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Implementing Residency Programs and its Challenges

Attaining international recognition through accreditation while responding to local contexts and demands is key for excellent medical training. The switch of Singapore’s curriculum to a United States residency model also aimed at accreditation by American institutions. In their second report, Yin et al. outline the challenges of program implementation from the perspective of manpower and resource allocation. The authors’ experiences may help other institutions intending to make similar changes anticipate required accommodations.
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The exponential growth of Singapore’s population from the influx of migrants over recent years, coupled with an aging population, has resulted in a need to increase the number of doctors and, in addition, raise their expertise. The British-based system of specialist training was inherited by Singapore and it consisted of two time-based phases: Basic Specialist Training and Advanced Specialist Training. However, in June 2010, the United States-based Residency system was adapted because it was curriculum-based with a more structured framework. This change in systems has resulted in a number of problems such as:  (a) additional faculty to train; (b) adequate manpower backfill; (c) adequate resources for residents, including new infrastructure to facilitate learning, and (d) the usual anxiety associated with such a major change, especially from those who did not see the need to change the current system. 

Since manpower backfill was a key issue, overseas specialist staff and non-specialist doctors were recruited to facilitate protected training time for residents. In addition, there was a redesign of service work for healthcare personnel. Although these solutions have helped to alleviate many of the problems, the challenge facing the program now is its sustainability since it has proven to be resource intensive. 

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residency; ACGME-I; pediatrics; postgraduate medical education; curriculum reform; Singapore



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