Medical education in Vietnam and its response to the country’s needs
With a population of 96,491,146 as of 2018, Vietnam is the third most populous country in Southeast Asia, and the 13th most populous country in the world. Alongside rapid economic development, the health status of people in Vietnam has significantly improved in recent years, with the life expectancy at birth increasing from 71 years in 1990 to 76 years in 2015. Infant mortality rates (under 5 years of age) decreased from 58 deaths per 1000 live births in 1990 to 18 in 2015; and the proportion of under-five-year-olds who were underweight decreased from 37% in 1993 to 14% in 2015. Vietnam also has one of the most rapidly aging populations in the world, with an increasing demand for quality healthcare services and new issues likely to emerge in the health sector in future years.
The healthcare workforce in Vietnam is currently insufficient to meet manpower norms and practical needs, with the number of physicians in 2015 (around eight per 10,000 population) being quite low when compared to other countries in Southeast Asia. Healthcare resources should be appropriately distributed to meet needs, but there is currently an imbalanced distribution of human resources and a shortage of manpower in Vietnam. Mountainous and remote areas have severe shortages of healthcare workers, with the number of physicians per population being lower than the national average.
There are currently about 20 universities and schools of health science Vietnam that are distributed along the country and are offering medical training programs. Prior to 2008, medical student quotas for each school year were mainly set by the Ministry of Education and Training and the Ministry of Health. Since 2008, in accordance with Ministry of Health Directive 06/2008/CT-BYT aimed at strengthening the quality of health worker training, medical schools determine on their own the number of students that they wish to admit each year. In addition, Vietnamese government Decree 43/2006/N-CP increased the autonomy and financial responsibility of state agencies. As a result, medical schools have increased the admission of students who pay full tuition and receive no subsidy out of the state budget.
Currently, two programs for generalist training exist in Vietnam: a 6-year program and a 4-year program. The 4-year program was established by the Ministry of Health in response to the shortage of community physicians. Students in both programs are admitted based on their examination scores, direct recruitment without examination, or by signing a contract with the locality where the student agrees to practice in following graduation. Students admitted to the 6-year programs are high school graduates who have passed the National Entrance Examination. Students admitted to the 4-year programs are usually assistant doctors who have passed the medical university’s in-house examination. None of the medical universities currently use interviews to select students for admission.
Each medical university bases its individual curriculum on the framework curricula. The framework curricula for both 6- and 4-year programs have two stages of training. The first stage is general education. It comprises the first 2 years at 6-year programs and the first year at 4-year programs. The second stage is professional education. In this stage, students do clinical rotations in the morning, attend lectures in the afternoon, and spend on average one-night shift per week on overnight call. Individual curricula vary significantly from university to university, with some universities offering general education courses during the professional education stage. The general education stage can be further subdivided into general and basic science courses. The framework curricula stipulate that approximately 25% of general education credits should be devoted to political education. The professional education stage is subdivided into basic and professional medicine courses. Students are assessed by either essay or multiple-choice exams. Clinical case testing is used when students complete hospital rotations. At the completion of their medical training, students must pass their university’s in-house graduation examination. No national examination or independent accreditation examinations exist in Vietnam, thus limiting health officials’ ability to objectively assess the training of recently graduated doctors and of the medical education system as a whole.
There are three tracks of graduate medical education in Vietnam: clinical training, academic training, and residency training. This clinical training track can only take two forms, Specialized Level 1 and Specialized Level 2. Academic training includes Master’s and PhD programs. Residency training started in 1973. As stated by Ministry of Health Decision 19/2006 QD-BYT, residency training is a special form of training young and talented health care workers. Unlike in the many South Est Asian Countries, Resident Physicians are expected to become experts in not only clinical practice but research as well. Residency training is available to a small number of students graduated in the past year, being less than 27 years old, and high examination scores. Residents are given both the Resident Physician degree and a Specialize Level 1 degree upon successful completion of their programs. They also can claim Master’s degree from Ministry of Education and Training. In addition, they are always invited to work by tertiary or national hospitals. However, the medical trainings in Vietnam were still considered extremely costly both in terms of time and money.
Medical education reform to respond to region’s needs and international standards
In recent years, medical education in Vietnam has undergone changes with the support of international donors. For example, the ‘‘Strengthening Medical Skills Training at Eight Universities’’ project supported by the Netherlands’ NUFFIC program from 2004 to 2008, in establishing and developing medical skills training units and new medical skills training curricula. The Dutch government also supported another project aimed at strengthening community-oriented education. A Knowledge, Attitudes, and Skills book was the result of this project, as the basis for a standard curriculum across all medical schools in the country.
In 2006, the Objective Structured Clinical Examination (OSCE) was introduced first time. Its success has led the sixth-year students. Evidence- based learning and problem-based learning have been introduced since 2007. To strengthen the primary care, trainings in Family Medicine was initiated in 2003.
A step forward, very recently, medical schools in Vietnam have led changes in their education models through Health Professionals Education and Training for Health System Reforms project (HPET), approved by the Vietnamese government in late 2013. The project sourced most of its $121 million in coordination with the World Bank, run by Vietnam Ministry of Health. The HPET project consisted of four components has targeted to raise the quality of education and training medical staff and managers in the medical field as well as strengthening the competencies of primary health care at local levels, have been implementing in 6 medical universities of Vietnam including Haiphong University of Medicine and Pharmacy. The initial results are creating new inspirations in targeted medical schools. The schools are working on limiting the number of mandatory course hours devoted to non-medical subjects, such as politics and even the basic sciences. Such time could then be used to teach more contemporary medical topics, such as genetics, molecular medicine, humanities, and mental health. New teaching methods are also being introduced. In addition, the development of a way to objectively assess the quality of medical training in Vietnam such as a national exam of medical graduation is under preparation. Such an exam would allow schools to improve medical education .The medical schools are now training medical doctors of Laos, Cambodia. They are now starting for accreditation of their training programs with ASEAN University Network Quality Assurance. With all these positive changes in Vietnam, we expect to provide quality medical manpower to respond to the regional needs.
About the Author
Dr. Pham Minh Khue is the head of Department of International Relations at Haiphong University of Medicine and Pharmacy and Vice-Dean of the Faculty of Public Health of the university. He graduated his medical doctor degree at Haiphong University of Medicine and Pharmacy, Vietnam, his master’s degree in International Health in University Bordeaux 2 and his PhD in epidemiology at University Paris 6 in France. He is teacher and researcher of Public Health at Haiphong University of Medicine and Pharmacy, since 2008. He was appointed being associate professor and vice-dean of the Faculty of Public Health at Haiphong University of Medicine and Pharmacy since 2015. Dr Pham Minh Khue has worked in epidemiology of infectious diseases, HIV, TB and infectious diseases control for 10 years in Vietnam. He also supervises a number of master and PhD students whose research topics are HIV-related. Since last 5 years, his research focuses on drug use and viral infections. He participated as investigator of several studies on harm reduction, access to opioid substitution therapy in Vietnam.