JOINT COMMITTEE ON SPECIALIST TRAINING BASIC AND ADVANCED TRAINING AND EXAMINATION REQUIREMENTS FOR DIAGNOSTIC RADIOLOGY

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1 JOINT COMMITTEE ON SPECIALIST TRAINING BASIC AND ADVANCED TRAINING AND EXAMINATION REQUIREMENTS FOR DIAGNOSTIC RADIOLOGY

2 The information in this guide/notes is correct at the time of publication. The University reserves the right to make alterations without notice. JULY 2006

3 CONTENTS BASIC SPECIALIST TRAINING (BST) IN DIAGNOSTIC RADIOLOGY PAGE 1. PROGRAMME TARGET 1 2. PROGRAMME STRUCTURE 2 3. MASTER OF MEDICINE (DIAGNOSTIC RADIOLOGY) EXAMINATION 3 4. LEAVE MATTERS 4 5. TRAINING DOCUMENTATION AND ASSESSMENT 4 ADVANCED SPECIALIST (AST) TRAINING IN DIAGNOSTIC RADIOLOGY 1. PROGRAMME TARGET 5 2. PROGRAMME STRUCTURE 5 3. LEAVE MATTERS 6 4. TRAINING DOCUMENTATION AND ASSESSMENT 6 ANNEXES A. ADDITIONAL INFORMATION OF TRAINING CONTENT FOR BST B. LOGBOOK STATISTIC REQUIREMENTS C. LEAVE REGULATIONS

4 Basic Training BASIC SPECIALIST TRAINING IN DIAGNOSTIC RADIOLOGY The basic training in Diagnostic Radiology is a 4-year programme aimed at training doctors to attain the MMed (Diagnostic Radiology) and prepare for further training as a specialist radiologist. 1. Programme target Year 1 Year 2 Years 3 & 4 This is a post-registration clinical year. The aim is to give trainees the clinical experience that would allow them to understand the role of Diagnostic Radiology in medicine. This year of clinical postings should also enable trainees to understand how clinical history enhances imaging diagnosis. The FRCR (UK) Part 1 examination may be taken during this first year. In this 2nd year, trainees commence on training in Diagnostic Radiology. Upon completion of this training year, trainees should be able to interpret plain films and perform urograms, barium studies and ultrasound, under supervision. Trainees would also be exposed to radionuclide radiology, computed tomography (CT), magnetic resonance imaging (MRI) and vascular & interventional radiology (VIR). Trainees are expected to obtain core knowledge in radiological physics, anatomy and techniques. Postings in Years 3 and 4 should provide trainees with adequate knowledge to practice as general radiologists. The training will cover various aspects of radiology with particular emphasis on the close relation with clinical medicine, surgery and pathology. Knowledge is acquired from structured lectures, tutorials and discussions with accredited radiologists. Trainees will be eligible to sit the FRCR (UK) Part 2A examinations from 18 months after commencing radiology training (from Year 3½). After passing all 6 modules of the FRCR (UK) Part 2A and completing 36 months of relevant postings (end of Year 4), trainees will qualify to attempt Final Master of Medicine (Diagnostic Radiology) examination. Page 1

5 Basic Training 2. Programme structure Year 1 Year 2 Years 3 & 4 A minimum of two 6-month postings in any of the following departments: i. 12-month posting in a major training centre (eg. radiology departments of SGH, NUH, i. Rotation of 3-month or 6-month postings in relevant radiology departments in accredited Cardiology, Cardiothoracic Surgery, Colorectal TTSH and CGH) centres (eg. NUH, SGH, TTSH, CGH, Surgery, Internal Medicine, Emergency Medicine, KKWCH, NCC, NNI, NHC, etc) Gastroenterology, General Surgery, Medical Oncology, Paediatric Medicine, Paediatric Surgery, Neurology, Neurosurgery, Obstetrics & Gynaecology, Orthopaedic Surgery, Respiratory Medicine, Renal Medicine and Urology ii. The following should form the basis of consideration when accrediting NS postings. a) MO serving full-time in medical centres b) MO in supervisory positions ie. Brigade MO who still at least spend 50% of total NSF time doing clinical work at medical centres. i. Other postings not mentioned above will be considered on a case-by-case basis. Postings of shorter duration may also be considered if the total period is equivalent to 12 months. In all postings, there should be inpatient, outpatient and emergency practice. A combination of surgical and medical postings is preferred. ii. Supervised sessions in plain film reporting and performing and reporting of urograms, barium studies and ultrasound. iii. Exposure to radionuclide radiology, CT, MRI and VIR through observation and tutorials iv. Exposure to emergency radiology through night duties. v. Those who have not obtained the FRCR Part 1 will attend a structured series of lectures covering basic radiological physics to be conjointly conducted at national level. 75% attendance is required. Lectures and tutorial programmes will be organised with faculty drawn from the training centres and other resources. vi. One session per week for study and other academic work. Compulsory postings - 6 months in KKWCH Paediatrics & O&G - 3 months in NNI & 3 months in NCC ii. Core teaching lectures will be given at national level to trainees in Year core lectures within one year - MCQ sessions and mock MCQ exams - At least one film tutorial per week iii. At designated training centres, trainees will be given supervised hands-on training in all modalities of radiology, as well as access to a library of books, journals and films. Tutorials will also be conducted. iii. Time-off for attending lectures, as well as one session per week for study and other academic pursuits. Trainees who are attempting the FRCR Part 2A examination would be allowed one week of study leave per examination sitting. Note: More details of the lectures / tutorials / teaching sessions are shown in Annex A, while logbook statistics requirements are listed in Annex B. Page 2

6 Basic Training 3. Master of Medicine (Diagnostic Radiology) examination Trainees are expected to obtain the Master of Medicine (MMed) (Diagnostic Radiology) degree, or equivalent, at the end of the basic training programme. To be conferred this MMed degree, trainees must pass the Final MMed examination. Examination requirement All trainees must fulfil the following criteria for purpose of admission into the examination: i. Completed 3 years of relevant radiology postings ii. Passed Part A of the Final Examination for the Fellowship of the Royal College of Radiologists in Clinical Radiology (FRCR) Examination format Trainees are examination comprises: i. Film reporting session - 6 cases to be reviewed in 45 minutes with written report being required for each case ii. Rapid reporting session - 30 cases to be reviewed in 30 minutes. Candidates are required to distinguish between normal and abnormal cases and to identify the pathology demonstrated. iii. Oral examinations - Two oral examinations each with a pair of examiners and of 30 minutes duration. Candidates are required to demonstrate their powers of observation and deduction over a wide range of conditions and investigations. Examination date and fee The Final MMed examination is scheduled to be held in mid-april in Singapore every year. The examination fee is S$ (subject to change without prior notice). Page 3

7 Basic Training 4. Leave matters Types of Leave Validity 14 days of Annual Leave Per 6 months posting 12 days of Study Leave Per Year 14 days of Medical Leave Per 6 months posting Maternity Leave As per statutory requirement Reservist Up to maximum of 14 days per 6 months posting 5. Training documentation and assessment All trainees will be supervised by Consultants of adequate seniority or experience. Trainees must regularly record the procedures / examinations performed under supervision in the official logbook. The training supervisor should carry out monthly meetings with the trainees to assess their progress, review the logbooks, feedback any deficiencies and rectify them. Designated training centres will conduct monthly MCQ assessment of topics covered in the lectures. Answer scripts should be marked and results collated. Supervisors will be informed of the results. The Head of Training / Head of Department should meet with supervisors at quarterly intervals to monitor the progress of the trainees. Head of Training / Head of Department should be informed of any trainee who is consistently performing under expectation. A report should be made the RAC after each quarterly meeting. Page 4

8 Annex A ADVANCED SPECIALIST TRAINING IN DIAGNOSTIC RADIOLOGY Upon completion of the basic training component, trainees would be expected to embark on a 2-year advanced training programme in Diagnostic Radiology. At least one year of traineeship must be completed upon obtaining the recognised postgraduate qualification (e.g. MMed or FRCR). Trainees are expected to spend 2 years in core curriculum training in radiology with 40% time in 7 8 chosen subspecialty areas. Up to 6 months may also be spent in research. After passing the Exit Examination at the end of the traineeship, trainees will be eligible to apply for FAMS of the Academy of Medicine, Singapore and Specialist Accreditation by the Specialist Accreditation Board, Singapore. 1. Programme target The work-based training covers a broad range of general and subspecialty radiology that will equip trainees with the necessary knowledge and experience to fulfil their roles as consultants. The programme also aims to inculcate an interest in medical research. At the end of two years, trainees should: - have a broad-based working knowledge of radiology - be able to provide consultation to clinicians - be able to work independently and make decisions relating to the management of patients with occasional consultation in subspecialised areas 2. Programme structure i. 3-monthly rotations through the following subspecialty areas in accredited government, restructured and university hospitals: - Neuroradiology (including ORLR) - Vascular & Interventional radiology - Breast Imaging (including mammography screening) - Body imaging - Musculoskeletal radiology - Paediatric radiology - Obstetric & Gynaecology imaging - Oncologic imaging - Advanced ultrasound - Nuclear medicine Page 5

9 Annex A ii. Daily work in the radiology department will include plain film reporting, barium studies, urography and ultrasound. iii. Stay-in call duties for emergency radiology. iv. Active participation in teaching (of radiology trainees, nurses and ancillary staff) and research activities of the radiology department, with 10 full written case reports. v. Logbook statistic requirements are stated in Annex B. vi. Attendance of up to 6 national CME lectures per year. vii. A maximum of 2 sessions per week for academic work. viii. A first authorship paper is required as part of the requirement for exit. This paper should be a first authorship paper published in a peer reviewed indexed journal. It must be an accepted paper. Provisionally accepted paper DOES NOT meet the requirement. The submission of 10 case reports is no longer applicable. The paper published or accepted for publication should be within the training period (BST & AST). A paper published prior to start of traineeship is not acceptable. ix. Attendance at AST lectures would be part of the exit requirements. All trainees should attend at least 75% of the AST lectures. The attendance should be logged into their logbooks and be available for audit during the exit assessment. x. Exit examination upon satisfactory completion of all postings. 3. Leave matters Trainees are subject to the following allocated leaves. Any extended leave may impose additional or remedial posting should the training be adversely affected. Trainees who wish to defer their training for 1-2 postings must seek approval from JCST. Types of Leave Validity 14 days of Annual Leave Per 6 months posting 12 days of Study Leave Per Year 14 days of Medical Leave Per 6 months posting Maternity Leave As per statutory requirement Reservist Up to maximum of 14 days per 6 months posting Page 6

10 Annex A 4. Training documentation and assessment All trainees will be supervised by Consultants of adequate seniority or experience. Trainees must maintain a log book of the training and procedures that he has done. Log books should be submitted to the supervisors every month and to the Heads of Departments every 6 months for certification. Computer printout confirmation of the cases logged must accompany the certification. Head of Training / Head of Department should be informed of any trainee who is consistently performing under expectation. A report should be made the RAC after quarterly. Page 7

11 Annex B LOGBOOK STATISTIC REQUIREMENTS FOR BASIC AND ADVANCED TRAINING IN DIAGNOSTIC RADIOLOGY Plain Films Plain Films Skull Chest - Cranium Respiratory - Orbits 20 - Mediastinal 1500 (combined) - Cardiac 100 Spine - Cervical 100 Abdomen & pelvis - Lumbar Gastrointestinal Sacro-coccyx 20 - Urological 200 Head & neck Obstetric & gynaecology - Face 50 - Pelvimetry 1 - Sinuses Neck (soft tissues) Mammogram 500 Extremities - Trauma Non-trauma 200 Page 8

12 Annex B LOGBOOK STATISTIC REQUIREMENTS FOR BASIC AND ADVANCED TRAINING IN DIAGNOSTIC RADIOLOGY (CONT D) Contrast Studies Contrast Studies Head & neck Urogenital - Dacrosystogram - Intravenous urogram (combined) - Sialogram - Retrograde pyelogram 5 - Video-swallow 10 - Micturiting cystogram 20 Musculoskeletal Obstetrics & gynecology - Shoulder arthrogram - Hysterosalpingogram 10 - Wrist arthrogram 20 (combined) - Knee arthrogram Gastrointestinal - Ba swallow 200 (combined) - Ba meal - Small bowel study (enteroclycis) 10 - Ba enema Sinogram 10 - Proctogram 5 - T-tube cholangiogram 5 - ERCP 20 Page 9

13 Annex B LOGBOOK STATISTIC REQUIREMENTS FOR BASIC AND ADVANCED TRAINING IN DIAGNOSTIC RADIOLOGY (CONT D) Ultrasound Ultrasound Neuroradiology Gastrointestinal - Carotid 10 - Hepatobiliary Transcranial doppler 10 - Appendicitis 20 - Abdominal mass 10 Head & Neck - Rectal - Thyroid & other soft tissue masses 20 Urogenital Musculoskeletal - Kidney & bladder Shoulder joint 20 - Prostate 10 - Other joint 10 - Testes 10 - Superficial lumps 10 Obstetrics & gynaecology Cardiovascular - Pelvic Echocardiogram 30 - Transvaginal Peripheral vascular study (Arterial) 30 - Obstetrics 30 - Peripheral vascular study (Venous) 30 - Aorto-renal 30 Breast 30 Page 10

14 Annex B LOGBOOK STATISTIC REQUIREMENTS FOR BASIC AND ADVANCED TRAINING IN DIAGNOSTIC RADIOLOGY (CONT D) Computed tomography Computed tomography Neuroradiology Respiratory - Brain Lungs - Orbits 50 - Mediastinum 200 (combined) - HRCT 30 Head & neck - Pulmonary embolism 30 - Temporal bones 50 - Nasopharynx 50 Cardiovascular - Sinuses 50 - Cardiac 20 - Larynx 20 - Aorta 20 - Neck 50 - Peripheral CTA 20 Musculoskeletal Gastrointestinal - Spine 20 - Hepatobiliary 200 (combined) - Pelvis 20 - Triphasic - Extremities 20 - GI, others 100 Urogenital Gynaecology - Urinary system - Abd / pelvis (combined) - Retroperitoneal Page 11

15 Annex B LOGBOOK STATISTIC REQUIREMENTS FOR BASIC AND ADVANCED TRAINING IN DIAGNOSTIC RADIOLOGY (CONT D) Magnetic resonance Imaging Magnetic resonance imaging Neuroradiology Musculoskeletal - Brain Cervical spine 50 - Sella 20 - Thoracic spine 25 - IAM 20 - Lumbosacral spine 50 - MRA / MRV 50 - Brachial plexus 3 - Orbits 20 - Shoulder joint 50 - Spectrocsopy - Knee joint (combined) - Functional - Other joints 50 Head & neck Gastrointestinal - Nasopharynx 20 - Hepatobiliary & pancras 50 - Larynx 5 - Salivary glands 10 Urogenital - Neck 10 - Urinary tract & prostate 10 Cardiovascular Obstetric & gynaecology - Cardiac 20 - Pelvis 10 - Great vessels 20 - Peripheral vessels 20 Breast - General & implants 5 Page 12

16 Annex B LOGBOOK STATISTIC REQUIREMENTS FOR BASIC AND ADVANCED TRAINING IN DIAGNOSTIC RADIOLOGY (CONT D) Nuclear medicine Nuclear Medicine Bone 150 Gastrointestinal 15 Renal 20 V/Q lung scan 20 Cardiac Miscellaneous 20 - Myocardial 20 - Muga 30 PET 10 Endocrine - Thyroid 30 - Parathyroid 5 Page 13

17 Annex B LOGBOOK STATISTIC REQUIREMENTS FOR BASIC AND ADVANCED TRAINING IN DIAGNOSTIC RADIOLOGY (CONT D) Paediatrics Paediatrics Plain films 300 Computed tomography - Head 50 Cardiac anormalis in children 50 - Neck 10 - Chest 10 Contrast study - Abdomen 20 - MCU 20 - Extremity 5 - Ba meal / FT 20 - Ba enerma 5 Magnetic resonance - Distal loopogram 2 - Brain 10 - Videofluoro 10 - Neck 5 - Heart 5 Nuclear medicine - Abdomen 2 - Renal 10 - Extremity 5 - Bones 5 - Thyroid 5 Ultrasound - Meckel 5 - Hip 10 - HIDA 1 - Spine 5 - Head 20 Page 14

18 Annex B LOGBOOK STATISTIC REQUIREMENTS FOR BASIC AND ADVANCED TRAINING IN DIAGNOSTIC RADIOLOGY (CONT D) Vascular & interventional radiology Vascular & interventional radiology Neuroradiology Gastrointestinal - 4 vessel angiogram - PTC / PTCD 5 10 (combined) - Spinal angiogram - Visceral angiograms 5 - Cranial interventions 5 - Visceral interventions (biopsies / Abscess drainage/ TIPSS) 5 Musculoskeletal - Biopsies 5 - Biopsy 10 - Spinal intervention 5 Urogenital - Non-spinal interventions 5 - Nephrostomy 5 - Embolisation 1 Respiratory - Biopsy 1 - Pleural aspiration 10 - Embolisation 1 Breast - Biopsy 10 - Localisation 5 - Biopsy 5 Cardiovascular - Mammotome 5 - Pulmonary angiogram 1 - Peripheral angiogram 15 - Central line insertions 20 - Vascular interventions 10 Page 15

19 Annex C LEAVE REGULATION FOR BASIC AND ADVANCED SPECIALIST TRAINING IN DIAGNOSTIC RADIOLOGY Purposes The purposes of the leave policy are: i. To maximise the training period for the duration of the traineeship ii. To allow for study leave before examinations iii. To standardise leave implementation across training departments Types of leave and duration allowed Types of Leave Validity 14 days of Annual Leave Per 6 months posting 12 days of Study Leave Per Year 14 days of Medical Leave Per 6 months posting Maternity Leave As per statutory requirement Reservist Up to maximum of 14 days per 6 months posting All vacation leave must be consumed during each 6-month posting and cannot be postponed. All other types of leave stated above are not entitlements nor transferable either from one category to another or from one posting to another. Excess leave of any kind above the duration allowed will be added to minimum period of AST training. Monitoring of leave All leave consumed must be logged in trainees logbooks and certified by the Head of Training / Head of Department and leave records should be forwarded to the RAC in the 6-monthly supervisors appraisal feedback. Page 16