RunningHead:TECHNOLOGYINMEDICALEDUCATIONINVIETNAM

Technology in Medical Education

in Medical Schools in
the Socialist Republic of Vietnam
EDU625 Integrating Learning and Technologies

Elisabeth Schlegel
Post University, August 19, 2016

Author Note
The write-up of the diagnosis and treatment of the broken femur used in Topic #3 was inspired and
written by Dr. Nancy Selfridge, Ross University School of Medicine.
Thank you very much, Nancy

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Overview of the Project

The Socialist Republic of Vietnam has been experiencing a steep socioeconomic growth while still
struggling with providing proper healthcare due to shortage of well-trained doctors (Yen Nhi, 2013). With
the support of Harvard Medical School and the University of Geneva Faculty of Medicine, Vietnams
premier medical school, the University of Medicine and Pharmacy in Ho Chi Minh City UMP, radically
revised its curriculum implementing up-to-date medical education including active collaborative learning
skills. In order to build capacity and implement innovative medical education at Vietnamese medical
schools, a generalized implementation training curriculum termed medical education executive
curriculum MEEC consisting of several modules will be provided to the faculty and leadership of
Vietnamese medical schools. The modules will introduce and demonstrate the basics of medical education
relevant to local institutions, train best practices and work-flows, and relate to leadership and teambuilding skills to ensure sustainability. Applying backward design concepts, the ideal outcome can be
summarized as establishing value-driven medical schools committed to continual quality improvement
and ongoing curriculum evolution to drive healthcare improvement in Vietnam (Wiggins and McTighe,
2012). Sensitive interactive group work to bridge English proficiency is most productive (Asia for
Educators, 2016). The MEEC will be delivered through team work alternating with plenary sessions and
include pre-reading and study assignments. Pedagogies include flipped classroom, audience-response
technology, cloud-based technologies such as social media platforms and other methods as applicable in a
low-resource environment (Wankel, 2011). Subtopics of the MEEC will include the following,

Sub-Topic #1: Organ-System Based Medical Education Aligned to the Institution.

Introduction to the concepts, applications, governance skills and developments necessary to
implement an organ-based medical program aligned to the needs and capacity of the
individual institution.

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Sub-Topic #2: Executive Faculty Development for Learner Centered Education.

Identification of specific teaching needs and training of active learning methods face-toface.

Sub-Topic #3: Executive Faculty Development for Modular Curriculum Education.

The content of this module will combine curriculum governance training (leadership) with
active learning methods face-to-face.

Sub-Topic #4: Continuing Online Faculty Development. The content of this module will
provide ongoing and special training to support emerging training needs.
Content Module SubTopic#1

Sub-Topic #1: Organ-System Based Medical Education Aligned to the Institution

Vietnamesemedicalschooldeansandfacultyworkmorningsinclinicalwardsandhavelimited
availability.Inaddition,thereisnomedicaleducationadministrationcomparabletoU.S.basedmedical
schools.Ontheotherhand,aleadershipcoreteamisneededtodrivecurriculumdevelopment.Theuseof
technologycanresolvethesecircumstancesbuildingtaskforces,examiningcapacityandidentifying
areasofeducationaldevelopment.
InVietnamasalowresourcecountry,freecloudbasedsocialnetworkenvironmentssuchas
Facebookarepopularandcanbeusedcreatingagroupadmittingonlytheprimaryleadershipteam.The
Facebookdiscussionthreadswillbefurnishedwithfinaldeadlinesandcoverexaminingmedical
curriculaofleadingUSbasedandEuropeanmedicalschools,identifyingachievablecurricularchanges,
thegenerationofavisualcurricularblueprint,anddevelopmentofanindividualidentitybrandadjustedto
theuniversitycapacity.SurveyMonkeysurveyswillbeembeddedintotheFacebookgroupinorderto
obtaindecisions,andtrendswillbedisplayedviamindmapstobedisplayedforfurtherfinetuningand
approval.
SMARTObjectives
Aftercompletingcontentmodule1,participantswillbeableto

TECHNOLOGYINMEDICALEDUCATIONINVIETNAM

listanddefinethe6stepsofcurriculardevelopmentasdevelopedbyKernsandcolleagues
(2009),astandardtextinthefield

identifyanddescribethemostcommonlyusedtypesofmedicalcurriculaofselectedUS
basedandEuropeanmedicalschools

listthemostimportantVietnamesehealthcaretopicstobeincluded
Instructions

Step-by-Step Approach for Participants

Step 1: Create a Facebook group and break out in teams per discipline and department for
collaboration and discussion.

Step2:Workthroughthe6stepsofcurriculardevelopmentandcreate6slideseachper
teamfordiscussiononFacebook

Step3:Completesurveymonkeyontheregionsmostneededhealthcareinterventions

Step 4:EachteamdevelopsonemindmapwithpossibleinterventionsonMicrosoftPPT

Step5:Agreeononeimportanttopicforhealthcareinterventionperbodysystem
Activities

After a brief morning session recapping the steps of a curriculum and comparing the learning
objectives of the teams, an easy and affordable way of creating mind maps will be used to develop the
critical care mind maps for the individual body systems.

TECHNOLOGYINMEDICALEDUCATIONINVIETNAM

SeveralmindmapswillbecreatedandsharedonFacebookforonlinediscussion.
As a final step, all participants complete the participant survey of the topic.
ContentModuleSubTopic#2
SubTopic#2:ExecutiveFacultyDevelopmentforLearnerCenteredEducation
TheEleventhCongressoftheCommunistPartyofVietnamprioritizeddevelopmentofcontent,
programsandpedagogicalmethods,includingmedicaleducationinResolutionNo.29NQ/TW,from
November4,2013.LearnercenterededucationbyAmericanorEuropeanstandardsincludecollaborative
learningsuchasTeambasedlearningandProblembasedlearning,interactionintheclassroomsuchas
audienceresponsetechnologyordiscussion,roleplay,orpreorpostassignedhomework(Glpinar&
Yeen,2005).
Previouscollaborationwiththefacultyrevealedthatsomeofthesepedagogieswereusedto
differentextentsindifferentmedicaldisciplinestaughtbythecognatedepartments.Theoverallgoalisto
trainthefacultyinstitutionwideaddressingadultlearningneedsandinvolvingadultlearnersinthe
creationoftheircourseofstudy(Chen,2014).Thus,facultywillworkingroupsbydepartment
representingindividualmedicalsubjectssuchasmicrobiologyorphysiology.
Facultywillfirstelicitrealdataaboutthecurrentuseoflearnercenterededucationthrougha
studentsurveydevelopedinSurveyMonkey,createchartsinExcelandpresenttheoutcomesbackto

TECHNOLOGYINMEDICALEDUCATIONINVIETNAM

faculty.Next,facultyexperiencedinaspecificpedagogywillgiveasamplepresentationtoall
participantsafterabriefintroductionbytheinstructor.Thatway,contextuallearningappropriatefor
adultsisincludedintothefacultydevelopmentempoweredbycloudbasedtechnologyandprocessedby
locallyavailableMSExcelandMSPowerPoint.AdditionalsignificanceofSurveyMonkeyand
MicrosoftExceldatapresentationinteachingandlearningistheirnumerouspossibilitiesofapplicationin
theevidencedrivenfieldofmedicaleducation.Inaddition,elicitingdataandtheirmeaningful
representationareimportantskillsofmedicaleducationresearch.
SMARTObjectives
Aftercompletingcontentmodule2,participantsoftheMEECwillbeableto

Gathercurrentdatafromtheirownstudentbody,exploreandevaluatetheminorderto
studyaliveexampleofevidencebasedinstructionanduseamethodofmedicaleducation

Collatecurrentdataandpresentoutcomesdemonstratingbasicstatisticalliteracyinorderto
instructstudents(Blagdanic,C.&Chinnappan,M.,2013)

Identifyandthemostcommonlyusedtypesoflearnercenterededucationatthehome
institution

Presenttoandlearnfromeachotherthemostcommonlyusedtypesoflearnercentered
educationatthehomeinstitution
Instructions

StepbyStepApproachforParticipants
Steps1),2)and3)shouldbecompletedaweekpriortothefacetofaceMEECmodule.

Step 1: Create a Facebook group and break out in teams per discipline and department for
collaboration and discussion.

TECHNOLOGYINMEDICALEDUCATIONINVIETNAM

Step2: Compose a survey template listing most likely used learner-centered education and
the individual medical disciplines such as microbiology, physiology or pathology as shown
below in the Activitysection.
o

SignupatSurveyMonkeyandcreatethesurveyusingmultiplechoicequestions
withafinaltextualansweroption(seeActivity).

Step3:Blastemailthesurveytotheentirestudentbodyorasectionthereofofthehome
institution.

Step4:Afterabriefdidacticoverviewcoveringtheobjectivesofthemodule,proceedwith
gatheringdatafromsurveymonkeyanddistributefeedbacktoindividual
discipline/departmentteams.

Step5:HaveeachdepartmentcopythenumbersintoatableinMicrosoftExcelandcreate
apiechartdiagramtoseethefractionsofeachmethodology(seeexampleintheActivity
section).

Step6:Havefacultyteamsdevelopbriefpresentationsabouttheteachingmethodstypical
forthedepartment,identifyingteachingexperts.

Step7:Afterbriefreviewoflearnercenteredmethodologies,havetheteachingexperts
presenttheiruseofthemethodintheclassroom.

Step8:Haveeachdepartmentdevelopandpresentoneexampleofusingtheleastused
teachingmethodtoallparticipantsforfeedback.

Step9:Distributeparticipantsurvey.
Activities

MicrosoftOfficeproductsorfreecloudbasedservicessuchasFacebookorSurveyMonkeyare
availableinVietnamasalowresourcecountry.First,asurveytemplateneedstobecreatedinMSWord
foritemofstep2.Thetemplatebelowisreadyfordistributiontoallfaculty.

TECHNOLOGYINMEDICALEDUCATIONINVIETNAM

Afterreceivingthecompletedsurveysfromthestudents,theevaluationanddatacollationfunctions
canbeusedtoreceivenumbersperchosenmethodology,whichcanbedisplayedinExcelbyaddingapie
chartshowingthefractionsofallresponsesforagivendiscipline.Thedatasheetwiththepiechartisthen
savedaspdfandthenasjpegformatstoallowcreatingMicrosoftPPTpresentationsforeachdiscipline.
ThedatarevealthatProblembasedlearningPBListhemethodmostoftenusedinmicrobiology,while
writingassignmentsinclassarerarelyrequestedbythefaculty.TheMicrobiologyDepartmentmaybe
readytoshowcaseasampleaboutPBLtoallparticipants,andwouldbeadvisedtoaimincludingwriting
exercisesintotheclassroomteaching.
Belowisanexampleofmicrobiologystudentresponsedata.456studentsansweredthesurvey.

TECHNOLOGYINMEDICALEDUCATIONINVIETNAM

Fig.2:PiechartjpegwithMicrobiologydata.
Content Module Sub-Topic #3
Sub-Topic #3: Executive Faculty Development for Modular Curriculum Education
In Vietnam, modules are mostly led by department chairs unfamiliar with educational requirements.
Thus, the preparation of department chairs for educational leadership roles and responsibilities has
become increasingly important. According to Steinert and colleagues (2012), medical faculty leadership
training is commonly perceived as gain in knowledge of leadership concepts, principles, and strategies
as well as specific leadership skills (e.g., personal effectiveness and conflict resolution) (Steinert et al,
2012). In addition, Martin, Furr, Lane and Bramlett show that simulation of major health incidents helps
connect learner engagement and personal relating to a realistic situation (Martin et al., 2016). A simulated

TECHNOLOGYINMEDICALEDUCATIONINVIETNAM

10

approach includes mindful and directive leadership. It will be the responsibilities of the department chair
who also directs the curricular modules, to decide what content will be taught. Thus, knowledge of local
epidemiology and public health as well as negotiating skills will be discussed. However, the clinical
aspect is prioritized over formal leadership training for the purpose of this paper.
In American and European educational institutions, a tremendous shift in medical training occurred
over the last decade using simulation as a foremost means of training for physicians, nurses, and medics.
Independent from animal suffering or difficult administration of expensive cadavers, simulations are
constantly improving towards higher fidelity, yet only available to affluent institutions (Talbot, 2013).
Ideal for low-resource countries such as Vietnam, free online interactive anatomy simulations offer highfidelity simulation, are accessible to teams and individuals, and allow self-paced learning. For the MEEC,
the anatomy simulation Biodigital Human, accessible on https://human.biodigital.com/index.html, was
chosen to develop interactive simulation learning.
As elaborated by Kerns and colleagues in the six-step approach to establishing or reforming
medical curricula, problem identification and general needs assessment is the first step in identifying
learning content (Kerns et al, 2009). According to the CDC in Vietnam Factsheet (2016), the ten leading
causes of death in Vietnam include road injuries, a reality on Vietnamese streets. Thus, teaching anatomy
through simulating a mass casualty in an urban area was chosen as example to guide and instruct
department chairs in the following,

identifying content, such as bone fractures as seen in a mass casualty

furnishing it with learning objectives,

identifying and developing a medical simulation activity and

Implementing it into the curriculum.

University leadership and faculty will work in department teams consisting of department chairs
with the department faculty. Leadership will be advised to consult and negotiate with all team members
who are also practicing physicians. All teams have the same assignment but will develop the learning

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11

activity individually and present to each other at the end of the faculty development. A survey monkey
evaluation about covering the learning objectives and the usefulness of the session will be available after
wrap-up.
SMART Objectives
After completing content module 3, participants of the MEEC will be able to

Identify a learning content area within a body-systems that reflects a healthcare need of the
institution and the region (Kerns et al, 2009)

Identify and develop a reliable and realistic low-resource simulation learning activity for
student teams

Present to and learn from each other the approaches taken to identify a specific activity
Instructions

Step-by-Step Approach for Participants

Step 1: Create a Facebook group and break out in teams per discipline and department for
collaboration and discussion.

Step 2: For anatomy education, explore online the most severe incidents of trauma and
injury through accidents in communities in Vietnam (Ngo et al., 2012). Each team identifies
one learning objective discussing one injury related to the musculoskeletal system.

Step 3: Teams are presented with a sample learning objective

o

Students will be able to evaluate a specific injury [impaled thigh leading to injured
femur], examine potentially affected structures on the Biodigital Human
application and write a brief medical evaluation to demonstrate understanding of
injury and possible treatment.

Alternatively: Teams develop and send in their learning objectives ahead of time,
and an activity is developed based on one of them

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Step 4: Teams are presented with the case of an injured femur. The pictures show a
laceration of a right thigh and the corresponding X-ray.

Step 5: Teams access https://human.biodigital.com/index.html, examine the structures most

likely injured and compose a brief medical evaluation and treatment in Microsoft PPT as
shown in the activity below.

Step 6: Teams present their medical assessments to each other.

Step 7: All participants complete the participant survey.

Activities

After a brief morning session comparing the learning objectives of the teams, introducing the
Biodigital Human simulation and the experiences leading the teams, the teams are presented with the
learning objective and the images of the injury and the corresponding X-ray. The injury indicates a
fracture of the bone structure underneath the muscles.

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Accessing the web site:

Zooming in on the vastus medialis muscle. The

https://human.biodigital.com/index.html

given images point towards injuries of the vastus

medialis and a fractured femur (below).

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The observations are summarized on a slide together with possible treatment. The teams will have
different approaches and possibly discuss tendons, arteries, and other impaired structures. Teams present
their medical assessments to each other.
As a final step, all participants complete the participant survey.
Content Module Sub-Topic #4
Sub-Topic #4: Continuing Online Faculty Development. The content of this module will provide
ongoing and special training to support emerging training needs.
Collaboration with Western medical schools and capacity building in remote medical education
centers are important steps for improving medical education and healthcare worldwide. As described by
Davis and colleagues this year, telesurgery involving nonrobotic tools that allow a geographically remote
surgeon to perform a procedure, has been introduced to medical practice in Vietnam (Davis et al, 2016).
Thus, telesurgery will be discussed at a high level of detail as example for emerging technologies in this
course topic.
In Vietnam, subspecialty surgical care such as neurosurgery is not available readily. In addition,
issues of cost, connectivity, and the continued need for skilled operators at the surgical site impair the
progress. According to Davis and colleagues, virtual interactive presence and augmented reality
(VIPAR) allow surgeons to provide real-time virtual assistance and training on standard internet
connection. A hybrid of local and remote video streaming allow remote surgeons to interact and add
pointers to digitally providing a visual demonstration of complex operative techniques. Two stations in
the collaborating locations interact over a local wireless or 3G mobile connection, providing worldwide
point-to-point connectivity in two separate hospitals. Downloadable apps allow evaluation of composite
image overlays of the video feeds, displayed on iPads. For the purpose of the MEEC, a simulation of the
VIPAR telecollaboration as workable approach will be covered. It allows

identifying a subspecialty area of need, such as neurosurgery

furnishing it with learning objectives,

TECHNOLOGYINMEDICALEDUCATIONINVIETNAM

working up a simulated VIPAR telecollaboration activity and

Implementing it into the curriculum.

15

University leadership and faculty will work in department teams consisting of department chairs
with the department faculty. Leadership will be advised to consult and negotiate with all team members
who practicing physicians with neurologists among them. All teams cover the same example but will
develop learning activities individually and present to and discuss with each other at the end of the faculty
development. A survey monkey evaluation about covering the learning objectives and the usefulness of
the session will be available after wrap-up.
SMART Objectives
After completing content module 4, participants of the MEEC will be able to

Identify a learning content area within a body-systems that reflects a subspecialty

healthcare need of the institution and the region (Kerns et al, 2009)

Identify and develop a reliable and realistic telesurgery learning activity for student
physician teams

Present to and learn from each other the approaches taken to identify a specific activity
Instructions

Step-by-Step Approach for Participants

Step 1: Create a Facebook group and break out in teams per discipline and department for
collaboration and discussion.

Step 2: For surgery education, explore online the most needed yet underserved fields
requiring subspecialty surgery, such as neuro, plastics, orthopedics or vascular. Each team
identifies one learning objective related to one subspecialty surgery need.

Step 3: Teams receive a plenary presentation about the setup and application of telesurgery
and VIPAR telecollaboration activity and receive preconfigured iPads

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Step 4: Teams are presented with a historic case of successful pediatric subspecialty surgery
applying VIPAR in Ho Chi Minh City in 2016 (Davis et al., 2016):
o

Teams will be able to evaluate a disease requiring subspecialty surgery and

simulate application of VIPAR, write a brief evaluation to demonstrate
understanding of setup and connection

Step 5: Teams examine and work up the case in their teams with commentary shared with
all participants

Step 7: Teams use their own learning objective and compose a simulated surgery approach
with correct use of VIPAR

Step 6: Teams present their work-up and intervention to all participants

Step 7: All participants complete the participant survey.

Activities

After a brief morning session comparing the learning objectives of the teams and introducing
virtual interactive presence and augmented reality (VIPAR), the teams are presented with a historic case
application. VIPAR was trialed in neuroendoscopy requiring the use of the operative microscope for
international telecollaboration.
The teams learn about VIPAR in a didactic session: The VIPAR system consists of both a local and
a remote station connected over a local wireless or 3G mobile connections, providing worldwide point-topoint connectivity. Both local and remote surgeons view a composite image of video feeds at each station,
allowing for visual demonstration and telecollaboration. The distant station image appears as a
semitransparent overlay on the local station image, and a single hybrid image is displayed to both parties.
Whereas early iterations required complex video capture and display systems, newer versions run on
iPad (Davis at al., 2016).
Teams activate the software and work on overlaying images and shown in the picture below.

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The teams are presented with a successful historic case. Below, the local iPad with camera displays
the microscopy picture (left), and the screen with red arrow pointer is directed toward the surgeon (right).

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After the teams completed the walk-through of the complete successful historic case, they simulate
a case based on their own learning objective and present to all participants. The teams will use different
diseases based on underserved surgical needs in Vietnam.
As a final step, all participants complete the participant survey of the day and meet to a brief wrapup session.

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Pictures
ImageImpaledthigh:http://fcdn.mtbr.com/attachments/riderdowninjuries
recovery/1083675d1469286695impaledthighimg_3254.jpg

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21

ImageXRay:
http://www.amhsr.org/articles/2013/3/2/images/AnnMedHealthSciRes_2013_3_2_197_113661_f5.
jpg
ImagesVIPAR:
Davis,M.C.,Can,D.D.,Pindrik,J.,Rocque,B.G.,&Johnston,J.M.(2016).OriginalArticle:Virtual
InteractivePresenceinGlobalSurgicalEducation:InternationalCollaborationThroughAugmented
Reality.WorldNeurosurgery,86103111.doi:10.1016/j.wneu.2015.08.053