A Guide For Clinical Year USM [MEDICAL posting]

Peace be upon all of you,

Internal medicine is one of the major posting. You will spend 6 weeks in year 4 and another 5 weeks during fifth year.

For me, this posting is challenging not because of the requirement but mainly due to the vast topic that you need to cover. Medical problem is from the top of your head until the bottom of your feet and involve all system. Therefore, you will having difficulties to choose which part or system that you need to study. Furthermore, dermatology has also being compacted into this rotation as well.

Again, it is important for you to cover common medical disease first and then goes to less common one.

Besides, challenge in establishing diagnosis, you also need to master technique on physical examination of various system like Cardiopulmonary system, abdomen, neck examination, cranial nerve, examination for diabetic patient, motor system examination and lymph node examination.

So here’s the thing that you need for your internal medicine posting

1) Guide book by Internal medicine department (compile together with log book)

2) Physical examination tool

a) Stethescope

b) Tendon hammer

c) Measuring tape

d) Two ruler (to measure JVP)

e) Two pen torch

f) PE set that you can buy from senior consist of (Snellen chart, cotton wool, tongue depressor, dark paper for lump examination, tooth prick to check for nerve sensation.

3) Pocket book to carry inside your pocket. I suggest two book

a) Oxford Handbook of clinical medicine

b) Sarawak pocket handbook

4) Reference book (you may use emedicine and journal as weel)

a) Kumar and Clark

b) Harrison

c) Davidson

d) Baliga 250 short cases in medicine

Requirement for this posting

1) Attendance

COMPULSARY and you may fail this posting if attendance is un satisfactory

2) Tutorials

Please divide yourself accordingly for tutorials and meet respective lecturer for

i. Internal medicine topic

ii. Dermatology topic

3) Special class by Prof Mustaffa Embong

He will teach you on Mustaffa Method on how to take history and perform physical examination. Make sure you did his homework.

4) Log book

i. You need to see cases listed in your log book. However, you do not required to present the case. It is merely for your self study.

ii. Please ensure that you perform or at least see the procedure listed inside the log book. Aim to master blood taking, IV canullation, ABG, reading X- ray, taking manual blood pressure.

5) Case presentation

- Divide yourself for case presentation. Each of you will have at least one chance to present to the lecturer.

6) Report writing

You need to submit total of two report writing to your supervisor which is at the end of second and fourth week.

7) Wards.

Divide yourself according to the team to cover 7S and 7U. you may also goes to 8S (high dependency medical ward), 1S and 3S (hematology ward) but no need to cover the case in these two wards. Here what you need to do

a) Morning rounds

Compulsory and follow your team. Be at wards at least at 8 a.m in the morning

b) On call

You are expected to cover the new admission and follow the round

c) Cover patient

Some may suggest that you divide the patient. But I don’t believe that this is the best approach. For me, It is better for you to know all the cases in your team by going through their medical note.

8) Mortality audit

This is only compulsory to year 5 due to limited seat. However, I suggest that you go to this session as well when you are free. It is a very beneficial session as you may learn from other mistakes in managing patient.

9) Grand ward rounds

Only for final year

10) HRPZ
you will be having short case teaching session at HRPZ once a week. so please discuss with department to contact respective doctor from HRPZ

11) Exam

a) MCQ

b) Pharmacology (MCQ and Short essay question)

c) Short case

d) Long case

Notes

1) Please get the time tables at department few days before you enter the posting.

2) You will divide yourself into two big group (A&B). each group will then divide into sub group to cover case in 7U and 7S. you should rotate yourself so that all of you can cover both male and female patient.

3) Most patient are nice and willing to co-operate. However some of them are so tired. Therefore, please have EMPATHY on them.

4) If you do any procedure, be confident. If you fail in your attempt, apologize from the patient and ask help from senior and doctor. Don’t be ego that you can do everything. Even the expert sometimes fail to perform easy procedure.

5) Have a lot of discussion with your colleague especially physical examination. Practice make perfect.