Continuing Medical Education in Vietnam:
New Legislation and New Roles for Medical
TON VAN DER VELDEN, MD, MPH; HUNG NGUYEN VAN, MD, PHD; HUY NGUYEN VU QUOC, MD, PHD, MIAC;
HUU NGO VAN, MD, MPH; ROBERT B. BARON, MD, MS
Driven by health care reform and the advent of the private sector in the late 1980s, and by commitments made to
the Association of Southeast Asian Nations (ASEAN), Vietnam is faced with a need to increase the regulation and
training of its health care professionals. Previously, a diploma from an accredited health professional school was
sufficient to practice for a lifetime. Legislation has recently been passed that will institute a licensing system, will
require continuing medical education (CME) to maintain the license, and will probably place a large burden on the
health professional schools and training institutes to provide CME. Supported by international nongovernmental
organizations and foreign universities, the medical universities in Vietnam are responding and are preparing for
their new and expanded role.
Key Words: Vietnam, continuing medical education, jurisprudence, education, medical, undergraduate, nursing,
diploma programs, universities
Vietnam: A Rapidly Changing Environment
Until recently it has been one of the world’s poorest coun-
tries, but Vietnam was granted World Trade Organization
membership in January 2007, and by late 2009 the Viet-
namese economy was among the fastest growing in the
world.1This success is widely attributed to the reforms un-
der the Doi Moi policy introduced in 1986, which launched
a move away from central planning and collectivist agricul-
ture toward a market economy and private ownership.2
Health-sector reforms were an integral part of Doi Moi.
They led to extensive changes in health care delivery, ac-
cess, financing, and utilization.3,4Among the changes was
the legalization of the private medical sector starting in 1989,
leading to a public0private mix of care. As a result, health
care is becoming increasingly driven by private, for-profit
incentives and is now estimated to consume 70% of all health
spending.5The private sector has proliferated, with over
35,000 registered private practices now operating in Viet-
nam.6The actual number of private practices may be much
higher. A 2005 community-based study found that less than
20% of surveyed private providers had gone through the
formal registration procedure required for opening a private
More than 96% of communes ~the grassroots level of the
administrative system! throughout Vietnam have a private
medical practitioner providing services, and it is estimated
that the private sector provides up to 60% of outpatient ser-
vices nationally.8A community-based study showed that at
least 11% of practitioners in the private sector surveyed were
not trained health professionals.7The same study found sta-
tistically significant lower-quality performance in the pri-
vate sector compared to the public sector in such common
tasks as identifying proper treatment for treating a child with
acute respiratory infection, and in providing correct advice
to the mother of a child with diarrhea without fever. This
signals a need for more and closer regulation.
The United States, United Kingdom, Canada, and Aus-
tralia have had physician licensing and specialty accredi-
tation for many years. In many European countries licensing
of physicians did not start until the early 1990s and the
process is still under development. Specific requirements
and the implementing bodies vary greatly between
Disclosures: The authors report none.
Dr. van der Velden: Country Representative, Pathfinder International Viet-
nam; Dr. Nguyen Van: Senior Lecturer and Chair of the Department of
Pharmacy, Hai Phong Medical University; Dr. Nguyen Vu Quoc: Associate
Professor of Obstetrics and Gynecology, Hue College of Medicine and
Pharmacy; Dr. Ngo Van: Program Manager, Pathfinder International Viet-
nam; Dr. Baron: Professor and Associate Dean for Graduate and Continu-
ing Medical Education, University of California, San Francisco.
Correspondence: Ton van der Velden, Pathfinder International Vietnam, 9
Galen Street, Suite 217, Watertown, MA 02472; e-mail: tvandervelden@
© 2010 The Alliance for Continuing Medical Education, the Society for
Academic Continuing Medical Education, and the Council on CME,
Association for Hospital Medical Education. • Published online in Wiley
InterScience ~www.interscience.wiley.com!. DOI: 10.10020chp.20068
JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, 30(2):144–148, 2010
In SoutheastAsia, licensing and relicensing requirements
are diverse. Some countries have stringent licensing and re-
continuing medical education ~CME! for renewal of its prac-
tice certificate for physicians since 2005.11Objective struc-
the Medical Licensing Examination in Korea in 2010.12In
contrast, Vietnam, Cambodia, and Laos do not yet require
licensing for health professionals. Physicians, nurses, mid-
wives, and other health care workers need only a diploma
from an accredited school to practice for the rest of their life.
In Vietnam this is about to change: In 2006 the Govern-
licenses by June 2009 within ASEAN countries.13This re-
quires Vietnam to institute a licensing system.
In 2006, there was no requirement to obtain CME for any
health professional and national systems for CME were and
are underdeveloped and underfunded.14The public-sector
budget allows for training of approximately 0.7% of the
public-sector professional staff in any given year, but even
this amount is often not completely utilized.15National train-
ing centers are severely overloaded and lack sufficient num-
bers of qualified trainers and necessary facilities to support
the training needs of an estimated 300000 health care work-
ers.14Overall standards of training are considered poor, with
few qualified staff, and little support for staff to participate
Constraints for CME inVietnam’s emerging private health
care sector are even more serious than those in the public
sector. Given the Ministry of Health’s ~MOH! difficulties in
reaching its own staff with in-service training, it cannot be
expected that a publicly managed CME system for private-
sector providers will be comprehensive enough to cover all
needs or to alert health care providers about training activ-
ities. Additional capacity to provide continuing education
for both public- and private-sector health professionals will
Current Preservice Training Capacity
Vietnam has 10 medical universities providing undergrad-
uate and postgraduate training for medical students and other
health professional students. See TABLE 1 for allopathic
medical schools. For medical doctors there are 2 curricula,
a 6-year curriculum and a 4-year curriculum. See TABLE 2.
In addition, Vietnam has 14 universities that provide 4-year
bachelor of nursing degrees; 30 junior colleges in 30 prov-
inces that provide 3-year training for nurses, midwives, med-
ical technicians, and laboratory technicians; and 35 secondary
medical schools in 35 provinces that train secondary and
elementary medical workers in 2- and 3-year curricula.
Medical Education Innovation in Vietnam
Eight of the universities, in Hanoi, Hue, Ho Chi Minh City,
Can Tho, Thai Nguyen, Hai Phong, Thai Binh, and Tay
Nguyen provinces, the MOH, and the Ministry of Educa-
tion and Training, in collaboration with a number of in-
ternational nongovernmental organizations ~NGOs! and
donors, have been working for over a decade to improve
the quality of medical education in Vietnam.16–18One of
these is Pathfinder International, an American NGO. In-
ternational partners in Pathfinder’s project include The
Center for Reproductive Health Research and Policy at
the University of California, San Francisco ~UCSF!, and
Jhpiego ~formerly the Johns Hopkins Program for Inter-
national Education in Gynecology and Obstetrics!. In this
project the 8 Vietnamese universities are assisted in im-
proving their undergraduate curricula in reproductive health,
in strengthening faculty classroom and clinical teaching
skills, in increasing the number of affiliated hospitals to
provide students with more clinical opportunities, in stan-
dardizing the way clinical teachers perform basic clinical
skills, in adding clinical skills examinations to student as-
sessment,18and in introducing evidence-based-medicine and
In 2006, all deans and vice deans of the 8 universities
~the Working Group! discussed the need for CME in Viet-
nam and the role the universities could play in providing
CME. One of the universities was supported in writing a
position paper on behalf of all 8 universities to the MOH
strongly advocating for obligatory CME.
The universities already provide occasional training
courses for public-sector medical doctors and other health
professionals. These are typically conducted by different
departments or under control of national programs. Al-
though they are not considered CME, they could provide
a basis for the development of CME in Vietnam.
New Legislation on CME
Recognizing the need for a licensing system and other pol-
icy reform in the health care sector, in November 2009 the
TABLE 1. University Training Institutions for Health Work Force
by Region, 200923
NortheastThay Nguyen Medical University
Red River DeltaHanoi Medical University
Hai Phong Medical University
Thai Binh Medical University
Military Medical Academy
North Central Coast Hue Medical and Pharmaceutical University
South Central CoastMedical Faculty of Da Nang University
Central HighlandsMedical Faculty of Tay Nguyen University
SoutheastHo Chi Minh City Medical and Pharmaceutical
Pham Ngoc Thach Medical University
Mekong Delta Can Tho Medical and Pharmaceutical University
Continuing Medical Education in Vietnam
JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS—30(2), 2010145
National Assembly of Vietnam passed the Law on Exami-
nation and Treatment ~LET! that calls for 1-time revocable
licenses to be issued to health care providers ~physicians,
when the LET will take effect.19The LET includes a pro-
vision that those who do not have the required CME for 2
years will have their license revoked. The LET does not
specify the detailed requirements for number of hours or
types of CME or when required CME begins, nor does it
specify which institutes will be accredited CME providers.
These provisions await the detailed guidelines and decrees
by the MOH that are currently being drafted.
In anticipation of the new law, and coincident with uni-
versity advocacy efforts, the Department of Science and
Training in the MOH in May 2008 issued Circular 7, which
recommends CME ~at 20 h per year!.20It provides for blan-
ket accreditation to all universities, medical colleges, and
secondary medical schools ~nurse, midwife, and assistant
doctor training institutes! as CME providers. It is likely that
these institutes will be accredited CME providers under the
LET. This will put a huge burden on these schools, which
will therefore need to strengthen their capacity in providing
University Responses to New Legislation
Strengthening CME capacity will require each university to
develop specific policies and the administrative structures
to support these policies. In addition, faculty and adminis-
trative staff will need to develop new skills and adapt to
changes in workload.
In early December 2008, Pathfinder International and fac-
ulty and staff from UCSF facilitated a roundtable discussion
with the Working Group on key priorities in medical edu-
cation reform, including CME. The seminar was an open
forum through which leaders of the 8 medical schools could
and discuss, among other things, the role of medical educa-
tion institutions in providing CME.At the seminar, all 8 uni-
versities concluded they needed to prepare the infrastructure
tures to respond to an expanded role in providing CME.
After 6 months, a follow-up workshop with the same part-
ners was organized. The workshop discussed the current sta-
tus of CME in Vietnam and more detailed descriptions of
how CME might be organized in medical schools. Topics
such as defining practice gaps and needs assessment, prin-
ciples of adult learning and learning strategies, outcomes
measurement, conflict of interest, and how to establish a
CME department were discussed. Most notably, 2 univer-
sities reported that they had started the formation of CME
centers, both placed administratively directly under the dean
of the medical school. Both CME centers had initiated CME
Hai Phong Medical University is a large university in the
northeast part of the country. Although it had already pro-
vided a significant volume of continuing education, these
short training courses were previously coordinated by dif-
ferent departments, under different leadership, without stan-
dard criteria for design, provision, follow-up, and evaluation
of training. In anticipation of the increasing demand, the
university recognized the need for a specialized administra-
tive structure to organize, standardize, and coordinate the
CME. Therefore, a CME center was established, directly
reporting to the dean board of Hai Phong Medical Univer-
sity. This center is expected to play a key role in coordinat-
ing and implementing all CME activities at the university.
To date the center has coordinated 2 distance-learning CME
TABLE 2. Description of the 6- and 4-Year Medical School Curricula
There are 2 medical curricula in Vietnam—a 6-y and a 4-y. Generally, for the 6-y program, students enter medical school directly after
high school graduation, at approximately 18 y old. High school graduates have to pass the national entrance examination for enrollment.
National entrance examination passing grades for students from remote and mountainous areas, where a severe health care worker
shortage exists, are lower. In addition, students from remote and mountainous areas ~all from ethnic minorities! can be nominated by
their Provincial People Committee, and enter medical education without entrance exams.24
The first 2 y of study include biology, histology, anatomy, physiology, biochemistry, and foreign languages ~either English, French, or
The third year of study includes pharmacology, pathology, parasitology, microbiology, public health, biostatistics, and forensic
medicine. During this year also students start acquiring clinical experience.
Year 4 includes internal medicine, surgery, pediatrics, and obstetrics and gynecology. They also do 8–10 wk of rotations in these
subjects. In year 5 clinical disciplines such as infectious disease, tuberculosis, radiology, anesthesia, otolaryngology, ophthalmology,
psychiatry, dermatology, and traditional medicine are covered. Internships of 2–4 wk in these subjects are included.
The sixth year is almost entirely used for internships and clinical lectures. Internships include a minimum of 10 mo of rotations
including 8–10-wk rotations each in internal medicine, gynecology and obstetrics, general surgery, and pediatrics. The internship
program is largely a hospital-based experience covering a spectrum of medical problems. Students have to take final exams for these
4 subjects. Both knowledge and skills are tested.
For the 4-y program, students are recruited from assistant doctors who already have at least 3 y of clinical working experience. They
are admitted upon passing an entrance examination. Those enrolled in the 4-y curriculum study the same topics as those in the 6-y
curriculum, but devote less time to each topic. Internships take place during years 3 and 4.
van der Velden et al.
146 JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS—30(2), 2010
activities, 1 on HIV0AIDS palliative care and 1 on metha-
done maintenance therapy.
Given the distribution of health care workers in remote
areas ~see TABLE 3!, the high cost of travel and lodging,
and the reluctance of health workers to leave their part-time
private practices, we believe distance learning has great po-
tential to become an important element in a larger CME
strategy for universities, as it has in many countries. Studies
have proven that Web-based CME can change provider
As the CME center and the upcoming legislation will
have significant impact on the professional lives of the uni-
versity faculty, it was felt that a comprehensive orientation
for them would be needed to establish the CME center. Two
workshops on Circular 7, the Law, the resulting CME re-
quirements, and the role of the new CME center were or-
ganized at Hai Phong Medical University. Representatives
of the dean board, the Training Department, and key faculty
members participated, and agreed upon how to coordinate
and implement activities related to CME.
The Hue College of Medicine and Pharmacy is the largest
training institution for medical professionals in central Viet-
lege of Medicine and Pharmacy established a CME center in
January 2009 and encouraged all faculty to become involved
in teaching CME. To date, 2 distance-learning CME activi-
ties on HIV0AIDS topics and 1 videoconference for practice
improvements in family medicine have been completed. A
a skills workshop with models and on patients.The Hue Col-
lege of Medicine and Pharmacy intends to expand its CME
such as short didactic courses and scientific conferences.
Driven by health care reform, the advent of the private sec-
tor, and commitments made to the international community,
Vietnam is currently faced with a need to increase regula-
tion and training of its health care professionals. In Novem-
ber 2009, legislation was passed that will require as-yet-
unknown amounts and types of CME. This is likely to place
a large burden on the health professional schools and train-
1. WorldBank. Taking Stock, An Update on Vietnam’s Recent Eco-
nomic Developments, Washington DC: WorldBank; 2009. http:00site
December2009.pdf. Accessed February 8, 2010.
2. Boothroyd P, Xuam Nam P, eds. Socioeconomic Renovation in Viet
Nam: The Origin, Evolution and Impact of Doi Moi. Ottawa, Canada:
International Development Research Center; 2000.
3. Glewwe P.An overview of economic growth and household welfare in
Vietnam in the 1990s. In: Glewwe P, Agrawal N, Dollar D, eds. Eco-
nomic Growth, Poverty, and Household Welfare in Vietnam. Washing-
ton, DC: World Bank; 2004:1–27.
4. Witter S. “Doi moi” and health: the effect of economic reforms on the
health system in Vietnam. Int J Health Plann Manage. 1996;11~2!:
5. Sepehri A, Chernomas R, Akram-Lodhi AH. If they get sick, they are
in trouble: health care restructuring, user charges and equity in Viet-
nam. In J Health Serv. 2003;33~1!:137–161.
6. Ministry of Health. Implementation of the 10 Year Socio-Economic
Plan 2001–2010 and Development of the 10 Year Socio-Economic Plan
2011–2020. Hanoi: Ministry of Health; 30 July 2009. Report No.
TABLE 3. Distribution of Allopathic Health Work Force16
Staff CategoryNo.% No.% No.% No.% No.%
Doctor 106272021678 40 14657 276957 13 53919100
Assistant doctor3021 798517 1475931 248425247888 100
Nurse 7933 13 27631 4417063 2710413 1763040 100
Midwife7343 5200 237047 319739 4222720 100
Total1959610% 6249433% 53526 29%51951 28%187567100
Lessons for Practice
• Vietnam is instituting a licensing system for
• Continuing medical education (CME) will be
required to maintain licensure.
• The medical universities in Vietnam are re-
sponding to prepare for their new and ex-
panded role as providers of high-quality
Continuing Medical Education in Vietnam
JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS—30(2), 2010147
7. Tuan T, Thi Mai Dung V, Neu I, Dibley M. Comparative Quality of Download full-text
Private and Public Health Services in Rural Vietnam. Oxford, United
Kingdom: Oxford University Press; 2005. http:00heapol.oxford
journals.org0cgi0reprint020050319. Accessed August 15, 2009.
8. Ministry of Health and General Statistics Office. National Health Sur-
vey 2001–2002. Hanoi, Vietnam: Medical Publishing House; 2003.
9. Maisonneuve H, Matillon Y, Negri A, Pallarés L, Vigneri R, Young
HL. Continuing medical education and professional revalidation in Eu-
10. Rowe A, García-Barbero M. Regulation and licensing of physicians in
the WHO European Region. Geneva, Switzerland: World Health Or-
ganization; 2005. http:00www.euro.who.int0document0e87789.pdf.Ac-
cessed August 15, 2009.
11. Singapore Medical Registration Act. http:00www.smc.gov.sg0html0
MedRegistration.html. Accessed August 15, 2009.
ung J Med Sci. 2008;24~12!:646–650.
13. ASEAN Mutual RecognitionArrangement on Nursing Services.Avail-
able at: http:00www.fta.gov.sg0afta08casean_mutual_recognition_
arrangement_on_nursing_services.pdf. Accessed August 15, 2009.
14. National Strategy and Policy Institute. Feasibility Assessment of the
Pilot Reproductive Healthcare In-Service Training Network. Hanoi,
Vietnam: Ministry of Health; 2007.
15. Ministry of Health. Joint Annual Health Review Human Resources for
Health in Vietnam. Hanoi, Vietnam: Ministry of Health; 2009.
16. Hoat LN, Yen NB, Wright EP. Participatory identification of learning
objectives in eight medical schools in Vietnam. Med Teach.
17. Luu HN, Nguyen SM, Wright EP. Perceptions of graduating students
from eight medical schools in Vietnam on acquisition of key skills
identified by teachers. BMC Med Educ. 2008;8~1!. www.biomedcen-
tral.com. Accessed August 15, 2009.
18. Smith J, Plotkin M, Truong Quang V, Cao Ngoc T, Ngo Van H, Nguyen
Thi Thu H, Van der Velden T. Introduction of OSCE for clinical as-
sessment in obstetrics and gynaecology in Hue, Vietnam. South East
Asian J Med Educ. 2008;2~1!:25–30.
19. Law No. 40020090QH12, of November 23, 2009, Law on Examina-
tion and Treatment.
Workers. Hanoi, Vietnam: Ministry of Health. Circular No. 702008TT-
BYT; May 28, 2008.
21. Mansouri M, Lockyer J. A meta-analysis of continuing medical
education effectiveness. J Contin Educ Health Prof. 2007;27~1!:
22. Lam-Antoniades M, Ratnapalan S, Tait G. Electronic continuing ed-
ucation in the health professions: an update on evidence from RCTs. J
Contin Educ Health Prof. 2009;29~1!:44–51.
23. Science and Training Department, Ministry of Health. Draft Master
Plan for Development of Human Resources for Health and the Medical
Training System to the Year 2020. Hanoi, Vietnam: Ministry of Health;
24. Ministry of Health. Decree 134/2006/ND-CP; Decision 1544/QD-
TTg approving the proposal for training of health workforce in dis-
advantaged, northern and central mountainous regions, the Mekong
Delta and the Central Highland by direct recruitment without entrance
exams. Hanoi, Vietnam: Ministry of Health; 2006.
van der Velden et al.
148 JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS—30(2), 2010