Clinical Electives Abroad: Cardiology Angioplasty & Stent placement and OBGYN laparoscopic Fibroid Removal clinical observation at UMMC

As an international medical student from Universitas Airlangga, one of Indonesia's leading institutions of higher education, I recently had the privilege of undertaking clinical rotations in the Cardiology and Obstetrics & Gynecology (OBGYN) departments at University Malaya Medical Centre (UMMC) for one month. The duration of the clinical elective was from 10th January to 9th February, 2024. This opportunity has been an eye-opening and enriching experience, providing invaluable insights into two crucial fields of medicine. 

University Malaya Medical Centre/private document

University Malaya (UM), Malaysia's oldest and premier institution of higher learning, was established in 1949. With a rich history of academic excellence and innovation, UM is located in the vibrant city of Kuala Lumpur and offers a diverse and dynamic environment for students from around the world. UM has steadily improved its position in the QS World University Rankings, frequently placing within the top 100 universities worldwide. In recent years, UM has been ranked as the highest Malaysian university on this list. Adjacent to the Faculty of Medicine is the University Malaya Medical Centre (UMMC), a premier teaching hospital and healthcare facility. Established in 1968, UMMC is one of the largest and most comprehensive medical centers in Malaysia. It serves as a vital training ground for medical students, offering a wide range of clinical services and cutting-edge medical care.

Cardiac Unit/private document

I had the esteemed opportunity to complete my clinical rotations for two weeks in the Cardiology Department, part of the Department of Medicine at University Malaya Medical Centre (UMMC) under the mentorship of the Consultant Cardiologist Dr. Samshol Bin Sukhari. During my rotation in the Cardiology Department at University Malaya Medical Centre (UMMC), I had the opportunity to work in various specialized wards and units, each focusing on different aspects of cardiac care and observed a variety of procedures including angiographies and angioplasties for treating coronary artery disease, echocardiograms for assessing heart structure and function, and cardiac stress tests for evaluating cardiac performance under physical exertion. Additionally, I witnessed electrophysiological studies and ablations for diagnosing and treating arrhythmias, as well as the administration of thrombolytic therapy for acute myocardial infarction. Each of these procedures provided invaluable hands-on learning experiences and deepened my understanding of cardiac care.

Coronary Care Unit (CCU)/private document

My first week round was in CCU with my supervisor and his other esteemed colleagues. Coronary Care Unit (CCU) is dedicated to patients with acute coronary syndromes such as myocardial infarction (heart attack) and unstable angina, as well as other critical heart conditions. This unit is equipped with advanced monitoring systems like continuous ECG monitors, defibrillators, and ventilators. Patients are admitted to the CCU for severe cardiac issues requiring intensive monitoring and life-support technologies, such as cardiogenic shock, acute heart failure, and life-threatening arrhythmias. I got to join the ward rounds in Rawatan Akut or Acute Coronary Syndrome (ACS) Ward with the Houseman and the residents along with the consultants in the first week. 

The ward provides immediate and comprehensive care for patients arriving through the emergency department. Conditions commonly treated include myocardial infarction, unstable angina, cardiogenic shock, and life-threatening arrhythmias. The ward utilizes advanced medical technology such as continuous ECG monitors, defibrillators, ventilators, intra-aortic balloon pumps (IABP), and coronary angiography suites. During my rotation, I observed and assisted in critical procedures including emergency angioplasty and stent placement, thrombolytic therapy, and Advanced Cardiac Life Support (ACLS). 

This experience highlighted the importance of rapid assessment and intervention in acute cardiac care. My time in the ACS Ward significantly enhanced my understanding of managing severe cardiac conditions and performing life-saving procedures.There was Cardiac Intensive Care Unit (CICU), which specializes in the intensive care of patients with severe cardiac conditions, including those who have undergone complex cardiac surgeries or are experiencing severe decompensated heart failure. Patients in the CICU require close monitoring and immediate medical interventions due to critical conditions like severe heart failure, post-cardiac surgery complications, and high-risk arrhythmias.  

Cardiology Ward /private document

Cath Lab /private document

Second week was in the Cardiac Catheterization Lab, I observed and assisted in procedures such as angiographies and angioplasties. This lab is equipped with state-of-the-art technology including fluoroscopy machines, angiography suites, and hemodynamic monitoring systems. Conditions treated here include coronary artery disease, where blockages in the coronary arteries are addressed through procedures like stent placements and balloon angioplasty. The lab also handles diagnostic procedures to identify blockages and other structural heart issues. 

Cath Lab /private document

In the lab ( Angiogram ) /private document

In the Lab /private document

Final Angiogram/private document

My visit and observation to the Heart Failure Unit was really insightful. The unit focuses on managing various stages of heart failure, including acute decompensated and chronic heart failure, aiming to optimize medical therapy, educate patients on lifestyle changes, and prepare them for advanced therapies like ventricular assist devices or heart transplants. Common complications managed include fluid overload, renal dysfunction, and refractory symptoms, using equipment like infusion pumps for inotropic agents and non-invasive ventilation devices.

Mechanical Ventilator/private document 

 The last round was in the Outpatient Cardiology Clinics, which manage a wide range of cardiovascular conditions, offering routine check-ups, diagnostic evaluations, and follow-up care for chronic conditions such as hypertension, stable angina, heart failure, and arrhythmias, as well as monitoring post-surgical recovery for procedures like coronary artery bypass grafting (CABG) or valve replacements. Diagnostic tools used in these clinics include electrocardiograms (ECG), Holter monitors, and echocardiography machines. As I conclude my cardiology rotation at University Malaya Medical Centre (UMMC), I reflect on the extensive knowledge and skills I have acquired during this period. Under the expert guidance of Dr. Samshol Sukhari, I had the privilege to engage in a variety of clinical experiences that have profoundly shaped my understanding of cardiovascular medicine.

Library for the Medical Professionals and Students /private document

On the way to Obstetrics & Gynecology Department  /private document

During my clinical rotation for two weeks in the Obstetrics and Gynecology (OBGYN) Department at University Malaya Medical Centre (UMMC) under the supervision of Dr. Rahma Saeed, I was exposed to a broad spectrum of cases, wards, and surgical procedures, enhancing my understanding of this critical medical field. For example- I had the opportunity to assist in and observe the procedure of controlled cord traction (CCT) during normal birth. This procedure is employed to aid in the delivery of the placenta after the birth of the baby, facilitating the third stage of labor and minimizing the risk of postpartum haemorrhage. 

Throughout my rotation, I worked in various specialized wards, each presenting unique learning opportunities. In the antenatal ward, I encountered a variety of conditions such as gestational diabetes, preeclampsia, and preterm labor. I also managed patients with hyperemesis gravidarum, a severe form of morning sickness, and multiple pregnancies, which require meticulous monitoring and care. The postnatal ward provided insights into postpartum hemorrhage, which can be life-threatening if not managed promptly, as well as lactation issues and newborn care, including neonatal jaundice and breastfeeding difficulties. In the gynecology ward, I observed the management of complex cases like ovarian cysts, uterine fibroids, endometriosis, and pelvic inflammatory disease. Additionally, I encountered patients with gynecologic cancers, such as cervical and ovarian cancer, which involved multidisciplinary care approaches.

Obstetrics & Gynecology Department /private document

Under Dr. Rahma Saeed's expert guidance, I had the opportunity to observe and assist in a range of surgical procedures. These included cesarean sections, both elective and emergency, performed for indications such as fetal distress, breech presentation, and placenta previa. I witnessed hysterectomies performed for uterine fibroids, severe endometriosis, and heavy menstrual bleeding unresponsive to medical therapy. Laparoscopic surgeries for ovarian cyst removal, treatment of ectopic pregnancies, and adhesiolysis for pelvic adhesions were also part of my learning experience. Additionally, I observed myomectomies for fibroid removal, which preserve the uterus for future fertility, and endometrial ablations to treat heavy menstrual bleeding. Diagnostic and therapeutic procedures such as hysteroscopies and colposcopies were essential in evaluating and managing various gynecological conditions, including abnormal uterine bleeding, polyps, and precancerous lesions of the cervix. 

Case Presentation /private document

Being in one team for case discussion with the UM Medical Students /private document

Throughout my rotation, I learned about the complications associated with both obstetric and gynecologic conditions. In obstetrics, complications such as preeclampsia can lead to eclampsia, a severe condition characterized by seizures, while gestational diabetes can result in macrosomia, increasing the risk of birth complications. In gynecology, endometriosis can cause severe chronic pain and infertility, while untreated pelvic inflammatory disease can lead to abscess formation and chronic pelvic pain. The OBGYN department's multidisciplinary approach, involving collaboration among obstetricians, gynecologists, nurses, anesthetists, and pediatricians, was crucial in managing these complications effectively and ensuring comprehensive patient care. In conclusion, my rotation in the OBGYN department at UMMC was an enriching and transformative experience. 

Submucosa Fibroid /private document

My clinical electives in cardiology and OBGYN at University Malaya Medical Centre significantly enhanced my clinical skills and broadened my understanding of these vital medical fields. The hands-on experience and exposure to a diverse range of cases under expert supervision deepened my practical knowledge and diagnostic abilities. These electives have equipped me with a solid foundation and confidence to pursue a career in medicine with a holistic, patient-centered approach.

Certification at the End of the Clinical Elective /private document