My Experience at 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.

SingHealth Chief Resident Dr Gayathri Devi Nadarajan is an Emergency Medicine (EM) Residency Alumnus, and is currently an Associate Consultant in the Department of Emergency Medicine, Singapore General Hospital (SGH). During her attachment at Duke University Hospital from 1 to 5 May 2017, Gayathri gained a better understanding of how various subspecialties develop within EM. She discovered new ways to improve patient care, and shares some of her memorable experiences and learning from the attachment.

Inspirational Educator: Prof Josh Broder

I had the opportunity to shadow Prof Josh Broder, Programme Director (PD) of the Emergency Medicine Residency Program, during my attachment at Duke University Hospital. He invited me to sit in on one of his classes, where he taught surgical Residents how to use ultrasound for procedures. Demonstrating how to perform an abdominal ultrasound in trauma to look for free fluid in the abdomen, he used an ultrasound program that allowed Residents to visualise real-time images when the probe was placed on the mannequin. The session allowed me to see first-hand the collaboration that exists between the departments–specifically, the EM team teaching surgical Residents. I also found the state-of-the-art simulation laboratory and its set-up impressive.

I was inspired by Prof Broder's enthusiasm and patience as he imparted listening skills and tips on providing constructive feedback. He was also educating juniors with clinical pearls, which are relevant for their clinical practice. Seeing Prof Broder successfully integrate teaching while he is supervising during a shift has taught me how to strike a balance between clinical work and teaching, especially during peak periods.

State-of-the-art Facilities

I found my visit to the hyperbaric chamber very memorable; walking into the room, I felt like I had just stepped into a scene from a sci-fi movie. The hyperbaric chamber in Duke may be one of the oldest in the USA, but it is well-maintained. I learned–through a consultation session with a patient–that the chamber is used for research on physiology, extreme medicine and a wide range of other conditions. In Singapore, the chamber is mostly used for diving-related emergencies.

I was excited and proud when I learned that the hyperbaric medicine unit was headed by an EM consultant. This spurred me to think about the possible ways to expand the scope EM services, and how my role as an emergency physician extends beyond the emergency room.

Another highlight was my visit to the helipad with the pre-hospital EM consultant. Since the USA is huge, it is common for larger American hospitals to own helicopters, which they use to transport patients between hospitals or from scenes of injury. This service is managed by EM consultants and Anaesthetists.

Turning my Experience at Duke into Transferable Skills

During my attachment at Duke, I gained a holistic overview and new perspective of the EM department. Through my day-to-day interactions with the staff, I heard about the perspectives of Chief Residents and of other Residents. Through observation, I have come to realise that the Residency Programme in the USA is similar to our programme in Singapore in terms of the overall aims and challenges faced by the Residents. The attachment was an eye-opener. I got to explore what lies beyond Residency and how we can expand our hospital services further.

A week at Duke reinforced the importance of teaching and research alongside clinical work as the pillars of an Academic Medical Centre. In Singapore, we are often limited by the width of cases being practised and when we observe practices in a different setting, we are stimulated to think of ways to do things differently. I gained an immense amount of knowledge from the attachment. My only wish is that it could have been a little longer so that I could learn even more. I better appreciate the Singapore system now as I have realised that there are shortfalls in every system and that no system is perfect. More importantly, we need to have insights into our strengths and weaknesses at an international level, and always strive to be better. Complacency will be our greatest failure.