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Master Surgery – Neurosurgery [M.S (Neurosurgery) USM]


1. BACKGROUND AND COURSE DESCRIPTION:

The USM Department of Neurosciences of the School of Medical Sciences which is part of the University’s Neuroscience Center of potential excellence in Services and Research awarded in December 2011 by the Minister of Higher Education Datok Seri Khalid Nordin is currently the leading provider of the comprehensive neurological and neurosurgical services to cater the needs of the whole population in the East Coast of Peninsular Malaysia. This civil responsibility and achievement is made possible with the availability of state of the art facilities for patient services whilst ensuring concurrent high quality teaching and research for medical, surgical and other allied health trainees. As the Malaysia's forerunner in providing clinical and basic neurosciences training for both undergraduate and postgraduate levels, the Department is proud to be the first to offer residency training program in neurosurgery in Malaysia since 2001.

This is a four-year residency training program by coursework leading to the award of USM Masters in Neurosurgery. Candidates selection are based on candidates' academic achievement as well as prior general surgical and neurosurgical experiences. This selection is made by a conjoint board appointed by the University. The main objective of this program is to train young surgical trainee to become competent neurosurgeons who will extend their expert neurosurgical skills with the community, conducting research in neurosciences and provide continuing training for medical under- and post-graduates.To date, the program has produced 30 trained and qualified neurosurgeons since 2001, serving the various hospitals/health institutions in Malaysia including Sabah and Sarawak.

Although the course is intended for local Malaysian surgical trainees only for the next 5 years to fulfill the Economic Planning Unit of the Government of Malaysia’s needs.
Foreign nationals working abroad(not working in Malaysian institutions) are invited and encouraged to apply, provided that they meet the following minimum entry criteria: completed M.R.C.S or equivalent qualification and completed at least 48 months* of general surgical posting/rotation in a recognised post (such as a medical officer) within recognised institutions/establishments. Bear in mind that there will be no exemption for such candidates whereby the course duration remains a minimum of 4 years and to sit all examinations required with successful submission and defense of a dissertation. The maximum duration allowed is 7 years. (*: 24 months for Malaysian candidates).The governments sending these candidates will need to make sure that the degree will be recognized in their country when they return back to work as recognized specialist in their country.

Candidates are strongly advised to discuss their expression of interest ahead of submitting a formal application with the Program Coordinator (see details below) to avoid disappointment with their applications for this highly competitive neurosurgical residency training program.

2. OVERVIEW

1. GENERAL CURRICULUM AND OBJECTIVES
   
   INTRODUCTION
   This is a 2 + 4 years programme.
   The initial 2 years are the prerequisite years and subsequent 4 years are the actual training in neurosurgery years.
   Successful candidate would be awarded a degree in Master of Surgery (Neurosurgery) by the Universiti Sains Malaysia (USM), UM, UKM (Doctorate in Neurosurgery).
   
   TWO PREREQUISITE YEARS AND BASIC SURGICAL
   
   Objective:
   To gain knowledge and understanding in principles of surgery and neurosurgery.
   The trainee must have completed the housemanship years.
   The trainee must have completed these two prerequisite years by having:-

1. 12 months experience in neurosurgery
2. 6 months experience in general surgery and
3. 6 months experience in any surgical-intensive care speciality (including general surgery and/or neurosurgery again and/or anaesthesia-intensive care)

Those attachments must be done in hospitals or institutions recognized by the University/Ministry of Health.

FOUR YEARS OF NEUROSURGICAL TRAINING
These are divided into 2 training parts with 3 phases.

1. Part 1 in neurosurgery (Phase 1 – Year 1)
2. Part 2 in neurosurgery (Phase 2 – Year 2 and 3; and Phase 3 – Year 4)

Objective:
The aim of this program is to provide the best medical training in Neurosurgery for Malaysia’s needs. The candidates would therefore be capable of carrying out responsibility as a Neurosurgeon in providing the best medical care for the patients.

Specific objectives:

1. To ensure a sound knowledge and understanding in basic medical science (physiology, pathophysiology, pharmacology) especially in the field related to Neurosurgery.
2. To ensure a sound knowledge and understanding in General Surgery, Neurology, Neurophysiology, Neuroanatomy, Neuropathology, Neuroradiology, Intensive care and Operative Neurosurgery.
3. Competence in performing neurosurgical procedures.
4. Capable of accurately diagnosing neurosurgical problems.
5. Be able to offer an appropriate and effective management to the neurology patients.
6. Possesses an outstanding leadership quality and a profound interest in promoting neurosurgical and neurological knowledge.
7. To promote and enhance the understanding of medical ethics. The exposure would emphasize on the understanding of the disease, holistic medical approach and providing the best medical care in accordance with international standard.
8. Thorough understanding of neurological diseases that require an effective care and commendable epidemiological knowledge relating to the disease.
9. To effectively manage all emergency neurosurgical and neurological cases.
10. To master the knowledge of neurosciences and thus keep abreast with current development in neurosurgery and neurology.
11. Acquire the ability of conducting research in neurosurgery.
12. To be a neurosurgeon that is highly competent in providing the necessary emergency care which comprises a prehospital care, in patient management including the rehabilitation aspect.

2. CURRICULUM STRUCTURE:
   

   Part 1 in Neurosurgery (Phase 1)

   Objective:

   1. To gain further knowledge and understanding in basic and related neurosurgical sciences or fields.
   2. To gain knowledge in neuro-localisation of the pathology
   3. To gain capability in accurately diagnosing neuro-related emergency or non-emergency problems.

   In order to achieve the objectives, Phase 1 covers the following subjects:

   1. Neuroanatomy
   2. Neurophysiology
   3. Neuropathology
   4. Neuropharmacology
   5. Neuroradiology
   6. Basic Neurosurgery
   7. Basic in Neurology
   8. Neuro intensive care

   Thus, the trainee must have attachment at the following specialty:

   1. Neurology for 3 months
   2. Neurointensive care for 3 months
   3. Neuroradiology and Neuropathology for 2 months (1 month each)
   4. Neurosurgery for 4 months

The summary:

Part 2 in Neurosurgery (Phase 2 - Year 2 and 3)

1. Phase 2 would emphasize on operative neurosurgery. The candidate will do the attachment at our various recognised training centre.
2. The trainee would be expected to continuously embrace and enhance the knowledge and be an expert in providing treatments in neurosurgical fields. In the years, the knowledge would also be provided through lectures, tutorials, demonstration, clinical conferences and hands-on experience whilst performing surgical procedures. Group discussions and journal club would also be organized. Candidates would be actively involved in seminars and post-graduate intensive/teaching courses organized by the university, other centres or society. The candidate would assume the ‘on-call’ responsibility with the specialists.
3. The knowledge in biostatistics, good clinical practice (GCP) and medical ethics would facilitate in producing neurosurgeons that are responsive and sensitive towards their environment. This would help in providing optimum medical care.
4. The candidates are also required to carry out research thesis or publication by research on interesting topics in order to achieve a better understanding regarding the disease processes
5. The university or training centre would provide lecture notes, articles and journals, reference books and audio-visual materials in related fields. The candidates and supervisors would prepare the materials
6. The candidates are also encouraged to be actively involved in the program organized by the university or society.
7. Candidates must successfully attend the compulsory courses and strongly advocated to attend the preferable courses .
8. Year 3 syllabus would emphasize on continuous self-learning in the aspect of operative neurosurgery. Candidates should also be able to examine, decide on further management and performing procedures under specialist’s supervision. They would also assume ‘on-call’ responsibility with the specialist.
9. Candidates would assume certain responsibilities allocated by the Supervisor.
10. Supervision by the department is conducted through supervisor’s report and log book.
11. Specialised case write up or case report in neurosurgery for every 4 months during only year 2 and 3 should be submitted to the supervisor and shown during the progress interview (total of 3 in a year; or total of 6 for the phase 2 – year 2 and 3)
12. Specialised case report is defined as interesting or advance case report in which its content seems as publishable in the journal.
13. There will be a 6 monthly progress-interview to monitor the trainees.

The summary

Part 2 in Neurosurgery (Phase 3 - Year 4/Registrar level)

1. Phase 3 would also emphasize on operative neurosurgery. The candidate shall do the attachment at our various recognised training centre. University attachment should ideally be at 3 to 6 months prior to final or exit examination.
2. Phase III is to provide a more challenging and detailed exposure to Neurosurgery. Candidate is expected to acquire an in-depth knowledge in order to synthesize an accurate diagnosis and also competent in operative techniques.
3. The university or training centre would provide lecture notes, articles and journals, reference books and audio-visual materials in related fields. The candidates and supervisors would prepare the materials.
4. Candidates would be assigned as a ‘Specialist in training’, and be responsible in managing Neurosurgical patients. Candidates are encouraged to decide on the management aspects. However, the specialists are still supervising.
5. Candidates are also required to present papers, research and attending conferences.
6. Candidates must have successfully attended the compulsory listed courses - a) Basic life support; b) Ethics and statistics; c) High speed drilling course organized by the university or any recognized centres.
7. The candidate is preferably had attended the: a) Good clinical practice (GCP); b) Advance trauma life support (ATLS); c) Paediatric life support (PLS); d) Spine; e) Microsurgical anastomosis; and f) Stereotactic, radiosurgery, image guided or functional course
8. Candidates would be expected to be able to resolve departmental issues and current issues arising in order to deliver the best treatment for the neurosurgical patient.
9. Timetable for lecture, tutorial, seminar, clinical teaching and other activities would be circulated from time to time.
10. The candidate should be actively involved in all aspects of patient’s care. They would also do ‘on-call’ with the specialists.
11. Candidates are also expected to attend and actively involved in all teaching activities organized by the university or any centre.
12. Candidates would assume certain responsibilities allocated by the Supervisor.
13. Supervision by the department is conducted through supervisor’s report (appendix 3) and log book.
14. No case writes up during year 4 or exit year.
15. There will also be a 6-month progress interview to monitor the trainees in this particular year
16. Final or Exit examination will be conducted at the end of the 4^th year in phase 3.

3. ENTERENCE CRITERIA FOR NEUROSURGERY :

A) Basic Qualification

1. The candidate should possess a medical degree (MD, MBBS, MBBCh or equivalent) and registered/recognised with/by Malaysian Medical Council (MMC)
2. The candidate must fulfil the 2 prerequisite years’ criteria.
3. Bahasa Malaysia (BM) with Credit in SPM (for Malaysian citizen) – it applies to USM candidate: If did not obtain credit in BM, the candidate must re-sit BM papers prior to graduation
4. Foreign candidates are required to submit result of TOEFL (minimum score or 550) or IELTS (minimum score of 6) with their applications. Foreign candidates are required to attach to the respective university neurosurgical department/unit for 3 to 6 months and have to pass the attachment evaluation before being accepted as master of neurosurgery trainee. Besides, foreign candidates must also have:
   a) Passed the MedEx with band 4 or above
   b) temporary registration certificate (TPC) or annual practice certificate (APC)
   c) those with unrecognised undergraduate degree in Medicine must undergo Malaysia Quality Examination (MQE) before proceeding to year 2 in the actual neurosurgery programme.
5. The candidate must pass with Grade 1 for Sijil Pelajaran Malaysia (SPM) or grade 1/4A
   (old system) or CGPA of 4 (new system) for Sijil Tinggi Pelajaran Malaysia (STPM) or Good
   Grade for Matriculation Examination.
   The foreign candidates must have good grade/score for the equivalent examinations in their own countries
6. Good physical and mental state

B) MedEx (Medical Specialist Pre-Entrance Examination) and Entrance-VIVA

1. The candidate must sit for MedEx MCQ examination. About the MCQ Examination: - The candidate should answer all 50 questions in total time of 60 mins (1 hour). There are two formats: single-best or one-true answer (SBA/OTA) format (25 Questions); and True-False (TF) format for another 25 Questions. Minus marking is not applied to this examination.
2. The candidate must attend entrance interview/viva (s)
3. The academic syllabus would cover ‘Principles and General Sciences in Neurosurgery’ and ‘Principles and General Surgery Sciences’ for both MedEx MCQ examination and interview/viva
4. MedEx MCQ examination is compulsory to all candidates (KKM, university and foreign candidates).
5. Ranking and/or band 4 or above of MedEx, Entrance-VIVAs and other parameters will finally determine the entry into the programme
6. Those failed to enter the programme in that particular year and/or obtained less than band 4 for the MedEx examination results, suggested to re-sit the examination for the subsequent application year. The intention is to have higher chance of getting into the programme with obvious improvement in the results. Noteworthy: application process follows like before.
7. Those passed the MedEx with band 4 or above, but failed to enter the programme. Candidate must reapply via a standard application process like before, and be likely asked to come for the entrance VIVAs again for the next admission year [unless other factors judged by neurosurgery viva committee prohibiting/delaying him or her to be called for viva (s) again]. Noteworthy, he or she may also re-sit the MCQ examination with intention to improve the results
8. Majlis Peperiksaan Malaysia (MPM) will announce where and when the virtual or non-virtual MedEx MCQ examination will be conducted
9. Vivas for entry into the programme will normally be done twice for MOH (KKM) candidates, and once for the University candidates (i.e., a final viva). For foreign candidate, it is case-by-case basis for entrance interview. Viva one is for general screening to look for some factors (mainly conducted by the KKM). Viva two is a “final Viva” in which some questions in principles of neurosurgery and surgery are going to be asked again to the candidates

Note: Other use of MedEx examination.

1. Results of MedEx examination obtained by medical officers currently working at non-neurosurgical centre, may be used to support his or her application to be posted in neurosurgical centre throughout Malaysia.
2. Do take notes that the certificate is valid for 3 years, thus further application for interview to enter the actual neurosurgery programme must be done within those 3 years (i.e., 3 years counting as time after gaining the MedEx-certificate).
3. Neurosurgery experience for 1 year, 6 months’ experience in general surgery and another 6 months in surgical specialty as pre-requisite postings for neurosurgery seems appropriate with those 3 years validity of the MedEx examination certificate.
4. If needed, he or she can indeed take another MedEx exam prior to entrance interview to obtain better results or band.
5. Once he or she obtained reasonably good results in MedEx examination, he or she should start soon applying for neurosurgical posting as medical officer in any neurosurgical centre in Malaysia (don’t forget to attach the entrance examination results together with change-in-posting application form). This statement meant for those being posted in non-neurosurgical centre, clinic or district hospital but interested to be a neurosurgeon.
6. Details on MEDEX or Medical Specialist Pre-Entrance Examination should easily be available at web: https://www.mpm.edu.my/en/medex/background-of-medex

4. SYLLABUS FOR ENTRANCE MCQ EXAMINATION, AND INTERVIEW/VIVA

A) Principles and General Surgical Sciences

Prophylaxis of Thromboembolic Disease
Surgery in Hepatitis and HIV carries – special precaution
Pain control, Pathophysiology of Pain, differences between acute and chronic pain
Respiratory Failure – recognition and treatment
Assessment and Maintenance of Fluid and Electrolyte Balance
Blood Transfusion – indication; hazard; complication; plasma substitutes
Surgically Important Micro-organisms / Principles of Microbiological Diagnosis
Septic shock – Pathopysiolgy and Principle of management
The sources of Surgical Infection – Prevention and control
Principles of Asepsis and antiseptic Aseptic technique
Principles of Sterilization
Skin preparation and Antibiotic Prophylaxis
Pathopysiology of the body response to infection
The Spleen – its role in Health and Disease : Spelenectomy and Hypersplenism
Local and Ligature material
Principles of Incision and their closure
Diathermy – Principles and Precaution
Disorders of Coagulation and Haemostatic
Pathopysiology of Wound Healing – classification of Surgical Wounds Principles of Wound management
Complications of Wound Healing – wound dehiscence, scars and contracture
Principle and techniques of Biopsy and Cytological sampling
Haemorrhage and Shock
Respiratory failure – Pulmonary Oedema : ‘Shock Lung’, ARDS, Labour and Pulmonary Collapse
Acute Renal failure in Surgical patients
Carcinogenesis : Principles of Molecular Biology of Cancer and Genetic factors
Benign and Malignant Neoplasm’s and mechanisms of Metastases
Epidemiology of common cancers : Principles of screening and Principles of treatment
Surgical aspects of Disordered Haemopoiesis and Haemolytic Disorders of Surgical importance
Haemorrhagic disorders : Disorders of Coagulation
Immune response to trauma, infection and tissue
Principle of Research, Design and Analysis of Clinical Trials
Post operative Pulmonary and non Pulmonary complications
Principle of Wounds Drainage and Wound Dressings
Diagnostic and Therapeutic uses of Radioisotopes
Monoclonal antibodies and their application clinical practice
Tumour markers in Surgical practice – Uses and Limitations
Electromechanical hazards in the operating room
Patient’s safety in the operating room – Precautions in the Anaesthetized patients
Metabolic response to trauma / surgery
Malnutrition in Surgical patients
Acid-Base Homeostasis and disturbance in the Acid-Base balance and Principles of management
Principles of Transplantation / Advances, uses and limitations

B) Principles and General Sciences in Neurosurgery

Neuroanatomy
Neurophysiology
Basic Neurophysiology of pain, spasticity etc
Neurochemistry
Neuropathology
Basic in Clinical Neurology – Localization and neurophysiological studies
Basic in Neurodiagnosis and Neuroinvestigations
Basic Principles in Neurosurgery – hemostasis, wounds in neurosurgery, sutures, etc
Basic component in vascular, tumor, congenital malformation, spine, functional, trauma Neurosurgery

5. PROGRAM COORDINATOR :

You may wish to address any queries to the Program Coordinator:

Professor Dr Zamzuri Idris,
Consultant Neurosurgeon and Head of Department
Department of Neurosciences,
School of Medical Sciences,
Universiti Sains Malaysia,
16150 Kubang Kerian, Kelantan, Malaysia.

Application is made directly via the USM Institute of Postgraduate Studies (IPS), 11800 Penang, Malaysia at www.ips.usm.my or the Kelantan IPS branch

Note:
• Closing date of application: 31st October each year for June intake (or as advertised in all major daily newspapers in Malaysia).

• For foreign applicants: Qualified candidates will be selected by a conjoint board comprising of members from the Ministry of Health, Malaysia and USM