Starting your life as a Postgraduate Year One (PGY1) after graduating from medical school may be exciting yet daunting at the same time, especially with so much unknown about the medical journey ahead.
We spoke with Dr Arel Chua, Dr Irene Tu and Dr Jeremy Lim (SingHealth PGY1s) and learnt about the misconceptions they had of PGY1 back in their medical student days.
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Dr Irene: False. It is important to perform our due diligence in getting to know our patients well, but it's impossible to know everything while on calls or making rounds when we are just starting out as a PGY1. That is why medicine is practised as a team, with junior doctors learning under the guidance of senior doctors. Beyond our medical textbooks, there is a lot more to learn about patient care.
Dr Jeremy: False. I was initially under the impression that to be viewed as competent and worthy of being part of this medical journey, I would have to constantly exceed expectations and go above and beyond. Thankfully, my worry turned out to be unfounded. None of my bosses has expected me to be an expert or to be flawless. The bosses and seniors I have had are extremely understanding and are aware that PGY1 is a year of learning. That said, as PGY1s, there is still an expectation for us to put our best foot forward and to bring a positive attitude to the job.
Dr Arel: False. It will definitely be helpful to know how to respond to everything on call, but it is okay if I don't. When the task is beyond one's capabilities, the most important thing is to ask for help or escalate the cases. Thankfully, there have been many helpful seniors who readily reached out to guide me along this journey. Furthermore, the online resources provided for junior doctors, such as the modules for KKH Paediatrics Medicine have been a helpful refresher to keep me updated with the commonly encountered conditions in my daily work.
Dr Irene: Definitely false. I have made many valuable friendships during my PGY1 postings. The learning curve of a PGY1 is generally steep, as we get used to transitioning from a medical student to a working adult with greater responsibilities. Rivalry was far and few between as we were all in the same boat together. I have met friends who are willing to lend a helping hand or a listening ear in times of need. Camaraderie naturally forms as we help each other to get through the seemingly endless tasks.
Dr Jeremy: False. I believe that the African philosophy of Ubuntu – "I am because we are" – applies in healthcare. Without teamwork and camaraderie, the hospital would cease to operate. Much of our waking hours are spent working alongside our fellow colleagues and PGY1s. It is only natural that friendships formed as we cover for each other and encourage one another to grow in pursuit of the betterment of our patients.
Dr Arel: False. Back at Changi General Hospital's (CGH) General Surgery department, it was not an uncommon sight to see fellow PGY1s going the extra mile for their peers, such as getting breakfast for those who had just finished their calls, ordering or even delivering food, even on their off days. The Medical Officer (MO) room was a balm to the soul, especially on call nights or public holidays, where we gathered to share food or to find a sounding board for on call decisions with fellow PGY1s. It was indeed a home away from home.
Dr Irene: False. I have learnt a lot of practical soft skills in patient care, such as how to talk to patients and their families, break bad news, and provide support to families when their loved ones passed on. In terms of medical knowledge, I learnt from my seniors on how to manage medical conditions with more confidence. There are also opportunities to have hands-on experience in suturing (for episiotomy repairs) as well as peri-operative preparation. Most importantly, I learnt how to cope with high patient workload without compromising on quality of healthcare.
Dr Jeremy: False. On the contrary, working in the wards as a PGY1 has taught me many skills, ranging from procedural, communicative and to administrative skills. In fact, I have had many hands-on opportunities thus far, including bladder ultrasounds and flushing of nephrostomies at Singapore General Hospital’s (SGH) Urology department, surgical drain removals at SGH’s Hepatopancreatobiliary (HPB) department as well as vascular line removals at Sengkang General Hospital’s (SKH) Renal department. Even daily ward work, such as blood-taking, plug insertions and urinary catheter insertions are opportunities to develop our skills! These hands-on opportunities, no matter how minute and common, have helped to advance my development as a doctor.
We also inevitably develop and hone our clinical acumen through communicating with other medical and surgical specialties outside our department. And not forgetting the thought process that goes behind the administrative tasks, which forms the backbone of our workflow and concepts as a doctor. These are definitely ‘real’ skills that cannot be taught or found in the textbooks.
Dr Arel: Perhaps, this misconception stems from the worry that PGY1s do not get much autonomy to make ‘real’ decisions in patient care since most of our work is supervised or administrative-based. As with medical school, much of our learning at the wards comes opportunistically and varies. Nonetheless, participating in a code blue with my MO, listening to the consultants relaying bad news in an empathetic manner, and watching the registrars perform physical examination and appreciating the finesse has taught me a great deal. With time and practice, I am gradually learning to be better in what I do.
What were some other misconceptions about life as a PGY1 that turned out untrue?
Lack of respectPrior to starting PGY1, I was prepared to deal with berating superiors and seniors as well as a lack of respect because PGY1s are at the bottom of the food chain. However, after starting work, I realise this was not the case. I have had the chance to work with superiors whose humility and patience inspired me to show the same kindness and respect to my colleagues.
Lack of work-life balanceAlthough life as a PGY1 can be hectic, there is always time to rest and have a life outside of work. In fact, PGY1 life is a marathon. Hence, it is important to set aside time to recharge after a long day at work, so as to be ready and refreshed for the next day.
Lack of opportunities to build up my Residency portfolioIn SingHealth Residency, learning opportunities are available to those who seek them out. Despite the fact that I am only a PGY1, I have been given many opportunities to expand my Residency portfolio, such as assisting my seniors in the Operating Theatre (OT) and taking on leadership roles etc. I could even work on Research projects at the side during the lighter postings!
Dull and routineI was told that my PGY1 life would be dull, and I would spend very little time practising medicine. Thankfully, I quickly discovered that this was not the case, at least not for me. Every day is different, with interesting patients and new things to learn all the time. I thoroughly enjoy working as a doctor and often wake up excited to come to work. I get paid to do a job that I am passionate about and that, to me, is a great privilege.
No work-life balanceAs medical students, most of us are concerned that we would be spending all our time at work when we become PGY1s. While some postings admittedly do have longer working hours, with good time management and an efficient working system, I have found that most PGY1s can still achieve a significant degree of work-life balance. Time can still be spent with our loved ones, and on activities and passions that we enjoy outside of work.
Finding joy at workAs with medical school and life in general, life as a PGY1 has its ups and downs, especially with the uncertainties and constant deployments as a result of COVID-19. But amidst all the hustle and bustle, joy can still be found in in the nooks and crannies of daily work, be it from the continued care of a post-Whipple operation uncle or going through the home, education, activities, drugs, sexuality and suicide (HEADSS) assessment with a child, to small acts of generosity and kindness from fellow doctors and nurses.
Finding opportunities for growthConsidering that COVID-19 was never really part of the medical school syllabus, the idea of working at the frontlines of a pandemic seemed so foreign to me then. Never did I expect that I would eventually graduate to be working at the frontlines as a junior doctor. I have learnt much about being flexible and adaptable when dealing with evolving workflow processes in such unprecedented times.
Finding work-life balanceThe working life of a PGY1 does thrust upon me the task of relooking and balancing of my priorities. But I am glad to say that it has still been possible to spend time to rest, pursue hobbies and hang out with family and friends is definitely possible.
Share one piece of advice that you were given and have benefitted from, before starting PGY1.
It is a personal choice to keep the fire in you burning.
While it is easier said than done, it is my goal to remain excited to come to work every day. On days when I feel disheartened or jaded, I will remind myself not to miss the big picture as it is a privilege to be called a doctor and for the healthcare team, patients and even their families to look up to us for medical advice. We may be the least experienced members of the medical team, but we can still use the little knowledge we have to empower our patients to understand their illness better so that they feel more in control. Our efforts may seem trivial, but being able to do our part, no matter how small or minimal, makes it meaningful and rewarding for me.
Always know your patients well.
This invaluable advice was shared by my senior, and has helped shape my approach and mind-set as a young physician. As a PGY1, I am the patient’s primary doctor during their stay. Getting to know my patient’s medical history and presenting their problems in detail is crucial towards providing them with the best possible care.
To never forget the reason why I chose to be a doctor.
Similar to the journey of a medical student, each PGY1 posting acts as a milestone with its own set of challenges. Recalibrating ever so often as to the reason why I chose to be a doctor and choosing to see the daily work more than just a set of task to complete has kept me happily focused.
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Interested to learn more about the SingHealth Residency's PGY1 Programme?
Join us at the virtual SingHealth Medical Students Forum on 19 November 2021 at 6.00pm! Chat with our Faculty and learn more about the PGY1 training experience and career opportunities in SingHealth.
Note: This forum is exclusively for medical students only. Look out for the email with registration details from your class representatives (for local medical students) or medical societies (for overseas medical students).
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