KUALA LUMPUR, June 25 — The Royal College of Surgeons of Edinburgh (RCSEd) now says it “never suggested” that graduates of Malaysia’s cardiothoracic surgery parallel pathway programme were guaranteed entry to the United Kingdom’s specialist register.
In a press statement last May 15, uploaded on the RCSEd website, the surgical college based in Scotland said UK-based surgical trainees – who have followed a training pathway regulated by the UK’s General Medical Council (GMC) and successfully complete the Joint Committee on Intercollegiate Examinations (JCIE) in the UK – are eligible to apply for, and join, the UK GMC register of specialists.
“This pathway to this specialist register is not available to surgeons from outside of the UK. Instead, surgeons wishing to join the UK’s specialist register must apply using the ‘portfolio pathway’ and submit other evidence of their eligibility to join the register,” RCSEd said in its statement.
“RCSEd has never suggested that successful completion of an international fellowship examination would, on its own, guarantee entry to the UK specialist register, something which is a matter for the GMC.
“However, the GMC may accept the JSF (Joint Specialty Fellowship) FRCSEd cardiothoracic qualification as part of the evidence for specialist registration application through the ‘portfolio pathway’.”
RCSEd claimed that its JSF exams – “which cover a variety of surgical specialties in Hong Kong, Singapore, and Malaysia” – are “of the same standard” as the JCIE exam, “but the format of the examinations is different.”
The royal college based in Scotland claimed that candidates who pass RCSEd’s JSF exam have “achieved the same high standards of knowledge and practice” as those who pass the fellowship examination set by JCIE – by virtue of the fact that RCSEd awards a fellowship to successful candidates in its own exam.
RCSEd’s May 15 press statement was issued two days after CodeBlue published a report on May 13 headlined, “UK Medical Council Denies Recognising FRCS Edinburgh Cardiothoracic Surgery Parallel Pathway Qualification For Specialist Registration”.
The Edinburgh surgical college never sent its statement to CodeBlue, despite CodeBlue’s request for a response to the GMC story.
The RCSEd’s May 15 statement was submitted by the Malaysian Medical Council (MMC) to the High Court here as part of evidence – via an affidavit-in-reply filed last June 15 – in a judicial review application filed by four cardiothoracic surgery parallel pathway graduates against MMC’s December 2023 rejection of their applications to register on the National Specialist Register (NSR). The MMC does not recognise their FRCS Edinburgh in Cardiothoracic Surgery qualification.
The GMC told CodeBlue that it does not recognise the FRCS Edinburgh in Cardiothoracic Surgery qualification for specialist registration in the UK, but graduates can apply to practise as medical doctors.
According to the GMC – which regulates the UK medical profession across England, Scotland, Wales, and Northern Ireland – the RCSEd’s JSF exam is “not equivalent” to the GMC-approved Intercollegiate Specialty Fellowship Examination by the JCIE.
The GMC also said section two of the Joint Surgical Colleges Fellowship Examination (JSCFE) is “substantially different” from the approved Intercollegiate exam.
No exam is mandated for applications via the Portfolio Pathway for specialist registration in the UK, said the GMC. Applicants using this route are evaluated on a case-by-case basis.
Citing the RCSEd’s May 15 press statement, correspondence between the MMC and the RCSEd, as well as the UK GMC’s Specialty Specific Guidance (SSG) for entry to the UK specialist register via the Portfolio Pathway in cardiothoracic surgery, the MMC said in its June 15 affidavit that the FRCS Edinburgh in Cardiothoracic Surgery qualification, obtained from passing the JSF exam, “is not recognised by the General Medical Council (GMC) of the UK, and does not guarantee entry to the UK specialist register.”
“As such, the various assertions contained in the articles referred to by the applicants are misleading and are aimed at influencing public opinion against the respondent,” MMC said.
MMC also submitted to the High Court, as evidence, four CodeBlue reports:
- Prove Direct UK GMC Recognition Of Cardiothoracic Surgery Parallel Pathway: Ex-MATCVS President
- UK Medical Council Denies Recognising FRCS Edinburgh Cardiothoracic Surgery Parallel Pathway Qualification For Specialist Registration
- CodeBlue Stands By Our Report On UK GMC
- MQA Must Warn MOH Over ‘Non-Compliant’ Parallel Pathway: Professors’ Group
Despite May 15 Statement, RCSEd Reportedly Told MOH Officials FRCS Qualification ‘Recognised’ By UK Authorities
Despite the RCSEd’s May 15 statement, British High Commissioner Ailsa Terry said in a text message to Health Minister Dzulkefly Ahmad that “there has not been any policy shifts within the UK GMC in the FRCSEd”.
“The qualification is recognised and should Malaysian doctors wish to work in the UK, they need to fulfill only the usual existing requirements through the portfolio pathway, like the Certificates of Eligibility for Specialists Registration (CESR)”, Terry said, describing CodeBlue’s GMC article as “sensationalised”.
Dzulkefly tweeted on May 17 a screenshot of Terry’s message.
Subsequently, RCSEd vice president Prof Dr Timothy Graham and JCIE chairman Dr Michael Lewis met with senior MOH officials in Putrajaya last May 30, including deputy secretary-general (finance) Norazman Ayob and medical development division director Dr Mohd Azman Yacob.
Citing an anonymous source, news portal Free Malaysia Today (FMT) reported Dr Graham as telling the meeting with MOH officials that “British medical authorities recognised the Fellowship of the Royal College of Surgeons (FRCS) obtained by Malaysian surgeons via the parallel pathway as equivalent in standards to the specialist qualification obtained by all successful UK trainees”.
According to FMT’s anonymous source, Dr Graham and Dr Lewis even allegedly “conveyed their displeasure” with questions raised in Malaysia about the quality of the cardiothoracic surgery parallel pathway training.
Given that local media, including CodeBlue, did not report RCSEd’s May 15 statement immediately after it was uploaded on the royal college’s website – presumably because RCSEd did not send it to Malaysian media – it is unclear if MOH officials were aware of the statement.
RCSEd: Parallel Pathway Graduates Must Undergo UK GMC ‘Equivalency Process’
Before the controversy surrounding the parallel pathway, particularly cardiothoracic surgery, blew up this year, the RCSEd privately told the MMC in March 2023 that graduates of the cardiothoracic surgery parallel pathway programme who took the RCSEd’s JSF exam must undergo an “equivalency process” by the GMC to register for practice in the UK.
In an email on November 2, 2022, seeking clarification from JCIE chairman Dr Lewis, MMC registration division deputy director Dr Goh Vern Zhi Denise wrote: “In summary, irrespective of what qualifications are listed as acceptable by the GMC, as long as the applicant is an International Medical Graduate possessing a qualification obtained outside of the EU/ UK/ Australia and New Zealand, they will be subjected to an equivalency process.”
RCSEd vice president Dr Graham, RCSEd president Prof Rowan Parks, and RCSEd professional standards committee chair Prof Philip Turner replied: “In line with other countries offering JSF examinations (Hong Kong and Singapore), this is correct; applicants must go through the GMC equivalency process.”
RCSEd’s response was sent to MMC’s Dr Goh in an email on March 20, 2023, by RCSEd Joint Specialty Fellowship coordinator Colin Mills.
“The examination sat by trainees is the Joint Specialty Fellowship (JSF) examination, held between the College of Surgeons of Hong Kong (CSHK), the Joint Committee on Higher Specialist Training, Singapore (JCST), the RCSEd, with local input from the Malaysian Association of Thoracic and Cardiovascular Surgery [MATCVS],” added the RCSEd officials.
“This examination is different to the JSCFE examination mentioned in your query, which is an Intercollegiate examination administered by the Joint Committee on Intercollegiate Examinations on behalf of the four Surgical Royal Colleges (Edinburgh, England, Glasgow & Ireland). The JSF examination is held to the same standards as the JSCFE Intercollegiate examinations.”
RCSEd’s March 2023 email to MMC was made public in court filings from MMC’s June 15 affidavit-in-reply in the cardiothoracic surgery parallel pathway graduates’ court case.
RCSEd’s open letter to Health Minister Dzulkefly, published by CodeBlue last April 1, did not mention the GMC’s “equivalency process” for cardiothoracic surgery parallel pathway graduates seeking to practise in the UK.
Neither did the royal college mention that graduates with the FRCS Edinburgh in Cardiothoracic Surgery qualification must “submit other evidence of their eligibility” to join the UK specialist register through the Portfolio Pathway, as successful completion of its exam alone doesn’t guarantee specialist registration in the UK that “is a matter for the GMC”.
Instead, the RCSEd merely told the government of Malaysia, represented by the health minister, that cardiothoracic surgery parallel pathway graduates “are eligible to apply for specialist registration as cardiothoracic surgeons in the UK through the portfolio pathway.”
RCSEd Says It Set Up Cardiothoracic Surgery Parallel Pathway On Request By MATCVS And Health DG
RCSEd’s May 15 press statement on its website contains other notable differences from its April 1 open letter to Malaysia’s health minister.
In its letter to Dzulkefly – in which the RCSEd criticised MMC’s non-recognition of the FRCS Edinburgh in Cardiothoracic Surgery qualification – the UK royal college alleged that it was invited by the “Ministry of Health of Malaysia (MOH)”, the Academy of Medicine of Malaysia (AMM), and MATCVS to help develop a national training programme in cardiothoracic surgery for Malaysia.
The RCSEd also claimed that it had undertaken work in the cardiothoracic surgery parallel pathway programme “at the request of the Ministry”, besides mentioning MOH several more times.
However, in its May 15 press statement, released after publication of CodeBlue’s GMC story, the RCSEd omitted mention of the MOH, saying instead that the royal college had set up the cardiothoracic surgery parallel pathway programme in 2014 in Malaysia at the request of MATCVS and “the then Director General of Health Malaysia”.
Dr Noor Hisham Abdullah was then Health DG.
“The programme is intended to help deliver high standards of cardiothoracic surgery in Malaysia. 35 doctors have taken part in the programme since 2016, with 12 successfully completing the JSF examination,” said RCSEd in its May 15 statement.
Five more Malaysian graduates were produced from the JSF exam held in Singapore earlier this month.
