The Complete Guide to the MMed Orthopaedic Surgery Examination 2025

The Master of Medicine (MMed) in Orthopaedic Surgery is the definitive exit qualification for orthopaedic residents in Singapore. Awarded by the National University of Singapore (NUS), it is the key milestone required for accreditation by the Specialist Accreditation Board (SAB). The Singapore training system is known for its intensity, academic rigor, and high clinical volume. This guide breaks down the examination process for 2025.

Visual Element: A flow chart showing the Residency years (R1-R5), the MMed timing (typically end of R4/early R5), and the subsequent FRCS (Orth) if applicable/required for certain pathways.

What is the MMed (Ortho)?

The MMed is a postgraduate degree that signifies a surgeon has reached the level of a specialist. While the FRCS (Edinburgh/Glasgow) was historically the standard, the MMed is now the local gold standard, often taken in conjunction with or as a precursor to the FRCS (Intl) depending on the specific residency track.

Key Facts at a Glance

The Singapore Residency Pathway

Singapore follows an ACGME-I (International) style residency model.

• R1 (Internship/Foundation): General rotations.
• R2-R3 (Junior Resident): Core orthopaedic rotations. Completion of MRCS is mandatory to progress.
• R4-R5 (Senior Resident): Subspecialty rotations, Chief Resident duties, and exam preparation.

The Examination Structure

The MMed exam is unique because it places a huge emphasis on Academic Research.

Part 1: The Clinical Viva (9 Stations)

This is a "bell-ringer" style rotation or a series of tables.

• Format: 9 stations, covering all subspecialties.
• Content:
  • Trauma: Complex fractures, pelvic/acetabular.
  • Arthroplasty: Hip/Knee primary and revision.
  • Spine: Degenerative, trauma, tumor.
  • Hand: Trauma, nerve compression.
  • Paediatrics: DDH, CTEV.
  • Oncology: Bone tumors.
  • Sports: ACL, shoulder instability.
  • Foot & Ankle.
  • Basic Science.

Part 2: The Article Critique (1 Station)

This station tests your ability to critically appraise medical literature.

• Task: You are given a journal article (e.g., from JBJS or NEJM) 30-60 minutes before the station.
• Viva: You must present a critique.
  • "What is the study design?"
  • "Are the statistical methods appropriate?"
  • "What is the bias?"
  • "Do the results support the conclusion?"
  • "How does this change your practice?"

Clinical Pearl: Learn the CONSORT statement checklist for RCTs. Being able to systematically rip apart a methodology section is a key skill for this station.

Part 3: The Thesis Defence

Unlike many other boards, Singapore requires an original research thesis.

• Submission: A full manuscript (often published or ready for publication).
• Defence: You stand before a panel of professors and defend your work.
• Questions: "Why did you choose this sample size?" "What was your p-value threshold?" "What are the limitations?"

Trap: Do not fake your data. Do not use a "weak" case report. The examiners are world-class researchers. They will spot statistical anomalies. A solid retrospective review or a prospective cohort study is expected.

Preparation Strategies

1. The "NUS" Style

Singaporean examiners value evidence-based medicine. When answering a clinical question, quote the paper. "The STITCH trial suggests..." or "The latest Cochrane review shows..."

• Resource: JBJS Reviews, Journal of the AAOS (Yellow Journal).

2. Thesis Management

Start your research in R2.

• R2: IRB approval and data collection.
• R3: Analysis and writing.
• R4: Submission.
• Do not leave this until the exam year. You will be too busy studying clinicals.

3. Viva Practice

• Mock Vivas: The residency programs (SGH, NUH, TTSH) run intensive mock exams. Attend all of them.
• Visiting Professors: Often, external examiners come from the UK or USA. Be prepared for different questioning styles.

Resources

• Statistics: Designing Clinical Research (Hulley). Essential for the critique and thesis.
• Clinical: Miller's Review, Postgraduate Orthopaedics (Banaszkiewicz) - the "Viva Book" is very popular in Singapore.
• Local Guidelines: MOH Clinical Practice Guidelines (e.g., for Osteoporosis).

How OrthoVellum Helps

OrthoVellum is tailored for the high-academic standard of Singapore:

• Journal Club: Summaries of landmark trials (e.g., PROMIS, SPRINT, DECADE) to help with the Article Critique.
• Statistics Module: "Stats for Surgeons" – explaining p-values, power analysis, and regression in plain English.
• Viva Scenarios: High-level complex cases typical of tertiary centers in Singapore.

Key Takeaways

1. Research is Key: The Thesis and Article Critique are unique barriers. Master them.
2. Evidence-Based: Always support your clinical answers with literature.
3. MRCS First: Ensure you clear MRCS early in residency.
4. Time Management: Balancing Chief Resident duties with thesis writing is the hardest part.
5. Global Standard: The MMed is internationally respected. Aim high.

Start your MMed preparation today with OrthoVellum.

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