Specialist Training in Obstetrics and Gynecology in Singapore: Transition to Structured Residency Program

Abstract

The article describes the experience of planning and implementing the transition of the residency program in obstetrics and gynecology at Singhealth, Singapore, from a model largely based on British training principles to a new model in accordance with the ACGME-International (ACGME-I) standards. Initial steps in transitioning to the new model entailed (1) identifying faculty with an interest in education to lead the various initiatives and programs and to ensure appropriate educational role models, (2) securing adequate funding, (3) holding focus groups with physicians to identify opportunities for improvement in the new system, and (4) developing a schedule for the phased implementation of key features of the structured system. The program started in July 2011, with 14 residents for a 4-year course of training. The curriculum consisted of 5 modules: (1) general obstetrics and gynecology and ambulatory care, (2) maternal fetal medicine, (3) urogynecology and minimally invasive surgery, (4) reproductive medicine, and (5) gynecology oncology. Faculty was assigned responsibility for teaching and assessing the 6 competencies, and appropriate training was provided through specially designed, professional-development programs. Challenges in the implementation of the new training program included the need to replace clinical service previously provided by trainees, a lack of fit between the traditional qualifying exam and the new model for training, and the need to adapt teaching strategies to new competencies not explicitly taught in the prior program, particularly practice-based learning and improvement and systems-based practice. The strength of the new obstetrics and gynecology residency lies in having a structured, competency-based, closely supervised approach to training with standardized evaluations, timely feedback, and a committed faculty.