Individualized Medical Education in Clinical Training in Internal Medicine: Sharing Experiences

Article information

Korean Med Educ Rev. 2025;27(3):215-222

Publication date (electronic) : 2025 October 31

doi : https://doi.org/10.17496/kmer.25.030

Tuyet Thi Nguyen^,1, Ryan James McAuley², Lisa Bellini²

¹Internal Medicine Residency Program, VinUniversity-College of Health Sciences, Hanoi, Vietnam

²Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

Corresponding author: Tuyet Thi Nguyen VinUniversity-College of Health Sciences, Vinhomes Ocean Park Urban Area, Gia Lam, Hanoi, Vietnam Tel: +84-919877200 E-mail: tuyet.nt@vinuni.edu.vn

Received 2025 August 28; Revised 2025 September 30; Accepted 2025 October 10.

Abstract

Introduction

Clinical training is a pivotal phase in medical education, bridging theoretical knowledge and hands-on patient care while playing a critical role in the professional development of physicians [1]. This process begins with clerkship rotations during medical school and continues through residency and other experiential learning activities. Diagnostic reasoning and decision-making skills are cultivated through repeated patient encounters, enabling learners to construct illness scripts and pattern recognition abilities [1-3]. Furthermore, the formation of professional identity requires learners to integrate into medical culture, navigating personal, social, and professional challenges [4].

Many parts of the world have adopted a competency-based education (CBE) framework in designing medical education programs. CBE combines an intentional and transparent approach to curricular design in which the time required to demonstrate competence varies, but the expectations for learning remain constant. Trainees acquire and demonstrate knowledge and skills through learning exercises, activities, and experiences aligned with clearly defined programmatic outcomes, while receiving proactive guidance and support from faculty and staff. Learners earn credentials by demonstrating mastery through multiple forms of assessment, often at a personalized pace. Several countries have implemented CBE frameworks, such as the Accreditation Council for Graduate Medical Education (ACGME) in the United States and the Canadian Medical Education Directives for Specialists (CanMEDS) in Canada [5]. Competencies typically include patient care, medical knowledge, professionalism, interpersonal and communication skills, systems-based practice, and practice-based learning and improvement. Procedural competency is often included for procedure-based specialties.

Competency-based training models emphasize individual progression toward defined milestones, recognizing that learners advance at different rates [6,7]. This approach necessitates frequent formative feedback and robust assessment [7,8]. Because time is no longer a fixed component of training, learners can progress at different rates, enabling more individualized instruction. The individualized learning plan (ILP) is a learner-centered strategy that tailors educational experiences to support the attainment of professional goals in preparation for independent practice [9]. ILPs consider residents’ interests, learning needs, available supports, elective choices, and other experiential opportunities throughout their training [9].

The residency programs at VinUniversity (VinUni) are designed in accordance with the regulations and requirements of the Vietnamese Ministry of Health (MOH), specifically following the MOH framework endorsed in Decision 19/2006/QĐ-BYT. This national framework defines the structure and standards for postgraduate medical training in Vietnam, outlining program duration, curricular components, supervision requirements, and expectations for residents’ clinical service and scholarly activities [10]. It serves as the foundational policy document guiding residency education across the country. In parallel, the programs have benefited from the Penn–VinUni Alliance, a strategic partnership with the University of Pennsylvania. Through this collaboration, faculty from Penn have worked closely with VinUni educators to co-develop curricula for the inaugural programs in Internal Medicine, General Surgery, and Pediatrics. These curricula were intentionally structured to harmonize Vietnam’s MOH requirements with international competency-based standards, ensuring that residents meet both national expectations and the performance benchmarks outlined by the Accreditation Council for Graduate Medical Education–International (ACGME-I). As a result, the programs not only comply with domestic regulations but also achieve recognition through ACGME-I accreditation, positioning them among the first in Vietnam to align fully with global residency training standards.

A distinguishing feature of the Internal Medicine Residency Program at VinUni is the integration of ILPs, which provide residents the opportunity to pursue their interests in later stages of the program. Each ILP incorporates a combination of clinical experiences, conferences, medical education activities, observerships outside VinUni, and scholarly projects.

Design and implementation of the VinUniversity Internal Medicine Residency curriculum

The Internal Medicine Residency Program at VinUni is a four-year, competency-based training program designed to provide residents with comprehensive and progressive exposure to the breadth of internal medicine, integrating inpatient, outpatient, and individualized learning experiences.

The program is structured to prepare residents to become not only experts in disease pathophysiology but also effective members of interprofessional teams who are responsive to the needs of patients, families, and communities [11]. In addition, the curriculum emphasizes experience in ambulatory care, multidisciplinary team-based practice, chronic disease management, and quality improvement [12]. A core objective is to develop educators who are proficient in mentoring, teaching, and evaluation across diverse clinical settings to strengthen the future teaching workforce within affiliated hospitals [12].

The principle of graded and progressive responsibility—central to competency-based clinical training—has been adopted as a core element of graduate medical education at VinUni. Supervision in Graduate Medical Education is designed to ensure safe and effective patient care, support each resident’s acquisition of the knowledge, skills, and professional attitudes necessary for independent practice, and establish a foundation for lifelong learning and professional growth. These principles are embedded in both curriculum development and the creation of a supportive clinical learning environment.

Clinical training is organized around six core inpatient teaching services: gastroenterology, pulmonology, emergency medicine, cardiology, intensive care unit, and general medicine, which includes both inpatient and outpatient care. Approximately 70% of training time is allocated to core rotations, 20% to non-core rotations, and 10% to an ILP, as illustrated in Figure 1.

Figure 1.

Internal medicine (IM) curriculum structure. ILP, individualized learning plan.

Each core service maintains year-round coverage and employs a standardized team structure comprising one faculty physician, one senior resident, one junior resident, and two to four medical students, with patient assignments adjusted to the learner’s level of training and case complexity. Daily faculty-led rounds form the principal teaching venue, incorporating both bedside and conference-based discussions. Rounds emphasize patient interviewing and examination skills, problem identification and prioritization, differential diagnosis formulation, and evidence-based management planning. Junior trainees focus on common inpatient conditions, whereas senior residents are expected to manage less common and more complex cases while developing their skills as clinical teachers in small-group and case-based settings.

Outpatient training is conducted primarily through the General Medicine Clinic and various subspecialty clinics, where residents provide care for assigned patient panels.

In addition to core rotations, senior residents undertake a six-month elective period dedicated to an ILP, developed collaboratively with core faculty and approved by the program director. This plan specifies learning objectives, instructional strategies, and assessment methods, allowing residents to pursue subspecialty experiences, external rotations, scholarly projects, or skill development in medical education.

Educational objectives for each rotation or clinical experience are clearly defined and communicated to both faculty and learners. Faculty members are responsible for establishing expectations at the outset of each rotation, leading structured discussions, ensuring that educational objectives are met, and providing verbal feedback on both clinical performance and teaching effectiveness. This structured approach fosters progressive responsibility, interprofessional collaboration, and the integration of knowledge, skills, and professional values essential for independent practice in internal medicine.

Progressive autonomy

Residents are expected to advance through the program by transitioning from the need for close supervision to progressively greater autonomy and readiness for independent practice. The program uses milestones (Figure 2), adapted from the ACGME-International competency framework, as developmental benchmarks that define successive levels of performance across the six core competencies. Milestone assessments are conducted by the Clinical Competency Committee (CCC), which is composed of seven faculty members. The CCC employs multiple assessment sources—including direct observation, rotation evaluations, procedural logs, multisource feedback, in-training examination results, and self-assessment—to evaluate each resident’s performance and assign milestone ratings across the ACGME-I core competencies. Strengths and areas for improvement are identified to guide ILPs and ongoing professional development.

Figure 2.

An example of milestones in the patient care competency domain.

In the early stages (postgraduate year [PGY]-1 and PGY-2), residents are expected to engage in the direct care of patients, performing accurate history taking, physical examinations, formulation of differential diagnoses, and initiation of evidence-based management plans. They are expected to demonstrate reliability in documentation, ordering of tests and treatments, and procedural skills appropriate to their level while engaging in self-directed learning and responding constructively to feedback.

By PGY-3, residents should function effectively as supervisors, managing patient panels on wards and guiding junior trainees in clinical reasoning, presentation skills, and procedural competence. They are expected to integrate critical appraisal of the literature into patient care, lead team-based discussions, and demonstrate organizational skills that ensure safe and efficient delivery of care.

PGY-4 residents are expected to demonstrate full readiness for unsupervised practice. This includes advanced diagnostic reasoning in complex cases, provision of consultative services, refinement of feedback and evaluation skills, and mentorship of junior trainees. They should consistently model professionalism, adaptability, and interprofessional collaboration while identifying and addressing personal learning needs through objective assessments such as the in-training examination.

Individualized learning plan

The ILP is closely integrated with the competency framework of the VinUni Internal Medicine Residency Program, with each resident’s ILP goals informed by their most recent milestone assessments. In practice, the ILP framework enables residents at different training levels to pursue tailored learning strategies and receive individualized feedback based on milestone progression. For example, two PGY-2 residents demonstrated divergent needs during CCC review: one struggled with structuring oral case presentations, while the other required greater procedural competence. The first resident’s ILP focused on enhancing presentation skills through weekly one-on-one sessions with a faculty mentor, incorporating targeted feedback on clarity and synthesis. The second resident prioritized procedural competence and was assigned supervised opportunities for central venous line placement, with direct observation and performance-based feedback. Similarly, at the senior level, a PGY-3 resident preparing for a cardiology fellowship directed their ILP toward evidence-based literature appraisal, leading journal clubs under faculty supervision. Another PGY-3 resident interested in academic medicine focused on developing teaching skills, receiving structured feedback on small-group instruction and bedside teaching. These examples demonstrate how ILPs facilitate differentiated instruction and personalized feedback, ensuring that educational activities remain aligned with both milestone expectations and individual career goals.

The use of ILPs in the VinUniversity Internal Medicine Residency Program has enabled personalized training by accommodating differences in learning pace, professional interests, and goal setting. For instance, residents who demonstrated rapid progression in procedural skills were advanced to more complex procedures under faculty supervision, whereas those requiring additional practice were granted extended opportunities until competence was achieved. Consequently, ILP goals varied according to each resident’s developmental trajectory. Goal setting, informed by milestone data from the CCC, also reflected residents’ career aspirations. Examples include cardiology-focused journal club leadership and echocardiography training for fellows-in-preparation, or structured teaching activities designed for residents pursuing academic medicine. Through this approach, ILPs function as a dynamic mechanism that aligns individualized objectives with both competency-based progression and long-term professional development.

The strengths and areas for improvement identified during CCC review form the foundation for targeted ILP objectives. By mapping each ILP goal to specific sub-competencies and milestone levels, residents can design focused learning activities—such as clinical electives, scholarly projects, or teaching responsibilities—that address identified gaps or further strengthen areas of proficiency. Progress toward ILP objectives is monitored through continuous faculty feedback and reassessed during subsequent CCC meetings, creating a cyclical process in which milestone data guide personalized learning, and ILP outcomes provide additional evidence for milestone advancement [13]. Biannual reviews integrate data from multiple sources, including direct observation, end-of-rotation faculty evaluations, in-training examinations, and procedure logs. These data are evaluated in relation to both milestone expectations and each resident’s ILP objectives. As part of this process, every resident participates in a scheduled one-on-one meeting with the program director. During these sessions, residents engage in structured self-assessment by reflecting on their ILP goals, while the program director provides individualized feedback on progression relative to milestones and personalized objectives. This dialogue ensures that feedback remains timely, specific, and responsive to each learner’s developmental needs, thereby reinforcing the ILP as a dynamic tool for guided professional growth. The process is illustrated in Figure 3. This integration ensures that individualized education remains competency-based, outcome-oriented, and aligned with both program expectations and readiness for independent practice.

Figure 3.

Individualized learning plan (ILP) workflow diagram. ITE, in-training examination; CCC, Clinical Competency Committee.

Expected impact and challenges

The results of graded and progressively supervised clinical training within the competency-based medical education framework at VinUni include reinforcing individualized learning and promoting lifelong, self-directed learning to ultimately enhance patient care quality and safety. This model ensures that each trainee meets the program’s expectations and defined learning outcomes.

To further illustrate the principle of progressive autonomy, the elective experiences of residents in the first graduating cohort exemplify how ILPs were operationalized in practice. Each senior resident selected a six-month elective tailored to individual goals, aligning with both milestone assessments and career aspirations, as illustrated in Table 1. These elective choices reflected a balance between individualized career planning and the program’s competency requirements, allowing residents to exercise increasing autonomy in selecting, structuring, and executing their learning activities.

Table 1.

Examples of elective selection and linked milestones in progressive autonomy

Across 10 graduating residents, milestone ratings demonstrated consistent attainment of the program’s threshold for independent practice (approximating ACGME-I Level 4, while Level 5 represents expert-level performance) across all assessed subdomains. Core patient care skills were uniformly strong (history and physical examination: 3.5–3.9; clinical reasoning: 3.5–3.9; inpatient management: 3.7–4.0). Medical knowledge showed parallel performance (applied foundational sciences and diagnostic testing: 3.5–3.9; therapeutic knowledge: 3.6–4.0). Systems-based and scholarly competencies were robust, with patient safety/quality improvement at 3.7–4.0, evidence-based and informed practice at 3.5–3.9, and reflective practice/commitment to personal growth among the highest (3.8–4.2). Professional attributes were a notable strength: professional behavior ranged from 4.0–4.4, and accountability/conscientiousness from 3.98–4.22. Communication competencies were similarly high (patient- and family-centered communication: 3.8–4.2; interprofessional/team communication: 4.0–4.5). Several subdomains—such as outpatient management, digital health, system navigation, ethical principles, and communication within health systems—were not assessed in this cohort’s dataset (Table 2). Overall, the competency profile indicates broad readiness for independent practice, with particular strengths in professionalism, reflective learning, and team communication.

Table 2.

Visualization of milestone competency achievement in the Internal Medicine Residency Program

In the annual survey conducted by ACGME-I, with responses from 40 residents and seven core faculty, approximately 70% of trainees in the Internal Medicine Program reported satisfaction with faculty instruction. Eighty-five percent highly valued the appropriateness of supervision levels, and 80% expressed satisfaction with how evaluations contributed to improving patient care and learning. Additionally, 100% of trainees were satisfied with learning goals and objectives, and all faculty (100%) agreed that they had sufficient time for teaching and supervision. The survey also indicated that trainees actively seek supervisory guidance when needed, and 100% of faculty confirmed that VinUni trainees work effectively within interprofessional teams.

The Internal Medicine Residency Program at VinUni is the first in Vietnam to design and implement a competency-based curriculum aligned with Western standards. Within this framework, learners progress at their own pace. Semiannual feedback from the CCC identifies learning gaps that are subsequently addressed through ILP development. The ILP process requires both residents and faculty advisors to engage in goal setting, mapping objectives to milestones, and monitoring progress. However, challenges in implementing ILPs remain. Limited prior experience with competency-based individualized planning can result in variable ILP quality; inadequate protected time for ILP development and follow-up can constrain depth; and a lack of longitudinal learning activities may hinder sustained progress. Most importantly, faculty engagement poses challenges due to limited faculty numbers and competing teaching responsibilities.

The VinUniversity curriculum was not merely replicated from international frameworks but was deliberately reconstructed to fit the Vietnamese cultural and educational context. Adaptations included the integration of national MOH standards with ACGME-I requirements and the incorporation of a 6-month elective structured through the ILP, during which each resident pursued individualized learning goals, interests, and pace. Progression was supported through continuous feedback loops involving the CCC, faculty, and program leadership. Given the limited faculty pool and challenges in recruitment, VinUniversity, in collaboration with the University of Pennsylvania, developed a structured faculty development program emphasizing competency-based medical education, programmatic assessment, and feedback based on resident performance—with a particular focus on CCC processes. Although ILPs integrated within a competency-based framework are still evolving, key areas for faculty development include training in SMART (specific, measurable, achievable, relevant, and time-bound) goal setting, as well as coaching and mentoring skills. In parallel, the program has adopted a long-term capacity-building approach by cultivating a pipeline of junior faculty from among residency graduates, preparing them to transition into future core faculty roles. Together, these measures strengthen both the immediate implementation of ILPs and the long-term sustainability of faculty expertise in competency-based education. For VinUniversity, this approach is feasible given the relatively small program size; however, for larger medical schools in Vietnam, significant investment in faculty development will be essential to ensure successful ILP implementation within competency-based medical education.

Conclusion

In summary, this competency-based model incorporating ILPs represents a new approach to medical education in Vietnam. Through semiannual CCC synthesis meetings and co-creation of ILPs by residents and program leadership, the model shifts emphasis from time and process to documented competence and progression. The CCC process not only identifies outliers but also provides every trainee with a developmental roadmap that can be translated into specific goals and measurable outcomes—thereby promoting learner ownership, continuous monitoring, and self-regulated learning. In a context where CBE is emerging, this approach offers a structured mechanism to align assessments with outcomes, support both remediation and enrichment, and determine readiness for independent practice through explicit, evidence-based decisions. The significance of this work lies in demonstrating a feasible, context-adapted pathway for operationalizing CBE in Vietnam—integrating milestones, programmatic assessment, and ILPs into a continuous improvement cycle that is defensible for trainees, accountable to patients, and scalable to other programs in low- and middle-income settings.

Article information Continued