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...

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...

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). This article is available only as a PDF. Please click on “Download PDF” on top to...

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...

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...

Malaria is an important and common infectious parasitic disease globally. It is associated with significant morbidity and mortality, especially in endemic areas. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Drowning victims suffocate from submersion. This may lead to immediate death or, if they survive, brain damage if significant cerebral hypoxia is present. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

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. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

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...

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...

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. This article is available only as a PDF. Please click on “Download PDF”...

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. This article is available only as a PDF. Please click on “Download...

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. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

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...

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. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

“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...

The burden of asthma appears to be increasing worldwide, especially in societies undergoing rapid urbanisation, and both morbidity and mortality from asthma have increased in many parts of the world, making it a global health concern. In Singapore, asthma is a highly prevalent problem, with an increasing societal and...

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. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

Disease management (DM) is an approach to patient care that coordinates medical resources for patients across the entire healthcare delivery system. It requires a shift in focus from viewing patient care as discrete episodes or fragmentary encounters with different parts of the healthcare system, to provision of high-quality care...

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. This article is available only...

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. This article is available only as a PDF. Please click on “Download PDF” on top to...

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...

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...

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. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

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...

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...

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. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

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...

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. This article is available only as a PDF. Please click on “Download...

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...

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. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

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. This article is available only as a PDF. Please click on “Download PDF” on top...

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,...

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. This article is available only as a PDF....

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. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

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. This article is available only...

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”. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

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. This article is available only as a...

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. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

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. This article is available only as a PDF. Please click on “Download...

Chinese medicine individualises its treatment plan and practice and refutes any general law. Therefore, Chinese medicine practitioners do not have the tradition of research. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

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. This article is available only as a PDF. Please click on “Download PDF” on...

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. This article is available only as a...

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...

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. This article is available only as a PDF. Please click on “Download PDF” on top...

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. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

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. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

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...

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...

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...

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...

Medical education is a lifelong learning process. Just as we remind our students and ourselves that the practice of medicine is a lifelong process in which we continually seek to improve our knowledge so that we give our patients the most effective care, so too with medical education. This article...

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...

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. This article is available only as a PDF. Please click on “Download PDF” on...

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. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

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...

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...

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. This article is available only as a PDF. Please...

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. This article is available only as a PDF. Please click on...

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...

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...

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. This article is available only as...

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. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

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...

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. This article is available only as a...

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. This article is available only as a PDF. Please click on “Download PDF” on top...

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...

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...

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...

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...

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...

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...

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. This article is available only as a PDF. Please...

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...

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”. This article is available only as...

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. This article is available only as a PDF. Please click...

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. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

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...

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. This article is available only as a PDF. Please click on “Download PDF” on...

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...

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...

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. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

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. This article is available only as a PDF. Please click on “Download PDF”...

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. This article is available only as...

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. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

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...

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...

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...

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. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Subjective health indicators including self-rated health (SRH) have been shown to improve patient care in the clinical setting1 and are also useful in measuring quality of life and planning health policy.2 Poor SRH is also a consistent predictor of cardiovascular disease and mortality across several populations.3 Mossey and Shapiro...

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%. This article is available only as a...

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. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

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...

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...

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...

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...

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...

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...

Primary care in Singapore is set to face challenges in managing a rapidly ageing population. The expected population of older adults aged 65 years and above will be close to 1.5 million by 2030, corresponding to 2.7 working adults per older adult in 2030.2 Between 2019 and 2050, Singapore...