Collaboration and trust in mentorship | MEDICUS 2024 Issue 2

Close to the bone: Collaboration and trust in mentorship journeys
By Tan Ruilin, Writer

During Research Day, medical students present their research projects to faculty, peers and juniors // Credit: Pixel.i Photography for Duke-NUS

How Professor Wang Linfa of the Emerging Infectious Diseases Programme at Duke-NUS, and Dr Wharton Chan, an MD-PhD student of the Class of 2025, met was, like all the best collaborations, entirely by chance.

While Chan was completing the last year of his undergraduate degree at the University of Oxford, Wang happened to be visiting his son—and taking the concurrent opportunity to give a guest lecture at the University. Sitting in the audience at Wang’s seminar, Chan was so inspired by Wang’s novel work in bat biology and emerging bat viruses that he had to act. As soon as the seminar was over, Chan wrote an email to Wang to request working under his supervision as a PhD candidate.

It helped that Chan had already been considering Duke-NUS as one of his options for postgraduate study, with his eyes on the MD-PhD programme, where students get to do a four-year PhD, sandwiched between four years of medical education. “I knew I wanted to do research, but closer to home, which is in Hong Kong.”

Describing how research fits into a clinician’s playbook, Chan said: “I think it’s an indispensable toolset for clinicians—not all clinicians need to do research, but in interpreting and analysing data, and to further clinical acumen and prowess, it is very important, especially as medicine is a rapidly advancing field in science.” Because of this focus on research, and research that “has real-world implications and reach” in particular, Duke-NUS would eventually become Chan’s land of plenty—when it came to academic inquiry—for the better part of a decade.

Wang, reading Chan’s email, had his interest piqued, yet took his usual critical approach to the offer. “Of course, being from Oxford, and actively pursuing [an MD-PhD], were tick marks in my book. But I don’t just take students based on one email,” Wang laughed. He proceeded to offer Chan a summer internship so they might be able to have a chance at a “mutual selection”—it was important to Wang that they meshed well, and not merely intellectually.

Wang mused, “I would say that sometimes I think I’m really lucky, and sometimes Wharton thinks he’s really lucky, especially from something like a chance encounter.” For Wang, it was Chan’s excellent work ethic and attitude that made him stand out as a candidate for mentorship. Even the other members of the lab, all highly motivated and dedicated in their own right, had told Wang that he had to accept Chan into the laboratory, such was the impression the aspiring clinician-scientist had made.

Prof Wang Linfa (left) and Dr Wharton Chan (right) have an animated conversation. // Credit: Norfaezah Abdullah, Duke-NUS

Often, students who cultivate a rich and collaborative working relationship with a trusted mentor, especially from an established institution, find that they have an advocate for the rest of their careers. This was certainly the case between Chan and Wang. When he started working in Wang’s lab as a newly minted PhD student, Chan intended to study the immune system of bats, a topic that has made some headway within the lab.

However, as a would-be clinician, he was intent on using bioinformatics to investigate his subjects—on which Wang was not an expert. This appetite for marrying intriguing research topics with cutting-edge methods could have easily become a hiccup in Chan’s academic journey at Duke-NUS, but did not faze Wang, who saw to it that Associate Professor Enrico Petretto—much better equipped for the job—would serve as a second (unofficial) advisor, as well as sit on Chan’s thesis advice committee.

“Basically, you can’t design your career, but you have to be ready for it.”
Prof Wang Linfa

Said Chan, “Prof described it as a “compromise”, but I was very touched by Prof going out of his way to get another mentor to work on the methods that I was interested in, to make that happen. It is totally possible that I would have had to figure it out myself.” This gratitude and ease of working with Wang has travelled by word-of-mouth amongst the Duke-NUS students, and this, coupled with the almost-fashionable research that Wang’s lab is doing with bat biology, made him a crowd favourite amongst the MD-PhD students, even though Wang himself does not have an MD.

Dr Wharton Chan at work in the lab // Credit: Duke-NUS

Asked what enduring thought sticks with him from his relationship with Wang, Chan brought up an inscription that Wang was asked to contribute to a wall in his alma mater, East China Normal University, apropos of nothing. Wang, drawing from the depths of his personal philosophy, wrote: “Being a nice person is more important than doing good science; doing good science is more important than publishing; and then publication is more important than being elected a fellow.”

Chan takes this to heart, clearly. He said, “I think good mentors not only teach you good science, they also teach you about life.”

Not merely content with this, Chan also displays an aptitude for being flexible and venture into things seemingly unrelated to his work. During the acute phase of the pandemic, Chan, as a part of Wang’s lab, was able to continue to work, was trained in biosafety level-3 certification, and contributed to the national response to COVID-19.

“Basically, you can’t design your career, but you have to be ready for it,” Wang commented.

The right fit: A recipe for success

Ms Esther Seow (left) and Prof Lee Haur Yeh (right) update each other on work—and life. // Credit: Norfaezah Abdullah, Duke-NUS

Even though their partnership was significantly shorter, the dedication shared by Ms Esther Seow, MD student of the Class of 2024, and her mentor, Professor Lee Haur Yeh, Head of Dermatology at Singapore General Hospital, is palpable, as is a gentle, ruminative commitment to curiosity and collaboration. Seow first found Lee’s work when looking for mentors who focused on allergies. She’d developed an interest in the topic as a trained pharmacist, having observed the high prevalence of drug allergies while working in the previous sector.

“I thought this would be a good bridge to medicine, and think the project itself was a good marriage between my background and my MD training,” Seow explained. Under Lee’s guidance, Seow embarked on a project about Steven-Johnson syndrome and toxic epidermal necrolysis, a surprisingly under-studied subject, given the high mortality rate of the disease.

Lee described it as a “nagging suspicion that patients with longer half-life tend to do worse, so we undertook to prove the hypothesis—Along the way, many other questions emerge and that’s the exciting and wonderful part of doing research.” When Seow approached Lee, interested in working on allergies, Lee felt the topic was distinctly suited to her. “Esther, with her prior training and interest, was the perfect fit for the project. It wouldn’t have been possible for someone else to do it,” Lee said. “It’s why I accepted Esther as a mentee.”

For Lee, taking on a mentee is most about a good fit of clinical interests and their desire to work on a project at hand. “It’s about finding out from each of them what their alignment is. If there’s great fit and alignment, and strong passion and desire, then I think it’s a recipe for success.”

After working with Lee, Seow seems to agree—albeit her initial trepidation about taking on a project in the absence of the large teams with which she was familiar. If she could tell her past self anything, Seow said it would be to “trust the process”.

“One of the joys of clinical work is that, over the years, you have accrued a list of questions that you wish you had the energy and time to try and answer. But most of the time you don’t, and so then come along all these budding enthusiastic young researchers.”
Prof Lee Haur Yueh

Tellingly, success did come with Seow’s completion of her project on Steven-Johnson syndrome. Her work saw her present their findings at the Global Severe Cutaneous Adverse Reactions Forum, as well as the quadrennial 25th World Congress of Dermatology—the largest conference of dermatologists in the world. Lee, with a keen eye for suggesting these opportunities, was likewise elated for her: “For Esther to be able to present at an international platform and to have people ask questions, that’s really exciting and another source of learning opportunities.” Duke-NUS then sponsored Seow’s travels to Berlin, where she presented it at the European Academy of Dermatology and Venereology.

Part of this success, too, is the ease which underlies Lee and Seow’s working relationship. In speaking of it, they repeatedly emphasised a commitment to independence and collaboration in the process of the project.

Esther Seow (right) receives her award from Duke-NUS Vice-Dean for Academic Medicine Associate Professor Chow Wan Cheng (left) // Credit: Pixel.i Photography for Duke-NUS

From the very beginning of her collaboration with Lee, Seow decided—after interviewing her seniors about Lee’s working style—“I can make this work.” She especially appreciated Lee giving her freedom, particularly in her schedule, but was also buoyed by the knowledge that she would be able to rely on him when she had questions.

This was the crux of Seow’s decision-making process when navigating her mentorship journey: “Selection of the mentor is important—firstly, find a few [mentors] that you’re interested in, because it’s a long journey, and if you’re not interested in it, then it’s going to be difficult. Secondly, maybe ask seniors about the mentor’s working style, because not everybody wants somebody who gives them too much free rein. It has to be a good fit on both sides. Ask your seniors about their experiences, and reflect on how you want your journey to go.”

Planning one’s journey—setting an itinerary, so to say—through academic and professional progress can seem daunting. A common thread through the students’ experiences, however, is that mentorship is often a transformative and evolutionary event in their endeavours.

For Seow and many others, mentorship has been valuable to expanding their perceptions of the role research plays in their professional life: “Being able to see how Prof Lee juggles both clinical and research work and always having to meet him at the end of the clinic, just shows how much he values both. It made me see that there’s a good future ahead where I’m able to do both at the same time. I didn’t think that was genuinely possible before.”

Chan, too, has had his preconceptions of clinical research roundly rearranged: “I felt that to do medical research you really have to work with human samples... but obviously I was proven wrong, there’s a lot of things we can learn from other organisms.”

On the mentors’ end, genuine delight is taken in seeing a mentee’s growth and orbit towards success. Lee, specifically, views new scientists through the lens of endless promise and curiosity: “One of the joys of clinical work is that, over the years, you have accrued a list of questions that you wish you had the energy and time to try and answer. But most of the time you don’t, and so then come along all these budding enthusiastic young researchers, to whom you can then say, have a look at this. This was an approach that I learnt being a junior doctor, and it’s a process that’s part of growth in the individual.”

Others, such as Wang, having seen batches of mentees come and go, have developed ideals for what makes a clinician-scientist outstanding: “Nowadays, it’s not politically correct to say you have to be smart, but I think in science, you still have to be intellectually capable, with a hardworking attitude, and the last part being luck.”

Being the subject of attentive and thoughtful mentoring can only result in a broadening range of capabilities, as well as a heightening of one’s aspirations. Chan summarises it best when he emphasises wanting to ensure a continuation of research, and making sure that research has genuine traction and impact on real-world problems.

“Some people do blue skies research for the fun of it, and it might have reach, but the reach will be in 10, 20 years—but in an ecosystem like SingHealth’s, you need to be razor sharp, because you have finite resources. You really want to be targeting something that the population needs, and you need it to gain traction, not just for you, but for patients, and for funding bodies, realistically.”

These stories of mentorship at Duke-NUS not only highlight our students’ personal growth and academic success, but also underscore the profound impact of thoughtful, flexible mentorship in shaping the future of medicine.

Giving medical students a head-start in research

“Many people may think that our MD curriculum focuses on research only in the third year. Little do they know how much goes into the entire four-year journey of a Duke-NUS Medical School student,” Professor Scott Compton, Senior Associate Dean for Medical Education at Duke-NUS, wrote in a LinkedIn post.

Preparation starts from the first-year of medical school, with programmes like “Research in Action” that enable students to meet research faculty with whom they can pursue their third-year research project.

“The goal is for our students to be exposed to the research environment and to know what’s going on and who’s doing it, so they can look at these role models who are doing research and say ‘I want to be like them’,” added Compton.

In their second year, courses such as Research and Critical Thinking equip students with critical thinking skills using clinically oriented research papers. Besides participating in events such as “Research Day”, which provide a platform for students to meet potential mentors, they are also introduced to innovation and design thinking. With the experience from their clerkships, Compton hopes that students will be inspired to help patients with unmet needs using research.

And to ensure that they receive the technical support they need, students also meet with a statistician and a clinician researcher on most Fridays during their third year to review their projects and receive feedback on their methods and presentations.

“Ultimately, we want our students’ medical school experience to inspire them and to provide them with the foundational skills and competencies needed to make an impact by addressing the unmet healthcare needs of patients. This can’t be done in a single course or even a year—it has to be part and parcel a part of the ethos of the environment and the entire lived curriculum. That’s why we weave these issues throughout their medical school career,” he concluded.