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      Pandemics and Their Impact on Medical Training: Lessons From Singapore

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      , MBBS, MRCS, DipSpMed, PhD, MBA 1 , , , MBBS, FRCSEd (A&E), MHPE, FAMS 2 , , MBBS, FRCS, DPhil 3
      Academic Medicine
      Published for the Association of American Medical Colleges by Lippincott Williams & Wilkins

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          Abstract

          The ongoing coronavirus disease 2019 (COVID-19) crisis has hit Singapore hard. As of February 25, 2020, Singapore had the fourth highest number of confirmed COVID-19 infections outside of China, only trailing behind South Korea, Italy, and Japan. This has had reverberating effects on Singapore’s health care system, and has, consequently, also affected medical education all the way from the undergraduate to the postgraduate level. While efforts are underway to contain disease spread and transmission, the authors believe that this is an opportune time to examine and reflect on the impact that medical crises like COVID-19 can have on medical training and education and to evaluate “business continuity plans” to ensure quality medical education even in the face of constant disruptions from pandemic outbreaks. Medical training is as important a mandate as patient care and service. The authors believe that even in trying times like this, rich and precious lessons can be sought and taught, which will immensely benefit medical students and residents—the health care leaders of tomorrow. In this Perspective, the authors discuss the various ways in which the COVID-19 crisis has affected medical instruction in Singapore and explore pertinent practical and creative solutions for the continuity of medical training in these trying times, drawing on their previous experience with the Severe Acute Respiratory Syndrome outbreak in 2003 as well as the current ongoing COVID-19 crisis.

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          A Novel Coronavirus from Patients with Pneumonia in China, 2019

          Summary In December 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. (Funded by the National Key Research and Development Program of China and the National Major Project for Control and Prevention of Infectious Disease in China.)
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            Infectious Disease Threats in the Twenty-First Century: Strengthening the Global Response

            The world has developed an elaborate global health system as a bulwark against known and unknown infectious disease threats. The system consists of various formal and informal networks of organizations that serve different stakeholders; have varying goals, modalities, resources, and accountability; operate at different regional levels (i.e., local, national, regional, or global); and cut across the public, private-for-profit, and private-not-for-profit sectors. The evolving global health system has done much to protect and promote human health. However, the world continues to be confronted by longstanding, emerging, and reemerging infectious disease threats. These threats differ widely in terms of severity and probability. They also have varying consequences for morbidity and mortality, as well as for a complex set of social and economic outcomes. To various degrees, they are also amenable to alternative responses, ranging from clean water provision to regulation to biomedical countermeasures. Whether the global health system as currently constituted can provide effective protection against a dynamic array of infectious disease threats has been called into question by recent outbreaks of Ebola, Zika, dengue, Middle East respiratory syndrome, severe acute respiratory syndrome, and influenza and by the looming threat of rising antimicrobial resistance. The concern is magnified by rapid population growth in areas with weak health systems, urbanization, globalization, climate change, civil conflict, and the changing nature of pathogen transmission between human and animal populations. There is also potential for human-originated outbreaks emanating from laboratory accidents or intentional biological attacks. This paper discusses these issues, along with the need for a (possibly self-standing) multi-disciplinary Global Technical Council on Infectious Disease Threats to address emerging global challenges with regard to infectious disease and associated social and economic risks. This Council would strengthen the global health system by improving collaboration and coordination across organizations (e.g., the WHO, Gavi, CEPI, national centers for disease control, pharmaceutical manufacturers, etc.); filling in knowledge gaps with respect to (for example) infectious disease surveillance, research and development needs, financing models, supply chain logistics, and the social and economic impacts of potential threats; and making high-level, evidence-based recommendations for managing global risks associated with infectious disease.
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              The Future of e-Learning in Medical Education: Current Trend and Future Opportunity

              A wide range of e-learning modalities are widely integrated in medical education. However, some of the key questions related to the role of e-learning remain unanswered, such as (1) what is an effective approach to integrating technology into pre-clinical vs. clinical training?; (2) what evidence exists regarding the type and format of e-learning technology suitable for medical specialties and clinical settings?; (3) which design features are known to be effective in designing on-line patient simulation cases, tutorials, or clinical exams?; and (4) what guidelines exist for determining an appropriate blend of instructional strategies, including on-line learning, face-to-face instruction, and performance-based skill practices? Based on the existing literature and a variety of e-learning examples of synchronous learning tools and simulation technology, this paper addresses the following three questions: (1) what is the current trend of e-learning in medical education?; (2) what do we know about the effective use of e-learning?; and (3) what is the role of e-learning in facilitating newly emerging competency-based training? As e-learning continues to be widely integrated in training future physicians, it is critical that our efforts in conducting evaluative studies should target specific e-learning features that can best mediate intended learning goals and objectives. Without an evolving knowledge base on how best to design e-learning applications, the gap between what we know about technology use and how we deploy e-learning in training settings will continue to widen.
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                Author and article information

                Journal
                Acad Med
                Acad Med
                ACM
                Academic Medicine
                Published for the Association of American Medical Colleges by Lippincott Williams & Wilkins
                1040-2446
                1938-808X
                27 April 2020
                23 April 2020
                : 10.1097/ACM.0000000000003441
                Affiliations
                [1 ] W. Wang is senior consultant and associate professor, Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; ORCID: http://orcid.org/0000-0003-3803-9392.
                [2 ] Z.C. Liang is a resident, Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; ORCID: http://orcid.org/0000-0001-7046-8918.
                [3 ] S.B.S. Ooi is senior consultant, Emergency Medicine Department, National University Hospital, National University Health System, associate professor, Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, and designated institutional official, National University Health System Residency Programme, Singapore; ORCID: http://orcid.org/0000-0002-8661-7225.
                Author notes
                Correspondence should be addressed to Zhen Chang Liang, Department of Orthopaedic Surgery, NUHS Tower Block, Level 11, 1E Kent Ridge Rd., Singapore 119228; email: zhen_chang_liang@ 123456nuhs.edu.sg .
                Article
                00001
                10.1097/ACM.0000000000003441
                7188065
                32304387
                3211dc15-31e7-4a9a-9ab5-93cb8346cd86
                Copyright © 2020 by the Association of American Medical Colleges

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

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