An appropriate baseline in quality and quantity of training — Dr Schee Jie Ping
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MARCH 23 — As a relatively junior medical officer, I started my housemanship training in Queen Elizabeth Hospital, Kota Kinabalu in July 2013 and completed the training in July 2015. Not so much of the “during my time” generation.
Just two to four years ago, we went through the shift working system as well. All of us went through tagging period whenever we started in new departments, working more than 16 hours per day (6am till 10pm) for at least 14 consecutive days with or without a day off in between. Moreover, if one's performance was deemed subpar at the end-of-tagging assessment then the tagging period could be extended to up to four full weeks.
Take our Obs & Gynae tagging in 2014 as an example. It was 14 consecutive days without any day off in between, started before 6am and only ended after 10pm, easily more than 16 hours per day. On top of the usual ward work, there were certain logbook procedure requirements to be fulfilled before one could even go for the end-of-tagging assessment.
Each of us had to perform 10 deliveries, five episiotomy repairs, assisted in at least three caesarean section and also other gynaecological procedures in operation theatres during the two weeks tagging. All of us stayed well beyond 10pm for the opportunity to perform and assist in those procedures.
Some camped overnight in the hospital. Instead of going home, some checked in to the nearest budget hotels to grab the precious few hours of rest before starting the next day.
Once house officers pass the tagging assessment, they will be able to off-tag and be expected to function independently. This has been so in the past few years or even decades. However, the normal working shift is not eight hours as mentioned in the above-mentioned article.
Our usual daily shift two to four years ago lasted for at least 12 hours each. Currently house officers in Hospital Kuala Lumpur work at least 10 hours per shift (7am till 5pm). These 10, 12 hours are the minimum length specified on paper but the actual working hours will always be longer.
For instance, back in 2013/2014, junior house officers like us working in certain wards had to start our day by 5am and only got to call it a day after 10pm, even though it was non-tagging usual daily shift. There were times when we literally punched out the next day (after 12 midnight) and continued by 5am again few hours later. Currently, most house officers in HKL start working at 6.30am–7am and finish after 5.30pm, easily more than 11 hours per day.
The long hour during tagging can be challenging indeed. However, bear in mind that once house officers complete their training they will all be medical officers and will have to be on-call, working for >33 hours continuously with heavier burden, higher stress level but less level of help and narrower margin of errors.
Sleep is indeed important for memory consolidation, so is doing enough during the day at work to have the memory to consolidate at night, as housemanship training is an apprenticeship, an on-the-job learning, i.e. spending time in hospitals to learn.
Reflecting on what we have learned and done for the day at work is much encouraged. It can be done at any time and whenever necessary through the day, not necessarily only at the end of the day. Six hours of sleep per day during the tagging period is challenging but not impossible (24–16=8).
If we shift those time spent on whining, complaining on mass media, browsing Facebook, Instagram, Twitter (any social media you name it) to sleep, five-to-six hours of sleep is still possible on most days. Some might argue that we do not have the time to study, to revise on theoretical knowledge.
True enough. If we wait to have the suitable time to study, it will never happen. Be proactive, make time to study as necessary, take control and dictate our own learning.
Meanwhile, house officers will never be treated like lesser beings. By default all senior doctors (consultants, specialists, medical officers) treat junior doctors with respect, dignity and professionalism. Credit will be given where credit is due.
Capable, responsible house officers who contribute to the teams will always be highly appreciated. For instance, the on-call medical officers buy supper for house officers during night shifts, specialists paying for your share of court fees during badminton sessions and so on.
It is blessed to be at the receiving end of our superiors’ acts of appreciation. Better still junior doctors will get to befriend these senior doctors who will provide precious guidance in the future training as well.
It was pointed out by some junior doctors that coming up with shorter sessions during the tagging period will result in a lower failure rate at the end of the two weeks, while shaping better functioning, thinking and rested house officers.
I beg to differ. Again, housemanship is an apprenticeship, an on-the-job learning, i.e. spending time on training in hospitals. This essential, irreplaceable learning process does not happen at home nor in front of laptops, smart phones, tablets and so on but only in hospitals.
Furthermore, we choose to be doctors not to be well-rested but to make a difference in every patient’s life. As quoted by Sir William Osler, the Father of Modern Medicine, “Live neither in the past nor in the future, but let each day's work absorb our entire energies, and satisfy our widest ambitions.”
Most house officers are young adults aged around 25. Personally I think this age is the peak of physicality, the best time to work the hardest. All doctors with passion for the career and passion to serve patients will not be too calculative with the necessary training.
Putting comfort before training and putting current ease before future competency are simply not the ways to go. Putting lifestyle first is how one finds a job, not a calling.
Junior doctors should not just be here to work and go home while getting paid for mediocrity because we bear the social responsibility to excel in our daily work and career as a whole. I believe when we truly choose this path out of love and passion, all hardships are just challenges to be overcome and necessary training for our local setting.
Looking back now, all those training and hardship that we went through previously, whether we liked it or not, had made us to improve exponentially, be functional in the shortest possible time, moulded us into safe doctors. Whenever we work, humans' lives are at stake.
We junior doctors dedicate to improve ourselves constantly not just to pass housemanship assessments or exams but to prepare for those moments when we are the only help standing between a patient and death. Therefore the quality and quantity of training can never be compromised regardless of how much we desire to improve the quality of life of House Officers. After all tagging will only last a few weeks.
Last but not least, medicine is indeed only for the true crème de la crème and housemanship is the easiest phase of the whole career. If one can't even endure this initial phase, the stepping stone to greater career accomplishments, one really needs to rethink the future and choice of career.
Still, to all the new junior doctors reporting to duty soon, welcome to the family. Embrace the challenges along the path of this fulfilling career and together we can achieve greater heights.
* This is the personal opinion of the writer or publication and does not necessarily represent the views of Malay Mail Online.