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Keywords:

  • education;
  • research;
  • geriatrics

Abstract

  1. Top of page
  2. Abstract
  3. The Singapore Healthcare System and Healthcare Financing
  4. Geriatric Medicine in Singapore
  5. Academic Geriatric Programs in Singapore
  6. Undergraduate Program Structure and Leadership
  7. Program Resources
  8. Research Funding
  9. Discussion and Future Perspectives
  10. Conclusion
  11. Acknowledgments
  12. References

Singapore is one of the fastest-aging countries in the world. The proportion of adults aged 65 and older is projected to increase from 8.7% to 20% over the next 20 years. The country has developed various strategies to meet the needs of this increase in older adults. There is an acute shortage of geriatricians and a need to train more healthcare workers to care for older adults. Geriatric medicine is a relatively new specialty, and a small number of geriatricians have been tasked with providing an increasing load of clinical service, education, and research. Hence, there is a need to develop a cohesive structure of support for faculty development and retention, advanced specialty trainee recruitment, leadership in medical education, research, and clinical service to care for the rapidly aging population. In addition, geriatric medicine is primarily a hospital-based specialty in Singapore. There is still opportunity to collaborate and improve the academic and practice integration of geriatric medicine into primary care and intermediate and long-term care where it is most needed.

Singapore is a small country situated at the southeast corner of Asia on an island smaller in land area than New York City. It is the second most densely populated country in the world,[1] with a total population of 4.8 million,[2] 25% of which consists of temporary residents from the neighboring countries of Malaysia, Indonesia, Philippines, India, and China.

The population is aging rapidly. Life expectancy at birth (measured in 2008) is 78.4 for men and 83.2 for women,[1] ranking Singapore fourth in the world (below Japan and higher than the United States).[2] Mortality (4.4/1,000 population) and the birth rate (10.3/1,000 population) are declining.[1] Adults aged 65 and older accounted for 8.7% of the population (ca 320,000) in 2008 and are projected to increase to 20% over the next 20 years,[3, 4] making Singapore one of the most rapidly aging countries. The speed of population aging is important, because the difficulty in adapting to a rapid demographic change increases with the speed of the change.[5]

Healthcare needs are different for people aged 65 and older. They have more chronic diseases than younger people and experience more acute exacerbations of these conditions. More older people are disabled and require the daily help of others, and they are also more likely to have atypical presentations of disease. Consequently, older adults tend to see doctors and use hospitals more frequently than younger people, and the type of medical care needed changes with an aging demographic.[6, 7]

To prepare for the accelerated growth of the older population, the Singapore Ministry of Health created the Workgroup on Training of Doctors to Meet the Needs of the Ageing Population in 2008 to identify the needs of Singapore's healthcare system to cope with this future increase. The workgroup's report emphasized the critical shortage in geriatricians and the need to increase the number of doctors trained in the care of older adults.[8]

Geriatric medicine is a young specialty in Singapore and has yet to carve out a niche in the academic environment. Professor Howard Bergman, a visiting geriatrician from McGill University in Canada in 2008, highlighted the need for the development of academic geriatric medicine and research activity in Singapore as important areas in the evolution of geriatric medicine and its acceptance as an academic and practice specialty.[9] Academic geriatricians are also necessary to provide leadership for the teaching of undergraduates, medical officers, and advanced specialty trainees (ASTs) and to engage in research in gerontology and geriatric medicine. This article describes Singapore's current education and research initiatives in geriatric medicine and details the major challenges and barriers to developing academic geriatrics in Singapore.

The Singapore Healthcare System and Healthcare Financing

  1. Top of page
  2. Abstract
  3. The Singapore Healthcare System and Healthcare Financing
  4. Geriatric Medicine in Singapore
  5. Academic Geriatric Programs in Singapore
  6. Undergraduate Program Structure and Leadership
  7. Program Resources
  8. Research Funding
  9. Discussion and Future Perspectives
  10. Conclusion
  11. Acknowledgments
  12. References

The healthcare system includes public and private health care and accounts for 3.4% of Singapore's gross domestic product[2] (Table 1). Publicly funded hospitals provide 80% of hospital care and private hospitals the remaining 20%.[10] Health care is operated through a mixed-financing system of government funding and individual out-of-pocket payment. Private insurance accounts for only 5% of healthcare financing in Singapore. The Ministry of Health supports up to 80% of the total bill of public hospital admissions. Every working Singaporean has a compulsory savings scheme, Medisave, to be used for personal or immediate family hospitalization, day surgery, and certain outpatient expenses. In addition, MediShield is a voluntary catastrophic medical coinsurance scheme to meet the increasing expenses from major or prolonged illnesses for which Medisave is not sufficient. The poor can apply to the government-appointed hospital Medifund committee for assistance in paying medical expenses. Intermediate and long-term care (ILTC) has a similar financing structure, with the government paying approximately 80% of expenditures. The amount that ILTC is subsidized depends on family income.[11]

Table 1. Singapore Profile for Demography and Health Indicators, 2008
Indicator Value
  1. a

    Estimated.

Total population[2], n3,642,000
Male1,803,000
Female1,839,000
Aged ≥65, %[2]8.7
Male, %7.7
Female, %9.6
Aged ≥80, %[2]1.7
Male, %1.2
Female, %2.1
Life expectancy at birth[2], yr80.9
Male, yr78.4
Female, yr83.2
Life expectancy at age 65[2]19.2
Male, yr17.4
Female, yr20.8
Total healthcare expenditures (% of gross domestic product 2006)[2]3.4
Geriatricians per 10,000 population aged ≥65a1.5
Doctors per 10,000 population[22]16
Registered nurses per 10,000 population[22]50
Acute care beds per 1,000 population[22]10.3
Nursing home beds per 1,000 population[22]9.4
Community hospital beds per 1,000 population[22]0.8

Geriatric Medicine in Singapore

  1. Top of page
  2. Abstract
  3. The Singapore Healthcare System and Healthcare Financing
  4. Geriatric Medicine in Singapore
  5. Academic Geriatric Programs in Singapore
  6. Undergraduate Program Structure and Leadership
  7. Program Resources
  8. Research Funding
  9. Discussion and Future Perspectives
  10. Conclusion
  11. Acknowledgments
  12. References

Geriatric medicine was introduced in 1987, when physicians were sent to the United Kingdom to observe and learn about the care of older people. Since its inception, geriatric medicine has remained a smaller specialty than other well-established medical specialties.

Following the U.K. model, geriatric medicine in Singapore is a hospital-based specialty, providing service across the spectrum of care, including preventive, acute, subacute, rehabilitative, long-term, and end-of-life care. In 2003, the Singapore Ministry of Health required every public hospital to provide basic clinical geriatric care. Six public hospitals with departments of geriatric medicine provide more than 80% of hospital-based geriatric care.[10] Only four of 48 geriatricians in Singapore are in private practice.

Although the clinical practice of geriatric medicine was supported, the structure of support for the development of research and training has been patchy. The lack of research and training support with tightened manpower created a situation in which clinical service needs dominate.

Academic Geriatric Programs in Singapore

  1. Top of page
  2. Abstract
  3. The Singapore Healthcare System and Healthcare Financing
  4. Geriatric Medicine in Singapore
  5. Academic Geriatric Programs in Singapore
  6. Undergraduate Program Structure and Leadership
  7. Program Resources
  8. Research Funding
  9. Discussion and Future Perspectives
  10. Conclusion
  11. Acknowledgments
  12. References

Undergraduate and Graduate Medical Schools

There are two medical schools with contrasting models of medical education. The Yong Loo Lin School of Medicine at the National University of Singapore (YLL SoM) was established in 1905 on a U.K. undergraduate model and has a class size of 260 students. Students undergo a 5-year program, with yearly clerkships and examinations, culminating in a final written and clinical examination. If successful, they are awarded the degree of Bachelor of Medicine and Surgery (MBBS). The geriatric component of undergraduate medical education is a 2-week course in a Year 5 clerkship. At the end of the course, students are expected to have developed proficiency in core competencies in geriatrics, such as prevention, evaluation, and management of falls; incontinence; impaired cognition; and end-of-life care. They are assessed at the end of the course using a multiple-choice written examination and a structured clinical examination. Thus, geriatrics is a short isolated component not integrated longitudinally into the remainder of the medical curriculum. There is a current initiative to include geriatric education in a 2-week clinical skills foundation course in Year 2. In the clinical blocks of internal medicine (IM) and family medicine (FM), the involvement of geriatrics is not routine and depends largely on the student's attachment to a faculty member who is trained in care for older adults.

The Duke National University of Singapore Graduate Medical School (GMS) was established in 2007 based on a U.S. model of postbaccalaureate medical education. The GMS is a collaboration between Duke University School of Medicine and the National University of Singapore and has a research-intensive curriculum that is based on the Duke University model of medical education. The GMS was established with an emphasis on medical research as part of Singapore's effort to develop the biomedical sciences. The GMS has a yearly intake of 50 students. Students who successfully complete the 4-year course of study are awarded the degree of Doctor of Medicine (MD). The Geriatric and Palliative Care Program is a 1-week course during the Year 2 clinical core. Students are exposed to a series of lectures and interactive sessions on comprehensive geriatric assessments, falls, dementia, aging, and end-of-life care with no requirement for assessment. In Year 4, students undergo a capstone course—a 1-month program with a series of activities designed to prepare students for residency. One of the sessions during that month is on delirium.

At both schools, geriatrics is presumed to be implicit or embedded and under the umbrella of other specialties. In FM at GMS, part of the program addresses patient-centered care that often involves topics related to older adults, but the degree to which geriatrics is taught is not known, because there are no course specifications or learning outcomes that explicitly address the geriatric competencies. Although there is some degree of structure in the geriatrics curriculum, the 2 weeks at YLL SoM and 1 week at GMS are inadequate to meet the objectives of attaining core competencies in geriatrics. In a 2009 study in Singapore, only one in three junior doctors felt that the knowledge they received during medical school was adequate for them to manage problems related to older adults.[12]

House Officers, Medical Officers, and Basic Specialty Training

House officers (Postgraduate Year 1—PGY1) have a broad choice of postings in medicine and surgery. They do not need to undertake any compulsory geriatric medicine training. Medical officers (PGY 2 and above) who are interested in geriatric medicine have to complete their Basic Specialty Training (BST) in IM or FM. In the 3-year BST training in IM, they have an optional 6 months training in geriatrics as a subspecialty rotation. For FM, the 3-year course structure consists of 2 to 2.5 years of hospital rotations, in which geriatrics is a core skill requirement, with a 3-month rotation within the hospital program.

In mid-2010, Singapore reorganized its residency training on the U.S. model. Residency programs are structured 3-year programs in which residents will spend 4 months in general medicine and another 4 months in general surgery in their first year, in compliance with the Ministry of Health guidelines. Medical officers are then rotated into IM and other medical subspecialties. The future practices of IM and medical subspecialties will necessarily emphasize providing care for older adults because of an aging population, but geriatric medicine is not a compulsory rotation. Details of the FM residency program will be defined in late 2011. Figure 1 gives an overview of the current medical career tracks for students after graduation.

image

Figure 1. Overview of current medical career tracks in Singapore.

Download figure to PowerPoint

Advanced Specialty Trainees

All six public hospitals now have an accredited program for ASTs, in contrast to only three public hospitals with accredited AST programs 5 years ago. Applications for advanced specialty training has not similarly increased. For May 2011, there were no applicants to geriatric medicine advanced specialty training out of 69 applicants for all medical-related specialties.

Doctors who have completed their BST and attained their Masters of Medicine in Internal Medicine (MMed, IM) or Membership at the Royal College of Physicians (MRCP) can apply to the geriatric medicine advanced specialty training program. The 3-year geriatric medicine advanced specialty training program has 24 months in acute geriatrics, 3 months in home care and transitional care and a medical subspecialty of their choice (e.g., neurology, dermatology), 4 months in general medicine, and 1 month each in geropsychiatry and rehabilitation medicine. The clinical training enables ASTs to experience the breadth and depth of a hospital-based geriatric medicine with a 3-month community-based training. There is no research component required, although they are expected to be able to critique journal articles. At the end of 3 years, the AST undergoes an exit examination to be accredited as a specialist under the Specialist Accreditation Board. Geriatric medicine specialists will take a minimum of 7 years to train.

In response to the lack of geriatricians, in 2009, FM physicians can apply to be a geriatric AST, but they must fulfill the requirement of IM rotations (total 3 years) during this “conversion scheme,” with additional probationary training. Since the start of this scheme, no FM physicians have been recruited.

Singapore believes in the principles of a free market for medical manpower, but the Ministry of Health exercises basic control in manpower planning by increasing financial incentives to attract ASTs to unpopular specialties. Geriatric medicine ASTs receive an additional 10% above regular compensation as a training allowance. There is no additional financial compensation as a geriatrician. There are 17 ASTs in the program; five will exit and be accredited in 2010 and six each in 2011 and 2012. In 2010, the total number of certified geriatricians is 48 or 1.5 geriatricians per 10,000 persons aged 65 and older and 3.5 geriatricians per 10,000 persons aged 75 and older. At this rate of training and a healthy retention rate of 70% over the next 20 years, the numbers would be further reduced to 1.1 per 10,000 population aged 65 and older and 2.8 per 10,000 population aged 75 and older. By comparison, the United States had 4.7 geriatricians per 10,000 population aged 75 and older (in 2000).[13]

Graduate Diploma in Geriatric Medicine and ILTC

The Graduate Diploma in Geriatric Medicine (GDGM) was established in 1997 to equip primary care doctors to care for older adults in primary care and ILTC. The program is a 1-year structured geriatric module.

The International Medical Graduate (IMG), from an accredited medical school recognized by the Singapore Medical Council, will join the medical career tracks of graduates from Singapore (Figure 1). Since 2007, in response to the acute shortage of medical manpower at ILTC, an avenue was opened for IMGs who do not possess a medical degree registrable with the medical council to work in transitional care in Singapore. The GDGM (ILTC) is used as an initial accreditation program for temporary registration. There has been heavy recruitment of doctors from Myanmar, India, and the Philippines who are placed on temporary medical registration with probationary training. In addition, a 2-year Advanced Diploma course in Geriatric Medicine was introduced for temporarily registered IMGs; upon graduation, they can apply for conditional medical registration and be accredited to work in transitional and long-term care.

Geriatric Medicine Training for Other IM Subspecialists, Surgeons, and Other Related Specialists

The demographic trend will result in an increase in the number of older adults being cared for by different subspecialties. Currently, there is no requirement for the other subspecialties to integrate geriatrics into their curriculum. There is no national coordinating body on subspecialist curriculum for aging. Each specialist training committee determines its certification program and submits to the Specialist Accreditation Board for approval.

Undergraduate Program Structure and Leadership

  1. Top of page
  2. Abstract
  3. The Singapore Healthcare System and Healthcare Financing
  4. Geriatric Medicine in Singapore
  5. Academic Geriatric Programs in Singapore
  6. Undergraduate Program Structure and Leadership
  7. Program Resources
  8. Research Funding
  9. Discussion and Future Perspectives
  10. Conclusion
  11. Acknowledgments
  12. References

Academic programs at the YLL SoM are organized within departments or divisions of medicine in the six public hospitals. The program directors (or program organizers) report directly to the Associate Deans of their respective hospitals. The Department of Medicine at the university directs the geriatrics undergraduate curriculum. At GMS, there is no geriatrics program director, although there is an adviser to direct the geriatrics curriculum who reports to the Vice Dean of education, Associate Dean for clinical affairs, and Associate Dean for curriculum development.

Program Resources

  1. Top of page
  2. Abstract
  3. The Singapore Healthcare System and Healthcare Financing
  4. Geriatric Medicine in Singapore
  5. Academic Geriatric Programs in Singapore
  6. Undergraduate Program Structure and Leadership
  7. Program Resources
  8. Research Funding
  9. Discussion and Future Perspectives
  10. Conclusion
  11. Acknowledgments
  12. References

The current number of certified geriatricians in Singapore is 48. To maintain a conservative manpower resource projection of two geriatricians per 10,000 persons aged 65 and older by 2030, Singapore will need 180 practicing geriatricians.[14] Estimates are based on projected resident population aged 65 and older in 2030 of 892,900. At the current rate of training, there would be a shortfall of 80 geriatricians, or 45% of total need.

There are no national figures regarding the time commitment of geriatricians at the university. At best, an estimate of 0.1 full-time equivalent (FTE) per geriatrician, because most are adjunct faculty, would mean that there are only 4.8 FTE geriatricians for the two universities. Currently, there are one clinical professor and five clinical associate professors. There are no full-time professors or chairs in geriatric medicine at either medical school. This is lower than in the United States, where in 2005, medical schools had a mean of 9.6 FTE geriatrics physician faculty.[15]

Research Funding

  1. Top of page
  2. Abstract
  3. The Singapore Healthcare System and Healthcare Financing
  4. Geriatric Medicine in Singapore
  5. Academic Geriatric Programs in Singapore
  6. Undergraduate Program Structure and Leadership
  7. Program Resources
  8. Research Funding
  9. Discussion and Future Perspectives
  10. Conclusion
  11. Acknowledgments
  12. References

Similar to the United States in the 1990s, geriatrics in Singapore has yet to carve out a niche in the academic environment. In a 2007 report, one hypothesis for this problem was that research on clinical concerns in older adults has been slow to develop.[16] Research will be an important area in the evolution of geriatrics and its acceptance as an academic and practice specialty. This, in turn, may positively affect attitudes of future fellows and doctors. In the data search for geriatrics- and gerontology-based research or researchers from the National Medical Research Council (NMRC) of Singapore, there were only three approved research project grants from 89 (2007) and none from 133 (2008). This represents approximately 1% of total projects awarded by the NMRC for both years. Of the three grants, two were from the Department of Community, Occupational and Family Medicine (COFM), and one was from the Department of Geriatric Medicine.[17] The two studies from COFM were a community-based intervention trial on nutritional, physical, and cognitive training for at-risk frail older adults, and the other was an epidemiological study on dietary and lifestyle risk factors of older adults with hip fractures; the study from the Department of Geriatric Medicine was a health services modeling of hospitalized older adults with pneumonia. Researchers compete for available competitive grants. In the largest funding agency, the NMRC of Singapore, there are flagship programs to develop certain areas of research (cancer, cardiovascular and metabolic disorders, neuroscience, infectious diseases, and eye diseases). There is no specific funding for geriatric medicine or aging research.

Discussion and Future Perspectives

  1. Top of page
  2. Abstract
  3. The Singapore Healthcare System and Healthcare Financing
  4. Geriatric Medicine in Singapore
  5. Academic Geriatric Programs in Singapore
  6. Undergraduate Program Structure and Leadership
  7. Program Resources
  8. Research Funding
  9. Discussion and Future Perspectives
  10. Conclusion
  11. Acknowledgments
  12. References

Despite an initial slow start, there has been an upswing in the funding for and interest by governmental agencies in improving the lives of older adults, as evidenced by the creation of national-level organizations such as the Inter-Ministerial Committee for Aging and the Council for Third Age, where the topics of housing, healthcare financing, and welfare are actively addressed. In the healthcare system, a small pool of geriatricians has been tasked with providing increasing clinical work with limited teaching and research efforts. The structure could be strengthened by recognizing, training, and retaining academic geriatricians to provide leadership for medical students, residents, and fellows and to engage in research. The projection of the number of geriatricians must include the allocation of manpower and time commitment needed for system leadership and educational and research efforts.[18]

Specific initiatives should be considered in medical education. In undergraduate medical education, the 2 weeks at YLL SoM and 1 week at GMS are too short to meet the objectives of attaining core competencies, and a longitudinal integration of geriatric principles into the overall medical curriculum would help maintain the learning objectives. In the teaching of FM and other specialties, course specifications or learning outcomes that explicitly address the embedded geriatric component should be established. In the new residency program for General Medical Education in Singapore, geriatric core competencies should be established and be made compulsory. This would enhance the geriatric curriculum in General Medical Education and establish a structure for the standardized assessment of medical officers. It would ensure that the general medical healthcare workforce attains core competencies in geriatrics. In a 2009 survey of junior doctors in a large acute hospital in Singapore, all reported difficulty in managing older adults. Three-quarters of the doctors reported multiple medical problems affecting older adults as the most common difficulty faced, followed by vague problems and atypical presentation (65%) and psychosocial problems (49%). Fifty percent found difficulty communicating with older adults.[12] With all adult subspecialties facing the increasingly older population, Singapore should embed and establish geriatric training and competency into all advanced specialty training in adult medicine and surgery. Because geriatrics is a hospital-based specialty in Singapore, there is opportunity to strengthen health care for frail older adults at the primary care level, where most care to older adults is provided. Since 2009, there have been no applicants from FM to geriatric medicine advanced specialty training. Major reasons include the additional requirements of a “conversion” scheme and a curriculum based heavily in acute hospitals. A simplified and different track could be created, for example, Geriatric Medicine-Family Medicine (GM-FM) track with an increase in community and primary care-based training. The inclusion and development of a GM-FM track for primary care would improve the uptake of the specialty and improve the academic and practice integration of geriatrics across the spectrum of health care. The inclusion of academic geriatrics in primary care would also assist in exploring and developing comprehensive community-based models of collaborative care, for example, with nurse practitioners or community nurses. Because of the current critical manpower need in ILTC, the recruitment of international medical graduates should be encouraged and accreditation be maintained for assessment of competency.

All specialists, including geriatricians, are paid a salary in public hospitals, but geriatricians are paid less as nonprocedurists. Payments for high-volume procedures drive the income gap between procedurists and nonprocedurists, a reason for the declining interest in a geriatric career among medical graduates. Increasing reimbursement would improve recruitment and retention of geriatricians.[19]

Singapore does not have a national program to coordinate, support, or fund aging and geriatric medicine research. There is still opportunity to improve funding and training, including a coordinated research mentoring program, funding for junior and senior research faculty development, and expanding opportunities through interdisciplinary research. Establishing full-time chairs in geriatrics and academic program directors would be beneficial to help the integration of geriatric medicine into the medical schools.[20] In 2011, the idea of a centralized Geriatric Education and Research Institute was announced to lead national efforts in education and research initiatives and strategic and health policy directions in aging in Singapore.

A major reason why aging and geriatrics research output is poor in Singapore is the lack of research training and mentors. It is a vicious cycle if enough researchers are not trained. The lack of inclusion of a research component in the current geriatric medicine advanced specialty training will hamper the development of academic geriatricians.[21] There is no consensus on the duration of clinical training suitable for specialist accreditation. Australia has a 3-year structure for advanced training, with 2 years of core training in clinical geriatric medicine and 1 year of noncore training that could include clinical epidemiology and age-related research. Similarly, Singapore's 3-year clinical advanced specialty training program could be restructured to 2 years of core clinical training followed by an option of 1 year of further clinical training (rehabilitation medicine, oncology, neurology) or clinical epidemiology and age-related research. The clinician–scientist program (Figure 1) recruits students who will, in their PGY2, enroll in a PhD research program and midcareer physicians who will complete a 2- to 3-year Master of Clinical Investigation. The program has yet to attract any geriatricians. Year 4 YLL SoM students can do an elective 1-month research or clinical attachment to geriatric medicine. The lack of mentors in geriatrics has hampered the research elective.

Conclusion

  1. Top of page
  2. Abstract
  3. The Singapore Healthcare System and Healthcare Financing
  4. Geriatric Medicine in Singapore
  5. Academic Geriatric Programs in Singapore
  6. Undergraduate Program Structure and Leadership
  7. Program Resources
  8. Research Funding
  9. Discussion and Future Perspectives
  10. Conclusion
  11. Acknowledgments
  12. References

Current challenges to the development of academic geriatrics include low interest of registrars and fellows, difficulty in funding research, few researchers and research mentors, and the low priority given to teaching and research in geriatric medicine. In some ways, the journey of geriatrics mirrors that of 20th-century pediatrics in the struggle to be recognized as a practice specialty. Singapore has done well to emphasize the importance of geriatric care, which the Ministry of Health has announced to be a top priority. The country needs to train more geriatricians, academic geriatricians, and healthcare workers with knowledge about care for older adults. A coordinated academic program would be able to mold the next generation of academicians to mentor students, influence undergraduate clerkships, lead residency training initiatives, retrain healthcare professionals, and the interdisciplinary academic development with therapists, nurses and social workers. In Singapore, there is also an opportunity to improve the delivery and development of geriatric competencies into ILTC and primary care. The GM-FM track would improve care and research in older adults at the primary care and ILTC level, where it is most needed. A well-planned academic program in Singapore would encourage the evolution of geriatric medicine from a service-based discipline to a more academic-based one, which would increase the acceptance of geriatric medicine as an academic and practice specialty.

Acknowledgments

  1. Top of page
  2. Abstract
  3. The Singapore Healthcare System and Healthcare Financing
  4. Geriatric Medicine in Singapore
  5. Academic Geriatric Programs in Singapore
  6. Undergraduate Program Structure and Leadership
  7. Program Resources
  8. Research Funding
  9. Discussion and Future Perspectives
  10. Conclusion
  11. Acknowledgments
  12. References

The authors wish to thank Dr. Weng Sun Pang, Dr. Sweet Fun Wong, Dr. Keng Bee Yap, and Professor Howard Bergman for their critical review of the manuscript.

Conflict of Interest Chek Hooi Wong and C. Seth Landefeld both state no financial interest, stock, or derived direct financial benefit. Chek Hooi Wong was funded by a Fulbright Singapore Researcher Program, U.S., Department of State, Bureau of Educational and Cultural Affairs.

Author Contributions: As principal investigator, Chek Hooi Wong obtained funding, developed the study concept and design, and prepared the manuscript. C. Seth Landefeld reviewed and revised the manuscript.

Sponsor's Role: The sponsors did not have any role in the design, conduct, interpretation, review, approval, or control of this article.

References

  1. Top of page
  2. Abstract
  3. The Singapore Healthcare System and Healthcare Financing
  4. Geriatric Medicine in Singapore
  5. Academic Geriatric Programs in Singapore
  6. Undergraduate Program Structure and Leadership
  7. Program Resources
  8. Research Funding
  9. Discussion and Future Perspectives
  10. Conclusion
  11. Acknowledgments
  12. References
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