• Resize Text: decrease increase
Introduction

The Singapore Medical Council (SMC) has a duty to ensure that patients’ safety is always safeguarded, and this is achieved through its implementation of a Supervisory Framework, which is a tool used by SMC to monitor foreign-trained doctors who are on Conditional and Temporary registration.

Objective

The objective of the SMC’s Supervisory Framework is to ensure there is direct and timely supervision for foreign trained doctors while they are at work, so that patient’s safety is not compromised.

Structure

A medical practitioner who is conditionally or temporarily registered will be subjected to monitoring under SMC’s Supervisory Framework throughout the period of his medical registration, which may range from 1 to 4 years or more. 

In order to ensure that there is optimum supervision, the supervisor must first meet the criteria and adhere to the supervisory ratio stipulated by SMC.

The supervisor’s assessment reports are required at periodic intervals, and multi-rater assessment reports from the supervisee’s colleagues e.g. doctors, nurses and other healthcare professionals, may also be requested to get a more holistic assessment of the doctor’s performance.

SMC will systematically review the doctor’s performance based on such regular assessment reports.

Details of the framework can be found in the “Guidelines” section below.

Guidelines

The supervisory framework guidelines are broadly categorised into:

(a) Orientation
(b) Supervision
(c) Monitoring & Feedback
(d) Supervisor’s Assessment Reports
(e) Multi-Rater’s Assessment Reports
(f)  Identification of Poor Performers
(g) Temporary Registrants on Service
(h) Temporary Registrants on Training (Clinical Fellows/Observers)

Supervisory Framework Guideline

Assessment Forms Reference Table

Letter of Undertaking by Prospective Supervisor

SMC reserves the right to subject the doctor on conditional/temporary registration to review(s) by registered medical practitioners and/or other healthcare professionals when it deems necessary.


Accreditation as Learning Institution

Currently new International Medical Graduates (IMGs) from schools on the Schedule in the Medical Registration Act may apply for Conditional registration (C-reg) to practise only in approved healthcare institutions (AHIs), under the supervision of fully registered medical practitioners.

Healthcare providers who wish to recruit new IMGs to work at their institutions are welcome to apply to SMC to be accredited as Learning Institutions (LIs). Healthcare providers may wish to note that certain structures and processes, as listed below, should be in place, for their applications to be considered. This allows healthcare providers to fulfil their medical manpower needs while enabling new IMGs to adapt to our healthcare system and continue their professional development through peer interaction and practice-based learning. This framework ensures the safety and well-being of our patients.

The pre-requisites are as follows:

1. The institution has been accredited by JCST and/or ACGME-I for the training of residents or trainees;

2. Otherwise, all the following criteria must be met:

(A) Institution Structure

There is a “departmental” structure in place within the institution where doctors are given the opportunity to work as a team in the management of patients.

The following will not be allowed:

a)  General Practitioners (GPs) named in a practice but who only work there on a part time basis for less than 50% of each week or who are deployed there only as and when required.

b)  Specialists who run their own practices calling themselves a ‘group’ when, in fact, there is no organised or structured institutional practice.

c)  Specialists named in an organised institutional practice, but who are not, in fact, working full time in the practice. (e.g. a hypothetical ‘cardiology centre’ which may exist in physical form, but where cardiologists with their own practices participate on a sessional or rotational basis each for less than 50% of each week).

d)  Different specialists physically co-located, but not involved in an institutional style service programme. (e.g. a hypothetical group comprising a cardiologist, a gastroenterologist, a paediatrician and a general surgeon who share a large combined clinic, but who actually work independently of one another.)


(B) Supervisory Framework

There must be sufficient supervisors who meet the criteria for supervising new C-reg doctors under SMC's supervisory framework.

  Description Requirements
1 Supervisor working full time? Full Time
2 Minimum number of Senior doctors

a. At least 2 fully registered (F-reg) senior doctors (including the supervisor) in the same practice place.

b. 2 part-time senior doctors (but not the supervisor) can be counted as 1 full-time doctor if they participate in at least 50% each of a working-week.

3 Criteria of Senior doctors in item 2 Supervisee is a Specialist
- The Senior doctors should:
a. be from the same speciality
b. be accredited by SAB and be in the Register of Specialists of SMC
c. have been fully registered for at least 5 years; and
d. have at least 5 years of experience as a specialist under F-reg

Supervisee is a FP/GP
- The FP Senior doctors should:
a. be accredited by FPAB and be in the Register of Family Physicians of SMC
b. have been fully registered for at least 5 years; and
c. have at least 5 years of experience as a FP and/or GP under F-reg.

- The GP Senior doctors should:
a. have been fully registered for at least 5 years; and
b. have at least 5 years experience of GP under F-reg.

Supervisee is a non-specialist (Medical Officer)
- The Senior doctors should:
a. be from the same speciality as the department where the supervisee is practising in (eg.if the supervisee is practising in the Department of Cardiology, the senior doctors should be Cardiologists); and
b. be accredited by SAB and be in the Register of Specialists of SMC;
c. have been fully registered for at least 5 years; and
d. not necessary to have 5 years of experience as a specialist under F-reg.
4 Supervisor - Supervisee Ratio The institution must observe and maintain the supervisor-supervisee ratio, the intensity of supervision as stipulated, and comply with the guidelines issued by the SMC.
5 Monitoring and Feedback

The institution must ensure there is a proper system of assessment, monitoring and feedback regarding the performance of both doctors and their supervisors, as follows:

a. There should be proper documentation of the feedback which may be audited at any time.

b. There should be multiple assessment tools and evaluators available – i.e. supervisors, peers, patients, and other professional staff, to review the performance of each doctor.

c. In the event of any weakness identified on the new doctor, there should be an appropriate action plan prepared to correct the deficiencies and properly documented

Log Book
a. Must maintain a log book with 3 cases per week for the first 6 months;
b. All cases must be signed by supervisor; and
c. To be submitted with 3-month and 6-month assessment reports.

6 Quality Assurance Framework The institution must have in place a quality assurance framework that allows quality improvement and system-based learning

Intensity of Supervision

Level of
Supervision
Month Percentage of Case Notes to be Audited
At the Registered
Practitioner level
(Medical Officer or equivalent)
At the
Specialist
level
L1 Month 1 100% 50%
Month 2 and 3 50% 25%
Remaining duration 10% 10%
L2 Entire duration 10% 10%

(C) Training Programme

The institution must have in place a structured training programme or programmes for its doctors, for peer interaction and practice-based learning.

Training Requirements
Frequency and Evidence of training At least 2 times a week -
  • A minimum of 1 structured internal event;
  • The other can be a grand ward round, mortality/morbidity round, case discussions, topical review, talk;
  • These programs must involve the participation of substantially of all of the doctors within the department or same clinic/practice place;
  • There should be live interaction, e.g. Skype conference;
  • The doctor must be provided time to attend other CME accredited activities organized by other institutions, chapters of AM or professional societies; and
  • There must be evidence of internal training activities in the form of monthly published schedules of events, rosters, records with participants, topics, dates etc, indicated.

The details of the supervisory framework, which is reviewed from time to time, can be found above. For more information, please contact Secretariat at enquiries@smc.gov.sg

Last Updated :  01 Aug 2014 18:48