After I completed my House Officer training at Kluang hospital on 5 January 2024, I worked as a floating Medical Officer in the Medical (Internal Medicine) department of Kluang hospital for 4 months and 3 weeks from 6 January 2024 to 26 May 2024. Throughout the floating period, I stayed in the house I rented at Bandar Seri Impian located near Kluang hospital. Here, I am sharing my experience working as a floating Medical Officer (MO).
I always had a high degree of theoretical interest in Internal Medicine. However, I found the large number of patients and heavy workload in the Medical department quite scary. I had initially wanted to join the Anaesthesiology department as an MO. Towards the end of my House Officer training, I spoke to my supervisor in Anaesthesiology regarding that, but she told me that I am more suited for Medical rather than Anaesthesiology. Later, I was informed by Kluang hospital that I had been allocated to Medical for the floating period. I decided to accept it.
The work hours for MOs in the Medical department is from 8AM to 5PM every day, excluding weekends and public holidays. In addition, we have to work about 4-6 oncall shifts every month. Each oncall shift is 33 hours long from 8AM till 5PM of the following day if the following day is a working day, or 24 hours long from 8AM till 8AM of the following day if the following day is a weekend or public holiday. There were regular Continuing Medical Education (CME) sessions for MOs.
I was supposed to begin working as an MO in the Medical department on 6 January 2024. However, as that day was a weekend, I started working only on 7 January 2024. On the first day, I met the Head of Department for an induction briefing before I began working. I was allocated to the back cubicle of the male ward for the first week. The patients in the front and back cubicles are generally quite stable and don't require a lot of management plans as compared to patients in the acute and subacute cubicles.
I was quite fast in reviewing my patients. However, I was still inexperienced in planning the management. I often relied on my specialists to give the management plans during the ward rounds. There were a few patients whom I had to make referrals to sub-specialties in other hospitals. When referring a case, not only I have to present the full history of the case, I also have to come up with a reasonable management plan, which the sub-specialty specialist will then add on or modify if necessary. I found that a really daunting task in the beginning. Thankfully though, my colleagues were quite willing to guide me.
Unlike some MOs, I was generally not too dependent on House Officers (HO). I was willing to carry out most of the active plans myself, including those that are usually done by HOs. I would only get HOs to perform blood taking and to write discharge summaries. On 12 January 2024, I went to Johor Bahru for a short getaway. There, I met up with my friend who had just completed his floating period as an MO in the Medical department of Kluang hospital. He gave me some useful tips for working in the department.
My first ever oncall shift was on 14 January 2024. It was 33 hours long and I was in charge of the male ward. As I was still in the tagging period, I had a senior colleague doing the oncall shift with me and I could seek her help anytime if needed. The oncall shift turned out to be not as bad as what I had expected. None of my patients had any emergencies throughout the night and I could sleep for several hours. Starting from that week, I was in charge of the subacute cubicle of the male ward.
On 17 January 2024, much to my disappointment, I found out that my application for my dream specialty was unsuccessful. That meant I had to continue working as an MO till I complete my compulsory service with the Ministry of Health. On 19 January 2024, it was my first 24-hour oncall shift. I was really busy during daytime as it was a weekend and there were far fewer MOs working compared to working days. Still, I found 24-hour oncall shifts so much more managable than 33-hour oncall shifts. How I wish all oncall shifts are just 24 hours long!
Later that month, I had to perform a central venous line insertion for a patient requiring ionotropic support. Under the guidance of my senior colleague, I successfully inserted the central venous line. On the following day, I had the opportunity to perform a pleural tapping for one of my patients with pleural effusion. I succeeded in performing it under guidance by my specialist. My success in the two procedures gave me a real sense of accomplishment and it boosted my confidence in working as an MO in Medical. Starting from 28 January, I was reallocated to the female ward. Still, I was in charge of the subacute cubicle.
As time went on, I began getting used to working 33-hour oncall shifts. Usually after 5PM, I would have my dinner and take a short nap. At 7PM, I would start doing the night reviews for patients that had to be reviewed 3 times daily, as well as the transfer-in reviews for new patients. The specialist would start the night ward rounds around 8PM which would usually continue until around 9:30PM. After that, I would carry out any urgent plans and then go to sleep. I would let the night-shift HO take the urgent and morning bloods. If there are any emergencies, the nurses would give me a call. Otherwise, I would sleep till 5AM, then I would do the transfer-in reviews for patients admitted over the night. As long as I could sleep for at least 5 hours in total, I wouldn't feel too tired to work from the next morning till 5PM. Despite that, I still really dislike 33-hour oncall shifts.
Around that time, I found out that starting from this year, new HOs would only be allocated to tertiary hospitals. That meant there wouldn't be any new HOs coming to Kluang hospital, and the Medical department would no longer have any HOs in a few months' time. When that happens, oncall shifts for MOs would become much more challenging, as MOs would have to take the morning bloods for patients, significantly reducing the amount of time we could sleep. I was quite concerned about that, and I thought of requesting to switch to the Anaesthesiology department. Unlike Medical, all oncall shifts in Anaesthesiology are only 24 hours long.
One day, I had to make sub-specialty referrals for 2 of my patients. Both cases were quite complicated and I struggled to understand what the sub-specialty specialists were asking me. Consequently, the sub-specialty specialists wanted to speak to my specialist directly instead. My specialist got quite upset about that as he thought that I failed to communicate properly with the sub-specialty specialists for both of the cases.
On 6 February 2024, I escorted a patient to Hospital Sultanah Aminah in Johor Bahru for an angiogram. I hadn't been to Hospital Sultanah Aminah since February 2020 and I was happy to be there again. I bumped up with one of my friends at Hospital Sultanah Aminah. The patient was very stable and there weren't any issues during the angiography and throughout the whole journey. It was 2PM when I arrived back at Kluang hospital. My colleagues had completed all the active plans in the ward and I was so glad about that.
I had 5 days of holidays from 7 to 11 February 2024 for the Chinese New Year. I went back to Kulim to celebrate Chinese New Year with my family members. I had to return to work on 12 February 2024. On that day, one of my patients required a bone marrow aspiration and trephine biopsy (BMAT). Since I had never performed BMAT before, I let my colleague perform it while I observed. The BMAT was quite challenging, as my colleague had to apply quite a lot of force in order to get a satisfactory amount of specimen.
On 13 February 2024, one of my patients required a chest tube insertion. The specialist told one of my colleagues to perform it as it was a high risk case. It turned out to be so difficult. My colleague had to try multiple times before she could insert the chest tube. Right after the procedure, the patient had a desaturation. We had to refer her to the Anaesthesiology team for non-invasive ventilation. In the end, I could only go home at 6:30PM. I had another 4 days of holidays from 14 to 17 February 2024. During that time, I went to Johor Bahru for another getaway.
I had gotten better in planning the management for my patients at that time. During my oncall shift on 23 February 2024, I helped my senior colleague to do the afternoon reviews for the patients at the Coronary Care Unit (CCU). That was my one and only time working at the CCU as an MO. On that night, one of the patients at the CCU required a central venous line insertion. I tried to perform it under guidance of my senior colleague, but I failed after attempting twice. My senior colleague had to take over.
On 27 February 2024, I was finally granted my Full Registration with the UK General Medical Council. The following weeks were quite uneventful. I continued to be in charge of the subacute cubicle of the female ward. None of my patients required any complex procedures or sub-specialty referrals. Throughout March 2024, I had one oncall shift every week. With the dwindling number of HOs in the Medical department, I made sure to rely even lesser on HOs. I began doing blood taking and discharge summaries myself as well. However, I still let the night-shift HO take all of the morning bloods during my oncall shifts.
One day, one of the patients collapsed. My colleague decided to intubate the patient, but she failed after attempting twice. I then attempted the intubation and I succeeded. That was thanks to my experience in Anaesthesiology during House Officer training. On 19 March 2024, I delivered a Continuing Medical Education (CME) presentation on Pain Assessment Tools. Around that time, my specialist told me that she was satisfied with my performance in the wards and thus I had completed my tagging period in the wards. Moving forward, I would be doing solo oncall shifts in the wards and she would start allocating me to the Emergency Department (ED) as well.
For the week from 24 March 2024 to 28 March 2024, I was allocated to the ED for the first time. I didn't have to do ward work or join ward rounds, but I had to be ready to see referrals from the ED at any time. I was tagging at the ED which meant that there was a senior colleague also in charge of the ED which I could seek their opinion or help anytime. Most of the cases referred from the ED weren't too complicated. Whenever there were a large number of referrals or complicated cases, my senior colleague will help me in seeing the cases. I had a good working relationship with the MOs and HOs at the ED.
Starting from 31 March 2024, I was reallocated to ward 7A. Ward 7A was formerly the Covid ward. Since there were no more Covid patients, it had been converted into a general Medical ward where the more stable patients were transferred here. I was in charge of the acute cubicle. As the patients in this ward don't require a lot of management plans, it's quite relaxing working here. On 31 March 2024, I found out that the Ministry of Health would be reallocating me to Sarawak starting from 6 May 2024, exactly 4 months after I began the floating period.
I wrote a letter to appeal to remain in West Malaysia and I managed to submit it before the deadline. A week later, much to my disappointment, the Ministry of Health informed me that my appeal was unsuccessful, which meant that I had to go to Sarawak and work as an MO there till I complete my compulsory service. However, I was allowed to apply to defer my start date in Sarawak for up to 2 weeks, which I did.
The first two weeks of April 2024 was quite relaxing as I only had one 24-hour oncall shift on 10 April 2024. That was first ever solo oncall shift and I was in charge of ward 7A and Periphery. Periphery is where we go to the wards of other specialties to review the patients that they referred to Medical. That oncall shift was quite relaxing. My patients in ward 7A didn't have any significant issues and I only received a few simple referrals from Periphery.
I had a passive oncall shift on 13 April 2024 where I had to stand-by for escorting any patient that needs to be transferred to another hospital from 8AM to 1PM. However, there were no patient transfers on that day so I just stayed at home. Starting from 14 April 2024, I was reallocated back to the female ward. This time, I was in charge of the front cubicle. The next 2 weeks were very busy as I had a total of 5 oncall shifts.
On 17 April 2024, I had my first oncall shift at the ED, where I was in charge of the ED from 5PM till 8AM. It was quite tiring as I was only able to sleep for about 4 hours. I had to admit a patient with thrombosed AV fistula and underlying end-stage renal failure. Worst of all, she was placed in the cubicle which I would be in charge of on the next morning and she would require an internal jugular catether insertion for haemodialysis on the next morning. Thankfully though, my specialist knew that I was quite tired so she told my colleague to insert the internal jugular catether, while I just had to assist her. Internal jugular catether insertion is quite similar to central venous line insertion.
I had another oncall shift at the ED on 26 April 2024. It was very tiring as well, but thankfully that was just a 24-hour oncall shift. My solo oncall shift at ward 7A and Periphery on 3 May 2024 was really busy. There were a large number of patients in ward 7A and I also received several complicated case referrals from Periphery. There was also a patient requiring an exchange of internal jugular catether. Although I had never observed or performed it before, I roughly knew how it should be done. Under guidance of my senior colleague, I managed to perform it successfully.
On 6 May 2024, I was informed that my start date in Sarawak had been deferred till 27 May 2024. My last ever active oncall shift was on 7 May 2024. I was in charge of ward 7A and Periphery. However, as my colleague in charge of the female ward was escorting a patient to Hospital Sultanah Aminah, I had to help her cover the female ward until she's back. There were many new cases in the female ward and I had to do the transfer-in reviews and join the night ward rounds with the specialist. Luckily, ward 7A and Periphery were quite uneventful. I could sleep once my colleague returned around 11:30PM. On that week, I successfully performed another internal jugular catether exchange.
Around that time, the CT scan machine at Kluang hospital broke down unexpectedly. Consequently, all CT scans had to be outsourced to KPJ Kluang. Many of the patients requiring CT brain had to be escorted to KPJ Kluang by an MO. I had a passive oncall shift on 11 May 2024. Around 1PM on that day, I was called to escort a patient from the ED to KPJ Kluang for a CT brain. I had never been to KPJ Kluang before and I was glad to visit it for once. It looks really nice.
On 12 and 13 May 2024, I performed pleural tapping for 2 of my patients. Both were successful and my specialists were quite satisfied with my performance. 23 May 2024 was my last day of work as an MO in the Medical department. On that day, one of my patients required an internal jugular catether insertion. I successfully performed it in my first attempt under guidance of my specialist. I bought some cookies as a gift to the nurses in the wards. I also took photos with the nurses. That marked the end of my journey at Kluang hospital. I left Kluang on 25 May 2024 and flew to Kuching, Sarawak on 26 May 2024.
Conclusions:
My floating period as an MO in the Medical department has been full of stress and challenges. The greatest challenge is certainly those 33-hour oncall shifts. Working as an MO would have been so much better without that. Despite that, I am glad that I performed fairly well as an MO in Medical. I had the opportunity to address the learning gaps from my previous Medical posting in House Officer training, and I gained a lot of clinical experience. It definitely made me much more matured. Following the end of my journey at Kluang hospital, I surely will miss everyone so much.
https://daniellimjj.blogspot.com/2024/02/my-house-officer-training-at-kluang.html
