Leadership in Health Professional Education: Case Study Report

This report delves into the complexities of leadership in health professional education, using the Duke-NUS Graduate Medical School as a case study to illustrate change management strategies. It examines the collaboration between the National University of Singapore (NUS) and Duke University School of Medicine (Duke Med), highlighting the challenges and successes of transplanting Duke Med's curriculum. The report analyzes the conceptualization of change, organizational change management, and the application of these concepts within an educational setting. It further explores leadership and change theories relevant to the case, discussing the impact of collaborations on funding, staffing, and curriculum development, while also addressing potential complications such as cultural adjustments and the importance of long-term sustainability. The report emphasizes the significance of adapting to changing circumstances and the benefits of international collaborations, including research opportunities and faculty exchanges. The report also discusses the failure of a previous collaboration between the government of Singapore and John Hopkins University. The report concludes by summarizing key points and limitations of the study.

Running head: LEADERSHIP IN HEALTH PROFESSIONAL EDUCATION
Leadership in Health Professional Education
Name of the Student:
Name of the University:
Author Note:

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Table of Contents
Introduction......................................................................................................................................2
Conceptualization of change and change management...................................................................2
Application of the issue in educational setting................................................................................5
Leadership and change theories for the analysis of the paper.........................................................7
Summary of the key points and the limitations of the paper.........................................................12
Reference.......................................................................................................................................15

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Introduction
Change management can be described as a systematic approach that deals with both the
transformation and the transition of an organization’s technologies, processes and goals. The
main purpose of the change management it to execute the strategies for the purpose of helping
people to adapt to the change and controlling the change. Companies that take up the change
management faces a lot of challenges (Hayes, 2014). The thorough understanding of the
company culture is essential. In this study, a case study based on the Duke-NUS Graduate
Medical School is taken into account for the purpose of conceptualizing the change management.
Conceptualization of change and change management
National University of Singapore (NUS) and Duke University School of Medicine (Duke
Med) collaborated together to form Duke-NUS Medical School. The main reason for the
collaboration was the transplantation of a medical curriculum of Duke Med is to be transferred to
a new medical school located in Singapore. There was an earlier collaboration between the
Government of Singapore and John Hopkins University but it was a failure. Thus, there was
much scepticism regarding the transplantation to a new medical school which is called the Duke-
NUS Graduate Medical School. This graduate medical school also have the responsibility of
choosing the best learning model and education to serve its purposes. The some of the aims of
the collaborations are: how the graduates will do after they complete the graduate program? will
the graduates pursue their career as the clinical scientists?
Thus, the collaboration itself is viewed as a change and change management in the paper.
The main aspects of the change management lie in the way the Duke-Nus graduate medical
school will take into account the various aspects of change due to the collaboration and the

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transplantation of Duke-Nus into a new medical school in Singapore. Due to the previous
difficulties faced during the collaboration of the John Hopkins University and the government of
Singapore that occurred in the year 1998 and the collaboration failed in the year 2006. The main
purpose of the collaboration of the collaboration was to take education and research to a higher
new level. The John Hopkins University was unable to deliver 8 out of the 13 performance
indicators which include the developing the graduate students and filing of patents. There were
claims by John Hopkins University that the government of Singapore was not able to stand by its
commitment and was not able to fulfil the financial and educational obligations that were the
core of the partnership. There were issues regarding the expectations that resulted in conflicting
expectations between the government of Singapore and John Hopkins University. The
government of Singapore thought that John Hopkins University will send reputed scientists so
that they can attract approximately 12 PhD students. While the main issue is that John Hopkins
University has sent young and comparatively inexperienced researchers.
Considering the failure encountered in the previous John Hopkins University and
Government of Singapore collaboration. The Duke-NUS collaboration took a time period of 5
years in order to iron out the differences. The major decision taken up by faculty members of the
Duke-NUS is to frame a totally new kind of curriculum that will suit the local requirements,
instead of adopting the entire curriculum of Duke-NUS in Singapore. The faculty members also
took the decision of keeping both the curriculum as similar as possible after observing the Duke
Med courses in the United States. However, there were concerns regarding whether the
collaboration will work out or not. The physicians also shared their concern regarding whether
the 4-year curriculum was potential enough to produce a highly competent doctor-researcher.
The major cause of concern was that in Duke-NUS the medical education was based on the

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American model of post-baccalaureate. The course details reveal that students in the first year
will be completing the basic science courses. In the second year, the students will undergo
clinical rotations and in the third year, the students will devote to independent research. The
different areas of specialization will be considered by the students in their fourth year. The
students after completing their bachelor’s degree will embark on the medical studies.
Singapore’s national neuroscience institute’s director has questioned that whether the graduates
of the Duke-NUS that follows a 4-year program will be on par with the three-year course offered
by the NUS’s Yong Loo School of Medicine. It was also pointed out that there involves a high
cost of cultivating the medical researchers and it is also important to note that the results of the
medical research were not guaranteed. There is a cause of concern that the economy of U.S is
able to bear the cost associated with the biomedical research, however, the problem is that
Singapore's economy is not capable of attempting the same on a smaller scale. The question that
arises here is whether the Duke-NUS GMS will be able to deliver the required number of the
clinical scientists that Singapore needs. The dean of the NUS YLLSoM opined that the
healthcare professionals of Singapore wanted to have another school based on the North
American model and it will play a complementary role instead of competing against each other.
There is a hype regarding the Singaporean’s substantial investment in the biomedical sciences.
However, it is important to note that the for the purpose of the translational and the clinical
research space, time and money is required for creativity. There is a no room for any kind failure
as it will render the clinical scientists and the disillusioned doctors jobless as no overseas
employers will be eager to employ them.
The change management and the concept of change are in accordance with the case study
provided relies on the fact that change management is a collective term and it incorporates the

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organizational change. In accordance to the collaboration and the transplantation the institutions
are undergoing the changes and thus it needs to incorporate changes in the modes of operation,
budget allocation, business processes and redefining the allocated resources (Van der Voet,
2014). The change management occurring here is an organizational change management and
thus it takes into account the changes occurring within the whole organization. In order to bring
some changes in the education system, the organizations are either collaborating with the other
educational institutions or the educational institutions are collaborating with the government so
that they can receive exclusive funding from the government (Moore, 2013). It is also important
to note that when there is a collaboration between two educational institutions there comes a
point where the institutions recognise to incorporate required change management strategies. The
change management strategies rely mostly on revamping the existing structures that exist with
the institution (Cameron & Green, 2015).
Application of the issue in an educational setting
The issue discussed in the paper is a common problem that occurs when the educational
institutions undergo collaborations with the other educational institutions or collaborations with
the governments. The educational institutions of a country offer a wide range of courses and
especially the medical schools are often considered the premier institutions. Thus, the medical
institutions require a lot of funding for the purpose of training the medical students in the
medical field. The courses are either 3 years or 4 years and it also involves the teaching and
training the students with the live samples, expensive medical equipment and top-class faculty.
Considering the burden of such medical institutions, these institutions often undergo
collaborations with collaborations so that they can receive the funding in order to carry out the
medical experiments and researchers through the usage of the equipment.

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Universities in one country are also found to collaborate with the foreign universities and
laboratories. It is often seen that due to the lack of proper government funding the universities in
the poor countries are unable to properly conduct the research at the doctoral level. Thus, the
lack of the expensive research equipment is compensated by collaborating with the foreign
universities that are either located in the developed countries or with the famous laboratories that
suffice the needs of the students. In order to conduct the high-level research, the materials
required for conducting the researchers are often not available in the home country. Thus, the
home universities often send their research fellows to the foreign laboratories and universities for
the purpose of completing the research by using the resources that are available in the foreign
countries. The collaborations that take place between the universities of two countries act as a
support system for the for the universities that are located in the poor country. The collaboration
leads to certain changes in the universities located in the home country. It is a fact that one in
five scientific journals published internationally is always co-authored internationally. Due to
this, the expansion in the communication methods, and the ease of doing the international travel,
researchers and the academicians are finding it easy to collaborate with the foreign counterparts.
This enhances the exchange of the academic ideas in an organized and simpler way. The ability
to share the experience, debate and scrutinize the scientific and the academic accomplishments
has led to the collaborations with the foreign universities. The partnerships have led to the
endless scientific and academic progress.
Going into foreign university collaborations, there are certain complications like the universities
must only pursue the partnerships that they are able to endure in the long run. Developing a
successful relationship with the foreign universities takes plenty of time and this includes
understanding the goals and culture of the institutions of each other. It is also important to note

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that building a strong relationship takes a long time and it involves an understanding and getting
a note of the compatibility issues of standards and ethics. The collaborations also impact the
individual universities and it includes the funding and staffing in the individual universities. The
collaborations also lead to change of the laws and governance in a specific country. In this light,
it is also important to note that the university partnerships and collaborations must be able to
adapt and survive the changing circumstances.
The universities often provide the students with plenty of opportunities for the students.
Along with the benefits of opportunities for research, the foreign institutions also offer the
international experiences like staff exchanges. There are other exclusive benefits like the
curriculum benefits that come into context due to the collaboration with the universities located
in foreign countries. Often it is seen that the faculties of a university are not of top-notch quality
and require more experienced faculty. This faculty member work to enthuse and teach the
students in a different way that facilitate the students to get more inclined towards the research.
Collaborations are thus important in this area due to the fact that foreign faculties and the guest
lecturers often come as a blessing for the receiving universities. The foreign faculties bring with
themselves experiences and new teaching ways through both the university and the students gets
benefitted. The foreign faculties bring with themselves superior quality of the expertise in a
specialized field and this helps in modifying the existing curriculum of the receiving universities.
However, it is also important to mention that such foreign faculties often face challenges in
getting accustomed to the culture in the receiving universities. The existing teaching culture
sometimes might hinder the teaching process taken up by the foreign faculties.
Leadership and change theories for the analysis of the paper

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Change is found to be common in all the business thread and these models run through
the business irrespective of the size, age and the industry. The world now is ever-changing and it
must change quickly so that they can handle the changing situations. The concept of change
management is very common in most of the businesses today. This is even very similar to the
process of change and developing strategies so that the change can be dealt effectively (Brown,
2012).
The Lewin's change management model is described in 3 steps like the unfreeze, change and
refreeze. Unfreeze is the first stage and it includes the preparing the organization so that it can
accept the necessary changes. This stage exclusively deals with the breaking down of the
existing framework before the new system is build up. The main message that this theory reveals
is that existing framework can no longer be helpful for bringing the necessary changes to the
present system. This is the organization phase and the process is initiated from the core itself.
The challenges arise in the in the behaviours, values and beliefs. It is always a hard job to bring
changes to a system which already has an established way of doing things. The first stage of the
change theory is like forcing an organization to examine the core (Shirey, 2013). This has the
potential of creating a controlled crisis. This, in turn, can be helpful in building a strong
motivation and helps to attain a new equilibrium. The next stage is the change and it comes after
the stage of uncertainty which is created after the unfreezing stage. This is the change where the
people try to solve the uncertainties and look for innovative ways to do things in a new way.
People try to work so that to support the new direction. It is, however, important to note that the
transition from the unfreeze stage to the change stage cannot be accomplished in one day. People
require time so that they can embrace the change and participate proactively for the purpose of
acclimatizing the change (Cummings, Bridgman & Brown, 2016). It is also important to note

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that the in order to accept the change and make the change a successful one, it is necessary to
understand how the process will benefit them. communication and time are the two major keys
that are going to work successfully. In order to understand the changes, people need to feel that
they are connected highly with the organization throughout the transition period. The last stage is
the refreezing stage. This is the stage where the people have embraced the changes related to
new ways of working, then the organization is considered to be ready for refreezing. The
refreeze stage requires the help of the so that they can internalize and institutionalize the
changes. This also means that the changes are utilized at the time and are incorporated into the
everyday business. The new sense of stability has led to the people working in an organization
feel comfortable with the new ways of working (Hornstein, 2015).
The leadership theories have been the source of numerous types of the studies. both in
practice and reality, what has actually differentiated the authentic leaders from the mass. Thus,
there are different types of then leadership theories that are studied by the professors, researchers
and philosophers (Landis, Hill & Harvey, 2014).
Fielder’s contingency theory fits well with the context of the study. Fiedler’s contingency
theory is one of the leadership theory that states that the effective leadership is the style which
gives control over a situation. Thus, it requires and a good leader and member relation and a
clear view of the goals, task and procedures. The leader must have the ability to mete out the
punishment and the rewards. Lacking the essential qualities will lead to failure into a leadership
failure. The Fiedler's contingency theory states that effectiveness of a leadership depends upon
the situation and associated with it are numerous factors like type of the group being led, the
personality of the leader, nature of the task (Fiedler, 2015). The contingency theory emphasizes
on the ability of a leader to lead, psychological disposition and leader’s personality, also

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emphasizes on how the group receives the leader, how the tasks are being performed and how
the leader exerts control over the group. These factors play a deciding role in finding out success
of the leader. The three main situational factor according to Fielder are position power, task
structure, and leader-member relations. Position power- the organizational position of a leader
confers him with the power and lets him have the authority within the group members and this
authority or the power forces the group members to comply with the leadership and the direction
(McCleskey, 2014). Task structure describes the extent to which the group's task has been
described as unstructured and structured and it clearly depicts the extent to which the task can be
carried out in detailed instructions. The leader-member relations describe the degree to which the
leader is trusted by the group and the liked among the group members. It also shows the extent to
which the group members are willing to follow the guidance of the leader (Tyssen, Wald &
Spieth, 2013).
Considering the paper, it is important to note that there were initial uncertainties
regarding the collaboration of the Duke University of Medicine (Duke Med) and the National
University of Singapore (NUS). The vital area of concern is that the collaboration was occurring
because the medical curriculum of Duke Med was transplanted to a new medical school in
Singapore. There were initial uncertainties regarding the earlier collaboration of the John
Hopkins University with the Government of Singapore. The failure of the John Hopkins
University (JHU) to deliver in 8 of the 13 performance indicators like the development of getting
graduate students and filing patents. There were also certain other issues with respect to the
failure of Singapore government to fulfil the educational and the financial obligations in relation
to the partnerships. The other issue is that the Singapore government expected that the JHU will
send reputed scientists to Singapore to attract approximately 12 PhD students. Thus, it can be

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concluded that there have been some conflicting issues from the collaboration of the JH and the
Singapore Government and this led to the failure of the entire collaboration. This can be
effectively related to the paper where it has been mentioned that the in order to avoid the
mistakes made by the collaboration of the JHU and Singapore Government. The Duke-NUS
collaboration took a decision of allotting a five-year time period to sort out the differences. A
vital decision was taken which emphasized that instead of adopting the entire curriculum of
Duke Med in Singapore, the local faculty members found it beneficial to customize the course
that will suit the local requirements. While care was taken in framing the curriculum that
focussed on keeping it as similar as possible after observing the Duke Med courses in the United
States. This one of the incident which showcases effective leadership and it includes the
application of the contingency leadership theory. The decision taken by the leaders of the Duke-
NUS collaboration has led to an effective management style and averting issues that first caused
issues in the JHU and Singapore Government.
Some of the eminent leaders like Frank Starmer (associate dean), Sand Cook (senior
associate dean), Robert Kamei (Vice Dean) brainstorming led to the transplanting of the Duke
Med curriculum into Singapore also led to the development of the Duke-NUS GMS. One of the
important thing to note that Singapore required a major thrust into the medical education and the
leadership style taken up by Starmer, Cook and Kamei. The change management theories come
into play when the Duke-NUS GMS was first planned, it was originally thought that the
professor would regularly commute between the Singapore and United States so that the same
curriculum is taught at the Duke Med. This was, however, not considered due to the considerable
jet lag. Thus the other alternatives were considered in which recordings of the lectures were from

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the Duke Med were used in the Duke-NUS. This will enhance and customize the materials and
develop a new teaching approach.
A new strategy was considered for the effective study and this was a team-based learning
technique in which the student gets prepared in advance for the lectures and when the students
appear in class, they perform as teams. This was suggested by Kamei but however, he faced
challenges from the stakeholders. The issue was that the decision took up by Kamei which
reflects his leadership failed because Kamei faced challenges in convincing the stakeholders
regarding the value of the modified course.
Summary of the key points and the limitations of the paper
The key points raised in the paper are as follows:
 In the year 1998, John Hopkins University first went for a collaboration between
the Government of Singapore and the collaboration failed in the year 2006. The
collaboration was initially viewed as a perfect integration of education and
marriage in Singapore to a higher level. It has also been mentioned that the
collaboration is meant to allow JHU to establish its presence in the region.
 The JHU was, however, unable to deliver the 8 of the 13 performance indicators
that it was supposed to deliver and it included the developing the graduate
students and filing of the patents.
 A similar kind of collaboration called Duke-NUS medical school and this was
made between the National University of Singapore and Duke University School
of Medicine. The vital motive behind the collaboration was the application of the
medical curriculum into a new medical school in Singapore. The collaboration of

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the Duke-NUS the implementation of its curriculum into a new medical school in
Singapore led to the formation of Duke –NUS GMS.
 Different questions were raised due to the previous failure of the collaborations of
JHU and Government of Singapore. One of the major concern is that the
curriculum was based on the 4-year curriculum at the Duke-NUS and thus the
competency of the curriculum in Singapore was questionable. In the Duke-NUS
the American model of the post-baccalaureate of medical education was followed.
 One of the remarkable points in the paper is the information regarding the
development of the new approach pertaining to the medical education. Due to the
brainstorming of Frank Starmer, Robert Kamei and Sandy Cook the first idea of
the transplanting the Duke Med curriculum into Singapore. As a result of the
brainstorming, Duke-NUS GMS was created and it was created to influence the
educational philosophies and education experiences in Singapore.
 One of the striking information found within the Duke-NUS GMS during its
initial stages was that it was planned that professors will commute regularly
between Singapore and United States so that the same curriculum can be taught at
the Duke Med. This decision was however not considered due to the jet lag and
thus other considerations were taken into account. Also, teaching by video was
also considered which was however rejected by Kamei and he wanted something
more stimulating other than distance learning. Thus, a novel decision was taken in
which the recordings of the lecturers for the Duke Med were used in the Duke-
NUS. This also included developing the new teaching approach and customizing
the materials.

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 The Duke-NUS introduced a Team LEAD and the LEAD acronym meant
representing the program’s goals to develop, apply, engage and learn.
 Between the year 2007 and 2011, the Duke-NUS GMS was able to build a strong
reputation due to the integration of a unique education model and the various
contributions of the Duke-NUS GMS in the field of biomedical research. The
Duke-NUS was able to attract outstanding faculty and students from all over the
world.
 The Duke-NUS GMS was able to provide a value and variety to the Singapore's
medical education. The school was rather found to be complementing the role
played by NUS YLLSoM rather than competing.
Limitation- The paper provided a brief account of the various situations that are initially
aimed at. However, the major limitations in the paper are the clear depiction of the change
management strategies taken up by Duke-NUS GMS. There is also a clear lack of the leadership
as well. The paper only a thin section of leadership activities during the initial framing of the
collaborations. The paper also does not provide a historical condition of the Singapore medical
education. Due to this, a clear distinction cannot be made on up to what extent the medical
condition has improved.

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