Presented by Nguyen Vu Quoc Huy, Hue University Medical College 33rd Annual Conference on Global Health • Washington D.C. • May 30 – June 2, 2006 Field Teaching: Strengthening Reproductive Health Teaching at Hue Medical University Presented by Nguyen Vu Quoc Huy, Hue University Medical College Truong Quang Vinh, Hue University Medical College Susan Clark, Pathfinder International/Viet Nam Ngo Van Huu, Pathfinder International/Viet Nam

Location of Medical Colleges in Viet Nam Hanoi Hai Phong Thai Binh Thai Nguyen Hue Tay Nguyen Ho Chi Minh City Can Tho Location of Medical Colleges in Viet Nam

Rationale Current gaps in Reproductive Health (RH) teaching Perception of RH too simple RH teaching emphasizes knowledge more than skills and attitudes Lack of focus on basic counseling and communication skills RH clinical skills not standardized Lack of quality training sites; too many students to practice at teaching hospital Inadequate facilities at teaching hospitals Hospital-based vs. community-oriented teaching

RH Medical Education Project Started in July 2001 Implementing organization: Hue University Medical College (HMC); technical assistance from Pathfinder International, JHPIEGO, UCSF, and other consultants Funding: Ford Foundation and anonymous donor Goal: To improve the quality of RH care in Viet Nam through improved pre-service teaching in medical schools. General objective: Improve the quality of RH teaching at HMC Improve RH teaching at all medical colleges by replicating lessons learned from the HMC project

Field Teaching Program at HMC Major objectives: To increase quality/quantity of clinical skill education (competency-based learning) To increase community–oriented teaching for medical students.

Field Teaching: Program Development Prioritization of RH KAS needed for medical education in Viet Nam Baseline Assessment: Facility assessment Staff’s RH knowledge/skills RH services, client load Teaching aids Sample of students’ skills

Program Development: Reaching Consensus Selection of field sites: Prioritization of RH skills/topics to be taught at each site Defining roles and responsibilities of key stakeholders: dean, board, teachers, health services, preceptors, and students Memorandum of understanding signed

RH Field Teaching Planning Design of FT program: based on KAS, chose essential contents: Pelvic/breast exams Infection prevention in RH Family planning counseling Antenatal care Postpartum and newborn care Submit detailed FT plan for school leader approval Design key interventions to prepare for FT FT preceptor selection: criteria, procedure, etc. Assign and define roles and responsibilities of FT coordinators

RH Field Teaching: Intervention (1) Develop curriculum and materials for preceptors and students: Develop Self-Directed Learning (SDL) materials Develop Learning Guides for all RH clinical skills, taught at field sites

RH Field Teaching: Intervention (2) Develop Orientation program: learning objectives, materials, time, where to get help, learning process, assessment, and regulation, etc. Logbook to monitor students’ learning Establish a skill lab with anatomic models and equipment for students to practice skills at each FT site

RH Field Teaching: Intervention (3) Standardize selected skills to be taught at FT sites for HMC faculty (18) and preceptors (21, including midwives) Train preceptors (21) on teaching methodologies, including demonstration, supervision, coaching, and student assessment Field site improvement, renovation, including new learning/ skills labs (1 per site). Monitor and support preceptors in their clinical practice (monthly basic)

Field Teaching: Implementation FT program started in 2004-2005 school year Y4 OB/GYN Students - rotations at Hai Lang DHC: 270 students IP, PP, and NB care, breast and pelvic exam, ANC Y6 students - 255 students Rotations at Hue City hospital: IP, ANC, breast and pelvic exam Rotations at Hue RH center: IP, ANC, breast and pelvic exam, and FP counseling

Monitoring and Supervision In the early phase, HMC supervises and supports FT preceptors teaching and helps students learn selected skills at their sites Faculty from OB/GYN Department take turns supervising and monitoring FT at sites Supportive feedback, coaching are provided by the end of the session Participation of Pathfinder and other international consultants (JHPIEGO)

Early Results of FT Program (Based on midterm evaluation) Students motivated to learn more; have more exposure to real clients and feel more confident working with clients Preceptors have improved their clinical skills Preceptors happy and willing to support student learning at their sites Teachers have more community-oriented approaches Teachers more motivated to work with students and preceptors Teachers use more evidence-based materials, based on local clinical experience

Key Challenges Time and staffing constraints — FT rotation is too short — Lack of FT preceptors, workload — HMC teachers are too busy Motivation for preceptors, including recognition and certification Motivation for students’ learning at FT sites

Strategies to Overcome Challenges Formalization of FT Program Intervention and support from Dean, Board, training department Stakeholders maintain commitment Supervision and coaching at the sites

Looking Forward Standardization of assessment system and integration into rotation rating system Expansion to other Medical Colleges