Broad-based medical training will stay

28 Oct 2009, The Straits Times

Question

Name of the Person: Dr Francis Seow Choen

Don't end housemanship

I READ about the move by the Ministry of Health to shorten specialist medical training and remove the housemanship year with great concern ('Faster route for medical specialists', Oct 12).

If this move is to accommodate the graduate medical school partnership between Duke University in the United States and the National University of Singapore, then it is short-sighted.

The purpose of a graduate medical school is to get more mature doctors. This means doctors who are:

Older. Older doctors are supposedly better able to understand patients' needs and problems. This is because they have seen more patients and conditions. That is why both doctors and lawyers' businesses are called practices - because the longer they work, the more they know and understand; and

More experienced in life. This will supposedly give them an edge in the way they practise or research medicine.

I therefore cannot understand how cutting housemanship and shortening training years will help new doctors or indeed Singapore in the long run.

Cutting housemanship because the Duke-NUS Graduate Medical School's students are too old panders to the weak. To be a doctor is a calling to a life of service and, in some disciplines of medicine, a constant barrage of emergencies and patients in need of help.

Housemanship is an important time of training where a doctor is tried and tested - but under supervision. His attitude and responses in housemanship may later in his life make or break other patients' lives.

Our system, which is based on the English system, has stood the test of time. Not everything American or Continental European is good. The Duke-NUS student may have a degree in social work or physics, but without a broad-based training in medicine, when he becomes a resident in surgery for example, he may be an ignoramus in diabetes or hypertension.

And the old saying may really come true: 'The specialist is one who knows everything about nothing.'

Reply

Name of the Person: Karen Tan (Ms)

Director, Corporate Communications

Ministry of Health 

IN HIS letter last Saturday, 'Don't end housemanship', Dr Francis Seow Choon, a medical practitioner, chose to base his comments on media reports and not on the letter sent by the Ministry of Health's (MOH) director of medical services, Professor K. Satku, to all medical practitioners on Oct 2.

Dr Seow saw housemanship as an important year of 'broad-based training' and was concerned that MOH will end the housemanship year. This is unfounded.

In that letter, Prof Satku clearly writes, referring to direct entry speciality training on graduation, that 'a broad-based educational experience will be ensured during the first year of training, satisfying current housemanship requirements for graduates of the Yong Loo Lin School of Medicine'.

The strengths of housemanship will be retained and enhanced in the new system, while the option of traditional housemanship continues for those who do not choose the new residency programme. MOH has informed all graduands of the Yong Loo Lin School of Medicine of this at various meetings.

Dr Seow goes on to ask if these changes are being made because of the Duke-National University of Singapore (NUS) Graduate Medical School. The rationale for the changes is also stated clearly in Prof Satku's letter.

Dr Seow's comments about Duke-NUS Graduate Medical School graduates are most inappropriate for a professional colleague. I would like to quote Mr Phua Yiyong's Forum Online letter on Monday ('Don't rush to conclusions on training sans housemanship'): 'To call cutting housemanship pandering to the weak because it is supposedly tough and trains you for a lifetime of hardship just about discredits every doctor the other side of the globe.'

MOH is extremely concerned with maintaining standards in postgraduate medical education and learning. It would be short-sighted to ignore the need to develop a better system to train more specialists and family physicians to meet the nation's growing health-care needs. We are at the confluence where opportunity and apprehension to change meet. We look forward to a shared goal of better care for all Singaporeans through better training of our doctors.