Thực trạng dạy học lâm sàng môn truyền nhiễm và hiệu quả can thiệp bằng sử dụng bệnh án điện tử tại đại học y khoa vinh tt tiếng anh

MINISTRY OF EDUCATION MINISTRY OF HEALTH AND TRAINING HANOI MEDICAL UNIVERSITY NGO TRI HIEP THE CURRENT SITUATION OF CLINICAL TEACHING OF INFECTIOUS SUBJECT AND INTERVENTION EFFECTIVENESS BY USING ELECTRONIC MEDICAL RECORD AT VINH MEDICAL UNIVERSITY Specialization: Social Hygiene and Health Organization Code: 62720164 SUMMARY OF DORTORAL THESIS HA NOI – 2020 This thesis was completed at: HANOI MEDICAL UNIVERSITY Supervisors: Assoc Prof Trinh Hoang Ha Assoc Prof Nguyen Van Huy Reviewer 1: Reviewer 2: Reviewer 3: The thesis will be defended in front of the PhD Thesis Assesement Panel, Hanoi Medical University At …… on 2020 The thesis could be found at: - Vietnam National Library - Library of Hanoi Medical University INTRODUCTION Clinical teaching (CT) is a special part of medical education in general and teaching of general medical students, in particular CT occupies a large part in training programs of medical universities in the world as well as in Vietnam Throughout clinical practice (CP) process, students are able to apply theoretical knowledge learned to make decisive diagnosis, offer treatment, address situations, monitor and prognose patients There are many CT methods applied in training for students at the hospital CT by medical record commentary (MRC) and case discussion becomes indispensable methods in medical universities Practicing of the medical record-making skills (MRMS) is one of the solutions to improve the effectiveness and quality of CT At present, there is a fact that many medical universities still lack a team of highly qualified lecturers Lecturers also participate in many tasks Besides, a part of students is still passive, lack of motivation, lack of knowledge, skills, and creativity affect learning efficiency In addition, the change in population structure, disease patterns, hospital regulations, people's intellectual life, the explosion of information tecnology (IT) also directly affects the CT process Researches on CT have been conducted in some universities Researches focus on CT characteristics and improve the effectiveness of CT through applicating of active teaching methods The feasibility of the interventions also depended on the factors and conditions of each university The application of IT in CT has not been fully mentioned and studied Vinh Medical University (VMU) was established in 2010 Since 2011, the University started training medical students In the condition of increasing infectious diseases, training of general practitioners with adequate knowledge and skills on infectious diseases is a requirement for the people's health care From that fact, the question is given that how is the current stuation of infectious CT in the VMU and if can apply IT to create the electronic medical record (EMR) to support medical students in making the medical record (MR) better from which to improve the efficiency and quality of CP process? To find the answers to the above questions, we implemented the application of E-learning technology using Moodle software to design the EMR for supporting medical students in clinical practice of infectious subject The thesis was implemented for the following objectives: Describe the current situation of clinical teaching of infectious subject for medical students at Vinh Medical University Evaluate the intervention effectiveness by using the electronic medical record in infectious clinical teaching for medical students at Vinh Medical University NEW CONTRIBUTIONS OF THE THESIS The thesis results provided evidences on the current situation of infectious CT, showed some limitations which affecting the effectiveness of CT Intervention by using the EMR to help students make infectious medical record (IMR) through E-learning course has achieved certain effectiveness High intervention effectiveness (IE) was recorded in the contents of the MR; the positive evaluation of students on the course, selfevaluation of MRMS have improved better The project is practical, feasible to overcomes a number of limitations in CT, is suitable with the trend of IT application and meets the needs of the university, lecturers and students The thesis also opens up a new direction in CT that is the application of IT not only for MRMS but also for other areas ARRANGEMENT OF THESIS The thesis consists of 130 pages, excluding appendices, in which: Introduction of pages, an overview of 35 pages of documents, the research methodology of 18 pages, the research results of 36 pages, the discussion of 35 pages, conclusion of pages, recommendations pages The references were written standardly, there were 112 references, including 38 documents updated within years, accounting for 33.9% CHAPTER OVERVIEW 1.1 Some basic concepts 1.1.1 Medical student General medical students are students who study to become a general practitioner who treats acute and chronic diseases, proposes preventive measures, rehabilitates health and prescribes medicine for patients 1.1.2 Infectious Diseases Infectious diseases are diseases that can spread directly or indirectly to surrounding individuals and tend to cause epidemics in population communities 1.1.3 Medical Record The Medical Record (MR) is a document that records everything necessary for understanding the situation of the patients’diseases from the time of admitting to the time of discharge The MR is done by the physician as soon as possible when the patient enters the hospital and records all the information related to the patient including name, age, address, occupation, arising status, and disease progression 1.1.4 Infectious Medical Record The IMR is a MR sample that is formulated when a patient is admitted to the department of infectious disease The IMR presents the personal patient's information, the patient's condition upon admission, the diagnosis of the physician, and the patient's examination results 1.1.5 Electronics Medical Record The EMR is a digital version of a MR, recorded, displayed and stored by electronic means, with the legal basis and the equivalent function to the paper MR, specified in the Law on Examination and Treatment 1.1.6 Information Technology IT is an engineering branch that uses computers and computer software to convert, collect, store, protect, process and transmit information 1.1.7 Terminology concept of E-Learning E-learning is the process of learning through electronic means, the Internet, and Web technologies The content is distributed to the classrooms via the Internet, Extranet, audiotapes, videos, broadcast satellites, television, CD - ROM and other electronic media 1.1.8 Moodle concept Moodle is an open-source online learning management system, also known as Course Management System or Virtual Learning Environment, which allows creating courses on the Internet or online Web pages 1.2 Overview of clinical teaching 1.2.1 The role and goals of clinical teaching CT often makes up a large proportion of medical staff training programs in medical universities Through CT, students will achieve common goals: 1) Learning attitudes, behaviors, and behaviors 2) Learning knowledge and career skills 3) Training the clinical thinking style, working style of health staff; learning methodology; forming self-study, self-researching, and building the working capacity 1.2.2 The features of clinical teaching CT takes place in hospitals, clinics, and is closely related to the task of healthcare for patients The relationship between teachers and students will motivate students to behave more flexibly to facilitate learning with good results CT is flexible in many places, many forms with different content and forms of learning The CT process requires teachers, students to be proactive, organized and methodical to achieve the best results 1.2.3 The current situation of clinical teaching CT plays an important role in medical training The method of education requires promoting students' activeness, self-awareness, initiative, and creativity Since the 1980s, innovations in teaching methods at medical universities have begun to be paid attention but moving slowly In fact, the CT skills and practices is gradually being forgotten and overlooked at some medical universities in the world CT methods also tend to confuse CP teaching with theoretical teaching Students not know the CP skills Active teaching methods have not been widely disseminated The organization and support of lecturers to make the CP process become more proactive and effective has not been paid enough attention The trend of floating CT, wasting training time are very common and serious in many universities Many important goals are neglected There is an imbalance between theory and practice; less teaching organization, management, statutes, rules, working style; a little combination of teaching community medicine skills, communication skills, counseling, health education, how to solve community-related health problems The university-hospital combination is not adequate which effects the hospital’s benefits as well as the student's academic results Defects in CT not only occur in a few universities but also can be seen in most medical universities 1.2.4 Several active clinical teaching methods Some active teaching methods are used in the world and in Vietnam Including 1) Small group teaching; 2) Problem Based Learning; 3) Teaching by case studies; 4) Teaching by roleplay; 5) Teaching by the bedside; 6) Teaching with progression diagram or flowchart; 8) Teaching by checklist 1.2.5 Some solutions to improve the effectiveness of clinical teaching There are many solutions to improve the efficiency of CT Depending on the universities, the time to apply Some solutions are: 1) Giving students early access to CT environment; 2) Improving the quality of clinical lecturers; 3) Improving the quality of CT methods with patients; 4) Innovating clinical evaluation methods; 5) Enhancing the application of IT in CT, and 6) Organizing students to self-study clinically 1.2.6 Some domestic and foreign studies on clinical teaching Le Van Cuong's study in 2008 applied active clinical learning methods on 145 medical students, of which 78 students in the 3rd-year and 67 students in the 6th year were divided into 15 groups Research by Tran Thi Thanh Huong, Le Thu Hoa et al in 2002 on 143 teachers and 1360 students of Hanoi Medical University on CT methods Research of Vu Dinh Chinh, Tran Thi Minh Tam, Nguyen Thi Lien et al in 2006 on CT method Research by Truong Viet Truong, Nguyen Thi Quynh Hoa et al in 2015 on regular students of Thai Nguyen University of Medicine and Pharmacy Pham Thi Hanh's study in 2018 on medical students from Hai Phong University of Medicine and Pharmacy on the status of CT and intervention through positive teaching methods Research of Nguyen Thi Quynh Nga in 2017 at VMU on CT method The study of Mc Manus I C, Richards P, Winder B.C in 1998 on 4,000 students at Marry Medical University in London on study habits affects the amount of clinical knowledge Research of Ghasemzadeh I et al in 2015 on students of Hormozgan University of Medical Sciences, Iran on the medical teaching method Research of Seki Masayasu et al in 2016 on the clinical learning model of students Research of Guishu Zhong and Xia Xiong in 2010 on students of Lusho Medical University on some factors related to clinical learning Josephine L Dorsch et al in 2004 studed on 3rd-year medical students on evidence-based CT Research of Sarah Parrott, Llison Dobbie, Heidi Chumley in 2006 and Research of Wolpaw Terry in 2012 on positive teaching methods 1.3 Overview of the medical record and electronic medical record 1.3.1 The role of medical record MR is medical and legal documents Each patient has only one MR per medical examination, and treatment at a health facility Internship students, researchers, practitioners in medical examination and treatment facilities may borrow on-site MR to read or copy in service of research or professional and technical work The role of MR: 1) Helping properly diagnose and treatment, disease monitoring, professional improvement; 2) Serving scientific research work; 3) Administrative and legal documents base 1.3.2 Basic functions of medical record The MR has the following functions: 1) Helping to identify and store patient records; 2) Managing the patient's anthropometric data; 3) Managing patient-specific issues; 4) Managing the list of medicines for patients; 5) Managing patient's medical history 6) Managing notes and documents: creating, supplementing, editing, and verifying information; 7) Creating the patient clinical documents from external sources; 8) Providing appropriate patient care planning, guidance, and implementation; 9) Summarizing and recording specific patient instructions 1.3.3 The structure and content of infectious medical record The IMR has a basic structure of internal MR including 11 contents: 1) Administration; 2) Reasons for hospitalization; 3) History; 4) Pre-history; 5) Physical examination; 6) Summary of MR and preliminary diagnosis; 7) Subclinical testing; 8) Diagnosis; 9) Treatment; 10) Prognosis; 11) Prevention, health education 1.3.4 The electronic medical record The EMR is a digital version of the MR, which is recorded, displayed, and stored by electronic means, has the same legal basis, and functions as the paper MR prescribed in Article 59 of the Law on Medical Examination and Treatment The content of the EMR shall include all information fields in the form of MR used in medical examination and treatment facilities The use of the EMR is a new step in medicine leading to changes in healthcare and medical research In this project, the EMR is a MR sample designed on the basis of the contents of an IMR based on the application of Moodle software and Elearning technology When using the EMR, medical students are assisted in MRMS to improve the effectiveness of internships, suitable in the era of IT, and the lack of lecturers 1.3.5 Some research works on the medical record–making skills and the electronic medical record Specialized case studies of medical students are often limited and integrated with other clinical skills Assessments of clinical skills are expressed in evaluating communication skills, examination skills, reasoning skills in making clinical diagnosis decisions, and health education counseling skills Pham Thi Hanh's study in 2018 at Hai Phong University of Medicine and Pharmacy through intervention with positive CT methods Research by Nguyen Duc Linh, Nguyen Thi Thanh Quyen, Ho Thi Le et al 2011 in Tay Nguyen University on CP skills Nguyen The Hien’s study in 2016 at medical universities on the quality assurance status of general practitioner education Research by Ivan Solarte, Karen D Könings in 2017 at San Ignacio Universitario Hospital - Colombia, EMR programs and policies for students Research by R Jacobs, M Kane in 2019 on medical students in the United States on the use of the EMR for students Research by White, Jordan et al in 2017 on the method of using the EMR with medical students 1.4 Application of information technology (IT) in medical training 1.4.1 Current situation of information technology application in medical teaching IT plays a role in the advancement of medicine today and motivates medical students to study, solve problems, and many other benefits In the clinical environment, the traditional method of disclosing inadequacies is not having enough time for clinical lecturers to interact with students An increase in the number of students learning leads to the lack of clinical lecturers, limiting the self-study spirit, limiting the skill level of students An opportunity set for medical education is to apply IT to achieve its goals in teaching and learning In 2017, the Prime Minister issued Decision 117/QD-TTg approving the Project "Strengthening the application of IT in management and supporting teachinglearning and scientific research activities, contributing to improving the quality of education and training in the 2016-2020 period, with orientations toward 2025” However, medical universities in Vietnam have not yet effectively applied IT to education, especially in CT 1.4.2 E-learning teaching method E-learning is a term used to describe learning and training based on information and communication technology, especially IT From a modern perspective, E-learning is the distribution of learning content, using modern electronic tools such as computers, satellite networks, Internet, Intranet Through a computer or television, teachers and learners can communicate with each other via the Internet in forms such as email, online discussion,forum, seminars, videos From 2000 to the present, E-learning has created a revolution in education and training E-learning has advantages: not limited by space and time; increased attractiveness; flexibility; updating; there are cooperation and coordination in learning; create pleasant psychology for teachers and learners E-learning has disadvantages that are: high technical cost; limited social communication skills; restricting experimental practices and requiring high personal awareness The functional model of an E-learning system consists of parts: Learning Content Management System and Learning Management System The system model consists of main parts: 1) Communication infrastructure and network 2) Software infrastructure 3) Content of training 1.4.3 Moodle course management system Moodle is an open-source online learning management system that allows creating courses on the Internet or online learning websites The characteristics of Moodle are: 1) Free and open source; 2) Educational philosophy; 3) Community Moodle has outstanding features compared to other CMS systems such as Blackboard, WebCT that help educators organize courses, effectively distribute learning materials, and introduce appropriate form to apply IT 85.8% of students needed to use the EMR 3.1.3 The situation of human resources, facilities, and training programs for CT CP facilities were relatively adequate with manpower and facilities for CT However, the number of lecturers with postgraduate qualifications was still low Patient flow and the disease structure at Military Medical Hospital were inadequate The training program to ensure basic CT was fully prepared The number of implementation of the MRC was 6-8 times/batch 3.2 The effectiveness of intervention by the EMR 3.2.1 The effectiveness of intervention through the assessment of MRMS - Comparison of the skill of exploitating the administrative information before, after the intervention, and compared with the control group: Before the intervention, the average score of administrative information exploitation skills of both intervention and control groups was medium After the intervention, the average score of the intervention group increased by 0.2 points (p 0.05) - Comparison of the skill of exploitating the reasons for the hospitalization before, after the intervention and compared with the control group: after the intervention, the average score of the skill of exploiting the reason for admission to the hospital in the intervention group increased by 1.3 points (p < 0.05), while the control group increased by 0.2 points (p> 0.05) - Comparison of the skill of historic exploitation before, after the intervention, and compared with the control group: The difference in scores after intervention between the control group and the intervention group was 1.9 points, the difference was statistically significant with p