Medical Education and Houseman Training

Houseman training is the most crucial part of the medical training. However, this is often poorly structured and it is very dependent on their immediate senior MOs, registrars and consultants and finally, the houseman’s own initiatives and commitment.

The standard of medical education has dropped dramatically over the last 20 years and this is due to host of reasons. Parental pressure for their children to do medicine is always there. Just a week ago, I received a call from an educated parents who was very insistent on his son doing medical course, either in India or even in Russia as long as he is a medical doctor. The reason is that medical profession is a money churning profession. I told him frankly this might be the case 30 years ago but not now anymore. If his son has no interest or passion to look after the sick, he would soon be sick of the profession and he will be a failure as a medical doctor. He was equally shocked to hear that in the Malaysia context on the average, about 5% of the houseman is not signed up because of poor competence and total lack of interest and commitment. Some just opted out to pursue other  job that they have interest, ranging from being a chef to medical sales representatives. I just hope that parents should have more confidence in their children to allow them to choose their own profession.

Over the years, MMC have recognized more than 300 over medical degrees all over the world. I did call for a review of all the degrees recognized by the MMC so that the list of recognition could be updated. Some of the universities have obviously passed their prime of life, for example the university of Iraq is also recognized for medical training. I generally support that there should be a total review of medical degree from Indonesia, Middle-East countries, Russia and  Ukranian countries.

Medical training requires you to take patience’s history and sending our students to foreign countries when English is hardly spoken, for example in Prague and Russia, Malaysia students have to struggle like hell to learn the language and then communicate with the patients. Back home, they have to translate these into Bahasa and English and local dialect and this is not going to be easy. Often, the student becomes an incompetent houseman. A lot of these houseman are often clueless about the pattern of medical diseases in a tropical country like Malaysia. A lot do not even know how to take proper medical history. Even a simple medical examination of a pregnant woman is beyond some of these young interns.

I used to hear how incompetent the housemen could be from senior doctors. When I was a minister, I decided to pay a surprise visit to the General Hospital KL. I had the opportunity to directly question 3 different housemen about 3 different patients under their care. Initially, I was hesitant since I had not practice actively since 1990. I left the ward convinced they were not up to mark. They just do not know how to manage a patient under their care from history taking, physical examination and further examination. They were too dependent on their senior doctors. What I asked was very basic question since I myself cannot claim to be updated about medical knowledge. I was shocked after my interaction with the 3 housemen.

Subsequently, I had the opportunity to talk to first year MOs that is one year after their internship in Sabah and Penang. That’s when I started further discussion with senior doctors and DG who is also the chairman of MMC that the time has come for the housemanship to be extended to 2 years. The 2^nd year of the housemanship, they will be paid as MOs and also regarded as part of the compulsory service so that they would not lose out in their seniority. Hopefully, with the one additional year of supervision, they become more competent doctors. Of course a lot of parents and housemen were highly critical of my decision then.

There’s a need for more hospitals to be gazetted as training centre for houseman. This may not be easy since the hospitals selected for houseman training must have adequate basic specialty services, adequate mixture of cases, and enough specialists to ensure proper supervision. Otherwise, we will be training incompetent doctors. Private hospitals would be most unwilling to be used as training for houseman. As part of the training, houseman needs to undertake procedure and this often become not practical in paying patients in private hospitals. They are also legal complications when houseman under government service undergoes training in private hospitals.

The MMC need to totally review and update:

1)   The list of medical universities recognized currently. It should be brave enough to recommend to the Minister of Health to deregister some of these as I did to the Crimea Medical University.

2)   The program training for housemen should be more structured with adequate supervision.

3)   Signing up housemen at the end of their two years should not be “fait acompli” so that housemen become more committed in undergoing 2 years of vigorous training.

I have to admit that the housemanship training everywhere in the world is the most frustrating, the most difficult period of training before one is allowed to practice as a doctor independently.

Parents should not have the impression and the public should not perpetuate erroneous impression that the medical profession is a highly lucrative profession. A frustrated doctor is a danger to his patient and the society. I have the unfortunate experience in meeting some of them and I can only sympathize with the patients under their care.