FCPS- Postgraduation in Pakistan

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FCPS

Fellowship of the College of Physicians and Surgeons (FCPS). College of Physicians and Surgeons Pakistan is a firm responsible for the registration of Postgraduate Doctors of Pakistan. It makes rules, enrolls doctors and conducts exams for the Post graduation in Pakistan. Currently, CPSP is registering for FCPSI, II and MCPS. CPSP also enrolls foreign qualified doctors. USA medical board, uk medical board, postgraduate medical degree, undergraduate medical degree.

The CPSP currently allows FCPS in the following fields:

	Anatomy		Anesthesiology
	Biochemistry		Cardiac Surgery
	Cardio-thoracic Anesthesiology		Cardiology
	Chemical pathology		Community Medicine
	Critical Care Medicine		Dermatology
	Diagnostic Radiology		Endocrinology
	Family Medicine		Forensic Medicine
	Gastroenterology		General Surgery
	Haematology		Histopathology
	Immunology		Infectious Diseases
	Medical Oncology		Medicine
	Microbiology		Neonatal Paediatrics
	Nephrology		Neurology
	Neurosurgery		Nuclear Medicine
	Obstetrics and Gynaecology		Operative Dentistry
	Ophthalmology		Oral Surgery
	Orthodontics		Orthopedic Surgery
	Otorhinolaryngology (ENT)		Paediatric Cardiology
	Paediatric Surgery		Paediatrics
	Pharmacology		Physical Medicine & Rehabilitation
	Physiology		Plastic Surgery
	Prosthodontics		Psychiatry
	Pulmonology		Radiotherapy
	Rheumatology		Thoracic Surgery
	Urology		Virology
	Vitreo Retinal Ophthalmology

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

The FCPS-I exam, in all the specialties tests knowledge in the basic sciences. It consists of 2 papers, each of 3 hrs. duration which take place same day simultaneously. The exam focuses on those sections of basic sciences that are relevant to its specialty. For example the FCPS-I exam for Gynecology and Obstetrics 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 Special Pathology (Part 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 form must reach CPSP 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 November / December. With the application form candidate must submit his House Job Experience Certificate and PMDC full registration. Those who have not finished theirs house job and do not have elevated their provisional registration to a full registration are not eligible to sit in the examination, so you may lose a chance to avail FCPS Part I attempt, if your house job session is delayed.

This means that the candidate cannot appear in the February/March FCPS-I exam and he has to wait for 5 months till the June/July attempt. CPSP has made another provision that if you have passed your FCPS in later time and you were working in a teaching hospital in a capacity of a PG student, that training will be counted towards your FCPS requirement up to maximum of one year, provided you are working under Registered CPSP Supervisor.

It is suggested that to save time, candidates must plan their FCPS part I according to their house job completion & eligibility to appear in the exam, and they must apply for some PG / MO post under CPSP supervisor, so that the time before the examination is utilized in the best possible way.

After passing: you will apply for a Post Graduate Trainee post in CPSP recognized hospital. It must be mentioned here that not all PGs are awarded the post. Every province in Pakistan has a fixed number of PG posts which it can give and if the number of applicants exceeds the number of PG positions available then some will be left out. Such applicants thereafter can either join the PG training as Honorary (i.e. without pay) or can apply for non-training jobs in private or government hospitals as Medical Officers

Components of FCPS training :

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

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

• 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 PGs regardless of their specialty and must be taken within the first 18 months of training.

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

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 Dissertation

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.

Before writing dissertation, candidate apply to the CPSP for formal approval of topic of his / her dissertation, this application with details that how that dissertation work will be carried out is called as synopsis. So approval of synopsis is first step towards dissertation writing.

The Intermediate Module (IM)

Recently, CPSP has decided that all candidates (fresh and repeaters) must have passed the Intermediate Module examination as one of the mandatory eligibility requirements for appearing in FCPS-II examination in September 2007 and onwards in the subjects listed below

SUBJECT OF FCPS-II	SUBJECT OF INTERMEIATE MODULE EXAMINATION
Anaesthesiology	Anaesthesiology
Diagnostic Radiology	Diagnostic Radiology
Obstetrics & Gynaecology	Obstetrics & Gynaecology
Ophthalmology	Ophthalmology
Paediatrics	Paediatrics
Psychiatry	Psychiatry
Internal Medicine	Medicine
General Surgery	Surgery

The condition of passing the Intermediate Module examination one year before appearing in FCPS-II examination has been withdrawn. Thus, if all other requirements have been completed, candidates can appear in FCPS-II examination any time after passing the Intermediate Module examination.

The Intermediate Module Examinations in Medicine & Surgery are already being held and they will continue. For all other subjects listed above, the first Intermediated Module Examination will be held in March 2006. Those FCPS – II candidates who have passed MCPS examination in the relevant subject earlier, will be exempted from Intermediate Module Examination.

The candidates who pass this examination will be issued a certificate of passing Intermediate Module examination. Such candidates will also be issued MCPS Diploma after they have completed all requirements for appearing in final FCPS-II examination and have appeared in this examination once.

FCPS PART II:

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 oral exam is divided into 2 parts, the Long Case and the TOACS (Task Oriented Assessment of Clinical Skills). Candidates must pass TOACS so that they can move to long case portion.

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.

THE COST FOR FCPS

By far, entering the FCPS program is the most cost-effective of all the options mentioned in this manual. The major costs involved are:

FCPS-I Exam Fee	Rs. 9,000
Registration Fee as a FCPS Trainee	Rs. 6,500
Workshops	Rs. 25,000 - 35000
Dissertation	Rs. 1,000 - 1500*
FCPS-II Exam Fee	Rs. 9,000

The dissertation costs range from 1,000 to 15,000 depending mostly on whether or not you employ the services of a computer professional who will type and arrange the format of your document. If you are skilled at using a word processor and can prepare the document yourself, the cost of preparing the dissertation will be correspondingly lower.

Assuming that the exams are passed in the first attempt (which is not the case for the majority of candidates), the costs range from Rs. 49,500 to Rs. 72,000. This is hardly 10% of the costs entailed in the entire USMLE and UK pathways.

For Further details please visit the official CPSP Site www.cpsp.edu.pk.