What difficulties may overseas Singaporean medical students face when returning back to Singapore for work?

That’s a good question to consider.

1. Acclimatisation (work hours, culture, hospital IT system)

Local grads are immersed in Singapore hospitals since year 3, and so are much more “acclimatised” to the Singapore system as compared to overseas grads.

It may take overseas grads a while to adapt to various aspects of the Singapore system. Examples include: the IT system, medication prescription, patient discharge notes, ward round style, early starts and weekends, call system etc.

I’ve overheard from MOHH staff (don’t quote) that Australian grads generally need longer than UK grads to acclimatise. Eg. if UK grads take 6 months to acclimatise, Australia grads may take 12 months. Probably because Australia’s work culture is much more chilled, and working conditions are generally much better.

A longer acclimatisation period is also needed if you chose to do your House Officer (HO) year in your country of study (to obtain full registration), for obvious reasons.

2. Networking opportunities for residency training

Are you disadvantaged when it comes to selection for residency training, compared to local grads? Perhaps, to some extent.

Hanging around for longer in Singapore hospitals generally enables local grads to network with the right speciality departments, and take up relevant projects that may help with residency applications.

Yet, I also know of colleagues who managed to get straight into residency upon returning to Singapore. Some of the savvier ones spent their relatively long summer holidays shadowing at local hospitals, and participating in projects over their final few years.

3. Knowledge gap

This may be what you worry about most, but it’s unwarranted.

You accumulate the necessary experience/know-how to be a good and competent junior doctor while on the job – most of the book knowledge acquired in med school by rote learning will have been forgotten by the end of your first year as a doctor anyway.

As a final word, there are plenty of overseas grads who’ve returned to Singapore over the last few years, as a result of the success of the PEG grant programme and overseas recruitment drive. I’d suggest that you spend some time talking to them to gain some insight into the various challenges they faced upon returning.

Cheers

Hi there! Small disclaimer before I take a stab at this question: I am a local grad from YLL. Although I had clerkships in India, UK and US, and studied for over a year in Australia when I was younger, I am not an international medical grad (IMG). That being said, I was asked my thoughts on this and so am commenting based on my perspectives as well as experiences working with fellow IMG colleagues.

My colleague has already nicely summarised the 2 main points (1 and 2) here that come to mind personally. Among them I would emphasise that getting used to the culture is the main and major difficulty. As a returning Singaporean, you already have an advantage over other IMGs as you are already familiar with our culture (my paragraph of a disclaimer for example is a clear testament of our kiasu culture and the ruthlessness of our keyboard warriors’ online commentary).

Everything different about our work culture can be gathered by applying everyday Singapore culture to medical practice. For example, we as a society are very patriarchal and family-oriented. One of the striking differences one may notice is how informed consent is handled locally as a group activity with family members heavily involved – vs certain western practice settings which mainly focus on the (cognizant) individual’s preferences. The full extent of this is too complex for me to cover in a comment like this.

However, ultimately in medicine (and most things in life) no one will (should) ever find fault with you for something you were not taught and that you asked for help with. If ever in doubt, ask for help or to observe something being done before ever doing it yourself – whether the act of taking consent, or doing a procedure such as inserting a CVP line.

Going to work with the awareness that you are entering into a high-stress and unfamiliar environment, and conducting yourself appropriately to contribute best you can without risking patient care will serve you well enough to get by. To excel, make it a point to regularly follow-up on new lessons learnt with further reading, and remain curious about the practices and protocols you pick up along the way (don’t have to become a professor, but evidence based practice is essential).

Being yelled at and told off is part of any job, and you can be sure in the highly stressful environment that healthcare can be, you will face your fair share of this here and in any other country. I’m not defending this global practice, but rather raising awareness about this so no one gets caught by surprise. Just remember that when your leaders and mentors sometimes seem unreasonable or overly picky/punitive about minor details, it is often because they have learnt through their practice experience that those minor details are important to ensure a good quality of patient care. Do not take negative comments personally, but instead ask where you can improve the next time to learn and grow with experience.

Ultimately a positive attitude, keenness to contribute the best you safely can to facilitate patient care, and a willingness to be a lifelong learner will probably take you far in Singapore (disclaimer: speculation since I too am a junior doctor and nobody myself, but consistent with the advice my mentors have given me). And just to add on a note on the second point – as mentioned, networking opportunities can easily be gained through clerkships during long summer holidays.

I do not believe that knowledge gap is a major issue for anyone that followed up on their medical school readings, as the bulk of medical knowledge beyond fundamentals that are truly of value to practice is contextual and well, practical. The main caveats being that (1) certain conditions such as dengue that are prevalent here may not be as familiar due to epidemiological variations from your country of practice and (2) certain overseas courses do not include work placements leading to a steep learning curve during housemanship. But here and always, the lifelong learner attitude (as well as perhaps some holiday clerkships in Singapore) will serve us well.

1. General introduction

• I’m a Malaysian who was fully educated in Malaysia prior to my medical degree at the University of Liverpool
• Currently Singaporean PR

2. MOPEX and Residency training in Singapore

• MOPEX: 6 month long postings tied to a particular institution (Eg. TTSH Internal Medicine, SGH Orthopaedics, NUH General Surgery etc.)
• Residency: Structured training programme for specialty training. Need to undergo post-grad exams during training to progress, very competitive
• As IMGs, MOPEX is probably the best opportunity to touch base with respective people involved in the Residency Selection Committee, or display interest in a particular field and obtain a good recommendation letter from bosses
• Some IMGs managed to do Electives in Singapore to gain early exposure
• Early entry into Residency is possible, but bear in mind that you are still very early in medical training. Consider working in the department first before deciding to spend the next few years of work committed to the field. (Eg Ask if this is what you want to do for the rest of your life? Is this the direction I want to go for my medical career? Can you get along with the department?)

3. Some challenges I faced upon coming to Singapore to work

• Housemanship will be tough. Long hours, heavy workload, demanding bosses etc. Going on-call will be scary
• Volunteer to tag on senior colleagues for half the call before going alone eventually
• Learning the IT system to ensure good workflow. I stayed back after work to learn the computers/software
• Knowing Mandarin and dialects (eg. Hokkien) will help
• Learning the local medical documentation pattern, as well as abbreviations in medical notes
• Social support if foreigner: Make friends, help each other when in trouble, learn to relax from time to time

4. Comparing and contrasting life as a doctor in the UK and Singapore

• UK had better working hours but lacked the elements I consider important. Friends with similar background, closer distance to family members, tropical weather with no winter, patients with relatable personal experiences etc.
• Hospital structures are more hierarchical here. (Eg. HO in charge of buying drinks for surgical team after rounds)
• Working hours can start very early here (Eg. Coming in before 6AM to do a rounding list on the computer followed by pre-rounding)
• Pre-rounding before seniors start round. (Ie Scanning the computer system to look at vital signs, overnight events, updates to plans etc.)
• Work-life balance. Posting dependent, but in general expect to have less of that compared to UK

5. As compared to Singaporeans that studied in YLL or LKC medical school, what difficulties may returning Singaporeans face when coming back?

• Refer to above.
• Adapting to the local system. YLL/LKC students had the opportunity to do shadowing in their final years to understand the workflow and expectations of a HO
• Respective residency programme committee members may not know you as local students have the opportunity to engage with them during their student years
• IT system familiarity will help immensely in work efficiency

1. Some challenges faced as an IMG upon returning to Singapore

Most challenges faced would be similar for medical graduates staying on to work in the same country they have studied/trained in as those who move to another country to work; they are challenges that medical students in general face upon becoming a doctor:

• Responsibility
• Diagnostic & therapeutic dilemmas
• Managing expectations of patients and families
• End of life issues
• IT system
• Medical jargon / acronyms
• Department culture & politics

The main differences between working in Singapore and the UK:

• On call hours – 30h (day work -> on call -> day work), some places do float system in Singapore; all float or shift system in UK
• Total working hours a week – 80h (residency rules) in Singapore, 40-48h in UK
• Weekends – half a day a weekend in Singapore, only if you’re on call on the weekend in UK
• Pre-rounding before ward rounds with seniors, so early starts
• (main differences are related to working hours and definitely affects work-life balance so people do get burnt out)
• Hierarchical – but now with more younger consultants this is less evident on day to day practise
• Certain medical practises – inotropic use in general ward via peripheral line, ICU care & intubation, antibiotic use, cost issues limiting investigations / treatment for patients
• Communications (& ethics surrounding confidentiality) with patients & families

With regards to networking opportunities for residency training, I don’t think this is too big an issue because in general there is no rush in going into residency until you are quite certain that it is the right choice.

As you work & interact with colleagues to find out if residency is for you, you will get to know relevant people who might help you later on to get in.

2. What was applying for housemanship in Singapore like for you?

Interview during MOHH recruitment drive in London:

• For me: interview questions were non-medical. Questions felt like they wanted to get to know me better, what I wanted to do in the future
• Some friends have had medical questions asked
• I’ve heard from talking to seniors that overall recruitment of doctors in Singapore is coming down – 5-10 years ago, it was rare that IMGs applying back to Singapore to work didn’t get a job, but in recent years have heard from juniors that it seems to be getting harder now

After interview, there is alot of admin! Mainly to get SMC registration done, and for hospital to obtain information/documents to prepare you to start.

• Felt this process frustrating because it felt like how people described NS: “rush to wait and wait to rush”
• Gathering documents that become available at different times
• Even though you would think hospital is expecting you to start work on a certain date, you end up still not having access to places or the system

At the end of the day, you should consider pros and cons of Singapore versus whereever you are thinking of; however it might be difficult since you’ve never fully worked before to know how it will be.

Knowing how work will be like (as above discussion) might not be that important afterall. Eg. if you are returning to Singapore mainly because of family (like for me).

Ultimately each individual’s decision will be unique as everyone will weigh different factors differently. You just need to know for yourself what factors are important to you.