Here we are http://www.amsa.org.au/internship-crisis#Advice%20for%20international%20students !! Australia is now in crisis due to overproduction of doctors and shortage of internship post. Australia has for long been dependent  on foreign trained doctors. To reduce their dependence, they doubled their number of medical schools over the last 10 years. Unfortunately, due to some poor planning they are now in crisis. We will be seeing the same scenario in another 3-4 years time in Malaysia. Can anyone deny that, now? Currently, we have more medical schools than Australia for almost the same number of population. In fact, they are targeting 3200 graduates next year (2013) when we have already achieved almost 4000 graduates last year ( 2011). They are only expected to reach 4000 graduates in 2015! Also remember few other issues:

1)Australians don’t go overseas to do medicine unlike Malaysians where almost 40% of our medical graduates still come from overseas;

2) They have a strict control of the quality of medical schools unlike bolehland

3) Almost close to 20% of their medical students are international students where as almost 95% of students in our 36 medical colleges in Malaysia are Malaysians

The article below by the Australian Medical Student’s Association is a good read. As you can see, international students most likely will NOT get an internship post next year. Monash Malaysia will definitely be in trouble as many students who enter Monash Malaysia, do so to be able to go to Australia to work/migrate, especially all their international students. With this new rule, Monash Malaysia may not be able to attract international students anymore as well as some Malaysians. Why should they pay such a huge amount of money when they can’t go to Australia to work/migrate? Monash Malaysia has been specifically mentioned in this article below. They have been downgraded from category 2 to 3 where they need to compete with interstate graduates.

I have told people many times that if your intention is to migrate to another country, DON”T DO medicine! A lot of my friends who are not doctors have easily migrated to Australia, New Zealand and even Canada. Unfortunately, as a doctor it is almost impossible to migrate to any developed countries now due to degree recognition issues, immigration laws and lack of post.

Interestingly, one of the suggestion that they have included is :

“Consider alternative employment next year. Medical graduates are able to make valuable contributions to society through a range of employment options beyond working as a medical professional”

Come 2015/16, we will be talking about the same issue in this Bolehland! Probably the students association of MMA can do the same thing as what the AMSA is doing. Unfortunately, our students themselves do not know what is happening in this country, thanks to our “katak bawah tempurung” education system and “brain washing” main stream media.

National Internship Crisis Updates

I was flipping my Star newspaper today and noticed an interesting article by Dr Miltun Lum who was a past president of MMA and MMC council member. He has summarised what I have been saying in this blog for the last 2 years. In my last posting https://pagalavan.com/2012/07/22/for-future-doctors-the-storm-in-coming-part-3/ , I mentioned 2 well-known figures in the medical fraternity in our country voicing out their concern regarding the future of medicine in this country. The oversupply of doctors, poor training of housemen and specialist and commercialisation of medical education were among the issues raised.

In this article below, Dr Milton Lum has voiced out the same concern. Almost all of these have been mentioned by  me many times before. Some of the facts that he mentioned is really interesting, like the ones that I have highlighted. According to him, a survey shows that more than 50% of students do medicine because of parental or peer pressure, glamour, hope of financial rewards later, etc.

Below this article I have attached another article of the critical situation in Australia http://www.northerndailyleader.com.au/story/142265/critical-condition-shortfall-of-internships/?cs=247 despite  having lower number of medical schools with the same population as Malaysia and their citizens do not go overseas to seek education! In fact they are only targeting 3500 graduates next year compared to Malaysia, where we have already achieved that figure last year itself!

Again, GOD bless this country………………..

Good doctoring

By Dr MILTON LUM

Ensuring everyone gets good doctors.

ONE of the basic principles taught to all medical students and doctors isPrimum non cere – first, do no harm. It is a reminder that an intervention can lead to harm to the patient, however well-intentioned it may be.

This principle is even more relevant today than in yesteryears.

Healthcare today is complex and more effective than before. However, according to the World Health Organization, the likelihood of harm is high, with a one in 300 chance of being harmed by healthcare compared to one in 1,000,000 chance of being harmed while in an aircraft.

The recent announcement that there is no limit to the number of attempts at the Medical Qualifying Examination raises fundamental questions about the quality of our doctors. Where in the world can someone be permitted unlimited attempts at any examination, let alone in medicine?

Data from developed countries reveal that one in 10 hospitalised patients are harmed because of adverse events or errors. Similar data has been found in local studies.

The future of patients and their families depend on what doctors say and do. Imagine the good and harm that can result from doctors’ actions and inactions.

The media focus on housemen in recent years raises questions about the quality of medical education and training, as well as the challenges in ensuring that everyone gets good doctors, and by extension, the quality of healthcare patients will be receiving in the future.

Studying medicine

There are more applications for entry to medical schools worldwide. Many young people want to become doctors, whether of their own volition, at the behest of their parents, or for other reasons.

Until 2011, high academic qualifications were the sole criteria for admission to all public medical schools except University Science Malaysia (USM), which required an interview as well.

Since 2011, the Malaysian Medical Council’s (MMC) guidelines require all applicants to local medical schools to pass an interview to assess the applicant’s aptitude.

Although the minimum academic qualifications for entry into medical schools are prescribed by the MMC and the Malaysian Qualification Agency (MQA), there are still reports of non-compliance by some private medical schools. There are also reports that some private medical schools take in more students than permitted.

The situation in foreign medical schools is varied. Medical schools in advanced economies require high academic qualifications and aptitude assessments. However, some medical schools in some developing economies admit students whose academic results would not even qualify them to enter a Malaysian university for other courses which require lesser academic qualifications.

Many such students gain entry through the good offices of the agencies of these medical schools.

It is necessary to emphasise that selection for entry into medical school implies selection for the medical profession. Findings from studies worldwide confirm that although some students have achieved the academic qualifications required for entry into medical school, they are not suitable for a career in medicine.

It is in the interest of the public and such students that they should not gain admission, rather than to have to leave the course or the profession subsequently.

Feedback from some public local medical schools indicate that more than 50% of students do medicine because of parental or peer pressure, glamour, hope of financial rewards later, etc.

Can such students end up as good doctors?

Should the quality of students doing medicine be of concern to the public?

What should be done to those admitted to local or foreign medical schools without minimum academic qualifications?

The message to parents that good examination results do not make a career in medicine suitable for their progeny has to be repeatedly emphasised. There is nothing worse than getting into a profession that is unsuitable for one’s personality.

Medical schools

There are currently 34 medical schools for Malaysia’s population of 28 million, compared to nine and 12 medical schools in 2002 and 2007 respectively. Sixteen new medical programmes commenced in 2009 and 2010.

Data from the Avicenna Directory maintained by the University of Copenhagen, in collaboration with the World Health Organization and the World Federation for Medical Education (WFME), show that countries with similar populations like Australia (23 million), Saudi Arabia (28 million) and Canada (35 million) currently have 26, 16 and 16 medical schools respectively.

Our ASEAN neighbours, Indonesia, Singapore, Thailand and Philippines, with populations of 238 million, five million, 65 million and 92 million respectively have 35, two, 19 and 54 medical schools respectively.

Germany and the United Kingdom have 41 and 38 medical schools respectively for populations of 82 million and 62 million.

The issue is compounded by the fact that the government recognises more than 370 medical qualifications worldwide. This list was inherited from our colonial masters and has been added to over the years.

In addition, graduates from unrecognised medical schools can sit for the Medical Qualifying Examination (MQE) and, upon passing, will be registered by the MMC. The examination, which used to be the final year examination of the University of Malaya, National University of Malaysia and University Sains Malaysia, is now also conducted by 13 other universities.

The recent announcement that there is no limit to the number of attempts at the MQE raises fundamental questions about the quality of some of these doctors. Where in the world can someone be permitted unlimited attempts at any examination, let alone in medicine?

In spite of the marked shortage of medical educators in Malaysia, the expansion of medical schools continued unabated in the past five years, thereby exacerbating the shortage. The majority of teaching staff in many medical schools are foreigners, some of whom do not speak any of the local languages, and some with no previous teaching experience.

It is not only the number, but also the quality of medical educators that is crucial in producing doctors that will make a positive impact on the public’s health. Medical educators are role models for students. It is well known that a deficient doctor is reflective of a deficient teacher; just as a child’s conduct is reflective of the parent’s.

Do the local medical schools take responsibility for the quality of their graduates? Are they responsive to societal needs and act proactively to meet those needs by addressing various issues that include selection criteria and admission policies; curricular improvements with emphasis on the concept of social accountability, medical ethics and human rights; and the quality and quality of medical educators?

Does the quality of medical education focus on the core educational needs of a doctor, providing him with the knowledge, attitude and skills necessary to address public health and clinical challenges?

Is this achievable when medical education is so much driven by the profit imperative?

What is the quality of medical education in recognised local and foreign medical schools, and how robust is its monitoring?

What is the role of agencies of foreign medical schools and how robust is their monitoring?

Housemenship

During the course of the newly graduated doctors’ future practice, there will be continuing advances in medical science and clinical practice, healthcare delivery and financing, increasing expectations of patients and the public, and changes in societal attitudes.

By itself, the basic knowledge and skills taught in medical schools is insufficient. The housemenship period is the time to start developing of the ingredients of the MMC’s “Good Medical Practice” (http://mmc.gov.my/v1/docs/Good Medical Practice_200412.pdf).

The young doctors have to learn to always put the interests of their patients first, and that the doctors’ professional practices affect the experiences of patients and their families. The skills of continuing professional development have to be developed so that their practices can advance in accordance to changes in medical knowledge and practices.

Prof TJ Danaraj, Foundation Dean of Medicine at the University of Malaya, wrote: “There is a worldwide acceptance of the views that the education of a physician extends over a lifetime, each stage resting upon the preceding one, and each preparing him for that which follows.”

Learning during housemenship is significantly experiential. There has to be sufficient quality teachers for this aspect of the young doctors’ training. The teachers, who are usually specialists, have a crucial role to play as they are role models for young doctors.

There has to be exposure to sufficient numbers of patients for young doctors to gain the experience required for independent practice. For example, they have to be exposed to the different ways in which the common conditions, appendicitis and urinary tract infections, present.

Failure to make an accurate diagnosis will lead to threats to life in the former, and long term consequences in the latter.

When there are few patients relative to the many housemen, it will, inevitably, have a negative impact on the latter’s training.

My classmates and I always remember our housemenship year. Some of our specialists were good teachers; some were less so. Some were excellent at expressing themselves verbally; others expressed their skills with their hands. Some did ward rounds before going home, and some even came back at night to do ward rounds.

We learnt from every specialist and from ourselves; what to do and what not to do in differing situations. Time was not a consideration. We finished our work before going home, whatever the time was.

There were instances when we would go to other wards or attend other specialists’ ward rounds, even after work, to learn from cases with interesting features. Those were not easy times. It was hard work, but our enthusiasm made the difference.

There were discussions and analyses which made us better doctors because we learnt from our specialists and ourselves. And, most importantly, we learnt how to learn.

The recent media report that “50% of housemen in Sabah can’t cope, need retraining” (http://www.theborneopost.com/2012/05/17/50-of-housemen-in-sabah-cant-cope-need retraining) is worrying.

Equally disturbing are media reports of claims by housemen that they are overworked, training is minimal or absent and there is “bullying” by specialists.

There are also statements by specialists that some housemen work by the clock and that they do not even know the names of some housemen assigned to their wards and clinics “because there are so many of them”!

What is the quality of housemenship training and how robust is its monitoring? What is the quality of healthcare that patients can expect from the large numbers of housemen who need retraining?

What happens when they become Medical Officers after completing their housemenship? The possible long term effects on the quality of healthcare delivery in the country are indeed mind boggling!

Government agencies

It may interest the reader to know that several government agencies are involved in medical education. The Ministry of Higher Education (MOHE) controls all medical schools. It grants approval to establish a new medical school and through the Malaysian Qualification Agency (MQA), it requires all medical schools to comply with accreditation standards.

The hospitals of the Ministry of Health (MOH) and MOHE provide housemenship training and employment for Medical Officers upon its completion.

There are reports from some specialists that they find it increasingly difficult to cope with the dual tasks of providing care to patients and training housemen, with the former always having to take priority over the latter. Even the Ministry of International Trade and Industry (MITI) impact upon the health sector. There is linkage between goods and services in MITI’s trade negotiations with the World Trade Organization (WTO), ASEAN and other trading partners. The concessions permitting the presence of foreign ownership of private healthcare facilities and practising rights for foreign doctors in Malaysia will inevitably have an impact upon the quality of healthcare provided.

It is regrettable that there is no published national medical manpower planning policy. How many doctors does the country need, and by extension, how many medical schools?

Do the MOH and MOHE provide feedback to medical schools, regarding the skills, knowledge, attitudes and competency of their graduates? What is the quality of the feedback? Do the medical schools act on the feedback?

How many top notch foreign doctors will come to Malaysia to practise on a long term basis? What mechanisms are there in place to assess the quality of foreign doctors intending to practise here? Are there robust and valid assessment mechanisms in place?

Malaysian Medical Council

The MMC’s function is that of recognition of medical schools and professional regulation, based on its Code of Professional Conduct and its guidelines.

The local medical schools are given time-limited accreditation after assessments by teams comprising representatives from the MMC and MQA. However, it is impossible to accredit all the foreign medical schools recognised by the government because of manpower, logistic and financial reasons.

Most governments in developed economies acknowledge their limitations in assessing the quality of medical education. They require all those who want to practise medicine, particularly graduates from foreign universities, to pass a licensing examination.

Many Malaysian doctors who have practised abroad, particularly those above 40 years, have passed these licensing examinations without difficulty simply because of the quality of medical education they received.

Why is there no licensing examination when about half of the doctors commencing housemenship are graduates of foreign universities?

The number of disciplinary cases per 1,000 doctors dealt with by the MMC has increased in recent years. Although it is less than that of Singapore, the question as to whether the increase is due to the public’s increasing awareness of their rights, quality of care or both is not easy to determine.

Like all medical regulatory authorities worldwide, the MMC is addressing the issues of professionalism and performance measurement. This is of relevance as it is crucial to the enhancement of the trust of the public in individual doctors, in particular, and the medical profession, in general.

What this means

Many in the medical profession have stated publicly their concern that there is more emphasis on the quantity instead of the quality of medical graduates. The consequences in other areas of studies may not be significant, but in healthcare, it can be a matter of life and death for a patient or potential patient, which means all the population.

Healthcare delivery is so complex today that it is crucial to have doctors who put a premium on patient safety. If one has to make a choice, the public interest is better served by fewer good quality doctors than larger numbers who are deficient in their knowledge, skills or attitudes.

Society deserves nothing less.

Everyone, whether students, parents, medical schools, governmental agencies and the MMC, has a role to play in ensuring that everyone gets good doctors. However, the onus on medical schools, policymakers and regulators is paramount.

In concluding, everyone, particularly medical schools, policymakers and regulators, should be cognizant of the instructive statements of Hippocrates (460-377 BC), Avicenna (980 – 1037) and Sir William Osler (1849-1919). Hippocrates wrote, “Whenever a doctor cannot do good, he must be kept from doing harm”, and Avicenna “An ignorant doctor is the aide-de-camp of death.” Sir William Osler’s statement, “The best preparation for tomorrow is to do today’s work superbly well” is very apt for medical education and training.

> Dr Milton Lum is a member of the board of Medical Defence Malaysia. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with.

Critical condition: shortfall of internships

By By Natalie Croxon

July 23, 2012, midnight

 WITH centres across the north, including Tamworth, desperate for more doctors a deficit in training places means many graduates might not be able to help fill the gaps.

Yesterday, the first round of internship offers for 2013 was released and the Australian Medical Students’ Association (AMSA) estimates more than 370 international students could miss out on positions next year, although the shortfall will not be known until final offers are released next month.

Hunter New England Health will take 100 interns, the same as last year, and while these graduate trainees will rotate through the service’s training hospitals including Tamworth and Armidale, the region’s acute doctor shortage is set to continue.

Australian Health Ministers’ Advisory Council chairman Kim Snowball said the 2012 class was expected to comprise more than 3500 graduates – an increase of more than 500 students on last year. It is the biggest number on record.

In NSW AMSA has predicted a shortfall of 123 positions, with 1040 anticipated graduates and 917 intern positions available.

Without the supervised year-long internship, these graduates will not be able to work as doctors.

Without the supervised year-long internship, these graduates will not be able to work as doctors.

Commonwealth-supported students are guaranteed an internship, but domestic and international full-fee paying students are not.

Acting director medical workforce at Hunter New England Health, Anthony Llewellyn, said 16 of the service’s intake of 100 interns would be at Tamworth hospital, with 14 positions recruited under rural preferential recruitment and the other interns allocated on a rotational basis.

The remaining internship positions will be filled by Health Education and Training Institute rounds, the first released yesterday.

Interns recruited through these rounds will undertake training across a number of sites, including John Hunter, Calvary Mater, Manning, Maitland, Belmont, Tamworth and Armidale

hospitals.

AMSA yesterday presented a petition of almost 6500 signatures to the country’s health ministers, calling for them

to create more internship positions urgently.

“To produce medical graduates and then not allow them to work as doctors is a waste of taxpayer dollars and valuable health system resources,” AMSA

president James Churchill said.

The Australian Health Ministers’ Advisory Council issued a statement yesterday that said the Commonwealth and state governments were working together to ensure that when the shortfall was known, measures would be implemented to quickly increase the number of intern placements.

The advisory council said it was considering additional positions in new settings such as the private and non-government sector, ensuring accreditation for any new places was fast-tracked, and identifying any additional capacity for intern rotation and places.

The issue was explored in the current edition of the Medical Journal of Australia and author Catherine Joyce, an associate professor at Monash University, said internships needed to take place in a wider range of settings.

“Now that would include private hospitals. It might include smaller hospitals in regional or rural areas,” she said.

“The storm is coming , Mr Wayne…………”  Well, I just watched Christopher Nolan’s  “Dark Knight Rises” movie last friday and I must say that it will go down as one of the best movie trilogy ever made.  A superb ending for the Batman trilogy. I have written twice on this topic above https://pagalavan.com/2011/11/07/for-future-doctors-the-storm-is-coming  and https://pagalavan.com/2012/03/07/for-future-doctors-the-storm-is-coming-part-2

I first started to write about the deteriorating quality of medical graduates and the reasons behind it almost 7 years ago https://pagalavan.com/my-mma-articles/november-2005current-quality-of-medical-doctors-are-we-going-down-the-drains/. How true has it become and people still say I am talking rubbish. Now, let me show you 2 speeches written by 2 well renowned clinicians in Malaysia. The first was my former dean of the medical faculty of University of Malaya and former Vice Chancellor, Prof Anuar Zaini. He was also my boss when I was with Monash Malaysia and he is still the Head of the School of Medicine, Monash Malaysia. He delivered this speech when he launched the book “TJ Danaraj Doctor and Teacher Extraordinaire” on 5th May 2012. Here is the speech which I find very interesting. FYI, he is also an elected MMC member. http://mmc.gov.my/v1/docs/bulletin/2012%202%20Medical%20Education%20Then%20&%20Now%20Prof%20Dato%20Anuar%20Zaini.pdf 

For those who don’t know, TJ Danaraj was the founder dean of University Malaya medical school.

Prof Anuar has quoted very well that we will be having surplus of doctors and most of the medical schools are not producing doctors of good quality. It is very clear that MMC’s hands are tied! He has also commented on the attitude of the current generation of doctors who wants office hour job and are not keen to really care for the patients. The shift system is just a knee jerk reaction from MOH to reduce the “surplus” scenario on public’s eye.

Then came another speech from our Ex-DG, Tan Sri Dr Ismail Merican during the MMA AGM in May 2012. His speech, even though is long, does tell us the current scenario that the medical fraternity is facing in Malaysia. In fact, his title ” Medicine at the crossroads: The Malaysian Dilemma” is well worded and appropriate. You can view his speech here https://dl.dropbox.com/u/55059024/Ex-DG%20speech.pdf According to him, we are already having surplus of doctors as we do not have enough training hospitals and trainers. He has also commented on the attitude of the current generation of doctors and parents who interfere and pamper their “grown-up” kids! A well written speech, I must say.

So, can anyone still dispute what I have been saying all this while ? We are hearing from 2 people who have held high post in government service who knows what is really happening and what is going to happen.

So, the storm is coming …………… for sure!

I thought of commenting on some of the amusing news that appeared today in the papers. This news below appeared in the Star from our Ex-Health Minister and the current Health Minister.

Whatever said and done, our ex-Health Minister Dato Dr Chua Soi Lek was the best Health Minister that we have ever had. Being a doctor himself, together with our ex-DG, they did form a good team of administrators running the health ministry. What he said below is the truth, which I have been saying since the last 2 years in this blog. http://thestar.com.my/news/story.asp?file=/2012/7/17/nation/11671578&sec=nation. Oversupply of doctors is a distant reality, which he himself admitted in this article. In fact, he also admits that there is lack of training of junior doctors and this is an unhealthy scenario.  Imagine 180 doctors for a 400-bedded hospital, that’s 1 doctor to 2 beds!! As someone said in this blog before, we may have more doctors then patients in some hospitals soon.  Most MO post in district hospitals in Peninsular Malaysia is already full. I still have people who do not believe it will happen. I had a budding doctor who said “ doctor don’t die or retire, is it?”. Well, let me explain to you the fact. Yes, doctors do die, retire and migrate but the numbers are less than 1000/year, in fact only about 500-600. On the other hand, we produced almost 5000 doctors last year with only 50% of the 36 medical schools producing graduates. The number will hit almost 8000 by 2016 when all medical schools begin to produce their graduates and later, 10 000 when they produce at maximum capacity. It is increasing exponentially compared to the number of doctors dying, retiring and migrating!

Now, lets come to our “foot in the mouth” syndrome guy, our current Health Minister. When the issue of jobless nurses came into the picture few months ago, our health minister made one of the biggest joke of all time “the nursing colleges are producing general training nurses and not specialized nurses which we are short of”: https://pagalavan.com/2012/02/07/clown-of-the-year-award-part-3/. I thought that was bad enough for a health minister to say but today’s comment by him really made my day “ Private hospitals should start training their own specialist?” http://thestar.com.my/news/story.asp?file=/2012/7/17/nation/20120717175709&sec=nation.  I mean, does he know what he is talking about? Does he even know how the private hospitals in Malaysia are run? I seriously feel this guy need proper briefing about the healthcare system of this country. I have written about the pros and cons of using private hospitals for specialist training here: https://pagalavan.com/2012/06/18/specialist-training-in-private-hospitals/.  This sentence really made my day: “They should also train their existing doctors to become specialists” What existing doctors??………… I give up!

Just a repeat of what I have said before, private hospitals DO NOT employ specialist. ALL specialists in private hospitals are self-employed and rent’s a room in the hospital to run their service. Private hospitals also DO NOT employ housemen and medical officers (except for emergency department). So, how in the world are these hospitals going to train their own specialist? Can someone explain to me, probably I am too exhausted thinking about the people who are running this country! Since consultants in private hospitals are self-employed, every other specialist is a competitor. So, do you think these consultants would even bother to train anyone to become their own competitor? At least he was right about one thing : we will achieve a doctor: population ratio of 1: 400 by 2020.

And just before we can swallow all this crap, here comes another news http://www.bernama.com/bernama/v6/newsgeneral.php?id=680881. Vinayaka Missions University is going to set up postgraduate medical faculty in Klang Valley!! Gosh, I think I should just stop writing before I blow my top!

Chua: Clinical training needed

By FOONG PEK YEE 
pekyee@thestar.com.my

BIDOR: Many junior doctors lack clinical training opportunities due to an oversupply of medical practitioners, said MCA president Datuk Seri Dr Chua Soi Lek. Citing a district hospital with about 400 beds and 180 doctors as an example, he said the doctors would not be able to get adequate opportunities for their clinical training.

“Clinical training and experience are very important for doctors.

“The lack of it will have serious repercussions on their abilities,” said Dr Chua.

He added that there were more than 300 recognised universities for medicine and about 4,000 medical graduates from local and foreign universities joining the workforce yearly.

He said those who were not offered medicine at public universities should be given science-related courses instead.

“The same principle should be applied to other types of courses,” he said after opening a karaoke competition and dinner here on Sunday.

Earlier, SMJK Sam Tet student Lee Kee Hon appealed to Dr Chua for help to get into dentistry.

Kee Hon, whose CGPA (cumulative grade point average) is 4.0, had put dentistry as one of his first two choices but was offered a course in food science and nutrition instead.

Meanwhile, an MCA Youth spokesman said students could forward a copy of their appeal to MCA Youth Education Bureau, 7th Floor, Wisma MCA, Jalan Ampang, Kuala Lumpur.

Private hospitals urged to train own specialists

KUALA LUMPUR: Private hospitals need to train more specialists on their own to assist the government in tackling the shortage of specialist doctors in the country, said Health Minister Datuk Seri Liow Tiong Lai Tuesday.

He said that, at the moment, the country had 5,000 specialist doctors and of this figure, 3,000 specialist doctors were now serving in the public sector.

“Private hospitals should also have their own specialists and should not depend only on government hospitals to obtain the service of specialist doctors.

“They should also train their existing doctors to become specialists,” he told reporters after opening the 20th International Conference and Exhibition on Health Care, here.

He said there were now 35,000 doctors in the country and the government hoped the ratio of one doctor to 400 people could be achieved by 2020.

Meanwhile, Private Hospital Association president Datuk Dr Jacob Thomas said the three-day conference which focused on human capital development in the hospital service sector attracted participants from 30 countries. – Bernama

In my earlier 2 posts , https://pagalavan.com/2012/06/17/for-future-doctors-the-deppresing-side-of-being-a-doctor , http://pagalavan.com/2012/06/22/for-future-doctors-the-depressing-side-of-being-a-doctor-part-2/ I wrote about how difficult our life as a doctor has become; Ungrateful patients, patient who shout and scolds you, patients who demand certain things to be done with no proper indications and the ever-increasing litigation rate in this country and all over the world. The real art of medicine is slowly dying due to these issues.

The doctors on the other hand have started venturing into unethical practices and trying to earn as much money as possible. The competition is getting so tough that many doctors are finding other ways to make money. I know many private doctors who do so many unethical practices to make money. I had mentioned about this before in some of my earlier postings. One of my friends in private sector told me that doctors are the BEST businessmen. This is because patients trust that their doctors will do the best for them and thus they do not question what you do. So, patients get cheated all the time. Most ethical doctors don’t earn much in private sector in comparison and will be labeled as useless doctor by patients themselves. Imagine when you tell a patient that he does not need to remove his incidentally found asymptomatic gallstone but another doctor tells him that it must be removed and does the surgery? The doctor who does the surgery becomes the good doctor as far as the patient is concerned. In fact there are also patients who are unhappy when you tell them that they do not have any illness and do not need any treatment!!. These are the issues that an “ethical” doctor needs to face on a daily basis. BUT the unethical doctors are laughing to the bank by earning money cheating the uninformed patients! Sometimes I laugh at people who tell me that “so and so” relative of theirs are earning more then RM100K in a private hospital. Have they bothered to find out what unethical things that this doctor is doing? I know of cardiologists who do angiogram on anyone who walks into their clinic and puts a stent into everyone despite having only 10-20% stenosis!! I am not saying that all private doctors are doing this but it is becoming more and more common due to stiff competition and wanting to keep their income at a certain level! That’s how money can corrupt people!

Another new trend is beginning to appear recently. Many doctors, especially general practitioners(GPs) are cheating patients with the incorporation of traditional and complimentary medicine (TCM) into their practices. It is wrong ethically and legally from MMC’s point of view. I just saw a Rheumatoid Arthritis (RA) patient from a district in Johor who has been suffering from RA for atleast 7 years. For the last 2 years, she has been seeing a clinic near her house, which is run by 2 MBBS doctors ( the patient quoted this). However, these doctors are also practicing TCM. The patient’s blood is taken on every visit and even her saliva is taken to send to India for development of specific “drug” for her disease!! None of these results were ever informed to her despite requesting for it (which is obviously against the Private Healthcare Facility Act). I saw some of the treatment that was given to her and I noticed that except for 1 drug, the rest are traditional medicine. The drug that I can recognize is Prednisolone! The clinic also refused to tell her the names of the medications. AND you know how much they charge her for every visit? A whooping RM 500-1000/visit, so much so, she now owes the clinic more then RM 1000!! This is what I call daylight robbery! The patient’s disease has progressed tremendously to the extent that her joints are severely damaged now.

Then I saw another patient who has been suffering from Psoriasis for many years. He saw this doctor in his hometown who offered him Ozone therapy which the doctor claim can cure his psoriasis!! This patient was also given Prednisolone!! I know many doctors who are practicing Ozone and chelating therapy. Some of these doctors are claiming that they can cure your ischemic heart disease (confirmed stenosis by angiogram) with this form of treatments. Mind you that these treatments are expensive and not regulated by the government unlike doctor’s charges. The therapy can cause RM 1000-2000/session and the patient will need about 10-20 sessions depending on their disease. Infact, I had a GP who even promoted this directly to me. I just laughed at him! I asked for evidence and the only evidence he could give is that the patient’s symptoms have improved! NO repeat angiogram evidence! Everyone in medical field will know of placebo effect!

MMC has issued a warning last year about doctors practicing complementary medicine, especially ozone and chelation therapy http://thestar.com.my/news/story.asp?file=/2011/10/18/nation/20111018134806&sec=nation. Actions can be taken against these doctors including revoking their license to practice if they are found promoting TCM by claiming that it can cure the patient’s disease. The patient’s are vulnerable to whatever the doctor says, as patients trust doctors will always do their best for them. Unfortunately, I am sorry to say that doctors are becoming the best robbers and conman in this country with the poor enforcement of law.

The other money-making business that doctors are flooding into is aesthetic medicine. Even though aesthetic medicine is recognized as a branch of medicine and is allowed to be practiced by medical councils around the world, it has to be done properly. At the moment, there is no guideline in Malaysia on how an aesthetic physician is going to be recognized. MOH did issue a guideline in 2008 on the practice of aesthetic medicine http://mmc.gov.my/v1/docs/Aesthetic_Medicine.pdf but no concrete registration was implemented. Today’s Star reported that soon, all aesthetic medicine practitioners will be required to be registered and show proof of their training http://thestar.com.my/news/story.asp?file=/2012/7/15/nation/11667960&sec=nation . So, from now onwards you can’t claim yourself as an aesthetic medicine practitioner without proper training. I know it is a money making business as a glorified beautician but also remember the high litigation rate involved. The indemnity insurance rate is only second to O&G: http//www.medicalprotection.org/Default.aspx?DN=c3681b59-1313-41ab-9fd5-dd11fe97c622. The rates are lower for GPs who are only doing part time aesthetic but always remember that you can get sued anytime for any unsatisfactory work.

Whatever passion and interest you have in medicine will eventually disappear as the time passes by. I know many of my friends who said the same when they entered medical school but I know what they are doing now. At the end of the day, it is all about earning money as a profession and to feed your family. There are very few doctors who really have the passion after some time. With the oversupply and over flooding of doctors soon, the situation will only get worst. That is the reality.

BUT how much money is enough? Don’t let money buy over you…………. Money can’t buy you everything as what Dr Koh has admitted after the death of his son, yesterday http://thestar.com.my/news/story.asp?file=/2012/7/14/nation/11660162&sec=nation

Guidelines soon on aesthetic treatment, says Liow
KUALA LUMPUR: Guidelines on aesthetic medical practice are being drawn up to protect the public from botched jobs.The draft is expected to be completed this month, which would lead to the setting-up of the National Registry of Medical Practi­tioners Practising Aesthetic Medicine next month.

Health Minister Datuk Seri Liow Tiong Lai said a committee comprising government and private practitioners had been selected to oversee the maintenance of the registry.

He said the registry would have three different categories of medical practitioners providing aesthetic medical services – general practitioners (GPs), dermatologists and other specialists and surgical specialists and plastic surgeons.

“We welcome GPs to practise aesthetic medicine but they need to take courses and be regulated by the ministry,” he said after the 1st Malaysia-Singapore Conference of Aesthetic Medicine opening ceremony here.

The minister said GPs would have to take up a course requiring up to 56 hours of study before they could be validated by the committee to be included in the registry.

Malaysian Society of Aesthetic Medicine president Dr Louis Leh said the main aim was to promote safe aesthetic medicine and cut down on people turning to fly-by-night operators.

“Many don’t know where to go for such treatment and they end up with botched jobs,” he said, adding that beauty consultants were not supposed to handle tasks that required the use of needles or knives.

On whether beauty consultants could hire trained aesthetic doctors to do minor procedures at their centres, he said doctors were not allowed to do so because the Private Facilities and Services Act required them to practise in a proper medical set-up

My 1st part of this topic was published about a week ago https://pagalavan.com/2012/06/29/for-future-doctors-subspecialist-training-in-moh-new-rules-and-regulations/. I just returned from the Malaysian Rheumatology Society annual conference in Penang last weekend. I had a oppurtunity to discuss various issues regarding the topic above with my colleagues from MOH.

The new rules mentioned before is causing a lot of dissatisfaction and disappointment among the specialist. It seems that the offer letter to do subspeciality must be signed by the DG and KSU. The authority to offer subspeciality training is now directly under the DG. I feel that it is indeed a good idea to have a system like this, if it is transparent. Previously, many specialist can take short cuts to enter subspeciality training. For example, a specialist under certain department in certain hospital can easily enter the subspeciality training as long as the HOD accepts him/her. This scenario will NOT happen again.

I was also made to understand that when you apply for subspeciality training programme, you must now determine where you are going to work after completing the training. The place you choose to work post-sub training must be agreed upon by MOH. If MOH do not agree, they will determine where you will be posted after completing your training. This place of practise will be included in your contract. For example, your contract might say that after completing your subspecialist training, you will be posted to Miri Hospital etc. If you don’t agree, you don’t get the training post. This is to prevent specialist from rejecting any transfer after training. With the new contract, the MOH has already decided where you have to work after completing your training. Furthermore, you will also be bonded with the government. It looks like, it is a well “planned” programme. Didn’t I say it is coming ? Please read my article in MMA which I wrote almost 6 years ago: https://pagalavan.com/my-mma-articles/july-2006future-of-government-doctors-die-another-day/. The same might happen to MO post soon where you can’t reject any transfer if you want to keep your job since the post will be limited with oversupply of doctors. I also heard rumours that the same rule might be applied to Master’s application soon.

However, as I said earlier, it might be counterproductive. It seems that the MOHE hospitals a.k.a University Hospitals do not follow the same rules and regulations. These hospitals can accept you into subspecialist training immediately after MRCP or Master’s gazettement. This is because they have their own rules and regulation of gazettement etc. It looks like, many specialist might resign from MOH and join these hospitals for faster training programme. When the new promotion scheme was introduced by MOH in 2010 https://pagalavan.com/2010/04/02/government-doctors-promotion/, the scheme was better than the MOHE hospital’s promotion scheme. Many who wanted to leave to MOHE hospitals decided to stay put in MOH hospitals. The reverse will happen soon.

Recently I had a comment saying that I am talking rubbish and a lot of issues that I bring up is just rumours and not conclusive. He said that people must only take info provided by the higher authority. Well, I never forced anyone to accept everything that I say but at least I am doing some sort of public service by informing the public and medical fraternity of what is coming. If you go back and read what I have been saying in this blog over the last 2 years and read what I wrote in my MMA Magazine over the last 8 years, you will realise that almost all that I said and predicted have come true. So, it is up to the readers to decide……………….

The official circular on subspeciality training in MOH is finally out. I have mentioned most of it over the last few months but finally it is official. From January 2013 intake onwards, subspeciality training will be done exactly how the Master’s application process is done. MOH will advertise on the application and due date. You need to fill up the application forms and send together with some relevant documents to MOH within the stipulated timeframe. The circular attached below have all the rules and regulations http://latihan.moh.gov.my/uploads/Syarat%20dan%20Borang%20Permohonan%20tawaran%20C.pdf.

These are some of the conditions:

1.1 Mempunyai kelulusan kepakaran yang diiktiraf seperti Program Sarjana Perubatan daripada universiti tempatan atau setaraf seperti MRCP, MRCOG;

1.2 Telah diwartakan sebagai Pakar Perubatan;

1.3 Mempunyai pengalaman sekurang-kurangnya dua (2) tahun selepas diwartakan sebagai Pakar Perubatan kecuali bagi bidang Geriatric, Hepatology, Respiratory Medicine, Palliative Medicine dan Neurology, pegawai hendaklah mempunyai pengalamansekurang-kurangnya satu (1) tahun selepas diwartakan sebagai pakar;

1.4 Laporan daripada Ketua Jabatan berkaitan kesesuaian pegawai untuk mengikuti latihan tersebut dari segi pengalaman, sikap dan minat;

1.5 Terdapat kekosongan tempat latihan bagi bidang subkepakaran yang dipohon;

1.6 Merupakan Pegawai Perubatan Pakar lantikan tetap;

1.7 Merit akan diberikan kepada calon yang bertugas di kawasan pendalaman;

1.8 Berumur tidak melebihi 46 tahun pada tarikh tutup permohonan;

1.9 Mempunyai prestasi cemerlang dengan markah purata Laporan Nilaian Prestasi Tahunan (LNPT) bagi tiga (3) tahun terakhir berturutturut (2009, 2010 dan 2011) tidak kurang daripada 85%. (penilaian genap 12 bulan bagi setiap tahun);

1.10 Tidak pernah menerima sebarang tajaan Kerajaan Malaysia bagi peringkat kursus yang sama;

1.11 Tidak pernah gagal atau menarik diri daripada sebarang kursus tajaan Kerajaan Malaysia;

It is interesting to note that you now need atleast 85% SKT marks for the last 3 years and atleast 2 years postgazettment training except for some subspeciality. Preference will be given for those who have done rural postings and publish papers. The circular also mentions about the bonding period and the amount that you have to pay if you resign early as what I have mentioned before in my blog. One good thing is the fact that they are giving partial scholarship for your training locally of 2 years and full scholarship for the last 1 year overseas training. The bond will be 4-6 years depending on whether you do everything locally or part overseas. Also remember that if you quit subspeciality training halfway, you still need to pay the bond as mentioned here http://latihan.moh.gov.my/uploads/Ikatan%20KontrakPSP.pdf, similar to the Master’s programme!!

I feel that all these rules may be counterproductive. I am already hearing a lot of news lately of specialist resigning from civil service without doing subspeciality. This is because all of them are already at the highest pay scale of U54 and there is nothing to hope for by doing subspeciality. The addition of all these rules and bonding will only make the situation worst. Only those who are really interested in doing subspeciality will procede. The rest will just leave…………………, not to say there is a lot of money in private………..

Circular :  Syarat dan Borang Permohonan tawaran C

When I wrote the first part of this topic few days ago, I received good and bad feedbacks. There was one unknown guy who called me “bodoh” and also called himself “bodoh”. If this is the type of young generation that we have than our country is doomed. I have always said in this blog that if you want to argue about something, do it intelligently with facts rather than emotionally.

Many people are still living in dream land and think that being a doctor is glamorous, will have a glorified life and rich with a lot of money a.k.a good life, good future and good money. BUT the reality is the opposite. I have written enough information about the life of a doctor and the general misconception of being a doctor. No one can deny these facts. It is the younger generations who are unaware of all these issues before they decide to do medicine. There is a blogger (who quit medicine during housemanship) who decided to post my article in his blog http://chroniclesofaloner.com/2012/06/20/an-overrated-job/. Just look at the questions that were asked to him when he decided to quit medicine. That is exactly what the public thinks about medicine which obviously is not the reality. All doctors are rich?? Gosh, have they seen a doctor driving Kancil? I have! I also know of many doctors who buy big cars just to keep up with the social status but have huge amount of debts! Even their own parents force them to buy big cars to show that their son/daughter is a doctor.  I still drive a Honda Accord with a RM 90 000 loan from the bank! Every now and then I get disturbed by Insurance agents and Banks to take up some investment plans. And guess what the amount they want you to invest? At least RM 100 000 – 200 000, one-off payment!! Even they think that we are being “paid” a huge salary. When I tell them that I am not employed by the hospital, they get a shock.

In many developed countries, doctors have a very stressful life with a lot of litigations going around. Some quit practising medicine when they get sued once or twice. The society will eventually get very demanding and would not hesitate to take any action against any doctors for the slightest mistake that you make. Everyone wants to make money and the lawyers are ever willing to sue you. The indemnity insurance is increasing by almost RM 200-300 every year. MPS (Medical Protection Society) http://www.medicalprotection.org/malaysia/membership/subscription which is the most well-known indemnity scheme in the world publishes case reports of some of the cases which they have to settle by paying quite a big sum of money. You can view these cases over here: http://www.medicalprotection.org/malaysia/casereports. As I have said before, the “forgive and forget” generation is slowly disappearing. Even in Malaysia, as I wrote in my first part, the litigation rate is going up on a daily basis especially in big towns like KL etc.

I was informed that under the recently amended Medical Act 2012, it is mandatory for every doctor to purchase indemnity insurance including government servants. Previously, government servants need not take insurance as the government will cover you but the situation will change soon when the Act is gazetted. This is because the government could not cope anymore with the rate the litigation is going up. So, eventually the government will also disavow your existence if you get sued.

Malaysian Medical Council is also receiving all sorts of complains from the public. As long as a complain reaches MMC, an investigation has to be conducted. You can view some of the cases over here http://mmc.gov.my/v1/index.php?option=com_content&task=view&id=90&Itemid=134 in each of their bulletin. Of course, most of these cases may finally turn out to be “no case” BUT the hassle that you have go through will only add more stress to your working life. FYI:  once MMC calls you for an enquiry, it will be held in Putrajaya and you need to take few trips between your hometown and Putrajaya. Finally, not only your insurance have to pay the compensation but MMC will also suspend you from practising, if they find any form of negligence or professional misconduct. These are the problems that a doctor has to put up with when you start to work.

This is the reason why many doctors DO NOT encourage their children to do medicine. Worldwide, most surveys have shown that more than 50% of doctors do not want their children to become a doctor. I found this article written by DR Greg Hood very interesting indeed http://boards.medscape.com/forums?14@@.2a31ed0c!comment=1 (see below). The article is spot on and he also talks about the debt that a medical graduate accumulates the moment he steps out of the university and the time taken to settle this when in most other profession, you can settle it within a few years. This comment by a surgeon also interested me:

“I am a surgeon and my wife is a family Medicine specialist , we pray together as muslims do everyday and in my prayers i ask for the normal things such as long life , good health but since 2 years back we always end our prayers with ” please Allah , do not let our children look at us and choose to become doctors, let them live their lives and have time for both themselves and their own families, let them have a fair chance of being happy”
I believe in Malaysia it is truly the wrong profession to be in —at the current moment”

I also had a very interesting comment on the “saving” life issue:

“During interview, most of the interviewers will start with this question, “why you want to become a doctor?”. When i am a first year medical student, my answer will be saving life. When i graduated, the answer is different. Doctor cannot save life, instead doctor can only help and comfort patient. Saving is the job of God.

i have a friend who did a great job. He saves earth. He owns a recycle factory. Guess what, he is a PMR leaver. Currently owned a semi detached double storey house, a few lorries and vans. His income is 5 digits. He is doing greater job than doctor. Better quality of life.

Another friend of mine who is an accountant who own an ACCA, currently married and owned a happy family, blessing with 1 kid. Income, amost 5 digit. She is doing her job in helping people as well.

In fact, we are helping each other. If want to save most people, then become government will be a better choice.

For sure, I will never encourage my children to become a doctor. So far, they do not have any intention as well. May God show them the way.

You Advised Your Child to not go into Medicine, How’d it go?

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.