Author: Medical Education Professor, Dr. Chi-Wan Lai
Dr. Lai currently holds the position of Professor of Medical Education at KFSYSCC and is the attending physician of the General Internal Medicine Department's Neurology Master's Program. He specializes in epilepsy, brain imaging, neurology, medical education, and medical ethics. He graduated from National Taiwan University College of Medicine. In 1974, he served as the attending physician of the Neurology and Psychiatry Department of National Taiwan University Hospital. In 1975, he went to the United States and worked as a researcher in EEG and epilepsy at the University of Minnesota Hospital and as a professor of neurology at the University of Kansas Medical School. He returned to Taiwan in 1998 and has held positions such as Vice President of Tzu Chi University, Dean of the College of Medicine, Chairman of the Taiwan Epilepsy Medical Association, standing member and convener of the Ministry of Education Medical Education Committee, and chairman of the Medical College Evaluation Committee. He has been serving at this hospital since 2001.
The Joy of Working with Those Who Share Our Philosophy
In 1998, I returned to my homeland, Taiwan, to join the educational team of Tzu Chi Medical College. This marked the start of my journey back home after being away for 23 years.
In 1999, I had the honor of attending an international medical education workshop titled "Innovative Medical Teaching: An Interactive Workshop for Leaders in Medical Education," organized by the Andrew T. Huang Medical Education Promotion Foundation in Taroko Gorge. This experience made me realize Director Huang's dedication to medical education in Taiwan and the passion of the three scholars he invited from the USA and Australia.
Two years later, due to my father's declining health and hearing at the age of 94, my spouse and I decided to move back to Taipei to care for him alongside my siblings.
Director Andrew t. Huang was the first person I consulted regarding my plans after returning to Taipei. I expressed my desire to work somewhere where I could contribute to Taiwanese medical education and not be confined to administrative duties. Director Huang moved me with his offer to join his foundation as a "Chair Professor," allowing me to serve as a "roving ambassador" for medical education in Taiwan, aligning with the foundation's goals.
I hesitated initially, as my expertise was quite different from oncology. Surprisingly, the founding dean of KFSYSCC and our former teacher at National Taiwan University College of Medicine, Professor Sung Jui-Lou, personally invited my spouse and me to join KFSYSCC. During our visit, he emphasized the meaningful work we could contribute to medical education in Taiwan.
Thus, from 2001 till now, I've been working here for a quick 19 years. As the hospital celebrates its 30th anniversary, I feel honored to share my sense of accomplishment working here. I often felt that joining this team was like joining the band of outlaws in the classic Chinese tale "Water Margin." Although we didn't face literal persecution, many of us felt stifled in previous work environments focused on "performance" and "efficiency" rather than true medical values. Here, we could prioritize patients' well-being without being sidelined by secondary objectives. I was fortunate to work with a team that shared the same ideals.
I'm deeply grateful to Director Huang for his trust. When I first applied for leave to attend a medical education conference, the then Chief of Medical Affairs, Professor Tsai, told me that as long as it was related to medical education, I didn't need to notify him. This profound trust also allowed me to focus on my duties at the Department of Medical Education and the Taiwan Medical Accreditation Council (TMAC) for many years. I also continued my passion for "bedside teaching" at NTU and Chang Gung Hospitals, integrating humanistic care into clinical teaching.
While working at KFSYSCC, I had limited exposure to clinical services. I mainly attended to a small number of general neurology patients in the outpatient department. Since I had previously spent over two decades abroad, focusing on epilepsy medical services and research, the majority of my patients were also in this domain.
I'd like to share two educational activities I participated in at this institution:
Bedside Teaching: My most significant experience from guiding medical students in their clinical training at this oncology-specialized hospital has been the “bedside teaching” sessions. In these sessions, I led students from Yang Ming and Cheng Kung universities in patient visits. Besides the standard neurology-related physical examinations and differential diagnoses, it was the questions posed by patients and their families that truly unveiled the inner world of cancer patients. This allowed both me and the students to gain a deeper understanding of their perspectives. Let me share some common questions:
"How much longer do I have?": I always explain that medical statistics come from data of the majority, but there are always exceptions. I share real stories where I had initially given a bleak prognosis, only to be corrected by the patient later. I encourage patients by telling them we would be thrilled if they turned out to be one of those exceptional cases, as this would inspire others in the future. I also emphasize the importance of living a meaningful life rather than focusing on theremaining time. I seize this opportunity to teach students the "art of instilling hope," but also to ensure that they never give patients unrealistic expectations.
"I regret not seeking treatment earlier; I've come back to you too late.": A common lament. Once, I comforted a patient by mentioning that even some who sought immediate treatment didn't always succeed, so they shouldn't be too hard on themselves. This led to a debate with a student, who thought I missed an "educational opportunity." I clarified that rubbing salt into wounds is a big no in medical practice, and what I said was based on fact since some cancers are indeed hard to treat.
"Why did I get cancer?": I once shared a touching article titled "Thank God, I have cancer" with a patient. The article was about a person who was grateful for the experience, as it allowed them to appreciate the love and gentleness between people. This piece resonated with the patient, who later thanked me for sharing and even recommended it to her students as an extra reading for their English class.
Medical Humanities Case Discussion: To provide medical students with the opportunity to discuss cases during their internship that, although the diagnosis and treatment are not problematic, leave them feeling perplexed. They ask questions like, "Is what we're doing right?", "I wonder, what does everyone think is the right action?", and "I don't know why I feel uneasy caring for this patient." This discussion is alternately chaired by Director Huang, Director Wang Jinlong, and myself. The presenting medical student reports the patient's history and their doubts, and a multidisciplinary discussion is held with the patient's medical team, social workers, and psychologists. We usually require every attending student to voice their opinions, sparking a variety of viewpoints and prompting students to revisit the humanities and ethics courses they studied before their clinical experience in the hospital. Through these discussions, we encourage medical students to consolidate their learnings and contribute to the "Doctor-Patient Platform" e-newsletter, set up by a group dedicated to improving doctor-patient relations. This encouragement for practitioners to understand patients deeply, empathize with the pain borne by patients and their families, and articulate these insights in writing is in line with the principles of "Narrative Medicine" currently promoted in medical humanities education. It stresses "Attention" to patients' suffering, "Representation" of the doctor's understanding in writing, and subsequently building a close "Affiliation" with the patient. We also encourage students to share their insights so the general public in Taiwan can understand how medical students learn to be patient-centered doctors from their involvement in patient care. We hope this promotes a culture in Taiwan where, when someone or their family member falls ill, they are open to the involvement of medical students in their care, ensuring a future of better doctors for Taiwan.
Finally, I'd like to use a popular saying, "The most beautiful scenery in Taiwan is its people," to tell my colleagues at the Koo Foundation Sun Yat-Sen Cancer Center that "The most beautiful scenery at KFSYSCC is its people." I'm deeply grateful to experience the joy of working with people who share my philosophy. I wish everyone good health and happiness as we collectively stride towards KFSYSCC’s 40th and 50th glorious anniversaries.
