Defining Healthcare: Learning from Duke University Hospital

Each year, three SingHealth Chief Residents are selected to take part in a one-week attachment at Duke University Hospital in Durham, the USA. The attachment is designed to give our Chief Residents insights into the roles of Chief Residents in their departments at Duke University Hospital, and to allow them to explore how their American counterparts add value to the organisation as well as integrate into the department workflow.

Chief Resident Dr Lim Kheng Choon is a SingHealth Diagnostic Radiology Residency Alumnus, and is currently an Associate Consultant in the Department of Diagnostic Radiology, Neuroradiology Section, Singapore General Hospital (SGH). During his attachment as a Duke University Hospital Resident earlier this year, he had a chance to learn about striking a balance between research and academic activities, and explore ways to better promote them amongst Residents.

How was your experience like at Duke University?

I was attached to the Radiology Department for four days (from 30 May to 2 June 2017), and was hosted by Dr Charles Maxfield, the ex-Program Director (PD) of the Duke Radiology Residency. Each day, I was enrolled into a different subspecialty – Paediatric Radiology, Neuroradiology, Abdominal Radiology and Chest Radiology. I got to meet the Duke Radiology PD, Dr Karen Johnson, and had the opportunity to interact with the Residents and Faculty in their daily work routines.

Describe a memorable experience during your attachment.

My most interesting experience was a conversation I had with the hotel driver. He is currently pursuing a degree in social work and takes up additional work to supplement his income. He mentioned how envious he is of Singapore. He has never been here, but he knows and reads about our little country. He was impressed with our public health system: its effectiveness at managing costs, while providing excellent medical treatment and easy access for the poor.

When I pointed that we have our fair share of problems, he recounted a story about a six-year-old boy whom he had found on the streets, scouring through the trash for a meal. One of his parents was in jail for drug offences. The other simply had not been home for weeks, and was probably on drugs. The poor boy was undernourished, his tummy bloated from parasitic worm infestation. The driver’s vivid descriptions shocked me. I stopped complaining about the problems we face at home.

What is the best thing about being part of the attachment?

The visit gave me insights into how Radiology is taught in world-class institutions like Duke University Hospital, and allowed me to use that as a benchmark against my training and experience. It is heartening to know that our programs share many similarities and strengths with theirs, and I was exposed to learning how to better improve our training. I also found it a valuable opportunity to get to know the Duke Residents and Faculty. I believe this can lead to future collaborations in research and training.

What is your biggest takeaway?

I hope to bring some of the ideas regarding training in Duke to SingHealth. For example, they have a comprehensive training package to prepare promoting R1 Residents for calls. It covers the majority of emergent and common imaging pathologies that are encountered on calls and ends with an objective assessment. While we have similar training, it is not as systematic and objective. I hope to push for something similar here. I am already developing a computed tomography brain pre-call training package for SGH Residents.