Rural hospitals will be used as classroom for medical students to solve doctor shortage

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Rural hospitals will be used as classroom for medical students to solve doctor shortage

TRANG, 2 March 2015 (NNT)-The Ministry of Public Health is turning a community hospital into a classroom for medical students in an attempt to solve a doctor shortage in rural areas.

According to chief Public Health official of Trang Dr. Witoon Leungdilok, the Ministry has taken a revolutionary approach by organizing clinical training for students at hospitals in remote areas.

The move is aimed at incorporating the training required for medical students into real-life health service beginning with 90-bed hospitals or larger that already have specialized equipment in various fields of treatment.

The first session will be held at Huay Yod hospital in Trang province next year under the collaboration between the Ministry and the Prince of Songkla University. It is a pre-requisite for graduation for fourth to sixth year students to work at a hospital.


-- NNT 2015-03-02

[diehard60]

Nice, but what age students?????? What is their major? If they are in college.

[Bob12345]

Not a bad idea at first glance, although it does nothing to tackle the cause of the problem (why there is a shortage of doctor's in rural areas; let me give you a hint: pay is about the same as in non-rural hospitals and that is less than half of what a private hospital pays).

Only problem might be that students will not learn much in a rural hospital and are therefore just (mis-) used as free labor. Teaching hospitals are normally large hospitals with many specialists and top-end equipment, that guarantees that all complicated cases in the region will be referred to that hospital which helps students with their training as they can see all the interesting/complicated cases day-in-day-out. That in turns helps again with correctly diagnosing illnesses later in their career. Rural hospitals make a quick assessment of the seriousness of the illness: if serious the patient is referred to a (larger) hospital and students will be stuck with common colds and patients with headaches.

In the short-run it helps patch-up the shortage of rural doctors, in the long-run it will lead to lower quality of doctors.

[bluebluewater]

So they will end up without knowledge and untrained. Kinda like they are now!

"Bacteria in Thailand not same for farang"

"Farang arm not same Thai arm"

I have actually heard these things.

[wabothai]

How abour educating more doctors in university hospitals.

With no sufficient supervision there are going to be problems.

[CantSpell]

Each of them equipped with a cleaver....

Expecting a few to graduate as Master butcher soon

[atyclb]

So they will end up without knowledge and untrained. Kinda like they are now!

"Bacteria in Thailand not same for farang"

"Farang arm not same Thai arm"

I have actually heard these things.

it simply means the local population have developed immune resistance to the strains of bacteria they grew up with, therefore if a non local gets infected with such an organism he/she can very well have a far worse time getting better.

need not be a farang quantum physicist to understand the concept.

[atyclb]

Nice, but what age students?????? What is their major? If they are in college.

are you joking? which story did you read?

are you pre or post mortem?

[atyclb]

Lots of rural hospitals in the usa are used for training also. a problem in thailand is some busy uni hospitals can be elitist and refuse to accept students from other universities.

theres lots that can be learned at rural hospitals especially if they are headed to staff such centers.

[Cent]

"Rural hospitals will be used as classroom for medical students to solve doctor shortage"

This solves nothing. These are students, NOT doctors. Yes, medical students, but unless they are in their final year as a resident they are not qualified to practice medicine.

They need to give free education for students wanting to become medical doctors, those who cannot afford schooling but have the brains and desire. Then, after they graduate, to pay back the government for their free schooling, they need to work where ever the government needs them - for the same amount of years as they had free schooling. Same for nurses. After they do their time repaying the government for their schooling they are free to go and practice where ever they like. This schooling should include room and board and a small stipend for spending money for clothing and such necessities.

Also there are many qualified medical doctors who could work here (and want to) from Malaysia, India, Philippines, etc. But the very strict Thai medical authorities make it very difficult for these perfectly qualified doctors to be able to practice here.

Edited March 2, 2015 by Cent

[laocowboy2]

Not a bad idea at first glance, although it does nothing to tackle the cause of the problem (why there is a shortage of doctor's in rural areas; let me give you a hint: pay is about the same as in non-rural hospitals and that is less than half of what a private hospital pays).

Only problem might be that students will not learn much in a rural hospital and are therefore just (mis-) used as free labor. Teaching hospitals are normally large hospitals with many specialists and top-end equipment, that guarantees that all complicated cases in the region will be referred to that hospital which helps students with their training as they can see all the interesting/complicated cases day-in-day-out. That in turns helps again with correctly diagnosing illnesses later in their career. Rural hospitals make a quick assessment of the seriousness of the illness: if serious the patient is referred to a (larger) hospital and students will be stuck with common colds and patients with headaches.

In the short-run it helps patch-up the shortage of rural doctors, in the long-run it will lead to lower quality of doctors.

It's not just the money - young doctors do not want to spend their student years in a rural backwater where there is little in the way of entertainment or out of hours activities. Same problem globally.

[frozin1]

If structured properly, rural exposure for medical students can be profitable (in an educational sense) for both the student and the site they are assigned to. The rural experience should be a part of all med students training as this can give them some perspective on rural health care issues no matter where they eventually practice after completing their training.

The sites they are sent to however, need to be carefully selected based on that particular sites ability to provide an educational experience to the students. Students should not be sent to sites unable or unwilling to mentor/precept. They should not be used to correct a manpower shortage as they have neither the skills or training to fulfill this role. They are students not practicing Physicians. They cannot see patients independently and actually make work harder for the staff Physicians precepting them. It's a form of paying it forward to the next generation of health care providers.

It is typical in the USA to have students rotate to different specialties during their last two years of medical school including a rural based Family Practice rotation. Duration of the rotations is usually six to eight weeks.

Now medical/surgical Resident Physicians are a totally different matter. They have completed their medical student training, have graduated, and have the right to use MD/DO after their names. They would be expected to provide independent health care although they are still in (advanced) training. They also spend rotations away from their main training center depending on the type of residency they choose.

Why rural sites have trouble attracting trained staff is multifactoral in nature and beyond the scope of this post.

F1

[harada]

Each of them equipped with a cleaver....

Expecting a few to graduate as Master butcher soon

. Scary stuff.

[Balance]

Not a bad idea at first glance, although it does nothing to tackle the cause of the problem (why there is a shortage of doctor's in rural areas; let me give you a hint: pay is about the same as in non-rural hospitals and that is less than half of what a private hospital pays).

Only problem might be that students will not learn much in a rural hospital and are therefore just (mis-) used as free labor. Teaching hospitals are normally large hospitals with many specialists and top-end equipment, that guarantees that all complicated cases in the region will be referred to that hospital which helps students with their training as they can see all the interesting/complicated cases day-in-day-out. That in turns helps again with correctly diagnosing illnesses later in their career. Rural hospitals make a quick assessment of the seriousness of the illness: if serious the patient is referred to a (larger) hospital and students will be stuck with common colds and patients with headaches.

In the short-run it helps patch-up the shortage of rural doctors, in the long-run it will lead to lower quality of doctors.

What may be needed in the rural hospitals is basic management of chronic diseases (diabetes, high blood pressure, obesity, anemia, alcoholism, etc.) The second thing that is needed is outreach and education of the public about diet and general preventive medicine.

The skill set needed in rural areas is not necessarily technical, but instead really good communication skills and the willingness to get involved with the people they serve. These same needs and skills exist at the district level for the nurses.

These are not glamorous jobs, but hard work, in the trenches. Maybe they should get paid the same as those folks in the big cities.

[Traveling Sailor]

Oh this sounds just wonderful. I have experienced the level of competence of doctors in a couple of rural Thai hospitals and it did not seem to be very high. While I have no way of knowing for sure, from what I have experienced, some rural hospital doctors probably graduated near the bottom of their class.

And now medical students will be sent to these places to learn from the resident doctors? Way to go! Since most Thai doctors that I have met don't know how to diagnose anyway, these medical students will probably end up being the worse of the worse. Smooth move, x-lax!

Edited March 8, 2015 by Traveling Sailor

[DaddyWarbucks]

So they will end up without knowledge and untrained. Kinda like they are now!

"Bacteria in Thailand not same for farang"

"Farang arm not same Thai arm"

I have actually heard these things.

My wife is a nurse in Chiang Mai.

Your ignorant comment is an insult to her and the Thai medical professionals who attract patients from all over the world.

[geriatrickid]

There are some excellent comments, even from those who disagree. The reported proposal is heavy on the concept, but short on the details.

A good teaching facility will require experienced clinicians capable of teaching, and I don't know where the proposed facility will recruit its "teachers".

However, Balance's post is very accurate in regard to the skill set that will be honed. We all know that physicians as a class of professionals fail miserably as communicators. It can sometimes be due to shyness or fear of giving bad news or sometimes personal bias. The rotation will expose the students to the human component of medicine. Bob 12345 also nailed it when he referenced that this is an opportunity to see the illnesses as they are manifested in the rural impoverished regions and that serious cases will be referred. It is a valuable learning opportunity. I am sure many of the students are going to welcome this. I just hope they are not treated as free help and overworked as is customary with all medical students and interns on rotation. The hours they work are deplorable and undermine the opportunity to learn. 24 hour shifts are wrong as are 12 hour shifts. Thailand is still old school in that regard.

My concern is that if this is not explained properly it will fail because the locals will think they are expendable experiment patients who will receive substandard care. The medical students are at not a stage to diagnose and treat illnesses. I expect that the students will see patients, develop a diagnosis and then quickly run it by a local physician for confirmation. Mistakes will be made if the supervision is inadequate. I have a feeling that the activity will be heavy on such things as taking medical histories, cleaning wounds, suturing, vaccinations, prenatal counseling, and dealing with minor abrasions, bites and wounds. All of this is now handled in large part by the nurses who have had their duties expanded over the years to fill in the service gaps. The downside is that the student learning to take blood, inject a hypodermic or insert a catheter is going to hurt a few patients along the way, and it won't play out well.

It's not a bad idea and has been used elsewhere, but it needs to be explained and set up properly. Unfortunately Thai methodologies always fall short in the execution and organization of the activity. Planning isn't a strong suit here.

[Bob12345]

"Rural hospitals will be used as classroom for medical students to solve doctor shortage"

This solves nothing. These are students, NOT doctors. Yes, medical students, but unless they are in their final year as a resident they are not qualified to practice medicine.

They need to give free education for students wanting to become medical doctors, those who cannot afford schooling but have the brains and desire. Then, after they graduate, to pay back the government for their free schooling, they need to work where ever the government needs them - for the same amount of years as they had free schooling. Same for nurses. After they do their time repaying the government for their schooling they are free to go and practice where ever they like. This schooling should include room and board and a small stipend for spending money for clothing and such necessities.

You know they already give free education for medical students in return for working upcountry, right?

Once you finish your 6 years as a doctor you need to work for 3 years upcountry or pay a "fine" to the government. This also extends to the 2-4 extra years for a specialisation.

[Bob12345]

These are not glamorous jobs, but hard work, in the trenches. Maybe they should get paid the same as those folks in the big cities.

Pay is actually a bit better upcountry, it is just that the quality of life is many times lower there for young doctor (6 years of studying, you get your first >100k monthly paychecks, and no shopping mall anywhere) and the work get boring soon (you get 30 patients an hour, all with common cold, hickups, or a minor headache).

[atyclb]

complaining about non english communication skills is a near moot point since english is not the language of the country and only some universities make it a requirement.

that is like a thai in europe complaining that the swiss doctor cannot speak thai

[Soutpeel]

excellent idea, let the students butcher the poor people before being unleased on the people of BKK to practice medicine

[poohy]

Nearly on topic

My local hospital has or had a sign saying foreigner check up !

I went, excellent service no complaints!

However town (Phrachuap) attracts a fair few tourists who may take advantage ....so its a good idea... but the doctor I met, who once again was excellent did not speak any English.

Surely to be fully qualified as a doctor you would have to speak some English.. even in Thailand

[rubl]

To enable medical students to observe or help seems a good idea. Part of being a doctor is practise and recognising symptoms.

Still as the OP mentions "solve doctor shortage" I have visions like

"Good morning class. These are your patients today. You are required to diagnose their ailings, operate where necessary and start the recovery process. Any patient still alive by tomorrow will be classified as a positive mark on your records. Good luck."

[Traveling Sailor]

So they will end up without knowledge and untrained. Kinda like they are now!

"Bacteria in Thailand not same for farang"

"Farang arm not same Thai arm"

I have actually heard these things.

My wife is a nurse in Chiang Mai.

Your ignorant comment is an insult to her and the Thai medical professionals who attract patients from all over the world.

With all due respect to your wife and her colleagues, I have been treated within hospitals in Nakhon si Thammarat, Samui, Phuket and Bangkok. I have been bedside in two other hospitals. I have seen first hand the poorly trained/informed doctors, un-professional and poorly trained staff at these so-called "international" hospitals and regional hospitals. I have witnessed abysmal care at a rural hospital in Nakhon si Thammarat Provence that caused the un-necessary death of a patient. So I must say that Bluewater's comments, while they may not be true where your wife works, are not ignorant, but definitely true in some, perhaps many, hospitals in Thailand.

[Soutpeel]

I have seen first hand the poorly trained/informed doctors, un-professional and poorly trained staff at these so-called "international" hospitals and regional hospitals.

By your comments then one assumes your a qualified doctor/professor in medicine who is able to assess the competency of a medical professional by virtue of advanced medical training and years of experience ?

or answer B

Your just another Farang know it all, who thinks he is superior to the natives, appears to despise the natives on all fronts but yet carries on living here due to the availability of cheap women who are not that choosy who they shack up with

[DaddyWarbucks]

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So they will end up without knowledge and untrained. Kinda like they are now!

"Bacteria in Thailand not same for farang"

"Farang arm not same Thai arm"

I have actually heard these things.

My wife is a nurse in Chiang Mai.

Your ignorant comment is an insult to her and the Thai medical professionals who attract patients from all over the world.

With all due respect to your wife and her colleagues, I have been treated within hospitals in Nakhon si Thammarat, Samui, Phuket and Bangkok. I have been bedside in two other hospitals. I have seen first hand the poorly trained/informed doctors, un-professional and poorly trained staff at these so-called "international" hospitals and regional hospitals. I have witnessed abysmal care at a rural hospital in Nakhon si Thammarat Provence that caused the un-necessary death of a patient. So I must say that Bluewater's comments, while they may not be true where your wife works, are not ignorant, but definitely true in some, perhaps many, hospitals in Thailand.

I have seen first hand the poorly trained/informed doctors, un-professional and poorly trained staff at these so-called "international" hospitals and regional hospitals.

By your comments then one assumes your a qualified doctor/professor in medicine who is able to assess the competency of a medical professional by virtue of advanced medical training and years of experience ?

or answer B

Your just another Farang know it all, who thinks he is superior to the natives, appears to despise the natives on all fronts but yet carries on living here due to the availability of cheap women who are not that choosy who they shack up with

Spot on. Soutpeel.

Medical care in Thailand's cities is world class... otherwise there would be no such thing as medical tourism.

Thanks for having the courage to stand up for these hard working dedicated people - and speak out against the misfits who should have gone home long ago.

[Bob12345]

I have seen first hand the poorly trained/informed doctors, un-professional and poorly trained staff at these so-called "international" hospitals and regional hospitals.

By your comments then one assumes your a qualified doctor/professor in medicine who is able to assess the competency of a medical professional by virtue of advanced medical training and years of experience ?

or answer B

Your just another Farang know it all, who thinks he is superior to the natives, appears to despise the natives on all fronts but yet carries on living here due to the availability of cheap women who are not that choosy who they shack up with

Incompetence raises its ugly head everywhere, even in the medical field and in international hospitals. Based on the stories i sometimes hear (from a doctor) you best stay away from smaller private hospitals/clinics and opt for the big international hospitals or for the best care: teaching hospitals.