Tagore Shephali, Min Bernard Chern Su, Goh Shen Li, Tan Lay Kok, Kwek Kenneth, Tan Kok Hian
J Grad Med Educ. 2012 Jun;4(2):272-5. doi: 10.4300/JGME-04-02-34.
The article describes the experience of planning and implementing the transition of the residency program in obstetrics and gynecology at Singhealth, Singapore, from a model largely based on British training principles to a new model in accordance with the ACGME-International (ACGME-I) standards.
Initial steps in transitioning to the new model entailed (1) identifying faculty with an interest in education to lead the various initiatives and programs and to ensure appropriate educational role models, (2) securing adequate funding, (3) holding focus groups with physicians to identify opportunities for improvement in the new system, and (4) developing a schedule for the phased implementation of key features of the structured system.
The program started in July 2011, with 14 residents for a 4-year course of training. The curriculum consisted of 5 modules: (1) general obstetrics and gynecology and ambulatory care, (2) maternal fetal medicine, (3) urogynecology and minimally invasive surgery, (4) reproductive medicine, and (5) gynecology oncology. Faculty was assigned responsibility for teaching and assessing the 6 competencies, and appropriate training was provided through specially designed, professional-development programs.
Challenges in the implementation of the new training program included the need to replace clinical service previously provided by trainees, a lack of fit between the traditional qualifying exam and the new model for training, and the need to adapt teaching strategies to new competencies not explicitly taught in the prior program, particularly practice-based learning and improvement and systems-based practice. The strength of the new obstetrics and gynecology residency lies in having a structured, competency-based, closely supervised approach to training with standardized evaluations, timely feedback, and a committed faculty.
本文描述了新加坡樟宜健康集团妇产科住院医师培训项目从主要基于英国培训原则的模式转变为符合美国毕业后医学教育认证委员会国际部（ACGME - I）标准的新模式的规划与实施经验。
向新模式过渡的初始步骤包括：（1）确定对教育感兴趣的教员来领导各项举措和项目，并确保有合适的教育榜样；（2）确保充足的资金；（3）与医生举行焦点小组讨论，以确定新系统中可改进之处；（4）制定结构化系统关键特征分阶段实施的时间表。
该项目于2011年7月启动，有14名住院医师参加为期4年的培训课程。课程包括5个模块：（1）普通妇产科及门诊护理；（2）母胎医学；（3）女性盆底医学及微创手术；（4）生殖医学；（5）妇科肿瘤学。教员负责教授和评估6项能力，并通过专门设计的专业发展项目提供适当培训。
新培训项目实施中的挑战包括需要取代此前由学员提供的临床服务、传统资格考试与新培训模式不匹配，以及需要使教学策略适应先前项目未明确教授的新能力，特别是基于实践的学习与改进以及基于系统的实践。新的妇产科住院医师培训项目的优势在于采用结构化、基于能力、密切监督的培训方法，具备标准化评估、及时反馈以及敬业的教员队伍。
