Frequently Asked Questions about Residency Updated 22 February 2014
(credits to Grace Tan and Clarisse Chu from Class of 2018, Davin Ryanputra from Class of 2017 and Wilnard Tan from Class of 2016)

Table of Contents

Overview:

1) The Post-Graduate Medical Scene
2) Application and admission
3) Career Progression
4) Other issues
5) Links to other useful resources

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1) The Post-Graduate Medical Scene


In 2010, there was a shift from the old UK-based system to the new US-based one:

Old British system
Progression of medical staff
Approximate timeframe
Undergraduate
5 yrs
House Officer (rotate through 2 or 3 rotations in medicine, surgery, orthopaedics, paediatrics, or obstetrics & gynaecology to acquire practical skills in doctoring to function in the public hospital setting)
1 yr
Medical Officer
~
MO: Basic Specialty Trainee (BST)
3 yrs
Registrar: Advance Basic Trainee (AST)
2-3 yrs
Associate consultant
>2 yrs
Consultant
>5 yrs, usually 5-6 years
Senior Consultant


New residency system
Under the new residency system, it will take an average of 3- 5 years to complete training in most specialties (vs. 7 years under the old system). Medical students can opt to join a hospital residency program upon graduation, if they are certain as to their future career (i.e. specialist) track. They become 1st-year residents in a specific field, equivalent to the current internship or housemanship, but with greater educational opportunities, structured teaching programmes and clinical involvement. From the 2nd to 5th years, the residents will continue to train in the specialty and subspecialty of their choice, and will theoretically become fully-trained specialists after the 5th year of residency – employed in the hospitals as specialists.

Features of the residency programme:
  • Based on established standards from the American Council for Graduate Medical Education (ACGME)
  • More structured than the old system, in that Sponsoring Institutions (SIs, see below) are take ownership of residents’ training outcomes, rather than MOs being responsible for their own training outcomes under the old system.
  • New evaluation methods - an ongoing system to assess residents' skills, ensuring a continual review of the learning progress. This differs from the old system, which utilizes a summative method where assessments accumulate in intermediate and final exams.
  • Three sponsoring institutions:
    • National Healthcare Group - Alexandra Health
      • Tan Tock Seng Hospital
      • Khoo Teck Puat Hospital
      • Institute of Mental Health
    • National University Health System
      • National University Hospital
      • Ng Teng Fong General Hospital (currently in Alexandra Hospital)
    • Singapore Health Services
      • Singapore General Hospital
      • KK Women and Children Hospital
      • Changi General Hospital

The road to Residency


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  • The Programmes (19 in total)
    • Phase 1
      • Who can apply: Everyone can apply (including graduating seniors)
      • The First Year: You will be a trainee in the specialty from Day 1 in PGY1. But still need to do specific HO postings for registration (General Surgery, Internal Medicine, Orthopaedics)
      • Emergency Medicine, General Surgery, Internal Medicine, Pathology*, Pediatrics, Preventive Medicine^, Psychiatry^
        • *Pathology still requires a clinical year; ^Preventive Medicine and Psychiatry are nation-wide programmes offered by NUHS and NHG respectively.
    • Phase 2
      • Who can apply: Everyone can apply (including graduating seniors).
      • The First Year: If you are a graduating senior, must complete 1 year of Transitional Year (called Categorical TY; See section "Some Q&A"). If you are a HO/MO who applied and got it, you will enter into the programme directly.
      • Anaesthesiology, Diagnostic Radiology, Family Medicine, Obstetrics and Gynaecology, Orthopaedic Surgery, ENT, Opthalmology

    • Surgery-in-general
      • Who can apply: Only after completing at least one year of training can you apply (i.e. HO/MO/Generic TY; NOT graduating seniors)
      • It will be a broad-based general surgical programme for 3 years before you embark on your actual training programme for the specialty
      • Cardiothoracic Surgery, Hand Surgery, Neurosurgery, Plastic Surgery, Urology
  • Some Q&A
    • What is a Transitional Year?
      • The Transitional Year (TY) Programme is designed to fulfill the education needs of graduands who desire a well-balanced, broad-based year in multiple disciplines and within the structured framework of the residency system.
      • There are 2 types of TY.
        • Categorical TY is followed by a specific Residency Programme. This categorical TY serves to broaden clinician (scientist)’s field of knowledge/ foundation before specializing.
        • Generic TY is not followed by a specific Residency Programme. Therefore, residents must still apply for a residency at the end of the TY.
    • What are the differences between Transitional Year and Housemanship?
      • Unlike Housemanship where Houseman gets to rotate through different Sis, TY trainees will be subjected to the same structured training and formative assessments that full-fledged resident trainees receive, within the same SI
      • Trainees have greater control over postings in generic TY and are likely to get offers from their SIs to advance to a specific Residency Programme
      • In similarity, both houseman and TY trainees would have didactic lectures for learning
    • When will Residency begin? How long will my Residency Programme last?
      • For local YLLSOM medical graduands, first year residency begins in May
      • For graduands of other schools, the start date is variable to cater to different graduation timelines which will last a minimum of 12 months
      • Thereafter, the regular residency cycle commences in July of every year
      • Generally 5-7 years of residency and fellowship training is required before specialist accreditation
    • How will assessments be carried out? At the end of training, how will I exit as a specialist?
      • There will be regular competency-based assessments to measure both theory and practical skills attained by residents. This will enable residents to realize their strengths and also highlight areas of weakness.
      • Accreditation to practice as a specialist in Singapore is wholly governed by the Specialists Accreditation Board (SAB) which will recognize local training programmes and existing intermediate and exit examinations. Exiting will depend on the criteria and assessment as specified by SAB.
    • How will switch between clusters and/or specialties be managed in the unlikely event that a resident needs to make a swop for unforeseen reason(s) and who will be involved?
      • To switch residency, you must resign from your current one and reapply for residency. There will be a one year penalty imposed, in this time you may not reapply for residency in the year after you resign from your current residency.
    • What happen if I go on long leave during the residency year, (e.g. maternity leave), does it mean that I will have to repeat the whole year?
      • Depending on your period of absence, the specialty you are in and the point at which you left residency training, you may enter where you left off
      • If the period of absence exceeds a certain number of days, you may be expected to make up for the missing days of training or repeat a posting
    • I heard instances when my seniors exceed the 80 hours work week. Why?
      • The 80 hours work week/ 6 calls a month is an ideal that they hope to achieve
      • While PDs do their best to make sure that these 80 hours are kept to, this is not always possible depending on the patient load and manpower of the department at different times. The 80 hours do however serve as a guide to manage the work load of residents



2) Application and admission


Why residency?

  • Residency was created to introduce more structure into our current post-graduate training, which has a lot of inefficiency.
  • One of the weaknesses in the previous system is that one is allocated to a supervisor and the quality of the supervisor is dependent on luck. There is poor regulation and standardisation.
  • Specifically, the residency programme improves the learning environment by ensuring that there are 3 tiers
    1. 1:1 faculty (mentor):resident ratio
    2. 1:6 core faculty:resident ratio with core faculty having 20% protected time
    3. Programme directors with 50% of the time protected to ensure they can focus on running the residency programme
  • Other reasons:
    1. To make students decide what they want to specialise in earlier so that they can commit earlier. This is good for the individual departments in hospitals, as they can have a group of trainees who will stick (instead of bailing out to another department/institution when their brief tenure is up)
    2. To attract and retain clinicians who mainly teach: the clinician educators. It is hoped that with such professionals, post-grad training could have better quality.

What are the judging criteria for the matching process?

  • Evaluation of your application is based on a few factors, and they are definitely not limited to your academic performance:
    1. Interview performance and letters of references (LORs) submitted by their referee
    2. Academic scores
    3. SIP performance
    4. Previous clinical work experience.
  • This framework varies from speciality to speciality, and from Sponsoring Institution to Sponsoring Institution.
  • An exception is the Transition Year, for which there is no interview, and your evaluation is based only on your portfolio and academic scores.
  • For academic results, it is a broad strata system with MOH intervention only at extremes, so there is no real quota based on grades.
  • Research may help as it acts as a surrogate measure for a candidate’s interest in a particular specialty, however, a generic research project will not give one a significant edge over his peers

What is the application process like?
  • July:
    • Open House/Career Symposium to explore and choose SIs
    • Encouraged to choose all 3 SIs regardless of actual preference
  • August-September:
    • Central applications for interview through MOH
    • Portfolio creation and submission at MOHH website
    • Choice of programme (2 choices) and sponsoring institution (3 choices)

  • October-November:
    • Multi-Mini-Interviews by National Interview panels
    • Interviewers consist of Programme Directors from the respective SIs, Residency Advisory Committee (RAC) member and a Clinician Scientist Mentor (if applicable)
  • December-February
    • Ranking by candidates and SI's preferences
    • The Match: Independently matches candidates and SI's preferences for each other
  • March-April
    • Release of Match results: 1 doctor to 1 specific programme of 1 SI
Applicants who do not obtain a successful match for residency will enter HOPEX/MOPEX with the applicants who chose HOPEX/MOPEX

Who can apply for the Residency Programme?
  • Graduands of Singapore medical schools and those with primary medical qualifications registrable under the Medical Registration Act (First Schedule) are eligible.
  • This includes current HOs and MOs, however they will still be expected to enter residency training at Residency Year 1 (R1)
  • Graduands with non-registrable medical qualifications may be considered on a case to case basis
  • Graudands from overseas need to secure an offer of employment as a doctor from MOHH or local healthcare institutions before they are eligible
How competitive is Residency?
  • Residency is competitive, and there is a higher demand than available positions for almost all residency programmes, across all sponsoring institutions for all specialties. Different programmes will have different levels of competitiveness; do refer to the relevant statistics for the programme(s) you may be interested in applying for.
How can we gauge our chances of successfully entering a specialty?
  • The statistics from previous years can only provide a benchmark for the chances you may have for getting into a specific programme. Each batch has different numbers of people who want any particular specialty, so take the data with a pinch of salt. Some specialties may have preferences for students who have dabbled in relevant projects before, so do talk to consultants and residents who are in the field you are interested in to find out more. You may wish to attend the various career guidance talks organized by Academic Affairs Directorate or some by the CSIGs

How important are the following in affecting our chances at residency? What weightage does the residency panel place on each of the following relative to each other?
  • Pre-clinical (M1-M2) performance + Clinical (M3-M5) performance – How will we know if we are competent enough for our desired specialty? Clinical skills assessments, exams, research, CV, etc?
    • There is a much greater emphasis on the grades in during the clinical years. The pre-clinical (M1-M2) grades are not an accurate reflection of how one will perform as a doctor later on. Do not worry too much.
    • As much as the SIs want an indicator of clinical skills and working experience, such evidence is limited for M5s who are applying directly for a residency programme or transitional year. The next best would thus be your academic performance and portfolio.
  • Extra-curricular activities – Which of these activities do PDs look favourably upon? Will we be disadvantaged if we do not take part in many such activities? (OCIPs, Medsoc, NUSSU, CCAs, etc)
    • Involvement in extra-curricular activities (from the PDs’ point of view) is but a reflection of who you are as a person, your interests and so on. They have no (overt?) preference toward any type of activities. That being said, having a rich portfolio will not be able to salvage the application should a poor impression be left during the residency interviews. What use is an over-achiever in all fields if the PDs feel that they will not be able to work well with him?
  • Research
    • How important is research for residency applications? Which specialties place an important emphasis on research (e.g. number of journals published) during their selection process for potential residents? Is there a particular type of research some departments would prefer its applicants to have dabbled in during medical school?
      • Some specialties place a greater emphasis on research than others (e.g. ophthalmology). (Hmm – can we say that they should go talk to people within the specific specialties to find out more? Or…)
    • When do students usually being research? When would you recommend we begin research – during the pre-clinical years when we have more time, or during clinical years when we know our interests a little more?
      • There isn’t a set time, people pick it up both early on and later in med school
      • There’s definitely more time for research in the pre-clinical years! But if you start too early, it’s unlikely that you’ll be able to come up with a project that has clinical relevance. That being said, you can participate in an existing research project just to learn the ropes  helps you come up with ideas for your own research project in the clinical years
  • Electives – Is it important that we do something relevant to the department of choice for residency? What if we have not made up our minds by then?
    • For those who have decided: Some of you may choose to do electives related to the specialty you intend to apply for later in M5. There is an advantage in doing so, not only to get to know the people in the field but also as a confirmation that you really want to do it. There are many seniors whose elective experiences paradoxically convinced them not to choose that specialty, after seeing some of the working aspects which may not have been evident or visible during clinical year postings or lectures.
      • If you perform well, you may consider asking your mentors to do the character referral during your residency applications. Also, some take this chance to do electives in one specialty but in different Sis (e.g. Emergency Medicine in NUH, then SGH, then KTPH) in order for them to make a better decision later on.
      • However, there are another handful of people who instead choose to do other electives even after having decided on their specialty of choice for residency. Some professors may also recommend you do so. Reasons include getting to know the related fields, or simply for exposure to medicine outside of the chosen specialty so as not to go in with a narrow view of the medical landscape. After all, deciding on a specialty does not mean you will succeed in your residency applications; on the contrary, one should be even more ready with a contingency plan in case their first few residency application choices are not met.
    • For those who have not decided: Don’t put all your eggs in one basket; try out different specialties which may pique your interest. That being said, the people in this group are very diverse – there are many steps to choosing a specialty.
      • There will be those who:

        1. Are on a completely blank sheet
        2. Have decided between the medical or the surgical specialties
        3. Have decided on a range of specialties
        4. Are choosing between sponsoring institutions
      • Depending on where you are, decide what the best electives are for helping you decide on what to go for. Don’t feel pressured by your friends to go on electives with them, or go for the more competitive or prestigious electives. They won’t do you any more good than a well thought-out one will!
Can MOHH increase the number of Transition Year residents?
  • Yes. Eventually, TY will apply for all, but it is limited by shortage of teaching faculty now as it is just starting off. However, don’t bet on this, because residency is still very far from maturation!
Which are the Residency Programmes with too many applicants and which are the ones with vacancies? Do Group 2 specialty (ENT, O&G, etc) residents have to worry about the scarcity of TYs?
  • Opthalmology, ENT and Pediatrics are the ones with too many applicants.
  • The residency programmes with vacancies include Pathology and Family Medicine Residency Programmes due to a large number of vacancies offered (~50)
  • The “limited” TYs are the Generic TYs. Group 2 specialty residents are under the Categorical TYs, and once they are accepted, the TY is considered part of their programme. Hence they do not need to worry about the limited spaces in the generic TYs. This confusion will be resolved once the naming is changed.
Should I apply for the Clinician-Scientist track if I don’t think I can make it for the standard residency?
  • Clinician-Scientist track is intended for candidates who have a strong interest in research careers. This is not a back door – candidates are expected to be good enough to be on the equivalent clinical track.
  • One year is added to the normal clinical residency duration. Clinician-scientist residents will be provided with close mentorship from a clinician-scientist mentor. They will be expected to complete at least a Masters in Clinical Investigation or equivalent, and publish as first author in a reputable journal.
  • Student can apply for one additional specialty if they apply for the research tracks (usual limit is 2 specialties)
  • Students are advised not to apply for the same clinician and research specialty
  • Many departments offer additional positions for those on the clinician-scientist track
Who will make up the National Interview panels?
  • The National panels for each specialty generally include the Programme Directors (PDs) from each Sis, representatives from the Residency Advisory Committee (RACs) and a Clinician Scientist mentor, if that interview is for your chosen clinician scientist program
What happen if I am unsuccessful in obtaining entry into, or do not wish to apply for a Residency Programme?
  • Unsuccessful applicants will either be offered a House Officer position (for medical graduands) or a service Medical Officer position.
It is perceivably easier to get a residency slot in M5 compared to being a HO/MO (competing with everyone else, including international graduates). Could more be done to assure students that they will not be at a disadvantage if they do not apply in M5 but only do so in their post-graduate years?
  • Entry to residency training will always be a competitive process, be it at M5 level or the HO/MO level
  • However, expectations are higher for those who are applying at the MO/HO levels as they would have been exposed to more clinical experiences and presumably acquired more clinical skills.
If there are such a small number of Residency places available, would a Doctor be at a disadvantage if he/ she delays making a decision?
  • When many doctors delay their decision-making far too long such that when they become Medical Officers for many years, they see their peers ahead of them and feel discouraged, they end up not specializing
  • However, sometimes it may be wise to take a step back or apply for a TY, in order to make a wiser decision at the end of the day. If you are good and you produce good work. people will notice

3) Career progression


MOs have to start from Year 1 in the residency program when they apply this year. Can they be allowed to skip/accelerate parts of the training?
  • Residents typically expected to start from R1. However, some candidates might have considerable relevant experience at point of entry (e.g. senior MOs, especially if they have already passed intermediate exams).
  • For such residents, the residency system provides for early progression to R2 after 3-4 months of observation at R1. This will be done based on departmental assessment of a resident’s capabilities, and in accordance with RAC and SAB guidelines.
What would happen to males who have to re-enlist to serve the remainder of their National Service? What are the allowances for National Service?
  • They may undergo a period of Residency training prior to their enlistment
  • Generally, re-enlistment occurs at the end of postgraduate year 2 (PGY2), which would be at the end of R1 or R2
  • At the end of the National Service period, one may resume where training left off but a certain period of remediation may be required by some programmes before trainee joins a higher residency year
  • NS takes priority as the SAF has medical needs that need to be met for its soldiers and training is 2nd priority to NS as was the case with BST/AST
  • There will continue to be a pay increment for ORD-ed MOs to compensate for lost increments during NS years.
  • There is no pay differential for HOs who ORD-ed prior to entering medical school as HO pay is a training allowance and is fixed.
For guys: How do the SAF mandated emergency medicine/anesthesia postings work?
  • 3 month emergency medicine/anesthesia posting
  • Previously, EMed couldn’t be done in the HO year, but under the residency programme, HOs can do it in the first year à Hospitals will try to give guys their emergency medicine postings first so they can finish the requirement (i.e. both NS and residency/TY requirements fulfilled at once)
  • But what if you’re in a specialty if EMed is not compulsory? E.g. Paediatrics
    • MOH says: not part of residency programme, no point prolonging vs. SAF says MUST DO (conflict of interest D:) à review on case by case basis
ACGME (I) is not recognized in the USA. For this reason, many will eventually still have to take Royal College Exams. Is ACGME recognized outside of Singapore?
  • No, it is not. In short, this is a one-of-its-kind thing from Singapore, and its main purpose is not to standardise training to send trainees overseas, but to help build and accredit Singapore’s Residency system.
  • Accreditation Council for Graduate Medical Education (ACGME) evaluates and accredits medical residency programs in the United States.
  • MOH has invited ACGME to assist us in the drive to improve the graduate medical education in Singapore. The collaboration between ACGME and MOH is known as ACGME-International (ACGME-I), and it is the first of its kind. ACGME-I will develop a set of standards for Singapore in the areas of curriculum development, assessment and teaching methods, data collection systems, professional development and training for program directors and program coordinators.
What are the opportunities for graduates intending to pursue a research scientist or a clinician-scientist career tracks?
  • Programmes with clinician scientist tracks will have at least a year of research built into the curricula of advanced residency years.
  • The entry requirements of such programmes will be similar to their corresponding default Residency Programmes.
  • Applicants however, can choose up to 3 programmes if any of their choices are clinician scientist tracks, and up to 2 programmes if otherwise.
  • Clinician scientist residents will be provided with close mentoship from a clinician scientist mentor and will be expected to complete at least a Masters in Clinical Investigation or equivalent, and publish as first author in a reputable journal
Will residents completing their basic residency programs be able to immediately pursue an overseas fellowship program? Will such fellowship programs be considered as relevant training for subsequent appointment as an associate consultant and registration by the Specialist Accreditation Board?
  • MOHH is working with ACGME to roll out Internal Medicine specialties by 2013 so that residents completing IM training can progress to further training immediately after completion of their IM residency
Is it possible to give HO/MO the same teaching and dedication as residents? If not, what can be done to ensure fairness in career progression for non-residents?
  • MOH is currently working with the different Sis to substantially increase the number of TY positions available starting 2012. However, graduands may still become HOs if they wish.
  • It is hoped that with working experience, whether as a houseman or as a TY resident, you may have sufficient insight to make a decision
  • If you choose not to join residency training after housemanship or TY, the system still allows you to join residency at any given training year
  • The goal is for the system to eventually be able to offer residency positions for all who are ready to start training, however, entry into a training programme is a competitive process and the hard truth is that not everyone may be accepted in their desired programme or SI, and they may need to re-consider alternative programmes or career paths
After I graduate from a residency, will I be an associate consultant?
  • No. Currently this is not the case. Assignment of job titles is not dependent on the amount of training and number of post-grad degrees you have in your basket, but on your 1) performance and 2) availability of empty positions.
  • This is how the system has been working for a very long time, and is unlikely to change even with residency. Remember that residency is a traineeship, not a ship that carries you to consultancy.
  • However, for less competitive specialties such as family medicine, it is correspondingly easier to become a consultant, since positions are usually available
Does General Practice fall under the family medicine residency? Career progression for GPs who are non-residents?
  • If no training after MBBS, can only become a GP BUT don’t necessarily have to open your own GP clinic, can still remain in the hospital as a resident physician (e.g. if you want to do ophthalmology, can become an eye resident physician. Pay isn’t as high as specialist but still much higher than MOs etc)
  • If you want to become a GP, better to get a family med residency as the training is very good – you’re put through lots of relevant rotations, can rotate in hospital and move back to polyclinics once a week vs. if you just come out straight away (and refer everyone to the A&E ‘cause there’s no one to consult)
  • Also, while this is not confirmed, there’s the possibility of the government eventually saying you can’t open your own clinic unless you have undergone the residency programme (i.e might only be able to work under a Fam Med Resident)

4) Other issues

Is there are any preferential quota set aside for the Duke students?
  • No, there isn’t. At least officially.
Is there a difference in treatment between Duke and YLLSoM students?
  • There will not be any difference in pay for Duke-NUS GMS or YLLSoM residents because both will be doing the same level of work. The first post-grad year remains a licensing year for both.
  • Beyond residency, Duke-NUS GMS graduates may progress faster in their careers on the basis of their prior academic qualifications, but that will depend on the specific paths they take. For instance, some Duke-NUS GMS students already have PhDs, which could be an advantage in academic medicine.
  • Ultimately, it’s still an issue of an individual’s competence and presentation, it has nothing to do with whether they are from the GMS or YLLSOM.
How much are residents paid? Is it different from the HOs?
  • Starting base pay is determined by MOHH and is consistent across all the specialties. Refer to your medclass emails for the figure
  • Allowance for some specialties may differ:
  • Additional training allowance is given for those pursuing less popular specialties such as Pathology.
  • Conversely, popular specialties such as Ophthalmology, Paediatrics etc require co-payment for training.

5) Links to other Useful Resources



Sources:

  • Residency Focus Group meetings with Prof Satku
  • Residency Clarifications Talk by Prof Shirley Ooi in Nov/Dec 2013
  • Websites listed above

Conclusion:

  • While Residency may have some imperfections with several things still vague or unclear to us in its primordial stages, it does seek to enhance our graduate medical education and equip us with better skills to meet the challenges of being future doctors.
  • As students who will quickly progress to the stage where choices are to be made with respect to our future careers, we should try to continually gain exposure in the fields where our interests and passions lie but at the same time, never stop having an open mind towards the different specialties available. Not all of us will be matched to our first choices, but as long as we constantly remind ourselves that our central goal should be to help our patients as best as we can, we believe all of us will eventually still attain the same kind of satisfaction no matter which field we end up in.
  • At the end of the day, it is important to remember that we are a first a doctor, then a specialist. May we all bear this in mind when we go through medical school and beyond!