SPECIALIST TRAINING PROGRAMMES
IN ADULT MEDICAL SPECIALITIES
The following are the training programmes for the adult medical specialities that are listed in Appendix 1 of this document.
GENERAL POINTS
• There must be at least one director/ coordinator of training and at least two officially
appointed trainers per specialty.
• The training programme of all specialities listed in Appendix 1 shall consist of a common trunk (basic training)
followed by a period of Higher specialist training in the relevant speciality. • All training will be performed in a locally approved institution.
• Four hours of formal academic activities will be organised each week, approved by the SAC.
• For the purposes of completion of training a 40-hour week (full time) must be worked with
on call rota according to the Specialist Training framework document.
• Part time trainees will have their training recognized pro-rata; 13 weeks of pregnancy leave (in addition to the normal entitlement of leave) can be recognized as part of the training period; however any longer period of leave will not be considered as training. Minimum training must be at least 50% whole time in order to be recognized as training.
• The trainee shall:
1. Record all stages of training and activities related to training in a log-book;
2. Have sufficient linguistic capabilities to communicate with patients and colleagues as recommended by the Union Europeene des Medicins Specialistes (UEMS) (Charter on Medical Training of Medical Specialists: Chapter 5, Article 2, 1993)
General Professional Training
(Basic Medical Training; Common Trunk)
Entry Requirements
Recognised First Degree in Medicine AND
Full registration with the Medical Council of Malta
Content of Programme
The programme shall involve supervised responsibility for:
• Unselected acute medical admissions (at least two years full-time or pro-rata
equivalent);
• Cover for ward medical emergencies (at least two years full-time or pro-rata
equivalent);
• Patients seen on an outpatient basis
• Experience in various specialities related to the practice of Medicine. This includes responsibilities in the care of both in-patients and out-patients. It is encouraged that trainees obtain experience in as many of these specialities as possible.
Emergency & Accident Medicine,
Endocrinology & Diabetes,
Cardiology,
Respiratory Medicine,
Nephrology,
Gastroenterology,
Neurology,
Rheumatology,
Infectious Diseases,
Dermatology,
Geriatrics and
Clinical Haematology.
This must include experience in at least 4 of the above-mentioned specialities of at least 3 months each. For this reason the trainee must rotate between the various specialities every 3-6 months.
For the purposes of the previous clause, a full time rotation at Medical Admissions Unit in an approved hospital, will also be recognized, as equivalent to one of the minimum specialities.
Language
Trainees shall have sufficient linguistic capabilities to communicate with patients and
colleagues as recommended by the Union Europeene des Medicins Specialistes (UEMS)
(Charter on Medical Training of Medical Specialists: Chapter 5, Article 2, 1993).
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Duration & Completion of General Professional Training
This must not be of less than TWO YEARS full-time or pro-rata equivalent AND
the trainee must
obtain one of the following qualifications as evidence of completion of training:
• MRCP (UK)
• MRCPI
• FRACP Part 1
• FRCP Canada
• Any other equivalent qualification approved by the Specialist Accreditation Committee
after consultation with the Association of Physicians of Malta.
Training Centre
Training shall take place in a recognised teaching centre. This must have access to a full range of laboratory and imaging investigations and fulfill other conditions that the Specialist Accreditation Committee may, from time to time, determine.
A Certificate of Completion of Basic Specialist Training shall be awarded if ALL the following criteria have been fulfilled.
· The trainee has undergone training of a minimum of TWO YEARS full-time or pro-rata equivalent in recognized specialities mentioned above.
· The trainee has undergone training of not less than 3 months in at least 4 recognized specialities mentioned above.
· The trainee has attained one of the following qualifications: MRCP (UK), MRCPI, FRACP Part 1, FRCP Canada, Any other equivalent qualification approved by the Specialist Accreditation Committee after consultation with the Association of Physicians of Malta.
· The trainee has out-of-office hours experience (duties) totaling at least 44 duties.
· The trainee has satisfactory consultant appraisals.
HIGHER MEDICAL TRAINING
COMMON PRINCIPLES & CONDITIONS
(These apply to all specialities in Appendix 1)
• Trainees shall be involved in the care of ambulatory patients and of inpatients (including management of emergencies);
• Trainees perform an adequate number of procedures of sufficient diversity as recommended by the UEMS;
• The definition of full time work and conditions pertaining to part-time work are the same as for the common trunk.
• The trainee can spend a maximum of one year of his training in a recognised foreign
institution, provided that such a rotation must be approved by the Association of Physicians and that the trainee must submit a certified logbook of the training he has undertaken at that institution.
• Trainees be exposed to at least two trainers, who shall be fully accredited in the relevant
speciality and one of whom shall be practicing as a specialist for at least 5 years;
• The director of training and respective trainers shall see that during this period the trainee gets adequate experience as in this document.
• Trainers shall provide yearly reports to the co-coordinator of training on the progress of the trainee, indicating possible areas where the trainee may benefit.
• Trainees shall have sufficient linguistic capabilities to communicate with patients and
colleagues as recommended by the Union Europeene des Medicins Specialistes (UEMS)
(Charter on Medical Training of Medical Specialists: Chapter 5, Article 2, 1993).
• The trainee shall participate in the departmental academic activities including those of other subspecialities. A minimum of 4 hours per week protected time is envisaged.
• Research and publications are strongly encouraged. The trainee should have performed a minimum of 2 audits and have at least one publication.
• Participation in and scientific contribution at national and international meetings are
strongly encouraged.
• Training shall take place in a recognised teaching institution or group of institutions which together offer the trainee practice in the full range of the speciality and an opportunity for interspecialty consultation. They must have access to a full range of laboratory and imaging investigations and fulfil other criteria that the Association of Physicians may, from time to time, determine.
· The trainee has out-of-office hours experience (duties) totaling at least 22 duties per year. At least 44 duties should be performed in the final 2 years of higher specialist training.
· Progression through the higher specialist training (HST1 thorough to HST4) is dependent on satisfactory appraisal
• Training shall conform to all other requirements as laid down by the Association of
Physicians of Malta following the broad outlines of the UEMS.
Dual Certification
• Trainees working with consultants who have unrestricted acute Medical Take, and who
accept general medical patients on their wards, and have general medical outpatients are entitled to dual certification in Internal Medicine and the other speciality being practisad.
• Dual certification requires the fulfillment of experience and competence requirements
of both Internal Medicine, and the higher specialist training requirements of the speciality.
• A certificate of completion of training in internal medicine may be issued after 3 years
of “DUAL” higher specialist training.
Certification in Resuscitation.
Certification of having passed a short course such as ALS or equivalent is required for all medical specialities.
Definition of Training activities
Please refer to the document labeled Appendix II
CARDIOLOGY
Entry Requirements
Completion of General Professional Training (see above)
Full registration with the Medical Council of Malta
Content of Programme
The duration of the training shall be 4 years during which time the trainee shall be involved in the:
· The care of acute coronary patients
· The care of ambulatory cardiac patients referred from primary care physicians as well as from other specialities
· The interpretation of at least 1000 ECG’s
· Reading of at least 200 Holter ECG’s
· Supervision and interpretation of at least 500 exercise stress tests
· Performing at least 400 transthoracic echocardiograms (including colour doppler)
· Performing at least 50 transoesophageal echocardiograms
· Pacemaker programming (at least 200)
· Gained experience in coronary angiography & ventriculography (at least 300), right & left cardiac catherisation studies (at least 100) and preferably in at least 50 invasive electrophysiological studies.
· Research and publications are to be encouraged
· Gained experience in at least 50 coronary angioplasties with or without stent insertion
· Gained experience in at least 20 other cardiac procedures such as closure of ventricular shunts
Training Centre
Training shall take place in an institution or group of institutions which together offer the trainee practice in the full range of the speciality and an opportunity for interspecialty consultation (in particular cardiac surgery and other medical specialities). They must include a suitably equipped coronary care and intensive care units. They must have access to a full range of laboratory and imaging investigations and fulfil other criteria that the Association of Physicians may, from time to time, determine.
Duration of Higher Medical Training
This shall not be less than four years full-time or equivalent.
DERMATOLOGY & VENEREOLOGY
Entry Requirements
Completion of General Professional Training (see above)
Full registration with the Medical Council of Malta
Content of Programme
The duration of the training shall be 4 years during which time the trainee must acquire experience:
· The management of patients suffering from dermatological and sexually transmitted diseases on both an in-patient and out-patient basis;
· Diagnosis and management of bacterial, viral and fungal infections and of infestations of the skin
· Contact, occupational and environmental dermatology;
· Diagnosis and management of benign and malignant tumours of the skin;
· Photo dermatology;
· Aesthetic dermatology;
· Paediatric dermatology;
· Dermatological formulation and prescribing with topical and systemic treatments;
· Dermatological surgery, electro surgery, cryotherapy, phototherapy and laser treatments;
· Immunotherapy;
· Dermatological manifestations of systemic disease;
· Genital dermatosis;
· Epidemiology, diagnosis and management of sexually transmitted diseases, including HIV infections;
· Prevention of sexually transmitted diseases (including partner notification), sexual health and education;
· Psychological and social aspects of dermatological and sexually transmitted diseases
Training Centre
Training shall take place in an institution or group of institutions which together offer the trainee practice in the full range of the speciality and an opportunity for interspecialty consultation (in particular plastic surgery and oncology). They must have in-patients beds for the treatment of patients dermatological and/or sexually transmitted diseases. They must have access to a full range of histopathological and microbiological investigations and fulfil other criteria that the Association of Physicians may, from time to time, determine.
Duration of Higher Medical Training
This shall not be less than four years full-time or equivalent.
DIABETES & ENDOCRINOLOGY
Entry Requirements
Completion of General Professional Training (see above)
Full registration with the Medical Council of Malta
Content of Programme
The duration of the training shall be 4 years during which time the trainee shall:
· Be involved in the Care of Acute Medical Admissions
· Be involved in the Care of Acute Endocrinological Emergencies
· Be involved in the Care of ambulatory patients with endocrinological disease
· Be involved in the Care of patients with lipid and other metabolic disorders
· Participate in Diabetes Education Programmes
· Acquire competence in Endocrinological/Diabetological Review of patients in other departments (including obstetric and surgical patients).
· Participate in diabetes foot care in conjunction with chiropodist, vascular and orthopaedic surgeons and orthotics specialists.
· Acquire competence and knowledge with regard to the indications, supervision and interpretation of dynamic endocrinological tests
· Participate in all other aspects of ambulatory diabetes care (of both major types of diabetes)
Training Centre
Training shall take place in an institution or group of institutions which together offer the trainee practice in the full range of the speciality and an opportunity for interspeciality consultation (in particular nephrology, ophthalmology, vascular surgery, cardiology and other medical specialities). They must include surgical and obstetric care. They must have access to a full range of laboratory (including endocrinological assays) and imaging investigations and fulfill other criteria that the Association of Physicians may, from time to time, determine.
Duration of Higher Medical Training
This shall not be less than four years full-time or equivalent.
GASTROENTEROLOGY
Entry Requirements
Completion of General Professional Training (see above)
Full registration with the Medical Council of Malta
Content of Programme
The duration of the training shall be 4 years during which time:
· The trainee must be involved in the care of Acute Medical Admissions.
· The trainee must gain experience in all aspects of medical (non-surgical) care of ambulatory and in-patient care of patients suffering from diseases of the gastro-intestinal tract, the liver and pancreas.
· The trainee must perform at least 300 oesophageal-gastro-duodenoscopies,
· at least 30 sclerotherapy procedures for oesophageal varices,
· at least 100 colonoscopies,
· at least 50 colonoscopic polypectomy and related procedures
· Experience in ERCP, manometric and pH investigation and therapeutic endoscopy is encouraged
Training Centre
Training shall take place in an institution or group of institutions which together offer the trainee practice in the full range of the speciality and an opportunity for interspecialty consultation. They must include other associated specialities especially other medical specialities and gastrointestinal surgery. They must have access to a full range of laboratory and imaging investigations and fulfil other criteria that the Association of Physicians may, from time to time, determine.
Duration of Higher Medical Training
This shall not be less than four years full-time or equivalent.
GENERAL (INTERNAL) MEDICINE
Entry Requirements
Completion of General Professional Training (see above)
Full registration with the Medical Council of Malta
Content of Programme
The programme shall involve supervised responsibility for:
· Unselected acute medical admissions
· Cover for ward medical emergencies
· Care of patients in a Medical outpatient setting
· Experience in all the following specialities related to the practice of Medicine: Emergency & Accident Medicine, Diabetes & Endocrinology, Cardiology, Respiratory Medicine, Nephrology, Gastroenterology, Neurology, Rheumatology, Infectious Diseases, Dermatology and Geriatrics). This includes responsibilities in the care of both in-patients and out-patients.
· Rotation in different specialities is recommended for trainees only seeking certification in Internal Medicine.
Dual Certification
· Trainees working with consultants who have unrestricted acute Medical Take, and who accept general medical patients on their wards, and have general medical outpatients are entitled to dual certification in Internal Medicine and the other speciality being practiced.