Saturday, August 22, 2009

Ukrainian CPR, Russian Life Support and The Boris Yeltsin Classification of Heart Failure V: A Final and Total Closure.

I’d like to pick up from where I left four months ago.

I have been working closely with many Russian and Ukrainian graduates over the last four months.

If I had been negatively and unfairly biased against any of my house officers at any time, may lightning strike me dead this very moment.

My conscience is clear in that I have treated each of my house officer with equality and justice.

A senior clinician has requested my help in submitting a report on the competency of Russian and Ukrainian graduates to Ismail Merican, Director-General of the Ministry of Health, Malaysia.

Seemingly, news of incompetent house officers have caught the attention of Ismail Merican and he is seriously considering derecognition of degrees from the institutions concerned.

I did not write that report.

I was too caught up in my personal affairs to write an official report on a topic so wide with so many confounding factors.

Nevertheless, my final stand after four months of quiet contemplation remains the same:
• The Russian and Ukrainian universities are providing substandard medical education to Malaysian students

• The MIC and its unscrupulous agents have effectively destroyed the future of thousands of young Malaysians aspiring to be doctors by cheating them into Ukrainian degree mills like CSMU

• The majority of graduates from Russian and Ukrainian institutions are indeed lacking in skills and knowledge. The competent and truly qualified graduates will unfortunately suffer the stigma resulting from their underachieving peers.

• Attitude goes a long way and will ultimately determine one’s competency as a clinician.

Speaking of attitude, it really doesn’t help when one hears from such a stupid and arrogant doctor:

“I am a Russian grad. All I can say say is that I am competent.I wanna do surgery but my MO always asks me questions that do not reflect practise like what class of antibiotic is this and this? Who cares? Just give the god damn antibiotic - the patient needs it. And then asking me about ABG interpretation. Hey - just give some oxygen, why the fuss on ABG? When I transfused a patient with 13.0 level of HB - my MO went mad. I’m like huh? The normal level is 15 - so i topped him up.

In short - I think we can learn more if these MOs let us do more and stop asking irrelevant questions. They wont even let me insert a central line-so how am i gonna learn??? Instead of teaching me - they ask me about anatomy.

I am so sick of this -why must Russian grads be treated so bad?”

Anonymous, July 22 2009, 5.29 pm.

At the same time, I also do not condone emotionally-charged comments such as this written by a very frustrated longtime friend of mine:

“Obviously if you don't know what class an antibiotic is, how to intepret an ABG, your anatomy or what the big fuss is all about transfusing a patient with Hb=13, you simply don't deserve to practise medicine. You are worse than a Form 5 student. Medicine is not a profession that you can do whatever you like with the patients, thinking that if you can operate on a patient you are a great doctor. If you still don't see my point, you are just too stupid to be a doctor.

Mind you, anonymous...I will say it again (and I don't regret it), you are just too stupid to be a doctor. Just go flush your face in the toilet bowl. If you guys don't know simple things like your anatomy after going through 5 years in medical school, there's essentially nothing more you guys can learn even if you were given the opportunity to learn.”

AK, August 2 2009, 11.57 PM

This will be the last article I’ll be writing on Russian and Ukrainian graduates.

This very eventful topic of will come to final and total closure hereafter.

You may now direct your curses and threats to the nearest brick wall.

Thank you.


Anonymous said...

i understand and truly feel the incompetentcy of the ukrainian and russian grads...i myself is graduated from ukraine, and i know we are too bad to be doctor....what else i can say, just accept it, and try my best to learn from 0..i know it's too late to start learning from 0 at HO...but this is the only way...i really hope malaysia would de- recognized all the institutes in russian and ukraine asap, but they never did, they still keep sending people there, it's not under our control..... just give us a chance? things just happened that way, i can only say that we'll try our best.... :)

Product of the System said...


That's the spirit.

But stop using anonymous, can?

lion said...

Can't agree more, POTS!

CSMU Bob said...

some of us were cheated by people to study abroad, places like ukraine and russia...we didn't know we will ended up like that...we didn't have the money either to go UK or US for medicine course....i really have to admit that we are incompentent...we knew it we gonna get tons of humiliations and scoldings when we got back to malaysia...we hated our university too..but what to do..we already paid so much, and we couldn't afford to loose more...then we continued..and ended up like this...yeap, try our best, that's the only way... i hope the MO out there would understand why CSMU or Russians grads are like that... i'll try my best though.... :)

Alan said...

Wow, looks like an excerpt from my comment made its way into your final part finally, POTS.

This will also be my final analysis on this neverending issue.

I honestly do not believe that the Russian and Ukrainian universities are inferior to that of Malaysia. How can these countries, who succeded in putting men into space fare worse than Malaysia? Nonetheless, I can't say the same for Indonesia.

The only conclusion we can draw from this is that the quality of students who "PAID" their way into the Russian and Ukrainian universities is deplorable and they do not even deserve to do medicine in the first place. On the other hand, I've personally worked with some Russian grads who were JPA scholars and I must concede that they are not too bad.

But, how can we single out the good from the rotten? The easiest and most plausible way is just to derecognize the Russian and Ukrainian universities. Takes away all the headache! This way, we can avoid getting substandard supply of doctors from these countries and at the same time allow our JPA scholars a chance to study at more reputable countries.

My sincere condolence goes out to the Russian and Ukrainian universities: You are not lousy, but the students who "PAID" their way into your universities have tarnished your good reputation, but you need money and these people have what you need. I guess it's a win-win situation, huh? Loss for Malaysia though...

Anonymous said...

i believe that we should never blame others for the mistakes and our regrets. as medical students and doctors, each of us should have the realization of responsibility to be competent not only to survive but also to provide the highest quality of care to our patients. regardless of wherever u graduate, hardwork, sacrifice and discipline are core values we should practice. never think that the med school makes who u are. it's ur choice to be the best that makes u different.

Product of the System said...


I sincerely echo your comment.

A victim mentality would not help.

I personally learnt that the hard way.

Anyway, as long as the Russian and Ukranian degrees are recognised in Malaysia, you guys have a chance to make it right.

It's just sad that some don't appreciate the opportunity they have been given.

CompleteProductOfTheSystem said...

i hope they do it asap, 4 yrs ago as a houseman in hosp melaka i had a russian grad colleague and we ended up doing double work just to cover him because the rest of us did not want to get scolded by the surgeons. he was incompetent and grandiose as well.

the last thing we want is on the day we ourselves need a dr most and the oncall dr is......

to med students studying in the countries mentioned, pls at least know your ABCDE of resuscitation and how to clerk patients till u get a prov diagnosis, then easier to help and guide that way

first anonymous, please dont start housemanship with zero bcos mo/physician/surgeon's patience are quite thin, that's injustice to patients and your fellow housemen colleagues

Anonymous said...


I have work with many HOs from U and R.

U know what, many actually doing pretty well.

Good attitude is the most important thing.

Don't worry about the knowledge. Work hard and soon later, believe me, you get better as the month progress and people more concern about your work rather than your degree.


dr Praveen (penang ) said...

I read your blog with disgust.
to propagate a propaganda against russian grads?
u are destroying careers that havent even begun.
Russian grads are no worse(and many times better than UK/USA/Ire/Can/NZ grads)
we get the best training in Russia.How many schools can boast a large anatomy class?
we dissect unlike IMU students who learn via computer and plastic models.
we learn from the best doctors in russia.Moscow Medical Academy is rated number 1 by the WHO.It is even better than Harvard or Oxbridge for medicine.We produced the most number of medical research in Europe.
also we get quizzed and as far as I know,the other medical schools just emphasize on written exams.
when we come back to malaysia,we are in fact very well prepared but due to the stigma,we have been chopped "useless"
the emphasis on practicals here are good,thats why we are adept at line setting,intubation,CPR etc.
And i dare u to say that the UK grads are better???i personally know a grad from Oxford-a pompous scholar who talks alot but sweats and tries miserably in setting in IV lines on his first day as a houseman.I had to help him fix that IV u mean to say that he is better than me?
The fact that some of us came from Arts stream or did less well in Pre-U just means that we still managed to get through the tough rigorous standards of medicine in russia.
So POTS,enough is enough.

Product of the System said...

Dr Praveen,

Yeah, you guys are the BESTest in the world!

Just like Najib Razak is the most fantastic PM throughout the universe!

Anonymous said...

POTS I have a few things to share - things that only Russian/Ukraine medical grads are capable of doing.

1) Collapsing pulse - defined as the pulse character of a patient on the verge of collapsing (yes the HO was serious!)

2) Locate the apex beat - defined as the location where one can hear the heart sounds using the stets.

3) Feel for the trachea - palpates both sides of the trachea simultaneously with all 10 fingers.

And the list goes on... infinitely. Yup they can't even do things that a 1st year clinical student is capable of doing. Sounds cruel but it is not my job to get them through medical school again, rather to expose them to real life medicine? Come on what's the purpose of HO-ship then?

keuq said...

boss...learnt lots from you..boss.. i'm a russia grad as well... i think i have too much to pick up dy, so i wish that those my junior really work hard on it..anyway, is a tough life to be a doctor, and sometime really feel like giving up..

Alan said...

Dr Praveen,

I dare tell you to your face that the UK grads are better.

Being able to set lines doesn't mean you can think and make decisions wisely. Even a monkey can be taught to set lines. That doesn't require much thinking power.

True enough Moscow Medical Academy is rated No 1 by WHO. Nobody's going to dispute that. What I'm disputing is that the Malaysian students who pay their way into this academy is useless.

Very well prepared when you guys come back to Malaysia?? My ass...

Anatomy in the 21st century is best learnt via computer models. You guys are so behind time that you still need to dissect and get your hands dirty. The other reason is also because you guys have got very poor power of visualization and that's why you really need to see to understand, whereas the UK grads can visualize by just looking at the computer models.

You fail to understand that dissecting in anatomy class doesn't mean you'll be a good surgeon cos a corpse will not bleed like a live patient and you can just dissect a corpse however you like. But you just can't do the same with a live patient. You are just so deluded.

Anonymous said...

POTS- if we are so bad.why not just do your job-but leave us alone.
why criticize us?
dont we have rights and dreams also?
i am sure alot of russian grads REALLY want to be doctors.
should money or marks be a deciding factor?
in the coming days there will be alot of Russian grads-so why not accept the fact that you have to teach and train us.
cos when your family is sick-it might be us who is treating them.
also,with more doctors -that strips the demand- medical treatment prices will go down.
this is a win-win situation for all.
I dont think Russian housemen are that bad as depicted by you POTS.
.if they are so bad,how did they come this far?
to get through medical school is Russia is no joke.Cold weather,unfriendly faces and widespread racism.and we come back to the likes of you,POTS.

Product of the System said...

Another anonymous,

Sigh, you Russians and Ukrainians just won't leave me alone would you?

Didn't i tell you to direct your threats and curses to the nearest brick wall?

Do i look like a brick wall to you?

Looks like i won't have my final and total closure.

Anonymous said...

To the above Anonymous,

"cos when your family is sick-it might be us who is treating them."

That is why we are very worried about our family.

To Product of the system,

Are you sure the government is now seriously considering deregconizing Russian medical degree? Because it seems the government likes to maintain good relationship with Russia.Maybe to buy weapon like helicopters. Furthermore,the de-recognition of Ukraine medical degree a few years ago caused an uproar among some Malaysians.Hence,it is not politically advisable.

Anonymous said...

Im working in KL. Thank god so far my experiences with Russian grads are OK. Heard lots of stories about them. Even from the Russian grads themselves. But I guess, some are good and some are bad. One of my HO said that the quality the Russian students intake are getting higher compared to previous batches. We'll see the progress.

Anonymous said...

The truth is.. no matter what uni they come from, HOs nowadays are not willing to be slaves. Most of them comes from 'i dont grow padi to feed myself and family' background.

Sarah said...

Hi, another russian medic student here. Seriously, reading all this stuff makes me want to pack up my bags and just pick some other profession! :s

But I think I'll choose to prove you wrong instead..I come back here to read the comments every time I'm in need of some motivation..and every single time, I just feel more driven to study. I certainly believe that some Russian medics /are/ incompetent but I'll be damned before I'll fall into that category... :)

CY said...

to Dr Praveen (penang),

U are deluded, in many ways. At first thought I thought u were joking about the anatomy class, oxbridge, and the TOUGH standard of russia medical university.

But u are serious, arent u?, and it surprised me to see the word "dr" behind ur name.

and by the way, MMA is ranked first, but ur international class, is not.

Dr. Hanz said...

I hve followed this postfor some time now and its time a neutral point of view is placed. First and foremost lets get a few facts right and clear.

1. According to the WHO RSMU is ranked 1st in the world. That being said the RUSSIAN medium is 1st. The English Medium (if it can be called that) is in the 100's.

2. Any Doctor, Or ANY profession for the matter needs to have a good understanding of Theoretical Knowledge. It is ABSURD that you know howto place and I.V or perform ABG, but have no idea what you may find from ABG, or what vein you are setting your I.V in.

3. There are 5 Medical Universities in Russia being recognized as of now. Why Many are still not de-recognized? Well, JPA has a scheme of making sure that all it scholars gaduate 1st and then derecognizing the University. As for some, JPA has stopped sending students to the University.

4. Russia remains a choice by the government as it has political significance and bi-lateral economic agreements.

5. The Government Should make it compulsory starting 2011 for all Graduates outside Malaysia, be it from a recognized or unrecognized university to sit for a standardized entrance exam. This way it can filter those who proceed to HO.

6. Why in Hospitals MO & Specialists pick on Russian graduates? Lets face it. If you get 9 rotten apples in a basket and only One good apple every year, you can safely conclude that the Farm is pretty awful and lousy.

7. So what does this mean for the rest in Russia? Fear not, Medicine is Thought in Many Ways and Methods, but you must be first of All be willing to learn and have the mind set and capability to accept medicine. You must go the extra mile or ten, if you know Russia is a problem. No MO or consultant will call you an idiot if you are brilliant. Talent and knowledge will always be recognized. Do not think that your knowledge is enough because even cosultants are learning. What more you a fresh Grad?

8. HO is usually said to start from 0. But dont take that literally. It means 0 work experience but there must be 100% Medical School Knowledge. That means knowing your drugs and what is does. If you are a HO and still dont know what the names or veins and arteries are, and you dont have basinc anatomy, GET OUT while you still can. It is not your pride or ego at stake, it is the life of another soul.

9. As for what Dr.Praveen wrote about art stream students should be able to give the chance, that is totally absurd. Why? It is simply because is one cannot keep up with Biology & Chemistry in High School, I doubt one would ever understand the Pharmacokinetics of ANY drug.

10. It is fair to say each HO starts with a white cloth. Its your own actions that stain it.

Best Regards. Dr. Hanz.

mohan said...

tired of POTS!
I am a Soviet bloc grad and my patients love me.
Because I am kind,caring and take time to listen to them.
Knowledge alone doesnt make one a good doctor u know.what i may be lacking i reimburse with good nice manners and rapport.
I used to locum alot and not once did any patient complain about me.
So why should u,POTS?

Anonymous said...

i represent Russian medical grads-we will form our own association and campaign against you.

one day we will be big specialists and we can set up Russian grad only hospitals-that way u cannot hurt us.

Anonymous said...

i have also worked with Russian grads. i must say that they are a different lot. i feel sad that our own malaysians have not assessed the quality of the universities before sending them there. many are from moderate families as they cannot afford high end expensive places like UK etc. as of the fruits, they are not all un- salvageable like portrayed & i don't think POTS mean harm by highlighting these problems. i have seen problems but i have also seen some putting the extra effort to learn where they lack. the important thing is to know that there is a lack (recognize the problem) and correct them before harm comes (good attitude), just like any new doctors from any part of the world would do.

The problem of the fruits lies with the tree which lies with the root of the tree. Our lackadaisical leaders have produced a bunch of people who misuse / abuse our system for themselve$. Guess who voted them?

Hence ... this problem is the P.O.T.S.

Anonymous said...

Blogging about medical graduates' incompetence rather than writing a report which could actually make a difference towards de-recognizing those universities, are you really making a difference??

Medical graduates are NOT equal, even if they come from the same country/ same system. There will always be the cream of the crop who know the names of all the arteries and veins, and those that get by medical school without knowing the top 3 causes of delirium.

And people from an arts background CAN actually practise medicine, have you not come across the idea of post-grad medical degrees?

I think the biggest issue is if one does not have good guidance and mentors in medical school, we do not know what we should aspire to be. If we do not know what is expected of us, how are we to work hard to achieve improvements at all? So when get asked a question, too easily we write it off as a "stupid" "irrelevant" question; but it would be better to know the answer or learn its significance before we judged the question.

Running exams for all overseas graduates? I would like to see if ANY worthy grads will end up returning to Malaysia at all.. As the situation is nowadays, I think that several overseas grads from good universities are already only returning to malaysia because of lack of job opportunities in those countries.

Anonymous said...

POTS, action speaks louder than words.Help your colleague writing that report about the competency of those graduates.Don't use any lame excuses and sit behind the scene and keep grumbling.

Anonymous said...


a previous minister of health (who was then married to the present president of the anc and the future president of this country. can you guess who it is?) made the comment that she wants to train african doctors for africa. then she proceeded to degrade the degree. after all, life in africa is cheap and africans don't need quality health care. i couldn't help thinking back to my own experience of african doctors for africa.

in the apartheid era russia was kind enough to train a few doctors up for africa. interesting to note that their qualification was not recognised in russia. they were only good enough to treat africans. i worked with a few of them. here follows one story.

she was a russian qualified doctor. she had been chucked out of a surgical registrar post at medunsa (who gets chucked out of medunsa?) and by some administrative shocker, she had been given a post at our university. she and i wrote primaries together. it was my first attempt there. it was her third.

the last exam was the anatomy oral. basically they showed cadaver specimens and asked us questions and to point out specific structures. my oral didn't go too well. when they went on about waldayer's fassia i struggled a bit. most of the other stuff i answered. her oral was a feast.

when she went in, the first specimen they showed was an open abdomen with everything removed except the retroperitoneum. they started easy. they pointed to the ivc, only the biggest vein in the human body, and asked her to identify it. she could not. after an awkward silence they moved on. maybe the ivc was a bit too difficult. they pointed at the left kidney. even in a second rate russian medical school the kidney must be an organ that can be identified without too much difficulty. she smiled;
"that i know," she piped up with confidence, "that's the spleen!" the examiners were a bit shocked. where do you go after a kidney is mistaken for a spleen? maybe they needed another specimen. they went for a pelvis cut through the middle. there was a clear bladder with a pipe exiting below and moving through a gland. it then continued on its merry way towards the penis. they asked her to identify the gland that pipe went through. she moved uneasily. it was clear she had no idea. then suddenly she redeemed herself, but only a little. she suddenly grabbed the penis and proudly proclaimed;
"i know what this is. this is the penis!"

the examiners did not share the anc's enthusiasm for producing pathetic doctors in a possible attempt to thin out the population. they therefore felt it was important to give a proportional mark. they felt that zero percent was too low because she did know what the penis was and it is as anatomical structure. however even twenty percent seemed a bit high because all she knew was the penis and that is maybe a bit too little for a future surgeon, even an anc approved surgeon. they settled on 5%. i thought it was a bit high, but possibly fair.

after failing three times and killing a quite a number of hapless patients she was thrown out of our university. many years later i saw her hanging with wits registrars at a symposium. the future looks bright.

Anonymous said...

samraat said...