PETALING JAYA, May 7 — Former Health Minister Dr S. Subramaniam characterises the open conflict over the parallel pathway as a “blessing in disguise” for medical specialty training in Malaysia.
The war between doctors in the Ministry of Health (MOH) and public universities over two tracks of medical specialty training – the parallel pathway with overseas royal colleges and local postgraduate programmes – exploded publicly in the past few months.
Last December, the Malaysian Medical Council (MMC) rejected specialist registration applications on the National Specialist Register (NSR) by four pioneer graduates of the cardiothoracic surgery parallel pathway programme with the Royal College of Surgeons of Edinburgh (RCSEd) – on the basis of not recognising their Fellowship of the Royal College of Surgeons of Edinburgh (FRCS Ed) in Cardiothoracic Surgery qualification.
“Actually, to me, this whole episode of medical specialist recognition, which has sort of exploded in the last few months, is a blessing in disguise,” Dr Subramaniam told CodeBlue in an interview here last April 24.
“It is a blessing in disguise because it has brought into open a debate on an issue which was simmering for too long, with different groups having different views”.
Dr Subramaniam explained that before the start of local Master’s programmes in medicine in Malaysia in 1973, all specialist doctors were trained by royal colleges in the United Kingdom.
He stressed that these royal colleges were not trainers, but provided the syllabus, standards, examinations, as well as certification of specialists in various fields like medicine, surgery, and obstetrics.
The first local Master’s programme in medicine began in Universiti Malaya in 1973. Today, 11 public universities conduct some 25 courses in medical specialisation and provide Master’s accreditation.
“So, while these things slowly evolved, the Master’s programmes slowly evolved, the doctors who chose to sit for the exams conducted by the Royal Colleges also continued to do so. So it was going simultaneously,” Dr Subramaniam said.
Dr Subramaniam – who was health minister from 2013 to 2018 during Prime Minister Najib Razak’s administration – pointed out that doctors from both the Ministry of Health (MOH) and public universities went for accreditation by the royal colleges in the United Kingdom.
“Of course, as the Master’s became more and more pervasive, then this sentiment grew among one group of medical professionals that we should strengthen the Master’s and slowly fade away the parallel programme – this has been going on, my time it has been going on,” he said.
“But what we saw was the Master’s programme was not able to provide the number of places to train the number of specialists which we genuinely require”.
Dr Subramaniam opposes abolishing the parallel pathway, due to insufficient specialist numbers produced by local Master’s programmes, saying that a full shift to local postgraduate medical specialty training may only occur in the next 10 to 15 years.
The former health minister explained that efforts had already begun for standardisation between the “very structured” Master’s programmes, where trainees work and also study, and the parallel pathway where doctors working in the MOH are trained on the job.
“So we actually said, ‘Okay, if that’s the situation, then there must be some standardisation between these two so that at least the training part is more or less equal’. And there was progress, in that sense,” Dr Subramaniam said.
He said he had informed the MOH’s medical development division to put more structure into the parallel pathway training.
Around 2014, the Dean’s Council, together with the MOH, held conjoined discussions and created the National Postgraduate Medical Curriculum in an attempt to synchronise both the local Master’s programmes and parallel pathway training.
By 2021, the National Postgraduate Medical Curriculum covered a dozen specialties.
“There must be an entry requirement, there must be a training period of four years for some specialties, and this should be supervised, and then there should be an exit examination, and then there should be a process of assessment, and then you go into the specialist register,” Dr Subramaniam explained.
However, recently, “for some reason or other”, a group of doctors – many of whom are from within the MMC, Dr Subramaniam alleged – decided that perhaps it was time to “fade away the parallel pathway and just recognise the Master’s programme”.
The former health minister stressed that the National Postgraduate Medical Curriculum team has already worked on standardising the local Master’s programmes and the parallel pathway, as he expects additional specialties to be covered beyond the existing 12.
“They have already created a structure which will be able to address this issue,” he said.
Hence, training inequality between the local Master’s programmes and the parallel pathway will reduce, “so long as they implement the recommendations within the curriculum”.
“For example, if the doctors are trained within the ambit of the Ministry of Health, then the Ministry of Health should ensure that these doctors actually follow or are trained according to what has been prescribed in the national curriculum. So long as that discipline is there and everybody is willing to work along that, that should be fine”.
Health Minister Dzulkefly Ahmad plans to table a Medical Act amendment bill in the upcoming parliamentary meeting next month to recognise the parallel pathway, but he has yet to disclose the specific proposed amendments.
