Since embarking on my post-graduate journey in Sri Lanka, I am constantly bombarded with questions pertaining to it – “How do I go about it?” “How do I get study materials?” “Where do I start?”
Whilst I am no expert in the field of navigating postgraduate studies (and you should probably speak to the Postgraduate Institute of Medicine if you need further clarification after reading this article), having just completed my Diploma in Family Medicine (DFM), I can now offer a little bit of advice and insight.
In the following article, I will describe the general approach to navigating postgraduate studies and then focus on my experience with Family Medicine.
Please remember that all opinions expressed here are of my own and does not reflect the opinions of anyone else.
How did I get started?
I always knew I wanted to do postgraduate studies even as a medical student, but I wanted to find a field of medicine that suited me and the work I wanted to do outside medicine. During my internship/RHO period, I perused all the prospectuses on the Postgraduate Institute of Medicine website (highly advise you to do this too!) and made a pro-con list for each subject. After much debate and discussion with consultants and seniors, especially taking into account their lifestyles, I narrowed down my choices.
I spoke to the PGIM examinations/academic branch when needed and found out the dates with regards to examinations and any documentation that I would need (all this information is available on their website).
Again, remember that most medics in Sri Lanka dedicate their whole life towards medicine and this is OKAY! It is the norm to “live, breathe and eat medicine”, but that just isn’t for me because I knew there was so much outside medicine in terms of advocacy and entrepreneurship that I wanted to try my hand at.
Why Family Medicine
Family Medicine to me gave me a broad understanding of all fields of medicine which meant that I didn’t have to narrow my knowledge and interest to just one field. I can treat all patients, from ‘cradle to grave’ and from all walks of life. This is in contrast to those who are specialists – for example, you wouldn’t ask a surgeon to prescribe an inhaler to a child and you wouldn’t ask a paediatrician to manage an infected wound. Family physicians have to know breadth, but not depth which was fine by me.
The main issue with Family Medicine at the time I decided to sit for the selection examination in 2019 was that candidates had to do the DFM prior to attempting to sit for the MD Family Medicine Selection Examination (this changed in 2021 and you can now directly sit for the MD Family Medicine examination).
Postgraduate training from the private healthcare sector
There are a couple of important points to remember if like me, you intend on doing your postgraduate training from the private sector.
- Coming from the private healthcare sector in Sri Lanka, I knew that places were very (VERY) limited – maybe 1 or 2 maximum per course.
- All private sector candidates must pay 1/3rd more than government sector candidates in terms of examination fees and course fees.
- Also do remember that private sector candidates are not entitled to any type of compensation (salary) when doing a diploma – when doing an MD examination there is basic salary payment as far as I know, but always good to double check!
The selection exam process
Every postgraduate course at the PGIM takes a limited number of applicants and this number is determined by the PGIM and Ministry of Health. Only on the circular issued on the PGIM website prior to calling for applications is the exact number mentioned.
The date of the examination and the closing date for applications to sit for the examination is available on the PGIM website under the examination calendar tab.
The content of the selection examination varies for each academic programme. For example, the DFM has an MCQ paper only, but the MD Selection Examination in Family Medicine has an MCQ paper, a 4 station OSCE and a 4 station OSPE (written OSCE). So, I would strongly advise you to read the prospectus for your subject of choice as all this information is clearly mentioned in the prospectus.
To prepare for any postgraduate selection examination you would first need study materials. All the prospectuses carry a list of recommended textbooks/websites for reading and this should give you an idea of where to start. Additionally, the bookshop found in the Doctor’s quarters of the National Hospital of Colombo has photocopies of the textbooks and past papers for all the postgraduate subjects. This is a great starting point!
It would be ideal to have a study group when revising for postgraduate examinations, but this is not always possible and when I was sitting for the DFM selection examination I studied on my own as there was no one else in the private sector that I knew who was sitting for the examination.
The selection examinations are always tough and this is because of the very limited number of vacancies available. The number sitting for the examination is always at least 2-3 times more than the number of places available. For example, the DFM has approximately 35-40 slots available (changes annually) and about 80-90 candidates sit for it every year. This is not to discourage anyone, but I firmly believe that everyone should be prepared and realistic about the competition.
The application for the selection examination can be found online and submission/payment is also online. You will receive an email with your candidate number, the exam rules/regulations and instructions about a week prior to the examination by email (it used to be by post but now has changed to email since the pandemic).
I personally found the DFM selection examination tricky, but as with all true/false MCQ papers with negative marking, it is very difficult to gauge how you did. Beware that they also tend to throw in quite a few very specialist level questions so that not everyone will pass.
My experience on the DFM course
Whilst being truly grateful for having been selected as a private sector candidate to do postgraduate exams in Sri Lanka, we as a batch unfortunately encountered numerous problems in our teaching year due to the pandemic which I will discuss later on.
The course requires trainees to undergo hospital training Monday to Saturday 8 am to 12 pm and thereafter you can do GP training placements. However, Friday afternoons, Saturday afternoons and Sunday mornings were dedicated to online lectures (usually conducted face-to-face, but again COVID!). There are 24 hospital training disciplines that vary in length from 1 to 2 weeks each. There are also workshops and tutorials which are held towards the end of the year.
The cohort splits into groups of 4-5 trainees at the initiation day itself depending on where you want to work – you can choose where you want to work, i.e. if you want to train in Colombo, try to get into a Colombo group, if you want to train in Jaffna, try to find a Jaffna training group. I was the youngest in the batch and didn’t know anyone as there was only one other private sector candidate, but found a group and everyone was very friendly and welcoming.
The training itself was great and definitely has breadth as you have to go through almost every discipline from General Medicine to Legal medicine to Rehabilitation. However, the trainee was responsible for finding a consultant trainer that had to certify completion of each placement. Trying to find a consultant that would allow you +/- the rest of your group for training was quite tiresome, especially when you had to do it more than 24 times. For general practice sessions, we were given a list of practitioners who had agreed to take students for training, however due to the pandemic, many were reluctant and it was exhausting trying to complete all the placements within the given time frame.
Our training was jam packed with only Sunday afternoons being technically free, but as lectures were online, I could join in from anywhere which was easy. I do feel though that in-person lectures would have been much more effective for learning as online lectures can sometimes get quite monotonous. It would have also given the chance for us as a batch to bond more – we primarily knew each other through a whatsapp group so putting a name to the face took me a long time.
Unfortunate Covid problems
The course commenced late due to a wave of Covid and we were not allowed to start our hospital placements for about 2 months as some postgraduate trainees were not yet gotten permission to enter hospitals due to overcrowding risk. We were allowed to start our general practice training, but again as mentioned above, many general practitioners were reluctant to take on trainees due to space restrictions and the fear of Covid-19 spread amongst us healthcare workers. Due to lockdowns, the patient load was also unpredictable and during some parts of our training we didn’t get enough patient exposure. Then in the middle of our training year, the whole cohort had to be rerouted to simultaneously work for the Home Care Covid System where medical officers/pre-interns would call us if they had any serious patients that may require admission or senior advice. Balancing the home care shifts with our training was a juggling act and during the peak of the covid waves, the number of calls we received was insane.
With all these interruptions, our one year course ended up becoming a 17 month course!
I also must mention that we sadly lost a colleague (Dr. Gayan Danthanarayana) to Covid a couple of months into our course. Even though we as a batch hadn’t known each other for long, it definitely hit us all hard and his jovial presence was sorely missed during our training.
The exit exam
Now the in-course assessment and exit exams for the DFM course is plenty!
The in-course assessment is a portfolio viva – the prospectus contains a list of outcomes for the training disciplines (some a little dated and uncommon e.g., rectal swab for cholera) and you need to include evidence for each outcome (e.g. a case study with a reflection, research presentations). At the end of the year, you should have about a 100 A4 page portfolio ready! Remember to get a signature from the respective consultant for each training discipline acknowledging that you have achieved the outcomes stated and include it in your portfolio. My advice would be to get started early on the portfolio – do not leave it for last minute! It’s way too much to do in a hurry. A couple of months before the end of the course you will be asked to turn in your portfolio and you will have a portfolio viva where you get grilled by 2 examiners on your portfolio for 20 minutes.
The exit exam consists of a 3-hour written paper – both true/false and SBAs. This requires the same prep as for the selection examination paper. Once you pass this, you proceed onto the next stage of examinations which include another written paper where you have one essay question and 2 MEQ questions. MEQ questions are basically long problem-solving questions – they hand you a paper with a few questions based on a case, once you answer it you will then hand it back and then receive another set of questions continuing on the same case, but you can’t change your answers that you listed on the previous paper.
There is also an 8 station OSCE circuit (10 minutes for each station) that is conducted in-person and a 10-station written OSCE (OSPE – 3 minutes for each station) that is held in the computer lab. The written OSCE is basically a slide show with questions asking for a spot diagnosis, management, prognosis, etc and you need to write down the answers.
Conclusion
In conclusion, I loved the content of the family medicine course, and it definitely broadened my knowledge. I only wish that we didn’t have so many Covid interruptions and the distance learning, as it would have given us a much different learning experience. Previous batches had thoroughly enjoyed the course as they had face-to-face learning and didn’t face the many challenges that my batch had during the course. This is something that even the board of studies for Family Medicine acknowledged and they did feel quite bad for our batch!
As everyone has got much more accustomed to Covid-19 now, I’m sure future batches would definitely have a good experience doing the DFM so I would definitely recommend the course!
Useful links:
- Postgraduate institute of Medicine (best accessed on a desktop rather than mobile) – https://pgim.cmb.ac.lk
