Proposed Medical Act Amendment ‘Huge Mistake’ With Non-Accredited Parallel Pathway: Paediatric Surgeon

Paediatric surgeon Dr Dayang Anita says amending the Medical Act will be a “huge mistake”, saying the parallel pathway is not equivalent to local Master’s programmes. “In the end, are we really producing safe specialists? We amend the law to let them in.”

KUALA LUMPUR, April 12 — A senior consultant paediatric surgeon has opposed the government’s plans to amend the Medical Act 1971 (Amendment 2012) in a bid to resolve the non-recognition of parallel pathway training for specialist doctors.

Dr Dayang Anita Abdul Aziz – who has a postgraduate qualification from the Royal College of Surgeons of Edinburgh, conferred as a Fellow in 2000 (FRCS Edinburgh UK) – stressed that there are “genuine concerns” with the Ministry of Health’s (MOH) parallel pathway training programmes.

“The parallel pathway is not equivalent to the local university’s training programmes,” Dr Dayang told CodeBlue today.

“So amending the Medical Act will perpetuate this difference. In the end, are we really producing safe specialists? We amend the law to let them in. 

“Obviously, with the current law, they cannot enter the National Specialist Register (NSR). So it’s not that the Malaysian Medical Council (MMC) refuses; MMC under this DG is following the law,” she added, referring to Health director-general and MMC president Dr Muhammad Radzi Abu Hassan, who took office in April 2023.

“If we are looking for fault, then question those who started the programme without due regard for laws.”

Health Minister Dzulkefly Ahmad told reporters last Wednesday that the MOH is at the final stage of reviewing amendments to the Medical Act with the Attorney-General’s Chambers (AGC), adding that the amendment bill will address MMC’s non-recognition of certain parallel pathway and local Master’s programmes.

“Amending the Act, in my opinion, is a huge mistake,” Dr Dayang told CodeBlue.

“It means the practice of MOH giving money to societies to run non-accredited training programmes will continue. Imagine, that money should have been put into proper use, improving the health system for children especially. 

“How can these programmes run by societies – which are not legally registered as higher education providers, but conducted through a memorandum of understanding (MOU) with international colleges – be equivalent to local postgraduate programmes run by trained lecturers, accredited universities, supervised by Conjoined Specialty Committees, and monitored by rules and regulations, i.e. the MQA Act, Medical Act, and the Universities and University Colleges Act?”

Dr Dayang believes it is a mistake to think that allowing parallel pathway graduates to be registered on the NSR will resolve the shortage of specialist doctors in the MOH.

“So many of the young consultants have left government service once they entered the NSR. To join private practice, they must be on the NSR,” said the senior consultant paediatric surgeon.

“If they genuinely want to serve MOH, waiting to have their qualifications reassessed, i.e. getting the right qualifications by the right authorities, shouldn’t be a problem.”

Dr Dayang pointed out that when she developed the Masters in Paediatric Surgery for Universiti Kebangsaan Malaysia (UKM) back in 2010, she had to ensure that the postgraduate programme received provisional accreditation from the Malaysian Qualifications Agency (MQA) through proper submission processes before enrolling students.

“Naturally, we had to go through more processes to get the full accreditation and continue to maintain our standards through the Conjoined Specialty Committee. We had our first cohort of graduates in 2019.”

The MQA Act 2007 has been imposed on all new clinical programmes since 2007. MQA empowers the MMC to accredit and recognise qualifications, she added.

Dr Dayang explained that in local Master’s programmes in medicine, because of Conjoined Committees for each specialty, the entrance, assessment, and exit examinations are the same for candidates regardless of which university they are registered with.

“This is to ensure high standards of graduates – to produce safe specialists for our people.”

Dr Dayang told the MOH to look at the statutes of the country, stressing that the training of undergraduates and postgraduates for medical specialties falls under the statute of the Ministry of Higher Education (MOHE).

“The training of specialists starts from looking at their qualifications to enter the programme, going through proper curriculum and modules, and standards assessments. If they don’t perform, we can terminate them. Do parallel programmes have these mechanisms?”

The senior consultant paediatric surgeon also questioned how much taxpayers’ money has been spent on the parallel pathway programmes.

“MOH could have used that budget to pay MOH consultants to be part of Tenaga Pengajar Klinikal (at the moment, universities are paying them). The training has always involved the universities and MOH. It cannot be that parallel programmes run on their own without being part of Conjoined Committees or be monitored,” Dr Dayang said.

Dr Dayang – who was in the MOH for 12 years before she joined UKM in 2007, where she served for 16 years, including as a Professor of Paediatric Surgery, before optional retirement – also questioned attempted intervention from foreign colleges into Malaysia’s medical specialist training, pointing out that each country has its own laws.

“You think we can go to Australia and tell them we can practise there? No way! One has to follow Australian law and regulations of the Australasian College of Surgeons (RACS), even though you have FRCS from the UK.”

In a recent open letter to Dzulkefly, the Royal College of Surgeons of Edinburgh (RCSEd) criticised MMC’s rejection of NSR specialist registration applications by four graduates from its cardiothoracic surgery parallel pathway training, describing it as a violation of the “partnership and work undertaken” at the MOH’s request.

Dr Dayang also pointed out that unlike local Master’s programmes, as a Fellow of FRCS Edinburgh UK, she is required to pay the royal college an annual fee to be able to say that she has that qualification.

“I have not made my annual payment in recent years, so I can’t put the qualification attached to my name,” she said. 

“Graduates of accredited programmes from accredited local universities do not have to do this. Once they receive their degree after the convocation, the qualification remains forever, carved in stone.”

Then, to be able to enter the NSR to be recognised as consultants (“note the difference between specialist and consultant”), these new specialists who graduated from local Master’s programmes need to fulfil the requirements for post-qualification training set by each individual specialty.

“The FRCS (Edinburgh UK) conferred to me in the year 2000 was recognised by the UK General Medical Council (GMC) and registrable to practise in the UK. I wonder what is the stand by UK GMC with regards to the current MOH parallel qualifications which involve the UK Colleges now?” Dr Dayang questioned.

“Let this be a lesson to all budding medical specialists to always remember – there aren’t any shortcuts to becoming good, competent, and safe consultants. Follow the law and get training from the right people.”

MMC is now embroiled in at least three court cases after 11 graduates from medical specialist training – both the parallel pathway and a local university postgraduate programme – filed judicial review applications in the High Court here between November 2023 and March 2024 against the regulator’s rejection of their applications to be registered as specialists on the NSR.

In these three cases, MMC rejected their NSR registration applications after refusing to recognise their postgraduate qualifications from the Fellowship of the Royal College of Surgeons of Edinburgh in cardiothoracic surgery, the Fellowship of the Royal College of Surgeons in Ireland in neurosurgery, and the Master of Pathology (Medical Genetics) from Universiti Sains Malaysia (USM).

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