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Duke-NUS Report Card A+

28 May will be a special date for Duke-NUS Graduate Medical School. It is when its first crop of graduates, groomed from the partnership betwen SingHealth and Duke-NUS, will bear fruit.

Duke-NUS pioneer batch students (L-R) Karen Nadua, Lim Kheng Choon and Ong Liming, pictured here with Dean Prof Ranga Krishnan. (Photo by Bryan Tan, Duke-NUS)

”It seems like only yesterday that the school started. Time has flown by and now the students are ready to fly on the next phase of their journey to become physicians! We are very proud of what the students have achieved and for the many faculty and staff who have helped make this a reality.” - Prof Ranga Krishnan, Dean

For the longest time, medical education has been considered a sacred cow. So when Duke-NUS decided to take a radical approach, it met with skepticism from many quarters.

“We felt we had a great idea,” Dr Sandy Cook, Senior Associate Dean, Curriculum Development of Duke- NUS said candidly. “But there was no precedence for this strategy and we were really going by faith that it would work.”

Now, four years on, with the pioneer intake of Duke-NUS students ready to graduate in May 2011, they have earned the right to say with every certainty that their staunch belief in the program has been well placed.

The results achieved by the students have been nothing short of outstanding, exceeding all expectations.

In the International Foundations of Medicine Examination, two Duke-NUS students emerged among the top ten of about 2,000 candidates from around the world. Some 34% of the class scored within the top 10% of the exam, and received a certificate of excellence.

Similarly in the United States Medical Licensing Examination, Duke-NUS students scored above the US national average, even impressing their counterparts from Duke, Durham. In fact, Duke has already sent several faculty to study the pedagogy of Duke-NUS, with every intention of applying the same methodology back home.

Preliminary data at KKH has also shown that, to everyone’s surprise, patients liked having the medical students attend to them because the students had more time to listen to their stories and had better continuity of care with them. This in turn, means more holistic and better care.

With SingHealth progressing towards academic medicine and Duke-NUS moving in tandem, it looks like a perfect partnership been born.

So what sets Duke-NUS apart from other medical schools?

Celebrate and Leverage on Student Diversity

Duke-NUS welcomes students from varied backgrounds and educational qualifications. Duke-NUS students have already earned Bachelors, Masters and PhDs in a variety of areas from the arts and humanities to science and engineering.

This, according to Prof Bob Kamei, Vice-Dean of Education, Duke-NUS, is one of the key strengths of the program. “If you’re going to be on the leading edge of medical science, you have to look at problems in new ways,” he explains.

“I remember sitting in the first year class and a student, who was a nurse, was able to see a problem from a much more patient-centric point of view than the other students who had little previous experience with patients.

People mistakenly think medical training as a graduate student is an “education startover”. It’s not. They’re bringing their wealth of experience to the training and adding medical training to it.

This is where the value lies. And with learning done in teams, the students bring these diverse backgrounds to help educate their team mates.”

These students hail from different countries and among them are two world-class sailors, a Peabody scholar who has competed at the prestigious International Frederic Chopin Piano Competition, a world class fencer and a chess champion.

To Prof Kamei, these achievements are examples of the students’ creativity and mettle. “We don’t just want the straight A student. Problem-solving is more than following best practices by memorising facts; it takes passion, dedication and the ability to see a problem from different angles. That’s why we look for people who are multi-dimensional.”

The Man Behind The Team

A paediatrician by training, Prof Bob Kamei had the largest general pediatric practice at the University of California, San Francisco, when he was asked to become the Director of the residency training program and take overall responsibility for the training of the pediatrics residents.

When he expressed concern over taking this role and giving up time to treat his patients, his mentor replied, “Bob, by training residents, you will be helping treat their patients.”

Having trained approximately 450 paediatricians over a period of 17 years, Prof Kamei is a fervent believer in the impact of teaching. “Physicians have a social commitment to pass on the knowledge,” he expounds. “I find it inspiring to be around brilliant minds and my students spur me to improve.”

The next step for Prof Kamei is to implement Team-based Learning into clinical training.

The Power of Teambased Learning

At Duke’s campus in the US, it was found that attendance at lectures had been dwindling, since students prefer to watch the video lectures at their own time outside of the classroom. Student feedback revealed that while they studied much of the “whats” and “hows” in their medical training, they did not always understand the “whys”. They didn’t understand how the science they were learning actually applied to clinical medicine.

Thus began a massive exercise and opportunity for Duke-NUS to redesign a different form of teaching, to provide students with a better educational experience. The result was TeamLEAD – a ground-breaking approach utilising the team-based learning concept.

Instead of attending a class to amass information, students at Duke-NUS are expected to do independent learning before they attend a class.

This allows students the flexibility of studying at their own pace – an important factor especially since the students hold vastly different pockets of existing knowledge. For instance, a PhD holder in microbiology will have pre-knowledge of certain modules compared to someone with an anthropology major.

In class, students sit for a Readiness Assurance Test, to assess their understanding of key concepts both as individuals and as a team.

Established clinicians partner with basic scientists as faculty to facilitate discussions where teams can pose additional questions and other teams are assigned to answer them.

Students then move to a practical application of the material through problem-solving activities. They are allowed to use textbooks and the internet to quickly answer questions they don’t know or facts they don’t remember that are necessary to solve these problems.

The active engagement of students means much higher-level discussions, moving away from basic concepts and delving into the “whys” of medicine.

Dr Cook admits that the debate is sometimes so challenging, even the faculty themselves are stumped!

“But this is excellent because as doctors and teachers, the worst scenario is to think that we have all the answers. The best doctors and teachers continue learning all the time.”

Studies have shown that students learn best by teaching and interacting with each other, instead of passively from a lecturer. TeamLEAD harnesses that power and translates it into results. As Prof Kamei succinctly puts it, “To teach is to learn twice.”

Set out to Groom Clinician-Scientists

One of the hallmarks of the Duke-NUS curriculum is its emphasis on research. Instead of the traditional two years on basic science that US medical schools undertake, Duke spends just one year on basic science (Year 1). The additional time is allocated to research in Year 3, something that is becoming increasingly important in medical science, especially in Asia.

“We used to think that we can rely on the research of other countries and just apply them here,” explained Prof Kamei.

“But for example in Asia, we’re finding that patients react very differently to medicine than those in US and UK. Another example, why is there such a high level of diabetes in Singapore?

What’s special about the disease pattern here? If we don’t do research in Singapore, we will not be able to find these answers and improve the way we practise medicine here.”

“It is much easier just to care for patients,” clarifies Prof Kamei, “At Duke-NUS, we want to groom academic physicians who improve the care of patients, which is a much bigger goal.”

Dr Cook adds, “A good doctor has clinical skills and knowledge. A great doctor uses that knowledge to improve the practice of medicine. Duke-NUS students all have signs of becoming great doctors.”

Caring for Future Doctors

At Duke-NUS, students are nurtured with the same warm and personalised approach that they experience in their learning. Students here are not just faceless entities. In fact, many of them are known by name even to those in the School’s top management.

Senior doctors are appointed as College Masters to look after student needs beyond academics. “Our faculty are engaged with our students in many ways, including coaching, advising, assessing, and encouraging” said Dr Craig Stenberg, Associate Dean of Student Affairs and Admissions. Financial concerns are also taken care of, with a team ensuring that needy students receive support.

“This is to ensure an environment where everyone is actively engaged in learning, where questioning is encouraged, where learners are from diverse backgrounds, where innovation and entrepreneurship is encouraged, where everyone is supported and challenged.”

Extracted from me+SH (Mar-Apr 2011), a SingHealth Publication