Robert Kamei, MDVice Dean, Education

Educational BriefingEducational BriefingKazakhstan Ministry of Education

& Science Delegation

February 2009

From the Test Tube to the Bedside:

the Duke-NUS Mission

Duke University School of Medicine

Durham, North Carolina

National University of Singapore

Typical Educational Paths

KindergartenElementary School

Middle SchoolHigh School

Undergrad UniversityMedical School

Internship & Residency

Fellowship (optional)

Attending Physician

Kindergarten 1 & 2Primary 1–6Secondary 1–4High SchoolUniversity (Medical School)House OfficerMedical Officer

Registrar (optional)

ConsultantSenior Consultant

USA Singapore5-6yrs

7-1213-1617-1819-2324-2525-on

5 yrs6-1112-1314-1718-2122-2526-on

Duke compared to Typical MD Program

Basic Science

Clinical

Research

Basic Science

Clinical

Research

Basic Science

Clinical

Undergraduate Science MBBS

The Duke-NUS Curriculum

“The learning process can be divided into the accumulation of bits of information (memory) and the movement of these bits into patterns (thinking)…

The compulsive learner is incapable of thinking. There is always another bit to be memorized and, if they are all learned, there is little time to rearrange the bits. It is also clear that without any bits there is no thinking.

The hardest theoretic question in educational circles is the determination of the optimum number of bits for the most effective manipulation.”

Eugene Stead, MDChairman, Department of MedicineDuke University School of Medicine

• Students retain 70% of material in the first 10 minutes, 20% in the last 10 minutes (McKeachie, 1986)

• Students are not attending to class 40% of the time (Pollio 1984)

• Four months after an Intro Psych course, only 8% had more info than a control group (Richard 1988)

• A review of 14 randomized controlled trials CME activities: didactic lecture alone was not effective in changing physician behavior or healthcare outcomes. (Davis, 1999)

Lectures

2 major learning tasks in the 1st year: – Information Acquisition (memory)

• Traditional emphasis for medical schools• Guided Independent learning• Individual learning style

– Information Processing (thinking)• Making connections with other information,

solving problems• Team GMS

Team GMS: Curriculum from Duke Univ but the instructional strategy is uniquely Singapore!

• Goals and objectives clearly stated• Independent/Team data acquisition (memory)• In student groups/teams (thinking)

– Readiness Phase• Individual • Group

– Application Phase• Work on case problems

• Peer evaluation on contributions to the group• Summative evaluation

The Duke-NUS “LEAD” Curriculum

LLearners who are:

EEngaged with their Independent and Team learning (TeamGMS)

AAdvocates for their patients, their society and their own education (Servant Leadership)

DDeveloping Critical and Creative Thinking skills (Pioneers)

Duke-NUS GMS Sample Week

http://horizonproject2008.ning.com/

Peer ReviewPeer Review

• While content knowledge improved, our primary objective of Team GMS were:– Creative and Critical thinking

• Searching and answering questions/chasing curiosity

• Incorporate what was learned into relevant situations

• Expressing their thoughts/position• Critically analyzing other opinions

– Learning to work in teams

TBL is not PBL (Problem- based Learning)

Similarities• Active Learning around Problems/Cases• Minimal lectures • Students work in Groups

Student Centered Teacher Centered

PBLPBL LectureLectureTBLTBL

Differences:• Faculty plan/actively lead a group discussion to review

and stimulate thinking– Vs. not participating in discussion unless necessary– Vs. minimal guidance instruction in complex environments– More efficient

• Less Faculty needed to teach a large number of students– Faculty work in teams, not assigned to each group

• Students have individual responsibility to the group– IRA, IF-AT, Peer Evaluation

• All Group work is in class (less divide and conquer)• Students learn from both group and entire class

TBL is not PBL

What we heard and What we heard and what we learned:what we learned:

• “Off-site” Educational programs at will never be as good as the “home base”

– Our students are comparable with the Duke students in Durham• Students from Asia won’t participate in class

– Our students were fully engaged and even “loud” during class• Team process “over-inflates” grades of lowest

performers and holds back others– Everyone’s learning is improved

• You need to lecture to “guarantee” students get all of the information

– Smart students can learn themselves (they don’t attend class)• Students won’t learn if they have open book/internet

– This learning process reinforces knowledge• “You can’t make learning fun”

Clinical Clerkships (2nd Year) Typical Educational Team @

Duke-NUSAttending Physician(Senior Consultant)

Attending Physician(Senior Consultant)

Senior Resident(Registrar)

Senior Resident(Registrar)

Intern/MO(Houseman/MO)

Intern/MO(Houseman/MO)

Intern/MO(Houseman/MO)

Intern/MO(Houseman/MO)

4th Yr Med Student4th Yr Med Student

PatientsPatients PatientsPatients

2nd Yr Med Student2nd Yr Med Student 2nd Yr Med Student2nd Yr Med Student PatientsPatients

PatientsPatients PatientsPatients

Education PhysiciansSurgery/Medicine/Peds-OG

Education PhysiciansSurgery/Medicine/Peds-OG

Singapore General Hospital

KK Women’s and Children’s Hospital

Class: 2011 2012

Class Size:

26 48

Age: Average: 25 yearsRange: 21 to 31 years

Average: 24 yearsRange: 20 to 32 years

Gender: Male 7 Female 19

Male 18Female 30

Class Statistics

Class: 2011 2012

Nationality: Singaporean (19)American (1)Indonesian (2)Hong Kong (1)Malaysian (1)Filipino (1)Indian (1)

Singaporean (26)American (5)Indian (4)Indonesian (3)Malaysian (2)Bangladeshi (1)British (1)Canadian (1)Chinese (1)Filipino (1)Sri Lankan (1)Vietnamese (1)Zimbabwean (1)

Class Statistics

• Undergraduate degrees– Biology/Life Sciences (14)– Engineering (5)– Pharmacy/Pharmacology

(4)– Computer Science (2)– Chemistry (1)

• Graduate degrees– Masters Degree (4)– PhD (1)

Academic Background

Class of 2011

• Undergraduate Degrees– Biology/Life Sciences (29)– Engineering (11)– Pharmacy/Pharmacology

(3) – Anthropology (2)– Chemistry (1)– Biopsychology & Cognitive

Science (1)– Nutrition (1)

• Graduate Degrees– Masters Degree (7)– PhD (2)

Class of 2012

– Singapore (15)• National University of Singapore, Nanyang

Technological University– United States (8)

• Brown University, Cornell University, Davidson College, Emory University, Pomona Claremont College, UC Berkeley, University of Michigan, Utah State University

– England (2)• Oxford University, Imperial College

– Australia (1)• University of Sydney

Academic BackgroundClass of 2011

– Singapore (20)• National University of Singapore, Nanyang Technological

University– United States (20)

• Amherst College, Case Western Reserve University, Columbia University, Cornell University, Dartmouth College, Duke University, Johns Hopkins University, Macalester College, Pennsylvania State University, Smith College, University of Michigan, University of Maryland, University of Arizona, University of California San Diego, Washington University in St Louis, Washington and Lee University

– United Kingdom (2)• University of London, University of Birmingham

– India (1)• Mumbai University (Sophia College For Women)

– Canada (1)• University of Toronto

– Australia (3)• University of Sydney, Melbourne University

– Philippines (1)• University of Philippines

Academic BackgroundClass of 2012

GMS Education TeamDr. Robert Kamei M.D.• Vice Dean, Education

Dr. Frank Starmer• Associate Dean, Learning

Technology

Dr. Sandy Cook• Associate Dean, Curriculum

Development

Dr. Craig Stenberg• Associate Dean, Student

Affairs & Admissions

www.duke-nus.edu.sg