ELECTIVE REPORT

3 WEEKS, 2 DEPARTMENTS, 1 EXPERIENCE

3 WEEKS,
2 DEPARTMENTS,
1 EXPERIENCE

Contents:

OBJECTIVE

INTRODUCTION TO HOSPITAL

INTRODUCTION TO WARD 1 AND 4

WHAT HAVE I ACCOMPLISHED

INTERESTING CASE

LOOKING BACK

CONCLUSION

REFERENCE

ELECTIVE FEEDBACK FORM

ATTACHMENT : APPENDIX

OBJECTIVES

There are several objectives that I intended to achieve

through this three-week elective posting. The objectives are
as follow:
i.

To develop clinical skills in clinical medicine

through active participation in bed-side teaching and
hands-on experience on real patient

ii.

To improve my formulation of differential

diagnoses, management plans, investigations and
patient follow up

iii.

To become familiar with the common diagnostic

tests and interventions used in the medical specialty

iv.

To effectively communicate and interact with the

multidisciplinary team

v.

To learn more about the particular specialties and

assess my own qualities

vi.

To decide if the particular specialties should be

pursued as a future career
.

INTRODUCTION
HOSPITAL TUANKU AMPUAN NAJIHAH, KUALA PILAH

Hospital Tuanku Ampuan Najihah is the second biggest government hospital in Negeri Sembilan and it is
located in Kuala Pilah, my lovely hometown. It is also a teaching hospital for IMU. The hospital was built
on 10 December 1990 with a cost of approximately RM97.5 million on 70 acres Yeoh Tiong Lay and John
Ling International Company. It started to operate officially on 16th January 1995. Residents from Kuala
Pilah, Jempol, Jelebu, Tampin, and around Pahang border also seek help from this hospital. Several facilities
are being provided by this hospital to the public:
i.

Specialist clinics (OBGYN, Internal Medicine, Pediatric, Orthopedic and Surgery, Periodontic and
others )

ii.

A&E Department

iii.

12 wards with 314 beds

iv.

Surgical theatre and labor room

Other facilities such as mortuary, pharmacy, pathology lab, blood bank, diagnostic lab,and others are also
available at this hospital.

INTERNAL MEDICINE/CARDIOLOGY DEPARTMENT (WARD 1 AND WARD 4)

WARD 1 : FEMALE WARD

WARD 4 : MALE WARD

Internal Medicine is the biggest department in
this hospital with approximately 96 beds (4
wards). Cardiology, Respitory, Oncology,
Endocrinology and Neurology are some of the
full-time services provided for this department.
Every morning, rounds will be done by
specialist, together with MOs and houseman
doctors for almost 1 hour. After that, the
MOs and houseman doctors will check upon
patients health status and do all the
paperworks (lab works, admission documents
and blood works). Common cases that are
found in ward 1 and 4 are Myocardial
infarction (MI), Unstable Angina, Dengue
Fever and Cerebrovascular accident (CVA) .

BUSY DAY IN WARD

WHAT I DID FOR 3 WEEKS??

Day Activities
1

Briefing about posting from Mr.Raki

Attend a talk about protection against sharp

Tour around hospital

Placement in Ward 1 attach to specialist and observed what doctors do

History taking from patient (B4-9), involve in rounds and help HO

H/T (B10-20) and present all cases to specialist

Help HO (learn documentation)

Handle A&E case + admittance + went to HTJ for CT scan in ambulance

10

Placement in Ward 4- observed the routine of doctors

11

H/T (B4-11) and present all cases to specialist + learn to read medical files

12

H/T (B12-20) and present all cases to specialist + learn to read medical files

15

Involve in diagnostic and lab work (pathology lab, blood work, X-Ray)

16

Involve in diagnostic and lab work (pathology lab, blood work, X-Ray) +
documentation

17

Help HO (B4-10) + visit hemodialysis session

18

Oncall with HO doctor

19

Finish oncall + clinic duty

INTERESTING CASE (1st Psychiatric Case)

Patient is a 54 year old Indian woman admitted by her husband. According to the husband, the wife is
mentally unstable and had several episodes of suicidal attempt for the past 5 months. It all starts with the
death of her first son in an accident. She starts to have an audio illusion where she can hear two voices
whispering, asking her to kill herself. After about three weeks, she started to hurt herself by knives,
but she thought the pain is inflicted by her family members.
Without knowing that she is a psychiatric case, I approach her to take history. She looked perfectly
normal and I started to introduce myself to her and inquired about her admittance to the ward. Having a
dry cough for one night was the chief complain of her. She carried on saying about being beaten by her
family members since her sons death and she wanted to escape from them by reporting to the police.
She wants to stay away from her family and inquire about living in homes. She further tells about her
family members-her mother and 3 other siblings had ended their life by suicide and she seems proud
about the fact. She also shows intentions to end her life and I ended up comforting her to not to do the
deed.
I talked to her for about half an hour, took her file and start to read it. I was surprised to see the diagnosis
in the file, stating that she is psychotic and depression. When I discuss the case with my specialist, I was
told to distance myself from the patient as she is unstable and they had to put her in the normal ward to
make her believe that they are not sending her to the psychiatric ward.
Later that day, I also observed no personnel in the ward approach to talk to her except her doctor in
charge. Everyone seemed to be afraid to talk to her and since I was the only one to approach her
unknowingly, she seemed to feel attached to me. Whenever she saw me, she started to stride over and
share her complains. I was unable to flee from her clutches without cause her any emotional pain. Thus, I
was sent to Ward 4 to prevent any unwanted incidences. After 3 days, she was sent to the psychiatric
ward.

Looking Back.

Throughout medical school time, especially since the start of clinical visits, I have
been attracted to internal medicine and emergency medicine, with cardiology and
diagnostic departments in particular. Therefore, this elective gave me a perfect opportunity
to explore in these areas of medicine further, and find out career opportunities in these
fields. It also provides a good chance for me to get an insight of what are expected from the
doctors, both by the patients and senior doctors in this area of medicine. Although I was
very keen on the idea of being able to do a hands-on elective, rather than a predominantly
observing, I realize that being in Year 2 does not give me enough knowledge to attend a
patient. Thus, in this elective, I was more of an observer, but did not miss any chances
when provided to get involve with patients.
After gathering some information regarding HTAN internal medicine department, I
was very enthused to do my elective posting. Fortunately, I was the only medical student in
the whole hospital and everyone from the hospital, starting from the patients to the doctors,
were very kind to offer me everything. I chose Internal Medicine to do my posting as I had
many interactions with the healthcare system as a patient, but never experienced it as a
member of the healthcare team.
To reflect back on my experience during electives, I learn to be more flexible and
adaptive to the changing situation, as well as always keeping a contingency plan, as things
could derail from the original track at any moment. As I was the only medical student in
HTAN, it was very awkward and unsettling for me for a few days. I had no one to turn
whenever I have no idea on what should I do. But I brace myself and plan what to do in the
hospital the day before with the help of several houseman doctors and my specialist.
Although sometimes I was unable to keep up with the plan, I tried to do something else that
might to contribute anything to my better self. At first, I planned and talked to my specialist
about going into several different departments, one for each week, but due to some
unforeseen situations, I was unable to step into surgical and orthopedic department. But
learning and working at the Internal Medicine department was the best experience I got till
now and I did not regret being there for whole solid three weeks.

Additionally, I learned to be more opportunistic and creative, to learn as much as I could

from the HOs. Truth to be told, I only meet the specialist during rounds. Thus, with the specialists
permission, I attach with the houseman doctors and learnt quite a lot. I am sure I can do houseman
doctors work now, but the knowledge is missing from the equation so I guess I will have
to equip myself with more knowledge. Again, working in Internal medicine and Emergency
department encompasses a wide range of acute medical conditions that need rapid assessment,
diagnosis and treatment. Although the nature of work really attracts me, looking from a more
objective perspective, I feel coping with the large number of on-calls and the shift pattern of work,
or the sudden deaths of patients in this specialty will be real challenges for me.
I had an opportunity to be on-call for a day, and even though I didnt do much except paper
works and lab work, I felt like I didnt sleep for a week. Even sleeping for the whole day did not
help me much. I wonder how the doctors are able to be on-call three days per week. It will be a
really tough job in the future for me, but I assured myself to not to go ahead the time and live the
life now. Other than that, taking a history from patient prove to be the easiest thing to do as the
patients readily give out all the information we need, but summarizing and report it to the specialist
was proved to be a hard task. I still remember how my hands tremble when I need to present the
cases (from Bed 4 to 9) in front of all the doctors. I thought I would get some scolding or at least a
look from them, but they were professional about that and told me I still have time to improve.
That makes me more enthused to learn something new and gave me something to look forward.
In the Cardiology placement, I learnt more about the interpretation of diagnostic tests.
Interpreting echocardiogram proved to be simple once you know what to look at and doing an
ECG proved to be not an easy task when some of the leads are missing and you need the result
urgently. I also had a chance to ask my supervisors there for their honest opinions about my strength
and weaknesses, to allow me to further assess my career options objectively.

Conclusion
My elective was an extremely enjoyable and educational experience. I feel that I have learnt a lot
about medicine, but also a lot about myself. I feel this elective definitely broaden my horizons in
clinical knowledge and skills, as well as being insightful to the various career options available
upon graduation from medical school. As a doctor I will meet people from all over the world, and
my experiences on my elective have wet my appetite for this opportunity.

REFERENCES:

1. Hospital Tuanku Ampuan Najihah.

http://ms.wikipedia.org/wiki/Hospital_Tuanku_Ampuan_Najihah (accessed 23
February 2015).

2. Web MD. Arterial Blood Gases. http://www.webmd.com/lung/arterial-bloodgases (accessed 23 February 2015).

3. HEMODIALYSIS. https://www.kidney.org/atoz/content/hemodialysis (accessed

24 February 2015).
4. NorAfidah Hassan. HTAN Picture.
http://www.sinarharian.com.my/edisi/utara/tikam-ibu-saudara-1.206291
(accessed 10 March 2015).