MMC’s Rejection Of Specialist Registration Applications By Cardiothoracic Parallel Pathway Graduates Is Alarming — College Of Surgeons Of Malaysia

The Malaysian Medical Council’s (MMC) recent decision to reject specialist registration applications from Cardiothoracic Parallel Pathway graduates is alarming and may have grave implications for patients awaiting surgery – College of Surgeons of Malaysia.

The College of Surgeons of Malaysia stands firmly in support of the Parallel Pathway for the training of Cardiothoracic Surgeons and Urologists in Malaysia.

We wish to address recent concerns raised in press statements by the Malaysian Association for Thoracic and Cardiovascular Surgery and the Malaysian Urological Association, dated 4th February and 6th February 2024, respectively.

We extend our gratitude to the Honourable Health Minister, Datuk Seri Dr Dzulkefly Ahmad, for his commitment to resolve this matter soon.

Established in 1972, the College of Surgeons of Malaysia serves a pivotal role in surgical education, representing various surgical specialties and subspecialties across the nation. The College’s aim is to uphold the highest standards of surgical practice through collaboration within its 13 chapters which, encompasses diverse disciplines.

Specialisation in surgical disciplines follows housemanship, with medical officers opting for the Masters programmes offered by universities or the Parallel Pathway provided by the Ministry of Health Malaysia (MOH). Notably, the Parallel Pathway remains the sole avenue for Urological specialisation in Malaysia.

The Malaysian Urological Association, which established a committee in 2000 and this was endorsed by the MOH in 2005, plays a pivotal role in providing quality Urological Training.

Their emphasis on standards, reflected in the 2017 Urology Curriculum, aligns with international benchmarks, as evidenced by their Memorandum of Understanding (MOU) with the Royal College of Physicians and Surgeons of Glasgow (RCPSG) established in 1599, which provides the external oversight.

Similarly, the Malaysian Association for Thoracic and Cardiovascular Surgery (MATCVS), established in 1993, spearheads the Parallel Pathway programme for Cardiothoracic Surgery.

Initiated by MOH in 2016, with collaboration from the Academy of Medicine Malaysia, this programme aims to address the shortage of heart surgeons, aligning with international standards through collaboration and an external quality assurance undertaken by the Royal College of Surgeons of Edinburgh (RCSEd), which was established in 1505 with more than 500 years of history of training surgeons.

To ensure the sustainability of the cardiothoracic surgical training in Malaysia, a more recent MOU had included Universiti Malaya, with commitment by all parties to work together to achieve and maintain the highest standards of surgical practice through education, training and assessment.

The recent decision by the Malaysian Medical Council (MMC) to reject specialist registration applications from Cardiothoracic Parallel Pathway graduates is alarming and may have grave implications for patients awaiting surgery.

The Fellowship of the Royal College of Surgeons (FRCS) awarded by the RCPSG and the RCSEd have enabled those who successfully completed specialist training in their respective specialties to be registered in the National Specialist Register (NSR) prior to the enforcement of the amended Medical Act 2017.

Regardless where the exam is held, whether in or outside the UK and Ireland, the FRCS award remains and is recognised by the General Medical Council (GMC) for applicants to apply for GMC specialist register through the Certificate of Eligibility for Specialist Registration (CESR) pathway, which is now referred as portfolio pathway, by providing evidence that they have the knowledge, skills and experience required to practise as a specialist in UK.

We urge MMC to rectify the “editorial error” in the MMC’s listing of FRCS by removing “Intercollegiate Specialty Board”, as this qualification does not exist. Once FRCS is listed, similar to GMC’s listing of FRCS, trainees who have completed six years of the Cardiothoracic Parallel Pathway training will be able to be evaluated for registration in the NSR.

The shortage of cardiothoracic surgeons and urologists in Malaysia is a critical issue that requires immediate attention. Both the Masters programmes and the Parallel Pathway are integral to producing quality surgeons.

Efforts must focus on harmonising and strengthening both programmes, rather than dismantling one at the expense of the other.

It is imperative to engage all stakeholders involved in the training of Cardiothoracic Surgeons and Urologists and make judicious decisions in the best interest of the nation, adhering to established rules and regulations.

Failure to do so risks exacerbating the shortage of surgical specialists and ultimately impacting the well-being of the rakyat.

Commonwealth countries in Asia have inherited a robust medical educational system from the Royal Colleges in Britain and Ireland. With a history spanning over 500 years, these institutions have cultivated a solid foundation in medical and surgical education, training, and assessment.

This legacy sets exceptionally high standards of surgical care in countries such as Malaysia, Singapore and Hong Kong, which have embraced this system.

Similarly, MOH functions not only as the largest health care provider in the country, but also boasts the nation’s premier health care equipment and facilities, serving as a hub for specialists from diverse fields.

Public hospitals have long been the primary venue for specialist training in both the Masters and the parallel programmes, with many surgeons actively engaged in surgical training initiatives.

Failure to recognise the significance of the parallel programmes would undermine the dedicated efforts of these health care professionals.

In the current landscape of surgical education and training – which is beset with numerous challenges, such as workforce limitations and financial constraints – there is a pressing need for a strategic emphasis on strengthening and aligning the existing system, rather than embarking on an overhaul.

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