Tuesday, February 8, 2011

The Star: MMA: Raise the bar for future doctors... By JOSHUA FOONG

MMA: Raise the bar for future doctors


Tuesday February 8, 2011

PETALING JAYA: There is growing concern about the quality of doctors that the country is churning out.

This is due to the low prerequisites allowed for preparatory medical colleges, known to accept SPM-level students with the minimum requirement of Bs in sciences.

From there, the students have a high chance of getting into universities in countries like Russia and Indonesia.

“There must be some quality or level of excellence before one can realistically aspire to be a doctor,” Malaysian Medical Association (MMA) president Dr David Quek told The Star.

“If one is not good enough there will be problems of quality later on when he or she becomes a doctor.

“It is not simply about getting a degree or a name. It has bearings on human life and patient safety,” he added.

“The association is unhappy that we are having so many routes to medical schools.

“We are creating an unrealistic atmosphere of easy entry for anyone who can afford to pay but whose scholastic ability may be way off the mark,” added Dr Quek.

Readers of The Star have also written in to express their concern on the many “shoplot medical schools.”

While medical universities require recognition by the Malaysian Medical Council (MMC) before their graduates can practise medicine, the council does not have the authority to regulate pre-university courses tied with medical degree programmes.

“We are now looking into the entry criteria for medical students, and if these are too low, then we have recommended remedial measures to limit these medical colleges from being recognised as acceptable standards,” said Dr Quek, who is a council member.

“We are also working with the Higher Education Ministry and its agencies to ensure that foundation courses be of acceptable standards and duration, and that only sufficiently qualified students are accepted,” he added.

Universiti Malaya physiology professor Dr Cheng Hwee Ming said a student also had to master the art of decision making besides having clinical skills.

Rheumatologist Dr Pagalavan Letchumanan, who has trained housemen and lectured for 13 years, said the key point should be clear standardisation for entrance requirements.

“If we regulate the intake of medical students, say through MMC-certified prerequisites, just like our medical degrees, we can be more assured of the quality of our future graduates,” he added.

Full email Interview with Star Reporter:

1) A doctor from Johor, recently wrote on his blog - Medicine which use to be done by the creams of the country, has now gone down so low that anyone with a low qualification and money, can become a medical student (eg: Cannot qualify for A Levels > foundation in science > Med degree). Do you see this as a concern?

I think the MMA and myself in particular have been very concerned about such a trend, where just about anyone who wishes to become a doctor can simply find the easiest way to gain entry through some dubious quality medical schools.

If someone is not good enough there will invariably be problems of quality later on when one becomes a doctor. It is not just the simple getting a degree or name, it will have bearings on human life and patient safety.

That is why since time immemorial, the medial career has always been for the very best of scholars and those who do better academically to be given a chance to do medicine as a tertiary course, because there is so much information that need to be crammed in within a very short period of time during medical school and beyond.

If one is mentally slow and takes too many readings or repeated teaching, then the learning process is so much harder and tedious. Then too, it will take so much longer to retain and gain enough working knowledge that can be usefully applied as a health professional. Imagine having a 'doctor' who needs to constantly refer to textbooks or notes just to address some ailments. Surely any patient would prefer the more able and knowledgeable skilled doctor!

We are not elitists as some have branded us to be, but just being realistic. For the aspiring student, being compassionate or ambitious is not enough, there must be some quality or excellence in achievement before one can realistically aspire to be a doctor. There are many other courses which do not require such an intense and humongous volume of core knowledge and curriculum.
2) Some of these preparatory colleges that will direct potential med students to foreign medical schools can even guarantee a place for these students despite not being able to get a seat for A-Levels, STPM and Matriculation. Do you think that these colleges are too liberal in their recruitment for their own good and for the industry?

Yes, we totally disagree with such a devious way to ensure that poor quality students bypass the usual requirements to become accepted as medical students. Short foundation courses of a few months is just too short and misleadingly inadequate to provide sufficient background basic knowledge which can serious impede the rigorous learning process that is required in medical courses.

3) With such standards, in the long run, with the influx of such doctors back home and with their academic history, how do you think it affects the quality of the medical practice in Malaysia?

I have already said that we fear the ultimate quality of the medical graduates that we have these days, as well as the many who have yet to return from lesser known colleges.
There is no doubt too many compromises on quality which will ultimately affect patient care and safety. I predict that such doctors would also face greater stresses and possibly make more medical errors and perhaps lead to many medicolegal challenges and negligence law suits, due to poorer quality care and results, as more of the public become even more knowledgeable. Sadly too, it is possible that more patients may be harmed due to incompetence and poorer quality medical graduates!

4) What is your comment on this existence of cheap and easy medical degrees. Is it due to the demand for these courses that has seen to the hike in availability.

Demand for medical seats is certainly high, but in many instances unrealistic. It is not just the cheap costs of some of these medical schools from lesser known countries that matters.

Parents and students must ask themselves why no one questions about those who obtain entry into medical schools in say the UK, USA or Australia. Because we know that the quality there, is without question above board. For others, well, we have to acknowledge that they have to prove themselves...

From some of our unrecognised medical graduates who have returned, we already know that their core knowledge is quite poor, because many have great difficulties passing similar-standard exit final year local medical school examinations, failing quite dismally, many times. Those who fail cannot always claim unfairness of the system or the examiners being biased, because, there have been many others who pass without difficulty!

Unfortunately our SPM/Matriculation/STPM school leaving examinations are becoming too generic in terms of results and are not discerning enough to distinguish truly better students from the above average or average. The hundreds and/or thousands of straight A or multiple A achieved students, do not allow easy choices for admitting colleges to help decide who is better qualified to be a good medical student.

Thus every parent thinks their child is the brightest and therefore good enough to enter any course of their choosing, including medicine, law, accountancy etc. But in truth, many such students are quite average and this may lead to further more discriminating testing in the near future, e.g. select aptitude tests for special discipline entry points, such as already applicable in the USA (i.e. the Medical College Aptitude test MCAT).

The MMA is unhappy that we are having so many medical schools so quickly that we are creating an unrealistic atmosphere of easy entry for anyone who can afford to pay, but whose scholastic ability or aptitude may be way off the mark; worse when their quality of teaching or curriculum may be too marginal or low. There is also that serious concern as to the sufficiency or quality of lecturers, teachers, proctors and supervisors, and there is that very deep concern as to the inadequacy of clinical or hospital teaching and experience--the lack of teaching hospitals, patients and the clinical learning experience!
5) The MMC accredits medical schools. Is the council also regulating Pre-U courses too? Should they do so to ensure that only the best qualify for medical schools?

Right now the MMC does not have the authority to regulate pre-U courses, but we are now looking into the entry criteria for medical students, and if these are too low, then we have recommended remedial measures to limit these medical colleges from being recognised as of acceptable standards. We are working with the Ministry of Higher Education and LAN, i.e the MQA to ensure that foundation courses be of acceptable standards and duration, and that only sufficiently qualified students only are accepted.
6) Physicians for Social Responsibility vice president Datuk Dr Abdul Hamid Abdul Kadir in a recent report said that parental pressure is partly to blame for the quality of our housemen. Quoting him, “Students who are pressured into medical school won’t make very good doctors as they lack interest in the first place." What are your advice for parents?

I totally agree. There are many other courses for students. Ensure that your child is seriously interested in medicine and is willing to work very hard and tirelessly to achieve such an ambition. Don't pressure them into this course just for our personal egos or to appease the Joneses!

Ensure that the young man or woman who wishes to take up medicine be of sufficient talent and of good academic standards, based on objective measures. If in school, the student is just quite average, chances are they would have difficulty coping with medical school or becoming a doctor.

Usually in every society the world over, only the top 10% of high achievers are accepted to medical school and training. But then again, many of these high achievers now opt for higher paying college courses such as law, economics or business!

Just having a string of SPM 8 to 9As is not enough. STPM or A level 2-3As are possibly the better criteria to discern the better qualified student, who might do better for medicine, but they must have interest.

7) For aspiring students who want to be doctors, what are the principles in which you feel they can refer to if they are stuck in their decision either to read medicine of something else?

Aspiring students must get away from the comfort zone that they are to be cloistered away from hard work or even overwork, just because they have their pampering parents who would look over their shoulders all the time. Grow up!

If he or she complains of having too little sleep or not coping with the stresses of too much rote learning or memorisation of huge tomes of medical books, then clearly these will fair poorly in real life clinical work later on! We hear of increasing complaints from harassed housemen who cope poorly because they are clearly out of their level of competence--the Peter principle applies, sadly....

Most doctors have gone through all such experiences. No, we are not all mean-spirited, masochists or deadbeat outdated professionals who only wish to victimise and bully new medical graduates, why should we? Think! But that is what some of the housemen around the country have been complaining anonymously, in many poison pen letters circulating in the internet and also to our politicians and health authorities!

We have also been having more young doctors breaking down from nervous or depressive conditions. We have never had such a serious spate of complaints of overwork and bullying ever, except for the past 2-3 years.

Perhaps, the supervising senior doctors these days are very bad and mean-spirited, perhaps; but truly, one must ask if this is a reasonable truth or would it be more reasonable to assume that some housemen are simply too weak and too ill-equipped to cope?

Real life medical practice implies sacrifices and occasional sleep deprivation, because our patients do not always fall ill or come calling only during office hours!

So if anyone wants to become a doctor, get with it! Know beforehand that you will have to be responsible and ready to work at all odd hours of the day and night, and yes, even if we are dead tired and exhausted!

Complaining per se will not wish the work or duties away! If anyone aspiring student baulks at such possibilities or are fearful of such challenges, it is best to walk away now. Pursue another course!

But for those made of stronger stuff, and are willing to pursue the profession of medicine regardless, then welcome and join in the hard fought course, and engage in this well-worth process of tough but satisfying life-long learning.

Here the final rewards (though slow in coming sometimes) are of compassionate caring, comfort sharing, healing of some wounds, some ailments and occasional saving of lives, as well as being usually regarded as the most respected and trusted profession, then please join us!

Dr David Quek
President, MMA

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