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Advancing as one TOWARDS AN ACADEMIC DIVISION OF MEDICINE
Contents FOREWORD 01 OUR PEOPLE 02 RESEARCH 06 EDUCATION 11 CLINICAL SERVICES 18 PHILANTHROPY 24 KEY CONTACTS 26
Foreword Dear Colleagues, I am sure many will agree that the past few years have been most eventful amidst many changes at work. Amidst all the challenges and excitement, I am glad, and proud, that many of our colleagues have risen to the occasion, and taken all that came along in good stride. In fact, as I look back, the spirit of enquiry, the desire and pride to do the best possible for every patient has always been evident among us, young and old. Therefore, I canâ€™t emphasise more that academic medicine is for every clinician. Being a proud member of our SGH family, I am constantly reminded of one fact: all that is grand and complex must rest on a strong foundation of fundamentals. There is no point doing tertiary work if we cannot ensure good clinical outcomes and optimal practices for patient safety. It is also futile to research and discover new diagnostic tools and therapeutic possibilities that are unaffordable, inaccessible, or not appropriately utilised and delivered to those who need them most. Hence, in demonstrating our commitment to good patient care through academia, Medicine ACP / Division Medicine has embarked on the journey of quality improvement and innovation for all clinicians since August 2014. We will continue to develop a health services research focus amidst our various areas of research interest. We should also better orientate the medical students and residents who join our departments, ensuring expected standards of clinical practice in our clinical areas are conveyed to all, and compliance checked. Good habits and attitude really start from young and require constant practice. So, all levels of staff should be equally involved: the clinicians, the clinician-researchers, as well as clinician-educators. Itâ€™s a culture that we need to build â€“ not only for the patients that we care for, who are at the heart of all that we do, but also for the true satisfaction of our practice. All of us must be ready to set examples and remind each other in our daily practice. It has been three years since we published the last Medicine ACP report. We want to recognise and celebrate the hard work and achievements of many of our colleagues who contribute in different ways. We also want to give respect to our great clinicians/mentors and encourage many others to join their ranks and perpetuate the culture of giving, teaching and paying forward; thus, the establishment of the Master Physician of Internal Medicine Award. On this note, I would like to extend my heartfelt thanks to the Lee Foundation, which shares our values and belief in our mission and vision. Let us continue the good work of our predecessors and preserve the name and reputation of this 195-year-old institution that has served many generations of Singaporeans. Yours sincerely,
Assoc. Prof Chow Wan Cheng ACADEMIC CHAIRMAN, MEDICINE ACP
Our People MEDICINE ACP COUNCIL
Research Team Working closely with AM.RI, the Research Team aims to improve clinical outcomes for patients and develop sustainable careers for clinician scientists through developing high-impact science, nurturing potential clinical scientists, and integrating research with clinical service and education programmes.
Education Team LEFT TO RIGHT:
DR CHARLES CHUAH A/PROF JENNY LOW PROF JULIAN THUMBOO
The Education Team sets the direction for medical education within Medicine ACP, forging an academic culture in the Division of Medicine and optimising the teaching and learning experience within ACP in collaboration with AM.EI.
Clinical Services & Improvement (CSI) Team LEFT TO RIGHT:
DR JASON CHANG A/PROF LOO CHIAN MIN A/PROF CHAN CHOONG MENG DR PHUA GHEE CHEE
Forging an academic and patient-oriented approach to the practice of clinical medicine, the CSI Team aspires to deliver the highest standard of clinical services and quality.
LEFT TO RIGHT:
A/PROF TAN THUAN TONG DR LOW SU YING A/PROF WONG KOK SENG
ADMINISTRATIVE TEAM The Admin Team plays an equally important role in shaping the landscape of academic medicine, providing support across all areas of Medicine ACP. The team includes administrators from Education to manage Residency and Undergraduate programmes, Research administrators to provide support for the research activities and Clinical Services administrators to support department initiatives.
Research Research is a vital pillar in the advancement of patient care. Medicine ACP aims to create a vibrant environment for clinicians, from junior to senior level, to pursue their interest in medical research through research-focused programmes and funding support.
PROGRAMMES Nurturing Clinician Scientist (NCS) Award The NCS Award aims to nurture and develop our clinicians to strive for competitive national grants, providing a stepping stone for our Associate Consultants and above. Currently, five clinicians – Dr Andrea Low Hsiu Ling, Dr Leung Ying Ying, Katy, Dr Damien Tan Meng Yew, Dr Ng Chin Teck and Dr Tan York Kiat – have attained the prestigious Transition Award (TA) by the National Medical Research Council (NMRC). Among them, four are NCS awardees.
LEFT TO RIGHT: DR ANDREA LOW HSIU LING DR LEUNG YING YING, KATY DR DAMIEN TAN MENG YEW DR NG CHIN TECK DR TAN YORK KIAT
Health Services Research (HSR) Our Medicine ACP HSR team provides strong support in study design, data collection, analysis and interpretation as well as manuscript writing for departmental projects that focus on enhancing adherence and developing innovative models of care. Two of our HSR projects were accepted for presentation at well-known international conferences in 2015:
• Randomised trial of nurse-led telemonitoring clinic for the care of hepatitis B patients – presented at the 27th Annual National Forum on Quality Improvement in Health Care held in Orlando, Florida, USA
• Study to validate a risk-stratifying tool for hospitalised patients – presented at the 20th International Forum on Quality and Safety in Healthcare held in London, UK
Pitch for Funds The two-tier programme, Junior Pitch for Funds (JPFF) and Pitch for Funds (PFF), provides seed funding to encourage junior residents/medical officers and senior residents/registrars to develop their research interests and kick-start their research projects. The winner of the inaugural round of Pitch for Funds, Dr Geoffrey Sithamparapillai Samuel, published his case study in the Singapore Medical Journal (SMJ), and was invited to present his project at the Singapore Rehabilitation Conference in March 2014.
Research Interest Group (RIG) RIG was initiated by a group of research-active clinicians with the goal of nurturing a richer research culture. At this casual monthly breakfast gathering, the clinicians take the opportunity to discuss their research projects and share feedback, while also extending support to younger clinicians who show potential interest in research.
RESEARCH AT A GLANCE
Since 2011, there has been a steady increase in the quantum of grants obtained by Medicine ACP clinicians in all three categories – internal, external and commercial – with the greatest increase in external grants.
In 2015, clinician researchers from Medicine ACP were authors and co-authors in a total of 187 publications, including 110 publications with JIF>2.
AMOUNT OF COMPETITIVE RESEARCH FUNDING SECURED BY MEDICINE ACP
NUMBER OF PEER REVIEWED PUBLICATIONS BY MEDICINE ACP
The table below shows the number of publications from CY11 to CY15.
(SGD’000) MULTI-YEAR FUNDING IS ANNUALISED
8,000 7,000 6,000 5,000
4,000 3,000 2,000 1,000
RESEARCH ACCOLADES: 2013 – 2016 2013 3rd SingHealth GCEO Excellence Award: Outstanding Clinician Research Award DR CHARLES CHUAH THUAN HENG
2014 4th SingHealth Excellence Award: Distinguished Research Award PROF JULIAN THUMBOO
2015 5th SingHealth GCEO Excellence Award: Outstanding Clinician Researcher Award A/PROF WILLIAM HWANG YING KHEE
A/PROF WILLIAM HWANG
OUTSTANDING CLINICIAN RESEARCHER A/Prof William Hwang is a passionate clinician researcher who dedicates much of his time and effort to scientific understanding to better help his patients with haematological oncologic conditions. He has close to 100 publications in Haematology and Transplantation and is one of the leading researchers in the field of haematopoietic and mesenchymal stem cell research. Among the many key leadership roles he holds, he is currently chairing the workgroup on Biobanking for the Ministry of Health, where he brings together Cell and Tissue Banking experts throughout the country to craft guidelines and regulations for clinical biobanking for Singapore. In 2015, he received the SingHealth GCEO Excellence Award for Outstanding Clinician Researcher in recognition of all his research efforts over the years.
THE FEELING WHEN YOU SEE YOUR WORK DOING SOME GOOD IN THE WORLD IS THE MOST IMPORTANT MOTIVATOR FOR CLINICIANS WHO SEEK TO DO RESEARCH.”
A/PROF JENNY LOW
LEADING THE FIGHT AGAINST DENGUE Dengue is the number one mosquito-borne disease in the world right now. This disease is claiming lives, especially among the young and elderly, in many parts of the world including Taiwan, India, southern China and parts of the USA. Finding a cure for a fast-spreading disease like this is no easy feat.
YOU CANNOT DO RESEARCH BECAUSE SOMEONE ELSE IS ASKING YOU TO DO IT. YOU HAVE TO ENJOY THE PARTICULAR CHALLENGE AND SCOPE OF WORK AND ONLY THEN WILL YOU BELIEVE IN IT AND PUSH YOURSELF FURTHER TO GET RESULTS.â€?
A/Prof Jenny Low has been working hard on this subject area for more than a decade now, with her fellow collaborators, Prof Subhash Vasudevan and Prof Ooi Eng Eong from the Emerging Infectious Diseases (EID) programme in Duke-NUS Medical School. The team recently secured funding for a co-development scheme from NMRC. The manufacture of the medications has begun with clinical trials starting in early third quarter of 2016. Should the drugs prove safe and efficacious, this will be followed by larger phase 2 and 3 studies that will test the drugs among populations in other parts of the world, potentially benefitting not just Singaporeans but having a tremendous global impact.
Plans & Priorities Continue career development programmes for NCS, PFF, and JPFF Restructure and strengthen training, orientation and mentoring programmes Integrate HSR with Quality Improvement
Education The passion to teach runs deep in our clinicians, driven by a genuine desire to groom the next generation of doctors to advance the practice of medicine, supported by a network of programmes and activities that encourage knowledge sharing and collaboration.
PROGRAMMES: UNDERGRADUATE Our clinicians do their part to groom the next generation of doctors by actively participating in educational activities. On average, approximately 330 students from NUS Yong Loo Lin School of Medicine and around 60 students from Duke-NUS Medical School are rotated into Medicine. With this steady stream of medical students, our clinicians facilitate in teaching programmes and exams to enrich their medical knowledge and skills. One of the epitomes of a clinician educator is Dr Daisy Chan from the Neonatal and Development Medicine Department, who is one of the few clinicians at the SGH campus currently teaching at all three medical schools, including Lee Kong Chian School of Medicine.
Here are some of the key people who work tirelessly to groom the next generation of competent and compassionate clinicians.
DUKE-NUS MEDICAL SCHOOL A/Prof Loo Chian Min Dr Tan Han Khim Year 2 Clerkship Coordinator
A/Prof Ng Heng Joo
Year 4 Medicine Sub-I Year 4 Medicine Deputy Coordinator / Year 4 Medicine Coordinator Electives Coordinator
YONG LOO LIN SCHOOL OF MEDICINE A/Prof Lina Choong
Dr Chiong Yi
Chief Coordinator, Undergraduate Teaching Committee
M3 Education Coordinator, Rehabilitation Medicine
Dr Ong Thun How
A/Prof Ng Beng Yeong
Coordinator, M5 Medicine / SIP
M4 Education Coordinator, Psychiatry
Dr Felix Keng
Dr Dennis Seow
Coordinator, M2 CSFP (Med)
M5 Education Coordinator, Geriatric Medicine
Dr Wong Gee Chuan
Dr Teh Yii Ean
Coordinator, M3 Medicine
M5 Education Coordinator, Infectious Diseases
PROGRAMMES: POSTGRADUATE Our residents benefit from a complete ecosystem of education, encompassing mentorship, leadership programmes and activities designed to train them to the best of their abilities.
Senior Residents’ Committee The Senior Residents’ Committee is the incubator for the next generation of Medicine ACP leaders. This committee takes leadership of the junior doctors and is empowered to identify, prioritise issues and challenges faced by the juniors. Organised in sub-committees such as Education, Welfare and Administrative, they work hand in hand with the Division to craft feasible solutions.
IM Residency and Senior Residency Programmes In 2015, all 10 of our specialty senior residency programmes and internal medicine residency programme were audited by ACGME-I, and were successfully re-accredited. Every year, the Education team organises two open houses, catering for junior residents and senior residents in the months of July and November respectively. The different medical subspecialties gather with programme directors, core faculty and current senior residents to share first-hand information and insights with the interested applicants.
SingHealth Residency Graduation In September 2015, we celebrated the graduation of our very first batch of Advanced Internal Medicine (AIM) senior residents. Many of them have embarked on their specialist career working within the SingHealth family. By end June 2016, four batches of junior residents would have successfully graduated from our residency programme.
On the same note, in September 2016, our second batch of AIM senior residents will be graduating along with senior residents from the Gastroenterology, Respiratory and Critical Medicine, Endocrinology, Renal Medicine, Haematology and Infectious Diseases departments. The Residents from the national programmes, like Dermatology and Psychiatry, where Medicine ACP acts as the participating site, have also successfully graduated.
The potential of the next generation of clinician educators is evident in our enthusiastic residents who embarked on three programmes that cater to the needs of their juniors, fellow residents and medical students, to make their journey to becoming a clinician a fruitful and enjoyable one. REACH: A peer-teaching initiative that helps to bring the Internal Medicine (IM) community together, where residents foster a genuine interest to help each other excel. Activities such as SIP Bootcamp and MBBS revision for medical students are organised under this programme. COMPASS: The Internal Medicine Residents’ Council designs the orientation programme for junior colleagues to ease their transition into the medical setting. The programme includes team-building activities and survival skills tutorials.
CADENCE: Residents serve as teachers to help their junior colleagues prepare for the PACES examinations. The registrars and senior residents organise the PACES Preparatory Course to provide juniors with the experience of an actual MRCP exam. The seniors, having passed their MRCP exam not long ago, are familiar with the format and play a vital role in organising this activity to share key learning tips. Our MRCP passing rate has been above the national average for three consecutive years. This course is held over two days in January each year.
Medical Grand Rounds
The Medical Grand Round (MGR) was revitalised in 2012 to encourage inter-departmental learning and continual medical education across the specialties. This event takes place on a quarterly basis and the departments take turns to host and share an interesting case, where active exchange of medical opinions and clinical approaches among colleagues of different specialties takes place. This year, the Department of Family Medicine and Continuing Care (FMCC) and SingHealth Transplant Centre collaborated closely with our colleagues from the Pathology and Diagnostic Radiology departments to present their valuable insights. This event continues to be well received through the partnership between various internal and external stakeholders. Subsequent grand rounds will be hosted by the Department of Internal Medicine on 24th August 2016 and the Department of Neonatal and Developmental Medicine on 9th November 2016.
EDUCATION AT A GLANCE NUMBER OF RESIDENTS
SUPPORT FROM DUKE-NUS & JOINT OFFICE OF ACADEMIC MEDICINE (JOAM) Academic Medicine Education Institute (AM.EI) One of the areas supported by AM.EI is faculty development, which aims to develop clinician educators who are passionate about nurturing the next generation of healthcare professionals. Under the AM.EI Fellows programme, passionate educators are developed with advanced teaching skills. This train-thetrainer programme is held over a period of 12 months and covers modules such as designing and planning of learning activities, mentoring and developing others, and providing assessment and feedback to learners. Below are some of our clinicians who have actively participated and are participating in the AM.EI Fellows programme.
IN INTERNAL MEDICINE (IM) RESIDENCY PROGRAMME
MEDICINE ACP PARTICIPANTS OF AM.EI FELLOWS PROGRAMME
2013/2014 INTAKE A/Prof Chan Choong Meng A/Prof Loo Chian Min Dr Phua Ghee Chee A/Prof Wong Kok Seng Dr Fong Yuke Tien
2014/2015 INTAKE Dr Jason Chang Dr Marjorie Foo A/Prof Ng Heng Joo
2015/2016 INTAKE Dr Lim Shao Ting, Dawn Dr Lim Yi Ying, Adoree Dr Lee Haur Yueh Dr Pang Shiu Ming Dr Ng Lee Beng Dr Tay Wei Yi Dr Leow Leong Chai
AMONGST THE 10 SENIOR RESIDENCY PROGRAMMES
Academic Medicine – Enhancing Training, Healthcare, Outcomes & Standards (AM-ETHOS) Under the AM-ETHOS Academic Mentor Development Fellowship, Dr Ng Yee Sien from Rehabilitation Medicine, with Prof Helen Hoenig from Duke Health as his academic mentor, obtained $40,000 funding support to further develop mentoring programmes through the College Deanery system, which improves research capability and focuses on attaining academic-clinical time harmony for all faculty. Under the AM-ETHOS Fellows Exchange programme, clinicians can develop best practices and research ideas and mentoring methodologies through academic exchanges and collaborations between faculty from SingHealth Duke-NUS AMC and Duke Medicine, Durham. Dr Jasmine Chung from Department of Infectious Diseases received the Academic Medicine Fellows Exchange Award with funding support of $85,400 to gain academic exposure and increase collaborations and networking with Duke Health in Durham.
What is AM-ETHOS? Administered by JOAM, Academic Medicine – Enhancing Training, Healthcare, Outcomes & Standards (AM-ETHOS) is a set of new initiatives for medical students, faculty and administrators to enhance their learning and practice of medicine. Funded by Duke-NUS, AM-ETHOS aims to build capacity and capabilities through the Academic Clinical Programmes (ACP) to drive improvements in healthcare. DR NG YEE SIEN
Our ACP clinicians can enhance their practice of medicine through a number of AM-ETHOS education programmes, including:
DUKE-NUS MEDICAL STUDENT RESEARCH FELLOWSHIP Aims to spur medical students’ interest in clinical and translational research, and build up a pipeline of potential Clinician Researchers and Scientists. For Duke-NUS Year 3 Medical Students and Research Mentors from ACPs
DR JASMINE CHUNG
Clinical Teaching for Duke-NUS MD/PhD Students Duke-NUS MD and PhD students put in an additional four to five years to do research work. Upon completing their research, the students usually lose touch with their clinical skills. As such, through collaboration led by A/Prof Ong Sin Tiong, Director of the MD/PhD Programme Office, Duke-NUS and Dr Phua Ghee Chee, Programme Director of IM Residency, SingHealth, this programme aims to provide clinical teaching to bring them up to speed. This pilot initiative started in March 2016 and currently nine PhD students are being trained. Having received positive feedback from the students, the team is working on ways to enhance this programme.
ACADEMIC MENTOR DEVELOPMENT FELLOWSHIP Cultivates strong Academic Clinician Faculty Leaders to become effective role models by pairing with Academic Mentors to gain leadership exposure from Duke Medicine, Durham and other renowned Academic Medical Centres (AMC). For ACP Academic Chairs, Vice Chairs, Directors and high potential Academic Clinician Faculty for leadership positions
For more information on these and other programmes, visit:
ACHIEVEMENTS The awards and achievements earned during the year are recognition for the dedication and commitment to excellence in educating the next generation of healthcare professionals.
SingHealth RiSE Awards Many of Medicine ACP’s clinicians and programmes were recognised at the SingHealth RiSe Awards ceremony, a testament to the culture of passion and excellence that we strive to build. Among them, the Infectious Diseases Residency programme received the Best Medical Subspecialty Award for being the best performing Medical Subspecialty programme for 2014, while the Gastroenterology Residency programme was named The Most Improved Programme for the year 2015.
A/PROF NG BENG YEONG
DR SUEZIANI ZAINUDIN
Teaching Awards by NUS Yong Loo Lin School of Medicine
Master Physicians of Internal Medicine Award
A number of our clinicians were also commended by one of our academic partners, NUS Yong Loo Lin School of Medicine. A/Prof Ng Beng Yeong from Psychiatry and Dr Sueziani Zainudin from Endocrinology were presented with the prestigious Dean’s Award for Teaching Excellence in 2015. Dr Teo Cheng Han Darren from the Rheumatology and Immunology Department received the Junior Doctor Teaching Award for his contributions. Awards for special recognition were also given to Dr Dennis Seow from Geriatric Medicine as well as Dr Sobhana Thangaraju and Prof Woo Keng Thye from Renal Medicine.
The inaugural Master Physicians of Internal Medicine Award was presented to Prof Ng Han Seong and Prof Ong Yong Yau for their many years of dedication to advancing the practice of medicine. Since joining SGH in the 1970s, these two great doctors and teachers have exemplified what Medicine ACP is all about, serving as role models to successive generations of doctors, with many of today’s outstanding doctors having trained under them.
PROF NG HAN SEONG
PROF ONG YONG YAU
EDUCATION ACCOLADES: 2013 – 2016 2013 3rd SingHealth GCEO Excellence Award: Distinguished Young Leader Award DR PHUA GHEE CHEE
3rd SingHealth GCEO Excellence Award: Outstanding Educator Award A/PROF CHAN CHOONG MENG
2014 National Outstanding Clinician Educator Award A/PROF CHOW WAN CHENG
2015 5th SingHealth GCEO Excellence Award: Distinguished Educator Award A/PROF LOO CHIAN MIN
2016 6th SingHealth GCEO Excellence Award: Outstanding Educator Award DR ANANTHAM DEVANAND
A/PROF LOO CHIAN MIN
DISTINGUISHED EDUCATOR A dedicated clinician-educator, A/Prof Loo Chian Min has devoted much of his time to clinical education in Medicine. He began teaching as a clinical teacher for NUS-YLL, even when he was still an Advance Specialty trainee in Respiratory and Critical Care Medicine. He has never stopped teaching since. Through the years, he has progressively expanded his commitment in medical education and has extended himself in more than one way to contribute to the nurturing of the next generation of clinicians. Leading a team of dedicated clinician-educators in Medicine ACP, he has embarked on the journey of harmonising the undergraduate education for Medicine in the SGH Campus, in anticipation of more learners coming into our campus. This will also allow us to define the brand of Medicine that we, as a campus and institution, want to consistently deliver to all the learners that come into our midst. In 2015, A/Prof Loo won the SingHealth GCEO Excellence Award for being a Distinguished Educator.
WE MUST SEE EDUCATION AS PART AND PARCEL OF OUR WORK AS CLINICIANS – JUST LIKE OUR WARD ROUNDS AND CLINICS. EDUCATION SHOULD BE LIKE SECOND NATURE TO US.”
DR JASON CHANG
PAYING IT FORWARD A firm believer in ‘paying it forward’, Dr Jason Chang fondly recalls the great teachers who took the time and effort to mentor him, and the kind and generous colleagues who teach him something new every day. His philosophy is that teaching is and will always be an integral part of medicine, whether it be from the pages of a textbook, or life lessons that are unique to the medical profession such as ethics, communication and humanitarian service. He strongly believes all clinicians have the innate ability to teach the next generation of doctors and teaching is a responsibility and privilege shared by clinicians from all levels.
E D U C AT I O N
IN MY DAILY ROUNDS, I TELL EACH RESIDENT: AT THE END OF THE DAY, AS YOU ARE PACKING UP TO LEAVE THE HOSPITAL, ALWAYS LEAVE WORK KNOWING A LITTLE SOMETHING MORE THAN WHEN YOU CAME TO WORK.” Dr Chang is currently the Programme Director for the Gastroenterology Senior Residency Programme, which was recognised as the Most Improved Programme in the SingHealth RiSE Awards 2015. He was also recently appointed as the Director of Faculty Affairs for Medicine ACP. In recognition of his active role in shaping the education infrastructure to better equip the next generation of healthcare professionals, Dr Chang was awarded the Outstanding Educator Award by AM.EI Golden Apple Award in 2015.
Plans & Priorities Engage education champions in every department Harmonise faculty appointments Harmonise the undergraduate curriculum Enhance the faculty development programme Harmonise student feedback on clinical training
Clinical Services Progressively trained in QI philosophies and methodology, our clinicians strive to lead the advancement of medical care through continual innovation and improvement.
CLINICAL PERFORMANCE IMPROVEMENT (CPI) COMMITTEE Formed on 1 January 2016, the committee is co-chaired by Dr Low Su Ying and Dr Tan Thuan Tong, Directors of the Clinical Services Improvement office under Medicine ACP. Together with departmental QI champions and representatives from Junior and Senior Residency and Clinical Governance, the committee is tasked to develop and implement a quality framework that will deliver the best clinical care and strengthen the safety culture in the Division of Medicine and our institution.
NEW CLINICAL INNOVATIONS AND INITIATIVES Acute Medical Ward (AMW) The pilot for AMW was launched in February 2015. Occupying 67 subsidised beds in Ward 73, the AMW admits patients with infection-related conditions.
This initiative was mooted to improve patient care and increase efficiency so as to shorten a patient’s length of stay in the hospital, without compromising clinical outcome and patient safety. This is accomplished through a multi-disciplinary patient care approach and widespread use of clinical care pathways. Initial pilot results showed a decrease in average length of stay from 8.3 days to 5.9 days for patients admitted for pneumonia.
Electronic Blue Letter Referral System Spearheaded by Dr Tan Ban Hock, this initiative was set up to explore how the inpatient specialist referral (better known as ‘blue letter referral’) process and its efficiency could be improved. This electronic referral system was rolled out to all clinical departments in SGH in March 2015. With electronic delivery of the blue letter, time is not wasted on waiting for the hard copy; action can be taken almost instantaneously. Overall, this initiative resulted in patients referred being seen earlier in the day, doctors working less overtime, and manpower savings as porters were deployed to other important job functions. The reviewing of referred patients can be prioritised as the system displays all the patients’ statuses at one glance electronically such that prompt decisions and follow-up actions can be initiated when necessary.
Our residents’ Clinical Handover Projects were selected for poster presentation at the distinguished Institute for Healthcare Improvement’s 26th Annual National Forum in Florida. PROJECT TITLE The use of a SituationBackground-AssessmentRecommendation (SBAR) ordering improving the quality of electronic clinical handovers TEAM Goh Qi Mei Orlanda (Team Lead), Ng Kangqi (Assistant Team Lead), Kaavya Narasimhalu, Chuah Bingfeng Matthew, Nur Emilia Roslan
Clinical Handover Another system that has also been adopted campus-wide by medical departments is the electronic handover which was launched in February 2014 to improve clinical handover that directly impacts patient safety. A team of clinicians, information technologists and administrators worked together to revive and improve on a previous pilot project using the electronic system by making it more intuitive and less demanding. Following that, our residents did a QI project with the aim of increasing usage compliance for the clinical handover system. Various solutions were employed, such as daily automated reminders and education posters, which gradually increased usage compliance to a steady state of over 90%. Not content to stop there, another team of residents embarked on another project to improve the quality of handovers. A series of lectures culminating in an educational video with compulsory quizzes were employed to educate junior doctors on how to use the SBAR format to standardise the information required in a handover. By June 2014, the clinical handover process was further optimised. These two accomplished QI projects were submitted and accepted for poster presentation at the Institute for Healthcare Improvement (IHI) National Forum on Quality Improvement in Healthcare, Orlando, USA, in December 2014. Quality improvement is really about daring to ask the question ‘How can I make things better?’ and then taking the brave step forward to try.” DR MUNIRAH ALHAMID
PROJECT TITLE Improving Patient Care Through Compliance to Electronic Handover TEAM Munirah Alhamid (Team Lead), Wong Hei Man Anson (Assistant Team Lead), Nurul Aidah Abdul Halim, Sii Sik Liong, Vignesh Sivasamy, Wong Ningyan, Wong Yu Jun Eugene
OUR JOURNEY TO COMBAT CHRONIC AND COMPLEX CONDITIONS Before we embarked on this academic journey, our departments were already arranged to render patient care holistically via multi-disciplinary team practice through our pre-existing centres like LIFE Centre, Sleep Disorder Unit, Endoscopy Centre and Allergy Clinic. To add to the list, we will be welcoming the Immunology Hub in 2016. Clinicians managing allergic, dermatologic and rheumatologic conditions notice many overlaps in their practice and see synergy in them coming together. As such, the Immunology Hub will be the place where physicians from these three specialties come together, facilitating more efficient and effective collaboration to address patient needs. DR MARIKO KOH Spearheaded by Dr Mariko Koh from the Respiratory and Critical Care Medicine Department, this upcoming establishment will strive to be the place where patients will receive all-embracing treatment for related conditions.
CLINICAL SERVICES AT A GLANCE In FY2015, the Division of Medicine (DOM):
PAT I E N T S
attended to through the Specialist Outpatient Clinics (SOCs) • AN INCREASE OF 5.1% FROM FY2014 • DOM ACCOUNTS FOR 38% OF TOTAL SOC PATIENTS
Admitted a total of
The Department of Internal Medicine saw the most number of patients with
A DM I S SION S • 1.6% HIGHER THAN IN FY2014 • DOM ACCOUNTS FOR 52% OF TOTAL INPATIENT ADMISSIONS
• ACCOUNTING FOR 63.6% OF TOTAL DIVISION OF MEDICINE A&E ADMISSIONS • AN INCREASE OF 7% FROM FY2014
MEDICINE ACP’S INVOLVEMENT IN SINGHEALTH DUKE-NUS DISEASE CENTRES With SingHealth Duke-NUS Disease Centres (SDDCs) coming on board, bringing clinicians together from across different specialties and institutions, Medicine ACP is proud to have our clinicians heading three of the SDDCs to provide comprehensive care for our patients with chronic and complex illnesses.
Diabetes and Metabolism Centre Diabetes is the number one chronic illness plaguing Singaporeans currently. If left unmanaged, the condition can lead to multiple comorbidities.
DR BEE YONG MONG
Led by Dr Bee Yong Mong, the Diabetes and Metabolism Centre (DMC) aims to be the national and regional centre of excellence for diabetes care, pushing the frontiers of clinical service, education and research. The centre will help to streamline clinical services across the continuum of diabetes care within SingHealth. In November 2015, the Diabetes Centre joined hands with Oral Health ACP to celebrate World Diabetes Day, organising free dental screenings for patients at DMC, and hosting a lunch symposium on the co-relation between gum disease and diabetes. DMC has plans to include a Diabetes Assessment Unit to promote early detection and treatment of diabetic complications to reduce the incidence of blindness, kidney failure and amputation. In future, there might also be a SingHealth Diabetes Registry, which will serve as a tool for quality control and improvement.
Blood Cancer Centre
Latest reports suggest that thoracic disease management will need prioritisation as lung cancer remains the number one and two cancer causing deaths in men and women respectively. Pneumonia and chronic obstructive pulmonary disease (COPD) are also cited among the top 10 causes of death. Asthma prevalence will continue to rise, affecting 5% of adults and 20% of children, and tuberculosis rates have also seen a resurgence. Projecting ahead, the demand for lung-related services is expected to continue to grow in tandem with an increasing and ageing population.
Blood cancers are on the rise in Singapore due to reasons such as longer life expectancy coupled with factors such as higher levels of environmental pollutants and radiation. Lymphoid neoplasms are now the fifth and sixth most common cancers in males and females in Singapore respectively. On average, the Haematology Department sees 80-90 newly diagnosed cases of acute leukaemia annually. This has contributed significantly to the clinical workload for blood cancers that has nearly doubled A/PROF WILLIAM HWANG over the last decade.
The Lung Centre, led by A/Prof Loo Chian Min from the Respiratory and Critical Care Medicine Department, aims to build a collaborative relationship between SingHealth institutions by pooling resources and streamlining services to offer integrated multi-disciplinary thoracic A/PROF LOO CHIAN MIN services and provide seamless care for patients. It will bring together parties from different departments such as thoracic surgery, oncology and physiotherapy across the various institutions so that patients can receive medical attention via a convenient, centralised system. Dr Anantham Devanand, Senior Consultant from the Respiratory and Critical Care Medicine Department, played a key role in the conceptualisation of the centre, which has been approved by senior management this year.
DR ANANTHAM DEVANAND
The team envisions itself being a thoracic community of excellence delivering unrivalled clinical care, providing a single referral channel for all thoracic conditions.
With effect from November 2015, the Blood Cancer Centre, headed by A/Prof William Hwang from the Haematology Department, will adopt a multi-disciplinary and multi-institutional service line approach to deliver integrated and seamless treatment for blood cancers. The Disease subgroups of the centre include Acute Myeloid Leukaemia (AML), Acute Lymphoblastic Leukaemia (ALL), Chronic Lymphocytic Leukaemia (CLL), Myeloproliferative Neoplasm (MPN) and Non-Hodgkin Lymphoma (NHL). The centre aims to provide a clear and seamless platform for referrals for patients with haematological malignancies by driving the development of cluster-wide integrated practice, facilitating unified collaboration among stakeholders.
CLINICAL SERVICES ACCOLADES: 2013 – 2016 2013 3rd SingHealth GCEO Excellence Award: Outstanding Clinician Award (Special Mention) A/PROF TAN BAN HOCK
2014 National Outstanding Clinician Award PROF FONG KOK YONG
2016 6th SingHealth GCEO Excellence Award: Distinguished People Leader Award A/PROF WONG KOK SENG
6th SingHealth GCEO Excellence Award: Outstanding Clinician Award A/PROF LEE LAI HENG
A/PROF WONG KOK SENG
DISTINGUISHED PEOPLE LEADER A/Prof Wong Kok Seng is a nephrologist who led the Renal Medicine Department for six years. He grew the strength of the department significantly by recruiting and training some of our best clinicians. With the medical landscape changing drastically, and Internal Medicine having to take a key role in meeting the emerging health needs of our population, A/Prof Wong stepped forward to lead the Department of Internal Medicine. In this endeavour, he demonstrated change management skills and worked with many internal and external stakeholders to bring about the necessary changes to the hospital. A/Prof Wong is also heading the AS Clinical Services and Improvement SINGAPORE’S team as Vice Chair in Medicine HEALTHCARE ACP and played an integral role in LANDSCAPE leading his team to push for the CHANGES, WE HAVE agenda of Quality Improvement (QI). TO CONSTANTLY The team planned a QI roadmap INNOVATE TO with several implementation PROVIDE THE BEST initiatives, which were presented POSSIBLE CARE TO at various Medicine ACP events. OUR PATIENTS.” For steadfastly demonstrating perseverance and resilience through the toughest times, leading by example and bringing about changes on the ground, A/Prof Wong received the SingHealth GCEO Excellence Award for being a Distinguished People Leader in 2016.
DR TEH MING MING
BATTLING DIABETES AS A TEAM About 1 in 4 patients admitted to SGH have diabetes. Many of them are acutely ill, leading to longer hospitalisation and a significant number of escalations to the intensive care unit. After studying this issue, Dr Teh Ming Ming from the Endocrinology Department found a way to manage and curb the problem, rolling out the Inpatient Glucose Management (IGM) project. The project involves a multi-disciplinary team, comprising doctors, pharmacists, nurses and administrators. The team
works together to improve the optimal care of inpatients with diabetes by providing timely interventions, which can potentially decrease the patient’s length of stay in hospital. In addition, the IGM service fulfils diverse roles such as educating staff as well as data collection and analysis in order to spur continuous improvement. What started as a pilot project in Ward 73 on 14 July 2014 has quickly expanded to Wards 54 and 46.
WE HOPE TO WIDEN IGM’S SUCCESS BY IMPLEMENTING A HOSPITAL-WIDE SURVEILLANCE OF HYPOGLYCAEMIA TO FURTHER IMPROVE THE CARE OF INPATIENTS WITH DIABETES.” THE IGM TEAM
CLINICAL S ERVICES
Plans & Priorities Continue the development of a QI Culture Improve training programmes to empower senior doctors as QI mentors Improve training of residents in QI methodology and tools Build resources and capabilities that support QI and QI-HSR projects
Philanthropy From raising awareness of diseases to raising funds for research, philanthropic projects have the potential to bring life-changing benefits to patients. Over the years, we progressively played a more active role in philanthropy through a variety of initiatives.
The Nurturing Clinician Scientist programme has been crucial as it provided funds to run my pilot studies. These studies generated data which was critical in the application for an NMRC grant. The programme also helped me to connect with the research community, including clinical, scientific and quantitative mentors through AMRI and the Duke-NUS Khoo Clinical scholars programme. Without their support, the application would not have been successful.” DR DAMIEN TAN MENG YEW NMRC Transition Award (TA) recipient, Nurturing Clinician Scientist awardee, Senior Consultant, Department of Gastroenterology & Hepatology, SGH
The seed funding I received from the Pitch for Funds programme was very useful for creating a programme for patients who recently suffered from a stroke. My programme helps to train movements for patients’ weakened arms by studying their brain functions, which helps delineate physiological changes brought about by therapy.” DR GEOFFREY SITHAMPARAPILLAI SAMUEL Awardee of the Pitch for Funds programme, Associate Consultant, Department of Rehabilitation Medicine, SGH
In 2014, the Rheumatology and Immunology Department established the Reverie Rheumatology Research Fund (RRRF) to support five key areas of rheumatology research where there are pressing unmet medical needs, namely: Systemic Lupus Erythematosus (SLE); Systemic Sclerosis (SSc); Osteoarthritis (OA); Rheumatoid Arthritis (RA); and Spondyloarthritis (SpA). Ms Helina Chan, the founder and managing director of iPreciation gallery, played an intrinsic role in the establishment of the RRRF. In 2008, Ms Chan discovered that she suffered from Sjogren’s syndrome, and this evolved into Lupus in 2011. Lupus is a chronic autoimmune disease with symptoms such as lesions on the skin, low-grade fever and persistent exhaustion. Determined to help herself and others, she brought together Asia’s master sculptor Ju Ming and Singapore contemporary artists and organised an inaugural benefit dinner to raise funds for rheumatological diseases, of which lupus is one. Ms Chan worked closely with Prof Julian Thumboo, previous Head of Rheumatology and Immunology Department and Ms Amy Gay, Director of SGH Fundraising team, to create the RRRF.
From my personal experience as a lupus patient, I understand the pain and struggles that individuals suffering from rheumatological diseases go through. I also realised that this field has not been sufficiently researched, particularly in Asian patients. There hasn’t been a new drug or medication available in the market for the past 20 years.” MS HELINA CHAN
FROM LEFT: MS AMY GAY, PROF ANG CHONG LYE, MS HELINA CHAN, PROF JULIAN THUMBOO
The Master Physician of Internal Medicine programme was established to support and recognise senior clinicians who are thought leaders with in-depth medical knowledge in their field and commit to nurturing the young and the practice of bedside teaching for Internal Medicine. They are also exemplary leaders who exhibit excellent clinical skills, holistic care and a strong value system that inspire their peers and other faculty. The Master Physicians of Internal Medicine Award FROM LEFT: PROF FONG KOK YONG, PROF NG HAN SEONG, A/PROF CHOW WAN CHENG, was launched in April 2016, PROF ONG YONG YAU, PROF ANG CHONG LYE with the support of the Lee Foundation. The inaugural award was presented to Prof Ng Han Seong and Prof Ong Yong Yau during the 23rd SGH Lecture and Formal Dinner. We hope this award will encourage the next generation of doctors and spur them to perpetuate the culture, tradition and professionalism in the practice of Internal Medicine paved by the likes of Prof Ng and Prof Ong.
Key Contacts Dr Chow Wan Cheng
Dr Jaime Chien
Dr Phua Ghee Chee
Academic Chairman, Medicine ACP Chairman, Division of Medicine
Consultant, Dept of Infectious Diseases
Director, Postgraduate Education, Medicine ACP
Dr Srabani Bharadwaj
Dr Jason Chang
Consultant, Dept of Neonatal & Developmental Medicine
Director, Faculty Affairs, Medicine ACP
MEDICINE ACP COUNCIL — CLINICAL SERVICES & IMPROVEMENT
Dr Pang Yee Hau Associate Consultant, Dept of Neurology
Dr Sin Gwen Li Dr Wong Kok Seng
Consultant, Dept of Psychiatry
Academic Vice-Chair, Clinical Services & Improvement, Medicine ACP
Dr Leow Leong Chai
Dr Tan Thuan Tong
Consultant, Dept of Respiratory & Critical Care Medicine
Director, Clinical Services Enhancement & Integration, Medicine ACP
Dr Chiong Yi
Dr Low Su Ying Director, Quality Improvement and Implementation, Medicine ACP
CLINICAL PERFORMANCE IMPROVEMENT COMMITTEE
Dr Sonali Ganguly (undergraduate education lead) Consultant, Dept of Endocrinology
Dr Kamaraj Kanagasabapathy
(postgraduate education lead) Senior Consultant, Dept of Endocrinology
Consultant, Dept of Renal Medicine
Dr Yeo Siaw Ing Senior Consultant, Dept of Rheumatology & Immunology
Dr Ng Kang Qi Senior Resident, Advanced Internal Medicine Senior Residency Programme
Dr Ryan Tan
Associate Consultant, Dept of Dermatology
Resident, Internal Medicine Junior Residency Programme
Dr Teh Ming Ming
Dr Ho Le Onn
Consultant, Dept of Endocrinology
Senior Manager, Medical Board
Dr Tay Wei Yi
Dr Lim Chee Hooi
Senior Consultant, Dept of Dermatology
Dr Kok Peng Chin
Senior Consultant, Dept of Infectious Diseases Chief Quality Officer, SGH
Associate Consultant, Dept of Family Medicine & Continuing Care
Dr Pang Shiu Ming
Consultant, Dept of Rehabilitation Medicine
Dr Tan Ban Hock (Advisor)
Dr Kirsten Yeo Yi Wei
DEPARTMENT EDUCATION LEAD
MEDICINE ACP COUNCIL — EDUCATION
Dr Tan Shu Yun Consultant, Dept of Family Medicine & Continuing Care
Dr Jason Chang Senior Consultant, Dept of Gastroenterology & Hepatology
Dr Nguyen Minh Ha Consultant, Dept of Geriatric Medicine
Dr Wong Gee Chuan Senior Consultant, Dept of Haematology
Dr Tan Chuen Wen Associate Consultant, Department of Haematology
Dr Krithikaa D/O Nadarajan Associate Consultant, Dept of Internal Medicine
Senior Consultant, Dept of Gastroenterology & Hepatology
Dr Chan Choong Meng
Dr Kang Mei Ling
Dr Kelvin Yip
Senior Consultant, Dept of Infectious Diseases
Associate Consultant, Dept of Geriatric Medicine
Advisor, Education, Medicine ACP Deputy Group Director, Education (Undergraduate), SingHealth
Dr Grace Kam
Dr Loo Chian Min
Associate Consultant, Dept of Respiratory & Critical Care Medicine
Consultant, Dept of Haematology
Academic Vice-Chair, Education, Medicine ACP Director, Undergraduate Education, Medicine ACP
Dr Bok Chek Wai
Dr Tharmmambal Balakrishnan Consultant, Dept of Internal Medicine
Dr Jessica Tan
Head, Dept of Rehabilitation Medicine
Dr Jason Choo
Dr Ong Thun How
(postgraduate education lead) Consultant, Dept of Renal Medicine
Programme Director, Respiratory Medicine
Dr Sobhana d/o Thangaraju
Programme Director, Rheumatology
Dr Ng Swee Cheng
(undergraduate education lead) Consultant, Dept of Renal Medicine
Dr Jon Yoong (undergraduate education lead) Senior Consultant, Dept of Rheumatology & Immunology
Dr Warren Fong (postgraduate education lead) Consultant, Dept of Rheumatology & Immunology
SINGHEALTH RESIDENCY PROGRAMME
MEDICINE ACP COUNCIL — RESEARCH Dr Julian Thumboo
Dr Kang Mei Ling Programme Director, Advanced Internal Medicine
Dr Kek Peng Chin Programme Director, Endocrinology
Dr Jason Chang
Assistant Manager, Education
Assistant Manager, Clinical Services & Improvement
Assistant Manager, Clinical Services & Improvement
Dr Jenny Low Director of Clinical Trials, Medicine ACP
Ms Lynn Tan RESEARCH PROGRAMME LEAD
Senior Administrative Manager
Dr Tan Hong Chang
Ms Shamana Menon
Programme Lead for Pitch for Fund Award Programmes
Dr Jeffrey Ngu Jing Hieng Programme Lead for the Research Interest Group (RIG) Initiative
Programme Director, Geriatric Medicine
SENIOR RESIDENTS’ COMMITTEE
Dr Limin Wijaya Programme Director, Infectious Diseases
Dr Victoria Ekstrom
Dr Bok Chek Wai
Chairman, Senior Residents’ Committee Senior Resident, Gastroenterology
Programme Director, Renal Medicine
Mr Cody Yuen
Ms Ratna Bte Abdul Rahman
Programme Lead for Investigator Initiated Trials (IITs)
Dr Jason Choo
Director of Translational Research and Early Career Development Programme, Medicine ACP
Dr Dennis Seow
Programme Director, Rehabilitation Medicine
Ms Xin Xiaohui
Dr Charles Chuah
Dr Sathish Kumar Gopalakrishnan
Programme Director, Haematology
Senior Administrative Manager
Mr Gary Ong
Programme Director, Gastroenterology
Dr Ng Heng Joo
Ms Lynn Tan
Academic Vice-Chair for Research, Medicine ACP Director of Health Services Research, Medicine ACP
Dr Phua Ghee Chee Programme Director, Internal Medicine
ADMINISTRATIVE TEAM LEADS
Dr Eileen Poon Vice-Chairman, Senior Residents’ Committee Senior Resident, Medical Oncology
OTHER USEFUL INFORMATION
Academic Medicine Education Institute (AM.EI)
Academic Medicine Research Institute (AM.RI)
AM.EI brings together educational expertise from Duke-NUS and SingHealth to provide support in the following areas:
AM.RI provides scientific support to nurture and enhance research careers of budding and established clinician investigators (CI) and clinician scientists (CS) through:
a) Faculty Development Programme – aims to develop clinician educators who are passionate about nurturing the next generation of healthcare professionals; b) Programme Review Consultation – aims to enhance existing educational programmes, or to develop new courses with appropriate learning strategies, assessments and measure of effectiveness; c) Education Research Consultation – aims to mentor educators to design and refine educational research questions, establish suitable research methods, data analysis and statistics support as well as provide advice for publication write-up; d) Education Portfolio Consultation – aims to provide clinicians with resources and opportunities to be recognised in their academic achievements through the tracking of their education contributions, which is important to their academic career advancement.
a) Providing an academic environment and resources that will support the CI and CS in the development of clinical, health services and translational research. Some of the services include medical editing support, medical writing workshops, quantitative sciences services, clinical and behavioural assessment and Lab Sciences coordination; b) Providing education, training, mentorship and career development programmes; c) Providing training and competency development for research support professionals such as research coordinators or research associates involved in planning, managing and implementing clinical, health services and translational research projects. For enquiries, email: firstname.lastname@example.org Web: www.academic-medicine.edu.sg/amri
For enquiries, email: email@example.com Web: www.academic-medicine.edu.sg/amei
SingHealth Academy SingHealth Academy aims to empower healthcare professionals with the training and resources needed to advance clinical knowledge and expertise, with the ultimate purpose of improving patient care. Services include: a) Administration of education facilities in Academia such as clinical skills laboratory and other specialised training facilities; b) Develop courses, workshops and other medical conferences; c) Develop and create online learning courses, multimedia content and course curriculum to sharpen pedagogy and enhance learning processes; d) Provide guidance and sharing expertise on the writing, production and publishing processes. For enquiries, email: firstname.lastname@example.org Web: www.singhealthacademy.edu.sg
SingHealth Office of Research SingHealth’s Office of Research (OoR) supports research strategy development and implementation, research risk management, collaborations and project management throughout the SingHealth Group. It provides: a) Comprehensive resources to harness an extensive suite of platform and services for project success; b) A network of talents to connect with leading scientific minds; c) Strong partnership to collaborate in translational and clinical research; d) Research excellence to be assured of the highest standards and compliance with international best practices. For enquiries, email: email@example.com Web: research.singhealth.com.sg
SGH Division of Medicine Executive Office Bowyer Block B Level 3 Outram Road Singapore 169608 Reg No. 198705907Z