Medical School in Indonesia

Today I’m excited to introduce to you Anna, a 22 year old medical student from Bogor, West Java province in India. She is in her last year of clinical clerkships at Universitas Pelita Harapan medical school, a bilingual (Indonesian and English) open to both local and foreign students.

Currently, Anna is undecided on a specialty, but is interested in both Neurology and Emergency Medicine. She has five more rotations before she finishes, so it will be interesting to see what she decides on! She blogs at Surreal Hours and you can catch her on Twitter @a_elissa.

She contacted me a few weeks ago asking if I was still open to having more posts in the Medical Education Monday series. I’m so thrilled that y’all find medical education in various countries as interesting as I do…it’s certainly been great to hear about all the different systems.

If you are (or someone you know is) a medical student or physician in a country not yet covered, please have them contact me! Here’s what Anna had to say about Medical School in Indonesia:

Getting In:

How old is one when they begin medical school?

We begin medical school directly after high school. However, some schools are open for students who already have an undergraduate degree, this is usually the case for foreign graduates.

What exams does one have to take to get in?

  • Public Schools: National exam called SPMB that is designed for a specific major, but is valid for any universities. This exam is not the actual entrance exam, it’s only for filtering out students who are academically eligible for a certain major, in this case for medical school. A prospective student sitting the medical school SPMB also needs to fill out a list of schools of their choice. The result of the exam is then sent out to those schools, and he will receive a notification about his acceptance. There is then another exam and an interview from each school that he has to complete and pass before being formally enrolled.
  • Private Schools: Each school has its own entrance exam, usually consisting of basic science focusing on human biology and chemistry, and an interview. Students applying for scholarship may be required to sit an additional exam.

Is there any required pre-requisite coursework?

The national high school system divides the curriculum into two major programs: Ilmu Pengetahuan Alam or IPA (Natural Sciences), and Ilmu Pengetahuan Sosial or IPS (Social Sciences). One has to do the IPA / Natural Sciences program to be eligible for medical school. If a student graduates from a foreign curriculum, like Cambridge or the International Baccalaureate (as in my case), then he must have taken at least biology, chemistry, and maths.

Is it a competitive occupation?

Very.

What are you called at this stage of training?

A high school graduate.

Being In:

How long is it?

5 years.

How are the years broken down?

  • The first 3 – 3.5 years are pre-clinical years. Using the new block system, we learn basic anatomy, physiology, biochemistry, and immunology for the first year, then system-based approach for the remaining pre-clinical years. The actual division of the organ systems depends on each school. In my school, it is musculoskeletal, cardiology, pulmonology, gastroenterology, genitourinary, endocrinology, neurology, obstetrics and gynecology, dermatology and venereology, tropical medicine, hemato-oncology, and emergency medicine.
  • Students who have completed the first 3.5 years are considered graduates already, and are granted the title “Sarjana Kedokteran” (Bachelor of Medicine). They can quit at this time and start working non-clinical jobs.
  • The last 1 to 1.5 years are clinical/clerkship years. We do 9 minor rotations and 5 major ones. They differ by duration: minors last 4-5 weeks, majors last for 10-12 weeks. Minor Rotations: Neurology, radiology, psychiatry, ophthalmology, ENT, oral medicine, dermato-venereology, anesthesiology (including critical care), and forensic medicine. Major Rotations: Surgery (including emergency medicine), internal medicine, obs/gyn, pediatrics, and public health. Upon completing the clerkship, we then graduate as Medical Doctors.

Describe your typical day.

  • Pre-clinical: Class starts at 7:30 AM. Some days start with lectures, some with PBL discussions. Labs are usually in the midday. On the last period every Friday, there is a plenary session where the PBL case study that week is discussed with an expert. The day usually ends at 3:00 PM.
  • Clinical: In my hospital, office hours start at 7:00 AM and end at 2:00 PM, while outpatient clinic starts at 9:00 AM. The first thing we do in the morning is write SOAP notes of ward patients, then wait for the attending physicians to come for the morning round. After rounds, activities vary according to department. We may have academic activities, like tutorials or case study presentations, or we may go to outpatient clinic and have academic stuff later in the day. For surgical specialties, most operations commence at around 10:00 AM, depending on the number and difficulty of the cases that day.

If you choose a specialty, when do you have to decide by?

There’s no requirement for that. Age-wise, residency programs only require applicants to be less than 30 years old by the time of entrance.

What are you called at this stage of training?

  • Pre-Clinicals Years: Medical Students.
  • Clerkship Years: Our formal name is “dokter muda” or junior physicians, but we are more often called with our colloquial names, “co-ass”, from the Dutch word co-assistant. We still use a lot of Dutch medical terms in spoken conversations.

Getting Out:

What exams do you have to take?

The law is changing as I’m typing this. There used to be no exam getting out, as each rotation in clerkship already has its own exam. However, the new bill proposes for a national board exam. It is still undecided whether the exam will be a test for theory or clinical skills, or both.

Do most people graduate?

Yes.

When are you finally considered a “doctor?”

When we have taken our Hippocratic Oath at the end of clerkship (and after the board exam, if the new bill passes).

Do you have additional training after MS or do you start working immediately?

Again, the law is under some changes. The new law requires an unpaid 1-year internship in a hospital chosen by the government. After that year, doctors can work independently.

What’s the average debt for attendance?

There is no debt, except for scholarship students. Regular students pay the full fee. Scholarship students will pay back by working for their universities or teaching hospitals immediately upon graduation for a certain period of time, usually 2n + 1.

What are you called at this stage of training?

A doctor. More formally, a general physician.

Being Out:

What’s the average salary?

Depends on where you work. The general rule is the same everywhere: it’s higher in private institutions than public ones, and is also higher in bigger cities than in rural communities.

Is the job security good?

Yes. There is a high demand for doctors throughout the country, especially outside the main islands of Java and Bali.

Can you switch specialties?

Yes, but people rarely do this.

Can you go back and choose a different specialty?

Technically, yes, as long as one has not reached the age of 30 by the time of entrance. However, I have never heard of anybody doing that.

What are you called at this stage of training?

A specialist.

Medical School in Canada

I was recently contacted by Jessica, a 21-year old 2nd year medical student at the University of Alberta in Canada, offering to teach us about Medical Education in Canada! She complete 3 years of undergrad in Vancouver, BC – her focus of study was Microbiology. Jessica runs the blog Atalanta’s Antics and also tells me she’s a film nut, choir director, hockey pseudo-player, actor, pianist and BBC fan. This chick is the dictionary definition of well-rounded, y’all.

If you’re new around here, let me explain. This post is an extension of the Medical Education Mondays series I started a while back. In addition to random Med Ed information, I’ve had an array of fabulous guest bloggers share info on medical school in the United States, Belgium, United Kingdom, Spain, Egypt, Australia, Saudi Arabia, Greece, South Africa and the Dominican Republic. You can see these cool posts, as well as the rest of the Med Ed Monday series, here.

Jessica’s Talks Medical School in Canada (frank additions by me are in orange):

Getting In:

At what age does one typically begin medical school?
It varies. I started when I was 20, but I’m a bit young for my class since I got in after only 3 years of university. Technically, you only have to finish 2 years of undergrad to apply for the University of Alberta, but it’s extremely competitive at that point. Most people get in after finishing their Bachelor’s degree, so that makes them about 22-23 years old. There’s also a lot of Master’s and PhD students, as well as people who had a career before applying, so ages can range anywhere from 21 to 40. Other schools are different – some require a finished degree, while others essentially require a Master’s to be competitive.

What exams does one have to take to get in?
The big one is the MCAT, just like in the United States. It’s a 5-hour with 4 components:

  1. Physical Science (ex. physics, inorganic chem).
  2. Biological Science (ex. biology, organic chem).
  3. Verbal Reasoning (i.e. reading comprehension).
  4. Writing Sample.

The first 3 are multiple choice and each are bell-curved and scored out of 15 (i.e. one year, getting 49/52 may be a 14, another year may be a 12). The writing sample is ranked from J (lowest) to T (highest), so you end up with something like 10-9-10 R (29R). For the year I wrote it, I got a 11-11-11 Q (33Q), which was about the 86th percentile.

In addition to the MCAT, you also have to interview at each school you’re invited to, usually using the Multiple Mini-Interview (MMI) format. This consists of a series of stations, each with a different topic or ethical dilemma to discuss with an interviewer. So, you’re not judged solely on one interview by one panel, but rather on multiple topics by multiple people.

Is there any required pre-requisite coursework?
This also depends on the school. The U of Alberta requires some general chemistry, organic chem, biology, physics, English, statistics, and biochemistry. Other schools like the University of Calgary don’t have a set list of courses. That being said, you don’t have to be a science major to get in – in our class we’ve even got a photography major and a carpenter!

Is it a competitive occupation?
Yes. The acceptance rate is about 10% across the country, with about 50% of those getting interviews being accepted. Doctors are in extremely high demand right now, so they can make excellent money. It’s not uncommon for people to apply for several years before getting in. I applied to 3 schools and got interviews for all of them. However, I think due to my age, I was rejected from 2 and waitlisted for the school I’m in now. A few weeks later I was accepted, but there are a lot of excellent, intelligent people rejected each year.

What are you called at this stage of training?
Before getting in, you’re just an undergrad student. Some people identify themselves as “pre-med,” but given the 10% acceptance rate, I think it’s a bit presumptuous.

Being In:

How long is it?
Four years.

How are the years broken down?

  • Pre-Clinical: The first two years include mostly classwork, labs, and some clinical skills and patient interaction. The year is broken down into system “Blocks” that vary by school. In first year my school has Infection Inflammation Immunology (Triple I), Endocrine, Cardiology, Pulmonary, and Renal blocks. In second year, we do Gastrointestinal, Reproduction and Urology, Musculoskeletal (MSK), Neurology, and Oncology. Throughout the year, we also have Patient-Centered Care (PCC) classes, cadaver lab, an elective, and clinical skills.
  • Clinical: 3rd and 4th years are “clinical” years, where you do rotations in all the major fields: Pediatrics, General Surgery, Anaesthesiology, Internal Medicine, Psychiatry, Obstetrics & Gynecology, Urban and Rural Family Medicine, Emergency Medicine, Specialty Surgery, and Geriatrics. There’s also elective time and a bit of mandatory lecture.

If you opt for the Integrated Community Clerkship (ICC) option, you spend your entire 3rd year in a rural community with no rotations, just learning everything at once and getting lots of hands-on experience.

Describe your typical day.
Applicable to pre-clinical years: Class usually starts at 8:00 with lecture for a few hours, followed by Discovery Learning (DL) where we get into small groups and work our way through some cases relevant to the block from diagnosis to treatment to prognosis. After lunch may be more lectures or clinical skills, depending on the week. Cadaver lab is Friday mornings with PCC on Tuesday and Thursday afternoons – right now, being in repro block, we’re practicing how to take a sexual history. There’s a quiz every Friday, so we really have to keep on top of our studying!

If you choose a specialty, when do you have to decide by?
Residency matching (CaRMS) is late in 4th year, so most people have it figured out by the beginning/middle of 4th year.

What are you called at this stage of training?
The lowly Medical Student. 😉

Getting Out:

What exams do you have to take?

  • At the end of 2nd year there’s a comprehensive exam and Objective Structured Clinical Exam (OSCE, i.e. interviews, clinical skills, patient interaction…) on all the pre-clinical stuff.
  • At the end of 4th year, there’s the MCCQE Part I (Medical Counsel of Canada Qualifying Exam) – a multiple-choice and short-answer, all-day test on everything you’ve learned. You need to be able to draw on clinical experience and medical know-how to explain decision-making. This must be passed to move onto residency.
  • The MMC part II is basically a 3-hour OSCE that determines if you can move onto independent clinical practice.

Do most people graduate?
Absolutely. It’s extremely expensive to train a physician, so the faculty does everything in its power to make sure everyone graduates. People don’t usually drop out because of the difficulty, it’s almost always for financial or personal reasons. At my school we have a tradition that if everyone that enters 3rd year graduates, the dean of medicine wears white gloves to the convocation.

When are you finally considered a “doctor?”
Once you finish 4th year and pass your MCC part I, you’re considered a physician.

Do you have additional training after MS or do you start working immediately?
Yes – there’s residency for every field. Residents are paid, but it’s not nearly as much as when you’re finished with residency. You can also do a fellowship after completing residency, which is extra specialized training. Often these are done if the community where you plan to work needs a specific skill or if there are no jobs available in your specialty (currently common in cardiothoracic surgery) and you want something extra to put on your CV.

What’s the average debt for attendance?
It varies a bit by school, but tuition is around $13,000 per year, and many students expect to accumulate upwards of $60,000 in debt by the time they hit residency. Some students I know have $100,000 lines of credit that they use to condense living and academic expenses.

What are you called at this stage of training?
Once you pass the MCC part I and complete, 4th year, congrats! You’re now a physician!

Being Out:

What’s the average salary?
It varies by specialty and province and the numbers given by the College of Physicians and Surgeons aren’t very accurate, since a lot of people work part time in certain fields. On average, though, family physicians make around $200K, specialists make around $250K, and surgical specialists make around $350K.

Is the job security good?
Generally, yes. Once you have a job, you can keep it for as long as you want. The trick is finding the jobs, sometimes. For example, right now we’ve got an excess of cardiothoracic surgeons, so it’s difficult for them to find OR time.

Can you switch specialties?
Yes, it’s difficult, though. There are a lot of hoops to jump through since you basically have to be re-matched (into a new residency). However, about 80% of medical students across Canada get their first choice in residency matching, so it’s rare for someone to want to completely switch fields. You need an extremely good reason and must not be leaving a gap in your specialty for the College to allow you to re-specialize.

What are you called at this stage of training?
Resident Physician until residency training is complete, then fully-certified Physician.

 

Overall, medical training in Canada seems to be almost identical to medical training in the United States. If you look through the other Med Ed Monday posts you’ll see that this is a drastic difference from the layout of medical school in many other countries around the world.

Santo Domingo Children's Hospital

Medical School in the Dominican Republic

Medical School in the Dominican

Today I am honored to be continuing our Medical Education Monday series with Medical School in the Dominican Republic. Our Mind On Med guest blogger for today is Vera, a 21 year old medical student in the Dominican. She’s starting her 5th year of medicine and is still wide open on the specialty front, but has a special interest in Neurology. She loves blogging, snail mail, singing and coffee (would we even call her a med student if she didn’t love coffee? I think no, but that’s likely the addiction speaking). And, get this, Vera is a Latin dancer! How cool is that?! We should get her to do a vlog lesson for us. Feel free to contact myself or Vera with questions about Medical School in the Dominican! My additions are in orange.

Santo Domingo Children's Hospital
Children's Hospital in Santo Domingo, photo by RIGHT TO HEALTH.

Getting In:

How old is one when they begin medical school?
A regular student who never repeated courses in high school graduates of at the age of 18. You start pre-med after that – when I started pre-med was one year, but now it’s two, so you enter properly to med school at about 20 or 21 years old.

What exams does one have to take to get in?
We actually just have to take the general exam everyone takes to get into college, it consists of questions on Spanish, Maths, Logics, and English.

Is there any required pre-requisite coursework?
No, there isn’t (just the two years of pre-med course work described above).

Is it a competitive occupation?
No, there is a place for everyone interested; the only requisite is to maintain a scoring upon 2.5/4 while you are in premed in order to get in to the med faculty.

What are you called at this stage of training?
Premed Student.

Being In:

How long is it?
6 years

How are the years broken down?
When I started: One year premed, two years basic sciences and three years of clinical training.
Nowadays: Two years premed, two years basic science and two years of clinical training.

Describe your typical day.
Every semester is different. In the current unit I’m on classes begin at 7:00 am with a 2 hour theorical class. Everyday it’s a different subject, this semester includes Peds and childcare, Endocrinology, Gastroenterology, Imaging and Clinical Pathology, Family and Community Medicine and Preliminary Research. After that I go to the assigned hospital for that day and take a 2 hour practical class, again the subject is different each day. About 11:00 am we have a two hour break for lunch, I usually get the chance to go home and eat. At 1:00 pm we are back at the classroom and get out by 4:00 pm, which is when our college and hospital hours end and our duties begin. We are now working in our thesis, so we have about two or three meetings a week (an important amount of hours of work) and the rest is dedicated to study. Usually I stay in week nights (like a little kid =P  [nah! like any dedicated medical student, if you ask me :)]), I’ve learn to value my sleep and I know I’ll do it even more in a few months and years. Weekends are pretty diverse, depending on what’s going on.

If you choose a specialty, when do you have to decide by?
You can have an idea of what field you preferred, but it’s after you graduate that you can start a specialty. You have to take an exam and attend to an interview at the hospital when you are planning to get in; if you are accepted you are good to go. At the interview, besides your personality, the interviewers notice the points you have accumulated along your career as doctor (you win points by papers published, hours in hospital work, an internship year for the government, your graduation scoring, being part of the national medical association and, of course, the interview itself).

What are you called at this stage of training?
Medicine Student. In two semesters I’ll be called Medical Intern (middle of 5th year of med school).

Getting Out:

What exams do you have to take?
To be a doctor you don’t need to take any exam, but to opt for a residency spot you must take a national exam, it is based on a 100% and the minimum to pass it is 70%.

Do most people graduate?
Yes, most people certainly do.

When are you finally considered a “ doctor?”
Right after finishing the one year Internship required in med school and then get your diploma, which gives you the title of Doctor in Medicine (so, if I’m interpreting right, that would be about 7 years into your training including pre-med, medicine and intern year).

Do you have additional training after MS or do you start working immediately?
Doctors have to work a year for the government after graduation (another one year internship, now as a doctor and not a medical intern, in whichever hospital they require you to go to)* in order to get their exequatur (a written official recognition and authorization by the government to which one is accredited to work as a doctor in medicine).
*(The further the hospital, the greater the points you get).

What’s the average debt for attendance?
Well, the cost of medicine career here is about 500,000 RD$, that number into dollars must be around $13,158 USD.

What are you called at this stage of training?
Doctor

Being Out:

What’s the average salary?
The average salary of a resident is about 34,000 RD$ ($790 USD) per month.

Is the job security good?
Jobs have a great availability in our country, the opportunities are better for doctors who work in private clinics or hospitals, although private offices are kind of expensive. Doctors who want to work at a private level have to have the resources or help themselves by loans, which actually pay off when they get established and start working. Not everyone finds opportunities, though.

Can you switch specialties?
Yes you can, but only if it’s related to the field your currently on.

What are you called at this stage of training?
It depends on the years that the specialty you’ve chosen lasts. The word “Resident” adds an R to the name and later the year you are currently on. Ex.: R1, to the residents that are on their 1st year. R2, R3… you guys get the point =P. (This is quite similar to US residency training where we are called “physicians” or “doctors” during our residency training years and PGY1, PGY2, PGY3, etc. to denote our year of residency training. Although, in the US your intern year is equivalent to PGY1). 

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