By Dr Cheah Tien Eang MD
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There are currently 33 medical schools in Malaysia. The latest check with the Malaysian Medical Council website only lists 18 medical schools as registered and recognised as of February 2011. The rest are probably in the process of applying.
We have one medical school per 900,000 people. Compared to developed nations, United States has one medical school per 2.3 million, Canada has one medical school per 2 million and the United Kingdom has one medical school for every 2.3 million Britons. The medical schools in these countries are highly ranked and well staffed. They attract a myriad of applications from abroad.
Malaysia has outdone these countries. Or have we?
University Malaya, one of the premier medical schools in Malaysia remains lowly ranked. We are not attracting talents to our shores. In fact, the reverse is occurring, a phenomenon we call brain drain. Many talents bypass our country for our more prestigious neighbour down south, who has two well recognised and highly ranked medical schools. Singapore has one medical school for every 2.9 million Singaporeans.
Many medical schools are so poorly staffed that we can count the number of faculty members with our fingers! Teaching hospitals are lacking and some of these schools resort to using smaller hospitals that are themselves struggling with human resource and may not be the best place for teaching medical students.
So what are the problems with our medical schools?
1. Admission criteria – Some of these medical schools do not have stringent admission criteria for entry. The bottom line for these ventures is profit. Turning away unqualified students is like turning away a business opportunity. Many students not only do not have the academic capabilities to handle the stress of studying medicine, but many of them are apathetic. This results in a large number resigning from active clinical duty upon graduation. How did they pass? Well, high failure rates is certainly not a good advertisement for these schools as well. Enough said.
2. Poor lecturer:student ratio – With 33 medical schools and a limited pool of academicians, there will some medical schools that are so poorly staffed leading to a high lecturer to student ratio. Many of these schools do not possess lecturing/teaching talents in every dicipline of medicine. So some vital specialties of medicine may be poorly taught. Ultimately, a medical student is being conferred a degree in medicine, having gaps in their knowledge that has been known to cause frustration to senior doctors in service. Some may even lead to mismanagement of patients endangering lives.
What can we do?
One fact remains, we do not need so many medical schools to increase the number of doctors in our country! This reason has been so blatantly abused in order to convince a gullible government in approving medical school ventures by private entrepreneurs.
1. Consolidation of resources – Instead of increasing the number of medical schools, we need to consolidate the existing ones. The government needs to encourage collaboration between foreign faculties and local ones. There is little point in allowing these foreign schools to set up their own campuses independantly. This will only result in further drain of our talents from local faculties. One good example of this is DUKE-NUS in Singapore which is managed separately from NUS but remains part of the local faculty in Singapore. In Malaysia, we are allowing Johns Hopkins and Newcastle to set up camp in our backyard without any serious collaboration with existing medical schools. So they end up competing with our local faculties, not only for talented students, but also lecturers who will no doubt leave in droves once these schools become established. What the government should have done is to encourage Johns Hopkins to collaborate with, for example, University Malaya, as a private venture similar to the Singapore example. In this way, we can consolidate resources and at the same time, improve the ranking of UM. Student admissions can then be increased to meet the demand.
2. Attracting foreign talents to our shores – Following the above point, once we have established local faculties, we can attract talents to our shores. Giving them tax exemptions or waiving their national service requirements is not going to do the trick as these were not the reasons these individuals bypassed Malaysia as a working destination. In fact, this will only draw ire from existing doctors in service, who have tirelessly served the country but yet do not get these perks. Such frustration leads to further drain from public service.
3. Keeping talents that we have – The government has been so focussed in attracting talents to our shores that they have forgotten how to keep existing talents that we have. The system governing doctors remain plagued by inefficiencies and is not transparent. Many policymakers themselves do not walk the talk. Let me illustrate how a previous Minister of Health lamented that doctors are unwilling to serve rural communities and this has resulted in the government having to force them into these positions. His son, who is a medical doctor, has remained in a major hospital in the city upon graduation and has not budged since. How many doctors in this country, including myself, have had this “luxury”??!
4. A common qualifying examination – One way of ensuring uniformity of quality is to have a common qualifying examination for all regardless of medical schools. Examples are the United States Medical Licensing Examination and the Licentiate of the Medical Council of Canada. Irrespective of medical school, any doctor aspiring to practice medicine in these countries will have to sit and pass this examination. This is one good way of measuring the quality of different medical schools as well and sets up a healthy competition among them.
Damage has been done. However, I feel that the Government can still reverse this trend by rescinding the recognition of medical schools that do not meet a certain stringent criteria. Any school that fails to achieve a certain standard should either be abolished or merged with another existing school. This exercise is pretty much similar to consolidation of banks. This is one way of making sure that our medical schools are well respected and are not made as a laughing stock to others.