‘Who Is Legally Accountable For Parallel Pathway?’ Galen Centre Asks

Galen Centre CEO Azrul Mohd Khalib asks who is legally accountable for parallel pathway programs, as MOH isn’t a higher learning institution, while AMM is an RoS-registered society. He suggests tying MOUs with UK royal colleges to local education partners.

KUALA LUMPUR, May 29 — The Galen Centre for Health and Social Policy has asked who is legally accountable for parallel pathway training in Malaysia, since these medical specialty programmes are not tied to any local education institutions.

Galen Centre chief executive Azrul Mohd Khalib said that under Malaysia’s higher education framework, there needs to be a registered education institution accountable for the education provided to specialist doctors in Malaysia to ensure regulatory standards and compliance with existing laws.

However, parallel pathway training for various medical specialties – such as the cardiothoracic surgery programme by the Royal College of Surgeons of Edinburgh – are conducted through memorandums of understanding (MOUs) with the Ministry of Health (MOH) Malaysia and the Academy of Medicine of Malaysia (AMM), rather than with accredited local educational institutions.

“In any institution that is providing education in Malaysia, they need to come from an education institution that is given the licence, the accreditation to be an education provider because if anything goes wrong, if standards are not being met, there’s fraud, there can be someone held accountable,” Azrul said at The Great Parallel Pathway Debate event co-organised by CodeBlue and the Malaysian Medics International (MMI) here last Saturday.

“At the moment, for the parallel pathway, there is none. And it is an exemption. What we’re actually talking about today is a decade-long exemption to what should not happen.”

Azrul pointed out that the MOH is not an institution of higher learning, while the medical specialty umbrella coalition of the AMM, with a dozen colleges or fraternities of specialists, is registered as a society under the Registrar of Societies (RoS) under the Societies Act 1966.

Meanwhile, the Malaysian Qualifications Agency (MQA) is a statutory body established under the Malaysian Qualifications Agency Act 2007 to accredit academic programmes provided by post-secondary or higher education institutions and to facilitate the accreditation and articulation of qualifications.

“Since 2007, this piece of legislation has been imposed on all new clinical programmes. They conduct reviews, audits and provide accreditation to educational institutions,” Azrul said.

“Rather than amending laws, would it not be easier to change the setup and framework of parallel pathway programmes to ensure compliance with the higher education legislation? Why are we trying to carve out and maintain exemptions that have allowed the current situation to occur?

“I don’t think that amending the Medical Act is a mistake. I just don’t think it is necessary. The current laws are adequate for our needs. Conform to them,” Azrul added.

Azrul questioned how postgraduate programmes run by entities that are not legally registered as higher education providers, but are facilitated through MOUs with foreign royal colleges, can be equivalent to local postgraduate medical programmes.

Local postgraduate programmes are run by trained lecturers, accredited universities, supervised by Conjoined Specialty Committees, and governed by laws and regulations such as the MQA Act 2007 (Act 679), Medical Act 1971, and the Universities and University Colleges Act 1971 (Act 30).

Azrul argued in opposition of the debate motion at The Great Parallel Pathway Debate, while New Sin Yew, a senior advocate at AmerBON Advocates, argued for it.

The debate motion was “This House believes that the Medical Act should be amended to recognise the parallel pathway”.

Every Country Has A Standards Board. For Malaysia, It’s MQA

From left: New Sin Yew (AmerBON Advocates), Nicolas Ong (Malaysian Medics International), and Azrul Mohd Khalib (Galen Centre for Health and Social Policy) at The Great Parallel Pathway Debate event co-organised by CodeBlue and the Malaysian Medics International in Kuala Lumpur on May 25, 2024. Photo by Saw Siow Feng for CodeBlue.

In any country in the world, there is a body or board entrusted by the government and the people to ensure standards, education quality, and accountability, Azrul said.

“You don’t just simply set up shop in another country and start teaching and handing out degrees. Although I think in the United States there are quite a lot of degree mills, basically what you want to avoid is a situation that has affected many Malaysians.

“When you go to a country or you take that degree or a qualification, and then you find out that it’s low quality, it doesn’t have anything to do with what you’re supposed to study, and it’s not recognised anywhere, that’s a problem.

“We want to avoid fraud and a whole series of circumstances where people have spent years of their lives doing their qualifications or degrees, to get a piece of paper that they thought would give them a better life and career prospects, and end up with nothing,” Azrul said.

Regrettably, members of the Malaysian Medical Council (MMC), led by the Health director- general from the MOH, have faced unfounded criticisms, including being labelled as gatekeepers and power-hungry figures.

“This has been incredibly unfair and what they have tried to do are their jobs within the framework of existing regulations. It is clearly a thankless task,” Azrul said.

In Malaysia, the MQA is mandated by law to uphold educational standards and ensure quality.

“For us to now question, ‘Who is MQA?’ is tricky because then we would argue, ‘We don’t need MQA. We don’t need anybody; we can regulate ourselves. We don’t need anybody to tell us, we know what we’re doing’. Then we don’t need MMC. Why do we need MMC?” Azrul asked.

“The point is, MQA exists because it has been given the trust and responsibility to carry out and make sure that standards are there. It has set up what is required.

“If Malaysians were to go to the UK, Australia, Japan, or Singapore and try to do some of these programmes, we would have to meet their requirements. Their boards would actually demand that we meet their standards for us to operate in that country and to give out degrees, diplomas, and qualifications.

“Yet, we are now undermining our own education standards board and questioning where they have the guts or authority to do this. We gave it, or rather, Parliament gave them the authority,” Azrul said.

Finding A Win-Win Solution: MOUs With Royal Colleges Can Be Revised To Include Local Education Partners For Accountability

An audience member asks a question at The Great Parallel Pathway Debate event co-organised by CodeBlue and the Malaysian Medics International in Kuala Lumpur on May 25, 2024. Photo by Saw Siow Feng for CodeBlue.

Azrul stressed the importance of finding a win-win solution to the parallel pathway issue, rather than abruptly halting all parallel pathway programmes not recognised by the MMC.

“We have to collaborate with others, but we must do it properly, not through ad hoc MOUs as we have been,” Azrul said.

He argued that it is simplistic and harmful to immediately halt these programmes, as it solves nothing and does not address the shortage of specialists in Malaysia.

“As I mentioned, there could be a way forward. We may need to discuss with RCS Edinburgh, RCS Ireland, whoever we’ve done these parallel pathway programmes, to see if we can amend the arrangement of the MOU that was done years ago to perhaps have a local partner here to ensure that there is a local education partner here in Malaysia who can take part in that programme but also be held accountable.

“There is a way forward, and I would like to say here that we have a dire need for specialists from all areas. It’s not just cardiothoracic surgery,” Azrul said.

Azrul suggested that the current quagmire persists due to a long-standing tolerance of an exemption in regulatory compliance in higher education standards. He clarified that this tolerance likely arose not out of malice or ill intent, but from good intentions.

“There is enough blame and criticism to be spread and shared on all sides. What we need to focus on is solving the problem and ensuring that the needs of the nation for specialised health care professionals are being met, without crippling the health system while doing so.”

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