No elective is too short or too challenging for us to plan. Whether you have one week or one month to train, we can plan an individualized programme to suit your training needs.
Interests in Electives can range from learning about challenging patient management in wide ranging clinical scenarios to innovative clinical or basic science research, from evidence based audit projects to stimulating Simulator training sessions with our experienced Faculty.
Contact our Program Director A/Prof Raymond Goy at raymond_goy@nuhs.edu.sg for your customized elective now!
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Electives are a time to chase your interests, to explore something further without the pressure of exams and end-of-posting-tests. My personal objective was to explore anesthesia in greater depth and breadth, and secondarily to improve my confidence in practical skills, and I’m glad to have achieved that with the conducive environment at NUH. There are a few key reasons for that:
1. Variety
Probably the most prosaic reason will be the sheer range of cases that can be seen at NUH. It is truly a one stop centre where you can watch an anesthetist skilfully bring a fretful child under general anesthesia, and then drop by literally next door to see cardiothoracic surgery done with double lumen intubation and bronchoscopy. It was an efficient way of being exposed to a wide range of cases, and aided by able and helpful administrators such as Ms. Vera Cai who took an interest in ensuring sufficient variety for the students under her care. I also had the opportunity to rotate through the pain service, anesthesia outpatient consultation clinic, acupuncture clinic and surgical intensive care unit, and join the on call team for operations in the middle of the night, experiencing first-hand the fatigue and the pitfalls of performing anesthesia under such conditions.
2. Teaching Culture
To learn quickly and well, one needs both an ample supply of learning opportunities and effective use of each opportunity.
Many of the tutors here were inspiring in that way – they ensured that each opportunity to learn was not wasted, by consciously looking out for learning moments, involving me in their decision making processes, allowing me to discuss and propose my plans, and then challenging my assumptions. This was a realistic way of learning that refined my ability to apply theory correctly to practical situations, rather than allowing my unrefined thoughts to be allowed to escape without scrutiny. For example, I would be quizzed about my proposed choices of anesthetic technique and airway selection, and explore the reasoning behind these decisions. It was a rigorous process that clarified the misconceptions and blind spots that I didn’t even know I had. She could have just gone on doing her clinical duties without sharing her thoughts, but by choosing to share, her generosity enabled safer and clearer practice for others in the future. And that spirit of sharing (and sharing effectively) which pervaded this elective was a true highlight that I am grateful for.
This was also true with regards to practical skills. Tutors were cheerful and willing to let a student have a go, calmly and patiently guiding, in an intelligent manner that again maximised learning opportunities. I wasn’t just told to go and try intubation, after being asked “you know how to do it, right?” Before starting a case, tutors diagnosed my own level of proficiency, discussed the process, mentally rehearsed, and drilled good habits and their own personal practical tips even before I laid my hands on a patient. Instead of being left on my own to figure out the little practicalities that make things work, tutors shared theirs. And afterwards, tutors would debrief, getting me to reflect, in a non-judgmental way that focused on coolly identifying ways to improve and even giving me analogues to practice with these new principles before the next patient, to inculcate it into my muscle memory. My skills improved more quickly this way, and quite a few patients probably benefited from improved performance too. This didn’t just apply to myself, as I saw residents also benefiting from such teaching, applied to more difficult procedures. If one puts in the mental effort to keep actively learning, there is a lot to be gained from such a learning model. It may also represent some personal bias – I learn best from reflection and such reflective/rehearsal methods suited my style very nicely. I leave this posting feeling much more confident about my practical skills.
Students were also welcome to join residents for their evening teaching after their operating theatre duties. This gave me a more realistic look at their lives and a better appreciation of the stresses that they go through. I was there to see their preparation for the difficult anesthesia post graduate exams. They have a tough life preparing for it, but they also have great support for those who want to grab it, with great accessibility to teaching materials, viva training, group tutorials, etc. It is a program and culture from which much is asked beyond the routine of day to day work, and much is given to help reach that goal.
3. People
The personalities in of the people in anesthesia are among the most interesting and engaging across the various specialties. The pantry was a glorious example of that, with fresh bread made by anesthetists to share among anesthetists. People weren’t all-out workaholics, and were well-grounded beyond medicine, and generally liked their lives and did what they liked. They were always concerned about their patients’ feelings and individual situations, and were flexible so that they could find the best way to do something comfortable or practical for a patient. It was something at the back of their minds as they evaluated their actions, tailoring anesthesia and counselling for the needs and fears of patients and their families.
From consultants to medical officers, the department was good-spirited, warm and undergirded by a desire to do things well and to do so by helping each other. I was glad to have had the chance to be part of that, and to be inspired by that, for an elective.
- Matthew Low
M4 Student
Holidays are meant for doing what you enjoy. For me, I am very grateful to the department for allowing me the chance to experience NUH anesthesia during my one week break. In the short week, I learnt a disproportionately amount of knowledge compared to my actual anesthesia clinical posting. I have to thank Prof Goy and Dr Poon for letting me acquire a deeper understanding for anesthesia as a career.
Beyond my attachment in the elective OTs, I was rotated through the subspecialities in anesthesia, including pain services, ICU and emergency OTs – an opportunity not available in my previous postings. It was a rather surreal experience to have Prof Lee explaining patiently the acupuncture concepts in English (e.g. meridians), then interjecting names of the various acupoints in Mandarin!
I was also fortunate to go on call in the EOTs and given the chance to perform intubation using RSI, guided CVP and IA lines insertions. Being a very hands-on person, I was very inspired to be actively involved in the anesthetic procedures. However, what I found more inspiring than the variety of experiences was how anesthetists in NUH were so eager to teach. Every operating theatre I was posted to had an exceedingly knowledgeable anesthetist who would take extra time to teach, share their experiences, and at the same time remain amiable enough for a casual conversation. Moreover, they always made it a point to guide me through procedures, even when I prove to be more of a hassle than help. Their patience towards me (and my failures) never waned.
Many people think that anesthetists do not require patient contact, but what I saw this posting will absolutely debunk that belief. I have come to learn that anesthetists require even more communication skills talking to pre-operative patients, who are at their most anxious states. It was amazing to see how they managed to calm crying pediatric patients down and at the same time reassure fearful parents.
It is surprising how much one can learn in a well structured one week programme. For anyone who would like to know gain more insight into anesthesia as a career, I would highly recommend signing up for an elective with NUH anesthesia department!
- Zeng Zhi Yong
M5 Student
I was very fortunate to be able to do 3 weekends ‘on call’ with the anesthetic team staffing the EOT over the month of December. This was a new experience for me as I had not had the chance to go on call during my 1 week of anesthetics or week of ICU in Edinburgh.
Prof Goy in particular was most helpful in arranging for this elective to be fitted around my schedule as well as showing me around the department and the ICU. As the website promised, no elective is too difficult for them to plan.
He was also very keen to teach and show me some of what life as an anesthesiologist is like, which was most useful to me in deciding to pursue a career in anesthetics. Even though I felt out of place in the beginning the team made me feel welcome, and allowed me to participate hands-on with peripheral cannulation, intubation and the induction of anesthesia. Sometimes EOT was slow, but that gave me some time to talk to Prof Goy and Dr Tay about anesthetics in Singapore.
In general it was an excellent experience in terms of seeing how the anesthetics department at NUHS functions, the pace was not too fast which allowed them time to teach and explain the principles of anesthesia. I am grateful to Prof Raymond Goy and Dr Tay Kwang Hui for bringing me on call with them. I would have very much liked to have done more shifts in the department if I had more time in Singapore.
- M5 Medical Student, Mr Huang Hian Liang
University of Edinburgh
I signed up for an elective programme to find out more about what Anesthesia was all about. At the end of the 1-week attachment, I left with my expectations surpassed; Not only was there a structured program, the anesthetists that I met were enthusiastic and approachable, always willing to answer any queries that I had. Opportunities to try out various procedures were also readily available.
The 2 overnight calls that were part of my schedule were particularly memorable. Prior to my call, I had thought that things could not get any more exciting, but being in the hospital in the wee hours of the morning soon proved me wrong. A wide range of P1 emergency cases, from an aortic dissection to a perforated sigmoid, were admitted during this time. While observing these high-risk operations, I was able to further appreciate the challenges of being an anesthetist, trying to maintain the haemodynamics of an unstable patient. Furthermore, I was able to assist in even more procedures. I am certain that going on call has contributed greatly to my learning and was one of the highlights of my attachment.
Other memorable events include watching a patient with a difficult airway. After a failed attempt at intubation, a decision was made for a tracheostomy to be done by the ENT (Ear Nose Throat) surgeon. I was inspired by the teamwork between the anesthetists and the ENT surgeons as they worked together, assisting each other so that the tracheotomy could be done efficiently and effectively.
I would have no qualms about returning for a second attachment in the years to come!
- Steffi Chan
M3 Student
Taking up an elective program at NUHS Anesthesia was a decision made out of curiosity. At the end of my 2 weeks attachment, I am one big step closer to investigating my way to what could be perhaps an exciting career ahead to look forward to. I am grateful and very much impressed by the well structured program by the department even for such a short posting period.
Viewing the operations from another point of view, as oppose to our general surgery or orthopedic postings, I began to understand the complexities in taking over maintaining the patients’ physiology as they were put under. The intricate differences in management of patients with different co-mobidities and issues (major GI op, orthopedics, difficult airway, obese patients, trauma, cardiac, renal failure), have indeed shown me that anesthesia will definitely be a challenging and rewarding specialty.
Having gone through the elective, major, cardiac and emergency OTs I have seen more operations than both my surgical postings combined. I am highly impressed by the range of cases that NUHS receives and handles. Not only did I see cases from every speciality including O&G, Neurosurgery, Paediatrics and even Cardiothroacic, their wide range in of complexity was also astounding. From a simple ray amputation to a 12 hour long arotic dissection repair in the middle of the night, NUHS seems to be a place where the caseload is well spread and diverse.
Beyond the Major OTs, I had the opportunity to be attached to the various sub specialties in anesthesia, including the Pain rounds where patients with epidurals/spinals/single-shots are reviewed. The pain specialist was patient to explain the many modalities and analgesic agents that we can use to help our patients. With so many receptors and chemical modulators yet to be fully understood, I understand that the area of research in the department is indeed aplenty.
Having a keen interest in Critical Care, I was thankful for my posting at the SICU. It is not widely known that SICU in Singapore are actually run and taken care of by anesthetists. It was a wonderful experience to take part in intensive medicine. Despite the constant struggle to help patients pull through the severity of their disease, critical judgement and sheer knowledge of all disciplines of medicine and surgery is paramount. Besides needing to troubleshoot various medical issues, a critical care specialist would need extremely good communication skills to speak to family members regarding care issues and inevitably in some cases, end of life issues. The need to work as a team is also important as we coordinate care between nursing, surgeons, physicians, imaging, interventionist and even medical social workers.
Two weeks and two 24-hours call later, my experience with the NUHS anesthesia department was nothing short of intriguing and amazing. I leave with hand on experiences of intubating using Rapid sequence induction, peripheral line insertions, learning Ultrasound guided spinal anesthesia and even learning how to perform bronchoscopy.
The anesthetists I met were knowledgeable, pro-active in teaching and incredibly friendly. My knowledge of pharmacology and physiology has indeed increased by leaps and bounds. It is surprising how within a well structured 2 weeks, I can gained so much knowledge and experience. It was an excellent experience to learn more about what life as an anesthesiologist entails. NUHS is a place where I would seriously consider my training and would definitely come back for a second attachment in the future.
- Jonathan Cheng
M3 Student
