Enhancing Postgraduate Medical Education

14 Oct 2009

MOH intends to introduce significant enhancements to the postgraduate medical education system, while retaining our current strengths. The proposed enhancements will enable us to educate larger numbers of specialists and family physicians to meet the nation’s healthcare needs. Senior doctors will have the satisfaction of relating to younger doctors as effective teachers and, in the process, rejuvenate the mentoring and learning culture of our institutions.

2. The proposed enhancements are as follows:

i) More teachers & training structures

There will be well-defined organizational structures with clear responsibilities to support postgraduate medical education. Core teaching faculty will be appointed to oversee training.

ii) Better curriculum

There will be a defined curriculum for each specialty with specified learning experiences and progressive, graded responsibilities. There will be regular formative assessments to asses competencies at each stage of training.

iii) Staying broad-based

For graduands who are certain about their choice of specialty, they will be given the opportunity to enter specialty training for most specialties on graduation. A broad-based educational experience will be ensured during the first year of training. This would be no different from current housemanship requirements for graduates of the Yong Loo Lin School of Medicine. For a

number of specialties, doctors will have to complete a broad-based educational year before entering specialty training.

For internal medicine specialties, trainees will begin with a common foundation programme before proceeding into specialty-specific training. A similar structure will also apply to most surgical specialties.

Similar duration of training will be retained for most specialties to ensure adequate learning experiences.

For graduands who are undecided, they are encouraged to have a broad exposure through housemanship and medical officer rotations before making a choice.

iv) Ensuring standards

We will also continue to require intermediate and exit examinations for specialties.

3. These enhancements will start with the following specialties from May 2010 - Internal Medicine, Paediatrics, General Surgery, Preventive Medicine, Psychiatry, Emergency Medicine and Pathology. For the remaining specialties, the changes will be introduced later.

Challenges facing postgraduate medical education

4. Singapore’s ageing population with its associated increase in chronic disease, advances in healthcare and rising patient expectations have led to a need to increase manpower capacity and capability in both the public and private healthcare sectors.

5. Our public sector hospitals have a long and illustrious legacy of learning and teaching. We have many examples of outstanding or even legendary clinicians and mentors. They have nurtured generations of good doctors, who in turn, have helped to shape our excellent healthcare system.

6. The exponential increase in the number of doctors and the ever increasing service needs will diminish this legacy if we do not take steps to transform the delivery of postgraduate medical education in Singapore. Senior doctors appointed as supervisors or trainers today face a seemingly indomitable task to fulfill teaching and training duties. The very ethos of learning and teaching is being challenged by increasing service demands.

Our approach

7. MOH and the Specialists Accreditation Board (SAB) have studied the postgraduate training systems of Australia, USA, UK, and Europe. There is a consistent trend towards more structured and formative training in these countries.

8. We have engaged many of our senior clinicians, senior management of our restructured hospitals, the Director of the School of Graduate Medical Studies, NUS, the Master of the Academy of Medicine, Singapore and the Deans of our medical schools to explore how we can incorporate the best practices of these training systems while preserving the strengths of our existing framework.

9. We have also engaged the Accreditation Council for Graduate Medical Education, USA, which has decades of experience in structured formative training, to assist us in this transformation. It is not our intention to adopt any particular country’s training system completely or to discard our current system altogether.

10. There are many strengths in our current system of postgraduate medical education. We have traditionally focused on broad based training, structured around hospital rotations under supervisors appointed by Heads of Departments, with intermediate and exit examinations. While many specialist and family medicine trainees do complete their training successfully, about

half their colleagues do not go through formal postgraduate training at the moment. To enable as many of our doctors to have this opportunity, change to the system is necessary.

11. Change to postgraduate medical education will take effort and time. It needs the collaboration of all our stakeholders. The next generation of doctors must receive the education and training commensurate with the patient needs of their day so that we can to continue to provide high quality care to all Singaporeans.

MINISTRY OF HEALTH