Remote international medical teaching in North Korea
Taehoon Kim and Taeyoung Kim are the Co-Founders of DoDaum, a non-profit organisation focused on health, education, and development programmes in North Korea. James Zuckerman is an Assistant Professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School.
The Online Medical Education Program (OMEP) is the product of a deliberate partnership between the North Korean Ministry of Education, DoDaum (a non-governmental organisation), Pyongyang Medical University (PMU), and Kim Il Sung Hospital to address the urgent need to improve the nation’s medical education systems. In Pyongyang in September 2016, the programme launched for physicians, public health specialists and nurse practitioners from three out of nine provinces in the nation. During this period, prerecorded video lectures served as training modules for topics including infectious diseases, health economics, epidemiology, and community health. In total, seven courses and 92 video lectures were prepared and delivered via an online web portal to 35 students. Students logged onto the portal to view their lectures, assignments, and even took some of their exams for the courses online. Participating students voiced positive sentiments upon deployment and nearly 55% of students responded that they wished to engage in live, interactive video teleconference lectures with educators from overseas.
In November 2017, 15 North Korean physicians and ten public health professionals connected with foreign educators from around the globe in virtual classrooms – the first time in history that any of the 25 million private citizens of the country has been provided authorisation to communicate with foreigners via the internet. By May of 2018, this programme is anticipated to cover over 30 courses taught by 35 faculty members from the USA, Canada, Denmark, and the UK for 80 students from diverse provinces across North Korea. Upon successful implementation and monitoring of these programmes, the Ministry of Education is set to begin a broader academic exchange programme, significantly expanding the regions of the world where North Korean health professionals can perform research and receive training.
OMEP has significant implications for North Korea’s health-care services. As health professionals return to their provinces of origin, they will seek to apply their lessons and curb the threat of public health issues, ranging from multidrug-resistant tuberculosis and malnutrition to hepatitis that are ravaging rural regions of the country. In this vein, public health trainees have voiced desires to create new systems of care delivery and revamp outdated programmes. For instance, a student in the programme remarked, “…my goal is to create an extensive telecommunications platform, much like Skype, to connect health professionals and patients across the country” to facilitate treatment support and improve clinical outcomes for patients from low-access regions. While the programme is still in its exploratory stage, this student’s vision captures the initiative’s significant potential to not just revolutionise the nation’s clinical services but also encourage a shift in social and cultural mores regarding the role of technology in medicine, from one of mere novelty to one of vital function.
This programme faces some limitations. First, given the small cohort, it remains to be seen how scalable the initiative will be as the programme begins to cover more students across the country. Second, current educational resources will need to be revamped to better reflect the real conditions of health and health-care services in North Korea. This will be approached through case-based discussions and role-play so that the education can better equip students to apply their new knowledge.
Two events that have occurred in the past 6 months illustrate the inevitable influence of geopolitics on humanitarian aid to North Korea. In September, the travel ban to North Korea disrupted existing humanitarian programmes and channels, many of which have taken years to develop and implement. Since March, there has been thawing of geopolitical tension with the possibility of even a Trump-Kim meeting in May, spurring talks of reconciliation and rapprochement. Such tenuous dynamics have hampered sustainable, long-term efforts at humanitarian assistance to North Korea. This telehealth model of education may perhaps serve as one of the few sustainable paradigms for circumventing the ebbs and flows of such geopolitical morass.