All over the world, and particularly in developing countries experiencing rapid economic growth, governments are striving to upgrade their healthcare systems in order to meet the demands of more prosperous and better-informed patients, while continuing to address the urgent needs of their most vulnerable citizens.
Building a world-class healthcare system has many components, including clinicians educated and trained to the highest world standard, well-funded biomedical and clinical research centres, advanced speciality care, modern campuses and access to a vast array of sophisticated information systems and processes.
Yet all of these factors may be in short supply in the very nations that are most eager to embark on healthcare upgrades.
To close the gap, governments and private sector players vested in healthcare development often choose to bring in clinicians and management experts from outside the country. However this strategy, though successful in the short term, doesn’t always ensure sustainability to the extent that growing local talent can bring.
Some countries have turned to the private sector to expand and improve healthcare. But often, these private investment-driven efforts can widen the gap in access to higher quality care between the affluent and the poor, and they don't provide for improvements in more basic healthcare infrastructure, such as medical education and research, both of which are critical to establishing a pipeline of sustainable future expertise and discovery.
As a result, many talented candidates for leadership-level healthcare careers choose to pursue opportunities in other parts of the world, thereby exacerbating their homeland’s reliance on importing clinical and administrative personnel.
The case of Malaysia
Nearly three years ago the Malaysian government, with the country facing shortages in specialist – internal medicine, paediatrics, family medicine – and subspecialist physicians, ventured to avoid this problem.
It entered into a public-private partnership with Johns Hopkins School of Medicine and a private investor to create the country's first academic medical centre containing an American-style medical school and a teaching hospital.
The Perdana University Graduate School of Medicine, or PUGSOM, which opened in 2011, and the Perdana University Hospital (PUH), planned for a 140-acre campus outside Kuala Lumpur, are designed to offer medical education and high quality healthcare to people of all income levels, and to use Johns Hopkins’ cutting-edge “Genes to Society” curriculum.
The new medical centre will establish an ambitious research programme focused on diseases and conditions specific to Malaysia and the region. This collaboration is based on extensive knowledge exchange between the new centre and Johns Hopkins Medicine in the United States.
But the founding of Malaysia’s first US-style medical school – and Johns Hopkins’ first such effort outside Baltimore – has entailed a number of significant challenges.
First came the necessity of recruiting the medical school's first incoming class. Before Perdana all medical schools in Malaysia, as in most of Asia, followed the British model of medical education, in which students are admitted to a five- to six-year programme after high school.
Alternating that timetable to require students to pursue and complete a college or university degree before committing to medical school required a large shift in thinking. In addition, Malaysia’s booming economy lured many top students towards business, science or engineering rather than medicine.
To overcome these problems, Perdana needed to recruit actively and convince talented students who had already declined or were denied a medical career to reconsider and apply to the graduate medical school.
The programme was attractive to many students who either were unable to enter undergraduate medical programmes out of high school or came to realise the appeal of a medical career in university.
The next big challenge was the establishment of a learning culture conducive to the US academic-medical-centre style of collaboratively and creatively coming up with solutions to medical problems.
As is common in Asian universities, Malaysian schools emphasise the memorisation of vast amounts of information and of standard procedures. In our view, students were not accustomed to being challenged to question and go beyond customary facts and procedures when necessary in treating patients or conducting research.
Anticipating that culture clash, PUGSOM had recruited several members of the Johns Hopkins University School of Medicine's faculty to work with the new students and to implement its “Genes to Society” curriculum.
The curriculum emphasises collaboration in the educational process, and makes patients part of the problem-solving team by highly valuing their needs and opinions. It puts a high premium on peer-to-peer learning, active pedagogy and integrated learning.
A third challenge was in utilising human cadavers for anatomy learning. To respect national customs regarding human remains and avoid the high cost of cadaver-based programmes, PUGSOM developed an anatomy section based on novel 3-D computerised dissection programmes, and realistic plastic models, supplemented with clinical correlations that include images and information taken from real-life patient cases.
Many of the learning innovations developed at PUGSOM have been ‘exported’ back to Johns Hopkins.
A fourth challenge was hiring local faculty and orienting them to the Genes to Society curricular approach. Many faculty members at medical schools in Malaysia sought positions at PUGSOM because they relished the opportunity to deliver a novel curriculum to more mature students.
Faculty development has been aided by strong collaboration from Hopkins faculty in Malaysia and Baltimore. All new PUGSOM local faculty members participate in an intensive two-week faculty development programme in Baltimore specifically tailored to their teaching activities.
Meeting high expectations
So far, PUGSOM is meeting the high expectations that were set for it. The first class of students will begin core clinical rotations in Ministry of Health hospitals until the teaching hospital opens in 2015.
The research programme has already kicked off with funding for several high-profile projects that will entail collaborations between students and faculty at both PUGSOM and the Johns Hopkins University School of Medicine, including research into communicable diseases and cancers that are prevalent in Malaysia.
Our hope is that Perdana will serve as a model for the establishment of a high quality healthcare infrastructure that serves the future needs of all citizens of a rapidly developing country.
The next several years will be critical in demonstrating that this model can deliver through better patient outcomes, research progress and the sustainable development of clinical talent and scientific expertise, all at good value.
* Steven J Thompson is CEO of Johns Hopkins Medicine International and Charles Wiener, MD, is CEO and dean of the Perdana University Graduate School of Medicine.
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