Learning from a Didactic Orthopaedic Elective in Singapore
The burden of musculoskeletal conditions prompted the World Health Organization to declare 2000-2010 as the ‘Bone and Joint Decade’, highlighting its severity (1). Coupled with my interests from third year musculoskeletal PBL scenarios, I sought to futher my understanding of the field of Orthopaedics through my junior elective. From the myriad of possible centres for my elective, I decided on the National University Hospital (Singapore) because of its rigorous undergraduate curriculum and established academic department in Orthopaedics.
National University Hospital, Singapore
I was assigned to one of the medical student clinical groups where we were given scheduled teaching. This comprised of tutorial groups, lectures, seminars and clinical examination sessions. In addition, I was expected to clerk patients in the clinics and wards, presenting them to my supervisor and clinical group. Daily ward rounds began at 7:30 am, where I was part of a multi-disciplinary team that reviewed new cases. By shadowing house officers on call, I was able to gain insight to my job-scope required in future. Mondays were fixed theatre days where I would scrub in and assist my Supervisor. I found this extremely beneficial to my practical skills of gowning, suturing and anatomy.
Personally, there was some initial culture-shock when exposed to the knowledge-intensive demands of the Singapore curriculum. I felt ill-prepared and hesitant of my abilities. However, good mentoring from my supervisor and support from the students allowed me to improve. An example would be my acquisition of good clinical skills. Research in Glasgow has shown that peer-assisting learning augments students’ clinical examination skills (2). Hence, I practiced this with my peers on patients during clinics, ward rounds and even on weekends. As a result, my musculoskeletal history and examination skills were constantly honed and improved on. I feel that the structured five weeks of curriculum allowed me to amalgamate the practice of independent PBL learning with a more didactic style of teaching, translating into a positive learning experience.
Clinically, I was exposed to a large volume of cases because my hospital was a tertiary centre, involving both Trauma and Orthopaedics. Subspecialties including Paediatric Orthopaedics, Adult Reconstruction, Spine, Hand, and Sports Injuries had their own clinics that I enthusiastically participated in. A memorable experience was with a patient affected with cervical myelopathy in the clinic. He presented with numbness in his hands and an unsteady gait. Upon eliciting the Hoffman’s sign and formulating the diagnosis, he was warded for spinal decompression surgery. Throughout this time, he was clearly distraught and concerned about this condition affecting his work and function. By allaying his fears in the ward and taking time to explain what the procedure involved, he became much calmer and was extremely appreciative for my efforts. I felt it was a particularly rewarding clinical experience by adopting an empathetic and patient-centred approach, addressing the patient’s concerns.
A patient’s hip X-ray after successful hip resurfacing surgery
My professional development was also nurtured during this elective, where I involved myself in my Supervisor’s clinics. In the ethos of holistic care, I learnt to apply the principles of Orthopaedic rehabilitation. Significantly, I was taught to perform a Harris Hip Score evaluation on my patient who had hip resurfacing surgery following septic hip arthritis. This allowed me to assess her well-being and whether she could cope with her new implant.
All in all, the elective challenged to seek dynamic levels where learning can occur and equipped me with important interpersonal skills. In retrospect, I feel that I could be better prepared if Glasgow’s curriculum integrated a core syllabus of Orthopaedic training with formal teaching on its principles. I managed to overcome this by utilizing lecture notes and specialist textbooks from the library. Orthopaedics constitutes an essential component of medical training and muculoskeletal problems are one of the top presenting complaints, hence I fully recommend this elective to fellow medical students.
Shaun Shi Yan Tan is a fourth year medical student at Glasgow University
0604599T(at)student.gla.ac.uk
References
1. WHO Scientific Group on the Burden of Musculoskeletal Conditions at the Start of the New Millennium. The burden of musculoskeletal conditions at the start of the new millennium : report of a WHO scientific group. Geneva: World Health Organization, 2003.
2. Burke J, Fayaz S, Graham K, Matthew R, Field M. Peer-assisted learning in the acquisition of clinical skills: a supplementary approach to musculoskeletal system training. Med Teach. 2007 Sep;29(6):577-82.