U PON completing the Bachelor of Medicine, Bachelor of Surgery programme (better known as MBBS), every medical student has to go through further training as a house officer, also known as houseman, to become a fully registered medical practitioner in the country.
The Malaysian Medical Council’s A Guidebook For House Officers states that the goals of internship (housemanship) is to provide medical graduates with appropriate knowledge, skills and experience.
The internship is a time when house officers consolidate and build on the theoretical knowledge they gained as an undergraduate and learn to apply it in caring for patients; develop the technical, clinical, personal and professional skills that form the basis of medical practice; as well as develop professional judgment in the appropriate care of patients and the use of diagnostic and consultant services.
University Malaya (UM) Medical Centre physician Dr Tan Guo Jeng, who specialises in internal medicine, said: “Housemanship can be stressful with long hours, sometimes extended to 36 hours, under the scrutiny of the attending medical officer or specialist.” However, many who have gone through the experience agree that it is one of the most memorable years of their lives. It was during the two years of housemanship to gain clinical experience that they found their true self, weaknesses and strength.
At the MEDxUM 2018 conference organised by medical students from the University of Malaya, several doctors were invited to share their experience on housemanship and the journey beyond.
Themed High School, Med School, What’s Next?, the event was aimed at medical students, with the aim to build up the future frontliners in the medical field.
Dr Tan credits his attachment as house officer with shaping him to become who he is today. His experience as a house officer at Hospital Sultanah Nur Zahirah, Kuala Terengganu in 2007 has taught him the true calling of a doctor.
His typical day as a house officer began at 5.30am (even though he officially started work at 8.30am) when he made his rounds at a designated ward, attended to patients and drew blood for tests.
“Ward rounds take place in the morning, the afternoon and at night. Those who are on call present the medical problem and treatment of a patient to medical officers, specialists and fellow house officers,” said Dr Tan.
“House officers must not panic but learn from mistakes. It is a learning process for everyone as we learn from each other.”
Dr Tan obtained the MBBS from Penang Medical College in 2007, and in 2012 he was granted Membership of the Royal Colleges of Physicians of the United Kingdom.
During his first three years as a clinical specialist, he worked at Hospital Klang, where he developed an interest in the education of house officers. He created the blog, angryspecialist.blogspot.com, for graduating medical students about to undergo housemanship.
In his blog, he shares the basics of clerking by getting more details of a patient’s medical history, summarising the information and presenting a case to the medical officer during rounds.
Dr Mohamed Iliyas Sultan Abdul Kader completed his housemanship six months ago at Hospital Raja Permaisuri Bainun in Ipoh.
Currently the medical officer in the Otorhinolaryngology Department at Hospital Melaka, the MBBS graduate from UM has Membership of the Royal College of Surgeons of Edinburgh.
He said medical students are cutting-edge researchers looking for new medicines and cures.
“No two housemanships are the same. Every department is run differently. No wards are the same.
“But as a house officer, you should know, for example, who should be notified of dengue patients and present your case to the medical officer with confidence,” he added.
“We are here to save people and to serve them — that should be a good enough motivation to keep our fire burning.
“Identify important tasks and prioritise your time.”
For every posting, he has set his objective — learn and repeat a task until he gets it right.
Dr Tan added that with better equipment and facilities, this generation of house officers should excel in their work.
After housemanship, a qualified medical officer has the option to specialise.
In order to be a registered specialist, the medical officer will need to pursue another four to five years of postgraduate studies plus two to four years of supervised training as a specialist.
It generally takes seven years to be a fully registered doctor. In total, it takes more than 10 years to become a specialist.
A specialist can pursue a subspeciality, a highly focused field within a speciality. For example, forensic pathology is a subspeciality of anatomical pathology.
In June 2017, it was reported that there were more than 7,000 specialists in the country, including 4,000 in the public sector, but this is not enough to meet the nation’s medical needs.
Orthopaedic surgeon Dr Amir Fariz Zakaria said: “Medical officers may opt to specialise in the surgical fields (including orthopaedic, general surgery, obstetrics and gynaecology and ear, nose and throat) or non-surgical fields (including internal medicine, nephrology, paediatrics, radiology and pathology).
“With more government hospitals being built, the government should continue grooming more specialists to serve the public sector,” he added.
A specialist in internal medicine, Dr Nurain Mohd Noor, who pursued the MBBS programme at UM, chose this field of specialisation for the “detective” work.
During the final year of the Master’s in Internal Medicine course at Universiti Kebangsaan Malaysia, she fell in love with endocrinology.
“House officers need exposure before deciding to specialise. If it offers satisfaction and makes you happy, then you have found your calling,” added Dr Nurain, who has headed the Clinical Research Centre in Putrajaya Hospital since 2011, and has Membership of the Royal Colleges of Physicians of the UK.
Universiti Teknologi MARA senior lecturer Dr Masri Muhamed said that with the medical field changing at a rapid pace, the country needs specialists to keep abreast of recent developments.
The paediatrician and neonatologist said: “Being a specialist opens up more work possibilities, as career options will be wider. For example, a specialist can be a medical lecturer.”
MEDxUM first annual conference titled High School, Med School, What’s Next? was held at the Faculty of Medicine, University of Malaya (UM) on April 21.
The event, with the support of Avicenna Residential College, aimed to build up the future frontliners in the medical field.
The one-day event saw prominent speakers such as the Health Ministry director-general Datuk Dr Noor Hisham Abdullah and UM Medical Centre director Professor Dr Tunku Kamarul Zaman sharing insight.
MEDxUM 2018 director Abdul Kadir Shah Sahibudeen, a final-year medical student at UM, said doctors and specialists also shared their experiences.
“Medical students and future house officers also gained useful information on housemanship.
“Many were unsure about what to specialise in and what are the proper steps to do so.
“Many also wondered how early they should start planning on specialisation.
“Specialising is very competitive so they need to plan their pathway. I encourage medical graduates, especially those who are planning to continue clinical practice, to start researching,” he said.
MEDxUM is not only for medical students, but also for those in medical-related fields such as nursing, pharmacy and biomedical sciences.
With the motto, Thinking of Tomorrow, Today, it aims to push boundaries in the world of medicine with generations of eager, compassionate and competent individuals from various fields and specialties.