Background ACGME-I requires sponsoring institutions (SIs) to have systematic oversight of program performance. This was initially carried out through annual review, however, maintaining compliance became a challenge for a large SI like Singapore Health Services (SingHealth) as the number of residency programs grew from 5 to 34 in 3 years. Objective We assessed the impact of quarterly monitoring using a dashboard on graduate medical education (GME) program performance and institutional oversight. Methods In 2014, the SingHealth GME Committee (GMEC) approved the dashboard covering 13 indicators with implication on program performance, resident/faculty performance, and finance. Indicators were given color-coded scoring for compliance, borderline compliance, or concern. From annual reporting, periodicity was increased quarterly with reports distributed to program directors, head of department, and academic clinical programs. Results Since implementation, programs consistently met or exceeded compliance standards in 11 of 13 indicators (84%), with 7 indicators (63%) showing upward trends. Programs with borderline scores in particular quarters showed improvement in subsequent quarters. By 2015, percentage compliance for the 3 dimensions of residents' perspectives were 1 to 2 points higher than the national compliance average. Of 19 programs undergoing ACGME-I accreditation in 2014, only 4 had citations in the foundational requirement. Institutional citations were resolved, with 0 citations in the reaccreditation site visit in 2015. Conclusions For a large SI, increased periodicity of program performance reporting from annual to quarterly effectively addressed the gaps in a timely fashion. Institutional performance also improved through the use of quantitative data aligned with institution and national performance indicators.

In view of the rise in child abuse in Singapore, our Family Service Centre developed a child welfare practice model to guide and anchor our practitioners in trauma-informed approaches. This practice model was developed over two years through literature reviews and qualitative interviews with practitioners. Three aspects of the practice model were found to be key in ensuring practitioners were trauma-informed in their practices, these being: the principles and values related to trauma-informed practice; reflection by practitioners on their attachment history and self; and the assessment of caregivers’ characteristics. Despite this practice model being largely beneficial for practitioners in our agency, implementation in the local context gives rise to certain challenges due to differences in beliefs about disciplining children.

Background Enhanced parenting self-efficacy (PSE) contributes to positive parenting and future parental-child health. First-time parents, in particular, are in need of support since the pregnancy until post-delivery to strengthen their early PSE. However, there is a lack of effective and sustainable relevant programmes in the community. The Community-enabled Readiness for first 1000 Days Learning Ecosystem (CRADLE) aims to develop a self-learning eco-community throughout the pregnancy and early childhood to promote PSE among first-time parents. We apply choice architecture strategy using behavioural nudges and midwife-led continuity care during the first 1000 days, and test their effects on PSE and mother-child health for first-time families in Singapore. Methods This three-arm randomised controlled trial will recruit up to 750 pregnant women from the KK Women’s and Children’s Hospital, Singapore. Participants will be randomly assigned to receive: (1) standard routine care; (2) behavioural nudges (text messages) along with the use of a social media platform; or (3) midwife-led continuity care involving individualised teleconferencing sessions, during pregnancy and post-delivery. Using web-based questionnaires, participants will be assessed for baseline socio-demography and health status in the first visit, with follow-up assessments in the third trimester, at birth, 6-week (primary end-point), 6-, 12-, 18- and 24-month post-delivery. The primary outcome is PSE. Secondary outcomes include health and birth experience, mental wellness, feeding practice, maternal and child nutritional status. Intention-to-treat and per-protocol analyses will be performed using general linear models to test the effects of interventions across three arms. Recruitment has begun in June 2020 and is estimated to complete in September 2022. Discussion This study may identify a sustainable effective strategy in the community by helping first-time parents to have a positive experience during the pregnancy, childbirth and parenthood, leading to an enhanced PSE and health outcomes for both mother and child. Findings from this study will provide insight into the implementation of early parenting and mother-child care programmes. Trial registration ClinicalTrials.gov NCT04275765. Registered on 19 February 2020.

death and lower the severity of injuries sustained in road traffic accidents. Objectives The main objective of our study was to explore the knowledge, attitude and practice of parents of newborn babies regarding infant or child car restraints during their homeward trip from the hospital. The secondary aim was to evaluate the reasons behind non-compliance to infant and child car restraints amongst those who intended to travel home in a motor vehicle, and compare our findings with a systematic review of child car seat restraints. Methods A 22-item self-administered questionnaire was completed by a convenience sampling of 200 parents of babies about to be discharged from a well-baby nursery in Singapore during the 4-month study period. Parents of babies who were admitted to the Neonatal Intensive Care Unit, transferred to other hospitals or passed on, along with unwell mothers, were excluded. Results Out of 200 parents, 98.5% intended to bring their newborn baby home by a motor vehicle. Parental knowledge of the local legislation on child car restraints was generally high (74%), with the majority aware of the correct location (93.5%) and orientation inside the vehicle (72%). Although 106 parents were already in possession of a child car restraint, only 81 (76%) intended to use it for the homeward journey. The remaining chose not to because of a personal belief, misperception of risk and/or logistical difficulty. Ownership and usage of child car restraints was positively correlated with household income. Conclusions The surveyed parents generally had a high level of knowledge regarding child car restraints. However, the misperception of need which led to inconsistent practice was worrying. A multi-faceted approach, including parental education and regulatory requirements, are important to increase compliance to child and infant car seat restraints in Singapore.

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