College Road in Singapore, a boulevard of skyscrapers and trim gardens, is 10,000 miles away from tree-lined Campus Drive in Durham, North Carolina. But the National University of Singapore (NUS) and Duke University have managed to jointly develop and run a respected medical-education institution, Singapore-based Duke-NUS Medical School. “We have become a model for how a successful international partnership can establish a high quality, research-intensive medical school,” says Dr. Thomas M. Coffman, dean of Duke-NUS.
Duke-NUS was established in 2005 and now enrolls more than 60 students a year in MD, PhD, and MD/PhD degree tracks, all based on the curriculum of the Duke University School of Medicine. The school is funded by the Singapore government and is focused on producing future leaders in medicine and biomedical research, who can support the country’s ambitious Biomedical Sciences Initiative and help establish the country as the biomedical hub of Asia.
Though Duke-NUS is relatively young for a medical school, its students and faculty members have already racked up an impressive list of accomplishments: The school boasts that its faculty and alumni have published more than 2,800 papers in peer-reviewed journals, and that its research work has resulted in nine patent licenses and six spin-off companies.
Dean Coffman trained at American schools and spent more than 30 years at Duke University Medical Center in North Carolina, where he was chief of the Division of Nephrology and senior vice-chair of the Department of Medicine. GHCI spoke with Coffman about the genesis of the partnership, the ways that the U.S. campus and the Singapore campus collaborate, and how Duke-NUS has become a mecca for other healthcare institutions interested in setting up their own cross-cultural partnerships.
GHCI: What drew Duke into the collaboration?
Dean Coffman: The process was initiated by the Singapore government, which wanted to diversify the medical landscape in Singapore. At the time, there was only an undergraduate medical school in Singapore, Yong Loo Lin School of Medicine at NUS, and it had been here for 100 years, so the government decided to start a new medical school. It wanted to capitalize on Singapore’s other investments to become a hub for biomedical research, and rather than launch another undergraduate medical school, it decided that an American-style, graduate-entry medical school would be an innovative disruptor in the field.
The government approached several universities in the U.S. about a partnership to begin such a school, and Duke University School of Medicine’s curriculum caught the attention of the planning committee. The curriculum is unique because the third year of the four training years is dedicated to research. Everyone in Singapore got behind the idea of a research-intensive school to train students and prepare them for careers as physician-scientists. On top of this, there was great chemistry between individuals involved in the partnership. Things really just clicked.
How was the Duke-NUS’s curriculum developed?
A new medical school provides a blank slate. While most of the curriculum material was brought over from Duke, Duke-NUS developed a novel approach to teaching that flipped the classroom and focused on team-based learning. That approach has now been emulated and adapted in other fields.
Unlike a traditional American medical school, we have no traditional basic medical departments, such as anatomy, biochemistry, etc. Instead, we organized around public health problems and disease themes that are of particular importance to Singapore. For example, we have a cardiovascular-metabolic-diabetes department; a program focused on emerging infectious diseases common in the region; a program in health systems and services research; a program in cancer and stem-cell biology specializing in cancers endemic to Asia; and a program in neurological disorders associated with aging, which is of special importance since Singapore has a very rapidly aging population.
We made a conscious choice to be very location-specific and address Singapore’s particular health needs. We have an eye on economic return and building economic development in the biomedical sector. We see commercialization as one way to impact broader populations, so we also do a lot of work with moving basic scientific discoveries into the clinic. It’s important for us to focus on translational research that could impact patient care over the long run.
Does Duke-NUS differ from American medical schools?
Singapore is a great city, with a really outstanding healthcare system. Our clinical partner is the SingHealth group, which is the biggest public hospital cluster in Singapore. This partnership has been very important for us, both from the standpoints of clinical education and translating research discoveries.
The unique educational opportunity that Duke-NUS provides draws in different kinds of students, from more diverse backgrounds and with different kinds of experiences. These include students who have spent time in business, or finance, or another field before studying medicine. These students tend to be very curious and innovative, and we try to cultivate their skills to work in teams, which is such a key part of modern medicine. There are lots of great opportunities for interchange in both directions. Students at Duke-NUS here in Singapore have lots of interactions with Duke students and faculty back in the U.S. One great success of Duke-NUS really has been the robust involvement of the “mothership” in North Carolina. They do everything they can to help us succeed.
As an American, I can say there’s a lot we can learn from this country’s health system and its success in delivering high quality healthcare at low costs. Singapore only spends about four percent of GDP on healthcare, and it generally achieves much better outcomes than in the U.S. Of course there are key differences with the U.S.; Singapore is a small country, allowing it to be very nimble. The public system is nationalized, and there are certainly benefits from that kind of organization and control. Still, there’s so much that can be learned here about efficiency and organization, and we’ve tried to take these lessons and use them to help Duke-NUS be successful.
How has the collaboration evolved?
We’re not a startup anymore, but rather a full-fledged, well-established institution in the medical education and research landscape of Singapore. The school’s mission in general is very integrated with the larger healthcare ecosystem of Singapore, across the government and with other university partners at NUS. In going from a small startup to an established research-intensive school, we’ve broadened and expanded our engagement with Duke’s campus in the U.S. Now, we have more than 50 active research collaborations between investigators there and here.
Business in Singapore is all very nimble and performance-based, and major programs here are reviewed and re-evaluated every five years. Our school has been reviewed and evaluated in a similar way. Earlier this summer, we had a ceremony marking the beginning of the next five-year phase of our collaboration, to show that this partnership is of continuing importance to all partners involved. The collaboration maintains very solid financial footing, and the ceremony reinforced our strong mutual support and commitment.
Has Duke-NUS had an impact on Asian healthcare education?
We’ve had more than 200 visits from other healthcare institutions, mostly from the region but also from other places around the world that came to learn how we do things here so others might set up schools like this. Often, we’re contacted about program development from other universities trying to set up institutions abroad. Our team’s education approach has been widely adopted by secondary schools in Singapore by the Ministry of Education with great success. We have become a model in the region and also around world, especially in the Middle East and Europe.
What support does the Singaporean government provide?
The government is very engaged. Much of our funding comes from the Ministries of Education and Health in Singapore. Board members from both Ministries sit on our Governing Board, helping us plot our course forward.
We’re lucky in that we’ve had a really great partner in the Singapore government. They had a vision for what Duke-NUS was going to be, and they supported it generously. Likewise, Duke also took the partnership seriously and sent some of its best people to be here full-time on the ground. And both sides have continued their strong commitments to this project. On the U.S. side, Duke views Duke-NUS as a “crown jewel” in their portfolio and is very proud of what we’ve done here. It took a real commitment and trust from both sides, with transparency and a shared vision, to really make this happen. It would be hard to duplicate our success without all of those ingredients.
— Ali Greatsinger
Ali Greatsinger is the senior editor at GHCi.