US-Malaysia medical school collaboration collapses

A dispute with Johns Hopkins University in the United States, ostensibly over “frequent late payments”, has led to a termination of the American institution’s partnership with Perdana University Graduate School of Medicine in Malaysia, both sides have confirmed.

Although the two sides are still disputing how much money is owed, Perdana in Malaysia has said it is intending to announce a collaboration with “another leading top tier” US university in due course, after an agreement was apparently signed on 11 August.

According to a separate statement from Johns Hopkins Medicine International, the Johns Hopkins University School of Medicine provided “advisory and consulting services” to Academic Medical Centre, or AMC – which owns Perdana – “to help develop Malaysia’s first private teaching hospital and private medical school offering a US-style curriculum”.

Lindsay Roylance Rothstein, Johns Hopkins’ director of marketing and communications, said in the statement by email to University World News that these services were delivered from November 2010 to July 2014, providing guidance and advice to the Perdana University Graduate School of Medicine, or PUGSOM, and “assisting in teaching and in the initiation of the school.

“However, we reached the difficult decision to end the existing relationship and agreement with AMC and we sent official notice of that decision to AMC on 17 March 2014.”

“We took this action because payments required under the agreement for the services provided by Johns Hopkins and its faculty were frequently received late and at the time the agreement was terminated, Johns Hopkins had not been paid for more than 12 months of work.”

Disagreement

But there appears to be disagreement over the arrears.

Perdana, in its own statement released last Monday 18 August, said AMC had paid US$34.199 million to Johns Hopkins on behalf of Perdana.

It said US$5 million was paid towards the Swami Institute for International Medical Education established at Johns Hopkins University, and a further US$29.199 million “as part of the affiliation and collaboration agreement”.

The last payment made to Johns Hopkins was US$2 million on 7 May 2014, Perdana said in its statement, adding: “AMC and Johns Hopkins are in dispute over whether any further sums are payable and the failure of Johns Hopkins to address the many grievances of AMC and Perdana University.”

Rothstein said in the statement that the situation with PUGSOM had become "untenable" but added that despite its disappointment over the outcome of the partnership, Johns Hopkins would not close its doors on other international collaborations.

As of 31 July, Johns Hopkins and its faculty and curriculum were no longer associated with PUGSOM. “While we are deeply disappointed by this outcome, we hold firm to our belief that international collaborations such as this are critical to advancing our mission.”

US system

Perdana, a private institution, was the first in Malaysia to offer a US-style four-year graduate entry programme, paying substantial sums for the right to use the Johns Hopkins curriculum.

With its first intake starting in 2011, Lim Guan Eng, secretary general of the opposition Democratic Action Party, or DAP, called the collapse of the US-Malaysian partnership “the end of a four-year medical romance.

“Following the abject failure, the federal government must explain to the public how much it cost for this failed venture,” Lim said last Monday.

A separate Johns Hopkins medical venture in Singapore failed in 2006. Singapore had provided state subsidies of over US$50 million for the graduate medical programme.

At the time it accused Johns Hopkins of not fulfilling its side of the bargain in ensuring senior staff with ‘international reputations’ were in residence in Singapore, according to the agreement at the time.

Full details of the collapse in the relationship have never been revealed by either side. Johns Hopkins continues to operate a private hospital in Singapore, without a teaching element.

Bolting on a US-style medical graduate school in a country where most students took British-style undergraduate medical degrees lasting four to five years after secondary school, was always going to be problematic, academics had warned before the institution was set up.

CEO of Johns Hopkins Medicine International Steven J Thompson and Charles Wiener, CEO of PUGSOM, acknowledged that the US system “required a large shift in thinking” for Malaysian students used to the British system of medical education.

In a recent commentary article for University World News, they said: “Perdana needed to recruit actively and convince talented students who had already declined or were denied a medical career [after secondary education] to reconsider and apply to the graduate medical school.”

Malaysia’s Deputy Education Minister P Kamalanathan told reporters last Monday: “The problem is that the PUGSOM course is American based, and most of the medical programmes here follow the British system.”

High fees

Tuition fees for the four-year graduate degree in medicine were around US$320,800 – a huge sum in Malaysia.

Although government scholarships were available, students said decisions on scholarships were delayed – sometimes announced only weeks before the beginning of term – so that those already working found it difficult to leave their jobs to commit to Perdana before they knew if they had secured funding.

Malaysian government scholarships also bound awardees to serve in government hospitals for 10 years – making it difficult to take up residencies overseas, as is common in the US system of medical education.

Questions had already arisen in the first year of Perdana’s operation as to how long the government would be willing to provide expensive scholarships, which amounted to a government subsidy for the private university – rather than expanding places in existing state funded institutions, which provide medical education much more cheaply.

Losses

Despite high tuition fees, Perdana appeared to be racking up huge losses year on year, in part due to recruitment shortfalls.

Dr Ong Kian Ming, a member of parliament for Serdang near Kuala Lumpur where Perdana is situated, said in a statement that the financial standing of the university was his main concern.

“According to the financial accounts submitted to the Companies Commission, Academic Medical Centre Sdn Bhd had negative reserves of RM189 million [almost US$60 million] and it made a loss of RM63.6 million as of the 2013 year end.”

Ong also said the government should immediately scrap any funding for building the new Perdana University campus that includes a 600-bed teaching hospital costing RM2.3 billion (US$730 million). It was reported in 2011 that Perdana would move to a 57-hectare campus by 2014.

Last Monday all mention of Johns Hopkins was removed from the Perdana University site, replaced with: “Perdana University is a project under the Public-Private Partnership in the Prime Minister’s Department, Malaysia” – an indication that some form of government backing would continue.

Perdana also continues its collaboration with the Royal College of Surgeons in Ireland, offering a five-year undergraduate medical degree.

Current students

Ong called for government “safeguards” so that current students could graduate in 2015 as planned. “The welfare of our current and future medical students must not be jeopardised or taken lightly,” he said.

Perdana Vice-chancellor Sothi Rachagan said in a statement that the 80 students currently enrolled in the programme “are entitled to their rights and this includes a teach-out on the terms on which they were admitted into the programme.

“Perdana University will ensure that the rights of the students are not in any way compromised.”

He added that the institution “continues to operate seamlessly with both foreign and local faculty with no disruption whatsoever from the departure of the three Johns Hopkins seconded staff”.

Johns Hopkins, meanwhile, said the official notice of its decision to end the partnership was sent to AMC on 17 March but it allowed the faculty to remain teaching until 31 July.

This was “in order to protect the interests of the students attending PUGSOM Johns Hopkins, voluntarily and at our own expense”, said Rothstein. Other aspects of the Johns Hopkins presence at PUGSOM were also maintained.

“Also during this timeframe, Johns Hopkins allowed the school to use the Johns Hopkins 'Genes to Society' curriculum and the 'in Collaboration with Johns Hopkins University School of Medicine' tag line.”

Perdana University dean Krishna Gopal Rampal, when contacted, declined to comment further, referring only to the Perdana statement issued last Monday.