Commentary
Transforming medical education in the AI era: Balancing technological expertise with humanistic care in tomorrow’s doctors
Standing at the precipice of a new era in healthcare, the integration of artificial intelligence (AI) into clinical practice is progressing at an unprecedented pace. From AI algorithms detecting tumours with remarkable accuracy to predictive models forecasting patient outcomes, these technological marvels are not only changing how we practice...
Editorial
The alcohol flushing syndrome: A risk factor for cancer
Globally, alcohol consumption is responsible for an estimated 3 million deaths annually and contributes to over 740,000 new cancer cases each year.1 Acetaldehyde, a byproduct of alcohol metabolism, has been designated as first-class carcinogens by the International Agency for Research on Cancer.2 In East Asian countries such as China,...
Letter to the Editor
VOWELS: A communication framework for disclosing medical errors in medical oncology and palliative care
Dear Editor,
Recognising the impact of medical errors on patients and the doctor-patient relationship has underscored the need for better communication.1,2 For the most part, these efforts are informed by Chafe et al.’s 6 steps that entail: (1) the identification of the error in a timely fashion; (2) determination of...
Letter to the Editor
HLA-B*5801 testing: Is it time to consider mandatory testing prior to prescribing allopurinol in Singapore?
Dear Editor,
Stevens-Johnsons Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe, life- threatening mucocutaneous reactions that most commonly occur as drug-related reactions.1 In recent years, several risk factors for the develop- ment of SJS/TEN, such as genetic factors, have been identified. Notably, carriers of the HLA-B*5801 and HLA-B*1502 alleles ...
Letter to the Editor
Knowledge, attitudes and practices of doctors on constipation management in Singapore
Dear Editor,
Constipation is a common gastrointestinal disorder, affecting about 15% of the global population and severely impacting patients’ quality of life.1 The global constipation treatment market is estimated to worth USD22.93 billion in 2025. Patients with functional constipation had the highest treatment dissatisfaction at 63.4%. Poor satisfaction was reported...
Commentary
Value the patient as a person: Answering the call for a person-centred model of care
There has been a change in patients’ attitudes towards healthcare professionals in recent decades, coupled with an increasingly evident shift in the care paradigm. In 2015, the World Health Organization released a framework of care that recommends healthcare professionals consciously consider the perspectives of individuals, carers, families and communities....
Original Article
Development and validation of a new self-assessment tool to measure professionalism among medical students
Professionalism is a concept that is difficult to define, but in relation to medical practice, it can be summarised as values, behaviours and conduct that foster the public’s trust in doctors. It comprises a complex interplay of abstract concepts that have led to many attempts at defining professionalism.1-4 With...
Editorial
Nurturing professional behaviours and ethical practice: From students to professionals
Medical professionalism refers to the set of values, behaviours, and ethical principles that guide the conduct of medical professionals in their interactions with patients, peers and the broader healthcare system. From a training perspective, it is easier to focus on striving to achieve excellence in medical practice and meeting...
Letter to the Editor
Script concordance test to assess diagnostic and management reasoning in acute medicine
Dear Editor,
Clinical reasoning, an essential skill for patient care, can be difficult to assess. We created and validated a script concordance test (SCT) to assess clinical reasoning in acute medicine. This tool was used to provide feedback and targeted remediation for Postgraduate-Year-1 (PGY1) doctors, guide teaching and learning, and...
Commentary
Leveraging ChatGPT to aid patient education on coronary angiogram
Natural-language artificial intelligence (AI) is a promising technological advancement poised to revolutionise the delivery of healthcare.1 Traditionally, inclusion of technology in the augmentation of healthcare communication comprised the use of chatbots, which is limited by a predetermined set of queries and matched answers.2 However, natural-language AI models prompt a...
Letter to the Editor
Investigating the stressors and coping mechanisms of students in medical school: A qualitative study
Dear Editor,
Medical school can be a stressful experience for students, with burnout being increasingly common.1 Stressors in medical education include a heavy academic workload, pressure of good academic performance, and comparison with peers of high aptitude.2 Stress can be either beneficial or detrimental to development, depending on personal regulation...
Letter to the Editor
Reducing non-clinical working hours of junior doctors could benefit patient outcomes
Dear Editor,
An 80-hour duty limit for residents was first introduced by the Accreditation Council for Graduate Medical Education (ACGME) in 2003, with the further addition of a 16-hour continuous duty period limit for first-year residents in 2011. Prior studies1 have demonstrated an association between longer working hours and...
Letter to the Editor
Teaching and learning during the COVID-19 pandemic: Perspectives of medical students in Singapore
Dear Editor,
The coronavirus disease 2019 (COVID-19) pandemic has resulted in many changes to medical education, including the site and mode of teaching, conducting of examinations and a shift towards prioritising the mastery of clinical skills relevant to infection control. Hence, Ng et al.’s suggestions on how to maximise learning...
Original Article
Treating acutely ill patients at home: Data from Singapore
Inpatient hospitalisation is the conventional strategy to care for acutely ill patients. However, demand for hospital beds and clinical manpower is escalating as populations age, and hospitals are expensive to build and run.1 There is increasing recognition of the risk of hospitalisation from potent nosocomial infections2,3 (exacerbated by the...
Editorial
Academic Medicine in Singapore
Academic medicine is currently grappling with the problem of whether the triple-threat academician is a species threatened with extinction in the 21st century, given the extraordinary growth of knowledge during the past decades. Academicians, by this definition, were expected to be original and productive investigators, inspiring teachers and outstanding...
Review Article
Foregoing Life Support in Medically Futile Patients
The origins of withholding medical support are found in ancient times. More than two millennia ago, Hippocrates (460 to 361 BC) stated that the role of medicine was “to do away with the suffering of the sick, to lessen the violence of their diseases, and to refuse to treat...
Review Article
Nitric Oxide in Septic Shock: Directions for Future Therapy?
In 1980, Furchgott and Zawadzki demonstrated that the relaxation of isolated arteries to acetylcholine required the presence of endothelial cells. This response was mediated by a labile humoral substance termed endothelium-derived relaxing factor (EDRF).
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Review Article
Critical Care Medicine in the Western Pacific Region
The Western Pacific region includes a very diverse group of countries varying in their culture, economic development and per capita income, disease prevalence and medical traditions. The Western Pacific Association of Critical Care Medicine (WAPCCM) includes countries from Japan in the north to Australia and New Zealand in the...
Review Article
Critical Care—The Worldwide Perspective
Although special areas for postoperative patients existed 50 years ago, the modern specialty of Critical Care began during the polio epidemic of the 1950s. Prolonged hand ventilation, and positive or negative pressure ventilation, enabled maintenance of oxygenation until some patients developed sufficient recovery or compensatory processes to enable separation...
Original Article
Malaria Requiring Intensive Care
Malaria is an important and common infectious parasitic disease globally. It is associated with significant morbidity and mortality, especially in endemic areas.
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Original Article
A Retrospective Study of Near-drowning Victims Admitted to the Intensive Care Unit
Drowning victims suffocate from submersion. This may lead to immediate death or, if they survive, brain damage if significant cerebral hypoxia is present.
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Others
Ergotism and Vascular Insufficiency: A Case Report and Review of Literature
Toxicity from ergot and its derivative is well known. Great epidemics occurred during the middle ages due to consumption of rye contaminated with the fungus, Claviceps purpurea, which elaborates the ergot alkaloids.
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Original Article
Plasma Vitamins A, C and E in the General Population of Singapore, 1993 to 1995
The current disease pattern in Singapore (an island state of 3.3 million people composed of 76% Chinese, 14% Malays, 7% Asian Indians and 3% Others) is dominated by non-communicable diseases. There have been increasing trends, though with recent declines, for coronary heart disease (CHD) and cerebrovascular disease.
This article is...
Review Article
Intravital Microscopy for the Study of the Microcirculation in Various Disease States
It is more than 150 years ago when the first detailed description of intravital microscopy was given by Waller, demonstrating in the frog tongue the passage of leukocytes (at that time interpreted as “mucous and pus globules”) through microvessels. Later, the mesentery was acknowledged as the most suitable object...
Review Article
Theory and Practice in Continuing Medical Education
A physician’s education in medical science represents a continuum of several interrelated phases. It starts with medical school, passes through brief housemanship year, and continues throughout the professional career.
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Others
Quality Assurance of Problem-based Learning (PBL): The Hong Kong Experience
The Faculty of Medicine of the University of Hong Kong (HKU) was established in 1887 and its curriculum has been run in a traditional manner for over a century. The Faculty has been a major training ground for doctors in the Community of Hong Kong.
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Others
Clinical Reasoning Learning Sessions
Many medical schools worldwide have made the shift toward problem-based learning (PBL) medical education. Some of them employ these new techniques in only part of their teaching, and usually in the pre-clinical phases, to make basic sciences easier and more attractive.
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Others
Is Problem-Based Learning a Quality Approach to Education in Health Sciences?
Since the pioneering adoption of problem-based learning (PBL) by McMaster University in medical education more than three decades ago, increasingly more medical schools around the globe have been undergoing curriculum restructuring by incorporating some forms of PBL philosophy into their new curriculum. Some schools have believed and trusted in...
Others
Book Review
The above is a textbook of medicine written by Singapore doctors and published in Singapore. It is difficult not to be over-enthusiastic about it as there are so few books of medicine written and published in Singapore.
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Others
Gemella Empyema Cured without Antibiotics: A Case Report
Gemella are gram-positive anaerobic bacteria that rarely produce serious human infections. We describe a case of thoracic empyema that occurred in an elderly Chinese male which, to our knowledge, is the first reported case out of Southeast Asia.
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Review Article
The Clinician Meets the Computer—Uneasy Bedfellows
Information technology has become a cornerstone of civilization as we know it. In its broadest definition, information technology encompasses all forms of technology required to create, archive, exchange and manipulate data.
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Review Article
Leveraging on Information Technology to Enhance Patient Care: A Doctor’s Perspective of Implementation in a Singapore Academic Hospital
Information technology (IT) has become truly pervasive in everyday life; however, in the field of medicine, we have yet to fully harness its full potential in the care of our patients. Most restructured hospitals in Singapore have been wired up with fast local area networks (LAN) and desktop personal...
Editorial
Internal Medicine
It has taken a long time to plan for this November issue in Internal Medicine. The topic is so wide and often neglected as the specialties take prominence.
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Commentary
General Medicine—Revisited, Rejuvenated, Revitalised and Reemphasised
“The irresistible swing towards medical specialisation has brought advantages for patients but arguably this has gone too far.” It is time to review the role of general medicine and general physicians in Singapore; with its own unique system of healthcare where patients can see any specialist and subspecialists without...
Others
A Countrywide Approach to the Control of Non-communicable Diseases—The Singapore Experience
In the area of health, the last two decades has seen a decline or eradication of deadly diseases, such as smallpox and polio, the introduction of the fatal disease, such as acquired immunodeficiency syndrome (AIDS), and a marked rise in chronic diseases, making them the leading worldwide public health...
Others
Causes for the Evolution of Case Management and the Development of a Working Model in an Acute Care Hospital in Singapore
In 1999, significant changes to the healthcare funding structure were introduced to public sector hospitals in Singapore. This was the advent of casemix-based funding for acute inpatient and day surgery episodes.
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Others
Evidence-based Medicine: The Key to Guidelines, Disease and Care Management Programmes
Health care in America and the rest of the industrialised world continues to reinvent itself at an ever-accelerating rate. The societal pressures for high quality, high value care that produces measurable improvement in quality processes and outcomes is increasing from the government and private sectors.
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Others
National Disease Management Plans for Key Chronic Non-communicable Diseases in Singapore
Like most other newly industrialised economies, Singapore has undergone a rapid epidemiological transition over the last 50 years. Chronic, non-communicable diseases have replaced infectious diseases as the dominant public health problems in Singapore today.
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Editorial
Chronic Disease Management: Challenges for Clinicians and the Way Forward
The healthcare, financial and social burden of chronic diseases, such as diabetes mellitus, coronary heart disease, asthma, chronic obstructive airway disease, hypertension, chronic depression, osteoporosis, end stage renal failure and stroke, are steadily on the rise. In the US alone, some 125 million people now suffer from at least...
Original Article
Measuring Health-related Quality of Life in Singapore: Normal Values for the English and Chinese SF-36 Health Survey
Advances in diagnosis and therapy in the second half of the 20th century have lead to impressive improvements in survival for patients with many chronic illnesses. With improvements in survival, patients’ perceptions of health are increasingly being recognised as an important outcome in clinical medicine, especially in illnesses where...
Editorial
Should Ethical Issues in Biotechnology Research be Decided by Physicians-Scientists or by Lawyers?
As with clinical practice, the practice of biomedical research is a moral activity. We have to think about what we should do, not just about what we can do, to modify life.
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Letter to the Editor
Stress among emergency medicine residents during the COVID-19 pandemic: A qualitative study
Dear Editor,
The COVID-19 pandemic has disrupted medical education1,2 and distressed clinicians.3,4 Understanding the impact of this pandemic on emergency medicine (EM) residents’ experience of stress will allow for more effective interventions to aid residents, while reducing attrition and its impact on pandemic response.
We present our qualitative study, guided by...
Letter to the Editor
Patterns and predictors of sound levels in hospital rooms
Dear Editor,
Excessive sound levels in the hospital can impair the work performance of healthcare professionals and affect patient well-being.1 Previous studies have also linked excessive sound levels with sleep disturbances and cardiovascular morbidity.2 While there have been data published regarding noise levels in the intensive care unit (ICU),3...
Others
1st College of Physicians Lecture: The Role of Internal Medicine as a Specialty in the Era of Subspecialisation
It humbles me to accept the invitation to give this lecture, the First College of Physicians Lecture, titled “The Role of Internal Medicine as a Specialty in the Era of Subspecialisation”. I believe I am given this honour as I am one of the few of a seemingly dying...
Others
Standards and Revalidation or Recertification
In my Gordon Arthur Ransome Oration and other papers, I have described the nature and development of patient-centred professionalism, the key features of which are summarised in Figure 1.
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Others
Continuing Professional Development – a Surrogate for Recertification?
The Hong Kong Academy of Medicine is a statutory body set up in 1993 with the objectives of fostering the development of postgraduate medical education and continuing medical education, the study and practice of medicine and its specialties, and medical research. It is concerned with the standard of specialist...
Others
Teaching and Learning of Professionalism in Medical Schools
There is now worldwide consensus that the elements of medical professionalism need to be enhanced and explicitly taught in medical schools. Medical schools in the United Kingdom (UK) have recently published a model for a core ethics curriculum.
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Others
The Challenge of Teaching Professionalism
For the past 25 years, professionalisation, industrialisation, large-scale infusions of technology into the healthcare system and consumerism, to name a few factors, have definitely contributed to changes in the healthcare environment. At the same time, society has moved from modernity to post-modernity with the adoption of pluralism, relativism and...
Others
2004 Runme Shaw Memorial Lecture: Professionalism – A Concept in Need of Nurturing
It is a great honour to be invited to deliver the Runme Shaw Memorial Lecture. I am grateful to the Runme Shaw Foundation for their support of this lecture.
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Others
17th Gordon Arthur Ransome Oration: Patient-centred Professionalism
When sickness strikes we all need doctors. People everywhere know that the quality of medical care can affect the outcome and possible consequences of illness, and at times mean the difference between life and death.
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Others
Refining Clinical Practice: Transforming Science Research into the Art of Medicine
I am humbled by the invitation given to me by Changi General Hospital to deliver this lecture at your 5th Annual Scientific Meeting with the theme “Frontiers of Medicine”. Thank you very much for the honour accorded me. Your CEO, Mr Udairam, and your CMB, Prof Fock Kwong Ming,...
Original Article
Extended-spectrum Beta-lactamases in Clinical Isolates of Escherichia coli and Klebsiella spp. in a Singapore Hospital: Clinical Spectrum
Extended-spectrum beta-lactamases (ESBLs) in gram-negative bacillary pathogens are a growing and important problem in hospital practice and it is tied to extensive use of broad-spectrum antibiotics. The emergence of ESBLs has increased the possibility that traditional, empiric antimicrobial regimens may be ineffective.
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Original Article
Routine Microbiological Screening in Septic Patients in a Cardiac Surgical Intensive Care Unit
Compared to in-hospital patients, patients treated in an intensive care unit (ICU) have the highest risk of contracting an infection. The risk correlates well with underlying and accompanying diseases and invasive monitoring.
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Others
Book Review
These are challenging times for medical schools as the frontiers of knowledge have expanded enormously and rapidly in recent years. In order to keep up with the expanding knowledge and to impart it effectively and efficiently to our students, we as medical teachers will have to adopt new changes...
Commentary
Medical Education in Asia: Is it a Time for Optimism?
Asia, the largest continent, is also an immensely diverse region with countries that vary in their socio-economic status, degree of urbanisation and health and disease profile. The objective of medical education is to create efficient and compassionate healers to serve indigenous society’s aspiration and priorities.
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Review Article
Issues and Priorities of Medical Education Research in Asia
Medical schools traditionally rest on the “three-legged stool” of research, education and service. Hence, medical teachers are sometimes referred to as “triple-threat academicians”.
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Original Article
Genital Herpes in a Sexually-transmitted Infection Clinic in Singapore: A 1-year Retrospective Study
Genital herpes simplex virus (HSV) infection is a commonly notified sexually transmitted infection (STI). Genital herpes can be caused by both herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2), with HSV-2 being the predominant infection in genital herpes.
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Editorial
Professionalism: Looking For Your Blind Spots
In 1996 a major breakthrough was reported in the medical literature. A 5-week ectopic pregnancy was re-implanted into the uterus via the cervix, and the fetus was successfully carried to term.
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Review Article
Methodological Aspects of Traditional Chinese Medicine (TCM)
Traditional Chinese Medicine (TCM) has a long history but its efficacy is not as well-documented as one would hope. Proof of efficacy has to come from clinical trials, i.e., prospective experiments for assessing the results of medical interventions.
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Review Article
A Practical Way of Research in Chinese Medicine
Chinese medicine individualises its treatment plan and practice and refutes any general law. Therefore, Chinese medicine practitioners do not have the tradition of research.
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Editorial
Complementary and Alternative Medicine, and Traditional Chinese Medicine: Time for Critical Engagement
Practice outside of mainstream or conventional medicine has always been an important part of public healthcare in some countries, particularly in the developing world. Recently the use of complementary-alternative medicine (CAM) has grown in popularity worldwide.
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Commentary
Student Academic Committees: An Approach to Obtain Students’ Feedback
The shift of medical curricula from a traditional subject based to an integrated module-based system can be seen in many medical schools worldwide. The change in curricular design was introduced to encourage student-centred learning and equip students with essential skills for future practice.
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Review Article
Curricular Trends in Malaysian Medical Schools: Innovations Within
Medical educators continue to evaluate and introduce innovations into their curriculum with the objective of achieving appropriate outcomes for their graduates so that they can meet the healthcare needs of the society locally and globally. They sought to develop approaches to teaching and learning that would address the goals...
Original Article
A Problem-Based Learning Pathway for Medical Students: Improving the Process Through Action Research
Problem-based learning (PBL) is a student-centred, self-directed, integrated and contextual mode of learning. It has been widely perceived by many to confer advantages in promoting critical thinking, retention of knowledge, independent learning and interpersonal skills.
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Original Article
A Simple Instrument for the Assessment of Student Performance in Problem-based Learning Tutorials
Assessment can be done in a variety of ways, for many purposes, and for different populations. It can occur at the classroom level, programme level, college level or even national level.
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Original Article
An Online Evaluation of Problem-based Learning (PBL) in Chung Shan Medical University, Taiwan – A Pilot Study
The goal of problem-based learning (PBL) is to motivate students to develop self-learning skills in a small group. PBL embraces principles of good learning and teaching.
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Original Article
Evidence-based Medicine in Clinical Curriculum
Evidence-based medicine (EBM) is “the conscientious, explicit, and judicious use of the best evidence in making decisions about the care of individual patients.” Considering the vast amount of medical knowledge available today through various media outlets with almost no boundaries, it is essential that our medical graduates should have...
Original Article
Leadership and Professionalism Curriculum in the Gross Anatomy Course
Healthcare delivery systems worldwide are currently undergoing significant changes to create resilient learning organisations that are able to adapt with ever-increasing speed to shifting business, regulatory, and competitive environments. The delivery of healthcare is no longer a single-provider responsibility; modern group practice organisations require a physician to be not...
Original Article
Constructing Multiple Choice Questions as a Method for Learning
Students in general and medical students in particular are often described as “strategic learners”, but in reality many become superficial learners out of necessity when faced with the seemingly boundless volume of material in today’s curriculum. The apparent enormity of the task might encourage rote learning and much of...
Original Article
Computer-based Versus Pen-and-paper Testing: Students’ Perception
Computer-based testing (CBT) has gained popularity as a testing modality, with large-scale professional examinations such as the United States Medical Licensing Examination (USMLE) adopting a CBT format since 1999, replacing the written pen-and-paper (PNP) format. Studies have found that testing format does not affect test scores, and that CBT...
Review Article
Community-associated Methicillin-resistant Staphylococcus aureus: Overview and Local Situation
The emergence and spread of methicillin-resistant Staphylococcus aureus (MRSA) isolates from the community that are distinct from their archetypal healthcare-associated counterparts (HA-MRSA) marked a critical evolutionary milestone for the organism. In less than 2 decades, particularly in the last 3 years, this initially sporadic phenomenon of community-associated methicillin-resistant Staphylococcus...
Letter to the Editor
Translational Research – A Multidisciplinary Approach
Translational research aims to convert laboratory discoveries into therapeutic gains for patients – in oncology, drug development is a prime example. This multifaceted process is often complicated and requires huge investments in time, money and expertise.
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Others
A Complex, Contagious, Evolutionary Habit
Yawning is often noted in medical seminars and conferences – be they surgical, orthopaedic, gastroenterological, endocrinological or neurological. Yet, this condition receives little coverage by professors in medical schools.
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Commentary
Amendment of the Human Organ Transplant Act
Kidney transplants have been carried out in Singapore for more than 35 years, with the first cadaveric kidney transplant operation performed on 8 July 1970. However, prior to the commencement of the Human Organ Transplant Act (HOTA) in 1988, there was only a small number of kidney transplants; between...
Others
Interesting In- and Outpatient Attendances at Hogwarts Infirmary and St Mungo’s Hospital for Magical Maladies
With the return of “You Know Who” (YKW) and the rise of Death Eaters, injuries amongst both muggle and wizarding folk (MF and WF) have escalated. Muggle medicine, with its quaint dependence on potions and “technology”, is inadequate to deal with magical injuries, and has much to learn from...
Others
The Doctor’s Multi-instrument Tool of the Future?
It is just another day in 2020, except that the eyes of the medical world are eagerly awaiting the latest invention to be revealed: the ingenious multi-instrument pocket tool. Precision, quality, functionality and versatility are what this invention promises to deliver.
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Original Article
Relationship Between Item Difficulty and Discrimination Indices in True/False-Type Multiple Choice Questions of a Para-clinical Multidisciplinary Paper
Multiple-choice questions (MCQs) are used more and more in departmental examinations or as comprehensive examinations at the end of an academic session. They may be used to determine progress or to make decisions regarding the certification of a candidate.
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Original Article
Facilitation of Students’ Discussion in Problem-based Learning Tutorials to Create Mechanisms: The Use of Five Key Questions
An important aspect of problem-based learning (PBL), particularly in the early years of the undergraduate medical, physiotherapy, nursing and dental courses, is teaching basic science in a clinical format.1,2 This approach should enhance students’ skills to develop reasoning strategies, use information in relevant situations, generate hypotheses for problems identified...
Review Article
What do You Mean by “Satisfactory”?
There were 2 questions which initiated this research. One became the title of this paper; the other was a concern that the integration of competencies into existing assessment practices could jeopardise the high standards required of trainees before they graduate as independent practitioners.
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Letter to the Editor
Towards a Global Educational Matrix for Tomorrow’s Health Systems
Society supports medical schools expecting them to produce physicians who can improve both the health of the population as well as the health system itself. This goal has not been achieved yet; deaths from tuberculosis (1.7 million, 2006) are but one of many examples that points to that failure...
Commentary
Harnessing the IT Factor in Medical Education
In this digital age, we are constantly inundated with breathtaking images worthy of an Ansel Adams photograph or a Zhang Yimou film. Is it any wonder, then, that we educationists feel compelled to “wow” our students, who may have become jaded by this daily barrage of digital wizardry to...
Commentary
A Systems Approach to Teach Core Topics across Graduate Medical Education Programmes
Core curricula including Ethics, Medico-legal issues, Socioeconomics, and Quality Improvement (QI) are relevant and significant for graduate medical education programmes, regardless of specialty. A lack of faculty expertise in these content areas is a frequently cited concern among specialty programmes in graduate medical education.
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Commentary
World Federation for Medical Education Policy on International Recognition of Medical Schools’ Programme
There is an increasing need for international quality assurance of medical education. However, there are no present mechanisms for international recognition of medical educational institutions and programmes.
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Original Article
Quality Management of Medical Education at the Carl Gustav Carus Faculty of Medicine, University of Technology Dresden, Germany
In Germany, medical education is an undergraduate programme for which the students applying at the “Zentralstelle für die Vergabe von Studienplätzen” (ZVS); the final admission is primarily based on the grades of the “Gymnasium”. The number of applying students is about 4 times higher than the number of university...
Original Article
Supporting Learners who are Studying or Training Using a Second Language: Preventing Problems and Maximising Potential
Travel and immigration are vibrant aspects of the international medical and educational field. Patients are increasingly mobile and finding healthcare professionals in a foreign country who can bring additional insights to help address their cultural and language needs can only benefit their care.
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Original Article
Development of a Tool to Evaluate Health Science Students’ Experiences of an Interprofessional Education (IPE) Programme
A shortage of healthcare professionals and resources in rural areas is well documented. These workforce shortages necessitate new models of healthcare in rural areas that focus on increased collaboration and communication to optimise patient care.
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Original Article
Step-2 Thai Medical Licensing Examination Result: A Follow-up Study
The Center for Evaluating and Accrediting Medical Competency of the Thai Medical Council has established the regulation that Thai medical graduates matriculated as of 2003 have to pass the Medical Licensing Examination of Thailand (MLET) to qualify for medical practice. There are 3 steps in this national test.
This article...
Original Article
Does Team Learning Motivate Students’ Engagement in an Evidence-based Medicine Course?
Team-based learning (TBL) is a well-defined instructional strategy that has generated considerable interest within the medical education community because of its potential to promote active learning with a limited number of faculty facilitators. This mode of learning was originally developed more than 20 years ago for college business and...
Original Article
A Survey of Medical Students’ Perceptions of the Quality of their Medical Education upon Graduation
Founded in 1934, Tehran University of Medical Sciences School of Medicine (TUMS-SoM) is the oldest modern medical school in Iran. It has the most number of academic staff and research productivity in the country, as well as the highest number of both undergraduate and postgraduate students enrolment per year.
This...
Original Article
The Learning of 7th Year Medical Students at Internal Medical – Evaluation by Logbooks
In 1945, Taihoku (Taipei) Imperial University was renamed the National Taiwan University and the Japanese teaching system was replaced with a system implemented by the Ministry of Education of the Republic of China. The 7-year curriculum in the School of Medicine, College of Medicine and the National Taiwan University...
Original Article
Use of Knowledge-sharing Web-based Portal in Gross and Microscopic Anatomy
The extensive use of and the rate at which medical technology is becoming an integral force in medicine has impacted on the way in which physicians are being trained to practise within this new environment. Medical informatics and the era of interacting over web-based systems require competencies that need...
Original Article
Assessment of Psychometric Properties of a Modified PHEEM Questionnaire
In Sri Lanka, after a 5-year medical undergraduate curriculum, graduates from the medical faculties undergo a one year mandatory internship or housemanship, 6 months each in 2 selected disciplines of clinical medicine, surgery, paediatrics, obstetrics & gynaecology and paediatric surgery in a recognised government hospital. After successful completion of...
Editorial
Medical Education in a Flat World
In 2005 Thomas Friedman published the international best-seller The World is Flat: A Brief History of the Twenty-First Century. He asserted that as the world becomes more connected, it becomes a level playing field, in which all players have equal opportunities.
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Letter to the Editor
Objective Structured Clinical Evaluation Should Not Only Be a Test of Clinical Skill
The Objective Structured Clinical Examination (OSCE) was originally a test (or summative assessment) specifically of clinical skills, using standardised patients (SP), anatomical models and itemised checklists3 for scoring medical students. However, if OSCE was restricted to a test, as with any other test, many students would learn tricks for...
Others
5th College of Physicians Lecture – A Physician’s Odyssey: Recollections and Reflections
Allow me to thank you Mr President and your Council for asking me to deliver the 5th College of Physicians Lecture. Your President has suggested that with over 50 years of association with Medicine, the title be “In the Service of the Medical Profession”.
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Review Article
Standard Setting in Student Assessment: Is a Defensible Method Yet to Come?
To validate any “adjective”, be it for living or non-living, a criteria or standard is needed. Globalisation, mobility of doctors and the rising number of medical institutions make it imperative to have comparable standards in medical teaching learning and assessment.
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Original Article
Innovative “Case-Based Integrated Teaching” in an Undergraduate Medical Curriculum: Development and Teachers’ and Students’ Responses
In Asia, the challenges facing medical education are similar across different countries. The learning process is still problematic with large classes, and most of the curriculum time being spent on traditional lectures.
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Others
The Future of Medical Education: The Second 100 Years
This is a proud year for the medical profession in Singapore, as we celebrate 100 years of medical education. As the oldest faculty in Singapore’s first university, we are reminded that it was the Medical School which laid the foundation for tertiary education in Singapore. It is appropriate that...
Others
The NUS MBBS-PhD Programme: Nurturing Clinician-Scientists for Tomorrow
The MBBS-PhD programme is a significant milestone in medical education in Singapore. In July 2000, the Faculty of Medicine, National University of Singapore (NUS) launched this programme in collaboration with the Institute of Molecular and Cell Biology (IMCB), with support from the Economic Development Board (EDB), and the Agency...
Others
A Century of Medical Students’ Activities (Medical College Union/Medical Society)
On 3 July 1905, the Straits and Federated Malay States Government Medical School was started with the objective of training the local men and women to become Assistant Surgeons and General Practitioners. After a petition set out by the Chinese and non-European communities to the then Governor of the...
Letter to the Editor
Assessment of Medical Graduates Competencies
Medical professional proficiency comprises a set of skills, knowledge, and attitudes necessary to efficiently accomplish the practice of medicine. The major aim of undergraduate medical education in the region is to produce doctors who are competent and able to meet the health needs of the community while also being...
Original Article
Evidence-based Medicine (EBM) for Undergraduate Medical Students
The practice of evidence-based medicine (EBM), which integrates individual clinical expertise with the best available evidence from systematic research, demands a set of skills. These skills help clinicians retrieve, appraise and apply the current best evidence.
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Original Article
Transudates in Malignancy: Still a Role for Pleural Fluid
According to Light’s criteria, an exudate is defined by at least one of the following: a total protein pleural fluid to serum ratio greater than 0.5, an lactate dehydrogenase (LDH) pleural fluid to serum ratio greater than 0.6, or an absolute pleural fluid LDH greater than 2/3 of the...
Others
The First Graduates in 1910
The Medical School in Singapore was founded on 3 July 1905; it was named the Straits and Federated Malay States Government Medical School. It was the forerunner of the Faculty of Medicine, National University of Singapore (NUS). This year (2005), the Faculty of Medicine (NUS) and the NUS celebrate...
Others
Milestones of the Medical School and Medical Progress of Singapore over the Past 100 years
1905: The Medical School started off in an old female lunatic asylum on the site of the general hospital at Sepoy Lines.1 Called the Straits and Federated Malay States Government Medical School, it was founded on 3 July 1905. The official launch was on Thursday, 28 September 1905. The...
Review Article
Self-directed Learning in Health Professions Education
More than 600,000 new citations were published in MEDLINE in 2005; this raised the total number of indexed citations to more than 14 million citations. In a study be Williamson et al, 2 out of 3 primary care physicians described the volume of literature as unmanageable, and 1 out...
Commentary
Sir Gordon Arthur Ransome (1910-1978) – His Teaching Style and His Legacy
Sir Gordon Arthur Ransome was born in Salop, England, in 1910.1 He came to Singapore in 1938, where he taught and practised medicine for 33 years before his retirement in 1971.
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Commentary
Translating the Family Medicine Vision into Educational Programmes in Singapore
The core of the Family Medicine (FM) vision is patient-centred care, requiring specific education and vocational training. Modern day FM began its existence as a “counterculture” to the disease-and-body-part focus of the hospital specialties in the 1960s.
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Letter to the Editor
Erysipelothrix rhuseopathiae Septicaemia with Prolonged Hypotension: A Case Report
Erysipelothrix sp. is a gram-positive, non-spore forming bacterium that was first isolated by Robert Koch. It has the unusual ability to infect a large variety of vertebrate and invertebrate animals, including various species of domestic and wild animals, mainly swine, cattle, fish and birds.
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Original Article
Seeing the Wood for the Trees: Approaches to Teaching and Assessing Clinical Pharmacology and Therapeutics in a Problem-based Learning Course
Over the last 3 decades, the rate of knowledge accumulation in drug development has been enhanced by advances in molecular modelling, the molecular genetics of drug action and the screening from natural sources for novel therapeutic agents. These advances mandate the need for a more adaptive and responsive educational...
Commentary
The Hospitalist Movement – A Complex Adaptive Response to The Hospitalist Movement – A Complex Adaptive Response to Fragmentation of Care in Hospitals
Healthcare systems are complex adaptive systems. They are capable of self organisation through interacting agents that adapt to changes to the internal and external environment.
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Commentary
Medication Use in the Transition from Hospital to Home
Hospital discharge can be a complex and challenging time for physicians and patients alike. Patients are being discharged sooner, often in the process of convalescence rather than at baseline health status. This requires physicians to more effectively communicate instructions for post discharge care to patients, family members, and outpatient...
Commentary
Family Medicine Education in Singapore: A Long-standing Collaboration between Specialists and Family Physicians
In the US, Canada and Australia, the postgraduate training of family physicians (FPs) involves the attachment of family medicine (FM) trainees to specialist departments, similar to the model currently employed in Singapore. Unlike Singapore, however, FM training outside these hospital attachments is largely administered by senior FPs with minimal...
Editorial
Bridging the Gap between Primary and Specialist Care: Formidable Challenges Ahead
The strong guiding hand and deep pockets of the state have brought about the growth of hospitals and national specialist centres while leaving the primary care sector largely to free market forces. Thus, it is not surprising that the evolution of Singapore’s healthcare system has largely favoured specialisation and...
Original Article
Clinical Skills in Final-year Medical Students: The Relationship between Self-reported Confidence and Direct Observation by Faculty or Residents
In clinical medical education, instructors train students in their medical knowledge and clinical skills. Medical educators also aspire to develop students’ self-confidence in medical practice.
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Others
Impact of Various Continuing Medical Education Activities on Clinical Practice – A Survey of Malaysian Doctors on its Perceived Importance
Continuing medical education (CME) plays an indispensable role in the clinical practice of any doctor. The practice of evidence-based medicine today,1 or any meaningful learning per se, requires at least appropriate access to relevant updated medical information. However, the acquisition of such relevant medical knowledge can prove difficult and...
Original Article
Characteristics of Medical School Graduates who Underwent Problem-Based Learning
Problem-based learning (PBL) is one of the medical education strategies to promote continuous active and self-directed learning.1,2 Our medical school implemented PBL in 1990 and currently there are 800 PBL graduates who are practising physicians. Studies have shown that PBL can change learning attitudes among undergraduate students3- 5 but...
Commentary
The Challenges of “Continuing Medical Education” in a Pandemic Era
Although pandemics of influenza have occurred (albeit rarely, i.e. once every few decades) for more than 3 centuries, recent outbreaks of H1N1 and H5N1 influenza1 and the severe acute respiratory syndrome (SARS),2 have necessitated the institution of such measures as school closure and mandatory quarantine of cases1 in a...
Original Article
The Pedagogical Value of a Student-run Community-based Experiential Learning Project: The Yong Loo Lin School of Medicine Public Health Screening
Experiential learning brings medical students out of the comfort zone of learning in their classrooms to acquire and apply knowledge and skills in an immediate and relevant setting. By linking theory and practice, experiential education differs from the traditional education in that it actively engages students in experiences that...
Original Article
Evaluation of Intensive Care Unit-acquired Urinary Tract Infections in Singapore
Urinary tract infection (UTI) is one of the most common types of nosocomial infections encountered in the inpatient settings including intensive care unit (ICU). Amongst patients admitted to ICU, studies have revealed the incidence of nosocomial UTIs to range from 9% to 29%.
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Editorial
Medical Professionalism in the Internet Age
Medical professionalism encompasses the conduct and practices of physicians, both as individuals and as a collective organisation. Professionalism enhances the trust and confidence of patients and society in doctors.
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Letter to the Editor
Developing the “NUS Tummy Dummy”, A Low-Cost Simulator to Teach Medical Students to Perform the Abdominal Examination
Simulators may be used to provide adequate exposure to learning experiences that allow clinical skills to develop, that is, allow medical students and trainees to perform the steps of clinical examinations and to acquire diagnostic skills. To date, simulators have been developed for trainees to perform cardiac and respiratory...
Original Article
Two Strategies to Intensify Evidence-based Medicine Education of Undergraduate Students: A Randomised Controlled Tria
Knowledge and skills of evidence-based medicine (EBM) can be taught by many methods, such as role modeling evidence-based care, using evidence for clinical medicine instruction, and teaching specific EBM skills. Standalone courses and workshops away from the clinical environment are usually the traditional educational designs for teachers to convey...
Commentary
Is Cost-Effective Healthcare Compatible with Publicly Financed Academic Medical Centres?
Nearly all legislation involves a weighing of public needs as against private desires; and likewise a weighing of relative social values.
—Louis D Brandeis
As a small island state with finite resources, Singapore’s healthcare philosophy is governed by pragmatism, rationing and cost-effectiveness (see Appendix 1 for definition) with an unrelenting emphasis...
Review Article
Cognitive Aspect of Diagnostic Errors
It was an unusually busy ward round. The newly promoted registrar was keen to review the patients handed over to him. But there were constant distractions from the other
things he needed to attend to quickly. The patient, Madam Sumar was referred by her family doctor for chest pain with...
Editorial
Mentorship in Academic Medicine: A Catalyst of Talents
The field of medicine is complex. Its interwoven structure of clinical practice, medical education and biomedical research, coupled with intricacies of the health system, makes it challenging for one to navigate through without any help. In any academic medical centre (AMC) or hospital, there is an imperative for senior,...
Original Article
Academic Medicine Education Institute (AM∙EI): Transforming the Educational Culture of Health Professionals
In 2010, Duke-NUS Graduate Medical School (Duke-NUS) and Singapore Healthcare Services (SingHealth) launched an initiative to improve the lives of patients by combining their individual strengths to become an integrated academic healthcare cluster. This new academic healthcare cluster has a mission to provide outstanding clinical service, discover and promote...
Letter to the Editor
Diagnosing Bacteraemia Early in Older Adults
Sepsis is a prevalent and important cause of morbidity and mortality in the general population. Approximately 750,000 patients in the United States alone develop severe sepsis each year. Of this, more than 60% are patients older than 65 years. Morbidity and mortality remain high in spite of advances in...
Original Article
“Are Medical Students’ Views of an Ideal Physician Eroding? A Study on Perceived Qualities of a “Role Model” Doctor Before and After Housemanship and between Two Cohorts Five Years Apart “
Role modeling has been reported as an increasingly prominent teaching need and strategy in the field of medical education. This aspect of training helps novice doctors to imbibe key values, attitudes, behaviours and ethics that define the medical profession. With the primary goal of medical education being to train...
Original Article
Factors and experiences associated with unscheduled 30-day hospital readmission: A mixed method study
Readmission leads to a greater demand for healthcare services, especially hospital beds, and contributes to the rising healthcare costs.1,2 With estimated one-third of the readmissions considered preventable,3 early identification of the underlying risk factors can offer better management and discharge planning.4 Some risk factors of readmissions related to patient...
Editorial
Potentially avoidable readmissions: Understanding drivers and technology-enabled solutions
Hospital admissions places high resource demands on the health system, and is a major cost-driver in Singapore and globally.1-3 Admissions have and will continue to increase given Singapore’s ageing population and growing chronic disease and multimorbidity burden, impacting care quality and patient/provider experience.2,4 While majority of admissions are clinically...
Editorial
Laparoscopic liver resection: Global diffusion and learning curve
Laparoscopic liver resection (LLR) is being utilised with increasing frequency worldwide, as initial concerns about the safety and feasibility of LLR, such as the risk of uncontrolled major haemorrhage and potential compromise of oncologic outcomes, were not supported by the data. On the contrary, LLR was found to be...