KUALA LUMPUR, May 13 — The United Kingdom’s General Medical Council (GMC) says it does not recognise the cardiothoracic surgery qualification from Malaysia’s parallel pathway programme with the Royal College of Surgeons of Edinburgh for specialist registration in the UK.
GMC’s unequivocal statement on non-recognition of the Fellowship of the Royal College of Surgeons of Edinburgh in Cardiothoracic Surgery – for the registration of doctors on the UK Specialist Register – shatters the cornerstone of advocates’ argument for Malaysian Medical Council (MMC) recognition of the parallel pathway for medical specialty training.
The Malaysian Association for Thoracic & Cardiovascular Surgery (MATCVS) and former Health director-general Dr Noor Hisham Abdullah previously claimed that the UK regulator recognises the FRCS Edinburgh in Cardiothoracic Surgery qualification and the exit examination for the Ministry of Health’s (MOH) cardiothoracic surgery parallel pathway programme with the Royal College of Surgeons of Edinburgh (RCSEd).
“The FRCS Edinburgh in Cardiothoracic Surgery does not lead to the award of a CCT (Certificate of Completion of Training) and therefore does not entitle an individual to specialist registration,” a UK GMC spokesperson based in London told CodeBlue last Wednesday in an email interview.
“The qualification is recognised as an acceptable postgraduate qualification for the purpose of applying for full registration and a licence to practise with the GMC provided it was following examination, but not specialist registration.
“It’s also important to highlight that the qualification approved by the GMC for the purpose of specialty training in the UK – that leads to the award of a CCT and subsequent recognition onto the specialist register – is the Intercollegiate Specialty Fellowship Examination (ISFE). Not the FRCS.”
Although the FRCS is awarded by a UK royal college, the GMC said it is “not a primary medical qualification.”
When asked if the FRCS Edinburgh in Cardiothoracic Surgery qualification is recognised in its “home country” of Scotland, the UK GMC pointed out that it is the regulator of doctors “across all four countries of the UK.”
“Meaning that a qualification deemed acceptable for the purpose of applying for registration with us is, by definition, acceptable across England, Scotland, Wales, and Northern Ireland.”
GMC Omits Mention Of JSF Exam, Says JSCFE And Intercollegiate Exams ‘Aren’t Equivalent’
CodeBlue cited the Royal College of Surgeons of Edinburgh’s open letter to Health Minister Dzulkefly Ahmad that said the exit examination for the cardiothoracic surgery parallel pathway training is the RCSEd Joint Specialty Fellowship (JSF) Examination in Cardiothoracic Surgery.
RCSEd said the JSF is a “different” exam from the Joint Surgical Colleges Fellowship Examination (JSCFE). The JSCFE exam produces the FRCS International qualification.
When CodeBlue asked if the GMC considered the JSF exam by the RCSEd to be equivalent to the Intercollegiate Specialty Board exam by the Joint Committee on Intercollegiate Examinations (JCIE), the regulator of the UK’s medical profession replied, “The two qualifications aren’t equivalent.”
Curiously, the GMC did not mention the JSF exam at all in its response to CodeBlue; instead, the UK regulator went on to explain the differences between the ISFE and the JSCFE examinations.
“The Intercollegiate Specialty Fellowship Examination (ISFE) covers all surgical specialties and forms part of the GMC approved programme of assessment that leads to the award of a CCT and entry to the UK Specialist Register.
“The Joint Surgical Colleges Fellowship Examination (JSCFE) is a parallel suite of examinations that are run internationally, covering the following surgical specialties:
- Cardiothoracic surgery
- General surgery
- Neurosurgery
- Otolaryngology
- Trauma and orthopaedic surgery
- Urology
“Examinations are made up of two components, section one and section two. The difference between the two section one examinations is that the international JSCFE avoids National Health Service (NHS)-centric questions and questions with religious connotations aren’t used.
“The syllabus for both assessments is published online, with the JSCFE being based on the ISFE. Following success in either section one examinations, candidates could then opt to sit either the section two of the JSCFE or section two of the ISFE.
“The section two examinations are substantially different to each other. You may find it useful to refer to the JSCFE website for further clarification on the different suites of examinations.”
The JSCFE website explicitly states that the JSCFE and the ISFE examinations – both administered by the JCIE – are not equivalent and that the GMC and Medical Council in Ireland only recognise the Intercollegiate Specialty Fellowship Exam.
“The JSCFE is aimed at surgeons in the international community who are about to, or who have recently completed their training and who wish to continue their careers in countries other than the UK or Ireland,” says the JSCFE website.
According to the JCIE’s website, JCIE is responsible to the four surgical Royal Colleges of Great Britain and Ireland, in line with the statutory requirements of the GMC, for the supervision of standards, policies, regulations and professional conduct of the Specialty Fellowship Examinations.
No Exam Mandated For Portfolio Applications To Enter UK Specialist Register
Citing GMC’s website, CodeBlue noted that there are various paths for specialist registration in the UK – including a CCT for doctors who completed an approved training programme in the UK and the Portfolio Pathway for doctors who have not trained in an approved programme – as CodeBlue asked the GMC to explain the differences between both pathways.
CodeBlue also asked if exams are only part of the evidence required by the GMC for registration on the UK Specialist Register and whether two applicants – one with an FRCS Edinburgh in Cardiothoracic Surgery who passed RCSEd’s JSF Exam and another with the FRCS (CTh) who passed JCIE’s Intercollegiate Specialty Fellowship Examination – could get registered as specialists in the UK if they had the necessary skills and experience, regardless of whatever exam they took.
The GMC replied that passing the exam noted in the CCT curriculum is a requirement for CCT trainees in the programme before they can be recommended for the award of a CCT by their royal college or faculty and, subsequently, make an application for entry to the Specialist Register on this basis.
“For cardiothoracic surgery, this is the Intercollegiate Specialty Fellowship Exam delivered by the JCIE,” said the GMC.
“There is not an exam mandated as part of making a Portfolio application for entry on to the Specialist Register; however, applicants are required to demonstrate they have the knowledge, skills, and experience required to practise as a specialist in the UK.
“Where applicants do not hold the Intercollegiate Specialty Board exam, they will need to demonstrate the same level of knowledge by providing a detailed mapping showing how every JCIE competency has been covered in their own qualifications.”
GMC’s response did not make reference to any specific exam or qualification – be it the FRCS Edinburgh in Cardiothoracic Surgery, the FRCS International, or any other – that would be considered in Portfolio applications for entry onto the UK Specialist Register as cardiothoracic surgeons.
When asked if the GMC has ever approved – for entry onto the UK Specialist Register – any graduates with the FRCS Edinburgh in Cardiothoracic Surgery qualification, plus the number, date, and country of origin of approved applicants, the UK regulator told CodeBlue to submit a Freedom of Information request under the UK’s Freedom of Information Act.
Royal Colleges Deliver Exams Overseas For ‘Wide Range Of Candidates’
CodeBlue asked if the GMC had any concerns with UK royal colleges offering postgraduate medical training, exams, and qualifications to developing countries that did not appear to be considered equivalent to the qualifications that these very same institutions provide to UK citizens.
The GMC acknowledged that royal colleges and faculties deliver exams overseas “that, for various reasons, are open to a wide range of candidates.”
“Our powers in respect of postgraduate medical education, as set out in the Medical Act, are to set the standards for medical education and training in the UK. Our standards cover the approval of curricula, assessments, programmes, and locations for training that lead to the award of a Certificate of Completion of Training (CCT) in the UK,” said the GMC.
“We have no legal powers to regulate the education of doctors not in GMC approved training.”
The UK regulator also said it was up to the royal college to award the FRCS Edinburgh, when CodeBlue asked if the GMC considered the cardiothoracic surgery qualification to be a “commercial” one.
“The examination that is approved by the GMC is the Intercollegiate Specialty Fellowship Examination in each recognised surgical specialty in the UK and is therefore different to the FRCS.”
GMC’s Malaysian counterpart, the MMC, said in a statement last March, issued by its president Dr Muhammad Radzi Abu Hassan, that it had never recognised the FRCS Edinburgh in Cardiothoracic Surgery qualification.
Last December, the MMC rejected applications by four pioneer graduates of the MOH’s cardiothoracic surgery parallel pathway programme with the RCSEd to register as specialists on the National Specialist Register (NSR), triggering an open war between parallel pathway and local Master’s advocates on medical specialty training in Malaysia.
For cardiothoracic surgery, MMC’s list of recognised postgraduate qualifications specifies the Fellow of Royal College of Surgeons (UK & Ireland) – Intercollegiate Specialty Board in Cardiothoracic Surgery.
