It begins with a grant

Kelvin Teo

On 11 March 2010, I attended a welcome reception in Brisbane (Australia) organised by the Overseas Singaporeans Unit and the Singapore High Commission.

During the reception, the Deputy High Commissioner Cheong Min Foong revealed that the government is considering to provide a grant for Singaporeans studying medicine abroad.

I am currently pursuing a graduate entry MBBS program at the University of Queensland (UQ). Naturally, the news piqued my interest.

Positive signal from the government

At the symbolic level, it is a move of positive engagement towards the students; it is not an exaggeration to assert that some local students will feel more appreciated by our current system despite studying overseas, because they may view it as a direct address of their welfare, both cost-wise and future employment-wise.

The more the students feel appreciated by the system, the more likely they are to return. According to TodayOnline, Chief Executive of Changi General Hospital Mr Udairam noted that the award of the grant would be viewed positively by students, because they will be assured of a job upon graduation.

The proposal of a grant comes six months after Prime Minister Lee Hsien Loong signalled that Singapore would continue to look at ways to expand the core pool of local doctors, even after raising the annual intake at medical schools in Singapore to 350 new doctors a year. This number may not be enough to cope with a growing and ageing population.

Promoting diversity

Yet engaging overseas medical students is a lot more complicated, given the diversity of medical eduation abroad and more importantly, how overseas medical programs engage the Singapore healthcare scene. At the end of the day, it boils down to how medical graduates from a variety of universities absorb strong points of each other’s medical school training, and improve themselves in the art of medicine.

There is a saying that a practitioner of medicine should expose himself as widely as possible within his discipline in order to make himself a better doctor. Each medical school, be it local and overseas, has its strong points. Graduates from medical schools will bring with them the strong points of their medical education, and in the spirit of the Hippocratic Oath (some versions), they pass on their knowledge to fellow peers and budding doctors-in-training.

Hence, one obvious benefit of the government’s proposed plans to award pre-employment grants is that it will contribute in some sense to a diverse pool of medical graduates, and with exchange of strong points from their medical school experiences, will add on to the learning curves of the graduates during their postgraduate training years.

For instance, the Duke-NUS graduate medical school was set up with the goal of producing outstanding physician-scientists. Duke-NUS has a mandatory Year 3 research component, whilst UQ students will do a project which requires them to pursue independent research, that is usually of a clinical nature, i.e. dealing with clinical data rather than basic science research, whilst the nature of research that Duke-NUS students can pursue can be of a basic scientific nature to clinical-based ones.

Medical residency matching

Singapore hospitals can perhaps come up with a system that makes it more convenient for overseas medical students to do their electives here in Singapore. Usually, medical school programs will allow students to pursue electives at any part of the world.

A pro-active approach by our local hospital can be two-fold, tying up with medical programs overseas so that it will be among the listed hospitals that students can pursue their electives, and secondly, to set up a system to allow convenient access to pursuit of clinical electives, especially amongst Singaporean students who are pursuing their medical programs overseas.

These electives will definitely be useful for our returning medical graduates because it allows them to be familiarised with certain aspects of our healthcare system. The other improvement is perhaps to further address the issue of International Medical Graduates in the residency matching system.

Currently, the residency matching system is pretty elaborate on how year 5 medical students from the Yang Loo Lin School of Medicine can participate in the match process, but information about the training of medical graduates from overseas is scarce, and may not be entirely useful.

It is not clear about how the training process for overseas medical graduates will be conducted within the framework of the new system, or whether or not it will take the same route as our local medical graduates. More information on the training process will perhaps be more useful.

Accelerated training for MD holders

Moreover, the phenomenon of medical education is gradually moving towards the postgraduate-type of medical education. It is based on the American system which requires prospective applicants to earn a prior first degree before applying. Medical schools in the United Kingdom and Australia have moved towards accepting mature applicants with degrees from other disciplines.

There was a series of changes made to our postgraduate medical training system, which allows medical graduates who have decided to specialise enter specialty training as early as possible. Our postgraduate medical training system has evolved to include elements of the American system, where prospective medical graduates undergo a residency matching system upon decision of the medical specialty that they would want to eventually end up in.

There is a pre-pondering viewpoint that medical graduates should spend a number of years in general practice before specialising. The years in general practice will allow junior doctors to be adept at the clinical aspects of various organ systems. Whilst there are merits in exhorting medical graduates to spend a stint of their careers in general practice, I have observed some among my peers whom were mature students with prior degrees have an idea of the specialty that they are aiming for.

These students were not in favour of spending a stint of their career in general practice, and their explanations are reasonable – the time factor. With a shorter career than the former, mature medical students prefer a residency programme that allows them to enter specialty training quicker. Due to the fact that Singapore will have a mixture of mature doctors and those with an undergraduate medical education, it is probably reasonable to have an admixture of the Commonwealth and American system of postgraduate medical education.