Associate Consultant in Orthopaedic Surgery, Dr Toh Rui Xiang, reflects on his 10 years of medical training and shares how he survived his grueling Residency years.

As a young medical student, I fractured my ankle badly in a rugby match. While it was painful, I was more frustrated that my mobility and function had evaporated overnight. After a successful surgery, I was amazed at my ability to return to hiking and trekking six months later. The gratification of restoring anatomy and ability was too great for me to resist, and that was when I first fell in love with Orthopaedics.

After 10 years of training, including six years as a Resident, I finally completed residency in late 2022 to embark on my dream career in Orthopaedic surgery, with an interest in foot and ankle conditions.

As a second-year Associate Consultant, I juggle my time seeing patients in clinics, or those admitted via the Emergency Department, and managing them peri-operatively in the operating theatres and wards. I see a nice mix of elective cases such as bunions, joint arthritis, ligament tears, and emergency cases such as fractures and infections.

The wonderful thing about my department and practice is that I can focus on my interest in foot and ankle surgery while still doing general Orthopaedics work in other areas, such as the shoulder, elbow, hip and knee. It is a challenge switching gears and managing the different types of injuries in different areas, but at the same time I find it very complementary in that techniques in one area can be adapted to suit others.

Amidst all this excitement, in late 2023 I was asked to give a 10-minute talk on my transition from Resident to Associate Consultant to fellow doctors. I have condensed my thoughts from that talk into six tips for surviving Residency:

Hone your decision-making skills

If I were to turn back time, my first priority would have been to focus a little bit less on the actual surgical skills and more on decision making. I say this because whenever I am faced with a complicated surgery that I have not done before, it is very easy to call a friend in the department to discuss the technique.

However, if I am alone in the clinic and faced with a complex case, and I am not quite sure how to proceed, it is not as easy to call a colleague in to assess the patient with me. I often fall back on giving the patient many options – 'You can do A; you can do B; you can do C; and it's up to you' - which I consider very poor form.

I think this fall back of dumping information and choices on a patient is a bit more obvious in Orthopaedics where there are many ways to approach a surgery. So during training, if you were to focus more on how your seniors make decisions, and deal with certain conditions - the first principles - it would serve you well when you counsel your patients in the future. So that is probably my biggest takeaway if I had the power of hindsight while training.

Make many friends

Of course, make many friends. When we are Medical Officers and Registrars we are understandably stressed. We are snappy when people call us for urgent referrals so we can be unreasonable, ask for many things, and respond in a less than ideal way. But these things come back to haunt you. As an Associate Consultant, you are often sadly the lowest priority in the operating theatre and clinic, and often you are alone with junior help - a junior nurse, a junior anaesthetist who is asking you to speed up. All these things add up when you are an inexperienced surgeon - perhaps doing a particular surgery for the first time and the setting is less than ideal. In such a big department and hospital, every little bit of support and goodwill you get helps. You know, a senior nurse who can tell you what you are missing, an anaesthetist who's willing to stay back a little later for you to take your time, colleagues who are willing to come in and lend an extra pair of hands. A little bit more kindness, a little bit more collegiality will come round one day.

Find a good mentor

A good mentor shows you not just skills and decision making, but also patient interaction, ethics, how they treat the patients on a day-to-day basis, and their demeanor at the bedside in the clinic. I think it goes a long way towards helping you develop into an all-rounded surgeon. Just because you have good technical skills may not be enough to help the patient feel comfortable and at ease with your decisions and management. So find yourself a good mentor who is willing to take the time to speak to you, to guide you even on small things, and not judge you when you have a problem.

Don't neglect your hobbies!

I find having hobbies very important. I love what I do but I also love my time-off to decompress and to take some time to think about how I can be better. Especially in Orthopedics, if you play sports, it is a lot easier to connect with your patients and be on the same wavelength as them. The more you go around doing different things, the more you interact with people of different interests and different demographics, the more you can connect with your patients.

Invest time in your Residency

Even though Residency is quite a high-pressure environment, we sometimes fail to remember that it is only five to six years out of the next 30, 40 years of our professional lives. So it may hurt now but whatever effort you put in is going to serve you for a much longer time. As far as investments come, this is probably the best thing to invest your time in and focus on building your skills, your decision-making, your friendships and your way of practice. It will pay off multi-fold.

No need to be an eager beaver

Eat while you can, sleep while you can. There is always another case out there that you can learn from; there is always another more complex patient coming by; there is always another OT; there is always another clinic. So I would not go out of my way to grab all the interesting and complex cases. When it comes, it comes. If it does not, it does not. Just rest up, build your energy so that you can do your best when a case actually comes your way.

It is easy to get stressed, discouraged or demoralized when a case goes bad. But when the case goes well, it is worth all the effort. So do not lose sight of why you first chose this path. If you look around, there is always a light at the end of the tunnel and always someone to help you reach there. If you enjoy what you do, it will feel like a walk in the park.


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