Housemanship postings
Housemanship: internal medicine
The internal medicine posting is where a new doctor first carries real responsibility for very ill adults. For a future psychiatrist it builds the medical judgement needed to spot physical illness hiding behind mental symptoms.
Depth by stage, Pre-U → Consultant (details)
What is it?
Internal medicine is usually the busiest posting of housemanship. The house officer (HO) clerks new admissions, reviews patients on the ward round, orders and follows up investigations, and looks after medical emergencies such as heart attacks, strokes, severe infections and diabetic crises, always under a medical officer and specialist.
The posting typically lasts about four months. Many wards have patients with diabetes, high blood pressure, kidney failure, heart failure, stroke and infections such as dengue and tuberculosis, which are common in Malaysia. The HO learns how to prioritise a long list of sick patients and how to call for help early.
Psychiatry is closely tied to medicine: delirium, depression after stroke or heart attack, alcohol withdrawal and overdoses are all seen on medical wards. Habits formed here, such as checking blood results and thinking about drug interactions, stay with a psychiatrist for life.
Why does a psychiatrist need it?
Many people with severe mental illness die years earlier than others, mainly from heart disease, diabetes and infections. A psychiatrist must recognise when confusion is delirium rather than psychosis, manage the metabolic side effects of antipsychotics, and treat overdoses safely. Housemanship medicine is where these skills are first practised on real patients.
What level is expected at each stage?
Scale: 1. Aware → 2. Understands → 3. Applies → 4. Masters / Teaches. What the levels mean.
- Pre-UNot expected
- Pre-clinicalNot expected
- ClinicalUnderstandsAs a student, clerks patients and presents cases on the medicine posting under close supervision.
- HousemanshipAppliesManages ward patients day to day, recognises deterioration and escalates appropriately.
- Medical officerAppliesHandles medical problems independently and supervises house officers.
- Psych traineeAppliesApplies medical knowledge to psychiatric patients: physical work-up, side-effect monitoring, liaison cases.
- Specialist / consultantAppliesLeads physical health policy in psychiatric services and works jointly with physicians on complex cases.
What are the key topics?
Daily ward work
- Clerking new admissions: history, examination, working diagnosis and plan
- Presenting patients on ward rounds and writing clear progress notes
- Ordering, chasing and interpreting blood tests, ECGs and chest X-rays
- Fluid balance charts, drug charts and early warning scores
- Discharge summaries and follow-up arrangements
Common acute conditions
- Acute coronary syndrome and heart failure
- Stroke and transient ischaemic attack
- Diabetic ketoacidosis and hypoglycaemia
- Sepsis, pneumonia, dengue and tuberculosis
- Acute kidney injury and electrolyte disturbance (sodium, potassium, calcium)
- Acute asthma and COPD exacerbations
Overlap with psychiatry
- Recognising delirium and finding its cause
- Alcohol withdrawal and Wernicke's encephalopathy prevention with thiamine
- Paracetamol and other overdoses: antidote protocols and medical clearance
- Depression and anxiety after heart attack or stroke
- Thyroid, calcium and vitamin B12 problems that mimic mental illness
- Medication interactions involving psychotropic drugs
Professional skills
- Breaking bad news and talking to families
- Calling for help early and handing over safely
- Working with nurses, pharmacists and dietitians
- Completing the posting logbook and getting competencies signed
How is it learned and assessed?
- Learned on the job: ward rounds, on-call duty and bedside teaching by medical officers and specialists
- Logbook of procedures and cases signed by supervisors
- End-of-posting assessment by the head of department or supervisor
- Continuous workplace assessment; poor performance can lead to extension of the posting
Typical textbooks and resources
- Oxford Handbook of Clinical Medicine — Oxford University Press; the classic pocket guide for house officers
- Kumar and Clark's Clinical Medicine — Elsevier; broader reference
- MOH Clinical Practice Guidelines (e.g. diabetes, hypertension, dengue) — Ministry of Health Malaysia
- Hospital and department protocols for emergencies and on-call
Titles are widely used examples; editions change. Use university libraries or legitimate purchases.
Common questions
Why does a future psychiatrist need to do internal medicine in housemanship?
Many psychiatric patients also have medical illnesses, and some physical illnesses look like mental illness. Working on medical wards trains a doctor to check the body first, manage overdoses and side effects, and know when a patient needs a physician.
How long is the internal medicine posting?
Housemanship postings are typically about four months each, but the exact arrangement depends on the hospital and current Ministry of Health rules. A posting can be extended if the house officer has not yet reached the expected standard.