THE FCPS PROGRAM

GME in Pakistan     GME in THE UK    GME in THE USA

The Different Specialties

The FCPS-I Exam.

Timing Of The FCPS-I Exam And The “1-Year Delay”.

After Passing FCPS-I

The Components of FCPS Training

Clinical Skills Courses

The Dissertation.

The FCPS-II Exam..

Upon finishing the house job, the doctor becomes eligible to pursue a specialization training program called the FCPS. This stands for ‘Fellow of College of Physicians and Surgeons’. The term FCPS is used loosely to refer not only to the system of post-graduate medical training, but the exams needed to complete such training, as well as the qualification itself. In other words after the house job, the doctor will enter the FCPS system of training, will give the FCPS exams in the process, and when successful, will attain the qualification of FCPS.

The term FCPS is used to refer to all the specialties. A doctor training and successfully completing the training program in ENT will be called an FCPS just as a doctor completing a training course in Medicine will be called an FCPS. This doesn’t mean however that the FCPS training programs for the different specialties are the same - on the contrary, the FCPS exams and training content are different for different specialties.

Regardless of the specialty, the FCPS exams consist of two parts: the FCPS-I and the FCPS-II.

To enter an FCPS training program, the doctor must pass the FCPS-I exam. After the exam, he will apply for training posts and take interviews to secure those posts. An FCPS trainee is called a Trainee Medical Officer, (TMO) or a Postgraduate (PG). His training will last for either 4 or 5 years, depending on the specialty. When his training period is over, he will be eligible to sit for the FCPS-II exam, and if he passes it, he will be awarded the qualification of FCPS – which designates him as a specialist in his field.

There are many specialties that the FCPS is offered in, although it must be kept in mind when choosing to pursue a certain specialty that the number of training posts for that particular specialty may be limited.

The major specialties are:

·         Medicine and Allied

·         Surgery and Allied

·         Anesthesia

·         Diagnostic Radiology

·         Dentistry

·         Gynecology and Obstetrics

·         Ophthalmology

·         ENT

·         Pathology

·         Psychiatry

·         Basic Medical Sciences

In order to enter any of these specialties as an FCPS trainee, the doctor must have done his house job in that specialty. He cannot, for example, do his house jobs in ENT and Eye and then sit for the FCPS-I exam for Medicine. If he wishes to pursue Medicine (or one of the Allied specialties), he must have done one of his house jobs in Medicine.

The Allied specialties for Medicine are:

·         Cardiology

·         Clinical Hematology

·         Dermatology

·         Gastroenterology

·         Neurology

·         Pulmonology

·         Physical Medicine & Rehabilitation

·         Clinical/Chemical Pathology

·         Community Medicine

·         Family Medicine

·         Nephrology

·         Nuclear Medicine

·         Pediatrics

If you wish to go into one of the specialties allied with medicine, you can do your house job in medicine and be eligible to enter the training program of a specialty that is allied with medicine. For example, doing a house job in medicine (6 months) and then surgery (6 months) will allow you to be eligible to pursue a Pediatric FCPS program.  However, when applying for such specialties (as a TMO), you must keep in mind the number of available TMO positions available in that specialty and the location of such positions. Information regarding the competitiveness of a specialty can best be obtained by asking those senior to you in the hospital you wish to apply to. If for example, there are only 5 TMO positions available in Clinical\Chemical Pathology (for the whole province), you should investigate the locations and availability of these positions and keep this information in mind when planning your FCPS training. It is quite possible, for example that a certain specialty is not available in your province.

The same principles apply to the specialties allied to Surgery:

·         Cardiac Surgery

·         Orthopedic Surgery

·         Plastic Surgery

·         Urology

·         Neurosurgery

·         Pediatric Surgery

·         Thoracic Surgery

The period of training for Medicine, Surgery and Allied is 4 years. For the ‘minors’ like ENT and Eye, it’s 5 years while Gynecology/Obstetrics is 4½ years. Every specialty has a detailed prospectus with information regarding the FCPS exams for that specialty, training requirements, dissertations, etc… Anyone interested in pursuing an FCPS training program should obtain the prospectus from regional CPSP offices or from the central CPSP headquarters in Karachi.

The FCPS-I exam, in all the specialties tests knowledge in the basic sciences. It is a single, 3 hour MCQ paper. The exam focuses on those sections of basic sciences that are relevant to its specialty. For example the FCPS-I exam for Gynecology and Obstretics will focus more on the Pelvis and Perineum in its questions of gross anatomy while the FCPS-I exam for ENT will focus on Head and Neck in its anatomy questions. Similarly, the FCPS-I contains questions from the other basic sciences (besides anatomy) that are relevant to its own field besides containing general questions relevant to all specialties.

There is no negative marking in this exam of 100 questions - however the pass rate is low, ranging from 8-30%. This is because the passing margin is set quite high at approximately 80%, which means a candidate cannot afford to get more than 15-20 questions wrong.

The subjects tested in the FCPS-I exam are:

·         Anatomy (Gross, Histology, Embryology, Neuro-anatomy)

·         Physiology

·         Pharmacology

·         General and (some parts of Special Pathology)

·         Microbiology

·         Community Medicine (not a major subject, unless the specialty itself is Community Medicine)

Specialty Related subject: Although clinical sciences are not included in the FCPS-I exam, reading a specialty related book would help integrate the relevant basic sciences information. For example, reading an ENT book for FCPS-I ENT exam would most definitely be of some benefit.

The FCPS-I exam is held 3 times a year. The dates for the exams are not the same every year, but approximately in the time-periods mentioned below.

·         February/March

·         June/July

·         October/November

In order to take the FCPS exam, the application to the CPSP must reach two months before the exam date itself. So if a candidate wants to give the exam in February/March, the exam application must be in the CPSP offices in December. In Khyber Medical College, the house jobs currently ends in late January so submitting an application for the FCPS-I exam for the February/March date is not possible because in December, the candidate would not have finished his house job and will therefore not have elevated his provisional registration to a full registration – which is an essential requirement for eligibility to the FCPS.

This means that the candidate cannot appear in the February/March FCPS-I exam, but will have to wait for 5 months till the June/July date. He will not be able to move forward in his post-graduate training during those 5 months. Even if he gets a job as an RMP somewhere, his work will not count towards his FCPS training.

Further, the delay is not of just 6 months, but it stretches out to one year. The reason is that FCPS trainees are entered into training hospitals every June and January. Since you are ineligible to take the exam in February/March, you will have to wait for June/July. However, when you pass the FCPS exam in June/July, the interview date for new trainees will already have passed and their training started. Therefore, if a graduate ends his house job in January, he will only be able to sit for the FCPS Part I exam in June, and will have to wait till the next January to start his FCPS training. There is, as a result a year-long gap between the end of the house job and the start of the FCPS training.

There is one possible way to avoid this one-year gap. You can, as you near the end of your house job obtain a statement signed by the administrative head of your hospital that you will finish your house job in a few months time. You can use this statement in place of your certificate of full registration with the PMDC in order to appear for the FCPS-I exam in March. In NWFP however, the one-year gap will still apply because TMOs are inducted into their FCPS training program only in January. Therefore, even if a house officer from NWFP gives his FCPS-I exam in March (a couple of months after finishing his house job) he will still have to wait for 8-9 months till January to start his TMOship. However, in other parts of the country like Punjab, Karachi and Islamabad, TMOs are inducted twice a year (in January and June) so a doctor from NWFP can choose to apply to a teaching hospital those areas in the following June.

After passing, you will apply for a TMO (Training Medical Officer) post in a certain hospital. It must be mentioned here that not all TMOs are awarded the post. Every province in Pakistan has a fixed number of TMO posts which it can give and if the number of applicants exceeds the number of TMO positions available then some will be left out. Such applicants thereafter can apply for non-training jobs in private or government hospitals as Medical Officers. The pay, in private hospitals may be marginally higher for non-training posts (although this is not always the case), but the downside of it is that the experience will not be counted towards an FCPS degree.

As a result of the limited number of TMO posts available, in some parts of the country, the induction of TMOs into FCPS programs may not be twice, but once a year.

After you have secured an FCPS training post, you will begin your duties. It is generally acknowledged that the workload for TMOs is very demanding, more so perhaps than for junior doctors in the US and UK. In many hospitals, TMOs are given a lot responsibility for patient care and management – with these responsibilities increasing as the TMO moves forward in his training.

During the course of training, the medical TMOs must take 3 mandatory workshops while the surgical ones must take 4. These workshops have to be taken within the first 18 months of TMOship:

·         Computer and Internet Skills. Lasts for 5 days and imparts basic knowledge of how to use computers and the internet. For those who feel they already have such skills, there is an equivalence test one can pass to attain a certificate attesting to the fact.

·         Research Methodology, Biostatistics, Dissertation Writing. Lasts for 5 days and gives an intensive course on how to conduct research, how to interpret the data from such research and how to incorporate these skills in a Dissertation (see below).

·         Communication Skills. A 3 day course on effective communication techniques in presentations, workshops and seminars.

These three workshops are mandatory for all TMOs regardless of their specialty and must be taken within the first 18 months of training.

For the TMOs in surgery, an additional 3 day workshop on Basic Surgical Skills is also mandatory – also to be taken within the first 18 months of TMOship.

These workshops cost Rs. 8,500 each except for the Computer and Internet Skills workshop which costs Rs. 7,500. They are held several times a year.

(The workshops can be taken by any doctor, not just a TMO. This fact was mentioned in the UK section of this manual to point out that such workshops strengthen an individual’s CV as they are officially organized by the CPSP and therefore recognized abroad.)

These are non-mandatory courses lasting 5-7 days in which a group of senior doctors volunteer to conduct a thorough revision of clinical examination procedures to candidates who will soon be appearing for the FCPS-II exam (which contains a clinical examination component). The course cost around Rs. 500 and are usually held some time before the FCPS-II exam dates.

For those non-FCPS-II candidates who wish to add to their CV, it should be noted that these courses are not formally organized by the CPSP, and as such will have limited value to a doctor who is not an FCPS-II candidate. In other words, attending such a course will not add appreciably to your CV in the way the CPSP-organized workshops will.

To quote the FCPS Dissertation Instruction Manual, issued by the CPSP.

“Submission of Synopsis/Protocol on a chosen topic, its approval from Research and Training Monitoring Cell (RTMC), CPSP, and preparing a dissertation, acceptable to the College, is mandatory for all candidates aspiring to appear in the FCPS II theory, clinical and oral examinations. In doing so, the CPSP aims at:

·         Cultivating an inquiring mind in its potential specialists.

·         Encouraging in-depth studies related to common health problems afflicting our people.

·         Generating scientific data in various medical and allied fields.”

Basically, the dissertation is an original work of research that is carefully preparing over the course of FCPS training and must be submitted at least 9 months before the date the trainee wishes to appear in the FCPS-II exam.

This exam has two components, a paper exam and a clinical/oral exam. The FCPS-II paper exam consists of 100 MCQ questions while the clinical/oral exam is held with the cooperation of real patients. When presented with a patient, the candidate will have to take history, conduct the clinical examination, and propose a management plan. In the oral component of this part of the exam, the candidate will be thoroughly tested for in-depth knowledge of his specialty.

The FCPS-II is not considered to be an easy exam. The pass rate is low and it is not uncommon for doctors to take it more than once before they pass. After passing however, the FCPS period of training is officially over and the doctor is awarded the highly regarded FCPS degree, and qualified as a specialist in that field.