October 2016 | Issue 26
Imperial med students get to know LKCMedicine on inaugural exchange visit to Singapore

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By Rachel Shaw, Imperial Year 3 MBBS student


Stepping off the plane was like walking into a giant, velvet cushion of warm air. After more than twenty hours of travel, my nine classmates and I knew, we were in Singapore.

Over the first couple of days, we were taken around LKCMedicine and NTU to see the differences that studying medicine in Singapore posed.

I was surprised to find that Team-Based Learning (TBL) was in fact a mainstream learning method at NTU, and as such the purpose-built TBL rooms made a lot of sense – certainly we had a lot of fun with the novelty of the microphones and screen projections, even the plug sockets were oriented upside-down to provide bend-free wiring. We spent a day with the Year 2s examining and discussing the gastrointestinal tract – an area we had covered earlier in our MBBS programme.

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The Imperial exchange students are briefed by Assistant Dean for Years 1 & 2 Prof Michael Ferenczi

Seeing content taught by a clinician expert was an interesting experience. The benefit is that you get answers with a real-world perspective. However, because they may not be the question-setters, this means they occasionally may not be able to give explanations derived from the forefront of biomedical science; something that can frustrate students. Personally, I respect that this in itself teaches a valuable lesson to students – as doctors we cannot know everything.

The set-up involving independent research and teaching their fellow students is an improved version of our own Problem-Based Learning. Where we return a week later to give five-minute long presentations, in TBL, the feedback is within minutes and feels a lot more like a discussion. Certainly, when you have to explain a concept to somebody, it consolidates your understanding and identifies any gaps in your knowledge.
Communality and shared responsibility were impressed upon us as a core part of the Singapore identity.

Whilst being taken around the polyclinics, Assistant Dean for Year 4 and Family Medicine Associate Professor Wong Teck Yee explained the system of co-payment and Medisave, which partly takes the place of general taxes (in the UK) or compulsory health insurance (as with Obamacare in the US).

Although I would have concerns if point-of-delivery payments were introduced into our NHS, I would welcome the resulting public awareness that must inevitably arise in Singapore, when a given percentage of your care is charged to your personal account.

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LKCMedicine Class of 2019 students, who had travelled to London earlier this year, host their Imperial med student counterparts in Singapore

In the UK, the average person has no concept of how much it costs to fulfil a GP appointment or an ambulance call-out and as such feels removed from the system, seeing it as a service for them, as opposed to a service that comprises as well as works for them. People can only accept responsibility for the healthcare of themselves and their fellow citizens if they first appreciate its cost, monetary or otherwise.

Assoc Prof Wong showed us a waiting room full of parents whose babies were waiting for their vaccinations; he explained that while not “compulsory”, in order to be enrolled in school a child must have an immunisation certificate. I was reminded of something one of the other exchange students, Year 3 student Naveeth, had mentioned when in London. Whilst you can opt out of organ donation, if you end up needing a transplant, you will be placed at the bottom of the list. My impression is that such Hobson’s choices reflect Singapore’s liberalism.

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Students from both schools taking a break after visiting patients in the clinics and hospitals

For our two days in hospital, I was paired with Year 3 student Berwyn, whom I had got to know a little in London. Following him on this rheumatology placement, I came to understand Singapore and LKCMedicine through his eyes.

Accompanied by his partner Kaiwei, we spoke to and examined patients with a range of problems, from allergic reactions like Steven-Johnson Syndrome to chronic inflammatory disorders like systemic lupus erythematosus. At risk of further portraying the Imperial medics as rather lackadaisical in their approach to learning, I have to remark on the rigorous self-teaching demonstrated by Berwyn and Kaiwei. In between patients, talk was constantly centred around medicine, a patient’s condition or their own examining skills.

Both Berwyn and Kaiwei are ethnically Chinese and as such bilingual in at least English and Mandarin. For them, it was unremarkable to take histories in Mandarin as well as English. However, for me, the idea that for many Singaporeans, English is a common, but not a first language was linguistically and culturally fascinating.

On one of our days off, my classmate brought us round to his friend Vijay’s house. Vijay explained to us that his apartment block, like every other form of state housing had maximum ethnic quotas. This, I presume, is to encourage affiliation between the communities and prevent the kind of ghettoisation that you see in many multicultural metropolises.

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Students from LKCMedicine and Imperial College London spend a day at Universal Studios Singapore

Possibly because of the post-Brexit social and political climate in Britain, the apparently seamless integration of the Chinese, Indian and Malay communities inside and outside the hospital resonates with me so powerfully. I feel that the Imperial medical school could learn not just from LKCMedicine, but from Singapore as a whole, to make doctors who are more aware, more conscientious and competent to include our patients in their healthcare, be they white, black or brown.