April 2015 | ISSUE 17


Clinical years: the medical students are in

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By Nicole Lim
Assistant Director, Communications & External Relations

In a mere four months' time, LKCMedicine's inaugural cohort of 54 students will don their white coats and step onto hospital wards for their first year of clinical rotations – breaking new ground for the students and the School.

In the run up to this early anticipated date, LKCMedicine clinical faculty have been busy planning the clinical teaching blocks, which include clinical postings at the School's healthcare partners and campus teaching weeks at LKCMedicine. As with any new project, the clinical years presented an opportunity to improve on and refine existing approaches.

LKCMedicine Vice-Dean for Education Associate Professor Naomi Low-Beer said, "For us, it was an opportunity to harness the teaching excellence of our clinical educators and deliver it in a structured way that helps to ease students through this first transition whilst at the same time retaining the ethos of the School."

As the School's curriculum is jointly developed with Imperial, the School's senior leadership, headed by LKCMedicine Dean Professor James Best, faculty and Year 3 clinical leads travelled to London in March to meet their counterparts at Imperial.

Vice-Dean for Clinical Affairs Associate Professor Pang Weng Sun said, "The aim was for our leads in Singapore to have an understanding of how Imperial manages their clinical years to augment our own experience of how we run clinical teaching here in Singapore."

The Singapore delegates visited the local visited three of Imperial's clinical sites to see the range of teaching hospitals Imperial and its students have to work with both logistically and educationally.

During the visit, the leads toured a number of London hospitals to see how they implement the Imperial curriculum, and manage and ensure the quality of the teaching across all the 2,000 or so clinical placements each year, which are sited in hospitals around London.

For some, the visit even offered new inspiration for their own rotations, such as the use of simulation in ear, nose and throat (ENT) clinical teaching and deploying students to the extended observation ward during their emergency medicine rotation.

Now back in Singapore, the clinical leads are putting the finishing touches to their teaching plans, pre-rotation teaching materials and learning outcomes.

With many of the clinical leads already involved in the School's pre-clinical teaching and familiar with the content taught in Phase 1, it appears the transition to clinical learning may be seamless. "This is a uniqueness that deserves preservation because it helps students to understand the clinical relevance of the science," said Assistant Dean for Phase 2 & 3 Associate Professor Tham Kum Ying, who is also the lead for emergency medicine.

DSC06799 (HiRes).jpgIn their first clinical year, students come together as one cohort for an introductory and closing week that book-end the academic year. For the rest of the year, they split into three streams, rotating through medicine, surgery and a first set of short postings in areas such as infectious  diseases, ophthalmology and ENT. Rotations last between two to 12 weeks and begin with one week of pre-rotational teaching.

"As well as preparing the students for the upcoming clinical postings, these pre-rotational teaching weeks focus on important clinical concepts, taught through Team-Based Learning, and integration of the School's vertical themes, such as clinical communication, ethics and patient safety," said Assoc Prof Low-Beer. The teaching blocks are supplemented with E-Learning materials that are delivered to students' iPads.

After a posting's introductory teaching block, students spend their time clerking patients, doing physical examinations, making preliminary diagnoses and helping with patient care. They will have bedside teaching as well as classroom-based lessons. The bedside learning will take place in the clinics, wards and operating theatres, as well as in polyclinics, rehabilitation centres and step-down hospitals. They will also shadow junior doctors on out-of-hours on-calls, which will complement supervised learning opportunities.

Throughout the clinical postings, students continue to use the iFolio to record their progress and reflect on their experiences. Clinical supervisors will also provide feedback via iFolio, completing workplace-based assessments on students' interactions with patients. In Years 3 and 4, these assessments are solely formative, to help students learn and improve.

"If the student is struggling it's a way to identify them and make sure they get the help they need," added Assoc Prof Low-Beer.

To give additional support to students and help their academic progress and professional identity development, LKCMedicine is appointing core tutors, who will guide small groups of students through each block. "The student may have great difficulty in explaining some of the intricate things unique to a posting to the house tutor, so a core tutor offers this additional support," said Assoc Prof Tham.

Students will also have the chance to work with and get to know students from the other medical schools during clinical postings. Lead for Body Systems, Critical Care, Organ Failure & Applied Physiology Associate Professor Kwek Tong Kiat said, "I anticipate that this will be a positive and enriching experience for everyone." He will supervise the students through their anaesthesiology short posting.

DSC06663.jpgBut interacting with real patients is undoubtedly where the students will develop and hone the art of medicine. With the integrated approach of early clinical encounters and extensive use of simulated patients, many hope that the students will be able to make the most of the opportunities to talk to patients.

"We're also working with clinicians to bring patients with clinical signs back to the outpatient clinic to give more students the opportunity to learn from them," said Assoc Prof Pang.​

Lead for Ophthalmology Assistant Professor Johnson Tan added, "With early integration with clinical materials, we also hope our students are able to better understand the basics in a more meaningful way."

With so many independent learning opportunities, students will need to manage their time well. "During the clinical years, the learning opportunities are plentiful but they do not always happen during office hours," said Assoc Prof Tham.

In fact, very often it is out of hours that the most interesting learning opportunities present themselves. While they can't expect to have the regular hours offered by Phase 1, students will need to balance their days to ensure they have sufficient rest and set aside time to read the preparatory materials for their Team-Based Learning (TBL) sessions.

Asst Prof Tan said, "Come with an inquisitive mind. Read the prep materials before the TBL sessions so as to engage fully in the discussions. Try to see as many patients as possible in the clinics. There is no better place to learn medicine."

"It will be really exciting to be immersed in an environment where doctors and other healthcare professionals look after patients, and our students will appreciate first-hand the difference that healthcare teams make to people's lives," added Assoc Prof Low-Beer.

​​Plans to branch out

For the inaugural cohort, most of Year 3 will be spent at Tan Tock Seng Hospital (TTSH), the most popular student choice for clinical postings. In Years 4 and 5, they will have the opportunity to experience life and work at other hospitals including the Institute for Mental Health and KK Women's & Children's Hospital.

For future years, discussions are already well-underway with Khoo Teck Puat Hospital and Ng Teng Fong General Hospital to rotate students through different hospitals. "We're meeting Changi General Hospital next, followed by National University Hospital and Singapore General Hospital," said Assoc Prof Pang.