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 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.


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.


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:
- 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:

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
- 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:

Monday 27 February 2023

The reality of clinical practice

If you are thinking of doing Medicine, you should read the whole of this post first.

Perhaps you had been observing general practitioners (GPs) working in private clinics, that they just had to sit in an air-conditioned room, wait for patients to come to them, do some checking on the patients and prescribe some medications, then they could earn a lot of money every month. Perhaps you had been watching some movies or TV series, where you see doctors working in nice hospitals and going around to save lives, which looked so great and interesting. Perhaps you are thinking that being interested in Medicine and being caring to your patients and having good knowledge, communication and clinical skills is all it takes to be a good doctor.

Let me tell you this: The reality of clinical practice is very different from that, and there's so much more required to be a doctor. Here, I will be explaining in detail about how working as a doctor is actually like, based on my own actual experience. 

Just in case you don't already know this, you cannot work as a doctor in any private clinic or private hospital in Malaysia straight away after you graduated with the medical degree. You must first undergo 2 years of House Officer training in a public hospital. After successfully completing House Officer training, you must then work as a Medical Officer in a public hospital for at least 1 year to serve your compulsory service with the Ministry of Health. After completing your compulsory service, only you will be allowed to work as a doctor in a private clinic or private hospital. 

Even then, you will be facing tough competition from many other doctors who are also seeking to work in private clinics or private hospitals, which makes it challenging for you to operate your own private clinic or to get a job offer in a private hospital. To stand out, you will have to become a specialist. The process of becoming a registered specialist is very long and complicated. You will need to complete a recognised Master's or Parallel Pathway Programme, which involves working as a Specialist Registrar in a public hospital for several years. The fact is that, working as a House Officer, Medical Officer or Specialist Registrar in Malaysia is extremely stressful and challenging.

First, there's long working hours. Although the standard work hours for House Officers isn't too bad, you have to undergo 2 weeks of tagging at the start of each of the 6 postings in House Officer training. During the tagging period, your work hours is significantly longer, which is from 7AM to 10PM every day, for 6 days each week with only 1 off day. Such long work hours is extremely tiring. At the end of the 2 weeks, you have to take the off-tag assessment, which is often difficult as it demands a lot of knowledge and skills. The long work hours means that you won't have much time to study for the assessment. If you don't pass it, you will have to continue tagging. As for Medical Officers and Specialist Registrars, they have to routinely work on-call shifts, about 4-6 times every month. Each on-call shift is 33-hour long, continuously from 8AM until 5PM on the next day. Just imagine how tiring and stressful that is! The long working hours means that you have to make sacrifices on your meals, sleep, personal time and your time with family and friends. Yet, doctors are always expected to put their patients above everything else, even above their own wellbeing.  You can't even help yourself first, yet you have to help others.

Often, there's a lot of patients and insufficient doctors in public hospitals, which results in a very high workload for doctors. When that happens, doctors have to work fast which is very exhausting. Doctors are expected to prioritise the more urgent tasks. It's often the case that the more urgent tasks are also the more difficult tasks. Some people may find it more efficient to do the easier but less urgent tasks first, but that's not allowed. You absolutely don't have the freedom in work in your preferred style. Doctors are also expected to multitask, even though it greatly increases the risk of medical errors which may cause harm to patients. Routinely, you will be asked to stop whatever you are doing to perform another new task that's more urgent. If you are the kind of person who doesn't like leaving unfinished work hanging around, you will find that very annoying. Doctors may get called to see new patients at the Emergency Department at any time, no matter how busy they are in the wards. Doctors are expected to answer their phone promptly at any time of the day, even when they are in the middle of doing a surgery. At the end of the day, you still have to complete all tasks regardless of urgency. If you haven't completed them by the time your shift ends, you have to work overtime.

You may be thinking that doctors don't face bullying at work, because after all, a core aspect of Medicine is mutual respect and collaboration. I hate to tell you this, but doctors actually do face bullying quite routinely. Some superiors will scold you if something doesn't go right, even if you made no mistakes at all or it's something where you have no control over. In addition to scolding, they may even bring up your mistake in front of all your colleagues or issue you with a warning letter, which will make you feel really bad. Your superiors will almost always expect you to join them when they conduct ward rounds and to assist them when they perform clinical procedures or surgeries, even when you are busy with other tasks. It's not just joining ward rounds, you are also expected to engage proactively during ward rounds, failing which you can be penalised for poor attitude. While some ward rounds can be fun, others are quite tedious especially if they go on for a long time. Occasionally, your superior may tell you to do something that's outside the job scope of doctors, and you are expected to comply with their instructions no matter what.

As a doctor, you are expected to know and remember the cases of all patients under your care by heart. While information on every case is recorded in the patient notes, your superiors may expect you to present the cases to them without flipping through the notes. Not only you have to know the diagnosis, you also have to know the whole progress of each patient from the beginning of admission until now. That's a lot of information to memorise which makes it very challenging. All doctors come from a scientific background, which emphasises more on understanding rather than memorising. You may not like memorising things, yet you cannot avoid that. Sometimes, you may even be asked to recall information about a patient from a previous admission if you saw the patient previously, even if that was a long time ago. In addition, there are all sorts of guidelines and protocols which doctors are expected to memorise.

A major part of clinical practice is history taking, not just from patients but sometimes also from their family members. History taking may look fun and easy, but it can actually be a very tedious task. Different patients may have very different ways of communicating their illness, and you are expected to tailor your communication for each patient as well as to accurately interpret what they tell you. It's particularly challenging to get a full history from patients who have reduced consciousness, dementia or a mental disorder, often requiring you to get a further history from multiple sources including from their family members, which can take a lot of time. In addition, doctors routinely have to get technical information from patients as part of history taking, such as their previous medications, surgeries and investigations. Getting technical information from a non-technical person can be really challenging, as you have to translate technical terms into non-technical terms that they can understand and vice versa.

A lot of unexpected can happen in clinical practice. Any patient in the ward may deteriorate quickly at any time. Whenever that happens, doctors have to attend to the patient immediately. You will then have to spend a long time managing the patient which can be very stressful. If your workload is already very high, that will worsen it. Moreover, doctors have to be able to perform all kinds of clinical procedures. There may be some procedures which you have never learnt before in medical school or in previous stages of your training or only have very little experience with, yet your superiors may expect you to be good at them from day 1 of your work. Not all of your superiors will be willing to properly teach you how to perform a procedure. Sometimes, you can only learn it through observation which may be inadequate for complex procedures. If you try to perform a procedure which you are not skilled at and end up not doing it right, you certainly will have to be responsible for that.

There's also complaints and medicolegal issues that doctors have to face. Some patients and their family members may make complaints for the tiniest issues which may or may not be the doctor's fault, yet doctors have to answer for every complaint made about them. Sometimes, a patient just won't survive or will develop a severe complication despite doctors having tried their best and not doing anything wrong. Yet, if you are unfortunate enough, the patient's family members may sue you in court for that. You may like to help others out of your goodwill. In actual clinical practice though, you cannot do things out of your goodwill, instead you are fully responsible for every single thing you do and you cannot avoid doing your job. If you do something for your patient with good intentions, but you unintentionally made a mistake in the process that causes harm to your patient, you still have to face all of the consequences for that. Nobody will bother about your intentions and efforts, everyone only cares about the outcome of the patient. The harsh reality is that clinical practice is not goodwill, it's an immense responsibility. That's what makes it so stressful.

Despite of all the stress and challenges of clinical practice, some doctors still enjoy their job a lot, while others don't. It really comes down to the individual. I have several friends who joined Medicine only to have to quit later because they realised that it's not for them.

If you are thinking about becoming a doctor, you most definitely should do comprehensive research on the job of doctors first. I hope you have read through and understood everything in this post. You should go a step further by doing a clinical attachment at a public hospital for at least a few weeks so that you can actually experience how doing clinical practice is like in reality. After that, ask yourself an honest question, are you ready to face all the challenges of clinical practice and is this really what you want to do for the rest of your life? If you can confidently say yes, then congratulations, you should go ahead with doing Medicine! Otherwise, please do yourself a favour by staying away from Medicine and exploring a different field instead.

Friday 20 January 2023

International Recognition of MUET

The Malaysian University English Test (MUET) is an English language proficiency test in Malaysia, mainly used for university admissions. All public universities and vast majority of private universities in Malaysia accept the MUET.

Starting from 2021, there is a significant change in format of the MUET, and the band scores of the MUET are aligned to the Common European Framework of Reference for Languages (CEFR).

It is widely believed that the MUET is only recognised in Malaysia. In reality, the MUET does have international recognition as well, though that is quite limited for now. Here is a list of foreign universities that recognise and accept the MUET.

Branch of foreign universities in Malaysia:

Singapore Management University

Hong Kong:
Hong Kong Polytechnic University
Hong Kong Academy for Performing Arts

United Kingdom:
University of East London
Manchester Metropolitan University


United States of America: