Residency 1 Surgical Rotation Reflections

Surgical rotation is quite a busy and hectic rotation. With daily sessions with
tutors and the number of personal cases needed to be seen, it is challenging
most of the time. I started my surgical rotation with 2 weeks in SJH, 1 week in
Orthopaedic clinic and 1 week in General Surgery. The first week of this rotation
which was the orthopaedic clinic session, was the calmest and relax week. We
learnt a lot within one hour session with the orthopaedic surgeon there, and
sometimes for me it might be too much to take. There was a miscommunication
as we were taught shoulder examination there but we are not supposedly taught
about shoulder examination in this particular rotation. For me, my problem is this
week was that I cannot practice what I learnt to a real patient. The reasons being
that most of the patients were in pain / had POP / bandaged, they are outpatient
not in patient and it was the first week of my clinical years, so the nervousness is
there. When I went to the ward, most of the patient were on skeletal tractions
and most of them are MVA cases. So I cannot really practice the skills that I
learnt in the clinic. Need to mention here is that all the tutors were superb,
especially Mr Lim.
Second week in SJH was quite nice. I learnt a lot especially the need to read
chapter 1 of Browses. Many cases were seen and discussed with the assigned
tutor. I also have the chance of seeing the seniors presenting their cases and
some sort of learn how to present better. The one thing that I think I was lacking
is that I do not read or prepare in advance or even read up about a particular
topic or pathology after the session. I find it hard to fit in the reading time into
my daily schedule. Maybe in the future I need to be more energetic, proactive
and have a better schedule. I think the clinic session was quite good to have of
at least once a week. We have the chance to see first-hand how would a patient
first presented, not after being admitted and where treatment might be started

already. But what I would suggest is that, instead of about 17 (Class of 2018 and
Class of 2016) of us go and crowd one clinic, maybe we can spread out to 3-4
person per clinic. But then this would make us more nervous as to be questioned
by the surgeons there.

3 weeks in PGH is quite something and different from SJH. The patients are more,
the ward is bigger and the turnover rate is faster. At first I was confused about
the system used in PGH. As Penang is my hometown, sometimes I can
communicate better with the patient as compared to my colleagues, but this is
not true for Hokkien-speaking patients. In PGH also, some of my weaknesses
become noticeable. Some of those are that I am lacking in confidence to engage
and initiate conversation with the patient, did not explore enough on certain part
of patients history, not proactive enough to go into OT, not proactive enough to
find patients with significant findings. Bed side teachings are something that I
like. It can be better if we can present a case and discussed as usual, and then
the tutor can take us to a specific patient for the session just to discuss about the
disease, red flags and clues in history, and physical findings that can be
appreciated. Most of the time, I cannot get physical findings that can be
appreciated, either because the patient is in pain and not allowed me to touch or
I somehow missed to spot the patient (or maybe it just because I am lazy).
It was quite challenging as most patient are either on post-op observation or
waiting for surgery. So it was challenging to talk to them.
Now Im going into the Family Medicine rotation. Most of my weaknesses is
basically can be overcome if I have more practice and talk to patient. So, my
plan is to talk more and engage more with patient throughout this Family
Medicine rotation. I also considering to go to the wards whenever I have the time
as Im going to be attached to OPD PGH for a week.

Tutorial is something that I appreciated most, second to bedside teaching. The

discussion in tutorial was superb. As for me, it is going to better if the computers
and projectors are working in the tutorial rooms where the tutor can actually
projects pictures and so on, to be discussed. This becomes significant when the
tutorial questions involve picture that is best seen in colour and on screen /
projected.

Im looking forward for the next surgery rotation and I hope that I can improve
more and more.