THE Medical Act 1971 was amended in 2012 in which the Malaysian Qualification Agency (MQA) relegated its power, to accredit medical training programmes and recognised the qualifications, to the Malaysian Medical Council (MMC) – the body that governs the profession.
Hence, only recognised qualifications by MMC can be used by doctors to enter the Medical Register (for undergraduates) and the National Specialist Register or NSR (for specialists).
The NSR was enforced on July 1, 2017. After this date, all qualifications for specialist training must be from accredited programmes in order for the qualifications to be recognised.
With this recognition, specialists need to undergo a minimum of two years post-qualification training before they can be eligible to apply to enter the NSR. The NSR is sacred to us.
NSR-registered specialists are allowed to practise independently anywhere in this country, not just in hospitals under the Health Ministry’s (MOH) purview.
Once in NSR, the specialists can sit for any other overseas examinations and add those qualifications to their CVs. Quality of the specialists entering the NSR is safeguarded with the amendment of the Medical Act made in 2012.
The duty of any head of programme and the higher education provider is to ensure standards of the specialist produced, meet the requirement of the law.
The accreditation process by MMC is transparent and carried out by a panel of assessors in the field. They will report back to MMC and suggest improvements or allow accreditation (provisional or full accreditation).
I know this as I had to go through these exercises when I was developing the Paediatric Surgery Programme for UKM.
The parallel pathway programme by the Health Ministry carries international qualifications but the training is 100% local and some have a stint overseas.
Our government has spent a huge amount of money on these programmes. Yet the ministry and the Head of Programmes (of all the 14 specialties) have not done their due diligence to ensure the programmes are accredited, hence these international qualifications cannot be recognised by MMC.
Some of the programmes are run by associations; one is actually registered under Registrar of Society (RoS) as a social society related to the occupation. They are not higher education providers.
Essentially, the ministry wants the international qualifications to be recognised without the quality assurance process.
The medical councils of home countries where these international qualifications originated (UK’s General Medical Council (GMC) and Australia Medical Council (AMC) have also stated formally that these qualified doctors will need to undergo further training if they are looking to work as specialists in the UK or Australia.
Each country has their own law to ensure the quality of specialists treating their citizens is of high standard.
The solution to this problem should not be to amend the law that has safeguard the quality of specialists but to find ways to enable the doctors to enter NSR legally.
The ministry must transfer graduates from the parallel pathway to the Higher Education Ministry’s (MOHE) accredited programmes and put them through the final year assessment which is the National Conjoined Assessment and Examinations organised by universities.
Once they pass the exams and assessment, they can fulfil the other requirements to enter NSR.
Each specialty has its own National Conjoined Committee. The members will be from each university running the specialty programme and experts from the Health Ministry.
For example, for Paediatric Surgery, the National Conjoined Committee Members are from Universiti Malaya, UKM and heads of Paediatric Surgery from the Health Ministry.
The ministry should adopt the same approach for the rest of the trainees in parallel pathway programmes if they are serious about increasing the number of specialists in our country.
Those trainees have been given scholarships to do specialty training. They must pass through accredited programmes so the qualifications they have are recognised to enter the NSR.
The ministry should reassess the parallel pathway programmes; have them accredited. Partner with registered higher education providers to run the programmes, not associations; or a much better way is to support the local training programmes.
The trainer-trainee ratio is affected when we have more than one route to specialist training. The local training programmes are subjected to stringent quality assurance processes in order to produce high standard specialists. The international programmes must do the same.
The Health Ministry has delayed resolving this issue with intention to amend the Medical Act. MOHE has agreed to this.
What will be amended no one really knows but we can make an educated guess that accreditation may not be needed, simply recognition by peers.
Such a decision is unwise as we need to discuss the impact of amending the law on the quality of training of all medical programmes, not just for specialists. What repercussions will we have to deal with?
Why didn’t MOH and MOHE act on the suggestion to enable the cardiothoracic “graduates” of parallel pathways to be absorbed into the local programme as mooted by Professor Raja Amin of UiTM?
He is UiTM’s head of cardiovascular and thoracic surgery.
Now, some of these doctors have chosen to leave the country. They are doing so at their own accord. They are cardiothoracic registrars in Malaysia, they are not jobless.
The impression the public gets is this is brain drain, that they are being accepted as specialists in the UK. Rather than believe this story, one should check with GMC.
It is a good move by these doctors to go to the UK and complete the portfolio pathway in the UK before they are registered as specialists by GMC. When they come back, if they want to, MMC can then recognise their qualifications; entrance into the NSR will not be an issue once they fulfil other requirements that are subjected to national-trained specialists.
We must not be hasty to amend laws that work. At the end of the day, we have the moral duty to ensure that all specialists in the NSR have gone through proper accredited training programmes and have achieved the standards for us to let them be independent.
They will be serving the people. We owe it to all to ensure these specialists are truly well trained and safe.
Paediatric Surgery UKM received its first intake in 2014, the same year MOH started the parallel pathway programmes. UKM has complied with all the quality assurance processes and the qualification is recognised to enter NSR. MOH should have done the same. – June 4, 2024
Dr Dayang Anita Abdul Aziz chairs the health committee at the National Council of Women’s Organisation. She was professor of paediatric surgery at UKM and developed the paediatric surgery specialist training programme. She also worked with MOH for 12 years prior to joining UKM in 2007.
*The proposal paper addressing the parallel pathway programme for cardiothoracic surgery will be presented by Health Minister Datuk Seri Dzulkefly Ahmad to the cabinet on June 5.
