Information Pack for General Surgery Residency … GS Residency Info...Prepared by Tan Kok Yang 1...

Prepared by Tan Kok Yang 1

Information Pack for General Surgery Residency

Programme as Participating Site

NHG-AHPL Residency

Programme

May 2011


Introduction

During the exciting times of moving into Singapore’s newest restructured hospital, we invite

you to take the challenge in being one of the team in delivering a seamless patient

experience. As the General Surgery Department looks towards expanding into KTPH,

bounderies will be redefined and new frontiers will be explored.

As part of the NHG Residency programme for General Surgery, we aim to continue our good

tradition of teaching both basic knowledge and clinical skills by exploring new approaches

and optimizing the commitment of senior staff. These will be through structured teaching

and academic activities in line with the philosophies of the NHG Residency Programme.

Our department will be able to provide a wide mix of general surgical cases which is bound

to enhance the experience of our residents. Current areas of development and expansion

include Hepatobiliary Surgery, Colorectal Surgery, Upper Gastrointestinal Surgery and

Bariatric Surgery, Advanced Laparoscopic Surgery, Breast and Endocrine Surgery and

Advanced Endoscopy. Some of these specialties are pioneering new techniques of surgery

substantiated by research findings from the department. Residents will be given

opportunities to experience all the various facets of and learn the skills of General Surgery

with a hands-on approach that is supervised.

Our department also takes pride in its research output with frequent publications in

International peer-reviewed journals. Our presenters have also been recipients of awards

for their presentations at Scientific Meetings. There are a number of ongoing prospective

randomized trials and international collaborations that are being undertaken by the

department. Residents will be given the unique opportunity to immerse in this research

culture and be given opportunities to perform and publish clinical research findings.

We look forward very much to your contribution.


General Surgery Faculty

Site Programme Director: Tan Kok Yang

Core Faculty: Kenneth Mak (HOD)

Tan Tzu Jen

Emile Woo

Cheah Yee Lee

Faculty: Anton Cheng

Poon Pak Leng

Jude Lee

Reyaz Singaporewalla

Subash Kumar

Radikha Lakshmi

(Ganesh Ramalingam)


The Department of Surgery at Khoo Teck Puat Hospital comprises a Division of General

Surgery as well as a Division of Urology. These two clinical divisions provide a broad range of

clinical services, supported by visiting specialists to provide selected surgical subspecialty

services within KTPH.

Scope of Services

The General Surgery (GS) Division provides all-hours care for patients within the following

general surgical subspecialty domains, including:

Upper Gastrointestinal Surgery

Colorectal Surgery

Hepatobiliary and Pancreatic Surgery

Breast Surgery

Endocrine Surgery

Bariatric Surgery

Trauma Surgery

Vascular Surgery

Minimally Invasive Surgery

Endoscopy (both basic and advanced)

The GS Division also partners other clinical departments in the hospital to provide multi-

disciplinary care in the following clinical areas:

Geriatric Surgical Service

o With the Departments of Geriatric Medicine, Anaesthesia, Cardiology,

Dietetics and Nutritional Service, Rehabilitative Services and Nursing.

Head and Neck Surgery

o With the Departments of ENT and Dental Surgery

Trauma Service

o With the Departments of Anaesthesia and Orthopaedics

Bariatric Surgery


o With the Health for Life Centre, Departments of Medicine, Anaesthesia,

Dietetics and Nutritional Service and Rehabilitative Services

Surgical Critical Care

o With the Department of Anaesthesia

The GS Division provides emergency surgical support for visiting consultants from KKWCH,

who in turn run an ambulatory antenatal clinic as well as outpatient gynaecology clinic in

KTPH. This includes support for peri-mortem caesarian sections in trauma patients.

The Urology Division provides both ambulatory and in-patient care for both elective and

acute urological clinical problems. Ambulatory urology includes a one-stop assessment

service in the outpatient clinics, with facilities for ultrasound scanning, cystoscopy and

Uroflow studies available. Outpatient management of urological stones is available through

ESWL facilities within the Urology clinic. In-patient services include the management of both

elective and acute urological problems, including the surgery for urological malignancies and

for urological trauma.

Visiting Specialists provide coverage in the following clinical areas:

Vascular Surgery

o Through service agreement with NUHS Department of Cardiothoracic and

Vascular Surgery, as well as by Dr Sanjay Nalachandran (private practice)

Plastic Surgery

o Through service agreement with SGH Department of Plastic Surgery

Neurosurgery

o Through service agreement with NUHS Division of Neurosurgery, Department

of Surgery

Emergency Cardiothoracic Surgical Support

o Through service agreement with National Heart Centre and NUHS

Department of Cardiothoracic and Vascular Surgery


o This provides emergency surgical support for the interventional cardiology

service as well as for acute thoracic trauma care, in patients too unstable for

transfer to a hospital with tertiary level cardiothoracic surgery services.

Medical and Radiation Oncology

o Through service agreement with National Cancer Centre

o This provides for medical oncology clinics to be run in KTPH, dedicated clinics

for GI malignancies (Dr Simon Ong, Thursdays), Breast and Gynaecological

malignancies (Dr Lynette Ngo, Fridays), Head & Neck, Lung and Urological

malignancies (Dr Ang Mei Kim, Tuesdays) on a weekly basis. The medical

oncologists will also attend to in-patient consultations.

o Ambulatory Chemotherapy services will be provided in KTPH from September

2010. The hospital has plans to set up an in-house radiation therapy service,

with one linear accelerator to be operational in Q1, 2011 and a second linear

accelerator in 2012.

Visiting Consultants have admitting privileges to care for patients at KTPH. The surgical

teams within the Department ‘adopt’ the relevant VC into their teams so that junior staff

members within the affected team have the designated responsibility to look after the

patients on behalf of the specific VC.


Department Staff Profile

Specialty/

Subspecialty

Remarks

Senior Consultants Clin Assoc Prof Kenneth Mak General Surgery, HPB

Surgery, Liver Transplantation, Trauma

Department Head, Educational Supervisor Core Faculty for NHG-AHPL Residency Programme

Dr Anton Cheng Kui Sing General Surgery, Laparoscopic Surgery, Bariatric Surgery

Dr Lim Tow Poh Urology

Consultants Dr Tan Kok Yang General Surgery, Colorectal

Surgery Associate Programme Director and Core Faculty for NHG-AHPL Residency Programme. Dept Research Coordinator

Dr Poon Pak Leng General Surgery, Colorectal Surgery

Coordinator for Medical Undergraduate Teaching

Dr Tan Tzu-Jen General Surgery, HPB Surgery, Bariatric Surgery, Laparoscopic Surgery

Core Faculty for NHG-AHPL Residency Programme

Dr Subash Kumar Breast Surgery

Dr Jude Lee E L General Surgery, Laparoscopic Surgery, Upper GI Surgery

Core Faculty for NHG-AHPL Residency Programme

Dr Emile Woo General Surgery Core Faculty for NHG-AHPL Residency Programme

Dr Amit Mukherjee Urology

Dr Colin Teo Chang Peng Urology


Specialty/

Subspecialty

Remarks

Dr Ong Chin Hu Urology 2 years as AC

Dr Reyaz Moiz Singaporewalla

General Surgery, Endocrine Surgery, Head + Neck Surgery

1 year as AC Junior Staff Supervisor

Dr Radhika Lakshmanan General Surgery, Breast Surgery

1 year as AC

Dr Ganesh Ramalingam General Surgery, Trauma Surgery

0.5 years as AC Junior Staff Supervisor

Dr Cheah Yee Lee General Surgery Core Faculty for NHG-AHPL Residency Programme

The Department is recruiting several additional specialists, who are scheduled to join KTPH within

the next 6 months. This includes

Dr Julian Wong MBChB (Aberdeen), FRCS (General surgery)

Vascular Surgery Dr Wong will be 0.5 FTE in KTPH and 0.5 FTE in NUHS


Visiting Specialists Prof Raj Nambiar Gen Surgery Ad hoc VC, participates in

teaching activities

Prof Low Cheng Hock Gen Surgery Ad hoc VC. Participates in teaching activities

A/Prof Chou Ning Neurosurgery Sessional visiting specialists. Provide 24/7 Neurosurgery cover in KTPH.

Dr Yeo Tseng Tsai

Dr David Choy

A/Prof Peter Robless Vascular Surgery Ad-hoc VC

Dr Chia Kok Hoong Ad-hoc VC

Dr Sanjay Nalachandran Sessional VC

Michael George Caleb Cardiothoracic Surgery Ad-hoc VC

Dr Francis Seow Choen Colorectal Surgery Ad-hoc VC

Dr Wong Soong Kuan Ad-hoc VC

Dr Eric Gan HPB, Advanced Endoscopy Sessional VC. Provides additional support for ERCP

Dr Ang Tiing Leong Gastroenterology, Advanced Endoscopy

Ad-hoc VC. Provides additional support for ERCP, EUS, stenting

Dr Christopher Khor Advanced Endoscopy Ad-hoc VC


Registrars and Advanced Specialty Trainees

List Names Specialty/

Subspecialty

Remarks

Registrars

Dr Eugene Yang Weiren Neurosurgery NUH AST for Neurosurgery

Dr Roy Koh Neurosurgery NUH AST for Neurosurgery; on HMDP

Dr Eugene Lim Kee Wee General Surgery Completed AST exit examinations in August 2010

Dr Surendra Kumar

Mantoo

General Surgery AST (4th year)

Dr Ngiam Kee Yuan General Surgery AST (3rd year)

Dr Sim Hsien Lin General Surgery AST (3rd year); Currently in TTSH Surgery

Dr Anil D Rao General Surgery Probationary AST

Dr Shum Cheuk Fan Urology Service Registrar

Dr Germaine Xu Guiqin General Surgery AST; Currently TTSH

Dr Desmond Ooi Guo

Shen

General Surgery AST; Currently NUH

Dr Aaron Poh Guo Han General Surgery Service Registrar

Dr Tan Chun Hai General Surgery Service Registrar

Dr Daniel Lee Jin Keat General Surgery Service Registrar

Dr Arunesh Majumder General Surgery Service Registrar


Junior Staff

Total number of MOs (out of complement of 10)

10

Total number of HOs 5

Number of Transitional Year trainees 1

Number of residents 5 From May 2011


Department Structure and Organisation

The General Surgical Division is organized into 4 teams. The Urology Division and

Neurosurgical Service are designated as separate teams within the Department.

The 4 GS surgical teams participate in providing acute emergency surgical call coverage, in

addition to ambulatory outpatient and elective in-patient surgical care. Teams 1 through to

4 have their calls on fixed week-days, with the remaining extended week-end calls shared

among the teams in rotation. On average, each consultant will have 5-7 calls per month.

Each surgical team is organized with a senior resident(PGY4-5)/registrar/AST and at least

one PGY2-3 resident/medical officer supporting the team clinician leads. The PGY1 resident/

Head

Clin Assoc Prof Kenneth Mak

Team 1

Mr E Woo Mr Reyaz

Team 2

A/P K Mak Mr Tan TJ

Mr Jude Lee Mr Eric Gan

Team 3

Mr Tan KY Mr Poon PL Mr Seow C

Mr Wong SK

Secretary

Grace Lim

Team 4

Mr A Cheng

Urology

Neurosurgery

Clin Assoc Prof Chou N Mr Yeo Tseng Tsai

Mr David Choy

Vascular

Mr Sanjay N A/Prof P Robless

Mr Ben Chuah

Breast

Mr S Kumar


house officers are distributed among the teams to maximize their learning opportunities.

The vascular service is supported by a GS registrar, and the neurosurgical team is supported

by a GS medical officer.

Acute Care Call System

Current Department on-call teams to comprise one senior resident(PGY4-5)/registrars, two

PGY2-3 resident/medical officer and one PGY1 resident/house officer. The senior members

of the call team reviews acute cases as far as possible at the A&E Department, clerking the

cases at the point of first review, so as to minimize the burden in the wards, after transfer

from the A&E.

All on-call staff have access to rest rooms during their calls. In addition, the hospital has a

staff lounge which the staff can utilize for rest during the day, even when they are not on

call. Duty hours will be guided according to ACGMEi requirements and will be tracked.

ICU – HD coverage

The ICU strategic development masterplan for KTPH envisages a phased expansion of the

SICU – High Dependency Unit bed capacity beyond its current 8 SICU + 4 HD beds. The

Department of Anaesthesia will continue to run the Surgical ICU in a closed concept. Surgical

High Dependency will be under the charge of Department of Surgery. There will be rotation

of residents into Surgical ICU and HD with formal training provided jointly by the

Departments of Anaesthesia and Surgery.


Educational Activities

Residents participate in educational activities at hospital level and department level. All

educational activities are designated protected time for training.

Hospital Level

Monthly clinical forum

Monthly clinic-pathologoical conference

Fortnightly Radiology Department tutorials

Department Level

Mon Tue Wed Thur Fri Sat

Am AST /PGY

4-5

teaching

0730-

0830

Grand Wd

Round

0730-0830

PGY 1-3

teaching

0730-0830

M&M

0730-0900

Journal

Club

0700-0830

Combined

programmes

with TTSH

AST

masterclasses

Pm Clinical

teaching

1630 -

1730

Breast

Tumour

board

Fortnightly

GI Tumour

board

1630 –

1800

Fortnightly

Radiology

conference

1630-1730

Monthly

To be

scheduled

by APD

Teaching

clinics

Subspecialty

teaching

Research

meeting


I) Monday Clinical Teaching by Core Faculty

Goal: To increase the knowledge involving common surgical topics, including diagnosis,

treatment and managements of surgical diseases.

Venue: To be confirmed with GS Department secretary

Time: Monday, 1630-1730

This will combine topic discussions with clinical teaching. Residents are required to present

1 intereresting case under their service each. Residents are required to read around that

particular topic prior to the teaching and present key points of learning.

Requirements:

1) Residents must attend at least 75% of clinical teachings.

II) Surgical Grand Rounds

Goal: To increase knowledge in the area of diagnosis and treatment of surgical diseases

with special emphasis on critical care issues. Surgical management will be scrutinized and

discussed.

Venue: SICU for all

Time: Tuesday, 0730-0830

The Surgical Grand Rounds consist of bedside teaching session and discussion on the cases

in the SICU. Clinical management, diagnosis, surgical and critical care management of these


patients will be discussed. The sessions are usually conducted by the HOD or Senior

Consultants of the department. Visiting consultants are usually present for further input.

Residents are expected to present these cases for discussion. Senior residents are expected

to be able to discuss their clinical decisions and management for the patients. All residents

are expected to discuss the cases for presentation with the consultant in charge prior to

presentation. Residents should read up on relevant topics

Requirements:

1) Residents must attend at least 75% of the Grand Rounds.

2) Active participation in the discussions is expected and will be tracked by APD.

III) Journal Club

Goal: This forum serves 2 purposes:

1. Updates of relevant surgical topics in various disciplines

2. Critical appraisal of journal articles and discussions on evidence levels

Venue: Boardroom

Time: Friday, 0730-0830

Trainees and residents will take turns to present at the journal clubs. The topic or paper for

presentation should be determined with the consultant in charge (teams will take turns) at

least 1 week prior to presentation and the topic or paper disseminated to the department

for prereading

Requirements:


1) Residents must attend at least 75% of the Journal Club.

2) For topic review, presenter should present a summary of a few key papers on the

topic.

3) For critical appraisal of a paper, the presenter is expected to do a well thought-out

summary, present key data and systematically criticize the methodology.

IV) Morbidity & Mortality Conference (M & M)

Goal: To provide residents and faculty an opportunity to review and improve their

approach to treatment and management of surgical patients through thoughtful and

systematic analysis of any complications, deaths and complex cases which occurred or were

operated on in the preceding week. To increase the residents’ knowledge and awareness of

system and evidence based practice in enhancing total patient care. Residents will have an

opportunity to learn from the management issues fo other residents and faculty members.

M & M is held weekly on Thursday to review current complications, deaths and interesting

or complex cases operated on the preceeding week. Listed operations for the following

week will also be discussed with emphasis on identification of correct indications for surgery

and preoperative work-up. This is a forum for open, non-heirachical discussion of

mortalities, surgical complications and management of complications with an honest review

of what could have been done better or whether changes need to be implemented.

Venue: Boardroom

Time: Thursday, 0730-0900

Objectives:

1) Residents will present surgical complications and/or deaths and systematically

discuss their decision making and management of care to identify possible

options which may have resulted in a more positive outcome. (Please follow the

format of the department M&M reporting)


2) Resident analyze decision making and apply knowledge, experience and feedback

to future practice experience.

3) The Senior Resident are tasked to manage M&M reporting will need to fill up the

reporting form and ensure that the information on the M&M reporting slides is

accurate for auditing and archiving by the hospital.

V) Teaching Lectures

Goals: To discuss and teach common core topics of managing medical and surgical

emergencies for interns and junior residents.

Core acute topics in medicine and surgery will be front loaded in the first few weeks of a

new residency year to facilitate understanding and increasing competency of junior

residents in handling common medical emergencies. (Organised by primary institution)

All surgical core topics will be covered in coordination with TTSH through these lectures.

Lectures should be interactive.

Venue: To be confirmed

Time: Wednesday, 0730-0830

V) General Surgery Tumour Board

Goals: For residents to understand and be involved in the multidisciplinary management of

cancer patients. Also become familiar with some of the complexities of certain cancer

patients.


This is a forum for multidisciplinary discussion of cancer patients including discussions on

surgical and histological findings that may impact on the further management of cancer

patients with neoadjuvant and adjuvant treatments.

Residents:

1) Residents should present cancer patients that they have been involved with.

Discussion points on the patients should be confirmed with the consultant-

in-charge.

2) Tumour board findings and recommendations should be clearly documented

by the resident in the case-sheets and follow-up ensured.

Venue: Boardroom

Time: Thursday, 1630-1800 fortnightly

VI) Radiology Conference

Goals: For residents to learn reading of diagnostic imaging findings through clinical

correlation with surgical and pathological findings.

This is a forum is conducted by radiologists with discussions on key findings of images.

Indications are discussed. Correlation with clinical and surgical findings are performed for a

learning experience for all levels.

1) Residents must attend 75% of radiology conferences

2) Residents are expected to present the clinical aspects of the cases

Venue: To be confirmed

Time: Friday, 1630-1730 monthly


VII) Research Meeting

Goals: Residents are expected to be involved in clinical research in the department and the

meeting is a time for discussions on the methodology and progress.

Time: Fortnightly with supervisor faculty

VIII) Teaching Clinics and Subspecialty Teaching

Goals: These are for clinical teaching in the outpatient setting and also for more specialized

teaching of subspecialties.

Courses and Workshops

The following are courses that the residents are expected to participate in while rotating to

KTPH General Surgery.

Hospital level

Combined perioperative services orientation workshop

Annual hospital-wide research forum

Research / Manuscript writing workshop


Department Level

American College of Surgeons Fundamentals of Laparoscopic Surgery

Bowel anastomosis workshop

Basic ultrasound workshop

Fine-needle aspiration cytology course


Educational Contents and Goals of GS Rotation to KTPH in R1

Goals and Objectives

Patient Care

Patient care responsibilities will be graduated according to resident proficiency and PGY

status.

The resident should demonstrate the ability to:

1. Evaluate common surgical conditions through a comprehensive history, physical

examination, and appropriate diagnostic studies and particularly identify ill patients.

2. Be familiar with fluid, electrolyte and nutritional requirements of surgical patients;

become competent with ward procedures including intravenous assess, central

venous line, chest tube insertion.

3. Understand the operative steps for commonly performed lower complexity

procedures

1. Appendicectomy for simple and complicated appendicitis including laparoscopic

approach

2. Inguinal hernia repair

3. Proper excision of lumps and bumps including lymph node biopsy

4. Incision drainage of abscesses

5. Principles of opening and closing the abdomen

4. Manage trauma patients including application of ATLS principles and basic surgical

management.

5. Be familiar with common general surgical conditions including hepatobiliary sepsis,

gastrointestinal bleeding and pancreatitis.

Medical knowledge

The resident should develop a modest understanding of

1. Physiology of surgical illness and stress

2. Basic pathology of surgical disease in a general surgery department

3. Resuscitation of surgical patient (sepsis, hemorrhagic shock)


4. Typical clinical presentation, basic evaluation and management of common general

surgical conditions

Appendicitis

Abdominal hernias

Cholecystitis

Hepato-biliary sepsis

Pancreatitis

Intestinal obstruction

Gastrointestinal perforation

Gastrointestinal cancers

Gastric outlet obstruction

Gastrointestinal bleeding

Practice Based Learning and Improvement

The resident should demonstrate the ability to

1. Critically evaluate published literature regarding the diseases managed on general

surgery service, and formulate evidenced-based therapeutic plan.

2. Summarise the relevant major cases and present them at the M&M meeting in a

constructive and educational manner

3. Prepare in advance for teaching rounds and conferences with an emphasis on

punctual and regular attendance.

4. Teach junior doctors and medical students posted to the department.

5. Residents should participate in workshop and conferences organised by the

department.

Interpersonal and Communications Skill

The resident should demonstrate the ability to

1. Work effectively with peers and nursing colleagues in managing patients.

• Communicate abbreviated yet thorough patient discussions with senior staff


• Counsel patients and their families, including discussions of complex general surgical

procedures and disorders.

• Update relevant involved medical and allied health personnel via phone or written

communication with regard to patient care.

Professionalism

The resident should

1. Demonstrate responsible commitment to patients; be ready to provide bedside and

operative care to patients irrespective of time of day.

2. Demonstrate sensitivity to age, gender, and culture of patients and their families and

other health care professionals.

3. Carry out administrative responsibilities (medical reports, discharge procedures) in a

time-sensitive manner

Systems Based Practice.

The resident should

1. Demonstrate the ability to efficiently organize the care of the surgical patient in a

cost-effective and evidenced-based manner.

2. Appropriately recruit other specialists and health care professionals to optimize the

care of the surgical patient

3. Adhere to hospital policies and procedures and other regulatory guidelines

Support for Training and Service

The programme is supported financially by the Ministry of Health (MOH) Singapore and

Alexandra Health Pte Ltd with financial commitment for hiring backfill for faculty to optimize

service and teaching.

Manpower backfills are as follows:


Protected Time for Education

– 0.5 FTE for Designated Institutional Officer

– 0.2 to 0.3 FTE for Associate DIO (ADIO)

– 0.5 FTE for Program Directors (PD)

– 0.3 FTE for Associate Program Directors (APD)

– 0.2 for Core Clinical Faculty Members (CCFM)

Education/Teaching Time includes:

a) Protected Education/Teaching Time (PET)

• Defined as teaching activities without any service rendered. E.g. lectures, journal club,

conferences.

b) Service Education/Teaching Time (SET)

• Teaching while providing service

• Includes ward rounds, clinics in which there is a resident with you and active learning is

taking place

• For CCFM= 15hrs per week PET+SET

• For Faculty Members= at least 0.1FTE, any combination of PET and SET

KTPH members of the NHG-AHPL GMEC, headed by ADIO Dr Tavintharan Subramaniam have

regular meetings to evaluate resources, training and have oversight on all residency

rotations in KTPH. Admin support will be from Institutional Coordinator, Sabrina Kay.

Faculty development funds are available for educational courses for the teaching faculty.

IT facilities and resources are provided with broadband access. Medline journal indexing as

well as electronic journal subscriptions are provided by KTPH. The hospital also has a

Learning Centre with a library being set up.


KTPH has a computerized clinical data management system that will allow all residents to

assess radiographic, laboratory data, discharge summaries from any computer in the

hospital using a secured password assess.

Information and resources for education will be available on the education website of KTPH.

At department level, the department has a library with a wide selection of textbooks and

reference materials. The department also has a collection of AV material, including training

course videos and videos on various surgical procedures.

The department also has specific surgical skills training facilites including an Experimental

Surgery Lab, Minimally Invasive Surgery trainers and facilities to conduct the FLS course.

All residents will have ongoing assess to TTSH simulation centre facilites.

Resident Orientation Hospital-wide orientation package for new staff will be provided. This will include the

perioperative services orientation, information on call rooms, safety and security, rest areas

and education and resources areas.

Residents will be briefed by the APD on the goals, learning objectives, team assignments and

expected duties at the start of each rotation. Roster of clinical activities will be provided to

the residents including their daily clinical duties and call duties. Education programme will

also be distributed.

The NHG Residency Handbook and General Surgery Program Handbook will be provided if

not already.


Other Learners

As stated previously, due to the department’s commitment to medical student, BST and AST

training, there will be a number of other learners. This has previously been factored in

during the projection for GS re.sidency numbers for the department. Adequacy of clinical

material will be deconflicted by the KTPH APD ensuring adequate faculty to resident ratio

and educational benefits.

Common educational training and resources are shared among residents and other learners.

There will be constant review to ensure adequate places for workshops for all residents.

Medical students will provide residents opportunity to engage in teaching, supervision and

leadership.

Complaints and Grievances Residents will be briefed on the possible communication channels for them to raise

complaints and concerns in a confidential manner with steps taken to minimize fear of

retaliation.


Oversight

Open doorpolicy

Minor concerns in daily work

Serious concerns

Unresolved issues

Channel of communication is as illustrated above. Any concerns of daily work can be

brought up directly to team consultant for rapid resolution and supervisors are responsible

for remedial actions. Any more serious concerns can be brought up either to the team

consultant or directly to the Site Director. Site Director will make necessary investigations

and appropriate measures instituted. All unresolved issues will be reported to the Head of

Department and KTPH ADIO if necessary.

There will be regular APD/Site Director feedback sessions conducted as well. Furthermore

residents will be informed of the NHG-AHPL GME Grievance Policy.

Evaluations

Formative assessments for residents will be conducted by KTPH faculty during their

rotations according to the program requirements. KTPH faculty will give input to the

summative assessments of the residents that have rotated through the department.

Formative Resident Assessment Schedule is as follows:


Assessments will be triggered by the Program Coordinator who maintains a program

calendar with the timeline for the assessments and evaluations clearly marked out. The site

director will oversee if there are any delays in the returning of evaluation and take

necessary action.

KTPH faculty are members of the Clinical Competency Committee which will use information

from resident evaluations and other sources including exam scores, patient feedback,

attendance records, publications to perform semiannual resident evaluations.

Faculty Evaluation Schedule:

Site director will have oversight of the feedback on his faculty. Program Evaluation

Committee will take into considerations feedback on faculty in discussing action plans.

Feedback to faculty will be provided yearly.

Program Evaluation

This will be performed as a whole together with TTSH.


Supervision

The Site Director/APD together with the HOD are the educational supervisors of the

department. The site director will meet with all residents at the start of the rotation and

also on a regular basis.

The team consultant is responsible for the care of all the patients under his/her team.

He/She will delegate graded responsibilities according to the competency of the residents.

Given the supervision is conducted within the team structure, the trainees will receive close

supervision during ward rounds, clinics and during the team’s weekly operating lists and

endoscopy lists.

Duty Hours and Fatigue

Duty Hours will be according to ACGMEi requirements which are available on the NHG-AHPL

Residency Handbook. The roster planner will take into account these requirements.

Averaged over 4 weeks, residents duty hours will not exceed 80 per week, night duties have

a 24+6 rule with 24 hours of duty followed by 6 hours of no further new cases. All residents

will get 1 full day of rest per week. After night duty, residents will get 10 hours off at least.

All duty hours will be reported by the resident to the Institutional Coordinator who will fed

back to the Site Director weekly. Remedial actions will be performed to ensure compliance

to the 320 hours per 4 weeks requirement.

In addition, all faculty will be informed to look out for signs of fatigue and stress in the

residents under their charge.

All residents will be informed of the symptoms and signs of fatigue and sleep deprivation.

Research and Scholarly Activities

The site director, Tan Kok Yang, is also the department research coordinator. He has the

responsibility of assigning research projects to all trainees in the department.

Scholarly Activities for the Department will have the following principles:

Core faculty should be PI/Co-I of at least 1 project


Faculty encouraged to be Co-I of at least 1 project

Research grants for the department

Involvement of ALL GS residents in at least 1 research project from R2 year

Research project will be assigned with option to change topic

Residents should have ownership of the project and will have 1 research mentor

Project to be completed in 1 year with communication with resident even after

leaving the department

Research presentations at least in local forums, KTPH Research Forum

Information Pack for General Surgery Residency … GS Residency Info...Prepared by Tan Kok Yang 1...

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