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Fellowship Programs

• Anaesthesia Fellowship

Programme description

The Department of Anaesthesiology in Singapore General Hospital offers a one year attachment programme for fellows to gain exposure through hands-on experience in managing a variety of subspecialty surgeries under supervision. These surgical disciplines include:

• Head and neck

• Surgical oncology

• Hepatobiliary and upper gastrointestinal

• Urology

• Vascular

• Kidney and Liver transplant

• Reconstructive plastic surgery and burns

• Obstetrics and gynaecology

• Bariatic surgery

• Minimally invasive and Robotic surgery

• General Surgery

• Orthopaedics

• Otorhinolaryngology

• Multidisciplinary procedures/surgeries done in operating theatres and in angiography, endoscopy and radiology suites


The Burns Intensive Care Unit is the only specialized facility managing major burns in Southeast Asia. The Hyperbaric and Diving Medicine Centre is also one of the largest tertiary hospital-based hyperbaric facilities in Southeast Asia. Rotation to the Burns Centre or the Hyperbaric and Diving Medicine Centre for observation can be arranged.


Objectives

The overall objective of the fellowship is to produce an independent and competent anaesthesiologist with the experience, skills and knowledge to manage patients requiring major surgery with the highest standard of safe and comprehensive perioperative care.

At the end of the fellowship, Fellows will be expected to:

• Manage major intra-abdominal surgeries in high risk patients

• Manage high risk obstetrics patients

• Manage high risk cardiac patients coming for non-cardiac surgeries

• Gain experience in airway management especially for major head and neck surgeries

• Be competent in ultrasound guided placement of catheters for invasive haemodynamic monitoring

• Learn and perform ultrasound guided regional and neuraxial techniques for surgery

• Manage acute post-operative pain


Clinical responsibilities

The Department of Anaesthesiology operates on a 5.5-day work week. Fellows are expected to do a minimum of 2 stay-in calls in a month after the initial 3 months if/when they are assessed to be competent in this duty. The duty starts at 0815 hrs, and ends at 0830 hrs the following day after the handover round.


Teaching

The department holds morning teaching sessions 3-4 times a week and fellows are expected to attend. Fellows are expected to assist in the preparation of/present in one of these sessions at least once during the fellowship.


Research

There will be opportunities to take part in existing research projects and initiate new ones under the guidance of their mentors.


Assessment

Fellows will be assessed on a regular basis and given feedback during the course of their fellowship. This will take the form of:

• Formative assessment:

✓ Regular evaluation between Fellow and Supervisor/HOD

✓ Reflective journal- logbook recordings of training activities

✓ Periodical assessment report as required by Singapore Medical Council (SMC)


• Summative assessment:

✓ Competency tests after the first month of orientation


• Feedback:

✓ End-of-training feedback form as required by SMC

✓ End-of-training feedback session with SGH-PGMI


Application process and cycle

General eligibility requirements:

• Postgraduate medical qualifications e.g. Master of Medicine or equivalent

• Minimum 2 years of postgraduate training experience in Anaesthesiology after obtaining the postgraduate medical qualification

• Current position as Registrar, Senior Resident or equivalent (Advance specialty trainee level)

• Proven competency in English Language



• Pain Postgraduate Fellowship Program

Program Description

The Pain Management Centre is the first and largest in Singapore to serve patients with chronic, disabling pain disorders. The centre helps patients to restore function and manage chronic pain, using a multi-pronged approach by addressing medical, physical and psychological aspects of pain. The one-stop centre is staffed by a team of internationally trained pain specialists, dedicated pain nurses, physiotherapists and psychologists.

The Pain Management Centre is also the first training unit outside of Australia and New Zealand, to be accredited by the Faculty of Pain Medicine, Australian and New Zealand College of Anaesthetists (ANZCA) to provide approved training for Pain Medicine. Fellows who successfully complete the fellowship are eligible to sit for the certification. The fellows spend time at several sites within the expanding hospital compound to cover the medical, psychological and interventional treatment of various pain conditions with exposure to inpatient and outpatient management of patients with cancer and chronic non-cancer pain.

Fellows learn different pain management interventional techniques performed with fluoroscopy or ultrasound. Interventional pain management and procedural competency and safe practices will be covered. These include basic procedures such as epidural steroid injections, facet blocks, sympathetic blocks, radiofrequency lesioning to advanced techniques including spinal cord stimulation, intrathecal catheter and pump insertion.

Exposure to multidisciplinary pain management techniques in inpatient and outpatient settings involve rotations to:

• Psychiatry and Psychology

• Physiotherapy

• Acupuncture

• Neurology

• Rheumatology

• Rehabilitation Medicine

• Palliative Care services ranging from inpatient, homecare and hospice setting


Objectives

The fellowship aims to provide a wide-ranging exposure to pain management so that graduates are equipped to practice independently in the field of Pain Medicine as part of continuing medical training in academic and community practices.


Who should apply

The comprehensive multidisciplinary pain fellowship is awarded for a training duration of 12 months. However, a minimum duration of 6 months may apply for selected applicants.

We are interested in self-motivated applicants, trained in anaesthesiology, who would actively participate in the multidisciplinary fellowship involving acute, chronic and cancer pain patients. The clinical responsibilities are detailed in Annex 1 and 2.

Educational activities at the Pain Management Centre include weekly presentations by invited speakers and fellows, journal club, case discussions, and multidisciplinary case conferences with other disciplines such as orthopaedic surgeons, psychiatrists, psychologists etc. Research interests should be discussed with their clinical supervisor.


Supervision

Fellows would be supervised for their hands-on training under direct level 1 or 2 supervision as stipulated in the Singapore Medical Council guidelines.


Training

A formative assessment of fellows is achieved by keeping a log-book documenting workload and experience throughout the training period as well as quarterly in-training assessment reports from the supervisor of training based on clinical performance, presentations at teaching rounds for continuous medical education, involvement in education and overall performance. Fellows are encouraged to cultivate their pain interests and develop their professional goals.


Application Process and cycle

Additional information regarding fellowship application can be obtained from the Postgraduate Medical Institute (PGMI) at SGH. Questions concerning Pain Management Fellowship may also be directed to Dr. TAN Kian Hian (tan.kian.hian@singhealth.com.sg).


ANNEX 1

Syllabus in Pain Management

To acquire a good grounding of physiology, pathophysiology and pharmacology related to pain management and principles of the practice of pain management in a multidisciplinary approach.

1. Acquire knowledge and skill set in diagnosis and management of:

• Acute pain

• All types of neuropathic pain

• Spinal pain

• Visceral pain

• Pain related to cancer

• Headache and orofacial pain

• Complex regional pain syndromes


2. Develop advanced clinical skills, including:

• Comprehensive pain history and psychosocial history

• Relevant physical examination to arrive at a diagnosis

• Appropriate pharmacotherapy in pain

• Basic psychotherapy

• Interventional Procedures in Pain Management


 ANNEX 2

Suggested postings outside of Pain Management Unit

• Department of Palliative Care Medicine, National Cancer Centre for 2 weeks

• Hospice Care Association for 2-7 days

• Dover Park Hospice for 2 weeks

• Department of Rehabilitation Medicine in Singapore General Hospital for 2-7 days

• Department of Rheumatology in Singapore General Hospital for 1 week

• Department of Neurology in Singapore General Hospital for 1 week.

• Department of Psychiatry and Psychology, Singapore General Hospital - weekly attachment in clinic

• Department of Orthopaedics Surgery, Singapore General Hospital - weekly Spine Clinic

• Department of Physiotherapy, Singapore General Hospital for one session



• Surgical Intensive Care Medicine Fellowship

Program description

The Department of Anaesthesiology in Singapore General Hospital (SGH) offers a one-year fellowship program for fellows interested in pursuing intensive care medicine as a subspecialty. Being the largest tertiary hospital in Singapore with the highest volume of surgeries as well as inpatients, fellows will gain in-depth clinical exposure and hands-on experience in the management a wide variety of critically-ill patients in the Surgical ICU. There will be ample opportunity for placement of invasive lines, use of advanced hemodynamic, respiratory and cerebral monitoring and support, bedside bronchoscopy and transthoracic echocardiography. Fellows can also have the option of rotating to Neurosurgical, and Burns ICU, each having their own specific learning objectives.  Fellows will be under the supervision of faculty consisting of consultant intensivists dedicated to teaching and mentoring trainees.


Objectives

At the end of fellowship, Fellows will be expected to demonstrate competencies in the following:

1. Professional Practice

• Perform immediate patient assessment and resuscitation

• Assess life-threatening problems accurately and quickly in critically-ill patients

• Apply principles of ICU triage

• Undertake emergency management including basic and advanced life support, and assist in/perform appropriate life-saving procedures, e.g. endotracheal intubation, cricothyrodotomy and decompression of tension pneumothorax etc

• Perform primary and secondary survey and manage acute problems


2. Communication

• Document patient information, presenting problems and progress clearly

• Communicate plan of care to patients and family

• Consult and collaborate effectively with all members of the ICU team

• Conduct appropriate handover to other colleagues, e.g. before or after surgery or on discharge to the ward


3. Monitoring of the Critically Ill patient

• Understand principles of monitoring cardiovascular, respiratory, renal and central nervous systems with its attendant complications

• Place invasive monitors, e.g. intra-arterial catheter, central venous catheters and various cardiac output monitors


4. Cardiovascular

• Appropriate choice and use of inotropic agents, vasodilators and vasoconstrictors

• Management of dysrhythmias, assisting with intra-aortic balloon pump, cardioversion and right heart catheterization


5. Respiratory

• Understand principles of oxygen therapy, non-invasive ventilation and mechanical ventilation

• Assist/perform pleural drainage, percutaneous tracheostomy and fibreoptic bronchoscopy


6. Renal

• Provide general care of continuous extracorporeal blood purification techniques, including insertion of dialysis catheters


7. Neurology

• Understand principles of management of cerebral perfusion pressure and intracranial pressures


Clinical responsibilities

Fellows are expected to participate in daily clinical ward rounds and other teaching, academic or research duties assigned to them. Fellows may also be asked to assist in resuscitation of surgical patients in other inpatient locations.


Teaching

We provide a comprehensive teaching program consisting of didactics, multidisciplinary care discussions and bedside teaching. These include the weekly Combined SICU/ NICU grand ward round, Neurosurgical grand ward round, Burns grand ward round and Intensive Care Medicine Teaching Series. There are also Journal Clubs and Mortality & Morbidity presentations occurring on a monthly basis. Fellows may be asked to assist in organizing and presenting at these teaching sessions. Fellows may also be tasked to teach junior residents or medical students rotating through the ICU.


Research

There will be ample opportunity to take part in existing research projects or initiate new ones under the guidance of their supervisors.


Application process and cycle

General eligibility requirements

• Postgraduate medical qualifications e.g. Master of Medicine or equivalent

• Minimum 2 years of postgraduate training experience in Anaesthesiology/relevant specialty after obtaining the postgraduate medical qualification, preferably with relevant exposure in managing critically ill patients

• Current position as Registrar, Senior Resident or equivalent (Advance specialty trainee level)

• Proven competency in English Language



• Cardiothoracic Anaesthesia Fellowship

Program description

SingHealth is a tertiary regional referral centre with the largest cardiothoracic surgical centre in Singapore for complex cardiothoracic surgical procedures.  Being part of the National Heart Centre Singapore (NHCS), the largest national centre for cardiovascular medicine, it provides care for patients in a wide variety of cardiothoracic procedures.

The Department of Anaesthesiology in Singapore General Hospital (SGH) offers a one year fellowship programme for trainees pursuing an interest in cardiothoracic anaesthesia as a subspecialty. Fellows will gain clinical experience through hands-on experience in managing a variety of cardiothoracic surgeries and cardiologic procedures (as elaborated below), and the opportunity to work in the state of the art hybrid theatre. Fellows will also rotate to the Cardiothoracic Intensive Care Unit, Perfusion Unit and Diagnostic and Imaging laboratories in NHCS to gain exposure.


Objectives

At the end of the fellowship, Fellows will be expected to be:

• Able to provide independent delivery of cardiothoracic anaesthesia for a range of routine cardiologic, cardiothoracic and vascular operations

• Competent in invasive line placements such as intra-arterial cannulation, central venous cannulation, pulmonary arterial cannulation and lumbar subarachnoid drains

• Competent in paraverteral blocks and thoracic epidural anaesthesia

• Competent in the placement of double lumen endotracheal tube, bronchial blockers and the use of fiberoptic bronchoscope

•  Able to acquire all 20 of the recommended cross sections of transoesophgeal echocardiography examination, and recognize markedly abnormal cardiac structure and function, severe hypovolemia, large pericardial effusions, and the presence of intra-cardiac air

• Able to interpret coronary angiogram

• Able to explain the pathophysiologic changes associated with cardiopulmonary bypass


Clinical responsibilities

The Department of Anaesthesiology operates on a 5.5-work week. Fellows are expected to participate in the clinical and academic duties assigned to them. These include hands-on experience to perform or assist in perioperative care of patients undergoing the following procedures under supervision:

• Coronary bypass surgery

• Valvular repair/replacement

• Repair/replacement of aortic aneurysm and dissection

• Robotic minimally invasive cardiac surgery

• Implantation and explantation of ventricular assist device/ extracorporeal membrane oxygenator circuit

• Heart and lung transplant

• Correction of adult congenital heart disease

• Mediastinoscopy

• Lobectomy, pneumonectomy

• Video assisted minimally invasive thoracic surgery

• Resection of thoracic wall tumour

• Thymectomy

• Cardiologic procedures eg  electrophysiological studies, insertion of automatic implantable cardiac defibrillator, device closure of atrial septal defect and left atrial appendage, mitralclip placements


In addition to the clinical experience in the operating theatres, we also offer:

• Basic transoesophageal echocardiography training in OT

• 1-2 weeks with the Echocardiography Laboratory, Vascular Laboratory, Nuclear Laboratory as well as the Angiography Suites to have a better understanding of the various investigations that are available and how they aid in the management of patients with cardiovascular disease

• 2 weeks attachment with the Perfusion Unit to learn the mechanics and components of heart-lung machine, and principles of cardiopulmonary bypass and various ventricular assist devices

• 2-4 weeks attachment in the Cardiothoracic Intensive Care Unit to acquire an understanding of the principles of postoperative care of the cardiothoracic patient

• Opportunities to tag on specialists on call for emergency procedures and surgeries


Teaching

The department holds morning teaching sessions 3-4 times a week and fellows are welcome to attend. There is also dedicated weekly cardiac teaching sessions conducted by the department and the National Heart Centre. Fellows are expected to assist in the preparation of or present in these sessions at least once in 6 months


Research

There will be opportunities to take part in existing research projects and initiate new ones under the guidance of their mentors.


Assessment

Fellows will be assessed on a regular basis and given feedback during the course of their fellowship. This will take the form of:

• Formative assessment:

✓ Regular evaluation between Fellow and Supervisor/HOD

✓ Reflective journal- logbook recordings of training activities

✓ Periodical assessment report as required by Singapore Medical Council (SMC)


• Feedback:

✓ End-of-training feedback form as required by SMC

✓ End-of-training feedback session with SGH-PGMI and NHCS


Application process and cycle

General eligibility requirements:

• Postgraduate medical qualifications e.g. Master of Medicine or equivalent

• Minimum 2 years of postgraduate training experience in Anaesthesiology after obtaining the postgraduate medical qualification, preferably with relevant exposure/experience in managing patients for cardiothoracic surgeries

• Current position as Registrar, Senior Resident or equivalent (Advance specialty trainee level)

• Proven competency in English Language



• Neuroanaesthesia Fellowship

Programme Description

SingHealth is a tertiary regional referral centre with a highly developed Neurosurgical / Neuroanaesthesia unit that is geared towards providing care for patients in various major neurosurgical subspecialties.

The Department of Anaesthesiology in Singapore General Hospital offers a one year fellowship programme for trainees pursuing an interest in Neuroanaesthesia as a subspecialty. Fellows will gain experience through hands-on clinical exposure to a variety of Neurosurgical procedures (as elaborated below) and the opportunity to work in the state of the art MRI theatre.

Fellows will rotate through the Neurosurgical Intensive Care Unit in Singapore General Hospital. The fellowship will also include a rotation to the Department of Anaesthesia, Tan Tock Seng Hospital.


Objectives

The overall objective of the Neuroanaesthesia Fellowship Programme is to produce a competent and independent neuroanaesthesiologist with the experience, skills and knowledge to manage cases with the highest standard of safe and comprehensive perioperative care.


Admission Criteria

General requirements (for all Fellows):

• Postgraduate medical qualification e.g. Master of Medicine or equivalent

• Minimum 2 years of postgraduate training experience in Anaesthesiology after obtaining the postgraduate medical qualification

• Current position as Registrar, Senior Resident or equivalent

• Proven competency in English Language


Clinical Responsibilities

Fellows will have hands-on experience and perform or assist in the following procedures under supervision:

• The assessment, anaesthesia and perioperative care of patients for :

1. Elective craniotomy for tumour surgery

2. Posterior Fossa Surgery

3. Neurovascular Anaesthesia

4. Endoscopic Procedures

5. Awake craniotomy

6. Elective Spinal Surgery

7. Intra-operative MRI

8. Deep Brain Stimulation

9. Neuroradiology

10. Emergency Intracranial Surgery

11. Spinal Cord Injury

12. Management or Severe Head Injury

13. Neuro-surgical Intensive Care


• The management of procedures and problems associated with anaesthesia for neurosurgery:

1. Positioning for neurosurgery

2. Use of TIVA

3. Hypothermia

4. Induced hypotension

5. Induced hypertension

6. Sitting position

7. Safety in the MR environment

8. Air embolism

9. Epilepsy

10. Circulatory Arrest


• Fellows should also be able to demonstrate appropriate technical skills in insertion / application / interpretation of:

1. Arterial cannulation

2. Central venous cannulation via the Internal jugular / Subclavian /Femoral routes

3. Pulmonary artery Catheter

4. Non-invasive cardiac output monitors

5. End tidal CO2 monitoring

6. SaO2 monitoring

7. ECG interpretation and analysis

8. Arterial blood gas/acid base

9. Cerebral function monitoring


• Fellows will also have the opportunity to observe the following procedures in the Neurosurgical Intensive Care Unit:

1. Management of patient with multiple trauma

2. ICU management of patient with cerebral vasospasm

3. Appropriate use and monitoring of inotropes

4. Appropriate use of sedation/analgesia

5. Possess basic scientific and clinical knowledge relevant to invasive / noninvasive monitoring and its appropriate use.

6. End of life decisions:

✓ Diagnosis of Brain Stem death

✓ Management of a potential organ donor

✓ Knowledge of ethical issues surrounding withholding / withdrawing

✓ Futile medical care


Assessment

Fellows will be assessed on a regular basis and given feedback during the course of their fellowship. This will take the form of:

• Formative assessment:

✓ Regular evaluation between Fellow and Supervisor/HOD

✓ Reflective journal- logbook recordings of training activities

✓ Periodical assessment report as required by Singapore Medical Council (SMC)


• Feedback:

✓ End-of-training feedback form as required by SMC

✓ End-of-training feedback session with SGH-PGMI


Teaching

Fellows will also participate actively in department/subspecialty teachings via various teaching methods.

Activity Frequency / No. of Sessions / Duration of session​ ​Teaching Methodology
​Combined SICU/NICU grand round1.5 hours​​Team based learning
​Neurosurgical grand ward round​1 hour​Team based learning
X-Ray round​1 hour​​Team based learning
Arterial Cannulation​​As arranged by supervisor​Skills practice
​Central Venous Cannulation​As arranged by supervisor​Skills practice
​Non-invasive cardiac output monitors​As arranged by supervisorSkills practice​
Cerebral function monitoring​​As arranged by supervisorSkills practice​
Incident reporting​​1 hourCase based study​
​FCCS course​2 daysDirect instruction/ simulation/ skills practice​
​Mortality and Morbidity Round​1 hour​Case based study
Combined anaesthetic meeting​​3 hours​Discussion
​Hospital wide meeting​1 hourDiscussion​


Research and Audit

Fellows will have the opportunity to be involved in research and audit during their fellowship. This will be discussed in conjunction with their Supervisor during the course of the programme.

Activity Frequency / No. of Sessions / Duration of session​ ​Teaching Methodology
​Clinical ResearchAs arranged by supervisor​Skills practice​
AuditsAs arranged by supervisor​​Discussion
​Quality Assurance Programmes​As arranged by supervisorDiscussion​


• Obstetric Anaesthesia Fellowship

Programme Description

KK Women’s and Children’s Hospital is a tertiary referral center that provides a full range of obstetric-related care.

The Obstetric Anaesthesia Fellowship offers advanced clinical training, teaching and research in a setting that delivers ≥ 12,000 women per year. This is a hospital with an interesting and challenging case mix devoted to the comprehensive anaesthetic management, perioperative care and pain management of women during pregnancy and puerperium. Commonly encountered pregnancy-related problems include pre-eclampsia, diabetes, prematurity, morbid obesity and multiple gestations. Complex patients are approached by an interdisciplinary team that includes perinatologists, neonatologists, anaesthesiologists and other medical and surgical consultants as needed.

Fellows are appointed for periods ranging from 12 to 24 months. The department is accredited for training by the Australian and New Zealand College of Anaesthetists and hosts rotating Registrars and Medical Officers training in Obstetric Anaesthesia and Research. Applications from overseas are welcomed and an application form is attached.

Program objectives (in both the one and two year fellowships) can be tailored to suit the career plans of the individual.


Objectives

1. To develop confidence in the anaesthetic management of the healthy and complicated parturient

2. To develop the ability to independently design and complete clinical research projects

3. To develop competence in teaching residents, medical students and other health care personnel

4. To participate actively in conference and seminars

5. To understand the administrative aspects involved in setting up and managing an Obstetric Anaesthesia Service


Structure

Fellows will have clinical, teaching and research responsibilities.

• Clinical Responsibilities: The program begins with a one-month intensive upgrade of clinical skills (including night calls). Thereafter, the fellow will spend 50 percent of the time providing clinical care. When assigned to the obstetric anaesthesia service (approximately 24 hours per week), the fellow will both directly provide clinical care as well as instruct and guide residents assigned to the obstetric anaesthesia service. The women’s division also is responsible for anaesthesia in gynaecology, oncology and urology patients. Other clinical responsibilities will include assignment to the general operating suites one day per week.

• Teaching: All fellows are involved in the teaching mission within the department by participation in Mortality and Morbidity conferences and weekly journal club. Clinical teaching includes instruction in the techniques of labour analgesia and operative anaesthesia as well as the more subtle understanding of how to manage the provision of anaesthetic services in a busy labour ward. Didactic teaching includes presentation at departmental journal club and organizing and participating in weekly resident and student discussions of obstetric anaesthesia topics.

• Research: Fellows are expected to actively participate in ongoing projects. In addition, fellows will design and carry out their own research projects with the support and guidance of members of the section of obstetric anaesthesia. Fellows are encouraged to attend local and international conferences to present abstracts and lectures; funds are made available to achieve this. 



• Paediatric Anaesthesia Fellowship

Selection Criteria

The Paediatric Anaesthesia Fellows Training Programme is suitable for qualified and practicing anaesthesiologists from countries which currently lack such services.  They will benefit by learning different clinical techniques, safety guidelines and workflow protocols that may contribute to advancing medical standards in their parent hospital and country.

The foreign doctor on training attachment must be required to be proficient in English language.

The Clinical Fellow will have to meet the following criteria as stated by Singapore Medical Council under the "Framework for Postgraduate Training of Temporarily Registered Doctors from Schools not listed in the Schedule":

1. Basic eligibility requirements for Temporary Registration

2. Categories of Temporary Registered Doctors for Postgraduate Training


Supervision Method

Each fellowship programme will last for 6 months to a year and a mentor will be assigned.  The mentor will be a senior staff of Paediatric Anaesthesia Department KKH.

Teaching material such as “Handbook of Paediatric Anaesthesia” (available as App titled: “KKH PAN”) can be downloaded from the Android or iOS App-store.

Fellows will be encouraged to participate in residency core lectures, journal club, and paper critique. Fellows will be required to attend the weekly department teaching sessions, quarterly department morbidity & mortality rounds and monthly hospital conference.

Anaesthesia Crisis Management resource is available in a file kept in all Operating Theatres.

A logbook will be given to each Fellow which will be used to assess the progress of training.


Assessment Method

1. Fellow’s log book will be reviewed quarterly.

2. Assessment will be conducted at the end of 3 months from the start of the Fellowship programme and the end of the Fellowship programme. Assessment criteria will be based on the Fellow Evaluation Form.

3. Feedback from Fellows are encouraged. Fellow can feedback to designated Supervisor or other Department Senior Staff. Formal Program evaluation will be done at the end of posting using the Program Evaluation Form (Fellows).


TRAINING OBJECTIVES: CLINICAL SKILLS/ PROCEDURAL SKILLS

1. Appreciate the anatomical and physiological differences between neonates, older children and adults. Understand how these differences affect clinical practice in anaesthesia

2. Perioperative management: preoperative assessment and preparation, intraoperative care and postoperative pain relief in various surgical disciplines (ENT, Eye, Plastic & Craniofacial, Orthopaedic, Cardiothoracic, Neurosurgery, General Surgery)

3. Regional anaesthesia techniques using landmark and ultrasound techniques

4. Safety in anaesthesia e.g.: Ultrasound guided vascular access

5. Management of chronic/ palliative pain

6. Advanced airway skills: Fiberoptic bronchoscope

7. Recognise the critically ill child

8. Resuscitation of the neonate and child

9. Fluid management, ventilation strategies, haemodynamic monitoring (invasive lines eg: Central Venous Line, IntraArterial line) and support

10. Transport of sick children and resuscitation of sick children

11. Presentation and research skills

12. Patient safety and quality improvement in Anaesthesia


ACTIVITIES (Operating Theatre)

1. Perioperative assessment of patients.

i. Fellow will be required to review their own patients whenever possible. If someone else reviews on their behalf, Fellow will still need to familiarize with the case. This includes fasting instructions, decisions regarding regional anaesthesia and EMLA time and LOOSE TEETH

ii. Fellow are expected to see their own premeds on Sundays for the first month

iii. Please do not go up to the wards without shoe covers and the blue gown when going to see patients in Operating Theatre scrubs. Please also remove Operating Theatre cap

iv. Do not cancel cases on own accord: always consult the senior who will be doing the list

v. If the case is cancelled by the anaesthetist, please ensure that the surgeon and Operating Theatre reception are informed

vi. If the child who is scheduled for elective surgery is having an active Upper Respiratory Tract Infection (URTI), the final decision on cancelling the case lies with the anaesthetic consultant and NOT the parent

vii. If the diagnosis of Upper Respiratory Tract Infection (URTI) is uncertain and the final decision to postpone the case rests on observing the child or investigations such as increased total white count, the parents must understand that the case can still be cancelled at the last-minute pending results

viii. Please discuss all potentially complicated cases with senior to find out the anaesthetic plan and appropriate preparations that have to be made

ix. If an anaesthetic consult is required, please refer to the anaesthetic consultant on-call

x. If investigations are done, the results have to be traced before anaesthesia is induced or regional anaesthesia performed. If investigation results are abnormal, please make sure that the surgeon knows

xi. If there are social issues surrounding the case or difficult patients to handle, please let senior know and let senior handle the issues. Fellow should not take it upon themselves to solve problems that can have medico-legal consequences

xii. If Fellow is scheduled to do cardiac Operating Theatre or cardiac catheterization, they will be required to see their own premed

xiii. Please use the latest weight of an inpatient which can be found on the clinical care charts on Citrix. This applies particularly to patients who are long stayers and come in repeatedly for procedures requiring anaesthesia

2. Provide anaesthesia (general and/ or regional) to children undergoing elective Operating Theatre emergency surgeries.

3. Acute pain service for children following elective/ emergency surgery

4. Assess and counsel SDA (same day admit) patient in the Preanaesthesia Clinic

5. Manage the airway during cardiopulmonary resuscitation (code blue) for inpatients and outpatients of KKH

6. Participate in teaching sessions within Department of Paediatric Anaesthesia and Hospital Continuing Medical Education (CME)


Activities in Children’s Intensive Care Unit (CICU)

1. Attend ward rounds with CICU team

2. Attend teaching sessions organized by the CICU team


SPONSORSHIP

The applicant (Clinical Fellow) will be financed by their country or institution.


DURATION OF PROGRAMME

Each fellowship programme will last for 6 months to 12 months.


LEAVE OF ABSENCE

​6-months posting ​ 12-months posting
​ Annual Leave one week


Study Leave (course/ conference) one week

Annual Leave two weeks


Study Leave (course/ conference) one week


SELECTION TO ENTER

It will be considered on a case-by-case basis by selection panel.

At any one time, only one trainee will be accepted to the fellowship programme.


HOSPITALS AND DEPARTMENTS IN WHICH FELLOW WILL BE ROTATED THROUGH

Training Programme

The Fellow will be rotated on a daily basis to different Operating Theatres to view cases that are interesting or from different disciplines.  They will be tagged on to a senior anaesthetist on call on a regular basis for exposure to management of emergency operations and resuscitation for "Code Blue" and "Trauma Code".

The Fellow may be rotated to other departments (Children’s Intensive Care Unit KKH) during their training in the department of Paediatric Anaesthesia depending on their training objectives at KKH. They may be rotated to Children’s Intensive Care Unit (CICU) KKH for a period not exceeding 2 weeks. They will be assigned a 2nd supervisor from CICU during their rotation to CICU.


SUPERVISOR

Clinical Fellow will be supervised by an Associate Consultant/ Consultant at all times.

One of the following doctors will be assigned as the designated Supervisor for the attached Clinical Fellow. To enable the Supervisor to carry out an adequate level of supervision, each supervisor will be allowed to supervise not more than two Clinical Fellows or as stipulated in the SMC Supervisory Framework.

​Senior Consultant ​Consultant

1.  Dr Siow Yew Nam (Head)

2.  Dr Josephine Tan Swee Kim

3.  A/Prof Agnes Ng Suah Bwee

4.  Dr Serene Lim Siu Tin

5.  A/Prof Lim Suan Ling

6.  Dr Shahani Jagdish Menghraj

7.  Dr Hee Hwan lng

8.  Dr Evangeline Lim Hua Ling

9.  Dr Bong Choon Looi

10.  Dr Lee Sumin

11.  Dr Lee Shu Ying

12. Dr Olivia Wijeweera  

1. Dr Sharon Wan Yuan Kwan

2. Dr Tracy Tan Yi Shuen

3. Dr Angela Yeo Siok Hoong

4. Dr Satish Challa Kumar Reddy

5. Dr Angela Tan Yun June

6. Dr Charis Khoo Ern Huey


CRITERIA FOR TERMINATION OF PROGRAMME

Candidate will be assessed within the first 3-months and if deemed suitable, he/ she will continue with the programme.  Candidate with poor interim assessment reviews, adverse performance assessment or competence during the programme will be considered for early termination.  Such early termination will be recorded on the stipulated SMC's assessment form and all relevant parties notified.

At the end of the Fellowship, a Certificate of Fellowship will be issued by KK Women's and Children's Hospital.


Note: Copies of the SMC's "Framework for Postgraduate Training of Temporarily Registered Doctors from Schools Not Listed in the Schedule" and "Revised Supervisory Framework For Conditional and Temporary Registered Doctors with new Assessment Forms" are attached for reference purposes.


Prepared by: Dr Josephine Tan Swee Kim

Senior Consultant

Department of Paediatric Anaesthesia

KK Women's and Children's Hospital