Residency Guidebook
Yong Loo Lin School of Medicine
A PRODUCTION BY THE 63RD MEDSOC ACADEMIC
DIRECTORATE
TABLE OF CONTENTS
I.







Overview
INTRODUCTION
STRUCTURE OF CURRENT SYSTEM – THE NEW VS THE OLD
HALLMARKS OF RESIDENCY
SPONSORING INSTITUTIONS
APPLICATION PROCESS AT A GLANCE
RESIDENCY PROGRAMMES
TRANSITIONAL YEAR CURRICULUM




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

The Match
INTRODUCTION
WHY DO WE HAVE THE MATCH?
WHAT IS THE MATCH?
WHO IS ELIGIBLE TO APPLY FOR RESIDENCY MATCHING?
THE ALGORITHM
DETAILED EXAMPLE
HOW DO I REGISTER FOR THE MATCH
SINGAPORE-SPECIFIC TWEAKINGS
THE US SYSTEM
II.
III.
Thoughts by Residents
IV.





Frequently Asked Questions
RESIDENCY STRUCTURE
APPLICATION AND ADMISSION
PROGRAMME
CAREER PROGRESSION
OTHER ISSUES
V.
1
Acknowledgements
RESIDENCY GUIDEBOOK
INTRODUCTION
The Residency Programme was introduced in 2010 as a new post-graduate medical training and
education system in Singapore. The advent of this programme had been marked by intense debate and
discussion, leaving innumerable frantic or clueless as to what exactly to make out of it.
This handbook thus seeks to expound on the core truths of the programme to ameliorate doubts and
reduce information asymmetry with regards to Residency. It also aims to shed light on the
programme’s goals and reveal the answers to some common queries on the Residency system. The
application procedure will only be described briefly here as all other information can be readily found
on the MOHH website (http://www.physician.mohh.com.sg/residency/faq.html). Also, details of the
various specialties and sub-specialties will be highlighted in a later production.
Put together by a team of equally curious and eager medical students under the Academic Directorate,
this booklet stemmed from the determination to help clueless or worried classmates on Career
Guidance. It is sincerely hoped that this booklet will go a long way in quashing your initial doubts and
providing a reliable source of information on the Residency programme. All sources of information are
from official sources and all facts written in this guidebook are indeed accurate at the moment of
publication, and facts are bound to change with time and will be updated accordingly in the guidebook. If
you would like to point out any clarifications or express your opinions, do drop an email to
acadmedsoc@gmail.com and we’ll address them as soon as we can.  Enjoy!
2
THE NEW VS. THE OLD
(EDITED FROM HTTP:// SINGAPOREMD.BLOGSPOT .COM/2009/09/RESIDEN CY.HTML)
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:
The Old
1.
2.
3.
4.
Medical students become house officers upon graduation. For one year, they will rotate through 2
or 3 rotations in medicine, surgery, orthopaedics, paediatrics, or obstetrics & gynaecology to
acquire practical skills in doctoring to function in the public hospital setting.
Upon completion of housemanship, one becomes a medical officer (MO), who will typically have 6monthly rotations through postings of one’s choice. MOs can elect to take up basic specialty training
(BST, i.e. surgery, medicine, family medicine, paediatrics 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, MOs could 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 could 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.
The New
Under the new residency system, it will take an average of 3- 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 1 st-year residents, equivalent
to the current internship or housemanship, but with greater educational opportunities and clinical
involvement. 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 specialists1.
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 could be
considered a good thing to shorten the time to being a specialist by 2 years, 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.
On exit of Residency, one may not immediately become an associate consultant. Promotion is based on merit
as well as availability of spaces. For more information, refer to the FAQ section below, question “5. After I
graduate from a residency, will I be an associate consultant?” under Programme.
1
3
STRUCTURE OF CURRENT RESIDENCY SYSTEM (AS OF 2012)
Available choices
Residency
Programme
Direct entryResidency R1
starting from
PGY1 or after
TY/HO
1. Emergency Med
2. Internal Med
3. General Surgery
4. Pediatric Med
5. Preventive Med
6. Psychiatry
Transitional Year
HO/TYEntry after
PGY1/TY/HO
1. Anesthesiology
2. Diagnostic Radiology
3. Obs & Gyn
4. Orthopaedic Surg
5. Otorhinolaryngology
6. Ophthalmology
7. Pathology
8. Family Med
9. Cardiothoracic Surg
10. Hand Surg
11. Neurosurg
12. Plastic Surg
13. Urology
Generic TY
Housemanship
Categorical TY
Medical
Officer
PGY1: Post-graduate year 1
TY: Transitional year
HO: Housemanship
FIGURE 1
4
HALLMARKS OF THE RESIDENCY SYSTEM
The Residency Program is a US-styled postgraduate medical education where medical graduates
undergo training in a supervised and organized way to ensure they become competent and excellent
specialists.
Although the old Graduate Medical Education (GME) system has served the Singapore healthcare sector
well, the need to constantly innovate and adopt the best practices in education in order to meet
with evolving healthcare demands and ensure that future generations of clinicians are welltrained has been strongly advocated by the Ministry of Health (MOH), Singapore. After discussions
with the Specialists Accreditation Board (SAB), MOH thus recommended the introduction of the
Residency Program. This was in response to a high percentage of doctors leaving for private practice
without undergoing any formalized training program.
The Residency Program will be a structured training framework and education curriculum, based on
established standards from the American Council for Graduate Medical Education (ACGME). The
program is a rigorous system designed on a formative model for quality training. The learning process
will
be
enhanced
through
the
6
core
competencies.
Under the old system, medical officers will rotate from one posting to another and be responsible for
their own training outcome. With the Residency Program, training will be more structured and
Sponsoring Institutions will take ownership of the training outcome of the residents.
A key feature is in its evaluation methods - an ongoing system to assess residents' skills, ensuring
a continual review of the learning progresses. This differs from the current system, which utilizes a
summative method where assessments accumulate in intermediate and final exams.
Accreditation Council for Graduate Medical Education (ACGME) evaluates and accredits medical residency programs
in the United States. The mission of the ACGME is to improve health care by assessing and advancing the quality of
resident's
education
through
accreditation.
MOH has invited ACGME to assist us in the drive to improve the graduate medical education in Singapore.
The collaboration between ACGME and MOH is known as ACGME-International (ACGME-I), and it is the
first of its kind. ACGME-I will develop a set of standards for Singapore in the areas of curriculum
development, assessment and teaching methods, data collection systems, professional development and
training for program directors and program coordinators.
Depending on the Residency Program you are enrolled in, the program can range from 3 to 5 years. You
may check out the number of training years for the specific department and Sponsoring Institution
stated in the table a few pages after.
(INFORMATION EDITED F ROM HTTP:/ / WW W . SI N GHEAL T H. C OM. SG/ EDUC ATI ON AN DTRAI N I NG / RESI DENC Y/ F AQS/ PAG ES/HOME. ASPX )
Quicks facts about the Residency Programme:

3 different Sponsoring Institutions (SIs for short)
Which are the Sponsoring Institutions?
Currently, there are 3 approved Sponsoring Institutions (SIs), namely:
1. National Healthcare Group (NHG): Tan Tock Seng Hospital , Institute of Mental Health,
Alexandra Hospital / Khoo Teck Puat Hospital
2. National University Health System (NUHS): National University Hospital, Jurong
General Hospital
5
3. SingHealth (SHS): Singapore General Hospital, KK Women's and Children’s Hospital,
Changi General Hospital






Has 35 specialties, 4 sub-specialties and Family Medicine
Retains the advantages of the HOPEX/MOPEX (Housemanship and Medical Officer Posting Exercise)
system while adapting to the current needs:
o Duration of training for each specialty retained
Allows longer exposure and training in each specialty
o Broader-based post-graduate education
Wider breadth of knowledge in relevant specialty covered such that new specialists have the
confidence to advise patients without the need to refer them to other specialists
o Supplemented by a dedicated teaching faculty – Senior physicians have protected time to
mentor and guide their students
Application choices
o Each candidate can only choose 2 specialties per SI, thus a total of 6 choices to be listed
o Advised to apply for all 3 SIs as shown in Figure 2 to increase chances of matching to SIs
o Candidates interested in the Clinician Scientist track can apply for one additional
specialty per SI, thus a total of 9 choices
Regular formative assessments
o Ensure trainees attain core competencies at each stage of training
o Assess both theory and practical skills attained by residents
Transitional year
o Designed to fulfill the needs of graduands who desire a well-balanced, broad-based year in
different disciplines within the structured framework of a Sponsoring Institution before
specialization
Clinician Scientist Track
o Programmes with clinician scientist tracks will have at least a year of research built into the
curricula of advanced residency years
o As aforementioned, applicants can choose up to 3 programmes if any of their choices are
clinician scientist tracks, instead of just 2
6
SPONSORING INSTITUTIONS
Sponsoring Institutions (SIs)
National Healthcare
Group - Alexandra
Hospital Pte Ltd
Khoo Teck Puat
Hospital (KTPH)
National University
Health System
National
University Health
System (NUHS)
Tan Tock Seng
Hospital (TTSH)
Jurong General
Hospital (JGH)
Institute of Mental
Health (IMH)
Singapore Health
Services
Changi General
Hospital (CGH)
KK Women's and
Children's Hospital
(KK)
Singapore General
Hospital (SGH)
FIGURE 2
APPLICATION PROCESS AT A GLANCE
July
Aug-Sep
•Central applications for interview through MOH
•Portfolio creation and submission at MOHH website
•Choice of programme (2 choices) and sponsoring institution (3 choices)
Oct-Nov
•Multi-Mini-Interviews by National Interview panels
•Interviewers consist of Programme Directors from the respective SIs, Residency Advisory Committee (RAC) member
and a Clinician Scientist Mentor (if applicable)
Dec-Feb
•Ranking by candidates and SI's preferences
•The Match (details below):
Independently matches candidates and SI's preferences for each other
Mar-Apr
•Release of Match results: 1 doctor to 1 specific programme of 1 SI
•Applicants who do not obtain a successful match for residency will enter HOPEX/MOPEX with the applicants who
chose HOPEX/MOPEX
FIGURE 3
7
•Open House/Career Symposium to explore and choose SIs
•Encouraged to choose all 3 SIs regardless of actual preference
RESIDENCY PROGRAMMES
Programme
Programmes
Group
Training
NHG - AHPL
NUHS
SHS











Length
(yrs)
Direct Entry
Emergency Medicine
Programmes
Internal Medicine
General Surgery
5
3 + 2/3
5
Paediatric Medicine
3+3
Preventive Medicine
5
Psychiatry
5
HO / TY
Anaesthesiology
5
Programmes
Diagnostic Radiology
5
Obstetrics &
6
(Entry after PGY
1)

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
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








Gynaecology
Orthopaedic Surgery
6
Otorhinolaryngology
5
Ophthalmology
5
Pathology
5
Family Medicine
3
Cardiothoracic Surgery
6
Hand Surgery
6
Neurosurgery
6
Plastic Surgery
6
Urology
6

TABLE 1
8
TRANSITIONAL YEAR CURRICULUM FOR EACH PROGRAMME
Programme Group
Programmes
No. of Months in Each
Direct Entry
Emergency Medicine
4IM + 4EM + 4GS + 2PM
Programmes
Internal Medicine
4GS + 1N + 1RP + 1G + 1C + 2GM + 1R + 1E + 1O
General Surgery
4GM + 8S
Paediatric Medicine
2GM + 2X + 4S (incl. 1PS) + 2GP + 1PaedsO+ 1PaedsR
Preventive Medicine
4GM + 4GS + 3/6 X
Psychiatry
3GM + 3N + 3IP
HO / TY Programmes
Anaesthesiology
4IM + 4GS +2PM + 2EM + 2A
(Entry after PGY 1)
Diagnostic Radiology
9FYAPC + 3(Chest, VIR, MSK)
Obstetrics & Gynaecology
4OP + 3LW + 3W + 2X
Orthopaedic Surgery
4A + 4GS + 4EM
Otorhinolaryngology
6GS/CC + 6ENT
Ophthalmology
Weekly EM + GOP + CTO
Pathology
CPT
Family Medicine
X
Cardiothoracic Surgery
6GS + 2U + 2NS + 2VS
Hand Surgery
6GS + 2U + 2NS + 2VS
Neurosurgery
6GS + 2N + 3NS + 2X
Plastic Surgery
6GS + 2PL + 2A + 1OR + 1X
Urology
8GS + 2NS + 2VS
TABLE 2
GS
N
RP
G
C
EM
IM
X
GP
FYAPC
OP
9
General Surgery
Neurology
Respiratory
Gastrology
Cardiology
Emergency Medicine
Internal Medicine
Elective/Misc
General Pediatrics
Foundational Year Anatomy &
Physics Course
Outpatient
GM
R
E
O
S
PM
A
PS
IP
LW
General Medicine
Renal
Endocrine
Oncology
Surgery
Pediatric Medicine
Anesthesiology
Pediatric Surgery
Inpatient Psychiatry
Labor Ward
CC
ENT
U
NS
VS
PL
OR
GOP
CTO
DR
Critical Care
General Otolaryngology
Urology
Neurosurgery
Vascular Surgery
Plastic Surgery
Orthopedic
General Ophthalmology
Cataract Teaching OT
Diabetic Retinopathy Screening Clinic
W
24 Hours Clinic
CPT
Core Pathology Training
THE MATCH
W HA T O N E A R T H I S I T A N D W H Y A R E W E C O P Y I N G T HE A N G M O H S
WHY DO WE HAVE THE MATCH?
Under the old HO/MO system, it would take a minimum of 7 years for a medical school graduate to
become a clinical specialist.
Under the new system, a specialist doctor can complete his training at least one year earlier,
depending on the discipline. This is especially important in view of the pressures presented by
Singapore’s aging and expanding population.
Not only is the duration of training shortened, the training programmes are also more structured,
ensuring more holistic training for the graduates. The Residency Programme strives to allow every
student to experience a value-added post-graduate education by emphasizing on systems-based
practice and practice-based learning (see chapters ? interviews with current residents to see
whether this is true or not ;))
WHAT IS THE MATCH?
The new residency programme for post-graduate medical education was introduced in May 2010.
Alongside the new system is a posting exercise based on the US medical system’s own, elegantly
fine-tuned to suit Singapore’s needs, in which medical students are sorted to their preferred
specialty and Sponsoring Institution (SIs). This exercise is known as the Match, developed by MOH
Holdings as an easily accessible, efficient online system, Residency Matching Exercise (RMEx).
The Match is a computer-run system that aims to match medical students with residency
programmes and residency programmes with medical students in such a way as to ensure greatest
utility for all; that is, medical students get posted to their most desired programmes while the
programmes are allocated students that they most desire. Ideally, it is a win-win situation for
medical students and SIs both. It uses an algorithm based on that used in the US for matching the
thousands of medical students they have to the hundreds of available residency programmes.
Of course, without proper knowledge of how the Match works, it is easy for students to end up
unmatched, which means that the student would automatically enter the House Officer Posting
Exercise (HOPEX), which is probably not, as the name suggests, the beacon of hope to most medical
students these days. However, failure to be matched doesn’t truly have the negative connotations
most people attribute to it.
WHO IS ELIGIBLE TO APPLY FOR RESIDENCY MATCHING?
In M5, Residency applicants will first sit for 2 rounds of interviews:

Multiple Mini-interview
10

Department Interview
Multiple Mini-interview

The Multiple mini-interview is a common, national interview by all 3 SIs for each specialty a
student is interested in. This interview is designed to find out whether an applicant is
prepared to start residency. This is done by putting an applicant in various scenarios. For
Clinician Scientist applicants, an additional interview session may be arranged.
Department Interview
The SIs may decide to do separate interviews (usually during their open house sessions) to help
them rank all the medical students who apply to their residency programmes.
Only if a student has sat and passed an interview are they eligible to apply for RMEx; otherwise,
M5s will need to re-sit for interviews the following year. In the meantime, they join HOPEX.
Successful Match
Pass
eNRMP
+ HOPEX
Unsuccessful match
Interviews
Fail
Specialise
Reapply
next year
HOPEX/
MOPEX
11
Residency/TY
Give up.
Go private
OR
Work as a non-specialist
doctor in the hospital
(resident
physician/service
registrar)
THE ALGORITHM
The RMEx matching algorithm based on the
same principles as its US counterpart. The
matching process will match candidates' and
programmes’ preferences for each other.
The basic goal in the simple case of the
hospitals/residents problem is to match
applicants to residency programmes so that the
final result is "stable". “Stability" in this case
means that there is no applicant A and
programme P such that both of the following are
true:
DID YOU KNOW?
The Match algorithm is an extension of the
stable marriage problem in mathematics and
computer science 
But let’s not get too confused with these
technicalities!

A is unmatched or would prefer to go to P over the programme he is currently matched with

P has a free slot or would prefer A over one of the candidates currently filling one of its slots.
The Rank Order Lists
Based on the specialty interviews,Each SI will rank interviewees based on the SIs’ order of
preference for offering the student a position. In arriving at their order of preference, SIs will assess
a student based on his online portfolio as well as his performance during the national and SIspecific interviews. The SI may or may not rank all interviewees who applied for training positions.
This produces an institution’s “rank order list” or ROL.
Students will also rank the programmes of their choice on the RMEx website. This produces a
student’s ROL.
The Confusing Algorithm
The computer will process students’ ROLs in a completely random order. For each student, based
on their and the SI’s ROL, the computer will make a tentative match. Matches
are "tentative" because an applicant who is matched to a program at one point in the matching
process may be removed from the program at some later point, to make room for an applicant more
preferred by the program (i.e., highly ranked by the SI).
This continues until all students have been matched, at which all matches become permanent.
Applicants are first matched to his first choice programme, then to his second choice programme if
he fails the first match, and so on, until a match is made or all applicant’s choice have been
exhausted (at which point, applicant
remains unmatched).
LONG STORY SHORT!
The algorithm aims to match the
Departments’ top choices to the Students’ top
choices as far as possible!
12
The algorithm in diagram
1st round of matching
1st applicant’s ROL
Programme’s ROL
Computer tries to place applicant into 1 st choice programme
Applicant ranked +
available spaces
Applicant not ranked/
spaces filled by more preferred applicants
Applicant matched with next choice programme
Tentative match
Process continues until tentative
match obtained
2nd applicant’s ROL
Unmatched
Programme’s ROL
2nd round of matching
Computer tries to place applicant into 1 st choice programme
Applicant is more highly
ranked than tentatively
matched applicant in full
programme
Least preferred applicant
in programme removed
and tentative match made
for 2nd applicant
Applicant not ranked/
spaces filled by more preferred applicants
Process continues until tentative
match obtained
Unmatched
Least preferred applicant goes through another round of matching until tentative
match made/all choices exhausted
Subsequent rounds
13
Process carried out for all applicants until each applicant has been tentatively matched to the most
preferred choice possible/all choices have been exhausted
FIGURE 5
SO LET’S SEE WHAT HAPPENS…
Illustrate with a few examples of students with choices are matched with the system; NRMP
website has good example
http://www.nrmp.org/res_match/about_res/algorithms.html
How do I register for the Match
Go to MOHH website 
http://www.physician.mohh.com.sg/residency/
Singapore-specific tweaking

Clinician Track (aka the usual way)
A candidate can only choose 2 specialties. Candidates
are advised to apply for all SIs because applying to
fewer SIs will reduce their chances of matching with
the SIs.
2 specialties X 3 SIs = 6 choices

Clinician Scientist Track
DID YOU KNOW?
Candidates are advised not to apply for a
clinician scientist track and clinician track for
the same specialty. Contrary to belief, this
will not increase the success rate by 2! In fact,
it may even lower your success rate because
the interviewers will be the same with the
exception of a clinician scientist in the
clinician scientist track interview.
2 specialties X 3 SIs = 6 choicesCandidates
interested in the clinician scientist track can apply for
one additional specialty.
3 specialties X 3 SIs = 9 choices
WHAT HAPPENS IN THE US
The NMRP is actually a non-profit, private organization formed in 1952. It was cosponsored by five
medical associations in the US to improve on the then extremely messy way of allocating students
to residency programmes. In the US, The Match is commonly views as a rite of passage for American
medical students, who eagerly await Match Day as the day heralding the rest of their lives. This is
not unlike the god-like status attributed to that first week of March when A level results are
released, or for medical students, the day that brown envelope arrives in the mail
Why did the NRMP come about?
By the late 1940s, the traditional matching process was growing increasingly chaotic. There were
almost twice as many residency positions as there were U.S. medical graduates. More competitive
programs had the luxury of receiving and reviewing large batches of applications before doling out
their residency spots late in the students’ fourth year. Less competitive programs tried to get a head
14
start by asking students to commit to the program early in the fourth year or even during the third
year. (there are 4 years of postgraduate medical school in the US) As a result, students were forced
to gamble by deciding whether to accept an early offer from a less competitive program and forfeit
a later shot at better programs or to pass up the early offer and risk not being accepted in a better
program. Residency directors faced a similar dilemma. If they filled all their positions too early, they
would not be able to offer a position to a more desirable candidate who applied later; however, if
they held out for better applicants, they risked not filling their programs. As a solution to these
dilemmas, the first Match was held in 1952. It was a huge success, with over 98% of the residency
programs and 97% of the students participating. The Match eliminated guessing games for the most
part by allowing applicants and programs to rank each other on the basis of desirability. The
algorithm used to match applicants with programs has remained largely unchanged over the years.
15
THOUGHTS BY RESIDENTS
INTERVIEWS (SOON TO COME!)
16
FREQUENTLY ASKED QUESTIONS
RESIDENCY STRUCTURE
1.
2.
3.
4.
5.
6.
7.
8.
What is the Graduate Medical Education Committee (GMEC)?
What is a Sponsoring Institution? How many Sponsoring Institutions are there in Singapore?
What are the roles and responsibilities of the Designated Institutional Official?
What is the role of Associate Designated Institutional Official?
What are the responsibilities of the Program Director?
What are the responsibilities of the Associate Program Director?
What is the main role of the Program Coordinator?
What are the roles of the core faculty members?
APPLICATION AND ADMISSION
1.
2.
3.
4.
5.
Why residency?
What are the judging criteria of the matching process?
Who can apply for the residency programme?
Can MOHH increase the number of Transition Year residents?
Which are the Residency Programmes with too many applicants and which are the ones with
vacancies? Do Group 2 specialty (ENT, O&G, etc) residents have to worry about the scarcity of TYs?
6. Should I apply for the Clinician-Scientist track if I don’t think I can make it for the standard residency?
7. Who will make up the National Interview panels?
8. What happen if I am unsuccessful in obtaining entry into, or do not wish to apply for a Residency
Programme?
9. It is perceivably easier to get a residency slot in M5 compared to being a HO/MO (competing with
everyone else, including international graduates). Could more be done to assure students that they
will not be at a disadvantage if they do not apply in M5 but only do so in their post-graduate years?
10. If there are such a small number of Residency places available, would a Doctor be at a disadvantage if
he/ she delays making a decision?
PROGRAMME
1.
2.
3.
4.
5.
6.
What is a Transitional Year?
What are the differences between Transitional Year and Housemanship?
When does Residency begin? How long will my Residency Programme last?
How will assessments be carried out? At the end of training, how will I exit as a specialist?
After I graduate from a residency, will I be an associate consultant?
How will switch between clusters and/or specialties be managed in the unlikely event that a resident
needs to make a swop for unforeseen reason(s) and who will be involved?
7. MOs have to start from Year 1 in the residency program when they apply this year. Can they be
allowed to skip/accelerate parts of the training?
8. What would happen to males who have to re-enlist to serve the remainder of their National Service?
What are the allowances for National Service?
9. What happen if I go on long leave during the residency year, (e.g. maternity leave), does it mean that I
will have to repeat the whole year?
10. I heard instances when my seniors exceed the 80 hours work week. Why?
CAREER PROGRESSION
1.
2.
17
ACGME (I) is not recognized in the USA. For this reason, many will eventually still have to take Royal
College Exams. Is ACGME recognized outside of Singapore?
What are the opportunities for graduates intending to pursue a research scientist or a clinicianscientist career tracks?
3.
Will residents completing their basic residency programs be able to immediately pursue an overseas
fellowship program? Will such fellowship programs be considered as relevant training for
subsequent appointment as an associate consultant and registration by the Specialist Accreditation
Board?
4. Is it possible to give HO/MO the same teaching and dedication as residents? If not, what can be done
to ensure fairness in career progression for non-residents?
OTHER ISSUES
1.
2.
Is there are any preferential quota set aside for the Duke students?
How much are residents paid?
18
ANSWERS
RESIDENCY STRUCTURE
MOH
GMEC
Sponsoring
institution
ADIO
DIO
APD
PD
Core
faculty
Faculty
Residents
FIGURE 6
1. What is the Graduate Medical Education Committee (GMEC)?


2.
What is a Sponsoring Institution? How many Sponsoring Institutions are there in Singapore?

The Sponsoring Institution (SI) is the organization (or entity) that assumes the ultimate financial and
academic responsibility for a program of Graduate Medical Education. The SI has the primary
purpose of providing educational programs and health care services
Currently, there are 3 approved Sponsoring Institutions, namely:
1. National Healthcare Group (NHG)
 Tan Tock Seng Hospital
 Institute of Mental Health
 Alexandra Hospital/ Khoo Teck Puat Hospital
2. National University Health System (NUHS)
 National University Hospital
 Jurong General Hospital
3. SingHealth (SHS)
 Singapore General Hospital

19
The GMEC exists to provide oversight and governance to all graduate medical education training
programs under the Sponsoring Institution (SI). It monitors and provides advice on residency
education and ensures substantial compliance withrequirements of the ACGME-I. The GMEC is
chaired by the DIO and comprises members including Senior Management, Program Directors (PDs),
peer-nominated residents, administrators and other members of the faculty.
The committee is responsible to establish and implement policies and procedures regarding the
quality of education and the work environment, and to ensure proper distribution of institutional
resources across the resident programs.
 KK Women’s and Children’s Hospital
3. What are the roles and responsibilities of the Designated Institutional Official?



The Designated Institutional Official (DIO) has an overview of the educational, fiscal and
administrative health of the SI’s GME activities. The DIO leads an organized administrative system
that oversees all ACGME-I accredited programs, maintain both ACGME-I Institutional accreditation
and Residency Programs’ accreditation.
With support from the GMEC, the DIO (who is also the chairperson of GMEC) establishes and
implements policies and procedures regarding the quality of education and the work environment
for the residents in all the programs.
Nonetheless, the DIO’s ultimate goal is to institutionalize an educational experience that would
enable residents to obtain the necessary knowledge, skills and attitude to practice as competent
physicians.
4. What is the role of Associate Designated Institutional Official?

The Associate Designated Institutional Official (ADIO) is the designee of the DIO. In the DIO’s absence,
the ADIO carries out the responsibilities and roles of the DIO. ADIOs are representations of the
respective participating institutions at Changi General Hospital and KK Women’s & Children’s
Hospital.
5. What are the responsibilities of the Program Director?


Each Residency Program will have a Program Director (PD) that is responsible for all aspects of the
Residency Program. The PD has to administer and maintain an educational environment conductive
to educating residents in each of the competency area.
The PD will oversee the recruitment of residents and faculty, development of the curriculum with
assistance from the faculty, and the assessment of the residents’ progress through the program. The
PD will have to certify the competency of the graduates to practice independently.
6. What are the responsibilities of the Associate Program Director?

The Associate Program Director (APD) is a faculty who assists the Program Director in the
administration and clinical aspect of the training program. There may be more than one APD for
each program.
7. What is the main role of the Program Coordinator?

The Program Coordinator (PC) assists the PD in the daily administration of the Residency Program,
especially to ensure that residents are informed and adhere to established educational and clinical
practices, policies and procedures.
8. What are the roles of the core faculty members?

Core faculty members are clinicians who work closely with the PD and APD on the development of
program, with matters ranging from curriculum to administrative planning and implementation.
Together with a fleet of physician faculty, they will lead the team to teach, supervise and mentor the
residents. For quality teaching, ACGME-I had stipulated a ratio of 1 core faculty to 6 residents for
programs.
APPLICATION AND ADMISSION
1. Why residency?
20




Residency was created to introduce more structure into our current post-graduate training, which
has a lot of inefficiency.
One of the weaknesses in the previous system is that one is allocated to a supervisor and the quality
of the supervisor is dependent on luck. There is poor regulation and standardisation.
Specifically, the residency programme improves the learning environment by ensuring that there are
3 tiers
a. 1:1 faculty (mentor):resident ratio
b. 1:6 core faculty:resident ratio with core faculty having 20% protected time
c. Programme directors with 50% of the time protected to ensure they can focus on running
the residency programme
Other reasons:
a. To make students decide what they want to specialise in earlier so that they can commit
earlier. This is good for the individual departments in hospitals, as they can have a group of
trainees who will stick (instead of bailing out to another department/institution when their
brief tenure is up)
b. To attract and retain clinicians who mainly teach: the clinician educators. It is hoped that
with such professionals, post-grad training could have better quality.
2. What are the judging criteria for the matching process?





Evaluation of your application is based on a few factors, and they are definitely not limited to your
academic performance:
a. Interview performance and letters of references (LORs) submitted by their referees
b. Academic scores
c. SIP performance
d. Previous clinical work experience.
This framework varies from speciality to speciality, and from Sponsoring Institution to Sponsoring
Institution.
An exception is the Transition Year, for which there is no interview, and your evaluation is based
only on your portfolio and academic scores.
For academic results, it is a broad strata system with MOH intervention only at extremes, so there is
no real quota based on grades.
Research may help as it acts as a surrogate measure for a candidate’s interest in a particular specialty,
however, a generic research project will not give one a significant edge over his peers
3. Who can apply for the Residency Programme?




Graduands of Singapore medical schools and those with primary medical qualifications registrable
under the Medical Registration Act (First Schedule) are eligible.
This includes current HOs and MOs, however they will still be expected to enter residency training at
Residency Year 1 (R1)
Graduands with non-registrable medical qualifications may be considered on a case to case basis
Graudands from overseas need to secure an offer of employment as a doctor from MOHH or local
healthcare institutions before they are eligible.
4. Can MOHH increase the number of Transition Year residents?

Yes. Eventually, TY will apply for all, but it is limited by shortage of teaching faculty now as it is just
starting off. However, don’t bet on this, because residency is still very far from maturation!
5. Which are the Residency Programmes with too many applicants and which are the ones with
vacancies? Do Group 2 specialty (ENT, O&G, etc) residents have to worry about the scarcity of
TYs?
21



Opthalmology, ENT and Pediatrics are the ones with too many applicants.
The residency programmes with vacancies include Pathology and Family Medicine Residency
Programmes due to a large number of vacancies offered (~50)
The “limited” TYs are the Generic TYs. Group 2 specialty residents are under the Categorical TYs, and
once they are accepted, the TY is considered part of their programme. Hence they do not need to
worry about the limited spaces in the generic TYs. This confusion will be resolved once the naming is
changed.
6. Should I apply for the Clinician-Scientist track if I don’t think I can make it for the standard
residency?





Clinician-Scientist track is intended for candidates who have a strong interest in research careers.
This is not a back door – candidates are expected to be good enough to be on the equivalent clinical
track.
One year is added to the normal clinical residency duration. Clinician-scientist residents will be
provided with close mentorship from a clinician-scientist mentor. They will be expected to complete
at least a Masters in Clinical Investigation or equivalent, and publish as first author in a reputable
journal.
Student can apply for one additional specialty if they apply for the research tracks (usual limit is 2
specialties)
Students are advised not to apply for the same clinician and research specialty
Many departments offer additional positions for those on the clinician-scientist track
7. Who will make up the National Interview panels?

The National panels for each specialty generally include the Programme Directors (PDs) from each
Sis, representatives from the Residency Advisory Committee (RACs) and a Clinician Scientist mentor,
if that interview is for your chosen clinician scientist program
8. What happen if I am unsuccessful in obtaining entry into, or do not wish to apply for a
Residency Programme?
 Unsuccessful applicants will either be offered a House Officer position (for medical graduands) or a
service Medical Officer position.
9. It is perceivably easier to get a residency slot in M5 compared to being a HO/MO (competing
with everyone else, including international graduates). Could more be done to assure students
that they will not be at a disadvantage if they do not apply in M5 but only do so in their postgraduate years?


Entry to residency training will always be a competitive process, be it at M5 level or the HO/MO level
However, expectations are higher for those who are applying at the MO/HO levels as they would have
been exposed to more clinical experiences and presumably acquired more clinical skills.
10. If there are such a small number of Residency places available, would a Doctor be at a
disadvantage if he/ she delays making a decision?


When many doctors delay their decision-making far too long such that when they become Medical
Officers, they see their peers ahead of them and feel discouraged, they end up not specializing
However, sometimes it may be wise to take a step back or apply for a TY, in order to make a wiser
decision at the end of the day
PROGRAMME
22
1. What is a Transitional Year?


The Transitional Year (TY) Programme is designed to fulfill the education needs of graduands who
desire a well-balanced, broad-based year in multiple disciplines and within the structured
framework of the residency system.
There are 2 types of TY.
o
Categorical TY is followed by a specific Residency Programme. This categorical TY serves to
broaden clinician (scientist)’s field of knowledge/ foundation before specializing.
o
Generic TY is not followed by a specific Residency Programme. Therefore, residents must
still apply for a residency at the end of the TY.
2. What are the differences between Transitional Year and Housemanship?



Unlike Housemanship where Houseman gets to rotate through different Sis, TY trainees will be
subjected to the same structured training and formative assessments that full-fledged resident
trainees receive, within the same SI
Trainees have greater control over postings in generic TY and are likely to get offers from their SIs to
advance to a specific Residency Programme
In similarity, both houseman and TY trainees would have didactic lectures for learning
3. When will Residency begin? How long will my Residency Programme last?




For local YLLSOM medical graduands, first year residency begins in May
For graduands of other schools, the start date is variable to cater to different graduation timelines
which will last a minimum of 12 months
Thereafter, the regular residency cycle commences in July of every year
Generally 5-7 years of residency and fellowship training is required before specialist accreditation
4. How will assessments be carried out? At the end of training, how will I exit as a specialist?


There will be regular competency-based assessments to measure both theory and practical skills
attained by residents. This will enable residents to realize their strengths and also highlight areas of
weakness.
Accreditation to practice as a specialist in Singapore is wholly governed by the Specialists
Accreditation Board (SAB) which will recognize local training programmes and existing intermediate
and exit examinations. Exiting will depend on the criteria and assessment as specified by SAB
5. After I graduate from a residency, will I be an associate consultant?



No. Currently this is not the case. Assignment of job titles is not dependent on the amount of training
and number of post-grad degrees you have in your basket, but on your 1) performance and 2)
availability of empty positions.
This is how the system has been working for a very long time, and is unlikely to change even with
residency. Remember that residency is a traineeship, not a ship that carries you to consultancy.
However, for less competitive specialties such as family medicine, it is correspondingly easier to
become a consultant, since positions are usually available.
6. How will switch between clusters and/or specialties be managed in the unlikely event that a
resident needs to make a swop for unforeseen reason(s) and who will be involved?

23
To switch residency, you must resign from your current one and reapply for residency. There will be
a one year penalty imposed, in this time you may not reapply for residency in the year after you
resign from your current residency.
7. MOs have to start from Year 1 in the residency program when they apply this year. Can they be
allowed to skip/accelerate parts of the training?


Residents typically expected to start from R1. However, some candidates might have considerable
relevant experience at point of entry (e.g. senior MOs, especially if they have already passed
intermediate exams).
For such residents, the residency system provides for early progression to R2 after 3-4 months of
observation at R1. This will be done based on departmental assessment of a resident’s capabilities,
and in accordance with RAC and SAB guidelines.
8. What would happen to males who have to re-enlist to serve the remainder of their National
Service? What are the allowances for National Service?






They may undergo a period of Residency training prior to their enlistment
Generally, re-enlistment occurs at the end of postgraduate year 2 (PGY2), which would be at the end
of R1 or R2
At the end of the National Service period, one may resume where training left off but a certain period
of remediation may be required by some programmes before trainee joins a higher residency year
NS takes priority as the SAF has medical needs that need to be met for its soldiers and training is 2 nd
priority to NS as was the case with BST/AST
There will continue to be a pay increment for ORD-ed MOs to compensate for lost increments during
NS years.
There is no pay differential for HOs who ORD-ed prior to entering medical school as HO pay is a
training allowance and is fixed.
9. What happen if I go on long leave during the residency year, (e.g. maternity leave), does it
mean that I will have to repeat the whole year?


Depending on your period of absence, the specialty you are in and the point at which you left
residency training, you may enter where you left off
If the period of absence exceeds a certain number of days, you may be expected to make up for the
missing days of training or repeat a posting
10. I heard instances when my seniors exceed the 80 hours work week. Why?


The 80 hours work week/ 6 calls a month is a cap
Extended hours once a while should be understandable and residents can approach MOH about their
situation if necessary
CAREER PROGRESSION
1. ACGME (I) is not recognized in the USA. For this reason, many will eventually still have to take
Royal College Exams. Is ACGME recognized outside of Singapore?



No, it is not. In short, this is a one-of-its-kind thing from Singapore, and its main purpose is not to
standardise training to send trainees overseas, but to help build and accredit Singapore’s Residency
system.
Accreditation Council for Graduate Medical Education (ACGME) evaluates and accredits medical
residency programs in the United States.
MOH has invited ACGME to assist us in the drive to improve the graduate medical education in
Singapore. The collaboration between ACGME and MOH is known as ACGME-International (ACGME-
24
I), and it is the first of its kind. ACGME-I will develop a set of standards for Singapore in the areas of
curriculum development, assessment and teaching methods, data collection systems, professional
development and training for program directors and program coordinators.
2. What are the opportunities for graduates intending to pursue a research scientist or a
clinician-scientist career tracks?




Programmes with clinician scientist tracks will have at least a year of research built into the curricula
of advanced residency years.
The entry requirements of such programmes will be similar to their corresponding default Residency
Programmes.
Applicants however, can choose up to 3 programmes if any of their choices are clinician scientist
tracks, and up to 2 programmes if otherwise.
Clinician scientist residents will be provided with close mentoship from a clinician scientist mentor
and will be expected to complete at least a Masters in Clinical Investigation or equivalent, and publish
as first author in a reputable journal
3. Will residents completing their basic residency programs be able to immediately pursue an
overseas fellowship program? Will such fellowship programs be considered as relevant
training for subsequent appointment as an associate consultant and registration by the
Specialist Accreditation Board?

MOHH is working with ACGME to roll out Internal Medicine specialties by 2013 so that residents
completing IM training can progress to further training immediately after completion of their IM
residency
4. Is it possible to give HO/MO the same teaching and dedication as residents? If not, what can be
done to ensure fairness in career progression for non-residents?




MOH is currently working with the different Sis to substantially increase the number of TY positions
available starting 2012. However, graduands may still become HOs if they wish.
It is hoped that with working experience, whether as a houseman or as a TY resident, you may have
sufficient insight to make a decision
If you choose not to join residency training after housemanship or TY, the system still allows you to
join residency at any given training year
The goal is for the system to eventually be able to offer residency positions for all who are ready to
start training, however, entry into a training programme is a competitive process and the hard truth
is that not everyone may be accepted in their desired programme or SI, and they may need to reconsider alternative programmes or career paths
OTHER ISSUES
1. Is there are any preferential quota set aside for the Duke students?

No, there isn’t. At least officially.
2. Is there a difference in treatment between Duke and YLLSoM students?


25
There will not be any difference in pay for Duke-NUS GMS or YLLSoM residents because both will be
doing the same level of work. The first post-grad year remains a licensing year for both.
Beyond residency, Duke-NUS GMS graduates may progress faster in their careers on the basis of their
prior academic qualifications, but that will depend on the specific paths they take. For instance, some
Duke-NUS GMS students already have PhDs, which could be an advantage in academic medicine.

Ultimately, it’s still an issue of an individual’s competence and presentation, it has nothing to do with
whether they are from the GMS or YLLSOM.
3. How much are residents paid? Is it different from the HOs?



Allowance for some specialties may differ:
Additional training allowance is given for those pursuing less popular specialties such as Pathology.
Conversely, popular specialties such as Ophthalmology require co-payment for training.
SOURCES:






1st Residency Focus Group meeting with Prof Satku,
2nd Residency Focus Group meeting with Prof Satku,
3rd Residency Focus Group meeting with Prof Satku
Singhealth Residency FAQ,
http://www.singhealth.com.sg/EDUCATIONANDTRAINING/RESIDENCY/FAQS/Pages/Home.aspx
MOHH Residency website FAQ, http://www.physician.mohh.com.sg/residency/faq.html
Pulse Residency Article, ‘Hard & Heart truths about Post-Graduate Medical Eduation: The Residency
Programme’
CONCLUSION
While Residency may have some imperfections with several things still vague or unclear to us in its
primordial stages, it does seek to enhance our graduate medical education and equip us with better skills to
meet the challenges of being future doctors.
As students who will quickly progress to the stage where choices are to be made with respect to our future
careers, we should try to continually gain exposure in the fields where our interests and passions lie but at
the same time, never stop having an open mind towards the different specialties available. Not all of us will be
matched to our first choices, but as long as we constantly remind ourselves that our central goal should be to
help our patients as best as we can, I believe all of us will eventually still attain the same kind of satisfaction
no matter which field we end up in.
26
ACKNOWLEDGEMENTS
Personal review (from The Old VS. The New): Singapore M.D. Blog
http://singaporemd.blogspot.com/
SingHealth Residency FAQ Webpage
http://www.singhealth.com.sg/EDUCATIONANDTRAINING/RESIDENCY/FAQS/Pages/Home.aspx
Editorial team
Chief Editors
Design
Research and writing
 Applications
 The Match
 Programme
 FAQ
With advice from
27
Liu Xuandao
Valencia Foo
Jacqueline Quek
Chua Min Jia, Margaret Teng
Valencia Foo, Rebecca Hoe, Liu Xuandao
Jacqueline Quek
Wang Daobo, Adita Sangam
Manpower Standards and Development Division, MOH