I was flipping my Star newspaper today and noticed an interesting article by Dr Miltun Lum who was a past president of MMA and MMC council member. He has summarised what I have been saying in this blog for the last 2 years. In my last posting https://pagalavan.com/2012/07/22/for-future-doctors-the-storm-in-coming-part-3/ , I mentioned 2 well-known figures in the medical fraternity in our country voicing out their concern regarding the future of medicine in this country. The oversupply of doctors, poor training of housemen and specialist and commercialisation of medical education were among the issues raised.
In this article below, Dr Milton Lum has voiced out the same concern. Almost all of these have been mentioned by me many times before. Some of the facts that he mentioned is really interesting, like the ones that I have highlighted. According to him, a survey shows that more than 50% of students do medicine because of parental or peer pressure, glamour, hope of financial rewards later, etc.
Below this article I have attached another article of the critical situation in Australia http://www.northerndailyleader.com.au/story/142265/critical-condition-shortfall-of-internships/?cs=247 despite having lower number of medical schools with the same population as Malaysia and their citizens do not go overseas to seek education! In fact they are only targeting 3500 graduates next year compared to Malaysia, where we have already achieved that figure last year itself!
Again, GOD bless this country………………..
Good doctoring
By Dr MILTON LUM
Ensuring everyone gets good doctors.
ONE of the basic principles taught to all medical students and doctors isPrimum non cere – first, do no harm. It is a reminder that an intervention can lead to harm to the patient, however well-intentioned it may be.
This principle is even more relevant today than in yesteryears.
Healthcare today is complex and more effective than before. However, according to the World Health Organization, the likelihood of harm is high, with a one in 300 chance of being harmed by healthcare compared to one in 1,000,000 chance of being harmed while in an aircraft.
Data from developed countries reveal that one in 10 hospitalised patients are harmed because of adverse events or errors. Similar data has been found in local studies.
The future of patients and their families depend on what doctors say and do. Imagine the good and harm that can result from doctors’ actions and inactions.
The media focus on housemen in recent years raises questions about the quality of medical education and training, as well as the challenges in ensuring that everyone gets good doctors, and by extension, the quality of healthcare patients will be receiving in the future.
Studying medicine
There are more applications for entry to medical schools worldwide. Many young people want to become doctors, whether of their own volition, at the behest of their parents, or for other reasons.
Until 2011, high academic qualifications were the sole criteria for admission to all public medical schools except University Science Malaysia (USM), which required an interview as well.
Since 2011, the Malaysian Medical Council’s (MMC) guidelines require all applicants to local medical schools to pass an interview to assess the applicant’s aptitude.
Although the minimum academic qualifications for entry into medical schools are prescribed by the MMC and the Malaysian Qualification Agency (MQA), there are still reports of non-compliance by some private medical schools. There are also reports that some private medical schools take in more students than permitted.
The situation in foreign medical schools is varied. Medical schools in advanced economies require high academic qualifications and aptitude assessments. However, some medical schools in some developing economies admit students whose academic results would not even qualify them to enter a Malaysian university for other courses which require lesser academic qualifications.
Many such students gain entry through the good offices of the agencies of these medical schools.
It is necessary to emphasise that selection for entry into medical school implies selection for the medical profession. Findings from studies worldwide confirm that although some students have achieved the academic qualifications required for entry into medical school, they are not suitable for a career in medicine.
It is in the interest of the public and such students that they should not gain admission, rather than to have to leave the course or the profession subsequently.
Feedback from some public local medical schools indicate that more than 50% of students do medicine because of parental or peer pressure, glamour, hope of financial rewards later, etc.
Can such students end up as good doctors?
Should the quality of students doing medicine be of concern to the public?
What should be done to those admitted to local or foreign medical schools without minimum academic qualifications?
The message to parents that good examination results do not make a career in medicine suitable for their progeny has to be repeatedly emphasised. There is nothing worse than getting into a profession that is unsuitable for one’s personality.
Medical schools
There are currently 34 medical schools for Malaysia’s population of 28 million, compared to nine and 12 medical schools in 2002 and 2007 respectively. Sixteen new medical programmes commenced in 2009 and 2010.
Data from the Avicenna Directory maintained by the University of Copenhagen, in collaboration with the World Health Organization and the World Federation for Medical Education (WFME), show that countries with similar populations like Australia (23 million), Saudi Arabia (28 million) and Canada (35 million) currently have 26, 16 and 16 medical schools respectively.
Our ASEAN neighbours, Indonesia, Singapore, Thailand and Philippines, with populations of 238 million, five million, 65 million and 92 million respectively have 35, two, 19 and 54 medical schools respectively.
Germany and the United Kingdom have 41 and 38 medical schools respectively for populations of 82 million and 62 million.
The issue is compounded by the fact that the government recognises more than 370 medical qualifications worldwide. This list was inherited from our colonial masters and has been added to over the years.
In addition, graduates from unrecognised medical schools can sit for the Medical Qualifying Examination (MQE) and, upon passing, will be registered by the MMC. The examination, which used to be the final year examination of the University of Malaya, National University of Malaysia and University Sains Malaysia, is now also conducted by 13 other universities.
The recent announcement that there is no limit to the number of attempts at the MQE raises fundamental questions about the quality of some of these doctors. Where in the world can someone be permitted unlimited attempts at any examination, let alone in medicine?
In spite of the marked shortage of medical educators in Malaysia, the expansion of medical schools continued unabated in the past five years, thereby exacerbating the shortage. The majority of teaching staff in many medical schools are foreigners, some of whom do not speak any of the local languages, and some with no previous teaching experience.
It is not only the number, but also the quality of medical educators that is crucial in producing doctors that will make a positive impact on the public’s health. Medical educators are role models for students. It is well known that a deficient doctor is reflective of a deficient teacher; just as a child’s conduct is reflective of the parent’s.
Do the local medical schools take responsibility for the quality of their graduates? Are they responsive to societal needs and act proactively to meet those needs by addressing various issues that include selection criteria and admission policies; curricular improvements with emphasis on the concept of social accountability, medical ethics and human rights; and the quality and quality of medical educators?
Does the quality of medical education focus on the core educational needs of a doctor, providing him with the knowledge, attitude and skills necessary to address public health and clinical challenges?
Is this achievable when medical education is so much driven by the profit imperative?
What is the quality of medical education in recognised local and foreign medical schools, and how robust is its monitoring?
What is the role of agencies of foreign medical schools and how robust is their monitoring?
Housemenship
During the course of the newly graduated doctors’ future practice, there will be continuing advances in medical science and clinical practice, healthcare delivery and financing, increasing expectations of patients and the public, and changes in societal attitudes.
By itself, the basic knowledge and skills taught in medical schools is insufficient. The housemenship period is the time to start developing of the ingredients of the MMC’s “Good Medical Practice” (http://mmc.gov.my/v1/docs/Good Medical Practice_200412.pdf).
The young doctors have to learn to always put the interests of their patients first, and that the doctors’ professional practices affect the experiences of patients and their families. The skills of continuing professional development have to be developed so that their practices can advance in accordance to changes in medical knowledge and practices.
Prof TJ Danaraj, Foundation Dean of Medicine at the University of Malaya, wrote: “There is a worldwide acceptance of the views that the education of a physician extends over a lifetime, each stage resting upon the preceding one, and each preparing him for that which follows.”
Learning during housemenship is significantly experiential. There has to be sufficient quality teachers for this aspect of the young doctors’ training. The teachers, who are usually specialists, have a crucial role to play as they are role models for young doctors.
There has to be exposure to sufficient numbers of patients for young doctors to gain the experience required for independent practice. For example, they have to be exposed to the different ways in which the common conditions, appendicitis and urinary tract infections, present.
Failure to make an accurate diagnosis will lead to threats to life in the former, and long term consequences in the latter.
When there are few patients relative to the many housemen, it will, inevitably, have a negative impact on the latter’s training.
My classmates and I always remember our housemenship year. Some of our specialists were good teachers; some were less so. Some were excellent at expressing themselves verbally; others expressed their skills with their hands. Some did ward rounds before going home, and some even came back at night to do ward rounds.
We learnt from every specialist and from ourselves; what to do and what not to do in differing situations. Time was not a consideration. We finished our work before going home, whatever the time was.
There were instances when we would go to other wards or attend other specialists’ ward rounds, even after work, to learn from cases with interesting features. Those were not easy times. It was hard work, but our enthusiasm made the difference.
There were discussions and analyses which made us better doctors because we learnt from our specialists and ourselves. And, most importantly, we learnt how to learn.
The recent media report that “50% of housemen in Sabah can’t cope, need retraining” (http://www.theborneopost.com/2012/05/17/50-of-housemen-in-sabah-cant-cope-need retraining) is worrying.
Equally disturbing are media reports of claims by housemen that they are overworked, training is minimal or absent and there is “bullying” by specialists.
There are also statements by specialists that some housemen work by the clock and that they do not even know the names of some housemen assigned to their wards and clinics “because there are so many of them”!
What is the quality of housemenship training and how robust is its monitoring? What is the quality of healthcare that patients can expect from the large numbers of housemen who need retraining?
What happens when they become Medical Officers after completing their housemenship? The possible long term effects on the quality of healthcare delivery in the country are indeed mind boggling!
Government agencies
It may interest the reader to know that several government agencies are involved in medical education. The Ministry of Higher Education (MOHE) controls all medical schools. It grants approval to establish a new medical school and through the Malaysian Qualification Agency (MQA), it requires all medical schools to comply with accreditation standards.
The hospitals of the Ministry of Health (MOH) and MOHE provide housemenship training and employment for Medical Officers upon its completion.
There are reports from some specialists that they find it increasingly difficult to cope with the dual tasks of providing care to patients and training housemen, with the former always having to take priority over the latter. Even the Ministry of International Trade and Industry (MITI) impact upon the health sector. There is linkage between goods and services in MITI’s trade negotiations with the World Trade Organization (WTO), ASEAN and other trading partners. The concessions permitting the presence of foreign ownership of private healthcare facilities and practising rights for foreign doctors in Malaysia will inevitably have an impact upon the quality of healthcare provided.
It is regrettable that there is no published national medical manpower planning policy. How many doctors does the country need, and by extension, how many medical schools?
Do the MOH and MOHE provide feedback to medical schools, regarding the skills, knowledge, attitudes and competency of their graduates? What is the quality of the feedback? Do the medical schools act on the feedback?
How many top notch foreign doctors will come to Malaysia to practise on a long term basis? What mechanisms are there in place to assess the quality of foreign doctors intending to practise here? Are there robust and valid assessment mechanisms in place?
Malaysian Medical Council
The MMC’s function is that of recognition of medical schools and professional regulation, based on its Code of Professional Conduct and its guidelines.
The local medical schools are given time-limited accreditation after assessments by teams comprising representatives from the MMC and MQA. However, it is impossible to accredit all the foreign medical schools recognised by the government because of manpower, logistic and financial reasons.
Most governments in developed economies acknowledge their limitations in assessing the quality of medical education. They require all those who want to practise medicine, particularly graduates from foreign universities, to pass a licensing examination.
Many Malaysian doctors who have practised abroad, particularly those above 40 years, have passed these licensing examinations without difficulty simply because of the quality of medical education they received.
Why is there no licensing examination when about half of the doctors commencing housemenship are graduates of foreign universities?
The number of disciplinary cases per 1,000 doctors dealt with by the MMC has increased in recent years. Although it is less than that of Singapore, the question as to whether the increase is due to the public’s increasing awareness of their rights, quality of care or both is not easy to determine.
Like all medical regulatory authorities worldwide, the MMC is addressing the issues of professionalism and performance measurement. This is of relevance as it is crucial to the enhancement of the trust of the public in individual doctors, in particular, and the medical profession, in general.
What this means
Many in the medical profession have stated publicly their concern that there is more emphasis on the quantity instead of the quality of medical graduates. The consequences in other areas of studies may not be significant, but in healthcare, it can be a matter of life and death for a patient or potential patient, which means all the population.
Healthcare delivery is so complex today that it is crucial to have doctors who put a premium on patient safety. If one has to make a choice, the public interest is better served by fewer good quality doctors than larger numbers who are deficient in their knowledge, skills or attitudes.
Society deserves nothing less.
Everyone, whether students, parents, medical schools, governmental agencies and the MMC, has a role to play in ensuring that everyone gets good doctors. However, the onus on medical schools, policymakers and regulators is paramount.
In concluding, everyone, particularly medical schools, policymakers and regulators, should be cognizant of the instructive statements of Hippocrates (460-377 BC), Avicenna (980 – 1037) and Sir William Osler (1849-1919). Hippocrates wrote, “Whenever a doctor cannot do good, he must be kept from doing harm”, and Avicenna “An ignorant doctor is the aide-de-camp of death.” Sir William Osler’s statement, “The best preparation for tomorrow is to do today’s work superbly well” is very apt for medical education and training.
> Dr Milton Lum is a member of the board of Medical Defence Malaysia. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with.
Critical condition: shortfall of internships
By By Natalie Croxon
July 23, 2012, midnight
WITH centres across the north, including Tamworth, desperate for more doctors a deficit in training places means many graduates might not be able to help fill the gaps.
Yesterday, the first round of internship offers for 2013 was released and the Australian Medical Students’ Association (AMSA) estimates more than 370 international students could miss out on positions next year, although the shortfall will not be known until final offers are released next month.
Hunter New England Health will take 100 interns, the same as last year, and while these graduate trainees will rotate through the service’s training hospitals including Tamworth and Armidale, the region’s acute doctor shortage is set to continue.
Australian Health Ministers’ Advisory Council chairman Kim Snowball said the 2012 class was expected to comprise more than 3500 graduates – an increase of more than 500 students on last year. It is the biggest number on record.
In NSW AMSA has predicted a shortfall of 123 positions, with 1040 anticipated graduates and 917 intern positions available.
Without the supervised year-long internship, these graduates will not be able to work as doctors.
Without the supervised year-long internship, these graduates will not be able to work as doctors.
Commonwealth-supported students are guaranteed an internship, but domestic and international full-fee paying students are not.
Acting director medical workforce at Hunter New England Health, Anthony Llewellyn, said 16 of the service’s intake of 100 interns would be at Tamworth hospital, with 14 positions recruited under rural preferential recruitment and the other interns allocated on a rotational basis.
The remaining internship positions will be filled by Health Education and Training Institute rounds, the first released yesterday.
Interns recruited through these rounds will undertake training across a number of sites, including John Hunter, Calvary Mater, Manning, Maitland, Belmont, Tamworth and Armidale
hospitals.
AMSA yesterday presented a petition of almost 6500 signatures to the country’s health ministers, calling for them
to create more internship positions urgently.
“To produce medical graduates and then not allow them to work as doctors is a waste of taxpayer dollars and valuable health system resources,” AMSA
president James Churchill said.
The Australian Health Ministers’ Advisory Council issued a statement yesterday that said the Commonwealth and state governments were working together to ensure that when the shortfall was known, measures would be implemented to quickly increase the number of intern placements.
The advisory council said it was considering additional positions in new settings such as the private and non-government sector, ensuring accreditation for any new places was fast-tracked, and identifying any additional capacity for intern rotation and places.
The issue was explored in the current edition of the Medical Journal of Australia and author Catherine Joyce, an associate professor at Monash University, said internships needed to take place in a wider range of settings.
“Now that would include private hospitals. It might include smaller hospitals in regional or rural areas,” she said.
Pagalavan's Avatar 
In my course of practise, i would like to state that 90% of students take up medicine for the wrong reasons. 50% is an under-estimation.
In the land where everyone can fly or “everyone can be UD41” any stringent exams to assess those already practicing medicine in the public hospitals will be faced with strong criticism and possibly with riots on the street.
The number of ex-ussr graduates/indonesia/egypt/PRC/india/new private medical schools being absorbed into the system is just too much too handle to introduce any changes. simply put the system is rotten (it is like changing UMNO from within, LOL)
Other than having stronger medical council with balls, one of the possible solutions is to make promotion of UD41 into UD44 more strict. Logbook is not enough. If we are confident that our newly promoted UD44s are good enough to man district hospitals that they should be able to pass a standardized exam done externally which test their competencies and skills as independent practitioner.
On top of qualifying exam, graduates should be assess for their competencies and working skills even before appointment. Currently the SPA is just for formalities. We should have a national matching system for hospital where hospitals can planned for the number of junior workforce they require. Public hospitals should be given the autonomy to limit the number of intake like university hospitals. Ultimately hospitals should be given the power to select.
The current post-run assessment and logbooks which differ from one hospital to another, from one specialist to another such system given the current circumstances is not without flaws. I personally have seen UD41 cheats with their logbooks and go to consultants who favor them for the end of run assessment. Having said that I’ve also seen consultant asking unfair question to UD41 simply to fail them.
If KKM are proud of our housemanship training and serious about our healthcare then we should seriously assess MOs especially in district and KKs on regular basis. Ideally consultants should be assessed regularly too like the US board exam but I shall left this discussion for those who are more senior than me.
Even ACLS was just recently introduce to the public hospitals. Some of these new graduates lack the skill to manage basic medical emergencies, something which the medical school should prepare them for.
The issue of doctor’s training is very sensitive and unpopular (read sothinatan and CSMU’s recognition). I guess given the current political climate we just have wait wait for new government to come in for any serious changes to happen which is why medical council should be given some power to grow balls. So that they can implement things without political interference.
I know I know the solutions are just too idealistic. In truth we have too many civil servants (where laziness, inefficiency and incompetency are core values) in all areas of public service. But hey, I’m too tired to talk about our government incompetency and nincompoops in the civil service.
I disagree with your statement “no limit to the no of attempts at the MQA raises fundamental questions”—
After that I did not read further as in my opinion this is the right decision on the part of the MQA .This is still practised in India in the private institutions I am not sure of the govt colleges anyway it should be the same.Yes sir I know Prof Danaraj and also Prof sinnathuray please do think out of the box and you will get the ans.
Regarding the surplus of doctors in the country it is the doctors to be blamed for why cry now if you love the profession u should have cried before.
Do u know something the pharmacist wants to charge a small fee for their consultation what a joke did we ask them to do this .
Last week I was with a friend of mine & he told me that today the colleges are producing gradutes that are not wanted by the industry and he pointed to me 2 Masters in 1 COURSE DOING LAB JOB.
I think you are not getting the point. Worldwide, there is no professional exam which is unlimited. In India, the exam is standardised by Indian Medical Council and ALL citizens who graduated from overseas have to sit for it. This is what we have been saying all this while. There should be a common entry exam for all overseas graduates which should be standardised by Malaysian medical council. Unfortunately, at the moment it is up to the 16 medical colleges to decide on these students.
Everyone have been crying but unfortunately, it is the politicians who are not interested to listen as they just want to have populist ideas. Create more colleges and make everyone happy to see their sons and daughters becoming doctors!
There is no such thing as human resource planning in Malaysia. The government does not bother what you graduate as as long as you are a graduate for their statistical reasons. It is the same for nurses, pilots and soon doctors
Dear Dr Paga,
Should our students stop going to Aussie U for medical course since the med student glut there has become a problem for hospitals?
http://au.news.yahoo.com/thewest/a/-/breaking/14136463/med-student-glut-a-problem-for-hospitals/
Just wonder whether the Malaysian HOs ( for yr 2013) in Australia will face the same problems like our HOs in Malaysia, ie not enough qualified trainers to train them due to the sudden glut?
you can still go to australia simply to get a well recognised degree but not necessarily you will get a job there.
Dear Dr,
No problem to get a job in Australia as long as you do not mind working in rural areas (as hulu as possible). Being a developed country, Australia’s health care system is facing the same ( if not almost) fiasco like Malaysia, a developing 3rd world country :-
1) Glut of houseman – not enough internship places, even for their own Australian students. (At least at this moment, Malaysia still have enough places for our own local-trained students as well as those coming back from overseas, but maybe very soon…..)
2) Not enough doctors (so more medical graduates, and for Malaysia more medical school too!!)
3) Recruit a lot of foreign doctors (same like Malaysia, you can see many foreign doctors too). It was reported that Australia already has the highest dependence on internationally recruited doctors in the developed world. And the report further said that many, including health economist Gavin Mooney, consider Australia’s dependence on doctors from other countries – often developing nations – as immoral. I wonder why immoral???
http://www.theage.com.au/victoria/no-doctors-in-the-house-20120626-210fg.html.
So, let’s ‘cheers’ ! As far as our health care system is concerned, we are almost on equal par with Australia………
As for medical students, maybe you should go UK as I heard internships are guaranteed there.
As for jobs, you (doctors) still can try Australia, as long as you have sufficient MO experience and do not mind working in rural areas. I have friends from local universities working there on contract basis, but a few are thinking of coming back because they said life in Malaysia is better!
In India, a MBBS graduate without post-graduation (MD) has no value at all, in fact, many graduates themselves admit that they dont deserve the Dr title. Malaysia is just gonna be like India after a few years seeing medical schools mushrooming up at this rate now. There will be plenty of incapable doctors in hospital, where probably their knowledge is worse than paraclinical staffs. My friend who is currently studying 4th year in IMU told me that they are not even expected to know the dose of anti-tubercular treatment!
It is OK not to know the dosage(you can always find out later) BUT you need to know the name of the drugs and the duration of treatment.
Dear enthusiasm,
I am surprised that you are surprised that a student does not need to memorize the dosages of anti-TB treatment.
For the young doctor, dosages should not be the most important thing he/she needs to learn. The most important should be the recognition of side effects of the drug, the typical duration a drug is given, the usual regimes etc.
Knowing the dosages of a non-emergency drug does not provide any benefit to the young doctor. In the new age with the advent of technology, I would encourage all young doctors to DOUBLE CHECK the dosages first before prescribing, and not to rely purely on memory work – especially when one is post-call and have a dropping GCS.
Do medical schools in India emphasize a lot on memorizing dosages?
We are not expected to know the dosage of all the drugs except the common ones. Since TB is very prevalent in India, there a specific treatment regime to follow and so all medical students should know it by heart. But most of the university exams are conducted in subjective style, so it is like “the more you know, the more you score”, the examiners mark the papers based on their impression on the answers you present, so students who want to score well have to study more and memorize more facts.
Indian education system emphasizes a lot on memorizing. It is a well known fact. You can see the movie “Nanban”
Or you can just be a fraud like this guy, Dr. Winson Seow, trauma surgeon, emergency physician and psychologist, with 15 years + of medical education and post grad studies rolled into 7 years:
http://thestar.com.my/news/story.asp?file=/2012/7/28/nation/11745915&sec=nation
Haha, I read about it the other day. A big Conman
Haha, I read about it the other day. A big Conman or a schizophrenic!!
hi doctor 🙂 in your view, which is the best medical university / college in malaysia?
I would still say UM, UKM and USM
what about private? 🙂
IMU, PMC, Monash, MMC are OK
thank you 😉
EVERYONE IN MEDICAL FIELD….DO SOMETHING EFFECTIVE AND DRASTIC TO SETTLE THIS PROBLEM!!!!DONT JUST TALK AND TALK
and what would you suggest? The government is not bothered. They never guaranteed you a job anyway. This article appeared in the mainstream media for everyone to read. You think the government gives a dam?
A good place to start is to assess the health workforce requirement for the next decade or two – something similar to the Health Workforce 2025 in Australia http://www.hwa.gov.au/health-workforce-2025 – ideally the government should conduct this assessment; however should they be unwilling/incapable of carrying this out, then the MMA should pick up the task. It’s their own profession after all, if they are not going to look out for it, then who else will? While I admire Dr Pagalavan’s efforts in advocating these issues, had the medical community in Malaysia been more vocal before all these medical schools started sprouting like mushrooms…well, it’s too late now 😦
Our government do have Ministry of Human resource BUT i got know idea what they are doing!! MMA can’t do much as they are just an association with limited fund. They can propose which they have been doing all this while BUT the government do not listen. The MMA has at many times brought the up the issue of medical schools to the Ministry but despite all the effort, the government still proceeded with the new medical schools. It is all about political connection. If you look into all these medical schools board of directors, you will know the answer!
Now with so many medical schools, the government should scale down the no. of students per intake to solve the problem of houseman glut, say if IMU or Monash are giving 100 places each, then it should be scaled down to 50 places. Same for other medical schools.
But all these medical schools will definately hike the tuition fee to cover up the lost of revenue.
Actually, the fee they are charging now is already quite high. Even with this fee, each med school will need at least 150 students to make profit!
Forget about MMA, they are just a social club without legislation power. They only interested in collecting medical indemnity premium.
http://lmgtfy.com/?q=how+to+turn+off+caps+lock I insist that you visit the informative link above.
are you DRASTIC or Dr Astic?
hi doctor, may i ask you is IMU a good medical school?
Among the better ones
In Klang Valley, IMU is usually the preferred private medical school for MOST parents and students for their local MBBS, if they can afford the tuition fee, and migration to Australia is not in their planning too. The reason being IMU is more established, and the teaching hospital in Seremban is nearby so the students can return homes during the weekends too.
I knew a few parents would like to send their children to IMU but the tuition fee is too high for them, so their children go to other cheaper medical schools instead.
over the years.. most HODs have always had respect for IMU grads. Some IMU grads have already become HODs (Oncology, JB)
Its probably more because IMU rejected poorly performing students right from the beginning. The other thing is, IMU has a very high failure rate in their second year. This is a form of ‘weeding’ exercise.
IMU Seremban still retains some good clinical and academic staff. You know who im talking about. These are clinicians who genuinely publish paper in international journals.
Most of the academics in IMU are senior consultants in civil service before. These were the consultants of those days who have superb clinical skills and pure dedication for medicine. These type of consultants are no more in civil service.
Heard that a recent MOH internal survey was done, to find out where do house officers with “problems” come from.
And they defined problems as :
1) Attitude/responsibility issues
2) Lack of sufficient knowledge to perform as HO
At the top : Russian universities
At the LOWEST percentage of “problematic” HO:
2nd lowest “problematic house officers” : International Islamic University Malaysia (IIUM)
Lowest “problematic” house officers : International Medical University (IMU)
Heard this from a second-hand source. May need someone who knows the exact details to clarify.
Thanks for the info but I am not surprised
reading your blog really made me worry of what will happen to our health care in near future. I am a medical student of a local uni sponsored by jpa. I just wish that the government do something about this and MMC would have more authority in the health care system.
i think the government need to stop sending students overseas and let the students studied overseas to do their intern in the country they studied to reduce no of houseman in this country.as for the local uni, i hope there will limit the number of intakes let say one uni can only take 100 students except for more established one like um/ukm/usm per year.to some extent maybe we could limit only like 3000 houseman can register per year and the extra graduates need to wait for next cycle to register.
and how about jpa scholars?as they have 10 years bond with the govt does that make them save and can easily continue working after the 2year HO contract?
The government must give a job for JPA scholars as stated in the contract. Thus you will be save.
As for the number of students: it is up to the colleges. The government can’t prevent people from doing medicine BUT the government is NOt duty bound to provide a job for you.
Dear Dr, I heard that the number of students is not up to the colleges or medical schools. It is decided or allocated by the government. This is to ensure that there will be enough places for the students during their clinical years in the hospitals. Is it true?
Nope. The colleges apply to MMC for the number of students they are going to take. MMC usually approves the number based on lecturer:student ratio.
In this case, MMC is the main culprit for the glut of houseman. They should do something to scale down their approvals on the no. of students.
MMC comes under Ministry of Health. The DG becomes the MMC Chairman. It is a non-independent body!
my HOD used to joke…during his days..the creme-de-la-creme come MU (University of Malaya) but now they still come from MU…but iMU.
Yes, when IMU first appeared as the first private medical college, the students who entered were good students who could not get a place in the 3 local universities. Hopefully, they keep the same standard.
IMU ‘somehow’ try to keep their standard ‘at the expense’ of some ‘unfortunate’ students (kicked them out). Most IMU students (both local and PMS) are those with very good pre u results (like straight 4As for their A level). But IMU will still take in those not so good students (being a private school, it is $$$ for them) within the min entry criteria if there are places for these not so good students.
As what chillax had mentioned, IMU has a very high failure rate in second year ( I would say 2nd and 3rd semester). If these not so good students (including some very good students) do not work hard will be weeded out. Those being kicked out in semester 3 would had already spent more than Rgt 90k tuition fee. I know a few (kicked out in semester 1 & 2) went to UK/Ireland for their 1st year again.
This is a recent article in the Medical Journal of Australia about their workforce numbers: https://www.mja.com.au/open/2012/1/3/medical-workforce-2025-what-s-numbers
Key points:
Medical graduates have increased from 1400 (2000) to 2733 (2010).
They are projected to reach 4000 in 2016.
To accommodate Australian medical graduates, they need an extra 1000 intern places over the next 5 years – despite intern places already having almost doubled between 2003 and 2010
In Australia, they can’t just chuck these new doctors into any hospital like they do in Malaysia. Special posts need to be created for them because the Aus govt subsidises these posts – i.e. the govt compensates the hospital for hiring an intern because there is recognition that an intern only has a partial service role. Australia also has a much more developed health infrastructure than Malaysia where small ulu towns in the middle of nowhere (i.e. the base hospitals) can sustain specialist services and have intern posts. Our district hospitals in Malaysia can’t do that.
Take home message: The Australians have also markedly increased the number of local grads, but not to the extent that we have. We also have a very large amount of Malaysians that return with medical degrees looking for jobs, something Australia doesn’t have. Yet, their government is aware they have a problem and is trying to figure out solutions. Ours have their head stuck in the sand and no one is capable of making the brave decisions partly because every other person associated with the private medical schools is politically connected.
Malaysia is a developing 3rd world country whereas Australia is a developed country. So obviously Australia is expected to have a much more developed health infrastructure/healthcare system/management, etc (the status of being a developed country). So why compare them?
…….. and yet Australia still have the same fiasco of not enough places for internship. They should have planned properly before taking in more medical students but not at last minutes trying to accommodate them.
Due to the glut, will there be enough qualified trainers? Will the training be compromised?
Australian medical schools takes in a lot of foreign students unlike Malaysian medical schools which is almost 100% Malaysians. Previously most of these foreign/international students stay back in Australia to complete their internship. This could be the reason why they do not have enough internship places. If they stop giving internship post to international students, they will have enough slots for their citizens and PRs. Atleast 20% of their graduates are international students.
Even without the international students, they are struggling to keep up with enough internship positions. But yes, the international students are the ones that are being placed at the bottom of the list. They are after all just a cash cow for the universities.
Dr. Pagalavan ..Why a glut of doctors is foreseen when Malaysia in a developing country whereby health care standard is not yet to the mark of WHO ?
what standard are you talking about ? If your are taking about doctor:population ratio, the ratio will be achieved by 2015. It is in the government’s statistics as mentioned in this blog
Achieving a high doctor population does not equate to good healthcare standards. Too high, and the standard may even drop due to lack of training/learning opportunities. Other questions one should ask:
– are these doctors being trained well in medical school?
– are they receiving adequate training and supervision during their HO and MO years?
– how many qualified specialists are actually being retained in the public service, in order to teach junior doctors?
– what facilities are available in the public hospitals?
– what is the quality of nursing and allied health services in these hospitals?
– does the population have access to healthcare (i.e. availablity and affordability)
I’m sure there are more, but I hope you get the picture.
Dr. Pagalavan..Isn’t IMU also admit students who cannot qualify for JPA students to study in UGM (Indonesia). These students only BBB at A Level (UGM require AAA at A level) and also parents can afford the fees at IMU…?
money