Postgrad pathways for doctors

Individual decision: Choose a specialty where work brings you joy, as busy or challenging as it may be. – Photo: 123rf.com

TO become medical specialists in Malaysia, doctors typically either enrol for a master of medicine (MMed) programme at a local university or opt for the parallel pathway.Whichever choice they make, there are a set of requirements to fulfil. If they opt for the former, they are required to apply for a fully paid study leave, besides meeting entry requirements.

“Government doctors under the Health Ministry must be in receipt of a fully paid study leave through the federal training grant, or Hadiah Latihan Persekutuan (HLP) programme,” said Dr Lam Chee Loong, former coordinator of the Master of Internal Medicine programme at Universiti Malaya.

According to the ministry’s website, the criteria for an HLP application include obtaining at least 85% in one’s annual performance report, or Laporan Nilai Prestasi Tahunan, for three of the past five years of service, as well as holding a permanent post and getting confirmed in service.

The HLP also requires a candidate to have a year of full registration experience, which is equivalent to three years from the start of housemanship, and to be under 43 years of age at the time of the application closing date.

“There are a few other conditions; it is important to check the government portal for the latest guidelines,” said Dr Lam.

For instance, the HLP sponsorship is limited every year with certain allocations given for each specialty.

“Around 100 to 120 awards are given annually for internal medicine,” he told StarEdu.With limited HLP slots being offered, Dr Lam shared that a small percentage of doctors enrol for specialist training as private candidates, with or without alternative employment.

“For self-funded applicants without sponsorship, besides paying for the university fees, they need to undergo four years of unpaid on-the-job training which involves clinical duties, as well as on-call commitments.

“This can prove a major challenge if such doctors are not employed through a university hospital or the Defence Ministry,” he added.

As for entry requirements, they vary according to the specialty chosen.

“As a minimum, applicants must have a recognised basic medical degree with full registration and a valid Annual Practicing Certificate from the Malaysian Medical Council for Malaysian candidates, or a letter of good standing from an overseas medical council,” he said.

He added that clinical experience requirements also vary with some programmes requiring up to two years of such experience in the specialty of choice or a related discipline, while other programmes accept housemanship clinical experience as a minimum requirement.

Dr Lam also said that an examination called the Medical Specialist Pre-entrance Examination (MedEx) has been implemented by many specialties since last year to screen potential candidates as part of a revamp of the National Postgraduate Medical Training Curriculum Project.

“MedEx questions are selected by a vetting committee appointed by the respective specialty boards with members from local public universities and the ministry.

“Questions are set by specialists in the respective fields and they are based on the knowledge expected of a medical officer upon entry into the programme,” he shared.

Although the difficulty level may vary from year to year, Dr Lam said a standard setting exercise is applied.

The entrance examination, which is conducted annually by the Malaysian Examinations Council, can be taken at any time from the start of housemanship.

“Results are expressed as one of six ‘bands’ with candidates who obtain Bands Four and above being eligible for admission into the programmes,” he said.

Besides the entrance examination, some university specialty conjoint boards require candidates to undergo a psychometric analysis and an interview.

Dr Lam shared that although applicants can state their universities of choice, placement is contingent on the candidates’ overall ranking from the interview selection process, each university’s admission capacity and the distribution of candidates across institutions.

The minimum duration of study for most MMed programmes is four years with the maximum being seven years.

“Medical education is shifting from one that is more oriented on completing a fixed amount of time, to one that is focused more on the measurement of competencies in practice.

“During the training period, depending on their specialties, trainees may encounter a mixture of continuous workplace-based assessments, summative annual reviews, a Research, Audit and Quality Improvement (RAQI) component, as well as theory and clinical examinations,” he said.

Dr Lam added that the assessments are mapped to the programme objectives and syllabus with the aim of training doctors to become capable specialists.

“Programmes are accredited by the Malaysian Qualifications Agency, which works with the Malaysian Medical Council to maintain standards in training,” he shared.

Upon completing the four years of training and passing all the summative assessments, Dr Lam said doctors will be required to undergo at least six months of gazetted training as specialists before they may apply for registration on the National Specialist Register.

Parallel pathway

The other method of obtaining specialist qualifications is through the parallel pathway. However, not all specialties offer this option.

“For internal medicine, eligibility for training through this pathway entails the passing of the first part of the Membership of the Royal Colleges of Physicians (MRCP) diploma examination from the United Kingdom or Ireland.

“Part I of the MRCP examination involves an entry-level examination consisting of Single Best Answer (SBA) questions and that can be taken 12 months after graduating from medical school,” said Dr Lam.

Upon completion of Part I, parallel pathway trainees normally register with the ministry’s Medical Practice Division for their training to be monitored and overseen.

“They also need to take the Part II Written Examination and the Part III Practical Assessment for Clinical Examination, which are mandatory components of the parallel pathway,” he said.

In addition to the examination component, those who opt for the parallel pathway need to complete a variety of postings, continuous assessments, annual reviews and a RAQI project mirroring the MMed programme elements.

Dr Lam added that the majority of MRCP candidates usually self-fund their examination fees.

“For the MRCP UK, all three parts cost approximately £2,390 (RM13,870), while for MRCP Ireland, the fee is estimated at £2,780 (RM13,756).”

Choosing a specialty

On the selection of specialty, Dr Lam emphasised that it is entirely an individual decision.

“Some have been passionate about certain specialties from an early age or through personal experiences, while others may pursue a specialisation after having been inspired by clinicians or teachers during their attachments and jobs,” he said.

Comparing between specialties, he stated that most clinical disciplines entail a mixture of consultative techniques using non-pharmacological and pharmacological treatments, as well as technical, procedural and more operatively oriented skills with the broad medical and surgical specialties.

“Some may wish to work with children and expectant mothers while others may be keen on intensive care, diagnostic and interventional radiology or laboratory-based specialities.

“Many opportunities abound but part of the challenge is securing a place for training in your area of interest,” he said.

Dr Lam reminded aspiring specialists that the specialty chosen will be the main field of practice for one’s entire life unless one decides to retrain at a later stage.

“It is important to choose a specialty where work brings you joy, as busy or challenging as it may be.

“All specialties have a mixture of cases and tasks that you will enjoy, along with scenarios and aspects that may be less appealing.

“The former is straightforward and can easily motivate you, whereas the latter will need resilience to keep you going.

“Choose a specialty that you will be happy facing both its enjoyable and challenging aspects, for the rest of your career.”Wong, 21, is a medical student at Universiti Malaya, Kuala Lumpur. He is a participant of the BRATs Young Journalist Programme run by The Star’s Newspaper-in-Education (Star-NiE) team. Throughout the year-long programme, participants aged between 14 and 22 from all across the country experience life as journalists, contributing ideas, conducting interviews, and completing writing assignments. To join Star-NiE’s online youth community, go to facebook.com/niebrats.