M203 Diary

Friday, November 23, 2007

An Extension

This started off as a comment to Daniel's previous post, but after a while, I decided that it was lengthy enough to deserve a proper space on this blog.

I have no problems with a 2 years housemanship program. The current program is 20 months long (comprising of 5 rotations, each lasting 4 months), so this new proposal is merely a 4 months extension and not a full year's. At the same time, I think it is great that the Health Ministry recognises that there is a problem with the standard of young doctors in the country.

“We have observed that in the past few years, about three to five per cent of graduate medical officers do not get full registration because they have weaknesses in knowledge or skills,” he (Datuk Seri Dr Chua Soi Lek) told reporters before chairing his ministry’s post-Cabinet meeting.

Assuming that statement is true, then we indeed have a problem that needs dealing with. Unsupervised doctors roaming the ward seems a little dangerous to me. However, how does the new housemanship program differ from the old one and is it a solution to the problem? And more importantly, what does this imply for young doctors?

Old & new
In the old system, HOs undergo 5 different rotations, each lasting 4 months. In the event that a HO is deemed to require more training in a particular rotation, he/she would be asked to extend that rotation by up to 2 months. The new system is proposing that on top of the 5 rotations, HOs would also spend 4 months in A&E. If the problem at hand is that junior doctors are found to be weak in knowledge or skills (which I assume would be in the 5 disciplines that they have to work in), how will greater exposure in a different field help them? While exposure is a good thing and I believe A&E is an integral part of health care, will this extra rotation make doctors more competent? Just as medicine, surgery, paediatrics, orthopaedics and obstetrics & gynaecology differ greatly from each other, emergency medicine is an entirely different field. Getting trained in A&E does not make one more knowledgeable in medicine or surgery.

At the same time, is the length of housemanship training the root cause of the problem? Has the ministry looked into undergraduate medical education? Are our universities (both local and private) providing good standard of education? How about the quality of training HOs receive on the job? Are they given an opportunity to learn? Do their senior doctors guide them? Or are they merely the scut monkeys of the ward who bear the brunt of anyone's ill temper and who never receive training on the job? Are our junior doctors overworked such that they do not have time for study or are constantly too exhausted to learn anything?

Like I said before, this new system is merely a 4 months extension to what is already in place. What is interesting, however, is that doctors would be able to pursue their specialist courses or Master’s after serving two years' compulsory service compared to the current situation whereby they can only apply to further their studies after three years. I will not go into the prospects of getting into a Masters program because that would mean I will have to veer off topic and talk about meritocracy in local universities and as we all know, meritocracy is a sensitive subject in Malaysia. (Yes, strangely, it can be a sensitive subject. :P)

On a purely financial front, the ministry of health will also be recommending that MOs be put on the U43 grade after the 24 months housemanship and surely, that is a good thing.

At the same time, those of us who plan to complete our housemanship training abroad should be aware of the changes in housemanship training in Malaysia and the rotations we would need to complete is we don't want to end up coming back and having to work an extra 4 months as a HO in a particular field because we had not done that before. However, for some of us, it is unavoidable. I don't know how the internship/housemanship program work in Australia/New Zealand (and will not go into the whole residency thing in US because that is entirely different). In UK, FY1 comprises of 3 rotations in medicine and surgery (meaning you do 2 of 1 and 1 of the other), and FY2 comprises of 3 different rotations, this means, we get 5 different rotations... and I suspect we will have to complete the "outstanding" rotation as a HO on returning before progressing to MO.

In conclusion, there is a need to look at the new housemanship program and dwell deeper into whether it would solve the problem the ministry claims it would, and from a junior doctor's perspective, it isn't all that bad a thing after all.


On a more frivolous note...

Coincidence that Daniel & I should both decide to blog on the same day; the different time zones could explain this actually being able to happen...

Right, not going to attempt physics now. I'm struggling enough with medicine as it is, without trying to philosophise the laws of time.

As the title says, it's a more frivolous note, as befits a 4th-year Southampton student. 4th-year = research year = holiyear.

Get it, holi-year? Like, holiday, holiyear?

See, it's exactly the presence of too much free time, which occurs in the absence of work, which causes the germination of jokes like that. According to my schedule:

November: 5th-6th (2 days): GP placement, 7th-30th: Research.
December: 3rd-14th (2 weeks): Dermatology & GU medicine, 15th-31st: Research.
January: 1st-27th: Research. 28th-31st: Neurology (1 week).

I love how Grace was complaining they only get, what was it, 5 weeks of Neurology in St. George's? We get 5 DAYS, k?

Lesse, where was I? Ah, yes, February. Research the whole month, with 1 day for CPR training. March, nothing until the 31st, for the beginning of my Orthopaedics & Rheumatology. And after that 2-week placement, nothing else until the end-of-term 4th-year conference.

To sum it up, we only have 8 weeks of placement (including my ENT & Opthalmology in October, which were both 1 week each, and of course, my introductory week, which was, surprise, surprise, 1 week as well), with the rest of the time to be spent on research.

The moral of this story, or rather, this schedule, is this:

When Sheena becomes a doctor, don't THINK of coming to her with any problems relating to the skin, the ears, the nose, the throat, the eyes, the brain, and the privates, because she's only had ONE-WEEK of teaching, maximum, and she knows JACK how to help you.

By the way, did I mention the annual fees for Medicine in the University of Southampton are 21 000 pounds?

21 000 for 8 weeks, means that a 1-week placement = 2625 pounds.

Sure, we get free tea & coffee, but wherefore the other 2620 pounds? Ananth thinks that at the rate they charge international students, we ought to be getting roast chicken, strawberries & cream, chocolate profiteroles, wine, and waiters going round to usher us to our white linen-covered tables, while the local students stand in a corner sipping insipid tea, coffee & munch on day-old biscuits. Mwahahaha!

But such is life not.

While some of us are busier than most, depending on their research project, my "research" has been mostly within the realms of studying House, Scrubs, Life on Mars, America's Next Top Model... A meta-analysis of TV shows, so to speak.

And it's hard work, mind you. I wake up at noon, watch 3 shows back-to-back, while snacking on crisps. In the evening, I have my cuppa tea & a biscuit. I go out for a little while to see my supervisor. Come back, have dinner. Facebook the rest of the night, read a storybook, then do it all again the next day.

Monotonous stuff, really, research. Wouldn't recommend it to anyone.

Anyway, with all this work on my hands, it's a wonder YK & I had any time to go audition for this year's Medics Revue.

The Medics Revue is well, a Revue put on by Medics. And every year, it aims to raise money in aid of charity. Like I said, it's put on by medics, so don't expect a fancy staging of a sophisticated play. Since I've come here, I've learnt that the obsession with sex, poo and other such crudity is not something unique to IMU, but seemingly the bread-and-butter - ugh, had a bad mental image of poo as spread on a slice of bread - of all medical schools, if Southampton is anything to go by.

We didn't get the parts, though, and I must say I was a bit affronted, because the actual singing during the Revue was appalling, and you all know how well YK can sing, even if I can't:

YK singing at International Medics' Night this year, with Alicia accompanying her on the keyboard. See, as Daniel suggested, what British institution wouldn't be proud to take on an IMU graduate?

Sure, the audition was hard-core. It was a 3-part audition: First, was the singing part, where we had to sing Twinkle, Twinkle Little Star and Angles Angels, by Robbie Williams. (Sorry, that was a Vasan-ism, there, eh, Forsaken Angle?)

Then, we had the acting bit, where we had to read a part of last year's script, and then read a couple of really dull paragraphs (I had one on the environment, and another on Clostridium Difficile, of all things) in a certain manner, eg. in a sad way, or exciting way, etc.

YK reading her script before going in for the acting audition.

Lastly, there was the dancing bit, where we had to learn an entire dance, and then perform it again for them.

All in all, it was a long audition. (You can imagine that learning the dance took a bit of time.) But, even though we eventually didn't get any parts, I have to say the audition was loads of fun. And it was good to know we did at least TRY to fill up our 4th-year by getting more involved with the local medics' scene here.

And so, I end this note with some gags from this year's Medics Revue:

(A running gag in the Medics Revue is that there will always be a scene where a guy, dressed in a thong will moon the audience. Butt-cheeks all-out. This dialogue happens nearing the end of the Revue, when all of the cast is fully-clothed.)

Friend: We have to find a way to make money! But, how're we going to get a job, when I'm on the wards from 9-5 everyday, pretending to look busy?

Ex-mooner: I know! Stripper! We can get a job as strippers!

Friend: What, you think people are gonna pay to see your skinny arse on stage?

Ex-mooner: (Gestures at the audience.) Why not? These guys did.


Radio DJ: Here we are at Radio Lollipop (Southampton General Hospital's radio-station) bringing you the Disease Hour! Our first song goes out to Jane, who's on the Maternity Ward at the Princess Anne Hospital. Jane has just delivered a 13-pound boy! Congratulations, Jane, and this song's for you:

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Radio DJ: And that was for Jane! This next song goes out to Lisa, on the Orthopaedics Ward, where she is waiting for an operation to fix her kyphosis. She's asked us to play her a song from Black-Eyed Peas, and here it is!

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Radio DJ: This next song is for Jake. Jake used to have a problem with his bowels. The good news is, he doesn't have that problem anymore. The bad news is, he also doesn't have a colon anymore. He has been fitted with a stoma bag, and is feeling pretty depressed about it. Don't worry, Jake, here's a song for you:

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Good luck to everyone studying for examinations, esp. org-org di Australia & Malaysia!

Oh, and for the sake of some British-ness, one more Radio DJ gag:
Radio DJ: We have Barry here in the Southampton General Hospital today. Barry has haemophilia, and he was wondering if we could play him a little something while he has his blood transfusion. Well, I hope you like this number by Leona Lewis, the last winner of Britain's X-Factor:

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Thursday, November 22, 2007

Just when you thought they have done it all...

Kah Yee...if you thought there was not much more you can get pissed off about...

The Star 22 Nov 2007

Move to make sure all doctors have required skills

PUTRAJAYA: Newly qualified doctors will have to undergo two years' compulsory housemanship from next year.

Currently, they only have to do a year of housemanship.

Health Minister Datuk Seri Dr Chua Soi Lek, who announced the Cabinet decision yesterday, said the move was considered important to increase the knowledge, skills and experience of graduate medical officers.

“This will improve the quality of services and healthcare standards,” he said.

A rotation system of four months in six departments will be implemented. With the newest inclusion being the accident and emergency department, the rest are medical, paediatric, general surgery, orthopaedic, obstetrics and gynaecology.

“We have observed that in the past few years, about three to five per cent of graduate medical officers do not get full registration because they have weaknesses in knowledge or skills,” he told reporters before chairing his ministry’s post-Cabinet meeting.

“We cannot let this continue. We hope the move is seen as a positive one by future graduates and we are confident the rakyat (people) will support us.”

After the two-year housemanship, the doctors would have to serve their three years' compulsory service with the Government or its agencies, he said.

Dr Chua said the ministry would apply to the Government to place them under the U43 grade upon completing the two years' housemanship compared to the current U41. The U43 pay scale is RM500 more than U41.

He said the doctors would be able to pursue their specialist courses or Master’s after serving two years' compulsory service compared to the current situation whereby they can only apply to further their studies after three years.

About 1,200 local medical students graduate annually.

Dr Chua also announced the Cabinet’s decision to disallow the future setting up of private cord blood banks because while it was a new service with huge potential to treat specific diseases, there were still ethical issues to be scrutinised.

He said the existing centres would have to apply for a licence from the ministry within the next two months and would be registered under the Private Healthcare Facilities and Services Act 1998.

To me, this nothing more than a big fat admission that our whole PUBLIC education system has failed so miserably...so so miserably. It's a downward spiral really...which I see no end to it. Its like, a self sustaining malignant disease which feeds on itself. What do i mean?

1) Accepting sub standard students

2) Giving sub-standard quality education (well have the proud honour of not having 1 university in the top 100 rankings! M'sia boleh!)

3) Passing and releasing them into hospitals and they start killing patients

4) Oh...we need 2 years of internship

5) repeat 1, only and the word super behind sub

6) Ohh...we need 3 years of internship..........

How dare they put the blame on the doctors, and punishing the able (a.k.a IMU) graduates for their own short-comings? I don't blame the doctors they produce, because whether they are smart or not, they have met the neccesary requirements to enter med school. So the whole racial/quota thing is not up for debate here, because its not the doctor's fault he/she was picked, but the system which picked them in the first place. What is up for debate though is the quality of doctors our public universities are producing. lets go through it point by point...

1) Accepting sub-standard students
This might be a bit of a touchy issue, but fact is fact, equal competition produces excellence. An impartial system produce the best out of competting individuals and when you pick the best, the cream of MALAYSIANS get streamed into the medicine program

2) sub-standard education
As much as i hate Singaporeans (I still maintain they are a Malaysian reject =P), you have to give it to them for their education excellence. Look at NUS, they are ranked amoung the top universities in the world! The whole bullshit about the ranking system used is unfair/biased is well, bullshit...the whole world is subject to the same ranking, so who are we to say that the whole world is wrong. And even if they want to push that point, how do they justify the move to make their own students go through 2 years of internship? Isn't that showing that we aren't producing quality students? And looking back at our own beloved IMU, not that i'm bragging, but we are producing top notch students as a whole. Why? because top universities all over the world are accepting products of IMU...you might argue the financial aspect of it but again fact is fact, the universities would not accept sub standard students who are not up to par with their own. And continuing that point, which means our local IMU grad's are at the same excellent level because they undertook the same course which is accepted by the top universities worldwide

3) Passing and releasing them into hospitals and they start killing patients
Gee...if they were so bad in the first place how in the world did they pass the exit exam to begin with?

4) Oh...we need 2 years of internship
When they start realizing the above mistakes, instead of rectifying it from the root of the problem, they take the easy way out...yes! We shd torture them more! Delay their career progress more...PISS THEM OFF EVEN MORE!

5) ENCOURAGING the overseas graduates to be patriotic
And just when u think they have done about all...they even take a pun at oversea's graduates. As if enough of us are going back to start with, they are saying we must take an ENTRANCE exam before being able to work. MY GOODNESS! even top countries have mutual acceptance of each other's medical graduates (UK to AUS). So apparently Malaysia is of such a high standard that we can afford to subject(degrade) graduates from well established education institutions to a qualification exam, and can afford to reject members of the royal college...nothing mah...MMed more keng...

Im sure this blog will invite lots of IMU/public Uni bashing, but I want to point out this is not a RACIAL debate...this is about quality of education. With this, im signing off, to a surgery exam in an hours time...haha


Tuesday, November 13, 2007

Colorectal Surgeon Song