Self-Regulation of Professional Bodies

I read in interest of the controversial CLP exam, which is said to be a very hard qualifying exam for many law graduates overseas before they can practice in Malaysia. The low passing rate seems to suggest that there is some quota involved, either in the numbers or racial composition. However, the examination director seemed to claim otherwise. Candidates, he said are judged based on merit and knowledge, and those who fail do not answer the exam questions accurately, through resorting to an academic discourse of the law.

While we have no reasons to question the credibility of the examinations director and the members of the board (that includes the members of judiciary and the Malaysian Bar), certainly many overseas graduate who are required to take such qualifying exam and fail, would tend to be critical.

While I do not pretend to know much about this, I would like to offer my opinion on this issue, from the medical perspective. In this post, I would like to justify the need for self-regulation to ensure both competence and protection of the local training, as well as addressing the question of quality and merit.

Firstly, I think that self-regulation is essential to maintain quality in professional practice within a local context. A university qualification, while giving necessary training and exposure to the profession, is not the sole determinant of whether one is qualified to practice.

For example, a medical graduate overseas may not necessarily gain entry to the medical profession until they show competence in practicing safely and effectively in a Malaysian context through years of housemanship. This means that a medical graduate from China, or Zimbabwe or even the United Kingdom, while may possess adequate medical knowledge and skills, may not necessarily be fit to practice in the Malaysian context.

It could be the language and cultural competence that are questionable or inadequate clinical skills and biomedical knowledge. A doctor may know the skills necessary to treat congestive heart failure, but may not have the cultural competence needed to deal with say a rural shaman from Kelantan who opt traditional medicine. Knowledge is culturally conditioned, and to train in one context and to bring it to another requires more than just good theoretical skills.

Hence, the medical qualifying board is justified to evaluate, refuse or retrain candidates before admission to the profession, on the basis of theoretical and practical competence.

Secondly, self-regulation is needed to ensure that the local training of graduates will be given primacy to meet societal needs. Thus, overseas graduates will naturally be given a secondary preference.

This is evident in the medical profession of many developed countries, like New Zealand where preference is given to locally-trained medical students instead of depending on overseas and foreign graduates. Besides the cultural and linguistic competence stated in the previous argument, it is essential for these countries to do so to ensure that they can adequately meet the needs of the society without forever depending on foreign medical graduates outside for various reasons.

It is reasonable therefore; that overseas graduates be given a secondary preference to ensure there will not be too many nor too little professionals in the particular field. Quotas and limitations are justified to serve the purpose of limiting the numbers to ensure quality and exclusivity of the profession, besides ensuring the viability of domestic training. To open up the profession and not to protect domestic interests is to do disservice to the society in the long run.

The question of quality and merit may come into the discussion, when there is protection towards domestic training. Proper quality control and assessment of domestic training can take place to ensure that it will not be compromised for the sake of protectionism. The question that we should ask now is not whether the self-regulation is justified, but rather whether the self-assessment and external evaluation are properly and thoroughly done, to suit and provide for local needs and context. With credible and qualified professionals on board, there is no valid justification for criticism aside from personal opinion.

Even the notion of quality is not fully unproblematic as it is context-conditioned. While there are some criteria of what constitute quality and competence, defined by the wider professional community, there are some criteria that are good somewhere but not necessarily be so elsewhere. For example, while good spoken English, awareness of social justice, competence for high-end clinical procedures and Maori culture may be considered as medical competence in the New Zealand, it may not be so in the Malaysian or American context. Thus when applied to compare competence between foreign and local graduates, a careful distinction must be made not to confuse between what are essential for quality and what are not, to offer a fair assessment of quality within one's context.

The question that we should frame therefore is not whether there are any qualitative differences between overseas and locally trained professionals, but what criteria we use to define quality, and whether they are fair criteria within a particular context. To carelessly compare is unjust and unfair to all.