Two Health DGs At The Heart Of Parallel Pathway War

Then-DG Hisham said in 2022 the RCSEd cardiothoracic surgery parallel pathway was co-organised by MOH. “It’s quality assured to international standards by RCSEd”. He said in 2014 the parallel pathway would halve the time to produce cardiothoracic surgeons.

KUALA LUMPUR, March 27 — The Malaysian Medical Council (MMC) finally broke its silence on the conflict with the parallel pathway programme – only to bizarrely deny having ever recognised the RCSEd qualification in cardiothoracic surgery.

The MMC’s statement last Monday was issued by its president Dr Muhammad Radzi Abu Hassan, who is also the Health director-general overseeing the public health service in the Ministry of Health (MOH), as the MMC president is the Health DG by law under the Medical Act 1971.

MMC was swiftly called out for its claim that it had never recognised the Fellow of Royal College of Surgeons of Edinburgh (RCSEd) in Cardiothoracic Surgery.

Citing archived versions of the NSR website, the Malaysian Medical Association Schomos said the Fellow of Royal College of Surgeons of Edinburgh (RCSEd) in Cardiothoracic Surgery was recognised on April 4, 2016 and listed on the National Specialist Register (NSR) as recently as January 23, 2022.

Bandar Kuching MP Dr Kelvin Yii pointed out that there are already seven practising cardiothoracic surgeons in Malaysia with that FRCSEd in cardiothoracic surgery qualification from the parallel pathway programme.

In 2014, then-Health director-general Dr Noor Hisham Abdullah described the parallel pathway programme as an “alternative training pathway” to produce more specialist doctors in Malaysia.

“Today marks another milestone in postgraduate training, particularly in cardiothoracic surgery, when Malaysian Association of Thoracic and Cardiothoracic Surgery with College of Surgeons Malaysia, Academy of Medicine Malaysia and Royal College of Surgeon (Edinburgh UK) signed a Memorandum of Understanding to provide fellowship training for our medical officers in cardiothoracic surgery,” Dr Noor Hisham wrote on August 27, 2014.

“The four-year fellowship programme will become an alternative pathway to the current master of surgery programme in producing more cardiothoracic surgeons in the country. Training will be done in collaboration with the Malaysian Association of Thoracic and Cardiothoracic Surgery while examination and certification will be done by the Royal College of Surgeon (Edinburgh UK),” added the then-Health DG, who is also a breast and endocrine surgeon.

He pointed out that the parallel pathway programme would shorten the time taken to produce cardiothoracic surgeons from seven to eight years to four years.

Eight years later in 2022, Dr Noor Hisham celebrated eight trainees from the cardiothoracic surgery parallel pathway programme, after they passed the Royal College of Surgeons of Edinburgh (RCSEd) Joint Specialty Fellowship Examination in Cardiothoracic Surgery and would be awarded the Fellowship of the Royal College of Surgeons of Edinburgh (FRCSEd) in the specialty of cardiothoracic Surgery.

“The exams were held simultaneously in KL and Hong Kong over the weekend, with examiners appointed by the RCSEd from the UK, Singapore, Malaysia and Hong Kong,” Dr Noor Hisham wrote on May 29, 2022.

The cardiothoracic surgery parallel pathway training for the eight successful trainees, he said, was sponsored by the MOH, the National Heart Institute (IJN), Universiti Malaya, and the Brunei government.

“The Cardiothoracic Surgery Parallel Pathway Training in Malaysia is jointly organised by the Ministry of Health, the Academy of Medicine of Malaysia, the Malaysian Association for Thoracic and Cardiovascular Surgery (MATCVS), Universiti Malaya, and the RCSEd,” said Dr Noor Hisham.

“It is quality assured to international standards by the RCSEd. Thirty-two trainees are currently undergoing cardiothoracic surgery training through the parallel pathway in the Ministry of Health, IJN, and Universiti Malaya.”

Like Dr Muhammad Radzi, Dr Noor Hisham was also the MMC president when he was in office as Health director-general. But Dr Noor Hisham, who is currently IJN chairman, has not issued any statements on the parallel pathway issue ever since the conflict broke out this year.

Despite Dr Noor Hisham’s quality assurance for the RCSEd cardiothoracic surgery parallel pathway programme, Dr Muhammad Radzi’s recent statement said registered medical practitioners must possess “recognised” qualifications and have undergone training with the “highest standards of the profession, in the interest of public safety and health”.

Although Dr Noor Hisham’s previous statements did not explicitly say that the FRCSEd in cardiothoracic surgery qualification was recognised by the NSR, it is reasonable to assume recognition of the parallel pathway programme, given that it was organised and sponsored by the MOH itself.

Hence, it’s unclear why, under Dr Muhammad Radzi, the MMC recently rejected NSR registration applications by four pioneer parallel pathway graduates with FRCSEd in cardiothoracic surgery.

Besides 17 elected members, the current MMC has nine appointed members from local universities and university colleges, as well as five appointed members from the private and public sectors.

No one has come on record yet to explain what are the real drivers of the conflict between the MOH’s parallel pathway and local universities’ Master programmes. The Medical Deans Council’s letter to The Star last February 7 simply reiterated issues of “quality”, competence, and “stringent standards” in the need to produce medical specialists, touting priority for national programmes.

There is still no end in sight to the turf war over the production of specialist doctors, with the MMC simply saying that a task force has been formed to resolve the issue. Although parallel pathway advocates have been calling for intervention from Health Minister Dzulkefly Ahmad (which may be questionable, given that this involves the practice of medicine that should be resolved by the profession itself), the MMC appears to have stood its ground with its March 25 statement.

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