The recent and sudden de-recognition of the Crimea State Medical University (CSMU) is in itself not so much an issue as compared to the manner in which it was handled by the Barisan Nasional politicians.

For many of us in the medical arena, the alleged commercialisation of medical education as alleged by the deputy health minister comes as no surprise. While there are possibly many other foreign universities supposedly producing substandard medical graduates, CSMU is but unfortunate to be singled out as the scapegoat.

A great number of students at CSMU are actually qualified candidates for the medical profession, comparable if not superior to the majority of our medical students at local universities.

Efforts by the Malaysian Medical Council (MMC) to maintain the quality of the medical profession in Malaysia will always receive the full support of the rakyat, but only if this is done in a manner that is professional and unbiased.

The pertinent questions are for one, what is a reliable gauge of quality of tertiary education? Perhaps more importantly, what is the quality of our own local medical education?

The deputy health minister and the MMC cited the increasing intake of students at CSMU had raised the lecturer/student ratio from 1:4 to 1:8 and used this as evidence of an alleged compromise in quality.

To the MMC, an acceptable lecturer/student ratio is at most, 1:6. Yet, it would come to the surprise of many Malaysians that such a 1:6 ratio does not exist even in the supposed top medical school of Malaysia.

In the university where I trained in, the pre-clinical phase of studies (first and second years) were conducted in 10 laboratories with one lecturer attending to16 students, way below the 'standard' set by the MMC.

When this university increased its intake of pre-clinical students in 2002 and 2003, the figure was one lecturer to 25 students. For certain classes, due to the lack of teaching staff, groups were combined, creating crammed, giant laboratories of 30-40 students.

In terms of bedside teaching during the clinical phase (third, fourth and fifth years), the lecturer/student ratio varied among the clinical disciplines. In the fourth year of medical studies at the Klang Hospital, 30 to 32 students were allocated to one clinician for a period of four weeks.

In order to prevent 'giant ward rounds' in the crowded general wards, the group is divided into two, allowing 15 students to be taught by the same clinician, but only on alternate days depending on the diligence of the clinician.

Either way, the figure is a far cry from the 1:6 ratio set by the MMC. In the fifth year of medical studies in this university, the allocation of lecturers was at least 1:10 in all clinical disciplines (General Surgery, Orthopaedics, Obstetrics and Gynaecology, ENT, Opthalmology) with the exception of Internal Medicine (1:5) and Psychological Medicine in which the ratio was 1:4, and even so, with only once-weekly tutorial.

In light of this, accusing CSMU of compromising quality merely by the calculation of lecturer/student ratio hardly makes any sense and the MMC might as well de-recognise our own local university.

The persistent insistence of the deputy health minister that our local medical universities do indeed have a 1:6 ratio could only suggest a refractory denial syndrome or a frank outright ignorance of the state of current affairs in our local universities.

The deputy minister should be taken to task either for being untruthful in Parliament or downright negligent in his ministerial duties. But that would not take place under a weak national leader, would it?

The gauge of quality medical education must go beyond a simple ratio which, I feel, is an unreliable method of evaluation. To begin with, baseline quality begins at the intake of medical students, and in this respect, the BN government has but zero credibility.

A government that declares meritocracy yet practices racial educational policies is in no position to question the quality of other universities. I have had colleagues unable to present a simple clinical case in Year Five of medical school.

This is not at all uncommon, and the proficiency of English is so pathetic to the extent that the faculty administration had to introduce Basic English classes at Year Two of medical school, compromising hours each week that otherwise could have been used for the strengthening of basic sciences subjects.

So tell me, is this quality?

Upon graduation, house officers have the omnipotent duty to relate an emergency clinical scenario by phone to the specialist clinician. Failing to do so is nothing short of a disaster especially in medical emergencies.

And thus this is my reply to Dr Mohd Nordin Musa . Yes, competency in English does make one a more competent doctor, for ineffective communication puts a patient's life is at risk, regardless of how well one sincerely tried to comfort the patient.

A desired lecturer/student ratio of 1:6 reflects nothing of the actual quality of teaching. From personal experience, a competent and gifted teacher can provide effective quality teaching to a large group of students, and conversely, a small group under an reluctant and incompetent clinician can walk away none the wiser.

Thankfully, in the university where I trained, there are but a remnant of brilliant teachers left, though these gifted clinicians are bound to be a rare sight with the aggressive implementation of the Skim Latihan Akademik Bumiputra as mentioned in my previous letter .

Such racial-based programmes are simply repulsive and effectively discourage clinicians of non- bumiputra backgrounds from pursuing a lifetime career in academic sciences.

A nation can never be built on principles of racism, discrimination and favouritism. With the pervasive racial policies and political intervention of the BN monster in the tertiary institutions, dubious quality will still be a feature of our local institutions.