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QUALITIES OF HOUSEOOFICERS: THE BLAME GAME CONTINUES……………………

 Lately, there seem to be a lot of interest in the quality of houseofficers (HO) in Malaysia. Four years ago, I wrote an article about “Current Qualities of Doctors:  Are we going down the drain?” In that article I predicted that the quality of doctors that we are producing will definitely deteriorate further due to various factors. Let’s revisit this topic again.

 The mushrooming of medical colleges in Malaysia since mid-nineties was one of the reasons that I suggested 4 years ago. From 3 medical schools in early nineties, we now have almost 21 medical schools in the country. As our usual “produce the numbers” mentality in Malaysia, this current situation is somehow expected. Those who did not expect this situation to occur must be leaving in dreamland (oops! bolehland probably).

 Well, we have 21 medical schools. Now let me ask you a question: “Where are the teaching staffs coming from?” Do we have so many academicians in this country that we can afford to have 21 medical schools? Or are we importing our teaching staffs from another 3^rd world country. Do these expatriates have enough knowledge of our health system in this country and the requirements of our health system? I was made to understand that even some of our public universities are now completely dependant on foreign lecturers. Do you think they will be interested in producing good doctors for our country? Let’s face the fact that only we can feed our children. Nobody else from anywhere is going to come and serve this country unless we can give them something in return. A mere 2-3 years contract without any long term benefit would not produce any beneficial result. We have successfully chased away all the best brains over the last 40 years and now the time has come for the country to pay the price!

 This shortage of teaching staff has made many medical schools to be dependant on Ministry of Health staffs to do the teaching. Well, there are some who are really interested to teach where as there are some who does “half past six” teaching just to get the money. The continuing tussle between the academicians of medical schools and the service consultants in the MOH hospitals has made it difficult for the medical schools to recruit enough staffs especially in surgical fields due to limited OT time etc etc. Furthermore, the MOH staffs who do the teaching have to be paid but the academic staff who does service to the MOH hospitals are not paid a single cent! Every HOD of MOH hospitals are paid a monthly allowance despite half of them never do any form of teaching or assistance! There is also a ruling that bars the MOH staffs from teaching the medical students during office hours. At the end of the day, all this extra payments and allowances will be transferred to the student’s tuition fee and then, some politicians will be screaming their head off about the high tuition fee that the private medical schools are charging! Hypocrisy to the best! The county’s future at stake!

 What about the quality of students that these medical colleges are recruiting. In 1990, we had 3 medical schools taking in about 450 medical students. We know that these 450 students were the top 450 students from the country, despite not based on absolute merit. Now, we have 21 medical colleges with more than 2000 students being enrolled annually.  What entrance criteria are we using? Is there anyone monitoring these criteria? More than half of it are private colleges and as such the number of students is important to run the colleges as the fees are financing these colleges. Don’t we think that there is a possibility that it can be misused to enroll unqualified students? It happened in some overseas countries that even Art’s stream students can enroll for medical studies. Are we sure it won’t happen here? Do they have the right attitude of being a doctor? What’s the failure rate of the students? Since the students are paying a full fee, wouldn’t there be a conflict of interest when it comes to failing a student?

 What about the curriculum? Are all these medical schools using a locally adapted medical curriculum or a foreign curriculum? In many western/developed countries, undergraduate medical study has been downgraded into a “diploma” course. It is such, because a nice carrier pathway is available for the graduates who are expected to enroll into specialty training after completion of internship. The doctors are supervised almost all the time as they have adequate manpower. The situation is different in Malaysia. Here the graduates are expected to meet certain requirements which may be above than what is expected in other countries. For example, our houseofficers are expected to do central venous line insertion where as in developed countries; it is done by an Anesthetist! Our graduates are thrown to the district hospitals without any supervision after housemanship which may not be the scenario in other countries where the medical curriculum originated from.

 Sad to say, many of our medical schools have adopted a foreign curriculum. Classroom teaching has overtaken clinical bedside teaching. Students spend more time doing homework for class room teaching rather than spending the whole day in the wards seeing patients (the real teachers!). Their exams are not based on real patients anymore but rather on “simulated” patients. Gone are the days where we are drilled by 3 lecturers on a long case of a real patient! Now we have dummies and actors playing as patients. I am not saying that this is not the right way of assessing a student but merely stating the fact that “all is not right in the state of Denmark”. We cannot blame the HOs all the time. We must look into the root of the problem. Quick fix solution like producing numbers is not going to work in long term. Singapore had their 2^nd medical school (a graduate school) only after 43 years of existence!

 Our primary and secondary education system is a failure. From a well known respected education system, we have become a mediocre. Product of this education system then pursues their tertiary education in our universities. The final product is what we see now, after 38 years of “rape” and political interruption. We have successfully produced thousands of graduates on “paper” but in reality, totally unemployable. Then they get absorbed to become school teachers!! What goes around comes around! Why just look at the HOs, what about our Master’s graduates? The blame game should stop and we should look at ourselves at the mirror and ask why we have reached such a sorry state. Till then, stop complaining about quality……………………………