Mastering medicine requires the immersion method

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One cannot learn medicine only from textbooks, stressed president and dean of Penang Medical College (PMC) Prof Amir S Khir when Penang Monthly caught up with him recently. You also need to be immersed in the medical world and to be doing continuous research. It makes perfect sense therefore that one of the college’s strengths is in its twinning programme with top universities in Ireland.

PMC’s medical programme is a partnership with the Royal College of Surgeons in Ireland (RCSI) and University College Dublin (UCD). What’s the best benefit a PMC student can get out of this?

I think this is the crux of the matter – when you have twinning programmes, each component must have something that makes it better than either of the places. Traditionally, people have gone to Ireland to do the whole five-year programme. The advantage in that is that most foreign universities are established and they’ve got very experienced teachers, but in a way, this may not prepare you in the best possible way for when you come back as an intern. Our interns do better than people who do the entire five years abroad because of their familiarity with clinical work.

There are also advantages and disadvantages in doing all five years here in Malaysia, the disadvantages being the scarcity of pre-clinical teachers here, especially medically-qualified ones. So what we’ve done is married the advantages – our students get pre-clinical experience in Dublin, where you have teachers doing research in their fields, and they then come back and learn medicine in the environment they are going to work in.

But I think it goes beyond that. Going abroad is a good experience – you broaden your mind and you are less likely to be narrow-minded. You view the situation at home – politics, socioeconomics – in a much more open way. The students mature better, they learn to manage themselves and they are more independent. To me, that is more valuable than just the academic experience. That’s what we give them.

Obviously, the other thing is the cost. Clinical medicine abroad is very expensive, and therefore the cost is greatly reduced by doing clinical medicine here. There are advantages all around.

What drew you to join the college?

I joined in 1999, and I am the longest serving academician here. I was just about to retire from Universiti Malaya when I was approached by the college. I’ve always been into student academic matters – I started in 1978 – so it was quite natural to take up the challenge of being in a new place and starting a new programme. At the moment, I’m temporarily both dean and president. Eventually, someone else will take over as dean.

With your new position, do you also have a new direction for PMC?

In education, it’s very hard to be too innovative – whatever it is, it has to be within a certain scope. One way is to look into new courses and, obviously, the choice is to go for other undergraduate courses. We’ll have to look at what’s in the market. Certain courses, such as pharmacy, are already over-subscribed. The only one that’s probably still required, undergraduate-wise, is dentistry. To do dentistry from the start means you have to have a basic science programme, which we don’t, and since our partners do not have dentistry either, it’s out of the question for now.

This is why we’re moving towards the postgraduate area. We’re looking at areas where there’s a need; it’s slightly more boutique-like in some ways.

We’re also building on the strengths of our own people. One of the things we’re starting to do is obstetric ultrasound – this is one area where we have the expertise. We’re also doing neonatal nursing as well as dermatology for family physicians.

On top of that, we’re in discussions with hospitals. We work with Penang Hospital, and one of our partners there said that we should go into areas of prehospital care – i.e. emergency medical technicians – so that our students will be better trained. We’re looking at where there’s a niche, in nursing as well, and we will go further when there’s a need. At the same time, we’re trying to strengthen our undergraduate medicine courses; we’re maximising our relationship with the Ministry of Health. It’s a two-way thing – not only do we use their facilities to teach, but we contribute with service in return.

Correct me if I’m wrong, but I read that PMC only accepts students with JPA or Mara scholarships.

That’s not true. We’re open not just to JPA and Mara – we take in private students as well. The number of private students has always been pretty stable, but from 2002 onwards, JPA has wanted us to take in their students. It was initially a small number, but they kept asking for more. We realised that it was a bit risky to put all our eggs in one basket, but they are good students – JPA scholars are highly qualified, multiracial and based on merit, and they all do well at the interviews. For instance, last year, 100% of our prize winners were JPA scholars.

Between JPA and Mara, which kept asking for more and more places, in a way they have displaced the fee payers. We still have them, but the proportion is much lower than we’d like. It is part of the risk.

It has come to pass that this year JPA no longer sponsors students to go abroad for an overseas degree. So now, we take in a lot more fee-paying students, and we are looking to recruit more non-Malaysian students as well. We’ve always had some Australian, Sri Lankan and Thai students, and this year we’ve had a couple of Japanese and Taiwanese students. It fits in with what we have to do if we’re working towards becoming an overseas branch of the two Irish universities. To get there, we need to have overseas students, and subsequently the bulk of international students would come for our postgraduate programmes.

I know it looks as though we’re not taking private students, but that’s not the case. We need to take more self-funding students. We’re looking to recognise the Unified Examination Certificate, and we now recognise the United Chinese School Committees’ Association of Malaysia (Dong Zong). We’ve also got the National University of Ireland to recognise them as an entry qualification. We’re expanding a bit more. Perhaps we had been a bit too comfortable with JPA and Mara scholars.

In June, PMC will be launching its Master’s degree in Health Research programme, which is also in collaboration with RCSI. Can you tell us more about it?

It’s a programme that RCSI was going to launch anyway, and our professor of Public Health, Prof Rashid, was very interested and had been linking with people there, especially Prof Ronan Conroy. It took a while – we had to take it through the proper processes with the Malaysian Qualifications Agency. The curriculum – the actual material – was jointly worked out between RCSI and our staff.

Prof Amir leading a class. He has been active in research since 1977, principally in the field of endocrinology, diabetes and metabolism.

Also in June, PMC will hold its inaugural Research and Education Day. Can you tell us more about it?

Like a lot of private medical schools, initially, the emphasis for the staff was just on teaching. Even the senior staff members we took in were doing a lot of teaching, but being an academic institution, we realised that research has to become a big factor not just among our staff, but among our students as well.

But just thinking about our staff first, we started to put emphasis on research activity and research output in promotions – you cannot be promoted from lecturer to senior lecturer, for example, without a certain amount of high quality research. It can be in any area of interest – a lot depends on the kind of opportunity that they have. We are lucky in that Prof Jacky Ho, our professor of Paediatrics, is the national coordinator for the Cochrane Collaboration, and you have the Cochrane Library, provided by the collaboration, which looks at evidence for things and produces reviews in healthcare. PMC is the coordinating centre for the Malaysian Cochrane Network, and through this, it allows for some critical review work and a chance for people to get published, which will also be taken into consideration. The staff realise that they have to do this, and we make sure that we at least help them with seed money for research and, hopefully, once they are more established, they will compete for external funding. What we’re hoping now is to link with our Irish partners to maybe compete for collaborative research and funding from European bodies.

That’s for the staff, and certainly the research output has gone up a lot in the last few years because of the emphasis on research for promotion. For our students, we emphasise evidence-based medicine. We want our students to practice it, so we teach them how to assess papers, and part of it is they start to do research as well and learn how to write.

One disadvantage – if you can call it that – of being just a clinical medical school is that we do not have pre-clinical departments with scientists. We have clinical scientists, but we do not have basic scientists. This can be overcome by collaboration – I did quite a bit of work with Universiti Kebangsaan Malaysia and Universiti Sains Malaysia – so it’s not a barrier.

Another aspect of research is clinical trials. We have a clinical trials unit that has been going on since 2000, and we’ve taken part in some big trials that made quite a difference in medicine.

You’ve been in academic medicine for many years. Have you observed any changes in the landscape, and what do you think of the quality of students these days?

I’m lucky in that I’ve always been working in top medical schools with high quality students, but it’s been said as well that a lot of the current graduates are “softer” – they cannot take criticism. I think that’s true; they seem to be much more fragile. There are some housemen who say that it’s very tough and there’s a lot of stress. This fragility cannot be a part of medicine.

It’s also wrong to say that it’s so stressful to the point that you cannot enjoy yourself. We used to work 100-plus hours a week as housemen. Most of us, looking back, enjoyed it – there was very heavy involvement. Nowadays, it’s protected. Housemen work 60 hours a week or so, and when they’re on call, they take half the day off the next day. That’s fine if the idea is to protect the patients so that housemen are not overly tired and would not make the wrong decisions, but I think we need to work on their mental toughness to improve their work ethic.

Any advice for medical students out there?

My main advice about medicine is to enjoy it. You must immerse yourself. I find the students who do well almost live in the ward. The patients are the textbooks – you learn from them. Apply yourself, and hang around and learn from the seniors. You learn to respect the patients, the junior doctors, the senior doctors – everyone – as colleagues. You learn that the textbook is simply too dry, whereas every patient teaches you something different. All patients are interesting – it could just be a fever, but it could be the start of something unusual. Without application, having the highest IQ in the world won’t help.



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