KUALA LUMPUR, June 20 — After a briefing from the Malaysian Medical Council (MMC), the Health parliamentary special select committee (PSSC) acknowledged that the problem with the parallel pathway for medical specialty training is non-compliance with existing regulations.
Acting MMC chief executive officer Dr Mohamed Anas Mohamed Hussain testified at the Health PSSC’s fourth meeting of the year last April 23 in Parliament on the parallel pathway issue, after the MMC rejected specialist registration applications by at least four graduates of the cardiothoracic surgery parallel pathway programme with the Royal College of Surgeons of Edinburgh on the basis of non-recognition of the FRCS Edinburgh in Cardiothoracic Surgery qualification.
“The issue is that the recognition of the parallel pathway does not comply with current regulations, even as the process of producing specialists is already underway,” Health PSSC chairman Suhaizan Kayat, who is also Pulai MP and former Johor state legislative assembly speaker, said in a text message to CodeBlue last Thursday.
“MMC said they are tied to existing legislations.
“I believe that due to the urgent need in addressing the issue of the National Specialist Register (NSR), which involves saving lives, relevant stakeholders must come together to negotiate and resolve the issues at hand, including amending the Act.”
This week’s Cabinet meeting is scheduled for today; it wasn’t held yesterday. Health Minister Dzulkefly Ahmad said the June 5 Cabinet meeting had “agreed in principle” for a proposal to amend the Medical Act, adding that the amendment bill is aimed at “regularising” medical specialty training.
It is unclear yet how exactly the government plans to amend the Medical Act to regularise the Ministry of Health’s (MOH) parallel pathway programmes organised through memorandums of understanding with royal colleges in the United Kingdom, including the Royal College of Surgeons of Edinburgh (RCSEd), and local medical fraternities registered as societies under the Registrar of Societies (RoS).
CodeBlue previously reported that the MOH’s stakeholder engagement session on June 12 on the proposed amendments to the Medical Act excluded parallel pathway opponents and certain subject matter experts who have raised patient safety concerns with the parallel pathway.
Notably absent were former Universiti Kebangsaan Malaysia (UKM) vice chancellor Prof Emerita Dr Sharifah Hapsah Syed Hasan Shahabudin, who developed the Malaysian Qualifications Agency (MQA) Act, and Prof Dr Raja Amin Raja Mokhtar – former president of the Malaysian Association for Thoracic and Cardiovascular Surgery (MATCVS) from 2017 to 2019 – who is currently on the Board of Studies of the cardiothoracic surgery postgraduate programme collaboration between Universiti Teknologi MARA (UiTM) and the National Heart Institute (IJN).
The MOH’s June 12 stakeholder engagement session on the parallel pathway included MMC, medical fraternities, Ministry of Higher Education (MOHE), the Malaysian Qualifications Agency (MQA), as well as the council of medical faculty deans at public universities.
The parallel pathway isn’t a conflict strictly between MOH doctors and those in universities who are also professors, as there are parallel pathway proponents and opponents across both the MOH and MOHE.
Opponents have repeatedly alleged a lack of assessment and monitoring of parallel pathway training that could harm patient safety, saying the Medical Act should not be amended to “legalise” the irregular parallel pathway programme. On the other hand, proponents cite the country’s specialist shortage as one of the reasons to register parallel pathway graduates on the NSR, even though such graduates can still gazette as specialists in the MOH.
PN Health Portfolio Head: Mistake To Amend Medical Act Solely To Register Parallel Pathway Graduates On NSR
Kuala Langat MP Dr Ahmad Yunus Hairi, who heads Perikatan Nasional’s (PN) health portfolio, said that the issue with the parallel pathway programme, particularly in cardiothoracic surgery training, stems from its lack of recognition and accreditation by the MQA over the years.
Dr Ahmad Yunus, who is also a Health PSSC member, described his long-held belief that this programme was recognised as “dishonest” and questioned the credibility of the association overseeing the parallel pathway programme to the extent that it never received accreditation from MQA.
“What syllabus does MATCVS use compared to the syllabus used in the International FRCS Ed course? Is it true that the recognition of the UK General Medical Council (GMC) for local FRCS Ed is also different from the International FRCS Ed?
“The key issue in producing experts is competence and safety. This requires training and curriculum monitoring that meet MQA accreditation standards,” Dr Ahmad Yunus told CodeBlue yesterday.
The PAS lawmaker said there is no need for legislative amendments solely to enable the specialist registrations of parallel pathway graduates because the Medical Act is already comprehensive.
“Although I am not sure exactly what amendments will be made, if the purpose is solely to allow parallel pathway graduates, who are said to be non-compliant with the law, to be registered as specialists in the NSR, I believe it is unnecessary and a mistake. For me, the credibility of MQA and MMC must be maintained,” said Dr Ahmad Yunus.
“Even if there are proposed amendments to this Medical Act, consultations should involve the Health parliamentary special select committee and all relevant bodies. We already have postgraduate cardiothoracic training institutions accredited by MQA and MMC — and that is UiTM.”
The Opposition lawmaker proposed that cardiothoracic surgery parallel pathway graduates “attach to UiTM” to qualify for NSR registration. The UiTM-IJN cardiothoracic surgery postgraduate programme has provisional MQA accreditation; its first batch of graduates is expected in 2026. Full accreditation is made only when the first cohort of students reaches their final year.
“For the purpose of NSR registration, perhaps they can undergo attachments at UiTM for competency assessment and safety expertise evaluation. It is time for qualification standards for postgraduate training to be thoroughly reviewed by experts and relevant bodies.
“The Ministry of Higher Education should continue to establish and expand universities as institutions for producing postgraduate specialists.
“The MOH should focus on enhancing health care services in our country, including providing necessary facilities for training and attachments to produce specialists, including in cardiothoracic surgery,” Dr Ahmad Yunus said.
Dr Raja Amin, a senior consultant cardiothoracic surgeon at UiTM, previously proposed opening up admissions to the UiTM-IJN cardiothoracic surgery postgraduate programme to non-Bumiputera so that all 30 plus trainees and graduates of the cardiothoracic surgery parallel pathway programme with the RCSEd, across ethnicity, can do credit transfer and curriculum mapping with the UiTM-IJN programme and obtain their qualification within just six months to a year.
Bentong MP: Health PSSC May Consider Holding Stakeholder Engagements On Parallel Pathway
Bentong MP Young Syefura Othman, who is also a member of the Health PSSC, said that the committee will consider whether the parallel pathway issue will be brought to a PSSC meeting for review and examination.
“This issue is still under discussion at the health ministry level. I believe the MOH will engage with stakeholders in several rounds of consultations.
“I am confident that the PSSC will also consider whether this issue should be deliberated and reviewed in our meetings. We still have time for engagement sessions if the PSSC deems it necessary,” the DAP lawmaker told CodeBlue.
Batu Pahat MP Onn Abu Bakar from PKR added: “We are still in the midst of consultations…God willing, moving towards that direction. Certainly, the PSSC will conduct studies and reviews.”
Prime Minister Anwar Ibrahim’s government set precedence in lawmaking when then-Health Minister Dr Zaliha Mustafa referred the Control of Smoking Products for Public Health Bill 2023 to the Health parliamentary special select committee – coincidentally headed by Dzulkefly as chairman then – immediately after it was tabled for first reading in the Dewan Rakyat in June 2023.
Under Dzulkefly’s chairmanship of the Health PSSC, the committee did numerous stakeholder engagement sessions and produced a 736-page report on the tobacco control bill.
The bipartisan PSSC, led by Dzulkefly, conducted 13 meetings with stakeholders, including senior officials from the Attorney-General’s Chambers (AGC) drafting division, to produce the text of its proposed revisions to the bill.
The standalone tobacco and vape control bill – albeit a different version that was decoupled from the generational end game (GEG) ban – was eventually tabled and passed during the subsequent Dewan Rakyat meeting in November 2023 and in Dewan Negara in December 2023.
