December 2018 | Issue 39
When Medical Education Meets IR 4.0

Anne (Custom).jpgBy Anne Loh, Assistant Director, Communications and Outreach

Imagine this: doctors never having to ask patients "How are you feeling?" or "What's wrong?" ever again, because they could tap into your wearable technology and be updated on your bio signs. Think that is too far-fetched? Not if you're one of the hundred who tested the made-in-Singapore smart T-shirt at one-North Run just this month where wearable tech in the form of carbon electrodes could send your ECG reading to the app on your phone. The T-shirt was developed by KaHa, a Singapore start-up and Tex Line, a textile company with assistance from A*STAR.

An NTU-TTSH research team, led by NTU A/Prof Ser Wee and TTSH A/Prof David Foo, has also invented a handheld medical device for patients at home with a receiver that could pick up breathing sounds and send the signal to a cloud-based server through a mobile app. Taking all of 10 seconds, an NTU-developed algorithm will identify congestive heart failure with a 92% accuracy with results shown on the app. The invention is pending patent approval and undergoing refinement.

Waiting to see a doctor could become just an option too, as patients could choose to have a video consultation wherever they are.

Die-hard Star Trek fans might have supposed that the 3D printer is the Replicator come to life. But at LKCMedicine, our students are starting to use 3D-printed plastinated specimens for their anatomy lessons. And while the Replicator could never produce anything living, there are trials of 3D printing of live human tissue going on, even though at the rate of one cubic inch a week, it won't be saving lives anytime soon.

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LKCMedicine students holding 3D-printed plastinated specimens, a future teaching tool for anatomy lessons

What has previously been so much science fiction has caught up with reality, and with disruptions rippling (make that "ripping") through various sectors, can the effects on medicine and medical education be far behind?

It's already here, said NTU President and Distinguished University Professor Subra Suresh in his welcome address at the inaugural Transform MedEd conference on 9-10 November, which was jointly organised by LKCMedicine and Imperial College School of Medicine at the Clinical Sciences Building in Novena. The two-day conference which welcomed close to 400 delegates from 15 countries looked at how innovation will impact the future of medical education and the healthcare industry through its people, practice and policy.

Staging this conference now is timely, he said, "We have an opportunity to transform healthcare – by choice or not – we should not let opportunities that come about because of crises or disruption go to waste, as Rahm Emanuel famously said. We may not get definite answers at this conference but we can start the conversation."  While technology might change the face of medicine, we cannot lose sight of patient-centred, empathetic, compassionate care, Prof Subra stressed.

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NTU President Subra Suresh giving his welcome address on the first day of Transform MedEd 2018

With the conference programme packed with plenaries, symposia, short communications and workshop sessions, as well as poster presentations, naturally artificial intelligence (AI), simulation through augmented reality (AR) and virtual reality (VR) as well gamification received heightened interest from conference participants. In addition to other touchstones of LKCMedicine such as its Team-based Learning or flipped classroom pedagogy, and anatomy learning through plastinated specimens, the Anatomage table and 3D-printed specimens, participants were hard-pressed to choose their parallel sessions carefully.

As promised at the start of the conference by Co-chairpersons Professor Naomi Low-Beer, Vice-Dean for Education at LKCMedicine, and Mr Martin Lupton, Vice-Dean for Education at Imperial's Faculty of Medicine and Head of the Undergraduate School of Medicine, "The conference is an opportunity to gain new insights into medical education and to take home new approaches that can be incorporated into practice. It's also an opportunity to build new collaborations with educators from across the world."

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Transform MedEd 2018 Co-chairpersons Professor Naomi Low-Beer and Mr Martin Lupton giving their speech on the first day


Is it time to ditch the textbook?
Keynote speaker Dame Parveen Kumar, Professor of Medicine and Education at the Barts and London School of Medicine and Dentistry, Queen Mary University of London and co-author of Clinical Medicine, now in its 9th edition, said in her speech with the provocative title "Time to ditch the textbook?", "Medical knowledge will double every 73 days by 2020. Online textbooks are now interactive, so it's important to have one for curated content by experts. After that, you can take it further however you want to." A combination of traditional and new teaching methods – coined 'blended learning' – is needed to deal with this time of education transformation, she said.

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Keynote speaker Dame Parveen Kumar giving her lecture on "Time to ditch the textbook?"


Shades of reality
The challenge of helping medical students to understand complex 3D structures for human anatomy learning as well as learning the skills needed for practical situations was addressed at the short communication session Immersive Learning in Medical Education chaired by LKCMedicine A/Prof and Acting Director for Medical Education Research & Scholarship Unit Nabil Zary.

The use of Hololens as an immersive and interactive learning tool was proposed by A/Prof of Developmental Biology at Leiden University Medical Center Beerend Hierck and Imperial Clinical Senior Lecturer in Colorectal Surgery Dr James Kinross. With this tool and a purpose-built app, it is possible to learn anatomy from your own body, according to A/Prof Hierck. With his Dynamicanatomy app, students can be fully immersed in and interact with fellow students while studying the ankle joint.

Dr Kinross' presentation on AR for the Intra-operative Visualisation of Anatomy and Tumour Regression in Rectal Cancer using the Hololens platform also addresses the need to help students simulate practical situations. AR is fully 3D and multiple students can learn together as the hologram can be walked around and and interacted with.

VR as an immersive learning tool with plausible feedback was covered in the presentation Designing a Virtual Reality Simulator for Total Hip Replacement by Imperial Clinical Research Fellow Mr Martik Logishetty from the Department of Surgery & Cancer, where the operation could be simulated in an operating theatre scenario.


Non-carbon intelligence
With artificial intelligence and IR 4.0 poised to challenge the standard modus operandi of medical education and disrupting healthcare, the symposium Artificial Intelligence in Medical Education was also well-received where Imperial Digital Learning Hub Director Gideon Shimshon presented Rethinking Teacher-student Interaction through AI-enabled Feedback and Grading, and Dean of Morling College, University of Divinity James Dalziel spoke about AI and Learning Design: Technical and Pedagogical Opportunities.

Expanding on the theme of science fiction becoming a reality, Mr Shimson said at the session, "Recent advances in AI have brought what sounds like science fiction into the realm of the possible." Science fiction fans would perhaps have put it the other way, that we are now seeing what science fiction greats have written about decades before the fact.  

Another interesting presentation at this session was from Dr Melvin Chen, a lecturer in philosophy at NTU School of Humanities who is researching Medical Artificial Intelligence. One aspect that he is concerned about is the inherent care deficit in AI.


And yet, patients must come first
We can either look forward to what IR 4.0 will bring to make all our lives better: busting frontiers in research, bringing healthcare to inaccessible parts of the world or aftercare into the home, predicting probability of health risk or epidemics, monitoring our health through wearables, remote diagnosis; or worry about whether AI will one day transplant healthcare workers at our bedside, taking over research labs and hospitals.

Professor Dato Dr Adeeba Kamarulzaman, Dean of Universiti Malaya's Faculty of Medicine during the panel discussion on Transforming Healthcare Through Our Graduates talked about curricula change and the need to include technology, perhaps telemedicine and mHealth, but balanced that with saying, "We will find as we use more technology, patients will expect more of doctor-patient relationships."

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Professor Dato Dr Adeeba Kamarulzaman addressing questions from the audience during a panel discussion on the second day

Early-patient contact and building familiarity with the clinical setting are both linchpins of the LKCMedicine MBBS, built upon practice in the Communications Suite with Simulated Patients (SP). LKCMedicine Assistant Dean of Clinical Communication Training & Student Welfare Dr Tanya Tierney thus led a SP scenario writing session with Professor of Surgical Education, University of Melbourne and Professor of Simulation Education at Monash University Debra Nestel where participants discussed factors that add to realism in the SP context as well as difficulties. Prof Nestel also presented on her experience and the importance of simulation education during the panel discussion on Transforming Healthcare.


Closing on a high note
Fully appreciative of the sheer amount of knowledge exchanged and shared over the two-day conference, Prof Low-Beer said in her closing remarks, "This conference was a bigger success than we had imagined with 393 registrations from 15 countries, one keynote, four plenaries, four symposia, 10 workshops; and 104 submitted abstracts with 54 selected for poster and 35 for oral presentations. Thank you to all who worked on this over the past year."

Mr Lupton added, "Collaboration between Imperial and NTU has led to profound improvements in medical education at both Imperial's School of Medicine and LKCMedicine. Advances in technology, pedagogy and practice have enabled this transformation. Our common ambition to push the boundaries of medical education catalysed this conference.

The inaugural Transform MedEd has been a resounding success and we look forward to exploring and applying these new ideas and connections with colleagues around the world. I would like to thank all the members of the Imperial team who worked so hard to make this possible." 

Imperial Vice-Provost (Education) Professor Simone Buitendijk who had given the Welcome Address as well as presented at the Transforming Healthcare panel discussion summed up her experience at Transform MedEd, "It was wonderful to attend such an exciting gathering of innovators in medical education who are all keen to evidence their interventions and make sure we give our students the quality education they deserve. From virtual reality in the classroom, to community engagement and novel forms of authentic assessment, all the topics were extremely relevant. To get together with educators literally across the globe was a real treat. Our LKCMedicine colleagues were great hosts and I am looking forward to organising the follow-up conference in London in the spring of 2020."

We are certainly looking forward to it!