PSGS

2017 GUIDELINES for ACCREDITATION

OF

RESIDENCY TRAINING PROGRAMS

IN

GENERAL SURGERY
 PREFACE

Three years have elapsed since we first drafted the Accreditation Manual.
Many revisions and updates have been made on a regular basis to keep up
with the fast changing and evolving teaching and learning environment for
our residents. More importantly, they were made to be able to serve efficiently
our patients who are in essence the most important purpose of training
surgeons.

Like its previous editions, this 2017 Manual is an objective means of

assessing the quality of Residency Training in General Surgery in the
Philippines. Aside from the minimum requirements needed to be granted
accreditation, the manual recognizes the essential aspect of patient safety
thru the PSGS Surgical Curriculum.

It is our vision that our graduates are globally competitive in the field of
surgery and align the programs towards ASEAN integration thus the shift to
Outcome-based Curriculum. We made the number of index cases more
efficient by making the cases required more realistic such as in gastric surgeries,
pancreatic surgeries and esophagus and head and neck surgeries. The
integration of the Minimal access surgery and the simulation into the
accreditation requirements as well as taking the initiative towards surgical
endoscopy will give our graduates a more competitive stance in the region.

The manual supports the Mission-Vision of the Philippine Society of

General Surgeons as it monitors the implementation of a standardized
instructional plan in general surgery.
 VISION - MISSION STATEMENT

VISION

To be globally recognized organization of General Surgeons

in the Philippines by 2020

MISSION

Ensure the development of General Surgery as a premier and distinct specialty

Pursue world class, competent, and ethical surgical education and training
to our residents and fellows

Deliver safe and compassionate service to our patients

 TABLE Of CONTENTS

INTRODUCTION 1

ACCREDITATION OF TRAINING PROGRAMs in GENERAL SURGERY 2

2.1. APPLICANTS for Accreditation 2

2.1.1. Institutions considered as a NEW Applicant GS-Residency Training Program

2.2. Application Process for Accreditation of Training Programs 2

2.2.1. Submission of documentary requirements for accreditation
2.2.2. Preliminary evaluation of submitted documents
2.2.3. PSGS Board approval for the Accreditation visit
2.2.4. PSGS Committee on Accreditation visit of a qualified applicant
training program
2.2.5. The PSGS Board of Directors (Post-Visit) decision on the application

MINIMUM REQUIREMENTS FOR ACCREDITATION IN GENERAL SURGERY 6

3.1. REQUIRED HOSPITAL FACILITIES & SERVICES 6

3.1.1. Department of Health accredited hospital with a minimum of 150 beds
3.1.2. All major clinical departments must be present and preferably accredited
3.1.3. Outpatient Facilities
3.1.4. Emergency Rooms, Operating Rooms, Recovery Room and Critical Care
Facilities, Minimally Invasive Surgery Facilities
3.1.5. Laboratory Services
3.1.5.1. Facilities for hematologic, serologic, biochemical and
microbiological examinations
3.1.5.2. Blood bank
3.1.5.3. Histopathology
3.1.6. Other Facilities/Services:
3.1.6.1. Radiologic facilities
3.1.6.2. Ultrasonography
3.1.6.3. Endoscopic Facility
3.1.7. Facilities available within the immediate vicinity of the hospital
3.1.7.1. CT Scan
3.1.7.2. Mammography

3.2. TRAINING FACILITIES, MEDICAL LIBRARY AND INFORMATION TECHNOLOGY

FACILITIES WITH SUBSCRIBED AND FUNCTIONING INTERNET ACCESS 7

3.2.1. Textbooks
 3.2.2. Surgical Journals
3.2.2.1. PJSS
3.2.2.2. Foreign Surgical Journals
3.2.3. PSGS Assessment and Surveillance (ASSURE) Online Database of Surgical Procedures
3.2.4. Functioning Hospital Tumor Board
3.2.5. Quality Assurance Board or Committee
3.2.6. Ethics Review Board
3.2.7. Required Skills Training Facility/Laboratory for Residents

3.3. STRUCTURED GENERAL SURGICAL RESIDENCY TRAINING PROGRAM

REQUIREMENTS 7

3.3.1. Policy on Commitment and Resident – Supervision

3.3.2. Qualified Training Staff

3.3.2.1. Department Chairperson
3.3.2.2. Residency Training Officer
3.3.2.3. Consultant Staff

3.3.3. Resident Staff

3.3.3.1. Basic Qualifications/Requirements of applicants for Residency Training
3.3.3.2. The Resident Complement
3.3.3.3. Lateral Entry Residents
3.3.3.4. Residents and the Program Factor

3.3.4. The Case Material

3.3.4.1. Program’s case load (volume and variety of cases) requirement
3.3.4.2. PROCEDURE as a RESIDENT’S CASE: Resident as “THE SURGEON”

3.3.5. DOCUMENTATION OF CASE MATERIAL OR CASES HANDLED

3.3.5.1. PSGS Prescribed Resident’s Logbook
3.3.5.2. PSGS Assessment and Surveillance Database

3.3.6. RESIDENCY PROGRAM DURATION AND STRUCTURED ROTATION

3.3.6.1. Duration of training
3.3.6.2. Structured Rotation

3.3.7. RESIDENTS EVALUATION

3.3.7.1. The Internal Evaluation Residents
3.3.7.2. The External Evaluation of Residents

3.3.8. TEACHING AND LEARNING ACTIVITIES

3.3.8.1. Minimum number of conferences per year
 3.3.9. DOCUMENTATION OF THE TEACHING AND LEARNING ACTIVITIES
3.3.9.1. All teaching and learning activities
3.3.9.2. MIS/Laboratory Trainer Exercises

3.3.10. THE ANNUAL REPORT OF THE GENERAL SURGERY RESIDENCY

TRAINING PROGRAM

3.4. THE ANNUAL ACCREDITATION FEE 20

3.5. EVALUATION OF GRADUATES OF THE TRAINING PROGRAM 20

CONDUCT OF VISITS 21

4.1. When should an accredited training program be visited? 21

4.2. What to evaluate during a VISIT 21

4.2.1. The CONTEXT within which the Program is being operated
4.2.2. The Training Resources (INPUT)
4.2.3. Implementation of the Training Program (PROCESS)
4.2.4. Resident performance at different levels of training
4.2.5. Promotion System
4.2.6. The PRODUCTS of the Program

4.3. Scheduling of a visit 22

4.4. Who will visit 23

4.5. Expectations During a VISIT 23

4.5.1. Expectations of the Visiting Team
4.5.2. Expectations of the Hospital

LEVELS OF ACCREDITATION OF TRAINING PROGRAMS and PERIOD OF VALIDITY 24

5.1. LEVEL I – CONDITIONAL ACCREDITATION 24

5.2. LEVEL II – FULL ACCREDITATION 25

5.3. WARNING Status 26

5.4. SUSPENSION of Accreditation 26

5.5. TERMINATED Status / TERMINATION of Accreditation 27

MEMORANDUM OF AGREEMENT forming or supporting a Training Program

(CONSORTIUM, AFFILIATION, LINKAGE) 28
 6.1. GUIDELINES AND REQUIREMENTS FOR CONSORTIUM 28

6.2. GUIDELINES FOR LINKAGE 29

6.3. GUIDELINES FOR AFFILIATION 30

6.4. OTHER MOA LIMITATIONS AND REQUIREMENTS 30

Guidelines infractions that may lead to one level downgrade of Current

Accreditation Status 32

APPEAL on PSGS BOD DECISIONS regarding Accreditation Status 33

8.1. PSGS BOARD DECISIONS NOT SUBJECT TO APPEAL 33

8.2. Appeals to the PSGS Board of Directors must be in writing 33

STEPS TO AMEND THE REQUIREMENTS AND PROCEDURES OF ACCREDITATION 34

APPENDICES 35

10.1. Appendix 1 – FORMS 35

10.1.1. PSGS Form 2017-1: Application for Accreditation in General Surgery
10.1.2. PSGS Form 2017-2: General Surgery Accreditation Information Sheet

10.2. Appendix 2 – ANNUAL REPORT TABLE OF CONTENTS 35

10.3. Appendix 3 – 2017 Content and FORMAT: PSGS ANNUAL REPORT 35

10.3.1. PSGS Table 2017-I: Signature page
10.3.2. PSGS Table 2017-II: Breakdown of Operations
10.3.3. PSGS Table 2017-III: Tabulation of Operations
(14 Main Categories and Specific Operations)
10.3.4. PSGS Table 2017-IVa: Tabulated Summary of Residents
Personal Census
10.3.5. PSGS Table-IVb: 3-year Cumulative Summary Tabulation
of Senior Residents’ Cases
10.3.6. PSGS Table 2017-IVc: Resident’s Tabulated Census for OUTSIDE Rotation
10.3.7. PSGS Table 2017-Va: PROGRAM STRUCTURE
10.3.8. PSGS Table 2017-Vb: Tabulated Names of Residents/ respective year level/
Annual Report Year Appointment dates/ divided according to year
level and schedule of rotators for the year.
10.3.9. PSGS Table 2017-Vc: Tabulations of Residents- New appointments/
Resigned/New Lateral Entry Residents/Terminated/& Rotators
from another institution
10.3.10. PSGS Table 2017-Vd: Tabulation of Resident’s CERES and PBS-RITE results
(including the year’s MPL)
 10.3.11. PSGS Table 2017-Ve: List of Graduates of the program and their status
10.3.12. PSGS Table 2017-Vf: Listing of Year’s CONFERENCES and Activities
10.3.13. PSGS Table 2017-Vg: 3-Year (past 2 years prior to and the annual report)
TABULATED CUMULATIVE OPERATION SUMMARY (including Index Cases)

10.4. Appendix-4 Guidelines and Criteria for Eligibility to take the Certifying
Examinations in General Surgery 35

10.5. GLOSSARY 62

10.6. PSGS Definition of General Surgery 65

 INTRODUCTION

General surgery training in the Philippines developed from the invaluable and progressive
efforts of our predecessors who have had the vision of an excellent and world class society of
practicing surgeons. An accrediting body, therefore, was created to ensure the delivery of the
highest quality of surgical care through a structured residency program with a standard
curriculum. Thus, the competence of those undergoing training in General Surgery in the
different training institutions nationwide is ensured.

The joint PCS Specialties Accreditation Committee was formed in 1976 with Dr. Alfredo
T. Ramirez as chair. It included all the chairs of the surgical specialty Boards and Presidents of
the surgical specialty societies. In 1977, eight hospitals received full accreditation and 26 had
partial accreditation. In 1995, the surgical curriculum for General Surgery was converted into
competency-based education curriculum. It was during this time that objectives, competencies,
content, rotation, teaching-learning activities, and resources were defined. The standardized
evaluation system for residents was introduced with rating scales using clinical competence,
psychomotor skills and attitudes as parameters to determine the accreditation status of the
training institution.

The Accreditation Committee worked cooperatively with the Committee on Surgical Training
(CST), Philippine Association of Training Officers in Surgery (PATOS) and Philippine Board
of Surgery (PBS).

In 1999, the moratorium for the residency training programs applying for accreditation was
lifted through Board Resolution 99-005. The implementation of the Surgical curriculum and
Standardized Evaluation began. It was also at this time that the Philippine Society of General
Surgeons was established specifically during the Midyear Convention in Subic. PCS then
gradually handed over its task of accrediting General Surgery training programs to PSGS until
May 4, 2002 when full devolution was made at the signing of the Memorandum of Agreement.

After a series of workshops and public fora, it has been agreed upon that there will be a
standard 5-year training program in General Surgery. All institutions desirous of receiving full
accreditation must comply with the minimum requirement prescribed.

The PSGS Accreditation Committee is composed of a minimum of 15 members, all Fellows

of the PSGS.

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 ACCREDITATION OF TRAINING PROGRAMS IN GENERAL SURGERY

2.1. Applicants for Accreditation

2.1.1. Institutions considered as New Applicants for GS-Residency Training Program

• Non-accredited Department of Surgery residency training program
• Previously PSGS-accredited Residency Training Program that was terminated
but still wishes to have the program re-accredited after a minimum period of one
(1) year from the date of termination of accreditation
• Non-accredited residency training program wishing to become PSGS-accredited
as a consortium either with another non-accredited program or with a currently
PSGS-accredited single institution or consortium training program. In the latter
situation, the existing PSGS-accredited single institution or consortium training
program shall lose its accredited status and shall be considered as a NEW applicant
that will become a NEW consortium.

• NOTE •
The PSGS Board of Directors must have been informed in writing, by the prospective
applicant training program, of their intention to apply for PSGS accreditation at the latest
two (2) years prior to the intended filing of their application. In the case of a consortium
between two or more non-accredited training programs, the notarized Memorandum of
Agreement between the involved institutions must have also been submitted for review and
approval by the PSGS Board of Directors at least 2 years before the intended date of
application for accreditation.

All institutions wishing to apply for PSGS accreditation are advised to review the current
guidelines for PSGS Accreditation of General Surgery Training Programs for their guidance
and compliance.

2.2. Application Process for Accreditation

A hospital or a consortium of hospitals applying for PSGS Accreditation must comply

with ALL the minimum requirements and follow the application procedure.

2.2.1. Submission of documentary requirements for accreditation:

a. Duly accomplished application form (Appendix 1-Forms, PSGS Form 2017-1:
Application for Accreditation in General Surgery)
b. Letter of application signed by the Department of Surgery Chairperson with the
written approval of the Hospital Medical Director or Chief of Hospital addressed
to the PSGS President thru the Committee on Accreditation stating the following:

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 (Appendix 1-Forms, PSGS FORM 2017-2: General Surgery Accreditation
Information Sheet)
- Mission-Vision of the Institution and the Department of Surgery
- Reason why the department is applying for PSGS accreditation
c. Signed written commitment to comply with ALL the rules and regulations on
accreditation set forth by the Society, to implement the Standardized Surgical
Curriculum for General Surgery, to actively participate and support all society
and chapter activities and projects, and to abide by the decision of the PSGS
Board of Directors (Appendix 1-Forms, PSGS FORM 2017-2: General Surgery
Accreditation Information Sheet)
d. Annual reports covering the 2 years immediately prior to the date of application
(Please refer to Appendix 2- Annual Report Table of Contents) that shows
satisfactory compliance with the minimum annual PSGS case load requirements
for accreditation during each of the 2 years (excludes Graduate Evaluation &
List of Graduates)
e. For institutions applying for accreditation as a consortium, a copy of the duly
notarized Memorandum of Agreement forming the consortium together with
the PSGS Board of Directors’ written approval of the MOA entered into at least
2 years before the intended year of application
f. Payment of application processing fee amounting to PhP 20,000.00 or as
determined by the Board of Directors for the initial and preliminary evaluation
of the submitted documents. This fee is separate from the fee for an actual
accreditation visit amounting to PhP 50,000.00 or as determined by the PSGS
Board of Directors.

2.2.2. Preliminary Evaluation of Submitted Documents

Upon payment of the required fee of PhP 20,000.00, a preliminary evaluation of

the submitted documents shall be done by the Committee on Accreditation to
determine its completeness.

A program must have the required hospital facilities and services, an organized
Department of Surgery, qualified training staff and resident complement, adequate
number and variety of case material to support the training of the resident
complement, a structured training program and resident rotation, properly documented
teaching-learning activities, documented internal evaluation of residents, documented
external evaluation of all residents (PSGS CERES-written examinations) during the
two (2) years immediately prior to the application for accreditation as well as other
requirements that may be deemed necessary by the Committee on Accreditation
and the PSGS Board of Directors.

2.2.3. PSGS Board Decision Regarding Accreditation Visit

Based upon the evaluation and recommendation of the Committee on Accreditation

and as concurred with by the PSGS Board of Directors, applicant training programs

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 that satisfactorily comply with the minimum requirements for accreditation and are
deemed qualified for a visit shall be informed of the favorable decision. The
Committee on Accreditation shall then schedule an accreditation visit, at the earliest,
one month after the PSGS Board approval for the accreditation visit and upon full
payment of the PhP50,000.00 accreditation visit fee to fully evaluate the Applicant
Training Program.

If an applicant training program fails to comply with the minimum requirements for
accreditation after the evaluation by the Committee on Accreditation and therefore
is deemed not yet qualified for an accreditation visit, the PSGS Board of Directors
upon the recommendation of the Committee on Accreditation shall likewise duly
notify the applicant training program of its decision. The training institution shall
also be informed of their deficiencies for their future reference should they wish to
re-apply for accreditation after a minimum period of one (1) year from the date of
denial of their application for an accreditation visit by the PSGS Board of Directors.

• NOTE •

Approved ('QUALIFIED) or Disapproved ('Non-QUALIFIED) Applicant Training

Program for an ACCREDITATION VISIT

Following the preliminary evaluation of the written documentary requirements submitted

by the applicant training program and upon the recommendation of the Committee on
Accreditation, the PSGS Board of Directors shall decide if an accreditation visit of the
Applicant Training Program is APPROVED or DISAPPROVED.

An APPROVED or 'QUALIFIED' Application for Accreditation only means that the

applicant program qualifies for an accreditation visit. The PSGS Board of Directors
shall schedule an accreditation visit upon the recommendation of the Committee on
Accreditation. The visit shall be conducted to fully assess the applicant training program
and does not guarantee that the visited training program shall be granted Level I
accreditation.

A DISAPPROVED or 'NON-QUALIFIED' Application for Accreditation only means

that the applicant program did not qualify for an accreditation visit because there are
still significant deficiencies that will likely lead to the non-granting of PSGS accreditation
based on the assessment of the written documents submitted to the Committee on
Accreditation and as sustained by the PSGS Board of Directors. Disapproved programs
may re-apply and go thru the same procedure of application after a minimum period of
one (1) year from the date of denial of their application for an accreditation visit by the
PSGS Board of Directors.

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2.2.4. PSGS Committee on Accreditation Visit of a Qualified Applicant Training
Program

A team composed of at least 3 members of the Committee on Accreditation shall

visit the applicant training program. The yearly requirements for continued
accreditation of general surgery residency training programs shall be used to evaluate
the qualification of the applying institution or consortium.

The visiting team shall report its findings and assessment to the Committee on
Accreditation for discussion and committee approval. The committee thereafter
submits its recommendations to the PSGS Board of Directors.

The PSGS Board of Directors shall decide based on the recommendation of the
Committee on Accreditation and will notify the applicant training program of its
decision immediately after the board meeting held for that purpose.

2.2.5. PSGS Board Decision on Application for Accreditation

A successful applicant training program or consortium shall be granted a LEVEL 1

accreditation status that shall be valid for 2 years from the time it is granted unless
deficiencies are noted before the end of the 2 year period. The training program shall
also be given a certificate attesting to their Level 1 accreditation by the PSGS.

A visited training program that does not satisfy the minimum requirements for initial
Level 1 accreditation based on the evaluation and recommendation of the Committee
on Accreditation and as sustained by the Board of Directors shall be duly notified
of the decision. The applicant training program shall be informed of the findings of
the visiting team for their future reference should they wish to re-apply for
accreditation after a minimum period of one (1) year from the date of denial of
their application for accreditation by the PSGS Board of Directors.

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 Minimum Requirements for Accreditation in General Surgery

3.1. Required Hospital Facilities & Services

3.1.1. It must at least be a Department of Health Level II accredited hospital. For consortia
programs, each member hospital must have a minimum of 100 beds, excluding
bassinets, per member hospital.

3.1.2. All major clinical departments such as Internal Medicine, Obstetrics & Gynecology,
Pediatrics, and Anesthesiology must be present and preferably accredited by their
respective specialty societies.

3.1.3. Outpatient Facilities including a properly equipped minor Operating Room.

3.1.4. Emergency Room, Operating Room, Recovery Room, Critical Care Facility
(preferably a Surgical ICU but may be an ICU shared with other specialty services),
and Minimally-Invasive Surgery Facilities

3.1.5. Laboratory Services:

3.1.5.1. Facilities for hematologic, serologic, biochemical, and microbiological
examinations
3.1.5.2. Blood Bank
3.1.5.3. Histopathology:
3.1.5.3.1. Submission of all specimens to a pathologist for documentation
and/or histopathologic analysis.
3.1.5.3.2. Facility and capability to perform frozen section must be
present in the hospital or within the immediate vicinity so that
results will be available within approximately one (1) hour.
3.1.5.3.3. Facilities for FNAC/core needle biopsy must be present.

3.1.6. Other Facilities/Services:

3.1.6.1. Radiologic Facilities
3.1.6.1.1. Plain x-rays: chest, abdomen, KUB
3.1.6.1.2. Contrast x-rays: Upper GI, Barium Enema, IVP
3.1.6.1.3. Intra-operative cholangiography
3.1.6.2. Ultrasonography
3.1.6.3. Endoscopic Facility
3.1.6.3.1. Upper & Lower GI endoscopy

3.1.7. Facilities that should be available within the immediate vicinity of the hospital:
3.1.7.1. CT Scan
3.1.7.2. Mammography

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3.2. Training Facilities, Medical Library and Information Technology facilities with subscribed
and functioning internet access

3.2.1. Textbooks
3.2.1.1. Principles of Surgery
3.2.1.2. Atlas of Operative Techniques
3.2.1.3. Surgical Anatomy
3.2.1.4. Physiology
3.2.1.5. Pathology
3.2.1.6. Surgical Oncology
3.2.1.7. Trauma and Critical Care
3.2.1.8. Training Resource Manual in Minimal Access Surgery
3.2.1.9. All PSGS published and prescribed reference materials

3.2.2. Surgical Journals

3.2.2.1. Philippine Journal of Surgical Specialties
3.2.2.2. Foreign Surgical Journals

3.2.3. PSGS Assessment and Surveillance (ASSURE) Online Database of surgical

procedures

3.2.4. Functioning Hospital Tumor Board

3.2.5. Quality Assurance Board or Committee

3.2.6. Ethics Review Board

3.2.7. Required skills training facility/laboratory for residents

3.2.7.1. Trainer Box
3.2.7.2. Logbook to document exercises performed by each resident stating the
date and time of performance and the time to completion of the task/
exercise (e.g. hand tying and suturing exercises, minimal access surgery
drills and exercises)

3.3. Structured General Surgical Residency Training Program Requirements

3.3.1. Policy on Commitment & Resident-Supervision

Since the training program provides both patient care and accredited training of
residents, it is incumbent upon the Qualified Training Staff to demonstrate their
commitment to the training program. There must be a sustained and appropriate
resident-supervision on patient evaluation/care, management decisions, and
performance of surgical procedures as the trainee acquires the skills and maturity to
be capable of practicing independently. As emphasized in the Standardized Outcome-
based Surgical Curriculum in General Surgery, these attributes are fundamental to
the provision of excellent patient care and the training of future board-certified general

7
 surgeons. The Qualified Training Staff has the obligation to follow-through with
resident supervision and to provide guidance during the pre-operative, intra-operative
& post-operative assessment and management of all their surgical patients. Such
duties and commitment are not confined nor limited to the supervision and oversight
functions done during conferences or actual surgery.

Determination of the degree of supervision is generally left to the discretion of the

qualified training staff within the context of the levels of responsibility assigned to
the individual resident involved. This determination is a function of the experience
and competence of the resident and the complexity of the specific case.

3.3.2. Qualified Training Staff

3.3.2.1. Department Chairperson

- Has administrative authority over the Department of Surgery. In the
case of a consortium, there must only be ONE chairperson for the
Surgery departments that form ONE consortium.
- Preferably, a general surgeon who must be a PSGS Fellow in-good-
standing or a PCS Fellow in good standing
- Is the Chairperson in only ONE (1) PSGS-Accredited Residency
Training Program at any given time

3.3.2.2. Residency Training Officer

- Has authority over the residents' surgical training program and functions
as the Head of the GS-Residency Training Program Committee that
is composed of consultant staff members
- Must be a PSGS Fellow in good standing who has been actively
practicing general surgery for at least five (5) years
- Must be a Philippine Association of Training Officers in Surgery
(PATOS) member in good standing
- Is the training officer in only ONE (1) PSGS-Accredited Residency
Training Program at any given time

3.3.2.3. Consultant Staff

All consultants involved in the training of residents must have written

appointments from the institution.

Only consultants who are PSGS Fellows in good standing or PCS Fellows
of other PCS Surgical Specialty Societies in good standing may be involved
in the training of general surgery residents. All general surgical operations
included in the list of case requirements for accreditation must be
supervised by PSGS Fellows in good standing while the rotation of residents
in other specialties must be supervised by their respective board-certified
specialists. Only cases supervised by these qualified trainers in good
standing may be used for accreditation and board-eligibility purposes.

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 A minimum of five (5) PSGS Fellows in good standing who actively
participate in the residency training program is required for every ten (10)
or fewer surgical residents. One (1) additional PSGS Fellow in good
standing must be added to the consultant staff for every two (2) additional
residents. Failure to comply with the 5 PSGS Fellows in good-standing
for every 10-or-fewer-residents ratio shall be a basis for the downgrading
of the institution's accreditation status by one level.

All PSGS fellows in the consultant staff of an accredited training program

are required to maintain their good standing as part of the requirements
for accreditation. A program's accreditation status shall not be affected if
the minimum required trainer in good standing to resident-ratio is
maintained. All the service and pay cases under the supervision of a
consultant staff, NOT 'in good-standing', shall however NOT be credited
as case material of the training program for accreditation or board-
eligibility purposes.

3.3.3. Resident Staff

3.3.3.1. Basic Qualifications/Requirements of applicants for Residency Training

A. Must have taken the PSGS National Surgical Assessment Test (NSAT)
which has a validity of 3 years from the time of examination

B. Must be duly licensed to practice medicine in the Philippines by the

Professional Regulatory Commission

C. Foreign Medical Graduates (FMG) must have been granted a written

permission or temporary license by the Professional Regulatory
Commission to undergo General Surgery Training in the Philippines.
If the foreign medical graduate is a graduate of a foreign medical
school, a current license to practice medicine from their country of
origin notarized/certified valid by their Department of Foreign Affairs
or equivalent agency must be submitted together with the Philippine
PRC temporary license.

3.3.3.2. The Resident Complement

A single institution training program must have a FULL resident

complement of at least FIVE (5) residents at any given time distributed
with at least one (1) 1st year level resident, one (1) 2nd or 3rd year level
resident, and one (1) 4th or 5th year level resident.

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 A single institution applying for PSGS Accreditation of their Residency
Training Program must have a MINIMUM of ONE (1) FULL resident-
complement as defined.

A consortium applying for PSGS Accreditation of their Residency Training

Program must have a FULL resident complement of at least SIX (6)
residents at any given time distributed so that there is a MINIMUM of
three (3) residents PER INSTITUTION with at least ONE (1) 4th or 5th
year level resident per institution at the time of application. Therefore,
there must be at least ONE (1) senior (4th or 5th year level) resident,
ONE (1) intermediate level resident, and ONE (1) junior level resident in
each of the institutions in the consortium at any given time.

THERE MUST BE NO LATERAL ENTRY RESIDENTS INTO THE

APPLICANT TRAINING PROGRAM during the two (2) years
immediately prior to their application for accreditation.

Upon being granted level 1 accreditation, all the residents in the applicant
training program however shall start their accredited residency training
levels one (1) year level lower than their residency levels immediately
prior to their accreditation, i.e., upon accreditation, a 5th -year resident
will start as a 4th -year resident; similarly, a 4th -year resident will start as
a 3rd -year resident; a 3rd -year resident as a 2nd -year resident; and, a
2nd -year resident as a 1st -year resident. The 1st -year resident shall remain
as a 1st -year resident.

Existing accredited training programs with an INCOMPLETE resident

complement is given ONE YEAR from the time it was incurred to correct
the deficiency in order avoid the downgrading of their accreditation status
by one level.

3.3.3.3. Lateral Entry Resident

This refers to a resident who wishes to transfer from a PSGS-accredited

residency training program to another accredited training program.

Requirements For The Lateral Entry Resident & The Accepting Training Program:

A transferring resident is required to submit to the PSGS Board of Directors thru the PSGS
Committee on Accreditation and to the accredited training program being applied to the
following duly signed and notarized letters of recommendation from EACH of the following
individuals:
- the department chairperson stating and attesting to the exact tenure of training of the
resident in their institution, the number of SATISFACTORILY COMPLETED years
of accredited residency training and the reason for the resident's resignation, non-
reappointment or termination

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 - the residency training officer stating and attesting to the exact tenure of training of the
resident in their institution, the number of SATISFACTORILY COMPLETED years
of accredited residency training and the reason for the resident's resignation, non-
reappointment, or termination

- the Medical Director or the Chief of Clinics from the institution of origin attesting to
the exact tenure of training of the resident in their institution, the number of
SATISFACTORILY COMPLETED years of accredited residency training

Upon acceptance of the lateral entry resident to another PSGS accredited training program, the
transferring resident shall resume his accredited residency training as an in-coming appointee
on the same year-level as the last satisfactorily completed year level in the previous institution
with an appointment, i.e., A newly appointed or mid-4th -year-level resident, who had
satisfactorily completed 3 years of training in a PSGS-accredited training program; and, who is
transferring to another accredited training program (Lateral Entry), may be accepted as a 3rd
year level resident upon his transfer to another accredited training program. The highest residency
year-level appointment that may be given, by an accepting training program, to any in-coming,
new appointee, lateral entry resident will be the same as the transferring resident's last
documented & completed year-level appointment at the program of origin.

The accepting training program must formally verify in writing with the institution-of-origin the
authenticity and veracity of the letters of recommendation and the documents submitted by
the transferring resident.

The accepting training program must likewise formally verify in writing with the PSGS Board
of Directors thru the Committee on Accreditation that the certified completed years of residency
training in the initial institution of the transferring resident is covered by the period of accredited
training.

The accepting training program is required to inform in writing the PSGS Board of Directors
thru the Committee on Accreditation within one month from the date of initial appointment
that a transferring resident has been accepted as a lateral entry into the training program. The
committee must be informed of the exact date of the appointment and the year level that the
transferring resident was accepted into.

Failure to comply with the aforementioned procedure for accepting lateral entry residents will
result to a downgrading of the accepting training program's accreditation status by one level.

3.3.3.4. RESIDENTS and the PROGRAM FACTOR

The program factor is used to compute the CASE LOAD
REQUIREMENT of a PSGS-accredited residency training program during
a given year and is based on the resident complement of the program for
that particular year.

11
The following residents shall be included in the determination of the program factor:

- All resident trainees who have regular appointments to the training program and who
are part of the resident-complement.

- All Foreign Medical Graduates who are not Filipino citizens and not qualified to take
the Philippine Medical licensure examination but who by special arrangement
(government-to-government, government-to-institution, institution-to-institution,
ASEAN agreement, etc.) are allowed to undergo the structured sequence and duration
of the training program in a PSGS accredited training institution. The "Foreign Rotator"
however is required to submit the following documents to the PSGS Board of Directors
thru the Committee on Accreditation:

a. Proof that the rotator carries an ASEAN passport

b. Valid passport and visa if the foreign rotator is a citizen of a non- ASEAN country

c. Notarized certified true copy of license to practice medicine in the country of origin
issued by the rotator's government or consulate

The following residents shall NOT be included in the determination of the program factor:

- A resident who has been duly certified and pre-identified by their specialties to undergo
further training in a specialty other than General Surgery in the SAME INSTITUTION
after completing the pre-requisite rotation in General Surgery. The resident will be given
yearly appointments for only a portion (1-4 years) of the full duration of the GS-Residency
Program and shall be considered as a 'STRAIGHT ROTATOR'. This intention must be
clearly stipulated in their appointment papers from other specialties such as Urology,
TCVS, Neurosurgery, Plastic and Reconstructive Surgery, and Pediatric Surgery, etc.

Although the cases that these rotators shall handle as 'SURGEON' shall be included in
the declared and tabulated-reporting of the host program's case material for the calendar
year, a separate listing of cases they handled must be included in the annual report of
the institution.

- Residents from a PSGS-accredited training program who rotate in another PSGS-

accredited training program on the strength of the memorandum of agreement for
affiliation or linkage between the two institutions as approved by the PSGS Board of
Directors. (The MOA must stipulate the category of procedures for which the resident
will be rotating. The outside rotation shall be limited to a maximum of two (2) categories
of operations.)

3.3.4. The CASE MATERIAL

3.3.4.1. Program's Case Load (Volume and Variety of cases) Requirement.

12
A minimum volume and variety of surgical operations is required, as listed in PSGS TABLE
2017-III Table of Operations, to ensure that all residents acquire mastery and proficiency in the
pre-operative, intra-operative and post-operative management of surgical cases that shall translate
to high quality surgical patient care. The 14 Main Case CATEGORIES OF OPERATIONS and
the specific INDEX CASES in certain Main Categories required annually for a training program
are enumerated below.

CATEGORY I. Head & Neck (20) ——

Index: Thyroidectomy – 10; Parotidectomy – 1; Neck Dissection – 1

CATEGORY II. Breast (10) ——

Index: Modified Radical Mastectomy – 5

CATEGORY III. Esophagus, Stomach, Duodenum (5) — (excision/resection/repair)

Index: Gastric Resection of any variety- 1

CATEGORY IV. SMALL AND LARGE BOWEL SURGERY (25) —

Index: Bowel Resection with or without anastomosis – 10; Adhesiolysis - 2

CATEGORY V. RECTAL SURGERY (2) — Index: either LAR or APR – 1

CATEGORY VI. ANAL SURGERY (10)

CATEGORY VII. APPENDECTOMY (ADULT or PEDIATRIC, OPEN or

LAPAROSCOPIC, COMPLICATED or UNCOMPLICATED) (20)

CATEGORY VIII. HEPATOBILIARY, GALL-BLADDER, PANCREAS, LIVER (30)

Index: Cholecystectomy (OPEN OR LAPAROSCOPIC) – 10; CBDE – 2; Biliary
Enteric - 1

CATEGORY IX. THORACOSTOMY (FOR TRAUMA OR NON-TRAUMA) (5)

CATEGORY X. TRAUMA (8)—

Index: Abdominal/Thoracic/NeckExploration/ Major Vessel Injury -4

CATEGORY XI. VASCULAR ACCESS (cutdown, IJ cath, subclavian, portacath) (5)-

CATEGORY XII. Hernia Repair (15)

CATEGORY XIII. SOFT-TISSUE TUMOR RESECTION (5)

CATEGORY XIV. OTHER SPECIALTY SURGERY (10)

(Urology; Thoracic and Vascular Surgery; Plastic & Reconstructive Surgery; Pediatric
Surgery (other than AP & Abdominal Wall Hernia), Neurosurgery; Orthopedics)

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Only cases properly supervised by PSGS Fellows in good standing or board- certified specialists
of their respective specialty societies shall be credited to the training institution as case material
for accreditation purposes and by the resident to fulfill diplomate board-eligibility
requirements.

The annual Case Load Requirement of a training program with a Program Factor of 1 (for
every 5 residents) is 170 cases. The cases must be of sufficient variety and distributed in
proportion to the main categories of operations. The Index Case Requirement pertains to
specifically identified procedures with a fixed volume requirement that a training program must
handle annually. The number of index cases required for a training program for a particular year
is a fixed number that shall not be affected by the number of residents in the program (Program
Factor). Taking as an example main Category II BREAST index case, MRM is 5: A Training
Program is required to handle annually specifically a minimum of 5 MRM index cases regardless
of its number of residents and its program factor.

A maximum of thirty-five per cent (35 %) per main category of operation of all the 'private'
cases of PSGS Fellows in good standing in the accredited training program regardless of whether
the resident performed the procedure or merely assisted the Qualified Training Staff shall be
automatically credited to fulfill the program's case load requirement. There will be no need to
claim any cases as resident performed or assisted for accreditation purposes.

There must be a reasonable quality instruction, commitment to the training program, and active
involvement of the qualified training staff as evidenced by regular supervision of residents and
presence in the operating room to maintain continuing and appropriate resident supervision. A
minimum of twenty per cent (20 %) per main category of operations of the training program's
annual case load requirement, except for trauma cases, must be service cases. All trauma cases
can be claimed by the residents. All operations performed as service cases in the training program
shall be credited as a resident-performed case.

Cases handled by a rotating resident during an outside rotation supported by a Memorandum

of Agreement specifying the category of operations for which the resident is rotating and duly
approved by the PSGS Board of Directors shall be credited as part of a rotating resident's
training program's case material to fulfill the rotating resident's institution case load requirements
if there is proper host-institution certified documentation. These cases, although reported, must
however be listed separately and bracketed [ ] in the list of cases [under Total Cases Handled -
PSGS TABLE 2017-III Table of Operations] of the host training program and shall not be
credited to the census of the host program.

Since the rotator is a resident from another PSGS-accredited residency training program thru an
affiliation or linkage, the listing of the cases handled by resident rotators must be included in
the annual reports of both the rotating resident's training program & the host institution in a
separate table similar to the senior residents' census. It must indicate the inclusive dates of the
rotating resident's outside rotation, the patient's initial, age, sex, and hospital number, pre-
operative diagnosis, procedure and date of procedure, post-operative diagnosis, histopathology,
and the outcome of the case (refer to PSGS TABLE 2017-IVc Resident's Tabulated Census for
OUTSIDE Rotation). Each procedure listed must be countersigned by the service consultant-
in-charge or the residency training officer of the host institution to ensure the veracity of the
submitted information.

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Surgical procedures performed by rotating residents that are NOT WITHIN THE SCOPE of
the Memorandum of Agreement for the rotation shall NOT BE CONSIDERED as case material
of the rotating resident's training program to fulfill their case load requirements for accreditation
and diplomate board-eligibility.

Cases performed during Surgical Outreach Programs OUTSIDE OF THE BASE HOSPITAL/
S may be credited as residents' cases for accreditation of the training program up to a maximum
of twenty per cent (20%) of the total number of cases required per main category of operation
provided there is adequate pre-operative care, post-operative care and direct supervision of the
residents during the performance of the operative procedure by a member of the qualified
training staff.

Example: If the required number of major head and neck cases is 20 and the required number
of hernia cases is 30 (i.e. if there are 10 residents in a 5-year program), and the
residents performed 50 thyroid surgeries and 20 hernia cases in surgical missions,
only 4 thyroidectomies (20% of 20 required thyroidectomy cases) and only 6
herniorrhaphies (20% of 30 required herniorrhaphy cases) may be credited for
accreditation of the training program.

There will be no limitation in the number of service cases to be credited to the training program
for accreditation purposes when these procedures are done as IN-HOUSE OR IN-BASE-
HOSPITAL Surgical Missions.

Only cases done under the supervision of PSGS fellows in good standing shall be credited to
fulfill General Surgical case load requirements for accreditation as listed. All other cases
supervised by PCS fellows in good standing of other PCS specialties shall be credited as specialty
procedures.

In case of suspension of accreditation of a training program, only cases done at the mother
institution during the period of suspension may be credited to satisfy the case requirements for
re-accreditation because OUTSIDE ROTATION OF RESIDENTS DURING THE PERIOD
OF SUSPENSION SHALL NOT BE ALLOWED. Although the cases performed in the mother
institution during the period of suspension shall be credited to the training program for
accreditation purposes, these cases may NOT be claimed by the residents to fulfill their case
requirements for diplomate board-eligibility.

3.3.4.2. PROCEDURE as a RESIDENT'S CASE: Resident as 'THE SURGEON'

The resident is considered as "THE SURGEON" of a case in the following

situations:
- Operations wherein the qualified training staff scrubs-in on the case,
assists and allows the resident to perform most of the surgical
procedure inclusive of the vital and more important parts of the
operation.
- Cases wherein the resident does the operation 'independently' (The
qualified trainer does not scrub-in on the case but has had pre-operative
discussion of the case and is available for intra-operative consultation).

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 3.3.5. Documentation of case material or cases handled
The cases handled by the program must be documented in the department's tabulated
case material (PSGS TABLE 2017-III Table of Operations) of the annual report,
conference reports, hospital database and operating room logbooks.

3.3.5.1. PSGS Prescribed Resident's Logbook

The officially-prescribed PSGS logbook must be filled up regularly and
conscientiously to prevent the backlog of cases and to assure uniformity
of reporting. The individual resident's entries in the logbook must be
regularly checked at least quarterly by the residency training officer of
the program and attested to as accurate and true by periodically affixing
his/her signature.

All service cases performed by residents during their rotations in other

institutions thru the strength of a PSGS-approved MOA for affiliation or
linkage must be authenticated and individually attested to as accurate by
the residency training officer or duly appointed authority (i.e., consultant-
in-charge) of the host institution. The same list of operations performed
by the rotating resident must be attached to the individual resident's
logbook and reported in the annual reports of both the host and the
affiliated institution for cross-referencing.

Only cases done by residents under the direct supervision of a member

of the qualified training staff may be included in the residents' logbooks
and annual report.

3.3.5.2. PSGS Assessment and Surveillance Online Database

All residents are required to log-in their cases into the PSGS ASSURE
Online Database beginning January 2017. The Committee on Accreditation
will utilize the database in its review of the accredited institutions annual
reports and for accreditation visits. Only the entries in the database shall
be considered official.

3.3.6. Residency Program Duration & Structured Rotation

3.3.6.1. Duration Of Training

The regular duration of General Surgery Residency Training is five (5)
years.

A resident may be promoted, suspended, retained in a year-level, or

expelled based on the results of the periodic evaluation and the promotion
policy of the training program. Suspension or retention in a year level
will prolong the sanctioned resident's residency-training for the same
duration as the penalty in order to satisfy the minimum 5-year required
period of accredited residency training.

16
 Suspension of a training program's accreditation shall prolong the duration
of all the residents' training in order to satisfy the minimum requirement
of 5 years of accredited training for a GS resident to qualify for graduation.

3.3.6.2. Structured Rotation

Since the minimum duration of regular residency training in a PSGS-
accredited residency training program is sixty (60) months, the rotation
in General Surgery must be at least forty-five (45) months while the
specialty rotations should be a maximum of fifteen (15) months.

The first and last years of residency training must be spent in General
Surgery at the mother institution. Therefore, rotations to affiliate or linked
institutions are NOT ALLOWED during the first and fifth years of
residency training.

First year residents must not be assigned to man the Emergency Room.

Only intermediate level (2nd and 3rd year) residents are allowed to rotate
in other specialty services. Flexibility is allowed in other specialty rotations
to provide adequate exposure by assisting or performing surgical
procedures in the following specialties: Thoracic & Cardiovascular Surgery,
Or thopedics, Urology, Neurosurger y, Pediatric Surger y, Plastic-
Reconstructive & Aesthetic Surgery. The duration and sequence of
specialty exposure will be the program's prerogative. A rotation in
Pathology is optional.

Only 4th year Residents are allowed to go on outside rotation for general
surgical procedures unless a special exemption is granted by the Board of
Directors on a case-to-case basis.

The outside rotation to other institutions must not exceed six (6) months
per resident per year and must be covered by a duly notarized
Memorandum of Agreement approved by the PSGS Board of Directors
specifically stating the purpose of the rotation and the specific operative
categories for which the resident is rotating for.
Per PSGS Board of Directors approved MOA, the outside rotation of
residents to comply with case load requirements of an accredited training
program shall be limited to a MAXIMUM OF 2 MAIN CATEGORIES
of operations only.

Residents in an individual training program may be allowed to rotate

outside of the training program to a non-GS-accredited training program
for the sole purpose of additional exposure (e.g., SICU, etc.) for a
maximum of 3 months but NOT to perform operations in order to comply
with the accreditation case load requirements of the training program.
This shall be subject to the written approval of the Board of Directors
upon the recommendation of the Committee on Accreditation.

17
 Although residents in a consortium are not allowed to rotate outside of
the training program in order to perform operations to comply with
accreditation case load requirements, an outside rotation to a non-GS-
accredited training program for the sole purpose of additional exposure
(e.g., SICU, etc.) for a maximum of 3 months and not to accrue cases for
accreditation purposes may be allowed subject to the written approval of
the Board of Directors upon the recommendation of the Committee on
Accreditation.

Consortia training programs are however allowed to accept resident

rotators from other PSGS-accredited residency training programs.

3.3.7. Resident Evaluation

The evaluation of residents should be properly documented and must have provisions
for feedback. This must be part of the bases for resident promotion that must be
utilized by the training program.

3.3.7.1. Internal Evaluation of Residents

- must be implemented in accordance with the prescribed evaluation
system (See Standardized Surgical Curriculum for General Surgery) and
must be done at least once a year
- Written examinations must be given periodically and at least once a
year
- Properly documented written evaluation of the resident's oral
presentations during conferences, case presentations, etc.

3.3.7.2. External Evaluation of Residents

- PSGS-CERES Written Examination, PBS-RITE, etc.

All residents in PSGS-accredited General Surgery residency training

programs including those rotating in General Surgery from other specialties
during their initial years of training are required to take the CERES written
examination administered yearly by the PSGS.

3.3.8. Teaching And Learning Activities

These activities include, but are not limited to, conferences, case presentations, grand
rounds, teaching rounds, journal clubs, seminars, and post-graduate courses.
3.3.8.1. Minimum number of conferences per year
Total
Morbidity and Mortality 6
Audit and Census 6
Pre-op & Post-op/ Case Presentation / Grand Rounds 24
Journal Club 4
Tumor Conferences 4

The training program should have a detailed discussion of one particular case during each of
the required six (6) morbidity and mortality conferences for the year.

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3.3.9. Documentation of Activities
3.3.9.1. All teaching and learning activities
The proceedings during all conferences must be properly documented in
a specific logbook for each type of conference. (i.e., M&M LOGBOOK,
Pre-op/Post-Op/Case Presentation LOGBOOK/ Census LOGBOOK,
etc.) The conferences must be arranged in chronological order and all the
major issues discussed must be properly noted.

The following entries/ inclusions and attachments must be included in

the logbook:
- Date and time of the conference, venue attendance list that includes
the name, position, and signature of the attendees;
- Name and position of the presenter, the topic for discussion and a
copy of the topic protocol
- Copy of the visual aid presentation and the proceedings of the
discussion to record the consensus and lessons learned during the
conference

3.3.9.2. MIS/Laboratory Trainer Exercises properly documented in specific

exercise LOGBOOKS with the following entries:
- Residents' name/date/ time done
- Type of exercise done
- Duration of exercise to completion

3.3.10. ANNUAL REPORT of the General Surgery Residency Training Program

The annual report is a collated documentation of the training program's activities
and census of cases for a particular year in compliance with the 2017 Standardized
Outcome-Based Curriculum in General Surgery.
3.3.10.1. Four (4) copies of the annual report must be submitted book-bound;
duly certified to be true and accurate by both the Department Chairperson
& the Residency Training Officer; and, duly noted by the Hospital
Medical Director. The Annual Report must be submitted to the PSGS
on or before February 28th of the current calendar year.
3.3.10.2. NO REVISIONS to the annual report shall be allowed once it has been
submitted to and accepted by the PSGS.
3.3.10.3. All the contents of the annual report must be verifiable through pertinent
documents such as the online PSGS Surgical Database and all other
documents that may be required by the Committee on Accreditation at
any time.
3.3.10.4. Submission of the annual report after February 28th but on or before
March 31st of the calendar year will be considered late submission and
shall automatically result to a downgrading of the training program's
current accreditation status by one level.
3.3.10.5. Failure to submit the annual report by March 31st of the calendar year
shall be considered as non-submission and will automatically result to
the SUSPENSION of the training program regardless of the program's
prior accreditation status.

19
 3.3.10.6. The annual report must follow the prescribed format and contain all the
required information and documents (Please refer to Appendix 2 - Annual
Report Table of Contents & Appendix 3 - PSGS Annual Report 2017
Format)

3.4. Annual Accreditation Fee

3.4.1. The prescribed annual accreditation fee must be settled on or before February 28th
of each calendar year.
3.4.2. Payment of the accreditation fee after February 28th but on or before March 31st
of the current year shall be considered LATE PAYMENT and will incur a 30 %
SURCHARGE.
3.4.3. Failure to pay the accreditation fee by March 31st of the current year shall
automatically result to a DOWNGRADING of the program's current accreditation
status BY ONE LEVEL.

3.5. Evaluation of Graduates of The Training Program

The list of all graduates of the training program from the time of its initial accreditation
and their current status (diplomate/non-diplomate/fellow) must be included in the annual
report submitted to the PSGS.

All eligible graduates of PSGS-accredited Residency Training Programs must take the
Philippine Board of Surgery Diplomate Certifying Examinations. At least fifty percent
(50%) of the training program's graduates during the last five (5) years must pass both the
written and oral examinations of the Philippine Board of Surgery. Failure to comply with
this minimum passing rate will automatically result to a downgrading of the program's
current accreditation status by one level.

Graduates of training programs undergoing fellowship training and who will subsequently
be practicing specialties other than general surgery in the Philippines and those who will
practice surgery outside the Philippines shall not be included in this requirement provided
proper documentation has been submitted to the PSGS Committee on Diplomate Board
Eligibility and Committee on Accreditation.

20
 Conduct of Visits

4.1. When should an accredited training program be visited?

4.1.1. Upon the recommendation of the Committee on Accreditation and with the
concurrence of the PSGS Board of Directors that the applicant training program is
qualified for an accreditation visit
4.1.2. Within three to six (3-6) months before the expiration of a training program's
accreditation
4.1.3. After a minimum period of six (6) months but within one (1) year after a training
program is warned pending the submission of a written request for a re-visit by the
training program to the PSGS Board of Directors thru the Committee on
Accreditation. If a warned training program fails to request for a re-visit within one
(1) year from the date of effectivity of the warning, the program shall be automatically
suspended by default.
4.1.4. After a minimum period of six (6) months but within one (1) year after a training
program is suspended. The suspended program must submit a written request for a re-
visit to the PSGS Board of Directors thru the Committee on Accreditation to schedule
the visit after the six (6) month period of suspension. If a suspended training program
fails to request for a re-visit within one (1) year from the date of effectivity of the
suspension, the program shall be automatically terminated by default.
4.1.5. At anytime that significant deficiencies are identified in the submitted annual report
regardless of the training program's current accreditation status. A program may be
visited upon the recommendation of the Committee on Accreditation and as
approved by the PSGS Board of Directors

4.2. What to evaluate during a VISIT

4.2.1. The CONTEXT within which the Program is being implemented:

4.2.1.1. Administrative support for the program to maintain the high quality of
residency training
4.2.1.2. Selection process for residents including the National Surgical Assessment
Test (NSAT)
4.2.1.3. Adherence to the stated vision and mission of the PSGS, the institution,
and the Department of Surgery
4.2.1.4. Commitment of the program, consultant staff, and residents to comply
with all the PSGS guidelines for accreditation and the Standardized
Outcome-based Curriculum in General Surgery
4.2.1.5. Commitment of the qualified training staff to maintain continuing and
appropriate resident supervision
4.2.1.6. Active participation and compliance with all PSGS mandated activities
and programs

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 4.2.2. Training Resources (INPUT)
4.2.2.1. Hospital Facilities and Services
4.2.2.2. Residency Training Program
4.2.2.3. Clinical Materials

4.2.3. Implementation of the Training Program (PROCESS)

4.2.3.1. The rotation, structure, duration and evaluation of rotations
4.2.3.2. The teaching-learning activities· conferences· rounds
skills training and workshops
4.2.3.3. The resident internal evaluation & feedback system
4.2.3.3.1. Methods used : - written examinations, - oral examinations, -
oral presentations, - observational assessment of actual
performance
4.2.3.3.2. Frequency

4.2.4. Resident performance at different levels of training based on:

· Internal Evaluation
· External Evaluation
CERES (Written Evaluation)
Residency-in-service training examination

4.2.5. Promotion System

4.2.6. The PRODUCTS of the Program

4.2.6.1. The graduates performance based on the passing percentage in the
Philippine Board of Surgery Diplomate Certifying Examinations for the
preceding five (5) years

4.3. Scheduling of a Visit

4.3.1. Training programs with Level I or II accreditation shall be notified of the scheduled
visit as decided by the Committee on Accreditation at least thirty (30) days prior to
the scheduled visit or as mutually agreed upon by the training program and the
Committee on Accreditation
4.3.2. Training programs on warning status that will be visited after the minimum period
of six (6) months has elapsed from the time the program was warned shall be notified
of the scheduled visit to be done as decided by the Committee on Accreditation at
least thirty (30) days prior to the scheduled visit or as mutually agreed upon by the
training program and the Committee on Accreditation
4.3.3. Suspended training programs that wish to be visited after the minimum period of six
(6) months from the time of suspension must submit a written request for an
accreditation visit to the PSGS Board of Directors thru the Committee on
Accreditation before that period has elapsed. Thereafter, the requesting training
program shall be notified of the schedule of the visit as decided by the Committee
on Accreditation at least thirty (30) days prior to the scheduled visit or as mutually
agreed upon by the training program and the Committee on Accreditation.

22
 4.3.4. Training programs applying for accreditation that are deemed qualified for an
accreditation visit shall be notified of the schedule as decided by the Committee on
Accreditation at least thirty (30) days prior to the scheduled visit or as mutually
agreed upon by the training program and the Committee on Accreditation.
4.3.5. Written requests for a re-scheduling of the accreditation visit shall be entertained on
a case-to-case basis as recommended by the Committee on Accreditation and with
the concurrence of the PSGS Board of Directors.

4.4. Who will Visit?

4.4.1. The Visiting Team

4.4.1.1. A team of at least three (3) members of the Committee on Accreditation
shall conduct the accreditation visit

4.4.2. The Director - in - Charge and / or the Chair of the Committee on Accreditation
may join any visiting team.

4.5. Expectations During a Visit?

4.5.1. Expectations of the Visiting Team

4.5.1.1. Physical presence of the Department Chairperson, Training Officer, the
Qualified Training Staff and Residents-in-training is required.
4.5.1.2. The recently graduated residents should preferably be present and their
logbooks MUST be available for scrutiny by the visiting team
4.5.1.3. All necessary documents, current Memoranda of Agreement, logbooks
and OR records (operative notes, procedures and anesthesia records) should
be available for inspection and verification.

4.5.2. Expectations of the Hospital

4.5.2.1. The hospital shall be informed in writing by the PSGS Board of Directors
regarding the schedule of the accreditation visit at least thirty (30) days
prior to the scheduled visit or as mutually agreed upon by the training
program and the PSGS.
4.5.2.2. Systems and mechanics of the visit shall be followed and adhered to.
4.5.2.3. Visiting team dialogue with the training program consultant staff and
residents.
4.5.2.3.1. An initial dialogue with the department officers, qualified
training staff and the residents will be conducted.
4.5.2.3.2. Visit interviews shall be done with the qualified training staff
and with the residents separately if deemed necessary upon
the discretion of the visiting accreditation team.
4.5.2.4. A post-visit, exit conference with the department officers, the qualified
training staff and the residents without divulging the assessment and
recommendation regarding the accreditation status of the visited training
program.

23
 Levels of Accreditation of Training
Programs & Period of Validity

5.1. Level I Accreditation

Residency programs that have been granted CONDITIONAL accreditation, for a period
of two (2) years, from the date of PSGS Board of Directors decision upon the
recommendation of the Committee on Accreditation. These programs have met ALL the
minimum requirements for conditional accreditation that include but not limited to:

a. Satisfied the minimum volume and variety of surgical operations required of the
training program based on the number of residents in the program. There must also
be a reasonable quality of instruction as evidenced by having at least twenty per
cent (20 %) of the case load requirement as service cases with the pre-operative,
intra-operative and post-operative management actively supervised by a member of
the qualified training staff
b. Creditable performance in the PSGS CERES written examination over the past 2
years as shown by a fifty per cent (50 %) passing rate for all residents
c. Properly documented clinical and teaching activities that are adequate in number
and variety
d. Active involvement of the qualified training staff as evidenced by regular supervision
of residents and presence of at least thirty per cent (30 %) of the qualified training
staff during surgical conferences
e. For training programs which have been accredited for the past 5 years, a creditable
performance in the Philippine Board of Surgery diplomate certifying examination
over the last 5 years. All eligible graduates must take the examination within five (5)
years of graduation. At least fifty percent (50 %) of the eligible graduates must have
passed both the written and oral diplomate examinations during the immediately
preceding 5-year period.

This accreditation status may be granted to:

- newly accredited training programs, including a previously terminated program
(considered as NEW applicant) that has been re-accredited.
- Previously warned or suspended training programs that were found to have corrected
all deficiencies and have satisfied all the requirements for accreditation based on
an accreditation visit. The upgrading of the accreditation status must have been
favorably endorsed by the Committee on Accreditation and concurred with by
the PSGS Board of Directors.

After re-assessment of the training program during the required accreditation visit two (2) years
after the granting of Level I accreditation, a program will either be upgraded to Level II
accreditation after satisfying ALL the requirements for this higher level or downgraded to a

24
warning status if the program is unable to satisfy ALL the minimum requirements for upgrading
to a Level II accreditation.

A training program may be re-visited at any time during the 2 years of Level I accreditation if
significant deficiencies are noted in the review of the training program's annual report.

Should a training-program with Level I accreditation fail to satisfactorily comply with all the
requirements to maintain this level of accreditation upon confirmation after a visit by the
Committee on Accreditation and as concurred with by the PSGS Board of Directors, the
accreditation status will be downgraded to Warning status.

5.2. LEVEL II Accreditation

Residency programs that have been re-accredited and granted FULL accreditation for a period
of five (5) years from the date of PSGS Board of Directors decision upon the recommendation
of the Committee on Accreditation. These programs have met ALL the minimum requirements
for a 5-year residency program as stipulated in this manual and must have satisfied the following
additional criteria:

a. Satisfied the minimum volume and variety of surgical operations required of the
training program based on the number of residents in the program. There must also
be a reasonable quality of instruction as evidenced by having at least twenty per
cent (20 %) of the case load requirement as service cases with the pre-operative,
intra-operative and post-operative management actively supervised by a member of
the qualified training staff
b. Creditable performance in the PSGS CERES written examination over the past 2
years as shown by a fifty per cent (50%) passing rate for all residents
c. Properly documented clinical and teaching activities that are adequate in number
and variety
d. Active involvement of the qualified training staff as evidenced by regular supervision
of residents and presence of at least thirty per cent (30 %) of the qualified training
staff during surgical conferences
e. Visible research achievement observable over a reasonable period of time. This will
include having each resident submitting two (2) satisfactorily completed published
or unpublished research papers before their graduation
f. Creditable performance in the Philippine Board of Surgery Diplomate certifying
examination over the last 5 years. All eligible graduates must take the examination
within five (5) years of graduation. At least fifty percent (50 %) of the eligible
graduates must have passed both the written and oral diplomate examinations during
the immediately preceding 5 year period.

A training program may be re-visited at any time during the 5 years of Level II accreditation if
significant deficiencies are noted in the review of the training program's annual report.

Should a training-program with Level II accreditation fail to satisfactorily comply with all the
requirements to maintain this level of accreditation upon confirmation after a visit by the

25
Committee on Accreditation and as concurred with by the PSGS Board of Directors, the
accreditation status will be downgraded to Warning status.

5.3. WARNING Status

5.3.1. Upon the recommendation of the Committee on Accreditation and with the
concurrence of the PSGS Board of Directors, a training program with a LEVEL I or
II Accreditation may be downgraded to a WARNING Status if they are ANY
significant deficiencies noted during a scheduled accreditation visit.
5.3.2. The residency program is still deemed accredited during the duration of the
WARNING Status.
5.3.3. A program on WARNING Status is given a minimum period of six (6) months and
a maximum period of twelve (12) months after the decision by the PSGS Board of
Directors to correct all deficiencies and to submit a written request for an accreditation
re-visit. If a WARNED training program fails to request for a re-visit within one (1)
year from the date of effectivity of the warning status, the program shall be
automatically SUSPENDED by default.

5.4. SUSPENSION of Accreditation

5.4.1. The accreditation of a program will be SUSPENDED if it fails to significantly

correct deficiencies within one (1) year after the issuance of a warning; furthermore,
even if the original deficiencies are corrected but new deficiencies are noted during
a subsequent visit, the training program will also be SUSPENDED.

5.4.2. A training program may be SUSPENDED from FULL (LEVEL II) or

CONDITIONAL Accreditation (LEVEL I) without the benefit of a WARNING, in
case it is determined during an accreditation visit and based on objective evidence
that there is intellectual dishonesty (ex. falsification of records; unverifiable, non-
existent claimed case material, etc.) in any of the data given to the accreditation
team.

5.4.3. NON-SUBMISSION of the Annual Report shall result in automatic SUSPENSION

by default. (Please refer to the items on submission of Annual Reports).

5.4.4. The period of SUSPENSION is for a minimum period of six months. The program
is strongly encouraged to correct all deficiencies, not to incur any new major
deficiencies and to submit a written request for a re-visit/re-evaluation before the
end of the one year period. The SUSPENSION may be lifted after six months and
within one year if all the noted deficiencies have been corrected and all the
accreditation requirements have been fulfilled as determined during a requested re-
visit by the Committee on Accreditation.

5.4.5. If a requested 'VISIT' is done within the period of SUSPENSION and the
accreditation team finds new deficiencies or a failure by the training program to

26
 correct the previously noted deficiencies, the program will be TERMINATED. A
program is not accredited during the period of suspension. Outside rotation of
residents to other accredited training programs especially to accrue cases to satisfy
accreditation case load requirements is NOT ALLOWED AND WILL NOT BE
CREDITED during the period of suspension. However, a suspended program will
have to continue the functions of a training program to satisfy the minimum
requirements for accreditation if it intends to request for a re-visit to lift the
SUSPENSION and get LEVEL I accreditation in the future. During the period of
suspension of accreditation of a training program, only cases done at the mother
institution or consortium and during surgical missions either in-house or outside the
hospital may be credited to satisfy the case requirements for re-accreditation. The
cases done during the period of suspension may however not be claimed by the
residents to fulfill their diplomate board-eligibility case requirements.

5.5. TERMINATED Status/ Termination of Accreditation

5.5.1. Termination of accreditation automatically results if a SUSPENDED program fails

to request for a re-visit within the one (1) year period of SUSPENSION.

5.5.2. TERMINATION of Accreditation also results if a suspended program fails to comply

with the PSGS requirements for accreditation after a requested visit for re-evaluation
which shows either a failure to correct the previous deficiencies or there are new
deficiencies incurred.

5.5.3. Terminated programs may apply for re-accreditation only after a period of one (1)
year from the date of termination of accreditation by the PSGS Board of Directors.
The program shall then be considered as a NEW Applicant Training Program. Should
the resident complement remain during the period of the TERMINATED STATUS
until re-accreditation, he will be considered a NEWLY accredited program resident
complement and downgrading of the resident year-level from the last satisfactorily
completed year level shall apply.

27
 MEMORANDUM OF AGREEMENT forming or supporting
a Training Program (CONSORTIUM, AFFILIATION, LINKAGE)

Before any MOA is implemented, a written approval of the PSGS Board of Directors MUST
be obtained.

Two (2) or three (3) institutions may group together empowered by a Memorandum of
Agreement (MOA) to FORM One (1) Structured GS-Residency Training Program called a
CONSORTIUM TRAINING PROGRAM.

Hospitals that either have different Department of Health licenses to operate or do not have a
single owner or Board of Trustees shall be considered as two different institutions. Should these
institutions wish to seek PSGS accreditation, they may apply either as two (2) separate single
institution training programs or as a consortium.

Late expansions of healthcare institutions into a 'conglomerate' or 'chain' of hospitals -- even if

the member institutions have the same proprietor or corporate owners, or do not exceed 3, or
will have the same Department of Surgery Staff, Officers, & Residents -- will be considered as
a CONSORTIUM should the conglomerate wish to apply for Accreditation.

6.1. Guidelines & Requirements For A Consortium

6.1.1. A consortium may be formed by two (2) or a maximum of three (3) hospitals with
a minimum of 100 beds per component hospital situated in geographic proximity to
each other if the individual training programs cannot meet the minimum requirements
for PSGS accreditation, following the one (1) program with 1 chairperson, 1 training
officer, 1 set of training staff and 1 set of residents requirement (AT LEAST ONE
FULL RESIDENT COMPLEMENT and 3 resident complement per member
hospital).

6.1.2. There must be a Notarized Memorandum of Agreement signed by the Hospital

Director, Department Chairperson and Training Officer of the institutions forming a
consortium. This MOA will contain the scope of involvement, functions and
responsibilities of its member- hospitals. The coverage period of such agreement
should not be less than 5 years and should be entered into at least two (2) years
before the intended year of Application (please refer to Procedure of Application).

6.1.3. There must be only one (1) set of Residents who will rotate among the member-
hospitals. The number of residents in training will depend upon the capacity of the
consortium.

6.1.4. There must be only one (1) Residency Training Program to be implemented by all
participating member-hospitals.

28
 6.1.5. Before any consortium program can be ACCREDITED, it will have to pass through
the PROCEDURE OF APPLICATION.

6.1.6. The accreditation status of the consortium training program shall apply solely to the
consortium and not to any of the individual Departments of Surgery of the member
hospitals. The initial accreditation of the Consortium will be Level 1 that is valid for
a period of two (2) years with provisions for regular visits.

6.1.7. Should the member hospitals in the consortium decide to seek separate accreditation,
they will first have to officially inform in writing the PSGS Board of Directors of
their intention to dissolve the consortium.
Once dissolved, the members of the consortium shall retain their current accreditation
status for a maximum period of three (3) months.
6.1.7.1. Thereafter, each member hospital of the consortium must submit a new
application as a stand-alone program so that they can be properly evaluated
thru an accreditation visit of the hospital's training program that wish to
remain accredited by the PSGS.

6.1.7.2. Prior to application as separate stand-alone Residency Training Programs,

the Consortium members are to hold 'individual training program activities'
(parallel to but separate from the consortium activities) and prepare
individual Annual Reports (separate from the Consortium Annual Report)
for the last one (1) year prior to dissolution of the consortium. The
individual annual reports must include the designated Department Officers
and Staff and the roster of residents from the consortium to be assigned
to the individual programs.

Two (2) PSGS Accredited GS-Residency Training Programs may be allowed through a
Memorandum of Agreement (MOA) to support one (1) or both Training Programs. A MOA
supportive of only one (1) of the 2 training programs effecting an 'affiliate outside rotation' is
called an 'AFFILIATION MOA'; a MOA supportive of both training programs effecting an
'exchange or linkage outside rotation' is called a 'LINKAGE MOA'.

6.2. Guidelines For Linkage

6.2.1. This is the bilateral exchange of residents from two (2) accredited residency training
programs.

6.2.2. There must be a notarized Memorandum of Agreement signed by the responsible

officers of the institutions desiring to form, and maintain a LINKAGE. This will
contain the scope of involvement, functions and responsibilities of the hospitals
involved with a maximum effectivity period of five (5) years.

6.2.3. Before any linkage is implemented, the approval of the PSGS Board of Directors
must be obtained.

29
 6.2.4. The exchange residents shall be governed by the rules and regulations of the host
training program/hospital.

6.3. Guidelines For Affiliation

6.3.1. This involves 'affiliate outside rotation' by residents from an 'affiliate' accredited
training program to a 'host' accredited institution. The host hospital does not send
resident rotators in return.

6.3.2. There must be a notarized Memorandum of Agreement signed by the responsible

officers of the Institutions agreeing to form and maintain an AFFILIATION. This
will contain the scope of involvement, functions and responsibilities of the hospitals
involved with a maximum effectivity period of five (5) years.

6.3.3. Before any affiliation is implemented, the approval of the PSGS Board of Directors
must be obtained.

6.3.4. The 'affiliate resident outside rotator' will be governed by the rules and regulations
of the host hospital.

6.3.5. An Accredited Training Program may enter into a MOA (of Affiliation for outside
rotation) with a PSGS recognized and approved high-volume, specific-category, non-
PSGS accredited institution.

6.3.6. The 'non-accredited host institution' must have been previously identified by PSGS
as an institution with 'Qualified Training Staff' who are willing to and shall 'supervise'
the resident rotators. It must also be PSGS verified and certified high-volume center
for the specific case category which is the purpose of the rotation (i.e., Trauma)
6.3.6.1. There must be a notarized Memorandum of Agreement signed by the
responsible officers of the institutions agreeing to form and maintain the
affiliation. This will contain the scope of involvement, functions and
responsibilities of the hospitals involved with a maximum effectivity
period of five (5) years.
6.3.6.2. Before any MOA is implemented, a written approval of the PSGS Board
of Directors must be obtained.

6.4. Other MOA Limitations & Requirements

6.4.1. Any MOA that is referred to in the guidelines for GS-Residency Training Program
Accreditation Guidelines must have official PSGS written approval before proper
implementation.
6.4.2. The maximum effectivity period of a MOA is five (5) years. Annual review of the
MOA, together with the annual report review, shall be done to ensure that all required
stipulations in the MOA are effectively implemented. A photocopy of any current

30
 MOA under implementation involving a training program MUST be included in
their submitted annual report.

6.4.3. An individual training program shall be limited to entering into a MOA with a
maximum of 2 different institutions especially if the MOA for outside rotation is
entered into with the intention of accumulating needed cases to fulfill the
accreditation requirements of the program. Moreover, a training program can only
enter into a MOA with other training programs for a maximum of two (2) case
categories (e.g., Trauma and Hernia categories; H&N and CTT categories) with the
purpose and specifics clearly stipulated in the MOA.

6.4.4. Subject to the recommendation of the Committee on Accreditation and with the
concurrence of the Board of Directors, a training program may enter into one (1)
additional MOA only if the intention is NOT to fulfill accreditation case requirements
but for additional exposure of the resident rotator (i.e., SICU exposure, Thoracic &
Cardiovascular Surgery, Additional MIS exposure). It must be verifiable in the annual
report that none of the cases handled during such rotations are used to fulfill minimum
volume requirements for accreditation. However, the period of total outside rotation
per resident rotator must not exceed three (3) months for the entire duration of
residency training of that particular resident.

31
 Guidelines on infractions that may lead to
one-level downgrade of Current Accreditation Status:

7.1. All PSGS fellows in the consultant staff of an accredited training program are strongly
encouraged to maintain their good standing as part of the requirements for accreditation.
Failure to comply with the 5 PSGS Fellows in good standing for every 10 or fewer resident's
ratio shall be a basis for the downgrading of the institution's accreditation status by one
level.

7.2. Submission of the annual report after February 28th but on or before March 31st of the
calendar year will be considered late submission and shall automatically result to a
downgrading of the current accreditation status by one level.

7.3. Non-payment of the PSGS accreditation fee on or before March 31st of the calendar year
will result to a downgrading of the current program accreditation status by one level.

7.4. Since all graduates of PSGS-accredited Residency Training Programs must take the
Philippine Board of Surgery Diplomate Certifying Examinations, failure of at least fifty
percent (50%) of the training program's eligible graduates to pass both the written and
oral examinations of the Philippine Board of Surgery Diplomate Examination during the
last 5 years will result to a downgrading of the current accreditation status by one level.

32
 APPEAL on PSGS BOD DECISIONS regarding
Accreditation Status

8.1. The following DECISIONS ARE NOT SUBJECT TO APPEAL and the program must
go through the accreditation process to lift the corresponding penalty:

8.1.1. Suspension after determination of intellectual dishonesty

8.1.2. Downgrading of accreditation status that result from NON-PAYMENT of

accreditation Fee or LATE SUBMISSION of the annual report

8.1.3. DISAPPROVED Training Program Application for Accreditation

8.2. Appeals must be made in writing to the PSGS Board of Directors within thirty (30) days
following receipt of the Board's decision

8.2.1. Re-evaluation of a PROGRAM WITH APPEAL

8.2.1.1. The PSGS Board of Directors will decide if a re-visit is merited for a
program that has made an appeal. The accreditation team shall re-
evaluate/ re-visit the program and thereafter submit its recommendations
to the PSGS Board of Directors.

8.2.1.2. The PSGS Board of Directors shall decide whether to sustain, reverse, or
modify the recommendations of the Committee on Accreditation.

8.2.1.3. The PSGS Board of Directors shall notify the concerned institution of its
final decision within one (1) week after the last Board of Directors meeting
held for that pur

33
 Steps to Amend the Requirements
and Procedures of Accreditation

9.1. Suggested changes must be addressed to the PSGS Board of Directors thru the Committee
on Accreditation

9.2. The Committee on Accreditation shall make its recommendations to the PSGS Board of
Directors for approval.

9.3. Any additional provisions approved by the PSGS Board of Directors thru a 2/3 vote of
all its members, shall be immediately executory and should be immediately disseminated
to all concerned.

9.4. Additional requirements may be added for implementation upon the recommendation of
the Committee on Accreditation and upon the approval of the PSGS Board of Directors.

9.5. NO CHANGE/S IN THIS PSGS ACCREDITATION GUIDELINES SHOULD BE

MADE EARLIER THAN 2021.

9.6. ALL OTHER ISSUES, NOT COVERED IN THESE ACCREDITATION GUIDELINES

AND THOSE ARISING FROM DIFFERENCES IN INTERPRETATION, SHALL BE
DECIDED UPON BY THE PSGS BOARD OF DIRECTORS. All such accreditation
issues not covered by the manual and decided on by the PSGS Board of Directors during
the period that these Accreditation Guidelines in General Surgery are in effect will be
immediately implemented and subsequently incorporated in the next revision of the
guidelines.

34
 Appendices

10.1. Appendix 1 - FORMS

10.1.1. PSGS Form 2017-1: Application for Accreditation in General Surgery

10.1.2. PSGS Form 2017-2: General Surgery Accreditation Information Sheet

10.2. Appendix 2 - ANNUAL REPORT TABLE OF CONTENTS

10.3. Appendix 3 - 2017 Content and FORMAT: PSGS ANNUAL REPORT

10.3.1. PSGS Table 2017-I: Signature page

10.3.2. PSGS Table 2017-II: Breakdown of Operations
10.3.3. PSGS Table 2017-III: Tabulation of Operations (14 Main Categories and Specific
Operations)
10.3.4. PSGS Table 2017-IVa: Tabulated Summary of Residents Personal Census
10.3.5. PSGS Table-IVb: 3-year Cumulative Summary
10.3.6. Tabulation of Senior Residents' Cases
10.3.7. PSGS Table 2017-IVc: Resident's Tabulated Census for OUTSIDE Rotation
10.3.8. PSGS Table 2017-Va: PROGRAM STRUCTURE
10.3.9. PSGS Table 2017-Vb: Tabulated Names of Residents/ respective year level/
Annual Report Year Appointment dates/ divided according to year level and
schedule of rotators for the year.
10.3.10. PSGS Table 2017-Vc: Tabulations of Residents- New appointments/Resigned/
New Lateral Entry Residents/Terminated/& Rotators from another institution
10.3.11. PSGS Table 2017-Vd: Tabulation of Resident's CERES and PBS-RITE results
(including the year's MPL)
10.3.12. PSGS Table 2017-Ve: List of Graduates of the program and their status
10.3.13. PSGS Table 2017-Vf: Listing of Year's CONFERENCES and Activities
10.3.14. PSGS Table 2017-Vg: 3-Year (past 2 years prior to and the annual report)
TABULATED CUMULATIVE OPERATION SUMMARY (including Index
Cases)

10.4. Appendix 4 - Guidelines and Criteria for Eligibility to take the Certifying Examinations in
General Surgery

35
Appendix 1-Form PSGS Form 2017-1: Application for Accreditation in General Surgery

APPLICATION FOR ACCREDITATION

IN GENERAL SURGERY

I, ________________________________________, by the authority vested in me

by the Governing Body or Director or Chief of Hospital of
____________________________________________ (Name of HOSPITAL), hereby
voluntarily apply for accreditation of our Residency Training Program in GENERAL
SURGERY.

We are fully aware that this application is on a voluntary basis and the hospital
authorities submit unconditionally to the inspection, review and survey of all items
pertinent to accreditation including the physical plant, facilities, hospital records, working
staff of the hospital, and processes particularly of the Department of Surgery.

We, the hospital authorities, express our commitment to comply with ALL the rules
and regulations on accreditation set forth by the Society, to implement the Standardized
Surgical Curriculum for General Surgery, to actively participate and support all Society
and Chapter activities and projects, and to abide by the decision of the PSGS Board of
Directors.

Signature and Printed Name of CHAIR

DEPARTMENT of SURGERY

Noted:

Signature and Printed Name of CHAIRMAN of

BOARD or MEDICAL DIRECTOR or
CHIEF of HOSPITAL

36
 Appendix 1-Form PSGS Form 2017-2: General Surgery Accreditation
Information Sheet

GENERAL SURGERY ACCREDITATION

INFORMATION SHEET
(To be accomplished in Triplicate by the Department applying for Accreditation)

HOSPITAL :
DATE :
TRAINING OFFICER :
Signature :
DEPARTMENT CHAIRPERSON :
Signature :
MEDICAL DIRECTOR :
Signature :

1. HOSPITAL

1. Total number of beds excluding bassinets

2. Existing Departments:
*Indicate if program is accredited by respective Specialty Society.
*Indicate if there is a separate department for:

DEPARTMENT ACCREDITED
Internal Medicine ( ) YES ( ) NO ( ) YES ( ) NO
OB-GYN ( ) YES ( ) NO ( ) YES ( ) NO
Pediatrics ( ) YES ( ) NO ( ) YES ( ) NO
Anesthesiology ( ) YES ( ) NO ( ) YES ( ) NO
Others:
Specify

3. Out-patient Department - ( ) YES ( ) NO

Number of surgical consultations per year

4. Laboratory
a) Name of Head
b) Examinations done:
( ) CBC, urinalysis, fecalysis, blood typing
( ) Blood Chemistry
( ) Serum Enzymes
( ) Microbiology (culture and sensitivity test)
( ) Others (Please indicate)

37
 5. Radiology

a) Name of Head
Name of other staff members:

b) Diagnostic Services
( ) Chest x-ray
( ) Skull and skeletal survey
( ) Upper G.I. Series & Barium enema
( ) I.V.P.
( ) Portable x-ray
( ) Operative Cholangiography
( ) Angiography
( ) Ultrasonography
( ) Upper and Lower GI endoscopy
( ) FNAB
( ) Nuclear Medicine
( ) CT scan
( ) MRI
( ) Mammography

6. Pathology

a) Name of hospital Pathologist

b) Frozen section ( ) YES ( ) NO
c) No. of autopsies done last year

7. Facilities for blood processing / storage ( ) YES ( ) NO

8. Ancillary Facilities
a) Electrocardiogram ( ) YES ( ) NO
b) Heart Station ( ) YES ( ) NO
c) Surgical Care Facilities ( ) YES ( ) NO
d) Recovery Room ( ) YES ( ) NO
e) Rehabilitation Facilities ( ) YES ( ) NO

9. Facilities for upper and lower GI endoscopy ( ) YES ( ) NO

10. Facilities for Minimally Invasive Surgery ( ) YES ( ) NO

38
11. Medical Library

a) Textbooks Name of Author Edition

( ) Principles of Surgery
( ) Atlas of Operative Technique
( ) Anatomy
( ) Surgical Anatomy
( ) Physiology
( ) Pathology
( ) Surgical Oncology
( ) Trauma
( ) Critical Care
( ) Minimally Invasive Surgery

b) Journals
Peer-reviewed Journals like
( ) Philippine Journal of Surgical Specialties
( ) Foreign Surgical journal/s
- Journal of the American College of Surgeons
- Surgical Clinics of North America
- Annals of Surgery
- American Journal of Surgery
- British Journal of Surgery
Others:

c) Information Technology with Internet access

12. Records Section ( ) YES ( ) NO

Number of years charts are preserved

DEPARTMENT OF SURGERY

1. Total number of surgical beds

a) Private beds
b) Service beds

Major operations per year, for the past two years - attach separate sheet. Medium
operations per year, for the past two years - attach separate sheet.

2. Name of the Head of the Department and qualifications

(Please attach curriculum vitae)

3. Staff (Names & qualifications - please attach curriculum vitae)

39
 4. Names of Training Officer and members of the Residency Training Committee and
their qualifications.

5. Conferences Frequency
( ) Mortality & Morbidity, CPC
( ) Case Presentation
( ) Lectures on Surgical Topics
( ) Journal Club
( ) Grand Rounds
( ) Tumor Conference
( ) Others (Please state)

6. Do your residents keep a record of operated and assisted operations?

( ) YES ( ) NO

Please submit a copy of the Annual Report for the last 2 years.

THE RESIDENCY TRAINING PROGRAM

1. Number of surgical residents

2. Names of Residents:

1st year:

2nd year:

3rd year:

4th year:

5th year:

40
NSAT RESULTS IF ANY:
Month / Year Taken Percentile Ranking

Names of Residents:

1st year:

2nd year:

3rd year:

4th year:

5th year:

3. Description of Residency Training. For those submitting for the first time, take into
consideration:

a) Rotation/Clinical Exposure (what departments or sections, and for how long)

b) Duties and responsibilities

c) Supervision
d) Operative opportunities
e) Others

41
 Appendix 2 ANNUAL REPORT TABLE OF CONTENTS

ANNUAL REPORT - GENERAL SURGERY TRAINING PROGRAM

I. Signature page / Department authorities attesting the report is true and correct

II. Breakdown of Operations

III. Tabulation of Operations

IV. Resident's Census

a. Tabulated summary of residents' personal census: Operation done by individual
(intermediate and Senior) Residents (PER Main categories) as Surgeon and First
assist to the consultants followed by INDIVIDUAL (senior Residents only)
b. 3 year cumulative Summary TABULATION of Senior Residents' cases (1st assist
to a consultant and surgeon - Main Category/Index Case requirement for
Eligibility)
c. IF APPLICABLE: (These LISTINGS are included in the annual reports of both
the Host and Affiliated/Linked institutions and institutions with "Straight
Rotators"
i. TABULATED LISTING OF CENSUS OF 1) OPERATIONS DONE BY
INDIVIDUAL RESIDENTS DURING OUTSIDE ROTATION certified by
Host Authorities (Chair, Training Officer, Chief Resident/Fellow) together
with a PHOTOCOPY of the CURRENT MOA and PSGS APPROVAL Letter
OR TABULATED LISTING OF CENSUS OF 1) OPERATIONS given to
INDIVIDUAL RESIDENTS on ROTATION from another institution.
Certified as Authorities of Host Hospital (Chair, Training Officer, Chief
Resident/Fellow) together with a PHOTOCOPY of the CURRENT MOA
and PSGS APPROVAL Letter.
ii. TABULATED LISTING OF CENSUS OF 1) OPERATIONS DONE BY
INDIVIDUAL "Straight Rotator Residents'

V. RESIDENTS AND PRODUCT STATUS / TABULATED ROTATIONS AND

PROGRAM STRUCTURE
a. Program Structure
b. Name of Residents, respective year level, Annual Report Year appointment dates
c. Tabulated Names of all residents divided according to year level and schedule of
rotations for the year
d. New residents appointed (for Annual Report Year), date of appointment, NSAT
result if any
e. Names of Residents who resigned (date and reason for resignation)
f. If any, Name of the LATERAL ENRTY RESIDENT and copy of notarized
Certification of last completed residency level from Hospital of origin and
required letters of recommendations/certification

42
 g. Names of residents terminated (date and reason for termination)
h. Names of resident/s who took the CERES and the Philippine Board of Surgery-
RITE / anf the results (including the year's MOPL)
i. Name of Residents from another institutions rotating in your program including
duration of rotation (specific date/period), parent institution
j. List of Graduates of the program and their status
i. Diplomate/Fellows
ii. Other Specialty Training

VI. LISTING OF YEAR'S CONFERENCES AND ACTIVITIES: Type of conferences

(specific topics/case, if any), Dates, Speakers (state whether resident, consultant
or invited guests)
a. PreOp/PostOp/Grand Rounds / Case Presentation
b. Census Conference (weekly or monthly)
c. Mortality/Morbidity Conference
d. Department Tumor Conference
e. Journal Clubs
f. Other Department Activities and Institutional Activities / Attendance to PSGS
activities and other Post Graduate Conventions
g. Scientific Research and Paper Outputs

VII. List of Department Staff (ROSTER of CONSULTANTS) for the Annual Report
Year

VIII. 3-Year (past 2 years prior to and the Annual Repor t) TABULARED
CUMULATIVE OPERATIONS SUMMARY (including Index Cases) i.e 2019
Annual report will have 2017, 2018 and 2019 tabulated cumulative summary of
cases.

43
 Appendix 3 2017 Content and Format: PSGS Annual Report

PSGS TABLE 2017-I SIGNATURE PAGE

ANNUAL REPORT 20XY

GENERAL SURGERY RESIDENCY TRAINING PROGRAM

HOSPITAL:

Certified True and Correct by:

TRAINING OFFICER:
Signature: Date:

DEPARTMENT CHAIR:
Signature: Date:

Noted by:

HOSPITAL DIRECTOR:
Signature: Date:

PSGS TABLE 2017-II BREAKDOWN OF OPERATIONS

BREAKDOWN OF OPERATIONS
TOTAL OPERATIONS (excluding minor procedures):

1. ELECTIVE
2. EMERGENCY
a. Trauma
b. Non - Trauma
Operations done by Consultants
a. Private Cases
b. Service Cases
Operations done by Regular GS Residents
a. Private Cases
b. Service Cases

Operations done by "Straight Rotators in the Institution:

Operations done by residents in outside rotation/
(or residents rotating from another institution):
Operations done in outreach surgical mission:

44
 PSGS TABLE 2017-III Tabulation of Operations
(14 Main Categories and specific operations)

CASE MATERIAL:
TABLE of OPERATIONS HANDLED in 20XY Number of Residents:
Program Factor (F):
Main CATEGORY Operations (170) NUMBER OF OPERATIONS
(Case Load Requirement for Program Factor 1)
SPECIFIC
Clustered Sub-Category OPERATIONS
As encountered by
the program
Service Pay/Private (Do Not Total Total Required
Fill Cells Procedures Program (Program
in this Handled Credited Case Load
column: (per Main Procedure Requirement
for PSGS Category) (per main per Main
use) Category) Category)
Resident Consultant Resident Consultant
(Rs) (Cs) (Rp) (Cp)

I. Head & Neck (20)

Specific operation as
encountered
A.Thyroidectomy/
Excision of Thyroglossal Duct
Cyst

B. Major Salivary Gland Surgery/

Neck Dissection/
Excision of Branchial Cleft Cyst/
Excision of Cystic Hygroma

C. Surgical Airway (tracheostomy

crico-thyroidotomy)

II. BREAST (10)

Specific operation as
A. Mastectomy with or without encountered
SLNB/ALND; BCS/ partial
mastectomy with SLNB/ALND
(5 -not factor dependent)

Specific operation as
encountered
B. Segmentectomy/quadrantectomy/
partial mastectomy/ WIDE
excision

45
 III. Esophageal, Gastric,
Duodenal Surgery
(excision/resection/repair) (5)
Specific operation as
A. Gastric/GastroDuodenal Surgery encountered

Specific operation as
B. Gastro-Intestinal Bypass encountered

Specific operation as
C. Esophageal Surgery encountered

D.Gastrostomy/Esophagostomy/
Duodenostomy

IV. SMALL and LARGE

BOWEL SURGERY (25)
Specific operation as
A. Adhesiolysis/Enterolysis encountered
(for endometriosis, bowel
obstruction and malignancy)

Specific operation as
B. Bowel resection and anastomosis, encountered
bowel resection and ostomy, and
bypass

Specific operation as
C. Intestinal OSTOMY/Closure of encountered
ostomy/Tube jejunostomy

V. RECTAL SURGERY (2)

Specific operation as
Low Anterior Resection/APR encountered
(2- fixed requirement and not
Program /factor dependent)

46
TransAnal Rectal Mass Excision/ Specific operation as
encountered
Total Proctectomy- Anal
Mucosectomy (sphincter-saving)

VI. ANAL SURGERY (10)

Hemorrhoidectomy/ Fistulotomy/ Specific operation as

encountered
Fistulectomy/ Incision and
Drainage/ Fissurectomy
Sphincterotomy

VII. APPENDECTOMY (ADULT

AND PEDIATRIC) (20)
A.Open Appendectomy Specific operation as
encountered

Specific operation as
B. Laparoscopic Appendectomy for encountered
Uncomplicated Appendicitis

VIII.HEPATOBILIARY, GALLBLADDER,
PANCREAS, LIVER, SPLEEN (30)
A. Open Cholecystectomy Specific operation as
encountered

B. Laparoscopic Cholecystectomy

C. Lap or Open CBD Exploration/

T-tube choledochostomy/
Biliary Enteric Anastomosis/
Biliary Drainage/
Sphincterotomy/
Sphincteroplasty
Specific operation as
D.Pancreatic Surgery (Whipple, encountered
distal pancreatectomy)

E. Hepatic Resection Specific operation as

encountered

IX. THORACOSTOMY (trauma and

non-trauma) (5)
THORACOSTOMY

47
 X. TRAUMA (8)
A.Exploratory Laparotomy for Specific operation as
encountered
intra-abdominal injuries

B. Conservative/Non-operative
Management for
Intraabdominal Solid Organ
Injury

C. Thoracotomy

D.Neck Exploration

E. Major Vascular Repair

F. Limb Amputation

XI. VASCULAR ACCESS

(cutdown, IJ, subclavian, portacath) (5)
Cutdown Cutdown

XII. OPEN/LAP ADULT AND PEDIATRIC

ABDOMINAL WALL HERNIA
(incisional, ventral, inguinal, umbilical)
(15)

Open Hernia Repair, Inguinal Specific operation as

encountered

XIII. SOFT-TISSUE TUMOR RESECTION (5)

XIV. OTHER SPECIALTY SURGERY

(Urology Thoracic and Vascular Surgery
Plastic & Reconstructive Surgery
Pediatric Surgery (other than AP &
Abdominal Wall Hernia)
Neurosurgery
Orthopedics (10)

48
Neurosurgery

Orthopedics

Pediatric Surgery (other than AP &

Abdominal Wall Hernia)

Plastic & Reconstructive Surgery

Thoracic & Vascular Surgery

Urology

GUIDE & Legend: for PSGS TABLE 2017-III Tabulation of Operations

(14 Main Categories and specific operations)
- Head & Neck (25): (25) is the Main Category annual requirement; or, annual case load
requirement for H&N of a program with a Factor of 1.
- Main Category Operations: Category of operations listed using Roman numerals
- (Rs): Service case, Resident is "Surgeon"
- (Cs): Service case, Consultant is "Surgeon"
- (Rp): Pay/Private case, Resident is "Surgeon"
- (Cp): Pay/Private case, Consultant is "Surgeon"
- SPECIFIC OPERATIONS: list of specific operations (within the Main Categories
and clustered Sub-category) as they are handled by the program; examples are entered
in this table BUT the program should enter only the specific operations that they
actually handled
- Index Case: Listed specific operations (blocked, underscored and italicized), under Major
Categories or Clustered Subcategories, that are FIXED number requirement for a program
to handle annually.
- Total Procedures Handled (counted per Main Category) equals Service Cases (or Rs
+Cs) plus Private/Pay Cases (or Rp + Cp).
- Total Program Credited Procedures (counted per Main Category) equals Service
Cases (or Rs +Cs) plus 35% of Private/Pay Cases (or 35% of [Rp + Cp])
- ONLY volume requirements for Main Category Operations (bulleted in Roman
numerals) are Program Factor Dependent

49
 PSGS TABLE 2017-IVa

TABULATED SUMMARY OF RESIDENTS' PERSONAL CENSUS: OPERATIONS

DONE BY INDIVIDUAL (Inter mediate & Senior) RESIDENTS (PER Main
Categories) as Surgeon (S) & First Assist (1A) to Consultant
Name of Resident/Year Level S or 1A
MAIN CATEGORY I (H&N)
Initials/Age/Sex/ Preop Diagnosis Procedure Postop Histopath
Hospital Number Date of Operation Diagnosis

MAIN CATEGORY I I (BREAST)

Initials/Age/Sex/ Preop Diagnosis Procedure Postop Histopath

Hospital Number Date of Operation Diagnosis

MAIN CATEGORY III to X IV

Initials/Age/Sex/ Preop Diagnosis Procedure Postop Histopath

Hospital Number Date of Operation Diagnosis

PSGS TABLE 2017-IVb

3-year Cumulative Summary TABULATION of Senior Residents' Cases (1st Assist to

a Qualified Staff & as Surgeon -- Main Category/ Index-Case Requirement for
Eligibility)

2 Years 1 Year Annual Report Requirement

Main CATEGORY Operations immediately immediately for the Current Compliance:
preceding preceding Year Fulfilled (OK)
current annual current annual or Deficient (D)
year report year report of so many cases
S 1st Assist S 1st Assist S 1st Assist Self
Assessment
Index Cases or Index
operations
I. HEAD AND NECK (20)
Thyroidectomy
Major Salivary
Gland Surgery
Neck Dissection
tracheostomy

50
II. BREAST (10)

Mastectomy with or
without SLNB/
ALND
III. ESOPHAGUS, STOMACH AND
DUODENUM (5)

Gastric/Gastro-
duodenal Surgery
Omental Patching

IV. SMALL BOWELAND LARGE

BOWEL SURGERY (25)
Adhesiolysis
Bowel resection and
anastomosis
Ostomy
V. RECTAL SURGERY (2)

APR
Low Anterior
Resection
VI. ANAL SURGERY (10)
Fistulotomy or
Fistulectomy
Hemorrhoidectomy
VII. APPENDECTOMY (ADULT AND
PEDIATRIC) (20)

Open
Appendectomy

VIII.HEPATOBILIARY,GALLBLADDER,
PANCREAS, LIVER, SPLEEN (30)
Open
Cholecystectomy
Laparoscopic
Cholecystectomy

Open CBD
Exploration
Biliary Enteric
Anastomosis
IX. THORACOSTOMY (trauma and
non-trauma) (5)
X. TRAUMA (8)
A.Exploratory
Laparotomy for
intraabdominal
injuries

51
 XI. VASCULAR ACCESS
(cutdown, IJ, subclavian, portacath)
(5)
cutdown

XII. OPEN/LAP ADULT AND PEDIATRIC

ABDOMINAL WALL HERNIA (15)

Inguinal
Herniorrhaphy

XIII.SOFT-TISSUE TUMOR
RESECTION (5)

XIV. OTHER SPECIALTY SURGERY

(Urology Thoracic and Vascular Surgery
Plastic & Reconstructive Surgery
Pediatric Surgery (other than AP &
Abdominal Wall Hernia)
Neurosurgery
Orthopedics (10)

52
 PSGS TABLE 2017-IVc

Resident's Tabulated Census for OUTSIDE Rotation. TABULATED LISTINGS

OPERATIONS DONE BY INDIVIDUAL RESIDENTS DURING OUTSIDE
ROTATION Certified by Host Authorities (Chair, Training Officer, Chief Resident/
Fellow) together with a PHOTOCOPY of the CURRENT MOA and PSGS BOD
APPROVAL letter. (Included in both the Host's and Affiliate/Linked Hospital's Annual
Reports)

OPERATIONS DONE BY INDIVIDUAL RESIDENT on Outside Rotation or as

Straight Rotator
Name of resident/year level -- Mother Institution:
HOST Institution

MAIN CATEGORY or Specific Operations as stipulated in a PSGS BOD approved Notarized MOA
Initials/Age/Sex/ Preop Diagnosis Procedure Postop HISTOPATH
Hospital Number/ Diagnosis if applicable S or A1
Date of Operation

Certified true and correct:

Signature/s of designated Host Hospital/Department authorities__________________________

Copy of the PSGS BOD Letter of Approval of Current Notarized MOA supporting the rotation.

Copy of the PSGS Approved Current Notarized MOA of Rotation

NOTE: Operations listed above and given to a 'rotator' from another institution:

- Are included in the TOTAL operations handled in the BREAKDOWN OF

OPERATION page of the ANNUAL REPORT and declared in the Operations given
to Rotators
- Included in the Case Material Tabulation BUT is EXCLUDED in the computation of
Total Program Credited Procedures (per main Category).
- S - as surgeon o A1 --- as First Assist to a QUALIFIED Trainer
- FOR STRAIGHT ROTATORS: NO NEED TO ENTER the 1. mother institution; 2.
host institution; 3. Copy of MOA or PSGS approval of MOA; also operations given to
straight rotators are still credited case materials of the training program.

53
 PSGS TABLE 2017-Va PROGRAM STRUCTURE
SAMPLE ONLY
PROGRAM STRUCTURE 5-YR GS RESIDENCY
January - March April - June July - September October - December

1ST YEAR GENERAL SURGERY OPD

2ND YEAR Pedia Surg / Plastic / Ortho / Neuro / Urology General Surgery / ER / OPD / Ward
/ TCVS

3RD YEAR General Surgery / ER / OPD / Ward Urology / Pedia Surg / Ortho / Plastic / TCVS /
Neurosurgery

4TH YEAR General Surgery / ER / OPD / Ward LCenter / BBB Hosp / Trauma /
TCVS / GS GS

5TH YEAR General Surgery / ER / OPD / Ward

1st Year NO ER Rotation

1st Year and 5th Year - GS Rotation
1st and 5th Year - NO outside Rotation
GS Rotation 47 Months
1st yr 12 months
2nd yr 6 months
3rd yr 6 months
4th yr 11 months
5th yr 12 months

Subspecialty 13 months
1st yr 0 month
2nd yr 6 months
3rd yr 6 months
4th yr 1 month
5th yr 0 month

a. General Surgery Rotation

45 months (General Surgery)
15 months (Subspecialty Surgery)

b. Rotation in other surgical specialties

Urology
Thoracic & Vascular Surgery
Plastic & Reconstructive Surgery
Pediatric Surgery
Neurosurgery
Orthopedics

54
 PSGS TABLE 2017-Vb Tabulated Names of Residents
SAMPLE TABULATION
RESIDENT and
APPOINTMENT date January - March April - June July - September October - December
to current year level
5th Name / date e.g. GS ER WARD e.g. GS ER WARD Graduated ------
YEAR

4th Name / date e.g. GS ER WARD e.g. GS ER WARD e.g. GS ER WARD e.g. GS ER WARD
YEAR

3RD Name / date e.g. GS ER WARD e.g. GS e.g. GS ER WARD e.g. ENTERED
YEAR URO NEURO another specialty
ORTHO ER fellowship program

2nd Name / date e.g. GS URO e.g. GS ER WARD GS PLASTIC e.g. GS ER WARD
YEAR NEURO ORTHO PEDIA
ER WARD WARD
1st
YEAR Name / date e.g. GS ER WARD e.g. GS ER WARD e.g. GS ER WARD e.g. GS ER WARD

PSGS TABLE 2017-Vc

Tabulation of Residents/New appointments/Resigned/New Lateral Entry

Residents/Terminated/& Rotators from another institution

Residents for the Annual Report Date of Appointment NOTE if regular GS resident or
Year and Year Level 'straight rotator' of (other specialty surgery)

New Residents for the Annual Date of Appointment NSAT Result and Date Taken, if any
Report Year

Names of Residents who Resigned Date of Resignation Reason for Resignation

Name of the LATERAL-ENTRY- Year Level and Date NOTE: Attach photo copy of notarized
RESIDENT of Appointment Certification of last completed residency level
from Hospital of origin, and, required letters of
recommendation/certification

Names of Terminated Residents Date of Termination Reason for Termination

(Annual Report Year)

Names of Rotators from Other Inclusive Dates of Rotation Mother Institution & Reason for Rotation
Institutions & Year Level (as stated in the PSGS approved MOA)

55
 PSGS TABLE 2017-Vd

Tabulation of Residents' CERES and PBS RITE results including the year's MPL
Sample: PBS - RITE 20XY PSGS - CERES 20XY
Philippine Board of Surgery PSGS
Residents Yr Raw Yr Level Overall Residents Yr Raw Yr Level Overall
Level Score Percentile Percentile Level Score Percentile Percentile
Ranking Ranking Ranking Ranking

PSGS TABLE 2017-Ve

List of Graduates of the program and their status

ROSTER OF GRADUATES

Graduate Name Year Graduated STATUS re: Certification & Area of Practice or Additional
Membership in Specialty Post-Graduate Studies
Society (PSGS, PCS etc.)

56
 PSGS TABLE 2017-VI

List of Year's Conferences & Activities

CONFERENCES & ACTIVITIES

a. PreOP/PostOP/Grand Rounds/Case Presentation

Conference Type & Specific Topic Date & Venue Presenter & Year-Level Moderator

b. Census Conference (Weekly or Monthly)

c. Mortality & Morbidity Conference

e. Journal Club

f. Other Department Activities/ Attendance to PSGS activities & other Post-Graduate Conventions
Activity Date/venue Attendees

g. Scientific Research Papers / Outputs (for the Annual Report Year)

TITLE AUTHOR/S PUBLICATION: Journal-Date/
Volume/Number/Pages;
State if unpublished

ROSTER of Consultants for the Annual Report Year:

General Surgery:
1.
2.
3.
4.
5.
6.

Other Specialty Surgery:

1.
2.

57
 PSGS TABLE 2017-VII

3-YEAR (past 2 years prior to and the annual report) TABULATED

CUMULATIVE OPERATION SUMMARY (Main Category Operations & Index
Cases only).
i.e., 2019 Annual Report will have 2017, 2018 and 2019 tabulated cumulative
summary of cases.

3-YEAR TABULATED CUMULATIVE OPERATION SUMMARY

Main Category Operations 2 Years 1 Year Annual Report For

immediately immediately for the PSGS
preceding preceding Current Year use
current annual current annual Please
year report year report do not
fill this
column
Service Pay/ Service Pay/ Service Pay/
Private Private Private

Index Cases

I. HEAD AND NECK (20)

Thyroidectomy
Parotidectomy
Neck Dissection

II. BREAST (10)

MRM (5)
III. ESOPHAGUS, STOMACH
AND DUODENUM (5)
Gastric Resection of any variety

IV. SMALL & LARGE

BOWEL SURGERY (25)
Adhesiolysis
Bowel resection with or without
anastomosis

V. RECTAL SURGERY(2)

APR 0r
Low Anterior Resection

58
VI. ANAL SURGERY (10)

VII. APPENDECTOMY (ADULT

AND PEDIATRIC) (20)

VIII. HEPATOBILIARY, GALLBLADDER,

PANCREAS, LIVER (30)
Open / lap Cholecystectomy

CBD Exploration
Biliary Enteric Anastomosis

IX. THORACOSTOMY
(trauma and non-trauma) (5)

X. TRAUMA (8)

Abdominal Exploration/ or /Thorco-

Abdominal / NeckExploration/
MajorVessel Injury operation -4
XI. VASCULAR ACCESS
(cutdown, IJ, subclavian, portacath)
(5)

XII. HERNIA Repair (15)

Open Hernia Repair, Inguinal

XIII. SOFT-TISSUE TUMOR

RESECTION (5)

XIV. OTHER SPECIALTY SURGERY (10)

Urology
Thoracic and Vascular Surgery
Plastic & Reconstructive Surgery
Pediatric Surgery (other than AP &
Abdominal Wall Hernia)
Neurosurgery
Orthopedics

59
 Appendix 4 - GUIDELINES AND CRITERIA FOR ELIGIBILITY TO TAKE
THE CERTIFYING EXAMINATIONS IN GENERAL SURGERY

1. The following guidelines and criteria shall be used for the evaluation of Graduate
Residents (candidate) from the different PSGS Accredited Training Programs in
General Surgery to determine their eligibility to take the Certifying Examination in
General Surgery given by the PBS.

2. Requirements for tenure of residency

A candidate must have satisfactorily completed a cumulative period of 5 years of
residency training in a PSGS Accredited Training Program in General Surgery.

3. Requirements on the qualifying examinations - The PSGS CERES Examination and

PBS RITE (Residency-in-Training Examination):
a. A candidate must have taken at least 4 PBS Residency-in-Training Examinations
during his tenure as resident in General Surgery.
b. A candidate to be eligible to take the PBS Certifying Examination must have
passed based on the minimum passing level (MPL) set for the particular CERES
examination at least one (1) out of three (3) examinations taken during the first
three (3) years of residency (Junior and Intermediate Levels) and at least one (1)
out of two (2) examinations taken during the last two (2) years of residency
(Senior level).
c. In the event a candidate fails to comply the above requirement and had already
finished his tenure of residency, he/she are required and shall be allowed to re-
take the CERES examination for the Senior Level until he/she is able to comply
and passes two (2) CERES examinations.

4. Requirements for operative experience:

a. Requirements for operative experience by the candidate shall be based on the
cases submitted for evaluation.
b. Cases submitted shall be reported and tabulated as 1) Independently Performed,
2) Performed under direct supervision and 3) Cases Assisted. For the cases
assisted, it should be further reported if the candidate assisted as first or second
assist and the year level when the operation was performed.
c. Operative experience and categories:
i. Head and Neck Surgery (15)
1. Thyroidectomy - must have performed at least 5 operations independently
and 5 operations under direct supervision.
2. Parotid Surgery - must have at least 1 independently performed or under
direct supervision.
3. Neck Dissection - must have at least 1 independently performed or under
direct supervision.

60
 4. [f a candidate cannot comply with the requirements above, assisting in 3
similar operations, as First Assist during his/her senior years of residency,
will be considered as 1 operation performed under direct supervision.
ii. Breast Surgery (10)
1. Includes major Breast Surgery such as Modified Radical Mastectomy and
variations of Breast Conserving Surgery. A candidate must have performed
at least 5 operations independently and 5 operations under direct
supervision of the preceding operations.
2. If a candidate cannot comply with the requirements above, assisting in 3
similar operations, as First Assist during his/her senior years of residency,
will be considered as 1 operation performed under direct supervision.
iii. Esophagus, stomach and small intestines (10)
1. Includes adhesiolysis, small bowel resection and gastric surgery. A candidate
must have performed at least 5 operations independently and 5 under direct
supervision of the preceding operations.
2. Gastrectomy shall include either total, partial or wedge resection
3. If a candidate cannot comply with the requirements above, assisting in 3
similar operations, as First Assist during his/her senior years of residency,
will be considered as 1 operation performed under direct supervision.
iv. Colorectal (10)
1. Includes Colectomy and EITHER Low Anterior Resection (LAR) or
Abdominoperineal Resection (APR). A candidate must have performed
at least 5 operations independently and 5 under direct supervision of the
preceding operations.
2. Low Anterior Resection or Abdominoperineal Resection shall remain as
index operation and a candidate MUST have performed at least 1
independently or under direct supervision.
3. If a candidate cannot comply with the requirements above, assisting in 3
similar operations, as First Assist during his/her senior years of residency,
will be considered as 1 operation performed under direct supervision, except
for LAR or APR.
v. Appendectomy (10)
1. A candidate must have a minimum of 10 independently performed
surgeries either for simple or complicated appendicitis.
2. If a candidate cannot comply with the requirements above, assisting in 3
similar operations, as First Assist during his/her senior years of residency,
will be considered as 1 operation performed under direct supervision.
vi. Hepatobiliary (25)
1. Includes Cholecystectomy (Open and/or Laparoscopic) with and without
common bile duct exploration shall remain as index cases with a minimum
of 10 independently performed surgeries and at least 15 surgeries
performed with supervision.
2. It is also required that a candidate must have performed at least five (5)
Laparoscopic Cholecystectomy independently or under direct supervision
and have assisted in at least ten (10) of the same procedure.

61
 3. A candidate is also required to have perfor med one (1) CBDE
independently or under direct supervision.
4. If a candidate cannot comply with the requirements above, assisting in 3
similar operations, as First Assist during his/her senior years of residency,
will be considered as 1 operation performed under direct supervision.
vii. Trauma (10)
1. Exploratory laparotomy for intra-abdominal injuries / neck exploration /
thoracotomy / major vessel repair with a minimum of 5 independently
performed surgeries and at least 5 surgeries performed with supervision.
2. Non-operative management for abdominal trauma may be considered as
long as the case reported is well documented to include the case abstract
and the necessary imaging modalities utilized available for verification.
3. If a candidate cannot comply with the requirements above, assisting in 3
similar operations, as First Assist during his/her senior years of residency,
will be considered as 1 operation performed under direct supervision.
viii. Major sub-specialty surgery (10)
Includes either performing independently or under direct supervision and
assisting in a minimum of 10 major sub-specialty surgeries

5. This guideline shall take effect upon joint approval of both the PSGS and PBS except
for certain provisions that are to be implemented after a specified transition period.
This includes the provision on the requirements on qualifying examinations, that is
the PSGS CERES and the PBS RITE.

10.5 GLOSSARY

1. (NEW) Applicant GS-Residency Training Prog ram: Any currently NON-

ACCREDITED General Surgery Residency Program, single institution or a
consortium of institutions, that applies to the PSGS for Accreditation of the Training
Program
2. ANNUAL REPORT of the Accredited GS-Residency Training Program or the
ANNUAL REPORT: a collated documentation of the year's Hospital (in relation to
the GS -Residency program) and the Department of Surgery activities and programs
implementing the structured GS-Residency Training Program using the Standardized
Surgical Curriculum for General Surgery
3. 'NON-Qualified' Applicant Training Program or 'DISAPPROVED' Applicant Training
Program: An Applicant Training Program that after preliminary evaluation, has NOT
MET the minimum PSGS requirements for an actual accreditation 'VISIT'; the
applicant training program is thus, denied a 'VISIT'
4. Outside Rotation for ADDITIONAL EXPOSURE': A rotation of a resident, from
one accredited training program to another accredited training program for the purpose
of supplemental experience on specified specialized areas of surgery (i.e. SICU

62
 exposure, Thoracic & Cardiovascular Surgery. Additional MIS exposure) and NEVER
the purpose of accumulating volume of case materials to fulfill Minimum
requirements of accreditation
5. 'QUALIFIED' Applicant Training Program of 'APPROVED' Applicant Training
Program: An Applicant Training Program that, after preliminary evaluation, has met
the PSGS requirements for actual 'VISIT' for the purpose of accreditation. A high
volume (eg. TRAUMA / MIS etc.) institution identified and allowed by the PSGS
BOD to accept resident rotators for specified purpose.
6. ACCREDITATION VISIT FEE: The FEE set by the PSGS for the actual 'VISIT'
and evaluation of a 'QUALIFIED' applicant training program for the purpose of
accreditation
7. Adequate Exposure in the Subspecialties: programmed rotation of GS - residents to
the other surgery specialties for them to be able to achieve listed competencies in the
Surgical Curriculum for General Surgery
8. AFFILIATION: Rotation on the strength of a PSGS approved MOA of residents
from an accredited affiliate training program to another accredited host surgical
residency program. The host hospital will not send a resident in return.
9. ANNUAL ACCREDITATION FEE: a schedule of annual fee required of ALL
PSGS Accredited GS Residency Training Programs
10. Annual Report of an Applicant Training Program: The same as the ANNUAL
REPORT BUT it should be identified in the signature page as Annual Report of an
Applicant Training Program
11. CASE LOAD REQUIREMENT: Program Case Load Requirement: the volume,
variety and service cases required to be handled by an accredited residency training
program in a given year to maintain PSGS accreditation.
12. CERES: Comprehensive External Residents' Evaluation System; written a skills
examination given by the Committee of the PSGS that serves as a multifaceted
external evaluation tools for GS-residents.
13. CONFERENCES: as listed in the guidelines, these activities must be conducted
regularly as prescribed.
14. CONSORTIUM: at least 2 (maximum of 3) hospitals whose individual capabilities
cannot meet the minimum requirements for accreditation of a general surgery
residency training program that group together to form one (1) program - with one (1)
chairman, one (1) set of qualified training staff and one (1) set of residents' staff - as
a consortium
15. FULL RESIDENT COMPLEMENT: a complement of at least five residents at a
given time AND distributed with at least 1 Junior level resident, 1 intermediate
level resident and 1 senior level resident. A JUNIOR LEVEL resident is a 1st year
resident. An INTERMEDIATE LEVEL resident is a 2nd and/or a 3rd year resident.
A SENIOR LEVEL resident is a 4th year and/or a 5th year resident.
16. GRAND ROUNDS: a case-presentation teaching- learning activity or conference
prescribed over by a Moderator with Specialist Reactors from the different medical
disciplines in attendance

63
 17. GS (General-Surgery) Rotations: rotations in Trauma. ICU/CCU/SICU, MIS, ER
and OPD are to be considered as GS rotations in the structure and design of the
program
18. GS-Residency Training Program Committee: a Training Program Department of
Surgery 'working group'. Headed by the Residency Training Officer, this group
implements the structured GS-residency training program and is composed of Qualified
Training Staff. As head of the committee, the Residency Training Officer may
designate members to assist in the implementation of some of his/her specific tasks.
19. INDEX CASE: listed in bold, italicized, underscored specific procedures, under a Main
Category Operation, that is training program requirement. These identified operations
are specific minimum case requirements that a training program must handle annually
to ensure residents' exposure to these specific cases. Index case requirement of a
program is fixed and independent of the program factor.
20. JOURNAL CLUB: a teaching-learning activity specifically set for discussion and
critical appraisal of scientific journal articles
21. LINKAGE: The bilateral exchange of residents coming from accredited residency
training programs
22. MEDICAL LIBRARY: an organized, systemized collection of medical and medically
oriented books, films, records, slides: their electronic analog or digital equivalents
used for storage and retrieval of knowledge.
23. MEMORANDUM OF AGREEMENT (MOA): a legally -binding, notarized
agreement entered into by two or more consenting parties to implement what is
contained therein (i.e. Affiliation, Linkage, Consortium, etc.) For the purpose of PSGS
Accreditation. NO such agreement may be implemented WITHOUT a written
APPROVAL from the PSGS BOD.
24. PROCESSING FEE: The FEE set by the PSGS for the preliminary evaluation and
processing of the submitted required documents in the Application of Accreditation
25. PROGRAM FACTOR: the factor used to compute the CASE LOAD requirements
of an accredited GS Training program at a given year: and is based on the resident
complement of the program during that particular year. If a stand-alone program has
5 residents (for 12 months) in a certain year, the PROGRAM FACTOR for that year
is 1. The minimum Program Factor for any accredited program is 1; any program with
less than 5 residents in a given year will still have a program factor of 1.
26. QUALIFIED TRAINING STAFF: the set of surgical consultant staff of an institution
that is recognized by PSGS as qualified to be involved in the implementation of a GS-
Residency Training Program. The minimum requirement is that the must be PSGS
FELLOWS IN GOOD STANDING, and PCS Fellows or Fellows of other specialty
societies IN GOOD STANDING for the other specialty staff.
27. RESIDENTS' CASE: CASE HANDLED whereby the Resident is THE SURGEON
of the procedure
28. RESIDENT-CANDIDATE FOR GRADUATION CASE LOAD REQUIREMENT
(for 'ELIGIBILITY): the volume, variety, and index cases required to have been
handled by a resident (performed or 1st assisted) during his/her intermediate and
senior years of residency for eligibility to take the Diplomate Certifying Examinations.

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29. RESIDENT EXPOSURE to a case: resident's handling of a case material either as a
'surgeon' or as an assistant to a qualified training staff
30. RESIDENT-SUPERVISION: a committed, appropriate and responsible, followed-
through, oversight or guidance of a Resident-in-training specifically in the aspect of
patient evaluation/care, management decisions, and performance of surgical
procedures-preoperative, intra-operative, and post-operative care of the surgical
patients.
31. SURGICAL OUTREACH PROGRAM or SURGICAL MISSION: Surgical
program/operations done by the Team (including training staff and resident staff)
from the Accredited Institution, OUTSIDE OF THE ACCREDITED TRAINING
HOSPITAL (as opposed to the In-House or In-Hospital Missions which are performed
within the accredited institution). In order to avoid itinerant surgery, the program
must participate in the preoperative, intra-operative and postoperative management
of the patients. There must be evidence of a teaching-learning process.
32. THE CASE MATERIALS OR CASE HANDLED: comprise all cases managed by
the program's qualified training staff and the resident staff, either operatively (as
surgeon or assistant) or non-operatively. This is a training program Resource of clinical
teaching-learning materials. In reference to Accreditation, there is a minimum yearly
case load requirement specific per training program/institution.
33. THE VISITING TEAM: A Team of at least 3 members of the PSGS Committee on
Accreditation that physically calls-on an institution to do a 'VISIT'.
34. TRAINING MATERIALS: consists of Histopathology reports, patients handled or
managed by residents in training under the supervision of a qualified training staff
and any other resources utilized for training purposes.
35. TUMOR BOARD: A Hospital Board that supervises activities and programs related
to tumors
36. TUMOR CONFERENCE: a specific time set aside by the Department for an activity
where a variety of malignancies, their diagnoses and management are discussed.
37. VISIT: a process wherein a Team, of at least 3 members of the PSGS Committee on
Accreditation, physically call-on a scheduled institution to evaluate if the Structured
GS-Residency Training Program fulfills ALL the requirements for accreditation and
properly implements the current Standardized Surgical Curriculum for General Surgery.

10.6 DEFINITION OF GENERAL SURGERY

The Philippine Society of General Surgeons, Inc. defines General Surgery as requiring:

A basic knowledge of surgical anatomy, physiology, pathology, oncology, metabolism,

wound healing, surgical bacteriology and sepsis, shock and resuscitation, immunology
and
organ transplantation, fluid and electrolytes, nutrition, burns, critical care and Minimally
Invasive Surgery.

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 A sound understanding of the principles of radiology, ultrasonography, CT scan, MRI,
and other diagnostic aids including the use of radioactive isotopes and mammography.

An adequate practical experience in proctosigmoidoscopy and indirect laryngoscopy. The

general surgeon must have participated in a variety of endoscopic examinations such as
direct laryngoscopy, bronchoscopy, esophagoscopy, gastroscopy, choledochoscopy,
colonoscopy and laparoscopy.

A comprehensive skill in diagnosis, preoperative, operative and postoperative care of

patients with diseases of the a) alimentary tract, b) abdomen and its contents, c) the head
and neck, d) breast, e) the vascular system, f) the endocrine system and g) skin and soft
tissues.

Adequate knowledge and skill in all phases of care of the injured patient, including care
provided in the Emergency Room and Intensive Care Unit. The general surgeon must
show
competence in the emergency management of trauma, including trauma to the head and
neck, chest, abdomen and the extremities.

An appropriate clinical experience to include operative and nonoperative care of common

problems in the special disciplines of thoracic and cardiovascular, gynecologic, neurologic,
orthopedic, plastic, pediatric and urologic surgery and anesthesiology, acquired by exposure
in these disciplines.

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 2017 BOARD OF DIRECTORS 2016 BOARD OF DIRECTORS

Rex A. Madrigal, MD Domingo S. Bongala, Jr., MD

President President
Jose Ravelo T. Bartolome, MD Rex A. Madrigal, MD
Vice-President Vice-President
Andrea Joanne A. Torre, MD Napoleon B. Alcedo, Jr., MD
Treasurer Treasurer
Venerio G. Gasataya, Jr., MD Ida Marie T. Lim, MD
Secretary Secretary

Directors: Directors:
Luisito R. Co, MD Romarico M. Azores, Jr., MD
Jorge M. Concepcion, MD Mario T. Bautista, MD
Shalimar C. Cortez, MD Michael L. Co Del Mar, MD
Vitus S. Hobayan, Jr., MD Jorge M. Concepcion, MD
Ida Marie T. Lim, MD Axel L. Elises, MD
Omarbasha S. Lucman, MD Venerio G. Gasataya, Jr., MD
Miguel C. Mendoza, MD Vitus S. Hobayan, Jr., MD
Leonardo O. Ona III, MD Omarbasha S. Lucman, MD
Rolando M. Reyes, MD Rolando M. Reyes, MD
Jose U. Tan, Jr., MD Andrea Joanne A. Torre, MD
Porfirio D. Tugas, Jr., MD Alex L. Tan, MD

2017 COMMITTEE ON ACCREDITATION 2016 COMMITTEE ON ACCREDITATION

William L. Olalia, MD William L. Olalia, MD

Chairman Chairman
Vitus S. Hobayan, Jr., MD Domingo S. Bongala, Jr., MD
Director - In - Charge Director - In - Charge
Jose A. Solomon, MD Jose A. Solomon, MD
Secretary Secretary

Members: Members:
Aaron Q. Agdamag, MD Dante G. Ang, MD
Dante G. Ang, MD Jose Ravelo T. Bartolome, MD
Dale C. Avellanosa, MD Rene Chan, MD
Rene Chan, MD Dakila P. De los Angeles, MD
Crisle O. Dychingco, MD Wilfredo C. Diansuy, MD
Surlito B. Encarnacion, MD
Crisle O. Dychingco, MD
Eduardo S. Eseque, MD
Henry G. Falcotelo, MD Surlito B. Encarnacion, MD
Alfred Q. Lasala II, MD Eduardo S. Eseque, MD
Dennis H. Littaua, MD Henry G. Falcotelo, MD
Elvis C. Llarena, MD Dennis H. Littaua, MD
Alejandro M. Palines, Jr., MD Alejandro M. Palines, Jr., MD
Danilo Francesco P. Querijero, MD Danilo Francesco P. Querijero, MD
Deogracias Alberto G. Reyes, MD Roberto A. Sarmiento, MD
Maximo H. Simbulan, Jr., MD

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