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.

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
(g) Temporary Registrants on Service
(h) Temporary Registrants on Training (Clinical Fellows/Observers)

Supervisory Framework Guideline [PDF, 1MB]

Summary of the Responsibilities of a Supervisor under the Singapore Medical Council’s Supervisory Framework [PDF, 272KB]

Handbook for Supervisor – Using SMC’s Assessment Form (revised in Nov 2022) [PDF, 471KB]

Letter of Confirmation by Employer (1st time employing C/T-reg doctors) [PDF, 63KB]

Letter of Undertaking (revised in Nov 2022) [PDF, 531KB]

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 new¹ 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.

An institution which intends to employ new IMGs as specialists in an ambulatory practice must produce evidence of at least three (full-time) specialist doctors (in the same specialty) with multi-layered supporting care, handling a wide range of simple and complex cases and a proper governance structure similar to the public healthcare institutions.

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.

Intensity of Supervision

(C) Training Programme

The institution must have in place a structured training programme or programmes for its doctors, for peer interaction and practice-based learning.

The details of the supervisory framework, which is reviewed from time to time, can be found above. For more information, please contact Secretariat at SMC@spb.gov.sg 

¹  ‘New’ IMGs refer to IMGs who are not currently practising in Singapore and are newly recruited to work for the LI.