Dear Dato’ Seri Dr Dzulkefly Ahmad,
The Royal College of Surgeons of Edinburgh (RCSEd) is very concerned to have been informed that the Malaysian Medical Council (MMC) has recently rejected the specialist registration application of four graduates from the Cardiothoracic Surgery Parallel Pathway Training and informed them that their postgraduate qualification has not been recognised.
This goes against the principle of the partnership and work undertaken at the request of the Ministry and places excellent surgeons, trained and assessed robustly, in an untenable, distressing and unfair position. We hope that with the information provided below that you may be able to facilitate their specialist registration by the MMC.
The RCSEd has a long relationship with Malaysia and has been involved in the training of Cardiothoracic Surgeons in the country at least since 2000 when Mr Pala Rajesh was invited by Institut Jantung Negara (IJN) to initiate and develop the Video Assisted Thoracoscopic Surgery programme.
The RCSEd was also invited by the Ministry of Health of Malaysia (MOH), Academy of Medicine of Malaysia (AMM), and the Malaysian Association for Thoracic and Cardiovascular Surgery (MATCVS) to help develop a national training programme in Cardiothoracic Surgery for the country.
We were made aware of a severe shortage of Cardiothoracic Surgeons in Malaysia and the absence of any structured training programme of an internationally acceptable standard to meet the needs of the population.
A Memorandum of Understanding (MOU) was signed in 2014 between the Academy of Medicine of Malaysia (AMM) and the RCSEd, endorsed by the then Minister of Health, Datuk Seri Dr Subramaniam, and the then Director-General of Health of Malaysia, Tan Sri Dr Noor Hisham Abdullah, to quality assure and accredit training centres in Cardiothoracic Surgery in Malaysia, and to develop a curriculum for the training of Cardiothoracic Surgeons.
The RCSEd were invited to Malaysia in 2015 to accredit training centres in Cardiothoracic Surgery. Mr Tim Graham and Mr Pala Rajesh, together with Dato’ Dr Mohd Hamzah Kamarulzaman, the then Head of Cardiothoracic Surgery services in the Ministry of Health, inspected five Cardiothoracic Units to quality assure and accredit them as training centres in a national training programme – Hospital Serdang, Hospital Pulau Pinang, Pusat Jantung Sarawak, Institut Jantung Negara (IJN), and Universiti Malaya Medical Centre (UMMC).
Working in partnership with the AMM, the MATCVS and the Ministry of Health of Malaysia (MOH), RCSEd developed a curriculum for the Cardiothoracic Surgery Parallel Pathway Training in Malaysia which follows the UK Intercollegiate Surgical Curriculum for Cardiothoracic Surgery.
The entry criteria, duration of training, formative assessments with work-based assessments, and Annual Reviews of Competence and Progression (ARCP) assessments follows the same criteria and standards as approved by the UK General Medical Council for training in Cardiothoracic Surgery in the UK. The RCSEd also conducted training-the-trainers courses to train the trainers to an acceptable standard for the training programme.
In July 2016, four candidates were accepted into the Cardiothoracic Surgery Parallel Pathway Training – two sponsored by IJN, one by MOH, and one by UMMC. As of today, 32 candidates have entered the Cardiothoracic Surgery Parallel Pathway Training, four of whom have completed their training, and another 8 have successfully passed their exit examinations.
In addition to the initial accreditation visits in 2015, further accreditation visits to quality assure and accredit training centres were conducted as follows:
- February 2018 to IJN and UMMC
- August 2018 to Universiti Teknologi MARA (UiTM)
- November 2018 to IJN, Hospital Queen Elizabeth II Kota Kinabalu (QE2 KK), and Hospital Sultanah Aminah Johor Bharu (HSA JB)
- September 2022 to IJN, UMMC, Hospital Pulau Pinang, Hospital Serdang, Pusat Jantung Sarawak, QE2 KK, HSA JB, Hospital Raja Perempuan Zainab II Kota Bharu, and Hospital Cancelor Tuanku Mukhriz Universiti Kebangsaan Malaysia (HCTM UKM).
The reports for each of the accreditation visits are attached. IJN, UMMC, Hospital Pulau Pinang, Hospital Serdang, HSA JB, Pusat Jantung Sarawak, QE2KK and HCTM UKM have been accredited as training centres in Cardiothoracic Surgery.
The exit examination for the Cardiothoracic Parallel Pathway Training is the RCSEd Joint Specialty Fellowship (JSF) Examination in Cardiothoracic Surgery. Please note that this is a different exam to the Joint Surgical Colleges Fellowship Examination (JSCFE), which is run by the Joint Committee on Intercollegiate Examinations (JCIE).
The RCSEd JSF exam is a summative exit qualification at the end of a quality assured training programme with a curriculum, annual progression points and assessments, and formative work-based assessments to ensure technical competence, all done to the standard of the UK National Training Programme in Cardiothoracic Surgery and quality assured by RCSEd.
The RCSEd JSF exams have been used as the only exit exams for Cardiothoracic Surgery training in both Hong Kong and Singapore for more than 20 years. Candidates from the Cardiothoracic Parallel Pathway Training in Malaysia began taking this same exam in 2022 through an MOU signed in 2018 between the RCSEd, College of Surgeons of Hong Kong, Joint Committee of Specialist Training of Singapore, and the AMM.
Candidates must successfully complete at least 4 years of higher specialist training in Cardiothoracic Surgery, and be signed off by their programme director, before being eligible to take the examination – as in the UK. The examination is to the same standard as the UK Intercollegiate Specialty Board examination in Cardiothoracic Surgery run by the JCIE. It comprises three sections:
- A written Single Best Answer paper which tests knowledge across the breath of the syllabus.
- A Clinical Examination section which includes clinical scenarios, communication, and patient engagement skills.
- A Viva Examination which explores the depth of knowledge, international guidelines, and complication management, amongst others.
A Quadripartite Board comprising representatives from the RCSEd, College of Surgeons of Hong Kong, Joint Committee of Specialist Training of Singapore, and the AMM provides oversight and facilitates delivery of the examination. Examiners are provided by the RCSEd from the UK and are also trained and appointed by the RCSEd locally in Singapore, Hong Kong and Malaysia.
The expertise with regards standard setting, quality assurance, psychometrics, and the question bank are provided by RCSEd. These are all done to the standards required by the UK General Medical Council (GMC) for Specialist Registration in Cardiothoracic Surgery in the UK.
On successfully passing the RCSEd JSF examination in Cardiothoracic Surgery, candidates are awarded Fellowship of the Royal College of Surgeons of Edinburgh (FRCSEd) in Cardiothoracic Surgery. Graduates from the Cardiothoracic Parallel Pathway training with this qualification are eligible to apply for Specialist Registration as Cardiothoracic Surgeons in the UK through the Portfolio Pathway.
The RCSEd highly values our long working relationship with the MOH, the AMM and the MATCVS in training Cardiothoracic Surgeons to the highest standards and quality. In addition to the training of Cardiothoracic Surgeons in Malaysia, we have also established a regional office in Kuala Lumpur, and also conduct training courses and examinations for surgeons and dentists.
We award the Tuanku Mukhriz Travelling Fellowship annually to provide surgeons with greater experience and training in rural surgery in Malaysia.
We hope to be able to continue these collaborative activities with the MOH, the AMM and other organisations in Malaysia to increase the standards and quality of surgeons practicing in Malaysia.
If required, we would be keen to meet with you in person to discuss any concerns the MMC may have with the Cardiothoracic Surgery Parallel Pathway training, examination and qualification.
By Professor Rowan W Parks, president of the Royal College of Surgeons of Edinburgh, United Kingdom.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
