MEDICAL SCHOOLS IN MALAYSIA - FOR BETTER OR FOR WORSE?
Your
article in the StarBiz Week on “Medical College Shakeup”, is certainly
timely after certain Medical Colleges has shamed Malaysia by recent bad
publicity for allegedly not paying staff salaries and not settling their
contractual dues. If the medical schools involved do not feel ashamed,
we Malaysians and Malaysian doctors feel shame. It is certainly not our
Malaysian Culture to be know across the world for this. Recently there
is also the irresponsible statement by the deputy minister to cut down
on places in Public medical school when the problem is with private
medical schools.
Private Medical Education is now a business
I
am writing to highlight this very important issue that Medical
Education has now become a business, important only for the bottom line
of the company owning the licence. One of the person you interviewed,
unashamedly said that it was important for his company to have a medical
school, because it is good for their branding, in other words to give
their business a better name. There seemed to be no concern about
helping Malaysia produce better doctors for the rakyat.
The wrong reason to have medical schools
There
is now 33 medical schools of various sizes and track record. The
majority are privately owned. I understand that there are licences,
already issued for another 7-8 more. Part of this mushrooming of medical
schools is because of the often quoted statistic that we should have a
doctor: patient ratio of 1:400 which is better than a 1st world country.
This data is used to justify having more medical schools. Let us not
forget that doctor patient ratio is never a stand alone statistics to
measure healthcare standards.
We must see
the healthcare needs of each country. Just simply aping another high
income economy healthcare needs is too simplistic. The specific
healthcare needs of each country is different. In high-income countries
this ratio is relevant to different disease patterns and a healthcare
expenditure nearer or in excess of 10% GDP. We in Malaysia spend only
about 4.6% GDP on our Healthcare, with a doctor : patient ratio of 1:800
and yet have similar healthcare outcomes . Basically we have a good
healthcare system and do not need a 1:400 doctor :patient ratio.
Healthcare outcomes are more important statistics than just a simple
doctor:patient ratio. You get to see a doctor ( he is there ) but he is
so poorly trained that he cannot help you. You maybe worse off than no
doctor.
There is certainly no need for 33
medical schools, many of doubtful quality, producing more than 3,500
medical graduates, many of which are also of doubtful quality. This
falling medical students standards is currently also affecting the
standards of our public medical schools. What we need is 4 to 5
well-funded, well-staffed good medical schools ( preferably Public ),
together producing about 1,000 medical graduates annually, forming an
annual increase of 5,000 new medical graduates ( together with those
returning from overseas ).
The state of affairs in some medical schools
Do any of you know the state of affairs in many private medical schools?
Many
have few permanent full time staff. They hire contract doctors to
teach. Some medical colleges time these contract medical teachers
arrival to coincide with the arrival of the regular checks by the
Ministry of Higher Education / MMC committee. This gives a false picture
for the inspecting team. Once the inspection is over, many contract
teachers are also send back.
The students
that we admit into medical schools are also of much lower standard. Many
of them do not have the linguistic and technical skills needed to be a
doctor. Many are products of “spoon fed” teaching methods. In
established medical schools around the world medical students are not
spoon-fed. They must be able to think and work out a problem. This
method is important as medical students (future doctors) must be able to
work out the complexities of a patient’s sickness based on varied
symptoms and signs.
The problem is that
these students are unable to switch overnight from one system to
another. Not to mention that many of the contract teachers themselves
are from countries where “think for yourselves” is also NOT a strong
point. So now we have a requirement not to spoon feed and students and
teachers who know nothing except the spoon feeding method. That
compounds the problem. Our secondary educational system is to blame.
So
how do medical schools short of teaching staff fill up their time
table? Take a look at the time table of many medical schools. They have
the headings “ self directed learning” and “ ward work” without any
guidance and any supervisor. Some medical school time table for their
final year, does not even cover 50% of the core curriculum. When queried
the answer we prefer not to “spoon-feed them”. We want to “ let them
study on their own”. Guess where the students are? Many are anywhere
except the ward and the library. Then they might as well just mark
everyday “self directed learning” and the students just buy a thick
medical textbook and study on their own. Just turn up for the exam. It
will save the parents plenty of money. Is this the kind of medical
school that we want? Is this the way we want our future doctors to be
taught?
Now, when medical students reach
Year 3, they have to begin to learn to begin their junior clerkship.
Meaning they must learn to clerk ( interview ) patients to try and work
out what disease the patient is suffering from. MOST OF THE PRIVATE
MEDICAL SCHOOLS DO NOT HAVE THEIR OWN HOSPITALS. So they borrow the use
of Public Hospitals. Now there are some public hospitals in Kuala Lumpur
who have medical students from 2 or 3 medical schools walking the
corridors. The patients are utterly fed up and many refuse to co-operate
with the medical students. So the medical students do not have enough
patients to practise their interviewing techniques and medical
examination. The medical students also do not get enough opportunities
to observe procedures and new treatment methods.
Without your own
hospital, private medical schools cannot attract good medical
specialist to teach, because medical specialist wants to continue to
practise their skills. So the medical specialists that teach in private
medical schools are part-timers. A specialist who is no longer in
practice clinically, is a theory only medical teacher devoid of clinical
relevance. All the while, medicine is progressing by leaps and bounds.
My colleague in your article called them “deskilled”. There are many
specialist teachers in private medical schools who are de-skilled.
So
now, you have a poor quality students, studying under a “no spoon
feeding system” which is alien to the students. The students have to
adapt overnight by hook or by crook. The students are taught b mainly
“deskill” medical teachers ( except for a few ). What do you think will
be the end result?
It is important that by law, all private medical
schools must have their own privately funded teaching hospitals to
provide for service and teaching. This will allow for better clinical
materials, better supervision of students, and better clinical teachers.
What are the implications of poorly trained medical graduates?
If
the medical graduates are too many and poorly trained, it is very
difficult to redress this in the housemanship years. Here too we see the
problem of too many housemen and not enough supervisors and clinical
material. That will mean that when they are medical officers, they are
still not ready for independent clinical work. So when they go to
district hospitals and rural hospitals, they cannot cope and so “safe
doctors” will refer everything (short of cough and cold ) to the
district hospitals and general hospitals, further clogging up the
system. The daring gung-ho ones will try on their own giving rise to
complications and in some cases death. Currently there is a rising
number of patient complaints in Public Hospitals.
What then is the solution?
To
begin with, there should be NO MORE LICENCES FOR MEDICAL SCHOOLS. Those
private medical schools that are small without adequate teaching staff
should be asked to merge. Either merge or close and have your students
transferred to another medical school. The cost of all this will have to
be borne by the school themselves. This is an important first step.
Laws
must be passed to allow setting up of private hospitals to be used for
medical education. Of course, such laws must be properly drafted so that
private hospital patients are protected. We need better trained medical
students but not at the expense of compromising private medical care.
Some “carrots may have to be given to these “ private medical teaching
hospitals”.
The relevant monitoring and
enforcement agency in the Ministry of Education must keep a close watch
on staffing in private medical schools, especially their teaching staff
numbers and quality.
All graduates from all
medical schools will sit for a common qualifying exam. Medical schools
whose graduates do poorly, will need to be closely monitored and their
license reviewed.
The ministry should also
hold regular meetings with student bodies and teaching staff of private
medical schools to get feedback. Parents of medical students should be
advised to take a more active interest in their children’s medical
education. Do not just pay the school fees ( which is a lot ) and do not
care what happens. Help the country. Help your child be a better
trained doctor.
It should be the policy of
government not to allow the commercial interest of private medical
schools to override public interest. Medical schools objective must be
to train doctors to take good care of our citizens, particularly our
workforce to that we have a healthy good work force to drive our
economy. To close an eye to the commercialization of medical education
will be a unmitigated disaster for the future healthcare system of
Malaysia.
This article was written in respond to the recent many
articles in the press highlighting the problems in Medical Schools and
the Deputy Minister's statement ( subsequently refuted by the DG MOH )
that the government is thinking of restricting the number of
enrollment to public medical schools.
This article was send to the Editor of STAR last night.
Source - medical-schools-in-malaysia-for-better.html
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