01 Dec 2014

Berita CSM December 2014

Table of Contents



Message from the President

It gives me great pleasure to brief our surgical colleagues on the many activities that the College has successfully carried out throughout the year. The Annual Scientific Meeting in 2014 held in Kuching, Sarawak was of international standing. It received excellent support and attracted one of the largest number of registered delegates in recent years. We would like to thank Professor Liew Ngoh Chin and the Organising Committee for the job well done.

The Breast and Endocrine Chapter of the College has been very active too. It successfully held the 3rd Breast and Endocrine Surgery Course on 15th & 16th August 2014 in Johor Bahru, Johor.

In line with its primary objective to maintain and promote the highest standards of surgical practice in Malaysia, the College is actively engaged in activities which enhance surgical education, training and examinations.

The Basic Science Examination (BSE) in Orthopaedic Surgery continues to play a very important role in the curriculum of Masters in Orthopaedic Surgery. Over the years, this examination has maintained a high standard. It has been recognised as a 'bye' for the Part 1 of the Masters Program. Professor David Choon has been actively involved in Orthopaedic Surgery training and represents the College in the BSE.

The Advanced Trauma and Life Support (ATLS) course held at the Animal Lab in the Sungai Buloh Hospital is now in its fifth year. It is remarkable that within this short period of time, as many as 400 providers and 80 course instructors have been trained, under the able leadership of Prof Lum Siew Kheong. We appreciate the dedication of the Instructors and the consistent support from the Ministry of Health and the Universities. We are much indebted to the Director and staff of the Sungai Buloh Hospital for their contribution towards the success of the ATLS courses.

Another important and useful course run by the College is the Care of the Critically Ill Surgical Patient (CCrISP). Since 2012, the College has successfully run five CCrISP courses at the University of Malaya, with Dr Ng Char Hong and Prof April Roslani as the course directors. The College would like to thank the Course Directors and Instructors, as well as the management and staff of University Malaya, for running the courses successfully.

The College also plays a role in the Conjoint Board of Surgery. In partnership with the Ministry of Health of Malaysia and the Universities, the College participates in the selection of the candidates into the Masters of Surgery training program and in the exit examinations. The College would like to acknowledge its Past Presidents who continue to actively support the College as Examiners for the Masters of Surgery examinations. They are Associate Professor Yushak Wahab, Professor Dato' Kandasami Palayan, Professor Lum Siew Kheong, Dato' Dr Yip Cheng Har and Dr Chang Keng Wee.

Board Certification Examinations that are currently conducted by some surgical specialist societies have received strong support from Dr Chang Keng Wee, currently, the Postgraduate Dean of the Academy of Medicine of Malaysia. The College, in collaboration with Malaysian Association of Plastic, Aesthetic & Craniomaxillofacial Surgeons, awarded the first Fellowship FCSAMM (Plastic) in August 2013. The College has also been in active discussion with the Royal College of Surgeons of Edinburgh on subspecialty training, examination and certification. A Memorandum of Understanding to formalize the collaboration was signed at the Ministry of Health in August 2014.

Associate Professor Hanafiah, Senior Vice-President of the College, is the International Advisor and local Coordinator of the Royal College of Surgeons of Edinburgh. The MRCS Part B OSCE examination was first conducted in Kuala Lumpur in January this year. It will be held again on 19th – 20th January, 2015. The Joint Surgical Colleges Fellowship Examination (JSCFE) in General Surgery is to be conducted in Malaysia for the first time in August 2015. Most of the candidates for these examinations are from overseas. Associate Professor Hanafiah is currently the Head of the Advanced Surgical Skill Centre (ASSC) at Universiti Kebangsaan Malaysia where the Membership and Fellowship Examinations are to be held in 2015. He recently organised Balasegaram Memorial Lecture in conjunction with the Basic Surgical Workshop held at ASSC.

The College also participates in the registration and maintenance of surgical specialists in the National Specialist Register. In consultation with the Surgical Societies, it submits the names of representatives from the different specialty and subspecialty societies to the National Credentialing Committee. Currently, Prof Nur Aishah Taib is working on the online system whereby surgeons can register and update their continuing professional development (CPD) points which is envisaged to be required for renewal of the Annual Practicing Certificate and for the revalidation in the NSR every 5-yearly.

The College also takes an active interest in the welfare of the surgeons. The College together with Surgical Societies and the Fee Committee made suggestions and recommendations to the Ministry of Health during the recent exercises on "Notes" and "New Procedures". The next task will be for the College and the surgical societies to come out with a New Fee Schedule that is acceptable to the stake holders. In collaboration with the Malaysian Association of Plastic, Aesthetic & Craniomaxillofacial Surgeons, the College recently published "Guidelines on Aesthetic Medical/ Surgical Practice for surgical specialists".

Regionally, the College enjoys good rapport with its ASEAN counterparts. It contributed to the formation of the ASEAN Federation of Surgical Colleges. Currently, the Federation is working on a common template that can form the basis for a framework for recognition of the surgeons under the Mutual Recognition Agreement (MRA) among ASEAN countries.

On the international scene, the College has active collaboration with sister surgical colleges of Australia, the United Kingdom and United States of America. We are proud to announce that two of our past presidents had been recognised by them. Prof Lum Siew Kheong was conferred Honorary Fellowship of the Royal Australasian College of Surgeons in 2012, while Dato' Dr Yip Cheng Har was conferred Honorary Fellowship by the American College of Surgeons in 2013.

The College will continue to play an important role in updating surgeons on the latest advances in surgery. The next annual scientific meeting will be held in Penang from 29th – 31st May 2015. For the year 2016, the annual scientific meeting will be held in Kuala Lumpur, in conjunction with the Golden Jubilee of the Academy of Medicine Malaysia. In 2018, the College will host the Endoscopic Laparoscopic Surgeons of Asia (ELSA) Meeting in Malaysia. We look forward to see you at these scientific meetings.

In conclusion, this College belongs to the Surgeons. Its strength lies in its members, in their unity and their contributions. Numbers do matter.

I urge surgeons who have yet to join us to do so soon.

Thank you.

Dr Peter Wong Toh Lee

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A Tribute to A Pioneer in Liver Surgery – The Balasegaram Memorial Lecture
held in conjunction with the
Entry into Post-Graduate Surgical Training Course
was delivered by Prof Dato' Dr P Kandasami

report prepared by Assoc Prof Dr Hanafiah Harunarashid

Dato' Dr M Balasegaram, often referred to as 'Prof Bala' passed away on the 5th May 2014 at the age of 85. A memorial lecture was held at the Lecture Theatre of the State of the art Advanced Surgical Skills Centre, UKM Medical Centre on the 23rd November 2014 to honor his immense contributions to the development of gastrointestinal surgery in the country. A strict disciplinarian with rigorous standards, he groomed many of top surgeons. Dr Balasegaram is best noted for his pioneering work in liver surgery. He researched and added more information to the understanding of the anatomy of the liver, and subsequently simplified liver surgery with his new specially designed liver instruments.

The lecture was organised by the Assoc Prof Hannafiah, the Director of Advanced Surgical Skills Centre, UKM Medical Centre with the endorsement of the College of Surgeons, Academy of Medicine Malaysia. The lecture was delivered by Prof Dato' Dr P Kandasami, the Master of the Academy of Medicine and a past president of the College of Surgeons, Malaysia. The family members of the late Prof Balasegaram and surgeons trained by him were present at the event.

Prof Balasegaram was one of Malaysia's most distinguished doctors, with an array of international awards for research that expanded the frontiers of surgery. He was the first Malaysian to be honoured by the Royal College of Surgeons in England's Hunterian Professorship award (1969) and won the coveted Jacksonian prize, the highest prize in surgery (1971). He also won honours from the Irish College of Surgeons and the Royal College of Surgeons in Edinburgh – respectively the Abraham Colles Lecture and the Chienne Memorial lecture.

Prof Dato Kandasami in his lecture paid tributes to Prof Bala's contributions to surgery and the profession. He spoke of how the practice of surgery has progressively evolved with the advances in technology. He spoke on the reforms in the training of surgeons to be tandem with the new developments. He spoke of training and assessing surgeons in skills centers using simulators. He said competence-based advancement, rather than time served shall be the standard in the surgical training.

The convenor of the lecture, Prof Hanafiah who is also the director of the Advanced Surgical Skills Centre said there is a need to build a training hospital for the future which includes the use of modern teaching methods and technology that will avoid the use of patients as a training material. Our aim is zero error, he said, citing the flight simulators to train pilots as an example.

Prof Bala will be best remembered as a greater teacher, a role model and doctor who gave himself to the profession and the country.

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Examiners' Training Workshops
report prepared by Professor Dr April Camilla Roslani

Training of examiners involved in the Malaysian Conjoint Universities Master of Surgery Final Examination is an increasingly important aspect of improving the standards of its conduct. This year, the Department of Surgery, University of Malaya, ran two examiners' training workshops, on 12th May and 7th November respectively. Participants included both experienced examiners, as well as those interested in entering the arena, representing all the institutions of the Conjoint Committee.

The College of Surgeons, as a key member of the Conjoint Committee, was well-represented at both workshops, with the President, Dr Peter Wong, and Councillors, Prof. Liew Ngoh Chin and Prof Nuraishah Taib in attendance. The Vice-President, Prof Hanafiah Harunarashid, and the Secretary, Prof April Roslani, contributed as Training Faculty. They were ably led by Professor David Galloway, the President-Elect of the Royal College of Physicians & Surgeons of Glasgow, and supported by Professor Thambidorai and Professor Alizan A Khalil.

The workshop comprised a combination of didactic lectures, interactive sessions and role-play, covering the evolution of the examination, characteristics of quality assessment, principles of evaluating higher order thinking and examiner-behaviour. The demonstration of the impact of good and bad examiner behaviours on candidates' performance was particularly well-received! Trainees bravely volunteered themselves to be grilled in front of the audience, and it was salutary to note the extent that bad examiner behaviours could adversely affect their performance.

It is hoped that such workshops will continue to evolve in tandem with the examinations themselves, thus improving the overall standard of surgical assessment in Malaysia.

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Care of The Critically Ill Surgical Patient (CCrISP) Providers' Course
report prepared by Professor Dr April Camilla Roslani

The fifth iteration of this course in Malaysia was held from 6th - 7th December 2014, at the Clinical Skills Unit, Faculty of Medicine, University of Malaya. The seasoned trainers, led by Course Director, Dr Ng Char Hong, and Co-Director, Professor April Roslani, facilitated the 16 participants through a series of lectures, small group sessions and role-play, culminating in a summative moulage. Participants this time comprised a mix of medical officers, surgical residents and surgeons.

The goal of the course is to provide participants with a systematic approach to managing a critically ill surgical patients, rooted in adult-learner education principles for maximum effectiveness. Despite the serious nature of the subjects at hand, and the intensity of the programme, much fun was had by all, particularly in the role-play and moulage sessions. Feedback from participants was excellent, with many keen to recommend the course to their colleagues.

In view of its effectiveness, the College hopes this course will become an essential component of surgical training in Malaysia. Those passionate about the latter are warmly invited to apply to become trainers – the next Trainers' Course will be in March 2015. Provider Courses are tentatively scheduled for March, May and December 2015.

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The Intercollegiate MRCS OSCE Examinations
by the Royal College of Surgeons of Edinburgh in Kuala Lumpur
26th to 29th January 2014

report prepared by Assoc Prof Dr Hanafiah Harunarashid

This new format part B OSCE examination was successfully conducted at the Advanced Surgical Skills Centre, Universiti Kebangsaan Malaysia for the first time in our history. A total of 62 candidates sat for the examinations over a two-day period. The candidates came from 10 different countries, making this examination truly international in nature:

Country Candidate numbers Percentage
Australia 2 3%
Brunei 1 2%
Iraq 3 5%
Kenya 1 2%
Kuwait 1 2%
Malaysia 22 35%
Pakistan 12 19%
Saudi Arabia 6 10%
Singapore 13 20%
United Arab Emirates 1 2%
Total 62 100%

A strong delegation of 17 examiners from the United Kingdom, joined by 15 local examiners consisting of senior surgeons and experienced examiners, conducted the examination.

The Chief Examiner was Mr Zahid Raza from The Royal College of Surgeons of Edinburgh and Assoc Prof Hanafiah Harunarashid, our College Senior Vice President, was the local convenor.

A formal Training the Examiners Course was conducted for our new examiners on 26th January 2014. Our College also hosted a welcoming dinner for the examiners and assistants on 28th January 2014 at the Majestic Hotel, Kuala Lumpur.

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Joint Surgical Colleges Fellowship Examination (JSCFE) in General Surgery
- Section 2 in Colombo
report prepared by Assoc Prof Dr Hanafiah Harunarashid

Recently two of our council members, Prof Hanafiah Harunarashid and Prof April Camilla Roslani were appointed examiners at the JSCFE held in Colombo Sri Lanka. 30 international candidates sat the exams, The examiners were appointed by the four Royal Colleges of Surgeons of UK and Ireland. Next year, this intercollegiate exams will be conducted in Kuala Lumpur and CSAMM is honoured to host it.

The examination consists of an oral component which was held at the Taj Samudra Hotel on the 23rd October 2014 and a clinical component which was held on the next day at the Colombo General Hospital.

Candidates wishing to sit for this exam must have successfully completed a locally recognised surgical training programme and are required to provide evidence of having achieved the required standard of a recognised specialist in the generality of General Surgery (day one NHS UK consultant standard). Applicants would normally have passed the MRCS exams, although the MS examination will be accepted as an alternative.

Upon passing this examination, the candidate will be awarded the fellowship from one the the four Royal Colleges of Surgeons (FRCS) at the candidate's preference.

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3rd Malaysian Breast and Endocrine Surgery Course Report
report prepared by Dr Sarojah Arulanantham

The 3rd Malaysian Breast Endocrine Surgery Course (MBESC) was held in Newcastle Campus, Nusajaya, Johor Bahru on 15th and 16th August 2014. This course was a continuation from the 2nd Malaysian Breast and Endocrine Surgery Course (MBESC) held in Trengganu in Oct 2013. The first being in Putrajaya in 2012.

This course was conducted following the Memorandum of Understanding signed on 25th May 2012 among Ministry of Health of Malaysia, College of Surgeons (CSAMM), International Association of Endocrine Surgeons (IAES) and Breast Surgery International (BSI). The MOU sets out plans for the IAES and BSI to send teams to Malaysia over the next 5 years under the "umbrella" of the ISS-Academy.

The objective of this course is :

  1. To expand the knowledge on the management of breast and endocrine conditions and diseases.
  2. To update ourselves on standard surgical procedures and also new procedures in breast and endocrine surgery.
  3. To expose and to give an opportunity, especially to trainees to discuss cases with the IAES speakers
  4. To provide an opportunity for the local breast and endocrine surgeons to exchange ideas and to discuss and manage difficult cases. as well as a venue for local and global networking.

This year the course was organised by the Surgical Department, Hospital Sultan Ismail.

We were privileged to have had two speakers from IAES (Professor Thomas Lennard from the UK & Professor Mark Sywak from Australia), and two speakers from BSI (Professor Gaurav Agarwal and Professor Seigo Nakamura).

15th - 16th August 2014

The program covered both endocrine and breast topics on these two days. The topics presented are relevant to the management of the local patients and covered the recent advances in the management of the disease worldwide.

On the 1st day (15th August) - the course was focused on the more difficult and challenging topics in Breast & Endocrine, hence only those in the Breast & Endocrine fraternity attended - consultants and trainees in the Breast & Endocrine Programme. We had a total of 43 participants on the 1st day.

2nd day (16th August) - were more general topics pertaining to Breast & Endocrine, hence it was open to all doctors. This was well attended by Breast & Endocrine Surgeons, General Surgeons, trainees and medical officers from all over Malaysia. We had a total of 129 participants on the 2nd day.

MBESC featured lectures given by the speakers, video presentations of "How I do it" and discussions in the form of case presentations by the Breast & Endocrine trainee from major training hospitals in Malaysia. It was designed in such as way, so as to engage the audience with an interactive discussion rather than a typical lecture course.

17th August 2014

Professor Dr Tom Lennard and Professor Mark Sywak visited Hospital Batu Pahat, a district hospital in the state of Johor. Professor Gaurav Agarwal visited Hospital Sultan Ismail in Johor Bahru.

The activities were interactive case discussion, examining patients in wards and visiting several facilities in the hospitals.

Based on the evaluation forms handed out during the course, majority had agreed MBESC achieved its objective.

The course was attended by Breast & Endocrine Surgeons (22.8%), General surgeons (18.4%), Surgical trainees (18.4%) Medical officers (26%) and others 14.2% (did not tick the column).

The format of the conference was rated as good by 69% of participants and excellent by 15.7% participants.

Discussion between participants and speakers were useful for future practices were rated as excellent by 30% of participants, and 55% rated good.

Practical and theoretical topics were balanced and useful for participants as 89.8% of them rated good.

66% of participants were satisfied with the course scope expectation. They were happy with the selection of topics, and found the discussions very useful for their practice.

Looking into the course as overall, majority of the participants (74.6%) evaluated it as good to excellent course, and 56.1% of participants would like to recommend the course to others.

This shows similar/ related course should be held more frequently as many more can benefit from this.

We noted that only 42.3% of participants were aware regarding previous such courses.

Some of the participants also felt that we packed the course, and would have liked more breaks in between.

In general this course was a successful event with many positive remarks from the participants. However many were unhappy as the 1st day was solely for Breast & Endocrine Surgeons, as they felt they could have benefited from it as well.

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The Edinburgh MRCS OSCE Preparation Course
report prepared by Assoc Prof Dr Hanafiah Harunarashid

Venue: Advanced Surgical Skills Centre, UKM
Date: 16th - 19th August 2014
Convenor: Mr Zahid Raza (RCSEd)
Local Host: Prof Hanafiah Harunarashid (CSAMM)

ASSC has been accredited by the Royal College of Surgeons of Edinburgh to conduct the official MRCS OSCE Preparation Course annually, in collaboration with the College of Surgeons Malaysia.

This course is aimed at medical officers, and primarily those preparing for the Intercollegiate Part B MRCS Examination. It is designed to help improve candidates' performance in the MRCS Part B Examination via practice sessions with 'mock' MRCS OSCE stations and discussions with examiners on the pitfalls and problems commonly encountered with the examination process. The course structure includes short lectures, discussion groups and OSCE stations.

Quoting Mr Zahid Raza:

"One important aspect of running each course is how we adapt it to each exam location. For instance, before the course is set out, we make sure that the OSCE stations reflect candidates' needs in that particular region. For example, in Kuala Lumpur, the knowledge base in anatomy was very high, but communication skills and clinical skills were areas requiring attention. This meant that we had more formative OSCE stations in clinical and communication skills and fewer of the knowledge stations."

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Mark Your Diary for the
Annual Scientific Meeting in Penang in 2015

by Associate Professor Datuk Dr Ismail Sagap, Organising Chairman
College of Surgeons, AMM
Annual General Meeting & Annual Scientific Meeting

College of Surgeons, AMM
29th - 31st MAY 2015
"Optimizing Patient Outcome"

The College of Surgeons, Academy of Medicine of Malaysia (CSAMM) Annual Scientific Meeting is back. This time it will take place at the G Hotel, Penang from 29th to 31st May 2015. It gives me immense pleasure to welcome you to this meeting where yet again we will have the opportunity to get closer to each other while enjoying the ever interesting scientific program. The topics, among others will be 'Optimizing patient outcomes', 'Managing difficult trauma and disaster' and many new techniques and technologies in surgery. In addition, we will also discuss issues concerning training Malaysian surgeons and strengthening collaborative effort in surgical research.

The 2015 CSAMM Annual Scientific meeting is also expected to benefit our junior colleagues i.e. medical officers, housemen and medical students plus the paramedics. We have prepared lectures, symposia and video presentations to be delivered by renowned local and international speakers. I am glad to inform you that this meeting has its unique ability to satisfy both your personal and career needs.

Penang Island has again been chosen as venue. It is known that the island offers numerous tourist places and attractive sites for leisure. We will host this meeting at the G Hotel along Gurney Drive where much 'happenings' take place especially in the evenings.

Bring along your family, mark your calendar and reserve your seats SOONEST. Let me be the first to welcome you to the CSAMM Annual Scientific Meeting 2015!

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