For the rejects

I went to a hospital open house yesterday that could rival the likes of St Vincent's. I was very impressed with their thorough and well-thought out residency program and commitment to having no-calls for residents! A resident is a medical officer who has been accepted into a training program. I do wonder if non-trainee medical officers get the same privilege. I was also surprised that fresh graduates could apply straight into residency - their housemanship year therefore would be considered one training year hence reducing the number of years they have to spend in training. I am glad a third medical school will be opening soon which will be linked to Imperial College. No longer can YLL graduates claim exclusive rights to being a local graduate doctor and all the pomp that goes with it. This article came at the right time, as do all things.

Rejection and Decisions by Dr Chong Yeh Woei

My son recently received a rejection letter for his application to the local undergraduate medical school, the Yong Loo Lin School of Medicine (YLLSoM). It was a tough pill for him and his parents to swallow. This was made worse as he had done very well in his International Baccalaureate exam and also completed several clinical attachments. I had to deal with the fallout from the situation and helped my son get through this setback. As for my wife, the thought of him going away for five to six years abroad to study Medicine gave her separation anxiety. I guess we had to endure the disappointment along with the 500 odd families who have the same experience on an annual basis. At least we have the means to send him abroad; quite a number of these families do not have this luxury.

This situation I was experiencing was juxtaposed with the graduation ceremony that I was invited to attend at the Duke- NUS Graduate Medical School recently. The pioneer batch of 24 students was graduating, and there were huge smiles all round, with proud parents, spouses and even children beaming away. I was told at the graduating dinner that during the graduating class’s gruelling four years of studying to become a doctor, there had been six marriages consummated and four babies welcomed. I had also been fortunate to be invited to be an examiner in their final exam. From their performance, I could see that there were great differences in going to medical school as an undergraduate and as a postgraduate student. That begs me to think whether Medicine is actually better appreciated as a postgraduate degree as opposed to our current system. The Americans have long stuck to this view and the Australians are slowly coming round as well.

In the midst of all these contrasting events, I started thinking about our motivations for studying Medicine. I do recall that when I made my decision back then in my late teens, I was following the herd instinct of those who had done well for their “A” Levels. I was also attracted by the idea that I could defer my National Service obligations and go straight to varsity. Now, looking back on my career, I have no doubts that I have chosen the right path. I did not have the luxury then of going abroad if I did not get a place, so I would have chosen some other path. I still remember the late Dean, Prof Wong Poi Kong’s parting words to me at my medical school interview. There had been some robust to and fro, and he told me that if I did get into medical school, I would have to change some of my views! I took that to mean I had failed the interview, and went home to start looking at the brochures for my second choice of Chemical Engineering!

I also remember that at that time, there was a deliberate policy to shunt good students away from Medicine to other fields such as Law. I believe one of the recently elected Members of Parliament for Aljunied Group Representative Constituency was a casualty of that policy. Again fate or karma would have had it that his rejection by medical school might not have been a bad thing!

I guess, in an emotional sense, rejection does put down a bright student who has achieved what he was told and tasked to do. In the end the prize he was aiming for was not awarded to him, and while he did his best, that apparently was not good enough. In a meritocracy, that does create quite a few problems as it seems to undermine the very foundations of the system. In our academic system where marks and scores are everything, admission to medical school is not based on grades alone. Perhaps that is why the YLLSoM administration does have some tough decisions and situations on its hands. On top of external audits, it faces pressures from parents for all manner of justifications, clarity and transparency for its decision-making process. I can imagine calls ranging from audiotaping or videotaping interviews to having the Dean or Vice Deans personally conducting all interviews.

As for motivations for studying Medicine, I think that as a teen, one may not have too many ideas about doing Medicine as a career. Some may think it glamorous, some may find it intellectually challenging, some may have been influenced by their family doctor or a relative in the same profession, and yet others might have developed a rose-tinted vision from watching medical soap operas.

I think that Medicine is fundamentally egalitarian, even doctors who are President’s Scholars are treated no differently by their colleagues in housemanship or in the early years of practice. I find the idea that Medicine is a great way for the lower socioeconomic classes to be upwardly mobile to be very attractive. The students who come from the bottom 20% of our socioeconomic strata and have benefited from the SMA Medical Students’ Assistance Fund have certainly impressed me.

To come back to my son, he will have to serve out his National Service and decide at the end of the day where he wishes to go for his medical studies. He will have to choose between an undergraduate programme or a postgraduate one. Of course, both options have their own merits. These days, quite a few of the postgraduate chools also bundle a basic degree with a postgraduate medical degree. He may yet have the option of staying in Singapore by applying to the upcoming Lee Kong Chian School of Medicine at the Nanyang Technological University. He will have to decide and as his parents, we must give him our fullest support.

Whatever the outcome, I believe his heart is still with Singapore, and despite their global exposure, our boys and girls doing Medicine out there in the Americas, Europe and Australasia will certainly look forward to coming home to serve the public and our patients in our finest healthcare institutions.