Research skills for doctors

WE read the letter “On the track of the silent killer” (The Star, March 6) by Professor Datuk Dr Ahmad Ibrahim with great interest, and we agree that proper research on the major health problems facing the country should be encouraged.

The writer also pointed out another worrying issue – the low quality and poor research planning in Malaysia. This is true especially in the medical fraternity.

We also share Dr Manimalar Selvi Naicker’s view in “Risk of low impact research” (The Star, March 8) on the reasons underlying low research quality in Malaysia and lack of effort in training a clinical research workforce.

Nowadays, most medical practitioners in Malaysia just adopt inherited past practices and treatments from their seniors or peers and follow them through without critically analysing the illness thoroughly.

Why is this so? Perhaps it all starts from the housemanship training in our country. Fresh medical graduates are trained to follow whatever has been done by their superiors and are not given much opportunity to think of or suggest other options. They are moulded to become “medical technicians”.

In Malaysia, soft skills involving scientific writing, critical thinking, evidence-based decision-making, and proving hypotheses are normally taught in research programmes. This component is, however, not given much emphasis in undergraduate medical training.

In order to qualify as a medical specialist, one could enrol in postgraduate training in master’s programmes or take the international professional examinations. For a doctor who chose to enrol in the Master of Medicine programme, a research thesis is a prerequisite to graduation. This is perhaps the only time medical practitioners seriously apply some research skills.

Regrettably, most research projects at present are largely duplications of published studies, with some even being irrelevant to Malaysian society. Most of the programmes do not require the trainees to publish their studies. Hence, these studies will just sit in the pile of theses presented on the shelf in the academic office, leaving us to wonder if the trainees have truly acquired the necessary skills for doing research.

Doctors who opted for alternative pathways such as overseas professional examinations are not required to master the skill of scientific appraisals. They are also not required to do any thesis or publications to become a medical specialist in our country.

This programme structure should be abolished because clinicians need basic research skills and the capability to comprehend complex research papers in order to keep abreast with current advances in medical technology and new practices.

Many of our medical specialists have generally regarded clinical skills as an orderly execution of known, validated Western medical practices. Research and scientific appraisal are regarded as rather impractical. Many clinical lecturers have never put research and publications as their priority, thus leading the next generation down a similar path and creating a vicious cycle of having “the blind leading the blind”.

Without critical appraisal of scientific literature, doctors can only follow blindly what has been told by their superiors, peers and representatives of drug or medical equipment companies, or base their treatment plan on pre-existing guidelines without tailoring it to the true needs of the patient.

As an example, the incidence of dengue in Malaysia has grown dramatically in recent years and claimed many lives. This infectious disease has made Malaysia as notorious for dengue as Ghana is for malaria. Yet, most of the high impact research data and publications on dengue are from the United States, Thailand and Singapore. There is still no specific medication to treat or prevent this disease from worsening and the situation is becoming more worrisome. What has gone wrong?

In government hospitals, every medical specialist is encouraged to produce publications every year, but the initiative has received a lukewarm response.

A retired veteran consultant tried to share her experience in presenting hypotheses and suggestions to other medical consultants on dengue, but the reply she got was “no literature is available to support such a hypothesis”. Isn’t it contradictory to request for references on new hypothesis when no one is keen to produce the literature in the first place?

In addition, over-dependence on research and technology beyond our shores without developing our own will be ineffective in the long term. Certain local diseases may not be thoroughly studied in other countries due to differences in demography, climate or genetic makeup.

Patients can only rely on local doctors to diagnose and decide on the treatment options. When doctors do not read or think critically and cannot translate what they read into action in the clinical setting, the situation can be rather appalling.

In summary, scientific appraisal and sharing of knowledge are important skills to be inculcated within the medical fraternity. This would not only enable the practitioners to keep up with the rapid advancement in medicine but also to enhance the clinical research workforce in the country.

Scientific publications should be made an important component in passing medical specialist training. Publishing clinical and research findings should also be considered one of the responsibilities of medical consultants, and merit should be given to those who are willing to contribute to the big clinical data.

DR CHONG SOON EU and DR TAN JUN JIE Universiti Sains Malaysia Penang