Speech by Mr Tharman Shanmugaratnam, Minister for Education, at SGH 15th Annual Scientific Meeting, MOH College of Medicine Building, on Friday, 21 April 2006, at 6.45 am

SPEECH BY MR THARMAN SHANMUGARATNAM, MINISTER FOR EDUCATION, AT SGH 15TH ANNUAL SCIENTIFIC MEETING, MOH COLLEGE OF MEDICINE BUILDING, ON FRIDAY, 21 APRIL 2006, AT 8.45AM

1. Singapore has to make new investments in medical talent to meet the changing needs of its healthcare and biomedical ecosystem. Our system of medical education has historically been shaped by the need for good-quality, yet affordable, healthcare for Singaporeans. Each year, over 200 students, selected from more than 2,000 applicants, most with exceptional academic credentials, enter NUS Yong Loo Lin School of Medicine (SoM). They are put through a rigorous 5-year undergraduate curriculum culminating in the award of the MBBS degree.

2. This is how we have trained generations of family physicians, internists and general surgeons, people with the interest and skill required for quality delivery of clinical services. It has also produced over the decades, a core group of doctors who had a love for research, and who have put Singapore on the global map in specific fields.

3. We now need to grow this pool of clinician researchers and clinician scientists. Today, Singapore looks to the healthcare sector to support our burgeoning biomedical industry and our aspirations to be a regional medical hub, while continuing to provide affordable patient care.

4. We are embarking on a major initiative to ramp up translational and clinical research - to translate discoveries in our laboratories into clinical and commercial applications (commonly called ‘from bench to bed’). This will require doctors with both research expertise and an intuitive appreciation of patients’ needs. Such doctors will also be in demand in the biomedical industry, for example in companies undertaking drug discovery.

5. Singapore’s reputation for clinical excellence positions provides a good foundation for us to become a leading centre for academic medicine. We have achieved a number of regional and international firsts, including the world’s first peripheral blood stem cell transplant to a Thalassaemia Major patient in 1995. In 2004, a team from the Singapore National Eye Centre and the National Dental Centre reported East Asia’s first successful case of ‘tooth-in-eye’ surgery (Osteo-odonto keratoprosthesis or OOKP), a procedure to restore vision to the most severe cases of corneal and ocular surface patients, who would otherwise remain blind.

6. We should aspire to emulate the leading centres of academic medicine, such as Johns Hopkins and Duke, where the synergies between the pursuits of top doctors and scientists leads to cutting-edge treatments based on advances in medical science. In these centres, clinical leaders themselves place significant priority on teaching and learning, even as they strive for excellence in patient care. Singapore has a good chance of succeeding if we broaden and deepen our capabilities in education and research, alongside our traditional strengths in healthcare service delivery.

7. To achieve our goals, medical education in Singapore must nurture and sustain a balanced mix of generalists, specialists and clinician scientists. We need family physicians, internists, surgeons and specialists who provide good quality care for the vast majority of patients and conditions. We will also need clinician-scientists to drive knowledge creation and provide state-of-the-art clinical services for more complex conditions. They are all part of the species diversity that we need for a thriving healthcare ecosystem.

8. Based on the 2001 Oxburgh report on medical education in Singapore, the Ministry of Health estimates that Singapore requires a cadre of at least 200 clinician-scientists to meet the needs of the healthcare and emerging biomedical sciences industry. Today there are almost 6,000 doctors in active practice, with 300 doctors registering each year. However, there are fewer than 50 clinician-scientists and clinician-investigators in the public sector. We will have to build up the pipeline of clinician scientists and investigators.

9. Going forward, therefore, we will need a hybrid medical education system. The majority of our medical school graduates will form a pool of generalists and specialists who can provide affordable and “appropriate-to-complexity” care of a high quality. However we hope to see an increased number of each cohort of medical students aspiring to become clinician-scientists.

10. As the principal provider of medical education in Singapore, the NUS SoM will evolve to meet these new economic and social needs. The School recognises that in addition to clinical competencies, doctors in training must also possess research skills as part of their core competencies, as only in this way will they be able to develop better diagnostic tools and therapies for their patients.

11. While some of the students in the MBBS programme will go on to successful careers as clinician-scientists, others will become important partners in translational medicine as general practitioners and medical specialists. I understand that the SoM is planning to convert a significant portion of its 4th year curriculum into a elective year to allow students the opportunity to do research, pursue community service, or gain insights into public health policy. The SoM also plans to expand its MBBS-PhD program.

12. The Duke-NUS Graduate Medical School Singapore (GMS) provides a new model of medical training in Singapore. Over time, it will add diversity within our medical profession. The GMS will as you know offer a new, research-intensive model of graduate medical education to complement our undergraduate MBBS programme. It is intended to create a pipeline of doctors who can be further trained as clinician-scientists with strong capabilities in translational medicine. The school will tap on Duke University’s expertise and outstanding international reputation to raise the level of medical education and research in Singapore.

13. The GMS will start with a small intake of just 25 students for the first year, to be increased to 50 places the following year. We expect entry to be extremely competitive, drawing from among the best and brightest students from Singapore and Asia.

14. GMS students, like their counterparts in the MBBS programme, will have the opportunity for clinical attachments across a range of medical specialities in our restructured hospitals, including SGH. They will be exposed to a research-intensive curriculum, and will be encouraged to apply concepts in scientific research to patient care, and vice versa. We hope that such training will help GMS graduates bring the benefits of basic research efforts to our patients.

15. Together, the NUS-NUH cluster at Kent Ridge and the GMS Outram campus will boost collaboration between science and medical care. But these focal points will not be exclusive. Singapore is too small for exclusive arrangements, and our small size in fact gives us advantage in fostering collaborative science. We have to build networks that criss-cross between the two medical schools, the hospitals, our A*STAR research institutes and the pools of research expertise in our universities in fields other than medicine, such as in materials science and bioengineering.

16. I am confident that these two complementary approaches towards medical education – a strong and evolving programme of undergraduate training in the NUS Yong Loo Lin School of Medicine and the Duke-NUS Graduate Medical School Singapore – will enhance Singapore’s position as a regional centre of excellence for medical care, education and research. Medical education in Singapore will help to attract not only top students, but also talented scientists and clinicians who have more reasons each month to base themselves in Singapore.

17. I hope to see communities of practice gradually emerge in Singapore, where students, clinicians and researchers engage in cutting-edge medical research that can be translated into affordable healthcare for Singaporeans.

18. It gives me great pleasure to declare the 15th SGH Annual Scientific Meeting open. I wish you all a fruitful and memorable discussion.