Sunday, June 10, 2007

Unified Examination for Doctors?

Less than 2 weeks ago, our Minister of Health announced the proposal for a “unified examination” for medical degree graduates seeking entry into our healthcare system.

Medical graduates who studied overseas may have to sit for a unified medical examination and, whether their university is recognised or not, a pass in the examination would allow them to practise in Malaysia.

Health Minister Datuk Seri Dr Chua Soi Lek said this would ensure these graduates had the required standard and quality to practise medicine in the country.

This proposal culminates from the issue of inconsistency of the quality of recent graduates recruited both locally as well as those from foreign universities who has demonstrated substandard performance at our local hospitals.
“...we should not focus on quantity. The standard is more important,” he said, adding that there had lately been a drop in the quality of doctors.
This blog is written extensively with regards to this issue, particularly on the fact that Malaysia recognises medical degree programmes from many third world universities with arguably dubious standards and standing.

These universities include 6 from Burma, 6 from Bangladesh, 11 from Indonesia, 14 from Pakistan, 4 from Iraq and even 1 from Uganda.

The simple question then to ask, is, whether the proposal by Dr Chua Soi Lek makes practical sense for all its good intent, and whether, we are trying to find a solution without addressing the crux of the issue.

As questioned in a letter to the Star from Savariath Beeve Meeralebei of Taiping, Perak, “What is the point of unified exams?”

I find the statement by the Health Minister about the unified medical exams for all overseas medical students very perplexing. It is confusing why the ministry continues recognising medical degrees from the Czech Republic and Taiwan, while several medical degrees in Poland are currently pending approval.
And Savariath added a very relevant point, that is “the ministry should have known better than to use SPM as an entry requirement for first year of medicine in Egyptian universities.”
How will the introduction of this exam affect the fate of 490 SPM school-leavers currently pursuing medicine in Egypt? Another point to consider is will the Higher Education Ministry guideline for attaining the “No Objection Certificate” be a prerequisite for those leaving the country to be doctors?
Savariath's point is very simple. If we are concerned about the quality of particular university which we have pre-approved for our Malaysian students to pursue their studies in Medicine, why should they be subjected to further examinations and tests on the same subjects? What will these students do, should they “fail” the proposed “unified examinations”, after having spent between 5-6 years to acquire their degrees at a significant cost to their parents?

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Anonymous said...

First ensure that everything are in order in our medical schools!
Second its ridiculous if graduates from universities recognized by GMC of UK are asked to sit for exams. To be fair then our local graduates too need to sit for our own unified exams

Deng Xio Ping said " black cats or white cats all sit for the Unified Exams"
At least there will be uniform benchmarking and see how our own graduates fare with those from recognized and unrecognized universities

H said...

My first, is to change the general perception that becomin a medical doctor is the ultimate success.

We need smart ppls in other field as well, be it science, engineering, social sc (i think social science needs lots of smart ppl, bcos we need smart policy maker) or even arts.
When a person have passion in the things s(he) do, it will be a success.

Q:But I love medicine, I wanna be a dr to help sick ppls.
A:If u love medicine, bcomin a doctor, pharmacist or dentist is not only the options, there are alternatives, you can still be Medicine, even in Science and Engineering, for example Biomedicine or Bioengineering, where findings in this fields are applied in medicine. Yes, a medical scientist, we also need smart ppls for breakthrough in medical research.

So, if we all understand this, there wont be anymore rush to get a MD or MBBS.

p.s. I think there r ppl takin advantage from this rush. Check out how much private colleges charge to get their MD,
or the agent that send ths students to rusia, indonesia etc, i can see many adverts in the newspaper.

Anonymous said...

Instead of having exams which takes time & money both for the govt and the students + the incessant worrying of parents, why not just produce a list of universities which have been audited and certified to be of equal or higher standard than the local ones?

In fact, we can just borrow the list from our neighbour:

Anonymous said...

Sounds like the politicians want to have their cake and eat it too: first recognise more universities to keep people happy who can't make it into the medical courses in the public universities (perhaps close to the general elections), then impose exams to deal with the inevitable fallout...?

The Singapore list has been criticised for being somewhat arbitrary...not that I can judge since I'm not a doctor.

Question: how do other countries (besides Singapore) deal with this?

Anonymous said...

The reasons why the authorities wanted those exams are quite obvious.

(1) When approached by all and sundry, we are too diplomatic and lacked the confidence to say the right things to those "applicants". Neither do we have the resources nor ability (just look at our own university rankings) to assess them objectively. So we generously accept all, and are now royally stuck for a solution to this tsunami of doctors flooding our shores.

(2) I had always suspected that the need for the rampant, free-for-all recognition of those foreign universities arose from the need to have a safety valve to diffuse the anger of parents and students who are too fixated on having a doctor in the family (on this point I share Hafiz mz's sentiments totally) but having no place to do so locally - hence giving "unlimited" choices to them through the cavalier practice of giving recognition. As in every aspect of our Malaysian life, short-term solutions are de rigueur.

(3) Having now at our doorsteps doctors with what are literally third-world mentalities (being graduates from universities in the Third World, for those who do not see the linkage :P),we are in a state of panick, knowing that if nothing is done about this, these doctors, and not the Nipah virus, will be the biggest epidemic to hit us.

(4) It is also probable that the government might have even found out that, although those universities in question are questionable (otherwise they would not be in question, would they?), the students entering them actually had brains and are posing serious threats to the sheer survival of local graduates who are less than qualified, by the normal STPM standards, to study medicine in the first place. Hence an artificial, meaningless and contradictory exam to "evaluate" those already-recognised degrees and serving as a second barrier to competition to assist local graduates who had not had the pleasure of a competitive enrolment system.

I believe what Dr Chua proposed to do is correct in the circumstances, in keeping in line with our habit to churn out short-term "solutions", but I cannot see how it will lead to long-term good unless he also addressed the hard and fundamental twin issues of local meritocracy and foreign degree re-evaluation.

Anonymous said...

BTW, Charis, the proper construction is "you cannot eat your cake and have it". For reasons unknown, the inaccurate construction has become the norm.

Think of it; if I am at this moment having a cake in hand, I can then eat it, can I not? But if, after eating my cake, I could not possibly have it any more, could I?

Anonymous said...

If the government wants to have a qualifying exam, why not apply it to all graduates irrespective of their university of origin like the USMLE? The issue here lies not in the incompetency of overseas medical school graduates, but the inconsistencies in recognition of overseas medical schools. The CSMU debacle is a very good example of the arbitrary decision making of the Malaysian Medical Council/Kementerian Kesihatan. Third World medical school recognitions are not a panacea to our chronic doctor shortages, they need to work out how to retain doctors in public service.

Also, the government needs to take a very good look at their own medical schools' intake before jumping on their high horse, labelling non-Malaysian grads incompetent.

keropok lekor said...

I think that having unified exam is a good move considering that medical education is somehow globalised with more countries opening up their medical faculties (For example, some Chinese universities start to offer medical degrees in English). Medical students take full-time study and their electives all around the world, some to even to Africa and non-English speaking countries. Its unfair/naive to discriminate them on the basis that they are from the Third World.

Besides its more cheaper/easier/practical to judge the competence of the graduates rather than the institutions involved. Plus, we can save the energy from politicking on which country/institution to recognise or which not to. Many countries, including Australia (correct me if I wrong) do have unified exams.

On the usage of Singapore's list of recognised degrees, I agree with Charis that it maybe arbitrary. Different countries have different healthcare system context, and certainly Malaysia would have its own issues and needs to deal with.

To sum up, recognition does NOT NECCESSARILY mean quality. It has a political/strategic/diplomatic side to it.

My 2 cents

Anonymous said...

I wonder whether there will be a day that there will be unemployed doctors?

Anonymous said...

Actually, there are unemployed Malaysian doctors who have received their medical education from non-recognised medical institutions.

Anonymous said...

I laud the Minister of Health's idea to have a 'unified' examination for all medical graduates who wish to practise in the country. I think this is a step forward and it will ensure that all medical graduates who return to practise in the country of of similar standard. I think no medical graduate who returns from abroad, be it the USA, Britain, Australia or other places should be exempt from this exam. All other developed nations in the world have similar exams in place. For example, a graduate of the UK would only be allowed to practise temporarily in either the USA or Australia. To practise full time, he/she would have to pass qualifying exams from the sountry they intend to practise in. What I think would be an even better idea, is to make this unifying exam a single examination that all graduates should sit for, wether they graduated from local or foreign universities. The only problem I have with this suggestion, is the same grouse I have with all suggestions involving the health system, the total and utter lack of transparency! This exam has to be monitored by qualified people who are of good standing in the local medical community and should be fair and qualitative in asessing medical graduates. As always, I feel this will be the biggest stumbling block. Once again, the ideas are there but the implementation is to be seen, and in previous cases, have left a lot to be desired.

Anonymous said...

I agree that both local and foreign medical graduate should sit for the same unified exam for licensing. That will at least ensure that our medical doctor has reached certain standard and not merely based on a degree they received from different universities with varied quality.

keropok lekor said...

And another issue to think about the unified exam is whether there is quota on how many overseas graduates that can come back to work (in the future), in case of overload of medical graduates?

Besides, I would suggest that the local exams will include Malaysian cross-cultural awareness and competence in our multicultural society, to let fresh graduates to be aware and equip themselves for the social realities and practice more efficiently in our Malaysian context.

Amir Dina said...

This is the list of colleges recognised by MMA

Need not borrow from neighboring country.

Anonymous said...

To a certain degree, it's necessary. Take the case in Australia where an under-qualified Indian doctor has cause severe impact on the life of his patients.

However, MMA has its list and are more qualified.

Given a medical practitioner of same calibre from US, UK, Australia, Singapore and Malaysia. Who would you trust to operate. I'll definitely choose the first four.

Anonymous said...

Yes, I would think transparency would be the main issue for a local unifying exam. Why not make all medical graduates locan and overseas sit for the UK's PLAB or the US USMLE? In that case, there won't be any cheating or favoritism. But I doubt it'll be implemented as UMNO Youth might start to rant about "level playing field" and meritocracy.

Anonymous said...

Anon, thanks for the idiom correction...that does make sense. As I have been saying in French class this quarter, 'I'm sorry I don't speak English very's only my mother tongue.' :-P

Anonymous said...

do away with this recognized universities stuff, make everyone local and foreign sit for a tough qualifying exam and have a practical to go along with it. candidates must pass both if they want to practise. and let all prospective doctor wannabes know the exam is really tuff
so that we dont have wannabes rushing in to become doctors.

Anonymous said...

Lol. You do that. I've qualified in the UK, at no cost to the government. I'm now halfway through a Specialist Registrar programme, have worked / studied / passed several postgraduate exams along the way.

And now I need to sit a tough qualifying exam with a practical that goes along with it ?. Sorry, but I did that when I became a member of the Royal College of Surgeons (UK).

I would certainly think twice now before coming back to Malaysia to take a job that pays a fifth of what I currently earn, and all the nonsense and hoops I need to jump through.

Maybe if the government paid me the cost of my training to get me to the stage I am now, I might consider it.

The reality is....people aren't rushing to practice in Malaysia, so making it easier, rather than harder is a better way to go.

Anonymous said...

I agree totally with the comments posted by anonymous on 7/16/2007 09:52:00 PM.
I think that if the unifying exams are implemented, it would actually be an impediment for doctors from well recognised institutions from coming back to Malaysia. The oft said qualifying exams (in various incarnations) in UK, US and Australia work because the pay and career opportunities there are very good, hence attracting doctors from all over the world. If I'm Malaysian, have multiple postgrad qualifications from reknowned institutions, and am working in US, UK, Australia or Singapore, why would I subject myself to an entry level exam just to earn a fraction of what I'm used to? This policy will more likely attract graduates from 3rd world countries rather that those who have made it to premier institutions overseas. Wouln't it be better to just restrict the number of recognised schools? But then again, the authorities probably feel that Malaysian graduates from premier institutions would not be interested in returning anyway.