This was an elective at the Department of Neurosurgery at Hospital Kuala Lumpur (HKL), Malaysia. This hospital was a main tertiary referral centre for neurosurgical cases in the Klang Valley with a large catchment area. There are 123 beds allocated for neurosurgical cases for adults and paediatrics, as well as neurointensive care units and high dependency units.
During my placement, I had the opportunity to get involved in ward rounds, outpatient clinics and theatre sessions. A typical day will start with a handover meeting at 8:00am to review patients who were admitted the night before and discuss cases that are scheduled for surgery on the day. This session is particularly useful for medical students and junior trainees as the senior registrars will usually be presenting and summarizing cases, which are reviewed by the consultants. Patient managements including medical and surgical approaches area also discussed during the session. Ward rounds will commence at around 9:30am, which are conducted by different consultants who are in charge of different wards. As in the UK, the trainees (registrars) will be presenting the cases to the consultants. Outpatient clinics are run by trainees and supervised by consultants. There are different sub-specialties of clinics on different days such as vascular, spine, tumours, and paediatrics. The clinics provide an excellent learning opportunity for medical students due to the large number of patients with varieties of cases with up to 80 appointments scheduled every day. HKL has 3 large operating theatres. Nevertheless, due to the lack of funding, the surgical facilities are not as advanced compared with developed countries, with limited access to image-guided surgeries and robotic surgeries. However, the facilitites are expected to be available in 2021.
I have found the theatre session very interesting if we make the most out of it. As medical students, we had the opportunity to take a history from patients who are scheduled for their surgeries, get involved in the theatre session, and monitor their progress afterwards. During my attachment, I had the chance to take a history and follow-up a patient with a huge tentorial meningioma measuring 6 x 7 x7cm. Due to the large size of the tumour with infra- and supra-tentorial extension, the surgery took about 13hours. Despite the long hours, the consultants and trainees were keen to teach on the technical aspect of the procedures while operating on the patient. Furthermore, I was also given the opportunity to write a case report on this case with regards to the surgical techniques and approach.
By the end of the placement, I have developed an appreciation on the clinical aspects of neurosurgical management of patients in a developing country. This placement is excellent not only to provide an insight for medical students who are interested in neurosurgery, but also for those who are interested in complex neurosurgical cases.
Due to time constraint, I only had the opportunity to write a simple case report. There is always an opportunity available for medical students for those who are keen to conduct a research if they express their interest to the consultants. However, conducting an audit will be quite challenging as most patients’ data are on hard-copy.
HKL is situated in the heart of Kuala Lumpur. Night-life is amazing with prime areas located just within walking distance. As Kuala Lumpur is the capital of Malaysia, it is also quite convenient for travelers to visit other countries, as most major cities in South-East Asia are accessible via Kuala Lumpur Airport.
Any other comments?
There are varieties of cases that can been seen in the Neurosurgery Department in HKL. However, to get the most out of your placement, it is best if students approach an individual consultant and follow him along during his/her clinics sand theatre sessions.