Academia - Pushing forth the boundaries by Singapore General Hospital

SINGHEALTH – TOMORROW’S MEDICINE STARTS HERE

thesundaytimes July 28, 2013

Pushing forth the boundaries The new building Academia offers a more conducive environment for greater synergies in pathology, medical research and education to raise the benchmarks for better healthcare The bigger capacity for research at Academia not only allows the sharing of space and equipment, it will also further fuel the exchange of knowledge and ideas. This will advance our research collaborations with universities, government agencies and industry integrating activities from basic to translational and clinical research.

Ahmad Osman DEFINING tomorrow’s medicine is the vision for SingHealth and the new iconic Academia building at Singapore General Hospital (SGH) campus. This will be achieved through excellent and innovative clinical care, new knowledge from research and dedicated training to build a highly skilled and compassionate health-care workforce with each generation exceeding the earlier one, says SingHealth group chief executive officer, Professor Ivy Ng (left). Costing $360 million, the 13-storey twin towers building with total floor area of 75,000sq m is the new home for the SGH Department of Pathology and SingHealth’s research, education and training facilities. Located within the vicinity of clinical services at SGH campus and Duke-NUS Graduate Medical School, Academia is a key milestone in academic medicine with a vibrant environment for networking and professional collaborations to advance the diagnosis, treatment and innovative care for patients. The school is SingHealth’s key partner in academic medicine. Its dean, Professor Ranga Krishnan, says: “The partnership is envisioned as an integrated working enterprise that guides and promotes the future of medicine, tapping on and combining the collective strengths of SingHealth’s clinical expertise and Duke-NUS biomedical sciences research and medical education capabilities.” Planning for Academia, which was opened on July 20, was originally prompted by the need to build capacity for the SGH Department of Pathology and integrate the latest technology into laboratory processes to further enhance test and diagnostic accuracy and reliability. This is in line with the Ministry of Health’s health-care infrastructure plan to meet the projected population growth.

PHOTOS: CHONG JUN LIANG,SINGHEALTH

— Professor Ivy Ng, group chief executive officer, SingHealth

As planning progressed, it became apparent that the building, jointly funded by the ministry and SingHealth, presented an excellent opportunity to create an environment to harness greater synergies from the convergence of pathology, medical research and education to set new benchmarks to achieve better outcomes for patients. It is the only building in the SingHealth cluster built specifically with its vision as a central theme, Prof Ng says, adding that expanded and improved pathology services will impact every area of patient care including better and earlier diagnostics and more specific information to guide treatment and enhanced prognostication. Academia’s state-of-the-art education facilities include simulation programmes, wet and dry laboratories, operating theatres, centralised and specialised research facilities. It is the location of SingHealth’s Translational Immunology and Inflammation Centre, Tissue Repository, the Advanced Molecular Pathology Laboratory and a collaboration with the A*Star (Agency for Science, Technology and Research) Genome Institute of Singapore to study individualised or stratified medicine. “We aim to improve the lives of our patients,” Prof Ng says. “Research must be done with the aim of better care for our patients. Education is pursued so that we can have better trained and more skilled health-care professionals.” Location of research entities in Academia, Prof Ng notes, will enhance effective and cross-functional

collaborations critical for research. Proximity of research facilities to the clinical care areas has been shown to significantly improve the output of clinically impactful projects, she says. She adds: “The bigger capacity for research at Academia not only allows the sharing of space and equipment, it will also further fuel the exchange of knowledge and ideas. “This will advance our research collaborations with universities, government agencies and industry integrating activities from basic to translational and clinical research. “On the education front, health-care staff will have access to more team-based training in simulated environments to hone their clinical, surgical, nursing care and life support skills. “Education labs at Academia will be test beds for the development of new curriculum and teaching methodology using the latest technology.” Space in Academia’s Diagnostics Tower is 75 per cent more than the former premises of SGH Department of Pathology, which will increase its capacity for pathology services by over 50 per cent. The department’s annual workload grew by an average of 6.4 per cent since 2008 and it handled close to 12 million investigations last year. An ageing population and the emergence of new diseases will drive continuing clinical demand for SGH pathology laboratory tests. It has the most comprehensive range of test menus and is the referral centre for many special-

ised tests and second opinion consultations for Singapore and other parts of the region. Academia’s Discovery Tower for SingHealth’s research, education and training facilities has 42 research groups from various specialties. This will help to build the critical mass, synergies and complementarities to transform SGH campus into a vibrant and holistic medical hub. Controlled and realistic team-based training is provided through a simulated patient ward, operating theatre, intensive care unit, specialist outpatient clinics and an emergency area resembling a mini hospital. Expanded facilities in Discovery Tower are expected to provide 35,500 annual training places for SingHealth staff and other people from external organisations. Academia is the first phase of SingHealth’s infrastructure development plan to meet the growing health-care needs of Singapore’s population. The new National Heart Centre Singapore building will be opened next year. By 2018, Sengkang General Hospital with an attached community hospital will commence operations. This will be followed by the opening of a community hospital at SGH campus in 2020. Prof Ng says the aim of these new SingHealth facilities together with SGH, KK Women’s and Children’s Hospital, five national specialty centres and SingHealth polyclinics is to seamlessly integrate patient centric primary, acute, intermediate and long-term care.

SINGHEALTH – TOMORROW’S MEDICINE STARTS HERE

It’s all for the patients Bigger space, up-to-date equipment and integrated operations will improve the performance of SGH’s Pathology Department Suki Lor STAFF at the Singapore General Hospital’s (SGH) Pathology Department now have a much more spacious and conducive work environment with the latest technology to do their job better to benefit the thousands of patients they serve each year. The department, which used to operate from different premises, can finally bring all its staff under one roof at the Diagnostics Tower, one of the twin blocks comprising the recently opened Academia at the SGH campus. This has been a definite boon for the department, says its head of department Associate Professor Tan Puay Hoon. Occupying the top seven floors in the new tower, the department’s laboratory space is nearly double what it used to be, enabling the installation of the most up-to-date equipment to further improve test accuracy and turnaround time. With 471 staff, SGH’s pathology department is the largest in Singapore. “Being at multiple sites required duplication of resources with logistical challenges. Relocating the laboratories within pathology into a single consolidated facility allows workflow reengineering, right-sizing of laboratory space requirements and sharing of resources while promoting staff interaction,” Dr Tan says. “Being at Academia allows us to be more efficient with the incorporation of new automated processes that were not possible with the previous limited space and infrastructure. We will be able to implement novel technology such as digital pathology, improved safety for biosafety level 3 laboratories and provide a more conducive environment for staff to continue to give their best to our patients,” she adds. The department’s biosafety level 3 labs handle certain infectious agents including mycobacteria and viruses. “Now we have the ability to put in the best equipment to handle the volumes and to further improve turnaround time. All these are for the improvement of patient services,” Dr Tan says. Test volumes have burgeoned over the years.

Backbone of medicine

Academic pathology At Academia, the department is in a better position to expand its role in academic pathology encompassing clinical practice, research and education. “Our department offers the most comprehensive range of tests to serve patient needs. It has also been and continues to be a major training facility for the next generation of pathologists and medical technologists. The move to Academia has improved the educational environment for this purpose,” Dr Tan

Working with bacteria Narendra Aggarwal

says. She is keen to groom the next generation of pathologists, but as they typically function behind the scenes, the low profile can make it a challenge to attract young doctors to the discipline. While she has spent 24 years with the department, starting as a trainee, she has lost none of her passion for pathology, which she describes as an invigorating discipline that is “very forward, very cutting edge”. “We require quite a number of pathologists over the next few years to fulfil our requirements not just for practice but also for education and research. Singapore is building more hospitals and every hospital will need a pathology department. We foresee that nationally pathology will be a critical area that we will need to plan for,” Dr Tan says.

Key diagnostic hub in laboratory work The new state-of-the-art pathology labs at Academia speed up and enhance the diagnostic processes and patient care at Singapore General Hospital AJ Leow A VISITOR entering the eight floor of the new Diagnostics Tower at Academia can easily mistake it for a high-tech manufacturing facility especially when confronted with an array of consoles linked by a circuitous, mini-conveyor belt similar to that in some sushi outlets — except that the multi-track line carries individually tagged test-tubes and is monitored by technicians in long white lab coats looking into computer screens. Most of these samples of body fluids — mostly blood but also urine and spinal fluids — have been sent to the biochemistry lab via an “underground” pneumatic-powered network of tubes from other sectors of the hospital. Covering an area of 1,200sq m, the main clinical biochemistry lab at the Department of Pathology which is augmented by smaller, specialised labs at different levels is a key diagnostic hub at the Singapore General Hospital (SGH). Backed by 80 clinical research and technical personnel and the largest of its kind in Singapore, the labs carry out tests of mainly blood and tissue samples, not only within SGH but also those from SingHealth polyclinics and some private clinics. The labs perform some 8.8 million tests last year. These range from the automated routine analysis to determine, for example, patients’ blood sugar and cholesterol levels with results available within two to four hours to highly specialised examinations of cells, chromosomes, tumour tissues at molecular levels or monitoring of therapeutic drugs to help doctors with their prognosis and treatment of diseases and ailments. The latter, for example, is used to determine what dosages of immunosuppressant drugs are needed to prevent organ rejection in transplant patients. Dr Yeo Chin Pin, head of Clinical Biochemistry who oversees the running of the lab, compared the dual-tier set-up to a TV channel which caters to a general audience and cable channels with more specialised programming such as foreign language offerings. She says: “The bulk of the routine tests — more than 2,000 a day — have been automated so that our staff can be redeployed to handle the growing clinical demand for more specific or elaborate laboratory investigations.” She adds that the higher capacity of the new 24/7 automatic systems also translates into greater cost-efficiency and turnaround time. “The downtime is reduced. For example, we have now three blood centrifuges — probably the most for such a centre in the region — with one more to be installed later. This allows us to continue to function at optimal levels even if one of them is being serviced. It enables us to take on heavier workloads which are expected to increase at a rate of 5 to 7 per cent per year,” Dr Yeo says.

July 28, 2013

Tests to detect a wide range of infections are done in a safe environment where the hazards are minimised

The department, which has a 110-year history, handled close to 12 million investigations last year, up 7 per cent from the previous year.

Apart from serving the patients of SGH and the various institutions such as the National Cancer Centre, the National Heart Centre, the Singapore National Eye Centre and the National Dental Centre, the pathology department also receives consults from other institutions and clinics. It also provides laboratory services to SingHealth Polyclinics. As pathologists work behind the scenes, the public and patients may be unaware of the critical role that they play in the treatment and management of diseases. “Pathology is the foundation of medicine. It is the basis for the diagnosis of disease. Clinicians managing patients use laboratory investigations carried out in the pathology department to confirm diagnosis, predict disease behaviour and help in deciding therapy. For instance, all patients who are being treated for cancer require a pathologist to confirm the diagnosis of the type of cancer before appropriate treatment can begin,” Dr Tan says. Apart from tissue diagnosis for cancer, the department also conducts blood investigations to detect conditions such as diabetes and heart disease, while its microbiologists work to detect infections by agents such as bacteria and viruses.

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A HOST of new labs with state-of-the-art facilities and equipment in Academia promises to take health-care delivery to greater heights in Singapore. They have been built to international standards to provide staff a safe working environment. Among them is the molecular laboratory of the Singapore General Hospital (SGH). It is a key component of the health-care system as it does tests to detect a wide range of infections. The lab helped in the investigations of the Sars outbreak in 2003 and the influenza H1N1 pandemic in 2009, among other such incidents, as it is involved in surveillance work for specific viral infections for the Ministry of Health. Dr Lynette Oon, senior consultant at the molecular lab, says that as the new lab has been designed with many new safety features and is more spacious, it provides a much better environment for the staff to work in. “For instance, the bio safety cabinets provide enclosed box-like space for staff to do open work on samples,” she says. The space for such safe work has been doubled and this will ensure that staff do not bump into each other. The molecular lab, with 16 staff, has a wide menu of infectious disease diagnostic tests and together with histopathology, it incorporates oncologic applications for increasingly individualised cancer treatment. It can also measure the level of the infection as it does molecular tests for monitoring of viral loads for treatment purposes, detection of mutations and genotyping of viruses. Dr Oon says that the lab is equipped to handle samples covering a wide range of viruses including hepatitis, HIV, influenza and dengue, which has been a problem this year. Often, when a specimen is sent to the lab to look for a particular virus or target, the result can be provided within a day. On the other hand, if a person has a chest inflection,

Having the new Academia building allowed us to rethink and redesign our labs with safety in mind. With the experience accumulated over the years, we have incorporated engineering safeguards into our news labs. — Dr James Sim, associate consultant, Microbiology

the lab has a kit that does 16 tests on the same sample. Dr Oon says that with more space available, new technologies will be added to strengthen and speed up its work for better turnaround time for providing results.

Safety first In view of the importance of a safe working environment, there is a pathology laboratories safety committee, which is chaired by Dr James Sim, associate consultant, Microbiology. “The key challenge for pathology is the wide variety of hazards we encounter in our daily work due to the extensive range of services we offer — physical, chemical, biological and ergonomics,’’ he says.

For instance, the number of chemicals handled by the pathology labs can be much more than other industries, even though they are in smaller quantities. Dr Sim and his safety committee members look into the risks of using these chemicals and ways to mitigate them. “Having the new Academia building allowed us to rethink and redesign our labs with safety in mind. With the experience accumulated over the years, we have incorporated engineering safeguards into our news labs,’’ says Dr Sim. Examples include better air handling in the labs, dedicated rooms and cabinets for storage of chemicals and enhanced ergonomic features. The new central tuberculosis (TB) lab housed in Academia is almost twice the size of the previous

one. This enables better compliance with recommended bio-safety practices and regulatory requirements through facility design and workflow. The lab gets over 55,000 samples for various diagnostic tests every year. About 150 clinical samples are processed every day in the high-containment lab for TB cultures. The lab plays a critical role in the diagnosis of TB and other mycobacterial diseases in Singapore and the region. Dr Sng Li-Hwei, senior consultant at the central TB lab says the work emphasis is on increasing staff proficiency and efficiency, improving staff safety, reducing turnaround times, improving the integration between the clinician, labs and TB controllers, and providing high-quality, cost-effective services.

We are now integrated at one site, which means that there is greater proximity for fellow consultants to get together for discussions. That helps to speed up the diagnostic process and deliver faster and better patient outcomes. — Dr Rafay Azhar, senior consultant for Histopathology

a mobile phone from the operating theatre to one of our consultants,” he says. And unlike slide specimens that are likely to deteriorate with time, digital images are easier to store and are a great repository for students, says Dr Tan Yong Cheng, a registrar for the department. “In the past, only one or two students had access to a specific slide at a time with a double-barrel microscope. With the image archival technology we have now, anyone can have access at anytime. This certainly helps to speed up the learning process.”

SGH’s cancer detectives Dr Yeo (right, with Ms Wong Sau Yeng) says that more than 2,000 routine tests have been automated so staff can be redeployed to more specific laboratory investigations.

The bulk of the routine tests — more than 2,000 a day — have been automated so that our staff can be redeployed to handle the growing clinical demand for more specific or elaborate laboratory investigations. — Dr Yeo Chin Pin, head of Clinical Biochemistry

The new and more spacious lab settings also enable the pathologists and trainees to work side byside in a more conducive and educationally enriching environment, she adds.

Better ergonomics and workflows For Dr Rafay Azhar, senior consultant for Histopathology, which is the study of diseased tissues, the advantage of the new labs is better workflow and improved ergonomics as well as a more spacious environment for his staff of 20. “We are now integrated at one site, which means that there is greater proximity for fellow consultants to get together for discussions. That helps to speed up the diagnostic process and deliver faster and better patient outcomes,” he says.

He adds that the new workstations for trimming tissues come with voice-activated systems — such as turning on taps as well as backend transcription to replace handwritten notes — which allow the clinical histopathologist to concentrate on the job of handling tissue specimens. The workstations have been doubled from three to six, cutting down the queue time to extricate tissue samples. The histopathology lab currently handles samples from 40,000 local patients annually or 60 per cent of the case loads in Singapore. These translate into about 300 slides from approximately 20 cases each day, most of them from cancer patients and including pap smears. The number of slides per case can range from one to 70. The samples are sliced and placed onto slides for scanning, which in the past was examined under a microscope and pictures taken with a camera. But with the latest equipment, the scanning is now automated and more uniform in terms of magnification and is faster as well as more accurate in looking out for cancerous cells. The lab’s newest auto-loading scanner, for example, is able to complete a scan of dozens of slides in two minutes instead of the previous 20 minutes. The use of such technology in digital histopathology, says Dr Azhar, means that not only can the results be obtained more quickly, but the easier transfer of images also allows physicians to get a second opinion in a shorter time. “You can now have an online conversation with an overseas expert with both looking at the same multiple images onscreen; or have images sent via

Like their counterparts in histopathology, the bulk of the workload for the clinical scientists at SGH’s cytogenetics lab involves tracking signs of cancer, except that it is done through investigation of human genes. The cytogenetics sleuths usually look into bone marrow, blood or lymph node specimens for signs of abnormalities in the chromosomes. As Dr Alvin Lim, deputy head of the Cytogenetics Laboratory explains, cytogenetics is the study of

Dr Azhar (right), pictured with Dr Tan, says that the use of technology in digital histopathology means results can be obtained faster and images are easily transferred to allow physicians to get a second opinion in a shorter time.

the structure of chromosomes at the cellular level to determine whether the DNA arrangement or sequence has been disrupted or deviated, leaving markers or signs of cancerous activities in the body. In some ways, he explains that the detection method is like face recognition software except that it deploys fluorescent dyes to probe the genome and observe if there is a gain or loss in the DNA genes. “What we do is to look out for the tumour suppressant genes or oncogenes — the good and bad guys — and see who is winning.” Dr Lim adds: “Cytogenetics can be a prognostic tool which informs the doctor if he should treat a patient conservatively without the need for

chemotherapy which can have strong side effects, especially in the case of children; or if the illness is at an advanced stage and needs to be treated aggressively.” At SGH, the bulk of work done at its cytogenetics laboratory or about 4,000 cases a year is focused on detection, diagnosis and treatment for leukaemia and lymphoma. With the new and more automated set-up, turnaround time is now faster. Bone marrow tests which used to take up to 21 days now take 10 and may be reduced further to eight or nine days. “We are letting the machines take over the more laborious and mundane tasks so that the scientists are freed to carry out more in-depth investigations as well as collaborative and research work with other institutes to find even better ways for detection and treatment,” says Dr Lim. He adds that efficiency has since doubled by 30 to 100 per cent depending on complexity of the cases and his staff are now able to look into four to five cases a day compared to two to three previously.

We are letting the machines take over the more laborious and mundane tasks so that the scientists are freed to carry out more in-depth investigations as well as collaborative and research work with other institutes to find even better ways for detection and treatment. The bulk of the work done at the cytogenetics lab is focused on detection, diagnosis and treatment for leukaemia. From left: Ms Teng Li Min, Dr Lim (standing) and Dr Chen Chuanfei. PHOTOS: CHONG JUN LIANG

— Dr Alvin Lim, deputy head of the Cytogenetics Laboratory

SINGHEALTH – TOMORROW’S MEDICINE STARTS HERE

thesundaytimes July 28, 2013

Fighting diseases

Medical ‘twin towers’

Research work in Academia will help to combat the superbugs and develop new antibiotics

Academia will nurture the next generation of doctors and offer researchers a stimulating environment to improve diagnosis and treatments Suresh Nair

Narendra Aggarwal SINGAPORE General Hospital’s (SGH) well-equipped pathology department is actively focused on research to help support diagnosis of diseases. Key among these areas is antibiotic resistance and infectious diseases research. The new strains of antibiotic resistant bacteria, commonly known as the superbugs, is under the microscope of Associate Professor Koh Tse Hsien, senior consultant, Diagnostic Bacteriology, Department of Pathology in SGH. Singapore became the second country in the world after Japan to isolate the superbug bacteria in 1996. “These carbapenemase-producing bacteria are known as superbugs because they are resistant to almost all antibiotics,” says Prof Koh. There has been mixed success in controlling the spread of the superbugs. There is now a National Public Health Laboratory that provides reference services to detect superbugs and the Ministry of Health has recently formalised a national antimicrobial resistance surveillance system. “Whereas in the past we could usually link a superbug to a patient with foreign travel, we are now increasingly isolating superbugs from patients with no history of overseas travel. This tells us that superbugs are spreading locally,’’ says Prof Koh. He collaborates with the infectious disease pharmacists and physicians who are trying to optimise the treatment for patients infected with superbugs. “Hopefully one day this will lead to antibiotic treatment that can be tailored to the specific bacteria causing the infection. Because we have a collection of superbugs, developers of diagnostic kits and pharmaceutical companies are also interested to access our bacteria strains.” Looking ahead, the public stands to benefit from the antibiotic resistance research as it helps identify and define a problem. Others then use this information to try and find solutions to solve the problem. For instance, the drug companies will be encouraged to develop new antibiotics. “The end result is either the risk of the common man getting infected with a superbug is diminished or if they do get infected, they can be properly treated,” says Prof Koh.

Speeding up research

An exciting new development in SGH’s pathology department is the Translational Pathology Centre (TPC), set up in November last year. It provides a common platform for doctors and researchers with the aim of speeding up delivery of research findings for patient care.

From left: Prof Lim, Dr Iqbal and Prof Koh. SGH’s pathology department is focused on research to help diagnosis and in particular, antibiotic resistance and infectious disease research. PHOTOS: CHONG JUN LIANG

The end result is either the risk of the common man getting infected with a superbug is diminished or if they do get infected, they can be properly treated. — Associate Professor Koh Tse Hsien, senior consultant, Diagnostic Bacteriology, Department of Pathology in SGH

Its role is to “set up a translational platform for clinicians and researchers to use a fully accredited lab set-up for tests which can be used to recruit and allocate patients into trials”, says Associate Professor Tony Lim, senior consultant, Histopathology. New advances in technology and research discoveries made can be validated in a clinical laboratory, provide opportunities for collaboration and make an impact on patient care. Prof Lim says: “We provide early phase trial support and offer a validation programme in the initial period for tests and treatments which may benefit patients.” While TPC is a common platform for SingHealth, a national-level platform has been set up under the name Polaris (Personalised OMIC Lattice for Advanced Research and Improving Stratification). “Polaris will leverage A*Star’s scientific capabilities to identify new biomarkers and technologies that can predict how patients would respond to medical treat-

ment, as well as how their disease would progress,” says Prof Lim. Polaris will work with leading Singapore clinicians to modify existing clinical care methods and refine stratified healthcare delivery approaches. It will bring cutting-edge science beyond a research setting and directly into patient care. This translates to better patient outcomes for treating individuals afflicted by cancer and chronic disease, based on their genetic and molecular biology profile. Polaris will help to improve patients’ response to personalised medicine. This is because patients with diseases such as cancer, heart disease, and diabetes who present similar clinical features may differ at the genetic or molecular level. “These patients experience different disease progression, and respond differently to the same treatment. By stratifying patients before treatment, specific therapies can be allocated to those patient subgroups that are best predicted to respond

well to the treatment, thus leading to better patient outcomes,’’ says Prof Lim. Polaris fills a critical gap in translational and clinical research in Singapore: It stratifies patients for effective and targeted treatment through the combination of scientific and clinical information specific to each individual. “Polaris is an integrated programme involving scientists and clinicians that seeks to identify and validate novel biomarkers for specific diseases, which will in turn support clinical decision-making on what treatment will benefit a patient most — in other words, match the right patient to the right drug,” says Prof Lim.

Breast cancer

Interesting disease-focused research work on breast cancer, which is common in Singapore, is being done by Dr Jabed Iqbal, senior consultant, Histopathology, Department of Pathology, SGH. He says that phyllodes tumour, which is a fibroepithelial tumour, is quite commonly diagnosed in Singapore women, and more common in Asians than in the west. It has propensity of recurrence, treatment options being limited in the malignant variety. “Our group has been working on this tumour and has recently developed a recurrence risk calculator after surgery. Scientists at National Cancer Centre Singa-

Peering through the microscope Professionals in the field of pathology are the unsung heroes who ensure that patients get the right treatment Gloria Chan IF YOU are a fan of crime movies and TV shows, you may associate pathology with images of dead bodies and people in lab coats investigating the cause of death in cases where foul play is suspected. But this area is only one aspect of pathology. Sometimes referred to as the “foundation of medicine”, pathology is a combination of basic science and clinical medicine through which critical decisions on patient management are made. It is integral in the diagnosis of every cancer. There are times when the doctors are unable to make a diagnosis based on clinical assessment and radiology investigations. This is when they need to do a tissue biopsy for histology, which is the microscopic study of the structure of the biological tissues to arrive at a definitive diagnosis. Histopathology is the speciality in medicine that studies human tissues in diseased states. Dr Timothy Tay, 29, who is a thirdyear resident specialising in pathology finds this aspect of medicine “interesting and challenging.” He likes peering through the microscope and studying tissue samples to investigate the cause or severity of the disease, or monitor its progress or the effects of treatment. He says: “We may be working behind the scenes, but it is as gratifying because what we do has an impact on the patients. If we make a wrong diagnosis, then the patient will not get the right treatment. This is why we demand highly of ourselves to get the diagnosis right.

Ms Soo and Dr Tay (right) are integral in ensuring that tests are carried out accurately and on time, and the right diagnoses are made. PHOTOS: CHONG JUN LIANG

“On occasions, the doctor operating on a patient will send tissues for testing and he needs to have the result as soon as possible while the patient is still under anaesthesia to decide on the next step to take. For example, if the tissue is found to be cancerous, the doctor will continue to remove the diseased organ from which the tissues are taken. “It can get quite intensive because

we’re under pressure to give our assessment of whether a tumour is benign or malignant in the shortest possible timeframe,” says Dr Tay. Apart from the doctors, medical technologists like Ms Soo Huey Fen are among the allied health professionals working in the lab to make sure that the tests are carried out correctly, efficiently and quickly. The Clinical Biochemistry

Laboratory in the Singapore General Hospital (SGH) which handles more than 3,000 samples a day. The laboratory is operational round-the-clock. Ms Soo, 26, graduated with a degree in biomedical science from the National University of Singapore. She has been working in SGH Department of Pathology for about three years. Patient safety is a top priority for her. “Although much of the analytical process is now automated, there is stringent quality control to make sure that the test results are not only reported quickly, but more importantly, also accurately,” says Ms Soo. She explains: “The sooner we are able to get the results back to the doctor, the sooner the doctors are able to start treating the patients.” And it is not always as straightforward. Assessment of quality control reports and patient test results — normal and abnormal — are not automated processes and requires the medical technologists to be well trained and vigilant. “We may not be in direct contact with patients, but we empathise with them. You need to feel the compassion so that you’ll be more vigilant. The correct results reported in a timely manner will ensure that the patients get the right treatment quickly,” says Ms Soo.

pore (NCCS) have cultured malignant phyllodes tumour cells into viable cell lines which will help us to test drugs specifically targeted towards this tumour. His team is studying triple negative breast cancer (TNBC), which occurs in about 10 to 20 per cent of diagnosed breast cancers and is more likely to affect younger people and/or those with a certain gene mutation. It lacks expression of certain biomarkers which are normally measured in breast cancer to plan proper management. Since the tumour cells lack the necessary receptors, common treatments like hormone therapy and drugs that target estrogen and progesterone, and HER-2 are not effective. Patients with TNBC have a significantly increased risk of relapse and shorter survival rate than patients affected with tumours of other subtypes. Although TNBC accounts for a relatively small proportion of breast cancer cases, it is responsible for a disproportionate number of breast cancer deaths. Additionally, a lower proportion of TNBC are discovered by breast screening, possibly due partly to the age distribution of these patients. Dr Iqbal says that using chemotherapy to treat TNBC is still an effective option and that TNBC responds better to chemotherapy in the earlier stages than other forms of cancer. These tumours are usually treated with some combination of surgery, radiation and chemotherapy.

ACADEMIC medical science will take a quantum leap with Academia. “Academia will help us nurture the next generation of doctors more effectively,” says Professor Soo Khee Chee, deputy group chief executive officer, Research and Education, SingHealth, and director of National Cancer Centre Singapore. A first in Singapore medical history, Academia will boost capacity for pathology, research and education to meet projected growth and clinical demand. Its design and infrastructure will change the way collaborative research and academic work aimed at improving health-care delivery, are performed. “Currently, the challenge in medical education is the ratio of people, space and patients to the number of students. The growing number of medical students each year, from 150 to 500, could lead to a degradation of medical education,” he adds. “To prevent this, we have to find creative ways of delivering education and teaching. Academia has the right infrastructure such as bedside learning, simulation and virtual learning to equip medical students with the skills-set that prepares them for clinical practice. “For research, Academia is a co-location of basic and translational scientists with clinicians. This leads to the sharing of resources, equipment, space and most importantly, ideas necessary to advance research for better patient care.”

Patients benefit

The real winners will be Singaporeans because Academia will offer a vibrant and stimulating environment where research, scholarly work

Prof Albani

thology; and Discovery Tower for SingHealth research and education.

The Academia has the right infrastructure such as bedside learning, simulation and virtual learning to equip medical students with the skillsset that prepares them for clinical practice.

Breakthroughs in cancer

— Professor Soo Khee Chee, deputy group chief executive officer, Research and Education, SingHealth, and director of National Cancer Centre Singapore

and education contribute to the advancement of better diagnosis, treatments and cures for patients. Its strategic location, close to clinical services and Duke-NUS Graduate Medical School, will foster a strong collaborative culture and further promote a spirit of enquiry to boost innovations in patient care. Prof Soo, who is also vice-dean, Clinical & Faculty Affairs, Duke-NUS Graduate Medical School, says the new medical infrastructure, through the collective efforts of SingHealth and Duke-NUS, will be a shot-in-the-arm in research and medical education capabilities. The programmes, he adds, bring together all specialists in a particular discipline from various institutions. This allows the cross-fertilisation of ideas and sharing of resources to progress clinical care, education and research and will help to groom a strong pipeline of outstanding medical professionals and clinician scientists. More than 1,500 health-care professionals will use the “Twin Towers” of Academia — Diagnostics Tower for SGH Department of Pa-

Among the leading medical pioneers is Professor Teh Bin Tean, one of the world’s leading kidney cancer research scientists and a pioneer in molecular profiling of kidney cancer, who specialises in translational cancer research, which transforms scientific discoveries arising from laboratory, clinical, or population studies into clinical applications to reduce cancer incidence, morbidity, and mortality. He says the facility’s new education labs will be test beds for the development of new health-care education curriculum, teaching methodology and education delivery techniques using the latest technology. In just three years, Prof Teh’s team made many breakthroughs in cancer research, particularly for cancers prevalent in the region. They have published papers in leading journals and identified hundreds of novel genes that are mutated in cancers, as well as potential drugs to treat them. “Eventually, it doesn’t matter where the cancer is, because as long as we know the molecular signature, we know which drug to target it with,” says the Penang-born scientist, who is professor, National Cancer Centre Singapore and professor, Duke-NUS Graduate Medical School. He has written in over 280 high-impact medical journals and also sits on the editorial boards of many internationally renowned publications. “It’s important to do such work here because the cancers we’re looking at are more prevalent in Asians and if we don’t drive it, who else will?”

Prof Teh’s team has made many breakthroughs in cancer research, particularly for cancers prevalent in the region. PHOTO: CHONG JUN LIANG

Helping patients to see better

Prof Wang

Cornea research gets a boost in the new Academia building, reports Narendra Aggarwal

PHOTOS: CHONG JUN LIANG

From bench to bedside Bridging medical research and patient care is the way forward for treatments and therapies

WORLD-CLASS professors Salvatore Alba- Infectious disease research ni and Wang Lin-Fa are passionate about China-born and US-trained Prof Wang is their research at Academia. an international expert in infectious disProf Albani is an internationally re- ease research. He is director, Emerging nowned rheumatologist and immunolo- Infectious Diseases Program, Duke-NUS gist. He says: “My strategic role will be to Graduate Medical School. act as a builder of bridges between molecuHe played a leading role in identifying lar medicine and patient welfare, between bats as the natural host of the Sars virus in ideas and their tangible applications to- 2003 when working with the World Health ward improvement of human life. Organization. He aims to collaborate closely “ Tr a n s l a with SingHealth and tional mediMy strategic role will be to other clinicians in Sincine spans this gapore to bring his react as a builder of bridges whole gradisearch from bench to ent. My func- between molecular medicine and bedside. tion will be to He emphasises the catalyse creativ- patient welfare, between ideas and importance of rapid ity, growth and their tangible applications toward identification of uncommunicaknown viruses and to tion and blend improvement of human life. prepare for the next coherently clin- — Professor Salvatore Albani, major outbreak. ical and basic director, SingHealth Translational Prof Wang says: research. A fun- Immunology and Inflammation Centre “We have much to damental mislearn from the bat, sion will also which has evolved to help new and promising talents to become avoid disease and live exceptionally long leaders in translational medicine.” lives. Although bats are the second largest His research focuses on understanding group of mammals, with over 1,000 species how the immune system is dysregulated of bats documented so far, they are distincin diseases like arthritis, allergy, infection tive because they are the only mammals caor cancer. pable of sustained flight; other mammals Prof Albani, who is director, SingHealth such as flying squirrels glide but do not fly. Translational Immunology and Inflam“Cancer, ageing and infectious disease, mation Centre, says: “My main ongoing these are the three major areas of concern projects are the development of a novel for people. We have studied rats for 150 therapy for human arthritis, and the idenyears to understand how to do better in tification of immunologic and epigenetic these three areas. patterns which determine resistance to “Now we have a system, the bat, which therapy. The first project will hopefully has done very well in evolution. We can lead to a therapy. The second may lead learn from the bat. With modern techto a chip which can prevent unnecessary niques, we can design new drugs to slow exposure to expensive and only partially down the ageing process, treat cancer and effective drugs.” fight infections.” His vision is to make Singapore a world Both professors agree that collaboration leader in translational medicine, and the with every medical party is crucial to be place where the evolution toward precision better prepared, because capacity building medicine, a patient-centered and knowl- during down time is the best way to tackle edge inspired way of practising, will occur. emerging infectious diseases. — Suresh Nair

THE Singapore Eye Research Institute (Seri), SNEC and clinical scientist and head, Tissue which has a special focus on cornea re- Engineering and Stem Cell Group, SERI. search, is now headquartered in the new Ac“The cornea is the No. 1 transplanted ademia building. Its move to the new hub of organ in the world. The ability to remove pioneering health research in Singapore will blindness and enable people to see is what give it significant synergy drives our research The cornea is the and provide new dynawork as often we can mism to its researchers. see the effect quite No. 1 transplanted “The move to Acafast,” he says. demia will allow Seri to organ in the world. Wi t h a $ 2 5 m i l consolidate its laboratolion grant from the The ability to remove ries and dry labs mostly Government in 2008, under one roof, which blindness and enable new equipment was is right next to the main purchased, additional clinical centre, the Singa- people to see is what manpower was hired pore National Eye Centre drives our research work and skilled research(SNEC). ers were attracted from “The arrangement as often we can see overseas to put together will be of great ben- the effect quite fast. a great team. efit for communication One of the projects and exchange of ideas — Associate Professor Jodhbir S. that Prof Mehta’s team and data,” says Profes- Mehta, head (Research), Cornea is working on focuses sor Aung Tin, head (Re- Service, SNEC, and clinical scientist on research in selecsearch, Education & De- and head, Tissue Engineering and tive tissue transplant velopment) and senior Stem Cell Group, SERI in the cornea. Another consultant, Glaucoma major project involves Service, SNEC, and deputy director, Seri. research to grow selective tissues. This “We hope that this will result in better means that healthy tissue from a cornea translational research and in the long term, could potentially be transplanted to two or the development of new research that may more eyes. benefit our patients,” he adds. A research project in an advanced phase Cornea research that can benefit the which would benefit most eye patients incommon man is being done at Seri and volves the development of drugs which SNEC by associate professor Jodhbir S. Me- would do away with having to put eye hta and his team of researchers in the Tis- drops daily after an eye operation. The drug sue Engineering and Stem Cell Group. Prof would protect the eye on a daily basis and Mehta is head (Research), Cornea Service, dissolve after 30 days.

One of the projects Prof Mehta (extreme right) and his team are working on focuses on research in selective tissue transplant in the cornea. PHOTO: CHONG JUN LIANG

SINGHEALTH – TOMORROW’S MEDICINE STARTS HERE Prof Phua (left) can assess and guide trainees in the simulated ICU by observing them through a one-way viewing window.

Mini hospital for doctors Training facilities equipped with wireless technology and crying manikins make training realistic for the new generation of medical professionals AJ Leow MEDICAL trainees — who are referred to in the health-care profession as residents — often picked up their experiential skills in handling critical care situations on the job, more often than not on an ad-hoc basis. In the case of rare or unusual events, this would normally happen only by chance. “In some of the extraordinary cases, it may take years before you encounter a particular medical scenario or not at all,” says Associate Professor Phua Ghee Chee, senior consultant for Respiratory & Critical Care Medicine at the Singapore General Hospital (SGH) and program director, Internal Medicine Residency. That is one of the reasons why SingHealth has set up a “mini hospital” at Academia with simulation-based facilities including authentic replicas of an intensive care unit (ICU) and an operating theatre to enhance the standards of medical training, for not only the next generation of health-care professionals including nurses, but also experienced surgeons. Prof Koo Wen Hsin, group education director at SingHealth, adds that the cutting-edge facilities incorporating live streaming and video recording for educational purposes provide a more structured and non-threatening environment that also enhances team-based training. “The simulation can range from the process of transferring a patient from a ward to an operating theatre or ICU — which in normal circumstance would not be possible in a hospital without causing disruption — to more complex set-ups such as emergency or crisis scenarios which might not be possible with real patients due to an unavailability of reallife cases coinciding with specific stages during a resident’s training span. “The result is that there is greater uniformity in the quality of training. Entire session can be recorded and replayed so that trainees can learn from their mistakes and respond better in real-life situations,” he adds. The state-of-the-art manikins used for the training purposes in place of real patients are so advanced these days that they can be pro-

grammed to imitate physical symptoms such as fluctuations in breathing patterns, dilation in the eyes, bleeding and even cry out in pain in Hokkien. Associate Professor Soh Chai Rick, Senior Consultant, Department of Anaesthesiology, SGH adds that simulation allows trainers to generate consistent and realistic scenarios to assess a physician or team’s ability to function.

Playback and learn The trainees get to review their performances via videos. “Seeing can be a power learning tool. They get to see and reflect on what they did well and not so well, which was not possible previously with real-life ICU cases,” adds Prof Phua. Dr Zhao Yi Jing, a resident in her second year of training, says: “The playback really helps to improve our thought processes and learn not to make any jarring mistakes when we have to face a similar situation with a real patient.” Dr Sim Yirong, a resident in general surgery, adds after a session in the simulated operating theatre that in the past, the main channels of instruction were through reading of texts and journals and by apprenticeship, which is through the observation of senior surgeons and hands-on learning assisting them. “With the simulation labs, we are now able to brush up our skills in a stress-free environment. The various life-like scenarios also enable us to practise and prepare for the day when we face a patient in a difficult or challenging scenario.”

Practice makes perfect Dr Jeremy Ng, consultant at the Department of General Surgery, SGH, notes: “With the simulation centre, we can teach the resident to manage stable or unstable patients with a single injury or multiple injuries that may require surgery or other forms of intervention. In short, it allows us to vary the pattern of injuries and increase the learning value for the resident. “In addition, the trauma team simulation programme also allows team dynamics to be

taught and learnt as clinical situations in trauma are often not handled by physicians working alone, but by working as a team.” His colleague and fellow trainer for the simulated operating theatre centre, Dr Kam Ming Hian, senior consultant at the Department of Colorectal Surgery, SGH, points out that the training allows residents to practise at their own pace and develop their skills with specialised instruments including those used in keyhole surgery. Residents are also exposed to a wide spectrum of clinical conditions until they become familiar with the procedures required before treating real patients. Such training programmes are however not confined to residents but also more experienced surgeons to master new techniques, especially with the introduction of new technology including robotics and instruments such as those used in laparoscopic or keyhole surgeries that involve the manipulation of miniature forceps, cutters and cameras. “The dexterity and skill sets required can be vastly different from traditional open surgery,” says Dr Kam, who adds that the current takeup rate for laparoscopic surgeries is only about 20 to 30 per cent. With more training, he says SGH hopes to double the percentage of such minimally invasive procedures that allow for faster recovery time and shorter hospital stays and hence better patient care.

thesundaytimes July 28, 2013

Training staff

in real-life scenarios

Simulated technologies enable nurse educators to better impart valuable skills and heighten confidence levels of trainees

“In such an environment, trainees would be more confident and ready to take on daily challenges like managing medical emergencies and providing good quality of care even when dealing with demanding customers. They can repeatedly practise and master the skills required to be competent practitioners,” Ms Low says.

Suki Lor

Training patient service associates

FOR seven years now, Ms Low Siew Ching, nurse educator at Singapore General Hospital’s (SGH) SingHealth Alice Lee Institute of Advanced Nursing (Alice Lee IAN), has been teaching at the same institution where she received training in the past. With the opening of Academia located in the SGH campus, the training will take on an added dimension. The simulated ward at Academia has enhanced facilities which will enable more effective and in-depth learning compared with a similar ward located at the Alice Lee IAN’s premises at Bestway Building, says Ms Low. “Trainees will be better off in both skills and confidence levels and will thus be able to provide safe, efficient and competent care to patients,” she says. Hospital staff such as patient care assistants, nursing students as well as new and existing nurses undergoing inhouse staff development programmes will receive training at the simulated ward. The four-bed ward is a replica of an actual hospital ward along with manikins but at the Academia, new facilities include built-in closed-circuit television which can capture staff in action while they undergo training, says Ms Low. “After that, trainees will be debriefed on the tasks they have performed through a playback of the video recording for a better learning outcome,” Ms Low says. Through the simulated ward, staff are taught both clinical skills and soft skills. The former include basic cardiac life support and cannulation, which refers to the insertion of a cannula or tube into a vein so as to start an intravenous drip to administer drugs for example, and venepuncture — the puncture of a vein through the skin so as to draw blood. “Besides learning clinical skills that the trainees have to practise and perform on real patients, they also need soft skills, such as counselling patients and teaching them to take care of themselves upon discharge,” Ms Low says. She notes that ward simulation training allows trainees to make errors and learn from them with no adverse impact on real patients.

Like Ms Low, Ms Cheah Le Le, nurse educator at Alice Lee IAN is “very excited” about the new and high-tech facilities available at Academia, including four simulated specialised outpatient clinics (SOCs). Each simulated SOC is set up to resemble a typical SOC but with loose furniture to provide for the flexibility of training using manikins. It also has one-way viewing windows and state-of-the-art audio visual monitoring systems to facilitate observation and recording during training. All sessions are captured on cameras in the room. A playback of the video recording makes possible a more sophisticated debriefing of all scenarios. Ms Cheah says the simulated SOCs will be used to train mainly patient service associates, who are typically the first point of contact for patients when they arrive in the outpatient area. She notes that each simulated SOC has a front desk to provide training in skills such as handling enquiries from patients, cashiering and bill payments in a simulated environment where it is easier to assess the trainees and track their progress. Trainees previously had to go to an actual hospital to practise these skills and learn on the job, Ms Cheah says. Apart from developing their administrative skills at the front desk, trainees are also taught how to help doctors in the consultation rooms. “When the doctor needs a chaperone, for example, or somebody to stand by when he does an examination on the patient, they can go in and hand certain examination tools to the doctor,” says Ms Cheah. They may also have to assist in preparing the tools required in a clinic. Training in such a simulated environment will boost the confidence of patient service associates when they communicate with patients and handle their requests. “This translates to patient safety because when staff know what they are doing, they are less likely to make mistakes. They are able to anticipate the needs of patients, who have fewer complaints,” Ms Cheah adds.

This translates to patient safety because when staff know what they are doing, they are less likely to make mistakes. They are able to anticipate the needs of patients, who have fewer complaints. — Ms Cheah Le Le, nurse educator, Alice Lee IAN

Ms Low (left) says that simulation training allows trainees to make errors and learn from them, without risk to patients. PHOTOS: CHONG JUN LIANG

Studying movement and pain The biomechanics lab takes research in this field a step forward Jamie Ee

With the simulation labs, we are now able to brush up our skills in a stress-free environment. The various life-like scenarios also enable us to practise and prepare for the day when we face a patient in a difficult or challenging scenario. — Dr Sim Yirong, a resident in general surgery

PHOTO: SINGHEALTH

ACADEMIA houses the most advanced and comprehensive biomechanics lab in Singapore — Human Movement Study Lab — which is dedicated to the learning and study of human movement. Located on Level 1, the 70sq m facility is dedicated to the learning and study of human movement and also one of the two key labs for human movement analysis and tissue testing within Academia’s Bioengineering Hub. Mr Hanniel Lim, senior executive, Group Allied Health, SingHealth, says the lab will fulfil two purposes: to train doctors, nurses and allied health professionals on how to use advanced movement assessment tools to conduct research, and to spur further studies in the biomechanics field. Elsewhere, research into the finer points of human movement has enabled doctors to define the mechanisms underlying movement

disorders and pain. This has improved patient care and treatment. “We are able to sub-classify certain disorders with the finer details captured by simulation technologies,” says Mr Lim, who is spearheading the setting up of the lab. “So rather than giving a standard generic treatment, we are able to zoom in to the specific condition and and give a targeted treatment.” Among the key features of the the lab are motion simulation equipment that consists of a 10-camera motion analysis system, force platforms, and an EMG (electromyography) system with fine wire needle capabilities that can record electrical activities of deep, specific muscles. The lab is also fitted with a cardiopulmonary exercise testing system, which can test how the heart, lungs and muscles react to stress and activity. There are also simulators used in nerve conduction studies to understand how nerves activate muscles and movement. Mr Lim believes the opening of the lab will

enable more high-quality local research in biomechanics, as well as spur collaborations with local and overseas researchers. Some possible work that can be done in the lab includes the testing of rehabilitation prototypes that SingHealth health-care professionals have jointly developed with local polytechnic students. In the pipeline is also the creation of a broad-based curriculum in the field of biomechanics, targeted at teaching clinicians in SingHealth on how to conduct clinically relevant research that can improve treatment for patients with movement disorders and cardiopulmonary-related conditions. There is currently no such curriculum here available to clinicians. Mr Lim says: “We are opening this up to everyone in SingHealth who has an interest in biomechanics and we hope we can bring people and resources from various institutions in Singapore together to engage and perform bioengineering activities.”

What’s inside the Academia building at SGH campus DIAGNOSTICS TOWER

DISCOVERY TOWER

The bridge between science and clinical medicine to achieve rapid diagnoses of diseases for better patient care.

The nucleus of research to push the boundaries of medicine.

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SingHealth Research Facilities

● leading centre for eye and vision research in Asia

SingHealth Research Core Platforms

SGH Research Laboratories

SingHealth Research Facilities SingHealth Research Core Platforms: ● SingHealth Translational Immunology and Inflammation Centre: drives clinical immunology and inflammation research through a joint academic collaboration between SingHealth and Duke-NUS Graduate Medical School. ● Clinical Pharmacology: provides core clinical pharmacological services.

Singapore Eye Research Institute (SERI) Laboratories

● SingHealth Tissue Repository — facilitates basic, translational and clinical research at SingHealth and Duke-NUS Graduate Medical School. ● AMPL@SingHealth — a collaboration between SingHealth and A*Star’s Institute of Molecular and Cell Biology; provides histopathology consultation and biomarker validation in clinical samples ● Flow Cytometry — provides cell sorting and analysis services ● Advanced Bio-imaging — provides stateof-the-art optical and electron microscopy imaging technologies. ● Polaris — a collaboration between A*Star’s Genome Institute of Singapore and SingHealth, which aims to deliver better patient outcomes through research.

SingHealth Office of Research

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SGH Division of Surgery

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SGH Division of Medicine, Division of Surgery, Division of Ambulatory Care & Clinical Support Service

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SERI Academic Medicine Research Institute Principal Investigator Offices

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SGH Division of Medicine Library

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Bio-Medicals Skills Laboratories Auditorium Seminar Rooms

SingHealth Experimental Medicine Centre Wet Skills Laboratory

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Diagnostic Bacteriology

Immunology and Serology

● provides diagnoses for a variety of infectious diseases through the detection of antibodies and antigens to bacteria, parasites and fungi

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Histopathology ● studies diseases at the macroscopic, microscopic

Haematology ● largest provider of haematology services in Singapore; delivers clinical and laboratory services for the diagnosis and treatment of all blood and blood-related disorders

● identifies and tests bacteria that cause infections provides diagnosis of parasitic and fungal infections; supports outbreak investigations within the hospital and community and carries out research; provides diagnosis of unusual or emerging pathogens and studying multi-drug resistant bacteria and their spread.

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Cytology ● evaluates cells in relation to disease, primarily in the detection of cancers, but also of specific infections or pre-cancerous conditions; accredited laboratory in the national cervical screening programme.

● offers tests for the detection of a wide range of viruses and other microorganisms; works with Histopathology to incorporate oncologic applications for increasingly individualised cancer treatment

Virology ● Protects the public against pandemics and provides a comprehensive range of virological tests

Molecular

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and molecular levels; evaluate tissue sections under the light microscope to provide a pathologic diagnosis. Through a histopathologic diagnosis, appropriate clinical care for cancer and other diseases can be given.

● provides tertiary reference-level laboratory diagnosis of tuberculosis and other mycobacterial diseases; TB control; and evaluation of new diagnostic methods.

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SingHealth Group Education, Postgraduate Medical Institute, Alice Lee Institute of Advanced Nursing, Institute for Medical Simulation and Education, Postgraduate Allied Health Institute Tutorial Rooms Seminar Rooms Auditorium Mini Hospital Dry Skills Lab

Central Tuberculosis

Cytogenetics ● offers state-of the-art chromosomal investigations for cancers, constitutional abnormalities and preand postnatal diagnoses; and conducts a wide range of molecular tests.

Clinical Biochemistry ● integrates state-of-the-art automated analytical processes with cutting-edge technology to offer a large repertoire of tests that complements the wide spectrum of clinical services in SGH

SGH Department of Pathology

SINGHEALTH – TOMORROW’S MEDICINE STARTS HERE

thesundaytimes July 28, 2013

Sharpening surgical skills Simulation technologies allow medical students to gain hands-on experience at their own pace At SingHealth, surgeons have been training using simulation technologies for a few years now, but GENERATIONS of doctors have sharpened their these were done in various locations. In Academia, surgical skills by observing the masters and per- these technologies — and new ones — will be cenforming procedures on patients under the watchful tralised and housed in the SGH Surgical Skills Centre. eye of more experienced doctors. The equipment ranges from basic task trainers But these days, surgeons are increasingly using like knot-tying boards and suturing pads to highsimulation technologies to hone fidelity computerised simulatheir craft safely and in a more tors that allow users to gain structured way, instead of learnhands-on experience for a ing on real patients. range of minimally invasive, There are several reasons for endoscopic and endovascular this shift: the increase in the procedures — all of which renumber of medical students and quire surgeons to have a high trainees, smaller patient volumes, level of psychomotor skills shorter training hours available and hand-eye coordination. and increasing patient expectaAs the users control the tions, which have resulted in fewer surgical tools on the simulalearning opportunities for training tors, they are able to feel resurgeons, says Professor London sistance from the tissues they Lucien Ooi, chairman, Division of are working on, which makes Surgery, Singapore General Hosthe experience very realistic. pital (SGH) and academic chair, The computerised simulators Surgery ACP (Academic Clinical are also able to track perforProgram), SingHealth. mance of the user, which is “With the changing landscape – Professor London Lucien Ooi, useful in deciding if a trainee in health care, there is a need to chairman, Division of Surgery, SGH can move on to contact with provide more training opportureal patients. nities in a more controlled enviSome of the simulators ronment before the student or trainee is allowed to also allow for specific patient data to be keyed in perform a procedure on a patient,” he says. so that surgeons can practise and perfect the proceComputerised simulation training overcomes some dure before replicating it on the real patient. of these limitations. Students and trainees are able to To maximise learning, the 24-hour centre can perfect their skills at their own pace, as well as have a be accessed at anytime with a card. It is also fitted clear measure of their competency. Since there is no with an AV system that allows live transmission of direct contact with patients, simulation training also a task being performed to other seminar rooms and reduces medical errors and enhances patient safety. classrooms for sharing, teaching and discussion.

Jamie Ee

With the changing landscape in health care, there is a need to provide more training opportunities in a more controlled environment before the student or trainee is allowed to perform a procedure on a patient.

PROJECT EDITOR Lai Yi Ming WRITER Ahmad Osman CONTRIBUTORS AJ Leow, Gloria Chan, Jamie Ee, Narendra Aggarwal, Suki Lor, Suresh Nair ART AND DESIGN Kimmie Tan, Vikki Ann Chan, Lynnette Chia PHOTOGRAPHER Chong Jun Liang EDITOR Lee Kim Chew DEPUTY EDITOR Leong Phei Phei CHIEF SUB-EDITOR Uma Venkatraman ART DIRECTOR Chris Tan ADMIN MANAGER Zain Afridi ADVERTISING SALES Lam Wy-ning (9368-5685), Lina Tan (9620-1355), Tan Keng Boo (9620-1363) For reproduction of articles or reprints of photographs, call SPH's Information Resource Centre: 6319-5508 or 6319-5726. E-mail feedback to spu@sph.com.sg

PHOTO: CHONG JUN LIANG

Training surgeons with human-like manikins that simulate a real patient’s physiological changes To provide greater realism, Academia is equipped with a fully functional, state-of-the-art operating theatre system that allows surgeons to gain hands-on experience working in a real operating room — but without real patients. The system, called the Storz OR1 Neo, is located in the Skills Laboratory on level B1, and is the latest operating theatre system from Karl Storz, a global medical device company. Instead of using mock-ups, trainee doctors and surgeons will use this real equipment to practise various surgical operations, particularly minimally invasive surgery, on “models”. These human-like manikins can simulate a real patient’s physiological changes, such as fluctuations in blood pressure, pulse rate and breathing rate, during an operation. Creating a real operating room environment is important, says Prof London Lucien Ooi, chairman, Division of Surgery, SGH and academic chair, Surgery ACP, SingHealth, as it allows trainees to learn how to handle various types of surgical emergencies without any risk to real patients. It also helps different groups of health-care professionals, including surgeons, anaesthetists and nurses, to become familiar and develop confidence in the operating room, he adds. The Storz OR1 Neo represents the latest in operating theatre system design, where integration is key. It provides centralised control of all surgical equipment and systems, and can gather and display realtime data from various sources, such as anaesthetic monitoring data, operating system images and X-ray information to everyone in the surgical team. The equipment costs $3.8 million, which also includes 10 minimally invasive surgery operating towers that can be used individually and simultaneously for training surgeons. Each tower is linked to the central Storz OR1 Neo system to allow trainers to view the procedures at each training table from the master table and vice versa.

July 28 2013 thesundaytimes