Vietnam - Doctor training quality on the decline, experts warn

Training for quantity, lacking facilities for studying and practicing, and having no standards in enrollment and graduation are all factors that have undermined the quality of doctors’ training in Vietnam, many experts say.

Dr T., head of the Cardiovascular Department of a public hospital in HCMC said, “I really don’t know how doctors have been trained, but I find many of them do not know many things that, as doctors, they should know.”

Huynh Thi Thanh Thuy, deputy director of Tu Du Obstetrics Hospital, said, “All young doctors who have just graduated must be re-trained for at least one year so that they can work. Even young doctors do not know how to use a speculum to examine a pregnant woman.”

Talking with Sai Gon Tiep Thi Newspaper, Dr Thai Hong Ha, head of the training management department of HCMC Pham Ngoc Thach Medicine University, said the school trained only 100 students in the first years of operation, but recently, the school has been assigned to train 230, then 420 and finally 620 this year.

“I heard that next year we will have to train 800 students. The training target has soared as the HCMC People’s Committee has set a target that the city will have 15 doctors per 10,000 inhabitants in 2015 to meet the public’s demand for healthcare services.”

Don’t focus on quantity

Dr Duong Quang Trung, former director of the HCMC Center for Health Professionals Training and Development (now Pham Ngoc Thach Medicine University), said, “It is unadvisable to train doctors with a way of thinking that values quantity above quality.

“Previously, the university trained 100 – 130 doctors per course, and we then thought if the number was increased, the training quality would be affected. Today, the figure is five times higher while the teaching and studying facilities have not improved, how can training quality be maintained or enhanced?

Such a quantitative increase resulted from the pressure of the target of 15 doctors per 10,000 inhabitants by 2015, he said.

“It will be excessive to increase the figure to 800-1,000. We must pay more attention to the quality of graduates, or to the building of graduation standards.”

Dr Pham Le An, at the HCMC University of Medicine and Pharmacy, said, “Besides setting out graduation standards, medicine universities must also organize quality audits, which are being done at advanced universities around the world, to maintain training quality.”

Practicing for form’s sake

The number of students has been increased, but the facilities for teaching and studying remain unchanged. “Our amphitheatre is designed for 200 students, but it now has to hold twice as many,” Q., a second-year student at Pham Ngoc Thach Medicine University, said.

Not only lacking seats for students, many schools do not have enough places where students can practice what they have studied.

H.S., a sixth-year student at the university, said, “Many of us practiced for form’s sake, since there were so many students practicing at the same time, while patients often did not want to be asked about their conditions or to be examined by students. We often just look at patients instead of examining them.”

Dr Ha said the student overloading has caused difficulties for the school in training. The school has to borrow space at other schools to have enough classes for students, and has to take students to hospitals at district levels for practice.

Inadequate enrolment

Another problem besides difficulties in facilities is the lack of criteria for enrollment, along with poor training standards, that have led to a poor quality of graduates from medicine schools.

A lecturer at the Pham Ngoc Thach Medicine University said a survey shows that many students choose to learn medicine to follow the studying tradition or their relatives’ or friends’ suggestions, or to make a lot of money or to be famous.

Dr. Do Hong Ngoc, chairwoman of behavioral science and health education department at the university, said admission that is based on scores students received in entrance exams does not help assess students comprehensively.

“Such an exam consists of three subjects: math, chemistry and biology. But in my opinion, students should be examined in foreign languages and be required to write an essay on “why they have opted to study medicine”. Moreover, they should also be interviewed to help ensure that they can become good doctors in the future.”

Such an admission method, which helps select deserving candidates, has been applied in many developed countries, but many universities in Vietnam have yet, or are not even allowed, to apply such a method.

In brief, there should be a standard for enrollment at medicine schools, said Dr. Nguyen Minh Tri Vien, from the HCMC Heart Institute.

No graduation standards

Moreover, a standard for graduates of medicine schools has yet to be established in many schools.

Dr Ha said Pham Ngoc Thach Medicine University adopted graduation standards for students just two years ago. Meanwhile, the HCMC Medicine and Pharmacy University said it has just sent a group of managers abroad to survey standards of graduates at many foreign universities of medicine and pharmacy.

When asked whether there is a big gap between what medicine students have been taught at school and what they are supposed to master at work after they graduate, Dr Ha said there should be a study about this issue to form a response, but there has been no such study.

“Such a study is necessary, since if there is such a gap, medicine universities must take necessary measures to ensure their graduates can meet the actual demands of society.”

Another issue is the income of lecturers. A doctor with a PhD degree at the HCMC Medicine and Pharmacy University said his monthly income is just VND3 million (US$144), whereas if he worked for a hospital he could earn twice as much.

Because of their low income, many teachers have had to work as presenters for pharmaceutical firms. “I can earn VND5-10 million ($480) for every presentation or report to compensate for low income at our school. We cannot live only on our salary,” a cardiovascular teacher said.

Solution remains on paper

At a national conference in 2005, Dr Nguyen The Dung, then director of HCMC Health Department, suggested the setting up of an “Institute of medical schools” in Cu Chi district, as a breakthrough to resolves problems – such as lack of space for training and practicing, having no ‘input’ and ‘output’ standards – and create conditions for the sustainable development of the health sector.

The institute is expected to cover 100 hectares, including treatment areas consisting of many hospitals with 3,000 beds in total, training areas, dormitories for students and experts, resorts, healthcare refreshment centers, and a high-tech research center.

However, after 7 years with three different directors of the city health department, this project remains only on paper.

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