Detours, discoveries and degrees | MEDICUS 2024 Issue 3

Celebrating the Class of 2024’s diverse journeys to graduation
By Nicole Lim, senior editor

Duke-NUS' newest graduates celebrate their milestone

“Don’t be afraid to take detours.”

That was one of four pieces of advice that renowned clinician-scientist and academic leader Professor Mary Klotman offered Duke-NUS’ graduating Class of 2024. Klotman, who is Executive Vice-President for Health Affairs at Duke University and Dean of Duke’s School of Medicine, was the keynote speaker at the Graduation and Hooding Ceremony on 1 June.

“As you have learned, life will present you with paths you never knew were there and that may, in turn, present you exciting detours that lead exactly to the right place.”
Prof Mary Klotman

For the newest graduates who came to Duke-NUS after pursuing degrees and even careers in other fields, that certainly rang true.

One such graduate is Dr Alyssa Chua (MD Class of 2024). For her, that detour saw her working as an architect—a field whose connections with sociology and the arts had attracted her.

“As I worked in the role of an architect, I realised that perhaps I was still yearning to care for others in need, and that medicine was what could give me that opportunity,” she wrote in an email interview.

“Through sociology exposure in architecture, I learned to understand the intangible constraints and limitations of social set-ups and caregiving—both of which play a big role in health and recovery—almost as much as physiology and physical health.

“I also appreciate how the built environment—lighting ventilation, social spaces—influence wellbeing and mental health.

“This background gave me a robust and holistic understanding of health beyond just an individual’s physiology and pathology—and included mental wellbeing and social support,” she added.

A background that she drew on as she partnered with Associate Professor Low Lian Leng to study the effects of the built environment on older person’s quality of life during her third-year research project and that will continue to inform her approach to patient care.

Stay curious, be inclusive and create that much-needed change

The US ambassador to Singapore, His Excellency Mr Jonathan Kaplan, joined the Class of 2024 at their Graduation and Hooding Ceremony as Guest-of-Honour. In his remarks, he reminded the graduating students that they are well-equipped to take on the challenges of the future and encouraged them to embrace diversity and inclusivity in all aspects of what they would do:

“Each patient you encounter, each research project that you do, these things may be different. Patients have different values. They have different beliefs.

We need to respect the differences in everyone.

“You’ll also foster a more equitable and compassionate healthcare system for all of us.

“Healthcare is an ever-evolving field. So, it is essential for you to remain curious, remain adaptable, try to learn every day and be open to new ideas, new collaborators, new discoveries.

“This commitment to knowledge will give you a unique opportunity to make great strides in advancing and improving patient care everywhere.”

Become champions of scientific truth

As members of the Class of 2024 stepped into their new roles in laboratories, hospitals and healthcare services in Singapore and beyond, they did so with Klotman’s reminder that facts do matter, especially in the current age of mis- and disinformation, and that the practice of medicine is best when it is informed by strong, basic scientific evidence.

Championing scientific truth, not just in their professional capacity, but for their families and communities, Klotman said requires graduates to listen with empathy.

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“Listening with empathy – to explore where individuals are coming from, an approach that transmits that you value other viewpoints, no matter how different they are from yours.
Ideally, as you build trusting relationships over time, this approach will facilitate the uncomfortable discussions as you guide individuals to more credible information….

Don’t underestimate how your knowledge and skills can be used to make a difference in your practice, in your families and in your communities. Harness your power as scientific communicators and don’t be afraid to use it.”
Prof Mary Klotman

Listening with empathy is something that MD-PhD graduate Dr Tay Shi Huan (MD-PhD Class of 2024), pictured above with his wife and baby, is determined to do as he enters medical practice as an aspiring clinician-scientist.

“One moment that stays with me was a fateful encounter with a patient newly admitted to my team.

“She had a right below knee amputation some time ago. Her latest diagnosis showed that she might have to get the other leg amputated as well,” said Tay, who joined Duke-NUS after completing a degree in Natural Sciences at the University of Cambridge.

“After the hustle and bustle of morning ward rounds, I returned to her, gently asking about her previous amputation and her thoughts on the proposed plans. She broke down and shared that no one from the team had broached the topic with her until now. She thanked me for the opportunity to air her concerns.”

That conversation was defining for Tay, who is determined to combine head and heart knowledge as he embarks on a career as a clinician-scientist.

“Although modern medical technology is very advanced, there are still many diseases whose causes we do not understand, and the treatments are not very complete.

“Sometimes we only treat the symptoms but not the root cause,” he observed adding that he hopes to combine his clinical experience with research to address these gaps and improve care for patients.

Associate Professor Hairil Rizal bin Abdullah (PhD Class of 2024) poses for a photo with his fellow Clinical and Translational Sciences PhD graduates as they get ready for the march in

“Be champions of responsible application of technology. You will be the first generation of physicians and scientists who will have the opportunity to fully harness the power of artificial intelligence.
It is not hyperbole to say that AI holds the potential to absolutely revolutionise healthcare for our patients, our communities and our workforce.

If harnessed appropriately, it will help us reduce disease burden, improve diagnostic and treatment accuracy, reduce clinical and administrative burdens, accelerate the path from discovery to cure, enhance public health and advance health equity.

But with the opportunity comes risks and responsibilities.”
Prof Mary Klotman

Be champions of the responsible application of technology

Associate Professor Hairil Rizal bin Abdullah (PhD Class of 2024), who works in the perioperative service at the Singapore General Hospital, wanted to use machine learning to provide augmented decision-making support to the team of 12 consultants in the service.

And to ensure he had a robust foundation, he embarked on a PhD in Clinical and Translational Sciences, where he focused on using data science, machine learning and AI for clinical applications.

Describing the opportunity for introducing machine learning into perioperative care, Hairil said during a radio interview:

“During a surgery, you look at a lot of data points…At least five or ten data points are there on the monitor and you have to be able to figure out the trends and what they mean.”

The output from his PhD? An AI model to support clinicians in assessing the risk of complications from surgery in patients who come for pre-planned procedures.

It does this by combing through medical records and laboratory test results to synthesise a patient’s overall risk of undergoing surgery.

It formulates its recommendations by generating a predicted risk score of a patient requiring intensive care or dying within 30 days of surgery.

These recommendations are then reviewed by the care team before a final decision is reached. And Hairil is ready to create more such innovative applications.

“I want to develop more machine learning decision support tools, not to take over any human decision making but to complement and help medical decision making which would at the end of the day improve outcomes for our patients,” said Hairil.

Completing the PhD was a challenging but rewarding experience for Hairil who observed that good support is essential—from friends, colleagues, bosses and family.

“In doing my PhD, my son also picked up coding, so at home we have that programming talk once in a while and that helps as well. It makes things more fun,” said the father of three.

The wonders of helping others

Addressing the Class during the ceremony, Duke-NUS Dean Professor Thomas Coffman, a kidney specialist by training, shared a vivid memory of an eventful—and impactful—evening from his early days as a junior doctor.

“I got a call from my chief resident, Paul Klotman, saying that a patient with diabetic ketoacidosis was being admitted to my service and to meet him in the emergency room…

“I went the emergency room to find a very sick patient who had low blood pressure, high blood sugar, literally every blood chemistry value was abnormal. I had no idea where to start.

“Paul came down, gave me a little pat on the back and then very succinct and clear instructions on what to do, particularly emphasising that I needed to make a chart to follow the clinical parameters…

“And then, he appeared to leave me to manage the patient on my own, although there was plenty of subtle and close oversight.

“The patient gradually got better and for one of the first times, I experienced the thrill and the fulfillment of helping someone who was really sick get better, reaffirming one of the main reasons that we all go into medicine.

“For me, also, it was a great lesson in the wonder of human physiology, fluid, electrolyte balance, kidney function—I realise that’s not everybody’s cup of tea—but it was fascinating to me. And it really did help set the course for the rest of my career…

“For the graduates, I very much hope that you can experience the same kind of excitement and wonder in your postgraduate training that I did with wonderful colleagues and mentors with patients, who teach you about the intricacies and the joys of medicine.”

Dr Felicia Ang, centre, celebrates completing her PhD wit her family

“Burnout is real; particularly experienced in the healthcare profession during COVID and none of us escaped that. Healthcare institutions must continually look at ways to mitigate that burnout, but each of you must find what uniquely sustains you.
Find what gives you joy – both in your daily work – and outside your profession and make sure there is balance…
Find your sources of happiness and fulfillment and nurture them.”
Prof Mary Klotman

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Choose to intentionally invest in your wellbeing

Just as Hairil’s journey was bolstered by support from all spheres of his life, MD-PhD and PhD class speaker Dr Felicia Ang (PhD Class of 2024) was surrounded by friends, mentors, colleagues and family as she navigated the highs and lows of her PhD journey.

“Although this journey often felt like a solo mission to Mars, it actually turned out somewhat like a Chan Brother’s group tour. It was a shared saga of endurance, of growth, and yes, the occasional free lunch,” she said during her speech, echoing Klotman’s earlier remark that professional colleagues can be a source of great joy.

For Ang, these moments of coming together forged bonds that extended well beyond the walls of the classroom.

“We supported each other through harsh feedback and changes in life and celebrated our milestones,” said Ang, who graduated with more than a PhD.

Alongside her studies, she also found time to get married and give birth to three children, demonstrating that academia and family can go together, each its own source of personal happiness.

“I’ll never forget how friends and colleagues from Duke-NUS gathered to celebrate my wedding dinner, turning a professional bond into a lifelong memory,” she said.

When asked for her secret to juggling it all, Ang replied: “I asked for help whenever I needed it and accepted rejection. Being collaborative helped me find support from those around me—clinicians, academics, family and friends—and, of course, a cold beer from time to time!”