Kicking off the 2 days of Careers Symposium was the talk “Introduction to Healthcare Clusters and PGY1/Residency Programs”, conducted by the Designated Institutional Officials (DIOs) representing their respective healthcare clusters -- Associate Professor Malcolm Mahadevan from National University Health System (NUHS), Assistant Professor Faith Chia from National Healthcare Group (NHG) and Associate Professor Tan Hak Koon from Singhealth. Through an engaging panel discussion, they shared on the changing landscape of residency programs and answered commonly asked questions about our postgraduate years.

In case you missed it, here are some of the highlights!

Question: Could you introduce your cluster and share how it is different or unique from other clusters?

Associate Professor Malcolm Mahadevan started the ball rolling by sharing that NUHS comprises 3 main hospitals: National University Hospital (NUH), Ng Teng Fong General Hospital (NTFGH) and Alexandra Hospital (AH). For AH, there will be future developments that may impact our choice of residency in the future. Of the three healthcare clusters, NUHS is the smallest, however, it is in an unusual position because NUH is next to the school and many doctors hold appointments in both the school as well as the hospitals.

Next, Assistant Professor Faith Chia shared that NHG takes care of the central and north area of Singapore. It comprises 2 hospitals currently, Tan Tock Seng Hospital (TTSH) and Khoo Teck Puat Hospital (KTPH), with another hospital upcoming in Woodlands.

Last but not the least, Associate Professor Tan Hak Koon shared that Singhealth is responsible for running 4 hospitals, with 1 more upcoming in Bedok. It also comprises the national specialty centres as well. This makes it the largest of the 3 clusters in terms of geography and patient load. He also added that training is standardised now for each speciality, and that all 3 clusters are good clusters, we just need to find which specialty suits us the best. He advised us to take our time, try new things, do postings and find out what we really like.

Question: What is the working culture in each of the clusters and what does it translate into when we are working as HOs and MOs?

Associate Professor Malcolm Mahadevan shared that while there are nuanced differences between the 3 institutions, the exact differences are difficult to explain as they only become apparent once we work as a PGY1. Giving the analogy of a car, he explained that similar to a car, the size, shape, design and number of doors appeal to different people.

Assistant Professor Faith Chia agreed, building upon the car analogy. When she was searching for a new car, she knew the car that she test drove was the one for her. Hence, these differences are hard to explain in words as we would need to experience them ourselves.

Associate Professor Tan Hak Koon further expounded on this, sharing that the culture today and twenty years ago are very different, highlighting that people are responsible for creating and changing the culture at each of the healthcare institutions.

Most importantly, all three of them agreed that across the three healthcare clusters, the framework for training and leave was all the same. Similarly, junior doctors in all three clusters were expected to work hard and learn along the way. In return, the faculty will reciprocate by nurturing them as well.

Question: Will the PGY1 institution we are assigned to influence our future residency selection in the same sponsoring institution?

Assistant Professor Faith Chia reassured us that the PGY1 institution we are assigned to does not affect the residency process, however it is a good opportunity for PGY1s to experience what working in the different hospitals is like. She also encouraged us to cross cluster and experience at least 2 different hospitals.

Associate Professor Malcolm Mahadevan also advised that for M5s, our first focus should be to work hard, follow instructions, be an active learner as well as perform well. Our second focus would be to look around and see what the situation is like in wherever we are training, assessing the speciality we are considering as well as the culture, before deciding where we would like to train.

Associate Professor Tan Hak Koon concurred, emphasising that PGY1 is a very important year where we should learn as much as we can and do our jobs well, while finding our way and working on the ground before we can determine what we like, which specialty we want as well as the institution.

Question: How important is having research experience or publications in the application for residency?

Associate Professor Tan Hak Koon shared that while research is one of the many things they look at, it is not one of the most important. Residency directors are looking at a few basic things, namely, honesty, integrity, commitment to specialty and competency. However, he added that each specialty is different and there may be some which will be more research focused.

Associate Professor Malcolm Mahadevan added that he knew someone who did research to the point of neglecting other areas, and it became detrimental to their growth as a doctor. He advised us that we should not jump the gun and learn how to run before walking.

Assistant Professor Faith Chia also added that when they match residents, they are not looking for a finished product, and emphasised that research is one of the things that they will train. Residency directors do not expect a consultant CV when someone comes in, rather, more importantly, they focus on personality, values and whether someone can be trusted before selecting them.

Question: In recent years there has been increased recognition of burnout and overwork especially in residents. What are some of the things healthcare clusters are doing or looking into to address this?

Associate Professor Malcolm Mahadevan answered that addressing burnout is a shared responsibility between healthcare clusters as well as ourselves when we start working. The hospitals make sure that the junior doctors do not hurt themselves and are able to take care of patients, whereas we also have a responsibility to take care of ourselves. In the workplace, he acknowledges that it is important to ensure that there is psychological safety, and added that there are rules for how faculty and residents should behave, and that the hospitals actually enforce these policies. Furthermore, hospitals also have welfare initiatives such as meditation and yoga sessions, as well as food baskets.

Associate Professor Tan Hak Koon added that medicine is a competitive field and that it will be busy no matter which field we choose to go into, whether we go down a clinical path or a research path. However, he shared that even though doctors are busy, it does not mean all work and nothing else, as many doctors still manage to get married and start families. Most importantly, we should learn how to apportion our time, as it is very possible to do things outside of work. He advised us to go in with the correct mindset, acknowledging that burnout is a big problem among healthcare workers. As for how the hospitals are tackling the issue, he shared that duty hour restrictions have been implemented and that on a ministerial level, policy makers are also looking into the issue. He ended off by reminding us that there is always help available!

Assistant Professor Faith Chia added to the discussion as well, as each of us have different boundaries and that there are some people who would want to work more. She acknowledges that burnout is higher in early career physicians, because as junior doctors, we may meet many hurdles and have very little autonomy over our schedules.