December 2012 | ISSUE 3
Making Medicine Care

By Richard Philip

It is not customary to start a story with a mission statement. But, that rule is worth breaking because the two bold and true sentences that make up the Lee Kong Chian School of Medicine’s mission statement are an apt start to a story on what is fast promising to be one of the more innovative medical schools in the world.

‘Equipping doctors who advance the science and practice of medicine for the good of humanity. The doctors you and I would like to have caring for us.’ This mission statement is LKCMedicine’s raison d’être and the soul and substance of what the school is setting out to achieve over the coming decades. Since the school’s establishment in 2010 no effort has been spared to turn this noble mission into a practical reality.

Dean of LKCMedicine, Professor Dermot Kelleher says that the mission statement is ‘a statement of purpose, which embodies who we are, what we stand for and what we do, and hence, it is the standard by which the world will judge our actions and achievements.’

‘We would have achieved nothing if at the end of the day we do not produce doctors who are able to dedicate their best efforts to what ought to be the centre and apex of all medical care – the patient’s wellbeing. LKCMedicine’s mission statement represents our resounding commitment to exploit the best research and medical knowledge to heal the ailing human being,’ he adds.

LKCMedicine Chief Operating Officer Dr Lionel Lee says that the school’s mission statement boldly pronounces two aspirations – to harness the best and latest in science and technology in the teaching of medicine and to imbue a caring and humanitarian spirit into the practice of medicine. ‘Our mission is to achieve a synthesis and balance of these two complementary aspirations so as to produce the doctors you and I would like to have caring for us,’ he states.

A century after the release of the Flexner report which advocated the need to incorporate the kind of formal analytic reasoning associated with the natural sciences into the intellectual preparation of physicians (an idea that contributed to vast improvements in the care of patients in the 20th century), new challenges have emerged in medicine that call for a further transformation in the way doctors are trained.

A 2010 Lancet report on medical education in the 21st century noted that professional medical training has not kept pace with current healthcare challenges, such as the increase in disease burden, escalating costs and inequities of public health within and between countries, largely because of a mismatch between the training of doctors and public health needs, outdated curricula, a hospital centric healthcare model, poor teamwork, lack of emphasis on the broader contextual understanding of a disease, and a focus on episodic rather than continuous care.

LKCMedicine’s own analysis of medical practice has found it absolutely necessary to counter the hospital- and doctor-centric medical environment marked by short-termism and the lack of service and professionalism in the handling of patients, with a patient-centric approach to care. The LKCMedicine approach upholds humility in service, a long-term integrated approach to care, the smart use of technology in the delivery of care, and shared decision-making.

LKCMedicine Senior Vice Dean Professor Martyn Partridge says the evidence is clear that patients enjoy much better health outcomes and reduced medical expenses when doctors listen to their concerns and expectations and work out a plan together with them. He adds that teaching students the value of shared decision-making is essential if they are going to be ready to practise in a world whose healthcare burdens are very different from those that existed 30 years ago. ‘Instead of a disease burden that is acute and often involving communicable diseases, we are now looking at a set of conditions, which patients live with for five, 10, 15, 30 years. We are also facing an ageing population and we need to ensure that the added years are years of quality achieved by the correct approaches to healthcare,’ says Professor Partridge.

Aware that the kind of doctors in a health system would ultimately define the proficiency and character of that system, LKCMedicine sees a significant role in, as its vision statement says, ‘Redefining Medicine, Transforming Healthcare.’ It understands the importance of implicit learning in the development of professional attitudes and behaviours in its medical students, and is clear about the culture that it wants medical students to immerse in. It wants to imbue undergraduates with the LKCMedicine values of humility, integrity, compassion, continuous learning and professionalism and inspire them to become dignified leaders, open collaborators, creative thinkers, and most of all, sincere people. ‘We think that to produce graduates who genuinely subscribe to a patient-centred approach involves our approach to the medical students themselves. So, LKCMedicine is devoting considerable thought and energy to ways in which we can be student-centred and demonstrate our value and respect for our young colleagues such that this fills them with the desire to treat others in the same way,’ Professor Partridge says.

The philosophy embodied in the school’s Vision and Mission statements will inform, play out and materialise into real benefits in the three focus areas of the school, which are, a world-class medical education, transformative research and synergistic partnerships.

World-Class Medical Education
The school’s curriculum will be made highly relevant to real world medical practice. Students will see the value of long-term care in an integrated healthcare system wherein patients are cared for by the appropriate professional, at the right time and in the right clinical setting, be it an acute hospital, the family medicine clinic, a rehabilitation centre, step-down care centre or the patient’s home. Through scenario-based learning, students will see how head knowledge is converted to practical care. Sophisticated simulations will be used to train students in complex procedures so that they reach a high level of technical competence before they conduct these procedures on real patients, hence, markedly decreasing the chances of harming patients. Students will also learn the importance of working in teams through team-based learning modules that teach them how to solve problems through cross-disciplinary interactions, a skill that is crucial in dealing with patients who have multiple conditions. The use of technology to enhance learning will be a key feature of LKCMedicine’s programme. Students will be issued iPads, which contain their timetable, assessments and e-learning materials, which they can access anytime at any place, and hence, optimise their time use.

Transformative Research
The school will be a place where a thoughtful team of researchers work to find solutions that save the lives of people. Eminent professors will conduct research in the areas of metabolic disease, neuroscience and mental health, medical and surgical technologies and the organisation of health services. These efforts will tap on the research work of LKCMedicine’s parent universities, Imperial College London and Nanyang Technological University (NTU); the interface of the disciplines of medicine, science, engineering, technology and business; and the convergence of Western and Eastern approaches to addressing the health issues of this century.

‘Translational Medicine can be defined in several ways. One used to speak of bench to bedside, but we should be thinking of bench to bedside to community. In research, medical education and in the delivery of healthcare we need to move on from the very traditional hospital-centric approach to an integrated approach,’ says Professor Partridge.

Synergistic Partnerships
The engagement of stakeholders is pertinent to ensuring the dynamism, adaptability, creativity, strength and relevance of health systems. This engagement is key to LKCMedicine’s social capital and a determining factor in the institution’s ability to make important contributions on the global stage.

‘In many countries, it has proved useful to combine an established medical school with a university wishing to start a new medical school. Whilst not stifling innovation, this provides a significant core of processes, content and regulation, which saves the new medical school tremendous time. It also, and this is of great importance, brings the experience that should lead to high quality education, from the beginning,’ says Dr Lee.

The heritage and networks of the two institutions together with the critical partnership with the National Healthcare Group and the strategic relationship with A*Star and the local biomedical research community, provide the cultural ballast necessary for LKCMedicine to cultivate other prestigious partnerships around the world in order to generate new ideas and innovative solutions that will improve the health and wellbeing of Singaporeans and millions worldwide.

All medical schools aspire to develop medical students into accomplished, responsible and caring doctors. ‘What is unique about LKCMedicine is that it has risen into being in the early part of the 21st century and hence occupies a historically strategic position to reconfigure the teaching of medicine so that doctors who graduate from the school will be equipped with the scientific understanding, clinical reasoning, practical skills, character, compassion and integrity suited for 21st century healthcare needs and challenges,’ stresses Professor Kelleher.