The integrated curriculum at the newly established medical school at University Malaysia Sabah is examined from aspects of the objectives of the medical training in achieving development of the required skills and knowledge as well as personal and professional development. The teaching is spread over five years with an emphasis on basic medical sciences in the first two years although the students are exposed to clinical skills right from the onset. A gradual transition to emphasis on the acquisition of clinical skills occurs from the third year onwards. However, community medicine and professional development are incorporated into the programme from the first year and are carried over to the final year. Although there are examinations to be passed in all the courses taught every semester, with a Cumulative Grade Point Average (CGPA) of 3.0 (65 percentile score) and the candidate has to pass all the examinations in that year to clear a particular year, two professional examinations are administered, one at the end of the Third Year (end of the Phase I of the Medical Programme) and another at the end of the Fifth or Final year (end of the Phase II of the Medical Programme). Programmes for Postings, Shadow House Officers (SHOP) and Population Health are also incorporated into the curriculum. Delivery of the courses involve Lectures, Self-Learning Packages (SLP), Small Group Discussions (SGD), Seminars, Debates, Dramas, Video clips, Special Study Modules (SSM), Computer-Aided Instruction (CAI), Problem-based Learning (PBL), Problem-solving Sessions (PSS) and Clinical Skills Learning (CSL). The examination involves elements of continuous assessment and final end of semester or end of phases I and II Professional Examinations. Practical may involve Objective Structured Practical Examinations (OSPE) and/or Objective Structured Clinical Examinations (OSCE). They may also involve viva voce and/or short and long case presentations and assessment of log book entries.
The Community Follow-up Project (CFUP) is a project where medical students choose a hospital in-ward patient during their clinical ward-based attachments and follow-up this patient's progress after discharge from the hospital. The students do a series of home visits and also accompany their patients for some of their follow-ups at the hospital, government clinics, general practitioners' clinics and even to the palliative care or social welfare centres. The students assess the physical, psychological and social impact of the illness on the patient, family and community. By following their patients from the time their patients were in the hospital and back to their homes and community, the students are able to understand in depth the problems faced by patients, the importance of communication skills in educating patients on their illness and the importance of good communication between primary, secondary and tertiary care.
The Russian Federation of higher medical institutions get State accreditation, if their activity conforms to criteria determined by the Ministry of Public Health and the Ministry of Education of the Russian Federation. Kursk State Medical University (KSMU) has a confirmed to requirement of accreditation by the Russian Federation, to conduct annually training of about 5000 students at 12 faculties. KSMU carries out pre-medical undergraduate and postgraduate training in the specialty "Doctor of medicine". For the first time in Russia KSMU was allowed to conduct a 6-year medical training with the use of English as an intermediary language by the Ministry of Public Health and the Ministry of Education. In this relation programmes of training teachers for conducting instruction with the use of an intermediary language (English) and training students Russian with the level necessary for free communication with Russian patients and staff of the clinics have been developed and realized.
In 1977, the World Health Assembly (WHA) set the social target--the "Health For All" goal and in 1995, urged member states to "re-orientate medical education and medical practice for "Health For All" (resolution WHA 48.8). This led to World Health Organisation to enunciate the "5-star doctor" needing skills in healthcare management, quality assurance and health economics. The Faculty of Medicine, University of Malaya introduced the New Integrated Curriculum (NIC) in 1995. The objective was aimed at producing a competent doctor with a holistic approach to the practice of medicine. This was to be achieved by having 3 strands of studies i.e. The Scientific Basis of Medicine (SBM), the Doctor, Patient, Health and Society (DPHS), and Personal and Professional Development (PPD) over the 5-year programme, split into 3 phases. Elements of the "5-star doctor" were introduced in strand 2--DPHS and strand 3--PPD. Management studies were introduced in the Personal and Professional Development (PPD) strand. This led to an instructional module--"Principles of Management in Health Care Services (PMGT)" comprising of the Management of Self, Resources and People and incorporating a three week field programme. Evaluation is undertaken at the end of the phase IIIA of the studies. This NIC approach will be able to produce a "5-star doctor", a team player, leader, communicator and an effective manager.
In Malaysia many new medical schools (both public and private) have been set up in the last 12 years. As a result of global changes and local adjustments made in medical training, cross-breeds of different medical curricula have produced a wide spectrum of teaching-learning methods in these medical schools. In this paper, we have selected three medical schools--two public (Universiti Malaya and Universiti Putra Malaysia) and one private (International Medical University) to illustrate different approaches in the teaching-learning of pharmacology that exist in Malaysia. How do these different teaching-learning approaches affect the students' interest and ability to "master" pharmacology and in turn to develop a good prescribing practice?
Accreditation is a process by which official accrediting bodies evaluate institutions using a set of criteria and standards, following established procedures, to ensure a high quality of education needed to produce highly competent graduates. Additional objectives include (1) ensuring quality institutional functioning, (2) strengthening capabilities of educational institutions for service to the nation and (3) improving public confidence in medical schools. The accreditation process provides an opportunity for the institution to critically reflect upon all the aspects of its programme and the level of compliance or attainment of the requirements. The self-evaluation exercise, which identifies strengths and weaknesses, is perceived as formative. It is envisaged that eventually institutions will adopt a learning culture for curriculum development, implementation, monitoring and matching the outcomes. In conclusion, periodic accreditation activities can act as a "monitoring" system to ensure that the quality of medical education is maintained according to established standards.
The paper presents a general characteristic of the organization of teaching of medicine to foreign students at the Crimean State Medical University. The Crimea State Medical University is a state higher educational establishment having the 4th highest level of state accreditation. The University prepares junior specialists and bachelors in specialties such as nursing, orthopedic dentistry, pharmacy and doctors in general medicine, dentistry and clinical pharmacy. At present there are 1,500 foreign students from 34 countries studying at the university, with more than half are students from Malaysia. The quality of education at CSMU is evaluated by the State accreditation commission an authorized central executive power in the field of education and science. Textbooks and manuals written in English, which have passed expert evaluation at a state level and approved by the Ministry of Public Health of Ukraine, was given permission to be used by all medical schools of the country.
This paper attempts to sensitize the participants to understand the benefits of looking at the regulations of accreditation for medical courses in the neighbouring nearby countries. Deregulation of Medical Education like what they have done will bring enormous revenue benefits for the existing assets like the airports, hospitals, hotels resorts and the communication infrastructure of Malaysia.
The Irish Medical Council has undertaken accreditation inspections of Irish medical schools on a regular basis since 1996. This document is a summary of the accreditation standards, a guide to the process for those involved and an overview of the complexity of the many elements involved in educating a doctor. It should be read in conjunction with previous Medical Council publications on medical education. It also provides the basis for the Evaluation System for Visitors 2003. The Medial Council's prime role is the protection of the public interest in relation to the practice of medicine. The Medical Council scrutinises medical schools. It has an important advocacy role with government, with the universities which operate medical schools and with the professionals involved to improve the standards and delivery of medical education.
With globalization education has become a tradable service governed by the rules and regulations of GATS and worth trillions of dollars. International standards are rapidly being developed to facilitate cross border supply of services. In medical education, the WFME has produced International Guidelines on Quality in Medical Education which has a regional equivalent in the WHO Western Pacific Region, and the IIME has defined the minimum essential requirements of standards in medical education in seven core competences. Malaysia, having an explicit policy of making education a sector for revenue generation, has put in place regulatory frameworks and incentives to make the country a centre of educational excellence. Within the ambit of this national aspiration, medical education has grown phenomenally in the last decade. Standards and procedures for accreditation of medical schools in line with the world standards have been developed and implemented and policies are enforced to facilitate compliance to the standards. The ultimate goal is for medical schools to be self-accredited. In striving towards self-accreditation medical schools should be innovative in making changes in the three requirements of medical education. These are the intellectual and social imperatives and strategies for effective implementation.
Medical schools have existed in Malaysia for a very long time. The majority of practicing doctors has trained locally. From the early nineteen sixties when the first medical school was established to the current 7 public medical faculties, the standards of local trained doctors have always been exemplary. Now with more need for doctors to serve the country and the mushrooming of medical schools, the question of needs and wants of future medical schools and medical education need to be addressed. In this paper I will try to highlight what we in Universiti Putra Malaysia have been working on to improve the Medical and Health Sciences faculty to achieve greater heights to reach the future in the shortest possible time.
The Australian Medical Council (AMC) accredits both Australian and New Zealand (NZ) medical courses and also college specialist training programmes. The common accreditation process allows mutual recognition of basic medical training and vocational training between Australia and New Zealand. The ultimate purpose of accreditation assure stakeholders including medical registration boards, health departments, students/trainees and the general community of the quality of the programs and the competence of those completing such training. AMC revised its own accreditation guidelines using the WFME standards as the model around which the new AMC standards were developed. The College Accreditation Process is similar to and builds on AMC experience in the medical school accreditation process. In conclusion, AMC accreditation has been successful in improving medical education in Australia and New Zealand and has been able to do so without the imposition of any exclusive educational model or philosophy.
Members of the medical profession are expected to be well aware and abide by the revised code of ethics adopted by the Malaysian Medical Council on 9th December 1986. Under the Act Council may, in the exercise of its disciplinary jurisdiction, impose punishments related to misconduct or malpractices. When a complaint or information is made against any practitioner, the President shall forward such complaint to the Chairman of the Preliminary Investigation Committee. The procedure of the disciplinary inquiry is not exactly like those in the court of law but the same principle of justice is adhered to and all evidence used to make a decision must only be those that are admissible in accordance with the rule of evidence.
The Malaysian Medical Council (MMC) operates under the Medical Act of 1971, which defines its core functions related to (a) the registration and practice of medical practitioners (b) the period of compulsory service (c) provisions to be enacted for purposes of (a) and (b). In the early years the MMC used the list of recognised colleges or Universities that appeared in the list of degrees recognised by the General Medical Council of United Kingdom (GMC). Over the years the MMC has undertaken the role of granting recognition to other medical schools in the country and overseas, and added the name of these schools to the existing register of recognised medical degrees in the second schedule of the Act. For the purpose of recognition of medical schools the MMC endorsed a guideline on standards and procedures on accreditation developed in 1996, which was later realigned with international and regional guidelines, in 2000 and 2001. It is recommended that the MMC establishes an active functional 'Education Committee' and that the role of MMC in medical education should be clearly and explicitly stated in the Act. An amendment to the Act would require the MMC to be responsible not only for undergraduate medical education but medical education in its entire phase.
Formative and summative student assessment has always been of concern to medical teachers, and this is especially important at the level of graduating doctors. The effectiveness and comprehensiveness of the clinical training provided is tested with the use of clinical cases, either with real patients who have genuine medical conditions, or with the use of standardised patients who are trained to simulate accurately actual patients. The Objective Structured Clinical Examination (OSCE) is one method of assessing the adequacy of clinical skills of medical students, and their level of competence. It can be used to test a variety of skills such as history taking (communication and interpersonal skills) and performing aspects of physical examination, undertaking emergency procedures, and interpreting investigational data. It can also be used to ensure an adequate depth and breadth of coverage of clinical skills expected of a graduating doctor.
Occupational risk of Human Immunodeficiency Virus (HIV) infection is a matter of concern for health care workers. We conducted a study to gauge the level of awareness amongst HCW (doctors and nurses) working in Hospital Sungai Petani regarding the post-exposure prophylaxis in case of needle stick injuries from confirmed or suspected cases of HIV. Nineteen Doctors (56%) and 13 nurses (25%) were aware of correct risk of transmission. None identified all the four risk fluids correctly. 94% of doctors and 98% of nurses correctly stated that washing the site with soap and water is the initial procedure, but only few (1/10 of doctors and 1/3 of nurses) knew whom to contact immediately after injury. Twenty three doctors (67%) and 41(78%) nurses were aware of the use of Zidovudine but only 10 participants were aware of the use of second drug. Only 6 doctors (17%) and 8 nurses (15%) knew the correct duration of post-exposure prophylaxis. Twenty-three doctors (67%) and 35 nurses (67%) knew that the drugs were available in Hospital Pharmacy and 11 doctors and 12 nurses knew the approximate cost of therapy. On the average about 50% of doctors and nurses have fair knowledge of post exposure prophylaxis against HIV. Ongoing awareness and training are necessary to improve the same.
This is a retrospective review of 200 day-care ureteroscopies performed between April 1998 and October 2002. The aim was to determine the feasibility and safety of this procedure. The mean age was 38.8 years and 75% of them were male. Eighty-three percent were ASA 1 and the remainders were ASA 2. The side of procedure were 48.5% right, 2.5% left and 6% both sides. Fentanyl and proprofol were used during induction. Calculi were found in 82.5% of cases. Rigid and flexible scope were used in 91.5% and 10.5% of cases. There were 33% upper, 23% mid and 44% distal ureteric stones. The mean stone size was 9.37 X 6.93mm. Seventy-four percent required a ureteric stent insertion. The mean operative time was 58.3 minutes. Four percent of patients experienced pain post-operatively relieved by NSAID injection. Repeat ureteroscopy performed in 30% of patients. There were zero admission rates. This study suggests day-care ureteroscopy is effective, safe and well tolerated by patients.
Cystic fibrosis (CF) is an autosomal recessive disease commonly found among the Caucasian population. The availability of sweat test and with increasing experience have made it possible to diagnose more cases of CF. Our first case of CF was diagnosed 16 years ago and to date we have managed sixteen cases of CF. Sixteen children were diagnosed with CF in our units at the Paediatric Institute and University Malaya Medical Centre (UMMC). They were referred with either one or all of the following symptoms: i) recurrent pneumonia, ii) bronchiectasis, iii) failure to thrive, iii) malabsorption or iv) history of meconium ileus obstruction during the neonatal period. When the clinical features suggested strongly of CF, sweat tests will be performed in duplicates and considered positive when the sweat chloride or sweat sodium was more than 60 mmol/l for both results. Seventy- two hours fecal fat excretion or stool for fat globule was performed to document malabsorption. From the year 1987 to 2003, 16 patients were confirmed to have cystic fibrosis in Malaysia by positive sweat tests. Thirteen patients were diagnosed in Paediatric Institute while the remaining three were diagnosed in UMMC. On follow-up two patients died due to severe bronchopneumonia at the age of two years old. Although once considered rare, CF should now be considered in any children with clinical presentations of recurrent chest infections, bronchiectasis, in the presence or absence of malabsoption stmptoms and in neonates with meconium ileus obstruction.