“What brought you to the hospital?” asks a Duke-NUS first-year medical student, sitting next to an elderly patient’s bed. Beside her sit two classmates, and just like her, they’re leaning in, eager to hear the patient’s response.

The patient furrows his eyebrows, perhaps thinking about the events that led him there or deciding how to reply. Eventually, he replies—and while what he says is personal and useful, it’s the fact that he replied to them that is the encouragement the students need.

Over the next half hour, after a briefing from a faculty, the students chat with the patient, getting to know him and how his condition is affecting him. The students ask about his experience in Outram Community Hospital (OCH)—one of three hospitals managed by SingHealth Community Hospitals (SCH)—his daily routine before he was admitted, and whether he will be able to care for himself once he has been discharged.

The lesson they learn from this conversation: a patient has needs beyond knowing what ails them and receiving treatment for it.

For many of these first-year students who started their medical training at Duke-NUS just three months ago, this is one of their first clinical attachments.

“This experience has reaffirmed the importance of incorporating humanities into the practice of medicine,” said Ms Chen Ying Jie, one of the 72 students from the Class of 2026. “I learnt that patients, especially older patients, appreciate and desire the initiation of conversation. The warm rapport built with the patients encourages me to persevere through my medical education and be more cognizant of viewing patient-centred care from a bio-psychosocial perspective.”

 
Taking social prescribing back to the beginning

This attachment is one of a number of refinements that educators at Duke-NUS have introduced to help prepare students for the future of medical practice—a future where “health” care is emphasised over “sick” care. And a key skill that the next generation of doctors will need to master is social prescribing.

In social prescribing, the focus goes beyond treating patients when they are ill. This nascent area of family medicine seeks to encourage patients to live healthier lives by empowering them to manage their illnesses well and use the resources around them, such as Senior Activity Centres, to improve their overall wellbeing.

“Give a man a fish, and you feed him for a day. Teach a man to fish, and you feed him for a lifetime,” said Duke-NUS Associate Professor Lee Kheng Hock, a practising family physician. “This analogy also works for patients. Give a patient their medication, and you might treat them for a disease. But teach a patient about the resources that they can reach out to, and you can improve the patient’s health, mental wellbeing and lifestyle for a long time.”

As a social prescribing champion, Lee has been fronting this addition to the School’s curriculum so that students begin medical school learning about patients’ needs outside their current illnesses while focussing on their diseases—just so their care for patients will be well-rounded.

“With the healthcare moving towards population health, it is important that we in medical education keep apace so that when our students graduate, they have the right skills to support their patients,” said Professor Scott Compton, Associate Dean for Education at Duke-NUS. “By introducing this right from the start of their studies, we hope that this experience will leave a lasting impression on them.”

Prof Lee Kheng Hock briefing some students from the Class of 2026 before their attachment

 

The Class of 2026 is the first cohort to benefit from this addition, which is timetabled during the first few months of their studies.

To healthcare workers like Ms Sing Qing, who have been guiding students during their attachment at SCH, this early exposure to social prescribing in medical education is a great way to change how doctors care for their patients in the future.

“These attachments help the students to get to know patients first and foremost as people before linking them up with suitable community resources after they are discharged so that they can live well in the community,” said Sing, an executive at SCH. “I hope that as the students continue to deep dive into their future medical studies, they will continue to retain this mental model of seeing patients as persons to care for and persons to improve wellbeing for.”

Prof Lee (far left), Chen and her classmates (middle; in white coats) and Ms Sing and her colleagues (far right; in orange shirts) at OCH on the day of the attachment

 
Bringing students to the heart of the community

Back at the bedside, another student asks the patient: “Can anyone take care of you once you’ve gone home?”

The patient offers a helpless smile before saying, “Actually, I live alone.”

While doctors have been focused on delivering care at their clinics or in hospitals, patients’ care journeys span well beyond these encounters. And often their hospital stay is only one step in their journey to recovery.

“When a patient is out of the hospital or the clinic, there is only so much that healthcare workers can do,” said Lee, who is also the Deputy CEO of Education and Community Partnerships at SCH.

“By guiding them to the right knowledge, the right resources, these patients may be more motivated to take charge of their health once they’re back in the community and will reshape their health-seeking behaviours and lifestyles—a little bit at a time.”

Associate Prof Lee Kheng Hock

“But doctors must first understand the social determinants of health, partly by knowing some of the resources that patients have access to back in the community,” added Lee. “And how best to instil that knowledge in students but for them to see it with their own eyes?”

That’s why students go on a different attachment, where they spend a half day at a Senior Activity Centre, learning from community nurses and the residents who live there.

Built to encourage senior citizens to participate in active ageing, these centres are set up at the void decks of HDB rental blocks and act not only as a place to engage the elderly in activities—such as exercise, bingo, etc.—but also as a communal space for them to socialise and find social support.

Within the centres, Community Nurse Posts—much like local neighbourhood police posts—offer ready access to a range of health services from community nurses. On top of providing health assessments, these nurses also conduct home visits and coach the elderly on managing their current conditions while educating them on how to prevent new diseases.

“I came to realise the importance of community healthcare through this attachment. We were shown a resident’s living environment in a rental block and learnt how living conditions can have a huge impact on their treatment and recovery. This attachment also reminded me of the importance of social factors in evaluating and helping a patient.”

Sahad Zahir, another first-year student

Impressed by how actively the first-year students have been participating in these attachments, Miss Nadiah Binte Norzaini, a senior staff nurse with the Population Health & Integrated Care Office’s Community Nursing team, said: “It’s great exposure for students to come to these attachments before they start their actual clinical ones, so they have a better understanding of what’s happening in the community. They show a lot of interest in understanding community services and the living condition of the residents. I hope this attachment will be beneficial throughout their learning journeys.”

Mr Richard D Roza, Miss Nadiah and Sahad (far right) and his classmates at Thong Kheng SAC on the day of the attachment

 
“It will be a few years before we start seeing the impact of teaching social prescribing to first-year medical students,” said Lee. “But seeing how well our first-year students have been taking to these attachments, they will be well equipped to support the Healthier SG initiative in whatever roles they choose.”