Explainer: Royal College Of Surgeons Of Edinburgh Isn’t A University, It’s A Surgical Society

The Royal College of Surgeons of Edinburgh isn’t a university, higher education institution, or “college” as Malaysians understand it. RCSEd is a surgeons’ society, the Scotland version of the College of Surgeons under the Academy of Medicine of Malaysia.

KUALA LUMPUR, July 3 — Contrary to public perception in Malaysia, the Royal College of Surgeons of Edinburgh (RCSEd) isn’t a university or a higher education institution, but a fraternity of surgeons.

RCSEd is an entirely separate entity from the University of Edinburgh with a College of Medicine & Veterinary Medicine that is an institution of higher learning in Scotland. 

RCSEd is a registered charity in Scotland with the SC005317 registration number. The University of Edinburgh, on the other hand, is registered under SC005336; its official website states that the University of Edinburgh is acknowledged by United Kingdom authorities as a “‘recognised body’ which has been granted degree awarding powers”.  

Malaysia’s six-year cardiothoracic surgery parallel pathway programme, which began in 2016, was formed on the basis of memorandums of understanding (MOUs) entered into by the Malaysian Association for Thoracic and Cardiovascular Surgery (MATCVS), the Academy of Medicine of Malaysia (AMM), and RCSEd. 

Trainees who pass RCSEd’s Joint Specialty Fellowship (JSF) Examination in Cardiothoracic Surgery, an exit exam, are awarded a Fellowship of the Royal College of Surgeons of Edinburgh in Cardiothoracic Surgery.

MATCVS, AMM, and RCSEd are not higher education providers in Malaysia; neither is RCSEd a higher education provider in the UK.

Like the College of Surgeons under Malaysia’s AMM, an umbrella body of specialist fraternities, RCSEd likewise is a surgical society — albeit with a far longer history spanning over five centuries, compared to the College of Surgeons, Academy of Medicine of Malaysia. Both the College of Surgeons of Malaysia and AMM are societies registered under the Registrar of Societies (RoS). 

What Does RCSEd Do?

RCSEd, one of the oldest surgical colleges in the world, was founded more than 500 years ago in 1505 by a royal charter granted by King James IV, according to its official website. Its origins in the early 16th century began as the Edinburgh Guild of Barbers and Surgeons.

RCSEd’s membership of more than 32,000 professionals in over 140 countries doesn’t just include surgeons, but every stage of the career path from medical student to consultant; it includes surgeons, dental surgeons, and members of surgical and dental teams. Just under half of the professional body’s members are based outside the UK.

RCSEd provides a wide range of courses, including surgical, dental, nursing, and perioperative care, besides hosting events, conferences, and symposia.

Courses and events include workshops; short courses running for a day or a couple of days on technical or non-technical skills, or lecture-based courses; and examination preparation or revision, among others.

RCSEd also provides a slew of various types of examinations in surgery and dentistry, among others. According to its 2022 annual report, the latest report available, RCSEd’s examinations team assessed more overseas candidates than from the UK for its surgical exams, at 2,589 candidates versus 2,021 candidates respectively in 2022. 

RCSEd delivered 63 surgical exam diets overseas that year, nearly double the 37 diets delivered in the UK. The surgical exam diets were offered in 23 locations overseas, more than the 12 in the UK. An exam diet is the period of time when exams are held. 

How Does RCSEd Generate Income?

The Fellowship of the Royal College of Surgeons of Edinburgh, or FRCS Edinburgh, denotes a specialist doctor’s membership in the prestigious RCSEd, hence the term “Fellow”. 

Because FRCS is membership in the surgeons’ society, Fellows are required to pay annual subscription fees to be able to continue attaching FRCS to their name, unlike conventional university degrees that are conferred for life without additional fees.

RCSEd charges an annual subscription fee of £221 (RM1,318) for Fellows (surgical and dental) from high or upper middle income countries, including Malaysia. 

RCSEd generates income mainly from Surgeons Quarter Limited – a trading subsidiary operating as a hotel, conferencing facility, and travel agent – as well as subscriptions and exams. According to its 2022 annual report, for the year ended December 31, 2022, the RCSEd group made income of £7.7 million (RM45.9 million) from Surgeons Quarter Limited, £5.9 million (RM35 million) from subscriptions, and examinations (HSET, JCIE, and JSCFE) at a combined £5.5 million (RM33 million), among other income-generating sources.

Income from subscriptions and examinations at £11.4 million (RM68 million) comprised about half of the RCSEd group’s total income for the 2022 financial year at £23.2 million (RM138.4 million). Overall, RCSEd spent a net expenditure of £2.4 million (RM14.3 million).

What Is RCSEd Malaysia Sdn Bhd?

The Royal College of Surgeons of Edinburgh’s international office at the Advanced Surgical Skills Centre, Hospital Canselor Tuanku Muhriz UKM in Kuala Lumpur. Photo by Boo Su-Lyn, taken on June 28, 2024.

RCSEd only has one international office, which is located in Malaysia at the Advanced Surgical Skills Centre (ASSC) at Hospital Canselor Tuanku Muhriz UKM in Kuala Lumpur.

Based on Companies Commission of Malaysia (SSM) documents accessed by CodeBlue last June 25, RCSEd Malaysia Sdn Bhd – an RM2 company incorporated on November 10, 2017 – is fully owned by the Royal College of Surgeons of Edinburgh.

The Sdn Bhd company’s business address is located at the ASSC. 

RCSEd Malaysia Sdn Bhd’s board of directors include most of the top RCSEd leadership, including president Prof Dr Rowan Parks, vice presidents Prof Dr Timothy Graham and Dr Clare-Ellen McNaught, chief executive officer Mark Egan, besides a few other foreign names.

Two Malaysians are also listed as RCSEd Malaysia Sdn Bhd directors: Prof Dr Hanafiah Harunarashid, the pro vice chancellor of the Kuala Lumpur campus of Universiti Kebangsaan Malaysia (UKM) and Prof Dr April Camilla Roslani, a former dean of the Faculty of Medicine at Universiti Malaya.

Dr Hanafiah was appointed as director right from the company’s incorporation on November 10, 2017, while Dr April was recently appointed director about a month ago on June 6.

In the past five years from 2018 to 2022, RCSEd Malaysia Sdn Bhd made modest annual revenue at between RM162,000 and nearly RM262,000. The company’s annual profits before tax were between about RM12,000 and some RM22,000.

Egan said RCSEd has a large cohort of members in the Asean region – particularly in Malaysia, Singapore, and Hong Kong – explaining that RCSEd’s first international office was opened in Malaysia in 2018 to support the need of those members, such as facilitating membership events, the organisation of courses and examinations, and support for travelling fellowships.

“Our Malaysian company was incorporated in 2017 to enable the College to open its office and employ staff lawfully. The legal structure we adopted was decided on the basis of local advice,” the RCSEd CEO told CodeBlue in a statement.

“The UK-based directors of our Malaysian company are the College office-holders with responsibility for directing the operations of the College. The company’s revenue comes entirely from a management recharge to the College, which reflects the services provided by the office and its staff.”

What Is The Current RCSEd Accreditation Status Of Malaysian Training Centres?

The Advanced Surgical Skills Centre (ASSC) at Hospital Canselor Tuanku Muhriz UKM in Kuala Lumpur is the only Malaysian centre listed on the Royal College of Surgeons of Edinburgh’s (RCSEd) webpage on RCSEd Centre Accreditation. Photo by Boo Su-Lyn, taken on June 28, 2024.

RCSEd also provides course and centre accreditation, charging different fees to accredit short (up to five days) surgical courses provided by for-profit or not-for-profit entities. No fee structure was listed on RCSEd’s website for centre accreditation.

The only Malaysian centre listed on the RCSEd Centre Accreditation webpage is HCTM UKM’s ASSC, with a five-year accreditation term from April 2022 to April 2027, besides just three other centres in the UK and Germany.

Yet, RCSEd president Prof Dr Parks told Health Minister Dzulkefly Ahmad in an open letter, published by CodeBlue last April 1, that several MOH cardiac centres – as well as the National Heart Institute (IJN), Universiti Malaya Medical Centre (UMMC), and HCTM UKM – were accredited by RCSEd as training centres in cardiothoracic surgery for the parallel pathway programme after initial accreditation visits in 2015, and further accreditation visits in 2018 and 2022. 

None of those training centres in the cardiothoracic surgery parallel pathway programme are currently listed on the RCSEd Centre Accreditation webpage. (The accredited centre at HCTM UKM is specifically ASSC).

MATCVS honorary secretary Prof Dr John Chan Kok Meng told CodeBlue that RCSEd did not charge MATCVS any fees for centre accreditation, expressing uncertainty as to why these training centres are not listed on RCSEd’s website.

“MATCVS just funds their travel and accommodation for accreditation visits.”

According to the Malaysian Medical Council (MMC), Malaysian law empowers only the Malaysian Qualifications Agency (MQA) to carry out accreditation in the country, 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. MMC stated that “self-accreditation is not available for professional programmes under the MQA Act.”

Why Did Universiti Malaya Sign An April 2022 MOU With RCSEd?

Since RCSEd isn’t a higher education provider in the UK, the surgeons’ fraternity would not be able to set up a campus in Malaysia – unlike Australia’s Monash University, for example – and legally own and run the cardiothoracic surgery parallel pathway programme.

On April 27, 2022, an MOU was entered into by Universiti Malaya (UM), MATCVS, AMM, and RCSEd on the cardiothoracic surgery parallel pathway programme, witnessed by then-Health director-general Dr Noor Hisham Abdullah – after 2014 and 2018 MOUs that didn’t include the local university.

The language used in a write-up on UM’s website is pertinent: “Universiti Malaya will be the educational providing body for the parallel pathway training programme in this MOU.”

The College of Surgeons, Academy of Medicine of Malaysia’s August 2022 issue of its Berita CSM newsletter said this about the MOU: “UM will provide the certificate of completion of training to all trainees who successfully complete their training.”

UM’s corporate communications unit did not respond to CodeBlue’s email requesting clarification on whether the university was meant to secure MQA accreditation for the cardiothoracic surgery parallel pathway programme and why the MOU eventually led to nothing.

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