The Academy of Medicine of Malaysia (AMM) applauds Health Minister Dzulkefly Ahmad’s pledge to promptly resolve specialist training issues and harmonise national training programmes in keeping with laws, regulations, and standards, to achieve the nation’s urgent need for specialist doctors.
This is consistent with the AMM’s objectives, which are to promote and advance the highest standards of specialist practice and ethical integrity through education and professional development.
In 2020, across Organisation for Economic Co-operation and Development (OECD) countries, the average population-to-specialist ratio was 10,000: 14.33. Alarmingly, in Malaysia, the current population-to-specialist ratio stands at only 10,000: 4, which is a definite wake-up call for the country’s health care stakeholders to enhance our capacity for specialist training.
Specialist training in the country is currently largely provided by public universities through clinical Masters programmes and the Ministry of Health (MOH) via the “parallel pathway”. Prior to 1973, almost all specialists obtained their training overseas or trained in Malaysia whilst attaining international qualifications by attempting international examinations to be recognised as specialists.
The earliest Masters training programmes for specialists were started by the Faculty of Medicine, Universiti Malaya in 1973 for three specialties.
Presently, 11 public universities and one private university offer specialist training programmes in 25 different specialties, culminating in the award of specialist qualifications which are recognised by the Malaysian Medical Council (MMC) to enable the holders of such qualifications to be on the Specialist Register.
MOH embarked on “parallel pathway” specialist training to address the shortage of specialists in the public sector and to cope with the rising demand for specialist training. The “parallel pathway” currently represents a form of on-the-job structured training provided by MOH for trainees who opt to sit for international examinations conducted by overseas Royal Colleges.
These Colleges award specialist qualifications, which have enabled specialists to be registered on the National Specialist Register (NSR) even before the enforcement of the amended Medical Act 1971, on 1st July 2017, which provides a regulatory mandate for all medical practitioners who wish to practice as a specialist to be on the Specialist Register.
MOH assists candidates in fulfilling a minimum of four years of supervised specialist training to gain the required competencies in the specialty, in addition to passing the specialist examination.
Unifying Specialist Training
There are compelling reasons for the unification or harmonisation of specialist training that occurs in Masters programmes and parallel pathways.
Firstly, the launch of the National Postgraduate Medical Curriculum (NPMC) by the Medical Deans Council in August 2021 paved the way to unify the Masters programmes and the parallel specialist training pathways.
The NPMC is a collaborative effort between the universities, MOH, and the AMM (representing medical professional societies and the private sector). The NPMC has clearly outlined similar entry and exit criteria, structured supervised specialist training, and core competencies required on completion of training for both the Masters programme and parallel pathway in a unified and structured manner.
Secondly, MOH has shown its commitment to implement the parallel pathway specialist training according to NPMC, and many MOH specialists have attended NPMC Train-the-Trainers workshops.
Thirdly, trainees registered in the Masters programmes are also placed in MOH hospitals, with formal appointment of the MOH hospitals as specialist training centres for a particular specialty and MOH specialists as supervisors for the Masters programmes.
Trainees in the parallel pathway attempting international examinations are trained at the same MOH hospitals by the same MOH specialists who conduct training for trainees in the Masters programme.
Specialist training by both the university-based Masters programmes and MOH-based parallel pathway have enabled trainees from both pathways of specialist training to be registered on NSR prior to, and after, enforcement of the Medical Act. These collaborative efforts between the education providers can be further strengthened.
A national-level body for the joint governance of specialist training is needed to bring together all relevant stakeholders to facilitate cooperation and collaboration between all specialist training providers and allow maximum utilisation of the expertise and facilities available in MOH, universities, and private hospitals.
The Academy of Medicine of Malaysia, a non-profit professional organization, and the only registered body representing medical specialists across various specialties in one umbrella body, has been actively collaborating with MOH and MMC since its inception 56 years ago, in matters concerning medical specialist recognition, training, and continuous professional development.
AMM also played a major role in collaboration with MOH in establishing the Specialist Register which was launched in 2006. The Academy actively administered the Specialist Register for 11 years before the enforcement of the Medical Act in 2017, and through a formal Memorandum of Agreement between MMC and AMM, has continued to assist MMC with the development of an online system and processes for applications to the Specialist Register.
Malaysia’s health care faces many challenges ahead from an aging population, a high burden of non-communicable diseases and an under-resourced delivery system.
A skilled health workforce is an integral component of any health care system and is critical in delivering good health outcomes and economic prosperity.
We, the under-signed:
- Academy of Medicine of Malaysia (Prof Dr Rosmawati Mohamed, Master)
- College of Anaesthesiologists (Prof Dr Ina Ismiarti Shariffuddin, President)
- College of Dental Specialists (Dr Ahmad Sharifuddin Mohd Asari, President)
- College of Emergency Physicians (Dr Alzamani Mohammad Idrose, President)
- College of Otorhinolaryngologists – Head & Neck Surgeons (Dr Zahirrudin Zakaria @ Azidin, President)
- College of Obstetricians and Gynaecologists (Prof Dr Siti Zawiah Omar, President)
- College of Ophthalmologists (Prof Dr Hajah Shatriah Ismail, President)
- College of Paediatrics (Prof Dr Thong Meow Keong, President)
- College of Pathologists (Emeritus Professor Dr Cheong Soon Keng, President)
- College of Physicians (Prof Dr Paras Doshi, President)
- College of Public Health Medicine (Dr Anita Suleiman, President)
- College of Radiology (Prof Dr Norlisah Mohd Ramli, President)
- College of Surgeons (Dr Siow Sze Li, President)
The Academy of Medicine of Malaysia, embracing 12 Colleges and 24 Chapters, is a registered, non-profit professional organisation representing medical specialists in various specialities in the country. The AMM actively collaborates with the Ministry of Health and the Malaysian Medical Council in matters pertaining to medical specialist recognition, training and continuous professional development.
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