There is a gap of knowledge and skills in the newly medical graduates (regardless numbers of years of study).
Therefore, medical graduates are required to undergo 6 different specialties rotation for a period of 2 years in Malaysia.
The training is called housemanship and they are call houseman (HO) which literally means one should regard ward as their house, and should be staying there all days and learn all the skills necessary.
After completing housemanship, they got their full registration and was promoted to medical officer.
I just read a message posted in Facebook where my course mate (a Medical officer) complaining the numbers and the poor quality of HO.
Well, a MO had the of guiding the HO and also have the role of teaching and supervising their in the procedures.
Let take example, a fresh graduated HO in a medical department, the training of the HO (in medicine specialty must included of)
1. Ability to obtain relevant history of illness, symptoms and signs, diagnosis and a basic management plan
2. Ability to perform basic procedural tasks – setting up branula, abdominal paracentesis, pleural tapping, CPR and CVP insertion
3. Ability to identify acute cases and should be able to takes step for management
Let illustrate a case of dengue.
A houseman must know how to manage a dengue case.
1. History – fever, unwell, retro-orbital pain, myalgia, history of dengue in place of staying, family members got dengue
2. Clinical skill – flushing, petechie rashes, pleural effusion and so forth
3. Investigation – FBC – leukopenia, thrombocytopenia; liver function test: raised ALT suggest of hepatitis
4. Management: set up Intravenous drips of normal saline of 5 pints, Full blood count test 3 times a day, vital signs monitoring – inform if persist tachycardia or blood pressure drop or patient unwell, review investigation Lab. To transfuse platelet if necessary.
The above just the basic of what a HO is usually will write in the initial management.
The basic plan will be reviewed by a Medical officer and usually the MO will reassess the patient and may added further plan of management.
One of the MO task is to guide and to teach the HO if they miss certain step of management or did not realise the significant.
For instance, it is important to teach HO to know the important of identify patients of high risk of developed severe dengue haemorrhagic fever and Dengue shock symptoms; Just to remind the HO to study the dengue management guideline and to give encouragement for them to improve.
Don’t know disregard HO management literally. Unless it is totally a wrong diagnosis.