Grit in healthcare education and practice

Dujeepa D. Samarasekera & Matthew C. E. Gwee

Centre for Medical Education (CenMED), NUS Yong Loo Lin School of Medicine, National University Health System, Singapore

What we eventually accomplish may depend more on passion and perseverance than on our innate talent.

—Angela Duckworth, Grit: The power of passion and perseverance, 2016 

There is now strong and compelling research evidence that individual grit (i.e. the combination of passion and perseverance of an individual for a given task—independent of the domain) is a better predictor of an individual’s potential for success in the future work environment (and, therefore, presumably one’s lifetime achievements as well) than just one’s innate talent. For example, cadets who gain admission into prestigious military institutions like West Point and the Army Special Operation Forces in the USA, are often selected from student cohorts with high scholastic achievements and excellent sportsmen: thus, acceptance into these prestigious institutions is highly competitive—requiring, both, intense physical endurance and high mental agility. However, …

Global Perspectives

Dental education in Singapore: A journey of 90 years and beyond

Mun Loke Wong1, Teresa Woon Oi Lee2, Patrick Finbarr Allen3, Kelvin Weng Chiong Foong4

Disciplines of 1Primary Dental Care & Population Oral Health; 2Oral Sciences; 3Endodontics, Operative Dentistry & Prosthodontics; 4Orthodontics & Paediatric Dentistry, Faculty of Dentistry, National University of Singapore, Singapore


In 2019, the Faculty of Dentistry celebrated its 90th anniversary. Since its beginning, the Faculty has grown from strength to strength and its efforts at nurturing generations of oral healthcare professionals have evolved. Such growth and evolution ensure that the Faculty’s mission of education remains contemporaneous, effective and relevant to future-proof its graduates to play an instrumental role in helping the population achieve good oral health. This article documents the Faculty’s early years; highlights its journey and educational endeavours which have transformed teaching and learning in dentistry. It also sheds light on key drivers of change which will shape the way the Faculty seeks to transform dental education for the future.

Review Article

Establishing and sustaining a transnational clinical teacher faculty development initiative

Justin Bilszta1, Jayne Lysk1, Ardi Findyartini2 & Diantha Soemantri2

1Department of Medical Education, Melbourne Medical School, University of Melbourne, Australia; 2Department of Medical Education, Faculty of Medicine, Universitas Indonesia, Indonesia


Transnational collaborations in faculty development aim to tackle challenges in resource and financial constraints, as well as to increase the quality of programs by collaborating expertise and best evidence from different centres and countries. Many challenges exist to establishing such collaborations, as well as to long-term sustainability once the collaboration ceases. Using the experiences of researchers from medical schools in Indonesia and Australia, this paper provides insights into establishing and sustaining a transnational collaboration to create a faculty development initiative (FDI) to improve clinical teacher practice. Viewed through the lens of the experiences of those involved, the authors describe their learnings from pathways of reciprocal learning, and a synergistic approach to designing and implementing a culturally resonant FDI. The importance of activities such as needs assessment and curriculum blueprinting as ways of establishing collaborative processes and the bilateral exchange of educational expertise, rather than as a mechanism of curriculum control, is highlighted. The relevance of activities that actively foster cultural intelligence is explored as is the importance of local curriculum champions and their role as active contributors to the collaborative process.

Keywords:        Faculty Development, Transnational, Collaboration, Clinical Teacher

Original Articles

How and what do laypeople learn about end-of-life care using narrative? A case study in educational research

Junji Haruta1, Ai Oishi2 & Naoko Den3

1Department of Medical Education, Faculty of Medicine, University of Tsukuba, Japan; 2Primary Palliative Care Research Group, Centre for Population Health Sciences, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom; 3Ouji-Seikyo Hospital, Japan


Background: Studies have reported positive impacts from community engagement in end-of-life (EoL) care. However, few studies have used a narrative for health promotion. Thus, we examined how and what lay participants learned through an EoL care education program using narrative.

Methods: A case study in educational research was implemented through qualitative process evaluation. The program was conducted in a hospital in Japan. Participants living in the surrounding community were recruited by convenience sampling. We conducted 90-minute focus groups with participants at two and eight months after the completion of the program. All data were audio-recorded, transcribed verbatim, and analysed using thematic analysis.

Result: We identified five themes. First, participants reconstructed the concept of EoL care using their own experience and new knowledge gained in the program. Second, the stories in the program stimulated participants to recall their feelings and emotions, which caused catharsis effects. Third, the stories evoked other perspectives through metacognition. Fourth, their experience inspired altruism towards patients and their families at the EoL. Fifth, they reflected on their own deaths as an extension of their relationship with others. This learning process was consistent with Kolb’s experiential learning. Their experience enabled lay participants to overcome the existential terror of death while using the narrative mode of thinking to perceive their relationship with others as a symbolic identity.

Conclusion: The educational program using narrative deepened lay participants’ understanding of the concept of EoL care. Such programs have the potential to enhance community engagement in EoL care.

Keywords:         Lay-People Learning, Public Health, Palliative Care, Qualitative Research, Narrative Medicine

Understanding factors that motivate research performance and career longevity of science, technology, engineering and mathematics postgraduates

Margaret Tan1, Jonathan S. Herberg1, Celestial Yap2,3, Dujeepa D. Samarasekera4 & Zhi Xiong Chen2,3,4,5,6

1Institute of High Performance Computing, Agency for Science, Technology and Research (A*STAR), Singapore; 2Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; 3National University Cancer Institute, National University Health System, Singapore; 4Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore; 5KK Women’s and Children’s Hospital, Singapore; 6Office of Student Affairs, National University of Singapore


Given the high investments in training and mentoring graduates who have chosen the research career path, and considering a high attrition of these graduates moving on to non-research type of careers, it is important to understand the factors that motivate young scientists to stay on the job as they could make important contributions to a better world with their scientific endeavours. It is in this context that we conducted an exploratory study to understand the factors that may drive the scientists’ performance as well as their expectations to remain in the research career paths. We found evidence for an indirect link (through research commitment) between need-for-cognition and career performance as well as evidence of an effect of research commitment on the anticipated research career length. There was also evidence that continuance commitment (but not other extrinsic factors) affects anticipated research career length, and that organisational support is linked to perceived research performance. Implications of our findings for student selection and graduate mentoring are discussed.

Keywords:        Research Career Path, Scientist’s Motivation, Graduate Mentoring, Intrinsic and Extrinsic Motivations

How perceptions of residents toward assessment influence learning: A qualitative study

Jaime L. Pacifico1, Julie Anne S. Villanueva1, Sylvia Heeneman2 & Cees van der Vleuten2

1Internal Medicine, De La Salle Medical and Health Sciences Institute, Philippines; 2Maastricht University, The Netherlands


Any form of assessment activity will act as a stimulus and provoke an educational response. There is a risk however that the response will not result in a beneficial educational response, thus there is a need to monitor and understand the relationship between assessment and learning. This is true at any level of education including postgraduate medical education. To understand how residents perceived assessment, we interviewed 20 residents from the departments of internal medicine and paediatrics. Our goal was to determine how assessment influenced their motivation to accumulate knowledge and skills and attain the competence levels expected of a specialist. We utilised grounded theory to analyse the data. Our results showed that the trainees acknowledged that assessment, in general, has a positive influence on their learning, it motivated them to study and fostered an active learning attitude. A high degree of self-directed learning was also present among the residents. An interplay of new or interesting patient cases, concern for the welfare of the patients, engagement with the consultants, and a supportive environment contributed to creating the motivation for the residents to study.

Keywords:         Assessment, Perceptions, Postgraduate Medical Education, Qualitative Study, Clinical Training

A tiered mentorship framework in an Orthopaedic Surgery Residency Programme

Min Jia Chua1, Gen Lin Foo2 & Ernest Beng Kee Kwek2

1National Healthcare Group, Ministry of Health Holdings, Singapore; 2Department of Orthopaedic Surgery, Woodlands Health Campus, Singapore


Introduction: Mentoring is a vital component of a well-rounded medical teaching environment, as evidenced by its implementation in many residency programmes. This study aims to evaluate the perceived value of mentoring by faculty and near-peer mentoring to the orthopaedic surgery resident.

Methods: An online survey comprising multiple choice questions and scaled-response questions with a few open-ended questions was created and distributed to all residents, from residency years 2 to 5, within an orthopaedic residency programme in Singapore to gather their views on a tiered mentorship programme.

Results: 100% of surveyed residents responded. 68.4% of junior residents had a senior resident mentor while 84.8% of all residents had a faculty mentor. Junior residents generally viewed senior resident mentors as being crucial and beneficial for training, with scores comparable to those for faculty mentors. Residents who had mentors, in particular those who had chosen their own mentors, tended to be more satisfied than their counterparts. The most desired characteristics of mentors among the residents included approachability, willingness to share, being able to give feedback and experience. 66.7% of residents felt that near-peer mentorship should be required in the residency programme but only 30.3% of them felt that it should be formalised. 78.8% of residents surveyed felt that mentorship by faculty was required.

Conclusion: Residents viewed mentoring by faculty and near-peer mentoring as being beneficial and crucial to their orthopaedic residency training. We propose that an ideal mentoring programme should be tiered, allow choice of mentors and include near-peer mentoring as a requirement but not necessarily monitored.

Keywords:        Orthopaedic Surgery, Resident Education, Mentoring, Medical Teaching, Tiered Mentorship

Proposal for What-If Kiken-Yochi Training (risk prediction training) Patient Safety Education Design: Improve risk assessment of medical students

Yoshitaka Maeda1, Yoshikazu Asada2, Yoshihiko Suzuki1 & Hiroshi Kawahira1

1Medical Simulation Centre, Jichi Medical University, Japan; 2Center for Information, Jichi Medical University, Japan


Students in the early years of medical school should learn the skills of clinical site risk assessment. However, the effect of this training on clinically inexperienced students is not clear, and it is difficult for them to predict risks from a wide range of perspectives. Therefore, in this study, based on Kiken-Yochi Training (KYT) for risk prediction using what-if analysis, we examined how to expand risk prediction among clinically inexperienced medical students. We divided 120 students in the first year of medical school into small groups of seven to eight students. First, each group predicted risks in the standard KYT (S-KY) method, stating what risks exist in the illustrations. Next, they conducted a What-If KYT (W-KY) analysis, brainstorming situations that differed from the illustrations, and again conducted risk prediction. Three kinds of illustrations depicting medical scenes were used. Last, each student proposed solutions to prevent risks. In this study, we clarify differences in risk assessment tendencies for students between W-KY and S-KY. We found that students could predict a wide variety of risks about illustrations using W-KY, particularly risks about patient and medical personnel. However, for risks regarding management, clinical rules, and stakeholders, prediction in both S-KY and W-KY was difficult due students’ lack of knowledge, but solutions proposed by students covered these elements. Improving the format of discussion in W-KY might allow students to predict risk from a wider range of perspectives.

Keywords:        Patient Safety Education, Undergraduate Education, Risk Assessment Skill, Kiken-Yochi Training, KYT, Risk Prediction, Clinically Inexperienced Medical Students

Short Communications

Authentic assessment utilising innovative technology enhanced learning

Carmel Tepper, Jo Bishop & Kirsty Forrest

Faculty of Health Sciences and Medicine, Bond University, Australia


Bond University Medical Program recognises the importance of workplace based assessment as an integrated, authentic form of assessment. In partnership with a software company, the Bond Medical Program has designed and implemented an online Student Clinical ePortfolio, utilising a mobile-enabled, secure, digital platform available on multiple devices from any location allowing a range of clinically relevant assessments “at the patient bedside”. The innovative dashboard allows meaningful aggregation of student assessment to provide an accurate picture of student competency. Students are also able to upload evidence of compliance documentation and record attendance and training hours using their mobile phone.

Assessment within hospitals encourages learning within hospitals, and the Student Clinical ePortfolio provides evidence of multiple student-patient interactions and procedural skill competency. Students also have enhanced interprofessional learning opportunities where nurses and allied health staff, in conjunction with supervising clinicians, can assess and provide feedback on competencies essential to becoming a ‘work-ready’ doctor.

Keywords:        Authentic Assessment, Interprofessional Learning, Technology-Enhanced Learning, Feedback, Workplace-Based Assessment

Personal View

If I had to do it all over again – Reflections of a clinician-educator

C. Rajasoorya

Department of General Medicine, Sengkang General Hospital, SingHealth, Singapore


Reflections represent exploration and explanation of events and may reveal anxieties, errors and weaknesses; they do however have positive influences highlighting strengths and successes for better future outcomes. The author reflects on his practice as a clinician-educator close to four decades and shares a perspective of his retrospectively pleasant but arduous journey into medical education.

Case Study

Teaching Family Medicine Approach in paediatrics with a patient having genetic syndrome – A case study

Rajeev Ramachandran1, 2, Clarice Chong3 & Lee Gan Goh3

1Khoo Teck Puat – National University Children’s Medical Institute, National University Health System, Singapore; 2Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore; 3Department of Family Medicine, National University Health System, Singapore & Yong Loo Lin School of Medicine, National University of Singapore


Family Medicine (FM) is an applied and integrative discipline. In 2011, the Ministry of Health introduced FM Residency Program in Singapore to train aspiring Family Physicians (FP). There are three sponsoring institutions, namely, Sing-Health Polyclinics, National Healthcare Group Polyclinics, and National University Health System (NUHS).