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BASIC SURGICAL TRAINING

Entry for Basic Surgical Training

Basic Surgical training occupies of no less than two years after internship. In this period, basic trainees must register with one of the four Surgical Colleges of Hong Kong and the Hong Kong Intercollegiate Board of Surgical Colleges (HKICBSC). HKICBSC composes of the College of Surgeons of Hong Kong, the Hong Kong College of Emergency Medicine, the Hong Kong College of Orthopaedic Surgeons and the Hong Kong College of Otorhinolaryngologists. Basic training is under the auspices of the HKICBSC. A register of Basic Surgical Trainees is maintained at the College of Surgeons of Hong Kong.

Basic trainees can have a choice to enter into the Hong Kong/Edinburgh system, the Hong Kong/Australasian system or the Hong Kong/Edinburgh/Australasian system. As the training requirements for the different systems vary slightly, trainees may have to spend more than two years in their basic training if they enter into the Hong Kong/Edinburgh/Australasian system. No matter which system the trainee elects to enter, he/she has to pre-register with the HKICBSC. Registration, which includes an annual fee, is applicable to basic trainees until they complete the training and pass the examinations.

Overseas training without prior approval in writing from the Chairman of the Accreditation Committee HKICBSC before the date of registration and commencement of the local training programme will not be recognized by the HKICBSC.

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Training Requirements


Hong Kong / Edinburgh System

1. Basic trainees must have at least twenty months’ experience in a programme or posts approved by the HKICBSC and the Royal College of Surgeons of Edinburgh (RCSEd) for Basic Surgical Training following their registration or Intern year. The two-year programme must include:


Twelve months made up from two specialties, in each of which a significant proportion of the work will be spent with surgical emergencies requiring the general care of the patient and/or the care of the critically ill drawn from the following list:

Six months in an approved post in General Surgery with emergency work;
Six months in an approved post in Orthopaedics with musculo-skeletal trauma;
Six months in Accident and Emergency Medicine.

Posts in other surgical specialties which provide a similar component care of the critically ill would be acceptable providing they have recognized as such by HKICBSC and the Royal College of Surgeons of Edinburgh.


The remaining twelve months should be spent in approved posts in other acute surgical specialties. This may consist of two posts, each of six months duration or more posts of three or four months duration of the latter form part of a suitable rotation. Stand alone post will be of six months’ duration irrespective of the design of the rotation:

Accident and Emergency
Cardiothoracic Surgery
Neurosurgery
Oral and Maxillofacial Surgery
Otolaryngology
Paediatric Surgery
Plastic Surgery
Urology
Three or four months of experience in intensive therapy, where the experience is not included above.
Orthopaedics or one of its subspecialties where the experience gained is not included in the 12-months described above.
General Surgery or one of its subspecialties where the experience gained is not included in the 12-months described above.
2. Basic trainees must keep a logbook prospectively recording all their training experiences. This must be certified as satisfactory by their supervisors/mentors before entry into the Final Assessment of the Membership Examination.

3. During the training period, trainees must obtain satisfactory assessments from their supervisors/mentors and copies of these assessments must be filled in the trainees’ logbooks and recorded by the HKICBSC.

4. During the training period, trainees must also successfully complete a Basic Surgical Skills Course approved by the HKICBSC and the Royal College of Surgeons of Edinburgh. They are also advised to take an ETCC, ATLS or equivalent course approved by the HKICBSC and the Edinburgh College. Attendance at the courses must be recorded in the trainees’ logbooks.

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Hong Kong / Australasian System

In addition to registration with HKICBSC, basic trainees would also be required to register with the Royal Australasian College of Surgeons (RACS) prior to making application for the MCQ Examination. The RACS Basic Surgical Training Programme is structured over two years and consists of the following:

1. A Clinical Programme of rotations through posts jointly recognized by both Colleges to include:
(a) Twelve months in approved surgical posts.
(b) Emergency Department 10-12 weeks, Intensive Care Unit - 8 weeks

2. Assessment Package
There would be continual assessment of the trainees during basic surgical training.  Satisfactory Mentor Assessments must be completed during this period.

3. Modular Distance Learning Programme - Surgical Trainees Education Modules (STEM)
The programme is of 20+ modules based on the application of Basic Sciences to Clinical Practice. The curriculum objectives are available on the RACS website http://www.racs.edu.au.

4. Skills Courses
(a) A three-day Basic Skills Course
(b) The Early Management of Severe Trauma Course
(c) A Critical Care Course

It is the obligation of basic trainees who have joined this system to submit their RACS Mentor Assessment Forms to mentors and to ensure their confidential return by the mentor to the Australasian College office in Melbourne. RACS Mentor Assessment Forms can be obtained from the Department of Examinations and Training of the Australasian College. On the successful completion of the Basic Surgical Training Programme and the Part 1 Examination and Assessment Package, trainees would be eligible to apply for admission to the Advanced Surgical Training Programme of the Royal Australasian College of Surgeons.

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Supervision of Basic Surgical Training

On entering Basic Surgical Training, trainees must maintain a logbook for their operative experience until the completion of their training. The Hong Kong Intercollegiate Board has adopted the following audit system in order to take a close interest in the overall training and assessment of basic surgical trainees.


In-training Evaluation
1. Individual trainee's Logbook should be reviewed regularly by his/her
- Mentor at 3-month interval
- Supervisor at 6-month interval
2. On completion of every 3-months training period, an interim face to face assessment between the mentor and the trainee should be carried out to thrash out any problems. During this interim debriefing assessment process, if serious deficiencies are evident, the mentor has to report in writing to the Chairman of the Accreditation Committee of the HKICBSC. The trainee should be advised what measures are required to reverse these deficiencies.

3. On completion of every 6-months training period, every trainee would be required to
- Complete a Log book Summary Report and Log book Summary
- Submit two Mentors Assessment Forms for assessing his/her performance in the past 6-months training period. Two mentors who must be delegated or designed by the supervisor of the training hospital should complete these forms.

The completed Log book Summary, Log book Summary Report and Mentor Assessment Forms should be submitted by the supervisor concerned at 6-month interval for vetting by the Accreditation Committee of the HK Intercollegiate Board regularly in January and July every year. The respective training period could be recognized and registered on condition that satisfactory assessment must be achieved.

Individual trainee who has been warned of the deficiencies during the 3-month debriefing still performs unsatisfactory at the end of the 6-month period. The Accreditation Committee would interview this trainee as well as the surgeons for whom the trainee has worked in the unsatisfactory period. Below average assessment of performance in any six month period will constitute grounds for disqualify of that six month training period.

Trainees who fail to meet the above requirements would be required to undertake further training before being considered eligible to sit for the examination. On going in-training evaluation is required throughout the basic surgical training period. Any trainees who do not satisfy the standards set by or under training assessments consecutively twice or non-consecutively three times will be disqualified from the training programme.


Interrupted Training

The continuity of basic surgical training may be interrupted to allow time for rotating to a non-recognized training centre and other reasons. Trainees may apply for suspension from the continuous training programmes for a maximum of 6 months and such application must seek prior approval from the respective Surgical College and the Accreditation Committee of the HKICBSC. Trainees would be required to repeat the stipulated training requirements if there is more than 6 months discontinuity of basic training. Only under exceptional conditions (e.g. health, family or personal reasons) that the suspension period can be longer than 6 months. It is emphasised that suspension of training should not be more than 6 months prior to examination.


Appeal Procedures

A trainee can appeal to the Chairman of HKICBSC concerning disqualification. However, the notice of such appeal must be lodged with the Secretary of the Hong Kong Intercollegiate Board of Surgical Colleges within 21 days from the date of notice in writing of such disqualification to the trainee.

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Format of Examination


Hong Kong / Edinburgh System

Trainees who choose to join the Hong Kong/Edinburgh System would have to sit for the Conjoint MRCSEd/MICBSC (HK) Examination that comprises of two parts. Syllabus for the examination is available from the College of Surgeons of Hong Kong and the Royal College of Surgeons of Edinburgh:


Multiple Choice Papers 1 and 2 :
The first paper will test the candidate’s knowledge of Sections 1-9 of the Syllabus. The second paper will be an examination of the specialist subjects, covered by Sections 10-19 of the Edinburgh Syllabus. Both MCQ papers may be taken at any time during the two years of basic surgical training and each paper will stand alone, candidates being awarded either a pass or fail. There is no limit to the number of times candidates may sit the papers. Both papers must be passed before candidates may enter the Final Assessment.


Final Assessment
After a minimum of eighteen months of the basic surgical training programme, candidates may apply to sit the Final Assessment, which may be taken no earlier than after twenty months of recognized training. Satisfactory completion of a Basic Surgical Skills Course is also a prerequisite for sitting the examination. The Final Assessment consists of an oral and a clinical component, as follows:

There will be three oral examinations, each lasting twenty minutes:
1) Critical Care;
2) Principles of Surgery, including Operative Surgery and applied Anatomy;
3) Clinical Surgery and Pathology based on the experience demonstrated in the candidate’s logbook.

There will be one clinical examination lasting 40 minutes with two examiners, during which candidates will see at least five cases. This examination will assess candidates’ ability to take an accurate history, elicit physical signs, produce differential diagnoses and briefly discuss investigation and treatment.


Candidates must achieve a minimum mark in the oral component in order to proceed to the clinical examination. Candidates who fail either the oral or clinical components only require resitting the failed part. There will be no refund or transfer of any part of the entrance fee for candidates who do not to proceed to the clinical component.

Candidates MUST PASS the final assessment within two years of their first attempt at the oral/clinical examination. Those who cannot do so would be advised to discontinue surgical training.

In the year 2004, the Royal College of Surgeons of Edinburgh and the Hong Kong Intercollegiate Board of Surgical Colleges will conduct both the new Intercollegiate MRCS MCQ Examinations in conjunction with the current MRCSEd MCQ Examination. For eligibility enter the examinations, please refer to the Intercollegiate MRCS Announcement on website - www.rcsed.ac.uk.




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Hong Kong / Australasian System

If trainees elect the Hong Kong/Australasian system, they would have to sit for the FRACS Part I Examination conducted jointly by the Royal Australasian College of Surgeons and the College of Surgeons of Hong Kong. The Part 1 (Basic Surgical Training) Examination Package comprises:


Multiple Choice Questions Examination (MCQ)
The Examination will consist of three, two and a half-hour papers, each of 120 multiple choice questions. The questions used in the examination are drawn from the 3 disciplines of Anatomy, Physiology and Pathology. A minimum standard is required in each of the Anatomy, Physiology and Pathology sections of the examination, at the same sitting, before a candidate can be deemed to have passed the MCQ Examination.


Interview
Interviews by panel members are designed to ascertain the progress a candidate has made during Basic Surgical Training. They will not be concerned with syllabus content. The information gained will be used in conjunction with the result of the MCQ examination to assess educational programmes in the various examination centres. While the information may be used to assist the Board in determining a candidate’s examination result, it will not be to the detriment of the candidate. The interview must be attended at each MCQ attempt.


Objective Structured Clinical Assessment (OSCA)
The emphasis of the OSCA will be on the application of basic science knowledge and understanding to clinical practice relevant to all forms of surgery at a level of knowledge, which can be expected of a candidate at the end of Basic Surgical Training. The test will comprise 15-20 stations at each of which the candidate will spend 5-10 minutes. The tasks required may include, but not be limited to, history taking and examination, demonstration of practical technical skills, the application of basic science knowledge, data acquisition and analysis.


The Part 1 Examination may be taken at any time after the completion of the Modular Distance Learning Programme - Surgical Trainees Education Modules (STEM) during year 2 of basic surgical training.

The MCQ and OSCA can be attempted at the one session or at separate sessions. However, it is a requirement that the MCQ component be attempted before, or at the same session as the OSCA. A successful MCQ or OSCA attempt can be carried forward to a subsequent sitting. Currently, the Part 1 MCQ and OSCA Examinations are offered in Hong Kong.

The RACS grants reciprocity to holders of the FRCS (United Kingdom and Ireland) A, B and C Examinations for the full Part 1 package. However, the granting of reciprocity is reconsidered from time to time as changes are implemented both in the RACS Part 1 programme and overseas surgical Colleges.


Review of Assessment Reports
The Part 1 package requires the satisfactory completion of an assessment component of not less than 12 months during basic surgical training. Each term of less than 10 weeks or greater than 26 weeks (6 months) will not be accepted for calculating such 12-months period.


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Hospitals Accredited for Basic Surgical Training

During Basic Surgical Training, trainees would normally rotate through a series of posts to include as many surgical specialties and related disciplines as possible. The following are the recognized training centres in various specialties :

SPECIALTY
HOSPITALS
Accident & Embergency Caritas Medical Centre
Kwong Wah Hospital
North District Hospital
Pamela Youde Nethersole Eastern Hospital
Prince of Wales Hospital
Princess Margaret Hospital
Queen Elizabeth Hospital
Queen Mary Hospital
Tang Shiu Kin Hospital
Tuen Mun Hospital
United Christian Hospital
Yan Chai Hospital

Cardiothoracic Surgery Grantham Hospital
Prince of Wales Hospital
Queen Elizabeth Hospital

Neurosurgery Kwong Wah Hospital
Pamela Youde Nethersole Eastern Hospital
Prince of Wales Hospital
Princess Margaret Hospital
Queen Elizabeth Hospital
Queen Mary Hospital
Tuen Mun Hospital

Orthopaedics & Traumatology Alice Ho Miu Ling Nethersole Hospital
Caritas Medical Centre
Kwong Wah Hospital
North District Hospital
Pamela Youde Nethersole Eastern Hospital
Prince of Wales Hospital
Princess Margaret Hospital
Queen Elizabeth Hospital
Queen Mary Hospital / Duchess of Kent Children's Hospital
Tuen Mun Hospital
Tseung Kwan O Hospital
United Christian Hospital
Yan Chai Hospital

Otorhinolaryngology Pamela Youde Nethersole Eastern Hospital
Prince of Wales Hospital / United Christian Hospital / Alice Ho Miu Ling Nethersole Hospital
Queen Elizabeth Hospital
Queen Mary Hospital / Tung Wah Hospital
Tuen Mun Hospital
Yan Chai Hospital

Paediatric Surgery Prince of Wales Hospital
Queen Elizabeth Hospital
/ United Christian Hospital
Queen Mary Hospital
Pamela Youde Nethersole Eastern Hospital
Tuen Mun Hospital
Yan Chai Hospital

Plastic Surgery Kwong Wah Hospital
Pamela Youde Nethersole Eastern Hospital
Prince of Wales Hospital
Princess Margaret Hospital
Queen Elizabeth Hospital
Queen Mary Hospital
Tuen Mun Hospital

Surgery in General Alice Ho Miu Ling Nethersole Hospital / North District Hospital / Prince of Wales Hospital
Caritas Medical Centre
Kwong Wah Hospital
North District Hospital
Pamela Youde Nethersole Eastern Hospital
Prince of Wales Hospital
Princess Margaret Hospital
Queen Elizabeth Hospital
Queen Mary Hospital / Tung Wah Hospital / Ruttonjee Hospital
Ruttonjee Hospital
Tuen Mun Hospital
United Christian Hospital / Tseung Kwan O Hospital
Yan Chai Hospital

Urology Alice Ho Miu Ling Nethersole Hospital
Caritas Medical Centre
Kwong Wah Hospital
Pamela Youde Nethersole Eastern Hospital
Prince of Wales Hospital
Princess Margaret Hospital
Queen Elizabeth Hospital
Queen Mary Hospital / Tung Wah Hospital
Ruttonjee Hospital
Tuen Mun Hospital / Pok Oi Hospital
United Christian Hospital
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Last update 01/2003

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The College of Surgeons of Hong Kong