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.


Tuesday 28 May 2024

Kluang: A place I will never forget

The first time I set foot in Kluang was in November 2016, as part of my clinical attachments in Stage 3 of MBBS. My impression about Kluang at that time was that it's a small town with many village-style houses. Subsequently, I went to Kluang several more times in 2017, 2019 and 2020. While I wasn't quite impressed with Kluang, I did have some really good memories with my friends in Kluang and I cherished that so much.

In June 2021, I made the decision to undergo my House Officer training at Kluang hospital. In early August 2021, I confirmed my House Officer placement at Kluang hospital. I rented a house at Bandar Seri Impian which is located near Kluang hospital. It's a partially-furnished new house that looks really nice, and the rental price is quite reasonable.

I moved to Kluang on 21 August 2021. In the beginning, I felt rather uncomfortable about living in Kluang, even though the house I rented was quite nice. During my first few days in Kluang, I went to the 99 Speedmart in Bandar Seri Impian and I explored some of the roads in the area. Somehow, the whole place just felt so weird and isolated. I was even unimpressed with Kluang Mall, a big modern shopping mall. Consequently, I became reluctant to explore Kluang further. I didn't know most parts of Kluang and I had to rely heavily on Google Maps every time I drove out of Bandar Seri Impian. The only part in Kluang I was familiar with was Taman Kluang Indah, located not far from Bandar Seri Impian, and I often went there for my meals.

Previously, I had been living in Johor Bahru for 7 years, with the most recent 3 years in EcoBotanic, a really nice residential area. The fact is that Kluang is much less developed than Johor Bahru, and I found it so difficult to adapt to the huge change in environment. I was also feeling really stressed about having to start House Officer training, which I knew would be very challenging. I really missed my Teaching Fellow post at NUMed, which I just left in July 2021. To add to my stress, Malaysia was under a really strict lockdown at that time due to the really bad Covid-19 situation.

As soon as the Covid-19 lockdown eased in early October 2021, the first place I went to was EcoBotanic in Johor Bahru. I relived my great memories there and I really wished I could just go back to staying there rather than in Kluang. It takes about 1 hour and 45 minutes to drive from Kluang to EcoBotanic. In the following weeks, I travelled to EcoBotanic several more times, as I really missed the place. Each time I went to Johor Bahru, I would watch a newly released movie at TGV Cinema in AEON Bukit Indah. There were no major cinemas in Kluang at that time.

In late October 2021, I began getting used to living in Kluang. I had become familiar with the road to get to Kluang town from Bandar Seri Impian. I started exploring some of the restaurants in Kluang and I felt that most of the food in Kluang are quite good. Other than Kluang Mall, Kluang Parade is another major shopping centre in Kluang. I had the impression that Kluang Parade is very old and I didn't bother to visit it at all. In mid-November 2021, a GSC Cinema was newly open in Kluang Mall. Just a week later, I went there to watch Venom: Let There Be Carnage. Since then, I no longer had to go to Johor Bahru for movies. However, I still went to Johor Bahru regularly as I missed EcoBotanic and the food there.

Starting from December 2021, my grandparents came to live with me in Kluang. I often brought them to Taman Kluang Indah, Kluang Mall and Kluang Market. In February 2022, I and my grandparents celebrated Chinese New Year together in Kluang. In March 2022, I discovered another better road to get to Kluang town from Bandar Seri Impian. During my birthday that month, I still went to EcoBotanic, Johor Bahru as I wanted to celebrate my birthday at my favourite place.

It was starting from April 2022 that I really enjoyed living in Kluang. I began to appreciate the fact that Bandar Seri Impian and the house I rented is actually a very nice place to live in. My House Officer training was really stressful, but I was glad that I could rest and sleep in a nice house after work every day. Bandar Seri Impian has lots of nature scenaries and it felt great to be close to nature. There are also some pine trees in Bandar Seri Impian which made it feel like I am overseas.  I also felt that Kluang Mall is actually a very nice shopping mall. Since then, I no longer went to Johor Bahru that frequently. On that month, I installed Astro's high-speed WiFi service at my house in Kluang.

One day in May 2022, I went to the Kluang immigration office to renew my passport. I had just finished working a night shift on that morning and the passport renewal took the entire day. When it was finally done, I was so tired and hungry. However, I suddenly couldn't think of where I should go for my dinner, as I still didn't know many restaurants in Kluang at that time. After contemplating for quite some time, I eventually went to a Chinese restaurant in Taman Kluang Indah.

In August 2022, one of my friends who grew up in Kluang introduced me to several more good restaurants in Kluang. Since then, I could enjoy a better variety of food in Kluang. At that time, I also found another shorter road to get from Bandar Seri Impian to Kluang town. In November 2022, my friend brought me to a steamboat restaurant in Taman Tasik Indah. Taman Tasik Indah and the neighbouring Taman Kluang Perdana are located in a new part of Kluang which looks really nice, comparable to EcoBotanic to a certain extent. However, as the place is quite a distance from Bandar Seri Impian and there wasn't a wide variety of food there, I didn't go there very often.

In January 2023, I once again celebrated Chinese New Year with my family members in Kluang. Around that time, I discovered the Kampung Paya Wet Market. It's newer and nicer than Kluang Market and I often brought my grandparents there since then. In March 2023, I celebrated my birthday in Kluang for the first time. In May 2023, I finally visited Kluang Parade for the first time. It turned out that it looks better than what I had expected. The interior of Kluang Parade looks like some of the older shopping centres in Kuala Lumpur, while the Parkson supermarket inside is quite nicely renovated. However, as it didn't sell much groceries, I didn't bring my family members there often.

In October 2023, a new Lotus's supermarket was open in Kluang, near Taman Tasik Indah and Taman Kluang Perdana. I and my family members like it a lot and we went there regularly. In January 2024, a huge Bin Siang food court with a wide variety of food was newly open in Taman Kluang Perdana. Since then, I went to Taman Kluang Perdana even more often. There was another nice supermarket, Target Grand, in Taman Kluang Perdana and I went there with my family members several times.

Throughout the entire 2023, I only went to Johor Bahru twice. I realised that Kluang actually has a lot of good food that are even better compared to those in Johor Bahru. Some good examples are Penang Hokkien mee, curry fish head, yam rice, bak kut teh, beef noodles, dim sum, lok lok, pork noodles, wan tan mee, curry mee, nasi kandar, nasi Briyani, nasi Arab, satay, apam balik, lemon chicken and grilled fish.

I successfully completed my House Officer training at Kluang hospital on 6 January 2024. I had planned to leave Kluang to pursue my dream specialty after the Chinese New Year in February 2024. However, I later found out that I had to complete my compulsory service with the Ministry of Health first before I could pursue my dream specialty. As a result, I continued working in Kluang hospital for my floating period as a Medical Officer. I requested to remain in Kluang hospital beyond the floating period.

Unfortunately in April 2024, I was informed by the Ministry of Health that I would be reallocated to Sarawak starting from 6 May 2024. I tried submitting an appeal but it was unsuccessful. That meant I had to work as a Medical Officer in Sarawak till I complete my compulsory service. However, I was allowed to defer my start date in Sarawak till 27 May 2024. I had been treasuring every moment of my stay in Kluang. I made sure to go eat at every one of my favourite restaurants in Kluang before leaving. Despite that, time still passed so quickly.

On 25 May 2024, I finally had to leave Kluang for real. Needless to say, I feel very emotional about this. I have been living in Kluang for 2 years and 9 months and I definitely have a lot of great memories here. I really look forward to the day I complete my compulsory service. If I can pursue my dream specialty, I will get to return to Kluang regularly.

If you liked this story, you may want to read this too:
https://daniellimjj.blogspot.com/2019/06/econest-place-i-will-never-forget.html

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