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Tuesday, May 9, 2017

Where is our medical education heading?



The last few months have seen a lot of discourse in the media on the plight of young trainee doctors, or housemen, as they are called.
We saw a lot of shocking headlines – ‘not cut out to be doctors’, ‘grappling with housemen woes’, ‘housemen buckling under pressure’ – just to name a few.
The most shocking revelation was that housemen comprised the highest number of civil servants who were sacked. According to some media reports, one out of five housemen drop out annually, with the total dropouts numbering up to 1,000 or more annually.
The average cost of studying medicine at a foreign university branch campus in Malaysia is around RM500,000 excluding living expenses. Just take this as a benchmark and you’re looking at a loss of RM500 million.
This is a colossal waste of resources. After spending years in tuition and training, only to drop out just at the threshold of their medical career.
Of course, the obvious question that arises is ‘why?’ The rigidity of training during the two year internship period could not have changed much. If anything, it was perhaps worse in the last few decades, as there was always a shortage of doctors in the government service and hence a heavier workload.
The notion of working through 36 hours is not new. Most senior doctors have gone through this and while it was tough and gruelling – it was seen as part and parcel of the rigorous training that is required for this noble profession of saving lives.
So, why is it now that there are not enough places for housemen training? In other words, when housemen are plenty and hence one would assume a lower work load than in the past, are these young people dropping out and not able to cope with the demands of the training?
It has a lot to do with the attitude and aptitude of these students towards medicine as a career.
Why choose medicine as a career when the attitude and aptitude is lacking? In secondary school itself, it can be assessed whether students are cut out for medicine as a career.
Some of the reasons for the current trend
Indiscriminate mushrooming of medical schools
There are 34 public and private medical schools in the country, churning out thousands of medical graduates every year. In 2014, over 7,000 new medical graduates passed out from these schools. The number increases every year. How did so many medical schools appear suddenly?
Was a needs assessment done before these schools were allowed to be established? Considering that the compulsory housemen training can only be done in government institutions, surely some assessment should have been done on the number of medical graduates that will be coming out annually, and whether the health system had the capacity to absorb them.
Lower entry standards
With so many schools and the need to fill up the space, the entry requirements would have been lowered over the years. At one time, entry to a medical school was one of the toughest and only the brightest and toughest students made it.
Now, it seems to be relatively easier to gain entry into medical schools. The quality of teachers and teaching too would have simultaneously lowered. It is common knowledge that education is a big business and some medical schools have been set up for financial reasons.
Student capability
Perhaps the most important issue is the capability of the students and their aptitude and attitude for medicine as a career. Despite the course being long and expensive, the demand is there. Many are lured by the notion of glamour and money that comes with the medical profession. Many others are unfortunately pressured by their parents to study medicine.
Some families who want to carry on a family business or practice in medicine go to extreme lengths to enrol their children in medical schools, even though they do not meet the academic criteria or have the aptitude.
It would not be far-fetched to say that the genre of students now is of a different quality from a generation or two ago. The present generation is a much pampered lot with a much lowered tenacity to withstand stress and reprimand. Hence the increasing drop-out rate during the housemen training period.
The solutions
The situation is dire and immediate measures are required to stop the rot from further setting in. The medical profession deals with human lives and any erosion of standards due to policy failure is a grave misgiving on the part of the government.

CAP calls for an independent panel of experts to be set up to look into the quality standards of medical education in the country. This panel should comprise not just of medical experts but include people from other fields as well, such as legal, engineering, nursing, etc. The aim of this panel should be:
  • To conduct an assessment of all medical schools in the country in terms of entry standards, quality of teaching, standards of examinations. External examiners should be considered;
     
  • To ensure potential students have the right attitude and aptitude for medicine and are fully aware of the challenges in a medical career; and
     
  • To set standards and ensure these are monitored and adhered to.


S M MOHAMED IDRIS is president of the Consumers Association of Penang. - Mkini

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