June 2016 | Issue 24
In pursuit of mastery

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 By Nicole Lim
Assistant Director, Communications & External Relations

 

See one, do one, teach one. This tenet has been at the core of medical education for centuries, when medical knowledge was seen as a static body that could not be improved on and dissections were done to confirm, not discover, the cause of death.
 
While this has changed gradually over the years, the last century saw the pace of discovery and medical innovation picking up exponentially. In fact, it has accelerated so much that in 1980, it was estimated that medical knowledge doubled every seven years; by 2010, it doubled every three-and-a-half years and, if it continues, by 2020, medical knowledge will be doubling every 73 days.

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Students at LKCMedicine are exposed to research throughout the curriculum

This ongoing transformation and society’s changing expectations of doctors pose a challenge to medical educators, calling on them to re-examine the defining features of medical education including the continued emphasis on the performance or outcome at the expense of the process of learning itself.

LKCMedicine Dean Professor James Best put it like this to prospective students at a recent engagement event, “Why would we continue to use medical education methods from the 1950s? Why would we try to cram your minds full of facts that may be out of date before you finish your course?”

Although changing these fundamentals is a tall order, the LKCMedicine team seized this opportunity and created a learning environment fit for the 21st century. They had to decide how students should learn in the context of this medical knowledge ‘explosion’ and with online information available 24/7, whilst keeping patient-centred care and collaborative learning at the heart of the new curriculum.

Vice-Dean for Education Associate Professor Naomi Low-Beer sums up the outcome as “a medical curriculum, where students are active and engaged in the learning process, enabling them to move beyond simple factual recall, so that they can access, analyse and apply knowledge to the care of their patients.”

Two key differentiating factors of modern day medical education that emerged are: the focus on nurturing a higher level of thinking and instilling a lifelong habit of inquiry in students.

 

Higher level of thinking
When making decisions about patient management, doctors have to weigh up individual patient needs, socio-economic factors, treatment options and context to arrive at the best solution. 

Juggling these variables requires a higher level of thinking. American educational psychologist William Perry demonstrated that students’ university years represent a key phase in their intellectual development. During this phase, students move from dualistic (right/wrong) reasoning to relativity, and eventually develop a way of thinking that allows them to commit to their own decisions.

Exposing students to the application of the principles of medicine and science right from the beginning – through the School’s Team-Based Learning (TBL) approach – nurtures their intellectual development and reasoning process as they discuss and defend their viewpoints to their peers and experts.

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Team-Based Learning creates an active and engaging learning environment

“During these discussions, the students are immediately faced with this issue that there are various approaches and points of view even in something as fundamental as the basic sciences,” said Deputy Director and Head of Educational Development & TBL Facilitation Dr Preman Rajalingam.

This is a big shift for many. Students no longer learn for factual recall alone. They focus on expressing, discussing, defending and reasoning out their ideas, rather than being the first to get the ‘right’ answer.

Class of 2018 student Leon Tan, who is just completing Year 3 (the first year of immersion in the clinical environment), said, “Just knowing the right answer doesn’t do us any good if we don’t process it and think. TBL helps to facilitate this process as it allows us to brainstorm and piece things together logically.”

Shifting the focus to the process is key to helping students learn better. Medical Education Research & Scholarship Unit Acting Director Associate Professor Nabil Zary said, “We push them to learn and collaborate more and better. After all, healthcare is all about teamwork.”

 

Pursuing mastery
Through nurturing a higher level of thinking in students, LKCMedicine also instils in students a habit of inquiry.

This habit, in turn, is underpinned by a learning environment that is based on mastery learning, which was defined by American educational psychologist Benjamin Bloom as a way of learning that sets an achievement goal and provides students with individualised instruction and varying instructional time to attain a pre-determined achievement level.

By adopting a flipped classroom model, students at LKCMedicine have to manage their own learning before class. They go through the content, which is delivered to them via pre-recorded lectures and reading material, supported by clearly stated learning objectives.

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Content experts challenge students to defend and reason out their positions during Team-Based Learning sessions

Class of 2019 student Rebekah Lee said, “Since lectures are pre-recorded, I can always pause and rewind or look up any concepts I am confused about. This ensures that I do not postpone my learning. Medicine is a steep learning curve, so it is imperative that I truly understand and learn these concepts.”

During TBL lessons, the time is spent reinforcing learning objectives through active learning tasks, ranging from individual and team readiness assessments to peer-led discussion and application.

The other essential feature of mastery is feedback, both corrective and for enrichment. With a custom-designed e-learning environment that students use throughout their five years, LKCMedicine faculty are able to track student performance as they complete various tasks and assessments live and respond almost immediately.

Assoc Prof Zary said, “We can use data to improve the lesson as it is happening, and tailor it to the needs of students.”

In fact, this move from performance towards mastery mirrors the Singapore education landscape, which is moving away from its strong focus on performance to a more balanced approach that rewards both outcomes and an understanding of the process. This shift is evidenced by the Government’s recent announcement that Primary School Leaving Examination (PSLE) scores will cease to be calculated as T-scores but turned into grade bands from 2021. To be ready for this new type of school leaver, universities are also remodelling their programmes to better cater to their needs.


Room for more than one JEDI master

Equipping students with the skills to remain abreast of advances in their field gives LKCMedicine an edge in today’s world. But to remain innovative and relevant, the School has to work on further individualising the learning experience that it can offer.

One advantage that medical education researchers at LKCMedicine have is access to data that can shed light on learning patterns and behaviour.

The Joint Education Data Infrastructure (JEDI) project will enable LKCMedicine to harness educational data to develop an Artificial Intelligence (AI) Advisor that will augment human capacity. When ready, this virtual tutor would be able to analyse students’ study patterns, health data and assessment performance, and nudge them to learn during times that work best for them.

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Through its integrated online e-learning ecosystem, LKCMedicine faculty is able to track students’ learning habits, allowing them to adjust lessons while in progress and even develop technology-based support systems

In addition, the curriculum team is looking at ways to standardise the students’ learning experience during the later years of the curriculum, when students are posted to different healthcare sites. This may take the shape of on-campus teaching clinics with volunteer and simulated patients to hone clinical and communication skills, or student projects that virtually bring student teams doing clinical postings at different sites together. Online clinical cases can also be constructed to enhance clinical exposure and promote reasoning skills.

Assoc Prof Low-Beer said, “We need our students to be exposed to a wide range of clinical cases regardless of which hospital they are posted to. We will be supplementing what they see and learn on the wards and in the clinics with a suite of e-learning modules that they can access 24/7.”

The benefits of remaining ahead of the curve in pedagogy means that LKCMedicine graduates will become highly sought after, believes Assoc Prof Zary. He said, “Overall, I’d expect that our curriculum will enable our students to acquire more competencies and develop greater ability in each of those competencies. More specifically, I’d expect them to be well integrated into healthcare teams, with high level communication skills, strong empathy and adept at using digital technologies.”