How We Slogged To Develop UKM’s Paediatric Surgery Specialist Programme — Dr Dayang Anita Abdul Aziz

Dr Dayang Anita details the extreme hardcore work involved in complying with regulatory requirements to develop UKM’s paediatric surgery specialist programme. “Without the MQA Act embedded in the Medical Act, many programme heads/ providers will cut corners.”

I would like to congratulate our Health Minister for finally admitting, in Parliament, to irregularities in the parallel pathway programmes. 

However, I feel insulted and offended that local universities’ clinical Master’s programmes were accused of having “irregularities” as well

I developed the Paediatric Surgery Specialist Programme for Universiti Kebangsaan Malaysia (UKM) in 2010. I did it by the book; there was no room for irregularities.

The word of the day is “accreditation”. In countries which do not have law on accreditation and recognition, they use the word regulation by independent bodies.

In Malaysia, we have a special law which has been existence the last 17 years; it is called the Malaysian Qualifications Agency (MQA) Act, enforced in 2007. 

Let me share the journey of developing an accredited specialist training programme. 

In 2010, I submitted an extensively written proposal to the Faculty of Medicine, UKM. The proposal covered 20 parts, inclusive of:

  • Where the training would be carried out.
  • Duration of training.
  • Which Malaysian Qualifications Framework (MQF) to comply with.
  • Reputation of the university on handling specialist training programmes.
  • Justifications to start the programme.
  • Objectives.
  • Learning outcomes.
  • Market survey.
  • Stakeholders’ survey reports.
  • Curriculum structure.
  • Training scheme.
  • Syllabus.
  • Ethics and humanity components of the programmes.
  • Estimated number of intakes for the first five years.
  • Entrance requirements.
  • Details of trainers.
  • Physical and financial implications.
  • Comparison with existing local and international programmes.
  • Details of main committee members overseeing the programme.

It received Faculty approval on February 10, 2010. It was then brought up for discussion at the Senate level of the university, and finally approved by the Board of Directors of UKM on May 9, 2010. 

The proposal went to MQA, as well as to the Ministry of Higher Education (MOHE) for approval. I had to revise several times the matrix taxonomies (cognitive, behavioural and affective) suited for the four-year programme. 

MQA gave unofficial clearance for provisional accreditation on June 28, 2010, but it took an entire year for the Higher Education Department at MOHE to approve the programme; the official letter from MOHE was released on May 13, 2011. 

There was extensive scrutiny of the proposal to ensure what were promised could be delivered. Finally, UKM received the official letter for provisional accreditation in April 2012, allowing UKM to start intake from September 2012.

UKM received quite a few applications from international students, mainly from the Middle East, but I decided not to take them in, because the justification of the programme was to increase the numbers of local paediatric surgeons.

There were only 14 paediatric surgeons in the country at that time, 10 were locals serving a 29.66 million population; 23.1 per cent were children under the age of 14 years, i.e. 14 paediatric surgeons for over 6.85 million children.

By the way, paediatric is defined as those aged 0 to 18 years old.

The Medical Act 1971 was amended in 2012, in which the MQA Act harmonised the Medical Act to ensure training of specialists in the country is streamlined, and all specialist training programmes undergo accreditation before the degrees are recognised. 

MQA relegated its power to accredit and recognise the qualifications to the Malaysian Medical Council (MMC). With this move, all the universities took the initiative to ensure standardisation of their training programmes collectively through individual National Conjoint Specialty Committees; Ministry of Health (MOH) experts are also part of the committees. 

It is pertinent that only via accredited programmes that the degrees are recognised. The recognition is solely for the purpose of entering the National Specialist Register (NSR) that was enforced on July 1, 2017.

With the amendment of the Act, a Medical Education Committee (MEC) of the MMC was also established. This certainly helped to expedite the accreditation process.

With the amendment, I set up the National Conjoint Committee for Paediatric Surgery in 2013. Paediatric surgeons from UKM, University Malaya (UM started their Paediatric Surgery Programme in 2005), MOH, and representatives from the Academy of Medicine of Malaysia (AMM) were part of this committee. 

We helped each other tremendously. We had one goal – to ensure the standard of training meets the requirements of the specialty, as well as the law.

In 2014, UKM received two local candidates from the MOH. They were given scholarships through the Hadiah Latihan Persekutuan (HLP). UM received four local candidates as they had more academicians in Paediatric Surgery at that time. 

The number of trainees were decided based on the number of accredited trainers and training centres. We wanted to ensure quality over quantity. 

The accreditation process did not stop with provisional accreditation. As head of programme, I had to keep evidence of all academic and clinical activities until the full accreditation exercise has been completed, which was when the first graduate will be produced. 

I also had to show evidence that everyone, including myself, who was directly involved with the training, maintained or improved our academic and clinical proficiency. I realised that it was important to push myself to meet the requirements to be a full Professor. 

In 2012, I was promoted to the position of Associate Professor of Paediatric Surgery, and I became a full Professor in Paediatric Surgery in December 2016.

The first cohort of trainees failed to finish the programme, hence the first graduate from UKM programmes was from the 2015 intake. UKM’s first graduate in Paediatric Surgery was in 2019; she was a trainee lecturer at International Islamic University (UIA).

Both UKM and UM programmes steadily produced about five new paediatric surgeons every year; naturally, there will be trainees who did not pass the final exit examinations. 

The Conjoint Committee of Paediatric Surgery prepared the questions, vetted them, and no one would know the final questions for the exams except the Examination Coordinator.

Every year, expert examiners from internationally recognised centres are invited to evaluate our exam standards. 

Marking of the examination papers was done according to international standards. Clinical examination cases were also chosen carefully and vetted by the Conjoint Committee. 

The full accreditation exercise for Paediatric Surgery UKM was severely delayed because of the Covid-19 pandemic. The exercise was delayed, but our graduates did not have to worry. The degree is recognised for entrance into the NSR. 

The full accreditation exercise was extensive and the panel of assessors were independent. This is the basis of accreditation – the awarding body cannot accredit or recognise its own qualifications. 

The full accreditation exercise was similar to the provisional accreditation, but with additional interviews with the Head of Programme, students/ trainees, trainers, supporting staff, and the deanery.

The full accreditation status comes with an expiry date, which means the Head of Programme and the institution shall be subjected to repeat processes to ensure the quality of training is maintained, if not bettered. 

When I took optional retirement in October 2023, UKM had already been informed about my intention nine months earlier. My absence would require the university to find a replacement with equal or similar standing. Otherwise, the accreditation expiry date would be affected, and the programme cannot have new intakes. 

This entire process means that running an academic programme is a full-time job. It requires commitment to constantly ensure the trainers, facilities, and governance are at their very best for the trainees.

The trainees do not feel the travails that the Head of Programme or Conjoint Committee members go through. 

I can assure you that without the MQA Act embedded in the Medical Act 1971, many Heads of Programme or programme providers will cut corners. Without the MQA Act, programmes can self-regulate; there won’t be any accountability. 

Self-regulation opens up the potential for abuse of power among individuals within decision-making positions. Self-regulation will breed little Napoleons. We have seen all of this happening before the amendment of the Medical Act in 2012; we cannot regress. 

There are legal means to solve irregularities in the parallel pathway without amending the Medical Act. This option must seriously be looked into urgently. 

I hope this article has made readers understand that it is nearly impossible for local specialist training programmes to have similar irregularities as the parallel pathway. 

I sincerely hope that those responsible for running the parallel pathway programmes will put aside their pride and listen to reason. I may be a retiree, but I did not leave behind my brain in the university when I retired. 

We are a thinking society. Think about the fate of over 34.6 million people in this country who will be served by NSR-registered specialists. Patients will not know whether specialists are a product of local or parallel pathway programmes. 

Our duty is to ensure that we have done our best to ensure that the training of each specialist meets the requirement of the specialty and the law. 

Keep the existing law and subject the parallel pathway programmes to a proper accreditation exercise.

Dr Dayang Anita Abdul Aziz is a senior consultant paediatric surgeon (Advanced Paediatric MIS).

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.

You may also like