DIRECTOR-GENERAL OF HEALTH MALAYSIA
STRENGTHENING THE HOUSEMANSHIP TRAINING PROGRAMME
The Ministry of Health (MOH) takes note of the concern of various parties involved on the issues and challenges related to the Housemanship Training Programme. Hence, MOH wishes to reassure the public and the healthcare professionals alike that there have been continuous efforts to transform and further enhance the training programme.
Numerous discussions and engagements have been made with various stakeholders from the Housemanship Training Hospitals, top MOH management, and relevant specialists; including engagements with the Ministry’s Clinical Specialists during the Specialists’ Conferences in Malacca (2013) and Port Dickson (2015). Various inputs were also sought from the Malaysian Medical Council (MMC) and Malaysian Medical Association (MMA).
To ensure adequate clinical exposure and good quality of training, the number of public hospitals that offer housemanship training have also been increased from 38 hospitals in 2009 to 44 hospitals in 2015. Several other hospitals will be accredited as Housemanship Training Hospitals in the near future, including Shah Alam Hospital and Langkawi Hospital. Likewise, Royal Military Hospitals were approved for accreditation and will begin accepting House Officers (HOs) from the year 2017.
To enhance their clinical skills, from 2008 the period of the housemanship training has been extended from one year to two years. Prior to 2008, HOs had to only undergo three major disciplines postings but this was improvised to encompass six major disciplines namely Internal Medicine, Paediatrics, Surgery, Obstetrics and Gynaecology, Orthopaedics and Emergency Medicine. To further increase the training opportunities without compromising the quality of training, three alternative postings were also introduced i.e. Anaesthesiology (2010), Primary Care (2013) and Psychiatry posting (2013); thus increasing the number of disciplines from six to nine postings while maintaining the two-year duration of training.
To further strengthen clinical supervision and assessment of HOs, Housemanship Training Committees were established at the hospital level in the relevant clinical departments, and at the State Health Department level. Efforts were also made to improvise the log book to record HO’s clinical encounters and experiences throughout their training in each discipline.
To ensure HOs receive adequate exposure in these postings while improving the working hours’ system for HO, the Flexi Working System was introduced in 2011. The training programme was reviewed further to ensure the HOs will have greater accountability and ownership of their patients. This was done through the introduction of the Modified Flexi System in 2013 where thereon HOs are expected to work 65-75 hours per week and will have adequate training exposure including in Wards, Clinics and Operation Theatres. This system will be continuously monitored and efforts will be made to improve it further from time to time.
To further improve the efficiency of HOs intake into the Housemanship Training Programme, the Public Service Commission have organised the appointment into public service to be done every two months, depending on the vacancy of posts. Since March 2015, MOH has introduced the ‘e-Houseman’ system by which the medical graduates themselves can choose via an online portal, the hospital where they wish to be posted for their housemanship training, subject to vacancy of posts. There will be a shorter waiting period for those who choose to undergo their housemanship training outside of Klang Valley, especially in the more remote hospitals that often have more vacancies. In contrast, medical graduates wishing to be placed in hospitals in bigger cities, with less post vacancies, will most likely have to wait longer.
To assist the HOs in understanding their work better, since 1stSeptember 2014, the HO induction course has been extended from a one-week programme to two weeks. The first week of the induction programme introduces HOs to the expectations of civil servants, integrity, ethics and Medical Acts and various others service issues. The second week involves clinical orientation conducted at each respective Housemanship Training Hospitals.
Moving forwards, the MOH is mooting a fast-track system to shorten the duration of training for HOs who excel in their training, whereby these exceptional HOs (who have passed part 1/ part A of the Parallel Pathway Membership programs such as MRCP, MRCOG etc.) will have the possibility of a speedier promotion to become Medical Officers in their chosen field, and subsequently be able to pursue their postgraduate training to become specialists in a shorter duration.
DATUK DR. NOOR HISHAM ABDULLAH
DIRECTOR-GENERAL OF HEALTH MALAYSIA
9 MARCH 2016