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Download it here Residency Guidebook v1.1.docx

Overview



Introduction

The Residency Programme was introduced in 2010 as a new post-graduate medical training and education system in Singapore. The advent of this programme had been marked by intense debate and discussion, leaving innumerable frantic or clueless as to what exactly to make out of it.

Put together by a team of equally curious and eager medical students under the Academic Directorate, this booklet stemmed from the determination to help clueless or worried classmates on Career Guidance. It is sincerely hoped that this booklet will go a long way in quashing your initial doubts and providing a reliable source of information on the Residency programme. All sources of information are from official sources and all facts written in this guidebook are indeed accurate at the moment of publication, and facts are bound to change with time and will be updated accordingly in the guidebook. If you would like to point out any clarifications or express your opinions, do drop an email to acadmedsoc@gmail.com and we’ll address them as soon as we can. Enjoy!


The New Vs. The Old

(edited from http://singaporemd.blogspot.com/2009/09/residency.html)
Singapore will start to switch to a US-style residency program for the graduating medical students of 2010. This is an almost complete revamp of our current training system for junior doctors, which is based largely on the UK system. Just a quick recap of the existing system, which can be somewhat confusing:

The Old
  1. Medical students become house officers upon graduation. For one year, they will 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.
  2. Upon completion of housemanship, one becomes a medical officer (MO), who will typically have 6-monthly rotations through postings of one’s choice. MOs can elect to take up basic specialty training (BST, i.e. surgery, medicine, family medicine, paediatrics etc.) which is usually a 3-year process, completion of which is contingent on passing yet another exam as well as jumping through whatever hoops set up by the all-powerful BST committees. Of course, MOs could also just float through the system for a few years before going out to set up their GP clinics or to join other GP groups.
  3. Those who complete their BST could then opt to join a relevant clinical subspecialty as a registrar (this can be tougher than it sounds for specialties that are over-subscribed – the wait for a training slot can be up to a year or longer), and the advanced specialty training (AST) is usually 3 years in length (again, it is longer for certain subspecialties such as cardiothoracic or neurosurgery).
  4. After finishing the AST, doctors become certified specialists and attain the rank of associate consultant in the local hospitals.
As you can see, it takes a minimum of 7 years (usually longer) before a medical school graduate becomes a clinical specialist under the current system. There are variations, of course – some specialties have a “through-train” training track that shortens the process considerably.

The New
Under the new residency system, it will take an average of 3- 5 years to complete training in most specialties. Medical students can opt to join a hospital residency program upon graduation, if they are certain as to their future career (i.e. specialist) tract. They become 1st-year residents, equivalent to the current internship or housemanship, but with greater educational opportunities 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*.
There are some advantages to the residency program – medical education becomes more important for the hospitals, and hopefully residents will get a more structured training program. It could be considered a good thing to shorten the time to being a specialist by 2 years, but the current batch of house officers and even 1st/2nd year medical officers may be a bit disadvantaged with the rollout of the new system. It will be interesting to see how things will unfold from next year.
*On exit of Residency, one may not immediately become an associate consultant. Promotion is based on merit as well as availability of spaces. For more information, refer to the FAQ section below, question “5. After I graduate from a residency, will I be an associate consultant?” under Programme.


Structure of Current Residency System (as of 2012)

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Hallmarks of the Residency System

The Residency Program is a US-styled postgraduate medical education where medical graduates undergo training in a supervised and organized way to ensure they become competent and excellent specialists.
Although the old Graduate Medical Education (GME) system has served the Singapore healthcare sector well, the need to constantly innovate and adopt the best practices in education in order to meet with evolving healthcare demands and ensure that future generations of clinicians are well-trained has been strongly advocated by the Ministry of Health (MOH), Singapore. After discussions with the Specialists Accreditation Board (SAB), MOH thus recommended the introduction of the Residency Program. This was in response to a high percentage of doctors leaving for private practice without undergoing any formalized training program.
The Residency Program will be a structured training framework and education curriculum, based on established standards from the American Council for Graduate Medical Education (ACGME). The program is a rigorous system designed on a formative model for quality training. The learning process will be enhanced through the 6 core competencies.

Under the old system, medical officers will rotate from one posting to another and be responsible for their own training outcome. With the Residency Program, training will be more structured and Sponsoring Institutions will take ownership of the training outcome of the residents.

A key feature is in its evaluation methods - an ongoing system to assess residents' skills, ensuring a continual review of the learning progresses. This differs from the current system, which utilizes a summative method where assessments accumulate in intermediate and final exams.
Accreditation Council for Graduate Medical Education (ACGME) evaluates and accredits medical residency programs in the United States. The mission of the ACGME is to improve health care by assessing and advancing the quality of resident's education through accreditation.

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.
Depending on the Residency Program you are enrolled in, the program can range from 3 to 5 years. You may check out the number of training years for the specific department and Sponsoring Institution stated in the table a few pages after.
(information edited from http://www.singhealth.com.sg/EDUCATIONANDTRAINING/RESIDENCY/FAQS/Pages/Home.aspx)


Quicks facts about the Residency Programme:

  • 3 different Sponsoring Institutions (SIs for short)

Which are the Sponsoring Institutions?
Currently, there are 3 approved Sponsoring Institutions (SIs), namely:
1. **National Healthcare Group (NHG)**: Tan Tock Seng Hospital , Institute of Mental Health, Alexandra Hospital / Khoo Teck Puat Hospital
2. **National University Health System (NUHS)**: National University Hospital, Jurong General Hospital
3. **SingHealth (SHS)**: Singapore General Hospital, KK Women's and Children’s Hospital, Changi General Hospital

  • Has 35 specialties, 4 sub-specialties and Family Medicine
  • Retains the advantages of the HOPEX/MOPEX (Housemanship and Medical Officer Posting Exercise) system while adapting to the current needs:
    • Duration of training for each specialty retained
      Allows longer exposure and training in each specialty
    • Broader-based post-graduate education
      Wider breadth of knowledge in relevant specialty covered such that new specialists have the confidence to advise patients without the need to refer them to other specialists
    • Supplemented by a dedicated teaching faculty – Senior physicians have protected time to mentor and guide their students
    • Application choices
      • Each candidate can only choose 2 specialties per SI, thus a total of 6 choices to be listed
      • Advised to apply for all 3 SIs as shown in Figure 2 to increase chances of matching to SIs
      • Candidates interested in the Clinician Scientist track can apply for one additional specialty per SI, thus a total of 9 choices
      • Regular formative assessments
        • Ensure trainees attain core competencies at each stage of training
        • Assess both theory and practical skills attained by residents
        • Transitional year
          • Designed to fulfill the needs of graduands who desire a well-balanced, broad-based year in different disciplines within the structured framework of a Sponsoring Institution before specialization
          • Clinician Scientist Track
            • Programmes with clinician scientist tracks will have at least a year of research built into the curricula of advanced residency years
            • As aforementioned, applicants can choose up to 3 programmes if any of their choices are clinician scientist tracks, instead of just 2




Sponsoring Institutions


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Figure 2

Application process at a glance

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Figure 3

Residency Programmes

Programme Group
Programmes
Training
Length (yrs)
NHG - AHPL
NUHS
SHS
Direct Entry Programmes
Emergency Medicine
5



Internal Medicine
3 + 2/3



General Surgery
5



Paediatric Medicine
3+3



Preventive Medicine
5



Psychiatry
5



HO / TY Programmes

(Entry after PGY 1)
Anaesthesiology
5



Diagnostic Radiology
5



Obstetrics & Gynaecology
6



Orthopaedic Surgery
6



Otorhinolaryngology
5



Ophthalmology
5



Pathology
5



Family Medicine
3



Cardiothoracic Surgery
6



Hand Surgery
6



Neurosurgery
6



Plastic Surgery
6



Urology
6



Table 1

Transitional Year Curriculum For Each Programme


Programme Group
Programmes
No. of Months in Each
Direct Entry Programmes
Emergency Medicine
4IM + 4EM + 4GS + 2PM
Internal Medicine
4GS + 1N + 1RP + 1G + 1C + 2GM + 1R + 1E + 1O
General Surgery
4GM + 8S
Paediatric Medicine
2GM + 2X + 4S (incl 1PS) + 2GP +1PaedsO+ 1PaedsR
Preventive Medicine
4GM + 4GS + 3/6 X
Psychiatry
3GM + 3N + 3IP
HO / TY Programmes

(Entry after PGY 1)
Anaesthesiology
4IM + 4GS +2PM + 2EM + 2A
Diagnostic Radiology
9FYAPC + 3(Chest, VIR, MSK)
Obstetrics & Gynaecology
4OP + 3LW + 3W + 2X
Orthopaedic Surgery
4A + 4GS + 4EM
Otorhinolaryngology
6GS/CC + 6ENT
Ophthalmology
Weekly EM + GOP + CTO
Pathology
CPT
Family Medicine
X
Cardiothoracic Surgery
6GS + 2U + 2NS + 2VS
Hand Surgery
6GS + 2U + 2NS + 2VS
Neurosurgery
6GS + 2N + 3NS + 2X
Plastic Surgery
6GS + 2PL + 2A + 1OR + 1X
Urology
8GS + 2NS + 2VS

GS
General Surgery

GM
General Medicine

CC
Critical Care
N
Neurology

R
Renal

ENT
General Otolaryngology
RP
Respiratory

E
Endocrine

U
Urology
G
Gastrology

O
Oncology

NS
Neurosurgery
C
Cardiology

S
Surgery

VS
Vascular Surgery
EM
Emergency Medicine

PM
Pediatric Medicine

PL
Plastic Surgery
IM
Internal Medicine

A
Anesthesiology

OR
Orthopedic
X
Elective/Misc

PS
Pediatric Surgery

GOP
General Ophthalmology
GP
General Pediatrics

IP
Inpatient Psychiatry

CTO
Cataract Teaching OT
FYAPC
Foundational Year Anatomy & Physics Course

LW
Labor Ward

DR
Diabetic Retinopathy Screening Clinic
OP
Outpatient

W
24 Hours Clinic

CPT
Core Pathology Training

The Match


Why do we have the Match?
Under the old HO/MO system, it would take a minimum of 7 years for a medical school graduate to become a clinical specialist.
Under the new system, a specialist doctor can complete his training at least one year earlier, depending on the discipline. This is especially important in view of the pressures presented by Singapore’s aging and expanding population.
Not only is the duration of training shortened, the training programmes are also more structured, ensuring more holistic training for the graduates. The Residency Programme strives to allow every student to experience a value-added post-graduate education by emphasizing on systems-based practice and practice-based learning (see chapters ? interviews with current residents to see whether this is true or not ;))
What is The Match?
The new residency programme for post-graduate medical education was introduced in May 2010. Alongside the new system is a posting exercise based on the US medical system’s own, elegantly fine-tuned to suit Singapore’s needs, in which medical students are sorted to their preferred specialty and Sponsoring Institution (SIs). This exercise is known as the Match, developed by MOH Holdings as an easily accessible, efficient online system, Residency Matching Exercise (RMEx).
The Match is a computer-run system that aims to match medical students with residency programmes and residency programmes with medical students in such a way as to ensure greatest utility for all; that is, medical students get posted to their most desired programmes while the programmes are allocated students that they most desire. Ideally, it is a win-win situation for medical students and SIs both. It uses an algorithm based on that used in the US for matching the thousands of medical students they have to the hundreds of available residency programmes.
Of course, without proper knowledge of how the Match works, it is easy for students to end up unmatched, which means that the student would automatically enter the House Officer Posting Exercise (HOPEX), which is probably not, as the name suggests, the beacon of hope to most medical students these days. However, failure to be matched doesn’t truly have the negative connotations most people attribute to it.

Who is eligible to apply for Residency matching?
In M5, Residency applicants will first sit for 2 rounds of interviews:
  • Multiple Mini-interview
  • Department Interview
Multiple Mini-interview
  • The Multiple mini-interview is a common, national interview by all 3 SIs for each specialty a student is interested in. This interview is designed to find out whether an applicant is prepared to start residency. This is done by putting an applicant in various scenarios. For Clinician Scientist applicants, an additional interview session may be arranged.
Department Interview
The SIs may decide to do separate interviews (usually during their open house sessions) to help them rank all the medical students who apply to their residency programmes.
Only if a student has sat and passed an interview are they eligible to apply for RMEx; otherwise, M5s will need to re-sit for interviews the following year. In the meantime, they join HOPEX[aut1]
resguide4.JPG

The Algorithm


The RMEx matching algorithm based on the same principles as its US counterpart. The matching process will match candidates' and programmes’ preferences for each other.
The basic goal in the simple case of the hospitals/residents problem is to match applicants to residency programmes so that the final result is "stable". “Stability" in this case means that there is no applicant A and programme P such that both of the following are true:
  • A is unmatched or would prefer to go to P over the programme he is currently matched with
  • P has a free slot or would prefer A over one of the candidates currently filling one of its slots.

The Rank Order Lists
Based on the specialty interviews,Each SI will rank interviewees based on the SIs’ order of preference for offering the student a position. In arriving at their order of preference, SIs will assess a student based on his online portfolio as well as his performance during the national and SI-specific interviews. The SI may or may not rank all interviewees who applied for training positions. This produces an institution’s “rank order list” or ROL.
Students will also rank the programmes of their choice on the RMEx website. This produces a student’s ROL.

The Confusing Algorithm
The computer will process students’ ROLs in a completely random order. For each student, based on their and the SI’s ROL, the computer will make a tentative match. Matches are "tentative" because an applicant who is matched to a program at one point in the matching process may be removed from the program at some later point, to make room for an applicant more preferred by the program (i.e., highly ranked by the SI).
This continues until all students have been matched, at which all matches become permanent. Applicants are first matched to his first choice programme, then to his second choice programme if he fails the first match, and so on, until a match is made or all applicant’s choice have been exhausted (at which point, applicant remains unmatched).


The algorithm in diagram

resguide5.jpg

So let’s see what happens…

Illustrate with a few examples of students with choices are matched with the system; NRMP website has good example
http://www.nrmp.org/res_match/about_res/algorithms.html

How do I register for the Match

Go to MOHH website
http://www.physician.mohh.com.sg/residency/


Singapore-specific tweaking
  • Clinician Track (aka the usual way)
A candidate can only choose 2 specialties. Candidates are advised to apply for all SIs because applying to fewer SIs will reduce their chances of matching with the SIs.
2 specialties X 3 SIs = 6 choices
  • Clinician Scientist Track
2 specialties X 3 SIs = 6 choicesCandidates interested in the clinician scientist track can apply for one additional specialty.
3 specialties X 3 SIs = 9 choices

What happens in the US
The NMRP is actually a non-profit, private organization formed in 1952. It was cosponsored by five medical associations in the US to improve on the then extremely messy way of allocating students to residency programmes. In the US, The Match is commonly views as a rite of passage for American medical students, who eagerly await Match Day as the day heralding the rest of their lives. This is not unlike the god-like status attributed to that first week of March when A level results are released, or for medical students, the day that brown envelope arrives in the mail
Why did the NRMP come about?
By the late 1940s, the traditional matching process was growing increasingly chaotic. There were almost twice as many residency positions as there were U.S. medical graduates. More competitive programs had the luxury of receiving and reviewing large batches of applications before doling out their residency spots late in the students’ fourth year. Less competitive programs tried to get a head start by asking students to commit to the program early in the fourth year or even during the third year. (there are 4 years of postgraduate medical school in the US) As a result, students were forced to gamble by deciding whether to accept an early offer from a less competitive program and forfeit a later shot at better programs or to pass up the early offer and risk not being accepted in a better program. Residency directors faced a similar dilemma. If they filled all their positions too early, they would not be able to offer a position to a more desirable candidate who applied later; however, if they held out for better applicants, they risked not filling their programs. As a solution to these dilemmas, the first Match was held in 1952. It was a huge success, with over 98% of the residency programs and 97% of the students participating. The Match eliminated guessing games for the most part by allowing applicants and programs to rank each other on the basis of desirability. The algorithm used to match applicants with programs has remained largely unchanged over the years.


Thoughts by Residents

Interviews (soon to come!)



Sources


ConclusionWhile 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, I believe all of us will eventually still attain the same kind of satisfaction no matter which field we end up in.


Acknowledgements


Personal review (from The Old VS. The New): Singapore M.D. Blog
http://singaporemd.blogspot.com/

SingHealth Residency FAQ Webpage http://www.singhealth.com.sg/EDUCATIONANDTRAINING/RESIDENCY/FAQS/Pages/Home.aspx

Editorial team
Chief Editors
Liu Xuandao
Valencia Foo
Design
Jacqueline Quek
Research and writing
  • Applications
  • The Match
  • Programme
  • FAQ
Chua Min Jia, Margaret Teng
Valencia Foo, Rebecca Hoe, Liu Xuandao
Jacqueline Quek
Wang Daobo, Adita Sangam
With advice from
Manpower Standards and Development Division, MOH

[1] On exit of Residency, one may not immediately become an associate consultant. Promotion is based on merit as well as availability of spaces. For more information, refer to the FAQ section below, question “5. After I graduate from a residency, will I be an associate consultant?” under Programme.