NUMed - An Inadequate Response to Student Concerns

Some weeks ago, students at NUMed wrote collectively to the senior management team, asking some very relevant and pertinent questions. They asked about the numbers and quality of faculty staff, particularly why so many staff had left in the 2019-20 academic year. They also wanted to know why the failure rate at NUMed was so much higher than it was in the UK, and how this was going to be addressed. They also made clear their views about the quality of some of the more recent online lectures and learning resources.

As one can imagine, the joint response from the CEO in Malaysia, and the Pro- Vice Chancellor in the UK was defensive, and not terribly informative. What follows is my critique of that response.

1. I have doubts about the veracity of staffing numbers described.
   
   I was on the faculty from Aug 2018, until I left in March 2020, and I am struggling to think of more than one faculty member who started with me, and who was still there when I left. I think it would be worth looking at numbers for those academic years, and comparing it to say 2016-2018. It would also probably make more sense to compare WTEs (whole time equivalents) rather than absolute numbers, as some of the faculty are part timers. In the department of psychiatry there were 5.0 WTEs then, down to 2.3 WTEs now. And surely student numbers have increased considerably in the last six years? I am glad that contractual differences and dissatisfaction with management were cited as reasons for staff leaving! I think that the organisation pays only lip service to the notion of an exit interview. I received no response to the statement I produced in March, and had it been face-to-face, it was made very clear to me that only the CEO could ask questions.
   
   
2. The students asked about teaching by non-specialists, for example GPs teaching psychiatry, but this was not addressed.
   
   It would also be interesting to understand how the Malaysian Qualifications Agency (MQA) standard for a lecturer: student ratio of 1:8 in the clinical setting is being met now, as there were certainly many more staff during the MQA accreditation visit in May 2019.
   I would also cast doubt on the claim that local clinicians are being engaged to teach the students. I am still in touch with a number of them, and all I hear about is the reasons why they are reluctant to engage with NUMed, and prefer, for example, to work for Monash. Some have, for example, been very reluctant to have SSC placements.
   
   
3. I am not surprised that the pandemic is being blamed for the current woes.
   
   Seasoned observers have noted that the pandemic has simply focussed the spotlight on institutions (including universities) and organisations (including the NHS) that were already dysfunctional, with inadequate leadership, and which were underperfoming. I am inclined to agree with this analysis. It has also been said that the crisis ‘has not created character, but has merely revealed it’.
   
   
4. I was staggered by the attitude towards differential attainment between the Malaysian and UK students.
   
   It would seem that NUMed recruited students in the knowledge that 12-14% of them would fail and have to do re-sits. This raises a number of moral questions: Was the organisation prepared to accept fees from some students for up to six or even seven years, knowing that some of them would fail again and have to exit the programme? Was this ever explained to prospective students and their parents? I have attended NUMed open days, and I am certain that this was not the case. It should be in the brochure!
   
   
5. I cannot help feeling that the strategy is to get ‘bums on seats’  to keep the finances flowing.
   
   Why not use the UKCAT, a cognitive test taken by potential medical students in the UK, for student selection in Malaysia, to keep the two cohorts more homogenous, with similar baseline attainment? My hunch is that it is not being done because it would undoubtedly lead to a dwindling of student numbers at NUMed, making the institution unviable.
   
   
6. If the two cohorts (in Malaysia and in the UK) are not homogenous, then why are they being exposed to the same curriculum and examinations and subjected to the same examination regulations?
   
   It seems a folly to think that this would somehow act as a ‘leveller’. Should NUMed not be delivering an accredited, but differentiated programme?
   
   
7. I have sat on two exam boards in the UK, and I know for a fact that all borderline candidates were discussed, and that a few were graduated as a result.
   
   It is obviously not something that these institutions would be prepared to discuss in public, so evidence is difficult to come by. The conduct of exam boards was also discussed at the Ottawa Conference in KL in March this year, so I know that this is an international phenomenon too.
   
   
8. I think it is ludicrous, and totally without evidence, to assert that a mere 0.1% in an SBA exam can distinguish between a safe and an unsafe doctor.
   
   I accept, with regret, that this is the approach the GMC will take from 2024, with the MLE. Students in Malaysia need to be forewarned about this-as they say, alternative institutions are available. The situation with postgraduate examinations is more nuanced, where passing is often the gateway to unsupervised, autonomous practice. This is manifestly not the case with undergraduate qualifying examinations. A related issue, again not widely advertised, is that NUMed has to satisfy the requirements of both the GMC and the MMC. It is akin to playing a football match with two sets of similar, but not always overlapping, rules. Predictably there can only be chaos on the pitch.
   
   
9. We know that International Medical Graduates struggle with UK postgraduate examinations, not because they lack knowledge, but often because of the ‘Britishness’ of the clinical components.
   
   There are clearly signs of this much earlier in the programme, where NUMed students do as well, or even better, than their UK counterparts, in years 1 and 2. Their performance then tails off in the clinical years.

I wish the students well in their ongoing quest to get proper replies to their legitimate questions!

Dr Al Amaladoss

Formerly Associate Professor (Clinical) in Psychiatry

NUMed.