Common licensing exam for medical grads 

By Tengku Azian Shahriman 

5/5/14

MEDICINE: Time to implement plan to streamline quality of doctors through a professional certification exam.

IN January this year, Health Minister Datuk Seri Dr S. Subramaniam was reported in the media as saying that his Ministry was in talks with the Education Ministry to tighten the admission requirements into medical schools in the country.

An online news portal reported that the Minister also said, "We are not going to allow (the opening of) new medical schools, neither are we going to allow them to increase the intake in any of the existing schools."

We warmly welcome the Minister's statements. For decades now, medical practitioners have raised concerns about an oversupply of poorly trained medical graduates in the country. There are also many anecdotal stories, ranging from funny to horrifying, which seemed to support the fraternity's alarm.

As such, we firmly advocate that the Health and Education Ministries work swiftly to address the matter which has snowballed into a national healthcare issue.

There are various reasons which led us into this quagmire. Firstly, there are too many medical colleges. At the last count, there were 33 public and private medical schools offering 49 programmes in Malaysia. On top of this, we recognised 378 institutions in over 35 countries.

Secondly, while the government acknowledged that the growing number of medical programmes was a problem and imposed a five year moratorium in 2005, and then again, in 2010 - the number of graduates continued to burgeon. As such, if there is to be another round of moratorium, it must be strictly implemented.

Thirdly, the existence of many medical colleges have led to an exponential growth in the number of medical graduates. If Malaysian Medical Council (MMC) member, Dr Milton Lum's predictions are right, the country would be looking at 5,000 to 6,000 graduates in 2015-2016, a marked increase from 3,100 in 2011 and less than 1,000 in 2001. This number is expected to rise, and rise.

The medical fraternity have also cited several reasons for the glut. Amongst others, these included slack admission criteria for some of the local and international medical colleges, commercialization of medical education, as well as the lack of qualified medical educators in these institutions.

Dr Lum said that even as far back as 2007, consultants in teaching hospitals such as University Hospital, Hospital UKM, Hospital USM have raised the alarm about the patchy quality of housemen. This saw MMC extending the tenure of the housemanship from one to two years in 2008.

The oversupply of medical graduates have also resulted in another problem; the quality of housemanship training, a critical component in their professional career.

According to Dr Lum, consultants in the hospitals reported that they are not able to keep track of their housemen. He shared that many consultants have told him that they do not know who their housemen are, and they do not even know if the housemen turn up for work or not.

A news article in 2010 reported that the oversupply has resulted in overcrowding of housemen at some of the country's training hospitals. Senior Hospital Kuala Lumpur (HKL) consultant physician and now Deputy Director General of Health, Datuk Dr S. Jeyaindran was then quoted as saying in some hospitals, there are more housemen than patients.

In addition, senior doctors and specialists are required to provide quality training during the housemanship. Housemen who find themselves in hospitals which are not well staffed by senior consultants are most likely to receive "second-class" training during this important part of their career development as care providers.

On top of this, there is another issue that has not been raised in this debate. The issue of cost.

According to Dr Lum, "There is cost to individuals and society - cost to the patients and cost to the hospitals to treat complications due to poor care. When you have poor quality care, the cost to the health system is tremendous. If you have good quality doctors and care, the cost would be much less."

It is, therefore, heartening to hear the Health Minister's statements. Perhaps it is also timely to reconsider MMC's proposal to streamline the quality of doctors through a Malaysian professional certification exam, which complements the Health Ministry's initiatives.

The MMC proposed a common licensing exam (CLE) in 1995 and again in 2011 - but the Council have not received the necessary approval from the authorities.

Dr Lum said CLE makes sense to deal with the key issues Malaysia is grappling with; differences in the quality of graduates with some of them ill equipped to practise due to poor training and lack of skills, and the difficulty MMC has in ensuring that the 378 institutions recognised are still providing adequate medical programmes suitable for Malaysia's need.

He pointed out, "The biggest problem in Malaysia is there is too much talk about quantity and too little about quality. (But) it's not just the numbers, it's the quality of the graduates, doctors, and the quality of training and supervision that patients' lives are dependent on.

"Medicine is not a management course. In medicine, you get your basic training at a medical school, but you need to learn and develop your skills as you go along, and then, there's further training and experiential learning. Medicine is a life-long learning course".

In view of this, PEMANDU commends the Minister of Health's effort to raise the bar on entry into medical schools. This is a step in the right direction as medicine is one area that we do not want to compromise on quality as lives can hang in the balance if the quality of care is compromised.

Let us all work together to ensure quality healthcare for all.

Tengku Azian Shahriman is the Director of PEMANDU'S Human Capital Development, Strategic Reform Initiative