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For Future Doctors: The Depressing side of being a doctor…..

June 17, 2012 by Pagalavan Letchumanan

All this while, I have been talking about the healthcare system in this country, the issue of oversupply of doctors within the next 4 years, unethical practises in private sector, poor quality control and lack of proper training of junior doctors and clear-cut mistakes committed by junior doctors and front-liners. One issue that I never touched was the issues concerning patients!! As a country develops, medico-legal issues will increase as well. In some countries like US, there are more doctors resigning then being produced. That is one of the reason why you don’t see many being interested in becoming a doctor in developed countries and they depend on foreign doctors.

The comment below was posted to me in my blog few days ago. I did reply him but then I thought there is a need to explain this issue in more detail as a blog entry. If your intention is to help people, then are more than many ways to do it. I know many successful business man who spend money to set charity foundations, gives scholarship to the needy students etc etc. You may not necessarily need to become a doctor to help people. Many believe that by being a doctor, they can save many lives. This is the general misperception among the public. Yes, you may be right as we can treat many infections with antibiotics, do a cardiac bypass surgeries to save the heart etc etc. BUT, how many patients that you can actually cure from an illness? This is a question that needs to be asked. Many at times, we are just prolonging the survival by controlling a disease. Can you cure Diabetes? Can you cure Hypertension? How many tumours that is operable by the time it is detected? Almost 50% of heart attack patients die even before reaching the hospital. Even for those who reach the hospital, how many still survives despite being in the best cardiac centre? All the glorious lifesaving stunts only occur in TV programmes but not in reality. How many cancers that can be cured despite all the advance surgical techniques and chemotherapy? We see many well-known celebrities with a lot of money still succumb to cancers. When I was a student in UM, our motto was “ to cure sometimes, to relive often but to comfort always”.

I had a 3rd year medical student who went into depression when she found out that a 14 year old boy in the ward who had leukaemia died. She refused to go to the ward for quite some time and needed counselling. So, being a doctor does not mean you can save lives all the time. Be prepared to see deaths and suffering where you can’t do much.

Now, coming to the next question: do I enjoy my work? I replied that sometimes yes and sometimes NO. I did almost quit medicine at one point in time. When I was sitting for my MRCP exams, I had a credit card debt of RM10K with a pathetic salary of RM 2100 permonth. A car loan of RM 600 permonth is deducted leaving with an income of RM 1500 with 2 kids to support. I was staying in a rented house with no furniture but thank GOD, JKR was willing to loan some furniture. That was the time that I felt that I should have done some other course as I saw my friends who did engineering, accountancy, IT etc were already driving big cars and having a well-paid job and need not pay more for postgraduate studies like what I was doing.

Let’s talk about patients. Seriously, how many patients really thank you for the job that you do? When I was in government service, many patients just feel that the government is paying you to work and serve them. Many don’t appreciate what you do as they hardly pay anything. You are considered as a cheap doctor! Of course, many of the patient’s relatives are never in close contacts with the specialist in the ward. On the other hand, you can also scold the patients if they do not want to listen to you as they are not paying for your service. Then when the patients make a complaint to the pengarah, rules can be bent to entertain the patient. Many superiors just do not want the complaint to be blown up. Suddenly the patient do not need to wait for appointment and can be seen fast etc etc. VIPs get treated instantly when the general public need to wait in a “Q”. One good thing of being in a government hospital is the fact that patients rarely complains about a particular consultant.

In private sector, the situation is entirely different. Patients pay for your service and they expect no errors. Being human, there is no way a doctor can have no errors. Patients are becoming more demanding and dictate what they want. This is a scenario that you will see in any developed country. “ We pay and you do” is becoming the motto. Being in a private hospital over the last 2 years showed me how the younger generations got no respect to doctors etc. Do you really think that the younger generations are like the older generation who respects and accepts whatever you say? The older generations often forgive and forget but the younger generations don’t. I have been scolded by patients for treating a acute cardiac failure just because I am not a cardiologist. Complains have been made against me for refusing to admit a patient to the ward just because there is no one to take care of the patient at home!! Admission for family indications and not medical indications!! There are also patients or relatives of patients who just want to find fault at anything possible so that they can blackmail the hospital and specialist. All in the name of not wanting to pay the bill. Almost every month, my hospital gets at least 4-5 complains and dissatisfaction from patients. They even complain of you answering a phone call while examining a patient and refuse to pay the bill by claiming that the doctor is not paying full attention to their son!!

The world is changing. The generation Y that keep complaining in the papers of housemanship etc is the same generation who will face this kind of patients in the real world. The “forgive and forget” generation are gone. The same generation Y will complain against you. The litigation rate is going up on daily basis and almost every doctor will be sued in their lifetime. Complains to MMC is also increasing daily and they have 6 Preliminary Investigation Committee to look into all the complaints. For all the life’s that you might have saved, a single complain or legal action will leave you in depression. You will begin to wonder why this is happening to me when I have saved many life’s before! So, if you think working as a doctor is exhausting, wait till you have a patient who scold you, complains about you and even shouts at you.

This is the reason why you find many doctors order all sorts of investigations to satisfy the patient and relatives. It is also known as CBM: cover backside medicine. In most developed countries, this is what that happens. CT Scans, MRIs, battery of blood tests are being done just to save their backside. I saw this happening when I was in Singapore. The real medicine is gone and will eventually disappear. We will be taken over by machines and robots which will interpret the test and tell the patient what he/she is suffering from. Even treatment will be decided by computers. BUT the human touch will be missing………………..

Hi doctor, thanks for the eye-opening article.

I am a final year student studying Biomedical Sciences in UK, and I have an interest to pursue medicine since young. However, my parents do enot have sufficient money to fund my medical studies overseas, and my current option is : either PUGSOM / Monash, and I am intending to apply for Singapore’s medicine programme as well. Given that the future of medicine in Malaysia is rather bleak, I am having doubts about medicine at the moment, regarding the future prospects as a doctor. I don’t mind working long hours, it’s just that the inability to get the deserved career development (with so many restrictions imposed by the government) after putting in so much effort will make me miserable.

I did consider to switch into private corporate sectors, as I am partially attracted by the lucrative salary offered for oversea students (since I am from a considerably good university most of my friends managed to secure jobs with minimum 3.5k salary); but however I insisted on staying because I believed that no matter how much I am earning, it would not make my life happy because I genuinely enjoyed bringing happiness in people’s life.

But as I am approaching graduation, I am getting more uncertain about this decision. What I would enjoy as a career is one that gives me the flexibility to go from one area to another (i.e. corporate), with full potential for development (i.e. corporate), but on the other hand I would really wish to make a significant impact on other people’s life as well, and that is the reason why I am applying for medical schools.

I am sure that you will try your best to make sure that I stay away from medicine, as this has always been the mainstay of your comments to anyone who expressed any doubts in medicine, but I consider my case rather different, as what I am looking for is job satisfaction. My question to doctor : do you enjoy your job ? I am hoping to seek answers from you to enlighten me and give me an insight of what is going to happen to me in the next 10 years time. It is not an easy decision to make considering both sides are equally attractive, but I am sticking with the decision to become a doctor thus far. I am sincerely hoping that your views would guide me in my decision-making. thanks.

Posted in Education | 45 Comments »

For Future Doctors: Bonded for life?

June 10, 2012 by Pagalavan Letchumanan

Since our new DG took over the Ministry of Health, there seem to be a lot of changes that are taking place. In my last post https://pagalavan.com/2012/05/31/for-future-doctors-recognised-specialist-degrees-and-period-of-training/, I mentioned about the new rules that are being implemented for those who are planning to sit for MRCP or MRCPCH. You need to have at least 4 years of training before even going for the gazettement process.

In March 2012, I wrote this https://pagalavan.com/2012/03/07/for-future-doctors-the-storm-is-coming-part-2/ where the new rule says that you can only apply for subspeciality training 2 years after you are gazetted as a specialist. AND during this 2 years, it is compulsory for you to serve rural areas for a minimum of 6 months, mainly in Sabah and Sarawak https://pagalavan.com/2012/02/08/for-future-doctors-panduan-penempatan-dan-pertukaran/.

There was one thing that I did not mention in all these postings : the bond with the government. I am sure everyone knows that all JPA scholars are bonded for 10 years. Almost all local university graduates are JPA scholars as it is offered to all of them. If you do Master’s, an additional bond of about 5-7 years is added depending whether you are doing under open or closed system. Since last year(2011), another new bond has been created for subspeciality training. Every subspeciality training except for cardiothoracic, urology etc is about 3 years. You are required to do 2 years locally and another 1 year overseas or at another centre locally. I was informed that the additional bond is 3 years for the 2 years local training and another 3 years if you go overseas under MOH, a total of 6 years.

Remember that these bonds do not run concurrently but one after another. So, the total number of years bonded will be 21-23 years with the government( if you are an undergraduate JPA scholar). This has created a lot of unhappiness among the doctors in Ministry of Health. Many feel that there is no point doing subspeciality now as they are already sitting at the highest salary grade of U54 and nothing to look forward in terms of salary increment. JUSA post is very much limited. I had written about this in MMA magazine in 2011 here : https://pagalavan.com/my-mma-articles/march-2011-the-great-transformation-revenge-of-the-fallen-to-the-dark-of-the-moon/.

So, with the salary being at the highest grade of U54( with RM300 annual increment for max 10 years), who wants to take another 6 years of bonding for doing subspeciality with no additional benefit? I was informed that many who wanted to go to private are already leaving the service without a plan for subspeciality ( about 100 specialist left MOH last year!). Only those who are genuinely interested in doing subspeciality for their own interest are staying on. I expected this to happen when I wrote the above article in MMA in March 2011. Again, what I said is coming true.

There are also many with MRCP or MRCPCH who are going to Singapore and IJN for a shorter route of subspeciality training. BUT a word of caution for junior doctors: the private sector is getting saturated as well in major towns and the soon to be introduced 1Care system may merge public and private healthcare in the country in near future. So, there will come a time where the income earned by a private doctor may not be much of a difference than a public doctor.

Till then, enjoy the bureaucracy in civil service, the reason I left!

Posted in Education | 61 Comments »

For Future Doctors: Time is running out ?……. Part 2

May 31, 2012 by Pagalavan Letchumanan

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.”

Posted in Education | 10 Comments »

For Future Doctors: Recognised Specialist degrees and period of training

May 31, 2012 by Pagalavan Letchumanan

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.

Posted in Education | 49 Comments »

Rest in peace………………

May 26, 2012 by Pagalavan Letchumanan

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.

Posted in Education | 14 Comments »

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

May 18, 2012 by Pagalavan Letchumanan

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

Posted in Education | 49 Comments »

World Class Education ? Part 2

May 13, 2012 by Pagalavan Letchumanan

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.

Posted in Education | 8 Comments »

For Future Doctors: Here goes another opportunity………………

May 7, 2012 by Pagalavan Letchumanan

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.

Posted in Education | 28 Comments »

For Future Doctors: Job demands long hours

May 3, 2012 by Pagalavan Letchumanan

 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.

Posted in Education | 21 Comments »

For Future Doctors: MQE in 16 Medical schools?

May 1, 2012 by Pagalavan Letchumanan

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.

Posted in Education | 39 Comments »

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