I was a young lecturer under Professor K Rajasuriya joining his department in 1973.

So, I recollect some of the conversation I have had with the late Professor to give you an idea of the relationship we have had with the Royal College of Physicians (RCP) in United Kingdom. Prior to formation of the Ceylon College Physician (CCP) we have occasionally had eminent physicians who have given Guest Lectures at the Sri Lanka Medical Association which is our main medical organization, now over 130 years old. However after 1967 we have had Annual Sessions of CCP in which the President or Councillor of the RCP London has been an honoured guest.

However in the last decade it has not been uncommon for a Faculty of eminent office bearers along with RCP Presidents from Royal College of Physicians in London, Royal College of Physicians in Edinburgh or the Royal College of Physicians in Glasgow to embellish our Annual sessions.

In the last decade we have also had similar Faculties from the Royal Australasian College of Physicians at our Annual Sessions.

Occasionally we have had President / Eminent Physician from similar organization from South Africa, India, Bangladesh, Pakistan and Singapore.

It is also important to put on record that late Professor K Rajasuriya started the first local MD of the University of Ceylon in 1958 (remember that the PGIM started functioning later from Jan 1980). Several early Physician used this qualification – MD (Ceylon) – to be appointed as a Consultant Physician in Sri Lanka until Post Graduate Institute of Medicine was setup. They also acquired the MRCP (UK) in addition to the local MD in order to be appointed as a Consultant Physician in Sri Lanka. The need for MRCP was dropped soon as only the PGIM MD was needed to be appointed to the Ministry of Health or University as Consultants from 1983.

The Physicians of the CCP protested vehemently at the time of the governmental pressure to start Post Graduates Medical education locally in Sri Lank and to break away from its long standing relationship with the Royal College Physicians UK. Our Minister of Health at that time finally gave in to a formula where the MD Colombo would be setup at the PGIM and it would invite Examiners from the Royal Colleges and also would include a mandatory one year training in UK or other Centres of Excellence in UK. They would also receive a scholarship for travel and subsistence in UK from the PGIM.

Prior to my MD (Ceylon) exam in 1973, I have heard of great names for example Prof Lord Rosenheim, Sir Bruce Perry and many others who came as Foreign Examiners who helped to maintain the standards of the MD (Ceylon), which was highly rated and of an International standard. This practice of getting a Royal College examiner was continued from 1958 by the University of Colombo when the exam was run by Prof K Rajasuriya and later continued by the PGIM when the 1st few MDs were coming out after a 3 year training program. A year in UK and another senior Registrar period locally were mandatory before Board Certification.

The Part I of the MRCP exam was also conducted in Sri Lanka from the early 1960s by the Ceylon College of Physicians but was stopped by the government in early 1970. I remember sitting for the last of the MD part I
of the Royal Colleges held in Colombo in 1972. The PGIM when it started its MD course was not prepared with a high standard MCQ papers and negotiated with our government and Royal College Physicians in London to use a combined MRCP part I paper in addition to a local Tropical Medicine paper in the PGIM and used the mark so obtained to be the PGIM Medicine part I exam result. The Royal Colleges of UK stepped in to help us obtain the same paper that was held in London at the same time as in Sri Lanka. It was called an “Agency Paper” and we had an additional component of Tropical Medicine by the local Board of Study. One could not claim to have passed MRCP part I if they sat from Sri Lanka as it was part of PGIM MD part I although part of the paper was the same British paper.

We used to pay about GBP £ 85 and nearly 300 persons sat for this paper twice / year and it was quite a tidy sum of foreign exchange at that time going out from the country. The government found this money for several years in order to ease the tensions locally of the College, students and the PGIM.

I was holding the Position of Board of Study Chairperson in Medicine for a few years prior to becoming the Director of PGIM (2006-2012). I was very keen on abolishing the agency paper and replacing it with a Sri Lankan produced MCQ paper. So I set up a MCQ core-group and built up a bank of questions. I also negotiated with RCP whether we could replace the UK agency MCQs with our MCQs I must say the three Colleges met and recognized the need for Sri Lanka to set up it is own MCQs and MCQs bank as a correct step in improving standards of post grad medical education in Sri Lanka. The CCP negotiated with PGIM that we should continue the practice of inviting Royal Collage Examiners for our PGIM MD in Medicine which practice we continued even today. Occasionally the PGIM invites two examiners one from London and one from Australian Collage of Physician Very rarely we have also included Eminent examiners from India and Pakistan and Malaysia to partner a British examiner in addition to our own panel of Examiners. The standard have been kept high. Pass rates usually vary from 25% to 50%.

In the last 10 years also there had been major reviews of PG exams in UK. The recognition of Sri Lanka PG exams have also suffered. They have insisted on the need to review our own exam processes and only some of the PGIM exam are recognized by the Royal Colleges and GMC because we have not kept up with the recent developments of the PACES exam and the new marking schema etc. I am currently not sure of the exact situation with respect to the PGIM MD Medicine Sri Lanka and whether it is recognized by the Royal College of Physicians and GMC acceptance for PLAB etc.

When I was later Director PGIM (2006 – 2012) in early 2007 the British government’s Health Minister decided to restrict PG medical education to International Medical Graduates (IMG). Our PGIM post MD persons also were not allowed to train in UK. I represented Sri Lankan with Mr Chandradasa Deputy Registrar PGIM and had direct negotiation with the GMC, International Office of the RCP (Mr Mathew Foster), Sri Lanka High Commissioner in London (Mrs Shenuka Seneviratne) and the Home Office of UK and successfully worked out a special visa scheme called the “MTI” scheme where our PGs can go to UK for training but allowed only two years and they have to return back to Sri Lanka. This was more than sufficient for our PGIM needs except in some speciality eg: Neuro Surgery. RCPL gave us maximum support during this difficult period in UK where IMGs from many countries were not allowed training opportunities in UK. This MTI scheme is still continued and the Royal Colleges go to many countries including Sri Lanka to interview and accept candidates to work in England to fill their vacancies to obtain training in many of their Trust Hospitals. The main reason I was able to get the Home Office to agree was quoting our long professional relationship in Post Graduate education between the Royal Colleges and Sri Lanka and that in our PG programs we have built in the mandatory period of training in UK for completion of Consultant Training.

This uncertainly caused a shift of our PGs seeking educational opportunities to Australia and with it came the strengthening of our relationship between CCP, the PGIM and the Australian colleges. We have also benefitted from the educational courses run by the Central Office of the RCPL and now in the last three or four years the CCP have held these courses in Colombo to benefit many physicians locally as Pre Congress Sessions in our Annual sessions.
As I have mentioned the Australasian College of Physician have increasing allegiance to CCP / PGIM as many of our Physician trainees have trained in Centres of Excellence in Australia. Our College Presidents have been reciprocally honoured with Fellowship (Honorary) of either college which has strengthened our mutual respect.

The last point I like to raise in our relationship with Royal Colleges in UK is regarding the new MRCP examination. The new examination now comes in three Parts, Part I Part II and PACES (III part). You may remember the PGIM stopped using the agency paper following the MRCP part one which was held in Sri Lanka from 1960 was and stopped due to government pressure prior to the PGIM been set up. So the only way to resume the MRCP exam starting from Part I was for the Ceylon College of Physicians to start negotiation to hold this exam independent of the PGIM. Here again I was entrusted this task by the CCP and the made the “MRCP Exam Coordinator” for the CCP which post I still hold. I had negotiated and after much correspondence RCP agreed to re hold the MRCP part I under the flag of the CCP and the British Council in Sri Lanka. This MRCP part I has been going on for the last 20 years (in all three diets). We have later added on the MRCP Part II examination which also two MCQ papers in the last 6-7 years also (in all three diets). It was only in the last one year that the Royal Colleges have agreed to have the PACES exam in Sri Lanka. For a few years prior we sent our students to Chennai PACES. Also few years prior I was selected as the first Sri Lankan PACES examiner. Now several other Physicians have joined me. The first local PACES exam was conducted in 2017 following a trial run (Pathfinder) in 2016. I must congratulate Past President Dr Lalith Wijayaratne and the efforts of Dr Barana Millawithana and many others who contributed to the success in Exam. At the winding up speech of the first PACES exam in Sri Lanka Dr Donald Farquar, the visiting chief examiner stated that standard setup by the CCP as a Host Center was equal to some of their best PACES centres in the world – Which is indeed a happy pat on our backs.