말레이시아의 의학교육: 질 vs 양 (Perspect Med Educ, 2017)

말레이시아의 의학교육: 질 vs 양 (Perspect Med Educ, 2017)
Medical education in Malaysia: quality versus quantity
Rebecca S. Y. Wong1 · Samiah Yasmin Abdul Kadir1

 

말레이시아의 의학교육은 1963년 말라야 대학교 의과대학 설립으로 거슬러 올라가는 오랜 역사를 가지고 있습니다[1]. 현재 말레이시아에는 32개의 의과대학이 있습니다(공립 11개, 사립 21개). 2014년 말 기준 말레이시아 의과대학에 재학 중인 학생 수는 18,789명이며, 해외에서 의학을 공부하는 말레이시아인은 약 15,000명으로 추산됩니다[2]. 이는 향후 5년 내에 3만 명의 의사가 말레이시아 의료 시스템에 합류하고 2018년까지 의사 수가 두 배가 될 것임을 의미합니다[2]. 이러한 의사 대량 배출을 정당화하기 위해 세계보건기구(WHO)가 권고하는 선진국의 인구 400명당 의사 1명의 비율은 종종 사용되어 왔습니다. 
Medical education in Malaysia has a long history dating back to the establishment of the Faculty of Medicine at the University of Malaya in 1963 [1]. Currently, there are 32 medical schools in the country (11 public and 21 private). At the end of 2014, there were 18,789 students in all years in Malaysian medical schools and another estimated 15,000 Malaysians studying medicine abroad [2]. This implies that 30,000 doctors will join the Malaysian healthcare system within the next five years and by 2018 the number of doctors will double [2]. The World Health Organisation’s (WHO) recommendation of 1 doctor to 400 persons for a developed nation has frequently been used to justify this mass production of doctors.

의사가 너무 많은 것도 문제가 될 수 있지만, 질이 낮은 의사가 너무 많으면 문제가 더 악화될 수 있습니다. 2009년 이후 의학을 공부하기 위해 외국 대학에 입학하는 의대생의 20%가 최소 입학 자격을 갖추지 못했으며[3], 말레이시아 주류 언론에서는 의대 졸업생의 자질 부족에 대한 뉴스가 심심찮게 보도되고 있습니다. 특히 지난 10년간 의과대학의 확산과 관련된 또 다른 문제는 학교 자체의 질입니다. 최근 몇 년 동안 소규모 또는 덜 안정적인 사립 의과대학이 재정 문제에 직면하여 일부 의과대학이 문을 닫거나 국제 파트너가 협력을 철회했다는 보고가 있었습니다. 
While having too many doctors can be problematic, having too many poor-quality doctors can certainly worsen the problem. Since 2009, 20% of the medical students who enter foreign universities to study medicine lack the minimum entry qualifications [3] and news on the poor quality of medical graduates is not uncommon in the mainstream media of Malaysia. Another issue concerning the proliferation of medical schools, particularly in the past decade, is the quality of the schools themselves. In recent years there have been reports of smaller or less stable private medical schools facing financial problems, with some of them closing down or having their international partners withdraw their collaboration.

수량 문제를 해결하기 위해 정부는 2010년에 의대 입학 프로그램을 5년간 유예(2011년부터 2016년까지)한다고 발표했고[4], 2014년부터는 공립 의대에 입학하는 학생 수가 감소하고 있습니다. 또한, 소규모 의과대학이 문을 닫거나 규모를 축소하거나 소규모 캠퍼스를 대규모 캠퍼스로 합병하는 등 업계에서 이미 일부 통폐합이 이루어지고 있습니다[5].
To combat the issue of quantity, the government announced a five-year moratorium (from 2011 to 2016) on medical programmes in 2010 [4], whereas in 2014, the number of students being accepted into public medical schools has decreased. Besides, some consolidation has already taken place in the industry with the smaller players closing down, downsizing or the merging of the smaller campuses into bigger ones [5].

한편, 인턴십 기간이 1년에서 2년으로 연장된 것은 2008년부터 시작되었습니다. 이는 교육의 질 문제를 해결하기 위한 것이지만, 또 다른 문제를 야기했습니다. 의대 졸업생이 증가하고 인턴 기간이 연장되면서 국공립 병원에는 하우스 오피서가 넘쳐나고 있습니다. 최근에는 2015년에 보건부가 더 이상 인턴십 배치를 주선하지 않고 의대 졸업생이 직접 인턴십을 제공하는 국공립 병원에 지원해야 한다고 발표했습니다[6]. 이로 인해 공석이 한정되어 있고 의대 졸업생 수가 증가함에 따라 인턴십 대기 기간이 길어질 수 있습니다.
On the other hand, the extension of the duration of internship from one to two years started in 2008. While this is supposed to address the issue of quality, it has contributed to yet another problem. With the rising number of medical graduates and the extension of internship, the public hospitals are now flooded with house officers. More recently, in 2015, the government announced that the Ministry of Health will no longer arrange internship placements and that medical graduates are to apply to the government hospitals that offer internship themselves [6]. This may result in a longer wait for internship as there are limited vacancies and an increasing number of medical graduates.

말레이시아의 의료 시스템과 의료 교육이 직면한 몇 가지 시급한 문제를 해결하기 위해 현재 상황을 개선하기 위해 다음과 같은 조치를 취할 것을 제안합니다:
With a handful of burning issues facing the healthcare system and medical education in Malaysia, we propose that the following actions are taken to improve the current situation:

• 전략적 장기 계획: 말레이시아의 의학교육을 위한 전략적 10년 이상의 장기 계획은 매우 중요합니다. 의료 및 의학교육 시스템에 변화를 부과하고 모니터링할 수 있는 보다 체계적인 방법이 있어야 합니다.
  A strategic long-term plan: A strategic ten-year or longer-term plan for medical education in Malaysia is crucial. There must be a more organized way of imposing and monitoring changes in the healthcare and medical education systems.
• 글로벌 표준 준수: 말레이시아 의과대학은 세계의학교육연맹(WFME)에서 정한 표준을 참조해야 합니다. WFME는 1997년에 의학교육의 국제 표준에 관한 프로그램을 시작했으며, 2004년부터 의학교육을 개선하기 위해 WHO/WFME 전략적 파트너십의 지원을 받고 있습니다[7]. 말레이시아 상황에 맞게 수정할 수 있는 이 표준은 국가 규제 당국부터 커리큘럼 개발자, 프로그램 평가 및 인증을 담당하는 사람들에 이르기까지 의학교육의 여러 중요한 영역을 다루기 때문에 매우 유용합니다[8]. 
  Adhering to global standards: Malaysian medical schools should refer to the standards set by the World Federation for Medical Education (WFME). The WFME started a programme on the international standards in medical education in 1997, which has been supported by the WHO/WFME Strategic Partnership to improve medical education since 2004 [7]. These standards, which can be modified to suit the Malaysian context, are very useful as they cover many important areas of medical education [8], from the national regulators to the curriculum developers, and those responsible for the assessment and accreditation of the programmes.
• WFME 프로그램을 사용하는 의과대학 인증: WFME와 WHO는 인증 기관은 아니지만 의과대학, 국가 기관 및 당국이 기본 의학 교육 인증을 수립하는 데 도움을 주는 프로그램을 제공합니다[9].
  Accreditation of medical schools using the WFME programme: Although the WFME and WHO are not accreditation bodies, they provide a programme for assisting medical schools, national agencies and authorities in establishing accreditation of basic medical education [9].
• 기준 상향 조정: 입학 요건(특히 사립 의과대학의 경우)을 높여야 할 뿐만 아니라 졸업 요건도 높여야 합니다. 이는 우수한 학생들이 의과대학에 입학하고 우수한 학생들만이 의과대학을 졸업할 수 있도록 하기 위한 것입니다. WFME는 시험의 횟수와 성격이 지식 기반과 통합 학습의 습득을 장려해야 한다고 권고합니다. 평가 방법의 신뢰성과 타당성은 모두 중요하며, 의과대학은 이러한 평가가 외부 전문가에 의해 면밀히 검토될 수 있도록 보장해야 합니다[8]. 
  Raising the bar: Not only should the entry requirements be raised (especially for the private medical schools), the exit requirements should also be raised. This is to ensure high-quality students get selected into the course and only high-quality students are allowed to graduate from medical schools. The WFME recommends that the number and nature of examinations should encourage the acquisition of the knowledge base and integrated learning. Both the reliability and validity of the assessment methods are important, and medical schools should ensure that these assessments are open to scrutiny by external expertise [8].
• 의대 과정 연장: 5년의 학부 의학 프로그램을 운영하는 학교의 경우, 이 과정을 6년으로 연장하면 학생들이 의료 행위를 시작하기 전에 더 적절하게 훈련받을 수 있습니다. 다시 말하지만, 프로그램 구조, 구성 및 기간과 관련하여 WFME 표준을 참조할 수 있습니다. 학생들이 적절한 교육을 받아야 할 뿐만 아니라, WFME는 기초 의학의 수평적 통합과 기초 의학 및 임상 과학 간의 수직적 통합을 강조합니다[8]. 
  Lengthening the medical course: For schools that run a five-year undergraduate medical programme, extending the course to six years may allow students to be more adequately trained before they start practising medicine. Again, the WFME standards may be referred to with regards to the programme structure, composition and duration. Not only should students be adequately trained, the WFME places emphasis on a horizontal integration of basic medical sciences and a vertical integration between basic medical sciences and clinical sciences [8].
• 소규모 의과대학의 합병 또는 통폐합: 재정 위기에 처한 일부 의과대학의 현재 상황이 반복되지 않도록 소규모 의과대학의 추가 합병 또는 통폐합이 필요할 수 있습니다.
  Merging or consolidation of the smaller medical schools: It may be necessary to further merge or consolidate the smaller medical schools to avoid a repeat of the current situation with some medical schools in financial crisis.
• 진로 상담: 진로 상담은 중등 교육이 끝날 무렵에 학생들에게 제공되어야 합니다. 학생과 학부모 모두에게 의대 외에 똑같이 좋은 다른 선택지에 대한 정보를 제공해야 합니다. 의대를 졸업한 학생의 경우 의학 연구원, 의학 강사, 제약회사의 의료 고문과 같은 다른 직업 옵션에 노출되어야 합니다. 
  Career counselling: This should be given to students towards the end of their secondary school education. Both students and parents need to be informed of other equally good options besides medicine. For those who have graduated from medical school, they should be exposed to other career options such as medical researcher, medical lecturer or medical advisor in pharmaceutical companies.
• 인턴십과 2년간의 의무 복무를 신뢰할 수 있는 민간 병원에서 수행할 수 있도록 허용해야 합니다: 이는 공보의와 의무장교를 민간 병원으로 전환할 수 있습니다. 그러나 민간 병원의 영리 목적과 환자들은 이러한 개념을 환영하지 않을 수 있습니다.
  Allowing internship and the two-year compulsory government service to be carried out in credible private hospitals: This can divert house officers and medical officers to the private hospitals. However, the for-profit nature of private hospitals and the patients may not welcome this concept.
• 도시에서 농촌 지역으로 하우스 오피서와 의료 오피서의 재배치: 말레이시아의 일부 지역에서는 의사 공급 과잉으로 인턴십 배치를 받기 위해 더 오래 기다려야 하므로, 정부는 인턴십의 일부(예: 2년 중 6개월)를 농촌 지역에서 의무적으로 이수하도록 하는 방안을 고려해야 합니다.
  Redistribution of house officers and medical officers from urban to rural areas: With an oversupply of doctors in some parts of Malaysia and a longer wait in obtaining an internship placement, the government should consider making part of the internship (e. g. six months out of the two years) compulsory in the rural areas.
• 인력이 부족한 전문 분야로 의료 장교 유입 증가 : 정부는 인기있는 전문 분야의 자리를 놓고 경쟁하는 대신 인력이 부족한 분야로 의료 장교를 전환 할 수 있습니다.
  Increase in the intake of medical officers into specialization with shortage of manpower: Instead of competing for places in popular specialties, the government can divert medical officers to areas where there is limited manpower.

말레이시아의 의학교육은 이제 전략을 바꿔야 할 때입니다. 이를 위해서는 교육부, 보건부, 말레이시아 의학위원회, 말레이시아 자격청이 긴밀히 협력하여 상황이 통제 불능 상태가 되기 전에 말레이시아 의학교육을 위한 실현 가능한 장기 전략 계획을 수립해야 합니다.
It is time for medical education in Malaysia to change strategy. This requires the Ministry of Education, the Ministry of Health, the Malaysian Medical Council and the Malaysian Qualifications Agency to work closely on a feasible long-term strategic plan for medical education in Malaysia before things become out of control.

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Perspect Med Educ. 2017 Feb;6(1):10-11. doi: 10.1007/s40037-016-0319-8. Epub 2017 Jan 3.

Medical education in Malaysia: quality versus quantity

Rebecca S Y Wong 1, Samiah Yasmin Abdul Kadir 2

Affiliations

1Faculty of Medicine, SEGi University, Kota Damansara, Selangor, Malaysia. rebecca@segi.edu.my.

2Faculty of Medicine, SEGi University, Kota Damansara, Selangor, Malaysia.

PMID: 28050881

PMCID: PMC5285279

DOI: 10.1007/s40037-016-0319-8

Free PMC article