August 2015 | Issue 19

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Preparing students for life as a doctor
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By Associate Professor Tham Kum Ying

Assistant Dean for Years 3 & 5

Year 3 is a transition year. Transition happens in a few aspects:

  • Students move from classroom learning to clinical and workplace learning, in ‘live’ and dynamic settings where situations are often fluid and change is the only constant
  • Teachers include not only clinical educators and faculty, but many other doctors and equally important, patients, their family members, nurses and other healthcare professionals
  • In addition to Standardised and Simulated Patients, students spend more time learning from and working with patients who are sicker and have complex medical, social and functional issues
  • The scheduled and measured tempo of the Year 1 and 2 timetable moves up a few notches to a faster pace matched to patients’ daily activities
  • While their primary role as learners remains unchanged, students begin to take on responsibility under supervision in a gradated manner as future doctors
  • Self-driven learning becomes even more important because the diversity of experiences creates some variation in learning opportunities that should encourage students to read beyond the recommended texts. Self-driven learning is closely related to time management whereby students need to find the right balance between time spent learning in the clinical setting and time spent studying in the library or at home
  • For the administrative team, working with colleagues from healthcare institutions adds complexity and often challenges to an already complex work situation
This transition while stressful is also exciting and full of promises for the students – of the many new things to learn, of enjoyable days in the clinical setting, of interesting people to meet, and of hard work that is critical for fruitful learning.

 
Outcome and competencies​​
Transition in the case of undergraduate medical education describes the metamorphosis of a medical student into a new postgraduate year 1 (PGY1) doctor. The Ministry of Health (MOH) states in the report Outcomes and Standards for Undergraduate Medical Education in Singapore: “Ultimately, the goal of undergraduate medical training is to produce future doctors with competencies and skills that meet reasonable patient expectations within a healthcare setting.”

The postgraduate education system in Singapore has adopted the competencies of the Accreditation Council for Graduate Medical Education-International (ACGME-I) since 2010. To ensure a seamless transition from undergraduate to postgraduate training, the core competencies of the ACGME-I are recommended for the medical schools. These competencies include patient care, medical knowledge, interpersonal and communication skills, professionalism, practice-based learning and systems-based practice.

The acquisition of these competencies is marked by achievement of learning outcomes along the way. The selection of learning outcomes for Years 3, 4 and 5 is therefore guided by what PGY1 doctors will need to know, be able to do and how they should conduct themselves. The learning outcomes are then crafted to align with LKCMedicine’s curriculum themes:

1. Scientific Basis of Medicine
2. Clinical Management and Patient-centred Care
3. Healthcare Delivery and Professional Standards

In Years 1 and 2, the introduction and learning of these curriculum themes began with a patient’s presentation. This continues in Year 3 where essential presenting of complaints and conditions are embedded in the learning outcomes.

 
Professionalism
Students grow rapidly in clinical knowledge and skills from Year 3 onwards. It is important that their growth in ethical practice and professionalism is given adequate attention too. MOH has made explicit that professionalism is a key outcome for medical students. The graduate must clearly demonstrate:

a. Awareness of his/her clinical responsibilities
b. Respect for patients’ rights and confidentiality
c. A commitment to protecting patients’ needs and safety
d. Improvement of care for patients
e. Ability and willingness to promote, monitor and maintain health and safety in the clinical setting

The LKCMedicine Student Guides to blocks and postings prepared by the faculty provide details on personal and professional behaviour, punctuality and attendance, dress code, chaperone, medical leave, leave of absence etc, which students are expected to become familiar and comply with.

Embracing professionalism and demonstrating professional behaviour must stem from a student’s own desire to do the right thing, and not from a wish to avoid punishment. In so far as this is concerned, students are urged to remember that several types of unprofessional behaviour, such as irresponsibility, diminished capacity for self-improvement, poor initiative and unprofessional behaviour among others, noted in medical school are strongly linked with disciplinary action in professional life later.

 
Conclusion
Year 3 is a transition year – one that is exciting in its promises, demanding in its commitment and enriching in its wealth of experiences. The successful student is one who is self-driven, works hard, works smart where appropriate and achieves a healthy balance between time spent on clinical learning, studying in the library or at home, and living his/her personal life meaningfully – the hallmark of a life-long learner.