DKK Ng, SWW Cherk, JCP Wong

Abstract

In Hong Kong, there are a number of commonly quotable medical qualifications related to the field of paediatrics, namely, FHKAM(Paed), MRCP and DCH. A questionnaire survey was conducted among nurses for their perception of these qualifications. They were asked which of these qualifications they would regard as implying: 1) competence; 2) expertise; 3) recognized specialist in the field of paediatrics. MBBS being the commonest basic medical degree held by medical practitioners in Hong Kong was used as a control item. One hundred and fifty-seven nurses took part in the survey. FHKAM(Paed) was the commonest answer to all three questions (63% to 76%). It was significantly better than the other three qualifications as representing competence, expertise and recognized specialist status in paediatrics. With regard to these three areas, DCH was found to be significantly superior to both MRCP and MBBS. There was no difference between participants' perception of MRCP and MBBS for all three questions.

Introduction

Registered medical practitioners are not allowed to advertise in Hong Kong in accordance to the regulations of the Medical Council of Hong Kong.¹ Quotable qualifications has hence become the main reference for general public on which to base their choice of medical practitioner of a particular specialty. In the field of paediatrics in Hong Kong, a number of quotable qualifications are commonly held. These include Fellow of Hong Kong Academy of Medicine (Paediatrics) (FHKAM(Paed)), Member of Royal Colleges of Physicians (MRCP) and Diploma of Child Health (DCH). FHKAM(Paed) represents a qualification granted after at least 6 years of accredited training in Paediatrics and success in 2 formal examinations organized by The Hong Kong College of Paediatricians. Until 1999, MRCP has been the intermediate qualification granted to trainees who pass the intermediate examination in Paediatrics. Since the establishment of the Royal College of Paediatrics and Child Health in 1999, either Member of Royal College of Paediatrics and Child Health (MRCPCH) or MRCP, has been granted to those who pass the intermediate examination in paediatrics. DCH is granted to those who pass the diploma examinations on child health organized by a number of Royal Colleges in the United Kingdom and Ireland. Clinical experience in paediatrics may not be a pre-requisite for some Colleges. We hypothesized that this array of qualifications was confusing even to our nursing colleagues and we conducted a questionnaire survey on nurses' perception of these qualifications.

Methods

Nurses who attended a training course on paediatric respiratory medicine were given a questionnaire containing three questions about FHKAM(Paed), MRCP, DCH and MBBS (Figure 1). Bachelor of Medicine, Bachelor of Surgery, MBBS, was used as a control item as it was the commonest basic medical degree in Hong Kong. One of the authors, DKKN, explained each question in turn and the nurse participants were asked to choose the most appropriate answer(s) as perceived by them. There could be more than one answer to each question. Numerical data was described by percentage. Chi-square test was used to compare different response to different qualifications (GraphPad Software, San Diego, CA, USA). Statistical significance was defined as p<0.05.

Results

One hundred and fifty-five questionnaires were distributed and all were completed and returned. The ranks of nurses involved were listed in Table 1. As expected, most nurse participants (64%) were registered nurses. For question 1 that asked which qualification implied competence in handling childhood illness, the result of choices was listed in Table 2. Sixty-three percent of participants chose FHKAM(Paed). An interesting finding was that DCH fared significantly better than both MBBS and MRCP, 18.6% vs. 8.6-9.5% (p<0.01). For question 2 that asked which qualification implied expertise in handling childhood illness, 75.3% of votes went to FHKAM(Paed) (Table 3). Compared to question 1, a higher percentage of votes went to FHKAM(Paed) amongst answers to question 2. However, this difference was not statistically significant, p=0.09. In this category, DCH was even more superior to MBBS and MRCP when compared with answers to question 1, 17% vs. 3-4% (p<0.001). For question 3 that addressed recognition of a paediatric specialist qualification, FHKAM(Paed) again gained most votes with 76.2% of all votes (Table 4). In contrast to answers to the two previous questions, votes to DCH was similar to that for MBBS and MRCP, 10.9% vs. 6.2-6.7 % (p=0.21).

Discussion

In this survey, nurses were asked about their perception of a number of medical qualifications related to paediatrics commonly held by registered medical practitioners. As they are medical care providers, it is expected that they would have more knowledge than the general public with regard to the meanings of various quotable qualifications held by medical practitioners. Over 60% of votes went to FHKAM(Paed) in all three questions. However, DCH was also well perceived by the respondents. Slightly below 20% of respondents chose DCH as representative of competence and/or expertise in childhood disease. There was no difference of perception in this aspect between MBBS and MRCP. It is one of the author's (DKKN) personal observation that there is a common practice of acquiring at least one DCH diploma before entering into private practice amongst paediatricians in Hong Kong. This is especially true in the past before the establishment of specialist qualifications of FHKAM(Paed) or MRCPCH. The authors propose that the rationale behind this common practice is probably related to this kind of unguided perception of the various medical qualifications of the general public. As the surveyed population is a highly informed group who is familiar with the practice of paediatrics, a similar survey of the general population might give a different result in the perceived difference by the public of these various qualifications.

The Hong Kong College of Paediatricians (HKCPaed) was founded in 1991 with the primary objective to accredit and organize training programmes for paediatricians, to certify specialists in the discipline and to ensure a high standard of paediatric practice for the community. It is one of the 12 foundation Colleges of the Hong Kong Academy of Medicine (HKAM), which is a statutory professional body of Hong Kong inaugurated in December, 1993.² Specialists in paediatrics are certified by the HKCPaed and they are recommended to be admitted as Fellows of the HKAM, i.e. FHKAM(Paed). Thereafter, they can register with the Medical Council of Hong Kong as specialists in Paediatrics. It appears from this survey that increased public education is called for to promote wider public recognition of FHKAM as the specialist degree in child health in Hong Kong. Hong Kong College of Paediatricains should take a leading role in ensuring that the high standard of training is recognizable to our nursing and paramedical colleagues whom we have a very close working relationship with.

In conclusion, this cross-sectional survey of 155 nurses showed that FHKAM(Paed) was recognized as representing competence, expertise and officially recognized specialist in the field of paediatrics in 63% to 75% of respondents. DCH was better recognized in these areas than MRCP and MBBS. No difference was detected between MRCP and MBBS with regard to these areas.

References

1. Medical Council of Hong Kong. Professional code and conduct for the guidance of registered medical practitioners 2000 .

2. Yeung CY. Inaugural message from the President of the Hong Kong College of Paediatricians. HK J Paediatr (new series) 1996;1:3.