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.
This article in NST http://www.nst.com.my/top-news/training-blues-for-housemen-1.134263#, basically talks about the SCHOMOS survey. But another article http://www.nst.com.my/nation/general/sunday-spotlight-housemen-can-rest-but-learn-less-1.134094 interested me more as right at the end, you will realise that whatever I have been saying in this blog over the last 2 and half years will eventually come true ! Jobless doctors! Please see the highlighted paragraphs.
Remember, I started ringing the warning bell of overflow of doctors way back in 2005. People laughed at me and said that I am over exaggerating. But now, almost all the top guys in the medical fraternity in Malaysia agrees with me. I guess that this blog did some good by exposing a lot of issues about medical schools and oversupply of doctors. Now, the newspapers seem to be more interested. Undertrained doctors will also eventually become a national issue when the rakyat starts to complain. I am already seeing more and more patients who were once loyal customers of government hospitals coming to see me and venting out their frustration. These are pensioners and senior citizens who are well-educated. Many openly told me that the current generation of doctors do not even bother to listen, examine and take concern of their problems. They can clearly see the deteriorating quality of the doctors. These people have been going to government hospitals for at least 20 years!
It is beyond doubt that the quality of intake of medical students have deteriorated over the years followed by the quality of the products of medical school. Mushrooming of medical schools, overproduction and inadequate training, further deteriorates the situation to a point where there will be no way of turning back soon. We are talking about this when the product stands at 4000/year but it will hit 6-8000 by 2016. Almost 50% of our 34 functioning medical schools have not produced their graduates.
AND when the jobless scenario hits, some knee jerks reaction will follow from our government! Don’t be surprised when they ask private hospitals to employ housemen with some pathetic salary!
Or, our jobless doctors will be performing “Gangnam Style” on the road side! Have you seen doctors working as Taxi drivers? It happens in some countries.
KUALA LUMPUR: MEDICAL house officers (HOs) or housemen feel they are not getting enough exposure and clinical training under the new flexi-hour shift system aimed at easing their workload, a survey by the Malaysian Medical Association (MMA) has revealed.
The results do not bode well for the nation’s healthcare sector.
The survey by the MMA’s Section Concerning House Officers, Medical Officers and Specialists (Schomos) revealed that 75 per cent of the 908 HOs who took part in the nationwide survey felt that they were not getting adequate clinical exposure and were unable to complete enough procedures as required for their training.
Sixty per cent felt there was no continuity of care for patients, with 52 per cent saying the previous on-call system was better than the existing system.
The results, made available to the New Sunday Times, echo the views of former director-general of health Tan Sri Dr Mohd Ismail Merican, who had said that while the shift system may have improved the quality of life of housemen, it may result in undertrained and untested HOs if strictly adhered to.
In an excerpt of his speech delivered at this year’s MMA Oration, which was carried in the New Straits Times on Aug 23, Dr Ismail expressed concern that with the shift system, there would be no continuity of patient care or accountability. Housemen also agreed that the shift system did not work well, especially in busy hospitals.
Read more: Training blues for housemen – Top News – New Straits Times http://www.nst.com.my/top-news/training-blues-for-housemen-1.134263##ixzz25I9cdwrT
SUNDAY SPOTLIGHT: Housemen can rest but learn less
The new shift system has to reduced the long working hours of housemen, which was the main cause of stress for them, and also prevented too many from working infrom overcrowding wards.
INTENDED to solve the woes of exhausted and overburdened housemen, the new flexi-hour shift system itself is turning out to be one of Gordian complexity.
One of the most vocal critics of the shift system has been Tan Sri Dr Ismail Merican, the former director-general of health.
He believed that while it might have improved the quality of life of housemen or house officers (HO), it might result in HOs being under-trained.
In an excerpt of his speech delivered at the Malaysian Medical Association Oration 2012, which was carried in the New Straits Times on Aug 23, Dr Ismail also expressed concern that with the shift system, there would be no continuity of patient care or accountability.
He also noted the lack of interest among HOs in attending professional development programmes because these were held outside their working hours.
“They may attend if their shift duty coincides with the programmes.
“Otherwise, they prefer to stay at home and rest than continuing their medical education,” he said.
Medical education in Malaysia is indeed at a crossroads, said Dr S.R. Manalan, president of the Malaysian Medical Association (MMA).
“It has been much politicised and faces many unresolved problems, such as shortcomings in the selection of students for entry into medical schools, structure of undergraduate training, cost of medical education and the need for dedicated medical educators.”
He said the apparent commercial interest in establishing medical schools because of the increasing demand to produce doctors was also not helping the situation.
In 2009, there were 3,058 HOs. In 2010, the figure rose to 3,252 and last year, there were 3,564.
According to statistics, Malaysia will reach the doctor-to-population ratio of 1:600 by 2015 and 1:400 by 2020.
“The question now is, why do we have to train so many to become doctors and is there a drop in the standard of knowledge and skills of these doctors?”
Dr Manalan said the shift system was implemented to replace the old on-call system. It not only reduced the long working hours of HOs, which was the main cause of stress for them, but also prevented too many from working in the wards.
Working in smaller numbers optimised their exposure to a wider spectrum of clinical cases.
He said following complaints from housemen about the shift system, the MMA ordered a survey and entrusted the Section Concerning House Officers, Medical Officers and Specialists (Schomos) with the task. About 908 HOs took part in the online survey.
“Overall results showed that 85 per cent felt they were getting enough rest in between work compared with the previous system.
“About 52 per cent felt the old system was better than the existing system. On whether there was enough teaching or ward rounds by medical officers and specialists in the shift system, 52 per cent felt there was,” said Dr Manalan.
Not so positive was that 75 per cent of the HOs who felt that they were not getting adequate clinical exposure and were unable to complete enough procedures as required for their training.
Of the total respondents, 60 per cent felt there was no continuity of care for patients.
The MMA presented its findings to the Health Ministry in July. Dr Manalan said the ministry felt the results submitted by MMA needed more study and, therefore, it might do a further survey.
“In the meantime, the MMA executive council’s recommendation to the health minister is that there be a moratorium on the number of medical colleges or house officers until we have enough training facilities in government hospitals and better supervision of the new doctors.”
Equally concerned about the efficacy of the shift system was Prof Datuk Dr Kew Siang Tong, dean of the School of Medicine in International Medical University.
Although housemen were getting enough rest, Dr Kew was concerned with the MMA survey of HOs thinking they were not getting enough clinical exposure compared with the on-call system.
“That’s very significant isn’t it?
“But it’s reasonable because they are spending less time in hospital, less time with patients.
“Then there is a question that asked if the housemen are able to log in more procedures than in the previous system — a very important question — and only 25 per cent of the respondents said yes. That’s a very telling indication about the current system.”
Another factor that pushed for the implementation of the shift system was the big increase in the number of HOs over the years.
“The Malaysian Medical Council used to register a few hundred house officers every year, but now, it’s about 4,000 annually.
“If we follow the old system where everybody works the same hours, there will not be enough place for them.”
But the major concern for Dr Kew, which she believed was shared by many of her peers, was the lack of continuity in caring for patients.
“Now, put yourself as a patient. You’re seeing different faces all the time. You’d be confused and worried when different doctors tell you to do different things.”
It also puts the housemen at a disadvantage, for if they didn’t see a patient from beginning to end, they would not know the patients’ progress.
When housemen don’t get proper exposure, are not confident of their skills and do not know their patients well, this creates extra stress for medical officers as the work burden would be shifted to the seniors.
Another senior specialist opined that if we wanted quality doctors, we should control the number of doctors being churned out.
“If you count, the number of medical schools in such a small country is amazing. Yet, we are also sending students to Russia, Europe and other places. If this glut continues, we will soon have more doctors than nurses and end up like the Philippines. We will have to export our doctors,” he said.
Although conscious of the fact that our doctor to population ratio has yet to reach the aspired 1:400 by 2020, Dr Kew thought the problem might be distributive in nature.
“There are more than enough doctors in the Klang Valley. But if you go to Sabah and Sarawak, there are clearly not enough. So, the medical and healthcare service planners have to look at the problem in its totality.”
The sheer number of housemen had made the previous on-call system unfeasible, but the criticisms on the current shift system cannot be ignored.
Dr Kew, who has trained housemen for years, candidly admitted that she did not know what was the best way forward.
“There are only 37 designated housemen training hospitals in the whole country.
“On the other hand, there are some 4,000 new housemen every year. They need to be paid too and the government’s coffers are not a bottomless pit.
“It’s a difficult problem to solve. It may come a time when there’ll be housemen without jobs because there are only so many vacancies.”
Read more: SUNDAY SPOTLIGHT: Housemen can rest but learn less – General – New Straits Times http://www.nst.com.my/nation/general/sunday-spotlight-housemen-can-rest-but-learn-less-1.134094#ixzz25I9tiHcV
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Hopefully MOH will take a serious look into this. But I think the root of the problem is the increasing number of the medical schools, producing too many houseman. And not to forget the recognization of some overseas unknown universities for ??? reasons.
Close down half the medical schools and impose a credentialling exam every three years. That will definitely reduce the ‘glut’.
an exam after housemanship will do to eliminate all the useless ones
An exam to eliminate a certain no of candidates is politically incorrect and
No politician will want to do this dirty job.
Yup! That’s the reason the cabinet rejected common entry exam and our ExDG got kicked out
Stop sending students to egypt/russia/indonesia.
Introduce common exams which our Ex-DG wanted to but rejected by cabinet! Thousands are being sponsored by MARA, Majlis Agama and JPA.
Stop sending student to oversea. No matter whre u’ve been sent for undegraduate, ultimately u’re just HO. There is no graduate from UK straight away become specialist.
As a beginning, stop sending student to indon, Russia, Egypt, Ukraine. These 4 countries mainly contribute to current prob.
They are not the main contributors. When all our 34 medical schools produces at maximum capacity, our local graduates alone will be 7000!! Do your maths! overseas contribute about 1-2000/year.
The problem is local private uni. , taking in as many students as possible to increase profit. The local uni should merge and also ensure 80% of teaching staff are locals . increase the admission criteria to at least SPM 5science subject A+, currently now 5 B, which is too low. Because many students who are getting 5As are also struggling with their medical studies .
then most of these schools will close down. Politically incorrect mah!
SPM standard is getting lower and lower. They really should raise the entry requirement.
So many blaming the universities, the system and others. I would say blame yourself as well the houseman (not all). When the houseman start working, they demanded fixed working hours, more pay, spoon feeding teaching, no on call, asking parents to write complaint letter and others. Now after become MO, only they admitted lack of training, no skill and confident. When there was a change for you to learn, you refused to sacrifice and now you dare to complain? Remember you are the one who made the system like today because you refused to sacrifice. I feel that those who were not willing to sacrifice has no right to complain, they deserved what they are now. Other reasons mentioned above are also the cause. The politician and medical school already earned the money and after graduation, they throw the problem (substandard graduate) to the system and hopefully the system can correct them but in fact, the substandard graduate already distorted the system.
Well, most of the med school are political connected. All they interested is money. Lets face most of the students and parents are to be blame too for this. U just go down to med school and ask them why the want to become dr, likely you will be told things like ‘I did well for my pre U’ or my fren want to be dr etc all these non sense. Young people these days are loss, perhaps everything are fix for them in their whole life until they have no idea how to plan for their life. The parents equally worse. They think dr in front of the name is for the ‘face’, think of it, what can be more ‘face’ rather your own child being called as dr. The others just simply wants to arrange everything for their child. That is why when something goes wrong in the work place you will see the news splash in the front page of our newspaper.
changing undergraduate med into graduate entry might be an excellent solution
possible but “parents” will complain!! Education is not free in malaysia. Do a degree before medicine !!
agree with u.I would have choosen graduate pathway if I were financially capable. not sure how US,australia med student support themselve.
Perhaps in consideration of giving scholarship,those who enter graduate entry should be given priority.
in the past few years australian medical school gradually “upgrade” into graduate entry.Athough this wouldnt solve the “quantity” problem but i believe this bring out the ‘quality’.
Most developed countries are moving into graduate schools. In Australia, education is free for their citizens! Same goes to some other developed countries.
I am a 4th poster HO, and being in the shift system, I can say my continuity of care extends to the whole ward I’m in. The reason? Because some useless fellas went missing in action during ward work! They can do all their photostated reviews that all I care but going missing for more than 2 hours more than once a day sums it all. Some went for solat for 2 hours every session, some went for lunch time 11am-3pm, some even went kenduri and worse still, some went doing locum in housemanship!
Continuity of care depends on how willing are you to participate in the care of the patient. In the old system, some may only be taking care of the same 2-3 patients a day till the very end. In the shift system, the number of HO dwindled, so you have to take care of around 8 pt at the very least. The problem lies in the attitude of the housemen because in the new shift system, everyone in the ward is your patient. This can’t be done if we have plenty of substandard HO’s with one leg kicking.
I am not that worried of the HO glut because there are only 10-20% functional HO in the hospital and perhaps another 20-30% are those who are willing to work hard to learn. But the rest, they are really murderers! Their ignorance can be brutally fatal to the patients. The same goes for our KKM nurses, who in fact had a worse scenario where a layman can do better than them. Hoepfully a proper selection would be enforced so that we could kick out these substandard HO and MO’s before they become substandard specialists.
Unfortunately, you can’t remove the 80% useless doctors from the system, which means, they will continue to occupy the post. This will reduce the number of vacancies and all the post will become full soon.
2-3 patient’s a day?! No kiddin?
The shift system does work… even when understaffed.
As an intern i’m very comfortable looking after around 10 patients. Things start to go crazy when you go above 15 patients due to simple logistic issues.
But with teamwork it is all possible.
Knowing your patients
– brief HOPC
– key Mx points
– ***what needs chasing
– d/c plan
^ and being able to handover all the above in under a minute to the next guy.
is very important.
Once the list goes above 15 patients, my team struggles to maintain a typed out handover list… so everything gets done verbally. It works.
The cover intern can make life alot easier for the team as well… when things go quiet, they can help update the handover list.
“teamwork” does not exist in our healthcare system! Too many “non-functional” interns in this bolehland! It is the entire system that needs change, kick out those who are not functioning.
Erm, teamwork is knowing your 15 patients in and out, and also knowing what the other 30 patients is doing.n_n”
In certain dept, we have one HO covering PM and also during night shift in each medical ward. That’s one HO for resuscitation, doing admission and taking blood for more than 40 patients the whole night (along with abg’s, RRT workup, anemic workup.. ) 😛
Are u a Ho? Each time I go and see a medical referral the Ho would gave a comment answer when I ask about they patient. Guess what they told me ‘ I was told to refer this case to you. I do not know this patient as I just incharge this patients ‘. Talking about team work, well I definitely never see before.
I have worked in the shift system in a different country before, the system actually working,if the doctors showing the right attitude; and if there is proper handover/passover after each shift. We would never go home after our shift unless the patients are stable and we all done our handover to the next person on subsequant shift.
In these countries, the quality of products are good and well controlled, unlike our Bolehland. Furthermore, they will kick you out if you don’t perform.
i think this is merely a symptomatic problem of a larger institutional, political and civil crisis looming in our country.
Dr Paga, why worry bout the “hematuria” when we should remove the “renal cell carcinoma”?
because it’s probably already metastasized…
The renal Cell Carcinoma is in advanced stage! Incurable!
And not only is houseman training affected, how about training to become a specialist, even in Masters program? With issues like “missing consultants” even in UMMC – the premier institution, how are the junior specialist going to learn properly? Refer : http://www.mmail.com.my/story/lamentable-patient-care-27549
This happens in all government hospitals in Malaysia. NO proper supervision from senior consultants. The good ones have left the civil service due to frustration with the system. So it is the “blind leading the blind” phenomenon. I just heard a patient who went for elective lap cholecystectomy died in a government hospital and the patient’s relative do not even know who is the surgeon who operated. No surgeon even explained what happen to the patient post op. They never saw any surgeon except some junior doctors!
How do I know whether I’ll be suitable to study medicine? I know passion is one and I want to save life and help people. Other than having smart brains what else should I have?
Not everyone has smart brains (I know I don’t.), but you do need a decent one. You have to be wise, instead of smart, to be precise. To know how to handle different scenarios and situations without doing harm to the patients. More importantly, you have to think on the patient’s behalf too. Imagine yourself in the patients’ shoes, and do the right thing as how you would want the doctor to do the same for you if you’re sick. If you’re doing that, you’re on the right path.
Go to the worst rated hospital in the country for a period of observation, and despite all that, if you still think you have the passion, then you may start considering. However, after med school and 1 year of housemanship, you’ll probably find that ‘save life and help people’ aren’t reasons to do medicine. If you want to save life and help people, be an organ donor rather than a doctor. For the record, doctors hardly ‘save life and help people’
medicine needs pit crews not cowboys.
It’s grueling, and the learning is continuous.
sheer perseverance.
you also need dashing good looks, ability to work without sleep, and a strong positive karma balance.
ok the last sentence is made up
You need brains for sure but this “saving life and helping people” thingy does not happen in real life. It only happens in TV dramas. I would say that less then 20% of the time, you can actually save lives. Most of the time you are just prolonging life and giving comfort. Except for some infectious diseases and some correctible surgical conditions, you can’t cure most of the other diseases. You are just controlling the disease and thus prolonging people’s life! As for helping people, there are many more ways you can help people!!
Have you read all my post under “For Future Doctors” page. Your answers are there. If not please read the following articles atleast
1) https://pagalavan.com/2012/03/28/for-future-doctors-do-you-want-to-be-a-doctor-by-dr-wong-yin-onn/
2) https://pagalavan.com/for-future-doctors/the-depressing-side-of-being-a-doctor/
3) https://pagalavan.com/2012/06/22/for-future-doctors-the-depressing-side-of-being-a-doctor-part-2/
GH is becoming rubbish with all of these young docs attending to patients with lack of supervision..had a bad experience when my dad was in hospital recently… Toally cannot make it both the MO and HO.
And the medical students!! Some patients were complaining that they were seen by a batalion of doctors!! I presume some of them were students.
Some of the H.O are aware that they are lack of training, but a big group of them still continue to make complain to KKM/newspaper, demanding more day off ( after PM shift one day off and after a double shift 2 days off)and to increase the RM 600 allowance. By the way, they also demanding for the 1 hour breaktime during every shift they work. So, it means that even the MO/ specialist are doing busy round in afternoon/resuscitating patient, H.O still can walk away and said that :” now, i am going for my one hour break”….and their superior cant say No…otherwise, they write another complain letter to KKM.
All you fellows really sound like cry babies…..in all jobs there is the supply & demand factor. Before you chose to study medicine or for that matter accountancy or engineering or IT, you should have investigated the future job prospects.
Someone suggested closing down medical colleges….why should they…as long as they get students and can make money they will go on. Its a matter of time…before the Supply & Demand factors will automatically adjust….and less students will opt for medicine…and that will automatically close down many colleges.
If you cant find a HO job, then look for other options…just grab any that comes along….lots of clerical jobs vacancies around…and they pay well too…in Klang valley you can easily get a job paying rm1500-rm2000. But if you got too much pride then sit home and lay eggs. In Malaysia we have maybe 1million foreigners…so dont say you can find jobs here. Graduates of all other fields too often settle for other jobs, so what is so special about you medical graduates.
Yes, that is what I am trying to say that doctors can also become jobless. However, many still don’t believe it. The only sad part is that they would have spent almost half a million doing medicine just to become jobless, unlike other field. Your options are also limited.
Of course, you can see MMBS grads working as pharma reps in Vietnam, India and Phillipines.
The supply and demand factor with medical schools in Malaysia is not totally market-driven. While I agree that there are many parents who want their children to do medicine without fully understanding what it entails, many medical schools also survive on govt-sponsored students.
For example, Perdana University’s first intake were all JPA-sponsored students ….. all 50 of them. This is because no parent was willing to pay RM1,000,000 for their child to get a medical degree from a new medical school (that isn’t even John Hopkins). Similarly, other private medical schools in Malaysia and some of the cheaper overseas ones have all made arrangements with the govt to accommodate sponsored students. This is for 2 reasons:
1. Guaranteed source of income
2. Almost no chance of their medical school being derecognised
The govt on the other hand, are still sponsoring students because:
1. It supports the cronies that have a share in these private universities
2. It’s good politics to show that more students are getting scholarships, especially medicine because this makes the voters/parents happy
3. It helps flood the market which will probably bring down doctors’ fees but this is of course at the cost of quality
I do agree with you that all jobs are governed by supply and demand factor. However, I disagree when you say that medical graduates are no different from others.
1. For starters, medicine is the most expensive course to study that no other course even comes close. Not every family can afford to pay for their children to study medicine. For some doctors to be, their familiess sacrifice a lot more compared to if they were to study other courses. In which case, are you saying that we should only allow the rich and those who can afford to pursue medicine ? Since when did medicine become a field exclussively for the rich ?
2. It has the longest course duration. Tell me another course that you need to study for 5-6 years before you get a basic degree, and despite that, you still cannot work independently because you need the full registration to do so, and that will only be granted with completion of housemanship. Therefore, you will be spending 5-8 years to accomplish what others will be able to do at 3 years if you were to opt out of medicine after you graduate. On top of that, it has a certain window period for you to get recognition. You cannot graduate from med school, spend 2 years working as a clerk and want to do housemanship again. If you do that, you will need to be assessed all over for competencies prior to getting a housemanship job, which is not easy as competencies can only be maintained with practice.
3. Because of the importance of housemanship training as the gatekeeper to ensure that doctors achieve certain standards before allowed to practice independently, it should never be messed around with. Here in Malaysia, we are seeing the entire housemanship training being messed about to the extent that some can waltz through the 2 years without having learned anything. Bear in mind that everytime you see a doctor, there is a 1 in 2 chance that you are misdiagnosed / mismanaged or even be killed, are you willing to risk your life by seeing doctors who are actually not competent because their education has been messed about at a very crucial stage ? You can say that if you got the money, you see an elite specialist, but even these world class specialist would have to go through housemanship before they can make strides to such greatness.
4. Regarding closing down medical schools, it is not about their ability to make money, but more concerning it is the way they are doing it. When you have so many medical schools that everybody is taking Tom, Dick and Harry, not providing adequate training and then let these people graduate, You are directly putting a strain on the housemanship system because not only are you required to provide job numbers for these people, but you also need to provide a lot more training and supervision so that a certain graduate from a certain medical college do not stand at the bed end for 2 minutes to ‘assess’ a patient when the cardiac monitor is showing ventricular fibrillation. By the way, I still don’t know what that above doctor who was a graduate of a certain private was assessing.
Nonetheless, you are right that a lot of other graduates have to settle for other jobs, but since it takes so much time and resources to train a single doctor, one should either not do medicine at all or opt out at an early stage, not after you have completed 5-6 years of training.
In the economical sense, medical graduate is indeed no difference with others and the value of such graduate is determined by the supply and demand. The pricing of medical course is expensive because the demand is high and thus the providers are able to put a high price tag on it. This is willing seller and willing buyer principle. The family may have to sacrifice a lot but the choice is still yours. The medical course is long duration because this is the nature of this course, you need 5 to 6 years to learn the basic things. If we follow the economy principle, the medical schools will close by themselves if the demand is low. They may have to cut the pricing as well if there is no takers.
However, it is a different story once the student graduate as medical doctors. It is again about demand and supply. When there is 6000 to 8000 new doctors per year join the market, the employer (MOH) has all the advantage to set the rules of the game. The doctors are simply don’t have any
bargaining chip. This is why medical education should not be a private business. In Malaysia, the politician set up the colleges, siphon out money through PTPTN and gov scholarship and churn out bunch of trash and make the MOH to accept them all. End result: Malaysian public will suffer. This is capitalism at its best!
[…] Comments « For Future Doctors: The Hurricane is coming ……… Part 2 […]
Dear Anaes SpR,
Your point 1.
No, medicine is NOT the most expensive course to study. It depends on where you study…if you wanna study in UK…well a million rinngit maybe be…but if you study in some other recognised overseas Unis …you just need one hundred thousand ringgit. Now dont argue on that because I have a child who just graduated as a doctor
Your Point 2.
Medicine is not the only degree that takes 5 yrs. Even architecture in UK takes 5 yrs plus 2 years professional work placement. You can check out the internet to see list of other courses that takes 5 yrs and maybe more.
Your Point 3.
Many other professional degrees also need 2-3 years practical experience in addition to their first degree to obtain a full qualitifcation..Let me give you an example…ACCA accountancy degree is incomplete without 3 yrs practical experience. And if you wanna continue with CPA or Masters etc …you will probably need another few years. Architecture also needs 2 years professional work placement. And btw, they dont get 3-4k like housemen during the 2 yrs. Do you know that in India housemen DONT GET PAID.
Your Point 4
I have heard this comment many times in this blog. I dare you or anyone here to mention by name a few medical universities that they claim produce sub-standard doctors. These are recognised universities..and students who qualify (at least after year 2004 ) have the required academic qualifcations..many even straight A student).
Now dont tell me the Malaysian public universities are fantastic, we all know the quality of the students enrolled in them.
There is that much a University can teach and train. It all depends on the individual student to excel & accquire good working experience…so dont make general statement based on one observation. Just like in all other profession there are good accountants & useless accountant, good engineers & useless engineers. Dont expect the Uni or your Superiors at hospitals to spoon feed. If you want to excel, you put in the hours.
I agree in all your statements except the last! Your claim that after 2004, all students who do medicine overseas are academically qualified is WRONG!! I know NOC was implemented after 2004 BUT even without NOC, you can still do medicine overseas! There is NO law to prevent this. I know many students who do not even get any As or Bs and arts stream students doing medicine in Russia, Egypt and Indonesia , of course in recognised universities!! Recognised universities does not mean “good” universities. Even in malaysia, I know private medical schools accepting students with Cs in SPM despite the criteria by MMC!
I have seen countless number of students graduated from Russia ( some even admitted this in this blog) who don’t even know how to take a history, examine patients and come to a diagnosis. These are basic stuffs that are thought in every universities in the world!! So, how come they don’t know? blame the students ? I have personally spoken to some of them and I know FOR SURE that the university DO NOT teach them anything !!. Before you can venture further in medicine, you need to know the basics. That is the reason why you spend 5 years in a medical school.
So, the universities do play an important role, no doubt about that!
Some of these Russian student told us that they paid their lecturer to get thorught the exams. The difficulty of the exams related to the amount paid. Some of the elective student even ask us to give them tuition. Not their fault but they said they don’t see any real patient in their clinical posting as all of them speak russian and most of these Russian patient don’t want to see them either. They end up reading books in hostel or having fun elsewhere. When they graduate, they expect us to teach them all over again during housemanship. I don’t think that’s fair for us the clinicians and certainly not fair for our malaysian patients.
Well, I do agree that its not the most expensive course, since I’m getting it for Rm15k for 5 years(tuition fees + accomodation) in local public Uni. And yes, other degree do have 5 years and beyond, which, just like any other professional course, we are advancing through more and more updates.
However, one thing is, recognition of university differs between countries as in due to political reasons and different needs and demands. Perhaps one would need to see to believe. I’d always thought I was underperforming, but I patched up with extra hours in the shift system, an hour earlier to work and back 2 hours later, esp during my very 1st few months at work, just to grasp a feel and to learn more. But the reason of such substandard HO’s are mostly due to attitude problem, unwilling to work or learn. Leaving when the workload gets more in the wards and to run off to sleep when their patients collapse, letting other housemen to attend to the patients where they are the main care-provider. (HO in-charge) I am seeing it with disbelief with the lack of concern.
whats not fantastic about students enrolled in pubic universities doing medicine compared to students in private universities?which one has high standard?explain………………..
Point 1:
i think that you are being unfair to compare worldwide because cost varies everywhere. If you want to compare, you should compare doing medicine in Malaysia vs doing other courses in Malaysia. If you exclude the government universities because they are more or less wholely subsidised, studying medicine privately is indeed the most expensive course in Malaysia. if you compare worldwide, you probably can study medicine with RM50k in Somalia, and likewise it will cost you a whole lot more to study engineering in MIT.
Point 2 + 3:
Again it is unfair to compare like this. You are talking of the time it takes before you can practice independently. 5 years of architecture + 2 years professional placement and your education is complete. Even for accountancy, it takes 3 years to do the course and 3 years for professional qualification, by that time you can put your signature independently. But not in medicine. If you compare it this way, you will have to compare against a consultant and it takes almost 15 years to be a consultant in medicine from entry into med school. I am a specialty registrar, a considerably senior position in the training hierrachy, yet it is illegal for me, at least in the UK, to practice without having a consultant who will be responsible for what I do.
Point 4:
What does ‘recognised’ mean ? I had a friend who went to a certain med school abroad who used to preach that his qualification is ‘recognised by WHO and MMC’. That doesn’t mean graduates of that school consistently achieves a minimum level of competency expected of a house officer, although by right, it should be that way. And speaking of ‘students who qualify’, when I was doing my final year elective in UMMC, there were 15 other final year students from a certain local private university with ties to a med school in the asian subcontinent also doing their elective as their final posting before they graduate. We are talking about people who will be doctors in the next month or two. 14/15 did not know how to do basic procedures, one of them attempted to put an IV cannula from proximal to distal. average time for taking history is 1 hour (most of the time missing the cardinal features), physical examination for each organ system 30 minutes (again missing red flag signs), formulating diagnosis by trial and error and have no clue on how to manage. Seriously, are you going to put your life in the hands of these doctors from ‘recognised’ universities ? If you are willing to, please let me know. I am more than willing to find such a doctor from ‘recognised universities’ to be in charge of your care. Please put in writing that you indemnify me against any potential bodily harm that will occur as a result of your decision. On the contrary, I think that most local public uni grads still have some level of competency, compared to none for those from certain ‘recognised’ universities. In the grand scheme of things, I think that having some competency is better than no competency.
In medicine, you can read all you want, but until a teacher has felt a lump that a student has felt, agrees or disagrees and corrects his / her technique / impression, a student will never be able to differentiate between a benign lymph node and a malignant tumour confidently. If indeed simply putting on hours is sufficient to be good doctors, I can provide you with the best medical textbooks in the world, all the world leading journals with high impact factor, but without clinical guidance. And with all that, if you managed to survive a 25 year career without making a single serious mistake (I am so kind to you for allowing minor mistakes), I think you deserved to be given a royal professorship.
oh sashi…i dont know if you completely lost the plot or i misunderstood you completely. maybe the former
sorry but my comment here is on another topic. Extension. Well first and foremost having the extension system is good to ensure quality. However is there a criteria to extend HOs? I have came across many incidents among housemen who get extended based on subjective criteria which is obviously unfair. There are assessments but it is of no point if there is already a result to fail even before one is assessed. There are also incidences when all assessments have been passed but still got extended with the reason of attitude (a very subjective criteria). Some are even left in the lurch why they get extended. Some have left sick of being untreated fairly. To extend for obvious reasons is fair like not turning up for duty, killing a patient, negligence and so on. There are those not extended even some of the above have occurred. Well lets bring to the criteria of attitude. There are hardworking houseman those fellow staff who like to work with get extended for a reason not tracing results soon. Truthful, sincere ones and those acted promptly to rectify problems were extended because they caused the problem even tough the patient was not affected. Those who dont work well with anyone but smart in being Mr nice guy is let loose.There are many examples but being extended due to unfair reasons breaks the spirit of the needed good houseman. I have observed that it looks like a HO does not need to be smart, hardworking but just needs to know how to polish the superiors will do.
The superiors should treat fellows HOs fairly especially those who are working in hospitals which DOES have a shortage of houseman and not to leave a fear filled anxiety among houseman. There are also this attitude among superiors to find scapegoats for some mistake done.What are they trying to achieve by extending such an HOs? They are just ruining his record. Aint it a pity.
Fell free to extend HOs who have no work ethics, abscond, treat patients badly mismanaging them etc.
How do you expect then HOs themselves to work optimally with a positive mental?
Furthermore …. where is work HOs are sitting ducks with no backing so much so everyone is for themselves whereby even HOs are weak to back each other up because they fend for themselves first when is this kind of situations. So is there a encouragement and practice of teamwork? NO. When HOs get mistreated, insulted, deceived by other staff we cant complain because the superior would just say why not u can do it yourself what. True. But what are the others for then? HOs being sabotage by other staff? Example: Forms filled by deliberately lost but said already sent.
How to work like this? Others can scold and complaint about us but we cant for if we do we would be MARKED and deliberately given an extension. For what? Attitude problem.
So called wanting the HO to change is attitude unfortunately is not but instead very damaging.
Extension is a good system if carried out fairly if not its just damaging and a lost if unfairly treated good HOs leave.
Being a doctor is also doing job and when you are working, you will some how involve in some working politic. So jut be smart. If you are good in our job and your interpersonal relationship, you should nt have any problem of getting extended.
In our government service, there is not such thing as a fair system. This problem is not just limited to doctors, it happens in the entire system. That’s why many of the good doctors/specialist have left the system, leaving behind the apple polishers and world travellers.
I have difficulty understanding half your sentences!
you have done better than me…..
You just have to be wise and street-smart in order to avoid yourself from getting sucked into these all kinda problems. It happens almost all the time, especially when you’re in this system, just like what Dr. Paga has said. You just have to learn how to deal with it. As long as you’re in the system, you have no choice but to play their game. Just learn whatever you can, and leave when you think the time is right.
Dr, i was offered medic in aucms and bio informatic in um. Which one doy u think has more promising career? i personally prefer bio informatic but still in doubt.. thanks for yr advice, doc.
Do what you are really interested in. JOb prospects changes all the time
Sir,I am going to study foundation in medicine at UPNM as a civilian student.Is the degree from public universities is recognized qorld widely especially in the countries like India,singapore and australia.I also want to know about the difference between MD and MBBS
Definitely NO. MD and MBBS is the same!
Sir,so can I go to overseas after getting some working experience here or I need to sit any test at overseas to recognize my degree.