In Focus: MBBS programme withstands outbreak

By Amanda Lee, Writer, Communications & Outreach
The ongoing coronavirus disease (COVID-19) outbreak has changed life as we know it. Education today, too, is in uncharted waters, as many universities have switched to remote learning and class sizes have to be limited. While most schools remain open in Singapore, they have had to make changes, implementing precautionary measures including fixed seating and safe distancing to ensure students’ health and wellbeing. 

LKCMedicine is no exception. With its technology-enabled curriculum and bespoke facilities, the School was able to adapt swiftly to the evolving situation. The School continues to configure lessons and learning activities in response to the latest national and university-level measures put in place to prevent the spread of COVID-19.

Vice-Dean for Education Professor Naomi Low-Beer said, “Our extensively digitised curriculum has put us in a strong position to respond to this crisis. Our Year 1 and 2 students use a fully mobile and digital curriculum, which has enabled them to make the switch seamlessly to interactive online learning. With our bespoke learning facilities, we have also been able to support our senior students with complex simulated learning scenarios through which they continue to learn under the supervision of dedicated clinicians. This has allowed us to provide our students with uninterrupted and structured training during this time of uncertainty.” 

Leveraging LKCMedicine’s technology-enhanced curriculum 
Since February, much of LKCMedicine’s teaching has moved completely online as class sizes were restricted to no more than 50 students. Because of the School’s extensive use of technology, students in Years 1 and 2 did not notice many changes to their learning.

They were already preparing for their classroom-based lessons using their iPads through which they access all their learning materials and resources anytime and anywhere. Students also rely on their iPads during lessons, completing tasks and posting questions on a dedicated Team-Based Learning (TBL) platform. 

Adjusting to the outbreak, the Year 1 and 2 students now “attend” TBL sessions online through video-conferencing platform Zoom, a form of TBL the School refers to as e-TBL. Far from being alone during these lessons, the team-based format of LKCMedicine’s pedagogy ensures students continue to learn in teams, albeit without the face-to-face interaction. 

Year 2 student Daryl Tan said he had no difficulties keeping up with lessons as all the learning resources he needs are available online. Agreeing, Year 1 student Ernest Ong said, “The content expert will address our burning questions, and often I found it easier to understand the content expert as it felt like I was having a one-on-one lesson with him or her.” 

This one-to-one feel is different from the classroom experience, where students and content experts are aware that they are addressing the whole group. And it is not just the students who have picked up on it.

“e-TBL is a new experience for all of us including students. e-TBL is something like having a phone conversation because it involves two parties listening to one another and then responding,” said Head of Anatomy Assistant Professor Sreenivasulu Reddy Mogali.

Assistant Dean for  Year 4 Associate Professor Wong Teck Yee holds a virtual session with students

For Year 4 students who were scheduled to be on the Obstetrics & Gynaecology posting, the School similarly leveraged its digitally enabled infrastructure to enable the students to master their learning outcomes. Lessons on topics such as ‘Bleeding in Early Pregnancy’ and ‘Miscarriage’ moved online. Other clinicians leveraged technology by recording hospital-based events, such as a caesarean section delivery (with the consent of those filmed), and using the real-time footage to provide a virtual OT teaching session, talking students through the events as they unfold. 

Assistant Dean of Year 4 Associate Professor Wong Teck Yee said they were able to facilitate lessons through such asynchronous teaching. However, he pointed out that tutors who are usually in hospitals may encounter different hiccups during online lessons, such as issues with internet connectivity. 

“Nonetheless, I am quite happy that our students and tutors have been responding to the MBBS programme quite well,” said A/Prof Wong. 

As the government continues to adjust its public health response to the COVID-19 outbreak, the School’s faculty and staff regularly review how they implement lessons. For instance, when the alert level was raised to Orange on 7 February, Asst Prof Reddy said stricter measures for learning were put in place at the Anatomy Learning Centre (ALC). 

To effect safe distancing, the ALC was divided into three separate teaching sections with no more than 24 to 30 students present in each section at any one time. Within each section, students were further subdivided into two or three alcoves of about 12 students each. Roller blinds were used to separate each alcove of students.

Precautionary measures at the Anatomy Learning Centre include the use of hospital screens to separate teaching sections

“We were able to subdivide the ALC into separate teaching sections using hospital screens and by design, each alcove of students was already separated by automated roller blinds during normal teaching periods. In this manner, we avoided the gathering of groups of more than 50,” said Asst Prof Reddy. 

However, this will change from 6 April when all anatomy practicals will be conducted online. This is in response to the latest restrictions announced by the Singapore government mandating strict physical distancing to reduce the risk of the virus spreading. 

Stress test of LKCMedicine’s future-ready curriculum
Back in 2010, a golden opportunity arose to create a new medical school that would deliver a world-class, future-ready curriculum for Singaporeans keen on studying medicine. In addition to customising the world-class medical curriculum from Imperial College London to Singapore’s unique needs, the School’s leadership transformed the way students would interact with the curriculum by incorporating the latest digital learning technologies. 

Not only did the School adopt TBL for all its teaching, but the TBL sessions were also turned into paper-free activities fully supported by an online Learning Activity Management System (LAMS). Learning resources were made available through a specially developed e-learning ecosystem that consists of five pillars – iLKC, iLecture, iLAMS, iFolio and Analytics. Together, the five pillars support learning activities across settings from on-campus to clinical environments.

As part of the School’s business continuity planning, the Digital Learning Department conducts routine tests of its systems. About a year ago, this involved holding a TBL lesson fully online. The department’s Senior Assistant Director of Content & Instructional Design Ng Aik Song said, “The team went through a few iterations of e-TBL and extensively tested integrating the Video Conferencing software into the LAMS system. The e-TBL workflow was still fresh in our mind.” 

“Thus, when the call came [in February], we did several rounds of dry run internally. Some of those dry runs involved the facilitator’s team. There were several challenges encountered, but we managed to overcome them and were ready just in time,” he added. 

The digital learning team and LKCMedicine faculty test e-TBL

Putting LKCMedicine’s facilities to good use
The School’s dual campus, built with state-of-the-art learning spaces, has also played its part in providing continuity of learning for the students during the COVID-19 pandemic.  

As students in Years 3 to 5 are unable to learn in clinical environments, the School has brought clinical encounters to its Novena Campus. 

For Year 3 and 4 students, the School conducted Direct Observation of Procedural Skills (DOPS) in the Practical Skills Lab. 

This is to make up for the work-based formative assessment that tests students on their practical skills such as drawing blood and performing an electrocardiogram. These skills are usually acquired during the clinical postings where students perform procedures on real patients, said Assistant Dean of Year 3 Associate Professor Koh Nien Yue. 

“With the current DORSCON Orange alert, students cannot be assessed with DOPS in the usual way. Hence, the School has arranged for practical skills sessions to be conducted on campus to facilitate the learning and assessment of practical/procedural skills through the use of task trainers and assessment by clinical practitioners [doctors and nurses],” she added. 

Conducting DOPS on campus has its benefits too. For instance, Senior Assistant Director and Lead for Practical Skills Ramani Saravanan said if students’ performance is unsatisfactory the first time, they can continue to practise their skills under supervision, something that is not always immediately possible when working with real patients.  

As the School has learning spaces that can be configured to life-like clinical settings, Year 5 students who were supposed to be on their Student Assistantship Programme in the hospitals were able to experience the work of a junior doctor by attending a simulated ward round instead. Called SimRound, this lesson is the brainchild of Assistant Dean of Year 5 Associate Professor Tham Kum Ying. 

LKCMedicine Year 5 students on their teaching ward round during the SimConsult

“SimRound is something that we have already done in a much simpler version in the early school years. So, to ramp it up and add on the rest of the features and complexity that are appropriate for a Year 5 teaching event didn’t take a long time,” said A/Prof Tham.

In pairs, the students clerked one of five ‘patients’, taking their history and finding out why the patient was admitted. A consultant later conducted a teaching ward round at the patient’s bedside with the students, where they presented their diagnosis. 

Everyone performed their role as they would on the ward. Only the ‘patients’ were simulated as they were played by trained actors who had been given a detailed script to help them portray a specific illness. 

Year 5 student Au Shu Ting said SimRound has allowed her to experience what happens during an actual ward round. 

“This is as close as it can get given the current situation, and I am grateful to the School for organising this session so quickly,” she added. 

LKCMedicine Year 5 student Au Shu Ting clerks her 'patient'

Uniting as one School, oneLKC
While the School’s faculty has responded with adjustments to learning, the students, too, have stepped up their peer teaching efforts, with seniors teaching their juniors. For example, the Year 4 students offered support to the Year 3 students to make up for missed clinical postings such as internal medicine and surgery. Developed by the LKCMedicine Students’ Medical Society Academic Committee and the Year 4 House Reps, the seniors organised several half-day sessions to cover important topics such as physical examinations, history taking and counselling. 

Year 4 Rep Jonathan Loke said many Year 4 students were involved in the teaching sessions and the decision-making on which content to cover. “It is very difficult for us to take over the roles of [teachers], but many of us tried our best to ensure the basics were taught well,” said Jonathan. 

Times of crisis bring out the most ingenious solutions, some of which will pave the way for tomorrow’s learning. For LKCMedicine, it has proven that the MBBS programme can continue to run smoothly by using its technology-enabled curriculum and advanced learning spaces. 

A/Prof Koh said, “The School is committed to providing quality medical education for our students and learning must continue in spite of the circumstances. With the help of technology, we are leveraging blended learning and simulation sessions to enhance our students’ learning. Students are able to ‘attend classes’ from wherever they may be through online platforms such as ZOOM or Google Classroom. Hence, enforced social distancing and physical constraints are no longer insurmountable barriers to learning.” 

While many of the initiatives put in place were implemented because of external pressures on medical education, some may have earned themselves a place in a peacetime curriculum, says Prof Low-Beer. Among them are the use of enhanced simulated clinical scenarios that will ensure all students have access to key learning opportunities and a greater role for peer teaching. Knowing that TBL can be as engaging in the virtual classroom as it is when everyone is in the same space has also been a useful learning experience. 

“Our teaching had to change because of the COVID-19 pandemic, but some of the innovative solutions developed by our faculty are more than stop-gap measures. These innovations can be embedded more routinely in our curriculum for the benefit of our students,” she said.

Additional reporting by Nicole Lim.