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.
Required learning of the basic medical sciences based on five clinical problems was compiled by teachers and subsequently derived as 'learning needs' by students during the problem-solving process. These lists of topics were compared in terms of number of lecture-hours and when these were taught in the traditional curriculum. The findings indicate that learning from problems is not entirely free-rein and can be largely determined by teachers; topics taught earlier in the course appeared more frequently than latter topics and there was a tremendous overlap of topics in both the traditional and problem-based list. Regardless of whether lectures have been given or not, students recalled facts better if they had encountered the related clinical problem. This study also reveals that problem-based learning can be as efficient as lectures in content coverage and concludes that the lecture method be retained provided the topics are selective and are derived and sequenced appropriately with clinical problems. Problem-solving should be adopted as a teaching strategy.
The belief that it is unwise to alter the initial response to a multiple choice question is questioned. Among 39 380 MCQ responses, there were 1818 changes (4.62%) of which 21.9% were correct to incorrect responses, 46.3% incorrect to correct responses and 31.8% incorrect to incorrect. This effect was very much more marked among the better students, incorrect to correct changes accounting for 61% of the responses in the upper group, 42% in the middle group and 34% in the lower group.
A cross-sectional national survey was conducted amongst a random sample of medical practitioners registered in 1988 with the Malaysian Medical Council with the purpose of determining their educational needs with regards to continuing medical education (CME). A 91.0% response rate was obtained. It was found that more than 70% wanted a programme that would provide them with new practical skills and new knowledge or advances in specific fields. About 2/3 also wanted their intellectual skills in problem-solving to be further developed. Reinforcement of communication skills appears to be of secondary importance. They would also like a programme of CME to help them monitor and improve their diagnostic accuracy, investigative habits, prescribing pattern, skills in interpreting diagnostic tests and management of common illnesses. As for content areas it was found that the problems they have least confidence in managing come mainly from the disciplines of psychiatry, obstetrics and gynaecology, and emergency and critical care. More than 90% preferred self-learning methods with some group-type activities. Based on these needs it was recommended that a programme of CME be developed with orientation towards a practice-based setting, self-directed learning, utilizing problem-solving approaches and focusing on the major content areas identified. In addition, activities such as small-group discussions, clinical rounds and journal clubs should be encouraged to develop into local network group activities to supplement the self-learning and present lectures and talks.
Three years ago the Universiti Kebangsaan Malaysia medical school changed its curriculum from the traditional discipline based curriculum to the integrated organ-system approach. Once change was effected a process of 'refreezing' had to be initiated whereby new responses had to be reintegrated into the ongoing personality or emotional relationships of important people so that the change process will endure and become stable. During this refreezing process the faculty encountered several problems which could thwart further development of the new curricula if left unresolved. The nature of the problems seemed to indicate that curricular change involves more than just efforts at bettering the what and ways of student learning and assessment. A lot of energy was also spent on keeping things going, keeping people motivated, making sure the work was done (at least as well as it has in the past), looking for better ways to do things, weighing new solutions and to be alert to new problems. In ensuring the continuance of change it was important to ensure, from the outset the institutionalization of policies, programmes, procedures and practices for continuing reward, routinization, structural integration into the system, continuing evaluation and providing for continuing maintenance.
A random survey of 400 doctors was carried out over a period of 3 months to determine the factors that would facilitate or inhibit the participation of doctors in continuing medical education (CME) in Malaysia. Regular participation in CME was defined as participation in any activity (self-directed reading or attending organized activities) at least once a month during the past year. It was found that 78% of doctors regularly participated in CME. Working in a hospital environment and being members of the Malaysian Medical Association and at least one specialty organization appeared to be important facilitatory factors in CME participation. These doctors also read the local medical journals regularly and subscribed to other journals. In addition, they were more likely to possess postgraduate qualifications and would have teaching, research, diagnostic or clinical responsibilities as major components of their work. They were more likely to practise in the big cities and would tend to be active in at least one voluntary or social organization. If they were in the Government sector, they were more likely to work in the Universities or in the Hospital Division of the Ministry of Health. The 22% who were less likely to participate in CME were general practitioners in the private sector. They worked long hours with day, evening and/or night shifts every day. If the doctors were in the Government sector, they were more likely to be in the Health Division, working in administration and public health, or they were in the armed forces and other organizations such as local councils. They worked in the smaller towns or in the districts.(ABSTRACT TRUNCATED AT 250 WORDS)
The competence of general practitioners (GPs) in diagnosing anxiety neurosis was assessed using standardized patients (SPs) unknown to the doctors. Out of a computer-generated random sample of 100 general practitioners in Kuala Lumpur, 42 volunteered to participate in the study. The results showed that the GPs can be divided into three groups: group A made the correct diagnosis and informed the SPs about their condition (11.9%); group B prescribed tranquillizers and did not inform the SPs of the actual diagnosis but instead said that they were either normal or were suffering from some stress (28.6%); and group C made various diagnoses of physical disorder or did not detect any abnormality at all (59.5%). Thus about 40% of the doctors considered an emotion-related disorder and only 12% of the doctors were confident enough to make and inform the patient of the actual diagnosis. Group A significantly (P < 0.001) asked higher numbers of relevant questions in the signs and symptoms section of the history than the other two groups. No differences between the three groups were observed in the other two sections of history-taking (personality, family, social and precipitating factors), in the general and specific physical examination and interpersonal skills. Generally, with the exception of the interpersonal skills section, the doctors performed less than 40% of the expected tasks in every section. The study highlighted the lack of competence in making a definite diagnosis of anxiety disorder. Among those who apparently made the diagnosis (group B) or made the diagnosis with certainty (group A), there was no demonstration of appropriate treatment behaviour with respect to pharmacological intervention.(ABSTRACT TRUNCATED AT 250 WORDS)
The purpose of this study is to explore the types of problem students that clinical teachers encounter in clinical settings. A questionnaire developed by the Association of American Medical Colleges that lists a variety of types of problem students was completed by 466 clinicians at the University of Washington School of Medicine (UWSOM) and 98 Malaysian clinicians from Universiti Kebangsaan Malaysia (UKM) and Universiti Sains Malaysia (USM). In addition, 120 medical students from UKM completed a slightly modified version of this questionnaire. Both the faculty and student questionnaires asked the respondent to identify the frequency of a given problem type. The faculty was also asked to estimate how difficult it was to evaluate a specific problem. In general, there was strong agreement among the North American and Malaysian faculty on the frequency and difficulty of the 24 types of problem students listed. There were some notable differences, such as Malaysian teachers perceiving the "shy" student more frequently than their North American counterparts who rated the student with deficits in knowledge more frequently. However, the overall similarity in the rankings suggest that clinical teachers face similar types of problems, independent of cultural differences and institutional differences.