Training Abroad - Melvin Chua

In 2006/2007, I managed to have a year Out-Of-Programme Experience (OOPE) in Singapore at the 800 bedded Changi General Hospital (CGH) as part of my second year General Internal Medicine / Geriatric Medicine training approved by my local deanery as well as the respective Special Advisory Committees.

Geriatrics in Singapore setup only in 1987 with help from visiting experts from Hong Kong. An arrangement was made with Dr John Dall, then Head of the Victoria Geriatric Unit (VGU) in Glasgow to train future registrars in Geriatric Medicine under the sponsorship of the Royal College of Physicians of Glasgow. Therefore, the Geriatric Training in Singapore is much modelled after our own training in Scotland.

The planning for my year OOPE started early when I was first appointed a Specialist Registrar in Aberdeen in 2005.

There were several reasons for exploring training opportunities overseas:

•  Experience of different healthcare systems with different challenges requiring a different set of skills and therefore, requiring a trainee to adapt and be flexible.

•  Experience of different cultures which may lead to differing needs between patients.

•  Different healthcare systems have different approaches towards addressing funding and resource issues. By comparing and contrasting both systems enable our understanding of balance between health economics and clinical governance.

I spent six months working under the supervision of Dr Edward Pratt, Consultant Physician (Diabetes and Endocrinology) who had trained in Southampton before moving to Australia for research and stopped over in Singapore initially for a holiday but decided to stay on. I spent the time as a General Medicine Registrar in a medical ward with twice daily wards rounds (Morning and Exit Rounds) and also had my weekly General Medical clinics as stipulated by JRCPTB guidelines for training. I was also Registrar resident on-call for General Medicine approximately 4-5 times a month and also participated in sub-specialty clinics e.g. diabetic clinics and cardiology clinics.

My second six months was spent under the supervision of Dr Christopher Lien, Consultant Physician (Geriatric Medicine) who had initially graduated from the University of Singapore before falling in love with the Scottish Highlands and decided to carry out his Specialist Registrar training in Tayside. During the six months in Geriatric Medicine, I looked after a ward of 36 patients with twice weekly geriatric referral responsibility and a weekly general geriatric medicine clinic. There was allocated time for attendance at sub-specialty clinics and the monthly national specialty teachings.

There are three main geriatric units in Singapore based at Tan Tock Seng Hospital, Changi General Hospital and Alexandra Hospital. In recent years, there has been a lack of trainees wanting a fulfilling and rewarding career in Geriatric Medicine with most local trainees opting for other specialties. Therefore, there are training opportunities available in these units.

Dr Melvin Chua ( melchua@nhs.net )
Specialist Registrar
Woodend Hospital
Eday Road
Aberdeen AB15 6XS

Tan Tock Seng Hospital http://www.ttsh.com.sg

Changi General Hospital http://www.cgh.com.sg