Training in Internal Medicine in Cyprus
The residency training in Internal Medicine spans 5 years and may only take place in accredited teaching state hospitals. At present (October 2015), the Nicosia and Limassol University Hospitals offer a full 5-year residency training programme, while the Larnaca University Hospital and the Pafos General Hospital only offer part-time training, followed by further training in either Nicosia or Limassol (as part of a unified 5-year contract). Residents are assessed informally through their consultants and director every 6 months to renew their contract, while the final examination to receive the certificate of completion of training and become Board Certified takes place after the completion of the 5-year training period and includes both a formal written and oral examination before an examination committee.
The residency programme in Internal Medicine includes a core component of 51 months plus 3 clinical rotation modules. The 51 month core component includes comprehensive clinical training in the Internal Medicine Ward, the Accident and Emergency Department and the Outpatient Clinics (general internal medicine, as well as specialized units for hypertension, diabetes/metabolic diseases and hepatology). Residents are allowed to spend one month per training year (but no more than 4 months overall) in university clinics abroad via exchange programmes so that they may benefit from the expertise of different training environments.
The rotation modules include a 3-month training in Clinical Cardiology and Cardiac Care Unit, a 3-month training in the Intensive Care Unit and a 3-month elective rotation in any subspecialty of Internal Medicine (Nephrology, Gastrenterology/Endoscopy, Pulmonology, Endocrinology, Oncology, Hematology).
In terms of working conditions, Cyprus has agreed to apply the EU work directive, thus residents are expected to work, on average, 38 hours per week for their main duties (Monday-Friday 7:30-15:06) plus 1-2 overtime duty shift per week (15:07-7:29 on weekdays, 24 hour shifts on weekends and holidays). In case of excess of maximum allowed working hours, additional compensatory leave may be arranged with the Clinic Management. The resident salary consists of both a basic allowance (increasing annually as the resident gets more senior and acquires higher responsibilities) as well as a reimbursement for the extra shifts worked. In terms of further employment, residents are not allowed to practice clinical medicine anywhere beyond their teaching hospital, but they may be involved in other paid activities (e.g. assisted university teaching, research) beyond their primary working hours.
In terms of educational content, each clinic/department organizes its own training program including clinical updates, journal clubs and case discussions. Moreover, intradisciplinary sessions are organized at a hospital level monthly and the Ministry of Health also invites speakers for a series of lectures in Internal Medicine 3-4 times a year. Moreover, residents are invited to participate in all educational activities of their local Medical Association, as well as the Cyprus Society of Internal Medicine and EFIM and have free access to all congresses organized in Cyprus. In addition, the Ministry of Health sponsors the participation of residents in up to 2 international congresses throughout their residency, with a priority for EFIM events or other European Society Congresses. Finally, residents in Internal Medicine who have not already received ALS accreditation are invited to do so during their first year of practice, with the relevant cost covered by the Ministry of Health.
The number of residents of Internal Medicine in Cyprus is about 30 annually, but the majority of these opt to only complete partial training (6-36 months) and then shift to other specialties for which such a prior training is a mandatory prerequisite (e.g. Cardiology, Nephrology).
Moving to Cyprus to train or work in Internal Medicine
Residency programmes in Internal Medicine are approved and supervised by the Medical Education Council operating under the auspices of the Ministry of Health (www.moh.gov.cy). Interested applicants must have an undergraduate training of no less than 6 years before applying for the programme. Thus, 6-year MD graduates are allowed to apply without other training, whereas 4 or 5- year medical degree holders must first complete foundation (pre-registration) programs either in their country of graduation or in Cyprus to reach the 6 year training requirement. Applicants must submit their application form and degree copy by the end of September each year to allow them to participate in the national residency entry exams. These take place in 2 stages: stage I takes place in October and includes a 3 hour written comprehensive examination in internal Medicine consisting of multiple choice questions with a single correct answer (usually best of five format). Applicants achieving a grade of 50% of more of all possible points are then invited for an oral examination in late November/ early December, including both short clinical case discussions and general orientation/ qualification review. Based on the result of both the written (80%) and oral (20%) examination, successful applicants are given a ranking used to receive offers to start residency training in Internal Medicine in accredited teaching hospitals across the country throughout the next year. Although success rates vary annually, generally less than 50% of applicants succeed in the exam and of those succeeding about 2/3 are usually able to secure a training position, while the rest may choose to re-sit the exam next year to improve their performance and ranking. All the application and examination documents are completed in Greek, which is also the language used during the oral examination.
This page has been prepared by Giagkos Lavranos, Young Internists assembly representative for Cyprus, September 2015.