Training in Malta

Malta is a European Union country, but it has been given a derogation from the European Working Time Directive and as a result doctors work longer hours per week than for example in the UK. Furthermore doctors are allowed to opt out of the EWTD and are able to work longer hours if they so wish.

The Job descriptions and basic roles and responsibilities of a Foundation Doctor are very similar in the different departments but there may be some logistical differences. We have asked the Chairpersons of each department to provide a description of the jobs which the junior doctor will be expected to undertake in each specific area. The main ones are shown below:

(for updated Job descriptions, the individual departments should be consulted)

Job Description Department of Medicine

Chairperson: Prof Stephen Fava

Introduction:
The department of Medicine provides a full range of general medical services to the population of Malta and Gozo. The department includes several sub-specialties: Acute General Medicine, Gastroenterology, Renal medicine, Infectious Diseases, Rheumatology, Respiratory Medicine, Neurology, Diabetes and Endocrinology, and Haematology.

The department also caters for all emergency medical services for the islands of Malta and Gozo. Within Mater Dei Hospital there are 6 medical wards (M1, M2, M3, M4, M5, M6) a neurology ward, a haematology ward, an infectious diseases ward, a renal unit and a day ward for day cases. and a 20 bed intensive care unit that also includes a high dependency area. There are currently 22 consultants in general medicine and related subspecialties, as well as 3 consultant neurologists and 3 consultant haematologists. All requests for medical imaging are made on-line and images are available digitally on-line on PACS system. Results of blood, microbiological and histological examinations are available on line through I-soft system. Discharge letters and prescriptions for drugs to take home can be made on an online electronic sytem which allows retrieval of those documents when necessary.

Work Patterns:
F1 doctors work an on-call rota within the department of medicine. Each F1 is predominantly ward based but opportunity exist for trainees to attend out-patients and endoscopy sessions. F1 doctors work within a consultant based firm, with a team that usually includes the consultant, a resident specialist, higher specialist trainee and a basic specialist trainee. The role of the F1 doctor in medicine includes clerking patients, maintaining and updating patient lists through an online electronic patient census, participating in ward rounds and reviewing patients and their management, requesting and following up investigations, liaising with other specialties and health care professionals, performing practical procedures, communicating with patients and relatives as well as administrative tasks such as filling in drug treatment charts, writing discharge letters, and liaising with the departmental secretaries. Occasionally, Foundation doctors may need to cover Anti-coagulant Clinic under the supervision of the Consultant Haematologists. They are also expected to help in covering for their colleagues within the department when the need arises.

Learning Opportunities:

• Medical Departmental educational meetings on Wednesday at 1pm-2pm
• Multidisciplinary meetings in different sub specialties on a weekly basis
• Foundation programme weekly lectures Friday 1.30pm-2.30pm
• Foundation programme organised teaching including clinical skills training and clinical simulation training

Supervision and Training:

Each foundation doctor will have clinical supervision and an allocated Educational Supervisor

Job Description Department of Surgery

Chairperson: Mr Gordon Caruana Dingli

Introduction:
The department of surgery provides a full range of general surgery services to the population of Malta and Gozo. The department covers general surgery, breast, vascular, endocrine and gastrointestinal surgery as well as plastic and reconstructive surgery and paediatric surgery. The department also caters for all emergency surgical services for the islands of Malta and Gozo. Within Mater Dei Hospital there are 5 surgical wards (S1,S2,S3,S4 and S5), a surgical admissions ward as well as plastics and burns unit, paediatric wards, and a 20 bed intensive care unit that also includes a high dependency area. There is also a day case unit and a preoperative assessment clinic. There are currently 10 consultants in general surgery and related subspecialties, as well as 2 consultant plastic surgeons and 2 consultant paediatric surgeons. All requests for medical imaging are made on line and images are available digitally on line on PACS system. Results of blood, microbiological and histological examinations are available on line through I-soft system.

Work Patterns:
F1 doctors work an on call rota within the department of surgery. Each F1 is predominantly ward based but opportunity exist for trainees to attend outpatients, theatre and endoscopy sessions. F1 doctors work within a consultant based firm, with a team that usually includes the consultant, a resident specialist, higher surgical trainee and a basic surgical trainee. The role of the F1 doctor in surgery includes clerking patients, maintaining and updating lists, participating in ward rounds and reviewing patients and their management, preoperative patient preparation and postoperative care, requesting and following up investigations, liaising with other health care professionals, practical procedures, communicating with patients and relatives as well as administrative tasks such as filling in drug treatment charts, discharge letters, and theatre lists.

Learning Opportunities:

• Surgical Departmental educational meetings on Tuesday at 1pm-2pm
• Surgical weekly journal club on Saturdays 8am-8.30am
• Multidisciplinary meetings in different sub specialties on a fortnightly basis
• Foundation programme weekly lectures Friday 1.30pm-2.30pm
• Foundation programme organised teaching including clinical skills training and clinical simulation training

Supervision and Training:

Each foundation doctor will have clinical supervision and an allocated Educational Supervisor

Job description Department of Paediatrics

Chairperson: Dr Paul Soler

The Clinical Department of Paediatrics includes two General Paediatric wards (29 beds), an Oncology ward (7 beds), a Neonatal and Paediatric Intensive Care Unit (14+5 cots, respectively), a Day Care Unit (12 beds), an Outpatient Department and Paediatric Casualty. It offers support for infants born in Malta (the birth rate is approximately 3,500 per annum) and reviews around 3,000 in-patients, 10,000 outpatients and a similar number of casualty referrals per year.

Doctors at Foundation Year 2 are attached to the Department for periods of 3 months and, in the main, are exposed to General Paediatrics when attached to a consultant-led medical firm, and Emergency Paediatrics in Casualty, mainly during nightime duties (generally on a 1 in 4 basis). In addition, they may obtain limited exposure in Paediatric Subspecialties including cardiology, endocrinology, gastroenterology, neurology and oncology. The Department runs an 'open-access', supportive policy such that they are supervised and have easy access to their peers and senior colleagues at all times. The Departnment also has an active CME/Postgraduate Training Programme and FY2 doctors are strongly encouraged to attend these sessions.

Job Description Department of Obstetrics and Gynaecology

Chairperson: Professor Mark P Brincat

The Department of Obstetrics and Gynaecology provides a full range of services including several sub-specialities like Fetal Medicine, Ultrasound, Acute Gynaecological Emergencies, General Gynaecology, Gynaecological Oncology, Urogynaecology and Minimally Invasive Surgery.

The Department caters for all Obstetrics and Gynaecology for the Maltese Islands. There is a Gynaecology Ward, three Obstetric Wards (Obstetrics 1, 2 and 3) and a Delivery Suite (Labour Ward. The department works closely with the Neonatal Unit. Obstetric and Gynaecological emergencies are managed primarly in the Emergency Unit in the Obstetric 2 Ward.

There are 9 Consultant Obstetricians and Gynaecologists in the Unit each having special subspeciality responsibilities of care.

Requests for Medical Imaging are available digitally on line on the PACS system. Results of blood, micobiological and histology are available through the ISoft System.

Work Patterns

FY1 and FY2 doctors work on an on call rota within the department of Obstetrics and Gynaecology. Each Foundation trainee is to attend to the wards, outpatients, theatre sessions and labor ward. F1 doctors work within a firm which usually includes the Consultant a resident specialist, a higher surgical trainee (HST) and a basic surgical trainee (BST). The working practice include clerking patients, maintaining and updating lists, participating in ward rounds and ward management, preoperative patient preparation ad post operative care, requesting and interpreting investigation results, practical procedures including suturing of episiotomies, communicating with patients and relatives, filling in drug treatment charts, discharge letters and theatre lists.

Learning Opportunities

Obs & Gynae educational meetings on Fridays
Bimonthly Journal Club
Foundation Programme lectures on Fridays
FP organized teaching including Clinical skill training and clinical care

Supervision and Training

Each Foundation doctor will have an assigned Educational Supervisor and Clinical Supervisor