Becoming a physician

I'm currently undergoing the processs of gazettement to be an internal medicine specialist. Call it a probation period if you will. Here in Malaysia, there are two pathways to become an internist. The first is to undergo a four year Masters program in one of the local universities. One can apply for Masters program after serving three years in government service (2 years as HO, 1 year as MO) and he must achieve a SKT mark of higher than 85% for 3 consecutive years. The second way is to go through the so-called "parallel pathway" and obtain one of the certificates recognized by the NSR (National Specialist Register). As I did the latter by sitting for the MRCP (UK) examination, I'll be talking solely about this exam.

MRCP (UK) consists of three parts. The first two are theory papers and the third is an assessment called PACES of which the candidate's clinical skills were put to the test. One of the mat salleh examiners described it as "making easy daily diagnoses difficult". Sounds about right.

Part I is made up of two papers consisting of 100 questions each. Each paper was three hours. I took my exam in Universiti Malaya some time in September 2014. It was during my final posting as a house officer in anaesthesiology. I subscribed to Pastest which had a bank of 5000 or so questions. I also used Phillip Kalra's "Essential Revision Notes for MRCP". The money spent on the revision materials is worth it. It might seem pricey in the beginning, but it's definitely much cheaper than resitting for the exam!

For part II, I used Pastest again - There were only 2000 odd questions for part II. A book you'd want to invest in is Sanjay Sharma's Rapid Review of Clinical Medicine. The exam was held in NUS, Singapore. This time around there were three papers each consisting of a hundred questions. By the end of the second paper, my mind was so fatigued and all I wanted to do was sleep. Following that was another time lag before the college announced the results.

After passing the first two theory papers, you'll reach your final hurdle. PACES is no joke. It's like the prospective father-in-law you don't really wanna see, but you still have to face the music because you wanna marry the girl. You can put in the hours and do everything in your power to prepare yourself, but there's no guarantee that you'll succeed on your first try. Or ever.

For those preparing for this exam, some general tips I could give are:

• Apply to a hospital that is geared for the MRCP exam. I worked in Hospital Seremban where most of the physicians were MRCP trained. The consultants were very kind to organize weekly classes for us on Friday evenings and they were all very encouraging. It helps to be in the company of like minded people.
• Form a small study group of 3-4 people. Any more than that and it takes too much time to examine patients together, and your discussions might go off on a tangent. Be accountable to one another, practice together as often as possible.
• Work in clinics often. This simulates the history and communication skill stations, and also helps with picking up signs in the clinical exam stations. I found rheumatology clinics to be VERY helpful for brief clinical consultation stations.
• Go to opthalmology clinic to look at diabetic and hypertensive patients' eyes.
• Go for as many mock exams as you can afford, and be a candidate. Don't just be observers. Simulate the stress and sinking feeling in your gut of the real exam. It helps to get used to that adrenaline rush.
• Oxford Clinical Medicine for the MRCP PACES. 'Nuff said. I found volume 1 to be much more useful than volume 2. The handbook is GOLD. Grind it into dust and bring it to a boil. Drink it. Consume it. Digest it.
• Understand the exam format. There are things you do that gets your marks. Understanding the rules of the game and knowing what to expect will help you focus on your preparation.
• Apply what you learn in your daily practice. Let every clinical examination and every difficult encounter become a part of you so that it comes out naturally during the exam.
• Be sincere in your daily encounter with patients. Again, this will become a part of you and it won't seem like you are faking it during the exam.
• Pray. There's only so much you can do. The rest is really up to God. ie. You don't get to choose your examiners.

After you pass PACES, pat yourself on the back. It's not an easy feat and you deserve to reward yourself with a hearty meal. Bear in mind, one other requirement in Malaysia to gazette as a medical specialist is that you must have 4 years experience in the medical department, of which 1 year must be after you passed the exam. So take your time with the exam, there's no real hurry to binge through it like a Netflix series.

My journey through housemanship - Part II

Following General Surgery, my subsequent rotations were General Medicine, Obstetrics & Gynaecology, Orthopaedics, Paediatrics, and finally Anaesthesia & Intensive Care.

As tough as it is, housemanship continues to be a rite of passage medical graduates undergo. Suffering produces perseverence; perseverence, character; and character, hope. It is during these two years that interns are shaped and refined into independent and safe doctors. It is also during these two years that you form lasting bonds with like-minded people. It is very difficult to tough it out through housemanship alone. Housemen who work together produce better and safer outcomes for patients. There are some days when things just don't go your way, and only a fellow houseman who is going through the same journey as you would be able to empathize. Busy as we were, we tried to make time to hang out. By the end of housemanship, I'm grateful to have met and work with many great colleagues and I know that they will all be wonderful healers in their own fields.

If I were to choose my favorite rotation as a houseman, it would have to be anaesthesiology. I didn't ask for it and it was just given to me by the office. We worked in the operating theatre for the first month, and then we were placed in the ICU on the second month onwards. It was a good refresher as anaesthesia dealt with patients from all other postings. I learned how to perform intubation and how to assess the intrathecal space in a safe and controlled environment. In the operating theatre rooms, we were only dealing with one patient at a time and this allowed us to take our time to prepare everything needed prior to performing the procedures. There were some who said that being posted to anaesthesia meant missing out on learning how to treat emergencies but that was not the case. Patients in the ICU were critically ill, that meant that emergencies could happen at any time. The hours for housemen in anaesthesia were better compared to other postings, so I had the time to study for my exam. The superiors were awesome. Even when I did rounds with the head of department, I felt like a colleague rather than a subordinate. The working environment was just pleasant and I looked forward to go to work.

Before I knew it, two years finally passed. It was a bittersweet moment, thumbing out as an intern for the very last time. I was glad that I finally made it through housemanship. I lost fifteen kilograms and I'm probably healthier because of that. At the same time, it saddened me that I was leaving HTAR Klang. I loved the specialists and MOs that were so approachable and taught us so much. I loved the fact that housemanship brought different people into my life. We were sent to different parts of the country after our training, and I haven't seen a lot of them since. Some decided to pursue their career in another country. Some stopped working as doctors altogether and went on a different path.

After housemanship, both me and my wife were transferred to Jempol, Negeri Sembilan. We started living by ourselves as a family for the first time with our son. Not knowing what to expect, we moved to a rented single storey house in a quaint neighbourhood to begin our new adventure.