The Malaysian Armed Forces mobile hospital on the grounds of Hospital Sultanah Aminah, Johor Baru.

LAST month, I talked about the considerations before entering the path of a life in medicine. Now that you have finally decided that this is the career for you, you will need to think about the next course of action: applying for the medical degree course.

There are a myriad of things to consider when picking a programme, and it can feel like navigating a maze. The decision to study locally or overseas is often the first confusing turn of the maze.

I am a graduate from the University of Nottingham, United Kingdom, and I pursued a five-year medical degree programme. I was lucky enough to get a full Public Service Department scholarship, without which I would never have been able to pursue my studies abroad. Financial constraints will probably be the deciding factor here, but assuming you have the ability to fund your studies both ways, you’ll also need to weigh the pros and cons of a local versus a foreign undergraduate experience.

Studying abroad has a very glamorous image, and indeed part of the attraction is the adventure and novelty of going to a foreign country, experiencing different cultures and lifestyles. The medical curriculum itself varies very little between countries, but the teaching system and exposure during your hospital attachments will be vastly different.

In the UK for example, the teaching system encourages independent study, case-based discussions and an emphasis on research and communication skills. Contrary to popular belief, hands-on learning and practical skills training are still a big part of teaching in the UK.

I can’t comment much on the medical education experience in other countries, so my advice is to speak to graduates from different countries and compare the systems. Even within the same country, universities can have different teaching styles, so read up on the university websites to find out more or contact a university representative. Do not be shy to ask, the course is going to take up five years (at least) of your life so ask 1,001 questions if you must!

Studying abroad will also equip you with the survival skills to be live independently. Living thousands of kilometres from home, you will learn to speak a new language, manage your finances in a foreign currency and deal with errant landlords.

You will learn to adjust recipes because you cannot find gula melaka (palm sugar) in your local supermarket, and you will feel excited when you hear someone speaking in a Malaysian accent on the bus. It has opened my eyes to different mindsets and viewpoints, and challenged a lot of my beliefs and principles.

It has allowed me to immerse myself in the work culture and health care system of a developed country, and hopefully be able to apply that knowledge to improve the system in Malaysia. It is more than just a medical degree, and I came back with a wealth of memories and experiences that have enriched not just my professional life, but also my personal life.

On the other hand, one advantage that local graduates have is being familiar with local diseases, hospital environments and work culture. As they would have done their placements in local hospitals, it would give them early exposure to life as doctors in Malaysia, as well as better knowledge on the management of common illnesses that foreign graduates may rarely (or never) see.

While in the UK, I never attended to a dengue fever patient. So imagine on my first day as a houseman, with three new dengue patients in the ward; I did not even know how to do a peripheral blood film! For my colleagues who graduated from local universities, this was a piece of cake. This gap in experience will eventually disappear with time and effort, but it is still a steep learning curve. Their familiarity with local hospitals and doctors during their practical attachments will also benefit them when it comes to applying for the housemanship programme, as it will be easier for them to decide on the hospitals they prefer for their training.

Another advantage of a local degree, which is often underestimated, is having a social support network which is close by. Medicine is a long and tough programme. Being alone and isolated in a foreign land, without family or close friends from similar backgrounds can take a toll on mental health. Not everyone adapts well to being far from home, and we all have different coping abilities.

I have had times when homesickness and loneliness got overwhelming, especially when I fell ill or was sitting stressful exams. Knowing that home is close enough to go back to when things get tough can make a big difference to your motivation levels. For those who wish to have the best of both worlds, one option is a twinning or an exchange programme. This will combine a taste of an overseas experience with exposure to local hospitals and diseases.

Regardless of where you choose to study, do make sure that your degree is recognised. I have a few friends unfortunate enough to have ended up with a degree that is not recognised by the Malaysian Medical Council (MMC), which means they cannot practise as a doctor here. Go to the MMC website (www.mmc.gov.my) and look up the list of recognised institutions before applying.

I hope I have been able to give a few pointers on whether to study locally or abroad. But the most important message is that wherever you graduate from, it won’t matter to patients. A positive work attitude, good patient care and professionalism are the makings of a good doctor, and that is what counts.

Bessima Jamal is a doctor at Hospital Enche Besar Hajjah Khalsom, Kluang in Johor. The secondary school national champion of the inaugural Spell-it-Right competition in 2008, she is passionate about education and sharing her experiences of her journey in medicine. Email her at education@nst.com.my

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