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“I’d never seen a gunshot wound before”

Bullet injuries, kindly doctors, historical specimens and more: NTU medical students share their best memories of Imperial College London
by Peter Yeo

NTU medical students performing surgery on a dummy in a simulated operating theatre

“When I first saw her, the woman, who looked to be in her 30s, was plugged into her music. A familiar face at the hospital, she had been coming to the emergency room for many years for a pain in her arm. I walked up to her and asked to examine her. She told me how the pain in her arm began. Apparently, she was caught in the crossfire of a shootout some years back. A bullet caught one of her nerves or bone and the pain has been there since. She started getting emotional while talking to me and I was quite taken aback as I’d never seen a gunshot wound before.”

Both Singapore and London face similar challenges of an ageing population and escalating healthcare costs. However, the financing models of the two countries are different as they are based on different principles. I learnt that healthcare systems have to fit the ecosystem of the country to deliver the best care for patients.
– Fourth-year student Tan Wei Jie, who visited Imperial when he was in his second year.

This story by 25-year-old doctor-in-training Stewart Retnam shows a different side of medical school that Lee Kong Chian School of Medicine (LKCMedicine) students experience as part of their five-year NTU journey, with medical placements and immersions abroad.

LKCMedicine is a joint medical school set up by NTU and Imperial College London. The NTU students go on an exchange programme for a week during their term break in their second year, then on a six-week elective that involves attachments to hospitals or clinics, when they are in their final year of their studies. They also go overseas for community involvement projects.

Unique learning path

The unique learning experience at LKCMedicine is designed to train new medical professionals with both heart and knowledge. To meet Singapore’s growing and changing medical manpower needs, NTU and Imperial developed a joint programme where the whole is greater than the sum of its parts, explains LKCMedicine’s Vice-Dean of Education, Prof Naomi Low-Beer.

NTU’s medical students have the benefit of observing the National Health Service (NHS) in the United Kingdom (UK) as well as learn from a team of experienced clinician educators from the National Healthcare Group in Singapore. For example, they understudy medical teams at Tan Tock Seng Hospital, Khoo Teck Puat Hospital, KK Women's and Children's Hospital, Ren Ci Hospital and other institutions and clinics.

Ails of two cities

Final-year student Toh Ching Han says: “Most patients in the UK are better historians. I met a patient in his 90s who had come to the emergency room for chest pains. He could tell me his complex medical history, all the medicines he was taking, and even what surgery was done decades ago. And he wasn’t an anomaly. Patients in Singapore seem less aware of their medical conditions.”

Students also said that the doctors in London spend more time on the consultation. “Singapore is pretty chop-chop. With the high patient load, you want to quickly find the diagnosis and start managing their illness,” says Stewart.

“In the UK hospital I was attached to, doctors see fewer cases per day, but that means patients may have a much longer wait for their next appointment,” adds final-year student Lee Hai Quan.

“During my exchange, I had my first posting at West Middlesex University Hospital, a small hospital where the doctors seem to know one another well and the case files are in hard copy,” says Leon Tan, who is sitting for his finals. “But the situation at the larger Charing Cross Hospital, where I did my second posting, is similar to Singapore hospitals. In terms of the doctor-patient relationship, doctors in the UK take time to listen to patients and care feels extremely holistic,” he adds.

“Even though the disease burdens of most developed countries are quite similar, London provided me with more opportunity to be exposed to patients with conditions like sickle cell anemia and Inflammatory Bowel Disease, which are much more uncommon locally,” notes graduating student Bryan Ng.

Problem-solving skills

Do the students ever feel lost when they come across a medical condition they are less familiar with?

“Problem-solving is a skill LKCMedicine has taught us well. We think about what we need for the solution, and how to find information to help our patient,” says Hai Quan.

Agreeing, Stewart shares: “You just use all the knowledge you have. For the case of the patient with the old bullet wound, the slug got stuck around the arm so I relied on what I had learnt about the anatomy of the area. I may not know everything, but I know where the important nerves are. It’s quite interesting. You get right down to applying everything you have learnt to try and figure out what treatment approach works.”

Shelves of pathological samples at the Pathology Museum at Imperial College LondonWith almost two centuries of heritage, Imperial also offered NTU students a peek into the annals of medicine through guided tours to medical museums located on its campus.

Holistic care

Every student at the NTU medical school is involved in the primary care management of one specific patient in the first two years of their curriculum.

However, final-year student Jean Chiew has been monitoring a patient who suffers from cerebral palsy throughout her five years at LKCMedicine. She says: “My patient has a complex condition that manifests as problems I was not able to appreciate in my first two years of medical school. I tried to understand the holistic implications on the patient and his family. I spent more time with the family to learn how the care burden affects them.”

“This holistic approach is a good start for us on our journey to become doctors. When I gained more medical knowledge in later years, I was able to understand and appreciate the medical aspect of the treatment. That is probably a luxury for doctors-to-be, since the focus in medical school tends to be on the medical aspects first when medical care is doled out to arrest a condition. Approaching a medical condition holistically makes me realise that every patient and family has a home, and every treatment we prescribe has a cost – and emotional – implication.”

  • NTU students looking at pathological samples at the Pathology Museum at Imperial College London
  • A large group of NTU students having dinner at a long table
  • NTU students getting a warm reception at The Bailey’s Hotel in London
  • NTU students visiting Windsor Castle on their day off
  • NTU students with their professor at a respiratory anatomy practical at Imperial College London