Fortify the middle ground with National Postgraduate Medical Curriculum

 

From Dr Musa Mohd Nordin, Dr Azizi Omar, Dr Zulkifli Ismail, Dr Wan Ariffin Abdullah, Dr Tan Hui Sui

Dear Dzulkefly Ahmad,

As five paediatricians, we humbly begin with the concluding aspiration of our earlier article, that the voice of reason and rationality should take precedence over the polarity of positions between the parallel pathway and the master’s medical specialty training programmes. We should all be part of the solution, not the problem.

To put it mildly, the haram fatwa by a non-medical, former vice-chancellor of a local university is incongruous and unhelpful. Simply put, this is part of the problem.

In one’s moral anger and hostility, one should not “throw the baby out with the bathwater”, or as the Malay proverb goes, “Jangan marahkan nyamuk, kelambu dibakar” (Don’t burn the mosquito nets from anger at the mosquitoes).

The nation’s interest is the priority, and it is now at a critical juncture. Any roadmap to the national medical specialty training must minimise harm – “first do no harm” – and maintain the continuity of the current healthcare and service provisions.

It must also embrace distributive and procedural justice, be socially and politically egalitarian, and produce quality medical specialists efficiently and productively. All processes should be transparent and accountable, with proper oversight.

The toxic media exchanges between the proponents of either pathway have shed some historical and contemporary perspectives. However, they are also loaded with their respective biases and innuendos and are equally problematic.

The feuds have completely missed the evolution of several excellent programmes, the exponential trajectory of which has been heading towards a unified and structured training module for our medical post-graduates.

The 12 specialties include clinical oncology, emergency medicine, general surgery, internal medicine, obstetrics and gynaecology, orthopaedic surgery, paediatrics, primary care medicine, psychiatry, radiology, and rehabilitation medicine

The pioneering efforts of our trainers, mentors and scholars in the health ministry, higher education ministry, Medical Deans Council, specialty/conjoint boards, and Academy of Medicine Malaysia (representing medical professional societies and the private healthcare sector) et al culminated in the milestone launch of the National Postgraduate Medical Curriculum (NPMC) on Aug 27, 2021 and must not be dismissed.

The unification efforts kick-started around 2012. While some have chosen to squabble and oppose other training pathways, many of our senior clinicians and educators decided to cast aside their training pathways and professional differences. They prioritised their obligations to the nation and developed the NPMC.

With these historical and present contexts as the bigger picture of our nation’s postgraduate medical education journey, we ask that you as the health minister, with careful and thoughtful deliberation seeking all voices, consider the following suggestions.

It would be virtually impossible to halt opposing positions and emotions from the hardliners of both camps. The best way is to fortify the middle ground, as in the “Madani” vision, to uphold the just culture of the “ummatan wasata” (“and so we have made you the middle nation…” – Quran 2:143).

The present impasse does not need to be a zero-sum game, as each training pathway has its strengths and weaknesses.

It’s heartwarming to know there will be a strengthening of the training and recognition of medical specialists through the amendments of the law to increase specialist numbers to serve the rakyat. Our healthcare ecosystem must be led by well-trained specialists who use evidence-based medicine and best practices. Any amendments to the law must include the voices of these specialists who serve the rakyat on the ground, not just academics or lawyers.

Please consider the input of the medical advisers, contributors, and reviewers of the 12 NPMCs, who have demonstrated collectively that it is possible to involve all relevant stakeholders in postgraduate training to develop a standard curriculum. Actually, more specialties are on their way as well for an NPMC.

As in our previous article, the 12 NPMCs have clearly addressed the three stringent issues of a central registry of training centres and entry criteria, a structured curriculum, and exit criteria.

We hope the ministry will adopt the NPMC protocol as the precursor to our own Malaysian Royal College of Paediatrics/Medicine or the Malaysian masters of paediatrics/medicine, for example.

After 67 years of independence, we can finally express our gratitude to our teachers in the UK, Ireland, Australia, and New Zealand. To quote Frank Sinatra: “The record shows I took the blows. And I did it my way.” - FMT

 

Dr Musa Mohd Nordin, Dr Azizi Omar, Dr Zulkifli Ismail, Dr Wan Ariffin Abdullah, and Dr Tan Hui Sui are paediatricians.

The views expressed are those of the writers and do not necessarily reflect those of MMKtT..