ASIA: World-class medicine pursuit drives collaboration

A need to train more doctors and modernise medical training in South East Asian countries to world standards has led to tie-ups with top medical schools in the US and Britain to create new flagship institutions in recent years. Governments in the richer Asian countries also want to upgrade research on the region's diseases to better cater for their people's health.

International collaborations have allowed many countries to leapfrog to a higher level of medical training and biomedical research, according to medical institutions in the West that are partnering with institutions in Asia, particularly in Singapore and Malaysia.

"South East Asia is huge and it is advanced, not underdeveloped, and crying out to develop medical education and clinical research," said Charles Wiener, Interim Dean and CEO of a new medical school being set up by the prestigious Johns Hopkins School of Medicine in the US.

Collaborations also enable medical schools in Asia to move away from old style rote learning, common in the region's schools and colleges, to newer systems which train medical practitioners to be more responsive to patients needs, and also to engage in collaborative research.

Singapore and Malaysia have been at the forefront of these efforts, but India and China are also waiting in the wings, although China is still seen as problematic for Western medical institutions to find a fit.

A crumbling health system makes it difficult to collaborate in training doctors in China's hospitals, and unlike India, Singapore, Malaysia and Hong Kong it does not have the legacy of a British or other western-style medical education system. Nonetheless, Hong Kong University will help to operate a new university hospital in Shenzhen in China later this year as part of an attempt to improve medical education and training.

Singapore invites US and UK collaborations

With more than a third of its 4,500 doctors trained overseas, Singapore is making a conscious effort to produce more home-grown doctors with world-class training, increase the doctor-to-patient ratio and produce a skilled labour force that will attract pharmaceutical and biomedical companies to the city-state.

It is looking to the best of both the British and US medical education and has turned to London's Imperial College to set up an undergraduate medical school with Nanyang Technological University (NTU) by 2013 and a top US institution, Duke University, to establish a postgraduate medical school which will graduate its first cohort this month in collaboration with National University of Singapore (NUS).

"It's an opportunity not to be missed. On the ground [in Singapore] there was a thirst for something new and innovative. It's difficult to change curriculum and turn around a big ship," said Martyn Partridge, Senior Vice-dean at Imperial Medical School who is also head of the institution's Singapore office.

Imperial is developing the degree content, which will be awarded jointly by Imperial and NTU. "The collaboration is quite precise - they want the Imperial undergraduate medical course delivered in Singapore, though there has to obviously be some adaptation to the medical system and disease patterns," said Partridge.

Singapore also invited Duke University to help set up a graduate medical school with NUS. "The Singapore government was looking for an institution for clinical scientists. It wants to create doctors who can also do clinical research," Dr Michael Merson, Director of the Duke Global Health Institute and Vice-chancellor for Duke-NUS affairs told University World News.

This way Singapore has been able to incorporate Duke's team-based learning. "This is quite an innovative thing," said Merson, not just for Singapore but for medical education generally.

Malaysia wants Western-level patient ratios

Malaysia is doing something similar with Johns Hopkins Medical School in the US, with a view not just to producing practising doctors but also clinical researchers who can work on particular disease problems prevalent in the region. They also have more experience in diseases that are becoming more common as Malaysia becomes richer.

"The top four killers in Malaysia are the same top killers in the West. So-called tropical diseases are under control," said Johns Hopkins' Wiener.

Johns Hopkins will help create the new Perdana University Graduate School of Medicine and Perdana University Hospital, as a fully-integrated private teaching hospital near Kuala Lumpur. Perdana will recruit its first cohort of medical students for the four-year postgraduate course later this year in a move that will compliment existing five-year medical degrees that start at undergraduate level.

"Clearly one of our hardest challenges is to try a postgraduate model in a country based on the British medical system of undergraduate medical education," Wiener admits, but he does not see a wholesale move to the American system. "We are not looking to imperialise them. We are not an outpost of any university but we are going to become a great Malaysian university," he told University World News.

Malaysia has allowed large number of foreign medical institutions to set up as it sought to increase its doctor-to-patient ratio to Western levels.

Ten years ago Malaysia trained only 700 doctors a year - a quarter of whom left to practice medicine in other countries. Now the country trains over 3,000 doctors a year and this will rise to more than 4,000 in the next five years with new institutions coming on stream, including Perdana and the undergraduate Allianze College of Medical Sciences in collaboration with Ireland's University College Cork and the National University of Ireland, Galway.

Perdana is being set up even as Malaysia considers that a proliferation of medical schools has raised concerns over quality. It has now announced a five-year moratorium on new medical courses.

"We don't want numbers. We want quality - quality of medical schools, quality of medical graduates, quality of postgraduates," Dr Abu Bakar Suleiman, a former Malaysian director-general of health in the 1990s, said in March. "What we should be doing is working hard to make sure our medical schools are of international standard."

Research and medical training go hand in hand

There is little doubt about the international quality of institutions such as Johns Hopkins, Duke and Imperial, among others. But these collaborations are part of a much broader expansion in Asia for some Western medical schools.

"Our MD [US-based medical] programme is very research-intensive and expensive to maintain. We are launching a clinical research programme aimed at shifting clinical research to developing countries like India and China. South East Asia, Indonesia, Central Asia - all the growing economies offer opportunities," said Krishna Udayakumar, director of Duke Medicine Global.

"The competitive forces of globalisation that shaped other parts of the economy are shaping medical education and biomedical research."

But it is not just about money. Advances in medicine require the internationalisation of medical research.

"Advancements in medicine and medical education demand the international characterisation of the human genome. There is a lot for us to explore. The aim is much more broadly to look at other [ethnic] groups and diseases," Steven Thompson, CEO of Johns Hopkins Medical International, told University World News.

"Particularly in biomedical science we understand that any disease is a complex set of variables including environmental, driven by genetics and other factors. We need collaborations around the world to understand the variables," Thompson said.

Singapore and Malaysia both understand that advanced research and world-class medical training that turns out practising doctors go hand in hand.

"I don't think any medical school is just one or another [training or research]. For good medical education you have to have research-active faculty," said Imperial's Partridge. "Singapore's major need is to have enough doctors to care for their population and to have the country recognised as a research leader. Medicine there is of a very high standard from a research point of view."

The same is true of Malaysia. "Perdana cannot be an international medical institution without a substantial research footprint. There has been a tremendous reception from Malaysians who are looking to raise their research profile," Johns Hopkins' Wiener said.

"It makes sense to bring the research to where the people are," Thompson argued. Asia's advances mean "there is a room for a lot of new medical schools. Asia is growing and needs more doctors," said Merson.

All articles in the Special Report: The Internationalisation of Medical Education

GLOBAL: Internationalisation and medical education
ASIA: World-class medicine pursuit drives collaboration
MIDDLE EAST: Medical cities seek foreign academics
INDIA: Medical education gets international flavour
CARIBBEAN: Medical schools battle to retain US access
SOUTH AFRICA: Cuba helps to train rural doctors
AUSTRALIA: Overseas doctors fill large gaps
FRANCE: Medical reform aims to fight 'human wastage'