Part I: Summary
The Commission of Audit (CA) conducted an audit on the recruitment and training of medical interns within the remit of the Health Bureau (SS, according to the Portuguese abbreviation). The audit focused on how the SS planned and carried out the recruitment of medical interns, how the internships were organized and how SS supervised and coordinated the training activities, with the objective to verify whether these works could be improved in terms of efficiency and effectiveness and to verify whether the public money have been adequately and properly spent.
1.1 Audit findings and opinions
1.1.1 Planning and preparing of medical internships
1.1.1.1 Frequency of the internships
The total number of internships and interns trained suffered a significant decline following the establishment of the Special Administrative Region. No new courses of general internship were organized during 3 successive years (following the year of 2006) and the complementary internship also had a hiatus of 4 successive years (following the year of 2005). What happened caused an insufficient number of qualified applicants for the medical career at SS. SS didn’t practice long-term planning for its medical human resources and didn’t organize internships in time to meet the future needs of medical staff.
As for the causes whereby the internships were not organized periodically, the explanations presented were contradictory and denoted that SS was unsure whether it should intensify or slow down the internships, revealing that SS might not be very clear of its own role.
1.1.1.2 Recruitment of medical interns
SS initiated an open recruitment process in 2006 to fill in 11 places of a complementary internship. However, the recruitment process was annulled two times, successively, due to claims against procedural errors, which resulted in a delay of over 3 years (from the recruitment announcement to the admission of the interns), causing considerable damages to the continuity of medical interns training. After this case, SS introduced some measures to improve future recruitment processes, namely providing the selection committee with a person from the Personnel Division to perform the administrative works. However, since this procedure was not compulsory, the selection committee could choose to make use of this advantage, which was not conducive to a complete avoidance of new annulments due to the same cause.
1.1.1.3 Planning of medical staff and assessment of demand for medical interns
SS doesn’t practice comprehensive and long-term planning for its medical human resources, based on a development plan. Effectively, throughout the whole audit process, SS was not able to present a concrete figure on how many doctors it would need, which is evidence that SS had no parameters or other scientific basis to correlate between the future needs of medics and the interns being trained and vice-versa. The finding — deficient planning of medical man¬power — also affects, indirectly, the effectiveness of the funds invested in the recruitment of specialists outside Macau.
1.1.2 Training of medical interns
1.1.2.1 Formulating of training programmes
The audit found that not all specialties in the complementary internship are provided with training programmes and the existing ones are outdated, because SS used to prepare a training programme when it effectively is going to organize an internship in certain specialty. Since SS has not organizing internships with regularity, there’s one medical specialty with no training programme and ten specialties with programmes not upgraded for more than ten years.
1.1.2.2 Approval of training programmes
At the level of complementary internship, only the training programmes of nine medical departments that conducted internships in 2010 have their programmes approved by the bureau director, in accordance with the Decree-Law Nr.8/99/M, article 8 (1). All other programmes written in prior years remained without the director’s approval. On the other hand, also the training programme for the general internship remains to be approved. The finding demonstrates that the supervision on the internship’s training activities has been lax.
1.1.2.3 Contents of the training programmes
In the internships organized by SS between 1999 and 2010, 15 out of the 27 medical departments involved (over 50%) applied trainings programmes which were no more than a calendar of training activities. Crucial items for assessing the learning of the interns laid out in the Decree Law Nr. 8/99/M, Article 8, paragraphs e), f) and g) were missing in those programmes, namely, training objectives, diagnostic and therapeutic as well as assessment methods.
1.1.2.4 Submission of assessments and activities reports
The submission of assessments and activities reports has not been in compliance with the Decree Law Nr. 8/99/M. From 2000 to 2010, 84% of assessments of the general internships haven’t been tendered in within 8 days after the respective internship conclusion and 57.43% of the activities reports were not submitted within 30 days after the respective internship finishing date. The fact revealed that SS didn’t find important following the deadlines for assessments and the activities reports submission, but this, in fact, caused serious damages to the internships managing unit, since it could not follow the internships timely.
1.2 Suggestions presented by the Commission of Audit
1.2.1 Dedicating more resources to organize internships systematically and constantly in order to keep a stable offer of doctors;
1.2.2 Accelerating the revision of the Decree-Law Nr 8/99/M (‘legal framework for medical internships”) in order to improve as earliest as possible the running of the internships.
1.2.3 Being more diligent with the recruitment procedures in order to avoid any errors which would cause wastage of administrative resources and delay in the hiring of interns and beginning of trainings.
1.2.4 Improving the planning of medical human resources and the mechanism for assessing the demand of medical interns, for which data on demand of interns and doctors should be cross analyzed.
1.2.5 Reviewing the procedure for preparing, revising and upgrading training programmes; also, more efforts should be dedicated to improve the system and regulation of medical internship.
1.2.6 Assuring that all training programmes are approved in accordance with the terms of law and contain all the items laid out in the applicable laws and regulations, in order to strengthen the oversight on their contents and quality.
1.2.7 Setting up an effective supervisory mechanism to assure the assessment and activities reports would be submitted to the internships managing department within the legal deadlines or within a reasonable period, wherever there are no fixed legal deadlines.
