My last blog entry on 17/02/2014 received the highest number of views in a single day since it started, 4 years ago. It achieved 11 195 views in a single day!! This goes to show that there are many who are worried about the situation. I also received few emails and blog comments from students who are doing medicine elsewhere without the minimum requirement introduced by MMC in 2011. It is very sad that our society is still a very ignorant society. Some of them are not even aware of the guideline! Are we leaving in caves? With the information technology, there is no excuse! I would blame it on our education system!
When I read some of the comments and emails, I realize that there are many who are doing medicine with pathetic SPM results. Majority do not understand what medicine is all about. With many dubious and mediocre medical schools out there, getting an MBBS degree is as easy as any other course. What you need is just money!! Money talks! How many students who go to Russia ever failed their 5 years medical course? We have heard and seen many mediocre students doing medicine in Russia as well as in some other universities in Indonesia, China and Eastern European countries. I know one who got 9Fs in SPM but was doing medicine in Ukraine! Some of the comments that I received in my last blog entry just proved the scenario. The poor entry qualification is one of the main reasons why you see graduates with poor quality from Russian universities ( the talk of the town). On another note, there are good students who go to Russia, as they could not afford any of the local medical colleges. These students generally do much better when they start working. I have heard horror stories of what actually goes on in some of the medical schools!! The fact that they do not even know how to take history and examine the patient, tells you a lot. The very basic reason why you go to a medical school !
Many were tricked by agents who promised guaranteed job, similar to what happened to thousands of nurses. They were told that as long as they have a MMC recognized degree, they would get a job when they return. Well, it is true at the moment but not anymore. With limited number of post within the next 2 years, having a MMC recognized degree does not mean anything. Having a degree, which is registrable by MMC, does not mean you will get a job. It is the same in any other country. In Malaysia, job is given by SPA and Ministry of Health. MMC only provides Temporary MMC registration for you to undergo Housemanship.
With so many dubious Foundation programs organized by many universities as a “short-cut” to attract students into their medical school, MMC had no choice but to introduce the minimum requirement based on SPM results in addition to pre-university results (only A level, STPM and few other courses can supersede)!! We are probably one of the very few countries in the world, which do not use a standardised pre-university qualifications as a sole requirement. I would rather prefer if MMC makes a few well-known Pre-U courses as the minimum requirement, such as STPM, A-Level, IB, Australian Matriculation etc etc. As far as I am concerned, Foundation studies SHOULD NOT be used as an entry qualifications into medical course. Not only it is NOT standardized but prepared and marked by the university itself!! Whatever said, you need certain level of intelligence to do medicine. You may not need to be a A-star student but at least the top 5-10% of the cohort. Medicine is not for any tom, dick and harry. That having been said, you also need genuine interest and passion to function as a good doctor.
Since the minimum requirement was introduced in 2011, all students accepted into local private medical schools have to submit their results to MMC for verification. The universities will do this. However, despite this I have heard and seen many students being accepted into medical schools locally without the minimum requirement. The students are accepted and subsequently asked to appeal to MMC. When Crimea Medical University was derecognized in 2005, the NOC was introduced. The government noticed that there are students who have very poor SPM/STPMresults, from Arts stream and even those who fail SPM, were doing medicine in Crimea. Unfortunately, there are still many students out there who are doing medicine WITHOUT NOC. This is simply because, they were told that as long as they have a recognized degree, it is not a problem.
Sad to say, the situation will change soon. Last year’s MMC’s guideline clearly says that those who do medicine in an unrecognized university without minimum requirement, will NOT be permitted to sit for the MQE exams. This basically means that you can forget about practicing medicine all together in this country. You can try to get a job in another country where your degree might be recognized.
When the job market gets saturated, the government will become choosy as any other profession in civil service. Preference will be given to government-sponsored students and local public university graduates. This will be followed, by the rest. With limited number of post available, what criteria will SPA use to offer employment? This is where your NOC will come into force. Very likely that those who do not have NOC or the Minimum entry criteria will be the last choice to be offered a job. You may end up jobless as there will be almost 6-7,000 graduates/per-year by 2017.
Obviously, there is no law to do this but getting a post in civil service is a privilege and not a must. The only problem in medicine is the fact that if you do not do housemanship, you will not be able to practise as a doctor in this country. Thus, MOH is working on a few formulas to decide on who will get a job in MOH in the future. With the civil service being controlled by almost 90% from a single race, the people as well as the politicians will make transparency and biasness as an issue. So, we need to come up with fair and transparent criteria.
Over the last few months, many suggestions are being discussed at MOH level. The first suggestion is to give housemanship post on contract basis, after which you need to sit for an exit exam. The exit exam as well as your superior’s assessment will be used to decide who will get a MO post. Basically, you need to reapply into government service after Housemanship. What happens to those who fail? Obviously, you may not be able to work as a doctor or may need to redo housemanship.
The latest suggestion, which is seriously being considered, is the common entry/licensing exam or MMLE. Many countries as well as many other professions do this. Even our nursing board has exams similar to this. The lawyers have CLP but they can still work as legal adviser without CLP. For me, this will be the best option. MMLE should include all graduates including the local public and private universities. It should be standardized and centralized by MMC unlike the current MQE exams. Only those who pass will be able to get a job. This will definitely remove the mediocre ones as long as it is fair and transparent. Unfortunately, this was suggested by our ex ex DG (Tan Sri Dato Dr Ismail Merican) but was shot down by cabinet due to political reasons!! In Malaysia, education is always politicized!
So, for those students who do not have the minimum criteria, please do some other course. This is my advise to you. Firstly, unless you do well in a well established, standardized Pre-U course, you do not qualify to do medicine. Secondly, with the soon to be surplus of doctors, your chances to get a job in Malaysia will be slim. Finally, do not waste your parent’s money. Put that money to good use. I would also like to advise parents that they should not force their child to do medicine and please do not ask your child with mediocre results to do medicine. You are committing a crime to the society. I have seen enough mistakes being done by the current generation of doctors, life threatening mistakes that I have hardly seen before. It clearly shows the deteriorating quality of doctors in our community. We do not want to see students with SPM results like below to do medicine. In “real and genuine” medical schools, they will not even survive the first year. I am not saying that all good grade students will become good doctors but you need certain level of intelligence to do medicine coupled with passion and genuine interest.
FYI, the SPM result below is a Russian graduate who applied for Master’s program. A friend of mine who were interviewing them sent it to me!! She got a shock of her life when she saw the result!! Obviously, this student would not have got a NOC based on the current criteria. Obviously, she may not get a Master’s seat, as the competition is getting tougher.
Our ignorant society needs a wake up call……………………
Failing is not an option in Russia, as the saying goes ” In Russia Everybody Can Pass !! ”
However, there are still students in Russia who work 2X maybe 3X hard to compensate what is lacking here. So i do want to salute those students because it’s not easy to keep working hard knowing that in the end the mediocre ones as well as yourself will get the final graduation certificates
And regarding why good students come to Russia, I think many of us have been cheated by good words by middle party !! Think about this, 18 yo fresh from SPM being offered Moscow, who wouldn’t accept this offer !!
And nowadays Russia’s fees have increased – hostel to university..It’s not cheap anymore..In Moscow itself without 1000/month you would not survive ( except if you eat white rice and fried egg everyday ), that is not including monthly hostel fees about 1200/month !!
Im now studying in Moscow myself, going to graduate in 1 year time. I admit I didn’t make a good decision when i was young so here is my advice: if you want to become a doctor, think twice, thrice, four times, maybe 10 times !!! Then think about 100 times before coming to Russia..If you still insist on coming to Russia, be prepare and you have to accept that we must work harder than local graduates because clinical exposure is very limited here !!!
But that does not go to say that Russian grads could not adapt when working in Malaysia, it all depends on yourself !!
Exactly, I have seen good students from Russia but generally most of them have a good entry qualifications like good STPM or A level results but unable to afford local medical school.
Im a student from Russia. I don’t have very good results in my SPM. But here Im sure I am hardworking enough and i scored excellent marks in all my exams so far. SPM doesnt judge how smart or stupid are you. When i was 17 I was not a very studious kinda person but now I am. So it doesnt matter what you got in SPM its about your further studies and how much knowledge you have after it.
The problem with many of you guys are the fact that you feel that just because you pass your university exams, you are good. The questions that you need to ask is the fact that there are no failures anyway? I know students who passed their first 2 years of the course locally with flying colours but failed when they entered their twining program in Canada, UK, Australia and NZ! Most of you all do not understand what a real medical school is all about. You have not tasted it and thus you feel that you are good. I am not saying you are not capable but you are not aware of what is on the other side of the fence.
Sorry dr Paga,I just felt the need to rectify the fact that you kept mentioning that there are 0%failure in Russian universities.There are people failing,in fact, a lot.Just that we have a chance to retake the test/exam,and had to pay for the extra classes and re-exams.
And there were students my batch being expelled in 3rd year because they cannot pass their 2nd year exams.
Yes, it’s true we Russian grads have limited clinical exposure,but what we were exposed to are according to the Russian system.they have their own classifications for practically everything..and we spent 6 years adapting and learning that. Then when we graduate and become HOs,bam,we are expected to know another set of completely(or almost)different classification of diseases and drugs and stuff..can you imagine the struggles we have to go through, not mentioning the language barrier(when you are used to using Russian to clerk patients,suddenly u have to use Malay or local dialects)and the pre-existing bias against us?
I do admit in the beginning,whenever being asked a question, I would need some time to process, and a lot of translating process going on in my mind at the same time(as there are a lot of terms that I knew in Russian but at a loss if in Malay), and when answered according to what I learnt, it’s a different explanation or classification than what the local students learnt..of course I would have appeared dumb.
But I’m glad to say, I don’t regret my 6 years in Russia.no one other than those who lived there would have understood what hardship we faced as foreign students there.it’s those experiences that made me who I am today, and that,I wouldn’t have changed for anything else.
I graduated 5 years ago,done well in my HO-ship,and now in my 3rd year of MO-ship.and I’m very sure I didn’t bring shame to my university.
All in all, I still think it boils down largely to the attitude one has, and the willingness to learn, to improve what is inadequate.
That is what I am saying, how many actually fails. repeat exams and eventually you will pass.
As I said above, generally the students who do well are those who have adequate entrance qualifications and the passion and interest.
Funny how the requirements were introduced in 2011 and I still know of friends who are doing foundation (some have gone on to degree now) in universities such as MMMC , Mahsa, etc
I will be honest, my parents wanted me to do medicine as well, they never outright said it but they hinted at it alot. Initially, it was my plan as well. Then after I got my results, I was offered a full scholarship in the IT field and I took it, thinking that I dont want to slog for the next 10 years of my life, no matter how much I love Biology.
Though, now looking at so many friends of mine, even the not so smart ones that are doing medicine, I can’t help but question my initial decision. Did I make a mistake? Should I have chosen medicine instead? I think one of the reasons tht people like to choose this field is because of the high pay. 3.7k nowadays and the most a job in my field wld be offered is 3.5k. I can’t help but be saddened by the fact that, had I chosen medicine and pulled thru (which I’m very confident that I can), I would be earning tht much in the future as well. Too think that all these rich people whom I know, who I performed better than during my school days will be earning more than me is quite depressing to be honest. I mean, I worked a lot harder! 😦 The pride that comes with being a doctor is just an added bonus of earning a good pay, so in a nutshell I believe that the pay is the factor that attracts students. You can check the pay for different professions in Malaysia, doctors are the highest (fresh graduates), ignoring those who venture out into business.
Just my thoughts. 🙂
See, that is exactly what I am saying. NEVER do medicine for wrong reasons. Have you read my article on “how much do doctors earn ?” Please read that and you will realize that the salary is not high compared to the workload, lack of social life and the risk that you are taking. Many people get excited about the starting salary but don’t bother what happens after that. Trust me, I have seen many of my IT friends earning more than me within less than 5 years of service. Mind you, rest of the profession start their working life 2-3 years ahead. Never look within a country as well.
Wrong place to go. Moscow is the heart of Russia. Prices are ridiculously high. I’m studying in a rural part of Russia. 🙂 Cheaper place to be. And I can guarantee the quality of education is very good here. To clarify some things, it’s a 6 years study (not 5), with 100% attendance rate (any miss classes MUST be replaced). Stricter rules than in Malaysia. The only problem is, we’re taking case history and conducting practicals in Russian language. We’re gonna be slow in adapting back to our society in Malaysia. It’s not like our local universities who prepare their students to work in the country itself. We’re being prepared to work in Russia, or other EU countries. Which is pointless if we’re going back to Malaysia anyway.
PS: if anyone wants to judge our standards, come and experience it first hand. It’s not a walk in the park. I’ll put it straight, we can’t study in Malaysia because of our ethnicity. We are the ‘immigrants’ who should go back to our respective countries.
PSS: I’m an STPM grad, yet I still feel very underqualified. Medicine is not simple. How ‘qualified’ must we be to become a doctor? A good one.
Being a STPM students itself gives you an upper hand. STPM is a tough exam, in fact one of the toughest in the world. If you can handle STPM, you should not have any problem doing any course. Even a B or a C in STPM is considered very good.
Your comment speaks highly of the level of your maturity, compared to some of the commenters (Russian medical students) here. It is obvious your maturity comes from your hard work you put in Form 6. You will fare well in housemanship to be honest.
Oh by the way, there is a lot of fallacy amongst Malaysians studying in Russia/Ukraine that they can work in EU upon graduation. They are obviously being duped by the agents and not aware of EU legislations. As far as I am aware of, none of the Western European countries would consider non EU students who are not local graduates to be given an internship/housemanship position in their respective countries although the medical degree may be from an EU country.
who said u could not study in Malaysia d2 ur ethnicity? half of UKM’s medical students each yr are non-bumis. Same goes to UM/UPM/USM. You did not get a seat becoz others did better, as simple as that. Don’t racialize it. Btw, UTAR’s and IMU’s med students are mostly non-bumis, and the Bumis have no issue with that. If you can afford it, why not.
Half are non-bumis? really?
Half of local grads were non bumi was in 2005 intake for UKM. Subsequently was around 30-35%. But that figure is nothing much to harp on cos UKM has almost 200-300 medical students, a very large pool.
If you can’t get a place in ipta, don’t racialise the issue. I haven’t seen students from that ‘special’ race go to med school with bad SPM / matriculation results. They have similar if not better results than you . Worse are those who have bad SPM results , falsified their results just to get entry in Eastern Europe med school . An example is what’s shown in this entry.
which uni r u studying in Russian. . ?
Dear Dr Paga,
I am sorry to say that your opinion was done with very little reseach about those medical universities and you have a bias mindset against Russian graduates. You have been mentioning about poor SPM results (which is small minority) as their entry criteria as the main reason for their eventual poor performance when they returned. Many people were confused between Ukraine as part of Russia and their educational grading system. Our grading, from good to poor is 1, 2, 3, 4, 5. but their is the other way around. That is why the exhibit given by you looked good to them.
Now, who is at fault? Of course, we cannot blame ourselves. We are good at finding scapegoat, thus we blame Crimean university or some naive students. The biggest culprits are those that sit in some high places that giving out no objection letters to those less qualified student.
When you go to Rome, you do as the Romans do. Yet, the majority that was sent by “The Agency” did their study in English medium. Russian are the people with national pride. They do not have even road signage in other language and yet we sent our student to study there in English medium. Haha…
Dr Paga, please do a bit more reseach and look a bit deeper into the Russian medical universities and their hospital practices before you comment on their medical qualities. I personally find that their is way ahead of ours.
I have done enough research. In fact I have documented evidence sent to me by students in Russia of what really happens there. Actually, most of the poor performing graduates comes from Ukraine and Kursk. Moscow and Kinzy is generally OK. BUt of course, people down here will always generalized it. FYI, the number of graduates with poor SPM results studying in Russia is more than the minority that you think
hi, I always wonder how you are able to understand complex things of medicine in russian language. even if you undergo one year language training.
I studied in english, from my preschool, however I find it difficult to understand cunningham, robbins etc…how the hell do these russian educated people undersstand these concepts in russian……….
with one year study , no-body can understand the medical concepts. it will only help you to find your accomodation or toilet.
I am working in the middle east for the past 10 years, and still I can only understand basic arabic. well I can communicate but will not be able to understand robbins if it was written in arabic…………
i got grade d in my spm. i have want to do medicine.i don’t know how
It’s simple; you are not fit to do medicine!!
i have a friend who graduated from medical school last June but is still jobless until now. Sad for him.
It is coming
That is because he didnt apply or apply late for mmc etc…there r lots of graduates n if ure late, ur interview will b late n inductio will be late…may take time up to 4 months the least before an induction.
I have a senior from my uni who specialized Ophthalmology and is now a Chief in his hospital’s department in France.
There is always an exception
Tell us more bout him…did he work in malaysia after graduating? Would b interested to know hw he ended up as chief in france. Mayb some of us would want to follow the footsteps..share us more of his story maybe? 😉
There are current Masters students with pathetic SPM results as above. No surprise that they are from Ukraine/Russian/Indonesian universities. At the end of the day, the public have to bear the brunt of these substandard future ‘specialists’!
A friend in the service commented that the Russian grads that he has worked with are the ones displaying MASSIVE over confidence to compensate for their lack of knowledge and training.
A fourth year student who was attached to one of the GHs in a big city were ill-prepared and shocked with the standard of HOs (also Russian grads) not knowing how to answer the consultant on ward rounds. Apparently questions posed were very basic and even a first year medical student in Australia/UK would be able to answer. This is very scary.
Yes I agree. Russian and Ukrainan grads generally exude over-confidence just to compensate for their lack of knowledge and training. Anyone who worked alongside would know they (not all) can be quite conniving too, a very Russian/Ukrainian trait rubbed in them I guess.
Bear in mind that, indeed that there are good quality and dependable graduates from these universities, but they are few and far in between. Also, they often come from proper pre-uni programmes like STPM/A-levels etc.
Well known fact
So much for doctors preaching on evidence based medicine.
Most of them may not end up completing the masters! I know many who dropped out. However, the masters standards has also dropped drastically over the last 10 years. This is because the government is pushing the universities to produce more specialist and not to fail students.
http://www.freemalaysiatoday.com/category/nation/2014/02/14/licensing-exam-for-docs/
According to this article, the total number of places for specialist training in local institutions had been increased from 300 to 1,000. A sudden increase and I doubt that there are enough clinical professors/lecturers to oversee these masters students, given with the sudden increase. For housemanship, there were never enough specialists to oversee HOs, and many HOs especially from certain countries got through housemanship, some which I would dare not let my family members to be treated. Would the same occur to these masters students?
This is just like the knee jerk reaction of the government many years ago to approve new medical schools when there were inadequate junior doctors and as an effect. now there are so many substandard doctors in the healthcare, putting patients health in jeopardy. So, it is probably safe to say that the same knee jerk reaction is going to produce quite a number of subpar specialists!
Actually it is not the case. It was 800, 2 years ago.However, I do agree that the MOH is pressurising the universities to increase specialist production. They even want all Master’s student to be passed!
Throughout my housemanship years ago, i witnessed how different house officers worked who graduated from different places. It’s true that there are some traits here n there in different HOs. However, it was quite established that during assessment in every postings, everyone scored equally good(if not bad), that u couldn’t tell the difference at all.
There might be some HOs who performed badly, but they could be from anywhere, coz in the end of the days, it’s all about one’s personality.
You are what you are. Our future is not some place we’re going, but one we’re creating.
It’s time for our society to grow and to be more mature.
Stereotyping is such an old-fashioned and backward kind of thing to do. To certain extent it’s just like labeling, not any far from being a racist or other discrimination.
Peace
Yes, that is what I am saying. The ason why Russia gets the brunt of it is due to poor entry qualifications.
I wonder how these MOs could pass their Masters entry exam? Isn’t that exam supposed to tough? Or part I mrcp/mrcog standard?
Majority will fail
but dr., dont they have to pass the entry exam first before they are called for the interview?
i am just curious. i am not a doctor, but i admire medicine.
Nope, not all disciplines
What is the issue of substandard SPM if they have solid Pre-U and finished housemanship succesfully. Did u ever encountered a person who have 5D in UPSR and emerged as a top scorer in SPM. Please don’t fall into fallacy that SPM is a determinant of a GOOD and SAFE doctor.
Please read the article carefully!! I have said very clearly that Malysia is probably the only country in the world which uses SPM and one of the entry requirement. Almost all other countries uses a good standardized per university entrance qualifications. That is why I suggested that MMC should just say that only certain per university courses should be used for medical school entry.
Dr.pa i agree with some points from you but , a better suggestion would be : related authority should look into these serious matter that is those mother f**ker agency like Medic Ed or (pardon for my language) who persuaded spm students to study in Russia at that time i was only 17 and naive at the education fair on the advertisements those agency looks promising but …… my parents at that time doesn’t know what course are the best choice for me as they are just secondary school level and knowing nothing regarding to higer education .obviously whatever ‘they'(Agent) i trusted them because they claimed to be the professional higher education advisor at the education fair . i’m 3rd year student of Russia best medical university who passed every single subject with spm holder(moderate scoring with 5A) , but i relatively knowing nothing related to medical field i strongly believe i’m not the minority . i’m not shifting the blame towards the government but they must responsible and be aware of this issues . i must say the exam standards of education for foreigners in Russia are low . The biggest mistake i made in my life is to study in Russia but what can i do more as my parents spent big sum of money with high expectation ? instead of lamenting i will do something like relying on international medical publications and try to fork out more time. i think my direction has changed over the years of studies , i’m stucked up all the way and spent so much money on something that i’m no longer confident with . In conclusion : i’m lacking of confident and knowledge , hand on clinical experience and etc . please don’t ever consider Russia as the choice for medical it might ruin your whole life .
At least you have the courage to admit what is going on in Russia. You do have the qualifications to do medicine but just in the wrong place due to financial reasons. FYI, actions cannot be taken against the agents because there is nothing legally wrong. It is verbal and not written on paper.
Wendy,
As you said, the main culprits are agents, and they prey on post ignorant SPM students and their families, promising 101 things and even able to perform tricks and magic. This is how substandard students end in Russia/Ukraine, in which a number defininitely had their academic qualifications ‘edited’ etc to get into those schools. Heck, there is even a Medical doctor graduated from a medical school in the one of the countries above who came from Arts background, and was in one of the poorer Arts stream class. No science subjects whatsoever in SPM and now a graduated medical doctor.
But do they (the agents) ever promise job security upon graduating or money back guarantee if you don’t get a job? Of course they don’t. Until today, agents are aggressively promoting seats in certain countries with ‘guaranteed seats’ and having paid slots in certain media too.
Another thing is that I appreciated that at least you are being real and honest about your experience and take of doing medicine in Russia, unlike some of them here.
what you fail to see is that the overall education in this bolehlan is of very low low standard … just talk english to these high scorers in english and you will know .. you can make out the good , bad and the ugly !! most of them maybe of quality but the standard of education and the standard of marking varies every year .! dont get personal the whole system has to be revamped ! a sound education is what you should have .. then all these agents will disappear !
Damn. My SPM results are better than that and Im in sales!
yur SPM results are better thats why yur doing sales , u prolly saw the light earlier than most .
Haha, good one
Mine is better than that (I thought I was the bad apple of my class, getting such low grades) and I’m now working as a helpdesk
-_-
This is bullshit!
You think marks make a good “pakar”?
One of my seniors from my uni (CSMU) made it to
competitive Masters of Plastic Surgery program even with similar
SPM results.
Does this mean everyone should discriminate based on academic
performance??Does this mean ur SPM should determine entry to Masters??
I find this article very bias and detracts from what is required to be a dr-
not marks but enthusiasm/dedication and loving touch.
One nurse has also told me she thinks nurses can be doctors given
a conversion course. I have to agree- they are practical and hands on
unlike many of the straight As STPM/A Level etc who are bombastic
sounding with MRCPs,FRCPs etc etc.
Nurses don’t even have straight As but in labour ward- I’ve seen some HOs from “prestigious” unis in the UK,Canada,Aus etc who cant deliver babies as well as the nurses. Or they may not even know how to put on ECG probes-
all these while bragging abt reading ECGs.
But who does the REAL work?? The ppl with practical skills and ward knowledge.
Bear that in mind
Your are quite over-confident in some of your remarks. Let me correct some of them if you may.
Do you know why graduates from ”prestigious” universities can’t deliver babies as well as the nurses as per your statement? That is because it is a policy in these developed countries that medical students are not allowed to deliver babies, due to medico legal reasons and also, at an internship level, these medical graduates most often than not, need not to do obstetrics and gynaecology as part of their internship, unlike in Malaysia.
On the other hand, midwifery students in Malaysia need to complete certain amount of deliveries before being signing off as competent. Part of their practical training also include deliveries in rural health clinics. So, as you can see, it is obvious that nurses/midwives have more practical approach in training as often, in these rural health clinics, the midwives are on their own in delivering babies, unsupervised without a doctor in charge.
In certain ”prestigious” countries and dependent on their local hospital policy, it is the nurses who does the ECG while the doctor needs to analyse the ECG. I think you should know why it is more important to know how to analyse ECG compared to putting them on.
Also, you should bear in mind that, in this age of increasing medicolegal issues, ”enthusiasm, dedication and loving touch” will not pay your legal fees when you are involved in a medicolegal case.
I would suggest that you do up some research before commenting blindly.
Dear GP, i would like to start by saying i agree with the points that you have put forth. I have particularly pointed out as to which one. 🙂
1. “Do you know why graduates from ”prestigious” universities can’t deliver babies as well as the nurses as per your statement? That is because it is a policy in these developed countries that medical students are not allowed to deliver babies, due to medico legal reasons”
– Very true and thank you for that. In the college i graduated from, we have to do a year of internship. So, during my OBGyn posting, the interns weren’t given much chance to perform a solo delivery. It was the OBGyn residents who would perform the delivery as they need all the practice they can get. The interns, are more than welcomed to observe and assist. Once in a while, is we get lucky, we might be given the chance to perform. If we get lucky and beg the residents to allow us.
I am wasn’t that much interested in OBGyn so i didn’t bother insisting. But, when it came to procedures like spinal tap, ascitic tap, intubations, i made sure i took the opportunity to be hands on!
2. “In certain ”prestigious” countries and dependent on their local hospital policy, it is the nurses who does the ECG while the doctor needs to analyse the ECG. I think you should know why it is more important to know how to analyse ECG compared to putting them on.”
– Hahaha! That was funny and again, very true!
I did my internship in Ms Ramaiah Hospital, Bangalore-India, after completing my MBBS in Ms Ramaiah Medical College. So, in that hospital, the nurses were the one who’d hook up the ECG leads to the patient and run the machine. We, as the interns would try to read it. First at foremost, knowing how a NORMAL ECG would like before attempting to diagnose. Now coming to think about it, i am not exactly 100% sure bout hooking up an ECG, but if a patient who came in breathless and had his ECG done, i could read the strip and tell if it’s MI or not. 🙂
Also, when it came to blood work, the nurses would do it. Withdrawing blood and sending in the necessary investigations. The interns would collect the results when they are ready and make it a point to highlight the abnormal ones and as usual inform the resident. Again, to know the abnormal values, we should first know the normal range.
So, right now, i am an aspiring HO. I’ve got my surat pelantikan from SPA and am waiting for the induction dates. I hope i do justice to this noble profession and prove to be competent, knowledgeable and all the other good things a doctor should be. 🙂
I am also slightly surprised that you agreed with a nurse’s idea that ”nurses can be doctors with a conversion course” just because they are ”practical and hands on” unlike many with ”MRCPs, FRCPs etc”.
Are you a joke?
He doesn’t know what he is talking about!!
Your statement and tantrum above shows what is the level of knowledge you have!! Please read the article and try to understand what is said rather than throwing your tantrum. I have said very clearly that SPM results should not be used as a entry requirement. IT should be a well standardized and recognised pre university course!!
Secondly, getting into masters program and passing out of it is 2 different issue.
Those graduates from developed countries can’t deliver babies because in their country only registra and above are allowed to deliver babies due to high litigation rate. The situation will be same in Malaysia few years down the line. Most GH are getting 1 legal letter every month for their O&G department.
One of my old professor use to say that any monkeys can deliver babies. It is NO big deal. What is important is picking up the high risk cases and making a decision in mode of delivery. That is what the doctors are trained and nurses are NOT. Same goes to ECG. Any monkey can learn how to do ECG in a minute. It is how you interpreted that test your knowledge.
I have also said above that you need certain level of intelligence in doing medicine as well as passion and interest.
With reference to LW and delivery of babies and “probe” I hope our friend did not mistaken CTG for ECG
chris, do not be quick to generalize based on your experience and chat with a single senior. Also, sentimentality like such does not hold well in an argument, much less when you’re standing on an unsupported ground. Congrats to your friend, acknowledge the fact that there are outliers in our society, extremely brilliant and extremely bad ones. The “enthusiasm and loving touch” you speak of is a facade any character can mimic and exaggerate. Clinical gestalt takes years and years of work experience to incorporate, but what we currently fear for are mistakes of omission which represent a HUGE loss of lives in Malaysia. I wouldn’t pinpoint where. MRCP/FRCP’s are accredited, revised board exams that ensure you’ve covered your grounds. In trying to highlight the ones truly with the passion and doctor skills, lets not claim the status of absolute use/disuse of these qualifications, they all hold bearing till our graves.
typical russian grad reply. In medical field, both theory (diagnostic capability) & hands on are equally important.
Ask the midwife regarding diagnosis and treatment. Sure they will not able to answer.
You sound like someone who struggles to read an ecg!!
SPM doesn’t prove much because SPM itself is mediocre (compared to UEC, A-lvls and such). Scoring 10As in SPM doesn’t necessarily mean that you can do well in medicine. Passion and the eagerness to learn are the essential qualities for a student who want to do medicine.
That’s where a good preuniversity entrance exam is essential
Actually I think SPM results is just a ruler to measure how well you studied in high school. Well the results does matters when you wanna apply for medicine. Currently I am studying Veterinary Medicine , yes I do admit i dont have straight A ‘s or a really good result compared to others. But then, the university I applied apparently have a entrance exam. I do really have the passion for this field and spend my entire year and work my brain out on studies, and all those hard work paid off. People in malaysia have a biased thinking that studying in indon is easy , thats not the fact. I don’t agree , the entrance exam I sat is definetly a level higher than STPM i could say ,and all those students who passed this entrance exam are really qualified to be a vet student. Malaysia also should start trying to implement this entrance exam system on universities instead of using SPM system, but then again, it is Malaysian goverment , it would take them years before even consider about it. Pardon my english btw. 🙂
Yes, agreed. Some of the Indonesian universities are good but there are also bad ones
So many in denial still, it seems, and trying to reinvent the wheel by taking out academic capability out of the prerequisite of doing medicine. If “passion and eagerness to learn” are all it takes, medical schools will be like a circus everyday.
I think exceptions are there, but sometimes we are talking of the majority. Therefore the common medical exam if executed well, would be able to screen through the better ones than the poor ones. Let the grades screen through the knowledge while the housemanship training screen through the ones with attitude problems, unless you wanna have another common medical exam to test attitude instead (But we Malaysians are great liars when it comes to such tests).
Sometimes, we want to tell everyone else a friend of a friend who would have perform well with such results, but such story are usually exaggerated. If you would have look at the results, there is only 3 credits which allow the student to enter diploma level studies and not even pre-uni courses such as A-level/ STPM to study medicine. If the majority of students with such results could fare well, I think all international universities would accept everyone into Medicine. Well of course, given the time, everyone could be a mediocre doctor, be it 10 years, 20 years or 30 years to train someone into a competent doctors via housemanship.
But my question is, would you allow yourself be treated with such doctors? Referring a patient with high grade fever, stiffness and acute psychosis (later diagnosed with meningitis) or jaundice with psychosis(decompensated liver failure) to Psychiatry? Or managing a gestational diabetes with control of 15-18 with diet control until intrauterine death? We have seen starkly poor management from these grads. With the lower passing mark in local universities, we are gradually seeing such poor grads in local universities as well, and perhaps even more in a few years time when those Middle East non-JPA students had been absorbed into local Uni. Perhaps it is high time we have a common exam, provided politics had no hands in it.
my friend’s mom presented to a government clinic in KK with post menopausal pv bleeding and was sent home by the doctor in that clinic telling her that it’s ok to have small amount of pv bleeding. Fortunately, she then visited her daughters in australia and told them about her symptom out of the blue and they asked me about it. Guess what, after all the investigation, she was found to have ovarian ca and was treated appropriately thereafter. It’s amazing how that doctor missed out on such major red flag!
Nothing new
Blogger and society equally stupid if looking at the SPM result as a benchmark for doctors,nonsense!!! Many local grads nowdays are more incompetance and not fit to become housemanship,they even quit during 1st posting,enough with this mentality
You are missing the point completely.
Haha! Unfortunately the number of bad apples in the Russian basket are definitely many folds than the local basket.
Those who quit are those who are not interested in doing medicine in the first place. They realized it too late that medicine is not as rosy as they thought. Please read the article above, did I say that SPM should be used as entry requirement ?? don’t make a fool out of yourself
Your english is atrocious, justifying your competency as a Russian grad and not surprisingly, your eligibility to enter a medical program in Russia.
Russian grad, seems like you just make a fool of yourself. Are you the benchmark?
I believe everyone should be given a chance to redeem themselves for what they did in SPM. There’s just too much factors to be taken into consideration that determines how well you’re gonna perform in those public examinations.
It’s a bit harsh to assume she’s probably one of the less-than-a-mediocre students who barely scrape through medical school and housemanship just by looking at her SPM results and the medical school where she graduated from. That’s a little bit rich to be honest because no one knows what she had to go through in her past to be at where she is today.
I would giggle a bit if I were the interviewer =P, but then what else is more important that decides whether or not she’s qualified for the masters program obviously depends on what she has to offer now. I know it sounds a little bit unrealistic as there are too many doctors with good results queueing up for a spot but looking at our current education system (good lord..!), I would think twice to even consider asking for her SPM cert as part of the application.
I did not tell the whole story on this application. It was not just the SPM result but she could not even answer simple questions !!
I for one disagree that SPM result should be taken into consideration as a qualification criteria to be a doctor. SPM is an exam, taken by all of us at just ONE PART of our life, and people do change after that. I’ve seen many people who had mediocre SPM result, but later on carried Master level qualifications and on their way into corporate society.
SPM only showed, perhaps the achievements of our education system (and not our true potential). We feed our students with facts, and expect them to regurgitate all of it during the exam, how does that works in medicine where creativity and critical thinking, not to mention high ethical values and moral are needed?
The concept of SPM is an old thinking, its time to move forward.
Anyhow I do agree for a standardised licensing exam.
Yes, we do need a standardized entrance exam. SPM, as I said above , should not be used a single yardstick. We should either streamline the preuniversity course for entrance to medical school or introduce a common entrance exam
If they could redeem themselves in medical school then good for them and the society, but many of the subpar SPM students will still end up dillydallying throughout their 5 years of tertiary education and end up being a horrible doctor. COMMON SENSE! People applying into medical university should BY RIGHT have the passion and great attitude as basic requirements but not everyone with such qualities are going to become doctors. Good results will be the factor that determine who is to enter the field. This is how the whole thing should work supposedly. Bear in mind that not everyone who wants to become a doctor get to be one. Majority wants to be rich, but can all of them be?
Dr Jay makes a point. More importantly tho, consistency in good academic performance is the sentinel expectation from each doctor. Fluctuations and setbacks in one’s academic track does raise an eyebrow and people do tend to extrapolate this into your workfield. The professional field does not give much wiggle room for mistakes, more so within one that involves caring for human lives.
Whether we like it or not, our collectivist society entertains the idea that graduates from UK,US,Aus are more suitable candidates for any clinical training resources made available in most countries. Then again, I’ve read about arrogant, brand-named practitioners falling through the cracks for damned, unethical behaviour. In the end, your “no-name” university graduate may prove to be your most trustworthy and brilliant doctor. Your overseas graduate degree does grant a convenient, prejorative ticket along the training path but medicine remains a competitve field and guarantees transparency in both attitude and knowledge when u start work.
Dr Pagalavan is right, money does talk. It’s sad that parents these days have misaligned hopes and dreams for their children’s ambitions and PLENTY of them see entrance into medicine as an end unto itself. Though Dr Pagalavan, I have to add that they’re not the ones doing a disservice to this country, and neither is their hard-earned money; these grown-up graduates and the system need to know better than to malign sick patients with poor learning clinical skills.
You wrote: “….these grown-up graduates and the system need to know better than to malign sick patients with poor learning clinical skills.”
Whatever happened to the Hippocratic Oath? Especially this one –
“I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery”
Please recite that particular one everyday!
Maybe we need a system eg NHS and Australia where training or middle grade jobs are only 6 months to 1 year, and there is no guarantee for subsequent jobs. The prospect or career advancement and future jobs is determined by the doctor’s work performance.
The only we can filter out those without the right academic ablity and work attitude.
The time will come
Hello Shah! You pun baca blog ini ah? … heh heh. Sorry my venture to join your department didn’t pan out, ended up staying where I am for career & lifestyle reasons. Please get in touch with me if you ever come down my way for a visit.
And yes, I wholeheartedly agree with you. The comfort and security of of civil service in Malaysia acts as a disincentive because you know you will always have a job. Some try to work harder to increase their prospects for Masters entry but many rely on other factors rather than their own merit.
There are so many students from European/Australian universities who still dont have the edge to be exceptional in their work during housemanship when they are back in Malaysia. These mindset where “grades make a good doctor” is very shallow and stereotyped.
Many successful doctors in various fields do come from unheard universities/ infamous ones and yet make it big with their perseverance.
We are all blinded with the stereotyped idea (i.e. students from medical universities in UK/India/US/Australia are the only good ones) that we fail to see the mistakes/ flaws/ lack of knowledge and competency in those from the above mentioned universities and we tend to pick on those from Russia/Ukraine/Indonesia and the like.
I believe its not where you study but its the mind and the person in you – the attitude and aptitude to be a doctor.
IF ONLY we open our minds and stop hiding behind the guilt / defensive shadows of ourselves and see that many doctors from so called reputable universities ( housemans/MO’s/even specialists) make blunders and why nothing much is commented on them?
ANSWER : the mindset which is so hypocritical/ defensive and in denial to comment on them just because they are from some reputable universities and some of them might be our colleagues / friends/ family.
Very immature attitude…!
So PLEASE stop putting people down when no one is better than the other.
Grade don’t necessarily make good doctors but bad grades is definitely has higher probability to make bad doctors. If they can’t handle the basic sciences in SPM level, the basic medical sciences in medical schools will be alien language for them.
I disagree. Else where in the world, education is a right. If someone wants to study medicine – graduate from it! Then you prove your worthiness.
A common entry exam is a norm in many countries. We should start
Please provide the statistics rather than just giving statements. YES, there are some from unknown universities who did well BUT the numbers are small. There are always exceptions but it is the majority that counts. Just because Steve Jobs and Bates are school dropouts who became billionaires with new inventions, does ALL school dropouts become the same?? Just look around and see what most school drop outs become ….. Mat rempits, Bohsia, bohjans, VCD sellers and snatch thief ……..
the brand of the stethoscope is not important but the man behind the stethoscope is…” ( quoted by someone dear to me, who has been in the medical industry for almost 40 years )
PLEASE live by this principle…!
Yes of course. For that you need certain level of intelligence
If spm results are so important.why not screen the students starting from upsr and pmr.that wud really show who among them are really bright from the beginning..and whos a late starter.Nonsense.
so much about russian n ukraine university..what about universities in indonesia..egypt..india who are sub par.not to mention the mushrooming of local colleges churning out medical grads.
All student enetering medicine should be screened by gov..if not they should not be allowed to work when they come back.n i agree with a common exam for all.but what i dont agree is comparing SPM results of students from which university n what not.if the student above went thru med school..got his degree..went thru housemanship…got recommended by his/her boss to do masters because he is good and knowledgable.. i think he has redeemed his spm results. My late father got grade 3 for his spm..but he continued to become a double doctorate and a lecturer in a local U. u r foolish if u think SPM carries any weight.
The article above did say about other universities. FYI, I did not tell you the earl story behind the SPM results shown above? She could not even answer simple questions!!
who, our society has gone a full circle from a lack of professionals in the healthcare field to a lack of competent professionals in the healthcare field. you must not be so naive to assume that the government is willing to filter and screen all candidates using upsr, pmr, and spm results.Btw, let’s not forget, our country holds a racial quota in med school admission. To suggest a system based on academic meritocracy would simply contradict that.
The novelty of this field has always held pride in its quality, not quantity, even though our country sadly doesn’t see so.
SPM does carry weight indeed, whether anybody likes it or not. Poor SPM results just mean you’ll have a harder time climbing the ladder and having to try to prove your worth to be the upper “p<0.0001" of the healthcare society.
Not necessarily as SPM level alone doesnt confined the ability of a person.
One can work hard to push one’s self towards achieving the aptitude to gain knowledge….
The mind can do what we sometimes cant think of consciously…
Degrading poor SPM leavers is something very shallow as MANY of those who didnt achieve good grades made it big in the medical field.
PLEASE open your mind to see beyond this….
Please provide the statistics. I have said above that SPM results should not be used as entry qualifications but a good Pre U should. Please provide the numbers of how many poor SPM or Pre U students are doing well in terms of academic performance after graduating ? Majority become GPs.
Majority become GPs?so u think GPs are sub par..spm leavers who just made it thru med school..
Keyword..shallow
Asking for statistics in a comment from a reader is also innapropiate.its not a debate.he was just commenting.u cant expect everyone to agree to whatever u write in ur blog..just because.
Who monitors GPs ?? In this country, GPs do not need to do anything like upgrading their knowledge, getting CME points etc etc. Who supervises them to make sure they are treating the patients appropriately. I have seen enough and I can tell you who are the GOOD GPs in JB town. Sorry to say, most mediocre doctors will end up becoming GPs because they got no where to go!! Worst still , no one monitors what they do.
Not sure whether I cn call myself a living proof or not since I am a dentist. Nevertheless, I’m a USM graduate. As few might have known, USM dental students sit for the same medical professional exams as med students during our first 3 years. During which abt 80-90% of our total marks will come from those papers and only 10% of our marks is contributed by dental papers. During th marking process, our papers join those of med students and med lecturers do not know the fact tht those poor exam candidates are actually dental students who had to sit fr med exams. Hence the reason annually 50% of each batch is retained for another year since there is no such thing as resitting a paper in USM.
During our final 2 years, 3months of attachment to various medical depts at several general hosps were required and we’re required to pass and perform procedures. Heck. I even did peritoneal tapping under th supervision of an MO.
Th total of med + dental students during my time ws abt 250 students initially. Only abt 10 scored an A fr medical professional exam. 2 of them were dental students n another 7-8 of them were medical students. Praises to God. I ws th only one out of 2 dental students who scored an A fr med professional exams n I ws offered a place in th medical school fr three years in a row due to my good results in medicine. When I graduated, apart frm getting an A despite being down with pneumonia. I received an offer to specialise in oral and maxillofacial surgery which I refused bcause I hoped to further my studies somewhere else. My CGPA during matriculation was 4.0. Nw that I’m already practising, again I received an offer to b a permanent officer under OMFS dept in case I feel like specialising soon due to good track record.
Guess how did my SPM results turn out? I only got 2As. N those peers who were retained r students who got straight As.
Atleast you got 2As. I am talking about people who got c6-c8!!I am very sure you had your pre-U course as well in USM. As I said above, you don’t need to be A star student but you need certain level of intelligence to do medicine.
Although it sounded disparaging towards GPs, it is a fact that becoming a GP (or ‘chronic MO’) is the default pathway for those who can’t get into Masters training and can’t go overseas. This is why I argued for a compulsory qualification (e.g. Diploma in Family Medicine) for those who want to practice as GPs, in order to set standards – some time back in a Berita MMA article.
Think about it. 4,000-6,000 graduates per yer. 1,000 Masters places per year (recently increased from 800). Where are all these doctors going to go?
typo : doesnt confine….
Many developed countries have required their medical students to have a degree before entering medical studies…not just academically, the med students should be mature enough to study medicine…is SPM result the main determinant to qualify for medical studies in malaysia? sadly to say, it is, in malaysia. i couldnt agree more to the author to standardize an entry exam which should include a well-written exam + interview. but again, it’s a political issue in malaysia.
How many MO/Specialist/Consultants agree with the so called “flexi-hour” which has been implemented to train current houseman?on paper, it’s kind to the medical newbies…but has anyone from the higher authority ever reassessed the horrible results (partially trained/poorly trained HO) who later on will become medical officer?
Not all HO are incompetently trained under current policy; not all HO from russia, ukraine, indonesia are inferior; not all locally or UK/US/Australia produced med grads are better than others.
We need a better system to draw a better guideline for qualification of medical studies and a better training system for current housemanship. if u are in the real world, battling to save lives every day, u know what i meant. increasing number of doctors in malaysia does not contribute to a better healthcare system in our countries if the quality of training is well beyond the standard.
Exactly
The idea of having “such intelligence” defines arrogance….
To remind all again, there ARE MANY who are good/great doctors and they were not school/university toppers…
Of course they are NOT toppers but would you ask a lorry driver with 9F to do medicine?? And to teat you?
Gps are doctors as well and being a specialist doesnt mean you have achieved the highest throne in the medical world and this doesnt make you extra intelligent.
This is sheer arrogance…..
Of course GPs are doctors but just look at many of them . I am not talking about the establish old ones. The current generation of GPs who are from the category we are talking about are messing up the patients !! I have seen enough out there. Who monitors them??
Dr Paga is right.
In countries like UK, Australia etc, in order to become a GP, one has to enrol in a competitive 4-5 year GP training programme and complete clinical rotations in necessary disciplines in approved hospital settings and passing postgraduate diploma in MRCGP/FRACGP. Similar like those doing Family Medicine in Malaysia. Even after being a GP, their continuous performance / competence would be assessed by the necessary regulatory bodies.
However, in Malaysia, any doctor can be a GP after finishing up their housemanship and compulsory service. GPs here are not regulated / monitored as in developed countries and are not subjected to competence/performance reviews by regulatory bodies.
Hence, nowadays, subpar doctors usually either become chronic MOs in government service or just open up their clinic, unsupervised and unregulated. Of course there are some good ones who chose to go into private GP practice for a host of reasons, but the subpar doctors know that they can’t go forward in clinical medicine and chose to become GPs instead.
I studied in Moscow and I have to agree the quality of education was subpar. I went there with great aspiration in 2003 but felt utterly disappointed. Partially I blame my immaturity at that time but mostly I blame the media and the government. They initially painted a very good picture of russian universities. Many articles were written at that time praising their quality. To top that the fees were reasonable and affordable if compared to local private universities and elsewhere. Over time the aspiration I had slowly dimmed and died off. It was even worse when housemanship started coz everyone had a bad impression of Russian graduates and I honestly can’t blame them. I would say there was a lot of potential in me at d start but a decade later I feel broken n empty. The source is the subpar education that I received in Russia. Wish politics hadn’t done what it did to so many young souls who pursued medicine in Russia.
It is the agents who promote these universities.
But why many post spm students with poor results were given letter of no objection by jpa back then. I personally know many of them from school days. It’s always business and politics. We don’t know things that go on behind close doors. Probably people sitting in high positions might have made a big cut from.all this.
Ask the agents!! The minimum criteria was started in 2011. I know agents who falsify SPM results to get the NOC!! I don’t want to mention any further. Who gives the NOC ?? A clerk in MOH office !
FYI, NOC was never been under the jurisdiction of MOH, infact it’s MOE’s requirement since 2002. Unfortunately MOH is the recipient of medical grads, which can be from any medical schools across 35 countries. However, NOC is not legally binding. Which means that medical grads that comes back from any medical school abroad can still be given provisional registration by MMC to start HOship even if their SPM &/or pre-U course result is sub-par, as long as their medical degree is listed in Second Schedule. MMC and MOH simply cannot reject them! MOH then have to retrain them in HOship & not to forget the MOship – basically MOH is the sole largest medical school in the whole wide world!
Thats where MMLE comes in – i cannot stress enough how important this is! There’s a need to weed out these dangerous doctors wannabe…too bad…as we cannot compromise on patient’s safety.
I have come across HO with worse SPM result – arts stream student with 9F in 7 subjects and 8D in 2 subjects, Indonesian medical school graduate. This is only the tip of the iceberg!
Yes but when the post becomes limited, MOH /SPA can pick and choose
Yes, NOC is not legally binding but when the post becomes limited, something will be used to give priority in giving a job
sharingan….
omg!.. does he/she even know how to read? how could someone with Fs & Es make it through medical school :(( and how could they hire these doctors?
yes those subpar / mediocre spm students should be given chance as SPM is not everything, but Fs is no longer mediocre!
Welcome to Bolehland
Firstly, I believe we should stop the barrage of attacks on eastern european graduates. My personal experience tells me that no matter where the graduate comes from, they all start off from scratch – the whole practical experience of it. A good example is a comment made above on HOs conducting deliveries in labor rooms. Apart from that, as medical practitioners we all know that text book theories DO NOT have a *major* role in managing diseases (esp. on complicated ones) – it’s the experience that counts. We learn while practicing, that’s how we enhance our skills and knowledge.
The whole brouhaha started off from bias perception towards eastern European grads coupled with racial undertones by senior doctors, specialists & consultants. Then you have all this domino effect kicking in and authors like Dr. Paga, ride on this: eastern European grads/Unis suck! Only those from “reputable” Unis are *perceived* to churn awesome grads. Why? Because during ward rounds, only those from eastern European grads get picked on. Those from “reputable” Unis are *perceived* to be on par with the seniors (specialists, consultants etc) – and probably the seniors were from those Unis anyways.
This whole thing is an issue of perception with stratifying undertone. Yes, we stratify the Universities based on perception. Yes, we inferiorly stratify the society into lorry drivers etc (the author blatantly mentions this in his comment). It is true that we have those with poor grades that made it into medicine – a handful of them (including those form “reputable” institutes) are eventually found not fit to practice. And for some, an opportunity to work in the medical field has breathe new life for their family. You know what’s bringing down the medical fraternity? Articles like this and those with bigotry views.
*This is just my personal opinion
You can only start your practical experience when you have enough basic knowledge on how to take a good history, examination and coming to a diagnosis. This is the reason why you go to medical school. BUT when you can’t even do that than why did you go to a medical school?? The rest comes from experience, which I agree.
The medical profession going downhill NOT because of articles like this. Please look around and see what is happening out there.
When you see an eastern european grad? What runs in your mind? Those that have been following your posts can postulate what’s in your mind. Based on many of your posts, I can certainly see how you view them. To answer your question: “Please look around and see what is happening out there.” – I see people like you.
If you do not know me, please do not comment!! You can ask those who have been my housemen before. I don’t even bother asking where they graduate from!! FYI I have been In charge of housemen for almost 7 years before I left government sevice
Typo: *when you see an eastern european grad, what runs…
When I see a Eastern European grad doctor, I fear for myself, and will definitely seek a second opinion. That’s how bad the perception is, in the urban areas.
It’s very unfair for those who are the exception, but there has just been too many negative experiences that the whole Russian grad perception is just clouded with darkness and uncertainty. I do feel sorry for them.
“If you do not know me, please do not comment” –> sounds alot like if u dun like ****this***, u can get out of Malaysia. Serious, Dr Pagalavan, u can do better than that !
You are acting like a child. Please grow up!! If you do not know a person, are you fit to comment on the person??
And Dr Pagalavan, wat do u mean by “its a majority issue”? Now r u gona sound like someone who jus came back from the market. What backs up ur “majority” definition? And u even mentioned about the comments here as ur point of justification? Cmonla, I guess there could better way to justify urself?
Please understand what is written first before throwing tantrum like a small child. When the majority of school dropouts become mat rempits, do the public generalize it !! Of course! That’s why when the majority of problematic housemen are Russian grads, the general medical community will generalize the situation.
D4rk, each of these medical schools hold a different school of thought, discipline and rigor in delivering the medical curriculum. Yes, the kidney is the kidney no matter which school delivers that teaching, but how much you actually know about the management of hyperkalemia or tranfusion gone wrong is serious red flag if you cant even prescribe or manage them properly ! these are the basic errors you want junior dr’s to avoid. A medical degree doesn’t give you a clean slate, there are things you’re supposed to be ready to hop on to as a junior doctor. Dr Pagalavan is pointing out the worst of scenarios and I promise you this post is not going to end our country in the next century. With free press these days, to each their own.
“each of these medical schools hold a different school of thought, discipline and rigor in delivering the medical curriculum.” – hence this is not an issue since these countries have comprable health outcomes.
“A medical degree doesn’t give you a clean slate” – exactly, so this applies to those from the aforementioned “reputable” Universities.
What I am trying to say is STOP being a bigot, stop all this SPM-witch hunting mission – eastern european grads get picked on is basically a perception issue.
Not really a perception issue. It is a majority issue. Even in this blog, you can read comments made by students studying in Russia etc on what is really happening there.
I am a doctor myself and currently working in Australia. My dad (in Malaysia) has been feeling unwell for the last year and had seen the MO at the free government clinic a few times. Blood tests were done, initially, with a Hb of 60 and neutrophil counts of 0.5. He was sent home with iron tablets and vitamins. No further follow up or investigations despite the red flags! (Though the Dr did ‘circle’ the numbers on the result). Neither did the supposedly qualified doctor noticed that my dad was cachexic and lethargic all the time! He went back to the clinic again after 6 months, did another blood tests with the same results – anaemia and severe neutropaenia – and again, was prescribed iron tablets and vitamins without further referral. When I found out after the second visit, I was outraged! These are the red flags we were taught to look out for in medical school! And how could they missed that?!
To make the story short, I found a haematologist through some medical friends, made the referral MYSELF and requested investigations to be done – and my dad is now formally diagnosed with MDS and B-lymphoma infiltration in his bone marrow, starting chemo next week. This took us 1.5years from the first time he presented to the government clinic, when the severity of the blood results should have been taken more seriously then. I can only imagine what would have happened if there was no one in the family with medical background, and my dad’s presenting complaint was lightly dismissed so easily.
While I do not know where the MO graduated from or what his spm results were, this is truly appalling the lack of knowledge and awareness of red flags that every person who call themselves a doctor should know, especially if you are working in the frontline of healthcare in the community, eg GP. I know we shouldn’t put everyone in the same basket, but if this is the indication of general competency level of healthcare providers in Malaysia, there is a problem with the system that needs addressing.
Houston, we have a problem!! Tell me about it. I have seen worst. Unfortunately many are still in denial and refuse to accept the fact!
Dr J,
Your father was lucky enough because you were monitoring his results. What about those the public dependent on government service without any family members in the medical fraternity?
If this were to happen in Australia or in any other developed countries, the MO would be held accountable for being grossly incompetent and may lose his/her license to practice, especially, God forbid, if something untoward happened to your father. However, in Malaysia, due to the Malaysia Boleh spirit, anything goes in Malaysia and it is a known face that a lot similar cases are swept under the carpet.
Dear Dr J,
I have heard numerous stories similar to your dad’s, affecting my family and friends and their families. I suspect negligence may have even contributed to the death of a family member but I can’t prove it as I wasn’t there and had no access to medical files.
You are absolutely right that there is no accountability and it is a sad state of affairs. Sometimes, it is made worse by the fact that society accepts what happens as fate or ‘takdir’ or god’s will. Even if they try to complain, there is no transparent process to do so.
Nav,
The older generation may accept ‘takdir’ or fate, but the newer more IT-savvy generation are definitely not going to take things easy. Complains do occur but the issue is transparency and also a lot of things get swept down the carpet.
Early on I was completely against the idea of suing. However, such severe incompetence like this warrants a lawsuit and the idea is that it delves into the root cause, keeps practitioner/system on their toes, and prevents similar future negligence. lawsuits can save the patients of tomorrow.
The idea isnt to bankrupt the institution but to start a chain of events to find out the root cause of such negligent practice. Was this a case of missed diagnoses? miscommunication? incompetence? a systems failure/issue?
complaint letters are dealt with internally without external accountability and is akin to leaving politicians to clean up their own house – ineffective.
That being said, courts shouldnt also create ridiculous settlements that promote cover-your-ass medicine. a middle ground somewhere is probably most reasonable.
D4rk, can you clarify what you mean by comparable health outcomes in these countries ? There’s no parallel between the training systems in these countries nor the healthcare structure. Again, I’m not undermining the graduates, the education system themselves hold the pitfalls. Additional support and training is needed, that’s all I think. Enlighten yourself.
References:
1) Elkin K, Spittal MJ, Studdert DM. Risks of complaints and adverse disciplinary findings against international medical graduates in Victoria and Western Australia. Med J Aust. 2012 Oct 15;197(8):448-52.
2) Watmough S1, Bowhay A.An evaluation of the impact of country of primary medical qualification on performance in the UK Royal College of Anaesthetists’ examinations. Med Teach. 2011;33(11):938-40.
Did you even read what you shared? It’s easy to copy/paste links and all. Anyways:
“While previous research has consistently shown that certain doctor characteristics, such as male sex,21 are positively associated with complaint risk, the international evidence regarding IMG status as a risk factor is less clear.”
Source: Risks of complaints and adverse disciplinary findings against international medical graduates in Victoria and Western Australia
D4rk, glad you paid your attention.
I hope you are right but from my experience as HOD supervising the HOs, I would say these graduate deserve the scolding and biased perception. They are suppose to be HOs with core knowledge. If they come to get experience of delivering a baby but without the basic knowledge of calculating the EDD, examine the stage and progress of labour, the basic definition like presentation, lie and position. DO you expect us to teach them all over again? In my opinion they should be send back to their respective medical schools with a feedback to be retrained which unfortunately we can’t do so.
I wonder which is worse.
Not knowing something but to learn it and be good at performing it.
Or to think that u know sumthing yet unable to perfom it.
This is a chicken or the egg problem. When one is good at practical and has less knowledge in theory, he gets screwed. Vice versa! So what? Just an excuse to pick on a HO.
Actually, as a housemen, we only assess their knowledge. The reason you do housemanship is to learn practical approach!BUT without basic knowledge, how do you want to learn practical ? It’s like teaching you to do surgery when you do not know the anatomy!
It is NOT a chicken and egg situation. You cannot be good without having a sound theoretical knowledge. Being good at some procedure just make you a technician. We don’t need doctors for technician jobs.
D4rk, if you are good, you will answer all the questions directed to you in the ward with flying colours despite the bias. Why get upset when eastern europe grad get picked on if you think that you have the knowledge? Just answer them and prove them wrong.
Is it too much to ask someone who is going to be responsible for thousands of lives in the future to at least produce above average SPM results ? Passion alone isn’t enough tk do medicine. Keep in mind passion gets the ball rolling but discipline and hard work keeps the ball rolling.
I personally feel this situation is beyond repair. Our government has done a ‘fantastic’ job to keep the competition in the medical field high. These requirements and entry exams should have been implemented much earlier. What’s the purpose of bringing it in when u have an overflow of doctors? So the way they deal with medical graduates is just to say no to them after studying for 5 years? The sad part is most of these students didn’t have a clue they would be facing this 5 years down the road.
Right now the only sensible solution would be to have stricter requirements for the current batch of SPM leavers who plan to medicine. And for those who will be practicing as future HOs should be sent for the MMLE and access thoroughly.
Another way would be to build a few more Hospitals but our government is probably too busy working on ideas to increase the GST and petrol prices to even look into this issue for now.
This is not a right thing at all…Its very unfair for the students now. We are eligible students whom can Pursue Degree in Medicine. Its very sad to see those doctors who did their medicine with such kinda bad results.Its very annoying to see Students with such bad results doing Medicine In Overseas.How did they enter their Foundation or Pre-Medicine courses with such results? What was the government doing ? Malaysian Education System is not strong enough !!
Welcome to Malaysia!! as I said, Money talks
First, i would like to say, it’s a very fantastic piece you wrote. This is what exactly is happening to me. I’m a russian med student. I’m in my 3rd year now. I always wondered whether i should do this profession cause of my under achieved qualification. The fact that i have a tremendously terrible SPM result and still think that i can somehow make it through is really scaring me. I don’t know whether i should continue doing this cause it would put a lot of pressure for my parents and a massive one for me cause a lot has been sacrficied just to get through my years here. So, i’m asking for honest opinion from people here.
May I ask how you are coping? Also, if you’re being honest with yourself, do you think the russian medical school is providing a course sufficient enough for you to practice alongside other graduates from established medical schools? I take it there’s no such thing as failure in russian medical schools (for international students) so you will surely pass.
What was your SPM results? Do you have NOC? if you are not struggling through your course now and stopping is not a choice, put in double effort in your studies. Nearing the end of your medical school, you can also try to prepare and write a general med school exit exam like the USMLE to gauge your knowledge in medicine. If you do well in the USMLE, you are on par with the rest of your (international) peers.
I do agree SPM and grades are not everything. However, the main point isn’t the grades or even the number of A’s. It doesn’t indicate your knowledge, but your work ethic and your willingness to put in the hours to sit down and study hard. That’s what is lacking in medical schools these days, everyone is looking for short cuts, reading condensed manuals instead of proper textbooks, purely memorizing past year answers to pass the exams etc.
It’s the Peter Pan generation mentality unfortunately, where most students enter feeling entitled and not willing to grow up and move away from the sheltered lifestyle.
That’s the reason developed countries are moving towards graduate medical school
Goverment ball gagger detected !
How could Education Ministry approve if an university is deemed “unfit” to educate the medical students?
Why no monitoring of the agents?
And Pagalavan, u sound reali old. Dun assume that you know everything, do you even know how foreign universities get their approval by our ministry? No idea? Go do some research.
How good a doctor is how he practises his medicine. Does matter where he comes from, but that aint conclusive. Which is why we have housemanship!! In my experience I see local grads who flaunt alot and stand still not knowing what to do with a hypoxic patient.. at the same time, russian grads who jump in to resuscitate them like how it should.. and vice versa as well.
So quit being jugdemental and stop picking on them ! As it is, the entrance qualification to local uni is not even standardized with race n religion playing as major criterias. Even with a common examination in uni, marks differ as well, not based on performance but based on a particular “criteria”. So when will it be fair?
And stop picking on young doctors! During the times of “oldies” have u guys heard of medicolegal cases? Mortality meetings? Things have changed so much. Its much more challenging to practise medicine now then wat it was decades ago, so please, no comparisons !
Here is another guy who does not know what is happening around him!! I know exactly how medical schools gets approval from education ministry! LAN as well as MMC. It is all paperwork. Do you know that you can open a medical school with just 6 full time lecturers?? that is the criteria to open a medical school. I have been in a medical school before, so don’t tell me I don’t know how are these things done. What is on paper is not what happens in reality. You can write you have 50 academics but only less than 10 are full timers. Don’t believe me, please check for yourself!!
Oh, and for your information, mortality meeting has been held since even before you were born! And the medico legal cases were less but NOT nonexistant
Haha, as I said: even before the common exam being implemented, some are prepare to put race as their excuse for possible failure in the exam. MMC this is your last chance fighting for your dignity, don’t give in to those who complaint they fail because of race.
That’s telling, isn’t it?
make them sit for the common exam like USMLE or IFOM. so there shouldnt be any race excuse for failing since everyone needs to achieve certain score to pass. and it’s SBA questions, and your paper should be checked by computer and score are reported on paper.
How would clinical exams be checked by computers?
like usmle.. you have step 1, 2ck and 2 cs.. only 2 cs is a clinical skill by specialist/consultant. i guess if you can show that you can pass the basic science and clinical knowledge, shouldnot be a problem to pass the clinical skills. plus, maybe there should not be a clinical skill exam at all, if you really want a transparency system.
Clinical skill exam can be transparent if it is done well
Im glad that you realized that there are good students who go to Russia. I have to agree that many students don’t really know how to take patient’s case history and things like that. But hey, even many local students don’t know much. In fact, I was attached to one of the government hospital two summers back. A HO was questioned about Hodgkin’s lymphoma during the rounds. This person did not know anything about it besides the fact that there is a non-Hodgkin’s lymphoma. And to my surprise, this HO graduated from a local government university. I’m not saying that Russian graduates know much more or we are the best of the lot. It would be great if people started realizing that Russia does produce amazing doctors. Many of them are in the USA currently doing their residency programs and in Europe (Germany, Poland) doing their specialization. I am a straight ‘A’s student currently completing my MD degree in Russia. Im sorry but I do take offense when someone keeps on pointing out the bad in Russian grads.
And yes, i totally got carried away and forgot about the fact that the Malaysian government is producing NOCs without checking SPM results. And that is why, we medical students in Russia have to deal with colleagues who don’t know basic chemistry and physics. I must thank our government for that!
The question on Hodgkin’s lymphoma is not really a good indicator of a HOs competence. It’s is a specialized field and as long as he knows such thing exist, he can go and read up the rest.
YEs, I do agree that there are good graduates from Russia but too few to be noticed. It is the majority that makes the public perception. Generally when you check their background, many of the subpar ones have either poor entry qualifications or forced to do medicine by parents.
Anyone can work in US as long as they pass USMLE. Their Russian toppers will definitely do well. What I know is the fact that the main medical college which teaches in Russian language is good but not the English wing where most foreigners land up
And the majority is here because the Malaysian government approved of it. It is sad that good students fall into that category. And by the way, during our clinical years, we are thought in Russian language too. Also, the students who are in the USA and Europe are Malaysians. 🙂 Speaking of USMLE, it is requires really good knowledge and also capabilities of a fully trained doctor to get through it. Non-US citizens are only chosen if they have remarkable grades.
And anyway, there is no point arguing over this because all we need is to prove ourselves despite all the allegations made. And that will be done! 🙂
Have a good day, Doc! 🙂
As I said, the real reason why Russia gets the bad name is mainly due to poor quality students from Malaysia who are doing medicine there. The good ones with good grade and interest in medicine will maximise what they want to learn. Unfortunately it forms the minority
And Doc, if you think that knowing just the existence of Hodgkin’s is sufficient, then i’m sorry but ANYONE can become a doctor. This HO did not know of the existence of RS cells. That is sad. 🙂
Of course he should atleast know the basics of lymphoma and it’s clinical presentation as it is thought in 2nd year med school. What I meant is the management of lymphoma which they can read up later.
As a HO, or MO, you are not expected to know the intricate details of a specialised disease process (thats the job and knowledge that will come with experience of a specialist). This is a misconception and unfair, and a very ‘medical student’ way of thinking (though good on you if you do know). However, as you start wearing the title Dr in front of your name proudly on the first day when you graduated from med school, you are EXPECTED to know and be AWARE of RED FLAG signs, what is normal or abnormal and ASK FOR HELP if you dont know. eg Hyperkalaemia above 5.5mmol/L is ABNORMAL, neutrophil counts of 0.5 is ABNORMAL, SpO2 of 90% in a usually fit and healthy young adult is ABNORMAL, ECG changes with ST elevations is ABNORMAL……etc etc. Form a preliminary differential diagnosis (ask for opinion if you dont know) and make appropriate referral to specialist.
This bring me back to the time when I was working in Emergency Department in Australia with a very bright foreign doctor from India who could impressively quote me pages from Harrison’s Internal Medicine back to front. And yet he totally missed a rip-roaring obvious consolidation on the right lower lobe on a CXR of a patient with pneumonia. He diagnosed the poor patient with ‘musculoskeletal pains’.
Well, according to the specialist in the ward, the HO should have at a simple description of the disease. I forgot to mention, it was an ONCO WARD. About the doctor from India, it is unfortunate for the patient and many other patients after that. It is disappointing that he did not graduate from Russia, China or Indonesia and yet he could not recognize a CXR of a patient with pneumonia. Just kidding. Despite physically examining the patient, he diagnosed the poor patient with musculoskeletal pains? That is bad.
There are worst thing happening in Malaysia but no action taken. That is the main problem here.
yada yada yada Mr. Paga, not every Russia graduated doctors are incompetent like what you always mention. I guess you know very well that many medical students in Russia are following what you put up here, and I’m sure many of us will disagree with your biased and generalized criticism. Just because of a few seniors who set up a bad example doesn’t mean we are all the same!
Of course, please read the article carefully. Did I say ALL?? And I also mentioned Indonesia, China etc. Don’t get excited and start accusing without understanding what I wrote. The whole issue was about unqualified students doing medicine, mainly in Russia. Grow up!
But you made it sound like the root of all these problems came from mainly the Russian students. You are very biased I’d say. One needs not only passion but hard work to be a good doctor. One need not to be a perfect high scorer to be a doctor. If one works hard enough, he or she can be one too. Even my attachment doctor agreed on it. SPM results doesn’t mean anything- you know perfectly that what the government did to make sure the majority quota can passed with an A too. If one works hard enough to achieve good result in Foundation, A levels and later on in the finals in medicine course, why care? But sadly, you made it seemed like “Oh wow SPM a must, yeah that’s right.” A wise man who is a doctor told me, “To be a doctor is to be humble and serve others first. And no matter where you studied your medicine, at least it is recognized worldwide and that will be enough. You need not to show off where did you came from as it is of no importance. The only thing that is important to treat a patient to the best extent.” Top scorer in SPM or any exams, so what? It is the matter if you actually apply your medical knowledge into use when in practical. You may swallow the whole book and pass with flying colors but sadly, not everyone can make use of the knowledge.
Please read my article again! I made it very clear that Malaysia is the only country that uses SPM instead of a standardised Pre-U course as an entry requirement into medical school. I also said that MMC should make only certain well recognised, standardised Pre-U course as the entry requirement. However, I do not agree with foundation studies as it is as biased as SPM, as what you have said.
As for medical school exams, how come despite poor entry qualifications, there is 0% failure rate ? Even in the top medical schools in the world with the best students, there are still failures!
Unqualified students doing medicine? Fair – but stop your barrage of attacks on eastern european grads! Just because someone didn’t fare well in SPM makes him a bad doctor. True that you never asked your HOs where they graduated from. But if you found out if she/he graduated from eastern european – your perception kicks in. You admit it quite clearly in your articles and in this thread of comments.
What attack? I am just replying to all the comments. The article above is talking about poor entry qualifications which in turn producing subpar students. the main source of these students are from Russia followed by Indonesia.
Do not judge the medical students of the whole country just because of a bad example set up by the very minority. Thank you very much for offending so many medical students don’t fall into that “category” that you’ve always mentioned. Kudos to you Mister!
Minority?? It is more like majority!!
that’s what YOU blatantly say!
Please come back and see for yourself. When every hospital in this country sa, ys the same, it can’t be minority , isn’t it? Please walk into any GH and ask the HOD
That’s more than majority. MOH even ask for additional assessment feedback from HODs specifically for Russian graduates.
ptui! My disrespect to you! Boycotting your blog!
I foresee how people will boycott your blogposts just like what’s happening to Raja Putra.
And how does that affect me?? A childish attitude
An example of a future doctor!!
Oh my God, he is so immature, should buck up instead of boycotting Dr. Paga who is telling the truth
This Jason guy…errr, studying in Russia. If so, I hope he is the exception. Sad day really for thousands of future patients!
Hi Guys.. stop being emotional and blaming each others. we are discussing important issues and individual / isolated case doesn’t define anything.
Well, i would just ask something not really related to this this post, Would a half-blind person be a good pilot later? well, debatable, as there are many ways to improve vision.. but do u trust or u want him to fly you?
Oh dear, russian med students all on the defensive and offensive at the same time!
Yes, this blog post is shooting off the roof with almost 27,000 views as of now. 1000+ views are coming from Russia and 21 000 from Malaysia!!I guess I really woke everyone up!!
WOW!! Dormant KGB alerts must be going off like crazy….kidding. What a wake up call eh? Thanks Dr. Pagavalan.
Whoa, what a heated up topic. I agree with most of the things you say Dr. I just want to express how shocked I was that SPM result is actually of concern at a Masters’ entry interview. That is somewhat unfair, and it seems like the interviewers are suggesting a person could not grow after SPM/ Pre-U.
I do agree that some universities have low entry requirements. But the doctor here actually completed his medical school (that’s 5-6 years?) and at least 2 years of housemanship, and a few years as MO. If they still look at his SPM and judge his credibility based on it, I say the interviewers are unjust and biased.
As I said, passing a medical school is easy nowadays. Housemanship in Malaysia is poorly regulated.
I did not tell the real story. Actually they only looked at his/her SPM results when she performed badly during the interview. Only then they realised how bad the SPM results were!!
aha, then that would make sense.
Hello. Im a csmu graduated doctor working in the biggest govt hosp in msia (go figure). Please forgive my english, i picked up a fourth language in ukraine and as an effect the rest deteoriated a little. To be clear, I had 8a1s 1a2 and 1b3 for my spm (a2 and b3 for english in science and tech and moral studies respectively) I have recently finished my housemanship, without any extensions. Mr pagalavan im aware you are/was a lecture at monash? Can see why u have a very biased view. Mr gp? Conniving? I beg to differ sir. I have seen grads from various other uni get away with shit. I’ve seen friends get extended and kicked out of the hospital. I also know some people who barely come to work, when they are there they are totally useless. When they open their mouth it’s utter nonsense. Patients criticise them. Specialists dont trust them. But they are still in service because of where they graduate from. I know what this is. It’s the same reason why america needed saddam, why ferguson hired moyes, why najib needs perkasa…you all need a black sheep so that you’d look good. So with that point, I shall take my leave. Please dont feel obliged to share your sarky, dark, twisted opinions. And please..please mr pagalavan do not repeat your mistake of posting private and confidential documents of other’s online. Tell your “friend” she shouldn’t have been sharing that info too.
Again, the article above is talking about entry qualifications. Unfortunately, majority of unqualified students are doing medicine in Russia followed by Indonesia. I have said this many times in my comment. You have a good SPM results and I presume you are a good student and thus do have enough qualifications to do medicine. I have also written many times in this blog ( if you have followed it right from the beginning) on how unstructured housemanship training in Malaysia is. It is poorly regulated and most will just get away with it.Once you are in service, you will be never be removed unless you resign yourself
BTW, the document has no name or any identification
BTW, I also criticise Monash if you care to read my blog from the beginning.
dr t has good SPM results and definitely has a higher probability of being a capable student. That however does not mean he/she is a good doctor, just more potential. Screening is not 100%!
Now u tak tau nak telan ke nak ludah kan andy 😉
dr t, I think you have a LOT of room for improvement, judging from your take on what Dr Pagal wrote.
Don’t get too worked up. It’s just a blog post. Learn to accept these criticisms as part of life. The bottom line is medicine in Malaysia is about to get really crowded. We are reaching the tipping point soon and Dr Paga was one of the first to publicly push this message across. Don’t shoot the messenger.
Chillax, long time no see!
Hehe, silently observing… keep up the good work!
From the quality of the responses, one can easily judge the maturity of the responders. The Internet is wide, but the Malaysian medical fraternity is still quite niche. We speak a very similar lingo and the style is often easily distinguishable.
I can easily say that 4/5 of the responses here are ‘younglings’. Not to objectify, just to point out that no matter how smart you think you are, medicine still requires a lot of ‘asam garam’. So, yes, theres a lot of wisdom to the group of people who say that results dont matter at the end of the day. Having said that, in the case of house officers from eastern european universities, bad eggs have certainly spoilt the batch.
But dont worry, the more ‘prestigious’ local unis or western european universities are certainly catching up. I’ll just ‘blame’ the doctors from the gen-Y and millenial group in general.
i see lots of butthurt russian/ukrainian/others grads here.. i am local grad.. ive worked with these russian,ukrainian grads before.. some are good.. some are.. i’d rather not comment for fear of being nuked… but hey, read the article carefuly…
nice article boss..
I don’t see how this is a big problem. below average medical students won’t get into master programs (unless u are from a certain skin colour), or complete MRCP, in other words they won’t become specialist. they will just become chronic MOs or open GPs and refer people around. what’s wrong with that?? will you complain when incompetent GP refer a simple case to you? more money for you mahh..
oh btw when junior drs make mistake its the specialist fault for not supervising and give appropriate instructions.
The problem is many incompetent GPs are ‘killing ‘ patients. That is the problem!
You are wrong. A number of ”below average medical students” are already in the Masters programmes. They know they are not able to do postgraduate diplomas like MRCP, MRCS, FRCGP etc but it is easy for them to weasel their way into a Masters programme. However, graduating from a Masters programme is a different story altogether.
The reason junior doctors make mistake is because there are an exodus of them and also there are minimal specialists to supervise them. Saying that, some specialists are not really bothered about supervising them.
Yes, and even under their supervision, the Specialist never treated all doctors (HO) equally….. some are so lazy, but when S comes, they just kiss the boss’s ass and get the credit, while those who always work, get the blame! See it or not….?
This is a very common phenomenon in civil service as well as private sector.
Very unethical of that interviewer to post that SPM results. Shouldnt those things be confidential?
Do you read newspaper? Please see how many “confidential ” information are published. When a doctor get penalised by MMC, your name appears in newspaper! Is that confidential?
No name or identity mentioned
There are no names mentioned. So anonymity/confidentiality is maintained. The main reason it was posted as it is a clear evidence of the quality of our medical graduates going into Masters programme.
Great article. I think the point here is that there are rogue universities in Russia (and other countries) who would take in overseas students to do medicine even if they are not anywhere close to the local students’ entry criteria for the sake of income. This problem is then passed back to Malaysia where the graduates would be working
Since there’s already a glut of HOs in Malaysia, I would encourage all the current medical students in Russian medical schools to take the USMLE and proceed to work in the USA, the land of opportunity….
Indeed. Since they are so good, getting good USMLE grades and getting a job in the US should be a piece of cake. No need to tolerate the prejudicial attitudes of Malaysia senior doctors. 🙂
My point exactly!!
Will be interesting to see how many will actually passed USMLE….
Oh, and those who couldn’t, they are still going to end up in Malaysia.
Who’s winning?
malaysia always losing 😦
Its the bloody agencies who are sending the students there.. they take a LOT of money and keep falsifying result certificates. And at the same time lobbying parents to send their children into medicine under them..what a a load of bollocks
Hey dr.paga , well to be honest the system in russia sucks. There is a way to go around everything here , at the same time . my own friend is doing med in our local u with just one B in general maths. and others were c/d. I wonder how he got his NOC. The thing is , it doesnt really matter where you come from as long you try to make a difference. And yes , we russian/indon/china/bangladesh graduates probably lack practical part but i think its possible to catch up with time. There is noone to be blamed here , your blog is purely for entertainment. Its BOLEH-LAND anyways. With the enough amount of cash , you could probably buy your med degree off some local university.
Yes, the local colleges were taking subpar students. That’s the reason why MMC introduced the minimum requirement
My classmate is some yayasan scholar without noc and yayasan just pumps money for her every year. lucky girl. apparently shes bonded 10 years. so for those who do not get a job due to noc , we could question the government for giving this people free scholarship , no?
Does she have the minimum requirement? If so then no issue.
My cousin went to Russia to study medicine. She told me a story of how her peers didn’t even attend the exams, yet still passed with distinction. When asked how was this possible, well, apparently all you need to do is buy an iPad for the professor. Sweet.
Then again, I have a high school friend who got into a medicine at a local Malaysian university via the matriculation pathway straight after SPM, just because she is a bumiputera. Even though her SPM results were not that impressive at all. Has she been of a different racial background, she would not have made it into medicine in Malaysia, without paying money and going to private/overseas institution.
And these are the doctors who are going to be looking after you, your family, your loved ones. Scary much?!
Yup
Dr.paga , whats the point of even having a minimum requirement when noone actually follows it? I mean the local uni is even more closely monitored by the MOE and MMC right? since everyone can do med in segi,masha,quest,masterskill? This issue has been going on and on for a long time now. Everyone gets so tensed about it but the end result is gonna be the same. They’re gonna say a million new things and their actions would differ.
Since 2012, MMC is more strictly monitoring the situation. That’s the reason why many colleges could not meet the target last year
Many IPTS medical schools are not filling their licensed capacity because of the guideline.
Same reason why some colleges are severely affected when the nursing Board reset minimum from 2 to 5 credits at SPM.
There is a short supply of good students with money. The best source to fill med schools is any student with money. 🙂
I remember having 4 Hos coming at 1 time(this was during the time where hos dont come in buses) 1 of them was eastern european..another 2 western europe who completed 1 year training there..and another local uni bright student.only the eastern eu guy didnt get extended.the rest got it for various reasons..not that its gonna change anybodys perpective..but i still think they are not so bad.ive seen worst from local grads/students
Of course if u failed ur biology in spm its difficult to prove ur case..heck i got bad results for my add math.n i still have no regrets.i still hate maths..i only like counting money.(from someone who was once state champ for math quiz competition)
Frankly, you don’t need excellent maths result to do medicine but I feel it gives a person critical and analytical thinking which is important to become a doctor.
ATTENTION: IMPORTANT INFORMATION!!!
For those who are still want to get a stable job with excellent pay, job security and have the prestige of having a ” Dr ” in front of their names, I would advice you to do dentistry. In dentistry, normal GP dentists can do all the advance procedures like root canal and braces application, veneer and implants after taking some short courses and can start charging their patients thousand of bucks. They no need to go through all the hardship and challenges of doing postgraduate like our medical counterparts and no oversupply worries. They can start earning money by venturing into private sector only after 2 years of government service!!! Even our health minister mention our country still need a whopping amount of 5000 dentists while doctors are super saturated and will surely have those that are jobless in the very near future.
Link: http://www.thestar.com.my/News/Nation/2013/10/07/Malaysia-still-in-need-of-over-5000-dentists-says-Subra.aspx/
Even a single dental implant with safety cap costs over RM5000, imagine the kind of money dentists make. Our Malaysian Dental Association (MDC) even posted the MINIMUM costs for dental treatments, take notice!! MINIMUM and that means no boundaries to how much you wanna charge as long as your patients are willing to pay for it. XD
Link: http://www.mda.org.my/assets/22fee/scale.pdf
I am so glad that I am doing dentistry and actually stood up to my choice of doing dentistry despite being objected by my parents initially. Now they know that I had made the RIGHT choice and glad about it. I feel bad seeing a lot of my medical friends being super anxious and worried as they know that there is oversupply of doctors now and they have high chances of becoming jobless next time. The competition is just too fierce and opportunities are just too little!! Getting into PG programmes are super hard !!! So my advice is NEVER FOLLOW BLINDLY WHAT YOUR PARENTS ASK YOU TO DO, FOLLOW YOUR HEART AND DO WHAT YOU LOVE THE MOST!!! I am happy with my dentistry programme and gonna graduate soon, cant wait for it, =)
Anyway, all the best and have a great day ahead!!
p/s : Just my 2 cents =)
#happy dental student
Actually soon we shall face the same thing our medical counterpart is experiencing. During my early days of attachment to various depts, I encountered quite a number of FYDOs – graduates frm certain private and foreign universities which I shall not expose here their names – who couldn’t even perform a decent extraction, let alone taking out fractured roots; who couldn’t even anticipate a single anterior crossbite outcome in a longer run, couldn’t manage abscesses or even just a dumb lichen planus lesion, and so many mores. I don’t blame them. I blame their schools n th gov fr somehow recognising such problematic dental school. So it comes to me as a prob to have to help orientate them to our system and also teach some basic stuff to them which they had learned wrongly. I don’t laugh at people’s mistakes. I usually feel sorry fr them, annoyed, but I couldn’t bring myself to let our patients be the victim. Not under my watch. I am patiently waiting till I get a better post in gov service n somehow bring this issue up although I’m pretty sure someone did it previously. I’m just gonna give it a try once more. Myself. We’re just as screwed up but on a smaller scale still
just my 2 cents
just do whatever u are interested in and u wil excel.that is no job guarantee for any occupation in Malaysia as anyone can get into any course they want as long they are willing to pay to money.thats the result of our education system being commercialised.the problem of oversupply is just a matter of sooner or later for any occupation.
Your wrote: “…just do whatever u are interested in and u wil excel…”
Should that not come with a a provision? Knowing what I now know, I would prefer telling a youngster who thinks he/she is interested in medicine this (assuming there’s a million ringgit sitting somewhere): “Fine, if you’re really interested, then you apply to the traditional medical schools in Australia and the UK or the reputable medical schools in India, assuming you cannot get into either UM/UKM/USM. If you get into any of those, then good on you”. This would mean the youngster would have to work his/her ass off, and at least their conviction to getting a place proves some genuine interest. What happens after, is another thing altogether, but at least get the first step “right”.
I agree with dr pagavalan..thx dr.
I salute you for your honesty. Do people still remember what kinda results you need to get into a Gov local uni to do Medicine, Dentistry, Pharmacy etc???
I have read you blog and agree with everything you have said because I have seen it myself.
‘Since 2012, MMC is more strictly monitoring the situation. That’s the reason why many colleges could not meet the target last year’
Greetings Dr Paga. Would you kindly elaborate further on this comment you made? What’s the outcome of MMC’s strict monitoring and private colleges not meeting MMC targets. Shutting down of subpar private college courses? Tqvm.
eventually, some of the medical schools may close down but then, almost all the private medical colleges are politically connected.
I dont knw whats the big deal about being a doctor…
Its a high risk jobs,
with virtually no time for yourself (especially in housmentship),
with extra stress life,
and extra responsibility…
Only good part its the pay…
Please, if you are not driven by your dream but instead by its paid,
you wuill never make it through…
Think again before you make your choice…
what pay? Do you know that there are people who are paid better with less stressful job? Look at the investment and the pay!
Hello.
Some part of me snap when i read this because some part of it was true, while some part of it was just another point of view from an old man with many fancy certificates.
This js a wakeup call for future doctors to NOT be bias like this Doctor.
Not only he have violated many ethical rules as a doctor, but have shamefully embarrass his own fellow Malaysians
Firstly, i am confused. Are you a doctor or a robot?
If you are really a doctor, you should have known better.
Have you ever diagnose a patient with a thin chance of surviving, but there is hope where this patient can still go through a procedure, recover and be at his tip top condition the next day?
I guess no.
Okay, we’re not talking about grey’s anatomy or house here.
We’re talking about reality.
People change, people learn and most importantly not everybody are the same, because everybody were raised from different backgrounds.
However the only thing i agree is on is the system and procedure that you have elaborated.
Maybe Russia is the same, but students aren’t. So what if few of them were forced by their parents, some of them have bad past. So what if they think Russia is a good place to invest their money and future?
It’s just some. You are talking about minority.
Sebab nila setitik, rosak susu sebelanga.
Have you ever visited Russia? Have you ever take a class, be a student there?
In moscow, in ukraine, in anywhere you think it’s not a suitable place to study, or anywhere, to earn or ‘ buy’ a degree.
Did you forget history? Did you honestly forget history of medicine? How many Russian scientist, biologist, doctors did many discover that have helped us in the medical world today?
Well if it weren’t for some Russian scientist, we might not even know what is blood pressure today.
If every Malaysian student were to be judged by their spm result, i’d say it is plain stupid.
Why? do you have any friends that are so smart but just couldnt be bothered to study?
Do you have any friends that work their brain off every night memorizing, understanding whatever he or she need to prepare for tomorrow and yet he or she cannot deliver on the spot?
I guess no. Because you are too busy being smart.
So you have many degrees, many years of experience, don’t the other doctors in Russia who are teachers, are too?
My psychology teacher holds a double degree and a phd and god knows what, but i don’t see her stereotyping students.
Why is spm result that important? Why is that the past of a person define them?
Why isn’t it now, what is on the table that matters?
If everybody were to be judged like that, i guess we all fail.
Well after reading your post i must say, you must be rationalizing. (A Defense mechanism term by Freud who quoted ‘life is not easy!’ just in case if you dont know) but… Probably you’d know that.
I do have alot to say, but i don’t think i should dedicate more time for people like you, sadly, doctor like you. Whom a malaysian, tanah tumpahnya darahku.
I guess only in Malaysia people try to condemn their own people.
Because in Russia, even with the ‘bad picture’ you guys have in your mind, is better than some of us Malaysian.
If any of you are against on this comment, i guess you are just like me, except that i am disagreeing on this biased post.
I hope you can take a look a from the other side.
And. I do hope.
I hope one day, or if you have a child today, i hope they fail and do good later but be judged for the past.
Because i don’t think this system work.
To other Malaysian student who studies in Russia, you guys work hard and i know you guys are better than this.
God bless us all.
Yes, some weak students do perform better with time. Some. Most still are weak students no matter what.
And medicine is NOT an appropriate testing ground to find this out.
Which is why in advanced countries, they do NOT allow weak students to even apply for medicine. There is no need to experiment. It is too dangerous.
Sorry. If you want to prove you can be successful after initial failures, try some other courses. There are plenty to choose from. Why medicine?
Another so called educated person who do not understand what the article is all about!! Stop barking at the wrong tree. The entire article is about entry qualification which is a standard practice all over the world especially in developed countries. Why don’t you go and rant about this in UK, Australia, US or NZ?? they will tell you to fly kite!!
Whatever said, you need certain level of intelligence to be a doctor. If you read the article above carefully, I have said it very clearly that SPM should not be a sole criteria. A standardized, established pre U course should be made as the entry qualifications. IT is very clearly written!! Stop throwing your tantrum like a child and grow up.
Just because there are scientist from Russia, does that make everyone as genius as the scientist? The fact remains that mediocre students go to Russia to do medicine and easily pass out. The evidence is clear.
medicine is not a field where you want to learn by mistakes. So you feel that killing few patients is OK since they are learning ??
Please think carefully before you make your comments.
Ms Wong,
Sorry to say that I think you missed the WHOLE point all together. I am not trying to take sides but that is my view. You seems like a nice person but still, you missed the trees for the forest. Dr Pagal has explained so many times that the SPM results was referred to after she failed to answer simple questions. It is just an illustration and to overcome it, maybe MQE should be implemented. The poor SPM students who are late bloomers can also make it.
Well written. I am a SPM leaver and currently waiting for the release of my result. Since young, my ambition is to become a doctor. I set it as a target and motivation for myself. Yes, I do have a passion to take up medical course. But after doing some research and reading your articles, I fluctuated and ask myself, what does passion really means about? Can I face all the challenges and issues that are rising regarding doctor career ? If I was to take a medical course, private uni which I can afford is AIMST or UTAR. Not really know about the detail of both uni. Any idea?
As now, Form 6 students are going through a new education system. There are so many rumour, pros and cons… So, is it still a better choice to choose Form 6 as a pathway?
Thanks for the advice.
I will surely think twice and carefully before I make up my mind here. Looking forward for your comment.
Form 6 is still one of the best pre-U course but a tough one
Hi dr Paga. Im graduated from one of the Indonesian university which is recognised by our mmc. As I know it is not easy to pass from my university. There is also drop out cases of
Malaysian students from my university, these are the students who failed professional exams and couldn’t cope with medical studies. I am very proud to say that im an indonesian graduate for many reasons. Our theory in Indonesia is as same as other best universities, our clinical studies even far better than other universities because in Indonesia there are a lot of diseases which cannot be seen commonly in developed countries. To get into clerkship (2 years) after 4 years of theory is not easy as well, students are selected based on final year mcq and OSCE. Many of the malaysian students here only able to passed after 2nd attempt of this exams, only few can passed at first attempt. The clerkship in Indonesia (in my university) is as doing housemenship in malaysia. We have log books as well, we need to hold patients, need to present cases, doing routine procedures like blood taking, setting line etc etc, doing 36 Hours call. We even done some other procedures like pleural and peritoneal tapping, intubation, LP, delivering, etc etc. As far im concerned malaysian and Russian trained students only able to do this during their housemenship in msia. Apart from that I do see local graduates from so called best university who doesn’t know to manage patients even simple cases ( hyper/hypo kalemia, etc, etc). Majority of them started to do routine procedures only during housemenship time.
I am also very proud to say that most of my seniors graduated from my uni are now specialist, few of them working in US as a specialist. So what I am trying to say is do not underestimate foreign graduates, its all depend on the individual itself whether he or she have the keen in medicine provided with good foundation in science prior to enter into medical school. Thank you
zzzzz all the log books thing, hold pts , present case… bla bla bla….we do it in our clinical years as medical student… we got NO MCQ to pass our professional…but SBQ and OSCE clinical
log book thing, present case, delivery, 36 oncall….all the things you mentioned above…. we did it during our clinical years as MEDICAL students.
we got NO MCQ to help us pass our professional exam but LONG CASE, SBQ, OSCE clinical, short case….
ps: local government public uni
A very good example is would you trust a half-blinded pilot to fly you across the vast oceans and natural motherland to safely arrive at your destination blending in worst case scenario and unforseen circumstances such as bad weather or an engine failure,, you would think 10 times because a pilot makes a mistakes, all on board perishes, a doctor makes a mistake, a soul is gone. But, i personally being a commercial pilot for Malaysia Airlines and a life long straight A student who considered medical as option B, would say THERE IS NO POINT PICKING ON THESE GRADUATES FOR THEIR APPROVAL OF MEDICAL STUDIES ABROAD DESPITE THEIR BELOW PAR SPM RESULTS. The same situation is happening in aviation world too with individuals not even capable of speaking proper english coming from Philipines as graduated pilots, hence saturating the local supply and demand market for pilots in Malaysia. I WOULD BLAME OUR FANTASTIC GOVERNMENT FOR THIS. Simply giving away approvals for those undeserved and uncreditable individuals. It has become politics and education is a business now, considering many private institutions are mushrooming year after year and simply to get their business running, who else to aim if all the good ones have already been taken by top institutions? The answer is definitely obvious. Even our government needs to ‘cari makan’ and in order for that, things like this happen. The agents definitely take advantage over this situation and start to advertise and market these institutions and they make huge profits out of it. The core of this problem would be our poor government who at times because of certain individual’s greed, opt for quantity rather than quality.
Another source to be blamed is our dear Indian parents with their old styled cliche ‘Doctor, Engineer, Lawyer’. Times have changed dear parents. This is the 21st century, the era of flat screens, not cathode-ray (CRT) box tv’s. My utmost respects to some parents who actually listen to what their children are aspiring upon. But, on the otherside, comes the dad and mum telling their kids to be doctor, doctor, doctor, nevermind the other two. It is okay if the children possess the required basic qualification needed to enrol in medical studies, but what about the cases where you know your child screwed up his or her exams, definitely not eligible for a loan or a scholarship, yet fork out money to send their children abroad for medical? One of the reason would be the pride amongst society individuals, that hey, my kid is doing medicine, a future doctor in the family. This applies to the well being families too. It would be okay and great if the kid turns around the fortune and come out as a victor despite below par SPM results, but certainly my question would be how would you expect the building to be strong if the basement was weak, or lets say was built perfectly, but somehow degraded and now that the building is half way complete? So, I would say the basics are important and take note dear readers, exams are not to test our intelligence, i bet Albert Einstein ever sat for an exam, exam is a form of evaluation of how well your basics are and your ability to deduce complicated solutions and derivations for it based on how strong your basics are, and SPM is a stepping stone. Definitely, a student with STPM or a Diploma or a Degree will show better maturity in how trainable and teachable they are. So, based on what Dr Paga said, if a drop in standards are occuring, the basics must be incremented and recently the government has announced that JPA scholarships and loans are no more for SPM leavers, you need to do your matriculation first or step into STPM and show the 4.0. Again, our government to be blamed, playing two stick matches. So, the root to this problem is our Government’s education policy which is being treated like a share market trading business. NO POINT POINTING AT THESE RUSSIAN, UKRIANIAN OR INDONESIAN GRADUATE DOCTORS, Dewi Mahaletchumy is right infront of your home knocking your door, rich or poor, smart or dumb, who cares? You definitely would want to live your life with HER blessings.
Well said and I have also said that SPM should not be used as the entry qualification. IT should be a well established standardized pre u course
You wouldn’t be so confident of Indonesia’s health care standards, if you have seen enough of what is done to patients there.
The fact that richer Indonesians openly express their distrust of Indonesian doctors and seek treatment elsewhere, particularly Singapore and Malaysia should tell you something, no?
Yes, I have seen many good Indonesian graduates. Some of the Universities in Indinesia are better ranked than Malaysian top units. I know for sure that Padjajaran, gajahmada are good universities. You even need to sit for entrance exams before being selected.
*Deletes “Medicine” on scholarship application form
*Types “Engineering”
Dear Dr,
After STPM , not being able to score full A, but B and C, I was not given medicine as a choice in the local university. My parents , knowing that medicine was my love, looked at many options locally and abroad. I had the entry qualification for IMU and Manipal Melacca. But due to financial constraints, we opted for ukraine.
What saddens me is this dr. During the period of which we were deciding, dad made the trip to MMC to decide if these universities that these agents were suggesting were recognised. They assured us that the university that dad was planning to send me was legitimate. If it wasn’t, dad would have done all he could to put me through IMU or Manipal Malacca. It was sad to see my parents going throughout the motions of worrying for my future when i was studying there , with ongoing unknown status of the university. I do hope, for the sake of other parents that invest a lot of their saving on their children, that the medical boards would properly make definite decisions when it comes to recognition of university.
And as for the students from ukraine and russia or other eastern european continent.That have made remarks here:
We will judged. There will be double standards. Make peace with that. Be happy that your parents did all they could to give you a medical degree. Now, all you have to do is work harder and study more that the rest the earn the respect. Don’t demand it.Youre nobody to begin with.They are suppose to be hard on us. How can they not be? We are dealing with human lives.If medicine is your dream, then working hard wouldn’t be a problem. In fact, your bosses will appreciate it, and when they see that your hungry to do well, they will teach you more. I had the wonderful experience of my MO and Master Students that would give me assignments ( they decided to do so, as my friend and I would keep asking them questions if we didn’t understand anything)and then test me during on call rounds with them, so that id be more prepared during my ward rounds in the morning with the consultants.During typing discharge summaries we would test each other.I didn’t have a social life.And I didn’t care. I have a wonderful father that would tell that the kite would only rise higher against the wind.
Many of us feel inadequate because of the lack of knowledge , but if we work hard enough to acquire the knowledge , we will have the confidence.Knowlegde is power. I spent all my internship years in the hospital. It was hard, long, working hours, cried a lot of tears in the toilet. But it was the best time of my life. Im an MO now. But i appreciated every scolding, every insult, every yelling. It isn’t personal. Get over yourself.As you make a lot of us that have graduated from these universities that don’t mind all of that look bad.
“A doctor must work 18 hours a day and seven days a week. If you cannot console yourself to this, get out of the profession.”
— Dr. Martin H. Fischer, University of Cincinnati, professor of physiology 1910-1950
Thank you for this “breakthrough” of sorts, eventhough I believe you are of the minority in this “Russian fiasco”. It is a refreshing mature comment after so many spewing vitriol at Dr Pagavalan and the other senior doctors here. If only the majority has the same attitude, this blog post may not even been here. May you continue to find joy in your chosen vocation.
Well said. You will become a good doctor
I have read most ( but not all ) comments here
I think after 5 years in Russia, I have at least some qualification to speak on behalf on the russian students here
I came here after SPM, i got straight As, went to apply for JPA, could not get it, met up with some agent ( u know who ) from some company, and in a blink of an eye I was here
First year, I was excited to just being here..In a foreign land, with winter and snow, who wouldnt?
Second year, I had problems with my accomodation. Agent didnt help much, I had to settle everything by myself, had quarrels ( a lot of time ) with my girlfriend because we were not seeing eye to eye in accomodation ( she suggested to move back to hostel, but me having to tumpang in others’ places for about 1 month, was too afraid to do so ). But, finally i gave in and thankfully I got into hostel here, which I have stayed until now
Third year, my first year of going practical. Up till now, I was an excellent student who all distinctions in exams. I was so proud of myself that I couldnt wait to prove my so called ‘knowledge’ during attachment. No sadly, things did not go by that way. I was ignored, stereotyped, often feeling useless during attachment. Yes that time i felt that what i was learning in Russia is utter useless, I was so sad but I couldnt tell my parents ( i didnt want them to be sad )
4th year, coming back facing my worst feared Russian subject..I was quite stressed out because i was needed to learn in Russian, answer the question in Russian ( and my Russian is just cukup makan ). I briefly went into some mild depression, i was hiding my feelings quite a lot of times but sometimes i just wanted to shout out my frustrations.
5th year, again the same prob happened.But after the turn of the year, I came to realize something..
All these hardships that I faced in Russia made me a stronger person, a more independent one. Yes i might be stereotyped, yes i might be looked down..But im not prepared to give into it..Stand strong in the face of adversity !!! I aspired to be a good doctor, and i still have the same aspiration from 6 years ago when i chose this path..Thing is Russia is bad ( yes ) but if you yourself cannot overcome this crap how can you overcome anything in your life? Think about in Malaysia..I may not be a HO now but i have heard a lot from graduated seniors..Berating, scolding is a norm..So? If u cannot take scoldings then dont work !! Thing is we are paid for it so expect the scoldings !! ( not like you dont get scolded if u work in private fields ) hurdles make a person grow, and it has definitely made me think so
Sorry i wrote an essay..Im not siding in Dr Pava or those who have commented here ( medic students from Russia, MOs or HOs or HODs ), it’s okay if you stereotype me..I dont mind being stereotyped but I will prove that you are wrong !!
Life is always a hardship. You learn along the way. The harder your life , a better person you become.
One question: despite all these that you had mentioned, you passed all the exams?
Sorry Dr Pagavalan cant find the reply icon so i will reply here
Yes, i passed all the exams..I mean if u cannot pass exams in Russia, do not expect you can pass exams in for example USMLE or MRCP
Work hard guys !!! Things dont come FOC
very interesting article..
Dr Paga, you have stepped on the toes of Russian grads unfortunately for not being politically correct.
I have heard of stories where patients who go to private hospitals only want to be seen by western graduates. Fair enough. We all want to be treated by the best if we can afford it.
Another point we missed out is that the MOs and specialists in our hospital must be more proactive in building up all these new HOs. Alot of time, there is a steep learning curve from medical school to being a doctor. And a really good doctor usually is trained up by a really good senior who takes the time to guide and supervise him.
Hence, a culture of teaching and supervising must be instilled among the more senior doctors to take responsibility to pass down their knowledge and skills.
Yes, medicine is a life long learning. As I said, if you do not know the basics, how to teach them?
Ill argue graduate medical education is even more important. from selection of candidates to formalized training programs – this is the best opportunity for a country to create a competent specialist workforce.
perhaps in subsequent postings dr paga will highlight the state of the local graduate medical education scene – from issues with mentorship, standardized selection and assessment programs, formal rotation syllabus, and amount, quality and benchmark of publications produced by both trainees and mentors.
maybe we might uncover that the way british/malaysian trained consultants have skepticisms about russian med school graduates, the developed world have skepticisms about malaysian trained specialists? or maybe not – either way it might be a good discussion.
by‘ reading this article can add insight for me. …..!!!
thank you for the information. …..!!!
Dr. Pagalavan, It’s good to know that you acknowledged good STPM graduates and said that we have the upper hands. However, pls bear in mind that we opted to complete our medical course in Russia solely because we could not afford local medical course and conned by ‘smart agents'(No scholarship-pls know that many worst spm leavers who are doing medicine especially in Russia are sponsored by the Gov!—MANY ARE SPONSORED regardless of their terrible results!-mostly because of their race and what they call ‘orang dalam’).
So, according to what you have mentioned, ‘Preferences will be given to government-sponsored students and local public university graduates’ , isn’t it to say that the jobs will be offered first to those who doesn’t meet the education requirements but are sponsored by the Gov??? This statement greatly contradicts the aim to filter out incompetent future doctors.
Regarding the MMLE, I’ve heard and read a lot about it being another bias evaluation where the advantages are given to ‘specific persons’.
After all the obstacles STPM graduates had to go through, and after 6 years of medical course, we will still be losing out due to the same cause. If you know what I mean. I hope that STPM graduates will be given what we deserve, pls include STPM leavers in the preference list. That’s all I’m asking for. Thanks.
MMLE is the only way forward. It has not even started, so difficult to say anything about bias
come’on.. jpa isnt that blind to sponsor students with terrible results! please do not racialised this issue.. but if it’s because of ‘orang dalam’ then that could be true
Hi Dr Letchumanan,
Thank you for highlighting this very important issue of the existence of sub standard entry requirements for certain medical schools overseas. I’m a Malaysian junior doctor currently working overseas and even now at times, i question my abilities as a doctor as it is definitely not easy to be a good doctor! One needs to have basic adequate knowledge to be able to understand clinical situations and with SPM results like that ( as shown on your blog post)- I fear for the safety of patients!!!!!!!!
Just a thought,
Is it possible to use the system like in US in this country? Instead of using SPM result, why don’t we make the study of medicine begin after completion of undergraduate study which includes meeting the pre-medical school course requirements along with obtaining a bachelor degree? From there we can see who’s gonna make it. And also provide escape route for those who think that medicine is not for them. It probably taking longer time though… just a thought
Yes, the time will come
What if you get straight A+s for SPM, do considerably well in A levels and have made the requirement for a Private Local Twinning University , that twins with Ireland? When I was younger I always had the confidence and thought I could manage this as I had the grades and true passion. I get mediocre results in university now and it makes me feel so inadequate as if it will make me a bad doctor, and thinking about the employment rate for the time I graduate worries me.
In good Med schools, it is common to be top students of your school/town/region, and yet be average amongst your peers.
That is what is called the crème de la crème.
You are just a proof of how even a good student find it difficult to pass exams in a establish medical schools. But we have mediocre students who can pass easily in some medical schools!!
hi, i have been following Dr Pagalavan blog since i was a 4th or 5th years med student and now, i just started my 5th posting of my housemanship
im a russian grad myself. when i first reading Dr Pagalavan’s blog, i felt depressed and worried.
to be honest, it was quite tough and stressful for me in the beginning of my housemanship a year ago as i have to re-learn everything from zero and i have to adapt to the local system. my consultant kept on telling me on almost everyday basis, that i need to buck up and my MO’s were complaining about me. at one point, i actually thought of quitting medicine for good, but i also don’t know why i didn’t do that. thank God that i have a bunch of good MO’s and my assessor/mentor was good and willing to guide me. at the end of my first posting, my consultant had changed her view of me and finally told me that im ok and passed my assessment without any extension.
when i was a 3rd year medical student, i met a cardio specialist, my friend and i can’t answer some simple questions, and he was very angry and i remember exactly what he said:”if i were you, i will dig a hole on the ground and bury my head in it”. when i did my medical posting as a 3rd poster, i met him again (and he was promoted as consultant already) and manage to answer some of his questions and he then said that im good.
im not trying to self praising myself or showing off, but im trying to encourage some of the russian uni students here. medicine is a life long learning course, so, don’t stop learning, be humble and be open to learn. when starting their housemanship, everyone (regardless local grads or foreign grads) is equally blur, although local grads do generally have better knowledge, doesn’t mean that we can’t read up and learn and one day, be better than them. be humble and learn from them.
everyone at some point will screw up (even sometimes specialists do) and get scolded,doesn’t matter, just apologize and learn from our mistakes and try not to repeat it again. don’t keep it in your heart.
besides, im a very jonah person, patients can become asystole when i just pass by in other people’s ward, but it actually force me to pick up things as fast as i can. because i know i need to prepare for the worse.
our housemanship will not make us to be a good doctor, it merely just train us to be a safe and competent doctor, it is our attitude that determine how good are we.
Well said. Unfortunately, just see how many of them reacted in this blog!! You have the right attitude and you admit that the training you got in medical school was almost “no training ” . However, you had the courage to learn fast and be humble!!
I cannot help myself but to give my personal opinion on this issue. From what I have heard from from fellow doctor friends and family, the Master programme interview weighs heavily on social circumstances (for female candidates). They want to know how many children you have, they want to know who are taking care of your children, they want to know whether or not you have a good family support etc.
Well, I understand that social circumstances is very important to make sure that the candidates are not going to stop half way due to social circumstances but seriously think about it. If that’s the main criteria for selecting a future specialist and consultants, Malaysia is a scary place to be. Because of the rigid system of the Masters programme and how the posting and placements are going to be (family, baby and mother are separated etc), many excellent and good female doctors are been put off from doing Masters programme. Imagine, you have to leave your 6 months old baby in the hand of your maid (when you do not have any mother or mother in law or family members to help caring for the child), live hundred miles away to study, hardly seeing your child. After graduating from Masters programme, God knows where you are going to be posted, again another years of separation and uncertainty.
Yes, for some people this is not a problem when they a have very good support. They can leave their family behind knowing they are in a right hand. For some, we are not that lucky. Most female Masters student that I have met are not the best in the field or have the best reputation but they are in the Masters programme because of their strong family support. So what are we producing now? A mediocre specialist with excellent family or social support? I have known many of my female friends from college time and university time back in United Kingdom who I know were excellent students and are excellent doctors but decided that family are their upmost priority and decided not to enter the Masters program me yet at least.
If we are to make Masters programme more accessible I suggest few changes at least to be made. When I was doing my Foundation training back in England, I have met registrars who were doing part time Specialty Training. And I have met specialist who are working part time but that does not make them any less. Working and training flexibility to ensure fair opportunities for excellent female doctors out there is the way to go. That is what I think, at least. I know many people may disagree with me, but that is just my personal opinion.
You need to forward this to MOH and education ministry. Sometimes sacrifices have to be made. That’s why I keep saying that medicine is not a bed full of roses.
To be frank, many drop out of Masters due to family reason and stress
These are common questions for female residency candidate everywhere. Don’t be so scared about Malaysia.
Hi dr paga, your blog post here is amazing. It does act as a wake up call not only to most of the Medical grads from prestigious uni, but also us(the Russian grads-to-be from mma). We certainly know that our system here are not up to par and so, we are ready to work 10x harder then others to compensate it. Even for now, we started to have small study group everyweek with different topics discussed everyweek. We do hope that we will be up to par by the time we graduate by year 2015 and also wish that all our hardwork is worth it. This post does act as a motivation for us to strive harder. Thanks dr paga.
PS: I have 8A1s , 1A2 and 1B3 for my SPM (A2 for chemistry and B3 for English literature) and cgpa 3.67 for my pre-u study. I choose to study in Russia because my family can’t afford for me to study in local universities. A lot of my friends with a better result in both of their SPM and pre-u came Russia to study with the same reason. It’s not that we don’t want to go to better universities. We are actually force to do here because of its affordable price and not because we have a sub par result.
You statement is humble and shows that you will become a good doctor. Generally, students will good entry qualifications do not face much problem.
You have excellent POTENTIAL to succeed.
I had a priviliged to work with some local students who passed local uni with all their glory and still cant clerk despite 6 years in the system not to mention go and sleeping in omcall room when time for pm review….everybody is the same ..no one is bad jz because they are from that one place…all uni produce good and bad grads….so dont be bias sir. U should look back all grads as a whole. U might jz suprised. Even their practical skill is the same as any othet grads from anywer…whether its uk/india/malaysia/russia/ukrqin/nz/indonesia. Somehow your blog has promoted biasness for many years now. Kudos for that and please sir go and see the enviromwnt as a 3rd person in the hosp. U might jz be suprised… we are all the same. Everybody has fundamental basics..just the level of experience is different . And medicine is a dedication to humanity.
Two wrongs do NOT make a right.
Yes, the IPTAs do select mediocre students, on the basis of their skin colour and religion. And some of them turn out badly.
But that does not give justification to selecting based on money.
in any case, even the worst student in IPTA still are academically stronger than the average Russian/Indon student.
Also, people needs to get away from thinking that being able to do some practical procedures defines a good student/doctor.
At junior level (ie Houseman), the most important attribute of a good doctor is a strong foundation in the basics of medical knowledge, and clinical methods.
NOT procedures.
If all you can do are practical procedures, you are a technician, not a doctor.
If you had followed my blog for the beginning, I had spoken about all this long time ago. Have you read what I wrote about local private and new public universities?? Do not judge what I wrote based on a single article.
I believe spm result shouldn’t be used as a measure of intelligence. As you say our education system is always politicised and the education system in malaysia is as bad as it goes.1 time science n maths was in english then changed to bm now I forgot whether it is in bm or english.and some students when they were 17 they didnt realise spm was important for them so they might not have done well but once they enter university they get more matured and decide to study hard and do well.so the question goes is it really necessary to use spm as a measure of intelligence? And spm results used to decide if the candidate is fit for the job?
The SPM is the last common exam the majority of students will sit together. After that, the pathways fragment up into myraid options, which cannot be equivocated. Therefore, while there is much criticism of the SPM, it is the BEST way of assessing the RELATIVE ranking students.
In other words, it helps to stratify the relative ability of the student (and subsequently doctor). The MMC is correct in using it as a yardstick. The requirements are very low anyway. It allows the top maybe 25% of the student cohort to pursue medicine, way lower standard than the 5% required by developed countries.
Surely no one is suggesting anyone weaker than the top 25% should be allowed to be a doctor? Or are they?
I have made it very clear above that SPM should not be used. A good established pre U course should be used
Reblogged this on aku berfikir,maka aku ada..
Why is it that so many Russian graduates agree they lack proper knowledge and training when they graduate and start as Houseman, and they can and are willing to learn, and still thinks that is NOT a problem?
If you have to be taught the basics again (like a few here demanded, that seniors be patient and teach them), what did you do during the 5-6 years of your studies?
And that is still not a problem?
Apparently, if I didn’t read it wrong, they were taught in Russian terms especially when they were doing clinical, and therefore need to “re-process” and “re-translate”. I thought they were taught in English, but I don’t suppose they can speak English with Russian patients. How do they do it in India?
We communicate in English, most Indians understand English, at times better than the people here, even on the roads. In the event they don’t, we have a translator and our professors will also help. All case presentations, history taking etc is in English.
Mainly because India is a commonwealth country just like Msia so in terms of management it’s similar. And considering many third world diseases such as TB is back on the rise in Msia due to many foreign workers, India is a good place to do medicine. I’ve no regrets.
They are supposed to be in English, and the programme is designed for International students.
Which then begs the question, why is there a medical programme in English in a country where hardly anyone speaks English?
And also, why are people going to a country where they hardly speak any of the local language, to learn medicine, the professional where effective and accurate communication is most vital?
I agree that medicine should only be read by those 25% cohort. Even among creme de la creme who had chosen medicine somewhat didn’t know the pathway that they chose require a life-long journey of dedication and hardship.I truly support if KKM and MMC made medicine as a graduate course rather than undergraduate than this issue of mediocre SPM could possibly be lashed out with the maturity of potential students who really made out their mind that medicine is what they are pursuing for and ready to sacrifice their life.
As by 2016/17 MMLE will do its honour by filtering those weak but it’s really sad reality that you had studied medicine for 5/6 years and your degree worth of nothing.
For a quick ponder, I have seen those mediocre school batchmates who did engineering and do better in life in term social stability, money and social-work balance. I met a senior MO who left medicine to become a cadet pilot!! I have a friend who is First Officer with Hong Kong Airline and earning RM30k/m at a mere age of 23. Think thrice because medicine is not a rosy pathway, its come with sweat, heat, and sacrifice and later you will realise to sustain life is both; money and passion.
That is actually wrong. Being in the 75% percentile is not good enough to read medicine. Most countries limit medical and other critical studies to the top 5%.
Unfortunate, in Malaysia, it is not possible to prevent weaker students from pursuing medicine, and MMC can only hope to limit potential damage but setting a low standards barrier. This is damage control, not setting excellence.
I’m in fact a Russian grad, scored 9As in SPM, 4As in STPM, a fully FAMA scholar, currently doing my 5th posting in my HOship, n I supposed it doesn’t matter where u graduated from as long as u have the passion in your job. I just feel that if u have the right attitude, and adequate knowledge, it really makes the difference. BTW, there was this local grad, my colleague who even had the idea of inserting a CBD in an ESRF pt on regular HD, with nearly nil UO. So, does it really matter where I graduated from? At least I know what I’m doing n my consultants in previous postings don’t think my knowledge is inadequate or me being non-competent although I’m actually graduated from Russia. And another grad (my MO) from India actually gave IV frusemide for pt post Hartman with BP 90/60, HR 120, just to achieve urine output of 0.5cc/kg/h. Does it not make any issue?
As I said, a good entry qualifications produces good students. I am talking about poor entry qualifications producing subpar students
Leong, you have good grades but you sound like an idiot to me! Don’t you know from your grades that you are an exception? All your Russian grads performed like you? You know what screening is all about? You may passed exams brilliantly but I doubt your judgments as a doctor!
Guys,we’re all from the same fraternity.Why on earth are we bashing each other.Be it,they graduated from Russia,Indonesia,China etc but they are now serving our people;Malaysians.SPM results?People change.Let’s stop being judgmental.I don’t agree with the idea of once you’ve failed/fumbled in any period of your life,you’re done.I can feel so much of negative vibe here.From my humble POV,i don’t see we can go further if we keep on wasting our time discussing about others’ mistakes.Let’s learn from it.Sorry if I’ve offended anyone of you.At the end of the day,unless you want to serve other countries,we’re all colleagues.
This is about quality of products and not serving the people.
being a doctor is a very hard job and a career that shows predilection in saving lives but nowadays medicine is very commercialized and people want money thats all they don’t have the penchant in curing lives and the amount of docs is so high in our country.
yes, exactly
SPM is not a benchmark for everything. Should revamp the whole thing. If you have Diploma, it should supersede your SPM same goes to your Degree, should supersede your Diploma and so on. The problem with Malaysians, even if you have a Masters, they still want to see your SPM results. It doesn’t matter whether you are applying for a job as a call-center operator, secretary, doctor, CFO, they still want to look at your SPM results.
The problem in Malaysia is, the standards of everything is so variable. If you cannot rely on your pre-u (foundations are ‘sure passes’), diplomas, degrees (give ipad and get distinction), how else can you judge the RELATIVE ability of the person?
You go look at the LAST common exam everybody took.
That’s because the education in Malaysia has become too commercialised and the best standardised exam that people can fall back is SPM. That’s why even MMC has to fall back to it. Have you interviewed graduates before? Try doing it and then you will realise what I am saying. As long as you have money, you can get a diploma or degree in Malaysia
Guys, I think everyone need to be humble when it comes to medicine. I eat my humble pie when I come to university in Aussie/Nz..this is the real medical field, of international standard.
From the comments posted, one factor stands out. Those who went/are in Russia medical schools with good SPM results accept the realities of what Dr P posted, even agree with him. Those who have graduated from this group, admit the initial challenges but have worked hard to overcome them, and they seem to be doing well.
Which now begs the question, are those spewing vitriol the ones being addressed by Dr P as having had undesirable results? Putting aside SPM results I hope these current students (in particular government sponsored ones) swallow a bit of pride and learn as much as you can, even extra to save you from the potential humiliation when you start work. The perception is really BAD in Malaysia. I guess the good ones would be looking to sit for the USMLE and try their luck in the US.
A good summary of the entire thread above
This is the current generation X or Y or whatever, who have loads of pride and as mentioned above, exude over-confidence. Most of them (non govt sponsored) should be already thinking of doing the USMLE with the current job insecurity in Malaysia.
But honestly, mediocre/substandard students may not fare well in USMLE and although they may pass them eventually, the competition is so high in US due to many Indian and Pakistani and doctors of other nationalities also vying for places in US, not to mention the international US graduates themselves.
yes
Hai Dr! i’d just drop my comment abt your post here.
i think that in the end, it all boils down to the fact that once you enter a medical school, regardless whether it’s local or private, you start zero!
if you do well in your med school and equipped with the appropriate knowledge when you enter you housemanship, nobody’s going to be curious abt which med school you come from.
the only time ppl would be curious is when you either do extremely good or extremely bad in your housemanship.
so, if you don’t want to get picked on when you’re a russian/ indon/ etc med student, do good, be prepared, and no one will undermine you because of your background (spm/med school).
even i i’m a local public med student, i don’t think i’m getting any golden treatment or anything. i’m still scolded and humiliated if i’m not able to answer a simple question by the lecturers.
so, study hard and prove your capability as a doctor, cause’ that’s all that matters!
Yes, exactly but a basic entry requirement is still necessary.
Dear Dr, you are just talking about what is happening within the medicine fraternity. This also happening across other sectors as well. the question is how many students obtain good results in SPM? How many students with good results in SPM excel in their career life? We can’t just point out the medicine sector alone. Let’s stop being judgemental on this particular issue. When one fail once, i does not mean that they will be failure forever. I understand your feeling and frustration over the issue. Lets see the overall picture. Every individual deserve to succeed in their life. I do excel in SPM with flying colours, but unfortunately, i don’t have anyone to guide me to the next level. I have to go to school and asked teachers for guidance in order to further my studies. But students with poor results manage to go to colleges like Inti, Help, Olympia, Sunway and more to further their studies. At least, they manage to succeed in their studies and career. Everything depends on luck. So, i don’t agree with you idea. Maybe you are one of those from school taught.
I have said many times in the comment, as well as the article above that I do not support that SPM be used as the sole criteria. IT should be a well established, standardised PreU course like STPM, A Levels, IB etc. The problem comes because there are too many dubious foundation courses being run by too many private colleges. So, to get into these colleges is not difficult, infact, everyone who apply will get a place. Ask any employer who interview graduates for jobs: every single of them will tell you that the graduates should not even be a graduate. It is not just medical field as you have rightfully have said. Education in Malaysia is too commercialised and money talks. Why do you think our country is going down hill in every field?
I think that this article is full of shit. Just because you don’t do well in your SPM doesn’t mean that your life is over. In fact, a lot of people don’t take their school years very seriously compared to their collage years. Everyone is different and who are you to say that people who didn’t do well in school don’t deserve to be in med school. I only achieved 1 A in my SPM but in my A-levels, I achieved 2A* and 2A. I am now studying Law which, obviously, varies from Medicine but I resent the comments you made on not being “smart” in school doesn’t give a person the right to study medicine. It’s a person’s basic right to have an education no matter what that education may be. Besides, are you saying that all medical students who got straight A’s in their SPM are likely to succeed in that field? If you are, I can give you numero us examples to rebut that claim. Btw, you cannot practice law in Malaysia without the CLP. You be allowed to do paperwork (assisting others in drawing up contracts) but in no way can you practice the law. So people out there, please don’t listen to this dimwit here. Even if you didn’t do really well in your SPM, go and do whatever the hell you want as long as it’s your passion.
It is the right of anyone to have an education, But it is equally the right of everyone to have safe competent doctors to take care of them.
There is no need to reinvent the wheel. The best predictor of a good outcome in the training of doctors is the academic ability. The selection is fine tuned with other variables to choose the right attributes. If you want details, google the selection process in these countries.
This is the current best practice in ALL advanced countries.
Try go demand your ‘right’ to a medical education say, in UK or US and see what happens.
You are not comparing apples with apples. A minimum standard is required for certain fields, including law and medicine. What that standard may be is up for debate but there should be one nonetheless.
Using your analogy, maybe people with sub-standard A-levels should be allowed to practice law … and why not? After all, it’s a basic right to have an education no matter what that education may be, as you put it. Where do you draw the line?
The reason decent SPM grades are required is because there is no other filter after that, unlike your A-levels. Many universities take students straight after SPM into their own foundation or matriculation programmes, which are usually not externally validated. Also, there is currently no equivalent to the CLP for doctors in Malaysia, although many including myself think there should be because of the problems people have stated.
I hope you can put forward your arguments better in the courtroom, rather than descending to name-calling.
You call yourself a law student but yet do not understand what I wrote up there!! Did I say anything about SPM being a criteria to enter medical school. MMC is the one who came up with the criteria. I have clearly written above that I do not agree with it as I would prefer a standardised, established Pre-U course to be used as the entry criteria. No country uses O level equivalent as the criteria to enter med school or anything else.
So, before you throw your tantrum like a kid, read carefully. Every university have to set a standard and one of the standard is the entry qualifications.
Another joker who cannot understand this article well. You have CLP but for doctors, what do you suggest?
Doubt you’ll read a comeback comment, same for all those self-entitled ones who commented without really thinking.
I’m a practicing lawyer and I can’t help it but to reply to Ashley. Please get your facts right before commenting. CLP is not the only way for you to practice law in Malaysia. If you are graduates from the local university, you can start your chambering upon completion of your LLB and likewise those that graduate from the UK can opt to sit for the Bar Exam in the UK.
Yes, I agree that not being “smart” does not stop you from studying medicine but I did agree with a lot of comments from most Drs here that you need to have the passion and of course the right attitude to be a good doctor. Same goes for lawyers. I’ve seen those with good grades but does that mean they are good lawyers? I’ve seen some pupils that dislike doing research, reading law books & cases but choose to do their pupillage in a litigation firm which obviously though they are smart but they don’t get retained in the firm as we being litigators we need to read loads of cases, do our research. You can’t do an opinion or a submission without doing research.
Don’t do law for the wrong reason and same goes for medicine.
ya agreed with the blog. Dr Paga is just explanning the real scenario which happen in the daily basis. The fact of surplus of doctor has reached a critical stage, which need correction from the MOH. The blog only provides an exposure to the people regarding the critical situation in the country. If you are not the group who doing the medicine for the wrong reason, why you need to worry or feel offended? Study hard and work hard during your University time, which provide you the best learning platform and gain strong foundation in your University year. Get your attitude right. However, if you are doing the medicine for wrong reason, despite you are coming from top Uni, do not give you extra benefit during your internship, and you will not be able to walk far in your career pathway as well.
So it will come back to the basic question..what do you want in your life ? This blog provided the real scenario regarding the life of a HO/MO/specialist etc..asking yourself. Is this what you are aiming for in the future? and you will be able to walk far in your career if you are mentally prepared. Cheers.
Never do medicine for money and glamour. You will regret…in reality, you are public servant !!! doctor is there to serve the public…
agreed
I’m just starting my MD degree at a university in Indonesia. But I went there as a private student, and not on any scholarship. I did not have NOC when I started there and I was planing on having a great result for my first year so that I can ask for the NOC or any scholarships. In my first semester I got 3.73 and will be starting my new semester in 1 month. What do you think of this situation? Should I continue to pursue my dream as a doctor or to stop right now as not to waste any time? In my past SPM result, I got straight A’s and enter a foundation program, only my foundation result is not that good. I really wanted to be a doctor, and I don’t even care if when I’m a doctor I’ll be sent to rural areas. Please advice me 😦
try applying for NOC first
Condescending sermons of righteousness coming from a frustrated man in private practice with no action whatsoever !
How do you I have not taken any action?? Do you know me?
Can you discuss issues, rather than resort to personal attacks?
FYI, the SPM result below is a Russian graduate who applied for Master’s program. A friend of mine who were interviewing them sent it to me!! She got a shock of her life when she saw the result!! Obviously, this student would not have got a NOC based on the current criteria. Obviously, she may not get a Master’s seat, as the competition is getting tougher.
?? Bias I shall say….
Well, she can survive till the moment to apply for Master, means that she is already a qualified doctor!
And whats the point that the interviewer exposed her result around the internet to humiliate her? Unless she had made some famous mistakes, killed patients…….
My very own experience, I was a grade A student, super great. Had all the good results since primary sch till sec sch, won all the academic competition, etc etc. however during my final year, somehow I stressed out and gave up on myself by ponteng sch, sleeping in class, and STPM scoring was very bad! very bad! And I had nowhere to go and no other course I wanted to join.
Ended up in one of the countries which you mentioned above, however, my good results came out again with my hardship.. actually not even hardship for me, just a piece of peanut, as I am intelligent (which you think as one of the essence to take medicine). All my results scored A (not just pass.. all were above 90-100%) during my 5year medicine.
So now if u only see my STPM result, would u think that it is so damn important to judge me as a stupid or intelligent doctor?
That piece of paper……. means nothing to me!
It is important for what I have achieved now.
No it is not bias because they only looked at the results after they interviewed her and she failed miserably. Surviving till masters in Malaysia is no big deal. Once you are in the system, you can never be removed!! That’s the reason why our civil service is rotting away in all field.
As for your self, you are a up good student to start with and thus there is no issue. You admitted yourself that you did not do well in STPM because you were stressed out. The situation is totally different and cannot be compared to a general situation.
OSL,You are good at studies. Period. Discipline? Cocky? Caring? Compassionate?
But I do agree with u,.. Some are really really bad….
In aspect of knowledge…… and not improving themselves at all even though they have poor performance…….. Their SPM results…. I am not interested to know.. I just know that Im very unlucky and unhappy to see these doctors bumping around me.
This is what I am taking about
They cannot improve anymore because they have reached the maximum capacity. Working harder sometime is of no help. The software cannot cope anymore.
Ouch!
I’m a russian grads who survived HOship. I truly admit that russian grads and probably other oversea grads need extra work not only to adapt the system but basically to start from 0. But ya, we got through it and improved a lot that you can’t really see the diff anymore. It doesn’t matter where you came from, as long as you have the determination and spirit.
Regarding minimum requirement, yes Go for it… SPM is definitely not a benchmark, even though I myself got 10As, and sponsored by government to study med in russia straight from spm.
We need regulation, this is the time… When we have a strict regulation from each level, I truly believe we will produce more capable and competent doctors… For the sake of our health care system.
Regards,
Yes, it’s already established many times that SPM is not the benchmark BUT that’s the only one that’s being used here. You had peers at medical school, and you would have encountered all sorts, those who managed, and those who struggled badly. It’s not difficult to put two and two together.
Agreed and that is what I am trying to say for a long time.
And surprisingly many could not understand this simple thing that you said. Phew!
It is now very obvious who among the Russian students/grads who have posted comments, had good SPM results. Somehow even the attitudes are different.
Although I kinda agree that we should not use SPM to measure the competent level of a doctor, but seriously with 6&7 in science subjects they allowed this person to become a doctor?? I finished SPM in 2000, at that time even ppl with B4 I didnt think they would go to medicine.
Malaysia boleh
i agree with a number of things on your post, especially about how we should have an MMLE in place and how it’ll be good to set a criteria as to which pre-university qualifications we should recognise. i think a reason why this post seems to have generated some negative sentiments and even anger is because of the way it seems to portray students who had subpar results as being in the wrong for wanting to go into medicine, and it seems to generalise all russian med grads as being bad doctors, unless proven otherwise, and there have been some commenting on the thread who may have proven otherwise. it probably wasn’t intentional, or at least, i don’t think this is the main message you wanted to get across through your post.
it may be a wake-up call to those who may be thinking of pursuing medicine with relatively subpar results but the thing about being a young fresh-out-of-school student with dreams is that you probably tend not to think that you’ll end up as one of the unlucky ones until it’s too late; rather, it’s much more encouraging to think that you’ll end up like the seniors who embarked on the same path and somehow made it with flying colours, and it’s not entirely wrong for them to think that way.
so, i think the best way to curb this problem is still via governmental policy, though there hasn’t seem to be much progress in that department yet. i’ve read about the exact same arguments/sentiments/problems ever since i was in high school, before i entered medical school, and even now, when i’m about to graduate in a couple of months. it’s been at least a decade since we recognised this problem. it’s just disheartening that after 10+ years, we’ve had to resort to advising students with subpar results to refrain from choosing medicine as their career, instead of fixing the system that exploits these students’ dreams. seriously though, why hasn’t the MMLE been in place yet?
Ask the politicians!! the Common entry exam suppose to be introduced in 2009 buy was shot down by cabinet. Only now when there is going to be oversupply, they start to get panic and wants to introduce the MMLE.
MY blog post is all about quality. I also mentioned china, Indonesia etc and Russia was only mentioned twice in the article. IT is only the fact that I mentioned. Even MOH has acknowledged that the worst group of graduates are from Russia. it is nothing new , you just have to prove yourself and everyone that it is wrong !! And when a short survey was done, the clear bad Russian graduates were those who had bad entrance qualifications. That is the fact
Perhaps it’s just me, but is anyone concerned about the level of English proficiency in some of the comments posted? An A1 in English in SPM nowadays just means you can probably hold a conversation in English, much less read, understand and critically appraise medical journals. As a specialist one is expected to write and hopefully publish journals. I shudder when I read some of these comments, especially those from indignant undergrads who think an education before medical school is unimportant.
I have seen worst
I don’t quite understand when the notion of subpar SPM suddenly went on to the attack of poor English proficiency. The English don’t really speak Queen English,the grammar errors are here and there. Now I come to conclusion how many articles have u ever critically appraised and journals did u ever published?
Can we get into the GIST here, either SPM could be a benchmark/determinant for a safe doctor? The argument has been clearly laid out that the government look at it as it is a common exam that everyone was sitting despite so many dubious foundation programme. Put aside those taking A level, IB or STPM but yes in order for them to have a general idea of candidate intelligence and sort into the 75% percentile is by looking at his/her SPM. I do agree that consistent academic performance does guarantee the quality of graduates but by just looking a mere of SPM to judge a person ability is condescending.
I notice not one of your sentences are grammatically correct. It’s very telling.
I notice your simple sentence is not correct either
Hello Dr Pagalavan,
I enjoy reading your articles, but let me point out; I think you use far too many full stops in one sentence. The only dotted punctuation marks in the English language are the full stop (.) and ellipsis (…), and they both have specific functions in grammar. Kindly refrain from long dotted sentences like this………………………………………………..!
Thanks. It is just for fun
Well said Dr Paga. I shudder to think of how many of us poor patients will suffer at the hands of these arrogant and uneducated medical personnel. I have come across medical students and freshly medical grads, and oh my… the lack of knowledge and atrocious english from Manipal, Egypt & Russia grads is simply astounding.
*poor patient without a medical degree*
typo: fresh medical grads
I could not agree more. Some people think they can buy futur
Seriousla. Itu result mohon buat master doctor ke? Patut aku mohon jd doktor jugak ni. Aku yg banyak A pun rasa tak layak jd doktor.
as i said before, i finished spm in 2000. even ppl with B4 in science subj, i didnt think they would get a place in medical school!
Dr Pag,
I have to agree with many readers here that you are going overboard in your critisisms….. of medical students from Russia…of SPM certs …of parents forcing the children to do medicine…etc etc.
You are beginning to sound like a frustrated old doctor. Every article of yours over the years goes like “i told you so before” and how smart you were to forsee the problems for future doctors.
I am a father of two doctors (housemen) myself. I think like one Ms Wong pointed out, you use a few cases from your experience to generalise and most of it are really outdated. Yes there were students upto year 2005 who went on to study medicine with basic SPM…who are now graduating in 2011 onwards and joining the service. For that matter my niece, now 43 was an Arts student who went on to do Medicine and she is a fine doctor now.
As with all professions, entry qualifications are revised as years go by. When i did my UK ACCA degree, only SPM was required. Now you need a first degree.
When my sister joined teaching service in the 70s…Form 3 cert was good enough. These days it is so competitive that most of the medical colleges only recruit the students with the best results. You always use extreme & isolated cases to make your point. (and then u say these days A1 has no value….u dont recognise the fact the most students these days go for double tuition to get excellent results.)
Gone are the days when parents can force children to do medicine. These days parents dont do that and neither do children follow blindly. Yes there are isolated cases…so stop harping on it.
My daughter is from a Russian uni…she went in in 2005 with straight A1s for all pure science subjects. In case you are not aware even way back in 2005 Russian Unis insist on a credit in Physics….when Unis in Malaysia & India dont need Physics in SPM to do medicine. All her batch mates as i know them were students with excellent SPM results.So please stop your crap about Russian students, its very hurtful when you speak low about them…just because some former students went in with lesser SPMs.
Lastly, as with any professional courses, there are good students and not so good one. The degree is just a paper to say you have passed the subject you studied for. Beyond the degree, its the individuals effort and passion that gets him for the future.
Its time you change the tone of your writings. Be fair & contructive in your criticisms.
My opinion is there is a incompatibility of the Russian system with our Malaysian system which is British based. The students have to learn some of the subjects in Russian and most Russian patients don’t speak English. This made their clinical exposure extremely limited. So while they are back here in Malaysia, they take a longer time to adapt, to understand our medical language and at the same time need to get experience as well. For good student they may still have time to play catch up. But for students with bad grade in SPM to start off, the odds is they may have lose interest and hope to cruise through the HOship and end up as GP with license to kill. A good student with incompatible system is a recipe to produce substandard quality product for Malaysian system.
ashraf, no doubt that many went to russia with good SPM results especially those who are sponsored by the government. but there are some private students go there with very bad spm results, because the agents in malaysia could falsify their results! if they cant comprehend basic chemistry, i doubt they will manage to pass through biochemistry, pharmaco etc.
and the thing with ‘ failure is not an option in russia’, this just makes things worse
Dear Mr Ashraf,
With all due respect, please read my article properly. How many times did I mention the word Russia?? The entire article is about unqualified students doing medicine in some universities ( I mentioned not only russia but also in many other countries including Malaysia!). So I don’t see why many people keep harping that I am being bias on Russian graduates only. Is it just because I posted a SPM result of a Russian graduate as a clear cut evidence? Who said that it is ONLY FEW Cases ? Please go to any hospital and ask for yourself. And FYI, there are still students with mediocre results going to Russia and many other countries to do medicine. Don’t think it is a OLD problem before 2005. Just last week I had a comment(see below) from a student doing 2nd year medic in Russia with 2E in A level. And the same student said that 60% of his batch are in the same category! FYI, I also receive numerous emails from students in Russia with lots of information of what is going around over there. I also know some from Indonesia and Egypt.
I obtained 2Es in my A Levels and am now in my 2nd year of medicine in **** ,Russia.
Will the MMC requirement affect me when I graduate?
Does this mean I will not be able to obtain a job or register with MMC when I return?
What should I do? I know of many ppl who did not obtain the necessary marks but are now studying medicine here as well.
As I thought ***** is recognized by MMC why is there a further requirement on minimum entry requirements???
In fact many students who did pass the STPM was still accepted by some universities here for medicine but have to undergo their Russian Preparatory Foundation Studies.
More than 60% of my classmates at ***** is also in the same scenario as we were unaware of the requirement. Many feel the MMC will definitely allow us to practice as it is compulsory to do government service and we will be registered then???
You see Mr ashraf, I don’t write article without knowing the facts. That’s the reason why all my prediction is becoming a reality slowly. When I first started blogging, I had many nasty comments from people like you who rubbished my claims. BUT then see what is happening now.
Your daughter is a good student to start with and thus she would not have any problem. That’s the whole issue of the article above. Did I say anything about good students doing medicine in Russia or anywhere else? And parents forcing students to do medicine, please ask psychiatrist who are seeing many of the housemen who are referred to their department. FYI, about 10 housemen are referred to psychiatrist on a monthly basis. Majority never had interest in medicine but forced by parents!
Yes, a degree is a paper but what if the degree can be bought!
ashraf
Gone are the days when parents can force children to do medicine. These days parents dont do that and neither do children follow blindly. Yes there are isolated cases
====================================
I have much that I want to say, but I will just respond to this. Parents still have a big influence in what their children eventually study. At least half of school leaving students do NOT know what they want to do. What they do eventually, is most often determined by parental inclination, and the opportunities parents open for them.
Parental inclination can often be subtle. Parents may even deny any bias.
The biggest driver of this is opportunity. No other country in the world current, has such opportunity been open, for everybody to embark on a medical course. All it need is money. With such opportunities, it is no wonder so many do.
In advanced countries, this cannot happen because there is NO such opportunity.
I think Dr Pagalavan has made a fair point.
Our standard and trust in doctors has dropped severely.
Now patients don’t trust their GPs- they want to see a specialist directly.
Previously people didn’t care where the doctor graduated from
but today patients look up a doctor’s qualification,
Couple that with the uncontrolled entry to medicine by less than mediocre students and the dwindling standards of training in hospitals.
Many MOs today lack basic medical knowledge and experience.
And these MOs are supposed to “guide” and “supervise” their juniors.
A lot of people are angry with Dr Paga because he told the truth. But many people are unable to handle the truth.
Being nice and having enthusiasm certainly will help one’s medical career.But people fail to understand that medicine requires a lot of memory, thinking and drilling to function as a competent doctor.
Many substandard doctors do indeed end up in GP/ aesthetic physician as they have little avenue for advancement in other fields. Overseas membership examinations are tough and our Masters have limited spots.
While there are good GPs- I know one oldtimer GP in Malaysia with MRCP,DRCOG and DCH who is without a doubt a rarity in today’s scenario.
Medicine depends on knowledge and diagnostic patterns that relies on a certain degree of intelligence and good memory. We can debate how much memory is needed but truly, memory is repetition, the best doctors that I know study 3-4 hours a day even after membership/fellowship/masters.
Medicine isn’t just about holding hands or being empathetic,sympathetic etc.
Soft skills are important but diagnostic/thinking skills and advanced technical skills are what is lacking today in Malaysia’s medical scene.
A lot of these newbies have little understanding on what being a real “doctor” is.
Try approaching a HO or even MO and ask for example ” please tell me the Glasgow Coma Scale” “demonstrate how you examine the cranial nerves” ” what is LBBB,RBBB, R/L axis deviation?” and ” what is a brachial plexus?”
and you will soon understand why many shoud never have been a doctor in the first place.
Dr Paga- congrats for the enlightening article and I hope somehow we can improve medical education and training in Malaysia-certainly no easy task but better regulations of local medical schools or even a review of MMC’s recognized list may be in order.
Thanks for your comment. Atleast you understand what I am trying to say all this while.
Your comment sums up pretty much the major issues highlighted in Dr Paga’s blog over the years.
The mushrooming of ”aesthetic physicians” in Malaysia is a worrying trend and some of them are branding themselves as ”Consultant aesthetic physician” despite barely 4-5 years graduating as a doctor, and completing their compulsory service with some doubtful postgraduate diplomas in dermatology/aesthetic medicine. These aesthetic physicians even advertise their products in discount websites and offer much more ”affordable” services compared to the certified dermatologists, which makes their products appear appealing.
Pity the public really as they are ignorant about the quality of these ”aethetic physicians”.
GP
Your observation on aesthetic physicians is spot on.
Many are not Plastic Surgeons or Dermatologists.
(In Malaysia to be a dermatologist -one would need the MRCP or Masters in Internal Medicine -followed by Dip/Msc Derm and further credentialing training such as the Master of Advanced Derm UKM.)
There is a certain “American Academy ” handing out Diplomas and Board certification after a 5-10 day course if you are willing to part with a certain amount of dough.
There are aesthetic physician/GPs who perform surgeries like eyelid, breast implants, tummy tucks after only observing the procedure without any surgical training or proper credentialing. The results are less than satisfactory to say the least, Most are done in clinics/beauty parlours with no resuscitation equipment or anesthetist on table without a sterile operating environment.
There is a certain Korean College giving out Diplomas in Cosmetic Surgery after 1-3 month observing/assisting on/off in Korea. While these may be beneficial for fully trained surgeons- I do not think one can be a “plastic surgeon” by attending one of these aesthetic medicine or surgery courses.
The path for a plastic surgeon is long – Masters in General Surgery or FRCS followed by 3 years of training by an MOH approved centre followed by a Board Examination and 6 months gazettement or the Master of Plastic Surgery USM followed by 6 months gazettement -which requires 2 years experience as a General Surgery MO prior to entry.
Even with these training- many plastic surgeons still have virtually no exposure to aesthetic plastic surgery- and will have to seek credentialed training overseas to round up their experience.
The plastic surgeons however are however a better bet than the GPs to carry out aesthetic surgery in any case.
Imagine this- a junior Dr with no formal surgical training going to a 3 month Cardiac surgery observership and coming back and calling oneself a cardiac surgeon.Would you want him to perform your CABG?
This is however the reality of our medical scene in Malaysia
When even parents are in denial, the situation does look bleak indeed.
Dr. Paga, I have a doubt. Hope you could clarify it for me. 🙂 It’s regarding the HO exit exam which is in discussion. As a HO to be in a month’s time, i would like to know that if it the suggestion is anywhere near to be considered or even implemented?
Also, once we are already HO’s, lets say finishing up the first year of in second year of Ho-ship, and such exit exam to proceed to MO is implemented, will it affect us, the HO’s already in training or ONLY the ones yet to start as a HO?
This though has been troubling me.
I for one, strongly agree with the suggestion of the MMLE’s. It’ll be much more manageable and linear than a HO exit exam.But, like the USMLE’s, candidates should be allowed numerous tries and it SHOULD BE TRANSPARENT (which i doubt will be the biggest obstacle to overcome)!
The HO exit exam like you said, is gonna create a big mess. Those who would want to stay back would fight it through. But, those with resources would move on to another country, possibly Australia or New Zealand. Some might even try their luck in pharmaceutical companies (i heard from my friend, a medical sales manager, that her company do hire doctors) or research labs.
This in turn, would eventually bring it back to square one all over again, NOT ENOUGH DOCTORS!
Why the building of new hospitals is not being considered? Is it of the lack of specialists or the cost? If it’s the lack of specialists, then why not open up job opportunities to the thousands of aspiring Indian post-graduate specialists? Oh, the Indian post-grad is not recognized in M’sia! While in Bangalore, plenty of my consultants and residents would ask me regarding job opportunities in M’sia. It saddened me to tell them that their post-grad masters while is recognized the world over, is not recognized in Malaysia. I would encourage them to try Singapore instead. It’s a known fact that Indian health care delivery in one of the best in the world, so why not bring in some of them who wants to, to enrich our health care system?
Dr.Paga, these are just my amateur thoughts. I am sure you would have more details upon these matters and would share some of your experienced thoughts. 🙂
Hi, do you think Malaysian post graduate master is recognized elsewhere? different country has different requirement. A friend of mine completed 5 years of residency in algeria,plus one year post residency still couldnt get a job in middle east. indian post grad is recognized the world over, are you sure!? I dont think they can practice in US if the are not ecfmg certified, and i bet they have to do the residency again and certified by the board before they can get the license.
If the HO exit exam is introduced, it will affect everyone, including those who are already doing Hosuemanship. Same goes to MMLE,everyone who graduates after MMLE is introduced will have to sit for the exam. However, none of this has been finalised. It involves a lot of work and planning. I presume the earliest will be 2017.
You can’t simply move on to another country unless your degree is recognised and do your housemanship over there.
To built new hospitals, involves a lot of money. The government would not be able to afford such amount. Furthermore, we are not really short of doctors. What we have is maldistribution of doctors between private and public as well as rural and urban. If you include all the beds in private and public hospitals, we have enough beds but 80% of the population goes to public hospitals.What we need in public -private integration which is politically incorrect
Thank you for your reply Dr. Paga. Much appreciated. 🙂
Well, having an MBBS degree which is recognized in the US, Canada, UK, Australia, Ireland, Germany, the Gulf Countries, Hong Kong and a few others, makes it seem like one has a handful of choices around the globe. The truth is, the medical profession is a tough competition in all the above mentioned countries. One has to pass the entrance exams and requirements of each these countries, and only then go through their internship, residency programs etc. Malaysia indeed has a very lenient entry to the work force, so far. 🙂
But most importantly, after being away from the Tanah Air for almost 7 years, being back home is all that i wanted to do. 🙂
Malaysia is always BOleh!
MBBS Graduate from Bangalore
their post-grad masters while is recognized the world over, is not recognized in Malaysia. I would encourage them to try Singapore instead. It’s a known fact that Indian health care delivery in one of the best in the world,
======================
Indian postgraduate qualification is not recognised anywhere in the world, not in Malaysia, certainly NOT in Singapore. That is why many try for British exams, as that helps them in getting to UK or Singapore.
Indian piblic healthcare system is near collapse, with gross inequitable access, many areas have little or no access to any healthcare. On the other hand, the private healthcare industry is thriving, as long as you have money.
Hardly a model of ‘the best in the world’.
Some people here seem to be in denial. I guess the discerning reader will be able to sift out the good and bad students just by reading the comments. A person who can’t see their shortcomings will never progress.
absolutely
All I can say “One man’s treasure is another man trash”
I’m really sorry for this judgmental attitude of the oldie. English use to say it’s senile but let’s be fair; an Alzheimer’s with provoking dementia
You indeed do have a problem with English. Even in sarcasm. lol
There seems to be a troop of brighter than thou in this blog. The All-Knowing with Godly-English eloquency
@ jk, I think shamrock’s sarcasm was what would be described as an “epic fail”.
@jaz1 Your self confession that you are not a doctor prolly a yardstick that you shouldnt act as one. Not only will be gibberish If you were to ask the criteria of AD in DSM4 or ICD. You absolutely will know nut!!. I suggest u see a doctor before your AD progresses to MDD and you found lifelless on your bed. by your loved ones.
A nice quote :Failure is a stepping stone to success, learn from your mistakes and do not sigh”
Oh dear, you poor sod!
@Shamrock: I am a doctor but rarely act like one. As a surgeon, I have no idea of AD in DSM or ICD. But when someone’s face gets half destroyed by cancer, I can rebuild it by techniques where my OCD traits prove to be advantageous.
But I guess since I am ignorant of AD in DSM or ICD, I “absolutely will know nut”.
Thanks God Mr Jon J, that u can understand my flawed English. By the way, that’s not the point of my argument. Im a bit dejected when the so-called “professionals” here turned down others based on English used but not the points especially when you see a novice comes to seek opinion with a bit of english errors despite understandable
“you are bastard, your english is atrocious” FULL STOP.
Anyways, I do admire Dr Pagal for this blog as it’s indeed very insightful and revealing.
Jaz, ignore shamrock. If he is a doctor, his attitude and choice of words do not reflect one. He is boasting of terminologies which I am sure he doesn’t fully understand himself.
A doctor ought to be humble, ready to admit mistakes and self reflects regularly.
You may not be a doctor, Jaz but simply judging from your response, you are a more respectable human being. For they say out of the treasures of the heart, the mouth speaks.
u r missing the point completely. Poor insight made these troopers are in oblivion.
A simple anology: No points knowing A to Z of STEMI management if you can’t recognise the chest pain is of cardiac origin (that’s very reason we call cardiologist to ask the dosage of enoxaparin but purely of no help if u missed the diagnosis-on which put the blame on you medical school)
For the layman who plays doctor im sorry if u take for a while to digest. rest this case. ciao
@shamrock….i really don’t get your point. Anyways, who call cardiologist to ask for enoxaparin dosage????
The point is if you miss the critical point, the rest of your argument is just awry/getting around the bush
Paga,
Your blog is an eye-opener.
If I were a Russian graduate, I will definitely be hurt by your blog posts. There’s no denying that.
I was shocked by how some were rude towards you in their responses. After all, you were only sharing your experience of these Russian grads. You are a doctor of many years of experience and qualifications. They ought to respect your analysis of the current dire situation.
I enjoy reading responses from some such as Jaz1, gp, to name a few. They seem to be very sensible doctors in their replies. But sadly I understand they are not practising in Malaysia at the moment.
Thank you for your passion for the healthcare in Malaysia.
I hope you will continue to speak for justice for the patients in Malaysia. We deserve better doctors to look after us.
If there is a prize for best medical blog, I will surely nominate yours.
Best wishes.
Thank you, but I’m not a doctor. I am just interested in knowing the going-ons in the healthcare industry, and have friends who are part of the medical fraternity. Also, I have been following Dr Pagavalan’s blog for a few years now. 😊
Now, it seems like everyone can become a doctor. I can’t wait to see Tony Fernandes opening his own medical and nursing college, maybe it will be called Tune Medical School. Please refer to the latest fiasco by Air Asia in regards to their advertisement degrading the nurses.
I strongly believe that medical education must be strictly monitored and regulated. You can’t allow underperforming students to take up medicine. There is a sentiment in our society where people judge one’s success if he/she becomes a doctor. I guess this is the reason why people with poor results want to do medicine; to prove they can be successful.
Dear dr., first of all i will like to thank you for all your informations given. I am in 3rd year in indonesia and i have to agree that the standard is really low.All art stream students or all E students are here. I passed my spm with 9As, got my noc already but i will not proudly say that i am getting good results for my medical study because anyone can easily get it by retake the exam over and over again. I admit that i was one of them who blinded by the colourful doctor dream the society give us. Being in a not so wealthy family, i cant got into jpa because the only b i got was malay and i couldnt afford the highy amount of fees by privates and blame myself that i didnt do enough research on all the scholarships etc, i chose to believe agents and got here. Although i am one of those who would study everyday (unlike others who choose to enjoy everyday and work hard the day before retake exam), i still know that i will be so poor of knowledges compared to others when i graduate. There are few batches of seniors graduated are doing well in msia but we know that after taking off the experience gained from clinical years (which is ho in indonesia), we have nothing to be proud of. In the end, i believe that it still depends on ourselves to choose to be a hardworking or a enjoy-life-first student, so for students who are going through the same thing as me, i wish you all goodluck and never give up.
At least you admit what is happening down there unlike the rest.
Dear student of Indonesia,
Im so happy to read your honest reply. I was in the same situation as you were.When dad was researching universities that the agents were recommending, while in KKM, they showed us a list of MARA students that were also going to my same university and since the government was sending them there, it had to be a good university that he could afford, so i didn’t go to IMU or Melaka Manipal though my STPM results were accepted in those universities for medicine.IT was financially a better option to go to the university that eventually became de-recognised after i had left. I am glad you acknowledge the inadequacy, instead of throwing tantrums at the drs blog. He is simply stating facts. The isn’t smoke without fire. Unfortunately a lot of fire has been ignited by seniors of our kind of universities. If you study well and not take an easier route that can be done in the loop holes of this universities, you have a lot theoretical knowledge.But the insufficient part would be the clinical portion of it.
This is what i did.Some universities require us to do elective posting in the local teaching hospitals during your studying years. My friends and I would make friends with the local university students and get their notes on things we aren’t fully taught and study it.
During housemanship, the local university students are kind and helpful. Study their notes to gain more knowledge. This is easy as you are already working and putting it into practise make the knowledge stick.You may have to put in extra hours and volunteer yourself for more on calls.Youd see the as the on calls days go by, you’re more confident with managing patients.I remember an incident, where i was sleep deprived after 36 hours of working and at 4 am, a patient was unstable and my MO was unable to help because she was already seeing a patient that need her more, and then suddenly your able to think and do the necessary to keep the patient alive by the time she got there. The next morning , my consultant that was doing morning rounds when reviewing the patient looking at how rattled i looked with no change of clothes, told me this ” its during those sleep deprived nights , when your able to make decision in a clear mind, that is when you stop being a medical student and start becoming a medical doctor” He was making his point as to how important on calls and internship training was. It always stuck with me. Btw, he was a wonderful consultant, always full of quotes and encouragement.
Never be disheartened with comments like ‘ its the university you graduated’ . Some senior dr would find you pointless to teach you. Never make the excuse of ‘well, no one wants to teach me’. My dad would say, if they don’t want to teach you, you have to show them you’re willing to learn, bug them until they have no choice but to teach you.But you have to do the groundwork so that they know they are investing their time on someone that is serious about the job.Dont take all the scolding, insult and yelling personally. Find the knowledge and experience your boss is trying to convey to you, hang on to that, and leave all the rest of the words aside.And then learn it and try to never repeat it.
Take tagging phase seriously when you start internship. You can learn a lot. IF you have a question, ask it. You may sound silly, but thats okay. Learn it and study it.
When reviewing a patient, take it seriously and really review them. You can learn so much. Don’t do a cut and paste job when reviewing patients. You would be in a shift system by the time you start housemanship. BE responsible and committed to the patient you’re taking care. Follow your patients progress until you’ve done all that is expected of you.Never pass over a half baked job, just because your shift is over.
Leave your ego and pride outside the door as soon as you enter the hospital premises.Your consultants and MO may already have a bad perception of you due to your universities, but they have their solid reasons. We are our experiences .You want them to change their perception, You become that change.
And always always continue to upgrade yourself, so that the stigma of your university will not follow you.
Many have this wayward understanding that just because the medical school has given you the suffix Dr, you are invincible. Respect is never to be demanded, but to be earned. Its such a dangerous way to live life by expecting it. Remember , you’re a nobody. You’re learning to be worthy to garland the stethoscope around your neck.Be humble with every adversity rather than fighting it with arrogance.
This is a very cliche thing to say, but knowledge is power.And handwork is the most easiest thing to do. You just need to be hungry for it.
Have the love of humanity in your heart every time and you won’t go wrong.There is a saying in the Bahai faith that says ‘Work is worship, and service is prayer’. If you do your job as such, you’re in the right path.
You’ll be okay dear friend.We are lucky that our parents gave us the gift of learning medicine. Where we go from there on, is really up to us.
I know medicine where you want to be. I hope you become a specialist of your choosing one day.
Good luck my dear friend.Never lose your humbling ways.
Very Well Said! you will be a good doctor.
Wow, your maturity must be way above your age. Well said. Very well said indeed. Examples
1. You want them to change their perception, You become that change.
2. Leave your ego and pride outside the door as soon as you enter the hospital premises
3. But you have to do the groundwork so that they know they are investing their time on someone that is serious about the job.
4. And always always continue to upgrade yourself, so that the stigma of your university will not follow you.
5. Don’t take all the scolding, insult and yelling personally.
6. Remember , you’re a nobody. You’re learning to be worthy to garland the stethoscope around your neck.Be humble with every adversity rather than fighting it with arrogance.
Dr Pagal, I am sure somebody like this brightens up your day. Brightens up mine even though I am not in the medical line at all.
Love Medicine,
Forgot to add. IMHO, your reply is the best so far. 5 *****. I hope others can learn a lot from you.
Dear Love Medicine,
While I agree with 95% of what you wrote, I just want to bring up the 5% which I quite disagree with:
“I remember an incident, where i was sleep deprived after 36 hours of working and at 4 am, a patient was unstable and my MO was unable to help because she was already seeing a patient that need her more, and then suddenly your able to think and do the necessary to keep the patient alive by the time she got there. The next morning , my consultant that was doing morning rounds when reviewing the patient looking at how rattled i looked with no change of clothes, told me this ” its during those sleep deprived nights , when your able to make decision in a clear mind, that is when you stop being a medical student and start becoming a medical doctor” ”
The myth of learning during sleep deprivation has long been disproved. 24 hours without sleep impairs your cognition and motor skills to the same extent as being just over the drink-driving limit. I know colleagues who have crashed their cars after night shifts and an ex Royal Australasian College of Surgeons readily admitted in a speech I heard him give that he had fallen asleep at the operating table more than once during the ‘good old days’ of 36 hour shifts.
None of this is any particular individual’s fault of course, it is the system which we work in. For those who think that the experience will be diluted, you are only partially right. While I doubt how much actual teaching takes place in those mid-morning hours, the breadth of experience can be maintained by increasing training time.
*Sorry, that should have read ex-RACS president
Agreed. Somehow I can recall there’s a literature review of what u just said. However, the oldie in Malaysia still ingrained with “during my time” and resist for change.
We don’t just need better healthcare for the people but neglecting our own kind.
dear nav and shamrock
Thank you for your feedback. I appreciate it. You are right , adequate sleep integrates efficiency.
But i think my consultant was just trying to make a point of the seriousness of training during those initial years and was trying to be encouraging as that was my first difficult case as a houseman. I can understand that.
But of course, you are right. we would benefit more if we were rested. Thank you for again for your feedback.
Have a good day ahead.
At least one Indonesian medical student who is obviously stating the truth about the quality of medical students there instead of some. Having ”all art stream students or all E students” tells the quality of the medical school and yet some of their commenters think so highly of their distinguished medical school!
No reputable medical school will accept these kind of students apart from certain medical schools in the world.
Hi Dr. Pagalavan, thanks for providing these useful information regarding the current situation of the healthcare industry in Malaysia. I just had my SPM last year and I’m waiting for my results to come out. I aspire to become a surgeon. Your articles have clearly shown that medicine isn’t the correct choice for people who want to be doctors just to get rich, have an easy life and drive big cars. After reading all your articles about the general misconception of being a doctor and the hardships faced by MOs trying to get a postgraduate seat etc., I asked myself whether or not I am determined to do medicine and do all the sacrifices in my life just for passion and interest. I am still determined. So I have a few questions.
1. If I graduated in an unrecognized medical school, did not get an NOC, do not fulfill the minimum requirement for SPM but fulfill the minimum requirements for STPM stated in the MMC guideline, am I still eligible to sit for the MQE exams?
2. I’ve heard from friends that local universities take in local matriculation students first before considering STPM graduates. I have a friend who scored a CGPA of 4.0 in STPM and she failed to get accepted by local universities for medicine. If that happens to me, where do you recommend me to study medicine?
Hope that you’ll give me some advice. 🙂
Never do medicine in a unrecognized university. If you fulfill minimum STPM requirment, you will get NOC as STPM supersede SPM.
Choose a good private uni like IMU, Monash, PMC etc
Thank you for your advice 😀
Are those degrees recognized overseas for my postgraduate training if I fail to get in the master’s program for general surgery?
None of Malaysian degrees are recognised overseas except UM/UKM recognised in Singapore and Monash recognised in Australia. Thus you will not be able to do post graduate degrees overseas
I see.. so is it possible for me to get a seat in the master’s program if i keep on waiting after failing several times?
No guarantee
Why would you want to put yourself through all that trouble and uncertainty? Passion and interest will quickly turn to misery and disdain under those circumstances. Do consider the overall scenario, which is really quite consequential : glut = supply > demand = employers’ market which means competition becomes stiff. Common sense will tell you that those with more stacked against them will lose out, everything else being equal. You need training to become a doctor, so what happens when training spots, ie housemanship posts are not sufficient anymore, or selection process tightened?
I’ll do my best to get the postings. I think every field has competition so I believe that I can do it despite the stiffer competition in the medical field, cuz I’m determined.
this is definitely the right approach. its dog-eat-dog in most fields these days anyway, but if youre passionate – i strongly feel medicine is a fantastic and rewarding career to have (both financially and emotionally)
doctorwannabe…
if the medical school is listed in the IMED international medical school directory, you can always sit for USMLE exams and try your luck for residency / specialty training in the US.
but this is a very risky route, and usmle is not easy. lots of preparation and cost. and even after you are ecfmg certified, you are not guaranteed to get matched in US residency program. you have to compete with the americans. img americans and those from indians. pakistani and middle easterners.
I see.. thanks for the info! 🙂
And it is expensive to sit for the USMLE. With not great passing rate.
I generally do not recommend Malaysians to go that pathway. Few did anyway, in the past. But this will change, as surplus forces some to seek employment elsewhere.
This is a departure from the previous defacto, ie most people return to Malaysia where there is a severe shortage of doctors, and those who are overseas actually overseas graduates who stayed on.
Now we have Malaysian local graduates seeking employment overseas, like has been happening for many years with Indian/Parkistani doctors.
i am very biased but will contend if you are determined, working hard for the USMLEs is a fantastic way to specialize in most fields (some like plastic surgery, neurosurgery, opthalmology are “almost” impossible to get into for FMG).
Hey doctorwannabe, other international options you may consider, if your results are good enough (you did give 4.0 CGPA as an example which is definitely good enough!) are Singapore (NUS), Hong Kong (HKU) and Taiwan (NTU). I may be outdated on this, but these unis have given out scholarships to international students before. The medium of instruction in both Singapore and Hong Kong are in English. I think you need to have had studied Chinese for Taiwan. You should check for the most updated school fees and application procedures but when I first applied for Hong Kong, the total fee for the whole MBBS course for medicine was cheaper than both IMU and Monash Malaysia. Worth a try. Do some research and good luck. 🙂
If you have 4.0 in hand you may try your luck for HKU and NUS but still it is extremely difficult to get in. I applied to HKU years ago with 4.0 and I didn’t even receive an interview call. Talked to some HKU students during a conference and apparently most of the foreign students/hong kong-born but brought up in Canada students who got into HKU have done a bachelor degree like physiology, psychology, or biochemistry from reputable colleges in the UK, Canada and US, and they have a strong research background. The local students stand a chance to go for interview right after high school if they score 6As and above. (ps. their exam is tough, not like SPM where anyone can easily get 10As). Getting into NUS is not easy though, many malaysians have tried but you can only find 1-2 malaysians in each batch of YLL school of medicine.
What is the most important trait a dr should have is analytical trait. Knowledge and experience can be gained. But wisdom comes with maturity, age and analytical trait. Even a Radicare cleaner lady can learn how to perform venepuncture, clerking pts, CBd insertion and god knows what if she gets enough exposure. What is more important is to learn when to and not to do certain things, relating clinical findings with investigations. I have HO who doesn’t even know the normal values of ix, yet they order every known ix once a patient is admitted. My initial assessment for HOs are to ask normal values then only I proceed to other questions during their assessment. Yes, Russian/Ukraine student are incompetent (majority). But the bad apples can be found among our local graduates nowadays, yet they are still the minority. My very good buddy graduated from Kursk and he is exceptional. Few of my other colleagues are from Ukraine and even though we are friends outside, I knoW I wouldn’t let my family members near them for any medical reason. grow up, face the fact
The first priority of any medical student/doctor is ability to acquire and keep knowledge. This is determined by the academic ability as indicated by pre-U results.
But knowledge by itself is useless, if it cannot be used. Application of this knowledge requires an analytical and logical thinking process. This is determined by various aptitude tests used in advanced countries.
Wisdom comes with experience. That cannot be taught, but will be acquired by the doctors through a lifetime of learning and working.
The problem highlighted in this thread, is we can’t even get the first step right.
Hi Dr Pagalavan,
I have looked through the minimum criteria obtain from the mmc link you have provided. May I ask you something? Here’s a scenario:
If I were to have fairly good grades for SPM with a BSc in Management from National University of Ireland, is there any way I can opt for MBBS?
I have to admit I was young and naive and I did not do well for STPM, not because I am not intelligent but was really due to my childishness-I have neglected my studies. I have regretted what I did and wish to pursue my dream of becoming a surgeon. If you are wondering why I did BSc in Management, it was because I was working full time as a flight attendant and I did not want to waste all my free time away so I took up part time degree.
Doesn’t everyone deserve a second chance? I have seen and met many medical doctors in Malaysia whom I personally think are not even close to being a professional qualified doctor. Some worst, can barely converse in simple English! I have classmates who scored lower grades than me and just because they have the money or the “right race”, they are now medical doctors, if you know what I mean..
It’s rather sad and very embarrassing for Malaysia to have such doctors.
Isn’t being a doctor is all about saving lives, improving lives, helping those who need the help and making changes medically to find cures and answers for all medical woes/illnesses? Not chasing for good salary or realizing parents’ dreams and so on. Whatever happened to all that really matters- like doctors without borders?
I had written enough of being a doctor in this blog
Since you have the minimum SPM qualifications, a degree course with CGPA of mor than 3.0 should make you eligible to do medicine.
Suggestion: since u wanna be a surgeon why not opt for dentistry instead? There’s a surgeon called OMFS. The prospect at least better as you can see even most medical students chide of their uncertain future due to glut of junior doctors.
If u wanna read medicine by all means go. I believe u r now a matured adult to think what is best and what is not. Read thru this blog it’s definitely will give u an insight
Please dont ignite a racial bigotry here. Again, english is not a determinant for a safe doctor.
Medicine is not what you really think abt-saving lives so on so forth. Walk to the ground that you’ll see the reality.
monomania, i know exactly what you meant.
it’s not fair to judge doctor capability by their english proficiency, doctors in japan, french, russia yada yada dont speak good english but they are still great doctors! i have met many consultants in gulf countries who dont really speak english but practicing in well established institution. you need to be in the right environment/ from english speaking family background to be able to have good command in english. for those who work in government hospital, daily conversation with nurses, colleague and patients is in bahasa, so what do you expect from them? and if someone cant speak good english, doesnt mean they dont have good comprehension in reading or listening. go look up on toefl statistics score for malaysians, which section we score most and worst.
if you ask ppl around you who you think have good english command, they may not even have A in spm english, and vice versa. it’s more to the environment they are in. I didnt have good english to start with, but now i can present papers in an international environment just like those mat salleh or europeans as i studied and now working and living abroad.
those who score lower than your ‘fairly spm grades’ might go to medical school if they have the money, but they will not get a seat in ipta/ good med school if they are just from the ‘right race’.
what i dont know about is if someone who cant comprehend basic spm/stpm sciences and claim those are not important to do medicine as long as they have the passion.. yeaa rightt..
Actually, if a is doctor working in a health system where the predominant work language is English, he/she should be fairly proficient in English. There is no excuse really. Otherwise, one can’t communicate with colleagues, can’t keep up-to-date with the literature, can’t teach, won’t understand what is being taught, etc. I remember a case in Hong Kong a few years ago, when a doctor handed over to a colleague in Cantonese instead of English about a patient with an acute abdominal aneurysm, leaving out or mistranslating the ‘acute’ bit. The patient died and the doctor was deemed to be negligent for not communicating porperly.
A doctor must be conversant in whatever language that is used in the normal working of any country’s healthcare system. Of course the Japanese need not know English. They use Japanese in Japan. But if you are in UK or USA, you will NEED to be good in English, to function.
Malaysian healthcare is still in English. Therefore, it is for the safety of patients, that all Malaysian medical staffs MUST be able to communicate adequately in English.
Dear Dr.
I’m a 1st year medical student from one of the most problematic medical college in Malaysia ( I think you know what my college is, it used to be a well-known college with the so-called twinning programs with some of the oversea uni but those program are no longer being offered anymore, I don’t know why it isn’t applicable now)
So, what brings me here is actually I just want to let you know about the ‘dirty culture of my medical college’. As for a new medical degree student, I just know that in my beloved college the lecturers (most of them are doctors from India, Bangladesh or etc) will actually give the answers for us during an exam ( end of semester), at first I was actually shocked by the fact that many of the students were quite shameless cause all they need to do if they do not know the answers were just raised up their hands and there would be a lecturer came and helped them to answer those question.
But there is still some of the students that do not use this kind of “OPPORTUNITY” and answered it by themselves without any help from those lecturer ( I salute). I have been experienced during my ospe there is some of the lecturers came to me and suddenly gave the answers for the question while I didn’t even get to finish reading all the question sentence. My question is….is it actually a kind of ‘Adat Resam’ in medical college? Some of my seniors said that it is actually something that I should be grateful for, it’s not being called as ‘cheating’ if you asked the lecturer for the answers, then I wonder what is the main purpose for medical student like me to study all day night if all the questions can be answered by my lecturers ? It is unfair for the students that actually used their own effort but getting lower results than those who took the ‘Opportunity’ during the examination. Do we actually need a wake up call for this problem too?
Pro Exam?
Well, the truths are finally coming out. If I can get the uni right, the reason why they do not have many of the twinning program is because many of the twinning universities withdrew due to poor quality of students that were sent to them over the years.
i do wonder which uni is this!
Thank you for all your comments.
I guess I may have been misunderstood by some when I mentioned things related to language skills and race.
I’m definitely not a racist. I am Chinese whose best friends are both an Indian guy and a Malay girl.
I do not underestimate anyone who can’t speak good English or have great written English. What I am trying to point out is just the obvious- many of our doctors are not qualified to be doctors, not because of their race or their ability to speak English well but their education standard. I do apologize if I may have sounded rude and racist over my previous comment. I’m no where near of having any intention of starting any racial comment here.
All I ever wanted to know was if I am able to take up a MBBS if I have a BSc in Management. If I am qualified, which is the right pathway for me to take?
monomania, you can check on mmc website on the requirement. if i am not mistaken, if you are from management you need either 3.5 or 3.75/4.0 depending on your undergraduate durations.
http://mmc.gov.my/v1/index.php?option=com_content&task=view&id=111&Itemid=161
btw, you can always go to medicine if you have the money and if you can get a place anywhere. it is more to if you can practice in malaysia or not afterwards.
You can try the graduate medical program
Truth being told is medical schools have a civil and legal responsibility to filter out doctors who are not clinically competent or not having the basic thought process and basic knowledge deemed necessary for safe medical practice.
Not knowing the different classes of antibiotics and organisms it targets is not permissible.
(Many prescribe blindly and often for pathology that does not warrant its use leading to antibiotic resistance)
Neither is inability to read rate,rhythm and basics of ECG.
(One may miss an infarct or heart failure,heart block, atrial fibrillation, SVT etc)
How can one direct appropriate resuscitation without being able to read normal ECG strips?
Inability to discern various heart sounds, crepitations, wheezes,etc is hazardous for a patient for obvious reasons.
(One may miss a life threatening murmur or an insidious murmur in a child that needs a referral)-
Today a lot of HOs even MOs have difficulty performing the basics of otoscopy, funduscopy and neurologic exams such as upper limb, lower limb & Cranial Nerves examination.
(A patient may come in with a headache and reflexly giving some medication without a funduscopy to rule out any papilloedema or raised ICP)
(Picture this- a patient in with ear pain and the doctor doesn’t know what structure he is looking at on otoscopy -light reflex, tympanic membrane etc but simply prescribes some analgesia, ear drops and discharge the patient while the poor patient may have early signs of cholesteatoma)- Gladly in many cases that a ruptured eardrum has been overlooked -it eventually seals itself.
Even reading a chest radiograph poses a major challenge for some let alone naming the carpal bones or looking for fractures of the carpal bones on a radiograph)
Medicine is a serious subject as we are dealing with human lifes.
It is not a business or feeling good having an MD with a white coat.
All of us will get ill one day and we will need to attended to by the next generation of doctors.We want care by competent doctors don’t we all?
I feel maybe the consultants- we need to get down back to the floor. Get our hands dirty- see what is happening down there.
Check our HO/MO if they can really examine and diagnose a patient properly.
Make them perform a funduscopy/otoscopy, ECG reading, CXR reading, heart/lung examination, full neurological examination in front of us and verify if they are capable. Too many times these HOs (who should’ve been taught these in medical school and should have had capability to perform all these with a degree of competence since they were allowed to graduate as doctors) do not know what they are hearing, examining or seeing. They become MOs and the vicious cycle repeats itself when the seniors are incapable to training the juniors leading to depreciation of medical care on all levels.
Many HOs just copy the examination findings off the previous notes (or what we call BHT in Malaysia) without performing any examination themselves. Granted even if they did, they may not know the proper technique or may even miss an obvious finding. They go through the housemanship and become MOs, GPs without the right foundation of being a proper Dr. This will in the long term really be a worrisome cause as many of these doctors will be first liners- many ill patients that need immediate emergent treatment or those with underlying possible oncological pathology may be dismissed with “OTC GP” style treatment.
In the end of the day- I feel patients have a right to proper care but the gatekeepers of the system have other political/business agendas. And many medical students who should never have been allowed to graduate( or some say be allowed into medical school in the first place) are practicing freely.
The problems
(1) Some institutions are probably degree mills with dubious entry requirements- some good students enter due to economic/social background & leave with inadequate training & will have to play catch up. Others leave with just the degree.
(2)Very subsatisfactory evaluation and housemanship “training” leading to more inadequate personell supervising the juniors. My ex boss used to say- “You really need a good mentor in medicine to guide you in the early years- things that you cannot read in the book, the thought process ,the small things that make a big difference”- Sadly this will be a rarity in years to come with poorer standards of teaching, supervision, evaluation and ultimately patient care.
“Blind leading the blind”
(3)Supply outstrips demand leading to saturation of medical market with drop in postgraduate opportunities for medical professionals and jobs. With more substandard doctors in the market, litigation will rise leading the lost in publics trust in doctors as a whole .
Some say let’s allow all these (1) -(3) as the cream will always rise.
I agree but this would be at the expense of the patients.
A question for all surgeons who are reading this – did you know you were going to specialise in surgery, BEFORE you even got into medical school?
Jaz, tbh I did think I will be a surgeon in med school but my consultants under their observations encouraged me to be a physician. I am going down the physician route now and I think the critical analytical nature of the job definitely suited me more.
Hence from my personal experience, sometimes we need a more experienced and mature trusted consultants/supervisors to tell us where our strength lies. As medical students or even junior doctors, we may not know the suitable specialty for us as our experience is limited and perhaps a bit too puffed up for our own good. (Cardiothoracic surgery, yeap that was what I wanted to do in med school, ain’t I glad I didn’t pursue it now!)
Thanks for the input. I suppose by completion of FY1/2 (eg in UK), one would roughly know, and applies to the respective CT, and proceeds with the pathway.
You cannot, sensibly. Hence i always cringe when I hear school leavers saying they aim to be a heart surgeon, neurosurgeon etc. You may have an idea by the end of your course. But the clincher will be the Houseman year(s), when you literally get your hands dirty, and you realise what it all means (minus the glamour) and what is best for you.
Jk, I was sort of certain at the end of my course that I wanted to be a medic. In my houseman years, I had applied for a rotation with only 1 surgical job (depending on your ranking and job applications) ie upper GI surgery. I applied for all medical jobs and the rotations I did was Gastroenterology, Cardiology, Acute Medicine, Endocrinology, Nephrology. I was fortunate enough to be doing them in tertiary centres – busy but good experience.
I never bother to get scrubbed in and go to theatre as a houseman because I knew it wasn’t for me. I spent all my time in the ward and sorting out pre and post op patients. My educational supervisor still gave me very good feedback at the end of my 4 month rotation even though i have never stepped into theatre!
Unlike another colleague of mine (who is now pursuing ENT) took every opportunity to be scrubbed in. By the time he was in his second year, he was happily doing appendicectomy!
In some hospitals in developed countries, surgical interns are not allowed to enter OT. They only do ward work only. Yet that does not deter them from pursuing surgical fellowship.
There is so much negativity. Does it wrong to for them to aim for whatever sub specialty they have in mind. At least it’s serves as a motivation even though yes some might just ended up being a GP or some might just quit medicine altogether. This typecast and stereotyping honestly try to undermines the power of mind. If you haven’t read Stephen Covey nah you go “Always begin with the end in mind”- A millions miles of journey always start with a first step. So people, dream big and yes ready to sacrifice for your own dream.
Footnote: ##A consultant General & Thoracic surgeon at med school said u only need a monkey to operate, what is the utmost important is pre and post-op care##
Hello Jaz1,
If you like Surgery and want to become a surgeon, go for it!
I am currently a medical officer and a trainee lecturer in Surgery in one of the university hospital and my advise is that when you have an interest in surgical field, you should always try to nurture it.Its like planting a seed.It requires adequate sunlight,the right soil and space to grow.One must have initiative and a great deal of passion to succeed, what more if it is Surgery.This field is very demanding as you need to develop your surgical skills over time which requires hard labour and sacrifice.Stay focus.I would like to quote a Malay proverb which I find very helpful when facing obstacles. “Ambil yang jernih, buangkan yang keruh”. People around you will always say something about you, you might as well give them something nice to say. 😉
I wish you all the best
Thank you, but am neither a medical student nor a doctor. I posed the question out of curiosity. I’ve recently met a third year medical student who said he wanted to be a surgeon before med school, but has since changed his mind, and apparently this is quite common among med students.
I hope not all surgeons are monkeys though! 😉
of course they are not;p what it means though once you have developed the hand dexterity it’s gonna be routine hence the most intriguing part is to ensure optimum pre and post op care. lol
Jaz, I have a story to tell about my medical school life where I experienced a severe life crisis. I would like to share it with you. It’s on my blog:
http://tillhiskingdomcome.blogspot.co.uk/2014/03/my-life-crisis-in-medical-school.html
Thanks, I’ve just read it.
It is my advises for those intend to apply MD Programs in AUCMS be it their own AUCMS or MD-UKM program
It is regretted to be made know that despite number of students for both AUCMS / MD-UKM programs been increased in the last two years, revenue being proportionately increased simultaneously.
Nevertheless, we are kept on hearing the college are in Big Financial trouble, running with Deficit & Debts every month since last two years.
It seems to me that the situation is from Bad to Worst, so much so that most of the Sr. & Experience lecturers left the college due to the delay & dragging of their monthly Paycheck.
I am rather puzzle why AUCMS NOT even bother to establish a strong base (Equip with good facilities at least to have a set up of Lab / Library in their Kulim Campus) and sustain the popularity (Own AUCMS / MD-UKM programs) in local Malaysia?
As many Parents with very much concerns, we don’t want our students being victimized.
The 1st batch of MD-UKM students also reach final year and expect to graduate this August.
Whatsoever, we sincerely hope that the College won’t breach the trust that we Parents, sponsorship’s bodies (such as JPA / MARA) have entrusted to the College all these whiles.
All in all, we want to see our students successfully graduate from a reputable University College.
Message from Parents with concern…
This is not new. I had mentioned about this college many times in this blog. Have you wondered why this college is the only college in the WORLD which conducts 5/6 medical programs! That itself tells you a lot. To run a medical college is not cheap. This college has a lot of connection(politically) and offers so called “scholarship” to students and promising them guaranteed job in their so-called upcoming hospital, which is no where to be seen. Please read what I wrote way back in 2011 and 2012 about this college over here, here and here
Well said indeed! I feel you… and many other silently suffering MO’s and specialists. The way you have to train them, they might as well join housemanship after SPM without any medical training. It seems you have to reteach everything anyway. It’s scary and there’s nothing much we can do.
I have a houseman who thinks all her patients in the Haematology ward have ALL. She can’t remember the actual diagnosis!
Ps. Sorry I’m a bit OCD.. *normocytic
Hi Dr Paga, heard that MSU local MBBS program is finally recognised by the MMC and the university hospital is being built as well.What is your take on the whole thing so far.tq
Obviously all local medical colleges will be given MMC accreditation eventually. The MMC’s hands are tied
As for university hospitals, I had written enough about it in my blog. At the moment, it is not economical or feasible
Tq Dr Paga
Dear Dr. Paga,
Thanks for your response to my (And of course Many Parents) of concerns.
We do agree that the college (AUCMS) have strong connections.
Nevertheless, they still have to function in reality world which is to work from Basic Fundamental and No Short Cut.
As the Old Saying, running Education Program is for Society and By Society, NOT meant to entirely chasing for Quick Profit.
It is regretted that they opt for the latter and to the extend that many of the Programs have been instrumented to reap much profit from the Public Sponsor Bodies (JPA / MARA).
And, the students thus being victimized.
Whatsoever, very much hope that the authorities such as those from the Public Sponsor Bodies will react on this.
Regards,
Education has become a business in Malaysia. That’s the reality
Eversince Pak Lah stepped down, AUCMS’s influence has faded.
Dear Dr. Paga,
Looking at this current situatiion, what is your opinion for the local University Medical students (UM) to take up JPA scholarship or PTPTN? Please enlighten us. Thank you very much
To be safe, it is better to take JPA unless you are planning to work in Singapore. But anything can happen in the future.
Dear Dr Paga,
Looking at our current situation, what is your opinion for a medical student in local university (UM/UKM) to take up JPA scholarship or just PTPTN? Please enlighten us. Thank you very much.
Based on the upcoming job constraints for medical graduates, you’re advisable to take up the JPA scholarship so that you’ll be given priority later in your housemanship compared to PTPTN holders, but you’ll be bonded for 10 years. If you later decided to accept job offer by Singapore government that recognise your UM/UKM degree, then you’d be required to compensate for what JPA had sponsored you. In local IPTA’s medical program, the total amount of scholarship is about RM70k for 5 years (RM55k living allowance and RM15k tuition fee). However, the compensation amount is substantial i.e. RM250k.
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The damage has been done. There are too many substandard medical schools and underqualified medical graduates.
Yes, the have passed medical school in spite of poor results and/or poor attitude.
But housemanship training and supervision should (and usually does) identify incompetent housemen.
HOWEVER, supervising specialists do little to correct this.
I find it very disheartening to know that most (if not all housemen, will eventually past a particular posting, pretty similar to medical undergraduates).
For those who are incompetent,
they may get extended for 3 months and then be allowed to “pass” because specialists do not want to deal with the lengthy KKM procedures to extend a houseman.
Some incompetent housemen, may even “pass” at 4 months or after 3 months extension simply because the specialists/MOs feel that these housemen are a burden to the department, “Better get rid of them quickly before they cause us trouble.”
Assessment SHOULD be continuous but often the supervising specialist knows little or almost nothing about the houseman and if the houseman can answer questions fairly well, he/she will “pass” the posting.
It is not uncommon to have an incompetent houseman with poor attitude/work ethics/knowledge passing a particular posting because the supervising specialist
1. Knows about his poor attitude/work ethics/knowledge
2. He/she could answer assessment questions fairly well (as questions are pretty much standard and one could easily ask fellow housemen to recall the questions and memorise them)
3. Closes one or maybe both eyes during the assessment to avoid extension and it’s lengthy procedure or due to “pity” (having to be thrown out after 5 long yes at med school)
I sincerely feel that the housemen assessment is lacking and substandard.
HODs should have meetings with specialists and MOs to discuss progress and competency of housemen (in terms of knowledge, skill, attitude) and structured regular assessment should be done.
I also feel that if a housemen if incompetent, he/she should NOT be allowed to pass and specialists/HODs should bear in mind that it is better for the housemen to lose than for many innocent patients to bear the brunt.
I have worked with a houseman who only came to work 1-2x/week, would not inform her whereabouts, on daily wage who was allowed to pass a posting by accumulating the 4 months of training. The HOD chose to close both eyes because he wanted to get her out of the department.
Another houseman, had very poor knowledge, could not insert IV cannulas, could only handle 1 patient per day and even then very poorly, came late to work, left although work not complete but was also allowed to pass at 4 months because the department found him a liability.
(He graduated from a local private institution after 8 yrs of study. Did the institution allow him to pass because they had enough of him as well?).
As harsh as it may sound, regardless of how many long years has been put in, if a medical student/doctor is incompetent even after training, he/she should not be allowed to go on to the next step. It’s endangering the lives of patients, it’s making doctors a laughing stock.
Surely, he/she won’t be able to run if he/she hasn’t learnt to stand!
This is exactly what was saying all this while since this blog started
A preach of condescending. It’s the people like this further jeopardising the honour of medicine. I’m not saying the fact that passing an incompetent HO is bliss but please reminisce of how you see your juniors. If they still at commando crawl don’t ask them to run. simple!
People argue that knowledge and skills can be acquired if they have the right attitude. To be honest this act of condescending further add insult to this “bad” HO to their breaking point. How would you nurtured a good attitude if you subject them to everyday’s humiliations?
We need a full reform of health in Malaysia, not only to safeguard the patients but the doctors alike.
The damage has been done. There are too many substandard medical schools and underqualified medical graduates.
Yes, they have passed medical school in spite of poor results and/or poor attitude.
But housemanship training and supervision should (and usually does) identify incompetent housemen.
HOWEVER, supervising specialists do little to correct this.
I find it very disheartening to know that most (if not all housemen, will eventually past a particular posting, pretty similar to medical undergraduates).
For those who are incompetent,
they may get extended for 3 months and then be allowed to “pass” because specialists do not want to deal with the lengthy KKM procedures to extend a houseman.
Some incompetent housemen, may even “pass” at 4 months or after 3 months extension simply because the specialists/MOs feel that these housemen are a burden to the department, “Better get rid of them quickly before they cause us trouble.”
Assessment SHOULD be continuous but often the supervising specialist knows little or almost nothing about the houseman and if the houseman can answer questions fairly well, he/she will “pass” the posting.
It is not uncommon to have an incompetent houseman with poor attitude/work ethics/knowledge passing a particular posting because the supervising specialist
1. Knows about his poor attitude/work ethics/knowledge
2. He/she could answer assessment questions fairly well (as questions are pretty much standard and one could easily ask fellow housemen to recall the questions and memorise them)
3. Closes one or maybe both eyes during the assessment to avoid extension and it’s lengthy procedure or due to “pity” (having to be thrown out after 5 long yes at med school)
I sincerely feel that the housemen assessment is lacking and substandard.
HODs should have meetings with specialists and MOs to discuss progress and competency of housemen (in terms of knowledge, skill, attitude) and structured regular assessment should be done.
I also feel that if a housemen if incompetent, he/she should NOT be allowed to pass and specialists/HODs should bear in mind that it is better for the housemen to lose than for many innocent patients to bear the brunt.
I have worked with a houseman who only came to work 1-2x/week, would not inform her whereabouts, on daily wage who was allowed to pass a posting by accumulating the 4 months of training. The HOD chose to close both eyes because he wanted to get her out of the department.
Another houseman, had very poor knowledge, could not insert IV cannulas, could only handle 1 patient per day and even then very poorly, came late to work, left although work not complete but was also allowed to pass at 4 months because the department found him a liability.
(He graduated from a local private institution after 8 yrs of study. Did the institution allow him to pass because they had enough of him as well?).
As harsh as it may sound, regardless of how many long years has been put in, if a medical student/doctor is incompetent even after training, he/she should not be allowed to go on to the next step. It’s endangering the lives of patients, it’s making doctors a laughing stock.
Surely, he/she won’t be able to run if he/she hasn’t learnt to stand!
dear dr.paga.i agreed that in the medical field we need certain level of intelligence + emotion quotient dr to serve.
Dr. i want to take fondation in science in private university..but im not fulfill the requirement ..my spm result in bio is c+, others still got A n B…i want to study pharmacy…so how can enter the university? do u think the university will allow me to take the foundation?
I am not sure why the university don’t allow. For medicine, yes but are they using the same criteria for pharmacy?
Yes, the same criteria is used for all the 3 critical courses. They may not prevent you from enrolling in the Foundation, but you will not be allowed to enrol in critical courses after.
Why is it so difficult for people to just go do a proper Pre-U programme before embarking on a critical course? Why must students be so insistent of doing ‘Foundations’? Just do STPM or A-Levels, or SAM/AUSMAT, and you need not worry about your SPM results. Or you have no confidence? Then why are you so confident you can handle the critical courses?
Everyone wants a shorter route
The 1 year SAM/AUSMAT is NOT any longer than the usual 1 year foundation. The reason is not shorter/faster route. It is easier/’guaranteed’ route they want, as many have no confidence they will do well enough in a proper foundation to get into medical school.
On the first day when I first start housemanship, the MO said seriously:
“I will teach you what I can, but at times you will be left alone in this ward, and you will be the only DOCTOR. They will turn to you for guidance, and in desperate times, you will have to make a decision until you manage to contact me”.
Now, many years down the line, I cannot say the same thing to HOs anymore. I have to teach them how to spell and write first, then medical knowledge, then clinical practice. I am not saying that they are illiterate as they can speak and write some understandable English, but I cannot discuss with them when they keep on writing new-more thorax (pneumothorax), no more cystic no more chromic anemia (normocystic normochromic anemia), and the best is cholelithiasis (no suggested spelling as they can’t spell it). This is not a joke, unfortunately. I understand that some here will howl for evidence but I am a man of ethics, and the BHT is a sacred document I can never reveal to those not authorized.
Next after they can spell the medical term for gallstones, I must make them understand that gallstones are nowhere near the kidney. It does not usually present with back pain or dysuria. Urolithiasis is kidney stone, Cholelithiasis is gallstone. You cannot have acute gallstone disease, and having gallstone in the gall bladder does not cause hematuria and dysuria. Again not a joke, and again, by revealing names, I can get sued.
Ok, as we are getting somewhere, I will now demonstrate that UFEME has blood 5+ is not suspicious of gallstone, because urine does not flow from the liver.
Pre-emptive answers to anticipated questions:
1. “You should teach them as a senior person”
-I just did, but it will take a very long process to achieve satisfactory results, and the shift system is not helping. If you put them 2 years in Surgical Department, I am sure to achieve a better job
2. “We have houseman CMEs”
-I may be old but I’m not blind. I can see a cut and paste or a downloaded ppt when I see one, and if would rather have an actor read the ppt out, then a HO who reads monotonously, without passion and with no interest or knowledge.
3. “You should extend or report them”
-Yes, that’s true. But then I will have to attend a meeting to explain to Pengarah (the HO could even be her son/daughter eh?), then to a HO board, then to a Persatuan Ibu Bapa HO (like the one in HTJ, Seremban) and have to fill letters, schedule for another assessment which he doesn’t prepare for, extend him so that he may further MIA again and again, and next… find my name being complained to some big-shot MOH/politicians. I have more responsibilities in this department.
4. “You shouldn’t have prejudice towards them”
-I never did. I’m just worried they’ll kill somebody and I will have to answer for it. The above can be from any university, initially I only see a few of them, now there are more and more than I can handle, and the government is not doing anything about it.
5. “They may have other problems”
-Indeed they have. I have seen Major Depression, Bipolar I or II Disorder, Adjustment Disorder, Schizophrenia, Schizoid Personality Disorder, Borderline Personality Disorder, and even Generalized Anxiety Disorder not in patients, but in HOs. Does that hold them back from passing housemanship? Not at all.
Well said. That’s how bad the situation has become. I have been saying this for the last 3-4 years but yet many refuse to believe the actual situation.
I sympathise with you. It is like trying the teach 5 years of medical school in 4 months of housemanship posting. Most people just give up. What some does is to triage the HOs. The good ones becomes the workhorse, they are asked to do most of the important tasks. The weak, but teachable ones, try to teach. They get by, and mostly will become functional. The rest, shunt them to somewhere where they cannot do any harm, and hope for the best. 4 months later, they are someone else’s problem.
sounds hopeless..if I were you, I think I will probably just look after the patients myself. means more work, but at least I can sleep in peace knowing I am doing no harm to the patients.
besides, all you have to do as a junior houseman is to do all the donkey jobs and be organised. If they can do that, that will be all I ask.
Hello doctor. I’m a spm leaver and I’m interested in medicine. I got an offer to do MOE Matriculation. I’m still thinking whether I should go or not. Plus, I went for ujian saringan asasi pintar which is under ukm and I’m waiting for the results now. Previously I thought of doing a levels but after I was offered matriculation my parents insist me to go for it. I’m totally clueless now. What do you think doctor?
Matriculation gives you a better chance to get into local public university.
Hi Vivi,
Without hesitation, I’d suggest you to go for Asasi Pintar, if accepted. It’s a one-year FIS course by UKM and it’s mainly catered for high IQ students. Selection is based on excellent SPM results and IQ tests. The Ujian Saringan also known as UKM2, is NOT an interview BUT an IQ test. It’s NOT as tough as Mensa but neither an easy test. Those who completed the Asasi program are guaranteed a place in the degree program in UKM. Top students from this program are given priority to choose and continue their field of interest in all UKM critical courses like medicine, dentistry, pharmacy, engineering, etc. Because it’s an intensive program covering some 1st year fundamental subjects, students are therefore exempted from sitting the same subjects in their 1st year degree program later. For Matrik, your placement into IPTA medicine is NOT guaranteed because you still have to face the stiff competition from both Matrik and STPM top students.
Hi Gett
Yeah I hope I’ll get that one. I’ve heard of it as well but it seems the chances to get into asasi pintar is very low for the nons. I went for the ujian saringan and I’m waiting for the results now. It wasn’t that bad. So, fingers crossed. Thank you very much Gett. Btw are your from asasi pintar?
Asasi Pintar is mostly reserved for their own genius students from Permata Pintar program. The same goes to UPNM Asasi Pertahanan which is also mainly reserved for their own students from Royal Military College.
Owh I see. Thank you very much Gett 🙂
ukraine and russian medical graduates are weak and definitely should not be allowed to work in this country. i’ve seen many from art stream enter medical schools in ukraine and russia and now a walking doctor amongst us. scary as it is. apart from being weak academically, most have attitude problem. ukranian and russian medical graduates have this superiority complex that makes them unteachable, defensive and refusing to be corrected, and worst being superconfident of themselves.. these ukrainian and russian graduate superiority complex is a common thing u can see amongst them, which occur as a reflex defensive mechanism to cover their lacking in medical basics. having said this, majority of them they have problematic attitude, i cannot understand why, probably discipline is not thought during their undergraduate.
a common attitude u see in a bright and promising student doctor-to-be, is the attitude he has towards achieving his ambition, be it managing his time to study to managing his civic and daily lifestyle/practice, DISCIPLINE in anything that he does, in everything that he does. with this combination of superiority complex and problematic attitude, i would like to comment how this would affect our society. when he or she , these ukrainian or russian graduates are due to perform a procedure or make a critical decision that determines life or death, despite being unsure or do not know, what to do or how to proceed, they will JUST PROCEED BLINDLESSLY WITHOUT CONSULTING their senior doctors or specialist. this is even worse than being careless. now this is not something that u can acquire in-a-day, it is a process since the younger years. this is what we call attitude. lacking in all these.. a walking criminal in healthcare. ukrainian and russian graduates is a danger in our society.
If you don’t know enough to know the dangers, you will be gung ho. Like they say, a little knowledge is a dangerous thing.
Well, just look at the comments in this thread and you will know the answer!
[…] especially from Russia, Indonesia, Egypt etc. I had written about this before especially over HERE. However, local university graduates are not that great either. Many of the medical schools do not […]
I don’t want comment further doctor graduate from local or oversea,
Good University no necessary produce good student,
all depend on yourself, how much afford you put on it, you bear the consequences, stop bias thought and open your mind, if exam is needed to prove who is qualified, go ahead!!! Example no certain race can do better than other, how good you are depend how much homework you do !!!
I’m very interested in pursuing a career in the medical line. Is UPM a good place to do it, dr paga?
Ok
Dear doc,
if I would like to pursue my mbbs, is it better to study in IMU compared to Russia?
[…] one!!“. That’s how bad the SPM results was, of an houseman. Remember my article over HERE […]
The conclusion ; to become a medical doctor, an excellent result must be prerequisites to entry this “crazy” field, if not, half of people in the world who are not qualified then passed their med school will kill the rest. Please gov keep the standard the tittle of doctor in medicine (not PhD) »all doctor are homosapiens, are homosapiens have the same intelligence? Don’t insult others because we are needed to each other, and the last of our journey are into the grave.
[…] countries, you need to be the top 2-5 % of students in Pre-university. Remember what I wrote in February 2014? That’s why MOE introduced NOC about 10 years ago when they noticed unqualified students […]
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For the sake of standardisation of pre-university qualifications to be a doctor in Malaysia, only a few well known and standardised pre-university qualifications such as STPM, IB, A Levels and Australian Matriculation should be used and accepted.
All other pre-university qualifications (which are not approved) should be rejected, including all unstandardised university-provided pre-university studies (such as university-provided Foundation Studies, Diplomas, pre-university studies, Matriculation courses excluding Australian Matriculation, Certificate-awarded pre-university studies with academic prerequisites worse than Foundation Studies and Diplomas, etc.).
STAM should be rejected for any medical job’s pre-university course acceptance, let alone allowed for working as a doctor or a nurse. It is, as the name suggests, only fit for Islamic religious jobs which are clerical or verbal (not that associated with hard, hands-on and technical or practical skills such as healthcare and STEM (excluding social, humanities, psychology, sociology and Islamic and other religious sciences, noting that the 5 clearly named categories of sciences don’t deserve STEM or healthcare recognition for classification and career advancement purposes)).