Introduction

Hi! My name is Daniel Lim Jhao Jian. Here is where I share my experience, knowledge and ideas. You are welcome to leave comments and follow my blog. You are free to copy anything from this blog. Please recommend this blog to your friends.


Thursday 4 April 2024

17 January 2024 tragedy

I have been longing to pursue my dream specialty.

The most important requirement to join the specialty is to have Malaysian Medical Council (MMC) Full Registration and Annual Practising Certificate (APC). The Person's Specification for the specialty recruitment also mentions about postgraduate qualifications (such as MRCP), but it's unclear whether that's an essential criterion or merely a desirable criterion.

After I successfully completed my 5th posting of House Officer training on 6 September 2023, I began applying for MMC Full Registration. After a long wait, I was granted MMC Full Registration on 7 November 2023. I then applied for my APC immediately.

I was granted my APC for 2024 on 22 November 2023. I then began writing my curriculum vitae (CV) to apply for my dream specialty. However, on the following week, I fell sick after getting infected with Covid-19 for the first time. Therefore, I delayed my application.

On 30 November 2023, I sent an email to enquire if I am eligible to apply for the specialty without a postgraduate qualification. On 4 December 2023, I received a reply which stated that they had informed the department in charge of the recruitment for further action and consideration. I formally submitted my application on 5 December 2023.

On 13 December 2023, I received an email saying that the shortlisting process would last until late January 2024 and I would only be informed of the outcome by then. On 14 December 2023, I was informed by sources close to the specialty that I almost certainly would get a place due to lack of manpower in the specialty.

On 6 January 2024, I successfully completed my House Officer training and began working as a Medical Officer. On 9 January 2024, I sent an email to enquire about the status of my application, but I never got any reply. I gave them a call on 12 January 2024, but I was told that the person in charge of the recruitment was on leave.

On 17 January 2024, I phoned the person in charge of the recruitment once again. Much to my disappointment, he told me that my application for the specialty was unsuccessful, as it requires a postgraduate qualification which I don't have.

Now, I have no choice but to continue working as a Medical Officer till I complete my compulsory service with the Ministry of Health. I will try my best to get MRCP(UK) Part 1 and Part 2 done in the near future. After that, I will apply for my dream specialty again.

Thursday 7 March 2024

My 2024 Chinese New Year

I had a truly wonderful Chinese New Year in 2024. It surely is the best Chinese New Year I've had in the recent years. For the first time since 2020, I could go back to my hometown Kulim to celebrate Chinese New Year.

I was working as a Medical Officer at Kluang hospital at that time. I had a total of 9 days of non-continuous holidays, from 7 February 2024 to 11 February 2024 and then from 14 February 2024 to 17 February 2024.

7 February 2024:

It was the start of the 1st part of my holidays. On that night, I had fish head curry for dinner at Restoran Patam. After dinner, I went to Jalan Ismail, Kluang where there were some really nice Chinese New Year decorations.

8 February 2024:

I had lunch at Cheese U in Taman Kluang Indah. I went to Kluang hospital in the afternoon to submit my on-call claims. On that night, I boarded the bus from Kluang Bus Station to Butterworth.

9 February 2024:

I arrived Penang Sentral, Butterworth early in the morning. I then took Grab to Kulim. The last time I went back to Kulim was in January 2021 and I was so glad to be back again. I followed my grandmother to the Kulim Market to do some shopping for Chinese New Year.

After that, I and my grandparents went to Bukit Mertajam and had Hokkien Mee for breakfast at 榕树下饭店. There were so many customers and we had to wait for almost 2 hours. After breakfast, we went to Kedai Makan Pokok Buluh, where I bought curry fish and fried chicken for lunch.

On that evening, my aunt and her family arrived Kulim. I hadn't met them since January 2020 and we had so much to talk. We had a great Chinese New Year Eve dinner together at home. The main dishes were roast pork and steamed chicken. After dinner, I prepared and served lychee drink for everyone.

10 February 2024:

It was the 1st day of Chinese New Year. We had roti canai for breakfast at home. My parents arrived in Kulim on that morning. Some of our relatives came to visit us on that day.

In the afternoon, we went to AutoCity in Juru, Bukit Mertajam and had lunch at The Brew House. After lunch, we went to Häagen Dazs for ice-cream.

On that night, we had a great steamboat dinner together at home. After the steamboat, I once again prepared and served lychee drink for everyone. I wanted to go to the Kwong Hock Keong Temple on that night, but unfortunately it was closed.

11 February 2024:

Early in the morning, I went to the Bukit Mertajam KTM station and boarded the ETS train. I had a 2-hour stopover at Kuala Lumpur Sentral, during which I visited the neighbouring NU Sentral Shopping Mall. There, I had lunch at Nando's. After that, I once again had ice-cream at Häagen Dazs.

I then continued my journey to Gemas. The ETS train was not yet in service to the south of Gemas, so I had to switch to the older train to continue my journey back to Kluang. I was feeling quite tired after returning home, so I just ordered food delivery for my dinner.

12 February 2024:

I had to return to work on that day. Thankfully, the work wasn't too busy so I could leave work on time at 5PM. On that night, I had dinner with my friend at XLL Mala Hotpot. After dinner, we went to Long Du Gong Temple to pray. After that, we went to Kluang Mall where my friend bought some new clothes.

13 February 2024:

It was another work day for me. The work was rather busy and I could only leave work at 6:30PM. After work, I and my friend had Mookata for dinner at Tong Fa Thai Restaurant.

14 February 2024:

It was the start of the 2nd part of my holidays. On that morning, I had bak kut teh for breakfast at Restoran Kon Kee. After that, I drove to Eco Botanic, Johor Bahru for a short getaway. I stayed at Rose Cottage Hotel.

I had lunch at Chow Chow Stir Fry at the ground floor of EcoNest. On that night, I had my favourite Korean fried chicken at Oven & Fried Chicken. After dinner, I went to Eco Galleria. There, I had Mixue ice cream.

15 February 2024:

I had my breakfast at Nasi Lemak Cincai. In the afternoon, I went to AEON Bukit Indah. There, I had Grilled New Zealand Ribeye Steak for lunch at Sizzling Stonegrill. 

On that evening, I met up with one of my NUMed friend at 汆悦麻辣烫. The last time I met her was in January 2022 and we had a lot to catch up. Later that night, I went to Mount Austin for supper. I drove through the EDL highway which gives a really nice view of Johor Bahru city.

16 February 2024:

I had breakfast at UG Kopitiam at the ground floor of EcoNest. On that afternoon, I had lunch at O'Coffee Club Atelier in Puteri Harbour. I then drove back to Kluang. At night, I had dinner at Bin Siang Food Court in Taman Parkland.

17 February 2024:

On that afternoon, I had lunch at Amiratham Indian Restaurant. In the evening, I and my friend went to Wei Guo Ding Zun at Taman Kluang Perdana for a steamboat dinner.

18 February 2024 marked the end of my Chinese New Year holidays.

I celebrated my Chinese New Year across 5 cities, Kluang, Kulim, Bukit Mertajam, Kuala Lumpur and Johor Bahru, which made it really remarkable.

Thursday 15 February 2024

My House Officer training at Kluang hospital

I underwent my House Officer training at Kluang hospital for 2 years and 4 months from 6 September 2021 to 5 January 2024. There were 6 postings in my House Officer training. Throughout my House Officer training, I participated in the NUMed ARCP programme that leads to UK General Medical Council Full Registration. I rented a house at Bandar Seri Impian which is located near Kluang hospital during my House Officer training. Here, I am sharing my experience working as a House Officer.

This is a list of abbreviations I am using in this post:
HO: House Officer
MO: Medical Officer
CME: Continuing Medical Education
Mini-CEX: Mini Clinical Examination
CBD: Case Based Discussion
MCQ: Multiple Choice Questions
O&G: Obstetrics and Gynaecology
CTG: Cardiotocography
PAC: Pregnancy Assessment Centre
OT: Operating Theatre
OSH: Occupational Safety and Health
SOP: Standard Operating Procedure
NICU: Neonatal Intensive Care Unit
ICU: Intensive Care Unit
CCU: Coronary Care Unit
MMC: Malaysian Medical Council
APC: Annual Practising Certificate

1st posting - Medical:

As my House Officer training intake was unexpectedly brought forward by several weeks, I was totally unprepared for the start of my 1st posting. I began my Medical posting on 6 September 2021. In the beginning, I literally didn't know what to do at all. It took me several days to learn about the job scope of HOs. Even then, I didn't know how to carry out a lot of the ward work and I had to constantly ask around. I faced huge difficulties with blood taking, where vast majority of my blood taking attempts failed. Lacking skills in blood taking meant that I was also very poor at intravenous cannulation.

I also had issues with requesting radiological scans. The first time I went to request a scan, I literally just placed the request form on the Radiologist's table and walked off, not knowing that I had to verbally present the case. The Radiologist said that my way of requesting the scan was totally wrong and told me to get a senior colleague to request the scan instead.

I took my off-tag assessment on 21 September 2021. It was disastrous, due to my lack of knowledge about the local clinical protocols and ward work. That, coupled with an extremely stressful work day on 22 September 2021, nearly resulted in me quitting House Officer training. I took 2 days of leave on that week. Thankfully though, I was allowed to work the normal working hours instead of the tagging hours starting from the following week.

On 28 September 2021, it was my first night shift. There were a lot of morning bloods which I had to take, which I thought would be a huge challenge for me due to my poor blood taking skills. But as it turned out, I succeeded in taking vast majority of the morning bloods. My blood taking skills improved tremendously and I was quite proud of myself. Being able to take bloods at my own pace without any pressure during the night shift certainly helped. Since then, I no longer had issues with blood taking.

On 5 October 2021, I retook my off-tag assessment and managed to pass it. However, a specialist complained about me due to the fact that I missed out 2 urgent CT scans ordered by her a few days ago. Consequently, I received a verbal warning and had to continue tagging for the time being. As time went on, my performance continued to improve and I could function properly as a House Officer. I had learnt the lesson not to miss out on any management plans again. On 23 October 2021, I finally completed the tagging period.

At that time, I was assigned to a newly opened female ward. Initially, there were only a small number of patients so my work was really relaxing. Later, the number of patients kept increasing, so did my workload. 12 and 13 November 2021 were extremely busy days, where there were only 2 HOs in the ward and I had to manage about 18 patients on my own. On 15 November 2021, I attended a workshop on Peripheral Intravenous Cannulation.

Later that month, a few new HOs joined the Medical posting. Being quite experienced at that time, I could offer them help whenever they required it. On 18 November 2021, I delivered a CME presentation on Malaria. I took the mini-CEX assessment on 28 November 2021 and the CBD assessment on 30 November 2021. Despite not making much preparation for the assessments, I managed to get a great score of 25/30 for the mini-CEX and 29/30 for the CBD.

On 20 and 27 December 2021, I had to do solo night shifts, where I alone was in charge of both male and female wards. I managed to take all of the morning bloods for the patients in both wards. I was also called to the CCU to help with a few of the more difficult blood taking there, which I succeeded. On 31 December 2021, I had to don a full personal protective equipment for the first time to take bloods from a few Covid-19 patients.

On 2 and 3 January 2022 which were my last 2 days of work in the Medical posting, I got assigned to periphery for the first time, where I would go to the wards of other specialties to review the patients that they referred to Medical. I found it quite fun as it gave me a good preview of O&G which is my next posting, and I even had the chance to speak to a few of the HOs in O&G. I successfully completed the Medical posting without any extensions. I was given 2 days of end-of-posting break on 4 and 5 January 2022.

2nd posting - Obstetrics and Gynaecology:

Before starting the Obstetrics and Gynaecology (O&G) posting, I had been hearing from my colleagues that O&G is a really relaxing posting, with claims that "the MOs are super nice", "you will get to eat almost every day" and "you can apply for leaves easily". Consequently, I decided to just take it easy. I started my O&G posting on 6 January 2022. For the 1st half of the posting, I was allocated to the labour room and PAC.

On my first day of O&G posting, I had realised the truth that it isn't nearly as easy as what others were saying. There were so many new clinical skills that I had to learn, such as vaginal examination, artificial rupture of membrane, vaginal delivery and perineal suturing. The MOs didn't really teach me those clinical skills, instead I was expected to be able to perform them well after observing a few times.

I kept struggling to find to os when performing vaginal examination. I found vaginal delivery and perineal suturing extremely difficult, as there are so many steps involved. HOs also have to enter the OT to assist with operations, most commonly caesarean section. I struggled a lot with assisting caesarean sections.

CTGs has to be performed for all patients at the PAC. It's quite common for there to be some abnormalities in a CTG. HOs are expected to recognise it and to inform the MO about it promptly, together with a full history of the case and the management plan. As a newcomer in O&G, that was a tall order for me.

At any time of the day, a new patient may come in to the PAC. HOs have to clerk every new patient, which is a long and tedious process, requiring half an hour at the minimum. Any of the patients at the PAC may have an emergency at any time that requires an urgent caesarean section or instrumental delivery. Whenever that happens, we have to stop whatever we are doing and attend to it immediately.

On 20 January 2022, I took my off-tag assessment. Due to my poor CTG interpretation skills, I failed the assessment and had to continue working the tagging hours. Worse still, an incident happened on that day. I was clerking a new patient at the PAC when the handover meeting started. I had to attend the handover meeting since I was told attendance is compulsory, so I couldn't complete the clerking. However, I got scolded by the MOs for that. A nurse also criticised me for not prioritising my patient.

I retook the off-tag assessment on 23 January 2022. I managed to pass it and I could start working the normal work hours. Later that week, one of the MOs gave me some detailed guidance on vaginal examination. I could finally feel the os for the first time. Since then, I was able to properly perform vaginal examination.

Night shifts in O&G are much more challenging compared to the Medical posting. Night shift HOs have to update the progress of all newborn babies admitted to the NICU, join the morning ward rounds and complete all of the discharge summaries on the following morning before they could go home. The exception is on weekends, where night shift HOs are not required to join morning ward rounds and thus can go home at 9AM. Fortunately for me, I was often allocated night shifts on weekends.

In February 2022, I got 3 days of holidays for Chinese New Year. By mid-February 2022, I could function fairly well as a HO in O&G. However, I still felt very stressed working at the labour room and PAC. This was especially the case when a new patient came in before I was done clerking the previous patient, or when two or more patients came at the same time. There was an MO who liked to order HOs around and she always expected her orders to be carried out immediately, even when we were in the middle of doing something else.

I attended the CTG course on 23 February 2022. However, I had to leave midway through the course as I was called to enter the OT. One night in March 2022, I got scolded very badly by one of the MOs due to the fact that I was still poor at perfoming vaginal delivery and perineal suturing. Later that month, I was allocated to the ward for the 1st time. I found working in the ward so much more relaxing compared to the labour room and PAC. There was no need to clerk new patients and usually there were very few active plans or emergencies.

On 1 April 2022, while performing a vaginal examination, I mistakenly inserted my fingers into the patient's rectum. The MO and nurse knew about it and they reported that to the Head of Department. On 12 April 2022, I was told that I had been extended by 2 months in the O&G posting due to my mistake which showed that I lacked clinical competency.

On 13 April 2022, I delivered a CME presentation on Menstrual Disorders and Vaginal Discharge. After I got extended, I put in my efforts to improve on my clinical skills. By May 2022, I could finally perform vaginal delivery satisfactorily. However, I was still poor at perineal suturing.

For the rest of my O&G posting, I was mostly allocated to the ward which was usually quite relaxing. Having a good amount of experience, I could perform quite well as a HO. On 16 June 2022, I had to do a solo night shift as my colleague took an emergency leave. That was really challenging, as I alone had to manage both the ward and the labour room and PAC. Luckily though, not a single new patient came to the PAC throughout the night. I managed to complete all of the work on time and the MOs were quite impressed.

In late June 2022, I took the mini-CEX and CBD assessments. I managed to pass both assessments with a good score of 24/30. On 28 June 2022, I attended the Basic Life Support course. My last day of work in the O&G posting was on 2 July 2022. I was given 3 days of end-of-posting break from 3 to 5 July 2022, during which I went back to Subang Jaya for 2 days and 1 night.

3rd posting - Orthopaedics:

I began my Orthopaedics posting on 6 July 2022. In the beginning, I found Orthopaedics to be rather relaxing posting. Unlike my Medical and O&G postings, I could adapt to the work and function well as a HO in Orthopaedics quite quickly. There were 2 new clinical skills I had to learn, performing ABSI and performing vacuum dressing. I could master both quite easily. After working the tagging hours for 1 week, I could start working the normal hours even though I hadn't taken the off-tag assessment. Night shift HOs are required to join the morning ward rounds and complete all the discharge summaries before they could go home.

Things then started going downhills. One day, when I was about to go home, my colleague told me that I had to take photos of the X-rays of my patient and send them to the WhatsApp group for the specialists to review. After doing it, I received several messages from the MOs saying that the X-ray images were unclear and they wanted me to take the photos again. However, after retaking the X-ray images, they were still unsatisfied. No matter how I tried, I just couldn't get a better image, due to the poor quality of my phone's camera. So much time was wasted and I was so annoyed about that. Eventually, my colleague helped me take the photos using her phone with a better camera.

Passing the off-tag assessment turned out to be so much more difficult than what I had expected. I failed it twice due to my lack of knowledge in Orthopaedics. I had never been interested in Orthopaedics. The 3rd time I took the assessment, I could answer the questions quite well, but towards the end I was asked a difficult question on sepsis. Although I could answer it correctly, my answer was quite a mess. Because of that, the specialist refused to let me pass and told me to reattempt the off-tag assessment with the consultant. The consultant let me pass the off-tag assessment on 27 July 2022, but not before he gave me a long lecture on what he expected of me in this posting, particularly emphasising on attitude.

On 12 August 2022, I got involved in a traumatic urinary catetherisation. My junior colleague was having difficulties inserting a urinary catether due to resistance and she asked for my help. I forced the urinary catether in but I still couldn't insert it fully, then I inflated it. Later, the patient had profuse bleeding from the urinary catether. Due to the traumatic urinary catetherisation, I was issued a warning letter which stated that I must improve my clinical skills or else I would be at risk of an extension. Since then, I had been working to improve my clinical skills, especially urinary catetherisation, which was acknowledged by several MOs.

Later that month, several of my colleagues were tested positive for Covid-19 and had to be quarantined. Consequently, there was a lack of HOs in the Orthopaedic wards. I had to so much work to do and I had to work overtime every day, making me feel really stressed. Worse still, some of the nurses were rather unhelpful, making me argue with them. On 21 September 2022, I took the CBD assessment, where I got a bare minimum passing score of 18/30.

On 23 September 2022, I had a needlestick injury. I was taking a blood culture for a patient, which has to be done in a sterile manner. There was no sharps bin nearby, and I was concerned that going elsewhere to get a sharps bin would compromise my sterility, so I decided to recap a used needle so that I could discard it later. I thought it would be safer this way, but I ended up pricking myself accidentally. I had to make an incident reporting to the OSH department and I was then given post-exposure prophylaxis for HIV. Later, I received a warning letter from the OSH for breaching the safety SOPs.

On 25 September 2022, I attended the Basic Suturing and Flexor Tendon Repair Workshop. On 10 October 2022, I delivered a CME presentation on Acute Major Joint Dislocation. I was delivering the presentation quite well, but midway through my presentation, a senior MO interrupted it and told me to present it again on another day, because I didn't include information about the Hippocratic manoeuvre, an ancient and risky technique for reducing anterior shoulder dislocations that is occasionally still practised nowadays.

On 12 October 2022, I was told by the consultant that I had been extended for 1 month in the Orthopaedics posting due to the fact that I had received 2 warning letters. He also felt that I had poor attitude, as evidenced by my lack of interest during his ward rounds and my arguments with the nurses. On 17 October 2022, I delivered my CME presentation once again. The senior MO was still not fully satisfied but she let me complete the presentation. On 31 October 2022, I delivered another CME presentation on Septicaemia and Hypovolaemic Shock.

On 1 November 2022, I took the mini-CEX assessment and got a great score of 25/30. Throughout November 2022, there was once again a shortage of HOs in Orthopaedics. To make matters worse, the wards kept having unstable patients which required a lot of time to manage. I had to work overtime quite frequently. At that time, I had become quite good at performing wound desloughing and skeletal tractions. My last day of work in the Orthopaedics rotation was on 2 December 2022. I had 3 days of end-of-posting break from 3 to 5 December 2022.

4th posting - Surgical:

Long before I entered the Surgical posting, I had been hearing scary stories about it. Surgical is widely considered to be the most challenging posting at my hospital. Therefore, I was quite scared about starting the posting. I began the Surgical posting on 6 December 2022.

In Surgical, it's compulsory to review all patients in the wards 3 times daily. While there usually weren't that many active plans in the Surgical wards, HOs are expected to complete all important active plans as well as the afternoon reviews by 2PM every day. For that to happen, all HOs have to work very fast. I struggled with that a lot in the beginning and I got scolded by the MOs and specialists several times.

On 8 December 2022, one of my patient with ascites was undergoing an ultrasound-guided pigtail insertion by the Radiology team. However, the patient kept being very uncooperative, so the Radiology team abandoned the procedure. Right after the patient was pushed back to the ward, an MO told me to perform a peritoneal tapping for that patient. I replied that I didn't know how to perform peritoneal tapping, and I was scolded by the MO.

Unlike other postings, HOs in Surgical have to perform referrals to sub-specialties such as Neurosurgical, Urology and Vascular Surgery for patients requiring referrals. Despite the challenges, I managed to pass the off-tag assessment just 10 days after I started the posting, as I found the assessment rather easy. That was the shortest time it took for me to off tag among all postings. Still, I had to work the tagging hours for a total of 14 days.

Night shift HOs have to join the morning ward rounds before they could go home, but they are not required to do the discharge summaries. As I found working in the wards so stressful, I preferred working in the Clinic, Daycare, Operating Theatre and Emergency Department. As time went on, I could work faster and function better in the wards. In January 2023, I got 3 days of holidays for Chinese New Year. On 24 January 2023, it was my first solo night shift. I struggled with it, but thankfully the MO was quite helpful.

On 8 February 2023, I took the mini-CEX assessment and got a rather good score of 23/30. As I was pre-occupied with the assessment, I didn't remember the cases in the wards. Consequently, I couldn't present the cases to the senior MO during the night reviews. I got scolded by the MO and I had to submit an explanation letter. After that incident, I put in my efforts to improve my performance in the posting and that was acknowledged by the senior MO.

One day, one of my patients was in sepsis and the MO told me to insert a urinary catether for him. Just as I was going to insert the urinary catether, the daughter of another patient came and ask me about his condition. I told her to wait and explained that I was attending to an emergency, but she insisted on an immediate answer. I refused to entertain her further. Later, she made a complaint about me.

On 23 February 2023, I took the MCQ examination. It was quite difficult and I failed it. I had to resit for the MCQ examination on 27 February 2023, and thankfully I passed it this time. On 28 February 2023, I went to see a patient at the Medical ward that was referred to the Surgical team. The patient's family member said that he seemed to be getting worse after he was admitted to the ward and asked me why. I explained that I was from the Surgical team and told them to ask the Medical team for further information. They got annoyed and they threatened to hit me. Later, I made an incident reporting regarding that.

Thanks to the fact that there were plenty of HOs in the Surgical posting during my time, I could get a replacement holiday or annual leave once every 2 weeks. On 11 March 2023, I was told that I had been extended by 1 month in the Surgical posting due to the previous complaint I got from a patient's daughter. The senior MO gave me some helpful feedback regarding my shortcomings, and I worked to address them.

On 6 April 2023, it was my CBD assessment and I got a great score of 25/30. In the following week, the senior MO got me to assist him with conducting the 2023 Trauma Audit. I collected data by reviewing the patient records, analysed the data and then created a presentation. It was really interesting and I was so glad to be given the opportunity to participate. I received myCPD points for that.

At that time, I had become very experienced and thus could perform very well as a HO in Surgical. On 21 April 2023, I had to do a solo night shift. It was a busy night shift with several emergencies, but I managed to handle them quite well. 1 May 2023 was my last day of work in the Surgical posting. I had 4 days of end-of-posting break from 2 to 5 May 2023, during which I returned to Subang Jaya for 3 days and 2 nights.

5th posting - Paediatrics:

Before joining the Paediatrics posting, I had the impression that working at the NICU is very stressful while working at the Paediatric ward is quite relaxing. I started the Paediatrics posting on 6 May 2023. My 1st week of tagging was in the ward while my 2nd week of tagging was in the NICU. Just like the Surgical posting, all patients in the Paediatric ward and NICU must be reviewed 3 times daily.

An important new skill to learn is Paediatric blood taking, which is different from that of adults in some ways. As I had a bit of experience performing blood taking from neonates during my O&G posting previously, I could pick it up quite easily. For most children older than 6 months, an assistant is required when taking blood as the child will keep resisting and moving about.

After I started working at the NICU, I realised that it isn't nearly as bad as what I had expected previously. Despite the large number of patients, there weren't a lot of active plans usually and the nurses there were very willing to assist HOs in performing clinical procedures. The only challenge was that HOs in NICU may get called to the OT or labour room for neonatal resuscitation at any time. I felt very stressed with performing neonatal resuscitation in the beginning.

On 21 May 2023, I took the off-tag assessment and managed to pass it in my first attempt. For next 7 weeks, I was allocated to the NICU. On 23 May 2023, I attended the Neonatal Resuscitation Programme course at the NICU. My first night shift was on that night. Night shift HOs are allowed to go home on time provided that they have completed all of their work, including taking all morning bloods.

As time went on, I became quite skilled at performing neonatal resuscitation and I no longer found it stressful. Despite being quite good at Paediatric blood taking, I was still struggling with intravenous cannulation where my attempts often failed. Intravenous cannulation was often performed by the nurses at NICU and therefore I didn't have much experience performing it. I then took my MO's advice to practice doing it more. Another clinical skill I found challenging was urinary catetherisation for urine cultures.

On 18 June 2023, I delivered a CME presentation on Paediatric Emergencies: Respiratory Failure and Shock. Later that month, several of the blood cultures taken by me were contaminated due to inadequate sterility during the procedure and I had to write an explanation letter for that. After that incident, I always took extra care to ensure sterility when taking blood cultures.

In early July 2023, I got reallocated to the Paediatric ward for the rest of the posting. Working in the ward was actually much more challenging compared to the NICU. There were much more active plans in the ward. Worse still, the nurses in the ward often couldn't assist with performing clinical procedures as there were a limited number of nurses and they were very busy with their work. On 6 July 2023, 2 new patients with urinary tract infection were admitted to the wards, both requiring urine cultures by urinary catetherisation. Due to my lack of experience, it took me a long time to perform it. In the end, I had to work overtime till 12:15AM.

On 15 July 2023, I starting feeling feverish and tired. After taking some rest during work and getting help from my friend, I could finish all my work on that day. On the following day, I visited the outpatient clinic at my hospital and the doctor suspected I had Dengue fever. Although my Dengue rapid combo test was negative, my blood counts were suggestive. I didn't have to be hospitalised and I was given 3 days of sick leave from 16 to 18 July 2023. I felt much better and could resume work on 19 July 2023.

In the following weeks, there was a shortage of HOs, with only 2 or 3 HOs working in the ward every day. As a result, my work became extremely busy and I had to work overtime a lot. Thankfully, the MOs were quite willing to help with the active plans and afternoon reviews. I also had to do solo night shifts every week. That was quite challenging as I had to manage both the ward and NICU on my own and there was a lot of work to do.

On 8 August 2023, it was the mini-CEX assessment and I passed it with a good score of 24/30. On 13 August 2023, I delivered another CME presentation on Child with Bleeding Problems. Later that month, several new HOs joined the Paediatrics posting and I finally didn't have to do solo night shifts anymore. At that time, I had become very good at performing intravenous cannulations and urinary catetherisations. I could also work much faster in the ward.

One night around 10PM, I and my colleague were told by the MO to take a blood culture and urine culture for a patient before going home. My colleague assisted me and I managed to do it all in just 15 minutes. I and my colleague could go home before 10:30PM and she was quite glad about that. On 22 August 2023, I took the CBD assessment and managed to get an excellent score of 28/30. I successfully completed the posting without any extensions. 2 September 2023 was my last day of work in the Paediatrics posting. I had 3 days of end-of-posting break from 3 to 5 September 2023.

6th posting - Anaesthesiology:

My 6th posting was an elective posting where I could choose either Emergency Medicine or Anaesthesiology. I chose Anaesthesiology as I found it more suited for me compared to Emergency Medicine. I started the Anaesthesiology posting on 6 September 2023. My 1st week of tagging was in the OT while my 2nd week of tagging was in the ICU. I submitted my application for MMC Full Registration at that time.

There were several new skills I had to learn, particularly intubation, general anaesthesia, spinal anaesthesia, arterial line insertion and central venous line insertion. I could pick up arterial line insertion quite easily, but I found the other skills quite challenging. Thankfully though, the MOs and specialists were always willing to teach HOs, motivating me to learn. Knowledge in physiology and pharmacology are very important for Anaesthesiology. I already had a good amount of knowledge in them and I worked to gain even more knowledge.

I really enjoyed working in the ICU. Just like the NICU, the nurses were very willing to assist in performing clinical procedures. As the ICU only had 9 beds, there wouldn't be too many patients or active plans. All patients in the ICU had to be reviewed 4 times daily. HOs are only allowed to review patients together with MOs or specialists during ward rounds, so we didn't have to come early in the morning to review patients.

On 19 September 2023, I took the off-tag assessment. Although I managed to pass it in my first attempt, there were certain areas which I had to improve my knowledge on. There were far fewer HOs in Anaesthesiology compared to other postings. However, as HOs only play a supportive role with the main focus on training, the workload is quite low. All night shifts were solo night shifts, but we would only be allocated to either one of OT, ICU or periphery, making it quite relaxing. We were allowed to have a lunch break and leave work on time every day, unless if there were emergencies.

There were frequent CME sessions in the Anaesthesiology posting. On 4 October 2023, I attended a course on Hands On Clinical Documentation Writing and Coding. On 22 October 2023, I was allocated to periphery for the first time. I had to go to the wards or ED to review the patients that were referred to Anaesthesiology. What makes it challenging is that any new patient could be referred at any time and the referral could be for an emergency intubation. However, we didn't have to carry out most of the active plans in periphery as it would be done by the primary team.

On 7 November 2023, I was finally granted my MMC Full Registration. I then proceeded with applying for my APC. Although I could perform very well as a HO in the ICU and was quite good at inserting arterial lines, I was still not skilled at performing intubation and spinal anaesthesia. Therefore, my mentor decided to allocate me to the OT more often. On 11 November 2023, I successfully performed intubation for the first time. Since then, I became much more confident with intubation.

I got a replacement holiday or annual leave once every 2 weeks. On 20 November 2023, I attended a course on Tracheostomy Care. During the course, there was an online quiz. I won the 3rd place in the quiz and got a desk lamp as the prize. On 21 November 2023, I delivered a CME presentation on Acute Pain Management. On 22 November 2023, I was granted my APC for 2024.

In the following week, I started having flu-like symptoms and lethargy. Later, my cough and sore throat worsened and my family members had similar symptoms as well. There was a Covid-19 outbreak at that time and our symptoms were suggestive of Covid-19, but our Covid RTK tests were all negative. I had to take 5 days of leave from 2 to 6 December 2023.

On 11 December 2023, I took the MCQ examination and managed to pass it. On 12 December 2023, it was the mini-CEX assessment which I passed with a good score of 25/30. On 19 December 2023, I delivered another CME presentation on Basic Pharmacology of Anaesthesia Related Drugs. At that time, I had performed intubation and spinal anaesthesia many times and I was quite experienced in them.

On 27 December 2023, I took the CBD assessment and got a great score of 25/30. I successfully completed the posting without any extensions. With that, I had successfully completed the entire House Officer training. 2 January 2024 was my last day of work in the Anaesthesiology posting. I had 3 days of end-of-posting break from 3 to 5 January 2024.

Conclusions:

Working as a House Officer is really stressful and challenging. However, I definitely gained a lot of clinical skills and knowledge. They will be very useful for me, regardless of which specialty I am pursuing in the future. The House Officer training at Kluang hospital is one with high standards. After completing House Officer training, I successfully gained Full Registration with the UK General Medical Council and I am eligible to apply for General Registration with the Medical Council of Ireland.

I performed particularly well in the Anaesthesiology and Paediatrics postings and I am proud of myself for that. Anaesthesiology and Paediatrics surely are my favourite postings. I am glad to have some really nice friends with me during my House Officer training. They definitely made the experience much more bearable. I cherish my time with them so much and I hope I will cross paths with them again in the future.

If you liked this story, you may want to read this too:
https://daniellimjj.blogspot.com/2021/08/my-teaching-fellowship-at-numed.html

Friday 9 February 2024

My GMC Full Registration

As a Newcastle University Medicine Malaysia (NUMed) graduate undergoing House Officer training at Kluang hospital, I am eligible to apply for Full Registration with the UK General Medical Council (GMC) after completing 3 postings, through the ARCP programme.

On 6 December 2022, I completed the 3rd posting of my House Officer training in Orthopaedics, fulfilling the requirements for the ARCP. That was after I got extended by 2 months in the Obstetrics and Gynaecology (O&G) posting and 1 month in the Orthopaedics posting.

The next ARCP meeting would be held in June 2023. On 10 May 2023, I submitted all of the required documents to the ARCP panel, well ahead of the deadline. In late June 2023 after the ARCP meeting took place, my batchmates received the outcome of their ARCP, but I didn't receive it.

On 7 July 2023, much to my disappointment, I was informed that my ARCP was unsuccessful due to the fact that I required extensions in the O&G and Orthopaedics postings and some concerns were raised by my clinical supervisors in those postings.

Consequently, the ARCP panel required me to complete another posting in House Officer training without an extension and with a satisfactory logbook and clinical supervisor's report. As I got extended by 1 month in my 4th posting in Surgical as well, that posting couldn't be taken into consideration.

I had received an offer for the highly competitive F2 Stand-alone Programme in UK due to begin in August 2023, which was subject to GMC Full Registration. Due to my unsuccessful ARCP, I couldn't get GMC Full Registration in time to join the F2 Stand-alone Programme. I had no choice but to withdraw from it.

On 6 September 2023, I successfully completed my 5th posting in Paediatrics without any extensions. I received my clinical supervisor's report for Paediatrics on 31 October 2023. I then submitted my Paediatrics logbook and clinical supervisor's report to the ARCP panel.

The next ARCP meeting was supposed to be held in December 2023. However, it got postponed to the next month due to unforeseen circumstances. On 6 January 2024, I successfully completed my 6th posting in Anaesthesiology without any extensions and successfully completed the whole of House Officer training.

In late January 2024 after the ARCP meeting took place, the ARCP panel informed me that they would also like to review the logbook and clinical supervisor's report for my 6th posting as well as my Certificate of Completion of Housemanship Training (CCHT). I received my clinical supervisor's report for Anaesthesiology and my CCHT on 1 February 2024. I then submitted both documents to the ARCP panel.

On 9 February 2024, the ARCP panel finally informed me that my ARCP was successful. I had been granted a Certificate of Experience which enabled me to apply for Full Registration with GMC. On 11 February 2024, I submitted my application for GMC Full Registration.

GMC then informed me that as part of my application for Full Registration, they required a completed Postgraduate Professional Experience (PPE) form and a Certificate of Good Standing (COGS) from the Malaysian Medical Council (MMC).

I submitted the PPE form promptly and applied for a COGS from MMC. On 25 February 2024, MMC approved my application for COGS and sent it to GMC. On 27 February 2024, I was finally granted GMC Full Registration.

With GMC Full Registration and having completed 2 years of House Officer training, I am eligible to apply for specialty training programmes in UK. From now on, I will always have a backup option available. For now, I have no plans to go to the UK, as I intend to complete my compulsory service with the Ministry of Health of Malaysia.

Saturday 6 January 2024

End of my House Officer training

After 2 years and 4 months, I have finally completed my House Officer training at Kluang hospital on 6 January 2024. I surely gained a lot of clinical experience, skills and knowledge. This journey has been one full of stress and challenges. Despite that, I have always persevered just so that I can achieve my dream. Thanks to all those who have been giving me continuous support and encouragement.

You can read about my House Officer training experience here:
https://daniellimjj.blogspot.com/2024/02/my-house-officer-training-at-kluang.html

Thursday 7 December 2023

My MMC Full Registration and APC

Following the completion the 5th posting of my House Officer training on 6 September 2023, I have gained my Full Registration with the Malaysian Medical Council (MMC). Subsequently, I have also gained my Annual Practising Certificate (APC) for 2024.

With this, I am now ready to pursue my dreams!

Thursday 9 November 2023

A weird dream (Nov 2023)

On 8 November 2023, I had a really weird dream.

In my dream, my hospital organised an exchange programme for House Officers. Selected House Officers would be sent to work at hospitals in various locations all over the world, while trainee doctors from those countries would come to Malaysia and work at our hospital.

I was one of the House Officers selected for the exchange programme. I saw the name list which stated that I would be sent to London, UK. I was so excited and I quickly agreed to join the programme. The flight tickets were funded and arranged by the government, all I had to do was to board the plane with my personal belongings. 

On the plane, I looked through the name list for the exchange programme once again. I was shocked to find out that I had made a terrible oversight earlier. It's my colleague, not me, that would be sent to London, UK. Instead, I would actually be sent to Ulaanbaatar, Mongolia! I didn't even realise that I boarded the flight to Ulaanbaatar.

That made me feel quite scared. Mongolia has a very different living environment and culture compared to Malaysia, and I have never been to Mongolia before. Mongolia also doesn't have a developed healthcare system, so working as a doctor there would surely be challenging. Unfortunately, there was no turning back for me at that point.

After landing in Ulaanbaatar, a car came to fetch me from the airport. Travelling through Ulaanbaatar, I could see a lot of forests and villages which looked quite similar to those in Malaysia. Surprisingly, I didn't see any deserts or yurts (round tents) which Mongolia is famous for. I wondered, is that really Ulaanbaatar?

At one point of the journey, the main road ahead was closed for construction works. To bypass that, the driver made a turn into a smaller road and drove through a few villages. The rural scenes looked quite nice and were reminiscent of those in Kluang. I thought, perhaps being sent to Ulaanbaatar isn't that bad after all.

After some time, we emerged back onto the main road and continued our journey. The driver told me that Ulaanbaatar was fast developing and that's why there's a lot of road constructions. He also said he was sure I would like the place after staying there for some time.

Then, I arrived at the townhood where the hospital was located. There was a sharp change in the surrounding environment. There was no more forests, as that was a desert area. Still, I didn't see any yurts. There were a few concrete buildings, with their signboards written in Mongolian Cyrillic.

I began feeling uncomfortable about being in a desert area. After the driver dropped me off at the hospital residences, the first thing in my mind was to get some food, as I was feeling hungry. I didn't even bother taking a look around the residences or the hospital. There was only one restaurant in that area, so I went there straight away.

As it turned out, the staffs at that restaurant could only speak Mongolian, not English or Chinese. I don't know Mongolian at all and I couldn't communicate with them no matter how I tried. They then refused to entertain me further. In the end, I left the restaurant without getting to eat anything. There was nowhere else I could get food, and I was so hungry.

I felt really jealous of my colleague who got sent to London, UK. This question kept going through my mind "Why did they send me to Mongolia instead of UK?" I then decided that I should leave the exchange programme and return to Malaysia as soon as possible.

I wanted to immediately send a message to my hospital to tell them to bring me back to Malaysia. I knew I had to provide a good reason for that, so I thought hard to come up with one. Then, I suddenly woke up from my dream. I was so glad that it's just a dream.

P/S:

In reality, November 2023 is the penultimate month of my housemanship at Kluang hospital. This dream may reflect the uncertainty regarding my future after completing housemanship. In the dream, I had no control over whether I would get selected for the exchange programme, where I would be sent to for the exchange programme, and whether I could quit the programme.

Being sent to Mongolia and feeling so scared about it in the dream could be a representation of my fear of being allocated to a district hospital in a rural area as a Medical Officer. Several of my friends from NUMed are currently working in UK and they are enjoying it a lot, which might be why I got jealous of my colleague who got sent to UK in the dream.

Lately, I have been going around exploring Kluang, especially the rural areas. That was probably the reason I dreamt about travelling through the rural areas in Ulaanbaatar and reminiscing about Kluang. I was feeling really hungry in the dream probably because working as a doctor often requires me to work long hours without having lunch.

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

Thursday 19 October 2023

NUMed MedX talk presentation slides

Since 2021, I have delivered several medical lectures as part of the MedX talk series of the NUMed Medical Education (MedEd) Society. The presentation slides of the lectures are available here. They are based on the UK guidelines.

Title: Bleeding Problems in Children
Date: 19 October 2023

Title: Intestinal Obstruction
Date: 25 February 2023

Title: Menstrual Disorders and Vaginal Discharge
Date: 19 April 2022

Title: Haematological Malignancies
Date: 28 November 2021

Title: Acute Red Eye
Date: 3 April 2021

Title: IV Fluid Management in Adults
Date: 27 March 2021

Thursday 21 September 2023

Why I chose Anaesthesiology?

For the elective posting of my housemanship, I chose to do Anaesthesiology. Why did I make this decision?

During the orientation at the start of my housemanship, we were told that the 6th posting of housemanship is an elective posting, where we could choose either one of Emergency Medicine, Anaesthesiology, General Practice and Psychiatry. I had always found General Practice and Psychiatry quite interesting, and the work is generally quite relaxing in these two specialties.

I immediately told myself that I must choose General Practice or Psychiatry. However, much to my disappointment, I soon found out that at my hospital, only Emergency Medicine and Anaesthesiology are available for the elective posting. I didn't like either Emergency Medicine or Anaesthesiology. 

Anaesthesiology is an area of Medicine which I had very little exposure to. There was no Anaest rotation in my MBBS course, and I hardly ever read up anything about it. I always had the impression that Anaesthesiology is very difficult because there's so many things to learn.

On the other hand, Emergency Medicine requires doctors to work very fast, which I had always been very bad at. I need to think before doing something, or else I would make mistakes or omissions. However, patients going to the Emergency Department may be very ill which requires urgent treatment.

Having to choose between Emergency Medicine and Anaesthesiology, I felt that Emergency Medicine surely would be more suited for me. At least, I had good theoretical knowledge in Emergency Medicine, unlike Anaesthesiology which I had so little knowledge in. Therefore, I made the preliminary decision to choose Emergency Medicine for the elective posting.

During my 1st housemanship posting in Medical, I often had contact with the Anaest team, who will come to review and manage the acutely ill and unstable patients in the Medical ward. I found the Anaest team quite terrifying. Whenever I saw them, I knew it meant there's some unstable patients which require a lot of work to manage. I also never really understood the Anaest management plans which looked so complicated. That made me want to stay away from doing Anaesthesiology.

Meanwhile, I had very little exposure to the Emergency Department throughout my Medical posting, so I didn't know how working there is like. House Officers in the Medical posting generally only work in the wards and they rarely get called to the Emergency Department.

After I got into my 2nd posting in Obstetrics and Gynaecology, I was allocated to the labour room and pregnancy assessment centre (PAC) for the first 3 months. I found the labour room and PAC a very stressful place to work at. For each patient that comes to the PAC, we have to take a full history, do abdominal and vaginal examination, insert an IV cannula, take bloods, perform CTG and plan the management. We also have to document everything properly in the clerking sheet and present the case to an MO.

Clerking a new patient at the PAC is a long and tedious process, taking 30 minutes at the minimum. Patients may come to the PAC at any time of the day and it's impossible to predict that at all. Sometimes, a new patient may come in before I'm done clerking a previous patient, or two or more patients may come at the same time. Whenever that happened, I would get panicked as I knew there would be a lot of work awaiting me.

House officers have always been told to prioritise the work when it gets busy. However, even with job prioritisation, we still have to complete all of the work at the end of the day. We are also expected to work fast and to multitask, which is something I'm very bad at.

Any of the patients at the labour room and PAC may have an emergency at any time, with common examples being pathological CTG, meconium stained liquor and bleeding. Whenever that happens, we have to stop doing whatever we are doing and attend to it immediately. I don't like leaving my work uncompleted and resuming later, as that greatly increases the risk of making mistakes and omissions, yet I'm forced to do so during an emergency.

I soon realised that the PAC is basically the Emergency Department for Obstetrics and Gynaecology. I felt that working at the real Emergency Department (ED) would surely be very stressful in a similar way, in fact it likely would be even worse than the PAC. Patients with all kinds of conditions of any specialty may come to the ED anytime, and we need to be able to manage them quickly and appropriately. I began to think that Emergency Medicine isn't for me.

By April 2022, I had decided that I wouldn't want to do Emergency Medicine for my elective posting of housemanship. That meant my only option would be Anaesthesiology. I began exploring Anaesthesiology. Whenever I entered the operating theatre for caesarean sections, I would take a look at how the Anaest team performs spinal or general anaesthesia. I could gain a bit of understanding about anaesthesia and I found it rather interesting.

In the subsequent Orthopaedics and Surgical postings, I often had to go to the ED to see new cases. I never enjoyed working at the ED, as I found the work environment there so stressful, especially when there's a lot of patients. I was even more convinced that I mustn't do Emergency Medicine.

The Anaest team reviews and manages the acutely ill and unstable patients in the Orthopaedic and Surgical wards as well. I made it a point to get to know and understand the management plans by the Anaest team. I also made sure to properly carry out the plans and communicate with the Anaest MOs regarding that. That enabled me to know the Anaest MOs better, and I felt that most of them are actually quite nice. I no longer found the Anaest team terrifying.

Later, someone remarked that he thinks I'm not suitable to do Anaesthesiology, so my only option would be Emergency Medicine which I should prepare for. I don't agree with what he said at all and I am determined to prove him wrong. That gave me the push for doing Anaesthesiology.

My friends who did the Anaesthesiology posting at my hospital gave really good remarks regarding it. According to them, Anaest has a really nice work environment, and the Anaest MOs and specialists are very willing to teach and guide house officers. Moreover, the workload in Anaest is generally quite manageable and house officers in Anaest rarely have to work overtime. That made the Anaest posting even more attractive for me.

A widely touted advantage of doing Emergency Medicine for the elective posting is that it gives us the opportunity to work as locum doctors at the ED of private hospitals, getting an additional source of income. Most private hospitals will only hire doctors with work experience in Emergency Medicine to work at their ED. While I appreciate that it may be beneficial to some people, I personally have zero interest in it.

I just don't like working at EDs, whether at public or private hospitals. The work experience as a locum doctor also contributes nothing towards becoming a registered specialist. Moreover, right from the beginning, I chose to do Medicine to help people, not to make big money. Working at a private hospital would go against that very principle of mine. Therefore, there's no reason for me to do Emergency Medicine at all.

In June 2023, I made the firm decision to do Anaesthesiology for my elective posting of housemanship and I communicated my decision to the hospital. I then received confirmation in August 2023 that I have been placed in Anaesthesiology. I started the Anaest posting on 6 September 2023.

Anaesthesiology has a rather steep learning curve compared to other postings, as there's many new things to learn. Despite that, the enthusiasm of the MOs and specialists in teaching and guiding house officers has enabled me to gain a lot of new knowledge and skills without much difficulties. I am confident that I will be able to master Anaesthesiology.

I hope the Anaest posting will be a great and satisfying ending to my housemanship.

Thursday 31 August 2023

My first time voting in an election

When the 1999 Malaysian general election was held, I was only 4 years old. I had absolutely no knowledge about it. The 2004 Malaysian general election was the first time where I knew what an election is. However, I didn't really understand its significance, and I got annoyed when I kept hearing people talking about the election.

By the time of the 2008 and 2013 Malaysian general elections, I had understood the importance of elections. I closely followed the news of the 2008 and 2013 elections. However, I still had little understanding about the parliamentary system in Malaysia.

The 2018 Malaysian general election was the first in which I was eligible to vote. Automatic voter registration hadn't been implemented for that election. I was in Year 4 of MBBS at that time. Considering that I would be in UK for my medical electives during the time of the election, I decided there was no point in registering for the election.

Although I was aware that it's possible to vote overseas, I felt that it was too big of an hassle so I didn't sign up for it. Due to the extensive news coverage of the election, I finally understood for the first time how the parliamentary system works in Malaysia. I told myself I should vote in the next election.

In September 2020, I found out from my friend that voter registration can be done easily through the MySPR website. I finally registered as a voter for the first time. I then got the confirmation that I would be voting in the Subang parliamentary constituency and in the Subang Jaya state constituency for Selangor.

I started my housemanship at Kluang hospital in August 2021. During the 2022 Malaysian general election, I was in the Orthopaedics posting and there was a lack of House Officers in the department. As a result, I couldn't apply for leave to go back to Selangor to vote in the election.

Since I am a healthcare worker, I could vote in the election through post. However, before I could complete the application process for postal voting, its deadline had passed. In the end, I couldn't vote in the 2022 Malaysian general election.

In the subsequent 2023 Selangor state election, I was determined to vote. I was in the Paediatrics posting during this election. Once again, there was a lack of House Officers which made it difficult for me to apply for leave. Therefore, I decided to vote through post.

As soon as the application for postal voting was open, I quickly applied for it, not wanting to miss the deadline again. I applied through the MySPR website, and as part of the application, I had to let my Head of Department sign the application form to verify that I would be working on the polling day.

My application for postal voting was approved. On 2 August 2023, shortly after the nomination day for the 2023 Selangor state election, the ballot paper was delivered to my house in Kluang through Poslaju. I then voted and returned the ballot paper. The polling day was on 12 August 2023.

I am glad to have exercised my responsibility as a voter for the first time. I certainly will be voting in future elections as well.

Saturday 5 August 2023

Dark mode for this blog

In view of the popularity of dark mode, I have now switched my blog to dark mode. This should help reduce eye strain and glare when you are reading it in low-light conditions and help reduce battery consumption.

Thanks for your continuous support!

Sunday 2 July 2023

NUMed ARCP Reflections Sample

Graduates of Newcastle University Medicine Malaysia (NUMed) who wish to apply for Full Registration with the UK General Medical Council (GMC) have to submit 3 pieces of reflections for the Annual Review of Competency Progression (ARCP).

Here, I am sharing my ARCP reflections. They are in a single PDF file. You may use them as a guide if you are seeking to apply for GMC Full Registration. However, please note that plagiarism is strictly prohibited.

Link:

Thursday 15 June 2023

GMC Full Registration programme for NUMed graduates

Newcastle University Medicine Malaysia (NUMed) runs a programme that enables its graduates to gain Full Registration with the UK General Medical Council (GMC) after completing a year of House Officer training at one of the 8 approved hospitals in Malaysia. This programme recognises the House Officer training as being equivalent to Foundation Year 1 (F1) in UK.

I underwent House Officer training at Hospital Enche' Besar Hajjah Khalsom, Kluang and I gained GMC Full Registration through the programme. Here, I would like to share some guidance for the programme.

The requirements for getting GMC Full Registration through the programme:

- You must be a graduate of the NUMed MBBS course.
- You must undergo House Officer training at one of the 8 hospitals approved by GMC:
(i) University of Malaya Medical Centre (UMMC), Kuala Lumpur
(ii) Hospital Enche' Besar Hajjah Khalsom (HEBHK), Kluang
(iii) Hospital Sultan Ismail (HSI), Johor Bahru
(iv) Hospital Sultanah Aminah (HSA), Johor Bahru
(v) Penang General Hospital
(vi) Hospital Sibu
(vii) Sarawak General Hospital, Kuching
(viii) Queen Elizabeth Hospital, Kota Kinabalu
- You must have Provisional Registration with GMC by the time you start working as a House Officer.
- You must complete 3 postings in your House Officer training successfully and keep the complete logbooks for the 3 postings.
- You must complete the Additional Procedures Form.
- You must complete the Your School Your Say (YSYS) survey and the Equality and Diversity (E&D) module.
- You must complete 3 pieces of reflective accounts. A sample of the reflective accounts is available here: https://daniellimjj.blogspot.com/2023/07/numed-arcp-reflections-sample.html
- You must keep in contact with NUMed and update NUMed regarding your progress in House Officer training when necessary.

The procedure for getting GMC Full Registration:

1. After you get a place for House Officer training at one of the approved hospitals, apply for Provisional Registration with GMC as soon as possible. You have to apply through GMC Online and pay GBP52 to GMC.
2. Email NUMed to inform that you would like to register for the programme. NUMed will send you the application form, Additional Procedures Form and Template for Reflections.
3. Complete the application form and pay RM2000 to NUMed. This should be done within 3 months of starting your House Officer training.
4. Within the first year of your House Officer training, complete the Additional Procedures Form and ensure that it is properly signed and stamped. You also have to write 3 pieces of reflective accounts based on the Template for Reflections.
5. At some point during your House Officer training, NUMed will send you the links for Your School Your Say (YSYS) survey and Equality and Diversity (E&D) module. Complete them accordingly.
6. If you have any extensions or unanticipated absence in your House Officer training, you need to inform NUMed about that promptly.
7. You have to complete 3 postings in House Officer training successfully. Ensure that you have complete logbooks that are properly signed and stamped for the 3 postings.
8. Once you have completed all of the above, you have to inform NUMed about that.
9. You will undergo the Annual Review of Competence Progression (ARCP). NUMed will inform you the date of the ARCP.
10. Once you are successful in the ARCP, you will be granted a Certificate of Experience which enables you to apply for Full Registration with GMC.
11. To apply for GMC Full Registration, you have to go to GMC Online and pay GBP166 to GMC.
12. GMC will send you a Postgraduate Professional Experience (PPE) form which you have to complete. You also have to apply for a Certificate of Good Standing (COGS) from the Malaysian Medical Council (MMC) through MeRITS, which requires you to pay RM500.
13. Once MMC approves your COGS and sends it to GMC, you will be granted GMC Full Registration.

The benefits of GMC Full Registration:

- Right after you gained GMC Full Registration, you are eligible to apply for the Foundation Year 2 (F2) Stand-alone programme in UK. After completing F2, you may apply for specialty training programmes in UK.
- There are also various locum posts in UK you can apply for with GMC Full Registration.
- If you choose to complete the 2nd year of House Officer training in Malaysia after gaining GMC Full Registration, you may apply for specialty training programmes in UK directly.
- Some other countries recognise GMC Full Registration, so you may be able to practise Medicine in those countries.
- Unlike GMC Provisional Registration, GMC Full Registration doesn't expire and is valid indefinitely.

Other information:

- In addition to this programme, NUMed graduates have the option of joining the 2-year UK Foundation Programme (UKFP).
- NUMed graduates are exempted from taking the PLAB, IELTS and OET when applying for Provisional Registration or Full Registration with GMC.
- House Officer training in Malaysia is only open to Malaysian citizens. Therefore, non-Malaysian citizens are unable to join the programme.
- If you do not fulfill every single one of the requirements for the programme (e.g. you are not a NUMed graduate or you are doing House Officer training at a hospital not approved by GMC), you are not eligible to join it.
- If you are not eligible for the programme, it may still be possible for you to apply for GMC Full Registration provided that you have completed a year of House Officer training at any hospital. In that case, you need to apply to GMC directly and they can take into consideration your work experience as a House Officer. However, the process is quite complicated and there is no guarantee of success.
- Other hospitals may be added to the list of hospitals approved by GMC in the future, but no information on that is available currently.

For more information on this programme, go to these pages:

You can read about my experience with this programme here:
https://daniellimjj.blogspot.com/2022/12/my-gmc-full-registration.html

Tuesday 16 May 2023

My application for the F2 Stand-alone Programme 2023

The Foundation Year 2 (F2) Stand-alone Programme in UK enables doctors who hold or are eligible for Full Registration with the UK General Medical Council (GMC) to directly enter the 2nd year of the UK Foundation Programme (UKFP). As a NUMed graduate who had completed a year of House Officer training at an approved hospital in Malaysia in December 2022, I was eligible to apply for GMC Full Registration through NUMed's ARCP programme.

Unlike the standard 2-year UK Foundation Programme where almost all eligible applicants are offered a place each year, the F2 Stand-alone Programme is much more competitive. In the recent years, there are 1000+ applicants but only about 100 places each year. This means just around 10% of the applicants can get a place, making it about as competitive as getting the Merit award at NUMed or getting a permanent Medical Officer post in Malaysia.

In January 2023, I submitted my application for the F2 Stand-alone Programme 2023. Never in my wildest dreams had I thought that I would get a place for the F2 Stand-alone Programme with such extreme competition. Still, I applied for it because I wanted to see how far I could go. I also knew that there were some useful things I could learn through the application process even if it wasn't successful.

In February 2023, my application was successfully longlisted and I was invited to book a slot for the Situational Judgement Test (SJT). My SJT was held online on 1 March 2023. I successfully got a very high score of 368/431 for the SJT. My previous experience of taking the SJT as part of my applications for the 2-year UKFP in 2021 and 2022 certainly helped in achieving this.

With that, I was successfully shortlisted for an interview. My interview was held online on 18 April 2023. I managed to perform quite well in the interview, getting a score of 71%. This was thanks to my teaching and research experience which helped build a strong curriculum vitae, as well as my good English language and communication and my good response in the ethical scenario.

On 26 April 2023, I was deemed appointable for the F2 Stand-alone Programme. I was ranked 149 out of the 222 appointable applicants and I was invited to rank all available posts based on my preferences. There were 157 posts available for the F2 Stand-alone Programme 2023, which meant that I definitely would be getting a place! I was over the moon.

On 15 May 2023, I was formally offered a place for the F2 Stand-alone Programme 2023 at South Tees NHS Foundation Trust. My successful application for the F2 Stand-alone Programme has shown that with the right efforts and opportunities and a bit of luck, I too can achieve what seems to be beyond my reach. It makes me hopeful of my future, that I will successfully achieve my career goal.

Unfortunately on 7 July 2023, I was informed by NUMed that my ARCP for GMC Full Registration was unsuccessful, due to the fact that I required an extension to training in my 2nd and 3rd placements in House Officer training and some concerns were raised by my clinical supervisors in those placements. Consequently, the ARCP panel required me to complete another placement in House Officer training without an extension before I could apply for GMC Full Registration.

That meant I would only be getting my GMC Full Registration in October 2023 at the earliest, long after the F2 Stand-alone Programme start date on 2 August 2023. It's not possible to join the programme without GMC Full Registration. Therefore, I had no choice but to withdraw from the F2 Stand-alone Programme 2023. I definitely felt very disappointed and devastated. I had successfully overcome an extreme competition to get a place, only for it to be taken away from me in the end just because of an unsuccessful ARCP.

In February 2024, my ARCP was finally successful and I was then granted GMC Full Registration. At that time, I had completed 2 years of House Officer training in Malaysia, making me eligible to apply for specialty training programmes in UK directly. Therefore, I decided not to apply for the F2 Stand-alone Programme 2024.

Saturday 29 April 2023

Why I chose the Google Pixel 6A over the iPhone?

In April 2023, I got my new phone, the Google Pixel 6A. I can say that I am very impressed with this phone. It has a Google Tensor processor, 128GB of storage and 6GB of RAM. It runs very fast and it's battery lasts quite long, and the quality of its camera is excellent.

Google Pixel phones have never been officially sold in Malaysia. I had to buy the Google Pixel 6A online through Lazada. It costs a total of RM1400 including delivery, mobile protection service, screen protector, phone case and some free gifts, and the phone is a brand new set. I certainly think it's a very good value for money. Just like the latest iPhones and Samsung phones, it doesn't come with a charger, but I can use my old phone's charger.

My previous phone was the Google Pixel 2. I had used it for more than 5 years since December 2017, and it had been functioning well. However, its camera stopped working in April 2023. Since the camera is an important feature which I use a lot, I had to get a new phone.

In 2021, someone hacked my Google account and used it to create several Google Ads accounts, trying to make me pay for that. When I seeked help from Google, they were extremely unhelpful. They stated that they could only help me after I provided them with the IDs of those Google Ads accounts, but when I gave them the IDs, they insisted those IDs were invalid and refused to proceed with helping me resolve the issue. I was really upset with Google over that.

Google Pixel phones didn't support VoLTE in Malaysia, as they are not officially sold here. Worse still, 3G networks in Malaysia were shut down in late 2021. Consequently, Google Pixel phones could only use 2G for making and receiving phone calls. If I received a phone call while browsing the internet, the phone would automatically switch the network to 2G, and the low speed of 2G would interrupt the internet connection. The aging infrastructure of 2G networks also resulted in a subpar call quality.

Consequently, I decided in 2021 that I would never get another Google Pixel phone again and my next phone would be an iPhone. However, the circumstances changed over the course of 2022 and 2023.

Apple introduced iPadOS 13 in 2019. It introduced a lot of new features which brought the iPad much closer to being a laptop replacement. That contributed heavily to my decision to buy the iPad Air 3 in August 2019. I was hopeful that future versions of iPadOS would make the iPad even more useful, eventually becoming a true laptop replacement. Unfortunately, that wasn't the case. iPadOS 14 didn't bring any significant new features apart from Universal Search which is just a glorified Spotlight search. iPadOS 15 introduced a much needed new multitasking interface, but didn't go far enough.

iPadOS 16 in 2022 finally introduced Stage Manager which gives a multi-window interface similar to those in desktop operating systems. Unfortunately though, Stage Manager was only available for the iPad Air 5 and iPad Pro 3 and later. My iPad Air 3 will never get the Stage Manager, neither will the iPad Air 4 or iPad Mini 6. I was deeply disappointed with Apple about that. It wasn't even the first time something like this happened. Previously in 2015, Apple introduced the Split View feature with iOS 9, but only made it available for the iPad Air 2, leaving out my iPad Air 1.

In August 2022, the power button of my iPad Air 3 stopped functioning, while issues with its Lightning connector port made changing more and more difficult. This was despite the fact that I always took good care of my iPad. Knowing that an official Apple service centre would charge a hefty price for repairing due to my iPad being out of warranty, I got my iPad Air 3 repaired at a third-party repair shop.

While the repair went well, just a few months later in April 2023, my iPad Air 3 started having another major issue. Every few minutes, it will display a purple screen and then restart on its own. I had tried resetting the iPad, upgrading to the latest iPadOS version and even erasing all data on the iPad, but the issue persisted. My iPad Air 3 is less than 4 years old and it's already having so much issues. In contrast, my Google Pixel 2 lasted more than 5 years without significant issues. This indicates that the quality of Apple products is going down the drain. How can I be confident that an iPhone will last long if I buy one?

Apple has insisted on using the Lightning connector port on iPhones, even though iPads, Macbooks and most Android phones have switched to USB-C ports. The Lightning connector port is an outdated technology. It only supplies a very small amount of power to connected accessories which is often insufficient for them to function properly. The data transfer speed of Lightning cables is also significantly lower compared to USB-C cables.

iPhones are very expensive. Even the most basic iPhone 14 costs RM4200. I bought my Google Pixel 2 phone for RM4000, which was very expensive as well. However, Google later introduced the cheaper A series of Pixel phones, starting with the Google Pixel 3A in 2019. The A series of Pixel phones are often available for sale on Lazada at a price less than RM2000.

I have considered Android phones other than Google Pixel. Samsung is the most popular brand of Android phones. However, I don't like the fact that Samsung heavily modifies the interface of Android and adds a lot of bloatware in its phones. I used a HTC phone before and I really liked it, but HTC hasn't produced a flagship phone in quite a while. While Huawei phones are great, they are banned from Google apps and services which are essential for me. Nokia was initially doing well after it started producing Android phones, but it has been struggling to keep up with Android updates for some time. Meanwhile, I have little interest in Asus, LG, Lenovo, Motorola, Sony, Oppo, Vivo and Xiaomi.

There are 3 things I have always liked about Google Pixel phones. First, Pixel phones, including the cheaper A series, have excellent hardware specifications. Second, they receive Android version updates and security updates as soon as they are available. Third, they offer the pure Android experience, without any user interface modifications or addition of bloatwares. 

In late 2022, in response to popular demand, Google finally released an update which added support for VoLTE for Pixel 6, Pixel 6A and Pixel 7 in Malaysia. However, older Pixel phones including the Pixel 2 aren't supported. With that, I was once again interested in getting a new Google Pixel phone for my next phone. This eventually culminated in my decision to buy a Google Pixel 6A in April 2023.

Wednesday 15 March 2023

Tips for UKMLA AKT and PLAB 1

Starting from the 2024/2025 academic year, all final year medical students in UK medical schools, including Newcastle University Medicine Malaysia (NUMed), have to take the UK Medical Licensing Assessment (UKMLA) as part of their medical degree before graduating. The UKMLA has 2 parts, the Applied Knowledge Test (AKT) and the Clinical and Professional Skills Assessment (CPSA).

Currently, all medical graduates from non-UK medical schools, with the exception of NUMed graduates and graduates with a relevant European qualification, have to take the Professional and Linguistic Assessment Board (PLAB) in order to apply for provisional or full registration with the UK General Medical Council (GMC) and practise Medicine in UK. The PLAB has 2 parts, PLAB 1 and PLAB 2. Starting from 2024, PLAB 1 will be aligned with the UKMLA AKT while PLAB 2 will be aligned with the UKMLA CPSA.

The UKMLA AKT and PLAB 1 are in the form of a Single Best Answer (SBA) examination. I got a score of 75.5% for my final year SBA examination in 2020. I completed my MBBS course at NUMed and subsequently worked as a Teaching Fellow there. Here, I would like to share some tips on passing the UKMLA AKT and PLAB 1.

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.

First, you have to start your revision no less than 2 months before the UKMLA or PLAB. I recommend studying at least 5 hours per day on weekdays and 7 hours per day on weekends and holidays. If possible, you should revise every day. To pass the exam, you should aim for a score of at least 66%.

If you do not understand any topic when doing revision, ask a lecturer or a friend for further clarification. Personally, I do not find group study helpful for the SBA examination.

All specialties will be covered in the UKMLA AKT and PLAB 1, including:
- Internal Medicine
- Obstetrics and Gynaecology
- Paediatrics
- Psychiatry
- Surgery
- Trauma and Orthopaedics
- Ophthalmology
- ENT
- Dermatology

When revising, you should go specialty by specialty. Finish all topics in a particular specialty before moving on to the next specialty. Your focus when doing revision should be on risk factors, pathophysiology, diagnosis, investigations, management and complications. You should complete at least 4 full rounds of revision for all topics if possible.

Medicine should be studied 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. Even if your explanation is wrong, it does not really matter as the exam questions will not ask for the explanation. 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 UKMLA AKT or PLAB 1. You also need not memorise the doses of drugs apart from very commonly used ones.

The most important revision resource for the UKMLA AKT and PLAB 1 is the textbooks. I recommend using the following textbooks and resources for each specialty:
Internal Medicine - Oxford Handbook of Clinical Medicine (11th Edition)
Ophthalmology, ENT, Dermatology, Trauma and Orthopaedics - Oxford Handbook of Clinical Specialties (11th Edition)
Surgery - Oxford Handbook of Clinical Medicine (11th Edition) and Surgical Talk (3rd Edition) 
Psychiatry - Psychiatry by Ten Teachers (2nd Edition), Psychiatry - A Clinical Handbook and ICD-11
Obstetrics and Gynaecology - Obstetrics & Gynaecology by Lawrence Impey & Tim Child (5th Edition)
Paediatrics - Illustrated Textbook of Paediatrics (6th Edition)

These textbooks are not essential for the exam but may be helpful to refer to if you are looking for some specific information:
Davidson's Principles and Practice of Medicine, Kumar and Clark's Clinical Medicine, Apley and Solomon's Concise System of Orthopaedics and Trauma, Robbins Basic Pathology, Underwood's Pathology, Rang and Dale's Pharmacology

While Year 1 and Year 2 knowledge can be helpful at times, they are not essential for the UKMLA AKT or PLAB 1. There is no need for you to specifically revise any Year 1 or Year 2 topics.

You need to know the clinical guidelines for the more common conditions. Important guidelines are those that can be found in the textbooks, and you should look up the internet for the most up-to-date version of those guidelines. For obstetrics and gynaecology, use NICE and RCOG Green-top guidelines. For asthma, use BTS guidelines. For other conditions, use NICE guidelines. However, do not place too much emphasis on the guidelines, as it is more important that you revise the textbooks and understand the facts.

You should also do practice SBA exam questions. Go through all practice questions on the Medical Schools Council website and those provided by your lecturers. Passmedicine and Pastest have a large number of practice questions. They require paid subscription and I recommend that you subscribe to one of them. Some of the practice questions are similar in style to those in the UKMLA AKT and PLAB 1 while others are not. After finishing each practice question, check the correct answer and make sure you understand the reasoning behind every correct or wrong answer. Although doing practice questions is important, you should not prioritise it over revising the textbooks.

During the UKMLA AKT and PLAB 1, you will have a limited amount of time to answer each question. Therefore, you should always 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.

All the best in your revision! I hope you will be able to do well in the exam.

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