Prepared by: Dr Panagiotis Antoniou, A/Prof Dr Lee Yew Kong, Hafsa Mahbub

1. Background
On 16/10/2025 the multiplier event titled “Southeast Asian Collaborations for Digital Healthcare Education Transformation” for two closely aligned EU projects in Southeast Asia took place.

CHAPTER SEA (Culture and Health system Adaptation of virtual Patients as collaborative learning eResources SouthEast Asia, Project Number: 101178356) and DISCERN-DSS (DIgitally enhanced SCenario basEd leaRNing for Digital Soft Skills, Project Number: 101179391) project teams held a multi-faceted event for proliferating their first results and building synergies for digital health in the SE Asia region. Both projects are capacity building Erasmus+ projects, funded by the European Union. They both aim to enhance digitalization of healthcare education in Malaysia and Indonesia respectively.

CHAPTER SEA (https://chaptersea.com) aims to enhance healthcare education in Malaysia and Indonesia by training five healthcare schools to adopt and implement virtual patient cases from Europe. Virtual patients are online cases used to improve clinical reasoning and decision-making skills. The project addresses challenges in using technology, especially in lower-middle-income countries, by providing guidance on selecting, adapting, and integrating digital tools into medical programs.

DISCERN-DSS (https://discern-dss.eu/), on the other hand aims to introduce digital scenario- based learning, virtual patients, for teaching digital soft skills to healthcare professionals in Indonesia. Skills such as ethical telemedicine, responsible use of digital tools such as AI and personal health record, are essential for digitally ready healthcare professionals. In that context, digital scenario-based learning in the form of interactive scenarios is essential for experiential teaching of such topics.

Both projects have shared goals in promoting the use of scenario-based digital health education in the Southeast Asian countries of Malaysia and Indonesia. In that context, the multiplier event that was organized had the aim to proliferate the first outcomes of these projects, reinforce their position as digital health force multipliers and new initiatives.

2. Program Flow

The following Table outlines the 3-hour online event program, with time slots in Malaysian time (GMT+8).

2.1 Formal address
The event kicked off with a formal address by Ms. Lauriane Bertrand, Deputy Head of Unit for Erasmus+ International Capacity Building, representing the European Union. Her opening remarks set the tone for the event, acknowledging the significance of international collaboration in advancing digital healthcare education and the European Union's commitment to supporting capacity-building initiatives in Southeast Asia.

2.2 Partner University Introductions
A segment of the program was dedicated to introductions from eleven partner universities. The European partners included:
• Aristotle University of Thessaloniki (Greece), represented by Prof. Panagiotis Bamidis
• Jagiellonian University (Poland), represented by Ms. Joanna Fafarek
• Karolinska Institutet (Sweden), represented by Ms. Natalia Stathakarou
• European Union of Medical Specialists (UEMS), represented by Ms. Isabelle Dumaine

The Southeast Asian partners comprised:

• Universitas Gadjah Mada (UGM), Indonesia, represented by Dr. Wika Hartanti
• Universitas Sebelas Maret (UNS), Indonesia, represented by Prof. Ari Natalia Probandari
• Universitas Muhammadiyah Yogyakarta (UMY), Indonesia, represented by Prof. Erna Rochmawati
• Universiti Malaya (UM), Malaysia, represented by Dr. Tong Wen Ting
• Universiti Putra Malaysia (UPM), Malaysia, represented by Dr. Irmi Ismail
• Taylor's University (TU), Malaysia, represented by Dr. Renukha Sellapans
• UIN Syarif Hidayatullah Jakarta (UIN), Indonesia, represented by Dr. Fika Ekayanti

2.3 Project Overview Presentations

Two foundational presentations introduced the core projects driving this collaboration:

Dr. Panagiotis Antoniou presented DISCERN-DSS, bringing his extensive expertise as a senior research associate and Laboratory Reader in the Lab of Medical Physics and Digital Innovation at Aristotle University of Thessaloniki's School of Medicine. As Implementation Coordinator of DISCERN-DSS, Dr. Antoniou has substantial experience in technology- enhanced learning research projects for healthcare.

Assoc Prof Dr. Lee Yew Kong provided an overview of CHAPTER SEA. As Main Coordinator of the project and Associate Professor at the Department of Primary Care Medicine, University of Malaya, Dr. Lee leads several eLearning and eHealth initiatives, positioning him ideally to articulate the project's vision and objectives.

2.4 Featured Speaker Sessions

The program featured four specialized presentations addressing aspects of digital healthcare education in Southeast Asia:

2.4.1 Culture and Content Adaptation of Virtual Patients

Dr. Puteri Shanaz Jahn Kassim from Universiti Putra Malaysia presented a needs analysis on culturally adapting virtual patients for Southeast Asian settings. Dr. Puteri Shanaz is a Family Medicine Specialist and Lecturer whose PhD research focused on digital behavior change interventions to promote physical activity among adolescents with overweight and obesity. Her work bridges research and education, with particular expertise in lifestyle medicine, behavior change, and evidence-based preventive care. Her presentation addressed the need of localizing virtual patient content to reflect regional medical education contexts and cultural nuances.

2.4.2 Digital Soft Skills Conceptual Framework

Dr. Niki Pandria from Aristotle University of Thessaloniki presented the conceptual framework for digital soft skills in healthcare education. Dr. Pandria brings a unique interdisciplinary background, holding a Medical Degree, B.Sc. in Mathematics, M.Sc. in Statistics and Modeling, and a Ph.D. in Computational Neuroscience focusing on biofeedback and neurofeedback. As a Postdoctoral Research Fellow at the Laboratory of Medical Physics and Digital Innovation, her research bridges neuroscience, biomedical engineering, and digital health.

2.4.3 Curricular Needs for Digital Soft Skills in Indonesia

Dr. Amandha Boy Timor Randita from Universitas Sebelas Maret addressed the specific curricular requirements for integrating digital soft skills into Indonesian medical education. As a lecturer at the Faculty of Medicine, his research focuses on curriculum development, interprofessional collaboration, neuromuscular rehabilitation, pain management, and child growth and development. His presentation illuminated why digital soft skills technology is essential for Indonesian healthcare education.

2.4.4 Best Practices for Open Educational Resources

Prof. Dr. Ardi Findyartini, Director of Transformative Learning Strategies and System at the Directorate General of Science and Technology, Ministry of Higher Education, Science and Technology, Republic of Indonesia, delivered the final speaker session. In her influential governmental role, Prof. Ardi provided high-level strategic perspectives on adapting open educational resources for Southeast Asian contexts, illustrating innovative approaches to strengthen accessibility and implementation of open educational resources throughout the region.

2.5 Panel Discussion

The program's capstone was a 40-minute panel discussion exploring "What is the Vision of Digital Healthcare Education in Southeast Asia?" This session was co-facilitated by Assoc Prof Dr. Lee Yew Kong (CHAPTER SEA Main Coordinator), Universiti Malaya, and Dr.
Anastasia Rodina-Theocharaki (DISCERN-DSS EU Projects Manager), Aristotle University of Thessaloniki.
The panel featured four distinguished experts:

Professor Dr. Lee Ping Yein (CHAPTER SEA) - Professor of Family Medicine and Consultant Family Physician at University of Malaya. Prof. Lee has led multiple projects on reusable learning objects, virtual patients, and eHealth apps. She is founding institutional lead of the Asia Pacific Academic Primary Care Group Foundation and Chief Editor of the Malaysian Family Physician Journal.
Dr. Lutfan Lazuardi, M.Kes, Ph.D (DISCERN-DSS - UGM) - Head of the Department of Health Policy and Management at Universitas Gadjah Mada. His expertise spans digital health transformation, health information systems, and policy innovation, having led national and international projects on digital health interoperability and curriculum development.
Dr. Sri Sundari, M.Kes (DISCERN-DSS - UMY) - Holds a Doctor of Medicine degree, Master of Health degree, and Doctorate in Medicine from Gadjah Mada University. Dr. Sundari is a certified primary care physician and certified professional lecturer by the Ministry of Education, Culture, Research, and Technology of Indonesia.
Dr. Fika Ekayanti, MD (CHAPTER SEA) - Senior Lecturer and Vice Dean of Academic Affairs at Syarif Hidayatullah State Islamic University Jakarta. Dr. Ekayanti has managed medical education projects related to curriculum modification and bioethics, and led her medical faculty's accreditation with distinguished results.
The discussion addressed questions affecting the future of digital health education in the region:
• Are there any regional collaborations or cross-border initiatives currently shaping digital health education in SEA?
• Are ERASMUS collaborations scalable and what is their position in relation to SEA digital health education transformation?
• How can SEA universities collectively address disparities in digital infrastructure and access?
• How do we ensure digital healthcare education reaches rural and underserved communities?
• What strategies are being used to support students with limited digital literacy or access?
• How do we ensure digital education doesn't compromise hands-on clinical training?

The interactive format encouraged speakers to give their take on digital health, fostering engagement between the expert panel.

3. Program result

The event attracted a total of 222 participants who registered for the event.

The event was coordinated by 14 volunteer committee members from both projects and from 5 different institutions.

4. Conclusion

In conclusion, the event demonstrated the untapped potential for regional collaboration in the sector of digital health education. From the event’s discussions it became clear that both DICERN-DSS and CHAPTER SEA can become the initial triggers for a cascade of future endeavors for digital health training in the region. New, disruptive technologies such as Virtual and Augmented Reality (VR/AR), Artificial Intelligence (AI) are quickly coming in the mainstream of healthcare sector. Training and exposure to these newer technologies underpinned by use of established pedagogical frameworks and implementation protocols facilitate a more robust application of these technologies in the region. By mainstreaming pedagogical innovations such as scenario-based learning it is expected that a virtuous cascade of digital health innovations will transform the landscape of tertiary healthcare education in the SE Asia region.

The workshop continued on the fourth day with a discussion on virtual patients from cultural and interprofessional education perspectives. Maxine G. Harjani and Klas Karlgren draw examples from various literature, the use of artificial intelligence (AI) for case adaptation, and several frameworks for understanding cultural differences in virtual patient scenarios.

The main framework discussed is Hofstede's framework, which focuses on six cultural dimensions including power distance, individualism vs. collectivism, masculinity vs. femininity, uncertainty avoidance, long-term vs. short-term orientation, and indulgence vs. restraint, to understand. Power distance shows data on how the distribution of power affects decision-making within a society, while individualism vs. collectivism examines how individual or collective approaches influence decision-making. Individualistic societies focus on personal goals, while collectivist societies focus on collective harmony. The gender approach to masculinity vs. femininity is no less interesting to discuss in relation to the different values between masculine and feminine societies. At the end of the session, Klas focused on data from various countries regarding uncertainty avoidance, long-term vs. short-term orientation, and indulgence vs. restraint. Klas also emphasized that Hofstede's Framework approach is often criticized for oversimplifying the highly diverse cultural landscape, but that it can at least be used to facilitate understanding of how international business and intercultural communication function.

The fourth day's workshop concluded with the creation of a CASUS patient concept map that will be implemented in the local setting.

The Workshop 2 – Implementation and Adaptation of VP’s

Chapter SEA 15^th – 19^th September 2025 Second Project Meeting Krakow

The third day's workshop was themed around implementation plans and action plans. The freezing temperature did not dampen the spirits of all consortium members to give their best presentations. In the morning session, all consortium members from Universiti Malaya, Universiti Putra Malaysia, Taylor University, Universitas Gajah Mada, and UIN Syarif Hidayatullah Jakarta presented their plans for implementing virtual patients at their institutions, as well as more detailed action plans on how cases would be applied in the curriculum, identifying strengths and challenges.
The workshop sessions were interspersed with hot tea and coffee to combat the increasingly cold temperature.

After morning tea, the session resumed with presentations from consortium members, coordinated by the Project Leader of CHAPTER SEA, Dr. Yew Kong Lee, covering case selection, adaptation to cards, adaptation to concept maps, and adaptation of documentation templates.
This session delves into more detail about the preparation for implementing virtual patients in the curriculum that will be used by each consortium member, with the hope that after Workshop 2, virtual patients can be implemented immediately across all consortium members.

The third day's workshop concluded with a "Walk Away" around Jagiellonian University to see more of the culture, history, and buildings of Poland's oldest university, and ended with a Social Dinner for all consortium members at Cafe Oranzeria Restaurant (Hotel Kossak 7th Floor) to allow all consortium members to get to know each other better and exchange experiences.

The Workshop 2 – Implementation and Adaptation of VP’s

Chapter SEA 15^th – 19^th September 2025 Second Project Meeting Krakow

Workshop 2, themed "Virtual Patient Implementation and Adaptation," began with a presentation by Dr. Andrzej Kononowicz on Implementation Science and its benefits in curriculum implementation and shifting from a "let it happen" to a "make it happen" paradigm. Five theories were presented as approaches to implementation science: process models; determinant frameworks; implementation theories; classic theories; and evaluation frameworks. The next session continued with Joanna Fąferek, who emphasized the need for a systematic review to determine the best framework for curriculum implementation. ICoVIP Framework 14 themes can be one of the frameworks for curriculum implementation, and one important thing to remember in curriculum implementation is that curriculum implementation is a continuous process that never ends. In Session 3, Małgorzata Sudacka added an explanation of the challenges and difficulties in implementing the clinical reasoning curriculum thru her multi-center research at several health faculties in Europe. Thru this qualitative research, many obstacles and challenges were found in the implementation of the clinical reasoning curriculum, including time, culture, teaching, assessment, motivation, infrastructure, and concepts.

The final workshop session by Klas Karlgren from the Karolinska Institute explained that curriculum implementation requires a lot of learning and some pilot tests need to be done, and not to be afraid of failure because challenges and failures will lead to more improvements, just like the story of the Andree's Arctic Balloon Expedition, which reinforces that success and failure are part of implementing educational innovation. The pre-lunch session was deepened with the sharing of educational innovation implementation by consortium participants from Universiti Malaya, Universiti Putra Malaysia, Taylor University, Universitas Gajah Mada, and UIN Syarif Hidayatullah Jakarta, while also identifying the challenges and strengths of each consortium member in implementing the curriculum. The first day's two-day workshop concluded with hands-on training on VP curriculum implementation, including details and assessments.

Chapter SEA 15^th – 19^th September 2025 Second Project Meeting Krakow

On September 15, 2025, all teams from the CHAPTER SEA consortium reconvened in Krakow, Poland, following a meeting at Universiti Malaya in Malaysia 9 months prior. In the tranquil city of Krakow, various delegations from Universiti Malaya (UM), Universiti Putra Malaysia (UPM), Taylor University (TU), Universitas Gajah Mada (UGM), UIN Syarif Hidayatullah Jakarta, and Karolinska Institute (KI), met at Jagiellonian University (JU), the oldest and number one university in Poland.

The opening ceremony was opened by the Vice-Rector for Research and Infrastructure, where the Vice-Rector emphasized the importance of international cooperation in improving education, including thru the CHAPTER SEA grant. After the opening, the Project Leader of CHAPTER SEA, Dr. Yew Kong Lee, did not forget to give a souvenir to the Vice-Rector for Research and Infrastructure for the exceptional reception by Jagiellonian University.

The event continued with Dr. Andrzej Kononowicz explaining the workshop's 5-day agenda in Krakow, including what would be achieved during the workshop. During this session, Dr. Yew Kong Lee, the Project Leader of CHAPTER SEA, also presented a "Summary of Current Project Status" to remind participants of the goals and outcomes to be achieved thru CHAPTER SEA, one of which is the implementation of virtual patient cases for 1000 students, approximately 120 – 400 students at each institution. Not to be forgotten, the first day included an icebreaking session led by Małgorzata Sudacka from Jagiellonian University, starting with morning exercises together, BINGO games, singing Polish songs, dancing traditional Polish dances, reading Polish poetry, and concluding with a presentation of traditional Polish costumes. The first day concluded with a Project Steering Committee Meeting for all teams.

We continued the workshop and simulated the CASUS application

Today is the last day for workshop.

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After a cup of warm coffee at the beginning of the second day workshop opening, the first workshop material began with what is meant by virtual patients. Presented by facilitators AP Dr. Andrzej Kononowicz from Jagiellonian University and Natalia Stathakarou from Karolinska Institutet, two pioneering universities in the development of virtual patients, this session discussed the implementation of virtual patients at the two universities.

"The use of virtual patients has been around for 40 years, so what we are doing today is not new, but the development will be very rapid, necessitating immediate implementation because it positively impacts the higher education learning process." According to AP Dr. Andrzej Kononowicz while presenting a meta-analysis on the development of virtual patients in the field of health education.

The next session covered an interesting topic on clinical reasoning as a skill frequently addressed through virtual patient simulations, encompassing an interprofessional definition, key components, selected basic theories, and common teaching methods used in clinical reasoning education. This session was complemented by a demonstration of the use of virtual patients in learning using the iCoViP Project through the CASUS System.

The next activity challenged workshop participants to create a virtual patient design from each university representative according to the provided template. The end of the morning session of the workshop was concluded with a very challenging small group activity involving the presentation of each group's virtual patient design using the World Café method.

After a Malaysian-style lunch, the workshop resumed with a focus on the implementation of virtual patients in the CASUS System. The facilitator walked around to ensure that the virtual patients created were correctly entered into the CASUS System. Creating virtual cases and making them seem real for use as learning materials is very challenging according to most participants. The second day of the workshop was concluded with feedback from the facilitator and participants regarding the CASUS System.

Tired but very challenging !

Landing in Kuala Lumpur, approaching the international traditions in Malaysia makes the atmosphere of the workshop held from January 13 to 17, 2024, more vibrant. Various nations and countries came together to unify perceptions and thoughts in a joint research workshop on the implementation of virtual patients in health care education across Malaysia and Indonesia, funded by the European Union through the grant Culture and Health System Adaptation of Virtual Patients as Collaborative Learning eResources South East Asia (CHAPTER SEA).

Starting with the explanation from Project Leader Assoc. Prof (AP) Dr. Lee Yew Kong about the CHAPTER SEA program and a brief overview of Universiti Malaya and how the program will proceed in the future, all participants listened attentively. AP YK reminded everyone that it is currently durian season in Malaysia, so he urged all participants not to forget to try the sweet durian, which has a very distinctive taste and texture. The next explanation about the CHAPTER SEA project and what Virtual Patients are was given by Jagiellonian University by AP Dr. Andrzej Kononowicz and Karolinska Institutet by Natalia Stathakarou, two pioneering universities in the development of virtual patients.

Another team actively participated, and each university introduced itself in turn, starting with Universiti Putra Malaysia by Ybhg Prof. Dr. Sazlina binti Shariff Ghazali, Taylor’s University by Dr. Renukha Sellappans, Universitas Gadjah Mada by Dr. Syahirul Alim, and Universitas Islam Negeri Syarif Hidayatullah by Dr. Fika Ekayanti. Mutually sharing the strengths of their universities and the natural wealth of their respective countries, including volcanoes and lakes, the entire team attempted to align their perceptions and strengthen their bonding to collaborate optimally in the future and achieve the best results.

"Welcome everyone, let's work together well to achieve the best results!" The closing statement from Project Leader Assoc. AP YK at the end of the first day of the workshop.

Landing in Kuala Lumpur, approaching the traditions between nations in Malaysia made the atmosphere of the workshop held from 13 to 17 January 2024 more colorful. Various nations and countries sat together to unite perceptions and thoughts in a joint research workshop on the implementation of virtual patients in health care education across Malaysia and Indonesia funded by the European Union through the grant Culture and Health System Adaptation of Virtual Patients as Collaborative Learning eResources South East Asia (CHAPTER SEA).

Starting from the explanation of the Project Leader Assoc. Prof (AP) Dr. Lee Yew Kong regarding the CHAPTER SEA program and a glimpse of Universiti Malaya and how the program will run in the future, all participants listened carefully. AP YK reminded that it is currently durian season in Malaysia, so reminded all participants not to forget to try the sweet durian which has a very distinctive taste and texture. The next explanation regarding the CHAPTER SEA project and what Virtual Patients are was given by Jagiellonian University by AP Dr. Andrzej Kononowicz and Karolinska Institutet by Natalia Stathakarou, two pioneering universities in the development of virtual patients.

Other teams actively participated and each university introduced themselves in turn starting from Universiti Putra Malaysia by Ybhg Prof. Dr. Sazlina binti Shariff Ghazali, Taylor's University by Dr. Renukha Sellappans, Universitas Gadjah Mada by Dr. Syahirul Alim and Syarif Hidayatullah State Islamic University by Dr. Fika Ekayanti. Conveying the advantages of their respective universities and the natural wealth of their countries, both volcanoes and lakes, the entire team tried to align perceptions, strengthen bonds so that they could collaborate optimally in the future and get the best results.

"Welcome all teams, let's work together well to get the best results!" Closing remarks from Project Leader Assoc. AP YK at the end of the first day of the workshop.