specialised procedures for credentialing 1. …

SPECIALISED PROCEDURES FOR CREDENTIALING

1. ANESTHESIA - Cardiothoracic Anesthesia - Paediatrics Anaesthesia - Intensive Care - Pain Medicine

2. MEDICAL - Endocrine - Respiratory Medicine - Advance Internal Medicine - Cardiology - Dermatology - Nephrology - Neurology

3. O&G

- Gynae – Oncology - Maternal Fetal Medicine - Reproductive Medicine

4. PAEDIATRICS - Neonatology - Paediatrics Cardiology - Hepathology / Gastroenterology - Nephrology - Neurology - Haematology Onclogy - Respiratory Medicine - Paediatrics Anesthesia

5. ENT - Otology / Neuro Otology - Rhinology - Head & Neck - Peadfiatrics ENT

6. PATHOLOGY

- Chemical Pathology - Medical Microbiology - Tranfusion Medicine - Cytopathology/Cytogenetic - Metabolic & Endocrine

7. PLASTIC SURGERY 8. FORENSIC MEDICINE

9. ORAL & MAXILLOFACIAL SURGERY

SPECIALIZE PROCEDURES - ANAESTHESIA

1. CARDIOTHORACIC ANAESTHESIA

2. PEADIATRIC ANAESTHESIA

3. INTENSIVE CARE MEDICINE

4. PAIN MEDICINE

CARDIOTHORACIC ANAESTHESIA

No Procedures Minimal Training necessary for competence

Maintenance of competence

1 Anaesthesia for cardiac surgery

6 month experience in cardiac anaesthesia

Active practice in cardiac anesthesia

2 Conduct of cardiopulmonary bypass

- attended short course - 6 months experience in running the heart-lung machine


3 Insertion and managem ent of an Intra- Aortic Ballon Pump.

-attend short course -performed 10 procedures under supervision


4 Trans-oesophageal Echocardium(TEE) in the Operation theatre And ICU

-attend short course -assisted in 10 procedures -performed 20 procedures under supervision

I. Active practice in cardiac anesthesia ii.Perform at least 30 procedures per year

PEADIATRIC ANAESTHESIA



1 Anesthesia for neonatal surgery

6 months experience in neonatal anaesthesia

Active practice In paediatric anaesthesia

2 Thoracic epidural Anaesthesia for pediatric Patients

i. 6 months experience in paediatric anesthesia

ii. performed 10 procedures under supervision

Active practice in paediatric in anaesthesia

INTENSIVE CARE MEDICINE



1 Percutaneous Tracheostomy in the operation theatre and ICU

i. 6 months training in ICU after being credentialed as specialist ii. assisted in 10 procedures iii performed 20 procedures under supervision

i. active practice in intensive care ii. perform at least 30 procedures per year

2 Continuous Renal Replacement Therapy in ICU

i. 6 months training in ICU after being credentialed as specialist ii. assisted in 5 procedure iii performed 10 procedures under supervision

i. active practice in intensive care ii. perform at least 30 procedures per year

PAIN MEDICINE



1 Sympathetic blocks -lumbar , coelic plexus and stellate ganglion(local anaesthetic blocks)

i. 3 months training in Pain Medicine after being credentialled as specialist ii. assisted in 2 procedures iii.performed 2 procedures under supervision

i. Active practice in Pain Medicine ii. Perform at least 5 procedures per year

2 Implantable intrathecal and epidural catheters and pump

i. 6 months training in pain medicine after being credentiallled as specialist ii. assisted in 2 procedures iii performed 3 procedure under supervision

i. Active practice in Pain Medicine ii. Perform at least 5 procedures per year

3

Spinal Cord Stimulation And other methods of neuromodulation

i. 6 months training in pain medicine after being credentialed as specialist ii. assisted in 5 procedures iii performed 10 procedured under supervision

i. Active practice in pain medicine ii Perform at least 5 procedures per year

4 Sympathetic blocks -lumbar, coelic plexus and stellate ganglion(neurolytic blocks)

i. 6 months training in Pain medicine after being credentialed as specialist ii. assisted in 2 procedures iii. performed 3 procedures under supervision

i Active practice in Pain medicine iiPerform at least 5 procedures per year

SPECIALIZE PROCEDURES - MEDICINE

1. ENDOCRINOLOGY 2. RESPIRATORY MEDICINE 3. ADVANCED INTERNAL MEDICINE 4. NEPHROLOGY 5. RHEUMATOLOGY

1. ENDOCRINOLOGY

No Procedures Minimal Training necessary for competence 1. Insulin Tolerance Test Aware of indications and contraindications

Assisted and interpreted at least 5

2. Water Deprivation Test Perform and interpret under supervision at least 5 3. 72-hour prolonged fast

for diagnosis of insulinoma

Perform and interpret under supervision at least 5

4. Fine needle aspiration of thyroid

Supervised on at least 5 occasions

Recognized Training Centres:

1. Hospital Universiti Malaya 2. Hospital Universiti Kebangsaan Malaysia 3. Hospital Universiti Sains Malaysia 4. Hospital Pulau Pinang

5. Hospital Putrajaya 2. RESPIRATORY MEDICINE

No Procedures Minimal Training necessary for competence 1 Fiberoptic

bronchoscopy (F.O.B)

-observe F.O.B-10 cases -Perform F.O.B under supervision-25 cases -Perform F.O.B competently by own self-50 cases -Perform F.O.B on ventilated patients-5 cases -Perform bronchial brushing – 20 cases -Perform bronchial biopsy-20 cases -Perform bronchio-alveolar lavage -20 cases -Perform trans bronchial lung biopsy-5 cases

3 Pleural biopsy -Perform under supervision –5 cases -Perform competently by own self -10 cases

4 Chest tube insertion

-Perform under supervision –5 cases -Perform competently by own self -10 cases

5 Medical pleorudesis

-Perform under supervision –2 cases -Perform competently by own self -5 cases

6 Spirometry -Perform under supervision –5 cases -Perform competently and interpreter correctly -50 cases

7 Full Lung Function -Observe-10 cases -Interprete correctly -50 cases

8 Radiological Interpretation

-Chest radiograph interpretation under supervision-100 cases -CT Thorax interpretation under supervision -50 cases

9 Tuberculin skin test

-Observe – 5 cases -Perform competently -20 cases

10 Sleep Study -Set up under supervision-5 cases -Interprete under supervision-10 cases

11 CPAP for sleep Apnoea

-Observe-5 cases

12 Non invasive Intermittent Positive Pressure Ventilation (NIPPV)

-Observe -5 cases

13 Percutaneous Lung Biopsy

-Observe-5 cases/procedures

ADVANCED INTERNAL MEDICINE



1 ECG/Holter 50 cases 10 cases

2 Exercise Stress Test 20 cases 100 cases

3 Transthoracic Echo 100 cases 100 cases

4 Temporary Pacing 10 cases 10 cases

5 Percardiocentesis 5 cases 5 cases

6 Bronchoscopy 40 cases 20 cases

7 Diagnostic OGDS 75 cases 50 cases

8 Diagnostic Colonoscopy 50 cases 25 cases

9 TEE 50 cases 25 cases

10 Abdominal Ultrasound 200 cases 50 cases

11 Swan-Gantz Catheterization 5 cases 5 cases

Criteria For Credentialing of Nephrologists.

1. A physician shall be credentialed as a nephrologist if he/she has successfully completed 3 years training in nephrology in accredited center/s.

2. For a physician who has been practicing before 1980 and who may not fulfill the

above criteria, to be credentialed as a nephrologist:

a. He/She should have a minimum of one year training in nephrology in a recognized center.

AND b. Spends a significant proportion of his/her time in clinical practice in

nephrology.

Core Procedural Skills Of Sub Specialists On Completion of Fellowship / Sub Specialty

Training In Nephrology

No. Procedures Minimal Training necessary for competence

Maintenance of

competence

Please indicate ( )

the procedures

that a generalist

can perform with the required minimum training

Minimum training

necessary for a

generalist to perform the procedure

competently

1. Percutaneous renal biopsy

1. Minimum training duration – 6 months. 2. Minimum successful procedures – 30 3. Supervised by credentialed consultant who has maintained credential status.

Remains in active nephrology practice.

2. Interpretation of basic renal histopathology

1. Minimum training duration – 1 year. 2. Supervised by credentialed renal histopathologists.

Continued interest in the field

3. Haemodialysis 1. Minimum training duration – 6 months. 2. Supervised by credentialed nephrologists.

Remains in active nephrology practice

4. Chronic Peritoneal Dialysis

1. Minimum training duration – 6 months. 2. Supervised by credentialed nephrologists.


5. Continuous renal Replacement Therapy (CRRT)

1. Minimum CRRT procedures – 10. 2. Supervised by credentialed nephrologists.


6. Plamapheresis 1. Minimum Plamapheresis procedures - 5

Remains in active


Maintenance of

competence

Please indicate ( )

the procedures

that a generalist

can perform with the required minimum training

Minimum training

necessary for a

generalist to perform the procedure

competently

2. Supervised by credentialed nephrologists.

nephrology practice.

7. Other extracorporeal therapies e.g. immunoadsorption, haemoperfusion.

Trained in basic extracorporeal therapies e.g. plasmapheresis/haemodialysis.


8. Basic Renal Ultrasound

1. 30 ultrasound examinations. 2. Supervised by credentialed nephrologists / radiologists.


9. Insertion of temporary vascular access

1. Minimum successful procedures – 30 2. Supervised by credentialed nephrologists

. Supervised by credentialed nephrologists

1. Minimum successful procedures – 30 2. Supervised by credentialed nephrologists

RHEUMATOLOGY

No. Procedures Minimal training necessary for competence


Please indicate(√) the procedures that a generalist Can perform With the required minimum training

Min. training Necessary for a generalist to perform the procedure competently

1 Joint Injection

Skills

2 Perform soft tissue

injections.

SPECIALIZE PROCEDURE-OBSTETRIC & GYNAECOLOGY 1. GYNAE ONCOLOGY 2. MATERNO FETAL MEDICINE 3. REPRODUCTIVE MEDICINE

1. GYNAE ONCOLOGY



Please indicate ( ) the procedures that a generalists can perform with the required minimum training

Minimal training necessary for a generalist to perform the procedure competently

1 Radical Hysterectomy

5 procedures /year Yes

2 Radical vulvectomy

MOG/MRCOG Fellowship in Gynae Oncology 1 procedure /year Yes

Six month attachment to a gynae oncology centre

2. MATERNO FETAL MEDICINE

1 Cordocentesis 10 procedures per year

No -

2 Chorion Villus sampling

10 procedures per year

No

3 Amniocentesis (Early 14-16 weeks)

10 procedures/year No

3 Amniocentesis (Late >20 weeks)


Yes Level 2 U/S Course 1 month attachment to a fetomaternal centre

4 Ultrasound scanning Level 3


Yes 6 month attachment to a recognised training centre

5 Doppler wave form studies

30 procedures/year Yes Attendance at a Doppler course and logged experience post training of 30 cases

6 In-utero fetal exchange transfusion

MOG/MRCOG Fellowship in Materno -fetal medicine

5 procedures /year No

3. REPRODUCTIVE MEDICINE





1 Tubal reanastomosis

2 procedures /year

Yes Attachment to accredited surgeon and perform 2 procedures under supervision

2 Laparascopic surgeries Ectopic pregnancy Cystectomy Adhesiolysis

10 procedures /year

Yes Attended formal laparascopic course

3 Laparascopic assisted vaginal hysterectomy

MOG/MRCOG Fellowship in Reproductive Medicine

5 procedures /year

Yes Attended formal laparascopic course

SPECIALIZE PROCEDURE-PEDIATRIC

1. NEONATALOGY

2. PAEDIATRIC CARDIOLOGY

3. HEPATOBILIARY /GASTROINTESTINAL – PAEDIATRIC

4. PEADIATRIC NEPHROLOGY

5. PEADIATRIC NEUROLOGY

6. PEADIATRIC HAEMATOLOGY-ONCOLOGY

7. RESPIRATORY

8. PAEDIATRIC ANAESTHESIA

9. PAEDIATRIC GASTROENTEROLOGY/HEPATOLOGY

10. PAEDIATRICS CHEMICAL PATHOLOGY

NEONATALOGY No Procedures Minimal training

necessary for competence


Please indicate ( ) the procedures that a generalist can perform with the required minimum training


1. High Frequency Ventilation of newborn

Working as a specialist for 6 months in a tertiary centre where HFV has been used on at least 6 patients, or have been certified after an intensive course in HFV

Ventilating at least 6 cases a year on HFV

2. Use of Nitric Oxide in newborn

Working as a specialist for 6 months in a tertiary centre and has used NO therapy in at least 6 babies, or have been certified after an intensive course in NO therapy

Using NO in at least 6 babies a year

3. Conventional Mechanical ventilation of ELBW infants (BW<10kg)

Working as a specialist for 6 months in a unit which ventilates at least 50 new cases a year of which at least 10 are ELBW infants

Ventilating at least 3 ELBW cases a year

√

Working as a specialist for 6 months in a unit which ventilates at least 50 new cases a year of which at least 10 are ELBW infants

No Procedures Minimal training

necessary for competence


Please indicate ( ) the procedures that a generalist can perform with the required minimum training


4 Percutaneous inserion of central venous catheter (CVC) in ELBW infants

Working as a specialist for 6 months in an NICU and has performed at least 6 CVCs of which at least 2 are in ELBW infants

Inserting at least 6 CVCs a year of which at least 2 are in ELBW infants

√

Working as a specialist for 6 months in an NICU and has performed at least 6 CVCs of which at least 2 are in ELBW infants

5 Cerebral ultrasound scanning of the newborn

Working as a specialist for 6 months in an NICU and has performed at 20 cerebral ultrasound scans

Performing at least 20 cerebral ultrasound scans a year

√

Working as a specialist for 6 months in an NICU and has performed at 20 cerebral ultrasound scans

6. Ultrasound Scanning of the neonatal Brain

Minimum training duration 6 months . Supervised by accreditated neonatologist or paediatrician at accreditated centres

7. Ventricular tap

Minimum successful procedures -3 supervised by neonatologist or paediatrician at accreditated centres

PAEDIATRIC CARDIOLOGY No Procedures Minimal training necessary for competence 1 Cardiology

Echocardiography Cardiac cathetherization(at IJN) Pericardial tap/drainage

1. Training in a recognized training centre for 2 years 2. ECHO-transthoracic

2nd operator: 300 cases of supervised training ECHO TEE- 30 supervised Cases after credentialing for transthoracic ECHO

3. Cardiac Catheterisation Diagnostic catheterization 100 cases or 1 year supervised training Interventional Cardiac Catheterisation PDA embolisation 2nd operator -50 cases First operator-25 cases Aortic valvuloplasty 2nd operator-10 cases 1st operator -15 cases Pulmonary valvuloplasty 2nd operator-20 cases 1st operator -10 cases

SPECIALIZE PROCEDURE- ORTHOPAEDICS

No. Procedures Criteria to fulfill 1 Primary Arthoplasty

Minimal invasive Arthoplasty Revision Arthroplasty

-Standard criteria, generalist can perform -Needs formal training

2. Arthroscopy Surgery-menisectomy, removal of loose bodies, debridement of knee, open ACL repair, menisci repair Diagnostic shoulder arthrosopy Advance arthroscopy procedures & multi-ligamentous reconstruction of knee. Arthroscopy of small joint. Arthroscopic assisted ACL/PCL repair. Acromioplasty, Arthroscopic Bankart/Cuff repair.


3 Posterior lumbar spine procedures for Stenosis , prolapsed disc, degenerative, Infective and traumatic conditions. Laminectomy for thoracic spine Drainage of epidural abscess. Vertebroplasty. Pedicle screws fixation Posterior cervical wiring, C3 & Below All anterior spine procedures, cervical spine And thoracic spine procedures,correction Of spinal deformities, micodisectomy, video assisted spine surgery, spinal tumour surgery, spine osteotomy, minimally invasive spine surgery and other advance spinal procedures.


4 Advanced musculoskeletal trauma Procedures-complex pelvic and acetabular fractures, complex malunited neglected fractures and dislocations. Correction of complex deformities, Bone transport/lenghtening

-Need formal training

5 Excision of long bone or soft tissue Tumours with minimal reconstruction Radical excision/excision of large Tumours with massive reconstruction


6 Advance procedures in Pediatric Orthopaedic Surgery-Complex dysplastic hip procedures, surgery on complex deformities associated with syndromes, complex osteotomy procedures

-Needs formal training

7 Advance hand procedures and microsurgery

-Needs formal training

HEPATOBILIARY /GASTROINTESTINAL –PAEDIATRIC No Procedures Minimal training necessary for competence 1 Hepatobiliary/

Gastrointestinal 1. Ultrasound –guided liver biopsy -Min. no. observed=10 -Min. no. performed under supervision to achieve competence=10 -Min. done competently by ownself=10 2. Oesophago-gastro-duodenoscopy(OGDS) -Min. no. observed=20 -Min. no. performed under supervision to achieve competence=20 -Min. done competently by ownself=50 3. Colonoscopy -Min. no. observed=10 -Min. no. performed under supervision to achieve competence=10 -Min. done competently by ownself=20 4. 24h pH study -Min. no. observed=5 -Min. no. performed under supervision to achieve competence=5 -Min. done competently by ownself=5 5. Small bowel biopsy with Watson Capsule -Min. no. observed=5 -Min. no. performed under supervision to achieve competence=5 -Min. done competently by ownself=5

PEADIATRIC NEPHROLOGY No Procedures Minimal training necessary for competence 1 Percutaneous

Renal biopsy 1. Min. training duration-6 month 2. Min. successful procedures -30 3. Supervised by accredited consultant who has maintained credential status

2. Haemodialysis 1. Min. training duration-6 months 2. Supervised by accredited nephrologists

3 Chronic peritoneal dialysis

1. Min. training duration- 6 months 2. Supervised by accredited nephrologists

4 Continuous renal Replacement theraphy

1. Minimum successful procedures-5 2. Supervised by accredited consultant

5 Insertion of permanent dialysis Catheter

1. Min. successful procedures-5 2. Supervised by accredited nephrologists

PEADIATRIC NEUROLOGY No Procedures Minimal training necessary for competence 1 Muscle biopsy 1. Minimum training 3 months or observed at least 3 muscle biopsies

2. Performed a minimum of 5 muscle biopsies under supervision 2 Nerve conduction

(NCT) 1. Minimum training 6 months 2. Observed minimum 20 NCT. Performed minimum 20 NCT under supervision by an accredited

neurologist. 3 Electromyography

(EMG) 1. Minimum training 6 months 2. Observed minimum 10 EMG. Performed minimum 20 EMG’s under supervision by accredited neurologist

4 EEG interpretation 1. Minimum training 6 months 2. Observed and performed minimum 10 EEG’s under supervision . 3. Interpret and report minimum 100 EEG’s under supervision by accredited Neurologist(for

neonatal EEG, need extended training and competence to be assessed by supervisor before accreditation )

5 Brain stem auditory Evoked response (BAER) interpretation

1. Minimum training 6 months 2. Performed minimum 10 BAER under Supervision. 3. Interpret and report min. 20 BAER under supervision.

6 Visual Evoked Response(VEP)

1. Minimum training 6 months 2. Observe and perform minimum 3 VEP’s under supervision

PEADIATRIC HAEMATOLOGY-ONCOLOGY No Procedures Minimal training necessary for competence 1 Paediatric Haemotology-

Oncology Chemotherapeutic Treatment for all pediatric malignancies 1. Haematological

Malignancies 2. Solid tumours

1. One year of attachment to an accredited center with documented evidence of training in an active paediatric oncology ward under supervision.

2 Paediatric Haemopoietic Cell transplantation 1. Allogeneic 2. Autologous 3. Cord blood

1. At least one year training under supervision in an acreditated centre with an active paediatric bone marrow transplant programme

3 Therapeutic paediatric Apharesis procedures using a continuous flow cell –separator

1. Peripheral blood stem

1. At least one year training under supervision in an acreditated centre with an active paediatric bone marrow transplant programme with facilities for apharesis procedures (observe 5 and perform 15 procedures)

cell(PBSC)collection

2. Leucopharesis 3. Plasmapharesis 4. Platelet collection 5. RBC exchange transfusion

RESPIRATORY No Procedures Minimal training necessary for competence 1 Bronchoscopy

- Trancbronchial biopsy

- Fluoroscopy-guided Needle biopsy and fine needle aspiration biopsy

- Pleural aspiration biopsy

1. Trained for 1 year or performed 20 bronchoscopes under supervision 2. Performed 3 bronchial biopsy and brushing under supervision 3. Perform 10 bronchial washing and lavage under supervision

2 Respiratory function - Lung function test

1. Perform 10 lung function tests under supervision. 2. Reported 50 lung function test results, counter checked by supervisor

3 Sleep study 1. Perform 10 sleep studies under supervision 2. Reported 10 sleep study results, counter checked by supervisor

4 Bronchial challenge - Hypertonic saline - Exercise testing

1. Observed 3 hypertonic saline challenges and perform 3 challenges under supervision. 2. Observe 3 exercise testing and perform 3 under supervision

PAEDIATRIC ANAESTHESIA No Procedures Minimal Training necessary

for competence Maintenance of competence

1 Aneasthesia for neonatal surgery

6 month experience in neonatal anaesthesia

Active practice in paediatric aneshesia

2 Thoracic epidural anaesthesia for paediatric Patient

-6 months experience in paediatric anaesthesia -performed 10 procedures under supervision

Active practice in paediatric anaesthesia

PAEDIATRIC GASTROENTEROLOGY/HEPATOLOGY

No. Procedure Minimal training necessary for competence(Criteria)

Maintenance Of competence

Please indicate(√)the Procedure that a generalist can perform With the required minimum training


1 Ultrasound –guided liver biopsy

Min.no observed=5 Min. no. performed supervised by Accredited consultant gastroenterologist

hepatologist/surgeon/radiologist to achieve competence=5 Min. no done competently by

ownself=10

Min. no. performed per year=10

√ 6 months attachment in an active paediatric gastroenterology/hepatology/

hepatology unit.

2 Oesophago- Gastro –duodenoscopy (OGDS)

Min.no. observed (adult/paediatric)=20

Min. no. performed supervised be accredited consultant gastroenterologist/surgeon to achieve competence(adult/paediatric)=20

Min. no. done competently by ownself (paediatric)=25

Min. no. performed per year=12

- MBBS/MD and MRCP(Paeds)/MMed(Paeds)or equivalent and Minimum 3 years training in Paediatric Gastroenterology in recognized centres locally and overseas

PAEDIATRICS CHEMICAL PATHOLOGY





1 Active involvement in technical aspects of test decision making for the diagnosis and management of paediatric patients with endocrine & metabolic disorders and/or inborn errors of metabolism

For endocrine & Metabolic disorders -20 cases/week For inborn error of metabolism -5 cases/week

12 month Nil Nil

SPECIALIZE PROCEDURE-OTORHINOLARYNGOLOGY

1. OTOLOGY/NEURO OTOLOGY

2. RHINOLOGY

3. HEAD & NECK /LARYNGOLOGY

4. PAEDIATRIC ORL

OTORHINOLARYNGOLOGY

No Procedures Minimal Training necessary for competence 1 Functional

Endoscopic Sinus Surgery(FESS)

1. 3 FESS course by certified FESS surgeon 2. 3 supervised cadaver dissections. 3. 3 supervised FESS surgeries 4. Attachment under recognized FESS surgeon for minimum Period of 3 month

2 Cochlear Implant 1. Attended 2 recognized cochlear implant course 2. 3 supervised cadaveric cochlear implantation 3. 3 supervised cochlear implant surgery

3

Skull Base Surgery

1. 1 year attachment in recognized skull base center 2. Hands-on assisting in at least cases 3. Perform under supervision at least 1 case

4 Laser Surgery 1. Attended at least 1 laser course/ types and technique 2. Observe at least 3 cases 3. Performed under supervision at least cases

OTOLOGY/NEURO OTOLOGY 1 Advanced Mastoid Surgeries 2 Tympanoplasties & Ossiculoplasties 3 Facial nerve exploration & repair 4 Cochlear implant 5 Labyrinthectomy 6 Approaches to internal auditory canal & cerebellopontine angle 7 Temporal bone resection (lateral & total) RHINOLOGY 1 Functional Endoscopic Sinus Surgery 2 Septorhinoplasty 3 Craniofacial surgery 4 Transpheniodal Hypopphysectomy 5 Endoscopic Dacrocystorhinostomy

HEAD & NECK /LARYNGOLOGY 1 Salivary Gland Surgery 2 Neck Dissections 3 Flaps & Reconstructions 4 Pharyngolaryngectomy 5 Phonosurgery 6 Pharyngeal tumours excision 7 Laryngeal & Tracheal repair PAEDIATRIC ORL 1 Laryngotracheal repair 2 Paediatric endoscopy and airways management 3 Paediatric Head & Neck tumours excision 4 Reconstruction & Repair of congenital abnormalities in head & neck 5 Pediatric otological surgeries

SPECIALIZE PROCEDURE- CARDIOLOGY

1. PHYSICIAN WITH INTEREST IN CARDIOLOGY/CARDIOLOGIST

2. CARDIOLOGIST-(INVASIVE PROCEDURES

3. CARDIOLOGIST-(NON-INVASIVE PROCEDURES)

4. CARDIOLOGIST-(INTERVENTIONAL)

5. CARDIOLOGIST-(PAEDIATRIC)

6. CARDIOLOGIST/ELECTROPHYSIOLOGIST

7. CARDIOLOGY PROCEDURES EXCLUDED

CARDIOLOGY PHYSICIAN WITH INTEREST IN CARDIOLOGY/CARDIOLOGIST CATEGORY SECOND OPERATOR FIRST

OPERATOR ACCREDITED CENTRE FOR

TRAINING TRAINERS

Echo (Transthoracic) 300 cases or 6 months supervised training

- All hospitals with physicians Credentialled trainers

TEE (transoesphageal)

30 supervised cases (after credentialing for transthoracic)

- IJN All Univ. Hospitals with

cardiologist Penang Hopsital Johor Bahru

Credentialled Cardiologist

Stress echo 50 supervised cases (after credentialing for transthoracic)

- Visiting Cardiologist or IJN Penang Hospital


CARDIOLOGIST-(INVASIVE PROCEDURES) CATEGORY SECOND OPERATOR FIRST


TRAINING TRAINERS

Coronary angiogram (L and R. H. Cath)

100 cases 200 cases IJN Penang Hospital Johor Bahru Hospital University

Hospital /UKM


Permanent pacemaker

20 cases 10 cases IJN Penang Hospital Johor Bahru Hospital University

Hospital/UKM/USM


CARDIOLOGIST-(NON-INVASIVE PROCEDURES) CATEGORY SECOND OPERATOR FIRST


TRAINING TRAINERS

Nuclear Cardiology 100 cases 50 cases IJN Penang Hospital Johor Bahru Hospital University Hospital


CARDIOLOGIST-(INTERVENTIONAL) CATEGORY DURATION FIRST

OPERATOR SECOND

OPERATOR ACCREDITED CENTRE

FOR TRAINING TRAINERS

PTCA After 2 years of basic training or 500 cases of diagnostic angiogram

100 cases 50 cases IJN Penang Hospital Johor Bahru

Hospital University Hospital


PTMS/Other valvulo-plasty

After 2 years of basic Training or 500 cases Of diagnostic angiogram

30 cases 20 cases IJN Penang Hospital Johor Bahru

Hospital University Hospital


CARDIOLOGIST-(PAEDIATRIC) CATEGORY DURATION SECOND

OPERATOR FIRST



PDA Embolisation

Coronary Fistula Embolisation ASD closure

(percutanane)

To be advised by Paediatric Cardiologist

To be advised by Paediatric

Cardiologist

To be advised by Paediatric

Cardiologist

IJN Penang Hospital

Paediatric Cardiologist

CARDIOLOGIST/ELECTROPHYSIOLOGIST CATEGORY DURATION SECOND

OPERATOR FIRST



EPS/RFA A/CD

IJN UNIVERSITY

HOSPITAL

CARDIOLOGY PROCEDURES EXCLUDED

CATEGORY COMMENTS

1 Exercise Stress Test Common procedures performed by M.O with Physician/Cardiologist

Supervision

2 Temporary pacing Life saving procedures

3 Swan Ganz Life saving procedures

4 Pericardiocentesis Life saving procedures

5 Holter analysis Interpreted by Physician/ Cardiologist

SPECIALIZE PROCEDURE-DERMATOLOGY

1. CHEMICAL PEELING

2. LASER THERAPHY OF SKIN DISEASES

3. PHOTOTHERAPY OF SKIN DISEASES

CHEMICAL PEELING No Procedures Minimal Training necessary for competence 1 Very Superficial

peels 1. Day course with lecture covering:- Chemistry of glycolic acid, Indications, Contraindications, & Complication

2 Superficial Peels

2. Hands-on With different AHA Contreations

3 Medium depth peels

1. Day course with lecture covering:- Chemistry of glycolic acid, Indications, Contraindications, & Complication

4 Deep peels 2. Hands-on With different AHA concentrations (+ 20 patients with follow-up 6 months


i. Dept. Of Dermatology , Phototheraphy unit,HKL & Ipoh GH ii. National Skin Center, Singapore iii. Institute Of Dermatology , Bangkok , Thailand iv. Other centres with reputable phototherapy services approroved by

PDM LASER THERAPHY OF SKIN DISEASES No

Procedures

Minimal Training necessary for competence

1 Laser theraphy Basic Training which include: a. Lectures(8-10 hours) Laser physics, Laser tissue interactions, Laser safety, indications, contraindication,complication b. Practical session( 2-21/2 hours) Observation /Hands-on Preceptorship (8-16 hours) Observation/Hands-on –Several brief visits or more prolonged period -10 cases , preferably different under supervision Important for all trainees in Laser Surgery to document all laser procedures performed under supervision. For specialist trained overseas , they should be advised to submit documented evidence of training , competence and experience


1. Dept. Of Dermatology , Phototheraphy unit,HKL & Ipoh GH 2. National Skin Center, Singapore 3. Institute Of Dermatology , Bangkok , Thailand 4. Other centres with reputable phototherapy services approved by PDM

PHOTOTHERAPY OF SKIN DISEASES No

Procedures Minimal Training necessary for competence

1 a. UVB Phototheraphy b. Photochemotheraphy

1. 4 weeks attachment in Centre accredited to perform phototheraphy with documented evidendence of cases done under supervision 2. Attended at least one hands-on course on phototheraphy (including sessions on basic principles of phototheraphy


1. Dept. Of Dermatology , Phototheraphy unit,HKL & Ipoh GH 2. National Skin Center, Singapore 3. Institute Of Dermatology , Bangkok , Thailand

4. Other centres with reputable phototherapy services approroved by PDM

CREDENTIALING OF GENERAL PSYCHIATRIST This committee proposes that all universities are required to fulfill the following criteria: General Adult Psychiatry 24 months Child and Adolescent Psychiatry 3 Months (minimum) Community Psychiatry and Rehabilitation 3 Months Forensic Psychiatry 3 Months (minimum) Addiction 6 weeks Geriatric 6 weeks Consultation Liaison 2 months Neuromedicine 3 months Psychotherapy (total of 50 supervised sessions inclusive of dynamic, CBT, marital, group and family therapy-conducted during the course) Research/Dissertation as per university requirement The specific tasks of the 4 year training programme include the following :

1. Assessment and diagnosis 2. Management

a. Drug treatment planning b. Rehabilitation c. Psychosocial management d. Psychopharmacological treatment

3. ECT a. Evaluation b. Administration of ECT

4. Psychotherapies and psychological counseling a. Dynamic b. Behavioral therapy c. Cognitive therapy

5. Training in subspecialty areas: a. General adult psychiatry b. Child and adolescent psychiatry c. Community and rehabilitation psychiatry d. Forensic psychiatry e. Geriatric psychiatry f. Neuromedicine

CREDENTIALING OF SUBSPECIALITIES Each accredited training centre ideally should have 2 accredited trainers.

1. Child and adolescent psychiatry Supervised training for 24 month : inclusive of 1 years overseas training Place : MOH Hospital in Klang Valley UKM USM

Hospital Permai, Johor Bharu 2. Forensic Psychiatry

Supervised training for 24 month : inclusive of 1 years overseas training Place : Hospital Bahagia, Ulu Kinta Hospital Permai, Johor Bharu

3. Substance Abuse/Addiction

Supervised training for 6 months Place : Hospital Kuala Lumpur University Hospital

4. Geriatric Psychiatry

Supervised training for 6 months Place : Hospital Kuala Lumpur Hospital Sultanah Aminah, Johor Bharu KIV Hospital Umum Sarawak (trainer dependant)

5. Community psychiatry Supervised training for 6 months Place : Hospital Permai, Johor Bharu Hospital Bahagia, Ulu Kinta Hospital Alor Setar Hospital Sentosa, Sarawak

UKM Hospital Kuala Lumpur

6. Liaison psychiatry

Supervised training for 12 months

7. Neuropsychiatry Supervised training for 12 months Place : no recognized centre (centre must also have an accredited neurologist)

8. Psychodynamic therapy /Cognitive-Behavioral Therapy (CBT)

Supervised training for 12 months

APPLICATION PROCEDURES

1. Psychiatrists are required to apply to the credentialing committee via the Ministry of Health

2. To be credentialed as a general psychiatrist, the person has to be actively practicing i.e. work that is equivalent to working days ( 1 working day/week) and satisfactory CME participation in a year (as determined by the MOH)

3. Any psychiatrist working in government/quasi government can be considered active practitioners if they satisfy the requirement for renewal of annual practice certificate (APC)

4. Psychiatrists in the private sector need to apply to the committee for credentialing. APPEAL MECHANISM If the committee rejects any application for credentialing, they may forward an appeal to the National Credentialing Committee.

PLASTIC SURGERY


1 Craniomaxillofacial surgery

6 to 12 months fulltime training/ fellowship in internationally recognized craniofacial centres

2

Advanced hand surgery

12 months fulltime training/ fellowship in internationally recognized hand surgery centres

ORAL AND MAXILLOFACIAL SURGEONS

No Procedures Minimal Training necessary for competence 1 a. TMJ Surgery

b. Management of complex Maxillofacial injuries

c. Rhinoplasty d. Maxillofacial reconstruction e. Parotid surgery f. Correction of complex

congenital dentofacial deformities

These procedures require 3 month of further training in a recognized center and Oral and Maxillofacial Surgeons

Specialized Procedures which needs separate Credentialing (UROLOGY)

Procedures Basic Qualification Criteria

1. Hypospadias Repair *10 + 10

2. Laparoscopic Marsupialisation 5

3. Laparoscopic Varicocelectomy 5 4. Incontinence (Sling Procedure) 5 5. Aus Procedure 5 6. Laser Prostatectomy 20

7. Renal Transplantation *5 + 10 8. Laparoscopic Nephrectomy *10 + 10 9. Radical Prostatectomy (Open) *10 + 10 10. Radical Prostatectomy

(Robotic)

*25 + 25

11. Laparoscopic Nephrectomy *5 + 5 12. Hand Assisted Nephrectomy

Gazetted

Consultant

Urologist

*5 + 5

SPECIALIZE PROCEDURE- PATHOLOGY

1. PAEDIATRICS CHEMICAL PATHOLOGY

2. MEDICAL MICROBIOLOGY 3. TRANSFUSION MEDICINE 4. CYTOPATHOLOGY/CYTOGENETICS 5. FORENSIC MEDICINE 6. METABOLIC AND ENDOCRINE

PAEDIATRICS CHEMICAL PATHOLOGY





1 Active involvement in technical aspects of test decision making for the diagnosis and management of paediatric patients with endocrine & metabolic disorders and/or inborn errors of metabolism

For endocrine & Metabolic disorders -20 cases/week For inborn error of metabolism -5 cases/week

12 month

Nil Nil

MEDICAL MICROBIOLOGY





1 2

Virology Immunology Mycology parasitology

Nil

Nil

a. 2 years in recognized centre b. Log book c. Supervisor’ report

a. 1 year in recognized centre

b. Log book c. Supervisor ‘s

QAP CME Practising

QAP CME Practising

TRANSFUSION MEDICINE





1 Aphaeresis Cryo Preservation Blood component prepation Clinical transfusion Transfusion microbiology

1.CME activity 2.QAP 3.Practising in transfusion centre

√ √ √

1 year

CYTOPATHOLOGY/CYTOGENETICS





1 2

CYTOPATHOLOGY Cytopathology reporting Including Gynae/Nongynae & FNAC CYTOGENETICS Cytogenetics processing And interpretation

1 year in a recognized centre with due completion of logbook & supervisor’s report 12 month

CME QA Practising in Cytopatology QAP CME Practising

√ √

FORENSIC MEDICINE





1 2 3

FORENSIC TOXICOLOGY Interpretation of difficult Toxicological results from post mortem samples PAEDIATRIC FORENSIC Special examination(Post Mortem)on paediatric Cases CLINICAL FORENSIC Special examination For clinical forensic cases

1 year 1 year 1 year

CME QAP Practicing CME QAP Practicing CME QAP Practicing

√ √ √

1 year 1 year 1 year

4. 5.

FORENSIC ANTHOROPOLOGY Examination of skeletal remains FACIAL RECONSTRUCTION AND IDENTIFICATION

1 year 1 year

CME QAP Practicing CME QAP Practicing

√ √

1 year 1 year

METABOLIC AND ENDOCRINE





1. 2.

Active involvement in patient management Active involvement in technical aspects

Active involvement In managing Endocrine cases

12 months Nil Nil

CORE PROCEDURAL SKILLS OF SPECIALIST ON COMPLECTION OF MASTERS OF

FORENSIC MEDICINE

All the specialist in Forensic Medicine after qualification should attain a wide range odd skills and knowledge in:

a) Performing medico-legal autopsy b) Interpretation of post-mortem findings

c) Preparation of post-mortem report

d) Examination of organs macroscopically and microscopically

e) Identification forensic cases that need to be referred and discussed with the senior

consultants

f) Attendance at the crime scene and to render help to the investigating officer in the collection of specimens

g) Giving evidence as an “expert witness” in court

h) Managing mass disasters

i) Collection of samples in forensic cases for toxicology and other relevant

investigations

j) Planning and conducting research in forensic medicine and pathology

k) Legal aspects of forensic medicine practice in Malaysia

l) Management of forensic (medicine) laboratory

m) Clinical forensic medicine

CORE PROCEDURAL SKILLS OF SPECIALIST UPON COMPLECTION OF MASTER

OF PATHOLOGY (FORENSIK) AND ITS EQUIVALENT

Forensic Pathology Performing complete medico-legal autopsies including specialized techniques

Interpretation of post-mortem reports Preparation of post-mortem findings Examination of organs macroscopically and

microscopically Managing mass disasters Legal aspects of forensic medicine practice in Malaysia Scene of Crime Management

The role of forensic pathologist at the scene of crime

Preparation and presenting evidence in Court

Giving evidence as an “expect witness” in court

Basic Forensic Toxicology and Science

Proper handling of medico-legal specimens

Interpretation of various toxicological and laboratory result

Clinical Forensic Medico-legal examination of the injured victims Medico-legal examination of the victim/suspects in

sexual offences Medico-legal examination of non-accidental injuries in

children Medico-legal examination of victims of interpersonal

violence, battering in custody, torture etc Medico-legal aspects of Traffic Medicine Identification of the living Medico-legal examination of drugs and substance of

abuse Specialty degrees that are recognized by the Malaysian Government following basic degrees of M.B.B.S or M.D are :-

1. M. Path (Forensic) or equivalent 2. D.M.J (Path) by The Society of Apothecaries 3. Masters in Medical Science (Forensic) from the University of Glasgow 4. M.R.C. Path / F.R.C.PA. (Forensic)

For Gazettement for all specialty degrees a period of 6 months is recommended. PROCEDURES FOR CREDENTIALING SUBSPECIALITY IN FORENSIC MEDICINE

Subspecialities Procedures Criteria

1. Clinical Forensic Medicine

Maintenance of competence by CME, QAP and practicing

Minimum of 12 months training under the charge of a person renowned in the field locally or overseas after gazettement in Forensic Medicine

2. Forensic Anthropology Maintenance of competence by CME, QAP and Practicing


3. Forensic Toxicology Maintenance of competence by CME, QAP and Practicing


4. Forensic Neuropathology

Maintenance of competence by CME, QAP and Practicing


5. Paediatric Forensic Medicine



6. Facial Reconstruction & Identification



7. Advance Forensic Histopathology



RECOMMENDATIONS OF THE SPECIALTY SUBCOMMITTEE IN FORENSIC MEDICINE. 1. High Risk Autopsy The speciality subcommittee recommends additional training experience in High Risk Autopsy Procedures. These procedures include carrying out autopsies on highly infectious cases, radiation, bioterrorism, physical and chemical hazards. 2. New Techniques and Technologies Application of new and advanced instruments and investigation kits – eg. MRI and CT scan autopsy procedures Missing Persons Identification Management of Mass Disasters Crime Scene Investigations High Technology Autopsy Room Cadaveric Organ harvesting procedures Virtopsy Thanatology eg. Body Farm in Tennessee Forensic Histotechnology 3. Employment of foreign Forensic Medicine Specialist The subcommittee recommends that any foreign Forensic Medicine Specialist who seek employment in the Ministry of Health and the universities in this country should be assessed and vetted by the Specialist Subcommittee in Forensic Medicine appointed by the Ministry of Health. The following justifications are recommended to be imposed to the foreign forensic specialist seeking employment in this country.

1. They must possess a basic medical degree recognized by the MMC. 2. The post graduate qualification must also be recognized by the MMC and the

Specialist Subcommittee in Forensic Medicine appointed by the Ministry of Health.

3. The laws of the country must be respected by these individuals.

The committee is concerned with the legal implications of foreign specialist who were employed here and later returned to their home countries and subsequently causing delays in court proceedings and other related complications

specialised procedures for credentialing 1. …

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