What our Trainees Say about EMD
Dr Kuan Win Sen
Position: Associate Consultant
Why I chose Emergency Medicine?
- Exciting field of practice which allows integration of multiple facets of medical specialties into one.
- Perpetually thinking on my feet
- A sense of fulfillment when I see patients improve within a short duration of time
- Allows activities with family (especially children) during non-shift times on weekdays.
- Interaction and camaraderie with colleagues (nurses, allied health) not seen in other disciplines
- No ward rounds!
Why NUH Emergency Medicine Department?
- Emergency Medicine in NUH offers an array of multiple subspecialties – critical care, trauma, resuscitation, observation medicine, radiology.
- Emphasis not solely on service.
- Prides itself on evidence-based medicine, not just eminence-based – for instance, NUH Emergency Medicine Department is the pioneer for the use of non-invasive ventilation among EDs in Singapore.
- Ample opportunities to perform surgical and orthopaedic procedures, as well as critical care procedures such as central line placement and chest drains.
- Bountiful research opportunities in line with hospital agenda on becoming an academic medical centre – building up of research base to facilitate budding clinician-scholars and clinician scientists to fulfill their full potential.
- Collaboration with inpatient specialties (e.g. Cardiology, Medical Intensivists, Trauma) to coordinate better care for patients, continuing education and facilitate research (Emergency Medicine-ICU and trauma conferences).
- Excellent friendly senior staff who are very approachable to teach.
- My mentor (Clinical A/P Manning) is a great example of one who prides himself with teaching and makes an effort to ensure that relevant material is prepared monthly beforehand to enable maximum benefit during the teaching session.
- Being a tertiary hospital, the casemix is varied indeed with multiple specialty patients seen (e.g. oncology, cardiothoracic, ophthalmology).
- Extra training time for trainees (residents) for in-house and externally-organized events that are relevant to the practice and improvement of Emergency Medicine. In-house training curriculum designed to supplement gaps in knowledge not covered by the combined national curriculum.
Dr Lau Thian Phey
Position: Registrar
It was more than two years ago when I first had a taste of the excitements that are well known for the Emergency Department. A short 6 month posting in the Emergency Department of NUH had made a great impact in the way I practice medicine subsequently.
The training experiences during my days in the department were both memorable and invaluable: there were well organised and structured teaching sessions for the MOs, which were particularly useful for new MOs trying adapt to the challenging daily work in A&E.
There is no shortage of both interesting medical and surgical cases in the department, providing constant learning opportunities. Handover rounds at the end of each sessions are not to be taken lightly as those are the best time to learn from the senior colleagues, which are always helpful and more importantly, willing to teach.
The department practices up to date, evidence based medicine, which is crucial for the best management of the patients and continuing education of staffs of various levels.
I’m thankful that I was given a chance to work in NUH Emergency Medicine Department and I will strongly recommend it to anyone who is keen to pursue their career in emergency medicine.
Dr Zulkarnain Bin Ab Hamid
Position: Registrar
How is the working environment conducive to your training?
More than just the working environment, the presence of a training culture makes training in NUH Emergency Medicine conducive. The dept sets aside adequate training time for formal training in the classroom. Furthermore, and frequently, lessons are brought out of the classroom and onto the shopfloor through bedside teaching - this mode of teaching merges theory and practice in a real scenario, resulting in a more comprehensive and holistic training experience. In addition, the seniors are training-oriented and have an open-door policy - any MO can have access to any senior - regardless of whether the senior is his/her supervisor - for help on any taining issues. How do you find the teaching program?
For someone who has been to other Emergency Medicine, I can say that the training program is NUH Emergency Medicine is superior - both in terms of quality and quantity. The training program does not stand on its own, being part of a larger training and learning culture that promotes learning at and off work.
Opportunities are always open and provided for those who requests for more teaching. In essence, you'll get more than what you thought you'd ask for.
How do you find the teachers / mentors?
The mentors, as mentioned above, are teaching-oriented. They cater the teaching for individual MOs (i.e. work-oriented, and exam-oriented training). The pervasive theme is the training and learning culture. You'll not find a senior who wouldn't take the opportunity to train and teach you whenever the opportunity arise. It's up to you to take advantage of this.
How do you find the working culture?
The nature of the work would mean that an MO would develop camaraderie with fellow colleagues rather quickly. The seniors also make the working environment a safe one by always reviewing cases with the MOs and adopting the open-door policy. You will be tired from the work, but you'll feel satisfied, appreciated and safe.
Comments on the patient load / case-mix.
A generous mix of both medical and surgical cases. As NUH catchment includes both residential and industrial areas, the Emergency Medicine sees enough of acute presentations of chronic cases, accidents, real emergencies... well, just about everything.
Why do you choose to specialise in Emergency Medicine?
I chose Emergency Medicine for both push and pull factors:
Push factors:
Ward work entails endless rounds and night shifts which may last 36h... oh, and did I mention the clinic sessions after rounds?
Pull factors:
The breadth of medical and surgical cases, the camaraderie that you form from having to work through a difficult shift together (for the guys, remember NS?), the exciting moment-by-moment turn of events that keeps you on your toes and mentally-stimulated at all times
How is Emergency Medicine exciting?
Emergency Medicine is a smorgasboard of medicine and surgery. It allows one to practice the breadth of medicine in a balanced fashion. Furthermore, being on the frontline allows EPs to think fast and to intervene in a timely manner. An EP gets to perform many life-saving procedures which gives immediate results, and as such, immediate gratification. No other discipline can promise the daily excitement that tests both brains and brawns (clinical and procedural skills).
Dr Chai Chew Yian
Position: Registrar
"One of the most wonderful experiences one can ever go through, NUH Emergency Medicine has given me the opportunity to handle a wide variety of cases.
I am proud to say that in NUH Emergency Medicine, our patients are thoroughly investigated and well managed prior to admission. Early goal directed therapy and starting BiPAP for COPD patients are examples of Emergency Medicine management which I am very impressed with. Beyond the traditional practice of Emergency Medicine where we triage and manage acute issues, we have also started moving towards Critical Care Medicine & Observational Medicine. Our EDTU (Extended Diagnostic & Therapeutic Unit) allows us to shorten the duration of stay and workup patients more rapidly before discharge.
There is never a lack of opportunities for hands-on procedures, never a day where you go home learning nothing new. NUH Emergency Medicine is indeed a good fusion of Emergency Medicine, Critical Care and Observational Medicine.
We get our support from a good team of senior doctors, who are ever so approachable. Coupled with excellent teaching programs, practicing here will definitely make the whole experience a holistic and beneficial one."
Dr Juliana Thay
Position: Registrar
General
- Generally a very friendly department with a strong teaching culture.
- Possibly the only Emergency Medicine which requires you to speak to the Chief for a MOPEX position before you apply; it’s that competitive!
- Has a decent ‘reputation’ with the ‘guys up there’ (the wards), which is good for the morale.
Working Environment
- Very supportive senior staff who will teach and guide, so that juniors will be protected from making serious mistakes. Generally encouraging and not punitive.
- Workload varies from shift to shift, but generally manageable.
- Good patient mix, with a good number of opportunities to practice procedures; not exposed to OG and paeds cases though
- Kopitiam and Mr Bean are just next to the Emergency Medicine Department! Not restricted to horrible hospital food during shift. There are scheduled breaks for P3 shifts.
- Established protocols that are easily followed, giving standardised care.
- 'Cutting-edge': the only Emergency Medicine Department that has its own BiPAP, and that practises EGDT for selected cases.
- Generally pleasant working environment as people are not too stressed and tempers are kept in check.
Cons
- During a busy shift, may not have time for a meal/toilet break. But this happens in other Emergency Medicine Departments too
- No MO room.
Welfare
- Nice waterproof electric blue baju with free laundry service!
- Extra off day for trainees; off-in-lieu if you are called back for standby. Rarely asked to come an hour or two earlier for shift.
Teaching / Training
- Excellent, possibly the best teaching staff and program amongst the Emergency Medicine Departments
- As a BST, there was a special structured in-house program to prepare us for the exams, and it was excellent.
- As a consensus, the trainees feel that NUH Emergency Medicine Department gives the best preparation for the MCEM exams.
- Good mix of caseload helps to accelerate the learning as we read up around the cases and practice our skills.
- Access to important journals such as EMP
- NUS medical library is just around the corner
- NUS medical bookshop is just around the corner too!
Why is EM exciting
- Broad range of topics, from medical to surgical and everything in-between as well
- If you liked, and was good at, most of your clinical rotations, then you are probably an EP J
- It is really like CSI (crime scene investigation)!
- We are the front line guys, the ones who get the first crack at the case.
- We have to consider a wide range of possibilities (differentials), narrow down the suspect (diagnosis), and try to nail it if we can (treatment).
- The guys who get the patients up there miss all the fun. They only get to manage and discharge.
- The sick ones who come in depend on us for their survival. EPs resuscitate.
- There are only 2 groups of people who own the airway – the anesthetists and us. And we are right there when it happens. They deal with elective cases mainly. We intubate violent drunks with HI vomiting away…on a daily basis.
- Nothing beats the thrill of a resuscitation; and there is no greater satisfaction then a successful resuscitation
- Emergency Medicine Department is still an excellent training ground for anyone who decides to venture out to GP-land in future; you can learn to perform procedures such as T&S and nailbed repair, as well as pick up acute emergencies which need to be redirected to the EMD.
Dr Toh Hong Chuen
Position: Registrar
My training experience at the Emergency Department, National University Hospital
Introduction
I stepped into the emergency department in NUH in 2006 as a medical officer seeking training in emergency medicine and have never looked back since. I am very grateful for the training I received and to the many seniors that have impacted on my life and my career. To all intents and purposes, I am confident that the training I had received is the best in Singapore, and I am thankful to have been trained here.
Patients
Firstly, the volume, diversity and acuity of patient load are impressive and in abundance. These are extremely useful for training purposes.
You get to manage the full spectrum of emergency conditions: from popliteal artery thrombosis to thrombotic thrombocytopenic purpura, methanol poisoning to submersion incidents, diffuse axonal injury to boerhaave’s syndrome …. You see both common & rare critical diseases presenting both typically & atypically e.g aortic dissection presenting with status epilepticus!
The breadth and depth of case mix that you find here will challenge you, day by day, patient after patient.
Practice
Secondly, the practice emergency medicine here is robust, innovative and certainly at the forefront, such as the use of the mini-chest tubes for pneumothorax, BiPAP for Chronic Obstructive Pulmonary Disease and Heart Failure, early goal directed therapy for severe sepsis and the use of ultrasound for a multitude of emergency conditions. Indeed, you get to practice what you read in the literature in this emergency department! The continuing emphasis on clinical excellence and drive towards evidence-based practice by the senior emergency physicians create an exciting, invigorating and stimulating environment for all who seek to be trained in this field.
People
The most capable machine, the best evidenced literature and cutting-edge management plan will be meaningless if there is no one to implement it, promote it, and above all, teach others how to use it.
In more ways than one, it is the people, especially the senior emergency physicians, working at the emergency department in NUH, who make it an extremely attractive and fertile ground for training.
The teaching culture is deeply embedded in department, especially amongst the senior emergency physicians. The in-house training program is very well structured, including a bimonthly inter-departmental round with the hospital’s intensivists and trauma service. Teaching is also regularly conducted at the bedside when the opportunity arises, and the discussion during the hand-over round led by the senior physician can be particularly illuminating. In fact, is it these active discussions (and education) on the management of the patients on a day to day basis that help to sharpen one’s clinical judgment, clarify concepts, honing of one’s skills, and above all, fuels passion and thirst for the practice of emergency medicine.
I am very grateful to my ex-mentor Prof Peter Manning, who religiously went through 2-hrly viva sessions with me individually, so as to prepare me for the MRCSEd (A&E) in Hong Kong, right from the first month of my posting onwards back in 2006 when I as a medical officer. In fact, as I continue to work in the department, I realized that every trainee who was mentored by him went through the same ‘ritual of fire’ as I did! Where else can I find a mentor with such commitment and dedication to the education and career advancement of his mentee?
I am also immensely blessed by the mentorship and friendship of many other senior emergency physicians there. They have guided me, not only in my pursuit of clinical knowledge and skills, but also lent a great helping hand and advice in my personal life as well. I have also greatly enjoyed working with my fellow registrars, who are an eager, energetic and enthusiastic group.
Conclusion
I stepped into the department back then seeking training in this field; I stepped out of the department getting more than what I had expected and more than what I had hoped for. And for this reason, if you ask me now where is the best place to be trained in Emergency Medicine, my answer will unequivocally be: Emergency Department of the National University Hospital.
Dr Paveena Gandhi
Position: Medical Officer Trainee
"My interest in emergency medicine began when I was posted to Emergency Medicine in my second year as a medical officer. Emergency medicine offers a diversity of clinical problems unparalleled by any other specialty.
As a frontline physician, one is exposed to acute problems from every field in medicine ranging from general medicine, surgical fields to psychiatry. In one minute one may be seeing a cardiac arrest in a 70 year old and in the next it may be a child with febrile fits. The Emergency Medicine is where people come when they are ill, frightened and not able to cope with their illness after exhausting their other resources. As an emergency physician, one is given the opportunity to help people through some of the most frightening time of their lives and to manage some of the most challenging clinical problems/circumstances.
Emergency medicine also allows one to have a good professional and personal life balance. Shift work allows for periods of intense work while in emergency department but at the end of the day, one leaves work to go home. There is no on-call services.
NUH Emergency Medicine has an excellent reputation for educating emergency physicians ready for both an academic and clinical career. The team of emergency physicians here are enthusiastic about their work and are excellent and dedicated teachers who are ever ready to supervise and guide. "
Dr Kanwar Sudhir Lather
Position: Medical Officer Trainee
I arrived in Singapore in the summer of 2007. Spoilt for choice between positions in Emergency Medicine at NUH, SGH and TTSH EDs, I chose NUH. A foreign graduate, I was not aware of the intrinsic complexities/ functioning of these esteemed institutions – so I did what any self respecting aspiring EM trainee would do – followed instinct, which told me that this was the place I wanted to call home. What followed was good old fashioned toil on the shopfloor - each day a rollercoaster! During these years of self-discovery, I found my calling in Emergency Medicine.
The rest, so to speak, is history. I am currently in my second year of traineeship in Em Med.
Emergency Medicine. A little known, poorly understood, occasionally maligned specialty that officially came into existence all of 50 years ago. A witch’s brew of Internal Med, Surgery, Orthopedics, Cardiology, Ob Gyn, Pediatrics, Geriatric Medicine and everything in between. Something the International Federation of Emergency Medicine describes as: … (a specialty) based on the knowledge and skills required for the prevention, diagnosis and management of acute and urgent aspects of illness and injury affecting patients of all age groups with a full spectrum of undifferentiated physical and behavioral disorders. It further encompasses an understanding of the development of pre-hospital and in-hospital emergency medical systems and the skills necessary for this development’. Heh-heh, enough there to scare off the saner fresh medical graduate(s), eh!
Emergency Medicine Med nuts n bolts: irregular, pressure cooker shifts; Passing recognition by other specialties (actually more disdain!); Poor patient recognition/ recall & poorer follow thru care (in-patient care, day to day management et al); Expose to high death rates (second only to Oncology); High stress levels; Lesser pay vis a vis other ‘surgical’ disciplines! OMG, I feel depressed now!
Why Emergency Medicine Med then? In the cardiac monitor beep-beep, ‘patient’s BP is unrecordable…’, ‘I’ve been constipated for 5 years…’, ‘can I show u my rash, Doc?’ – of the average week, there is an occasional pause when the fog clears & the mind thinks ‘normal’… In these moments of pause, I see the loosening of a painful grimace, the easier breathing, the restful sleep following hours of agony, the occasional smile and nod of thanks… and I’m back! The staggered shifts - with their clear on & off hours, infinite possibilities of clinical exposure - suit my need-for-speed-and-no-baggage-home credo. AND I get quality time for home & heath. Hey, for all the above riders, the money’s not too bad!
NUH Emergency Medicine Department. We’re a tertiary referral centre. The case mix is super diverse. The clinical exposure possibilities – infinite. All shifts have cover by board-certified A/Cs, Consultants. My seniors – Dr Shirley, Dr Manning, Dr Malcolm, Dr Suresh, Dr Lit Sin, Dr Li Lee and the team are a mother lode of knowledge/ experience and humility. Each day spent working with them has enriched me – personally & professionally. The mood is relaxed on the worst of days!
The training is hands-on and the teaching is structured, evidence-based medicine oriented. Weekly lectures from in-house speakers and invited faculty. Multiple research projects are underway and residents are actively encouraged to engage in original-/ ongoing research projects. In house dedicated research staff assist immensely in formulating manuscripts, publications.
Dr Derek Heng JY
Position: Medical Officer
A year ago, I was told that I must make a "pilgrimage" to NUH Emergency Medicine Department as part of my training in Emergency Medicine. I wondered why... but I came nevertheless.
The working environment is very conducive for training. The clinical decision making process is thorough and evidenced-based, and the disposition is well deliberated.
Furthermore, the senior doctors are very friendly when approached so the whole process of discussing cases is very pleasant and educational.
The teaching program here for MOs is very rigorous. Although this translates to more time spent on tutorials, I believe this is extremely beneficial to the MOs as it equips them with the necessary skills to diagnose and manage the plethora of cases that come through the door. It also benefits the trainees immensely as it helps plug the gaps in their clinical knowledge and training.
Being a tertiary hospital, the variety of cases presenting to NUH Emergency Medicine Department includes renal medicine, oncology and other subspecialty cases. The load is moderate and allows sufficient time for thorough discussions and acute management of cases, which further enhances the educational experience.
I have benefited immensely from my stint in NUH Emergency Medicine Department and very thankful for the teaching and guidance here.
My friend was right.
I took up Emergency Medicine because I enjoy the diagnostic considerations. I also feel that the training is broad-based and suitable for my aspiration to do medical work overseas. Furthermore, I like the camaraderie in the Emergency Medicine, where senior and junior doctors, nurses, PCAs even security work together as peers who do their own stuff well. This is in contrast to the wards when there seems to be a huge hierarchy and even worse, doctors scolding nurses instead of educating.
Emergency Medicine is exciting. Why do we even need to explain? :) just come and find out. haha!
