Combine best of both worlds to train cardiothoracic surgeons

 

From Dr Sivakumar Sivalingam

I am a qualified cardiothoracic surgeon from one of the premier cardiac centres in the country.

I am a product of an era which was transitioning between training in cardiothoracic surgery as an apprentice and the one undergoing training through a structured training programme.

I would consider myself lucky as I had the opportunity to experience both types of training modules, and I would like to share some insights through my training experience.

As a trainee in Malaysia, one should consider oneself lucky as you can hone your surgical skills in a short period of time if you put your time and effort into it. I underwent my initial cardiothoracic surgical training in Malaysia, and I was mentored by some of the best local cardiothoracic surgeons.

However, I still felt a void in my training as it had some deficiencies like how to provide holistic care for the patients especially in some important aspects such as evidenced-based practice and importance of academics and research related to patient care.

Hence, I enrolled myself into the training programme in the UK. My decision to enrol into the training programme was because that was a prestigious and well-established programme with reputable standards that rarely gave the opportunity for a foreign graduate to directly apply without any formal training experience in the UK and Ireland.

This experience was indeed an eye-opener as I was able to achieve competency in some aspects of training that was not available to me in Malaysia at that time. I completed my training in the UK with a formal qualification in cardiothoracic surgery and until today, I am a member of good standing with the Royal College of Surgeons of Edinburgh.

Following my return to Malaysia, I honestly felt that it was best to amalgamate the training components between Malaysia and the UK with the intention of getting access to the holistic training approach which I had experienced and be available to the future Malaysian trainees.

As the Royal College of Surgeons of Edinburgh had already established a structured training programme with Singapore and Hong Kong, it was a conscientious effort from all members of the cardiothoracic fraternity to have a similar collaborative programme for cardiothoracic surgery.

This collaborative programme came to fruition with the establishment of the Malaysian Board of Cardiothoracic Surgery wherein the board established a comprehensive training programme based on the structured curriculum in the UK with attention given to the requirements that will be pertinent to the Malaysian system.

One of the impetuses to set up the board was that during this period there were a few attempts to establish a Malaysian Masters programme in cardiothoracic surgery, but all the efforts were futile due to the lack of manpower in the universities to sustain the programme in this specialty.

This training programme developed by the board was what one would experience if the trainee would have enrolled into training in the UK and Ireland. The qualification provided at the end of training is the Fellow of the Royal College of Surgeons of Edinburgh (FRCS).

This is the same qualification that I had received following my training in the UK. Furthermore, this qualification is eligible for one to apply for a consultant’s job in the UK. For some reason, the qualification is being deliberately misconstrued by some quarters as akin to the FRCS international qualification which is given to candidates who pass the Joint Surgical College Fellowship Examinations (JSCFE), without obtaining their training through a structured cardiothoracic surgery training programme.

I have personally been involved in the establishment of the parallel pathway programme right from the beginning because of my past acquaintance to training in the UK. Following my successful training, a few junior colleagues of mine were able to undergo similar training through the parallel pathway module and are practising as independent and successful cardiothoracic surgeons in various health organisations in Malaysia.

These qualified surgeons too got very much involved in the establishment of the parallel pathway programme. This goes to show that the programme was established by surgeons who had experience of how a structured training is conducted and not by novices as what is claimed in the public domain.

As per the curriculum in the UK, the parallel pathway has similar entry requirements, number of training years, the number of trainers to trainee’s ratio, qualification examinations and surgical competency assessments.

Hence, it is unfair to brand this programme illegal, as maliciously claimed by some parties who do not comprehend the robust curriculum that has all the requirements to make one a competent and safe cardiothoracic surgeon.

One of the key factors to be taken into consideration is the financial impact to the government by having a successful parallel pathway programme. During my training in cardiothoracic surgery both in Malaysia and the UK, I did not apply for any scholarship from the government and was able to complete my training successfully without any government dependency.

Certainly, it will be cost-effective to run a parallel pathway programme that will require some minimal support and not complete dependency and burden to the government coffers, especially when the plan is to increase the number of specialists in training to meet the needs of the nation.

I believe it is time that we focus on how to produce the best cardiothoracic surgeon who will save the rakyat from going overseas to seek treatment in the future.

It is imperative to have a local Master’s programme that follows a similar curriculum which has stood the test of time as the parallel pathway programme. This can only be achieved by giving some independence to the fraternity to run the programme and not by armchair critics who are not involved in the actual training. The way in which the university can run a successful programme is to engage trainers who are currently actively involved in training.

I am proud to be a part of the committee which initiated the parallel pathway programme and have been through it and seen it all as a programme of high quality and international standards. I will vouch that the parallel pathway deserves its due recognition and be reinstated as a recognised training programme. - FMT

Dr Sivakumar Sivalingam is a senior consultant cardiothoracic surgeon at the National Heart Institute.

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