QUALIFYING EXAMS FOR NEW DOCS
by AZK

“You don’t have to blow out anybody else’s candles…
to make yours shine brighter…”

I read with interest the Health Minister’s proposal to have common qualifying examinations for all foreign-qualified doctors. The Health Minister appears to have discovered that all these frequent visits to assess and continually evaluate new medical schools are a costly affair.

In fact, in the age of the internet, it is nothing more then a scam by our free-loading MMC council members to claim allowances and fly business class to various, sometimes exotic destinations just to see if these schools produce bona-fide doctors, all courtesy of the tax-payer when much of the information can be gathered via the net.

More importantly though, now that Chua has proposed a qualifying examination in line possibly similar to Britain’s PLAB (Professional and Linguistic Assessments Board) or the USA’s USMLE (United States Medical Licensing Examination) it boggles the mind if our lot of council members are really up to it in conducting examinations of this complexity.

Needless to say the current Unscheduled Universities Examination under Section 12(1) (aa), Medical Act 1971 is so hopelessly biased especially in the clinical sections, that, like the legal profession’s CLP where there is an incredibly high failure rate, it gives rise to suspicions that the examination is yet another tool to discriminate and meet political agendas to right racial imbalances in the profession.

More alarming is its selective application on foreign graduates but not on local graduates who today are mainly responsible for our notorious healthcare deliver systems.

Chua’s frustration could be real. The Malaysian Medical Council is a discredited body. Among others, it currently consists of a member who graduated after 40 years of age, another who is being sued [deleted], yet another who chairs meetings and doesn’t operate anymore [deleted].

Many are involved in businesses such as housing development, private medical schools, nursing schools, etc therefore bringing to the body a conflict of interest that will eventually skew any decision they try to make.

A significant number of these members are downright academically uninclined including deans with dubious qualifications.

All of them are led by a chairman, the current DG, who is now noted more for leading a health service comprising of crumbling hospitals, ambulances without petrol and a skyrocketing incidence of HIV, dengue, heart disease, diabetes and hypentension.

The MMC in its current form and especially after the CSMU affair cannot be relied upon to effect the changes needed to maintain and elevate the quality of health-care in this country. Despite its “independence”, it has not only demonstrated its lack of political impartiality but may have also outlived its usefulness.

Like many other institutions in this country, it is hopelessly corrupted in its methods. In the local context, recognition of universities may be best left to a select committee in the Education Ministry which has shown more professionalism.

There may be a more cost-effective way in ascertaining if the new apprentice can indeed stand on his own feet. It is the time-tested system of continuous appraisal.

The medical profession is after all an apprenticeship and many new graduates look-up to mentors which unfortunately in today’s service are known more for their bullying ways as a result of their own insecurity rather then lending a helping hand in teaching.

Every new medical graduate needs to undergo housemanship. But this period can easily be extended to 3 to 5 years if the candidate irrespective of which medical school he or she graduates from is found to be lacking in certain areas. Anyone can be taught, but sometimes, some require a longer period.

To exclude doctors and label them as “unscheduled” in a country that lacks doctors and using the term “standards” as a shield to keep the club intact is a failure of the mentor system which for centuries the medical fraternity thrived on. Continuous appraisal by the various consultants at work is the way forward.

However, for the system to work, mentors (read specialists) need to be of respectable caliber and this is where unfortunately the country is lacking.

Ever since Malaysia came up with its local specialist programs due to a variety of reasons especially economic, we have had specialists who can’t even string a proper sentence in English.

Worse still there have been reports of cheating in examinations especially in specialties that are not conducted conjointly. Examiners both local and foreign have noted in horror how some candidates appearing for these specialist examinations appear to know what examination questions are going to appear or which clinical case is coming up.

To borrow Mahathir’s phrase, if we are going to churn out half-past six specialists, then we will have half-past six mentors in which case an appraisal system which formed the hallmark in the advancement of medicine since time immemorial cannot be applied to the Malaysian scene.

It is here that the system has failed us. We should be able to take in any graduate from any university and still turn him into a good doctor if we had the proper mentors/specialists, obviating the need for any qualifying examination. The fault does not lie in all those medical schools scattered in this country and around the far corners of this world. The fault lies here in Malaysia where we just don’t have enough of those quality specialists anymore.

Medical teaching is a hopelessly neglected profession in this country and its ill effects may come to roost our healthcare system sooner rather then later.

In this day and age, General Hospitals should have been turned over to medical schools so that teaching and services are upgraded.

But the unending politically tiresome adversarial battles between the Health and Education ministry has contributed to the attrition of medical standards and detriment patient care.

Medicine entails lifelong learning. It does not matter when you start, but never forget that the learning can never stop.