Speech by A/Prof Benjamin Ong, Director of Medical Services, Ministry of Health, at the 14th Asia Pacific Medical Education Conference 2017

Dr Dujeepa D. Samarasekera, Chairman, Organising Committee 14th Asia Pacific Medical Education Conference 2017, National University Health System,
Distinguished guests,
Ladies and gentlemen,

A very good morning to everyone.

1.    I am pleased to join you today at the opening of the 14th Asia Pacific Medical Education Conference. I would like to extend a very warm welcome to all, especially our overseas guests.

2.    This year’s APMEC is special as this is the first time it is organised with the Accreditation Council for Graduate Medical Education-International (ACGME-I). I understand that this is also ACGME-I’s first foray in organising an educational conference outside of the United States, and ACGME-I has specially invited several education leaders to join us. I look forward to their insights and sharing.

AN EVOLVING HEALTHCARE LANDSCAPE

3.    Today’s society sees increasing disease burdens, rising medical costs, as well as novel and constantly evolving external pressures. In Singapore, our healthcare needs have been changing due to our demographic profile. Our rapidly ageing population – where one in four people will be aged 65 and above by 2030 – has intensified and altered care needs, and has spurred us to develop new models of care. There is a greater need than ever for multi-disciplinary teams to work together to deliver accessible and effective care for patients. The challenge for the future therefore, is to move away from the traditional focus of training the individual healthcare professional, to one where the trainee is part of a multi-skilled team, with each person proficient in breadth as well as depth of capabilities.

THE NEED FOR QUALITY MEDICAL EDUCATION – MEDICAL SCHOOL STANDARDS

4.    Against this national backdrop of social and demographical change, medical education becomes one key driver of healthcare transformation. NUS Yong Loo Lin School of Medicine is now joined by Duke-NUS Medical School and Lee Kong Chian School of Medicine in producing a talent pool of competent professionals to look after our healthcare needs. The three schools have the huge responsibility of training doctors who are fit for purpose, and able to provide care in the new and changing environment. The dynamic relationship between medical education and care model means that training must be nimble and continually tuned in to our changing healthcare needs to remain relevant. Many of our students, however, still spend a huge proportion of their learning time in large specialty centred facilities, and are taught about disease at molecular levels of understanding. How do we ensure that we do not lose sight of holistically managing patients in this future focussed educational milieu will be the challenge.

5.    At the undergraduate level, MOH appointed the Medical Students Training Standing Committee (MST-SC) to oversee the development of a core set of national standards for the three medical schools in Singapore. This national framework ensures consistently high standards in medical school training and graduate outcomes relevant to the practice of medicine in Singapore, while allowing the three schools flexibility to develop their unique pedagogy and style.

6.    Medical education goes beyond the medical school. As a continuum to medical school, all graduates now undergo a structured Postgraduate Year 1 (PGY1) training and assessment framework. The national framework defines the training standards and outcomes to ensure that the goals are met. This is a critical year where PGY1 doctors are put through their paces to ensure that they can practice throughout our healthcare ecosystem safely, competently and aware of their limitations.

SPECIALTY AND FAMILY MEDICINE TRAINING

7.    In order to strengthen specialist and family medicine training, residency was introduced in 2010 as part of an ongoing collaboration with ACGME-I. Through residency, four key areas were restructured – curriculum, assessments, people and systems. Residents are assessed at each level of training by a designated core faculty using regular formative assessments and tools, and are provided with qualitative feedback.

8.    A review commissioned by the Ministry of Health two years ago concluded that residency resulted in better accountability and ownership of training. Feedback about residents’ performance within the training system prior to exit was also satisfactory. However, in line with the changing demographics and disease epidemiology, there is now a need to strengthen broad generalist capabilities to ensure delivery of holistic care to patients and manage healthcare costs. A separate committee has been set up to look into ensuring that all specialists are equipped with such generalist competencies as part of their training.

9.    While residency training equips doctors with the core competencies required for practice, the continuous learning and development of post-residency training are vital in ensuring that new specialists gain the necessary clinical experience and skills to practise independently and confidently.

10.    Like medical research, pedagogical developments will continue and we should be prepared to embrace them. Whilst we should remain open to international trends in medical education reforms, we must always strive to work towards a system that adopts the best practices and contextualise them, so that there is a close alignment between our medical education system and healthcare delivery system appropriate to our societal needs.

CONCLUSION

11.    Policies and structures are important; but ultimately, our healthcare eco-system is only as good as our people designing and running it. I am heartened to know that our healthcare educators are continuously inspiring the next generation as models of values and ethos. In the words of Aristotle “Those who know, do. Those who understand, teach.”

12.    I wish all of you a fruitful and enriching time at the conference. To our foreign delegates, I hope you have an enjoyable stay in Singapore.

Thank you.