01 Jan 2015

Berita Akademi - January 2015

VOL. 23 No. 1

Table of Contents




Message from the Master of the Academy of Medicine of Malaysia
Subspecialty Training Programmes Have To Be Formalised

At a 'National Fellowship Training Committee' meeting held on 25th November 2014 arranged by the Ministry of Health Malaysia (MoH), a proposal was made for the establishment of a National Committee to oversee the governance of the subspecialty training programmes in the country. The National Committee for Subspecialty Training Programmes, under the authority of the Malaysian Medical Council (MMC), is to consist of representatives from the MoH, the Academy of Medicine of Malaysia (AMM), the Universities and the private sector. The subspecialty training programmes will be administered by the respective subspecialty training committees. The National Committee is expected to enhance the organisation and coordination of training programmes. The setting up of a National Committee to coordinate subspecialty training programmes is most welcome as it gives the specialty bodies an opportunity to play a lead role in determining the training requirements and competencies expected for independent practice in their respective specialties. The idea for National Committee for subspecialty training programmes is not new; at a joint meeting of the AMM, the MoH and the Universities held at Grand Seasons Hotel in Kelantan on 9th March 2002, the meeting adopted the following resolutions which are relevant to this day.

  1. "Malaysia is a small country with limited resources. For training to be effective it must maximize the available resources"
    • The subspecialty training is a collaborative effort by the MoH, the Universities and the AMM.
    • Training must utilize the expertise and training facilities available in the private hospitals and private universities"
  2. "Avoid lengthy delays before entry into postgraduate training system".
    • Early entry into postgraduate training-one year after housemanship
    • Part of the initial postgraduate training is conducted in the MoH Hospitals/Centers so that MoH will not lose the services of MOs
    • 3 year compulsory service can be done whilst the MO is undergoing training
  3. "Excessive specialization can have a deleterious effect on the Health Care System"
    • Specialty bodies identify the specialties and subspecialties that need to be developed.
    • That General Medicine and General Surgical Training be re-evaluated and be recognized as an individual specialty

Unlike the specialty training programme (Masters Programme) which is university based and governed by the National Conjoint Board for Postgraduate Medical Education, the subspecialty training programme is largely a MoH Programme. The subspecialty (Fellowship) training has progressively evolved over the years in the MoH Hospitals. The 'Fellowship' training is based on apprenticeship; the trainees undergo supervised training under a consultant for two or three years locally with an option for exposure in an overseas centre for a year. The MoH conducts training in a number of subspecialty fields, and although over the years the programme has become more formalised there is still a lack of clarity with regards to governance.

The Medical (Amendment) Act 2012 will have a significant impact in regulatory framework on postgraduate medical education and training. Under the amended Medical Act, medical practitioners intending to practise as specialists must be registered with the National Specialist Register (NSR). The NSR allows doctors to indicate subspecialty as a field of practice along with the main specialty. The NSR assists the public and medical practitioners to find appropriate medical expertise for consultation and referral. The NSR will ensure doctors designated as specialists are appropriately trained and competent to practice with the expected level of care in the specialty. The new regulations are being put in place to ensure our patients receive safe care of the highest quality. With the amended Medical Act, the end point of specialist training will be to acquire credentials for registration in the NSR.

We need to ensure our postgraduate training is efficient and effective. Subspecialty training should no longer be in the exclusive domain of the MoH; the resources available in universities and the private sector must be optimally utilized. The establishment of a national body to oversee the governance of subspecialty training will allow better coordination between MoH, the Universities, the AMM and the private sector. The new system can create more training opportunities and allow trainees to receive exposure in different settings, and different management approaches. Training sites must provide sufficient clinical exposure supported by appropriate facilities. For this to happen, we need to establish a proper accreditation and credentialing mechanism. The specialty bodies of the AMM in consultation with the MoH, the Universities and the private sector must develop formal, structured and quality assured training programmes that will lead to credentialing in their respective specialties. Training should be limited to places that provide high quality training and supervision whch are approved and quality assured by the regulating bodies. Networking and collaboration with established institutions overseas should be encouraged to support the training programmes.

The challenge in specialist education is not only to deliver at the end of the training programmes but throughout the lifelong learning process. In an environment of rapidly changing scientific knowledge and increasing sophistication of healthcare delivery system, doctors can no longer be considered as trained for life upon completion of a training programme. It is important for us to recognize that subspecialty training is part of the continuum of learning in Medicine. The amended Medical Act 2012 requires medical practitioners to acquire compulsory CPD points for the renewal of the Annual Practicing Certificate (APC) and revalidation of specialist registration. Medical practitioners are expected to take responsibility for the maintenance of lifelong professional competency. The modern doctor must recognise that continuing professional development is a continuance of the specialist training and education.

We made significant collective resolutions regarding subspecialty training in 2002; the desire to achieve excellence in postgraduate training remains. We must make a concerted effort to formalize subspecialty training. This shall be our first and most important task for the year.

Wishing You A Very Happy And Successful Year

[ Back to top ]

'Apa Khabar' from Aberdeen Hong Kong –
Memoirs of the HKCR 22nd Annual Scientific Meeting 2014
by Dr Subapriya Suppiah

Corresponding author:
Dr Subapriya Suppiah, Senior Medical Lecturer and Radiologist,
Faculty of Medicine and Health Sciences, Universiti Putra Malaysia.
Email: subapriya@upm.edu.my
Life Member of College of Radiology, Academy of Medicine Malaysia

"Don't forget to taste the 'Lo Por Bang' (wife cake) - local delicacy while you are there!" were the words of Jessie Fung from our college secretariat; when she informed me that I had been nominated as the Young Radiologist representing Malaysia at the Hong Kong College of Radiologists (HKCR) 22nd Annual Scientific Meeting 2014. I was excited that my oral and poster presentation abstracts had been accepted and I had been given the opportunity to present at this world-renowned platform for radiologists. It was also indeed an honour to receive the Education and Research Fund awarded by HKCR, Hong Kong Academy of Medicine.

The Hong Kong College of Radiologists 22nd Annual Scientific Meeting 2014 was held at the Hong Kong Academy of Medicine Jockey Club Building at Aberdeen, Hong Kong. There were three main tracts comprising General Radiology, Oncology and Nuclear Medicine; which included general lectures, oral scientific proffered papers and e-poster presentations. The participants and invited faculty were from multinational countries including Australia, India, United Kingdom and the U.S.A.

The general radiology lectures were very informative and up to date. Inviting an international forum of senior radiologists mixed with local expertise; including Professor Donald Resnick and Professor Emeritus Hans Ringertz; was indeed a plus point and well received especially with all sessions being conducted in English.

With the guidance of my mentor Professor Abdul Jalil Nordin, Director and Consultant Radiologist, National Nuclear Diagnostic Centre, Universiti Putra Malaysia (UPM), I took part in the oral scientific presentation. The title of our paper co-authored by Dr. Fathinul Fikri and Nur Hafizah Binti Mohad Azmi; was 'Non Small Cell Lung Cancers With Emerging Resistance To Epidermal Growth Factor Receptor Inhibitors (EGFR) Treatment: Can 18- FDG PET/CT Help?'. It was also a double honour for me to be awarded the Young Presenter Award for Scientific Proffered Paper in Nuclear Medicine Discipline. It was very insightful for me to listen to the work of researchers with similar interests in Hong Kong.

The e-poster presentations were also reflective of advances in the field of medical diagnostic imaging, with many categories of topics including abdominal radiology, neuroradiology, and nuclear medicine. My topic, coauthored with fellow radiologist and Senior Medical Lecturer at UPM, Dr Hasyma Abu Hassan and two of our medical students Lee Roy-Ming Chow and Nur Sharmin Sazali, was titled 'Contrast-Enhanced Computed Tomography for the Quantification of Non Alcoholic Fatty Liver Disease in Patients with Metabolic Syndrome'.

It was indeed a great pleasure to be invited to attend the jointly organised HKCR and the UK Royal College of Radiologists Dinner of the Colleges during this meet. An exciting lion dance performance and vocal performance by local member radiologists including an inspiring piano and opera performance were certainly memorable highlights of the event.

Apart from attending the conference, I took the opportunity to visit Disneyland Hong Kong that is a major attraction not to be missed. I watched the parade of the Disney characters that came down Main Street USA, took photos with Minnie Mouse, visited the attractions there and shopped at the mesmerizing merchandize shops.

In short, the trip to Hong Kong was an exciting, fruitful and memorable one. I will certainly encourage my fellow Malaysian radiologists to attend future HKCR annual scientific meetings and participate in the many prize categories awarded including oral sessions, original manuscript and e-poster presentation categories. Zàijiàn

My memorable moments at HKCR 22nd ASM 2014 (clockwise from left):
In front of Academy of Medicine Hong Kong Building with the HKCR President Dr Law Chun Key and Senior Vice-President Dr Jennifer Khoo Lai San; at AstraZeneca vendor booth at HKCR conference exhibition hall with my niece Ms Sharmala Nedunchezian, Dr Subapriya Suppiah at Disneyland Hong Kong, at the Dinner of the Colleges, lunch with charming Dr Darling Lee Allison @Ai-Xin-Jue-Luo, a Fellow of the Hong Kong College of Radiologists and descendant of the last Qing Dynasty Emperor.

[ Back to top ]

Obituary on Dato' Dr Khoo Kah Lin
DIMP, AMN, MD (Singapore), MBBS (Singapore), FRCP (Lond), FRCP (Edin),

18th December 1938 to 7th November 2014
by Professor Dato' Dr Mrs S T Kew

Dato' Dr Khoo Kah Lin was born on 18th December 1938 in Penang, the eldest of three children of Mr & Mrs Khoo Teng Keat. He grew up in Penang, completed his schooling in St Xavier's Institution, and went on to the University of Singapore to read Medicine. Upon graduation, he was posted to Hospital Alor Setar as house-officer, and later as medical officer.

Dato' Dr Khoo was appointed as Registrar in Hospital Kuala Lumpur under Tan Sri Dr R P Pillay in 1969. He went on to the United Kingdom to train as a Physician, obtained his Membership of the Royal College of Physicians (MRCP) in 1970, and subsequently spent a stint in Belfast to study mobile coronary care under Prof Dr Frank Pantridge. Upon his return to the country, he was instrumental in starting the first Coronary Care Unit in Hospital Kuala Lumpur.

Dato' Dr Khoo's interest and fascination with Familial Hypercholesterolaemia (FH) started when he was in Hospital Kuala Lumpur. This took him through a life-long journey of case finding, research, education both for the health care professionals and for the public. Because of his passion and interest for FH, we learn about this genetic disorder, its recognition and the appropriate management. In recognising his tremendous contributions, he was bestowed the Gold Medal Award for Research from the Rotary Club of Malaysia, as well as the Gold Medal

Award and Outstanding Services Award from the Malaysian Medical Association. He was conferred Darjah Indera Mahkota Pahang (DIMP) which carries the title Dato' by KDYMM Sultan Ahmad Shah of Pahang in 2003.

I came to know Dato' Dr Khoo in 1973/74 when I joined the Department of Medicine in Hospital Kuala Lumpur as registrar under Tan Sri Dr R P Pillay. He was at that time the specialist physician and cardiologist. Besides being an astute clinician, he spent a lot of time and effort in training the younger doctors and nurses on lipids and cardiology. I still remember the regular stream of patients coming for blood tests to monitor their lipid level. Dato' Dr Khoo not only sourced for patients in the Klang Valley, he got his patients also by referral of colleagues from all over the country, and even from neighbouring country i.e. Indonesia.

After he left the government service, he continued his Cholesterol Journey as a Cardiologist in private practice. This led him to eventually obtain his Doctor of Medicine (MD) based on his work on Familial Hypercholesterolaemia from the National University of Singapore in 1983.

Besides the passion for FH, Dato' Dr Khoo also had a passion to serve the profession. He served as Director of the Heart Foundation of Malaysia since 1987. When he launched his book "My Cholesterol Journey in Malaysia", he made a sizable donation of RM75,000 to the Heart Foundation of Malaysia. In turn, the Heart Foundation donated the funds to Sau Seng Lum Foundation, a non-profit organization, for its H.E.L.P (Heparin-Induced Extracorporeal Low-Density Lipoprotein Precipitation) Dialysis Programme.

Dato' Dr Khoo served as the President of the Malaysian Medical Association from 2007 to 2009. He also served as council member of the Academy of Medicine Malaysia from 2003 to 2013. In 2013, he was elected as Master of the Academy of Medicine. Dato' Dr Khoo also made a personal donation of RM100,000 to the Building Fund of the AMM in 2005.

In his own words, at the launch of his book, that "I feel so blessed that the dreams that I dared to dream at the start of my cholesterol journey came true," It was not just the cholesterol journey dream that had come true for Dato' Khoo, also his dream of serving the medical profession in the Heart Foundation, in the MMA and in the AMM had all come true as well.

Dato' Dr Khoo is survived by his wife Datin Dr Liew Yin Mei, and their children, Khoo Lay Seng and Khoo Po Ai.

We are forever indebted to Dato' Dr Khoo for the legacy he left behind: the knowledge on cholesterol and in particular on Familial Hypercholesterolaemia, his unstinting effort in educating the health care professionals and the public, his strong commitment and dedication to serve the medical profession in leading the MMA and the AMM. Thank you Dato' Dr Khoo, yours was a life well lived!

[ Back to top ]

Inaugural International Pathology Day
5th November 2014

The idea of having an International Pathology Day was first mooted about 2 years ago during the annual meeting of the International Liaison of Pathology Presidents. The idea was keenly taken up by member organisations and later on the World Association of Pathology and Laboratory Medicine (WASPaLM). Finally, 5th November was proposed to be the day by the Royal College of Pathologists of the United Kingdom and accepted by all the participating pathology organisations across the continents. The idea was announced on a special website as well as the respective website of the respective pathology organisation.

The College of Pathologists, Academy of Medicine of Malaysia, too celebrated the inaugural International Pathology Day on Wednesday 5th November 2014. A Clinical Cytometry Symposium supported by Beckman-Coulter was organised and representative pathologists from various states were invited to attend the Symposium as well as celebrate the occasion. A special cake was made for the day and a cake-cutting ceremony was held during the break.

Figure 1: Cake-cutting ceremony. From left to right:
Dr Nik Rus Mazeni, Dr Raja Azma, Datuk Dr Faraizah, Prof SK Cheong, Dr SC Ng, Dr Eusni Rohayu

Flow cytometry was first introduced to Malaysia in the mid-Eighties in the Institute for Medical Research (IMR), Kuala Lumpur. The cytometer then was monstrous in size as it was water-cooled and occupied a whole room. The first air-cooled, small foot-print, flow cytometer was acquired by a UKM research group funded through an IRPA grant in 1988. This single-colour flow cytometer was very robust and served the research group for more than 20 years. According to Prof S K Cheong who mooted the idea to acquire this instrument, it was particular popular among research students and young pathologists who first learnt about flow cytometry. This cytometer was finally retired a few years ago as they could no longer able to find an engineer for maintenance support. This cytometer is now a museum piece saved from the scrap yard and placed in a corner in the Stem Cell Transplant Laboratory of Hospital UKM. You are welcome to have a peep at this antique machine and even study the anatomy of this first generation model. For those who have used the machine, it will be a nostalgic trip down the memory lane!

The Pathology Day was celebrated in a variety of ways across the globe. You may visit the following website to have a glimpse of the celebrations around the World on that day - http://tinyurl. com/psfj89u.

Figure 2: Souvenir programme for the Symposium

[ Back to top ]

The Fourth Annual MPS-AMM Medical Experts Training Course
29th November 2014

The Fourth Annual Medical Protection Society (MPS) – Academy of Medicine of Malaysia (AMM) Medical Experts Training took place on Saturday 29th November in the packed auditorium of the Prince Court Medical Centre. Delegates were welcomed by Prof Dr Kandasami, Master of the Academy of Medicine and the opening address was delivered by Dr Ahmad Razid Bin Salleh, Director of the Medical Practice Division of the Ministry of Health.

The course consisted of a day of talks and interactive sessions, led by Dr Ming Keng Teoh, Head of Medical Services – Asia, MPS, designed to equip experienced doctors with the knowledge needed to act a medical expert. The practical and ethical considerations of being a medical expert were explored and discussed, as well as the wider context of the principles of medical negligence and the Malaysian legal landscape. Expert lawyer speakers Raja Eileen Soraya, Sagadaven Thangavelu, and Selvamalar Alagaratnam, from MPS panel law firms Raja Darryl & Loh, Shearn Delamore & Co and Skrine respectively, expounded upon the legal aspects with participation from colleagues and delegates alike, while the expert's perspective was covered by Datuk Dr Abdul Aziz Yahya, an O&G Consultant from Prince Court Medical Centre. There was a lively discussion on medical reports – The Good, The Bad & The Ugly, and learning points were reinforced by a fun but tricky Quickfire Quiz to round off the day.

All told, 64 delegates were trained in the principles of acting as a medical expert, including a strong contingent from the Ministry of Health. No doubt the delegates will look forward to putting their learning into practice!

[ Back to top ]

Golden Jubilee of the Academy of Medicine of Malaysia &
50th Malaysia-Singapore Congress of Medicine / 3rd Tripartite Congress of Medicine

19th to 21st August 2016
Shangri-La Hotel, Kuala Lumpur

The Golden Jubilee of the Academy of Medicine of Malaysia (AMM) will be celebrated on 19th – 21st August 2016. For this special occasion, the AMM will be hosting the 50th Malaysia- Singapore Congress of Medicine & 3rd Tripartite Meeting 2016. The three day scientific meeting will be organised by the College of Surgeon. Leading experts across all disciplines will provide insights into the latest scientific knowledge and facilitate the translation of this knowledge into daily clinical practice.

The highlight of the social event, The AMM Golden Jubilee Gala Dinner, which will be held at the Grand Ballroom, Shangri-La Kuala Lumpur on 20th August 2016, promises to be an exciting evening with fine food, spectacular live entertainment and exciting visual presentations

A souvenir book outlining the Fifty Golden Years of AMM will be published to commemorate this historical milestone, profiling distinguished Academicians and memoirs by the different colleges in the Academy.

[ Back to top ]