GME Resident Manual - 2011 - 26 Apr

SINGHEALTH RESIDENCY
GRADUATE MEDICAL
EDUCATION

RESIDENT MANUAL

Nurturing Leaders of Tomorrow 1

Updated on 26 Apr 2011

TABLE OF CONTENTS

Section I. Welcome to SingHealth Residency 3

Section II. Institutional Oversight of Graduate Medical Education Programs
A. Affiliated Hospitals 4
B. Graduate Medical Education Committee Commitment 5
C. Graduate Medical Education Committee Duties and Responsibilities 6
D. Graduate Medical Education Committee Members 8
E. Graduate Medical Education Office 9
F. The Office of Resident Affairs 9
G. Institutional Agreements 10

Section III Institutional Responsibilities for Residents
A. Eligibility and Selection of Residents 11
B. Agreement of Appointment 13
C. Appointment, Re-appointment and Promotions 13
D Transfer 14
E. Condition of Separation 15
F. Resident Supervision 15
G. Resident Evaluation 15
H. Resident Educational Environment 16
I. Leave Benefits 18
J . Resident Duty Hours 19
K. Resident Benefits 19
L. Program Curriculum Review 19
M. Moonlighting 19
N. Resident Physician Impairment 19
O. Program Reduction/Closure 19
P. Disaster Preparedness 20
Q. Vendor Interaction 20

Section IV Resident Responsibilities 20

Section V Attachments
Annex A: Redress of Grievance Policy 22
Annex B: Separation Policy 24
Annex C: Resident Supervision 26
Annex D: Counselling Services 27
Annex E: Sexual Harassment 28
Annex F: Leave Policy for SingHealth Residents 30
Annex G: Resident Duty Hours 35
Annex H: Residents Benefits 37
Annex I: Program Curriculum Review 39
Annex J : Impairment Policy 40
Annex K: Reduction in Size or Closure of a Training Program 43
Annex L: Disaster Preparedness 45
Annex M: Medical Indemnity Insurance 48
Annex N: Disabilities 49



I. WELCOME TO SINGHEALTH RESIDENCY

On behalf of the GME Office and the Residency Faculty, we are pleased to welcome you to
SingHealth Residency. The Residency Program is powered by people with the passion to
nurture outstanding well-rounded clinicians by providing a holistic learning environment and a
vibrant research culture.

The SingHealth Residency program is based on the principle of six core competencies, namely
Patient Care, Medical Knowledge, Practice-based Learning and Improvement, Interpersonal
and Communication Skills, Professionalism and Systems-based Practice. SingHealth
Residency has added a seventh competency, Faculty Development, that will give our residents
an edge in learning as their mentors sharpen their pedagogy skills and equip themselves with
competencies in leadership and administration. As the Sponsoring Institution for the Residency
program, we have clear ownership in charting the training and development of our future
doctors, hence allowing us to build up the medical talent pool for improved patient care.

With a new structured medical program and a curriculum based on core competencies for our
future doctors, SingHealth Residency is well poised to transform graduate medical education,
one of the main thrusts in our pursuit of academic medicine excellence. As a leader in
Academic Medicine, SingHealth offers a spectrum of 42 specialties and a vibrant research
culture that will give our residents vast opportunities to hone their clinical acumen and research
capabilities to provide better care for patients. With a wide range of patient case mix, our
hospitals and specialized institutions provide a holistic and comprehensive learning
environment for the residents, who will also be learning from the best.

SingHealth Residency programs vision is to be a renowned graduate medical education centre
at the leading edge of medical competencies, empowering clinicians to deliver quality
healthcare to meet our nations aspirations.

SingHealth Residency programs mission is to deliver exemplary medical education through
innovative teaching, collaborative learning and research to develop the next generation of
clinical educators and researchers. Our illustrious legacy in medical education makes us a
reputable training ground for the best in Medicine.


II. INSTITUTIONAL OVERSIGHT OF GRADUATE MEDICAL EDUCATION PROGRAMS

A. Affiliated Hospitals

The SingHealth group comprises:
1. 3 Hospitals
Singapore General Hospital
Changi General Hospital
KK Womens And Childrens Hospital
2. 5 National Specialty Centres
National Cancer Centre Singapore
National Dental Centre
National Heart Centre
National Neuroscience Institute
Singapore National Eye Centre
3. A network of 9 Polyclinics
Sengkang Polyclinic
Pasir Ris Polyclinic
Tampines Polyclinic
Bedok Polyclinic
Geylang Polyclinic
Marine Parade Polyclinic
Outram Polyclinic
Bukit Merah Polyclinic
Queenstown Polyclinic



B. Graduate Medical Education Committee (GMEC) Commitment



C. Graduate Medical Education Committee Duties and Responsibilities

The GMEC is responsible for providing oversight and governance to all graduate medical
education training programs under the Sponsoring Institution (SI), SingHealth. It is to
monitor and advise all aspects of residency education and to ensure substantial compliance
with the institutional, common program and specialty specific requirements of ACGME-I.
The SingHealth GMEC is chaired by the DIO and comprises Senior Management, Program
Directors, peer-nominated residents, administrators and other members of the faculty.

The committee is responsible for establishing and implementing policies and procedures
regarding the quality of education and the work environment for the residents in all
programs, and to ensure proper distribution of institutional resources across the resident
programs.

Duties and Responsibilities
1. Stipends and position allocation: Conduct annual reviews and make
recommendations to the Sponsoring Institution regarding resident stipends, benefits
and funding for resident positions.

2. Communication with program directors:
Ensure that communication mechanisms exist between the GMEC and all
program directors within the institution.
Ensure that program directors maintain effective communication mechanisms
with the site directors for their respective programs at each participating site to
maintain proper oversight at all clinical sites.

3. Resident duty hours: Develop and implement written policies and procedures
regarding resident duty hours to ensure compliance with the institutional, common and
specialty/subspecialty-specific program requirements.

4. Resident supervision: Monitor programs supervision of residents and ensure that
supervision is consistent with:
Provision of safe and effective patient care
Educational needs of residents
Progressive responsibility appropriate to residents level of education,
competence and experience
Other applicable common and specialty/subspecialty specific program
requirements

5. Communication with medical staff: Communication between leadership of the
medical staff regarding the safety and quality of patient care that includes:
The annual report to the Organized Medical Staff(s) (MOS)
Description of resident participation in patient safety and quality of care
education
The accreditation status of programs and any citations regarding patient care
issues

6. Curriculum and evaluation: Ensure that each program provides a curriculum and an
evaluation system that enables residents to demonstrate achievement of the ACGME-I


general competencies as defined in the common and specialty/subspecialty-specific
program requirements.

7. Resident status: Select, evaluate, promote, transfer, discipline and/or dismiss
residents in compliance with the institutional and common program requirements.

8. Oversight of program accreditation: Review all ACGME-I program accreditation
letters of notification and monitor action plans for correction of citations and areas of
non-compliance.

9. Management of institutional accreditation: Review the Sponsoring Institutions
ACGME-I letter of notification from the IRC and monitor action plans for correction of
citations and areas of non-compliance.

10. Oversight of program changes: Review the following for approval prior to submission
to the ACGME-I by program directors:
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 program directors
Progress reports requested by any Review Committee
Responses to all proposed adverse actions
Requests for exceptions of resident duty hours
Voluntary withdrawal of program accreditation
Requests for an appeal of an adverse action
Appeal presentations to a Board of Appeal or the ACGME-I

11. Oversight of reductions and closures: Oversee all processes related to reductions
and/or closures of:
Individual programs
Major participating sites
The Sponsoring Institution

12. Vendor interactions: Provision of a statement or institutional policy (not necessarily
GME-specific) that addresses interactions between vendor representatives/corporations
and residents/GME programs.

Meeting
The GMEC shall meet quarterly or more often as determined by the DIO, who is also the
Chair of the GMEC. The minutes of each GMEC meeting will be forwarded to the GMEC
members, Program Directors, and Associate Program Directors for information and follow-
up action where appropriate.

Resident Representation
Resident representatives will be elected by their peers to serve on the Graduate Medical
Education Committee.


D. Graduate Medical Education Committee Members

Chairman
Prof Colin Song Cluster Designated Institutional Official, SingHealth

Members
A/Prof Lim Boon Leng Associate Designated Institutional Official, SGH
Prof Chay Oh Moh Associate Designated Institutional Official, KKH
A/Prof Goh Siang Hiong Associate Designated Institutional Official, CGH
Prof Ivy Ng Deputy CEO, SingHealth
Prof Soo Khee Chee Deputy CEO (Research & Education), SingHealth
Prof Ng Han Seong Chairman, Medical Board, SGH
Prof Low Cheng Ooi Chairman, Medical Board, CGH
Prof Kenneth Kwek Chairman, Medical Board, KKH
Prof Ranga Krishnan Dean, Duke-NUS GMS
Prof Robert Kamei Vice Dean, Education, Duke-NUS GMS
Dr Lee Ee Lian Director, Medical Manpower, SingHealth
Prof Fong Kok Yong
Group Director of Research, SingHealth
Chairman, Division of Medicine, SGH
Prof Donald Tan Medical Director, SNEC
Dr Tay Ee Guan Director, Education and Research, SingHealth Polyclinics
Prof Lee Wei Ling Director, National Neuroscience Institute
A/Prof Koh Tian Hai Medical Director, National Heart Centre Singapore
Prof Wong Wai Keong Program Director, General Surgery
A/Prof Chow Wan Cheng Program Director, Internal Medicine
Dr Ruban Poopalalingam Program Director, Anaesthesiology
Dr Sally Ho Program Director, Family Medicine
Dr Edwin Low Group Director, Strategic HR, SingHealth
Ms Serene Lim Assistant Director (Legal), SingHealth
Dr Tan Yih Hua Peer Selected Resident Rep, Pediatrics
Dr Lee Gouzhang Peer Selected Resident Rep, Internal Medicine
Mr J oselito Balingit Peer Selected Program Coordinator Rep, Transitional Year
Ms Angeline Yong Senior Program Coordinator

Administrators
Ms Diana Goh Senior Manager
Ms Christine Neoh Institutional Coordinator, SingHealth & SGH
Ms Karen Yeo Institutional Coordinator, CGH

Secretariat
Ms Lun Hwee Leng Institutional Coordinator, KKH



E. Graduate Medical Education Office

The Graduate Medical Education Office facilitates the adoption of the ACGME-I
competencies. While medical knowledge and patient care is primarily program specific, the
GME Office collaborates with the Program Directors and the core faculty in designing
curricula that covers all common aspects of resident training, keeping in mind the concepts
of graded responsibility and increasing competency.

Prof Colin Song
Cluster Designated Institutional
Official, SingHealth
colin.song@sgh.com.sg
A/Prof Lim Boon Leng
Associate Designated
Institutional Official, SGH
lim.boon.leng@sgh.com.sg
Prof Chay Oh Moh
Institutional Official, KKH
chay.oh.moh@kkh.com.sg
A/Prof Goh Siang Hiong
Institutional Official, CGH
siang_hiong_goh@cgh.com.sg
Ms Diana Goh Senior Manager diana.goh.m.w@sgh.com.sg
Ms Christine Neoh
Institutional Coordinator
(SingHealth & SGH)
christine.neoh.g.y@singhealth.com.sg
Ms Karen Yeo Institutional Coordinator (CGH) karen.yeo.b.e@singhealth.com.sg
Ms Lun Hwee Leng Institutional Coordinator (KKH) lun.hwee.leng@singhealth.com.sg

F. The Office of Resident Affairs
The Office of Resident Affairs is dedicated to looking into the welfare and general affairs of
SingHealth Residents. The SingHealth Residency Program recognizes that residents will
encounter many challenges during the course of their residency. Should residents require
peer support networking/counselling, the Office of Resident Affairs serves as a platform for
residents to communicate their needs and provide feedback.

The peer support groups currently available in the various SingHealth institutions are:

Singapore General Hospital
SGH Peer Support Program
Support Action for Employees (SAFE) Access Line: 6321 5358 /
6326 6671

Changi General Hospital
P.E.E.R Network
P.E.E.R Network Access Line: 8125 8452

KK Women's and Children's Hospital
Carers' Support Group
Contact person: Ms J oanna Goh, 6394 1635 / 8121 7901

Contact information for Office of Resident Affairs
Ms Veronica lee
Executive
Contact No: 9654 6775



G. Institutional Agreements

SingHealth Residency Program, as the institutional sponsor of the training program,
continues to have responsibility for the quality of educational experience when resident
education occurs in a participating institution. To ensure that educational goals and
objectives are attained, patient care activities are appropriately supervised and a learning
environment conducive to educating the residents in the ACGME-I competency areas is
maintained, SingHealth Residency Program will ensure that the program letter of
agreement (PLA) between the program and the participating institutions outlines the faculty,
supervision, evaluation, educational content, length of assignment and policy and
procedures for each required assignment that occurs outside of the sponsoring institution.
To ensure institutional oversight of the quality of GME at all participating sites outside the
Sponsoring Institution, the DIO signs all PLAs, both renewals and new ones.



III. INSTITUTIONAL RESPONSIBILITIES FOR RESIDENTS

A. Eligibility and Selection of Residents
1. Eligible applicants must:
Be graduates of a Singapore medical school with MBBS or equivalent or be from
medical schools that confer medical degrees that are eligible for licensure by the
Singapore Medical Council (SMC). For a list of registrable postgraduate degrees,
refer to
http://www.physician.mohh.com.sg/registrable_basic_medical_degrees.html.
Be considered on the basis of residency program-related criteria such as their
preparedness, ability, aptitude, academic credentials, communication skills and
personal qualities such as motivation and integrity.
Participate in the National Residency Matching System organized by MOH.

2. Foreign medical graduates who are employees of MOH Holdings Pte Ltd (MOHH) are
eligible to apply.

3. Upon verification by MOHH that an applicant has met eligibility requirements,
completed the application process and been selected according to established criteria,
the applicant will begin the process of appointment with the GME Office/MOHH. Refer
to http://www.physician.mohh.com.sg/residency for more information on the residency
programs and application guidelines.

4. An applicant is considered fully appointed and registered only after all the following has
been submitted to MOHH.
Verification of successful graduation if previously anticipated, including letter
from Dean of the School of Medicine
Completion of all the following forms (with valid signatures):
- Letter of Employment Offer
- Resident Medical Examination Form (pre-employment health assessment)
- Graduate Medical Education Biographical Form
- Trainee Medical License applications for the Singapore Medical Council
Completion of all institutional required documents

5. SingHealth and its ACGME-I accredited programs will not discriminate with regard to
sex, race, age, religion, disability or any other applicable legally protected status.

6. As the Sponsoring Institution, SingHealths written policies and procedures for resident
selection are:
i. Applicants to SingHealth Residency Programs are first required to apply for an
interview for the specialty they are interested in pursuing.
ii. Programs must participate in the National Residency Matching System
organized by MOHH.
iii. Each program should consider the following in their selection process:
- Each program must have a selection committee consisting of a
representative from the PDs of the relevant SIs, members of the Specialist
Training Committee (STC) and the Chairman of the relevant Residency
Advisory Committee (RAC). The selection committee reviews the
applications of all candidates, whether applying for appointment as a first
year postgraduate member of the Residency Program (through the National
Residency Matching System) or to fill a subsequent program vacancy for
advanced-level residency positions.


- In the Singapore process, after the national panel decides on applicants
eligibility, the respective PDs will begin a preliminary ranking process of the
applicants.
- Subsequently, after the SI Open House (Applicant Day), SingHealths final
ranking of applicants will be conducted by a committee which includes PDs,
APD(s), core faculty members and/or senior residents where applicable.
Programs will accept application materials as provided by MOHH, which
coordinates the national application system.
- The selection process should be broad-based to include participation by
faculty and residents and to showcase facilities.
iv. Each program must include the following for applicants invited for interview or to
the Open House (Applicant Day) conducted in SingHealth institutions:
- Candidates for interviews must receive oral and written information regarding
the clinical rotations, didactic program, procedures for evaluating residents
and programs, requirements for duty hours and call schedule, benefits,
salary, ex-gratia payment, medical/dental coverage, annual leave, training
benefits, medical/hospitalization benefits, sick leave, family leave, work injury
compensation insurance and group term life and personal accident
insurance.
- After the resident has been selected and matched, the resident folder must
retain all letters of recommendation and references.


B. Agreement of Appointment
The Ministry of Health through its subsidiary MOH Holdings Pte Ltd (MOHH) is the
employer of all the residents. Once the resident is successfully matched to a SingHealth
Residency Program, a letter of offer will be issued by MOH which will be signed by the
Director of Manpower Standards and Development and the DIO.

The resident will sign the Letter of Employment Offer by MOHH, which spells out the terms
and conditions of employment such as the salary, anniversary bonus, ex-gratia payment,
income tax, medical malpractice insurance and indemnity, extent of employment, duties
and responsibilities, prohibitions/secondary employment, termination, dismissal, rules and
regulations and conditions of offers.

SingHealth Residency Program, the Sponsoring Institution, will attach an addendum to the
Letter of Employment Offer which includes the condition of re-appointment, renewal of
resident agreement, non-renewal of appointment, condition of separation, resident
responsibilities, professional liability insurance, grievance procedures and due process,
disciplinary action, duty hours, counselling services, physician impairment, accommodation
for disabilities, reduction and closure, faculty responsibilities and supervision, harassment,
evaluation process, annual In-Training Examination and financial support.

C. Appointment, Re-Appointment and Promotions
1. SingHealth residents are appointed for a defined period unless sooner terminated in
accordance with applicable policies. The term of appointment is dependent on the
specific program. Post-Graduate Year 1 (PGY1) residents will be re-appointed to
continue with their residency training if they:

(i) Successfully complete their first year according to the level of competencies
defined by each specific Program;
(ii) Are able to continue with the Program; and
(iii) Fulfill the licensing requirement imposed by the Singapore Medical Council
(SMC)

2. For senior residents who have already obtained full practicing licenses from the SMC,
continuation of appointment till the expiry of the term of appointment and promotion to
the next level or year of post-graduate training will be assumed so long as the Resident
has successfully completed the assigned post-graduate level of the specific Program as
evaluated by its Program Director.

3. If significant deficiencies in the residents performance are identified, a plan for remedial
work, including monitoring performance, may be arranged by the residents Program
Director. The resident will remain at his/her current stipend level during the remediation
period. If a resident is assessed to be under-performing during evaluation, the residents
appointment will not be renewed or promoted to a higher level of post-graduate training.
The resident should be informed in writing by the Program Director of the non-renewal
or non-promotion at least four (4) months prior to the end of the Residency Agreement
or end of the academic year.

4. If the program is unable to inform the Resident of his or her non-renewal or non-
promotion within the four (4) month period, the program will provide the Resident with
written notice of the intent not to renew or not to promote as early as circumstances will
reasonably allow prior to the end of the Residency Agreement or academic year.


5. A resident who is informed of non-renewal of residency appointment and/or non-
promotion to the next level of training, may, if he or she chooses to do so, lodge an
appeal in accordance to the Redress of Grievance Policy. The SHS GME Policy on
Redress of Grievance Policy is attached as Annex A.

D. Transfer
Resident transfers are defined as withdrawal of a resident from one residency program
to enter another residency program in:
i. The same specialty offered by a different Sponsoring Institution; or
ii. A different specialty offered by the same Sponsoring Institution; or
iii. A different specialty offered by a different Sponsoring Institution.

1. A resident who wishes to transfer to another residency program must first resign
from his or her current program. He or she should adhere to the procedures in the
Separation Policy Voluntary Separation for resigning from the program.
Residents are to note that they will not be able to return to their previous programs
once they have withdrawn or resigned from them.

2. Upon acceptance of the residents withdrawal or resignation from the program, the
Program Director is required to provide a written or electronic verification of his or
her:
i. Training and educational experiences;
ii. Summative competency-based performance evaluation including
assessment of competence in:
a. Patient care
b. Medical knowledge
c. Practice-based learning and improvement
d. Interpersonal and communication skills
e. Professionalism
f. Systems-based practice
iii. Any other information relevant in program transfer (e.g. reason for
withdrawal)

3. The information is for the residents personal records and will also become part of
the residents educational file.

4. After resigning from his/her current program, a resident will have to wait for one year
from the date of discontinuation of the original residency program before he/she is
eligible to apply to enter another residency program.

5. After the 1-year wait, residents are required to apply to their desired programs on a
competitive basis during the annual resident applications. The application procedure
is stated in the Residency Selection, Employment, Appointment, Re-appointment
and Promotion Policy Selection of Residents. To facilitate the Program Directors
decision-making process in the ranking and selection of ex-residents in the National
Resident Matching Program (NRMP) Exercise, the Program Directors must first
obtain the information in Para 2, either from the applicant or his or her ex-program.

6. Residents are to note that they may not get their program of their choice if they are
not selected or matched in the NRMP exercise.



7. For special unforeseen circumstances, residents may appeal to the Ministry of
Health (MOH) for the rules to be waived. Those who commenced residency in May
2010 will be exempt from above conditions till 31 May 2011.

8. If the resident is successfully matched to his/her choice program and Sponsoring
Institution, he or she will be appointed as a R1 Resident, 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 current
program rules.

9. The transfer procedure in this policy will be superseded by any revised or updated
Training Circular issued by MOH (if any).

E. Condition of Separation
The SHS GME Separation Policy establishes the different modes of separation
amongst SingHealth (as a Sponsoring Institution), MOHH as the employer and the
residents, and the proper procedures to manage these separations.

This policy is attached as Annex B.

F. Resident Supervision
The teaching staff will supervise the resident in a manner designed to facilitate
progressively increasing responsibility for patient care according to the level of training,
ability and experience. The level of responsibility assigned to each Resident will be
determined by the Program Director and/or teaching staff.

The SHS GME Policy on Resident Supervision is attached as Annex C.

G. Resident Evaluation
Residents are evaluated in writing at the end of each clinical rotation by their faculty.
Residents' "professionalism" is evaluated by other members of the healthcare team and
is included as part of the evaluation process. Residents are expected to evaluate each
other in accordance with the program policy. Every six months, each resident receives a
formal formative evaluation conducted by his/her Program Director (or designee). A
written summary of this six-month performance review meeting is part of each
resident's permanent file. The Common HO/MO/MOT/Resident Evaluation Form will be
maintained within New Innovations.

1. Each program has to use the Common HO/MO/MOT/Resident Evaluation Form
implemented by MOH and MOHH.

2. These evaluation forms are completed by attending faculty upon completion of
clinical rotations and other criteria.

3. Completed evaluation forms are signed by the faculty member(s) and the resident
and are placed in the resident's file.

4. Evaluations of the resident by nurses, staff and other health professionals who work
with the residents will be considered in the overall evaluation of a resident's
performance in accordance with program policies.



5. At the end of each six month period of training, the Program Director or a
designated faculty member must meet each resident to discuss the faculty's
evaluations of the resident, the non-physician evaluations of professionalism and
the peer (i.e. resident) evaluations. At this time, the resident is required to sign each
of the faculty's evaluation forms to verify s/he has seen its content. A resident may
write a letter of dispute for any evaluation s/he feels is inaccurate or incomplete.

6. During the six-month performance review, the Program Director (or his/her
designee) discusses the resident's performance as indicated by the evaluations.
The resident's strengths and areas for improvement are noted; any corrective
measures are also discussed. A written summary of this meeting, signed by both the
Program Director (and his/her designee) and the resident, is placed in the resident's
permanent file.

7. Continued unacceptable or marginal performance, as noted on the evaluation forms,
will be addressed through the development of a formal academic remediation
program which details specific corrective actions. The resident will be considered to
be on formal academic remediation during this period. The remediation program will
include a timetable for completion and the actions to be taken as a result of the
residents performance during this period. Both the Program Director and the
resident must sign the remediation program before it is implemented.

8. A copy of the remediation program for any resident on formal academic remediation
must be submitted to the Designated Institutional Official for the GME Office before
the remediation period commences.

9. Semi-annually, the residents will also meet with the Program Directors/designee to
discuss and review their performance, the 360 evaluations, the in-training
examination if applicable, global evaluation, case logs and mini CEX.

10. At the end of the rotation, the faculty will evaluate the residents using the global
evaluation.

H. Resident Educational Environment
The educational environment must be adequate for the physical, emotional and
educational needs of all residents and be conducive to resident education and patient
care.

SingHealth provides an educational environment in which residents may raise and
resolve issues related to their residency programs without fear of intimidation or
retaliation.

Physical Facilities: Appropriate physical facilities are provided to the residents to meet
each residency program's goals. This includes access to appropriate food services in all
institutions participating in the residency programs as well as adequate on-call rooms.

Resources: Adequate resources, e.g. clinical and research facilities, library materials
and computers are provided to meet the educational needs of the residents.

Professional Attire: All residents (specialty and sub-specialty) are expected to dress in
appropriate professional attire when engaged in any residency activity. Residents must
abide by the SingHealth institutions Dress Code Policy.


Faculty Responsibilities: SingHealth will ensure that all patient care is supervised by
qualified faculty. The program director must ensure, direct and document adequate
supervision of residents at all times. Residents must be provided with rapid and reliable
systems for communicating with supervising faculty. Faculty schedules will be
structured to provide residents with appropriate supervision and consultation.

Medical Records: SingHealth provides a medical records system that documents the
course of each patient's illness, adequately supports quality patient care, provides
information for residents' quality assurance and quality improvement activities and
serves as a resource for scholarly activities. Residents are required to complete medical
records in a timely manner. Medical records are the property of the respective
hospital/clinic and are not to be removed unless properly authorized. All requests for
and/or legal processes relating to patients medical records must be referred to the
Program Director.

Patient Support Services: SingHealth provides adequate and appropriate patient
support services such as phlebotomy, laboratory, porter services and diagnostic testing
along with nursing and other allied health services.

Counselling and Medical Support Services: Confidential counselling is available to
residents through his/her Program Director, the Office of GME, or the Director of
SingHealth Medical Manpower Department at 6557 4966.

The SHS GME Policy on Counselling Services is attached as Annex D.

Car Park Facilities: Please contact the respective department secretary.

Non-Discrimination and Harassment: Each residency program must foster humanistic
values and cross-cultural sensitivity and respect for all individuals. If any resident feels
s/he has been subjected to a violation of such harassment or related retaliation is
strongly encouraged to promptly report to the Program Director or SingHealth Medical
Manpower or the GME Office.

The SHS GME Policy on Sexual Harassment is attached as Annex E.

Staff Facilities: Lounge, gym facilities, audiovisual entertainment, etc. are open to
residents. For locations, please contact your Program Coordinator.

Call Rooms: Residents on call will have access to clean and adequately lit call rooms.
The call rooms will be assigned by the department/unit secretary.

Work Environment: SingHealth, the Program Director, the faculty and the Office of
GME will provide an environment in which residents a) can develop a personal program
of learning to foster continued professional growth with guidance from the teaching
staff; b) participate fully in the educational and scholarly activities of their programs and,
as required, assume responsibility for teaching and supervising other residents and
students; c) have the opportunity to participate in appropriate institutional and
departmental committees whose actions affect their education and/or patient care; d)
participate in an educational program regarding physician impairment, including
substance abuse.



Security: SingHealths institutions provide appropriate security and personal safety
measures to residents at all hospital locations including but not limited to parking
facilities, on-call rooms, hospital and institutional grounds and related facilities.

Seven General Competencies: SingHealth ensures that each program defines, in
accordance with its program requirements, the specific knowledge, skills, attitudes and
educational experiences required for residents to demonstrate attainment of the seven
general competencies:

a. Patient care that is compassionate, appropriate and effective for the treatment of
health problems and the promotion of health;

b. Medical knowledge about established and evolving biomedical, clinical and cognate
(e.g. epidemiological, social and behavioral) sciences and the application of this
knowledge to patient care;

c. Practice-based learning and improvement that involves investigations and
evaluations of a residents own patient care, as well as appraisal and assimilation of
scientific evidence and improvements in patient care;

d. Interpersonal and written communication skills that result in effective information
exchange and collaboration with patients, their families and other health professionals;

e. Professionalism as manifested through a commitment to carrying out professional
responsibilities, adherence to ethical principles and sensitivity to a diverse patient
population;

f. Systems-based practice as manifested by actions that demonstrate an awareness of
and responsiveness to the larger context and system for healthcare and the ability to
effectively call on system resources to provide care that is of optimal value.

g. Faculty development to better empower the Residency team of Program Directors
and the pool of dedicated faculty in the nurturing of future medical practitioners.

Open Door Policy: The GME Office, Program Directors, Program Coordinators and the
faculty adopt an Open Door Policy for all the residents. This is to encourage open
communication, feedback and discussion about any matter of importance to the
residents.

I. Leave Benefits
Whilst Residents undergo their Residency training with SingHealth institutions, they are
employed by MOHH. As such, their leave entitlement and utilization procedures will be
governed by the applicable leave policies of MOHH.

SHS GME Policy on Leave Policy for SingHealth Residents is attached as Annex F.

The leave entitlement and utilization procedures listed in this policy serve as a guide
only. Residents and SingHealth Residency Programs are strongly encouraged to refer
to the Human Resource & Talent Division (HRTD) of MOHH for more detailed
information or clarification.



J. Resident Duty Hours
SingHealth is committed to providing residents with a sound academic and clinical
education which must be carefully planned and balanced with concerns for patient
safety and resident well-being. Each program must ensure that the learning objectives
of the program are not compromised by excessive reliance on residents to fulfill service
obligations. Didactic and clinical education must take priority in the allotment of
residents' time and energy. Duty hour assignments must recognize that faculty and
residents collectively have responsibility for the safety and welfare of patients.

The SHS GME Policy on Resident Duty Hours is attached as Annex G.

K. Resident Benefits
There are various medical benefits and insurance schemes that SingHealth Residents
are entitled to as employees of MOHH. SHS GME policy on Resident Benefits is
attached as Annex H.

L. Program Curriculum Review
The SHS GME policy on Program Curriculum Review is attached as Annex I.

M. Moonlighting
The resident may not provide physician services to other healthcare institutions for
remuneration outside the scope of their educational activities and regular assigned
duties of the training program unless prior and specific written notification detailing such
activities is given to and written consent for such activities is obtained from the Program
Director. Moonlighting shall not be approved if the Program Director believes such
activities may interfere with the residents ability to perform his/her obligations and
duties in the Residency Program.

Residents must adhere to the policies and procedures on secondary employment of the
respective institution that they are posted to.

N. Resident Physician Impairment
SingHealth recognizes the importance of providing and ensuring a drug-free and safe
work environment for residents, co-workers, patent and visitors.

The SHS GME policy on Resident Impairment is attached as Annex J .

O. Program Reduction/Closure
SingHealth Services Pte Ltd (SingHealth) recognizes the need for and benefits of
graduate medical education and sponsors residency programs that emphasize
personal, clinical and professional development. SingHealth ensures, through the GME
Internal Review process, that its residency programs are in substantial compliance with
the institutional, common and special requirements of the Accreditation Council for
Graduate Medical Education International (ACGME-I) and its individual Residency
Review Committees.

In the event of a transfer or reduction in size of a residency program, SingHealth will
follow all ACGME-I guidelines and assist in placing affected residents in other
accredited residency programs of the same specialty.

The SHS GME Policy on Reduction In Size or Closure of a Training Program is
attached as Annex K.


P. Disaster Preparedness
SingHealth recognizes the need to ensure continued, high quality educational
experiences of residents enrolled in the SingHealth Graduate Medical Education (GME)
programs in the event of a disaster or interruption of training sites impacting the
graduate medical education programs.

The SHS GME policy on Disaster Preparedness is attached as Annex L.

Q. Vendor Interaction
Residents are to adhere to the respective institutions policies and procedures regarding
gift declaration and sponsorships offered by vendors/suppliers. This is to ensure that
the graduate education activities at SingHealth and affiliated training are not
compromised through vendor influence, either collectively or through interactions with
individual residents and fellows and to further the professional accountability of
residents to their patients and colleagues.

IV. RESIDENT RESPONSIBILITIES
Residents are expected to consistently demonstrate competent and compassionate patient
care and to work effectively as members of the SingHealth Service Pte Ltd Residency team.
This implies professional demeanor and conduct both in direct patient care and in
communication with family members, other healthcare professionals and support staff. In
addition, residents are expected to:

Demonstrate competency as defined by the residency curriculum, including keeping charts,
records and reports signed and up to date.
Abide by the SingHealths institutions policies and procedures.
Refrain from accepting fees from any patient for services rendered.
Read and understand all the residency-related policies.
Comply with the employer, MOHH's terms and conditions of employment.
Know the graduated level of responsibility described for their level of training and not
practice outside of that scope of service.

Residents must demonstrate competency defined by the programs at each yearly level of
training as a requirement for promotion and advancement.

The seven competency domains are:
Patient care Residents must be able to provide patient care that is compassionate,
appropriate and effective for the treatment of health problems and the promotion of health.
Medical knowledge Residents must demonstrate knowledge of established and evolving
biomedical, clinical, epidemiological and social-behavioral sciences, as well as the
application of this knowledge to patient care.
Practice-based learning and improvement Residents must demonstrate the ability to
investigate and evaluate their care of patients, to appraise and assimilate scientific
evidence and to continuously improve patient care based on constant self-evaluation and
life-long learning.
Interpersonal and communication skills Residents must demonstrate interpersonal and
communication skills that result in the effective exchange of information and collaboration
with patients, their families and health professionals.
Professionalism Residents must demonstrate a commitment to carrying out professional
responsibilities and an adherence to ethical principles.


Systems-based practice Residents must demonstrate an awareness of and
responsiveness to the larger context and system of healthcare, as well as the ability to call
effectively on other resources in the system to provide optimal healthcare.
Faculty development Residents are expected to demonstrate graduated responsibilities in
supervision, teaching and leadership roles. They are also expected to be increasingly
involved in different clinical or educational committees, with more ownership to decision-
making processes.

1. Discipline-specific Education
The program director is responsible for the organization and implementation of a
competency-based curriculum with discipline-specific learning objectives and performance
criteria. The resident is expected to demonstrate active learning:
Knowing the program's competency objectives, learning opportunities and performance
expectations
Developing a personal program of learning to foster continued professional growth
Participating in all aspects of the training program and actively engaging the learning
resources available

2. Other Educational Requirements
Residents are also expected to teach and mentor junior residents and medical students.
Collaborative learning is an important part of graduate medical education, and residents'
involvement with the education of other members of the healthcare team is essential.

All residents must provide data on their educational experience to their program. The
provision of regular feedback about faculty, the program, and overall educational
experiences via confidential written or electronic evaluations is required for continuous
evaluation and improvement of each residency program.

All resident must keep up-to-date procedures logs. They must be recorded in the ACGME-I
Resident Log System. Residents are to use New Innovations for their evaluations and to log
their duty hours. All residents are expected to complete the Resident Evaluation Form and
enter their duty hour information in the New Innovations website.


ANNEX A
REDRESS OF GRIEVANCE POLICY

Objective
1. To set out an equitable and uniform method to resolve resident grievances or disputes between
residents and residency programs.

Guiding Principles
2. SingHealth believes its residents have a right to appeal against decisions of their Program
Directors that affect them.

3. A resident who surfaces a grievance shall be accorded access to the proper channels for his or
her grievance to be heard and addressed.

4. All participants in the grievance procedures must maintain confidentiality by not discussing the
matter under review with any external party except as may be required for purposes of the
grievance procedure.

Grievable Matters
5. SingHealth recognizes the responsibility and authority of Program Directors to make judgments
pertaining to a residents academic performance, such as the development of clinical skills and
professional competencies, and to take corrective action(s) to address identified deficiencies in
a residents performance and/or training. These deficiencies include, but are not limited to,
clinical knowledge, skills, ethics and behaviour/conduct. Residents who dispute the following
corrective action(s) are entitled to surface a grievance:
a. Counselling
b. Censure verbal/written warning
c. Suspension from Residency Program
d. Termination from or non-renewal in or non-promotion in a Residency Program (related to
evaluation of their performance)
e. Withholding of or restriction in clinical privileges
f. Removal from or denial of re-appointment in a particular post, position or appointment with
SingHealth

Non-Grievable Matters
6. As MOHH is the employer of SingHealth Residents, the following matters do not fall under the
ambit of this policy:
a. Employment matters, including termination of employment or service
b. Salary, bonus, benefits matters
c. Performance grade (after moderation by MOHH)
d. Decisions on medical registration made by Singapore Medical Council (SMC)

7. Residents are advised to contact MOHH HRTD and/or SMC directly to surface grievances
related to the above matters.

Procedure
8. A resident who has a grievance under the purview of SingHealth (outlined in paragraph 5)
should schedule a meeting with the Program Director to discuss the matter within 7 days of
being notified of the disciplinary decision.



9. When a resident lodges an appeal, the proposed corrective action(s) will be temporarily put on
hold pending the outcome of the appeal.

10. The purpose of the meeting is to review the rationale of the proposed corrective action(s) and
to determine if the action(s) should be modified.

11. The decision shall be conveyed in writing to the affected resident within 7 days following the
meeting with the Program Director, who may decide to affirm or modify the corrective action(s)
decided earlier. One copy of the decision is to be filed in the residents P-File.

12. Appeal against the Program Directors decision shall be lodged with the GME Office which
shall, within 7 days of receipt of notice of appeal, arrange an interview with the resident.


ANNEX B
SEPARATION POLICY

Objective
1. To establish the different modes of separation amongst SingHealth (as a Sponsoring
Institution), MOHH as the employer and residents, and the proper procedures to manage these
separations.

Policy
2. This policy applies to SingHealth residents employed by MOHH.

3. Voluntary Separation
a. This occurs when a resident wishes to discontinue with the program for whatever reason(s)
before completion of training. He or she must notify the Program Director in writing of his or
her intention to leave or resign from the program at least four (4) months prior to the end of
the Residency Agreement or end of the academic year. A copy must be given to the GME
Office.

b. The GME Office must forward a copy of this notification letter to Medical Manpower,
SingHealth, whose responsibility is to inform Clinical Manpower, MOHH officially that the
resident(s) has resigned from the program. Henceforth, Clinical Manpower, MOHH will
handle his or her postings under HOPEX/MOPEX.

c. After resigning from his/her current program, the resident will have to wait for one year from
the date of discontinuation of the original residency program before he/she is eligible to
apply to enter another residency program. E.g. a resident who withdraws from his/her
program on 1 May 2010 will only become eligible to apply for residency on 1 May 2011.

d. When a resident resigns from MOHH, the termination of the employee-employer
relationship between the resident and MOHH effectively ends his or her training with the
SingHealth Residency Program.

e. The Program Director should, at the earliest opportunity, arrange an exit interview with the
resident to find out the reason(s) for leaving the Program.

f. As the employer, MOHH will be responsible for the administrative procedures upon a
residents resignation. Hence residents are strongly advised to contact MOHH for
clarification on any monies, leave and other administrative issues related to their
resignation.

4. Involuntary separation
a. This occurs when:
i. A resident is certified to be suffering from a form of impairment and the DIO deems
it necessary to terminate him or her from the Residency Program.
ii. A resident is found guilty of misconduct or any disciplinary issue that warrants
termination from the Residency Program.
iii. The residents employer, MOHH, terminates his or her employment for whatever
reason(s), e.g. the residents medical licensures and/or Employment Pass is
cancelled and not renewed by the Singapore Medical Council.



b. A residents appointment will not be renewed if he or she is assessed to be under-
performing during evaluation. He or she will then be released to MOHH for HOPEX or
MOPEX. The Resident should be informed in writing by the Program Director of the non-
renewal at least four (4) months prior to the end of the Residency Agreement or the end of
the academic year.

c. If the program is unable to inform the resident of his or her non-renewal within the four (4)
month period, the program will provide the Resident with written notice of the intent not to
renew as early as circumstances will reasonably allow prior to the end of the Residency
Agreement or academic year.

d. The resident may surface a grievance in accordance to the procedures set out in the
Redress of Grievance Policy if he or she has received a written notice of intent not to renew
or continue the Residency Agreement or of intent to renew/continue the agreement but not
be promoted to the next level of post-graduate training.

e. A resident who is suffering from long term illness that impedes his or her contribution may
have his or her employment terminated by MOHH on medical grounds. In such a case, the
residents residency training with SingHealth will be deemed as terminated as well.
Residents are advised to contact their employer, MOHH, for more clarification on its
Prolonged Illness Leave Policy.

5 Others
a. A resident who completes his or her training satisfactorily and graduates from SingHealth
Residency Program.

b. Reduction in size or closure of a training program.


ANNEX C
RESIDENT SUPERVISION

Purpose
Graduate Medical Education provides an organized educational program with supervision until
competency is documented while ensuring safe and appropriate care for patients.

Careful supervision and observation are required to determine the residents abilities to perform
technical and interpretive procedures and to manage patients. Residents must be given supervised
graded levels of responsibility while assuring safe care of patients.

This policy establishes the minimum requirements for resident supervision at the clinical affiliate
sites of the Sponsoring Institution. A clinical site may have additional requirements for resident
supervision. Requirements by a site take precedence over this policy, as do applicable laws.

General Policy
It is the responsibility of Program Directors to establish detailed written policies describing resident
supervision at each yearly level of resident training. These descriptions must be distributed (e.g.
website) regularly to all residents and the faculty. At all times, patient care will be the responsibility
of a licensed practitioner with appropriate clinical privileges. The requirements for direct or indirect
supervision will be established by the Program Director for each residency program in accordance
with the ACGME-I requirements and will be monitored through periodic departmental reviews, with
institutional oversight through the Graduate Medical Education Committee (GMEC) internal review
process. Generally, site directors or faculty listed in the program letter of agreement oversee
supervision for his/her site. The type of supervision required for residents at various levels of
training must be consistent with the requirement for progressive increase in resident responsibility
and applicable program requirements.

Procedure
1. Residents will be supervised by licensed practitioners. The licensed practitioner must be
credentialed for the specialty care and diagnostic and therapeutic procedures that they are
supervising. The medical attending is ultimately responsible for the care of the patient.
2. Each Program Director will define policies in his/her discipline to specify how trainees
progressively become independent in specific patient care activities while still being
appropriately supervised. These policies must provide information concerning the method of
scheduling attending physicians so that they are available to the residents at all times. In most
instances Program Directors are required to prepare written explicit lines of responsibility for
the care of patients in all clinical sites. These documents must be included in the programs
policies and procedures and be submitted to the DIO during annual reports and for internal
reviews.
3. The Program Director will ensure that supervision policies are distributed to and followed by
residents and the licensed practitioners who supervise residents. Compliance with the resident
supervision policy will be monitored by the Program Directors.
4. Annually the Program Directors will determine if residents can progress to the next higher level
of training. The requirements for progression to the next higher level of training will be
determined by standards set by each Program Director. This assessment will be documented
in the annual evaluation of the trainees.


ANNEX D
COUNSELLING SERVICES

Objective
1. This policy sets out the avenues available for residents seeking counselling while undergoing
training with SingHealth.

Guiding Principles
2. SingHealth recognizes that residents are likely to come across many challenges during their
course of training with SingHealth. Therefore, SingHealth has put in place an
informal/unstructured framework for its Residents to seek access to counselling services.

3. Counselling may include, but is not limited, to the following issues that are likely to affect
residents academic performance, health and general well being:

a. Academic difficulties and other work-related problems
b. Resident Impairment (e.g. physical/psychological issues, drug/alcohol dependencies)
c. Personal challenges such as marital/family issues and other emotional problems

4. Counselling services will be kept confidential and available to SingHealth residents on an as
needed referral or self-referral basis.

Counselling Procedures
5. Residents should first approach their respective Program Coordinators to seek counsel on the
problem(s) they are facing. If the problem(s) cannot be solved at their level, they should
arrange a meeting with the Program Director to discuss or resolve the issue.

6. If Program Coordinators notice that any Resident may need counselling, they should refer them
to their Program Directors without delay.

7. If the resident agrees, the Program Director may rope in the confidence of the Director of
SingHealth Medical Manpower Department to provide counsel.

The office of the Director of SingHealth Medical Manpower Department, is also contactable at
+(65) 6557 4966 to provide counselling to residents directly.


ANNEX E
SEXUAL HARASSMENT

Purpose
SingHealth Services Pte Ltd is committed to maintaining a workplace and an educational
environment that is free from sexual and other forms of illegal harassment.

The purpose of this policy is to prevent sexual harassment and to offer residents who believe they
have been sexually harassed a means of redress and an environment conducive to learning and
working.

Retaliation against an individual who truthfully complains about sexual harassment or who
cooperates with an investigation of a complaint will not be tolerated.

Definition
Sexual harassment can be identified as the inappropriate introduction of unwelcome sexual
advances, requests for sexual favour and other verbal and physical conduct of a sexual nature
where sex would otherwise be irrelevant.

Procedure
1. Complaints of sexual harassment, submitted in writing or accepted orally, are taken seriously
and will be dealt with promptly. Allegations of sexual harassment shall be judged on the facts
of the particular case and the context in which the alleged incident(s) occurred. The
complainant has the responsibility of providing evidence to substantiate the alleged sexual
harassment. The specific action taken in any particular case depends on the nature and
gravity of the conduct reported and may include intervention, mediation, investigation and the
initiation of disciplinary action as described above. Where a violation of the Sexual
Harassment policy is found to have occurred, SingHealth Medical Manpower or the DIO Office
will act to stop the harassment, prevent its occurrence and discipline those responsible.
2. Any resident who believes that he or she has been subjected to a violation of this policy or
related retaliation is strongly encouraged to promptly report such behaviour to the Program
Director so that the matter can be investigated and action taken. As a general principle, the
resident should inform the next highest administrator of the alleged sexual abuse.
3. Residents who need to report an incident of sexual harassment after regular office hours
should report the incident to the police department if the Program Director, the SingHealth
Medical Manpower or the DIO Office is not available. Residents who witness possible sexual
harassment should report their concerns to the Program Director or the next highest
administrator.

Investigatory Process
1. The SingHealth Medical Manpower or the DIO Office will investigate complaints of violations
under this policy.
2. A complaint alleging a violation of this policy may be submitted in writing by providing a written
statement that contains the following information:
a. Name and employee number of the complainant(s)
b. Contact information, including address and telephone
c. Name of person(s) directly responsible for alleged violation(s)
d. Date(s) and place(s) of alleged violations
e. Nature of alleged violation(s) as defined in this policy
f. Detailed description of the specific conduct that is the basis of alleged violation(s)
g. Copies of documents pertaining to the alleged violation(s)


h. Name(s) of any witnesses to alleged violation(s)
i. Action requested to resolve the situation
j. Complainants signature and date of filing
k. Any other relevant information
3. It is expected that complainants cooperate with the investigation and actively provide
information in the time and manner deemed necessary and appropriate by the SingHealth
Medical Manpower or the DIO Office to continue with the investigation and prevent SingHealth
Medical Manpower or the DIO Office from taking prompt remedial action.
4. Please refer to Disciplinary Policy and Procedures for residents for remedial/disciplinary actions
that could be taken against offenders.

Confidentiality
SingHealth Medical Manpower and the DIO office recognize that confidentiality is important and
will attempt to protect the confidentiality of harassment proceedings to an extent reasonably
possible and permitted by law. All participants in the process (including complainant, respondent
and witnesses) are expected to respect the confidentiality of the proceedings and circumstances
giving rise to the complaint. Participants are expected to discuss the matter only with those
persons who have a genuine need to know and to respect the privacy of the individuals involved.


ANNEX F
LEAVE POLICY FOR SINGHEALTH RESIDENTS

Objective
1. To set out a policy to govern the entitlement and utilization of the following types of leave for
SingHealth Residents:
A. Annual Leave
B. Medical Leave
C. Compassionate Leave
D. Marriage Leave
E. Maternity Leave
F. Paternity Leave
G. Prolonged Illness Leave
H. National Service (NS) Leave
I. Unpaid or no-pay Leave
J . Training/Conference Leave

Guiding Principle
2. Whilst residents undergo their Residency training with SingHealth institutions, they are
employed by MOHH. As such, their leave entitlement and utilization procedures will be
governed by the applicable leave policies of MOHH.

3. The leave entitlement and utilization procedures listed in this policy serve as a guide only.
Residents and SingHealth Residency Programs are strongly encouraged to refer to the Human
Resource & Talent Division (HRTD) of MOHH for more detailed information or clarification.

A. Annual Leave
4. Residents are eligible for the following Annual Leave entitlement:

Residency Year Entitlement
Resident (PGY1) 21
Resident (PGY2 & above) 24

5. Leave entitlement will be calculated on the basis of a calendar year. Residents who have not
completed twelve (12) continuous months of service at the end of the calendar year will be
entitled to pro-rata leave based on calendar days.

6. Where the fraction of leave as a result of computation of pro-rata leave is less than 0.5 days, it
will be rounded off to 0.5 days. If fraction of leave is above 0.5 days, it shall be rounded off to
the nearest full day.

7. Applications for Annual Leave should be made via MOHHs online HR system (iHR). All
applications are subject to the approval of the Program Director and the respective programs
training requirements.

8. Post-Graduate Year 2 (PGY2) and above residents are allowed to carry forward 5 days of
Annual Leave to the following year. Leave carried forward must be consumed by the 31
st
day of
December of the second calendar year or else such leave will be forfeited without
compensation. Residents who have to carry forward more than 5 days of leave should send in
an appeal via email to the HRTD Director, copied to the Program Directors, stating reason(s)
for doing so. Appeals will be considered on a case-by-case basis.


9. Post-Graduate Year 1 (PGY1) Residents are not allowed to carry forward any unconsumed
Annual Leave.

B. Medical/Hospitalisation Leave
10. Residents will be eligible for paid medical leave upon certification by a registered medical or
dental practitioner in Singapore.

11. Entitlement to paid medical leave for both PGY1 and PGY2 (and above) residents shall not
exceed:
a. Fourteen (14) days in each calendar year if no hospitalization is necessary (i.e.
outpatient medical leave);
b. Forty-six (46) days in each calendar year if hospitalization is necessary. Where excess
hospitalization leave is required, the unconsumed outpatient medical leave may be
used as hospitalization leave.

12. Residents must apply for their medical leave via MOHHs online HR system (iHR) and submit
the Medical Certificate (attached with the iHR confirmation slip) to HRTD for certification upon
their return. A copy should also be submitted to their Program Directors through the
Coordinators for records.

13. If medical leave is unscheduled, Residents are also required to inform their clinical
supervisor(s) and secretaries of their current rotation department by 7.30am of that day, so that
service coverage can be arranged.

C. Compassionate Leave
14. Residents are eligible for up to three (3) continuous calendar days per occasion in the event of
the demise of any of an immediate family member (grandparents, grand-parents-in-law,
parents, parents-in-law, spouse, children, and siblings).

15. Residents must apply for their compassionate leave via MOHHs online HR system (iHR) and
submit the Death Certificate to HRTD (attached with the iHR confirmation slip) for certification
upon their return. A copy should also be submitted to their Program Directors through the

D. Marriage Leave
16. Residents are eligible to marriage leave of three (3) continuous working days on the occasion
of their registration of legal marriage.

17. Residents must apply for their marriage leave via MOHHs online HR system (iHR) and submit
the Marriage Certificate to HRTD (attached with the iHR confirmation slip) for certification upon
their return. A copy should also be submitted to their Program Directors through the

E. Maternity Leave
18. Female residents who have completed at least ninety (90) days of continuous service with
MOHH immediately preceding the day of confinement will be eligible for maternity leave of up
to sixteen (16) calendar weeks in accordance with the relevant provisions of the Employment
Act. This is applicable up to the fourth confinement.



a. Singaporean child/children
For mothers of Singapore citizen child/children, the resident is entitled to 16 calendar
weeks of maternity leave per occasion and MOHH will pay the sixteen (16) weeks of
maternity leave at the normal rate of pay up to four (4) living children.
b. Non-Singaporean child/children
For mothers of non-Singapore citizen child/children, the resident is entitled to 8 calendar
weeks of maternity leave for two confinements and MOHH will pay the eight (8) weeks
of maternity leave at the normal rate of pay.

19. Residents must take the eight (8) calendar weeks of maternity leave continuously, starting not
earlier than four weeks before birth of the child child.

20. Residents must inform the Program Director once the estimated date of confinement is known.
All applications for maternity leave must be made via MOHHs online HR system (iHR) at least
two (2) months prior to the anticipated commencement of maternity leave. Documentary proof
of pregnancy obtained from a registered medical practitioner must be submitted to HRTD upon
the Residents return to work.

21. While on maternity leave, residents are also required to notify the Program Director as soon as
possible if she intends to extend her leave (i.e. apply for unpaid leave after maternity leave to
look after newborn child.)

F. Paternity Leave
22. Married male residents will be entitled to paid paternity leave of three (3) working days on the
occasion of the birth of their children, applicable up to 4 living children. Such leave must be
applied and consumed within 1 months of the childs birth.

23. They must apply for their paternity leave via MOHHs online HR system (iHR) and submit the
childs Birth Certificate to HRTD (attached with the iHR confirmation slip) for certification.

G. Prolonged Illness Leave
24. Residents with at least one years service with MOHH will be entitled to apply for prolonged
illness leave if he or she has contracted a chronic diseases or illness verified by a medical
practitioner as a long term illness. Prolonged illness leave will only kick in upon consumption of
all earned annual and medical leave.

25. Prolonged illness leave entitlement shall be as follows:
a. First 6 months: Full pay based on monthly total base rate of pay and the full portion
of payout for AWS.
a. Next 6 months: Half pay based on monthly total base rate o pay and half portion of
payout for AWS.
b. Further 6 months: no pay and no AWS payout

26. During the period of prolonged illness leave, the Resident will not be entitled to any other forms
of paid leave benefits.

27. Application for prolonged illness leave should be made to HRTD through the Program Director,
accompanied with certification from a registered medical practitioner.

H. National Service (NS) Leave
28. National Service (NS) leave is granted to male Residents liable for reservist training under the
Enlistment Act (Chapter 93).




29. They must apply for their NS leave via MOHHs online HR system (iHR) and submit the
supporting documents to HRTD (attached with the iHR confirmation slip) at least one month
before the date of reservist training for recording and payroll computation.

I. No Pay or Unpaid Leave
30. No-pay leave application must be discussed in advance with the Program Director as it may
necessitate program extension.

31. Approval of a Residents no-pay leave is subject to the sole discretion of the Program Director,
after considering the merits of his or her application and reviewing the existing Resident
assignments.

32. All annual leave must be fully utilized before MOHH processes the PD-approved no-pay leave
applications.

J. Training/Conference Leave
33. There is no additional training leave for Post-Graduate Year 1 (PGY1) Residents,

34. For Post-Graduate Year 2 (PGY2) Residents, they can take up to 12 days of
Training/Conference Leave per year, as part of protected time for structured training activities
1
.
They must apply for their Training/Conference Leave via MOHHs online HR system (iHR) and
submit supporting documents to HRTD. All Training/Conference must be approved by their
Program Directors.

K. Allowable Absence From Training
35. The total number of days of absence
2
from training for PGY1 Residents should not exceed 35
days in a year.

Duration of
Posting (Months)
Maximum Days of Absence Days of Absence
beyond which posting
will be repeated
2 6 10
3 9 15
4 12 21
6 18 31

1
Activities include but not limited to: Conferences/Symposiums, seminars, workshops, lectures, courses.
PDs should exercise due discretion.
2
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.) except for Training
Leave.

36. The total number of days of absence from training for PGY2 and above Residents should not
exceed 38 days in a year.

Duration of
Posting (Months)
Maximum Days of Absence Days of Absence
beyond which posting
will be repeated
2 6 11
3 10 17
4 13 23
6 19 34

37. For Residents who exceed the maximum number but within the threshold for repeat posting,
PDs should assess and recommend remediation if necessary.


ANNEX G
RESIDENT DUTY HOURS

Purpose
SingHealth is committed to providing residents with a sound academic and clinical education,
which must be carefully planned and balanced with concerns for patient safety and resident well-
being. Each program must ensure that the learning objectives of the program are not compromised
by excessive reliance on residents to fulfil service obligations. Didactic and clinical education must
take priority in the allotment of residents' time and energy. Duty hour assignments must recognize
that faculty and residents collectively have responsibility for the safety and welfare of patients.

Definition
Duty hours are defined as all time spent on all clinical and academic activities related to the
residency program, i.e. patient care (both inpatient and outpatient), administrative duties related to
patient care, the provision for transfer of patient care, time spent in-house during call activities and
scheduled academic activities such as conferences. Duty hours do not include reading and
preparation time spent away from the duty site.

Responsibilities/Requirements
1. The Program Director is responsible for the duty schedule and for making the ultimate decision
regarding scheduling of all duty hours for all residents within their scope of supervision.

2. On-call rooms are provided for residents with nighttime duty hours.

3. The on-call schedule will be tailored to be consistent with the residency requirements set forth
by ACGME-I in the Institutional Requirements, Common Program Requirements and Program
Requirements.
A. Duty hours must be limited to 80 hours per week, averaged over a four-week period,
inclusive of overnight calls.
B. Residents/fellows must be provided with one day (24 hours continuous) free from all
educational, clinical and administrative responsibilities, averaged over a 4-week period,
inclusive of overnight calls.
C. Adequate time for rest and personal activities must be provided. This should consist of
a 10 hour time period and must consist of at least an 8 hour time period between all
daily duty periods and after overnight calls.
D. Residents should not take overnight calls any more frequently than once in every three
days when averaged over a four-week period.
E. Continuous on-site duty, including overnight call, must not exceed 24 consecutive hours.
Residents may remain on duty up to six additional hours to participate in didactic
activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of
medical and surgical care as defined in Specialty and Subspeciality Program
Requirements.
F. No new patients, as defined in Specialty and Subspecialty Program Requirements, may
be accepted after 24 hours of continuous duty.

4. All programs must track resident duty hours daily for a 4-week period. SingHealth residents
are responsible for logging in their duty hours daily for the entire duration of the tracking period.
If the duty hours are flagged out to be a concern, they will be required to track their duty hours
more frequently.



5. The duty hours will be monitored closely by SingHealth GMEC for compliance. Program
Directors will be asked to review their duty hour schedules and processes for ensuring
compliance of their schedules with GMEC.

Duty Hours Exceptions
6. Program Directors may submit a request to a Review Committee to allow exceptions for up to
10% or a maximum of 88 hours to their programs based on a sound educational rationale.
However, prior to submitting the request to the Review Committee, the Program Director must
obtain approval of GMEC and the DIO.

Oversight
7. Each program must have written policies and procedures consistent with the institution's
requirements for resident duty hours. These policies must be distributed to the residents/fellows
and faculty. Monitoring of duty hours is required with sufficient frequency to ensure appropriate
compliance.

8. The Program Directors must communicate with program faculty/trainees regarding changes in
duty hour policies or changes in trainee/faculty work hours to accommodate duty hour
requirements.

9. Faculty and residents must be educated to recognize the signs of fatigue and to apply proactive
and operational counter measures. The Program Director and faculty must monitor
residents/fellows for the effects of sleep loss and fatigue and respond in instances when fatigue
may be detrimental to resident performance and wellbeing.

10. Back-up support systems must be provided when patient care responsibilities are unusually
difficult or prolonged or if unexpected circumstances create resident fatigue sufficient to
jeopardize patient care.

Reporting on Duty Hours Violations
11. Any residents concerned about a possible duty hour violation or working in excess of the hours
mentioned in item 3A-F are encouraged to first report the situation to their Chief Resident,
Program Director, or the Associate Designated Institutional Official/Designated Institutional
Official.


ANNEX H
RESIDENT BENEFITS

Objective
1. To set out the various medical benefits and insurance schemes that SingHealth residents are
entitled to as employees of MOHH.

A. Medical/Hospitalization Benefits Co-Payment Scheme
2. Residents and their family shall be entitled to MOHHs Medical and Hospitalization Co-Payment
Scheme as provided herein:

a. Family for the purpose of this clause means:
i. The spouse of a resident who is unemployed and who does not enjoy medical
benefits provided by his/her past employer, or if employed, is not entitled to medical
benefits provided by his/her current employer; and;
ii. A residents dependent children including step-children and legally adopted children
who are under the age of 18 years and who are not provided with medical benefits
by the current or past employer of his or her spouse.

b. MOHHs Medical and Hospitalization Co-Payment Scheme is as follows:

Outpatient Treatment
i. An annual sum of S$400.00 for the resident and his/her family combined per
calendar year.
ii. Outpatient treatment may be sought at any Registered Medical Practitioner but the
maximum claim allowed for treatment by a private practitioner is S$35.00 per visit
subject to the maximum claim of S$400.00 per calendar year.
iii. An original receipt must support the claim.

Outpatient Specialist Consultation
i. A resident is also entitled to an annual sum of S$550.00 per calendar year for any
outpatient specialist consultation at public healthcare network of hospitals and
specialist centres.
ii. The residents family as a whole (and not individually) is also entitled to a further
sum of S$550.00 for such specialist consultation per calendar year.

Hospitalization Fees
A resident is eligible for hospitalization fees incurred in the public healthcare network of
hospitals and specialty centres at a sum of S$10,000.00 per calendar year. His or her
family as a whole (and not individually) is also eligible for a further sum of S$10,000.00
for such fees.

Rate of Co-Payment
A resident is required to co-pay at a rate of 10% for self and 30% for family for all
medical and hospitalization claims subject to the maxima stipulated.

c. MOHHs Medical and Hospitalization benefits Co-Payment Scheme shall not cover any of
the residents pre-existing illnesses.



B. Dental Benefits
3. A resident is entitled to claim for dental treatment expenses up to a maximum of S130.00 per
calendar year at any dental clinic for preventive and restorative treatment. The residents family
is not entitled to any such benefits. Documentary proof of payment must be attached when
making the claim.

C. Travel Insurance
4. Travel insurance will be provided when a resident travels on official business on behalf of
MOHH or as approved by MOHH, in the course of Residency training in SingHealth.

D. Group Term Life and Personal Accident Insurance
5. Group Term Life Insurance MOHH will provide Term Life Insurance coverage to Residents
effective upon confirmation. Coverage covers death and permanent disability and is subject to
the acceptance by the insurance company and the terms and conditions of the policy. The
coverage is worldwide, on a 24-hr basis and the sum is 12 months of the total base salary. Any
expenses incurred beyond the insurance coverage will be borne by employees.

Group Personal Accident Insurance MOHH will provide a Group Accident insurance coverage
to Residents effective only upon confirmation. Coverage is subject to the acceptance by the
insurance company and the terms and conditions of the policy. Coverage covers death and
permanent disability, except suicide, self-injury, war participation in riots and competitive racing
of any kind. The coverage is worldwide, on a 24-hour basis. The coverage for Resident
(classified as executive staff) is 26 months of the total base salary. Any expenses incurred
beyond the insurance coverage will be borne by employees.

E. Work Injury Compensation Insurance
6. Residents are covered under the Work Injury Compensation Insurance that covers against
work-related death and disability in accordance with the provisions of the Work Injury Act.

F. Medical Malpractice Insurance
7. Please see Medical Indemnity Insurance Policy for more details.

G. Others
8. Residents on night calls will have access to food outlets (with some operating 24 hours) in all
participating sites, and will be eligible to claim meal subsidies from MOHH when they are on
night calls.

9. In order for residents to rest/sleep during night calls, they are given access to clean and
comfortable call rooms that are located within the hospital wards.

10. Individual residents with disabilities are advised to contact SingHealth GME Office for transport
and wheelchair assistance.

H. Clarification
11. Residents are strongly advised to refer to their employment contract and/or contact MOHH
Human Resource & Talent Development for clarification on the medical benefits and insurance
schemes available.


ANNEX I
PROGRAM CURRICULUM REVIEW

Objective
1. To establish an institutional policy and guideline for programs within SingHealth Residency on
the development and implementation of program curriculum.

Policy
2. Program Directors are required to develop and implement the academic and clinical curriculum
of resident education by:
a. Preparing an outline of the educational goals and objectives of the program to include
the knowledge, skills and other attributes of residents of each rotation and each level of
the program. This outline must be distributed to residents and faculty and reviewed with
residents prior to the assignment.
b. Preparing and implementing a comprehensive, well-organized and effective curriculum,
both academic and clinical. This includes the presentation of core specialty knowledge
supplemented by the addition of current information. The residency program must
require that residents obtain competence in the six core competency areas:
Patient care
Medical knowledge
Practice-based learning and improvement
Interpersonal and communication skills
Professionalism
Systems-based practice
Programs must define the specific knowledge, skills, behaviours and attitudes required
and provide educational experiences as needed in order for residents to demonstrate
these competencies.
c. Providing residents with direct experience in progressively increasing individual
responsibility regarding patient management.
d. Providing residents with the opportunity to:
Develop a personal program of learning to foster continued professional
growth with guidance from the teaching staff
Participate in safe, effective and compassionate patient care under
supervision, commensurate with their level of advancement and
responsibilities
Participate fully in the educational and scholarly activities of their program and
as required, assume responsibility for teaching and supervising other residents
and students
Participate, as appropriate, in institutional programs and medical staff activities
and adhere to established practices, procedures and policies of the institution
Have appropriate representation on institutional committees whose actions
affect their education and/or patient care
Submit to the Program Director, at least annually, confidential written
evaluation of the faculty and of the educational experiences.
e. Each program must comply with the respective RAC requirement.
f. Monitoring the residents progress at least twice a year. In these semi-annual meetings,
resident educational accomplishments, procedural skills acquisition and performances
must be reviewed to formulate individualized learning plans with residents.


ANNEX J
IMPAIRMENT POLICY

Objective
1. To provide a process for SingHealth Residency Programs to follow if any of its residents is
deemed to be suffering from impairment.

2. For the purposes of this policy, an impaired Resident is one who is unable to practice medicine
with reasonable skill and safety to patients because of a physical or mental illness including
deterioration through the aging process,loss of motor skill or excessive use or abuse of drugs,
including alcohol.

Guiding Policy
3. It is the policy of SingHealth to provide and ensure a drug-free and safe work environment for
its residents, co-workers, patients and visitors.

4. Therefore, residents must not be under the influence of an illegal drug/legally obtained drug
while on duty (includes on-calls) as it could impair his or her ability to function safely in his or
her job, or jeopardize the safety of co-workers, patients and visitors.

Procedure
5. If there is reasonable suspicion that a resident is under some form of impairment, the Program
Director should immediately discuss the suspicion with the resident is question. If the suspicion
still exists, the Program Director (PD) will submit a written report to the DIO within 7 days,
which should include the facts (e.g. description of the incident[s]) leading to the suspicions.

6. The PD and the DIO will discuss the report and determine whether a further investigation is
warranted (i.e. likelihood of impairment is low or high).

7. If no further investigation is recommended, the initial report will be filed in the Residents
confidential P-File for record and future reference.

8. If it is determined that an investigation is warranted, an Medical Inquiry Panel (MIP) comprising
of the following will be appointed to investigate the alleged Resident impairment:
a. Director, Medical Manpower, SingHealth (Chair)
b. Program Director, SingHealth
c. Head of Department/Senior Consultant/Immediate Supervisor of hosting
department, SingHealth
d. Secretary (to be appointed by Director, Medical Manpower, SingHealth/DIO)

9. The PD and/or DIO will request a meeting with the resident to notify him or her of the intent to
initiate an investigation. If alleged impairment is related to drug or alcohol abuse, the resident
will need to be tested for drug and/or alcohol use. The resident will be informed that refusal to
consent to the screening will result in discharge from the Program and/or termination of
employment from MOHH.

10. Pending the findings and report of the MIP, the Resident will be temporarily removed from
patient care and have his or her clinical privileges restricted (suspension).

11. The MIP must initiate, complete and provide a written report of their findings to the DIO within
14 calendar days of notification to the suspected resident.


12. If the MIP finds no credible evidence to merit a concern that the resident is impaired, the PD
will notify the resident in person of the findings. The case will be considered closed and the
written investigation report filed in the residents confidential P-File.

13. If the MIP finds evidence to merit some concern that the resident is impaired, but not of the
quality or quantity to justify immediate action against the Resident, the PD will notify the
resident of the outcome and the need for ongoing monitoring.

14. The PD will develop and implement a plan for ongoing monitoring of the resident until it is
established that there is or there is no impairment. The PD will update both resident and MIP
on the progress of the monitoring on a regular basis.

15. If sufficient evidence of impairment is uncovered from the investigation or the ongoing
monitoring, the PD will meet with the resident in person to notify him or her of the outcome of
the investigation.

16. Depending on the nature and severity of the impairment, the DIO may apply the following
options as appropriate:
a. Seek medical and/or psychiatric treatment. The PD shall assist the resident in
locating a suitable treatment or rehabilitation program. The resident will be informed
that participation in the treatment or rehabilitation program is a condition for him or
her to remain in the Residency Program.
b. Immediate suspension from the Residency Program for a period not exceeding one
month and referral to MOHH (as the employer) and SMC (as the regulatory body)
for further action if the resident refuses to undergo the recommended action.
c. Termination from the Residency Program and referral to MOHH (as the employer)
and SMC (as the regulatory body) for further action.

17. The payment of the treatment/rehabilitation program, as well as the leaves of absence granted
to participate in such a program, shall be governed by the medical benefits and leave policies
of the residents employer, MOHH.

18. Re-instatement into the Residency Program is not automatic. In order for the resident to
resume Residency training, he or she must provide the PD and DIO a letter from the physician
in charge of the treatment program attesting that:
a. The resident had cooperated fully during the entire course of treatment or
rehabilitation
b. The resident is capable of resuming medical training and providing safe and
effective care to patients
c. Any supervision or appropriate actions the Residency Program should take in order
for the resident to resume training.

19. The resident shall also authorize his or her physician to release information pertaining to his or
her condition and treatment so that the PD and DIO will be able to obtain information to their
satisfaction that the resident can be re-instated.

20. Upon reinstatement, the PD will closely monitor the Residents training and job performance
with reports presented to the DIO for a period of 6 (six) months.

21. If the impairment is related to drug or alcohol consumption/abuse/addiction, the resident must
submit to drug or alcohol screening test(s) upon request of the PD and/or DIO.


Appeal
22. The resident has the right to appeal the above decisions or actions to the GMEC as detailed in
the Redress of Grievance Policy. The appeal outcome of the GMEC is final.


ANNEX K
REDUCTION IN SIZE OR CLOSURE OF A TRAINING PROGRAM

Purpose
To describe the circumstances and procedures for reducing the size of or closing a residency
(includes fellowship) program or closure of the institution.

Policy
SingHealth Services Pte Ltd (SingHealth) recognizes the need for and benefits of graduate medical
education and sponsors residency programs that emphasize personal, clinical and professional
development. SingHealth ensures, through the GME Internal Review process, that its residency
programs are in substantial compliance with the institutional, common and special requirements of
the Accreditation Council for Graduate Medical Education International (ACGME-I) and its
individual Residency Review Committees.

In the event of a transfer or reduction in size of a residency program, SingHealth will follow all
ACGME-I guidelines and assist in placing affected residents in other accredited residency
programs of the same specialty.

Circumstances that may lead to the closure of reduction in the size of or closing a program may
include:
1 Failure of the program to correct concerns and/or to comply with recommendations of the
GMEC based on the Internal Review of the program.
2 Failure of the program to correct citations of ACGME-I.
3 Decreased financial or educational resources to support the program.

Circumstances that may lead to closure of the Institution include:
1 Failure to demonstrate substantial compliance with the requirements.
2 Delinquency in payment of fees according to ACGME-I policies and procedures.
3 Failure to undergo a site visit and Sponsoring Institution review.
4 Failure to follow directives associated with an accreditation action.
5 Failure to supply a Review Committee with requested information (e.g. Progress Report,
operative data, resident survey).
6 Failure to maintain current data through Web ADS.

Procedures
SingHealth recognizes that it becomes necessary, at times, to decrease the size of a training
program or completely close the training program. In this situation, it is the primary goal of
SingHealth to ensure that residents or fellows in the training program at the time of the change
receive an ongoing, high quality education and clinical experience with as little interruption as
possible. The following procedure will be followed in the event that SingHealth and/or a Program
Director decides to reduce the number of positions in or close a program or close the Institution:

1. The Sponsoring Institution will inform the GMEC, the DIO, and the residents as soon as
possible when a reduction in size or closure occurs. In addition, at the time SingHealth informs
residents of a termination, transfer, or reduction of residency program, SingHealth shall provide
resources including but not limited to contact names, addresses, and phone numbers which
may be helpful in a residents search for placement. In such events, MOHH shall continue to
pay the salaries of displaced resident for the remainder of the residency year or until said
residents are placed in other salaried and accredited residency programs at another facility if
such placement is within the residency year.


2. This notification should be accomplished in a timely manner.

3. Whenever possible, a training program should be down-sized in a phased-in manner, allowing
all current trainees to complete their education without transferring to another program or
interrupting their training experience. Similarly, program closure should ideally occur at a time
that would allow all current residents or fellows to complete their educational experience
without transfer or interruption.

4. When a decrease in the size of a training program or a program closure must occur in a
manner that will not allow for all current residents to complete their educational experiences at
SingHealth, it is the responsibility of the Program Director to assist residents in enrolling in an
ACGME-I accredited program at which they may continue their education. This assistance will
include letters of recommendation, the timely provision of training and employment records.

5. The Program Director must receive approval and documented support from the GMEC prior to
submitting the request for reduction in size or closure of a training program to ACGME-I.


ANNEX L
DISASTER PREPAREDNESS

Purpose
1. The purpose of this policy is to ensure continued, high quality educational experience of
residents enrolled in the SingHealth Graduate Medical Education (GME) programs in the event
of a disaster or interruption of training sites impacting the graduate medical education
programs.

Definition
2. A disaster is an event or set of events (e.g. natural disaster, human generated or internal
disaster, etc.) causing significant alternation to the residency experience at one or more
residency/fellowship programs.

Procedure
3. Assessment of the situation. As soon as possible, the GME Office, in conjunction with the
Designated Institutional Official (DIO) will:
i. Gather information from programs regarding the extent of damage and the impact of the
disaster on the short-term (days/weeks) and long-term (weeks/months) function of
individual programs and/or sites of training.
ii. The DIO will collaborate with the Program Directors to assess the short-term and long-
term impact on clinical operations at sites affected by the disaster.
iii. The GME Office will meet regularly and as necessary to monitor operational effects on
the quality of education provided to affected programs and to make decisions regarding
needed additional actions. The GME Office will continue to provide administrative
support to all affected programs during this period.

In the DIOs absence or if he is incapacitated, his designee will be appointed in the following
sequence:
i. ADIO, SGH
ii. ADIO, CGH
iii. ADIO, KKH

4. Following declaration of a disaster. The DIO, Program Director and other Sponsoring
Institution leadership will strive to restructure or reconstitute the educational experience as
quickly as possible following the disaster. Issues to be reviewed, assessed or acted upon by
the GMEC are as follows:
i. Patient safety
ii. Safety of residents, faculty and staff
iii. Supply and availability of faculty and residents for clinical and educational activities
iv. Extent/impact of damage to the physical plant/facilities
v. Extent/impact of damage to clinical technology and clinical information systems
vi. Extent/impact of damage to communication technology (e.g. phones, intra/internet)
vii. Changes in the volume of patient activity in the short-term and long-term
viii. Restoration of clinical services and educational resources to the normal pre-disaster
situation in order to reinstate resident training at SingHealth institutions as soon as
possible.
ix. Copies of the residents credentials, training records, evaluations are also kept at MOH
Holdings Pte Ltd and the GME Office.



5. MOH/ACGME-I Communication. It will be the responsibility of the DIO or his designee to
notify the MOH/ACGME-I within two business days of the initial assessment to provide an
update on the disaster potentially affecting the course of training of residents and initial steps
taken by the institution and the GMEC.

The DIO or his designee will continue to communicate with MOH/ACGME-I regularly as needed
to provide updates on any additional program or institutional issues. Within 30 days of the
disaster, the DIO or his designee will contact the MOH/ACGME-I with regard to final plans to
reconfigure any programs.

6. Institutional Impact Assessment. The Associate DIOs (ADIOs) of the Sponsoring Institutions
(SIs) will be responsible for assessing the impact of the disaster on their individual
organizations ability to provide uninterrupted and ongoing graduate medical education. The
assessment will include determination of general capacity (common facilities and services) as
well as individual program capacity for ongoing training. If at all possible, this assessment
should be completed within 72 hours of the occurrence of the disaster. If the disaster limits the
capacity of an affiliated institution to provide GME training, it will also be the responsibility of the
ADIO or his/her designee to determine if and when the full pre-disaster training experience can
be resumed at his/her institution.

7. Individual Impact Assessment. The Program Directors will be responsible for reviewing
contingency plans and procedures to address continuation of program leadership, evacuation
planning, relocation, program recovery, maintenance of communication and for working with
affiliates training sites.

The Program Directors are responsible for establishing procedures to protect the academic and
personnel files of all trainees from loss or destruction by disaster.

The Program Directors will be responsible to contact each of their residents/fellows. The
Program Directors will ascertain the health and safety of the residents or fellows and determine
their capacity and desire to continue training. If at all possible, this assessment should be
completed within 72 hours of the occurrence of the disaster.

8. Training Capacity Determination. Upon receipt of reports from the Sponsoring Institutions
and the Program Directors and with their input and guidance, the DIO or his designee will
determine the capacity of each individual training program to provide ongoing, high quality
graduate medical education to each of its residents or fellows.

9. Transfer of Training Experience. Once the DIO or his designee determines that one or more
training programs cannot provide an adequate educational experience for some or all of its
residents or fellows, the Sponsoring Institution will, to the best of its ability, arrange for the
temporary transfer of the residents to programs at other affiliate training sites until such a time
as the residency/fellowship program can provide an adequate educational experience for each
of its residents/fellows.

The Sponsoring Institutions cooperate in and facilitate permanent transfer to other
programs/institutions. Programs/institutions will make the keep/transfer decision expeditiously
so as to maximize the likelihood that each resident will timely complete the resident year.

If this cannot be achieved within a reasonable amount of time following the disaster, the PD will
take appropriate steps to arrange permanent transfer of residents to other accredited programs.


For residents temporarily relocated to an affiliated training site, MOH Holdings Pte Ltd (MOHH)
will continue to pay resident stipends and benefits consistent with applicable law.

In the event of a disaster affecting other Sponsoring Institutions of residency/fellowship
programs, the program leadership at the Sponsoring Institution will work collaboratively with the
DIO or his designee who will coordinate on behalf of the medical centre the ability to accept
transfer residents from other institutions. This will include the process to request complement
increases with ACGME-I that may be required to accept additional residents for training.
Programs currently under a proposed or actual adverse accreditation decision by ACGME-I will
not be eligible to participate in accepting transfer residents.

Residents/fellows will continue to receive salary and benefits from MOHH during temporary
relocations. For program closures/disruptions that are permanent, residents will continue to
receive salary and benefits until the trainees are placed and begin in another institution, or until
the end of their contract.

10. ACGME-I Requirements. The DIO or his designee will be the primary institutional contact with
the ACGME-I Executive Director regarding disaster plan implementation and needs within the
sponsoring institutions.

The DIO within 10 days of declaring a disaster will contact ACGME-I to discuss due dates that
ACGME-I will establish for the programs to:
i. Submit program reconfigurations to ACGME-I, and
ii. To inform each programs residents and fellows of transfer decisions. The due dates for
these submissions are expected to be no later than thirty days after declaration of the
disaster, unless extensions are approved by ACGME-I.

11. Ongoing Communication. It is the responsibility of the Program Director to notify each
transferring resident of the expected minimum and actual duration of any temporary
transfer. The Program Director must also maintain ongoing contact with all temporarily
transferred residents, keeping them informed of expected times of transfer back to the
respective Sponsoring Institutions. The Program Director is also expected to provide any
information reasonably expected to be necessary to the accepting Program Director, including
individual resident educational experiences, performance and expected needs. Finally, it is the
Program Directors responsibility to obtain from the accepting institution a report of the
academic progress for each resident that has been temporarily transferred. This report should
be of sufficient detail to allow the Program Director to determine if the resident has met the
training requirements of the appropriate specialty board and the RRC for the specialty.

12. Program Oversight. The DIO or his designee will be responsible for regular reporting to the
GMEC on the status of each program affected by the disaster. Upon review of the impact of
the disaster, the GMEC may recommend an increase in the intensity of program oversight for
affected programs, including additional internal reviews.


ANNEX M
MEDICAL INDEMNITY INSURANCE

Objective
1. This policy specifies the requirement of a valid medical indemnity insurance coverage for the
strict compliance of all SingHealth residents.

Policy
2. All residents must possess valid medical indemnity insurance at all times while undergoing
Residency training with SingHealth. Failure to comply with this requirement may result in
severe disciplinary action(s), including suspension or termination from the Residency Program.

3. MOHH, as the employer of all residents, shall be responsible for ensuring that they are
adequately indemnified while undergoing Residency with SingHealth.

4. SingHealth residents are required to pass a copy of proof of coverage (e.g. certificate from
insurer) to the Program Coordinators at each renewal for proper documentation. In addition,
before starting each rotation, residents must also produce proof of coverage (e.g. certificate) to
the hosting department.

5. SingHealth residents are strongly advised to contact Clinical Manpower Division, MOHH, on
any medical indemnity insurance related matters.




ANNEX N
DISABILITIES

Purpose
1. SingHealth Services Pte Ltd adopts the Ministry of Manpowers Good Employment Practices &
Guidelines on recruiting and treating employees fairly and equally, without prejudice or
discrimination. SingHealth provides disabled, but qualified applicants and employees,
reasonable accommodations that do not impose undue hardships on SingHealth.

Definitions
SingHealth defines a person with a disability as an individual who:

2. Has a physical or mental impairment that limits one or more of the individuals major life
activities, such as caring for oneself, performing manual tasks, walking, speaking, seeing,
hearing, breathing, learning or working.

3. Has a record of such impairment, even if the individual no longer has the impairment; or

4. Is regarded as having a substantially limiting impairment even though that individual is not
actually impaired.

Procedure

5. Resident who qualifies as disabled based on the above definition must make their Program
Director aware of the need for a possible accommodation, if this is necessary to maintain
acceptable performance.

6. The Program Director shall determine which training functions are essential and then in
collaboration with the resident shall determine the precise limitations of the individual and the
potential reasonable accommodation(s). This interactive process will identify the aspects of the
function and/or work environment which limit the individuals ability to perform the task which
requires accommodation. SingHealth reserves the right to request documentation related to the
disability, limitations and requested accommodation.

7. The Program Director shall notify the Division Chair in writing of any accommodations
requested by an employee. The Program Director shall consult with the Division Chair to
determine and implement an accommodation, which is most effective for SingHealth and the
employee. This accommodation shall not impose any undue hardship to SingHealth.

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