For Future Doctors: The Standards of Medical Education in Malaysia and Its Acceptability by David Quek
November 17, 2011 by
Pagalavan Letchumanan
Since I started blogging in January 2010, I brought up various
issues regarding the standards of medical education, commercialisation
of medical educations and oversupply of doctors by 2015. Many did not
believe what I had said and some even accused me of being selfish,
trying to save my rice bowl and preventing people from becoming doctors.
The aim of my blog is to educate the public and budding
doctors regarding what being a doctor is all about as well as the
current and future prospects of doing medicine. You should never do
medicine for wrong reasons.
2 days ago, my blog was quoted by a writer in Malaysiakini (
http://pagalavan.com/2011/11/15/malaysiakini-storm-is-coming-for-our-medical-profession/)
who even borrowed my title. Today, I was quoted again by Dr. David
Quek who had given an excellent speech at the Medico-Legal conference in
KL
http://myhealth-matters.blogspot.com/2011/11/standards-of-medical-education-in.html.
I was actually invited to attend this conference but due to work
commitments, I could not attend. Dr David Quek is a MMC council member
and immediate past president of MMA. He is the best person to tell us
all, that what I have been saying all this while is coming soon……………….
Please see the highlighted paragraphs
ON 22/11/2011, I will be interviewed by Astro regarding the prospect
in doing medicine in this country. It will be in Tamil to educate the
Indian population in this country. It may be hired on air somewhere
early next year. Malaysian Nanban will also be writing an article on
medical education by quoting my blog.
The Standards of Medical Education in Malaysia and Its Acceptability
The Standards of Medical Education in Malaysia and Its Acceptability
Dr. David KL Quek,
MBBS, MRCP, FRCP, FAMM, FCCP, FASCC, FAPSC, FNHAM, FACC, FAFPM (Hon.)
Immediate Past President, Malaysian Medical Association (MMA)
(Lecture presented at the Medico-Legal Society of Malaysia Conference, Royale Chulan Hotel, Kuala Lumpur, on 16 November 2011)
Glut of Medical Graduates—Too Many, Too Soon…
The past 5 to 10 years have been a watershed period for medical
education in the country. During this time, Malaysia has embarked on an
ambitious if misguided (in my opinion) approach to rapidly attaining
‘self-sufficiency’ in health care providers for the nation’s perceived
needs and demands. For doctors, it was finally announced that
there is now a directed plan by the government to try and achieve a
doctor-population ratio of 1:400 from the current (2010) 1:903.
To achieve this, some 34 medical schools have been now licensed by
the Ministry of Higher Education (MOHE), with almost 50 medical
programmes (these include public medical schools teaming up with other
foreign or local medical schools to form for-profit private joint
medical programmes). The objective is to generate the requisite medical
graduates to quickly fill in the projected and computed vacancies for
the various public sector health facilities. The ultimate goal is to
become a country with the so-called ‘recognised’ developed status
doctor-population ratio of under 1:400. And we aim to do this in a short
span of under 10 years—by 2020!
By comparison, the United Kingdom has some 32 medical schools for a
population of 63 million, producing some 7,500 medical graduates per
year. It is good to remember that the UK has had a long hallowed
tradition of excellent medical services and education for centuries,
with an extensive cohort of ready-made clinical teachers, professors and
academicians. We are just about 45 years since we began our first
medical programme at the University of Malaya, in 1965.
In UK, the annual output of medical graduates is
around 7,500 and they are trained in 140 hospitals; in Australia 3,400
graduates are trained in 60 hospitals; in Hong Kong, 350 graduates in 13
hospitals; and in Singapore 150 graduates in 4 hospitals. In Malaysia,
2008, there were 2,274 graduates undergoing training in 38 hospitals
and, since then, the number has increased tremendously, so much so that
the Ministry of Health has had to increase the number of accredited
hospitals for housemanship training, barely scraping by with sometimes
just a single clinical specialist for each discipline, at more remote
district hospitals.
And the truth is that we really don’t have a happy history of strong
medical educational expertise and consistency of academicians; most of
our senior and experienced medical specialists and professionals are in
the private sector, or they would have migrated overseas. (It is
estimated that as many as 40-50% of Singapore’s health service personnel
are manned by Malaysian medical graduates!)
A few dedicated senior doctors are in our medical schools, but most
are driven and run by relatively ‘young’ post-graduates or even
specialist in training, whose ability to impart and inculcate ethical
healthcare values and inspiration for compassionate care may be
untutored, wanting or uninspired.
(I would at this juncture like to apologise to our younger
colleagues out there, that this is not a disparaging remark to belittle
their efforts at medical education or their skills—age and seniority are
not requisites for medical excellence, for sure. Indeed when we are
young, hungry, and foolish even, we tend to have the best and most
aggressive approach to learning and hopefully teaching special
skills—“see one, do one, teach one”.
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I began as a lecturer at the age of 29 years, and I fully recognise
that we can all be good dedicated teachers, when we choose to become
one—yet there is no denying that experience and seniority helps create a
sense of stability and perhaps more importantly, ethical balance and
professional equipoise, particularly in the field of medical education
and the hugely important responsibility and privilege of training
medical professionals!)
Yet by 2020, we are targeted to produce some 5000 medical
graduates every year for our projected population of 35 million,
excluding those others who might be returning from foreign medical
colleges. This is by any measure a humongous number of new
medical graduates, which any middle-income country can ill afford to
sustain or worse to develop a sensible program at accommodating the
requisite progressive training of young interns or even to provide a
quality health service!
Table 2.4.: Number of Annual Practicing Certificates Issued
According to State and Sector, 2007 to 2009.
STATE
|
2007
|
2008
|
2009
|
Public Sector
|
Private Sector
|
Public Sector
|
Private Sector
|
Public Sector
|
Private Sector
|
KUALA LUMPUR
|
2,239
|
1,762
|
2,590
|
1,881
|
2,797
|
1,952
|
LABUAN
|
18
|
16
|
12
|
17
|
12
|
17
|
PUTRAJAYA
|
254
|
9
|
257
|
10
|
294
|
10
|
JOHOR
|
612
|
981
|
752
|
1,041
|
933
|
1,072
|
KEDAH
|
446
|
458
|
484
|
483
|
580
|
482
|
KELANTAN
|
637
|
209
|
784
|
207
|
926
|
218
|
MELAKA
|
306
|
378
|
322
|
363
|
374
|
406
|
NEGERI SEMBILAN
|
354
|
341
|
401
|
401
|
532
|
372
|
PAHANG
|
340
|
355
|
440
|
378
|
489
|
385
|
PULAU PINANG
|
514
|
874
|
559
|
938
|
683
|
960
|
PERAK
|
662
|
803
|
759
|
835
|
924
|
854
|
PERLIS
|
95
|
28
|
120
|
28
|
139
|
38
|
SELANGOR
|
1,198
|
2,337
|
1,393
|
2,508
|
1,692
|
2,624
|
TERENGGANU
|
260
|
166
|
266
|
182
|
335
|
193
|
SABAH
|
462
|
342
|
592
|
358
|
696
|
379
|
SARAWAK
|
471
|
357
|
543
|
378
|
605
|
382
|
TOTAL
|
8,868
|
9,416
|
10,274
|
10,008
|
12,011
|
10,344
|
GRAND TOTAL
|
18,284
|
20,282
|
22,355
|
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Malaysian Medical Council—Annual Report 2009