Before coming to Singapore, I had spent my entire professional life at Duke University School of Medicine and Medical Center in Durham, North Carolina, USA – first as a medical resident and nephrology fellow, then later as a faculty member and eventually as chief of the Duke Division of Nephrology. When I left Durham 15 years ago to come to Duke-NUS Medical School, I had no idea that I was stepping into the most fulfilling chapter of my professional life.
In fact, when my friends heard I was moving to Singapore, halfway around the world, they asked with both scepticism and concern: "Are you sure you know what you're signing up for?" The honest answer was "no". But that leap of faith led to something remarkable: a journey of purpose, partnership and discovery in a place that continues to surprise me with its dynamism and heart.
As I prepare to step down as dean, I have been reflecting on how this journey began, what we have built together at Duke-NUS, and why I remain so optimistic about the school and Singapore's academic medicine community.
Starting in Singapore
When Prof Victor Dzau, Chancellor of Duke Health, first approached me years ago about taking on a new position, his pitch was simple: help build a new cardiovascular research centre at Duke and, at the same time, go to Singapore to help grow the Duke-NUS Cardiovascular and Metabolic Disorders (CVMD) Programme.
At the time, the CVMD Programme had "two-and-a-half" faculty members – the "half" being Prof Shirish Shenolikar, who was splitting his effort with the neuroscience programme. Accordingly, my main job as programme director was to recruit new faculty. I thought that this might be a difficult task, but by working closely with Prof Patrick Casey – then Vice-Dean for Research – and capitalising on the remarkable talent, bold ideas and outstanding environment in the school and the Singapore biomedical sector, it turned out to be surprisingly easy.
Before I started the job, Prof Christopher Newgard, longstanding director of the Duke Molecular Physiology Institute and frequent visitor to Singapore, told me: "Unlike in the US, your ability to build a thriving research programme in Singapore depends much more on your imagination than on resource availability." I actually used that line often while recruiting faculty... because it was true. And it worked! Over the next three years, we were able to recruit an outstanding cadre of faculty who became among the most productive in the School.
My vision as dean
In 2014, when there was an opening for a new dean, I put my hat in the ring. Becoming a dean had never been part of my career plan, much less doing it 15,000 kilometres from home. However, it turned out to be the best professional decision I had ever made.
My predecessors, Prof Robert "Sandy" Williams and Prof Ranga Krishnan, had built an extraordinary foundation at Duke-NUS, creating a new medical school that dared to challenge assumptions about how clinicians could be trained and how discovery science could be organised and executed. When I took over, Duke-NUS was viewed as a successful start-up, a disruptor in the domains of medical education and research. Therefore, I considered the question: what was next for Duke-NUS? How could we take this innovative, high-energy venture and transform it into a mature, trusted institution, woven into Singapore's medical community and national landscape?
To accomplish these goals, I began with a focus on three areas.
Strengthening clinical education
I had heard murmurs – which were occasionally louder than murmurs – about whether a four-year, American-style medical curriculum could produce capable clinicians in Singapore, compared to the existing five-year programme at the National University of Singapore's other medical school, which had been in place for 100 years (as well as a similar programme in the third medical school at Nanyang Technological University, which was then just getting started). Coming from the US, I knew that the curriculum could be effective, but I listened to the feedback as there were legitimate questions about whether our curriculum could be effective in the Singapore context. Moreover, our programme was different and not necessarily comfortable for the majority of our clinical instructors, who had been brought up in the Singapore system.
Nonetheless, thanks to the commitment and hard work of our education leaders, and with the flexibility, patience and understanding of our clinical faculty, we reshaped the curriculum, modifying and strengthening clinical rotations, ensuring that our graduates would enter postgraduate training with competence and confidence. Today, it seems clear that our graduates bring something distinctive to the ecosystem, complementing the skills and outlook of their peers trained at the other Singaporean medical schools.
Deepening the academic medicine partnership
Playing a role in building the Singapore Health Services (SingHealth) Duke-NUS Academic Medical Centre (AMC) has been a highlight of my term as dean. Growing up within the academic health system at Duke, I understood the power of a strong academic partnership between the medical school and the health system. I had seen up close and personal how embedding education and research with clinical care benefitted patients, while creating a wonderful atmosphere of curiosity and innovation for clinicians and staff.
When I started as dean in 2015, the Academic Medicine Memorandum of Understanding between Duke-NUS and SingHealth had just been signed and we were still learning each other's rhythms. The success of this venture required forging trust between two independent institutions, each with its own complexities, imperatives, boards and cultures. This process necessitated patience, candour and countless face-to-face conversations. With Prof Ivy Ng and later Prof Ng Wai Hoe, we developed a genuine and durable partnership: honest when things were hard, aligned when it mattered most and always focused on the shared purpose of building a world-class AMC. This alliance stands today as one of Duke-NUS' greatest strengths.
Translating research into impact
To accomplish the long-term vision of Duke-NUS of "Transforming medicine and improving lives", we built strong basic discovery programmes focused on critical public health problems in Singapore. But we also realised that for discoveries to truly impact human health, they must emerge from the laboratory and broadly enter the public domain. To facilitate this process, we created an Office of Innovation and Entrepreneurship, led first by Adj A/Prof David Epstein and then A/Prof Christopher Laing, building infrastructure to protect intellectual property, foster an entrepreneurial spirit among our research faculty and guide innovations into the commercial sector to reach patients. Despite the relatively small size of our research group, the transformation in our translational ecosystem has been remarkable, producing a generous number of licences and spin-off companies, and I believe this will only accelerate in the coming years.
The COVID-19 pandemic
No reflection on these past ten years would be complete without acknowledging the COVID-19 pandemic, which certainly impacted my experience as dean!
Like every institution involved in healthcare and medical education, we faced fear, uncertainty and relentless pressure. Personally, I spent two years in Singapore alone without my family, but I was fortunate to have my team, Jenne and Alina, who became my surrogate family and kept me grounded, organised and out of trouble.
But the true story of COVID-19 at Duke-NUS was about how our students, educators, scientists and clinical faculty rose to meet the moment. Our students stepped up with maturity beyond their years, while our education team and clinical faculty worked creatively to keep the students safe and their learning on track. Despite the constraints of the lockdown and difficult working conditions, our researchers prospered and helped shape our understanding of SARS-CoV2 transmission and immunity globally. Everyone worked together and looked out for one another during this difficult time.
Despite the crisis, we continued building: expanding research programmes, strengthening our AMC work and deepening our international collaborations. Going far beyond a matter of leadership, that progress is a testament to the overall strength of our community.
What I have learnt along the way as dean
A few lessons stand out:
- Nothing of consequence happens because of just one person. Everything moves because of partnerships – between individuals, schools, departments, hospitals and ministries. Academic medicine, education and research are truly team sports.
- Trust is built through conversations, clarity and showing up – not through perfectly crafted emails.
- Humour and optimism are essential.
- Imagination still matters. Indeed, the role of a leader is to create space for imagination and creativity to flourish.
As I step down, I do so feeling very grateful and confident. Grateful for the people I have worked with (especially my vice-deans and the Dean's Office team) and confident because Duke-NUS is in exceptionally capable hands with my successor, Prof Patrick Tan.
Patrick has the vision, energy and clarity to effectively lead the school into its next chapter. Watching him take the helm will be one of the great pleasures of my "post-dean" life.
Happily, I will remain in Singapore for now, still cheering for the school, and I remain deeply invested in the success of Singapore's academic medicine and research communities. This ecosystem has been generous to me and I am very grateful to all of my colleagues: scientists, educators, clinicians, staff, hospital partners and, of course, our students.
And last but not least, I am very thankful for my family's love, patience, understanding and support during these years away from home.
This unexpected journey has indeed delivered many treasures!