Malaysia is facing the danger of producing inadequately trained doctors

Malaysia today with a population of 27 millions, we are having 24 medical schools. (see Appendix A). This compares with UK which has a population of 61 millions but only 26 medical schools or Canada with a population of 34 million and 17 medical schools. Our of 24 medical schools, at least 21 medical schools started in the last 10 years.
When fully functional, these medical schools are expected to produce about 4000 doctors a year. There will be hundreds more Malaysian doctors being produced overseas, since many Malaysians are studying medicine in the UK, Australia, New Zealand, India, Indonesia, Russia, Taiwan and  Ukraine.

The sudden mushrooming of medical schools means that there is inevitably a shortage of qualified and   experienced medical teachers. There is also a shortage of hospitals big enough for these medical students to receive proper training and teaching. So much so, even district hospitals are utilized. (Appendix B)

In most advanced countries, the setting up of medical schools requires many years of planning to source for qualified and experienced medical teachers and to build new or source for existing teaching hospitals, which must be big enough and well equipped enough for the placement of these medical students to do training. Because of these factors, the sudden mushrooming of medical schools may result in inadequate teaching of medical students who may not be exposed to the spectrum of diseases and disorders required of them.

Apart from the undergraduate training, the sudden increase in the number of doctors being produced means that we do not have enough houseman positions for all of them.

Even now, with some of the medical schools not yet fully functional, and the number of doctors being produced is much less than the 4,000, the wards in some of the bigger hospitals are filled with so many housemen that, in some wards, there are not enough patients for these housemen to learn management skills. As more and more medical schools become fully functional, this problem will be more and more acute.

As an example,  as of end of April 2010, these are the number  of housemen in Hospital Kuala Lumpur:
 
Unit                                     Number of housemen in the unit
Orthopaedic Department        52
O & G Unit                            50
Medical Department               72
Surgical Department               57
Paediatric Department            62
 
As an illustration, in Orthopaedic Department, there are only 182 beds but there are 52 housemen, giving a ration of one houseman to slightly more than 3 patients. The ideal number would be one house officer to 10 to 15 patients, as is the case in some of the hospitals overseas.

House officers often learn their skills from apprenticeship to senior doctors, but with so many house officers, the senior doctors are simply overwhelmed.

A poorly trained houseman will become a mediocre medical officer, and since now most of the specialists are trained internally, it will be a matter of time before future specialists may not be as well trained as presently.

In view of this situation, PGRM calls upon the government that in our haste to reach the targeted 1:400 doctor: population ratio as in some of the OECD countries (Malaysia has a commendable ratio of 1:1100 as of beginning of 2009), we should not compromise on the quality of the doctors produced.

PGRM strongly urges the government to stop issuing new licenses for medical schools until such time that we are assured of the availability of training facility and necessary infrastructures so that the standard of our medical graduates is not compromise.

PGRM also urge the government to find ways to ensure a high standard of the doctors produced, and seek ways to alleviate the problems of too many house officers being posted in some of our hospitals.

In order to produce good quality medical graduates, PGRM also calls upon the government to ensure that the entry requirements of the students into these medical schools meet the required standards. The sudden increase in the medical schools may result in fierce competition to enroll students and there is a real danger that some of the schools may lower their admission requirement.

Last but not least, PGRM urges the government to spare no effort to ensure continued public confidence in our healthcare system by ensuring the standard of all our health personnel, and not just by building grandiose 5-starred hospitals without considering the aspect of staffing these hospitals with competent and well-trained medical personnel.  

Appendix A

List of medical schools in Malaysia as of May 2010:

Public universities:

  • University of Malaya, Faculty of Medicine
  • Universiti Kebangsaan Malaysia, Faculty of Medicine
  • Universiti Sains Malaysia, School of Medical Sciences
  • Universiti Putra Malaysia, Faculty of Medicine and Health Sciences
  • Universiti Malaysia Sabah, School of Medicine
  • Universiti Malaysia Sarawak, Faculty of Medicine and Health Sciences
  • International Islamic University Malaysia, Kulliyyah of Medicine
  • Universiti Teknologi Mara, Faculty of Medicine
  • Universiti Sains Islam Malaysia, Faculty of Medicine & Health Sciences
  • Universiti Darul Iman, Faculty of Medicine

Private Universities and Colleges

  • UCSI University, Faculty of Medical Sciences — School of Medicine
  • Monash University Malaysia, School of Medicine and Health Sciences
  • International Medical University, Faculty of Medicine
  • AIMST University, Faculty of Medicine and Health Sciences
  • Allianze College Of Medical Sciences, Faculty of Medicine
  • Management and Science University, Faculty of Medicine
  • Cyberjaya University College of Medical Sciences, Faculty of Medicine
  • Royal College of Medicine Perak, School of Medicine
  • Melaka Manipal Medical College, School of Medicine
  • Penang Medical College, School of Medicine
  • MAHSA University College, Faculty of Medicine
  • Newcastle University Medicine Malaysia (NuMED)
  • Taylor’s University College, School of Medicine
  • Utar

Appendix B

List of Hospitals approved for Housemanship training

Bil.    Name of Hospitals

  1. Hospital Kangar
  2. Hospital Alor Star
  3. Hospital Sungai Petani
  4. Hospital Pulau Pinang
  5. Hospital Seberang Jaya
  6. Hospital Taiping
  7. Hospital Ipoh
  8. Hospital Teluk Intan
  9. Hospital Manjung-Lumut
  10. Hospital Kuala Lumpur
  11. Hospital Putrajaya
  12. Hospital Tengku Ampuan Rahimah
  13. Hospital Selayang
  14. Hospital Serdang
  15. Hospital Kajang
  16. Hospital Seremban
  17. Hospital Kuala Pilah
  18. Hospital Melaka
  19. Hospital Muar
  20. Hospital Sultanah Aminah, JB
  21. Hospital Batu Pahat
  22. Hospital Tengku Ampuan Afzan
  23. Hospital Temerloh
  24. Hospital Kuala Terengganu
  25. Hospital Kota Bharu
  26. Hospital Umum Sarawak
  27. Hospital Sibu
  28. Hospital Queen Elizabeth
  29. Hospital Tawau
  30. HUKM
  31. HUSM
  32. PPUM
  33. Hospital Sungai Buloh
  34. Hospital Ampang
  35. Hospital Kulim
  36. Hospital Sultan Ismail
  37. Hospital Miri
  38. Hospital Sandakan

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