Many hurdles to practising medicine

Star Education:
SOME foreign graduates who failed the Medical Qualifying Examination (MQE) have accused the local universities which conducted the test – Universiti Sains Malaysia, Universiti Malaya and Universiti Kebangsaan Malaysia – of being biased against them.
Thirty of them are even suing these public universities, the Malaysian Medical Council (MMC) and the Health Ministry. Their case is still pending.
“To offset any aspersions cast on the universities and the government, the Cabinet directed that a one-off unified Conjoint Examination for graduates of foreign universities be held,” explains MMC president and health director-general Datuk Dr Ismail Merican.

One last chance
The Conjoint Examination was aimed at helping unrecognised medical graduates familiarise themselves with the local system.
“It was also to give another chance to those who had exhausted all their attempts at passing the MQE at the three universities. This shows how caring our government is,'' says Dr Ismail.
Dr Ismail adds that there were no major changes in the Conjoint Examination compared to the MQE. The only difference was that the same examination procedures and questions were applied to all candidates.
All foreign medical graduates were allowed to register for the the one-off test. However, the 30 medical graduates from unscheduled universities who had sued the Government were barred from sitting for it.
The candidates came from unscheduled universities in India (34), Indonesia (15), China (9) and the Philippines (7). Others were from Japan, Bangladesh, the Caribbean, Romania, Armenia, and Russia.
The exam was divided into two parts – theory and clinical. Before the examination, all candidates were coached and trained in nine government hospitals by Health Ministry specialists.
The training was conducted over a period of six months, from June to November last year, and the trainees were paid a monthly renumeration of RM500.
Although over 200 students were eligible, only 71 registered for the examination. A total of 69 candidates sat for the examination. However, only 26 passed the theory paper and of this number, 14 went on to pass the overall examination.
“Even with six months of training, a majority of the graduates were not able to get through.
“The outcome speaks for itself, that the graduates’ lack of theoretical knowledge is the main factor that caused them to fail the examination, not the local universities’ alleged bias.
“The passing rate was about the same as in the MQE too,” says Dr Ismail.
Dr RS, who has been practising medicine for 12 years and has about 20 years of experience in medical education, believes that the six months of training that the graduates went through might not necessarily be of much help.
“There were no proper schedules or guidelines, so it was left to each hospital’s head of department (HOD) to decide how much guidance these graduates needed. And of course, the HODs had enough work of their own.”
Dr RS adds that this meant that many students were basically left to fend for themselves during the training period.

Poor skills
Under the Medical Act 1971, graduates who have obtained bona fide medical degrees (based on Western and not Eastern medicine) but are not among the 343 institutions recognised by the Government, have to sit for the MQE upon their return before they can be registered as doctors.
The MQE is actually the final-year exam for medical undergraduates in UM, UKM and USM. Just like the internal medical undergraduates, foreign grads are given three attempts to pass the exam.
“The candidates must register with the MMC. A balloting process is done to determine which universities they are placed in. The principal aim (of the MQE) is to determine whether these candidates have the necessary knowledge and skills to practice safe medicine. They are assessed on equal terms with final year medical undergraduates,'' says Dr Ismail.
Unfortunately, many don’t make the grade. Generally, the average passing rate for foreign undergraduates from unrecognised medical institutions is about 30% as compared to 98% for local undergraduates.
Coordinator for the MQE at UKM Assoc Prof Dr Seri Suniza Sufian says the university has been running a six-week intensive programme over the past few years for the MQE. There are two intakes for the programme and students sit for the exam in April or October.
“This is actually a refresher course aimed at preparing them for the exam, assuming they have been taught properly in their previous universities.”
Dr Seri Suniza echoes the comments made by Dr Ismail – that the foreign graduates are weak in both clinical skills and theoretical knowledge.
“Some are also poor in language skills as English was not the medium of instruction in their universities,” she says.
USM School of Medical Sciences deputy dean Assoc Prof Dr Abd Rahman Noor admits that the passing rates of the MQE have been fairly low.
”Candidates from unscheduled universities have been coming to our institution to sit for the final MD professional examinations together with our own students since 1994. The average passing rate has been about 32%.
“The candidates who failed were weak both in theory and clinical skills and knowledge. These observations were noted by our internal as well as external (national and international) examiners,” adds Dr Abd Rahman.

Need to be versatile
Dr RS, however, believes that MQE has several weaknesses that need to be addressed.
“When an exam is conducted, there needs to be a proper syllabus for it.
“It is only fair that the students are made aware of what areas they will be tested on because medicine is such a vast field,” he says.
He also suggests that the exam be made more transparent.
“The universities should give the students a general analysis of which areas they are weak in. This will then be a learning experience for both parties,” he says.
Lecturer Dr Kuljit Singh believes that foreign graduates might need more time to adapt to the Malaysian system.
“Some unscheduled universities have good standing. The fact that the graduates are allowed to sit for the exam also shows the university is quite good. It’s just a different system.”
Another reason for the high rate of failure for the MQE could be that some of the graduates allow several years to pass before sitting for the exam, says Dr Kuljit.
“These people have left their books for several years, so it’s very difficult for them to get used to sitting for examinations again,” he says.
Dr Kuljit advises students to ensure that their medical college is recognised at the time of admission.
“Do this on your own, don’t rely on your friends or an agent. Go directly to the MMC and find out. Don’t go into the university hoping that it will be recognised in the future; that may never happen.
“There are also parents who think their children can safely go to an unscheduled university as long as they return and sit for the MQE. It’s not that easy,” he says.
“These graduates have to work at least two or three times harder than the others, because they have to cram in all their knowledge as well as familiarise themselves with the new system. They will really need to put in 100% effort.”
Dr Ismail assures those who failed the Conjoint Examination that it is not the end of the world.
“There is more to life than becoming a doctor. They can pursue other related fields such as pharmaceutical studies, biomedicine, and science and research.
For those who feel that their vocation is really in medicine, Dr Ismail says they should work hard and get good grades so that they are able to pursue their medical dream locally or gain a scholarship to do it overseas.
“Basically, if you have studied at a good university and have what it takes to be a doctor, you should not have a problem passing the MQE," he says.