A third wave in medical education

Dujeepa D. Samarasekera & Matthew C. E. Gwee


During the years preceding 1910, the education and training of physicians (doctors)-to-be was based mainly on a master-apprentice model; the primary focus then was on the teaching and development of clinical skills.

In 1910, however, Flexner submitted a highly influential report to the American medical authorities: in it he recommended that all medical schools should be university-based and that, importantly, medical practice should have a scientific basis strongly underpinned by the basic medical sciences such as anatomy, biochemistry and physiology. Flexner’s1 recommendation was readily accepted, not only in the USA, but also globally- including Asia.

Global Perspectives

Excellence in medical education – Can it be assessed?

Ronald M. Harden



The ASPIRE-to-Excellence Initiative was established in 2013 to provide a mechanism where Excellence in teaching in a medical school received international recognition. Excellence was recognised in one or more of the following areas – Student Assessment, Student Engagement with the curriculum, Social Accountability of the medical school, Faculty Development and Simulation. Dental and Veterinary schools were included in the programme in 2015. To date, 23 schools from 12 countries around the world have received an ASPIRE award in one or more of the areas.

Original Articles

“The team is more than the sum of its parts”: Implementation of charters to improve team dynamics in an anatomy course

Ryne W. Dougherty, Cody C. Wyles, Wojciech Pawlina & Nirusha Lachman


In the current healthcare environment, team-based models in the teaching and practice of medicine have become more a norm than a preference.  Renewed focus on team-based practice discloses the effect that poorly functioning teams may have on successful outcomes in team-based delivery of patient care. Team incompetence compromises learning and work performance for all members; an outcome often rooted in poor communication and understanding of role responsibilities within the team. Business schools have been innovative and proactive in recognizing this problem and have instituted team charters to align team expectations and norms through discussion and consensus. Team charters were introduced in Block 2 Microscopic Anatomy and Block 3 Human Structure courses at Mayo Medical School in the first year curriculum. Teams were oriented on the concept of the team-charter and given the opportunity to create individual team charters to suit each team’s work ethos.  Teams were encouraged to revisit their charters midway through the course to maintain a dynamic contract.  Students took time to reflect on and adapt their strategy in order to facilitate better team cohesiveness, communication, interaction and ultimate performance.  Qualitative student feedback indicated that the exercise fostered better group dynamic and improved communication within the team. Students were empowered to take responsibility for their own learning, professional identity formation, performance, academic development and their impact on total performance of the team.

Keywords:          Gross anatomy education; Medical education; Team-based learning; Team charters; Assessment

Compounding training in pharmacy education in Singapore: Perceptions of final year undergraduate pharmacy students and compounding pharmacists

Yuen Teng Choo, Mui-Ling Tan, Cheong Hian Goh & Wai-Ping Yau


Aims: To assess the importance of compounding training in today’s pharmacy education in Singapore, this study examined the perception of final year National University of Singapore (NUS) pharmacy undergraduates on compounding training in pharmacy education and their awareness of compounding services in Singapore in relation to compounding pharmacists’ perception, practice and role of pharmacy compounding in Singapore.

Methods: A cross-sectional survey was carried out between November 2013 and January 2014. It comprised of a questionnaire survey conducted on 134 final year pharmacy undergraduates, and face-to-face interviews conducted on 7 retail compounding pharmacists. Questionnaire responses were analysed using descriptive statistics, while the interviews were transcribed verbatim and analysed by thematic coding.

Results: Less than 40% of final year pharmacy undergraduates were aware of compounding activities and compounding pharmacies in Singapore. Nonetheless, majority agreed that compounding should be included in the pharmacy curriculum (83.6%) as it is an important part of pharmacy education (78.3%) and pharmacy profession (61.2%). All the interviewed compounding pharmacists felt that compounding in pharmacy education has provided them with the basics to build on knowledge and skills at work. Compounded medications were also viewed as necessary by 71.4% of the pharmacists in fulfilling the needs of certain patient populations.

Conclusion: Compounding training is necessary in pharmacy education. Pharmacy compounding has evolved from its traditional role into a professional speciality of customizing medications to meet different patient needs today. Hence, knowledge and skills in pharmacy compounding remain a relevant foundation for practising pharmacists to enhance pharmaceutical care at work.

Keywords:      Pharmacy compounding; Pharmacy education; Pharmacy students; Compounding pharmacists; Perceptions; Survey

Assessment of attitudes for interprofessional team working and knowledge of health professions competencies for final year health professional students

Pei Se Wong, Syed Shahzad Hasan, Jinly Ooi, Lawrence, S. H. Lim & Vishna Devi Nadarajah


Inter-professional education (IPE) contributes to the development of an ‘inter-professional, collaborative and practice-ready’ healthcare workforce that is well prepared to respond to local healthcare needs. Little is known about the extent, to which health professional students who are nearing graduation understand the competencies of diverse health professions. The aim of this study was to investigate the perception of final-year undergraduate students’ towards interprofessional team working and their knowledge of the competencies of 6 health professions. This study evaluated the final-year health professional students’ from six (6) health professions programmes namely medical, dental, nursing, pharmacy, dietetics and biomedical sciences programmes. Attitudes towards Health Care Team Scale (ATHCTS) was used to measure students’ attitudes towards teamwork while a checklist was used measure students’ knowledge of 6 health professionals competencies. Construct validity was ascertain and findings from ATHCTS showed mean scores ranges from 48.57 to 54.23 indicating positive attitudes toward working within interprofessional health care teams. While the ACTHS findings were positive, the competencies checklist showed mixed findings in that students correctly identified some competencies and had misconceptions for others. For example, the majority of students regarded physicians as competent in ‘assessment and evaluation’ and ‘medication management’ while less than 50% of participants recognised the importance of assessment of patient’s health-illness as a competency for dieticians. Gaps identified in final year students’ knowledge of the roles and competencies of health professions has an impact on future interprofessional collaborative practice suggesting a need to further improve curriculum design and delivery of IPE.

Keywords:      Allied health, Inter-professional, Learning, Inter-professional education


Short Communications

Why do Team-Based Learning educators use TBL?

Sean Wu, Julia Farquhar, Scott Compton


Aim: Evidence suggests that Team Based Learning (TBL) is an effective teaching method for promoting student learning. Many people have also suggested that TBL supports other complex curriculum objectives, such as teamwork and communication skills.  However, there is limited rigorous, substantive data to support these claims. Therefore, the purpose of this study was to assess medical educators’ perceptions of the outcomes affected by TBL, thereby highlighting the specific areas of TBL in need of research.

Methods: We reviewed the published research on TBL in medical education, and identified 21 unique claims from authors regarding the outcomes of TBL.  The claims centred on 4 domains: learning, behaviours, skills, and wellbeing. We created a questionnaire that asked medical educators to rate their support for each claim.  The survey was distributed to the medical educators with experience teaching via TBL and who were active users of the Team Based Learning Collaborative listserv.

Results: Fifty responses were received.  Respondents strongly supported claims that TBL positively impacts behaviours and skills over traditional, lecture based teaching methods, including the promotion of self-directed learning, active learning, peer-to-peer learning, and teaching. In addition, respondents strongly supported claims that TBL promotes teamwork, collaboration, communication and problem solving.  Most participants reported that TBL is more effective in promoting interpersonal, accountability, leadership and teaching skills.

Conclusion: Medical educators that use TBL have favourable perceptions of the practice across a variety of domains.  Future research should examine the actual effects of TBL on these domains.

Keywords:      Team based learning; Medical education; Teaching

A study on the usefulness of high fidelity patient simulation in undergraduate medical education

Bikramjit Pal, M. V. Kumar, Htoo Htoo Kyaw Soe, Sudipta Pal


Introduction: Simulation is the imitation of the operation of a real-world process or system over time. Innovative simulation training solutions are now being used to train medical professionals in an attempt to reduce the number of safety concerns that have adverse effects on the patients.

Objectives: (a) To determine its usefulness as a teaching or learning tool for management of surgical emergencies, both in the short term and medium term by students’ perception. (b) To plan future teaching methodology regarding hi-fidelity simulation based on the study outcomes and re-assessment of the current training modules.

Methods: Quasi-experimental time series design with pretest-posttest interventional study. Quantitative data was analysed in terms of Mean, Standard Deviation and standard error of Mean. Statistical tests of significance like Repeated Measure of Analysis of Variance (ANOVA) were used for comparisons. P value < 0.001 was considered to be statistically significant.

Results: The students opined that the simulated sessions on high fidelity simulators had encouraged their active participation which was appropriate to their current level of learning. It helped them to think fast and the training sessions resembled a real life situation. The study showed that learning had progressively improved with each session of simulation with corresponding decrease in stress.

Conclusion: Implementation of high fidelity simulation based learning in our Institute had been perceived favourably by a large number of students in enhancing their knowledge over time in management of trauma and surgical emergencies.

Keywords:      High fidelity simulation, Simulation in medical education, Stress in simulation

At The Forefront

Tri-Generational Homecare, a student-led interprofessional project

Dillon Guo Dong Yeo, Carey Yun Shan Lim, Yao Chi Gloria Leung, Celine Yi Xin Tham

I. Introduction

The advent of the silver tsunami (Gan, 2015) highlights the need for the younger generations to be aware and exposed to the challenges and struggles that our elderly face daily. 2 medical students, Kennedy and Angeline, foresaw this need. Many of our elderly are afflicted with chronic conditions that result in frequent readmissions and associated morbidity. They are besieged (Donaldson, Smith, Balakrishnan, Kadir & Mudaliar, 2015) with multiple non-medical issues such as insufficient finances, poor medical literacy and a lack of social and family support, resulting in poor control of their diseases – many of which can potentially be arrested in the community.