KUALA LUMPUR, July 15 — The 2024 Medical Act amendment bill threatens to undo whatever progress was made in the past seven years to ensure standards for medical specialty training in Malaysia.
This major piece of legislation – which was tabled by the government for first reading in the Dewan Rakyat earlier today and expected to pass in just two days – was proposed after the Malaysian Medical Council (MMC) rejected applications by four graduates of the cardiothoracic surgery parallel pathway programme to register as specialists on the National Specialist Register (NSR).
Instead of subjecting parallel pathway programmes run by local medical specialist societies to the regulatory and accreditation process imposed on universities’ postgraduate medical programmes for quality assurance, Prime Minister Anwar Ibrahim’s government has, ironically, proposed transferring such responsibilities (over both types of programmes) entirely to the MMC. The MMC was previously denounced by parallel pathway advocates as a “cartel”.
The 2024 amendment bill completely decouples the Malaysian Qualifications Agency (MQA) from the Medical Act, placing the burden of auditing and evaluating medical specialist training – whether provided by medical non-governmental organisations (NGOs) or universities – solely on the MMC.
Under the MQA Act, the MQA has the following functions, among others:
- Implement and update the Malaysian Qualifications Framework;
- Accredit programmes, qualifications and higher education providers;
- Conduct institutional audit and review of programmes, qualifications and higher education providers;
- Establish and maintain a register to register programmes, qualifications and higher education providers;
- Conduct courses, training programmes and to provide consultancy and advisory services relating to quality assurance;
- Establish and maintain liaison and cooperation with quality assurance and accreditation bodies in higher education within and outside Malaysia;
- Act as a qualifications reference centre on accredited programmes, qualifications and higher education providers.
Does the MMC have the capacity to perform – for medical specialist training provided by medical societies or postgraduate medical education provided by universities – any of these MQA functions?
Under the 2024 amendment bill, it’s not only parallel pathway programmes run by local medical fraternities that are exempt from MQA accreditation, but also all postgraduate medical programmes run by local universities.
Universities do not have to bother getting either provisional or full accreditation from MQA for their Master’s or doctoral programmes in medicine; all they need is approval from either the MMC or the Health Minister to get their graduates registered as specialist doctors.
Under the new Section 14B(3) of the amendment bill, “specialised training” refers to “a training approved” by the MMC in a new Fourth Schedule of the Act, as provided by the Ministry of Health (MOH), a local higher educational institution, or “any other institutions within Malaysia as approved by the Council”.
In the cardiothoracic surgery parallel pathway, the programme is carried out fully in MOH facilities and administered by a local medical specialist society that also carries out assessments. The Royal College of Surgeons of Edinburgh (RCSEd) simply provides the exit exam and the FRCS Edinburgh in Cardiothoracic Surgery qualification.
While opening up medical specialist training beyond the confines of universities or higher education providers may be perceived as liberalisation, the 2024 Medical Act amendment bill does not propose setting up a medical equivalent of the MQA, or a separate agency, to accredit medical specialist training or postgraduate medical programmes.
Instead, a new Section 4A(2)(j) of the 2024 amendment bill broadly empowers the MMC to “appoint any registered medical practitioner to represent the Council in any committee, panel or institution where that person would subsequently make recommendations to the Council on all matters relating to the qualification of medical practitioner or the regulation of the practice of medicine.”
Under the 2012 amendment of the Medical Act, which was enforced just seven years ago in 2017, medical specialist training was restricted to universities or higher education providers, while MQA was relied upon to ensure the standards of such local Master’s or postgraduate programmes in medicine.
MMC played the role of the final gatekeeper, i.e even if a particular programme was accredited by MQA, the MMC made the final decision on whether to register graduates as specialist doctors.
But the 2024 amendment bill expects MMC to play both roles: auditing the quality of medical specialist programmes (the word “accredit” is removed from the bill) and evaluating individual graduates for specialist registration.
While specialist training in the United Kingdom is carried out by centuries-old surgical societies like the RCSEd, the UK has multiple bodies and structures to run and regulate specialist training, not just the General Medical Council (GMC) alone.
RCSEd – unlike local specialist societies like the Academy of Medicine of Malaysia (AMM) or the Malaysian Association for Thoracic and Cardiovascular Surgery (MATCVS) – is run as a multi-million pound business that likely has many full-time staff.
Do local specialist societies, whose leadership are also likely working in the MOH, have the same capacity as universities to run specialist training programmes? As it is, the MOH is struggling with a shortage of health care professionals across all levels, with medical officers playing the role of housemen, and specialists playing the role of medical officers.
Removing MQA’s role from auditing medical specialist training does not empower, but instead will likely overwhelm the MMC into paralysis.
The 2024 amendment bill also weakens the MMC by transferring powers over the List of Registrable Specialist Qualifications (renamed from List of Recognised Postgraduate Qualifications) and the List of Subspecialty – under the new Fourth and Fifth Schedules of the Act – to the Health Minister, with the MMC reduced to playing a “consulting” role for the minister.
The “saving and transitional” clauses under the bill – which register specialists and specialised training between July 1, 2017 and the date of coming into operation of the 2024 amendment – will also likely open Malaysia to graduates with foreign qualifications that are not recognised in the country of origin for specialist registration.
For cardiothoracic surgery, the UK and Singapore only recognise locally trained doctors, though these countries also review applications from specialists trained outside on a case-by-case basis.
Does the government plan to substantially increase financial and human resources for the MMC, local specialist societies, and the MOH to audit and run medical specialist training, even as the roles of all three appear to be merged in the 2024 amendment bill?
If MPs pass this bill, they will be responsible for drastically revamping the entire structure of medical specialist training and postgraduate medical education. Is this in the best interest of the country? We will only know in several years’ time.
Medicine is not TVET. Self-regulation in medicine and health care is never acceptable.
