THE CASE FOR A UNIFIED ORGANISATION FOR POST-GRADUATE MEDICAL EDUCATION
A A Sandosham

The rapid expansion of the medical and health services in the country with the aim of government in the Third Malaysia Plan to make available these services to the rural areas, will impose an increasing demand on the medical profession to provide the highest possible quality of medical care for our people. It is vital that the standard of medical care in the ultimate analysis be best safeguard by the professionals themselves. This is particularly true in the field of postgraduate medical education and accreditation.

The public at large in our country is becoming increasingly aware of the need for good and, wherever possible, specialised medical care in the various disciplines. So far, Colleges in the United Kingdom and Australia and the Specialist Boards in the U.S.A. have helped us to conduct the necessary examinations in order that these standards are maintained. But the time is more than ripe for us to make available to our doctors a system of training andn examinations locally, and to have a professional body which could conduct such examinations, in the initial period wiht the help of our sister colleges abroad, and grant local diplomas which would be of international standing. This would enable us to provide the up-and-coming doctors in the country with an avenue to plan their future postgraduate training programmes without uncertainty or frustration. Such a programme will also help attain the required quota of specialists within at least the next decade. Under no circumstances, should the standard for training and accreditation be compromised; experience in some of the developing countries has shown that once the standards are compromised, it is almost impossible to regain the standards or gain confidence for such degrees or diplomas. Because overseas institutions in the U.K., Australia and in the U.S. have never allowed their standards or their requirements to be compromised, their diplomas are still much coveted and respected.

The Board of Postgraduate Medical Education in the University of Malaya runs courses for the diplomas in Public Health, Pathology and Psychological Medicine and has successfully conducted courses and held local examinations for the first part in Medicine and in some cases for the first and second parts in Surgery of Colleges in the Commonwealth. With the establishment of the University Kebangsaan it will be possible in future to utilize not only the facilities of the Medical Faculty of the University of Malaya, but also the facilities and staff of the University Kebangsaan and the specialists in government service and the private sector to conduct the courses locally. What is required, however, is a unifying body, which could gather under its wing all the major specialities either as Colleges or as Faculties to draw up the necessary syllabuses and requirements and at the same time conduct examinations and grant diplomas in the various specialities.

For historical reason in the U.K., respective Colleges were formed in the various specialities. One estimate has it that there are 107 postgraduate diplomas in the U.K. and at a conference in Glasgow in 1967, "multiple diplomatosis" was diagnosed as one of the problems facing postgraduate qualifications in the U.K. Several Royal Commissions and Committees have been appointed on Medical Education, the most recent one being the Committee of Inquiry into the Regulations of the Medical Profession under the chairmanship of Dr A W Merrison, F.R.S. in 1975. This is known as the Merrison Report. In order that the many specialised organisations could be unified, a Joint Consultants' Committee was formed in the U.K. as "it was essential in the interest of Consultants that a joint committee of bodies concerned should be established to speak for Consultants with one voice".

Recently, at the 10th Singapore Medical Congress of Medicine in Singapore, Mr James Ross, President of the Royal College of Surgeons of Edinburgh and Mr R B Wright, former President of the Royal College of Physicians and Surgeons of Glasgow emphasized the fact that it would be better, following their experiences in England to bring the various specialities under one organisation. They said that what may be lost by individuality of the specialities is more than gained by unity of the specialist groups which can talk with one voice and endeavour to maintain a uniform standard.

In Canada, they have a College known as the College of Physicians and Surgeons of Canada and examinations in the various specialities are conducted by this College. In South Africa, the Colleges which were initially formed as the College of Physicians and Surgeons in 1926 and the College of Gynaecologists in 1971, have recently been combined and called the 'College of Medicine of South Africa'. This College has all the specialities under its fold an dit even includes general practice as one of its specialities in which it conducts its examinations.

In Malaysia, over the past several years, attempts have been made to establish the College of Surgeons, the College of General Practitioners and the College of Physicians and draft a Bill for the Registration of these Colleges to be put through Parliament. The Bill as it was planned was circulated to the respective organisations and we understand that it has not been found generally acceptable either to the College of General Practitioners or the College of Physicians. Even amongst the Surgeons and the Anaesthetists, there is said to be a division of opinion with regard to this proposed Act.

Under the circumstances, it is felt that the time is opportune to bring about cohesion in the profession as a whole and it is suggested that a national body be now established by Act of Parliament with powers and facilities to organize and conduct courses and examinations for various postgraduate diplomas utilizing the resources of the universities, hospitals and medical organizations in the country.