KUALA LUMPUR, April 9 — The National Heart Institute (IJN) has instructed eight cardiothoracic surgery parallel pathway trainees and graduates from the Royal College of Surgeons of Edinburgh (RCSEd) to seek “accreditation” from Universiti Teknologi MARA (UiTM).
The directive last January from the head of IJN’s Department of Cardiothoracic and Vascular Surgery to trainees and graduates of the Fellowship of the Royal College of Surgeons of Edinburgh in Cardiothoracic Surgery, or FRCS CTh (Edin), came after the Malaysian Medical Council (MMC) rejected National Specialist Register (NSR) registration applications by four graduates on the basis that the MMC did not recognise their postgraduate qualification.
Dr Nur Aziah Ismail, Dr Syed Nasir Syed Hassan, Dr Chong Kee Soon, and Dr Lok Yuh Ing – who all have the FRCS Ed in cardiothoracic surgery qualification after passing the Joint Examination – subsequently filed a judicial review application in the High Court against the MMC last March 20 to legally challenge the regulatory body’s refusal to register them as cardiothoracic surgery specialists on the NSR.
Dr Nur Aziah and Dr Chong are currently employed by IJN, a cardiac centre owned by the Ministry of Finance, while Dr Syed Nasir and Dr Lok are working in the Ministry of Health (MOH).
MMC’s letters dated December 21, 2023, to the four graduates stated that MMC’s 435th meeting on October 17, 2023, had decided that the graduates were not entitled to be registered as specialists under the Medical Act 1971 because the MMC did not recognise their postgraduate qualification.
Based on court filings, as sighted by CodeBlue, Prof Dr Alwi Yunus, a senior consultant cardiac surgeon and head of the Department of Cardiothoracic and Vascular Surgery at IJN, wrote an email to eight FRCS CTh (Edin) trainees and graduates, including Dr Nur Aziah and Dr Chong, last January 12 with the subject: “Pre-Application Masters in Surgical Sciences and Doctorate in Cardiothoracic Surgery UiTM”.
His email – citing MMC’s October 17 meeting where it was “deemed” that the FRCS Edinburgh cardiothoracic surgery programme was not recognised by the MMC – said it was critical to identify a solution that “meets the training and manpower needs of IJN and also does not jeopardise the career progression of our trainees”, as he ordered the parallel pathway trainees to complete some forms by January 17 to apply to the UiTM board and senate.
“The details that you provide will be utilised for purposes of mapping and credit transfer in order to recognise the training that you have already received,” he said.
One of the parallel pathway trainees wrote back to Dr Alwi on January 15, expressing surprise that the FRCS CTh (Edin) programme has been “deemed” to not have been recognised by the MMC in its October 17 meeting, pointing out that he has been enrolled in the programme since 2018 to the knowledge of both IJN and MMC.
The doctor, writing on behalf of himself and five other FRCS CTh (Edin) trainees, requested approved minutes of the MMC meeting before they could make an informed decision.
“As you have correctly noted, the decision taken has an impact on my right to work; right of practice and livelihood,” said the doctor, while questioning the “very tight” deadline of three working days to submit forms to UiTM.
These six FRCS CTh (Edin) trainees are not part of the judicial review application against MMC filed by their two coworkers at IJN, Dr Nur Aziah and Dr Chong who are graduates of the parallel pathway programme. The eight of them are all currently cardiothoracic surgery clinical fellows at IJN.
Dr Alwi replied that he was not privy to the minutes of MMC’s meeting, explaining that the deadline of three working days to submit forms was meant to process their transfer to UiTM.
“We have discussed this at length. I would advise you to comply as planned. If you choose to complicate this, it would not be beneficial to the best interests of the group,” Dr Alwi, who is also a senior consultant cardiac surgeon, said in a January 15 email.
In another email sent last January 16 to the eight FRCS CTh (Edin) trainees and graduates, Dr Alwi “duly noted” their “reluctance” to complete the attached forms for their credit transfer to UiTM.
“Please be assured that your requirement to complete these forms is your prerogative. It is similar to when we consent a patient for multivessel CABG and on the day before the surgery he tells us that he would rather have a repeat angiogram and go for PCI instead,” Dr Alwi wrote.
CABG refers to a coronary artery bypass grafting (CABG) procedure, or heart bypass surgery, whereas an angiogram is a diagnostic test that uses X-rays to look at the heart’s blood vessels. A PCI (percutaneous coronary intervention) is a minimally invasive procedure to open blocked heart arteries.
“It’s a choice and we support your right to make that choice. You will however have to endure the delays and consequences of this decision,” Dr Alwi told the eight FRCS CTh (Edin) trainees and graduates in his January 16 email.
“I do fail to see why it is so difficult to provide information that will be used to map the training that you have received in order to provide accreditation that you require. I also need to remind you that you remain bound by the terms of your scholarship to IJN.”
In a January 16 email response by the representative of the six FRCS CTh (Edin) trainees, they requested a three-month extension to the deadline from Dr Alwi to fill up the forms for UiTM, pending verification of MMC’s “de-recognition” of their qualification and MMC’s remedial steps.
“We are fully aware of the consequences of delaying our application and resulting in a delay in the university intake. Please understand this is a very major decision for us.”
The emails by Dr Alwi and the representative of the collective of six FRCS Edinburgh cardiothoracic surgery trainees at IJN were obtained by CodeBlue in court filings from the joint judicial review application by four graduates of the parallel pathway programme.
Former Health director-general and MMC president Dr Noor Hisham Abdullah is chairman of the IJN board, while his successor, Dr Muhammad Radzi Abu Hassan, is a board member.
The MMC’s rejection last December of NSR registration applications by four pioneer graduates of the RCSEd cardiothoracic surgery programme occurred under current MMC president and Health DG Dr Muhammad Radzi.
Dr Noor Hisham had, in 2014, described the parallel pathway – specifically, the cardiothoracic surgery programme by RCSEd – as an “alternative training pathway” to produce more specialist doctors in Malaysia.
According to the website of UiTM’s Department of Cardiovascular & Thoracic Surgery at the Faculty of Medicine, UiTM, in collaboration with IJN, is offering a specialty training programme to produce cardiothoracic surgeons, designed to cater to standards set by the Malaysian Qualifications Agency (MQA), the Malaysian Qualification Framework, and MMC.
The two cardiothoracic surgery programmes offered by UiTM, a local public university, are a two-year Master in Surgical Sciences (Cardiothoracic) and a four-year Doctorate in Cardiothoracic Surgery.
On the doctorate programme, UiTM’s website states: “After fulfilling all the requirements and registration with the National Specialist Registry (NSR), the graduate will be able to function as an independent cardiothoracic surgeon in Malaysia”.
Health Minister Dzulkefly Ahmad said in his winding-up speech at the Dewan Negara last March 27 that UiTM’s cardiothoracic surgery doctorate programme received provisional accreditation from August 13, 2020 to August 12, 2025.
“The MOH recognises UiTM’s role,” Dzulkefly posted on Facebook, sharing a poster with the quote, “Recognition of UiTM as a provider of cardiothoracic specialisation”.
UiTM’s cardiothoracic surgery programmes aren’t included in the list of recognised postgraduate qualifications on MMC’s website.
