A publicAtion of the SingheAlth AcAdemic heAlthcAre cluSter

Every day, patients’ lives are saved in our institutions, thanks to the availability of new, better treatments

and healthcare professionals who are well-trained in the latest innovations in Medicine.

But what may not be apparent to all is that it is always a team effort. Only a multidisciplinary team can have such an impact on the care of a patient.

Recognising that good team collaboration and communication are critical in enhancing continuity of care, improving clinical outcomes and patient satisfaction, the inaugural SingHealth Duke-NUS Education Conference, which ran from 15 to 17 August, placed inter-professional learning and collaboration in the spotlight.

Professor Chay Oh Moh, Director of Education at KKH Campus and Chairperson of the conference, said, “Focusing on inter-professional learning, the conference provided an excellent opportunity and platform for all healthcare professionals to come together and share best practices in clinical education with one another.”

Along with well-accomplished education partners SGH Postgraduate Medical Institute, SingHealth Alice Lee Institute of Advanced Nursing, SGH Postgraduate

Allied Health Institute and the SingHealth Polyclinics Primary Care Medical Education, the education conference offered plenary sessions, workshops and discussions in two programme streams: educators and learners.

Some 673 doctors, nurses and allied health professionals (AHPs) from various SingHealth institutions, including 293 residents, participated in the conference.

Prof Chay elaborated on why inter-professional collaboration was increasingly critical in today’s evolving healthcare landscape: “Healthcare has become much more complex, and there is no one person who can meet all the needs of a single patient. Working as a team to provide collaborative care is the way to go.”

Recent examples have shown positive outcomes. An initiative by nursing educators and medical specialists at KKH has resulted in the development of a new cadre of resident nurses, who have acquired competencies similar to those of junior doctors’. They are equipped with interview and history gathering skills, and are able to perform physical examinations as well as initiate investigations and management.

Inter-professional learning is also defining how knowledge is shared systematically

throughout the cluster. For example, community outreach programmes on asthma are jointly organised by KKH and SGH with nurses leading the way. Nurses and AHPs are also imparting skills to medical trainees to help them in the clinical setting.

Encouraging healthcare professionals to learn from one another also strengthens the culture of education in Medicine. “From residents to nurses, everyone can teach and teach better. We teach our patients and we teach one another in the form of peer learning, which can be very effective,” Prof Chay said.

SingHealth’s Centre for Resident and Faculty Development (CRAFD) and its Residents as Future Teachers (RaFT) programme, a joint initiative with the Academic Medicine Education Institute, also aims to cultivate the spirit of education across the cluster in residents and faculty. CRAFD holds workshops such as Bedside Teaching and Giving Effective Feedback as part of RaFT.

As the practice of multidisciplinary care grows, inter-professional learning becomes necessary to address the gaps and keep patient care consistent across the board.

Prof Chay put it simply, “As medical subspecialties develop, there will be a concern with support services trying to keep pace. Having tighter communication and collaboration among the different professions and disciplines will ensure that patients receive the same quality of care from doctor to nurse to AHP.”

the voice of AcAdemic medicine

medicinetomorrow’S

iSSue 3, october 2013

Learning beyond the boundariesInter-professional learning is changing the face of education in SingHealth

Having tighter communication and collaboration across different professions and disciplines will ensure that patients receive the same quality of treatment from doctor to nurse to AHP.

– Prof Chay Oh Moh

MICA (P) 143/07/2013

Today’s medical classroom is a far cry from the heavy books, paper trails and overhead projector

transparencies of a not-so-distant past.

Cutting-edge digital technologies such as game simulations, virtual classrooms and on-demand video streaming enhance the domain of medical education and enrich the learning experience of a new generation of learners.

The SingHealth Blackboard eLearning portal and the Mediasite eLecture recording platform are just two of the cluster-wide developments that have changed the way educators teach and how students learn at SingHealth, since their implementation five years ago.

The two platforms integrate into the Learning Management System, which will centralise all future learning activities. (see box article)

Medical classrooms in an increasingly mobile future

Supporting education through technology

Continued on page 2

Photo Credit: SingHealth Group Education

Providing a one-stop portal for educators and students, Blackboard has become a cornerstone virtual workspace for collaborations, self-learning and interaction. Users can access reading material, watch video lectures and take assessments without setting foot in a classroom.

The portal has seen an explosive increase in the number of users since its introduction five years ago, reaching close to 17,000 unique users in FY2012 as compared to 500 in FY2008.

It can now also be accessed via portable devices; ideal for the time-poor educators and learners.

Mediasite moves the traditional classroom to the virtual domain by recording lectures on video and enabling online live streaming and archiving. A lecture recorded today can be preserved and viewed decades later by a learner from another country.

One of the heaviest users of Mediasite is SingHealth Residency, which currently has 433 videos housed on the server. Most of the Residency programmes have already adopted the eLearning platform.

Orientation programmes for residents have proven popular online. The contents are available for multiple batches of students, and what used to be a two-day programme has been reduced to one day. Students read materials before the session, leaving important face time for interaction and engagement with teachers.

Edison Ng, Manager, Learning Technologies at SingHealth Group Education, shared, “Educators can now use interactive games and simulations, live video demonstrations and mobile applications to engage learners.”

Besides learner engagement, education technology has also improved the quality of assessments. Educators can track an individual student’s progress and online attendance with automatically generated reports, and assessment videos created by students can be shared for peer review.

Interaction and engagement in education is boosted further by the state-of-the-art learning facility located within Academia.

From the extensive use of simulation in Academia’s mini hospital to live streaming and recording facilities, Group Education hopes to enhance education both inside and outside the classroom.

Tan Wei Ming, Director, SingHealth Group Education, considers education technology as one of the key pieces that makes education at SingHealth vibrant and ahead of its time:

“One of SingHealth Group Education’s key priorities is to let our learners know that we are here to help them develop and enhance their learning journey.

“Well-trained faculty supplemented with advanced learning technologies take their experience beyond the classrooms because truly, learning has no boundaries.”

SingHealth Group Education has harnessed technology to make learning available anytime, anywhere through the use of the Learning Management System (LMS)

What?A One-Stop Learning Management SystemLMS is an internet-based education platform where users can learn and share information at their own convenience, promoting student-centric active learning. It hosts and shares contents across SingHealth institutions. Its features include virtual classrooms, online chat, video conferencing, tracking of progress and results.

Where?SingHealth Blackboard eLearninghttp://blackboard.singhealthacademy.edu.sg

Mediasite eLectureshttp://mediasite.singhealthacademy.edu.sg

How?eLearning Platform- online learning materials, graded assessment and discussion forums- interactive content with animation, videos, games and quizzes

Multimedia Development- interactive games that improve retention- interactive 3D graphics for simulation exercises- education videos

Lecture Recording and Live Broadcast- one-stop digital media library hub- live simulcast to different locations- on-demand recording and viewing

Blended Learning- combination of different learning styles using the latest technology to create a new, stimulating learning experience through multichannel learning tools (video, audio, interactive content, face-to-face)

EdiTorS-in-CHiEfTan-Huang Shuo MeiAudrey Lau

EdiTorSJennifer WeeKenice TayArthur WongStephanie Jade

JoinT EdiToriaL TEamGoh Sai Luan (SGH)Ichha Oberoi (KKH)Edwin Yong (NCCS)Lio May Fern (NDCS)Jessica Koh (NHCS)Christina Valerie Wee (NNI)Dr Thiyagarajan Jayabaskar (SNEC)Eric Lim Wei (SHP)Wee Lai Ming (Duke-NUS)

dESignRedstone Communications

CopyWriTingHedgehog Communications

TomorroW’S mEdiCinE - ISSUE 3, oCtobEr 2013pagE 2Continued from front page

Edison ng demonstrating

mediasite – SingHealth’s

eLecture recording platform that

can be accessed anytime, anywhere

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.

tomorrow’s Medicine is a monthly publication on Academic Medicine news

on 16 August, we welcomed future doctors to the SGH Campus - the 7th Intake of Duke-NUS MD Students (Class of 2017) - at the White Coat Ceremony in the College of Medicine Building. The students were presented with their white coats

and recited the Hippocratic Oath together, affirming their commitment to the profession and the patients they will serve. Guest-of-Honour Professor K Satku, Director of Medical Services, Ministry of Health, as well as many Duke-NUS faculty, Governing Board members, parents, relatives and current students were present.

Similarly, 300 freshmen from the NUS Yong Loo Lin School of Medicine (Class of 2018) donned their white coats on 7 August at the NUS University Cultural Centre, with Associate Professor Chin Jing Jih, President of Singapore Medical Association gracing this rite of passage in the journey towards a medical career.

White Coat Ceremony 2013

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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 medicineDuke-NUS Graduate Medical School Singapore

(Duke-NUS)

tomorrow’s Medicine welcomes comments from our readers.

Write to us at editor@singhealth.com.sg

Visit tomorrow’s Medicine onlinewww.tomorrowsmed.com

Learning on the move

Well-trained faculty, supplemented with advanced learning technologies take their experience beyond the classrooms because truly, learning has no boundaries.

– Tan Wei Ming

nUS yLL Som

duke-nUS gmS

Number of recordings on Mediasite

1520

28

112

14

433

24NCCS, NHCS, SNEC, NNISingHealth ResidencyCGHSGH / KKHSHPSingHealth Corporate OfficeSingHealth Research

Users of Blackboard

5002,000

4,0005,492

16,936

FY08 FY09 FY10 FY11 FY12

a 49-year-old mother of three young children was found to have advanced kidney cancer extending into the cava all the way to the liver and right atrium. After a detailed workup and

discussion with the family, she was taken to surgery despite a likely poor outcome.

A multidisciplinary team undertook the marathon operation which included a cardiopulmonary bypass with profound hypothermia and circulatory arrest.

She recovered miraculously and was home within two weeks after surgery. Seven months on, she shows no evidence of disease and went back to work.

Scientific evidence had suggested a dismal outcome. The fact that she is free of disease may be attributed to excellent emotional support – she has a loving husband and three concerned children in a close-knit family. Throughout her treatment they showed total faith in the medical team, and the patient herself was highly motivated to recover.

This semi-miracle might be possible even with mediocre physical facilities but never without an organisational culture of team work and human empathy.

Hospital planning and design is about going beyond the science of efficient and safe design to creating a total experience where fruitful collaborations and compassionate care take place in a trusting environment.

This total experience is not merely a matter of achieving technical excellence. Patients can scarcely differentiate clinical outcomes of technical excellence due to the complexity of medicine and individual variability. In short, a technically brilliant outfit drained of human touch will be a hostile environment for healing.

Imagine navigating impossible car parks, lying in an uncomfortable environment or queuing up to watch electronic numbers tick. How do we build trusting relationships from such a negative starting point?

Planners and users need to get together to focus on more than physical design for efficiency. Operational processes and models of care are as important as physical and aesthetic quality in ensuring the right user experience.

This is not just a “good to have” but an imperative. The hospital build is only one part of the Sengkang Health journey. The residents of the Northeast, living in the vicinity of the Sengkang General Hospital, need to view the hospital and its associated facilities as a detour in their journey of health and sickness while the larger component of health maintenance occurs in the community.

For this reason, building social equity with the residents of the Northeast where the Sengkang General Hospital will be located is just as important as hospital planning to us.

The Sengkang Health team has been reaching out to residents and community leaders of the Northeast and has kept them abreast of our hospital planning developments. We value their input and feedback and have incorporated quite a few of their suggestions into our hospital design. We plan to continue to involve the community as we build our programmes to promote healthier communities.

In this journey, there is a danger of succumbing to the numerous constraints and become penny wise and pound foolish. We can be more or less certain of building an efficient hospital, but are we any closer to building a hospital of the future?

Some say the future of healthcare is social. I agree. We build the people, the system and the structure to cater for this new chapter of healthcare. Together with our community, we aim to arrive at this place of total experience where healing and wellness take residence.

Q. What is a VAP?A. VAPs are recorded slide presentations

that may be streamed online from any mobile device including smartphones and tablets. Each slide of the VAP is voice annotated and the VAP contains an indexed playlist so viewers can return to or skip to any slide within the presentation.

VAPs are open access, meaning they provide free, quality, education to everybody. It is also easily accessible to anyone who needs it globally. It enables the bigger aim of Duke-NUS as a quality education hub, sharing our expertise with a wider audience.

Q. What kind of VAP content is available?

A. There are two main groups - VAPs on “Principles of Clinical Research” connected to the mission of educating and improving skills of clinical researchers, and VAPs under the module “Learning in Ten” with clinical case content for medical students and clinicians.

We are also developing integrated assessment tests and a VAP competency certificate programme on clinical research skills for healthcare professionals and students.

Q. What are the most viewed VAPs?A. Research methods have proven popular,

but “10 reasons why your research grant is not approved” is probably the most popular. Other topics such as why one should go into research, how to develop a clinical research career or how to write a research proposal are also used widely.

Currently, we have more than 300 VAPs in the library and growing. We are recording lectures for the PhD programme in Integrative Biology and Medicine. ACPs and Signature Research Programs are using VAPs to present to our second year medical students.

Q. WhatarethebenefitsoflearningviaVAPs?

A. Learners gain greater control over their learning. They can learn at their own pace – pausing or skipping over parts, learn in transit and stream information on demand to get better time management and focused learning. VAPs are also a great aid for instructors, for example in running a workshop.

Instead of giving the same lecture every time, participants watch it prior to the workshop. At the workshop, ample time is available for case studies and discussions.

We are also working on developing the site as a workspace where learners can create playlists, edit and combine slides from various presentations, create learning goals, add notes and develop a personalised working notebook.

Q. What if I am interested in contributing a VAP?

A. If you have a specific area of knowledge to share, you can create and upload a VAP. To get started, contact us at vap.team@duke-nus.edu.sg.

Frequently Asked

QuesTiOns

pagE 3TomorroW’S mEdiCinE - ISSUE 3, oCtobEr 2013

Dr Silke Vogel, Assistant Dean of Graduate Studies, Associate Professor, Clinical Sciences, Duke-NUS answers questions on Duke-NUS’ Voice Annotated Presentations (VAPs)

Hospital of the futureby professor Christopher ChengPro-tem CEo, Sengkang Health

in short, a technically brilliant outfit drained of human touchwill be a hostile environment for healing.

good leaders build good health systems to improve patients’ lives - the SingHealth Leadership Competency Model (LCM) was conceived with this goal in mind. LCM runs leadership

training programmes to build a sustainable leadership pipeline of leaders with behaviours aligned to SingHealth’s core values. More than 400 employees have attended its programmes since April 2012.

LCM is just one of the many impactful ideas and initiatives displayed at the poster competition at the inaugural Singapore International Healthcare Week from 19 to 21 August. Local healthcare administrators submitted 130 innovation and improvement projects on supply chain, service quality, human resource, risk management, finance and communications. Prizes were awarded to 27 winning posters from across the different categories.

Tan Jack Thian, Group Chief Operating Officer and Group Procurement Officer, shed light on the significance of the event, “This is an exciting initiative to provide a world-class learning and networking platform for local and overseas healthcare leaders and administrators.

“Coming together to exchange ideas and best practices enables us to tap on collective wisdom to address common challenges faced and set new benchmarks to raise the standards of patient care.”

The Singapore International Healthcare Week offered administrators the opportunity to acquire new knowledge and perspectives on healthcare management, discuss solutions to common problems as well as the opportunity to connect with like-minded partners.

Very often, healthcare administrators do not see a direct link between their work and impact on patient outcomes. But one winning poster, HealthXchange by SingHealth, proved that the link is indeed strong.

The HealthXchange internet portal was set up in 2010 amidst the rising health literacy in Singapore. It offers visitors localised health advice from healthcare professionals in SingHealth institutions. Since its launch, it has become the second-highest visited site among SingHealth’s websites, with 100,000 to 150,000 unique visitors a month.

Apart from the myriad of projects displayed, some 700 visitors to the event attended more than 80 interactive sessions featuring various industry experts and renowned thought leaders from local and overseas healthcare and academic institutions.

Voice annotated presentations (Vap) at www.duke-nus.org

Healthcare administrators in the limelightSingHealth administrators showcase more than 100 innovative projects at Singapore International Healthcare Week

The inaugural singapore international Healthcare Week included the singapore Healthcare Management Congress, singapore Healthcare enterprise Risk Management Congress and singapore Healthcare supply Chain Management Congress. For more information, visit www.sihw.com.sg

Coming together to exchange ideas and best practices enables us to tap on collective wisdom to address common challenges faced and set new benchmarks to raise the standards of patient care.

– tan Jack thian

TomorroW’S mEdiCinE - ISSUE 3, oCtobEr 2013pagE 4

news over multiple Channels

www.tomorrowsmed.com

Grant Closing Date Grant Amount

National Research Foundation (NRF) Competitive Research Programme (CRP) 12th Call-For-Proposals

11 October, 3pm

<$10million up to a period of 5 yrs

Singapore Sports Institute Sports Research Grant (SSI SRG)

18 October, 5pm

Up to $50,000 for ≤ 1 yrUp to $100,000 for ≤ 1.5 yrsUp to $150,000 for ≤ 2 yrsUp to $400,000 for ≤ 4 yrs

Singapore Sports Science & Technology Research Grant Call

15 November, 5pm

Up to $50,000 for ≤ 1 yrUp to $100,000 for ≤ 2yrsUp to $200,000 for ≤ 3 yrsUp to $400,000 for ≤ 4 yrs

National Medical Research Council Clinical Trial Grant: Clinical Trials Grant Co-Development Scheme

Open throughout the

year≤$5 million

Ministry of Health Industry Alignment Fund Category I

Open throughout the

year

Up to 30% of total project costs, capped at

> $500k per pre-clinical project> $1million per clinical project> $1.5million per translational

project involving both pre-clinical and clinical elements

GlaxoSmithKline (GSK) Academic Centre of Excellence

Open throughout the

yearBased on evaluation by GSK

research grants For more information on funding sources and support for research in SingHealth, visit http://research.singhealth.com.sg or email office.research@singhealth.com.sg

AM•EI EventsFor details and registration, contact the Academic Medicine Education Institute (AM•EI) at amei-info@duke-nus.edu.sg

AM•EI EDUCATION GRAND ROUND (at KKH)10 Oct, 5.30pm-6.30pm: Giving individualised feedback in a group setting is possible 18 Oct, 1pm-2pm: What do you need to think about when creating a learning activity?

FACULTY DEVELOPMENT WORKSHOPS8 Oct, 1pm-5pm: Learning at the bedside – creating a positive learning experience16 Oct, 9am-1pm: Advancing your career as an educator: building your education portfolio22 Oct, 1pm-4pm: Why keep your plans a secret? Designing effective objectives and their links to quality multiple choice questions1 Nov, 1pm-4pm: Issues and challenges with assessment and evaluation5 Nov, 1pm-4pm: Making learning sessions engaging – the role of facilitation in group teaching environments

amri EventsFor details and registration, contact the Academic Medicine Research Institute (AMRI) at amri_info@dukenus.edu.sg

30 Oct, 9am-5.30pm: Duke-NUS SingHealth Inaugural Omics Symposium13 Nov, 9am-6pm: Linear and Logistic Regression in SPSS

AcAdemiAAT

Undergoing organ transplant is a life-changing experience. For many patients, it is one marked by both

hope and fear. Transplant patients could face great inconveniences if they had to make multiple appointments to see different specialists, some of them requiring different investigative procedures to be done. This could add stress to an already nerve-wrecking ordeal.

Thanks to a S$5 million donation by the Lee Foundation in 2010, transplant patients now experience a smoother process. Intended for expanding transplant programmes and research activities, the gift helped establish the SingHealth Transplant Centre which started operations this September at SGH Campus.

All transplant-related healthcare professionals are now housed under one roof and can see patients during a single visit to the centre.

“More interaction between physicians, surgeons, transplant coordinators, pharmacists, physiotherapists, dieticians, nurses and patient service associates allow for better planning, resulting in more holistic care for patients,” explained Dr Terence Kee, Director of the SingHealth Transplant Centre.

Dedicated infrastructure ensures a higher level of service, without having to compete with facilities used for other patient care services. Procedures that previously required patients to be admitted to hospital, such as kidney transplant biopsies and intravenous drug treatments, can now be performed as outpatient processes.

The gift from Lee Foundation also funded the “Thanks a Million” project to raise awareness about organ donation.

Some 40,000 participants from across Singapore set out to fold a million origami flowers in appreciation of organ donors. It was certified by the Singapore Book of Records as the “largest project to fold paper roses”. The flowers were installed as an artistic display at ArtsExpressions wall, SGH Block 2 Level 1, which was launched during the Transplant Awareness Week on 27 August.

Home for transplant on SgH CampusNew transplant centre centralises services for more effective care

STIIC is one of SingHealth’s research core platforms at Academia led by its Director, Prof Salvatore Albani, an internationally renowned rheumatologist and immunologist. Dr Lakshmi Ramakrishna, Centre Lab Manager, STIIC, shared with us how the centre will help patients.

The “Thanks a million” project to raise awareness on organ donation was also funded

by Lee foundation’s gift.

singHealth translational Immunology and inflammation Centre (sTiiC)

academic medicine news when & where you want it -

all at your fingertips!

is a dynamic model to study the regulation of the immune system by integrating information

from

STIIC is a translational research

platform set up to fulfill currently unmet medical needs.

Located in the Discovery tower of Academia, it aims to foster

research collaboration between SingHealth and Duke-NUS

focusing on

are available at STIIC, providing an integrated set

up in SingHealth that include cutting edge high throughput

technologies CyTOF2, FACS ARIA, Digital Droplet PCR and Nanostring

under one roof.

These technologies allow researchers to dissect immune cells and analyse

their relationship with patients, at high speeds, readily answering

questions on various

that STIIC can help shed light on include autoimmunity, microbiome, allergy, OBGYN/

neonatology, immunotherapies, transplantation, cancer and infectious

diseases.

With data from STIIC, clinicians can better formulate the most appropriate

treatment to groups of patients based on their unique biological

signatures,

immunomics

multiple technology platforms

patients’ conditions

maximising patient outcomes