SingHealth Education Special Inside
The voice of academic medicine
MICA (P) 143/07/2013
A publication of the SingHealth Academic Healthcare Cluster
A new hope for patients SingHealth’s Investigational Medical Unit performs critical clinical trials that bring new treatments from the lab to the patients
key cornerstone of all clinical research and discovery is clinical trials – the process whereby any novel medical treatment, from new medication to medical devices and surgical techniques, is tested for safety and effectiveness in patients. This critical medical research phase, which can last from a few years to decades, determines whether a treatment is able to make the translational leap from bench to bedside. For some patients, the clinical trial affords early access to treatment that is very new and with potential for benefit. For the rest of the population, clinical trials advance the continuous discovery and implementation of novel treatments to continually help improve medical knowledge and care.
Phases of a clinical trial Phase I: Proof-of-concept
This is the first time that a potential new treatment is tested on humans. Phase I trials involve only small groups of volunteers and involve simple trials – for example, how a drug reacts following ingestion after a meal.
3 Phase III: Regulatory approval
This phase involves thousands of patient volunteers who suffer from the condition the new treatment is aimed at and can last several years. After phase III trials are completed, all the data are submitted to regulatory bodies for approval. If the regulatory body approves the treatment, it can be administered to patients.
2 Phase II: Wider application
This phase involves more volunteers to test efficacy and safety on a broader level.
Phase IV: Post-marketing
This phase evaluates how effective the treatment is when used by patients in non-clinical trial situations. These studies involve tens of thousands of people and can last several decades.
ISSUE 7, march 2014
Breakthrough in dengue research Researchers from Duke-NUS’ Emerging Infectious Disease (EID) Signature Research Program have uncovered the way dengue bypasses our immune system during secondary infection. Dengue virus is unique in that it is able to exploit antibodies developed after an infection and make patients more susceptible to subsequent infections. Published in the week of 13 January, 2014 in the journal Proceedings of the National Academy of Sciences, USA, the breakthrough research shows how the dengue virus activates an inhibitory receptor, LILRB1 (leukocyte immunoglobulin-like receptor-B1), which dampens our immune response during infection. Their study suggests that the risk of dengue infection would be reduced if vaccines could be engineered to produce antibodies that block the dengue virus from activating LILRB1.
At the core of the clinical trial operations at SingHealth is the Investigational Medicine Unit (IMU), which was set up in 2008 to develop and accelerate early phase clinical research in SingHealth and Singapore. IMU collaborates with local and international researchers, investigators, industry partners and pharmaceutical companies to evaluate new medical discoveries for various disease types relevant to the region.
Associate Professor Ooi Eng Eong, who led the research and is also Deputy Director of the EID Program at Duke-NUS, shared, “An analogy of the mechanism we discovered would be that of a door tightly linked to an alarm system. Our research found a previously unknown mechanism – which the virus rigged to get through the door using antibodies as the key, without setting off the alarm.”
The rigorous clinical trial process involves four phases. The first stage starts with very small doses to observe the safety and effectiveness in humans. As the research progresses, it is introduced to patients and tested on a wider population. Once this stage is completed, the data is submitted to the regulatory body, Singapore’s Health Sciences Authority, for approval. Following which, the treatment can finally be administered to patients. (see box)
Currently, Prof Ooi and his team are working on isolating the exact part of the dengue virus that binds itself to LILRB1, in order to develop a targeted vaccine therapy. He said, “A dengue vaccine is a holy grail of research. The world has been trying to develop one for more than 30 years.”
However, the research does not end here. As the treatment goes into the post-marketing phase, the effectiveness of the treatment is continually evaluated, monitored and assessed. Dr Darren Lim, Clinical and Scientific Director at IMU, and also a Senior Consultant in Medical Oncology at NCCS elaborated, “Clinical trials are at the end point of a whole long process of drug discovery. It is an iteration of going back to bench to understand the drug and coming forward to understand how it acts in a patient population; to find out whom it works best for and how we can accelerate its development.” To date, 36 trials involving IMU have been completed, ranging from biomarker “proof-of-concept” studies to medical devices. These trials have been conducted in IMU alone or in collaboration with Clinical Trial Units within the SingHealth cluster, the rest of Singapore and the world. A recent successful trial involving a firstin-human drug for lung cancer patients
Dr Darren Lim and Sue Tee lead the operations of IMU conducted at NCCS and IMU has helped to put Singapore on the world map. Dr Lim said, “The trial made global biopharmaceutical companies aware that we have a unit here that can help deliver on such early phase studies.”
We are a crucial piece of the jigsaw in Singapore’s Biomedical Sciences Initiative. – Dr Darren Lim, Clinical and Scientific Director, SingHealth IMU, and Senior Consultant, Medical Oncology, NCCS “We are a crucial piece of the jigsaw in Singapore’s Biomedical Sciences initiative,” he added. However, not all trials end up successful and may fall into what Dr Lim has called a ‘valley of death’ or ‘the translation gap’. He said, “We might have a great drug but we have to understand the dynamics and kinetics of the drug in individuals. All cancers and all individuals are different so it can be difficult to match the drug with the patient.”
Helping to progress the area of clinical trials is Sue Tee, Director of Administration and Operations at SingHealth IMU and Director of SingHealth’s Clinical Trials Business Development. She works to raise IMU’s profile among the major biopharmaceutical companies through industry collaborations such as conducting comparative drug studies in larger patient populations.
The world-first discovery is an important breakthrough for the EID Program. The program focuses some 50 per cent of its research on dengue alone, a virus that is distributed throughout the tropical world and infects some 400 million individuals a year. Other research interests of the EID Program include the lethal bat-borne virus nipah, SARS, avian influenza or bird flu, and yellow fever.
She sources for drugs or medical device trials that may be suitable for our population and liaises between SingHealth’s Principal Investigators and pharmaceutical or biotech companies who are seeking researchers to conduct their trials. She also looks for biopharmaceutical partners willing to work with SingHealth clinicans who are researching on and keen to do trials on new treatments for patients.
Along with this discovery, the EID Program works with various partners, including Dr Jenny Low and Dr Limin Wijaya from the SGH Infectious Disease Department, NUS, Tan Tock Seng Hospital, A*STAR, DSO National Laboratories and the Novartis Institute for Tropical Diseases to combat the threat of emerging infectious disease in Singapore and the region.
She said, “We participate in a global ecosystem of drug development and discovery. Our perspective is that we help in all we can to execute a trial in Singapore successfully. We do our best to encourage patients and healthy volunteers to participate so that the trial can finish in the shortest time possible and accelerate the drug’s development.”
Continued on page 2
Said Prof Ooi, “Singapore is a major travel hub, making it vulnerable to the importation of viruses and potential epidemic. With its partners, the EID Program aims to make Singapore a viable surveillance hub of the region.” This research is supported by the Singapore National Research Foundation under its Clinician Scientist Award (CSA) and administered by the Singapore Ministry of Health’s National Medical Research Council.
Tomorrow’s Medicine - ISSUE 7, MARCH 2014
March 2014 Editors-In-Chief
ll that we do, we tell the world. “That, in my opinion, is the reason we started Proceedings [of Singapore Healthcare]. It is to showcase to the whole world our capabilities,” proclaimed Professor Hwang Nian Chih, inaugural Chief Editor of the cluster journal who recently stepped down, and Senior Consultant at the SGH Department of Anaesthesiology.
Audrey Lau Editors
Jennifer Wee Arthur Wong Stephanie Jade Joint Editorial team
Goh Sai Luan (SGH) sub-editor Ichha Oberoi (KKH) sub-editor Eric Lim Wei (SHP) sub-editor Edwin Yong (NCCS) Caroline Chia (NDCS) Jessica Koh (NHCS) Christina Valerie Wee (NNI) Dr Thiyagarajan Jayabaskar (SNEC) Wee Lai Ming (Duke-NUS) Design
Redstone Communications Copywriting
Hedgehog Communications Members of the SingHealth Academic Healthcare Cluster
Singapore General Hospital (SGH) KK Women’s and Children’s Hospital (KKH) National Cancer Centre Singapore (NCCS) National Dental Centre Singapore (NDCS) National Heart Centre Singapore (NHCS) National Neuroscience Institute (NNI) Singapore National Eye Centre (SNEC) SingHealth Polyclinics (SHP) Bright Vision Hospital (BVH) Sengkang Health (SKH)
Partner in Academic Medicine
Duke-NUS Graduate Medical School Singapore (Duke-NUS)
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An amalgamation of scientific writing from hospital journals SGH Proceedings and KKH Review, Proceedings of Singapore Healthcare took careful, calculated steps to showcase SingHealth institutions and academic partner Duke-NUS. Reasoned Prof Hwang, “We want to be inclusive.” The dreams of Prof Hwang (SGH Proceedings) and the Chairman, Medical Board of KKH, Prof Alex Sia (KKH Review) didn’t stop at just playing house. Proceedings would be a platform for all in SingHealth to publish their early findings, and to showcase the cluster’s wide array of clinical knowledge and outcome. Their audience was the world. “And this cluster journal is our front,” said Prof Hwang. So naturally the journal went online. It was searchable. It was fast. It was a window from the outside world into SingHealth. Taking a thematic approach, Proceedings opened itself to all sub-disciplines within the cluster. This meant a good deal to the trainees in our midst – junior doctors now had access to information from cluster practice, to use as reading material in their pursuit of Medicine. But apart from reading, the clinicians were also encouraged to submit writings to the cluster journal. The submissions were then peer-reviewed for acceptance by a panel of experts within and outside Singapore, including healthcare professionals from the subspecialties. Many young doctors and Duke-NUS students had their research beginnings with Proceedings. With the support of GCEO Prof Ivy Ng, acknowledgement from Proceedings could be used as criteria for promotion, and that made the cluster journal even more popular.
Our cluster journal has come a long way. With so much done and accomplished, Prof Hwang looks back with pride. The years of planning and hard work have paid off, and he is letting go on a high. Also because he has found worthy successors. “Yew Long works well with the staff, and he has good ideas that are different from mine. We are like a venn diagram, with two sets of life experiences and a common interest. Alongside him is Siang Hui, and I think they make a great team.”
Prof Hwang Nian Chih (left) handed over the baton to Prof Lo Yew Long (middle), the new Chief Editor of Proceedings and Assoc Prof Lai Siang Hui, its new Editor, in February this year
Proceedings of Singapore Healthcare is run by an editorial committee comprising representatives from SingHealth, Duke-NUS and Eastern Health Alliance. You can read it online at http://www.singhealthacademy.edu.sg/Pages/MedicalJournal.aspx
Dr Lim also shared, “Singapore is a small country and we are a relatively small unit but there are advantages to being small – we have good data quality and with our multiethnic population, we can potentially study differences in drug and disease across different population groups.”
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All rights reserved. Reproduction in whole or part is prohibited without the written permission of SingHealth and the publisher. The views and opinions expressed or implied in the publication are those of the authors or contributors and do not necessarily reflect those of SingHealth and the publisher. Whilst due care has been exercised, both SingHealth and the publisher do not accept responsibility for errors in advertisements or articles, unsolicited manuscripts, photographers or illustrations. Tomorrow’s Medicine reserves the right to edit all materials submitted for publication. While contributors will be given the opportunity to comment on articles for factual accuracy, this policy is about ensuring a consistent and clear writing style throughout.
– Prof Hwang Nian Chih, former Chief Editor, Proceedings of Singapore Healthcare, and Senior Consultant, Anaesthesiology, SGH
That task lies in the hands of Proceedings’ new chief editor, Associate Professor Lo Yew Long, senior consultant at the SGH department of neurology, and editor, Associate Professor Lai Siang Hui, senior consultant at the SGH department of pathology.
Critical clinical trials Continued from front page
Tomorrow’s Medicine welcomes comments from our readers. Write to us at firstname.lastname@example.org
That, in my opinion is the reason we have Proceedings (of Singapore Healthcare). It is to showcase to the whole world our capabilities.
Proceedings now has its sights on indexing. Being indexed would open the door to international recognition and extend its influence to more of our researchers looking for their papers to be published.
Established in 2010, Proceedings might actually have been one of the first movements to stake our claim as an academic healthcare cluster.
In-depth view and highlights in research, education, & clinical outcome
Professor Hwang Nian Chih just stepped down as chief editor of the cluster medical journal - but for someone who’s been in it for so long, it seemed too easy to let go
Tan-Huang Shuo Mei
Proceeding on a high
As of 31 Dec 2013
While some clinical trial volunteers are patients who may lack effective treatment options and are keen to seek out novel treatments – for example in the case of cancer patients – IMU also has a healthy database of volunteers who are in the pink of health. For these volunteers, their motivation is being a part of an important process in advancing medical research and improving patient care.
Our perspective is to help in what we can to execute and perform a trial here successfully. – Sue Tee, Director, Clinical Trials Business Development, SingHealth Dr Lim believes that clinical trials create many tangible and intangible benefits to the system. All advances in medical care and improvement to our health are products of clinical research, and clinical trials are the incubators that can birth new treatments, bringing new hope to patients.
For more information on IMU, collaboration opportunities and volunteering for ongoing clinical trials visit http://www.singhealthimu.com.sg
SingHealth Education Special
SingHealth Education Special
At SingHealth and Duke-NUS, we advance healthcare education and embrace lifelong learning for one purpose – to improve our patients’ lives. We teach and develop the next generation of healthcare professionals so that they can deliver even better care tomorrow.
Generating Educational Excellence for Better Patient Care
The pioneers of the Academic Medicine Education Institute (AM•EI) Fellows Programme draw from their diverse backgrounds and knowledge to create a more integrated approach to Education.
s Goh Soo Cheng is a Principal Medical Social Worker at SGH and Adjunct Associate Professor Yong Wei Sean is a Senior Consultant Surgical Oncologist at NCCS. They come from different backgrounds and specialise in different fields. Yet, both are passionate about education at a time when the healthcare landscape is growing not only more integrated, but also more multidisciplinary. “Patients require holistic, multidimensional care,” said Ms Goh. Drawing from her experience working in multidisciplinary teams to deliver care to help patients smoothly reintegrate into their communities, she noted, “We cannot practise in silos. In the best interest of patients, we have to come together despite our different backgrounds to learn from and with each other.” This sentiment is echoed by Prof Yong. “Inter-professional learning is the way of the future,” he said. “As we move from doctor-centred models to patient-centric care, we will require different groups of professionals learning from other individual fields of expertise to deliver more enhanced and coordinated care.”
Generativity is important to ensure healthcare continuity. We need to train the trainers so that they can better groom the next generation of healthcare professionals to achieve improved patient care outcomes. – Adj Assoc Prof Yong Wei Sean, Senior Consultant, Division of Surgical Oncology, NCCS Part of the first batch of 37 pioneers in the Academic Medicine Education Institute (AM•EI) Fellows Programme launched in February 2013, Ms Goh and Prof Yong are now helping to build a community of like-minded passionate clinician educators. By immersing themselves in inter-professional and inter-departmental teaching such as Residency training, they hope to nurture and sustain current and future generations of healthcare professionals
Nurturing Future Leaders in Medicine Chief Resident Dr Mark Cheah from the SingHealth Internal Medicine Residency Programme believes peer teaching and learning can fundamentally change medical education for the better.
as well as raise the standards of healthcare education. Their efforts are aimed at achieving one ultimate target — better patient outcomes. What they are trying to achieve is in line with the aims of the AM•EI, which are to encourage faculty development, educational programme development and education research across SingHealth. The all-inclusive institute for healthcare educators supports educators by offering a range of programmes and incentives, including personalised consultancy sessions and the award of an annual Education Innovation Grant. Currently, more than 1,500 AM•EI members have the opportunity to participate in the institute’s wide range of faculty development programmes, which cater to all levels of educators. These and other efforts are focused on engaging healthcare professionals in inter-professional learning to better deliver multidisciplinary integrated care. This blurring of traditional boundaries makes diversity a strength. Prof Yong shared, “The Fellows Programme has provided us with new perspectives and different innovative approaches to teaching. Our workshops make use of the strengths of people, both medical and non-medical, and also reach out to interprofessional participants. In the end, it is about how we can work together to achieve the shared objective of bettering care outcomes for patients.” What Ms Goh and Prof Yong are hinting at is the concept known as ‘Generativity’. Put briefly, it involves tapping into what one person knows, and sharing it with another so that together they can better nurture the next generation.
ometime during your career, you will find the need to pay it forward, to mentor your juniors just as you were mentored. To keep people passionate, you need to share with them your passion. I find teaching to be a good way to do that. As the philosopher Socrates once said, teaching is the highest form of learning – it forces you to understand your knowledge well enough to pass it on. Teaching can fulfil you and help you mature as an individual in a way that cannot be quantified. My passion for peer teaching was realised through programmes such as CADENCE and the Student Internship Programme (SIP) Bootcamp. CADENCE was started in April 2012 to help Internal Medicine Residents pass the notoriously difficult MRCP PACES exams. At the core of the CADENCE programme is the concept of ‘paying it forward’; Residents who have just passed the MRCP PACES exams are assigned the role of Resident-mentors to guide their compatriots through the exams. We sought to change the angst-ridden, isolationist experience of the MRCP PACES exams into something we can move forward on together as a community. To date, more than 80 Residents
In the year following the launch of the Fellows Programme, the pioneers have already made an impact. Several Pioneer Fellows have started teaching their fellow educators in the AM•EI Education Grand Rounds and other educational workshops. Others have taken on educationrelated research, exploring how they may improve teaching outcomes. Ms Goh has found it an honour to teach beside colleagues from other backgrounds. “Our common passion for education is a bond that inspires us,” she said. “I am very keen to see how we can further collaborate to nurture the next generation of clinician educators.” Prof Yong agreed and noted, “Generativity is important to ensure healthcare continuity. We will get old eventually and it is up to the current guard to pass the baton. We need to train the trainers so that they can better groom the next generation of healthcare professionals to achieve improved patient care outcomes.”
We recognise the following Pioneer Fellows who have exemplified the spirit of Generativity by sharing knowledge with their peers in AM•EI workshops. •
Dr Chan Hong Ngee Senior Principal Clinical Pharmacist, Pharmacy – Inpatient, SGH
Dr Eugene Wee Senior Registrar, Orthodontics, NDCS
Ms Goh Soo Cheng Principal Medical Social Worker, SGH
Ms Joyce Lim Soo Ting Advanced Practice Nurse (SNC), Division of Nursing (Nursing Specialist Services), KKH
Assoc Prof Lai Siang Hui Senior Consultant, Department of Pathology, SGH
Assoc Prof Loo Chian Min Director, Undergraduate Education, Medicine ACP Head & Senior Consultant, Department of Respiratory & Critical Care Medicine, SGH
Adj Assoc Prof Mark Leong Senior Consultant, Department of Emergency Medicine, SGH
Adj Asst Prof Matthew Ng Consultant, Department of Family Medicine and Continuing Care, SGH
Adj Assoc Prof Nigel Tan Academic Vice Chair, Education, Neuroscience ACP Senior Consultant, Neurology & Education Director, NNI
Adj Asst Prof Preetha Madhukumar Senior Consultant, Division of Surgical Oncology, NCCS
Ms Rachelle Lim Hao Yu Senior Physiotherapist, Department of Physiotherapy, SGH
Assoc Prof Simon Ong Academic Vice Chair, Education, Oncology ACP Senior Consultant, Division of Medical Oncology, NCCS
• Asst Prof Suzanne Goh Assistant Professor, Key Education Faculty, Duke-NUS
Prof Robert Kamei, Co-Director of AM•EI, facilitating a Pioneer Fellows session having benefitted from CADENCE and MRCP pass rates have significantly increased from 20-30% to 80%. The other Resident-led initiative, the SIP Bootcamp, helps to bridge the gap between knowledge from books and actual clinical situations for medical students during their internship. Some 900 medical students have attended the Bootcamps and feedback has been extremely encouraging. CADENCE and SIP Bootcamp have become self-sustaining initiatives, with each new batch of Residents taking the lead to pay it forward to the following batch. This is crucial for continuity and creates a self-sustaining culture of learning that will yield returns for medical education in the years to come. I am a strong believer in the idea that your role defines what you do. If medical students can see themselves as future Resident-mentors, and Residents as future clinician educators or leaders, the mentoring instinct will become natural. Eventually, this will create a deeply embedded culture of teaching and learning. Beyond passing examinations, peer teaching is also about an investment in our future as
Ms Tan Hui Li Advanced Practicing Nurse, Nursing Division, Specialists Nursing Services, SGH
Adj Assoc Prof Wong Kok Seng Academic Vice Chair, Clinical Services & Improvement, Medicine ACP Head & Senior Consultant, Department of Internal Medicine, SGH
Adj Assoc Prof Yong Wei Sean Senior Consultant, Division of Surgical Oncology, NCCS
healthcare professionals. We want to work with people we care about, and see them succeed. This will build a community of like-minded passionate clinician educators who will work together to contribute to education and improve patient care in the future. Another key developmental programme, the Singapore Chief Residency Programme (SCRP) plays an important role in shaping our Residents’ future aspirations as leaders. The structured leadership training programme brings together Residents from across institutions and specialties, and challenges us to take on roles as change agents within the existing healthcare system to improve it for the patients we serve. As for my own future, medical education is a calling. It is not just about being a good teacher but also about driving systemic change in healthcare education so as to ultimately improve care outcomes for patients.
SingHealth Education Special AM•EI partners with various education institutions in SingHealth and Duke-NUS to develop faculty development programmes for healthcare educators across all professions and levels. Find out more about the faculty development programmes at www.academic-medicine.edu.sg/amei or email email@example.com. Join us as part of a community of passionate academic medicine educators. For membership enquiries, email firstname.lastname@example.org.
PD, APD and Core faculty
Education Admin Staff
Allied Health Staff
AM•EI Education Grand Rounds (EGR) The AM•EI Education Grand Rounds is a series of talks for healthcare educators and learners to exchange ideas and best practices in education, so as to promote a vibrant, inter-professional learning culture. Session speakers comprise overseas faculty as well as educators from SingHealth and Duke-NUS.
10 Apr 1700 - 1800 Academia, L1-S1
8 May 1700 - 1800 Academia, L1-S1
AM•EI Education Innovation Grant The grant aims to support our community of passionate inter-professional educators in their healthcare education research projects, such as implementing and developing a teaching project with measurable learning outcomes.
Special Intensive ProgramMEs (By invitation only) FP02
AM•EI Fellows Programme (Train-the-Trainer)
AM•EI Fellowship in Team-Based Learning (FTBL)
AM•EI Education Leadership Programme (AMLEAD)
PGAHI & AM•EI
7 - 11 Apr F1S3, F2S2, F3S1 Duke-NUS & Academia
Core Values CV1001
Advancing Your Career as an Educator: Building Your Education Portfolio
Essentials in Clinical Education
Design and Planning of Learning Activities (PLA) PLA1001
Creating E-Learning Content With Articulate Studio Software
The “Flipped” Classroom: Using Team-Based Learning to Enhance the Learning Within Your Course
Designing Effective Objectives and Quality Multiple Choice Questions
Mastering Your Presentations (Train-the-Trainer)
AM•EI & CRAFD
22 May 0900 - 1700 Academia, L2-T2
27 May 1630 - 1930 Academia, L1-S4
Teaching and Supporting Learners (TSL) TSL1001
Bedside Teaching – Creating a Positive Learning Experience
Enhancing and Enriching Learning Through Effective Facilitation
Issues and Challenges with Assessment and Evaluation
AM•EI & CRAFD
Assessment and Feedback to Learners (AFL) AFL1001
Strategies to Improve Feedback
Using Logic Model as a Road Map to Your Assessment Strategies
Educational Research and Evidenced-based Practice (ERP) ERP1001
How Do I Get My Research Message Out? Basic Abstract Writing
AM•EI & AMRI
How Do I Get My Research Message Out? Advanced Manuscript Writing
AM•EI & AMRI
Qualitative Research Workshop, “Why, When, How?”
AM•EI & AMRI
What Is The Best Instrument for My Research Outcomes?
AM•EI & AMRI
Integrating Quality: Creating QI Education and Operational Programmes
Education Research Journal Club
Personalised 1-to-1 Consultation in Education Research
25 Apr 0900 - 1700 Academia, L1-S4
28 Apr 1300 - 1700 Academia, L1-S4
25 Apr 1200 - 1300 Duke-NUS, Rm 3A
30 May 1200 - 1300 Duke-NUS, Rm 3A
Educational Management and Leadership (EML) EML1001
Becoming a Leader in Academic Medicine: Honing and Developing your Skills
28 May 0900 - 1300 Academia, L1-S3
Residents as Future Teachers (RAFT) RFT1001
Bedside Teaching – Creating a Positive Learning Experience [For Residents]
AM•EI & CRAFD
Strategies to Improve Feedback [For Residents]
AM•EI & CRAFD
*Information is correct at the time of printing and subject to changes.
14 Apr 1300 - 1600 Academia, L1-S2 5 May 1300 - 1600 KKH
SingHealth Education Special
12 Jun 1700 - 1800 Academia, L1-S1
10 Jul 1700 - 1800 Academia, L2-S3
14 Aug 1700 - 1800 Academia, L1-S1
9 Oct 1700 - 1800 Academia, L1-S3
13 Nov 1700 - 1800 Amphitheatre
8 Jan 1700 - 1800 Academia, L1-S1
12 Feb 1700 - 1800 Academia, L1-S1
12 Mar 1700 - 1800 Academia, L1-S1
Application opens on 23 June 2014. Closing date for submissions is 31 October 2014
A 12-month structured programme beginning in May 2014. Please contact AM•EI for more information on the next intake.
A 12-month structured programme beginning in May 2014. Please contact AM•EI for more information on the next intake.
6 Aug 1400 - 1700 Academia, L1-S4
6 Feb 0900 - 1200 Academia, L1-S4
Please contact AM•EI for more information.
30 Oct 0900 - 1700 Academia, L2-T2
25 Feb 0900 - 1700 Academia, L2-T2
9 Jul 1400 - 1700 Academia, L2-S1
14 Jan 1400 - 1700 Academia, L1-S4 28 Oct 1630 - 1930 Academia, L1-S4
27 Jan 1630 - 1930 Academia, L1-S4
Please contact AM•EI for more information.
16 Jul 1400 - 1700 Academia, L2-S1
5 Nov 1400 - 1700 Academia, L2-S1
4 Mar 1400 - 1700 Academia, L2-S1
8 Jul 1400 - 1700 Academia, L2-S1
11 Nov 1400 - 1700 Academia, L2-S1
10 Mar 1400 - 1700 Academia, L2-S1
23 Jul 1630 - 1930 Academia, L1-S4
4 Feb 1630 - 1930 Academia, L1-S4
24 Sep 1400 - 1700 Academia, L1-S4
18 Mar 1400 - 1700 Academia, L1-S4 15 Oct 1400 - 1700 Academia, L1-S4
11 Sep 1300 - 1700 Academia
12 Sep 1300 - 1700 Academia
Please contact AM•EI for more information. 27 Jun 1200 - 1300 Duke-NUS, Rm 3A
25 Jul 1200 - 1300 Duke-NUS, Rm 3A
29 Aug 1200 - 1300 Duke-NUS, Rm 3A
26 Sep 1200 - 1300 Duke-NUS, Rm 3A
31 Oct 1200 - 1300 Duke-NUS, Rm 3A
28 Nov 1200 - 1300 Duke-NUS, Rm 3A
Please contact AM•EI to arrange for a consultation session on your education research project.
13 Aug 0900 - 1300 Academia, L1-S1
6 Jun 1300 - 1600 Academia, L1-S4
15 Oct 0900 - 1300 Academia, L1-S3
11 Feb 0900 - 1300 Academia, L1-S3
28 Nov 1300 - 1600 Academia, L1-S4 5 Dec 1300 - 1600 Academia, L1-S4
SingHealth Education Special
Advancing Medical Education as One
The SGH and KKH Campus Education Offices (EDOs), in close collaboration with SingHealth Group Education, work together to raise the standards of patient care through synergies in education.
ith multidisciplinary teams being the mainstay in healthcare today, the SGH and KKH Campus Education Offices (EDOs) are working closely to harmonise the inter-professional education activities on the campuses of both institutions. Assoc Prof Chan Choong Meng, Director of the SGH Campus EDO, noted, “Education can no longer work in isolation within each institution. There needs to be both vertical and horizontal integration among all healthcare professionals. We should also promote and encourage inter-professional teaching and work towards harmonising the various teaching activities within SGH campus.” Prof Chay Oh Moh, Prof Chan’s counterpart at the KKH campus EDO, is of the same mind. “Healthcare is a team effort,” she said. “For healthcare to be sustainable, inter-professional collaboration becomes very important. We cannot depend on the same few doctors to deliver across every area. To sustain our high standards of care, we have to nurture the next generation.” Assoc Prof Koo Wen Hsin, SingHealth’s Group Director of Education and Co-Director of AM•EI, emphasised, “SingHealth aims to be the education
provider of choice for healthcare professionals, doctors and medical students. This can only be achieved through establishing cluster-wide conducive infrastructure and efficient training systems, to facilitate teaching and learning.” “The transfer of knowledge will ensure a pipeline of competent healthcare professionals for quality patient care,” he added. Together, SingHealth Group Education works in tandem with the two Campus EDOs to streamline processes, optimise training capacity and enhance the quality of undergraduate training in SingHealth across healthcare professions, including nursing, allied health and clinicians. A key goal is to design a new framework that will create a seamless transition between undergraduate and postgraduate studies, providing a smoother journey for students as they progress in their training. More structured curricula and integrated training standards will allow practitioners to be trained in delivering better and more harmonised patient care. The SGH Campus EDO is also working closely with postgraduate units such as the Alice Lee
Institute of Advanced Nursing (Alice Lee IAN), the Postgraduate Allied Health Institute (PGAHI), Postgraduate Medical Institute (PGMI) and the Academic Medicine Education Institute (AM•EI) to enhance and improve cross-collaboration across the SingHealth cluster.
educators would see their positions as ones of prestige and honour.
“We need to eliminate education workload duplication and maximise both the human and structural resources that we have. Our role is to make it easier for people to work together, and to facilitate the work across boundaries,” Prof Chan said.
Also in the pipeline are plans to beef up education research, publishing and scholarly activities. Prof Chay said, “We need to work together to increase the level of such activities. This will create greater impact and raise our profile as an international academic centre.”
Leveraging each institution’s strengths, providing support and bridging gaps will be the main roles of the Campus EDOs as they create more formalised, structured pathways for greater inter-professional collaboration. For example, nurses can lead training workshops for clinicians or allied health professionals, while Residents can help to further train junior medical students.
The activities are expected to further extend SingHealth’s reach across borders and seed evidence-based medical education research for future generations of healthcare educators.
To cultivate such practices, it is necessary that healthcare professionals perceive themselves as educators. Prof Chay pointed out that this is a commitment not only in terms of time and effort but also in terms of the quality of their education involvement. Prof Chan expressed hope that
“When you take pride in yourself as an educator, you can inspire and influence others to follow in your footsteps, albeit slowly,” he said.
Both Campus EDO Directors believe that their effort will improve patient care by creating a sustainable and efficient healthcare system for the future. Prof Chay summarised the ultimate aim of their endeavours, “We are working together as one towards Academic Medicine and with one common purpose — to improve patient care.”
Nurturing Residents as Educators Creating a Culture of Lifelong Teaching and Learning
he Residents as Future Teachers (RaFT) programme gives SingHealth Residents a head start in their journey to become clinician educators. In line with SingHealth’s Academic Medicine vision to improve patient care via a holistic culture of education, RaFT was designed to turn competent Resident educators into effective teachers and leaders - role models that junior doctors and medical students can look up to.
RaFT is spearheaded by the Centre for Resident and Faculty Development (CRAFD), which was set up in 2009 to look into several areas of focus for Residency, namely programme support, instructional design, curriculum & evaluation, and education technology to equip Residents with medical knowledge and skills to deliver quality patient care. Dr Denise Tan Yan, Internal Medicine Resident, discovered her teaching abilities through one of these workshops. “I used to think that someone had to have a gift for teaching in order to do it, but through the RaFT sessions, I understand that there
is a science behind it and that there are specific steps you can take to become a better teacher.” The structured approach that RaFT injects into the teaching methodology facilitates improved ward and clinical teaching. CRAFD has built the RaFT programme in partnership with the Academic Medicine Education Institute (AM•EI). Based on the Practice-based Learning & Improvement competency, which refers to the ability to continuously improve patient care based on constant self-evaluation and lifelong learning, a specially structured curriculum was designed to facilitate Resident teaching. To date, CRAFD has organised six RaFT workshops, training more than 100 Residents. Dr James Li, Internal Medicine Resident, is another RaFT participant. He attended the twoday “Clinical Teaching Workshop” conducted by Dr Bradley Sharpe, Professor of Medicine at the University of California, San Francisco (UCSF), and found it enlightening. “Dr Sharpe taught us that although we teach a lot, what we lack is
the ability to give effective feedback and evaluation. Even if we recognise the importance of teaching, most of us are not equipped to give proper evaluation and feedback to help improve the performance of the person being taught.” As Dr Mohammad Taufik Bin Mohamed Shah, Diagnostic Radiology Resident puts it, “I teach because I do not like seeing new Residents and students struggle. Teaching reinforces my learning and my knowledge, and I am able to learn from those I teach as well.”
Residents honing their teaching skills at a RaFT workshop
By creating a culture of education programme among Residents and equipping them with teaching skills, the future pipeline of clinician educators is assured. This translates into real benefits not only for the medical community but more importantly, the patients.
Honouring Education Innovation and Excellence
Outstanding educators across healthcare professions transform education by advancing the boundaries of excellence and innovation.
ach year, the AM•EI Golden Apple Awards recognise faculty and staff who teach in SingHealth and Duke-NUS for their dedication, passion and innovation to improve teaching and inspire learners for better patient care.
Using SMS to Improve Feedback to Learners The winner of last year’s Golden Apple Award for Programme Innovation in the medical category is the team behind the Learning Teaching System (LTS) —a collaborative development between Nanyang Polytechnic (NYP), the National Cancer Centre of Singapore (NCCS) and Duke-NUS Graduate Medical School. The LTS is an automated system that utilises SMS messaging to engage surgical clerkship students and faculty in frequent, focused dialogues. LTS’s Facebook-like interface allows students to post their clinical reflections online and receive MEDICAL Learning Teaching System Duke-NUS Graduate Medical School/ National Cancer Centre Singapore/ Singapore General Hospital/ Nanyang Polytechnic
feedback from their clerkship supervisor almost immediately. Easy-to-use and intuitive, LTS has facilitated students’ clarity of expression, clinical reasoning and use of medical terminology. Submissions can be further shared among groups for additional learning points. Educators are alerted of postings via SMS and may provide feedback at their own convenience or pose further questions, allowing clinical learning to extend beyond the hospital. The founder of this innovative system, Assoc Prof Koong Heng Nung, Head and Senior Consultant, Division of Surgical Oncology at NCCS, said, “LTS enables educators like myself to extend the teaching environment beyond the physical environment into cyberspace and harness the power of digital communications. The SMS notification feature has shortened the turn-around time of feedback to the learner.” According to a student, “LTS has revolutionised and re-imagined learning and teaching for the digital age. It has empowered educators and learners to more effectively improve the outcomes of education; facilitating the training of better healthcare professionals and educators for improved care outcomes.” Since LTS was rolled out to 85 students under the surgical clerkship in March 2012, the system has increased the frequency, quality and detail of teaching feedback: students received an average of 18 responses from faculty during their 8-week clerkship, all occurring between six minutes to 2.4 days of the original posting.
Empowering the nursing profession as Resident Nurses Another award-winning programme in the nursing category, the Resident Nurse Training Programme also stood out for contributing to the grooming of Resident Nurses. Conducted under the aegis of the SingHealth Alice Lee Institute of Advanced Nursing, the training programme empowers Resident Nurses and equips them with competencies similar to that of junior doctors, often allowing the Resident Nurses to act as a bridge between clinicians and patients. Patients in turn benefit from more holistic and personalised care, in line with the vision for our healthcare system to move towards providing more integrated and seamless care across institutions. Dr Tracy Carol Ayre, SingHealth’s Group Director of Nursing and Director of Nursing, SGH said, “We introduced Resident Nurses to complement the healthcare team in providing prompt care to our patients.” NURSING Resident Nurse Programme SingHealth Alice Lee Institute of Advanced Nursing, Singapore General Hospital/ National Heart Centre Singapore
“The scheme is beneficial for Senior Staff Nurses and Nurse Clinicians who are keen to develop their expertise as practitioners,” she added. Since its commencement, the Resident Nurse Training Programme has trained 41 nurses in enhanced care competencies, including skillsets that were originally only taught to doctors, such as interview and history-taking, drawing blood specimens for blood culture as well as male catheterisation. Senior Staff Nurse Lissa V. Joseph shared her training experience, “I am more effective as a link between clinicians, nurses and patients. I can explain the care plan to my fellow nurses and help them better understand it, which improves the quality of care we are able to deliver.” The Nursing Resident Training Programme is led by Assoc Prof Lim Swee Hia, who has often been credited for single-handedly raising the profile of nursing in Singapore. She said, “The roles of nurses have changed to one with more empowerment and autonomy. There are more career paths, for example in nursing informatics, research and with advanced roles such as the Resident Nurse. These roles attract nurses to strive to advance further and render the best care for their patients.”
Nominate an educator for the AM•EI Golden Apple Awards 2014! Visit www.academic-medicine.edu.sg/amei/ gaa2014 for more information.
Tomorrow’s Medicine - ISSUE 7, MARCH 2014
SGH-Mayo collaboration bears fruit The long-standing ties between SGH and Mayo Clinic have created new inroads in patient care, including a novel procedure for tennis elbow
or years, the Department of Orthopaedic Surgery in SGH has kept a close and trusted working partnership with Mayo Clinic, a global leader in healthcare. The department regularly conducts visits to Mayo Clinic in Minnesota, to upgrade skill and learn from the institution, and also seeks consultation with their US counterparts for basic research projects. When the time came to look for an Asia partner to launch a new procedure for tennis elbow known as “percutaneous ultrasonic tenotomy”, Mayo Clinic knocked on the doors of SGH. Dr Joyce Koh, Senior Consultant, Department of Orthopaedic Surgery, SGH said, “It is one of the first official collaborations between our department and Mayo Clinic. We were approached by Dr Bernard F. Morrey, Emeritus Chairman and Professor of Orthopedics at Mayo Clinic, to be the first centre overseas to conduct a collaborative clinical trial to test the safety, good tolerability and early efficacy of the procedure.” In particular, SGH was chosen for its reputation as a tertiary institution in healthcare in Asia and beyond. Dr Koh elaborated, “We were trusted to be able to do the job properly and Mayo Clinic wanted to establish us as their Asia Centre of Excellence for this technology.”
Percutaneous ultrasonic tenotomy The new non-invasive procedure involves using ultrasound and a toothpick-sized probe to remove damaged tissue in the elbow. No sutures or stitches are needed for the new procedure for tennis elbow, and only a sterile adhesive bandage is used to cover the would. worked with the SGH team to develop and fine-tune the technique for clinical application. The first commercially performed procedure was successfully conducted at SGH in August 2012.
Twice, in June and November 2011, Dr Morrey and his team from Mayo Clinic flew into Singapore, bringing the equipment they developed. Here, the Mayo Clinic team
The institute is Singapore’s largest to specialise in neuroscience research and seeks to address the nation’s rapidly-ageing population and the rise of age-associated neurological diseases. Today, some 28,000 Singaporeans aged 60 and above suffer from dementia while the number is projected to increase to 80,000 by 2030. Jointly launched by NNI and Duke-NUS, the NNRIS will leverage strengths from the two organisations’ neuroscience research programmes. Some of the
Intellectual Property Koh Choon Heng, Senior Manager of SingHealth Intellectual Property (SHIP), answers questions on intellectual property in Medicine and SHIP’s role in SingHealth. Q: Why is the protection of Intellectual Property (IP) important in Medicine? A: You invest a significant amount of time and resources in developing a new diagnostic test, therapeutic process/ product or medical device to fulfil unmet patients’ needs. But you may find out that your ideas and findings have been copied, developed elsewhere and someone else is launching a similar product or service just before you do. You can prevent this by having the appropriate form of IP protection to stop competitors from copying and developing your idea. Q: What is SHIP’s role? A: SHIP protects SingHealth cluster’s IP and builds intellectual assets through patenting and trademark protection. We also commercialise SingHealth’s IP so that patients can benefit from them. When possible, we assist in gaining financial returns that can be used to fund further research and development.
On a personal note, Dr Koh shared that she has learnt much from the fruitful collaboration, “Consultative teamwork was something I picked up strongly from the collaboration; a professional interchange and two-way interactive process where we take turns to consult and listen to each other.”
Q: How do I go about filing a patent for my invention and commercialising it? A: Upon receiving your full invention disclosure submission, we assess its patentability, examine the commercial potential and talk to you to gain a better understanding of it. If the evaluation is positive, we submit a recommendation for patent application, engage an external patent agent to draft a patent document and work closely with you and the agent to have it filed at the appropriate Patent Office.
“Mayo Clinic’s patient-centeredness and orientation towards outcomes can also be further replicated here,” she added.
Mayo Clinic wanted to establish us as their Asia Centre of Excellence for this technology. – Dr Joyce Koh, principal investigator of the local study and Senior Consultant, Orthopaedic Surgery, SGH
National Neuroscience Research Institute Singapore launched ringing together more than 200 neurologists, neurosurgeons, neuroradiologists, neuroscientists and research professionals, the newly launched National Neuroscience Research Institute Singapore (NNRIS) will be dedicated to discovering cures and improving treatment for neurological disorders such as stroke, Parkinson disease, Alzheimer’s disease and dementia.
Frequently Asked Questions
The first-ever paper on the technology was published in The American Journal of Sports Medicine with Dr Koh as Principal Investigator and has been presented at conferences such as the Singapore Orthopaedic Association 36th Annual Scientific Meeting as well as the ASEAN Arthroscopy & Sports Medicine Congress 2013.
The novel, minimally invasive procedure is similar to cataract treatment and uses finely focused ultrasonic energy to break down a targeted area of scarred tissue responsible for the persistent pain and functional disturbance suffered by tennis elbow patients. Currently, SGH is the only centre in Asia offering this procedure. The road towards launching this treatment was a rigorous undertaking, and included seeking approvals from regulatory bodies such as the Singapore Health Sciences Authority , The American Food and Drug Administration and the SingHealth Institutional Review Board . Clinical trials commenced in August 2011 under the aegis of SGH’s Clinical Trial and Resource Centre and showed positive results that the procedure would be beneficial to patients here and in Asia.
objectives include integrating research resources, developing a new research facility as well as creating greater synergy among neuroscience professionals. Professor Lee Wei Ling, Director of NNI, said, “NNRIS represents Singapore’s first concerted step to tackle neurological problems and to look for practical solutions for our patients in the face of our ageing population and the rising incidence of neurological diseases.” While the NNRIS has its primary focus on local neuroscience research needs, it also aims to attract prominent collaborations with global scientists and industry players. Said Professor Ranga Krishnan, Dean of Duke-NUS: “The critical mass of talent and resources at the NNRIS makes it fertile ground for scientific discoveries and medical breakthroughs.”
SHIP also facilitates and fosters collaboration between researchers/clinicians and industry through executing research collaboration agreements. We safeguard SingHealth’s interests in IP ownership and commercialisation rights during the negotiation process of those agreements so that patients get the best opportunities from our investment in research.
Typically, after your patent application is filed and as it matures, SHIP will seek out a potential company (licensee) who wants to, and can, further develop the invention towards the patient and for marketing to the Healthcare market.
SHIP then negotiates commercial terms and works with SingHealth’s Legal Department to draft an appropriate license agreement to grant rights for commercialisation, including details like how/when/where this IP can be used, royalty, improvement rights, IP maintenance and enforcement.
Q: What is the one most important thing I should take note of when it comes to protecting my IP? A: File a patent application before disclosing your work or results of your invention that might have significant benefits to patients and possible commercial potential. Not doing so can seriously ruin your chances of obtaining good patent protection. If in doubt, contact SHIP for advice. From 2008 to January 2014, SHIP has filed more than 110 patents applications and executed 13 licenses for transfer of IPs to industry for further development, manufacturing, marketing and sales. One such recent successfully licensed invention was a device developed by Prof Alex Sia of KKH, on computer assisted, patient controlled administration of analgesia. If you would like to speak to SHIP about patenting your invention, please contact Choon Heng at email@example.com
NHCS new building Newly relocated to 5 Hospital Drive (opposite SGH Block 4), NHCS received its first patients at its bigger and better premises on 10 March 2014. Covering a gross floor area of 48,000m2, the building features 38 specialist outpatient clinic rooms, six cardiac catheterisation labs and three major operating theatres - doubling its previous location. One-and-a-half floors have been devoted to cardiovascular research activities and facilities. For further queries, email firstname.lastname@example.org
Tomorrow’s Medicine - ISSUE 7, MARCH 2014
Tan Cheng Lim Research and Education Fund
esearch and education for paediatrics in Singapore received a boost on 22 February at the Festschrift dinner that paid tribute to Emeritus Consultant Professor Tan Cheng Lim.
The Tan Cheng Lim Research and Education Fund was successfully launched with more than S$1.4 million raised through donations and pledges. The fund, established by Paediatrics ACP, aims to pioneer advances in paediatric medicine, promote innovative research to discover new cures for patients, and prepare paediatric healthcare leaders of the future.
The fund was launched at a Festschrift dinner with more than S$1.4 million raised
Prof Tan said, “My vision for healthcare is for every patient to receive care from dedicated, well-trained, knowledgeable and efficient healthcare professionals. The Research and Education Fund is created to develop such individuals, and through them, to advance paediatric medicine for the enduring benefit of every child.” In celebration of Prof Tan’s 75th birthday; the evening also honoured his legacy as Singapore’s longest-serving public paediatrician. Prof Tan served as the President of the Singapore Paediatric Society in 1973, and has helmed the paediatrics department at Alexandra Hospital, SGH and KKH. Said Professor Kenneth Kwek, CEO of KKH, “With 50 years of clinical practice, medical research and education, Prof Tan has been prolonging and improving the lives of countless patients and their families, contributing to medical science and bringing up future medical practitioners.” Prof Tan continues to contribute as an Emeritus Consultant in KKH, a member of the SingHealth Institutional Review Board, and a teacher at Duke-NUS Graduate Medical School and Yong Loo Lin School of Medicine.
1960s: Prof Tan Cheng Lim as Medical Officer in Paediatrics.
SingHealth Office of Research Grant Call Reminder
National Research Foundation (NRF) Investigatorship
31 Mar 2014, 5pm
S$3M for a period of 5 years
Traditional Chinese Medicine Clinical Research Grant (TCMCRG)
31 Mar 2014
S$750K for a period of 3 years
NUS Master of Clinical Investigation (MCI) programme
31 Mar 2014, 4pm
Total fees for the course: S$25K + S$5K Research Fee
FACULTY DEVELOPMENT WORKSHOPS
Singapore NRF Fellowship 2015
11 April 2014, 5pm
5-year research grant of up to S$3M
based learning to enhance the learning within your course
NRF Competitive Research Programme (CRP)
Open throughout the year
Realistic budget with appropriate justifications for a period of 5 years
my research message out?
Duke/Duke-NUS Research Collaborations
Open throughout the year
• USD$50K to USD $150K to Duke PI • S$$50K to S$150K to Duke-NUS PI
NMRC Clinical Trial Grant - Co-Development Scheme (Co-D)
Open throughout the year
<S$5M for a period of 3 years
RESIDENTS DEVELOPMENT WORKSHOPS
MOH Industry Alignment Fund (IAF Cat 1)
Open throughout the year
<S$500K; <S$1M; <S$1.5M (3 subcategories) for a period of 3 years
Khoo Mentored Research Award (KMRA)
Open throughout the year
<S$300K for a period of 2 years
EDUCATION GRAND ROUNDS
Khoo Pilot Award
Open throughout the year
<S$30K for a period of 1 year
Open to all SingHealth and Duke-NUS staff. For details and registration, contact the Academic Medicine Education Institute (AM•EI) at email@example.com WORKSHOPS
26 Mar, 11.00am-2.00pm: The “flipped” classroom: Using team25 Apr, 9.00am-5.00pm: Advanced manuscript writing: How do I get 28 Apr, 1.00pm-5.00pm: What is the best instrument for my research outcomes?
14 Apr, 1.30pm-4.00pm: Bedside teaching – Creating a positive
10 Apr, 5.00pm-6.00pm: i-Paddle – An interactive web-based
For more information on funding sources and support for research in SingHealth, visit http://research.singhealth.com.sg or email firstname.lastname@example.org
Singapore Healthcare Management 2014 co-located with Singapore Healthcare Management Congress 2014 Singapore Healthcare Supply Chain Management Congress 2014 Singapore Healthcare Enterprise Risk Management Congress 2014
19 to 21 August 2014
Call for Abstracts
Submission deadline : 20 April 2014
For more information, please contact Ms Celene Oh or Ms Nancy Ng at email@example.com
TRANSFORMING VISION INTO REALITY A signature event showcasing the synergy in the SingHealth and Duke-NUS’ joint a cademic partnership – this Scientific Congress brings together thought leaders and healthcare professionals to share insights in care improvement, research and education to improve patients’ outcomes.
Published on Apr 7, 2014
Published on Apr 7, 2014
In this issue we take a look behind clinical trials, intellectual property in Medicine, and a collaboration with Mayo Clinic that resulted i...