KUALA LUMPUR, July 22 — The Malaysian Public University Medical Deans Council (MDC) has demanded the formation of a medical equivalent to the Malaysian Qualifications Agency (MQA) to oversee the evaluation of specialist qualifications and training.
The Medical (Amendment) Bill 2024 – which was passed by the Dewan Rakyat last July 17, just some 48 hours after it was first tabled for first reading on July 15 – decouples MQA from the Medical Act, but does not provide for a new separate agency to replace the MQA, concentrating sole power to recognise specialist qualifications, training institutions, and training programmes in the Malaysian Medical Council (MMC) instead.
“We emphasise the importance of establishing an independent and external entity to oversee the evaluation of specialists’ qualifications and training in Malaysia,” MDC said in a statement today.
“This entity’s credibility must be on par with, if not superior to, that of the MQA. This will ensure a rigorous and impartial evaluation process that upholds the highest medical education and training standards.”
MDC represents the deans of medical faculties in 11 public universities: Universiti Malaya (UM), Universiti Kebangsaan Malaysia (UKM), Universiti Sains Malaysia (USM), Universiti Malaysia Sarawak (Unimas), Universiti Putra Malaysia (UPM), International Islamic Universiti Malaysia (IIUM), Universiti Teknologi MARA (UiTM), Universiti Malaysia Sabah (UMS), Universiti Sains Islam Malaysia (USIM), Universiti Sultan Zainal Abidin (Unisza), and the National Defence University of Malaysia (UPNM).
If the government were to decide that a new medical equivalent to the MQA needs to be set up, the government will have to avoid tabling the Medical amendment bill in the Dewan Negara that began sitting today, but instead revise the bill and table a new version in the next Dewan Rakyat meeting.
The MDC – which described itself as the “main custodian” of master’s and doctorate specialty training in the country – noted that the Medical amendment bill allows “various organisations” to offer medical specialist training programmes.
“Therefore, robust regulations must be in place to facilitate its implementation. These regulations must ensure that all training programmes meet stringent quality standards and that the training providers offering these programmes are held accountable,” MDC said.
“The quality of specialist training must be maintained at all times. The integrity and excellence of Malaysia’s medical training programmes are paramount and must not be compromised.
“This includes the enforcement of the existing Malaysian Standards for Medical Specialist Training and the relevant Specialist Specific Requirements for all specialist training. Our resources in the country remain limited; doing things in silos can further deteriorate the quality of the training rather than improve it.”
The Medical amendment bill removes medical specialty training from the exclusive purview of universities or higher education providers, opening it up to the Ministry of Health (MOH), “any other institutions within Malaysia”, and training provided outside Malaysia as well.
The parallel pathway programmes, such as cardiothoracic surgery, are mainly provided by local specialist societies registered under the Registrar of Societies (RoS), such as the Academy of Medicine of Malaysia (AMM), with exit examinations and qualifications provided by foreign institutions like surgical societies or fraternities in the United Kingdom.
Under the Medical amendment bill, a new Fourth and Fifth Schedules were established, containing the List of Registrable Specialist Qualifications and List of Subspecialty respectively. Powers over these lists or Schedules were transferred from the MMC to the Health Minister, with the minister empowered to add, remove, or amend the lists via a gazetted order “after consulting” the Council.
For cardiothoracic surgery, the Fourth Schedule lists the Fellowship of the Royal College of Surgeons of Edinburgh in Cardiothoracic Surgery – without specification of the exit exam.
Malaysia’s parallel pathway programme produces the FRCS Edinburgh in Cardiothoracic Surgery qualification after an exit examination provided by the Royal College of Surgeons of Edinburgh (RCSEd) and local training provided by a registered society, the Malaysian Association for Thoracic and Cardiovascular Surgery (MATCVS). This RCSEd exit exam is not equivalent to the Intercollegiate exam taken by UK-trained doctors to specialise in cardiothoracic surgery.
Malaysia’s first local university cardiothoracic surgery specialist programme – the cardiothoracic surgery postgraduate programme by a collaboration between UiTM and the National Heart Institute (IJN) – is not listed on the Fourth Schedule even though it has already received provisional accreditation from MQA. Only foreign qualifications from the United States, Australia, Canada, Ireland, and the UK are listed.
“There must be a transparent and well-defined process for regulating Schedule 4. This regulation should not be perpetual; it must include a validity period to ensure continuous reassessment and relevance. Clear guidelines and timelines for reviewing and renewing entries in Schedule 4 are essential,” MDC said.
The Fourth Schedule was included in the Medical amendment bill, even though the Health Minister has yet to prescribe regulations on whatever standards need to be fulfilled for qualifications to be added to the List of Registrable Specialist Qualifications.
Under the previous 2012 amendment of the Medical Act, the administrative list of the National Specialist Register (NSR) – which was not codified into law, unlike the new Fourth and Fifth Schedules – was dynamic as it could change based on the accreditation status of the programme. University programmes (including those in medicine, before this bill) require regular MQA accreditation that isn’t a one-time occurrence.
MDC requested continued support from the Ministry of Higher Education (MOHE) and the MOH for master’s and doctorate medical specialist programmes.
“It is essential to strengthen and enhance the faculties and teaching hospitals in the country that offer a cost-effective means to improve the quality of health care services and ensure the sustainability of the training programmes,” said MDC.
“The National Postgraduate Medical Curriculum (NPMC) has effectively streamlined training across most specialties, aligning the syllabus with the country’s health care needs.
“The Medical Specialist Pre-entrance Examination (MedEx) has been instrumental in ensuring that candidates are well-prepared to commence their training. It is our hope that the national medical training programmes will remain the preferred choice for medical training in Malaysia.”
The medical deans’ council also warned the country of “potential implications and risks” if the Medical amendment bill is passed into law.
“The new amendments open up numerous possibilities for the future of medical training in Malaysia. However, as the saying goes, ‘The devil lies in the details’. It is crucial to meticulously address the specifics of the implementation to avoid potential pitfalls and ensure that the intended benefits are fully realised.”
