Monday, November 23, 2009

A Historical Perspective and the Challenges in The Way Forward for MMed Programs in Malaysia: Lessons I Learned From a Recent Conference

The 7th National Course on Postgraduate Supervision and Assessment organized by the School of Medical Sciences, Universiti Sains Malaysia, kicked off with the keynote address by Associate Professor Dr. Zarida Hambali (representative from Ministry of Higher Education Malaysia [MOHE]). She is the Director of Academic Division from the MOHE.

She gave an overview of the aspiration that Malaysia hopes to achieve in terms of academic excellence and innovation. In a nutshell, the hope is for Malaysia to be a developed nation with first class mentality (as I shall elucidate later, this is, of course, easier said than done). One of the aims (or as she put it, a 'key result area') of the MOHE is to encourage up to 75% of academic staffs to be principal investigators in R&D.

Nevertheless, in the process of achieving such aspiration, we are reminded that it is not enough for the nation to increase R&D activities, but also to encompass a holistic student development program. This holistic perspective includes developing future leaders and professionals of the nation that have good 'soft skills' acquisition.

The 7 domains of 'soft skills' (known as the Malaysian Soft Skill Score, or My3S) are:

  • Communication skills

  • Critical thinking and Problem solving skills

  • Teamwork skills

  • Moral and Professional ethics

  • Life long (continuous) learning and information management

  • Entrepreneurship skills

  • Leadership skills

She closed her talk with the challenge whether MMed holders (with many of them being busy clinicians) can be one of these key participants with the MOHE and many other stakeholders to increase R&D activities? Then, as she mentioned, there is always the dilemma among MMed holders (particularly, I guess, among the academicians) is: should a MMed holder pursue subspecialty training or PhD?

The second talk by Prof Patrick Tan from Universiti Malaya, was an eye-opener to me! He started off by re-iterating the common national goals and aspiration by all universities, including access to affordable healthcare services, access to affordable higher education, achieving the targeted doctor:patient ratio as well as achievement of academic excellence. He then proceeded to give a historical perspective of the development MMed programs in Malaysia. Among the facts he presented:

The first ever batch of MMed program in Malaysia, was in 1973/74 in Universiti Malaya, in the field of Public health, Pathology and Psychological Medicine

The first batch of MMed program in UKM was in 1981/82, in the field of Orthopedic surgery and General surgery

The first batch of MMed program in USM was in 1988/89 in the field of Internal Medicine

For UNIMAS, the first MMed program started in 2004/05 in Public Health, and for UPM 2009/10, in Pathology, whereas UIAM, also 2009/10, in O&G.

So, in short, the three big boys in MMed program are UM, UKM and USM and the new kids on the block are UNIMAS,UPM and UIAM, offering up to 22 master degrees in various medical fields.

To date, from 1973 until 2009, up to about 4600 candidates had graduated with master of medical degrees from local universities, with another about 300 foreign candidates graduated, making it to a total of close to 5000 graduates.

Nevertheless, the nation has targets to achieve. The current doctor : population ratio is 1:1,145 (or translated to about 0.88 doctor per 1000 population) and the targeted doctor: population ratio in 2020 is 1: 600 or about 1.67 doctors per 1000 population. In Greece, the current ratio is 4.9 doctors per 1000 population, in UK, it is 2.4 doctors per 1000 population.

In terms of specialists per 1000 population, it is targeted to be around 0.45 specialist per 1000 population, or about half of the Canadian's ratio in 2006 (which is 0.92 specialist per 1000 population). When calculated, this would mean the need to produce more than 12,000 specialists in various healthcare fields by 2020 (the current Malaysian population is about 28 million people). This would mean to produce another 7000 specialists in the next 10 years (from 2010 to 2020), whereas the historical background has shown that the number of specialists produced from 1973 - 2009 are 5000!

Therefore, driven by these national's goals and aspirations (of producing quality, affordable healthcare to meet the increasing population demand), there has always been this tussle between the "quantity" and the "quality" of the medical specialists to be graduated locally.

Furthermore, certain medical specialties are more popular than the others. He cited the example of the imbalance between anesthesia versus surgery, where the ratio, according to him, is about 6:1. This would further mean, that, because of the need to fulfill national's target, there would be some degree of curtailment of individual freedom to choose the course they want, as well as the limited number of scholarships to be given by JPA.

Compounding this drive to fulfill national's aspiration is the astounding grassroot statistics shown by the following speaker, Dr. Zainal Ariffin bin Azizi, the Consultant surgeon from HKL (representing the voice of the Ministry of Health, MOH Malaysia). For example, out of the over 400 scholarships by the Malaysian government through JPA offered in 2004/05, only 55% finished the program within the stipulated time (of 4 years), with another 11% required some extension, and about 26% eventually kicked out of the program, etc, etc. The figures shown by the year before and after give around the same sort of figure (about 50 - 60% completed on time, 10 - 20% required extension, about another 20% eventually out without completing the program). I tend to agree with the fourth speaker, Prof Victor Lim (representing the view of the Academy of Medicine Malaysia) that failure rate of 20 - 25% of a structured program of MMed is considered high (although some may debate on this).

My personal sentiment is, before one ever think of embarking on a MMed program, one should think of the various stakeholders, particularly the tax payers, as ultimately the money to produce a specialist (which can be considerable, although the actual breakdown of the cost to produce a specialist in each discipline was not brought up in that conference) comes from the pockets of the tax payers.

It is always easy to start on something, to finish off what one has started is the real challenge. There must be some amount of sacrifices, including personal and family sacrifices, e.g., temporary separation from home, temporary separation from family, etc, etc.

In summary, we have national aspirations and goals to be achieved on one hand, yet, there is always the struggle to balance between the quality and quantity of medical specialists to be graduated; and not forgetting, the need to acquire a good grasp of the 7 soft skills, as are what make a medical professional a professional.

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