A final year medical student in Egypt asked me for some tips. She has been put in charge of a pre-houseman course and wanted me to answer some questions.
I said ok, no problem. I'll do my best.
Then she said she is in charge of paeditrics. Ok.
Not my specialty but I will do my best to answer.
Answers denoted with ** was suggested by paediatrician Dr Adibah Abdul Ghafar:
1.below are the list of common peds disease in msia, can u tell me which disease are most most common for us HO to face in hospital later on,maybe u can give 3-4 name of disease.
Common pediatric disease
1)respiratory
-Tonsillopharyngitis
-Bronchiolitis
-AEBA (acute exacerbation of bronchial asthma)
-pneumonia
**Otitis media & Croup
2)Gastroenterology
-AGE
**Intussusception
3)Neurology
-febrile fit
-meningitis
4)infectious
-dengue fever
-HFMD
-impetigo
-scarlet fever
-kawasaki's disease
-varicella zoster
-measles
-scabies
5)Nephorology
-AGN
-Nephrotic syndrome
**UTI (urinary tract infection)
6)Haematology/**Oncology
-thalassemia
-ITP
**ALL (acute lymphoblastic leukemia)
7)Neonates
-IDM
-Prematurity
-sepsis
-TTN**(spelling error)
-NNJ
-Down syndrome/**Edward syndrome
-congenital defect (especially cardiac)
8)others
-developmental delay
**just have to build on the foundations laid during med-school.-NEED TO GO BACK AND READ ABOUT THE CASES JUST LIKE IN MED-SCHOOL.
Frankly speaking, I have never actually worked in paediatrics in Malaysia, but I did back in Ireland for 6 months, in a busy tertiary referral center (Temple Street Childrens Hospital) many years ago.
Depression-inducing it was, I vowed never to go back (to paediatrics), but I am very glad I put myself through it and didn't call it quits. I did learn a lot.
I do have experience working in family medicine in Malaysia, where a reasonable number of patients are less than 18 years old.
The list that you have given is pretty comprehensive, and I would say probably contains 90% of the cases I saw in a paediatric hospital setting (some conditions, like acute gastroenteritis, were more common in the emergency department compared to the ward).
Other conditions, like dengue fever and thalassaemia, I have never seen in Ireland but are very common here in Malaysia (and perhaps Egypt too).
The only other thing I would mention that is more common in Malaysia compared to Ireland, is the amount of pulmonary tuberculosis and leptospirosis (this is of course, referring to the adult general medical ward setting).
As always, for housemen, you are required to have a working knowledge of the common conditions, and (hopefully as was the case in Ireland) you will not be managing the patients on your own. All your actions will be supervised initially and as you gain more experience and confidence, only will you be expected to be fully responsible for managing patients - this wont happen as a housemen except for many straightforward procedures.
So I wouldn't be too worried about knowing all the diseases. You either already know enough, or just have to build on the foundations laid during med-school.
Being a housemen is acquiring the know-how and skills part of being a doctor. You already acquired the knowledge part, from all the studying during medical school.
The second question was...
2.can u list out the common procedure for an HO on pediatric posting need to do with assisst and without assist by senior doctor
**YOU WILL GET A LOGBOOK. JUST FOLLOW the instructions given. IV CANNULATION, LUMBAR PUNCTURE, SUPRAPUBIC ASPIRATION, CATHETERISATION
Ok.
Paediatrics was a pain for me because I did my first job in paediatrics after working two plus years in general medicine/emergency medicine postings.
At that point in time, my main interest was emergency medicine. So I figured it would be helpful to get six month experience in paediatric accident & emergency department plus paediatric general medicine.
By that time, I was pretty good at the adult procedures, and it was frustrating having to re-learn doing almost everything (procedure wise) for kids. Taking blood from a baby or toddler is very different compared to an adult, and so is something simple like putting in an IV line (my first paediatrics IV line insertion took between 30 minutes to one hour, when I could easily get an adult one in most cases, even the difficult ones, in 2-3 minutes). What a nightmare.
Still, practice makes perfect. After six months, I could put in an IV line in a spinning toddler single-handedly, with no help from the nurse or mum. So don't worry too much.
"Every master was once a disaster".
Here are my tips for future housemen...
Tip #1: Wear the most comfortable pair of shoes you can afford. The first two weeks of work were a killer because most of us med-students were just not used to being on our feet 70 hours per week.
Tip #2: Don't skip meals. There will be times when you cant avoid skipping it.
Tip #3: Get enough sleep and rest.
Tip #4: Learn how to get along with the nurses, other doctors and health professionals. If you can make them like you, life will be much easier.
Tip #5: Learn how to manage stress. Some like sports, others turn to their faith, hobbies, whatever.
Tip #6: Keep in touch with friends outside of medicine. While medicine is great, its good to keep in touch with the outside world.
Tip #7: Focus on the future. Make plans where you are headed next. It's not an easy time, but knowing where you are heading will make the journey more bearable.
Tip #8: Learn. Ask the people who have gone before you (the housemen who just finished). They will have plenty of advice. Read up on the cases you see in your allocated study time.
Tip #9: I use to have a piece of paper with all the patients name, and just jot down the job to be done next to each patient. I also had a file with all the request forms. Pens are needed and you'd be surprised how many get lost during a course of a day. I don't know how much this is true or relevant today.
Tip #10: I used to carry the yellow oxford handbook and BNF (British National Formulary) in each white coat pocket. The other indispensable item would be the stethoscope. Nowadays, you only need your smartphone and stethoscope.
Tip #11: In Malaysia the housemen are fixed to a ward for a period of time. In Ireland we were attached to teams. On-call was mainly inserting IV lines so it made sense to learn where equipment was kept, which wards were well stocked, and to carry some spare in case the ward was out of them at night.
Extra tips from an anaesthetist Dr Afaf Azlin (denoted*):
*The most important thing that ho should learn is to work as a team.. All for one. One for all.. The horrible n insurmountable tasks would be doable when u have good friends to help u along..I did enjoy my paeds posting.. And it was in seremban gh.. Cos we had a good bunch of people to work with!!
This is from Dr Poh Ban Chung (from Dobbs facebook group)
1. Take care of yourself FIRST. It is your own responsibility. Make sure to be adequately hydrated and fed while working. Avoid skipping meals. No time to eat is a poor excuse. You do not need an hour to eat. You just need 5-10 minute to drink some water and eat some biscuits. If you become hypoglycemic or dehydrated and collapse while working, your colleagues will have to resuscitate you and complete your part of the duties as well.
2. Make yourself COMFORTABLE while doing procedures e.g. blood taking, setting line etc. Position yourself and the patient in such a way that you can do your work with the minimum effort. Being a contortionist usually makes your procedures more difficult.
3. Humility goes a long way. Especially with the nurses.
These are additional articles on the matter:
Tips for housemen by the Malaysian Medical Resources
House Officer's Survival Guide by the Malaysian Medical Resources
Both were shared by Dr Alan Teh (haematologist and Dobbs facebook group founder).
Hope this helps.
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