Family medicine course for GPs to be revamped

'Intensive upgrade' to ensure doctors are able to tackle various health issues in ageing society

Singapore's main training programme for general practitioners (GPs) to get certified in family medicine will, for the first time, undergo an "intensive upgrade".

The revamp of the two-year graduate diploma in family medicine is driven by a growing need for primary-care doctors who can deal with the myriad health issues brought about by a greying society.

The new curriculum - which will feature new aspects including transitional care and extra training specific to facilities like nursing homes - is to take effect next year, the College of Family Physicians Singapore (CFPS) told The Straits Times.

The college oversees the development of family medicine here.

The Ministry of Health (MOH) said it is working with the college to "review and enhance" the programme in "key areas of national priority". They include chronic disease management, geriatric care, mental health and community hospital practice, said an MOH spokesman.

This comes as a record 169 doctors enrolled in the course last year. This is up from the 114 sign-ups in 2014, and 98 in 2011.

While the course - which started in 2000 - is regularly updated to keep its content current, the latest review will be far more extensive.

Dr Xu Bang Yu, senior staff registrar at Sengkang Health, used to be a surgical trainee
before switching to family medicine. He currently works at Alexandra Hospital. ST PHOTO:

Associate Professor Lee Kheng Hock, president of CFPS, said: "This time, we are carrying out a major upgrade where we will make the course more relevant in view of the changing needs of our community and the enhanced role of family doctors in the healthcare system."

A committee comprising 17 senior family physicians across public and private sectors is carrying out the review, which will be completed in about three months.

  • 169
    Number of doctors who enrolled in the graduate diploma in family medicine course last year, a record.

    Number of sign-ups for the course in 2014.

    Number of sign-ups for the course in 2011.

  • Looking at the bigger picture

  • After a patient undergoes an operation, such as for a bad fracture after a fall, family physician Xu Bang Yu and his team will step in.

    Among their tasks are examining factors that could have led to the patient's fall, and how it could be prevented in the future.

    "The surgery solves the fracture, but why did the patient fall in the first place?" said the senior staff registrar at Sengkang Health.

    It could be that the patient has issues with blood pressure and blood sugar control, a heart condition or undiagnosed osteoporosis, which causes brittle bones, he added.

    Dr Xu is among more than 1,700 family physicians on the family-physician register.

    Three in four practise in general-practice clinics, while 15 per cent work in polyclinics in the public sector, said the Health Ministry. The rest are at health institutions such as community hospitals and family medicine units in restructured hospitals, like in Dr Xu's case.

    The 35-year-old works at Alexandra Hospital, which is currently run by the Sengkang Health team while Sengkang General Hospital is being readied for opening next year.

    "Apart from the underlying reasons for a patient's hospitalisation, we also look at psychological factors - for example, how the patient is coping with the disease," he said.

    The family physicians at Sengkang Health also work with rehabilitation specialists and allied health colleagues, such as physiotherapists and dietitians, to tailor a care plan for each patient.

    Dr Xu, who used to be a surgical trainee before he switched to family medicine, said such a plan may include post-discharge care and rehabilitation in daycare centres. "It is about the long-term well-being of patients," he added.

    Poon Chian Hui

Prof Lee added: "The teaching faculty will implement the new curriculum in the next academic year in 2018."

Today, about 2,600 doctors provide primary care in Singapore. As of the end of last year, 1,750 family physicians count among them.

Singapore will need 3,500 family physicians by 2030, said the MOH spokesman. This is based on preliminary projections.

Family physicians provide comprehensive care for a person, in the context of his family and the community he lives in. They are trained to manage both acute and chronic ailments - a dislocated shoulder and diabetes, for instance - and prevent them from spiralling into complications.

To be accredited as one, a doctor may obtain the graduate diploma. It is a part-time course that includes workshops and case discussions.

The other path is a three-year residency offered by public healthcare groups. Started in 2011, the full-time programme involves clinical rotations in hospitals and polyclinics.

Some overseas certifications are also recognised.

Prof Lee said the revamped curriculum will feature new areas of focus, such as integrated care and transitional care, where a person moves from one healthcare facility to another, or back home.

"There will also be additional training to boost the competency of family doctors in certain settings, such as nursing homes, community hospitals and home care," said Prof Lee, who is also the medical director of Bright Vision Hospital.

More emphasis will be placed on caring for older people and managing patients who are recently discharged from hospitals, he added.

Family physician S. Suraj Kumar said the diploma course revamp is "definitely timely".

"The problems of an ageing population are already here; we have to gear up to meet the challenges," said Dr Suraj, who works at Drs Bain & Partners, a private practice.

The 58-year-old, who completed the diploma about eight years ago, said it was an "important first step" in learning how to deliver more well-rounded care. He has gone on to obtain a master's degree and fellowship in family medicine.

"My level of care has improved. I became very confident in identifying problems that I might not have done previously," he added.

A version of this article appeared in the print edition of The Straits Times on June 13, 2017, with the headline 'Family medicine course for GPs to be revamped'. Print Edition | Subscribe