01 Sep 2010

Berita Akademi - Sept 2010

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:

  1. Education and training after the basic qualification should be an integrated and logical progression until such time as the doctor can safely function as an independent practitioner whether in a core specialty, a subspecialty or general practice. These pathways need to be mapped out with clear outcomes and competencies to be achieved at the end of the various stages including at the end of the basic undergraduate medical programme. Ideally undergraduate and postgraduate medical education and training should be viewed as a single process.
  2. With the increasing number of new medical graduates expected to come on-stream in the near future, it is prudent to ask whether the current system can cope with the anticipated demand for postgraduate training. Currently, the Master programmes offered by the various universities can cater for just over 600 candidates per year. How do we increase this number without compromising on quality?
  3. Is core specialty training essential and an exit qualification in a core specialty required before a doctor is eligible for subspecialty training?
  4. Should all candidates be required to sit for the local assessments regardless of previous qualifications, training and experience that had been acquired overseas, as is the case in Hong Kong?
  5. Is the duration currently required to obtain specialty and subspecialty qualifications too long? Normally, a candidate would be eligible to enter a Master programme only four to five years after graduation, spend a minimum of four years in the Master programme and another two to five years in subspecialty training.
  6. There are abundant and valuable resources in the private sector. How can we tap these resources for postgraduate medical education and training in Malaysia?
  7. What governance structure is required to oversee postgraduate medical education and training in Malaysia and what mechanisms need to be in place to assure and ensure quality. In the United Kingdom, the General Medical Council is now responsible for the quality assurance of both undergraduate and postgraduate education and training. Should a similar role be ascribed to the Malaysian Medical Council?

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)

At the Lembaga Iklan Ubatan meeting in July 2010, the advertising guidelines for medical practitioners and hospitals was revised to allow clinics and hospitals to advertise in the written media. This is in line with the revised MMC guidelines regarding advertising as well. It is following MOH's aspirations towards promoting health tourism. Attached, is the guidelines for reference.

  1. Introduction
    1. These Guidelines are intended to complement the provisions of the Medicines (Advertisement and Sale) Act 1956 (Revised 1983) and the Medicine Advertisements Board Regulations 1976.
    2. Advertisements include any notice, circular, report, commentary, pamphlet, label, wrapper or other document, and any announcement made orally or by any means of producing or transmitting light or sound.
    3. Unless exempted as laid out in section 3.0, advertisements shall only be publicised upon approval by the Medicine Advertisements Board.
    4. Registered medical practitioners who wish to advertise their facilities or services should also abide by the 'Code of Professional Conduct' of the Malaysian Medical Council and related guidelines and directives issued by the Council.

  2. General Principles
    1. The purpose of these guidelines is to provide information to private hospitals, clinics, radiological clinics and medical laboratories regarding the regulations governing advertisements of healthcare services offered by these facilities that are disseminated to the general public.
    2. The information provided in the advertisements must be factually accurate and capable of being substantiated. It must not be exaggerated, false, misleading or deceptive.
    3. The authenticity and the accuracy of the information imparted in the advertisements should be verifiable by the Medicine Advertisements Board. The public should not be misled into drawing inaccurate impressions of the ability or services offered by the healthcare facility.
    4. The information provided in the advertisements shall be in strict compliance with this set of guidelines.
    5. Information about advances in medical services and therapeutics is best conducted through the appropriate medical forums and professional publications to avoid the risk of unbalanced and inaccurate reporting.
    6. Features or articles that contain elements of advertising of skills or services will be deemed to be promotional in nature and regulated as such. For opening ceremonies, the management is responsible in ensuring that there is no undue publicity to the new healthcare facility and of the skills of professionals providing services related to the event.

  3. Exemptions
    Approval by the Medicine Advertisements Board is not required for the following:
    1. The current practice of information being circulated within the profession through medical journals and newsletters which are published by medical professional bodies.
    2. The present arrangement whereby any professional body related to the medical profession, or any other allied profession established by or registered under any written law which has been granted approval by the Honourable Minister of Health, Malaysia may publish announcements or information for the general public.
    3. The following do not require Medicine Advertisements Board approval subject to the condition that all stated criteria are met.
      1. Calling cards, Letterheads, Rubberstamps and Signboards
        Information published in professional calling cards, letterheads, rubberstamps, clinic signboards, road directional signboards, directory signboards in commercial complex, should abide by the 'Guidelines on Dissemination of Information by the Medical Profession' set by the Malaysian Medical Council.
      2. Seminar / Public Lecture / Public Forum Announcements
        The announcement or notice should only contain the title / topic of the talk or forum, date, venue, speaker's name and place of practice, speaker's picture (MyKad size), and contact person/number for enquiries.
      3. Advertorials / Educational Articles / Community Health Messages
        Educational articles regarding healthcare issues can be communicated to the public through speaking, writing and media broadcasting without Medicine Advertisements Board approval. However, the practitioner should not encroach into the area of encouraging the public to seek consultation or treatment from him or the healthcare facility he is associated with by publicising detailed service or contact details.
        Only the practitioner's name, registered field of practice and place of practice can be mentioned. Photographs of practitioners performing surgical, interventional or investigational procedures on patients are prohibited.
        Practitioners must ensure that the press / media articles based on interviews are solely for public education. They are responsible for these articles and for ensuring that journalists do not breach these Guidelines in reporting about them

  4. Information Which May Be Disclosed In The Advertisement(s) Is As Follows:
    1. General Information of the healthcare facility
      1. Name and location
      2. Telephone number
      3. Hours of service
      4. Types of accommodation and facilities
      5. Charges for the various services and facilities
      6. Photographs of practitioner(s) should not exceed 'MyKad' size
    2. Professional Services available at the healthcare facility
      E.g. Surgical, Maternity, Accident & Emergency, Rehabilitation (as recognised by the relevant statutory bodies).
      The name, qualification and field of specialty of practitioners are allowed to be listed for information purposes. Promotion of any individual practitioner's skills, knowledge and experience, is not allowed.
    3. Accreditation/Award Announcement, Congratulatory Message
      Healthcare facilities are allowed to announce the following:
      1. Recognised certification received by the healthcare facility e.g. ISO, hospital accreditation, national or international quality awards, initiative awards, etc
      2. Congratulatory message on the occasion of opening/launching of a new wing / branch / department / discipline / healthcare facility / equipment
        The validity period is one month from the date of approval of the advertisement.
    4. Please refer to section 6.0 for further information relating to specific media.

  5. Information Which Is Not Permitted
    1. Comparison, either direct or implied between healthcare facilities is prohibited.
    2. The use of superlative (e.g. 'the best', 'the first', 'latest', 'state-of-the-art', 'unique', 'most advanced', 'breakthrough') in describing the available services or facilities is also not permitted.
    3. Testimonials from patients shall not be publicised or printed.
    4. Celebrity Endorsement:
      The use of celebrities to promote the services of a healthcare facility is not allowed.
      These Guidelines define celebrities as:
      1. Local/International celebrity
      2. Local/International athlete
      3. Patients receiving treatment
      4. Local/International model
      5. Professionals (Practitioners, Dentists, Pharmacists)
    5. Display of Human Tissue Specimens and Photographs
      The display of photographs of preserved human tissue specimens e.g. biopsy parts or excised lesions from patients, or photographs of patients with diseases mounted as posters on the outside walls of clinics are not allowed.

  6. Approved Media
    1. General
      Unless otherwise provided in these guidelines, advertisements approved by the Medicine Advertisements Board can be publicised in any media which is based, registered and published or circulated in Malaysia.
    2. Newspapers
      Advertisements are allowed in the lay press.
    3. Magazines
      Advertisements are not individual-magazine specific and once approved may be published in different magazine titles.
    4. Directories
      Information in directories containing the name of the healthcare facility, address, specialty, contact details, hours of consultation is allowed.
    5. Brochures, Pamphlets and Leaflets
      The date of publication must be stated.
    6. Billboards
      There should be minimal use of words and the message should be as simple as possible.
      Billboards which are only road directional in nature and without advertisements of services do not required Medicine Advertisements Board approval.
    7. Banners
      A temporary banner to announce the opening of a new healthcare facility is allowed for the purpose of public information provided it conforms to local government regulations. It can only be displayed at the entrance to the premise.
      The banner should not be displayed for a period longer than one month prior to the date of opening and should be removed within one week after the opening of the healthcare facility.
      Banners announcing services provided by the healthcare facility, special equipment and diagnostic services, awards or recognitions are not allowed.
    8. Websites
      The information disseminated through this medium has to be carefully designed and worded, as well as comply with the relevant sections in these Guidelines, and all statutory instruments.
      The information on the healthcare facilities and services, registered medical practitioners, their names and photographs (MyKad size), qualifications, and specialities must be informative and simple, without laudatory remarks.
    9. Radio, Television, Cable Television, Cinema and In-House Videos
      Advertisements are allowed in all broadcast media. Live consultation sessions on radio and television in association with advertisements must comply with the requirements of these Guidelines.

  7. Inducements To The Public
    No financial inducements or benefits for treatment by way
    of sales promotions or discounts on professional fees shall
    be offered to the public.

  8. Related Acts
    1. The Private Healthcare Facilities and Services Act 1998 (Act 586) states:
      s.108. No private healthcare facility or service of health-related facility or service shall publish any advertisement:
      1. In such a manner as to mislead the public on the type or nature of the healthcare facilities or services or health-related facilities or services provided; or
      2. Which is contrary to any direction on advertisement issued by the Director General.
    2. The Pathology Laboratory Act 2007 states:
      s.75 (1) No licensed pathology laboratory shall publish any advertisement:
      1. In such a manner as to mislead the public on the class and speciality of the licensed pathology laboratory
      2. Which contravenes any written law regulating advertisement for medical matters or purposes
      3. Which is contrary to any direction on advertisement issued by the Director General

  9. Others
    1. Publicity outside Malaysia
      Facilities which advertise in countries outside Malaysia shall comply with all the relevant requirements of those countries. However, in the event that such advertisement is also available to the general public in Malaysia (e.g. through the internet), then such publicity shall also conform to these Guidelines.

  10. Review
    These Guidelines may be reviewed as and when necessary.

    Reviewed and approved by the Medicine Advertisements Board at its 5/2010 meeting dated 27th July 2010. These amended Guidelines take effect on 27th July 2010.

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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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Office Bearers 2010 - 2011

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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Calendar of Events

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