text:
After reading a local final year medical student's comments to the original "Residency" post, I think it deserves to be reproduced as a separate entry:
"Hi, i am a final year student at YLLSOM and i have a few comments on this issue.
We have brought up quite a few of the questions that spacefan has mentioned today at a NUHS briefing on the residency program. The answers we were given were rather vague, with the higher powers knowing little/unwilling to commit as they too have no idea what the finalized plans by the DMS are.
This puts us in an extremely tight spot, as we were informed of this new program only 2months ago, and are now given ONE month to decide and make up our mind and subsequently submit a portfolio in October and go for interviews in January, on top of studying for the final MBBS.
The whole process has been rushed through with little thought given to the current batch of graduating students, with the reasoning being that with us being guinea pigs and that the kinks that we encounter will be ironed out in time to come.
However, this is OUR future we are placing on the line, not theirs.
With regards to the trainee not performing up to expectations, the panel of program directors assured us that it will NOT happen, as we will be very closely monitored and supervised every step of the way(hand-holding). I have serious doubts about that, but they declined to elaborate further with a sweeping statement of if we fail, the sponsoring institution will suffer and the program directors face the sack, hence we will NOT fail.
This whole residency thing benefits those who have made up their minds about their future, and in a short 5 years most will become associate consultants equivalents,(attending physicians). In fact, most will hit reg levels in 3years, which is a boon for them.
However, those of us who are still undecided are "forced" to make a less informed decision of signing up with a residency program, or for that matter ANY residency program if we do not want to be left behind. I say this because even though they have repeatedly stressed the option of a transitional year to look around and decide, we will be severely disadvantaged as the number of places allocated for that particular year will have been almost, if not totally filled, hence we might have to start from the postgradyear1 again in that particular residency should we decide AND get accepted.
The process of the interviews is also a hot topic of discussion, primarily because we have very little to present to the interviewers, who will now scrutinize our medical school grades, down to our anatomy grades in year1 and that biochemistry TEST in CA2. Many of us are caught off guard, as we were time and again told by our seniors and many junior doctors to just pass all the tests and exams in med school, even the MBBS. As long as we pass, our application for speciality training will be based on our performance as a HO/MO.
But now it's a whole new ball game, and many of us are on a wrong footing.
Lastly, all three clusters are scrambling to give us talks on the residency program the past few weeks, treating us as hot commodities and trying to sell their department/programme as the better one.
So do we now choose a particular hospital because say, the programme director was extremely charismatic and eloquent? Or that they gave us more freebies, a better tea session and promises to treat us BETTER than the other hospitals?
If, for example i have been posted to the surgery department in SGH surgery for my third year rotations in medical school, i will almost certainly choose it over the TTSH department as i will have no clue on how their department operates. But will i be making an informed decision? I highly doubt so. Of course if SGH rejects me and i put TTSH surgery as my 2nd choice i might not get it compared to someone who placed it as his 1st choice.
Dear seniors, if you were in our shoes, what will you do?"
It is my hope that putting this comment up will spur the powers-that-be to tackle this issue head-on. I wasn't at the abovementioned briefing, so I have no idea whether any MOH official was present, but I do know that Singapore MD is monitored by MOH, so perhaps this poor M5's S.O.S. will filter through to the DMS.
That said, I'd also like to point out that since emergency medicine is one of the disciplines that has been earmarked for this residency programme, patients can look forward to having fresh med school graduates in our ERs. And I don't mean "look forward to" in a good way.
Back in my medical officer days, ERs were staffed with a good number of medical / surgical trainees, and only 2nd-year or more senior medical officers were allowed to rotate through.
Over the past decade, there's been a huge paradigm shift such that 1st year non-trainee MOs ( and 1st posting MOs especially ) now throng ERs all over the country, with a significant portion of these hailing from overseas ( i.e. returning to Singapore after completing their housemanship in Australia / the UK, etc. ).
Even with 12 months of internship behind them, most 1st year MOs are ill-equipped to handle the stress of ER work, which involves constant multi-tasking, rapid and accurate clinical decision-making, and the difficult job of handling anxious / hysterical / violent patients and relatives.
While I make room for the possibility of fresh graduates mastering the art of communication and public relations quickly, clinical skills is an entirely different kettle of fish. We already face problems monitoring our current MOs. Imagine having a group of even more inexperienced junior doctors added to the mix.
Did this new programme get any coverage in the local news? Don't remember reading anything, and was away during the 1st half of September. Is the public aware of any of this?
68 comments:
- Anonymous said...
I agree with that
My first mo posting was polyclinic and my second posting was a and e.
Everyday was hell for me.
I hope they allow only experienced drs in a and e as a and e is the last line of defense! - 22 September, 2009 00:09
- Anonymous said...
I applaud your efforts to make this public as the top administrators typically don't bother acting on anything until something goes terribly wrong or a big wooha has been made :)
- 22 September, 2009 07:44
- gigamole said...
The new residency programme is clearly a rush-job that defies both conventional logic and wisdom.
The pressures to implement appear to be related to 2 main issues - firstly, the 'desperate' need for specialists to fuel our 'commercialization of medicine' initiatives, and secondly, the impending 'coming on-line' of the Dukes-NUS graduates, and who will be starting their own residency programmes. NUSYLLSOM, not wanting to be left on the sidelines appear to be now scrambling to dovetail their own medical graduates into the same residency programme.
Neither of these reasons are actually matters which have developed overnight and one wonders why the residency was not thought through earlier, and given a longer lead time to develop and implement. There certainly could have been a lot more airtime given to prepare the ground.
Apart from these organizational deficits, the whole idea of the residency programme smacks like too much imitation of the US system without thinking if it is really good for us. The previous requirement for a rotation posting was much better, I felt, because it allowed all intending specialists to rotate through a variety of different disciplines before entering into their intended area of specialization. I think this produces more well rounded practitioners, even if it might a little longer. Now with the residency programme, young graduates (much younger than US grads) jump straight into specialization and superspecialization straight after med school. Considering that many graduates already feel inadequately prepared at the point of graduation, I can't see how we are going to have a good specialists later on.
Organizationally, I am not even sure how individual hospitals (other than those with large specialty units)can adequately mount their own residency programmes, if the system degenerates into an 'every hospital for itself grab for candidates'.
So far talking to different people about this I have not met a single person in the system who felt comfortable about the developments. So I am biting my nails and hoping for the best. - 22 September, 2009 16:17
- Anonymous said...
well i don't think they r going to broadcast such a bad idea to the public rite? :0P..
i graduated from med sch not too long ago. n this residency program was brought up to my attention one fine day at work. actually, i remembered being asked about how we felt if the duke-nus graduates do not have to do HOship upon graduating. well, no prizes as to what kind of response we gave.
if implementing this residency program is so that 50 graduates can feel that they are the same as their american counterparts, then i think whoever that is agreeing to this is simply short sighted.
the residency program may offer a quick and almost painless route of getting the position which i currently may be working my ass off for, but i am not thrilled. simply because i don't see how 5yrs can make u an AC. oh pardon me... i mean an Attending. what is more, we r talking about 5 yrs from the time u graduated from medical sch.
i'm sure many out there agree with me that even the most experienced of us still make mistakes. what more of a fresh graduate.
n whoever has been talking to our current poor m5s has certainly forgotten abt us. those who r still in the current bst/ast system. what will happen to us when this residency thing starts? do we enter it seamlessly and if so, who determines which level we enter at? n when this residency thing kicks off, how then is work distributed? as far as i understand, they seem to only be able to work a certain number of hours in a day/week.
my thinking may be old sch but i just don't see how this works in everyone's favour. how can the current m5s decide now (while in the midst of their studies) which path they want to go? don't we all rather discover what we want to do or not do rather then to be forced to make a hasty decision? even some of my seniors didn't make their choice until they have rotated through enough postings. some even changed speciality just when they were going to become registrars.
n yes, as with the previous person, there has not been anyone else whom i know who seem to agree or rejoice about the implementation of this new program.
i certainly hope that these comments do not fall on deaf ears.. - 22 September, 2009 21:29
- Anonymous said...
I believe there's some pressing need on the need to have 'more' specialists due to (1)aging population and then intuitive (2) building of new hospitals recently.
There's a need to fill up the rosters of the new hospitals when they start coming online.......and not forgetting the recent talks about MOH taking more charge of the nursing homes etc.
For those who can consider their specialty/sub-specialty early, it's a good thing. They get to become specialists/sub-specialists really quickly.
I agree with most of you that for the majority of students/junior doctors, there's really no way for them to find out more about each different specialty until they jump into the deep end of the pool and start working there.
With news of the 3rd medical school coming up (NTU), it is clear that there is going to be alot more doctors graduating every year.
Used to be 100, 150, 180, 200....and in the near future, with the 3 medical schools going at full steam, we'd likely have 500 per year at least.
With the growing list of 'approved' institutions under SMC, I'm sure the numbers of NTS would go up as well.
I see the manpower pool enlarging really quickly and this may in some way help prevent/alleviate increases in medical spendings due to wage adjustments.
It's going to get tougher and tougher especially for those in the private sectors. - 23 September, 2009 09:53
- Game1980 said...
Actually more doctors better
Now see doctor very expensive and must wait very long.
Hopefully with more doctors, medical fees will drop and Singaporeans need not worry about expensive healthcare! - 23 September, 2009 16:25
- Anonymous said...
My sympathies with the junior batch affected by this. I'm personally an in-flight BST, and I'm hoping to quickly get thru to escape the mess. Have spoken to some of the senior people planning the residency programs, and this seems to be what I've gathered...hope this will help our final year medical student.
The basic rational behind this exercise seems to be that DMS wants to 1) churn out more specialists faster due to shortages (maybe coz everyone's leaving the public sector, and Singapore Inc is trying to commercialise healthcare?) & 2) push our training system to conform to the US model. So MOH is trying to modify our training system to allow us to be accredited by the american boards.
Unfortunately, last I heard, none of our hospitals' training programs meet the requirements of the american boards, which are pretty strict. Hence there's no confirmation that anyone going thru the S'pore residency programs will be allowed to take the american board exams and be registered as an american specialist equivalent. Seems like the current plan is to set up a separate residency program that will result in our local residents passing out as specialists recognized only locally.
Pros & cons? They've promised that residents will be given protected training hours and patient loads, and have special wards and clinics set up where 'interesting' cases will be shunted to. But anyone on the ground who knows our current manpower and workload levels will know this will not be feasible for many years. Cons? You're forced to choose your specialty AND training institution when you're young, naive and maybe a little gullible. The rose-tinted glasses fall off soon enough once you start working, and many people do have a change of heart.
Things seem to be moving very fast without much thought. The past few years have seen the standard of teaching and health care drop precipitously on the ground... some places which used to be excellent departments have become places where I'd hesitate to admit my grandmother to. Moral keeps dropping and senior staff with years of experience seem to be leaving.
As for our medical student, I'd advise that no one will look out for you except yourself. Until things firm up, I'd be keeping my safety net and take the UK exams. A very viable alternative is for you to quickly take your USMLE and join a proper US residency program, since you are just starting out and won't have any wasted years of HO & MO-ship which aren't recognised by the americans.
Game1980 - you may not realise it, but compared to many other countries, your health care cost is already very cheap and much subsidised. MOH really don't pay public sector doctors very much compared to our peers in other professional vocations.
~medicalgrounds~ - 23 September, 2009 22:05
- angry doc said...
Yes, do NOT believe when they tell you this programme means you can practise in the US until it is confirmed by the US Board.
- 23 September, 2009 22:51
- Anonymous said...
If healthcare cheap, how come people say can die but not fall sick in Singapore?
Bring in more foreign doctors and create more jobs for local doctors! - 24 September, 2009 00:39
- Anonymous said...
The most pertinent question that everybody should ask but is not asking is: "when the powers-that-be who are proposing and implementing the new residency programs and medical schools get to their old age, will they be willing to be treated and operated upon by the very doctors that their programs have trained?" This I think will be the true litmus test of whether the program is a success -- if you are confident enough to allow yourself to be treated by the very people that you trained.
I firmly believe that as doctors, your job is not just to alleviate suffering and heal, but also to ensure that our skills and knowledge gets passed on to the next generation so that good work can be continued. If we compromise on the training of junior doctors for some political agenda, when these very junior doctors become seniors themselves, our healthcare system will be in a sorry state indeed.
Game1980/Anonymous: Mass produced items cost the cheapest, and are usually also of lower quality/standards compared with items made in limited quantities with more QC. True, you can bring in all the FTs you want and bring down healthcare cost by pumping out more doctors each year with shorter training but the question then remains -- will you get the same standard of healthcare when the prices go down? - 24 September, 2009 09:49
- angry doc said...
"when the powers-that-be who are proposing and implementing the new residency programs and medical schools get to their old age, will they be willing to be treated and operated upon by the very doctors that their programs have trained?"
The point of being a power-that-be is so that you will not have to asnwer that question, isn't it? :)
I believe no matter how bad this new system is, doctors will still get better at what they do since learning is a life-long process. The proposed system short-changes the current junior doctors, and may not adequately train new doctors before they are 'qualified' to call themselves Attending or AC. But the best will still overcome the deficiencies in the system and become good doctors, and powers-that-be will still be able to avail themselves of their services when required. - 24 September, 2009 11:14
- Anonymous said...
With the increasing pool of new doctors and NTS doctors, I believe it may be a big PUSH factor for existing 'more senior' doctors to leave for private practice.....
From the way things are going, I'm quite sure wage adjustments of doctors in the public sector would be under tremendous pressure moving forward.......
Sad state of affairs in future as pte sector would start to get too crowded as well.......
If the policy makers are not careful, they'd start driving out some local doctors to start looking for avenues to practise overseas--China, Auzzie, perhaps even Europe/Canada where there are severe shortages of doctors too....
My teochew speaking grandma already complained to me that during her last admission, she did not see any 'chinese' doctor till her 3rd day in the hospital....Guess it may just get worse..... - 24 September, 2009 11:21
- Anonymous said...
What a racist post!
why must see chinese doctor?
Singapore is not another China!
NUS should admit less Chinese and more non-Chinese instead! - 24 September, 2009 16:13
- Anonymous said...
I am also a final yr student from YLLSOM. Just have some comments to make..
1) Not all Singaporean doctors are Chinese. We are a multiracial society!
2) Agreed, our doctors are not compensated well, especially for the effort they put in. Just to see the amount of sacrifice these people put in for their patients / students is amazing..
3) I hope to clarify some of the things my classmate (Anonymous) posted:
We have been told that we should only make the decision to take up a residency program if we are sure about it. For the rest of us, there is the transitional year (TY), that will let us do 1 yr of HO-ship, and we can decide after that. As for the issue my classmate raised about being "left-behind" and having to compete with the batch below us for places, I feel this is totally unwarranted. The departments have stated that when the next yr application process comes, they will prefer those who have had a yr of working experience over the fresh grads. It is more an issue of being kiasu and trying to get a residency position as fast as possible, which I don't think is the right thing to do. So, we are not being 'forced' to do anything.
As for passing us no matter what, that is also untrue (were we at the same meeting by NUHS?), as they did say that we would be graded year by year, and to pass from PGY1 to PGY2, we would have to fulfil certain requirements. If we do not meet these requirements, we'll have to repeat the year.
As for having to "look forward to medical students", they also explained in the briefing that the 1st yr is broad based, and we may be under the purview of the departments (ED, Gen Med, Gen Surg), but we still will have to do the HO stuff. We will only get to work in those specific departments later in our training. Again, this is dependent on the program. For example the ED residency may require us to do certain postings like ortho first. I seem to like this system, as it can help us avoid the dreaded MOPEX, and I will have someone monitoring my training and postings.
However, I do have some grouses with the process. I do not know how to make a decision on the institution to apply to. NUHS and NHG are out there with facny presentations, while SingHealth is apathetic (prob cos they know no matter what, alot of us will still flock there).
That's all I have to say.
Thanx! - 25 September, 2009 22:46
- Chung King said...
I have put a rather lengthy reply to the student's concern at our website forum: http://www.nhgresidencyprogram.com/forum/topic.php?id=14
Dr Chia Chung King
Associate Program Director
Internal Medicine
NHG Residency Program - 26 September, 2009 03:38
- dave said...
With changes to any system there is bound to be unforseen problems. However the rush to adopt this residency programme is either the brain-child of one of our many 'elite scholars' or a political one aimed at churning out consultants US-style.
Of course the serious deficiencies of the US health system is of no concern. Singapore is more concerned about health care as a product to be advertised to the world and thus boost our economy. Who cares about service to our own citizens.
And no health care cost will not drop ... look at the US.
It surprises me that no one has mentioned that the US med school system is VERY much diff from YLLSOM or many other Cwealth countries. Their graduates tend to be older and are more well-rounded. They have had time to thing about what they would like to accomplish as doctors. Also in the US the final 2 yrs of med school = internship. They are expected to function as interns for the unit. They do not start PGY-1 with the same level of experience as a YLLSOM student. In fact I have been told by many friends (overseas med stud) that YLLSOM students lack experience in the wards/clinical setting.
I think this lack of clinical experience entering a residency program will result in problems. BUT knowing Spore plenty of $, resource and effort wiil be thrown at these problems. Inefficiency is only a SMALL obstacle on the road to results, right? - 26 September, 2009 09:23
- Anonymous said...
Dear colleagues and seniors,
More details on the residency program are available here: http://www.nhgresidencyprogram.com
Kudos to the program staff at NHG for coming up with this! - 26 September, 2009 19:03
- Clueless said...
Correct me if I am wrong. Does this mean that our new Residency programme will neither be recognised by the UK system (royal colleges) nor the USA system? Does it mean that there will be more hurdles for us if we were to practice outside Singapore in the future?
- 27 September, 2009 19:36
- Anonymous said...
why clueless so ungrateful?
Stay in Singapore lah
More good years
Vote PAP - 29 September, 2009 01:11
- AverageStudent said...
I am also a M5 student. I have one huge obstacle, my grades are not the worst, but probably below average, and this was in no part thanks to many seniors and doctors telling me that its more important to perform well in housemanship, and that MBBS is a pass/fail exam, as long as you pass, its good enough. Therefore their advice was to enjoy medical student life and experience the undergraduate training as a last hiatus before the perpetually stressful and incomparably taxing working life.
Clearly, with not much to show for my resume besides my poor grades, how can I expect to get into a residency programme with such short notice? I could not even turn back time to create some CCA records to bolster my bid to specialise in something I really have a passion for.
I do know that this is hugely my own fault for not striving to score As and mugging 10 hours a day in the library, but the fact that the rules of the game were changed right at the death makes me feel rather outdone, with no option left but to accept defeat and leave things to chance.
Before I get blasted with, "its too bad you didnt study harder" or "you poor thing, bad luck", could I receive constructive criticism on how I can improve my odds in getting into a specialty? Especially when I'm pitted against my peers with stellar grades.
Thanks. Sorry if I offended anyone, but its just that its quite difficult to accept last minute changes that have apocolyptic implications on your future and life. - 29 September, 2009 14:29
- Anonymous said...
At the risk of sounding naggy, why was this programme only announced barely 2 months ago when it has been in the pipeline for more than 8 months? Wouldn't it give the graduating class more time to ponder over their career options?
I personally dislike the tone Dr Chung has taken in replying the M5 student who posted on the original topic. Perhaps his "too-bad-just-accept-that-it-is-happening-and-move-on. STOP-worrying-and-start-studying-and-go-with-the-flow-lest-i-fail-you" tone is dripping with sarcasm. Time to lose that ego dude. You are now posting on the internet and everything you do has implications, lest you forget and think you're still some hot shot in the hospital. - 29 September, 2009 16:56
- Chung King said...
I do empathize with the average student. The late announcement does caught people off guard.
I would advice that you still seek for posting related to the specialty of your choice and try to perform well at work. Taking the part 1 exam and try to publish some relevant paper may also increase your chance.
You may end up entering the program slightly later. Even at the current system, you find many people entering BST/AST later than their peers. This may not be a bad thing. You may be more sure of your choice/ more mature to take on challenges etc. At the sametime there are also many who decided and then change their minds later.
This few years of "delay" does not have a large impact on your overall career advancement. Many people who are so called "delayed" for one reason or another ended up doing extremely well. Ask around, there are many such example.
If you are planning to do specialty other than those already offered, your performance at transitional year will certainly carry more weight than your university grade.
Sarcasm is not my intent. I am sorry if it come across as that and no, i certainly am not a hot shot in the hospital or anywhere. I am just some dude that care enough to take time to teach.
Dr Chia Chung King - 29 September, 2009 22:10
- angry doc said...
I have worked with Chung King and I can say for certain he is sincere and not being sarcastic.
- 30 September, 2009 10:25
- Singapore M.D. said...
SingHealth seems to be staying silent, at least on this blog. Surely someone involved with the residency programme is reading this?
- 30 September, 2009 16:29
- Anonymous said...
hi m5 student here. unlike many of my peers who are very worked up over the new residency program, i feel that in the end it won't be that big a deal.
if you are good enough to be trained, you will get training in the end. even in the old BST system, not everyone gets to train in what they want. if you screwed up med school, take a TY, do well and if you really are good, the training position will be there for you.
same for accreditation. if any of us are really worried, just go take your MRCP/S on your own. no one is going to stop you. and in fact in your TY you should supposedly be getting better training than a HO.
if you choose too early and realise later that you chose wrongly (ie. surgery and can't cut), just change. go back to R1. sure, you'd have wasted time. but is wasting 3 years worth doing what you really want? in fact those 3 years could have been wasted during your MOPEX while you were deciding in the old system anyway.
maybe i'm being too optimistic, but things will work out for most (at the expense of the unfortunate few, just hope it's not me). - 30 September, 2009 22:18
- angry doc said...
Correct. Like I wrote in the earlier thread, a year or two (or even three, now that you mentioned it) isn't going to be a big deal. As a wise woman once wrote: the race is long, and in the end, it's only with yourself.
My main concern is with having doctors specialise too early in their practice and being declared a specialist too soon, but I suppose this 'practise in silos' phenomenon will become a norm in our healthcare system; and if it works, when why should I insist on having all-rounded doctors? - 30 September, 2009 22:46
- scoobydoo said...
Looks like every doctor is going to be a specialist.
Interesting direction we are moving. Where will this put Family Physicians?
In the USA they are also specialists. Ditto for Australia. There is a residency program and they end up as board certified Family Physicians.
Is MOH going to allow Family Physicians to charge specialist consult rates? This will drive health care costs up.
Is Family Medicine included as one of the options for specialties in the residency programs?
Currently, the way it seems to go is that all those who are "not good enough" end up being GPs and "Family Physicians". Perhaps we should do away with GPs and just make everyone specialists. I know some people feel that way. - 01 October, 2009 22:22
- Anonymous said...
Just to point out 1 potential flaw.
Their healthcare system is insurance based, where admissions to hospitals are governed by insurance coverage and the population is self checked with such a healthcare policy really fit into ours.
Wheres in Singapore, the number of admissions per night to most general departments which train our interns or junior doctors are usually more than 5, or even more than 10. in some departments, even more than 20-30.
This is because of the sheer volume of of attendance in Singaporean Emergency Departments, the numbers that get admitted are invariably of equivalent proportion. because of a completely different socio-economic healthcare model.
Who is left to clear the remaining cases after the residents see them? Are we going to depend forever on the non-residents or whoever is subsequently designated to clear numbers. Such a system will create more distrust, unhappiness and negativity among doctors who are already dealing with increasing public pressures daily.
As much as if they current system is not perfect, and there is need for change. and change is always difficult.
Is there such a need to push it with such pace, where details of the programme aren't even ironed out. according to forum discussions on this website http://www.nhgresidencyprogram.com
Alot of details have not been fixed and also still awaiting the return of a team from ACGME International in December 2009.
Surely there is no hurry in that case to roll such a programme out by next year if the details are not finalised. Especially since are not investing in the resource of putting the ACGME International team here permanently to better understand our local constraints or Singaporean medical climate and agree to tweaking some of the conditions to acknowledge the unique local training culture that already exists. Let us not also forget the unique situation of our defense considerations and the need for young Singaporean male doctors to do National Service as Medical Officers.
Is the hurry really necessary especially if the main aim of this programme is to remove the flaws of the previous. Starting a new programme with questions or concerns or system errors not addressed will do it more harm than good
If we still insist nonetheless then the roll out date of 2010/2011 should be postponed till clear details are fixed and explained to everyone involved.
Is there a particular rush for the above dates? If there is then maybe more resources like getting a permanent ACGME team is necessary to facilitate the process to allay concerns fears and distrust.
Surely more time to iron out details of the programmes, and make clear decisions on the faiths of all involved including the current junior doctors/trainees/HOs/MOs and medical students included is only fair to the large numbers of local Singaporean graduates who form the majority of the system who serve in public health.
Change is never easy but faith and confidence will make all that much of a difference.
I do seriously hope the people involved do consider the feedback that is provided for by many who are directly affected and involved as this is their education, career and lives that are at stake as much as the patients that they treat and have to serve. - 04 October, 2009 00:31
- c said...
To address Anonymous00:31's queries, its obvious everything is being rushed because the first batch of students from a certain school are about to graduate and need to be fitted into a special post-grad program.
This just smarts of poor planning. All these preparations could have come online as long as 4-5 years ago.
To all the confused M5 students out there, please DON'T get distracted. STUDY. Pass your MBBS first. You stand to lose the most if you waste your time worrying as much is out of your control. You WILL have a job when you graduate. We need you guys onboard without a doubt. Dreams can be chased later when the storm clouds have blown over. - 04 October, 2009 15:35
- Anonymous said...
if what c is saying is right then it doesn't make sense changing a whole system with something new that is not even finalised properly for a number of 25, instead of the 250. and don't forget the current batch of HOs, which is another 250 or what more the many MOs who are non-trainees.
maybe the M5s should get together and make themselves be heard, instead of letting a certain school get all the limelight just because of its american association.
the irony is that our current system has produced the standards we apparently are known for. this system is already attracting so many foreign doctors and foreign univesity tie ups like duke and apparently now imperial college.
or maybe it's time for the senior members of the profession to step up and speak up for the majority, after all they are the ones who will form the bulk who will get the large volume of work done. - 04 October, 2009 17:48
- Anonymous said...
I refer to the post by anonymous on 30 September 2009 16:29. Yes, like what you yourself have concurred, you are indeed too optimistic.
What you are choosing here is not just a specialist course. It is a career, it is your life, it is your future. No one should take this lightly and conclude that "if it doesn't work out in the end, just change and do a new one".
As far as the program directors have mentioned that there would be no penalty or financial disincentive should anyone choose to bail out of any residency program and decide to go for another, there is no stopping for the development of stigma, or in otherwards, putting yourself in the optics of being a trainee who does "residency shopping". No tutor will ever take it lying down if their students give up on a wimp after 2-3 years of training or even with a year of training. The program directors of your next prospective residency program will definitely want to know why you quit, and how you actually fared in your previous program. And if i were your tutor, i may not have very much positive things to say about someone who quitted my programme. Another thing to consider is this: will tutors even have stamina remaining to continue teaching should their students keep changing their courses? I don't think so.
Secondly, if you talk to enough MOs or registrars when you are in the wards, you should be well aware that a good many of them make changes in their career decisions before finally deciding on what to specialise. The difference between you and your predecessors is your seniors have the luxury of trying out a few postings, from general ones to hone their clinical acumen to the ones that they are interested in, before they finally decide on the one they choose to specialise.
The current TY seems to be able to allow you to do so, for it claims to give you enough exposure and such. Frankly speaking, I won't be too sanguine even with the TY program. One, you still have to indicate what specialty you are aiming towards. if you should find that that is not the one you want in the end, you still face the disincentive of having to start all over again, as modules you may have covered in your TY may not be valid in the next prospective residency programme you are applying for.
And if you think that one or two years don't really matter, think again. How many of us really have the stamina to "start all over" to train, train and train? Medical school takes up 5 years of your time, or 6 if you include HOship. Upon graduation, students are already older than the majority of our peers. How about other things like starting a family/marriage? If you think these are things too far away or not worth considering, do take note not to regret when you finally find yourself too late or too embroiled in your training or wasted too much time to even start a family. - 04 October, 2009 21:34
- Anonymous said...
continued from my previous post.
Also, aren't people curious why is family medicine left out of this whole package of new programmes? A good many doctors nevertheless eventually choose family medicine as their final career path. be it whether it's for the lifestyle, the simplicity, the autonomy of running one own's business etc, all of these are legitimate reasons enough to make a doctor decide a career in family medicine. If i were in your class, i would be asking your class rep whether a petition should be drawn to MOH to consider opening up family medicine as a choice. Forcing a whole batch of students to specialise in many specialties but denying a path which many of your predecessors have already taken doesn't seem to bode well in me.
Finally, from a bystander perspective, the introduction of this program by MOH wipes out anyone hoping to do their specialist training overseas. I don't know if anyone from your class actually asked the higher-ups about this. Training overseas has potential to hone a doctor better than one who does everything in his own country. You get to work with people from a different environment, with very different socioeconomic profiles, with very different disease/epidemiology/clinical presentation, with very different healthcare systems etc. These are intangible, yet invaluable experience as it trains you to be a more versatile, more well rounded doctor.
Lastly, the program may not have enough international recognition compared to the classic MRCP/MRCS or other board exams. I'd really be questioning why this is the case. If this new programme doesn't carry enough weight or international recognition, why would i want to choose it compared to another elsewhere which offers me similar training but more recognition?
One final word of advice to you guys is this. Everyone up there can give you enough anecdotal evidence, successful and inspiring stories enough to spir you up emotionally and motivate you in making your decisions. It is however, your job to discern all of this hype presented to you and what's really there on the ground. A castle isn't built on questionable foundations. Similarly, a training program shouldn't be built on questionable intent from the higher-ups, which will ultimately serve not to be your benefit at the very end of the day. - 04 October, 2009 21:35
- angry doc said...
I think you are being too pessimistic about the whole programme.
People have been switching specialties for a long time now, and I don't see them being seen as "quitters". Granted the residency programme will be different from the current MOPEX/BST-AST programme, but the US system is not littered with "quitters" either, is it?
Medical students do get rotated to different departments during their training, and as I understand it the final year will soon be more like a housemanship (in effect an extended SPI year?), so they will get an idea of what work is like.
And don't worry about Family Medicine too much - there are existing programmes for FM, and as I understand it there will also be a direct residency programme for FM (details when the DMS returns?).
Finally, with regards to:
"What you are choosing here is not just a specialist course. It is a career, it is your life, it is your future."
I would like to say I am sorry you feel this way about your life.
The specialist course is not your career - it is merely one step on a journey, albiet an important one. Your career, assuming you live to practise to 'retirement age', will certainly be longer than your years spent as a trainee or resident. Being made a specialist just says you have made the minimum grade - there is still a whole lot of learning and getting better ahead.
It certainly shouldn't be your entire life or future either. - 04 October, 2009 22:16
- Anonymous said...
To angry doc. Let's cut the semantics.
Whatever the case, i agree with the anonymous person who wrote that two posts.
Choosing a specialty is no doubt a significant choice determining one's future and career and ultimately fulfillment in life.
It is not pessimism that the writer of that post chose to take. It is pragmatism and reality which he's trying to elucidate in this whole residency saga.
Quitters are everywhere indeed. Like another writer has written, the US system is different in a sense that the students are older, more mature and had a medical education which is streamlined towards the path of residency.
Compare that to the current undergraduate medical education system in singapore and you will be able to realise that this additional gear added to the current cogwheel is just going to throw the whole machinery all asunder.
- By realisticstudent. - 05 October, 2009 21:07
- Medboy said...
i'm a yr 5 student.
Just wanna comment on a part of ngrydoc's recent post:
"Medical students do get rotated to different departments during their training, and as I understand it the final year will soon be more like a housemanship (in effect an extended SPI year?), so they will get an idea of what work is like."
One thing i'd like to say is that as far as what i've experienced, training and working is really two different things. The "idea of what work is like" from what one sees while training, is really different compared to when you are really holding the responsibility during work itself. (like in SIP) - 05 October, 2009 21:15
- angry doc said...
Well, realisticstudent, I am sorry that you too feel that way about your life. Life is about more than your day-job, and medicine is a wide enough profession that fulfillment can be found even if you do not become a specialist in the specialty of your choice.
I think you too are too pessimistic about the new programme, but until the first batch enters and exits from it we are just trading speculations.
Like I said the new 5th year will be an extended SIP, and not just one whole year of looking.
I agree with you that there is nothing like being responsible for a patient that makes one learn. - 06 October, 2009 09:13
- angry doc said...
One more thing: I understand that change, especially sudden and unexpected change, can be threatening.
However, having spoken to some of the people involved in the programme I understand that they are trying to help make things better. No one is doing this to put obstacles in your place.
At the same time, no one owes you your specialty of choice, and certainly no one owes you fulfillment in life.
If you know what you want and you want what you want, go out there and get it.
If you don't get it, remember William Hung. - 06 October, 2009 09:33
- realisticstudent said...
again, i find what angrydoc's comments a no-brainer.
Let's not kid ourselves.
We in the medical profession spend years of time devoting our lives to training to treat patients better and to learn about diseases and managing them.
Let's take a look at the work life of a doc/consultant/senior consultant. He spends 20 yrs, 8 - 5 am in the hospital, working, teaching and training.
To say that medical training and working doesn't form a significant portion of your life, LITERALLY, is an understatement.
Like i said earlier, lets cut it short by not arguing about whether there is life out there or what. We can indeed choose how we lead our lives etc.
One thing however, we should know, that in the medical profession, sometimes, in fact, MOST times, your time is spent in the hospital. - 08 October, 2009 19:56
- Anonymous said...
Another M5 student here who is bothered about this whole Residency Issue. Some thoughts from one of my classmates. He may not speak for the entire class, but he speaks for me.
The senior doctors in the fraternity should speak up for us. We ARE getting our hands quite full down here. Q&A sessions have been arranged for us not for FEEDBACK but for disseminating information. Those up there THINK its the best for us.
No one owes us our degrees, but can you imagine half the cohort failing their finals as a result of this fiasco? - 08 October, 2009 22:47
- Anonymous said...
there seems to be a wrong relation on this thread between the problems in the US healthcare system and problems in the US healthcare education. US system might have it's problems, it is expensive etc.. but we are NOT adopting their health care system . We will sick with our more highly ranked system we are taking JUST the way they train doctors which last time I checked was as excellent as anywhere in the world. Those "unqualified" products of US residencies are very competent doctors. Your worries about us says more that you think we are less intelligent which is untrue.
- 09 October, 2009 04:03
- angry doc said...
I think you need to get some perspective, realisticstudent.
Under the old/current system, no one guarantees you your specialty of choice either.
So if you are going to pin your life's fulfillment on getting the specialty/subspecialty of choice, you can become disappointed under the current system too. Why is it any differnt under the new system? - 09 October, 2009 17:12
- Anonymous said...
@angrydoc: under the current system, you will get to rotate through different postings and your competency is assessed on your work attitude and aptitude towards the handling of patients before you are offered the specialty of choice should you make the cut.
under the new system, you will be accepted into the programme based on your grades in med sch, a portfolio which has been hastily put together in less than a month and an interview which during the short duration the committee is supposed to be able to sieve out the BEST who have yet to be in their field.
what say you? - 09 October, 2009 21:30
- angry doc said...
I would say that sounds pretty much like getting into medical school, doesn't it?
You make it sound like you either make the first cut, or you never become a specialist in the specialty of your choice - that is not true.
You can wait and watch, and you can apply for a different specialty if you change your mind. If you are good you can still get in, and if you are bad you can still be dropped. Getting a foot in the door first is not the be-all and end-all, or the key to fulfillment in your life.
It's not that different from the current scheme, is it?
I'm not saying that it isn't unfair to change the rules of the game so late in the final period, but I think the essence of the game is still the same - you present your best work, and you keep at it.
But have some perspective - if your chances for getting into the specialty of your choice were good to begin with under the old system, will they diminish drastically under the new system?
Will your classmates whom you think are less deserving of getting the specialty of your choice suddenly have an advantage over you that he doesn't deserve?
Why should the same people who made the right descision to admit you into medical school when you had zero medical experience, and based only on a few interviews, suddenly make the wrong decision and not admit you to the residency programme you deserve when they have more to work on now?
Finally, even if this system is unfair, even if it means you don't become a specialist in the specialty of your choice (which you oh so deserve), does that really mean that you won't find fulfillment in your life?
Do you really *know* that there is no fulfillment in your life outside what you imagined what life as a specialist in the specialty of your choice is like, in your 5th year medical student mind?
Or are you just *imagining* that you deserve to be admitted into the specialty of your choice, and that under the old system it would *surely* have been yours, and that you will *definitely* become successful in it, and you will find fulfillment in life?
Are you not mourning a future that was never certain to begin with?
No one has snatched anything that you have truly earned by your efforts out of your hands yet. They may have shifted the goalposts, but you haven't scored a goal in the old goalposts either. You haven't even taken a shot yet.
Now are you going to stand there and whine about how they shifted the goalposts and that prevented you from becoming the greatest football player ever, or are you going to play ball? - 09 October, 2009 22:31
- angry doc said...
Funny thing is, no medical student seems to have commented that they find their chances of getting a traineeship raised by this new programme; looks like everyone thought their chances were better under the old system. If everyone's equally disadvantaged, doesn't it mean it's not unfair? :)
- 09 October, 2009 22:34
- Realisticstudent said...
again, angrydoc, i really don't understand why the argument about life fulfillment.
i have mentioned earlier, that we shouldn't kid ourselves. That the decisions we make on our residency programme does have impact on our lives.
The fact that you don't really see this shows how detached you are from the ground level. The level of your juniors, or us M5s for that matter.
One - there is nothing or little for the higher-ups to work with. We have ZERO work experience. if SIP counts as work experience, i'd say that's too lousy a predictor of how that student will fare in future, as a SIP student still takes responsibilities which are not up to HO-lvl YET. SIP, for any matter, was instituted to ensure a smoother transition into HOship. It was not really meant to serve the purpose of assessing or predicting accurately how a student is going to perform in future.
TWO - Like someone else in this blog post has mentioned earlier. Not everyone has the luxury and time to "start all over" should the programme not work out for them. There are other things, those "fulfillment" which you have so spoken, like family, romance, travelling, whatever. Notice the common factor here? Time. The opportunity cost of training over and over again due to erroneous decision making or decisions made too early is that you waste time doing training which may not help you enough in getting where you want to get in life.
Our predecessors have the luxury of trying out postings without committing to training in a specialty too early.
We on the other hand, face the risk of wasting effort, time, and maybe even money. The future programmes also face a high risk of high turnover due to ppl quitting after finding out the specialty is not for them. - 10 October, 2009 23:19
- Anonymous said...
I agree that with this program, more of us will be able to specialise. The only problem is that we aren't in a position to make a good choice, given that our exposure to a particular field of medicine/surg thus far has been limited to a few weeks of the clinical posting, and so some of us might end up specialising in sth we may later regret.
Anw my question is this. I spoke to one of the senior doctors on the residency panel and he kept calling this program the "ACGME" program. I understand this is the same term that is used for US residency programs. Does this mean that should an NUS student take the USMLE, he/she can practice in the US after the bond, with the years spent in the residency program, carried over to the US? Does anyone have any idea what steps are necessary for an NUS student to practice in the US? - 10 October, 2009 23:35
- Worried and confused student said...
This just uploaded on the NHG Residency Program website:
Update on selection
By CHUNGKING | Published: OCTOBER 11, 2009
Dear M5s
We are glad to announce that MOH has given some clarity about the residency application and selection process. While we await MOH's actual announcement, we have decided to remove the NHG Residency Selection criteria from public view to avoid confusion. The information we placed on the "NHG Residency Selection" was based on many US residency application and selection common requirements, and what we had submitted to MOHH. For the M5s who have already obtained requested letters of recommendation, please feel free to bring them, together with any other supporting documents, to the pre-matching interview.
Please check back at our web site for more updates.
A/Prof Lim Tock Han
NHG residency program
What is going on? - 11 October, 2009 09:19
- angry doc said...
I think you may be over-romanticising the current programme.
Firstly, people do drop their traineeship after a few years and after taking their Part I now, so they do 'waste' time under the current system.
Secondly, if you were to spend two years shopping around for a specialty before deciding on the one you want, what difference in time 'wasted' is there from if you picked a residency, did it for two years, and then decided you wanted to specialise in something else?
Both routes are hard - neither one is a bed of roses. The decision on your choice of residency does impact your career, but why do you assume that your path would have been smoother under the old system than the new? - 11 October, 2009 10:06
- Realisticstudent said...
the difference is that committing to a specialty training early means we'll miss out on needed broad-based training.
Sure, the residency programme has promised some degree of broad-based training. However, 8 months of GM and GS in the first year of residency isn't quite enough to qualify as broad based training.
Let's say if i were to sign up for pathology as my specialty of interest for the residency programme. mid-way in yr 3 i feel that it isn't the right one for me, i'll have to start from scratch in another specialty cos what i've learnt may not have been relevant for the new prospective specialty.
isnt' it time wasted? Ppl can sugar-coat it and say it isn't cos the value of finding out that the path isn't suited for you is more valuable than whatever time spent.
Let's cut the crap and get to the realistic facts. Time wasted is time wasted. Like i've mentioned before, and like what the other writer before me mentioned, not all of us have the luxury of time, effort and money to keep this up.
The old system offered ppl the choice of experiencing work postings first before they decide to specialise in a particular area. This has been, however, taken away from the new system as you have to now choose one to go into early based on, like Worried and Confused student said, a few weeks of clinical postings which are barely enough exposure to tell one that that specialty is his/her particular calling. - 11 October, 2009 12:30
- angry doc said...
If you want to wait and watch, there is nothing to stop you from doing so. If indeed the new residency programme is going to produce some many "quitters" as you fear it will, I am sure you will find vacancies when you have finally made up your mind.
I still think you are over-idealising the current programme.
To use your own example, let's say I obtain a traineeship under the current system in pathology and I begin to do postings to fulfill the training criteria. Mid-way in yr 3 I feel that it isn't the right one for me, I will still have to start from scratch in another specialty because what I've learnt may not have been relevant for the new prospective specialty.
How is that different from the new residency programme?
(As a matter of fact I have heard of a patho reg who quit recently - so has her life's fulfillment been ruined by the old system?)
I have tried to understand why you are so opposed to the residency programme because the faults you find with it are neither absent from the current system, nor are they insurmountable.
I believe your grouse is this: you are not worried about your time being wasted in and of itself. You are worried about your peers "getting ahead" of you because they happen to be able to decide on what specialty they want to do before you do. You would rather everyone get posted around for a few years before having a chance to get a traineeship, by which time you are certain you would have proven your worth over your classmates and will definitely get the specialty of your choice, go through a smooth training programme where you will have the time for the other aspects of life, become a successful specialist, and find fulfillment in life. To you, that is the "fair" system.
Well here's news for you: people who make up their minds early and take their exams and publish papers do get accepted into traineeships in their first year; some medical students participate in papers, and some HOs get offered traineeships even during HOship (ask Dr spacfan). These people get ahead of those who don't decide early under the current system anyway - the residency programme helps these people.
If you don't decide next year, so be it - deciding early is no virtue in itself, and like I (and others) have said, 2 or 3 years is not too long to wait or "lag behind" your peers. The race is long, and in the end it is only with yourself.
Do it at your own pace. - 11 October, 2009 14:14
- Realisticstudent said...
Like i said, the main pertinent flaw of this programme is that when ppl commit too early due to a premature decision, there will be time and effort wasted.
Sure, you have rightfully said too, ppl are or will indeed worry about the limited places.
You quit a programme a year or two later, you still have to compete with your junior batches or any other person for that matter for the same place. Places are not unlimited. The competition is there for the best person suited for the job. This has been there since the beginning of time and hence i have no grouse about this.
The thing which you didn't realise which is going to complicate this whole programme is that premature decisions due to inexperience and inadequate exposure to work postings is just going to throw this whole programme asunder.
One: Who is going to deal with the job vacancy left behind as the new programme starts in July? Overseas HOs? Or are our current in-phase HO seniors going to continue to work another few more months getting less pay than they rightfully deserved?
Two: There is already significant turnover rate. You have mentioned that in the current BST/AST system, there are already "quitters" or "changers". Isn't this going to be worse? Since now ppl don't have the luxury to try out postings on neutral ground before committing to a specialty?
Third: You have mentioned about life fulfillment. I'm saying this one final time. When you waste time, your incur the opportunity cost to pursue this life fulfillment.
Fourth: Put yourself in the place of the tutor. How are you going to feel if you have to keep repeating your teachings to batches of trainees but none of them are going to work in your department or in the same specialty elsewhere cos they quit due to premature decisions made? Will you, taking with you your altruism to teach, be able to outlast against the fatigue and demoralisation you sustain with the numbers of quitters, who are definitely going to increase cos now the current students are making premature decisions cos they have barely any work exposure apart from SIPs and maybe a couple of elective postings? - 11 October, 2009 14:52
- angry doc said...
We repeat ourselves, realisticstudent, and at the end of the day your argument hinges on the fact that people are more likely to regret their choice if they choose a residency programme prematurely.
Isn't the solution to that simple?
Postpone that decision.
If you won't postpone that decision, perhaps you need to ask yourself why. - 11 October, 2009 15:11
- Anonymous said...
Under the "old" system, doctors are not required to choose a specialty until they've actually started working. Of course there will be some with a burning desire for a certain specialty, who would have set the groundwork (i.e. research papers, electives) for that speciality during medical school. But the vast majority of incoming housemen who wouldn't have made up their minds, wouldn't be under such intense pressure to make a choice the moment they leave medical school, thus giving them time to work, prove themselves, and eventually choose a speciality, safe in the knowledge that the majority of the places allocated for specialisation would be open till they've completed their HOship.
Under the new system, the "pressure" on medical students to pick a speciality even before they've worked a day in the wards has been significantly ratcheted up. Now the vast majority will choose a speciality even before they've worked. So those who do their HOship/transitional year rather than specialise straight away will end up competing for a significantly reduced number of places. And thus far, MOH has not provided any assurances that a certain number of places will be reserved for those doing a transitional year.
And then there's this issue of foreign graduates. One of the senior board members I spoke to told me that NUS students will not only be competing with Duke students, but with fresh grads from uk/australia, even the US. Apparently there is currently a quota system for the proportion of foreign grads in a given speciality (under the old system). But with this new residency system, the quota will be done away with, thus "opening up the market". Anyone who has gone thru NUS will know how hard it is to get good grades, how demanding our EOPTs are, and the ridiculous work load that we have to grapple with. But overseas grads, left with much more time than us to pursue electives and research projects, and thus build up a formidable portfolio, with their accents and significantly better soft/people skills, will now come striding into our country, taking our places, and leaving us high and dry. This opinion isn't from me, but this is from a senior doctor on the panel, who also said that the newfound reliance on foreign grads stems from MOH's concern that NUS students "lack maturity"
So how exactly can this new program possibly be fair? - 11 October, 2009 17:57
- disgruntledmedic said...
The higher ups have REPEATEDLY told us to shop around if we are unable to decide which programme we are interested in.
However in that SAME breath they have IMPLIED that should we NOT choose a particular specialty in the first year we would be disadvantaged as we will be competing with the junior batches for the limited spaces available.
Lastly they have warned that should we decide to change tracks, there will be PENALTIES, both financial and perhaps even consequential as the programme directors of the new track that we are interested in MIGHT not take us as we have DROPPED OUT of a particular programme.
They have clearly indicated that THEY ARE NOT SURE of the guidelines and proposals, so much so that NHG has to retract its public forum JUSTINCASE, which implies that they are anticipating MOHH to make sudden drastic changes every now and then. - 11 October, 2009 19:03
- angry doc said...
realisticstudent (if you are realistic student, you didn't sign off in your latest comment),
"... safe in the knowledge that the majority of the places allocated for specialisation would be open till they've completed their HOship."
That's not true. First-year MOs compete with older MOs under the current system - they do not have places reserved for them.
"... those who do their HOship/transitional year rather than specialise straight away will end up competing for a significantly reduced number of places."
By this same argument, those who do not apply for traineeship as MO1"lose out" to those who do under the current system too!
"And thus far, MOH has not provided any assurances that a certain number of places will be reserved for those doing a transitional year."
They don't, and neither do they guarantee a fixed number of traineeship in your specialty of choice, in your department of choice, each year under they current system.
"... overseas grads, left with much more time than us to pursue electives and research projects, and thus build up a formidable portfolio, with their accents and significantly better soft/people skills, will now come striding into our country, taking our places, and leaving us high and dry... how exactly can this new program possibly be fair?"
Yes. How can a system that awards residency places to students with more formidable portfolios be fair? In fact, how can any programme that does not give *you* the specialty of *your* choice be fair, right?
I'll tell you what your problem is: you have an imperfect understanding of the current system and imagine that it is rigged to your favour, and that the new system is not.
You believe that residency spots should be reserved for you (after al, this is *your* country and the places are *your* places!) and not people who have different accents and impressive portfolios, because they *can't possibly* be better than you, which you could easily have proven if you just didn't have so much workload under NUS.
It's just not possible that the people who seem to be able to benefit from the new system - people who did well in medical school, people who have decided on their specialty early, foreign grads - *deserve* residency places, and will make better specialists than *you*, is it?
Yes, I have gotten personal because you have shown that your concern for the supposed shortcomings of the residency programme is also personal. You are not concerned as to whether or not this programme will produce better specialists, but whether your own chances of becoming one will be affected.
Ask yourself this: if at this very moment you are guaranteed of a residency spot of your choice, without any further need for portfolio or interview, as long as you passed your Final MBBS, will you still speak against the residency programme? Don't answer the question on this blog, just ask yourself and examine your own motives. - 11 October, 2009 19:17
- angry doc said...
"...they have IMPLIED that should we NOT choose a particular specialty in the first year we would be disadvantaged as we will be competing with the junior batches for the limited spaces available."
As I wrote in my earlier comment, this is true for the current system too.
"... they have warned that should we decide to change tracks, there will be PENALTIES, both financial and perhaps even consequential as the programme directors of the new track that we are interested in MIGHT not take us as we have DROPPED OUT of a particular programme."
Again, true for the current system too.
"They have clearly indicated that THEY ARE NOT SURE of the guidelines and proposals, so much so that NHG has to retract its public forum JUSTINCASE, which implies that they are anticipating MOHH to make sudden drastic changes every now and then."
Yes, I share your unhappiness over this. I hope the programme's implementation can be delayed by a year but from my current understanding that is unlikely to happen. - 11 October, 2009 19:35
- Realisticstudent said...
those posts without my moniker isn't written by me. I'll just reply with respect to what angrydoc said regarding my post.
Postponing the decision?
Apparently, if i'm not wrong, all current M5s have to make up their minds by the end of october. Which is either a transitional year/residency programme. Transitional year isn't really the same as the current HO postings, as we still have to indicate what which specialty we are working towards. - 11 October, 2009 20:06
- Realisticstudent said...
Excuse me angrydoc, pardon me for asking. Are you a programme director for any of the residency programs?
Secondly, i did not wrote those posts. Seeing that you have the urge to reply in such an arrogant manner, and in such a personal approach, demonstrates how much maturity you have in a discussion.
My stand remains that you are far too detached from the current state of affairs, the views and concerns of your juniors.
I have no hidden agenda behind my arguments, if that is what you are concerned about. What is on the palate is on the palate. Don't go around trying to find bugs in a plate of fried kway teow when ppl have already showed you there isn't a single one.
Like i said before, the competition is there all the time. I don't think many of us have anything to grouse about with the competition. The thing which most of us are concerned about are
1) Why the need to decide so fast?
Will we benefit from premature decisions made when we haven't even started work yet? Learning and working are really two different things. It's just like army training. Running 2.4km in army fatigues is definitely a different experience than running 2.4 with a 15kg full pack. In similar steed, learning about diseases and working in an instituition, carry the weight of responsibilities in treating these diseases in patients is definitely different.
2) What happens should we want to change later?
Some talks have implied that it is alright to change. there will be no penalties blah blah. Obviously, one will find these hard to believe. Just like how in the medical profession we dichotomize things to list our differential diagnosis. The dichotomy here is that there are tangible penalties and intangible ones. One, financial penalty. Some of the popular programmes may require us to pay upfront "tuition fees". Two, which has not been said, but definitely not unthinkable, is what an anonymous post above have mentioned before - the biaseness which tutors will develop towards the students should they quit the programme. Let's put it this way, will one be more compelled to give bad comments or not-so-good comments should they quit the programme? Chances are this is likely. - 11 October, 2009 20:19
- angry doc said...
No, realisticstudent, I am not a programme director.
- 11 October, 2009 20:36
- spacefan said...
Actually, wrt all this talk about competition for specialist training programmes - I've heard that the quota on the number of specialists has been lifted. Whether an official statement was made and I'm unaware of it, maybe someone can enlighten me about that.
So if there's no quota, shouldn't there be more flexibility in terms of residency positions?
Also, to address realisticstudent's comments:
angry doc is correct about the similarities between the current BST and the upcoming ACGME programmes. That includes the fees, the penalties, the stigma of sorts, etc.
The big difference is probably more obvious for specialties like surgery and medicine - residents are likely to be posted to purely surgical / medical depts throughout their training period from Yr 1 onwards.
Not so much for emergency medicine ( also on the ACGME list ) - trainees still go through medical / surgical / paediatric rotations, in addition to A&E.
I've never been a fan of narrow-based learning. Surgeons who can't read ECGs and internists who can't detect a surgical abdomen or diagnose fractures on xrays just don't sit well with me.
And if the new programme limits this further, I worry about the effects it will have on the quality of younger specialists.
And asking M5s to decide on their future careers on such short notice - a case of poor planning on MOH's part.
In a much earlier post, I asked if the M5s would like to get their class rep to approach the Dean or MOH to clear up this mess. At least compel them to iron out the details and release official guidelines, rather than leave you all hanging like this.
Of course, I'm not that optimistic that anything will be done. But you can consider trying. - 11 October, 2009 22:15
- Anonymous said...
Stole this off my classmate's blog. He has been rather vocal in the past about issues regarding the medical system in singapore. Hope he doesn't mind.
A residency thing....
It is most evident that whatever is happening is definitely going to happen regardless of anyone's approval/disapproval. And with the MBBS coming up in a few months time, it is a much wiser choice to concentrate on consolidating our knowledge and aim towards passing our finals.
I think the stand most students have consciously taken is that of "going with the flow", with some bordering towards that of "resignation". Although the residency issues are indeed concerning and worrying, practically speaking, there is no point concerning/worrying ourselves with such uncertainties when they are constantly evolving.
However, trying to concentrate on the MBBS is no easy task with numerous distractions everywhere.
First and foremost, this whole idea of a residency only cropped up a few months back. The concept of having to decide on a life-path even before we graduate is indeed a daunting thought. To make matters worse, the uncertainty of what criteria the "program directors" are looking out for in their future residents is proving to be very unsettling to the graduating batch, especially when every senior in the past (ranging from recently graduated HOs to senior consultants) have told us, "just aim to pass MBBS!". Their age-old advice is that "grades are never a true reflection of how good a doctor one usually is."
Imagine the confusion and helplessness when final year students are told that certain aspects of their medical school years are taken into consideration for their selection into the residency program.
Admittedly, numerous assurances that no one will be "adversely disadvantaged" have been made. But the fact remains that with just a few months left to our final year, our previous humble mindset of aiming to gain a holistic education and just passing MBBS, is now turned 180 degrees to that of....make an impression, get to know the "right people", choose your specialty soon, and start earning some "brownie points".
And do it quick! - 11 October, 2009 22:35
- Anonymous said...
The next set of distractions is that of the numerous "roadshows" held by the individual clusters/hospitals.
To cut a long story short, each hospital does not have the full picture. Most of them are honest enough to admit this. But despite their honesty, most hospitals paint very variable pictures of what they interpret the residency program to be. These varying details include the application process, the transitional year, the issue of NS, timelines, exams, etc etc etc.
The way this whole residency thing is being advertised has also resulted in several groups of unhappy people.
1) The incoming batch--- for the respective reasons.
2) The equally clueless graduates (including HOs and present BST/AST trainees) who have been told that the residency program is not open to them. Most of them seem upset because from the way the various sources have "advertised" the residency program, the present system that they are in is painted as a flawed one, while the residency program is painted as a "solution". Of course, these "paintings" lack details. Some have also expressed concern over the success in integrating the 2 systems concurrently and whether they will be disadvantaged.
3) The senior doctors and teachers. A significant proportion of senior doctors who actively engage in teaching are unaware of the details of the change. Most have shrugged off this issue with nonchalance saying that they will continue to teach the juniors with similar passion and methodology. Whereas, some have taken the issue to heart with sincere concerns over the merits of the system----- taking in fresh graduates into a specialty program and the need to revamp a system that has served well for all these years.
Looking at the 3 groups stated above, they practically encompass the majority of the medical fraternity. Which begs the question, who are making these decisions?
It is an accepted fact that these decisions are political in nature and were made in line with "national interests". What these "national interests" are is another pandora's box that is best left unopened.
For now, the main point of this little discussion is that of distractions.
As a medical student, the pursuit of knowledge (should) remains top priority. Choosing which specialty one is interested in should and must take a back seat to first becoming a safe doctor. (Whether or not it is fair to expect medical students, with no working experience, to choose a specialty is not even a topic of discussion here, since it is pointless discussing about an issue that has been decided already.)
We trust that each hospital/cluster is aware of these changes. We do not doubt the capabilities in MOH/MOHH in disseminating information to them. There is no need for them to hold roadshows to tell us that they are "planning" something, especially when the full details are not yet confirmed.
Personally, the most useful piece of information is regarding that of the individual specialties---like what they entail, their experiences, their scope etc etc.
There is no real point advertising the differences in the training program. Doesn't the advertising of the individual training capabilities defeat the purpose of having a residency program? The supposed whole idea of a residency program was conceptualized so that MOH/MOHH can have better control over the quality and content of teaching of junior doctors--- ensuring less inter-cluster/hospital variability and quality of teaching. So it does not make much sense for hospitals to go on "advertising campaigns/roadshows" to showcase their "superior" training programs. - 12 October, 2009 06:32
- Anonymous said...
At the end of the day, if someone has a passion for general surgery and his first choice cluster does not accept him/her, does it mean that he should choose a different specialty just so that he can get into that cluster, since it "promotes" itself to have a "better" training program?
Let MOH/MOHH finalize their details and brief everyone about them, including us. When they have answered everyone's questions, it would be best for everyone to take a step back and digest all these details.
Let the roadshows wait? (It almost seems like a competition amongst clusters to "fight" for the "best future-residents", while painting a picture that they are the "best".)
It is not like we will be running anywhere. We are bonded for 5/6 years.
This is an important decision, and we will definitely consider everything carefully in due time.
Just do not distract us? There is no point making us come back for roadshows twice a week on evenings (or making us feel guilty when we don't) and we end up failing our MBBS.
But then again, the fault cannot be placed on the clusters/hospitals either, especially when the deadlines are so rushed. (Application supposedly opens in October). Most of the time, the doctors giving the briefings have our best interests at heart. Moreover, some of these sessions were organised in a bid to answer some of the students' numerous questions that surround this whole residency issue. Unfortunately, most of these answers are yet to be finalized from above. Hence, only creating a situation of increased uncertainty instead of the initial intention of quelling it.
At the end of the day, this residency thing is going to happen. Period
We understand. - 12 October, 2009 06:32
- Anonymous said...
Worried and confused student,
seems like there is a follow-up to the selection message from prof lim.
also, MOHH also has a residency site coming up in 6 days time. http://www.physician.mohh.com.sg/ - 15 October, 2009 11:41
- Anonymous said...
Just attended the singhealth residency talk this evening. Was quite shocked at what transpired in the talk.
They gave various presentations on the various specialities offered and for many, the lack of a transitional year presentation was evident. When questioned, SHS said that the TY was not even planned yet even though they were offering it!! how can this be possible when applications are about to open next week??
Furthermore, for specialities such as Internal med and GS, SHS is opening up 2010 residency applications to the current HOs. What happened to all that talk by DMS that applications for 2010 are SOLELY for the current m5s?? Wont that mean the current HOs are at an advantage as they have gone through the various postings before applying?
Why are the sponsoring institutions not in line with what the DMS is saying and who do we trust?? - 17 October, 2009 00:15
- angry doc said...
"Wont that mean the current HOs are at an advantage as they have gone through the various postings before applying?"
The fact that they will be exclude from the residency scheme is a main complaint of those serving their housemanship now...
I guess there's no pleasing everybody, is there? - 17 October, 2009 19:20
- Realisticstudent said...
There's alot of contradiction lately surrounding this whole residency program issue.
just a couple of days ago. DMS in the press commented that there are only 40 specialist trainee places for this program.
I wonder what happened to all that transpired in previous talks, about having more than enough places for everyone in the m5 batch.
First came many questions unanswered. Now comes all this contradiction. I guess we should all be careful and it's not too bad to have some skepticism regarding this program. - 17 October, 2009 21:48
- Anonymous said...
Just read this posting by MOHH on this website:
"hospadmin Says:
September 9th, 2009 at 1:19 am
For paeds
In public sector, only National University Hospital and KK Hospital
work culture: Paed well respected in Singapore, chance to go private and earn more money
Salaries: MO salary (3500-5000)exclude bonus
foreigners get housing allowance
Since you have MRCPCH,u can negotiate for 500 more per month (postgrad qualification)
AST competitive and they are thinking of making it seamless i.e like us residency programme.
Current system is like uk system
This is to cater to Duke-NUS medical graduates who are graduating next yr.
Contact my director for further details
Human Resources & Talent
Development Division
MOH Holdings Pte Ltd
83 Clemenceau Avenue #15-03
UE Square, Singapore 239920
Fax : (65) 6720 0980
Email : firstname.lastname@example.com
http://www.physician.mohh.com.sg/career.html" - 24 October, 2009 21:28


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subset: commoncrawl


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Originally Posted by Jorick I'll take part in this, but only if everyone takes you literally all the time to ruin your sarcastic snarking. This is a new movement. BOWELMOVEMENTsnicker
Oh god. We're all fucked now.
Act my age? What the fuck is that, act my age? What do I care how old I am? The Ocean is old as fuck. It will still drown your ass with vigor. RIP PLATINUM VAGINA THREAD </3 | Watch my bullshit. Originally Posted by Sophistikit 8D Originally Posted by Grif Normal people -> regular tier -> turbonerd -> Smiral Originally Posted by SmexySpiral Is your computer a giant penis? Originally Posted by SmexySpiral I was a very angry child that turned into an even angrier adolescent. Originally Posted by Esper Svenn quit pretending your head is a phallic shaped object and mind your manners. Originally Posted by Kill Bones Who the fuck is teaching math in my shower Originally Posted by Sophistikit cool Originally Posted by Kenyi Zed, which part of your not-even-close-to-adult brain does not understand "Shut the fuck up"? Originally Posted by Kingdoml1 You people disgust me Originally Posted by Sophistikit I'm gonna tattoo your face on my face so my face looks like your face so it'll be like you have abs with Holmes tattooed on them Originally Posted by SmexySpiral no Originally Posted by sobamushi ..........apparently I have standards. Originally Posted by RandomEncounter I remember those. Originally Posted by Azarthes I'm glad I'm such a positive influence in your life. Originally Posted by Kill Bones Who the fuck are you Originally Posted by Card VII Or you could liquify them and inject those delicious carbs right into your eyeballs. Like a real American. Originally Posted by Kill Bones Don't you make lewd hand gestures at me Originally Posted by Hellis Originally Posted by SmexySpiral I slammed my dick on the table. RIP table. ;_; when will the carnage stop! Originally Posted by Taaja Hart I am a crashing wave on the beach of humanity. - - - Updated - - - I am a smashing slave on the bleach of profanity. - - - Updated - - - I am a dashing cave on the speech of insanity. Originally Posted by Hank You're fucking retarded as dicks, please don't try to get involved in anything ever again. Leave serious matters to the people who know what they're doing. Originally Posted by Sophistikit HAHAHA Originally Posted by TripMyHop Smiral is like an ocean. She's salty and things go to her when they want to drown. Take that as a compliment, somehow.
Originally Posted by TripMyHop Good god. I constantly bitch about that. That would be awful. fuck off jorick just go away Im reporting your post. D: I know it would be, but you're just going to have to deal with it now. Why would you report me? I didn't break any rules. Originally Posted by SmexySpiral Actually, you're not that far off. Though not a direct connection. - - - Updated - - - /clinging I knew it. Also, lol babby clinging to her mommy's skirts. You're lucky you have your gang connections.
Did you know we have a Writer of the Month contest? Come join it. Entries for WOTM #32: Change are up for voting until December 17th. Casual | Advanced Originally Posted by Sophistikit I don't know why, but this fucking killed me. Maybe it's your utter determination to be an asshole, but wow, I lol'd. Originally Posted by Turtlicious And now I can't stop laughing, Thanks Jorick. <3 Originally Posted by Darkdrago666 You loveable asshole, you. You are blunt, and to the point. Originally Posted by Sophistikit If I had feels, they'd be all yours. :'D Originally Posted by Myyt Jorick: This guy is an evil genius. In the dry, in your face trufax sorta way. If you ever want the blunt truth, this is the guy to ask, which makes him amazing. Originally Posted by Esper Jorick is one of those people you shouldn't take seriously. He is rude for the sake of being rude much of the time. Outside of Spam that is not who he is, but here in Forum that is how he carries himself. Why do I respect that? He doesn't give an apology for being himself or making ridiculous claims to deflect when people call him on it. Jorick is Jorick, a charismatic ass to the end. Originally Posted by Elendra Ladies, contain your orgasms for Jorick I had dibs first. Originally Posted by Rilla Put it this way. If me and Jorick meet docile or non-docile lifeforms... they'll bow. Without a fight. Why? Because it's me and Jorick. We'll use our combined charisma, wit, and generally dickish attitudes, to put them in their unwelcome places. Vote Rilla/Jorick - Space Emperors... To Infinity... and Beyond. Originally Posted by overwatch When Jorick says something, It's like adding a 100,000 ton weight onto a side of a scale. Originally Posted by Kill Bones Jorick is like a monster truck shaped like a t-rex He is elegantly designed, menacing, loud, a bunch of people love him for reasons I don't understand, and he makes no fucking sense when described by similes Originally Posted by Walker of Darkness You're an egotistical, sociopathic, insufferable jackass, but you stick to your convictions and in general show others respect until they prove to be nothing more than bumbling idiots. You've also shown a kinder side from time to time, but very rarely. Other than your blown out of proportion ego, I have no issues with you. Originally Posted by ★LunaLight★ Jorick, I find you to be really witty and fun. I'm also jealous of your writing ability. I get mad at you when you do stupid things that get you banned, but at the same time I don't think it is my place to tell you those things since we aren't good friends yet. You seem like the kind of person I would consider dating. Originally Posted by Hank Jorick is a monster. The way he perfectly knows how to emulate this depravity of a subculture with cold, unerring accuracy is just inhuman. Ted Bundy raped and killed women. Jorick's worse. Originally Posted by PrimezTime I imagine Jorick as Khal Drago. His victim would either suffer, take it, and cry about it or learn to please him and become his Khaleesi. Originally Posted by SmexySpiral I think Jorick's the only person who can make giant posts and I'll still read them anyway.
Originally Posted by Jorick Also, lol babby clinging to her mommy's skirts. You're lucky you have your gang connections. Need you to pick a place on the family trees still, bro
Thanks Megs <3
Originally Posted by SmexySpiral Oh god. We're all fucked now. I just wanted to bother you but now it backfired. - - - Updated - - - Originally Posted by Elendra Need you to pick a place on the family trees still, bro He should totally be in the Rew family. Either an uncle or brother. 8D
awko taco Originally Posted by Ruby To quote the great Location: "shut up scribz."
Originally Posted by Elendra Need you to pick a place on the family trees still, bro I did, on Skype. I said you should make me a cat in the Wimbleton household. - - - Updated - - - I'll bump your Sims thread with that info too, because why not.
Originally Posted by Jorick I did, on Skype. I said you should make me a cat in the Wimbleton household. Good, our family didn't want you anyway. t.t
Originally Posted by TripMyHop Good, our family didn't want you anyway. t.t Looking at the chart thing, you're technically in the Turtleton household, not Rew. Marriage stuff and last name shenanigans, I guess. Also, c'mon, look at the people in the Wimbleton house. There was no way I wasn't going to choose that one.
Originally Posted by Jorick I did, on Skype. I said you should make me a cat in the Wimbleton household. - - - Updated - - - I'll bump your Sims thread with that info too, because why not. Well might as well make your feline sheet done so I can throw you in, ami-- wait you wanna be a cat around hank... sure you don't mean dog? Or a cat elsewhere?
This whole thread made me laugh.
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Be on the lookout for a tour announcement this week from Kenny Chesney! The Lucky Old Son will reveal the details behind his 2013 tour on NoShoesRadio.com Thursday at 9 a.m. ET.
Kenny headlined 23 stadium dates with Tim McGraw this summer, and the pair currently share the CMA Award for Vocal Event of the Year for "Feel Like a Rock Star."
Kenny's next performance will be halftime at the Dallas Cowboys football game on Thanksgiving Day to kick off the 122nd Salvation Army Red Kettle Campaign.


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Transparent Quartz over Neolite Turquoise makes this strong statement of style an absolute marvel in "Barbados" blue. Layered gemstones create a dazzling, multidimensional look, framed in rich 18k yellow gold with sculptural crescent-woven side details.
Precious MetalsAvailable in Sterling Silver with 18K Yellow Gold or Rose Gold Accents.
Gemstones Pictured in Clear Quartz over Neolite Turquoise. Also available in Rose Quartz over Pink Mother Of Pearl, Chalcedony, Smokey Quartz, Rutilated Quartz over Black Onyx Approximate carats as pictured: 20.02ct
0.83"w X 0.83"l


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You Are Here: AHRQ Home > Quality & Patient Safety > Measuring Healthcare Quality > National Healthcare Quality & Disparities Reports, 2008 > Data Tables Appendix
a The 2007 data reflect care for the period 7/1/07 to 12/30/07; 2002 data reflect care for the period 1/1/02 to 6/30/02.
b A facility had to have at least 20 residents in the denominator for a postacute care measure to be calculated; therefore, the number of facilities may vary for each measure reported in a State.
Key: SE: standard error.
Source: Centers for Medicare & Medicaid Services, Minimum Data Set. Data were downloaded from www.medicare.gov/nhcompare/home.asp. The 2007 data were downloaded on April 18, 2008; the 2002 data, in November 2002.
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