House officer in malaysia work in general hospitals after they graduate for training to prepare themselves to work independently after their traineeship. therefore, depend on which hospital they go to, generally they went through a few posting before becoming a full fledged medical officer that we all r seeing outside. major postings include medicine, surgery and obs&gynae, followed by orthopedic and pediatric. we have just include accident&emergency in the latest freshgraduate training programme. now, new house officers will have to undergo full 2 years of training before confirmed as medical officer and serve the health industry.

so we have 2 years to divide among the 5 (or 6) postings, which give around few months (4mths) in each posting to learn what is essential n needed to work in future. we have medical officers and specialists to guide them during their postings, tht's the purpose of teaching hospitals we have here in m'sia. house officers should come early in the morning n review patients, update their progression and look for new problem or pts' complaints. then medical officers will do round with them, n they have the opportunity to learn what should be done, what's not discovered yet, n any change of diagnosis. then finally we have input from specialists also when they come n do rounds (again, :) ) HO learned the most during rounds with MO and specialist. after rounds, they will have to carry out the job list or ward work. this largely train their clinical skills, how to set intravenous access, calculate drip for patients, prescribe antibiotic and pain killers for patients, clerk new admission and diagnose patient's problem, order the necessary investigations, n most importantly, inform their superior for any emergency arises in the ward. although HO is the lowest at the hirearki in medical field, they r the first hand staffs come into contact with patients.

normal working hours for HO (practically) usually is around from 6 till 6, including they finish all the work being ordered by medical officer and specialist, with no guarentee for lunch time or even lunch break. sometimes u have to stay back n finish the work if there r alot of patients (s/time u skip ur dinner). N dun forget about on calls also, means after office hours, if needed u have to stay in the ward for the night, unable to go back for clothes change or meal time, till the next day n work till 6 pm again. round the clock, u have 36 hours non stop working. from this massive amount of time, HO learn, train, n practice under supervision

so, imagine our HO work in shift, say around 8 hours per shift, one to two shift per day, with no on call system, they will have roughly 1/3 of 4 months(!!!) to come contact into patient, n even less time to learn n practice, n therefore less skill n knowledge being imparted.

unfortunately our medical field does not practice the western style programme, in which their HO (internship) train straight in the programme (surgery, medicine, pediatric etc etc) they interested in n no need to run the hassle to go through other discipline. so they have years ahead of them to train n gain knowledge from tht department. with that, shift system is practical to ensure they have enough rest. in our setting, we see new rotation of HO changing posting in 4 months time n they will not repeat their posting unless they come back as medical officer for tht particular discipline. here, shift system does not seem beneficial to HO (from my point of view :P )

HO is years of hardship n mental challenge. if u can go through it, u can go through future stress and responsibility in thie field (coz u will be better equipped) it's always wrong impression things will get easier after medical students years. things will just worsen the longer u stay in the medical field. stress and hardship rise skyhigh the higher level u go through (MO, specialist, consultant, head of department, hospital director)

i'm so into this topic today coz there's a specialist want to promote HO to work in shift system, which i strongly against it. i n few of my close friends went the traditional method of training have agreed that we learnt the most from our training years (1 and half year), not from our books. :) efficiency in work depends mostly on clinical skills, n knowledge can bring us to further study.