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Education - the past, present and future (Part 1)

At SingHealth, we believe that by advancing knowledge and embracing life-long learning, we can improve our patient’s lives in an ever-changing healthcare landscape. In this two-part series, we take a look at how healthcare education in Singapore has evolved from past to present, and how it might look like in the future.  

Let’s go back to the very beginning…

Healthcare education in Singapore had its humble beginnings in the 1900s. Back then, there was a lack of trained staff and local doctors in the hospitals. Education for the young who were keen on studying Medicine was also limited. This spurred Mr Tan Jiak Kim, a prominent businessman, as well as a few other community leaders, to raise funds to set up a medical school and offer scholarships. Their efforts paid off – the first medical school in Singapore, the Straits and Federated Malay States Government Medical School, was established on 3 July 1905, with 23 students in its pioneer cohort.

The school was later renamed the King Edward VII College of Medicine in 1921. Since then, it has nurtured generations of doctors, many of whom had gone on to impact medicine in Singapore through various ways. Some of the graduates whom you might find familiar include Dr Gopal Haridas (Class of 1922), Dr Benjamin Sheares (Class of 1929) and Professor Baratham Ramaswamy Sreenivasan (Class of 1931).

 

Established in SGH, the Straits and Federated Malay States Government Medical School, later renamed the King Edward VII College of Medicine, has trained generations of doctors.


Unfortunately, the Japanese Military Administration hit the brakes on medical education in Singapore when they shut down the college in 1942 during the Japanese Occupation. Despite this, when the college eventually reopened in 1946 after World War II, enrolment numbers doubled.

Formal nursing training and specialisation began in 1926, with the start of the Preliminary Training School by Singapore General Hospital (SGH). Following the end of World War II and the government’s drive to develop public healthcare services, the demand for nurses grew.

 

Nursing discussion workshop in the School of Nursing Auditorium in SGH that was built in 1956

The first School of Nursing (SoN) in Singapore was built in SGH in 1956, now occupied by Outram Community Hospital. It was home to thousands of student nurses, many of whom lived on-site during their training.
[Fun fact: To find out which year the student nurses were in, one just needed to observe the colour of the epaulettes on their uniforms – green for first-year, blue for second-year and maroon for those in third/final year.]

In 1929, Singapore’s first public dental school and clinic was set up at SGH’s Norris Block. It was relocated and renamed the SGH Dental Clinic in 1938. The clinic provided dental treatment as well as training for dental students in order to meet the increasing needs of the growing population.

 

First public dental clinic and dental school set up at Norris block in the SGH in Sepoy Lines in late 1920s



When I was a medical student/trainee…

“As a medical student in the 1970s, we did not have Google, laptops or the internet, which made searching for updated information on any topic at short notice tough. Instead, we had to pay attention, listen carefully and read widely. Books were the often sought-after resources then. We had to think about how to wisely invest our parents’ scarce hard-earned dollars. We also turned to our classmates and seniors to teach us. They would take us to bookshops, give us tutorials and have group study discussions. We would go to Ah Leng’s Canteen (at the former University of Singapore Faculty of Medicine – Outram Campus) to get low-cost snacks and interact with others as a means of learning.

We also had a grand anatomy dissection hall and a wonderful museum. We could dissect the human anatomy, rather than depend on pre-dissected specimens shown to us by our teaching faculty. Many pioneers who built Singapore in the early days chose to continue contributing even after they passed on by donating their bodies for our education. It was a truly humbling experience for us.

Clinical postings were also fun. We saw many types of patients in the old SGH at Bowyer, Norris and Stanley Blocks, Mistri Wing and the Kandang Kerbau Hospital, then the world’s largest baby-producing factory. We literally stayed at KKH during our O&G postings, managed at least 20 normal and 20 abnormal deliveries and were taught by the President of the Republic, Dr Benjamin Sheares, himself!”


Prof Anantharaman Venkataraman, Emeritus Consultant, Emergency Medicine, SGH


“’I am the teacher’ is the mindset of teaching years ago, with little chance for the learners to explore or enquire. Today, however, educators welcome the concept of open teaching and learning. By learning, you will teach and by teaching, you will learn. I believe that two-way communication, respecting opinions and venturing along with the learners has enhanced the journey of learning and teaching.”



Ms Joyce Lim Soo Ting, Senior Nurse Clinician, Advanced Practice Nurse, Division of Nursing, KKH


“More than 10 years ago, learning and teaching were often done along the way. There was little attention paid to how teaching (clinical & didactics) was done, with clinical service being the mainstay of the institution. Residents learnt in the workplace mostly through apprenticeship and on-the-job training by treating patients under the supervision of clinical faculty. This can sometimes be challenging because patient workload is constantly heavy in a public institution. Clinical faculty face the perennial challenge of finding a balance between meaningful teaching of residents, meeting the patients’ demands for treatment and ensuring optimal patient care delivery during clinical sessions.

Today, there is a gradual move from traditional lectures to case-based discussions and flipped-classroom seminars when appropriate. We have developed blended learning curriculum for dental officers that consists of interactive voice-annotated presentations, virtual seminars and workshops using inanimate models and simulation of dental procedures using pig-jaws.”

Assoc Prof Marianne Ong, Chair, College of Clinical Dentistry, SingHealth Academy; Academic Vice Chair, Education, SingHealth Duke-NUS Oral Health Academic Clinical Programme; Senior Consultant, Department of Restorative Dentistry, NDCS


“I am a product of the classroom which was unidirectional and didactic in nature. There was more reliance on books and physical journal papers for academic research, whereas today nearly everything is available online. Back then, teachers may not receive feedback from students so easily; now, learners have instant access to feedback portals and may use social media to give immediate feedback to their teachers. There has been a conscious movement from a behaviourist to constructivist approach, where students today are more actively involved in self-discovery and constructing their own knowledge, versus passively receiving information.”


Dr Selena Young Ee-Li, Head & Senior Principal Speech and Language Therapist, Craniofacial Speech Pathology, KKH


“In my preclinical years, there was tremendous emphasis on memory work. When studying genetics, I resorted to using flash cards and carried them everywhere I went, even quizzing myself during meal times. There was also a lack of engaging medical texts, so I bought many different books and extracted the best parts from each to form my own set of notes. On the very first day of our elementary clinics (called clinical skills foundation programme today), my core tutor gave us a stack of notes – except those weren’t really medical notes, but rather advice on how to dress appropriately!”

 

Adj Assoc Prof Derrick Aw, Senior Consultant, Department of General Medicine, SKH & Clinical Education Lead (Medical), Education Office, SKH


“One of the fond memories I had as a nursing student was when I had a clinical attachment in a nursery to care for the newborns. I was given the opportunity to feed them, change their diapers and bathe them. I quickly learnt that caring for a newborn is different from caring for an adult patient. As I had no experience with bathing newborns at that time, I was lucky to have my nursing lecturer by my side who guided me on how to hold and care for the safety of these fragile patients. Many years later, I am grateful to be able to render the same care to my own newborn baby.”



Ms Mas Linda Mohamad, Senior Nurse Educator, Nursing Education, CGH


“Back then, resources were limited. The internet had only just started and we often had to go to the NUS medical library to do research. I could not afford a computer or laptop until my third year of study and was reliant on the school’s computer lab. I certainly don’t miss the long hours spent in the computer lab rushing to get my assignments completed!”

 


Dr Clement Yan, Senior Principal Physiotherapist, Department of Physiotherapy, SKH & Deputy Chair (Academic Support & Continuing Education), SingHealth Academy College of Allied Health (CAH)


One thing remains the same…

As we celebrate 200 years of Medicine in Singapore this year, it is important that we revisit our roots to remember those who laid the foundation for us. Their dreams made healthcare education in Singapore possible, which till today, has groomed generations of healthcare professionals committed to caring for the Nation.

While many advancements have been made in this field over time, one thing never changes – “The emphasis on the patient, good clinical history and careful systematic physical examination. This should continue to be the focus of clinical education and should not be replaced by a predominance of technology in the form of investigations and machines for clinical diagnosis,”, shares Prof Venkataraman.

Stay tuned for Part 2!