Stage 4 of 7 · 2 yrs · age ~24–26
Housemanship (house officer)
Supervised work in public hospitals, rotating through major departments (typically six postings of about four months). Leads to full registration with the Malaysian Medical Council.
Background required for this path This stage in the matrix
What is learned at this stage, and how deeply?
Masters / Teaches 1
- Resilience & self-careThe most demanding stage for many: long hours, fast pace and steep learning; must ask for help and avoid isolation.
Applies 31
- BiochemistryApplies clinical biochemistry daily when reading blood results.
- Communication & languages (BM, English and more)Communicates fast and clearly on calls and handovers, writes legible notes, explains procedures for consent.
- Communication skills & professionalismApplies communication under pressure: handovers, families, consent.
- Cultural & religious sensitivityAdapts care to patients' faith, diet, modesty and family structures under time pressure.
- Curiosity & lifelong learningLearns quickly from each posting and from mistakes; looks up guidelines at the bedside.
- Delirium, dementia & neurocognitive disordersRecognises and manages delirium in medical and surgical wards, finding and treating causes.
- Doctor wellbeing, burnout & resilienceApplies coping strategies during the hardest years.
- Emergency medicineWorks emergency shifts under supervision where postings allow.
- Empathy & compassionKeeps compassion under heavy workload and long hours; treats families kindly when breaking bad news.
- English & study skillsWrites clear, accurate notes and handovers under time pressure.
- Ethics, integrity & professionalismWorks honestly under pressure — accurate notes, admitting mistakes, asking for help.
- General surgeryManages pre- and post-operative care, fluids, wounds and surgical emergencies under supervision.
- Housemanship core skills (on-call, procedures, documentation)Performs core skills routinely under supervision until competent.
- Housemanship: emergency medicine & other postingsTriages and manages common emergencies under supervision.
- Housemanship: general surgeryManages pre- and post-operative care and recognises surgical emergencies under supervision.
- Housemanship: internal medicineManages ward patients day to day, recognises deterioration and escalates appropriately.
- Housemanship: obstetrics & gynaecologyManages labour ward and post-natal patients and recognises obstetric emergencies.
- Housemanship: orthopaedicsManages trauma admissions and post-operative orthopaedic care under supervision.
- Housemanship: paediatricsManages common paediatric illnesses and emergencies under supervision.
- Internal medicineManages ward patients day to day, including on-call emergencies, under supervision.
- Medical ethics & lawApplies consent, confidentiality and documentation rules in daily work.
- MicrobiologyApplies infection knowledge daily: sepsis recognition, cultures, antibiotics, infection control.
- Neuroimaging & investigationsOrders and follows up routine blood tests, ECGs and imaging daily under supervision.
- Obstetrics & gynaecologyManages labour ward and gynaecology patients under supervision, including obstetric emergencies.
- OrthopaedicsManages trauma and post-operative orthopaedic patients under supervision.
- PaediatricsManages children on the ward and in emergencies with supervision.
- PharmacologyApplies prescribing under supervision: charts, doses, allergies, interactions.
- Physical health in mental illnessManages medical problems day to day, which builds skills later used for psychiatric patients.
- PhysiologyApplies physiology daily: fluids, electrolytes, blood pressure, oxygen.
- Psychopharmacology (basic)Prescribes common drugs safely under supervision and spots interactions and toxicity.
- Substance use disorders & addictionManages alcohol withdrawal, overdose and intoxication on wards and in casualty.
Understands 33
- Anaesthesiology & critical careUses sedation, pain and resuscitation skills on postings; some housemen do an anaesthesia posting.
- Anatomy (incl. histology & embryology)Uses anatomy for procedures such as cannulation, catheterisation and suturing.
- Anxiety disordersDistinguishes panic attacks from cardiac or respiratory emergencies in casualty and wards.
- Behavioural science & medical psychologyUnderstands how stress, adherence and family factors affect patient care.
- Bipolar disordersRecognises lithium toxicity and manic presentations on general wards and refers appropriately.
- Clinical pharmacotherapy & safe prescribingCharts and continues psychiatric medicines prescribed by others, spots obvious interactions and side effects.
- Consultation-liaison (psychosomatic) psychiatryMakes appropriate psychiatric referrals and manages simple mental health needs on wards.
- Continuing professional development (CPD)Understands CPD in preparation for full registration.
- Cultural psychiatry (Malaysian context)Communicates across languages and cultures in daily ward work.
- Depressive disordersSpots depression in medical and surgical patients and assesses patients after self-harm with supervision.
- Dissociative & bodily distress (somatic symptom) disordersMeets patients with unexplained symptoms or non-epileptic attacks in wards and emergency and responds respectfully.
- Emergency psychiatryManages overdoses, intoxication and agitated patients medically, and refers to psychiatry.
- Entry to psychiatry training: MMed & MRCPsychHouse officers plan ahead: aim for full registration on time and seek exposure to psychiatry.
- Ethics in psychiatryApplies consent and confidentiality rules daily.
- Geriatric medicine & palliative careCares for many older patients on medical wards.
- ImmunologyUnderstands allergy and anaphylaxis management and immunosuppression risks.
- Mathematics & basic statisticsUnderstands and checks dose and fluid calculations; errors here are a known safety risk.
- Mental health law (Mental Health Act 2001)Understands consent and capacity, and when to call psychiatry for legal admissions.
- NeuroanatomyApplies it informally when assessing stroke, head injury and confusion on medical and surgical wards.
- NeurochemistryApplies this when prescribing and recognising side effects and toxicity under supervision.
- NeurologyManages stroke, seizures and neurological emergencies on medical postings.
- NeurophysiologyApplies knowledge when managing seizures, sedation and electrolyte problems on the wards.
- Neuropsychiatry (epilepsy, brain injury, movement disorders)Recognises seizures, stroke and confusion on medical wards and their mental health effects.
- Old age psychiatryManages confusion and mood changes in elderly medical patients and avoids risky prescribing.
- PathologyUnderstands and acts on laboratory results such as blood counts and liver tests.
- Perinatal psychiatryScreens for low mood in postnatal wards and recognises postpartum psychosis as an emergency.
- Psychiatric interview & mental state examinationPerforms brief mental state and risk checks in medical and emergency patients.
- Psychiatry (undergraduate posting)Uses this knowledge to recognise mental illness on medical and surgical wards.
- Psychoeducation & psychosocial interventionsExplains conditions and discharge plans to patients and families.
- RadiologyRequests and reviews imaging for ward patients.
- Risk assessment & suicide preventionScreens for suicidal thoughts and manages self-harm patients medically before referral.
- Schizophrenia & other psychotic disordersRecognises acute psychosis or delirium on medical wards, gives safe emergency sedation under guidance and refers to psychiatry.
- Time, cost & career outlookContract and posting realities; full registration timeline.
Aware 47
- Assessment, formulation & rating scalesUses delirium and cognitive screens on the wards.
- BiologyBackground knowledge only.
- ChemistryBackground only, for example in fluid and electrolyte management.
- Child & adolescent psychiatryRecognises child abuse warning signs and distress in paediatric patients.
- Classification: ICD-11 & DSM-5-TRUses diagnostic labels in documentation; little detailed use.
- Clinical audit & quality improvement basicsAware; may help collect data for department audits.
- Cognitive psychology & neuropsychologyUses brief cognitive tests to detect delirium and confusion on the wards.
- Community medicine & public healthAware; focus is on hospital care.
- Critical appraisal & evidence-based psychiatryUses guidelines; little formal appraisal time.
- DermatologyRecognises drug rashes and skin infections on general wards.
- Descriptive psychopathology & phenomenologyRecognises obvious psychotic or mood symptoms in medical and surgical patients.
- Electroconvulsive therapy (ECT)Aware of ECT if covering psychiatric or medical patients who receive it.
- Epidemiology & biostatisticsAware; little time for research, but uses evidence-based guidelines.
- Family & couple therapyCommunicates with families on the wards and breaks news sensitively.
- Family medicine & primary careLimited direct exposure; some housemen meet primary care in assigned postings.
- Feeding & eating disordersRecognises refeeding risk and electrolyte disturbances in medical or paediatric wards.
- Forensic medicineDocuments injuries and completes basic medico-legal forms.
- Gambling, gaming & behavioural addictionsRecognises problem gambling or gaming behind presentations like self-harm or debt.
- Gazettement & National Specialist RegisterAware that specialist registration exists.
- Human development & developmental psychologyApplies milestone checks in the paediatric posting; limited use elsewhere.
- Leadership & service managementOrganises own workload and team tasks on the wards.
- Learning theory & behavioural psychologyLittle formal use; may meet behavioural plans in paediatrics.
- Medical geneticsAware; background knowledge.
- Medical officer in psychiatryAware, through referrals and any psychiatry exposure.
- Medical officer: general clinical workAware of the MO role by working under MOs every day.
- Medico-legal reports & expert evidenceAware; writes basic medical reports.
- Mental health in primary care & district hospitalsAware of referrals from clinics into hospitals.
- Motivational interviewingUses brief motivational conversations with patients on the wards.
- Neurodevelopmental disorders (ADHD, autism, intellectual disability)Meets children with developmental conditions in paediatrics and communicates with families.
- Obsessive-compulsive & related disordersRecognises severe OCD or skin damage from washing in other wards and refers.
- OphthalmologyUses basic eye checks on general wards.
- Other therapies: IPT, supportive, ACT, mindfulnessUses basic supportive skills with distressed patients.
- Otorhinolaryngology (ENT)Uses basic ENT knowledge on general wards.
- Personality disordersMeets patients after self-harm and learns calm, consistent responses.
- PhysicsBackground only.
- Preparing for specialist training entryAware; starts considering specialty choice.
- Psychiatric epidemiologyLittle formal application.
- Psychiatric geneticsRecords family history; little specific application.
- Related background that helpsLittle time for extras; keep notes of interesting psychiatric cases seen in other postings.
- Religion, spirituality & mental healthAccommodates religious practices in ward care.
- Research methods & the dissertationAware of research in the service; limited time to do it.
- Sexual dysfunctions & sexual healthAsks about medication side effects including sexual ones when appropriate.
- Sleep–wake disordersManages night-time sleeplessness on wards and avoids unnecessary hypnotics.
- Social psychologyNotices social influences on adherence and help-seeking but rarely studies them formally.
- Teaching & medical educationTeaches students on the wards occasionally.
- Telepsychiatry & digital mental healthUses electronic records and remote communication within hospital systems.
- Trauma- and stress-related disordersRecognises acute stress reactions in casualty and trauma wards and provides basic support.