Continuous education plays a fundamental role in the life-long professional development of physicians. It allows medical professionals to increase their knowledge, improve their skills and keep abreast with the latest developments in clinical management. The vital need for continuous medical education has remained unchanged over time, while teaching and learning methods have evolved to take advantage of integration of learning resources and technology.

Traditional Teaching and Learning

Traditionally, teaching/learning methods focus on classroom lectures, actual hands-on training with real patients during clinical practices, group discussions, theoretical and practical examinations, as well as printed books and other reading materials. These teaching/learning sessions involve a limited group of participants and are held at fixed venues and times.

With the breakthrough in information technology and the invention of sophisticated electronic gadgets, the limitations encountered by traditional teaching/learning methods are overcome by distance learning—namely, individual study of specially prepared materials, supplemented by integrated learning resources.

Advantages of Distance Learning

Factors contributing to the increasing popularity of distance learning to complement traditional teaching/learning methods are as follows:

• the flexibility of teaching/learning in aspects of time and place;

• the accessibility to a large pool of quality-assured, up-to-date learning resources;

• the capability to reach out to an almost unlimited number of students;

• the flexibility of adapting the learned knowledge to local settings.

Experience with Distance Learning

The Graduate School of Medical Studies, realising the advantages of combined teaching methods (traditional and distance learning), has since incorporated such a teaching concept into the curriculum of its graduate diploma programmes:

1. Graduate Diploma in Geriatric Medicine

• aims to provide primary care physicians with basic skills in caring for the elderly;

• comprises 4 modules of self-directed learning and assignments, 10 workshops, clinical attachments and site visits.

2. Graduate Diploma in Occupation Medicine

• aims to provide comprehensive skills to doctors in general practice and specialists who wish to have a better understanding of the occupational aspects of their specialty;

• comprises 6 weeks of face-to-face learning and site visits (a total of 100 hours), assignments, continual assessments and submission of a written portfolio.

3. Graduate Diploma in Psychotherapy

• aims to equip practising mental health professionals with basic proficiency in individual psychotherapy based on various theoretical approaches;

• consists of lectures, group seminars with self-directed learning, supervised discussion sessions, case conferences, weekend workshops and clinical work at the participant’s place of work.

4. Graduate Diploma in Basic Ultrasonography (O&G)

• aims to enable participants to be proficient in basic ultrasonography in obstetrics and gynaecology;

• includes lectures, hands-on-training, log work and formative self-assessments.

5. Graduate Diploma in Family Practice Dermatology

• aims to equip Family Medicine practitioners with the knowledge and skills to deal with skin diseases at a primary care level;

• contains large distance-learning components (self-study notes and formative assessment), one-week clinical attachment and a training seminar.

6. Graduate Diploma in Family Medicine

• introduced jointly with the College of Family Physicians, Singapore;

• aims to train primary care doctors to practise Family Medicine at an enhanced level to meet the needs of the child, the adolescent, the adult and the elderly;

• consists of distance learning, face-to-face workshops, quarterly tutorials and 3 Family Medicine practice skills courses.

Combinations

These programmes are based on a modular system with significant components of distance learning. Participants are only required to attend minimum hours of workshops, lectures, practical sessions and other scheduled sessions. They are provided with reading materials and assignments/tasks to be completed at their own convenience. Assessments and examinations are also held regularly to evaluate the participants’ performance. Pre-assigned supervisors assist the participants in their studies and monitor their progress.

The distance learning component is vital in these graduate diploma programmes as the majority of participants are medical officers and private general practitioners with busy schedules. Distance learning enables participants to plan their own study time, fitting it around their clinical work. Distance learning also allows a free choice of study venues, thus saving participants’ travelling time and boosting convenience.

Self-paced learning allows participants of different calibre to pursue the same course. The slow learners will not be stressed for trying to keep up with the pace of the class, while the fast learners will not be hindered by their peers. Participants proceed from one module to another at a speed that is most comfortable and suitable for them.

The flexibility in time and venue is not only advantageous for the participants, but also the teachers. Most teachers of the graduate diploma programmes are medical professionals with other commitments (e.g. clinical duties, research, other teaching obligations). With distance learning, teaching materials can be prepared at their own convenience and delivered to the participants in the most efficient manner (e.g. via postal/courier services, internet communications, facsimile, video conference).

By not being tied down to fixed times and venues, a large pool of resources is unlocked. Expertise from all over the world can be tapped upon, information can be discussed and notes be exchanged. Coupled with strict monitoring, these factors ensure up-to-date and high-quality education materials.

Although the information is obtained internationally, local teachers can structure the information to be of greater relevance to the local settings. As the participants are pursuing the course locally, they are able to apply the knowledge gained from foreign resources (through distance learning) into their own settings.

Taking advantage of the flexibility of distance learning, the medical graduate diploma programmes in Singapore can in fact be offered to foreign medical professionals who have difficulties travelling to Singapore or leaving their job for an extended period. However, the implementation of such programmes at the current moment is not possible because many limiting factors (e.g. partnership with foreign medical institutions, accreditation of consultants who can supervise the ‘hands-on’ clinical component where the course participants are practising) are still under review. Foreigners who wish to pursue the graduate diploma programmes still have to travel to Singapore periodically for practical sessions that require their physical attendance. Nevertheless, we hope to implement the following in the near future:

• interactive assessment such as online clinical quizzes;

• interactive discussions between teachers and course participants as well as amongst course participants;

• links with foreign medical institutions which can provide ‘on-site’ clinical supervisors.

The Way to Go

Despite its many advantages, the distance learning component cannot be conducted solely without being combined with the traditional teaching/learning methods. Medical studies in Singapore still put much emphasis on the hands-on clinical practice sessions and examinations. Face-to-face interaction still plays an important role in the passing of knowledge from teachers to students, especially in patient management issues such as ‘communication skills’ and ‘bedside skills’. Hence, distance learning is used as a complement to the traditional teaching/learning methods, instead of being a replacement. Striking a balance between traditional learning and teaching methods and distance learning is the way to go.