NHG-AHPL Residency Handbook

NHG-AHPL Residency Handbook

TABLE OF CONTENTS Content Page I About this Handbook 1 II About NHG-AHPL Residency 2 Commitment to 3 NHG Committee (GMEC) 4 GMEC Membership 6 Institutional Agreements 6 III Appointment to NHG-AHPL Residency Programs Eligibility of Appointment 8 Application 9 Selection 9 Appointment 10 Transfers/Switches 10 Resident Responsibilities 11 Conditions for Reappointment and Promotion 12 Program Closure/Reduction 14 Conditions for Separation 14 Certification Requirements 15 Academic Records 15 IV Resident Supervision and Duty Hours 16 V Resident Impairment and Substance Abuse 17 VI Other Provisions for Residents Access to Confidential Counseling, Medical, and 19 Psychological Services Complaints and Concerns 19 NHG Disciplinary Policy and Procedure 20 Residents with Disabilities 20 VII Employment and Related Benefits Salary and Services 21 Access to Food Services 23 Reasonable Accommodation 23 E-mail Access 23 Overseas Conference Sponsorship 24 VIII The Resident Council 25 IX Other Important Policies, Procedures and Guidelines Moonlighting 26 Disaster Preparedness Policy and Procedure 26 Vendor Policy 26 Non-Discrimination and Harassment 27 Release of Information 27 Confidentiality 27 Corporate Communications and Social Media Guidelines 28 Other Important Policies 29 NHG-AHPL RESIDENCY HANDBOOK - Table of Contents

ANNEXES Annex A Annex B Annex C Annex D Annex E Annex F Annex G Annex H Annex I GME PP3-1 NHG GME Grievance Policy and Procedure GME PP11-1 NHG GME Policy on Resident Transfer-Switches-Resignation GME PP8-2 NHG GME Policy on Resident Evaluation and Disciplinary Guidelines GME PP4-0 NHG GME Policy on Program Closure & Reduction GME PP5a-0 NHG GME Policy on Supervision of Residents GME PP5b-1 NHG GME Policy on Duty Hours in Learning and Working Environment GME PP13-1 NHG GME Policy on Addressing Complaints and Concerns NHG GME Leave Application Procedures GME PP1-0 NHG Institutional Disaster Preparedness Policy and Procedure NHG-AHPL RESIDENCY HANDBOOK - Table of Contents

I ABOUT THIS HANDBOOK 1. This handbook has been developed as a guide and resource to all NHG-AHPL residents. It outlines what a resident needs to know about graduate medical education in NHG-AHPL and in particular, policies and procedures as established by the NHG Committee (GMEC). 2. These policies and procedures pertain to training matters under all NHG-AHPL residency programs. They are not intended to replace non-training related policies and procedures of individual participating sites, clinical departments and MOH Holdings Pte Ltd (MOHH). If areas of conflict develop, such conflicts are to be evaluated by the GMEC for a resolution. 3. This handbook will be amended and updated as necessary with the latest version posted on the NHG Residency website (www.nhgresidencyprogram.com.sg). When additions, changes or revisions are made to this handbook, notice will be sent to Program Directors (PD), Program Coordinators (PC), Core Faculty and residents. Updated policies will become effective upon posting. Residents are expected to be familiar with and comply with all policies set forth in this handbook. NHG-AHPL RESIDENCY HANDBOOK 16 APR 2012 1 of 30

II ABOUT NHG-AHPL RESIDENCY 1. In 2009, the Ministry of Health, Singapore (MOH) identified National Healthcare Group (NHG) as one of the 3 Sponsoring Institutions (SIs) for residency programs in Singapore. MOH has also agreed that NHG may partner one of its major participating sites, the Khoo Teck Puat Hospital (KTPH) under the Alexandra Health Pte Ltd (AHPL), to offer residency programs. NHG and AHPL thus agreed to adopt the co-branding of NHG-AHPL Residency and this name will be used in this document and publicity material. 2. With the mission to develop medical professionals who are competent, compassionate, team-focused and committed to life-long learning, NHG-AHPL is committed to providing excellent graduate medical education for Singapore s future generations of doctors. 3. NHG as a Sponsoring Institution (SI) sponsors the following programs under the umbrella of NHG-AHPL Residency: i) Anaesthesiology ii) Diagnostic Radiology iii) Emergency Medicine iv) Family Medicine v) General Surgery vi) Internal Medicine vii) Ophthalmology viii) Orthopaedic Surgery ix) Otorhinolaryngology x) Pathology xi) Psychiatry (National Program) xii) Surgery-In-General leading to Hand Surgery, Plastic Surgery and Urology xiii) Transitional Year 4. NHG-AHPL Residency will also take part in the national Preventive Medicine Residency Program sponsored by NUHS. NHG-AHPL Residency will sponsor more programs (Phase 3) from 2013. 5. Other participating sites for NHG-AHPL residency programs include but not limited to: i) Health Science Authority (HSA) ii) KK Women's & Children's Hospital (KKH) iii) National Cancer Centre Singapore (NCC) iv) National Neuroscience Institute (NNI) v) National Skin Centre (NSC) vi) National University Hospital (NUH) vii) Singapore General Hospital (SGH) viii) Dover Park Hospice ix) Renci Community Hospital NHG-AHPL RESIDENCY HANDBOOK 16 APR 2012 2 of 30

NHG s Statement of Commitment to As a Sponsoring Institution for graduate medical education, NHG is committed to support graduate medical education, and to provide the necessary educational, financial, and human resources, to ensure compliance to the prevailing training and educational standards stipulated by the Ministry of Health, Singapore (e.g. the ACGME-I Institutional, Foundational and Specialty/Subspecialty Specific Requirements). NHG will provide continued support towards quality graduate medical training, in an environment that is conducive, encouraging and safe, while committed to quality care for our patients. NHG-AHPL RESIDENCY HANDBOOK 16 APR 2012 3 of 30

NHG Committee (GMEC) 1. All NHG-AHPL residency programs are overseen by the NHG GMEC. The functions of the NHG GMEC include: a. Complying with existing NHG GME policies and procedures that ensure quality education and conducive work environment for residents and fellows in all programs; and where such policies and procedures are absent, establish and implement them to ensure quality education and conducive work environment for the residents and fellows in all programs, including: i) Perform annual review and make recommendations to relevant Assistant Chairman of Medical Board (Clinical Manpower) or equivalent in participating NHG, AHPL institutions, Human Resource Director, MOHH and other relevant departments/services regarding resident and fellow stipends, benefits, and funding for resident positions. ii) Establish and maintain effective communication mechanisms between GMEC and all PDs within NHG-AHPL. iii) Ensure that PDs: Maintain effective communication mechanisms with Site Directors at each participating site for their respective programs; Maintain proper oversight at all clinical sites. iv) Develop and implement written policies and procedures regarding resident duty hours to ensure compliance with the Institutional, Foundational, and Specialty/Subspecialty Specific Program Requirements. v) Consider for approval requests from PDs prior to submission to a Residency Review Committee (RRC) for exceptions in the weekly limit on duty hours in compliance with ACGME-I Policies and Procedures for duty hour exceptions applicable to Singapore. vi) Monitor programs supervision of residents and fellows and ensure that supervision is consistent with: Provision of safe and effective patient care; Educational needs of residents and fellows; Progressive responsibility appropriate to residents and fellows level of education, competence, and experience; and Other applicable Foundational and Specialty/Subspecialty Specific Program Requirements. vii) Communicate between leadership of the medical staff regarding the safety and quality of patient care that includes: The NHG GMEC Annual Report (see para c below); Description of residents and fellows participation in patient safety and quality of care education; Accreditation status of programs and any citations regarding patient care issues. viii) Ensure that each program provides a curriculum and an evaluation system that enables residents and fellows to demonstrate achievement of the ACGME-I general competencies as defined in the Foundational and Specialty/Subspecialty Specific Program Requirements. ix) Select, evaluate, promote, transfer, discipline and/or dismiss residents and fellows in compliance with the Institutional and Foundational Program Requirements. x) Review all ACGME-I program accreditation letters of notification and monitor action plans for correction of citations and areas of noncompliance. NHG-AHPL RESIDENCY HANDBOOK 16 APR 2012 4 of 30

xi) xii) xiii) xiv) xv) Review NHG ACGME-I letter of notification from the Institutional Review Committee (IRC) and monitor of action plans for correction of citations and areas of non-compliance. Review the following for approval prior to submission by PDs to ACGME-I: All applications for ACGME-I accreditation of new programs; Changes in resident complement; Major changes in program structure or length of training; Additions and deletions of participating sites; Appointments of new PDs and re-appointments of PDs; Progress reports requested by any Review Committee; Responses to all proposed adverse actions; Requests for an appeal of an adverse action; Appeal presentations to a Board of Appeal or the ACGME-I; Requests for exceptions of resident duty hours; Voluntary withdrawal of program accreditation. Oversee all phases of educational experiments and innovations that may deviate from Institutional, Foundational, and Specialty/Subspecialty Specific Program Requirements including: Granting approval prior to submission to the ACGME-I and/or respective Review Committee; Ensuring adherence to Procedures for Approving Proposals for Experimentation or Innovation Projects in ACGME-I Policies and Procedures; and Monitor the quality of education provided to residents for the duration of such a project. Oversee all processes related to reductions and/or closures of: Individual programs; Major participating sites; and National Healthcare Group. Provide a statement or institutional policy that addresses interactions between vendor representative / corporations and residents and fellows/gme programs. b. Exercising authority and responsibility for the oversight and administration of NHG- AHPL residency programs and responsibility for assuring compliance with ACGME-I Foundational, Specialty/Subspecialty Specific Program Requirements. c. Preparing an annual report henceforth known as NHG GMEC Annual Report to the NHG CMB Committee and relevant Medical Board of NHG institutions, AHPL and participating institutions, and i) Present the annual report which describes activities of the GMEC during the past year with attention to: resident and fellow supervision; resident and fellow responsibilities; resident and fellow evaluation; compliance with duty-hour standards; resident participation in patient safety and quality of care education. ii) Deliver the NHG GMEC Annual Report to the Medical Board or equivalent Organized Medical Staff of major participating sites that do not sponsor GME programs. NHG-AHPL RESIDENCY HANDBOOK 16 APR 2012 5 of 30

d. Developing, implementing, and overseeing an internal review process by: i) Appointing an Education Review Committee for each program that: must include at least one faculty member from NHG-AHPL but not from within the program being reviewed; must include at least one resident from NHG-AHPL but not from within the program being reviewed; If necessary, include additional internal or external reviewers; If necessary, include administrators from outside the program. ii) Establishing the policy NHG Education Review Protocol that incorporates the items detailed in the ACGME-I Institutional Requirements and ensuring compliance by the programs. iii) Documenting in GMEC minutes of meeting, the internal review process at the approximate midpoint of the accreditation cycle for each program. iv) Demonstrating continued oversight of program(s) with no resident, through a modified internal review to ensure maintenance of adequate Faculty and staff resources, clinical volume, and other necessary curricular elements required to be in substantial compliance with the Institutional, Foundational, and Specialty/Subspecialty Specific Program Requirements prior to the program(s) enrolling a resident. v) Monitoring the response by the program to actions recommended by the GMEC and internal review process. vi) Submitting the most recent internal review report for each training program as part of the Institutional Review Document (IRD). If the institutional site visitor simultaneously conducts individual program reviews at the same time as the institutional review, the internal review report(s) for the/those program(s) must not be shared with the site visitor. e. Meeting at least quarterly and maintaining written minutes. GMEC Membership 2. The NHG GMEC is chaired by Designated Institutional Official (DIO), A/Prof Nicholas Chew. Full list of members as at 16 Apr 2012 can be found on the NHG-AHPL Residency website (http://www.nhgresidencyprogram.com.sg). Institutional Agreements 3. To ensure quality and consistency of graduate medical education for NHG-AHPL residents provided at all participating sites, all NHG-AHPL residency programs sign Program Letter of Agreement (PLA) with each agreement outlining the responsibilities of the Sponsoring Institution (NHG) and of the participating site towards ensuring the quality of graduate medical education for NHG-AHPL residents at that site. 4. The DIO reviews all program letters of agreement when a participating site is added. By this, the DIO ensures that all PLAs for new participating sites contain the four key components as outlined in the ACGME-I Foundational Program Requirements of: a. identification of the faculty who will assume both educational and supervisory responsibilities for residents; NHG-AHPL RESIDENCY HANDBOOK 16 APR 2012 6 of 30

b. specification of faculty s responsibilities for teaching, supervision, and formal evaluation of residents, as specified later in this document; c. specification of the duration and content of the educational experience; and, d. statement of the policies and procedures that will govern resident education during the assignment. 5. Each of these agreements is signed by the PD/DIO, as well as, by the Site Director (SD) and his DIO/Chairman of Medical Board (CMB) or his/her designee for the participating site in order to ensure that both parties agree to the content of the agreement. NHG-AHPL RESIDENCY HANDBOOK 16 APR 2012 7 of 30

III APPOINTMENT TO NHG-AHPL RESIDENCY PROGRAMS Eligibility of Appointment 1. All programs sponsored by NHG-AHPL: a. will select residents from among eligible applicants on the basis of preparedness, ability, aptitude, academic credentials, communication skills and personal qualities such as motivation and integrity; b. will not discriminate with regards to sex, race, age, religion, ancestry, color, national origin, disability or any other applicable legally protected status; c. will participate in and abide by the rules and regulations established by the national resident matching program administered by MOHH. 2. Applicants must meet the following criteria to be eligible for appointment as a resident: a. Possess appropriate qualifications: i) Possess a MBBS degree from the National University of Singapore; OR ii) Possess a basic medical degree awarded by an overseas medical school listed in the Schedule of the Medical Registration Act (MRA) of Singapore (for complete list, please refer to http://www.healthprofessionals.gov.sg/content/hprof/smc/en/leftnav/beco ming_a_registereddoctor/international_medical_graduates.html) Those from recognized medical schools listed in the Schedule must pass the relevant national licensing examinations in the listed country e.g. in the USA medical graduates must pass the USMLE and in Canada, they must pass the MCCQE to be registered to practice in Singapore. For any country that imposes such national licensing conditions on its own medical graduates, the corresponding conditions will also be required for registration to practice in Singapore. The medical school conferring the qualification must also be registered in the International Medical Education Directory (IMED) (http://www.faimer.org/resources/imed.html). b. Eligible for medical registration with the Singapore Medical Council (SMC) (for complete list, refer to http://www.healthprofessionals.gov.sg/content/hprof/smc/en/leftnav/becoming_a_ registereddoctor/registration.html). c. Fulfill the applicable Residency Advisory Committee (RAC) specialty and subspecialty requirements. d. Must have discharged any outstanding obligations and must forego any pending claims against NHG, Tan Tock Seng Hospital (TTSH), Institute of Mental Health, NHG Polyclinics or any of the participating institutions within the NHG-AHPL. 3. Other than the above criteria, a. A criminal background check and drug screening may be conducted on prospective residents and fellows. If an individual is found to be convicted of serious criminal offences such as assault, criminal sexual conduct, etc. that disqualify the individual from positions with direct patient contact, the individual NHG-AHPL RESIDENCY HANDBOOK 16 APR 2012 8 of 30

becomes ineligible for appointment or continuation of appointment in NHG-AHPL residency programs. b. A pre-admission health review and current immunization record are required prior to commencement of graduate medical education in keeping with NHG HR staff policy. c. Non-Singaporean or a non-singapore permanent resident must be eligible to be issued with a Work Pass by the Ministry of Manpower to be employed. Application 4. Application for residency programs in Singapore is coordinated by the MOHH. 5. Calls for applicants to apply for residency programs will be announced on the MOHH s Physician website (www.physician.mohh.com.sg) and all SIs sites every year. 6. Applicants are encouraged to apply early to the programs that interest them and travel for interviews (for overseas graduates) if invited. New graduates who are unsuccessful with their applications with Residency will have to apply for their preferred postings in the national House Officer Posting Exercise/ Medical Officer Posting Exercise (HOPEX/MOPEX), also administered by MOHH. 7. Applicants must submit a completed application with supporting documents as prescribed by MOHH. Selection 8. NHG-AHPL Residency follows the selection process defined by MOH and MOHH. 9. A two tier system is used to determine the eligibility of applicants: a. a specialty-specific National Selection Panel comprising the PD from each SI or their representatives and a representative from the Residency Advisory Committee (RAC) of the specialty determines the eligibility of applicants. This panel determines the eligibility of an applicant to enter training in the specified specialty and to provide a national ranking of all applicants for the same specialty. b. the NHG-AHPL Residency Program Selection Panel comprising the PD, Associate Program Director (APD), Core Faculty/Designated Faculty will also internally rank the applicants and participate in the national matching exercise, administered by MOHH. 10. NHG-AHPL Residency then takes part in the national matching exercise administered by MOHH. 11. The rules of the matching exercise are devised to be impartial to both hospitals/healthcare institutions and the applicants. Applicants rank the residency programs that they are interested in, and the SIs rank the candidates of their choice separately. Candidates and SIs are blind to each other s ranking. 12. Candidates are then offered based on their preference within the training capacity of the SI during the matching exercise. NHG-AHPL RESIDENCY HANDBOOK 16 APR 2012 9 of 30

Appointment 13. Upon successful match through the national matching exercise and fulfilling the criteria for appointment, successful applicants will be issued with a Residency Offer Letter co-signed by the DIO and Director (Manpower Standards and Development)/MOH, a Residency Agreement, together with the offer of employment letter from MOHH, where applicable. 14. All residents will be appointed for the duration of the residency program they are offered, subject to yearly renewal. 15. Training duration may be extended by long leave and absence from training beyond the allowed number of days, below par performance during the residency, failure in examinations and where competency to progress to the next level is not evident. Transfers/Switches 16. The following guideline on transfers is based on the MOH Residency Terms and Conditions dated Apr 2012. 17. Residents who withdraw from one residency program and wish to enter into another residency program or BST/AST/Seamless programme in: a. the same specialty offered by a different SI; or b. a different specialty offered by the same SI; or c. a different specialty offered by a different SI will be required to re-apply. However they cannot reapply in the subsequent year but can only reapply the year after next (one year penalty) unless the change is due to strong reasons 1, and recommended by the PD and approved. This is to ensure responsible decisions when you enter into training and accountability of funded training programs. 18. Residents are to note that they may not get the program of their choice if they are not selected. They will not be able to return back to their previous program once they have withdrawn from it. 19. Program Withdrawn From The PD of the program from which the resident withdrew is required to provide a written or electronic verification of the transferring/ switching resident s a. training and educational experiences; b. performance evaluation including assessment of competence in: i) Patient care ii) Medical Knowledge iii) Practice-based learning and improvement iv) Interpersonal and communication skills v) Professionalism vi) Systems-based practice c. any other information relevant in program transfer (e.g. reason for withdrawal). 1 Eg health reasons that render a resident unsuitable for a particular specialty NHG-AHPL RESIDENCY HANDBOOK 16 APR 2012 10 of 30

20. The information should be provided at the point of withdrawal for the resident s personal records. The program from which the resident withdrew should also keep a record for their own use. 21. The NHG GME Institutional Policy on Resident Transfer/Switches/Resignation shall apply. The policy is attached as Annex B for reference. 22. Program Receiving The PD of the receiving program should obtain the information in Para 18 before accepting a resident transfer/ switch into his or her program. 23. Resident transfers/switches, if successfully matched and accepted, are to commence residency at R1 and must be placed on close monitoring/supervision for assessment of competencies and the appropriate remediation required if needed, to determine placement at R2 under the current rules. Resident Responsibilities 24. Residents shall: a. Provide patient care, under appropriate supervision, as assigned by the Residency PD or his/her designee, consistent with the educational goals of the program and high standards of patient care. ("Patient care" includes responsibility for associated documentation in the medical record, which should be completed in a timely fashion, and attendance at patient care rounds as assigned); b. Make appropriate use of the available supervisory and support systems, seeking advice and input from faculty when and as appropriate, and in accordance with the NHG GME Policy on Resident Supervision; c. Participate fully in the educational and scholarly activities of the Residency Program as specified by the PD, including attendance at didactic teachings, and other responsibilities which may include research projects, the completion of examinations, the maintenance of procedure logs, or other items; d. Develop a personal learning program to foster continued professional growth, with guidance from the teaching staff; e. Assume responsibility, as called upon, to teach more junior trainees and medical students, within the scope of the Residency Program; f. Participate in improving the quality of education provided by the Residency Program, in part by submitting any confidential evaluations of the faculty, the program and the overall educational experience requested by the PD; g. Adhere to the established practices, procedures and policies of the SI, the SI's Medical/Professional Staff, the Department and affiliated training sites; h. Participate in institutional programs, councils or committees and other medical staff activities, as appropriate; i. Abide by the institutional and program-specific Resident duty hours policies and, as scheduled by the PD, accurately report his/her duty hours; j. Comply with MOHH and institutional requirements for health and safety training, vaccinations and health screening; k. Comply with MOH's Residency terms and conditions. 25. The SI is responsible for overseeing the resident s training and rotations throughout the period of residency. Residents should check with their respective PC prior to beginning rotations at an affiliated site to obtain the necessary procedures for reporting to the rotation site. Upon arrival for a rotation in an affiliated hospital, residents must report to the appropriate office to complete necessary paperwork. NHG-AHPL RESIDENCY HANDBOOK 16 APR 2012 11 of 30

Residents are responsible for adhering to the policies and procedures established by the GMEC, the institutions in which they function, and their individual programs. 26. While on rotations, residents shall also be: a. accountable to the PD to whom they have been assigned for all matters pertaining to the professional care of patients. They are accountable to the Site Director and Chairperson of the Medical Board at each facility to which they are assigned for matters of administrative policy and procedure; b. responsible for checking with the PD regarding any response time requirements while taking call from home. Conditions for Reappointment and Promotion 27. Evaluation Each residency program will develop educational goals and objectives for its residents, which are consistent with the ACGME-I criteria for the particular specialty. Evaluations shall use criteria and procedures appropriate to the particular program and shall include, but are not limited to, the core competencies of Patient Care, Medical Knowledge, Communication and Interpersonal Skills, Practice-Based Learning and Improvement, Professionalism, and Systems-Based Practice, as defined by the ACGME-I. 28. A written evaluation of each resident addressing medical knowledge, competence in patient care, professionalism, system-based practice, interpersonal and communication skills, and practice based learning and improvement will be completed at the end of each major rotation. The PD or faculty designee will share the evaluation(s) with the Resident and provide feedback in accordance with ACGME-I requirements for that specialty. This evaluation sharing will occur at least semi-annually, includes a written review of performance, and a discussion of areas of strengths and deficiency and plans for improvement. 29. The written evaluation and any documentation regarding the meeting will be maintained in the Program file by the PC. 30. If an evaluation indicates unsatisfactory performance, the resident will be provided with a remedial plan for correcting any deficiencies, in accordance with the NHG GME Policy on Resident Evaluation and Disciplinary Guidelines. If remediation is not satisfactory, it may be cause for probation or termination from the Residency Program. 31. The Resident s advancement to a position of higher responsibility will be made only on the basis of an evaluation of his/her readiness for advancement. 32. Reappointment The term of appointment expires at the end of the period defined in the Resident Appointment Agreement signed by the resident, unless sooner terminated in accordance with applicable policies. Re-appointment of Post-Graduate Year 1 residents will take place upon their successful completion of the first (1 st ) year, according to the level of competencies defined in each program, their ability to continue with the program, and upon fulfilling licensing requirements defined by the SMC. 33. For residents who have already obtained full practicing license from the SMC, reappointment will take place annually with the successful completion of each residency year, according to the level of competencies defined by each program and NHG-AHPL RESIDENCY HANDBOOK 16 APR 2012 12 of 30

as determined by the PD. In making this determination, the PD will take inputs from the Clinical Competency Committee and may consider inputs from supervising attending physicians, Chief Residents and others who have worked closely with the resident during the period of this engagement. The PD may also consider the results of an in-training examination, where applicable. Residents must, at a minimum, have completed responsibilities as appropriately assigned within the scope of the Residency Program and attained the knowledge and skill necessary to progress to the next level of post-graduate training. 34. Non-promotion The PD, with inputs from the Clinical Competency Committee and other faculty members, with ample reasons, may decide on a non-promotion of a resident in his residency program. The resident will be notified in writing of the nonpromotion at least four (4) months before the expiry of the term of appointment. The resident may appeal against the decision following the NHG GME Grievance Policy and Procedure (Annex A). MOHH will also be duly informed. 35. Final Evaluation The PD or his/her designee will provide a written final evaluation for each resident who satisfactorily completes the program. The evaluation will be based on performance during the final period of training and will verify that the resident has demonstrated sufficient professional ability to practice competently and independently. The PD is responsible for providing verification of residency education for any resident who may leave the program prior to completion of his/her training. 36. Completion of Residency Program A Resident will be certified to have completed the Residency program if he has fulfilled all the requirements stated in the program requirements and completed the mandatory courses set out by the Specialists Accreditation Board (SAB) including the prescribed Medical Ethics, Professionalism and Health Law Course. All Residents are required to register for the course and make payment directly to the provider. For more information on the course, please visit the Specialists Accreditation Board s website at: http://www.healthprofessionals.gov.sg/content/hprof/sab/en/topnav/specialist_training /general_overview/medical_ethics_law_professionalism.html. 37. Successful completion of the Residency program and the prescribed exit exam does not equate to automatic entry into the Specialist Register or Family Physician Register. Residents are required to personally apply to the Specialists Accreditation Board (SAB) or the Family Physicians Accreditation Board and the SMC before they are statutorily eligible to practice as a Specialist or Family Physician. 38. Non-Renewal of Appointment Non-renewal of appointment will be based on the program s evaluation of a resident s performance and progress, decided by the PD, with inputs from the Clinical Competency Committee, and in consultation with the DIO. The resident will be notified of the non-renewal of the appointment in writing at least four (4) months before the expiry of the term of appointment. MOHH will also be informed to prepare for the subsequent rotations of the resident. 39. The NHG GME Policy on Resident Evaluation and Disciplinary Guidelines is attached as Annex C. NHG-AHPL RESIDENCY HANDBOOK 16 APR 2012 13 of 30

Program Closure/Reduction 40. If, in its sole discretion, NHG-AHPL decides to either reduce the size of, or close a program or certain parts of a program, residents will be notified as soon as practicable. 41. Residents already in the program at that time will be allowed to either complete the program or be assisted in identifying another ACGME-I-accredited program in which to continue their education. 42. The NHG GME Policy on Reduction in Size or Closure of a Residency Program is attached as Annex D. Conditions for Separation 43. Resignation The Resident may resign from the Residency Program he/she is appointed to with one (1) month written notice of his/her intent to resign in accordance to the NHG GME Institutional Policy on Resident Transfer, Switches or Resignation from Program. The Resident s resignation must be submitted to the PD. All conditions of appointment will terminate on the effective date of the resignation. 44. Separation Separation may occur at the end of an appointment term under any circumstances in which reappointment does not occur, including a resident s successful completion of the Residency Program. 45. Termination A resident s appointment may be terminated at any time by the NHG Residency upon notice to the resident due to the following conditions: a. Without the consent of the SI, abandons the Residency Program or is disqualified from the Residency Program owing to unsatisfactory attendance at the Residency Program or without good reason in any way fails or renders himself unable or unsuitable to pursue the Residency Program before the completion thereof; or b. Fails in any of the prescribed tests and/or examinations; or c. Is convicted by a Court of law in any country of any offence involving dishonesty or moral turpitude or of such nature, which offence, in the absolute opinion of the SI renders the Resident unsuitable for an appointment for service with the SI s; or d. Willfully and persistently disobeys or fails to conform with the lawful and reasonable orders or directions of the SI s supervisors, tutors or instructors associated with the Residency Program or the prescribed institutions; or e. Refuses or in the opinion of, the SI willfully renders himself unable to serve in accordance with the provisions of this Terms and Conditions; or f. Is found to have committed any act of dishonesty or misconduct which, in the absolute opinion of the SI, is likely to bring the SI or any officials of the SI into disrepute, whether or not such dishonesty or misconduct or act is directly related to the affairs of the SI; or g. With or without the consent of the SI, resigns from or leaves the service of the SI and fails to serve or complete the term of the appointment Period; or h. Before the expiry of the appointment Period, is dismissed from the service of the SI for misconduct, negligence, incompetence, poor work performance not meeting the SI's standard or breach of discipline or for any reason whatsoever, has his service terminated; or i. Is terminated by his/her employer. NHG-AHPL RESIDENCY HANDBOOK 16 APR 2012 14 of 30

Certification Requirements 46. ALL NHG-AHPL residents are to ensure that he/she holds a valid: a. SMC practicing certificate; b. Medical Malpractice Insurance (MMI) or alternative professional indemnity coverage; c. BCLS certificate; d. ACLS certificate; and e. Certificate to Administer Moderate Sedation in SI and affiliated training sites (if applicable) for himself/herself throughout the entire period of appointment with the SI/participating training sites during which the resident is providing patient care and clinical services at the SI/participating training sites. 47. The MMI coverage provides legal defense and protection against awards from claims for which the resident may be liable even when reported or filed after completion of the training period if the alleged acts or omissions had occurred within the scope of the education program. 48. Should the resident fail to maintain such insurance coverage at any particular time during his/ her appointment with the SI, the SI shall have the rights to terminate the agreement of appointment with immediate effect. 49. In the event of financial difficulties being encountered by the resident s medical defense insurance organizations or indemnity providers, the above clause shall apply. Academic Records 50. The NHG-AHPL Residency upholds the highest standards regarding the management of resident academic records and confidentiality. Faculty and administrative staff may have access to resident records on a need-to-know basis in the course of training, performance improvement, research, or education/training. Misuse of medical data and/or inappropriate release or disclosure of information may result in penalties for violation of medical privacy. 51. Disclosure of resident information and requests from outside parties shall require an appropriate signed release from the resident specifying what information NHG-AHPL shall disclose. Exceptions to this policy may apply for requests from Governmental agencies where NHG-AHPL is required to respond to requests for information, inspections, or investigations. NHG-AHPL RESIDENCY HANDBOOK 16 APR 2012 15 of 30

IV RESIDENT SUPERVISION AND DUTY HOURS 1. NHG-AHPL and all residency programs it sponsors are committed to and responsible for: a. promoting patient safety and resident well-being and to providing a supportive educational environment; b. ensuring that the learning objectives of the programs are not compromised by excessive reliance on residents to fulfill service obligations; c. ensuring that residents education and clinical training have priority in the allotment of residents time and energy; d. ensuring that duty hour assignments recognize that faculty and residents collectively have responsibility for the safety and welfare of patients. 2. The NHG GME Policy on Resident Supervision and Duty Hours is attached as Annex E and F respectively for reference. Residents are also to refer to program specific policies on resident supervision and duty hours, where applicable. NHG-AHPL RESIDENCY HANDBOOK 16 APR 2012 16 of 30

V RESIDENT IMPAIRMENT AND SUBSTANCE ABUSE 1. NHG GMEC recognises the need to help residents who may suffer from impairment, to maximise their potentials in training and to maintain clinical quality and safety. 2. Parties who bring to the attention of the NHG GMEC possible impaired residents will be protected with anonymity and from any forms of reprisal. This policy is in keeping with Ethical Code published by the SMC. 3. Resident Impairment is defined as a resident who is unable to perform his duties in a safe and competent manner by reason of physical, psychological, substance misuse or social factors. 4. Substance misuse is defined as inappropriate, excessive or recurrent use of substances or drugs that result in adverse consequences. 5. All residents and training faculty will attend and document participation in a training session on the following: a. How to identify Impaired clinicians b. Fatigue and sleep deprivation c. Psychological factors d. Substance use disorder 6. It is the responsibility of any resident to disclose to the APD or PD in charge of the training rotation if he is suffering from any medical, psychological or substance misuse conditions that might render him/her unable to practice safely and competently. 7. It is also responsibility of any resident or faculty to inform the APD/PD if they suspect that a resident is suffering from impairment or exposing patients to unnecessary risks. 8. In the event that a potentially impaired resident is reported to the APD/PD, the APD/PD will conduct an investigation to determine the validity of the report. If the report is valid, the APD/PD will notify the NHG GMEC. During this time, the APD/PD may decide to temporarily suspend the resident from training and clinical work if there are any potential patient safety issues. 9. The APD/PD will offer assistance in obtaining the necessary medical, psychological and social assistance for the resident and monitor the resident s progress in treatment. 10. An ad-hoc meeting of NHG GMEC will review the report and decide on the severity of the impairment. This meeting should consist of at least 4 APDs/PDs and the DIO or Acting DIO. 11. Where there are concerns regarding severe impairments leading to patient safety concerns, the NHG GMEC will raise the matter to the CMB of the respective hospitals. 12. After reviewing the facts, the NHG GMEC will recommend to the CMB the following outcomes: a. Specialist assessment and treatment where necessary. b. Full reinstatement of training privileges may be recommended NHG-AHPL RESIDENCY HANDBOOK 16 APR 2012 17 of 30

i) On obtaining adequate treatment and assistance, and ii) Assessed by the NHG GMEC to be able to return to full time training. iii) This may result in an increase in duration of residency programme. c. Partial reinstatement may be recommended, i) On obtaining adequate treatment and assistance, and ii) Assessed by the NHG GMEC to be able to return to training but requiring limited caseload; and/or closer supervision; and/or remediation. iii) This may result in an increase in duration of residency programme. d. Termination from training maybe recommended in the event that i) full or partial reinstatement is persistently deemed to be unsuitable up to 1 year following adequate treatment; or ii) if the resident should refuse evaluation by appropriate specialist or comply with recommended treatment. 13. The final outcome decision will be made by the CMB of the hospital in which the resident is based and communicated to the NHG GMEC. The NHG GMEC will inform the resident of the decisions taken in writing. NHG-AHPL RESIDENCY HANDBOOK 16 APR 2012 18 of 30

VI OTHER PROVISIONS FOR RESIDENTS Access to Confidential Counseling, Medical, and Psychological Services 1. All NHG-AHPL residents in distress or in need for confidential counseling, medical and psychological services are encouraged to tap on the NHG s 3S Program. 2. The 3S Program is a TTSH wide staff support network that trains and utilizes the peer as a resource person to provide emotional support. The program has identified and trained registrars and consultants in both medical and surgically related departments to help identify doctors in need and provide emotional assistance to them. 3. All doctors working in TTSH have easy access to staff support and mental health services if required. Doctors who feel the need to talk to someone confidentially can activate help by contacting: a. Hotline: 97208515 b. Email: Staff_Support_Staff@TTSH.com.sg 4. NHG Residents training in any participating sites may also utilize this service. Complaints and Concerns 5. Residents could raise complaints and concerns that they might have with fellow residents, other members in the healthcare team, faculty members, including PDs, and administrators from the GME Executive Office including the DIO, following the NHG GME Policy on Addressing Complaints and Concerns. The policy is attached as Annex G of this handbook. 6. NHG Residency assures residents who raise any complaints or concerns that they will be accorded protection against retaliatory acts from their supervisors or any other staff. If the resident suspects that he/she is a subject of retaliatory action, he/she is to report directly to the PD or DIO. Faculty members, supervisors or staff who are found to have taken reprisal actions or victimized the resident will face disciplinary actions, including possibility of dismissal from NHG Residency, and will be referred to the CMB, of the respective institution for disciplinary hearing. 7. Residents may also report any misconduct, negligent or improper activities following the guidelines and procedure set out in the NHG Whistle-Blowing Policy. The policy is available for all residents reference through the NHG Intranet. NHG-AHPL RESIDENCY HANDBOOK 16 APR 2012 19 of 30

NHG Disciplinary Policy and Procedure 8. NHG Human Resource s Disciplinary Policy and Procedure provides for staff/residents to raise and resolve concerns about other matters not related to training, e.g. harassment (including sexual) and other forms of misconduct in a confidential and protected manner without fear of intimidation or retaliation. If any resident raises such a concern directly to the DIO, the DIO will guide him/her to the proper channel. The NHG Human Resource s Disciplinary Policy and Procedure is available to all residents through the NHG Intranet. Residents with Disabilities 9. NHG and NHG Residency do not discriminate against any staff/resident with physical disabilities as long as the staff/resident is able to fulfill his/her roles and responsibilities as required. Access and facilities for disabled residents are available at common areas of the various participating sites. 10. All call rooms have lifts and wheelchair access. Wheelchair assistance is available twenty-four (24) hours a day by contacting the appropriate Security Office. NHG-AHPL RESIDENCY HANDBOOK 16 APR 2012 20 of 30

VII EMPLOYMENT AND RELATED BENEFITS Salary and Services 1. MOHH 2 administers the resident s employment contracts and other relevant Human Resources matters including leave, medical benefits, salary, insurance coverage, etc. Residents shall abide and receive salary, annual leave, medical benefits, insurance coverage and other benefits set out in the MOHH employment contract. 2. Annual Leave and Training Leave All residents should note that: a. For PGY1, the following conditions apply: i) Residents are entitled to 21 working days per calendar year and the annual leave is allocated according to their PGY1 posting period as follows: Posting Period (Months) No. of Annual Leave Days 2 3.5 4 7 6 10.5 ii) The annual leave will be pro-rated according to completed calendar days where the resident s period of service with MOHH is less than a calendar year. iii) Such leave is to be taken at times convenient to MOHH and not be accumulated without the prior written permission of MOHH. Any unconsumed leave will be forfeited upon completion of each posting period. iv) PGY1 residents are also entitled to 14 days of medical leave in a year. v) PGY1 residents are not entitled to specific training leave as the entire year is considered training for the licensing year. vi) Should PGY1 residents be required to participate in activities like conferences/symposiums, seminars, workshops, lectures, courses, examinations relevant to the program, PDs are to plan them as part of the residents Protected Training Time, capped at a maximum of 12 days per year. As a guide, for 3-month rotations, up to 3 days could be planned; 4-month rotations, up to 4 days could be planned; 6-month rotations, up to 6 days could be planned. vii) viii) For longer period of absence possibly due to overseas travel, PD are to preplan with residents at least 6 months ahead to facilitate manpower planning. The total number of days of absence 1 in PGY1 should not exceed 35 days in a year with the allowable days for each period of posting shown in Table 1. 2 Or the SAF for SAF Scholars 1 Days of Absence is defined as the total number of days a resident is absent from training whether from official leave entitlements or any other reasons (e.g maternity leave, no pay leave, etc.) NHG-AHPL RESIDENCY HANDBOOK 16 APR 2012 21 of 30

Table 1 Period of Posting (Months) Allowable Days of Absence 2 6 3 9 4 12 6 18 b. For PGY2 and beyond who have completed their licensing year in PGY1 successfully, the following conditions apply: i) Residents are entitled to 24 working days 3 per calendar year. ii) The annual leave will be pro-rated according to the completed months of service where the resident s period of service with MOHH 2 is less than a calendar year. iii) Such leave is to be taken at times convenient to MOHH 2 and not be accumulated without the prior written permission of MOHH 2. Residents may only carry forward a maximum of five (5) days of annual leave entitlement to the next calendar year (the second calendar year). Leave carried forward must be consumed by 31 December of the second calendar year, failing which such leave will be automatically forfeited without any compensation or notification. iv) PGY2s and beyond are also entitled to 14 days of medical leave 3 in a year and a maximum of 12 days of training leave 3 is allowed in a year. v) Training leave is defined as leave taken for activities relevant to the specific Residency program (including but not limited to conferences/symposiums, seminars, workshops, lectures, courses, examinations) and hence will not be considered as leave of absence. Training leave cannot be cumulated and carried forward to the following year. vi) Examinations may be considered under activities relevant to the specific residency program. For approved training activities requiring travel overseas, up to a maximum of 2 days before and 2 days after of training leave may be approved for travel. PDs should exercise discretion when approving the number of days for travel. vii) Residents who apply for training leave must obtain approval from the PD. The PD will decide whether the training leave is considered appropriate and relevant to the program. Should there be misinformation or misuse of training leave, action will be taken to recover funding for training days and the leave days will be forfeited from the annual leave. viii) The allowable days of absence for each period of posting for PGY2 and beyond are as shown in Table 2. Table 2 Period of Posting (Months) Allowable Days of Absence 2 6 3 10 4 13 6 19 3 SAF Scholars are to refer to the SAF employment contract for the leave entitlement. NHG-AHPL RESIDENCY HANDBOOK 16 APR 2012 22 of 30