By Judith Tan

SINGAPORE is looking to revamp the training of medical specialists in a move that will produce specialists in five years, down from seven now.

The proposed move will drop the one year of housemanship. This means that, after four years of basic medical training, young doctors will launch into five years of training in any one of 35 existing specialities. They will do this as residents at one particular hospital.

Under the current system, doctors must do four years of basic training and a year of housemanship.

Following this, all go through three years of basic speciality training from Year 6, during which they are rotated among departments in a few hospitals for exposure to medical disciplines ranging from cardiology to paediatrics.

To be specialists in one field, they must go through two to four years more of advanced speciality training, so it can take up to seven years to become one.

As at the end of last year, of the 7,841 doctors registered here, 2,962 or 37 per cent were specialists.

Medical students have been told of these changes, and a Health Ministry (MOH) official has blogged about the changes on the ministry's website. Professor Chee Yam Cheng, a senior physician in the Office of the Director of Medical Services at MOH, noted in the blog that the focus thus far has been on raising the number of doctors, such as by taking in doctors trained abroad, increasing student intakes and opening another medical school.

The proposed change, a move to review the quality of post-graduate medical education, would 'ramp up the expertise of future generations of doctors to prepare for Singapore's ageing population and the increased chronic disease load', he wrote.

Under the current system, the three years of basic speciality training starting in Year 6 are largely unstructured. Doctors in training are assessed by the various heads of department as they cover the various disciplines in rotation.

The new system, however, will tie them to a specific department in one hospital as residents. This gives hospitals a bigger role in overseeing their training. The result: Structured training, a better curriculum and accountability for the training, said the MOH blog.

The change may also go some way towards meeting the aspirations of students at Duke-NUS, who wish to be trained following the American style without having to go there, said Prof Chee, referring to the graduate medical school created from a tie-up between the American university and the National University of Singapore.

The proposed change has created a buzz in the medical fraternity, with several medical students expressing concern over not being exposed to other fields.

A third-year medical undergraduate said: 'I would like to be rotated around the hospitals and experience the work cultures. That way, I'd be able to know what I'd be good at later. Taking up a residency would mean being tied to just one hospital, which limits the scope of my training.'

MOH is expected to address this and other issues at a press conference on Wednesday.

Reactions to the change were mixed among specialists. Professor Tan Huay Cheem, who heads the National University Heart Centre, welcomed the move, saying the scheme ensured that the hospitals took ownership of the specialists they produced.

But neurosurgeon Alvin Hong pointed out that a bottleneck would result in the more popular disciplines; conversely, less-popular choices like geriatrics could still suffer shortages.

Dr Ann Tan, who heads the Association of Women Doctors, expressed concern that the new scheme will take away the experience of various postings, so young doctors may be unable to decide on which speciality to go for.

Plastic surgeon J. J. Chua said: 'The new system will churn out more specialists faster, but at what cost?...What this means is that we would get better specialists but worse generalists.'

This article was first published in The Straits Times.