Vol 19 No 3
Table of Contents
Message from the Master
Professor Victor Lim
Postgraduate Medical Education and Training
In Malaysia, specialty training is largely provided by the universities. Currently, five universities provide training in 22 specialties. University Malaya and Universiti Sains Malaysia lead the pack in offering 18 specialty programmes each, followed by Universiti Kebangsaan Malaysia with 14 programmes. UNIMAS and Universiti Putra Malaysia have one programme each. Universiti Islam Antarabangsa and UiTM are expected to commence their specialty programmes in the near future. These programmes are four-year structured programmes leading to a Master degree. There is a National Conjoint Board overseeing all these Master programmes and Specialty Conjoint Boards overseeing their respective disciplines. The conjoint boards have representation from the universities, the Ministry of Health Malaysia and the Academy of Medicine of Malaysia.
A smaller number of candidates opt for the specialty diplomas awarded by the various Royal Colleges in the United Kingdom and Australia and an even smaller number may undertake the residency programmes and sit for the Specialty Board Examinations in the United States.
Subspecialty training is even less uniform. Under the National Specialist Register are the Subspecialty Committees which have established criteria for registration in the various subspecialties. The criteria would generally include having specified recognised qualifications and/or prescribed durations of training in accredited centres and/or practice experience in the subspecialty. Some disciplines notably Urology and Nephrology, already have exit examinations after the period of subspecialty training. The criteria adopted are derived primarily from those established by the Ministry of Health Malaysia for government specialists.
Recently, there has been some discussion in the Academy of Medicine of Malaysia on making subspecialty training more structured and to ensure that candidates have achieved the necessary competencies and outcomes at the point of exit. To this end, the College of Obstetricians and Gynaecologists had put forth proposals to streamline and rationalise subspecialty O & G training in Malaysia. The National Credentialling Committee had in principle, agreed to this proposal and it is hoped that this model may eventually be adopted by the other disciplines.
It is also perhaps timely to review not only subspecialty training but the entire system of postgraduate medical education and training in Malaysia. There are many important issues that need thorough discussions. Among these would be the following:
Any review process should be meticulously undertaken and involve all stakeholders. It is also very important that the main drivers of any reform should be the profession itself. In this, we can learn important lessons from the United Kingdom.
In August 2002, the Chief Medical Officer of the UK issued a publication entitled Unfinished Business. In this publication, it was pointed out that many Senior House Officers (SHOs) were not in structured training and had to repeatedly apply for jobs. This led to a significant transformation of postgraduate medical education and training in the United Kingdom in the form of an initiative called Modernising Medical Careers or MMC for short.
In the document on MMC published by the National Health Service, it was stated that "MMC aims to provide the right numbers of doctors to meet changing service needs . . . " and is thus " . . . a key enabler for other flagship programmes in the Department of Health." The changes were therefore, largely driven by pressing political and service imperatives rather than primarily from professional or educational concerns. The British Medical Association in responding to these changes had stated , "MMC represents a huge threat to medical training. It is a political process, rushed through with minimal thought and consideration, loved by politicians, but irrelevant to patients and doctors".
Implementation of MMC commenced in August 2005. It was soon evident that there were a lot of deficiencies in its implementation causing widespread unhappiness. Under MMC, about 32,000 doctors competed for 23,000 posts. An online application system was abandoned after some of the best qualified junior doctors failed to get job interviews.
In April 2007, the then Secretary of State for Health, Patricia Hewitt, announced that an Independent Inquiry be established to look into MMC. The Inquiry was led by Prof Sir John Tooke and the final Tooke Report was published in January 2008. The report highlighted weaknesses in the Department of Health's policy development, implementation and governance, together with poor inter- and intra-departmental links. The original principles of MMC were lost in translation resulting in an inflexible structure that does not encourage excellence. All in all, the Inquiry made some 47 recommendations to restructure MMC and to correct its deficiencies. The Tooke Report was generally wellreceived by the medical profession in the UK.
The conclusion in the Interim Report is particularly noteworthy. It states:
"In conclusion, although a deeply damaging episode for British Medicine, from this experience must come a recommitment to optimal standards of postgraduate medical education and training. This can only occur if a new partnership is struck between the profession and the DH, and between Health and Education. Each constituency, has been found wanting thus far. In future, each must play its part. An aspiration to clinical excellence in the interests of the health of the population must be paramount."
Should we plan to reform our postgraduate medical education and training, it is perhaps also appropriate to reflect upon the words of Dr Patrick Ongley, the President of the China Medical Board when he delivered the 3rd Tun Dr Ismail Oration on Postgraduate Medical Education in Malaysia in 1978. Dr Ongley said,
"One of the planning difficulties in developing countries is that small numbers of highly capable, highly motivated, and often highly articulate individuals, may, because of their personal drive, are outside of the mainstream of government educational systems. Sometimes it is difficult for them to realise that their individual personalities and abilities may lead to the short term success of their cause in spite of unsound, long range planning, and that these unsound plans may cause great harm after they themselves are gone. It is important that these individuals participate in sound, thoughtful planning to develop systems which will survive after their time. This often requires considerable insight and submergence of personal drives and ambitions for the long term benefit of the group."
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Advertising Guidelines for Healthcare Facilities and Services
(Private Hospitals, Clinics, Radiological Clinics and Medical Laboratories)
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Conferment of Fellows & Induction of Academicians
Annual General Meeting
8th August 2010
The Academy of Medicine held its Annual General Meeting on 8th August 2010 at the T J Danaraj Hall in the
Academies Building. The Annual General Meeting was preceded by the conferment of 23 fellows and induction
of 165 academicians.
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|Prof Victor Lim Kok Eow||Master|
|Dato' Dr Zaki Morad||Deputy Master|
|Dr Chang Keng Wee||Scribe|
|Dato' Dr Khoo Kah Lin||Bursar|
|Datuk Dr N Arumugam||Deputy Scribe & Chief Censor|
|Dr Chan Kheng Khim||Council Member|
|Prof Looi Lai Meng||Council Member|
|Prof Dato' P Kandasami||Council Member|
|Prof Rosmawati Mohamed||Council Member|
|Dr Evelyn Ho||Council Member|
|Prof Lim Thiam Aun||Council Member|
|Dr Ng Char Hong||Council Member|
|Dr Mary Cardosa||President, College of Anaesthesiologists|
|Datuk Dr Johan Thambu Malek||President, College of Obstetricians & Gynaecologists|
|Prof Lee Way Seah||President, College of Paediatrics|
|Prof Dato' Khalid Yusoff||President, College of Physicians|
|Prof Cheong Soon Keng||President, College of Pathologists|
|Prof Lekhraj Rampal||President, College of Public Health Medicine|
|Prof Dato' Humairah Abdul Samad Cheung||President, College of Radiology|
|Prof Yip Cheng Har||President, College of Surgeons|
|Dato' Dr Lian Chin Boon||President, College of Dental Specialists|
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