Pathfinder Looks to Mobile Technology to Improve Vietnam’s Continuing Medical Education

With funding from the Fogarty International Center of the National Institutes of Health, Pathfinder has begun a new project to test the effectiveness of a mobile phone-based continuing medical education strategy among Vietnamese community-based physician assistants.

In partnership with the International Health Training Center of Boston University, the project sends SMS messages to community-based physician assistants (CBPAs) over a six month period of time with the goal of addressing retention of professional knowledge, making community health workers more effective in the long-term.

"The idea of using mobile phones in continuing medical education training is very new to us. We welcome the idea and view it as a positive direction,” --Dr. Nguyen Thanh Duc

"We appreciate the idea and have a belief in its applicability and its potential in improving the knowledge of medical workers,” said Dr. Nguyen Cong Khan, General Director of Administration of Science Technology and Training in the Ministry of Health. “We look forward to the results in order to consider for wider application of this approach.”

A new look at continuing education

In 2009, Vietnam passed the Law on Examination and Treatment which required continuing medical education (CME) among health providers for the first time. Most CBPAs in Vietnam practice independently with little professional training due to relatively short time of training at the medical colleges. The need for continuing education is urgent. 

Under this regulation, health practitioners have to complete at least 24 hours of CME a year. If he fails doing so two years in a row, his practice license is revoked by the health authorities. 

While this is good news for the Vietnamese population, the Ministry of Health is concerned: Vietnam has nearly 300,000 practitioners nationwide and not enough infrastructure or budget to accommodate this training requirement. There is worry among practitioners as well. Many find themselves unable to leave their workplace to participate in the required in-class training courses. 

And so the Ministry of Health has set out to find new approaches to make CME more cost-effective and accessible to health providers, especially in rural parts of Vietnam.

Since 1994, Pathfinder has collaborated with the Ministry of Health and different partners to improve the capacity of the country’s health care workforce. From pre-service training to in-service trainings, Pathfinder is now recognized as one of the most active and capable organizations in CME in Vietnam’s health sector.

While mobile technology is a popular and cost-effective tool in health care, there isn’t much evidence on the effectiveness of mobile tools in CME. Pathfinder’s work will focus on the effectiveness in improving the knowledge of health practitioners but also the cost impact of this type of intervention. And the Ministry of Health is confident it will be successful. 

"The idea of using mobile phones in CME training is very new to us. We welcome the idea and view it as a positive direction,” said Dr. Nguyen Thanh Duc, Head of the CME Bureau of the Administration of Science, Technology and Training at the Ministry of Health.

Already, Hanoi Medical University has expressed interest in applying this approach if the results prove to be effective: "If the upcoming results show effectiveness, we will deploy the training widely for our students," said Ms. Ngoc Anh, Head of the IT department of the Hanoi Medical University.

Randomized and controlled research

The project uses randomized and controlled research with a research group of 660 CBPAs. They are divided into three groups: the control group receives weekly SMS messages that do not contain any medical content; the passive group receives daily SMS messages containing medical content; and another group called the “active group” receives SMS messages in the form of multiple choice questions where they are required to send their answer (if their answer is incorrect, the system will automatically send the correct answer).

The three groups will receive the intervention over a period of six months. 

All CBPAs will also participate in a baseline and end-line survey. Comparing the scores between the two surveys will identify the difference between the baseline and the end-line surveys as well as the differences recorded among the three groups. 

The study consists of three main stages: preparatory stage, interventions stage, and then finally, the analysis and validation stage. 

Pathfinder collaborated with the Center of Population Research, Information and Database of the Ministry of Health to develop the software. With Pathfinder technical assistance, the team of technicians was able to design, develop, and put the system into operation. 

With help from the Thai Nguyen Provincial Health Department, Pathfinder identified 660 eligible and volunteering CPBAs for enrollment. Then Pathfinder worked with the content development team from Boston University and the team of faculty members in Hanoi School of Public Health and Hanoi Medical University to develop 360 SMS messages. 

From May 20-22, the 660 CPBAs completed the baseline survey. The SMS messages began on May 25 and will continue for six months. 

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