Minion Much? (Firsthand Experience as SGH HO)

"How bad a life of a houseman could be?"🤔

Often, back to the time when I was still a medical student,  that was one of those questions that I had been curious of. Well.....by hook or by crook, into 20 months of housemanship, I can tell you this much
Depends on how you look at it

(P.S. depending on your mentality strength too)

Back when I still have faith towards society

In Malaysia, 

HOship is a 2-year compulsory training programme for all medical graduates which consisted of:

- 5 compulsory rotations (4 months each)(medical/surgery/O&G/paediatrics/orthopaedics)

- 1 elective (anesthesia/ETD/psychiatry/KK)

Housemen work in shift system:
Working days: 6 working days + 1 OFF day

[Official working hours: at least 65 hours/week]
subdivided into 2 short days (7am-5pm) + 2 long days (7am-9pm) + 1 on call/post call (8pm-9am)

Tagging period: 7am-10pm 

[time varies depending on workload]

All HOs will start off with 2 weeks of tagging when entering new department in which it is the time for you to get familiarised with the department working system as fast as possible aka the toughest and the most tiring period of the posting.

The more senile (senior) you get, the more tiring this period would be)...🤢

Working time can be up to more than 16 hours depending on your workload, efficiency +/- ongoing active issues 

There has been an unspoken norm at least in SGH whereby HOs were expected to finish reviews and know each of your patients from top to bottom, inside out before MOs come for rounds. Same goes to the later (HO --> MO --> Specialists)

So imagine if MOs were to come for rounds at 6.30AM hmmmm😐😐😐

So the BIG question that most of you have been asking me and also the main reason for me deciding to write on this post! 

Which posting will I recommend to begin with as a fresh unbroken HO with eyes full of lights and hope?

Well, I will leave the decision to you after reading my experiences throughout the 5 core postings

(Disclaimer: the below is purely based on my own experience so to define at your own risk)

FIRST posting: MEDICAL

Waking up as early as 4am, punched in by 5am just to bewildered by the ward overflowed by patients, there goes my first day as a confused lost potato. 

‘Has the scan be requested? Why was it not done yet?  Where’s my blood? Have you referred to anesth?’

Ok to be honest my experience in medical was bad. Terribly bad. Life for me was tough in medical due to never ending joblists and the need to adapt. The verbal abuse is real in working life. Maybe it was worse since I was still fresh to the system, thinking that life would be all sweet and unicorn. 

With that being said, during those downhills, I met good people; instead of demeaning me as a person (you know who you are and I will remember for life), I find my strength and motivation to continue on😤

Medical department in SGH consisted of variety subspecs but hos were to rotate in limited subspecs (from the busiest to the least in accordance)

Respiratory, Nephrology, Neurology, Infectious disease, Hematology

Based on my opinion, medical is a good place to practice your basic procedural skills for eg. venepuncture, blood cultures and CBD insertion.

If you have the opportunity to go into subspec rotation, you will have more chance to perform more advanced procedures such as femoral cath insertion, chest tube insertion or peritoneal tap under supervision!

Assessments

1. Off tag (by D10 of tagging)

2. Mid posting assessment 

3. EOP assessment

- 2 case based discussions + 1 mini CEX (with specialists)

- MCQ assessment (passing mark 70%)

SECOND posting: PAEDIATRICS 

Rumour has that paeds is one of the toughest postings in SGH with the highest extension rate. To make things more surreal, only those from 2nd posting onwards were allowed to enter this posting. THE PRESSURE though 

But to be honest, paeds is tough for a reason. We are trained to deal with tiny humans. Unlike adults, they are fragile and more susceptible to insults. Thus, the learning environment is more tense and strict but in a good way. So, that rumour is definitely DEBUNKED! Fear not my fellow warriors. 

In SGH, paediatrics consisted of general paeds, oncology, nursery, NICU-neonatal ICU, PICU-paeds ICU and isolation ward (dealing with infectious disease, OSCC). Throughout the posting, each is compulsory to finish at least 8 weeks of nursery +/- NICU and another 8 weeks of the others. 

During the nursery rotation, we underwent compulsory Paeds  life support course. You will be eligible to be paeds resus HO once passed the test. There will be at least once per week that you will be assigned to be as one. Attending deliveries and receiving referrals. Adrenaline rush is real👶

Assessments

1. Offtag (2 parts: D9-D10 of tagging)

2. MO mentor assessment (2nd and 3rd month respectively)

3. EOP

- MCQ assessment (passing mark 70%)

- case based discussion with specialist

THIRD posting: OBSTETRICS AND GYNECOLOGY

Next, O&G! Yet another department with the highest extension rate. Despite being an amateur ho by then, it feels like I’m back to zero...

Everyone will start tagging in labour ward. It’s the time that you start to learn how to interpret partogram, perform a proper VE and came the most fun part..to deliver 👶! 

In O&G, we will rotate to maternity ward at least for 6 weeks, gynae for at least 4 weeks and the remaining days in labour ward. The turnover rate in maternity ward could be and would always be obnoxious....the craziest patient count that I had encountered was 50....5.0.! So be prepared to start reviewing patients as early as 4.30am🤧

Expect your mos to arrive ward by 6.30am🤭💆🏻‍♀️

Assessments

1. Offtag (by D14)

2. 5 assessments (3 case based discussions+2 mini CEX)-to be done with specialists 

3. MCQ assessment 

FOURTH posting: ORTHOPEDICS

Gulp...finally the time to face my nightmare. Orthopaedics is never my cup of tea ever since medical school. 

In SGH, the subspecs consisted of spine, arthro and tumour. Bear in mind that not everyone will have the opportunity to join subspec but once you are in, it will be a total of 1 month. And towards the end of posting, the senior ones will be deported to a baby branch in Charles Brooke Hospital in which your tasks would mainly be in wound care management (either for optimisation prior op or to prepare pt to discharge home)

For my first 3 weeks in ortho, I got to experience the infamous morning handover. This event will happen every morning which usually started around 730am. During the handover, Hos were expected to present cases (new admissions overnight) to the consultants/specialists/MOs. Yeap as how nerve wrecking as it sounds it is indeed.

For ortho, I couldn’t comment much as it was the time that covid actually struck us. Hence everything went haywire during that time. But this incident was actually a blessing in disguise to me as I got the opportunity to be a part of the spine team for QUITE some time🤭

Nonetheless, my ortho posting was fun and most of it if not all was accredited to the spine rotation. I got to appreciate the importance of rehabilitation and emotional support to spine patients. The feeling of witnessing from a severely ill bedridden patient to her being able to be discharged with a smiley face sitting on a wheelchair saying thank you is indescribable.

Ortho is fun because of them❣️

Assessments (during COVID time)

1. Offtag (by D14)

2. CMR with MO mentor 

3. Case based discussion (EOP) with specialist mentor 

FIFTH posting: SURGERY

Saving the best for my LAST!  

First day into the posting, I had been doing cpr on a UGIB patient. Speaking of an eventful day. Gosh 😭😭😭

Anyways, in surgery, you will get opportunities to go into subspec rotation (at least 1 minor and 1 major rotation+1 compulsory HPB rotation)

Minor: uro/vascular/plastic 

Major: paeds surg or neurosurg 

The happiest time that I had in my posting was during the plastic rotation. Despite the busy days there, I enjoyed seeing wounds (the more sloughy it is, the better), learning about dressings and most of all getting first hand experience to do TE/SSG❤️

So HIGHLY RECOMMENDED👏🏻👏🏻👏🏻

Assessments

1. Offtag (by D10)

2. MO mentor assessment (6th and 12th week respectively)

3. MCQ assessment (passing mark 70%)

All in all, 

Working life could be overwhelming and at times, helpless. Adaptation is the key to survive.

I started off in the busiest posting in which if I were to think back now, it was the best decision that I would never regret. Why? Because it prepares me well to be a 'functioning' ho. Once you start working as a ho, at least in my own personal perspective, being able to complete a task efficiently far exceeds having a rich level of medical knowledge. Even so, at least having the basics inculcated especially in terms of managing emergency situations is vital and life-saving.

Seniors also play a vital role. I was fortunate enough to have met some of those angels in which I would always be grateful for. At times when I hit almost the rock bottom, they guided me and gave me advices in which I will forever be grateful for❣️ When you start working in the society, life will never be all sweets and honey. There would be times that you will face with all sorts of degradation and unfairness. But what doesn't kill you makes you stronger isn't it?

Last but not least, find an appropriate way to release your grudge, frustration or any negative emotion. Do not keep it in. Depression is real. Despite working for less than 2 years, I have heard and seen depression. As doctors ourselves, we should know better. If you happened to identify those red flags, do not hesitate to seek help.
Whenever you feel down and overpowered with feeling of giving up, always remember the reason you choose this path.
No success starts off easy. Nothing bad is going to last forever.

And last piece of advice from me save the postings that you’re interested in for your 2nd year of hoship. From there you will get to learn more besides given the sufficient opportunities to perform more hands-on!

Life is tough but so do you!

Stay strong 💪🏻 🍀