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Tuesday, February 3, 2009

The Lack Skills

Assalamualaikum wbt

Housemen lack basic know-how

KUALA LUMPUR: Some medical universities, both local and overseas, are churning out doctors who cannot carry out common medical procedures, have no proper clinical exposure, cannot communicate effectively and cannot even take down the history of patients properly for diagnosis and treatment.

Senior medical consultants in government hospitals are now saddled with the task of having to retrain these people to ensure they meet the country's standard of medical practice.Some of these fresh doctors are retained in their houseman training postings for years, some even up to six years, because they cannot meet the standards. The compulsory housemanship is two years.

In view of this problem, the Malaysian Medical Council has issued letters to all heads of department in government hospitals where housemen are posted to open a file on each of them, containing information on the university they graduated from, their performance and shortcomings.It is learnt that by the end of the year, the MMC and Health Ministry will nail down the sub-standard medical universities and tell them to buck up.

Kuala Lumpur Hospital's Medical Department head, Datuk Dr Jeyaindran Sinnadurai, said housemen come from 300 medical colleges all over the world. These colleges churn out 1,200 doctors a year and this number is expected to increase to almost 2,000 next year.

"When they come back to work in Malaysia we have been forced to extend the period of housemanship from one year to two years in order to ensure the standard of medical practice is maintained in this country for the safety of our patients," he told the New Straits Times.

Dr Jeyaindran handles about 140 housemen a year and he noticed that some 15 per cent of them do not have enough experience to take down the medical history of patients."When they are taught to take the history properly and put the findings and various symptoms in a sequential order they can come to a proper diagnosis very rapidly," he said.

However, he added, this was seriously lacking in many new doctors because they have not been trained during their years in clinical exposure. Thus, during their housemanship training programme they needed to be retrained to do this properly."Because they have to be retrained, some of their postings are extended," he said.

Dr Jeyaindran has come up with a syllabus where a house officer must have core knowledge and experience before he leaves for his next posting."A houseman who comes in for training should be able to manage hypertension, asthma, diabetes and common medical emergencies appropriately based on current clinical practice guidelines, besides acquiring adequate generic skills," he added.

He said some were never taught this properly during their years in medical school and hence they were taught and assessed in a fair and objective manner during their training."We want doctors to examine patients properly and not take notes from the nurses' chart."

"We also do not want doctors to be over-dependent on investigative procedures which is time-consuming and expensive. "One loses the ability to use clinical acumen to make judgment when he becomes too dependent on procedures for a result and diagnosis," said Dr Jeyaindran.

He also expressed great concern that some house officers were not able to perform even the most common procedures such as setting up an intravenous line, central line, and inserting a chest tube.

There have been complaints from patients that there were housemen who cannot even draw blood for a blood test and had to seek the help of nurses."Miscommunication with patients can also lead to a lot of problem and this we have encountered with housemen," he said.

"To be a good doctor it is not how much knowledge you have... it is clinical acumen and the skills developed in treating a patient."

"Medicine is not black and white but lots of grey in between and in order to identify the grey areas the only way is the more you see, the more you do, the more you understand," he added.

Dr Jeyaindran said housemen have become something like a production line."They come, they take some history of patients and go away."They never come back to check whether their diagnosis of the patient was correct or wrong," he added.
My comments :

Frankly speaking, I was kinda worry because medical theories are now no longer an issue. The important concern going forward on my medical studies are clinical skills.

Eventhough we (Egypt's Medical Graduate) are theoretically knowledgable but we often lack of clinical skills.

I do not yet undergo any clinical courses (clinical courses start on 4th year. I am now in my 3rd one) but there was some conditions from my current and previous experiences that made me judiciously think that we wont be trained or even exposed to the skills needed.

During our lab course for instance, we never did any lab work. We did learn about how to prepare samples and how does it works but we never practiced. The samples shown were all ready-made.

When the question comes in the exam, of course we can do well on the paper, but I guess, we wont be able to deal and work with the instruments if they're given. How pathetic~

I envy those who have privilege of practicing the real course-work. They will possess skills and a knowledge base that will differ substantially from us.

The Medical school career are kinda tough and the Internship-course will be even tougher. Ehmm..well, life is challenging. And that is how we learn from life. Work hard and good luck for the endeavour Syakila!


shatrah said...

mhmmm kak ila. kat semua negara ke, atau kat mansurah/egyot je bila 4th year baru masuk clinical skills? hmmm, teragu pulak nak blaja kat egypt .. = /

Anonymous said...

HO memang kadang2 tak tau wat kejer,, suke je arahkan nes2 pastu marah2 je,,,nes2 n kakitangan kesihatan yg lain sentiasa membantu tapi tak di hargai ,, suka marah2 tak tentu pasal,, tapitak semua,, ada gak HO yg baik ati sangat,, ^_^