First things first, MCEM is an entry-level examination. In plain speak, it means the diploma is solely intended to rule in a select number of candidates deemed qualified for higher specialist training in Emergency Medicine. The successful award of MCEM is a testimony of the candidate’s competency in the safe clinical practice of Emergency Medicine.
So are we Malaysians eligible for the examination? This is a decidedly tricky question, as nobody has done this before. I will attempt to demystify the matter. There are in essence TWO possible ways. Let’s dissect the more straightforward method.
The Singapore Route
At first thought, this may appear to be a burdensome pathway. Read on and you will agree with me this is the more conventional and, I think, better way. Here is how you do it:
Par excellence: Singapore leads the region in Emergency Medicine education. Its senior consultants in Emergency Medicine are dedicated teachers and are passionate about ensuring high quality emergency care is consistently practiced.
1. Check on Singapore Medical Concil (SMC) website and see if your Basic Medical Degree is registrable with the SMC. If you are a Malaysian graduate, only MBBS (Malaya) or MD (UKM) is recognized as a ‘Traditional Source Doctors (TSD)’.
2. If your Basic Medical Degree is not on the list, do not despair. You can go through the ‘Non-traditional Source Doctors (NTSD)’ program. In order to qualify, you must have completed ONE year of housemanship and THREE years experience as a medical officer in Malaysia.
3. With TSD, you have the easy ticket to the system as you are qualified to practice in Singapore straight out of the medical school and not have to wait for the THREE years of medical officership experience to complete.
4. With the prerequisites secure, you then apply for a working position to one of many excellent hospitals in Singapore via their various healthcare management groups such as SingHealth and National Healthcare Group. You do not apply for employment opportunities through Singapore Medical Council. You do it through the very hospital you intend to work in.
5. Once you are employed as a doctor with the Singapore healthcare system, things will become easy. The difficulty is in securing an employment position.
6. Apply to become a Basic Specialist Trainee (BST). Here, I quote a Singaporean acquaintance who has graduated from the system not too long ago: “ There is no strict criteria for BST application, but they usually prefer if you’ve done at least 1 A&E posting before, with good appraisal grades. They don’t require a Part 1 or anything fancy like research papers, so as long as you have a good track record, was reviewed favourably and highly recommended by your HOD, the panel will strongly consider taking you on board. “
7. BST itself is 3 years of structured clinical training—1 year compulsory A&E, 1 year surgical ( 6 months compulsory General Surg ) and 1 year medical ( 6 mths compulsory Internal or General Medicine ). The remaining 6 months surgical or medical can be spent in subspecialties like cardiology, orthopaedics, ENT / eye, paeds. They do backdate relevant postings but not sure if this occurs if you did the rotations outside of Singapore.
8. Go for the Part 1 MCEM exam. This is multiple choice question format with 50 questions. It examines basic sciences as applied to Emergency Medicine.
9. With Part 1 MCEM, you then continue and complete the 3 years of BST, after which you will be eligible for MCEM Part B and C exams. MCEM Part B is lab data interpretation. MCEM Part C is an OSCE exam consisting of 18 stations of 8 mins each.
10. If you pass the final exams, you will be then awarded the combined MMed(Singapore) and MCEM diploma.
11. Continue on with Advanced Specialist Training and subspecialize in areas like Toxicology, Resuscitation Medicine or Pediatrics Emergency Medicine.
12. Or return to Malaysia and work as a registrar until the lethargic Ministry of Health wakes up to the malaise of the country’s emergency care system and decides to recognize you as a Pakar.
What about MRCSEd(A&E)?
MRCSEd(A&E) was previously the de facto diploma in Emergency Medicine in UK and many commonwealth countries especially Singapore and Hong Kong. It has recently be end-dated to avoid the clash of interest between the Royal College of Surgeons and the College of Emergency Medicine. This makes a lot of sense as Emergency Medicine is showing abundant promise as a full-fledge medical specially on her own. Besides, it gives more standing and prestige to the profession with a fully dedicated body like the reputable American College of Emergency Physicians. It is only natural and practical that the entire governing and physician assessment system be revamped.
The last MRCSEd(A&E) is in August 2008 in Singapore. Beyond that Singapore and Hong Kong with offer conjoined MMed(Emerg Med)/Membership of College of Emergency Medicine (MCEM) exams with UK. The MRCSE(A&E) will be totally phased out.
Singapore has successfully organized the MCEM Part A exam in December 2007. Part B and C exams will begin in 2009.
For those seeking exemptions to the MCEM Part A, the MRCP Part I or other equivalent exams (vide supra) will still be valid towards the MCEM (Part B and C) exams until 31st July 2009.
The Malaysian Route
I have said before the Singapore route is the easier one, so then the local option must be impossible. Truth is, ‘impossible’ is not exactly the correct description. If you allow, I would say it’s doable, but with alot of persuasion and determination on the doctor’s part.
I say this because there is not a single hospital in Malaysia identified as an accredited training center for the previous MRCSEd (A&E) diploma. When MRCSEd (A&E) was end-dated, I have yet to receive news about MCEM showing any keen interest to establish a commitment towards recognizing our medical institutions as valid training hospitals.
Furthermore, if you are not a General Medical Council registrant, you are not eligible for MCEM (Part A), unless of course you enter as a Hong Kong or Singapore trainee ticket (vide supra). As far as I know, Malaysian basic medical degrees are not recognized by the GMC. So you will have to endure the torment of PLAB in order to be GMC certified. Wicked stuffs!
No MCEM Part A – How lah?
Remember I said there is an exemption? Yeah, if you have MRCP Part 1, say, you are good to go till mid-2009! But in order to qualify for Part B & C of MCEM, you must have an adequate documented evidence of your experience in Emergency Medicine. Details of this can be found here.
Despite the fact that no hospital in Malaysia provides valid accredited training which satisfies MCEM terms, MCEM has stipulated in no uncertain terms (good news there) any well-organized, supervised experience in relevant postings overseas (outside of UK) will be considered as equivalent requirements to enter their diploma exams. This is an individual consideration and does not guarantee eligibility. A consultant will have to couch for you for you to have any chance of success.
I suspect your clinical experience must at least include stints in a busy teaching hospital Emergency Department with a thriving emergency medicine faculty. Your training must also be consistently supervised and graded preferably by a consultant in emergency medicine. In short, your CV ought to be first-class.
Nobody has gone through the application process in Malaysia, I am pretty sure. So I think you will agree with me that this precarious pathway is anything but attractive. At the moment, the best bet is still the Master of Medicine program in Malaysia. (sigh)
Interesting reading above. MCEM is indeed an entry level exam, very much like the MRCS and MRCP. There is an exit exam, the FCEM, taken at the last year of higher specialist training, but I suspect that will be impossible (even more so than MCEM) to take in Malaysia, not sure about Singapore. But then again, all the surgical specialities have exit exams, its just the MRCP that doesn’t….yet.
With regards to equivalency, I suspect the College of Emergency Medicine is fairly reasonable about what they class as a valid training hospital, clearly non accredited training sites outside the UK will be considered on an individual basis.
My advice to people considering the MCEM, it’s not a in depth exam by any means, but it certainly is a broad test of overall knowledge (as it should be). Also, for Part C in particular (don’t know about the Singapore diet), if you haven’t worked in the UK, or at least have a working knowledge about how things are managed in the UK, you are going to be at a disadvantage.
And yes, I do have the MCEM (actually got it when it was still the MFAEM)
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It is very interesting info and grateful to you. One question you may help. age?? is age a limitation? i am 53 and i want to work in emergency medicine…spent many years in this….
DEAR FRIENDS,
I AM SHAKIR KATEA FROM IRAQ I HAVE A DIPLOMA IN EMERGENCY MEDICINE,AND I WISH TO GET MRCP IN EMERGENCY MEDICINE BY PARTICIPATION IN MRCP EXAMINATION ,TELL ME HOW CAN I GET THIS?
THANK YOU
YOURS,
DR.SHAKIR KATEA
I am presently a final-year medical student studying in the University of Southampton. I however do not have GMC registration, and will in most likelihood not be able to obtain it as I will be returning immediately to Malaysia after my graduation to do my housemanship, etc.
I e-mailed the College of Emergency Medicine yesterday to ask if it was possible for me to sit for MCEM Part A even though I didn’t have GMC registration, and I received a reply today saying that it was possible, provided I was able to show documentation certifying that I was registered with the body in Malaysia. Here is the relevant extract from the MCEM regulations:
4.2 Part A
Part A may be taken in the first SHO year after gaining full registration with the Medical Council. This will be the second Foundation year or equivalent.
Part A must be passed prior to progression to Parts B & C.
Application to any part of the examination must be accompanied by all the required documentation:
· Copy of certificate of success in exam (other than MCEM Part A)
· Passport sized photo
· Fees as appropriate – undated cheque made payable in Pounds Sterling to The College of Emergency Medicine. (A separate, undated cheque must be submitted for each part applied for).
· Completed equal opportunities monitoring form
· For overseas candidates – a copy of your medical registration issued by the appropriate body
· Primary medical qualification (Overseas only)
Therefore, the person from CEM confirmed that to apply for Part A, I need to submit a copy of your overseas medical registration, so it appears that not having GMC registration does not mean all is lost
just to share info… malaysian can apply for MCEM exam as I myself has gone through the exam using my medical degree from university malaya. However I din get through the part c examination…still trying to pass. you need any further info.. can email me.
regards…