ICMMS 2017

2nd International Conference of Military Medical Schools 2017 2nd ICMMS 2017 “Simulation-BasedMedical Education and Military Medicine” 13-15 September 2017Phramongkutklao College of Medicine Bangkok, Thailand



Her Royal Highness Princess Maha Chakri Sirindhron The Patron ofPhramongkutklao College of Medicine FoundationICMMS 2017 3



MESSAGE FROM THE CHAIRMANDear Sir / Madam, It is such a pleasure and honor to welcome youand your delegation to the educational conference, the2nd International Conference of Military Medical Schools(ICMMS 2017) to be held at Phramongkutklao Collegeof Medicine in Bangkok during 13-15 September 2017with the theme “Simulation-Based Medical Education and Military Medicine”. This conference is hosted by Phramongkutklao College of MedicineFoundation under the Royal Patronage of HRH Princess Maha Chakri Sirindhorn;Royal Thai Army Medical Department; Phramongkutklao Medical Center; andPhramongkutklao College of Medicine (PCM) with the core objective to create aplatform for military medical school community to share body of knowledge andinnovations in Military Medical Education and Military Medicine. This will help toachieve sustainable development among military medical schools across the globe. In this regard, it is sincerely hoped that this meeting will create strongerfriendship and cooperation among the Military Medical Schools. Hope all of youenjoy contributing to this conference and have a great time in Thailand.Sincerely yours,Lt.Gen. Saroj Keokajee, M.D.Surgeon General,Royal Thai Army Medical DepartmentChair, ICMMS 2017ICMMS 2017 5

COMMITEE Lt.Gen. Saroj Keokajee, M.D. Surgeon General, Royal Thai Army Medical Department Chairman of the Steering Committee Lt.Gen. Sayan Sawadsri, M.D. Director of Phramongkutklao Medical Center Vice-Chairman of the Steering Committee6 ICMMS 2017

Maj.Gen. Channarong Naksawasdi, M.D. Dean of Phramongkutklao College of Medicine Director of Phramongkutklao Hospital Chairman of the Organizing Committee Col. Assoc.Prof. Kitti Torcharus, M.D. Col. Pajaree Thitthiwong, M.D. Deputy Dean for Administration, Assistant Dean for International Affairs Phramongkutklao College of Medicine Phramongkutklao College of MedicineVice-Chairman of the Organizing Committee Conference SecretaryICMMS 2017 7

Maj.Gen. Assoc.Prof. Prapaipim Thirakhupt, M.D. Director of Academic Affairs Division, Phramongkutklao College of Medicine Chairman of the Scientific CommitteeCol. Asst.Prof. Chantrapa Sriswasdi, M.D. Col. Asst.Prof. Arom Khunpasi, M.D. Deputy Dean for Academic Affairs Deputy Director of Academic Affairs Division Phramongkutklao College of Medicine Phramongkutklao College of MedicineVice-Chairmen of the Scientific Committee8 ICMMS 2017

ORGANIZING COMMITTEEChairman: Maj.Gen. Channarong NaksawasdiVice-chairman: Col. Assoc.Prof. Kitti TorcharusScientific program &Exhibition: Maj.Gen. Assoc.Prof. Prapaipim Thirakhupt Col. Asst.Prof. Chantrapa Sriswasdi Col. Asst.Prof. Arom Khunpasi Col. Asst.Prof. Dusit Staworn Col. Asst.Prof. Panadda HatthachoteConference Secretary: Col. Pajaree Thitthiwong Col. Chetana Ruangpratheep Col. Chanwit WijaranaRoyal reception and Protocol: Col. Assoc.Prof. Nantaporn Viravathana 1st Lt. Monthalee ThiraapisakkunPublic Relation: Col. Assoc.Prof. Rachata Lumkul Lt.Col. Pitipat ChamnanvechRegistration and Evaluation: Col. Asst.Prof. Krittika Chumpolbunchorn Col. Raweewan EkgasitHospitality: Col. Asst.Prof. Paanjit Taamasri Lt.Col. Asst.Prof. Nithipun SuksumekBanquet and Activities: Col. Asst.Prof. Chananan Khoprasert Col. Asst.Prof. UnchaleeVisawapokaInvitation Protocol: Col. Asst.Prof. Jeeranut Tankanitlert Maj. Sumaiya SensathienAudiovisual: Col. Assoc.Prof. Sangkae Chamnanvanakij Lt.Col. Anandorn WongthirasutOfficial Website: Col. Kasom Bhangananda 1st Lt. Pakorn KupkanjanakulProcurement: Col. Ouppatham Supasyndh Col. Assoc.Prof. Suthee PanichkulTreasurer: Col. Suthee Ratanathummawat Maj. Montree BeawthungnoiHousehold management, Col. Asst.Prof. Kijja SuwanVehicle services and Col. Thaweesak MeechamnanTrafficManagement: Col. Thaweesak RachanonthadSecurity: Col. Wichet Rattanajaratroj Lt.Col. Komgrit WorabutrCommittee: Col. Prof. Mathirut Mungthin Col. Asst.Prof. Tunyarut Koonchornboon Col. Asst.Prof. Ram Rangsin Col. Thamrongroj Temudom Col. Asst.Prof. Phunphen Napradit Col. Yutthaphong Imsuwan Col. Kitiporn Putthikhunt Col. Roongkajee Utaimongkol Lt.Col. Yatima Khunnawat Lt.Col. Vijit Pimrat Lt.Col. Boonnum Sriwaurai 1st Lt. Pisanupong BuddhadecharadICMMS 2017 9

CONTENTMESSAGE FROM THE CHAIRMAN �������������������������������������������������������������������5ORGANIZING COMMITTEE ��������������������������������������������������������������������������������9THE 2nd ICMMS 2017 CONFERENCE OVERVIEW ������������������������������������������ 11PROGRAM AT A GLANCE..................................................................................13CONFERENCE PROGRAM.................................................................................14PHRAMONGKUTKLAO COLLEGE OF MEDICINE ���������������������������������������19PLENARY SESSION AND WORKSHOP ������������������������������������������������������������21LECTURE............................................................................................................... 25ORAL PRESENTATION........................................................................................43POSTER PRESENTATION....................................................................................55AUTHOR INDEX..................................................................................................7410 ICMMS 2017

THE 2nd ICMMS 2017 CONFERENCE OVERVIEWTheme Simulation-Based Medical Education and Military MedicineHosts Phramongkutklao College of Medicine Foundation under the Royal Patronage of HRH Princess Maha Chakri Sirindhorn Royal Thai Army Medical Department Phramongkutklao Medical Center Phramongkutklao College of Medicine (PCM)Date 13-15 September 2017Conference venue Phramongkutklao College of Medicine 317 Rachawithi Road, Bangkok, Thailand, 10400Objectives 1. To share the knowledge, best practices and teaching methods focusing on the topic: “Simulation-based medical education among military medical schools” 2. To enhance capabilities of military medical school faculties in providing medical education using simulation environment 3. To be a platform for military medical students and faculties to present their scientific works or learning experiencesConference details 13 September 2017 : Opening ceremony by HRH Princess Maha Chakri Sirindhorn Plenary lectures, Lectures, Countries’ presentation, Exhibition 14 September 2017 : Workshop : Conducting Effective Simulation-based Training by  Dr. Joseph O. Lopreiato; Val G. Hemming Simulation Center, Uniformed Services University of the Health Sciences, USA  Dr. Miriam E. Bar-on; University of Nevada, Las Vegas School of Medicine, USA 15 September 2017 : Military Medical School Networks; Collaborative Opportunities  Heads of delegation and faculty session only Focusing on Learner Competence and Outcomes  Dr. Miriam E. Bar-on; University of Nevada, Las Vegas School of Medicine, USA Students’ Presentation, Closing remarksDelegates This conference is for military medical school faculties, students and those who involve in medical education or military medicine.Official website: bit.ly/icmms2017Official email: [email protected] for speakers  Personal computer notebook is not allowed for presentation.  Speakers can submit presentation file(s) at the slide preview desk during the Welcome Reception at the Sukosol Hotel on 12 September, 5-8 pm or submitting your presenta- tion file at [email protected] 2017 11

Instruction for poster presentersPoster orientation  Poster contents should be summarized using brief written statements or graphic materials and text should be of sufficient size for easy reading at a distance of 1.5 meter. Title must be displayed clearly at the top of the poster and should include the names of the author(s) and the institution of origin. Poster orientation should be landscape. Your poster(s) will be shown up at the Scientific Exhibition Hall at Niranvichaya Room, 2nd Floor of Conference Building.Poster presentation  During the exhibition opening on 13 September 2017; those who participate in the ICMMS 2017 as a poster/exhibition presenters are required to show up at the Scientific Exhibition Hall at Niranvichaya Room, 2nd Floor of Conference Building during the Opening of Scien- tific Exhibition on 13 September 2017 at 8:00 am. During the Opening Session of Scientific Exhibition, less than 2 minutes are required for presentation.Accommodation  International delegates will be advised to have their hotel reservations at The Sukosol Hotel Bangkok, locating in the heart of Bangkok within only 15-20 minutes from the conference venue at Phramongkutklao College of Medicine.  The Sukosol Hotel Bangkok, 477 Si Ayuthaya Road, Phaya Thai, Bangkok 10400, http:// www.thesukosol.com/Transportation  The airport transfers and hotel-conference venue transfers are provided with compliments from the organizing committee.  Please provide us the name list of delegation in individual country basis together with the air ticket flights no later than 15 August 2017 for proper arrangement of the vehicles.Staff in charge for hospitalities  The organizing committee will provide 1-2 staff in charge to facilitate the group of delegation in individual country basis.  The liaison will receive the group at the airport upon arrival and in charge until the group departure from Thailand.Welcome reception  We are very pleased to welcome all distinguished guests to the welcome reception on 12 September 2017 at 6:00 pm at The Sukosol Hotel Bangkok  International speaker(s) can deliver their presentations in CD or flash drive to our assigned Audio-Visual staff on duty at the Welcome Reception at 5:00 pm.Dress codes Tuesday, 12 September 2017 Welcome Reception: National Dress or Business Casual Wednesday, 13 September 2017 During Opening Ceremony: Ceremony Uniform / White Uniform During Conference: Working Uniform / Summer Uniform Reception Dinner: National Dress or Business Casual Thursday, 14 September 2017 During Conference: Working Uniform / Summer Uniform Friday, 15 September 2017 During Conference: Working Uniform / Summer Uniform Social Events: Working Uniform or Civilian Attire12 ICMMS 2017

PROGRAM AT A GLANCE Date TUE WED THU FRI Time 12 SEP 2017 13 SEP 2017 14 SEP 2017 15 SEP 2017 0730 Registration0800-0830 Workshop: PMK Visit A: Military0830-0900 Opening Ceremony Conducting ST1: Medical School0900-0930 Main Conference Hall, Networks; Effective Cardiac Center Collaborative0930-1000 4th Floor Simulation - based ST2: Opportunities1000-10301030-1100 Opening of Training by: Central Laboratory B: Focusing Scientific Exhibition Joseph O. Lopreiato, Services on Learner1100-1145 Niranvichaya Room, Miriam E. Bar-on ST3: Competence and PM&R Outcomes1145-1200 2nd Floor1200-1300 Orthopedics C: L3-Military1300-1330 by Medical Schools1330-1500 HRH Princess Coffee Break Around the World: Maha Chakri Sirindhorn Experience Sharing1500-1530 PCM Visit by Medical School1530-1630 Scientific Exhibition ST4: Faculty Coffee Break Classroom Visit Coffee Break Plenary Lecture: ST5: Simulation-Based Student Oral Medical Education by Study Laboratory Presentations: Joseph O. Lopreiato Visit USA, Thailand L1:Medical Education and Military Medicine Lunch Japan, India, by Head of Delegation Cambodia, or Representative (1) Workshop: AFRIMS Visit Bangladesh, China, Thailand, China, Conducting 1330-1530 Thailand, India, Research Japan Effective China Simulation - based Laboratory Visit L2: Medical Education Closing Remarks and Military Medicine Training by: by Head of Delegation Joseph O. Lopreiato, Bangkok Sight or Representative (2) Miriam E. Bar-on Seeing USA, Bangladesh Vietnam, Myanmar, India, Cambodia Coffee Break L3: Military Medical Schools Around the World: Experience Sharing by Medical School Faculty1630 Registration 1800 Welcome Reception Dinner1900-2100 Reception Devaraja Sabharamaya Sukosol Hotel, Hall, Phaya Thai Palace Bangkok* L: Lecture, ST: StationICMMS 2017 13

CONFERENCE PROGRAM 2nd ICMMS 2017 TUESDAY, 12 SEPTEMBER 2017Venue : The Sukosol Hotel, BangkokAttire : National Dress or Business Casual16:30 Registration18:00-21:00 Welcome Reception WEDNESDAY, 13 SEPTEMBER 2017Venue : Phramongkutklao College of Medicine (PCM)Attire : Ceremony Uniform / White Uniform during Opening Ceremony07:30-08:30 RegistrationSession 1 Main Conference Hall, 4th Floor09:00-09:30 The Opening Ceremony presided by Her Royal Highness Princess Maha Chakri SirindhornSession 2 Niranvichaya Conference Room, 2nd Floor09:30-10:00 The Opening of Scientific Exhibition presided by Her Royal Highness Princess Maha Chakri SirindhornSession 3 Niranvichaya Conference Room, 2nd Floor10:00-10:30 Scientific Exhibition10:00-10:30 Coffee Break: Corridor, Main Conference Hall 3rd, 4th FloorSession 4 & 5 Main Conference Hall, 4th Floor Chair: Col. Kitti Torcharus Co-Chair: Col. Dusit StawornSession 410:30-11:00 Plenary Lecture: Simulation-based medical education Dr. Joseph O. Lopreiato Uniformed Services University of the Health Sciences (USU), USASession 511:00-12:00 L1: Medical Education and Military Medicine by Head of Delegation/Representative (1) (20 minutes for each presentation)  Simulation-based medical education: PCM experience Maj.Gen. Prapaipim Thirakhupt, PCM, Thailand  Simulation-based clinical skills training program for medical undergraduates in Chinese Military Medical University Wang Zhinong, Second Military Medical University (SMMU), China  “Defense Medicine” at NDMC- education and research Lt.Gen. Norihiko Yamada, National Defense Medical College (NDMC), Japan12:00-13:00 Lunch: Conference Building 3rd, 4th Floor14 ICMMS 2017

Session 6 Main Conference Hall, 4th Floor13:00-15:00 Chair: Col. Chantrapa Sriswasdi Co-Chair: Col. Ram Rangsin L2: Medical Education and Military Medicine by Head of Delegation/Representative (2) (20 minutes for each presentation)  Uniformed Services University of the Health Sciences: An overview RADM MC USN (ret) William M. Roberts, USU, USA  Concurrent infection of Tuberculosis and Leishmaniasis in patients from Kala-azar endemic areas admitted to Surya Kanta Hospital in Mymensingh Maj.Gen. Md Fashiur Rahman, Armed Forces Medical College (AFMC), Bangladesh  Some solutions to improve the quality of clinical practice of military medical students at Vietnam Military Medical University Maj.Gen. Do Quyet, Vietnam Military Medical University (VMMU), Vietnam  Curriculum reform for basic medical education in DSMA Col. Ko Ko Lwin, Defence Services Medical Academy, Myanmar  Simulation based medical education at Armed Forces Medical College (AFMC, India) : An overview Brig. Navdeep Sethi, AFMC, India  Medical simulation in Cambodia Col. Kang Virak, Health Science Institute of Royal Cambodian Armed Forces, Cambodia15.00-15.30 Coffee Break: Corridor, Main Conference Hall 3rd, 4th FloorSession 7 Main Conference Hall, 4th Floor15:30-16:30 Chair: Col. Arom Khunpasi Co-Chair: Col. Thamrongroj Temudom L3: Military Medical Schools Around the World: Experience Sharing by Medical School Faculty (15 minutes for each presentation)  Simulation-based medical education and military medicine Lt.Col. Abu Noman Mohammed Mosleh Uddin, AFMC, Bangladesh  Education and research of basic medical sciences in National Defense Medical College (NDMC) Toshiaki Ishizuka, NDMC, Japan  Efficacy of simulation based training in surgery at Armed Forces Medical College (India) - An objective structured assessment programme Gp Capt. Biju K Varghese, AFMC, India  Influenza surveillance and outbreaks among army personnel - Bangkok, Jan 2012 - June 2017 Capt. Anupong Sirirungreung, PCM, Thailand19:00-21:00 Venue : Devaraja Sabharamaya Hall, The Phaya Thai Palace Attire : National Dress or Business Casual Reception DinnerICMMS 2017 15

THURSDAY, 14 SEPTEMBER 2017Venue : Phramongkutklao College of Medicine (PCM) Emergency Medicine Department, Phramongkutklao Hospital (PMK)Attire : Working Uniform / Summer UniformSession 8 Emergency Medicine Department, PMK08:00-16:30 Workshop: Conducting Effective Simulation - based Training (Faculty Session, by Pre-Registration only) Instructors :  Dr. Joseph O. Lopreiato Uniformed Services University of the Health Sciences, USA  Dr. Miriam E. Bar-on University of Nevada, Las Vegas School of Medicine, USA  Col. Dusit Staworn Phramongkutklao College of Medicine, Thailand  Col. Pramote Imwatana Army Medical Field Service School, Thailand  Lt.Col. Suthee Intharachat Phramongkutklao College of Medicine, Thailand  Lt.Col. Panithan Kwangwaropas Phramongkutklao College of Medicine, ThailandSession 9 Hospital / Classroom / Laboratory Visit (Parallel Session)09:00-12.00 For delegates who would not attend the Workshop in Session 8 (Head of Delegates and Students) ST1: Sirindhorn Cardiac Center, PMK Hospital ST2: Central Laboratory Services, PMK Hospital ST3: PM&R, Orthopedics, PMK Hospital10:30-11:00 Coffee Break: Conference Building 3rd Floor, PCM ST4: Classroom Visit, PCM ST5: Study Laboratory Visit, PCM12:00-13:00 Lunch: Conference Building 3rd Floor, PCMSession 10 AFRIMS Visit (Parallel Session)13:30-15:30 For delegates who would not attend the Workshop in Session 8 (Head of Delegates and Students) Research Laboratory Visit, AFRIMS (Transfer by Shuttle Vans from PCM at 13.15)16 ICMMS 2017

FRIDAY, 15 SEPTEMBER 2017Venue : Phramongkutklao College of MedicineAttire : Working Uniform / Summer UniformSession 11 (Parallel Session)08:30-09:30 A: Rapee-Sagarik Conference Room, 3rd Floor Heads of Delegation and Faculty only Chair: Maj.Gen. Prapaipim Thirakhupt Co-Chair: Col. Dusit Staworn Military Medical School Networks; Collaborative Opportunities Free Discussion B: Neena-Nirun Conference Room, 3rd Floor Chair: Col. Sangkae Chamnanvanakij Co-Chair: Col. Thanainit Chotanaphuti Faculty Session only Focusing on learner competence and outcomes Dr. Miriam E. Bar-on, University of Nevada, Las Vegas School of Medicine, USA C: Main Conference Hall, 4th Floor Chair: Col. Mathirut Mungthin Co-Chair: Col. Panadda Hatthachote L3: Military Medical Schools Around the World: Experience Sharing by Medical School Faculty (15 minutes for each presentation)  First-aid training with simulation-based Nguyen Thai Linh, VMMU, Vietnam  Simulation based training in medical education - our experience at Armed Forces Medical College (India) Lt.Col. Karuna Datta, AFMC, India  Training nursing practice with simulation-based Huu Duc Nguyen, VMMU, Vietnam09:30-10:00 Coffee Break: Corridor, Main Conference Hall 3rd, 4th FloorICMMS 2017 17

FRIDAY, 15 SEPTEMBER 2017Session 12 Main Conference Hall, 4th Floor10:00-11:45 Chair: Col. Piyapan Cheeranont Co-Chair: Col. Suthee Panichkul Student oral presentations: 10 minutes for each presentation  Operation Bushmaster: Pushing the limits of simulation in combat medical education Michael Porambo, USU, USA  A 12-year trend of heatstroke among Royal Thai Army recruit in basic training Aticha Udomdech, PCM, Thailand  Wound healing effect induced by 5-aminolevulinic acid (ALA) Wataru Terabaru, NDMC, Japan  Off-site simulation based training on management of post-partum hemorrhage: Subjective assessment amongst final year medical students Lakshmi Renganathan, AFMC, India  My learning experience as a medical cadet in Cambodia Maj. Sin Daro, Health Science Institute of Royal Cambodian Armed Forces, Cambodia  Simulation-based medical education and military medicine Tasnuva Tarannum, AFMC, Bangladesh  An experimental simulation device for underwater explosion Danfeng Zhang, SMMU, China  An integrated training program of mass casualty and disaster management (Yok-Pira-Rak) for the 4th year nursing students of the Royal Thai Army Nursing College (RTANC) Napasorn Srisattayawongsa, RTANC, Thailand  Sensitisation of medical undergraduates in doctor-patient relationship using simulated standardized family module Gunta Satya Preetham, AFMC, India  Exploration on the new health support system for China Navy offshore operations Rong-Bo Wen, Second Military Medical University, ChinaSession 13 Main Conference Hall, 4th Floor11:45-12:00 Closing Remarks Group Photo12:00-13:00 Lunch: Conference Building 3rd, 4th Floor13.30-16.00 Half Day Bangkok Sight Seeing for International Guests18 ICMMS 2017

PHRAMONGKUTKLAO COLLEGE OF MEDICINE Phramongkutklao College of Medicine (PCM) was officially established on16 June 1975. The name “Phramongkutklao” was the regal name of His Majesty KingVajiravudh granted by His Majesty King Bhumibol Adulyadej. PCM is located withinthe grounds of Phaya Thai Palace at 317 Ratchawithi Road, Ratchathewi District,Bangkok, 10400. PCM is Thailand’s military medical school under direct command ofPhramongkutklao Medical Center and is an affiliated college of Mahidol University.Principal missions of PCM are to produce qualified graduates with international standardof knowledge in medicine and military medicine, to promote integrated research inmedical, military and local Thai wisdom fields, to provide standard academic servicesto society, to preserve arts, culture, Thai wisdom and soldier tradition, includingmanaging good governance administration follows Sufficiency Economy Philosophy. PCM provides medical cadet with knowledge, skills, attitudes and ethicsnecessary to become competent physicians. The medical curriculum of PCM is dividedinto three program levels of six academic years (12 semesters). Pre-medical program(Year 1) is studied at Faculty of Science, Kasetsart University which is a civil universitystudying scientific subjects such as Mathematics, Statistics, Biology, Chemistry, Physicsand other subjects in humanities and social science. Pre-clinical program (Year 2-3) isprovided at PCM studying basic medical sciences including: Physiology, Anatomy,Biochemistry, Microbiology, Pharmacology, Pathology, Parasitology and CommunityMedicine. Clinical program (Year 4-6) is at Phramongkutklao Hospital and PCMICMMS 2017 19

studying on theories of diseases, their prevention and treatments as well as Militarymedicine. Apart from the medical curriculum, medical cadets must complete militarytraining throughout their course. PCM has a unique curriculum for “Military Medicine”. Military Medicineinvolves prevention, threat assessment, evacuations and clinical management ofdiseases and injuries resulting from military occupational exposures. The MilitaryMedicine curriculum covers all the entities of knowledge of Military Sciences, CombatMedical Skills, Military Preventive Medicine, Military Applied Physiology and MilitaryContingency Medicine. The highlight of the curriculum is “Operation Petcharavut”that represents simulated battlefield operations, involving multidisciplinary clinicalintegration and military regulation. In this course, medical cadets review all theknowledge that they have learnt and in addition, Medical Platoon leader strategies,Advanced Cardiac Life support and Phramongkutklao Traumatic Life support, crucialmedical practices. Medical cadets would experience simulated patients with minimalinjuries to critical wounds and complications including combat stress syndromes invarious situations, from advancing to retreating units and from Battalion Aid Station toDivision Medical Operations Center. Recruitment is through the direct admission of the Consortium of Thai MedicalSchools. Graduates from PCM are granted degree of Doctor of Medicine of MahidolUniversity and are appointed as military physicians for Royal Thai Army, Royal ThaiNavy, Royal Thai Air Force and as civil physicians for Ministry of Public Health.20 ICMMS 2017

PLENARY SESSION AND WORKSHOPICMMS 2017 21

SESSION 4 - PLENARY LECTURESimulation-Based Medical EducationJoseph O. Lopreiato, M.D., MPH, CHSEAssociate Dean for Simulation Education, Uniformed ServicesUniversity of the Health Sciences, Bethesda, Maryland, USA Simulation based medical education is the application ofhealthcare simulation methods to the learning environment. It isdesigned to teach or refresh clinical skills, procedural skills andteamwork skills. This lecture will cover the four main methods usedin healthcare simulation today and the advantages and disadvantagesof each of them. 22 ICMMS 2017

SESSION 8 - WORKSHOPWorkshop: Conducting Effective Simulation – Based TrainingCourse director: Dr. Joseph O. Lopreiato Uniformed Services University of the Health Sciences, USADate/Time: 14 September 2017/ 08:00-16:30Supervisors: Dr. Miriam E. Bar-on University of Nevada, Las Vegas School of Medicine, USA Col. Pramote Imwatana Army Medical Field Service School, Thailand Col. Dusit Staworn Phramongkutklao College of Medicine, Thailand Lt.Col. Suthee Intharachat Phramongkutklao College of Medicine, Thailand Lt.Col. Panithan Kwangwaropas Phramongkutklao College of Medicine, ThailandLearners: Pre-registration delegates of 2nd ICMMS 2017Learning Goals: 1. Conduct faculty development for accreditation and teamwork 2. Review for simulation instructors: a. Principles & practices b. Simulation theory c. Pitfalls in instruction d. Quality improvement for simulation scenarios 3. Practice pre-brief, brief, debriefing and use of DASH tool in simulated learner sessionsLearning Objectives: Given several facilitators, simulators and a group of instructors, learners will beable to: • Describe the basic theory that underlies simulation instruction • Write goals and objectives • Describe psychological safety, fiction contract, pre-brief and brief • Describe common pitfalls in simulation instruction • Design or critique simulation scenarios • Describe the advocacy-inquiry method of debriefing • Practice pre-brief, brief and debriefing in role play • Run a simulation session as an instructor and get feedback • Discuss lessons learned as a simulation instructorICMMS 2017 23

Course Agenda:0800-0815: Sign-in0815-0830: Introduction Drs. Lopreiato and Bar-on0830-1000: Conducting a simulation and evaluating performance Drs. Lopreiato and Bar-onOutline: (90 min)1. Define the 4 main methods of simulation in healthcare2. Describe the main theories that drive healthcare simulation3. Discuss common pitfalls of instructors4. Highlight importance of determining learning goals and objectives5. Introduce the concepts of psychological safety, fiction contract, pre-brief, brief, mastery learning, deliberate practice and the idea of expertise.6. Work in groups to critique scenarios to use later today when training other learners1000-1015: Break1015-1130: Debriefing Dr. LopreiatoOutline: (90 min)1. Define debriefing in medical simulation2. Describe the stages of a debriefing3. Discuss and practice the ‘advocacy and inquiry’ model4. Show how to conduct an effective debriefing1130-1230: Lunch: Operator can program the simulator using the scenarios over lunch1245-1600: Hands-on simulation experience (180 min) Dr. Lopreiato & ICMMS staffThere will be 4-5 learners around each simulator with one learner playing the role of theinstructor. Groups will rotate to several stations based on enroute care scenarios with ahigh complexity mannequin, monitors, code and trauma supplies at each station.Participants will run the simulations they developed and conduct a brief and a facilitateddebriefing session. DASH tools will be distributed for assessment by peers and thefacilitator. Practice debriefing then rotate learners so all get a chance to play instructor withthe scenarios. An operator will be needed to run the simulator.1600-1630: Q and A and Lessons learned Dr. Lopreiato, et al.24 ICMMS 2017

LECTUREICMMS 2017 25

SESSION 5 - LECTURE 1: THAILANDSimulation-Based Medical Education : PCM ExperiencePrapaipim Thirakhupt, M.D.Director of Academic Affairs Division,Phramongkutklao College of Medicine, Thailand Phramongkutklao College of Medicine (PCM) is the firstand only military medical school in Thailand established in 1975.The College is affiliated with Mahidol University. The undergraduatemedical curriculum is a six-year curriculum that follows the curriculumof the Medical Council of Thailand. In the first year, students studybasic science at the Faculty of Science, Kasetsart University. Fromthe second to the sixth year, students study pre-clinical and clinicalsciences in various subjects at PCM and Phramongkutklao Hospital with both horizontaland vertical integration. Simulation-based Medical Education is used throughout the curriculum to teach andevaluate the students on their required competencies with keen awareness of patients’ safety.In the preclinical year (year 2-3), students practice some clinical skills such as history takingand physical examination with standardized patients. Manual skills such as venipuncture,intravenous fluid administration and basic life support are performed using the task trainersor manikins. In the clinical year (year 4-6), students practice basic surgical skills, focusedassessment with sonography for trauma (FAST), advanced cardiac life support, advancedtrauma life support, vaginal deliveries and newborn resuscitation with task trainers andhigh fidelity manikins. The sixth-year students also receive military medical training in thesimulated field operation called “Operation Petcharavut” where they are trained to work ina critical situation using standardized patients with moulage and human patient simulators. The Military Medical Simulation Center is a new project of the College. Aneight-storey building will be built at the end of 2017 and completed in 2020. It will be aplace to perform simulation-based medical training for undergraduate medical and nursingstudents, postgraduate students (residents, doctors) and military medical personnel.26 ICMMS 2017

SESSION 5 - LECTURE 1: CHINASimulation-Based Clinical Skills Training Program for MedicalUndergraduates in Chinese Military Medical UniversityWang ZhinongDepartment of Cardiothoracic Surgery, Department of SurgicalEducation &Training, Second Affiliated Hospital (ShanghaiChangzheng Hospital) of Second Military Medical University,Shanghai, China Simulated medical education has evolved significantly duringthe past decade. Simulation-based training (SBT) has also brought aboutparadigm shifts in the medical and surgical education arenas. Thus, wedeveloped the Simulation-Based Skill curriculum for Chinese militarymedical students to standardize medical training. This study aims to present the feasibility andvalidity of implementing the clinical skill training program. The training program, which comprisedof simulation-based clinical skills course, military medical rescue drills and assessment framework,was conducted for all the 5-year medical students from across 7th to 10th semester. The clinicalskills course, including three modules (basic clinical skills, advanced clinical skills and traumamanagement skills) was initiated in three phases (Preclinical, In-clinical and Medical RescueDrills), accordingly. In Phase one, the students received Basic Clinical skills Module, includingcase briefing, physical examination, aseptic technique and basic surgical skills (knotting, incisionsuture, hemostasis, debridement, bandage, etc.) by using standardized patient, different modularsimulators, and experimental animal models. In Phase two, Advanced Clinical Skill Modulewas introduced during the students’ internship and mainly focused on basic airway, laparoscopicand endoscopic fundamentals, advanced life support techniques and nontechnical skills (NTS)including decision making, situation awareness, communication and teamwork skills. Phase threemodule located emphasis on trauma management skills (e.g., Triage, Tactical Combat CasualtyCare, Damage Control Resuscitation as well as basics for Damage Control Surgery) in whichbattlefield environment simulator and virtual reality (VR) training system were applied. ObjectiveStructuredAssessment of Technical Skills (OSATS) combined with Procedure-BasedAssessment,Global Rating Scale, perioperative time-out checklist and Nontechnical Skill Scoring were usedto evaluate the students’ performance and the Visual Analogue Scale (VAS) was employed toconduct self-appraisal. Most of the students (96.2%) could complete the training program. Thescores of OSATS showed 81.4% trainees had good command on basic and advanced clinical skillsas well as trauma management. The VAS results indicated significant improvement in students’abilities of independent learning, confidence, and efficiency. In conclusion, the use of SBT canfacilitate more structured, comprehensive clinical skill acquisition and reduce training time throughgaining knowledge, skills, attitudes, and behaviours. Patient-specific SBT, which combining VRsystem with physical simulation training environments would be our future direction of clinicalskill education.ICMMS 2017 27

SESSION 5 - LECTURE 1: JAPAN“Defense Medicine” at NDMC- Education and ResearchNorihiko YamadaNational Defense Medical College, Japan National Defense Medical College (NDMC) was establishedin 1973 to alleviate the serious shortage of medical officers. At first,NDMC put great importance on the establishment of qualified medicaleducation modelled after excellent civilian counterparts, and paidlimited attention to military medicine. It was not until the post-coldwar era, during which we coincidentally experienced Tokyo Sarin Gas Attack Incident andserious disasters, that we realized the importance of systematic education of military anddisaster medicine. Through trial and error, we finally established the ‘section of defensemedicine’ in 2005. Its responsible area of education is restricted to rather distinctive sub-specialties such as “NBC defense”, aero-space medicine, and so on. We’d like to expand thearea to encompass and systematize military-relevant aspects of other major medical fieldssuch as internal medicine. I expect that the cooperation with oversea peers which could bedeveloped at ICMMS would greatly contribute to this goal. NDMC research institute has been engaged in ‘defense medicine’ research suchas basic traumatology since its establishment in 1996. In 2015, Defense Ministry started anew research fund for advanced research on defense medicine. Using this financial back-up,we installed a new blast tube in the institute this year and started invigorating the existingresearch program concerning blast injuries. I will also introduce some other examples ofrecent research achievements. I am confident that the vigorous research activities in NDMCdefinitely provide a good chance for our students to have a close access to advanced research.28 ICMMS 2017

SESSION 6 - LECTURE 2: USAUniformed Services University of the Health Sciences: An OverviewWilliam M. RobertsUniformed Services University of the Health Sciences (USU), USA USU students are primarily active duty uniformed officersin the Army, Navy, Air Force and Public Health Service who receivespecialized education in tropical and infectious diseases, TBI andPTSD, disaster response and humanitarian assistance, global health,and acute trauma care. USU is home to the F. Edward Hébert Schoolof Medicine, the Daniel K. Inouye Graduate School of Nursing,the Postgraduate Dental College, and the College of Allied HealthSciences. USU offers a variety of graduate degrees in a number ofdisciplines including medicine, advanced practice nursing, oral biology,biomedical sciences and public health, clinical psychology, healthprofessions education and health administration and policy. USU also offers undergraduateassociate and bachelor degrees in the health sciences for military medical and surgicaltechnicians. Clinical teaching sites for these unique programs include US Military TreatmentFacilities and partners from around the world. USU’s research portfolio includes a widerange of clinical and basic science research important to both the military and public health.For more information, visit www.usuhs.edu.ICMMS 2017 29

SESSION 6 - LECTURE 2: BANGLADESHConcurrent Infection of Tuberculosis and Leishmaniasis in Patientsfrom Kala-azar Endemic Areas Admitted to Surya Kanta Hospitalin MymensinghMd Fashiur Rahman1, Selina Banu2, Md Jahangir Alam3,Md Jalal Uddin4, Md Abu SayeedSarker5, Ariful Bashar6,Proggananda Nath6, Chizu Sanjoba7, Eisei Noiri8,Yoshitsugu Matsumoto9, Md Bahanur Rahman10,Md Abdul Alim111Armed Forces Medical College Dhaka Cantt, Bangladesh2Essential Latex Plant, Pirgacha, Modhupur, Tangail, Bangladesh,3Cox’s Bazar Medical College, Bangladesh, 4Chittagong MedicalCollege Hospital, Bangladesh, 5Gouripur Upozilla, Mymensingh,Bangladesh, 6Infectious and Tropical Medicine Department,Mymensingh Medical College Hospital and SKKRC, Bangladesh, 7Department ofMolecular Immunology, School of Agricultural and Life Sciences, University of Tokyo,Japan, 8Department of Nephrology and Endocrinology, University of Tokyo, Japan,9Laboratory of Molecular Immunology, Department of Animal Resource Sciences, GraduateSchool of Agricultural and Life Sciences, University of Tokyo, Japan, 10Department ofMicrobiology and Hygiene, 11Department of Microbiology, Bangladesh AgriculturalUniversity, Mymensingh, Bangladesh Co-infection of visceral leishmaniasis and pulmonary tuberculosis are increasingpublic health problem especially in developing countries and both are major public healthproblems in Bangladesh. Bangladesh ranks 6th among the top 22 high TB burden countriesin the world. For Kala-azar, Bangladesh is one of the 72 developing countries where thisdisease is present and one of the three countries of WHO’s SEA region (Bangladesh, Indiaand Nepal) where this disease is endemic. TB is an immunosuppressive condition thatprogresses latent leishmaniasis, results in clinical leishmaniasis. Visceral leishmaniasiscan also reactivate latent tuberculosis. Concurrent infection inhibits the host’s immuneresponse and increases antibacterial therapy intolerance. This study was a descriptive cross-sectional and non-interventional study conducted at Surya Kanto Kala-azar Research Center(SKKRC), Mymensingh, Bangladesh from May 2014 to May 2016. All patients from fourKala-azar endemic areas were included in this study. Laboratory works were performed atSKKRC, Department of Microbiology and Hygiene, Bangladesh Agricultural University.One hundred and sixteen TB patients including 79 male and 37 female (a ratio of 2.1:1) whowere diagnosed by smear test, Mantaux test, and Gene Xpert were examined for the presenceof leishmaniasis. Five patients (4.31%) were confirmed to have Leishmania by rk39 test kitand DNA by PCR. Furthermore, 110 Kala-azar patients including 60 male and 50 female(a ratio 1.2:1) who were diagnosed by rk39, spleen aspirates, and PCR were examined fortuberculosis and four patients were confirmed to have TB by Gene Xpert. Approximately45 to 50% of the patients had family monthly income up to Bangladeshi Tk 5,000 (US $65). In this study, out of 226 TB and Kala-azar patients, 9 (3.9%) patients were found tohave concurrent infection with Kala-azar and TB. This situation is not a big concern onlyin Bangladesh but should also in South East Asian region which warrants in-depth furtherresearch.30 ICMMS 2017

SESSION 6 - LECTURE 2: VIETNAMSome Solutions to Improve the Quality of Clinical Practice of MilitaryMedical Students at Vietnam Military Medical UniversityDo QuyetVietnam Military Medical University, Vietnam Clinical practice is an extremely important part of the trainingprocess in medical university. Therefore, Vietnam Military MedicalUniversity (VMMU) has focused as much as possible and findingall positive solutions to ensure the process of clinical practice ofstudents achieve the highest quality. Some effective solutions havebeen implemented including innovation of content, curriculum andteaching methods. The training content focuses on the core issuestowards achieving the medical skills of the general medical doctor. The objectives of eachsubject are fully reflected in three areas including knowledge, attitudes and skills. Basicscicencific subjects, basic medicine subjects and humanities and social sciences must bedirected towards the direct competencies, which are clinical skills. The organization ofteaching with integration of three areas of knowledge, attitudes and skills will be implementedin each lesson. Innovation of teaching methods at VMMU will be performed in order to bringinto play the initiative and creativity of the student, such as clinical illustrations by videoclips of typical cases, direct broadcast of surgery operation etc., Unification of the clinicalteaching process including clinical illustrations, medical technique guides, and clinical signs.The clinical departments will enhance the students to participate in the examination andtreatment and patient management activities which appropriate for each subject. Focus ontraining basic medical techniques. Enhancement of the quality management of student’sclinical practice through clinical practice booklets. Standardization of procedures and criteria for accreditation of clinical faculty.Staff resources for faculty members must be fostered and tested and evaluated on clinicalpractice skills before demonstration at the Teaching Council. Annually organize clinicalexamination, encouraging students to have positive motivation in clinical practice. Step by step applying the method of assessment based on capacity in order to assessfully and comprehensively include knowledge, skills and attitudes (through the constructionof the checklist to evaluate each capacity) which wil be implemented from the finished examof subjects to graduated exam. The exam may be carried out on animals, simulated modelsor real patients, stunt patients. Building and using simulation center with modern equipmentin training that suitable for the content of teaching clinical skills.ICMMS 2017 31

SESSION 6 - LECTURE 2: MYANMARCurriculum Reform for Basic Medical Education in DSMAKo Ko LwinRector, Defence Services Medical Academy, Myanmar The structure and curricula of basic medical educationin Myanmar have largely remained unchanged for 50 years andare in need of extensive revision and reform. All medical schoolsin Myanmar employ a discipline-based curriculum model, wherepre-clinical, clinical, and internship are completed in three isolatedphases. The current system of extensive traditional didactic trainingand passive clinical teaching is insufficient to meet the needs formodern health care and disease prevention. The objectives of the DSMA curriculum reform are to foster life-long learningin students, and to give them increasing responsibility for their own learning. A range ofeducational strategies, including Problem Based Learning is implemented, based on theconcepts that it would stimulate students towards constructive, collaborative, self-directedand contextual learning. The new curriculum is competency based, integrated and communityorientated, with specifically identified outcomes to be achieved on graduation. A structuredapproach is used with early clinical exposure starting from Phase1. Phase 1 is organized insystems, while Phase 2 is organized into clinical disciplines. In addition to the core curriculum,a directed Student Selected Component is included to give students an opportunity to choosethe area they wish to study in more depth. Reform efforts include some characteristics such as curricular integration, increasedemphasis on clinical training and analytical problem solving abilities, introducing militarymedicine and more use of group and independent learning. The comprehensive reformprocess of DSMA medical curriculum is mainly based on the requirements of MyanmarMedical Council and WFME Global Standards for quality improvement.32 ICMMS 2017

SESSION 6 - LECTURE 2: INDIASimulation Based Medical Education at Armed Forces MedicalCollege (India) : An OverviewNavdeep SethiArmed Forces Medical College, Pune, India Medical Education at AFMC (India) has always heldparamount importance since its hoary beginnings in the early90s. Simulation was ingrained as an integral part of our medicalteaching but it took a quantum leap from 2006 onwards when theHuman Patient Simulator (HPS - Metiman) was installed at AFMC,the first installation at a medical college in India. Since then simu-lation modalities are being actively employed to train and obtainvaluable feedback from undergraduates, postgraduates, paramedical trainees and staff,nursing students and staff, medical officers and specialist officers as part of a structuredprogramme. The Skills Lab also incorporates a variety of Low Fidelity modalities like 3Dmodels, basic manikins, human cadavers, standardized patients and ‘standardized family’.High Fidelity entities include computer based simulators, task trainers, HPS and virtualreality scenarios. Numerous studies conducted at various departments of the collegeare evidence of the success of the simulation programme. Simulation based education(SBE) at AFMC is now moving towards incorporation of 3D ultrasound and virtual realityprogrammes as regular features of medical training at all levels.ICMMS 2017 33

SESSION 6 - LECTURE 2: CAMBODIAMedical Simulation in CambodiaKang VirakHealth Sciences Institute of Royal Cambodian Armed Forces(RCAF), Cambodia Health Sciences Institute of Royal Cambodian Armed Forcesis the biggest military medical Institute in Cambodia. It belongs toMinistry of National Defense. We provide education module forMedical Doctor, Dentistry, Pharmacy, Nursing midwife. Technicallaboratory was provided to military students from all parts at themilitary regions in our country for about 40 years ago. Simulation-based Medical Education is a kind of technique that we use recently. Education strategy formedical simulation provides students with realistic experience and allows them to practiceand learn in a safe environment. This technique offers students an opportunity to assess,interact and evaluate patient outcomes. With the 2nd International Conference of Military Medical schools (ICMMS 2017)in Bangkok, we hope that we can share and get more experiences form this conference.34 ICMMS 2017

SESSION 7 - LECTURE 3: BANGLADESHSimulation-Based Medical Education and Military MedicineAbu Noman Mohammed Mosleh Uddin1, Wahida Rahman21Department of Community Medicine, Armed ForcesMedical College (AFMC, Dhaka), Bangladesh; 2Departmentof Pharmacology, AFMC, Bangladesh Simulation is a new addition for graduate medicaleducation, though the aeronautical, judicial, and military fieldshave been using it for hundreds of years with positive outcomes.It is used in a variety of settings, such as hospitals, outpatientclinics, medical schools, military medical training centers forlearning and meeting standards for high quality education ina safe and effective way by reducing medical errors whichenhance patient safety. The military has embraced simulation with more vigor than civiliantraining programs, resulting in a wealth of experience and success. Simulation can provideopportunity to perform high risk medical tasks in a no-risk training environment. Simulationis used in Armed Forces Medical Institute (AFMI), Armed Forces Medical College (AFMC)and Combined Military Hospital (CMH) to teach anatomy, physical exam skills, clinicalskills, disease recognition, medical team training & equipment proficiency, team leadertraining, critical thinking, situational awareness, crew resource management and interpersonalcommunication skills training by using proprietary medical simulators, cadavers, disposablematerials, etc. A large number of medics are trained emphasizing the following: EmergencyMedicine Technician Basic (EMT-B), limited primary care, tactical medicine, situationaltraining exercises. Simulation is used extensively in cardiopulmonary resuscitation (CPR)and EMT-B, also in combat casualty assessment, tourniquet use, utilization of hemostaticagents, needle chest decompression, surgical airway, laryngeal airway, intravenous catheterplacement etc. Pre-deployment training platform for an entire deployable hospital is practicedand exercised in basic military medical training in Army Medical Corps Centre and School(AMCC&S), AFMI and AFMC at all levels and for the entire hospital personnel and theirspecialties. Simulation is playing an ever-increasing role in medical education at all levelsof military medical training.ICMMS 2017 35

SESSION 7 - LECTURE 3: JAPANEducation and Research of Basic Medical Sciences inNational Defense Medical College (NDMC)Toshiaki IshizukaDepartment of Pharmacology,National Defense Medical College, Japan At first, I will introduce our education contents of basic medicalsciences held in the Department of Pharmacology. In particular, Iwill point to how we have modified the contents to fit in with specialrequirements for the education of Self Defence Force medical officers.It is very important to learn the management of combat injuries anddiseases such as infection, trauma, chemical poisoning, or depressive illness. Thus, the mainpurpose of our education program is to acquaint pharmacological actions of therapeuticagents such as antibiotics, opioid analgesics, antidotes, or anti-depressants and how to usethese drugs. Then, I will show some examples of our research and mention their relevance topost-graduate education. In Military Medicine Research Unit (MMRU) of Japan Ground SelfDefense Force (JGSDF) which has been engaged in CBRNE research since 2001, postgraduatemedical officers work as researchers. My staff and the MMRU researchers have studied thetreatment of intestinal radiation damage by transplantation of iPS cells-derived intestinalstem cells (ISC) and endothelial progenitor cells (EPC). We have also developed severaldrugs which enhances the function of ISC or EPC in the treatment. In addition, we and thepostgraduate students of NDMC have evaluated treatment of depressive disorders or PTSDwith some candidate drugs by modulation of neuroinflammation and neuronal regeneration.Finally, I would like to talk about problems and improvement on basic medical educationin NDMC, which might be pointed out at other military medical schools.36 ICMMS 2017

SESSION 7 - LECTURE 3: INDIAEfficacy of Simulation Based Training in Surgery at Armed ForcesMedical College (India) - An Objective Structured AssessmentProgrammeBiju K VargheseArmed Forces Medical College, Pune, India Simulation based training has been in vogue and wellestablished as an effective teaching tool in emergency medicine.However there are only few virtual trainers in the field of surgery.For a successful residency programme especially in scenarios ofmilitary medicine there is a felt need in simulation based trainingin basic psycho motor, visio-spatial, perception and training inbasic skills and thereafter to progress to specific tasks andprocedures. This holds good even for imparting basic skills in undergraduate trainingprogrammes. To validate the importance of simulation technology in training we helda pilot simulation workshop at Armed Forces Medical College for surgery residents andcadets. Forty residents and 60 undergraduate cadets were imparted training in basic skillsand specific tasks over a period of 6 days using simulation technology and were tested atthe end using an objective structured assessment by experienced surgeons. They wereassigned scores at the start of the programme at each level of simulation and again at theend of the programme. The results showed significant difference between the baselineassessment and the final test with an increase in overall improvement. Based on theseresults it was concluded that simulation is an effective tool for teaching core competencies,skills and basic surgical tasks and procedures and can be evaluated effectively. This hasnow become a standard teaching protocol and module for all our surgery residents andundergraduates.ICMMS 2017 37

SESSION 7 - LECTURE 3: THAILANDInfluenza Surveillance and Outbreaks among Army Personnel -Bangkok, Jan 2012 - June 2017Anupong Sirirungreung1,2, Ram Rangsin1,2,Suthee Panichkul1,31Clinical Epidemiology Unit, Phramongkutklao Hospital; 2Departmentof Military and Community Medicine, Phramongkutklao College ofMedicine; 3Department of Obstetrics and Gynecology, PhramongkutklaoCollege of Medicine, Thailand Clinical Epidemiology Unit (CEU), PhramongkutklaoHospital, has provided surveillance system on influenza among armypersonnel in Bangkok and civilians who attended a hospital services.There are two types of surveillance system: indicator-based surveillance and event-basedsurveillance. This analysis aimed to describe an influenza activity among army personnelduring Jan 2012 to Jun 2017. We reviewed and described the situation of influenza fromboth kinds of surveillance data. For indicator-based surveillance, the data of influenzapatients who visited the hospital and had ICD-10 code J10 during Jan 2012 to June 2017were retrieved. For event-based surveillance, the data of outbreak events reported by everyarmy health care units in Bangkok were reviewed. The number of influenza cases whoattended to hospital services was increased which was concordant to the number of influenzaoutbreaks in Bangkok army personnel. During 2016, the seasonal trend of influenza increasedbetween February to March and August to November. However, in 2017, the number ofinfluenza cases increased earlier during June. There were eight influenza outbreaks betweenJan 2015 to Jun 2017. The attack rate ranged from 11.4 - 56.0%. Five of eight outbreaksoccurred among a new military personnel during recruit training. Four of eight outbreakswere identified Influenza A virus, H3N2 subtype and two outbreaks were Influenza A virus,H1N1 subtype. Two of eight outbreaks were occurred among vaccinated population whichthe identified pathogen strains were similar to vaccine strains. In conclusion, there was increasing trend of influenza cases among army personnelin Bangkok. In 2017, the influenza seasonal was earlier than previous years. The newmilitary personnel were high risk group to influenza outbreak.38 ICMMS 2017

SESSION 11 - LECTURE : USAFocusing on Learner Competence and OutcomesMiriam E. Bar-onUniversity of Nevada, Las Vegas School of Medicine, USA Medical education is moving from teacher centered tolearner centered processes. The focus is now what the learner is ableto do or his/her competence in performing specific tasks. Desiredoutcomes drive learning objectives, educational experiences andevaluation. Assessing learner performance in a developmental modelusing milestones to achieve ultimate outcomes or independent orunsupervised practice is key. Implementation of group assessmentsessions or clinical competency committees is a proven method to determine milestoneprogression and incorporate the perspectives of others. These major changes in medicaleducation span the continuum and should ease the transitions between phases in trainingfrom student to resident/fellow to practicing physician. Learning Objectives: • Describe the shift from teacher centered to learner centered education • Discuss competency based education • Consider evaluation methods to measure competency • Describe the use of milestones for documenting progressICMMS 2017 39

SESSION 11 - LECTURE 3: VIETNAMFirst-Aid Training with Simulation-BasedNguyen Thai LinhVietnam Military Medicine University, Vietnam Our delegation comes from the Vietnam Military MedicalUniversity (VMMU), which is established in 1949. At the moment, I’m working in Department of MilitarySurgery, which is one of the most important roles of the VMMU.Being organized in 1972, with the history for more than 40 yearsof building and developing, our department takes responsibility ofemergency and standard healthcare function for wounded soldiers. VMMU has applied the simulation based on learning and training since 2003but we have completed and put into operating the Medical Simulation Center with modernequipment since 2014. These modern simulators are very important in enhancing the clinical expertise,particularly in the training sector for students. At the same time, the process of exploitingthe medical imaging system will enable students, lecturers and young doctors throughout theUniversity to improve the ability of how to use, exploit and maintain high tech simulationequipment. We practice on both humans and the simulators. However, to deal with injuriesin medical simulation, we must proceed on animal or simulators. Our university has beenprovided some simulators for training cases. For example: CutSuit, Ceasar and iStan. In case of lesions that can not be shown in real people, simulators will beextremely useful. By these simulators, we have begun to familiarize ourselves with thecure and management of lesions. Since 2015, we have been trained by professionals to getthe technology transfer and training to utilize state-of-the-art simulations, control all of thefeatures to training and rehearsal.40 ICMMS 2017

SESSION 11 - LECTURE 3: INDIASimulation Based Training in Medical Education - Our Experienceat Armed Forces Medical College (India)Karuna DattaArmed Forces Medical College, Pune, India Simulation based training is a key to enhanced learningand recall. At our center, simulation is used in impartingclinical skills competence and also in strengthening cognitive andattitudinal domains. The simulation model is used for both teaching-learning and assessment during formative and summative exams.Apart from the state of the art skills lab in department of surgeryand anesthesia, the college has incorporated simulation basedlearning at a conceptual level both at undergraduate and postgraduate training includingneonatal resuscitation protocols, kangaroo mother care with mannequins, neonatal hearingscreening programme, head and neck cadaveric dissections, temporal bone workshops, atdissection hall, obstetric training, teaching communication skills, surgical skill training,basic life support, advanced cardiac life support, advanced trauma life support, standardisedpatients in OSCE, etc. An innovative method of ‘Standardised Family’ for teachingcommunication skills to undergraduates has been formulated. Volunteer faculty membersand students are trained to simulate as a family member with different issues related tovarious aspects of communication skills including doctor-patient, doctor-doctor, doctor-industry relationships, breaking bad news, etc. This strategy works not only in enhancingcommunication skills but also makes the students sensitised about the economics of medicine,impact of disease on society and society needs making it a trans-disciplinary approach ofintegration. Particular examples of use of simulation at our center, in all three domains oflearning will be presented and discussed.ICMMS 2017 41

SESSION 11 - LECTURE 3: VIETNAMTraining Nursing Practice with Simulation-BasedHuu Duc NguyenVietnam Military Medical University, Vietnam Vietnam Military Medical University is one of topuniversities on medical training in Vietnam. Vietnam Military MedicalUniversity has 3 main duties that are education and training, scientificresearch and treatment. Military Hospital 103 is the first multi-department levelhospital, with the highest level of military medical departments. Thishospital carries out examination for hundred thousands of patients,emergency, treatment, surgery. Beside examination and treatment,this hospital also do healthcare consult presented free drugs and gifts for several tenthousands of wounded soldiers and rural area patients. The Department of Nursing, Military Hospital 103, Vietnam Military MedicalUniversity was established on December 20, 1993. The department’s mission is to teachbasic nursing subjects to undergraduate medical students. Teaching includes basic nursingsubjects and management, nursing research for nursing practitioners, medical technicians. There are 4 methods applied in nursing training: Demonstration, Team work, Roleplay, and Context. All students use simulation samples. All students are trained principlesand nursing skill steps before practicing. Trainers make examples on technical operationfollowing to steps. Trainers check students’ understanding by acting some steps in technicaloperation. Students’ practices include working in a group of 4 to 6, practice one by one andfeedbacks. Students practice manipulation techniques in skill lab. Then, they practice athospitals to improve nursing ability. Student practice at hospitals is under trainers’ andNurses’ supervision.42 ICMMS 2017

ORAL PRESENTATIONICMMS 2017 43

ORAL PRESENTATION: USAOperation Bushmaster: Pushing the Limits of Simulation inCombat Medical EducationHolly Berkley, Michael Porambo, Joseph V. Lopreiato,Arthur L. Kellermann, Richard W. ThomasUniformed Services University, USA The objective of this presentation is to provide an overviewof Operation Bushmaster, the capstone experience of the militarymedical practice and leadership curriculum at the Uniformed ServicesUniversity. Operation Bushmaster is a full-scale medical field exercisethat aims to provide leadership challenges that require students toapply principles of military and medical ethics, decision making,and critical thinking. The USU School of Medicine, USU Graduate School of Nursing, aswell as international military medical officers participate in this six-day exercise at FortIndiantown Gap, Pennsylvania. The goal of the presentation will be to provide insightinto the following aspects of Operation Bushmaster: integration of simulation, examplemissions and scenarios, structure for evaluation and feedback, the unique benefits and thefuture direction of the exercise.44 ICMMS 2017

ORAL PRESENTATION: THAILANDA 12–year Trend of Heatstroke among Royal Thai Army Recruitin Basic TrainingAticha Udomdech1, Anintita Pongsaboripat1,Ornida Angsawetrungruang1, Supanat Puangjit1,Phunlerd Piyaraj2, Panadda Hatthachote3, Ram Rangsin41Medical cadet, Phramongkutklao College of Medicine,2Department of Parasitology, 3Department of Physiology,4Department of Military and Community Medicine,Phramongkutklao College of Medicine, Thailand Climate change has become more interesting because ofits impact to the severity of global warming due to the increasingheatstroke prevalence. In Thailand, there are new cases of heatstroke especially in the RoyalThai Army (RTA) training every year. Thus, there are some researches related to theseinjuries. However, there is no study showing the long-termed relationship between morbidityand the case fatality rate among recruits in each intervals and regions of RTA. Thus, weinvestigated those trends in the military training in RTA between 2004 and 2015 in orderto benefit the further research. We aimed to determine trend of heatstroke in Royal ThaiArmy during training from 2004 to 2015. Descriptive data about the incidence of heatstrokein RTA from 802,224 recruits in each divisions and regions and the temperature obtainedfrom Territorial Defense Command and Meteorological Department of Thailand, data during2004 to 2015, are collected. The information are analyzed into statistic data in 2 importantparameters: morbidity (the number of individuals that become ill due to a specific within asusceptible population during a specific time interval) and the case fatality rate (Measure ofthe severity of a disease which defined as the proportion of cases of a specified disease orcondition which are fatal within a specified time). About the last 12 years among 802,224recruits in RTA in Thailand, there are 134 cases admitted with heatstroke, 125 cases werereported during the 1st interval (May-July) and 9 cases were from the 2nd interval of the training(November-January). However, 21 fatality cases were reported from 1st interval. Moreover,from the study, the trend of morbidity rate over 12 years has increased slightly while thefatality rate has decreased. From our information, the trends of morbidity and mortality rateswere significantly correlated with the differences of temperature. In the year that had hightemperature, the rate of heatstroke increased significantly. However, the highest-temperateregions were not related to the highest incidence of heatstroke. For example, in 2010, thehighest-temperate region was in Northeast part of Thailand but the highest incidence ofheatstroke was in central Thailand. Incidence of heatstroke in this particular area was highestevery year since 2007 to 2015 compared to other regions. Although temperature is themajor contributing factor of heatstroke, other preventable risk factors should be identified.ICMMS 2017 45

ORAL PRESENTATION: JAPANWound Healing Effect Induced by 5-Aminolevulinic Acid (ALA)Wataru TerabaruNational Defense Medical College, Japan Aminolevulinic acid (5-aminolevulinic acid, ALA) is anendogenous amino acid and precursor of the heme synthetic metabolism.Previous reports showed exogenously administered ALA changescellular metabolism and may be related to the upregulation of themitochondrial function. Hence, we examined whether ALA promotedwound healing using skin defect mice models. Dermal tissues inthe back of the mice (C57/BL6 8-10 w♂) were resected with a sizeof 15 mm diameter. ALA mixed with cellulose based gel (ALA contents ranged from 0.01% to 10%) andapplied onto the skin defect area. The result showed that ALA facilitated wound closure: aspeed of closing wound skin was more rapid in ALA treated mice, comparing to the non-treatedmice. The wound closure was faster in the groups treated with high concentration of ALA.Pathological examination revealed that angiogenesis in the connective tissue surrounding theskin defect was augmented in the ALA treated groups. These results suggest exogenouslyadministered ALA promotes epithelization in the skin defect area, probably due to angiogenesis.We presume that mechanism of the healing is related to heme oxygenase 1, which degradesheme into carbon monoxide (CO) and biliverdin that is reduced into bilirubin. Bilirubin andCO are known to induce several reactions including angiogenesis and anti-inflammation,which are likely to relate to the mechanism of the healing. In conclusion, the wound healingin the skin defect area is promoted by exogenously administered ALA. This implies thatALA gel is useful in military medicine such as treatment of battle injury.46 ICMMS 2017

ORAL PRESENTATION: INDIAOff-site Simulation Based Training on Management ofPost-Partum Hemorrhage: Subjective Assessment AmongstFinal Year Medical StudentsLakshmi Renganathan, Karuna Datta, Navdeep SethiArmed Forces Medical College, Pune, India Post-partum hemorrhage is an obstetric emergency andtraining of healthcare providers for early diagnosis and interven-tion improves morbidity and mortality. Regular simulation basedtraining modules are conducted in our institute for healthcare pro-viders. The objective of this study was to assess the final yearmedical students on their subjective improvement on managementof post-partum hemorrhage after an off-site simulation based train-ing. A survey was administered on medical students and their subjective retrospectiveanalysis of both pre off-site and post off-site simulation was collected. The survey wasanalyzed and results were formulated. Though 78.26% of the students felt their confidencelevel in enumerating the steps in management of post-partum hemorrhage was less than50% before the drill and it increased to 70% after the drill, but the confidence in carryingout the procedures of post-partum hemorrhage was less than 50% below before the drillin 82.6% of the students which became more than 50% capable in 95.5% of the students.Similarly, 73.9% were less than 50% confident in diagnosing post-partum hemorrhagebefore the drill but post off-site simulation training 91.3% felt that they were more than50% confident. The results show a considerable improvement in subjective skill andcognitive enhancement after an off-site simulation based training.ICMMS 2017 47

ORAL PRESENTATION: CAMBODIAMy Learning Experience as a Medical Cadet in CambodiaSin DaroHealth Science Institute of Royal Cambodian Armed Forces,Cambodia This guide represents an overview of my learning experienceas a medical cadet in Health Science Institute (HSI) of the RoyalCambodian Armed Forces (RCAF). HSI of RCAF is the unique institutein Cambodia which provides medical academy to military studentsto enhance high-quality military internists in military environments.Medical cadets are educated by instructors, professors, specialists andexperienced trainers. Furthermore, medical cadets would experience simulated patients orobservation in laboratory after theory’s class. Medical cadets also have a medical practicumin hospital. Apart of medical curriculum, military curriculum is also included. To sum up,medical cadets can gain the knowledge from expertise educators and proficient practicingfor improving the standard of military service in the Royal Cambodian Armed Forces.48 ICMMS 2017

ORAL PRESENTATION: BANGLADESHSimulation-Based Medical Education and Military MedicineTasnuva TarannumArmed Forces Medical College, Bangladesh Simulation-based medical education signifies the utilizationof state-of-the-art simulator aids to replicate clinical scenarios ineducational purposes. It’s a modern day methodology applied tothe training of health care professionals through the use of advancededucational technology. Simply, it can be stated as an effective formof experiential learning every health care provider will need, butcannot always engage in during real life patient care. It is typicallyused to model random processes that are too complex to be sortedby analytical methods thereby making its mark as one of the most frequently used scientifictechniques. The constraints and the challenges met in training programs in various educationalfields can be effectively overcome by the use of simulation aids to enhance, modify andrevolutionize the modern medicine. The treatment procedure of the common mass is arisky business without a doubt. In such circumstances, simulation-based education can berighteously regarded as device to the rescue. Simulation-based medical education is a way tolearn in an error tolerant environment with minimalist risks involved. The ethical conundrumcan be well tackled by evoking its benefits to provide satisfactory and equitable treatmentto a huge proportion of the patient population. The use of simulation can provide us withgroundbreaking breakthroughs at all levels of civilian and military medical training. It canand has been incorporated into training programs at all tiers of disciplinary education andmulti-disciplinary simulation training has been evolving to enhance the inter-disciplinarycollaborations, communication and resource management along with transition of care.Simulation based medical education is constantly evolving to meet the demands of theexpanding medical knowledge, limited time and exposure to trainees, and limited financialresources. This is true in both civilian and military medical education. Research efforts mustbe focused to optimize the utilization of the current simulations practices and to advancesimulation with new technologies and experiences.ICMMS 2017 49

ORAL PRESENTATION: CHINAAn Experimental Simulation Device for Underwater ExplosionDanfeng ZhangNeurosurgery Department, Changzheng Hospital, SecondMilitary Medical University, China In the modern naval warfares, underwater weapons suchas mines, torpedoes are widely used, producing underwater shockwave. Such shock wave evolves into stress wave after encounteringships, imposing severe impact not only to the ships, but also tothe naval personnel. Currently, plenty studies are available aboutthe effects of underwater explosion on ship structure, but littleis known about its injury to personnel. Due to the difficulties inimplementation and high cost of underwater explosion, most researches are theoreticaland lack of reliable animal model. In order to solve these problems, we aim to provide anexperimental simulation device for underwater explosion, which includes a water tank andan animal fixation platform. The tank involves a water channel, slide bars, spare slide barsand fixed rods. The animal fixation platform includes a fixed plate and a fixed bucket. Allmaterials are made of 1.0 cm-thick-stainless steel, which can endure a maximum pressureof 30MPa. Results from experimental tests suggest that the present invention has severaladvantages. Firstly, the material has strong impact resistance. Secondly, the position ofexperimental animals is fixed. Thirdly, the length of slide bars could be adjusted accordingto the experimental needs. Finally, the device is simply structured, practical and reliablefor underwater explosion experiment.50 ICMMS 2017