The successful, rapid transition to a new model of graduate medical education in Singapore.

Graduate medical education (GME) in Singapore recently underwent major reform (2009-2012), leading to accreditation of residency programs by the Accreditation Council for Graduate Medical Education-International (ACGME-I) within two years of the initial commitment to change. The main aims of the reforms were to implement best practices in GME, to provide better support structures for program administration, and to bring all specialty training under one administrative umbrella. The authors outline the historic development of GME in Singapore, the complexities of the model in place immediately prior to ACGME-I accreditation, and the difficulties addressed by the proposed changes, leading to a description of implementation efforts at the National University Hospital of Singapore, a university-affiliated academic medical center. The authors describe the institutional factors uniting hospital leaders in support of reform, the recruitment of a team to manage change within the institution, the inauguration of a new office for GME, and the faculty development initiatives needed to educate faculty leading the change process. The preparation and execution of specific initiatives designed to improve GME and the communication strategies needed to coordinate and publicize change efforts are outlined, as well as strategies for sustaining improvements and building them into the culture of the institution. The authors demonstrate that external accreditation can be a powerful driver of educational reform and summarize key lessons derived from Kotter principles, a current model of change management.

Motivation, study habits, and expectations of medical students in Singapore.

OBJECTIVES: To determine the motivation and incentives in education, learning experience and teaching techniques, and expectations about future careers among medical students from a multi-ethnic Asian country. METHODS: Pre-validated questionnaire-based survey with stratified random sampling among medical students. The questionnaire combined qualitative responses with semi-quantitative measures of available alternatives. RESULTS: The response rate was 83.1%. The most important factor for pursuing university study was 'prospect of finding an interesting challenging job' (rank 1-75%). Family made a significant contribution in decision making. Given the chance, a majority (67.2%) of respondents would prefer to study overseas. The main deterring factors were cost (67.7%), distance from home (28%), and local opportunity for post-graduation (23.4%). Despite their inclination of study overseas, the majority (73.9%) of the respondents indicated they were either very satisfied or satisfied with their current choice of university study. Only 20% of students were comfortable in asking questions in classroom as asking questions was deemed 'too risky' and 'unnecessary to get better grades'. Students adopted strategies related to assessment and competition to monitor their study. Senior students reported university education as less relevant to their future careers as compared to junior students (p = 0.002). CONCLUSIONS: Students' learning behaviour is determined by complex factors such as educational incentives, learning support, assessment and competition. Among several external factors, family, job prospects and expectations about the future play a critical role in education.