I came across this blog today: http://jimbocyberdoc.wordpress.com/2011/09/09/disowned/. An interesting and short write-up about the current situation of the glut and the problems with shift duties. The situation is only going to get worst. I just completed writing an article for MMA magazine about the situation of oversupply of doctors and poor quality of medical schools which will be published by next month.
I have said this before that if the shift duties are not done properly, it will make the situation worst than before. I like the last sentence written by this blogger “So, if you are sick, come to the hospital at your own risk – you shall be DISOWNED!” The shift duty may actually deteriorate the continuity of care of the patients. We can already see a lot of half-baked houseofficers who are not interested in taking care of the patients and this shift duties will only give them more chances to take their own sweat time to do their work so that they can dump it to the next person. Please read the comments on this blog above for the said article and you will realise that these problems have already started.
I was also informed by various sources that soon, you will need to apply for a medical officers(MO) post after your housemanship! It seems that the government may only provide post for housemanship on a 2 year contract basis after which you need to apply for a job! Compulsory service will be scraped! So, you’re going to see a lot of jobless doctors running around as I have predicted before. And some said, it will not happen……………..! of course, JPA and all other sponsored students including local public uni students will be given priority. The rest can say sayonara! Being in Malaysia, you can forget about a transparent selection process.
Disowned
Much has been written about the oversupply of new doctors, like this well written article by a concerned medical student: Too many doctors, too few hospitals.
I said in jest to a group of medical students yesterday while taking them for bedside teaching: “If I close my eyes and walk, I’d likely walk into 10 house officers and if I throw a rock, I’d hit 5 of them!”
Actually, at the rate we are going, there won’t be any bedside space left for teaching – right now the hospital where I am working in serves as a teaching hospital to medical students from 1 private university, nursing students from at least 3-4 private and government-owned nursing colleges and physiotherapy students from similar number of institutions. When I walked into the ward in the mornings, I get a feeling that I am walking into a Jusco sale.
The reason I jested with my students was because I was trying to impress upon them the need to “shine and rise above the rest”, because despite the sudden rise of number of house officers, the number of training centres have more or less remained stagnant, likewise with the number of specialists/consultants to train them and similarly with the number of postgraduate places available; and this does not bode well for the nation.
We will (or already have) produce a generation of incompetent doctors who will be a danger to society.
When I came back from Melbourne 2 months ago, I discovered that I had 4 house officers assigned to the 2 cubicles that I usually perform my rounds. These 2 cubicles have 16 beds, giving an impressive ratio of one doctor to 4 patients! Since the beds were not often fully occupied, the ratio was much higher in most instances. There is a medical officer overseeing these 4 house officers and then there is me…so the doctor:patient ratio was indeed very impressive.
At least on paper it was.
I don’t want to go into details but suffice to say, I’d rather have 1 house officer who thinks and analyzes than many who merely act as scribes, penning down every word spoken by the medical officer or by me or what I would term as “palliative doctors” – prescribing Panadol for fever or Benadryl for cough, without much thought on why a patient has fever or cough to begin with!
And to add to the woe, these house officers are rotated between cubicles or wards every TWO weeks making it very difficult for me to train them. By the time I see something positive in them, they would have vanished to the next ward or cubicle!
Frankly I’d rather that house officers stay in a single ward or cubicles for a prolonged period of time instead of being moved around. Like they say, “a rolling stone gathers no moss”; likewise a junior doctor being constantly moved gains no knowledge or skills.
And then last week, the department started the shift system for house officers – basically now, medical house officers work in 2 shifts per day. I am not too clear about the way it works but I believe those who work 3 night shifts would be given the 4th day off being starting the day shift. It’s the ‘knee jerk’ reaction from the powers-that-be as a short term solution to the oversupply of young doctors.
Again on paper it looks good. Shorter working hours for young doctors (no one gives a hoot to the long working hours of more senior doctors), the massive amount of money saved because technically since these doctors are no longer “on call”, they are not paid call claims, and it clears the congestion in the wards.
All very good indeed.It’s a win-win situation, they tell us.
I tell you this is NOT a win-win situation. Now, house officers change places faster than you can say “dysdiadochokinesis”!
The BIGGEST LOSER in this whole fiasco, ironically, are the very ones the health care system was set up in the first place: THE PATIENTS.
Now patients had to content with seeing different doctors every day in the wards, each doctor not knowing the management plan for the patient because with all the shifting and moving, no one will take ownership of the patients!
So, if you are sick, come to the hospital at your own risk – you shall be DISOWNED!
Pagalavan's Avatar 
Introducing shift duty to housemanship without proper channel of communications, methods of practice and adequate procedures will probably make the HO ‘lepas tangan’ right after their shift ends.
I’m afraid that HO’s will be like those bloody nurses we have at our public hospital. Nearly half an hour before their shift ends, they don’t want to cater to any work/request. Will leave as soon as shift ends. Let the other fella at the next shift handle new work load.
One question, what’s the passing rate for all these private medical schools we have here in Malaysia? 50%? 60%?
I question every medical school here if their passing rate 100%. That sounds ridiculous!
Haha, it is indeed 100% passing rate for our medical schools!
at least my Uni has 89% passing rate for my senior this year..UKM has better passing rate but I’m not sure about the percentage coz if I’m not mistaken only 7 students sit for remedial among 200++ students.. May I know which Uni has 100%?
even the 7 will pass after the resit, right? so it is almost 100%!! I do not want to mention the names of the unis but mostly private medical colleges. You can check with staffs who are teaching in these universities.
Hi Dr Paga.
I was googling random topics and came across your blog. I was wondering if I could have your email address to ask some questions about the policies, terms and conditions of working in the Malaysian public health service.
Thanks.
pagal72@gmail.com
“Now patients had to content with seeing different doctors every day in the wards, each doctor not knowing the management plan for the patient because with all the shifting and moving, no one will take ownership of the patients!”
That’s very interesting, and not something I considered in my support for a shift system on the wards. In countries like UK/Aus/NZ, patient’s are admitted under a consultant’s team/firm, and therefore a particular specialist is directly responsible for them. That specialist makes sure the Registrar/MO and house officers in the team takes care of the patient, and they cannot run away from that responsibility. The doctors in that team therefore ensure a good handover is given to the person on nights, when required, ‘cos otherwise blame can be traced back to them. The junior doctors stay in a team for 3-6 months, so working relationships are built and expectations are established.
Now you look at the Malaysian system, where patients are admitted to a ward and not under a particular doctor. Specialists change the management every time one does a round. Junior doctors don’t have to take ownership, especially when they can hand over any ‘difficult’ patients 8 hours later. No continuity of care. No wonder bad things are happening.
In principle, I support a shift-type system but I am now not so convinced you can apply it to the Malaysian system unless you overhaul the whole systen.
I have been saying this all the while that it is not feasible in our health care system. We don’t work in team based system like in many other countries, including Singapore. Patient gets admitted to a ward and discharged to a clinic. Even now, there is no long term continuity of care. Different MO/Specilaist sees the patient in the ward and then dumped to the general clinic for follow-up. BUT at least the same MO and HO was seeing the patients daily in the ward till they are discharged. Now, the housemen will be changing all the time. The MOs probably have to work harder once this shift system starts.
like I commented few times on previous post. Malaysia is not ready yet to change to shift system. even in western world things get missed no matter how well you train HO/residents to do hand over, how perfect you prepare your hand out. things will get missed because human make error.
shift work is an interesting idea but it will defenitely take out alot of teaching time and experience. someone previously suggested prolonging housemanship will not fix the problem because it will only lead to accumulation of houseman that has not graduated after 2 years.
Bottom end the problem is overload of number of graduates, and mostly incompetent ones. Its like…overloading patient with fluids. No matter what correcting and reducing the fluid is the only way to correct the problem.
** just for fun **
before the shift system started, it was quite often to hear that there was no proper case pass over among the doctors, especially the junior doctors.. so the following situation happened:
(during night round)
MO: the blood results back oredi ar..??
Oncall HO: got blood results to trace meh..?? the ward HO didn’t inform me la.. they just asked me to take blood 4 hourly but never tell me need to trace the blood results wor..
(during morning round)
MO: the urgent scan done oredi ar..??
Ward HO: got urgent scan to do meh..?? the oncall HO didn’t inform me la.. when i came to work this morning, the oncall one oredi cabut liao..
now the shift system started.. a briefing session was given to all the HOs and emphasizing on the importance of proper case pass over.. but, would the following situations happen in future..??
morning shift, HO 1: emmm, hungry la.. let’s go makan 1st.. if cannot finish all the tasks can always PASS OVER to the afternoon shift people ma.. KKM hospital always busy in the morning, no one will blame me.. hehe..
afternoon shift, HO2: wa lao er, i just punch in, but there are oredi so many things awaiting for me to do.. how to finish them..?? hopefully can PASS OVER some to the night shift people..
night shift, HO3: it is not my fault.. i’m a good and dedicated doctor, u know.. actually huh, i wan to do all the things over night.. but unfortunately, the lab doesn’t do ESR at night, they also said at night time only can do BUSE in batches, cannot do urgent one.. the pathology and microbiology lab were closed, so i couldn’t trace the results.. i also couldn’t use the computer to trace coz the nurse was using it for facebooking.. the radiology only got 2 radiographers on duty, the emergency department was so busy, so the x-ray couldn’t be done oso.. boss, u don’t wori k.. i will PASS OVER all the cases COMPLETELY to the morning shift HO..
next morning, back to HO1: @#$%$#&….
so the “shift system syndrome” vicious cycle continues..
conclusion: patients = always the poor things lor..
Our local private medical school pass rate is NOT 100% just to let you know….
there are people and my friends who fail and have to repeat the year…. so it is NONSENSE to say we all pass 100%
Shift time in Kuala Terengganu HSNZ
AM 7.00am – 8.00pm
PM 8.00pm – 7.00am
am 7.00am – 3.00pm
i would like to know other place???
You said: repeat the year! Yes, I know about this but eventually they will all pass!! Unless they drop out themselves.
i dont know about others, but my school has some cases who got kicked out as they failed multiple times or even got banned for few years… however, those with cables can pass happily although they has serious discipline problem and result not up to par. Now i’m slowly numb to those situations, and the world.
Yup, exactly. Since you are paying cash, which private college is going to sack you? I know IMU do ask poor performing students to leave the faculty but most others don’t. At the most, they will ask the student to resit the exam and these resit exams are much more easier than the original!
well Bryan if not 100% I am pretty sure it is close to 100% =P if you include those who have to retake.
I am a graduate from private medical school that has twinning. I have seen both teaching and attitude of students from both ends. Teachings/lectures provided in local private med school for basic science year are mostly by non-MD/MBBS alot of times. they teach you everything under the sun without emphasizing clinical importance. Problem based learning(PBLs) that some school are doing are even worse – they hire research tech and master students to conduct pbl for them. I have been in those pbl before as a student and I have been lead by psychologist for pneumonia case, master student for dysphagia and etc. Most of the time they dont have a clue on what we are talking about.
anyway like CC commented below. If you stay long enough you will see these scenarios – it all comes to cable in the end=P
I agreed. Do not over estimate the private medical school of their teaching staffs. Most of them are waiting for retirement. You see some medical schools got so many lecturers, most of them are visiting or come only ONCE / TWICE.
Ask them to sit again for MRCP? They told me they no confident to pass it (The senior specialist told me one).
Some senior specialist / HOD in government also forget how to do resuscitation and manage patient. Last time my pediatric specialist admitted that she did not know how to do cardiac resuscitation, only rely on the senior MO.
If your life isn’t working don’t blame the product. If your everyday life seems poor, don’t blame it; blame yourself; admit to yourself that you are not enough of a poet to call forth its riches; because for the creator there is no poverty and no poor indifferent place.
Rainer Maria Rilke
I sure everyone is aware of the gravity of the situation now in Malaysia. Not only in the medical field, almost every other aspects had been invaded by these “bolehland” attitude.
Dr. Paga, everyone is pissed with what is going on now. But by bashing others in almost every of your post isn’t going to do any good.
Two simple questions that you need to consider. When you are blaming, how does that make you feel? Blame never, never evokes positive feelings or makes you feel good. You never feel joyous or uplifted after blaming.
Perhaps you wanted more people to be aware of the current screwed up situation in Malaysian health care. You can’t achieve this just by mere criticism. Where are the constructive criticism? Where are the well-meant critique intended to help someone to improve?
You probably will say that I’m still too naive, but hey, after publishing all these solely negative articles – do you feel any better?
Usually people who blame others usually try to hide their feelings of helplessness. If they didn’t blame anyone they would admit that they are not in control and that there is nothing they can do.
I come in peace.
Dear CikBayut,
Thanks for the comment. I presume you have not read ALL my postings in my blog and what I have written in MMA magazine since 2004. Most of what I have been writing now (criticism) has been written and brought to the attention of the authorities way back in 2004-2006. I was the SCHOMOS chairman of Johor from 2002-2004 and National SCHOMOS Treasurer from 2004-2006. WE have had multiple meetings with MOH/JPA etc etc but every effort that we made fell into deaf ears! Now, you are seeing the effects of it. Secondly, I am NOT blaming anyone other than the powers to be. And who put these people up there to run this country? it’s us!
How can someone know the fault in a system if there is no criticism? If everyone remains quiet, then it means that we accept all this nonsense, right? If another person does not tell you that your management of a patient is wrong, would you change your management? Criticism suppose to make a person become a better person and that is what I am doing here in this blog. I am telling the truth that is happening and truth hurts. How you take it, is up to you. I have done my part to change the situation but failed due to too much bereaucracy and politics. I have even kicked out a clerk in my previous hospital for messing up all the houseofficers documents. The working paper for the promotion scheme of medical officers that the doctors are enjoying since 2010 was written by me single handedly in 2006 and handed to the Minister of Health then, Dato Dr Chua Soi Lek.
My intention in this blog is to tell the public the mess that we are in, so that they will know the reality. It is a form of constructive criticism and if you read all my articles carefully, I have given solutions to the problems on and off.
BTW, just to add to the clerk story that I mentioned above. way back in 2003, I brought this matter up to the state pengarah and an investigation that was conducted showed that some doctors who had finished housemanship almost 3 years before have not got their full registration because the clerk did not even send the documents to MMC. These doctors realised only when they were about to apply for Masters. So, the timbalan pengarah has to sit with few clerks to clear the backlog and it took 6 months to clear it. The said clerk was transferred to the store. 2 years later , he was promoted to chief clerk in the state health department and now, this year, he was promoted again to become the chief clerk in the same hospital where he was demoted!! You see the logic? That is Malaysian civil service. Whether you do your work or not, you will be promoted and no amount of goodwill work by you will change the scenario. It needs a complete change!
Cikbayut, I also come in peace. Let me tell you, if not for Dr Pagalavan’s criticism, I would have been in a semi-naive construct of my own as to what the Malaysian health system is really about. It’s not as simple as what Michael Jackson sang, “be the change that you want the world to be”. It’s about awareness. With more and more doctors being aware, then we can make the decision to help change the system OR help change your career path.
Not criticizing doesnt make any difference. Yes, you can argue that the shift system is going to improve the outcomes etc etc. You can also argue that it doesnt. Right now, its very difficult to prove the former.
Cikbayut, when i first stumbled across this blog 2 years back, I too had your thoughts. What the heck is up with this paga-dude? He only whacks the gomen without any constructive criticism.
After 4 years in service, I can tell you one thing. No one gives a damn about your constructive criticism in this country. Probably Dr Paga discovered this many years ago.
totally agree
I know this topic was raised multiple times at least for past 3 years. government just brushed MMA off and told them to hush.
CikBayut
Just try to think – who is governing and having the final say if a med school graduate is competent and eligible to practice in Malaysia. and If constructive opinion(like reducing and controllling total number of graduates) is being considered why are our private med school expanding.
and I am pretty sure not everyone is pissed – especially those who are earning by scamming medical students lol.
Problem: Not enough doctors. Crony not making enough money. Need to maintain NEP outcomes.
Solution : Shunt certain people out of local public unis. Churn out more doctors via crony owned private colleges. Send overseas to rubbish unis. Maintain special ratios for postgraduate masters programs.
New Problem: Toooo many doctors. Spiralling costs. Poor health outcomes. Sub-standard junior specialists. Pissed off senior specialists.
New Solution: Introduce Shift system. Introduce 1Care system. Import foreign specialists.
So whats next?
NEW new problem: Care is compromised. Too many negligence. Too long waiting time from “national health service” duplicate. Junior doctors not trained effectively by new specialists. Healthcare quality spirals downwards.
Whats the new solution???
1. Those who can afford/ are covered by insurance – flock to private hospitals (btw, half GLC owned.. sheesh)
2. Those who cant afford insurance – suffer (The group of people we really need to help)
3. Will there be a significant health disruption via ASEAN community + health tourism + globalization? maybe not so soon…
Yeah, to serve under such government is really depressing and frustrating.
It’s everyone’s right to complain, no doubt.
You see, we have a complicated relationship with the grudges we hold. We get obsessed and aggravated by the many slights that befall us, but we’re ever reluctant to bury our pain and move on.
The tendency to itemize every unfair knock we’ve ever suffered is known as injustice collecting. Sometimes, the injustices are personal, as in – “My boss promoted Ali over me, cause he’s a Malay.” This kind of self talk leads to anger. At other times, the cataloged outrages lead to overwrought generalizations, such as, “Nothing ever goes well; this is too unfair.” This type of thinking leads to hopelessness and rage.
Enough grudge holding and soon you’ll see more iniquity than actually exists. The injustice collector becomes a trigger-happy perceiver. If you walk down the street recounting the affronts you’ve suffered lately, you’ll kick up quite a cloud of dejection.
“Feeling like a victim of injustice in one situation does not make us less likely to commit an injustice against someone else, nor does it make us more sympathetic to victims”
The more I think about it, the more it seems to me that most of us (myself included) are hypocrites by default. If you’re like me and most, you probably think that throughout your life you’ve hurt others less than they’ve hurt you.
I’m not against any attempts to create more public awareness regarding the state of healthcare in Malaysia, neither I’m having a semi-naive construct of my own view towards our collapsing nation.
But it seems that the post are getting more like promoting the idea of “injustice collecting”. Find out why injustice collecting is bad here :
Characteristics of Injustice Collectors
1. Injustice collectors are never wrong. How is it possible that they are never wrong? It’s simple: They are always right.
2. Injustice collectors never apologize. Ever. For anything.
3. Injustice collectors truly believe they are morally and ethically superior to others and that others seem incapable of holding themselves to the same high standards as the injustice collector does.
4. Injustice collectors make the rules, break the rules and enforce the rules of the family. They are a combination of legislator, police, judge and jury to those they consider their subjects. They forever banish from their kingdom any subject they deem disloyal, and only grant clemency if there is sufficient (in their eyes) contrition.
5. Injustice collectors never worry about what is wrong with them as their “bad” list grows. Their focus is always on the failings of others.
6. Injustice collectors are never troubled by the disparity between their rules for others and their own expectations of themselves. Injustice collectors rationalize their own behavior with great ease and comfort.
7. Injustice collectors have an external orientation; the problem always exists in the world, outside of themselves, and in their view, the world would be an acceptable place if their rules and standards were followed at all times.
8. Injustice collectors do not have a capacity for remorse, empathy or guilt.
9. Injustice collectors scoff at the idea of therapy, therapists, self-help books, and other tools used by people who struggle to live with them.
10. The phrase “walking on eggshells” describes life with an injustice collector.
11. The IC (injustice Collector) will prey upon your weaknesses to frame all issues in their terms.
12. IC’s will always cry foul when you are ‘mean’ to them and accuse you of being nasty when you are confronting them with their negative behavior.
13. They are titanically insecure and cannot trust anyone. All relationships they have, even with their own parents and children and trustless and must be reinforced by subordination over and over.
14. They can only strengthen relationships through imprisoning their mates and banning behaviors and other relationships. Friends and family are a huge threat to the IC.
15. They must repetitively revisit situations where you service them, give in to them and agree with them. They will over time shrink your world to a small plot of empty activities that only they like. They are terrified of travel, meeting new people, understanding new concepts and paroling you from any punishment they have previously ‘convicted’ you of.
16. They do not care about you at all, they care about aggrandizing themselves with you as an assistant producer.
17. They will occasionally do something for you, but if you are not completely brainwashed, it will be a negative experience for you in the end. Example is throwing you a birthday party. I guarantee you will not have fun at your own party.
18. They will force you to choose between them and other things you like or love. The more you choose them, the more they will make you choose them over and over. They do not understand the concept of loyalty at all.
19. Hypocrisy is their modus operandi for debating and arguing with you. Everything they say about you is true about them. (aka Projection) It makes it so you try to ‘win’ fights by getting them to agree with you, which they never can because their whole position is false.
20. Your life will disappear into their lives. Your hopes and dreams will fade, even in your own mind. You will eat what they want, you will watch what they want on TV, you will vacation where they want, or not at all.
Is this the type of example you wanted to set for the next generation?
Lastly, are you really trying to create more awareness, or merely just finding for a place to rant?
Doing something excessively sometimes, may ended up losing it’s original point.
Dear Cikbayut ( you’re still using a psuedonym? wonder why?)
Either you are a psychiatrist or a psychologist. For these 2 people, every person they talk to is having a psychiatric disorder. Every human being seem to be having a psychiatric disorder . That’s how they come up with all these terms ( they wil say that the prophets are also psychiatric patients!). The person who came up with these terms is a family psychologist Mark Sichel and these terms were created for reasons of a dysfunctional families. Injustice collectors and people pleasers are among the terms used to asess a dysfunctional family. I did realise that almost the entire comment of yours were taken from here http://www.psychologytoday.com/articles/200612/injustice-collecting.
If you read too much of psychology, you will forget about what we are trying to say in this blog. Everything we say will become an psychological issue! As I have said, you need to go back and read all that I have written since 2004 before coming to a conclusion. Furthermore, you do not know me personally for you to judge who am I. Yes, of course everyhting that is mentioned in this blog may sound negative BUT we are talking about a nation and it’s future and NOT some dysfunctional family. These are 2 different matters. Every citizen has his right to voice out what is wrong with the system and try to change it. The more people who are aware of these issue, the more people will try to change the system. WE don’t need people pleasers and people who keep quiet and just let everything to go as usual and hope for the best. You will become a manic at the end.
Creating awareness may sound like ranting but it is my blog and I have the right to write what my opinions regarding certain national issues. It is up to the people who read to decide whether they want to agree or disagree. I have never censored any of the comments that people have said in my blog no matter whether it is for or against me.
For all that you have written above, Have you given a solution to the problems? You seem to be picking on my blog entries but did not give any solutions. I wonder what psychological terms used for this type of behaviour? Keeping quiet and letting injustice to happen and destroying our future generation is a bigger sin to commit. At least I am trying to change the future by exposing all these wrongdoings.
I am wondering who is treating a psychologist IF they have psychiatric illness?? I know a senior psychiatric specialist that her closest family member committed suicide. She only knew it when it happened and she couldn’t detected it despite they have been living together for so many years. I wish to point out that it is not easy to become a psychiatrist. Nobody give advice or know how to treat you IF you are ‘out of normal mind’
Some times I feel that psychologist themselves actually have pschiatric illness! Ha ha……….. Most of them have some perculiar behaviour.
I don’t see how your psychobabble is in any way constructive in helping to solve the potential future disaster faced by our nation’s healthcare system. We are now on the brink, and this is a problem which will affect us all personally in some way eventually.
Dr Paga raises important issues about the future of doctors and healthcare in Malaysia, and in his way is trying to generate awareness via his blog. Change will not come unless there are enough who know the truth, and care enough to vote for change. I guess you are naive, and I am a cynic.
I don’t care who get pomoted as long as my patients are fine lol. I am pretty sure most doctors are. There will be no difference in patient care if someone dumb gets promoted – the smart and useful ones in department still get to do all the job and push for chnages, or even hange things without the dumb head knowing. If the smart one gets promoted there will be good changes.
If simple suggestion like limit total of graduate can’t be accepted and implemented properly what other thing can the government do.
blatant plagairism. Cikbayut you should be ashamed of yourself.
Not only that, but you have ignored the key points that Dr Paga raised. Using red herrings and personal attacks do not change the validity of any of Dr Paga’s points one bit. EVEN IF DR PAGA IS AN INJUSTICE COLLECTOR… or whatever fancy psych term u wanna use… IT DOES NOT CHANGE THE VALIDITY OF HIS STATEMENTS… much of which are not widely known. Hence I fully support Dr Paga and may we all spread his message on facebook/email/twitter. Spread the word people!
There is nothing wrong with criticism so long as it is warranted.
I can say Joe Blogs is an idiot….well that’s uncalled for.
But if I say Joe Blogs is an idiot because of X Y and Z… and X Y and Z are all valid points most reasonable people would agree with, then my critiicsm stands.
Dr Pagalavan is raising awareness. Without more awareness, change will not happen. Awareness is the first step to change.
It is all over now. Nothing has been done by our government and MoH. Instead, each year JPA and MARA sent more students to do medic either locally and internationally. Self sponsored students are also increasing tremendously.
I wonder what the parents and form 5 students are thinking. Do they know what is going on with our healthcare system especially regarding the HO gluts issue? To shed light on them, these information must reach them or publicize in media. But sadly, some of the person who controlled our mass media esp newspapers and tv news are the same person who controlled these medical business in Malaysia.
Cikbayut, I know ur intentions are good and well. Trust me, you wont find many people out there who have exposed the madness in our health system as well as dr paga has done.
Well written articles, nice to debate and get into a ‘fight’ with…..
But dont tell him or anyone on this site to keep quiet.. students and junior doctors need to ‘stumble’ on this site more and more to balance the one sided view most of them have after going through BTN..
Or students that want to do medicine should come here before they get scammed lol
Pgy1: They should at least know the ugly truth behind our healthcare system. Have you read the news yesterday? DPM said Malaysia will be a hotbed for medical tourists in the near future and also our PM an ex-PM was made chancellor and vice-chancellor of Perdana University. What is the use of having 31 or more medical universities when the quality of Drs are doubtful? And also what is the point of doing medicine when the future of being able to work as a doctor in Malaysia or overseas looks bleak and uncertain.
What the government needs to do know is to learn from mistakes. It is still not too late to counter the HOs glut.
PS: Most students get scammed anyway by their parents, agents, ‘over-rated SPM results’ and government but I will say the ‘over-rated SPM results’ is the biggest scam. During 90’s each state could only produce less than 10-20 straight As but now each state is proudly having 100+ plus straight As. And even the grade A is categorized into 3 levels. Maybe in few years time, we will see at least 5 levels of A = A++, A+, A, A-, A– . 🙂
Lol dont they already have 3 levels of A. Anyway I was just being sarcastic. Anything that will make government look good and help politician and businessman to earn money will look good.
I always question education background of politicians that are involved with medical school.
I am currently training in USA but I want to come back to my home country to serve. Now I don’t even know if I can get a job as consultant back in msia (or how long would it take).
Hey Pgy1, just want to ask did you took the usmles and went to US? Which speciality are you training in?
Hello, housemen/interns they are here to learn!
Hello, they are not here to just learn!
Some portion of their work is service work, and the rest is learning (no one can measure the proportion accurately).
The key to their learning is that they have to build on what has been taught in medical school. If they don’t know how to write ABCDE…., how can you teach them to write a sentence? Senior doctors don’t have time to sit the incompetent ones down and teach them how to write ABC.
If your medical school hasn’t taught you the basics, you become an unsafe doctor. Unsafe doctors cause harm to patients. Patients should not be treated as collateral damage because houseman ‘are there to learn’.
They’re in medical school for 5 years or even 6 years. They might not know everything but something!
What’s tagging for?
Unfortunately, that something is also missing !! Tagging is for you to get use to the system. It can be few days to 2 weeks.
Medcine is a life long learning process but after 5 years of medical school, you can’t expect the specialist/MOs to teach you how to take history, do physical examination, interprate investigations and come to a diagnosis. If you can’t do these, then how did you graduate in the first place?
And to add on to what have been said, those lecturers in your uni have been assigned, and paid well enough to teach you to write ABCDE…
Whereas, the poor specialists/consultants/MOs have so many things to do, thus don’t expect them to teach you to write. Yes, we can teach you to perfect your grammars, teach you new words to use, but not teach you to write ABCDE.
If you want us to teach ABCDE, why don’t you get the lecturers to pay us their salaries instead. No need to go medical school, just come to govt hospital to study medicine.
Pls kindly be certain you have what it is needed to become a house officer, and not start to learn only when you are one.
Dear Dr Paga, I have an innocent question. Jimbo jested in front of his students so that they should know the importance of “rising and shining above the rest”. In your opinion, do you think that an honest, hardworking and passionate medical student from those “crap” medical schools (Ukraine/Egypt/Indonesia/Russia etc.) will have the chance to do well in their housemanship?
By what criteria can we measure a houseman’s capability, such that we know he/she is “shining above the rest” in the new shift system? I’ve heard of specialists classifying HOs based on where they come from, basically saying “you are from UK, you have some hope” or “you are from Indonesia, you better stay away” from their very first day. Now I feel that is very unprofessional and childish, to pigeonhole HOs, don’t you think?
So, Dr Paga, any pointers about how one can “shine”?
Firstly, which medical school you graduate from does not make any difference if you do not have interest in medicine and interest in taking care of sick patients in hospital. However, you still need to know basic knowledge of being a doctor like taking good history, physical examination, ordering and interpreting investigations and coming to a diagnosis. IF you don;t know these then you are not fit to graduate in the first place. Unfortunately, we are seeing more and more of these type of graduates lately from some local as well as overseas universities. Thus, the generalisation. I still feel that a good entry qualifications is the most important factor of making a good doctor in addition to interest and passion.
Right from Day1, you need to show interest in your work, work hard and eager to learn. Come early to work, take bloods and start the rounds even before the MO or consultants come to the ward. Know all your patients by heart and trace all the results without being asked. Learn to manage patients than being pen pushers. If you are like this, no consultant/MO can say that you are hopeless. When I was in public hospital before, I usually give every houseman about 2 weeks to accomodate themselves and another 2 weeks to get use to my flow. After that, I know who are good and who are bad housemen!
I totally agree with last paragraph from Dr Paga. When I was HO, I had to come earlier than the specialist. Worst still I encountered with one hard working who used to come to the ward at 6:30am. So I have to come as early as 5:45am in order to know the newly admitted cases. At the end of the posting, I could remembered each of everyone of the 45 patients history, progress and blood result without looking to the BHT. I taught it was impossible when I first joined the dept but eventually I did it. Not afraid of Grand Ward Round. Can easily finished all 45 pt in 90 minutes. What the specialist want is no concellation of any operation because of avoidable problems. Specialist is going to love you and treat you like his pet and you feel the satisfation and confident when they give you more MO responsibity.
The systematic thinking make you work faster and more efficient. Not need to afraid of making decision. The skill you learn will benefit you when you go to other dept. The specialist know who can do work. No need to purposely shine yourself out from other.
maintain good knowledge of your basic science from day one, dont get extended in any postings, see as many patients as possible complete with procedures and all, study for your desired field as early as possible, and sit for exams as early as possible. If you get picked on personally by a m.o or specialist, develop patience (and maybe extreme patience in extreme cases). All else is pure luck my friend.
Thank you all for the pointers, I can say that I nearly broke my pen scribbling down notes from your replies.
Dr Paga it is true that good qualifications are definitely desirable. However, I know personally of some who ended up studying in Russia, Ukraine, Indonesia etc. but not because they were not good enough for better places. I’m sure every serious medical student would have wanted an Oxford, Harvard or any other posh-er degree. Unfortunately for our countrymen due to political and economical reasons, the some talented ones are forced to go to more affordable medical schools (in an ideal world they should actually work hard and enter a local U but we all know that usually does not work out fairly). But they still do their best and make the best out of their situation. But I’m sure it is incredibly heart wrenching for them to be lumped time and again into the Ukrainian/Indonesian/Russian undesirables pile.
I hope Dr Paga, that you can do a write up for this unfortunate bunch. A collection of pointers and tips on what they can do with their lousy diplomas, but not necessarily empty heads. I’m sure that article will definitely score loads of pahala or karma points. Cheers!
dear sparks, at least someone else sees the light in these foreign student issues…just as an example or as an enlightment;
MO tells HO1 from Indon(first day) : can u please do an ‘admission clerking’ on this case
HO1 ; HUH? Admission clerking? i’m here to be a dr not to be a ‘clerk’
MO : wei, u graduates’s from indon all stupid ah?
HO1 ask senior HO : what is admission clerking?
Senior HO : its when u take a detailed medical history of a patient, with clinical examination, differential diagnosis etc.
HO1 : Ooooh..Anamnesis.
Senior HO : WHT????
HO1 : case history of a patient….very commonly used in Indon
i’m not saying every specialist need to know all languages/dialects from these countries…we have enough of those just in Malaysia…just give these students a little more time…this is what they studied for 5-6 yrs, ain’t gonna change in 2-4 weeks…i’m just saying
Thanks for the suggestion. Will try to write something when I am free. It is not about which university that you do your medicine but the entry qualifications. If you have the entry qualifications but unbale to get a place locally, then I got no problem if you can do the course in some oversea countries. BUT I have seen students who have failed almost half of SPM subjects but yet doing medicine in Russia/Indon. That is the problem. From my experience, the problems usually lies in this type of students. These are the type of students who will give the bad name to the university. Not only they have bad results but also no actual intention in helping people. They did it because their parents want tthem to be a doctor and earn big fat money!
i know off students who got mediocre results in SPM/STPM but still did medicine overseas…and now they are MRCPians/MRCPCHians who have passed…hats off to them…its all determination to improve and work hard…
those days it was hard to score A1/A2 in SPM, or A’s in STPM, so very few did medicine..those were the cream of the crop..now…..straight A’s is a must….B=Bodoh, i presume…
The problem is : A’s now is NOT equivalent to A’s 15-20 years ago! At that time even getting a B and C is considered very good because it is not easy to score this. Thus we do see these type of students going on to do medicine and become good doctors. Now, you throw a stone, you will hit an 8A student! So, if you get a B/C/D or E, you know what type of students they are?
At that time, even if you score 8As in SPM , you may just end up with 2As in STPM, That’s how tough it was. Every state will have only less than 10 students scoring 8As. Now , you have hundreds scoring 8As in each state! WTH! Pre-U courses were compulsory in entering medical schools those days, even for those who go to India. ONly STPM, Matriculation and A-Levels were recognised. Now, you can do some dubious 3-6 months foundation course and be guaranteed a medical seat! You see the difference?
I get your drift now Dr Paga. When you said entry qualifications, you meant entry qualifications into the university, not into the medical line. I agree with what you say 100%. The fact remains that Indon/Ukraine/Russia are considered poor-er countries that need FDI, the FDI of the foreign medical students that is.
Money from the foreign students are much needed funds for new books, teachers pay, university renovation and such – of course the group who gains the most are their own local students. It really does not matter to these universities about how these under-qualified students perform, in and out of the university. As a professor from one of these medical schools aptly put it – You will practice in your own country, those you treat will not be my people, it is your own problem.
j12, the MO and senior HO in the example proves their air headed ignorance to an extent… anamnesis simply means “recall” in greek, which in the context of medicine is the history. Oh well, as Alex Pope put it – A little learning is a dang’rous thing; drink deep, or taste not the Pierian spring: there shallow draughts intoxicate the brain, and drinking largely sobers us again.
HOUSE OFFICER GUIDE
by Dr Goon
1.be up early,dress neat,shave.
2.finish your rounds before your consultant.(and arrive before your MO/Reg/Consultant)
practice correct examination technique and REALLY examine the patient not just copy the previous BHT update.
(always practice examinining in a systematic manner and in your spare time-watch how the MRCPians do it with style and clarity)
3.if the nurses chart monitor seems suspicious/made up-check the vitals yourself.
(carry a handbook-e.g Oxford handbook of clinical medicine to check dosages/terms/clinical conditions etc you are unsure).Trace all the results and more importantly INTERPRATE them and act on them accordingly.
4.If dressings are not done by the nurses- check it and do it yourself.Do it for your patient.You will learn how to do dressings effectively and watch wounds heal before your eyes.
5.Do not dissapear from wards and go for long lunches.This isn’t an office job.A patient may collapse or may need medical attention right away.Take turns with fellow HOs to take short breaks(obviuosly only with ones you can trust).
6.If you have referred a case,ordered blood products,arranged for scans/X-rays but it is still not done-please follow up and do not wait to be asked to do that.
A HO is the ” ward producer” and this is an important responsibility.
7.Do not argue over whose patient is this or that- if the work isn’t complete-the patient suffers.Whilst some HOs couldn’t care less-you should be different and care.After all that’s why you chose MEDICINE in the first place.Help your colleagues with their work.
8.If some nurses do not do their jobs,there is no need to argue with them-just a gentle reminder-better yet, do it yourself.Nurses are not trained to understand the urgency of certain medical conditions and the complex pathophysiology and pharmacological interactions.You chose MEDICINE-so be a doctor.If the patient needs to be wheeled down for an investigation and the MAs or nurses are delaying time-offer to wheel the patient down with them.Remember-its not beneath you to do that.Lead by example.
9.When you are on call-know the problematic patients or critically ill patients.Keep a tight watch and review the patient yourself periodically.DO NOT RELY on nurses’ reports which may be inconsistent and inaccurate.(One patient i treated was recorded as BP 120/80 by a certain nurse-he was having hematemesis-when i checked myself -BP was 85/40)
10.Don’t be a hero-inform your MO/Reg/Consultant when a patient deteriorates or when you get referrals that need urgent attention.But obviously-you will need a strong background of medical knowledge to convey information in a legible/intelligent manner.Institute emergent attention yourself whilst waiting for MO/Reg/Consultant.
11.STUDY STUDY STUDY- If you get depressed thinking all you do is scut duties-you should be even more depressed knowing that you do not know enough.Study
-get good materials for the MRCP/MRCOG/MRCPaed/FRCS-. learn how to read CTs/MRIs/X-rays- you can use the chance when you request for investigations from the Radiologists to teach you a thing or two.Study,memorize and examine patients.Think of differentials and don;t just accept what the casualty officer’s diagnosis is.If your MO/Reg is not knowledgable-use that to funnel your own efforts to be a better clinician so as to guide your future HOs.
12.Come on the weekends and do your rounds-know your patients inside out.
Remember,one day you may be a Specialist and if your HO does all these like you do-you can rest well at home.
Dear Dr Goon,
I think your houseofficer guide is too tough.
This is what doctors should do? No good lunches, no good weekends, have to learn how to read MRIs, do dressings when nurses are not doing it.
It’s hard to become a doctor in Malaysia. I think the creme de la creme in the country did not choose medicine for that.
Hey queen,
i am just wondering where are you training or serving.
Goon’s criteria is not hard at all. I am in US Doing traing and thys what all of us are doing in our hospital. As doctor everything you get to do in hospital is part of your learning and I can pretty much guarantee you will be grateful following his criteria.
And as a doctor we are here to serve. If we cannot put patients priority over self during work hours who else can take care of them. How long do you need to eat lunch? And how many times do you eat a day? And after 1 year training and if houseman or intern cannot at least pick up acute findings or obvious pathology from MRI I am pretty sure something is wrong with either the teaching system or the doctor himself.
I apologize but I always get ticked off when someone claiming to be the top and yet not knowing doctor’s job involves taking care of the nastiest body fluid and secretions, worse for those expecting nurses to do everyhing for them.
Dear PGY1,
I serve in a non-Asian non-US country.
For me Dr Goon’s criteria is hard (in fact really hard out for me). While I understand that as a resident in the US you have to work really hard (possibly the hardest in all countries), but that is in the context of shorter training time with faster board certification, hence your learning and experience are condensed into intense clinical work. Ie, lesser time for recreational activities. Also, since residency is instant it is vital for you to go all hardout as it will be the only chance to manage patient outside your specialty training.
I am not saying when the patient is unstable I’ll still go ahead to have my nice long lunch. Well it always depends on the patient load and how unstable are they. I guess I got the wrong impression from Dr Goon that during the first few years of HO life you are not going to have a 30-45 minutes of good lunch. Just 10 minutes of a short bite, everyday, for the rest few years.
Also, working is not enough and Dr Goon also suggested to study study study from those Royal College’s material (I am assuming that is regardless of what specialty that you want to venture in). While clinical work is time consuming (in Msia I guess it is about >60 hours/ week?which is still nothing compared to the US) and after you go home you still have to study (on the things that may be unnecessary for you to know), it sounds a bit depressing. Well I’m not talking about in a surg posting you should not read about fluid balance, post-op management etc, I’m talking about reading about the anatomy, the surgical procedures and some random stuffs that if you dont want to do surgery it will be useless to you.
In the place I practice I seldom encounter MRIs in the acute settings, probably in acute limb ischaemia which I can probably can identify some critical stenosis? And I think all competent interns should know how to recognise acute and life-threatening conditions in common scans ie CT and X-rays, possibly USS a bit, and such stuffs should have already been acquired in medical school.
I apologise for sounding so shallow and immature too. I dont mean “aiya i dont need to do other stuffs that is out of my job scope, screw them not my problem”. I just thought when the system is not efficient, and all we do is to keep quiet and do what the others didn’t do, it would be so unproductive. Ie when you spend time to change the dressing, you could have admit another patient.
And no, I dont want to come to the ward during weekends when I am not rostered =(
Dear PGY1,
PS mind to reveal if you are matched to the US as an IMG or US graduate ? =) am glad to see Malaysians that are so onto it abroad!
I get what you mean. And I agree there is minimal value to go to ward in weekend if you are not on schedule.
Match here as Canadian med grad.
I was just trying to emphasize that it is really important for interns to go all out to learn-as residency or housmanship is he only time that you have someone watching you. I don’t know about other board but for us our board exam still have questions on basic science that is related to different specialty.
DrGoon,
Good advices. Will try to achieve that. Thanks.
Hi Dr Paga,
I’m Samantha and I’m about to leave soon to pursue a Medical degree ( MB ChB) in University of Bristol. I plan on working hard and graduating with at least upper second class honours to enable me to complete my foundation programme in the UK ( the UK equivalent of housemanship). I am aware that training in the UK will mean that I will have less experience and exposure to tropical diseases. However, I believe that the quality of training I will receive outweighs the aforementioned disadvantage. After completing FY1 and FY2, all doctors in UK will then begin the speciality training. My initial plan was to specialise there and return to serve, not the Malaysian government( which in my opinion, has just been disappointing on so many levels) but the Malaysian people. My mother however, wants me to return after completing my foundation programme and specialise here instead. Is that possible? Or would I have to enter into any compulsory government service before specialising? If yes, could I apply to work while specialising in Singapore then after completing my Foundation programme? Will they accept me then as a registered doctor? ( Junior doctors become registered doctors after passing FY1 and FY2). Thank you very much for your time and I hope to hear from you soon.
Firstly, please remember that this year, for the first time in the history of UK medical education I was informed that 10% of UK graduates did not get a place for FY1. So< i don't know how the situation will be in 5 years time. Even if you get FY1 post, there is no guarantee that you will get a specialist training post due to preference to EU citizens etc. If you come back after FY2, you still need to do 3 years of compulsory service with the governement. Whether you can specialise in Malaysia or not, depends on which field you are going to choose. Please read my articles on postgraduate studies etc under "For Future Doctors" page.
Yes, you can work in Singapore after FY1/2 but no guarantee that you will get a specialist training post. BTW, how are you planning to serve the Malaysian people without serving the government?
Samantha,
There used to be a provision in the UK where all medical school grads are guaranteed Foundation Year posts. Based on current trends though, there will be more applicants than vacancies from for posts commencing Aug 2012. It would make sense that non-EU doctors will be the ones to not get jobs, so watch what happens to your seniors.
As for specialty training, assuming you’ve completed FY1&2, the same situation applies. Non-EU doctors are sent down to the bottom of the list. The popular specialties are harder to get on. Seeing what happens to your seniors will be a good guide, but a lot of things can change 5-7 years from now (probably not in your favour).
If you can specialise in the UK, you should. The competition in Malaysia will be at its peak by the time you graduate and specialty training not as good as the UK/Aus/NZ. Also, you have the option of moving to Aus/NZ after FY1 should you choose to, not just Singapore.
If you are not serving the Malaysian government, then you will be working in private practice. Although you will still be serving Malaysians, the Malaysians who really need serving are those that go to govt hospitals beacuse they can’t afford private healthcare. Don’t let your dissatisfaction with the govt and its policies cloud your thinking.
Dear Nav,
Hi, thank you for your insightful explanation on the Foundation Year Posts (FP) in UK. Just a minor point to make: There are already more applicants than vacancies for foundation posts in UK in the last FP application process (ie. for the 2011 intake application). However, it is still easy to get a post if you perform well in your university as the application process does not take the status of your nationality into account (UNLIKE SPECIALTY TRAINING PROGRAMME). It is generally considered as a transition period between medical students and doctors. Thus, the programme is a collaboration between the universities and the NHS. Therefore, you only need a T4 VISA (Student visa) for the FP posting. Obviously, it might change over the time in the next few years, as I heard they might change the FP application process in the near future.
However, even in Malaysia, once you graduate, there will be a long wait before you will be called for housemanship posting. I am a JPA scholar who rejected my FP job in UK to come back for good. However, after 2 months back at home, I am still waiting to be called for induction while my fellow colleagues have worked for 1 and a half month now. I also know there are hundreds of us waiting around for our turn to be called for induction. Yet, they can’t give us a definite date of induction. I do not understand the reason of the delay…. most probably due to the lack of HO post available…… thus, my frustration goes on…..
A frustrated doctor to be (finger-crossed)
the situation will get worst. IT is not hundreds anymore waiting, it’s thousands…..The number of post is getting very much limited. As I said, soon, housemanship may need to be done on contract basis and then apply for a job later. Tme will tell……………..
I doubt that the Tier 4 (student visa) arrangement which make it relatively easy for international medical students (who graduate from UK medical schools) to enter the Foundation Programme will be abolished anytime soon. Whilst there can be no guarantees when it comes to the UKBA, removal of the Tier 4 visa will mean loss of the final remaining incentive for overseas students to come here and study medicine.
No UK medical school can easily give up the £££ brought in by its international students! (Home/EU students fees ~£3000/yr. Overseas students ~£27000/yr.)
Dear Samantha,
Congratulations on qualifying to read medicine at Bristol. You will love it there. Be sure to visit Bath (I’m sure you will, and more than once!).
I would advice you not be overly concerned at the present time about the potential difficulty of postgraduate training opportunities for non-EU candidates which you may have to face in 5-7 years time. A lot can change in that time and for now you should simply focus on things that you have control over ie: making sure you do your very best in your medical studies.
Be glad (and be grateful to your sponsors) that you will graduate with a degree that gains you access to the global village. Most countries that practise western medicine recognise UK degrees. Even if you have to sit a licencing or qualifying exam, the type of training you will acquire will make it easier to get through such exams.
The world is now a very small place and you will come to realise that many people now choose to work and settle where the best opportunities (this does not necessarily mean financial) for that time are available. I am a Malaysian who came to the UK 20 years ago and am currently a consultant surgeon in the UK NHS. I am one of many!! Most of us travelled great distances to get our degrees, then travelled even more to get our subspecialist training. Despite the NHS consultant tenure which guarantees employment to age 65, many of us would happily travel again if situations change and other better opportunities present themselves. Most Malaysians have the narrow minded view that assumes “opportunities” to mean monetary gain. In fact, it means different things to different people and could be our childrens’ futures, family security or career subspecialist progression etc.
What I can tell you from experience is that no matter how fierce the competition, or how protective employment laws are for locals against foreigners, any country that practices meritocracy will always have opportunities for quality candidates.
So worry not about what you cannot control and pursue that which is in your hands. Make yourself a quality candidate and embrace the global village. You are at the start of a potentially wonderful journey. Enjoy it!
Thank you everyone for your prompt reply. Dr Paga, I agree that I cannot serve one without the other, I believe its important to keep in mind our FIRST PRIORITY is to serve the PEOPLE, our patients. I don’t know about you, but I belive this mindset will help me pull through the dark days of housemanship or foundation programme. Yes GCH, you’re right in saying that there is a collaboration between the NHS and the University, and hence, a high chance of participating in the foundation programme. Although Dr Paga and Nav are right in saying that competition for places is becoming increasingly severe everyday, I still believe that as long as we work hard and do all we can to be capable students and doctors, there will be a place for us. That’s all 5 years away anyhow, so I shall just concentrate on passing medical school with flying colours.
Cheers,
Samantha.
P.s. Dr Paga, I’m struggling to word this in a way that won’t offend anyone so please, do not take offense at what I am saying. I am very grateful for your frankness and brutality in describing recent medical issues the way they are. But in a way, I don’t know why, I feel bad for you. I hope that despite all your cynicism and scepticism, you are still happy and passionate in your job, I hope that everyday, you go to work with a smile on your face and purpose in your steps. Thats my biggest hope for us all really, that despite all the challenges, we never forget why we wanted to be a doctor in the first place. Take care Dr Paga and try every once in awhile to look at the glass half full? 🙂
Haha, I am always happy with what I do but sometimes injustice and what is going to happen to the future generations are also important for every citizen. Everyone should play a role to change things for a better. Good luck in your medical education, long way to go.
Dear Dr P
Just wondering if you know how is the Australia training prigramme for medical doctor? Is it better than in Malaysia? I heard that they have very good training program. However a friend’s son who is in Australia suffering from frequent headaches was diagnosed by the doctor he sees to have tumor ( the doctor just touch his head and make that diagnosis). The family is now in shock and am consulting another doctor and doing further diagnostic.
Whether the training system is better or worst all depends on the person himself. Of course, the training system in Australia is more structured than Malaysia but Hands on training is definately better in Malaysia. About, your friend, sometimes you can suspect a tumour with proper physical examination like doing a fundoscopy and cranial nerve examination. So, it is possible for the doctor to diagnose the possiblity by touching the patient.
“Hands on training is definately better in Malaysia.”
I used to think this, too. But now, I’m not so sure anymore. In absolute terms, there is no doubt that the number of patients available per specialist trainee is higher in Malaysia. But the assumed benefit of this is based on the belief that “practice makes perfect”. Unfortunately, as I always say to my surgical trainees, “practice does not make perfect, it makes permanent”.
Greater numbers is only meaningful in the presence of good guidance. Otherwise, one could just end up doing an operation 1000 times badly.
Samantha.. I am guessing you must be really young or inexperienced. I apologize for my frankness and brutality as well.
I’m a fourth year medical student in Australia and I’m a JPA scholar. I really want to work in Malaysia. Hopefully, when I graduate, the condition will improve slightly. I am not worried about salary too much, (although I hope it’s not too low), but I am very concerned about the working environment. The consultants in Australia are very supportive and never scold a junior doctor in front of patients. I have heard many horror stories in Malaysia that have demotivated a lot of my friends to continue working in Malaysia.
What do you mean by “you really want to work in Malaysia”? Isn’t it your legal and moral obligation to serve Malaysia as a JPA scholar?
I have heard thru the grapevine that the JPA person in Australia is not so strict about making scholars go back home. Lots of ‘case reports’ from my JPA scholar friends about those in Aus staying back.
Sorry Fadh, that’s the Malaysian mentality. I should say Asian really, because Singapore and India for example do the same thing. Some specialists expect to be treated like god and take some form of perverse pleasure in scolding the junior doctors around them, They probably think they are helping them learn because they don’t know any other way to teach them (that’s probably what they went through themselves). Some of this can cause a fair amount of stress: http://thestar.com.my/news/story.asp?file=/2008/3/11/nation/20603361&sec=nation
There was also the case a few years ago of the surgeon (male) slapping the face of an anaesthetic MO (female) with his bloodied glove in UM, who got away with just a minor rebuke (“these things happen” apparently).
You will meet some nice people along the way, but not everyone will be nice. And not everyone in Australia are nice – I’ve met some surgeons whose attitudes wouldn’t be out of place in Malaysia (but you’re less likely to get away with this sort of nonsense in Aus).
When you come home, do your job diligently and you should be fine. There will be times when you can never please anyone. take a deep breath in and don’t let it get to you. By all means, if you feel you’ve been treated unfairly, take it up thru the proper channels – but be prepared to be enormously frustrated by this because our Malaysian civil service is rotten to the core. You won’t find anyone taking any action unless your uncle has a post in BN or something.
Thanks nav for the encouragement. Of course there are Australian consultants that are mean but the numbers are low and there is a proper channel to report that if you are treated unfairly. Hopefully I will enjoy my time working in Malaysia, at least most of the time. Thanks to Dr Pagavalan too because without his blog, I wouldn’t know what to expect when I start working soon.
As a JPA scholar, you should and must come back to serve the people of Malaysia. You are paid by tax payers money. Of course the situation will be different . You can’t compare a developed country from a developing country which has 3rd class mentality. It is your duty as a citizen to come back and change the system.
I always want to work in Malaysia but the horror stories did hinder me slightly. I guess that’s just parts of life that I have to go through. Thanks again!
I am a UK graduate and I’ve been working in Malaysia for almost a year. On my first day, I called my MO by her first name (respectfully) to ask her a question, and she did not answer, so I asked again, and she said to me ‘I would like to be addressed as Dr xxx’. For someone who has been calling all doctors, even my consultants in medical school by their first name, how lame that is, I thought. But I’m used to that now. Just because I am addressing them by their title doesn’t mean that I respect them all of them, especially ones who are obviously empty tins. If I disagree with something, I will say it out.
In Malaysia there is this thing that HO should round early in the morning first, then the MO will round again (which we are suppose to follow and write), then again with the reg and the specialist. I have never encountered anything like this where I studied. There is just so much repetition here. What is the problem with everyone just arriving at the same time and then we do ONE single round together? Are consultants too mighty high to be asking questions or examining patients? Yes, the juniors should know and present the cases, but so should the specialists and the consultants. Here, we come at 6:00-6:30am in the morning to see all the patients, then there will be another 2 or 3 rounds with people more senior than us so we can ‘update’ them patient condition so that they are able to add on their own management plan. Most of the specialist/consultant would just stand at the bedside listen to the juniors present, bombard lots of question, dictate some plans then move on, without even saying a word or looking at the patient. Then when the intimidating boss-like figure is finished, the patient would rush to ask me what had he just muttered before I had to rush off to tail ward round. In the UK, junior doctors come half an hour earlier than the consultant to get the investigations results ready and find out if anything happened overnight/over the weekend, then wait for the consultant to turn up to start the round. If it is a non-consultant round, everyone would get on with the round as a team. There is no such thing as HO to see the patients before the reg. There, the registrars, SHO and HO help each other out so they finish their work as quickly as possible. Isn’t that a much more efficient use of everybody’s time? Once, my nice MO was helping me with a particularly difficult IV line, and another MO asked him ‘why are you doing HO’s work?’ You see the attitude? Don’t get me started on the TDS round. Yes, they do rounds three times a day here (in most specialties), sometimes x 3 due to the hierarchical arrangement as I have mentioned above.
The worst part is having to play the servant for MO/reg/specialist/consultants. In my hospital, HOs have to regularly to go the record department to trace files for the reg’s case presentation/ write up. Last week, my friend had to go to my specialist’s car to fetch a stack of photo frames to her office. In departmental census, the HOs does all the data collection (trawling through the case records) not knowing the end results whilst the boss gets to present and publish. We call patient up to inform op date, cancelled op, rearrange op so often I thought we sounded like a professional telephone operator. You can’t blame me for cursing under my breath whilst performing these stupid errants.
In Malaysia, HOs are unappreciated slaves. Everyone, senior and junior figures in the medical profession, should rethink the way we are doing things here. You may say the practice has stood the test of time but is it really worth wasting so many hours for sometimes so unproductive as three morning ward rounds in a day just because of hierarchy? Is it fair to treat HO as your servant doing your secretarial job? Are MO/Reg/Specialist incapable of occasionally helping your new HO make some referrals or write a prescription or ask for a CT scan, or God forbids, take blood? Are we not in the same boat to make patient better? I foresee that it will take another 10-20 years for us to change the culture, if it ever will. The seniors always have their ‘back in those days’ or ‘you have to learn’ excuses.
where is the learning part?
The superiors are busy, therefore they have to find the HOs to do some important tasks and it’s normal. Doing more rounds is a way of killing time and learning, just that it’s not that effective in the way that they do it. There are bosses who do the work of houseman but that’s not compulsory, HO still have to do the works of admin, become telephone operator and nurse. That is called multifunctional HO.
I could not agree with you more. Have voiced similar comments in the past, always met with a “that’s just the way it’s done here”. Just because that’s the way it’s done, doesn’t make it the right way.
Will comment about this in my next blog posting. Will use your comment as a starter.
I’m sure there were compelling reasons for which you chose to return home rather than remain in the UK to pursue your further training. Integrating into a new system is never easy, but in time, you will get so used to it that it will be the norm. Besides, your houseofficer time runs for just two years and it is remarkable how quickly the brain learns to ignore the unpleasant memories once they are in the past.
I guess I am one of the modern NHS consultants whom you allude to, who runs by first name with everyone including medical/nursing students as well as patients. For me, titles are rather meaningless. But some people like them, and if they have earned it fairly, then I have no issue if they insist on being addressed as such. Whilst it seems trivial to you and me, your MO is still your senior and has done her (painful) time as you are now doing. She’s earned the right to expect to be addressed by her JHO in the fashion that she wishes.
In the UK, HO’s are also underappreciated slaves – even if they have to do and put up with a lot less crap than their contemporaries in Bolehland. I still think it is the hardest period of a young doctor’s life because we’re all intelligent people but our contribution at that time is so undervalued. Yet the health service would melt down without competent HO’s. This is why if someone gets through their HO period , gets fully registered, and then quits medicine for good, they’ve still earned my respect for sticking through it.
As far as doing multiple rounds goes, it does seem a little over the top and rather inefficient having 3-4 rounds in a day. However, here’s a little perspective from a consultant who works in a surgical subspecialty where there are areas that even the registrars find themselves in unfamiliar territory. In my unit, the subspecialist nature of our work means that the consultants adopt a “lead from the top” approach. As such we have no problem with trainees of any level calling us to discuss things before decisions are made.
There is one main ward round in the morning, and this is normally consultant-led due to the expectation that most JHO’s, SHO’s and even junior registrars will have had little exposure to the specialty. Even so, the consultants do hold in esteem the JHO/FY’s who go round on their own prior to the main round starting, ensure the notes and investigations are in order and have formulated a provisional plan of management. We may not offer praise often, but the effort is noted. There candidates are few and far in between, but the really good ones by the end of 6 months are able to lead the round and discuss management issues with confidence.
Those are the ones who get stong support when the applications for specialist training come round. And given that some subspecialties (eg: sugical disciplines like ortho, plastics and paeds surgery) have applicant-to-place ratios in excess of 150:1, you’re going to need all the support you can get if you hope to get a place. As is often said, “If you didn’t pay the full price of admission, why should you get a chance to see the movie?”.
It may seem to be a waste of time on your part, but you will come to realise as you get further in your training that the lessons you remember best are those challenging cases you had to independantly assess and come to a sensible plan of action prior to calling your senior to discuss things. You might think you learn just as well by tagging along with your senior, but unfortunately, this is not the case.
I understand your unhappiness and bitterness over the pathetic processes you have to face in your day to day work. We’ve all had our share of them! But since there is little one can do to change that, my best advice is always to focus on that which is in your hands and make the best of what you can so that you can be competitive when it comes to applications for specialist training.
The best way to change things is to get yourself into a position where you can. Even if you can’t change the entire system, when you are senior yourself, you can at least make a good microenvironment within the area that you have influence.
Wishing you the very best.
yeah, its happening everywhere in MALAYSIA. They bully HOs, insult their qualification, yet they’re not good either. They should treat and teach HOs in proper way. Sad.
And they’re very racist! Like how if you graduated from Indo/Russ-you’re hopeless/useless so your job is to buy coffee. But if you’re graduated fom some world class university/ UM,UKM etc.-you’ve bright future and be their fav. and learn lots procedure etc. Shameful!
Dear New Houseman,
I can emphatize your current situation.
And yes it can be stressful and you begin to wonder what am I learning?
Did I study to be a “glorified clerk”?
Now,as disheartening as this may be-you need to learn the hierarchy of hospital based specialties.Housemanship is not for life-but they are a rite of passage-you learn how to deal with people-DIFFICULT PEOPLE,UNCOOPERATIVE NURSES,AGGRESSIVE PATIENTS,DEMANDING PATIENTS,OBNOXIOUS BOSSES.And not withstanding, learning medicine on the job.
At the meantime-it also trains you to be mentally resilient.You have to keep humble because when you move up the ladder,these same people ultimately decide if you get their vote or not.
For example,if there is a HO is always happy doing his/her work,learning all patients by hard,tracing all results on time,doesn’t mind coming in on the weekend or going home late and on the polar opposite – a HO is always in a bad mood,complaining and playing the victim card; when it comes time to teach a clinical procedure e.g Chest tubes,Central Lines,venous cutdown- guess who gets the go ahead?
Also,who will get better SKTs which will allow them a better chance for postgraduate training?
New Houseman,
just some thoughts for you to ponder.Again when you get frustrated-ask yourself-if you are not going to do the job-who will do it for the patient?
Don’t you care about your patient?
And also see how lucky you are- okay you are busy doing some “scut” duty,but what about the patient with terminal cancer at the ward corner.
Humanity and doctoring come hand in hand.
Hello Dr,
My name is MeiShien and I found your blog very helpful. Hi Samantha, I’m happy theres another Msian goin 2 Bristol. I got in 2 Bristol and Monash and NuMed and I hope i can get advise. My family cannot afford medicine in UK cos too expensive. We must borrow money to go Bristol but we can afford Monash and NuMed. Should I risk so much 2 go 2 UK or should I play safe and go to Monash? I really want to do my training in Singapore or Australia. How hard is it to go to Spore or Aus after graduating from Monash? Will you reccommend Monash or a new uni like NuMed? NuMed oredi start but I ask them to give me more time..
Monash Malaysia is NOT recognised in Singapore. Thus you can’t work in Singapore. You can try Australia/NZ. No guarantee as Australia is also getting saturated at intern level. There will be a reaccreditation by Australia Medical council in 2012 for Monash Malaysia. If they don’t get it then you can forget about working in Australia without entrance exam.
Of course, if you have the money, bristol is better but no point taking high loan to do medicine. Forget about Numed as it is not recognised elsewhere.
I wish I was here after my SPM… =-=
Frankly, the standard of medicine in this country has gone from bad to worse. When Malaya University’s medical course was set up in the early 70s, it was set up in such a way that it was given international recognition by the British Medical Association? That meant that Malaya University’s qualified doctors was considered of the same standard as British universities doctors!
Come the early 80s, it was derecognised by the BMA due to falling standards. Oh, the dean of the medical faculty than tried to play the racial angle by saying that BMA derecognised Malaya U’s medical course because it was taught in Malay and not in English. One writer to the New Straits Times pointed out to him in a letter that the BMA recognised medical courses in Europe and Japan where the language of instruction was not in English! That shut him up. They then tried to say that oh, as long as its recognised by the Malaysian Medical Association, it was a prestigious and quality degree.
Hmmm, if so, I wonder why a few years ago, when the Dentistry course in Malaya U was recognised by the British Dental Association, Malaya U made such a big fuss about it? They advertised it in the newspapers and hung big towering banners outside Malaya U to advertise to one and all about the British recognition of their course! Hypocrites!
As for the standard local private universities offering medical courses, well, I think my uncle said it the best. He is a medical specialist who studied medicine under the Colombo scholarship. He was one of the few Malaysians who became a Colombo Scholar and did medicine. Amongst his patients, you can count a who’s who in Malaysia but he was and remains a very low profile but dedicated doctor. Probably that’s why his patients have remained with him for so many years.
He was asked to teach/head the first private medical degree course in Malaysia when it was first started all those years ago. But he turned it down because he said that the quality and teaching standard was not up to par and would not produce the type of quality doctors that he was used to. Fast forward to the present, and that private college is now a medical university, and considered one of the best in Malaysia. But mind you, its standard is probably very different from when it first started, when it was the only one in Malaysia with the pick of doctors to lecture there. Now, with the myraids of medical colleges springing up left right and centre, who would bet that the standard there has improved?
As for the medical course in the local public universities, I have a cousin who graduated a few years ago from UNIMAS (her family couldn’t afford to send her overseas let alone afford the private medical colleges). She and her colleagues are all trying to sit for the Royal College of Physician exams in order to get some international recognition qualification. She told me that her lecturers told them to try sitting for these international British medical examinations in order that they can gain some recognition as her medical degree was certaintly not recognised overseas! After all the sweat and tears in obtaining it, to be told that your medical degree is only recognised locally! What a bloody farce!
My 2 cents.
The definition of social accountability of medical schools is the obligation to direct their education, research and service activities towards addressing the priority health concerns of the community, region, and/or nation they have a mandate to serve. The priority health concerns are to be identified jointly by governments, health care organizations, health professionals and the public. WHO, 1995
Way to go, Malaysia, way to go…
Dear Xenotzu,
Since you said that the standard of medicine in this country has gone from bad to worse,can you tell us why UM and UKM medical degrees are recognized by Singapore Medical Council ?
This is not a difficult question to answer when one examines the demographics of Malaysian doctors employed by the Singapore healthcare system.
Consider:
1) LKY/PAP’s (unstated but blatantly obvious) social engineering masterplan
2) Which group of UM/UKM medical graduates are actively recruited by Singapore
3) The entry qualification requirements of this group to enter medicine at UM/UKM
Dear Xenotzu,
I think you’re talking out of arse a little bit. The BMA does not recognize medical degrees. That is the job of the General Medical Council. The GMC recognized UM, NUS, HK, Trinidad & Tobago, and degrees from South Africa, Aus, NZ all for historical reasons only (commonwealth countries with similar standards). During this time, even US and Canadian degrees were not given full recognition (i.e. they had to sit the PLAB exam to work in the UK).
I myself am not clear about why the GMC derecognised UM in the late 80’s, ask someone who was there.
In any case, the GMC derecognised NUS, HK, Aus, NZ, etc in 2003 and instead gave recognition to EU universities to comply with EU labour laws.
Given Singapore Medical Council recognizes UM for social reasons and General Medical Council recognized UM for historical reasons, it is a common misconception among Malaysians to think that UM medical degree is world-class.
In addition,I am shocked to find out that this country is not on the list of GMC acceptable overseas postgraduate qualifications, despite the fact that less advanced countries such as Bangladesh and Sri Lanka have made it to the list.
as I said, none of our local Masters degree is recognised elsewhere. UM was derecognised because GMC did not agree with matriculation being an entrance exam for Medicine. STPM was recognised.
“After all the sweat and tears in obtaining it, to be told that your medical degree is only recognised locally…”
Isn’t that the purpose of having a local medical school in the first place; why would you need recognition from another country – both medical school and medical students have a common obligation towards society – unless of course you’re desperate to ditch Malaysia. It will BE farcical if public funds used to train your cousin is lost to another country because she decides to migrate.
I guess the 1.7 million taxpayers are the ones handed the short end of the stick…everyone else, well there’s really nothing to complain right?
I think you’re maybe being a touch harsh. You don’t really know the circumstances of Xenotzu’s cousin, yet have judged her as someone who is seeking to leave Malaysia for good.
Did you ever consider the possibility that she might be a trainee of excellent potential who for a variety of (“mediocracy”) reasons has little chance of further career training and advancement? She may well hold the ideal of seeking the best specialist training possible overseas so that she can then return to serve her country.
Hi Everyone!
Considering the fact that a medical education in England is so expensive, is it actually worth paying 1.2million and over? Is it worth the financial and emotional burden? ( My family will have to sell a house or take a loan, but they are willing to do it and I am committed to the study and practice of Medicine) After graduating from UK, will I stand a chance of working in Australia? How is the healthcare system there? Will I get good training and exposure? Is the lifestyle better there? The salary?
To answer your questions:
1. Is it worth paying 1.2 mil for a UK medical degree? Really depends on you and your personal circumstances. If you’re doing it as an investment to make money, then don’t bother.
2. Can you work in Aus with a UK degree? Currently, yes. But the Australian Medical Tsunami is hitting and they have already had problems fitting all interns in. 4 more new Aussie med schools will have their first graduates at the end of this year (hitting the workforce in early 2012) with another the following year. Bear in mind that previously, when Aus had enough doctors, it was extremely difficult for people from overseas (even with UK degrees) to work and train in Aus. UK degree holders before 2007 could only work in Aus for 3 years under temporary registration. If they wanted to stay longer and/or get General Registration (which you need to enter training programmes), they had to sit the AMC exam. Before 2004, your medical degree gave you negative points if you applied for Aus PR. There’s nothing preventing them from reinstating these policies once they can fill vacancies with their own graduates.
3. How is the healthcare system? Good.
4. Good training – yes. Good exposure – yes but not as much as Malaysia. You get more exposure in rural Aus than you would in the big cities. But that is the same everywhere.
5. Lifestyle better in Aus? I’d say lifestyle in Aus and NZ is probably the best in the world. Melbourne and Auckland consistently get ranked near the top of the list of world’s most liveable cities. Work environment is much much better than the UK, and people are happier overall.
6. The salary? Good. Where does this rank in terms of importance to you? Even if you worked in Malaysia, you will be comfortable with a govt doctor’s salary (but not super-rich). If you really want to make megabucks, don’t do medicine.
Why Australia?
1. Internship is only 1 year… but seriously, it doesnt really matter because interns are treated no different from HMO’s.
2. There is an effective work ethic. Path nurses collect bloods. And in some hospitals you dont even need to do cannulas (the nurses only page you if they cant get it in). This means interns have time to mull over what to do next with a patient… hmm maybe ill check the therapeautic guidelines to see if Amytryptaline is really ideal for Joe Blog’s nocturia…. there’s time for things like that.
3. NO NIGHT SHIFTS (in some states). Minimal in some others.
4. Working hours are humane. 8.30am to 5.45pm mostly. Patients that arrive from 5pm onwards are admitted by the next guy. There’s no squabbling or pushing work to the next shift – things get done professionally. Besides, you are responsible for your patient and will likely be responsible for the patient until discharge.
5. GOOD…and i mean very good… access to materials. Every hospital I have been to has access to UpToDate and the Therapeautic Guidelines…adequate terminals…and most have clear cut protocols for common calls.
6. Consultants acknowledge you (even medical students) and expect to be called by their first name. They actually discuss patient management with you on the wards.
7. Ward rounds are done once a day with the _TEAM_. Usually one reg, one HMO and one Intern… or a Reg and an intern….or in the less acute wards, a HMO and intern with a Reg bouncing back and forth between wards on alternate days. Consultants will join your ward round once or twice a week…and are always available for advice by phone.
8. EVERY PATIENT IS ASSIGNED A CONSULTANT. This sounds trivial, but it means that each team sees the _same_ patients under the same consultant everyday. Continuity of care is excellent. The person that admits usually discharges the patient. Since consultants are ultimately responsible, they usually care deeply and will make sure the reg and hmo and intern are doing their job…and is more than happy to answer questions regarding patient management. The clinical pearls you pick up during the consultant ward rounds are priceless… and just about every consultant I have ever been with* has been very, very, helpful and inclined to teach. A few minutes here and there during ward rounds… clinical pearls. Priceless.
9. Some places have _protected teaching time_. Yup. That’s right… You are encouraged to ignore all pages (or hand it to your reg) for a few hours a week during a fixed time for CME.
10. Finally, salary is decent…around AU4k a month after tax..which can be scary high as you climb up the medical hierachy. It sounds like a lot if you convert, but in an age where property prices average AU500,000 in most suburbs, it’s really not much….and keep in mind DOCTORS DO NOT COMMAND THE SAME RESPECT IN AUSTRALIA… so the same rule applies: Dont do medicine unless you are really interested in it. There are much more lucrative industries… A labourer at an australian mining company gets a starting pay of AU$80,000 per year (read this in the Herald Sun today, 22/9/11)
Dear Nav,
Thank you for your prompt reply. I’ve never even considered the idea of entering Medicine for money, simply because its just stupid. My brothers are studying economics and accounting and finance and at the rate they’re going, with degrees that cost less and take up less time, they’re going to be more successful than me. I’m entering Medicine for personal reasons.
I’m just wondering if its worth spending double the amount of money and living a crap life to go to England to study. Will the training I receive be worth it? Will the exposure to world class research be worth it? What can UK offer that Malaysia can? That’s what I want to know Nav, not the money and future investment returns.
If you really want to do medicine because it’s what you want to do, then go ahead and pursure your dream. Go to the UK and try and specialise there if you can. If your parents can afford to pay your tuition, then go for it. Ultimately, that is a personal decision between you and your family.
The training in the UK will be worth it. Living overseas will also be a life-changing experience and will help you grow as a person. Training in the UK, compared to Malaysia, will let you see how things should be or could be done. Having said that, the earlier to return to Malaysia, the more a ‘waste’ your UK degree is – because you will conform to the Malaysian system and the more junior you are the harder it is to instigate change.
Hi Kevin,
This is a very difficult moment and you were trying to find an ideal option that works the best for you. I faced almost similar situation like you 10 years ago and I think I understand your situation. There are many things that you can not plan for your life and the situation will keep changing. If you have the option to go to UK, then go and then look around the country and then figure out the best step for you then. Whether 1.2 million is worth it or not, that will be the answer for you and your parents to find out. I went to IMU first because it was the lowest fees I could without giving too much burden to my parents and I took the standard chartered bank loan ($120 000 ringgit) to finance my study in Canada.
I came to Canada to do medical school after IMU and I did not plan at all that I would stay back, and just finished the cardiology fellowship a few months ago and be a cardiologist here. Still cardiology is still one of the most competitive subspecialty even for the local. I am not a smart person, but I worked hard and treat my patients very well as the way I want to be treated in the future.
Pick the best opportunity right in front of you now, and then decide later. The door will keep open for you no matter where. I heard in UK it is very difficult for non-EU to get in the training, but I also believe in one thing, as long as you treat your patients with respects and dignity, there always someone there to help you and to try to keep you there in UK or Australia. And you may like UK more then. I think a non-malaysian medical degree will give you more options in the future if you can afford that.
this discussion is seriously amazing and good. we have some top notch quality in this thread, and i hope the thousands in Malaysia who will enroll in medicine over the next two years have an opportunity to go through the thread above.
“UM was derecognised because GMC did not agree with matriculation being an entrance exam for Medicine. STPM was recognised.”
The medical faculties of UM/UKM are now almost flooded with matrikulasi students, the STPM-ers could hardly get into these two U to do medicine. It seems that if u can get into a kolej matrikulasi, your dream to do medicine in UM/UKM is guaranteed whereas if u r a STPMer and scored with flying colours also cannot be guranteed to get a place.
Under such circumstances, can these two U maintain their standard in medicine and is it still recongnised by Singapore Medical Council?
The standards are dropping dramatically since 1990s. SMC recognises UM/UKM to get all the best brains! Still the best STPM students are in UM and UKM!
Well, the number of STPM students are around 10% in each batch, I supposed, judging the odds of a 4.0 for STPM: local matriculation is 1:16 (at my time, of course). SMC does not recognises all UKM/UM student, as they would still have to interview them for their English and medical proficiency, despite their desperation for house officers too. So, yes, they can still “recognise” UM/UKM, but everyone will have to go thru the interview process! As of now, I heard they are willing to interview med grads from other local universities in Malaysia, be it private or government, as long as they can quite make the cut.
And of course, I’ll still have to give some credits to some matriculation students, who still manage to give some good competition in academics to the STPM students. I guess sometimes it comes down to attitude in learning. In reality, it’s all back to square one when you get back to work.
I have a large number of friends who had already left for Sg, but I ain’t going for personally compelling reasons. With my high expectations, they would have thought that I would be the first to go. Or perhaps it is still not home there. -.-“
SMC recognition is one thing, but it does not guarantee that any UM/UKM doctor will necessarily get a job in Singapore.
As admission standards are dumbed down to facilitate matrikulasi student entry, STPM candidates are squeezed even harder. Ironically, this does mean that if you got into UM/UKM medicine via STPM, it does say a lot about your academic capabilities.
All developed countries which embrace meritocracy suffer from “brain drain” to some extent. This is because they seek to employ the best person for the job. Just as employers will draw from the global talent pool, prospective employees will go where their talents are best appreciated.
What Singapore realised many years ago is that talent recruitment and retention needs to be an active process. As some of their own best brains leave for UK/Oz/NZ/China/US, they will seek to redress the balance; and one method they have used for the last few decades is to conveniently poach the best brains from their nearest neighbour.
Ironically, squeezing the STPM entry route into UM/UKM medicine only serves to provide a refined shortlist of top brains for any prospective international medical recruitment team.
With the entrance requirement of 90% academic & 10% co-curricular marks, the best brains of STPM might not get into UM/UKM medicine, because there is no show of certificates for the co-curricular marks. Students can simply put down their co-curricular marks without supervision from the schools. Students who are honest and come from schools that follow strictly what the rules say lose out. Of course the kolej matrikulasi case is another matter. Their co-curricular marks are so high until you cannot believe it.
I know a friend’s son who is awarded top scorer STPM, scoring 5As in which he gets 13As in all the papers taken cannot get into UM medicine but instead given UNIMAS medicine. Besides scoring 5As for STPM and a grade A for co-curricular, he is one of the representatives in the national team for International Chemistry Olympiad. He also won the High Distinction award for Malaysian National Quiz and bronze medal for Physics National Quiz.
There are many others who scored 5As n 4As can’t even get into any medicine faculty in local public universities. What a sad story for the best brains from STPM. They have studied so hard and yet cannot get what they want.
So much has been talked about private u, I am very worry about the quality of the medical students graduated from public u too.
Yes, exactly. I know public U graduates now who can’t even speak proper english!
I guess we all know entry into public U medicine course is quota based. as long as the word “quota” stays it will be difficult to improve standard of med school. I have yet to see any other multiracial country has “quota” on medical student enrollment.
NOOO… I would like to scream that entry into local med school is based on meritocracy. And so the breakdown of on racial is around 55-60%, 30% and 10%. Hmm.. surprisingly weird… 😛
Dear Dr. Pagalavan,
Firstly, i would like to say thank you for all the wisdom that you have put in this website. You are a real blessing to medical students such as myself. I would like to humbly ask if you could spare a few minutes to enlighten me on some of the queries that i have.
1. I’ll be graduating in a couple of months time, and i would like to spend the holiday i have after graduation to hone my skills before i start as a house officer. i was thinking of joining a NGO’s such as MERCY Malaysia or Doctors Without Borders or something so that as i learn, i can help out people who are in need. Do you have any info on how i can get about this? or any suggestions as to a way i can hone my skills, yet serve the public whether locally or abroad?
2. I have a lot of confusion as to where to apply to do my houseman training. I am actually very open to be sent anywhere by the government, even to district areas in East Malaysia. Could you highlight for me the pros and cons of working in a general hospital and a district hospital? And could you also suggest which hospitals provide good teachings and good experience for housemanship? Do the shift system vary among the hospitals? Currently my choices are Queen Elizabeth GH, Kuching GH, Sibu Hospital, Sandakan Hospital, and Kuala Pilah Hospital.
3. Would it be possible for me to sit for MRCP/MRCS theory papers during my first or second posting of housemanship? I would prefer to sit for the exams as soon as possible, as i would have the time to study after i graduate and while most of the basic sciences are still relatively fresh. Secondly, would it be possible for me to use the result of the theory papers to gain access to the UK to complete the clinical part of the exam and subsequently enroll into a specialist training in the UK? Or must i complete the entire exam before entry is possible?
4. If i were to sit for the AMC/ PLAB/USMLE exams, are there venues for the exam locally for the theory part? or must i go to for ex. Manchester/ Melbourne/ Boston to sit for the exams? Secondly, must both the theoretical and clinical part of the exams be completed before i gain access to those countries, or can i sit for the theory exams first, start work under supervision in those respective places, and finally sit for the exams after about a year of experience. I have some reservations about sitting for the clinical part of the exams, as i am unfamiliar with the clinical practices, requirements and ethics of those nations.
Thank you so much for your time. May God bless you.
1. I don’t know about Mercy Malaysia, but MSF does not usually allow fresh grad to joins. Usually need experience in Emergency Medicine.
2. Pass – don’t know enough about the situation in Malaysia these days for those hospitals
3. Go to the websites of those colleges and look up the requirements for sitting. All the information you need is there. Even if you have all parts of MRCP/MRCS, you won’t be able to work in the UK unless your basic medical degree is recognised. In the UK, MRCP/MRCS are qualifications to gain ENTRY into specialty training – they are not exit exams and just by having all parts does not make you a specialist.
4. There are venues in Malaysia for the written parts, or at least Singapore. Clinical parts you have to fly to those countries. You won’t be able to start work with just the written ones, but some places may allow you to be there as an observer (unpaid). Australia might be different in some areas of need.
Hey Medstudent,
For USMLE you can sit part 1 and 2CK in Malaysia but CS you need to do it in United states. You can do observership in United states as long as your license is recognised in United states. But to apply for residency training you will at least need to complete Step 1 and 2. You can only do step 3 after starting residency(in most states) after starting residency – which will be a better choice.
Like I said – you cannot work unless you have your own professional insurance but you can do observership (meaning you cannot touch patient). If you are still in medical school and your school allows you to do Sub internship and they will cover your liability insurance, then you can do sub internship in alot of hospitals in united states. But as long as you graduated and you are on your own, it will be more difficult. Both will not get paid tho =P
I would recommend more to do sub-I as you will get to interact with patients and do procedires (as you have insurance coverage), but for observership – just like the name, you only get to observe. However, both these options will increase some chance to get into a training program.
If you are interested to apply to united states for residency, general rule of thumb will be good step 1 score for getting interview spots, and good step 2 scores to get into program during match season.
1) If I am not mistaken, you need to be a registered doctor to be able to take part in charity work that involves treating patients. Thus, you can’t do that without first finishing your housemanship. Remember, you can’t joint NGOs to learn something. Your learning starts with housemanship.Only when you start housemanship, you will realise how much you don’t know!
2) General hospitals are still better in terms of seeing patients with multiple complications. District hospitals may be better in doing practical skills but most complicated cases will always be transferred to nearby general hospitals. Looking at the current situation of glut, you can put your choices but MOH will decide on where you will be posted. Most hospitals are flooded with houseman and how much you will learn depends on you.
3) To be able to sit for MRCP/MRCS, you need to complete atleast 1 year of service. Having MRCP does not allow you to get a job in UK. Your undergraduate degree still need to be recognised. If not you need to sit for PLAB exam. Of course, if you are consultant of certain number of years in Malaysia, then you may get a post.
4) I think someone have asnwered this. Australia sometimes do allow you to work with Part 1 and you need to pass the Part 2 within 2 years.
You guys speak like you guys not once a top scorer of spm, if those students did well in the exam, you guys are afraid that one day they might overtake you guys in the medical field! And please, you are not noble prize winner, so it is not very hard to overtake isnt it? Dont lmao, yOu guys once HO too, you are once part of our health care system, i believe at that time, our system is even worst! So dont destroy the bridge once you cross it….. Laugh at stupid HO while you are specialist, dont forget our country is just increasing the number of unqualified ho but the no of good ho is still the same
I am not sure what you are talking about. Medicine is a continuos learning process and the experience counts. There is no way one can overtake the other except for some hand skills. BUT still you need someone to teach you all the stuff, You can never learn on your own.
BTW no one is laughing, we are actually crying! As a medical students, you will not know what we are talking about. You will know when you hit the job market. Then you will realise how much you do not know.
About the only sensible thing you said in your comment is that “our country is just increasing the number of unqualified HO but the no of good HO is still the same”.
Unfortunately the lack of meritocracy, transparency and accountability in our country means that there no guarantee that the good HO’s are the ones who will be given the opportunity for career advancement. And even the ones who get the opportunity will find that the quality of training is declining since our government does not value its quality workforce enough to make it attractive for them to remain in government service.
So here we are now. The good senior guys are leaving/have left, there are not enough quality trainers, and no assurance that the potentially outstanding HO’s will become our healthcare leaders of tomorrow. Malaysia Boleh!
Dr Pagal is not being condescending when he tells medical students that they do not know just how bad things are until they start working in the system. Sadly, it really is as bad as he says it is.
Dear Honest, I no understanding you england =P
Paga and Jon are raising very valid comments about the current state of decline in the malaysian healthcare system from a doctor’s perspective. Medicine is unique in that training and learning really happens on the wards, in real life when treating patients. That’s the reason why medical graduates (regardless of university) are not full fledged doctors until completing their internship/housemanship. The quality of the training received really makes a difference in their future performance. That said, the quality of the candidates also makes a difference, as I will feebly try to explain below:
Define “top scorer”. A person with straight A’s is no longer a ‘top scorer’ as standards have declined over the years.
That’s the reason why most well recognized institutions only look at credentials such as the A-levels, Intl Baccalaureate, and other various regional examination bodies with well defined marking criteria (eg, scoring 7/7 in a subject for IB means you are above XX% of students who sat for the same test).
Human intelligence cannot be categorically measured as it is diverse and ranges from things like mathematical ability, to the more abstract things like kinesthetic knowledge (eg gymnasts) and intuition (ability to extract knowledge subconsciously from sheer experience).
Personally I dont think you need to be born smart to do well in medicine. That said, having brains does help, and clinical decision making is a mix of well-grounded science/facts/principles, intuition, and instinct.
THe clinical years, internship…and how much real thinking and time one puts into the care of his/her patients is what’s important. Of course, being smart will make the thinking part easier… but the sheer time you’ll need to spend seeing patients is still the same.
Compare for example the Australian system whereby to get into medical school as an undergrad you will have to be within the top ~5% (it varies year to year) of students (unless you are from a very rural area). Alternatively you can do medicine as a postgrad where the same strict criteria does not apply but the fact that you have completed undergrad training and still want to do medicine shows… And many postgrad students are registered ED nurses and such.
Now the malaysian system whereby relatively mediocre students are graduating with medical degrees…and you have a different situation alltogether.
I just wanted to say that it took me a while to decipher what Honest was trying to tell us.
Just so that you know, what Dr Pagal stated in the blog, and most negative comment made here are true.
And I don’t think anyone here will ever be afraid that someone will overtake them. As doctors I believe most of us are born to be competitive, but all of us are grateful and happy to see others shine in medicine as we have the same common goal which is to take good care of patient.
I don’t know what position, or how long have you been in the healthcare system, but from the English…i mean attitude and comment it just reflect on how naive and immature you are. If you are HO/intern I would advice you to be more humble. If you hold higher positions, maybe that explain part of the reason why healthcare system is bad in Malaysia.
Sounds sacarstic but really no offense just stating the fact,
[…] I found some interesting articles (below) in NST today. In fact, it is a follow-up to an article published last week (http://www.nst.com.my/opinion/columnist/doctors-may-end-up-being-under-trained-and-untested-1.128106) which was an abstract of our Ex-DG’s MMA AGM speech which I had published before over here. The recent SCHOMOS/MMA survey of about 908 HOs who had undergone training in both the old and new system showed that almost 75% claimed that they are not getting adequate training under the new shift system. Something that I had expected when it was introduced. Remember my post on this matter last year ? see here and here. […]