Prehouseman Attachment at USM (Day 7)

Assalamualaikum semoga kita sentiasa berada dibawah lindunganNya :)

FIRST DAY ELECTIVE POSTING AT  "OBSTETRIC AND GYNAECOLOGY"

My target to achieve during this posting are:
1)clerk cases
2)study the Ong clerking form
3)Join morning ward round
4)Learn to apply and read CTG
5)Familirize common abbreviation for Ong cases
6)know common cases
7)observe VD & LSCS
8)know how to document post and pre op review
9) observe common procedure as CBD, PV etc
10) Do or observe physical examination
11)Join USM students' classes

1) Went to ONG department to meet secretary ONG department. Want to meet HOD Ong but he didnt present at his office at that time.

2)Followed Nurse in charge for orientation. She explained to us about the ONG ward.

-Room for labor.
-Room for premature cases
-Room for HDU (high risk cases)
-Room for pre eclampsia
-Room for epidural
-Labour room (Cs) must wear scrub, shoes, and different scarf)
-Ante natal clinic at ground floor
-Antenatal & postnatal ward. (3 ward)

*we can help nurses to detect BP and call the husband.

3) Join MEDICAL Ho teaching with fellow HOs and one specialist

-They presented about communication skills that involve consultations, breaking bad news, communication while clerking, cultural sensitivity.

-Specialist, Dr Abu added the informations about:

A ho must master 3 languages :
*BI to communicate with colleagues, consultant, registrar
*BM (community language :dialect: to talk with patients

Must always introduce ourself before examine or do procedure to patients

Practice RAPPORT when clerking the patient

Learn when clerking, try not to write while clerking.

Paternalism : Inform choice
                       : Decision making
                       : explain to patient what he need to know and deserve to know
                       : doctor act as agent to deliver the information
 

My partner whatspp status about what Dr Abu said during HO teaching ;)

4) At evening, go to labor room for the
 first day:

-observe dr do vaginal examination before delivery to detect the opening of OS (how many cm)
-observe nurse perfomed CTG
-observe and assist Dr do episiotomy
-observe MO do CBD before labor to fasten delivery because full bladder  that compress the uterus will lengthen the delivery process.
-A pt asked me for a small bottle to fill her 'air selusuh' (she claimed it) but doctor didnt give her permission to drink that because fluid can make the pt to choke and enter the lung.

5) Study how to clerk ONG cses and study common abbreviations.

Post operation review

Template ong clerking page 1

Template ONG clerking page 2

Memory of 1st day ONG elective attachment

**ops today baru dapat nametag after one week here hehe. 

Prehouseman Attachment at USM (Day 6)

Assalamualaikum semoga kita sentiasa berada dibawah lindunganNya :)

Day 6 ( 7/10)

1)clerk one case with general examination and half physical examination (sebab tak sempat)

Pt U/L with:
-spina bifida since congenital
-regular haemodialysis since diagnose with CKD at age of 13years old.
-Bilateral hydronephrosis

2)Perform ECG with ECG machine with staff nurse

3)Meet my highschool senior, Dr Afham. Observed him doing ABG.
He told me to go oncall with him this Wednesday to learn how to do branula insertion and clerk cases.

4)Join EBM (evidence based medicine ) class with year 5 USM students.
-2 students present the slides and 1 student present the case.

-Topic : Uses of ACEI in chronic heart failure.

Prehouseman Attachment at USM (Day 5)

Assalamualaikum semoga kita sentiasa berada dibawah lindunganNya Amin:)

Day 5 (6/10)

1) Take a look with details pt 55years old underlying with
-DM since few years ago
-spondylitheasis
-obstructive jaundice to rule out malignancy

I paid attention on how the Dr clerks the cases through clerking sheet, review forms, results, forms that need to be filled and drug prescription.

2nd patient present with End stage renal failure (ESRF), tertiary hyper Paratyhroidism, Multinodular goiter with retrosternal extension, Hpt on T.felodipine, ch lung disease with pulmonary HTN, B/l renal parenchyma disease and degenerative spine disease.

2) Done observe and do short case on female pt ( I act as chaperone) from general examination and physical examination.

-Hand: detect water hammer pulse, pulse, pallor of hand, clubbing of hand, peripheral pulse.
-eye for jaundice
-mouth for cyanosis
-JVP raised
-palpate abdomen
-CVS: apex beat pulsation
-Resp: movement of chest, auscultate chest sound
-leg: pedal edema
-examine JVP while auscultate the lung usng small cone stethoscope
-apex beat displaced at 6th intercostal space ant axillary line.
-auscultate heart at tricsupid, mitral, pulmonary, aortic area to hear the murmur.

3)  observe eye dressing for corneal ulcer

4) observe MO and HO do peritoneal tapping.

Summary of procedure:
-Inject anesthesia first
-IV Line to draw ascitic fluid -> put into specimen urine container 100ml & collect urine in urine bag (3000ml) .
*if ascitic fluid not flow automatically, drain manually using syringe.

Prehouseman Attachment at USM (Day 3 & 4)

Assalamualaikum dan semoga kita sentiasa berada dibawah lindunganNya Amin:)

Day 3 Attachment 3/10

-Join ward round with senior Ho and Mo
-clerk patient CKD . First time smell pt with CKD Halitosis
-observe 3 MO do femoral cathether vein for haemodialysis.

1) must know the anatomy of femoral vein
2)technique of insertion
3)complication

Day 4 Attachment 5/10

-at 1pm join war round at ward 7S
-Meet with senior Zagazig Dr Amirah & Dr Alifah

-Dr Alifah explain about:

1) simple procedure in ward (Bilik Rawatan), 

2) how to do branula insertion (VBG, ABG)

3)explain about different blood tube

4)explain about common form used in USM Hosp

5)explain about tools and different oxygen mask

Variable of forms.

Trolley tray for branula insertion

Basket that Dr must fill will blood tube and others tools for the next Dr to do branula insertion.

Prehouseman Attachment at USM (Day 2)

Assalamualaikum semoga kita sentiasa berada dibawah lindunganNya.

Things done:

1)Meet and greet with Sister Wahidah
-she explained to us about ISBAR when meet everyone in ward.
I: INTRODUCTION
S: explain the SITUATION
B: BACKGROUND
A: ASSESSMENT
R: RECOMMENDATION

*ISBAR was taught detail during medicorp preho course.

-always do hand hygiene/ hand scrub when entering the ward.
-we are restricted to do procedure unless with permission


2) Morning ward round with specialists,registrar, Mo, Ho and USM students

Points taken during morning round:
-see seniors Dr present the cases
-know what finding that present in pt (do physical examination)
-during clerking must ask detail on every point to reach diagnosis.
-know important and common cases
-interpret and read ecg , know most common questions about ecg

3)clerk one case with acute tonsillitis case

-know the template of clerking
-familirize the abbreaviation
-take a look at patient's file, result and forms.

4)Meet my high school senior, Dr Afham (Ho) & Dr Adilah (Mo)
-observe Dr Afham do am review.
-Dr Afham explain the ward system,  what to do during medical attchment, common disease in medical

5) Take home message for today 2/10
-read management based on CPG (must read once before entering HOship)

Prehouseman Attachment at USM ( Day 1 )

Assalamualaikum dan semoga kita sentiasa berada dibawah lindunganNya Amin. :)

Sebelum menjalani latihan prehouseman saya telah listkan beberapa target yang perlu dicapai selepas tamatnya latihan prehouseman ini iaitu:

- Belajar  macam mana sistem gerak kerja dalam hospital Malaysia.
-Belajar apa tugas houseman dalam ward.
-Belajar dan kenal pasti sebanyak mungkin common abbreviation yang digunakan.
-Belajar template dan cara clerk patient dari sudut sebagai seorang houseman (bukan student)
-Belajar,dengar ,teliti cara houseman present case (bukan cara student) semasa ward round bersama MO,registrar dan specialist..
-Tahu common cases yang terdapat pada department tersebut
-Kenalpasti common form dalam wad yang perlu diisi oleh houseman
-Belajar common drug untuk setiap cases.
-Belajar do and observe some procedures (blood taking, Nasal tube n so on)
-Tengok cara Ho review patients every morning.
-Belajar trace result dalam BHT dan computer ward.
-Do some physical examination.
-Attend some classes of USM student.

Prehouseman Attachment at USM (DAY 1)

-7-8am 
Go to USM from home with Amalia

8-9am
 Isi borang penginapan di pejabat hostel USM

9-1pm
Angkat barang naik ke hostel.

Bayar sewa penginapan (RM 131 selama 3minggu ) dan bayaran attachment (RM375 untuk          3minggu) di Jabatan Bendahari.

Serahkan resit ke Bahagian Korporat USM ( Puan Azizah)

Isi borang untuk nametag di Jabatan Pendaftran

Ambil kunci hostel.

Kunci hostel untuk bilik bertiga

2-2.30pm
Met with Dr Mohammad  Rosdi untuk pembahagian department dan briefing
 tentang  prehouseman di USM ini.

Dan saya dapat 3 department iaitu Medikal, Surgery dan ONG iaitu masing2 satu minggu.

2.30-3pm 
 Meet with Prof Madya Dr Azlan Husin (Ketua Jabatan Perubatan) to introduce
ourself and briefing about the medical department.

3-5pm
 Go to medical ward to greet Sister or Team leader to introduce ourself to her
 but unluckily she did not present at ward at that time. 

 Quick review about the ward. :)

     Our first day

Pre Houseman Attachment at USM (Registration)

Assalamualaikum dan semoga kita sentiasa berada dibawah lindunganNya.

Alhamdulillah beberapa bulan sebelum dipanggil untuk menempuhi alam pekerjaan iaitu fasa housemanship, diberi peluang untuk menjalani latihan prehousemanship di hospital USM selama 3 minggu bermula 1 Oktober sehingga 21 Oktober 2019.

Semestinya hospital pilihan untuk membuat attchment ialah Hospital Universiti Sains Malaysia di Kubang Kerian Kota Bharu Kelantan.

Ini adalah kali ketiga saya menjalankan attachment di hospital ini. Kali pertama adalah semasa saya di tahun 3 perubatan dan mendapat attach di Jabatan Kecemasan dan Trauma . Boleh rujuk posting ini,https://thebestwomanwins.blogspot.com/2015/10/pengalaman-attachment-di-dept.html . Dan kali kedua ialah ketika saya berada di tahun 4 Perubatan dan mendapat Jabatan Medikal . Boleh rujuk posting ini https://thebestwomanwins.blogspot.com/2016/10/elektif-posting-medical-dept-usm-1st.html

Hospital USM menjadi pilihan saya untuk menjalankan attachment sebagai medical  student atas beberapa faktor iaitu:

-Ianya boleh dkatakan agak dekat dari rumah saya (Pasir Puteh) iaitu selama 30mins perjalanan.

-HUSM ialah teaching hospital dan kurang sibuk dibandingkan dengan HRPZ yang terletak dibandar Kota Bharu yang agak sibuk dan jem. Doktor2 disini juga lebih terbuka untuk memberi panduan dan mengajar kami sedikit sebanyak.

-HUSM mempunyai pelajar medikal . Maka ini memudahkan saya untuk membuat kenalan dengan local students Medic dengan bertanyakan tips study mereka, dapat bertanyakan soalan mengenai sistem Malaysia dan kami dapat sertai aktiviti pembelajaran, pengajaran dan CME dijabatan jika dibenarkan oleh ketua jabatan.

-HUSM merupakan 1st choice dalam pilihan penempatan saya ketika mengisi e-ho kelak.

Cara untuk apply attachment di hospital USM ketika masih bergelar student dan graduan adalah berbeza.

Jika masih belajar, boleh isi borang (download) di website USM dan hantar di pejabat HEPA USM.

Jika bergelar graduan PREHOUSEMAN steps nya ialah:

1)Buat surat kepada Dato Pengarah USM (can google)
2)Sertakan:
- sjil grad dari university masing2
-surat sijil pengesahan dari universiti sekiranya belum ada sjil
-Surat pendaftran sementara daripada MMC
-Resume diri.
*USM ialah badan berkanun jadi dikenakan yurann sebanyak RM375 untuk tiga minggu.
*Perlu apply sebulan lebih awal.

Sekian sahaja bersambung dientry seterusnya with #PREHO label.

Surat balasan dari pihak USM dihantar melalui email

Tatacara sepanjang Prehouseman Attachment.

Sekian. :)