Training Around the World
Singapore Residency Training
| Gen Lin Foo |
Orthopaedic surgery training in Singapore has undergone significant changes over the past few years with the introduction of the residency system modelled after the American Residency Program. The first intake of this new system which consists of a rigorous and structured programme started in 2010. There are currently 3 Sponsoring Institutions (SIs): National Healthcare Group (NHG), SingHealth Group and the National University Health System (NUHS) Group each offering about 5 to 8 slots per year. These SIs work closely with the American Accreditation Council for Graduate Medical Education (ACGME) to obtain accreditation for their residency programme.
Interested applicants can apply for the residency programme from the final year of medical school but due to the limited intake applicants with less experience and sparser curriculum vitaes (CVs) have a lower chance of getting in. Even if they do get in, they can only start after completing their Housemanship or Post-Graduate Year 1 (PGY1). The selection process includes submission of their CVs as well as referees and an interview with members of the Core Faculty which consists of 4 scenarios testing the candidates’ communication, decision-making, ethical and clinical abilities.
After getting through this first round, successful candidates are then given the option of ranking their SIs of choice. Usually they would have worked at the hospitals which come under the SIs and have also been in contact with the Program Director (PD) and Core Faculty members in order to decide which are their top options. The final selection is decided again by the staff of the SIs that they have chosen after reviewing their academic, clinical and extra-curricular records as well as their interpersonal skills.
Once they have gained entry into the programme, residents start a 6-year programme with the first year consisting of ‘external’ rotations in Anaesthesia, General Surgery and Emergency Medicine to provide a thorough and holistic training programme. From year 2 to year 5 (R2 to R5), residents go through 2- to 4-monthly rotations in all the orthopaedic subspecialties (Trauma, Adult Reconstruction, Foot and Ankle, Spine, Hand, Sports, Oncology, Paediatrics). For the final year of the programme, residents can choose to spend more time in the subspecialty of their interest as well as being allocated time for research and even community work.
The teaching schedule is structured over 2 years based on the programme curriculum with residents coming together each Friday afternoon for dedicated teaching led by Core Faculty members. This can consist of didactic teaching, case discussions, workshops or seminars. Senior residents who have completed the 2-year run-through of the curriculum are expected to contribute more of their added insight and also use these sessions to reinforce their knowledge.
As the current programme is an integration of the previous system which is more United Kingdom-based and the American residency system, residents undergo evaluations from both. Residents are expected to clear their Member of the Royal College of Surgeons (MRCS) exams in their first 2 years and are also assessed yearly with the online Orthopaedic In-Training Examination (OITE) organised by the American Academy of Orthopaedic Surgeons (AAOS). There is no set passing mark for the OITE which is meant to be formative but residents are expected to show improvement year on year. They are also regularly assessed by their mentors in the different rotations that they go through with a combination of Direct Observation of Procedural Skills (DOPS) and mini-CEX (Clinical Evaluation Exercise). Year 3 residents have to undertake a viva examination combined with a written thesis as part of their Master of Medicine (Orthopaedic Surgery) which is a prerequisite to becoming Senior Residents (or Registrars in the previous system).
R6 residents have to undergo their final assessment in the form of the Fellow of the Royal College of Surgeons (Orthopaedic) examination which is held locally. In order to attain specialist status, residents also need to fulfil other requirements set by the national Residency Advisory Committee (RAC) which includes research publications and presentations.
- National University Health System Orthopaedic Residency Program: http://www.nuhs.edu.sg/nuhsresidency/programs/orthopaedic-surgery.html
- SingHealth Orthopaedic Surgery Residency Program: http://www.singhealthresidency.com.sg/Pages/OrthopaedicSurgery.aspx
- National Healthcare Group Orthopaedic Surgery Residency Program: https://www.nhgresidencyprogram.com.sg/programs.aspx?id=137