Residency Programme for doctors

14 February 2012

Question No. 104

Name of person: Associate Professor Fatimah Lateef

Question

To ask the Minister for Health (a) if he can provide an update on the Ministry's Residency Programme for doctors; (b) what have been the numbers across the different disciplines over the last 3 years; and (c) whether these numbers are in alignment with the projected need for specialists in the coming years.

Answer

1.     Introduced in 2010, the Residency postgraduate training system provides trainee doctors (“residents”) with a structured curriculum to achieve a defined set of objectives and core competencies.  Training is provided by designated core faculty, and residents undergo regular formative assessments. The residency system was an important step forward from the traditional training method of apprenticeship to a more structured and streamlined training system.  

2.     The implementation of the residency system was carried out in different phases, bringing in additional specialties in each phase. The first phase of residency was rolled out in July 2010 with 7 specialties offered. These specialties were Internal Medicine, General Surgery, Emergency Medicine, Pathology, Paediatric Medicine, Preventive Medicine and Psychiatry. A Transitional Year residency programme was also implemented which allowed residents a one-year exposure in various clinical disciplines to facilitate the choice of and preparation for a chosen specialty. 

3.     In July 2011, the second phase was rolled out comprising 11 specialties and Family Medicine. The phase 2 specialties were Anaesthesiology, Diagnostic Radiology, Obstetrics and Gynaecology, Ophthalmology, Otorhinolaryngology Orthopaedic Surgery, and a common-trunk Surgery-in-General leading to training in five surgical specialties namely Cardiothoracic Surgery, Hand Surgery, Neurosurgery, Plastic Surgery and Urology. The next phase of the residency system is being developed and is tentatively slated to commence in 2013, offering the various internal medicine specialties eg., cardiology, renal medicine and gastroenterology.   

4.     A robust quality assurance framework by the Ministry of Health and the Accreditation Committee on Graduate Medical Education International (ACGME-I) ensures that each resident consistently receives quality training. 

5.     Seventy-two trainees commenced specialist training in 2000 compared to 176 in 2009. With the roll out of residencies, the combined trainee intake number increased substantially to 377 in 2010 and to 451 in 2011. A summary of the specialist trainee intake number is provided in the table below.

Table 1: Intake of Specialist Trainees

6.     The table below provides the number of residents in the different specialties since 2010.  

 
Table 2: Number of Trainee Doctors ("Residents") under the Residency System (2010-2011)

7.     Rising demand for specialist care, as a consequence of a growing population, increasing proportion of aging Singaporeans and higher prevalence of chronic diseases, will require a commensurate expansion in the training of specialists. MOH gives broad directions to training institutions on the number of specialists to be trained annually to address rising demand. Between 2001 and 2011, the number of specialists practicing in Singapore grew substantially by 88% (1930 in 2001, 3634 in 2011). However, we will need to further ramp up our own training pipeline to ensure that our healthcare institutions have sufficient specialist manpower.  Between 2014 and 2018, 2 new general hospitals (Ng Teng Fong Hospital and the Sengkang General Hospital) as well as 3 new community hospitals will commence operations. 

8.     There is also urgency to increase training numbers for specialties with high demand such as cardiology, orthopaedic surgery, ophthalmology and gastroenterology. 

9.     Since residency started in 2010, 32% (183 residents) of the entire residency pool is made up of residents in Internal Medicine, a base specialty that can lead to other related specialties such as cardiology or gastroenterology. These specialists can also be dually accredited in Internal Medicine and their chosen related medical specialty. This will minimize fragmentation and enable the provision of holistic care for patients. We will continue to provide incentives to encourage young doctors to take up these critical specialties. Family Medicine residency started last year and we are looking into further increasing the number of positions available. For specialties with training constraints, MOH will work with the healthcare institutions to ensure a sustained and rational expansion of the training pipeline. 

10.   MOH will continue to monitor and calibrate the training pipeline for different groups of specialties to meet the nation’s evolving healthcare needs.