Historical background and current situation of pharmacy education in Mongolia

Abstract

In Mongolia, the medical education system with a long history has developed with its characteristics since ancient times. Modern medical education, including pharmacy education, began to grow in 1921. Before modern pharmaceutical science developed in Mongolia, pharmacy and pharmacy education were part of Traditional Mongolian Medicine and education. Medical knowledge and experience were transferred from generation to generation through simple teaching. From the sixteenth century, Manba Datsan was established in religious temples to teach Mongolian medicine through discipleship. Modern pharmacy education in Mongolia began in 1926 with the course training of pharmacy technicians, and pharmacist training started in 1961. Pharmacy technician training with a 3-year and pharmacist training with 5-year programs oriented on patient-centered pharmaceutical care are implemented in Mongolia. Pharmacy technicians can also study towards a B. degree in Pharmacy with an additional 3 years of training. As of 2023, seven state-owned and private higher education institutions offer pharmacy education and the number of institutions and students of pharmacy is expected to increase. The pharmacy education policy and the license examination type may be reformable, and the curricula should be regularly updated in line with international trends.

Introduction

Higher learning in Mongolia has been closely related to its history of statehood since the establishment of the Khunnu Empire in the third-century BCE and the Great Mongol Empire in the thirteenth century.[1] Traditional Mongolian medical knowledge was passed on over generations through private practitioners, who obtained their medical knowledge from the elders and through educational and faculty systems established in the sixteenth century.[2] Medicine was one of the ten subjects studied by disciples at monasteries and home tutoring with Buddhist monks until the early twentieth century.[1] After the People’s Revolution in 1921, the modern education and health system, including a pharmacy, began to develop in Mongolia, and the training of health professionals started. A sanitary and pharmacy technician course was organized in 1926; a 2-year formal nursing course, a foundation of modern medical education in Mongolia, was opened in 1929. In 1931, the Human Medical College was established to train health specialists such as nurses, feldshers, pharmacy technicians, and others.[3]

Because the higher education system was not developed in Mongolia, higher professional specialists were trained in countries such as the Soviet Union (USSR) and Germany till the first university was established. The first national institution for formal higher learning, the Mongolian State University, with three departments: pedagogy, medicine, and veterinary medicine, modeled after universities in the USSR, was established in 1942 in Ulaanbaatar.[4] In 1954, the first Mongolian pharmacist graduated from the USSR, and pharmacists have been trained in Mongolia since 1961.

Few articles about Mongolian pharmacy education have been internationally published, and little is known about its history. This report will provide an overview of the general understanding of past and present pharmacy education in Mongolia.

Historical Background

The history of medical education in Mongolia has six periods [Table 1].[3]

Table 1.

The historical periods of Mongolian medical education

Periods	Duration	Feature
Healing, recognition, and learning the art of medicine	From the Khunnu Empire to the sixteenth century	The transfer of medical knowledge and experience from generation to generation through simple teaching is considered the beginning of medical education’s development.[3]
Traditional medicine developed	From the sixteenth century to the middle of the nineteenth century	Manba Datsan, a particular school, was established in some religious temples to teach Mongolian medicine through discipleship. Doctors were trained to master the skills of treatment and nursing, and well-educated doctors enrolled in other advanced training to get a Maaramba degree. Doctors improved their profession by translating and annotating Indian medical books, inviting renowned doctors and scientists from abroad, and studying in India and Tibet.[3]
Medical Datsan and apprentice training developed and expanded	From the middle of the nineteenth century to 1921	The national medical education system was expanded and strengthened. The oriental medicine concepts were passed from the doctors and Maarambas to the younger generation through discipleship at the Manba Datsan.[3]
Western medicine was introduced based on traditional medicine, and health professionals were trained	1921–1942	Modern medical education developed, and health professionals were trained. Training of pharmacy technicians started with a course in 1926, and formal training began in 1941.
Health professionals were educated at a national university	1942–1990	The National University was established, and higher education for health professionals, including pharmacists, started. Specialized training for pharmacists has begun, and a system of professional degrees for pharmacists has been introduced.
The transition from the conventional system to international standards	Since 1990	Private universities and colleges were established, education reform started, and a credit system was introduced in higher education.

Pharmacy and pharmacy education were closely connected with Traditional Mongolian Medicine and education and were one part of them before 1921. The history of pharmacy education is covered in this report since the development of modern pharmaceutical science in 1921.

Western medicine was introduced based on traditional medicine, and health professionals were trained (1921–1942)

In 1923, when Mongolia’s first Western medicine pharmacy was established, there was no pharmaceutical staff or medical school, and the optimal solution was to train Mongolians through on-the-job training. Soviet specialists, who worked in the pharmacy, trained Mongolians, and they were first accustomed to pharmacy, then gained knowledge of pharmacy and learned about professional activities. A well-trained person was selected to work in the pharmacy under the supervision of a Soviet specialist.[5] In 1926, a pharmacy technician course, the first training for pharmaceutical specialists in Mongolia, opened at the Red Army.[3] Pharmacy technicians trained in short-term courses till an official permanent course started in 1937.[5] 3-year training of pharmacy technicians officially began in 1941 at the Human Medical College, the only educational institution for pharmacy technicians until its closure in 1993.[6]

Health professionals were educated at a national university (1942-1990)

In 1960, only six national pharmacists graduated in the USSR, and 463 pharmacy technicians worked in Mongolia.[7] As the population grew and the health sector expanded, the demand for health professionals, including pharmacists, increased. In 1961, when the Medical Institute (current Mongolian National University of Medical Sciences—MNUMS) separated from the Mongolian State University, the foundation of the present School of Pharmacy, MNUMS, the only institution for pharmacists training until 2000, was established. The lessons were taught in Russian by lecturers invited and graduated from the USSR. When pharmacist training started in 1961, the terminology of the specialist trained for 3 and 5 years was the same as a pharmacy technician. This caused doubt in understanding the difference between training and profession, leading to the temporary closure of pharmacists’ training. There were no admissions in 1965, 1967-1973, and the training was restarted under the name of a pharmacist in 1974.[7] By 1972, 157 pharmacists had graduated in Mongolia, 94.6% of pharmacists worked in Ulaanbaatar, and the number of pharmacists and pharmacy technicians per 10000 population was 1.4 and 6.0 with a ratio of 1:4.4.[8]

During socialist society, the state owned all property, and the institutions served as a training base for educational institutions. Pharmaceutical organizations, the Central Drug Testing Laboratory, and the hospitals were a training base for pharmacy education. As the activities of the pharmaceutical sector expanded, there was a need for specialized pharmacists. The Medical Institute, the Central Drug Testing Laboratory, and the Pharmaceutical Factory have jointly conducted specialized training since 1974. Since 1979, professional degrees have been given to pharmacists.[7] Pharmacists have received academic degrees abroad since 1972 and graduate training for pharmacists in Mongolia began in 1989 at the Medical Institute with Ph.D. training.

The transition from the conventional system to international standards (Since 1990)

After society changed in the 1990s, the higher education sector was transformed from a single, state-run multipurpose university into a decentralized group of specialized universities.[9] The Medical Institute was designated as a university in 1991. The values of autonomy and academic freedom of universities were redefined and reflected in legislation, and educational institutions had the privilege to appoint their instructors, set their admission policies, and confer degrees.[9,10] There was a reform in the education system, which was stimulated by the situation following the break-up of the USSR.[1,4] Due to Mongolia’s reduced budget allocations in 1993, higher education institutions began charging fees and introduced a credit system.[11,12] There was no master’s degree course in Mongolia before the higher education reform, and it was implemented in the early 1990s.

The pharmacist curriculum has been updated several times with two significant changes. With the collapse of socialist society, certain political subjects were withdrawn from the curriculum in the early 1990s. The last major revision of the curriculum focused on patient-centered pharmaceutical care. MNUMS began revising the pharmacist curriculum in the mid-1990s; only some subjects were included initially. Radical revision began in 2005, and the revised curriculum with 21.8% changes was implemented in 2008. Since 2012, a 3-year pharmacist training for pharmacy technicians has been implemented. The first pharmacist and pharmacy technician curricula were accredited in 2011 and 2012, and MNUMS competence frameworks were approved for pharmacists in 2016 and pharmacy technicians in 2018.[7]

Current situation

In Mongolia, higher education offering diploma, bachelor, master, and doctorate curricula is provided by universities, institutes, and colleges. A significant difference between these three categories is that universities provide various degree programs, institutes offer programs up to master’s degrees, and colleges give vocationally oriented bachelor degrees and non-degree programs.[1]

Graduates of secondary schools are admitted to pharmacy technician training with a 3-year and pharmacist training with 5-year programs oriented on patient-centered pharmaceutical care according to the general entrance examination score. Pharmacy technicians can also study towards a B. degree in Pharmacy with an additional 3-years training. Pharmacists are specialized and can apply for master’s and postgraduate training [Figure 1].

Figure 1.

The education system for pharmacy in Mongolia

In 2022, 3875 students studied pharmacy in seven universities and institutes out of 148954 students in 88 higher education institutions. Pharmacy students accounted for 2.6% of higher education and 15.9% of health students. 13.1% (508) of all pharmacy students studied for a diploma, 81.8% (3168) for a bachelor, 4.7% (184) for a master, and 0.4% (15) for a doctorate.[13]

There has been a steady increase, from 1448 pharmacists and 1790 pharmacy technicians in 2015 to 2949 pharmacists and 2024 pharmacy technicians in 2021. The ratio of pharmacists to pharmacy technicians has changed from 1:1.23 in 2015 to 1.46:1 in 2021. In 2021, the number of pharmacists and pharmacy technicians per 10000 population was 8.65 and 5.94, respectively. 56.3% (1660) of pharmacists and 35.7% (723) of pharmacy technicians were employed in Ulaanbaatar, and 1289 (43.7%) pharmacists, 1301 (64.3%) pharmacy technicians worked in rural. As of 2021, 4973 pharmaceutical professionals worked in Mongolia: 78.6% (3909) worked in 2335 community pharmacies, 5.1% (252) at 444 pharmaceutical suppliers, 14% (697) at hospitals, and 2.3% (115) at other facilities.[14]

The number of institutions engaged in pharmacy education and students is expected to increase. More than 400 pharmacists graduate annually, which will likely increase to more than 700.[13] International accreditation of curricula and implementation of national frameworks for comprehensive competencies are essential. Identifying the areas and components and effectively promoting professionalism are important issues in medical education.[15] The pharmacy education policy and the license examination type may be reformable, and the curricula should be regularly updated in line with international trends. As the world recovers from the COVID-19 pandemic and the current healthcare system is reevaluated, health education programs are a crucial consideration that can tremendously impact citizens’ lives worldwide.[16]

Conclusion

The pharmacy was not separately developed from Traditional Mongolian Medicines before the People’s Revolution; pharmacy education was closely connected with traditional medical education. Modern pharmacy education has grown in Mongolia since 1921; pharmacy technicians were first trained, and later, training for pharmacists started. Currently, seven higher education institutions are engaged in pharmaceutical education, and both pharmacist and pharmacy technician curricula focus on patient-centered pharmaceutical care. The pharmacy education policy and the license examination type may be reformable, and the curricula should be regularly updated in line with international trends.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.