Learning curve: HK policy on foreign doctors needs urgent treatment

PUBLISHED : Monday, 21 April, 2014, 10:16am
UPDATED : Monday, 21 April, 2014, 10:16am

I need to declare a vested interest. Our son is a doctor.

In fact he is the kind of doctor Hong Kong needs. As a clinician-scientist, he is committed both to his patients and to contributing to the growing body of medical research.

Although he has studied in Hong Kong from kindergarten through to his A-levels, poor long-term projection and planning regarding needs of the community disadvantaged passionate students like him. Fierce competition for few available places required him to seek a medical education outside Hong Kong, despite excellent A- level results.

I question rules that preclude doctors like him, Hong Kong residents, from returning to their home and families. I question why they are disadvantaged by prohibitory licensing exams while they read about government concerns to reunite families from across the border.

I question why his classmates who studied banking and law and some who did very little, are able to make a life in a place that is their home, while he cannot.

In fact I have a lot of questions.

Since the Licensing Examination of the Medical Council of Hong Kong (HKMLE), "aims to ensure that those who wish to register as medical practitioners in Hong Kong after having received medical training elsewhere have attained a professional standard comparable to that of local medical graduates", I question why international medical graduates need to undertake a different examination from local medical graduates?

"This is to safeguard the quality of our medical services and hence public health," Secretary for Food and Health Dr Ko Wing-man said in the Legislative Council.

So foreign medical graduates undertake a three-part examination, of which part two - the Proficiency Test in Medical English - is the only examination they can feel confident of clearing. Part one comprises of 240 multiple-choice questions that are "designed to test candidates' professional knowledge in basic sciences, medical ethics/ community medicine, medicine, orthopaedic surgery, psychiatry, paediatrics and obstetrics and gynaecology".

And that is all the information that is provided to doctors taking the examination.

There are no recommended text books. There are no past papers and there are three, yes, just three, sample questions per discipline provided as guidelines. The goal of the exam clearly seems to be ensuring that few doctors are able to pass it.

I question why more information is not made available.

Here's how the HKMLE compares with the US Medical Licensing Examination (USMLE). Physicians trained outside the US take the same three-part exam, and are scored by the same standard as US medical school students.

An exhaustive list of recommended books, sample questions and past papers are readily available. Students can avail themselves of online-revision courses and timed tests or attend classes that prepare students for taking the test.

The Professional and Linguistic Assessments Board test is the assessment procedure that international medical graduates undertake prior to being allowed to practice medicine in Britain and is a different examination from that undertaken by British medical graduates as are the exams administered by the Australian Medical Council (AMC). However, the standard of results attained in the AMC exam is intended to be the same as that required of a newly qualified Australian medical graduate. And again, there are detailed guidelines, recommended books and past papers easily available to help meet the required standards.

Recently, results of AMC part one examination held in March have been declared and a total of 140 of the 221 candidates passed the examination and qualified to sit the AMC clinical examination. A comparison of the clinical aspect of these examinations with those set by the HKMLE yield similar information.

Interestingly, foreign medical graduates are not able to achieve these results at the HKMLE. There exists a notion that a low-pass rate will ensure that foreign medical graduates who pass the HKMLE will attain a certain medical standard, and thus sub-standard health care service to the community will be avoided.

The reality is that this standard is determined by ambiguous questions collated in an arbitrary manner and has been described by doctors who have passed this examination as "shooting darts".

I don't ask that rules be relaxed and my son be granted an exemption from the HKMLE. As an educator, parent and a taxpayer - I simply ask for a transparent examination.

It is only when assessment criteria are clearly articulated, standards clearly established and textbooks recommended to facilitate acquiring knowledge that is deemed essential and disseminated to Hong Kong medical graduates that it will be possible to ascertain whether or not foreign medical graduates achieve similar standards.

Anjali Hazari teaches IB and IGCSE biology at the French International School