HO assessments

HO assessment

It is not nice to get extended when you are working as a HO, especially we are all contract based. So make sure you take precautions and get prepared to make sure you pass the assessments. 

common reason for extension:

make sure you complete all your log book and assessment before finishing a posting, dont get extended because of this two reasons!

1. approach specialist early for assessment 

    - procedure

    - knowledge - long case, short case, 

    - feedback, communication

    - mcq (bank of question to study within 4 months)

- some departments have MCQs to pass before you can proceed for specialist assessment. make sure you ask your seniors about the details and start prepping early. Usually dept for internal med, pediatrics have MCQ assessmentss

    - basic life support - to make sure you are a save dr before they "graduate" you from the department

2. assessment

• DOPS: 
• doctor will observe how you do the procedures and see if you pass - blood taking, CBD, iv line, ryles tube insertion.... (complete it within the first 2 weeks)
•     compulsory perform : in the posting (by 12 weeks) 

•  make sure you fill up all the RN and diagnosis of patient once you are in charge of one. otherwise you will have trouble filling them up when you are about to finish your posting
•     compulsory observe/assist : in the posting (by 12 weeks)

•     case base discussion: 1-6 long case 1-6 short case. (within first 8 weeks)

•  can attempt 3 times before extended. (1on1/bed side)*** try to approach supervisor/specialist incharge a month before if possible. 
•     incident of concern (error on your means- blood transfusion)

• always double check the registration number and name of patient before you send the blood for transfusion or GSH. Check if it is your MPM number while requesting for blood especially those on the computer! it is very important. you can get extended because of this little incidents. 
•    complete your log book
•    taken leave in excess
• all department usually have 8days leave(include EL, MC and Leave)
• varies depends on dept, some dont include MC in the 8days leave.

So we can't just try our best to pass the department, we should also try to strive and learn in order to pass as a safe doctor.

How to EXCEL?

• case base discussion 

(you can pick the case yourself, which one you are confident in? usually will check which ward you look for, to know how you manage the case, diagnosis must fall in the mandatory topics.)

- mini cx

- 50% attendance, fill in before deadline lnpt? msf

- attend as needed, mcq 20%

- 40% logbook, communication and log book

- 35% , 5% logbook on time, cpd pass at first attempt 15%

• Compulsory procedure

- indication and contraindication

IF you got extended, usually it is another few weeks to 2 months before another assessment. this is the time for you to rebound and get back on track, make sure you reach their requirements! 

*Tips to pass: 

1. study throughout your posting and not a few days prior assessment.

• good practice to be a capable medical officer in the future

2. to study each case you handle if possible everyday

• the best time to combine what you learn in the hospital with the theory in the books
• if you realise management by the doctors are different, you can still go back to them and ask the second day instead of 1 month later!

3. Remember it is not just about working fast but it is about your KNOWLEDGE application.

• YOU are a DOCTOR in TRAINING and not some clerk or runner boy/girl or assisstant,
• always be vigilant in what the doctor is asking you to do.
• ask for the indications/reasons for certain procedures(blood Investigations, Xrays, Surgery, medications) or referral. 
• --> so you know the reasons for their work and not just running all blood as baseline😵

will update more in my upcoming posts. 

Template for study guide

When you are studying  each disease, do not just memorise them but to understand them throughly.

For me I always remind myself of the 5 key points to make sure I fully understand each disease from its core. Hopefully it is useful for you and gives you a rough idea what to do when you are studying. 

Don't rush unless you have no time. the point is to understand how all this works in real working life. 

Key Points for each Disease 

Definition	Disease name, definition - what are the cause, factors - signs and symptoms - common in which age group? - significant characteristic
Ix&I	Investigation and their interpretation Example: CXR, ABG, CT, CTG, Partogram, etc.  what is the point of the investigations?
Lab values	Normal lab values for each FBC, LFT, etc… how the changes of value affect how you treat the patient?
Medications	What are the common medications - normal dose - any side effects? - contraindications? what are the meds you need to avoid if the it is contradictory
Others	Differential Diagnosis - a great help to make you remember the disease "characteristic" better.

Some other commonly used diagrams

Murmur locations

causes: MR: RHD, CHD, IE, 
MS: Rheumatic fever
TR: RF, IE, VSD
TS: RF, CAD, CTdisorder
AS: degenerative calcification

NYHA classification

GCS charting

ECG sections

TIMI

Killip class

week before HO

What to do a week before HO?

or at least the things i wished i could have done during my time😂

1. fitness

- It is easy to tell everyone to start exercising, ain't easy but we need to start keep fit before starting work. especially to those who has been slacking behind for about a year before getting into hospital. waited for 2 years and I cant imagine how rusted I am going to be, oh lord...

2. Prepare things for work and your PTM documents

- Stethescope

- HO kit (measuring tape, ruler, small stapler, lanyard, scrubs, black pen, notebook)

- Prepare photo and documents (different hospital different document)

- Rubber stamps (blue ink/depends on hospital) and name tags(magnetic)

- Formal clothes and comfortable shoes

- Bag that can be used during rounds (girls)

3. Start revising

at least 30 minutes a day to get it started, the more the better!  (How much I have hoped that I could do before starting, instead of shopping.)

- revise format of documentation

- 5 core knowledge brush up - N&A

- build networking

4. Hospital orientation

- weekend off you try to go for pre-tag. 

- list of thing need to do during pre tag

- need to ask if senior ho can help and bring you around. (informal orientation of the respective department). They will be more available and free during weekend rounds. 

checklist to ask the senior:

1. department orientation & layout (how many ward, how many male/female where is the ward, OnG antenatal or postnatal, labor room; OT?poly OT? where to find things to get blood)

2. ward work flow & Timing

- make sure you clear up all patient before turn over. 

- all different in different department, reach 2 hours before specialist come. 

- how to manage & prioritize ward work: what to do during ward round, what must do immediately, what can wait?

3.  how to do review, how to do round? 

    --first day report to the department clinic first, to the HOD/kerani. give logbook or documents.  

    -- go to the ward that you are assigned. 

4. introduce urself, name in front of others(especially nurses)

- use ur free pass to ask all question, help senior ho as much as possible. 

- pm round, take a few patient for review. 

- what are the common cases. question to ask, sign to look out, how to do review. ask how many pt to cover during morning round. 

5. how to do referral, request for radiological investigation, posting case to anaesthetist.

6. common procedure for department (how to fill up common forms, order investigation through Hospital System)

7. know your superiors and adjust to their work style, hod, supervisor, specialist, MOs in charge 

8. books, reference, app needed

- incident of extend

- know the style of supervisor, what are their favourite question. 

9. assessment, structure and deadline

- short case: cpd, long case: bdcs, mcq

- make sure you take the long case assessment with specialist 2 weeks before.

- present one cma topic, log book submit 2 weeks before finish posting. 

 

Readings you can do before going into HO

- https://mmc.gov.my/laws-regulations/

- code of professional conduct

- Guides to good medical practice

- Guidebook for Houseofficers

good luck and all the best to everyone in and those going into the system.

 

Clinical Skills for Respiratory system

HI everyone!

 

This is a page where I accumulate all the study resources in one place especially for respiratory system, enjoy!

It includes:

1. Respiratory clinical skills checklist
2. Things to master for respiratory OSCE
3. Sample OSCE demonstration
4. Chest X-ray Quizzes
5. Sample Cases for practice
6. Peak flow meter and Inhaler techniques
7. Common used Malay terms for doctors in Malaysia
8. Further readings on management for common Respiratory diseases

Clinical skills checklist

Things to master for OSCE EXAM

Communication Skills 

1. Elicit a comprehensive occupational and social history from a patient.

2. Elicit a comprehensive past medical history from a patient. 

3. Give simple instructions to a patient. 

Clinical examination skills 

1. Carry out a fluent and structured examination of the respiratory system in a  simulated patient. 

2. Recognise normal breath sounds, wheeze and crepitations using the stethoscope

3. Recognise abnormal findings on percussion and auscultation and explain the  pathological processes that would produce these. 

4. “Putting All Together” to reinforce clinical reasoning and introduction to early  differential diagnosis. 

Practical skills 

1. Accurately perform a peak flow measurement. 

2. Demonstrate the correct use of an inhaler (with and without a spacer/aero chamber) to a patient. 

3. Identify the key features of a plain chest radiograph and recognise common  respiratory abnormalities. 

 

Sample OSCE for respiratory

Chest X-RAY study resources

• chest review
• Chest X-RAY quizzez

Sample cases for practice:

1. Mr. Y, is an 88-year-old gentleman who complains of progressive worsening  of breathlessness since 2 weeks ago. He also complains of a pain at the right  side of his chest. He used to work at the docks in the UK in his teens.  

a) Does the patient require urgent intervention? 

b) Is the shortness of breath acute or chronic? 

c) What additional questions would you ask to learn more about his  shortness of breath? 

d) What is the organ system involved in the patient's shortness of breath  (cardiac, pulmonary, hematologic, or psychiatric)?

2. A 55-year-old man presented with the history of cough for 4 weeks comes to  the GP clinic and is very concerned after having 2 episodes of prolonged  coughing that produced blood-streaked sputum. He also complaints of fever  for 7 days and cough productive of yellow sputum. This is the first time he  has experienced this symptom. 

a) What additional questions would you ask to learn more about his  hemoptysis? 

b) How would you classify his hemoptysis in terms of quantity? 

c) Can you make a definite diagnosis through an open-ended history  followed by focused questions? 

d) What are the alarm features when evaluating a patient with hemoptysis? 

Post E-ho documents

 

Once you get your hospital , now you need to do several things

1. download all 4 documents, confirm the hospital name on the letter(very important!)

    -  some of my friends didn't have the hospital name on their letter and it is considered they did not choose any hospital. They need to call KKM to reset their status, but sadly the hospital they want is long gone. 

2.  We have a telegram group for each batch of Pre-HO graduates, find someone who are inside and help add you in. they are very helpful when you have questions to ask regarding things to do after HO application. 

3. prepare documents: 

• this is a template i come up with on documents we need to prepare. you can download it and modify depends on your hospital needs.

Suggestion from seniors:

Day 1
- Do the Medical checkup, Akaun sumpah.
- do the rubber stamp, nametag, photo
- make copy of necessary docs above
* medical checkup in gov will take about 1 hour to complete
* at KK, u can ask for the MO to certify ur MMC docs (surat tawaran each page, degree and transcript)

Day 2
Finance day
- go to KWSP - open new account and keep the penyata
- LHDN (matikan setem for 4 kontrak perjanjian & open new ldhn account)
-go to bank (ask for bank statement or confirmation of account for job w gov)
- make copy of necessary docs

*dont stapler or do anything to ur to perjanjian kontrak, just follow the panduan given.

Day 3 ( on 31 Oct)
-download them from merits.com

- Conclusion from seniors.

1. Print semua yang diperlukan
2. Isi semua (including buat med checkups + surat akuan + ambik gambar ukuran passport)
3. Photocopy apa yang patut
4. Pergi sahkan mana yang patut
5. Settle merits (perlu update merits untuk dapat MMC certificate, no more go to office/email)
6. Put all benda yang perlu in file for PTM
7. Put all benda yang perlu untuk melapor di hosp dalam file

Jumlah perlu print, apa perlu certified, follow previous post tu.

Print 1- sehelai. 2- dua helai, 3- 3 helai

4. book kk appointment

        - Go to MySejahtera, click Digital Heatlh, choose Clinic Appointment Booking, and find your KK in 3 others choice.

        - Go to BookDoc, look for GP, Klinik kesihatan (near your place) and choose medical examination.

5.merits website

After they announce to open the merits website, you can log in and apply to get the provisional registration certificate (Surat Perakuan Pendaftaran Sementara). It took about a week for me *after several changes, rescan and re-upload the documents on the website before getting reviewed. 

There are 3 steps of complete review by PT, Officer and HOD before you finally get the certificate.

6. make rubber stamp and other necessary things needed for HO

- HO kit (measuring tape, ruler, small stapler, lanyard, scrubs, black pen)

- stethescope

- watch, pocket notes (either you buy it or make it yourself)

7. DAYS later, the E-ho website will be open again for you to update the status. 

    - things to download are

    a. Surat PTM (print 2 copies)

    b. Lampiran A/B

    - Lampiran A/B can only be available after you updated your data. 

  After log into E-HO again after a few days

↓

↓

click semakan keputusan PTM and click Borang Profil Peserta

to update your status, and click tambah 

↓

this is the page you will see after clicking "tambah"

Click 'simpan' after filling up the forms

Make sure you key in your parents/ emergency contact details here by  clicking ''tambah'' two times. 

   ↓

Then click "profile peserta" to go into this page, update your information and press "KEMASKINI". 

↓

then click cetak lampiran A

(print 2 copies)

Advice on using E-HO system

Hey guys, it has been a while since I have an update on this blog because been busy with e-ho placement. 

This time i am here to share my experience on how we can get the hospital we want. 

1. which hospital you want? is it Semenanjung or Sabah / Sarawak?

- no worries if you want Sabah / Sarawak they always has a lot of placement. unless like this batch bil 6/2020 they did not have any Sabah hospital because of covid-19 situation. But this situation does not happen often. 

- if you wanted Semenanjung (exp: Penang, Melaka, Seremban, Perak, KL) then you should consider what i am telling you below. 

MY experience

            -    from my experience of 3 times joining e-ho i realise a trend on how it works. Here is my story...

            -     I joined the July batch BIL 4 (tapisan september-october) to help my friend, then September batch BIL 5 (tapisan Dec-March), and now October batch BIL 6 (tapisan April-early July) .

• BIL 4/2020 experience

            - July batch: log in 10 minutes later all hospitals are unavailable and taken. The hospitals that are still available are kelantan, sabah and sarawak.

            -so my friend has no choice but to choose among those three as she didnt want to postpone anymore. PLEASE dont panic choose, or you will regret your decision.😅

• BIL 5/2020 experience

              -     and then I realise that in bil5/2020, the hospitals that are unavailable within 10minutess are mostly empty during BIL 5 batch. so if you really wanted the hospital YOU WANT (the popular spots ) you can register with MMC slower so your tapisan is later, and your chance of getting the hospital you want is higher (might not apply every year, but can try) . 

            Check out the picture below that shows which hospitals are still available on the next day, you will feel surprised!

• Sept batch 9.32 am the next day after eho, even hospital melaka is still available. 

• BIL 6/2020 batch

Log in 30min later, and many hospitals are still available. So if you cant get in the hospital you want in previous batch, just defer and wait for a while (might not apply for everyone). 

9.32 am next day

How they notify us about e-ho:

1. quite sudden and random, can from within 24 hours to a few days

• Batch1,2 eho tuesday
• Batch 3 eho wednesday
• Batch 4 (july) email on 1st 12pm, wednesday 12pm
• Batch 5(september) got their email on 1st sept - Tuesday 3 pm and eho on 2nd sept -Wednesday 12pm
• Batch 6(october) email 7th oct 6pm wed, eho on 8th oct 3pm thursday

- before eho what i did is i join the tapisan group --> watch the video on how eho works, read the pdf --> write down what i need to fill up , then prepare the internet--> 

**please don't click the log in button like a crazy person, the whole system will crash

Internet

- internet: i just went to my friends house to do it, their ping was quite good (make sure you choose the 5G line), and open several browsers, 2 laptops. 

Should I defer?

- I deferred the first time on the september intake, I called MMC and they mention if you have solid reasons like married/ spouse/studying master in another state, although you chose a hospital they can help you reset your status, so you could choose to defer. If only i knew this earlier😂

On the 2nd time when I choose the hospital, all the details was autofill, I do not have to key in anything (super convenient), and I get a good hospital. Thank God!

Important phone numbers

1. e-ho issues (example call to defer, ask if you are included in the tapisan): 

- call KKM +0388832735 

      2. mmc issue : 

- whatsapp 016-2946947

      3. post e-ho issue call: 

- Puan Maznah SPA: 03-80919368

- Cik Zuriani SPA: 0388856339

- En Asrul SPA: 03-88856471

- En Azri SPA: 03-88856137

- Pn Normah SPA: 03-88856313

- Pn Shahida SPA: 0388856338 

 

 

 

 

 

 

ENT OSCE sample

 STATION 6 

This patient has a 6-month history of ear discharge. 

INSTRUCTIONS TO CANDIDATE: 

A. Take a focused history. 

B. Examine the ear and present your findings as you proceed. 

C. The examiner will then ask you some questions. 

Sample Marking Scheme

Readings: 

Chronic suppurative otitis media (CSOM) is one of the most common childhood infectious diseases worldwide and is a common cause of hearing impairment in resource-limited settings. It is characterised by chronic drainage from the middle ear associated with tympanic membrane(TM) perforation and usually preceded from an acute otitis media (AOM.)

Clinical Presentation:

1. Ear discharge - chronic purulent middle ear discharge (typically >6 weeks) 

2. Hearing loss - due to TM perforation

3. Cholesteatoma

4. Physical Examination: 

- reveals TM perforation and purulent middle ear drainage, typically minimal to no edema of the external auditory canal. 

- otoscope 

Treatment:

1. Aural toilet along with and ototopical fluoroquinolone for initial therapy (eg, ciprofloxacin, ofloxacin). 

- The goal is to eradicate the infection by making sure the ear is dry hence preventing complications. The best goal would be to have the TM heal and improve their hearing. 

2. Advise strict water precautions (no swimming, prevent water to get into the ear) for prevention and management of recurrent disease

3. Tympanoplasty for patients without cholesteatoma who have recurrent disease despite water precautions, or a persistent tympanic membrane perforation for more than 6 to 12 months after resolution of CSOM.

Reference: 

1. https://pubmed.ncbi.nlm.nih.gov/16198004/

2. https://www.uptodate.com/contents/chronic-suppurative-otitis-media-csom-treatment-complications-and-prevention?search=csom&source=search_result&selectedTitle=1~20&usage_type=default&display_rank=1#H9146042

3. 

OSCE sample 5

 STATION 5

Madam ZZ is a 30 year old G4P3 lady at 38 weeks of gestation. She has one previous Caesarean Section delivery for cord prolapse. Otherwise her current antenatal care has been uneventful. 

INSTRUCTIONS TO CANDIDATE: 

A. Examine her abdomen.

B. Present your findings.

C. The patient is anxious about vaginal birth.

Address her concerns. 

Marking scheme:

Provisional registration application via Merits

To apply for MPM number before E-HO application

Go to https://meritsmmc.moh.gov.my/

1st : Click Provisional Registration

2nd: Fill up the form for fitness to practice form --> click confirm

3rd: Fill up the Forms listed in the website.

   

      

4th : wait for the approval and check from time to time if they need you to re-upload the documents. 

** for International Medical Graduates  

    >> make sure you have the Primary Source Verification (PSV) to get your graduation certificate verified. You can check this thread for more information.

https://yu4med.blogspot.com/2020/07/verify-your-graduation-certificate-for.html

5th : Once approved, you just need to wait for your surat tawaran. You will get the surat tawaran after you choose your hospital during E-HO. So you can apply for Provisional Registration Certificate. 

Good luck and all the best!