Postgraduate Training Surgery General Surgery Postgraduate Training In .

Guide for Applicants, Version 1, 2020General Surgery Postgraduate Training in Malaysiabut also entails hard work and dedication. Asurgeon’s life isn’t confined to the operatingtheatre, they need to divide their time betweenmany activities, including; outpatient clinics,ward rounds and daily visits to check on thecondition patients under their care, liaising withnursing staff and colleagues and teaching juniordoctors. General surgeons need to be leaders,often taking full control of multi-disciplinaryteams all working together to ensure the bestpossible care and outcome for patients. GeneralSurgery provides a solid foundation for thosewishing to develop in a particular sub-specialty.It is an exciting, innovative and constantlyevolving speciality.Is General Surgery for you?N8CMPBeing a general surgeon is unlike any othercareer, you get to operate on people, improveand sometimes even save their lives. It is amulti-skilled speciality requiring medical andsurgical knowledge, dexterity, leadershipand the ability to cope and communicate insometimes difficult and emergency situations.A surgeon must regard their career as avocation, and be capable and self-motivatedto further develop their skills especially astechniques and technology advances. Do youhave the qualities above and want a satisfyingand gratifying career with a fantastic range ofsubspecialties and skills? If you want to make asignificant change to an individual’s quality of lifeand save lives, then General Surgery is definitelyfor you.

Training pathwaysThere is only one pathway for attaining thequalification as a specialist in General Surgery, theMaster’s degree programme through the Ministryof Education pathway MOE-MOH. The trainingduration is outlined in the following section.Stages of trainingThe programme is made up of three Stagesand the actual number of years may extenddepending on the trainee’s progress. Thetrainee is evaluated at each stage forprogression to the next stage should they wishto pursue it.Stage 2: Advanced Surgical Training (AST)(4-7 Years)On completion of BST, trainees may apply for ASTin programmes that offers a recognised higherqualification i.e. Master of General Surgery. Theduration of AST is a minimum of four years, up toa maximum of seven years. Following successfulcompletion of AST, and other criteria such as postqualification surgical experience a trainee mustsubsequently apply to the National SpecialistRegistry to be recognised as a General Surgeon.CStage 3: Higher Surgical Training (HST)(3-5 Years)MPStage 1: Basic Surgical Training (BST)(2 Years)Sub-specialty training, or clinical fellowships, takesplace through various pathways, in hospitalsthat fulfill the training criteria. This may include anoverseas attachment. Sub-specialty training is forthe acquisition of specific advanced skills (e.g. breastoncoplastic surgery, advanced minimally invasivesurgery etc.), and requires a minimum of three years,with a maximum of five years. For further details, referto the specific sub-specialty curricula.Following the completion of housemanship,doctors who wish to pursue a surgical careershould register their interest with CSAMMwho are responsible for the coordination ofBST. Rotations in the general surgical unitsof recognised training centres for a minimumof two years are required. Specific trainingKey elements of each stage are summarised inrequirements are detailed in the BST Curriculum. Figure 1.NFigure 1: General Surgery Training PathwayBasic2 YearsObjectivesTraining in basicsurgical competenciesEvaluation of thesuitability for ASTAdvancedHigher4-7 Years2-5 YearsTraining in advancedsurgical competencies(including research)Consolidation ofgeneral surgicalexperience(gazettement/NSR/GSWI)Evaluation of suitabilityfor independentpracticeLaying the foundationfor HSTAND/ORTraining in generalsurgical subspecialties9Guide for Applicants, Version 1, 2020General Surgery Postgraduate Training in Malaysia1. The General Surgery Programme

Guide for Applicants, Version 1, 2020General Surgery Postgraduate Training in MalaysiaCompetenciesBasicAdvancedHigher2 Years4-7 Years2-5 YearsKnowledgeFurther developknowledge, skills andprofessionalism in:Refer to the relevant criteria/ curricula.Applied basicsciences: anatomy,physiology, pathology,medical microbiology Principles of surgerySkillsScrubbing & handwashingGowning & glovingGeneral Surgery Breast Colorectal Hepatobiliary Endocrine Trauma Uppergastrointestinal VascularSuturing & knottingHandling ofinstruments Handling of tissuesUse ofendolaparoscopicinstrumentsUse of energy devicesNUniversal precautionsBasic andatory: Urology Neurosurgery Wound managementAntisepsis Optional: Plastics PaediatricSurgery fe surgery practicesTeachingCME activitiesAuditResearchEthicsClinical decisionmakingTeamworkCommunication10CMPOT navigationResearchcompetenciesValue-based clinicaldecision-making

Higher2 Years4-7 Years2-5 YearsMandatory:Mandatory:Basic surgical skills(BSS)ATLSRefer to the relevant criteria/ curricula.Basic Life Support(BLS)NoTSSScience of tissuemanagement (SoTM)Recommended:Advanced trauma lifesupport HernioplastyBasic LaparoscopicSurgery:appendicectomy &cholecystectomyMPNon-technical skills forsurgeons (NoTSS)Care of the critically illpatient (CCrISP)Gastrointestinalresection &anastomosisMastectomyThyroidectomySurgical trauma careResearch methodologyDocumentationNSurgical portfolio, withevidence of:rotationstrainers’ reportsScientific writing skillsClinical statisticsGood clinical practiceAs per BSTAdditionaldocumentation:assessmentsSuccessful completionof research projectEPAsCase write-upscoursesAs per BSTpresentationspublicationsother achievements11Guide for Applicants, Version 1, 2020AdvancedGeneral Surgery Postgraduate Training in MalaysiaCoursesBasic

Guide for Applicants, Version 1, 2020General Surgery Postgraduate Training in MalaysiaAssessmentsBasicAdvancedHigher2 Years4-7 Years2-5 YearsFormative:Formative:Formative:WBAs - CBDs, CEx,DOPS, PBAsWBAs - CBDs, CEx,DOPS, PBAs, NoTSSCBDsMulti-source feedbackMCQs/EMQ/essaysCase write-upsCore topicpresentationsCSummative:Multi-source feedbackCritical appraisal ofthe literatureMRCS Part A / MedExResearch progresspresentationsSummative:MRCS Part BExit interviewSummative:MPEntrance evaluationPart 1 examinationPart 2 examinationDefense of researchprojectTraining CentresHospitals with GSserviceAt least one GS trainerPrimary centres:Hospitals fulfilling allcriteria for ASTSecondary centres:N12Hospitals fulfillingsome criteria forAST. Under oversightof primary centre;rotations not longerthan six months.Hospitals fulfillingcriteria for HST.

Prospective candidates must meet theacademic and professional medicalqualifications as outlined in this document withadequate clinical experience and must havesuccessfully completed Basic Surgical Training(BST as stated above), before applying foradvanced surgical training. An applicant to ASTmust fulfil the following requirements:CMaster of General Surgery Entrance RequirementsMOH Administrative requirements:A minimum of two years’ service post-housemanshipScores of 85% or more on annual performance evaluations for three consecutive yearsFree of disciplinary issuesMPWritten recommendations from two supervising consultantsUniversity requirements:A Bachelor of Medicine and Bachelor of Surgery degree, or equivalent medical qualification, asrecognised by the Malaysian Medical Council.At least one year of relevant surgical experience following full registration with the MalaysianMedical Council.Other requirements:Qualifies for registration as a medical practitioner under the Medical Act 1971 (Act 50) ofMalaysia.NSatisfies the institution responsible for the programme in a recognised Entrance Evaluation.Achieves at least IELTS Band 6.0 or TOEFL 550 if their first degree was obtained from auniversity where English is not the medium of instruction, or pass an English course determinedby the appropriate authority.Undergoes a minimum of three months’ clinical attachment in a Malaysian surgical departmentprior to entry into advanced surgical training (for international applicants).Has completed Basic Surgical Training (BST) (or its equivalent for international candidates).13Guide for Applicants, Version 1, 2020General Surgery Postgraduate Training in Malaysia2. Entry Requirements

Guide for Applicants, Version 1, 2020General Surgery Postgraduate Training in Malaysia3. Entry ProcessCalls for applications will be advertised, andentrance evaluations conducted by the relevantauthorities (e.g. Conjoint Specialty Committee forGeneral Surgery).Applicants from the Ministry of Health need toapply through the “Sistem Permohonan HadiahLatihan Persekutuan”, (HLP)’s website at ehlp.moh.gov.my.Other applicants who are not from theMinistry of Health are required to apply at therespective university’s graduate website; e.g.,for University of Malaya, the online applicationis through the http://ips.um.edu.my website.The application status can be checked onlineat http://pgadmission-status.um.edu.my fromtwo months after the application procedure iscompleted and confirmed.Examination, (MedEX), for General Surgery.The examination syllabus, or scope ofknowledge, can be viewed at the MalaysianExaminations Council (Majlis PeperiksaanMalaysia, MPM) website, in reference to theMedEx Pre-Entrance 156/bd398004-27d1-4098a292-a0cc74432d89The Entrance Examination is given thegreatest weight in ranking applicants, (40%).2. Applicants who have passed the MedEX arerequired to submit their portfolios for review.MPFollowing Application, the entry process is athree-stage evaluation1. All applicants are required to sit forthe Medical Specialist Pre-Entrance3. Interview and Assessment. Applicants willbe called for the interview in January of thefollowing year. The final list of successfulapplicants will be decided and made availableby April of the same year for the postgraduatetraining intake in June of each year.The tables below summarise the entry processfor General Surgery training.NApplication Entry Process and TimelineMOH applicantsApplications are made online atehlp.moh.gov.myThe application is to be completed by July of each year.Overseas/PrivateapplicantsOnline application via the appropriate web link for postgraduate studiesat each UniversityScreening ofapplicationsCompleted by end of OctoberInterview andAssessmentOutcome ofprocessBriefingJanuary each yearApril each yearMay each year.Report to the University June each year.14

MedicalSpecialistEntranceExamination(MedEX)MedEX is a written examination comprising of 300 multiple choicequestions (MCQ), made up of 60 questions with 5 stems each, and eachstem requires a response.Portfoliosubmission andreviewA portfolio must be submitted and consists of the evidence of theapplicants’ professional qualifications and clinical experience. It iscompulsory for the applicants to complete the portfolio requirements andsubmit it to the postgraduate training institution, after passing the MedEX.Applicants will be called for interview by the training institution onlyfollowing a satisfactory portfolio review.Interview andAssessmentThe interview will be based on the clinical knowledge as well as clinicalexperience, opinions in General Surgery and assessment, and oncommunication aspects.CMPOrientation ProcessTraining in General Surgery starts with anOrientation Process to ensure that traineesare familiar with the relevant clinical areas andpractice, and introduced to trainers, supervisorsand other academic/hospital staff in order tofacilitate interactions and training opportunities.The orientation process for General Surgeryshould include the following:N Legal requirements (for example, Healthand Safety training) Regulatory requirements of training (rulesand regulations of program) Introduction to terms and conditions oftraining (Leave entitlement, expense claims,etc.) Basic introduction to the training centre A guided tour of the training centre Completion of government andadministrative requirements (Tax forms,employment issues, Credentialing andPrivileging in the training centre) Payroll details Introductions to key members of staff Specific job-role training expectations Clinical Academic; Research & EducationAs advanced surgical training programmes mayinvolve multiple clinical and academic facilities,orientation will take place over a number ofdays. Sufficient time should be set aside beforethe commencement of training and planned bymembers of the training faculty in advance.Attendance at the orientation process iscompulsory. Failure to attend will result inthe trainee not being able to commencetheir training.15Guide for Applicants, Version 1, 2020General Surgery Postgraduate Training in MalaysiaApplication Evaluation

Guide for Applicants, Version 1, 2020General Surgery Postgraduate Training in Malaysia4. SyllabusThe syllabus defines what will be taught orlearned throughout the training in GeneralSurgery. It outlines the knowledge, proceduralskills and professional values to be achievedby the trainees during each phase of theprogramme. The syllabus helps to set theexpectations for both trainer and trainee as towhat should be achieved during each phase. Itis essential for trainees build their competenciesin a progressive manner throughout the trainingprogramme. Full details on the syllabus canbe found in the General Surgery CurriculumDocument.Phase IOn completion of Phase I, trainees are expectedto demonstrate competencies in the initialmanagement of common, uncomplicatedgeneral surgical conditions. These include:knowledge of the Basic Sciences andPrinciples of Surgery which includes appliedsurgical anatomy, applied physiology,general pathology and principles of surgeryN basic surgical skills in endoscopic andminor procedures in general surgicalconditions professional behaviours for managingsimple general surgical conditions.Trainees will also gain exposure to the definitivemanagement of more complex general surgicalconditions and critical care, as well as explorerelated areas of interest through approvedelectives. Training placements must fulfil thefollowing criteria:16The option of up to two (2) electives of three(3) months’ duration each in related specialtiesthat are not included in Phase II or III, subjectto the approval of the Programme Director.CTrainees will be expected to initiate a researchproject, and preferably complete the followingmilestones by the end of Phase I: successful defense of a research proposal ethics approval of research proposal submission of grant applications (if required) attendance at research-related coursesMPThe programme is structured into three phasesand progression to each successive phaseof training will require increasing levels ofcompetency in each domain. A minimum of one (1) year in total A minimum of six (6) months’ placement inGeneral Surgery, including modules in BasicSciences and Principles of SurgeryPhase IIOn completion of Phase II, trainees are expectedto demonstrate competencies in the initialmanagement of common, uncomplicatedacute non-general surgical conditions,that would be managed by general surgeonsin hospitals without non-GS specialties. Initialmanagement would include: initiating resuscitation and initialinvestigations performing damage-control procedures effecting safe transfer to referral centresTrainees will also gain exposure to the definitivemanagement of more complex non-generalsurgical conditions. They will understand thescope of the specialty, be able to identifyindications for appropriate referral, and provideessential services in areas with limited access tospecialties. Training placements must fulfil thefollowing criteria: A total duration of one (1) year. Four (4) placements of three (3) months each. Mandatory placements in Urology andNeurosurgery.

Remaining placements to be selected from:Cardiothoracic Surgery, Intensive CareMedicine, Plastic & Reconstructive Surgeryand Paediatric SurgeryThe research project should ideally be in thedata collection stage in Phase II.CPhase IIIOn completion of Phase III, trainees areexpected to demonstrate competencies inthe initial management of complex subspecialty general surgical conditions, anddefinitive management of complicatedcommon general surgical conditions.MPTrainees will be expected to play more of aleadership role in surgical teams, includingsupervising less-experienced colleagues andhouse officers. Training placements must fulfilthe following criteria: A minimum of two (2) years in total inGeneral Surgery and its sub-specialties A minimum of eight (8) placements of three(3) months eachAt least four placements in General Surgerysub-specialties, to be selected from: ColorectalSurgery, Upper GI Surgery, HepatobiliarySurgery, Breast Surgery, Endocrine Surgery,Vascular Surgery and Trauma SurgeryNAll milestones of the research project mustbe completed by the end of Phase III: successful defense of thesis approved submission of thesis (orequivalent)The minimum skill attainment levels in indexprocedures for each phase of training isshown in the Appendix. For full details on theknowledge, procedural skills and professionalvalues can be found in the General SurgeryCurriculum document.17Guide for Applicants, Version 1, 2020General Surgery Postgraduate Training in Malaysia

Guide for Applicants, Version 1, 2020General Surgery Postgraduate Training in Malaysia5. Assessment ToolsAssessments in surgical training are used toprovide a measure of the functional readiness ofa surgical trainee. Traditional assessments havefocused on knowledge, clinical decision-makingand technical skills. It is now recognised thatthe modern surgeon requires competencies inprofessional behaviours, which increases thecomplexity of measuring surgical competence.review (e.g. every six months), of thelogbook should be carried out by the trainerwith the trainee, to correlate the volume andvariety of suitable procedures/surgery to thecompetence level of the trainee. A summaryof the PBAs, and the required skill level ateach phase is provided in the Appendix. It is the responsibility of each trainee tomaintain a training portfolio of these activities asevidence that assessment of learning has takenplace. Inability to provide such records (e.g. lossof electronic records), may require the traineeto repeat parts, or the whole, of the trainingprogramme.Formative AssessmentsMany of these are associated with theEntrustable Professional Activities (EPAs);Workplace-based assessments (WBAs)NThe purpose of work-place basedassessments is to facilitate and improvelearning by providing trainees immediatefeedback in a real clinical environment,provide reflections, measure theirperformance and identify areas ofdevelopment. A summary of WBAs isprovided in the table below. Logbook, Procedure-BasedAssessments (PBAs), andConsolidation SheetsA surgical logbook documents the trainee’soperating experience, and should be keptthroughout training. The logbook shouldconsist of the evidence of each patient’sregistration

Postgraduate Curriculum for General Surgery and provides key summaries about the training, structure, syllabus and assessments. The National Postgraduate Medical Curriculum The General Surgery curriculum is the product of a collaborative effort by members of the Conjoint Specialty Committee for General Surgery comprising of representatives from