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Numed – HEE NE Malaysian Housemanship Programme for Attainment of Full Registration with the General Medical Council

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Numed – HEE NE Malaysian Housemanship Programme for Attainment of Full Registration with the General Medical Council NUMed – HEE NE Malaysian Housemanship Programme for attainment of full registration with the General Medical Council Introduction Newcastle University Medicine Malaysia (NUMed) was established to deliver the Newcastle University (UK) MBBS programme in Johor, Malaysia. The Undergraduate curriculum is approved by both the General Medical Council (GMC) in the United Kingdom and the Malaysian Medical Council (MMC), which allows graduates to be provisionally registered for medical practice with both organisations. NUMed wished to ensure that their graduates with a UK Primary Medical Qualification (PMQ) had the opportunity to obtain UK full registration with the GMC. Following an application in 2013 from Professor Steve Jones (previously The Dean of Clinical Affairs, NUMed) and Professor Namita Kumar (Postgraduate Dean, Health Education England North East - HEE NE) the GMC approved the programme which, apart from the UK Foundation Programme, was the first additional route to full registration. The Malaysian House Officer Curriculum and the UK Foundation Programme Curriculum were mapped and outcomes were found to be very similar. The principles are therefore of ‘equivalence for full registration’ rather than meeting the requirements of the UK Foundation Programme, which was the approach taken to obtain GMC approval. There are some UK universities which offer undergraduate medical courses overseas but the route to full registration is still through the Foundation Programme: The Bachelor of Medicine (EU) Study Programme of the University of Southampton is offered in cooperation between the Kassel School of Medicine and the medical faculty of the University of Southampton. University of Nicosia Medical School in Cyprus in cooperation with St. George's University of London These provide registration via the Foundation Programme Curriculum. Principles This is not a foundation programme in Malaysia, but recognition of the Malaysian House officer programme meeting GMC requirements for signing the Certificate of Experience (COE) as defined in the GMC document ‘Outcomes for Provisionally Registered Doctors’: https://www.gmc- uk.org/education/standards-guidance-and-curricula/standards-and-outcomes/outcomes-for- provisionally-registered-doctors Content of the Malaysian House officer programme working arrangements, clinical exposure, clinical teaching, curriculum and assessment were mapped against GMC Standards in The Trainee Doctor and Standards for Deaneries. 1 | Page Prospective Approvals were obtained from the GMC, MMC, Malaysian Ministry of Health and the State Directors of Health. All hospitals where NUMed graduates, working towards full UK registration through signing of the certificate of experience were prospectively visited by the Postgraduate Dean to ensure that the curriculum was being met and house officers were appropriately assessed. Educational resources and capacity were also assessed by the Postgraduate Dean in the first instance and are subsequently monitored by the Foundation School director via quality processes. Requirements of the Trainee Doctor The Duties of a Doctor as described by the GMC in Good Medical Practice were clearly within the Malaysian Medical Council’s (MMC) Code of Professional Conduct, and Good Medical Practice. All NUMed graduates are provisionally registered with the MMC and so are required to work to these professional standards. In addition, Newcastle University’s MBBS that all NUMed graduates have undertaken has the GMC’s Good Medical Practice embedded and, if necessary, individuals are managed via the university’s Fitness to Practice procedures as in the UK. The MMC has set standards in the House Officer Curriculum, which outline knowledge, skills experience and attitudes. The structure of the Malaysian pre - registration House officer programme consists of 6, four- month postings. These included Medicine, Surgery, Orthopaedics, Paediatrics, Obstetrics and Gynaecology, Emergency Medicine, Anaesthetics. Expansion into Psychiatry and Primary Care is underway. The trainees complete detailed log books at the end of each post which contain Work Based Assessments (WBAs), procedures observed and completed as well as attendance at educational sessions. The House officers are increasingly delivering teaching and undergoing various forms of 360 degree assessment. Each log book is countersigned by the equivalent of the clinical supervisor who completes an end of post supervisor form. Enforcement of Malaysian Medical Council Standards and Ministry of Health Standards In order to receive House Officers, hospitals in Malaysia have to be accredited by the Malaysian Medical Council. The nine criteria defined by the MMC relate to: 1. All seven disciplines are represented 2. Adequate senior staff (specialists and medical officers) 3. Adequate number of beds in each department 4. Appropriate case mix 5. Full provision of clinical support services such as pathology, radiology and ICU 6. Educational facilities 7. On call room provision 8. House Officer training programme provision 9. General Hospital training programme Quality Management 2 | Page Training takes place in Hospitals in Malaysia which have been approved prospectively for this purpose by the Postgraduate Dean. These hospitals are already approved for House Officer Training in Malaysia through the Malaysian Medical Council accreditation process. To date, eight hospital sites have been approved for the programme based on combined visits carried out by the Postgraduate Dean and senior representation from Newcastle University. The sites are recommended by the Malaysian Ministry of Health and visits are organised by NUMed. Not all Malaysian Hospitals are approved for HO training. Only Hospitals from the pool approved by the MOH in Malaysia are used for the Malaysian House Officer programme leading to full GMC Registration. Most Malaysian House officers have paper log books to record progress, however, some hospitals have adopted online logbooks. Approval for GMC registration is based on evidence collected by the trainees, including log books, sign off for additional procedures required for UK full registration but not by the MMC (e.g. intramuscular injections) and reflections as part of their training programme. These are then assessed through an Annual Review of Competence Progression (ARCP) process against the GMC’s outcomes for provisional registration. Assessment occurs after completion of 12 months of the 2 year Malaysian HO programme. Table 1: Hospitals in Malaysia approved for the Full registration Programme Government Hospital Ministry of Education Ministry of Health University of Malaya Medical Centre Kuala Lumpur (UMMC) Hospital Sultanah Aminah (HSA) Hospital Sultan Ismail Johor (HSI) Enche' Besar Hajjah Khalsom Hospital, Kluang Penang General Hospital Penang Queen Elizabeth Hospital, Kota Kinabalu Sabah Sarawak General Hospital Sarawak Hospital Sibu 3 | Page Further delivery of the programme will have oversight by the Foundation School Director (Northern Foundation School, HEE NE), reporting to the Postgraduate Dean, mirroring both HEE NE governance and the Northern Foundation School Quality Management model. There are therefore equivalent tutors and programme directors at NUMed, a programme of annual site visits, a Malaysian version of the Northern Foundation School ‘Your School, Your Say’ trainee survey and regular meetings with hospital faculty. The NUMed HEE NE programme is subject to the same GMC scrutiny as other UK programmes. However there remains confusion within the GMC about this programme and Foundation Programme abroad, which are different. This is a recurring problem and associated with turnover of GMC staff. There is ongoing work to ensure changes to GMC standards and UKFPO curricula have been considered and met. The current GMC action plan raises issues of following process rather than outcomes within ‘Promoting Excellence’, and appropriate context if the UK is to become global in this regard. All costs are met by NUMed. Outcomes The inaugural ARCP took place in 2016 and so three ARCP cycles have now been completed. No NUMed graduate who provided completed log books and the correct paperwork was considered to fall below the standard required for UK full registration. In fact, their clinical skills are far greater than UK doctors at the same level of training. Thirty doctors have received a signed certificate of experience to date, enabling them to apply for full registration through the NUMeD HEE NE House Officer Programme. The numbers wishing to pursue the route in Malaysia may increase as NUMed student numbers in each year increase. A complication around this has occurred as a result of the welcome change to visa requirements for doctors and other health care professionals wishing to work in the UK. In the summer of 2017, 78 individuals (who were either NUMed final year students or NUMed graduates) applied via open competition to the national applications process for a place within the UK Foundation Programme commencing August 2018. After a long and protracted process which understandably led to a number withdrawing to pursue other options, all remaining in the system by July of 2018 (a total of 48) were successfully placed within the UK. 12 are working within the Northern Foundation School. More students and recent graduates (96) are applying this year. It is therefore difficult to predict how many NUMed graduates will wish to pursue the Malaysian route of gaining full GMC registration over the next few years. Table 2: Conversion
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