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PSGS 2017 GUIDELINES for ACCREDITATION

The 2017 Guidelines for Accreditation the requirements for accreditation are grouped into 5 main requirements: 

1.      Hospital Facility & Services Requirements:

The bed-capacity of the institution; clinical and therapeutic services with necessary support physical facilities; Laboratory, Diagnostic and Ancillary services and their support physical facilities.

2.      Teaching Facilities & Resources Requirements:

Medical Library and required books & periodicals; Internet Access and Foreign Medical Journal access; access to and participation in the PSGS ASSURE program; Institutional Tumor Board, Quality Assurance Body, & Ethics Review Body; required training facility/laboratory.

3.      Structured General Surgery Residency Training Program Requirements:

a.      Policy on commitment & resident supervision;

b.      Qualified Training Staff;

c.       Resident staff;

d.      Case material;

e.      Documentation of the Case Material;

f.        Residency training program duration & structured rotation of residents;

g.      Documented resident evaluation with feedback mechanisms;

h.      Documented teaching & learning activities; and,

i.        The Annual Report for submission to the PSGS.

4.      Annual Accreditation Fee

5.      Evaluation of Graduates of the Program

The new guidelines integrated most of the requirements previously entered as subheadings under Training Program Requirements and Structured Residency Training Program Requirements into, just, Structured General Surgery Residency Training Program Requirements. Also, clearly required is the proper documentation of the case material; teaching & learning activities; trainee assessment & feedback; other activities; roster and professional status of graduates of the program; and, roster of current (to the annual report year) department officers & staff.

PSGS now requires the Training Programs to explicitly express, as a policy, their commitment to the supervision of their trainees (residents); to sustaining the training program; and to abiding by the PSGS guidelines for accreditation.

There are adjustments made in the 2017 guidelines pertaining to the case material requirements. Glaring of which is the program factor dependent main volume requisite on the case material. From the 100 major (7 main categories) and 100 medium (6 main categories) operations volume-requirement for a total of 200 cases, the 2017 guidelines merged the major and medium categories into 16 main categories of operations, but reduced the volume- requirement to only 170. Overall the requirements on the variety of cases had only minor change like the addition of soft tissue tumor resection category. However, esophago-gastro-duodenal surgery is made as 1 category; small and large bowel another separate category; and, rectal and anal surgeries categories on their own. Appendectomies, whether uncomplicated or complicated, adult or pediatric, are placed as another category. Abdominal wall hernias, pediatric or adult, fall under a single category.

With regards to the index cases, the index case requirement is fixed for a training program and is not affected by the number of residents nor the program factor. Of note, which needs emphasis, is that for a given year, a program that has 4 or 5 graduating residents may fulfill its

index case requirements BUT (as stated that the requirement is not program factor dependent) the graduating residents may not be able to comply with their eligibility requirements for certification. It is therefore the responsibility of the programs to track the recruitment of required cases for the graduating residents. The 2017 guidelines left-out the ‘requirements for graduating residents' that was addressed in the 2012 manual.

The 2017 guidelines automatically credit 35%, of private cases per main category, a part of the program case material – whether performed or just 1st assisted by the residents. From another point of view, some accredited ‘private’ institutions may have to increase their handled service cases (beyond the 20% required) to fulfill their volume requirements.

The new guidelines increase from 10% to 20% (of the volume requirement per main category) the service case requirements. This will promote commitment to the training program and resident supervision by qualified training staff. My 2 cents worth, something to consider in the next revision: a significant percentage equivalent to the volume requirement of the program should be 1st-assisted by the senior residents and performed by a qualified training staff (whether service or 'private' cases), yet, if those were service cases, will still be fully credited as case material of the program; this is concrete evidence that the resident (being 1st-assist) is directly and hands-on learning from a qualified training staff (who is performing the operation); this is tangible proof of teaching-staff commitment to direct resident supervision. 

 

The Residents and the Program Factor are discussed more thoroughly in the new guidelines. The different types of 'resident rotators' and their effect the program factor computation are identified. More rigid conditions are demanded of 'lateral-entry' residents, as Wallas, the institutions accepting them. Foreign local graduates or foreign medical graduates (non-Filipinos), who apply as GS-residents are required to present Philippine PRC license - limited to practice medicine in the country while undergoing residency training.