Submitted: 16 December 2022
Accepted: 3 January 2023
Published online: 4 July, TAPS 2023, 8(3), 68-69
https://doi.org/10.29060/TAPS.2023-8-3/LE2930

David Mathew

Department of Anaesthesia, Khoo Teck Puat Hospital, Singapore

Dear Editor,

I read with great interest the article entitled “The associates of Emotional Intelligence in medical students: A systematic review” (Edussuriya et al., 2022) in your journal published in October 2022. The association of Emotional Intelligence (EI) with wellbeing cannot be underestimated, especially with the plethora of positive effects it has on mental health and academic performance. In fact, I think this can be extended beyond students, to all healthcare professionals.

In my opinion, humanities in medicine provide a potentially novel way of improving emotional intelligence. The writer of a piece acknowledges the scientific experience that has moved him/her, and subsequently reflects on the entire experience through the arts and writing. The process of writing can be cathartic as it presents an avenue for the writer to release emotions that might have been pent-up or hidden as we provide a brave front to our patients. Once written, the piece can be shared, and reach out to other healthcare professionals who might have encountered similar experiences. Some may find comfort in reading such pieces, as they realise they are not alone in experiencing the roller-coaster of emotions in their daily lives.

I have appended a piece I wrote regarding my experience with an obstetrics patient and how sometimes the lesser said, the more it means. The process of writing and sharing this piece helped me better understand and appreciate what I went through and I hope it can do the same for fellow readers.

Cry

The day I saw her cry

was when her baby’s heart

slowed.

She needed the Caesarean

quickly.

 

Her eyes conceived tears

crawling down her cheeks

shaping into an anxious cry.

I counted the tears

and spoke more words

comforting, reassuring.

 

I saw her cry

one week later,

this time her littlest bundle

the greatest joy.

 

Tears of happiness

dancing muted screams of relief

I counted the tears

but spoke nothing

comforting, reassuring.

 

Tears

instead of words,

won wars of emotions.

And staying silent

might be the most reassuring cry

of comfort.

Note on Contributor

DM came up with the concept of the manuscript, and wrote the entirety of its contents.

Funding

There was no funding for this paper.

Declaration of Interest

There is no conflict of interest declared.

References

Edussuriya, D., Perera, S., Marambe, K., Wijesiriwardena, Y., & Ekanayake, K. (2022). The associates of Emotional Intelligence in medical students: A systematic review. The Asia Pacific Scholar, 7(4), 59–70. https://doi.org/10.29060/taps.2022-7-4/oa2714

*David Mathew
Khoo Teck Puat Hospital,
90 Yishun Central, Singapore
Email: davidmathew3142@gmail.com

Submitted: 27 December 2022
Accepted: 13 March 2023
Published online: 4 July, TAPS 2023, 8(3), 70-71
https://doi.org/10.29060/TAPS.2023-8-3/LE2938

Hirofumi Kanazawa¹ & Ikuo Shimizu^2,3

¹Shinshu University School of Medicine, Matsumoto, Japan; ²Safety Management Office, Shinshu University Hospital, Matsumoto, Japan; ³Department of Medical Education, Chiba University Graduate School of Medicine, Chiba, Japan

Medication errors are one of the most serious problems in healthcare, and their occurrence is due to a wide variety of causes. While almost all drug-related medical errors are potentially avoidable, the main obstacles are primarily health system vulnerabilities and human error. To remove those obstacles, the World Health Organization (WHO) suggested providing more education (World Health Organization, 2017), specifically by participating in medical care. Graduation competencies in many countries, which include activities about medication and patient safety, are consistent with the statement. In addition, it is known that more prescribing errors occur in the first postgraduate year. Learning about prescriptions during medical studentships must be enhanced.

Nevertheless, we are concerned that medication safety education is still insufficient in the current undergraduate curriculum because of license-based regulation. It is considered difficult for clinical students to incorporate prescribing and ordering medication as part of medical studentship. Such license-based regulation is typical in Asia, where authoritarian attitudes are strong. We would like to point out that invasive clinical procedures are handled differently from prescriptions, despite the fact that such procedures are also medical practices that can involve risk. While medical students have the opportunity to conduct invasive medical procedures in the workplace, they scarcely prescribe medication before graduation.

It is time for medical educators to take the WHO statement seriously and organise more opportunities to learn how to prescribe medications safely. We can transfer learning strategies from invasive clinical procedures, even in the context of strict regulations. For example, we can implement more simulation practices. Although the WHO Curriculum Guide for Patient Safety does not yet include scenario simulation, research suggests that education with appropriate feedback can be very effective (Motola et al., 2013). Simulation-based prescription practice, especially in situations where medication errors are likely to occur, would allow for focused practice in a zero-risk environment. Another concern is that there have been relatively few published studies on the effectiveness of medication safety in undergraduate education, including simulation. High-fidelity simulators are available in many medical schools, but the usability is still limited because they do not cover a wide variety of situations to use medications. A possible breakthrough can be the implementation of virtual or mixed reality environment. Enhancing the reality of prescribing and administrating medications through these educational strategies could be a very useful tool to apply not only in Asia but also in other contexts.

Notes on Contributors

Hirofumi Kanazawa conceptualised and wrote the manuscript.

Ikuo Shimizu wrote and supervised the manuscript.

All authors discussed and contributed to the final manuscript.

Funding

This work was supported by JSPS KAKENHI Grant Number 21H03161.

Declaration of Interest

There is no conflict of interest.

The main idea of this article was presented at The 17th Annual Congress of Japanese Society for Quality and Safety in Healthcare on November 27, 2022.

References

Motola, I., Devine, L. A., Hyun, S. C., Sullivan, J. E., & Issenberg, S. B. (2013). Simulation in healthcare education: A best evidence practical guide. AMEE Guide No. 82. Medical Teacher, 35(10), e1511-e1530. https://doi.org/10.3109/0142159X.2013.818632

World Health Organization. (2017, May 15). Medication Without Harm – Global Patient Safety Challenge on Medication Safety. https://www.who.int/publications/i/item/WHO-HIS-SDS-2017.6

*Ikuo Shimizu
Safety Management Office,
Shinshu University Hospital,
Matsumoto, Japan
3-1-1, Asahi, Matsumoto City,
Nagano, Japan, 390-8621
+81 263 37 3359
Email: qingshuiyufu@gmail.com

Submitted: 26 May 2022
Accepted: 10 June 2022
Published online: 4 October, TAPS 2022, 7(4), 86-87
https://doi.org/10.29060/TAPS.2022-7-4/LE2816

Tomoko Miyoshi¹, Fumiko Okazaki², Jun Yoshino³, Satoru Yoshida⁴, Hiraku Funakoshi⁵, Takayuki Oto⁶ & Takuya Saiki⁷

¹Department of General Medicine, Kurashiki Educational Division, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama University, Japan; ²Center for Medical Education, The Jikei University School of Medicine, Japan; ³Department of Physical Therapy, Faculty of Health and Medical Science, Teikyo Heisei University, Japan; ⁴Emergency and Critical Care Medical Center, Niigata City General Hospital, Japan; ⁵Department of Emergency and Critical Care Medicine Tokyobay Urayasu Ichikawa Medical Center, Japan; ⁶Department of General Dental Practices, Kagoshima University Hospital, Japan; ⁷Medical Education Development Center, Gifu University, Japan

Dear Editor,

We are delighted to report that the Japanese translated version of R2C2 (relationship, reaction, content, coaching) was published in the Journal of Medical Education in Japan, under kind permission of the author and Journal of Academic Medicine. The R2C2 model, developed by Sargeant et al. (2015), promotes behavior change through reflection and feedback, while incorporating coaching. The effectiveness and influencing factors have been demonstrated in supervisor–resident pairs in various residency programs (family medicine, psychiatry, internal medicine, surgery, and anesthesiology) in the U.S., Canada, and the Netherlands. The R2C2 model is fascinating since it emphasises the relationship and dialogue between the resident and the supervisor, and provides insights into the residents’ in-depth learning.

While we are interested in factors that influence feedback, common across different specialties and contexts, we hypothesise that national culture and health profession disciplines may affect the dialogue and impact of the R2C2 model, especially in bridging the gap between self-assessment and supervisor’s assessment.

Reports of such cultural differences demonstrate the Japanese learning more from their failures, while Westerners learning more from their successes, as well as differences in learners’ self-evaluation. In addition, Hofstede reports that the relationship between learners and teachers in East Asia, including Japan is hierarchical, and feedback is therefore likely to be one-sided. Regarding mentoring/coaching, we have revealed that Japanese physician–scientist relationships are dependent on trust in mentors, and the cultural influence of acceptance of paternalistic mentoring (Obara et al., 2021) suggests the need for building trusting relationships. Furthermore, we as multidisciplinary author teams are keen to explore how different health profession disciplines shape the different perspectives on effective feedback and supervisor–learner relationship. We expect this topic to become more apparent as modern health services are becoming more multi-professional and the discourse may develop in a multi-professional relationship.

The Japanese version has been cautiously translated and published to overcome any issue involving translation. Although we had successfully conducted the nationwide workshop on R2C2 in Gifu, Japan in 2021 to disseminate its philosophy, we realised variety of factors should affect when we conduct R2C2 in our context. Our future goal is to examine the utility of R2C2 model in cross-cultural settings as well as cross-disciplinary situations in order to generate findings that will contribute to the glocalisation of medical education and multi-disciplinary education.

Notes on Contributors

T Miyoshi conceptualised and wrote the manuscript and approved the final version.

F Okazaki conceptualised cultural difference of R2C2 and revised and approved the manuscript.

H Funakoshi conceptualised cultural difference of R2C2 and revised and approved the manuscript.

T Oto conceptualised different health profession disciplines of R2C2 and approved the manuscript.

J Yoshino conceptualised different health profession disciplines of R2C2 and approved the manuscript.

S Yoshida conceptualised different health profession disciplines of R2C2 and approved the manuscript.

Prof T Saiki supervised and edited the manuscript.

Acknowledgement

We would like to acknowledge Rintaro Imafuku, Kaho Hayakawa, Chihiro Kawakami in Gifu University Medical Education Development Center, for writing and editing the Japanese translated version of R2C2 collaboratively.

Funding

There is no funding provided.

Declaration of Interest

There is no conflict of interest, including financial, consultant, institutional or otherwise for the author.

References

Obara H, Saiki T, Imafuku R, Fujisaki K, & Suzuki Y. (2021). Influence of national culture on mentoring relationship: a qualitative study of Japanese physician-scientists. BMC Medical Education, 21, 300. https://doi.org/10.1186/s12909-021-02744-2

Sargeant J, Lockyer J, Mann K, Holmboe E, Silver I, Armson H, Driessen E, MacLeod T, Yen W, Ross K, & Power M. (2015). Facilitated Reflective Performance Feedback: Developing an Evidence- and Theory-Based Model That Builds Relationship, Explores Reactions and Content, and Coaches for Performance Change (R2C2). Academic Medicine, 90(12), 1698-1706. https://doi.org/10.1097/ ACM.0000000000000809

*Tomoko Miyoshi
2-5-1 Shikata-cho, Kita-ku,
Okayama, Japan, 700-8558
+81-86-235-7342
Email: tmiyoshi@md.okayama-u.ac.jp

Submitted: 15 March 2022
Accepted: 23 March 2022
Published online: 5 July, TAPS 2022, 7(3), 63-64
https://doi.org/10.29060/TAPS.2022-7-3/LE2777

P Ravi Shankar

IMU Centre for Education, International Medical University, Malaysia

I read with great interest the article titled ‘Humanism in Asian medical education – A scoping review’ (Zhu et al., 2021). The article provides an overview of the teaching of humanism in medical schools in Asia. Teaching humanistic values is still not common among Asian medical schools and the published literature is predominantly from a few countries.

The Himalayan country of Nepal has also taken initiatives to strengthen the learning of humanistic values by medical students.

Initiatives have been conducted at different institutions including KIST Medical College, Lalitpur, Nepal, and Patan Academy of Health Sciences (PAHS), Lalitpur, Nepal among others. I believe that the medical humanities can play an important role in fostering humanistic values among medical students. An overview of the discipline in Nepal was provided in an article published in 2014 (Dhakal et al., 2014). Recently several initiatives are being undertaken at PAHS and the undergraduate medical program at the institution has the objective of creating doctors for rural Nepal.

I do agree that there have been problems with the sustainability of these initiatives in Nepal. The language of medical education in Nepal is English like in many other Asian countries. However, the activities and material used were adapted to the Nepalese context, where possible. The scoping review about humanism in Asian medical education can be made more comprehensive by including the initiatives and publications from Nepal, a country where despite various challenges, initiatives have been undertaken in this important area. These studies do fit into the core characteristics of the Integrity, Excellence, Compassion & Collaboration, Altruism, Respect & Resilience, Empathy, and Service (IECARES) framework used by the authors.

The immediate and short-term impacts of these initiatives have been published and the medium-term impact has been studied and is under review for publication. The challenge with measuring the medium to long-term impact of these initiatives is the possibility of other activities undertaken by the student also influencing the outcomes and introducing bias. A variety of methods have been used to foster teaching-learning of humanistic values. Though there are limitations as mentioned earlier, the addition of these initiatives may add strength and greater representativeness to the scoping review.     

Note on Contributor

Dr Shankar was involved in conceptualising writing, and editing the manuscript.

Funding

No funds, grants, or other support were received.

Declaration of Interest

No conflicts of interest are associated with this paper.

References

Dhakal, A. K., Shankar, P. R., Dhakal, S., Shrestha, D., & Piryani, R. M. (2014). Medical humanities in Nepal: Present scenario. Journal of the Nepal Medical Association, 52(193), 751–754.

Zhu, C. S., Yap, R. K. F., Lim, S. Y. S., Toh, Y. P., & Loh, V. W. K. (2021). Humanism in Asian medical education – A scoping review. The Asia Pacific Scholar, 7(1), 9-20. https://doi.org/10.29060/TAPS.2022-7-1/RA2460

*P Ravi Shankar
International Medical University,
Bukit Jalil, Kuala Lumpur, Malaysia
Email: ravi.dr.shankar@gmail.com

Submitted: 17 September 2021
Accepted: 4 October 2021
Published online: 5 April, TAPS 2022, 7(2), 61-62
https://doi.org/10.29060/TAPS.2022-7-2/LE2691

Gabriela González & Mildred Lopez

Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico

Although there have been many calls for dental education to move to comprehensive training, many have remained in rhetoric. However, recently the strategic analysis of the American Dental Association of Education recommended a curriculum transformation to engage students in life-long learning and nurturing an educational community with well-qualified teachers to mentor students and model the values of the profession (Formicola et al., 2018).

Reimagining dental education demands a curriculum that considers the unique characteristics of learners. The generation to come has grown in a globalised world where information about what is happening in remote geographical places is quickly available, which has shaped their cultural and political points of view. Their idealism and advocacy have marked how they relate to patients. As part of the inherent characteristics, students thrive in experiential learning and rely on the internet and multimedia content. Therefore, incorporating technology is a must for engaging them in meaningful learning activities.

Instead of theory-oriented education, institutions should foster learning environments that depict the immediate community’s health challenges, for example, childhood caries, poor access to dental care, and the increase in the number of people with untreated oral conditions. A starting point is to transition to context-rich educational experiences where students can make a positive social impact. While doing so, they honour their social commitment to patients and families and transform into health advocates.

Additionally, this comprehensive approach needs to nurture a professional that can work within a health system. Dentists that are successful in practice are immersed in a community and have an interdisciplinary approach to deliver quality care. To achieve this competence undergraduates, need more opportunities to develop critical thinking skills, engage in self-assessment of performance, provide, and receive feedback to spark growth, and practice evidence-based decision-making (Kornegay et al., 2021).

Considering the evolution of technologies and the emergence of diseases, it is impossible to think that dental training has not changed. However, the unique profile of the new generation of students demands that we accelerate the change process. Learners have raised to the challenge and have demonstrated their will to positively impact their communities and society. The call for action for educational institutions is to embrace a new vision for a wide comprehensive dental education model where students learn from dental sciences and medicine to advocacy and ethics.

Notes on Contributors

Gabriela Gonzalez prepared first draft; literature review; writing and Mildred Lopez revised the final version of the manuscript. ML wrote and revised the final version of the manuscript.

Funding

There is no funding for this study.

Declaration of Interest

Authors declare no conflict of interest.

References

Formicola, A. J., Bailit, H. L., Weintraub, J. A., Fried, J. L., & Polverini, P. J. (2018). Advancing dental education in the 21st century: Phase 2 report on strategic analysis and recommendations. Journal of Dental Education, 82(10), eS1–eS32. https://doi.org/10.21815/JDE.018.109

Kornegay, E. C., Jackson, T. H., LaGarry‐Cahoon, A., Reside, J. M., Wolcott, M. D., & Quinonez, R. B. (2021). “I don’t think the problem’s the student… I think it’s us”: Engaging faculty in curriculum innovation. Journal of Dental Education, 85(4), 582-588. https://doi.org/10.1002/jdd.12495  

*Gabriela González
Tecnologico de Monterrey,
Escuela de Medicina y Ciencias de la Salud
Av. Morones Prieto 3000 Pte
64710 Monterrey, N.L. México
Tel: 52/81 8888 2254
Email: dra.gabrielaglzl@gmail.com

Submitted: 2 June 2021
Accepted: 21 June 2021
Published online: 4 January, TAPS 2022, 7(1), 115-116
https://doi.org/10.29060/TAPS.2022-7-1/LE2546

Clement Luck Khng Chia¹, Shaun Wen Yang Chan¹, Priscilla Ng² & Chee Chew Yip³

¹Department of General Surgery, Khoo Teck Puat Hospital, Singapore; ²Department of Geriatrics, Khoo Teck Puat Hospital, Singapore; ³Department of Ophthalmology, Khoo Teck Puat Hospital, Singapore

Dear Editor,

Khoo Teck Puat Hospital held its first LOTTE (Learning Oriented Teaching in Transdisciplinary Education) elective program for Yong Loo Lin School of Medicine students in April 2021. The four-week program focuses on undergraduate medical education in an inter-professional collaborative setting through observation and presentation of complex clinical cases. Its teaching-learning activities are underpinned by the Learning Oriented Teaching (LOT) theory (ten Cate et al., 2004) to improve learning at the cognitive, affective and metacognitive levels with shared guidance between students and faculty.

At the cognitive level, students were encouraged to take ownership of learning, do literature review and present cases. Faculty critiqued and helped students to refine learning objectives and identify pertinent clinical aspects for elaboration and learning.

At the affective level, students were motivated to present cases on Zoom videoconferencing to classmates as they learned through active doing and attained peer recognition of their good effort. The teacher highlighted the importance of peer learning through discussing authentic, complex cases that required transdisciplinary holistic patient care.

At an interactive self and peer learning level, students used tools such as the Kahoot! game-based app for peer teaching to optimise learning and increase participation.

With a greying population, there is a need for transdisciplinary education to improve patient outcomes in the geriatric population (Chia et al., 2016). LOTTE provided an introduction to transdisciplinary education and highlighted importance of integrating competencies from various disciplines in preparation for future practice.

The first run of LOTTE consisted of seven transdisciplinary themes. An example of a transdisciplinary theme would be “Palliative Surgery” offered by both a palliative physician and an oncology surgeon. LOTTE differed from traditional “single discipline” electives as it emphasised inter-professional collaboration and collective learning involving the surgeon, physician and students. Students divided their time equally in both subspecialties, attending ward rounds, clinics, operating theatres and home visits. They encapsulated their learnings by presenting real-life complex cases via Zoom in the last week to their peers and faculty. Learning opportunities in two subspecialties were maximised with the student following through the patient journey from ‘Start to Finish’ (Chia et al., 2016).

Medical graduates face an increasingly complex healthcare landscape where management of co-morbidities may be beyond one’s expertise. LOTTE may be helpful to promote transdisciplinary collaboration for holistic management of complex geriatric patients and nurture the development of independent learning in medical undergraduates.

Notes on Contributors

Dr Clement Chia conceptualised and designed LOTTE framework, was a faculty in LOTTE and wrote the manuscript and approved the final version.

Dr Shaun Chan conceptualised and designed LOTTE framework, helped coordinate students, was a faculty in LOTTE and revised and approved the manuscript.

Dr Priscilla Ng conceptualised and designed LOTTE framework, was a faculty in LOTTE, revised and approved the manuscript.

A/Prof Yip Chee Chew conceptualised and designed LOTTE, revised and approved the manuscript.

Acknowledgement

We would like to thank all the transdisciplinary educators who made this inaugural run of LOTTE possible. They include A/Prof Tan Kok Yang, A/Prof Toh Hong Chuen, A/Prof Tavintharan Subramaniam, Dr Desmond Ooi, Dr Tan Mingyuan, Dr Tan Bo Chuan, Dr Ruth Chua, Dr Benjamin Lam, Dr Visnja Baksa Reynolds and Dr Gabriel Cher.

Funding

There is no funding for this study.

Declaration of Interest

Authors declare no conflict of interest.

References

ten Cate, O., Snell, L., Mann, K., & Vermunt, J. (2004). Orienting teaching toward the learning process. Academic Medicine, 79(3), 219-228. https://doi.org/10.1097/00001888-200403000-00005

Chia, C. L. K., Mantoo, S. K., & Tan, K. Y. (2016). ‘Start to finish trans-institutional transdisciplinary care’: A novel approach improves colorectal surgical results in frail elderly patients. Colorectal Disease, 18(1), O43–O50. https://doi.org/10.1111/codi.13166

*Clement Chia
Khoo Teck Puat Hospital,
90 Yishun Central,
Singapore 768828
Department of General Surgery
Tel: +6566022207
Email: chia.clement.lk@ktph.com.sg

Submitted: 1 June 2021
Accepted: 21 June 2021
Published online: 5 October, TAPS 2021, 6(4), 148-149
https://doi.org/10.29060/TAPS.2021-6-4/LE2545

Wai Jia Tam, Divya Hemavathi & Tikki Pang

Yong Loo Lin School of Medicine, National University of Singapore, Singapore

Dear Editor,

Engaging medical students in frontline efforts during the COVID-19 pandemic has varied greatly worldwide (Kachra & Brown, 2020). This paper illustrates policy challenges in student volunteerism, focusing on Singapore. Although Asia often seeks policy guidance from the West, it possesses a unique culture, political climate, regional solidarity, evolution of the disease, and learnings from prior pandemic responses to SARS and MERS, which warrants distinctive guidelines.

Following the spread of COVID-19 in early 2020, many countries, including Singapore, rapidly suspended student involvement in direct patient care activities and converted clinical training to online modes (Kachra & Brown, 2020). However, others like the United Kingdom and University of Toronto provided detailed guidelines and activated processes set-up during past pandemics for interested medical students to volunteer (Kachra & Brown, 2020; Medical Schools Council, 2020).

In Singapore, by June 2020, 95% of the COVID-19 cases were from migrant worker facilities. Medical students were offered reimbursements for help with contact tracing by Ministry of Health. Manpower strains existed, especially when lockdown ended, as healthcare workers returned to their usual duties. This presented an opportunity for medical students to continue with risk communication and community engagement (RCCE) efforts. However, direct medical student involvement was disallowed, until community transmission rates stabilized in April 2021. Even then, students were barred again before volunteer recruitment began, as community cases rose in May 2021.

Scepticism of the value of RCCE, ethical concerns about the safety and uncoerced, voluntary participation of students, political concerns to manage public fear of community spread through medical students, and educational and practical barriers to coordinating medical training with on-ground efforts contributed to the impediment of the mobilization of medical students in frontline efforts at the start of the pandemic.

Clear, evidence-based guidelines may be articulated to overcome these challenges and enable safe and effective deployment of students to provide thoughtfully matched and risk-mitigated help in context during evolving pandemic situations, even in the immediate aftermath of an outbreak. This exposure to global, social and equity dimensions of pandemic impacts helps foster future public health leaders. Given Singapore’s position in the intersection between the East and the West, it can lead such education policy reform in Asia, providing valuable input for policy development regionally and internationally.

Medical education policy is affected by governments, public opinion, international issues, and health policies. Comparative evaluation of medical education policies in Asia, may reveal their influence on health outcomes.

Note on Contributor

Dr. Wai Jia Tam conducted the literature search, conceptualised and drafted the manuscript. Prof. Tikki Pang and Divya Hemavathi critically revised the manuscript for intellectual content. All authors read and approved the final manuscript.

Funding

No funds, grants or other support was received.

Declaration of Interest

The authors have no conflicts of interest to declare that are relevant to the content of the article.

References

Kachra, R., & Brown, A. (2020). The new normal: Medical education during and beyond the COVID-19 pandemic. Canadian Medical Education Journal, 11(6), 167-169. https://dx.doi.org/10.36834%2Fcmej.70317

Medical Schools Council. (2020, March 25). Statement of expectation: Medical student volunteers in the NHS. https://www.medschools.ac.uk/news/msc-issues-statement-of-expectation-for-medical-student-volunteers-in-the-nhs

*Tam Wai Jia
Dean’s Office, Yong Loo Lin School of Medicine,
National University of Singapore,
Level 11, NUHS Tower Block,
1E Kent Ridge Road,
Singapore 119228, Singapore
Tel: +65 9627 3580
Email: waijia@nus.edu.sg

Submitted: 20 April 2020
Accepted: 29 April 2020
Published online: 1 September, TAPS 2020, 5(3), 88
https://doi.org/10.29060/TAPS.2020-5-3/LE2252

Wenqi Chiew

Yong Loo Lin School of Medicine, National University of Singapore, Singapore

Dear Editor,

I read with great interest your editorial “Grit in healthcare education and practice” published on The Asia Pacific Scholar (Dujeepa & Gwee, 2020). I agree that grit is an important trait to develop in healthcare, especially for patient care. In addition to focusing on grit at the institutional level, we could look at it on an individual level. The question henceforth is that–How do we develop or strengthen the grit in ourselves? Angela Duckworth proposed 5 ways to develop grit–pursue what interests you; practice; find purpose; have hope; and join a gritty group (Barker, 2016).  Personally, I feel that finding purpose plays a large role in developing passion and perseverance.

I would like to share this poem that I wrote after my first attempt on blood taking on a patient. Amidst hectic schedules and difficult tasks in medical school, this promise that I made years ago helped kept my passion and perseverance alive.

 

With shaking hands and a sweaty palm

I slide the needle in and try to calm

And I heave a sigh of great relief

As I watch the backflow fill beneath

 

Just minutes before, my mentor had asked

“Do you mind if my student try this task?”

With trusting eyes and a reassuring grin,

The patient said, “go ahead, do your thing.”

 

The trust that you have given to me

Even though I may now be unworthy

Inspires me and greatly spurs me on

To be a better doctor hereupon.

Notes on Contributors

Wenqi Chiew is listed as the first author and she wrote this paper.

Funding

There is no funding provided.

Declaration of Interest

There is no conflict of interest, including financial, consultant, institutional or otherwise for the author.

References

Barker, E. (2016). This is how to increase grit, according to research. Retrieved from TIME, https://time.com/4323260/how-to-increase-grit-perseverance/

Dujeepa, D. S., & Gwee, M. C. E. (2020). Grit in healthcare education and practice. The Asia Pacific Scholar, 5(1), 1-2. https://doi.org/10.29060/TAPS.2020-5-1/EV5N1

*Wenqi Chiew
Yong Loo Lin School of Medicine,
1E Kent Ridge Road,
National University of Singapore,
Singapore 119228
Email: wenqi@u.nus.edu

I read with great interest Samarasekera and Gwee’s article in TAPS (January, 2020) entitled: “Grit in healthcare education practice”. The authors cited Duckworth’s seminal studies on grit and its strong correlation with success. The authors suggested that grit be used to select for medical students and for healthcare systems to adopt organisational grit. I applaud the authors’ call for implementing organisational grit in healthcare. This is a step forward in working out the multiple issues plaguing healthcare. Interestingly, the call to implement organisational grit might not make it necessary to select for grit upon medical school admission.

Duckworth had posited that the mere assembly of gritty individuals might not necessarily create a gritty organisation (Duckworth, 2016). Students who test as gritty upon admission might be gritty in a different context than that of a medical school. Medical school has its own specific set of challenges which are not shared in many other pre-medical school experience. Hence, students who type as gritty on a medical school entry exam might not remain gritty in medical school.

Grit needs to be developed as a team within an organisation with a shared goal (Duckworth, 2016; Lee & Duckworth, 2018). This development starts with assembling a group of individuals with similar interests. These individuals are then encouraged to work together with chances to carry out deliberate practice and constant reminders of their shared purpose. This group should be even encouraged to fail and learn from those failures. This group will then develop grit as a unit (Duckworth, 2016).

Creating an environment which is demanding yet nurturing is key in promoting grit (Lee & Duckworth, 2018). Team-based or problem-based learning provides a conducive setting for such an environment to thrive in medical school. Students are grouped in teams and are faced with demanding challenges which would force them to work together over an extended period of time. These students are allowed to fail and learn from their mistakes. Over time, the team develops grit.

The formation of a culture which promotes and breeds grit within an organisation would be a stronger force to withstand the demanding challenges of healthcare than just a selection of gritty individuals. Structural changes in healthcare to allow for organisational grit to take root should be undertaken. Increased reports of physician burnout necessitate that healthcare workers be given support. Organisational grit would give healthcare workers the support they require.

Note on Contributor

Muhammad Raihan Jumat, PhD, is an Education Fellow in the Office of Educaiton at Duke-NUS Medical School. The author conceived the idea and wrote this letter.

Acknowledgements

The author would like to thank Professors Scott Compton and Sandy Cook for their advice and encouragement in writing this letter.

Funding

No funding was involved in this letter.

Declaration of Interest

The author does not have any competing interests.

References

Duckworth, A. (2016). Grit: The power of passion and perseverance (First Scribner hardcover ed.). New York, NY: Scribner.

Lee, T. H. & Duckworth, A. L. (2018). Organizational grit. Retrieved from Harvard Business Review, https://hbr.org/2018/09/organizationalgrit

*Muhammad Raihan Jumat
Office of Education,
Duke-NUS Medical School,
8 College Road,
Singapore 169857
Tel: +6 56516 4771
E-mail: raihan.jumat@duke-nus.edu.sg

Published online: 2 May, TAPS 2017, 2(2), 34-35
DOI: https://doi.org/10.29060/TAPS.2017-2-2/LE1043

Siti Rohaiza Ahmad

PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Brunei Darussalam

I. INTRODUCTION

I am an educator in a local university keen on exploring different types of teaching methods, including collaborative activity in class. I have explored several approaches of collaborative activity and here, I would like to reflect on my experience. First and foremost, as usual, I will prepare for a lecture that takes about 30 to 45 minutes depending on the topic. For most of my class, I like to integrate my teaching with interactive or collaborative activity such as a brainstorming activity. The aim of the brainstorming activity is to explore the student’s current level of understanding of certain topic and also an opportunity to explore their creativity and ideas. In order to facilitate a more effective brainstorming activity, before the class, I also provide the students with some reading exercises or learning questions. This will help the students prepare themselves with some prior knowledge before coming to the class. I have discovered that, such brainstorming activity encourages the students to do prior learning and will helps to facilitate a more effective and collaborative class discussion.

II. TYPES OF BRAINSTORMING ACTIVITIES

One of the traditional methods of brainstorming activities is by directly asking the students questions during class time. In this process, I normally give a chance for any students to volunteer by scanning around the students in the classroom. Most of the time, normally, the active ones were the one who normally volunteers. I realize that by doing this process, I only manage to get a couple of ideas from the whole lot of students. Sometimes, I do call up names to ask for their opinion but this does not gives everyone the opportunity to say their thoughts and ideas.

In one of my class, I have also used sticky post-it brainstorming method. I find that this activity is useful when the class size is big (more than 50 students). The students tend to come up with different ideas and then my job is to pull them together into several categories, wherever possible. Most of the time, the students were able to identify the important points. But I also found that, their ideas tend to be a bit narrow, if no learning questions or reading homework were given before the brainstorming activity. The issue with this activity is that, we need a lot of post-it and also the students are not able to keep a permanent record of what has been written in their post-it. Nevertheless, I find that this particular method is still quite effective as it encourages the students to think in-depth about a certain topic and it also gives every single student a chance to voice out their opinion.

Another brainstorming tool that I have utilized is using an e-learning tool called Padlet. Padlet is available freely online. The incorporation of an e-learning tool such as Padlet encourages student’s interaction among their peers and myself, as their lecturer. One of the benefits of such tool encourages the quieter students to gives out their opinion or ideas.  This is because in most of the case, when question were asked verbally, only one or two of the usual students will volunteer to answer the questions. To make the discussion more effective, I find that encouraging them to talk among themselves in smaller groups of 3 to 4 students able them to discuss and then jot down variety of ideas together. Some time is given for the students to think about their ideas, normally about five to ten minutes, depending on the question. One of the handy features of Padlet is that, at the end of the session, I am able to organize their answers and saved them as pdf copy or image version to be shared to the whole class. The outcome of their brainstorming session can be projected onto the screen and discussed further.

Apart from that, I also like to conduct brainstorming activity at the very end of the class, asking the students general questions regarding what they have learnt so far. In order to use e-learning tool such as Padlet, however, a good Wi-Fi connection and computers is required throughout the session. However, unstable internet connections may not be much of a trouble because nowadays, most of the university students have mobile phone. Padlet is accessible via mobile phones as well. However, as a back-up plan, when utilizing any e-learning tools, I suggest to prepare some sticky post-it, just in case there is problem with the Wi-Fi connection during the session.

III. CONCLUSIONS

Therefore, student’s interaction is very important; I always encourage the students to conduct brainstorming in class, which will help improve their communication and collaborative skills among their peers and the lecturer. Furthermore, in the past decade, the advancement of Information Technology (IT) is taking place very rapidly. In-line with this, I do believe that educators should take advantage of the various tools to stimulate their traditional classroom teaching. In conclusion, I found that the incorporation of brainstorming activity during class encourages the students to express and crafts their thoughts and ideas more effectively and this can be achieved with the help of various learning tools such as post-it or e-learning tool such as Padlet.

Declaration of Interest

The author declares no competing interests.

*Siti Rohaiza Ahmad
PAPRSB Institute of Health Sciences
Universiti Brunei Darussalam
Jalan Tungku Link, BE1410
Brunei Darussalam
Tel: +673 2463001 ext 2243
Fax: +673 2461081
Email: Rohaiza.ahmad@ubd.edu.bn