Orientation Manual

for
House Officer

Department of General Surgery

Hospital Kajang
2018

1
Table of Contents

PAGE
GENERAL INTRODUCTION 3
ORGANIZATION CHART 4
PART 1: GENERAL INFORMATION
1.1 GETTING STARTED AT SURGICAL 5
DEPARTMENT
1.2 THE LEARNING OBJECTIVES 5
1.3 RULES AND REGULATIONS 6
1.4. REQUIREMENTS 7-9
1.4.1Reporting of duty
1.4.2 Tagging
1.5 WORKING HOURS & JOB SCOPES 10-14
1.6 LEAVE POLICY (POSTING LEAVE, SICK LEAVE 14
AND NO – PAY LEAVE)
1.7 MENTOR-MENTEE SYSTEM 15-16
1.8 CME 17-18
1.9 ASSESSMENT 19
1.10 POSTING EXTENSION 19-20
PART 2: OTHERS
2.1 CHECKLISTS & ASSIGNMENTS DATELINE 21
2.2 GUIDELINE FOR ESSAY 22
2.3 HOUSEOFFICER REPORTING PLEDGE FORM 23
2.4 DAILY MORNING ROUND FRAMEWORK 24
2.5 GUIDELINE FOR POST-PROCEDURAL 25
DOCUMENTATION

2
INTRODUCTION

Dear Doctor,

Welcome to the Department of Surgery Hospital Kajang. The internship

is a training period and the opportunity for you to gain as much practical
experience as possible before you are allowed and expected to be able to
function independently wherever you may be posted to. Part of your training
includes the development of good interpersonal relationship and the ability to
work with others as part of a team, the ability to take orders from your
superiors and the ability to give orders to your subordinates in a professional
and also cordial and polite way.

You are expected to be contactable at all times even when you are not on call
unless you have prior permission and have taken your official leave.

At the end of your posting you are expected to have reached a reasonable
standard of proficiency or you will not be signed up.

You will be helped by your senior colleagues and allied staffs. You are
supposed to be supervised and are not to make any crucial decisions without
consultation unless it is so urgent that you have to act decisively.

Have an enjoyable stay with the department.

Head of Department
Surgical Unit
Hospital Kajang.

ORGANIZATION CHART

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Head of Department: Mr Andre Das

House-officer Supervisor: Ms Afizah Binti Salleh

Surgeons: Ms Azlin, Mr Firdauss, Ms Rubiah, Ms Nurul

Panels:

Dr. Hazim
Dr. Farabi
Dr. Vivian
Dr. Mugi

DATE OF MANUAL: MAY 2018

NEXT DATE MANUAL TO BE REVIEWED: MAY 2020

PART 1: GENERAL INFORMATION

4
1.1 GETTING STARTED AT SURGICAL DEPARTMENT

STANDING INSTRUCTIONS TO HOUSE OFFICERS JOINING

DEPARTMENT OF SURGERY HOSPITAL KAJANG:

THE STATUS OF HOUSE OFFICER:

House Officer is posted to the department by the Pengarah of the Hospital. A

formal letter of posting must be obtained. The house officer has temporary
registration with the Malaysian Medical Council. He is not a fully registered
Medical Officer ( Pegawai Perubatan ). He needs to work under the
supervision of a registered medical practitioner. Internship means that you are
required to be on duty and contactable throughout your posting unless you
have prior permission from the head of department.

1.2 LEARNING OBJECTIVES

Basically, the house-officer-ship period should be a time when you:

1. Consolidate and build on the theoretical knowledge you gained as an

undergraduate and learn to apply it in caring for patients.

2. Develop the technical, clinical, personal, and professional skills that form
the basis of medical practice.

3. Take increasing responsibility for patient care, as your experience and

understanding allow.

4. Start to develop professional judgment in the appropriate care of patients

and the use of diagnostic and relevant health services.

5. Work within the ethical and legal framework taught at medical schools.

6. Contribute to a multidisciplinary health care team.

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7. Explore personal career goals and expectations.

8. Encounter and develop strategies to deal with the professional and

personal pressures associated with being a medical practitioner.

1.3 RULES AND REGULATIONS

1) Follow Rules and Regulations as in General Orders for Government

Servants as well as in the MMC Guidebook for HouseOfficers

2) Follow Rules and Regulations and Policy of Hospital Kajang, especially

with regards to Corporate Culture,Blood Transfusion,Patient Safety Goals,
ISO 9002, Infection Control

3) Follow Rules, Regulations and Policy of Department of Surgery especially

with regards to
a) Requirement of Chaperone during Examination of Patients
b) Sexual Harassment Policy
c) Leave Policy
d) Documentation especially with Date/Time and Name (Legible chop or in
block letters)

1.4. REQUIREMENTS

1.4.1 Reporting of duty

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FLOW CHART FOR REPORTING OF DUTY
• Report to Sisters in charged in SOPD, Ward 1 and Ward 4
• Make an appointment to see Head of Department (Mr Andre Das)
(ON THE DAY OF REPORTING)

• To introduce yourself to specialists/MOs/Hos in the department.

• To meet HO captain and get your ward assignment and format for
opening 2 files.
• To fill and sign your departmental pledge and fill the date/timeline form
for assignments.
(ON THE DAY OF REPORTING)

To fill up biodata form and give a copy of your passport photo to be put on the
display board in SOPD. Open 2 Files, one personal file to be handed to the
HOD and one departmental file.
(ON THE DAY OF REPORTING)

To attend Scrub training session in OT and orientation by pharmacist(Ms

Shantini)

Orientation in Ward 1, Ward 4, Ward 7b, Major and minor OT, Endoscopy
room, SOPD, Emergency Department.

Hand up your orientation form at the end of your tagging.

ORIENTATION FORM:

TEMPAT TARIKH TANDATANGAN

WARD 1

7
 WARD 4

WARD 7B

OT-MAJOR & MINOR

SOPD

ENDOSCOPY ROOM

EMERGENCY
DEPARTMENT

1.4.2 Tagging

Period for tagging :

-1 week for second posting and above

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-2 weeks for first posting

Offtagging assessment form:

NO CRITERIA SIGNATURE
1 Complete reading The Surgical HO
Manual
2 1 day tagging in ED

3 1 day assisting in OT

4 1 tagging in scope room

5 Introductory session with sister ward 1

6 Introductory session with sister ward 4

7 Scrub and briefing session in OT

8 Offtag assessment:
to present fresh cases that you clerked,
MO/surgeons will decide whether you are
competent according to your clerking, case
management and presentation.
9 Basic procedures:

CBD insertion

Ryle’s tube insertion

Blood C&S

Assembly of ambubag and oxygen masks

1.5 WORKING HOURS & JOB SCOPE

RESPONSIBILITIES REMARKS
Ward 1 Post-call HOs: Working
Ward 4  To complete blood taking by 6am Hours:

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  Passing over to morning HOs at
6.30am Post call:
 To trace all investigation in the Until 11am
morning
 Do all the procedure needed in Extended:
wards till 8am such as inserting 6.30am-9pm
branula , blood taking, etc
 Help to do morning review(for Oncall:
subacute patients C3/C4) 6.30am-4pm
 COMPULSORY To follow ward Then rest,
round by MO/Specialist & 9pm-11am
present new cases which was
admitted overnight
 Help settle ward works if HO in-
charged need to go to OT
 Accompany patient to another
hospital for procedure/imaging
 Will cover the minor OT on
Friday
 Need to participate if there is any
available courses
 Attend CME on Tue/Thurs
Extended HOs:
 In-charged of HDU & acute
 New cases admitted to HDU must
be clerked within 30min.
 Do noon and night review.
 Will be in-charged of the ALL the
patients in ward from 4-9pm
 Clerk new admissions(within 1 hr
after patient admitted)
 Settle ward works(post
case/imaging
requests/discharges/referral)

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 Oncall HOs:
 Will be covering HDU & acute
 Do noon review.
 Settle ward works(post
case/imaging
requests/discharges/referral)
 Will receive passover from
Extended HOs at 9pm
 Will do the discharges on that day
during night time and for MO to
counter check the next morning
 Clerk all new admissions between
9pm-6.30am
Ward 7B/ED Extended Peri HO:
 Do morning review for patients in
ward 7B & obstetric wards
 Follow MO/surgeon ward round
 Settle ward works and clerk new
cases in ward 7B.
 Clerk new cases in ED as informed
by MO oncall
 Cover peri medical from 4-9pm,
clerk new peri referral.
W2,W3 Oncall Peri HO:
(Peri medical)  Do morning review for patients in
peri
 Follow MO/surgeon ward round
 Settle ward works and clerk new
referral in medical wards
 Receive pass over from extended
peri HO at 9pm
 In-charged of ED, ward 7B and all
peri wards from 9pm-6.30am.
EMOT  To be mindful of all the emergency

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 cases booked for OT by surgery
department.
 To inform MO 2nd call once patient
is pushed to OT
 To update SSSL board in OT
 To dilute antibiotic and make sure it
is given if indicated
 Assist operation
 Post-op: fill up HPE form
completely & correctly,endorse
post-op medications, fill up details
in OT book, make sure op note is
written completely by surgeon.
ELOT  Follow pre-op round with
MO/surgeon 1 day prior to op.
 Marking of operation site.
 Make sure consent taken.
 To call up patient if they are not in
the ward 1 day prior to op.
 Make sure blood investigations,
HPE report, imaging films,
antibiotic are ready prior push to OT
 To standby in OT once 1st case is
called at 7am
 To inform surgeon once patient is
pushed to OT
 To update SSSL board in OT
 To dilute antibiotic and make sure it
is given if indicated
 Assist operation
 Post-op: fill up HPE form
completely & correctly,endorse
post-op medications, fill up details
in OT book, make sure op note is

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 written completely by surgeon.
 Any URGENT HPE should be
written in capital letters in the HPE
form, & to arrange transportation to
send to Hosp Serdang if its on a
Friday.(To avoid delay in sending
specimen over the weekend)
SOPD  Clerk clinic cases and to discuss
(Tue/Thurs) with MO/surgeon before giving
plan.
 To request urgent imaging as
ordered by MO/specialists.
 To do clinic works and update in
HO pass over book in SOPD
 To assist/perform FNAC/Trucut
biopsy under supervision on
Tuesday 2pm.
 To help with ward works after clinic
finishes.
Scope Room  To take procedure consent from
(Mon/Wed/Fri) patient and make sure signed by MO
 To explain to patient properly
regarding indication and risk of
procedure properly before getting
consent
 Set branula
 Assist OGDS/Colonoscopy
 To assess patient carefully prior
discharging them
 To prescribe medications prior
discharge and make sure TCA date
given.
 To help with ward works after scope
settled.

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1.6 LEAVE POLICY

1.6.1 Leave criteria

a) Not more than 3 days in a row.
b) Attend funeral of close relatives (up to 2nd degree relative)
c) Wedding ceremony
d) Study leaves
e) Planned holiday
f) Paternal leave(inform HOD earlier if wife is pregnant & her EDD)
g) Maternal leave (to inform EDD)

1.6.2 How to apply

a) House officers are required to be aware of various types of leave under
the General Order. (Perintah Am). They will be allowed paid leave (for about
8-9 days in each posting). They are required to stagger the leave so as not to
disturbed the service provided to the public e.g. 2-3 days at one time and not
to accumulate leave for more than 3 days
b) 7 days notice must be given prior to taking leave. Annual leave(AL)
form should be approved and signed by HO captain, MO in-charged and
specialist.
c) Not more than 1 H.O. is allowed to apply leave at the same time unless
there is an exceptional situation.
d) Leave must be approved (except emergency leave) before the H.O. can
leave the station
e) If emergency leave need to be taken, or if the H.O. falls ill, he must
obtain permission from the Head of Department otherwise it will be classified
as AWOL ( away without leave).

1.7 MENTOR MENTEE SYSTEM

Below listed how this MENTOR-MENTEE system works:

MENTOR MENTEE DUTIES
DUTIES

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SMART CARD - To assess - To approach
mentee(HO) monthly mentor monthly for
and to record in smart assessment
card
- To make sure
mentee smart card is
fulfilled by the end of
posting
CME - To make sure - To complete
CME/research presentation 1
presentation is week prior date
completed 1 week of presentation &
prior date of show them to
presentation mentor for
- To go through improvisation.
mentee presentation - To make sure
and improvise if the surgeon in charge
presentation prepared is well informed
contain updated, regarding date and
adequate and accurate topic of
information presentation
Logbook Review - To review and make - To fill up own
sure mentee logbook logbook and show
is adequately filled up them to mentor at
at least twice(middle least twice(middle
and end) during entire and end) during
posting entire posting
- To make sure - To make sure
mentee’s logbook is logbook is
delivered to completed 2 weeks
supervisor 2 weeks prior end of posting
prior end of posting - To send logbook

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 to MO in charge
after completion of
logbook for
assessment
Viva - To make sure - To approach MO
surgeon is informed 1 and surgeon in
week prior to date of charge of viva to
viva appoint date, venue
- To accompany and and time of viva
assist surgeon during
viva if mentee failed
end of posting
assessment and
decided for viva
Personal & - To arrange regular - To approach
Professional meeting with mentee mentor on regular
Issues for feedback basis and inform
- To help mentee any issues arises
regarding personal during surgical
and professional posting
issues which affect
his/her work during
entire posting

1.8 CME

1. A monthly or bimonthly roster of CME will be prepared:

 Topic
 Date and Time

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  Presenter
 Specialist and MO supervisor
2. The Goals of the CME is for:
 Education
 Time management
 Presentation skills including public speaking.
3. HO should inform specialist 1 week earlier. Any change in dates of the
presentation is allowed subject to the following:
 All personnel must be informed early.
 The new date/time should be arranged on Monday/Wednesday/Friday
so that it will not interfere with the original schedule.
4. All HO should read the topic beforehand.
5. Presentation should follow the given format guideline. Liberty is given
for creativity as long as the Spirit and Timing of the guideline is followed.
6. All attendence later than 5 minutes will be considered Absent.
7. It is the responsibility of the presenter to ensure the attendance of the
MO and Specialist Supervisor or their replacements.
8. Presentations will be given a subjective grading for contents and
delivery : A (Good); B (Average); C (Below Average); and lastly D (Poor)
which has to be represented.
9. A total attendance of minimum 75% is required for an HO to complete
the posting successfully.

Format of CME:
INTRODUCTION (<5MINS)
1. OBJECTIVES
2. QUESTIONS THAT WILL BE ANSWERED BY THE
PRESENTATION

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3. CASE SCENARIO THAT IS EITHER COMMONLY
ENCOUNTERED OR CAN HELP ACHIEVE THE OBJECTIVES.

Eg - After this presentation you should be able to know what sort of

drip to us & for which situation

CONTENTS (<25MINS)
1. FACTS RELEVANT TO THE TOPIC
2. SPECIAL FACTS/PITFALLS/PRECAUTIONS
3. COMMON MISTAKES

Eg. -The most important aspect of managing inhalational injury is early

intubation before oedema makes it impossible
-We should always ensure there is a distended bladder before inserting a
SupraPubic catheter and we can do so by aspirating for urine beforehand
-Common mistakes in managing intestinal obstruction is inserting an
enema which can make the condition worse

QUESTION AND ANSWERS (<5MINS)

1. ANSWER TO CASE SCENARIO
2. OTHER ARISING QUESTIONS
3. TWO WAY INTERACTIONS

Eg. If nobody has any questions, then I have one to ask?

CONCLUSION (<2MINS)
1. TAKE HOME MESSAGE
2. SUMMARY OF PRESENTATION
Eg. In conclusion, the management of UGIT bleed is making a correct
diagnosis,proper and timely intervention when needed, and anticipation and
management of rebleeding. Also we should be aware of a Malaysian CPG on
non- variceal UGIT bleed.

1.9 ASSESSMENT

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a) The House Officer need to be evaluated by the head of Department and his
senior colleagues with regards to suitability for signing up at the end of the
posting.
b)Pre-test will be done during your first reporting of duties to the HOD.
c)Post-test will be done 2 weeks before he finishes the posting.
d)If he fails the post-test, or faces any disciplinary/attitude issues; he will be
subjected to Viva assessment by surgeon.
e) The HO should approach his mentor and 3 other different MOs for
assessment monthly and has it recorded in the Smart Card.
f) The H.O. is required to maintain a log of all the clinical activities he is
involved in a logbook. This book must be maintained everyday, as it requires
the grading and signature of the supervising officer.
g) All logbooks must be submitted 2 weeks before completing the 4 month
posting.

1.10 POSTING EXTENSION POLICY / DISCIPLINARY ACTIONS

1.10.1 Critical Responsibilities that may lead to extension

a) Blood transfusion error
b) Did not respond to patient’s complaint that lead to serious avoidable
events Eg death/cardiac complications (Eg pain/airway compromise)
c) Adverse drug reaction (Failed to identify history of drug allergy) &
wrong prescription of drugs/dose
d) Poor discharge summary
e) Unable to carry out basic procedure that lead to complications/serious
events (Eg inserting CBD into vagina/hematoma after Venofix)
f) Missing in action during working hours
g) Poor or No documentation of events or orders
h) Poor or No review of patient's investigation results. For administrative
purposes, the first HO arranging/taking the investigations such as blood or
radiological, is responsible for it being reviewed and will be punished if it is
not reviewed even though it has been handed over to a collegue.

1.10.2 Extension criteria

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a) Breach of critical responsibility as mentioned above
b) Attitude
-Inability to carry out ward duties
-Frequent lack of Punctuality
-Poorly contactable & unspeedy response
c) CME
-Attendance of CME less than 75%
-Did not present CME
d) 2 or more warning letters

2.1 CHECKLISTS & ASSESSMENTS DATELINE

CHECKLIST FOR HOUSEMAN

NAME;___________________
DATE OF REPORTING:___________________
ALL DOCUMENTS TO BE HANDED TO THE SOPD NURSE AND YOU
ARE TO RECEIVE A SIGNED ACKNOWLEDGEMENT ON YOUR COPY
DATELINE
ORIENTATION FORM DATE:________
1 WEEK FROM REPORTING
(If Unable to Achieve this date, Reason
and new Date)

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 ACKNOWLEDGEMENT DATE:________
FORM OF RULES AND WITHIN ONE WEEK OF REPORTING
REGULATIONS FILLED
IN, SIGNED AND DATED.
HANDWRITTEN ESSAY DATE:________
WITHIN 2 WEEKS OF REPORTING
AND AT LEAST ONE DAY BEFORE
SEEING HOD

BIODATA FORM DATE:________

ONE WEEK FROM REPORTING
APPOINTMENT MADE DATE:________
TO MEET THE HOD WITHIN TWO WEEKS FROM
REPORTING
STUDY PRESENTATION DATE:________
BEFORE TWO WEEKS FROM END OF
POSTING
SURGICAL TEST DATE:________
DAY OF REPORTING
REPEAT SURGICAL DATE:________
TEST BEFORE FOUR WEEKS FROM END OF
POSTING

2.2 GUIDELINE FOR ESSAY

1. Handwritten in English
2. Not less than 800 words in A4 paper ( please record the number of
words)
3. Essay form without Point Bullets
4. Should Include:
a) Your family including what your parents do and where are they
staying?
b) Personal information about yourself including marital or fiancé details.
c) A time frame of your brief schooling history with SPM or equivalent
results and Medical school attended.

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 d) Any family members or relations in the medical line especially any
working in Kajang Hospital
e) The present place you stay and how you come to work
f) Personal Medical information that is relevant
g) Where (hospital) was your first choice for HO posting and why?
h) Extra Medical Activities/Hobbies/Social/Political/ Interests and level of
participation including Sports/IT/Arts and Cultural relevant issues.
i) Any commendable Achievements
5. Lastly Why did you become a doctor and your future plans and
ambition?

HOUSEMEN REPORTING PLEDGE FORM

the responsibility of the house officer to ensure the following matters are complied
during your surgical posting otherwise you may be subjected to extension or
plinary actions without further notice.

Understanding and complying with all aspects of KKM/Hospital Kajang Safety Goals
Understanding and complying with all aspects of KKM/Hospital/Surgical
artment SOP and Policies
essment: (Please fill in the Dates)
Completed Log book which must include one CME presentation and 70%
16) CME attendance, and 60% procedures to be handed before _________ ( 14
from end of posting)
Assessment to be carried out before______________( 21 days from end of
ing)

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 cal Responsibility with no room for Errors:
INTEGRITY AND HONESTY AT ALL TIMES
Documentation especially date, time and name chop.
Matters pertaining to Blood Transfusion
Matters pertaining to Safe Surgery Saves Lives
Matters pertaining to review and taking action for all Laboratory Investigations
ered.
Matters pertaining to Proper Handover of duties.
Matters pertaining to Administration of Chemotherapy
Ward Procedural and Morning rounds documentation as per guideline.
rgency or Medical Leave( Leave application < 2 weeks from date of leave):
r informing the House Officer and Medical Officer in charge, Permission must be
ined from The Head of Department or Specialist on call before taking the leave.
absence without prior permission will be considered AWOL (absence without
ial leave) and will be dealt with following the General Orders (Perintah Am) at
discretion of the department.

ature and Chop of House Officer:

:
2.4 DAILY MORNING ROUND FRAMEWORK

PLEASE FILL RELEVANT DETAILS DEPENDING ON THE CASE

Date: dd/mm/yy
Time: tt.tt am/pm

DATE OF ADMISSION: dd/mm/yy

POST- OP( BRIEF DETAIL) DAY :__?_
POST- TRAUMA (BRIEF DETAIL) DAY :__?_
POST-UGIT BLEED( BRIEF DETAIL) DAY :__?_
(Antibiotic 1 Name) DAY :__?_
(Antibiotic 2 Name) DAY :__?_

PROBLEMS WITH THE PATIENT:

1.___?___

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2.____?____
3. ____?___

EDD ( ESTIMATED DATE OF DISCHARGE) : dd/mm/yy

O/E:
BP: systolic range (highest to lowest previous day) / diastolic range
(highest to lowest previous day)
PR: range (highest to lowest previous day)
RR: range(highest to lowest previous day)
Temperature : range (highest to lowest previous day)
Pain score :
Urine Output : range (highest to lowest previous day)

IX:

PLAN/INSTRUCTIONS:

2.5 GUIDELINE FOR POST-PROCEDURAL

DOCUMENTATION

ALL INVASIVE PROCEDURES OTHER THAN BLOOD TAKING

MUST BE DOCUMENTED IN THE NOTES BY THE PERFORMER
AS DETAILS

Date: dd/mm/yy
Time: tt.tt am/pm

PREPROCEDURAL:
INDICATION FOR PROCEDURE:__________________
WHAT CONTRAINDICATIONS/SPECIAL PRECAUTIONS
CHECKS DONE:_________________________
SUPERVISED BY (IF ANY):_______________________
POSTPROCEDURAL:

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POST PROCEDURAL CHECKS DONE:________________

POST PROCEDURAL INSTRUCTIONS:_________________

SIGNED AND CHOP

25