Actually not that interested in chopping people up at the moment, but who knows what will happen in the future?

A-levels yeah... it probably can bring one to more places overseas compared to SAM yet at the end of the day it depends on one's preferred destination and also other factors like accessibility/affordability/willingness to endure the extra 1/2 a year... I guess the choices for medical education in M'sia and overseas are abundant and it's not necessarily hard to get in. To survive it (with an intact sanity ) is another matter though.

The actual number is not the most important thing. The issue now is WHY and HOW TO SOLVE IT.

It's known that medical professionals are at high risk of developing mental illnesses no thanks to the heavy workload and pressure-cooker like environment. And it probably stems all the way back into med school where there will be people stepping over others' heads to climb up the ladder.

Now that they have identified the problem, let's see how they can solve it. Better working hours, better pay, revamp the corrupted if not biased system, improve working environment... easier said than done though; we're still a long way off compared to other countries.

Selective selection will only weed out those unsuitable ones from entering med school, but not enough attention is being paid to problems developing after medical school/working as a doctor. The underlying problems amongst the medical system in our country is well known especially to those involved, but are there enough measures done to solve it?

This is a good blog from a local doctor who has served in Sabah. Browse through his entries and one will realise some of the problems that haunt our healthcare system.

I'm not sure what do you mean by experience before-hand, but I assume it's like those pre-medschool entry kind of thing where aspiring students apply for a short term (few days to 1, 2 weeks) of posting at hospitals. IMO it's not particularly helpful.

Sure, its aims is to expose students to the real life of being a doctor, and it surely dispels most myths (mainly those glamourous and exciting perceptions) that a layperson could have. Nevertheless, being someone who has very limited, if not zero, knowledge about the medical world, one is probably going to end up standing in a corner listening to jargons which sound like alien language. I'm currently doing my electives in S'pore and last week I met two students who did the same pre-med school attachment thingy. We had a patient who suffered an extensive subdural hemorrhage and eventually coned; and when the ED consultants were explaining the CT scans and other medical stuff eg resuscitation to us, the two students just couldn't make any sense out of it. This is not to show off or anything, but rather to highlight the relative uselessness of doing such activities especially when one has no real knowledge of the medical side of things.

I'm not sure about shadowing GPs, and would GPs be willing to take in students who have no prior medical teaching? Volunteering at a hospital on the other hand is a bit difficult as well if one is not particularly trained in specific medical procedures. I don't think any volunteer would be allowed to perform venepunctures or cannula insertions or set up drips etc, so one might end up doing boring stuff like pushing trollies and wheelchairs/show directions/ office and paper work. I could be wrong, so correct me if I am.

First of all, it's interesting for me to read that you're a Singaporean studying in M'sia. I come from JB so it's more common for me to know Johoreans crossing the causeway daily to study rather than the other way round.

As for your questions, most of them are very hard to answer:
1. Depending on which uni - private ones usually have slightly lower requirements but the competition for places doesn't necessarily makes it easier to enter.

2. Hard to say. Every institution has its pros and cons, and sometimes it's a perception (or misconception if you want) of "the grass is greener on the other side".

3. Self-funded, bank loans, scholarships, etc... there's lots of ways to pay for it, but bear in mind it's not really a good thing to insist on studying medicine if the costs will bankrupt you and your family. Sounds harsh but that's the truth.

4. Interviews for medical school are kinda bullshit anyway. The one that I had for IMU consists of typical talk cock questions such as "why do you want to study medicine" bla bla bla, and a couple of random stuff about your life both academically and extra-curricular activities. IINM, Uni Melb doesn't even have interviews but it might change as they've started the Melbourne Model which is a post-grad course. In short, it's really hard to "prepare" for interviews but you'll need to be articulate and enthusiastic, yet not appear fanatical and aggressive.

5. Public Unis in M'sia? Get a CGPA of 4.0 first, otherwise it's really hard to even fathom about it. Even 4.0 won't guarantee a place in your desired institution, eg you might only get UKM/UPM instead of UM.

Well private sectors are obviously going to pay you more so your example isn't particularly valid.

Like they always say, if money is your top priority, DON'T study medicine and become a doctor. To make things simple, being a doctor will put food on your table; yet it's not a guarantee that you'll become the next big thing on the Forbes' coverpage.

It's undeniable that doctors in M'sia aren't exactly as well-paid as their counterparts in other countries, plus the working hours and environment are in much dire states as well. If you're planning to work in UK then it's another matter compared to M'sia as there are other issues and requirements for working over there eg visa/PR/qualification stuff. Those who are studying/working in UK would be more qualified to answer than I am so I'll leave this out.

As for NUS, it's notoriously strict in its student selection; plus the quota for international students is very limited as well. Many Singaporeans who fail to enter NUS end up going overseas for their tertiary studies and it's not exactly a bad alternative either.

Think wisely and thoroughly before making a decision. My best advice would be, "Things aren't exactly as they seem", but once you get the hang of it, it's not too bad.

This post has been edited by StarGhazzer: Jan 7 2009, 03:36 PM

What interests me is that Ibrahimovic states that he has been studying in M'sia for his whole life, which means he's not just another one who's merely here for tertiary education like most foreigners do. The fact is that there are more Chinese/Indonesians (not forgetting our own people esp Johoreans) spending their childhood in Singapore to receive basic and later tertiary education, rather than making Malaysia their preferred destination.

Your example of foreigners coming to Malaysia to gain entry to first world countries is indeed not a surprise. However, Singaporeans in IMU are a new thing for me. During my time over there I didn't exactly meet many of them - Malaysians who studied primary/secondary school in Singapore are pretty common, but not Singaporeans who came over to IMU for pre-clinical years. My experience is that Singaporeans who failed to receive entry to NUS will often go directly to overseas rather than choose to do so via Malaysia/IMU as a temporary gateway.

However, it's been nearly 3 years since I've left IMU so things could have changed drastically by now.

This post has been edited by StarGhazzer: Jan 8 2009, 06:05 PM

Good on you to prioritise on your education, but I still don't think anyone should be too cocky about being "better" than others. Humility is a vital aspect of being in the medical profession.

Anyway, OmniAtlas has explained the IMU-UK Twinning programme as below, so I'll leave this one out. There's no guarantee that you'll be matched to your preferred university be it UK, NZ, Australia etc. No one really knows how the matching process is being conducted despite a short briefing given to students (which doesn't make any sense anyway), and I doubt there's any transparency in it. Just do your best in your studies and pray really hard so that you'll win the russian roulette.

IMU's still building the extensions? Which part are they building now? The admin block which takes up the place of the previous flagpole area should have been completed by now. Unless they are refurbishing the interior of the old building, which at times seem old, creaky, and sometimes leaking when it pours.

Just to side track a bit, is the "hawker centre" in front of Vista B still around? Or has the local council shut them down after complaints were lodged last year?

Don't remind me of those crappy motivational talks. They do nothing but con my money as they are deemed compulsory by the school.

Don't expect to pay less than RM450K to gain your basic MBBS if you decide to go to Australia. It just ain't going to happen, Aussie tertiary education doesn't come cheap and they tend to increase on a yearly basis. Throw in the overseas living costs and your overall expenses in Bukit Jalil and you'll realise that 450K is absolutely inadequate.

Give IMU a call and ask them for the latest tuition fees for their partner medical schools. Bear in mind that by the time you complete your pre-clinical years it's probably much higher than the current fees. To play it safe, add an annual 5-10% increment and you'll get a rough idea of the tuition fees, EXCLUDING the living costs and miscellaneous stuff you'll need when you're overseas.

OMFG... Reading Davidson's even before you entered med school. Can you do us a favour, and play as much as possible for the time being? You'll have shit loads of chances later to read Davidson's once you get enrolled.

So that's where my money went... lol IMU is becoming a luxurious campus instead of the worn out, leaky, smelly shack previously known as Wisma Komanwel. Triple the com labs, that couldn't come any sooner. But LCDs and TVs in PBL rooms are kinda redundant eh? Might as well put PCs there instead - we have Macs in every PBL room over here in Melb. Then again, who the heck does powerpoint presentations for every PBL? Rajinnya...

The community clinic is a good idea as it will service the Bukit Jalil area and provide some clinical experience for medical, pharmacy, and nursing students. Hopefully the various clinics in Sri Petaling won't mind the competition hehe...

If you don't mind working in Malaysia, then don't give a damn to what other people say. Having said that, make sure you understand the real life situation of the Malaysian healthcare system, working environment, and all the political/racial bias shit going on first before making a decision. I'll say if possible try to get as much exposure as possible to different environment, eg doing electives overseas or (doing electives back home if you're studying overseas) etc so that you have an idea of which system that suits you.

I don't think IMU would prefer one pre-U over another as long as you get good results, but maybe they do have some insider criteria that non-admin people wouldn't know. A-levels may teach slightly more stuff than SAM yet it all depends on your chosen subjects in your pre-U course - if you don't take Biology in A-levels obviously the SAM student with Bio would know more than you.

But it doesn't matter... You'll get to learn the essential biology stuff in the first semester whether you've learned it in pre-U or not. I didn't take biology in my pre-U but I didn't feel any disadvantaged than my other peers, since everyone would still have to revise the same stuff for exams anyway.

This post has been edited by StarGhazzer: Feb 10 2009, 09:36 AM

Erm... I didn't cross the bridge for my education, I headed north then down under
Oh yeah I did cross the bridge, but only for a 1 month-long elective hehe...

Anyway, every now and then a verbal melee breaks out between several members regarding the standard of M'sian medical students and the dire state of our healthcare system It's a known fact that our universities' student selection may not necessarily be the best, and there are far too many complaints about sub-standard care in public institutions.

Nevertheless, I must say our healthcare system and subsidies aren't exactly too bad, in fact it's pretty beneficial for people whose income isn't at stratospheric levels. I've a friend who severed his extensor pollicis tendon at work during the holidays and required surgical repair. He ended up staying one day in a public hospital post-surgery. The management of his wounds were pretty ok, and with the surgery expenses, medications, followup review, and a one day hospital stay all he needed to pay was a meagre RM30. If that ain't affordable I don't know what is. Having said that, my friend didn't understood much about his injuries - it could be due to poor doctor-patient communication, or possibly that my friend was just too busy looking at pretty nurses distressed by his floppy thumb.

My point is, despite all the crap publicity that our doctors and hospitals and other healthcare personnel is getting, it's still a relatively efficient system where the public gets the care they need at an affordable price. If anyone's too desperate, there's always private institutions provided you have enough cash in your pockets.

LOL... summer camp... that's the best description for our NS !!

I've a friend in Melb who used to be a Singaporean who skipped his NS with overseas education as an excuse (illegally I presume), and he mentioned that he couldn't go back to S'pore because the minute he step foot into Changi Airport he'll be arrested. He's now an Aussie citizen so I'm not sure whether he's still subjected to S'pore's NS laws anymore or not.

You're the first Singaporean I know that prefers to be a Malaysian than a Singaporean hehe, but then again considering your childhood I'm not surprised.

As for generic vs branded drugs... IIRC the patent for a new drug only lasts a certain period of time (10 or 15 years I'm not sure) and after that any company can produce the same drug under a generic brand and sell it at a lower cost. Generally speaking generics should have the same, or at least similar efficacy as branded medications; yet I reckon the psychological and placebo effect of using a branded medication shouldn't be overlooked especially in those who are less enlightened. It's a personal choice I guess, it's like whether you want to wear a RM 25 Forest cotton T-shirt or a RM80 Nike equivalent.

cool...

I see lots of familiar faces around there...

Just to add something:
Over in Australia the general consensus for non-metastatised breast cancer is "total mastectomy" = "lumpectomy + adjuvant radiotherapy". Both will have similar, if not equal cure rates. The location of the lump and the size of the breast, plus the patient's wishes of course, will decide which route is chosen. So no, the best practice does not necessarily require any chemo/radiotherapy; it all depends on the case.

As for medical education in China, well like what you said, if it's a decent university plus able to get you a job in the future, it's not a bad choice to consider. Oh yes, mandarin will be a huge requirement over there and I would sheepishly admit that I find it hard to explain certain medical terms in mandarin despite being a native Mandarin speaker as we're mostly trained in English.

Well I did specify non-metastasised brca to start off with so yeah The likelihood of adverse events is probably associated with the side effects of subsequent radiotherapy, but the fact that it does not impact overall survival means that we have the same viewpoint. And as mentioned before, it depends on the breast size and patient's wishes. For someone with large bosoms conservative surgery might yield better cosmetic results (or not, it depends) whereas someone with a small breast would probably not even be considered for lumptectomy as the removal of the lump plus surrounding margins would likely mean taking out almost the entire breast.

Nodal disease is another kettle of fish where the sentinel node theory is the widely accepted rule, although there might be some arguments about it. I'm merely a lowly student who probably doesn't know too much about oncology, but from what I know radical surgery for localised brca is likely to be phased out, if not already; in fact I'm not sure whether people still do radical resections for these lesions anymore... At least not in my area.

Whatever, I wasn't exactly basing my previous posts on the case you were referring to anyway, in fact I wasn't conflicting you in the first place regarding radical surgery as I believe our current teachings (if you disagree with the word "viewpoint" so much) is pretty much similar.

Cool mastectomy pics from the link you posted, but I think the surgeons should be given the benefit of doubt. We can't be sure about the initial presentation of the patient, the position/size of the lump may have been such that the chosen prodecure would have benefited her the most despite leaving behind the ugly scar. The wound closure is kinda messy though, with all the staples and unburied sutures; yet again I'm not going to criticise too much based on a single picture without fully understanding the entire case.

She's like to have chemo and possibly other adjuvant therapy eg hormonal/immuno after the surgery, we don't know for sure but fingers crossed that she receives the most appropriate treatment.

Like I said, I wasn't referring to your node-positive case to begin with, I was only adding on some information regarding non-mets brca which for you may just be basic undergrad information but others here might not know. And my statement of "So no, the best practice does not necessarily require any chemo/radiotherapy; it all depends on the case. " isn't necessarily wrong because it does depend on every individual case and presentation.

Let's not continue this anymore as we're on the same path regarding cancer treatment, plus this is a thread about medical education, not an oncology forum.

PBL is variable. You get shit group mates... you suffer. You become a shit groupmate, your group suffers. You get a facilitator who can't be arsed, all of you suffer. Behavioral sciences stuff is boring but relevant indeed, yet I don't see how sitting in a group of 8-10 talking about how to talk is going to help - one's better off learning it by observing real doctors working in real life (albeit sometimes crap attitude btw doc and patients does happen).

POTS is a breath of fresh air, a feisty critic; not only in the flawed healthcare system of M'sia but also the murky world of politics Love his posts.

However I'd like to comment on one thing from the other blog that you posted:

http://efenem.wordpress.com/2008/05/22/the...es-from-russia/

It's sad that they end up learning stuff that may not necessarily be clinically relevant.

However, during clinical years the amount of proper, structured teaching we receive is minimal (rotation dependent of course). What we end up doing most of the time if self-studying, like what one professor put it: "Write it down in the little book, read it up in the big book." Not that I'm whinging too much about it as we are supposed to cultivate the habit of self-learning; but more didactic teaching will always be appreciated. A balance is required of course, we don't want to end up like what happened to Faiz, the blogger, where they end up in classrooms all the time rather than the wards.

Like what my angmoh friend's sister (non-medical) said, "You bloody medical students, get an extra half an hour tute and you're happy... We would have complained about the overtime."

Anyway, nice blog for a Russian perspective... going to bookmark it

This post has been edited by StarGhazzer: Mar 28 2009, 07:52 AM

Not really. You do save heaps, although don't expect to save 50% of the costs compared to those who went overseas straight into first year of uni. Depending on the currency exchange and when you started the course (as Aussie uni fees esp UniMelb skyrocketed in recent years), going through IMU may potentially save you up to 100-200K ringgit on tuition fees, possibly even more. And that alone, is a huge saving for paying parents... and don't forget the living costs one will save in Malaysia, especially if one's still staying with parents, using parents' car, eating meals at home etc.

Yes, if "easier entry" to you means lower entry score like what limeuu mentioned below.
Think of it as an alternative choice, or a second chance.

The bolded part is true, but not always the case. There are people who choose not to go directly due to various personal reasons, mainly financial issues; but quite a number of students went into IMU instead as their TER score did not meet the requirements - the minimum 97 TER for UniMelb (previously of course) is misguiding as competition for places would push the requirement score unofficially up to 99 and above.

As mentioned many times before, the IMU-PMS matching system is like a lottery. They did explain the matching process to us before, but conflicts, dissatisfaction and subsequent b*tching and appeals will occur every time. The best advice is still to put wherever that you want to go as number 1 choice.

This post has been edited by StarGhazzer: Apr 14 2009, 07:12 AM

Probably not entirely obsolete, but yeah less people tend to use those two terms these days... They mean the same thing anyway, so I don't see why people would want to remove the terms other than convenience's sake. I think the more interesting thing is the attempted abolishing of Reiter's Syndrome. Morality and ethics aside, I don't think it's fair to remove Reiter's contributions to the medical field but I couldn't really care less. They can call it whatever they want - medical terms change all the time... Pneumocystis carinii/jerovicii pneumonia bla bla bla... We still call it PCP rather than PJP.

Ondine's curse... lol... this was mentioned for interest's sake during my pre-clinical years, but I don't think most of us would have experienced someone with it anyway. Lost of automatic, reflexive respiration due to central respi centre insult; hence the patient has to "remember" to breathe voluntarily. As you would have expected, they probably won't "remember" to breathe during sleep so they go into respi arrest if no ventilatory support was provided. The various steal syndromes on the other hand, I understand how it works but don't really know much about the significance of it or how to manage it, that's probably out of my depth for now anyway...

Anyway, there's far too much to know in medicine, and even the most knowledgeable doctor would certainly struggle in areas which he/she is not specially trained in. It's good to know as much as possible, even those rare shit that occurs in 1/10M people; but there are certainly some exotic stuff that very few people hear about, let alone master and understand.

The advice that we often get is to know those diseases that are:
1. Common and simple
2. Common and deadly
3. Rare and deadly

But yeah, that itself is probably a never-ending list.

I just read this on the previous page, and I have something to add in:

First of all... the perspective of "your results are good, why not study medicine" in our community is wrong and should ideally be changed. No point forcing someone who has straight As in SPM to go down the medical field when his/her interests lie somewhere else, be it engineering/accountancy/law/art/commerce bla bla.

Secondly, how many of those "straight As" students are actually the real cream of the crop? Talk to any teacher today, and I bet my arse that at least 9 out of 10 will say the SPM marking criteria is a joke. Everyone gets an A for everything, and if previously schools are competing for excellent passing rates, now they are competing for straight As rate. Not to belittle the students who worked hard for great results in SPM; but either our marking criteria is far too lenient, or maybe our next generation's intellect has outgrown our examination standards (ie the education syllabus should be revamped !!).

The third issue would be PSD/JPA scholarships and loans. The aim of the scholarships is for the rakyat's benefit, where students get trained and return to serve the country. I'm not sure about any available statistics, but the majority of my cohort who are actual scholarship/loan holders are probably not going back, at least in the near future and possibly forever. One may argue that it doesn't matter as long as they pay back, which they are planning to do anyway.

Nevertheless, would it be better if the money was spent on improving the facilities, personnel, and resources at local institutions to provide more medical student intakes and of course improve the quality of the course? More students would get a chance in pursuing their aspirations, probably more would be retained in the country and hence reducing brain drain, and definitely providing more graduates who are well-trained and fitting our local population demographics.

Like what Dr Wee said:

Maybe JPA would like to offer more local medical scholarships instead of sending people to overseas (and risk them not returning later)... The money spent on sending one student to say UK, could easily be used on producing 2 students from local private unis. Probably 10 or even more from UM/UKM. I probably am being a bit impractical and unrealistic here; but I can't help but feel ironic that our country's best brains are being lost to other countries while our own country is seriously lacking medical staff and is forced to recruit foreign personnel, which may not necessarily be less smarter but surely less comfortable because of the language, cultural, and environmental difference.

So why not use our people's money to train our own doctors, in our country, to serve our community?

This post has been edited by StarGhazzer: Jun 3 2009, 01:46 PM

I'm not advocating that JPA shouldn't send people overseas, in fact if those scholars are able to bring not only knowledge but also work ethic and other qualities back to M'sia, that would be even better. It's just that maybe a portion of money used on sending our students to overseas (and risk losing most of them) could be used to revamp our own medical curriculum and facilities instead, as to provide more and better opportunities to students who wish to study and stay locally.

Burgadawtf?

Peritonitis should be pretty distinct from other forms of abdo particularly colicky ones, but there is never absolute certainty in medicine.

Actually money wise, M'sia isn't too bad to be honest... Tax rates are sky high in foreign countries, my friend was mentioning recently that his wife who's an intern here in Aust barely got 3K/month after deducting the amount paid for tax. It's the environment and unfair policies that deters people from going back, and if the government wants to attract more people they'd have to do something about it. The SLAB thingy is something that many people don't know about, especially if you're overseas. I admit I didn't exactly know until I read POTS, and none of the Msians I talked to here knew anything about it either. It's one of those things that our beloved government carries out in a blatant manner yet without actually talking much about it.

"Grand mal" does refer to "generalised tonic clonic seizure", unless there are more subdivisions beyond our level which are used by neurologists. Oh well.

As for why "well if one was unsure about pledging their future to the govt....they shouldnt have signed...", let's just say that there are people who regard JPA's loan as a no frills, no interest, long term loan. No interest loan... seriously how good is that compared to bank loans? After speaking to my JPA friends recently, I only realised that JPA biasiswa and pinjaman are actually different things. Biasiswa means you have no choice but to go back, while pinjaman means you can choose either way. Most pinjaman students that I know are choosing to repay the debts to break the bond, but none of them could answer how much would they have to pay back. All they said was it's likely that they will have to pay back everything including college/pre-U fees as well, but the actual amount and the payment period/installments are uncertain.

With such confusing terms and conditions that the JPA scholars themselves don't even know either, I wouldn't be surprised if there are people who manage to escape through the loopholes or get some benefits ie no need to pay back the entire amount etc.

This post has been edited by StarGhazzer: Jun 3 2009, 08:09 PM