An Exterior Photograph of the Entrance to Queen Mary Hospital Taken at 11 PM.
doi: http://dx.doi.org/ijms.2024.2495
Volume 12, Number 3: 345-346
Received 22 12 2023; Rev-request 21 05 2024; Rev-recd 05 06 2024; Accepted 14 07 2024
Hong Kong is a coastal city in Southern China and a former British colony, located nearly 10,000 kilometers from my home country of Ireland. It's known by many names, including The Pearl of the Orient and Asia's Finest City. For me, it presented an exceptional learning experience within the field of plastic and reconstructive surgery, as I had the privilege of working with the esteemed team at Queen Mary Hospital, a prestigious institution situated in this vibrant city. Although Cantonese is the primary language spoken in Hong Kong, the doctors speak fluent English, which benefited me as an English-speaking medical student.
Summer elective attachments offer students a fantastic opportunity to gain real-world exposure to specialties of interest without the pressure of exams. Additionally, they demonstrate a student's organisational skills and early interest in a specialty which are valuable assets in future interviews. International electives also facilitate personal growth and cultural enrichment outside of the hospital. I would encourage all medical students to complete an elective attachment.
As a child, my father often told me stories about the positive experiences he had as a patient at Queen Mary Hospital. I yearned to work with the esteemed doctors there. As a penultimate-year medical student, I embraced the opportunity to do so. I applied for the elective eight months in advance via the Hong Kong University (HKU) website so that the relevant documentation and paperwork could be arranged.
Upon arrival, I immediately noticed differences between the healthcare systems in Hong Kong and Ireland. For instance, the scope of plastic and reconstructive surgery in Hong Kong exceeded that in Ireland. While I expected to learn about burn management, breast reconstruction, and skin excisions, I was surprised to see that the plastic surgery team also performed head and neck procedures such as thyroidectomies and lymph node dissections. This was impressive and spoke to the high quality of surgical training in Hong Kong. It ensured that patients with complex oncologic and reconstructive needs received timely, comprehensive care, while also minimising costs and logistical requirements of the surgery department.
To fully assimilate with the team, I attended all the early morning ward rounds, multidisciplinary team meetings, journal clubs, procedural clinics (Ultrasounds, Fine-Needle Aspiration Cytology), and outpatients. Because I showed a high level of interest and engagement, I was invited to teaching sessions with the HKU medical students where I learned new knowledge such as how to describe and spot-diagnose CT-TAPs and the procedural steps of Bilroth 1, 2, and Roux-en-Y gastric bypass surgeries. Upon conversing with the HKU students, I was surprised to learn that the final-year students had no summer holidays after their 4th-year exams. I wonder how my classmates in Ireland would react to this if implemented here. Such a change would likely face significant resistance, as it would exacerbate student stress and potentially increase medical school dropout rates. However, this issue may be less pronounced in Asian countries, which often have more intense working cultures compared to Western countries1.
The most memorable operation I witnessed was a 13-hour total laryngopharyngoesophagectomy. Thanks to the broad scope and high standards of training, the surgical team excised the tumor and also performed the pectoralis major flap for the hypopharyngeal reconstruction. This was a lifesaving and life-changing operation for the patient and was breathtaking to watch. I was impressed and enthralled by the technical dexterity required to perform this procedure as well as the effective team dynamics which allowed for smooth problem solving. It was a privilege for me to be involved (in a minor way) in this patient's care. I left the hospital at 11 pm that night, knowing that helping patients through surgery was my calling in life (Figure 1).
Figure 1.An Exterior Photograph of the Entrance to Queen Mary Hospital Taken at 11 PM.
The price of high-quality surgical care in Hong Kong is a grueling training scheme. Through conversing with “housemen” and interns, I was informed that 90–100-hour work weeks were routine2. While the average working hours of physicians in Ireland often exceeds the European Union's 2003 Working Time Directive3 it allows for time to relax and pursue other interests, thus maintaining physician longevity. However, the increased intensity of surgical training in Hong Kong allows for faster career progression, which may be appealing to many trainees. Additionally, the remuneration of doctors in Hong Kong often exceeds that in European countries4.
Amid the differences between the healthcare systems in Ireland and Hong Kong, I also noticed similarities. Public medical services in Hong Kong are provided by the Hospital Authority, which functions similarly to the Health Service Executive in Ireland, or the National Health Service in the United Kingdom. All of these public systems are said to be overcrowded and underfunded, resulting in increasing numbers of patients and doctors alike flocking to the private sector to work and receive care5-7. I wonder if this trend can be reversed or is it an inevitability for all governments who wish to provide a public health service?
In the evenings after work, I ate at local restaurants and food stalls dotted throughout Hong Kong. The Dim-Sum was second to none. I will forever remember the “Char-Siu bao”, “Har Gow”, and “Lai Wong bao”. Highly recommended! As the population density in Hong Kong is almost 100 times that of Ireland, restaurants are extremely busy, and I was often told to eat right beside other diners to maximize restaurant space efficiency.
Throughout the elective, I appreciated the differences and similarities between Hong Kong and Ireland. The impactful cases I witnessed alongside the support I received from the surgical team strengthened my resolve to become a surgeon. The teaching I received helped to cement my understanding of surgical pathologies and treatments. Aristotle's timeless quote resonates with me, “Educating the mind without the heart is no education at all.” This encapsulates the essence of my surgical elective in Hong Kong, where not only did I gain knowledge but also cultivated a deeper understanding of the human side of surgery.
The authors would like to acknowledge the clinical and administrative staff at Queen Mary Hospital, University of Hong Kong, and University College Cork for facilitating this elective.
The Authors have no funding, financial relationships or conflicts of interest to disclose.
Conceptualization: MH. Supervision: VC. Writing – Original Draft: MH. Writing – Review Editing: VC.
1. Working Hours - Our World in Data [Internet]. cited 2024 May 27. Available from: https://ourworldindata.org/working-hours
2. Hospital Authority: Doctor Work Reform Recommendation Report 2007/08 [Internet]. cited 2024 May 27. Available from: https://www.ha.org.hk/visitor/ha_visitor_index.asp?Content_ID=1260&Lang=ENG&Dimension=100&Parent_ID=695
3. Directive 2003/88/EC - working time | Safety and health at work EU-OSHA [Internet]. cited 2023 Dec 18. Available from: https://osha.europa.eu/en/legislation/directives/directive-2003-88-ec
4. The Census and Statistics Department of the Hong Kong Special Administrative Region. Annual Statistical Survey Report. 2022 Report on Annual Earnings and Hours Survey. cited 2024 Jun 5; Available from: www.censtatd.gov.hk
5. Health Insurance in Ireland. cited 2024 May 25; Available from: www.hia.ie
6. Shah SA, Robertson C, Sheikh A. Effects of the COVID-19 pandemic on NHS England waiting times for elective hospital care: a modelling study. Lancet. 2024;403(10423):241–3.
7. Schoeb V. The Role of Health Professionals within a Social Model of Health. China Perspect. 2016(2016/4): 51–58.
Martin Ho, 1 Final-year Medical Student. University College Cork, Cork, Ireland.
Velda Chow, 2 MBBS, FCSHK. Division of Plastic and Reconstructive Surgery and the Division of Head and Neck Surgery, Queen Mary Hospital, Hong Kong SAR, China.
About the Author: Martin Ho is a final-year medical student at University College Cork, Ireland.
Correspondence: Martin Ho. Address: 3.02 O'Rahilly Building, University College Cork, Ireland T12 K8AF. Email: martinho6278@gmail.com
Editor: Francisco J. Bonila-Escobar; Student Editors: Amna Zaheer, Theophilus Barasa & Ojaswi Phal Desai; Proofreader: Laeeqa Manji; Layout Editor: Julian A. Zapata-Rios Submission: Dec 22, 2023
Cite as Ho M, Chow V. Summer Surgical Elective in Hong Kong. Int J Med Stud. 2024 Jul-Sep;12(3):345-346.
Copyright © 2024 Martin Ho, Velda Chow
This work is licensed under a Creative Commons Attribution 4.0 International License.
International Journal of Medical Students, VOLUME 12, NUMBER 3, July 2024