Family Medicine Specialisation in Malaysia
By: Assoc Prof Dr Kwa Siew Kim
Designation: Head of Department Family Medicine
Development of Family Medicine as a Specialty in Malaysia
Family Medicine trainees at present have the opportunity to select one of the following programmes to qualify as a Family Physician:
I. Masters of Family Medicine offered by three local public universities.
II.The Conjoint MAFP/FRACGP (Member of Academy of Family Physician of Malaysia/Fellow of Royal Australian College of General Practitioners) Vocational Training Programme (VTP) run by the Academy of Family Physicians of Malaysia (AFPM) which was previously known as College of General Practitioners of Malaysia.
I. Masters of Family Medicine in Public Universities
The Primary Care Department was first established in University Malaya (UM) in 1987 on the initiative of Council Members from the Malaysian College of General Practitioners. However its training in Master of Family Medicine was only recognised by the Ministry of Health when it conjoined with National University of Malaysia (Universiti Kebangsaan Malaysia, UKM). UKM started their postgraduate Family Medicine training programme in 1993 followed by Universiti Sains Malaysia (USM) in 1995. Currently three public universities offer this programme, i.e. UM, UKM and USM.
It is a four-year structured programme and the candidates must pass Part 1, Part 2 and Part 3 examination. Part 1 is at the end of first year, Part 2 at the end of third year and Part 3 is at the end of fourth year. Part 1 is a theory paper based on questions from Obstetrics and Gynaecology, Internal Medicine and Paediatrics. Part 2 includes theory and clinical examination on all the above subjects including other specialities. On passing, candidates can proceed to conduct a research thesis project. The Part 3 examination consists of satisfactory completion of the research project, practice diaries, case summaries and exit viva.
All the examinations are conducted conjointly with the three universities. There is a component of continuous assessment which is incorporated into the final marks. On fulfilment of all the requirements at the end of the fourth year, the trainee will be conferred the postgraduate degree of Master of Medicine (Family Medicine) and qualify as a Family Medicine Specialist (FMS). They will then work in the public Health Clinics and be gazetted by the government. They will enjoy salaries comparable with other clinical specialists in government service. Following post-graduation, the Ministry of Health grants awards for further training in areas like geriatrics, adolescent medicine, etc.
The programmes for the three different universities differ slightly in their course curriculum delivery but all students undergo the same Parts 1-3 conjoint examination.
Subjects taught include the principles of Family Medicine, Internal Medicine, Obstetric & Gynaecology, Paediatrics, Emergency Medicine, Surgery, Psychiatry, Orthopaedics, Anaesthesiology, Pathology, Geriatrics, Dermatology, Radiology, Ophthalmology and ENT. The clinical skills taught will enable them to make accurate diagnosis and implement relevant management including performing minor surgical procedures.
In addition, students are taught managerial skills to manage family medicine at the community level and carry out suitable intervention.
THEORY AND PRACTICE OF FAMILY MEDICINE (adapted from USM MSc FM Handbook)
Principles of Family Medicine
The graduate should be able to demonstrate:
1. The ability to make diagnoses which take into consideration the physical and psychosocial aspect of the illness using a problem-oriented approach.
2. Understanding in the different stages of human development and how they impact on the different tasks and health at each stage of life, e.g. childhood, adolescence, old age.
3. Understanding of normal and abnormal behaviour, in health and in sickness, in the family & community e.g. be able to cope with manipulative patients.
4. Understanding of the effects of the culture and class among the population e.g. awareness of traditional medicine, culture, religious proscriptions and prescriptions.
5. Ability to work in a healthcare team, as a member or leader, in rural or urban setting, serving patients of all ages and social strata.
The graduate should be able to demonstrate:
1. Understanding of various approaches to the consultation.
2. Understanding of the tasks of the consultation; e.g. to include opportunistic health promotion.
3. Ability to use different styles of consulting appropriately e.g. sometimes an authoritative style, sometimes a counselling style.
Approach to Clinical Care
The graduate should be able to:
1. Recognise early, treat and/or manage emergencies, i.e. acute and life-threatening diseases.
2. Detect and treat diseases early so as to prevent and reduce complications.
3. Recognise and treat a wide range of common conditions.
4. Recognise in chronic conditions the important factors requiring continuing care.
TEACHING AND LEARNING SKILLS
The graduate will be:
???? Committed to lifelong learning, able to use a variety of media, journals, meetings and audio-visual materials.
???? Able to transfer skills and knowledge about health to students, colleagues and the community, especially to women, children and the elderly.
???? Able to use adult education methods in health education, including working with the media.
The graduate should be able to show knowledge of:
???? The concept of health systems, specifically as applied to Malaysia.
???? The variety of systems in Malaysia e.g. Government, private, traditional and other community health services.
???? The health programmes in Malaysia e.g. Factories and Machinery Act, 1967.
The graduate should also be able to demonstrate application of principles of medical ethics and professionalism in his work.
The graduate needs to demonstrate knowledge of:
???? Setting up and managing a practice: finance, organization, selection and training of personnel, legal aspects.
???? Medical records and appointment systems.
???? Use of age, sex and disease register.
???? Use of the computer in family medicine