Continuing Medical Education Programs for Primary Care Physicians in Remote Areas of Vietnam: A Needs Assessment | BMC Medical Education



Primary Health Care (PHC) is the first point of contact of the individual, families and societies in health systems [1, 2]. In many low- and middle-income countries, primary health care providers provide a range of services, including identification and monitoring of prevalent health problems, maternal and child health care, family planning, immunization , treatment of common illnesses, emergency health services and provision of essential drugs. [1]. Providers at primary health care facilities also provide regular and extensive clinical management, including diagnosis and referral to specialist service providers and hospitals. [3]. Despite the large contribution of primary health care providers, insufficient attention has been given to ensuring continuous training to improve their knowledge, skills and capacities, especially in remote, hard-to-reach and mountainous areas. low- and middle-income countries, including Vietnam. .

In Vietnam, health care is provided by a combination of public and private health systems. The public system plays an important role in preventive and curative health care services for the population, through hospitals and specialized tertiary health care professionals as well as PHC services at the community level. [4]. Primary health services are managed by Communal Health Posts (CHS), which have been considered the foundation of the national health system and play a very important role in the implementation of national health programs at the community level. CHS provide very basic health care services as well as initial diagnosis, treatment and referral to public hospitals [4]. Each CHS is equipped with a primary care doctor (PCP) as well as a midwife, a nurse, a traditional medicine assistant doctor or a pharmacist to serve an average population of 8,000 people. in its catchment area. Currently, more than 11,000 CHS are operating in Vietnam, spread across the 63 provinces located in the six major geographical regions of the country. [5].

In Vietnam, the training program for doctors includes six years of university studies. After graduating from college, physicians who work in large hospitals should also have 3 years of residency training or a 2-year master’s degree program. In addition, doctors working in a large hospital constantly follow several Continuing Medical Education (CME) courses and have the opportunity to participate in seminars and different scientific activities. However, CHS doctors were recruited right after their six years of study and they do not have the opportunity to obtain further training or participate in a CME, except for a few targeted national training programs, for example training on HIV/AIDS. On the other hand, it is very difficult to organize CME programs for communal doctors, because a CHS usually has only five medical staff, of which only one person is a doctor in charge of emergencies and medical examinations and care for the whole community. Therefore, the professional knowledge of communal doctors comes mainly from 6 years of university studies, professional experience and self-reading.

Despite a well-structured health care system at the community level, the quality of PHC services provided by CHS remains a concern [6]. The quality of health services provided by less qualified health personnel in CHSs has been evident for several decades, mainly due to declining public funding for human resource development [7]. The quality of health personnel in CHS in the diagnosis and management of certain common diseases and emergencies is limited due to a lack of professional knowledge, ability to assess the situation of patients and skills in clinical practice [8]. A previous study identified a range of both supply and demand-side factors associated with the quality of health services in CHSs in Vietnam, including contextual factors such as limitations in drug availability. and other clinical resources, the geographical locations (mountainous and remote areas) that create the difficulties in accessing health care and the limited support of skilled manpower are also very important to consider when planning. evaluation of the quality of health services [6].

To address these challenges, the Vietnamese government has undertaken a Master Plan for Health Workforce Development from 2012 to 2020, which has defined comprehensive measures focused on increasing the number of health workers and improving the quality care through training and education programs. [9]. The master plan also paid particular attention to building capacity in human resource management and staff retention in remote and mountainous areas, which led to an increase in the number of doctors per 1,000 inhabitants. [10] and more than 80% of CHS care providers have received at least one continuing education in the last two years [11]. Despite these findings, numerous reports indicate that existing human resource development training and approaches for CHS in Vietnam are not adequate, highlighting the need for targeted training. [12,13,14]. Therefore, the National Health Workforce Development Master Plan has been renewed to cover the next 10-year period (2020-2030) [10]. The master plan foresees that recurrent training including short courses on day-to-day clinical management and undergraduate and postgraduate level training focused on primary health care can enable CHS health care providers to be upgraded. day with advanced knowledge that would enhance their skills and abilities [10].

To achieve the goals of the Health Workforce Development Master Plan, the Vietnamese Ministry of Health and Hanoi Medical University have developed a training program for doctors. As part of this training program, a pre-test questionnaire was carried out as a knowledge assessment tool. This article reports the results of this pre-training assessment and aims to measure the knowledge of Vietnamese doctors regarding the correct medical responses to general emergencies. Findings are discussed in the context of identifying the most important training needs of CHS physicians in these topical areas of primary care, as well as the options and modalities that can be used to implement such training. as part of continuing medical education (CME) programs. across the country that are part of the national health workforce development plan.

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