Profile: Up close with Professor Wong Tien Yin

By Kimberley Wang, Manager, Media and Publications, Communications and Outreach

Beyond COVID-19 that has transformed healthcare, our medical students face future healthcare challenges like an ageing population and new technologies. Eminent clinician-scientist Professor Wong Tien Yin shares his insights on how our students can prepare to become doctors in this rapidly evolving healthcare landscape and the impact of artificial intelligence on the future of medicine.

In March, Prof Wong was appointed Nanyang Professor of the Practice (Clinical) at NTU, which brings outstanding clinicians as visiting professors to engage with students, faculty and staff. A trailblazer who is constantly challenging himself, he took on the role of Founding Head of Tsinghua Medicine, a new academic entity focusing on healthcare and medical sciences at Tsinghua University, earlier this year. He previously served as Medical Director of Singapore National Eye Centre and as SingHealth’s Deputy Group Chief Executive for research and education as well as Vice-Dean of the Office of Academic and Clinical Development at Duke-NUS Medical School. 

Listed among the world's most highly cited researchers, his work in eye diseases such as age-related macular degeneration and diabetic retinopathy, has been published in numerous prestigious medical journals like New England Journal of Medicine, Nature and The Lancet.

Q: It has been about six months since you were appointed as Nanyang Professor of the Practice (Clinical) at NTU. Please share with us your aspirations for this role.

I am honoured and humbled to be appointed to this very prestigious professorship. My main contribution to this role will be several folds. 

The first is to provide a role model for Singaporean doctors, particularly medical students, to hopefully aspire to in the future. I graduated in 1992 from NUS Yong Loo Lin School of Medicine. It has been thirty years now and I have gone through pathways that were challenging in those years while Singapore’s medicine and healthcare developed. I hope medical students can see that it is possible to do well in both medicine and research – to be a physician-scientist – and to stay in the public healthcare sector, straddling academia, medicine and healthcare, and have a successful and fulfilling career. 

The second is to provide the occasional lectures or workshops to support the development of academic medicine and physician-scientists and the partnership between LKCMedicine and the National Healthcare Group (NHG). 

The third is to provide specific mentorship and career advice to junior faculty and students at both LKCMedicine and NHG. I welcome anyone who would like to seek some guidance!

Lastly, as I am currently based in Tsinghua in China, I also want to facilitate partnership between Singapore and China, even as China becomes a very important part of the Asia-Pacific academic and medical network.

Q: You are also Founding Head of Tsinghua Medicine, a new healthcare and medical sciences academy at Tsinghua University. What is your strategic vision for this new medical school?

We have a long-term vision to build an integrated academic healthcare system that combines the Schools of medicine, clinical medicine, biomedical engineering, and healthcare management – the four schools under the Tsinghua Medicine umbrella – with a number of affiliated hospitals. The aim is to support the triple mission of research, education and clinical care in a seamless and highly adaptive ecosystem. Previously, Tsinghua had significant development and focus on basic medicine, and had only a loose partnership with the hospital and healthcare system.  

A key second part of this vision is that in Tsinghua Medicine, we hope to have a diverse faculty who may be scientists, doctors and physician-scientists working together, leveraging on fundamental discovery science and clinical care. 

Finally, a third aspect of this vision is that Tsinghua Medicine has a global and international perspective. China, because of its development, has done very well in the last 20, 30 years. But it is also time for them to contribute to the global community in clinical medicine, medical innovation, and new concepts in clinical care. This is possible only with a very large and closely knitted international network. Tsinghua Medicine aims to be different from all the other medical schools in China – where physician-leaders, physician-innovators and physician-scientists can be a catalyst for healthcare transformation in China with an aim to make a broader impact in the Asia-Pacific.

Q: This role offers exciting opportunities to build links and collaborations between Tsinghua and Singapore entities. What are some of the potential areas for collaborations with LKCMedicine?

We anticipate exciting opportunities for collaboration. We are planning for medical students in LKCMedicine to be able to spend time in Tsinghua, whether it is for the shorter-term electives or a longer-term attachment such as a gap-year in a research project. We also hope to be able to send our Tsinghua students to LKCMedicine, NTU and NHG so that they can get exposure to Singapore and build a next generation network with Singaporean students. 

We will also broaden collaboration into other areas related to healthcare and medicine – bioengineering, material science, public health, and global health programmes. This collaboration will not only be confined to medical students and will extend to PhD students and postdoctoral fellows. We hope to offer opportunities for them to spend some time in Tsinghua and with our related partners in China. 

At the faculty level, the possibility of joint symposia and joint research projects linking up LKCMedicine and NTU with Tsinghua on areas which are mutually beneficial. Some areas would be bioengineering, regenerative medicine, immunology – which are strong areas in Tsinghua – and with partners of LKCMedicine in the NHG system, for example, infectious diseases and population health. 

Q: COVID-19 has transformed healthcare. Today’s medical students also face future healthcare challenges like our ageing population and new technologies. What advice do you have for our students who are training to become doctors in this rapidly evolving healthcare landscape?

The traditional model of medical education has evolved over a century. When I started medical school in 1987, you first learn basic medical science, biology, physiology, biochemistry and anatomy. This is followed by pathology and pharmacology. Then you go to clinical disciplines – internal medicine and surgery etc. Then you start your apprenticeship, housemanship and then residency. I think this model is outdated and should be improved for a few reasons. 

Knowledge is very different nowadays. In the past, it was very simple, a few textbooks will give all the basic foundations you need to be a doctor. You use that textbook, apply it to patients that come in, improve with some experience and then you become a reasonably competent doctor. Now, knowledge has exploded and it is everywhere and exponentially increasing every day. There is no way to keep up with those kinds of medical knowledge. 

Thus, the first important differentiation for new medical students is that they need to “learn how to learn” rather than learn specific knowledge by reading their textbook. When they come to medical school and go into a new phase of learning exponential knowledge, the first thing they need to know is: how do I handle all this new knowledge, medical advances and new drugs every other day? There are many ways to do this. One is building on intellectual curiosity, focusing not on the details but on the broad principles – from health to disease, from prevention to treatment. They will then only need the specific knowledge which they can get from the larger ecosystem. 

The second thing is medicine or healthcare is only a small component of what causes disease and what causes disease to be prevented or treated. The medical student of the future cannot think of absolutes: a healthy person and not have a disease, or a patient and have the disease. The simple paradigm of I diagnose something, I prescribe a drug or I do a surgery, and the disease is cured. The bigger aspects of health and disease are the socio-environment where we live in, how our early lives have been from childhood, the social and family structure and network, and our lifestyle behaviours over time. Knowledge of the broader determinants of health and disease beyond traditional paradigms is important. 

The third is in fact a key strength of NTU and LKCMedicine which is the convergence of biomedical technology, engineering and medicine. This convergence is very apparent in almost all aspects of life – from how we work to how we move around to how we interact with people. The digital ecosystem of health is going to play a much more prominent role in the foreseeable future. Therefore, future doctors must understand, appreciate and be exposed to these kinds of concepts.

Q: On the topic of technology, you have piloted a deep-learning artificial intelligence (AI) programme to determine eye diseases. How do you envision healthcare professionals tapping on AI, which will play a key role in the future of medicine?

AI is only one specific area under the broader scope of digital medicine. Thus, to appreciate AI, we must not only understand AI, which is really an algorithm, but how AI sits in the digital environment that we live in, that is the internet now, and in the future, possibly the metaverse. AI connects digital medicine to hardware, which means mobile health, wearables – our watches, phones and in the future, glasses or skin wearables and sensors – and even our environment, in our cars and homes. This is the connected digital world that is going to play a very important part in healthcare and medicine. 

Specifically for AI, there are elements that are not well handled. When you have technology that is so pervasive, you need to start looking at the governance and the ethics of it. Who owns it? How do you regulate it to ensure it is safe and authentic? Should AI be governed by private or public? These issues are only being played out right now. AI of medicine is really just the beginning. 

There are two important analogies. One would be driverless cars. This concept has been around for 15 years but yet, people are still afraid. It is not so much about driverless cars as a technology problem anymore, but other areas such as when there is an accident, who is going to be responsible for it? When do you allow someone who is not to be able to drive themselves to sit in fully automated cars? 

The second area that is quite successful and has now started having an impact is genomics. That was 30, 40 years of journey since the discovery of DNA. They have now made genetic therapy a possibility for many diseases, but they went through all sorts of challenges and issues that needed to be addressed before you can have genetic therapy that could be put into the patient. 

At the moment, AI is still in a “technical” phase of the journey – how do you develop algorithms, make them better and make them more efficient? As AI goes through actual clinical practice, AI will have to undergo the journeys that I mentioned – the ethical, societal, the legal, the moral, the regulatory and financial pathways, before it can become a core part of medicine and healthcare.

Q: Earlier this year, the Ministry of Health announced the Healthier SG strategy with a strong emphasis on population health. How do you think this will shape the practice of medicine in Singapore?

We have gone a full cycle of developing basic medicine into the sub-specialisation that is now pervasive which supports tertiary treatment of severe and late-stage diseases well – the robotic and keyhole surgeries, the new gene therapies, the novel cancer therapies. We have not done so well “upstream” in the broader definition of health, before disease starts, partly because that is an unexplored area that overlaps with how we live in society, and it is unclear as to who is supposed to manage the challenges and issues here.  

Population health is a field in which we have to look at the entire society and the determinants of health at this stage, and many areas are not traditionally classified as “medical”. Population health has to deal with our living space, our environment, our lifestyle, the food that we eat, the physical environment we live in, the schools our children go to, and the social network for our elderly. There continues to be very little knowledge and research in that area as compared to specialised medicine we practise in. It is an area where many doctors and healthcare professions traditionally trained in medicine and healthcare are not very comfortable in. Doctor and nurses are comfortable in the emergency room and surgical operating theatres.  

But it is important because an increasing number of landmark research has shown that when you prevent diseases and you pay the costs of preventing diseases, through screening, identifying and treating risk factors for disease and continue to maintain health before pre-clinical and clinical disease, the downstream rewards are significant, possibly 10 to 15 years later, for the entire population and society. What we are really looking at for population health is that there will be fewer late-stage diseases and related complications because we have prevented them and caught them early. For example, in diabetes, we will have less amputations, less blindness and less kidney failures downstream.

Q: You are also a highly cited researcher with groundbreaking work in eye diseases which has resulted in new innovations. What mindset should our young clinician-scientists adopt in working towards new discoveries and treatment?

My first mindset is we need to take opportunities when they come. Opportunities come once every few years, perhaps once every few decades, and are sometimes fleeting. If we don’t take real opportunities, we will miss that chance. We cannot go backwards and regret. You cannot say “maybe I'll do this in the future” because it will not be there.

The second mindset is to take careful risks. The challenge for our young Singaporeans is that we are too comfortable in a well-curated, well-managed environment. Now that I am in China, the outside “real” world is bigger, messy, complex and things don't work in a linear fashion. You cannot depend on others. Most of the time, you have to find your own solutions. That is the real world. Our young medical students and young scientists in Singapore cannot take the laboratory or medical school environment as the real world. They need to take risks and to expect failure. I am not sure our young medical students and scientists are used to that. They have never failed in their examinations all the way to medical or graduate school. 

The third mindset is keep a positive attitude to learning. To take on this challenge of working in China, I have to be on my toes in learning and feel uncomfortable all the time. In sports, we know an athlete can never become better if they continue the same training pattern and programme. If you can run 100 metres in 12 minutes and you don't push yourself to run faster in 11 minutes, you are never going to improve. The only way to do this is to take on challenging and difficult assignments. As an ACS boy, my Chinese is terrible, and I have to re-learn this. If I can challenge myself at 54 years of age, then why shouldn't our younger students do something that they are uncomfortable with? If you are too comfortable, then it is not a learning opportunity.

Q: In your multiple senior leadership roles, you wear many different hats. Could you share with us your leadership philosophy?

My leadership philosophy is simple: you are always working for the institution and its people, and for the broader society and country. I have always been guided that what I am trying to do is for a higher purpose and for me, it is God’s purpose in my life. 

A second aspect of leadership is patience. When I was young, I was much more impatient. As I gain more experience in different senior leadership roles, I am in fact forced to be much more patient. Leadership is about making a change for the better and most of the time this cannot be done quickly. Leadership is not authority and therefore, making things change quickly with orders and instructions. In fact, what is changed quickly will reverse quickly too. Leadership is about changing the culture of an organisation and the people in that organisation, and this requires time and patience.

Professor Wong Tien Yin (fourth from left) with staff from the Singapore National Eye Centre, where he was formerly Medical Director