18 Jul 2014
Dear Fellow Academicians
As Fellow Academicians, I am inviting you to give feedback on training of specialists in Singapore.
If you are already familiar with the training system in Singapore, you may skip the next section and move onto the “Role of the Academy in Specialist Training?” and “Fellows’ Valuable Opinion and Constructive Feedbacks on Specialists Training Needed!”
Historically, through collaboration with University of Singapore (now National University of Singapore) and Ministry of Health (MOH), the Academy was primarily involved in training and certification of medical specialists for almost 40 years.
After the creation of Specialists Accreditation Board (SAB) in 1998, training, examination and certification of medical trainees have been placed under the purview of SAB, executed through the Joint Committee of Specialists Training (JCST), specialty-specific Specialist Training Committees (STCs), and Sub-Specialty Training Committees (SSTCs). For specialties adopting US-style Residency Programme, STCs were recently replaced by Residency Advisory Committees (RACs).
With implementation of ACGME-type training in Singapore from 2010, training is now more structured and is conducted in the 3 Sponsoring Institutions (SIs), with Designated Institution Official (DIO), Associate DIOs (ADIOs), Programme Directors (PDs), Associate Programme Directors (APDs), Core Faculty / Physician Faculty administering, monitoring and/or conducting the training.
Since training methods have modelled after US’ residency system, assessment of trainees is also moving towards US-style. On top of having periodic formative assessment of ACGME’s six (6) core competencies, trainees in 21 specialties have to take their respective annual In-Training-Examinations (ITEs). Furthermore, residents in Internal Medicine, Paediatric Medicine, Pathology, Family Medicine, and Psychiatry have to pass a hybrid form of the American Board of Medical Specialists (AMBS) examinations, in order to progress from junior residency programme into senior residency training (R3 to R4) or from R4 to R5. There are plans to introduce ABMS-type examinations for other specialties. An Office of Medical Assessment (OMA) has been set up within MOH to oversee these intermediate and final Exit Examinations.
While SAB-JCST-RAC-STC-SSTC and MOH with its 3 SIs are taking charge of training, assessment, certification and accreditation of specialists, what role(s) can Academy now play other than being appointed by MOH to administer the 21 ITEs?
The greatest asset of the Academy is having more than 2,800 Fellows in 35 medical specialties. Many of you are experienced clinician educators, previously or still actively involved in training and assessment of trainees. If you had recently exited from advanced training, you also could contribute to training and assessment because of your familiarity with the curriculum, training system and its pitfalls.
With a large group of experienced specialists and clinician educators, Academy can contribute to training in Singapore by contributing in quality assurance and assessment of the current training systems so as to further improve the training of our specialists.
After 4 to 5 years of modelling the US-style training system, it is time for us to review and reflect how well this training system suits us in the Singapore’s setting, and whether further modification or re-adoption some of our previous BST-AST training methods are necessary.
The attachments in this email are the training curriculum used currently and/or in the past. If you are unable to access the attachment, please go to the following 2 websites to down load your specialty-specific training curriculum which include assessment methods currently used and exit examination:
You are encouraged to give feedback in one or all of the following areas by 8 August 2014. Other than general feedback and comments, we would like to hear your opinions on some of the specific issues mentioned below:
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Areas
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Specific Issues
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A) Curriculum
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· Is the curriculum meeting the educational objectives?
· Are the competencies set in the curriculum realistic and could be met?
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B) Training Methods and System
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· Despite ACGME-I allowing us to have our own country addendum, is the current ACGME training requirement, e.g. case log and duty hours, restraining us from training enough specialists to meet the manpower needs of Singapore?
· Should every doctor go through a housemanship or transitional year before commencing any residency training?
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C) Formative and Summative Assessment
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· Formative assessment of ACGME Competencies is good, but are our trainers overwhelmed with assessment?
· Are our trainees spending too much time preparing for examinations (ITEs, ABMS, Master of Medicine, UK’s or co-joint Exam) and spending less time in learning the specialty?
· With many experienced Clinician Educators within the Academy, and with further training of Fellows to be Examiners, should Academy request SAB to conduct the FAMS Certification Examination?
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In your feedback, you can indicate which aspects of the above are good and therefore should continue, and also which are less than desired and therefore needs further improvement. Though highlighting issues and problems will be valuable, offering solutions and alternatives will be even more constructive.
Please return your feedback to feedback@ams.edu.sg in any format you deemed fit. Please let us have your name (optional) and your specialty (important) so that your respective College Council or Chapter Board could summarise specialty-specific inputs.
We hope to receive your feedback by 8 August 2014, and we will collate all specialties’ inputs into a document to be sent to SAB for further deliberation.
Closer collaboration between MOH (and its training institutions), medical schools (Yong Loo Lin School of Medicine, Duke-NUS-GMS and Lee Kong Chian School of Medicine) and medical professional bodies (Academy of Medicine, Singapore & College of Family Physicians, Singapore) will allow all of us to achieve a common goal of training better specialists for tomorrow.
Thank you.
Dr Lim Shih Hui
Master
