THE IDEAL HOUSE OFFICER: TRAINEE’S PERSPECTIVES

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N. Alozie¹, K.I Egbuchulem², M.C Okor¹, F. Akintepede¹, C.A Omogiade³,M.M Awodiji⁴

1. Medical House Officer, Department of Surgery, University College Hospital, Ibadan.
2. Division of Paediatric Surgery, Department of Surgery, University College Hospital, Ibadan.
3. Postgraduate Student, Chemical Pathology, University of Benin, Benin City.
4. Department of Plastics, Reconstructive and Aesthetic Surgery, University College Hospital, Ibadan.

Abstract

Introduction: The housemanship period is a peculiar time in a doctor’s career, and some have described it as a “Nuisance year” during which the junior doctor assumes many roles at the same time – as a doctor of his patients, a student of his trainers (Resident doctors and Consultants) and a teacher of medical students. He is also at the same time undergoing training and research to practice as a professional in an increasingly competitive society-https://youtu.be/SaaQmMHy_qI.

Nigerian perspective: A typical House officer is seen neatly dressed with black circles around the eyes depicting tiredness, ward coat pockets stuffed with enough materials to start up a new ward; ranging from continuation sheets, syringes, water for injection, capillary tubes, hand gloves, investigation forms, commonly used drugs, cannula, torniquet et cetera, smart shoes and feet ready to move on large doses of caffeine, and with carbonated drinks at arm’s reach for a quick glucose rush for the day. He or she is faced with institutional problems, staff and workplace disharmony ranging from lack of adequate residential apartment for interns, early daily resumption and retires much later than the team to effectively carry out the work plan among acute shortage of staff. Majority of interns also try to adapt to the internship workings because they are new to the system, and some health workers typically try to take advantage of them which sometimes interfere with their work and the intern struggles to give the patients his best. Despite all these, the house officer interacts with the patient and relatives more often than the rest of the team. He builds the trust, respect, and confidence the patient has for the team as he represents not only himself but also the team.

Conclusion: As once said by Sir William Osler – the great physician whose name is still being invoked in modern day medicine – that “his time was ripe for him, and he was ripe for his time”. Trainees must always make themselves “ripe for their time”, and the relevant authorities must also make time “ripe for trainees”. The ideal scenario will then be a nexus of an ideal trainee and an ideal work environment.

Keywords: House officer, Housemanship, Intern, Nigerian, Trainee

Introduction

‘A house officer is a doctor who is the most junior member of the medical staff of a hospital, usually resident in the hospital, United States and Canadian equivalent; Intern’.¹

The house officer, as the most junior doctor of the team, supposedly fresh out of medical school, is mandated to undergo one year of practical training called internship (houseman ship) under the supervision of a senior doctor referred to as a consultant. This doctor is faced head on with an abrupt change in relationship with fellow colleagues, other health workers and patients (Figure 1).

The physician’s pledge is the oath to which all doctorsincluding intending house officer, swear prior to the beginning of their respective medical careers and gives one an insight as to what is required of a doctor as regards his duty to his patients, his teachers, medical students and his or herself. This pledge, previously known as the Hippocratic oath, is an ethical code that serves as a guide for medical practitioners and embodies principles that dictates the obligations of the physicians to students of medicine and the duties of interns and trainees to teacher. It also pledges physicians to prescribe only beneficial treatments, to refrain from causing harm, and to live an exemplary personal and professional life. Using this code as a basis for discussion, one can see how the housemanship year serves as an introduction to the medical practice and now becomes the perfect opportunity to imbibe these attributes.^2,3 The houseman ship period is a peculiar time in a doctor’s career, and also described as the “Nuisance year” during which he or she assumes many roles at the same time – as a doctor of his patients, a student of his trainers (Resident doctors and Consultants) and a teacher of medical students. He is also at the same time undergoing training topractice as a professional in an increasingly competitive society which continues to get even smaller by the unavoidable consequences of brain drain.

In examining who an ideal house surgeon or physician is, it is imperative to consider the kind of person he should be and what he should know or know how to do. It is however also pertinent to consider the totality of the environment in which the ideal house officer must work. This is even more so considering the radical change in healthcare delivery that promotes the role of the physician as clinical and economic manager rather than professional decision-maker and patient advocate in this era of unhealthy inter professional rivalry.

The Physician’s pledge suggests that the house officer should treat his trainers as his local parents. The scope of the trainee-trainer relationship can only then be imagined. The same document enjoins a house officer indeed like any other doctor “to apply, for the benefit of the sick, all measures which are required” and to “keep them from harm and injustice”.2

The scope of what must be done to fulfill the two responsibilities will depend on the peculiarities and the vagaries of the doctor’s conditions and his environment. Indeed, requirements like these lend themselves to personal and cultural interpretations.