Graduating clinically competent doctors amidst a pandemic

It is vital that medical schools graduate well-trained and competent clinicians capable of compassionate care for patients. During a pandemic, such as in the case of COVID-19 this year, conducting clinical training and graduation exams have been an enormous challenge for medical schools all around the world.

Duke-NUS Medical School’s Office of Education was able to adapt, innovate and administer safe and effective final year exams to medical students to ensure they are competent to enter the medical workforce and contribute to the COVID-19 response. The Office of Education’s report on this challenging but unique endeavour, published in journal MedEdPublish, is, we believe, a world-first on the conduct of high-stakes, graduation-level clinical examinations during the COVID-19 pandemic, and has attracted a lot of international attention and support.

Led by Professor Ian Curran, Vice Dean of Office of Education, and Associate Professor Katharine Boursicot, Associate Dean for Assessment and Progression, Duke-NUS developed a strategy that can ensure the clinical and procedural skills of final-year medical students are safely and reliably assessed.

In March 2020, 56 final year students were separated into four cohorts of 14 students, with each cohort assigned separate locations, examiners and patients. The health, travel history and contact with ill persons for every participant, including students, examiners and patients, for two weeks prior to the exam, were reviewed on the day. The School complied with strict COVID-19 safety and control measures, including ensuring all participants wore masks, practised strict hygiene and frequent cleaning, maintained careful cohorting of participants, and physical distancing. Further social distancing and separation measures, such as separate washrooms, individual lunches, were also implemented. Health and safety were paramount throughout the entire process.

“By applying innovative strategy in conducting our final examinations, we managed to demonstrate that our students met our required high standards for graduation. These stringent measures allowed Duke-NUS Medical School to robustly assess and graduate clinically competent new doctors, who can now join the medical workforce without delay and contribute to the national effort in overcoming COVID-19,” said Prof Curran, senior author of the study.

The achievement of such an important clinical examination was made possible through the support and close collaboration of Singapore’s Ministry of Health, SingHealth’s healthcare institutions, and with the team of clinicians, staff, faculty, and real and simulated patients.

Changing of the guard

Duke-NUS bade farewell to the outgoing Chairman of its Governing Board, Mr Kai Nargolwala, at a transition ceremony in September last year, and at the same time, welcomed the new Chairman, Mr Goh Yew Lin.

The event was attended by faculty, staff, and leaders of SingHealth, Duke-NUS and Duke University, including Professor Ivy Ng, Group CEO of SingHealth, and Laurene Sperling, Vice Chair of Duke University’s Board of Trustees.

The school honoured Mr Nargolwala’s contributions during his seven-year tenure, during which he saw several milestones being set, including the formalising of the SingHealth Duke-NUS Academic Medical Centre (AMC) partnership. A veteran of the finance industry, he was recently awarded the Public Service Star Medal (Bintang Bakti Masyarakat) in recognition of his contributions to Singapore.

Professor Thomas Coffman, Dean of Duke-NUS, commended Mr Nargolwala for his  steady hand in guiding the  school from a start-up to an established, world-class medical school with an international reputation.

“His business and political acumen have greatly informed the school’s strategic development in areas ranging from recruitment to commercialisation of our research discoveries. We are very grateful for Kai’s wisdom and advice during his years as our Chairman,” said Prof Coffman.

Incoming Chairman, Mr Goh, Managing Director of G.K. Goh Holdings Ltd, comes to Duke-NUS backed by a decades-long business career.

Treatment of neuropsychiatric disorders using a novel drug formulation

Depression is a common and serious illness that affects many people, worldwide. Certain types of clinical depression can be combatted with 5-hydroxytryptophan (5-HTP), a precursor of the neurotransmitter, serotonin. Widely used drugs, such as Prozac, enhance serotonin availability as an effective way of treating depression. However, when taken orally, 5-HTP doesn’t reach sufficient levels in the blood or brain. That is, the bioavailability of 5-HTP is too low.

A start-up company called Evecxia, headquartered at Research Triangle Park in North Carolina, is developing 5-HTP as a treatment for depression and other neuropsychiatric and non-psychiatric disorders by designing new formulations that could make the drug more effective. Dr Jacob Jacobsen, one of Evecxia’s founders, its chief scientific officer, and a faculty member at Duke-NUS Medical School (Duke-NUS) was able to take this research on 5-HTP to the next level with the support of Duke-NUS’ Centre for Technology and Development (CTeD).

CTeD was instrumental in assisting Dr Jacobsen in bringing this research to Singapore and establishing a collaboration with colleagues at the National University Hospital (NUH) and Nanyang Technological University (NTU) to find solutions to the 5-HTP bioavailability challenge. Together, this multi-institution team led by Dr Jacobsen designed new slow-release formulations of 5-HTP. These new formulations help achieve desirable 5-HTP levels in the blood and brain, and can be used alone and in combination with other drugs.

This intellectual property, jointly owned by Duke-NUS, NTU and NUH, was licensed to Evecxia, which in March 2020, announced it had raised US$5.5 million to help advance its lead product candidate (EVX-101) to the clinic. These funds allow Evecxia to make progress in developing a treatment that could help countless numbers of people worldwide to have a more effective treatment for depression.

This island-wide collaboration between Duke-NUS, NUH and NTU, facilitated by CTeD, highlights the essential role played by scientists, technology transfer and business development teams in nurturing start-ups and delivering unique healthcare solutions to patients who are in need.

Annual Review 2019

This year we celebrate 15 years since being established as Singapore’s first and only graduate-entry medical school, marking a significant milestone in Duke-NUS Medical School’s journey.

Duke-NUS has come a long way from conducting classes and doing research at the old nursing quarters at Jalan Bukit Merah. Fifteen years on, we are a world-class medical school with innovative education programmes and impactful research to improve health outcomes in Singapore and beyond.

The Annual Review 2019 highlights the exceptional achievements of our students, faculty and staff, who make great things happen through their talent and dedication.

Read more in the Duke-NUS Medical School Annual Review 2019.