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HIGHER SURGICAL TRAINING
 Entry for Higher Surgical Training
Upon completion of basic training and passing the Conjoint MRCSEd/HKICBSC or the FRACS
Part I Examination, trainee may apply for membership of any one of the surgical colleges
before they could enter into higher surgical training. Higher Surgical Training in the six
surgical specialties (General Surgery, Urology, Neurosurgery, Paediatric Surgery,
Cardiothoracic Surgery and Plastic Surgery) is under the auspices of the respective
Specialty Boards of the College of Surgeons of Hong Kong. The programme takes a minimum of
4 years depending on the specialty. Higher trainees of these specialties must be
registered with the College of Surgeons of Hong Kong. A register of Higher Surgical
Trainees is maintained at the College Secretariat. Registration, which includes an annual
fee, is applicable to higher trainees until they pass the exit examination.
Basic trainees registered after August 1996 must obtain Membership of the College of
Surgeons of Hong Kong (MCSHK) before they will be considered for entering the Higher
Surgical Training Programme accredited by the College. FRCS obtained after the year 2000
and MRCS obtained overseas will not be considered equivalent to the MCSHK.
Overseas training without prior approval in writing from the Censor-in-Chief of CSHK
before the date of registration and commencement of the local training programme will not
be recognized by the College of Surgeons of Hong Kong.
Trainees may choose to join the Edinburgh and/or the Australasian systems for higher
surgical training in General Surgery provided that the centres in Hong Kong, which they
are working in, are jointly accredited by the Colleges. Those who elect the Australasian
system would have to register with the Royal Australasian College of Surgeons (RACS) as
advance trainees and would have to pay a yearly annual subscription to the RACS.
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Higher
Specialist Training
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Introduction:
Trainees in higher specialist training will follow a structured programme of training and
assessment lay down by the College of Surgeons of Hong Kong. There are six specialties in
Surgery, which the College recognizes to be so distinct and independent of each other in
terms of training that independent training programmes are recommended. These specialties
are :-
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General Surgery
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Cardiothoracic Surgery
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Neurosurgery
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Paediatric Surgery
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Plastic Surgery
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Urology
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Common Features
of Training Programmes:
| 1. |
GENERALITY
The training programmes follow the recommendations set forth by the Hong Kong Academy of
Medicine and follow the '2+4' guideline. After graduation and completion of the necessary
one-year internship, leading to registration as a medical practitioner, the trainee in
each of the programmes spends a minimum of two years in basic training. Following this,
the trainee undergoes an intermediate assessment/examination and if successful enters into
one of the higher surgical training programmes of one of the Specialties. At the end of
the four years or more of the higher surgical training, the trainee undergoes an exit
assessment/examination and if successful is recommended by the College to the Academy for
the award of Fellowship of the Academy.
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| 2. |
ORGANIZATION OF TRAINING
PROGRAMMES
Although the six training programmes differ in terms of training schemes, exposure and
clinical experience required of the trainees, they have the following common features :
| (a) |
Each programme is
formally structured and is recommended and approved by the Council of the College;
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| (b) |
Each programme is
directly under the supervision of a Specialty Board;
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| (c) |
Each programme includes
the continuing evaluation of the quality and effectiveness of a trainee's practice.
Medical audit, quality assurance, patient care evaluation and performance review are
important parts of the training programmes;
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| (d) |
All training centres
involved in training are inspected and recognized by the College for the purpose of
training in that area of surgery. Set criteria are laid down for centres to be recognized
for the training of the Specialties, including the availability of training facilities
like libraries, lecture facilities and specialist journals;
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| (e) |
Each centre is
accredited a number of recognized training posts for basic and higher surgical training by
the College;
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| (f) |
Each programme is
supervised at the hospital level by the appointment by the College of recognized
supervisors and trainers in the training centres;
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| (g) |
Specialist supervisors
trainers (who must be Fellows of the Academy) are appointed, on the recommendation of
Specialty Boards, by the College to supervise the training of the trainees. There are set
criteria laid down and approved by the College on the definition and acceptance of
trainers.
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| (h) |
Each trainee entering
into the training programme has to be approved by the College and occupies one of the
recognized training posts as accredited by the College;
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| (i) |
The College maintains,
and updates every 6-monthly, a central registry of trainees who occupy the recognized
training posts as accredited by the College;
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| (j) |
Each trainee possesses a
Log book and is required to update the Log book regularly. The clinical experience and
exposure have to be certified by his supervisor in surgical training every 6-monthly;
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| (k) |
The supervisor/trainer :
trainee ratio in all training programmes is usually 1 : 1 or 1 : 2. In no programme is the
ratio worse than 1 : 3;
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| (l) |
All training programmes
give trainees knowledge and understanding of research methods;
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| (m) |
Each programme has an
assessment/examination at the end of the basic as well as the higher surgical training;
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| (n) |
The College has an
examination board with panels of examiners to oversee the conduct and standard of
assessments/examinations of the different training programmes;
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| (o) |
Each candidate in the
assessment/examination is examined by at least a pair of examiners appointed by the
College. At least one overseas examiner is involved in each of the
assessments/examinations;
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| (p) |
An upper limit (which
will be decided by the College Council from time to time) on the attempts of
assessments/examinations may be set on an individual candidate by the College and a time
limit (which will be decided by the College Council from time to time) may be set for the
candidate to complete the basic or the higher surgical training;
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| (q) |
The College has an
Appeal Committee to handle appeals on the results of assessments/examinations;
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| (r) |
General contents of
training of all training programmes include :
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Basic science |
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Clinical skills |
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Review of current
literature |
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Communication skills |
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Prevention and treatment
of illness and the promotion of health |
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Teamwork |
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Management skills |
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Knowledge and skills
which cross specialty boundaries |
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Profesional ethics and
conduct
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| 3. |
SUMMARY OF THE TRAINING
PROGRAMMES IN SURGERY
All six specialties in Surgery have the same basic surgical training in Surgery and its
related specialties for at least 2 years. At the end of the basic training, the trainee
has to pass an intermediate examination before entry into higher surgical training which
can be one of the following :
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General Surgery
Duration: 4 years
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Conjoint Exit Examination with the Royal College
of Surgeons of Edinburgh
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Conjoint Exit Examination with the Royal
Australasian College of Surgeons
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Cardiothoracic
Surgery
Duration: 5 to 7 years of full time
supervised training in cardiothoracic surgery depending on trainee's clinical exposure.
Trainee required performing a minimum of 200 major cardiothoracic operations under
supervision within the training period.
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Exit Examination can be taken at beginning of the
fifth year. But the candidate must complete 5 years of training.
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Neurosurgery
Duration: 5 years continuous full time
training in neurosurgery of which 4 years have to be training after passing the
intermediate examination.
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Exit Examination at end of training programme
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Paediatric Surgery
Duration: 4 years of paediatric surgical
training
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Conjoint Exit Examination with the Royal College
of Surgeons of Edinburgh
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Plastic Surgery
Duration: 4 years of training in Plastic
Surgery
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Exit Examination at end of training programme
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Urology
Duration: 4 years of urology training
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Conjoint Exit Examination with the Royal College
of Surgeons of Edinburgh
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Supervision of Higher Surgical Training
The responsibility for
accreditation and recommendation for approval by the Council of the College of Surgeons of
Hong Kong is vested jointly by the Education Subcommittee and the Specialty Boards. All
trainees embarking on higher surgical training must obtain a Logbook which could be
purchased from the College Secretariat :
The Logbook provides information on:
| (a) |
Operation
Statistics:- |
Range (No less than 75% of
the subspecialty claimed, if any)
Emergency Content
Supervised Experience
Unsupervised Experience
Minor Surgery
Endoscopy
Record of Complication and Death
Summary
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| (b) |
Academic
Activities:- |
Research
Publications
Presentation at Meetings
Attendance at Courses, e.g. Workshops and
Seminars
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In-Training Evaluation
A “Flagging Criteria” for monitoring higher training is being enforced. Higher
trainees should have the ability to achieve the number/percentage of caseloads stipulated
in the criteria which is available from the College Secretariat.
| 1. |
Individual
trainee's log book should be reviewed regularly
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3
monthly by mentor
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6
monthly by |
(i)
Suppervisors
(ii) The respective Specialty Board |
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| 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 respective Specialty Board. The trainee should
be advised what measures are required to reverse these deficiencies.
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| 3. |
On
completion of every 6-months training period, every trainee would be required to
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Complete
a Log Book Summary Report and Log Book Summary
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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. |
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It is the obligation of higher
trainees to submit the above requisite documentation through their supervisors/trainers
for vetting regularly in semi-annually by
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Training
Subcommittee (for higher trainees in General Surgery)
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Hong
Kong Regional Subcommittee of the Board in General Surgery RACS (for higher trainees who
have joined the Hong Kong / Australasian System) |
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The
respective Specialty Board
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The Education & Examination
Subcommittee of the College of Surgeons of Hong Kong would endorse the respective training
period 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 respective Specialty
Board 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 fails 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 higher 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.
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Interrupted Training
The continuity of higher surgical training may be interrupted to allow time for rotating
to a non-recognized training centre and other reasons. Application for suspension from the
continuous training programmes for a maximum of 6 months and such application must seek
prior approval from the respective Special Boards and the Education & Examination
Subcommittee of CSHK. Trainees would be required to repeat the stipulated training
requirements if there is more than 6 months discontinuity of higher 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.
Research/Higher Degree
The High Training Programme can be interrupted for one or two years for prospectively approved
research for a university higher degree. In such a situation, the trainee is still required to
complete the required years of surgical training.
Overseas Training
The Education & Examination Subcommittee may prospectively pre-approve elective
training in an overseas post for higher surgical trainee. The trainee concerned would be
required to submit the assessment from his supervisor after the completion of his
training. The Subcommittee may consider recognition of the respective training upon
receipt of the respective assessment.
Appeal Procedures
A trainee can appeal to the Appeal Board of the College of Surgeons of Hong Kong
concerning disqualification. However, the notice of such appeal must be lodged with the
Secretary of the Appeal Subcommittee within 21 days from the date of notice in writing of
such disqualification to the trainee.
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Hong Kong
/ Australasian Training Programme
Surgical Trainees in General Surgery will be accepted for Hong Kong / RACS Advanced
Surgical Training Programme when they have passed either the FRACS Part I Examination or
the MRCS / MICBSC (HK) Final Assessment. Application should be submitted to the Chairman
of the Hong Kong Regional Subcommittee of the Board in General Surgery CSHK. Higher
trainees of this Programme would have to register with the Royal Australasian College of
Surgeons and pay the annual registration fee to them.
Hong Kong / RACS Advance Surgical Training
Higher trainees in General Surgery who elect the Hong Kong / RACS Training Programme will
need to have spent at least three months, since graduation, working in an Emergency
Department and a minimum of eight weeks in an Intensive Care Unit. From Year 2000 and beyond,
this Training Programme consists of 2 segments: The first 3 years in undifferentiated General
Surgical Training Programme, designed to give the trainee as broad an exposures as possible
to a wide range of general surgical conditions; and the final 2 years of programme is
undertaken in one of the nine subspecialties of General Surgery (including "general surgery").
If trainees elect this programme in the course of their higher surgical, he could apply for
retrospectively recognition of their training experience if they started their higher training
programme in the years before 2000. The final decision rests on the Board in General Surgery,
RACS. Trainees would be required to be rotated out of their training base centre for at least
one year.
For in-training evaluation, they have to submit the completed Log book summary, Log book
summary report and two mentor assessment forms to the Hong Kong Regional Subcommittee for
vetting. This documentation would be forwarded to the Royal Australasian College of
Surgeons for endorsement. Other details of in-training evaluation should be referred to
the Hong Kong / Edinburgh System.
It is recognized that trainees selected into the training programme may subsequently be
found to be unsatisfactory by the mentors / supervisors. The Regional Board of RACS may
decide to dismiss trainees from the training programme following due process that
satisfies all legal and administrative requirements.
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Exit Examination
Upon satisfactory completion of higher surgical training, trainees who go for the Hong
Kong/Edinburgh system may sit for the Conjoint Specialist Examination conducted jointly by
the Royal College of Surgeons of Edinburgh and the College of Surgeons of Hong Kong. The
examination should be uniform in content and standard, be similar to those conducted by
the Intercollegiate Examination Board of the Royal Colleges in the United Kingdom.
Examination will be held at an interval agreed by both Colleges.
There will not be any automatic recognition of overseas qualifications being equivalent to
the exit qualifications for the College of Surgeons of Hong Kong. All candidates of the
exit examinations conducted by the College must undergo local training of not less than 12
months at a training centre accredited by the College of Surgeons of Hong Kong or
supervised by a trainer, who must be approved by the College of Surgeons of Hong Kong in
that specialty.
Higher trainees in General Surgery who have chosen to join the Hong Kong/Australasian
System could be allowed to sit for the FRACS Part II Examination at the end of the third
year of advanced surgical training. The final Conjoint Fellowship Examination would be
conducted with involvement of at least one examiner from the College of Surgeons of Hong Kong.
The examination will be held once every year in Hong Kong. On completion of all requirements
of the old four-year programme and successful completion of the Conjoint Examination, the
trainee will be granted the Australasian Fellowship. For those who are in the new 3+2
Advanced Surgical Programme, first presentation for the Part 2 Examination can be towards
the end of the third year of Advanced Surgical Training. On completion of all requirements
of the undifferentiated three years programme, and successful completion of the Part 2
Examination, the trainee will be granted Provisional Fellowship of RACS. The trainees have
to complete the Differentiate Plus 2 Programme with assessment be taken at the end of each
six month period before the Board in General Surgery RACS will recommend the awarding of the
full Australasian Fellowship in General Surgery. The successful candidate would also be
recognized to have passed the Hong Kong Exit Examinations.
Successful candidates of the above examinations would be elected to full Fellowship of the
College of Surgeons of Hong Kong and to the Fellowship of the respective Royal Colleges.
They would also be eligible for being nominated for Fellowship of the Hong Kong Academy of
Medicine.
The College of Surgeons of Hong Kong at present is conducting conjoint examinations with
the Royal College of Surgeons of Edinburgh in general surgery, urology and paediatric
surgery. Conjoint examinations with the Edinburgh College in neurosurgery, cardiothoracic
surgery and plastic surgery will be conducted soon. The College of Surgeons of Hong Kong
is now conducting conjoint examination with the Royal Australasian College of Surgeons in
general surgery only.
Hospitals with Approved Programmes for
Higher Surgical Training
SPECIALTY
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HOSPITALS
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| Cardiothoracic
Surgery |
Grantham
Hospital
Prince of Wales Hospital
Queen Elizabeth Hospital
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| Paediatric
Surgery |
Prince
of Wales Hospital
Queen Elizabeth Hospital / United Christian Hospital
Queen Mary Hospital
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| 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
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| General
Surgery |
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*
United Christian Hospital* / Tseung Kwan O Hospital*
Tuen Mun Hospital*
Yan Chai Hospital*
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| Plastic
Surgery |
Kwong
Wah Hospital
Prince of Wales Hospital
Princess Margaret Hospital
Queen Mary Hospital
Tuen Mun Hospital
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| Urology |
Pamela
Youde Nethersole Eastern Hospital
Prince of Wales Hospital / Alice Ho Miu Ling Nethersole Hospital / North
District Hospital
Princess Margaret Hospital
Queen Elizabeth Hospital
Hong Kong West Hospital / Kwong Wah Hospital
Tuen Mun Hospital
United Christian Hospital
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Hospitals accredited for Hong Kong / RACS Training Programme |
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