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From Knowing to Growing


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 Puah Ken Lee is an Orthopaedic Surgery Residency Alumnus and is currently an Associate Consultant in the Department of Orthopaedic Surgery, Singapore General Hospital (SGH). He shares the valuable experience and insights gained during his attachment at Duke University Hospital as a visiting Chief Resident for five days in May 2017.

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What was the overall training experience like at Duke University?

My experience gave me insights into how the Duke Orthopaedic Residency Programme has been set up to meet Accreditation Council for Graduate Medical Education (ACGME) requirements, as well as clinical service demands. The attachment helped me see how Duke and SingHealth Residency have similar challenges in a range of areas, including selection criteria for Residents, evaluation of Residents, assessment of competencies, and engagement of Core Faculty. I learned that their solutions to these challenges are evolving, just like ours.

The opportunity to interact with Residents and Faculty at Duke as a visiting Chief Resident allowed me to participate in and witness the department’s daily activities at the level of a trainee.


What have you learnt from the attachment?

The strength of this programme is that it allows us to observe day-to-day clinical work and processes on the ground as a Resident in the Duke healthcare system. This includes attending all the teaching activities together with Duke Residents.

As the first Orthopaedic Chief Resident from SingHealth to be hosted at Duke, I was allowed to gain further insight into the selection process of Chief Residents and Orthopaedic Residents under the Duke system. The hosting department was flexible enough to allow observations of its concurrent services and training commitments. My counterpart at Duke, Chief Resident Dr Michael Morwood, was pivotal in helping to contact the relevant clinicians in the department for my daily attachment.

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What is your most memorable experience during your overseas attachment?

It would be the chance to meet world-famous Orthopaedic and Hand Surgeon, Dr James R. Urbaniak, Chief Emeritus of Orthopaedic Surgery on the first day of my attachment.


What are some ideas we can incorporate into our Orthopaedic Surgery Residency Program?

I think we should explore how we plan Residency didactic lectures and teaching activities around the daily department schedule. We may have to re-evaluate our role, and the emphasis on in-training examinations and formal assessments in our programme. We can also look into developing our own in-house tools for assessment of core competencies, simulation work and cadaveric training.


What have you learnt from the attachment, and how can you apply it to your day-to-day work?

I have learned that some challenges are universal: balancing the allocation of limited resources for healthcare service provision and for medical training, answering the increasing need for patient care by multi-disciplinary teams, and developing good patient communication and education. However, the wholesale importing of another country’s system or solution may not work for us. It has to be tailored to our environment and existing structure. I see our daily challenges in a different light after having experienced how similar problems are being tackled overseas with a view to collaboration and sharing of ideas.