The house job survival guide

Why this guide exists

Nobody hands you a manual when you start your house job. You go from final-year student to the person a nurse calls at 3 am about a patient who "doesn't look right", and the gap between those two roles is enormous. Most of what you need you learn by getting it wrong in front of someone.

This guide is the conversation you would have with a kind senior over chai on your first day, if you were lucky enough to find one.

What the year actually looks like

In most Pakistani teaching hospitals the house job is twelve months, usually split into six months of medicine and allied and six months of surgery and allied, sometimes with rotations through paediatrics, gynaecology or emergency. Some hospitals run three-month blocks.

Your days will be some mix of:

• Morning rounds, where you present new patients and carry out the plan.
• Ward work: bloods, cannulas, catheters, referrals, discharge slips, chasing reports.
• Admissions in casualty or the ward on call days.
• Night duties, often 24 to 36 hours straight in many units.
• OPD days, where you see a queue of patients that never seems to end.

The workload varies wildly between units. Some are humane. Some will test you. Most are somewhere in between, and how your year goes depends a lot on the people around you.

The first week

The first week is about learning the system, not medicine. Spend it finding out:

• Where the lab is, how to send samples, and what happens to a sample sent after 2 pm.
• How to book a CT, an ultrasound or an echo, and who actually decides.
• Who the head nurse is, and what she expects from house officers.
• Where emergency drugs, oxygen, the defibrillator and the crash cart are on your ward.
• How the previous house officer kept track of patients, and copy what works.

Read our first week guide for a day-by-day plan.

Keep a list and live by it

The single most useful habit is a written patient list with a task box for each patient. Write every task the moment you hear it on rounds. Tick it off when done. Hand it over at the end of the day.

Your memory will fail you at 2 am. Paper won't.

Seniors: how to work with them

Your PGs and registrars are tired, overloaded and often studying for their own exams. That doesn't excuse rudeness, but it explains a lot of it.

What makes seniors trust you:

• Do what you said you would do, and tell them when you couldn't.
• Present a patient in one minute: who, why they came, what you found, what you think, what you did.
• When you call, have the observations, recent bloods and drug chart in front of you.
• Never hide a mistake. Seniors forgive errors. They don't forgive cover-ups.

If a senior is abusive, rather than just stressed, keep a written record and talk to someone you trust in the department. You don't have to accept being humiliated to finish your house job.

Attendants

In Pakistan, patients come with families, and families come with expectations. Some attendants will be the most helpful people on the ward. Others will be angry, scared and occasionally aggressive.

What helps:

• Introduce yourself and explain the plan in plain Urdu at least once a day.
• Tell them what you're waiting for and roughly when.
• Never promise what you can't control, like a bed, a scan time or a cure.
• If things become threatening, step away and call security or your senior. Your safety comes first.

We wrote more in dealing with attendants.

Nights

Night duty is where you grow fastest and where mistakes happen most. The key ideas:

• Prioritise sick over busy. A breathless patient comes before a discharge slip.
• See the patient before you prescribe on the phone, whenever you can.
• Know your escalation route: PG on call, then registrar, then consultant.
• Eat something real before midnight and drink water.

Our night duty guide goes into detail.

Protect yourself

You are not a machine, and the system will take everything you give it.

• Sleep whenever you are off. Guard your post-call time.
• Eat at least one proper meal on every shift.
• Don't sign anything you didn't do.
• Document clearly: time, what you saw, what you did, who you told.
• Get your hepatitis B vaccination status checked, and report every needle-stick.

If you notice you're dreading every shift, sleeping badly even when you can, or feeling numb about patients, read our piece on burnout and talk to someone.

Learning while working

The house job is the best clinical teacher you will ever have, if you pay attention:

• Look up one thing properly from every interesting patient.
• Ask seniors why, not just what.
• Do every procedure you can, supervised at first. Keep a log.
• Read the guides on this site for your common calls: fever on the ward, low urine output, high potassium and the fitting patient.

Plan your next step early

By month four or five, decide roughly what you want next: FCPS, a job abroad, a specific specialty or a break. Your choice affects what you should be studying alongside the job.

• FCPS Part 1 guide
• NRE Step 1 guide for foreign graduates
• Careers after MBBS

Common mistakes that cost you

The same few habits cause most of the regret: not writing things down, bluffing instead of saying "I'll check and come back", ignoring your own health, arguing with every attendant and leaving handover incomplete. The full list is in common house job mistakes.

Studying for FCPS while doing the job

Protect one block on off days, use short gaps on duty for questions and stick to one resource. See studying for FCPS Part 1 during house job.

More for each part of the year

Your first on-call · Medicine ward tips · Surgery ward tips · Handover and notes · Difficult seniors · Breaking bad news · Private vs public house job · Choosing rotations for FCPS · How to get a house job · Medicine vs surgery rotation tips · Writing notes and discharge summaries · Presenting on ward rounds · Medico-legal cases

Frequently asked questions