Duke-NUS Medical School and SingHealth mark milestone anniversaries this year, but celebrations had to be deferred as the two academic medicine partners took on the COVID-19 pandemic. MEDICUS speaks with Professor Thomas Coffman, Dean of Duke-NUS, and Professor Ivy Ng, Group CEO of SingHealth, about how this Academic Medical Centre (AMC) partnership has withstood the onslaught of a global pandemic and the secret formula that lies behind the AMC’s success.

MEDICUS: COVID-19 remains on everyone’s minds. So, tell us, how has the SingHealth Duke-NUS Academic Medical Partnership withstood the onslaught of COVID-19?

Ivy Ng: We more than withstood it! The partnership, as in many other situations, made us stronger for the situation at hand. We managed to mitigate the risk of infection in our community because we acted concurrently and quickly. We continue to be grateful and very watchful for any clusters. (I’m touching wood here!)

Thomas Coffman: We’ve weathered this together, drawing on our respective expertise and experiences to drive research and get our students trained. The pandemic also highlighted the real strengths of having bench-to-bedside research capabilities. SingHealth clinicians sent patient samples directly across the road to our labs, where our scientists worked on the science, developing solutions like the serum test, and brought those back to the clinic and public health arena. That’s just one example that epitomises what our AMC is all about.

MEDICUS: How has the partnership allowed both institutions to respond more effectively and contribute both locally and internationally?

Thomas Coffman: We have a fantastic reservoir of human talent on our AMC campus. And not just talented people, but people who are dedicated and want to do the right thing. This gives you tremendous strength to deal with whatever comes your way and continue to flourish even amid this pandemic.

Ivy Ng: One example of this strength would be in the COVID-19 vaccine development. We had the labs at Duke-NUS, the Emerging Infectious Diseases Signature Research Programme, ViREMiCS [the Viral Research and Experimental Research Centre @ SingHealth Duke-NUS AMC] and then, when we had a vaccine candidate, it seamlessly flowed into SingHealth’s Investigational Medicine Unit, right on the doorstep.

This integration allowed us to start the first trial quickly. And whatever the outcome of this trial is going to be, it will add to the body of knowledge and advance vaccine development here and around the globe.

MEDICUS: The partnership between Duke-NUS and SingHealth was formalised in 2014 and it is still going strong. How did you bring two very different organisations together? What was the biggest challenge?

Ivy Ng: We made it official in 2014, but the journey started much earlier. It dates as far back as March 2011 when we had the first Academic Medicine Executive Committee meeting. This was followed by the first wave of Academic Clinical Programmes and SingHealth Duke-NUS Disease Centres in August 2011 and 2013, respectively. It was a good collaboration before the official partnership was signed.

But what made this partnership work was that we shared a single vision – even before we formalised anything, we shared that single focus. On the SingHealth side, our single motivation was patients at the heart of all we do, while Duke-NUS’ vision was focused on improving lives.

The greatest challenge was bringing very diverse groups, particularly on the SingHealth side, to resonate with our single vision. Dean Ranga [Krishnan, former Dean of Duke-NUS] and I would just do countless lunches and breakfasts with small groups, talking about the vision. We must have presented the vision close to 100 times at different institutions and campuses.

Thomas Coffman: The amount of culture change that’s happened in a fairly short time is hard to imagine. By the time I got involved in the Dean’s Office, a sea change was happening. People embraced the vision of academic medicine. They were committed to bringing education and research together to improve lives and outcomes for the people who come through the health system.

But academic medicine also provides a landscape where people can pursue careers that are enhanced by getting involved in education or research, even peripherally, where they work in an environment full of discovery [and] innovation and are encouraged to think how clinical care can be delivered more effectively.

Duke-NUS Deans’ annual pancake breakfast brought together leaders from Duke-NUS and SingHealth who would flip pancakes to raise money for Duke-NUS students’ community engagement activities

MEDICUS: In forming this partnership, you set up many new structures from joint institutes and disease centres to shared processes. Are the structures able to hold the partnership together?

Ivy Ng: That is an easy one — no! It’s all about the people and that’s also why we spend the most time talking about the people and planning succession, training and experiences that leaders should have because the AMC is only as good as the leader you have in place now. The next generation of leaders will always be better than the leaders of today. That’s the only way we’ll progress and that extends to the faculty and staff as well.

The structures are enablers. If you just had the structure but you didn’t have the people and the drive, it wouldn't have happened.

Thomas Coffman: In fact, the structures evolve based on what we need. Certain things that worked before need to be modified or we need new structures to deal with the evolving healthcare needs and demands. So, it’s not static.

MEDICUS: So what’s the most important ingredient in this successful partnership?

Ivy Ng: Trust. I think that’s critical. And it is so precious that we need to always guard it fiercely. Dean and I have a regular meeting that’s no holds barred, where we can highlight worries and concerns and address them immediately or as soon as possible without letting things ferment. That’s been key. And it has to happen at every level across the AMC. That’s one of the key ingredients that will keep us successful.

Thomas Coffman: Trust was exactly the word I was going to say. It is the real foundation of everything that we do. Across the institutions, when people trust each other, they work well together. It’s a pretty incredible thing.

And the AMC bridge that physically connects the two buildings cemented our partnership!

MEDICUS: What is your favourite discovery that will change patient care that came about because of the partnership?

Ivy Ng: There are so many, but if I really have to pick one, it is probably Stuart Cook’s antifibrotic research because that's going to be impactful. So many diseases are caused by fibrosis, not just the cardiac ones. I look forward to that being taken forward.

Thomas Coffman: Stuart’s discovery epitomises how these successes can happen in an Academic Medical Centre (AMC). We worked together to recruit him. He works as a clinical cardiologist in the National Heart Centre Singapore but also runs one of our Signature Research Programmes. He made a very basic discovery that was published in Nature. Right from the beginning, he was focused on turning it into something that could help patients. The discovery was spun off into a company to help make antibodies that could be used as drugs and the technology has now been licensed to a pharmaceutical giant. This is what you have to do to have an impact. You have to involve the commercial sector to get these kinds of discoveries out to patients.

This discovery could influence and impact millions of people, and that’s at the heart of our aspiration as an AMC.

MEDICUS: What is next for the AMC?

Ivy Ng: We aspire for this AMC to be among the top ten globally. I honestly believe we can get there. We have some unique ingredients that put us in good stead, that allow us to dream the big dream.

We have the best from the West and the best from the East, and we’ve got a location that allows us to host talent. We must not forget that Singapore is a good place and many strategic hires, even if they had to leave us, say that their time here was exceedingly fruitful.

The continued focus [on biomedical sciences] in Singapore’s RIE [Research Innovation & Enterprise] 2025 strategy is key. Our investment in campus renewal and the expansion of the regional health network are also crucial. These commitments demonstrate that this pandemic is not going to detract Singapore from playing with the big boys, which has helped us attract really good talent, and once COVID-19 is over, will allow us to do so again.

And then I would say if you look into the future of the AMC, it has to be looking into the future of our local context as well as the global context. We’ve just launched a new disease centre to focus on dementia and cognitive disorders, which are not just problems in Singapore, they are problems everywhere else too. When we focus on clinical care, research and education in these strategic areas, we’re going to make inroads not just for Singapore but globally.

Thomas Coffman: I will only add that another vital aspect is the continued philanthropic collaboration that leverages our strengthened academic medicine culture. Thanks to the generous support of our benefactors, who share our joint vision of improving lives, we have been able to make many impactful discoveries. Going forward, we hope to sustain these activities with the continued support of our existing benefactors and reach out to new potential donors.

MEDICUS: Any last words for us?

Thomas Coffman: This virus is going to have a lasting impact on life around the world, and it will impact us as a functioning AMC but in a way that will benefit everyone. We’ve embraced an evidence-based approach to innovative thinking that allows us to evaluate what we have done, take the good and make it better.