1. Objectives

2. Areas of Training

3. Orthopaedic Sub Specialty Training Committee

4. Entry Requirements

5. Duration of Training

6. Trainers

7. Training Format

8. Training Centres

9. Overseas Training

10. Evaluation, Supervision and Assessment

11. Appointment of Assessors

12. Academic Activities

13. Trainee’s Commitment

14. Certification

15. Re-Certification

16. General Rules and Regulations

17. Future areas of Training

18. Orthopaedic Subspecialties

- General Orthopaedics and Advance Musculoskeletal Trauma

- Spine Surgery

- Joint Arthroplasty

- Upper Limb Surgery

- Sports Injury and Arthroscopy

- Pediatric Orthopaedics

- Orthopaedic Oncology

Appendix A - Competency Assessment
Appendix B - Supervisor’s Report
Appendix C - Log Book

ORTHOPAEDIC SUB SPECIALITIES FELLOWSHIP IN THE MINISTRY OF HEALTH, MALAYSIA.

Objectives

The objectives of the Orthopaedic Sub Speciality Training Programme are: -

1. To produce competent and safe Orthopaedic & Traumatology sub specialists capable of independent practice.

2. To further improve the quality and standards of Orthopaedics & Traumatology in the country.

3. To enhance and make accessible the delivery of high quality Orthopaedics & Traumatology care to the public.

Areas of Training

1. General Orthopaedics and Advance Musculoskeletal Traumatology

2. Spinal Surgery

3. Joint Arthroplasty

4. Upper Limb Surgery

5. Sport Injuries and Arthroscopy

6. Pediatric Orthopaedics

7. Orthopaedic Oncology

Orthopaedic Sub Specialty Training Committee (OSSTC)

This committee oversees the planning, organization and conduct of the training programmes. The committee meets once a year or whenever directed to do so.

The Orthopaedic Sub Speciality Training Committee comprises of: -

Ketua Perkhidmatan Otopidik (Co-coordinator)
The Programme Heads of all the sub specialties.

Advisers: 1. Ketua Pengarah Kesihatan 2.Timbalan Ketua arah Kesihatan (Perubatan), KKM

2. Pengarah Perkembangan Perubatan, KKM

3. Cawangan Pembangunan Profesyen Perubatan, Bhg. Perkembangan, KKM

Functions of the committee: -

· To ensure a high standard of training suited to the needs of the country

· Review the training curriculum, short attachments & overseas training

· Review & monitor the accreditation status of training centers and the appointment of trainers

· Monitor the progress of trainees and make recommendations

· To recommend to KKM on the appointment of examiners / assessors to conduct appraisal/assessment of the trainees

· Evaluate and recommend to KKM the successful candidate for certification

· Advise KKM and recommend disciplinary actions / termination of training on any trainee involve in gross misconduct.

· Re-certification, re-validating and audit of the programme and the candidates.

· Oversees all other matters pertaining to the training programme and its implementation in accordance to the objectives and planning.

Entry Requirements

The prospective candidate must fulfill all of the following criteria: -

A Malaysian citizen, confirmed in service.
Possessed a recognized postgraduate qualification in Orthopaedics.
Gazetted as an Orthopaedic Specialist
Minimum of 12 months working experience as an Orthopaedic specialist post gazettment.
Has been exemplary in behaviour, in work, in attitude and in service.
Age 40 years or less at time of application*.

Candidates are chosen by “peer selection” and importance is given to attitude and personality; able to get along well with others; being a team player; publications; presentations and other related academic activities. Other plus points includes seniority, contributions and interest shown in the sub specialty and favourable referees’ reports.

* At the inception of this programme until 2007, candidates between 40 to 45 years of age with good service track records can still be considered.

Selection committee comprises of the following: -

The respective sub speciality programme Heads.
Trainers from the respective sub specialty
Ketua Perkhidmatan Otopidik (Co-coordinator)

Advisers:- 1. Pengarah Perkembangan Perubatan, KKM

2. Timbalan Pengarah, Cawangan Pembangunan Profesyen

Perubatan, Bahagian Perkembangan, KKM

The selection committee meets in July / August and all applications for fellowship training must reach Cawangan Pembangunan Profesyen Perubatan, Bhg. Perkembangan, KKM, latest by the 15 th of June. Late applications will not be entertained. Training commences in January, the following year. At least one of the Orthopaedic representatives in the committee should be the candidate’s designated mentor / trainer.

As training places are limited, candidates might be offered training in sub specialty not of their first choice. Subspecialties offered for training each year depends on the availability of training posts for that year.

Successful candidates will be intimated by post and will be given 2 weeks from the date of the letter to accept or decline the offer.

There is a possibility that the successful candidate might be transferred to another Hospital for training if there is no training post in the candidate’s present hospital.

Trainees accepting the offer and is involved in transfer will be given a time frame of one month to report to the training hospital and to his/her designated trainer. Failingto do so without valid and acceptable reasons will result in the trainee’s place being given to another candidate.

If a candidate turns down an offer of his/her first choice or refused to be transferred to another hospital for training without any good valid reasons, his / her subsequent application for training will not be considered for the following 3 years.

All decisions made by the Selection Committee are final. Applicants who have not heard from the Selection Committee by September are deemed to have beenunsuccessful in their application. Unsuccessful candidates will have to re-apply for the next intake or for subsequent years either in the form of a letter to indicate their interest in applying or in submitting a new set of application.

DURATION OF TRAINING

Total duration of training is 4 years, which is divided into 2 parts. Entry into the 2^nd part is only possible after successful completion of the 1^st part and the candidate passed the required assessment.

1^st Part (1st & 2nd years) – In house training, preferably with rotation to

different centers under different trainers. Part of this training can be done in local Universities / overseas.

2^nd Part (3^rd & 4th years) – The candidate works in partial independence and is supervised by his/her mentor from time to time. Part of this training can be done in recognized oversea centers, preferably during the 3^rd year.

TRAINERS / MENTORS

Only accredited trainers can carry out full time training. All appointments are based on a case-to-case basis under the prerogative of the OSSTC. Aspiring trainers must preferably have at least 2 years of working experience in General Orthopaedics & Traumatology post gazettement plus at least 2 years of satisfactory working experience in the sub speciality after one year of formal post-sub speciality training.

Other criteria’s considered for appointment are, the needs of the country; the need for such trainers; the locality of training; the attitude and aptitude; seniority and experience; proof of work experience; academic activities; & etc. The Orthopedic Sub Specialist Training Committee reserves the right to appoint or revoke the appointment of trainers and the decision of the Committee is final.

Trainers for short- term attachment, as in allied units, private sector or University Hospitals need not be accredited.

Trainer to trainee ratio

Maximum at any one time: 1 trainer for 1 trainee

All effort is made to maintain this ratio, but circumstances may dictate a change, depending on the number of trainers/trainees/ centers and the needs of the country.

In the event of a trainer with a trainee resigning from Government service, all attempts will be made to ensure that the affected trainee will be place under another trainer, which can sometimes be a transfer to another hospital. Such disruptions will however be dealt with amicably in the interest of all those concern.

Training Format

Training should be in the form of supervised apprenticeship and perceptorship with emphasis on one to one teaching from the mentor. Center based training rather than surgeon based training in view of the high turnover rate. There should be strong commitment to teaching of the fellow as judged by time allowed for didactic sessions, case presentations, journal reading, formal discussions, interest in clinical and basic research and studies / publications by fellows. The trainee should be provided with time and space for individual study and access to the relevant facilities.

TRAINING CENTERS

1^st Part of training - in house training

Regional centers to be maintained as the hub of training because of their established supporting services; allied departments; and teaching facilities. Such centers also have a high patient volume turnover with a good yield of operative and non-operative cases. From here the trainees can be rotated and networked to other centers, attend short courses and attachments.

2^nd Part of training – partial independence

In any General Hospitals or DGH with specialists which is able to support the sub speciality. Trainees can attend short courses and attachments. Trainers must visit and supervise / audit the trainee’s work at least 4 times a year if not working in the same hospital. Part of this 2^nd part training can be done in recognized oversea centers preferably during the 3^rd year.

Overseas Training

To be undertaken preferably during the 3^rd year of training. Application for scholarships, bursaries, paid leaves or other forms of aid to be done early. The respective sub specialty training committee will attempt to procure a suitable overseas training center for the trainee.

It should be noted here that this Fellowship is not tied to any form of Scholarship / Bursary / Paid Leaves or Sabbaticals. But the reverse applies, one has to be in the Fellowship to qualify for the scholarship. ***From 2007/ 2008 onwards, only candidates who has passed their 1^st assessment will be considered for scholarships / paid leaves for overseas training.

However, every effort will still be made to obtain scholarships and other forms of financial support for the candidates to enable them to attend overseas training. Unfortunately, such scholarships are very limited; hence not all candidates will be successful in obtaining a scholarship for overseas training. Joining this Fellowship is not a guarantee to overseas training. ***Candidates who are willing to be posted to unpopular places on completion of training or willing to take up not so popular disciplines may be given scholarships in preference to others.

EVALUATION, SUPERVISION AND ASSESSMENT

1. Maintain a log - book throughout the whole training period and complete it towards the end of training. The logbook is important for assessment.

2. Six monthly assessment by the Trainer and report send to the Ministry.

3. There will be frequent supervision of the trainee’s work during the 1^st part of training.

At least a quarterly audit of the trainee’s work during the 2^nd part of training.

4. At the end of the1^st part of in house training there will be an assessment of the trainee’s overall performance including a viva voce and discussion.. The

supervisor can defer the candidate’s appearance in the assessment exam to the next diet upon evidencesubmitted to the OSSTC that the candidate is not ready or prepared to be assessed. Only successful trainees can proceed into the 2^nd part of training.

5. At the end of the 2^nd part of training, there will be a thorough review into the trainee’s work and the outcome of the patients treated. Assessors can interview and examine the trainee’s patients, gain access and check at random the patient’s records and also assess the trainee’s maturity in management and technical skills.

6. Supervisor’s report at the end of 1^st & 2^nd part of training. Overseas center supervisors report if applicable.

7. Trainees failing the 1^st part assessment will be given a chance to re-sit after 1 year. Failing in this re-sit will have the candidate terminated from the programme.

Those who have obtain overseas scholarship but failed in their assessment may have to defer / cancel their scholarship.

8. Trainees reaching towards the end of the 2^nd part of training are expected to pass the final assessment. In the event of the trainees failing the 2^nd part, the trainee will be re-trained for 6 months. If the trainee fails again subsequently, he/she will be terminated from the programme and no certification will be given.

Appointment of Assessors / Examiners

The Orthopaedic Sub Specialist Committee can appoint assessors / examiners from:-

1. The Ministry of Health

2. Local Universities

3. Academy of Medicine, Malaysia

4. Malaysian Orthopaedic Association

5. Overseas

Academic Activities

The trainee is expected to be involve in academic activities like CME, teaching junior doctors / residents and conduct research. Also, for certification purposes, the trainee must have:-

1 publication as first author in a peer review journal
Presented in meetings, seminars or conferences (2 oral & 2 posters)

Trainee’s Commitment

The trainee must endeavour to complete the sub speciality training within the stipulated period with distinction. Upon completion of training, the trainee may be bonded to serve with the Government for a period of time that will be determined by The Ministry of Health and JPA. At present, there is no provision of such a bond unless the trainee goes for overseas training or other forms of training paid for by the Government.

Certification

After having satisfied all the requirements of the training programme, the trainee will be recommended to the Orthopaedic Sub Speciality Training Committee by their respective Sub Specialties and peers for the purpose of certification. The certificate of successful completion of sub specialty training will be issued by The Ministry of Health, Malaysia.

RE-CERTIFICATION

Successful candidates are subjected to re-certification every few years and their work audited according to the rules and regulations set up by the National Credentialing Committee.

General Rules And Regulations

Trainees may be required to help out in general on call duties during their training and also may be called upon to run the general wards on top of their sub-speciality wards.

Trainees terminated from training by the Training Committee or stopping on their

own for whatever reasons will not be accepted back into training and may have to

serve out their bond with the Government.

The OSSTC reserves the right to change the rules and regulations from time to time without any prior notice or reasons given.

Future areas of training

Future areas of training may include Foot & Ankle Surgery; Shoulder & Elbow Surgery; Upper limb surgery, Surgery & treatment of Metabolic & Inflammatory Bone & Joint Disorders; Cervical Spine & Base of Skull Surgery; Orthopaedic Research; Rehabilitative Orthopaedics & Locomotor Assessment (Gait Analysis, Orthopaedic Biomechanics, Orthotics & Prosthetics).

OTHOPAEDIC SUB SPECIALITIES

Each sub specialty will have a committee, which have the following functions:-

1. To plan and map out the selected trainee’s training programme for the whole duration of training.

2. To review and maintain the standards of training and to oversee all training aspects of their Sub Specialty.

3. To make necessary recommendations to the Orthopaedic Sub Specialty Training Committee in regards to training matters in their Sub Specialty.

4. Implementation of the programme according to its objectives and planning.

1. General Orthopaedics and Advance Musculoskeletal

Traumatology

General Orthopaedics and musculoskeletal traumatology is recognized as a sub specialty because of the importance of the role of a generalist not only in our healthcare system but also in those of developed countries. Musculoskeletal Traumatology is included here because approximately 70 % of the workload of the Orthopaedic surgeon in MOH is due to trauma. A General Sub Specialist can contribute significantly in DGH with specialist as well as in General Hospitals.

General Orthopaedics and Advance Musculoskeletal Traumatology Training Committee

Accredited Centers for 1^st Part of Training:

Main Centers : 1. Hospital Pulau Pinang

2. Hospital Ipoh

3. Hospital Kuala Lumpur

4. Hospital Tengku Ampuan Rahimah, Klang

5. Hospital Sultanah Aminah, JB

6. Hospital Umum Kuching

Affiliated Centers:- University Hospital, Hospital UKM, Hospital USM

Rotation to any of the following Hospitals:

(1). Hospital Alor Setar (2). Hospital Seberang Jaya

(3). Hospital Sg Buloh (4). Hospital Serdang (5). Hospital Selayang

(6). Hospital Melaka (7). Hospital Seremban (8). Hospital Tengku Afzan, Kuantan (9). Hospital Kuala Trengganu (10).Hospital Kota Bharu (11). Hospital QE, KK

Training in the main centers will invariably expose the trainee to the many aspects of General Orthopaedics and Traumatology and for specialties not found in their center the trainee can rotate to the other centers that have the specialty. Whenever practical, the trainee is encouraged to rotate between centers to learn from different trainers. For example, main center HTAR – General Orthopaedics, Spine Trauma, Ilizarov and rotate to HKL for Pelvic Trauma, Vascular Trauma, Sport Injuries and to H. Selayang for Hand Trauma. The Committee will have to plan and map out the trainee’s training programme from the beginning.

For the 2^nd Part of training, the trainee can be send to DGH with specialists, to run the Orthopaedic Department in such Hospitals under supervision from the trainer.

Training Contents

1. All aspects of musculoskeletal trauma management and care.

2. Spinal Trauma – Anterior and posterior decompression and stabilization of the spine. Management of the spinal injured and paralysed patient.

3. Pelvic Trauma – Stabilization of the pelvis, ext. or int. fixation. Management of acetabular fractures, Sacroiliac dislocations and sacral fractures.

4. Vascular Trauma – Identification of limb arterial injuries. Direct repair, vein grafts or bypass grafts. (Rotate to Vascular Surgery Department)

5. Wound Management – Flaps, rotational or free. (Rotate to Plastic Surgery Dept.)

6. Hand Trauma – Management of hand injuries, fractures and the mangled hand.

7. Ilizarov Procedures – For salvaging limbs, bone transport & lengthening, correction of deformities and fixation of fractures.

8. General Orthopaedics – Exposure to Arthroplasty, Sports Injuries, Ortho. Oncology, Pediatric Ortho., Hand Surgery, Spine Surgery, Management of Diabetic Foot, Metabolic Diseases of Bone, Orthopaedic Rehabilitation and Prosthetics.

The trainee is encouraged to attend courses related to trauma like ATLS and those related to Mass Casualty Incidents.

2. SPINE SURGERY

Spine Surgery Training Committee

Accredited Centers for 1^st Part of Training:

Hospital Kuala Lumpur, Hospital Pulau Pinang

Hospital TAR, Klang., Hospital Ipoh, Hospital Kuala Trengganu,

Hospital Umum Kuching, Hospital Sungai Buloh

Affiliated centers:- Hospital UKM, University Hospital

For rotation:-

1. Hospital QEH., 2. HAS / H Kangar

Training Contents

1. Spinal Trauma

2. Degenerative disease of the spine

3. Deformities of the spine

4. Spinal infections

5. Spinal Tumours

6. Spinal Rehabilitation

7. Rotation to Neurosurgical Dept. – Skull base procedures, Intradural pathologies.

5. Joint Arthroplasty

Joint Arthroplasty Training Committee

Accredited Centers for 1^st Part of Training:

Rotation between:-

1. Hospital Kuala Lumpur

2. Hospital Pulau Pinang

3. Hospital Alor Setar

4. Hospital Melaka

5. Hospital TAA, Kuantan

6. Hospital Umum Kuching

Affiliated centers:- University Hospital, Hospital UKM

To be considered in the future; Hospital Pandan

Training Contents

1. Primary Total / Uni Arthroplasty & Hemiarthroplasty

2. Revision Arthroplasty

3. Osteotomy and Realignment Procedures

4. Arthroscopy, imaging, histology & pathology of joint replacement

5. Minimal invasive arthroplasty

6. Infection in arthroplasty & thromboembolic disease

7. Bone grafting procedures

8. Treatment of peri-prosthetic fractures

9. Materials for joint replacement

10. Joint reconstruction after tumour resection

11. Arthrodesis for failed joint replacement

5. Upper Limb Surgery

Upper Limb Surgery Training Committee

The proposed training contents are as follows:-

Training Contents

1^st Year Training

Injury of the hand and Distal Upper limb

Skin- techniques of skin cover

Tendon- management of flexor and extensor tendon injury- primary techniques and secondary techniques e.g. graft, transfer, tenolysis.

Nerve- management of injury- primary and secondary procedure, microsurgical techniques including Brachial plexus injury.

Vessel- management of arterial injuries, microsurgical techniques, compartment syndrome and ischaemic hands.

Bone- management of hand bone fractures, wrist injuries, use of fixation-external and internal, splint and cast and secondary management of complicated fractures

Ligaments- management of injuries, acute and chronic ligament injuries of the wrist with primary and secondary procedures. Arthroscopic surgery of the wrist.

Amputation- replantation and revascularization, reconstructions following the amputation for prosthesis and orthoses, thumb and digits reconstruction.

Special Injuries- thermal injuries, pressure and injection injuries, degloving injuries, radiation and thermal injuries, vibration injuries.

2^nd Year Training

Elective Surgery of the Hand and Upper Limb

Congenital- Management of complex congenital hand deformity, techniques used in management of congenital anomalies.

Paralyses- principle in management of cerebral palsy and other spastic paralyses, reconstruction of paralytic hand deformity, tetraplagia, poliomyelitis, reconstruction for peripheral nerve injuries.

Arthritis- general principle in management of arthritis in hand and upper limb, rheumatoid arthritis, osteoarthritis including arthrodesis and arthroplasty.

Nerve Compression Syndrome- management of compression syndrome median, ulnar, radial nerve and thoracic outlet syndrome.

Tumor-principle of soft tissue and bone tumor management

Infection-general principle , prevention and use of antibiotics, wound infection and deep sepsis.

Connective tissue Disorders- stenosing syndromes, Dupuytren’s contracture, ischaemic condition.

Pain syndrome in the upper limb.

Sport Injuries in the Upper Limb.

5. Sports Injuries and Arthroscopy

Sports Injuries and Arthroscopy Training Committee

Accredited Centers for 1^st Part of Training:

1. Hospital Kuala Lumpur

Affiliated Centers: - University Hospital, Hospital Tentera Lumut

Training Contents

1. Arthrosopic reconstructive procedures of the knee, shoulder and other joints.

2. Non arthroscopic reconstructive procedures

3. Management of sports injuries

4. Sports medicine and sports physiology

5. Rehabilitation in sports injury

6. Pediatric Orthopaedics

Pediatric Orthopaedics Training Committee

Accredited Centers for 1^st Part of Training:

Hospital Kuala Lumpur

Hospital Selayang, Hospital Kota Bharu

Affiliated centers: - University Hospital, HUKM

Training Contents

1. Embryology

2. Bone Dysplasias (Dwarfs)

3. Chromosomal and teratologic disorders

4. Haematopoietic Disorders

5. Athritides

6. Metabolic diseases

7. Birth injuries

8. Cerebral palsy

9. Neurofibromatosis

10. Neuromuscular disorders

11. Pediatric Spine

12. Upper extremity disorders

13. Rotational & angular deformities of the lower limbs

14. Hip – DDH, SUFE, Perthes

15. Pediatric knee

16. Proximal focal femoral deficiency

17. Gait abnormalities

18. Infections

19. Leg length inequality

20. Pediatric foot, CTEV, Flatfoot, Pes Cavus

21. Pediatric trauma

7. Orthopaedic Oncology

Orthopaedic Oncology Training Committee

Accredited Centers for 1^st Part of Training:

Important deciding factors are present of supporting facilities such as:

MRI
Oncologist (medical and radiation)
Radionuclid scan facility
Bone and tissue bank (preferably)

1. Hospital Kota Bharu with networking to HUSM

2. Hospital Kuala Lumpur / Putrajaya 3. Hospital Pandan, Johor

4. Hospital Pulau Pinang 5. Hospital Umum Kuching Sarawak with UNIMAS

Affiliated Centers: - HUSM, University Hospital, UNIMAS

Training Contents

First year:

Principles of surgical oncology
Principles of biopsy
Oncology attachment- medical and radiotherapy (1 month)
Musculoskeletal imaging attachment (1 month)
Basic musculoskeletal tumour pathology attachment (1 month)
Benign and malignant musculoskeletal (bone and soft tissue) tumours and their management
Principles of soft tissue coverage
Principles of arthroplasty (1 month attachment in arthroplasty unit) – optional.
Rehabilitation
Psychology in cancer patients
Counseling in cancer patients
Cancer pain management

Procedures allowed:

· Biopsy of bone and soft tissue tumours

· Excision of benign soft tissue tumours

· Benign bone tumour surgical procedures

· Assist in malignant bone and soft tissue tumour surgery

Second year:

Advance/complex oncology resection and reconstruction procedures in various anatomical regions (including spine- with spine surgeon)
Management of surgical oncology complications
Management of chemotherapy complications
Management of radiation complications
Revision procedures in fail oncology reconstructive surgery
Principles of oncology amputation
Management of local recurrence
Management of skeletal metastasis (including spine)

Procedures allowed:

Excision of malignant bone and soft tissue tumours
Reconstructive surgery
Excision and reconstruction in skeletal metastasis
Amputation in oncology patients
Revision surgery

APPENDIX A

Competency Assessment

Competency assessment will be continuous throughout the training programme by the trainee’s supervisor. There will be six monthly assessment reports by the Supervisor to be sent to the Ministry. Second year-end and fourth year-end assessment will consist of viva voce, discussions and audit of the candidates work relevant to the subspecialty. Parameters of “surgical competence” like knowledge, decision-making, communication, psychology, technical ability and dexterity will be assessed. The candidate is expected to know the latest / current knowledge in their field and also be able to discuss controversial issues with the backing of evidence based knowledge.

APPENDIX B

Supervisor’s Report ( Six Monthly)

ORTHOPAEDIC SUBSPECIALITY FELLOWSHIP IN ………………

SIX MONTHLY ASSESSMENT FORMAT

Name : Place of Attachment :

Training Number : Period of Attachment :

Identity Card No : Name of Trainer :

Please Tick

Particulars

Weak

Fair

Good

Very

Good

Remarks

1.

Attitude

2.

Responsibility

3.

Dedication

4.

Ethics

5.

Professionalism

6.

Knowledge

7.

Punctual / Availability

8.

Clinical Skills

9.

Technical Skills

10

Patient Management

11

Decision making skills

12

Teaching Skills

13

Communication

14

Personal Learning

15

Managerial/Leadership

Relationship with: -

1. Patient / family

2. Colleagues

3. Non clinical staff

16

Record Keeping

17

Participation in: -

Ward Rounds

Clinics

Case presentations

Journal Read

Operating Sessions

Mortality / Morbidity Conference

If the candidate has been graded WEAK for any of the above, please elaborate in narrative format in a separate sheet to be attached to this form.

Other Comments: -

Signature & Designation of Trainer

APPENDIX C

Log Book

A logbook must be maintained at all times during training for all procedures done. It should consists of the patient’s name, I/C number, R/N, date of procedure, duration, type of procedure, status- assisting, carried out under supervision or independently, any complications / difficulty encountered and relevant remarks. The supervisor must attest all procedures done. The log book will have to be scrutinized by respective supervisors quarterly and the OSSTC once yearly.

B C Se To 2004

Updated 2005