ELECTIVE POSTING IN UNIVERSITI KEBANGSAAN MALAYSIA MEDICAL CENTER REPORT BY: FAIZ NAJMI BIN MANSOR GROUP 631A

UNIVERSITI KEBANGSAAN MALAYSIA MEDICAL CENTER (UKMMC) Is located at Bandar Tun Razak, Kuala Lumpur. It has a history with Medical Faculty of National University of Malaysia. The Faculty of Medicine, now 35 years old, was established on 30 May 1972 as a medical institution to carry out medical and nursing training activities, medical research and clinical services, under the administration of a Dean.

UNIVERSITI KEBANGSAAN MALAYSIA MEDICAL CENTER (UKMMC)

What is Elective Posting? It is a program of which any medical student can rotate in a department of his or her choice (e.g. medical, surgical, obstetric) to obtain clinical exposure. For students of Nizhniy Novgorod State Medical Academy who did elective posting in UKMMC, they got to follow ward rounds, clerk patients, perform physical examinations, case presentations, doing and observing medical procedures, attend medical conference, assisting in specialist clinics as part of the program of their elective posting under the supervision of the department’s specialists and consultants. Medical students (not from UKMMC) have to pay RM750 (RUR6530) for 4-8 weeks elective posting in UKMMC.

Ward rounds Ward rounds are usually in the morning (0700) and afternoon (1400). There are three steps of ward rounds 1st- Presenting to peers junior medical officers. 2nd- Presenting to registrars and specialists. 3rd- Presenting to Senior Consultants and Head of Department. Teaching and case presentations usually take place during ward rounds

What do the medical students do in the ward? Medical students are supposed to clerk patients, perform physical examination, suggest investigations, diagnosis and treatment, and assist in medical procedures. They have to prepare case presentations and case reports to specialists as part of learning. Rotation in department of Surgery (as an example), 5th year medical students have to present 10 patients during ward rounds and prepare case reports for another 10 patients. Medical students also have to do on-call duties (дежурство) for at least 5 times. This work shall be evaluated by specialists and noted into the medical students’ logbook.

Specialist Clinics UKMMC clinics are specialist clinics. The cases are referred from local polyclinics and other hospitals. There are medical clinics, surgery clinics, obstetric and gynecology clinics, pediatric clinics, ENT clinics, eye clinics and many other specialist clinics. The specialist clinics are managed by the head of departments (of medical, surgical, obstetric, pediatric and etc)

What do medical students do in clinics? Medical students are required to find new cases (undiagnosed and untreated patients) Medical students have to clerk patients for anamnesis and HOPI, perform PE, suggesting provisional and differential diagnoses and suggesting treatments. The medical students present these new cases to specialists, who will be supervising and evaluating their works. Medical students need to present five new cases which are evaluated by specialists and noted in the logbook.

Case in Endocrine Clinic 49 years old Malay female with history of hyperthyroidism and thyroidectomy 2 years earlier came to endocrine clinic for a 3-monthly follow up. She has no complains. On questioning, she has not been taking her calcium supplement. On physical examination, she has positive Chvostek sign (facial muscle spasm on tapping of facial nerve). Lab result shows hypocalcemia. Diagnosis: Post-thyroidectomy with hypocalcemia Treatment plan: Thyroxin and calcium supplements Education: To increase compliance of the patient to her calcium supplements (She was not compliant)

Medical Procedures Medical procedures vary between departments. There are must-do and must-see medical procedures that medical students need to complete. The procedures they do or watch are supervised under specialists, evaluated and noted in their logbook.

Medical Procedures for Medical Students Must-do Must-see Venofix (10 patients) Insertion and removal of nasogastric tube (6 patients) Insertion of urinary catheter (3 patients) Removal of urinary catheter (3 patients) Wound dressing (3 patients) Suture To Open (3 patients) Blood taking (5 patients) Per rectal examination and proctoscopy (10 patients) Intravenous drip (3 patients) Blood taking for culture and sensitivity (3 patients) Arterial blood gas (3 patients) Insertion of central line (3 patients) Insertion of chest tube (3 patients) Removal of chest tube (3 patients) Insertion of ravine enema (3 patients) Insertion of suprapubic catheter (2 patients) Trucut biopsy (2 patients) Fine needle aspiration (3 patients) Banding of hemorrhoid (3 patients) Taking informed consent (3 patients) Oesophageogastroduodenoscopy (3 patients) Colonoscopy (3 patients) Endoscopic retrograde cholangiopancreatography (3 patients)

Operations Students must also observe at least 10 surgical operations and daycare procedures (sutures, biopsy). These will then be evaluated and noted into the logbook.

Continuing Medical Education (CME) Medical conference according to department. Mortality and morbidity conference Teaching for junior doctors and medical students Medical updates and guidelines National and international medical conference

What is my opinion on elective posting in UKMMC? Advantages disadvantages More participation and responsibilities towards patients well-being More clinical exposure and learning specialized cases Learning to adapt Malaysian system of clinical duties Priority is given to UKMMC students instead of Elective Posting students Some patients are not so cooperative and do not want medical students to perform examination Expensive (RUR6530)

Comparison UKMMC Character NNSMA Entrance fee of RM750 (RUR 6530) Charge Free of charge English and Malay Language Russian Emphasis on ward rounds Ward Emphasis on case report and presentation Referral from local clinics to specialists Clinics Various cases from various medical fields Limited (priority given to UKMMC students) Procedures Medical students “supposedly” can do a lot of procedures Once or twice a week CME Limited Allowed On-calls Never experienced Departmental – by UKMMC department specialists Supervision Central – by Department of Practical Affairs of NNSMA

QUESTION AND ANSWER SESSION You’re welcome to ask FAIZ NAJMI anything about Elective Posting in Malaysia

THANK YOU FOR YOUR TIME