity of the patients even extended to us, as one of the patients gave us some traditional Thai snacks during a particular follow-up consultation with her surgeon.
This symbiotic relationship between the doctors and their patients is truly as inspiring as it is heartwarming. Despite the extremely high patient load, where a doctor can see anywhere between 30 to 50 patients in a morning clinic, they still take the time to actively listen to their patients' issues and concerns. Hence, the patients' trust in their doctors does not go misplaced, and it fosters better and more open communication between both parties.
In the OT, though it may not look quite similar to the ones back home, the processes are all very much the same. More importantly, the level of experience and skill that the surgeons have accumulated over the years with their high patient load is evident. The speed and precision with which the surgeons operate is truly remarkable, and they do all this while still fostering a positive and nurturing environment of teaching to their residents and medical students alike. Despite the language barrier, the senior surgeons, junior residents and fellows went out of their way to translate their teachings for us, so that we could learn from them as well.
The king's coronation
Outside of work, we had out of aware of fun as our elective period continued with the annual commemoration of the Thai king's coronation. On top of exploring the numerous temples, shopping malls and the Grand Palace in Bangkok, we also explored popular beach resorts in Pattaya, such as the Haad Tien Beach Resort where we went for a boat tour on Ko Tao island, and paid a visit to the Nong Nooch Tropical Garden. The breathtaking scenery and amazing Thai food offered us the opportunity to relax and unwind after months of clinical postings and electives, and the Thai massages rejuvenated us for the work that laid ahead.
A unique milestone
This inaugural transnational trans-disciplinary collaboration between KTPH and the Faculty of Medicine Siriraj Hospital, Mahidol University was a unique milestone for the LOTTE programme. Having the privilege to learn and experience two different healthcare systems and cultures, while still receiving a comprehensive, structured and holistic education here in KTPH, is an opportunity that is hard to come by and we are truly appreciative.
Acknowledgements
We would like to thank Adj Asst Prof Clement Chia and Dr Pongthep Pisarnturakit for making this transnational collaboration possible, and for the assistance rendered to us as the first batch of students doing this elective. We would also like to express our heartfelt appreciation for Dr Jolie Hwee, Dr Ivy Ng, Dr Trishna Ramesh, Dr Jerry Goo, Dr Lavenia Kulendran and Dr Gehlot Pritish Kumar for taking us under their wing and teaching us during our time in the LOTTE programme at KTPH.
We would also like to sincerely thank Prof Waraporn Imruetaicharoenchoke, Prof Suebwong Chuthapisith, Prof Pradit Rushatamukayanunt, Dr Visnu Lohsiriwat, Dr Mongkol Boonsripitayanon and Dr Chatbadin Thongchuam from the Siriraj Hospital for being so welcoming and hospitable to us while we were in Bangkok.
Finally, we would like to give a huge thank you to Ms Fion Chee for working tirelessly to coordinate our lessons and administrative affairs, and the rest of the medical students in the LOTTE programme for being a joy to work with.
A picture with Dr Pongthep Pisarnturakit (centre) on our last day in Siriraj Hospital, Mahidol University