Number of Citations: 0

Submitted: 21 December 2024
Accepted: 14 May 2025
Published online: 6 January, TAPS 2026, 11(1), 4-8
https://doi.org/10.29060/TAPS.2026-11-1/GP3610

Ganesh Ramachandran¹, Aung Ko Ko Min² & Vivian Fernandez¹

¹School of Medicine, Faculty of Health & Medical Sciences, Taylor’s University, Malaysia; ²Faculty of Medicine, MAHSA University, Malaysia

Abstract

Introduction: The provision of higher education has been for the longest time the responsibility of the state. With increasing demands for places in institutions of higher learning, there has been increasing involvement of the non-public (private) sector in this area. The extent of this involvement is wide and encompasses both nonprofessional and professional qualifications. This involvement has brought the issue of ensuring that graduates from the non-public sector institutions are on par with their public sector counterparts.

Methods: This paper looks at strategies that are in place or that may be employed to ensure that the non-public sector plays its part in developing holistic and fit for purpose healthcare practitioners with a primary focus on the Malaysian doctor. It is largely based on the local landscape, referring to global standards, expectations and recommendations.

Results: Developing a holistic healthcare practitioner begins with appropriate selection and delivering accredited standardised training and assessment.

Conclusion: It is expected that these strategies are similar for all healthcare professionals, and that adhering to the required measures will meet the expectations of the primary stakeholder, the patient.

Practice Highlights

• A holistic healthcare professional is knowledgeable, skilled and will have the required affective attributes to provide safe, high quality and empathetic healthcare with an emphasis on prevention of disease and staying healthy.
• This requires the selection of appropriate candidates, standardised training and assessment to produce a fit for needs practitioner.
• Defined standards will ensure that we are able to meet this aim more effectively.

I. INTRODUCTION

The Good Medical Practice Guide of the Malaysian Medical Council (2019) states that “the doctor is traditionally held in esteem by society as a highly qualified professional who is expected to serve his fellow human beings in a dedicated and selfless manner. His opinion on matters, not just medical, is often sought and received with respect.

As such while theoretical knowledge, practical and clinical skills are a given requirement for a doctor or any healthcare professional, these must be complemented by a good standard of soft skills that are necessary to meet the demands of the end users, primarily the patient, family and the employing authority (AlThukair & Rattray, 2023).

II. DEVELOPING A HOLISTIC HEALTHCARE PRACTITIONER

Traditionally, tertiary education as a whole and tertiary education leading to a professional qualification in particular has always been within the realm of the public sector or the state.

This has changed because of increasing demands and “democratisation” of all areas of education including higher education. Regulations have been modified to attract international students and develop “educational hubs” in some countries. Economic considerations have resulted in decreased funding of public sector institutions making them unable to meet demands and appear inefficient in delivery, paving the way for the non-public or private sector.

The non-public sector contribution to higher education may be in the form of government aided institutions, not-for-profit institutions and for-profit institutions.

In developed economies such as the United Kingdom and the United States of America, private higher education providers comprise about 3% and 23% respectively of total enrolment. This is in contrast to Asia where as much as 80% depend on the private sector for higher education. In India, more than 50% of students are enrolled in private institutions. Korea reports figures as high as 85%, and in Malaysia up to 52% are enrolled in private institutions. Almost all of these are for profit institutions.

A study by the United Kingdom’s Centre for Global Higher Education looked at for-profit providers in six countries (USA, Germany, Australia, Poland, Japan, and Chile) and reported that the standards in these institutions tend to be inferior to that of a public institution. This finding gives rise to the possibility that standards in these institutions may be more malleable and that is worrisome for countries where the numbers seeking private higher education is high. This situation, if not addressed, will be detrimental to the healthcare provisions in the country in the middle and long term.

Inevitably, the perception of private institutions is usually negative. They are perceived to be for profit and not particularly interested in quality, without any positive impact for the stakeholders and community. However, this is not entirely accurate. In many countries including Malaysia, these providers are regulated and must meet the standards of the accreditation agency in the country. In the case of Malaysia, it is the Malaysian Qualifications Agency and for medicine the standards are determined by the Malaysian Medical Council and contained in a document called the Standards for Undergraduate Medical Education (2^nd edition 2022). All medical schools are regularly monitored, and accreditation is a requirement for recognition and registration with the council prior to employment as interns.

Having more medical schools will address the need for more locally qualified doctors and meet the needs of an increasing population. Prospective students will have increased choices in terms of institutions they choose to attend.

In the long run it will reduce dependence on an expatriate workforce by providing local doctors for a local populace. Job opportunities for qualified specialist staff will also increase with healthy competition between the public and private sectors.

Private institutions are also able to operate without too much dependence on policies driven by politics of the land and may be able to introduce more cutting-edge teaching and learning technologies because of financial viability and less red tape.

On the other hand, private institutions must always guard against being overwhelmed by the for-profit motive and must ensure that standards are not diluted. The institution must ensure employment of adequate numbers of trained academics to prevent any compromise in teaching, while investing in physical infrastructure, laboratory equipment, simulators, cadavers and prosected specimens among others. These schools may not be able to address the needs of the whole community because they are likely to be situated in urban and affluent environments and may contribute to a lack of racial diversity among the student population. 

Additionally, unplanned expansion may also result in excessive numbers which may lead to a reflex moratorium on new schools, this in turn may impact numbers down the line leading to a shortage of doctors as seen in Malaysia currently.

A robust accrediting body and medical council which sets standards and guards against the above is always required to ensure compliance. In the Malaysian landscape this is largely in place to ensure standards of all local graduates from the public and private educational sector. Evidence from the Ministry of Health Malaysia seems to indicate that most attrition is due to mental health and coping issues as well as disciplinary matters such as non-completion of logbooks and tardiness in fulfilment of required duties. This means that checks and balances regarding theoretical and practical competence are largely in place, with the problems being related to attitudes, resilience and expected standards of conduct. This is a real challenge and must be addressed to ensure holistic medical practice.

A holistic healthcare practitioner is one who takes consideration of all the patient’s needs as far as possible when delivering care. This implies a practitioner who is theoretically and practically sound with the necessary soft skills to provide care for the patient under their charge. The practitioner must also be resilient, mindful and be aware of the expectations of the community they serve in.

While many of us assume that our stakeholders want healthcare providers that are competent and fit for purpose in terms of expertise, it appears that there are unmet needs in many encounters.

Patients want to be treated as a person not a number. They want community-based care that addresses social issues and family involvement in decision making. Patients also expect affordable care, destigmatisation of certain types of diseases, and avoiding stereotyping (Natafgi et al., 2022).

This then is the expectation, and the challenge is how we meet these. The Institute of Medicine (National Academies of Science, Engineering, and Medicine, Washington USA) in 2019 has outlined the six aims to improve health care delivery. It emphasises safety, effectiveness, equity, efficiency, timeliness, and a patient centred focus (Torralba & Katz, 2020) which broadly resonates with patient expectations outlined previously.

The BMJ in 2002 posed two questions to its readers, “what makes a good doctor?” and “how can we make one?” Answers varied but some important takeaways regarding a good doctor were that

• A good doctor had to be a good human being.
• A good doctor had to be one that genuinely liked people and wanted to help them.
• A good doctor had to be special in some way, extra dedicated, extra humane or extra selfless.
• A good doctor had to take care of themselves first.
• A good doctor had to find medicine fun, fascinating, and stimulating (Rizo, 2002).

Producing a good doctor appears to be more challenging. It is a given that providing quality healthcare requires quality medical education. Correspondingly, providing quality medical education depends on

• good student selection mechanisms.
• attracting and maintaining highly qualified academic and practice staff.
• designing a curriculum that is current and reviewed regularly to ensure active learning, problem solving, and critical thinking with appropriate use of technology grounded in real life examples.
• basing curriculum design and renewal on multiple stakeholder feedback and on real time performance of graduates in the workplace.
• a high standard of cognitive and psychomotor learning coupled with affective attributes of safe, ethical, and empathetic practice.
• designing valid assessments that ensure achievement of learning outcomes in the area of cognitive, psychomotor and affective skills.
• adequate investment in infrastructure in terms of classrooms, laboratories, libraries and clinical teaching sites that are all equipped to provide quality teaching and learning.
• developing links with other institutions of learning and practice to benchmark standards and provide opportunities for internships and elective placements in preparation for their future careers.
• incorporating quality assurance in all aspects of teaching, learning and assessment.

All of these are generally the norm and are contained in accreditation standards which are based on the recommendations of the World Federation of Medical Education.

In effect, all medical schools, public or private need to commit to producing a competent practitioner who is knowledgeable, skilled, and has the necessary positive affective attributes to deliver holistic care. We have got it right to a large extent in the areas of cognitive and psychomotor competence which are tangible and measurable. The affective competencies in terms of soft skills, resilience, coping mechanisms, and mental health are something that we all continue to work on. It is less tangible and is ever changing because of the changing expectations of all stakeholders. To ensure a competent professional we also have to take into consideration the environmental and animal health issues that have an increasing impact on our health. There is a need to refine our curriculums to move from one that emphasises treatment to one that emphasises prevention and staying healthy. Additionally, incorporation of digital skills and the utilisation of artificial intelligence is another space that needs to be explored and incorporated into the curriculum aiming to create a holistic and complete healthcare professional.

This will require the implementation of a minimum acceptable standard for entry that is based on a set of acceptable qualifications, or a standardised entrance test. Selection of a student should also take into account affective attributes, needs background, and aptitude. This entails the use of interviews, multiple mini-interviews and aptitude tests in the selection process. Complying to a required curriculum standard with a common exit examination for all medical schools will help achieve the above targets (Aftab et al., 2021).

We will also need to explore and incorporate elements of the one health curriculum, preventive medical care and digital competencies into an already packed curriculum in a meaningful and practical manner.

Different countries and institutions are on different stages of this path but what is evident is that there is an acknowledgement of the need to set a common minimum standard of entry, competency and outcome.

Figure 1. Attributes and the regulatory mechanisms to achieve this aim. Solid arrows are the processes in place and dotted arrows are the processes in progress.