To cure sometimes, to treat often, and to comfort always. A known quote from the late Hippocrates states that we should always comfort our patients no matter what. In medicine, gaining diverse clinical experiences is a pivotal step to becoming an aspiring doctor. To fulfill these needs, the Faculty of Medicine, Universitas Airlangga, offers an innovative elective program that allows students to select clinical or non-clinical fields of interest, whether inside or abroad country. This year, I had the privilege of participating in the elective program at Universiti Kebangsaan Malaysia, where I explored two departments: Pediatrics and Emergency Medicine. These experiences enhanced my clinical skills and deepened my understanding of patient care across different specialties. Working in Pediatrics and Emergency Medicine presented unique challenges and opportunities to sharpen critical reasoning and problem-solving abilities. Each rotation offered invaluable insights from the delicate, patient-centered care in pediatrics to the fast-paced, high-stakes emergency medicine environment. Together, these experiences honed my ability to make informed decisions under pressure, adapt to diverse medical scenarios, and develop a well-rounded approach to patient management.
The first two weeks in Malaysia started with the Pediatrics Department. Located at Hospital Pakar Kanak-Kanak HCTM, Kuala Lumpur, it is a first-of-its-kind hospital in Malaysia specializing in and focusing on pediatric care. My rotation in this field allowed me to dive into children's healthcare, which emphasizes a holistic approach, family, and children-centered care. Pediatrics teaches how to accurately diagnose and approach with compassion and empathy, including the well-being of the child and their family, which became central to treatment. From understanding developmental milestones seen in children to managing acute illness, I gained a deeper understanding and appreciation for the unique challenges and joys of treating young patients.
On a routine basis, I would start my morning wards at 07.30 AM, observing and noting new cases, updates on old cases, and discussing with the doctors the differentials and plans for that patient. Our team will have clinic rotations at the Child Development Center (CDC) on Mondays, Wednesdays, and Thursdays. This CDC is the first CDC of its kind in Malaysia. The scope of the CDC is for the assessment, diagnosis, and intervention of children with special needs and neurodevelopmental issues. Subspecialty training for Developmental Pediatrics was initiated in this CDC, enabling the establishment of more CDCs nationwide. I observed and discussed various cases in the clinic with the attending doctors. We reviewed and took the patients' medical histories and discussed their symptoms, diagnoses, and treatment options in detail. It was mostly a rapport interaction between the children's parents and the doctor to learn more about the kid's issues. In the meantime, the nurses would conduct a schedule of growing skills II (SGS-II) assessment for the kid to note all four domains of development: gross motor, cognitive, speech and language, and social-emotional. Growth charts are also vital to ensure the baby is growing adequately. By interpreting growth charts during wellness visits, I understood how to identify subtle signs of malnutrition or developmental delays. This required correlating historical data with clinical findings, emphasizing the value of critical analysis. One unique healthcare system in Malaysia that differs in Indonesia is that you cannot see a specialist unless the medical doctor thinks you need to. If required, the case will be discussed with a specialist to determine further plans, or the specialist will see the children in person. I actively debated with other doctors and specialists when they were referred for each case. Other than that, I also participated in the SGS-II assessment with other nurses to assess the kids. I also interacted with the parents, listened to their concerns, and explained their children's condition. This experience enhanced my communication skills and deepened my understanding of approaching pediatric patients and their families.
Morning rounds by specialists involved going around pediatric wards to review, follow-up cases, and discuss treatment plans for each patient assigned to the specialist's team. Many common diseases involve wheezing, prolonged jaundice, and congenital or malignancy. I am lucky enough to be able to engage with the supervising pediatrician to discuss the diagnostic approach and mindset of "how to think like a pediatrician" to deepen my understanding of systematic, clinical reasoning. Balancing empathy with evidence-based care is crucial in pediatrics since the parents get involved. I witnessed doctors reassure parents about fever management in children, break the "bad news" of chronic illness, and educate the parents about disease management. It taught me the importance of merging compassion with evidence when counseling families.
My elective clinical rotation in the Emergency Department has been an inspiring and eye-opening experience for first-hand exposure to hospital life. This experience brought my understanding of the theories I studied in my pre-clinical years to be applied and tested my critical thinking skills when facing the real deal. Each day brought new challenges, allowing me to immerse myself in daily clinical and life-threatening situations to deepen my understanding of emergency medicine. My mornings always started around 8 AM, and I would finish mostly at 3--4 PM, even a few times I finished at 8 PM. One of the first skills I practiced extensively after learning the theories deeply was interpreting electrocardiograms (ECGs). Under supervision, I conducted ECGs for multiple patients, including one with palpitations and chest pain and another with an irregular heart rhythm. Analyzing the results from the sinus until finding abnormalities in the QRS and coronary artery allowed me to identify critical features like atrial fibrillation, ST-elevation myocardial infarction (STEMI), bundle branch blocks, and many other ECG findings. Each case provided a deeper understanding of how immediate clinical decisions hinge on these findings.
Trauma patient management was another pivotal aspect of my learning. I was directly involved in assessing and stabilizing a patient involved in a motorcycle accident. My tasks included assisting with a log roll to check for spinal injuries and performing a physical examination to identify fractures and internal bleeding. Additionally, I observed the use of imaging modalities like focused assessment with sonography for trauma (FAST) to detect free fluid in the abdomen, enhancing my understanding of diagnostic adjuncts in trauma care. Another case involved a 25-year-old construction worker who sustained a crush injury to his foot, where I assisted in wound cleaning and dressing while discussing compartment syndrome risks with the attending physician.
One of the most challenging yet rewarding experiences was managing critically ill patients. During my time in the ED, I observed and participated in several cardiopulmonary resuscitations (CPRs). In one notable case, a 58-year-old patient presented with hemoptysis and type 2 respiratory distress and was placed on BiPAP, later progressing to tachycardia, ventricular tachycardia (VT), ventricular fibrillation (VFib), and asystole. I performed CPR for the first time during the resuscitation effort and witnessed the importance of teamwork and adherence to protocols. Despite the outcome, the case reinforced the need for emotional resilience and precise execution in life-threatening situations.
Medical cases also presented opportunities for thorough history-taking and differential diagnosis formulation. For instance, I took a detailed history from a hypertensive emergency patient with a blood pressure of 190/100. I observed their treatment, which included discussing the IV antihypertensives that will be used and close monitoring for end-organ damage. Another case involved a 60-year-old with chronic hepatitis B and hepatocellular carcinoma presenting with severe anemia (hemoglobin 3.7). I contributed to discussions on the management plan, which included transfusions, antibiotics for suspected peritonitis, and diuretic adjustments for ascites. These cases emphasized the complexity of managing chronic diseases in acute settings.
Furthermore, I gained hands-on experience with venipuncture, administering intravenous fluids, peritoneal tapping, and managing fluid therapy. In one case, I calculated fluid requirements for a dehydrated child with gastroenteritis, ensuring appropriate maintenance and resuscitation fluid rates. For an elderly patient with septic shock, I observed the administration of crystalloids and discussed the rationale for transitioning to vasopressors when fluid resuscitation alone was insufficient. Such cases highlighted the critical balance between addressing immediate needs and monitoring for complications like fluid overload. I have done many venipunctures to take blood samples to be sent to the lab and run for arterial blood gas (ABG) analysis and be able to interpret the acid-base results and whether there is compensation or not. In peritoneal tapping, I assisted twice in inserting the catheter needle to release the fluid, performing antiseptic procedures, and fixing the needle in place.
I encountered a variety of respiratory cases, from chronic obstructive pulmonary disease (COPD) exacerbations to asthma attacks. These cases made me understand more about the management of each of the types of respiratory distress and also management in cases of acute, subacute, and chronic compensation of each acid-base disorder. I learned to perform a cranial nerve examination on a suspected stroke patient and observed non-invasive ventilation setups, distinguishing between CPAP and BiPAP based on clinical scenarios. Another memorable case involved a young female adult with suspected tuberculosis (TB), where I discussed differential diagnoses with the doctor specialist, including malignancy, and observed the initiation of empirical treatment while awaiting biopsy results.
In addition to patient interactions, I actively participated in continuing medical education (CME) sessions, which deepened my theoretical understanding. A session on diabetic ketoacidosis (DKA) explained its pathophysiology and reinforced the importance of managing electrolyte imbalances and acidosis. Another session is about stroke ischemia and also acute abdomen. The department also prepared an introduction from pre-hospital care that introduced me to ambulance transfer protocols, portable monitors, and effective communication between paramedics and ED Staff.
