What the future is like for us medical students? Quantity Over Quality?

Article By SMMAMS Chairman, Mr. Justin Lee

Take a moment, to make a few guesses.

1. How many medical schools we have in Malaysia?
2. From 2006 to 2009, the number of house officers in Malaysia increase by how many percents?

I am sure you have been hearing people saying "overcrowding of doctors", "lack of training opportunities" etc. I am also sure that there was a moment before when you read the newspaper and saw articles on college or universities setting up new medical courses, you, just like me, saying something like "not another one!". I also get worried when I read the ads on the papers advertising something that goes like "Fully English Medical Course in University XYZ, only require SPM CCC, less than 100k. Become Doctors Now!"

It is good to have more doctors serving Malaysia. Our country can do well with more doctors serving the Rakyat in government sector. However, rush to fulfill this goal may not be a good idea.

In 2006, 978 doctors entered housemanship training.

In 2009, 3150 doctors entered housemanship training.

This year, with more than 3650 HO thus far.

Look at how drastic the increase within 3 years! Which year are you graduating? How many doctors do you think will enter housemanship training the year you graduate? Experts have foreseen that by 2015 our country will have oversupply of doctors in the healthcare system,. This mass production of medical graduates would already quickly reach a doctor-patient ratio of 1:597, what the WHO has touted as optimum. The MMA is seriously concerned as to the likely glut, which will swamp the medical profession in the very near future.

There are currently 28 medical schools operating in Malaysia, with 37 medical programs, producing more than 2000 medical graduates a year LOCALLY, and this number will be increasing yearly, with the mushrooming establishment of new medical schools here and there! Another 2000 medical graduates return yearly from oversea medical schools.

Do you think there is a parellel increase in the housemanship training centre and adequate number of qualified experienced trainers? Many people are concerned that in the coming years, the competency and experience of a fully registered doctor in Malaysia may become critically flawed, and this pose risks to the quality of healthcare delivery in Malaysia. This pose risk to the patients we sworn not to harm.

Anyone of you ever wonder, you or me might be unemployed and have to beg for job when there is oversupply of doctors?

Clinical medicine is always learned in an appreticeship model. The apprentice follows and learns from his/ her teacher. Medicine is an art passed down from generation to generation. To think that MO who in charge of me when I start housemanship may not be genuinely interested in Medicine, scored a C C C in his SPM and was put through medical school only because his parents want him to do medicine, is kind of scary actually.

Nobody will stand up for the medical profession besides us, the medical professional. Currently, MMA is in the movement towards the regulations of the number of medical graduates. If you are concerned about the welfare and future of us, future doctors in Malaysia, then we will have to stand together, sail together in one ship.

What can you do now, as a medical student? Sign up as a MMA Student Member (SMMAMS). Give MMA the ability to strongly say that MMA represents you, the medical students, future doctors in Malaysia. An association, be it medical association or workers' association, can only stand strong for his profession if more people show their support for it, reflected by the number of members we have.

Bersatu teguh! Bercerai Roboh!

What will be the future of us? Malaysian doctors? Malaysia Health Care System?

QUANTITY OVER QUALITY?

Online Registration for Sports Medic 2010

Dear all colleagues,

You can now Online Register for the Intervarsity Sports Medic 2010 with us by click here.

Or if you found any difficulties in the online registration, just send us your details. After the online registration, we will direct you to your respective school's student representatives. Thank you so much.

If you found difficulties in online registration, just fill in the following:

1. State your corresponding email which we can reach you.

2. Subject: INTERVARSITY SPORTS MEDIC 2010

3. Please state the following: 

(a) Your name and your team mates' name if possible

(b) University/ college name

(c) Sports category which you are interested e.g. Badminton Double, Futsal etc.

(all your details will be sent to president.smmams@gmail.com)

Happy 53rd MERDEKA Day

To all Malaysians, Happy 53rd Independence Day!!! May our beloved country will continue to move forward to be a developed country and that all of us living peacefully and happily on our motherland.

Greetings from SMMAMS Committee

Site Upgrading

We are so sorry for the inconvenience caused. We are upgrading our site and if you found any problems with the online sports registration, please do drop us some comments. Yours comments and contributions are highly appreciated. Thanks!

Warmest regards,
SMMAMS

INTERVARSITY SPORTS MEDIC 2010 - Thinking of a Good & Meaningful Weekend?

DETAILS OF THE GAMES:

1. FUTSAL

• 8 persons per team
• Category (a) MALE (b) FEMALE
• Registration Fee : RM12 per person
  
  
  2. BASKETBALL
  
  8 persons per team
  
  Category: (a) MALE
  
  Registration Fee: RM 12 per person
  

(3) BADMINTON

• Groups : (a) Single (b) Double,
  
• Category : (i) MALE (ii) FEMALE
  
• Registration Fee : RM20 per person

Registrations are opened to all Malaysian medical students (SMMAMS / Non-SMMAMS member). Forms and official letter have been sent to your respective university's dean office and Student Representative Council.

Please register online with us and we will direct your university representative to you. Or if you have problems with the online registration, you can always email president.smmams@gmail.com on the games you want to participate. You should include the details like: 1) Name (please specify Mr/ Ms); 2) University and 3) Futsal/ Basketball/ Badminton (single/double)

To all student representatives / student bodies, if your school has not receive our invitation letter and registration form, please do not hesitate to contact the following person:

(a) Ms. Jayanthi Selvam - 012-2946077 (jeqq2005@gmail.com)

(b) Mr. Ravi - 017-7962634 (ravi_devilz@hotmail.com)

As some colleagues had asked "why only 3 games?". Well, this is the first time we are organizing such event and we hope to start good in a smaller scale. Maybe in the coming year, we will include other games like Bowling, Swimming, Chess, Table Tennis, Squash etc. Let us just come and participate in the above games. Winning is not the most important matter. You will have the great opportunity to make new friends and new networks here. Just come for fun!

Please feel free and do not hesitate to drop us your feedbacks and comments. We will be grateful to hear from you! Hope to see you soon here!

p/s : You can do SMMAMS a kind favour by clicking on the tiny facebook icon about 1 cm below this post. :)

Health Care Workers Equipments and Dress Code- A potential source of nosocomial infection

A colleague from UKM approached me, to do an interesting survey on medical students' dress code and its relationship with nosocomial infections.

Have you ever wonder that you might be a source of serious infections within the hospital settings? The lab coat you are wearing everyday, then you carry it back to your hostel or into the lecture theatre and so on. The stethoscope you use everyday to auscultate chestsssss of different patients, do you clean it before you proceed to next examination??

Please participate in our poll on the right side of the website, just take your time and choose the answer. Let see what is going on everyday around us!!

Thanks to Mr. Levin from Universiti Kebangsaan Malaysia for his inputs and ideas. Thanks to all visitors and medical students who spend their precious time reading our blog and answering the poll.

July & August 2010 Polls Result

We had done online polls and surveys from July 2010 to August 2010 regarding the incoming 3rd Malaysian International Medical Students Conference (MIMSC).

Productive Cough, Hemoptysis and Evening Rise of Temperature

A 34 years old male consults you because of cough, sputum production and mild hemoptysis. He has had evening rise of temperature for the past one month and claims to have lost 12 kg over 3 months period. On examination, he appeared to be chronically ill and cachexic. Carvenous breath sounds are heard over the right apex.

Chest X-Ray shows fluffy infiltrates and some amount of contraction of the right upper lobe. There is cavity in the superior segment of the right upper lobe. A working diagnosis of tuberculosis is made.

QUESTIONS:

1. Which spontaneously expectorated sputum would be adequate for the mycobacteriology lab? - A.M. sputum or 24 hours pooled specimen?

Fluorescent staining is positive for organism. ZN stain shows Acid Fast bacilli.

2. Is ZN stain specific for tuberculosis?

3. If the smear is positive, is there a need to send for culture?

He is a school teacher for standard 1, and the physician decided to admit him for hospital care. An intermediate strength of PPD was applied. There is 12mm induration in 48 hours.

4. How do you intepret the result? Does he has TB infection or disease?

We always ask about "Evening Rise in Temperature", as we know that it somehow point towards Tuberculosis infection.

5. What is the basis and reasons behind "EVENING RISE OF TEMPERATURE in TB"?

Source: www.meddean.luc.edu

8 Lies of a Mother... Something to share...

I came across this very interesting article from one of my Lions club's website and I found it very meaningful and wanted to share with every medical students out there. At times, we people in medical lines are so busy with our hectic lifestyles, postings, assignments, activities and we might be even more busy once we start our housemanship and venture deeper into the medical fields... perhaps you might want to read this.

It's a true story from a successful Malaysian who studied and worked abroad. Here we go:

***************************************************************************************

8 Lies of a Mother:

The story begins when I was a child: I was born poor, often we had not enough to eat. Whenever we have some food, Mother often gave me her portion of food. While she was transfering her rice into my bowl, she would say: "Eat this rice son! I am not hungry."

This was Mother's first lie.

As I grew, Mother gave up her spare time to fish in a river near my house; she hoped that from the fish she caught, she could give me a little bit more nutritious food for my growth. Once she had just caught 2 fishes, she would make fish soup. While I was having the soup, Mother would sit beside me and eat what was still left on the bone of the fish I had eaten; My heart was touched when I saw it. Once I gave my fish to her on my chopstick but she immediately refused it and said: "Eat this fish son! I don't really like fish."

This was Mother's Second Lie.

Then, in order to fund my education, Mother went to a Match factory to bring home some used matchboxes which she filled with fresh new matchsticks. This helped her to get some money to cover our daily needs. One wintry night I awoke to find Mother filling the matchboxes with candle lights. So I said, "Mother, go to sleep! It's late, you can continue working tomorrow morning." Mother smiled and said: "Go to sleep, son! I am not tired."

This was Mother's Third Lie.

When I had to sit my final examination, Mother accompanied me. After dawn, Mother waited me for hours in the heat of the sun. When the bell rang, I ran and meet her... Mother embraced me and poured me a glass of tea which she had prepared in a thermos. The tea was not as strong as my Mother's love. Seeing Mother covered with perspiration, I at once gave her my glass and asked her to drink too. Mother said: "Drink, Son! I am not thirsty."

This was Mother's Fourth Lie.

After Father's death, Mother has to play the role of single parent. She held on her former job; she had to fund our needs alone. Our family life was more complicated. We suffered from starvation. Seeing our family's condition worsening, my kind Uncle who lived nearby my house came to help us solve our problems big and small.

Our other neighbour saw that we were poverty stricken so they often advised my mother to marry again. But Mother refused to remarrying, saying "I don't need love."

This was Mother's Fifth Lie.

After I had finished my study and gotten a job, it was time for my old Mother to retire but she carried on going to the market every morning just to sell a few vegetables. I kept sending her money but she was steadfast and even sent the money back to me. She said: "I have enough money."

This was Mother's Sixth Lie.

I continued my part-time studies for my Master degree, funded by the American corporation for which I worked. I succeeded my studies. With a big jump in my salary, I decided to bring my Mother to enjoy life in America but Mother didn't want to bother her son. She said to me: "I am not used to high living."

This was Mother's Seventh Lie.

In her dotage, Mother was attacked by cancer and she had to be hospitalized. Now living far across the ocean, I went home and visit Mother who was bedridden after an operation. Mother tried to smile but I was heartbroken because she was so thin and feeble but Mother said: "Don't cry, Son! I am not in Pain."

This was Mother's Eighth Lie.

Telling me this, her Eighth Lie, she left me.....

M - O - T - H - E - R

"M" is for the million things she gave me.

"O" means Only that she is growing old.

"T" is the tears she shed to save me.

"H" is for her Heart of Gold.

"E" is for her Eyes with love-light shinning in them.

"R" means Right, and right she will always be.

Put them all together, they spelled "MOTHER".

A word that means the world to me...now, it may not mean so much, as I could have done a little bit more when she was alive.

-----------------------------------------------------------------------------------------------------

If your mum is still around, taking 2 hours drive back to your home town and pay her a visit won't kill you. If you are living with her, bringing her out for a dinner or shopping, won't kill you. Giving a surprise present to your mum when you are back from oversea trips wont kill you. Giving her a HUG, send her a sms saying "I love you Mum" wont kill you...

Humans are very weird. When we do not have something, we worked very hard to own that; when we have it, often we take it for granted. We will not appreciate whatever we have until we have lost it. So, don't give a chance for yourself to regret one day, for not appreciating whoever is around you now, especially your parents who are getting older and older.

Most of our time we are preoccupied by knowledges and information every day. We think that distinction students will become a good doctor. At times, we neglect the most important part of becoming a good doctor- "Love and Passion". It takes more than Med school to make a good doctor. To be a good loving doctor, you need to love yourself, take good care of your health, and next, love whoever around you: family, parents, siblings, partner, TRUE friends. Without loving yourself and people around you, it is hard for you to care about the patients. So, start from yourself and start from your home. Be a good loving son, loving brother/sister, you are half way of being a good loving doctor.

The journey of venturing deeper into the medical field, to be a good doctor, starts from Home!

*My english and grammars might not be perfect, please correct me if I written anything wrong. This is only my personal opinion, it doesn't represent the opinion of SMMAMS.

With warmest regards,

Vincent Khor

SMMAMS Webmaster

SELAMAT MENYAMBUT PERAYAAN

Kepada Semua Kawan-kawan Muslim,

Tulus Ikhlas daripada SMMAMS

A Neonate with Dysmorphic Facial Features

BACKGROUND:

A boy is born with a distinctive dysmorphic facial appearance to a mother with known epilepsy, who has been treated throughout the pregnancy with Valproic Acid.

WHAT IS THE DIAGNOSIS?

HINT: Note the characteristic physical appearance.

Prof. Barry Marshall and Helicobacter Pylori

Prof. Barry Marshall (left) and Prof. Robin Warren - Nobel Laureate 2005 for Physiology and Medicine - "for their discovery of Helicobacter Pylori and its role on gastritis and Peptic Ulcer Disease"

When we first study about the pathology of Gastritis and Peptic Ulcer Disease (PUD), we always came across "Helicobacter Pylori" in the etiology column. We all know that this is a Gram Negative spiral bacteria living in the stomach and duodenum, which causes inflammation in the stomach and duodenum and eventually causes Gastric Ulcer and Duodenal Ulcer respectively.

However, how many of you know about the history behind the discovery of H. Pylori 26 years ago? Who are the people discovered this bacteria? Unless you are interested in medical history and read constantly, I bet you don't know the answer.

Last Monday (2/8/2010), I have the honor to meet with the scientist cum gastroenterologist who discover the H.Pylori bacteria back in 1984. He is also the Nobel Laureate 2005 for Physiology and Medicine --> Prof. Dr. Barry Marshall.

Prof. Barry Marshall, together with 2 other scientists from University of Western Australia (UWA) were invited by Sunway University College, to deliver their inspiring talk and experience sharing to the students and faculty members there. And of course, I pay more attention on the talk by Prof. Barry Marshall.

First of all, let us go briefly about how Prof. Barry Marshall discover this bacteria and then won the Nobel Prize. Prof. Barry Marshall was invited by Prof. Robin Warren study on the cases where the stomach was found red in colour during autopsy and also spiral shaped bacteria was found during the histopathological studies. They then conduct a 100 persons research study, which according to him, it is easier to count the percentage!! (I think it was a joke!) One day, they successfully cultured the bacteria, and they were trying to infect in the animal models. Unfortunately, the human bacteria doesn't infect the animals. So, Prof. Barry Marshall took up the courages to drink the bacteria culture, and he ended up vomiting for 5 days. After that, his colleagues put an endoscope on him and found his gastric mucosa to be severely inflammed.

Prof. Barry Marshall and Prof. Robin attempted to publish their first paper on 1983, but was rejected for some commercial reasons behind (Gastric medication were huge income for pharmaceutical firm on that time). On 1994, they successfully proved that H. Pylori bacteria is the culprit behind the pathogenesis of gastritis and PUD, which fullfilled the criterias of Koch's Postulates. Then on 2005, both of these great physicians were awarded the Nobel Prize for Physiology and Medicine.

First rejection letter from Journal Editorial (an encouragement for him to keep moving forward and keen on his research study) "the fruit of never giving up"

Prof Barry Marshall as the "Guinea-pig-doctor" who drink the H.Pylori culture and found the cause of PUD.

Prof. Barry Marshall felt ill and vomited for about 5 days after he drank the bacteria culture.

Repeated troublesome endoscopies motivate him to develop a simple non-invasive test which is available today - Urea Breath Test

During the sharing session titled "Before and After Nobel Prize", he encouraged us to put our passion and interest in science. He said, there are thousand times of failure and rejection behind a great success, just as his achievement for example, which he had face multiple criticism and rejections from colleagues and other parties. He even showed us his rejection letter from the Journal Editorial for his first attempt to publish the study.

Well, how does Helicobacter Pylori gets it's name? According to Prof. Barry Marshall, it was because there were times where he travelled with Helicopter quite frequently, so that "Helico" came his mind when he named the spiral shaped Gram Negative bacteria. (Although the meaning we learned in Microbiology, it is the helical and spiral shape of H.Pylori, so I think it was just a joke from him.)

One of the interesting thing he had said was that he compared himself with Prof. Robert Koch. Both of them seems to have some coincidence:

Prof. Robert Koch - successfully cultured the Koch Bacillus (tubercle bacillus) on 1884

successfully proved the Koch's Postulates on 1894

Awarded Nobel Prize on 1905

Prof. Barry Marshall - successfully cultured H. Pylori on 1984

successfully proved the etiological role of H. Pylori in PUD using the Koch's postulates on 1994.

Awarded Nobel Prize on 2005

During the sessions, he also shared with us about his current study on Oral H. Pylori Vaccines and harmless H.pylori as vector to deliver other vaccines into the gut of human beings.

It was a great day I ever had and it was a great honor to meet and listen to him. Meeting with wise men is better than 10 years study of books.

For more information, you can visit the Helicobacter Foundation and Prof. Barry Marshall on Nobel Laureate website.

Stimulating Student's Interest in Physiology: the Inter Medical School Physiology Quiz

Research article by:

Professor Dr. Cheng Hwee-Ming

Department of Physiology, Faculty of Medicine, University of Malaya, Kuala Lumpur.

The Inter-Medical school physiology quiz (IMSPQ) was initiated in 2003 during my last sabbatical from the Universiti Malaya. At this inaugural event, there were just 7 competiting teams from Malaysian Medical Schools. The challenge trophy for IMSPQ is named in honor of Prof. A. Raman. Prof. Raman was the first Malaysian Professor of Physiology in and University of Malaya and he passed away suddenly due to cardiac arrest on 1998.

The interest generated by this physiology quiz has been very encouraging. At the sixth IMSPQ in 2008 and 7th IMSPQ in 2009, the competition expanded to >30 teams with more than half of the teams from overseas. IMSPQ gatherings have included medical students from Taiwan, Hong Kong, China, Thailand, Philippines, Indonesia, Singapore, India, Sri Lanka, Australia and the Czech republic.

The IMSPQ has become a wonderful platform for international students to meet and establish friendships. The accompanying lecturers of the teams also have the opportunity to network and share interest in the teaching of physiology.

I had personally participated once in the quiz, on 2008. It was amazing and it had successfully stimulated my interest in physiology. Unfortunately, I am unable to participate in the 2009 quiz as I have classes and could not take leave to participate in this meaningful event. However, I am participating this year again. Besides competition, I have the opportunity to meet and social with medical students from different parts of the world. If you have not registered for this quiz, never mind, its ok!! Please come on 25 September at University of Malaya to witness the great "battle" among the universities. I am looking forward to see all of you there!!

Please click here to download and read the full article by Prof. Dr. Cheng.

Click here to download the program booklets of 7th Inter-Medical School Physiology Quiz. It is interesting. Please download it and have a look!