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The news below appeared in the Star yesterday (17/06/2012) http://thestar.com.my/education/story.asp?file=/2012/6/17/education/11466151&sec=education. Many asked for my comments on this matter and here I will give my comments.

There are pros and cons. No doubt that KPJ hospitals do have a good pool of experienced specialist in various fields. Some of them have worked in universities before and some are still interested in teaching. However, doing attachment with these consultants does not make you a well-trained specialist. The private healthcare system in this country is different than many other countries. It is profit driven and are not supported by any form of healthcare financing scheme. The consultants are NOT employed by these hospitals. All of them are self-employed and run their service by renting a clinic in the hospital. Do you know that if you get sued by a patient, the hospital will not take any responsibility? You need to deal with the legal action all by yourself. The hospital will disavow your existence.

So, the consultants have full responsibility in dealing with his/her patients. Anything happens to the patient, the consultant have to answer. So, will the so called “trainee” ever get anything to do?  Will the patient allow the “trainee” to even touch him/her? This is something that we need to wait and see. You also cannot cheat the patient by saying that it is you who did the surgery when indeed it was your trainee who did it.  Legal actions will follow if the patient finds out.

What about tutorials, lectures , case presentations, thesis etc etc. Who will supervise and teach this Master’s student. The consultant obviously will not have the time to deal with this.  Would tele-conferencing be enough for this? We are talking about postgraduate training and not some undergraduate training. Clinical knowledge should go hand in hand with academic excellence. Who will assess these “trainees” and what exams do they sit? UKM/conjoint exams? BUT KPJ says that it is NOT a franchise but their own degree!!

I am very sure it is going to be another money making business. The government will offer full scholarship to these trainees to be “trained” in these hospitals. After the training, they will have to come back and be gazetted in government hospitals and serve their bond. The headache will then fall onto the HODs in government hospitals to train this so called “specialist”. It is already happening now in many MOH hospitals as the quality of Master’s graduates are dropping gradually. This new training programme by private hospitals will only make the situation worst.

One thing for sure, these “trainees” will become coolies for the consultants. As you know, private hospitals do not have housemen or medical officers to help the consultants in doing ward rounds or procedures. These “trainees” will end up doing all these donkey jobs for free as you will not be paid by the hospital. The consultants will use them to reduce their workload but still charge the patient for their own income. This is what I feel is going to happen. The trainee will become the HO and the MO for the consultant while the consultant makes the money. Doing on-call together? I don’t think so! It will be the trainee who will be doing the “on-call” daily, from setting lines and stabilising the patient in the name of training!! Trust me……. , you will become a free coolie for the hospital.

Lastly, are the cases in private hospitals as challenging as the government hospitals? My answer is NO. There are very few private hospitals in this country which has facilities as equivalent to a general hospital. So, many of the complicated and difficult cases will be transferred to government hospitals. This is a fact. Furthermore, the cost of managing complicated cases in private hospitals is simply too high for anyone to afford. So, your exposure to complicated cases is going to be very much limited. However, some speciality like radiology may be useful for speciality training as they don’t deal much with procedures.

I can go on and on talking about it as I have worked in 4 different government hospitals, in a university and finally in a private hospital. I have also been a Visiting consultant in 2 private hospitals before. I can tell you for sure that the training is never going to be the same as in University hospitals or MOH hospitals. The quality is going to be atrocious. We are already suffering from poor quality undergraduate training and it is going to progress into postgraduate training for sure. God save this country……………….

Training doctors to become specialists

By KAREN CHAPMAN educate@thestar.com.my

AS one of the biggest health conglomerates in the country, KPJ Healthcare Bhd will tap on the skills of its specialists as it expands into the postgraduate training of doctors.

The School of Medicine under the KPJ International University College of Nursing and Health Sciences (KPJUC) intends to offer postgraduate clinical specialist programmes.

Prof Lokman says the institution will implement the UKM curriculum but with the innovation and delivery methods that suit it.

However, what makes these programmes different is that the trainee specialists will not be based at the institution’s campus in Kota Seriemas, Nilai.

Instead, they will be placed on one-to-one apprenticeships with a specialist at one of KPJ’s 21 hospitals around the country.

KPJUC’s newly appointed president and dean of the School of Medicine Prof Datuk Dr Lokman Saim said KPJ has been running a nursing college for many years and also offers diplomas in allied health fields such as physiotherapy, pharmacy and medical imaging.

“The potential is there for KPJ to be a main player in healthcare education and research. We have over 700 specialists and over 200 health professionals in fields such as pharmacy, radiography and physiotherapy,” he said.

The nurses are trained for its own specialist hospitals as well as other hospitals in the country.

Prof Lokman said the move by KPJ to engage in education and research is the brainchild of KPJ Healthcare Bhd managing director Datin Paduka Siti Sa’diah Sheikh Bakir.

Her visionary leadership and encouragement drives this transformation project, he added.

Prof Lokman believes that KPJUC will be the first private medical school to offer the specialist training for doctors.

“The institution is embarking on this as the country needs more specialists,” he said.

About 600 places are offered under the postgraduate clinical specialist programmes at Universiti Kebangsaan Malaysia (UKM), Universiti Malaya and Universiti Sains Malaysia. Universiti Putra Malaysia, the International Islamic University Malaysia and Universiti Teknologi Mara have also started offering the specialist training, he added.

“We usually receive over 900 applications for the 600 places available.

“If you send the doctors for postgraduate studies overseas, it is not easy to obtain work permits and there are also limited placements so we must have training opportunities here,” he explained.

He said the medical school will start with a few programmes. Ear, Nose and Throat (ENT), radiology and paediatrics have been identified. These four-year programmes are to train doctors to become specialists in their fields of interest. It will be called Masters of ENT or radiology depending on the specialisation.

Other fields such as general medicine, orthopaedic surgery and anaesthesiology will be introduced later. A graduate entry medical programme will also be offered later.

There are also plans to eventually offer programmes in sub specialisation training as there are not enough places at present.

Higher Education Minister Datuk Seri Mohamed Khaled Nordin announced last July that the institution would be the last new medical school before the moratorium on medical schools and programmes.

He said the decision stemmed from KPJ’s existing facilities that its education arm could leverage on. The minister was referring to KPJ’s hospitals nationwide which could be used as training hospitals for nursing students and aspiring doctors when the institution launched its medical programmes.

Smart partnership

As the medical school is new, Prof Lokman explained that it will collaborate with UKM in the implementation of the postgraduate programme.

“We will implement the UKM curriculum but with the innovation and delivery methods that suit us. By this, I mean the training of these doctors will be like an apprenticeship, that is on a one-to-one basis,” he said.

These trainee specialists would be placed under a specialist in selected KPJ hospitals. “As an example, if the trainee specialist is pursuing his programme in ENT, he will be rotated among the ENT specialists in the different hospitals so that he can learn from each. The students in these apprenticeships will be closely supervised and well-trained,” he said.

The specialists will continually assess their students’ skills and knowledge.

“The trainee specialists will initially observe what the specialists do,” he said.

Once the specialists are confident that their trainees have obtained more knowledge and skills, they may assist or carry out some procedures but with their close supervision. This is because the responsibility of the patients lies with the specialist, he added.

The trainee specialists’ clinical skills and competency will be further enhanced through the use of clinical skills laboratory and simulators. The UKM Medical Centre will provide further assistance in their training if there is a need.

“This is an excellent example of a smart partnership between public and private higher education institutions in delivering an innovative specialist training programme,” he said.

On whether patients will allow these trainees to clerk, that is taking their history and making an examination for diagnosis, Prof Lokman believes it should not be a problem if the specialists and trainee specialists carefully explain the matter to the patients.

“We want to emphasise on good communication skills in the programmes offered,” he said. In fact the presence of trainee specialists in KPJ hospitals will enhance patient care as the management of patients by the specialists will be assisted by doctors trained in the specialty.

He stressed that the degree awarded would be by KPJ International University College of Nursing and Health Sciences, and is not a franchise programme.

Citing Johns Hopkins University, Duke University Hospital and the Mayo Clinic in the United States as examples, he said these institutions are not limited to being hospitals.

“They have the best teachers to teach the younger doctors and researchers who produce new knowledge. They have new treatment modalities.

“I took on the challenge here as I believe in the potential of KPJ Healthcare, the institution and the ability to work together with the specialist hospitals. My mission is to blend the three — excellent service, good education and research in KPJ,” he added.

Prof Lokman is an ENT specialist and one of the country’s neuro-otologists. He was seconded from UKM where he was the former dean of the Faculty of Medicine and director of the UKM Medical Centre.

“As for the delivery of lectures and tutorials, all KPJ hospitals will be well-equipped with tele- and videoconferencing facilities.

“What we will do is to get the specialist who is delivering a lecture to use these facilities. This would then be connected live to all the trainee specialists in different hospitals,” he added.

Giving an example, he said if the lectures were from 8am to 9am, trainee specialists would follow these lectures through tele-video conferencing. They would then be following the specialists doing ward rounds or attending clinics from 9am to the afternoon. Later, they would be on-call at night together with the specialists.

Prof Lokman said he had been meeting the specialists in all the hospitals, explaining that their practice would not be disrupted as they did not need to move around.

“The best trainers are practising specialists. What we do differently from a traditional approach where a large number of trainee specialists would need to be physically at a university hospital is that we at KPJUC attach a small number of trainee specialists to a large pool of KPJ specialists so that they will get close supervision and personalised training,” he shared.

As the institution is offering postgraduate clinical specialist programmes, approval is needed from the Malaysian Qualifications Agency and the National Conjoint Board of Studies,” he said.

If approved, intake is expected to start at the end of this year.