Heavy Rain

The SMART Tunnel has been closed for the last 3 days and there was no sign of it being opened. It has been consistently raining heavily by late afternoon and today, the heavy downpour hit me hard while driving home from my lecture in Kelang. I thought of ex aping early, by leaving the hospital before 4. By the time I reached Puchong, it started to rain and I made the mistake of driving into town rather than endure the carpark that was MRR2.

Halfway in, I saw the message that the SMART tunnel was closed for flood mitigation operation. Oh dear! I only managed to reach home just after six. A solid couple of hours in the car. Certainly not good for my sanity I would've thought!

Short Cases

I have just completed a three-day stint, assessing my Medical Students through short case examinations as part of their end-of-posting assessments. 44 students, 3 days. 15 students per session on average, when you have to locate the patients and material for discussion. It was hard work. The main issue was the venue. It was a general third class ward, and there were no proper place to conduct a proper assessment or engage in discussion. It was too noisy and loud. Patients, doctors and relatives were everywhere. Patients were hot and grumpy. Getting through the 15 students at 10 minutes each, even if we stick to the time, will set me back 2 and a half hour.

By noon, everyone was grumpy and the lunch trolley have already started its rounds. So planning was the key.

Planning .... and planningThe main obstacle I had was actually something very different. As I can’t bar the student from entering the ward, they were practically hovering around me, spying while I was performing assessment. Worst still, they had been practicing on the patients I planned to use, and by the time I got around to use them, they were already tired and irritated. Sigh! So, the students were smart after all. Smart enough to make my life miserable! And I was sure you won’t like a miserable examiner, or do you?

Thank you and see you next week

As I mentioned earlier, next week will be exam week in Kelang and with the Xmas break coming up, it was understandable that once the exam was done, everybody would start to shut down. Some have even made plans to return to Mum and Dad - the one from Cameron Highlands, you know who you are! Since I will not be taking any formal classes next week, the students asked me to join them for some afternoon tea. We did so at the nearby Pizza Hut - apparently at the only shopping mall in Kelang as they admitted so grudgingly.

I left my wallet at home, so I was not able to fork out any park of the bill. I did offer to clean the plates and mop the floor however. It was nice to chat with them in matters outside medicine for a change. They tried hard however to pry out any clues from next week exam, but I managed to resist it. So, to all of you, good luck and please calm down and not get too excited during the clinical short case. If you just follow the steps, all of you will be fine. I shall see you next week!

It was raining outside

It looked like it would be raining outside. I just had lunch and was about to leave for Friday Prayers. But with the rain, I may have to give it a rest.

Today would mark the third week that I would be in Kelang teaching my Medical Students. I have another week to go, but it would be the exam week then. So, the students were understandably anxious - Malaysian education system is exam-driven, right from kindergarten to Medical School. We finished our clinical session just now and after another tutorial this afternoon, that would be it for the week. They had another pair of lecturers before me for four weeks, so all together they would have a total 7 weeks of teaching. For the exam next week, I prepared an essay question, as well as organising the clinical examination short cases for each one of them. All 44 of them.

When I first started coming to Kelang back in 2004, there were only 32 students in my class. All of them have graduated, and some of them still kept in touch. It was easy as I enjoy teaching, but 44 students to one lecturer was just way too much. There were too many compromises being made, and in the three weeks I had so far with them, I was sure not all of the students were happy. They had to understand however that I can;t please everyone, not it was my job to please them.

I kept on stressing to the department and the students that my role here in Kelang would be to facilitate teaching. Facilitating does not mean spoon-feeding them with information. As Medicine was such a wide and varied subject, I was not capable, or should be expected to be able to know everything. The pace of the development in Medicine was also very rapid. I read journals just to keep up and it was not easy to stay at the cutting edge of things. But at least the UM Medical Students should be grateful. They have dedicated lecturers who came and taught, them, not only from my department, but from Surgical, Gynaecology and Paediatrics as well. I can name a few other medical schools who struggle to keep up. They may have far too many medical students to cope with and were not able to supervise all of them. Here, at UM, even though we had to struggle at times, we tried our best to keep up and were successful most of the time. But I was not sure how long we can keep up with the 44 to 1 ratio. It was starting to break my back ….. I was worried that we give too much emphasis on quantity rather than quality.

The students complained that they did not have enough teaching. The lecturers complained that it was too much work to do going about teaching these large group. The Management were under pressure to produce more doctors by the powers that be. And I understood that Malaysia needed more doctors in general. The solution here may be very obvious. We need more lecturers. We need more people on the ground. We need to recruit more people. We need to bring the 44:1 ratio down. But there were not too many people to take up the task of being medical lecturers as it took time and commitment to do it well. There were many more easier path to take on to progress in medical career compared to being a lecturer. It was a vicious cycle. But we have to start somewhere and we have to make the job of being a lecturer more attractive.We have to start paying the medical lecturers better salary. Certainly there were move in that direction, but would be enough to make the carrer choice more attractive would it be able to make the career choice more attractive , than say, a chronic MO in Kementerian Kesihatan. I bet some of them were paid more than me doing half the amount of work.

It was raining heavily outside. It looked like that I will be missing my Friday prayers. 

Return to Kelang

The last time I was posted to teach in Kelang, I have not even started the blog yet. It must have been close to 3 years back. Certainly a long of things have changed. I also remember still the first time I was posted here back in 2004. Idlan was only just born and the partner I was assigned with have left for private practice. It certainly have been a long time since I first step there and for old time sake, let see what had happened.

The session being plannedThe first thing I noticed was the number of crows around the place. The number had certainly gone down. It was a norm to have team of shooters doing the rounds there shooting these pesky birds down. Walking from the hostel to the hospital building was also a risk. You never know what would land on your head if you were not careful. The place has certainly been better kept. A lot of investment has gone in with the building of a new multistory car park and an outpatient complex. There was a new cafeteria there - where I now have lunch.

Give me more roti canaiThe hostel building. Not much change there.I also remember looking forward for a proper roti canai at another cafeteria there - the one in the old building, near the Casualty. I was disappointed with the offering on my last stint there, but this week, it was very nice, although the curry could have been better. The wards were just as crowded as ever, although the main medical ward had managed to rid of their dengue patient to a new designated ward. I remember at least 50% of admissions every night into the medical ward was dengue back then. The patients were still as grumpy and the condition were less than ideal for teaching medical students, especially those who were just learning their trade. The first teachers are very in important in getting the students to get into the right habit. With the less than ideal condition on offer, it would take a lot of commitment to get things right.

The new outpatients buildingThere was also this tendency amongst the students to make sure all their boxes were ticked. They were more adept at making sure that the lecturer cover as wide a range of subject as possible, but the danger of that would be the compromise in quality. On a personal level, I much prefer the qualitative approach rather than getting as much done as possible. That was easier said than done, and as a result I can appear to be too overbearing and tend to elaborate more than I possibly need to. But then again, that was me, and I can only strive to do the best that I can. So, quality boys and girls, rather than quality.

Taking notesTaking a breatherAlong the same vein, the class size has certainly increased along the years. There used to be around 30 to 32 students per group. The current group I have was 44, including a number of students who dropped down a year. This will certainly put a strain on things especially in the final week, during which I will be taking them for a short case examinations. 44 students. All for short case. Sigh!

On a personal note, the lady in charge for the program in Kelang for the UM side has also changed. It used to be Kak Ani. She has since retired. It was now Kak Salmah. It will take a while for me to get to know her. The lecture schedules were still the same, but apparently, the Consultants would be coming here more regularly than before. I will have to wait to see how things pan out.