2022年07月09日
Secretary, Dean Designate, fellow former deans, chief executives of our teaching hospital partners, president of our medical alumni association, parents, colleagues, and above all graduands, ladies and gentlemen,
First and foremost, allow me to congratulate and welcome back our colleague and friend, Professor CM Lo, on taking up office as Secretary for Health. His ministerial appointment follows in an uninterrupted line of succession by HKUMed alumni since the political accountability system was introduced: Dr EK Yeoh (Medic 1971), Dr York Chow (Medic 1971), Dr Ko Wing Man (Medic 1981), Professor Sophia Chan (PhD 1999) and now Professor CM Lo (Medic 1985). Thank you, CM, for gracing the occasion on the 25th anniversary of the Hong Kong Special Administrative Region as well as the 135th anniversary of our alma mater, from 1887 to 2022. Moreover, this Congregation bears witness to a time of transition for both of us: your first as Secretary and my tenth and final as dean.
This is then also my tenth State of the Faculty Address. In your hands, you will find my “graduation thesis” as dean. In reverse order, we have included my vision statement for the Faculty during the deanship selection exercise; in other words what I promised I would do if appointed. Then comes my first broadcast message to the HKUMed community on the day of announcement of my appointment in May 2013. Thence follow 10 State of the Faculty Addresses reporting progress and envisioning the future since the 2013 annual Congregation. For those of you who would like to follow, I will now be giving the 2022 Address, which can be found on pages 4 through 25 in your book.
Ten years, 十年, is a blink of the eye in the long arc of history. At the same time, even as the third oldest medical school in the country and one of the longest established in all of Asia, we are but a spritely 135 years old. From this viewpoint, a decade forms a considerable proportion of the whole. This past decade, I would venture to say, has been more eventful than almost any past decade in our history. We have doubled the number of undergraduate degree programmes as well as student numbers, doubled available space for research and teaching, raised the most donations totalling HK$2.7b+ including the single largest to date received by HKU writ large, garnered the most number of international prizes and awards, weathered two epoch-defining social movements, and rose to our highest ever global ranking of 20th.
But do not let me get away with glossing over the details. As our Chief Executive cum Chancellor, has time and again emphasised, from the moment of declaring his candidacy to his inauguration last week, a key quality of leadership must concern the question: can one deliver the outcomes as undertaken –「以結果為目標」? And in the spirit of self-reflection, I offer you an audit of the past decade in the confessional of my final Congregation.
Structure and Infrastructure
Schools and Departments
First, in true Donabedian fashion, let us review the academic structure. At roughly one-tenth the size of most major medical schools nationally and internationally with under 350 full-time faculty members, we were siloed into 20 departments and schools, where some units are constituted by as few as a handful of professoriate staff. Today, we organise ourselves into five schools and one department (which we very much hope will be allowed to become a school by the University soon).
The amalgamation of the pre-clinical disciplines of anatomy, biochemistry and physiology into a synergistic and fit-for-purpose School of Biomedical Sciences had been long overdue and since its formation has gone from strength to strength in organic growth as well as attracted excellent new blood.
The newly formed School of Clinical Medicine will in good time benefit from the added flexibility of true inter-departmental work, breaking new ground that had previously been stifled by the high walls of tradition, while retaining conventional disciplinary focus with external interlocutors including the Hospital Authority as well as local and overseas learned bodies.
Within the School of Clinical Medicine, it is most pleasing to witness Emergency Medicine having done itself proud, growing from a small unit into a department that is now running not only GHK but HKU-Shenzhen Hospital and progressively getting more involved at Queen Mary Hospital. Well done Dr Rex Lam and thank you Professor Tim Rainer!
I am hopeful that the founding dynamic duo of Critical Care Medicine, Drs Simon Sin and Pauline Yeung, respectively from the constituent disciplines of medicine and anaesthesiology, will likewise nurture this seedling of a unit into a research and clinical care powerhouse in the fullness of time.
HKU Health System
University administrators often forget about the wider reality outwith the lofty aspirations of our ivory tower. In clinical medicine, we must always remember and acknowledge that our main theatre remains on hospital wards and in ambulatory clinics. HKU Health System was conceived thus in 2015, serving as a convening platform for robust clinical governance of all our clinical activities covering the four teaching hospitals and the myriad other outpatient facilities and surgeries we operate.
They have grown from an initial nidus of three into a professional team of 21, who oversee mission-critical functions of audit, finance, legal and practice-track professoriate grade management amongst others. These dedicated professionals absolutely enable what we do at the bedside.
During the ongoing pandemic emergency, HKU Health System rose to the occasion in spades, having pioneered the role of a medical post at the first Community Isolation Facility at Choi Wing Road at the height of the fifth wave and paediatric split-dose BioNTec vaccination rollout at Gleneagles Hospital, as well as operated literally every mode of community-based support function including Community Vaccination Centre, Community Testing Centre, Call Centre, nursing home vaccination outreach, and so on.
It has also overseen the planning and development of the HKU Eye Centre at Wong Chuk Hang that will start receiving patients this summer. This newest of our outpatient facilities, along with other preexisting and future sites, is excluded from the Private Healthcare Facilities Ordinance (Cap 633) precisely because HKU Health System has demonstrated robust self-sufficient governance oversight to satisfy the authorities.
Research Core
In 2019, in line with the current and future state of life sciences development, we established the Centre for PanorOmic Sciences, or CPOS in abbreviation. CPOS originated as the HKU Genome Centre, that had been formed to attract Professor Lap-chee Tsui to become its inaugural director over two decades ago. While Lap-chee did indeed join the University, he became Vice Chancellor instead. The Genome Centre then evolved into the Centre for Genomic Sciences, and proudly contributed 2% of the global genome sequencing effort in the International Haplotype Mapping or HapMap Project. CPOS now additionally incorporates the following functions: biobanking, bioinformatics, bioreagents procurement and distribution, proteomics and metabolomics, imaging and flow cytometry, so as to be fit-for-purpose for and take full advantage of the multi-omics and big data era. Professor SY Leung, Chairperson of Pathology and former Associate Dean of Research directs CPOS and Dr Agnes Chan ably leads the superlative team of professional scientific staff.
Of particular note, CPOS forms the lynchpin to HKUMed’s research central core. In constellation with CPOS, there is also the HKJC Centre for Clinical Innovation and Discovery (CCID) dedicated to fundamental and applied cancer research at the Grantham Hospital University Block when it is commissioned in 2024.
Since 2020, the former Laboratory Animal Unit has undergone a major HK$90M upgrade and been rechristened as the Centre for Comparative Medicine Research or CCMR. Beyond nomenclature, it is an acknowledgement of the ever growing role of laboratory animal research in our burgeoning discovery portfolio. Eventually, as one of only a handful of AAALAC(American Association for Accreditation of Laboratory Animal Care)-accredited facilities in the region and the only one locally, we should hope to introduce Hong Kong’s first large animal facility for pharmaceutical and surgical experiments, especially if the SAR were to take seriously its innovation challenge. Dr Dewi Rowlands and Professor YS Chan deserve our deep gratitude of having the foresight and patience to plan and execute this ongoing transformation.
We also eagerly anticipate the first images from the Li Ka Shing Cryo-Electron Microscopy Laboratory when it commences service next year, thereby boosting the capability of our structural biology enquiry.
Finally, to complete our suite of central laboratories, the Laboratory of Cellular Therapeutics, masterminded by Professors Tse Hung-fat and Eric Tse, will become the first stem cell GMP facility cum training centre locally next summer. It will eventually span four sites at the Hong Kong Jockey Club Building for Interdisciplinary Research, Queen Mary Hospital, Grantham Hospital as well as the new Green Belt campus.
Student Centredness
If central strategic laboratories are the core of our research superstructure, an unrelenting centredness on students has been our teaching and learning equivalent during the past decade. We have completely reorganised our teaching and learning deanery into two full-fledged teams – one focused on curriculum and assessment and the other on student wellness and extracurriculars.
Together they have brought about the 130th anniversary curriculum, and the Enrichment Year in particular. The MBBS graduands who are about to walk across the stage are our proud first ‘enriched’ cohort. Their intercalated dual degrees here and overseas, humanitarian service experience in rural China, Africa and South America, research experience in laboratories, the community and by the bedside will stand them in good stead as budding clinicians. With the liberalisation of local medical labour supply, our enriched graduates can compete against the best of those from the other 100 schools worldwide. They will in fact form the bridge to our future Shenzhen medical campus, as we envision candidates who would become qualified across multiple jurisdictions being prepared by HKU on both sides of the Shenzhen River. Similar enrichment schemes have also been instituted for our nursing and pharmacy students.
Engagement Channels
Global and local thought leadership, knowledge exchange and communication in our hyperconnected metaverse age cannot be an afterthought. This is why HKUMed has proactively strengthened our engagement channels in the digital metaverse, going fully into but above and beyond traditional print and electronic media or even social media. We have already minted non-fungible tokens or NFTs for research-inspired art, as well as took prospective GenZ students touring our facilities in the metaverse during the height of COVID when physical tours were rendered impossible.
Architecture
From organisational structure to architecture that houses the organisation, from the metaverse back to brick and mortar, please allow me to recapitulate how far we have come.
As a candidate running for the deanship at a presentation to the entire faculty on March 5, 2013, I outlined my vision of an integrated Sassoon Road campus running from Pokfulam Road to the north-east and Victoria Road to the south-west. This was affirmed, even demanded by the Faculty Review in 2016. Earlier this week, we celebrated the formal opening of the fruits of our labour, namely the HK$800M complex on 3 Sassoon Road that houses the Schools of Nursing and Chinese Medicine as well as the HK$400M brand new Faculty Administration Wing at 21 Sassoon Road.
We also secured Town Planning Board support to rezone a green belt site to be granted by government immediate adjacent to 3 Sassoon Road along Pokfulam Road last November. We are now earnestly preparing for and eagerly anticipate the successful final step of gazettal of the outline zoning plan before the end of the current calendar year. Once that is secured, the land will be assigned to us and funding has already been set aside as per previous Policy Address and Budget commitments.
Nevertheless let me sound a note of caution. The open and covert opposition of the vested interests is robust, fiercest amongst which are those with strong pecuniary conflicts concerning potential property valuations of existing and upcoming residential homes in the neighbourhood. Lobbying by opposing forces will intensify in the coming months. We stand on the side of public interest, and continue to pursue our 135-year and counting mission of advancing health through science. This converges with the vision for an innovation-based life sciences future for Hong Kong and the Greater Bay Area as endorsed by the Central People’s Government and the SAR Government. Stay true to this path and our building dreams will be realised, although the night can seem long.
In her final Policy Address, the last Administration committed to HKU the rest of the green belt slope sandwiched between Pokfulam and Victoria Roads leading up almost to Baguio Villa for deep tech laboratories development. The potential synergies between our four STEM faculties – Dentistry, Engineering, Medicine and Science – would indeed be a dream come true. Again, as we tell our children, nightmares are not real, be brave and everything will be fine when morning comes.
People
As Hong Kong, and the world, tentatively march from COVID pandemicity towards endemicity, we are finally relaunching the ‘140 for 140’ global recruitment drive. Our goal is to recruit an additional 140 world-class scientists and practitioners into our professoriate ranks by HKUMed’s 140th anniversary in 2027. While the repatriation of many ethnic Chinese researchers from the US have significantly expanded our recruitment pool, the same set of reasons accounting for this reverse migration have made international recruitment of other nationalities increasingly challenging. Real and perceived geopolitics are progressively crowding out other considerations of relocation to our part of the world from the global scientific North, that remains mostly concentrated in the geographic west so far.
Our task is to convince prospective new recruits of the unprecedented policy and financial support from different levels of government in Hong Kong, Guangdong province and nationally to boost human capital in the life sciences. The stars have lined up for a transformative leap. There has been no better time to join our ranks, in terms of start-up support, laboratory infrastructure, a nurturing work environment and for entrepreneurial start-ups.
We are already seeing the first signs of success. Even under Hong Kong’s strict COVID travel restrictions and against the background of a higher than usual attrition that is reflective of Hong Kong’s situation generally, we managed to recruit 41 new professoriate staff in the past 12 months. This gives us added confidence going forward as we emerge from the emergency phase of COVID.
While recruiting new talent is important, we must never forget the great people we have always had in situ. True though that academic inbreeding and self-coddling can be deleterious, we must refrain from dogmatically sacrificing meritocracy. Reflexive discrimination against one’s own is as deadly as autoimmune dysregulation. We need to treasure ourselves. No trauma surgeon would miss cauterising an internal bleeder to prevent the patient from haemorrhaging out. It is ultimately much more effective than continuous fluid resuscitation and transfusing packed cells and plasma as replacement.
To honour our best professors, over the past decade, we have established 24 endowed professorships and a distinguished visiting professorship with the support of our donors totalling HK$260M that was matched dollar for dollar by the University. After all, we have increased the number of HKUMed ‘Highly Cited Researchers’, from 2 to 17 since 2013.
Similarly, our philanthropic supporters invested HK$70M establishing seven Springboard and Second Chance entrance scholarships to attract the most deserving new MBBS students.
Recognising that it takes a village to raise a child, and all sorts to make a medical school truly great, we have institutionalised a human capital policy that allows for functional differentiation. Specifically, in addition to the classical academic track that is best suited for clinician-scientists, those whose calling leaning closer to the clinician-educator mode can flourish on the practice track. The non-clinician equivalent is the lectureship track. For the more technically minded, research and scientific officer grades are another option. Non-tenure track posts give further flexibility to take advantage of the increasing availability of funds external to the UGC block grant, that now makes up over half of our expenditure. Of course we are always careful in ensuring fairness to colleagues in these transitory positions by offering more permanent career prospects here and elsewhere.
More recently in the current academic year, HKU Health System instituted the Faculty Clinical Service Excellence Award scheme to shine a spotlight on colleagues who excel in the practice environment. It complements but does not overlap with the Hospital Authority awards because our assessment criteria take a different focus and we cover all of our clinical practice sites, including those in the private sector and in Shenzhen. This completes our internal award schemes for the four key dimensions of our work: research, teaching and knowledge exchange being the other three.
It would be remiss of me not to address the potential implications of the Special Registration scheme that has just been rolled out by the Medical Council of Hong Kong. At longrun equilibrium, by liberalising the medical labour market, it would once again put Hong Kong on the world map in terms of being able to attract the best and brightest, in sufficient quantities, thus serving the public interest and that of our national remit and self ambition of becoming a major life sciences and health care hub. That said, the road to this eventuality is fraught with obstacles and pitfalls. Non-local graduates would need to be treated fairly and welcomed warmly, not just tolerated. Currently rigid and siloed human resources structures and policies need complete rethinking in an open and creative manner. Personal or corporate pecuniary interests must become secondary to societal good, while allowing parties to compete freely and fairly, and reaping the rewards of superlative performance. For this to happen, trust between those in authority and amongst the ranks needs to be restored and enhanced posthaste. Only then could people be reasonably expected to look and plan for the long term, when the pie will surely grow to accommodate everybody’s needs and wants.
Ladies and gentlemen,
Having looked back from the perspective of leadership accountability, as one must, allow me to turn it upside down and persuade you that describing the experience of those whom we purportedly serve and care for, be they students, patients or the general public, would be of even greater import. Too much of history is written about kings and emperors, generals and leaders, or victors generally. History is his story. Let us rather turn it into our common story, one that we can feel together and find consonant echoes. Particularly in our line of work that stresses empathy as a core professional tenet, healthy questioning of pieties and received wisdom by critical reflection with constructive alternatives is a sine qua non to sustained flourishing for the long term. I still recall that I opened last year’s Address by the following age-old quote:
「十年之計，莫如樹木；終身之計，莫如樹人。」
《管子‧權修 第三》
Therefore, good governance is ultimately concerned with a lifelong humanistic focus. Further it should not only be the mean that counts but the distribution around that average person. Particularly when celebrating high achievers, we must never forget those who are the worst off. By the Rawlsian maximin principle, they must be the very group to whom we should give maximum support. A good way to constantly remind those of us in leadership positions of the necessary humanistic focus is to think about our own inadequacies.
Mea culpa
Audits and self-reflections are only as good as they are truthful and honest. Indeed Veritas (Latin for ‘truth’) is the motto of one of my alma maters. Qiushi (求是) is the flagship bimonthly periodical published by the Central Committee of the Communist Party of China. In that spirit then, please let me share with you some difficult questions I have been struggling with for a while now.
Do the corridors of the Queen Mary University Medical Unit still unequivocally and solely befit the moniker ‘Shaolin Wooden Men Alley of internal medicine’ (內科少林木人巷)? For that matter, do surgeons in town, let alone the region, still unanimously defer to our Department of Surgery as the final arbiter cum salvage for the most complicated cases?
However, have the broader circumstances outwith HKUMed been conducive to upholding and improving standards, clinical and ethical? The first casualty of a system at risk of decline is quality, that can initially be brushed off as aberrant ebbs but slowly then suddenly turns into a flood.
Have we been treating our colleagues fairly? Often times, it is not a matter of remunerative bean counting, but a sense of self dignity and respect.
Appealing to our colleagues’ higher calling only carries our mission so far. We must make sure they do not end up directly or indirectly subsidising the mission through lost opportunity costs. Our salary scales and career progression must be on the leading edge of, and in any case must not lag behind, alternative comparators such as Hospital Authority terms and conditions of service. Currently unresolved items that require attention include retirement age and post-retirement medical benefits for self and spouse especially of expensive biologics and consumables. For younger colleagues, ancillary benefits of housing loans as well as the uneven application of the Special Honorarium Scheme across different hospitals remain major deterrents to fulfilling our clinical-academic mission.
Are we truly and pervasively student-centred? Do we ever make students feel bad unnecessarily or shame them publicly, however apparently justified the circumstances?
On the other hand, are there a few amongst our charge who would rather ask but never give, despite their oath on the first day of school to ‘give to my teachers, colleagues, and students the respect and gratitude that is their due’? Both students and teachers would do well to revisit the HKUMed Teaching and Learning Charter.
League tables intrigue the public and provide fodder for after-dinner banter, drive behaviour of prospective students and parents, frustrate or delight university leadership and are generally dismissed by faculty professoriate. Disappointingly, they are even enshrined in statue as a core criterion of the Special Registration scheme by our own government recently. So regardless of how we feel, rankings are here to stay.
Given that different ranking exercises have different, and sometimes orthogonal, key performance indicators (KPIs), the question we should really deliberate is in which dimensions, thus league table, would we rather do well.
At HKUMed, we are overwhelmed with an alphabet soup of such rankings: RAE, THE, QS, and their sub-indices. At the same time, the following agencies carry out professional accreditation every few years: MCHK, NCHK, P&PB, CEPH, AAALAC, ACHS, 3A (三甲). All of the above apply to the institution. Colleagues in fact face their harshest test at the individual level in the form of tenure and promotion exercises, that seem to have an ever rising threshold. How should we, as academic leaders, reconcile these bewildering KPIs for the common person, and stay true to our lifelong humanistic focus – 終身之計 莫如樹人?
These inconvenient questions are surely toe-curling. They are meant to make us uncomfortable, to jolt us out of our daily routines and to confront potential answers that shape who we will become.
Many of us often commiserate about the system and externalities falling outside our remit or expertise. We feel helpless and are angry or despondent. Drowning in our own emotions is a coping strategy but does not change the fundamentals. As much as our id wishes to find repose (躺平), we must steel our minds and nourish our sprits to plough ahead, if not for ourselves then for the sake of our patients and the general public. The opening lines of the Declaration of Geneva come to mind again: ‘I solemnly pledge to dedicate my life to the service of humanity; the health and well-being of my patient will be my first consideration’.
Alumni, friends and colleagues of the HKUMed family,
We, not I alone but very much including you our entire family of students, alumni and staff, have remade HKUMed during the past decade. We have moulded it into the institution we are so, so proud of in our 135th birth year. We have lived out the 135th anniversary motto of ‘Building Dreams, Realising Possibilities’. We have done it through improving our structure, infrastructure and architecture, enhancing our talent pool and nourishing our people, as well as taking a self-critical attitude towards continuous improvement in all that we do. It has been a hard slog but well, well worth the collective sweat and tears, amidst much laughter and camaraderie.
I was a boy scout in primary school. As Robert Baden-Powell, founding father of the worldwide scout movement once taught, ‘try to leave this world a little better than you found it’. I hope you will agree that I will be leaving HKUMed a little better than I found it 23 years ago as a junior lecturer and as your dean since 2013.
Graduands,
The Scout’s Slogan has also stuck in my mind since I was little: do a good turn daily or 日行一善. Not only would I commend you to do the same in your professional lives from this point onwards, let me go one step further and remind you of 劉備’s parting words to his son:「 勿以善小而不為，勿以惡小而為之。」 After all, as healers in the Hippocratic tradition we all swore to ‘first do no harm’ when you embarked on your professional journey five or six years ago.
Ladies and Gentlemen,
I undertook a seamless transition with my successor, Professor CS Lau, when his appointment was announced back in April. As the final act in this transition, let me call upon the Dean Designate to deliver upcoming plans for the Faculty in the coming year as he readies to take over the reins in a week’s time. I give you our next leader, the gentlest of gentlemen and one who commands enormous respect through persuasive whispers, Professor CS Lau.
