Faq

:: Res­i­dency Pro­gram | Fac­ulty | Program-Related ::

Res­i­dency Program 

1. Why is there a need to change?
2. How is the new res­i­dency sys­tem dif­fer from the old BST/AST system?
3. Infor­ma­tion seems to be chang­ing all the time, what is going on?
4. What is the dif­fer­ence between res­i­dents, house offi­cers and med­ical officers? 
5. What are the res­i­dency pro­grams avail­able in July 2010?
6. Can cur­rent med­ical offi­cers and house offi­cers join the pro­gram? Should they?
7. I have some work­ing expe­ri­ence; can I join the pro­gram in its sec­ond year?
8. What is going to hap­pen to the cur­rent BST and AST trainees?
9. Will there be a bond for the residents?
10. Will the salary of res­i­dents be less than the cur­rent med­ical officers?
11. What are the restric­tion of duty hours, what do they mean?

Fac­ulty

1. Who are the core fac­ul­ties and what are their responsibilities?
2. What is the require­ment for core faculty?
3. Will there be a pay cut for the core faculty?
4. Will there be pro­tected time for the core fac­ulty to carry out their teach­ing duty?
5. What is the required fac­ulty to res­i­dent ratio?
6. How many core fac­ul­ties do we need?
7. What is pro­gram director/asst pro­gram director/subspecialty coordinator/core faculty/faculty?

Program-Related

1. What is ACGME? What is ACGME-International?
2. Why do we want to change the BST program?
3. How is the Amer­i­can sys­tem different?
4. What is the time line? When is res­i­dency going to start?
5. How long is the program?
6. Who are eligible?
7. How many res­i­dents are we taking?
8. What is the role of KTPH?
9. What are the core post­ings? Which are the elec­tive postings?
10. What about post­ings which are not avail­able in TTSH or KTPH?
11. How is KTPH going to par­tic­i­pate in the res­i­dency train­ing if they are mov­ing in 2010?
12. What is done to train the PGY 1 (fresh grad­u­ates) to ensure that they are able to man­age sim­ple cases and learn the system?
13. What kind of teach­ing activ­i­ties are there?
14. What kind of eval­u­a­tions and what are the con­se­quences of fail­ing them?
15. What is the final sum­ma­tive assess­ment? Can our res­i­dent sit for the board?
16. Who is respon­si­ble for the run­ning of the program?
17. Where can I find out more about the program?

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Res­i­dency Program

1. Why is there a need to change?

Change can be uncomfortable.

How­ever, our cur­rent post-graduate train­ing has many prob­lems that need to be addressed:

Train­ing is cur­rently frag­mented, oppor­tunis­tic and highly vari­able. There is no pro­vi­sion for recog­ni­tion of train­ers’ (fac­ul­ties’) time.

As a result, many doc­tors do not take up trainee­ship and many of those who do, drop out.

It is hoped that the new sys­tem and the addi­tional resources can address some of the problems.

2. How is the new res­i­dency sys­tem dif­fer­ent from the cur­rent BST/AST system?

The new sys­tem dif­fers in a few aspects:

Insti­tu­tions take own­er­ship of res­i­dents and they are respon­si­ble and account­able for their wel­fare and progress in train­ing. Under the cur­rent BST sys­tem, trainees go from post­ing to post­ing and no insti­tu­tion is respon­si­ble for their progress. Under the new sys­tem, the pro­grams not only pro­vide good train­ing but are com­mit­ted to pro­vide resources (like train­ing facil­i­ties, on-line jour­nals and train­ers’ time etc).

Train­ing is much more struc­tured. The core-curriculum will be deliv­ered to all res­i­dents. There will be for­ma­tive assess­ments to mon­i­tor progress and graded respon­si­bil­ity is an impor­tant guid­ing prin­ci­ple (i.e. a 3rd year res­i­dent will have a heav­ier respon­si­bil­ity com­pared to a 1st year).

A frame­work of eval­u­a­tion of fac­ul­ties, pro­grams and insti­tu­tions will also be set up. There will be con­tin­u­ous improve­ment based on the feed­back from residents.

3. Infor­ma­tion seems to be chang­ing all the time, what is going on?

There are many par­ties involved in this change and they all have dif­fer­ent per­spec­tives and con­cerns. Hos­pi­tals need to think about ser­vice deliv­ery, ACGME needs to uphold accred­i­ta­tion stan­dards, uni­ver­si­ties need to ensure that their stu­dent can tran­sit into the new sys­tem. Min­istry needs to ensure that all par­ties are heard and all con­cerns are addressed.

So, it is not sur­pris­ing that things change along the way. The only con­stant is that we are all here to make your train­ing better.

4. What is the dif­fer­ence between res­i­dents, house offi­cers and med­ical officers?

The cur­rent med­ical offi­cers will remain as med­ical offi­cers until they are pro­moted to reg­is­trars or leave the sys­tem. The cur­rent house offi­cers will become med­ical offi­cers when they com­plete their one year house­man­ship. The term res­i­dents applies to those who join the res­i­dency pro­gram in 2010. i.e. those who grad­u­ate from Yong Loo Lin (YLL) School of Med­i­cine in 2010.

5. What are the res­i­dency pro­grams avail­able in July 2010?

The res­i­dency pro­grams that will start in 2010 are:

• emer­gency medicine
• gen­eral surgery
• inter­nal medicine
• pae­di­atric medicine
• pathol­ogy
• psy­chi­a­try
• pre­ven­tive medicine

If the grad­u­ate has decided on a spe­cific spe­cialty where the res­i­dency pro­gram is avail­able, he or she should join the res­i­dency. If he or she intends to join a spe­cialty where the res­i­dency pro­gram is not yet avail­able, he or she should join the tran­si­tional year program.

6. Will the cur­rent med­ical offi­cers and house offi­cers be eli­gi­ble to join the res­i­dency pro­grams in 2010 / 2011 & beyond? 

For 2010, they can­not. How­ever, please check this web­site for any updates because things may change.

For 2011 & beyond, Yes they can but how it will actu­ally work out is uncer­tain at the moment. Please check this web­site for any updates because things may change.

7. I have some work­ing expe­ri­ence; can I join the pro­gram in its sec­ond year?

The cri­te­ria for accred­i­ta­tion for prior work­ing expe­ri­ence have not been worked out. The intake in 2010 is solely for the 2010 graduates.

8. What is going to hap­pen to the cur­rent BST and AST?

They will con­tinue as BST and AST until the end of their train­ing. Over time, BST and AST as we know it will be phased out.

9. Will there be a bond for the residents?

Cur­rently there is no plan to bond the residents.

10. Will the salary of res­i­dents be less than the cur­rent med­ical officers?

Cur­rently there is no plan to cut pay for res­i­dents. In addi­tion, regard­less of NHG or NUHS or Singhealth res­i­dency, the pay for all res­i­dents is stan­dard­ized by MOHH.

11. What are the restric­tions of duty hours, what do they mean?

The ACGME man­dates a lim­i­ta­tion to duty hours to ensure that there is suf­fi­cient rest for the res­i­dents. The idea is that if the res­i­dents are too tired, they will not be able to learn.

Some rules:

• Res­i­dents can­not work for more than 80 hours per week on average.
• After 24 hours of con­tin­u­ous work, they must not see any new patients.
• There should be at least 10 hours of rest in between 2 duty periods.
• In a period of 7 days, one day must be com­pletely devoted to rest.

The ACGME takes all the above very seri­ously. Fail­ure to com­ply will result in cita­tion of the program.

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Fac­ulty

1. Who are the core fac­ul­ties and what are their responsibilities?

Most if not all clin­i­cians teach as a fac­ulty of the res­i­dency pro­gram. The core fac­ul­ties are the clin­i­cians who take on a greater role of teach­ing. Some of them may spend some time eval­u­at­ing the res­i­dent or the pro­gram or even review­ing the cur­ricu­lum. The pro­gram needs to have one core fac­ulty for every six residents.

2. What is the require­ment for core faculty?

The core fac­ulty are required to spend at least 15 hours per week involved in the train­ing of res­i­dents. This 15 hours includes all hours spend with the res­i­dents in addi­tion to other edu­ca­tion related work. Ward round, where teach­ing occurs in a mean­ing­ful man­ner, tak­ing res­i­dents through pro­ce­dures, lec­tures, tuto­ri­als and teach­ing related com­mit­tee works are all “counted” towards this 15 hours.

3. Will there be a pay cut for the core faculty?

As it stands, the insti­tu­tion is com­mit­ted to ensure that the annual pay pack­age of the core fac­ulty is not affected adversely.

4. Will there be pro­tected time for the core fac­ulty to carry out their teach­ing duty?

The core fac­ul­ties must have the time and resources to carry out their duty or the pro­gram will be cited and risk los­ing accred­i­ta­tion. In USA res­i­dents com­plete an annual sur­vey to give feed­back; e.g. teach­ers not spend­ing enough time in teach­ing activities.

5. What is the required fac­ulty to res­i­dent ratio?

The core fac­ulty to res­i­dent ratio is 1:6.

6. How many core fac­ul­ties do we need?

Please refer to the spe­cific pro­grams for more details. A pro­gram can have more core fac­ulty but not less.

7. What is pro­gram director/asst pro­gram director/subspecialty coordinator/core faculty/faculty?

PROGRAM DIRECTOR: There must be a sin­gle pro­gram direc­tor with author­ity and account­abil­ity for the oper­a­tion of the pro­gram, who will ded­i­cate no less than 50% (at least 20 hours per week) of his or her pro­fes­sional effort to the admin­is­tra­tive and edu­ca­tional activ­i­ties of the inter­nal med­i­cine edu­ca­tional pro­gram and receive insti­tu­tional sup­port for this time.

Asso­ciate PROGRAM DIRECTOR: Asso­ciate pro­gram direc­tor (APD) is a fac­ulty who assists the pro­gram direc­tor in the admin­is­tra­tive and clin­i­cal over­sight of the edu­ca­tional pro­gram. He/she must ded­i­cate an aver­age of at least 20 hours per week to the admin­is­tra­tive and edu­ca­tional aspects of the edu­ca­tional pro­gram, as del­e­gated by the pro­gram direc­tor, and receive insti­tu­tional sup­port for this time. There may be more than one APD for each program.

SUBSPECIALTY COORDINATOR: Coor­di­na­tor for the sub­spe­cialty is appointed by the pro­gram direc­tor and over­sees the train­ing and related mat­ters when the res­i­dent rotates through that par­tic­u­lar subspecialty.

CORE FACULTY: The core fac­ulty mem­bers are expert com­pe­tency eval­u­a­tors who work closely with the pro­gram direc­tor and asso­ciate pro­gram direc­tors. They assist in devel­op­ing and imple­ment­ing the eval­u­a­tion sys­tem, and they would teach, super­vise and coun­sel residents.

FACULTY: All clin­i­cians involved in the teach­ing of the res­i­dents are fac­ulty members.

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Program-Related

1. What is ACGME? What is ACGME-International?

Accred­i­ta­tion Coun­cil for Grad­u­ate Med­ical Edu­ca­tion is the accred­it­ing body for grad­u­ate med­ical edu­ca­tion in Amer­ica. ACGME has been invited by MOH to help us enhance our grad­u­ate med­ical edu­ca­tion in the form of res­i­dency and fellowship.

ACGME’s col­lab­o­ra­tion with MOH, Sin­ga­pore is the first of its kind. They will develop a set of stan­dards suited for Sin­ga­pore, under ACGME-International (ACGME-I).

2. Why do we want to change the BST program?

Direc­tor of Med­ical Ser­vices (DMS) of MOH, Sin­ga­pore pro­posed to change the train­ing pro­gram to:

1. Improve train­ing by mak­ing it more structured
2. Improve train­ing by mak­ing insti­tu­tions and fac­ulty mem­bers account­able for the qual­ity of train­ing delivered
3. Increase the num­ber of doc­tors tak­ing up traineeship/residency
4. Develop our own board examinations

3. How is the US ACGME sys­tem different?

It is:

1. Resident-centred/ learner centred
2. Highly struc­tured in terms of orga­ni­za­tion, imple­men­ta­tion and review
3. Rig­or­ous in doc­u­men­ta­tion of activ­i­ties and time spent
4. Robust with mul­ti­ple eval­u­a­tions of insti­tu­tion, pro­gram, fac­ulty and residents
5. Strong on its empha­sis on for­ma­tive assessment
6. Strict with spe­cific require­ments for work­load and duty hours
7. Guided by graded respon­si­bil­ity. i.e. increas­ing respon­si­bil­i­ties and expec­ta­tions as the res­i­dent pro­gresses through the years e.g. by the 3rd year, the res­i­dent is expected to func­tion like the registrar
8. Account­able at many lev­els. Pro­grams are account­able to pro­vide good train­ing and insti­tu­tion are account­able to pro­vide resources to ensure that train­ing is delivered

4. What is the time line? When is res­i­dency going to start?

Pre-accreditation site visit by ACGME-I is in April 2010 (we should get most if not all things ready by then). Accred­i­ta­tion site visit is in July 2010. Res­i­dency pro­grams will start in July 2010.

5. How long is the program?

Please refer to the spe­cific pro­grams for more details.

6. Who are eligible?

For 2010, fresh grad­u­ates from Yong Loo Lin School of Med­i­cine are eli­gi­ble. For 2011 & beyond, please check this web­site for any updates because things may change. Duke-NUS grad­u­ates are eli­gi­ble from 2011 onwards.

7. How many res­i­dents are we taking?

Please refer to the spe­cific pro­grams for more details.

8. What is the role of KTPH?

KTPH is a par­tic­i­pat­ing site for Gen­eral Surgery and Inter­nal Med­i­cine res­i­dency programs.

9. What are the core post­ings? Which are the elec­tive postings?

Please refer to the spe­cific pro­grams for more details.

10. What about post­ings which are not avail­able in TTSH or KTPH?

We are col­lab­o­rat­ing with other insti­tu­tions, e.g. NCC for med­ical oncol­ogy, NSC for der­ma­tol­ogy, NNI for neu­rol­ogy, NUH for emer­gency med­i­cine, SGH & KKWCH for pedi­atric surgery, SGH & NUH for trans­plant surgery, KKWCH for pedi­atric emer­gency med­i­cine and pedi­atric pathol­ogy, Health Sci­ences Author­ity for foren­sic pathol­ogy, etc.

11. How is KTPH going to par­tic­i­pate in the res­i­dency train­ing if they are mov­ing in 2010?

Res­i­dents will first rotate to KTPH only for clin­ics. Inpa­tient rota­tions are done in TTSH in the first 6 months to 1 year. The res­i­dents will start rotat­ing to KTPH inpa­tient ser­vice when things sta­bi­lized there.

12. What is done to train the PGY 1 (fresh grad­u­ates) to ensure that they are able to man­age sim­ple cases and learn the system?

We will have a series of generic teach­ing for all PGY 1 who have con­tact with patients includ­ing inter­nal med­i­cine, gen­eral surgery, emer­gency med­i­cine and psy­chi­a­try res­i­dents, as well as tran­si­tional year res­i­dents. This teach­ing will cover acute med­i­cine and surgery top­ics, as well as com­mon pro­ce­dures, com­mu­ni­ca­tion and ethics.

13. What kind of teach­ing activ­i­ties are there?

1. Clin­i­cal teach­ing: Teach­ing ward round, teach­ing clinic, teach­ing dur­ing con­sults e.g. blue let­ter referrals
2. Didac­tic teach­ing – generic top­ics, discipline-specific topics
3. Case-based teaching
4. Depart­men­tal teaching
5. Teach­ing exam­i­na­tion tech­niques in prepa­ra­tion for the sum­ma­tive assess­ment e.g. MRCP, MRCS, MCEM, etc.

14. What kind of eval­u­a­tions are there? What are the con­se­quences of fail­ing them?

Expected eval­u­a­tions include:

1. Eval­u­a­tion of the institution
2. Eval­u­a­tion of the program/curriculum
3. Eval­u­a­tion of the residents
4. Eval­u­a­tion of the faculty

Eval­u­a­tion com­mit­tees will be formed and a stan­dard set of eval­u­a­tion tools will be developed.

Res­i­dents who fail the eval­u­a­tion will go through a reme­di­a­tion com­mit­tee to deter­mine if the res­i­dent needs to repeat the post­ing or the year. An appeal and griev­ance process will be in place. An appeals panel will address any con­cerns brought up by the res­i­dents appeal­ing against the decision.

Fail­ure to com­ply to the require­ments set by ACGME-I at any level will result in cita­tion and if severe, can lead to sus­pen­sion of train­ing status.

15. What is the final sum­ma­tive assess­ment? Can our res­i­dent sit for board examination?

For now, it is still UK Col­leges exam­i­na­tions that will be built into our pro­gram as inter­me­di­ate sum­ma­tive assessments.

MOH is dis­cussing with ACGME-I regard­ing an “Inter­na­tional” board exam­i­na­tion. Our res­i­dents will not be eli­gi­ble to sit for the Amer­i­can Board exam­i­na­tions or go on to a Fel­low­ship pro­gram in USA as yet. There is talk on “exchange pro­grams” between the Amer­i­can pro­grams and ours but this has not been con­firmed. Please check this web­site for any updates.

16. Who is respon­si­ble for the run­ning of the program?

The pro­gram direc­tors are directly respon­si­ble for the program:

• plan­ning curriculum
• recruit­ment of residents
• pro­mo­tion of residents
• reme­di­a­tion and
• day to day run­ning of the program.

They are assisted by the asso­ciate pro­gram direc­tors, the pro­gram coor­di­na­tors, core fac­ul­ties and the faculties.

17. Where can I find out more about the program?

For US ACGME please refer to their offi­cial web­site at ACGME​.org, for NHG res­i­dency pro­gram please refer to our spe­cific pro­grams for more details.

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