KEYNOTE ADDRESS

BY YANG BERBAHAGIA PROF. DR. ZARIDA BINTI HAMBALI ON BEHALF OF SECRETARY GENERAL, MINISTRY OF HIGHER EDUCATION

AT THE NATIONAL CONFERENCE ON REDEFINING & REFORMING MEDICAL EDUCATION

21 JULY, 2011, 9.00 am

PUTRA WORLD TRADE CENTRE, KUALA LUMPUR

 

 

YANG BERHORMAT DATUK ROSNAH BINTI ABD. RASHID SHIRLIN

DEPUTY MINISTER

MINISTRY OF HEALTH MALAYSIA

 

YANG BERBAHAGIA  IR PROF. DR. MOHAMED AMIN ALIAS

CONFERENCE DIRECTOR

WORLDWIDE CORPORATE RESOURCES

 

DISTINGUISHED PRESENTERS

AND FRIENDLY MEDIAS

 

Ladies and Gentlemen,

 

A very Good Morning & Salam Satu Malaysia,

 

 

First and foremost I would like to welcome all guests, speakers and participants to the National Conference on  REDEFINING & REFORMING MEDICAL EDUCATION : A CALL FOR SAFER, BETTER AND MORE ACCOUNTABLE HEALTHCAREâ??.   We are gathered here today to ponder and discuss on   the issues and challenges. We are indeed blessed to be able to convene here today,   together with such distinguished and learned persons, stakeholders, policy makers, administrators, concerned individuals and those who are directly or indirectly involved in the healthcare domain. The topic that I will be addressing is on the : â??GOVERNMENT STRATEGIES AND CHALLENGES FOR CREATING GRASS ROOT REFORM IN SYSTEMS, REGULATIONS AND POLICIES TO FIX, REFORM AND RE-BUILD A SUSTAINABLE WORLD CLASS MEDICAL EDUCATION SYSTEMâ??.    

 

It is clearly known amongst us all that our nationâ??s shared Vision 2020 is amongst others, to be developed nation by 2020 with the ration of one doctor to 400 population (1:400) and a â??Knowledge-based Economyâ??. Thus, Knowledge plays an integral part as the core foundation to drive our nation to greater heights. But the National Vision will only remain a vision if we do not strive and make a concerted effort to make it a reality. And in nurturing knowledge, it entails its early initiation that involves the continuum range from the early childhood years, right up to tertiary level, professional training and retraining, and the life-long learning phase. Thus, it is indisputable that the education system plays and eminent and crucial role in shaping the vibrancy and robustness of a nation. We are aware that the prevalent education ecosystem is rapidly changing, and its management decisions needs to be made with best practices as role models; and hence pragmatic and intelligent deliberations are paramount to the success of the countryâ??s overall education system and environment .

 

Today, I stand before you as a representative for Malaysiaâ??s Ministry of Higher Education. Yet, we at our Ministerial level, have always open our doors to welcome suggestions and ideas. We scour the world scenario, and transverse time and distances to study and analyse Global â??Best Practicesâ?? and to adapt and adopt them to suit our needs and environment, and in view of todayâ??s discussionsâ?¦.for a better, safer and accountable healthcare provision and environment.

 

Ladies and Gentlemen,

 

As of January 2011, there are 33 HEIs offering medical program. 17 have been accredited (8 public and 9 private HEIs). In order to streamline our course of actions, we have frameworks set in place, with various Education acts to buttress the Education structure; ever conscious of maintaining and sustaining a solid foundation as a legacy for generations to come. Quality is of the upmost important consideration, with the peopleâ??s best interest at heart. Currently, Malaysia possesses a hosts of Education Acts, comprising of: the Education Act of 1995, the 1995 Amendments to the University and University Colleges Act of 1971 (1995 Amendments to the UUCA 1971), the Private Higher Education Institutions Act of 1996 (PHEIA 1996), and the National Council on Higher Education Act of 1996 (NCHEA 1996), in addition with the implementation of the Private Higher Education Institutions Act of 1996. Besides these Acts, we have also formed the â??Majlis Professor Negaraâ??- the National Professors Council (NPC) acting as advisors to advise and assist us in strengthening the nationâ??s education system.

 

With the mushrooming of medical schools in Malaysia, concerns have even been raised pertaining to the standards of medical education itself. There are â??too many doctors in the houseâ??. In 5 years, there has been a 200% increase in graduate-doctor output. More than 4000 fresh doctors are licensed annually. Some questions and concerns that arose are: Are these newbie doctors established with the adequate clinical abilities and problem-solving skills needed? Are they fit enough to practice with the quality and credibility required? Are they psychologically wired? Are they passionate and committed in their profession?

 

To add to the present predicament..there are concerns that mediocre students are becoming doctors There are indications that there are no uniform consensus of absolute standard in the admission process from less-established, profit orientated foreign medical Universities. There are practices of huge capitation fees, the employment of agents, donations, the implementation of shorter/easier foundation programs â?? and the enabling of weak and mediocre students for admission. There have been numerous complaints and these cases are acknowledged.

 

Recent years have seen an excessive/overcrowding of housemen; with too few training hospitals. As the result of this, the housemen are getting insufficient clinical experience. The congested internship causes inadequate procedural and patient-compliance exposures. Their skills, attitudes, behavior and knowledge are questionable. Specialist doctors are overburdened with supervising 4 times more housemen. In 2008; there were 2,297 housemen, and in 2010 this figure has risen to 6,500 housemen. To make matters worse, in some hospitals there are more housemen than patients.

 

For that MORATORIUM of new Medical Program (new medical schools) has been endorsed by Cabinet and this moratorium is effective from 1^st May 2011 â?? 30^th April 2011. With the moratorium in place other strategic measures commence.  These include the followings :

1.    All HEIs must comply to the accreditation requirement through periodical monitoring visit.

2.    Review on policies, regulations and criterias for  any HEI to offer medical program.

3.    Common entry academic qualifications for all HEIs;

4.    Reducing the no of scholarship for medical schools abroad;

5.    No Objection Certificate (NOC) for self-sponsored candidates applying medical schools abroad;

6.    Cooperation between public and private medical schools locally;

7.     Council of Examiners (MCE)?

 

Curriculum and content are indeed important aspects in any education set upâ?¦Apart from that, another important element in the matrix is the students. The Ministry of Higher Education has noted that it is highly critical and necessary that the entry requirements and benchmarked standards should be setâ?¦ for the selection of students in all public and private medical colleges. Even more so in private colleges as to ensure that these colleges are not driven solely on their commercial interests. It should be the call for all medical colleges to be above and beyond that, to produce quality doctors and healthcare personnel. 

 

In view of these identified challenges, the government and its agencies, stakeholders, private entities and the public should execute a comprehensive and integrated effort with a viable      short-term and long-term plan. Among the strategies that should be in place is the reform in our medical schools and nursing colleges, which should be closely monitored. There should be the incorporation of research findings into medical practice.  The Medical pedagogical approaches are  being reviewed and monitored periodically . In addition, as mentioned earlier, there is need to make adjustments and adaptation of Western models to match local context. The Problem-Based-Learning (PBL) approach should be incorporated in the teaching-learning experience. This should lead to a vast improvement in the studentsâ?? problem-finding and problem-solving skills. It is imperative that the medical students should no longer be passive learners but they should shift their learning mode to that of a self-directed, problem-based mode.

 

There should a balanced education systemâ?¦.meaning that the general public should also be educated on health issue matters, to be better-informed patients or family member or care givers, thus ensuring a more comprehensible intelligent interactions with doctors and nurses. In studying the Malaysian Medical Schools and Healthcare matrix, certain unique contextual patterns emerged. It is realized that in order for local needs to be fulfilled, the provision of community-based health care service should be set up where necessary. This is due to the multiethnic, multicultural and multilingual society. Thus, it is noted that specific healthcare services are tailored to meet the needs of certain communities. An example of such a system that is being practiced is that of the School of Medicine, at the Universiti Malaysia Sabah. It has an integrated basic medicine and clinical skills curriculum, and tailored to best-fit the local needs of the people of Sabah. In addition, the Medical School of Universiti Malaysia of Sarawak has also taken up the community-based curriculum, with the value added adoption of the PBL approach to meet the heath care needs of the people of Sarawak.. The two mentioned universities are both sensitive to the ethno beliefs and cultural practices of the ethnic groups of the people of Sabah and Sarawak, to provide the best healthcare services

 

Recent global research findings on Medical Education reforms have suggested that many regions are adapting and localizing Western models to suit their needs and socio-cultural environment. Some of the challenges faced are resource constraints, and the need to upgrade the local curricula to meet the global benchmarked standards. In his paper on â??The Reform of Medical Educationâ??, Professor Victor Lim identified several challenges faced by medical education today. Amongst them are the inflexible medical training that are traditional and not sufficiently student-centred, the emphasis on memorization and rote learning with insufficient clinical experience gathering which were done in haste, with the lack of understanding and holistic view of patient experience and a poor grasp of the civic and advocacy roles of physicians, medical practitioners and healthcare service providers.

 

Challenges in implementing the strategies are :

1.    Small number of trained and experienced staffs for the Enforcement division to run the monitoring tasks and further take action;

2.    Getting input/complaint/comment/support and cooperation from stakeholders with â??bad medical schoolsâ??;

3.    Irresponsible AGENTS doing for BUSSINESS only;

4.    Withdrawal of accreditation to these non-performers;

5.    â??no room for appeal for HEIs which fail to comply to the accreditation regulations.

 

Ladies and Gentlemen,

 

In considering teaching approaches, Medical School, Nursing Schools and Health Care training centres should seriously take into account the various learning styles of their students. They should design their teaching program to match their studentsâ?? personalities and preferences. Various methodology and pedagogical approaches must be considered with the integration of disciplines, such as the behavioural sciences, the liberal studies, philosophy and other relevant courses to produce holistic doctors, nurses and health care providers. All medical schools should provide a wide range of teaching strategies that satisfy the learning needs of students.

With these questions and issues in mind, our medical schools, the Ministry of Higher Education, the Ministry of Health, the relevant regulatory authorities, the professional societies and associations, and other major stakeholders need to convene to discuss and set the direction that the medical education in Malaysia should execute. In discussing the â??Government strategies and challenges for creating grass root reform in systems, regulations and policies to fix, reform and re-build a sustainable world class Medical Education systemâ??â?¦â?¦â?¦â?¦a comprehensive and concerted integrated effort is needed to identify the challenges and gaps, in order to create the reforms. To find the remedy is not as easy as concocting a magical potion. There might be some prescription that can be used as an immediate remedy in the short term periodâ?¦while others may need a longer time frame to bear fruits. In terms of sustainability, any possible reforms should factor in the principles of  cost-effectiveness, alongside the considerations to improve the health status of the population, to improve the responsiveness of health services to the population, and to improve the financial fairness of funding for the health system, with the enabling for the provision of the required quantity of healthcare providers, doctors and nurses without compromising quality.

 

Ladies and Gentlemen,

 

With the unfolding of the various vibrant and exciting strategies and programs in place, ongoing or in the pipeline, I am sure that you will have a genuine meeting of minds and I wish your discussions and deliberations every possible success. THANK YOU.

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