KUALA LUMPUR, June 28 — Singapore medical authorities say they recognise the Joint Specialty Fellowship Examination in Cardiothoracic Surgery (JSF Exam in CTS) for specialist registration in Singapore, but only for graduates who were locally trained.
The JSF exam is a quadripartite examination with the Royal College of Surgeons of Edinburgh (RCSEd), Singapore, Hong Kong, and Malaysia, conducted in Singapore, Hong Kong, and Malaysia on a rotational basis.
For Malaysia, this exit examination is used for the cardiothoracic surgery parallel pathway programme, producing the Fellowship of the Royal College of Surgeons of Edinburgh in Cardiothoracic Surgery qualification.
“SAB [Specialists Accreditation Board] and SMC [Singapore Medical Council] recognises applicants who had completed the local cardiothoracic surgery training in Singapore and had successfully passed the JSF Exam in CTS for the purpose of specialist accreditation (in CTS) and registration by SAB and SMC in Singapore,” Singapore’s Joint Committee on Specialist Training (JCST) told the Malaysian Medical Council (MMC) last February.
“Applicants who had completed foreign training outside of Singapore will be assessed and reviewed on a case-by-case basis for the purpose of specialist accreditation and registration by SAB and SMC in Singapore. This applies to all specialties.
“Candidates from Malaysia and Hong Kong – who had successfully passed Quadripartite JSF Exam in CTS (be it conducted in Singapore, Hong Kong or Malaysia) – will not be entitled to specialist accreditation in CTS and registration by SAB and SMC in Singapore and may be assessed and reviewed on a case-by-case basis.”
This statement was made by Michelle Tay, the JCST secretariat in charge of cardiothoracic surgery, in a February 28 email to Malaysian Medical Council (MMC) registration division deputy director Dr Goh Vern Zhi Denise.
Dr Goh had enquired whether graduates from JSF in Malaysia awarded with the FRCS Edinburgh in Cardiothoracic Surgery are entitled to specialist accreditation and registration by Singapore’s SMC.
JCST is appointed by the SAB to oversee the accreditation of training departments and institutions in Singapore.
Enquiries from MMC’s Dr Goh to Singapore’s JCST were made after MMC’s visit to SAB and SMC from June 22 to 24, 2023, verified that FRCS holders are considered together with their Certificate of Completion of Training from the United Kingdom together with their General Medical Council (GMC) registration for the purpose of specialist registration.
“International FRCS (conducted outside of UK and Ireland) is not recognised for purpose of specialist accreditation and registration by SAB/ SMC,” Dr Goh wrote to Tay last February 28.
“Unfortunately, we continue to receive conflicting information from various stakeholders and require your assistance to verify more information again.”
These emails were made public through court filings via MMC’s affidavit-in-reply filed in the High Court here last June 15 in a judicial review application by four graduates of the cardiothoracic surgery parallel pathway programme against MMC’s rejection of their National Specialist Register (NSR) registration applications. MMC does not recognise the FRCS Edinburgh in Cardiothoracic Surgery qualification.
Acting MMC chief executive officer Dr Mohamed Anas Mohamed Hussain said in his June 15 affidavit that Singapore’s SAB and SMC have confirmed that they only recognise applications who have completed local cardiothoracic surgery training in Singapore, “and that candidates who have completed foreign training outside of Singapore will not be entitled to specialist accreditation and registration by SAB and SMC in Singapore, but may be assessed and reviewed on a case-by-case basis.”
“As such, the various assertions contained in the articles referred to by the applicants are misleading and are aimed at influencing public opinion against the respondent.”
MMC’s affidavit also cited a March 20, 2023 email by the RCSEd to MMC that confirmed that graduates of the cardiothoracic surgery parallel pathway programme who took the RCSEd’s JSF exam must undergo an “equivalency process” by the GMC to register for practice in the UK.
In a press statement uploaded on its website last May 15 – two days after CodeBlue reported GMC’s statement that the FRCS Edinburgh in Cardiothoracic Surgery does not entitle one to specialist registration in the UK, as only the Intercollegiate exam is recognised – the RCSEd said it “never suggested” that completing its JSF exam on its own would guarantee entry to the UK specialist register.
Based on JCST’s response to MMC, Singapore recognises the FRCS Edinburgh in Cardiothoracic Surgery obtained from successfully completing the quadripartite JSF exam, but only for doctors who were trained in that specialty locally in Singapore, not Malaysians or residents in Hong Kong who were trained in their respective countries.
RCSEd also told MMC in its March 20, 2023 email that the curriculum used in Malaysia’s cardiothoracic surgery parallel pathway programme was “designed and developed by the Malaysian Association for Thoracic and Cardiovascular Surgery (MATCVS)” with its collaboration.
Training is carried out fully in Ministry of Health (MOH) facilities, MMC noted. But it pointed out that neither MATCVS nor MOH are “recognised training institutions”, as per the Medical Act 1971 (amended 2012) that defines these as higher education providers, defined under the Malaysian Qualifications Agency (MQA) Act 2007.
Yesterday, Health Minister Dzulkefly Ahmad acknowledged, for the first time, that the 14 parallel pathway programmes with foreign royal colleges are irregular, but claimed in Parliament that all 120 local Master’s programmes in medicine by universities are also irregular, saying that proposed amendments to the Medical Act seek to regularise all these medical specialty training programmes.
Proponents of the cardiothoracic surgery parallel pathway – such as the Academy of Medicine of Malaysia (AMM) and MATCVS – have repeatedly claimed that the FRCS Edinburgh in Cardiothoracic Surgery obtained from the JSF exam is recognised for specialist registration in the UK and Singapore.
Both AMM and MATCVS were parties to memorandums of understanding (MOU) with the RCSEd on the initiation of the cardiothoracic surgery parallel pathway programme in Malaysia. The MOH was not a party to these MOUs.
On the JSF exam, the College of Surgeons Academy of Medicine of Malaysia claimed in a May 18 statement that the JSF exam used in Singapore and Hong Kong is “fully recognised by both countries”, omitting the fact, as stated by Singapore’s JCST to Malaysia’s MMC, that it is only Singapore-trained graduates of that exam who are entitled to specialist registration in Singapore.
Similarly, in a May 1 statement, MATCVS claimed that the JSF exam is “fully recognised” by both Singapore and Hong Kong, without mentioning that only graduates who completed local cardiothoracic surgery training in Singapore are recognised for specialist registration in Singapore.
“We…humbly request all parties with constructive criticisms of the Cardiothoracic Parallel Pathway training to engage with us directly for further information, clarifications, and discussions, and avoid further unnecessary and often inaccurate and wrong negative public statements which are causing confusion to both the medical profession and the public,” MATCVS had said in that same statement.
