For Future Doctors: The Standards of Medical Education in Malaysia

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”.<!–[if !supportFootnotes]–>[1]<!–[endif]–> 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

 

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