Over the last 20 years the number of private Sri Lankan "foreign medical graduates" (FMG) has increased tremendously. The number of private and state foreign institutions catering to this demand has also increased. Some make it more attractive by offering courses in English. China is the latest addition. These institutions with curricula ranging from 4-8 years, various combinations of languages, different teaching methodologies, vast range of teaching staff (sometimes also foreign) do indeed pose a real problem in standardization. Most such institutions proclaim that their degrees are recognized by the Sri Lanka Medical Council (SLMC) and the WHO. The author is unaware of the process involved in this evaluation but assumes that such a system is indeed in operation. It seems a necessary process to maintain basic quality standards. Occasionally it is found that some of these institutions do not even have good local standing in the very countries they operate.
 |
Dr. Nihal de Silva (MD, MPH, ACOG (USA)
Dean, International Institute of Health Sciences. |
This medical degree is a certification of successful completion of a specified course of studies in the field of medicine and does not empower the holder to practice medicine. In some countries a further period of internship has to be completed before this degree is granted. After obtaining the degree one has to apply for a licence to practice medicine. This is called registration in some countries. The power to grant such licensure lies with the state in most countries. Irrespective of the reputation of the institution from which the medical degree was obtained the state has a standard examination for licensure. On successfully passing this examination the state (not a university) confers the power to practise medicine by awarding a licence with a licence number which is entered in a registry. Now you are "a real doctor" and ready for the practice of medicine. Although in some countries this licence is good for life, in most "advanced" countries it is time limited and has to be renewed every two years or so, by examination, after showing proof of study of the latest medical information. This is quality assurance for the public good.
It is not known how many Sri Lankan FMGs have such foreign licences. I have questioned many FMGs only to discover that they are unaware of the significance of this process as they do not have a licence in the country in which they obtained their degree. The distinction between a medical degree and a licence to practice medicine seems not to be appreciated by the FMG and sometimes more importantly, their family who "imagine" them to be "doctors" even though they may not have a licence (abroad or locally). It is unknown how many of these foreign countries allow non citizens to take their licensing examination. It is also not known if some of these newer institutions catering to FMGs are recognized within the country itself to offer candidates (degrees) for licensure examination. The USA, the largest recruiter of FMGs over the last 40 years requires that all FMGs must have obtained unrestricted licensure (not conditional) in the country and language of their medical education.
The author, having first obtained a Japanese medical degree, then obtained a Japanese medical license (as was allowed by Japan) and was then allowed entry to the USA for registration there after further examination, again by individual states. There is no "one common license" for the whole country in the USA although there is a common standardization examination called FLEX.
It is estimated that there are more than a thousand FMGs who have returned to Sri Lanka. This is potentially a very rich reservoir of "free" resources for the country as the government has not spent on them for their higher education. In recognition of this potential and the growing numbers a system seems to have been developed to accommodate such FMGs. Presently an examination called the "Act 16" is in operation to "standardize" and register FMGs. I have recently found Sri Lankan medical undergraduates abroad who have not heard of the Act 16 process although they claim to be interested in returning to Sri Lanka as doctors. This is quite shocking unless they are secretly not wishing to return. When perusing the local newspaper advertisements targeted to potential FMGs I have seen only one institution that says that Act 16 is required for registration on return to Sri Lanka although they all say they are recognized by the SLMC and the WHO. This is potentially confusing and misleading information. The Act 16 requirement should be stressed and mentioned.
Although the author in not aware of real figures it is rumoured that the pass rate of the Act 16 exam is very low. Assuming that the exam is a fair one and given with a view to welcome this huge resource this low pass rate requires further investigation and analysis. It is reasonable to assume that the diverse academic environments from which these FMGs come is an issue by itself as their curricula may not be very relevant to Sri Lanka. To compensate for this it may be reasonable to conduct a basic standardization course before the ACT 16 process begins. Although this would add further time to the FMGs' study period, the return should be more than compensatory for the FMG and the country. The experience and results of the past years' Act 16 examinations could be used to design such a course. This could be a private or public or a partnership venture for a national cause.
It is unknown how many of these Sri Lankan FMGs have a license in the country in which they obtained their degree. To obtain this license they have to have sat for an examination given in the language of that country. Some countries may not grant this privilege to FMGs. If granted, and if their medical education was in English, then the language issue would prevent the student from passing the exam. If the education was in the native tongue, then a good degree of proficiency in that language (and not medical knowledge alone) would be necessary to pass the examination. There are further implications. Depending on the medical service system of the country even the possession of a license may not be a help to practice. For example, if the country has a "National Health Service" their doctors will be working for the government. Foreign citizenship FMGs may not be able to enter the workforce despite possession of a medical license. If the country has an open system which allows private practice, the FMG will have to compete in the established private sector and this may not be easy. Many countries where FMGs are studying are recovering from their socialist/communist economies and are not the most fertile ground for private practice. In addition, the FMG (and family?) will have to adapt to a new cultural setting on a long term basis.
Potential Sri Lankan FMGs should pay special heed to the above information before committing themselves to years of study with huge financial outlays. The doors to the practice of medicine (by licensure) are getting narrower by the day and what regulations govern today's licensure (in individual countries) may be different 5-6 years hence. |
E-mail