For healthcare institutions

Details about accreditation as Learning Institution.

Last updated 10 April 2025

Accreditation as Learning Institution

Currently new International Medical Graduates (IMGs) from recognised schools on the Schedule in the Medical Registration Act may apply for Conditional registration to practise only in approved healthcare institutions (AHIs), under the supervision of fully registered medical practitioners.

Healthcare providers who wish to recruit new¹ IMGs to work at their institutions can apply to SMC to be accredited as Learning Institutions (LIs). Healthcare providers may wish to note that certain structures and processes, as listed below, should be in place, for their applications to be considered.

The pre-requisites are as follows:

1. The institution has been accredited by JCST and/or ACGME-I for the training of residents or trainees;

2. If not accredited as above, all the following criteria must be met:

(A) Institution structure for LI

There is a departmental structure in place within the institution where doctors have the opportunity to work as a team in the management of patients.

An institution which intends to employ new IMGs as specialists in an ambulatory practice must produce evidence of at least three (full-time) specialist doctors (in the same specialty) with multi-layered supporting care, handling a wide range of simple and complex cases and a proper governance structure similar to the public healthcare institutions.

The following will not be allowed to fulfil criteria:

a) General Practitioners (GPs) named in a practice but who only work there on a part time basis for less than 50% of each week or who are deployed there only as and when required.

b) Specialists who run their own practices calling themselves a ‘group’ when, in fact, there is no organised or structured institutional practice.

c) Specialists named in an organised institutional practice, but who are not, in fact, working full time in the practice. (e.g. a so-called ‘cardiology centre’ which is organised in a way where cardiologists with their own practices participate on a sessional or rotational basis each for less than 50% of each week).

d) Different specialists physically co-located, but not involved in an institutional style service programme. (e.g. a hypothetical group comprising a cardiologist, a gastroenterologist, a paediatrician and a general surgeon who share a large combined clinic, but who actually work independently of one another.)

(B) Supervisory Framework for LI

There must be sufficient supervisors who meet the criteria for supervising new conditionally registered doctors under SMC's supervisory framework.

Supervisory framework for LI

Index	Description	Requirements
1	Supervisor working hours	Full Time
2	Minimum number of Senior doctors	a. At least 2 fully registered (F-reg) senior doctors (including the supervisor) in the same practice place. b. 2 part-time senior doctors (but not the supervisor) can be counted as 1 full-time doctor if they work at least 50% each to cover the working-week.
3	Criteria of Senior doctors in item 2	Supervisee is a Specialist The Senior doctors should: a. be from the same speciality b. be accredited by SAB and be in the Register of Specialists of SMC c. have been fully registered for at least 5 years; and d. have at least 5 years of experience as a specialist under F-reg in Singapore Supervisee is a FP/GP The FP Senior doctors should: a. be accredited by FPAB and be in the Register of Family Physicians of SMC b. have been fully registered for at least 5 years; and c. have at least 5 years of experience as FPs and/or GPs under F-reg in Singapore The GP Senior doctors should: a. have been fully registered for at least 5 years; and b. have at least 5 years experience as GPs under F-reg in Singapore Supervisee is a non-specialist (Medical Officer) The Senior doctors should: a. be from the same speciality as the department where the supervisee is practising in (e.g. if the supervisee is practising in the Department of Cardiology, the senior doctors should be Cardiologists); and b. be accredited by SAB and be in the Register of Specialists of SMC; c. have been fully registered for at least 5 years (N.B. need not necessarily be a specialist for 5 years under F-reg in Singapore)
4	Supervisor - Supervisee Ratio	The institution must observe and maintain the supervisor-supervisee ratio, the intensity of supervision as stipulated, and comply with the guidelines issued by the SMC.
5	Monitoring and Feedback	The institution must ensure there is a proper system of assessment, monitoring and feedback regarding the performance of both doctors and their supervisors, as follows: a. There should be proper documentation of the feedback which may be audited at any time. b. There should be multiple assessment tools and evaluators available – i.e. supervisors, peers, patients, and other professional staff, to review the performance of each doctor. c. In the event of any weakness identified on the new doctor, there should be an appropriate action plan prepared to correct the deficiencies and properly documented Log Book a. Must maintain a log book with 3 cases per week for the first 6 months; b. All cases must be signed by supervisor; and c. To be submitted with 3-month and 6-month assessment reports.
6	Quality Assurance Framework	The institution must have in place a quality assurance framework that allows quality improvement and system-based learning

Intensity of supervision for LI

Level of supervision	Month	Percentage of case notes to be audited
Level of supervision	Month	At the Registered Practitioner level (Medical Officer or equivalent)	At the Specialist level
L1	Month 1	100%	50%
	Month 2 and 3	50%	25%
	Remaining duration	10%	10%
L2	Entire duration	10%	10%

(C) Training programme for LI

The institution must have in place a structured training programme or programmes for its doctors, for peer interaction and practice-based learning.

Training programme for LI

Training	Requirements
Frequency and Evidence of training	At least 2 times a week - A minimum of 1 structured internal event; The other can be a grand ward round, mortality/morbidity round, case discussions, topical review, talk; These programmes must involve the participation of substantially of all of the doctors within the department or same clinic/practice place; There should be live interaction, which may be virtual, e.g. through Skype conference; The doctor must be provided time to attend other CME accredited activities organised by other institutions, chapters of AMS or professional societies; and There must be evidence of internal training activities in the form of monthly published schedules of events, rosters, records with participants, topics, dates etc, indicated.

Training

Requirements

Frequency and Evidence of training

At least 2 times a week -

A minimum of 1 structured internal event;
The other can be a grand ward round, mortality/morbidity round, case discussions, topical review, talk;
These programmes must involve the participation of substantially of all of the doctors within the department or same clinic/practice place;
There should be live interaction, which may be virtual, e.g. through Skype conference;
The doctor must be provided time to attend other CME accredited activities organised by other institutions, chapters of AMS or professional societies; and
There must be evidence of internal training activities in the form of monthly published schedules of events, rosters, records with participants, topics, dates etc, indicated.

The details of the supervisory framework, which is reviewed from time to time, can be found above. For more information, please contact Secretariat at SMC@spb.gov.sg

¹ ‘New’ IMGs refer to IMGs who are not currently practising in Singapore and are newly recruited to work for the LI.