Medical education reforms are a crucial component to ensuring healthcare systems can meet current and future population needs. In 2010, a Lancet commission called for ‘a new century of transformative health professional education’, with a particular focus on the needs of low-income and-middle-income countries (LMICs), such as Vietnam. This requires policymakers and educational leaders to find and apply novel and innovative approaches to the design and delivery of medical education. This review describes the current state of physician training in Vietnam and how innovations in medical education curriculum, pedagogy and technology are helping to transform medical education at the undergraduate and graduate levels. It also examines enabling factors, including novel partnerships and new education policies which catalysed and sustained these innovations. Our review focused on the experience of five public universities of medicine and pharmacy currently undergoing medical education reform, along with a newly established private university. Research in the area of medical education innovation is needed. Future work should look at the outcomes of these innovations on medical education and the quality of medical graduates. Nonetheless, this review aims to inspire future innovations in medical education in Vietnam and in other LMICs.
The role of as-needed inhaled short-acting β 2 -agonists (SABAs) in the management of asthma has become a subject of debate due to differing opinions in the professional community relating to the use of SABAs. In this article, we summarize the current position of SABAs when used as reliever medications and examine the challenges to appropriate use including a critique of the data that have led to the condemnation of SABA used as a reliever. We consider the evidence for the appropriate use of SABA as a reliever together with practical solutions to ensure such use, including identifying patients at risk of misusing their SABA relievers and managing issues of inhaler technique and treatment adherence. We conclude that inhaled corticosteroid (ICS)-based maintenance treatment with SABA used as-needed as a reliever is an effective and safe treatment for patients with asthma, with no scientific evidence of a causal link between SABA use as a reliever and mortality or serious adverse events (including exacerbations). Increased SABA use warns of a deterioration in asthma control, and patients at risk of misusing their ICS and SABA medication should be rapidly identified to ensure they are receiving adequate ICS-based controller therapy. Appropriate use of ICS-based controller therapy and as-needed SABA should be encouraged and promoted with educational activities.
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