KUALA LUMPUR, May 27 — Parallel pathway opponents are not questioning “old” programmes, but are simply saying that post-2017 postgraduate medical programmes require accreditation and recognition by the Malaysian Medical Council (MMC).
Many proponents of the Ministry of Health’s (MOH) parallel pathway programmes with royal colleges in the United Kingdom, especially senior doctors or consultants, appear to take personal offence with opposition to the parallel pathway, acting as if their own qualifications from decades ago are being questioned.
However, senior consultant paediatric surgeon Dr Dayang Anita Abdul Aziz explained that the problem is exclusive to new non-accredited programmes that were set up after the 2012 amendment to the Medical Act 1971 took effect in 2017.
After the 2012 amendment was enforced, all new postgraduate programmes in medicine, both local and international, must have accreditation and recognition from the MMC, the regulator of the medical profession.
“This problem arises because you run a non-accredited programme. You run a programme when you shouldn’t and you put MMC on the spot because you think you are being victimised, but you don’t see it from the point of law,” Dr Dayang Anita told CodeBlue in an interview here last May 15.
“To me, if you are a responsible head of programme, you would ensure, and this is my principle and a lot of people, when you are a responsible head of programme, you want to make sure that your programme, the graduates from your programme can enter NSR (National Specialist Register).
“Therefore, the provider must not continue to give scholarships for programmes that will cause difficulties to enter the NSR because that is law. As soon as people understand this, the better because then we can move on to discuss how to improve health care in this country and we will not just focus on this.”
No Issues With ‘Old’ International Programmes, But New Ones
Dr Dayang Anita said that the problem does not lie with existing international programmes, but with new ones that require accreditation.
According to Dr Dayang Anita, when the parallel pathway was introduced in 2014, the MOH took ownership of the nine international qualifications that would later be listed in the 2017 NSR.
The nine international qualifications that is on the NSR list that MOH took ownership as parallel pathway in 2014 were:
- Royal College of Obstetricians and Gynaecologists UK
- Royal College of Psychiatrists UK
- Royal College of Radiologists UK
- Clinical Oncology Royal College of Radiologists UK
- Royal College of Ophthalmologists UK
- Royal Colleges of Physicians UK & Ireland
- Royal College of Emergency Medicine UK
- Royal College of Paediatrics and Child Health UK/Ireland
- Graduate Certificate & Advanced Training in Family Medicine/ Fellow of the Royal Australasian College of General Practice (GCFM/ATFM/FRACGP)
“In 2014, MOH took ownership of these nine programmes. And by right, if you understand MQR (Malaysian Qualifications Register), all the programmes need to undergo accreditation and recognition. But MMC told us, the grandfather clause masuk, remains as that. They said it’s already in there and these are the old ones, so we let it be,” Dr Dayang Anita said.
The list of qualifications that MMC uses as their administrative list of qualifications to enter NSR is a mixture of the old qualifications and some local programmes which are already in the MQR, and those undergoing full accreditation, she added.
The issue now lies with new, unaccredited programmes added after 2017. “After 2017, everyone understands that we cannot, MMC cannot simply put in new qualifications without accreditation,” Dr Dayang Anita said. These include:
- Royal College of Physicians and Surgeons of Glasgow (Plastic Surgery)
- Royal College of Surgeons of Edinburgh (Cardiothoracic Surgery)
- Royal College of Physicians and Surgeons of Glasgow (Urology)
- College of Anaesthesiologists of Ireland (Anaesthesia)
- Irish College of General Practitioners (Family Medicine)
- Diploma of the Worshipful Society of Apothecaries of London (Medical Jurisprudence).
“You cannot have recognition, according to the law, without formal accreditation. For professional programmes, there’s no self-accreditation. You have provisional accreditation and full accreditation.
“The NSR was only legalised in 2017. Along with that 2017 NSR was the formation of the Medical Education Committee (MEC) of MMC.
“So, from 2017, there is no more accreditation without passing through the MEC of MMC, or rather, for postgraduate medical training, if you develop a new programme after 2017, you have to go through the pathway of accreditation by MMC for recognition and therefore, you cannot add qualification to the list anymore,” Dr Dayang Anita said.
Among the nine programmes taken over by MOH, if they have a change in the way they run the programme previously and now, they have to be accredited. If it is exactly the same, then it’s fine, said the former paediatric surgery professor from Universiti Kebangsaan Malaysia (UKM).
“The whole Act [Medical Act 1971 (Amendment 2012)] is to ensure standardisation. When I talk about accreditation, you cannot talk about a different set of accreditation. When I talk about recognition, it is to enter the National Specialist Register. It’s not to enter anybody else’s register. But if you are a new programme, definitely, you shouldn’t be enrolling candidates or students until you get provisional accreditation.”
Proponents of the parallel pathway, however, argue that these parallel pathway programmes don’t need accreditation because they are professional qualifications that are exempt from the Malaysian Qualifications Agency (MQA) Act 2007.
“No, it’s very clear. The MQA Act says professional qualifications cannot be self-accredited,” Dr Dayang Anita said.
“I cannot pat myself on the back and blow my own trumpet saying, ‘I’m good, I’m this, I’m that’. For professional qualifications, the accreditation must follow the proper way, that is there is a panel of assessors that is not from your own.
“The awarding body cannot accredit and recognise your own qualification.”
Health Minister Dr S Subramaniam, in an interview with CodeBlue previously, admitted that the parallel pathway lacked structure compared to local Master’s programmes, and 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.
Dr Dayang Anita used a road safety example to illustrate her point.
“You have one road to the end destination, and you build a parallel road. When you build a parallel road, the law to safeguard safe travel must be applied to both, right? So, if you want to drive on the parallel road, you need a driving licence, you need to wear a safety belt, you need to watch the speed limit – the same as this road – because you call yourselves a parallel road.
“But that is not happening with the parallel pathway,” Dr Dayang Anita said. “If the qualification that we are running at the moment, or whoever is running at the moment, cannot even be recognised by their home country, why are we using it to produce specialists for our country?”
Parallel pathway proponents seemingly dismiss the need for a regulator or a third party to accredit or recognise a particular medical specialty training programme, touting instead that it is enough for a training or education provider to simply say that its own programme is good.
A recent statement by the College of Surgeons Academy of Medicine of Malaysia curiously said that “of greater importance to recognition by the GMC (United Kingdom General Medical Council)” is the standards and quality of specialist training, and that such “quality assuring” was done by the royal colleges in the UK – for their own programmes.
The UK GMC – which regulates the medical profession across England, Scotland, Wales, and Northern Ireland – told CodeBlue in an email interview that it does not recognise the FRCS Edinburgh in Cardiothoracic Surgery for specialist registration in the UK, as the regulator only recognises the Intercollegiate Specialty Fellowship Examination.
MMC’s Method For Accrediting And Recognising Qualifications
Dr Dayang Anita said MMC is empowered, through its Medical Education (MEC), to accredit and recognise new programmes and qualifications for NSR registration.
“What they do is they will nominate names of experts from your fraternity. It could be from the university, it could be from MOH, it could be from whichever, who has been trained.
“MEC will nominate three to four names and then submit them to MQA. MQA is the secretariat. They will do the conflict-of-interest checks and all that and then give the appointment because they are the ones who are going to make the payment.
“What do they do? Provisional accreditation or full accreditation, they will accredit the provider, make sure it’s a registered provider, and at the moment, the registered provider is under the Ministry of Higher Education. It could be a private institution as well, but it has to be registered.
“And then they look at the head of programmes. They look at your credentials, they look at your quality, they look at who’s going to train, they look at the programme, syllabus, curriculum and so forth, all the training, and then they come for visits to look at the facilities and all.
“What is the difference between provisional and full? By the time they do full accreditation, they have graduates. They can interview the students. The provisional [accreditation] – they don’t have students.
“During the full accreditation exercise, the panel of assessors will come and do what they’ve done in the provisional accreditation, as well as interview the staff, the ongoing students, the graduates and so forth.
“Then, the panel of assessors will give their recommendations to MMC and MMC will bring these recommendations whether this programme and the qualification can be recognised. Is the programme accredited and can we recognise the qualification? Then, after that, it goes to the Joint Technical Committee of MMC to endorse it.
“Even the MQA cannot enter anyone in the MQR unless it is recognised by MMC because for medical, especially postgraduate, the power has been relegated to MMC. It cannot be reversed. It cannot be said that MMC has the power to include this qualification into the list without accreditation.
“So what we are all bickering about now is who should do the accreditation when the law clearly says that it’s relegated to the MMC, and there is a pathway already,” Dr Dayang Anita said.
Editor’s note: The headline for this story was amended to better reflect the interviewee’s comments.
