Dr J Veight misses the real point about medical training that it is for life. He gives an impression that once one is 'trained' one is set for life. This might have been so years ago but certainly not now, and certainly not outside Malaysia.
For example, whilst I agree that the training of a traditional surgeon or a procedurist could be 'complete', even they need to update their knowledge of medicine constantly.
A surgeon's or a procedurist's technical skills are his or her assets although in modern day practice, thinking skills are also equally important. The most obvious is that one has to maintain one's practical skills by regular practice.
What is the point of an operation being successful if the patient is maimed or confined to a bed or a wheelchair?
For non-surgeons, medical training for life is even more pressing. The training is in order to be able to critically learn and unlearn during the whole span of one's professional life. This was noted in Hippocratic's early writings.
Unfortunately, despite efforts by the Malaysian Medical Association, state-based private practitioners and specialist societies and even individual practitioners, I would suggest that very few doctors actually practice the above.
Those who do learn do it by themselves by reading journals, browsing the Internet and by communication with colleagues overseas and locally.
I would also beg to differ with Veight's assertion that the Malaysian medical environment is just as good for life-long medical training. The reasons are as follows:
1. The clear definition of a 'specialist' still befuddles not only the public but the profession. Although there is an Academy of Medicine Specialist Register in place, the registration of specialists is not compulsory and not subject to a set of standard criteria of minimum standards.
2. Large scale pharma-sponsored Continuous Medical Education /Continuous Professional Development (CME/CPD) programmes appear to be only mainly for show. As others have pointed out, the majority of doctors are there for the meal and for the fellowship and local gossip.
Some pharma companies conduct these meetings and although they have generated some debate, most often the speakers are actually those who hold vested interests in their products. Remember, there is no such thing as a free lunch - the cost is actually passed to the consumer.
3. Written communication between doctors on patients is very poor. One hears incessant complaints from private practitioners that specialists (especially government ones) do not respond to referrals and worse still, completely take over the care of their patients.
4. Medical association-sponsored activities without decent meals (and sometimes entertainment) are a rarity and when held, the attendance is usually very low. Some turn up just to put a tick on their names and they disappear. Nobody checks whether they have acquired the knowledge or whether they have been subjected to any evaluation on what they had learnt.
5. The acquisition, crediting and recording of sufficient CME points, long discussed to be a prerequisite for the issuance of the Annual Practicing Certificate, leaves much to be desired.
For example, my application with strong evidence of having attended several overseas and local conferences was returned with zero points. So I tore up my certificate and continued my life's medical journey away from Bolehland. I have not regretted since.
6. Self-learning from various professional journals, electronic bulletin boards and others depends on the motivation of the individual. If there is little or nothing which sustains the person's interest (ie, no research opportunities, no support from colleagues, political interference both at the medical and non medical levels) how is the individual going to remain enthusiastic?
7. Research nurtures critical thinking skills. The quality of research is not high. Most articles reporting research are published in local medical journals which only attract low (or no) impact factor scores (the impact factor is a global measurement of the quality of a scientific article).
8. Many Malaysian researchers who present abstracts abroad are inconsistent with their appearance. Last year, I attended a scientific conference in Florence and met many overseas- based Malaysian researchers and we all spotted in the programme several abstracts from a local Malaysian university.
Sadly, neither the abstract posters were mounted nor did their authors ever appear. This reflects the sad state of discipline and attitude prevailing in the culture of the researchers.
9. Finally, the intellectual maturity of the profession remains juvenile; intellectual debates are often taken personally and the problem evolves into a life-long acrimonious defence or counter-attack. If doctors could learn to differentiate between intellectual attacks and personal attacks, it would make a huge difference in practice.
