message from director - htar

Transition from Medical Students to Career as a doctorDr Hj Ghazali Hasni Bin Hj Md HassanHospital Director Hospital Tengku Ampuan Rahimah Klang

ContentsJob requirement/ duties as a doctor. Benefits of being a doctorChallengesAttachment in multiple disciplinesCSMU and Malaysia : what’s the difference?The Next Steps. Career Path

INTRODUCTION

KKM REQUIRES MORE DOCTORS WHO ARE

COMMITTED, DEDICATED AND WELL-TRAINED SO THAT THEY

ARE ABLE TO CONDUCT MEDICAL PRACTICE

PROFESSIONALLY, ETHICALLY AND LEGALY.

WHY I WANT TO BE A DOCTOR ?Ask yourself:

1. Easy To Get A Job 2. Rich And Famous3. Your Interest To Be A Doctor4. Parental Influence5. Challenges6. ????????

To be a doctor…..Work hard/study smartDisciplineEffective communication/soft skillCaringTime managementTheory application vs practical ( actual duties)Knowledgeable, skillful and good attitudeMedical Act 1971

Life as Medical Students

MOH HEALTH SYSTEMPROMOTIVE

PREVENTIVE

CURATIVE

REHABILITATIVE

Job requirementDuty beyond self irrespective of geographical location or family attachmentCaring towards patient and staffProfessionalismAbility to work as a teamWork smart -Disciplined and systematicWell attired /manneredHigh self esteemConsistent and responsibleBrave to make decisions -Accountable for all actions made.

DUTIES OF A MEDICAL DOCTORMedical diagnosis based on history, examination and basic investigations, Provide treatment,To conduct delivery,To perform medical/surgical procedures,To conduct post mortem,To provide counselling/health education

Duties of a doctorTo get involve in prevention and controlling of diseasesNotification of the notifiable diseases,Research,Continuous Medical Education Others

Sambungan……….

TUGAS SEORANG DOKTOR LEBIH MENCABAR KERANA…….

Doktor merupakan tulang belakang kepada perkhidmatan kesihatan dan perubatan

Doktor memainkan peranan penting dalam merancang, melaksana dan memeriksa semula aktiviti/program kesihatan dan perubatan

Rakyat semakin sedar penting nya penjagaan kesihatan

ETHICS The discipline dealing with what is good and bad, with moral

duty and obligations- Webster’s Dictionary

The study of questions about what is right and wrong – Collin

A medical doctor has the duty to protect the individuals, families, and the community, by demanding high level of ethical professional conduct whether on duty or off duty

A need for rules to enable health care providers to practice legally, ethically and professionally and to maintain their professionalism

ETHICAL CODE Doctors have to use their code as yard stick for their conduct

and behavior in their profession. Adherence to their code will enable patients and society to have trust and confidence in you and the profession generally

Presentation as a doctor 1. Proper attire and well dressed 2. Identity 3. Communication

The ethical principlesBENEFICENCE - ‘ do good and not harm’

NONMALEFICENCE - ‘ do no harm’

AUTONOMY - right of self determination: freedom to act

JUSTICE - obligation to be fair

VERACITY - truthfulness, not to deceive or mislead patient

FIDELITY – faithful to commitment, concept of accountability

Benefits 1 Guaranteed job on qualification No need to search for job Offer upon graduation Interview before final exam Salary started 1st day of induction

Regarded as a leader Teamwork leader in the ward/clinic/organization Respect by family Command respect by society Title as DR

Benefits 2Entitled to quarters / housing allowanceCar allowanceOther Financial Benefits Salary/ pay upon report duty Entitled critical allowance Overseas allowance On call allowance Travelling allowance Schorlarship for further training as specialist Locum

BEFORE AND AFTERBEFORE AFTER

DURATION OF HOUSEMANSHIP

I YEARS 2 YEARS

NUMBER OF POSTINGS

3 6

EXTENSION UP TO 1 YR EACH POSTING

UP TO 1 YR EACH POSTING

OPTIONS FOR POSTINGS

YES AND NO YES AND NO

GRADE ON ENTRY U41 U41GRADE ON EXIT U41 U44OPPORTUNITY FOR FURTHER TRAINING

YES YES WITH MORE EXPOSURE

OPPORTUNITY FOR HIGHER GRADE

NORMAL FASTER

Challenges Earns adequately fairly – may never become richRisk and success in private practise.Guarded family life – risk of staying apart.Limited social lifeStress – ability to overcome it.Liable to be suedGlobalization – knowledgeMis-match after graduation/before HO

FRESH GRADUATE

TEMPORARY REGISTRATION(SEC. 12)

PROVISIONAL REGISTRATION(SEC. 16)

COMPLETED HOUSEMANSHIP

FULL REGISTRATION(SEC. 14)

ANNUAL PRACTISING CERTIFICATE

(SEC. 20)

REGISTRATION PROCESS FOR MEDICAL GRADUATES

HOUSEMANSHIP POSTINGS: 6 MAJOR POSTINGS- 4 months each posting:

Medicine – what lies behind the screen

10 GOLDEN RULES OF GOOD MEDICAL PRACTICE:

1. Practice with kindness and honesty according to ethics2. Upgrade professional knowledge and clinical skills

regularly3. Maintain good patient records (documentation)4. Maintain good communication with patients/relatives5. Maintain staff- patient confidentiality6. Do not hesitate to seek 2nd opinion7. Maintain good working relationship with superiors,

colleagues and subordinates8. Be conscious of cost of health care9. Avoid publicity, self promotion and abuse of position10. Be a partner in promoting global health

Team Work – with the Sisters

HOW TO AVOID MEDICO-LEGAL ISSUES?Practice Good Communication skillsMeeting patients’ expectationProper documentationThe care of patient must be the first concernEveryone should be treated politely and consideratelyRespect patient dignity and privacyListen and respect patient’s viewProvide information in a way that is to be understoodTake responsibility for whatever form of action to be takenRespect the right of the patients to be fully involved in decision about their care Practice professionally, ethically and legally

THE DOCTOR & THE PATIENTDoctor- patient relationshipConfidentialityChaperonPrescribingTreatmentSecond opinionConsentProfessional feesUniversal precautionsRelatives & friendsInfamous Conduct

Radiology :what to look

BINOCULAR VISION

HOUSEMANSHIP POSTINGS.DIFFERENCES FROM CSMU AND MALAYSIA – STRENGTH AND WEAKNESSHOW TO STRENGHTEN SKILLS AND EXPERTISEHOW TO PREPARE FOR THE COMING HOUSEMANSHIP/TRAINING YEARS

MAJOR DIFFRENCES: CSMU AND MALAYSIA

KNOWLEDGE: SPECTRUM OF TROPICAL DISEASE

LIMITED E.G. MALARIA, DENGUE NOT EXPOSED.

CLERKING OF PATIENTS/HISTORY TAKING BEYOND OPTIMAL.

ABBREVIATIONS NOT REGULARLY USED

Medicine n anesthesiology-ICU

MAJOR DIFFRENCES: CSMU AND MALAYSIA :PRACTISE

EXAMINATION OF PATIENT INSUFFICIENTEXPOSURE TO DELIVERY PRACTISE :LIMITED TO OBSERVATION DUE TO SUPERSTITION.DISASTER MANAGEMENT GOOD BUT PREPARATION FOR SURGERY AND WORK UP INSUFFICIENTWORKING HOURS – LONG N MAYBE TIRING

MAJOR DIFFRENCES: CSMU AND MALAYSIA : PROCEDURES

LESS EXPOSED TO PROCEDURESBASIC PROCEDURES IN WARDS E.G. SETTING UP OF DRIP, USING BRANULAS AND BLOOD TAKING INSUFFICIENT. LUMBAR PUNCTURE, PLEURAL TAP, PERITONIAL TAP

PRE OP AND POST OP ASSESSMENTS: NEED TO LEARN HOW TO PROCEEDPREPARATION AND WORK UP OF PATIENTS BEFORE SURGERYLOG BOOK ENTRY IS COMPULSORY.Name might be different./method 1 /method 2.

In the ICU – medical postings

Surgery – with the surgoen

THE NEXT STEPS. HOW TO PREPARE FOR HOUSEMANSHIP/TRAINING YEARS IN MALAYSIA

Knowledge : What they did not teach you in CSMU.PractiseAttitudes.

Teamwork - with Paramedics

HOW TO STRENGTHEN KNOWLEDGE

Knowledge need to be sought proactively and not only taught by teachers.Need to appreciate the difference and recoup before coming back.Intelligent Discussion broadens knowledge – ask the right questions all the times.

Discussion - Forensic

Green zone –ED

HOW TO STRENGTHEN SKILLS AND EXPERTISE

Observation - focus on the detailsPractise makes perfect- log book as reminder for minimum exposure.Procedures- guided /under supervision

Red Zone – reality at ED

MAJOR DIFFRENCES: CSMU AND MALAYSIA : Attitudes Development

IQ : basis of intelligence.Moral intelligence

Ability to communicate with social background experienceEmotional and Psychological Intelligence

MENTAL CAPACITY TO ACCEPT CRITISISM AND IMPROVE. ABILITY TO WITHSTAND LONG HOURS

SOCIAL intelligence. To act with social judgement.

Attitude the right attitude towards patient care independence of

parental, VIP or external interference Self Esteem and spirit as a practising doctor Ability to manage independently as a professional

M.E.S.A.Q - MUST BE WILLING TO LEARN.

STRESS ON HEAVY WORKLOAD

HOW DOCTOR SHOULD……..

Q n A

KEMAJUAN KERJAYA DOKTORMBBS/MD/MBBchB

LATIHAN SISWAZAH

PEGAWAI PERUBATAN

PAKAR PENTADBIR KLINIKAL PEG. PERUBATAN

50

Career Path For DoctorsUndergraduate

5 – 6 years leading to initial medical degree (MBBS or equivalent).

Housemanship 2 year leading to full registration with the MMC

Basic Medical Officer (MO) Training3 years of compulsory service as MO rotating through disciplines, which qualifies trainee for entry into Specialists Training.

51

Career Path For Doctors

Housemanship Training x 2 year

Medical Officer (Basic Training) x 3 years

Postgraduate (Specialty) Training x 4 years

Subspecialty Training x 3-4 years

MOH Goal

Everyone MUST be a “Specialist” Clinical Specialist

Public Health

General Practice

(everyone must go through a proper training program in area of choice)

52

Career Path For DoctorsSpecialist Training

4 years of specialist training in clinical specialties or public health leading to the award of:-

CLINICAL(i) Masters Programme (UM/UKM/USM)

eg. Masters Programme (Internal Medicine)

Masters Programme(Surgery)

(ii) MRCP/FRCS/MRCOG (UK/Ireland)

PUBLIC HEALTH

Masters Programme (UM/UKM/USM)

4 years programme majoring in specialties such as Epidemiology, Family Health, Occupational Health, Environmental Health, Hospital Management, Health Management.

53

Career Path For Doctors

Subspecialty Training(Entry requirement - minimum of 6 months to 1 year ofservice as specialist in the field to qualify for Subspecialty Training)

3-4 years of apprenticeship training in the various subspecialty areas such as Cardiology, Gastroenterology, Endocrinology, Colorectal Surgery, Cardiothorasic Surgery etc.)Shorter training for “generalist” with “special interest”