Medicine Internship

This report highlights the work that I have done during my internship from March 14th to June 28th. In this period of time, I had the opportunity to work at Ngee Ann Polytechnic for the first three weeks of my internship and subsequently spent the remainder of the time in National Centre for Infectious Diseases (NCID). I had the honor of being accepted as a student intern for the Infectious Disease Research Lab (IDRL) at NCID. This provided me with an environment in which I was able to pick up skill sets that were not taught in school.

Furthermore, this has also given me the opportunity to put the skills which I have acquired in school to the practice, thus allowing me to reflect on what I have learnt during my educational journey.

The objective of this report is to give a summary of my progress during my internship. It displays my progress throughout my internship and notes down my accomplishments.

It also shows my experience towards work and my capability to face the challenges and improve myself.

The main goal of National Centre for Infectious Diseases (NCID) is to protect the people of Singapore from infectious diseases, it aims to be able to contain any outbreak of infectious disease locally. Any patients with or suspected to have infectious diseases are brought to NCID for quarantine. Thereafter, laboratory tests are done by an onsite laboratory, Infectious Disease Research Lab (IDRL), which is capable of performing a variety of analysis of the disease.

NCID is a unique set up as it has housing clinical services, public health, training and education integrated into one structure, setting it apart from other companies. Firstly, NCID is a 330-bed facility which is set in 17 wards. These wards are high-level isolation units (HILU), which are meant for treating high-risk pathogens. Secondly, NCID is also known for its onsite amenities. All the 17 HILU wards are considered intensive care units which are always ready for any emergencies, in case of an outbreak. This leads to the third point, NCID has a larger screening center which can hold 520 patients as well a specialist outpatient clinic which can be converted so that 130 more patients can be screened in comparison to local healthcare institutes.

This shows that NCID is prepared to deal with the spread of infectious disease and is capable of handling the large amounts of patients when necessary. Lastly, due to its infrastructure, the building can essentially be shut off from the surrounding buildings, in the case where there is an outbreak of disease in the building, minimizing the risk of the infection spreading toward the general public. As such, it shows that NCID is ready to deal with any pandemic infectious disease outbreak much better than other companies.

The Infectious Disease Research Laboratory (IDRL) is a facility within NCID that enables clinical researchers and scientist to conduct their infectious disease laboratory-based studies. IDRL will promote study results to be translated and applied as well as to garner the increase in public awareness of infectious diseases.

During my internship, I received training on the use of electronic pipettes, techniques for testing against antibiotic resistant superbugs, the importance of inventory check and writing work protocols. Being responsible for various duties which I had not done before, I was mostly unclear on how to proceed. However, through the guidance of my peers, I managed to learn what was needed to be done.

My first task was cataloging all existing equipment in the lab. As I was unclear what was needed to be done, I was taught by my direct supervisor, Dr. Yazid Abdad. He taught me to take down the serial number, model number, last equipment check date, if there was, and also to reorganize the equipment to the places they belonged to. The inventory checking technique that I have learnt from Dr. Yazid was a whole new experience for me. In school, we are not required to take note of the serial number of the machine, know where each pipette is supposed to be nor are we required to know when the equipment is due for servicing. Through the entire period of taking down the equipment’s information, I realized that the best way for me to acquire the skill of inventory checking is through constant practice.

My second task was to assist one of my colleagues on a study, the study was based on testing for the presence of antibiotic resistant bacteria. When I started to do bench work, I expected a simple experiment such as one performed in school. The experiment done in school showed that the antibiotic disc would cause a zone of clearance around it. We simply plated the bacteria in school and placed an antibiotic disc to view the results. However, the experiment my co-worker did was very different. As mentioned before, the purpose of the test was to test for antibiotic resistant bacteria. My colleague taught me that before we can begin to place the antibiotic disc on the plate of Escherichia Coli bacteria, we had to inoculate the bacteria into a tube and place the antibiotic disc inside the tube. This procedure is done to test if the bacteria in the tube is able to produce carbapenemase. If the bacteria is able to produce carbapenemase, the antibiotic disc will be ‘inactivated’. When the ‘inactivated’ disc is placed on a plate E.Coli, there will be no zone of clearance, signifying that the inoculated bacteria is anti-biotic resistant.

What my co-worker taught me impacted me greatly, due to the fact that even though the experiment done in school was fundamentally similar to the experiment that was being done in the lab, there was still a stark difference in the level of details. This prompted me to start thinking deeper and realize that what we are taught in school is simply a precursor to what is done in the real world. Through the multiple times that we conducted the experiment, I found out that the best way for me to learn was through note-taking and academic research. After taking down the notes, I would have to research on the topics mentioned to further my understanding and increase my capabilities.

Thirdly, I was taught by my colleague on how to use an electronic pipette. The electronic pipette is a useful and convenient tool as there is no need to press, hold and release like that of the trigger of a manual pipette. However, through constant use of the electronic pipette, I discovered that it has its own shortcomings of only being able to extract and release a fixed amount of liquid that it is set to hold. This meant that for samples where the quantity of liquid that is required to be extracted is not specific, such as removing the supernatant, a manual pipette will work better as you are able to hold and release an unspecified amount of liquid.

As an intern, my role was to assist the permanent staff in extracting serum and plasma from blood samples of patients that fit the criteria of the study. Before the extraction of the serum and plasma, I had to prepare the Bio-Safety Cabinet (BSC) by wiping its surface with 70% ethanol and made sure that the filtered pipette tips as well as the pipettes were in the BSC. Thereafter, I had to use a centrifuge to spin down the tubes of blood. Some tubes were special as they were serum separator tubes, tubes with a filter. The filter would provide a physical barrier between the serum and blood so the pipette tip will not be in contact with the red blood cells.

However, for plasma extraction, the tubes do not have a separator. After the extraction of the plasma and serum, we had to label the tubes with stickers, which contained the information of the sample such as the time and date the sample was procured, as well as the date the sample was processed. One of the ways to shorten the time needed for the overall process is to have a computer which is connected to a printer to print out the labels. As there was an average of 40 samples per batch and each sample of plasma or serum had to be separated into 3 cryovials. The stickers that contained the information were printed from a portable printer which required constant manual input of information individually as the information would differ within the samples. If a computer and printer were involved, it would shorten the time to print the stickers.

Another accomplishment which I achieved was to write the Work Instructions (WIs) for the study before it started. The WIs are there so that other staff involved in the study can read them. This would increase their understanding towards what they are tasked to do, thus reducing the risks of any accidents occurring. The steps toward writing the WIs included researching on the topic of study, understanding and rephrasing the information to a more generalized term for easy digestion. Thereafter, I would then submit the WI to the study Principal Investigator (PI) to keep and distribute when necessary. The entire process to write out a WI is highly time consuming, as such I would propose that different institutes create a database so they can share, update and even evaluate the WIs. This would shorten the time needed as WIs that have already been written can be referenced from and even improved or updated.

On the first day of work, I was given a mandatory safety briefing of the office and the laboratory. In the laboratory, my colleague showed me where the chemical and biohazard spill kits are placed. She also demonstrated how to use the different spill kit and tested me on the steps to utilize the spill kits. Thereafter, she showed me where the general Personal Protective Equipment (PPE) and assigned me my personal lab coat. After we were done with the lab induction, I was briefed on what to do in the event of a fire – staff are to remain in their office after hearing the fire alarm, and would only move to the gathering site once a safety announcement has been made. She also passed me files which contained the lab safety manual, the BATA schedules for all materials to read, I then had to sign a document stating that I had read the files and understood the information within.

In the laboratory, there exists different machines and chemicals. The lab makes it a priority to do up a Work Instruction (WI) whenever a new piece of equipment is brought in. Furthermore, for every reagent in the lab, there is the respective Material Safety Data Sheet (MSDS). The MSDS contains information on how to best store the reagents, health complications and also how to deal with exposure to the reagent. The lab manager constantly checks for updated MSDS’s every year to ensure that the information is up to date and safety is not compromised.

There are also labels on every door or equipment to ensure that members of staff are always be reminded how to best handle the equipment. This is a good practice as staff will always be reminded that the equipment that they are using, for example a -80 °C freezer, would require them to wear cryo-loves and that no food or drinks are to be stored within.

Overall, the lab has covered majority of safety practices that should be implemented. However, I have a few suggestions that could further improve the lab safety. Firstly, in one of the rooms, the route to the fume hood is not completely accessible as there is a cabinet that is partially blocking the path. The cabinet should be moved so that there is a clear route, so in the event that anyone has breathed in or have contact with the fumes, they are able to move directly to seek help with ease without the need to maneuver through a maze. Secondly, in the media preparation room, glassware is placed on the higher shelf. This is a risk as it is hard to reach for and in the process of reaching out, there might be a probability of glassware dropping and causing damage and injury. The glassware should be placed in a cabinet to minimize the risk of it becoming hazardous.

In the first few weeks of entering the laboratory, I was careless as I brought items that were from another lab without sterilizing it. This did not cause any major problems as my colleagues were monitoring me and reminded me of the mistake. From then on, I wrote a reminder for myself that I should remember to sterilize equipment before bringing it from lab to lab.

During my second month, I was tasked to inventorise the previously frozen samples according to their batch number. As this was my first time working with a -80 °C freezer, I frequently removed samples from the freezer, opening and closing the freezer door multiple times, and left the sample boxes out in the open which inadvertently caused the freezer temperature to increase and one of the samples to melt. My supervisor noticed what I was doing and advised me to pay attention to the freezer temperature. Due to the sensitive nature of the frozen samples, the moment the freezer temperature increases to -55 all freezer works should be stopped. From then on, as I continued to inventorise the freezer, I would pay attention to the temperature display, the formation of water droplets through ice melting and also reminding myself before I start that the samples should not be placed at room temperature for more than 5 minutes.

`The Applied Microbiology module greatly aided me during my internship, as we were taught about the different characteristics of Gram-Negative bacteria, the agar used for different bacteria, the type of medium that should be used and also the understanding of certain strains of bacteria. Although I was involved in only a few work projects, I was able to quickly understand what medium or agar would best facilitate the growth of the target bacteria. Furthermore, due to the time spent using the fume hood and BSC, I grew accustomed to it in school although the equipment in the lab had its difference.

In applied microbiology practical lessons, we were taught how to make our own agar plates with the 16 – streak method as well as the inoculation of bacteria into a broth. As I was in the laboratory for most of my internship, I helped out in multiple studies that involved the culturing of bacteria for future use. Although agar plates used in the lab are bought from vendors, the knowledge on how to make our own agar plates benefitted me as it helped me in writing out a WI for my supervisor.

In the CCA that I joined, I had to interact with people that I was unfamiliar with and work well with them which greatly helped in boosting my confidence, helping me develop interpersonal skills as well as taking responsibility. This allowed me to break the ice between my colleagues even though I was new to the lab. Due to the responsibilities I had in my CCA, it did not take me too much time before getting used to the tasks handed to me.

Although we picked up skills and knowledge during classes, it was still not enough to prepare me for working in a laboratory. This was mostly due to the fact that the course only covers information on a very superficial level. As such I feel that it would benefit the students greatly if the school were to be able to provide enrichment classes during the long holidays. The classes can be as detailed as teaching students in depth lessons towards a specific characteristic of a bacteria; ie what makes a bacteria gram-negative. The classes can also encompass practical lessons which can further help students fine-tune their existing laboratory skills or teach students new lab skills; ie identification of bacteria, production of nutrient broth, casting agarose gel and much more.

With the experience that I have gained during my internship, I am more confident to work in a research lab. The internship allowed me to experience first-hand what it feels like to work in a lab every day which was a far cry from what I previously envisioned it to be. There are more facets to the job then just academic researching, researchers are also required to do various administrative matters which are not limited to keeping tracking of all inventory, updating new versions of MSDS and writing up endless amounts of WIs. Although the scope of a researcher is wider than I expected, it has not deterred my interest as it remains a goal for me to be able to lead my own study. As the diploma course has equipped me with basic skills and knowledge, it is possible for me to get a job as a research assistant in a research lab. However, the knowledge and skills that I have picked up is still insufficient for me to lead my own study team. In order for me to increase the quality of my knowledge and fine tune my laboratory skills, I will have to further my studies in the scientific area to gain deeper and more advanced knowledge. From there I would be able to identify the gaps in today’s level of science, allowing me to conduct more purposeful studies and to eventually allow me to head my own study group.

I am thankful for the opportunity that was provided by National Centre for Infectious Disease (NCID) and Ngee Ann Polytechnic for me to be an intern. The internship opportunity has me given me the experience of working in a research lab, providing me with a conducive and enjoyable environment to work in.

I am very grateful to have had the opportunity to intern at NCID and to have, Dr Yazid Abdad, as my mentor and supervisor. You have always been patient with me and have always been there with me every step of my internship. I appreciate the effort that you took when you took time out of your work to break down any answers to the questions I had so I could comprehend them. I would also like to thank you for caring for my well-being during my internship to ensure I was not stressed out and also giving me advice for my future studies.

I would also like to thank all the staff in IDRL for extending their hospitality to me. The staff in IDRL have always showed me concern and have guided me in majority of the works that have I have done. Without their concern and guidance, I would not have felt as welcome and enjoy my internship there. Furthermore, I would like to thank the staff for giving me advice to what I should do in the future.

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