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I was sent this link today http://www.araratadvertiser.com.au/news/national/national/general/anger-as-medical-graduates-miss-out-on-internships/2573501.aspx.

For over 2 years now I have been saying that time will come when the market will be saturated and doctors will be treated as any other graduates with no guaranteed job. The only problem is that medicine is more complex than any other profession. No internship/housemanship means you cannot practise as a doctor after spending so much money and time(if you are not sponsored)!

Australia was also having shortage of doctors few years ago. The number of medical schools almost doubled over the last 10 years. At least it just doubled and almost 20-30% of their intakes are international students. Their locals also do not go overseas to do medicine. In Malaysia, our medical schools increased from just 4 in 1995 to about 36 in 2012, a whooping 800% increase!! On top of that, we send thousands to do medicine overseas.

Since last year, certain states in Australia have already started to have shortage of internship post. Obviously, citizens and PRs will be given priority. The news below which appeared today is a clear indication that Australia will not guarantee anymore internship post for international students. The door is closing for sure ! The same is happening in UK as well.

So, you say it will NOT happen in Malaysia? …………………… time will tell.

Anger as medical graduates miss out on internships

MELISSA DAVEY
30 May, 2012 03:00 AM

MEDICAL graduates will be forced interstate or overseas to secure internships next year, potentially costing the state government more than $20 million in lost investment.

Students and universities are angered by the waste and the dire shortage of available positions for junior doctors, which means 146 NSW graduates will miss out on completing their mandatory year of training locally.

A Sydney Medical School review of the true cost of a medical degree found it cost $85,000 a year of study in 2010, with $35,000 of that funded by the state government in the form of in-kind support from the NSW Ministry of Health; health system employees who teach for free; and the use of medical facilities for training.

The state funding also applied to international students, but with internships first offered to local graduates, international graduates were likely to miss out.

Nearly 90 per cent of international student graduates would work in NSW if they could, said the University of Sydney’s medical society president, Zac Turner, potentially filling dire shortages in rural areas.

”Given the cost to Australia in training them, it seems a waste to send them home, and unfair since without that one year internship, they cannot become a registered doctor,” he said.

Sean McIsaacs has applied for internships next year in nearly every state, but said he was preparing to get rejected by all of them. The final-year student from Vancouver said he was unlikely to secure work back home in Canada either, since he would be classified as an international graduate, for who there were few positions.

”This shortage of places is unprecedented,” he said. ”As international students we’ve shown our own initiative to come here as full fee paying students who want to contribute to the Australian workforce, and we were hopeful the government would reach out to aid us.”

The University of Sydney’s international students’ representative, Blaise Wardle, said given Australia was a net importer of doctors, locally trained international students should be valued. ”It seems preposterous to allow this resource to disappear,” Mr Wardle said.

”There would be enough work for them – if only the state government was willing to fund internship positions.”

Last week the Health Education and Training Institute released provisional numbers for medical internships next year, with 894 internship places available for an estimated 1040 NSW graduates -a stand-out year for shortages.

The University of Sydney’s dean of medicine, Bruce Robinson, said international applicants were warned there was no guarantee of an internship.

”But the argument we have been making is that we ought to be getting a return on our investment and not be losing locally-trained graduates interstate or overseas,” Professor Robinson said.

The NSW Health Minister, Jillian Skinner, said the government had no obligation to offer an internship to every applicant.

”As part of the 2011-12 state budget, the NSW government committed new funding of $11.2 million over four years to support the establishment of additional intern training opportunities,” she said. ”However, this is not just a state responsibility; there needs to be an agreement between the Commonwealth, the universities and the state government about providing internships for all medical students.”

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The Ministry of Health has updated the list of recognised post-graduate degrees in their latest circular issued last month as attached below. You can also view the document here http://www.mma.org.my/Portals/0/Surat%20Pekeliling%20Ketua%20Pengarah%20Kesihatan%20Bil.%2015-2012.pdf. Once the new medical act is amended (currently in Parliament), the national specialist register(NSR) will be made compulsory and everyone will need to fulfill the criteria mentioned before he/she can be recognised as a specialist. I also heard that the UKAPS unit of MOH has asked all private hospitals to submit the NSR registration of consultants in their hospitals. The “so-called” specialists from certain countries who came back and happily practising in private hospitals may get into trouble if they cannot produce enough evidence of training.

If you look at MRCP and MRCPCH qualification, a new gazettement criteria has been included. You must have at least 4 years of internal medicine training which should include 1 year post qualification training before even going for gazettement process. The question is whether the gazettement process after this 4 years training is going to be 18 months or 6 months as it is not mentioned in the circular.  I am sure those who have been reading this blog are aware of this coming changes since I have been saying this for quite some time now.

I just hope this criteria will apply for those who are coming back from overseas “training” as well, as I have written before https://pagalavan.com/2012/04/04/trained-specialist/

Surat Pekeliling Ketua Pengarah Kesihatan Bil. 15-2012

It is also interesting to note that UiTM has started atleast 3 Master’s programme in just about 8 years of their existence. Wonder whether it is open for Non-Bumis……………. I am sure you know the answer.

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I wanted to refrain myself from commenting anything about this student’s death but I thought that there are some lessons to learn from this tragedy. When the news appeared 2 days ago and sent to me via email, I told the sender that I know what is the likely problem. It is unlikely going to be anything to do with stress of medical educations as he did complete 2 years of education in Ireland. It must be something else, likely personal and inability to handle acute stress/emotional disorder.

The next day, his own father has revealed the truth. Not only he said that it is a love triangle but he admitted that money can’t buy everything!! He had given valuable advise to all parents as highlighted below.

I know of many doctors who are busy earning big fat money in private sector, working day and night but forget to spend time with their family. How much money is enough? Being a doctor means that more money is equivalent to less family time. Most of them think that by throwing money to their children and getting them everything they ask for will make them happy. I know some consultants who dedicate their entire life of medicine in setting up departments, units and treating patients in the hospital but hardly spend anytime with their children. To cover their guilt, they buy all sort of things for their children including buying big expensive cars and even paying everything for them. Trust me, it is this type of attitude that destroys a child’s life.

This 3rd year student was driving a BMW sports and I have seen many students driving big cars nowadays , all bought by parents. Of course, you can’t do medicine nowadays unless you are from a rich family or under scholarship. Money can’t buy everything, I use to say this! How true has it become.

Children who grow up in this kind of environment will not be able to handle a simple stress in their life. I have seen many junior doctors who have similar problems. We call them “pampered” child! I had a good HO and subsequently became a MO who committed suicide by injecting Ketamine and potassium  few years ago. He was the only child in the family who grew up by getting everything he wants. He was a top student in school and graduated from a local university. He even passed his MRCP Part 1 just after housemanship and wanted to become an Interventional Cardiologist. He was a good doctor thou. One fine day, he realised that he is Hep B +ve during routine investigations. Thinking that he can’t become a cardiologist and his future is not secured, he decided to take his own life!! This is similar to the case below as a simple dejection caused him to commit suicide.

So, to all parents out there, please take the advise given by this doctor below. I never pamper my children. Till today, they still go to school by bus and get only limited amount of money from me. They are thought to save their own money to buy anything and I always teach them to be independent. I hope they will grow up well and able to handle everything in life.

R.I.P………………………

Student falls to his death

GEORGE TOWN: A medical student fell to his death from a multi-storey car park of a shopping mall here.

Steven Ko Yiu Hing, 24, (pic) is believed to have fallen from the fourth floor of the car park. His BMW was parked on that floor.

Ko’s father, founder of a chain of skin specialist clinics, declined to speak to reporters at the Penang Hospital mortuary where his son’s body was sent for post-mortem.

OCPD Asst Comm Gan Kong Meng said the father had told police that his son was under pressure since beginning his studies at the Penang Medical College here a few months ago.

He said Ko’s body was found sprawled on the ground floor by three workers at about 2am yesterday.

“Ko’s parking ticket showed that he had parked his car at the mall at about 4pm on Wednesday,” ACP Gan said, adding that police had not ruled out foul play.

The case has been temporarily classified as sudden death.

College president Brendon Lyons said he was saddened by the incident.

“Ko was an active person in college and had done volunteer work at an education fair,” he said.

Lyons said Ko had continued his studies at the college after completing about two years of his course in Ireland.

In another case, a Chung Ling High School Form Six student was found hanged at his flat in Gat Lebuh Macallum here.

The body of Arizona Tan, 17, was discovered by family members in a bedroom.

Initial investigation showed that Arizona could have died for more than six hours before his body was found.

It is learnt that the deceased was staying with his parents, a younger sister and a grandmother.

Neighbours described him as a well-mannered teenager.

One of them, who declined to be named, said she was told that Arizona had been a good student too.

Initial investigations showed that the teenager did not attend school yesterday.

ACP Gan said the case has been temporarily classified as sudden death.

Doc: My son was in love triangle

By TEH ENG HOCK and WINNIE YEOH newsdesk@thestar.com.my

KLANG: The father of the medical student who plunged to his death in Penang believed it was due to relationship problems.

Dr Ko Chung Beng claimed that his son, Steven Ko Yiu Hing (pic), 24, was dejected after deciding to give up his relationship with a girl.

Dr Ko, who is a skin specialist, said his son had been seeing the girl for a month, who also happened to be an ex-girlfriend of a friend.

Recently, the friend had expressed his intention of resuming his relationship with the girl and Steven decided to give way, said Dr Ko.

The trio had spent more than two years studying medicine in Ireland before returning to complete their studies at the Penang Medical College.

“He (Steven) had sent an SMS to the girl saying that he did not want to give her any trouble or pressure her. He advised her to watch the movie Casablanca,” he told reporters at the wake here yesterday.

On Thursday, at about 2am, Steven’s body was discovered sprawled on the ground floor of a shopping complex by three restaurant workers.

He was believed to have fallen from the fourth floor of the car park where his BMW was parked. He had gone to the complex at about 4pm on Wednesday.

Casablanca is a 1942 movie starring Humphrey Bogart, Paul Henreid and Ingrid Bergman set in World War Two. It features a love triangle between two men and a woman with Bogart’s character giving up Bergman.

Dr Ko, who has a daughter, blamed himself for not spending enough time with his son when he was going through an emotional phase.

“My advice to parents is to spend more time with your children. Do not pamper them too much by giving them all they want.

“Otherwise they may not be able to take rejection, as there are some things that money can’t buy,” he said.

In GEORGE TOWN, police are pursuing all angles, including relationship problems that could have led to Steven’s death.

George Town OCPD Asst Comm Gan Kong Meng said Steven did not leave behind any note.

“Police are ascertaining whether there was any foul play,” he said yesterday.

The case has been classified as sudden death and police have surrendered his belongings, including his car, to Steven’s family in Klang.

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I found this article in the Borneo Post interesting http://www.theborneopost.com/2012/05/17/50-of-housemen-in-sabah-cant-cope-need-retraining/. For once, a top civil servant in a state has openly said that the current generation of housemen are unable to handle stress and the workload of a doctor. It is indeed the truth. Many of these housemen have some serious attitude problems where they think that they know everything and don’t need to ask or learn from anyone. Trust me, patients are getting smarter and more patients are going around doing further investigations on their own and seeking 2nd opinion etc.

Just 2 days ago I had a patient who came for a check up. He was just discharged from a district hospital after a MVA with cerebral concussion. He is known to have complicated diabetes on insulin therapy and was told to have renal impairment by the klinik kesihatan quite some time ago (2010) where he is still under follow-up. He was admitted for 8 days , not sure why but was put on drip and some blood investigations were done. Towards the end of admission he complained of shortness of breath but nothing was done by the doctor. He was discharged with the following medications:

What do you notice ?

The moment the patient walked into my clinic , I knew what is the diagnosis. He was slightly tachypnoeic with sallow appearance, classical of a renal failure patient. His Creat was 640 mmol/L.

So, do you see what I am trying to say? I use to say that doctors can save lives and kill patients  with just a stroke of a pen!. This patient was given Ponstan (NSAIDS) which is contraindicated in renal impairment as it can worsen renal function and lead to acute renal failure! I am very sure the same medication was given right from the day of admission! I am also very sure a renal profile blood test would have been done. So, is this doctor who have completed housemanship successfully not aware of this, something that I knew even when I was a medical student?

Did you notice Ventholin tablet being prescribed? It has been ages since I prescribed Ventholin(Salbutamol) tablets to any patients. The fact that this tablet was prescribed to this patient shows that the patient did have shortness of breath before discharge!! Nothing was mentioned to this patient about his renal condition. His daughter brought him to see me as the shortness of breath was worsening. CXR showed fluid overload.

I referred him to GH for dialysis. I just hope he survives as he is just 50+ years old. I brought up this case as I feel very sad to see that basic medicine is not being practised. Did the doctor ever bother why this patient is having shortness of breath? Does he even care for this patient?

It is sad indeed………………..

50% of housemen in Sabah can’t cope, need retraining

by Mariah Doksil. Posted on May 17, 2012, Thursday

KOTA KINABALU: About 50 per cent of some 500 housemen in Sabah have to  undergo retraining after being found to be unable to cope with work-related  stress, while some of them were suffering from depression, according Sabah  Health Director Dr Mohd Yusof Ibrahim.

He said the new generation of housemen or medicine graduates  undergoing supervised practical experience is not the same as the housemen many  years back.

“My personal opinion, the new generation does not having the  ability to cope with stress and their field of training, especially those who  graduated from overseas, are unable to face the same situation in our country,” he said.

“Under the new system, housemen are only required to work for an  average of 60 hours in a five-day week with two days off, which is even better  compared to our times when we didn’t have days off,” he told the press after  launching the Queen Elizabeth Hospital 1 (QEH1) 8th State Clinical Conference on  Sports Medicine.

Yusof said that apart from failing to cope with stress, those  trained outside Malaysia experienced culture shock when facing the situations in  the country.

Some claimed they are overworked, but most doctors were trained  like that in order to be good doctors, he said.

Yusof said that apart from the hospital authorities, parents should  explain to their children that working as a doctor is tough as it involves  saving lives.

He stressed that the two-year training they received is not enough  for the new generation housemen because it is very common to see many of them  having to repeat their training before their posting to district hospitals.

“If they fail during the second training, we will send them to  another hospital. I am sure all specialists and senior doctors are willing to  help them because it is important to have

Read more: http://www.theborneopost.com/2012/05/17/50-of-housemen-in-sabah-cant-cope-need-retraining/#ixzz1vERmDSYE

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On the 1st of April 2012, I wrote this https://pagalavan.com/2012/04/01/world-class-education/. The situation seems to be getting more interesting day by day!! In my earlier post then, I had mentioned how messed up is our education system in this country. So many different type of schools, different curriculums and race based systems. A total mess, so much so, even out politicians do not send their children to our national schools.

Every now and then, our Education Minister makes a fool out of himself. I first called him a clown here, https://pagalavan.com/2011/10/21/clown-of-the-year-award/ and it looks like he is becoming one after all!! Just few weeks ago, he said that our education system is at par with developed countries but today, he claim that we WILL be at par in 10-15 years time, based on The Star report today http://thestar.com.my/news/story.asp?file=/2012/5/13/nation/11283649&sec=nation, attached below.

Then I saw this interesting headline in NST today http://www.nst.com.my/top-news/international-schools-quota-lifted-1.83311. Now, international schools can enroll 100% local students. Not enough of vernacular schools, national schools, agama schools, boarding schools, science schools, MARA colleges, private schools and now rich parents can enroll their children into international schools which conducts a totally foreign curriculum/subjects!! What a mess !!

At the end of the day, our politicians are only thinking of how to make money! period! So, now, the rich will go to UK or US-based education, the privileged and elites will go to MARA and boarding schools and the poor souls will end up in the national schools!!

My goodness………………………..

International schools’ quota lifted

By ELVINA FERNANDEZ AND LAVANYA  LINGAN | news@nst.com.my

LIBERALISING EDUCATION: More local students can now enrol

KUALA LUMPUR: MORE Malaysians can now be enrolled in international schools  locally as the country moves to further liberalise its education With immediate  effect, the Education Ministry has decided to do away with the previous 40 per  cent quota for local students in the nearly 100 such schools now operating.

Deputy Education Minister Datuk Dr Wee Ka Siong, who confirmed the move,  told the New Sunday Times yesterday that “we decided on this as it is in line  with the government’s Economic Transformation Programme (ETP) to make the  country a regional education hub”.

He stressed that the lifting of the quota was necessary because “we have to  compete with neighbouring countries in the educational field”.

He said Singapore and Thailand had already lifted their quotas and Malaysia  needed to follow suit.

“The ministry has endorsed the change and we are implementing the  move  with immediate effect.”

He  said the decision also followed the many requests from Malaysian  parents for more places for their children in international schools.

Sri Kuala Lumpur International School chief executive officer Hanif Othman  Merican, when contacted, said they had yet to receive the directive from the  ministry, but he welcomed the move.

“There is a demand for more places from local students and the decision will  open the doors for greater enrolment,” he said.

Asked about plans to increase the number of students in the school, he said  there was none at the moment.

Hanif also said there may not be an increase in  fees although there  would be more local students seeking admission.

Meanwhile, Parent Action Group for Education (Page) president Datin Noor  Azimah Abdul Rahim disagreed with the move as she said  this  would  create “a new social divide between communities of different socio-economic  levels”.

She added that  parents who could afford the fees would send their  children to international schools, while the rest of the children would be  enrolled in national schools.

Noor Azimah pointed out that  this could result in reduced  competitiveness among  students in national schools   because   the more brighter ones would be studying in international  schools.

Read more:  International schools’ quota lifted – Top News – New Straits Times http://www.nst.com.my/top-news/international-schools-quota-lifted-1.83311#ixzz1ukGXf7i2

Education system will be on par or better than that of developed nations

By KANG SOON CHEN  and A. RUBAN educate@thestar.com.my

SHAH ALAM: It will take another 10 to 15 years for the country’s education system to be on par or better than that of developed nations.

Deputy Prime Minister Tan Sri Muhyiddin Yassin said the realistic target was set so that the existing education system could be reviewed and benchmarked against the developed countries.

 We want to benchmark ourselves against the developed nations and not with the countries which are lagging behind. – TAN SRI MUHYIDDIN YASSIN

“The people have high expectations of the standard of the education system in the country. Our benchmark is not just to be excellent but par excellence in comparison with the developed countries,” Muhyiddin said in his speech when launching the 10th anniversary celebration of SK Bukit Jelutong yesterday.

Muhyiddin, who is also Education Minister, added that although the present benchmark was good, it was still not up to international standards.

“We want to benchmark ourselves against the developed nations and not with the countries which are lagging behind in their development,” he added.

“The quality of teachers is the first issue that will be addressed in our effort to boost the education system. We will look into teacher training and the roles played by teachers inside and outside of the classroom in the review,” he added.

The Government had formed a panel last year comprising educationists and corporate leaders to review the education system in nine priority areas.

The priorities include teachers, school leaders, school quality, curriculum and evaluation and multi-lingual proficiency.

The blueprint for education reforms would be ready by August after taking into account all findings and feedback from the ongoing series of dialogues with the public and interested parties from now till July.

Muhyiddin also said the low poverty rate of 2% was the result of the education system in the country.

“No one can deny that our education system has contributed to the success that we enjoy today,” he said.

He also announced an allocation of RM2mil for the school’s new hall. SK Bukit Jelutong has over 2,500 pupils.

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I just received an info today that the Australian and New Zealand College of Anaesthetist(ANZCA), after more than 50 years, will no longer offer its training program to new trainees in Hong Kong, Malaysia and Singapore http://www.anzca.edu.au/communications/Other%20publications/front-page-announcements/front-page-news/anzca-training-in-south-east-asia. Previously, training in HKL, UMMC, HUKM, IJN and Penang GH was recognised as part of the training programme http://www.anzca.edu.au/trainees/supervisory-roles/supervisor-of-training/anzca-representatives/malaysia. Those who are already in the programme will not be affected.

It is rather sad to hear this. With this, the only way to become an anaesthetist in Malaysia will be via the local Master’s programme. Many Master’s student from UM and HUKM use to sit for FANZCA exams before. I must admit that many do this to get a well recognised postgraduate degree and to migrate to Australia/N Zealand.

So, as the saying goes…………… life is only going to get tougher……………………

Withdrawal of training in Asia – update       

            After more than 50 years, ANZCA will no longer offer its training program to new trainees in Hong Kong, Malaysia and Singapore.       

To commence work on future support for trainees and Fellows in Hong Kong, Malaysia and Singapore, and a new partnership with our sister colleges in the region, ANZCA President, Professor Kate Leslie, and President-elect, Dr Lindy Roberts, met with ANZCA Fellows and trainees, and leaders from the Hong Kong College of Anaesthesiologists in Hong Kong on Friday April 27.
Three areas of support and collaboration were discussed:

1.    Support for trainees Trainees were concerned about provisions for those who chose to complete ANZCA training. The areas of concern were noted and will inform discussions about the package to be provided. Trainees and their supervisors will be consulted during this process and these provisions will be finalised by the ANZCA Council at its June 2012 meeting.

2.    Support for Fellows Fellows were reassured that the decision to withdraw from training does not affect the privileges and opportunities available to ANZCA Fellows resident in Hong Kong, Malaysia and Singapore.

3.    Inter-collegiate collaboration The Hong Kong College leaders joined with ANZCA in supporting a new partnership among colleges in the region that includes collaboration in education, training and assessment; continuing medical education; quality and safety; research and international aid. Work will commence on this initiative shortly.
On behalf of ANZCA Council, Professor Leslie and Dr Roberts expressed their gratitude to the Fellows, trainees and supervisors who participated in these meetings. The findings from the visit will be discussed by the Executive Committee at their next meeting and this message will be updated as progress is made.

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 Dr. Mary Cardosa who is the President of MMA wrote the letter below in the Star today. It is a well written letter which summarises whatever that I have been saying all this while.

For budding doctors, please realise that being a doctor is stressful and demanding. Even in UK, about 30% of the doctors are having stress disorder and needed psychological help. So, don’t assume that stressful situation only happens in Malaysia. It is everywhere.

The more developed a country becomes, the more demanding the patients become and the litigation rate will increase. With the poor quality of doctors being produced lately, the litigation rate is only going to get worst!

Job demands long hours

THE recent tragic death of a young doctor (The Star, April 12) has led to renewed discussions on the working conditions and training of housemen in Malaysia. In initial news reports, working long hours was implicated as a source of stress for the young doctor.

In fact, the complaints about “long working hours” of housemen had been forthcoming for some time and the Health Ministry implemented a flexi-hours system for housemen in the third quarter of last year.

The Malaysian Medical Associa­tion (MMA) has been monitoring the system since its implementation, and has continually sought feedback from housemen as well as from medical officers (MOs) and specialists involved in houseman training.

We have called on the ministry to carry out a comprehensive review of the new system, not just in terms of the workload of the housemen but, more importantly, in terms of how it affects their training.

Based on feedback, we are concerned about the reduction in houseman training time, resulting in inadequate exposure to patients, limited opportunities for observing and performing basic procedures and operations, and lack of continuity of care for patients.

We would like to emphasise that the housemanship training period is a critical time in a doctor’s career, the time when he/she applies all that he/she has learnt during medical school in real-life situations – fully supervised by more senior doctors.

It is thus extremely important that the young doctor uses this time to learn, and to gain as much experience as possible, as it will be the foundation of his/her future career in medicine.

The medical profession is such that one cannot work “by the clock”. Sickness does not recognise “office hours” or “shift times”.

When caring for a sick patient, e.g. someone who has just been admitted or someone who has taken a turn for the worse, a doctor has to examine, send for the necessary tests, and do the needful to resuscitate and stabilise the patient before “clocking out”.

The nature of the profession calls for such a commitment and dedication, and this culture is instilled in us during our formative years – medical school and housemanship.

Young doctors are also taught to put their patients’ interests and welfare first, before their own.

Sadly, this culture of commitment and caring seems to be getting lost in the name of improving “quality of life”.

This brings up what is, in our opinion, a more important negative impact of the flexi-hours system – the possibility that this will result in doctors lacking a sense of responsibility for a patient.

While discussing the plight of young house officers, the equally (or more) strenuous working hours of MOs and specialists in government hospitals may have been forgotten.

Training and supervision of housemen is the responsibility of MOs and specialists in the respective departments, who are already overworked with patient care.

These more senior doctors are finding it difficult to cope with training the large numbers of house officers being posted to our public hospitals, especially the many who lack basic medical knowledge and skills.

Which of course brings into question the quality of our medical graduates now. In this regard, the MMA welcomes the recently tabled amendments to the Medical Act 1971 which includes a proposal for the establishment of a Medical Qualifying Committee to look into the accreditation of qualifications of both local and international training institutions.

However, we are disappointed that the original proposal – for a common qualifying examination for medical graduates – was set aside.

We call upon the Malaysian Medical Council to carefully examine the quality of medical schools (local and international) and to take the necessary action where shortfalls in quality occur.

With regard to training of housemen, the MMA feels strongly that decisions on these matters should be left to medical professionals, with no external interference from parents, politicians or others.

As doctors, we know what training is needed to produce a good doctor, and hard work and long hours are certainly some of the necessary “evils” that we cannot escape from!

The MMA calls on the ministry to ensure that the number of house doctors posted to each unit is based on the number of trainers (i.e. specialists and MOs) available.

Only then will specialists and medical officers be able to guide each houseman in the right direction.

The MMA would also like to recognise the specialist and medical officers who have continued to train housemen despite being overworked themselves.

Dr MARY SUMA CARDOSA, President, MMA.

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We have another brainless idea from our Health Minister, as usual. I wonder why our Health Minister (who is not a doctor) seem to be making these announcements rather than MMC? The news below appeared in the Star today, http://thestar.com.my/news/story.asp?file=/2012/5/1/nation/20120501165752&sec=nation. Since our new DG took over the chairman post, many funny things seem to be happening!! Trying to make politicians happy, I presume.

I am happy for the graduates from unrecognised universities as now, they can sit for the exam unlimited number of times. BUT, rather than allowing 16 medical schools to run this exam, attempts should have been made to standardised the MQE exams like many other countries. Basically, you will be sitting for the final year exam of the respective universities. Every university has its own curriculum and exam format. For example: Monash DO NOT have a final year exam!! Their exams are in 3rd and 4rd year only. Final year is a continuous assessment. So, how are they going to conduct this MQE exam?? Has it been thoroughly discussed with these universities or our Minister is talking rubbish as usual?

I would have definitely preferred a standardised exam conducted by MMC rather than each universities running their own format and exams. Will the students be allowed to jump colleges if they fail their attempt? If you sit for the exam at the same uni repeatedly, would they eventually pass you? Most of our medical colleges have almost 100% passing rate, I wonder what will happen to MQE later.

The MMC has also been ordered to recognised more universities worldwide since the idea of common entrance exam for all overseas graduates was rejected by cabinet ( politicians again!). The common exam was approved by MMC under the previous DG. I was told it was one of the reason why he was asked to leave as he could not agree with many of the politicians idea. Due to political agreement between China and Malaysia https://pagalavan.com/2012/03/17/money-money-moneylots-of-money-part-2/, MMC is being forced to recognise graduates from China!

Whatever said, one thing is for sure going to  happen! We are going to be flooded with doctors by 2015!! Will we be seeing doctors becoming tuition teachers, pharma company reps and taxi drivers? Only time will tell…………………………. we are in TOTAL mess………………..

Medical qualifying exam now available at 16 local varsities

By SHARON LING

Liow: The medical graduates can now take the exam an unlimited number of times instead of three previously.

KUCHING: Medical graduates from unrecognised universities overseas can now sit for the Medical Qualifying Examination (MQE) at all 16 medical schools in the country, including private universities.

Health Minister Datuk Seri Liow Tiong Lai said previously these graduates could only sit for the exam at three local universities – Universiti Malaya (UM), Universiti Kebangsaan Malaysia (UKM) and Universiti Sains Malaysia (USM).

“From now onwards they can sit for the exam in all medical schools in Malaysia. We have 16 medical schools offering 17 medical programmes.

“All students coming back from unrecognised universities overseas can sit for the exam in all these universities,” he told reporters after holding a dialogue with several Sarawakian medical graduates who earned their degrees in China here on Tuesday.

The 16 universities are UM, UKM, USM, Universiti Putra Malaysia (UPM), Universiti Malaysia Sarawak (Unimas), Universiti Malaysia Sabah (UMS), Penang Medical College, International Medical University, AIMST University, Melaka-Manipal Medical College, Royal College of Medicine Perak, Monash University Sunway Campus, UCSI University, Cyberjaya University College of Medical Sciences, Universiti Sains Islam Malaysia, and Management and Science University.

Liow said this move would make it easier for medical graduates to sit for the MQE, particularly Sarawakian students who would no longer need to travel to Kuala Lumpur for it.

“They prefer to take the exam here because the cost will be lower,” he said, adding that this was one of the problems brought up by the graduates during the dialogue session.

Liow also announced that the medical graduates could now take the exam an unlimited number of times.

“In the past it was limited to three times. Now they can sit for it unlimited times to make sure they pass,” he said.

Medical graduates from unrecognised universities need to pass the MQE in order to start their housemanship and be registered as medical doctors in Malaysia.

In addition, Liow said the Malaysian Medical Council (MMC) was currently in the process of recognising medical programmes in China.

He said MMC would focus on accrediting the 11 top universities in China first as many Malaysian students were studying there.

He said although Malaysia and China had signed a memorandum of understanding (MoU) on recognising the universities, medical courses needed to be accredited by MMC.

“MMC will visit the universities in China to accredit their medical degrees so that we can recognise them as soon as we can,” Liow said, adding that MMC would try to complete the accreditation process in one year’s time.

At present, MMC recognises 375 universities in over 30 countries, not including China.

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Well, I have been saying this all the while. The government is set to meet the doctor:population ratio target of 1: 600 by 2015 and 1:400 by 2020. The news that appeared in the Star today http://thestar.com.my/news/story.asp?file=/2012/4/30/nation/11201514&sec=nation  is a clear indication of what is coming soon. However, I feel that we will achieve the ratio very much earlier. With the highest number of medical schools per capita population in the world, we will likely achieve the target of 1:400 by 2017/2018. Our Minister’s calculation of 3500 graduates annually is grossly miscalculated. By 2015, we will be producing at least 5000 graduates locally and another 1000-2000 from overseas. I don’t think our Minister knows what he is talking about, as usual. I also don’t believe that there is a 60% vacancies in civil service for doctors. In a true Malaysia Boleh spirit, our Minister has proudly said that we will “do better than WHO’s recommendation“. WTH, of course he never says anything about quality! Chasing quantities is not going to take us far.

I have attached another article below which caught my eye 2 days ago http://thestar.com.my/news/story.asp?file=/2012/4/28/nation/11196903&sec=nation. I have highlighted 2 sentences which is what I expect to happen to medical graduates by 2017. When all the posts in MOH are filled, I am sure local public university graduates and government sponsored students will be given priority. The self sponsored, whether from overseas or local private universities will most likely have wait in a “Q” or just have to find another job !

Doctor target within reach

By CHRISTINA TAN newsdesk@thestar.com.my

KLUANG: Malaysia is optimistic of having a doctor-population ratio of 1:400 by the year 2020, beating the World Health Organisation’s standard of 1:600.

Health Minister Datuk Seri Liow Tiong Lai said the Government was confident of meeting the standard despite currently facing a shortage of doctors with a ratio of only 1:800.

He said the ministry was however on track to achieve WHO’s standard of a doctor-population ratio of 1:600 by 2015.

We are optimistic that we can do better than WHO’s recommendation,” he told reporters after visiting the new Kluang Hospital in conjunction with the MCA roadshow here yesterday.

Liow said the present shortage of doctors was quite high with 60% vacancies that needed to be filled nationwide.

Several measures, he added, had been drawn up to increase the number of doctors and medical graduates, with the country producing about 3,500 every year.

“With the continuing efforts and measures to increase the number of medical personnel, the country can achieve its target,” he said.

At the event, Liow said the ministry would also provide Kluang Hospital with CT scan facilities worth RM5mil and 25 doctors, including specialists.

He also said the hospital needed an additional 150 nurses and other staff, adding that he would talk to the Public Service Department soon on resolving the matter.

4800 New Teachers

PETALING JAYA: The Education Ministry is taking steps to ensure Bachelor of Education graduates from public universities (IPTAs) will be absorbed in schools from May.

Over 4,800 new graduate teachers from IPTAs will receive their posting next month.

“A total of 4,671 graduate teachers will be sent to schools on May 23 while another 150 graduate teachers will be posted in July,” Deputy Prime Minister Tan Sri Muhyiddin Yassin said in a statement.

He revealed that the Education Services Commission had interviewed 4,953 candidates from IPTAs.

Only graduate teachers from IPTAs will receive their postings while graduates from private institutions of higher education (IPTS) will not be called for an interview by the commission yet.

Muhyiddin, who is also Education Minister, explained that graduate teachers from IPTAs were given preference over those from IPTS because their intake and the subjects they majored in were planned by the ministry.

Graduate teachers from IPTAs had earlier experessed concern over a delay in their      posting.

In Ranau, Sabah, Muhyiddin, who was on a two-day visit to the state, said the education system needed a revamp to produce a new breed of experts and skilled workers.

He said the current system had been adequate but the time had come to elevate it further to ensure the country achieved its goals.

“We must place importance on education to meet the manpower needs of the country,” he said when opening SMK Ranau and handing over of land to Institut Aminuddin Baki.

Malaysia, he said, would need another 3.3 million new workers in the next eight years in addition to the existing 12 million.

Meanwhile, at a dialogue in Kota Kinabalu later with the DPM, teachers said they were not given any special allowance for teaching the Kadazandusun language.

Muhyiddin urged teachers who were about to retire to properly plan for their golden years.

Also at the event were Chief Minister Datuk Musa Aman and Ex-Education Officers Association of Malaysia Sabah branch chairman Datuk Khamis Noyo.

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This news appeared in the Star 2 days ago: http://thestar.com.my/news/story.asp?file=/2012/4/17/nation/11116137&sec=nation. A MOU was signed to allow some private and public university lecturers to run specialist services in district hospitals. Few people asked for my opinion on this issue and whether it is a prelude for something else that is coming. I would say that there are pros and cons to this arrangement. One of the main reason why many do not want to join the private or public universities is because majority would not be able to do clinical practise. Even though all these medical schools are attached to a MOH hospital, the politics that goes inside these hospital prevents the academics from running any service for the hospital. I had written about this in March 2007 in Berita MMA https://pagalavan.com/my-mma-articles/march-2007academicians-vs-service-providers-clash-of-the-titans/. Allowing these specialist to run services in district hospitals will allow them to keep the clinical skills intact and at the same time teach the students.

However, we must understand that majority of the academics in most of our private and some public medical schools are expats. That is the reality. In fact, there is even a joke that some universities can be known as Burmese universities as almost all their lecturers are Burmese. I have seen good ones and bad ones. Some of these academics have not done clinical work for many years. Thus, they may be good in theoretical knowledge but not clinical acumen. Secondly, how many of this district hospitals have enough facilities to run specialist service? For example, do Tapah hospital have ultrasound facilities, CT scans, operating theatres etc? The OT is mainly for minor cases and not for major cases. Most of these hospitals do not even have enough A class medications. Even LSCS cannot be done in their OT.  Most of the hospitals mentioned below are in this category. So, having a specialist in this hospital may not add any benefit. It may be useful for Internal medicine services but not surgical services. I am also not sure whether MOH is paying for these services, as previously they don’t.

The government prevented medical schools from building their own teaching hospitals since the late 1990s, after HUKM. Unfortunately, this rule was removed when our PM launched Perdana University!! Now, every medical school is racing ahead to set up their own teaching hospital. UCSI is setting up in PD, IMU is buying over Pantai Ampang, Melaka Manipal is setting up Manipal Hospital and I heard even Allianz Medical college is building a private hospital too!! So, here comes another madness after 36 medical schools. It is a way for the private uni to make more money. Frankly speaking, private hospital are not suitable to be made a teaching hospital at this moment. How many private hospitals have all the specialities and manage complicated and chronic cases? WE do not have a National healthcare scheme yet to subsidise patients in private hospitals. Almost 80-90% of the patients in private hospitals now are insurance paid. The cost is just too high for any cash paying patients. Most of these patients wants privacy and personalised care by a consultant. Any new private hospitals will take 5-7 years to be fully occupied by patients. It does not mean that when these hospitals open, patients will be rushing in like a shopping complex! There will not be enough pool of patients for training purposes.

Private hospitals do not hire medical officers or housemen. The only medical officers they hire is for the emergency department. Consultants are NOT employed or paid a salary by these hospitals. Will this scenario change? There are still few questions that are unanswered .  Are these hospitals only meant for their lecturers ? Will the specialist be paid a fixed salary by the university unlike the normal private hospitals? Will this private hospitals start to hire MOs and HOs? Economically, it is not viable. That’s the reason why Monash decided to put their plan on hold. Private hospitals will take at least 5-7 years to start to make profit for the investment made. Thus, it is very unlikely they can employ MOs and HOs as financially they will not be able to cope. Furthermore, under the Medical Act, housemanship can only be done in public hospitals. And, will the consultants/lecturers have enough time to teach the students when they are busy with their patients in the ward/clinic?

I was informed that some private hospitals which belongs to big corporate giants are proposing to use their hospitals for postgraduate training. Well, it may be useful for certain subspeciality training in big private hospitals but not for basic speciality training. Again, there will be a lot of issues to settle. Will MOH pay the trainees to be trained in these hospitals? How much will MOH pay to these hospitals to run this “training” scheme? How much will the consultants be paid by MOH or will MOH pay the hospitals only? Will the consultant really train these trainees or merely use them as their free coolie?

Whatever it is , I smell something fishy in all this. For sure, there will be a lot of money involved and changing hands, from right pocket to left pocket! The standard of healthcare will definitely go down the drain due to poor training etc. I wonder whether there will come a time where the rakyat will lose faith in our doctors and go elsewhere for medical treatment? Our politicians are already doing it! Will we become like the Indonesians who rush to Malaysia and Singapore to seek treatment??? Only time will tell……………….

Varsity lecturers to help out at 22 hospitals

By ROSHIDI ABU SAMAH  roshidi@thestar.com.my

TAPAH: The Health Ministry has identified 22 public and private universities which will provide specialist medical services in 22 district hospitals nationwide.

Minister Datuk Seri Liow Tiong Lai said the universities were among 33 public and private universities in the country that offer medical courses.

He described it as a smart partnership as the hospitals would provide all the necessary facilities while the universities would send their lecturers who are also medical experts with various specialisations.

He said the collaboration would result in more patients receiving specialist treatment with a shorter waiting period.

“It is a win-win solution for the ministry, universities and the public,” he said after witnessing the signing of the smart partnership between the ministry and nine universities at the Tapah Hospital yesterday.

The ministry was represented by its secretary-general Datuk Kamarul Zaman Md Isa while the nine universities were represented by their vice-chancellors or top officials.

The nine universities that inked the partnership agreement were Universiti Tunku Abdul Rahman that would provide specialist medical service at the Tapah Hospital, Management and Science University (Kuala Kubu Baru Hospital), Perdana University (Bentong Hospital), Universiti Malaysia Sarawak (Serian Hospital), UCSI University (Dungun Hospital), Lincoln University College (Lahad Datu Hospital), Allianze University College of Medical Sciences (Kepala Batas Hospital), Melaka Manipal Medical College (Jasin Hospital) and Mahsa University College (Tanjung Karang Hospital).

Liow said the signing ceremony with the remaining 13 universities would be held later.

“The partnership will help ease congestion at main hospitals and increase the bed occupancy rate at district hospitals,” he said, adding that priority areas include internal medicine, general surgery, paediatrics, obstetrics and gynaecology, orthopedic and anaesthesiology.

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