Housemanship (for future houseman)

What is housemanhip?? It’s a training programme for medical graduates who wish to work in Malaysia.

Currently (as far as I know), regardless from local universities or overseas, all medical graduates have to undergo at least 2 years of housemanship (Latihan Siswazah). Why “at least 2 years”?? I’ll explain later.

Within the 2 years, housemen are expected to finish 6 postings; Medical, Surgical, Paediatric, Orthopaedic, Obstetrics & Gynaecology, Emergency / Anaesthesiology. Each has to go through at least 4 months for each posting.
**For the 6th posting, the ministry recently (if I'm not mistaken at the end of Dec'2013) introduced houseman participation in Primary Care and Psychiatric Department, apart from Emergency or Anesthesiology Department. This is due to to overloading of medical students,

Many names have been called for housemen. I have heard of many things which are not pleasant to ears, but it is the reality. Housemen are the lowest of the food chain. Worst I heard was, “bawah alas kaki” (under the doormats).

Houseman is a doctor

Regardless of the name callings, HOUSEMEN ARE DOCTORS. You are qualified enough to ask patients questions regarding their illness, taking their blood, doing necessary procedures with or without supervision (depending on your competency),  giving patients advice and counselling, treating patients but under the supervision of medical officers and specialist, prescribe medications (well, not all) and instruct the nurses on necessary things.

However, houseman cannot sign for MC yet!!
(unless there are special situation where you are already a senior poster usually in 6^th posting and already have your full registration number from MMC)

**Houseman has only temporary MMC registration number

Learn

My O&G specialist once said, housemen are so lucky that they are paid for being in training programme, so be ashamed and learn!! There are so many things to learn during housemanship because whatever you have learnt and experienced during your study is definitely different from this real work experience.  What to learn? Everything!!

During medical school, some might have been lucky to get their hands on patient, doing procedures, but some were just being able to observe even when they were doing practical. Some are from local universities, some are from overseas. In other words, you are going to meet many types of people as your fellow housemen. Luckily, you can learn many things from people with different backgrounds. Aside from your senior housemen, you can learn from your MOs, specialists, and nurses. Always treat your fellow colleagues with respect. Most importantly, learn from your patients. During school years, I was taught that in medicine, your patients are the best teachers J

Newbie

Usually, when you first come reporting for your first posting, the fact of interest of yourself that they really want to know is “Which university do you come from?”. In hospital setting, for a newbie, they usually have these stigmas; local grades are better, Russian/Ukraine grades are not good at skills, Indonesian grades are struggling with English, etc. Despite the stigmas, just show that you are doing your best, wanting to learn, and most importantly be humble.

Remember, being a first poster always a struggle. It depends on how you deal and adapt with it.

Struggle

Those from non local universities may struggle a bit in the beginning with the terms and abbreviations used in Malaysia. Some may struggle with the computer system if you get into hospitals which are using computerized system. As a newbie, you might be struggle with almost everything, but it is okay. It is normal.

You may feel that you are too slow, incompetent, giving hardships to fellow housemen even when you are actually trying to help. Your time management is suck; you don't have time to eat, drink, pee or even perform prayers. You get scolded by your consultants, specialists, MOs, nurses, patients.  You have many things to do in your hands, wishing you have 5 pairs of them. You are running around, trying to get tasks done until you don’t feel your legs anymore. You are sleep deprived because you work beyond your hours the day before, because you finish your tasks late, and you go to sleep late. At the end of the day, what do you do? Cry by yourself in the corner of the room, wondering why you chose to be a doctor in the first place. Believe me, tagging week is the worst. (I will explain about tagging week later).

You rarely have weekends off because you are working shift, so you might have no time meeting with your family and friends. Sometimes, you even rarely saw your housemates in one week, because your working hours are different. You will miss many weddings, family events, and many more. If you have your own family, I don't want to comment since I don't have one, but I can't imagine the struggle to balance it all.

Tagging

In my words, tagging is a period for you to learn and adapt with the system of each department. It is also a zombie period.

Tagging period is varies in each department, but usually for first poster it might take longer time since you are still adapting the hospital system generally, the working environment, the department, and a new chapter of your life. In my understanding, there is no exact official guideline on how long a tagging period should be. Usually, it was already decided long time before you start working. During my time, first poster was expected to undergo tagging period of 2 weeks, and the rest usually for 1 week. However, as I said before, it can be varies for many reason. It depends on each department, your attitude and your competency.

During tagging period, houseman usually works from early morning (usually 7am) till night (around 9-10 pm). It can be varies too in each department, depends on your colleagues, MOs or specialist, and your workload. Sometimes, you might have to work beyond your working hours, even you are already working for 15 hours! So don't be surprise when you have to.

During tagging period, you learn to adapt. Adapt to the department system, learn how things are run and done in the department. Also, it is important to get to know your fellow housemen, MOs, specialists, nurses and PPKs in the department. If you are a first poster, learn to do common procedures as many as possible; blood taking, IV line insertion, blood transfusion procedure, normal delivery (if you are in O&G dept), or other procedures that commonly done in respective department. Besides, taggers usually are expected to clerk new patients (Don't see this as getting bullied by your fellow housemen, because you can learn a lot through clerking your patients). 

During tagging period, you learn how to survive in the department if you are left to work alone, and be someone the patients, nurses and your colleagues can rely on. 

Shift system

Housemen are working according to shift system. It started in 2011 (if I am not mistaken, I don’t remember exactly when). It was initially introduced at Hospital Temerloh, and then followed by others. Shift system was implemented because some argue that housemen are working crazy working hours and overwork, and the system is believed to increase the quality of life of housemen. However, many experts also argue that with shift system replacing the on call system, housemen nowadays end up being under-trained and untested.

The system has been modified regularly since it was introduced. Each hospital and each department have different settings, as long as the required working hours are fulfilled. Recently (if not mistaken early this year), I heard the shift system was modified again to meet the working hours that the management saw fit for each department.  So I can’t argue much about the shift system because different hospital might have different system.

Extension

Remember that I said before for “at least 2 years”? Because it can be more than that.

Some might have to go through each posting longer than 4 months for various reasons, which mainly divided into two main categories; Knowledge and competency OR Attitude. The extension period is varies, depend on the decision made usually during the extension meeting. Extension meeting, from what I heard usually attended by the person of interest (houseman who got extended), the Hospital Director and Head of Department of each postings (The 7 postings I mentioned before).  I heard many stories about the meeting, but I am not sure if any of it is true. So, I am not going to discuss further more about the meeting. Your extension can be 1 month or 3 months, from what I usually saw happened.

If I can still remember from my induction lecture (it’s important you listened carefully about these things during induction), one can be extended maximum 3 months x2, and if more extension required, one might have to be transferred to another hospital to continue the extension and finish the rest of housemanship *correct me if I’m wrong*.

However, there are other cases which I saw houseman stuck in one department for more than a year, usually due to MIA (missing in action) case. There is one person I met during my surgical posting. I heard from the nurses and colleagues, he has been in the department for over a year. He came to work for 2 months, and suddenly MIA for few months, then suddenly appeared again at work and the cycle goes one. I found out that he has personal problems and request for transfer but that took quite a long time due to many problems with the high up in the management.  I am not sure what happen to him now, because last time I saw him he is still in surgical posting, but that was quite awhile ago. I also able to meet with someone who is extended in every posting he went, and finally finish his housemanship anyway.

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I feel like I still have many things to share, but this is for now.
Please be aware that housemanship journey for everyone would be different. Even the system will change, new rules and regulations will be introduce over the time. Just be prepare for it.

Later if I have the time, I will share about my personal experience and tips how to survive housemanship.


== any inquiry can email me at nukezonne@gmail.com ==