Quản lý hoạt động thực hành lâm sàng theo định hướng phát triển năng lực của sinh viên ngành y các trường đại học thành phố hồ chí minh tt tiếng anh

Aims Based on theoretical research and assessment of the current status of clinical practice management in the direction of capacity development for medical students at universities in

VIETNAM ACADEMY OF SOCIAL SCIENCES

GRADUATE ACADEMY OF SOCIAL SCIENCES

PHAN HOANG TRONG

CLINICAL PRACTICE MANAGEMENT UPON DIRECTION

OF DEVELOPING CAPACITY OF MEDICAL STUDENTS AT

UNIVERSITIES IN HO CHI MINH CITY

Major: Educational Management Code: 9.14.01.14

SUMMARY OF DOCTORAL DISSERTATION

Ha Noi, 2020

The dissertation has been completed at GRADUATE ACADEMY OF SOCIAL SCIENCES

Supervisors:

1 Assoc Prof Dr Nguyen Thi Hoa

2 Assoc Prof Dr Nguyen Sy Thu

Examiner 1: Assoc Prof Dr Nguyen Xuan Thuc

Examiner 2: Dr Nguyen Thi Yen Thoa

Examiner 3: Assoc Prof Dr La Thi Thu Thuy

This doctoral dissertation will be defended before the Panel of Examiners, at Graduate Academy Of Social Sciences

At…… on…… 20

This doctoral dissertation can be found at:

National Library of Vietnam Library of Graduate Academy of Social Sciences

1

INTRODUCTION

1 Rationale for the study

Among training activities at university, vocational training plays a key role in improving the quality of professional training, determining the working ability of students after graduation Following the current trend of integration of the country, vocational training for students should focus on comprehensive development which integrates knowledge, skills, and practice, as well as on how students after graduation are able to put things they learned into practice, to orientate and to develop themselves in the direction of the defined educational goals, on which basis, vocational training promotes the quality and capacity values to meet the requirements of society Therefore, vocational practice management, in general, is one of the urgent needs The medical profession is directly related to human life and health That requires medical students, in the learning process, to practice prudence, thorough thinking, positive thinking, practical problem solving, and decision-making skills, as well as teamwork and the ability to work independently Students who are able to practice health care treatment for the sick need to spent 4-6 years on clinical practice during their studies In addition, medical ethics stipulates that protecting, preventing, maintaining, and improving human health is a noble responsibility and obligation of medical students Therefore, even when studying at university or after graduation, medical students cannot make mistakes in practice Therefore, the management

of professional medical training should focus on the management of clinical practice Practical training needs to help students integrate knowledge, reasoning and practice

Clinical practice management of medical students has attracted many research projects with different approaches Currently, clinical practice training upon direction

of developing capacity has been implemented at many medical universities across the country However, there is little in-depth research on evaluating the clinical practice management process following the capacity-building for medical students From the

above reasons, we choose the issue of "Clinical practice management upon direction

of developing capacity of medical students at universities in Ho Chi Minh city" as

the doctoral dissertation topic

2.Aims and objectives of the study

2.1 Aims

Based on theoretical research and assessment of the current status of clinical practice management in the direction of capacity development for medical students at universities in Ho Chi Minh City, the thesis proposes many management solutions for clinical practice activities in the direction of capacity development of medical students at universities in Ho Chi Minh City, contributing to improving clinical practice activities for students

2.2 Objectives

1) Review the research situation on clinical practice manage ment upon direction of developing capacity of medical students

2) Build a theoretical basis for managing clinical practice activities upon direction of developing capacity of medical students

3) Assess the current situation of clinical practice management upon direction of developing capacity of medical students and the factors affecting the management of clinical practice activities upon direction of developing capacity of medical students at universities in Ho Chi Minh City

4) Propose some solutions to manage clinical practice activities in the direction of capacity development for medical students at Ho Chi Minh City universities Conducting one trial solution in practice

3 Subject and scope of the study

3.1 Subject of the study

Solutions to clinical practice management upon the direction of capacity development for medical students at universities in Ho Chi Minh City

3.2 Scope of the study

3.2.1.Limitations of the scope of study

The research on clinical practice management in the direction of capacity development for medical students focus on the following aspects: Managing the clinical practice objectives in the direction of developing students’ capacity; Managing clinical practice content in the direction of developing students’ capacity; Managing facilities for clinical practice in the direction of developing students’ capacity; Managing the examination and assessment of clinical practice activities in the direction of developing students’ capacity

This study was only conducted on nursing students at universities with nursing majors in Ho Chi Minh City

3.2.2.Limitations of participants for the actual situation survey:

Managers, lecturers, nursing students of medical universities, and doctors mentoring nursing students in clinical practice placements

3.2.3.Limiations of study areas:

This study was conducted at 3 universities/ colleges with nursing majors in Ho Chi Minh City, namely University of Medicine and Pharmacy at Ho Chi Minh city; Hong Bang International University; Nguyen Tat Thanh University

3.2.3 Limitations of the dissertation research objects

-The number of participants surveyed by questionnaire includes: Managers (of universities and faculties), lecturers, students of 3 universities: 350 people; Doctors mentoring students at the hospital: 10 people Total number of participants surveyed by questionnaire (quantitative): 360 people

-The number of participants surveyed by in-depth interviews: Managers (of universities and faculties), lecturers: 15; Doctors mentoring students at the hospital: 10 people; Nursing students: 30 people The total number of participants surveyed by in-depth interviews: 55 people

3.2.4 Limitations on management subjects

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There are many subjects involved in the management of clinical practice activities in the direction of developing students’ capacity, including (1) The main management subjects that manage the clinical learning activities of medical students (nursing students) are: university leaders (mainly the university principle), leaders of nursing faculties; (2) The direct management subject is the departments and doctors mentoring nursing students in the clinical practice placements

However, in this dissertation, the main subject is identified as the principal

of the medical university and the other subjects coordinate to manage clinical practice activities in the direction of developing medical students’ capacity

4 Research Methodology and Research Method

4.1 Research approaches

In order to conduct the research on clinical practice management upon direction of developing capacity of medical students, the dissertation identifies these following research approaches: Systems approach; Approach according to the capacity of medical students (nursing students); Standard approach; Process approach

4.2 Research methods

The dissertation uses the following research methods: 1) Method of studying documents and materials; 2) Method of experts; 3) Method of investigating by questionnaire; 4) Method of in-depth interview; 5) Method of testing; 6) Methods of processing data by mathematical statistics

4.3 Scientific hypothesis

Clinical practice management upon direction of developing capacity of medical students at 3 universities in Ho Chi Minh City is performed at an average level Among the management aspects, the highest-scored aspect is the management of examination and evaluation of clinical practice activities in the direction of developing students’ capacity The lowest-scored aspect is the management of clinical practice objectives in the direction of developing students’ capacity If management solutions focusing on developing professional capacity in line with the law and ethics for nursing students are proposed and tested in clinical practice activities, it will contribute to improving the efficiency of the clinical practice management in the direction of developing medical students’ capacity at universities in Ho Chi Minh City

4.4 Research questions

This dissertation will answer the following research questions:

1) From what scientific point of view is the research on clinical practice management in the direction of developing capacity of medical students approached? What is the rationale for the management of clinical practice activities in the direction

of developing capacity of medical students?

2) What is the current situation of clinical practice management in the direction

of developing capacity of medical students at universities in Ho Chi Minh City? What are the strengths and weaknesses of this management activity? What factors affecting this management activity?

3) What solutions to improve the efficiency of clinical practice management activities in the direction of capacity development for medical students at universities in

Ho Chi Minh City today?

5.New contributions of the dissertation

5.1 Theoretical contributions

The research on clinical practice management in the direction of developing nursing students’ capacity at medical universities in Ho Chi Minh city is currently one of the few studies on clinical practice management following the capacity-building for medical students The dissertation has identified a number of concepts served as a basis for practical research, clarifying the content and management of clinical practice activities upon direction of developing capacity of nursing students, pointing out the factors affecting the management of this activity

The dissertation has constructed criteria for managing clinical practice activities

of medical universities in the direction of developing nursing students' capacity This

is the basis for organizing clinical practice activities and for clinical practice management in line with the capacity-building for nursing students at medical universities

The dissertation has evaluated the status of clinical practice activities as well as the clinical practice management in the direction of capacity-building for nursing students through 4 following points: Managing the clinical practice objectives in the direction of developing students’ capacity; Managing clinical practice content in the direction of developing students’ capacity; Managing facilities for clinical practice in the direction of developing students’ capacity; Managing the examination and assessment of clinical practice activities in the direction of developing students’ capacity The thesis also assesses the status of the factors affecting the management

of clinical practice activities in the direction of developing nursing students’ capacity Experimental results show that it is possible to improve the clinical practice capacity

of nursing students when applying the proposed solutions

6 Theoretical and practical significance of the dissertation

6.1 Theoretical significance

The research results of the dissertation contribute to completing a number of theoretical issues about clinical practice activities in the direction of developing capacity of nursing students as well as the management of clinical practice activities in the direction of developing capacity of nursing students, showing the role of entities in managing clinical practice activities of medical students

6.2 Practical significance

The research results of the dissertation can be a reference for principals, faculties, managers, and lecturers of nursing departments of medical universities in planning and managing content and activities of clinical practice upon direction of developing capacity of nursing students

7 Structure of the thesis

Besides the introduction, conclusion, and annex, the dissertation has 4 chapters

Chapter 1 OVERVIEW OF EXISTING RESEARCH ON CLINICAL PRACTICE MANAGEMENT UPON DIRECTION OF DEVELOPING CAPACITY OF

In this regard, there are also studies by Al-Dabbagh and Al-Taee; Horntvedt (2018), Jauhiainen 2009, Hoffart et al 2017, Nousiainen et al 2018

1.2 Overview of the management of clinical practice activities of medical students upon direction of capacity building

Stark, Warne & Street have studied the clinical practice of nursing students, and Xie et al 2013 showed that the capacity of medical students in clinical practice is also reflected in their communication competencies In general, the implementation of CBME-oriented education has been carried out quite early in the world for about 20 years, and studies on the management of construction, implementation, evaluation has been conducted specifically

In Vietnam, there are a number of authors interested in doing research on clinical practice management Some of the following authors may be mentioned: Nguyen Thi Kim Thoa studied the practical teaching management at The University of Medicine Pham Ngoc Thach Regarding clinical practice training at Ho Chi Minh University of Medicine and Pharmacy, Huynh Thi Minh Hang 2008 and Vo Thanh Nhan 2009 worked on the management of students' academic quality Dang Van Phuoc, Tran Ngoc Bao, and Tran Thi Bich Huong 2006 studied the advantages of OSCEs and concluded that OSCEs are clinical evaluation methods that bring about more positive results than the old method Vu Thi Loan at Thai Binh University of Medicine performed research

on managing clinical practice The research by Nguyen Thanh Son, Yersin Medical University, Da Lat argued that the current practical training for medical students does not yet meet the competency standards Besides medical universities, some researchers such as Le Duc Trung 2015, Le Xuan Truong 2015, Nguyen Duc Chinh 2014, Nguyen

Thi Ngoc Xuan 2015, Nguyen Thu Ha 2014, in various fields of vocational education and training, also conducted research on vocational training upon direction of developing students’ capacity

The issue of clinical practice management has been studied by a number of authors, but each study approaches a certain aspect Therefore, the theory about managing students' clinical practice activities has not yet proven to be comprehensive, systematic, and intensive There is some research with a general perspective, some with a specific perspective Meanwhile, managing clinical practice activities of medical students towards competency-oriented is a matter which is yet to be studied in a fundamental and systematic way Therefore, there should be scientific studies on this issue

Chapter 2 RATIONALE FOR CLINICAL PRACTICE MANAGEMENT UPON DIRECTION OF DEVELOPING CAPACITY OF MEDICAL STUDENTS 2.1 Clinical practice activities for medical students upon direction of capacity building

2.1.1 Concept

Clinical practice of medical students is a process of implementing actions, putting theory into practice, including the activities of talking and taking care of patients in order to collect sufficient information to make a diagnosis, specific care and treatment plans for patients in accordance with their needs to alleviate the patients' diseases, suffering or disabilities

2.1.2 Developing capacity of medical students

Medical students have diverse majors, in this thesis, we only study nursing

students

"Capacity is a combination of unique psychological attributes or personal

psychosocial qualities that act as an individual internal condition, facilitating a certain form of activity to well perform."

The capacity development of medical students (nursing students) is a change in the direction of promoting the unique psychological attributes or personal psychological qualities that act as an individual internal condition, facilitating for the good

implementation of nursing activities by students

According to Decision No 1352/QD - BYT on 24 April, 2012 on the competency standards of nursing in Vietnam, the capacity of nursing students is also determined the basis of competency standards of nursing in Vietnam, which includes the following 3 basic competencies: Capacity of caring practice; Capacity of professional management and development; Capacity of professional practice in accordance with law and nursing ethics

1) Capacity of caring practice

Students need to know the health and illness status of the patients Students have the ability to make decisions about appropriate care plans for the patients’ illnesses and needs

2) Capacity of career management and development

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Along with the capacity to practice caring for patients, in the clinical practice process in the hospital, nursing students also need professional management and development competencies This competency is reflected in the following specific aspects: Students need to be able to manage, record and use medical records in accordance with regulations; Students need to be able to manage patient care; Students need to be able to manage, operate and use medical equipment effectively

3) Capacity of professional practice in accordance with laws and nursing ethics

Besides the capacity to practice patient care, professional management and development, nursing students also need to be able to work in accordance with laws and professional ethics It is the ability to carry out professional activities in accordance with the legal regulations of the medical sector and the nation’s laws for medical sectors, as well as the ethical standards for nursing This capacity manifests itself in the following specific aspects:

Students practice in accordance with laws; Students practice in accordance with nursing ethical standards

2.1.3 Clinical practice activities upon direction of developing capacity of medical students (nursing students)

2.1.3.1 Concept

Clinical practice activities upon direction of developing capacity of medical students is a process of implementing actions, putting theory into practice, including the activities of talking and taking care of patients, which helps promote the unique

psychological attributes or personal psychological qualities that act as an individual internal condition, facilitating for the good implementation of nursing activities by students

2.1.3.2 Some characteristics of nursing students

Nursing training is a sector in the human resource training system for health care Nursing students are trained to assist doctors, pharmacists, technicians, and other staff

in the health care system to perform health care in accordance with the needs of the sick

To perform the above tasks, nursing students must have the following necessary qualities: Love for a job, medical ethics; carefulness, high sense of responsibility; patience, ability to handle pressure; ability to learn and acquire knowledge

2.1.3.3 Content of clinical practice activities upon direction of developing capacity of medical students

a Practice taking care of patients:

Learn about the patient's health and illness: Read the patient's medical record; Implement the technique of taking vital signs and record on the vital function monitoring sheet; Communicate with patients, relatives of patients; Collect data and comments;

Perform care for patients: Instruct patients to take medications as prescribed, on time, in the right way; Implement specialized surgical care techniques such as taking care of wound drainage, infected wounds, artificial anal sphincter, skin avulsions ; Perform communication activities with patients;

b Practice professional management and development during clinical practicum

Manage, record, and use medical records in line with regulations; Manage patient care work; Manage, operate and use medical equipment effectively; Use appropriate financial resources to taking care of patients effectively; Establish a safe and efficient working environment; Strengthen scientific research activities

c Practice professional capacity development in accordance with laws and nursing

ethics

Work in accordance with the laws; Work in accordance with nursing ethics

2.2 Clinical practice management upon direction of developing capacity of medical students

2.2.1 Management

Management is the directed, purposeful, planned, and systematic impact of the managing subject on the managed object

2.2.1.2 Functions of management

Planning, organizing, implementing, directing, evaluating

2.2.2 Concept of clinical practice management upon direction of developing capacity of medical students (nursing students)

Clinical practice management in the direction of developing capacity of medical students (nursing students) is a directed, purposeful, planned and systematic impact of managing subjects to students during the course of action of putting theory into practice, talking and taking care of patients, in order to develop the capacity of caring practice; capacity of professional management and development; capacity of professional practice in accordance with laws and nursing ethics

2.2.3 Managing subjects in clinical practice management upon direction of developing capacity of medical students

Managing subjects are collectives or individuals that are assigned with tasks and direct or indirect power in leading, managing education and training students during clinical practice

The main subjects that manage the clinical practice activities of medical students (nursing students) are: University leaders (mainly the university principal), the leaders

of the nursing department, faculties of the university The direct managing subject is the hospital where students perform their clinical practice Specifically, it is the departments and doctors who directly guide nursing students during their clinical practicum

These subjects are related as follows: The university principal directs the nursing department and other departments to develop a clinical practice plan for students (goals, requirements, content, time, and results of clinical practice)

2.2.4 Content of clinical practice management upon direction of developing capacity of medical students (nursing students)

From the content and process of clinical practice activities of medical students and from the basic functions of management, we identify the content of clinical practice management in the direction of developing capacity of medical students (nursing students)

2.2.4.1 Managing the clinical practice objectives in the direction of developing students’ capacity

a Clinical practice knowledge

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The knowledge that nursing students need to gain during clinical practice includes: Knowledge of understanding the health/ illness status of the patient; Knowledge of caring for patients

b Clinical practice attitude

Based on the regulations of the Ministry of Education and Training and the Ministry of Health, the universities determine the goals to be achieved in terms of students' working attitudes during clinical practice as follows:

Define the role and scope of nursing practice in accordance with the laws and health policies of the Party, the State, and localities in comprehensive care for patients and their families; Use medicines, chemicals, and equipment effectively in specialized practice

c Clinical practice skills

Based on the regulations of the Ministry of Education and Training, the Ministry of Health, the universities determine the goals to be achieved in terms of clinical practice skills for students as follows: Skill of managing, recording, and using medical records

as regulations; Skill of managing patient care; Skill of managing, operating and using medical equipment effectively; Skill of using appropriate financial resources to care for patients effectively; Skill of building a safe and efficient working environment; Skill of doing scientific research and evidence-based practice; Skill of developing a health education program for patients with a typical content/ specific pathology

2.2.4.2 Managing clinical practice content in the direction of developing students’ capacity

a Management to develop the capacity of taking care of patients for nursing students

Manage students in learning about the health/ illness status of patients; Manage students in performing patient care

b Management to develop the capacity of professional management and development for nursing students during their clinical practicum

Manage students in recording and using medical records in accordance with the regulations; Manage students in their patient care work; Manage students in operating and using medical equipment effectively; Manage students in maintaining and developing competencies for themselves and their colleagues

c Management to develop the capacity of working in accordance with laws and

professional ethics for nursing students

In order to implement this management content, the Principal of the University directs the functional departments of the university and works with the hospital where students practice clinical activities in the following aspects: Manage students in practicing in accordance with the laws; Manage students in practicing in accordance with professional ethics standards

2.2.4.3 Managing facilities for clinical practice in the direction of developing students’ capacity

The Principal directs functional departments and nursing faculty, along with the hospital to manage students for these following issues: Helping students keep and effectively use the facilities for clinical practice including medical equipment, medical records, sample procedures ; Instructing students how to use medical equipment,

including consumables such as gauze, gloves, face masks, bandages, syringes, drainage tube, medicine and pliers, scissors, surgical tools,

2.2.4.4 Managing the examination and assessment of clinical practice activities in the direction of developing students’ capacity

The principal instructs functional departments and nursing faculty, along with the hospital to carry out the following points:

Develop and implement a system of criteria for evaluating clinical practice activities of students according to the competency standards of Vietnamese nurses Follow the systematic process to evaluate clinical practice activities of students according to basic competency standards of Vietnamese nurses

2.3 Factors affecting the clinical practice management in the direction of developing

students’ capacity

Based on the points of view of the World Health Organization (1997) on clinical teaching management, as well as on literature research and surveys at hospitals where nursing students perform their clinical practice, we identify a number of factors affecting the management of clinical practice activities in the direction of developing capacity of medical students as follows:

2.3.1 The caring from university leaders

The caring from university managers is one of the decisive factors in clinical practice management towards the development of medical students' capacity This is the basis for organizing clinical practice activities in the direction of developing students’ capacity

2.3.2 The management experience of university leaders

The management experience of school leaders, especially the principal has a direct influence on the management of clinical practice activities in the direction of developing medical students’ capacity

If the university principal has a wealth of management experience, then the planning for clinical practice activities will be meticulous, appropriate, and quick

2.3.3 Management capacity of university leaders

Leaders of the nursing faculty are those who implement the decision of the university president about the clinical practice activities for students, who directly organize clinical practice activities for students If the leaders of the nursing faculties have good competencies, the implementation of the clinical practice plan will be immediate and effective

2.3.4 Policies of the State, the university and the hospital in terms of clinical practice activities

State policies in this context refer to decisions, circulars, and regulations of the Ministry of Health as the authority which directly affects the management of clinical practice of nursing students These state policies specify the goals, content, standards, and clinical practices of students These State policies also stipulate the university's management and organization of clinical practice activities for students

2.3.5 Awareness of students about clinical practice activities

Awareness is always a psychological factor to ensure the actions of an individual Oriented awareness acts as the basis for students' clinical practice activities When a

2.3.6 Attitude of students towards clinical practice activities

Attitude of students towards clinical practice activities is a decisive factor of students' clinical practice activities When a student has a positive and enthusiastic attitude, they will perform clinical practice activities with good quality

Chapter 3 PRACTICAL RESULTS OF CLINICAL PRACTICE MANAGEMENT UPON DIRECTION OF DEVELOPING CAPACITY OF MEDICAL STUDENTS 3.1.Practical research design and methodology

3.1.1 Research areas and subjects

3.1.1.1 Research areas

This study was conducted at 3 universities with nursing majors in Ho Chi Minh City Including: University of Medicine and Pharmacy at Ho Chi Minh city; Hong Bang International University; Nguyen Tat Thanh University The three hospitals include: Army Hospital 115; University Medical Center of Ho Chi Minh City; Binh Dan Hospital

3.1.1.3.Research design

1) Phase of designing research instruments

- Aim: Develop research instruments (questionnaires, in-depth survey outline)

-Time: From January 2017 to January 2018

-Content:1) Design 1 questionnaire for university leaders and lecturers; 2)

Design 04 in-depth interview outlines for university leaders, lecturers, students, and doctors mentoring students during their clinical practicum

2) Phase piloting investigation

-Aim: To determine the compatibility and reliability of the questionnaire so that

necessary corrections can be made to unsatisfactory questions

-Time: April 2017

3) Phase of official investigation

-Aim: Find out the current situation of clinical practice management, the factors

affecting clinical practice management and information on social demographic characteristics such as gender; age; academic level; years of working; working position; University name

-Time: From May 2017 to August 2017

4) Phase of data procession and thematic writing