Letters to the Editor
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COMMENTARY / MINISTER's ADDRESS AT THE APPOINTMENT OF ASSOCIATE DEANS
Reflections On Clinical TeachingSir William Osler noted the importance of clinical learning at the turn of the century. He said, "To study medicine without books is to sail the uncharted seas; but to study medicine without patients is not to go to sea at all."
In the Inspirational Lecture Series to medical undergraduates this year, Dr Wong Heck Sing pointed out the importance of the Elementary Clinics as an introduction of the undergraduate into clinical medicine and exhorted the students to make use of every opportunity to learn about the basic skills of history, examination and management.
Clinical teachers have been exhorted to "return to the bedside" so that the three critical parties _ teacher, trainee and patient _ can participate together in the educational encounter. The presence of the patient is essential for the optimal demonstration and observation of medical history taking and interpersonal skills, physical examination as well as role modelling professional and humanistic behaviour (Ref 1).
Calman has highlighted the important role of the clinician as a medical teacher (Ref 2). He said, "Indeed it is difficult to be one without the other. The medical teacher serves a range of functions such as the developing education programmes, imparting a wide range of techniques for medical education and identifying informal teaching situations. Enthusiasm, commitment and motivation as well as clinical experience of a wide range of conditions are needed. So is the ability to be flexible in approach. Teaching is an exciting and creative activity and is the responsibility of all doctors, not just a few medical educators."
An important observation was made by the Minister for Health in his speech at the appointment of the Associate Deans. He said, "Clinical teachers not only impart medical knowledge and skills, but also serve as a role model for their students. It is through the subtle process of osmosis, that students and young doctors absorb the attitude of their teachers towards the practice of medicine and the behaviour towards patients and fellow workers."
A/PROF GOH LEE GAN
Minister's Address At The Appointment Of Associate Deans
"A very demanding and challenging job awaits you. Medical students and postgraduate trainees will be looking to you for guidance in their training." _ Mr Yeo Cheow Tong
In his speech at the Ceremony of Appointment of the Associate Deans, Mr Yeo Cheow Tong, Minister for Health said that the appointment of the Associate Deans for teaching hospitals by the Ministry of Health and the National University of Singapore, marks a major milestone in undergraduate medical education and postgraduate medical training in Singapore. Bedside teaching and hands-on teaching He said, "The practice of medicine, unlike many other subjects cannot be learnt solely based on textbooks, classroom teaching or even laboratory studies. The role of doctors is to provide medical care for people. Through observation of the well and the sick, bedside teaching, and hands-on training, medical students and young doctors learn from the experience and knowledge of practising doctors. In fact, for medical students of the National University of Singapore, clinical attachment starts as early as the second year of the 5-year medical course. From that point onwards and throughout a doctors entire career, the learning and teaching of medicine will be closely linked to clinical practice.
"Undergraduate and postgraduate medical training world-wide has always taken place in teaching hospitals and institutions. Their teachers and trainers cannot be limited to university staff. They must include the pool of practising doctors working in the hospitals and clinics. My Ministry therefore mooted the idea of appointing a senior doctor in each of the major teaching hospitals in Singapore to be Associate Dean. They will be in charge of medical students and postgraduate doctors, and to oversee the smooth implementation and evaluation of teaching and training programmes in their respective hospitals. I am very happy that the University has responded enthusiastically to this proposal.
"To ensure the successful implementation of the scheme, we have spent several months preparing and searching for the right candidates for the appointment. We have in place now the necessary support for the operations of the Associate Deans and identified 4 very experienced and respected clinical teachers for the 4 largest teaching hospitals affiliated with the National University of Singapore."To the Associate Deans
To the Associate Deans, he said, "Let me say that a very demanding and challenging job awaits you. Medical students and postgraduate trainees will be looking to you for guidance in their training. Your hospital will also be relying on you to ensure that an effective training system and programme is implemented, and the training conducted is of the high standards required by the University and my Ministry. You will report on the performance and progress of medical students and postgraduate trainees, as well as the clinical teachers. We must give due recognition to doctors who have spent time and effort to teach and train the next generation of doctors and specialists. Lastly, you will also be involved in providing feedback to help the University and the specialist training bodies in Singapore formulate medical education curricula and postgraduate training requirements. This will enable us to continuously improve the training of future doctors and specialists to meet the health care needs of Singaporeans.
"Besides training programmes in your hospital, you will co-ordinate with your counterparts, local and overseas, to ensure a comprehensive training programme. You will also advise trainees as well as the relevant authorities on overseas training programmes and opportunities where necessary. In this way, our specialist trainees will be able to learn from the top medical centres in the world and return equipped with the latest knowledge and skills to serve our patients in the most cost-effective manner."Two issues
The Health Minister observes that two issues challenge the medical profession worldwide.
The first issue is CME. The Minister said, "The rapid advances in medical science and technology have resulted in some of the knowledge acquired in medical school becoming already outdated by the time the student commenced medical practice. The result is that most medical textbooks have to be revised every 4 to 5 years. Also, many medical schools are beginning to shift the emphasis of education and training from a didactic style to that of imparting the skills and cultivating the habit of continuous self-learning. It is important to ensure that doctors have the basic medical knowledge and skills. But it is equally important that they have the learning skills and the habit of continuously upgrading and updating themselves.
"The Singapore Medical Council shares this concern about the need for continuing medical education. It is now working towards a more comprehensive system of monitoring continuing medical education for all registered medical practitioners. This will help ensure that Singaporeans have access to the most cost-effective medical treatment."
Threat to the ethics of medicine
He also said, "The second issue is the threat to the ethics of medicine. In many countries, concerns have been expressed about the slow but steady commercialisation of medicine. In Singapore, similar concerns are increasingly being expressed.
"While our rapid economic growth over the past ten to twelve years may have tested the ethics of some doctors, I am quite confident that the vast majority continue to see medicine as a calling and do put the interests of their patients first and foremost. Nonetheless, we must recognise that the medical profession will continue to be subjected to the pressures of the market place. We therefore strongly need to inculcate positive values in our medical students while they are still idealistic and committed to absorbing the wisdom of their teachers."To the clinical teachers
To the clinical teachers, the Minister said, "Clinical teachers therefore play a very important role _ you not only impart medical knowledge and skills, but also serve as a role model for your students. The 3 Cs desired of a doctor _ care, compassion, and commitment, cannot be taught through didactical means. Through a subtle process of osmosis, your students and young doctors will absorb your attitude towards the practice of medicine and your behaviour towards patients and fellow workers. Your efforts will help to ensure that those promises contained in the Physicians Pledge are not mere empty words but are a true reflection of the practice of Medicine in Singapore."