Institution In Singapore Research Articles

Inclusive Transnational Education Partnerships: A Case Study of a Master of Arts in TESOL Program

Recent nationalist and isolationist policies coupled with travel restrictions have prompted a shift in perspectives on the internationalization of higher education. Furthermore, criticisms surrounding issues such as the widespread adoption of English as a medium of instruction in higher education and quality assurance of transnational programs have emerged, with increasing calls for more inclusive models and greater emphasis on quality over quantity. This paper presents an evaluative study of a transnational Master of Arts in the Teaching of English to Speakers of Other Languages (MATESOL) program delivered in partnership by an institution in Singapore (SI) and a university in New Zealand (NZU) and designed for English language teachers from the Association of Southeast Asian Nations (ASEAN) region. Drawing on an impact evaluation, the paper identifies key design features in the program that contributed to its effectiveness as an inclusive model of English medium instruction (EMI) and internationalization in transnational higher education (TNHE).

Applying team-based learning in a transnational post registration bachelor of nursing program in Singapore

BackgroundTeam-Based Learning (TBL) is growing in popularity as a method to create active learning within larger group lectures. It is facilitated through phases of individual work, teamwork with immediate feedback and an application exercise, to develop students’ understanding and assessment of conceptual knowledge. A single facilitator can manage many groups within larger lectures. The study aim was to evaluate the impact of TBL on the engagement, learning and satisfaction of students enrolled in a transnational post registration Bachelor of Nursing (BN) program in Singapore.MethodsA cross-sectional design was employed. The TBL approach was delivered during lecture sessions within a post registration BN program delivered in a Higher Education Institution in Singapore. A sample of BN students was drawn from 305 students undertaking the program. An online anonymous university-delivered student evaluation of course (SEC) survey and an online anonymous survey using the Student Assessment Instrument, were used to collect quantitative and qualitative data. Survey participation was voluntary with informed consent protocols followed. Student performance in the course was also reviewed.ResultsEighty-two students (27%) completed the SEC scoring a median of 4/5 for satisfaction, and 68 (22%) completed the online survey. As 93 was the neutral score for the survey, there was a moderately positive evaluation with an overall score of 108.5/155 for TBL in accountability for learning, TBL preference and satisfaction with TBL compared to traditional lecture approaches.ConclusionsImplementation of TBL with this cohort demonstrated evidence of moderately positive engagement, learning and satisfaction when compared to traditional didactic lectures.

A Pilot Study of External Counterpulsation on Reactive Hyperemia, Levels of Glycemia and Metabolic Parameters in Type 2 Diabetes Mellitus

Introduction: External counter-pulsation (ECP) involves cuff inflation over the lower extremities to generate sheer stress, thereby improving endothelial function and anginal symptoms in coronary artery disease. Endothelial dysfunction is also involved in the pathogenesis of T2DM. We hypothesized that 1) ECP will be associated with an improvement in endothelial function in T2DM as measured by peripheral artery tonometry, and 2) explored whether this would vary with different dose and frequency regimens. A shorter or less intensive regimen could potentially reduce cost and improve patient compliance if a similar therapeutic response is achieved. Methods: This single-center prospective study in a tertiary institute in Singapore involving 46 adults with T2DM of HbA1c between 7 to 10%, who were randomly assigned to receive 35 sessions of ECP at different regimens and duration. Subjects in arm 1 received 1-hour daily sessions 5x per week for 7 consecutive weeks, subjects in arm 2 received 0.5-hour sessions 5x per week for 7 consecutive weeks, and subjects in arm 3 received 1-hour sessions 3x per week for 12 consecutive weeks. Endothelial function was evaluated by reactive hyperemia index (RHI) via peripheral arterial tonometry measured at the start, midpoint and end of study. Other secondary outcomes included fasting glucose, homeostatic model assessment of insulin resistance (HOMA-IR), HbA1c, blood pressure, lipid profile, weight and vibration sense. Results: 42 subjects completed the 35-session course of ECP. Mean age was 56.1±9.3 years, duration of diabetes 8.8±4.7 years, baseline RHI 2.0 (1.3–3.7) and baseline HOMA-IR was 3.1 (0.5–18.7). All regimes of ECP were well-tolerated. There was no change in RHI across all 3 regimens of ECP individually or collectively at the end of the study (ΔRHI +0.01%, p=0.458). Glycaemic markers of fasting glucose, HbA1c and HOMA-IR, as well as blood pressure, lipid profile, weight and vibration sense also remained unchanged at endpoint. Subgroup analysis showed a significant improvement in RHI (ΔRHI +20.6%, p=0.0178) in 7 subjects with more severe endothelial dysfunction (defined by RHI<1.67) at baseline who had a trend to having a longer duration of diabetes, however there was no improvement in fasting glucose, HbA1c, HOMA-IR or metabolic parameters in this group. Conclusion: ECP did not show a beneficial effect on endothelial function, glycemic control or metabolic parameters in this South-East Asian population with T2DM at any of the three regimens. This may partly be explained by less severe endothelial dysfunction and less insulin resistance in our population at baseline. Future studies of ECP may investigate its potential benefits in a larger population of T2DM with more severe endothelial dysfunction, higher insulin resistance and/or longer duration of diabetes at baseline.

Cost-effectiveness analysis of the nonavalent human papillomavirus vaccine for the prevention of cervical cancer in Singapore

BackgroundThe nonavalent human papillomavirus (HPV) vaccine has been shown to extend protection against oncogenic HPV types 31/33/45/52/58 (HPV-OV) not covered by the bivalent and quadrivalent HPV vaccines. Besides its clinical benefit, evidence on the economic value of the nonavalent vaccine is required to inform local vaccination strategies and funding decisions. This study evaluated the cost-effectiveness of replacing the bivalent vaccine with the nonavalent vaccine in the national school-based HPV vaccination programme in Singapore. MethodsAn existing age-structured dynamic transmission model coupled with stochastic individual-based simulations was adapted to project the health and economic impact of vaccinating 13-year-old girls with two doses of the nonavalent or bivalent HPV vaccines in Singapore. Direct costs (in Singapore dollars, S$) were obtained from public healthcare institutions in Singapore, while health state utilities were sourced from the literature. Incremental cost-effectiveness ratios (ICERs) were estimated over a lifetime horizon, from a healthcare system perspective. Probabilistic sensitivity analysis was performed to obtain the ICERs and corresponding variations across variable uncertainty. Particularly, this study tested the scenarios of lifelong and 20-year vaccine-induced protection, assumed 96.0% and 22.3% cross-protection against HPV-OV by nonavalent and bivalent vaccines respectively, and fixed vaccine prices per dose at S$188 for nonavalent and S$61.50 for bivalent vaccines. ResultsCompared with the bivalent vaccine, the use of the nonavalent vaccine was associated with an ICER of S$61,629 per quality-adjusted life year gained in the base case. The result was robust across a range of plausible input values, and to assumptions regarding the duration of vaccine protection. ConclusionGiven the high ICER, the nonavalent vaccine is unlikely to represent a cost-effective option compared with the bivalent vaccine for school-based HPV vaccination of 13-year old female students in Singapore. Substantial price reductions would be required to justify its inclusion in the school-based programme in the future.

Appropriate attitude promotes mask wearing in spite of a significant experience of varying discomfort.

BackgroundDespite increasing evidence to support mask effectiveness in mitigating the spread of COVID-19, there is still raging controversy regarding the use of masks. Evaluation of public perceptions, attitudes and the individuals’ experience towards mask-wearing is integral to ensuring reasonable compliance and allows authorities to address concerns held by the population.MethodsA cross-sectional survey of lay-people was conducted within a high volume tertiary level institution in Singapore, from 16 October to 16 November 2020. Surveys administered evaluated five questions: 1) duration of mask wear per day, 2) mask-type used, 3) perceived necessity, 4) discomfort level experienced and 5) causes for discomfort.ResultsOut of 402 respondents, 67.2% primarily wore disposable surgical masks. 72% felt mask-wearing was necessary to control COVID-19 transmission. 78.4% reported discomfort while wearing masks, with mean discomfort levels of 4.21 out of 10. Impairment to breathing and communication difficulties were the most common discomforts faced. Younger respondents complained of higher incidence of dermatological issues and sweating (p < 0.05). Respondents who wore masks for longer duration reported higher incidence of dermatological issues (p = 0.001) and sweating (p = 0.032).Conclusion and RelevanceEven with an available vaccine, adjunctive public health measures such as mask-wearing will likely continue in order to curb COVID-19 transmission. Experience from past pandemics is likely to propagate self-protective behavior within a community. Our study identified several common mask-wearing discomforts, allowing respective organizations valuable market feedback for research and development. With appropriate public attitudes, effective mask-wearing compliance can be attained in a concerted effort against the coronavirus.

University engagement to improve safety education

AbstractWith major hazards installations regulatory framework implemented in Singapore, taking effect from September 2017, the chemical and pharmaceutical industry needed to build up its capabilities to demonstrate to regulators how risks from major accident hazards in the premises can be reduced to as low as reasonably practicable. Specialist Certificate in Process Safety was initiated after discussion between Singapore Institute of Technology and Pfizer. It was established that there was a need to harmonize process safety training across the industry and a need to train process safety practitioners to build up in‐house capability to meet the new standard. After the discussion with Pfizer on their needs, a program outline was drafted and subsequently sent to Pfizer's process safety subject matter experts for comments. Upon receiving their feedback, the Process Safety Workshop Series for Pharmaceutical Industry was developed. The training pedagogy for this workshop integrated hands‐on learning at the workplace by collaborating with the company for plant walk‐throughs of relevant areas during the workshops. In addition, the fundamental topics from the workshops were integrated into the BE Pharmaceutical Engineering's Process Safety Module to ensure new engineering graduates entering the pharmaceutical industry have basic process safety skills needed by the industry.

THE EFFECT OF COVID-19 TO ISLAMIC EDUCATION IN SINGAPORE (THE EXPERIENCE OF MUHAMMADIYAH ISLAMIC COLLEGE)

This paper aims to determine the effect of Covid-19 which is currently hitting the entire world with a very high mortality rate in the world of education, especially the Islamic Education Institution in Singapore, namely the Muhammadiyah Islamic College. With a qualitative method and a literature review approach through the official website of the Singapore government, it was found that MIC took a policy to conduct online learning through zooming and changes to the student evaluation system. With the current excellent acceptance of online learning, it is hoped that an online-based international Islamic university will be built.

Erratum to: Prevalence of positional obstructive sleep apnoea (OSA) among patients with OSA in a tertiary healthcare institution in Singapore.

Erratum to: Prevalence of positional obstructive sleep apnoea (OSA) among patients with OSA in a tertiary healthcare institution in Singapore.

Factors Associated with Intended Postpartum OGTT Uptake and Willingness to Receive Preventive Behavior Support to Reduce Type 2 Diabetes Risk Among Women with Gestational Diabetes in Singapore: An Exploratory Study.

Aim:To assess and explore the factors affecting willingness to undergo an early postpartum oral glucose tolerance test (OGTT) and receive postpartum lifestyle modification assistance.Methods:An explanatory sequential mixed-method design was used. A prenatal cross-sectional survey questionnaire (n = 216) was given to women diagnosed with GDM in a tertiary health institution in Singapore and followed up with postpartum semi-structured interviews (n = 30). Multivariate logistic regression and thematic analysis were conducted before merging the findings.Results:Despite universal GDM education, fewer than 75% intended to take the OGTT postpartum, and only 63% felt it was very important. The plan to take the OGTT postpartum was positively associated with a prenatal care provider’s specific recommendation. In contrast, Malay women were less likely to take the test. Most women interpreted a care provider’s recommendation as implying standard practice, which encouraged intended and actual compliance with testing after giving birth. The perception of moderate to high T2DM risk in the following decade, and subsidized prenatal care, and plan to take the OGTT postpartum were positively associated with willingness to receive postpartum lifestyle behavior support. A mobile application was the preferred method to receive support.Conclusions:In the early postpartum period, women with a history of GDM were willing to receive measures to reduce T2DM risk, primarily if it was under the supervision and recommendation of a care provider. A carefully designed but simple postpartum lifestyle intervention incorporating these preferences that can be integrated into mainstream diabetes prevention programs is warranted.

Real-Time OEE for Industry 4.0 Learning and Practice Training

Overall Equipment Effectiveness (OEE) is a well-established KPI metrics to measure the equipment effectiveness. OEE has been widely used for many industries as a quantitative tool for measuring of productivity. Singapore institute of manufacturing technology (SIMTech) designs the “Real-Time OEE for Industry 4.0 implementation and OEE improvement” training program using Learn-Practice-Implement (LPI) model. The learner could practice OEE implementation in Model Factory@SIMTech before actual implementation at customer site. This paper presents the training methodology and the benefit of the training program.

Understanding the Psychosocial Needs of Women who Present with Advanced Breast Cancer

Advanced breast cancer (ABC) remains common in Singapore. In 2019, 22.1% of breast cancer patients presented with ABC in our institution. Despite increasing affluence and the advent of national mammographic screening, the incidence of ABC has not changed significantly. This suggests inherent differences in women who present late. We aim to explore the socio-economic background, knowledge and attitudes of women who present with ABC. Between December 2013 and July 2015, 100 patients who presented consecutively with ABC in a tertiary institution in Singapore were recruited to participate in an interviewer-led questionnaire exploring psychosocial and economic issues. Among the 100 patients, 63 and 37 presented with stages 3 and 4 breast cancer respectively. Median age was 57 (27-86), 52% had at least secondary education, 53% had no formal employment and 71% were married; 88% were aware of breast cancer symptoms, 82% were aware that mammography can help detect cancer, 82% believed that current treatment modality for breast cancer is effective, 96% had never undergone a mammography and 52.9% felt mammograms were unnecessary. A total of 64% presented symptomatic from the breast tumour, with a median duration of 3 months. Many of the patients were aware of breast cancer symptoms and the utility of mammography. However, a group of patients did not comply with screening. This may be due to poor understanding about breast screening and detection in its asymptomatic phase. Further public education to improve understanding of breast cancer and screening mammography may help to improve rates for earlier detection of breast cancer.

Prevalence of positional obstructive sleep apnoea (OSA) among patients with OSA in a tertiary healthcare institution in Singapore.

Prevalence of positional obstructive sleep apnoea (OSA) among patients with OSA in a tertiary healthcare institution in Singapore.

Dialogic discussion as a platform for constructing knowledge: student-teachers\u2019 interaction patterns and strategies in learning to teach English

Beginning teachers are frequently heard making observations that the knowledge and skills they have acquired on the training programmes do not come handy when they want to apply them in their real-work situations. They have also reported lacking the ability to integrate theory and practice in reality. Henceforth, teacher-educators are faced with challenges of how to proportionally balance the two strands of pivotal knowledge that are necessarily connected with teacher-education curricula in pre-service teacher preparation. One of the approaches to examining the issue is to investigate student teachers’ dialogues for knowledge-construction to uncover the interaction patterns and strategies they use in negotiating lesson objectives and processes. Against such a background, this paper reports on a study of 24 student teachers receiving training in English language teaching on the Postgraduate Diploma in Education programme at a teacher education institution in Singapore. It was intended to find out the negotiation processes in relation to lesson-planning objectives and how student teachers positioned themselves and others in the processes in the pre-service teacher-education classroom. Results show that student teachers were more concerned about surviving the first lesson than about promoting pupil learning in constructing knowledge about language teaching. The stronger peers’ dominance in the discussion process was taken for granted, suggesting that learning took place in a mutually beneficial and constructive manner and that student teachers’ willingness to cooperate and readiness to express themselves were indicative of their intention to maintain group cohesion and dynamics. These, in turn, are necessary prerequisites for student teachers to become collaborative and reflective practitioners.

Fish bone ingestion presenting to a local institution in Singapore.

Fish bones are the most commonly ingested foreign bodies in Singapore, accounting for up to 83.9% of ingested foreign bodies.(1) The use of chopsticks to consume fish, the personal habit of deboning fish in the mouth and denture usage in the elderly have been described as risk factors for the ingestion of fish bones.(2) The first line of investigation after ingestion of fish bones would include plain radiography, but this was shown to have poor sensitivity of 23.5%–54.8%(3-5) and false negative rates of up to 40%.(6) An alternative radiological modality would be the barium study, but it is limited by its false negative rate of 40%–50%.(7) Furthermore, barium contamination can render subsequent examination and removal of the ingested fish bone more technically challenging. Therefore, the current gold standard radiological modality for diagnosis is fine-cut computed tomography (CT), which not only confirms the diagnosis and reveals associated complications but also boasts a superior sensitivity of 90.9%–100%.(4,5,8) One should, however, note the caveat that the use of oral or intravenous contrast during CT can obscure the presence of a fish bone.(8,9) Hence, for a patient with a high index of suspicion for fish bone ingestion, the ordering clinician should specifically communicate with the radiologist on the indication as well as the need for a non-contrast scan. After the diagnosis of fish bone ingestion, endoscopic removal using laryngoscopy or oesophagogastroduodenoscopy (OGD) is usually sufficient in most cases, with surgery only required in less than 1% of patients. We herein present a series of patients who ingested fish bones and presented to a local tertiary hospital in Singapore, discussing the associated complications based on the location in the gastrointestinal tract where the bones were impacted.

Short-Course Systemic and Topical Non-Steroidal Anti-Inflammatory Drugs: Impact on Adverse Renal Events in Older Adults with Co-Morbid Disease.

Prolonged systemic non-steroidal anti-inflammatory drugs (NSAIDs) have been associated with adverse renal outcomes among older adults. However, there is scant data regarding the renal safety of topical and short-course systemic NSAIDs. We aimed to evaluate the risk of acute adverse renal outcomes among older adults prescribed topical and short-term systemic NSAIDs. We conducted a retrospective cohort study of all older adults, age 60 years and above, who received prescriptions between July 2015 and December 2017 from the largest tertiary hospital and a major public primary care institution in Singapore. Data from 6 months before until 30 days after the first prescription were retrieved from electronic medical records. The primary outcome was the incidence of acute kidney injury (serum creatinine increased >26.5 µmol/L or >50% from baseline) and/or hyperkalemia within 30 days. A multi-variate analysis taking into account age, sex, co-morbidities, baseline-estimated glomerular filtration rate and serum potassium, NSAID route of administration, and concurrent renin-angiotensin-aldosterone system blocker and diuretic prescription was performed to evaluate factors associated with the primary outcome. We identified 12,773 older adults with incident prescriptions: 3982 (31.2%) received short-course systemic NSAIDs, 3784 (29.6%) received topical NSAIDs, and 5007 (39.2%) did not receive any NSAID. Both short-course systemic NSAIDs (adjusted odds ratio [OR] 1.59, 95% confidence interval [CI] 1.41-1.80, p < 0.001) and topical NSAIDs (adjusted OR 1.48, 95% CI 1.31-1.67, p < 0.001), compared with the no-NSAID group, were independently associated with the primary outcome. Among older adults with co-morbid conditions and prescribed NSAIDs, topical NSAIDs had a reduced odds of 30-day incident acute kidney injury and/or hyperkalemia in diabetes mellitus (adjusted OR 0.78, 95% CI 0.65-1.06, p = 0.007), chronic kidney disease (adjusted OR 0.74, 95% CI 0.60-0.90, p = 0.003), and cardiovascular disease (adjusted OR 0.54, 95% CI 0.37-0.79, p < 0.001), compared with short-course systemic NSAIDs. NSAIDs increased the risk of acute adverse renal events. Topical NSAIDs, compared with short-course systemic NSAIDs, were associated with a reduced incidence of acute kidney injury and/or hyperkalemia among older adults with additional risk factors.

Comparison of Outcomes of Intra-operative Neuromonitoring of Recurrent Laryngeal Nerve Versus Visualisation Alone during Thyroidectomies: A Singapore Experience

Although intra-operative neuromonitoring (IONM) has become commonly used to identify the recurrent laryngeal nerve (RLN) during thyroid surgeries, its value is still debatable. This study aimed to evaluate the outcomes of thyroid surgery using IONM versus visualisation alone (VA). We conducted a retrospective analysis of all the open thyroidectomies performed by the otolaryngology department in a tertiary institution in Singapore (Khoo Teck Puat Hospital) from 1 January 2014 to 31 December 2018. There were 301 nerves-at-risk (NAR), 139 in the IONM group and 162 in the VA group. The primary outcome measure was the incidence of RLN injury and the secondary outcome measure was operative duration. There were 33 NAR with immediate post-operative RLN injury, of which 7 had permanent (>6 months) injury. There were minor improvements in the respective rates of immediate and permanent injury in the IONM group (7.9%, 0.7%) compared to the VA group (13.6%, 3.8%), but these were not statistically significant (P=0.14, 0.13). The average operative duration of total thyroidectomies in the IONM group was 37 minutes shorter than in the VA group, but the difference was not statistically significant (P=0.40). The current study shows that the use of intra-operative neuromonitoring shows a tendency towards better RLN outcome and operative duration for total thyroidectomies, but the study may be too small to demonstrate a statistical difference.

Limited efficacy of diphenylcyclopropenone in the treatment of alopecia areata: Experience from a Tertiary Healthcare Institution in Singapore

Alopecia areata (AA) is a common cause of nonscarring hair loss. Diphenylcyclopropenone (DPCP) is a form of contact immunotherapy used in the treatment of AA. We retrospectively reviewed all patients who were diagnosed with AA over a 4-year period (1st January 2012 to 31st December 2015) and who have received DPCP. Forty patients were studied in total. The mean duration of disease prior to the study was 195 days. Patients received a mean number of 14.91 sessions (range: 1-65). The mean number of sessions required before clinical response was seen was 2.33 sessions, corresponding to 0.001% DPCP. Based on the modified Global Assessment Grading System, 33.5% (n = 11) of the patients experienced less than 25% improvement, 48.5% (n = 16) experienced 25%-74% improvement and 18.3% (n = 6) experienced more than 75% improvement. One patient had severe sensitisation reaction amounting to near erythroderma which resolved completely upon cessation of DPCP therapy. No other adverse reactions were noted in the cohort. DPCP remains a valuable tool in a dermatologist's armamentarium in treating alopecia areata as it is safe, well-tolerated, and shows limited efficacy.

Safety and Tolerability of Sacubitril/Valsartan Initiation in Inpatient Versus Outpatient Setting: A Retrospective Real World Study

The Comparison of Pre- and Post-discharge Initiation of LCZ696 Therapy in HFrEF Patients After an Acute Decompensation Event (TRANSITION) and PIONEER-HF trialsa have shown that sacubitril/valsartan can be initiated early and safely in patients with heart failure with reduced ejection fraction (HFrEF) shortly after an acute heart failure episode during hospitalisation. However, it is unclear whether the results can be translated to Asian populations. Hence, this real-world study was designed with the aim of comparing the safety and tolerability of sacubitril/valsartan initiation in an inpatient versus outpatient setting. A retrospective review for all patients initiated with sacubitril/valsartan from 1 November 2015 to 30 September 2018 was conducted in a tertiary health care institution in Singapore. Patients with HFrEF and aged ≥21 years were included. Incidence of adverse drug reactions (ADRs) and discontinuation rate of sacubitril/valsartan were compared between initiation of sacubitril/valsartan in inpatient and outpatient settings. Reasons for discontinuation were investigated. Subgroup analysis was performed. Cox regression was used to analyse the primary outcomes. Of the 1,022 patients who were screened, 840 (289 inpatient group; 551 outpatient group) were included. The inpatient group experienced significantly higher ADRs (34.6% vs 22.7%; adjusted hazard ratio [HR], 2.28; 95% confidence interval [CI], 1.68-3.10; p<0.01) and discontinuation rate (18.0% vs 10.3%; adjusted HR, 2.11; 95% CI, 1.37-3.26; p<0.01) than the outpatient group. The safety outcomes were consistent across all the subgroups. Initiation of sacubitril/valsartan in an inpatient group was associated with higher ADRs and discontinuation rate as compared with an outpatient group in an Asian population. However, given that the majority of patients in the inpatient cohort could tolerate sacubitril/valsartan, it would still be feasible to initiate this drug with close monitoring. Further randomised clinical trials in Asian populations are required to confirm this finding.

Enablers and Barriers of a Cross-Cultural Geriatric Education Distance Training Programme: The Singapore-Uganda Experience.

Background: By 2050, 80% of the world’s older population will reside in developing countries. There is a need for culturally appropriate training programs to increase awareness of eldercare issues, promote knowledge of how to better allocate resources to geriatric services, and promulgate elder-friendly policies. A monthly distance geriatric education programme between a public hospital in Singapore and health institute in Uganda was implemented. This study explored the enablers and barriers to the delivery of culturally appropriate geriatric education programmes via a videoconferencing platform. Methods: We conducted 12 in-depth interviews with six teachers from Singapore and six learners from Uganda. The interviews were audio-recorded, transcribed and analyzed using an inductive thematic approach to analysis with the aid of the NVivo software. Results: Enablers included inter-personal real-time interactions between teachers and learners whereas misaligned perceptions of cross-cultural differences between Singaporean teachers and Ugandan learners were a barrier. Rapport building, teacher motivation and institutional support were perceived to contribute to the programme’s sustainability. Overall, Ugandan learners perceived that the training improved knowledge, skills, attitude and practice of geriatric care. Participants suggested that future initiatives consider aligning cross-cultural perceptions between partners, conducting a training needs analysis, exploring complementary modes of information dissemination, and allotting time for more interaction, thereby reinforcing mutual sharing. Adequate publicity and appropriate incentivisation may also better sustain the programme. Conclusions: Our findings suggest that cross-cultural training via a videoconferencing platform was feasible. Our results inform planners of future distance educational programmes of how to improve standards of cross-cultural competency and forge promising international partnerships.

Full-Dress Rehearsals with Actual Non-Infected Patients Builds Confidence and Familiarity – An Experience from Singapore during the COVID-19 Pandemic

Purpose COVID-19 has spread throughout the world with merciless pace. Personal protective equipment (PPE) is required to protect healthcare workers from contracting the virus. The authors evaluated the use of full-dress rehearsals (FDR) to familiarize staff with protocols and equipment that are not often use otherwise. Methods A single institution in Singapore performed FDR with noninfected patients for endoscopy after refresher courses with PPE were conducted. FDRs were conducted between February and March 2020, during the initial phase of the COVID-19 outbreak. The FDRs involved all phases of endoscopy. Statistics from the FDRs were compared against baseline procedure statistics. A self-administered survey was conducted for the procedurists after the FDRs. Results A total of 26 FDRs were conducted and 20 (77%) completed the survey. Among all the FDRs conducted, there was a slight increase in duration for colonoscopy FDRs (21.5 min vs 20.0 min, p = 0.22). There were no complications. All respondents had a good experience (score rating of 4-5/5). On qualitative analysis, the themes identified were: FDRs provided a good opportunity to have hands-on familiarization of the equipment on top of routine refresher training. Participants were cognizant of the ongoing outbreak and the evolving threat. Safety measures were reinforced. Procedurists who acknowledged weaknesses, requested for more training. Conclusions Simulation training with patients provides participants with a level of realism that is critical for rapid learning. In crisis management, the most effective protocol familiarization is important to instill confidence in the PPE, workflows and healthcare partners.