FOLLOWING the conclusion of the Malaysian Medical Summit 2021, this statement is being released to advocate for the improvement of the housemanship training system in Malaysia and welfare of house officers. Approximately 200 medical students based throughout the world assembled during the virtual international summit to produce a memorandum during the Malaysian Medics International (MMI) general assembly. With this memorandum, MMI calls upon various stakeholders to improve the housemanship training system in Malaysia for the betterment of its healthcare system.
Since the onset of the Covid-19 pandemic, there have been changes to the number of intake for house officers and quality of housemanship training. At the same time, the future of house officers remains insecure as several issues that lie within the contract system remain unresolved.
MMI thereby requests:
Six bimonthly house officer intakes per annum post-Covid-19
Due to the pandemic, the predetermined six annual intakes for housemanship training were not attained. Thus, we call for a return to this as soon as possible to cater to the increasing pools of medical graduates waiting for their training.
Firstly, we urge the Public Service Department (JPA), Human Resources Department and Health Ministry’s (MoH) Bahagian Pengurusan Latihan to establish a fixed housemanship intake structure and reinstate the six annual bimonthly intakes post-Covid-19 to accommodate the supply of medical graduates.
We suggest the disclosure of intake dates and release of a comprehensive guide (regarding the registration process and estimated timeline) on the e-housemen website with a one-month prior notice to facilitate the application process, with frequent updating and reviewing after establishment.
Post-pandemic, we call for a systematic plan to ensure the housemen graduation rate is progressively restored to free up training spaces. This includes methods such as, but not limited to, setting and enforcing district- and state-level targets (i.e. return to 15% of the original intake’s capacity every quarter) with consideration to housemen quality assurance, and appointing district MoH offices to set up networks between MoH hospitals for the flexible reallocation of housemen to better capacitating hospitals.
Addressing the quality of housemanship training
Our housemanship teaching system faces issues like burnout and a disproportionate teacher-to-student ratio. Senior doctors numbers are insufficient, leading existing senior doctors to feel overburdened in the government sector, and resulting in many departures from the system.
We request MoH, the Academy of Medicine of Malaysia and Finance Ministry to review the financial allocation for the healthcare sector, in comparison with regional peers. We propose to increase incentives to retain specialists and award scholarships for specialties required to accredit housemen training hospitals (e.g. O&G, orthopaedic and paediatrics), which enhances the learning of housemen with an improved teacher-to-student ratio.
We request the Malaysia Medical Council (MMC) and the cabinet to scrutinise and reduce the list of recognised universities in the Medical Act 1971 to diminish the glut of medical graduates without affecting current students and graduates. To create a healthy workplace culture, medical universities should initiate mentorship programmess to supplement medical education and empower student-driven initiatives.
We also humbly ask the medical fraternity to engage in open discussions with junior doctors as this will encourage a culture of teaching. Besides that, we hope MoH will consider initiating a feedback system for all houseman postings. Not only will this help bring meaningful changes, but it will show junior doctors that the healthcare system values them.
Enabling and improving specialisation pathways
We call on MoH, MMC and JPA to approve the extended 10-year contract system proposed by the Malaysian Medical Association. We recommend granting contract extensions on a 2+4+4 yearly basis, with further automatic extensions to allow the completion of speciality training and gazettement.
We recommend the expansion of the current list of accredited overseas postgraduate training programmes by the MMC. We also support the introduction of an education loan for medical officers (MOs) intending to pursue accredited postgraduate training programmes, with incentives (e.g. loan forgiveness) available to doctors that remain in public service post-specialisation.
We recommend that MoH adopt a new nomenclature system for MOs at different stages of training to clarify the different roles of MOs within the health system and facilitate the re-admittance of foreign-based speciality trainees to the Malaysian health system.
We recommend that MMC recognises time spent in speciality training under accredited postgraduate training programmes overseas and permits returning speciality trainees to take on more advanced duties, thus shortening the time to completion of speciality training. We also recommend a probation period for any returning speciality trainees, to ensure their quality is on a par with service needs.
Full transparency in the selection process for permanent position
While the selection criteria are published and a meritocratic selection process is promised, MMI calls upon more comprehensive selection criteria and transparent selection process should new permanent positions for medical officers are appointed. This will ensure the quality of the selected doctors and reduce candidate dissatisfaction.
We call upon the assessment of the doctors for permanent doctors in a fixed period (e.g. in the last posting of housemanship) using standardised and more comprehensive criteria. This includes the end-of-posting assessment, competency of procedures, operations assisted and case reports.
Candidates who have shown interest in specialisation by obtaining Part 1 of the parallel pathway examination (e.g. MRCS, MRCP or equivalent) or a passing grade in the Medical Specialist Pre-entrance Examination should also be given additional merit points in the selection process. Additional selection criteria could include research and voluntary work. We propose these selection scores and criteria for contract positions be known to all candidates under consideration through official correspondence or seminars.
We also suggest the publication of candidates’ overall performance score or ranking in a centralised system to ensure transparency.
This memorandum was tabled to MoH’s Medical Development Division deputy director Dr Shahrum Ismail. It is further supported by a list of medical societies and organisations in Malaysia.
House officers in training are future assets of our healthcare system. We plead that they are given the opportunity to maximise their potential during the training and be guaranteed specialisation options.
The housemanship training system and guidelines should be revised soon to ensure these young doctors are of quality to be able to serve the country to their best capacity.
Malaysian Medics International is an international medical student-led organisation that aims to connect, educate and cultivate
