Circular 21/2020/TT-BYT internship of medical practitioners to obtain general practice certificates

CIRCULAR

Guiding the internship of medical practitioners to obtain general practice certificates

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Pursuant to the Law on Medical Examination and Treatment No. 40/2009/QH12;

Pursuant to Decree No. 109/2016/ND-CP dated July 01, 2017 of the Government prescribing the grant of practice certificates to medical practitioners and of operation licenses to health facilities;

Pursuant to Decree No. 155/2018/ND-CP dated November 12, 2018 of the Government on amendments to some articles related to business conditions under state management of the Ministry of Health;

Pursuant to Decree No. 75/2017/ND-CP dated June 20, 2017 of the Government defining the functions, tasks, powers and organizational structure of the Ministry of Health;

At the proposal of the Director of the Department of Medical Services Administration.

The Minister of Health hereby promulgates the Circular guiding the internship of medical practitioners to obtain general practice certificates.

Chapter 1

GENERAL PROVISIONS

Article 1. Scope of regulation, scope and subjects of application

1. This Circular specify the components and organization of medical examination and treatment internships of medical practitioners to obtain general practice certificates and relevant responsibilities.

2. This Circular does not apply to doctors (odontostomatologists, traditional medicine doctors, preventive medicine doctors, other specialists or people with bachelor's degrees in medicine who have received additional training in accordance with Clauses 2 and 3, Article 5 of Circular 42/2018/TT-BYT dated December 26, 2018 of the Minister of Health), assistant doctors, nurses, midwives, and medical technicians. The medical internships of these titles to obtain practice certificates shall comply with another Circular promulgated by the Minister of Health.

3. This Circular applies to authorities, organizations and individuals involved in the internship of medical practitioners to obtain general practice certificates.

Article 2. Principles of internship

1. Details of the internship of medical practitioners (holders of medical practitioner's or general practitioner’s degrees or bachelor's degrees in medicine who have received additional training in accordance with Circular No. 42/2018/TT-BYT dated December 26, 2018 of the Minister of Health specifying additional training for holders of bachelor's degrees in medicine awarded by foreign countries to be recognized as doctors) must be consistent with the general practitioner training programs and the professional competency standards and scope of professional practice of general practitioners, as specified in Circular No. 35/2019/TT-BYT dated December 30, 2019 of the Minister of Health specifying the scope of professional practice for medical examination and treatment practitioners (hereinafter referred to as Circular No. 35/2019/TT-BYT).

2. Medical interns (who are medical practitioners) are allowed to perform medical examination and treatment techniques directly on patients and prescribe medications under the supervision of their mentors (the mentors shall meet the conditions specified in Clause 3, Article 16 of Decree No. 109/2016/ND-CP).

3. Medical interns must strictly follow the instructions of the mentors. Medical interns must fully complete their internships which shall last 18 months. In the case where an intern suspends his/her internship due to maternity, accident or other force majeure reasons, the duration of the internship may be accumulated but the intervals shall not exceed 6 months.

4. In the case where a civil servant or employee is recruited by the health facility to do professional work thereat, but he/she have not yet obtained a medical practice certificate, such recruit must sign an internship agreement with such health facility and a mentor shall be assigned to supervise him/her in accordance with this Circular.

5.       The mentors to be assigned shall have appropriate expertise and qualifications for mentoring.

Chapter 2

DETAILS OF MEDICAL INTERNSHIP

Article 3. Preparation and issuance of the internship programs

Based on the framework specified in Article 4 of this Circular, the internship-hosting health facilities (general hospitals that have been granted operating licenses in accordance with the Law on Medical Examination and Treatment) shall prepare and issue detailed internship programs appropriate to the capacity and conditions of each health facility, but the principles specified in Article 2 of this Circular must be followed.

Article 4. Framework and duration of medical internship

1. A detailed medical internship program shall be based on the competency standards of general practitioners issued by the Minister of Health under Decision No. 1854/QD-BYT dated May 18, 2015; the knowledge and skills of general practitioners and medical practitioners that have been trained at specialized medical schools as well as the scope of professional practice of general practitioners as prescribed in Clause 1, Article 4 of the Circular No. 35/2019/TT-BYT.

2. The aggregated duration of the medical internship is 18 months, allocated to each specialty as follows:

a) Internal medicine (including intensive care medicine): 5 months;

b) Surgery: 3 months;

c) Obstetrics and gynaecology: 3 months;

d) Pediatrics: 4 months;

dd) Some techniques of other specialties (otorhinolaryngology, odontostomatology, ophthalmology, dermatology, functional rehabilitation, traditional medicine and other specialties specified in Circular No. 35/2019/TT-BYT): 3 months.

3. During the professional and technical internship, the interns shall be also trained in law regulations on medical examination and treatment, professional regulations, professional ethics, patient safety, communication skills and etiquette in total 20 sessions (each session of 4 lessons). This period of training shall be included in the aggregated duration of 18 months of the internship as specified in Clause 2 of this Article.

Chapter 3

ORGANIZATION OF MEDICAL INTERNSHIP

Article 5. Development of internship hosting plans

1. On an annual basis, in accordance with the demand for internships and the capacity to host interns, internship-hosting health facilities shall formulate their own internship hosting plans.

2. An internship hosting plan shall include the quantity of interns the health facility can host during the year; the quantity and list of mentors; and the internship hosting cooperation contract (if any);

In the case where the internship-hosting health facility lacks the required specialties outlined in Article 4 of this Circular, it is permissible to enter into a cooperation agreement with another internship-hosting health facility possessing the necessary specialties.

3. Internship-hosting health facilities shall send annual internship hosting plans to the Ministry of Health, or the provincial-level Departments of Health decentralized to manage them before January 31 for the latter to summarize the plans, monitor and manage the hosting of internships. At the same time, the internship-hosting health facilities must publicly post the plans on their websites.

4. The Ministry of Health and the provincial-level Departments of Health shall summarize internship hosting plans of the internship-hosting health facilities under their management and post such information on the web portals of the Ministry of Health or the provincial-level Departments of Health.

Article 6. Acceptance of interns and signing of medical internship agreements

1. Internship-hosting health facilities shall accept interns in accordance with the internship hosting plans publicly announced by them. In case of refusal, they shall send written replies to the interns, clearly stating the reason for such refusal.

2. Internship-hosting health facilities shall sign medical internship agreements with the interns as specified in Clause 1, Article 16 of Decree 109/2016/ND-CP.

Article 7. Assignment of mentors

1. Heads of internship-hosting health facilities shall assign mentors to supervise the interns as specified in Clause 2, Article 16 of Decree 109/2016/ND-CP.

2. In the case where various mentors supervise one intern, the scope and period of supervision by each mentor must be clearly defined.

3. In the case where an internship-hosting health facility signs an internship hosting cooperation contract with another health facility, the head of the latter must assign in writing specific mentors for respective specialties.

Article 8. Monitoring, management, evaluation, and certification of the internship

1. Internship-hosting health facilities must assign functional units to monitor, oversee and manage their hosting of internships.

2. The mentor directly supervising the intern shall evaluate and give his/her comments on the internship of the intern for each item specified in the form of evaluation and comments on the internship issued with this Circular. Evaluation and comments must be done immediately after the intern completes each components of the internship. One mentor shall give comments only on the part of the internship program that he/she supervises.

3. Taking into consideration the form of evaluation and comments on the internship, the head of the health facility shall issue a Certificate of Internship Completion to the intern, made using Form 02 specified in Appendix I of Decree No. 109/2016/ND-CP.

Article 9. Costs of internship

1. Internship-hosting health facilities should determine the costs of internship by accurately and comprehensively calculating the costs of hosting internships and utilizing revenues to offset expenses. All accounting, revenue and expenditure management, as well as payment and settlement processes, must adhere to law regulations.

2. Internship-hosting health facilities must publicly disclose the costs of internship on their websites.

3. Internship-hosting health facilities must notify the persons demanding internships of the costs of internship and clearly state such costs in the medical internship agreements made using Form 02 specified in Appendix V to Decree No. 109/ 2016/ND-CP.

Chapter 4

IMPLEMENTATION RESPONSIBILITIES

Article 10. Responsibilities of an intern

1. Comply with the internship-hosting health facility's rules and regulations.

2. Comply with the professional regulations and rules of the internship-hosting health facility and follow the instructions of the mentor.

3. Ensure safety for patients during the internship, keep confidential information of patients and the health facility during the internship.

4. Fulfill the obligations stated in the medical internship agreement. Pay all costs of internship as agreed in the medical internship agreement signed with the internship-hosting health facility.

5. Interns are not allowed to sign prescriptions or medical treatment records. Refrain from unsupervised performance of procedures and techniques without the permission of the mentor.

Article 11. Responsibilities of a mentor

1. Adhere to the mentorship responsibilities assigned by the head of the internship-hosting health facility.

2. If the mentor finds that the mentorship exceeds his/her professional capacity or for other legitimate reasons, he/she may decline the mentorship responsibilities and report this to the head of the internship-hosting health facility.

3. Ensure patient safety while supervising the interns. Assume responsibility if the intern commits professional errors during the internship that adversely affect the patient's health due to the mentor's negligence.

4. Monitor, evaluate and comment on the intern's results of the internship part the mentor is assigned to supervise and take responsibility for his/her comments.

Article 12. Responsibilities of an internship-hosting health facility

1. Develop its internship program and internship hosting plan.

2. Host interns in accordance with its internship program and internship hosting plan.

3. Issue a Certificate of Internship Completion to those who complete their internships, taking into consideration the mentor's comments as specified in Clause 4, Article 11 of this Circular.

4. Report on an annual basis on its hosting of medical interns:

a)       Internship-hosting health facilities under the Ministry of Health, internship-hosting health facilities under other ministries and sectoral authorities (other than the Ministry of National Defense) shall report on the hosting of interns to the Ministry of Health (attention to the Department of Medical Services Administration).

b)       Internship-hosting health facilities under the provincial-level Departments of Health, internship-hosting health facilities that are private hospitals shall send reports to the provincial-level Departments of Health of the localities where they are headquartered.

Chapter 5

IMPLEMENTATION PROVISIONS

Article 13. Effect

1. This Circular takes effect from January 15, 2021.

2. The regulation: “General practitioners must register internships in one of the four specialties including internal medicine, surgery, obstetrics, and pediatrics or in one of the groups including internal medicine - pediatrics or surgery - obstetrics. In case of internship in a group of specialties, the aggregated duration of the internship is 18 months, of which the allocation to each specialty within the group is at least 09 consecutive months” in Article 15 of Circular No. 41/2011/TT-BYT is annulled.

Article 14. Transitional provisions

1. In cases where medical practitioners have been undertaking medical internships before the effective date of this Circular, they will continue to comply with Article 15 of Circular No. 41/2011/TT-BYT.

2. In the case where a general practitioner wants to obtain a practice certificate with the medical examination and treatment scope of internal medicine or surgery or obstetrics and gynecology or pediatrics, he/she must register his/her internship in one of the four specialties including internal medicine, surgery, obstetrics and pediatrics within a period of 18 months in accordance with the law regulations on medical examination and treatment.

Article 15. Reference provisions

In the case where the documents referenced in this Circular are replaced or amended or supplemented, the new ones shall prevail.

Article 16. Implementation organization

1. The Ministry of Health shall assign the Department of Medical Services Administration to direct, guide, inspect, supervise and urge the implementation of this Circular. The Agency of Science, Technology and Training, Departments, the Ministry’s Office, the Ministry’s Inspectorate, Agencies and General Departments under the Ministry of Health shall be responsible for coordinating with each other in guiding the medical internship under their ambit.

2. The Directors of the provincial-level Departments of Health, Heads of health authorities under Ministries and sectoral authorities shall be responsible for organizing and implementing this Circular under their ambit.

Difficulties that arise during the implementation of this Circular should be reported by authorities, organizations and individuals to the Ministry of Health for consideration and settlement./.