Primary Trauma Care Course Report

Luangprabang College of Health and Sciences Luangprabang, Lao PDR

Monday, 11th – Friday, 22nd of November 2019

Executive Summary

The content of this report covers the 8-day Primary Trauma Care course from November 11th- November 22nd, 2019 at the Luangprabang College of Health and Sciences in Luangrabang, Lao PDR.

These trainings were organized and conducted by the University of Health Sciences (UHS) and Health Leadership International (HLI) with the approval and support of the Ministry of Health, Lao PDR. The majority of funding for these PTC Instructor trainings was provided under a grant from the U.S.A. Department of State though Health Leadership International.

The Primary Trauma Care Foundation has endorsed the delivery of their life saving PTC training course in the Lao PDR. The Lao PDR Ministry of Health joins over seventy countries who are providing PTC, the trauma and disability training for “front-line health workers on how to deliver emergency medical care with only basic equipment.” The goal of PTC in the Lao PDR is to save lives, prevent disabilities and give medical providers at all levels of health care the medical knowledge and skills to make a difference in the trauma statistics in their nation.

The goal of this medical collaboration in the Lao PDR is to train key emergency medicine providers at UHS and at the Provincial and District level in the hopes of spreading the PTC model throughout the Lao PDR.

Key Staff Involved in Planning and Coordinating

Dr. Khamsay Detleuxay, the Vice -Director of Mahosot Hospital and the Director of the Emergency Medicine Residency at UHS is the Director of the Primary Trauma Care training to be conducted in the Lao PDR at both the Provincial and District levels. Dr. Khamsay provided medical leadership for course preparation, organization, and invitation of attendees for the 8-days PTC training of trainers from the nine Provinces and 66 Districts from the Northern Provinces of Lao PDR.

The HLI Executive Team which includes Reba McIntyre PhD, Cam McIntyre MD, Steve Dunning MD, and Khampho Thammavangxay Ohno, MPH, PA-C, worked with key Lao PDR leaders over many months to plan, coordinate, staff, equip and fund these PTC trainings.

Course Participants for Training Course in Luangprabang, Lao PDR

The course participants were selected by Dr. Khamxay Detleuxay and approved by the MoH for participation in the PTC training. Participants were emergency medical providers including emergency medicine physicians, IUC intensivists, anesthesiologists, and key emergency room staff.

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Training Sessions: Course 1: November 11th-12th, 2019 This training had 15 participants from eight districts in XiengKhouang Province and 12 participants from six districts in Luangprabang Province. Each province had one-two returning PTC provincial trainers who completed the 2-1-2 PTC course in November 2018 and served as Provincial faculty for this training.

Course 2: November 14th-15th, 2019 This training had 14 participants from seven districts in Xayaburi Province and 18 participants from nine districts in Vientiane Province. The two remaining districts from Vientiane Province will complete the 2-day PTC training in 1/2020. Two returning PTC trainers who completed the 2-1-2 PTC course in November 2018 served as Provincial faculty for this training.

Course 3: November 18th-19th, 2019 This training course had trainees from fourteen districts from the Northern Provinces of Bokeo, , and Phongsaly. There were a total of 38 trainees and four returning provincial trainers who had completed the PTC 2-1-2 course in November, 2018.

Course 4: November 21st-22nd, 2019 This training had 36 participants, 18 from the districts of Huaphan Province, 12 from the districts of Oudomxay, and 6 from the districts of Luangprabang who were unable to make it to the prior training. In addition, there were 4 returning provincial trainers from Huapan and Oudomxay.

The goal of the training in 2019 is to train two providers from each of the district hospitals in each province. The overall goal nationwide is to provide PTC training to two providers from all of the 139 district hospitals in the Lao PDR in 2019. Both the Emergency Medicine Residents and Provincial trained PTC instructors from the November 2018 training served as faculty in this nationwide training program.

All PTC materials have been translated into Laotian by HLI and were provided to all the attendees.

PTC Course Leadership Course Director: Dr. Khamsay Detleuxay; PTC Director, Vice-Director of Mahosot Hospital, and Director of EM Residency at UHS Course Coordinator: Dr. Steve Dunning – Health Leadership International , HLI Medical Director of PTC Course Financial Director: Dr. Cam McIntyre– Health Leadership International

Dr. Khamsay Detleuxay and Dr. Steve Dunning

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UHS Faculty, HLI Faculty, and Co-trainers from the Northern Provinces of Bokeo and Luang Namtha.

PTC Training Staff

PTC Director – Khamsay Detleuxay, MD

Emergency Medicine Residents – UHS Anouphet Nhengtavan, MD, Year 3 Mouavang Xiapao, MD, Year 3 Pouifai Houangsavanh, MD, Year 3 Bounlom Santisouk, MD, Year 2 Kingchan Khammavong, MD , Year 2 Chanthao Chue Fue, MD, Year 2 Somphone Oulaychanh, MD Year 2 Khamsay Inthavong, MD Year 2

HLI Training Staff – Steve Dunning, MD – Internal Medicine, ATLS, Lao Speaker Khamph Southisombath, MD– Family Medicine, Lao Speaker Rick Arnold, MD – Internal Medicine, Thai Speaker

PTC Course Administration Team

A collaborative team of HLI and UHS worked together to provide the administration and evaluation tasks that supported this PTC training course.

Course Administrator – Southida Vilayvieng, MD, Ministry of Health UHS Administrator - Thepbandith Phommachanh, MD

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PTC Course Participants: There were a total of 131 participants, 33 females and 98 male participants. Participants were Emergency Medicine Physicians, ICU intensivists, General Surgeons and key ER staff. Participants were from 65 districts of the 9 Northern Provinces of Lao PDR (XiengKhouang, Luangprabang, Vientiane, Xayaburi, Luang Namtha, Bokeo, Phongsaly, Huapan, and Oudomxay).

PTC Course Participants for Week 1: November 11th-12th, November 14th-15th 2019 See Appendix A for a list of course participants, which includes names, districts, age, and gender

Course participants from XiengKhouang Province along with UHS and HLI Faculty

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Course participants from Xayaburi and Vientiane Province along with UHS and HLI Faculty PTC Course Participants for Week 2: November 18th-19th, November 21st-22nd, 2019 See Appendix B for a list of course participants, which includes names, districts, age, and gender.

Course participants from Bokeo, Phongsaly, and along with UHS and HLI Faculty

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Course participants from along with UHS and HLI Faculty

Course participants from Huapan Province along with UHS and HLI Faculty

The PTC Program The PTC Program was taught entirely in the Lao language. There were a total of four courses, each course consisting of a two-day training, over a span of two weeks. The trainings were taught by 3rd and 2nd year EM residents with HLI faculty serving as consultants/co-teachers. The two-day training course consisted of four skill stations, four workshop stations and eight scenario stations to provide an intense hands-on trauma training.

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See Appendix C for the course schedule and content.

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PTC Course Evaluation, Training Feedback, Training Outcomes Summary of Pre and Post MCQ

WEEK 1: November 11th-12th, 14th-15th 2019 WEEK 2: November 18-19th, 21st-22nd, 2019

XiengKhouang Province (N=11) Luang Namtha Province (N=8)

Mean % Pretest 50% Mean % Pretest 60%

Mean % Posttest 82% Mean % Posttest 89%

% of Mean Improvement 31% % of Mean Improvement 29%

Luangprabang Province (N=22) (N=8)

Mean % Pretest 54% Mean % Pretest 52%

Mean % Posttest 82% Mean % Posttest 86%

% of Mean Improvement 28% % of Mean Improvement 34%

Vientiane Province (N=22) (N=12)

Mean % Pretest 50% Mean % Pretest 57%

Mean % Posttest 74% Mean % Posttest 85%

% of Mean Improvement 24% % of Mean Improvement 28%

Xayaburi Province (N=18) Huapan Province (N=18)

Mean % Pretest 54% Mean % Pretest 52%

Mean % Posttest 87% Mean % Posttest 79%

% of Mean Improvement 31% % of Mean Improvement 27%

Oudomxay Province (N=12)

Mean % Pretest 57%

Mean % Posttest 83%

% of Mean Improvement 25%

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Summary Pre and Post Confidence Matrix – Course 1 -4 Scenarios A B C D E F G H Average 5 yo 30 yo 25 yo 60 yo 50 yo man 20 yo 2 yo child 50 yo man with pregnant male femal unconscio male with a cyanosed pelvic woman with e with us with a who is major from a fx with knife in 40% fixed conscio hemorrha tension femur fx abd burns dilated us but ge from a pneumoth pupil cannot traumatic orax move amputati his legs on of his leg Course 1: XiengKhouang/Luangprabang Pre 1.9 2.2 1.8 2.4 2.2 2.2 2.0 2.1 2.1 Post 3.6 3.9 3.9 4.0 3.9 4.0 3.4 3.9 3.8 Course 2: Vientiane/Xayaburi Pre 1.8 2.3 2.3 2.3 2.1 2.4 2.0 1.8 2.1 Post 4.2 4.3 4.4 4.4 4.2 4.4 4.2 4.5 4.3 Course 3: Phongsaly/Luang Namtha/Bokeo/+ 2 districts Vientiane Pre 2.1 2.3 2.3 2.4 2.4 2.8 2.4 2.3 2.4 Post 4.0 4.1 4.1 4.3 4.4 4.1 3.8 4.6 4.2 Course 4: Oudomxay/Huapan Pre 1.9 2.1 2.1 2.3 2.1 2.2 1.9 1.9 2.1 Post 4.3 4.1 4.2 4.4 4.2 4.2 4.0 4.3 4.2

Course Evaluation

The PTC training for the Northern Provinces was very successful. The trainees stated the course was an excellent trauma model for all levels of healthcare providers. They valued the ABCDE approach and the hands-on skill and knowledge in small group sessions.

Participant skill and knowledge improved as shown by MCQ results and higher confidence matrix scores in managing trauma patients.

Recommendations and Conclusion

UHS and HLI will continue to strengthen the Laotian medical edits of the PTC curriculum and skill scenarios.

There was positive feedback and support from the MoH, UHS, and participating faculty and trainees that the PTC training would help improve significantly trauma care in the Lao PDR.

HLI has planned with MoH and UHS support a 2-1-2 PTC training of trainers in January 2020 in Vientiane. The attendees will be 3rd year EM residents and district physicians and other professionals from Vientiane Xayaburi Provinces.

UHS will continue to provide leadership and ongoing coordination with the PTC program in the Lao PDR.

Acknowledgments and Thanks

HLI wishes to thank the following supporters for the planning, organizing, instructing and funding efforts that made the PTC training possible. This training was funded by a generous grant to HLI from the USA Department of State. 10

MoH, Lao PDR U. S. Department of State Primary Trauma Care Foundation Dr. Niranh Phoumindr MD, Director General; MoH Department of Health Processional Studies Dr. Phouthone Vangkonevilay - President of UHS Dr. Alongkone Phengsavanh – Vice Dean Dr. Thavone Chanthasone – Vice Dean Dr. Molina Choummanivong Vice Director, International Relations Suzie Nui MD- PTC Foundation –PTC coordinator

Appendix A: Demographics of Course Participants, Week 1: November 11th-12th, 14th-15th, 2019 Total Number Participants – (73)

No NAME IN ENGLISH DISTRICT Age GENDER XIENGKHOUANG PROVINCE (N=11) 1 Dr. Paoyang CHONGYING Mork 34 M 2 Dr. Sailor NHIACHAO Mork 33 M 3 Dr. Thoryang DAXUE Nonghet 36 M 4 Dr. Yerya NORTOU Nonghet 42 M 5 Dr. Leamthong MANISOKXAY Phoukoud 31 M 6 Dr. Sidthixay BOUNXAY Phoukoud 29 M 7 Dr. Phonesonchai XIONG Phaxay 36 M 8 Dr. Khanthaly THAVIVONE Phaxay 52 F 9 Dr. Poryang YIAYENG Kham 40 M 10 Dr. Soutthiwet MOUNPHOXY Kham 31 M 11 Dr. Thongsavat THONGKEOPASERT Khoun 45 M

LUANGPRABANG PROVINCE (N=22) 12 Dr. Saykham VEANVONGTHONG Pak Ou 33 M 13 Dr. Kee YANG Pak Ou 33 M 14 Dr. Baoher LIANOSAY Pakxeng 32 M 15 Dr. Anonsith PHOMHACKSA Pakxeng 28 M 16 Dr. Kuethai YIALY Phoukhoun 31 M 17 Mr. Khamsaeng LORPHACHANH Phoukhoun 24 M 18 Dr. Soua XIONG Phonexay 32 M 19 Mrs. Latsamy YAXENG Chomphet 25 F 20 Mrs. Thinada VANNACHIT Chomphet 27 F 21 Dr. Sombath XAYHONGTHOR Ngoi 31 F 22 Mr. Khonechalern MANIVONG Ngoi 27 M 23 Dr. Sourivong KOUNTHIKOUMMAN CHS 26 M 24 Dr. Hiker PHIMMACHAN Nambak 27 M 25 Mr. Lita BOUNSAVANH Nambak 21 M 26 Dr. Bouavanh VANG Phonthong 43 M 27 Dr. Lamphanh SINGTHAMMAVONG Phonthong 35 M 28 Dr. Latdavanh THITTHIVONG Xiengngeun 31 F 29 Mrs. Oraphan MOUNMACHIT Xiengngeun 27 F 30 Dr. Phonevilay THAMMAVONG Nan 48 F 31 Dr. Phimphone SOUKSAVATH Nan 32 F 32 Mrs. Somdy XAIYAVONG Viengkham 29 F

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33 Mrs. Lavilaysit INTHISAK Viengkham 28 F

VIENTIANE PROVINCE (N=22) 34 Dr. Viengkhone PHANHSY Sanakham 51 F 35 Dr. Nivonevang BOUAYER Sanakham 31 F 36 Dr. Onhkeo PASEUTH Viengkham 53 F 37 Dr. Kongthieng NOITEPAMNOUAY Viengkham 52 F 38 Dr. Lavanh LATTANA Keo Oudom 31 M 39 Dr. Khamka SYYASHEN Keo Oudom 36 M 40 Dr. Xongmoua YOUAYEE Thoulakhom 31 M 41 Dr. Phongsavat VIXAYGNALATH Thoulakhom 27 M 42 Dr. Phonemany THIPPHAVONG Meun 31 M 43 Dr. Kouthao SAYPHIA Meun 32 M 44 Dr. Misay SIPASIRD Pheung 30 M 45 Mr. Vongxay CERTIONGXIONG Pheung 36 M 46 Dr. Khanxay PHOMMACHACK Kasy 37 M 47 Mrs. Boualaphanh MHONKUNKHAM Kasy 31 F 48 Mr. Chan INTHALATH Maed 29 M 49 Dr. Ding SENGTHICHACK Maed 24 M 50 Dr. Sengphet SOMMYSAY Vangvieng 48 M 51 Dr. Amin ANOULACK Vangvieng 33 M 52 Dr. Lamphan KEOCHANTHAMIXY Phonehong 43 F 53 Mrs. Bounnoy PHATHAMMAVONG Phonehong 54 F 54 Dr. Somsana BOUNTA Hinherb 42 M 55 Dr. Khamphui SYMOUKDA Hinherb 48 M

XAYABURI PROVINCE (N=18) 56 Dr. Fony VONGPASERTH Hongsa 37 M 57 Dr. Osai OUDOMSIN Hongsa 27 M 58 Dr. Kongkham THAMMAVONG Kenthao 36 M 59 Dr. Bounmy CHANTHIMA Kenthao 30 F 60 Dr. Sathien KHIENTHONG Paklai 32 M 61 Mrs. Phonethavy SAYAFENG Paklai 25 F 62 Dr. Chansamouth PHINTHONG Saysathan 27 F 63 Dr. Somphone LATHVONGSA Saysathan 30 M 64 Mr. Khammuan OUNVONG Phiang 36 M 65 Dr. Bounthavy CHANTHAVONG Phiang 30 M 66 Dr. Phonesavath SITHIPONG Bortene 30 M 67 Dr. Chanthalansy SAYASAN Bortene 32 M 68 Dr. Dethmixay KHAMPAVONG Xienghorn 30 M 69 Dr. Len PATHOUMVAN Xienghorn 29 M 70 Dr. Kaewpasong PHIMMASONE Ngern 27 M 71 Dr. Takob CHANTHAVONG Ngern 26 F 72 Dr. Soudsakhone PHONEKHAMMA Khop 31 M 73 Dr. Phonethip KEOCHINEDA Khop 34 M

Appendix B: Demographics of Course Participants, Week 2: November 18th-19th, 21st-22nd, 2019 Total Number Participants – (58)

No NAME IN ENGLISH DISTRICT Age Sex LUANG NAMTHA PROVINCE (N=8) 1 Dr. Souphasay SINGNGAM Long 27 M 12

2 Mr. Phonepaserd HUANGMANY Long 28 M 3 Dr. Akhom INPHANTHALAY Viengphukha 29 M 4 Dr. Sysavath KEOCHANSY Viengphukha 30 M 5 Dr. Bounsong KEOPASERD Nalae 26 M 6 Dr. Khay MANIVONE Nalae 27 M 7 Dr. Somphad SOCHAMPA Sing 36 M 8 Dr. Amphone KATIVAVONG Sing 32 F

BOKEO PROVINCE (N=8) 9 Dr. Khamlah PHOMMACHIC Meung 42 M 10 Dr. Munthong KEOPASERTH Meung 27 M 11 Dr. Onkham INTHALA Pha Oudom 32 M 12 Dr. Kongkham THAMMACHENE Pha Oudom 43 M 13 Dr. Lue THOR Paktha 31 M 14 Dr. Souvixay SOUTHAPHONE Paktha 39 M 15 Dr. Phetsamone BOUNVILAY Tonpherng 31 M 16 Dr. Southalith VANNASY Tonpherng 27 M

PHONGSALY PROVINCE (N=12) 17 Dr. Onkeo PHANTOULATH Khua 36 M 18 Dr. Somchit DALASACK Khua 30 F 19 Dr. Khamphone TAOSENG Yod ou 29 M 20 Dr. Bounhong PHETBOUN Yod ou 34 M 21 Dr. Somdy SENGALOUN Bountai 26 M 22 Dr. Boun DUANGKHAMDY Bountai 26 M 23 Dr. Chansamai SOUTHLIN Phongsaly 29 F 24 Mrs. Sipheng KEONA Phongsaly 29 F 25 Dr. Vanhthong VANGHAN Samphan 31 M 26 Dr. Norpaeng PHIMMACHUN Samphan 27 M 27 Mr. Southin PIYADETH Mai 46 M 28 Dr. Khonesuly SOUKDALAVONG Mai 33 F

HUAPHAN PROVINCE (N=18) 29 Dr. Souvanpheng INTHAVONG Kuan 32 F 30 Dr. Vilaphone THAMSYTHONG Kuan 33 M 31 Mrs. Bangphone XAYLEEVONE Ead 28 F 32 Dr. Bounthieng KOEMESAY Ead 29 M 33 Dr. Phouvone VOUTBAMPHEN Xamtai 30 M 34 Dr. Chailythor BUALAO Xamtai 29 M 35 Dr. Adeng SYSOMBATH Xone 33 M 36 Dr. Kita SAENGSOMBOUN Xone 26 M 37 Dr. Phone MANYVANH Sopbao 31 M 38 Dr. Phetnaly HEUNGMISUK Sopbao 33 F 39 Dr. Yervang GNIALOR Xiengkhor 37 M 40 Dr. Aith Xiengkhor 47 M 41 Dr. Noy ONKHAM Huameuang 30 M 42 Dr. Thilakoun CHANDINOUPHAB Huameuang 28 M 43 Mr. Sanny KEOBUATHONG Hiem 22 M 44 Dr. Nuinanthakan THIPHAVAN Hiem 32 F 45 Dr. Phanousone SISAVATDY Viengxai 31 F 46 Dr. Khamphan INSAVANTHONG Viengxai 30 F

OUDOMXAY PROVINCE (N=12) 47 Dr. Somphet XAYBOUNSONE Beng 39 M 48 Mr. Khamphone VILAKET Beng 39 M 49 Dr. Booksi SOUNPASERTH Pakbeng 32 M 13

50 Dr. Seuth XAYAPHERM Pakbeng 34 M 51 Dr. Vilay XAYTHONGPANE Houn 35 M 52 Dr. Lanee INTASONE Houn 26 M 53 Dr. Touy VILAISOUK Namor 30 M 54 Dr. Thanongsak SUVIAT Namor 44 M 55 Dr. Choy MONEKALAY Nga 29 M 56 Dr. Keomany CHITTVONG Nga 27 F 57 Dr. Saveng VONKHAMPHANH Lar 31 M 58 Mrs. Somly LATTANAVONG Lar 29 F

Appendix C: Schedules for the Training in Luangprabang, November 11th-22nd, 2019 DAY ONE:

Time/Minutes Topic Slides Lao Lead G1 Lao Lead G2 HLI Lead 8:30 / 30 min Welcome, Intro, Dr. Khamsay Dr. Khamsay Dr. Steve MCQ 9:00/15 min Local Trauma Dr. Khamsay Dr. Khamsay Dr. Steve Perspective 9:15/15 min PTC Overview 1-13 Bounlom Pouifai Dr. Steve 9:30/30 min Trauma ABCD 14-37 Anouphet Chaothao Dr. Khamph Primary Survey Province Inst 1 Province Inst 2 10:00/10 min Break 10:10/40 min Airway & 38-62 Bounlom Kingchan Dr. Rick Breathing 10:50/35 min Circulation & 63-85 Somphone Pouifai Dr. Steve Shock 11:25/35 min Chest Injuries 86-104 Khamsay In Moavang Dr. Khamph 12:00/45 min Lunch Break 12:45/80 min Skills /40 min Basic/Airway Somphone Kingchan Dr. Steve Advanced Khamsay In Moavang Dr. Khamsay Airway /20 min Cervical Bounlom Pouifai Dr. Khamph Spine/Log Roll /20 min Chest Drains Anouphet Chaothao Dr. Rick 14:05/10 min Break 14:15/60 min Abdominal 105- Somphone Kingchan Dr. Steve Pelvic Limb 141 Province Inst 2 Province Inst 2 trauma 15:05/15 min Demonstration All All Dr. Khamph scenario 15:20/60 min Scenario Practice

No. #1 Khamsay In Kingchan Dr. Steve Province Inst 1 Province Inst 1 No #2 Anouphet Chaothao Dr. Khamph Province Inst 2 Province Inst 2 No #3 Somphone Moavang Dr. Rick No #4 Bounlom Pouifai Dr. Khamsay 16:30/5 min Overview & Dr. Khamsay Dr. Khamph Summary 14

DAY 2 : Time/Minutes Topic Slides Lao Lead G1 Lao Lead G2 HLI Lead 8:30/45min Head & Spinal 126-182 Khamsay In Moavang Dr. Steve Injuries 9:15/30 min Trauma in 183-214 Bounlom Pouifai Dr. Khamph Children & Province Inst 2 Province Inst 1 Pregnancy 9:45/30 min Burns 215-235 Anouphet Chaothao Dr. Rick 10:15/15 min Break 10:30/ 80 min Workshops 20 min Analgesia Khamsay In Moavang Dr. Steve Province Inst 1 Province Inst 1 20 min Transport Somphone Kingchan Dr. Khamph Province Inst 2 Province Inst 2 20 min Peds Trauma Bounlom Phouifai Dr. Rick 20 min Neuro Anouphet Chaothao Dr. Steve Assessment 12:00/ 30 min Secondary 236-248 Somphone Pouifai Dr. Rick Survey 12:30/40 min Lunch Break 13:10/50 min Disaster Anouphet Moavang Dr. Khamph Management 14:00/80 min Scenarios /20 min No #5 Khamsay In Kingchan Dr. Steve Province Inst 1 Province Inst 1 /20 min No #6 Anouphet Chaothao Dr. Khamph Province Inst 2 Province Inst 2 /20 min No #7 Somphone Moavang Dr. Khamsay /20 min No #8 Bounlom Pouifai Dr. Rick

15:20/10 min Break 15:30/15 min Repeat MCQ Khamsay Dr. Khamsay Dr. Khamph 15:45/20 min Summary, Dr. Khamsay Dr. Khamph Feedback Evaluation 16:05/15 min Close, Dr. Khamsay Dr. Steve discussion Planning for Instructor Day 16:20/15 min Certificates Dr. Steve

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