The tale of two paradises

There are actually many similarities between my current Medical Officer (MO) post at Klinik Kesihatan Ibu dan Anak (KKIA) Limbang and my Teaching Fellow (TF) post at Newcastle University Medicine Malaysia (NUMed) from October 2020 to July 2021.

• Both posts give me a very high degree of job satisfaction, totally feeling like paradises.
• They both are fun and relaxing jobs with no on-calls in a nice and supportive environment.
• They both are Contract of Service posts.
• Both posts are temporary. I cannot stay and keep working in the long term due to the realities of life.
• They both make me discover my true interests (NUMed TF post: Medical Education; KKIA Limbang MO post: General Practice).
• I work towards some postgraduate qualifications in both posts (AFHEA and FHEA in my NUMed TF post; MRCP(UK) Part 2 and DCH FOP in my KKIA Limbang MO post).
• I took and passed an online entrance exam during both posts (UKFP Situational Judgement Test in my NUMed TF post; MInTFM Clinical Entrance Test in my KKIA Limbang MO post).
• For both posts, I live in a very nicely furnished house, located about 2km from work.
• Both posts feature a slightly old but very nicely furnished office.
• Both posts provide me with an email account for professional work purposes.
• They both involve regular Continuing Professional Development sessions that are quite helpful.
• They both require me to be far away from my family, with limited opportunities to return home (NUMed TF post: Due to the Covid lockdowns; KKIA Limbang MO post: Due to the long distances).
• During both posts, I voluntarily take on extra work to gain more experience (NUMed TF post: Extra teaching sessions; KKIA Limbang MO post: Locums).
• Both posts involve a 7-person team with very nice colleagues.
• In both posts, I took some time to get to know my colleagues well as I was new to the circle. We then started having interesting group activities regularly.
• I experienced an adjustment period during the first month of both posts, but I adapted very well to the job afterwards.
• Both posts saw me working with my fullest enthusiasm and dedication.
• In both posts, I like to give long and detailed TED talks (to my students or patients), sometimes going overtime.
• Both posts were offered to me at a very unexpected time, and turned out to be the greatest gifts for me.
• They both gave me an escape from the preceding months of isolation (Isolation due to Covid lockdowns before my NUMed TF post; Isolation at Sundar before my KKIA Limbang MO post).
• They both give me a lot of free time for leisure activities outside of work hours.
• Both posts make my friends envy me.
• In both posts, I avoid taking leaves (except for Chinese New Year and for postgraduate exams) because I love the job so much.
• Both workplaces are located near an international border (NUMed is near the Singapore border; KKIA Limbang is near the Brunei border).

My MRCP(UK) Part 2 exam

On 26 March 2025, I took the Membership of the Royal Colleges of Physicians (United Kingdom) [MRCP(UK)] Part 2 exam for the 1st time. That was 6 months after I passed the MRCP(UK) Part 1 exam in September 2024.

The results of my MRCP(UK) Part 2 exam were released on 25 April 2025. I successfully passed it with a great score. I got a scaled score of 592, while the pass mark was 454 and the mean score for all candidates was 538.

This is the breakdown of my score by specialty:

Cardiology - 47%

Clinical Pharmacology and Therapeutics - 72%

Dermatology - 78%

Endocrinology, Diabetes and Metabolic Medicine - 79%

Gastroenterology and Hepatology - 68%

Geriatric Medicine - 100%

Haematology - 56%

Infectious Diseases - 68%

Neurology - 59%

Oncology - 33%

Ophthalmology - 100%

Palliative Medicine and End of Life Care - 67%

Psychiatry - 100%

Renal Medicine - 58%

Respiratory Medicine - 63%

Rheumatology - 56%

Next, I won't be taking the MRCP(UK) Practical Assessment of Clinical Examination Skills (PACES) exam in the near future. Instead, I will be taking the Diploma in Child Health (DCH) Foundation of Practice (FOP) exam in June 2025.

You can read about my journey towards MRCP(UK) here:

https://www.daniellimjj.com/2024/04/my-journey-towards-mrcp-uk-part-1.html

I have shared tips for the MRCP(UK) Part 2 exam here:

https://www.daniellimjj.com/2024/09/tips-for-mrcp-part-1.html

My journey towards General Practice (Family Medicine)

Since I started studying Medicine in 2014, I kept being asked this question "What do you want to specialise in?" I had always found it a difficult question to answer. As a matter of fact, I found every specialty interesting in its own way. Choosing a particular specialty would mean that I would be out of touch with the other specialties. It would be quite boring if I could only do one specialty.

I was also told "Don't be a GP (General Practitioner). There's already too many GPs in our country, it's useless to become one. You should become a specialist instead." I never agreed with that statement. I firmly believed that as long as you genuinely want to contribute to the society, all doctors including GPs and specialists play a very important and noble role.

In fact, I found the job of GPs really great from my observations. General Practice is very broad. Being the first point of contact for patients, GPs get to see cases of all specialties. This is certainly more interesting than doing a specific specialty. I also value work-life balance very much. GPs certainly have much better work-life balance with more manageable workload and working hours compared to doctors in hospital-based practice.

In 2017, I finally understood that General Practice is actually a specialty on its own, which is also known as Family Medicine. We can specialise in General Practice, and I started considering it. I was aware that it's extremely competitive to get into a Master's programme for Family Medicine at public universities in Malaysia. Therefore, I thought of taking the Membership of the Royal College of General Practitioners (MRCGP) exam instead.

Throughout Year 3 to Year 5 of MBBS, I performed particularly well in the General Practice rotation compared to other hospital-based rotations. I also found myself learning much more efficiently in General Practice settings compared to hospital settings. During my Electives in Year 4 of MBBS, I chose to do General Practice. Meanwhile, many of my friends had little interest in General Practice.

In 2019, I realised that GPs have to regularly follow up patients with chronic conditions. I didn't have much interest in that, due to my style of studying Medicine which places huge emphasis on managing acute conditions and acute presentations of chronic conditions. During the End of Stage MOSLER for Year 5 of MBBS that year, there were several follow up cases for chronic conditions. I performed poorly in those cases and ended up failing the MOSLER and having to repeat Year 5.

I also found out that the MRCGP exam can only be taken as part of a General Practice specialty training programme in UK; it cannot be taken in Malaysia. Consequently, my interest in General Practice waned and I had a change of plan. I decided to take the Membership of the Royal Colleges of Physicians (MRCP) exam and pursue Internal Medicine instead. Just like General Practice, Internal Medicine is very broad and encompasses many specialties. Unlike MRCGP, the MRCP can be taken in Malaysia as a standalone qualification.

After I started House Officer training at Kluang hospital in 2021, I found out a harsh reality that Medical Officers (MO) and specialists in hospital-based practice in Malaysia have to routinely work continuous 33-hour on-calls lasting from 8AM till 5PM on the next day. Just imagine how tiring and stressful it is! As a result, I decided I most definitely don't want to do hospital-based practice, including Internal Medicine. That leaves General Practice as the only viable clinical specialty for me.

In October 2022, I discovered that the RCSI-UCD Malaysia Campus (RUMC) offers a General Practice specialty training programme known as the Malaysia-Ireland Training Programme for Family Medicine (MInTFM), which incorporates the Membership of the Irish College of General Practitioners (MICGP) exam. This provides an alternative route for joining General Practice specialty training in Malaysia apart from the very competitive Master's programmes at public universities.

I was once again interested to specialise in General Practice and I seriously considered joining RUMC's MInTFM programme. Later in 2023, I found out that we are only allowed to join the MInTFM under the Ministry of Health's Hadiah Latihan Persekutuan (HLP) scholarship; self funding isn't allowed. Only MOs working with the Ministry of Health are eligible for the HLP.

After completing House Officer training in January 2024, I worked as a MO in Internal Medicine at Kluang hospital. Although I had a high degree of theoretical interest in Internal Medicine, the 33-hour on-calls and heavy workload were totally unbearable for me. I desperately wanted out of it, hoping to move to a General Practice setting or to become a Medical Lecturer instead.

In June 2024, I got transferred to Klinik Kesihatan Sundar in Sarawak. That was my first time working in a General Practice setting. Sundar is a very secluded village. Although the work there was quite fun and relaxing, I was deeply troubled by the extreme isolation and difficult life at that place. I couldn't enjoy the job and I was constantly stressed and frustrated. I applied for Medical Lecturer posts at multiple universities, but all were unsuccessful.

Eventually in October 2024, I was transferred to Klinik Kesihatan Ibu dan Anak (KKIA) Limbang, another General Practice setting. KKIA Limbang is a total paradise, with supportive work environment, manageable workload and no on-calls, in the nice town of Limbang. I enjoy my work there so much and I make sure to show my fullest enthusiasm and dedication in my work. I always put in my time and efforts to communicate properly with every patient to address their concerns and expectations. I also realised that following up patients with chronic conditions is actually quite interesting.

I finally understood that General Practice is my true calling and I want to keep doing it in the future. With that, I set my minds on applying for RUMC's MInTFM programme. After my application was shortlisted, I took the Clinical Entrance Test on 21 January 2025 and attended the interview on 20 February 2025. On 26 February 2025, RUMC informed me that I was successful in the application. However, I may only join the MInTFM in July 2026, due to the fact that I am only eligible to apply for the HLP in the following year.

It marks a very significant milestone in my life, as this is my first time receiving an offer for a specialty training programme, even with the delayed start. I will still go ahead with completing the MRCP, as it too is very valuable for GPs. I look forward to my future career in General Practice (Family Medicine).

My 2025 Chinese New Year

I had a truly wonderful Chinese New Year in 2025. It surely is the best Chinese New Year I've had in the recent years. Just like in 2024, I went back to my hometown Kulim to celebrate Chinese New Year.

I'm working as a Medical Officer at Klinik Kesihatan Ibu dan Anak Limbang in Sarawak at that time. I had 16 days of holidays, from 25 January 2025 to 9 February 2025. It's the longest Chinese New Year break I've ever had.

24 January 2025:

It was my last day of work before the start of my Chinese New Year holidays. On that day, I and my colleagues had a photoshoot in front of the Chinese New Year decorations at Klinik Kesihatan Ibu dan Anak Limbang.

25 January 2025:

It was the start of my Chinese New Year holidays. On that morning, I went to Limbang airport and took a flight to Kota Kinabalu. The flight used a tiny Twin Otter plane. That was my first time taking a Twin Otter place. It was also my first time in Sabah.

After landing in Kota Kinabalu, I went to Queen Elizabeth Hospital to have a look. I then went to Imago Shopping Mall. There, I had lunch at Nando's. After lunch, I checked into Aeropod Suites at Tanjung Aru near the Kota Kinabalu International Airport. On that night, I had mala hotpot for dinner at 蜀天下老火锅.

26 January 2025:

I had nasi kandar for breakfast at Restoran Hameed Maju near Aeropod Suites. I then went to Kota Kinabalu International Airport to fly to Kuala Lumpur. I had my lunch at the airport. On the flight, I was served asam pedas fish with rice. I landed at Kuala Lumpur International Airport around 7PM.

My parents came to pick me up at the airport. We went for dinner at Old Western Cowboy Steak House in Taman Desa Petaling. After dinner, we went back to our house in Subang Jaya and I stayed a night there.

27 January 2025:

Around noon, my father took me to KL Sentral. There, we had lunch at Secret Recipe. After lunch, I boarded the ETS train to Bukit Mertajam. On the train, I ordered Nasi Lemak for my snack. I arrived Bukit Mertajam around 5:40PM.

My grandparents came to pick me up at the train station. We had bak kut teh for dinner at 老乡肉骨茶. After dinner, we went to see the Chinese New Year decorations in Bukit Mertajam town before going back to our house in Kulim.

28 January 2025:

It was the Chinese New Year's Eve. On that morning, I and my grandparents went to the Lunas Food Court to collect the roast pork which my grandmother ordered earlier. We then had dim sum for breakfast at 富二代 in Bukit Mertajam. That was my first time dining at that restaurant as it hadn't opened the last time I went back.

After breakfast, we went to AEON Mall Bukit Mertajam for some shopping. My grandparents bought some new clothes and shoes at UNIQLO and Skechers. We then returned home. For lunch, we had roast pork and steamed chicken at home. 

Later, I helped my grandmother with the preparations for dinner. On that night, I and my grandparents had steamboat at home for the Chinese New Year's Eve dinner. After dinner, we went to Kulim town to look at the Chinese New Year decorations. There's a new area near Kulim Central with many beautiful shops.

29 January 2025:

It was the 1st day of Chinese New Year. My grandparents gave me angpows on that morning. We went to Kulim Central and had breakfast at Texas Chicken. After breakfast, we walked around Kulim Central and my grandparents took a Chinese New Year photoshoot.

On that afternoon, we went to the Bukit Mertajam train station to pick up my parents who were coming back to Kulim on that day. My parents gave me angpows too. We then went the nearby Bandar Perda to have a look. After returning home, we had cappuccino using the new coffee maker machine at our house.

Once again, I helped my grandmother in preparing for dinner. On that night, I, my grandparents and my parents had another round of steamboat at home. After dinner, I prepared and served lychee drink for everyone.

30 January 2025:

It was the 2nd day of Chinese New Year. On that morning, I and my family went to the 广福宫斗母宫 temple in Kulim to pray. The last time I prayed there was during the Chinese New Year in 2020. After that, we had roast duck and pipa duck for breakfast at Lunas Food Court.

After breakfast, we went to Karangan. I hadn't been to Karangan for so many years. There's Klinik Kesihatan Merbau Pulas in Karangan. I had previously compared Karangan to Sundar in Sarawak. As it turned out, Karangan actually looks much better than Sundar.

In the afternoon, we had noodle soup with roast pork at home for lunch. On that night, we went to AutoCity Juru and had Nando's for dinner. After dinner, I wanted to have ice-cream at Häagen Dazs, only to find that it had closed down, even though it was still there just a year ago. We then went to Baskin Robbins instead.

31 January 2025:

It was the 3rd day of Chinese New Year. I and my family initially wanted to go to 榕树下饭店 for breakfast, but there were too many customers which meant having to wait for a very long time. Therefore, we changed the plan and went for hokkien mee at 亚丝福建面. That's one of the best hokkien mee ever.

After breakfast, we wanted to get roti benggali. However, the shop selling roti benggali in Bukit Mertajam had moved, and we couldn't find the shop in the new location no matter how we tried. We then went to Kedai Makan Pokok Buluh, where I bought curry fish and fried chicken for lunch. We also went to Minat Supermarket in Kulim. I had lots of childhood memories there.

On that evening, I and my parents went to Penang. The last time I went to Penang was in December 2020. We visited my maternal grandmother's house. We then went to the Penang Sports Club, where we had dinner with our relatives. My aunt bought me my favourite Phong Pneah from Ghee Hiang Bakery in Penang. The RCSI-UCD Malaysia Campus was just nearby and I could take a look at it. 

While I and my parents were in Penang, my grandparents had nasi lemak for dinner in Kulim. They left a small packet of nasi lemak for me, and I had it for my supper after returning to Kulim.

1 February 2025:

It was the 4th day of Chinese New Year. I and my family went to Restoran Yang Way in Butterworth for breakfast. There was a famous duck soup noodle stall there, but unfortunately it was closed. My grandparents and my parents had chee cheong fun there, while I just had kaya and butter toast as I don't eat chee cheong fun.

We then went to the neighbouring Kuan Nan Coffee Shop. There was another stall selling duck soup noodle there. It was open and I had it. After breakfast, I drove my family through the Butterworth Outer Ring Road, a new highway which we had never taken before. We passed through Penang Sentral, which I took a bus there when returning to Kulim for Chinese New Year in 2024.

After that, we went to Kepala Batas. Universiti Sains Malaysia had set up a new Advanced Medical and Dental Institute there. On our way home, we bought apam balik at a stall in Bukit Mertajam. My grandmother made steamed fish for lunch. We had planned to have dinner at Hilltop Thai Tomyam Restaurant in Bukit Mertajam on that night, so I called the restaurant to reserve a table.

However, it turned out that I had mistakenly called the neighbouring Tok Tok Restaurant, not realising they were two separate restaurants. As a result, we decided to have dinner at Tok Tok Restaurant instead. Tok Tok Restaurant serves Sichuan-style food and it's quite unique. During the dinner, we also celebrated my grandfather's birthday. My parents bought him a cake.

2 February 2025:

On that morning, I and my family had yam rice for breakfast at Sentosa Corner in Bukit Mertajam. It's the best yam rice ever.

After breakfast, I and my parents drove back to Subang Jaya. The traffic along the North-South Expressway was quite heavy and our journey took more than 7 hours. We stopped at the Ulu Bernam R&R, where I had the Yik Mun Pau. It's my childhood favourite and I last had it many years ago.

We had planned to have dinner at Fatty Crab, only to find it closed on that day. We then went to The Ship for dinner instead. After dinner, we went back to our house in Subang Jaya.

3 February 2025:

My parents took me to University of Malaya Medical Centre on that morning. After that, we also went to the Faculty of Medicine of Universiti Kebangsaan Malaysia to have a look. Later, we had lunch at Restoran Sin Leong Huat in Subang Jaya. We also had yee sang during lunch.

On that evening, I met up with my friend at Sunway Pyramid. We had a hotpot dinner at Wagyu More. We did a lot of catching up.

4 February 2025:

I just stayed at home in Subang Jaya for the whole day on that day. I ordered food delivery for my lunch. I also did revision for my upcoming MRCP Part 2 exam. On that night, I and my family had steamboat for dinner at home.

5 February 2025:

My mother brought me for breakfast at Kayu Nasi Kandar in USJ Taipan. In the afternoon, we had lunch at Nikonhai Japanese Restaurant in Kota Kemuning. After that, I went swimming in the swimming pool of my apartment.

On that day, I was informed by RCSI-UCD Malaysia Campus that I had successfully passed the Clinical Entrance Test which I took on 21 January 2025 as part of my application for the MInTFM programme and that I had been shortlisted for an interview on 20 February 2025.

I met up with my friend again in the evening and we went to Pavilion Bukit Jalil. We had dinner at 农耕记. This restaurant serves Hunan-style food, which is a bit similar to what I had at Tok Tok Restaurant a few days ago. After dinner, I brought my friend to visit my house in Subang Jaya.

6 February 2025:

I and my mother had breakfast at Kaw Kaw Pakkopi in USJ Taipan. Later, we had lunch at Lim Fried Chicken in SS15, which is one of my favourite restaurants. On that evening, I and my family went to Fatty Crab for dinner. It's finally open this time.

7 February 2025:

My mother had planned to bring me for American breakfast at Peppercorn Cafe in SS15. However, it was closed on that day. We then went to the nearby Ooi Noodle House. It's one of the best pork noodles.

On that afternoon, I and my parents went to Kuala Lumpur International Airport and took a flight to Kota Kinabalu. On the flight, I had Korean chicken with steamed rice. After arriving in Kota Kinabalu, we had dinner at Welcome Seafood Restaurant. We then stayed a night at Pan Borneo Hotel in Putatan.

8 February 2025:

Early in the morning, I and my parents took a flight to Limbang. Once again, it was a Twin Otter plane. That was the first time my parents went to Limbang and I brought them around the place. We had breakfast at Thien Thien Chicken Rice, my favourite chicken rice in Limbang. We also visited Limbang Plaza.

Later, we had lunch at D'SOUP. My mother really liked the Sarawak Laksa there. We then went to the newly open MK Hypermart. On that evening, we had dinner at Crystal Palace Seafood Restaurant. We stayed together at the house I rented in Limbang for a night.

9 February 2025:

I and my parents had breakfast at Buffalo Corner Food Court in Limbang Plaza on that morning. In the afternoon, I drove my parents to Lawas, passing through the Temburong district of Brunei on our journey. We stopped at Ya-Nur Restaurant in Temburong for lunch. I had chicken briyani there.

I brought my parents to Sundar to let them see the place. I had previously worked at Klinik Kesihatan Sundar. We arrived Lawas around 5PM and checked into Hotel Perdana. We went to Lawas Supermarket before having dinner at the nearby Hao Wei Restaurant, my favourite restaurant in Lawas.

10 February 2025:

Early in the morning, I drove from Lawas back to Limbang, once again passing through the Temburong district of Brunei. I arrived Klinik Kesihatan Ibu dan Anak Limbang at 8AM and began my work. That marked the end of my Chinese New Year holidays. My parents flew from Lawas to Kota Kinabalu on that afternoon and they would fly back to Kuala Lumpur on the following day.

I celebrated my Chinese New Year across 13 cities, Limbang, Kota Kinabalu, Subang Jaya, Kuala Lumpur, Kulim, Bukit Mertajam, Butterworth, Penang, Damansara, Shah Alam, Petaling Jaya, Temburong and Lawas, which made it really remarkable!

If you liked this story, you may want to read this too:
https://www.daniellimjj.com/2024/03/my-2024-chinese-new-year.html

My bittersweet journey in 2024

At the start of 2024, I had high hopes for the year. I was looking forward so much to pursuing Medical Education after finally completing my House Officer training which took 2 years and 4 months.

Unfortunately, I soon found out the harsh reality that I have to work as a Medical Officer (MO) to fulfill my compulsory service with the Ministry of Health (MOH) before I can leave to pursue Medical Education. Most medical schools in Malaysia also require their lecturers to have a postgraduate qualification such as MRCP, which I didn't have.

From January to May 2024, I had to work at the Medical (Internal Medicine) department of Kluang hospital. Although I have a strong theoretical interest in Internal Medicine, the very heavy workload at the Medical department made me really stressed. The worst part was the grueling 33-hour on-call shifts, which I hated so much. I didn't even have time to study for the MRCP(UK) Part 1.

I then got transferred to Sarawak on 27 May 2024. From June to October 2024, I worked at Klinik Kesihatan Sundar (KK Sundar). Although the work at KK Sundar is quite relaxing with a lot of free time every day, Sundar is a very secluded village, with the nearest Lawas town 30km away. The infrastructure in Sundar is so poor, with horrible living quarters and routine electricity and mobile network outages.

Since the very beginning, I didn't like Sundar. The extreme isolation made life quite challenging for me. Consequently, I was often stressed and unhappy. I kept complaining about everything. I looked forward so much to leaving after completing my compulsory service. The only silver lining was that the relaxing work at KK Sundar gave me plenty of time to study for the MRCP(UK) Part 1. I registered for the MRCP(UK) Part 1 exam on 8 June 2024.

On 19 July 2024, a vacancy for a Fixed-term Clinical Lecturer post was open. This post doesn't require any postgraduate qualifications, not even MRCP Part 1. I quickly submitted my application for the Clinical Lecturer post on 20 July 2024. I was confident that I would be the favourite candidate for the post, considering my experience and enthusiasm in teaching.

Even though MRCP Part 1 wasn't a requirement for the post, I still continued studying for it wholeheartedly. On 14 August 2024, I took the MRCP(UK) Part 1 exam. Coincidentally, that day was also the application deadline for the Fixed-term Clinical Lecturer post. I was confident that I would get a positive outcome within a few days. But 2 weeks later, I still didn't hear anything.

On 6 September 2024, I completed 1 year of compulsory service with the MOH, which supposedly would make me eligible to apply for exemption from further compulsory service. However, a few of my friends told me a bad news that effective 14 August 2024, the MOH no longer allows shortening of the compulsory service to 1 year; every one must complete 2 years of compulsory service, with the sole exception of those who got a lecturer post at a public university. That meant I couldn't join the Fixed-term Clinical Lecturer post even if I got it, since the post is at a private university.

I did a quick search and found a vacancy for a DU51P Trainee Medical Lecturer post at a public university, with its application deadline on 8 September 2024. I quickly submitted the application on 6 September 2024 itself. On 9 September 2024, I received confirmation that I wasn't selected for the Fixed-term Clinical Lecturer post; no reason was given for that.

On 13 September 2024, my MRCP(UK) Part 1 results was released and I passed it. I promptly updated it to the public university. On 17 September 2024, I was shortlisted for an interview for the DU51P Trainee Medical Lecturer post. The interview was held on 19 September 2024. It was particularly important, being my last chance to leave Sundar and pursue my Medical Education dream.

Unfortunately, despite all my efforts, I was informed on 24 September 2024 that I was unsuccessful in the interview. That didn't just mean I failed to secure the DU51P Trainee Medical Lecturer post, it also meant I would have to continue working at KK Sundar for another year till 6 September 2025, due to MOH's latest rules on the compulsory service.

I was deeply frustrated, affecting my emotional wellbeing and my enthusiasm for the job. It's clearly not productive for me to keep working in KK Sundar. My colleagues then suggested for me to be transferred to somewhere more urban.

At that time, Klinik Kesihatan Ibu dan Anak Limbang (KKIA Limbang) was looking for a new MO to take charge of the tuberculosis clinic. Since I had passed the MRCP(UK) Part 1 exam which demonstrated my good knowledge in Internal Medicine, I became a good candidate for it. On 7 October 2024, I was offered to transfer to KKIA Limbang, which I gladly accepted.

I started working at KKIA Limbang on 28 October 2024. Limbang is a nice town similar to Kluang. KKIA Limbang has a supportive work environment, with manageable workload and no on-calls. It's very much like what I envisioned about working as a doctor, back when I first decided to do Medicine. I am finally enjoying both my work and personal life now.

As 2024 ends, I am still unable to achieve my Medical Education dream. But what I have got now, feels like an acceptable start, and I am grateful about it.

My weird dreams (Aug 2024)

On 25 August 2024, I had two weird dreams, one after another. They were interconnected.

In the first dream, I successfully got offered a Clinical Lecturer post which I coveted so much. On the first day of my work as a Clinical Lecturer, I was assigned as an examiner for the final-year MOSLER examination.

That was my first time examining a MOSLER examination. I tried my best to ensure that I gave every student a score that accurately reflected their actual performance and that I assessed every student in the exact same way so that it's fair.

It took me quite some time to decide on the final score for each student. Despite some of my colleagues teasing me for my OCD, I was proud of the fact that I ensured the validity and reliability of the MOSLER scores.

After the MOSLER, I looked forward to my teaching sessions scheduled in the following days. The best part about working as a Lecturer is the interactions with students in teaching sessions. Suddenly, I woke up from my dream. I was quite disappointed that it was just a dream.

Soon, I fell asleep again and had the second dream which was a continuation from the previous dream. In the second dream, I signed up for the Postgraduate Certificate of Medical Education (PGCertMedEd) programme at my university as part of my Clinical Lecturer post.

However, I was informed that the PGCertMedEd programme had been discontinued this year. That was quite disappointing, but I was then told that as an alternative, I could join another PGCertMedEd programme offered by a newly established institution nearby.

The only prerequisite for joining the PGCertMedEd programme at that institution was that I had to be a Medical Lecturer with active teaching responsibilities. The programme costed a few thousand ringgit, which I was totally willing to pay.

To get the PGCertMedEd, I only had to pass a single examination. There was no need to attend regular sessions or complete assignments, so it wouldn't conflict with my duties as a Clinical Lecturer.

The registration deadline for the PGCertMedEd examination was on that day itself. I immediately rushed to that nearby institution. To enter that institution's building, I had to present the staff card of my university.

However, my staff card couldn't pass the validation checks no matter how many times I tried, thus I couldn't enter the building to register for the PGCertMedEd. I was so stressed, considering that the registration deadline was on that day. I asked for help from a security staff.

The security staff did some checking and said there was no record of my employment at my university. I told him that I am a Clinical Lecturer, having examined the final-year MOSLER just the day before. He then said to me "You didn't get the Clinical Lecturer post, did you?"

At that time, I woke up from my dream. In real life, I never got offered the Clinical Lecturer post.

If you liked this story, you may want to read this too:
https://www.daniellimjj.com/2023/11/a-weird-dream-nov-2023.html

My Medical Officer placement at KK Sundar

After I completed my Medical Officer placement at Kluang hospital in May 2024, I got transferred to Sarawak. I flew to Kuching on 26 May 2024. I reported for duty at the Sarawak State Health Department in Kuching on 27 May 2024. After reporting for duty, I was told that I got allocated to Klinik Kesihatan Sundar (KK Sundar) in Lawas. I stayed in Kuching throughout that week, where I had the opportunity to explore the city and taste some good food. On 2 June 2024, I took a flight to Limbang. Limbang is a rather nice town that looks a bit like Kluang, but unfortunately I wouldn't be working there.

On 3 June 2024, the driver from KK Sundar came to Limbang to bring me to Sundar. I had to pass through the Temburong district of Brunei to get to Sundar and that was my first time entering Brunei. Sundar is a very isolated village, with the Lawas town located 30km away. The only accommodation available in Sundar is the quarters right next to KK Sundar. The quarters is a poorly maintained wooden house and it's a horrible place to live in. There are dust and spider webs everywhere and the facilities in it are in poor condition. I stayed there for 2 nights and I felt extremely uncomfortable. There are a few eateries and grocery stores in Sundar within walking distance from KK Sundar. The food tastes fairly good, although its variety is quite limited.

On 5 June 2024, I went to Lawas town and reported for duty at the Lawas District Health Office. Lawas is a rather nice town, it's smaller than Limbang but it looks newer. On that afternoon, I began working as a Medical Officer (MO) at Klinik Kesihatan Sundar. There was another MO as well as several Medical Assistants (MA) and Nurses at KK Sundar. There was no specialist here, instead we had to call the specialist at Klinik Kesihatan Lawas to seek his input if necessary. The standard working hours is from 8AM to 5PM every Monday to Friday, excluding public holidays. In addition, every MO has to take turns doing passive oncall. For the passive oncall, we have to stand by 24 hours every day including weekends and public holidays, to attend to patient referrals by the MAs. For less severe cases, we can just give the management plan over the phone, but for more severe cases requiring admission, we may have to escort the patient in the ambulance to Hospital Lawas. There's no active oncall.

The work at KK Sundar is quite relaxing. Every day, there's usually no more than 20 patients and most of the cases are quite simple. KK Sundar is fairly nice with fairly good facilities, despite its isolated location. It certainly is much more comfortable compared to the quarters. I decided that moving forward, I would stay at the MO room of KK Sundar instead of the quarters, and I would only use the quarters for keeping my luggage. On 8 June 2024, I, my MO colleague and the MAs went to Limbang to attend the Mesyuarat Penyelarasan Pengurusan Murid Berkeperluan Khas Pendidikan dan Kanak-Kanak Autism. On 9 June 2024, I registered for the August 2024 MRCP(UK) Part 1 exam. I began my full-scale revision for the MRCP(UK) Part 1 at that time. 

On the week starting from 10 June 2024, I had to undergo my 1st week of tagging at Klinik Kesihatan Lawas (KK Lawas) in Lawas town. KK Lawas has many more patients and a much greater variety of cases compared to KK Sundar, but the MOs at KK Lawas don't have to do passive oncall. An important new clinical skill I had to learn was antenatal ultrasound. I had never performed any ultrasound before that and it certainly was a challenge for me. However, I could pick it up with some practice under the specialist's guidance. Throughout that week, I stayed at Hotel Perdana in Lawas. It's a simple yet comfortable hotel. There's a variety of good food in Lawas and I really enjoyed them. My favourite restaurant is Hao Wei Seafood Restaurant which serves all kinds of dishes. There's a restaurant selling good bak kut teh and roasted pork next to Hotel Perdana. Everyday Chicken Rice is really good, in fact it's one of the best chicken rice I have tasted. As Lawas is a quite a small town, I could get around just by walking.

On that Wednesday, my colleagues told me that it's compulsory to wear batik shirt every Thursday at KK Lawas and KK Sundar. I didn't have a batik shirt and couldn't get one in time for that Thursday, then my specialist gently reminded me to get a batik shirt by the following week. As the specialist wouldn't be around on the following week, my 2nd week of tagging was postponed to the subsequent week. I would only begin doing passive oncall after completing the whole tagging period. I returned to Sundar on 17 June 2024 by taxi. Having experienced the nice Lawas town, having to return to Sundar felt so disappointing. To make matters worse, I forgot to take away some food from Lawas for my dinner, and all of the eateries in Sundar were closed on that day as it was a public holiday. I was looking forward to my 2nd week of tagging in Lawas so much and I booked Hotel Perdana for that week in advance.

On 18 June 2024, my MO colleague told me that he wanted me to come back to KK Sundar to cover for him for 2 days during my 2nd week of tagging, as he would be away for a health screening programme at a school, adding that he had obtained the specialist's approval for that. I got quite upset considering that my MO colleague didn't discuss it with me beforehand and I had already booked the hotel in Lawas for the whole of that week, resulting in us having a minor argument. At that time, I found an eatery in Sundar selling good tomyam chicken. Later that week, I had a very bad diarrhoea. I bought 10 bottles of mineral water from a grocery store in Sundar so that I could replace my water loss.

I took a taxi to Lawas on 23 June 2024 and stayed there for a night. I managed to find a batik shirt at Lawas Supermarket. Lawas Supermarket is located right behind Hotel Perdana and it sells all kinds of food stuff and living appliances. After tagging at KK Lawas for a day on 24 June 2024, I returned to Sundar to cover for my colleague on 25 and 26 June 2024. I then resumed tagging at KK Lawas on 27 and 28 June 2024. To make up for the 2 days lost, my tagging at KK Lawas was extended for another week from 1 to 5 July 2024. Throughout the tagging period, I saw a good variety of cases managed under primary care and I became quite skilled at antenatal ultrasound. I also had the opportunity to learn implanon insertion.

I really hoped I could keep working at KK Lawas, as Lawas is a much better place to live in compared to Sundar. However, KK Lawas already had sufficient MOs while KK Sundar only had 1 MO excluding me, so I couldn't transfer to KK Lawas. After completing the tagging period, I began doing passive oncall on 6 July 2024. As my MO colleague had done passive oncall continuously for the past 1 month while I was tagging, I decided to do passive oncall continuously for the next 1 month. My car that was shipped from Kuala Lumpur finally arrived in Lawas on 6 July 2024. I stayed in Lawas for another night and then drove back to Sundar on 7 July 2024. I bought some food and living appliances in Lawas prior to returning to Sundar. I had been staying at Hotel Perdana for 10 days continuously from 27 June till 7 July 2024.

Power outages are very common in Sundar, affecting the whole village including KK Sundar. It would occur at least once in a week, lasting around 2 hours each time. Power outages at night can be quite scary. In contrast, I hadn't experienced a single power outage in Lawas town. The mobile network in Sundar is surprisingly strong and fast despite the isolated location. However, whenever there's a power outage, the mobile network will be totally lost immediately, and it can take up to several hours for the mobile network to recover after the power is restored. Sometimes, the mobile network may also be lost at random times even when there's no power outage. Power and mobile network outages are among the greatest annoyances in Sundar. At that time, I discovered a Ramly burger stall in Sundar. Its burgers are really tasty.

Majority of the patient cases at KK Sundar are follow ups for common medical conditions such as diabetes, hypertension, hyperlipidaemia and asthma. There are also maternal and child cases. Acute cases are less common but are more challenging to attend to. As working at KK Sundar was quite relaxing, I had a lot of free time every day to revise for the MRCP(UK) Part 1. In the middle of the night on 10 July 2024 when I was sleeping at KK Sundar, I suddenly got awakened by my MO colleague who told me that there's a pregnant patient in active labour. I got panicked as it had been more than 2 years since I last conducted a delivery. To make matters worse, the patient had a whole lot of antenatal issues and had defaulted follow up for some time. I quickly called Hospital Lawas to refer the case and then escorted the patient to Hospital Lawas. Thankfully, we reached Hospital Lawas in time before the baby was delivered.

On 13 July 2024, I went to Lawas and stayed a night at Hotel Perdana. With my car, getting between Sundar and Lawas is easy and it takes about 30 minutes. As I was doing passive oncall, I had to stay alert at all times for any phone calls from the MA referring cases. Early in the morning on 14 July 2024, the MA called me to refer a patient with STEMI. After giving the immediate management plan through the phone, I had to rush back to KK Sundar to escort the patient to Hospital Lawas for admission. On 19 July 2024, I found out that a Clinical Lecturer post was newly open for application and that I fulfilled all of the essential and desirable criteria for it. I quickly submitted my application on the next day and I was hopeful of getting a place. I told my colleagues at KK Sundar about it and even promised to give them a banquet before leaving KK Sundar to join the post.

In the following weeks, I went to Lawas and stayed at Hotel Perdana every weekend. Even though staying at the MO room of KK Sundar is much more comfortable compared to the quarters, it's still far from perfect, so I wanted to enjoy staying at the hotel during the weekends. I was still doing passive oncall, but fortunately for me, there were no further cases requiring me to go back to Sundar to escort the patient. Throughout that period of time, I was busy revising for the MRCP(UK) Part 1, spending at least 3 hours on it every day. I discovered a really delicious chicken curry at an eatery in Sundar. It's one of the best chicken curry that I have tasted. Regularly, a staff at KK Sundar would sell fried rice. I really liked her fried rice, especially with fried chicken, fried egg and extra chilli.

At that time, I had gotten used to working at KK Sundar. While I appreciated how relaxing the work is, I still didn't like living in Sundar. I often got annoyed whenever the MAs or Nurses forgot to trace the patients' blood investigation results before handing the patients' notes to me, which would sometimes occur when they were very busy. On 3 August 2024, I finally completed my 4 weeks of continuous passive oncall. My MO colleague would be doing passive oncall for the next 2 weeks. On 8 August 2024, I was granted my Annual Practising Certificate for 2025. On 9 August 2024, there was a Continuing Medical Education session on Pain as 5th Vital Sign at KK Sundar. On 11 August 2024, I had lunch at Gaya Cafe in Hotel Seri Malaysia for the first time. It's the highest class restaurant in Lawas. The food tastes really good, but it's quite expensive and the portion is rather small.

On 12 August 2024, the Sister seek my help in blood taking for a neonate after multiple unsuccessful attempts. I gave it a try and managed to get the blood. On that afternoon, a pregnant patient in active labour came to KK Sundar. I immediately attended to the patient, feeling calmer this time after the previous experience. My MO colleague then escorted her to Hospital Lawas for delivery. I took 3 days of leave from 13 to 15 August 2024, during which I went to Bandar Seri Begawan, Brunei. There, I took the MRCP(UK) Part 1 online exam at Times Hotel on 14 August 2024. I also did some sightseeing and tasted the local food in Brunei. On 17 August 2024, I resumed doing passive oncall. On 18 August 2024, I attended the Ectopic Pregnancy Webinar. I didn't stay in Lawas on that weekend, having spent quite a lot of money in Brunei.

On the following week, there were several power outages in Sundar. Unlike previously where it would only occur about once a week, there were multiple power outages a day for 2 days, with one lasting longer than 4 hours! I got so upset that I telephoned Sarawak Energy to make a strong complaint. Around that time, Lawas Supermarket began selling mooncakes as the Mid-Autumn Festival was approaching. Only Kee Fui mooncake was available and I bought several of it. Later, my mother sent me some Oversea mooncakes by parcel. The postman couldn't deliver it to KK Sundar and instead told me to collect it at the Lawas post office. Starting from 24 August 2024, I once again went to stay at Hotel Perdana in Lawas every weekend. There weren't any patients requiring me to escort during the 2 weeks, and my passive oncall ended on 31 August 2024.

On 2 September 2024, a new MO was transferred to KK Sundar. With 3 MOs here, the work became even more relaxing. However, the new MO wouldn't be doing passive oncall until he had completed his tagging period. At that time, KK Sundar was undergoing some renovation, making it look nicer than before. On 9 September 2024, much to my disappointment, I was informed that my application for the Clinical Lecturer post was unsuccessful, without any reason given. I then quickly applied for a DU51P Trainee Medical Lecturer post. On 13 September 2024, a patient in cardiac arrest was suddenly brought to KK Sundar. We performed CPR for 30 minutes but couldn't revive the patient. That was the first cardiac arrest case I encountered in Sundar. Later that day, my MRCP(UK) Part 1 results were released and I successfully passed it with a great score.

That weekend was busy for everyone at KK Sundar. On 14 September 2024, we organised a community health screening event at Dewan Masyarakat Sundar. It was fun yet tiring. On 15 September 2024, the Deputy Premier of Sarawak visited KK Sundar and we were involved in the reception. We then had a free lunch at Dewan Masyarakat Sundar. After the busy weekend, I was glad to have a holiday for Malaysia Day on 16 September 2024. I resumed passive oncall on 17 September 2024. After updating my MRCP(UK) Part 1 results, I was informed that I had been shortlisted for an interview for the DU51P Trainee Medical Lecturer post. The interview was held online on 19 September 2024, and it included a 10-minute teaching presentation. I did the interview at Hotel Perdana in Lawas and I felt that I performed fairy well. But much to my disappointment, I was informed on 24 September 2024 that I was unsuccessful in the interview. On 30 September 2024, I tried nasi bungkus for the first time. A staff at KK Sundar made it and it was quite good.

On 2 October 2024, the Deputy Minister of Health visited KK Sundar. I had the opportunity to speak to him. On 4 October 2024, I had to go to Wisma Persekutuan Lawas to reset my MyDigitalID after I forgot the password. On that afternoon, there was a steamboat party at KK Sundar. The steamboat tasted quite good. My passive oncall ended on 5 October 2024. At that time, I applied for another DU51P Trainee Medical Lecturer post. On 7 October 2024, I was unexpectedly told that I would be transferred to Klinik Kesihatan Ibu dan Anak (KKIA) Limbang in the coming weeks, as KKIA Limbang was lacking MOs while 2 MOs would be sufficient for KK Sundar. Considering that I never liked staying in Sundar and I would very much prefer to live in Lawas or Limbang, I happily agreed to transfer to KKIA Limbang. On 9 October 2024, I stayed at All Are Welcome Inn in Lawas for the first time. It's nicer than Hotel Perdana, but also significantly more expensive.

At that time, my colleagues at KK Sundar introduced me to an eatery in Kampung Baru Sundar. The food there is very good and it's unfortunate that I never discovered the eatery earlier. On 11 October 2024, a patient who collapsed was brought to KK Sundar. We found him to be in cardiac arrest and we performed CPR, but we failed to revive him. On that afternoon, the Sister held a farewell party for me and another staff who would be transferred to KK Lawas soon. There was a barbeque which was really fun. At the end of the party, the Sister gave me a simple trophy as recognition for my contributions to KK Sundar. Knowing that I would be leaving Sundar and Lawas soon, I made sure to go eat at every single one of my favourite restaurants in Sundar and Lawas. I decided to honour my previous promise of giving my colleagues at KK Sundar a banquet before leaving. The Sister helped me organise the banquet while I paid for all the costs. My banquet was held on 17 October 2024, during which I gave a heartfelt speech to my colleagues. They appreciated the banquet very much. 

On 18 October 2024, I went to the Lawas District Health Office to submit the documents for my new MO contract. After returning to KK Sundar at noon, I suddenly heard through the WhatsApp group that there had been a bad accident nearby where a car fell into the river. I was alone in KK Sundar at that time as the MAs and Nurses were having lunch. Then out of sudden, several victims who drowned in the river were brought to KK Sundar by their family members, all in cardiac arrest! I got panicked as I couldn't possibly perform CPR for all of them all by myself. I could only perform CPR for one of the victims while telling the family members to try to do the same for the others. Luckily, my MO colleague and the MAs arrived soon enough to help with the CPRs. Each of us then escorted a victim to Hospital Lawas. MOs from all over the Lawas district had been called to stand by at the ED of Hospital Lawas to attend to this mass casualty event. We then had to wait for quite some time at Hospital Lawas for a debriefing before we could leave. 

On 19 October 2024, I resumed passive oncall for the final week. On 23 October 2024, there was a 2-hour power outage at noon, followed by another 7-hour power outage at night. Even the emergency lights went off due to the extended duration and I was in complete darkness. That was the worst ever power outage in Sundar I had ever experienced. There was a planned power outage on 24 October 2024, but it was cancelled following the terrible power outage on the previous day. 24 October 2024 was my last day in Sundar and I said goodbye to all of my colleagues. On that night, I stayed at Hotel Perdana in Lawas for the last time. Early in the morning on 25 October 2024, I drove to Limbang and attended the Approach To Unwell Children Under 5 Years (ATUCU-5) Course. After the course, I just stayed in Limbang without returning to Sundar. My passive oncall ended on 26 October 2024, marking the end of my work at KK Sundar. I began working at KKIA Limbang on 28 October 2024. After this, I will surely miss Lawas a lot but I will only miss Sundar a little.

If you liked this story, you may want to read this too:
https://www.daniellimjj.com/2024/05/my-medical-officer-floating-period-at.html

Tips for MRCP Part 1 and Part 2

The Membership of the Royal College of Physicians (MRCP) examination is a postgraduate examination taken as part of specialty training in Internal Medicine. I took the MRCP(UK) Part 1 for the 1st time in August 2024, and I managed to pass it with a scaled score of 694, while the pass threshold was 540. I took the MRCP(UK) Part 2 for the 1st time in March 2025, and I managed to pass it with a scaled score of 592, while the pass threshold was 454.

Here, I would like to share some tips for passing the MRCP Part 1 and Part 2. These tips are relevant for both MRCP(UK) and MRCPI General Medicine. I am writing the tips based on how I revised for the exam previously. However, different individuals may have different learning styles, so you should just take this as a guide.

The MRCP Part 1 and Part 2 are in the form of Single Best Answer (SBA) examinations. For each question, there are 5 answer choices and you have to choose the most appropriate answer. The questions in MRCP Part 1 do not include any images. The questions in MRCP Part 2 may include images such as clinical photos, pathology slides, inheritance trees, ECGs, X-rays, CT scans, MRIs, ultrasounds and echocardiograms, and you have to interpret them.

While MRCP Part 1 and Part 2 are both based on the same curriculum, MRCP Part 2 questions are generally more challenging, with increased emphasis on making clinical judgements and planning management.

You have to start your revision no less than 3 months before taking the MRCP Part 1 or Part 2. I recommend spending at least 3 hours per day on the revision. If possible, you should revise every day. To pass the MRCP Part 1 or Part 2, you should aim for a score of at least 65%.

All of the following specialties will be tested in the MRCP Part 1 and Part 2:

- Cardiology

- Clinical Pharmacology and Therapeutics

- Dermatology

- Endocrinology, Diabetes and Metabolic Medicine

- Gastroenterology and Hepatology

- Geriatric Medicine

- Haematology

- Infectious diseases

- Neurology

- Oncology

- Ophthalmology

- Palliative Medicine and End of Life Care

- Psychiatry

- Renal Medicine

- Respiratory Medicine

- Rheumatology

Clinical Sciences will also be tested in the MRCP Part 1, in addition to all of the above specialties. MRCP Part 2 will not test on Clinical Sciences directly, but some questions may require knowledge and understanding of it.

The parts of these specialties related to Internal Medicine will also be tested in the MRCP Part 1 and Part 2:

- Anaesthesiology and Intensive Care

- Obstetrics and Gynaecology

- Orthopaedics

- Otorhinolaryngology

- Paediatrics 

- Surgery

These are the 3 important textbooks for the MRCP Part 1 and Part 2:

- Oxford Handbook of Clinical Medicine (11th Edition)

- Oxford Handbook of Clinical Specialties (11th Edition)

- Medicine for MRCP (by Rupa Bessant)

Start by revising Oxford Handbook of Clinical Medicine and Oxford Handbook of Clinical Specialties. You should cover all of the materials in both books. Of particular importance are the risk factors, pathophysiology, diagnosis, investigations, management and complications for each condition. Do not miss out on any condition, even if it is very rare.

After revising Oxford Handbook of Clinical Medicine and Oxford Handbook of Clinical Specialties, proceed with revising Medicine for MRCP. Medicine for MRCP only contains some of the conditions covered in the other textbooks, so it is not sufficient to be used on its own. However, Medicine for MRCP contains some important extra information at postgraduate level that are not found in the other books. Focus on revising the extra information for each condition, as well as the extra conditions and topics.

When revising the textbooks, I recommend going specialty by specialty. Finish all topics in a particular specialty before moving on to the next specialty. You should complete at least 3 full rounds of revision for all topics if possible.

You need to know the latest NICE guidelines. Important NICE guidelines are those covered in the textbooks, and you should look up the NICE website for the most up-to-date version of the guidelines. Take note of the publication date of each textbook and focus on NICE guidelines released or updated after the textbook's publication date.

It is very important to do practice questions for MRCP Part 1 or Part 2. Start doing practice questions after you have completed at least 1 full round of revision of the textbooks. Go through all Part 1 or Part 2 practice questions on the MRCP(UK) website. Apart from that, you should subscribe to PassMedicine and Pastest. They have a large number of practice questions. After finishing each practice question, check the correct answer and explanation and make sure you understand the reasoning behind every correct or wrong answer. Take note of question themes that appear commonly in the practice questions.

PassMedicine also has some revision materials. You should revise the high-yield textbook in PassMedicine. It summarises the important information you need to know in a concise manner, and it also contains some extra information not found in the textbooks.

You should study for MRCP Part 1 and Part 2 mainly through understanding, not memorising. Basically, for every fact you come across in your revision, try to think "Why is this the case?" If there is an explanation, read it and make sure you understand what it says. If there is no explanation, try to come up with your own explanation based on your knowledge. You can also look up the internet for an explanation. The fact is that, when you actively seek an explanation for a fact, you will end up remembering the fact much better and your revision will also become more interesting. This is so much more effective than simply memorising the facts. However, do note that not everything can be studied this way. Certain facts have no possible explanation at all, so the only way to study them is by memorising.

You do not need to memorise the normal range of values for investigations as it will be provided in the questions during the MRCP Part 1 and Part 2. You are not allowed to use a calculator during the exam. All calculations that you need to perform will be simple calculations that do not require using a calculator.

You will have an average of 108 seconds to answer each question in the MRCP Part 1 and Part 2. Although that is quite a plenty amount of time, you should still be careful not to run out of time. Time yourself when doing the practice questions. As you are reading the question, you should already be thinking of the diagnosis so that you can get to the answer faster. Even if you are unsure of the correct answer, you can try to elimate the wrong answer choices one by one to help you reach the correct answer.

All the best in your revision! I hope you will do well in the MRCP Part 1 and Part 2 examinations.

Tips for the UKMLA AKT and PLAB 1 can be found here:

https://www.daniellimjj.com/2023/03/tips-for-ukmla-akt.html

Tips for the Prescribing Safety Assessment (PSA) can be found here:

https://www.daniellimjj.com/2019/02/tips-for-prescribing-safety-assessment.html

My Brunei trip

I went to Brunei for 5 days and 4 nights in August 2024. It was my 4th time entering Brunei. I had wanted to visit Brunei since a long time ago. Previously, I entered Brunei 3 times in June 2024, when travelling by road between Limbang and Lawas in Sarawak, but I didn't actually stop anywhere in Brunei. Therefore, this was my first time visiting Brunei for real.

At that time, I was working as a Medical Officer at Klinik Kesihatan Sundar in Lawas, Sarawak. My MRCP(UK) Part 1 exam was scheduled on 14 August 2024, and it was held online. The internet connection in Sundar is very unstable. Even though the internet connection in the Lawas town centre is usually stable, it's still prone to disconnections at times. Limbang is the next nearest town, but going to Limbang requires passing through Brunei and I wasn't sure how stable the internet connection in Limbang is.

The nearest major cities to me were Bandar Seri Begawan in Brunei, Kota Kinabalu in Sabah, and Labuan. Kota Kinabalu was 3 hours' drive away, which I felt was too far, while getting to Labuan required taking a boat. On the other hand, Bandar Seri Begawan was just 90 minutes' drive away. I was also confident that I could get a fast and stable internet connection in Bandar Seri Begawan, the capital city of Brunei. I decided to take the online exam in Bandar Seri Begawan, while also taking the opportunity to visit Brunei. I received confirmation that I am allowed to take the online exam in Brunei.

As I had brought my car to Sarawak, I just drove it to Brunei. As a Malaysian, I don't need to apply for a visa to enter Brunei. However, I had to apply online for an Exit & Entry System (EES) Pass and an E-Arrival Card before entering Brunei. My passport was still valid for another more than 2 years. I booked Times Hotel, which had a good WiFi connection according to the online reviews.

12 August 2024 (Monday):

After finishing work at Klinik Kesihatan Sundar at 5PM, I began driving to Brunei. I entered the Temburong district of Brunei through the Labu-Mengkalap border post. There were minimal queues at the border post and I cleared the immigration quite quickly. The Temburong district mostly consists of rural areas and villages.

After that, I took the Sultan Haji Omar Ali Saifuddien Bridge to get to the Brunei-Muara district, which Bandar Seri Begawan is located in. The bridge was open 4 years ago in March 2020, just as the Covid-19 lockdown started. The bridge looks quite beautiful, and it reminded me of Penang Bridge. Some parts of the Brunei-Muara district are well developed, while others are less developed.

I then drove to Times Hotel and I arrived there around 6:30PM. Times Hotel is located at the 2nd floor of Times Square Shopping Centre, near the Brunei International Airport. It's a high-class hotel. After checking in to the hotel, I went to the neighbouring Airport Mall for dinner. After dinner, I took a short rest and then revised for my MRCP(UK) Part 1 exam.

13 August 2024 (Tuesday):

I had chicken rice at the food court of Times Square Shopping Centre for breakfast. A famous food in Brunei is nasi katok. However, as nasi katok is commonly available in Sundar and I had it regularly, I wanted to try something else in Brunei. On that afternoon, I had nasi ayam bakar at KaKa Restaurant in the Airport Mall. After lunch, I had Doki Doki Ice Cream.

For most of that day, I just stayed in the hotel room to do my final revisions for the MRCP(UK) Part 1 exam. On that night, I had dinner at Secret Recipe in Times Square Shopping Centre. Although Secret Recipe is widely available in Malaysia, it had no outlets in Sundar or Lawas. Times Square Shopping Centre is a nice mall and it has a good number of shops, although certain parts of it looked a bit old.

14 August 2024 (Wednesday):

Early in that morning, I had breakfast at SugarBun in Times Square Shopping Centre. SugarBun actually originated from Sarawak and I had it every week in Lawas. However, as most other shops in the mall weren't open at that time, I chose to have SugarBun. After breakfast, I readied myself to take the MRCP(UK) Part 1 online exam in the hotel room using my M1 MacBook Air and the hotel's WiFi connection. 

The internet connection in Brunei isn't very fast, in fact it's significantly slower compared to that in Malaysia. However, it's very stable, which is what matters most for the online exam. Paper 1 of my MRCP(UK) Part 1 exam began at 2PM. The questions weren't too difficult and I managed to answer fairly well. Although it was supposed to last 3 hours, I had finished answering all questions by 4PM and I decided to submit the paper early.

After that, I went to Rumah Sate in Times Square Shopping Centre for lunch. Paper 2 of my MRCP(UK) Part 1 exam began at 6:30PM. It was more difficult than Paper 1, but I still answered the questions fairly well. At 9PM, I finished answering the paper and submitted it early. Having completed the exam, I wanted to explore the area, but most of the shops in the area had closed at that time. I bought pizza from Pezzo for my dinner. I decided to sleep early so that I could explore Brunei on the next day.

15 August 2024 (Thursday):

On that morning, I woke up early. I first went to visit the nearby Brunei International Airport. The airport looked very beautiful and modern. After that, I drove to the city centre of Bandar Seri Begawan for some sightseeing. I visited the Omar Ali Saifuddien Mosque. I went to Brunei Waterfront and took some photos of the Brunei River. The Sultan Haji Omar Ali Saifuddien Bridge was visible in the background. Someone offered me a ride on his boat on the river, but I respectfully declined.

I had local breakfast at the nearby Syazwan Cafe & Catering. The waitress at the restaurant asked me if I am a local Bruneian, to which I told her I am from Malaysia. I then walked around the area to have a look. Interestingly, a section of Jalan Sultan Omar Ali Saifuddien looked so reminiscent of Jalan Dato Kaptain Ahmad in Kluang, Johor. While Bandar Seri Begawan is quite well developed overall, certain parts of it looked quite old. The people in Bandar Seri Begawan generally can speak both Malay and English quite well.

On the way back to Times Hotel, I drove through Jalan Subok. Several high commissions and embassies were located along that road. Later that afternoon, still feeling full from my breakfast, I only had a light lunch at Pastamania in Times Square Shopping Centre. After lunch, I watched the movie Deadpool & Wolverine at Times Cineplex Times Square. There are no cinemas in Sundar, Lawas or Limbang. It's a fun and hilarious movie that's a great addition to the Marvel Cinematic Universe. The movie had Malay and Chinese subtitles. Interestingly, I had also watched the previous Deadpool 2 overseas, in Middlesbrough, UK.

On that night, I had kolo mee for dinner at All Seasons Restaurant, a Chinese restaurant in Times Square Shopping Centre. After dinner, I had ice cream at Mykopitiam. I bought a reusable bag with the word Brunei from one of the stalls in the shopping mall as souvenir.

16 August 2024 (Friday):

I had to wake up very early in the morning. I had breakfast at Airport Mall and then checked out of Times Hotel. After that, I began my journey back to Klinik Kesihatan Sundar since I was working on that day. I took the Sultan Haji Omar Ali Saifuddien Bridge to get back to the Temburong district. There was a long queue at the Labu-Mengkalap border post, and I was stuck there for almost 2 hours before I could clear the immigration and reenter Malaysia.

Conclusions:

I definitely had a great trip to Brunei. There aren't many things to do in Brunei, it's just the local food and a bit of sightseeing. However, I am glad to be able to take the MRCP(UK) Part 1 online exam and to watch Deadpool & Wolverine in Brunei. Although Brunei isn't very well developed, it's a beautiful country. The people in Brunei are generally happy and satisfied with their lives, and they have been quite friendly to me. After so long, I finally had the opportunity to visit Brunei. Brunei is the 9th country I have visited so far.

Playing computer games - A true luxury?

Some people had this misconception that I enjoyed my Teaching Fellowship at NUMed so much because I had so much free time to play computer games. Is that really the truth?

In reality, the part where I had a lot of free time to play computer games was one of the worst parts of my Teaching Fellowship. At that time, the very bad Covid situation in Malaysia resulted in the cancellation of most teaching sessions at NUMed. Some teaching sessions were moved online, others had to be outright cancelled. That was how I got all the free time.

During my Teaching Fellowship, I actually liked being busy and hated having lots of free time, which is in total contrast to during my House Officer training and Medical Officer post. I always wanted to deliver as many teaching sessions as possible. Every time a teaching session got cancelled due to Covid, I would get so upset. I never felt stressed about the occasionally busy work schedules, the only thing that made me stressed was the constant possibility that a teaching session would get cancelled.

Getting to be a Teaching Fellow is surely one of the best things to have happened in my life. But it's unfortunate that my Teaching Fellowship got ruined by the Covid pandemic. I never got to experience it fully because of that. This is what makes me want to pursue Medical Education even more.

Now, as a Medical Officer working at Klinik Kesihatan Sundar, I too have a lot of free time to play computer games every day, especially after I finished taking my MRCP Part 1 exams. If all I want is to have free time to play computer games every day, I can simply continue working this job. But this isn't what I want. For sure, I am not happy now.

Playing computer games is fun, that's why I do it every day now. It's a great way to spend my free time and de-stress myself. But in the end, it's just a hobby. That alone doesn't give me true happiness. I can only be truly happy when I get to dedicate my life to something I truly love, in Medical Education.

I pray that I will get to pursue Medical Education real soon. I promise, there will be no "adjustment period" this time, there will only be my fullest enthusiasm right from the 1st second.

My MRCP(UK) Part 1 exam

On 14 August 2024, 4 years after I graduated with the NUMed MBBS degree, I finally took the Membership of the Royal Colleges of Physicians (United Kingdom) [MRCP(UK)] Part 1 exam for the 1st time.

The results of my MRCP(UK) Part 1 exam were released on 13 September 2024. I successfully passed it with a great score. I got a scaled score of 694, while the pass mark was 540 and the mean score for all candidates was 531.

This is the breakdown of my score by specialty:

Cardiology - 85%

Clinical Pharmacology and Therapeutics - 75%

Clinical Sciences - 81%

Dermatology - 56%

Endocrinology, Diabetes and Metabolic Medicine - 67%

Gastroenterology and Hepatology - 71%

Geriatric Medicine - 57%

Haematology - 100%

Infectious Diseases - 81%

Neurology - 64%

Oncology - 80%

Ophthalmology - 100%

Palliative Medicine and End of Life Care - 100%

Psychiatry - 88%

Renal Medicine - 86%

Respiratory Medicine - 73%

Rheumatology - 73%

Next, I plan to take the MRCP(UK) Part 2 exam in March 2025.

You can read about my journey towards MRCP(UK) here:

https://www.daniellimjj.com/2024/04/my-journey-towards-mrcp-uk-part-1.html

I have shared tips for the MRCP(UK) Part 1 exam here:

https://www.daniellimjj.com/2024/09/tips-for-mrcp-part-1.html

My journey towards MRCP(UK)

I first heard about the Membership of the Royal Colleges of Physicians (United Kingdom) [MRCP(UK)] exam in 2015, but I didn’t understand what it is back then. It was in 2017 that I found out that the MRCP is a postgraduate exam for specialty training in Internal Medicine. I had the misconception that having the MRCP would automatically make one an Internal Medicine specialist. As I had no plans for specialisation at that time, I wasn’t interested in the MRCP.

In 2019, I kept hearing my friends talking about their plans to take MRCP after graduating, and my mentor too advised me to sit for the MRCP Part 1 exam as soon as possible. I also noticed many private general practitioners in Malaysia having the MRCP. Among all clinical specialties, I had the greatest theoretical interest in Internal Medicine. As a result, I got interested in taking the MRCP for the first time.

However, I soon found out that we must complete at least a year of housemanship training before we are eligible to take MRCP. At that time, I wasn’t confident that I could even survive a year of housemanship. Consequently, the MRCP became something which I coveted so much yet I thought was out of reach for me.

In May 2021, I made the firm decision to pursue Medical Education. With that, I set my mind on completing housemanship no matter how challenging it is, so that I could get my Malaysian Medical Council (MMC) Full Registration. I also decided to take the MRCP for real. Even though it might not be compulsory, it would certainly help me in pursuing Medical Education.

I didn’t immediately start preparing for MRCP Part 1, as I wanted to fully relax before starting housemanship. In August 2021, I began my housemanship at Kluang hospital. I had a rather difficult time adapting to my new role as a House Officer (HO), which was the case throughout much of my 1st posting in Internal Medicine and the first half of my 2nd posting in Obstetrics and Gynaecology (O&G). Feeling so stressed and tired after work each day, I didn’t want to spend my free time studying for MRCP Part 1.

In May 2022, I could finally start functioning well as a HO in O&G. At that time, I began preparing for MRCP Part 1 for the first time. I subscribed to the MRCP Part 1 practice questions on PassMedicine. As my plan was to take MRCP Part 1 some time in 2023 which was still a long way to go, I only spent a rather short amount of time studying for it each day. That was the case for the rest of my O&G posting, continuing into my Orthopaedics posting.

In November 2022, my PassMedicine subscription expired. At that time, my training got extended by a month in the Orthopaedics posting amid some challenging circumstances. To make matters worse, there were a lot of patients and insufficient HOs throughout that month, making my work so busy. As a result, I put my MRCP Part 1 preparation on hold, and I didn’t renew my PassMedicine subscription.

In December 2022, I started my Surgical posting. Well anticipating that the Surgical posting would be very difficult and challenging, I decided to focus on completing the tagging period. Therefore, I continued putting my MRCP Part 1 preparation on hold. My plan was to resume studying for MRCP Part 1 in January 2023, once I get familiar with working as a HO in Surgical.

Unfortunately in January 2023, the Malaysian Medical Council (MMC) announced that moving forward, only doctors on the National Specialist Register (NSR) would be allowed to practise as Medical Specialists or Medical Lecturers. Someone had told me that back in June 2021, but I never really believed it due to the lack of information on the Internet all this while. Yet, the harsh reality just hit me, crushing my dreams.

Following that, I decided there was no point for me to take the MRCP anymore. Even if I have the full MRCP(UK) qualification, I still won’t be able to get onto the NSR without completing the Parallel Pathway programme which would take years. Consequently, I didn’t resume studying for MRCP Part 1.

In October 2023, I got a pleasant surprise when the MMC announced they had decided to abolish the requirement that only doctors on the NSR can be Medical Lecturers. With that, I regained hopes on achieving my dreams. At that time, I had completed my 5th posting in housemanship and I had applied for my MMC Full Registration.

It had been a year since I last studied for MRCP Part 1 and I had forgotten most of it. I would have to restart my preparations from scratch which I knew would take a long time. Instead of doing that, I made an enquiry on whether I could pursue Medical Education without MRCP, but I didn’t get a clear answer on that. I decided to go ahead with applying for a Clinical Lecturer post anyway.

In January 2024, I successfully completed my housemanship training and began working as a Medical Officer (MO) in Internal Medicine. Later that month, I finally got the reply that my application for the Clinical Lecturer post was unsuccessful, as a postgraduate qualification such as MRCP is an essential requirement. Amid the disappointment, I began my preparations for MRCP Part 1. I renewed my PassMedicine subscription after so long.

Due to my very busy work as an MO, with regular 33-hour oncall shifts that are really exhausting, I didn’t have much time to study for MRCP Part 1. Despite trying my best to study consistently, I made little progress over the months. Later in May 2024, I got transferred to Klinik Kesihatan (KK) Sundar in Lawas, Sarawak.

Working at KK Sundar is much more relaxing, and I have a lot of free time to study for MRCP Part 1 every day. In June 2024, I finally registered for the MRCP Part 1 exam in August 2024. I really put in my efforts to study for MRCP Part 1 consistently, spending at least 3 hours every day. Apart from doing practice questions on PassMedicine, I also read the relevant textbooks extensively.

The MRCP Part 1 exam is only available online. I didn’t have a stable internet connection in Lawas, and the nearest major city to me is Bandar Seri Begawan, Brunei. I received confirmation that I am allowed to take the exam in Brunei. I travelled to Bandar Seri Begawan and took the online MRCP Part 1 exam at Times Hotel on 14 August 2024.

I found the MRCP Part 1 exam moderately difficult and I was cautiously optimistic of passing it. On 13 September 2024, the results were released and I successfully passed it with a great score. I am so delighted about this. Finally, I have attained the much-coveted MRCP(UK) Part 1!

In early November 2024, I began preparing for MRCP Part 2. At that time, I had been transferred to Klinik Kesihatan Ibu dan Anak (KKIA) Limbang. The work at KKIA Limbang is very relaxing as well, giving me a lot of free time to study for MRCP Part 2 every day. Unlike KK Sundar, I enjoy the environment of KKIA Limbang so much more, enabling me to focus even better on my MRCP revision.

Once again, I studied for MRCP Part 2 consistently, spending at least 3 hours every day. I subscribed to the MRCP Part 2 practice questions on PassMedicine. I focused on doing the practice questions and revising the relevant textbooks. In January 2025, I registered for the MRCP Part 2 exam in March 2025.

In February 2025, I finished doing all of the 2800 practice questions on PassMedicine. I then subscribed to the MRCP Part 2 practice questions on Pastest. Just before the actual MRCP Part 2 exam, I completed more than 3000 practice questions on Pastest.

The MRCP Part 2 exam too is conducted online only. The internet connection in Limbang is rather stable, but disconnections can still occur rarely. I again wanted to take the online exam in Bandar Seri Begawan, Brunei. However, unlike the MRCP Part 1 previously, I wasn't granted permission to take the MRCP Part 2 in Brunei. Eventually, I took the online MRCP Part 2 exam at Purnama Hotel in Limbang on 26 March 2025.

There weren't any technical issues during the online exam and I managed to complete it. The MRCP Part 2 exam questions were more difficult than expected but still reasonable. I was cautiously optimistic of passing it. On 25 April 2025, the results were released and I successfully passed it with a great score. I have finally attained the much-coveted MRCP(UK) Part 2 and I am over the moon!

Tips for the MRCP Part 1 and Part 2 can be found here:

https://www.daniellimjj.com/2024/09/tips-for-mrcp-part-1.html

My Medical Officer placement at Kluang hospital

After I completed my House Officer training at Kluang hospital on 5 January 2024, I underwent a Medical Officer (MO) placement in the Medical (Internal Medicine) department of Kluang hospital for 4 months and 3 weeks from 6 January 2024 to 26 May 2024. Throughout the placement, I stayed in the house I rented at Bandar Seri Impian located near Kluang hospital. Here, I am sharing my experience in the MO placement.

I always had a high degree of theoretical interest in Internal Medicine. However, I found the large number of patients and heavy workload in the Medical department quite scary. I had initially wanted to join the Anaesthesiology department for the MO placement. Towards the end of my House Officer training, I spoke to my supervisor in Anaesthesiology regarding that, but she told me that I am more suited for Medical rather than Anaesthesiology. Later, I was informed by Kluang hospital that I had been allocated to Medical for the MO placement. I decided to accept it.

The work hours for MOs in the Medical department is from 8AM to 5PM every day, excluding weekends and public holidays. In addition, we have to work about 4-6 oncall shifts every month. Each oncall shift is 33 hours long from 8AM till 5PM of the following day if the following day is a working day, or 24 hours long from 8AM till 8AM of the following day if the following day is a weekend or public holiday. There were regular Continuing Medical Education (CME) sessions for MOs.

I was supposed to begin working as an MO in the Medical department on 6 January 2024. However, as that day was a weekend, I started working only on 7 January 2024. On the first day, I met the Head of Department for an induction briefing before I began working. I was allocated to the back cubicle of the male ward for the first week. The patients in the front and back cubicles are generally quite stable and don't require a lot of management plans as compared to patients in the acute and subacute cubicles.

I was quite fast in reviewing my patients. However, I was still inexperienced in planning the management. I often relied on my specialists to give the management plans during the ward rounds. There were a few patients whom I had to make referrals to sub-specialties in other hospitals. When referring a case, not only I have to present the full history of the case, I also have to come up with a reasonable management plan, which the sub-specialty specialist will then add on or modify if necessary. I found that a really daunting task in the beginning. Thankfully though, my colleagues were quite willing to guide me.

Unlike some MOs, I was generally not too dependent on House Officers (HO). I was willing to carry out most of the active plans myself, including those that are usually done by HOs. I would only get HOs to perform blood taking and to write discharge summaries. On 12 January 2024, I went to Johor Bahru for a short getaway. There, I met up with my friend who had just completed his MO placement in the Medical department of Kluang hospital. He gave me some useful tips for working in the department.

My first ever oncall shift was on 14 January 2024. It was 33 hours long and I was in charge of the male ward. As I was still in the tagging period, I had a senior colleague doing the oncall shift with me and I could seek her help anytime if needed. The oncall shift turned out to be not as bad as what I had expected. None of my patients had any emergencies throughout the night and I could sleep for several hours. Starting from that week, I was in charge of the subacute cubicle of the male ward.

On 17 January 2024, much to my disappointment, I found out that my application for a Clinical Lecturer post was unsuccessful. That meant I had to continue working as an MO till I complete my compulsory service with the Ministry of Health. On 19 January 2024, it was my first 24-hour oncall shift. I was really busy during daytime as it was a weekend and there were far fewer MOs working compared to working days. Still, I found 24-hour oncall shifts so much more managable than 33-hour oncall shifts. How I wish all oncall shifts are just 24 hours long!

Later that month, I had to perform a central venous line insertion for a patient requiring ionotropic support. Under the guidance of my senior colleague, I successfully inserted the central venous line. On the following day, I had the opportunity to perform a pleural tapping for one of my patients with pleural effusion. I succeeded in performing it under guidance by my specialist. My success in the two procedures gave me a real sense of accomplishment and it boosted my confidence in working as an MO in Medical. Starting from 28 January, I was reallocated to the female ward. Still, I was in charge of the subacute cubicle.

As time went on, I began getting used to working 33-hour oncall shifts. Usually after 5PM, I would have my dinner and take a short nap. At 7PM, I would start doing the night reviews for patients that had to be reviewed 3 times daily, as well as the transfer-in reviews for new patients. The specialist would start the night ward rounds around 8PM which would usually continue until around 9:30PM. After that, I would carry out any urgent plans and then go to sleep. I would let the night-shift HO take the urgent and morning bloods. If there are any emergencies, the nurses would give me a call. Otherwise, I would sleep till 5AM, then I would do the transfer-in reviews for patients admitted over the night. As long as I could sleep for at least 5 hours in total, I wouldn't feel too tired to work from the next morning till 5PM. Despite that, I still really dislike 33-hour oncall shifts.

Around that time, I found out that starting from this year, new HOs would only be allocated to tertiary hospitals. That meant there wouldn't be any new HOs coming to Kluang hospital, and the Medical department would no longer have any HOs in a few months' time. When that happens, oncall shifts for MOs would become much more challenging, as MOs would have to take the morning bloods for patients, significantly reducing the amount of time we could sleep. I was quite concerned about that, and I thought of requesting to switch to the Anaesthesiology department. Unlike Medical, all oncall shifts in Anaesthesiology are only 24 hours long.

One day, I had to make sub-specialty referrals for 2 of my patients. Both cases were quite complicated and I struggled to understand what the sub-specialty specialists were asking me. Consequently, the sub-specialty specialists wanted to speak to my specialist directly instead. My specialist got quite upset about that as he thought that I failed to communicate properly with the sub-specialty specialists for both of the cases.

On 6 February 2024, I escorted a patient to Hospital Sultanah Aminah in Johor Bahru for an angiogram. I hadn't been to Hospital Sultanah Aminah since February 2020 and I was happy to be there again. I bumped up with one of my friends at Hospital Sultanah Aminah. The patient was very stable and there weren't any issues during the angiography and throughout the whole journey. It was 2PM when I arrived back at Kluang hospital. My colleagues had completed all the active plans in the ward and I was so glad about that.

I had 5 days of holidays from 7 to 11 February 2024 for the Chinese New Year. I went back to Kulim to celebrate Chinese New Year with my family members. I had to return to work on 12 February 2024. On that day, one of my patients required a bone marrow aspiration and trephine biopsy (BMAT). Since I had never performed BMAT before, I let my colleague perform it while I observed. The BMAT was quite challenging, as my colleague had to apply quite a lot of force in order to get a satisfactory amount of specimen.

On 13 February 2024, one of my patients required a chest tube insertion. The specialist told one of my colleagues to perform it as it was a high risk case. It turned out to be so difficult. My colleague had to try multiple times before she could insert the chest tube. Right after the procedure, the patient had a desaturation. We had to refer her to the Anaesthesiology team for non-invasive ventilation. In the end, I could only go home at 6:30PM. I had another 4 days of holidays from 14 to 17 February 2024. During that time, I went to Johor Bahru for another getaway.

I had gotten better in planning the management for my patients at that time. During my oncall shift on 23 February 2024, I helped my senior colleague to do the afternoon reviews for the patients at the Coronary Care Unit (CCU). That was my one and only time working at the CCU as an MO. On that night, one of the patients at the CCU required a central venous line insertion. I tried to perform it under guidance of my senior colleague, but I failed after attempting twice. My senior colleague had to take over.

On 27 February 2024, I was finally granted my Full Registration with the UK General Medical Council. The following weeks were quite uneventful. I continued to be in charge of the subacute cubicle of the female ward. None of my patients required any complex procedures or sub-specialty referrals. Throughout March 2024, I had one oncall shift every week. With the dwindling number of HOs in the Medical department, I made sure to rely even lesser on HOs. I began doing blood taking and discharge summaries myself as well. However, I still let the night-shift HO take all of the morning bloods during my oncall shifts.

One day, one of the patients collapsed. My colleague decided to intubate the patient, but she failed after attempting twice. I then attempted the intubation and I succeeded. That was thanks to my experience in Anaesthesiology during House Officer training. On 19 March 2024, I delivered a Continuing Medical Education (CME) presentation on Pain Assessment Tools. Around that time, my specialist told me that she was satisfied with my performance in the wards and thus I had completed my tagging period in the wards. Moving forward, I would be doing solo oncall shifts in the wards and she would start allocating me to the Emergency Department (ED) as well.

For the week from 24 March 2024 to 28 March 2024, I was allocated to the ED for the first time. I didn't have to do ward work or join ward rounds, but I had to be ready to see referrals from the ED at any time. I was tagging at the ED which meant that there was a senior colleague also in charge of the ED which I could seek their opinion or help anytime. Most of the cases referred from the ED weren't too complicated. Whenever there were a large number of referrals or complicated cases, my senior colleague will help me in seeing the cases. I had a good working relationship with the MOs and HOs at the ED.

Starting from 31 March 2024, I was reallocated to ward 7A. Ward 7A was formerly the Covid ward. Since there were no more Covid patients, it had been converted into a general Medical ward where the more stable patients were transferred here. I was in charge of the acute cubicle. As the patients in this ward don't require a lot of management plans, it's quite relaxing working here. On 31 March 2024, I found out that the Ministry of Health would be reallocating me to Sarawak starting from 6 May 2024, exactly 4 months after I began the placement.

I wrote a letter to appeal to remain in West Malaysia and I managed to submit it before the deadline. A week later, much to my disappointment, the Ministry of Health informed me that my appeal was unsuccessful, which meant that I had to go to Sarawak and work as an MO there till I complete my compulsory service. However, I was allowed to apply to defer my start date in Sarawak for up to 2 weeks, which I did.

The first two weeks of April 2024 was quite relaxing as I only had one 24-hour oncall shift on 10 April 2024. That was first ever solo oncall shift and I was in charge of ward 7A and Periphery. Periphery is where we go to the wards of other specialties to review the patients that they referred to Medical. That oncall shift was quite relaxing. My patients in ward 7A didn't have any significant issues and I only received a few simple referrals from Periphery.

I had a passive oncall shift on 13 April 2024 where I had to stand-by for escorting any patient that needs to be transferred to another hospital from 8AM to 1PM. However, there were no patient transfers on that day so I just stayed at home. Starting from 14 April 2024, I was reallocated back to the female ward. This time, I was in charge of the front cubicle. The next 2 weeks were very busy as I had a total of 5 oncall shifts.

On 17 April 2024, I had my first oncall shift at the ED, where I was in charge of the ED from 5PM till 8AM. It was quite tiring as I was only able to sleep for about 4 hours. I had to admit a patient with thrombosed AV fistula and underlying end-stage renal failure. Worst of all, she was placed in the cubicle which I would be in charge of on the next morning and she would require an internal jugular catether insertion for haemodialysis on the next morning. Thankfully though, my specialist knew that I was quite tired so she told my colleague to insert the internal jugular catether, while I just had to assist her. Internal jugular catether insertion is quite similar to central venous line insertion.

I had another oncall shift at the ED on 26 April 2024. It was very tiring as well, but thankfully that was just a 24-hour oncall shift. My solo oncall shift at ward 7A and Periphery on 3 May 2024 was really busy. There were a large number of patients in ward 7A and I also received several complicated case referrals from Periphery. There was also a patient requiring an exchange of internal jugular catether. Although I had never observed or performed it before, I roughly knew how it should be done. Under guidance of my senior colleague, I managed to perform it successfully.

On 6 May 2024, I was informed that my start date in Sarawak had been deferred till 27 May 2024. My last ever active oncall shift was on 7 May 2024. I was in charge of ward 7A and Periphery. However, as my colleague in charge of the female ward was escorting a patient to Hospital Sultanah Aminah, I had to help her cover the female ward until she's back. There were many new cases in the female ward and I had to do the transfer-in reviews and join the night ward rounds with the specialist. Luckily, ward 7A and Periphery were quite uneventful. I could sleep once my colleague returned around 11:30PM. On that week, I successfully performed another internal jugular catether exchange.

Around that time, the CT scan machine at Kluang hospital broke down unexpectedly. Consequently, all CT scans had to be outsourced to KPJ Kluang. Many of the patients requiring CT brain had to be escorted to KPJ Kluang by an MO. I had a passive oncall shift on 11 May 2024. Around 1PM on that day, I was called to escort a patient from the ED to KPJ Kluang for a CT brain. I had never been to KPJ Kluang before and I was glad to visit it for once. It looks really nice.

On 12 and 13 May 2024, I performed pleural tapping for 2 of my patients. Both were successful and my specialists were quite satisfied with my performance. 23 May 2024 was my last day of work as an MO in the Medical department. On that day, one of my patients required an internal jugular catether insertion. I successfully performed it in my first attempt under guidance of my specialist. I bought some cookies as a gift to the nurses in the wards. I also took photos with the nurses. That marked the end of my journey at Kluang hospital. I left Kluang on 25 May 2024 and flew to Kuching, Sarawak on 26 May 2024.

Conclusions:

My MO placement in the Medical department has been full of stress and challenges. The greatest challenge is certainly those 33-hour oncall shifts. Working as an MO would have been so much better without that. Despite that, I am glad that I performed fairly well as an MO in Medical. I had the opportunity to address the learning gaps from my previous Medical posting in House Officer training, and I gained a lot of clinical experience. It definitely made me much more matured. Following the end of my journey at Kluang hospital, I surely will miss everyone so much.

If you liked this story, you may want to read these too:

https://www.daniellimjj.com/2024/11/my-experience-as-medical-officer-at.html

https://www.daniellimjj.com/2024/02/my-house-officer-training-at-kluang.html