Recommended Website: Life in The Fast Lane

Life In The Fast Lane is, as it describe itself, is "a medical blog and website dedicated to providing online emergency medicine and critical care insights and education for everyone, everywhere... usually with a healthy dose of good humour, and always with endless enthusiasm".

There are many great resources over there, but one particular feature that may especially interest candidates sitting for their master degree (MMed) in Emergency Medicine in Malaysia or equivalents is the revision page with plenty of MCQs, short answer quizzes, OSCE-like questions, etc, etc.

For Phase I (or entrance exam candidacy), click here to access the page ACEM Primary Examination

For Phase II (or exit exam candidacy), click here to access the page ACEM Fellowship Examination.

Enjoy!

Discussion Points for Intensive Course Final Year MMed 2010

A Review On Hematology and Oncology Emergencies

View more presentations from Chew Keng Sheng.

Intensive Course Discussion for the topic of Hematology and Oncology Emergencies.

Discussion Points:

1. Describe the differences between intrinsic and extrinsic pathway of coagulation

2. Discuss on the clinical uses of blood and blood products
- Whole Blood
- Packed Red Blood Cells
- Platelets
- Fresh Frozen Plasma
- Cryoprecipitate

Discuss on which of the above products require cross matching, ABO compatibility prior to transfusion.

CLICK here to download a copy of Practice Guidelines For Blood Transfusion

3. Discuss on transfusion trigger
- What level of hemoglobin do you take when deciding on transfusing patients

4. Discuss on the various levels of platelet counts you would use in making decision whether to transfuse platelets to the patients.

Discuss on why platelet is usually not given to patients with ITP, TTP, untreated DIC & thrombocytopenia associated with septicemia

5. Define massive transfusion

6. List down the major complications of transfusion

7. Describe in details of the following specific drugs affective hemostasis
- aspirin
- clopidogrel

8. Discuss on the following changes in the 2009 Focused Update: ST-Segment-Elevation MI and Percutaneous Coronary Intervention (updating the 2004 Guideline and 2007 Focused update) [DOWNLOAD the Focused Update 2009 here]:

In regard to thienopyridines:
- Relying on data from the TRITON–TIMI 38 trial, the guideline authors now recommended prasugrel as an option for antiplatelet treatment before PCI (except in STEMI patients with a history of stroke or transient ischemic attack).

- More emphasis is given to the alternative of an increased clopidogrel loading dose (600 mg instead of 300 mg)

- Despite a recent FDA advisory (click here to read the advisory), the guideline authors declined to make a specific recommendation about the concurrent use of clopidogrel and proton-pump inhibitors.

9. Discuss on the following oncologic emergencies:
- neutropenic sepsis
- tumor lysis syndrome

Research Report, Dissertation and Thesis

Many people are unsure of the number of words needed for a research report, a dissertation and a thesis for a master degree in Malaysia.

Research report: usually up to 20,000 words
Dissertation: usually up to 30,000 - 50,000 words
Thesis: 100,000 words

TWO Differences between a dissertation and a thesis:
A thesis means that original research is needed, perhaps with groundbreaking new findings.
A dissertation means to gather and synthesize information, known and unknown, and include your own thoughts on it.

A thesis allows getting the higher degree, e.g. PhD
a dissertation is more likely to be the smaller part of the 1st degree, or obtaining a master degree.

FAQ By Malaysian Medical Students From Foreign Universities Regarding Emergency Medicine in Malaysia

Over the few months since I have started this blog, I have received few emails from medical students studying in foreign universities asking me about emergency medicine in Malaysia and what are there prospects for them.

So, I think, probably I put up some relevant and common questions I have been asked before in this blog post. Bear in mind, these merely represent my own personal views I have also included a link before for anyone out there interested to find out what the relevant officers of USM has to say regarding applying for master of medicine (emergency medicine) in USM.

I also invite all my fellow emergency physicians all over our country (especially those from the Ministry of Health) to contribute their opinions here. Then we will have a good pool of answers.

Cheers,
Chew

FAQ

1. Is our Malaysian emergency departments only functions as triage area and primary management of patients and not having any inpatients?

Though triaging and acute management of patients' conditions are our main business, most ED have now what we called observation ward. It is something of a "hybrid" between the in patient ward and the out patient setting -- it is the place where we need longer time to observe the patient, awaiting certain investigation results, repeating certain tests, giving short term medications etc etc but we usually keep patient no more than 24 to 48 hours

The patients either will be admitted to definite wards or discharged home. We do not have in-patient wards to keep patients for days.

Besides, most EDs also handle prehospital and ambulances services although this field is also supported by NGOs such as St. John's Ambulance Malaysia, Red Crescent Malaysia as well as JPA (Jabatan Perkhidmtan Awam).

2. Is there any posts for overseas trained EM physicians in USM?

So far, we do not have any overseas trained EM physicians in USM but I am sure we will be most delighted to have one if there is anyone interested. Just write in to the Dean of the Medical School, USM and see what are the options (e.g. visiting professors/lecturers, contract basis lecturers, etc etc). Links to USM website below.

3. Does an EM physician conduct emergency endoscopy?

As far as I am aware, there is no EM physicians in Malaysia who has subspecialized in doing endoscopy, but who knows may be there will be someone interested.

4. Does EM have a bright future in Malaysia?

Emergency medicine is a relatively new field in Malaysia. Look at it positively. Because it is a relatively new field, therefore there are lots and lots of room for expansion. So many ways one can subspecialise. Like one of my lecturers, Assoc Prof Kamaruddin Jaalam, used to say "For emergency medicine in Malaysia, the sky is the limit". Since now we already have already sent astronaut out there, may be the universe is our limit.

But ultimately what do you mean by "bright future". Is it about earning a big fat salary? Or is it regarding the academic and clinical development of emergency medicine in Malaysia?

5. I am currently a medical student in Country XXX, and will be back in [YYY, Malaysia] after my housemanship. I am interested in emergency medicine. Any route for me to continue my education in emergency medicine . other than local universities (due to limited seats and great competition)?

My reply to you is simply this: depending on your university status, you may or may not need to sit for another exit exam in one of the local universities in order to join Malaysian Medical Council to get registered as a doctor.

During these two years, try to get yourself confirmed in service (very important) ASAP - in order to do that, you also need to attend an induction course -- how to go about it? Ask the personnel or clerk in charge in the adminstation office in whichever hospital you are placed in and they will be able to help you.

Once confirmed, you apply to any local universities that offer emergency medicine - at the moment (Universiti Sains Malaysia is the pioneer group; we have had this program for 10 - 11 years now; and now we also have Universiti Kebangsaan Malaysia and Universiti Malaya - these two universities, the first batch of emergency physicians to be produced by them will be in another one to two years time).

But regardless of which universities you are getting yourself into, now that we have conjoined board exam for the entrance and soon, the first ever exit exam too. So every candidate will sit for the same paper.

Any other route besides MMed Program for emergency medicine? Yes, you can also sit for MCEM (UK) exam [Member of the College of Emergency Medicine (UK)]. It used to be the exam MRCS (A&E) [Member of Royal College of Surgery (Accident and Emergency Medicine) (UK)] exam but MRSC (A&E) will be phased out soon - either one or two more batch of exams. The Emergency Medicine in UK will have their own board and their own exam. You can check out their website here: http://www.collemergencymed.ac.uk/CEM/default.asp.

However, none of the emergency physician has yet to have graduated with MCEM. So I am not quite sure how this qualification will work out in our system. But I supposed it is the same with MRCP and the other MRCSs.

There are some courses offered in the UK for preparation of MCEM. You can also check out here: http://mcemteaching.co.uk/links.aspx

The MCEM exam has been brought into Singapore and so you can the sit the exam there. I am also contemplating of sitting for the exam--- something extra - but I need some preparation and to put down some assignments and tasks I am currently doing. Need time lah for preparation.

My personal advice to you is this - I firmly believe it is not true that graduates from foreign universities are not given equal chance to apply for master program. However, the MAIN problem is get yourself registered with MMC. Once you are absorbed into the system, you will be treated as the same way. SO GO AHEAD AND APPLY :)

But the more important question I need to ask you of all is this - is emergency medicine really what you want? I am now in a university - which means I spend more academic activities.

It may be different for you - you may be working in the MOH hospitals. Private hospitals with emergency medicine post? Very minimal at the current moment.

At the end of the day, you must have passion for your job - then you will enjoy it. You won't see it is a burden to carry.

Update 18 Jan 2010

At this moment, there aren't any Emegency physician in Malaysia who have graduated with an MCEM.

So, to be honest with you, no one knows exactly how a graduate with MCEM will work out but I suspect it will be the same as for all other disciplines, like MRCP in internal medicine, and MRCS in surgery, where the gazettement period to be a full specialist after obtaining your external board certificate is 18 months, as compared to 6 months for an MMed holder.

The reason given is that MMed is a structured training programme (not just a exam passing certificate) geared for the working environment in Malaysia. I know that sounds a little bit unfair, and in fact, I have seen people who had passed with external board certification who have better knowledge than a MMed holder, but that is the rule set by MMC at the moment.

I remembered this is what my head of department said: UK board certification will be accepted by MMC as a specialist, but not the American board or Australian board because the syllabus is different.

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