THE ultimate goal of medical education is to produce competent and ethical doctors. Universiti Kebangsaan Malaysia has gone a step further by including personal and professional development as part of its medical degree.
FROM gynaecology to cardiology, medicine is a career with many choices.
But there’s more to being a doctor than diagnosing patients and treating their illnesses.
A doctor’s personal and professional development is just as important.
Universiti Kebangsaan Malaysia (UKM) medical faculty dean and UKM medical centre director Prof Datuk Dr Lokman Saim said the ultimate goal of medical education is to produce competent, safe and ethical doctors.
“The recent trend among medical schools is to put emphasis on students’ personal and professional development, and for this to be assessed.
“Traditionally, students who began their clinical training in their third year often acquired their ‘professionalism’ by observing their seniors and specialists who trained and imparted not only their knowledge, but values to them. However, there was no way of knowing if the students actually picked and practised their good habits,’’ he said.
In traditional medical education, students had lectures in areas such as anatomy, pharmacology and biochemistry and spent time in laboratories in the first three years.
In their third year (of the medical degree), they would be sent for their clinical postings to hospitals where they would obtain further training in diagnosing patients.
“This has been the tradition and it is during clinical postings that students are supervised by doctors. Apart from getting hands-on training, the students can also gauge and observe the manner in which their superiors conduct themselves before patients.
“This is also the time when they (students) too build their own character in terms of bedside manners and ethics, and in doing so, acquire a level of professionalism for themselves.”
Prof Lokman however pointed out that “professionalism’ in itself, could not be taught.
Communicating with patients like how to convey bad news, and whether to tell family members of a patient’s illness, were in the past learnt through apprenticeship or clinical postings.
“But in the actual practice of medicine, besides the knowledge and clinical skills, professionalism is very important as it makes a doctor ethical, courteous and able to communicate well with patients.
“All this while, these factors were not formalised in the curriculum, but the recent trend in medical education is to include issues of personal and professional development as part of the curriculum,” he added.
In short, they have to be included in the medical curriculum to ensure that future doctors would turn out to be both compassionate and knowledgeable professionals.
The subject is called Personal and Professional Development (PPD) and is a part of UKM’s new five-year medical curriculum for students.
“PPD is emphasised in our new university curriculum as we have changed from the traditional curriculum to one which is more integrated and this is one of the subjects.
“University officials visited medical schools in Australia and the United Kingdom before reviewing the curriculum but the PPD and student camps are our own innovation,” he added.
Prof Lokman said this subject is taught throughout the five years of the medical degree, and is not limited to just one or two lectures on ethics or how to be a good doctor.
“We decided to add PPD in response to the demands of the society where we see many complaints regarding doctors, mainly due to ethical issues, doctors not being professional and most important is a problem with communication as some doctors don’t communicate.
“Very few problem cases are on inadequate skills or knowledge. Patients sue doctors because they don’t know how to communicate with them, not just in Malaysia but throughout the world,” he said.
The most common problem with some doctors is that they “see” patients but they do not say anything or look at them and just dispense the medicine, he added.
Since personality and professionalism are issues, it was decided that the medical curriculum at UKM should include them.
This is also the trend of medical education throughout the world, where personal and professional development are taught and assessed.
“If they have not passed the subject, they cannot graduate as doctors,” he said.
How PPD is taught
It is not just about lectures and notes for PPD but a mixture of learning styles.
There are several general concept lectures on ethics and professionalism but a person cannot change just by attending them, he added.
“The other method is to have small group discussions where they discuss real or simulated cases which involve ethical or personality issues.
“About 10 to 12 students will discuss the issue and come up with an opinion — again developing personality cannot be done in a big group,” he said, adding that the discussions are supervised by facilitators who are specialists.
Another method of teaching is to face simulated patient scenarios — where they are put in situations that would test their skills in dealing with a difficult patient, having to break bad news or how to explain procedures and obtaining consent for them from patients.
“This wasn’t taught previously, so some doctors could have explained the wrong thing or used very medical terms.
“We teach them how it should be done using layman terms,” he said.
Prof Lokman highlighted that camps to further emphasise students’ personal and professional development, are held three times during the five-year medical degree — in their first, third and fifth years of study. “Usually when students go camping, it is for leisure but this camp is part of the medical curriculum.
“They are gathered in a camp for four days with about 20 lecturers,” he said, adding that most activities are carried out in small groups of 10.
According to Prof Lokman, the objectives of these camps are to inculcate the spirit of working together as a team and leadership qualities.
The camps for first-year students are like a transition period as they prepare students to move from a school environment to one that houses doctors-in-the-making.
Besides seminars, there are also small group discussions on the importance of practising good values as well as the esssence and meaning of humanity, sincerity, kindness and love. At the first-year student camps, students also identify the attributes of good and bad doctors.
Fourth-year medical student Mohd Fadhli Mohd Fauzi said the camp is a good introduction to what life as a medical student is about.
“We learn about the different learning styles and time management too,” he said.
Mohd Fadhli who is also president of the medical student association, said the role plays during the camps are useful as they help with picking up skills.
“We are given a scenario and students will either act as patients and doctors so we can better understand what our patients go through,” he said.
Prof Lokman said selected movies which have legal and medico issues are also shown and students will then discuss them.
As an example, in the camp for first year students, the movie Patch Adams is shown — it is the story of Hunter “Patch” Adams (as portrayed by Robin Williams), a medical doctor who became famous for his unconventional approach to medicine.
But it is not all serious discussions as there is time for games and jungle trekking too.
Recalling one fun game, Mohd Fadhli said it was a telematch where groups of students had to dress in surgical scrubs and carry out activities — whoever was the fastest won the game.
“It was fun as we had to really work together till the end,” he added.
Another activity which Mohd Fadhli liked during the third year PPD camp was the white coat ceremony — when the facilitators gave them their white coats.
“It is a symbolic gesture as the third year is the first time we go to the hospital wards for our clinical postings,” he said.
Prof Lokman said other activities for the third-year student camps include the students demonstrating their abilities to work in a team and having sketches and role play.
“There are also small group discussions on confidentiality and the doctor-patient relationship,” he said.
At the third-year PPD camp, he said students discuss skills on keeping proper documentation for medico-legal records, death certificates, disease notification, sexual violence and child abuse.
There are also discussions on identifying misconduct and negligence in current medical practice.
“As an example, the students learn about medical certificates and the importance of not issuing them unethically,” said Prof Lokman.
Fifth-year medical student Farin Masra who has attended all three camps, feels they have helped her become a more holistic doctor in the making.
“The fifth-year student camp has also prepared me to become a houseman as I finish in eight months’ time,” she added.
Farin said the camps have also been useful as the facilitators themselves have shared what it is like to be practising doctors and the importance of balancing relationships with both patients and family.
Prof Lokman said feedback from students is that they enjoy the camps as it is a different environment from the university.
“These activities are all assessed. Facilitators give marks on students’ performance and participation.
“There are also mini tests and these marks are added up as a continuous assessment of how students are doing,” he added.
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