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:
- Medical students become house officers (or interns, to use the US term) upon graduation. For one year, they will rotate through 2 or 3 rotations in medicine (compulsory), surgery, orthopedics, pediatrics, or obstetrics & gynecology to acquire practical skills in doctoring (and surviving in the public hospital setting).
- Those that pass through housemanship become medical officers, who typically have 6-monthly rotations through postings of their choice. Medical officers (MO’s) can elect to take up basic specialty training (BST, i.e. surgery, medicine, family medicine, pediatrics, 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, MO’s can 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.
- Those who complete their BST can 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).
- 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.
Under the new residency system, it will take only 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), which is 14 months for the YLLSOM graduates and 12 months for the Duke-NUS graduates. This is so that everyone will be in sync for the second year of residency, since the Duke-NUS students graduate 2 months after the YLLSOM students (a classic case of the tail wagging the dog, since there are about 50 Duke-NUS students and between 260 to 300 YLLSOM students in the coming years). Of course, the YLLSOM students will be compensated by having all the requisite pay raises after the 12th month of work.
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 associate consultants.
Not all the details have been worked out, of course. 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 will be nice to shorten the time to being a specialist by 2 years (I expect to get some flak for this comment!), 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.
Under the new residency system, it will take only 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), which is 14 months for the YLLSOM graduates and 12 months for the Duke-NUS graduates. This is so that everyone will be in sync for the second year of residency, since the Duke-NUS students graduate 2 months after the YLLSOM students (a classic case of the tail wagging the dog, since there are about 50 Duke-NUS students and between 260 to 300 YLLSOM students in the coming years). Of course, the YLLSOM students will be compensated by having all the requisite pay raises after the 12th month of work.
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 associate consultants.
Not all the details have been worked out, of course. 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 will be nice to shorten the time to being a specialist by 2 years (I expect to get some flak for this comment!), 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.
26 comments:
To be perfectly honest when you are 45 you won't care about 2 years' difference between yourself and your peer.
What worries me is whether people should make specialists so quickly... but then I'm an old-school doctor brought up to thnik that all doctors should be able to function as a ship's doctor.
How will this shift in specialty training affect someone like me who graduated overseas and will do internship in Australia before returning home ?
Does it mean I have to enter specialty training as a 1st-yr resident even though I completed internship ?
I wonder how NHG or Singhealth are poaching us to be part of their program? Wld be nice to see some form of recruitment exercise :)
Dave, the details are not fully worked out yet, but it may be possible that you can start as a 2nd year resident if you have finished your internship elsewhere.
Heidi, the hospitals (and clusters) will soon be out in force to recruit final year students. Essentially, MO's in the residency program are "locked in" to that hospital for a considerable period of time, so the net worth of undifferentiated students/junior doctors will increase exponentially.
I would say you can expect a lot of kinks in the first few years we do this - my understanding is that not all the details are ironed out but the political pressure to roll this out is very strong.
Also, with MOHHS being your employer the clusters will have less reason to fight over you until you exit the system.
I have strong doubts about the benefits of recruiting straight out of med school, but who can stop the powers that be once they've made up their minds?
In all likelihood, those with better grades will have their pick of the traineeships. However, my experience with juniors indicates that academic performance in no way translates directly into equally excellent clinical performance.
This is why allowing at least a year or two of hospital postings is invaluable in assessing these junior doctors more adequately, since performance appraisals contribute significantly to an interview panel's final decision.
What happens if the new programme results in a trainee not performing up to expectations, or worse? Will s/he be expelled, or allowed to continue so that particular specialty won't be penalized?
And what if a final year med school grad chooses to join, say, surgery, then later finds the lifestyle doesn't quite suit him? Again, the importance of doing at least one clinical posting in a specialty one is considering a career in.
Hi, i am a final year student at YLLSOM and i have a few comments on this issue.
We have brought up quite a few of the questions that spacefan has mentioned today at a NUHS briefing on the residency program. The answers we were given were rather vague, with the higher powers knowing little/unwilling to commit as they too have no idea what the finalized plans by the DMS are.
This puts us in an extremely tight spot, as we were informed of this new program only 2months ago, and are now given ONE month to decide and make up our mind and subsequently submit a portfolio in October and go for interviews in January, on top of studying for the final MBBS.
The whole process has been rushed through with little thought given to the current batch of graduating students, with the reasoning being that with us being guinea pigs and that the kinks that we encounter will be ironed out in time to come. However, this is OUR future we are placing on the line, not theirs.
With regards to the trainee not performing up to expectations, the panel of program directors assured us that it will NOT happen, as we will be very closely monitored and supervised every step of the way(hand-holding). I have serious doubts about that, but they declined to elaborate further with a sweeping statement of if we fail, the sponsoring institution will suffer and the program directors face the sack, hence we will NOT fail.
This whole residency thing benefits those who have made up their minds about their future, and in a short 5 years most will become associate consultants equivalents,(attending physicians).
In fact, most will hit reg levels in 3years, which is a boon for them.
However, those of us who are still undecided are "forced" to make a less informed decision of signing up with a residency program, or for that matter ANY residency program if we do not want to be left behind. I say this because even though they have repeatedly stressed the option of a transitional year to look around and decide, we will be severely disadvantaged as the number of places allocated for that particular year will have been almost, if not totally filled, hence we might have to start from the postgradyear1 again in that particular residency should we decide AND get accepted.
The process of the interviews are also a hot topic of discussion, primarily because we have very little to present to the interviewers, who will now scrutinize our medical school grades, down to our anatomy grades in year1 and that biochemistry TEST in CA2. Many of us are caught off guard, as we were time and again told by our seniors and many junior doctors to just pass all the tests and exams in med school, even the MBBS. As long as we pass, our application for speciality training will be based on our performance as a HO/MO. But now its a whole new ball game, and many of us are on a wrong footing.
Lastly, all three clusters are scrambling to give us talks on the residency program the past few weeks, treating us as hot commodities and trying to sell their department/programme as the better one. So do we now choose a particular hospital because say, the programme director was extremely charismatic and eloquent? Or that they gave us more freebies, a better tea session and promises to treat us BETTER than the other hospitals? If, for example i have been posted to the surgery department in SGH surgery for my third year rotations in medical school, i will almost certainly choose it over the TTSH department as i will have no clue on how their department operates. But will i be making an informed decision? I highly doubt so. Of course if SGH rejects me and i put TTSH surgery as my 2nd choice i might not get it compared to someone who placed it as his 1st choice.
Dear seniors, if you were in our shoes, what will you do?
Sounds like a raw deal.
I think that any course that does not fail any candidate has no value. Am I to trust a surgeon who graduated from a training programme where, no matter how incompetent he was, he simply could not flunk out of?
My first advice to to take all advice with a pinch of salt, because as you can see no one is sure what exactly is going on (trust me, they are less certain than they make themselves out to be). We can say all we want, but it's your career on the line, not ours.
My second advice is what I stated in the first comment - two years is a very short span of time in a medical career, so don't sweat it.
I don't know how mobility between clusters and traineeship will be, but if that will not be a problem then it may be better to hang back and shop around a little, unless you are dead sure what specialty you want - which you can't be as a final year medical student. If you have something of value to offer, people will take you up on it.
Talk to some of the younger consultants, and even old profs - some of them have failed their final MBBS and had to retake, and some of them changed specialty half-way, or took up specialist training late in their career. If at the end of the day you do good work and is recognised for it, who cares how you got there as long as you got there honestly?
The things you can't control or predict applies to everyone (well, not the sons and daughters of certain people, but that's another story...), so it's fairly unfair, or unfairly fair. Don't sweat them.
The thing you CAN control is how good a worker and doctor you become. Focus on that. If you become a good doctor and the system recognises and rewards that, good. If it doesn't, then take your efforts elsewhere - the healthcare system does not consist of only the three clusters or specialities, there is a huge private sector and a primary care sector.
Take a long-term view.
Dear M5, your account of the Q&A session raises the following questions:
1) whether the panel's inability to address the issues stems from lack of knowledge, or a flat-out refusal to admit the programme's potential faults
2) if it's the former, then it seems either the panel didn't make much of an effort to prepare responses beforehand, or the entire process is being rushed
3) if it's the latter, the lack of foresight may prove disastrous a few years down the road
I fully understand your distress about being given such a short time period in which to decide your professional fate. I was previously unaware of this and am nothing short of appalled at the way this is being handled.
However, to quote a senior consultant, "we are faced with the proverbial immovable object and... have to make the best of the situation as it exists".
If I were in your shoes, I would probably apply for residency if I'm already leaning towards specializing in one of the disciplines that has been shortlisted.
If you have doubts, the best option is to approach a senior from that discipline, preferably someone who will give you a realistic view of what to expect, rather than a "recruiter" who may sugarcoat everything.
If a significant number of your cohort feels the Q&A session was essentially useless, one possible way to get the answers you need is to speak to your Dean about organizing a second session, or have your class chairman draft a letter including, say, a Top 10 list of concerns, and have this signed by the entire class.
That said, I can't help but wonder what will become of those who aren't in residency programmes, especially in surgical postings.
Will 1st year residents ( previously known as house officers ) be diverted to the operating theatres, leaving non-trainees to set IVs, take bloods and do all the paperwork?
Currently, housemanship treats everyone pretty much as equals. How much of this will change come 2010?
as a junior non-trainee MO, i wonder what's going to happen to us.. no briefing has been given so far regarding the residency program. if no one is able to give us concrete details about the old vs the new, how will we be able to make informed decisions about whether to apply for the last batch of old-fashioned BST trainees or the first batch of the new residency program? preferably before the application deadline for the last BST intake is over..
i echo angry doc's first comment about no one caring in the end how long one took to specialise. however, many students/young doctors still think that way and want to quickly attain their fellowship ASAP, just like any rat race in SG.
a potential solution to those who might be undecided about their career choices right after graduation is a preliminary internship. that is what is happening in the USA. prelim / transitional med/surg programs. however, in the USA, these are the ones no US medical graduate would want to take, most want to match into a Categorical position (i.e. guaranteed in the program, will finish in 5 or so yrs as an attending)
who will be certifying the new batch of residents? Academy of Medicine, Singapore? AST trainees used to take the FRCS/FRCP exams.
and as someone already mention, there are many in Australia and UK who are intending to return home to Singapore, but kinda keen to avoid the hellish 360hr/month housemanship and so will do theirs in Aus/UK. will they be given a spot in PGY2 residency?
just a really random and silly observation.
with all the jousting to get into residency in the months leading up to the final MBBS, time to study will be quite the luxury.
the final irony will be that, after spending countless hours deciding and fussing over which residency/specialty to choose, apply and go interviewing for, half the batch fails MBBS because of the lack of time.
random 2 cents from another M5 student.
yk: Haha, good point. :)
Hi, i am the med student who commented on the previous post. Thank you for giving my comment due coverage, though we all know how our system works and once the people up there have made up their minds, no amount of feedback or criticism will change anything.
The program was not given any coverage in the media, but instead the secondary problems that this program creates were. The program in question allocates all of the residents protected learning time, which translates to seeing 3-4 patients a day under supervision of a tutor in the clinics and perhaps ward rounds which they will have 5-6patients under their direct care, and a lot of other training time. As you can imagine, under the current system in which most A&Es see an average of 500 or more patients daily, there simply aren't enough working doctors, or what the program terms them "SERVICE MOs". I personally dislike that term, as there is a lowly status of the personnel involved, be it care in the wards or just emptying the clinics.
Hence the hospitals have started on an aggressive recruiting campaign of foreign doctors to bolster the shortage of service MOs, as more than half of the subsequent graduating batches of local medical students will be purportedly offered residency positions. This huge influx of foreign doctors has its own political and social issues with the public, hence i do not this it would be wise to bring it up in this debate. Rather it is the increased competition for specialization the local graduates dread. The relevant authorities have assured us that these foreign born and trained doctors will remain in the system purely as service MOs, to run the hospital whilst the residents are free to indulge in their training. However, if i were the hospital administrator and i have recruited many brilliant foreign MOs who have a keen interest in the residency program, but is simply here working as a service MO for whatever reason (better pay, better standard of living) i would choose the foreign grad over the local to participate in the program as he represents a better investment for the hospital. Hence in the years to come most local grads might be forced out of the playing field. Of course one could argue that it would be high time for us to pull up our socks and aim to better them, but who are we kidding with the aggressive recruiting efforts put in by the hospitals to attract the foreigners whilst us locals are resigned to being stuck within the system simply because we have a $500k gold chain shackled to our feet?
Moreover, we have currently been told that upon completion of our residency we will be issued certs from a combined board of local and an American board which will NOT be recognized in other part of the world other than our little red dot. We would, of course still be provided with the option of taking the FRCP/FRCS, but the main issue at hand most of us feel (and even the DMS has alluded to some point in time during his talk) was to tie us down to S'land.
To sum it all up, we will now be less all-rounded than our seniors who have undergone many other rotations before deciding on their eventual speciality, graduate with a potentially useless degree AND cert that no one else in the world recognizes (but at the same time race to include more than 150 other medical schools in the world to allow them to be employed in S'land).
At the end of the day, who has the shorter end of the stick?
With this new residency program and promise of protected training time and good working environment, I wonder who will be around to do all the 'grunt' work eg busy SOC, busy A&Es, ward work/changes etc. I hardly think the foreign doctors will be able to cover all this.
Does this means, this is where APN(Advance Practice Nurse)comes in?
Hi Singapore M.D. My name is VJ I am a medical student from Indonesia and in few the months I will get my MD.
What should i do if i want to follow a cardiac surgery training in Singapore?
I have a good GPA and a good English speaking,and considering I am still a fresh graduate and dont have work experience yet.
Thank you.
Hi Vallentino, since you're trained overseas, you should find out if the university you're graduating from is recognized by the Singapore Medical Council ( http://www.smc.gov.sg/html/1150880211414.html ).
I'm not too sure whether all foreign grads who haven't at least gone through housemanship ( or internship ) are allowed to work here, or whether this is allowed in certain specialties.
If you can't find the information you need at the above link, you can contact SMC via phone or email (http://www.smc.gov.sg/html/SMC_ContactInfo.html ).
Hope this helps. Good luck!
i see this info from http://www.nusantaraku.org
i dont see info about "could unrecognize university do housemanship in singapore"
thanks
Hello,
I noticed that medical students can enter a pathology residency straight out of medical school. It's supposed to be a five year program, but on the SGH website the sample curriculum has a "R0" year. So it is really a six year program? Or is an internship not required for pathologists (it is not required in the US).
Thanks!
Those who endeavour to enter the pathology residency will have to complete a transitional year (R0)
hi, what will be the requirements for a fresh licensed foreign doctors?thank you
HI singapore md....does anyone have any idea about the yllsom final year exam pattern.I have been informed by smc to take up this as qualifying exam as my MBBS is not a recognised degree...can any current students share with me any examination tips/notes etc?any kind of help/pointers will be very helpful thank u.
If you are a foreign doctor don't waste your time coming to Singapore especially if you are looking for further training. If you just want to be a service MO to tend to prawn patients with sacral sores so that Singaporean residents can have protected teaching time, then it's ok. Count the number of foreign names in the residency list at the mohh websites. It's better to be in your own country or go to us/uk, as Singapore can never attract or retain top foreign talent. Only those who cannot make it on thier own countries or anywhere else should come here, because you have no exams to give and u can easily get in.
What is going to happen to the current batch of MOs who are not in the residency training program? When they finally do get in, will they have to start from the first year like the YLL-SOM or Duke-NUS students? Some of them already have PACES/MRCS and a couple of postings under their belts.
I am Dr.Mayukhmoy Maiti(medical graduate from India).Currently I have cleared PLAB exam in 2011 and now fully registered with GMC.(GMC registration no-7063411).I am now working as a Senior Clinical Fellow(middle grade) in Royal Blackburn Hospital,UK(East Lancashire Trust) in the department of Accident and Emergency(since 1st February till date.)I am appearing for IMRCS part A in September'2012.
As a junior doctor I am interested in residency programme in General Surgery in Singapore.Can you please help me?
I am not sure about the system and how to apply
Thanks
Dr.Mayukhmoy Maiti
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