checks and balance should and MUST occur at selection into, and during med school level......once a doctor graduates, he/she is like 007......licensed to kill......

during clinical practice, checks and balances should be for HONEST mistakes that will inevitably be made........NOT as a means to weed out incompetent/poor attitude/dishonest doctors........by then it is TOO LATE........

no amount of rationalising about the 'bed real world' can excuse this dishonesty........

Ever considered being a law student bhypp? A few sessions in the Magistrates Court, reading of a few appeal cases, and you'd end up cynical and wishing there was a black book on the floor on a rainy day.

But I digress.

I do not know of anyone who has not lied. Skipping classes in university is also all too common, in ANY medical school. The difference is some know how to fail and boot you out, while others will turn a blind eye with the correct grease.

People are always going to exploit and get around any system. The question is, how many will? Not many people get away with bringing more than what is allowed on a international flight (even if there are loopholes), but there are no lack of people, by hook or by crook, trying to get into restricted courses, by any means.

A good doctor is not "good enough". We need competent doctors. While admittedly not all who skip classes will be bad doctors, empirical evidence would suggest that statically, there are more number of "bad doctors" who cheat, lie and skip classes, than those who stay on course. No one is saying you need to be at home, studying at every waking hour of the day (through I have to say the life of many university students is as such at times).

And cheating is a VERY SERIOUS offense in almost all university disciplines. It doesn't matter if you cheat and you become "good enough", you are still a cheat, and in many professional bodies that is an unforgivable crime. It need not be malicious: a few years back there was a international student (who are allowed to bring in bi-lingual dictionaries for exams if they apply for the privilege) was found in possession of a bi-lingual dictionary with writing in it in the exam hall itself.

His paper was taken away, and I never saw him again. Rumor has it he was kicked out of university, and the writing in the dictionary was allegedly non-IT related to start off with. Myth or not, I have to say it is a good deterrent.

But I suppose in Bolehland, as long as you boleh stay undetected, all is well..........
So the world is full of cheaters, so we can also cheat then? The white man also practiced discrimination, so it is okay for us to?

The check and balances is to prevent accidental mistakes that humans make, not compensate for an incompetent person. There is a system to make sure all OT tools are accounted for, yet there ate no lack of cases where things are left in patients.

The question is, what proportion of "excellent students" come out of "bad unis", and what proportion "rappy students" come out of "good unis"? My maths may be the product of my imagination, but apparently my imagination is shared by many other people in society.

To those who insist that one should be judged on their personal qualities and not their institution of learning, well, until you prove yourself, this is how society is going to judge you, rightly or wrongly.

i agree....this is not what the checks are really for....but with so many dodgy uni's around...and the govt / medical body is always 1 step behind...when they recognize a uni as a bad one....producing dodgy docs.....the docs would be already out there....in the hospitals, posing threats to patients....

but just to make things clear...im in no way condoning such acts and i hold on to the ideals just like u guys....

@haya....im in no way wanting to be a lawyer...im close enough to hell alrdy...no need to take up a profession that guarantee my spot there... and i dun get ur black book thingy...whats that suppose to mean?

true thats why i said...he/she should try to hard n prove the public worng....not all med students from russia are poor, incompetent n cheats...he/she felt a great sense of injustice, whinges, felt very bitter but i think he/she has lotsa growing up to do....the world is never fair...and instead of whinging on the press, he/she could maybe write a letter to the med. body (MMA issit? or issit MMC?) and ask them to review the whole thing...or to JPA to send someone over an do a thorough evaluation....

maybe he/she already done that....but im just saying...whinging is not the way to go....

This post has been edited by bhypp: May 29 2009, 10:11 AM

Well, I agree with you on the growing up part. There were several times when she was passing unnecessary moral judgements on others(girls wearing skimpy clothes, choosing to have sex). The letter was also written in an emotionally charged manner without any suggestions on how to improve the situation.

Having said that though, I believe that many Malaysians do not have the right perception on education to start off with. Many are just interested in passing the exams, by hook or by crook. With such an attitude, it's no wonder that they would resort to cheating when the opportunity presents itself.

Alright, it has been a week already. Spot diagnosis time over, Time to give the patient's history:

The patient was a 63 years old Indian farmer.

Presented at the hospital's emergency department with complaint of severe pain and difficulty walking, there is an extensive cellulitis extending from the distal and medial aspect of the right leg up to the proximal posterior aspect, involving the areas around the medial malleolus and the calf.

Several fluid/puss-filled bullae are also present on the affected area of which some has burst forming exudating cavities. The patient however does not present with fever, shock or any signs or symptoms indicating the presence of septicemia.

The patient previously had a deep puncture wound caused by a stick near his right heel while farming 1 week before. The wound was neglected by the patient which subsequently became infected and inflamed to the previously mentioned state. Patient only sought treatment when the pain and difficulty walking has become unbearable.

The patient is non-diabetic and non-hypertensive. The patient did not seek any medical treatment prior to the presentation in the emergency department and had instead consulted an ayurvedic practioner for treatment.

The patient had refused admission and undergone drainage of puss and debridement of the necrotic tissues, cleaning and dressing of the affected limb, administered broad spectrum antibiotic pending the result of C&S and was told to return for a follow-up 2 days later.

The patient however disregarded the advice given and only returned 1 week later due to the worsening of the condition (as seen in the pictures above).

The dressing was evidently not changed and was soaked with exudative fluid/puss (note the greenish discoloration). Upon removal of the dressing, the limb also showed greenish discoloration (see pictures) at some areas along with a distinct necrotic smell. The physician on duty concluded that there might be an added pseudomonas infection present and have sent another sample for C&S.

Debridement was done again and this time the patient was admitted and treated for streptococcal and pseudomonas infection. Due to the extensive damage, skin graft from the patient's left thigh was taken and grafted on the affected limb. The patient was discharged after a few days of observation.

(i might add more pictures from other cases later)

what else to do? hmm

We live in an imperfect world. The fact that Malaysia is in it's current state of "turmoil" per se shows just how much change we should be expecting from the higher ups. Tight airport security can hardly be considered as a margin of which we can use to gauge this situation. Why? Simply because it would be a shame if Malaysia can't even live up to the international standards of which most other international airports adhere to. It's the most tangible thing that foreigners notice the moment they step foot in Malaysia. Even then, like you mentioned - there are loopholes.

Bribery is considered a norm even in Malaysian culture. How many of you out there DID NOT bribe your driving instructors in order to get that 'P' stuck on your windscreen? Or how about bribing that traffic policeman for overtaking on a double-lined road or forgetting to put on that safety belt or double parking, etc etc etc?

It's a fine and dandy playing the blame game but in reality, the sad fact is that there is a lot that Malaysia needs to work on. This is hardly the most important(although it IS pretty significant) thing on that long to-do list.

What point would there be to treat a disease for its symptoms and not its cause?


Essentially it all boils down to interest and perspective. It would be pointless being in a world renowned university if one didn't have any real interest in the particular subject. It's like forcing down bad medicine. Don't even get me started on those whose parents hand-picked(or forced?) medicine as a career for them.

Same goes for those who choose to throw a fit and make a fuss about things instead of growing a pair and actually dealing with the situation. After all, life's all about the choices we make and how we deal with whatever implications there may be.

Note: In the post-Soviet countries, Academy is actually of a higher ranking than University.


@drgadgets: You've got it spot on.

On a short note, the Malaysiakini article was actually written few months back and was featured in THIS blog, which also touches on a MO's personal experience with some students from Russia.

THIS blog (it's link was placed up on this thread a couple of dozen pages back) has a brief and relatively accurate description of how my university, Moscow Medical Academy is like.

In Russia, it's a case of pure misconception and lack of open-ness to the IMMENSELY DIFFERENT culture around us. Many here choose to stick to the Malaysian community consisting of rudimentary mindsets which have unfortunately syndesis-ed and hence we get cases like that article. Perfect setting for stagnant philosophies. Do take into account that most leave home for Russia immediately after SPM (this is true especially for government students, who only go through a 3 month prep course before being admitted into the 1st year) some as young as 15, 16 year olds. That plus the Malaysian attitude towards learning (which to a certain extent we all are/were guilty of) whereby obtaining high marks trumps getting an actual grasp of the subject - you get the oh-so-perfect students who say oh-so-wonderful things about a place they know oh-so-well.

Of course, Russian universities aren't perfect, especially not mine - but who asked them to blindly jump on the bandwagon?

This post has been edited by it-int: May 30 2009, 11:53 AM

since you are in the "Russian bandwagon" (along with all the criticism etc), what are you planning to do now?

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Added on May 31, 2009, 12:03 pmOn another note, here is today's article in StarEd (Sunday - 31/5/2009):



This post has been edited by CyberSetan: May 31 2009, 12:03 PM

What any other student who's actually interested in learning would do - gain as much knowledge as I can and make full use of the resources available here. Undoubtedly, action in the end speaks louder than words.

I know a guy from my university who knew better theory than a HO did during his elective posting. I know of local graduates who know squat about ECGs. I also know that medical students from UM find it ok to shake sleeping patients up because they did a crappy job getting the patient's case history the first time and the second time as well as the third time around. And that some doctors actually find it a waste of time to get proper case histories from patients - only focusing on the symptom but not the disease.

And regardless of how well anyone did for his pharmacology/anatomy/physiology exam, if he doesn't take the effort to constantly read up on past subjects - he's bound to forget. Good student/bad student, local uni/UK, US, Aust, Russian uni - whatever. If one can't challenge or motivate himself to complete a task and is stuck on society's prejudices - What else can be said?

Everyone has the ability to make their own choices in life. Why most let the mainstream mindset make the choices for them is beyond me. Perhaps the Malaysian education system needs to be improved. We seem to be producing too many "Alah, buat ape study banyak2? Study senior's notes cukup ah. buku tu tebal sangat, malas nak bukak" people and when they fall short "eh, babi ah cikgu tu. Racist/sexist kut, semua benda pun tanya - hapak pun takde dalam senior's notes" or the sit on their ass "God will bring me through(even if I stayed up watching animes/dramas/playing DOTA all night)" holier-than-thou ones or the "eh, my last year di, I better enjoy myself kau-kau before I grad, later no life (and proceed to throw EVERYTHING to the wind and choose to live up to everyone's 'expectations') after all MOs all going to 'kill' me wat, layan oni"

So yes, stereotype Russian graduates. Most are probably sub-par anyways. But occasionally, try not to be too surprised when there are those who come out with knowledge paralleling that of seasoned MOs. Who knows, you might learn a thing or two from them.

This post has been edited by it-int: May 31 2009, 01:22 PM

Look up the premise of Death Note, and how some schools in China (amongst other nations) have banned the carrying of black colored books.


I got my wheels the legal way, I paid my fines when it came. I don't broadcast it to everyone around me. As they say, it is the empty can that resonates the loudest.
That is what the whole purpose of this discussion is about: to hopefully enlighten people who otherwise may have "blindly jump[ed] on the bandwagon". Even if we change the mind of ONE doctor-death-to-be, it would be enough.

I don't expect revolutionary change, as most here seem to seek. If I can convince one person against pursuing a MD in fleabag eastern Europe countries, maybe others will redirect their friends/relatives to me for "advice", in the hope that one day, demand for places in questionable medical schools will not be such a big thing, and the MMC may have some willpower to deregister them.

It will probably wouldn't be fast enough to stop me from being looked at by Dr Death through.

Dude, I'm pointing out an undeniable fact that bribery is RAMPANT in Malaysia. Just because neither one of us have resorted to bribery doesn't mean the rest of the Malaysian population don't.

We come from a society brainwashed into thinking that becoming a doctor is all glory and fame and wealth. Almost everyone under the age of 18 has an idea of how things would be but not many really try to know more than they need to - most don't really BOTHER to really get to know what they're going into.

About 1/3 the UM medical faculty quit by the time they hit third year because they FINALLY realized that medicine's not for them. It's easier for them since they wouldn't have spent as much on the course anyways.



Tsk. So yeah. Whatever else I'd written seems to have fallen on blind eyes.

There are a few types of people who come to Russia:
1 - Those who scored 3-5As for their STPM but didn't get offered medicine in their local uni apps.
2 - Those who did average during their pre-U but are insaf and determined to do better
3 - Those who did average and don't know what the hell they want to do.
4 - Scholars - MARA and JPA students

Reason why 1,2 and 3 chose Russia was because it was cheap. Not many can afford to go to UK, US, Australia. I can't imagine having to make my parents shell out >RM1 million just because I want to be a doctor. Money DOESN'T grow on trees. And as much as we want, some have siblings who also want to become future professionals.

Like I said before, the stuff they teach you here? TOP NOTCH. And if you've mastered Russian - a world of possibilities opens up for you. If the administrative side here would be more efficient, local unis don't even stand a chance.

The fact that they're lax with their policy on cheating doesn't mean that they don't try. For certain subjects, the lecturers had to constantly change the mcq programs but time and time again, the students would steal the newly reconstructed mcq programs. Eventually, the lecturers gave up.

During classes and lectures, lecturers go the extra mile to teach students - What's the response?
- "This teacher... teruk lah - teach everything that's not in the book, jump here jump there" when what the lecturer did was condense material from previous classes.

Tell me... As much as you hope to enlighten these future 'aspiring' doctors, what kind of "advice" are you going to give? Because from the looks of it, all you seem to have under that belt is a string of prejudices about something that frankly, you don't seem to know enough of.

Russians have lived a hard life that none of us can even begin to imagine. Most of us don't even know our own Malaysian history all that well apatah lagi the history and culture of another country? Here - You get what you paid for. And a whole lot more. What won't kill you will only make you stronger.

For the record - MMC has already de-recognized one of them. The final batch graduates next year. And as much as people tend to equate Ukraine to Russia, after USSR collapsed - Ukraine and Russia became 2 totally different countries.

that is not true........

This post has been edited by limeuu: Jun 1 2009, 02:59 PM

Guilty by association. That is what every doctor from Russia will be facing because of bad apples amongst them.

Can you tell me where did you obtain this piece of information? Because it's a blatant lie.
2 or 3 yes, but not 1/3. Tsk tsk tsk

Okay, maybe I was a bit harsh on the "flea-bag country" statement, and I do apologise. I will admit that it was the Russians who were first in space, first to send something to the moon, and gave us probably the most popular weapon on earth. Their literature has a place in this world, more than a few stations along the Moscow metro are amazing works of arts, and they did give us Dmitri Mendeleev and Dmitry Sklyarov. The Soyuz-TMA and Proton rockets are still going strong (which is more than I can say for the Space Shuttle).

All this from a nation which is very poor.

And prima facie, those who survive their medical schools and do come out of the other end seem to be strong. However, one has to ask, are they the rule, or the exception?

I will not be surprised if "there are those who come out with knowledge paralleling that of seasoned MOs". That is how the world works. I would be very impressed through, if the majority of Russian graduates are like that.

I know people who went to Russia. I have friends in KSMU. I did tell them the misgivings of the medical profession towards Russian medical schools. They have told me horror stories, but also anecdotes of resilience. Yes, their parents wanted them to be a doctor. Yes, money was a factor. No, they did not get straight A1's in SPM before they left to do a "foundation" program.

Some would say they are not qualified to be doctors. As they say, the proof is in the pudding. A pudding that my nourish me, or kill me.

Now I know why Russian roulette is named as such.

And I know "Melayu mudah lupa", but it wasn't that long ago when the MMC deregisted Crimea State Medical University (yes, I know it is in Ukraine), to howls of protest.And like everything else Malaysian, accusations of racism. But is it not limited to Ukrainian universities.

It is not politically viable to deregister any medical school in Malaysia.

I'll have to admit that I did slightly overexaggerate the number of UM dropouts/failures/quitters - For that I apologize. Broaden the scope and compare the number of those who enter and the number of those who graduate. More than just 2-3.

I was merely trying to point out a fact that most people do not know what they're getting themselves into when it comes to medicine or any other profession for that matter.

In the course of 6 years here in Moscow Medical Academy,

1. Microbiology class, students are taught the many different hands-on methods of cultivating the microbes, preparing slides using Gram stain, Kligler agar test, Ziehl-Neelsen staining, Methylene blue staining, Carbol fuchsin staining, and identifying the microbes involved.
   
   
2. Histology and Pathology classes, we're taught to identify slides based on their composition - healthy components from the neutrophils, engorged vessels, sclerosed/hypertrophied/atrophied glomerulus, etc etc etc
   What do these jokers do? Memorise the number on the slides(150+ numbered) and which number has what on what slide. Many don't even know what differentiates a large intestine slide from a small intestine. Or even what the word 'engorged' means.
   
   
3. Pharmacology - where most stumble. Unfortunately here we sometimes have what ranges from 20 - 40 students per class. BUT the teachers are nothing but strict. Efficient and merciless - they ask thinking questions NOT found in seniors' notes. Failing people on the dot for not knowing. But what happens during finals? Gune handsfree bawah tudung/long hair. Shocked siut dengar people bisik-bisik cam tu. (although, I suppose this practice has been going on for a while now for. I wonder just how long exactly?). Sure they tell you not to bring in your handphones - But what do you expect? Them to frisk every single student?
   
   
4. Clinical years - Try speaking broken, unintelligible English/Chinese/Malay to your patients and see what kinda answers you get? It sickens me to see students who hear sounds of a mitral prolapse and get so overly excited they forget there's an old man under that stethoscope. Even worse are those who don't know what they hear and 'fake' answers when the lecturers quiz them about it. We were taught the different heart and lung sounds - difference between types of murmurs, etc - I'll bet most have either forgotten or never bothered to learn it in the first place.

Humans - we forget. Too easily sometimes. Hence why there's the constant need to refresh our memory. What we have most are lazy students who're more interested in DOTA, anime, drama series and griping about the strict teachers that teach "too much". So what if most do well in the finals - with or without that 'toyol'? Main memorize je for exams. Hapak pun tak faham. Lagi la cepat lupe.

Pray tell, without Google and be honest with yourself, after all you only have yourself to answer to:
- What is absence seizure?
- Coronary steal syndrome?
- Ondine's Curse?
- Heard of aseptic peritonitis?

All these taught by 3rd year. Not the lecturer's fault the students don't know now is it?


On a separate note, rubbish bins are few and scattered around Moscow, and yet it's almost as clean as a whistle. Unlike Malaysia where tong sampah everywhere, but sampah merata-rata and even AROUND the tong sampah.

There's a difference between cultured and uncultured mentalities. All countries have varying degrees of the 2. Which one does Malaysia seem to have more of?

This post has been edited by it-int: Jun 1 2009, 11:43 PM

between 10-20% of every cohort will drop out, either completely or retained in a year........

almost all will be because they flunk out.......few quits.......

this is a standard attrition rate in all high quality med schools all over the world....(same in imu, but for slightly different reasons)......

when it doesn't happen in a med school, one will need to ask why.........

when the students starts to quit because 'most people do not know what they're getting themselves into when it comes to medicine'......then it is also time to ask what kind of selection process the med school has......quality med schools which selects carefully have few quitters........acquaint yourself with british med school selection process, for example......

This post has been edited by limeuu: Jun 1 2009, 11:59 PM

I have a question that is long in my mind here. Was PMC initially recognized by SMC? or PMC was never recognized by SMC before, and they only take in graduates on a case by case basis?

(coz I knew of PMC graduates that are working in SG)

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Added on June 2, 2009, 8:54 pmOh yea and...

Absence seizure is a type of generalised seizure known as petit mal seizure (i guess). Usually the person will blank out for a few seconds before regaining his consciousness again (posture remained).

I dont know what is coronory steal syndrome. I guess it's coronary artery got stenosed, so there was a higher pressure and blood flow generated from the collateral vessels to reperfuse areas which are supposed to be perfused by the stenosed vessel, leading to some hypoxia of the areas supply by the collaterals.

Ondine's curse is a curse when a patient lost in automaticity to breath (respi center something wrong). He can only breath when he remembered to breath. He must not sleep. (not sure about a mechanical ventilator).

Aseptic peritonitis means er... non infective peritonitis? I supposed it means it's a peritonitis without bacteria lol. Cause ar... er... autoimmune? foreign object?lol

But... are these important? i dont think i'll see a patient with ondine's curse in my life lol

This post has been edited by cygoh9: Jun 2 2009, 08:56 PM

it is a common mistake for medical students, to miss the woods for the trees.......

and somehow, the rarest disease is easily remembered......

Sigh

Somehow it seems pointless to try to reason with people who have become so prejudiced that words just don't seem to get through to them.

Even if common sense comes knocking on the door, it will NEVER get in unless you actually open the door.

To compare Russia and UK.... Can you even compare local unis to UK unis? You think Malaysia is so much better? Has anyone read THIS before? Tell me exactly how is this better in terms of cheating? SAMA JE.

My university requires all of us to have the "No Objection Certificate" (better known as the NOC letter) in order to study here. And who gives these letters out? So now what? Derecognize the government?

ALL my lecturers so far have been practicing doctors, researchers and professors with years of Russian experience. Some have even presented at international medical conferences. Been invited or paid to present in Russian, English, German. Some conduct ongoing researches and speak from experience of the results obtained.

I only just recently heard about SLAB and SLAI. If there's even an ounce of truth there then I'm rendered speechless because in that case, Moscow Medical Academy lecturers trump local universities'.

Tsk tsk tsk. You guys. To say shame on you would probably be too harsh - but there, I said it.

Just because you think some diseases are rare and irrelevant DOESN'T MEAN it's irrelevant. And it is SIMPLE COMMON SENSE to know about the common diseases but that should not restrict you from knowing about the rare ones. Are you implying that a person suffering from a rare disease is less deserving than one who suffers from a common disease? So because you are not well read enough and are unable to diagnose a patient suffering from a rare disease ultimately it EXEMPTS you from taking responsibility?

Doctors konon. Study just enough to pass. Yeah, it's rare therefore its unimportant - you wouldn't even know if you missed a diagnosis and caused the death of a patient. Ignorance is bliss isn't it?

Come on, dude. I'm really disappointed with a potential future doctor writing something like that. That sort of reaction is unwarranted. There is a lot of truth in what limeuu said. If you follow ward rounds in the hospitals you will realize that common diseases ARE far more important than rarer ones(from a doctor's point of view). Not because patients with these diseases are less deserving than those with more common diseases, but because you're going to be managing them far more frequently! There is a saying in medicine: "Common things occur commonly".

It is IMPOSSIBLE for a doctor to be able to achieve a right initial diagnosis ALL the time. We are all human, and try as we might, there are limits to our abilities. So yes, to a certain extent, missing an extremely rare diagnosis does absolve you from blame...the same way you wouldn't expect a single electrical engineer to explain ALL the details of say Core 2 Duo microprocessor design and operation(they have many teams of engineers working together to make things happen). However, missing a common diagnosis is far less excusable, especially with a fairly classic presentation. If you're in clinic and see a young Malaysian child with fever, shortness of breath and a productive cough would you consider infectious causes first or would you order a high-resolution CT of the thorax to rule out any microsopic lung cancer(NB:extremely unlikely!). Missing a diagnosis of early lung cancer(by not performing a high resolution CT, which by the way, exposes a patient to radiation risk) in such a case would be understandable....but missing pneumonia would not.

Some diseases are so rare that an average doctor might never see them in their lifetimes. If you apply the standard of "a doctor must be able to diagnose all dieseases, even extremely rare ones"....then i'm afraid no one would qualify to practice medicine.

We study to provide the best level of care to as many people as possible. And because our resources like time an energy are limited, we choose to devote more of them to common diseases. You write as if we live in an ideal world where doctors are all-knowing and infallible. Well, wake up kid. We're not!

This post has been edited by drgadgets: Jun 3 2009, 04:58 AM