KUALA LUMPUR, June 26 — Court filings reveal that the curriculum in Malaysia’s cardiothoracic surgery parallel pathway programme was actually primarily designed by a local medical association, not a royal college in the United Kingdom.
This statement by the Royal College of Surgeons of Edinburgh (RCSEd) itself was made internally in March 2023 in response to queries from the Malaysian Medical Council (MMC) – before the controversy over the parallel pathway issue, particularly cardiothoracic surgery, blew up this year.
“The curriculum used in this programme was designed and developed by the Malaysian Association of Thoracic and Cardiovascular Surgery (MATCVS) in collaboration with the Royal College of Surgeons of Edinburgh (RCSEd),” RCSEd president Prof Rowan Parks, RCSEd vice president Prof Dr Timothy Graham, and RCSEd professional standards committee chair Prof Philip Turner said in their response to MMC.
“As an ongoing process, the programme is reviewed and accredited by RCSEd.”
MATCVS is a society registered under the Registrar of Societies (RoS). It is not an education provider or a recognised training institution. MATCVS’ website describes itself as a professional organisation.
The Joint Specialty Fellowship (JSF) exit examination for the cardiothoracic surgery parallel pathway programme is by the RCSEd, while the FRCS Edinburgh in Cardiothoracic Surgery qualification is awarded by the same royal college.
The General Medical Council (GMC), which regulates the medical profession across the UK, does not consider the JSF exam to be equivalent to the approved Intercollegiate exam for specialist registration in the UK.
The response by the three RCSEd officials was emailed by RCSEd Joint Specialty Fellowship coordinator Colin Mills on March 20, 2023, to MMC registration division deputy director Dr Goh Vern Zhi Denise.
Mills’ email to Dr Goh was cc-ed to Joint Committee on Intercollegiate Examinations (JCIE) chairman Dr Michael Lewis; MATCVS president Dr Basheer Ahamed Abdul Kareem; MATCVS honorary secretary Prof Dr John Chan Kok Meng; Prof Dr Hanafiah Harunarashid, pro vice-chancellor of Universiti Kebangsaan Malaysia’s (UKM) Kuala Lumpur campus and former RCSEd international surgical advisor; as well as Prof Dr April Camilla Roslani, former dean of Universiti Malaya’s Faculty of Medicine.
RCSEd’s email to MMC was part of the evidence submitted to the High Court here by the regulator of the Malaysian medical profession, via an affidavit-in-reply filed last June 15, in response to the judicial review application by four cardiothoracic surgery parallel pathway graduates over MMC’s rejection of their applications to register on the National Specialist Register (NSR).
The March 2023 response by Parks and his colleagues to MMC that the cardiothoracic surgery parallel pathway curriculum was “designed and developed by MATCVS” with the RCSEd’s collaboration directly contradicts Parks’ own April 2024 open letter to Health Minister Dzulkefly Ahmad that “RCSEd developed” the curriculum, working in partnership with the Academy of Medicine of Malaysia (AMM), MATCVS, and the Ministry of Health (MOH).
In its open letter to the health minister, RCSEd had complained about MMC’s rejection of NSR registration applications by pioneer cardiothoracic surgery parallel pathway graduates, on the basis of non-recognition of their FRCS Edinburgh in Cardiothoracic Surgery qualification.
Proponents of the cardiothoracic surgery parallel pathway have repeatedly touted the over 500-year history of the RCSEd, the oldest surgical college in the world founded in 1505, to back the quality of the specialist training programme.
The RCSEd is a surgical college based in Scotland. The regulator of the medical profession in the UK across England, Scotland, Wales, and Northern Ireland is the General Medical Council (GMC).
MOH And MATCVS Not ‘Recognised Training Institutions’, MOH Not Party To MOUs Over Cardiothoracic Surgery Parallel Pathway
In his June 15 affidavit, MMC acting chief executive officer Dr Mohamed Anas Mohamed Hussain said training in the cardiothoracic surgery parallel pathway programme – which produces the FRCS Edinburgh in Cardiothoracic Surgery qualification – is carried out fully in MOH facilities, and administered by MATCVS.
“The curriculum was designed and developed by MATCVS in collaboration with the Royal College of Surgeons of Edinburgh (RCSEd), and the assessments are carried out by MATCVS. MOH provides training slots and facilities, supervision and financial assistance,” he said.
“However, MATCVS is a society registered under the Societies Act 1966, and neither MOH nor MATCVS are ‘recognised training institutions’ within the meaning of Section 14B(b) of the [Medical] Act.
“There is in fact no statutory governance over the conduct and administration of the parallel pathway training towards the FRCS Ed CTS qualification. The entire training programme has been carried out solely on the basis of the MOUs (memorandums of understanding) entered into by the RCSEd, AMM (Academy of Medicine of Malaysia), and MATCVS.”
It is noteworthy that the MOH itself was not party to these MOUs for the cardiothoracic surgery parallel pathway, even as proponents have repeatedly described the parallel pathway as an MOH-led programme.
Section 14B(b) of the Medical Act states attendance of specialised training in that specialty in a “recognised training institution”, as among the criteria for an individual to be entitled to be registered as a specialist under the Act.
Like MATCVS, AMM and its College of Surgeons are also registered societies under the RoS, not education providers or recognised training institutions.
Trainees who complete training conducted under the parallel pathway programme for the FRCS Edinburgh in Cardiothoracic Surgery qualification in Malaysia sit for the JSF exams that are held by rotation in Malaysia, Singapore, and Hong Kong, according to MMC.
“However, the FRCS Ed CTS qualification obtained by way of the JSF examinations is not recognised by the General Medical Council (GMC) of the UK, and does not guarantee entry to the UK specialist register contrary to the statements contained in the various articles referred to by the applicants,” MMC said.
Two days after CodeBlue reported the GMC as saying that it does not recognise the FRCS Edinburgh in Cardiothoracic Surgery qualification for specialist registration in the UK, the RCSEd issued a statement last May 15, uploaded on its website, stating that it had “never suggested” that successful completion of its exam alone would guarantee entry to the UK specialist register.
RCSEd Not Legally Empowered For Accreditation, MATCVS And RCSEd Did Not Seek Recognition Of FRCS Qualification
RCSEd’s April 1 letter to Dzulkefly listed several cardiac centres in the MOH and university hospitals, and IJN, that were “accredited” by the RCSEd as training centres in cardiothoracic surgery.
MMC, however, pointed out that the only body empowered to carry out accreditation in Malaysia is the Malaysian Qualifications Agency (MQA), or in the case of professional programmes, the relevant professional body based on recommendation of the Joint Technical Committee (JTC) established under the MQA Act 2007.
“I further state that self-accreditation is not available for professional programmes under the MQA Act,” Dr Mohamed Anas said in his affidavit.
MMC claimed that MATCVS and RCSEd never applied to the MMC or sought recognition of the FRCS Edinburgh in Cardiothoracic Surgery qualification.
“At no time has the FRCS Ed CTS programme or qualification undergone a process of accreditation and/or review and/or evaluation and/or assessment towards recognition of the qualification by the respondent,” said MMC.
“There has therefore been no de-recognition or non-recognition of the FRCS Ed CTS qualification as alleged by the applicants. There has simply been no attempt by any party to seek recognition of the qualification from the respondent at any time after the amended Act came into effect.”
The regulator of Malaysia’s medical profession also asserted that it had never recognised FRCS Edinburgh in Cardiothoracic Surgery, nor was the qualification ever listed in the 2017 List of Recognised Postgraduate Qualifications.
