Enhancing our educators’ competencies

Jointly organised by the Duke-NUS SingHealth Academic Medicine Education Institute (AM•EI), SingHealth Residency and SingHealth Academy, the 2nd SingHealth Duke-NUS Education brings together more than 1,000 educators across medical professions. 
Themed ‘Education across the Continuum for Improved Healthcare’, the conference focuses on enhancing teaching competencies at all levels – from undergraduate, postgraduate, to continuing professional development.

Co-organising Chairperson, Prof Tan Hak Koon, shared, “We developed the two-day programme with a grassroots approach to cater the needs of our educators. So we added new sessions such as the technology track and the recruitment and retention track.”

Highlighting the importance of healthcare education in meeting Singapore’s future healthcare needs, Dr Lam Pin Min, Minister of State, Ministry of Health, said during his opening address, “We need a competent and dedicated pool of healthcare educators to enable our successors to be better clinicians, nurses, and allied health professionals than we are today.”

Healthcare education in the 21st century

The thinking that the education process stops after medical school is an outdated concept. Prof Robert Baron, Professor of Medicine and Dean of Graduate and Continuing Medical Education, University of California San Fransisco, said, “Formation of the 21st century healthcare professional involves a lifelong continuous process of learning.”

At his keynote address, Prof Baron proposes that learners, be they doctors, nurses or allied health professionals, be part of the solution that can make the system better. Hence the need for the right competencies to be taught in healthcare education.

To figure out what they are, the first priority is “not what the learners need but what the health system needs.” Prof Baron explained, “Once you know what needs to be fulfilled, you can build the right curriculum.”

To improve the existing healthcare system, it is not enough to teach only clinical skills. The science of health system environment has to also be strategically taught.

This means a new set of basic sciences are needed to complement the traditional sciences taught. For example, human factors engineering and public and global health.
Similarly for clinical science, learners needs to know how to measure and improve patient safety and outcome, work with an interprofessional team, and analyse and communicate errors.

Prof Baron said, “Quality improvement is core to what it means to be a physician. We need faculty who can teach this.

“We may have great teachers: those who are experts in clinical medicine and education. But what we need are system educators – great teachers who are knowledgeable in the science of improvement.”

Why team based learning?

In traditional teaching, educators wish students do active learning during classroom session. But in reality, most students are passive in class and do most of their studying after the class, in preparation of examinations.

Team based learning flips this and makes students come prepared for active discussion and assessment in class.

Dr Peter Balan, a Senior Lecturer at University of South Australia Business School gave workshop participants at the Conference first-hand experience in team based learning to illustrate the benefits.

As observed in most team based learning session, the groups found that team assessment results are better, with smaller variation, compared to individual results.

There was also lively discussions happening throughout the session.

Dr Balan said, "Team based learning is a self regulating experience. Students know that team scores are higher than their own, so they want to be in class. It also forces students to be accountable so they come prepared to be able to contribute readily and defend their team decisions."

In fact, team based learning has been implemented in several education Institutes in Singapore, such as in Duke-NUS Graduate Medical School and the Singapore Institute of Technology.

Dr Balan concluded, "Team based learning really provides a framework that encourages innovation and experimentation."

Conceptual frameworks in education

Conceptual frameworks provide a solid foundation for educational developers and researchers to build on.

A conceptual framework make assumptions more explicit, helps focus research questions and identify key variables and guides the interpretation of results.

At the Conference, Prof Georges Bordage, Professor in the Department of Medical Education, College of Medicine, University of Illinois at Chicago, shared examples on how to use conceptual framework in education research.

Other than guiding development and research, conceptual frameworks can also be used to be tested.

Prof Bordage said, "Ask yourself: What type of practice best enhance learning?" He illustrated this by sharing a theory that says the more you teach, the less the learners remember. He embarked on a study to test this and concluded that the theory was right.

Conceptual frameworks can also be challenged. Prof Bordage gave the example of  gravitational theory which stayed unchallenged until the advent of quantum mechanics.

Leading from where you are

Other than teaching and learning, education also necessitates leadership. Contrary to common notion, leadership can happen at all levels of the organisation, not just at the top management level.

At the Conference, Chief Residents from across Singapore and nursing, medical and allied health student leaders to share their thoughts on leadership.

Educating for critical thinking skills

A wall of text bombards the audience, tightly packed and larger than life because of the auditorium projector.

“You have one minute and ten seconds to solve this,” challenged plenary speaker Paul Koles, Associate Professor and Chair of Pathology from Wright State University.

The exercise, it seems, is to ascertain one’s level of critical thinking. The ability to dissect information that has been presented and abstract what is practical and useful for the current situation.

In this area, Prof Koles admits he is a learner. Studying various popularly accepted definitions of critical thinking derived by researchers before him, he states a preference towards an attribute he feels is particularly important in healthcare – attitude.

“In the context of healthcare, critical thinking determines whether a clinician can make a proper diagnosis,” he explained.

To Prof Koles, the pedagogy behind teaching critical thinking is vital in advancing healthcare. Students should not be assumed to be able to absorb the skills and knowledge by being around capable clinicians. What is needed is a curriculum centered on their learning and developing critical thinking skills.

Mentors in healthcare should then craft their teaching methods not only to impart a base of knowledge into their learners, but also hone their ability to apply the knowledge in the clinical setting.

That said, he also cautions the over-zealous pursuit of critical thinking as a science, “Mentors should spend more time on teaching students instead of creating a neuro-anatomy atlas for critical thinking.”

The cause for his mission is simple – non-critical thinkers are potentially dangerous to patients.

To that end, Prof Koles encourages everyone to adopt the attitude that critical learning can be taught, and that it requires a concerted effort by medical educators.