Medical training : More can be done


Recently, the minister of health announced that there will be no new medical schools and existing ones can no longer increase intake. Entry requirements are also being reconsidered, due to the decline in the standards of national examinations. These measures alone are insufficient. Here are 10 further recommendations:-

1. Existing medical schools need to be re evaluated for their teaching and infrastructure standards. As it is, new graduates are still of poor standards, putting lives at risk. Failure in meeting minimum requirements should result in suspension of the schools concerned.

2. Training of housemen remain poor. As they are flooding some hospitals, supervision is minimal and training standards can vary. The honorable Minister has said that the ministry will not compromise on standards. Unfortunately, the protocols downstream is unclear and manpower for training is still lacking in many government hospitals. There need to be strict and clear guidelines as to housemen training and evaluation. There should be no compromise on this. As of now, there is no standardisation between hospitals in terms of housemen evaluation and training.

3. To add to that, many training hospitals for housemen are also doubling as teaching hospitals. Due to a lack of lecturers in most medical schools, the hospital staff consultants are then roped in to teach in return for cash. This will further deplete the resources for housemen training . Medical schools with an inadequate lecturer to student ratio cannot be allowed to operate . Depending on staff doctors to fill this gap is untenable in the long run and compromises on the standard of the school.

4. Postgraduate training must be strengthened in order to allow doctors better avenues in specialising. It is perplexing that the minister said that we are achieving the ratio of one doctor to 600 population. However, there is still severe shortages in many subspecialties in medicine. The government must formulate ways to enable junior doctors better access to post graduate positions in the country . We are still short of specialist doctors!

5. It is time to de-recognise many overseas medical schools, which may be producing graduates that do not meet the needs of our country. We have way too many medical schools on our list.

6. Merge smaller medical schools now. Leaving some medical schools to continue is a danger to the public. Many doctors who graduate remain poorly trained and have a poor grasp of basic principles. Consolidating resources is important to ensure that quality is maintained.

7. Publicise rankings of local medical schools. Many of these ranking systems may highlight the strengths and weaknesses of each medical school. This encourages healthy competition and allows students to choose their medical school appropriately .

8. Have a common entry examination for students aspiring to do medicine. Similar to the North American Medical College Admission test (MCAT). This will allow schools to sieve away students that will likely not make the grade despite excellent academic scores in national examinations. Medicine must support meritocracy . Failure to abide is a recipe for disaster which may affect us more than we think it will.

9. Making medicine a post graduate course may help in ensuring that only serious students are accepted and thus mature enough to decide on a career in medicine. Fresh high school graduates often enter medicine for all the wrong reasons.

10. Utilise the private sector hospitals in training students and new doctors alike. Public hospitals are running at maximum capacity. There needs to be a mechanism where the consultants in private hospitals or clinics can be roped in to teach and that these hospitals/clinics be allowed to take in students and housemen for training purposes. This can be done on a rotational basis. Perhaps this can also enlighten doctors on the scenario in private practice.

There you go. I am sure more can be added to the list. There is much more that can be done if we are all really serious in improving the quality of our medical training and restore it to its past glory.


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4 thoughts on “Medical training : More can be done

  • January 18, 2014 at 8:03 am

    Agree with most of your proposals.
    However I would suggest an qualifying exam, akin to USMLE, would be better than an entry exam. We have standardize national exams (STPM) unlike the US.
    Also I am against training HOs & postgraduates in the private sector. The patient population there is very different, severely limiting exposure.

    • January 18, 2014 at 2:27 pm

      USMLE would be further downstream when money would already have been spent in medical school. Having an entry examination prior to entry will help medical schools accept only the best and most appropriate. USMLE type examinations will be good to maintain standards between medical schools.

      Training in private hospitals should be rotational as mentioned. Like many western medical schools , private practitioners and hospitals are roped into the training of their medical students. Perhaps this can happen for housemen training too in selected disciplines. Depending on public sector alone for housemen training may at this moment result in sub standard training.

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