February 2020 | Issue 46
Keeping LKCMedicine safe and going amid novel coronavirus outbreak

Amanda Lee byline pix.jpgBy: Amanda Lee, Senior Assistant Manager (Media), Communications & Outreach

Real heroes don't wear capes. Take a group of 17 LKCMedicine alumni, for example, who have stepped forward on top of their daily doctor duties, to assist faculty at their alma mater to draft materials for lessons now going online.  

Why? You may ask. With the Singapore Government raising the alert level for the novel coronavirus disease (COVID-19) to Orange, clinical postings for LKCMedicine Year 3 to 5 students have been suspended until further notice. Instead, their clinical postings have been substituted with classes on campus, with most of it going virtual.

However, as these students were on clinical postings after the Chinese New Year period, LKCMedicine Assistant Dean of Year 5 Associate Professor Tham Kum Ying said each student were given five surgical masks for a week. "This gives the hospitals time to take stock and ensure that there are masks available for students too," she added. 

This is the second time that the Republic has activated Code Orange. Under DORSCON (Disease Outbreak Response System Condition), Orange means that the outbreak is deemed to have moderate to high public health impact.

The Year 5 students may be the most affected, as they are supposed to be on their Student Assistantship Programme (SAP) for nine weeks, where they would be firmly embedded within the workings of a clinical team, both in hospitals and in the community. Until DORSCON returns to yellow or green, students will not be able to undertake clinical postings.

However, the School is pulling out all the stops to ensure that the MBBS programme is carried out dutifully in times of crisis like this. For the alumni, they are drafting clinical scenarios for "SimConsult", a simulated clinic session where a Year 5 student on his/her SAP conducts a consultation with a patient, who is a Simulated Patient (SP) scripted to the role. These clinical scenarios are near-ready to be rolled out. 

"We understand that medical students are not allowed to go to the clinical setting during DORSCON Orange for their safety. However, we know time in the clinical setting is very precious for students to learn, especially for the Year 5 students who have their Student Assistantship Programme planned after their MBBS. As they will be turning House Officers in May 2020, as alumni who have been through housemanship, we want to help them as well. That's why a few of us have volunteered," said LKCMedicine Alumni Association President Dr Leon Tan.

So far, Dr Tan and his fellow alumni mates have worked on some family medicine clinical scenarios.

"These are good scenarios for students to revise their content knowledge, which is highly important. Given that there will be simulated patients, this will be useful to give them the confidence to approach patients in the real-world setting. Of course, nothing beats the experience of being in the real clinical world and learning on the ground. However, in view of the current situation, having the simulation sessions will be a good interim alternative," added Dr Tan.

During "SimConsult", a family physician will observe the consultation through Zoom, a cloud video conferencing platform that provides high-quality audio and video conferencing, collaboration, chat and webinars across mobile devices, desktops, telephones and room systems for LKCMedicine students and staff.

When the consultation is completed, the family physician will give feedback to the student on his/her consultation, and discuss the management of the patient. Upon completion of the feedback, the family physician will exit the video conference. The SP will then give feedback to the student, who will complete a Clinical Case Record for the patient including reflection/learning points.

Dr Tan added, "Hopefully we will be able to do face-to-face teaching as well, but that is still in the plans."

Impact of DORSCON Orange for LKCMedicine students

In a university-wide approach, classes with more than 50 students will be replaced by digital forms of learning. This also applies to all assessments such as tests, quizzes and exams that must be conducted face-to-face.

Although classes with 50 or fewer students may continue as usual, faculty and instructors may also implement e-learning for those classes. Schools are required to inform affected students about changes to the arrangements of their learning and assessments.

In the week of 10-14 February, several classes were conducted off-site through online learning for the Year 4 students. For example, students who were supposed to be on the Emergency Medicine posting, had online lessons conducted by A/Prof Tham.

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Classes with more than 50 students are taken virtually, and clinical postings are suspended  

Likewise, for the Year 3 students, classes were conducted online. However, the Year 3 formative Objective Structured Clinical Examination (OSCE), where students were to be tested on clinical communication, clinical methods, and practical skills, has been postponed.

Meanwhile, the Year 1 and 2 students are having their Team-Based Learning (TBL) sessions online. For anatomy practicals, a "laboratory segregation" kicks in. This means that the class will be divided in such a way that there will not be more than 50 students per segregated area.

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Classes with more than 50 students are taken virtually, and clinical postings are suspended  

The unsung heroes

In an email sent by LKCMedicine Dean Professor James Best on 7 February, he assured all staff and faculty that the School is monitoring the novel coronavirus situation closely, and taking all precautionary measures necessary to ensure the health and safety of LKCMedicine students and staff.

These include closing the link bridge between the School's Clinical Sciences Building (CSB) and Tan Tock Seng Hospital (TTSH), implementing mandatory temperature screening for all visitors to the Novena Campus, increased sanitising of the School's facilities and setting aside a holding area for those who are unwell.  Hand sanitisers are also readily available throughout the campus.

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Travel declaration is mandatory at LKCMedicine, while hand sanitisers are made easily available throughout campus to instil good personal hygiene

All LKCMedicine faculty and staff are also required to declare their travel history and report their body temperature twice daily in the NTU Temperature Recording System. 

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LKCMedicine mandates twice-daily temperature taking for all staff and students

Further and where needed, thermometers and surgical masks are made available – for now, only Year 3 to Year 5 students who do not have their own thermometer are given one.

LKCMedicine Director of Operations and Resources Mr Tan Hee Kiang, who oversees the implementation of operational policies and procedures, said he is "mindful" of the need to work closely with TTSH on the developments of the COVID-19 outbreak as the Novena Campus is located close to the hospital and the National Centre for Infectious Diseases (NCID).

"We have also put in place the necessary standing operating procedures (such as setting up a holding area for a person who is unwell while waiting for transport to the hospital, setting up temperature-screening stations). Our staff members also conduct scenario-based exercises to familiarise themselves with the standing operating procedures to test their response to any emergencies," said Mr Tan.

More recently, faculty and staff are also required to check-in their attendance at shared indoor campus facilities by scanning a QR code using their smartphones.

This is implemented by NTU Singapore for all classes, meetings and events, to facilitate contact tracing should the need arises. Contact tracing is a mandatory national precautionary measure to limit person-to-person transmission of the COVID-19.

In the meantime, the School is working in concert with NTU to put in place a robust business continuity plan to ensure critical work is not disrupted. 

When duty calls

All the technology eablers were made possible by a team led by LKCMedicine Deputy Director of InfoComm Infrastructure Alan Loe, who had to cut short his Chinese New Year celebrations, after a phone call. 

"I received a call asking my team to set up for a remote classroom. I quickly contacted one of my staff, Joe Shim, to brainstorm ideas. We both felt it is important that students should be able to attend their classes virtually. Hence, we decided to get it done quickly in CSB the night of 27 January," said Mr Loe.

To ensure that the students can attend classes the next day, Mr Loe and Mr Shim assembled a mobile unit that combines a computer, wide-area sensitive microphone and a high-definition camera. They are mobile for ease of use within the CSB Learning Studio.

"We used the mobile TV stand as the main point of access, to which the students connected remotely from wherever they were. This allows the Year 5 students to see, hear and view the presentation slides, as if they were inside the CSB Learning Studio," explained Mr Loe.

He added, "We had it done by 1am fortunately, with the assistance of another staff member, Johnson, who was willing to assist remotely at that hour to verify the audio and video quality as well as affirm the system workflows. We managed to get some rest and came back to CSB around 7.30am the same morning. Joe, who was on leave, also provided online Zoom support to the students during the Zoom session itself."

Clearly, the School isn't leaving anything to chance, taking all necessary precautions as advised and mandated by NTU and the Singapore authorities. One can never be too careful. The advice, as any good doctor would give, is for everyone to practise good personal hygiene and for those who are unwell to seek medical attention.

As Prof Best stated in his message to all at LKCMedicine, "Let us work together and remain vigilant at all times in safeguarding the health and safety of everyone in LKCMedicine."