On November 12, the Government's electronic information portal held a seminar on "Renewing training of human resources in the medical sector".

Instead of medical training for 6 years as currently, according to the draft Decree on specialized training in health that the Ministry of Health is developing and submitting to the Government, after 4 years of training, students Medical will be recognized as a medical bachelor. From there, it will be divided into 2 systems, which are the research system (master, doctor) trained in 2 years and the clinical system (examination and treatment) also trained for 2 years.

Also according to the draft Decree, those who study clinically to become medical doctors, is equivalent to a master's degree, but have not yet practiced. The holder of a medical doctor's degree must continue to take a competency assessment and take part in professional practice for a period of one year before being granted a practice certificate. The research system will be managed and specified by the Ministry of Education and Training.

Why is it appropriate to change and change at this time, what are the shortcomings and limitations of the current training model and if the training model is changed, the content of the training program will have to How does it change?

To answer the above questions, the Government Web Portal held a seminar on "Renovating training of human resources in the medical sector".

Guests participating in the seminar:

 

Prof. Dr. Ta Thanh Van, Rector of Hanoi Medical University

Prof. Dr. Pham Minh Thong, former Head of Diagnostic Imaging Department, Hanoi Medical University, former Deputy Director of Bach Mai Hospital

Prof. Dr. Le Thanh Hai, Director of Central Pediatric Hospital

Mr. Nguyen Minh Loi, Deputy Director of Department of Science, Technology and Training, Ministry of Health

Discussion content:

 

Could you please summarize the main contents and new points in the draft Decree regulating specialized training in the health field of the Ministry of Health?

Mr. Nguyen Minh Loi: In general training, especially training for health human resources, there are 3 training directions: The first is the career training direction, the second is the academic direction, the third is the training direction. create a professional to practice.

In Vietnamese practice, university, master's and doctoral training has been implemented for a long time and is strongly institutionalized through the documents of the Education Law as well as guiding documents. In practice, Vietnam has implemented it since the 1970s, in which it is shown through the practice of internship in Specialization I and II. However, the legalization is not specific yet.

In this regard, through the process of exchange and international integration, implementing the guidelines of the Central Conference 8 session XI issued Resolution No. 29-NQ / TW on fundamental and comprehensive innovation of education. and training to meet the requirements of industrialization and modernization in the context of a socialist-oriented market economy and international integration and the implementation of Resolution No. 20-NQ / TW dated October 25, 2017 on strengthening the protection, care and improvement of the people's health in the new situation, the Law amending and supplementing a number of articles of the Higher Education Law has institutionalized the contents of special training regulations. enemies in the specialized field and assigned to the Government for regulation.

In order to institutionalize specialized training in the health sector, the Government has assigned the Ministry of Health to lead the development of this Decree for promulgation in the field of health human resource training.

The content of the Decree mainly approaches 3 issues: First, clearly affirms training directions in expertise, professional activities in the health sector. The second is to standardize the program to ensure that the competency and qualifications framework meets the requirements of the job position, professional qualifications as well as corresponding to the national qualification framework. Thirdly, the recognition of diplomas and certificates of intensive training is compatible in the system of general qualifications in the civil education structure of Vietnam as well as in international reference.

Please ask the representative of Hanoi Medical University - one of the cradles for training talents in the medical industry of the country, what model is Hanoi Medical University training medical students according to today? 

Prof.Dr. Ta Thanh Van: Hanoi Medical University is like medical universities across the country, currently we are implementing training according to the old, traditional model, which has not changed so far. This model with the specialties General Doctor, Dentist-Facial Doctor, Doctor of Traditional Medicine, Doctor of Public Injecting, we train 6 years. After 6 years, under the Law on Examination and Treatment, those physicians have an 18-month pre-practice clinical practice program and will be granted a practice certificate. Then, will join the social workforce in the medical industry.

Following that, there is a 2 year training system for specialist I and 2 years of training for specialist II. The feature of this model is that between training phases, between training levels is not continuous and requires years of experience, this is a very important issue.

Dear Prof.Dr. Pham Minh Thong, as both a teacher (Head of Diagnostic Imaging Department of Hanoi Medical University), and a manager of a large hospital nationwide, receives human resources from Training Department, please tell us, what are the advantages and disadvantages of the current training and teaching model for the capacity of students after graduation ...?

Prof.Dr. Pham Minh Thong: The old model of training that all medical universities are doing is the one that was used in developed countries a few decades ago and they have stopped this model and moved to a new one. But we still maintain this paradigm, so we need a change.

The advantage of the model is that we can quickly respond to the needs of society. Medical doctor 6 years can graduate and then send to the internship institutions and work. After that, back to school to take the exam, majoring in I; continue to work a few years and take the specialist II exam.

However, the disadvantage of the model is that the learner is not continuous. In fact, in hospitals, 6-year graduate students are still not able to work, mainly grasp theoretical knowledge and do not have specialized knowledge, cannot work immediately, are required to study. continued. Therefore, those who study Specialized II are usually those who are older, usually 50 years or older.

Because of the intermittent training, the quality of doctors is not uniform. Especially, in remote areas, there is often a shortage of doctors, so there is no doctor to go to school. Therefore, there are many doctors at the grassroots level who do not return to study again after graduation, leading to the uneven quality of doctors nationwide and at all levels. This is the weakness of the old model.

It is known that the Central Children's Hospital is implementing an intensive training program for human resources specialized in Pediatrics. How is this program being implemented at the National Children's Hospital?

Prof.Dr. Le Thanh Hai: About the past 10 years, along with the development of the national health system, the children's healthcare system, especially the local system of pediatric and obstetric hospitals. developed a lot. Thus, the need to provide high quality human resources, particularly doctors and nurses of the medical industry, is a great requirement.

In practice, doctors and nurses who graduated from training institutions cannot work, especially independently. Even doctors who are trained in high quality human resources in the industry are resident doctors, immediately after graduating from school, they cannot work immediately or independently. We have to dig about 6 months to a year more proficient to be able to work independently and autonomously.

Stemming from this practical need, the hospital must organize training such as inpatient training. This means that after graduating from universities (6 years), the students wishing to strive to serve in the medical industry are recruited for training. The initial start is to train as a basic pediatrician, formerly known as a pediatric orientation for 6-9 months. After that, they can depend on facilities using manpower. But if you continue to work in a hospital, in medicine, you must study for 3 more years.

We apply advanced countries' inpatient training into hospital training environments, mainly on patient hands-on training, focusing on the practical needs of society. As from the training programs of the universities, adding essential training programs such as primary health care programs, practical knowledge of infection control, implementation of tissue training. new diseases appear to be consistent with training programs.

The second is to incorporate practical training, each student will be tutored by an experienced teacher during the 3 years of study, with a close exchange between students and faculty. If students meet the requirements, they can transfer to a new faculty or new program.

In the first 2 years, they have to pay completely their school fees. But by the 3rd year onwards, those with good academic results will be supported by the hospital to train, even with a temporary salary. By year 3, it is possible to allow students to take entrance exams to university institutions to further study for a master's degree.

Therefore, there are many students graduating from university who have passion, strive and also continue to pursue their careers to become pediatricians and pediatric nurses.

How do you comment on the two new training models that Hanoi Medical University and the National Hospital of Pediatrics are implementing?

Mr. Nguyen Minh Loi: I think that the model implemented by Hanoi Medical University as well as the one being deployed at Bach Mai Hospital or the National Hospital of Pediatrics is essentially the same in that both learners can achieve output standard capacity according to each level and each professional requirement to be able to practice professionally in the medical field.

For example, Bach Mai Hospital or Hanoi Medical University with multidisciplinary training must choose research-oriented majors. A specialized or inpatient intensive training program are programs for each different specialty.

But the nature is the goal for learners to meet the competency standards for each level and the requirements of the expertise to be able to meet the requirements of practice and service in the health system.

As the Chairman of the Rectoral Council of medical universities across the country, how do you propose and comment on a common and unified training model for human resources in the health sector today?

Prof.Dr. Ta Thanh Van: The Rectoral Council of Medical and Pharmaceutical Universities met and discussed the issue. The general opinion of presidents of medical universities in the country is to keep the 6-year training model, a common body. After 6 years, they learn 3 more years. These 3 years could be the family doctor and maybe the preventive medicine doctor, maybe the traditional medicine doctor, but the general life is 6 years.

During those 3 years, in the first year, they will go on an internship and obtain a temporary practice certificate. After finishing 3 years of specialized training, they continue to study in-depth. Specialization will depend on each profession, each specialty such as neurosurgery is 5 years, a specialization in molecular testing biochemistry sometimes only needs 2 years, lasting from 2-3 years depending on each specialty. deep branches.

Therefore, we agree that 6 plus 3 and adding a number x, x can be from 2 to 5. Principals favor this model.

One important issue is that we must train continuously. Continuing training, we produce a highly qualified product to put into the labor market.

Next is to unify the ongoing training process and must be managed by the universities. Even though specialized training, specialized training is the practice of skills in hospitals, but must be managed by universities. This is the law of the world, we must be.

I feel like disturbance can be avoided. We are training 6 years, 3 years in traditional residency is something we do very well. Currently, just strengthening training program innovation and training management in such a time is also very effective and accompanied by specialized training, specialized expertise. The time varies depending on the majors and ongoing training.

In specialized training, it is imperative that doctors have a salary, at present resident doctors are not paid. In the world, after graduating from 6 years of specialized study, students will be paid salary. This salary is paid by the hospital, possibly from the State budget or possibly self-managed by the hospital, but a salary is required.

I act on behalf of the principals of medical universities and give my opinion on the new training model we are planning to implement.

Dear Prof.Dr. Pham Minh Thong, do you suggest any further directions in the issue of training human resources for unified medical profession today?

Prof.Dr. Pham Minh Thong: It is an extremely good job to train unified human resources in the whole medical profession, and there must be a criterion for what school is to be trained at university. Basically, medical schools, medical schools can be trained at university, but postgraduate training must have very clear criteria. Since postgraduate training is practical training, there must be a coordination between universities and practice hospitals.

I had the opportunity to go to France and the US and also worked as an inpatient. Even after I worked, I was paid by the hospital.

Currently, graduate students have no salary, in the past they did. I got a salary to study a resident doctor like we were in our time, but later I got cut because I didn't have that fund. Currently hospitals usually have a certain amount of inpatient spending. It is the hospital's expenditure, not the salary fund of the State or the Ministry of Health for the inpatients. We need to research and unify nationwide, must have a certain salary fund, deduct some fund to study.

Dear Prof.Dr. Le Thanh Hai, what is your assessment as well as your share of the opinion that boarding students need to be paid and will be paid by the hospital?

Prof.Dr. Le Thanh Hai: I very much agree with the opinions of Professor. Van and GS. Information. However, I think it is called a pediatrician but it is actually a pediatric general practitioner. That means what specialty adults have, children have specialties there. Geriatric is not. Children have different ages, weights, physiological and physical characteristics, so training a pediatric specialist is very meticulous. My point of view is that after graduating from school for 6 years, if you want to work, you must invest. The first is to train for 3 years to be a general pediatrician, and then to specialize in specialization, it takes 3 to 5 years or more to become a specialist in medicine and of course because of that. in accordance with the guidelines and policies of the Party and State only.

Medical industry is a very special industry, with a special enrollment method, special training, special treatment, there are very special enrollment stages, training is also very meticulous but no compensation is called. is special. Mostly, when the resident doctors go back to schools, hospitals, the hospital has to pay a certain amount because they are a high quality human resource later on for the hospital, for the country. So surely by a certain source, it is right to pay the salary for boarding school children.

Mr. Nguyen Minh Loi, what are your views on this issue and whether the draft decree that the Ministry of Health is drafting will overcome this point as well as the shortcomings that the three guests have just share?

Mr. Nguyen Minh Loi: As we initially stated, the Decree on specialized training in the health sector is the Ministry of Health assigned tasks and guidance by the Government to institutionalize the provisions of the Law on amendments and supplements. some articles of the Higher Education Law. In the content of this Decree, there are several points that we would like to emphasize.

The first is like GS. Van also stated that the Board of Principals has also determined that in order to be granted a medical doctor degree, there must be 6 years of training. However, the spirit of the Decree is divided into 2 phases, after 4 years, meeting the output standards equivalent to level 6 will be recognized as a medical bachelor, so that if any If there is a need to join the labor market, join the jobs in society, they can participate immediately.

If you continue to focus on professional practice, you will study for 2 more years to be recognized and granted medical doctor degree and medical doctor degree, then according to the international trend is to have a national exam. After the national exam, being recognized as a doctor and participating in the practice of care as the current Law on Examination and Treatment stipulates that it is 18 months.

If you want to study a specialty, you must have a practice certificate and study a specialization, which will solve many problems: Firstly, when you study a specialty, you already have a practicing certificate for the national exam. These people have met the national common standard of being eligible to participate in the professional activity. The second problem is that when there is a national exam and a practicing certificate, when going to a specialty school and, as the guests said, specialist learners are participants in real professional activities. In medical facilities, if people have qualifications and confirmed their job positions, then there will be a basis to consider the regimes and policies on remuneration, allowances and wages. be suitable.

Secondly, in the decree also clearly defined, specialized training is required to have medical facilities, so we in the Decree also designed how as Professor Van said training In order to grant a degree, it is mandatory to have a training institution but it cannot be separated from hospitals, medical facilities and we design in the Decree how to standardize to any institution, university Which hospital is eligible to receive training in specialized programs.

For example, the National Hospital of Pediatrics, which is the leading specialist in pediatrics, is receiving intensive training programs in the field of pediatrics and of course there will be a coordinated participation from training institutions. For example, in Hanoi, the Hanoi Medical University, this Decree will solve many problems. Examples include standardization of qualifications, standardization of outcomes, standardization of training institutions and also resolution of regimes and policies for learners in intensive training to operate professionally in the medical field. health.

Dear Prof.Dr. Ta Thanh Van, it is known that Hanoi Medical University is renewing its training model for a number of disciplines in the past 2 years, such as the program of molar teeth and nursing. Please share how this model of the school was made?

Prof.Dr. Ta Thanh Van: Medical University in Hanoi we are in a comprehensive renovation roadmap in undergraduate and graduate education. As for university training, we have implemented a renewal program this year which is the second year for 2 subjects: dentists and nurses. For us, teaching instead of the old form is teaching in classes, at the end of the first year, the second year, and the third year, the training is now problematic, that is, the problems of the first year will is passed through to the 2nd and 3rd year, divided into phases.

This year is the first year that Hanoi Medical University implements a program of renewing the training of general practitioners and similarly, we are divided into 3 phases: The first is the first year of problem-based training. combined with teaching facilities. Phase 2 will have the coordination between basic and clinical medicine and phase 3 that is ultimately devoted entirely to clinical.

Over the past 6 or 7 years, Hanoi Medical University has invested in a lot of facilities and it is expected that when completing a training course, a general practitioner under the new program, the school will have to invest about nearly 100 billion in facilities, teaching materials, program equipment ...

Dear Prof.Dr. Le Thanh Hai, what do your views and comments about Van's share and the training model of the Central Pediatric Hospital have similarities with the training model of Hanoi Medical University Hospital? is not?

Prof.Dr. Le Thanh Hai: For the past few years, Truong Nuong Children's Hospital has trained about 100 so-called resident doctors. The trend of basic content is very similar to Hanoi Medical University. However, as I said, based on practical needs, there are additional learning content to suit the practice. So during the 3-year study period, they must have 2 months of fieldwork with the community to increase their knowledge.

Second, in terms of infection control, this is a very practical thing to strongly deploy in facilities with hospital beds.

Thirdly, problems of occupational communication and call-to-treatment model such as Prof. Van shared, the hospital has also deployed a relatively long time based on programs that we learned from abroad.

Dear Prof.Dr. Pham Minh Thong, from the shortcomings that you have just shared from the beginning of the program, in your opinion, if applying the new model of training human resources in the medical profession, what current limitations will be overcome?

Prof.Dr. Pham Minh Thong: We have also applied the old model for many years and reformed in some places. In particular, Hanoi Medical University has renovated the teaching of the block solving module and thus comprehensively innovates the teaching method and the output will change, the output quality will be much higher. with before.

However, it is very important now that we must renew graduate training so that all doctors who graduate will have to graduate, not go to work immediately, will have to study for a certificate. After that, they have to study after graduate school, at least 3 years, more than 5 years, 7 years before they can go to practice.

Sir, it is true that the draft Decree that the Ministry of Health is drafting has many very positive points compared to the present. However, according to the draft, after 4 years of study, the graduate student will be a medical bachelor, but according to the current regulations, there is no job position in the medical system. What is your opinion on this matter?

Mr. Nguyen Minh Loi: Actually, as far as I know, the training models in the world as well as even in Vietnam, the training categories after graduating from university are not always associated with a specific job position in the structure of the labor market. However, for a medical bachelor, if after 4 years of graduation, the student is granted a medical bachelor's degree, if anyone wants to enter the labor market, there are still a number of job positions. make it possible to participate in the health system.

And we also determined that the majority of people who have approached and trained in medicine will be towards practicing doctors, so most of them will continue to study from 6 years to become doctors. At the same time we have calculated the next step as GS. Thong also just mentioned how in the coming time, when medical training reform, it must be synchronized from university training to post-graduate training. Therefore, after 6 years, students with practicing certificates, the majority will participate in the direction of specialized training to approach the human structure needs of the health system according to each specialty to ensure the quality of care. medical care.

Dear Prof.Dr. Ta Thanh Van, if a new training model is officially applied across the country, we will definitely have to change the curriculum as well as the teaching content. So the school has prepared in advance as well as anticipating these difficulties like?

Prof.Dr. Ta Thanh Van: As I just presented, Hanoi Medical University in conjunction with a number of other universities, such as the University of Medicine and Pharmacy, Ho Chi Minh City, is implementing a new training program on the subject. By block and phased, from 6 years, it will be divided into 3 phases and fundamentally change the program, content method as well as facilities.

Indeed this is a problem, because in my opinion the first important thing is that we must decide the model as soon as possible. 4 plus 2 plus how many, it should come out, just like when we build a house, we have to design first instead of building the bedrooms, living room, renovating to build the overall design of the house Not yet. Then I think the most important thing now is we have to come up with the model of medical doctor training for the whole system.

On the basis of that model, on the basis of such a house that has been designed, we go into building the bedroom design, building the design of the living room, building what is related and the function in that frame.

We still have to innovate, cannot fail to renew in the old framework. Now, when we issue a new framework, there must be some adjustments. And this is a very costly innovation that requires determination of each staff member of the whole school and this innovation leads to a change in the organizational management system in the school.

Dear Prof.Dr. Le Thanh Hai, if this new model is applied, will the National Hospital of Pediatrics face any difficulties in the training process as well as renew its training model? ?

Prof.Dr. Le Thanh Hai: Decree 111 of the Government on innovation, coordinating innovation in training is very necessary and now, the hospital has also started and applied, of course there will be a number of difficulties. .

The first is the increasing demand for training, meanwhile, the teaching staff has been trained in a new way with a new method that has not been carefully trained and the third is the faculty of the school as well as the patient side. In addition to participating in training, hospitals must also participate in examination and treatment for patients. Therefore, the time required is multiplied by many sacrifices to meet the training needs of students, students and people.

Viewpoints of Prof.Dr. Pham Minh Thong about this issue like?

Prof.Dr. Pham Minh Thong: I also agree with Prof. Van's opinion, that is, training innovation is extremely important and the Medical University has done a great job of innovation and is currently doing and will have to continue to do so. new in training. It is very important as well as GS. Hai said that there must be a very close coordination between universities and practice hospitals, all major hospitals in Hanoi or big cities will have to be practice hospitals of the schools. University. Because I will utilize the resources of the hospitals as well but not every doctor can participate in the training. It is imperative to train doctors in hospitals who can do the training and be certified, not everyone can train.

In addition, the practice hospitals of the entire system must also be strong. Currently, the universities are not just big cities in Hanoi or Saigon or Hue city. Provincial hospitals must also quickly be built into large hospitals for practice and so will be like France and the US, that is, the medical system is not only 3, 4 big cities but many big cities.

Dear Prof.Dr. Le Thanh Hai, GS. Pham Minh Thong has just mentioned a problem that is the practice hospital, it can be said that the more time students can practice clinically, the better the output quality. So, in your opinion, what are the advantages or disadvantages of the coordination in the curriculum and assessment of students' competencies and results between training institutions and hospitals?

Prof. Dr. Le Thanh Hai: Currently, in the provisions of the Decree, there must be coordination between practice facilities, ie practice hospitals and training institutions, ie universities with students. to learn, it is necessary to build a uniform assessment program for students.

And now, at the hospital, when the trainees come to train, all the faculties later on themselves have become the so-called research subjects. Every passing period like that, there must be assessment, must be given points including theory or practice as well as on the required behaviors of a student.

Mr. Nguyen Minh Loi, in order to innovate, it is necessary to invest in human and financial resources. So does the Ministry of Health have a solution to this problem or not?

Mr. Nguyen Minh Loi: In fact, it can be said that there is no need for an innovation policy, in my opinion, during the operation of the training, even the training institutions themselves often need to innovate. quality.

The Ministry of Health as well as the Government has also had many major undertakings and policies. Firstly, in 2017, the Government issued Decree 111 which, as stated by the guests, affirms the role of closely combining training institutions and medical institutions in specialized training, especially. Practice for health workers.

The second problem is that when changing, renewing programs, or renewing training methods, there is definitely a need for investment resources in human and physical facilities. Firstly, in terms of infrastructure, financial investment, the Ministry of Health has also sought support from projects of ADB, World Bank and other projects to support training institutions. Secondly, we think right from the training institutions themselves, for example Prof. Van also stated, the training institutions have been proactive in realizing that when innovating, it is necessary to invest in resources. force, finance, people.

The third issue is preparing the team, innovating so that there is synchronization between the faculty of the school as well as the teaching staff of the hospital, when participating in teaching to approach the same method, Innovative methods to help the quality of training for health workers change.

Dear Prof.Dr. Le Thanh Hai, what is your opinion on the financial solutions that Mr. Nguyen Minh Loi has just shared?

Prof. Dr. Le Thanh Hai: For specific policies, the Government and the Ministry of Health will have regulations. However, I only framed in a hospital unit to apply all possible sources of revenue, legitimate sources of income to focus on the training.

When I conceive that practitioners, especially resident doctors with inpatient treatment come to work in the hospital, I also see them as a certain level of workforce, so the hospital must also have. responsibility to share revenue sources to pay salaries and costs of study for that broad audience.

Dear Prof.Dr. Nguyen Minh Thong, how do you share about financial issues, sir?

Prof.Dr. Nguyen Minh Thong: The financial issue is a very complicated issue, very difficult for the hospital as well as for the school. Because at present, the income from graduate training is very low and that income is not enough to pay, not even enough to pay for teachers and facilities. Therefore, it is impossible to have money to pay for trainees to practice hospitals and in principle, graduate students who go to internships must go to work in the hospital, that is, when they have an practicing certificate. After that, people go to work and study at the same time

Currently, Bach Mai Hospital has also set aside a certain amount to pay for all resident doctors, even arranging houses and boarding rooms. However, the number of trainees could not be satisfied due to too much. For countries, the Government allocates a training fund for postgraduate medicine and that fund belongs to the Government to the Ministry of Health, then assigns to institutions with certain training norms.

We also need the support of hospitals or training facilities, but if we rely entirely on hospitals, I am afraid I will not be able to meet all the requirements.

Dear Prof.Dr. Ta Thanh Van, from the initial financial sharing of Hanoi Medical University and listening to the other 3 guests, do you want to add or contribute any more comments?

Prof. Dr. Ta Thanh Van: Perhaps the guests also talked a lot about Decree 111 on hospital integration, in reality, some hospitals now require schools to pay for the number of students going to hospital internships. I also would like to report to the guests that in the current tuition fees, there is no clear payment component, while the school is autonomous, we will have to calculate correctly and fully in the cost of training.

At that time, the school will also be willing to pay the fees for hospitals, my point is postgraduate training like GS. Thong and the professors told them to be paid, and for graduate training, they must pay. I also recently accompanied the Minister's delegation to work with Harvard Medical University and also informed the Minister that the tuition fee for a year here is 80,000 USD, while the 6-year tuition of Ha Ha Medical University. Internal 105,000,000 Vietnamese Dong, ie less than 5,000 USD in 6 years. However, $ 80,000 / year is only enough to cover 20% of training costs, while another 80% is due to businesses, school funds, and donors.

Looking at those numbers, we see that it is very expensive to train a doctor abroad, while it is much more economical to train a doctor but still has a certain level and degree. This we must be proud of.

Therefore, when innovating, I think we have to finance the new training model so that our determination must be accompanied by financial support to be able to implement it, otherwise it is very difficult.

Thank you very much for your guests!

 

Source: //media.chinhphu.vn/video/doi-moi-dao-tao-nhan-luc-nganh-y-12930