School of Medicine
Personal Narrative – Sean Tackett, Vietnam for medical education
I went to Vietnam to help the non-profit of a friend from my residency. They had a program in which urban physicians work with rural providers to improve management of common primary care conditions. He felt that I could help by working with the urban providers on their educational skills.
My stay was fascinating. As an educator my focus was on how physicians were trained and how they viewed learning. When I observed physicians in practice, their communication was physician-centered, characterized by short, targeted questions and a brief set of instructions for what the patient needed to do. Physicians interacted with learners in similar ways – targeted questions with brief explanations as to why an answer was right or wrong. All this was done in a well-intentioned and caring manner, but it seemed that it could limit learners’ growth in understanding. I had seen similar behaviors when I was in China, and in both cases, this prompted reflection on my own medical training. Most importantly, it made me appreciate the importance of role modeling - in discussing with these physicians their approach to educating patients and trainees, it was clear that they were imitating teachers they had had. I feel in the U.S., while we may have more formal curricula on communication skills, in many ways we also learn to communicate and teach by imitating the physicians who taught us.
Despite the differences in our current teaching practices, when I held a workshop on educational skills for faculty at a cardiology hospital, everyone agreed that more active learning strategies, which require the learner to take the lead and teacher to take more of a guiding role, would be preferable (also something that had happened when I taught in China). This strengthened my belief that while some aspects of education are culturally variable, the physiology of learning is the same everywhere. People learn best through authentic experiences and practice, and most people understand this intuitively.
I was told that the approaches to education that I observed were representative of all of Vietnam, which made me wonder how teaching strategies could be improved across the country. I was in touch leaders from Vietnamese medical schools, national NGOs, and the WHO and learned that national medical education reform is happening in Vietnam; the government was hoping to create national admissions criteria, national exams, and an accreditation system. However the major realization that I came to is that, while these may be beneficial in standardizing physician knowledge and some physician skills, their impact on overall educational quality could be limited. Vietnam has a legacy of shortages of physicians, faculty, and medical schools. With so few faculty, implementation of educational reform is challenging, and may in some cases be impossible. While Vietnam has made great strides in health over the last few decades, improvement in physician training could take much longer as programs for faculty develop more role models who can influence the behaviors of students. Before I went to Vietnam I was convinced that medical education quality was the most important factor for excellent physician performance. Spending time with physician-educators and learning about Vietnam’s medical education system added another layer: faculty are the most important factor for excellent medical education, and a shortage of qualified faculty can cripple a medical education system, more, I believe, than many really appreciate. Now that I realize this, I will look for more opportunities to engage in faculty development as I continue my work in improving medical education internationally.
Finally I should add that being an American in Vietnam was also a fascinating cultural experience. The American war ended about 40 years ago, so many whom I met had no real recollection of what it was like to live through the decades of war which had preceded. I was welcomed and found the society in general to be quite open-minded. It was heartening to see how Vietnam has been gradually opening to the rest of the world.
Me with VNMAP leaders after a teaching session at Tam Duc Heart Hospital:
Dr. Phan holding up free HIV medications which are given out at Xom Moi clinic, a charity clinic in Ho Chi Minh City:
Dr. Hieu teaching clinic providers at Tan Thanh Station:
Community residents outside Tan Thanh Station clinic during medical mission, a daylong open clinic with health screenings and educational sessions:
VNMAP volunteer educating about use of a medication: