MRCP derecognised?
posted in - General, - Palmdoc |ch hu has pointed out a rumour in the MMR Forums:
A fresh graduate mentioned she heard the rumour that MRCP – adult internal medicine, (not paediatrics) would soon be recognised as in UK. It means that it will be only a diploma enabling one to be selected for further training to become specialists, either through Masters routes or otherwise. That means that MRCP would not be a specialist diploma per se. One needs something like CCT, CCST, or Masters or FAMS etc to be registered as specialists with Academy of Medicine. Anyone have a better picture?
I also spotted a letter to The Sun (Feb 4-5 2006) by Dr SN entitled “Move to de-recognise programmes unwise”:
I’m a Government doctor currently doing my rural posting in Selangor. I come from a family of doctors who are state physicians and state surgeons and I too intend to further my studies and pursue a post graduate qualification. It is a known fact that getting a place in the local masters programme is not easy and many only got their chosen field for post graduation only after several attempts and after losing a number of years. There is a sizeable number of doctors who have opted to do the membership programme instead, offered by the Royal Colleges in the UK. What I would like to know from the DG of Health is why the Malaysian Medical Council is derecognising these programmes and making things more difficult for doctors here
Well my understanding of the matter is that the MRCP was never considered an “exit” examination which qualifies the post-graduate doctor as a “specialist”. It was always considered an “entrance” examination which qualifies the post-graduate doctor to begin his training as a specialist. In Malaysia, while there are no formal training programmes for the fresh post-MRCP holder, there was (is?) an 18 month “gazettement” period before the MRCP holder could be considered a specialist. Now I don’t know if the rules are about to be changed again – if anyone has any news please post a follow-up comment here.
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February 5th, 2006 at 2:04 pm
Given the fact that Malaysia do not have a proper specialist registry, perhaps it is a good move to derecognise these qualifications which is indeen an ‘entry’ exam NOT ‘exit’ qualification. There are too many so called specialist who claim themselve as ‘consultants’ in various feild especially in private sector. These specilaist do not even have proper gazettment done. Gazettment is a requirement to be specialist in public hospital but it is not necessary in private sectors. Anyboday can cliamed themselve as specialist in various field in private sectors and MMC rarely has any monitoring mechanism. Qualifications such as MRCP, MRCS and MRCOG are only recognised as permission for further training even in UK. Our public deserve proper qualified specilaist in stead of ‘condoctors’.
February 5th, 2006 at 7:23 pm
Oh, the register and specialist accreditation/standards are definitely coming. Perhaps this rumour stems from some coming changes for fresh MRCP holders.
We need to look beyond this and also think of re-accreditation. It doesn’t mean that once one is recognised as a “specialist” that’s it. I also feel this should also apply to family practice/GPs – the issue of accreditation and re-accreditation.
February 5th, 2006 at 10:40 pm
MRCP is NOT being derecognised. It is being recogonised for what it is – an entrance qualification to begin training for a specialty. In UK, you are not considered to be a “specialist”, but get on a plane and once back home in Malaysia, you are transformed into one. Maybe back in those “bad old days” when there was a serious shortage of specialists, this was acceptable. Something was better than nothing.
“See one, Do one and you are specialist”. Surely as “poor doctor” says, our sick deserve better today.
February 6th, 2006 at 10:48 am
I believe MRCP has always been an ‘entrance’ exam in M’sia, in the sense a gazettement period after passing is required to be considered a specialist. yep, the 18 month gazettement is still in force(last I checked).
Just b’cos of some pseudo-consultants in private practice due to non-enforcement/no compulsary specialist register, MRCP should not be derecognised. That would be throwing the baby out with the bathwater. As the letter mentioned, it is not that easy to get into our local Masters programme. And MRCP is not that easy to pass. I hope it remains an alternative path to ‘specialisthood’ for some time to come.
February 6th, 2006 at 2:53 pm
With systems in place in Europe and an evolving set of changes in Australia and a better one in NZ, surely the Academy of Medicine should not rest on its laurels after having established a ‘Specialist Register’ This is the beginning of some development of a common and fair structured system of granting someone a formal specialist status. The UK one has matured over the past 9 years.
In 2001/2002 whilst I ‘transited’ in the UK, I had no problems getting my training assessed and got entry into the GMC SR but, there are many who have MRCPs and even FRCPs and FRACPs who had encountered problems. The previous Specialist Training Authority (http://www.sta-mrc.org.uk/) has now been replaced by the PMETB (http://www.pmetb.org.uk/)
Some of the methods used are much to be desired and highly discretionary and the way forward is to have good transparency and no favoritism from the start. Do you think Bolehland (read – Academy of Medicine and autonomy) is professionally matured enough to have this?
February 6th, 2006 at 9:30 pm
It was reported in the Sun today that the DG of Health stated clearly that the MRCP is not de-recognised. However it is not considered an exit exam and you need to be supervised for 18 months before gazettement, 6 months if you do a local postgrad programme.
February 7th, 2006 at 12:35 am
“Most of the programmes although undoubtedly good, are not structured (i.e. they are not exit examinations) and therefore those who pass the examinations conducted by these colleges will have to undergo 18 months of supervision and monitoring as opposed to the six months for local graduates, before being gazetted as specialists,” said Ismail.
Don’t know what he meant by ‘most programmes not structured’. Please get your facts right, Ismail. MRCP is not a programme, it is an exam. Neither is the Intercollegiate Exit exam a ‘programme’, but a small part of a very comprehensive, structured programme.
The structure is that we start as BST(SHO), sit for MRCP/MRCS, then compete for HST(SpR), then pass our Intercollegaite exam, then take up a sub-specialty interest locally or overseas (without the need to call our self sub-specialist).
Each trainee has many consultants to rotate to (in my case more than 30!) throughout the HST, assessed EVERY 6 months from communication skills to clinical skills to academic achievement. Each assessment is attended by 7-8 consultants and a visiting external consultant. Every year the local training committee has to submit a report to London about a trainee’s progress. Every year, we are either passed or given targetted training to a weakness identified or concern raised by our trainers, or SACKED.
If all well, then only we get CCT/CCST.
If people can use an entrant exam or exams (multiple MRCPs) to qualify themselves as specialist in M’sia, then it is because Bolehland is not structured enough in its administration and regulation, not ‘most UK programmes’, Ismail.
February 7th, 2006 at 5:30 am
I think the “not structured” is in reference to the situation for post-MRCP holders in MAlaysia.
February 7th, 2006 at 5:50 am
UK Doc is correct with his/her facts. The robustness of the process is obsessional and appears to be harmonising with the European directive. In Bolehland, the questions any specialist recognition body (there now appears to be more than one!) need to ask are going to lie in two categories.
First, the basic specialist training structure and what minimal standards need to be achieved. Common curricula and common exams may be one way out. One already faces problems with the huge diversity of Masters courses locally and, to add to that, MRCP, MRCPI and FRACP etc. There will be odd wild card from France, Russia, Taiwan, Japan, Egypt and so on! Malaysians are very determined to get their letters whether real or unreal; recognised or unrecognised!
Second, for post basic specialist training. Having sorted this out, the next headache to is determine what needs to constitue post basic specialist training….another lifetime of debate and arguments
Finally, reaccreditation. What possibilities?
February 7th, 2006 at 5:55 am
Oh, and for those of you in such structured programmes in developed nations where you are likely to get specialist registration and recognition, the answer regarding returning home ‘to serve’ is very clear! Unless you miss someone or some food or the environment so much (check it out if you have not been back), you really have to ask yourselves very serious questions.
February 7th, 2006 at 7:19 am
LF Ng, can’t decide if you’re being sarcastic or not
So are you saying grads of structured programs will get easier specialist registration? Cos I’m in a very structured 6 year internal medicine/endocrinology program, yet i’m fully expecting to get screwed by KKM when i return.
February 7th, 2006 at 8:59 am
No, I am being cynical about Bolehland….you have provided the answer yourself! You are going to get screwed because you are going to be a threat to them, not because they do not wish to recognised your experience. This phenomenon is world wide except in the UK for the moment (because they desperately need you). That is why a central autonomous and powerful body to determine specialist is necessary – not Colleges or Universities etc. Australia is also breaking down….just mark my words. In the next year, you will be just able to walk in with your six year stint in the UK.
February 7th, 2006 at 10:16 am
Supervision? Gazzetement after 18 months? What a load of BS! If you want to be specialist, you owe it to yourself and to the patient you treat, that you are properly trained. That you are judged and recognised by your qualified peers to be competent is a high honour. Gazzatement? What’s that? Some short-cut or backdoor way to be a specialist?
Yes “huajern”, the road to become a specialist is long,tedious and difficult. It is meant to be. Lest we forget, we are dealing with human lives and “short-cuts” are not accepatable when we can do better.
February 7th, 2006 at 7:22 pm
Would those with FRCP, FRCPI, FRACP, FACP or Diploma of Americian Board of Internal Medicine coming back to our country need to go through the same 18 month supervision and monitoring— under some possibly younger locally trained MRCP or MMed “gazetted” specialists?
February 7th, 2006 at 9:51 pm
mikkey,
I understand training to be a specialist is a long & difficult process (though I wouldn’t call something I enjoy ‘tedious’). That is why I am still at it. And I very well know my responsibilties to my patients, thank you.
But to call 18 months of gazettement after MRCP as a ‘short-cut’/backdoor/’BS’ way of becoming a general physician is a gross insult, to me and the many physicians who are competently serving the community. Do you mean local MMed holders or those with overseas training are ‘proper’ physicians, while those who took the trouble to slog diligently and ‘lonesomely’ thru MRCP in service hospitals are BS physicians? I do not question the expertise of other doctors, but I feel you are mistaken in your opinion of MRCP holders.
mikkey, you also seem dismissive of the consultants who supervise and train MRCP holders during their gazettement. From my limited experience, these senior doctors take their duty seriously and would not certify/recommend anyone anyone they find incompetent.
February 7th, 2006 at 9:55 pm
mikkey,
Could you suggest any alternatives to a young Malaysia-based doctor on how to train as a sphysician, other than MMed or MRCP? Taking into account the limited university places approved by MoH.
February 7th, 2006 at 11:50 pm
Dear Huajern,
Do I think that MMEds or “gazzeted” MRCPs are inferior or “BS” phyiscians. No I do not! Some fine doctors I know, are graduates from “unrecognised” colleges. It is just that you started off less well trained. And you,judging by the passion in your letters, will eventualy be a “better” doctor no matter where you trained. But what about those less passionate and less motivated?
My comments were directed at a procedure (not doctors) that do liitle justice to those who have truly strifed, and has oullasted ite usefulness.
February 8th, 2006 at 4:30 am
CH HU: Yup. I have my ABIM, and yet when i return I’ll have to do the 18-month stint. I guess that’s how it’s gonna be.
Question is, once I complete my subspecialty training, who’s going to supervise and gazette me?
February 8th, 2006 at 5:56 am
Vagus,Now that you have revealed more about yourself, send me private mail (lfng@cantab.net) I would share something with you. For the rest, you will prob realise that many contributors are at the crossroads about returning or training locally.
February 8th, 2006 at 6:38 am
@vagus: hopefully not some fresh MMed 3 years your junior or something like that!
February 8th, 2006 at 7:12 am
Huajern, don’t be discouraged. I have great respect for many M’sian trained doctors, although there are also many mickey mouse doctors who just look for every loop hole and short cut in the system. OTOH, we overseas doctors are not any superior than you guys and indeed have a lot to learn from you guys about tropical diseases and how to handle Asian patients. Medicine is a very humbling career, we never stop learning, yet at the same time there is nothing much to be ‘kembang’ about, we are all here to serve people. Keep up the good work.
The system sucks though. Your position is a good example of how illogical are the people in power. If they are prepare to gazette you and recognise you as specialist at the end of your spell, why don’t they just let you sit an exit exam?? It seems on one hand they will recognise you as qualified specialist, yet OTOH, they say you are not qualified to sit for their exit exam because you have not attended their lectures and ‘structured programmes’. Post-graduate training is all about apprenticeship and handling real cases, I never realise attending lectures is so important. I thought people are old enough to do their own reading.
February 8th, 2006 at 7:27 am
No, there is a high likelihood that he might have been my student at the IMC in PJ State (the start)
February 8th, 2006 at 11:02 am
Dear mikkey,
I am still concerned with your ‘bias’ that MRCP holders have not ‘strived’. I understand there are always blacksheep in any group, but it is unfair to generalise if you met a few ‘passionless’ MRCP holders, assuming that is the reason for your opinions.
It is not easy studying on your own time without a ‘structured programme’ while doing 8-10 MO calls a month in a service hospital. I would think this eliminated most of the less passionate and less motivated. And MRCP is not that ‘cincai’ with its standards if we consider the passing rate of around 30%.
Outlasted its usefulness? Then how are we going to train adequate physicians in the future? I don’t believe in lowering standards to make up numbers, but the Universities with postgrad programmes are just not able to take in sufficient numbers. Furthermore, one runs the risk of being picked but not released by MoH.
UKDoc,
Thanks for your words of encouragement.
The system does suck. And logic is not a strong-suit of administrators here.
February 8th, 2006 at 2:27 pm
Correct me if I am wrong, but as far as I know, aside from the MMed from Malaysia and Singapore, only the ABIM and FRCP (canada) are exit qualifications.. Not sure about the RACP (aust & NZ) though.
Does one work as an MO then whilst awaiting gazettement?
February 8th, 2006 at 3:20 pm
Personal experience: Many moons ago, and a year before coming home, while a registrar/acting SR in orthopaedics in the UK:
I was of course post FRCS (prob 3 years, but I wouldn’t swear to it), I made an appt to see the head of ortho at a public university.
Gist of the meeting…we don’t want you, you don’t have a orthopaedic higher degree (true), no, we don’t really care about your experience, we are not bothered about your plans to get a higher qualification….No you cannot sit OUR exit exam(Masters Orthopaedics) , as you have not done the course(!), etc
All said while happily smoking a cig, puffing in my face.
What did I feel: Unwanted, Uncared about, A Threat to the chap? All I knew then was that I would not like to work as a lecturer there, even if given the chance. I was reconsidering my plan to returh home, when I met (by appt) the dean of another university who was the exact opposite…come, Malaysia needs you, you kave good training, and we will give you excellent experience, etc…
I came, stayed in the uni for almost 6 years, and then finally left after the beaurocrazy finally got to me.
So yes, exit qualifications are important, eventually. And I think that eventually Conjoint Board speciality exams will be the norm, but open to all to sit, NOt just after a spoon-fed Masters course. (Apologies to some excellent Masters specialists out there, but I *was* there, and know the amount of uncritical swallowing that went on).
No one who has made it through higher qualifications has had it easy, we all deserve recognition and nurturing, especially in the loca;l context, where there are not enough of us.
And definitely, NO ONE who has just done the Masters is a specialist in my eyes yet, It is NOT a true end qualifying exam, it merely acknowleges your superiority to a basic degree holder. EXPERIENCE is what makes the difference, and turns a registrar/senior registrar into a consultant
Apologies for the rambling post, between patients, lah!
GS
February 8th, 2006 at 3:28 pm
Yes, I believe FRACP is an exit qualification. And FRCPs (UK and Ireland) are awarded for those ‘consultants’ who have more than MRCPs—that is eminent doctors with achievements in teaching, research and other fields over the years, possibly more than ten.I believe many FRCPs (maybe they are already professors) do not have CCT or CCST, as they are new things, am I right? Please refer RCP websites for details. Do these contributions count in our system?
February 8th, 2006 at 5:40 pm
In 1996 when the UK Specialist Register (SR) was established, all and sundry who were resident in the UK and who prove that they had a consultant post full time in a public hospital were auto-granfathered. This was the first step.
Then, it became harder and harder to get into the SR until post 2002 when the STA was in full control. They were exceptionally robust and turned down many applications. The idea of the PMETB was mooted and the transition has led to some loosening of training criteria.
There are only few FRCPs in the UK who are not on the SR – principally because they were retiring or had retired during the watershed period. The entry into the SR had 3 routes:
i. the CCT or CCST (most common route) – candidates compete for NTNs (National Training Numbers) which are job associated. Few non UK citizens or residents were eligible for NTNs till recently.
ii. the Overseas Route – evidence of structured overseas training plus a qualification
iii. the Academic Route: many high quality publications in peer reviewed journals. The last two are used less often. I guess, if Bolehland graduates would like to pitch their worth, the Overseas route would be worth tackling.
The FRACP is an exit qualification but certain FRACPs will not be eligible for GMC SR as some specialties have shorter training periods than those recommended by EU Directives: so, they are not automatic.
Until recently, the FRACP was not awarded without examination. Because of shortages, they have changed the rules and have awarded the FRACP to “appropriately qualified candidates” after a period of robust peer review (not worth it as taking the exam is prob less stressful with a lot of discretionary insertions possible)which has to be College preapproved.
Regarding local recognition procedures, the issue is whether Bolehland administrators accept FRCPs, FRACPs, ABIMs as first timers in the system without prior experience. I would guess not – as there is always the discretionary elements of ‘local experience’ and “local knowlege.”
So, my personal feeling is that some form of peer review practice for gazzetement should be spent within the system. It is sad that some overseas specialist have short circuited the system and joined private hospitals:which makes it very unfair to Malaysians.
Sorry for the ramble
February 9th, 2006 at 11:42 am
Thanks to all for the clarification.
Will just have to wait and see how things pan out when I go back to Malaysia in 4 years!
February 9th, 2006 at 3:23 pm
Antatosh, if I remember correctly you are finishing your residency and going into clinical fellowship. I think if you complete your clinical fellowship, then you should not be made to go through gazzetement anymore. Negotiate with MOH before you go home, your bargaining power is only with you as long as you stay overseas. But beware of broken promises, make sure every agreement is written in black & white, not verbally.
February 10th, 2006 at 11:11 am
UK doc, you remember correctly. Will be starting a fellowship in hematology/medical oncology soon.. Thanks for the sound advice.
February 10th, 2006 at 11:54 am
Would our system differentiate those with MRCP alone, MRCP with CCT/CCST or FRCP? Is it fair for all three to do the same 18 month supervision and monitoring period?
February 10th, 2006 at 12:19 pm
Obviously no, ch hu, there ought to be some clear guidance about these three classes of individuals. Not trying to be a wet blanket, why fight so hard to return to have a hard time not practising scientific medicine and fighting against those experts in opinion based medicine when you have alread achieved these? Stay back in the West. For example, if you want how to make char kuay teow, I will give you my personal recipe, which has been tried by many and appreciated overseas! (or even nasi lemak or satay) The air is fresher and the views less stifling etc and, of course the grass always greener.
March 5th, 2006 at 1:15 pm
MRCP is always an entrance exam for entering for advance specialist training. Malaysia recognise it as clinical specialist which i think is fair because it is equivalent to registra before subspecialisation. I hope that MRCP will be recognised as equivalent to MMed as there are too many aspiring physician in this country and the waiting list for MMed is just TOO long!
March 14th, 2006 at 8:09 am
[...] Post-graduate examination is a part of many doctors’ career development. Before I go any further, I would like to stress that examination (entrance or exit alike) is only a test, it alone is far from adequate to qualify a doctor as a specialist. It is unfortunate that doctors carry MRCP or FRCS behind their names, rather than titles that indicate their training history. The title MRCP or FRCS is one excuse for the colleges to charge doctors membership or fellowship fees. Without paying their annual fees, doctors (not necessarily specialists) are not allowed to wear these titles. [...]
August 2nd, 2006 at 10:33 am
I have both MRCP(UK) as well as MRCP(Ireland).The MRCP prospectus clearly says that attaining MRCP, does not confer specialist status. Infact, it would be detrimental to public, if one assumes and practices as a specialist after attaining MRCP(UK or Ireland).The MRCP is an entry level qualification ensuring that you have adequate basic knowledge to launch upon a specialist training program.
After attaining MRCP,You need to get into some structured training program like residency training(3yrs) in USA followed by a Fellowship(2 yrs) in speciality of your choice, to gain a solid knowledge,clinical skills and procedural skills to be a safe practitioner(specialist).
Having worked in Ireland as well as in UK for several years, I am sorry to say majority of SHO/Registrar posts in UK&Irel do not meet the requirement of standardized structured training. Majority of NHS posts exploit overseas doctors and extract scut work from them and do not in return, impart Knowledge/Clinical skills/Procedural skills.
June 5th, 2007 at 4:13 pm
as far as i know, there are no MRCS, MRACS (aussie), MACS (USA) like MRCP and MRCP(ireland).
If one like to be a surgeon, he/she must have a status FELLOW – like FRCS (glasgow or edinburgh or england) or FRACS (aussie) or FACS (USA).
and to get these fellowship tittle after one name, a surgeon-to-be need to finished the study program oversea for at least 4 years under supervision of a surgeon committee. And of course it cannot be done in malaysia like MRCP.
March 17th, 2008 at 1:08 pm
Specialist is a resposibility. It is like SPM, during those years, having passed the exam was already a wonderful results, but today, more and more students are ace-ing the exams.
If we give doctors who passed their part 1 MRCP during the housemanship years and then passed the MRCP programme, subsequently producing young specialist with little to no experience in the field, is that fair?
It is like giving datukships to those who can pay.
I suggest all doctors wanting to specialize to undergo a masters degree. Like our undergraduate programme, the MOH should select universities abroad and provide the doctors with financial assistance for further studies.
And most importantly … please be fair in selecting the students eligible for master studies, because they will become the specialists and leaders to lead our future generation of medical healthcare.
I suggest that even the trainee lecturer from teaching hospitals do the same thing. Send out for proper training and experience before recruiting them as master students, just because they work for the hospital.