Summary:

Dr Dujeepa D. Samarasekera discusses recent and future transformations in medical education in Singapore, with reference to both undergraduate and postgraduate education.

Article:

Undergraduate Medical Education

Undergraduate medical education in Singapore has transformed greatly in the last decade expanding from a single medical school to three medical schools. All three medical schools are government and there are no private medical schools in Singapore.

• Yong Loo Lin School of Medicine – Established in 1905 and offers Bachelor of Medicine Bachelor of Surgery (MBBS) degree. This is a 5 year program and the entry is for the Junior College students. The curriculum is an integrated system based in the first two years and from third year it is clinical clerkship based with the final phase consisting of a Student Internship phase. The school uses a variety of teaching-learning methods which includes small groups (Case Based Learning, tutorials, and simulations) and interactive large groups using technology based modalities. Annual student intake is approximately 300.

• DUKE-NUS Graduate Medical School was established in 2005 and is a graduate entry program. The school is collaboration between Duke Medical School in USA and National University of Singapore. The program is a four year course leading to a MD degree. The first year focus is on learning basic sciences and in the second year, the students get an in-depth understanding into biomedical research. The last two years are based on clinical clerkships. The school uses Team-Based Learning as the main modality of instructions in the early years of learning. Annual student intake is approximately 50.

• Lee Kong Chiang School of Medicine was established in 2013 and is a collaborative project between Imperial Medical School UK and Nanyang Technological University, Singapore. This is a 5 year program leading to MBBS and the entry is for the Junior College students. The current student intake is approximately 50.

Postgraduate Medical Education
Postgraduate specialist training has also undergone major shifts over the past few years. From the traditional training format of one year housemanship to medical officer and then to Basic Specialty Training to final Advance Specialty Training to become an associate specialist or specialist was restructured to a North American style residency training. The current training has adopted the Accreditation Council for Graduate Medical Education- International format and is now accredited by ACGME-I. Singapore is the first country outside USA to adopt this system of residency training.

Teaching-Learning Environment
Clinical and Basic Science Teachers To support the major shifts in both UG and PG medical education, the government together with the ministry of health/education and the training institutions have incorporated changes to teaching positions as well as developed supportive infrastructure. One of the main changes to the current system is the new Teaching Track for basic science and clinician educators. This track is now a tenure track at National University of Singapore. Similarly the major hospital groups have incorporated clinician educator track as a career development pathway for their clinicians and other health professionals. To support the educators each training institution has invested in support staff and education offices. Faculty training has also being developed through professional medical educators and medical education units.

Teaching-Learning Settings
Another significant development is the establishment of Academic Medical Centres. Presently there are two such entities – National University Health System (NUHS) and Singhealth Academic Medical Centre. NUHS is the umbrella organization for Yong Loo Lin School of Medicine, Alice Lee Centre for Nursing, Dental Faculty NUS and the National University Hospital. Singhealth AMC has Duke-NUS graduate medical school and Singapore General Hospital as partners. The focus of AMC’s is to incorporate their three missions – Service, Teaching and Research successfully.
Technology Enhancement
Another major focus is the investment and development of technology enhanced learning. New state of the art learning facilities, Simulation Hospitals and learning systems are developed and incorporated. Uses of videos, virtual patients, anatomical dissection models and newer learning methodologies such as “Flipped Classroom” are incorporated.

Future Directions
Singapore plans to extend the advances made in medical education to other health professions specially to Nursing education and Allied Health. As the first step, in all major hospital groups, training in these professions and medicine are harmonised through a designated education office. Increased funding is made available to all the health professional training programs.

Professional bodies such as the Academy of Medicine are establishing chapters for educators to assist the training as well as to share experiences of senior clinicians. These institutions together with the established training institutions are also extending the assistance, sharing of experiences to neighbouring countries.

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