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Accelerating Change in Medical Education and Research

Power of Ideas
Accelerating Change in Medical Education and Research

Duke-NUS Medical School is a graduate-entry medical school that brings together experienced and highly accomplished students with outstanding faculty, translational biomedical research programs, bench-to-bedside innovation, lifelong learning, and, above all, a collaborative spirit. Along with many industries worldwide, we faced pressing challenges across all of our missions when the pandemic descended.

One of our first challenges when COVID reached the shores of Singapore was the abrupt removal of our medical students from the hospital environment where they would typically spend almost half of their training time learning the practical basis of medicine.

While nothing substitutes for clinical learning at the bedside, we leveraged technology and the collective strengths of our partners to craft educational programs sufficiently resilient to promote effective learning and training. This allowed two classes of medical students to graduate on time during the pandemic, adequately prepared to step into Singapore’s public hospitals as highly functioning doctors. Some clear highlights and principles that will likely persist beyond the pandemic include:

  • Our flipped classroom pedagogy proved to be pandemic-ready. We also demonstrated that high-stakes clinical exams can be conducted even under pandemic restrictions without compromising reliable assessment of student competency.

  • We swiftly transitioned to train simulated patients to interact with students virtually, allowing students to continue practicing critical clinical skills such as history-taking and clinical assessment despite hospital restrictions. With the rise of telemedicine, we anticipate skills around interacting with patients remotely will be important for future medical practice and will likely retain these exercises in the curriculum going forward.

  • Likewise, companion modules developed during the pandemic for teaching students to make differential diagnoses in a virtual environment using face-to-face simulations also provide valuable skill training, enabling our students to make the most out of these interactions when they reach the hospital wards. These will continue to be valuable training adjuncts post-pandemic.

In the face of widespread border closures, virtual communication technologies paradoxically facilitated international collaborations and interaction with key global bodies.

While our researchers also endured many challenges, our long-term strategy of recruiting the best scientists from around the world, and, in particular, assembling a multidisciplinary team of scientists focused on the problem of emerging infectious diseases, provided a strong core foundation allowing Duke-NUS to make valuable contributions to the global fight against COVID. These contributions extended well beyond basic scientific discoveries such as:

  • Development of the only US Food and Drug Administration-approved surrogate neutralizing antibody test, now widely used to assess the extent of antibody-based immunity in the community and to assess vaccine effectiveness, helping to provide crucial evidence for planning national exit strategies.

  • Understanding T-cell responses to SARS-CoV-2. While these measurements are complex and laborious compared to antibody testing, these discoveries have led to a practical surrogate test, potentially enabling clinicians to monitor T-cell responses and allowing a full assessment of an individual’s immune response to SARS-CoV-2 in the clinic.

  • Developing novel vaccines for SARS-CoV-2 and against coronaviruses more broadly. This work, carried out by Duke-NUS scientists working with commercial partners, has the potential to transform Singapore into a leader in vaccine development, not only for coronaviruses but also for neglected tropical diseases like dengue, providing another opportunity to improve lives globally.

In the face of widespread border closures, virtual communication technologies paradoxically facilitated international collaborations and interaction with key global bodies such as the World Health Organization, opportunities that would previously have required travel and physical face-to-face meetings. As a result, we have seen many new partnerships between our school and partners to expand the reach of our innovative models and technologies. These virtual interactions will likely remain an important part of our normal operations going forward.

These developments feed into a wider shift in outlook and emphasize the importance of broad and transparent global interactions for sharpening future pandemic preparedness. Looking forward, we believe we can leverage our strengths in emerging infectious diseases combined with our expertise in health systems research, regulatory excellence, and global health to build on our global partnerships and enhance our resilience in the face of future pandemics. Through our parent universities—Duke University and the National University of Singapore—and our academic medicine partner SingHealth, Singapore’s largest public health-care provider, we can build global networks for genomic surveillance, capacity building, and health-care transformation.

In the context of our SingHealth Duke-NUS Global Health Institute, we also have the capacity to use our experiences to reach populations that have experienced health-care disparities during the pandemic, especially in our region. Several countries in Southeast Asia have suffered disproportionally from COVID because of underdeveloped health-care infrastructure and limited vaccine access. Capitalizing on our organizational lessons learned, we are well-positioned to contribute to improved future preparedness and resilience in Singapore, regionally and globally, thereby transforming medicine and improving lives.