SPECIAL ARTICLES Pharmacy Education in Vietnam

American Journal of Pharmaceutical Eucation 2013; 77 (6) Article 114. SPECIAL ARTICLES Pharmacy Eucation in Vietnam Thi-Ha Vo, MSc, a,b Pierrick Beouch, PharmD, PhD, b,c Thi-Hoai Nguyen, PhD, a Thi-Lien-Huong Nguyen, PhD, Thi-Kim-Huyen Hoang, PhD, Jean Calop, PharmD, PhD, b,c an Benoît Allenet, PharmD, PhD b,c a Faculty of Pharmacy, Hue University of Meicine an Pharmacy, Hue, Vietnam b Grenoble-Alpes University, Grenoble, France c Department of Pharmacy, Grenoble University Hospital, Grenoble, France Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam Submitte January 10, 2013; accepte March 26, 2013; publishe August 12, 2013. Pharmacy eucation programs in Vietnam are complex an offer various career pathways. All inclue theory an laboratory moules in general, founation, an pharmaceutical knowlege; placements in health facilities; an a final examination. The various pharmacy egree programs allow specialization in 1 or more of 5 main fiels: (1) rug management an supply, (2) rug evelopment an prouction, (3) pharmacology an clinical pharmacy, (4) traitional meicine an pharmacognosy, an (5) rug quality control, which are offere as main specialization options uring the reforme unergrauate an postgrauate programs. However, pharmacy eucation in Vietnam in general remains prouct oriente an clinical pharmacy training has not receive aequate attention. Only stuents who have obtaine the bachelor of pharmacy egree, which requires a minimum of 5 years of stuy, are consiere as fully qualifie pharmacists. In contrast, an elementary iploma in pharmacy aware after 1 year of pharmacy stuy permits entry into more junior pharmacy positions. Since the 2000s, there has been a surge in the number an types of schools offering pharmacy qualifications at various levels. Keywors: pharmacy eucation, pharmacy practice, Vietnam INTRODUCTION While pharmacy eucation in Vietnam, a country in Southeast Asia with a population of 88 million, 1 has unergone many changes since the first faculty of pharmacy was establishe in 1914, 2 it has witnesse the most profoun evelopments uring the last 3 ecaes. Since the mi-1980s, because of rapi inustrialization in the pharmaceutical sector, privatization in the retail sector, an economic growth, there has been an increase in eman for qualifie pharmacy personnel. Newly establishe pharmacy schools an egree programs have provie more opportunities for stuents wishing to pursue a career in pharmacy. There are a variety of pharmacy qualifications offere. This article escribes Vietnamese pharmacy eucation programs, incluing criteria for amission, the type an length of training, an an overview of the curricula; an outlines the system of pharmacy schools. The career opportunities for pharmacy grauates, eucational barriers, an recent an future irections in pharmacy eucation are also iscusse. Corresponing Author: Thi-Ha Vo, Laboratoire TIMC- IMAG UMR 5525/Themas, Pavillon Taillefer - Faculté e Méecine, 38700 La Tronche France. Tel: 33-4-76-76-54-97. Fax: 33-4-76-76-51-09. E-mail: havothipharma@gmail.com 1 PHARMACY EDUCATION PROGRAMS Compare to France, 3 the Unite Kingom, 4 an the Unite States, the variety of pharmacy qualifications in Vietnam is more heterogeneous. Various flexible training programs have been evelope to meet the iverse learning nees of prospective stuents. A range of pharmacy qualifications are offere (Figure 1) incluing: elementary iploma in pharmacy (EDPharm), seconary iploma in pharmacy (SDPharm), college iploma in pharmacy (CDPharm), bachelor of pharmacy (BPharm), master of pharmacy (MPharm), octor of philosophy in pharmacy (PhDPharm), first-level iploma of specialization in pharmacy (FDSPharm), an the secon-level iploma of specialization in pharmacy (SDSPharm). After 12 years of formal eucation, high school grauates wishing to pursue a career in pharmacy can choose between courses leaing to 1 of the 4 first-level qualifications: EDPharm (1 year), SDPharm (2 years), CDPharm (3 years), or BPharm (5 years), epening on their acaemic achievement, references, an motivation. After completing a first-level pharmacy program, stuents can enter the workforce or follow a higher-level course (Figure 1). Pharmacy programs vary in length epening on the preexisting pharmacy training of the caniate (Table 1). For example,

American Journal of Pharmaceutical Eucation 2013; 77 (6) Article 114. Figure 1. System of Vietnamese pharmacy egrees. a high school grauate can choose to enroll irectly in the 5-year BPharm program or complete a 2-year SDPharm program followe by the 4-year BPharm program. Stuents holing a bachelor s egree in biology, chemistry, or meicine can apply for the 3-year BPharm program. There are 2 parallel postgrauate programs: the new master s-octorate system, similar to that in Europe, an the traitional Vietnamese iploma of specialization. The most significant ifference between them is that the master s-octorate egree program aims to enhance acaemic knowlege an research competence, while the specialization programs focus on practical knowlege an skills. Therefore, there is a tren for pharmacists in research institutions an universities to follow the former option. In 2002 the Ministry of Health issue rules regaring transferable accreitation between the 2 egree systems. 5 Thus, a MPharm or a PhDPharm grauate can transfer to the FDSPharm or SDSPharm program, respectively, an vice versa. If a stuent wants to transfer, they have to apply for the esire program; if accepte, the committee of each school consiers the previous courses followe by the caniate so as to exempt him/her from some moules. However, few stuents have pursue these pathways because of the complexity of the transfer process. 6,7 In practice, there is not much istinction in requirements between the 2 postgrauate iplomas except in universities an research institutes where the MPharm an PhD Pharm are preferre. Amission Criteria In Vietnam, there are many mechanisms for amission to pharmacy school. The ominant one is a formal 2 application, base on an entrance examination an sometimes the acaemic achievement of the stuent. Table 1 summarizes the formal amission criteria for entry into pharmacy programs. Other mechanisms inclue (1) the irect recruitment of caniates from ethnic groups after they have followe a preparatory course, or of high school stuents who have obtaine a national or international awar in chemistry, etc; an (2) lower amission criteria (extra points ae to the caniate s entrance score) for specific groups, eg, applicants contracte by local autorities (after grauation stuents are then oblige to work in the locality in which they were recruite), stuents from remote areas, etc. Nevertheless, the caniate s entrance score must be above a cut-off point establishe annually by the Ministry of Eucation an Training. 8 In general, amission criteria iffer between programs an between caniates from ifferent backgrouns, an epen essentially on the iniviual pharmacy school. After 12 years of formal eucation, high school stuents must pass the National Higher Seconary Examination an obtain a Higher Seconary Certificate. After that, epening on the pharmacy school for which they want to apply, there are 3 alternative examinations: the National University-Entrance Examination, the National College-Entrance Examination aministere by the Ministry of Eucation an Training; or a Local Entrance Examination organize by some iniviual schools. Amission to a first-level pharmacy program epens on the caniate s scores on these examinations or graes on high school continuous assessments. After grauating from a first-level pharmacy program, stuents wishing to pursue a higher-level pharmacy program have to sit for/ complete a competitive entrance examination organize by the iniviual pharmacy schools. However, amission to the SDPharm program epens on graes obtaine in the EDPharm program an entry to the PhDPharm program is base on the caniate s research project, 2 references, an an oral presentation in front of a scientific committee. 9 In general, competence in a foreign language is require for access to all postgrauate programs. The pharmacy schools etermine quotas for stuent amissions epening on the nee for healthcare manpower, the capacity of the school, an the criteria of eucation quality assurance. The 2 main criteria inclue the teacher/stuent ratio an the space/stuent ratio (eg, the teacher/stuent ratio is 20 for the SDPharm, 15 for CDPharm, an 10 for BPharm, an the space/stuent is 2m2/stuent). 10 The quota an the numbers of stuents applying vary across universities. For instance in 2011, 2,500 stuents applie for 550 BPharm places (ratio 5:1) at Hanoi University of Pharmacy (HUP), while 6,488 stuents

American Journal of Pharmaceutical Eucation 2013; 77 (6) Article 114. Table 1. Characteristics of Vietnamese Pharmacy Eucation Programs Program Duration, Years Qualification Require for Amission EDPharm 1 Higher Seconary Certificate or Seconary Certificate a SDPharm 2 Higher Seconary Certificate Formal Amission Criteria Duration an Types of Settings of Placements QD 8 weeks in CHC or hospital; pharmaceutical company, an pharmacy b QD or HSNE, UENE, CENE or LEE. 17 weeks: of these 2 weeks in a CHC, 10 weeks in hospital, pharmacy, pharmaceutical company, DRA, an DQCC; an all mornings for 5 weeks in hospital Final Examination for Grauation Objectives Written an/or skill-base practical examination Written an/or skill-base practical examination 1 EDPharm QD b CDPhar 3 Higher seconary UENE or CENE 300 hours (Not etermine c ) Written an/or skill-base Certificate practical examination 1,5-2 SDPharm LEE BPharm 5 Higher seconary certificate UENE placements of 140-280 hours in generalize pharmacy settings an specialize placements of 170-340 hours (Not etermine c ) Written an/or skill-base practical examination OR Obtain basic knowlege an skills of some aspects of pharmacy practice. Perform a limite number of professional activities, ieally uner the supervision of BPharm. Obtain in-epth knowlege an skills in all aspects of pharmacy practice e or in a branch of pharmacy practice. f 4 SDPharm LEE Research issertation Practice inepenently as pharmacists in all settings. 1,5-2 CDPharm LEE 3 Bachelor s egree in biology, chemistry, or meicine MPharm 2 BPharm with GPA. 7/10 or BPharm with 1 year of experience LEE LEE, Language g Not etermine c Research issertation Acquire avance level theoretical knowlege an practical skills, an evelop capability to o research. (Continue) 3

American Journal of Pharmaceutical Eucation 2013; 77 (6) Article 114. Table 1. (Continue) Program f Duration, Years Qualification Require for Amission 1-1.5 FDSPharm FDSPharm 2-5 BPharm with 1 year of experience Formal Amission Criteria 1 MPharm PhDPharm 3-4 MPharm 2 letters of reference, an oral presentation of a research project. Language. g 4 BPharm with GPA.7/10 2-3 SDSPharm SDSPharm 2-4 FDSPharm with 6 years of experience 1 PhDPharm QD Duration an Types of Settings of Placements Final Examination for Grauation Objectives LEE, Language g Not etermine c Written an/or skill-base practical examination OR Research issertation Acquire avance practical knowlege an skills. Not etermine c Thesis Acquire avance level theoretical knowlege an practical skills, an evelop capacity of research. LEE, Language g Not etermine c Thesis Acquire excellent practical knowlege an skills. Abbreviations: QD 5 quality of ocuments require to amission; CHC 5 community health clinic; HSNE 5 higher seconary national examination; UENE 5 university entrance national examination; CENE 5 college entrance national examination; LEE 5 local entrance examination; DRA 5 rug regulatory agency; DQCC 5 rug quality control center; GPA 5 grae point average. a Some pharmacy schools can also offer the EDPharm program for seconary school grauates after 9 years of formal eucation. b Accoring to the EDPharm curriculum of the HoChiMinh University of Meicine an Pharmacy. c Not etermine, epens on each school. Excellent stuents in some universities such as the Hanoi University of Pharmacy, HoChiMinh University of Meicine, Pharmacy an Hue University of Meicine an Pharmacy, an Cantho University of Meicine an Pharmacy. e Accoring to the 2001 national BPharm curriculum framework. Accoring to the 2012 national BPharm curriculum framework. g Competence in a foreign language (require). 4

American Journal of Pharmaceutical Eucation 2013; 77 (6) Article 114. compete for 300 places (ratio 22:1) at HoChiMinh University of Meicine an Pharmacy (HCMUMP). Curriculum Pharmacy programs in Vietnamese pharmacy schools are base on national curriculum frameworks outline by the Ministry of Eucation an Training an/or Ministry of Health in terms of main contents, the proportion of theoretical an practical sessions, an the number of creits per moule. All national curricula are esigne by a national committee of experts in the fiel of meical an pharmaceutical eucation, practice, an management. The structure of pharmacy programs inclues moules (theory an laboratory), a series of placements in a variety of health facilities, an a final examination for grauation (Figure 2). There are 3 types of moules: general knowlege, which inclues philosophy, language an informatics, etc, which are common to all Vietnamese unergrauate programs; founation knowlege, which inclues moules such as botany, analytical chemistry, an basic meicine, etc, proviing sufficient backgroun knowlege for stuents to unerstan the pharmaceutical moule; an pharmaceutical knowlege, which is compose of moules such as pharmacology, pharmaceutics an pharmaceutical management, etc. For placements, unergrauate stuents generally spen 1-2 weeks in each of several ifferent health settings (eg, community health center, hospital, pharmacy, pharmaceutical company, rug regulatory agency, rug quality control center, etc) with which the pharmacy school has establishe a partnership. Commonly, a school assigns a group of stuents to each setting an then rotates them every 1-2 weeks to another setting. The aim of placements is to enable stuents to become familiar with ifferent professional environments, to get insight into their subsequent professional activities, an to perform some simple tasks in each setting. All stuents follow the same placements; except for stuents following the 2012 BPharm curriculum (see BPharm in Figure 2). Stuents are evaluate by report-base, oral, an/or skill-base assessments at the en of each placement, an/or at the en of a series of placements. Finally, all stuents are require to (1) pass a final examination (written an/or skill-base practical), or (2) o a research project, write a issertation, an present their work to a scientific committee in orer to grauate. The uration an types of health settings for placements an the type of final examination for each program are summarize in Table 1. The 1-year EDPharm program emphasizes basic knowlege an skills require to enable stuents to perform the simple tasks encountere in pharmacy practice such as rug ispensing, proviing rug information, preparing simple solutions, an counseling patients regaring local herbal remeies. Most moules are highly pertinent to everyay pharmacy practice. For example, the typical EDPharm curriculum of the HCMUMP inclues philosophy, basic meicine, writing an reaing rug names, management of rug an meical evices, rug use, pharmacognosy, pharmaceutical management, pharmaceutics, an pharmaceutical law. Stuents have 32 weeks of classroom teaching an 8 weeks of placements. 11 Figure 2. General structure of the 2012 National BPharm Curriculum. 5

American Journal of Pharmaceutical Eucation 2013; 77 (6) Article 114. The national SDPharm curriculum framework was issue in 2003. 12 In this 2-year course, pharmaceutical knowlege makes up about 60% of the total number of creits. Stuents spen 2 weeks in a community health clinic at the en of the first year an 1-2 weeks each in a pharmacy epartment of a hospital, a rug regulatory agency, a pharmaceutical company, an a rug quality control center over a 10-week perio at the en of the secon year. Also, for 5 weeks at the beginning of the secon year, stuents spen the mornings in hospital clinical epartments to observe the ay-to-ay therapeutic approach to treating major iseases. The first national CDPharm curriculum framework was set up in 2010. 13 Compare to the SDPharm, the CDPharm curriculum offers more moules in founation knowlege an a selection of optional moules in pharmaceutical knowlege. The introuction of optional moules (23% of the total number of creits) in the CDPharm curriculum is aime at giving the stuents an opportunity to explore their own professional interests. Pharmacy schools are free to esign optional moules epening on their capacity; however, the 2 optional specialize fiels suggeste by the Ministry of Eucation an Training are (1) rug management an supply an (2) rug quality assurance. In the last ecae, all pharmacy faculties have been require to evelop their own specific BPharm curriculum base on the 2001 National BPharm Curriculum Framework. 14 This curriculum was esigne with the aim of proviing stuents with a broa eucation in all fiels of pharmacy practice that woul enable them to enter a iverse range of jobs. Therefore, all stuents followe virtually the same curriculum. However, this moel prove ineffective an the eman for more specialize pharmacy training within the BPharm program was recognize by Vietnamese acaemic leaers. In 2012 a new national BPharm curriculum was issue in orer to meet this eman (Table 2). 15 After finishing the general knowlege, founation knowlege, an obligatory pharmaceutical knowlege moules, an following initial placements (140 to 280 hours) in several general pharmaceutical settings; stuents stuy 1 of 5 optional moules an complete longer, more specialize placements (170-340 hours) accoring to their professional interests. The 5 optional specialize fiels suggeste by the Ministry of Eucation an Training are (1) rug management an supply, (2) rug evelopment an prouction, (3) clinical pharmacy, (4) traitional meicine pharmacognosy, (5) rug quality assurance. Finally, while a few stuents with high acaemic performance in some universities have an opportunity to carry out a research project, write a issertation, an present their work to a scientific committee, most stuents have to pass a final examination for grauation (Figure 2). The number of selecte stuents, level of require acaemic performance, an kins of research projects vary among pharmacy schools epening on the capacity of pharmacy eucators, competence of stuents, etc. In general, a grae point average above 7-8/10 is require, an stuents can conuct a research project in any of the 5 core fiels of pharmacy in the 2 largest pharmacy schools, the HUP an HCMUMP, while those in the Hue University of Meicine an Pharmacy have a more limite choice. The moification of the BPharm curriculum is consiere as a major breakthrough in pharmacy eucation. However, it will take time to see how pharmacy epartments implement the new BPharm curriculum. The HUP is the only university that has initiate (in a pilot phase) the more specialize BPharm program. In the acaemic year 2011-2012, between 120 an 240 out of over 400 fourthyear stuents were offere more specialize pharmacy courses in pharmaceutics, clinical pharmacy, or pharmacy economics, while the other stuents followe the ol BPharm program. The MPharm program requires an aitional 2 years of stuy after obtaining a BPharm. In the first year, stuents Table 2. Overview of the 2012 National BPharm Curriculum in Vietnam Knowlege Moules General knowlege Philosophy, Foreign Language, Computing, Physical Eucation, Military Eucation Founation knowlege Maths-Biostatistics, Computer Applications, Physics, General Inorganic Chemistry, Biology, Meical Psychology an Ethics, Health Communication an Eucation, Analytical Chemistry, Anatomy, Physiology, Pathophysiology-Immunology, Biochemistry, Pharmaceutical Physicochemistry, Microbiology, Parasitology, Pathology, Botany, Organic Chemistry Pharmaceutical knowlege Pharmacognosy, Traitional Meicine, Pharmaceutical Chemistry, Pharmaceutics- Pharmaceutical Inustry, Pharmaceutical Management an Economic, Pharmaceutical Law, Pharmacology, Clinical Pharmacy, Pharmacokinetics, Pharmaceutical Analytics, Toxicology, Several Placements I, choice of Specialize Moules an Placements II in specialty settings 6

American Journal of Pharmaceutical Eucation 2013; 77 (6) Article 114. stuy common funamental moules (eg, research methos or biostatistics at the HUP 16 ; or meical an pharmaceutical sociology, or pharmaceutical law at the HCMUMP 17 ) In the secon year, stuents follow specialize moules an conuct a research project in either: (1) the pharmaceutical inustry an pharmaceutics, (2) pharmaceutical economics an management, (3) pharmacognosy an traitional meicine, (4) pharmacology an clinical pharmacy, (5) pharmaceutical analytics an toxicology, or (6) pharmaceutical an biological chemistry. 16 The courses an opportunities for specialization of the FDSPharm program are similar to those of MPharm programs, but the purpose is more vocational. As a result, the training is preominately practical, with laboratory or fielwork accounting for at least 50% of the whole program (in term of teaching metho) an preominately specialize courses (in term of teaching content) accounting for at least 60% of the whole program. 18 The minimum uration of PhDPharm stuy is 3 acaemic years after a MPharm egree (a total of 10 years of pharmacy stuy), which inclues some time spent completing aitional courses, but most time spent carrying out a research project. Those BPharm stuents transferring irectly to PhDPharm programs are require to stuy supplementary courses from MPharm programs. 9 Like the FDSPharm program, the SDSPharm program has a more practical focus. The structure of the programs, the number of creits, the istribution between theoretical an practical training, an the time allotte to optional specialize stuies is similar to that of the FDSPharm program. Stuents pursuing the SDSPharm program have to unertake a research project before grauation. 19 CLINICAL PHARMACY EDUCATION The basic concepts of clinical pharmacy were introuce in Vietnam in 1990 through the project The Rational Use of Drugs an Drug Information organize by Curtin University in Australia an HUP. 20 The pharmacy faculties began aapting their curricula to focus on the patient an on clinical practice. Many of these changes were introuce by faculty members returning from France, Australia, an The Netherlans, etc. The master s an octoral egree programs in pharmacology an clinical pharmacy that were starte in 1998 an 2006, respectively, nee to be expane an improve. Government authorities, acaemics, an pharmacy professionals recognize that the evelopment of clinical pharmacy is essential to improve the safety, effectiveness, an efficiency of rug therapy for patients. The 2011 National Survey on Clinical Pharmacy Services in Vietnamese Central an Provincial Hospitals, conucte by HUP an the Worl 7 Health Organization, aiming to help the government authorities to issue policies an acaemics to improve the initial an continuing pharmacy programs of clinical pharmacy, foun that nearly half of hospitals assigne pharmacists to work in clinical wars (47.4%), but often for only a limite amount of time. The number of pharmacy epartment staff members an pharmacists per 100 bes was 5.3 6 1.9 an 1.4 6 1.0, respectively. Of 137 clinical pharmacists responing, nearly 40% were not traine in clinical aspects of pharmacy at university an only 58% of them participate in continuing eucation courses. 21 Entities promoting clinical pharmacy eucation inclue (1) the 2007-2012 project Strengthening the training quality of clinical pharmacists in Vietnam in which 6 Vietnamese schools of pharmacy collaborate with Dutch, Thai, an Inonesian institutions to introuce clinical pharmacy as a specialization into existing pharmacy programs 22 ; (2) the Ministry of Eucation an Training issue the 2012 BPharm curriculum reform which will require the pharmacy school to increase the proportion of clinical components an offer the a specialization in clinical pharmacy 15 ; an (3) Ministry of Health issue regulations efining the role an uties of clinical pharmacists in 2011 23 an guielines for clinical pharmacy practice in health care facilities (rafting) which create the eman of well-traine clinical pharmacists. 24 These riving forces aim to bring the benefits of clinical pharmacy practice to a large part of Vietnamese society. SYSTEM OF PHARMACY SCHOOLS Vietnamese pharmacy schools inclue technical high schools, colleges, an universities. The technical high schools can train EDPharm an SDPharm, an colleges can offer the CDPharm an lower-level programs, but only universities can awar the BPharm an postgrauate egrees. Accoring to the 2012 Global Pharmacy Workforce Report, the number of pharmacists per 10,000 people in Vietnam is lower than in 50 of 82 countries. 25 In 2006, the Ministry of Health set a target to ouble the number of pharmacists by 2020 (from 1.2 pharmacists per 10,000 people in 2006 to 2 to 2.5 in 2020). 26 In the last 5 years, 5 universities have opene a BPharm program, bringing the total number of BPharm programs to 11 in 2012. 2,8 Table 3 lists all Vietnamese universities offering the BPharm program in 2012. Only the HUP is solely eicate to pharmacy training. Establishe in 1902, HUP is the olest an largest pharmacy school in the country an where virtually half of all new pharmacy personnel grauate each year. 27 Pharmacy schools are regulate by the Ministry of Health an/or Ministry of Eucation an Training. Most pharmacy schools are public-fune;

American Journal of Pharmaceutical Eucation 2013; 77 (6) Article 114. Table 3. Pharmacy Programs Offere by Vietnamese Universities in 2012 a University Type Available Programs Hanoi University of Pharmacy (pharmacy only) Public SDPharm, CDPharm, BPharm, MPharm, FDSPharm, PhDPharm, SDSPharm HoChiMinh University of Meicine an Pharmacy Public EDPharm, SDPharm, BPharm, MPharm, FDSPharm, PhDPharm, SDSPharm Hue University of Meicine an Pharmacy Public BPharm, FDSPharm Thainguyen University of Meicine an Pharmacy Public BPharm Cantho University of Meicine an Pharmacy Public BPharm National University of Hanoi b Public BPharm Haiphong University of Meicine b Public BPharm University Tay Do b Private BPharm University Vo Truong Toan b Private CDPharm, BPharm University of Science an Technology of Hanoi b,c Public BPharm Abbreviations: SDPharm 5 seconary iploma in pharmacy, CDPharm 5 college iploma in pharmacy, BPharm 5 bachelor of pharmacy, MPharm 5 master of pharmacy, FDSPharm 5 first-level iploma of specialization in pharmacy, PhDPharm 5 octor of philosophy in pharmacy, an secon-level iploma of specialization in pharmacy SDSPharm. a Does not inclue military university. b University has recently opene a BPharm program. c University of Science an Technology of Hanoi offers the 3-year BPharm program, similar to a 3-year license program in European countries. however, the number that is privately fune has significantly increase. In 2008, there were about 32,700 pharmacist s assistants with an EDPharm egree an 29,800 with an SDPharm egree, 28 an as of 2010, there were approximately 13,900 pharmacists, of whom about 1,400 hel a postgrauate egree. 29 (These figures o not inclue people working in pharmacy schools, research centers, an some central hospitals). Accoring to 2009 ata, the expecte annual number of grauates was about 5,200 with an EDPharm egree, 2,000 with an SDPharm egree, an 1,300 with a BPharm egree. 26 Only 3 universities offer postgrauate pharmacy programs. In 2010, about 300 positions were available in the MPharm an FDSPharm programs, an about 20 positions were available in the PhDPharm an SDSPharm programs. Because of the limite numbers amitte to postgrauate pharmacy programs, as well as concerns about the quality of eucation, some prospective pharmacists seek opportunities overseas to pursue a masters or PhD egree. Eucation Quality Assurance In Vietnam, the quality of eucation has been given much attention in the last 10 years. There is a general system for the accreitation of establishments an quality assurance, but no specific system exists for pharmacy eucation. The General Department for Eucational Quality Assurance, Accreitation, an Testing uner the Ministry of Eucation an Training was establishe in 2004 an has evelope many innovative policies of quality assessment at the national level. Since 2007, each pharmacy school is 8 oblige to set up a Unit for Quality Assurance, Accreitation, an Testing that is responsible for quality assurance at the institutional level. 30 The pharmacy schools are assesse accoring to a set of 10 criteria (mission, management, programs, eucation activities, research, staff, stuents, international cooperation, materials, an financial management). The process of quality assessment must inclue 3 steps: (1) internal assessment by the school, (2) external assessment by the Ministry of Eucation an Training, an (3) an accreitation ecision. 31 The internal assessment began as a voluntary exercise but became manatory in 2007. The pharmacy school is require to report the results of internal assessment to the public an the Ministry of Eucation an Training, annually. 30 Schools have starte to conuct surveys about opinions of stuents in orer to improve the eucation programs. 27,32 The accreitation requirement is a first step in improving the quality of pharmacy eucation in Vietnam. CAREER OPPORTUNITIES With a egree from pharmacy school, grauates are able to be employe immeiately in most public or private settings. While the lowest entry-to-practice qualification is the EDPharm, only those who have obtaine the BPharm areconsieretobefullyqualifiepharmacypractitioners. 33 For example, a BPharm is require to be a hea of a pharmacy epartment, a clinical pharmacist, or compouning pharmacist for peiatric, cancer, an aictive rug users in a hospital, except for small hospitals in which a SDPharm is obligatory. 23 However, pharmacy staff members must apply for a Private Pharmacy Practice

American Journal of Pharmaceutical Eucation 2013; 77 (6) Article 114. License to become the chief or a professionally responsible person in a private pharmaceutical company. The BPharm with a minimum of 5 years of practical experience is generally require to be a chief of a private pharmacy in an urban area (or 2 years of practical experience for rural areas), or require with a minimum of 3 to 5 years of practical experience to be a professionally responsible person for a private pharmaceutical company (eg, company proviing pharmaceutical quality control services, a pharmaceutical manufacturing company, a wholesale rug istributor, or a company proviing pharmaceutical storage services). EDPharm holers with at least 2 years of experience can work as the person in charge of a community health center or as a istributor-owne wholesale ealer. 33 Career opportunities in pharmacy are quite abunant because of the large shortage of pharmacists in all sectors. In 2010 all BPharm grauates of the 2 largest pharmacy faculties ha a job 1 year after grauation. 27,32 Accoring to the Vietnamese Drug Aministration, there were 15,150 pharmacists in 2010 (not incluing pharmacists working in pharmacy schools, research institutions, an some central hospitals), 59% of whom worke in community pharmacies, 23% in the rug inustry, 12% in hospitals an health care facilities, 3% in government agencies, an 3% in other settings. 29 Because of the lack of pharmacists, many register to work in community pharmacies but also have jobs in a pharmaceutical company. In fact, for most pharmacists, the pharmaceutical inustry was their first career choice. There is a highly unbalance istribution of the pharmacy workforce between urban an rural regions, with 82% of pharmacists working in urban areas where only 27% of the population lives. 1,26 In particular, nearly half the pharmacy workforce is concentrate in the 2 largest cities, Ha Noi an Ho Chi Minh. 29 In 2012, the total number of pharmacies (efinitions may operate as a faculty in the provision of pharmacy services in the community or hospital settings by International Pharmaceutical Feeration) was 43,629, while there are only 12,000 pharmacists. 25 Therefore, pharmacies are largely staffe by EDPharm or SDPharm. Particularly, private pharmacies are largely staffe with pharmacists assistants or even untraine personnel, while the pharmacists in charge are often absent. Career opportunities in the pharmaceutical inustry also seem abunant an promising. Positions ranging from research or quality control management to prouct marketing are reaily available. Many young pharmacists start to work as pharmaceutical sales representatives in the first years after grauation an then open a private pharmacy for extra income when they have gaine 5 years of experience. Domestic rug manufacturing companies have focuse 9 on research an evelopment capabilities to gain a competitive avantage over foreign rug companies, 34 an this is likely to expan the number of job opportunities in the future. There is a consierable shortage of pharmacists in hospitals an healthcare facilities. However, many grauates are unwilling to assume the role of hospital pharmacist because of low salaries an a heavy supply management an aministrative workloa. The majority of pharmacists with an MPharm or PhDPharm egree work in pharmacy schools, research institutions, an hospitals. These pharmacists with postgrauate egrees often have positions of high responsibility in pharmaceutical settings, such as regulatory agencies, hospitals, an the pharmaceutical inustry. Those grauating from overseas MSc or PhD programs often ecie to return to work in Vietnam an contribute enormously to foster innovation in pharmacy eucation, research, an practice. Pharmacist s assistants account for about 82% of the pharmacy workforce an represent about 85% of the annual supply of newly qualifie pharmacy personnel. 26,28 The expecte role of pharmacist s assistants is to assist a pharmacist in his ay-to-ay uties. However, because of the serious lack of pharmacists in all settings, pharmacy assistants in many settings aroun the country, such as community pharmacies, primary healthcare facilities, an small hospitals, are performing tasks that are usually consiere to be solely the omain of qualifie pharmacists. There is a wie gap between Vietnam s increasing eman for qualifie pharmacists an its limite capacity to train sufficient numbers to meet the nee. For the foreseeable future, pharmacists will continue to be in short supply in Vietnam an pharmacist s assistants will continue to shouler most of the responsibilities. EDUCATIONAL BARRIERS While the roles of pharmacists have rapily evolve an broaene, the existing pharmacy programs have yet to prepare grauates aequately for these professional emans. Obstacles to the improvement of quality pharmacy eucation inclue: A lack of involvement of professional boies in the improvement of the quality of pharmacy eucation. Vietnamese pharmacy programs focus heavily on the basic sciences an the curriculum is still prouct oriente. Laboratory-base courses are still seen as an important metho of teaching skills, but clinical training an practical experience have not receive aequate attention. There is a lack of qualifie pharmacy acaemics an a poor institutional infrastructure (basic

facilities as well as learning an teaching resources are insufficient). Innovative teaching methoologies (eg, casebase learning, teaching in small groups, stuent presentations) are being introuce at several schools, but this is often hampere by large class size. Traitional teaching methos restricte to large group lectures using a white boar an PowerPoint slies still ominate. Places in postgrauate pharmacy programs are limite. Continuing eucation opportunities for life-long learning by all practitioners are few an not compulsory. RECENT AND FUTURE DIRECTIONS OF PHARMACY EDUCATION In Vietnam, serious shortages in the number of traine pharmacists an concerns over competency have spurre reforms in pharmacy eucation. A coorinate an multifacete effort to avance pharmacy workforce planning, training, an eucation is being mae in orer to train an aequate number of highly qualifie pharmacists: 2,26,34-36 To overcome the shortage of pharmacists in isavantage areas, pharmacy schools are allowe to: Organize in-service pharmacy eucation programs for workers from health centers, hospitals, rug regulatory agency, pharmaceutical company, etc, who are unable to atten acaemic programs. Develop briging programs for pharmacy staff members to earn a BPharm egree. Strengthen nees-base eucation of the pharmacy workforce in mountainous an other isavantage regions by waiving amission criteria for applicants. Some efforts to evelop the system of pharmacy schools inclue: American Journal of Pharmaceutical Eucation 2013; 77 (6) Article 114. Enlarging existing pharmacy schools an encouraging the establishment of new pharmacy schools. Enhancing the autonomy of pharmacy schools financially, aministratively, an in esigning their own curricula an the moalities of teaching, evaluation, an research. Increasing investment in public pharmacy schools; upgraing teaching facilities such as classrooms, laboratories, teaching instruments, materials, an computerize services. To improve the quality of pharmacy eucation, some strategies inclue: 10 Set up a national framework of pharmacy programs as guielines for pharmacy schools to evelop their own specific curricula. Promote participative learning an teaching methos. Elaborate stanar pharmacy textbooks with upate an avance content. Improve the quality of postgrauate pharmacy programs an increase the number of stuents enrolle. Promote cooperation between pharmacy schools an research centers, hospitals, an inustry. Train pharmacy acaemics (lecturers, eucational managers) through government projects or in cooperation with overseas organizations. Enhance the research capacity of pharmacy schools. Offer continuing eucation to upgrae the knowlege an skills of the existing pharmacy workforce. Perform quality control an accreitation of pharmacy eucation programs. CONCLUSION With the rapi expansion in the number of pharmacy schools an egree programs, ensuring high-quality pharmacy eucation is a major challenge for Vietnam. The nee for increase acaemic capacity an builing strategies shoul be taken seriously. Data collection on the characteristics of the pharmacy workforce an pharmacy practices, ientifying the specific nees of the country, an using these to evelop comprehensive eucation is consiere as a first step towars improving the quality of pharmacy eucation in Vietnam. Like many (if not most) Southern countries, clinical pharmacy eucation an practice in Vietnam is not or only partially integrate into patient care. 22 The recent legislative changes an innovations in pharmacy eucation in general are preicte to be a springboar for the further evelopment of training in clinical pharmacy in the near future in Vietnam. ACKNOWLEDGEMENTS We wish to thank Viet-Thanh Truong, Minh-Nguyet Le, MSc, Department of Pharmacy, Hue University of Meicine an Pharmacy, for their assistance uring the preparation of this article an Dr Alison Foote (Grenoble Clinical Research Centre) for critically reaing an eiting the manuscript. Thi-Ha Vo is a PhD caniate fune by The Vietnamese Ministry of Eucation an Training s Scholarship. Beouch P is fune by a Poste accueil CNRS/CHU Grenoble awar of the CNRS (French Center for Scientific Research).

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