Lecture for academic staff of the Faculty of Medicine National University of Malaysia Friday 10th April 2003 by Prof Dr Omar Hasan Kasule Sr. MB ChB (MUK), MPH & DrPH (Harvard) Deputy Dean Kulliyah of Medicine, International Islamic University, Kuantan. E-MAIL omarkasule@yahoo.com . WEBSITE: http://doctor-omar.net/


Several issues have been raised about medical education. It seems that the medical school by itself has few solutions to most of them. This is because they arise out of fundamental visions of the world and paradigms of life. Any serious solution must start at the level of paradigms. This however cannot be done in the isolation of the medical school. It must involve overall reform of the society so that positive values are imbued in all aspects of its life.  A reformed society will facilitate good teaching and eventually practice of good medicine. Before establishment of the reformed society, interim measures to resolve outstanding problems of medical education can be undertaken. These include review of the admission process, overhaul of the medical curriculum, and creation of an ethical ambience for the practice and teaching of medicine.



Many of the qualities of leadership needed in a future physician are not identifiable from the academic record. It is risky to admit students without the required personal and ethical qualities in the hope that they will be taught by the medical school. The medical school can not teach all these qualities; they have to be taught by society before entry into medical school. The medical schools will have no choice but to select candidates with acceptable academic and non-academic qualifications. Research is needed on whether there is a definable personality profile for those attracted or admitted to medical schools. Anecdotal observations indicate that physicians in several countries and practice settings share some characteristics among which are: bad handwriting, a big ego, mastery and self-control, hard work and activity. It could be possible to define a new personality profile including some of the good qualities and excluding the bad ones and submitting it to experimental verification over a period of 10-15 years. The process of selection needs to be reviewed to identify those students who have the required qualities. Medical schools will have to draw up criteria, both academic and non-academic, suitable for their community and use them in selecting physicians. The future behavior of the graduates should be used as an evaluation tool of how good the criteria were.


Students admitted, in addition to academic competence, should possess the following qualities: a comprehensive holitistic approach, a service vocation, ethical and community leadership, and motivation to get knowledge. A heavy weighting may have to be given to the non-academic qualities such that some students may be admitted with lower academic standards if they have the ethical and personality traits needed in a good physician. Entry into Malaysian medical schools is basically dependent on academic credentials. There is no clear-cut evidence that good grades are related to being a good and successful physician. In Malaysia and other countries intrinsic motivation, personality, attitudes, values are not usually considered.




The curriculum of the medical school will have to be reformed along 2 fronts: (a) increase of methodological subjects and decrease of biomedical information and (b) early involvement of students in health care delivery not as bystanders but as actual providers. What is suggested is a medical curriculum that provides the future physician with basic methodological tools that he can use for life-long learning. Such a curriculum will be limited to the essentials that remain relevant for a long time. It will not be burdened with bio-medical information that is either made obsolete at the time of teaching or soon after by the rapid scientific progress or is forgotten by the student even before graduation and should not have been taught in the first place. Such a curriculum can aptly be referred to as the fundamentals of medicine, asaas al tibb.


It is suggested that the student should spend 30-40% of his time at medical school involved in direct health care delivery. This direct contact will provide the student with practical skills, attitudes, and motivation needed in a physician by an apprenticeship process. The laws of medical practice may have to be revised to accommodate the apprenticeship system. Apprenticeship as a method of medical education needs to be revived. Ancient medical schools in Egypt, Syria, and Iraq taught most by apprenticeship. Teachers were practicing physicians who did most of their teaching at the bedside. Another dimension of leadership in medical education is the mentor role of the senior physicians who are supposed to be a model especially in the domain of physician-patient relationship. Besides facts and skills, medical education imparts attitudes and assumptions. These are part of the non-factual learning that students acquire by watching their teachers. Students are wont to follow what their teachers do and not what they say. For apprenticeship to produce the physician with the desired qualities, the ambience in the hospital or primary health care setting must reflect the Islamic teachings and should be set up in such a way that there are many formal and informal learning opportunities. A system under control of the medical school should ensure systematic continuing medical education; the exact form and nature of this education can be worked out. Knowledge either becomes obsolete or is irrelevant to the particular circumstances in which the physician is practicing. Whatever useful knowledge the graduate may retain is the real education that he/she got since education can be alternatively defined as ‘what you know minus what you leaned at school’. At the opening of the UM faculty of medicine in 1965, the then dean, said: ‘ I tell my students that 50 percent of what I teach them today in clinical medicine will be proved wrong in 20 years’ time but I do not know which 50 percent it is; if I did I would not teach it to them.



Wide scope of research: Every disease there is a cure that can be found by research. The scope of knowledge is wide, Humans must explore the signs of God in themselves and the universe around them. Blind following is condemned. Evidence based knowledge is what is required.. Research is a type of ijtihad. Research by understanding the signs of God leads to even more iman. The human researcher learns to appreciate the majesty of Allah by finding that human knowledge is limited. There is always more to be discovered about Allah’s signs.


Shift from ‘consumption’ to ‘production’ of knowledge: The physician of the future will have to change easily between three inter-related roles: research, teaching, and care delivery. The research called for is not a full-time occupation and will normally be carried out as a multi-disciplinary effort. The need for research capability is motivated by the fact that the undergraduate curriculum cannot provide all the knowledge that a physician will need. There is thus a need to acquire new knowledge on a continuous basis by reading and research. Medical graduates are not prepared to be researchers. An average medical graduate tends to lack curiosity and initiative, his powers of observation are relatively underdeveloped, his ability to arrange and interpret facts is poor, and he lacks precision in the use of words. The medical curriculum should aim at preparing the student to be a researcher, mujtahid, who will extend the frontiers of medical knowledge. The paradigm shift involved here is to change the student and future physician from a consumer to a producer of knowledge. The physician must be trained to be a life-long learner. Research is the best way to learn and stay on the frontiers of knowledge because it is learning by doing and being the midwife of new knowledge. In practical terms, preparation for research means increasing time devoted to subjects on basic research methodological tools and decreasing the amount of biomedical scientific information that is either forgotten or becomes obsolete by the time of graduation. Student research projects are a good introduction to life-long curiosity in science and discovery.


Research, medical care, and teaching: Physician actively involved in research will be more dynamic and innovative in caring for patients. Research combined with patient care fulfils the Prophetic guidance to look for useful knowledge because the practitioner does not have the luxury to research into esoteric problems and leave challenges that face him daily in the clinic or hospital. Applied research is needed to find out how available bio-medical knowledge can be used. Knowledge alone is sometimes not enough for a good health outcome. Physicians who know the dangers of alcohol are sometimes the worst abusers. The most challenging topic for research as far a physician is concerned is to understand what constitutes quality of life since this is the main aim of medicine. A researcher who is a teacher will always have something new and interesting to share with the students. His teaching will be exciting and students will look forward to it. Research has been proposed as a measure of excellence of a medical school. A question of balance arises. The teacher will have to find the right balance in time allocation between research and teaching. The practicing physician will have to strike the right balance between research and patient care.

ęCopyright Omar Hasan Kasule Sr, April 2003