Nguyen a physician from Vietnam
Nguyen, a palliative care physician and oncologist from Ho Chi Minh City, Vietnam, received an IAHPC Traveling Scholarship grant to attend the Palliative Care Education and Practice (PCEP) Program at Harvard Medical School, Massachusetts, US, earlier this year.
In the March 2017 Project Report, we shared his experiences on the first part of the program. Having now completed the program, he explains how he has put into practice what he learned.
Can you remind us why you applied for an IAHPC grant?
Nguyen: As a palliative care physician, oncologist and teacher, I realized the importance of communication skills - for sharing information with my patients and their families, for teaching medical students and younger physicians during their placements in our palliative care department, and for my lectures on the annual palliative care basic training program at our hospital. However, I lacked confidence in my communication and teaching skills, since we had no specific training for these in medical school. I thought that the PCEP would give me the skills to improve my efficiency as well as to share my knowledge with other palliative care practitioners.
Can you tell us how you have begun to put new skills and learning into practice?
Nguyen: After the first part of the PCEP, I taught on some basic palliative care training courses for physicians and nurses in Ho Chi Minh City Cancer Hospital and in local hospitals in central and southern Vietnam: ethics in palliative care, decubitus and malignant wound care, communication and case presentations. Hopefully, our young physicians can now grasp the principles of palliative care, such as pain and symptom control, breaking bad news, and apply these to their daily practice.
Some local hospitals were interested in using opioids to control pain and dyspnea and how to manage adverse effects of opioids, and were eager to use these skills after the course. Many young physicians spend their training time in our department, and I instruct two to three physicians every two months.
What are your take-home messages from the program?
Nguyen: Part two of PCEP enabled me to consolidate and enhance the skills I had acquired previously.
Communication skills - will help me deal with conflict in family meetings, in difficult situations such as responding to the expectation of a miracle when a patient is reluctant to talk about it, and how to hold a family meeting. In Vietnam, due to shared-decision-making, we usually have to talk to the many relatives and friends of a patient before we reach a goal of care, and there's often conflict among family members. Patients are often the last ones to know about their own diseases and prognoses, since their families are afraid that bad news will be bad for them.
Teaching skills - since teaching seems to be my part-time job, the teaching topics of PCEP part two will, I hope, allow me to give my audiences a more interesting and productive lecture that they can easily understand and apply to their practice. And the "How to give constructive feedback" or "Being a one-minute preceptor"should help me provide effective mentorship to younger physicians.
How has the program helped you to overcome some of the barriers and challenges In Vietnam that you discussed in our last interview?
Nguyen: As palliative care's influence is expanding in our country, more people realize the importance of symptom control as well as psychosocial issues. But we still have many barriers and challenges, particularly: Lack of essential medicines; lack of public and professional awareness; lack of specialist staff (we still have only physicians and nurses in our department), and lack of support from insurance companies (many drugs, eg. oral oxycodone, topical metronidazole, are not covered). Also, patients have to pay personally for home care services.
The first step to overcome these issues is to expand the understanding of palliative care concepts through teaching and training. I would hope that PCEP has enabled me to improve my teaching skills - not only to better share my knowledge but also to inspire others to see the necessity and meaning of our work. Most hospitals where we have delivered training have now begun to store oral morphine in their pharmacies and integrated palliative care into their daily care (mostly cancer care).
As the number of palliative care practitioners grows in our country, and more people become aware of the same issues that we have now, then our voices and actions will bring greater influence.
On behalf of our scholarship recipients and the entire IAHPC team, thank you for your generosity and making the Travel Scholarship Program possible.