Supervisory Framework
Introduction
The Singapore Medical Council (SMC) has a duty to ensure that patients’ safety is always safeguarded, and this is achieved through its implementation of a Supervisory Framework, which is a tool used by SMC to monitor foreign-trained doctors who are on Conditional and Temporary registration.
Objective
The objective of the SMC’s Supervisory Framework is to ensure there is direct and timely supervision for foreign trained doctors while they are at work, so that patient’s safety is not compromised.
Structure
A medical practitioner who is conditionally or temporarily registered will be subjected to monitoring under SMC’s Supervisory Framework throughout the period of his medical registration, which may range from 1 to 4 years or more.
In order to ensure that there is optimum supervision, the supervisor must first meet the criteria and adhere to the supervisory ratio stipulated by SMC.
The supervisor’s assessment reports are required at periodic intervals, and multi-rater assessment reports from the supervisee’s colleagues e.g. doctors, nurses and other healthcare professionals, may also be requested to get a more holistic assessment of the doctor’s performance.
SMC will systematically review the doctor’s performance based on such regular assessment reports.
Details of the framework, based on each institutional setting, can be found in the “Guidelines” section below.
Guidelines
The supervisory framework guidelines are broadly categorised into:
(a) Orientation
(b) Supervision
(c) Monitoring & Feedback
(d) Supervisor’s Assessment Reports
(e) Multi-Rater’s Assessment Reports
(f) Identification of Poor Performers
Guidelines that are applicable to different types of institutions:
Public Sector Hospitals/Specialty Centres
Polyclinics
Health Sciences Authority/Health Promotion Board
Private hospitals
Community hospitals/Hospices
Medical Centres/General Practices
Assessment Forms Reference Table
Letter of Undertaking by Prospective Supervisor
SMC reserves the right to subject the doctor on conditional/temporary registration to review(s) by registered medical practitioners and/or other healthcare professionals when it deems necessary.
Accreditation as Learning Institution
Currently new International Medical Graduates (IMGs) from schools on the Schedule in the Medical Registration Act may apply for Conditional registration (C-reg) to practise only in approved healthcare institutions (AHIs), under the supervision of fully registered medical practitioners.
Healthcare providers who wish to recruit new IMGs to work at their institutions are welcome to apply to SMC to be accredited as Learning Institutions (LIs). Healthcare providers may wish to note that certain structures and processes, as listed below, should be in place, for their applications to be considered. This allows healthcare providers to fulfil their medical manpower needs while enabling new IMGs to adapt to our healthcare system and continue their professional development through peer interaction and practice-based learning. This framework ensures the safety and well-being of our patients.
The pre-requisites are as follows:
1. The institution has been accredited by JCST and/or ACGME-I for the training of residents or trainees;
2. Otherwise, all the following criteria must be met:
(A) Institution Structure
There is a “departmental” structure in place within the institution where doctors are given the opportunity to work as a team in the management of patients.
The following will not be allowed:
a) General Practitioners (GPs) named in a practice but who only work there on a part time basis for less than 50% of each week or who are deployed there only as and when required.
b) Specialists who run their own practices calling themselves a ‘group’ when, in fact, there is no organised or structured institutional practice.
c) Specialists named in an organised institutional practice, but who are not, in fact, working full time in the practice. (e.g. a hypothetical ‘cardiology centre’ which may exist in physical form, but where cardiologists with their own practices participate on a sessional or rotational basis each for less than 50% of each week).
d) Different specialists physically co-located, but not involved in an institutional style service programme. (e.g. a hypothetical group comprising a cardiologist, a gastroenterologist, a paediatrician and a general surgeon who share a large combined clinic, but who actually work independently of one another.)
(B) Supervisory Framework
There must be sufficient supervisors who meet the criteria for supervising new C-reg doctors under SMC's supervisory framework.