KUALA LUMPUR, July 26 — A consultant paediatrician cum clinical immunologist has raised concerns that the Medical (Amendment) Bill 2024 favours foreign specialist qualifications at the expense of local universities’ postgraduate programmes in medicine.
Dr Lokman Mohd Noh – a consultant paediatrician (immunology) formerly at Tunku Azizah Women & Children Hospital Kuala Lumpur and previous professor of paediatrics at Universiti Kebangsaan Malaysia (UKM) – questioned the basis of the decoupling of the Malaysian Qualifications Agency (MQA) from the Medical Act in the 2024 amendment bill.
He also questioned the Academy of Medicine of Malaysia’s (AMM) position touting a different set of standards or regulatory requirements for parallel pathway programmes – or programmes run by local specialist societies or the Ministry of Health (MOH) – from local university Master’s or doctorate specialty programmes in medicine.
“I am curious at why two sets of standards of assessment are being proposed? Why not work in synergy – talk to each other and agree on one set of standards for both?” Dr Lokman told CodeBlue today.
“It has always been a wish that there would be synergy and cooperation between University and MOH and fraternities on both sides. It is unwise to make it appear that MQA decoupling would be at the expense of the nation’s Master specialty programmes that have been nurtured and prospered for almost four decades.
“Just when it is increasingly relevant to the needs of the nation, it is neutralised.”
The Medical amendment bill does not provide for differential treatment between various medical specialty training programmes. Under the bill, universities (and all other training providers like local specialist fraternities and MOH) are not legally mandated to seek MQA accreditation for Malaysian Medical Council (MMC) recognition or for National Specialist Register (NSR) registration of their graduates, now that MQA and its associated Joint Technical Committee have been decoupled from the Medical Act.
Dr Lokman stressed on the need for a single entity to govern the recognition of both training pathways, not unlike the United Kingdom’s General Medical Council (GMC).
“The weightage and process for recognition of UK specialist training qualification (for example, FRCS Edinburgh in Cardiothoracic Surgery) and the established Malaysia’s Master specialty (for example, MMed) or subspecialty programmes should not be diverging. A set of different standards between the two will create different perceptions of credibility in future,” he said.
“More privilege to UK specialty qualifications should not be at the expense of local Master specialty programmes.”
Following intense media coverage of the MMC’s rejection of NSR registration applications by four graduates of Malaysia’s cardiothoracic surgery parallel pathway programme with the Royal College of Surgeons of Edinburgh (RCSEd), the government listed FRCS Edinburgh in Cardiothoracic Surgery in the Fourth Schedule, which contains the List of Registrable Specialist Qualifications, in the 2024 Medical amendment bill.
Training in the cardiothoracic surgery parallel pathway programme is entirely local, run by Malaysian specialist societies, with the RCSEd merely providing the exit exam and FRCS qualification.
Malaysia’s first local university cardiothoracic surgery specialist training programme – the cardiothoracic surgery postgraduate programme by a collaboration between Universiti Teknologi MARA (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 for cardiothoracic surgery in the Fourth Schedule.
Dr Lokman also said the manner and duration of gazettement of specialists should not put UK specialty qualifications, such as FRCS Edinburgh, at an advantage. “The manner and duration should be equivalent to the nation’s Master specialty qualifications in term of years after graduation from medical school up to gazettement.”
The clinical immunologist explained that UK medical specialist qualifications, for example MRCP, remain favoured in Malaysia, despite the introduction of a new Master’s medical specialty (MMed) programme in the mid 1980s.
“The MRCP candidate route to gazettement as a specialist is much earlier than the MMed (local Master’s Specialty). There isn’t any need for a certificate of completion of specialist training (CCT) as in the UK, while the MMed embeds in the programme a four-year training in local hospitals (akin to a CCT). Thus, even though both may graduate together in the same year, the MRCP candidate reaches promotion to another grade much earlier than the MMed candidate.”
Dr Lokman pointed out that Malaysia should instead aspire for its local specialty qualifications to acquire the credibility and status of foreign UK and Australia royal colleges, as well as the American Board of Medical Specialties (ABMS).
“It is known that the specialty boards of countries, especially US (ABMS), Australia (RACP), and UK (RCP) do not automatically recognise the other. At best, it’s a case by case basis. An exemption or a shortcut at the resident exams is also possible.
“As an example, the MRCP UK qualifier may be exempted for the MRCP Ireland’s earlier exams, needing to appear only at the final. It is an achievement that the same privilege is given to a Malaysian MMed Paediatrics.”
Citing an op-ed by Prof Emerita Dr Sharifah Hapsah Syed Hasan Shahabudin, who developed the MQA Act when Dr Abu Bakar Suleiman was then Health director-general, Dr Lokman pointed out that the MQA system of accreditation for the medical and health sciences was carefully structured by studying foreign models like the UK’s GMC; the United States’ Educational Commission for Foreign Medical Graduates (ECFMG) and ABMS; and the Medical Board of Australia.
“It was painstaking, carefully structured, and not hurriedly pushed through. It had a financial cost,” Dr Lokman said.
“So why is it that the existing accreditation needs to be unravelled so hurriedly? I’m not sure if there had been a dialogue between the advocating parallel pathway group and the University group and a consensus arrived at the proposed Medical Act amendments.
“Prof Emerita Sharifah Hapsah and the Director-General of Health then should be given credit. Let us learn from history.”
In her op-ed, Dr Sharifah Haspsah pointed out that the procedures and standards used by the MQA were modelled on the accreditation system earlier developed and used by the MMC.
“In fact, the MQA Act was developed to ensure that professional bodies such as the MMC had absolute power in selecting accreditation panels and making decisions about approving programmes and giving the final accreditation,” she wrote.
Dr Lokman said what began as a parallel pathway issue concerning medical specialty training in Malaysia is “no longer parallel, but divergent and divisive.”
The 2024 Medical amendment bill – which was drafted in less than four months amid a belligerent conflict between advocates and opponents of the parallel pathway – was bulldozed through the Dewan Rakyat last week in some 48 hours. It is expected to be tabled and passed by the Dewan Negara on Monday.
Prime Minister Anwar Ibrahim’s administration proposed amendments to the Medical Act, even though the 2012 amendment came into force less than 10 years ago in 2017.
“This has long-term implications for medical specialty training for the nation,” Dr Lokman said.
“Assembling and disassembling policies should not be a culture for the medical fraternity in the long haul. Ultimately, it is the local medical specialty that should be prospered, like in all developed nations.”
