Public Health & Occupational Medicine. Senior Residency Hand Book

Transcription

1 Public Health & Occupational Medicine Senior Residency Hand Book

2 Contents CONTENTS 2 OVERVIEW OF PROGRAMME 3 Faculty Members 3 PROGRAMME SUPERVISION 5 Primary supervisor 5 Secondary Supervisor 6 ENTRUSTABLE PROFESSIONAL ACTIVITIES 7 Common EPAs for Public Health and Occupational Medicine 7 EPAs for Public Health Epidemiology and Disease Control Track 8 EPAs for Public Health Health Policy and Management Track 9 EPAs for Public Health Health Services Research Track 9 EPAs for Occupational Medicine 9 FORMATIVE ASSESSMENT 11 Schedule for Formative Assessment 11 Log of Preventive Medicine Training 11 Mid-posting Formal Assessment 11 Fulfilment of training requirements before exit examination 12 Exit Examination 12 ANNEX 1: GUIDE ON PRESENTATIONS TO RAC 14 ANNEX 2: GUIDE ON PROJECT PRESENTATION: MID-TERM ASSESSMENT 15 Page 2

3 Overview of Programme The Public Health and Occupational Medicine Senior Residency is a two-year programme. It focuses on developing skills in a specialty area of Preventive Medicine. The training must include at least six months of training experience outside the main training site to gain depth and breadth in either Occupational Medicine (OM) or Public Health (PH). This may be in the form of attachments locally or overseas and may include additional didactic courses or modules. The competences expected of Senior Residents are to consistently: (a) Demonstrate integration and application of concepts and skills from the Masters in Public Health; (b) Demonstrate and role model effective team and leadership skills; (c) Demonstrate depth and breadth of knowledge, evaluate and critically apply current knowledge from wide range of sources, including current literature, and identify research questions that would answer specifics of public health issues; and (d) Effectively self-direct improvement activities that seek out and incorporate feedback and improvement information into their daily practice. Completion of the Senior Residency and passing the final exit examination will qualify the individual to be accredited as a Specialist by the Specialist Accreditation Board, Ministry of Health, and registration as a Specialist by the Singapore Medical Council. Public Health Senior Residents shall select one of three tracks: Epidemiology and Disease Control Health Policy and Management Health Services Research Faculty Members Programme Director Associate Programme Directors Senior Residency Associate Programme Directors - Sites Public Health Occupational Medicine Agency for Integrated Care Communicable Disease Centre / Tan Tock Seng Hospital Eastern Health Alliance Health Promotion Board Health Sciences Authority A/Prof Wong Mee Lian mee_lian_wong@nuhs.edu.sg A/Prof Angela Chow angela_chow@ttsh.com.sg Dr Judy Sng judy_sng@nuhs.edu.sg Dr Jason Yap jason.yap@aic.sg A/Prof Angela Chow angela_chow@ttsh.com.sg Dr Eugene Shum eugene.shum@easternhealth.sg Dr Chew Ling Chew_ling@hpb.gov.sg Dr Raymond Chua Raymond_chua@hsa.gov.sg Page 3

4 Jurong Health Services Dr Yang Kok Soong Ministry of Health Dr Steven Ooi Ministry of Manpower: Occupational Safety & Health Division National Healthcare Group Polyclinics & HQ National University Health System Singapore Armed Forces Singapore General Hospital Dr Ho Sweet Far Dr Matthias Toh Dr Judy Sng Gek Khim A/Prof Vernon Lee Dr Fong Yuke Tien Senior Residency Guidance Counsellor: Dr Jason Yap ( 大哥 ) Page 4

5 Programme Supervision Primary supervisor The primary supervisor is responsible and accountable for the supervision and training of the Senior Resident for the whole of the two-year Senior Residency Training Programme to ensure depth and breadth for the Interest Track. Breadth would include at least six months of work exposure outside the Programme site in any form (including sequential posting or concurrent posting) as well as some breadth outside of his track and specialty. The primary supervisor shall provide on-site supervision for the Senior Resident at the primary site. He may post the Senior Resident to other departments in his institution or outside his institution for short periods during his training at his site to provide breadth or depth or to ensure that the training meets the requirements of the Entrustable Professional Activities (EPAs). The primary supervisor and the Senior Resident must meet monthly to discuss the Senior Resident s training performance and progress in the achievement of the EPAs. The supervisor will also review the log book of the Senior Resident during the monthly meetings. He shall coordinate with the secondary supervisor for supervision at the secondary site. He will hold meetings jointly with the secondary supervisor, reporting officer and Senior Resident at quarterly intervals to review the progress of the Senior Resident in his achievement of the EPAs. List of primary supervisors and interest tracks under their supervision Site Primary supervisors Epi & Dis Control (EDC) Health Policy & Management (HPM) Health Services Research (HSR) AIC Jason Yap EHA Eugene Shum HPB Chew Ling Chow Khuan Yew HSA Raymond Chua JHS Yang Kok Soong MOH Steven Ooi Jeffery Cutter Occupational Medicine (OM) MOM Ho Sweet Far NHG Matthias Toh NUHS Judy Sng Wong Mee Lian SAF Vernon Lee SGH Fong Yuke Tien TTSH Angela Chow Page 5

6 Lee Lay Tin Secondary Supervisor The secondary supervisor shall be from the same Interest Track and will give the breadth for the track. The secondary supervisor must be equivalently qualified to an APD and should preferably be another site APD collaborating in the training of the Senior Resident. The secondary supervisor must meet his trainee monthly to discuss his training performance and progress in the achievement of the EPAs during the secondary posting. He will also review the log book of the resident during the monthly meetings. Page 6

7 Entrustable Professional Activities Senior Residents are required to achieve the required Entrustable Professional Activities (EPAs) during their rotations. The EPAs are mapped to the Public Health and Occupational Medicine competencies. The rotations and activities to achieve the EPAs will be planned by the Primary Supervisor and the Secondary Supervisor, and discussed with the Senior Resident before the start of the senior residency. The EPAs are a key component of the formative assessment for the Senior Resident. The EPAs will be reviewed regularly by the Program director/ccc, and the RAC. Common EPAs for Public Health and Occupational Medicine SA1 Patient (population care and medical knowledge) Systematically assess risks for diseases/injuries, review and apply scientific evidence, and develop an evidence-based guideline to address a proposed clinical preventive service. SA2 Epidemiology Assess the health of a local population and identify groups with poorer health. Design and conduct a basic epidemiological study to assess health status and risk factors for a range of diseases and conditions. Recommend appropriate courses of action to prevent and control a range of diseases and conditions. SA3 Biostatistics Use appropriate statistical methods to analyse a health problem. SA4 Behavioural Aspects of Health, Disease and Injury Prevention, and Health Promotion Demonstrate sufficient knowledge to identify the need for appropriate complex statistical analyses Assess individual and population risk behaviours by integrating best practices and tools. Develop, implement and evaluate programmes to promote health and modify individual and population risk behaviours. Contribute to the development and/or implementation of a policy to promote health SA5 SA6 Disease and Injury Surveillance and Outbreak Investigations Health Planning and Evaluation Monitor surveillance data to identify appropriate targets for individual, community, and/or systems interventions. Evaluate the quality and effectiveness of a surveillance system Systematically review, assimilate and apply scientific evidence, and use a range of information sources and surveillance systems to inform policy and practice on the improvement of health services and programmes Develop and implement a plan to address a health improvement need in the community Page 7

8 Complete a risk assessment for a hazard not commonly found in a population, drawing on external expertise as appropriate. SB SC Practice-Based Learning and Improvement Interpersonal and Communication Skills Systematically analyse and improve practice by using advanced quality improvement methods and implementation science. Act independently in a consultative role to other physicians and health professionals Lead and communicate effectively within inter-professional and multi-disciplinary teams. SD Professionalism Demonstrate professional behaviour by role modelling, performing lifelong learning and publishing at least one firstauthor paper SE Systems-Based Practice Teach and mentor junior residents in Preventive Medicine. Teach other professional groups to promote Preventive Medicine in the practice of individual and population-based medicine Incorporate and discuss considerations of cost awareness and risk-benefit analysis in patient and/or population-based care as appropriate Assess and improve performance in a healthcare delivery system. Advocate for quality patient and/or population-based care. SF Leadership and Communications Lead and work effectively within multidisciplinary/multiagency team. SG Program Planning Integration of Diverse Disciplines/Sectors Demonstrate sufficient knowledge to contribute to the development of a programme or policy by applying a multifaceted assessment process and integrating different healthcare disciplines. SH Implementation Science Change/Conflict Management and Organizational Psychology Systematically apply key implementation principles in the implementation of a project to reduce resistance to change and promote its early adoption and sustainability. SI Evaluation Demonstrate a level of expertise in in the evaluation of a programme or expertise by appropriate use of quantitative and qualitative methods EPAs for Public Health Epidemiology and Disease Control Track SA2 Epidemiology Apply epidemiological knowledge and skills in the design and conduct of a complex study of high validity. SA3 Biostatistics Use statistical software to perform statistical tests; and understand the application of more advanced statistical methods. Page 8

9 SA5 Disease and Injury Conduct an outbreak investigation and implement control Surveillance and strategies Outbreak Investigations Design and manage a surveillance system; plan an outbreak investigation SA6 Health Planning and Evaluation Use appropriate epidemiological and statistical methods to analyse disease burdens. EPAs for Public Health Health Policy and Management Track SA6 SE Health Planning and Evaluation Systems-Based Practice Understand medical manpower management, planning and professional development. Understand clinical governance. Coordinate, implement or develop the delivery of effective, efficient and safe patient care services in various healthcare delivery settings and systems. EPAs for Public Health Health Services Research Track SA2 Epidemiology Apply epidemiological knowledge and skills in the design and conduct of a complex study of high validity. SA3 Biostatistics Use statistical software to perform statistical tests; and understand the application of more advanced statistical methods. SA6 Health Planning and Evaluation Use appropriate epidemiological and statistical methods to analyse disease burden. EPAs for Occupational Medicine Entrusted Professional Activities (EPAs) Competency/Milestones SA2 Epidemiology Identify and address individual and organizational factors in the workplace in order to optimize the health of the worker and enhance productivity SA5 Disease and Injury Surveillance and Outbreak Investigations SA6 Health Planning and Evaluation * includes all kinds of programmes or interventions related to prevention, health promotion, service improvement, patient Develop, evaluate, and manage medical surveillance programs for the workplace Plan, design, implement, manage, and evaluate comprehensive occupational/environmental health programs, projects, and protocols that enhance the health, safety, and productivity of workers, their families, and members of the community Page 9

10 Entrusted Professional Activities (EPAs) Competency/Milestones SE engagement Systems-Based Practice Coordinate, implement or develop the delivery of effective, efficient and safe patient care services in various healthcare delivery settings and systems Page 10

11 Schedule for Formative Assessment Formative Assessment Senior Residents should meet their supervisor monthly with their updated EPAs and SR logbook. The objective is to review the progress of the Senior Resident in his/her achievement of the EPAs. The trainee must meet the PD and the Senior Residency Clinical Competency Committee (CCC), and the Residency Advisory Committee (RAC) respectively, at six-monthly intervals. During these meetings, there will be an oral assessment of his competencies. His log book and EPAs will also be reviewed during these meetings. During the meetings with RAC, the Senior Resident will give presentations on his career goals and his proposed project for his Exit examination. Guidelines for the presentations are shown in Annex 1 In summary, the frequency of the reviews is as follows: Panel Supervisor CCC (including PD, APD(PH) and APD(OM) RAC Frequency Monthly 6-monthly 6-monthly Log of Preventive Medicine Training All Senior Residents are expected to keep a log book of which will be reviewed on a regular basis. The logbook will have a record of projects undertaken and participated CME activities. All other teaching experiences e.g. conferences, seminars, papers presented should also be recorded. In addition, Senior Residents should achieve at least 70% attendance at training sessions provided by the residency programme including journal clubs, seminars, and grand rounds. Mid-posting Formal Assessment (Formative) At the end of the first year of the Senior Residency training programme, the Senior Resident will undergo a formal assessment by a review panel comprising the PD and APDs from the interest core group of the same interest track as the resident. After the review, the Senior Resident will be provided with written qualitative feedback on identified gaps in competencies (if any) and suggestions for remedial actions (if required). The Senior Resident is expected to work with the primary supervisor to address the competency gaps and to provide a progress report to the CCC in 3 months. The resident will be evaluated on: (a) Performance during the senior resident posting(s) (based on C1 Form) (b) Projects and learning activities documented in the logbook (c) Attendance at training sessions provided by the residency programme (d) Participation in scholarly activities e.g. teaching, presentations/posters at conferences (e) Progress on publication of first-author paper Page 11

12 (f) Professional behaviour e.g. respect, compassion, integrity (g) Project presentation to the review panel (please refer to Annex 2 for guide) Fulfilment of training requirements before exit examination The resident must fulfil either of the following during the training programme: (a) Publish at least ONE first author paper on a public health or occupational medicine topic in a refereed journal, or (b) Maintain a portfolio (during R4 and R5 years), which demonstrates a systematic approach to acquiring knowledge and skills in their chosen field. The portfolio will have two parts: Part 1: Three technical reports, each at least 2000 words in length, which exemplify the application of best practices. These reports may include: i. Scholarly article / review of a standard acceptable for journal publication. ii. Series of policy papers. iii. Comprehensive needs assessment exercise. iv. Study report, covering the collection, analysis and interpretation of data for monitoring or evaluation of a health program for a defined population. Part 2: Three process reports, one for each of the technical reports required in Part 1. These reports should document the learning experience, showing evidence of depth and rigor in the preparation of the technical report. Exit Examination At the end of the Preventive Medicine Senior Residency Programme, the Senior Resident will have to pass an Exit Examination to qualify as either a Public Health Specialist or an Occupational Medicine Specialist accredited by the Specialist Accreditation Board, Ministry of Health, and registered as a Specialist by the Singapore Medical Council. In general, the assessment will be in four parts: (a) Review of work and training of the Senior Residents according to a submitted portfolio (including log book). (b) Discussion of projects/assignments undertaken, and an oral presentation of one project (c) Critique and discussion of one or two published paper(s) in public health or occupational medicine, which will be given to the Senior Residents at least one week in advance. (d) General review of public health and occupational medicine knowledge, for the trainee to demonstrate expertise in a wide range of public health or occupational medicine situations, including recent developments in the field. Page 12

13 (Information is correct as of , subject to changes and review as and when appropriate) Page 13

14 Annex 1: Guide on Presentations to RAC Guide for your first presentation 1. Where do you want to go? - Your career aspirations. - Your track/concentration. 2. What do you need to do to get there? - What training do you need to get? - Where will you get your training -primary and secondary sites? - Who will be your supervisors? 3. Conclude with your plan of action for the PH/OM exit exam. - What do you need to do and by when? - E.g. write up paper and submit to journal for consideration for publication by XXX Guide for your second presentation 1. Plan for your SR program: Duration, sites - Summary of Senior Residency & specialization track competencies. - What has been achieved so far? 2. Progress of your work so far -projects you are currently involved and how it helps you achieve the EPAs. 3. Proposed Project for your exit interview - Objectives - Review of existing program or needs assessment of problem - How will your project fill the gaps? - Plan for implementation and evaluation of your project Page 14

15 Annex 2: Guide on project presentation: Mid-term Assessment 1. Critical analysis and integration of R1-R3 and SR competencies. 2. Demonstration of systems thinking, leadership in multidisciplinary teams, and implementation and evaluation plan. 3. Demonstration of the competencies for your track e.g. HPM, OM, HSR competencies. 4. Critical appraisal of limitations of existing program 5. Demonstration of breadth and depth for example, a MULTI/MACRO LEVEL (individual, institutional, environmental and community level) ecological and/or system based model should be applied in the project design 6. It should demonstrate different competencies from the 1 st author paper publication. Page 15