Maintaining Quality Amid the Acceleration of Specialist Medical Education
The debate surrounding the implementation of specialist medical education has resurfaced following the Ministry of Health’s expansion of the education model based on primary teaching hospitals (RSPPU). The goal of increasing the number of specialist doctors is certainly commendable. Indonesia still faces a shortage of specialist doctors and their distribution remains uneven. However, efforts to accelerate the fulfilment of this need must not disregard the principles of the rule of law, higher education governance, and quality assurance.
Law Number 12 of 2012 on Higher Education explicitly places professional education and specialist education as part of the higher education system. Therefore, the opening, implementation, accreditation, and closure of a study programme fall under the authority of the minister responsible for higher education through mechanisms regulated by legislation. Study programmes are also required to meet accreditation requirements from the outset of their implementation.
Law Number 17 of 2023 on Health does grant a greater role to the Ministry of Health in developing specialist education through RSPPU. However, this provision does not explicitly transfer the authority to open study programmes from the ministry responsible for higher education to the Ministry of Health. Instead, the law emphasises that the implementation of specialist education must be carried out through collaboration between teaching hospitals, universities, the Ministry of Higher Education, the Ministry of Health, and the colleges.
The issue at hand is not the need for innovation in specialist medical education, but rather how such innovation is implemented without disregarding existing regulations. In higher education, adherence to procedures is not merely an administrative matter, but part of a quality assurance system designed to protect both students and the public.
The next challenge is the readiness of education providers. Specialist medical education requires more than just a hospital with a large number of patients. What is far more important is the availability of clinical faculty who meet academic requirements, a documented learning system, a standardised curriculum, evaluation mechanisms, and an accountable quality assurance system.
Teaching specialist doctors requires educators who possess both clinical competence and educational competence. Being a good specialist does not automatically make one capable of training future specialists. Medical education is a complex process, as errors in learning can ultimately impact patient safety in the future. Therefore, the presence of clinical faculty who are registered in the higher education system and meet academic requirements is a crucial element in ensuring the quality of graduates. These requirements have been developed over decades through the university-based system.
Another issue requiring attention is the accreditation status of study programmes conducted at RSPPU. Accreditation is not merely an administrative formality, but an independent mechanism to ensure that all educational standards have been met. If study programmes proceed before all academic requirements are fulfilled, what is at stake is not only the institution’s reputation but also the quality of the specialist doctors produced.
The rapid expansion of dozens of new RSPPUs also needs careful consideration. If the six programmes that have already been running still face challenges in meeting standards for faculty, governance, and accreditation, a much larger-scale expansion could potentially create new problems. Sound public policy should be based on an evaluation of the initial phase before being expanded nationally.
Beyond regulatory aspects, there is also a philosophical issue in education. Medical education is built upon academic freedom, scientific integrity, and professionalism. Therefore, resolving differences of opinion between institutions should be done through evidence-based dialogue, not through power-based approaches or bureaucratic pressure. The relationship between ministries, universities, hospitals, and colleges should be collaborative, as each has distinct authorities and responsibilities.
Most importantly, the ultimate goal of specialist medical education is not merely to increase the number of graduates. The far more critical objective is to produce specialist doctors who are competent, have integrity, and are capable of providing safe services to the community. Increasing educational capacity is necessary, but quality must not be sacrificed in pursuit of quantitative targets. Indonesia needs more specialist doctors, but it also needs a credible and sustainable education system. Balancing acceleration with quality assurance is the key to the success of medical education reform. Compliance with regulations, respect for accreditation mechanisms, readiness of clinical faculty, and synergy between institutions must remain the primary foundation. Ultimately, the success of a policy is not measured by how quickly programmes can be opened, but by the ability to produce specialist doctors who meet competency standards, uphold professional ethics, and provide safe, high-quality health services for the entire community.