MEDICINE Translating the Academic Medicine Vision
issue 04/2012 Academic Medicine Education Institute pg6 What I didn’t Learn in Medical School pg16
D ATE L C I D DE EDICA S TO M ENT D U ST
The Future of Medical Education
We learn from our teachers and pass our knowledge to others. In the study of Medicine, nothing can hold truer. The future of medical education lies in our own hands. Page 6 The SingHealth - Duke-NUS Academic Medicine Education Institute Page 16 What I didn’t Learn in Medical School VISION
Page 4 Behind the ACPs: Assoc Prof Tay Sook Muay
Page 10 Defining Tomorrow’s Medicine at the Scientific Congress
Page 22 Letters From Overseas: Izza Atiqa Ishak
Page 26 Improving Patient Safety at NHCS
OTHERFeatures Page 14 Page 28
Take 5: Ow Yong Lai Meng
Letters from Emeritus: Prof Tan Ser Kiat Page 30
Our Heritage: Teaching at the Bedside
Translating the Academic Medicine Vision
’ve always likened choosing the path of Medicine as a marriage. If you dissect it, many of us actually end up spending more years accumulatively practicing Medicine than with our spouses. I, for one, have been married to my job for more than 25 years.
Traditionally, we’ve relied on the medical icons and luminaries to inspire students. But the younger generation may not recognise who these famous figures are. To give a more relatable role model, we’re identifying Chief Residents – future doctors who are young, approachable and can inspire their juniors.
For this reason, I always urge students to be truthful to themselves in their passion for Medicine. True love never goes away and it is the key ingredient for a happy marriage and in our case, a happy medical career.
The challenges for new graduates today are ever-changing. Where once having medical knowledge and good patient care were sufficient, now doctors must have additional competencies: interpersonal and communication skills, professionalism, system-based practice and lastly, evidencebased practice.
Now that residents are able to choose their specialities earlier, they must also begin their courtship with Medicine earlier. Find out what speciality you are interested in as soon as possible to help with the decision. My role as the Designated Institutional Official (DIO) is to ensure that all programmes have achieved both international standards as well as the standards set by the Ministry of Health. More importantly, it is about giving our clinical educators sufficient support to carry out their roles as teachers. Medicine has always been a unique profession with its model of teaching and apprenticeship. In my House Officer days, we were taught to learn from everyone – from our seniors to nurses and other specialists. And this hasn’t changed - it is in our culture. It is not merely enough to have a good generation of doctors. For a sustainable future, we need generations of doctors to look after future generations of patients.
Medicine has never been a static discipline and we must constantly update our practice to stay relevant and effective to our patients. We must also have a high adversity quotient – everyone can perform well in peacetime but it is only during a crisis when a real leader will emerge. I hope that the future healthcare professionals among us will be able to discover their true love for Medicine, and wish them all the best in their endeavours.
Assoc Prof Lim Boon Leng Designated Institutional Official, SingHealth Residency
Senior Consultant, Anaesthesiology, SGH 1
Translating the Academic Medicine Vision
SingHealth Editorial Team Katheryn Maung Kenice Tay Arthur Wong Stephanie Jade Arlindita EDITORIAL ADVISOR Tan-Huang Shuo Mei Acknowledgements Assoc Prof Lim Boon Leng Assoc Prof Tay Sook Muay Prof Bob Kamei Assoc Prof Koo Wen Hsin Assoc Prof Sandy Cook Dr Tay Ee Guan Ow Yong Lai Meng Isabel Sun Karen Zhang Rachel Ng Dr Keefe Lai Dr Darryl Lim Izza Atiqa Ishak Dr Krishnamoorthy S S
Chen Xiao Rong Bay Qin Yao Vanessa Quek Ang Hui Gek Anna Tan Vanessa Quek Teo Cheak Han Angeline Yong Prof Tan Ser Kiat Prof Foo Keong Tatt
Tomorrow’s Medicine is a quarterly publication that helps translate our Academic Medicine vision by sharing our journey and relentless efforts in improving patient care and outcomes to define tomorrow’s Medicine.
Design Redstone Communications - Steve Teoh Copywriting Hedgehog Communications - Monica Lim & Debbie Chia
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Standing on the Shoulders of Giants Assoc Prof Tay Sook Muay teaches with her heart. In her roles as Director of Continuing Education in Surgery ACP and also YLL Associate Dean at SGH, she takes care of the development of both current and future doctors.
Assoc Prof Tay Sook Muay
Director, Continuing Education Surgery ACP
Associate Dean, SGH Yong Loo Lin School of Medicine Senior Consultant Department of Anaesthesiology, SGH 4
Clinicians behind the ACPs
midst all the talks about becoming an academic healthcare cluster, Assoc Prof Tay Sook Muay is quick to acknowledge that there has always been a culture of learning in SingHealth institutions. Building on a rich heritage of education “Even as we talk about stepping up our education efforts, we should keep in mind teaching activities in the past,” she asserts. ”The culture of learning has been ongoing through the long history of Medicine in Singapore. All we’re trying to do now is build on the already rich culture of learning in our campuses.” She cites the apt quote “If I have seen further, it is by standing on the shoulders of giants.” In surgery, for instance, surgeons frequently discuss their cases and experiences in informal sessions with all staff on the ground. Assoc Prof Tay feels that the key is to capture the wealth of formal and informal learning and find ways to track and integrate it. “My role in the ACP is to help people galvanise their ideas,” she explains. “We do this by melding platforms for them to learn and gain capabilities, facilitate resources and implement formal structures for learning without impeding it. Change is most effective when it is introduced in a non-disruptive manner.” Overcoming challenges in Surgery ACP Assoc Prof Tay is acutely conscious of the fact that surgery is a very precise branch of Medicine, with extremely specific and immediate outcomes. Good surgeons do not merely have the knowledge and skills, they also think on their feet and make sound judgement calls. This poses a challenge. On one hand, we want to give clinicians protected time for education; on the other hand, clinical workload is needed for surgeons to practise their skills. Nowhere is Gladwell’s 10,000 hours to greatness theory more apt than for surgeons. Assoc Prof Tay believes that we have to leverage on
advances in technology and learning techniques to create the needed learning hours for mastery without humanistic cost to patients. One of the tools that will be leveraged in surgical skill training and education is simulation – both for technical skills and soft skills like handling patients and decision making. Simulation, both mannequin-based and computer simulation programmes, will be used more as it provides the opportunity for the honing of surgical skills while using minimal patient involvement. Furthermore, it also translates to better patient safety. In the pipeline are professional courses to build competency, communications, leadership, governance and policy and medical ethics, among other areas. For each module, three levels are planned intermediate, advanced and mastery. Teaching with a heart
“I would love it if everyone always tries to ask the what-ifs and why-nots.”
Vision of borderless learning Assoc Prof Tay’s ideal scenario for the future is that of a borderless, blended and integrated education with every point of interaction an opportunity for learning. “Knowledge is borderless – it has no territory,” she firmly states. “Whether it’s in Duke-NUS, Yong Loo Lin, SGH, KKH, it doesn’t matter. We can add value wherever we are. I would love it if everyone always tries to ask the what-ifs and why-nots.” It all starts with mindful learning and reflecting on our own learning and teaching process. Assoc Prof Tay strongly believes in inculcating mindfulness knowing how we learn best, how to be proactive and use available resources well. She added that “when we integrate awareness and reflection in the process, it becomes a habit that translates to mindful practice.”
In her role as Associate Dean, SGH, her job is to “humanise healthcare delivery and healthcare education for the students.” Most doctors, she feels, are already intrinsically motivated to teach. She demonstrates this heart of service by staying in public service to pay it forward for future clinicians. Towards her students, she takes on a nurturing role through small gestures like providing blankets and sandwiches for students doing night duty during their internship rotation. “Every learner thrives when they feel cared for,” she adds. Our professional relationship and connection with future generations of doctors and other healthcare professionals start when they are still students. “Life is unpredictable,” she says philosophically, “whatever good we can do, we should. Just a small ripple can effect change.”
SingHealth Senior Management and representatives from various professions at the launch of AM•EI.
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ed. c n e eri p x n e d nd itutio uil a b t e wis n Ins r in es to nd e a h r t catio embe y, hop tors, o f t u t a a jus ne Ed 6 Sep rs’ D educ r i e t ge on edic ed on each ellen the l o n T s n mic M unch with of exc set o n. i n a tio cade EI), l tion nity sight ratio a c A c u e s u Ed The (AM• onjun omm got it g gen c a c it’s youn
he room was packed and there were hardly any space to stand. News had got out that education in SingHealth will get a facelift, and people thronged to catch a glimpse of the new kid on the block. And they got what they came for. A New Generation Of Educators Taking the podium were two outstanding examples of young educators – Dr Keefe Lai, first year Medical Officer (MO), and Dr Jonathan Yap, a resident with the SingHealth Internal Medicine Residency Program. They are teachers while being students, sharing their knowledge with the next generation of medical students who stand to benefit immensely from their selfless act of mentoring. Keefe found something lacking in the curriculum and decided to take matters into his own hand, starting an after-work course for his fellow Medical Officers to help them handle night calls better. Apparent in his classes are a culture of mentoring and the sharing of experiences from one MO to another, helping each other become better doctors. The better educators were then spotted by Keefe and asked to become mentors themselves, expanding the circle of education to future participants. His courses are so popular that it’s being adapted into the regular curriculum. (Read more about Keefe and his night call course on page 19.)
Dr Jonathan Yap, a SingHealth Resident, shared with the audience about education initiatives by the residents. Teaching starts young.
Jonathan’s achievements are no less. He leads the REACH (Residents as Teachers) education initiative that includes mentoring fellow medical trainees including junior residents, incoming residents and medical students. These are great examples for trainees to realise that the educator title is not just reserved for senior doctors. Together with like-minded “student-educators”, Keefe and Jonathan are changing the face of medical education. Jonathan and Keefe are not the only young doctors who have the passion to share their wisdom. If there is any message that is to be taken away from all the festivities of the launch of AM•EI, it is that teaching starts young. The Next Step And that is the way AM•EI wants everyone to view medical education, Prof Koo Wen Hsin explains, “AM•EI empowers clinicians to share their knowledge and enables recognition of their efforts. We will give them an opportunity to initiate their interest and keep the flame alive.”
“We will become the Teachers’ University in Asia, centred here at SGH Campus.” – Prof Bob Kamei This partnership between SingHealth and Duke-NUS Graduate Medical School marries the best of both institutions, serving the role of a “teaching academy”. “The AM•EI is for educators by educators. There is already so much teaching happening now at SingHealth and Duke-NUS across educational groups in the different professions. We are simply bringing together all that talent,” said Prof Kamei. Prof Kamei painted the vision: “We will become the Teachers’ University in Asia, centred here at SGH Campus.”
One half of the AM•EI leads, Prof Koo teams up with Prof Robert Kamei from Duke-NUS to organise the activities of the institute in coordination with the SingHealth Education Council. (Read about the education council in issue 03/2012.)
AM•EI: Developing Educators Generativity Supporting Prof Kamei’s ideals of a bustling community of excellent educators is the Pioneer Fellows Program, an advanced specialised education training with multi-disciplinary participants trained with one main goal – to expand and guide the education community of the AM•EI. And we call that Generativity, which means sharing knowledge to nurture the next generation and stretch our academic impact. The AM•EI will train two types of educators: Clinician Educators with significant commitment in an education role and Clinicans who teach in the wards and clinics. Supported by resources and opportunities to improve their abilities, the education institute also provides academic support to assist these educators in sharpening their teaching skills and encourage the improvement of teaching methodologies.
ge owled and n k g tion arin ty: sh ext genera ct. i v i t a a r Gene rture the n emic imp d u a n c to h our a stretc
Train the Trainer, Pioneer Fellows
EI Teaching Skills Courses
Academic Clinician Educators
Clinician who teach
AM•EI AM•EI develops Clinician Educators to teach learners in the wards and clinics.
• Education Research and Evaluation • Train the Trainers • Administer Education Program • Mentoring and Advising • Teaching Students AM•EI will develop faculty capabilities to increase their academic impact, formalised in medical faculty promotion.
AM•EI aims to help our own people develop a bigger academic impact (see figure). They do it by developing our faculty’s capabilities in teaching and formalising it in academic promotion through the ACPs. The Education Institute has also created three workgroups to help make this a reality. The first one is the Faculty Advocacy workgroup. Its job is to recognise outstanding contributors in teaching and develop the criteria for academic promotion. The Educational Scholarship workgroup guides educators in evaluating their own programs and projects. At the same time, the workgroup creates collaborative opportunities and oversees educational research projects. None of this will work without the people who teach the faculty development programs or without events that promote knowledge sharing among the educators. This is where the Professional Development workgroup comes in. If we take a look at established Academic Healthcare Clusters around the world, development of educators plays a pivotal role in all of them. With strong educators we teach new knowledge in a better way, paving the path for discoveries from clinical care and research to reach practitioners who can make Academic Medicine meaningful for our patients. And that’s exactly what we want.
Gift from the Heart – AM•EI had recently received a donation of S$1M endowed gift from the late Mr Tan Yew Hock, who was a grateful patient of SGH. This led to the establishment of the “Tan Yew Hock Faculty Development Fund”, which will spearhead selected education and training programs for clinician educators who are passionate in developing and nurturing the next generation of healthcare professionals. 8
the C o of Ex mmunit y celle nt Ed u
Is education in your blood? Register online and get one free program of your choice! www.duke-nus.edu.sg/academic-medicine/academicmedicine-education-institute
Programs offered by AM•EI are structured within five key domains: 1. Design and Planning of Learning Activities Programs under this domain: Team-Based Learning, designing multiple choice questions, pedagogy for primary care providers, using Standardized Patient for learning, Voice Annotated Presentations, presentation skills and e-learning with Articulate
The AM•EI was launched at Teachers’ Day for all our Educators. Along with the occasion, we showed our appreciation to all educators in SingHealth and Duke-NUS with a vibrant celebration that ended on a sweet note with toffee apples for all.
2. Teaching and Supporting Learners Programs under this domain: micro skills for bedside teaching, creating an engaging learning session and optimising performance through coaching 3. Assessment and Feedback to Learners Programs under this domain: issues and challenges with assessment and evaluation, strategies to improve feedback and logic model as roadmap to assessment strategies 4. Educational Research and Evidence-based Practice Programs under this domain: Academic Medicine dissemination, creating QI education and operational programs, abstract and manuscript writing and Qualitative Research 5. Educational Management and Leadership Programs under this domain: building your education portfolio, defining and understanding yourself as a leader and the Chief Resident development program Membership Categories The AM•EI welcomes all levels of doctors, nurses, allied health professionals who are keen on contributing to education in healthcare. Trainee Membership - for healthcare professionals who are still in training, including medical students, residents, PhD candidates, post-doctoral fellows, nursing students, allied health trainees and dental students
The celebration included a showcase of education groups entities in SingHealth that caters to different professional groups. Shown here is mannequin-based simulation from SGH’s Institute for Medical Simulation and Education.
Full Membership - for all non-trainee staff and faculty at SingHealth or Duke-NUS interested or involved in healthcare education. Fellow Membership - for teaching faculty who have taken on significant responsibilities in education, for example, faculty in the Clinician-Educator track, nurse educators, course directors of medical school programmes and faculty with significant commitment to education. Teachers’ Day photo booth at the Duke-NUS atrium added the fun element to the celebration. 9
Defining Tomorrow’s Medicine At the SingHealth –
Duke-NUS Scientific Congress In the recent SingHealth – Duke-NUS Scientific Congress, Dr Tay Ee Guan and Assoc Prof Sandy Cook were actively involved. They defined areas where challenges can be addressed and where further progress can be made.
Dr Tay Ee Guan
Director, Education and Research SingHealth Polyclinics
What were some areas of focus in this year’s congress for you? The keynote lecture by Prof Michael Faston described the journey of how a research question was first birthed in clinical practice, answered through research, and how the findings of the project has impacted clinical care, illustrating the important role of research in the practice of medicine. We hope the audience would be inspired by this story and be excited in our pursuit of Academic Medicine. Beside the clinical topics that were of interests to the various SingHealth institutions, there was also a focus on the education agenda in this meeting. The role of education in our Academic System and Education innovation was discussed in this meeting and will certainly bring our education efforts to another level. What made the congress a fruitful event for all? Bringing different clinical disciplines and healthcare professional groups into a single scientific meeting promotes better understanding of the work done by various groups within SingHealth. It also facilitates the sharing of ideas. This was one of the objectives of the organising committee. One of the reasons for the event’s success is the fact that SingHealth is the largest healthcare cluster, encompassing all clinical disciplines in Singapore. The strong allied health community and the richness of the academic environment provided a very good multidisciplinary symposium with carefully prepared presentations approached from different angles and perspectives. What impact does the congress have on the research landscape? The congress has opened up numerous opportunities between SingHealth and Duke-NUS in terms of more joint projects, collaborations and research presentations. It has become a synergistic platform between the two organisations, where we provide programmes and showcase research projects that are more collaborative, multi-disciplinary and integrated for the audience.
OPEN OPPORTUNITIES As a member of the congress’ organising and scientific committee, Dr Tay Ee Guan, Director of Education and Research for SingHealth Polyclinics, was deeply involved in its logistics planning, administration and content development. Dr Tay shares his thoughts on how the congress can help realise goals in collaboration. The congress is also a showcase of the fruits of SingHealth’s collaboration with Duke-NUS. We have kicked off the SingHealth Residency Programme and seen the formation of the Academic Medicine Education Institute (AM•EI) and the Academic Medicine Research Institute (AMRI). These joint institutes are the beginnings of a system and framework for deeper partnership on further projects and deeper collaborations that can bring us further in medical research and education. What benefits do you see the congress having for research? I see the congress as a unifying event for the whole healthcare cluster, from doctors to dentists, pharmacists and students. What we lack in depth we make up for with having multidisciplinary topics and broad interest activities that everyone in the ecosystem can be involved in. We were clear of our role and chose to be this broad-based platform versus smaller, multiple groups of special interest and focus. A research-based participant will come away knowing that the academic world
is much bigger than you thought, with plenty of potential opportunities and partners around to work with. The congress is a collaborative network that makes it easier for researchers to seek out someone of like-mindedness and similar interest to do a project together. Any thoughts for the next congress two years from now? We are constantly soliciting feedback from the ground to see how we can better meet the audience’s appetite. The concept and spirit of the congress should continue and we would like to develop it into an inter-professional platform. We are also looking at increasing partnerships and engagement with General Practitioners (GPs) and the Family Physician community. GPs provide 80 per cent of family care in Singapore and we need to support them in terms of their education and research needs. This year, we focused on Coronary Artery Disease as an opportunity to update them on how to better manage patients with this disease.
activities of creating the Academic Clinical Programs and both the newly established AM•EI and AMRI will continue to foster these collaborations and strengthen our relationships. What is the significance of the congress on the education landscape? The congress has been a place where we can showcase what is happening in education, and hopefully as the AM•EI progresses, there will be more opportunities to highlight our accomplishments, but also recognise those individuals responsible for helping Duke-NUS and SingHealth achieve these accomplishments. This will be the overall goal: creating a positive culture of education and appreciation for educators. Any thoughts for the future?
Four Key Areas At the congress, Assoc Prof Sandy Cook presented the audience with a progress card on the Duke-NUS Graduate Medical School for the past six years. Here she talks about key areas that medical education needs to address. What did you learn from the congress? I spent most of my time in the educational related sessions. What struck me the most was the amazing commitment and passion to promote education here in Singapore. Based on the great response and level of audience engagement, it shows great promise for the future of additional education topics within the congress. What are some of the key areas that medical education needs to address? Based on the 2010 Flexner report, there are four recommended goals that Academic Medicine needs to address. First, we need to standardise learning outcomes and at the same time balance the need to provide some personalisation of learning processes for each individual. 12
Second, we need to integrate basic science knowledge with clinical experience, roles and responsibilities. Learners need to understand these interrelated roles. Third, we need to develop and encourage habits of inquiry and continual improvement. Last, we need to explicitly address the formation of these clinical professional identities that merge research and education. I am glad to say that these key areas are closely aligned with the goals of DukeNUS and SingHealth in establishing excellent medical education in Singapore. Has the Scientific Congress improved education collaboration between SingHealth and its partners? The congress is a reflection of the growing interconnection between SingHealth and Duke-NUS. The future
The AM•EI is hoping to organise special education-focused event every other year when the congress is not in place, so that the education message does not fall off the radar in between. We envision an event that highlights the educational successes and achievements of our faculty. This will further develop the culture and value of education, leading to improved quality healthcare. What do you hope to stem out of this new AM•EI event? I hope that the event, alongside with other educational conferences, will be able to recognise those individuals who have contributed to the education of all learners; as well as begin to translate that culture of education, inquiry and improvement to better patient care. This means bringing a scholarly approach to education and creating a larger sphere of influence by teaching other teachers, all in the plans of AM•EI. A milestone for us would be to see increasing numbers of people promoted along a Clinical Educator academic track. The bigger goal is for SingHealth to be recognised as the “Teacher of Teachers” and the learning culture to be so well known that students want to come here to learn and faculty want to come here to teach; people see this as the most exciting and energised place to work in and ultimately that patients will know they will be provided with the best care.
Held from 3-4 August 2012, the bi-annual SingHealth – Duke-NUS Scientific Congress brought together various institutions across SingHealth and around the region to share the latest developments and scientific advances in medical practice, research and education. Themed ‘Defining Tomorrow’s Medicine’, this year’s congress was a vibrant occasion with more than 70 local and international speakers and more than 3,000 doctors, nurses and allied health professionals in attendance.
For more information, visit www.singhealthacademy.edu.sg/sites/sdc
with Ow Yong Lai Meng We take 5 with the recent Golden Apple Award Winner for Outstanding Young Educator on the topics of teaching, resilience and social media.
“[Teaching] is about believing in a person’s potential and knowing how best to help a person achieve that.” Ow yong lai meng
Principal Medical Social Worker, SGH 14
medical social worker by profession and an educator by passion, Ow Yong Lai Meng is a Principal Medical Social Worker at SGH and adjunct lecturer at NUS who also recently received the SingHealth Golden Apple Award as Outstanding Young Educator.
We get to know Lai Meng better and see his Take on 5 questions.
On teaching, the educator sums it up succinctly: “I believe in believing”. Granted support by the Public Service Commission as a student, Lai Meng first felt a desire to pay it forward by doing social work. He explains, “I wanted to do something that could benefit society. It is about how we can best bring better care to patients and the society around us.” He adds, “I had found an appreciation for social economic policies and healthcare by my second year in university. It was something that I could relate to and this drew me in to doing medical social work.” He graduated in 2000 with an upper honours Bachelor’s degree in Social Work from the National University of Singapore. Lai Meng is also an art enthusiast. As he likes to paint, he attends the Western Art certification class at Nanyang Academy of Fine Arts (NAFA) every week. When asked about painting a picture-perfect day, he replies happily, “every day is a perfect day. It is true that certain things could speed up or work the way you want them to, but in reality, things take time to work out.” In Lai Meng’s world of clinical work and in influencing policies, changes take time and effort in working with relevant authorities before they are implemented. In a similar vein, patients need time to get better. The answer to these setbacks is building a stomach for resilience. Though resilience is what Lai Meng singles out as a lesson that needs to be taught, he admits that it takes experience to learn how to build one’s adversity quotient. “It is something we need to learn over time, but certainly good support, supervision and having people to consult on will help you reach there faster.” Lai Meng draws his own teaching inspirations from his former supervisor, a psychiatrist at the Institute of Mental Health. He shares that, “he was very patient and inspiring by being involved
not just in clinical work but also teaching and research. He sets the standards for us all.” For this award-winning educator, teaching is a constant source of fun and engagement. It also takes up some 40 percent of his time. Speaking of his students, he says, “they may be young but they offer interesting and challenging perspectives and analyses of social situations.”
“It is about how we can best bring better care to patients and the society around us.” “The challenge for me,” he reveals, “is to not just broaden the breadth of the knowledge that they have, but also anchor them in depth.” But the learning does not just occur one way. Lai Meng shares how his students have taught him how to stay updated and relevant with social media applications such as Twitter, and remind him of the importance of staying curious by always questioning and wondering how things may be done differently or better. It also certainly keeps him on his toes, having to be updated with the latest policy changes, practices and opinions in the industry. The educator relates on his teaching role: “It is about believing in a person’s potential and knowing how best to help them achieve that.”
What is the first thing you think of doing when you wake up in the morning? The plan for the day. I run through my schedule which usually begins with meetings and ending with dinner.
If you could have dinner with someone famous who would it be? Having dinner with my friends is great. The older you get, the less likely you are to meet them so their company is always welcome.
What is your favourite way to relax after work? I enjoy reading non-fiction books and on things relating to work such as books by the economist, Dan Ariely. I find it relaxing. For example, I enjoy the new perspectives that they provide on the interactions between the social and capital markets, and how that affects human behavior and in health policies.
What’s your favourite food place around work? Great World City as a place out of the office.
If you could be in any other occupation, what would you be? An economist!
n i n r a l e l o t o ’ h n c d i ls d I ica t a ed h W m
Isabel Sun Clinical Instructor KKH
A reflection of how education as an ongoing journey is not just for veterans but those fresh out of school. This candid bunch of the SingHealth family reveals the important lessons they picked up outside medical school, and the lessons that they themselves would like to pass on.
s a clinical instructor, I work closely with new staff nurses and graduates, including those who come from foreign countries, to guide and orientate them at the hospital. If there is no such role in the ward setting, they might feel very lost. It is a rather big responsibility as everyone depends on us to set the standards for the ward. Certainly there are high expectations, but the satisfaction comes from seeing fresh graduates progress to become more independent. When I first graduated, I was closely mentored by Senior Nurse Clinician Sim Boon Eng. She was exceptionally strict and always drilled us in the correct method of doing things thoroughly from head to toe, no matter how troublesome they were. There was no easy way out with her. I myself try to adopt a friendlier approach with my students. I do not scold them harshly for making mistakes and I try to be more approachable so that they feel comfortable to come to me with any question at any time. This encourages their spirit of inquiry and ensures that
eal r e l nd a h o t “How babies ons” i t o l em a e r with
they always have someone to turn to for answers. It is impossible for anyone to know everything, so it is often that I find myself learning while teaching as well. It is important to relearn and refresh certain procedures to stay on top of things, and for this, my students keep me on my toes. I usually tell my students not to be afraid of trying new things, as only through hands-on practice will one find out how things are really done. A good example is bathing babies! Unlike the mannequins used in school, real babies have emotions and can really make a mess. My students often get flustered bathing a baby for the first time and there is also the baby’s safety to consider. That is surely one thing you cannot learn in school. Giving medication to young infants and children is another tricky business, but over the years I have developed a few tricks to convince our young patients into taking their medication. It is small lessons like these that I pass on to our staff nurses, which can help make their jobs much easier and more efficient.
had a 2-day attachment with SNEC before my scholarship and decided then that I would pursue Orthoptics. This was largely due to the Chief Orthoptist that I was attached to, Mr Linley Seenyen. I saw the way he interacted with kids and the dedication he showed and I decided I wanted to pursue the same vocation. I have learnt from healthcare professionals like him to always be sincere to a patient. Especially in the case of kids, whom I work around a lot with, you have to be their friend first before you can get them to do what you want. My young patients and their boundless curiosity have also driven me to constantly desire to learn more. It is important to keep a constant thirst for knowledge and never stop asking questions. Once you realise how little you actually know, you push yourself to find out more, and you can make learning a very fun process. Kids also have a certain resilience that we can learn from; it is so easy for them to cry once, forgive and forget and restart again. In this department, Prof James Cullen is also a personal inspiration to me. Despite being in his 80s, he still works here as a Neuro-Opthalmologist and is like a grandfather to us. He is such a good mentor, always approachable and very patient in answering our questions. He still walks over to our rooms to discuss our cases and it is a great honour that he values our opinions. It is a great reminder that no matter how old, you can still be learning and doing something that you love. My hunger to learn extends beyond work and I am also taking up piano, French, photography and am reading about Roman and Greek history when I have the time. As long as you have the interest, you should not stop learning. Learning is a lifelong process as mentors such as Prof James Cullen have shown us. ď Ž
Karen Zhang Orthoptist SNEC
re, s a ou hing y old do t ow and h er arn t â€? t a e e l v m till lo o s u o â€œN an y uc o y 17
i n r a l e l o t ’ ho n id l sc d t I dica a Wh me
“Every case is unique, and each patient has their own needs” Rachel Ng Fourth year medical student Duke-NUS
omething that you do not quite learn in medical school is the art of patient contact. You will never completely understand, predict or learn this as patients are dynamic and often cannot fully describe their condition to you. Each patient comes with different presentations of symptoms and different social backgrounds, lifestyles and stories. Each case is unique and must be learnt on the spot. This also means that your patient care should be equally dynamic and personalised. When you take the effort to care and communicate, you build a good patient-doctor relationship and most importantly, trust. A mentor taught me to never take short cuts and be as thorough and efficient as I can. If you simply go through the motions
and steps that you have been taught in school, you might miss certain things or not completely understand what a patient needs. This will also lead to poor patient compliance and hence, poor outcomes. I also believe good relationships must be cultivated with your colleagues. Medicine is too wide and too multi-faceted for us to work in silos. It is definitely teamwork. In light of this, I feel that we should reserve our negative comments of each other’s work. We all have different clinical views, values, experiences and knowledge that we should respect and value. My goal for the future is to be a Clinical Educator. I have an equal passion for teaching and geriatrics, and through education I hope to inspire younger doctors in the future to join the fraternity and help the elderly.
I founded a start-up company in 2003 to help children from primary school till junior college to enjoy learning as I did. I myself struggled through my secondary school days but taught myself techniques to study better and cultivate personal motivation. I now use that experience to help younger generations boost their confidence and performance in their studies. Sometimes, it is not a matter of how much you know but how much you care. When your juniors see that you care, they respect you as someone they can look up to and seek advice from – that is in essence the role of an educator.
wh t u ” o ve tient ai a L le pa efe cer r Ke l Offi H e v the SG ica e ed logy, n M r io s, rs – yea Rad i st s r i F no atte g ia m d “In
difficult lesson that I had to learn out of medical school was one of holistic treatment. I had to treat a patient who suffered from dementia and was tasked by the consultant on call to conduct a complete history and physical examination. I was so goal-oriented in my task that I became visibly frustrated to my patient when she was unable to answer my questions. Unable to accomplish my goal, I became further frustrated, which led her to become depressed and angry at me. Although I have since made it up to the patient, the experience has impacted me deeply. It made me realise that in our quest to become excellent doctors and “ticking off the good medicine checklist”, we have left out what really matters – our patients. It has taught me that our goals may not be aligned with the patient’s best
interest and in trying to achieve the best diagnosis, we might cause more harm than good. The night call medicine course I started was conceived to help students be more comfortable, thorough and safe in emergency situations that they will face as a house officer when they are alone on call. I felt that by doing so, I would be able to improve patient care. The course teaches them ubiquitous skill sets such as how to write patient notes, how to evaluate patients for passive and active calls as well as how to handle passive complaints such as chest pain. These are skill sets that are ubiquitous to every posting, across orthopaedics, general surgery or OB-GYN, so teaching them is of high yield.
a t re
It is hard work to sustain and every project’s enemy of success is its own success because the demands become greater. A lot of the courses conducted are the result from our labour of love. This is simply because we believe in it. For that, I am grateful for mentors like Assoc Prof Lim Boon Leng who has helped this course become an accredited one. I never really regard myself as an educator, but I do believe in trying to help people become better doctors and build them up in areas of need. I am thankful that many people could identify with the goodness of this idea and are now a pool of greatly capable junior doctors I can count on and whom I can trust.
My hope is that this course can be sustainable for my juniors to take over.
i n r a l e l o t ’ ho n id l sc d t I dica a Wh me
“Often, the extra push from your friends is what gets you through”
Dr Darryl Lim Third year SingHealth Resident General Surgery, CGH
eaching occurs on a dayto-day basis in the wards, clinics and operating theatres. They may not be formalised but I believe that there are valuable learning points to be picked up from just about anything that we do. Medical learning should not be just by rote and can come in many different forms. Problem-based learning and onthe-job training provides a bigger picture to supplement the usual lectures and tutorials. This is especially pertinent in the field of Medicine where the permanence of change brings about a unique challenge in that we have to keep abreast of ongoing technological and medical advances. Continuous learning will ensure that we are up to date with such changes.
My patients have taught me to value diversity. Each patient is different and provides a unique challenge. Through them, I have also realised the importance of good communication, and how seemingly small breakdowns in communication, such as language barriers, can have a profound effect on the doctor-patient relationship. Simple mindful steps such as being more aware of what we say to the patient and being clear in our communication can go a long way. The importance of good communication extends to our fellow professionals. As a student, you are focused on studying and grades but on the job, you learn from fellow professionals. No man is an island and often the extra push or support from your friends can help you get through an exhausting night call.
Another lesson I find valuable is in providing patient-centred care – seeing patients as a whole rather than as a disease process. Other factors such as medical social issues often come into play and must be considered in our overall treatment and processes. Much of these lessons I have learnt were through observing mentors and colleagues on the job – how they speak to patients and handle difficult situations. Although there are now specific courses on such subjects, nothing can compare to receiving these lessons in real life.
Heart Come, live your Love of Medicine with SingHealth Residency! Learn from our 800-strong faculty who are passionate about sharing their love of Medicine to help you discover yours. You will enjoy comprehensive training from our extensive case-mix and 42 specialties across SingHealth.
dr jonathan yap Best Junior Doctor Award Winner, 2012 Resident Educator Internal Medicine Resident, SingHealth Residency YLLSOM Alumni
dr pek wan sze Best Junior Doctor Award Winner, 2011 General Surgery Resident SingHealth Residency YLLSOM Alumni
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As Singapore’s largest public healthcare group, SingHealth provides a spectrum of care, ranging from primary to tertiary care, across two major hospitals, five national specialty centers, and a network of nine polyclinics.
• • • • • • • • • • • • • •
Singapore General Hospital (SGH) is Singapore’s flagship hospital, and our main teaching site with the most number of specialties locally. Our other major teaching site, KK Women’s and Children’s Hospital (KKH) runs the largest specialist training program for Pediatrics and Obstetrics & Gynecology in Singapore.
Anaesthesiology Diagnostic Radiology Emergency Medicine Family Medicine General Surgery Internal Medicine Obstetrics & Gynecology Ophthalmology Orthopaedics Otorhinolaryngology Pathology Pediatrics Surgery-In-General (Surgical Specialties) Transitional Year
Major Participating Site
Australia Step-by-Step My name is Izza Atiqa Ishak, and I am currently studying Podiatry in the University of Western Australia (UWA) in Perth, Australia, under a Public Service Commission Scholarship. It is a four-year course and I am now in my third year. When I graduate next year, I will be working at SGH.
aving been introduced to most of the aspects of Podiatry, I must say I am enjoying the course immensely! Pursuing the course in UWA has helped me gain deep insight on podiatry and on all the aspects that it encompasses. We started out with foundations in anatomy, physiology and biomechanics, and it was the first time I had to dissect animals and examine cadaveric specimens! Although I felt nervous initially, it soon became an exciting part of school life. As we moved on to our second and third years, the course progressed in depth. We were introduced to most of the foot pathologies, especially in relation to biomechanical, neurological and vascular causes. We gained the practical aspects of Podiatry through tutorials and laboratory sessions, where we also learnt how to make orthotics, carry out biomechanical and neurovascular assessments as well as provide simple treatments for common foot problems. Hands-on experience We were exposed to the clinical setting for the first time in our second year. Allocated a session in the UWA Podiatry clinic once a week, we learned how to communicate with patients effectively and manage simple cases with the help of our supervisors. It was during our third year of study that we had the opportunity of doing external clinical placements. My rotations at the various private practices and hospitals, such as the Fremantle Hospital and Health Service, taught me the various assessments and treatments carried out by the practitioners, as well as adjunctive treatments such as dry needling and ultrasound therapy. Being involved in the decision-making and learning from the podiatrists made my learning experience even more valuable.
It was also the first time I was exposed to high-risk foot problems, predominantly among diabetic patients. From my hospital placements, I understood the multidisciplinary approach needed in managing patientsâ€™ problems, and appreciated the many programmes and services that hospitals offer to help patients recover and educate them. Learning from patients Apart from the knowledge gained from classes and placements, I have learnt a lot from meeting patients â€“ an aspect of this profession that I truly enjoy. It is indeed a humbling experience meeting patients from all walks of life and being able to make a difference in the smallest of ways. I have also learnt the importance of cultural awareness and respect in patient care, especially in Australia where there is a large diversity of people. Having met many indigenous Australian patients, I understood how simple things like respecting their cultural needs can make a difference in their responses to our treatments. This is definitely something I can apply when I start work in Singapore, where a similar cultural diversity is present. Holistically, my study experience has been fulfilling and enriching in many ways. I hope to further develop my skills as a podiatrist and contribute to the development of Podiatry in Singapore. Most of all, I hope to return to Singapore with an understanding of the wholesome nature of podiatric care, and endeavour to be an all-rounded health professional with the skills, knowledge and compassion to deliver the best care to my patients. ď Ž
Izza’s Perth Travel Tips Although only a five-hour flight from Singapore, Perth is a different world altogether and is the perfect escape from the hectic urban life! The UWA campus is situated beside the Swan River, which flows through the city of Perth. There is also the renowned King’s Park overlooking the city, which is a must-visit. Things to do Take a cruise along the Swan River and soak in the beautiful scenery of the riverfront. If you are lucky, you may just catch a glimpse of the occasional dolphins frolicking in the water! For the animal lovers, Caversham Wildlife Park is the perfect place to get up close and personal with kangaroos, koalas, and other Australian native animals. Perth is also famous for its weekend markets, such as the Subiaco and Fremantle markets, where you can find fresh produce and many quirky items and souvenirs. There is also a lot to explore in the town of Fremantle, such as bookstores, vintage clothing shops, and the historical Fremantle Prison. Travelling If you have more time in Perth, travel beyond the city to discover some of Western Australia’s best-hidden secrets. Head south to the towns of Busselton, Margaret River, and Albany, where you’ll get to visit famous lighthouses, explore cave formations, and take a hike amidst the abundant flora and fauna. For those who want to experience the true outback of Australia, drive up north and be captivated by the cliffs, waterfalls, and magnificent rocky landscapes outlining the area.
Treating patients and getting hands-on experience in the UWA Podiatry Clinic.
Travelling and experiencing the vast beauty of Australia! SingHealth offers medical, nursing and allied health professional scholarships and sponsorships both locally and overseas. If you have any relatives or friends interested in pursuing a career in healthcare, please visit http://www.singhealth.com.sg/careers/scholarships-sponsorships 23
Gains Momentum Dr Krishnamoorthy S S Consultant, General Paediatrics KKH
The five Quality Priorities – Safety, Professionalism, Respect, Experience and Efficiency, or in short SPREE – acts as a compass for SingHealth staff in our journey towards strengthening our quality culture and consistently delivering quality in all we do. In the last issue, we featured our staff who practise Safety and Professionalism. This time, we take a look at the remaining three Quality Priorities.
Having been in paediatrics for over 25 years, I have been exposed to problems of children in different parts of the world. Working in an interprofessional environment for training, I have always put the needs and safety of my patients on the top of my list of priorities. In the practice of clinical Medicine, I strive to uphold the high ethos of medical profession, demonstrating my respect to my patients and the team. Maintaining patient confidentiality is one of the ways in which I demonstrate respect for my patients. Chen Xiao Rong Nurse Educator SingHealth Polyclinics We show our respect to the people we come into contact with. Little gestures like greeting my colleagues with a smile at the start of a day’s work and getting warm responses from them help us to afresh our mutual respect. Sometimes, it is the little things that make a difference, such as holding the lift door open for an elderly patient or offering a cup of warm water for patients to take their medication. As for the people I teach, I respect their views by learning to listen to them and understand their learning needs. Even as I teach them, I learn a great deal too.
Bay Qin Yao Transplant Coordinator SingHealth Transplant In my job, it is important to clearly explain the diagnosis and procedures of organ donation to the next-of-kin. I make it a point to listen carefully and address their concerns clearly. For the elderly especially, I need to be very patient as they sometimes take more time and effort to understand the diagnosis and prognosis. My colleagues at the SingHealth Transplant office are my role models as they are always cheerful and helpful. I believe both clinical and non-clinical staff play a part in projecting a good impression of SingHealth and giving the best experience to patients.
Mr Bay Qin Yao
Dr Krishnamoorthy S S
AHP - The SGH Allied Health Division. Anna Tan is seated fourth from left.
Ms Chen XiaoRong
Ms Ang Hui Gek
Ms Vanessa Quek
Vanessa Quek Executive, Medical Department SNEC Efficiency means the optimum use of time and effort required for every task. When my responsibilities pile up, the ability to prioritise and multi-task is vital, so I can bring order to the chaos. Several initiatives, such as forwarding issues to the correct channels and leveraging on effective information sharing, enable tasks to be carried out with minimum delay. In an effort to simplify matters, I have been actively trying to better understand the workflow and eliminate redundant processes. This will help reduce frustration and time wastage for all parties.
The SGH Allied Health Division Experience One of the pioneering divisions in SGH to embrace SPREE was the Allied Health Division. SPREE standards were shared with all staff and displayed at strategic locations within the departments and also made available online. Leading her staff by infusing SPREE into their work is Anna Tan, Head of the Occupational Therapy Department at SGH. “From the simple tasks of being able to hold a toothbrush in their hand to being able to take a shower independently, these are important milestones for patients who just recovered from surgery,” she explains. “Occupational therapists need to respect patients for what they value as the most important goal to achieve after their illness or injury. From there, we set achievable goals at each therapy sessions to create positive and successful experiences.” Ang Hui Gek, Director of Allied Health Division at SGH says, “What patients go through during an illness, we can never totally understand. But by showing genuine care with our competence, respect, empathy and assistance, we can make their experiences bearable, dignified, reassuring and even pleasant.”
Safety in Numbers The NHCS Quality Assurance department improved patient safety by increasing the rate of Hospital Inpatient Discharge Summaries (HIDS) vetting from 3.2% to 80%
hen it comes to patient safety, there should be no room for error. So when the Quality Assurance Department in NHCS discovered that a mere 3.2% of their Hospital Inpatient Discharge Summaries (HIDS) were being vetted by senior doctors, alarm bells went off. HIDS contain pertinent patient information, including prognosis, investigation results and treatment plans. Because any error or omission in the HIDS could compromise patient safety, senior doctors are required to vet the HIDS after they have been completed by Medical Officers. However, reality was far from the ideal. Upon investigation to understand the reasons behind, many senior doctors replied that they do not know that they needed to vet the HIDS or felt that they are too complicated to read through. An NHCS team, led by Dr Kenneth Guo, Associate Consultant at the Department of Cardiology and Angeline Yong, Executive at Clinical Review Programme, decided to rectify matters by embarking on a SingHealth Enhancing Performance Improving Care (EPIC) project to improve the percentage of vetted HIDS. They set two targets - to improve the percentage of vetted HIDS to 80% and to reduce vetting time from an average of 15 days to five days. The first initiative undertaken in end August 2011 was text messages sent
twice weekly to the senior doctors’ mobile phones, reminding them to vet their HIDS. Within two weeks of this initiative, the percentage of HIDS vetted leaped from 2% to 31%.
“Ultimately, we want to ensure patient safety” In early September 2011, they introduced two additional steps. The first was a series of sharing sessions conducted to show doctors the compliance rates and guide them on the process of vetting. Concurrently, a redesigned template for HIDS was introduced into the online system to make the vetting process simpler.
Every month, the number of vetted HIDS is emailed to doctors in both the Cardiology and Cardiothoracic Surgery departments. By spurring competition, the two departments are motivated to maintain the high level of compliance. Currently, the average number of vetted HIDS is stable at about 80%. “The heads of both departments are very supportive and that helps tremendously,” explained Angeline. “Ultimately, we want to ensure patient safety and I feel we have achieved that with this project.”
Created in response to feedback by senior doctors, the template contained the prepared sentences to ensure all pertinent information is entered in an organised format. This made the vetting process a lot easier. By October 2011, the average number of vetted HIDS had risen impressively to 88%. The number of days taken between submission and vetting had also plunged to three days from the original 15. “It is usually very hard to break habits, so we were deeply encouraged by the results,” commented Angeline. Despite having met both targets, the team went the extra mile in an effort to maintain the results.
Angeline Yong Executive, Clinical Review Programme NHCS
The average percentage of vetted HIDS had risen impressively to 88%.
SingHealth Enhancing Performance, Improving Care (EPIC) is a multi-pronged programme aimed to rapidly accelerate understanding and adoption of improvement and creative thinking principles. Read more EPIC articles at: http://mysinghealth/ singhealth/ corporateoffice/qm/ epic/epicnews
This article is part of a series of EPIC Heroes stories by SingHealth Clinical Governance and Quality Management (CGQM) showcasing care innovation by staff.
The medical profession is unique amongst the learned and hallowed professions because it embodies teaching and training future generations of doctors as part of its ethical obligations. This is illustrated in the earliest writings dating back to the 4th century BC, embodied in the widely known Hippocratic Oath. The relevant part of which is:
“to teach them this art – if they desire to learn it – without fee and covenant; to give a share of precepts and oral instructions and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and taken an oath”
Life’s lessons in Medicine “NOT PRIDE OF KNOWLEDGE BUT HUMILITY OF WISDOM.”
Prof Tan Ser Kiat Board Member, SingHealth Emeritus Consultant, SGH Chairman, Sengkang Project Committee Chairman, SingHealth Foundation 28
(quoted from the translation of the original Hippocratic Oath 460 BC – 370 BC) As we pursue our vision of Academic Medicine, the education pillar of the mission is an important and critical part of our journey to continuously improve our care for patients. This is essential to ensure that succeeding generations of doctors must be better than their predecessors, as otherwise we would have failed in our responsibility to the profession. I remember very vividly my own experience, both as a medical student and as a young doctor, of how extremely committed and dedicated my teachers and mentors were in teaching and passing of knowledge, experience, wisdom, the right ethical and moral values and obligations of doctors towards their patients and colleagues.
The clinical acumen, diagnostic skills, depth of knowledge and experience of my teachers and mentors have left an indelible mark in my mind and have influenced my own career in healthcare. My mentors did not have the benefit or luxury of “protected time” or additional compensation for teaching. They did so because they believed that it was part of their professional obligation and responsibility beyond their clinical duties. I was and still am deeply impressed by how Professor Gordon Arthur Ransome (who can be described as the father of Modern Medicine in Singapore) illustrated the presence of minimal peritoneal fluid (ascites) by percussing the abdomen with the patient in the knee-chest position, a test not even mentioned in Harrison’s textbook of Medicine – the “bible” of Internal Medicine at that time. But beyond the mere transfer of knowledge and skills, what is more critical to me is their exemplification of moral and ethical values that all doctors should and must have. The late President Wee Kim Wee related to me an incident that deeply touched me. He was in consultation with the late Prof Seah Cheng Siang one day when halfway through the consultation, Prof Seah hurriedly left President Wee after receiving a call. Initially somewhat annoyed, President Wee later discovered that Prof Seah had left to attend to a dying ‘C’ class patient in the ward. That incident, President Wee told me, left a deep impression in his mind and his respect for Prof Seah increased several fold. To Prof Seah, all patients are important and they should be treated with the deepest respect and importance according to clinical priority, irrespective of whether they are presidents or paupers.
The teaching of the late Prof Balachandran, too, has made an impact on me and has influenced my own career. He walked the talk and would never let anyone or anything influence his decision on what is good or in the best interest for welfare of patients. I’ll always remember his “Grand Ward” rounds on Fridays, which were full of ethical, moral and philosophical lessons in addition to his wisdom and clinical acumen. These cannot be gleaned from textbooks or journals, much less so from didactic lectures or tutorials. We must remember that part of our responsibilities is to train future generations who must surpass us in knowledge, skills and values. Sir William Osler said:
“The best preparation for tomorrow is to do today’s work superbly well ” and that includes teaching our younger staff for tomorrow superbly well. Perhaps I would like to conclude by quoting the motto of our Post-Graduate Medical Institute (PGMI) that says: “Melius Medicus Scientius” which in Latin means “The Better Doctor is the Learned One.” The better doctor is someone trained with the knowledge to Heal the Body, have the Temperament to Soothe the Mind and the Wisdom to Comfort the Soul.
Write to us What do you think about Prof Tan’s lessons learnt in his medical career? Send your letters to firstname.lastname@example.org and we will feature your best letters in the next issue.
Prof Tan Ser Kiat
SinghealthREVIEW Physician Engagement
Sharing the Academic Medicine Journey
Since June last year, SingHealth and Duke-NUS management have been regularly meeting doctors from all institutions at Physician Engagement Sessions. They are co-hosted by SingHealth GCEO Prof Ivy Ng, DGCEOs Prof Ang Chong Lye and Prof Soo Khee Chee with Duke-NUS Dean Prof Ranga Krishnan and Vice Deans. Done across the cluster, they help our leaders and clinicians connect and solve issues on the ground, address concerns and share the journey of transforming Academic Medicine in our partnership with Duke-NUS. At the sessions, issues concerning the academic culture, care, education and research were brought up by clinicians. From there, the main challenges faced by the ground were identified by our senior management and now changes to address them are being implemented. Beginning in October, the engagement sessions are brought to individual clinical departments in the institutions. To get the complete details of issues identified and points discussed at Physician Engagement Sessions, visit http://mysinghealth/am/physicianEngagement.html on the intranet.
have heard directly and have been heard by our senior management
Number of physicians reached
me+SH Smartphone Application
Get the intranet on your mobile phone! On the move and want to stay connected? The SingHealth Desktop Portal is now at your fingertips*! Scan the QR code or visit the www.singhealth.com.sg/mobile/mesh to get started! 30
*Available for iPhone, Android and Blackberry smartphones. Experience may vary between the different operating systems. Use your windows login to access the application (e.g. seoabc; gcoabc)
In the journey of pursuing Academic Medicine, the availability of educational resources such as the SingHealth e-Library, which provides online access to most commonly needed medical journals and databases, is useful for physicians as they pursue research. This online resource is managed by SingHealth Group Education.
e-Library Easy Access
In the physician engagement sessions, one of the topics frequently discussed, was the issue of getting easy access to online reference journals and databases. The e-Library has since been enhanced and remote access is available through Citrix. The need for specialised journals and databases will be further resourced by the respective Institution libraries. Watch out for a revamped SingHealth e-Library portal in 2013!
If you are On a Mobile Device
TO ACCESS ONLINE JOURNALS:
With Citrix access, you can access the e-Library using any mobile device with a browser, including your smartphones.
Access to online journals anytime anywhere is not only for senior physicians. Doctors in training also need to keep updated with medical journals. A trial was conducted for SingHealth Residency by granting the Chairpersons of the Residents’ Committee remote access to the e-library and it was a success! Now all SingHealth Residents can access e-Library remotely using Citrix.
If you are On Campus
visit the SingHealth e-Library on the intranet http://mysinghealth/Singhealth/ELibrary/
If you are Outside Campus Get remote access to the intranet through Citrix at http://citrixapps/
For more information about the SingHealth e-Library, email: Elibrary@singhealth.com.sg
If you do not have access to Citrix, you may request for access through your Head of Department. When you login from home or other locations outside campus, a password will be sent to your mobile phone. With this password, you can access the SingHealth Intranet, including the SingHealth e-Library.
Main features eDirectory
Find your colleagues where ever you may be! Search, save, call or email them at your convenience.
Take part in quick polls and let your voice be heard.
Quench your thirst for Academic knowledge by flipping through one of the many SingHealth and institution newsletters and publications.
Know what’s happening in SingHealth and its institutions
Have an issue you wish addressed? We’d 31 appreciate if you can send us an email.
SinghealthREVIEW NEW APPOINTMENTS Prof Ng Han Seong Group Chief Risk Officer (wef 1 November 2012) With this new position, Prof Ng will relinquish his role as Chairman, Medical Board of SGH. Read more about Prof Ng on page 35.
Dr Teoh Khim Hean Deputy Executive Director (Clinical) NDCS
Prof Fong Kok Yong Chairman, Medical Board SGH (wef 1 November 2012)
Dr Poon Choy Yoke Deputy Executive Director (Research & Education) NDCS
Assoc Prof Chua Yeow Leng Deputy Group Director, International Cooperation SingHealth
Ms Ho Ai Lian Director of Nursing NHCS
Mr Johnny Quah Chief Financial Officer (Special Projects) SingHealth
Get The Right Online Etiquette Are you a regular on Facebook, Twitter or do you like to blog? Remember that when you put a comment online it is like speaking to a gathered crowd – if you can’t imagine saying it out loud to a room full of strangers, then don’t post it online!
Confidentiality Matters Confidential information such as patient and work-related information is off limits, so don’t post it online. Say it Right We all play a part in upholding SingHealth’s reputation. So be accurate, communicate transparently and behave professionally, respectfully and legally. Where to get advice If you have any doubts, contact your Communications team or SingHealth Group Communications for advice. For more tips on how to engage safely online, check out the SingHealth Social Media Policy at http://mysinghealth/Singhealth/CorporateOffice/GroupComms/Media/ 32
SinghealthREVIEW GIVING BACK Pancake Breakfast for Charity Imagine buttered pancakes smothered in maple syrup. Imagine eating them warm, served fresh by Duke-NUS education deans and SingHealth senior management - all for the sake of charity. The Pancake Breakfast at Duke-NUS on 12 October was attended by 300 staff and students and raised more than $8,000 that will go directly to beneficiaries the students engage in their community projects. “The event has become an annual tradition and I am very pleased that it is now becoming a shared SingHealth and Duke-NUS initiative. Coming together to support our students’ community service projects is an important way to show that we are becoming an academic healthcare cluster that gives back to the community and cares about our students,” said Dr Craig Stenberg, Associate Dean, Office of Student Affairs & Admission, Duke-NUS Graduate Medical School Singapore. “The Deans’ Pancake Breakfast has provided the means of support in bringing our community service projects to life. It also allows us to design a greater program such as Project Karen, one of Duke-NUS first international health screening community project,” said Jason Lam Shang Leen, Class of MS4, Duke-NUS Graduate Medical School Singapore. We thank you for your spirit of giving.
SingHealth Brings the Love to Yong Loo Lin’s Public Health Screening Appearing at the annual Public Health screening was a newly designed SingHealth goodie bag! Part of our ongoing sponsorship of medical students’ initiatives, the Public Health Screening saw over 2,000 members of the public turn up at Toa Payoh Central for basic health checks and health education booths. Apart from this annual screening, SingHealth also supports community projects by young doctors-to-be from the NUS Yong Loo Lin School of Medicine and Duke-NUS Graduate Medical School.
to Tomorrow Your gift to your patients
How can Academic Medicine improve your patients’ lives? Tell us your story and you may be rewarded with up to $400 worth of Apple vouchers. Send your entry (300-500 words) to email@example.com by 31 December 2012.
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Bronze Winner in the Mobile Application Category of SiTF Award 2012 34
Singapore General Hospital · KK Women’s and Children’s Hospital National Cancer Centre Singapore · National Dental Centre Singapore National Heart Centre Singapore · National Neuroscience Institute Singapore National Eye Centre · SingHealth Polyclinics
The Mentors’ Mentor not in is s n ia ic n li c f o generation w e n a g in h ersonal c p a e e t th in e e ib g b n e im ll a to h c “ The ut for them b , e g d a little d n le a w y o it n il k b a in t a n u m o o c d c imparting patients, a h it w n o ti a soft skills ic n re u a m n m o o ti c a t, ic c n e u p s m re touch, y and com th a p m e , y th a p Seong m y bit of altruism. S t from textbooks.” – Prof Ng Han arn that cannot be le Prof Ng Han Seong, has handed over his baton of SGH Chairman of Medical Board to Prof Fong Kok Yong, but continues his service in SingHealth as Group Chief Risk Officer. In his more than 30 years of service in SGH, Prof Ng is known to be a wellrespected and well-loved mentor. He has groomed many healthcare professionals, including our clinicians in leadership who are also actively teaching the current young doctors. Prof Ng’s credentials to excellent mentoring does not only come from those he has taught. He received a National Outstanding Clinician Mentor Award from the Ministry of Health in 2009, the highest accolade the state gives to individuals who contributes to the training of clinicians. We thank Prof Ng Han Seong for his many years of dedication in healthcare leadership and in educating medical professionals. A Mentor is a brain to pick, an ear to listen and a push in the right direction. Prof Ng Han Seong is the epitome of a true Mentor, in every sense and more. He is a person who advises, counsels, teaches and guides both directly and indirectly. As an outstanding role model Mentor, Prof Ng actively listens to his mentees, helps them build self-esteem and confidence, pushes them to achieve his goals and offers stability and positive reinforcement in the mentees’ life. - Eileen Liew Assistant Director, Preparedness and Response SGH 35
Reflections on bedside teaching Prof Foo Keong Tatt, an experienced doctor and Emeritus Consultant in SGH, ruminates on the importance of bedside teaching through the ages and beyond the books.
he practice of Medicine cannot be learnt from books. In real life practice, doctors treat patients and not just the disease. Therefore, students need to be taught by the bedside and not just on theoretical knowledge alone. Knowing how to treat a particular disease is the science, but how to individualise the management to a particular patient is an art.
would spend hours discussing symptoms and differential diagnoses, but when asked how to treat, he would just tell us to look up the “blue book” – a pocket book we used on medical therapy with a blue cover. We did not appreciate the importance of diagnosis then. We were impatient to learn how to treat patients and never realised that to treat, we had to first learn how to diagnose.
The doctor first needs to make the correct diagnosis, learning to prioritise the various signs and symptoms before balancing the risks and benefits of the treatment. This requires experience, which can only be acquired by the bedside.
The skill to make a diagnosis can never be learnt without bedside experience. Over the years, more and more beds are being trimmed to save costs.
I remember as a young medical student in the early 1960s – and ever so keen to start treating patients – we were disappointed that some of the tutors did not bother to tell us how to treat. The late Prof Gordon Arthur Ransome
Patients are kept in the ward shorter and with same-day admissions and day surgery; the opportunities for bedside teaching are compromised. Medical educators should plan for special rooms and facilities to teach students in a clinical setting. Volunteer patients can be roped in and tutors should be given time just to teach groups of students
in this set up. I am pleased to know that some new clinics have already implemented this. Clinic or bedside teaching also helps students to look at patients as a whole. Each patient is different even though they may have the same disease or show the same symptoms. Accordingly, patient management needs to be individualised along with how we communicate with patients. We clinicians learn from every patient encounter, especially from patients who have a long follow up period. We learn the lesson that not all pathologies need to be treated. Most of the time, nature is the best healer. Our bodies have a natural built-in defence and healing system. Whether patients do well or fare badly depends more on the nature of the disease than actually what we can offer in our treatment. One example is in the management of prostate cancer.
Teaching at the bedside has been done throughout the history of Medicine. It is where a learner can be taught in the presence of a patient and use nearly all their senses to observe the patient’s condition, his environment and directly confirm key aspects of the history and physical examination. It is where the teacher is able to be a role model in vital skills and attitudes around the patients. Sir William Osler, the father of modern Medicine, said Prof E S Monteiro (seated) examining a patient with Prof Gordon Arthur Ransome with an unidentified nurse and British doctors, 6 Feb 1954. Source: Ministry of Information, Communication and the Arts
A well-differentiated prostate cancer will do well, whatever modalities of treatment are offered. Whereas a poorly differentiated prostate cancer will continue to spread even with the most aggressive multiple therapies. Therefore it is important for clinicians not to overtreat and cause more harm with the many side effects of treatment. We have learnt from the bitter truth of our mistakes, commissions or omissions, and hopefully we can pass on our valued experience to the next generation, so that hopefully, they will not make the same mistakes, and help to continuously improve on our patient care. “To cure seldom, to relieve sometimes but to console always” is still as relevant today in this modern age of medicine as was quoted many hundreds of years ago.
“There should be no teaching without a patient for a text, and the best is that taught by the patient himself.”
DR KT FOO Emeritus Consultant Department of Urology Singapore General Hospital Clinical Professor YLL/NUS school of Medicine Adjunct Professor Duke-NUS
Prof Foo as a young lecturer, demonstrating how to examine the abdomen
We thank Toby Huynh, Curator of SGH Museum, for her ideas and contribution in researching for this article. Visit the SGH Museum at SGH Campus’ Bowyer Block to learn about the rich history of medical specialties and medical education in Singapore. http://www.sgh.com.sg/museum 37
issue 04/2012 Translating the Academic Medicine Vision
The medical technology we use to treat our patients today are much more advanced than what we had less than ten years ago. But much of our medical knowledge is inherited from our mentors and forebearers in the field. What will our generation discover in the next ten years? Who will we pass on this knowledge to? We learn from our teachers, pass the knowledge to others and improve it along our practice. In the study of Medicine, nothing can hold truer. We are the hands that shape the future of Medicine. This issue is specially dedicated to all medical students, learners and teachers. Pg 6-9, 16-20