Vol 19 No 1
Table of Contents
Message from the Master
Professor Victor Lim
The Reform of Medical Education
In 1908 the American Medical Association, concerned with the unsatisfactory state of many medical schools in the United States, approached the Carnegie Foundation for the Advancement of Teaching for assistance to conduct a comprehensive survey on the state of medical education in the country. The Foundation appointed Alexander Flexner, a retired headmaster of a private high school in Kentucky for the task. Flexner visited Johns Hopkins Medical College in Baltimore and after speaking with the faculty members decided to use the Johns Hopkins model as the benchmark for medical education. Flexner visited a total of 155 medical schools in Canada and the United States and produced in 1910 the Flexner Report.1 The Flexner Report was a landmark in setting standards for medical education not only in North America but all over the world. Within a decade of the publication of the Flexner Report a third of the 155 schools in North America had closed or had merged with other medical schools and by 1920 all the necessary structures for the standardization of medical education in North America had been established.
In the 1910 Report, Flexner identified four areas of concern. (i) There was lack of standardization among medical schools in terms of curriculum thus leading to poorly prepared students and variations in student achievements. Students were often taught by local practitioners to supplement their clinical income and schools were small and typically owned by doctors who ran them for a profit. Admission criteria were minimal and all graduated regardless of academic achievement. (ii) There was lack of integration between theory and practice with most medical schools relying on lectures and there was little or no laboratory or clinical sessions. (iii) There was a lack of inquiry and a scientific culture in many schools. Students relied on rote memorization of lectures (iv) There was little development of the professional identity as students had little opportunity to observe the behavior of doctors in practice.
Flexner made several key recommendations which had become standard features in all US and Canadian medical schools today. They include (i) admission to medical school based on a bachelor’s degree with a strong science background (ii) a university-based medical school providing two years of basic science instruction in laboratories and classrooms, and two years of clinical experience in a teaching hospital (iii) instruction by physician–scientists who engage in teaching, research, and patient care, bringing the benefits of the laboratory to the bedside (iv) experience with investigation through supervised participation in laboratories and university-based teaching hospitals.
Although the standards in the Flexner Report had served medical education well over the last 100 years; the new forces demand a relook of these standards. In a recent paper published in Academic Medicine recently, the authors call for a new model in view of the strains imposed by changes in the practice of medicine today.2 While the Flexnerian model had placed as paramount the educational mission; this may no longer be the case as the result of the revolution in biomedical research and the transformation of clinical practice into a business. The culture of “publish or perish” has made it increasingly difficult for faculty to conduct quality laboratorybased research and, at the same time, to continue to strive for teaching excellence. In more recent years the primary source of revenue of medical schools in the United States is derived from the clinical practice of its faculty members. The demands made by clinical service has further compressed or even eliminated time for teaching.
Like a century ago, medical education today is once again lacking in many aspects. Some of the major challenges identified by the authors are (i) medical training is inflexible, overly long, and not sufficiently learner-centered. (ii) clinical education largely emphasizes mastery of facts, inpatient clinical experience, and teaching by clinical faculty who have less and less time to teach (iii) hospitals with marginal capacity or willingness to support the teaching mission. (iv) poor connections between formal knowledge and experiential learning and inadequate attention to population health, health care delivery, patient safety, and quality improvement (v) learners lack a holistic view of patient experience and poorly understand the broader civic and advocacy roles of physicians. (vi) the pace and commercial nature of health care may hinder the inculcation of fundamental values of the profession.
These challenges to medical education do not seem too unfamiliar to us in Malaysia. Because of the mushrooming of medical schools in Malaysia, concerns have even been raised regarding the standard of education itself, concerns alluded to by Flexner a century ago. There is a need to have a comprehensive review of medical education in Malaysia based on a rational assessment of the kind of doctor Malaysia needs and a pragmatic evaluation of the numbers we require. The accreditation criteria developed by the Malaysian Medical Council and the Malaysian Qualifications Agency are generally still applicable but certain aspects may have to be revised. There are indications that the delivery of health care in Malaysia may soon undergo a significant transformation. Can the current medical education system produce practitioners who will function effectively in the new transformed environment? Should our focus be on training competent primary care physicians willing to serve in the rural areas? Are large tertiary teaching hospitals necessarily the best places to train our future doctors? Should not our accreditation criteria emphasise outcomes instead of processes? There are many more similar important questions that need answers. Our medical schools, the Ministry of Health, the relevant regulatory authorities, the professional societies and other major stakeholders need to come together to discuss and set the direction medical education in Malaysia should take. Last year the General Medical Council has revised the outcomes and standards for undergraduate medical training in the United Kingdom. The Association of Medical Faculties of Canada has also recently published similar recommendations. Perhaps it is timely that we do the same in Malaysia.
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"Radiology - The Core of Healthcare" at the 13th Asian Oceanian Congress of Radiology, Taipei International Convention Centre
20th - 23rd March 2010
by Dr Evelyn LM Ho
The 13th Asian Oceanian Congress of Radiology (AOCR2010) kicked off with concurrent tracks in musculoskeletal, abdominal, breast, cardiovascular, emergency, genitourinary and interventional specialities at 8.30am on Saturday, 20th March with world famous experts such as Donald L Resnick from San Diego, California, giving refresher topics on Injuries of the Knee: Detective Work for the Radiologist and Tendon Failure: Anatomy, Biomechanics, Pathophysiology and MR Imaging. Anne G Osborn, University Distinguished Professor of Radiology at the University of Utah School of Medicine, delivered one of the opening plenary lectures at the Opening Ceremony of the AOCR2010, the same afternoon. Chinese drums and a lion dance added fanfare to the Opening Ceremony.
The distinguished international faculty for the AOCR2010 boasted more than 100 speakers, whilst about 2000 participants descended on the Taipei International Convention Centre in Taipei, Taiwan Republic of China. The three and a half days were packed with myriad topics to choose from, case of the day, over 500 papers proffered (oral presentations, e-posters and printed posters) and a trade exhibition with close to 40 booths. Lunch symposiums as well as some satellite sessions were held in the nearby Grand Hyatt Taipei Hotel.
At the AOCR President’s Dinner, 20th March, the stipends for those who qualified for the Young Investigators’ Award/Scholarships were given out. One of the recipients was Ahmad Razali from Malaysia and he submitted a paper on the "Role of Superselective Embolisation in the Management of Acute Lower Gastrointestinal Haemorrhage".
The AOCR Banquet & Taiwan Night was held on 22nd March in the Grand Hotel, an imposing building with its ornate and traditional décor. Gold Medals of the AOSR were awarded to Alexander R Margulis from the USA and Sudarshan Aggarwal from India. Alexander Margulis, a renowned researcher, educator and administrator had dedicated his career to the advancement of radiology. His passion, achievement and contribution to the development of radiology and his international relationships and collaborations particularly with the AOSR have been widely recognised. Sudarshan Aggarwal‘s gold medal was accepted on his behalf by his son, Bharat Aggarwal. Sudarshan organised the tremendously successful 1991 AOCR in New Delhi and has contributed to the growth and development of global radiology. Both radiologists are recognised internationally for their sterling contributions.
The AOSR General Assembly was held on 21st March and the new AOSR Executive Council meeting was held the next day on 22nd March. Byung-Ihn Choi from Korea is the new President of the AOSR (2010-2012). The AOSR Executive Council also met with the President of the Radiological Society of North America (RSNA), Dr Hedvig Hricak and the Executive Director of the RSNA, Mark G Watson to explore areas where greater collaboration could be forged.
The AOCR2010 was organised by the Chinese Taipei Society of Radiology (CTSR) and co-hosted by the Asian Oceanian Society of Radiology (AOSR). Congratulations to Yi-Hong Chou, President of the AOCR Executive Committee and his team for an educational extravaganza and indeed, a congress to be remembered. The AOCR is now a biennial event and the next AOCR will be from 29th August to 2nd September, 2012, Sydney (www.aocr2012.com). So mark your calendar and see you in Sydney, mate!
About the AOSR
The Asian Oceanian Society of Radiology was established in 1971 with the aim of developing radiology in the region and enhancing the networking of doctors and researchers. It has 24 member national societies within the Asian and Oceanian region with about 12,000 individual members. Its main activities include hosting the biennial congress and educational programmes.
2010-2012 AOSR Executive Council
President: Byung-Ihn Choi (Korea)
President-Elect: Kazuro Sugimura (Japan)
Secretary: Kundur Probhakar Reddy (India)
Treasurer: Yi-Hong Chou (Chinese Taipei)
Immediate Past President: Jian-Ping Dai
Executive Committee Members: Winston E H Lim (Singapore), Evelyn Lai-Ming Ho (Malaysia), Stephen Chi-Wai Cheung
(Hong Kong), Dinesh Varma (Australia)
Melbourne, Australia (1971)
Manila, Philippines (1975)
Bangkok, Thailand (1983)
Seoul, Korea (1987)
New Delhi, India (1991)
Kuala Lumpur, Malaysia (1995)
Kobe, Japan (1998)
Hong Kong (2006)
Seoul, Korea (2008)
L to R: From Malaysia -
Prof Dr K H Ng, Dr Ahmad Razali and Dr Evelyn Ho
The AOSR Executive Council from L to R: Evelyn Ho,
Yi-Hong Chou, K P Reddy, Jian-Ping Dai, Byung-Ihn Choi,
Kazuro Sugimura, Winston Lim, Osamu Matsui
L to R: The AOSR Council meets with the
P Reddy Kundur, Ken Thompson, Evelyn Ho,
Mark Watson (CEO of the RSNA), Byung-Ihn Choi,
Hedvig Hricak (President of the RSNA),
Jian-Ping Dai, Osamu Matsui, Yi-Hong Chou &
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Dato' Dr Selvarajah Sivaguru - A Man of Distinction and His Moments
Dato' Dr Selvarajah who passed away on 7th January 2010 will be remembered as a man who had contributed immensely to the profession, as an ophthalmology surgeon, acclaimed within the country and overseas, a medical educationist and for his leadership in numerous professional bodies in the country.
Born in Johore Bahru in 1935, Selvarajah had his early education in the English College, before entering the University Malaya in Singapore for his medical education, graduating in 1958.
He then served as houseman and medical officer in the General Hospital Johore Bahru, before proceeding to the United Kingdom to further his postgraduate studies, obtaining the Fellowship in Ophthalmology of both the Royal Colleges of Edinburgh and England, On his return he served as ophthalmology consultant in Pahang, Johore before being elevated to the position of senior national consultant in his specialty in the then General Hospital, Kuala Lumpur.
In recognition of his service and contributions, Selvarajah was conferred Datoship by DYMM Sultan Pahang and Sultan Perak, and many honours ( JSM, JSD, SMJ and PIS) by DYMM SPB Yang di-Pertuan Agong.
On his retirement in 1990, he was appointed Professor of Ophthalmology in Universiti Kebangssan Malaysia, then in University Putra Malaysia, and also as guest professor in International Medical University.
In spite of his busy clinical and academic responsibilities, Selvarajah, had at various times served as the President of the Malaysian Medical Association (1978 - 1979), the Chairman of the Ophthalmological Society of the MMA (1982-1988), the President of he College of Surgeons of Malaysia (1987-1990), and had served as the Bursar of the Academy of Medicine of Malaysia (2008-2010)
It is noteworthy that Selvarajah also served as President of the Asia Pacific Academy of Ophthalmology (1995-1997).
Internationally, Selvarajah had been eminently recognised and had received numerous accolades, having been elected to membership of the Academy of Ophthalmological Internationale, appointed member of the International Council of Ophthalmology (1995-2000) and on its Advisory Committee (2001-2002).
Dato' Selvarajah was always an ardent supporter of Malaysian professional bodies, and continued to make his presence felt every year in the meetings of the Academy of Medicine of Malaysia and the Malaysian Medical Association, besides his specialty organisation. He was never a man to hold back in airing his opinions at these meetings, and imparted his experience and wisdom in guiding the activities of these august bodies.
He had served in numerous committees in the professional bodies locally and, as Chairman of Elections Committee of the MMA for many years he had to make many difficult but correct decisions.
Perhaps the final pivotal contribution of Dato’ Selvarajah was in compiling Volume II of the History of Medicine in Malaysia for the Academy of Medicine of Malaysia, covering the period in the development of medicine in the post-Independence period. It was an arduous and demanding assignment which he finally completed a year ago in spite of his illness. The publication has been published.
Dato’ Selvarajah was a man of consummate integrity, who carried his opinions on many topics with conviction, without fear or favour of consequences or outcomes. He always believed personally and intellectually that he was acting in the best interests of society and the profession. This was also reflected in the dignity of his personality and the upright stature of his physical bearing. It would have been extremely rare for anyone to have seen him withdrawn or dejected at any time, a personal fortitude which he had carried with dignity throughout his life, even up to the last few days.
All his friends, colleagues and relatives will miss Selvarajah dearly, and to Datin Khairun, his beloved wife, and their son, Sharman, we wish inner strength and peace during this difficult period.
A Tribute to Dato' Dr G A Sreenevasan
The medical fraternity of Malaysia lost one of its illustrious members recently when Dato’ Dr G A Sreenevasan died on 3rd February 2010 after a short illness. In a career that spanned nearly sixty years, Dato’ G A Sreenevasan contributed enormously not only to the discipline of his choice – Urology - but also to the development of the profession in the country as a whole.
Dato' Sreene as he was usually called graduated in Medicine from the University of Adelaide in 1951 and pursued a career in surgery after his early training. He became the first Malaysian to specialise in Urology. He initiated the development of the Institute of Urology and Nephrology at General Hospital Kuala Lumpur and was responsible for the training of the early batch of Urologists in the country. Dato’ Sreene was the first man to introduce Hemodialysis in the country in 1964. He distinguished himself in the field of Urology especially with his work on obstructive uropathy from renal calculi. He gained international recognition for his work in Urology and was made the Hunterian Professor of the Royal College of Surgeons of England in 1973 and also its Moynihan Lecturer in 1989. After his retirement from public service he continued his practice at Pantai Medical Centre.
His work outside Urology distinguished him as someone concerned about his profession, about his fellow men and his country. He campaigned tirelessly to promote professionalism amongst his fellow doctors exhorting frequently that only through ethical and caring practice that we doctors will be respected by society. He became the Master of the Academy of Medicine, Malaysia from 1973 to1976 and the President of the Malaysian Medical Association from 1976 to1977. He also became the Chairman of the Board of Managers of the National Kidney Foundation (NKF) for twenty-eight years from 1974 to 2002. It was during his tenure that the NKF started dialysis service for the less privileged members of society who had the misfortune of developing end stage renal failure. He was interested in all aspects of medical practice in the country. He chaired the first Fees Committee of the MMA which produced the Fees Schedule that was used in private practice. Towards the latter part of his career, he chaired the Academy of Medicine’s History of Medicine Committee and with the late Dato’ Dr Selvarajah produced the two volumes on the history of medicine in the country. The Academy recognised his contributions to the practice of Medicine in the country when it made him the first recipient of the Tun Dr Mahathir Mohamad Merit award in 2005.
Throughout the years of his leadership, Dato’ Sreenevasan assiduously advocated and constantly reminded the organisations he led of a value system that they should strive for. The principles he advocated were what guided the conduct of his personal life. He reminded us that we here to serve the community and we must always conduct ourselves with utmost integrity. There must be transparency and accountability in whatever we do. A deeply religious man he never looked for rewards in whatever he did. He will be dearly missed; the values he preached will always be with us and be even more relevant now given the challenges of present day practice.
To Datin Visalakshi and family we extend our deepest condolences.
By Dato' Dr Zaki Morad
Deputy Master, Academy of Medicine of Malaysia
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1st AMM-AMS-HKAM Tripartite Congress / 44th Malaysia-Singapore Congress of Medicine
"Benefits and Risks of Recent Medical Advances"
12th - 14th November 2010 - Hong Kong Academy of Medicine Jockey Club Building
The First Tripartite Congress of the Hong Kong Academy of Medicine, Academy of Medicine of Malaysia, and Academy of Medicine, Singapore, will be held from 12th to 14th November 2010 in Hong Kong. This will also be the 44th Malaysia-Singapore Congress of Medicine. The theme of the Congress is "Benefits and Risks of Recent Medical Advances".
|REGISTRATION FEE (per person)||EARLY BIRD RATE (before 1st June 2010)||Normal Rate|
|Fellow / Member of
AMM / AMS / HKAM
|HK $600||HK $800|
AMM / AMS / HKAM
|HK $300||HK $500|
|Paramedical Participant**||HK $300||HK $500|
|Other Local participant||HK $800||HK $1,000|
|Overseas Participant||HK $1,560||HK $1,950|
** Restricted to nurses, radiographers, allied health professionals and medical students in Hong Kong, Malaysia and Singapore.
Reference letter from the working company, academic institute or university may be required.
|12th November 2010, Friday|
|1700 - 1800||Registration|
|1800 - 2000||Opening Ceremony
Halnan Lecture (HKAM)
Tun Dr Ismail Oration (AMM)
|2000 - 2100||Welcome Reception|
|13th November 2010, Saturday|
|0900 - 1030||Symposium 1
Advances in Oncology
|0900 - 1030||Symposium 2
Advances in Transplantation
|1030 - 1100||Coffee|
|1100 - 1230||Symposium 3
Advances in DM
|1100 - 1230||Symposium 4
Advances in Emerging Infection
|1230 - 1400||Lunch|
|1400 - 1530||Symposium 5
Advances in Resuscitation
|1400 - 1530||Symposium 6
Advances in Spine Care
(Low Back Pain)
|1530 - 1600||Coffee|
|1600 - 1700||Symposium 7
Advances in Fetal Medicine
|1600 - 1700||Symposium 8
Advances in Preventive Medicine
|14th November 2010, Sunday|
|0900 - 1030||Symposium 9
Advances in Vascular /
|0900 - 1030||Symposium 10
Challenges in Substance Abuse
|1030 - 1100||Coffee|
|1100 - 1230||Symposium 11
Advances in Minimal Invasive Surgeries
|1100 - 1230||Symposium 12
Advances in Mental Health
|1230 - 1300||Closing|
Tripartite Congress Secretariat
Hong Kong Academy of Medicine
Room 808, HKAM Jockey Club Building, 99 Wong Chuk Hang Road, Aberdeen, Hong Kong
Tel: (852) 2871 8896 / 2871 8841 Fax: (852) 2871 8898
Email: email@example.com Web: www.tripartitecongress.org
Deadline for Abstract Submission: 31st July 2010
The Academy has arranged with a local travel agent for a package for members wishing to attend the 1st Tripartite Meeting.
Please contact Ms Jane Lee of Angel Tours (KL) Sdn Bhd (Tel: 603-21488288) if you are interested in this package.
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Inter-Academy Medical Panel Scientific Meeting and 3rd General Assembly
9th-11th June 2010 - The Corus Hotel, Jalan Ampang, Kuala Lumpur, Malaysia
Theme: Global Collaboration for Local Health Action
Day 1 (Wednesday, 9th June 2010)
|0830 - 1030||IAMP Executive Committee Meeting
Closed session. IAMP Executive Committee only
|0815 - 1230||Registration|
|0845 - 1030||
Symposium 1: CANCER CONTROL
|1030 - 1100||Morning Break|
|1100 - 1145||Keynote Address 1
HEALTH DEVELOPMENT GOALS: MALAYSIA'S ACHIEVEMENTS & CHALLENGES
Tan Sri Dato' Seri Dr Hj Mohd Ismail Merican, Director General of Health, Ministry of Health Malaysia
Keynote Address 2
HEALTH IN AN UNEQUAL WORLD
Sir Michael Marmot, WHO Social Determinants Commission
|1230 - 1330||Lunch Break|
|1330 - 1530||
Symposium 2: HEALTH SECTOR REFORM
|1530 - 1600||Afternoon Break|
|1600 - 1730||
Symposium 3: MEDICAL PRACTICE IN THE DEVELOPING WORLD
|1730 - 1930||Free|
|1930 - 2200||OPENING CEREMONY & Welcome Reception|
Day 2 (Thursday, 10th June 2010)
|0830 - 0915||Keynote Address 3
NEW CHANGING GLOBAL HEALTH RESEARCH ARCHITECTURE
Dr Anthony Mbewu, Global Forum for Health Research
|0915 - 1045||
Symposium 4: EMERGING INFECTIONS: LOCAL AND PANDEMIC ISSUES
|1045 - 1100||Morning Break|
|1100 - 1230||
Symposium 5: OBESITY IN THE 21ST CENTURY
|1230 - 1300||Closing Session for Scientific Meeting
Report by Chairs of the Symposia
|1300 - 1400||Lunch Break|
|1400 - 1530||IAMP Project Updates & Presentations|
|1530 - 1600||Afternoon Break|
|1600 - 1800||Special IAMP Round Table Discussion
Role of Academies in evidence-based advice
|1800 - 2000||Free|
|2000 - 2200||IAMP Official Dinner
By invitation only
Day 3 (Friday, 11th June 2010)
|0830 - 1030||Third General Assembly of IAMP For IAMP Members only|
|1030 - 1100||Morning Break|
|1100 - 1300||Third General Assembly of IAMP (Continued)|
|1300 - 1430||Lunch|
|1430 - 1630||IAMP Executive Committee Meeting
Closed session. IAMP Executive Committee only
|1630 - 1700||Afternoon Break & END|
Academy of Sciences Malaysia
902-4, Jalan Tun Ismail, 50480 Kuala Lumpur
Tel: 03-26949898 Fax: 03-26945858 Email: firstname.lastname@example.org
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The Multi-Purpose Hall at the Medical Academies Building is fully functional. Members and pharmaceutical companies are encouraged to use the Multi-Purpose Hall at the Academies Building for talks, seminars and meetings or even dinners.
Please contact the Academy Secretariat for more information:
Academy of Medicine of Malaysia
G-1, Medical Academies of Malaysia,
210, Jalan Tun Razak, 50400 Kuala Lumpur
TEL (603) 4023 4700, 4025 4700, 4025 3700
FAX (603) 4023 8100
EMAIL email@example.com, firstname.lastname@example.org
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