Issue 7 – Volume 2 – March 2017
by Jonathan Tan
Motivation and early beginnings
Since my high school days in Malaysia, I was keen on a becoming a doctor. My Christian belief was a strong driving force in selecting an altruistic career to help and make a difference in people’s lives. Having an AUSAid scholarship to study medicine in Australia cemented my pathway to reaching my goals.
Working in developing nations
[The AUSAid Scholarship] is now called the Australian Awards scholarship and it provide opportunities for students from developing countries, particularly those countries located in the Indo-Pacific region, to undertake full time undergraduate or postgraduate studies at participating Australian universities and Technical and Further Education (TAFE) institutions. The scholarship in my time was solely based on grades and the tuition was paid by the Australian government. I got the scholarship even before matriculating into an Australian medical university and it really took the pressure of payment and studying overseas off my family. The only condition of this scholarship was that I had to leave Australia immediately after I graduated to return to my home country and work for 2 years.
Making Australia home
I found Australians very friendly and enjoyed my time in college. First year university was difficult as the teaching style was different as compared to Malaysia. I was used to being provided information and rote learning in school, so it was difficult because the university embarked on a problem-based learning system that year with truncated lecture hours. Students had to go and look for the information themselves, and that was hard in my first year, especially with unfamiliar jargon and concepts, and selecting which books or articles to read and learn. It was tough but you have to be adaptable, especially in medicine.
The call of surgery
Back then [my medical degree] was a 6 year MBBS program and I really enjoyed my time as medical student in general. But I really found surgery most to my liking. I loved being in theatre and surgery gave me the opportunity for hands on experience. The systematic structure and approach to diagnoses and management was something that I particularly enjoyed. It is just one of those specialities where you can deal with a disease process definitively and quickly, and patients were grateful for what you had done.
Of course I didn’t know which area of surgery I wanted to go into. So when I graduated, I went back to Malaysia to do my internship. I was assigned to Seremban General Hospital, a 900 bed hospital with all specialities, and it was really good because we stayed on site and the high volume of patients really gave me a lot of practical and clinical experience. After that I moved to a Selayang Hospital and worked in the hepatobiliary unit. I always knew I wanted to come back to Australia but I had to fulfil the terms and conditions of the scholarship.
Experience helps when choosing a specialty
Select a speciality that you are interested in.
Working in a developing country gives you insight into how surgery is practised with limited resources, and provides plenty of hands on experience. You will get to see things you wouldn’t normally see in a first world country. However, what you learn or experience in a third world country may not be applicable when you come back to Australia. Going to pioneer centres in first world countries to do surgical programs exposes you to the latest surgical techniques and ground-breaking research. However, you would need to be fairly proactive and well read, to be able to fit into the intense work environment and make a lasting impression.
There will always be pros and cons to where you go and what you do. I personally went to Fiji during my own exchange, which was funded by a Commonwealth Medical Electives bursary. So look out for these things and take the opportunity to travel!
The challenges of surgical training problems
[The barriers...] having children? Haha. I’m just joking. I came back to Australia in 2002 and got into basic surgical training in Perth in 2003. The application process was fairly easy, but the challenges I faced were having my first child and studying for the Part 1 examinations. I remember memorising thousands of anatomy, pathology and physiology facts, some of them seemed quite irrelevant, e.g., What is the molecular weight of some obscure glycopeptide (answer = 30 kDa); and, Where does the 9th nerve run in the jugular foramen, medial or lateral to the 10th nerve? Even my anatomy professor did not know the answer to that one, and we decided that the exam was more a test of endurance, perseverance and discipline (very important traits for a surgeon) than knowledge.
During my basic surgical training, I actually wanted to do plastics as my specialty. But it all changed when I got a urology service registrar rotation instead of plastics. I fell in love with the field, it’s one of those surgical specialities that allow you to see a wide range of pathology and incorporated laparoscopic, open, reconstructive and endoscopic surgical skills. The specialty seemed family friendly with few acute emergencies apart from testicular torsion or infected obstructed kidneys which involved quick operations.
Applying for advance training was quite different. You had to present yourself well and know how to “play the game”. Every candidate applying for advanced surgical training was comparable on paper so you had to stand out from the crowd. I spent a lot of time preparing for the interview process, and that paid off when I got offered places in general, paediatric and urological surgery. I did not expect that and found it hard to decide which one to do. I certainly preferred the sterile urinary tract to the smelly intestinal tract, there are always some things you just know when picking your specialty! I really liked working with children and was drawn to the challenge of dealing with congenital malformations with paediatric surgery, but ultimately, I picked urology because I had enjoyed it so much as a junior doctor, and it would be difficult to move interstate every year for paediatric surgery training with my husband studying in UWA and school aged children.
Advance surgical training was exciting and demanding. There was a lot to learn and many skills to acquire. I had to manage the ward, emergency referrals, consults, theatre bookings, learn to operate proficiently and do 1 in 5 on call covering Royal Perth, Sir Charles Gairdner and Fremantle Hospitals. I would spend entire weekends driving between these hospitals, dealing with acute problems and operating. But the intense training and hours really helped me to hone my skills and experience. The Part 2 exams were the biggest challenge of all. The preparation involved weekly tutorials, learning everything about a specialty in great detail and countless mock viva sessions over 3 years. This is the one exam that really defines you and what will happen to you in the future. Thank God I cleared that in 2009, it was one of the best feelings in the world. I did a year of Paediatric Urology at Princess Margaret Hospital, then completed 18 months with the Royal Adelaide hospital to finish my fellowship in 2012 before coming back to Perth to set up private practice in Mt Hawthorn and acquiring a public appointment at Sir Charles Gairdner Hospital.
The consultant life
To be quite honest, being a first year consultant had its challenges too. I had to learn how to run a business, and accept full responsibility for patient care without a direct safety net and support base. Thankfully the training program in Australia prepared me very well to face the clinical challenges and I was blessed to have strong support from my senior colleagues for complex cases. One bit of advice I would offer is to take the opportunity to do post-fellowship training in a world recognised,high volume centre overseas for a year or two because it is where you will consolidate your experience, knowledge and define your surgical practice.
Life outside surgery
Well I was quite lucky in the sense that I didn’t experience the same kind of perceived bullying that other surgical trainees experienced during my time. I found Western Australia a really good place for training compared to the Eastern states which can be more competitive and stressful. Female urologists are the minority, we were 3 of 18 nationally in my training cohort, and there are currently 7 of 40 urologists in the state of WA. We were selected and treated the same as everyone else and that is how it should be.Having my children during my surgical training was something I struggled with. But there really isn’t a “perfect time” to have children.
Having children early meant dividing my time between surgical training and children. If I had chosen to have children later like most of my colleagues, it would mean having to look after young children when you are older whilst trying to establish your career. I remember taking 8 weeks off when I had my 2nd child and then it was back to work!
I think another issue was watching my non-medical friends around me rise in their respective careers, while I still had to go through a tough training process and study for exams. I felt like I was still struggling financially, socially and professionally compared to everyone else and as I mentioned before, it was that one exam that would determine if all my efforts over the past 10 years were worth it. But once you pass that exam, you quickly make up for lost time!
Have you ever had a moment of hesitation?
Moment of hesitation? Haha.. I can’t really remembered one at this point. But I can say this though. I really like the human aspect of caring for someone and to me, it is my privilege to provide that care. Patients tell you things that they may never tell their closest friends or family members. Surgery really provides the hands on experience and tangible aspect of making a difference. Patients put their complete trust in you, and I hope that as future doctors/surgeons, you never forget or abuse that trust. Always treat your patient like you are the first doctor they have met. When you provide treatment, always ask yourself, if you were the patient, would you allow the surgeon to do the same thing for you? Would you take a short cuts or go the extra mile if it was your life at stake?
Defining moments in surgery
For surgery, I was and am passionate about being in theatre and using hand-eye skills to achieve definitive results. I love the variety in urological surgery, the wide range of skills used and diseases that I manage. I have a strong conviction that it is where I am supposed to be and that continues to be affirmed daily.
Personal faith and medicine
There are many times when it’s not easy, especially in surgery. It is one of those specialities that, if you are not being challenged, perhaps you are not doing enough. Having that faith in God is believing that you have done your best despite feeling like it wasn’t enough, and helps to put things in the right perspective. In difficult times, having faith is also the feeling of Someone having your back.
Typical schedule
My schedule changes from day to day, but usually involves half a day of consulting and half a day of operating. A typical day would be something like this: dragging my feet to personal training at 5 am, working with my children or taking them to lessons or school between 6-8am, attending fortnightly multidisciplinary meetings at 7:30 am, doing post-operative ward rounds in various hospitals, consulting from 9- 12:30 pm, operating from 1-5:30 pm, sorting out paperwork and attending to at least 30 phone calls and e-mails in between, then doing more stuff with the kids until 9pm, catching up on letters and billings after that and hoping I don’t get called into hospital for a sick patient. I do one in three on call for Sir Charles Gairdner Hospital, and am on call 24/7 for my private patients. Unfortunately, most surgeons are workaholics and my typical day reflects that.
Robotics and the future of surgery
Robotic surgery was introduced to the world in 2004, and to Western Australia in 2009. In robotic surgery, you get 3D vision with depth perception with the console and it provides added dexterity by providing wristed articulation in a confined space like the pelvis as compared to laparoscopic or open procedures. It also removes tremor by applying what is known as 3-5:1 scaled movement, where the operator moves the handpiece 3-5 cm for the robotic arm to move 1 cm, thereby providing a steadier and accurate movement. Personally, it is ergonomical because l am sitting down and my neck, back and arms are relaxed, decreasing the likelihood of muscle fatigue, spasm and arthritis. Studies have also shown that it provides better post-operative recovery for patients by reducing bleeding risk, hospital stay and better surgical outcomes.
Dr Ooi’s advice to medical students
Try to get some research which can be accredited for application to surgical training done and published. This will help boost your CV and relieve the pressure of having to complete a lot of studies just before applying, bearing in mind the submission and approval process for a journal may take up to 3-6 months. However as I mentioned earlier, it is really the interview and referee reports that will determine if you get into the training program. Getting into good surgical rotations when you graduate and working with surgeons who are good role models is important. I’m not entirely sure that networking at a student level is that important because politics and people holding positions of influence often change but having a good surgical mentor is useful. Personally, I won’t mind taking on mentees as well but like all other specialists, time my biggest enemy and constraint.
More importantly, I think you have to be sure of why you want to do surgery. I think you have to want it so badly that you can’t imagine doing anything else. You’ve got to love and want to be in the theatre doing stuff. This is one of the strongest factors that will get you into and through the surgical training program. Doctors can make up to 100 life changing decisions a day, even more so for surgeons. You have to be prepared, willing and ready to embark on this incredible journey that promises plenty of ups and down, joys and tears, rewards and punishment!
A brief biography of Dr Ooi
Dr Ooi is a consultant urologist at Swan Urology, Mt Hawthorn, Sir Charles Gairdner Hospital, Osborne Park Hospital, Hollywood Private Hospital, St John of God Hospital, Subiaco and Mount Lawley, Glengarry Private Hospital and Mount Hospital.
She obtained her MBBS from the University of Adelaide, undertook basic and advanced surgical training in Western Australia, and is a fellow of the Royal Australasian College of Surgeons and Society of Robotic Surgery. Her previous appointments include
Paediatric Urology Fellow at Princess Margaret Hospital and Robotic Surgery and Oncology Fellow at Royal Adelaide Hospital. Her sub-specialty interests are robotic prostatectomy, laparoscopic pyeloplasty, prostate brachytherapy and minimally invasive surgery for urinary tract stones, voiding dysfunction and overactive bladder.
Dr Ooi is an instructor on the Emergency Management of Severe Trauma (EMST) course, Cutting Edge: Essential Surgical Skills course, Core Skills: Intermediate Laparoscopic Skills Workshop and URGE Active Learning Module Workshop for general practitioners.
She is a mother of two and her interests include playing in Vivo Music (a flute, violin and piano chamber music ensemble), hiking, tennis, participating in church activities and medical mission work.
Jonathan Tan is a third year MD student. He likes hands on work and is hoping to perform surgery sometime in future.
