What's Up Doc?

Well nothing too much actually, besides more visiting and hosting an open house for my long-suffering employees :-) Apologies for the lack of posting over the last 2-3 days - for those that are concerned, no, I've not been put in lock up for meddling with firecrackers (my friend did though) nor have had my head shaved bald for shuffling numbered tiles. :-)

There have however been no shortage of issues to write about though - which means an even longer backlog of blogs to write. There is however, one particular issue, which I've been meaning to write for the past 8 months or so, but for one reason or other have not gotten around to it. It has to do with the fact that everybody have the irresistable urge to become a doctor. Well, either that or they would like their sons and daughthers to become one.

Well, I think I've got enough materials to put up at least 3 separate posts on the issue, especially now that something unsurprising but critical has been "exposed" with regards to medical education in Malaysia. And not surprisingly with me warming my butts for a couple of days, Sdr Lim Kit Siang was the first to the post to blog the issue.

In a fearful frontpage report by the New Straits Times, the Director-general of Health Datuk Dr Ismail Merican said that there are many doctors in hospitals "who did not have clinical skills such as patient care, familiarity with the signs and symptoms of diseases, diagnosing illnesses, and doctor-patient communication."

He asked the simple question of "Who do we blame when we get doctors who do not have the necessary clinical skills?"

Ouch. Obviously the Ministry of Higher Education felt the pinch for the Deputy Minister, Datuk Fu Ah Kiow replied with all guns blazing.

"There is no reason why we cannot produce competent doctors with enough clinical experience when their syllabus is checked by the Malaysian Medical Council, which is chaired by Dr Ismail, and by academicians... We only give out medical degrees when the college and the degrees are recognised by the MMC. With this condition in place, I cannot understand why Dr Ismail has to say that the doctors produced are lacking in clinical skills."

The focus of the criticism by Datuk Ismail appears to be with the private medical colleges who were unable to provide sufficient (if any at all) clinical training for the medical students. There was even an accusation somewhere which alleged that certain private colleges were conduct medical classes out of rented shoplots, which was true for Asian Institute of Medicine, Science and Technology (AIMST) as a temporary measure prior to moving to their new campus in 2005.

For those interested, there are only a total of 12 medical colleges in Malaysia, 7 and 5 government and private medical colleges respectively. The other medical colleges are International Islamic Medical College (1995), Penang Medical College (1996), Melaka-Manipal Medical College (1997) and Perak Medical College (1999).

As rightly pointed out by Sdr Lim Kit Siang, pin-pointing the exact fault contribution between the Ministry of Health and the Ministry of Higher Education will not be a particulary fruitful exercise. What is important now, is how will we resolve the critical issue of incompetent doctors in our public hospitals.

The Malaysian Medical Association (MMA) has raised, as far back as 2002, concerns with regards to the rapid increase in private medical colleges in Malaysia.

Owing to the increase in the number of medical colleges within a short period, the MMA is very concerned that standards will be compromised if the following issues are not addressed.

• Lack of trained and qualified lecturers
  
  
• The ratio of lecturers to medical students should be transparent. In the medical faculty of the National University of Singapore, it is 1:5
  
  
• The curriculum now varies from traditional to problem-based learning (PBL) and there are 10 different examinations conducted by 10 different colleges. To maintain a uniform standard, it is advisable to have the same curriculum, and one common examination
  
  
• Attaching private medical college to an existing government hospital may put a stress on existing manpower resources, and also the physical facilities may not be adequate. Private medical colleges should build their own teaching hospitals
  
  
• Selection of students in all private medical colleges should be supervised by the Ministry of Education and minimum criteria for admission should be met

Obviously the suggestions made by the MMA have not been heeded by the Ministry of Higher Education.

The problems faced in private medical colleges is not any different from the other private colleges. The only difference is that one deals with the lives of the people, which makes it critical, while others will just be unemployed. When private college churn out computer science degree holders who had little or no practicals in programming, I just don't recruit them. However, I believe that the local public hospitals are actually obliged to employ these doctors upon their graduation, irrespective of their abilities.

While the case involves the quality of medical students our private (and possibly public) colleges and universities are producing in Malaysia, the bottom line is something which I've harped about consistently over the last couple of months. The uncontrolled liberalisation of the education sector and the mushrooming of private colleges with the necessary regulation and quality enforcement has resulted in the predictable steep decline in standards.

It is not difficult for the Ministry of Higher Education to enforce some of the sensible proposals made by the MMA. How difficult is it to ensure certain minimal qualifying criteria to study medicine and standardise examinations? It is obviously difficult as it will affect the viability of these colleges as they may not be able to attract sufficient students to these courses. And with standardised examinations, students from weaker colleges will fail badly which will in turn objectively tarnish the reputation and hence the financial viability of the college.

The clear question to ask then, is whether there is a conflict of interest in the Ministry's attempt to increase the number of private colleges and it's objective to set Malaysia as a commercial education centre for foreign students with the need to maintain and raise the standards of higher education in Malaysia.

Will it come the day when the first question we ask the doctor, is where he obtained his degree? There'll be a few more posts on this topic.