On 23 September 2024 this year, SMA sent a letter to the Singapore Medical Council (SMC), enquiring about the process governing the application for full registration. We herein reproduce SMA’s letter and SMC’s response. SMA hopes that the information provided will be helpful in reducing information asymmetry for Members who are conditionally registered.
SMA's letter to SMC
23 September 2024
Prof Chee Yam Cheng
President
Singapore Medical Council
Optimising the Process for Full Registration Application
Dear Prof Chee,
The SMA Doctors-in-Training Committee has received feedback from many junior doctors over the years, raising concerns on the process governing the application for Full Registration.
We have summarised the situation as follows:
- Despite the criteria for Full Registration being published on the SMC's website, there remains poor awareness among Conditionally Registered doctors on the Supervisory Framework1 and the prerequisites for Full Registration2 in practical terms;
- While the progression to Level 2/3 supervision is based on the Supervisory Framework, the application for Full Registration remains a manual process that needs to be initiated by the doctor/department;
- Even while efforts have been made to improve the clarity of the Supervisory Assessment Report3, supervisors may misinterpret 'Borderline' as a 'Pass', and inadvertently impede a doctor's progression to Level 2/3 supervision or application for Full Registration;
- Applicants have cited logistical constraints in applying for leave to attend the SMC Physician's Pledge ceremony on short notice, even if they are aware of the implications on their progression to Full Registration;
- Applicants are not directly informed on the reasons for failure to progress (to Level 2 or 3 supervision) or for rejection (for Full Registration).
We seek the SMC's consideration for the following recommendations:
- To circulate the criteria for Full Registration to doctors upon Conditional Registration, and regularly via SMC's outreach channels;
- To automate the tracking of eligibility for Full Registration, so as to prompt doctors/departments to apply once the prerequisites have been met;
- To further improve the design of the Supervisory Assessment Report (eg, with explicit prompts and colour coding) to reduce ambiguity on Passing criteria;
- To forecast and provide longer advanced notice (eg, three to six months) for SMC Physician's Pledge ceremony dates, so that doctors can arrange for cover at the workplace and apply for leave;
- To directly inform doctors on the specific reasons for failure to progress (to Level 2 or 3 supervision) or for rejection (for Full Registration), preferably with personalised recommendations on how to improve their performance, so that they can be more meaningfully prepared for reapplication.
- To establish an appeals process, through which applicants and supervisors may opt to jointly request a review of the outcome, after being informed of the reasons for failure to progress or for rejection.
On the SMA's part, we will utilise our engagement and educational touchpoints with international medical graduates to reduce information asymmetry on the matter.
We thank you for your consideration and look forward to your response.
Regards,
DR IVAN LOW JINRONG
Chairperson
SMA Doctors-in-Training Committee Member
65th SMA Council
DR NG CHEE KWAN
President
65th SMA Council
References
- Supervisory Framework. https://bit.ly/4eVF1IV.
- Full Registration eligibility requirements. https://bit.ly/4eQxifa.
- Supervisory Assessment Report. https://bit.ly/3UiZTl4.
SMC's response
Clarification on Full Registration Process
Information on F-reg application
All conditionally registered (C-reg) doctors would have received a Letter of Approval from SMC at the start, stating the conditions of registration, the SMC Supervisory Framework and the prerequisites for Full registration (F-reg). These approval letters which are specific for various categories of doctors would have been sent individually to all the C-reg doctors and the HR of their employing institutions. Doctors receiving the approval letters should read the conditions of registration stated in their Letter of Approval before they sign and acknowledge the letter and provide a copy of their acknowledgement to SMC. However, if they have lost their personal letters sent from SMC by email, they can request SMC for a copy. Doctors may also look at the criteria for F-reg and Supervisory Framework as published on the SMC website.
Qualifying for F-reg
For a C-reg doctor to be considered for F-reg, he/she must be at Level 2 (L2) supervision for at least six months. It is not required for a doctor to be at L3 supervision to apply for F-reg. Application for progression to L2 supervision must be submitted by the employer/institution. However, for those whose supervisory assessment reports have been consistently good, SMC will continue to assist in progressing them, if their employer/institution failed to submit for the progression in a timely manner.
Supervisor training
All supervisors are required to have the standard training to properly assess conditionally and temporarily registered doctors before they can be approved as SMC supervisors. They are required to provide reasons for all borderline reports. SMC will seek further details from the supervisors if the reasons or comments are not clearly stated, and we encourage the doctors to meet with their supervisors to identify specific areas for improvement.
Performance requiring improvement/remediation
A very small number of doctors may receive a Letter of Advice from SMC concerning performance which was not considered satisfactory by SMC. Such letters of advice will indicate the domains which would require remediation via a structured performance improvement plan (PIP). The doctor will then have to work with his/her supervisors for the aspects of the performance that require remediation. Most of these (small number of) doctors complete the PIP successfully to eventually progress to F-reg.
Pledge attendance
In the past, SMC had noted that doctors have cited constraints in applying for time off or leave to attend the SMC Physician's Pledge Affirmation Ceremony on short notice. Going forward, SMC will continue to inform eligible doctors, respective chairmen of medical boards or heads of department, and institution HRs earlier to facilitate the administrative arrangements for doctors in their hospitals to be given protected time off to attend the Pledge Ceremony.
Thus far, almost all invited doctors have been able to attend the Pledge Ceremonies, unless they are on leave or overseas. However, SMC had encountered challenges in getting responses from a small group of doctors who did not respond to the invitation despite multiple reminders or who responded very late. We would like to urge all doctors to take note of SMC's or MOH Holding's emails.