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Wednesday, April 16, 2008

FAQ By Malaysian Medical Students From Foreign Universities Regarding Emergency Medicine in Malaysia

Over the few months since I have started this blog, I have received few emails from medical students studying in foreign universities asking me about emergency medicine in Malaysia and what are there prospects for them.

So, I think, probably I put up some relevant and common questions I have been asked before in this blog post. Bear in mind, these merely represent my own personal views I have also included a link before for anyone out there interested to find out what the relevant officers of USM has to say regarding applying for master of medicine (emergency medicine) in USM.

I also invite all my fellow emergency physicians all over our country (especially those from the Ministry of Health) to contribute their opinions here. Then we will have a good pool of answers.

Cheers,
Chew

FAQ

1. Is our Malaysian emergency departments only functions as triage area and primary management of patients and not having any inpatients?

Though triaging and acute management of patients' conditions are our main business, most ED have now what we called observation ward. It is something of a "hybrid" between the in patient ward and the out patient setting -- it is the place where we need longer time to observe the patient, awaiting certain investigation results, repeating certain tests, giving short term medications etc etc but we usually keep patient no more than 24 to 48 hours

The patients either will be admitted to definite wards or discharged home. We do not have in-patient wards to keep patients for days.

Besides, most EDs also handle prehospital and ambulances services although this field is also supported by NGOs such as St. John's Ambulance Malaysia, Red Crescent Malaysia as well as JPA (Jabatan Perkhidmtan Awam).

2. Is there any posts for overseas trained EM physicians in USM?

So far, we do not have any overseas trained EM physicians in USM but I am sure we will be most delighted to have one if there is anyone interested. Just write in to the Dean of the Medical School, USM and see what are the options (e.g. visiting professors/lecturers, contract basis lecturers, etc etc). Links to USM website below.

3. Does an EM physician conduct emergency endoscopy?

As far as I am aware, there is no EM physicians in Malaysia who has subspecialized in doing endoscopy, but who knows may be there will be someone interested.

4. Does EM have a bright future in Malaysia?

Emergency medicine is a relatively new field in Malaysia. Look at it positively. Because it is a relatively new field, therefore there are lots and lots of room for expansion. So many ways one can subspecialise. Like one of my lecturers, Assoc Prof Kamaruddin Jaalam, used to say "For emergency medicine in Malaysia, the sky is the limit". Since now we already have already sent astronaut out there, may be the universe is our limit.

But ultimately what do you mean by "bright future". Is it about earning a big fat salary? Or is it regarding the academic and clinical development of emergency medicine in Malaysia?

5. I am currently a medical student in Country XXX, and will be back in [YYY, Malaysia] after my housemanship. I am interested in emergency medicine. Any route for me to continue my education in emergency medicine . other than local universities (due to limited seats and great competition)?

My reply to you is simply this: depending on your university status, you may or may not need to sit for another exit exam in one of the local universities in order to join Malaysian Medical Council to get registered as a doctor.

During these two years, try to get yourself confirmed in service (very important) ASAP - in order to do that, you also need to attend an induction course -- how to go about it? Ask the personnel or clerk in charge in the adminstation office in whichever hospital you are placed in and they will be able to help you.

Once confirmed, you apply to any local universities that offer emergency medicine - at the moment (Universiti Sains Malaysia is the pioneer group; we have had this program for 10 - 11 years now; and now we also have Universiti Kebangsaan Malaysia and Universiti Malaya - these two universities, the first batch of emergency physicians to be produced by them will be in another one to two years time).

But regardless of which universities you are getting yourself into, now that we have conjoined board exam for the entrance and soon, the first ever exit exam too. So every candidate will sit for the same paper.

Any other route besides MMed Program for emergency medicine? Yes, you can also sit for MCEM (UK) exam [Member of the College of Emergency Medicine (UK)]. It used to be the exam MRCS (A&E) [Member of Royal College of Surgery (Accident and Emergency Medicine) (UK)] exam but MRSC (A&E) will be phased out soon - either one or two more batch of exams. The Emergency Medicine in UK will have their own board and their own exam. You can check out their website here: http://www.collemergencymed.ac.uk/CEM/default.asp.

However, none of the emergency physician has yet to have graduated with MCEM. So I am not quite sure how this qualification will work out in our system. But I supposed it is the same with MRCP and the other MRCSs.

There are some courses offered in the UK for preparation of MCEM. You can also check out here: http://mcemteaching.co.uk/links.aspx

The MCEM exam has been brought into Singapore and so you can the sit the exam there. I am also contemplating of sitting for the exam--- something extra - but I need some preparation and to put down some assignments and tasks I am currently doing. Need time lah for preparation.

My personal advice to you is this - I firmly believe it is not true that graduates from foreign universities are not given equal chance to apply for master program. However, the MAIN problem is get yourself registered with MMC. Once you are absorbed into the system, you will be treated as the same way. SO GO AHEAD AND APPLY :)

But the more important question I need to ask you of all is this - is emergency medicine really what you want? I am now in a university - which means I spend more academic activities.

It may be different for you - you may be working in the MOH hospitals. Private hospitals with emergency medicine post? Very minimal at the current moment.

At the end of the day, you must have passion for your job - then you will enjoy it. You won't see it is a burden to carry.

Update 18 Jan 2010

At this moment, there aren't any Emegency physician in Malaysia who have graduated with an MCEM.

So, to be honest with you, no one knows exactly how a graduate with MCEM will work out but I suspect it will be the same as for all other disciplines, like MRCP in internal medicine, and MRCS in surgery, where the gazettement period to be a full specialist after obtaining your external board certificate is 18 months, as compared to 6 months for an MMed holder.

The reason given is that MMed is a structured training programme (not just a exam passing certificate) geared for the working environment in Malaysia. I know that sounds a little bit unfair, and in fact, I have seen people who had passed with external board certification who have better knowledge than a MMed holder, but that is the rule set by MMC at the moment.

I remembered this is what my head of department said: UK board certification will be accepted by MMC as a specialist, but not the American board or Australian board because the syllabus is different.

Click on the banner below to go to the Postgraduate Section of the School of Medical Sciences, USM


9 comments:

Y said...

I would like to know if there is any workshop specially held for medical students? maybe by you or by your fellow emergency physicians? I am sure there are many people out there who are interested in emergency medicine, furthermore A&E has been made a compulsory posting in housemanship now, so i am sure there will be great response. Pls do let us know in your blog if there's such workshop.

pf said...

I am also an aspiring emergency physician. I just finished my housemanship and currently is an anaes MO.I am interested in taking the MCEM but is uncertain whether I'm eligible. My questions are:
1) Do I have to be in emergency dept to qualify to sit for the exam, what does it mean by having 2foundation years as the prerequisite of the exam?
2) Do I have to train in UK after passing the part A, B, C of MCEM or do I automatic become a specialist.
3) How to apply for masters programme in emergency medicine?

cksheng74 said...

Hi pf,
thanks for visiting the site

if you are interested in MCEM, may i suggest you to email Dr. Nick Jenkins at info@mcemoxford.co.uk

he and his team are organizing prep course for MCEM. they are going to bring the course to Singapore, I think.

if you hv any question on MCEM and the prep course, u may email him...

also, regarding MCEM holder being recognized as specialist, i believe, sure as it is....it may be like MRCP, MRCS...they are membership exam, not training program...so the gazettement program is about 18 months..

i suggest you write in to the ministry of health, malaysia and also to the three universities offering emergency medicine as a specialty program --- namely USM, UKM and UM....

i am sure happy to meet you should you be back to do ur specialty program in emergency medicine

cksheng74 said...

one more thing...
just check out this post in Malaysian Medical Resources blog:

http://medicine.com.my/wp/?p=626

regarding MRCP derecognised?

pf said...

I just visited www.nocturnale.com in his Part 3 of Postgraduate training oppo in malaysia.I am actually quite disappointed in finding out that malaysians are not eligible to sit for MCEM. That leaves me no choice but to go through the masters road.The problem I face is I found the lack of proper training in most of the A&E dept in our country(maybe due to lack of specialist?).That is 1 of the reason why I opt to go to anaes dept after my housemanship.Can you share with me what pathways you took that lead you to getting masters and being a specialist after your housemanship?

cksheng74 said...

dear pf,
i don't understand... no reason why malaysian doctors are not eligible to sit for MCEM.
i have been communicating with a tutor of MCEM who is interested in bringing the course to malaysia.
don't just trust any information - either in my blog, or even in nortunale.
go find out from the MCEM website...
contact Dr. Jenkins and ask him...
u can quote my name --- as i have been recently been in communicating with him
i will try to find out for you more once i am more free -- at the moment, i am a bit tied up...very very sorry :(

cksheng74 said...

sorry...dr. jenkins' email is given in my earlier comment above...

again, no reason why u can't sit for the exam.. as long as u are willing to try and to pay

dr.leong said...

Read the farking rules and regulation lah, you people! I visited this link http://www.mcem.org.uk/eligibilityparta

It says very clearly:

The candidate must hold a primary medical qualification that is acceptable to
the United Kingdom General Medical Council for Full or Limited Registration
or to the Medical Council in Ireland for Full or Temporary Registration.

Part A cannot be taken sooner than the second foundation year of training
or its overseas equivalent.

But the problem is: rules always change, maybe sometime in the future we Malaysians can have MCEM exam in malaysia loh.

Anonymous said...

Guys, guys,
these membership exams are merely a qualification that says that u may now start to train as a specialist, thats all. Traditionally the MRCP has been accepted simply becasue they probably needed to increase the number of specialist in medicine urgently and also local postgraduates factories were just starting. And this has continued fortunately till now. Similarly for the FRCS for the surgeons. Now the FRCS is no longer available. They introduced a surgical membership exam called the MRCS which most surgical trainees in Malaysia have done. But unlike the MRCP it is not recognized for specialist training. I think the only good thing about it is u maybe able to get temporary registration as u train or do subspecialities later in the UK. Or if u are lucky enough with the MRCS u can to land a training job in surgery in UK. Similarly for the most talked by ED aspirants in malaysia...the MCEM.
The MCEM is a a membership exam. I dont think it will be recognized for training as an EP in Malaysia just like how they didnt for the MRCS. MCEM is money making just like MRCS and MRCP. U can do it by all means but it really carries no weight if it is not followed by the FCEM. Now that is what u wanna get, THE FCEM. In order to get that u need the MCEM and undergo a EP training programme in the UK. Now before the UK opened its doors to the EU, they were opportunities, but today it is extremely difficult. So how useful is it in Malaysia, personally I think its just for your personal satisfaction. Like the MRCS, if u do subspecialist u may get temp registration and even then remember your subspecialist(if u from malaysia) is merely an attachment so u dont get a subspecialist certificate or diploma, its just says u did some work in the field. Furthermore u have to wait as the queue for subspecialising in Malaysia is endless.
The MRCS has been around for about 8 years and it still hasnt gotten recognition and there is no blue print to get it recognised. I doubt seriously the MCEM will. And I really doubt the powers that walk the corridor in the Emergency Services will allow it either.
As for the private sector, our Health Service structure does not favour Eps in the private sector otherwise many would have gone out already. An EP in the private sector at this moment will be quite frustrated because all his MOs will be doctors who are uninterested in ED and foreigners! Most of them are there because it pays more than the government service. why do u have to suffer the same workload maybe even more and get paid less. Figures right. There are no trainees either. The private Emergency Depts are not really seen as a money generating dept and in the private sector, as u all know money in numero uno.
I agree Emergency doctors are a different lot esp. in Malaysia because u must really have the passion for as it does not pay well. U must remember money is not everything but at the same time u will have a family, kids, bills, loans, insurance and kids education etc. The surgeon and physicians know that they suffer for a while in Government service but they can leave and make a bit more money and retire happily. In ED, it is a bit more difficult because of the way the Health System is run.

AT AUS

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