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Vong et al. J Cancer Metastasis Treat 2020;6:54 I http://dx.doi.org/10.20517/2394-4722.2020.116 Page 9 of 11

sessions. Educators also need to adapt to these new practices and come up with effective teaching strategies
for web conferencing, which can be challenging for physicians who are used to conventional bedside
[29]
teaching of students and trainees .
To reduce the risks of inter- and intra-departmental infection transmission, different meeting rooms are
also utilized to segregate the inpatient and outpatient service teams during the videoconferencing teaching
sessions or multidisciplinary case discussions. The weekly scheduled medical oncology teaching sessions
at TTSH utilized pre-recorded lectures on various subspecialty topics supervised by a consultant in charge.
Bedside teaching during ward rounds to the inpatient junior team would be led by the ward consultant in
charge. Case discussions and clinical handover to the weekend on-call team using third party software and
online platforms also posed concerns in ensuring security of information in terms of the Personal Data
Protection Act (PDPA), which came into full effect in July 2014 in Singapore.

During the DORSCON Orange alert period, there is a need to minimise cross cluster transfer of medical
staff, hence rotations of residents and registrars could only be limited to the current institution that they are
based in with no external rotations to other hospitals allowed. Although this may lead to a certain level of
disruption to the training exposure, measures are in place to ensure that they are allowed to be rotated to a
different department of choice within the same academic institution.

For staff deployed to the NCID to manage outbreak wards, timely training is conducted to refresh their
knowledge on Personal Protective Equipment (PPE) and to orientate them to the facilities and equipment
at NCID. Communications on the latest developments of the COVID-19 situation and updated protocols
on screening and managment for COVID-19 cases are available on the hospital’s intranet and distributed
electronically to staff via emails.

It is critical to provide emotional support to clinical staff and trainees during this difficult period given
the high risk of burnout when faced with such a prolonged crisis. A recent survey was conducted by the
NHG residency office pertaining to the challenges faced by residents as a result of the interruptions to
training posed by the ongoing COVID-19 outbreak. They reported an increase in the level of stress and
burnout, citing an average of 4.7 on a scale of 0 (no stress at all) to 10 (extreme level of stress) and 61%
of the respondents either agree or strongly agree when asked whether the current outbreak had adversely
[30]
affected their training and or career . TTSH has set up the 3S (Staff Support Staff) hotline with the
ICU(Intensive Care Unit) teams providing an emotional debrief session and also a technical debrief to iron
out any problems faced at each shift. The Staff Wellbeing Committee is also set up to ensure that staff feels
supported and to ensure meals and snacks are distributed to the staff on duty in the outbreak wards.

VACCINE DEVELOPMENT IN CLINICAL TRIAL EVALUATION
It is a race against time and a global effort is made towards rapid SARS-CoV-2 vaccine development with
the aim of inducing protective immunity following vaccination. There are now phase II clinical trials with
a trajectory towards phase III efficacy evaluation, however there are added challenges with the dynamic
changes seen with this virus [31-33] .

Patients with advanced cancer have historically been under-represented in vaccine clinical trials. As
targeted therapy and immunotherapy have significantly improved the life expectancy for patients with
metastatic NSCLC, these patients should not be reflexively excluded from vaccine trials on the basis of old
preconceptions limiting care for these patients. We advocate that vaccine trials should include patients with
malignancies including thoracic cancers, so as to ascertain safety and efficacy in this group of patients.