1. 1 skill learnt
   • How to listen to the different heart sounds
     1. Our heart beat is 2 sounds the first softer one then the louder one, occurring at regular intervals. It sounds a bit like “lub-Dub lub-Dub”.
     2. The first sound is the sound of the tricuspid and mitral valves closing
     3. The second sound is the sound of the aortic and pulmonary valves closing
     4. When doctors listen to heart sounds they first need to locate the four heart valves, the pulmonary and aortic valves are usually located around the second intercostal space between the ribs. The pulmonary valve is located on the left of the sternum and the aortic valve is found to the right of the sternum
     5. The tricuspid valve is found at the fourth intercostal space to the left of the sternum. You can best hear tricuspid valve and right heart sounds in this area.
     6. The mitral valve is located at the fifth intercostal space in the midclavicular line. It’s easiest to hear mitral valve and left heart sounds in this area
     7. It is important to listen to the different heart valves as heart murmurs or unusual sounds between heartbeats caused by irregular blood flow. As heart murmurs can occur in different valves hence one may be unable to hear the murmur clearly or at all if they place a stethoscope in the general area of the heart

1. 2 interesting aspects of your learning
   • Getting to tour the hospital
     1. As our group was attached to Dr Endean and several medical students, we got to see many things that visitors and even most patients would not be able to see. For the first day we toured the emergency department and learned about certain architectural features of the hospital built to support the emergency department. For example the section of the emergency department dedicated to respiratory disease is located in an open air area to reduce the risk of hospital acquired infections from developing.
     2. We also visited the national center for infectious diseases and the lecture theatres and classrooms in the annex buildings near TTSH.
     3. We also got to attend weekly teachings conducted by different Medical officers and consultants for the doctors in TTSH. While we did not understand all that was taught, we did learn a lot about how doctors choose to give patients certain treatments and that even doctors never stop learning despite knowing so much about the medical field already.
   • Talk to overseas medical students about the different medical systems and work culture
     1. We were working alongside several medical students from Ireland and Australia as well as a student from NUS. We also met a nurse in training from China. As we watched them present cases and interact with patients we noticed a few differences in how they approached certain things.
     2. The local student who was a final year student was very knowledgeable. She would ask many advanced questions and seemed to already have the knowledge to become and execute house officer duties despite not having passed her final year exams yet.
     3. In comparison the overseas students tended to ask less questions and their questions to Dr Endean were less specific as technically advanced. Despite this, they tended to be more comfortable when interacting with patients such as taking down their histories.
     4. The overseas medical students also explained the different styles of case presentations. When presenting to Dr Endean, they would state their diagnosis first then bring up the evidence that shows why they came to this diagnosis. However in Ireland, the senior doctors prefer to not know the diagnosis till the end of the presentation so that they can follow the doctors thought process. This allows them to draw their own conclusion then compare it with the other doctors diagnosis.
     5. According to Dr Endean, Singaprorean medical students are able to do house officer duties while still in medical school and have vast technical knowledge compared to overseas students. However, overseas students tend to have better communication skills with the patients.

1. 1 takeaway for life

Throughout this attachment Ilearned that being a doctor is a relatively thankless job. Especially if one is not a specialist, we tend to not appreciate our doctors as much as we should. Healthcare professionals often work long hours and are expected to come back to the hospital when on call, even on public holidays. Being a doctor is actually a very difficult and challenging job with a lot of responsibility. One mistake could have fatal consequences. Hence, after the first few days, I was wondering why so many people would be willing to work in such a gruelling job. However, as our group spent more time with our mentor, Dr Endean, we were surprised by his seemingly endless energy and enthusiasm to help his patients. Dr Endean often goes above and beyond for not only his patients but his students as well. When we talk to him about healthcare, his depth of knowledge and his ability to simplify complicated medical concepts was very impressive.

If there was one thing to learn while watching Dr Endean was that you should do things you are passionate about. While being a doctor may be very tiring, Dr Endean is always enthusiastic because he loves his job. People should allow passion to drive them in their work as it makes the person working happier and lets them fulfill their calling. Additionally, when someone lets passion drive them, they tend to be more energetic and more open to taking initiative. Thus the main takeaway for life was that it is okay to let your passion be your job as it lets you enjoy your job even more.