The Journey Towards the - MMed(FM) & Fellowship - College of Family Physicians Singapore
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March 2019
INTERVIEW & INVITED ARTICLES VOL 45(1)
The Journey Towards the
MMed(FM) & Fellowship
The College Mirror had the privilege to speak to recent graduands NK:
of MMed(FM) and Fellowship. We hear the ups and downs they Preparing for examinations
had to face while these graduands juggled their time among work, involved a lot of determination
studies and family - and hopefully inspire current trainees through and resilience as all the residents
their journeys! were working full time. Whilst
we tried our best to use
whatever sufficient time we had
College Mirror (CM): after work hours to revise or
What have you all learnt or benefited I’ve made (who are now at least
go to the hospitals to examine
from completing the [MMed(FM)] registrars in their fields) when I
patients, the feeling of not having
training? need help. Conversely, they also
done enough never seemed
text me if they need to ask about
to disappear due to the vast
SingHealth FM Resident, things in primary care.
breadth of knowledge required
Dr Navpreet Kaur (NK): in Family Medicine. Having a
Family Medicine Residency in supportive study group was one
MMed(FM) College
summary was an exhausting yet of the best parts of the whole
Programme Graduand,
exhilarating roller coaster. Steep process as we were able to push
Dr Natasha Leng (NL):
learning curves and changing each other along through the
Throughout my learning journey,
rotations just as soon as you had different phases.
I’ve learnt not to give up and
gotten used to the environment
to persevere. I’m glad to have
became a norm for us residents.
stuck through with it as it has
By going through such a wide JK:
improved my knowledge and
variety of rotations that would Family Medicine is comprehensive,
skills so I am better equipped to
have taken us years to cover hence the examinable topics are
treat patients holistically.
independently, Residency has very comprehensive as well.
equipped us with sufficient The study masterplan I drew
knowledge and grasp of common up was 13 daunting pages long!
MMed(FM) College
problems that we encounter in The sheer amount of content to
Programme Graduand,
our daily lives to assist with cover was the biggest challenge
Dr Chua Lee Lea Im (CLLI):
managing and counselling our in itself.
Having left hospital practice
patients for the next step of
since 2009, enrolling in the
treatment. Exam preparation also
College Programme availed me
required good time and energy
the chance to extend my hospital
management. Closer the exams,
exposure. It also introduced me
NUP FM Resident, my batchmates and I spent at
to the new fields of adolescent
Dr Joanne Khor (JK): least 3 evenings a week sparring
and sports medicine, as well as
The Family Medicine residency with each other and being brutal
provided a chance to obtain
provided 3 solid years of at least with our mutual feedback. The
the latest local updates from
17 major rotations. While the rest of the evenings were spent
infectious disease, emergency
adjustment to each new posting consolidating our knowledge and
medicine and various other
was often challenging, the mugging guidelines. It was both
specialties. Not only did the
frequent 1- to 3-monthly changes physically and mentally tiring
course widen my horizon when
forced us to be adaptable and but it helped that we knew we
I am faced with a patient with
versatile - a important trait of weren’t going through it alone.
multiple problems, it also taught
a good family physician. Having me communication skills to
gone through many postings also delve deeper into each of them. NL:
meant working with and getting Life definitely had some
to know many people across CM: challenges for me. I got pregnant
disciplines. Even after residency What were the challenges faced in the during the College Programme
is over, I still text the friends examination preparations? How did
you overcome them? (continued on the next page)
THE
College Mirror 21♦
March 2019 March 2019
INTERVIEW & INVITED ARTICLES VOL 45(1) INTERVIEW & INVITED ARTICLES VOL 45(1)
(continued from Page 21: The Journey Towards the MMed(FM) & Fellowship)
training, which was a nice clinic arranged by my boss and course materials, such confident you will appear to be
surprise. The pregnancy was an additional daily practice with as video demonstrations in your history taking, physical
extra ball to juggle amidst the colleagues plus 110% support will be helpful. exam and patient education,
coursework, full-time job and from my dearest husband and even under exam stress.
family. And it was manageable, family, I finally made it.
even after giving birth to my CM: Exams are important, but not
second child, and I was on Could you share some everything. As you study how
ur
course towards the first part of CLLI: Dr Navpreet Ka advice for the next batch to better care for patients,
with her fello w
examinations, the MCQ. The scope of family medicine of trainees? remember to take care of
coursemates
is extremely broad, therefore yourself. Remember your calling,
Then two weeks before the the task of preparing for an make time for friends and family,
NK:
MCQ, my 3-week-old son was examination with such an and don't lose sight of the bigger
Residency and
admitted for viral meningitis. It extensive scope was daunting. picture.
CLLI: preparation for the
was a terrifying experience, and I I also had difficulties obtaining
the appropriate examination examination is a challenging
time off from my small set-up The camaraderie between senior
was filled with constant fear for techniques but also managed the experience that will stress you
practice due to the relatively tutors and current year entrants, NL:
my son. So, my first shot at the load of patients in our absence. emotionally and physically. It
small manpower pool and having was palpable throughout the Practice and perseverance is
MCQ did not pan out. We have a lot to thank for the is important to have a good
to attend urgent administrative course. I am deeply grateful for the key. Putting in the time and
amazing Family and Resident support group within residency
matters which tends to crop up the dedication they showed effort will be what gets you
I was determined to give Physicians at Marine Parade itself as well as outside to
at the most inconvenient times. to helping us. Hopefully this through. If life knocks you down,
it another go. As my 2nd Polyclinic. The only way to help motivate you during this
Not only was revising on the tradition will stand the test of pick yourself up and get back
attempt at MCQ approached, further enhance the programme journey. Throughout this period
job tough, I could not attend time. into the thick of it. Convert your
several challenges presented would be to organize even more always remember that all these
themselves. First and worst was some of the courses. Thankfully, negativity from past failures into
teaching sessions to continuously sacrifices are worth it when
I managed to get some of my As for suggested enhancement, a positive drive to succeed.
that my father was diagnosed pull us out of our comfort zones. you are able to apply the
specialist friends’ help after an official online depository of
with cancer. I had to make the knowledge gained to help
necessary arrangements for his work hours.
your patients through their
care and treatment in Malaysia. eng: tough times. Cherish every CLLI:
ha L the
's
Secondly, my mother who had CM: atas The breadth of the examinable
moment- good and bad as it
Dr Nrd Time
"T rm"
been helping me to look after What do you think has been done well hi has gotten you to where you material makes it nigh impossible
my kids decided to return home, and which areas of the programme Cha are today! to cover on your own. Thus, it
so there was a bit of a scramble could be enhanced? is of paramount importance to
to find a helper. During this time form study groups. Preferably,
we had bought a new home to JK: this should be done with people
NK: Lea
renovate and move into. My 2nd Dr Chua Lee s and Use your daily work as from different institutions.
attempt at the MCQ was not to Singhealth Family Medicine Im wi th friend I would also recommend
practice for the exams.
be. Residency organized sessions colleagues simulating examination
During my RCC sessions in
to help to target areas that conditions in your daily practice.
residency and daily polyclinic
The second failure made a graduating residents had given For example, practicing full
work after residency, I would
serious dent in my confidence, feedback about. Sessions NL: physical examinations and
choose 1-2 cases a day
far more than the first. Should ranging from lectures to a small The support from the previous consultations within the
to simulate an exam case,
I really commit to another group examination session to batch mates, additional training, stipulated examination time limit
mock VIVA sessions helped Dr Joanne Khor complete with a stopwatch
attempt, potentially waste tutorials and practice sessions with NUHS Residents discreetly hidden behind the on at least one of your patients
another year of my life in us to prepare for the big day. definitely helped. and Faculty each day so as to develop good
computer monitor. I would
pursuit of this goal? More time Constructive feedback from habits. Habits prevail over
then review the cases after
spent away from the children? seniors pushed us past our stratagems!
the day’s work and reflect
After much introspection and boundaries and encouraged
on how I could have done
encouragement from family, us to think differently. Our
better.
friends, colleagues, previous individual Polyclinics, Marine
batch mates and support from Parade Polyclinic for myself, gave
Start early. As mentioned,
the institution I decided to go us endless support during this
there is a lot to cover. The
for it. time. Our colleagues and seniors
more times you practise
at work not just supported us Read on
Go to Page 25
the approach to a condition,
With the Programme C by providing extra sessions out
the more second-nature
training, practice sessions in of office hours to equip us with
it becomes, and the more
THE THE
♦ 22 College Mirror College Mirror 23♦
March 2019
INTERVIEW & INVITED ARTICLES VOL 45(1)
adult learners, are supervised with
eng : guidance by the programme directors
Dr Tan Wei B ioner in UK to a and tutors. On a personal level, from
ctit
A general pra in Singapore
being a GP registrar trainer before, I
had become a MMed trainee again! In
ian
family physic
many ways, the course has enhanced
and sharpened my clinical knowledge
and skills, very relevant in my day-
to-day clinical practice. Especially
Through a series of domestic events, it is having worked in UK, the course
interesting to see how I, once a general has provided me an in-depth study,
practitioner (GP) in UK, would become a family specialised in Family Medicine in
physician (FP) in Singapore complete with an Singapore.
MMed in Family Medicine.
Truly, adult learning is a lifelong
Professional development is an ever evolving, a journey.
process which is vital to meet the changing patient needs
from cradle to grave. In the UK, the qualification of MRCGP “Every great dream begins with a dreamer. Always remember,
(Membership of Royal College of General Practitioner) has you have within you the strength, the patience, and the passion
transformed quite extensively since I completed it a few to reach for the stars to change the world.” – Harriet Tubman
years ago. MRCGP was once acquired on an adhoc basis
reflecting any individual GP’s interest to pursue further in “Only those who will risk going too far can possibly find out how
General Practice; it has now become a compulsory qualifying far one can go.” – T. S. Eliot
exit examination in order to become a registered GP in
UK. In Singapore, though not strictly required for practice MMed in Family Medicine is not an easy course to pursue,
in family medicine, it has also evolved to its current state, especially for those who have many other commitments,
where MMed in Family medicine or GDFM are required to however it is achievable if the candidates maintain the
become a registered FP. Both the Royal College of General commitment and perseverance in learning, as well as building
Practitioners (RCGP) and College of Family Physicians up that fundamental inner passion for Family Medicine.
Singapore (CFPS) require continuous pedagogic summative
and formative assessments, whereby the candidates, all Be encouraged, you can do it! “
:
Dr Patricia Chia Things improved by mid-2nd trimester. Second hurdle came
after delivery. I had a large bleed which required transfusions.
In 2015, I was PGY13 and it was my 6th year working in It was very exhausting and painful with the sub-rectus
the polyclinic. My son was just 1-year-old then. I wanted sheath bleeding; it was very depressing and I so wanted to
to progress further in my throw in the towel. Thankfully,
career as a family physician and my husband, parents and in-
provide more for my family, so I laws rallied around and helped
enrolled in the Family Medicine me through this tough period.
Masters Programme (College After 2 months, the dust
Programme). Little did I know settled, my mood improved,
that I would be facing multiple and studying resumed during
challenges before I was finally my maternity leave. I managed
able to achieve my goal. to clear the MCQ in my first
attempt. However, I only
Two months after the course managed to clear the clinicals 2
began, my 1st hurdle presented years later.
itself. I found myself pregnant,
with twins! Preparation needed for the
clinicals were very different
Morning sickness, full time work, attending tutorials and from the MCQ. Lots of practice using sample of clinical
clinical teachings in various hospitals, preparing the course cases during the pockets of time that I had every day were
work, whilst still having to look after a toddler took its very important, with studying done after the children
toll on me. It was all too overwhelming. I wanted to stop had gone to bed. Being focused and organised with good
pursuing this goal but life would just get tougher after time management (especially when life was chaotic!), and
delivery, hence I continued.
(continued on the next page)
THE
College Mirror 25♦
March 2019
INTERVIEW & INVITED ARTICLES VOL 45(1)
(continued from Page 25: The Journey Towards the MMed(FM) & Fellowship)
being able to multitask was the way to success. Constant life, help from colleagues with similar experiences would be
encouragement and support from peers and family were useful. I have reached my goal and the journey has not only
invaluable when having so many stresses in life, and with improved my medical knowledge but also taught me crucial
having experienced failure twice.The programme by CFPS is coping and management skills in stressful situations.
a guideline, but for candidates who has multiple stresses in
to endeavor. In addition to one’s own sphere of
Dr Xu Bangyu : rney -
clinical experience and practice, there
are various platforms of learning one
ou
The Fellowship J the has to undergo as well. These includes
ome
Blossoming to bec
didactic lectures, small group discussions,
"Iron Flower"
workshops and seminars.
Doing a systematic review and conducting
a research project is one of the most alien
College Mirror (CM): experience for myself due to my lack of
Congratulations on your examination experience in this field and not forgetting
success. What have you learnt or the alien language of statistical analysis!
benefitted from completing the
Fellowship training? Yet somehow I managed to pull through this
Dr Xu Bangyu (XBY): arduous journey. I would not have achieved
The completion of the Fellowship programme has this without the support of many people: my
broadened my roles as a Family Physician. The programme wife and daughter, my fellowship comrades, my workplace
is designed to prepare the trainee to embrace the following bosses especially Dr Luke Low, my various supervisors
essential roles of a Family Physician: Family Medicine Expert, and many more. Most importantly, the resilience inside me
Communicator, Collaborator, Manager, Health advocate, never faltered: once a goal is set, keep moving forward and
Scholar and Professional. Indeed as one progresses through never stop until you reach the goal, no matter how tough
the programme, the dormant seeds of these roles slowly the journey will be.
start to germinate and eventually blossom to become the
“Iron Flower”. CM:
Can you share some advice for the new trainees?
CM: XBY:
What were the challenges you faced in the examination The need to build resilience for this journey. This journey
preparations? How did you overcome them? will be tough with many obstacles to overcome, self-
XBY: sacrifices and moments where one would feel like throwing
Notice that I used the term “Iron Flower” to describe the in the towel. One who keeps moving forward and never
outcome.The Fellowship programme is definitely not a walk- stop until one reaches the goal will be the one to blossom
in-park experience, in contrary to what many would think. into the “Iron Flower”.
This journey has many on-going parallel routes that one has CM
Use of codeine-containing
cough medications in children
by Adj Asst Prof Tan Tze Lee, President, 26th Council, College of Family Physicians Singapore
A/Prof Ng Kee Chong, College of Paediatrics and Child Health, Singapore
Over the years, we have had instances of young children In general, cough and cold preparations have not been shown
being prescribed codeine-containing cough mixtures. One to be efficacious for its intended use and side effects have
case hit the news in 2017, when a 14-month-old child was occurred, especially for the very young. In October 2007,
alleged dispensed Fedac syrup, with instructions to take the Singapore Health Sciences Authority (HSA) in its letter
10ml of the medicine three times a day. to healthcare professionals made interim recommendations
to restrict the use of these products in those below 2 years
of age.
THE
♦ 26 College Mirror
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