Saturday, 20 August 2011

her last say

in her blog.....

How to supervise HO or junior doctors - my perspective

We have heard about story about competency of doctors nowadays especially HO. As HOD, I can see a lot of differences between HOs today and HOs many years back. I think there are various factors involved that make that differences. I can list down a few factors that I think are relevant for the differences.

a. Many years ago, there were only a few established local universities were recognised to train medical students with enough lectures and facilities. Selected students will be sent overseas to study medicine in recognised universities. But now, anyone can go to any universities for political reasons even to the unrecognised universities. We are now looking more towards numbers rather than qualities. We can't really blame the students for not performing sometimes. When you asked them, they said that they didn't have any exposure in certain disciplines. Lectures used to be cancelled many times due to many reasons. Sometimes they have to learn on their own without guidance. They learned from videos rather than real patients. Well, technology does play an important role in learning but to become a doctor I feel that we have to learn from a real patients.
b. I agree that we need changes in life or education system if the need is there. But don't make those changes for the sake of making changes or based on political pressure. When we politicised education, it will bring the whole system down. If the education system is almost perfect to produce good doctors why we have to change to a terrible one. If the changes needed, it should be done slowly and not abruptly. The education system keep on changing before you can see the outcome from the previous changes. When the minister change, the system change regardless how good the system is. I felt that the new medical education system is making the medical students more a follower and memorizer rather than having a critical and analytical thinking process. Their way of thinking is very compartmentalised rather than generalised. Intergrated system doesn't seem to help them in connecting their knowledge toward disease and patient as a whole.

c. Student factors. There are two extreme conditions. Those who got 4 flat during exam, all of them wanted to become a doctor even though they have no interest. Sometimes they are being forced by their parents. The parents dictate what their children need. Those who didn't get 4 flat but wanted to be a doctor badly have to go to the other universities in overseas where the training was terrible. There were another group of students who are second grader, badly wanted to be a doctor, went to the cheapest and affordable universities abroad under their parents scholarship and manage to go through the medical school with difficulty. Another group of students from the private universities whom their parents are well to do and not on any scholarship, don't really bother what's going on. Social background also play an important factor in determining the product of the good doctors. Mental, physical and innerself strength are important for the medical students to have because as a doctor, stress is part of our life. From my observation, our junior doctors are very weak and fragile on top of having lack of knowledge and attitude problems.

HOs many years ago easily can be trained, most of them. There were faster learner. They can stand alone after one month of initial training. They were more proactive and ever willing to learn. No questions asked. There will be no parents or politician interference. Rarely you hear that consultants or specialists being threatened by parents for teaching their children to become a good doctors. Now it become fairly routine. Yesteryears HOs were more polite and respect their seniors and superiors. Again I must say most of them. Therefore, one year HO training is adequate for them to be a safe doctors. They managed to handle many patients at one time. At the end of their housemanship, you will be able to see their maturation and competency. Now, the HO training is extended to 2 years duration. They have to go through all the disciplines in medicine before they can go out and practice on their own. Some of them need more than 2 years. There are so many of them, out numbers the patients. They come from various universities that you never heard before. 2 patients under their care, they can't even remember.

I attended a few motivational talk given by well known motivators talking about how to train the HOs. Look who is talking. I just smile to myself. Most of these motivators, they have left the government service long time ago and they don't really have the experience of training the new breed of HOs the way I and my friends do. It is very tough. The things that they do, the mistake that they have done are beyond our imagination. "Bodoh sombong pun ada". Sometimes you really have to go into the basic of medicine as if you are teaching the third year medical students. Attitude problems another one to handle. The worse thing is, went they make mistake they have no regrets. No guilty feeling. Caring is not in their vocab. Politeness is too far to practice. Some of them have no insight. For me, if the young doctors are incompetent and willing to learn, I will go all out to teach them and make them competent. It is my responsibility to ensure they are safe and the patients are safe as well. I am willing to take that challenge and I will do it my own way. You have to be firm and consistent. As a teacher or supervisor to these junior doctors, our aim is to make sure that the quality of medical services are up to the standard. If your are fast learner, you will leave my department on schedule but if you are slow learner, you will be with us till you learned. I don't really care what people say.

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