‘Doctors must provide value-based medicine’

ASPIRING healthcare professionals should be trained to provide “value-based medicine”.

They must understand the importance of evidence-based treatment that is cost-effective and acceptable to patients, said Universiti Malaya (UM) Medicine Faculty dean Prof Dr April Camilla Roslani.

This, however, can only happen if early exposure to the principles behind clinical research, including how research is done and how researchers manage to come up with statistical numbers, is given to students in their undergraduate days, added Dr April Camilla, who is an honorary fellow of the American College of Surgeons (ACS) and the American Society of Colon and Rectal Surgeons (ASCRS).

Cognisant of this, UM is working on a proposal – which is in the final stages before it is submitted for consideration – to incorporate an optional year of intercalation for its medical undergraduates to be involved in research, she told StarEdu.

“Creating new programmes or making changes to existing programmes takes time because they are subject to approval by regulatory bodies.

“As most of our medical undergraduates are scholarship holders, they are bound to contracts by their sponsors that stipulate their duration of study and it becomes a problem if the scholarship agreement is for five years.

“When a student decides to intercalate for a year, it may contravene the terms of agreement, which are among the aspects that need to be resolved,” she explained.

As the option to intercalate has yet to be established, she recommended medical undergraduates, especially those from non-research universities without affiliated hospitals listed as clinical trial sites, to seize opportunities through other methods.

“There are many research competitions or scientific conferences with a section for poster or oral presentations from medical students.

“At these events, students meet professionals from outside their institutions, and this allows the initial engagement that may lead to opportunities for collaboration and further research,” she offered.

Dr April Camilla also urged medical undergraduates to build their curricula vitae with clinical and research-related experience, especially if they are undecided about a career pathway between the two.

“If medical students are unsure of whether they want to pursue an academic research career, having some research-related achievements will be helpful because over time, it will be very hard to catch up with their colleagues who started early on.

“Even if they have decided to pursue a pure clinical career, just looking at years of experience and the number of cases seen, many medical graduates will fulfil those criteria, so the selection into training will be quite competitive, which makes research-related experience something that will help them stand apart from the rest,” she pointed out.

She added that while waiting for housemanship placements upon graduation, fresh medical graduates can apply to work on existing projects as research assistants.

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Additional one-year option

Weighing in on the need to give medical students early exposure to clinical research, Universiti Sains Malaysia (USM) School of Medical Sciences dean Prof Dr Abdul Razak Sulaiman is also in favour of the one-year research option in addition to the students’ five-year medical studies.

“With the current number of medical graduates produced by the country, it is time for Malaysian varsities to give medical students a choice to pursue an alternative path of one-year research during their medical studies and graduate with double degrees like Doctor of Medicine (MD) or Bachelor of Medicine-Bachelor of Surgery (MBBS) with Master of Science (MSc) or Master of Public Health (MPH).

“The extended programme of Doctorate of Medicine and of Philosophy (MD-PhD) is also an option,” he asserted.

Dr Abdul Razak added that while the research component has been embedded in the five-year course in Malaysian medical schools through exposure to research methodology and evidence-based medicine, the main focus has always been on the core component of clinical competencies.

At USM, he said, a research culture is introduced as early as the preclinical years.

“Students are taught the methodology of research, statistical analysis and research ethics. In the clinical years, they go through a specific community and research posting,” he shared.

He added that those who are interested in research will be able to go through specific training after they graduate, with some candidates being offered opportunities to join their lecturers as research assistants.

“Postgraduate training for clinical specialists offered by Malaysian universities makes research part of graduation requirements. Most high-impact research are led by medical specialists,” he said.

Fulfilling needs, filling gaps

Universiti Kebangsaan Malaysia (UKM) Medicine Faculty former dean Prof Dr Raja Affendi Raja Ali said several steps had been taken at the varsity to encourage a research culture among its medical undergraduates.

Among them were early research methodology exposure in the form of lectures and seminars, particularly during the preclinical years; student exchange and mobility programmes; research funding; and collaboration. “We also instituted the Special Study Module (SSM) to give Year Four medical students the chance to carry out actual medical research while they are studying.

“The study’s findings will be presented at the faculty’s scientific meeting and released in a medical journal that has undergone peer review.

“The module is conducted weekly throughout Year Four and the first seven weeks of Year Five.

“This helps students to polish up their communication, critical thinking, and data handling skills. Some of the research findings have been published in high-impact journals,” shared Dr Raja Affendi, who served as the faculty dean until March this year.

In addition, students who emerged the top 10% in the final year professional examination would be given research assistant positions while they wait for their housemanship postings, he said.Even with these measures in place, Dr Raja Affendi acknowledged that there are still many unmet needs and gaps for medical students to perform high-intensity research during their undergraduate studies.He urged lecturers to engage with pharmaceutical industries to obtain educational grants for specific research projects to be performed by medical students.

“This will enhance public-private smart partnership in performing important research to fulfil the needs and demands of the community, industry and country. Industrialisation and being enterprising in research is something that we should focus on heavily at present,” he stressed.

As performing clinical and basic science research requires a lot of money, he said lecturers are also strongly encouraged to apply for national, industry and international research grants.

“However, not all will succeed as the competition is stiff. Therefore, medical schools should also provide financial assistance in the form of research grants to allow lecturers to hire medical students to be their research assistants along with the support system to facilitate the smooth process of research.

“Perhaps the creation of a ‘one stop research centre’ will further enhance the research ecosystem in medical schools,” he said.

Zhi Yong, 22, a medical student at Universiti Malaya, is a participant of the BRATs Young Journalist Programme run by The Star’s Newspaper-in-Education (Star-NiE) team. To join Star-NiE’s online youth community, go to facebook.com/niebrats.

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THE VIEWS

Where there’s a will...

Universiti Malaya (UM) medical students share their take on clinical research

''By reaching out to my lecturers, I have been able to involve myself in eight research projects since my second year in medical school. Most of my initial projects were conceptualised by specialists or seniors who are content experts. As a student, I am able to play a significant role in literature review, data collection, extraction and analysis, and manuscript writing as I have more time to study patients’ records. My research has given me the opportunity to present my findings at the Asia Pacific Medical Education Conference, and has resulted in four publications in international peer-reviewed journals. My involvement in multiple projects has enabled me to get a glimpse of the process and challenges of producing good-quality scientific evidence.'' -Tan Chee Yang, 25, fifth year student, research in surgical care and medical education

''Research opportunities for medical students are available by approaching lecturers who are actively involved in research or by looking through social media pages such as ‘International Opportunities for Medical Students’ and ‘Malaysian Medical Students’ Network’ on Facebook. In my third year – where all students were required to complete a six-week research elective – I was involved in an interventional programme-based research which focused on tackling obesity among adolescents. My team members and I came under the supervision of paediatrics professors, a sports medicine team and dietitians. Through the research, I not only obtained direct results from the participants, but also learnt the process of clinical research, from formulating the research methodology to obtaining the ethics board’s approval and applying the various data analysis methods. With the project currently in the data analysis phase, I hope to present my findings at international conferences and publish an article in a peer-reviewed journal.'' -Muhamad Mirza Azri Dzulzalani, 23, fourth year student, research in paediatric endocrinology

''I participated in a clinical research on tuberculosis when my lecturer recruited medical students to join the team. I am currently involved in laboratory research on Covid-19 at the Tropical Infectious Diseases Research & Education Centre at UM as part of my medical school research elective attachment. For the clinical research, I was given a chance to contribute at every step, including doing a literature review, writing the proposal, collecting and interpreting data, and manuscript writing. We were highly encouraged to submit our research abstracts to various conferences to share our findings. For my laboratory research, I was given a lot of hands-on opportunities in collecting samples from eligible volunteers, processing and running tests on the samples in our laboratory, and subsequently interpreting the data and findings. Having conducted both clinical and laboratory research made me realise that there are many aspects of medicine that are not just about seeing patients in the hospital and treating them. Ultimately, conducting research is to better understand how diseases affect us and how to approach them to improve healthcare. Clinical care and research development are by no means superior to each other but rather, should progress in tandem and support each other, especially in the field of infectious diseases.'' -Gerald Ser Tze Zhen, 22, fourth year student, research in infectious diseases