Participatory identification of learning objectives in eight medical schools in Vietnam

Transforming medical education to strengthen the health professional training in Viet Nam: A case study

The competency-based undergraduate curriculum reform at the University of Medicine and Pharmacy at Ho Chi Minh City, Faculty of Medicine (UMP-FM) is detailed and reviewed in reference to the instructional and institutional reforms, and enabling actions recommended by the Lancet 2010 Commission for Health Professional Education. Key objectives are to: revise the overall 6-year curriculum to be more integrated and competency-based; reinforce students' knowledge application, problem-solving, clinical competence, self-directed learning and soft skills; develop a comprehensive and performance-based student assessment programme; and establish a comprehensive quality monitoring programme to facilitate changes and improvements. New features include early introduction to the practice of medicine, family- and community-based medicine, professionalism, interprofessional education, electives experiences, and a scholarly project. Institutional reform introduces a faculty development programme, joint planning mechanism, a "culture of critical inquiry", and a transparent faculty reward system. Lessons learnt from the curriculum reform at UMP-FM could be helpful to medical schools from low- and middle-income countries considering transitioning from a traditional to a competency-based curriculum.

FUNDING

This work receives no external funding.

Becoming Agents of Change: Contextual Influences on Medical Educator Professionalization and Practice in a LMIC Context

Medical educators are particularly needed in Low- and Middle-Income Countries (LMIC), where medical schools have grown rapidly in size, number, and global outlook in response to persistent health workforce shortages and increased expectations of quality care. Educator development is thus the focus of many LMIC programs initiated by universities and governments of high income countries. While signs of medical educator professionalization such as postgraduate qualifications, specialized units, and professional associations have emerged in LMIC, whether these relate to programs originating from outside LMIC contexts is unknown. This study investigated the contextual influences on the long-term impact of an international faculty development program a decade after its delivery in a LMIC context - Vietnam. Ten years after an international aid program to develop clinical skills teaching expertise in Vietnam, we conducted in-depth qualitative interviews with eight medical educators from all eight participating medical schools. Selected for their leadership potential, each participant had completed the Maastricht Masters in Health Professions Education during the program. Interview transcripts underwent thematic analysis, using the Theory of Practice Architectures as a conceptual lens to highlight the contextual influences on professional practice. Four themes were identified: Careers and Practices before, during, and after the program, Unrecognized and Unseen practice, Structural Restraints on individual advancement and collective activity, and the Cultivation of Connections through social traditions. Participants reported being in well-established teaching delivery roles. However, the absence of professionalizing discourses and material resources meant that practice was restricted and determined by institutional leadership and individuals' adaptations. Informed by the theory of practice architectures, we found that change in medical education practice will falter in contexts that lack supporting discursive, material-economic, and socio-political arrangements. While there were emerging signs of individual agency, the momentum of change was not sustained and perhaps unapparent to Western framings of educational leadership. Practice architectures offers a framework for identifying the contextual features which influence practice, from which to design and deliver sustainable and impactful interventions, and to advance context-relevant evaluation and research. Our findings suggest that faculty development delivered across diverse contexts, such as in distributed or transnational medical programs, may have more effect if informed by a practice architectures analysis of each context.

Academic Pediatric Surgery Capacity Building in Vietnam Through PASS, a Pediatric Acute Surgical Support Course

Neonatal and pediatric surgical emergencies in Low and Low Middle Income countries remain a significant challenge in combatting the burden and inequities of global health. IPSAC-Vietnam is a small Non-Governmental Organization that has been engaged in a 12-year multi-pronged partnership with several children’s hospitals in Vietnam VN to enhance pediatric surgery capacity. We describe the health care, medical training and emergency system in VN as the background for IPSAC activities and development of Pediatric Acute Surgical Support (PASS) course. The course goal is to prepare health care personnel in the immediate management of neonatal/pediatric life-threatening surgical conditions and road injuries at their first point of entry into Vietnam hospitals. PASS is a horizontal outreach initiative that adopts an interprofessional, multidisciplinary, team-training, train-the-trainers, and outcome-based training approach. PASS can be used as a tool for sustainable horizontal capacity-building by champion leaders at the teaching children’s hospitals and medical universities in developing countries, to strengthen training for pediatric surgical emergencies, to integrate pediatric and pediatric surgical care and to advocate for a comprehensive approach to emergency care of the critically ill child.

Problem-based learning (PBL) and public health: an initial exploration of perceptions of PBL in Vietnam

INTRODUCTION

Worldwide interest in problem-based learning (PBL) has grown in past decades. This article aims to evaluate the perceived effectiveness, appropriateness, benefits, and challenges attributed to the use of PBL in public health education in Vietnam with a view to providing recommendations for curricular design and future policy.

METHODS

Teachers at 2 universities in Hanoi participated in group interviews, and students from these 2 universities completed Likert-style questionnaires.

RESULTS

Students and teachers regarded PBL positively. However, there was consensus that hybrid models that used PBL alongside other methods are probably the most beneficial for public health education in Vietnam. Teachers discussed the educational and systematic advantages and difficulties associated with PBL.

CONCLUSION

Themes arising from this analysis may be helpful in guiding future research-namely, regarding the application of PBL in low- and middle-income countries and in public health. Further exploration of the use of PBL hybrid models is discussed.

Medical education in Vietnam

BACKGROUND

Vietnam is one of the most populous countries in Southeast Asia, yet it displays an unsettling lack of doctors.

AIMS

Medical education is an important factor contributing to this issue, yet little is known about the system currently in place in Vietnam.

METHODS

Through an extensive literary search of medical schools' and Ministry of Health's data, we have examined the current medical education system in Vietnam.

RESULTS

At present, there are 12 medical universities, and the general curriculum at each university follows a national framework but tends to vary from university to university. Medical training lasts either 4 or 6 years, with competitive graduates attending residency programs following graduation. While examinations are required to graduate, the lack of a national licensing exam makes it difficult to ensure that a nation-wide standard of quality exists, both at the medical universities themselves as well as amongst the doctors graduating from them.

CONCLUSIONS

The development and institution of a national exam would introduce a standard of training throughout Vietnam's medical education system. Further, a substantial portion of a doctor's education is in subjects that are loosely related to medicine. When looking forward it will be important to evaluate whether or not these non-medical subjects detract from the quality of medical training.

Setting school-level educational goal and objectives with the modified delphi method

PURPOSE

The aim of this study was to set the school-level educational goals and objectives, based on the needs analysis, by modified Delphi method.

METHODS

A needs analysis and workshops were performed to establish educational goals and objectives. The needs analysis comprised 3 rounds of questionnaires and a panel and reference group that compared the results. Various workshops were held to set, outline, develop, and promote the educational goals and objectives and perform a satisfaction survey.

RESULTS

In the needs analysis, we identified 8 keywords for 'ends' and 12 for 'means' with regard to educational goals and 25 keywords for educational objectives, which were summarized in 5 factors (categories). There were significant differences between the panel and reference groups. Through the workshops, we established new educational goal and objectives that met with high satisfaction among members.

CONCLUSION

The developmental process with which the educational goals and objectives were established through a needs analysis and workshops was effective, efficient, and supportive in medical education.

Continuing medical education in Vietnam: new legislation and new roles for medical schools

Driven by health care reform and the advent of the private sector in the late 1980s, and by commitments made to the Association of Southeast Asian Nations (ASEAN), Vietnam is faced with a need to increase the regulation and training of its health care professionals. Previously, a diploma from an accredited health professional school was sufficient to practice for a lifetime. Legislation has recently been passed that will institute a licensing system, will require continuing medical education (CME) to maintain the license, and will probably place a large burden on the health professional schools and training institutes to provide CME. Supported by international nongovernmental organizations and foreign universities, the medical universities in Vietnam are responding and are preparing for their new and expanded role.

Motivation of university and non-university stakeholders to change medical education in Vietnam

BACKGROUND

Both university and non-university stakeholders should be involved in the process of curriculum development in medical schools, because all are concerned with the competencies of the graduates. That may be difficult unless appropriate strategies are used to motivate each stakeholder. From 1999 to 2006, eight medical schools in Vietnam worked together to change the curriculum and teaching for general medical students to make it more community oriented. This paper describes the factors that motivated the different stakeholders to participate in curriculum change and teaching in Vietnamese medical schools and the activities to address those factors and have sustainable contributions from all relevant stakeholders.

METHODS

Case study analysis of contributions to the change process, using reports, interviews, focus group discussions and surveys and based on Herzberg's Motivation Theory to analyze involvement of different stakeholders.

RESULTS

Different stakeholders were motivated by selected activities, such as providing opportunities for non-university stakeholders to share their opinions, organizing interactions among university stakeholders, stimulating both bottom-up and top-down inputs, focusing on learning from each other, and emphasizing self-motivation factors.

CONCLUSION

The Herzberg Motivation theory helped to identify suitable approaches to ensure that teaching topics, materials and assessment methods more closely reflected the health care needs of the community. Other medical schools undertaking a reform process may learn from this experience.

Perceptions of graduating students from eight medical schools in Vietnam on acquisition of key skills identified by teachers

BACKGROUND

The eight main Vietnamese medical schools recently cooperated to produce a book listing the knowledge, attitudes and skills expected of a graduate, including specification of the required level for each skill. The teaching program should ensure that students can reach that level. The objective of this study was to determine the perception of graduating students on whether they had achieved the level set for a selection of clinical and public health skills as a guide for the schools to adjust either the levels or the teaching.

METHODS

From all eight schools, 1136 of the 1528 final year students completed questionnaires just before completed all the requirements for graduation, a response rate of 87% overall (ranging from 74-99% per school). They rated their own competence on a scale of 0-5 for 129 skills selected from the 557 skills listed in the book, and reported where they thought they had learned them. The scores that the students gave themselves were then compared to the levels proposed by the teachers for each skill. The proportions of the self-assessed achievement to the levels expected by the teachers, means self-assessed scores and the coefficients of variation were calculated to make comparisons among disciplines, among schools and among learning sites.

RESULTS

Most students felt they had learned most of the skills for key clinical departments to the required level; this varied little among the schools. Self-assessed skill acquisition in public health and minor clinical disciplines was lower and varied more. Sites outside the classroom were especially important for learning skills. The results revealed key similarities and differences between the teachers and the students in their perception about what could be learned and where

CONCLUSION

Revising a curriculum for medical schools demands inputs from all stakeholders. Graduating class students can provide valuable feedback on what they have learned in the existing system. Learning objectives should always be checked with students who have followed their study under existing teaching conditions. The information from the graduates helped to identify potential problem areas where either the objectives or the teaching need adjustment.