This summer, the first class of medical students at Duke-NUS Graduate Medical School in Singapore officially becomes its first graduates -- receiving the first joint degrees ever to be granted by its parent schools, Duke University and the National University of Singapore (NUS).

It’s a major milestone in the short but action-packed history of Duke-NUS, which has grown in a mere six years from a promise on paper into a dynamic institution that is well on its way to becoming one of the leading medical schools in Asia.

Exceeding All Expectations

By any account, the school’s achievements are remarkable.

Since its 2005 launch, it has gone from 16 faculty and staff to more than 850, including 83 regular-rank faculty -- many of whom are internationally recognized biomedical researchers.

The student body has soared from an entering class of 26 in 2007 to 186 MD and 12 PhD students today, from 21 countries and more than 40 undergraduate institutions including Oxford, Cambridge, Johns Hopkins, Yale, Harvard, Peking University, and Stanford.

It has created robust research programs, with faculty attracting more than S$100 million (U.S.$81 million) in competitive research funding and publishing more than 370 papers in international peer-reviewed journals. The school has also generated innovative models of medical education that are drawing interest from programs across the globe.

“Duke has built many relationships with strategic partners around the world, but we will always see Duke-NUS as the crown jewel of our international activities,” says Victor J. Dzau, MD, Duke’s chancellor for health affairs. “It represents a distinctive achievement by multiple committed and trusting partners -- Duke, NUS, and the Singapore government -- that is unparalleled.”

Victor J. Dzau, MD, talks with medical students at Duke-NUS in Singapore. The school is graduating its first class this summer.

In fact, the school has zoomed past the initial goals its partners set for it, achieving milestones that had been established for its first seven years in just a little over four.

In an era when many U.S. universities are attempting to forge global academic collaborations, “Duke-NUS is a real success story,” says Michael Merson, MD, director of the Duke Global Health Institute and vice chancellor for Duke-NUS affairs. “What has been accomplished there since its founding is tremendous.”

“In terms of university partnerships on a global scale, there are not many like Duke-NUS,” agrees Patrick Casey, PhD, senior vice dean for research at Duke-NUS, who was among the school’s founding administrators. “In terms of medical school partnerships, there are none.”

Committing to Excellence

What has made the difference, he says, is commitment: “The commitment of Duke leaders, Duke faculty, leaders in Singapore -- commitment at the highest level. There were many times we could have stumbled, but everyone was committed to succeed and because of that we were able to work through the challenges.”

The commitment needed to build a medical school from scratch was no small thing. In 2000, the government of Singapore -- a city-state of 5 million people -- had launched an ambitious S$3-billion biomedical sciences initiative aimed at establishing the country as the biomedical hub of Southeast Asia.

As part of that effort, Singapore sought to create an American-style graduate-level medical school aimed at producing research-trained physician-scientists, complementing its existing British-model undergraduate medical school at the National University of Singapore.

Singapore approached Duke as a potential partner in establishing the new school based on its unique research-oriented medical school curriculum and its track record in producing leaders in academic medicine, research, industry, and clinical care delivery.

Silencing Skeptics

While the initiative was to be funded entirely by Singapore, it would require a significant investment of time and expertise from Duke.

“Many people were skeptics at first,” recalls R. Sanders Williams, MD, president of The J. David Gladstone Institutes, who served as dean of the Duke University School of Medicine from 2001 to 2007, and in 2005 became the founding dean of Duke-NUS.

“I myself wondered how on earth we could support a serious program halfway around the world when there were so many important things to do in Durham. But over time, as we got to know the remarkable people in Singapore and better envision the opportunities, that skepticism turned into excitement. We became convinced that this partnership could greatly advance medical care, education, and research not only in Singapore but also for Duke.”

“The benefits outweighed the hesitations,” agrees Rebecca Trent Kirkland, MD, a Duke University School of Medicine alumna and member of the Duke family, who served on the Duke University Board of Trustees during the years leading up to the 2005 partnership agreement and later visited the school on behalf of the Duke University Health System Board of Directors.

“We knew that some of our faculty would need to spend a good bit of time in Singapore, but we have been able to weather that and it’s actually been beneficial, as our faculty have been able to ally with NUS faculty in many areas."

"In the end, we believed that this partnership would broaden the reach of the university and provide wonderful opportunities for our students and faculty as well as the students in Singapore. It’s truly a partnership where we can grow together.”

Building an All-Star Team

As the new school took shape, so did a new world of possibilities for global collaboration. Respected Duke faculty relocated to Singapore to help get the school off the ground, including Casey and Ranga Krishnan, MB ChB, then chair of psychiatry and behavioral sciences, who would succeed Williams as dean of Duke-NUS in 2008.

They were joined by other distinguished faculty from Singapore and all over the world -- including early recruits such as Sir Colin Blakemore, former chair of the British Biomedical Research Council (comparable to the NIH), David Virshup, MD, a noted cancer researcher and pediatric oncologist, and Duane Gubler, ScD, a globally recognized infectious diseases researcher.

“We began with a few really good people and like began to attract like,” says Krishnan. “Along with the significant scientific resources available in Singapore, I believe that has been a major reason faculty have been drawn to Duke-NUS -- having strong potential partners in place for research collaborations, not only within the school but with other research groups in Singapore as well as with faculty at Duke in Durham. It’s an environment conducive to good science.”

Constructing a Cogent Curriculum

To focus the school’s efforts, leaders from Singapore and Duke early on identified five signature areas of research emphasis -- emerging infectious diseases, cancer and stem cell biology, neuroscience and behavioral disorders, cardiovascular and metabolic disorders, and health services and systems research.

Rather than being lodged in traditional academic departments, faculty have been recruited into these five specialized programs. “We identified these areas because they represent the major health needs of Singapore and Southeast Asia, while also capitalizing on Duke’s strengths in research,” explains Casey.

As notable faculty from Singapore, Duke, and all over the world have converged at the school, they have formed productive new research partnerships in those key arenas. Progress has been rapid on the education front, as well.

The school had a strong foundation to begin with, since the Duke-NUS curriculum is based on that of Duke University School of Medicine -- which condenses basic-science study into one year instead of the usual two, giving students earlier clinical experience as well as an entire year devoted to independent research.

With the fresh start in Singapore, however, leaders took advantage of the opportunity to innovate, introducing a new, technology supported model of team-based learning called TeamLEAD that’s been hailed as the future of medical education -- and a critical factor in the school’s success.

“As a faculty, we’re asking ourselves how we can promote creativity and critical thinking and how course material will actually be used down the line in the students’ professional  ives,” says Doyle Graham, MD, PhD, former dean of medical education at Duke University School of Medicine, who now directs the TeamLEAD-based Body and Disease course at Duke-NUS.

“It’s the most powerful learning situation I’ve ever been in -- I consider it the highlight of my teaching career.”

Duke-NUS students have proven the power of the approach, scoring well above the mean for all U.S. medical students on both the clinical knowledge and basic science United States Medical Licensing Exams.

In 2010, the school expanded its academic offerings, opening an Integrated Biology and Medicine PhD program designed to produce leaders in translational research.

Looking Toward the Future

Although the initial 2005 partnership agreement between Duke and NUS was to last seven years, the school’s round success prompted both partners to renew their agreement early and enthusiastically, committing in November 2010 to another five-year tie-up (as it’s called in the local parlance).

“I would say that this partnership has greatly exceeded our already high initial expectations,” said NUS president Tan Chorh Chuan at the signing ceremony. “The second phase . . . promises to be even more exciting and productive.”

A primary goal for the partnership’s next half-decade is to more closely integrate Duke-NUS with SingHealth, Singapore’s largest health care group, which serves more than 4.3 million patients a year.

The school is located on the same campus as SingHealth’s 1,500-bed Singapore General Hospital as well as national heart, cancer, and other specialty centers, providing fertile ground for collaboration, says Krishnan.

“Our faculty and students are already deeply engaged in these institutions. Many of our faculty serve on their medical staff, our students perform clinical rotations there, and we work together to conduct clinical research.”

For example, he notes, Duke-NUS helped establish the SingHealth Investigational Medicine Unit, a 32-bed research unit which opened last year to conduct early-phase clinical studies. Duke-NUS also founded an Office of Clinical Sciences to provide specialized training to third-year medical students and to SingHealth clinicians interested in clinical research.

The office is led by vice dean John Rush, MD, who also serves as CEO of the Singapore Clinical Research Institute (modeled after, and in collaboration with, the Duke Clinical Research Institute).

“Our charge in phase two of the partnership is to build on this foundation to create a true academic medical center, which will help us connect research efforts inside the school to clinical care delivery and develop next-generation treatments and technologies,” Krishnan says.

Already, Duke-NUS and SingHealth leaders have worked together to create academic departments within SingHealth institutions. Graduate medical education is also being strengthened; recently, the U.S. Accreditation Council for Graduate Medical Education (ACGME) established a new international arm that is working with Singapore’s Ministry of Health to accredit 38 residency programs at SingHealth and other Singapore hospitals by 2012.

These are the first residency programs to be accredited by ACGME International standards, says William E. Rodak, PhD, ACGME-I’s vice president for international accreditation. “We’re contributing to improving graduate medical education outside of the United States and in turn, health care in other parts of the world,” he says.

The new programs will provide the next step for this summer’s graduating class, almost all of whom will complete residency training in Singapore. “These are wonderful students, and they will be excellent physicians -- bright, accomplished, committed to service, and with a truly global perspective,” Krishnan says. “We can be very proud of them as the first to graduate under the Duke-NUS banner.”

“The graduation gives us an opportunity to pause and truly appreciate the success of this venture,” adds Kirkland.

“It makes me think of the words of the Indenture that originally established Duke University, which called us to ‘provide real leadership in the educational world’ and to teach what would ‘most help to develop our resources, increase our wisdom, and promote human happiness.’ Well, with Duke-NUS, that’s just what we’ve done.”