What will happen to medical students after they graduate this year? Medical education is being shortened by a year: how will the quality of treatment change? Distribution of medical university graduates per year
No one can yet answer this question with confidence.
What is known for sure is that the Ministry of Education of the Russian Federation has approved the federal state educational standard, abbreviated as Federal State Educational Standard.
Briefly, the main provisions of this standard are that training is carried out only on a full-time basis.
The duration of education is 6 years.
The program has a structure consisting of 3 blocks.
Block 1 - disciplines
Block 2 - practices, including research work (R&D). By the way, research work is mandatory for obtaining a diploma. It is necessary to have at least one publication in your university by the time you graduate.
Block 3 State final certification, which is this moment is a mystery.
Internships have been completely abolished in medical universities since 2017.
Upon graduation, a medical student will have to choose either an expensive residency or go to work in a clinic as a general practitioner, local internists or pediatricians.
Such changes are dictated by the new educational standard.
It is well known that at present there is an acute shortage of primary care specialists, that is, therapists, for this reason the state has developed a new educational standard aimed at strengthening primary care.
Thus, yesterday’s students will be able to immediately go to work after receiving their diploma. Previously, they had to wait at least a year for this. Let me remind you that until last year, internship was considered a mandatory form of postgraduate medical education. Only those who chose residency or graduate school, which allowed them to master a narrow specialty, were exempt from it. All others had to become interns, that is, work for a year in a public medical institution under the supervision of a practicing physician. Only after this did university graduates receive a certificate giving them the right to practice.
Now students will receive practical training already in the sixth year of study, when they work under the supervision of their teachers, this is the so-called subordination. It is necessary to emphasize what most experts believe this position not entirely literate, explaining this fact by the fact that it is impossible to “shut up” the outpatient link with newcomers in the field of medicine, because almost 80% of all treatment depended on this stage. Such functions must be performed by qualified people who have already completed postgraduate education. The preparatory stage is very important, but it is impossible to work as a doctor immediately after being a student, because at a university they give theoretical knowledge, but practice can only be obtained in real working conditions.
Stage 1 and 2 of certification of medical students
Since 2017, upon graduation from medical school, students are required to undergo a final certification. The final certification includes stage 1, which is computer testing, after stage 2, a test of practical skills on simulator dummies, by the way, every medical university should have a simulation center where this stage is carried out. Based on the experience of last year, we can say that future dentists demonstrate on simulator mannequins the technique of filling a tooth, or pulling out a tooth.
Stage 3 is the interview.
It is expected that this stage will be carried out either by answering questions from an independent commission in person, or by the student sitting in front of a computer and by recording the answer on a webcam, his answer is also assessed by an independent commission.
After successful completion exams, young specialists can work as therapists in clinics or go to residency. The duration of residency training lasts from 2 to 5 years. The problem of admission to residency is the high prices for training and a small number of places. So in past years there were literally 10-15 in each specialty budget places, now you’ll be lucky if there is at least one budget place. The number of places on a commercial basis has also been reduced. All this is aimed at ensuring that young specialists go to work in primary care.
Every medical student is a potential primary care employee.
Development human resources is a priority task in the development of healthcare. The introduction of a new educational standard is designed to improve outpatient care in clinics. Often they lack primary specialists. However, it is necessary to understand that there is often a shortage of personnel there, not because there are no specialists, but because they exist, but prefer to practice in private clinics. Therefore, along with improving educational standards, it is also necessary to improve working conditions for doctors in the state. Uchr-x.
The scheme of education in medical universities in Russia has changed radically. Due to cancellation of internship Many are afraid that dropouts will come to clinics. The introduction of new medical standards divided doctors into two classes.
Since 2016, future local pediatricians and therapists begin studying under a shortened program, which involves six years of training. Potential surgeons, cardiologists and other medical specialists will have to spend 8 to 11 years studying.
As it was
Previously, all doctors studied for seven to eight years. It took six years to study at medical school, and then either an internship for a year or a two-year residency. Moreover, in some specialties it was necessary to go through both of these steps. However, for many medical specialists, one internship or residency to choose from was enough.
An intern and a resident are considered something like students in a medical institution, since they are not on the staff and do not receive salaries. They do essentially the same thing as a doctor, with only one difference - interns and residents perform all actions under the vigilant supervision of senior colleagues.
It is not surprising that many, trying to quickly get rid of this half-hearted status, choose a one-year internship as the next step after university. However, from 2017, medical graduates will no longer be tormented by such a choice.
How will it be
Now, starting from 2017, medical university students will be taught according to new educational standards. Immediately after the institute, graduates will have the right to immediately, without any additional training, work in clinics (as therapists or pediatricians). For these purposes, much more practical training was introduced for training students, both with patients and on simulators.
Rector of the First Moscow State medical university named after I.M. Sechenov, Professor Pyotr Glybochko shared his thoughts on how the new education system will be implemented:
“Now, in the first year, educational practice in caring for therapeutic and surgical patients is expected. In this regard, it is planned to introduce a training module “Basics of Patient Care” in the amount of 36 hours (24 hours will be allocated for practicing skills on dummies and simulators in our own training room training center and 12 hours for practice in clinics). Sophomores will study “the fundamentals of nursing” for 72 hours, and they will also have work and practical training in the simulator training center.”
For third-year students, they want to add hours of practical courses in emergency medical care. They are going to develop additional training modules for fourth- and fifth-year students in specialized departments of surgery, therapy, obstetrics and gynecology.
And here, too, you cannot do without simulators and dummies. In the sixth year, classes on medical simulators will be held in the form of consultations with teachers from departments of the chosen profile.
“A medical university graduate must be ready for independent work immediately after receiving a medical degree. Let this be primary health care - outpatient clinics - but our graduates will be prepared for this work already during the standard university program,” summed up the rector of the First Medical University.
However, not all teachers in the field of medicine see such bright prospects. Simulators and dummies are, of course, good, but they cannot replace living patients.
“In my opinion, immediately allowing graduates to work with patients would be a big mistake. A doctor needs certain skills for this,” Professor Viktor Frolov, dean of the RUDN Faculty of Medicine, expressed his concerns.
Also, the overwhelming majority of specialists seriously doubt the productive work of yesterday’s students in clinics. It is unlikely that the skills acquired at the university will be enough, but after the introduction of new standards, graduates will have even less knowledge.
“To free up time for practical training, we had to narrow the programs in certain areas of medicine, such as neurology or, for example, surgery. These courses will be taught in a more general, theoretical form,” explained the Ministry of Health and Social Development.
It turns out that if previously a medical graduate was something like a “universal soldier” who could, with the help of a medical reference book, understand most diseases and pathologies, now certified local doctors will have only a theoretical understanding of many diseases.
Graduates of higher medical educational institutions are required to undergo primary postgraduate training - residency. With its help, future doctors are able to develop independent skills and achieve a certain level of mastery in such a difficult task as providing emergency medical care to the population.
Residency 2017 includes not only testing in medical specialties, but also conducts a qualifying stage based on passing exams. Resident education is considered expensive, since the cost per year is comparable to paying in advance for 2-3 courses at a medical institution.
Latest news about residency
Since 2016, graduates of medical schools in some specialties can immediately return to work, bypassing years of internship. Its abolition in the healthcare system will allow future doctors to limit themselves to two years of residency training. However, before entering residency, the student is required to work for three years in a medical institution.
As soon as three years of work experience have been completed, the future graduate has the right to submit the appropriate documents for residency training. Officials of the State Duma of the Russian Federation are proposing a new health care reform. According to them, residency is a mandatory area of postgraduate education for young doctors. After all, at the stage of obtaining residency training, the student will receive a narrow specialization. However, news about residency 2017 in the provision of highly specialized areas is being finalized.
Features of resident education
Students medical universities are required to go through a qualifying stage, on the basis of which low-skilled personnel are eliminated. Obtaining a residency education opens the door only for those students who have successfully passed entrance exams. The preliminary selection of candidates for residency is tough and unprincipled. Those who have passed all exams with “A” grades and passed a serious interview with doctors and professors of medical sciences can count on training.
The cost of residency in 2017 is not cheap. One year of residency training is equal to three years of medical school tuition. For cost educational services influenced by the following list of factors:
- applicant's specialization;
- territorial affiliation of the university (district of federal significance);
- prestige of the medical university;
- availability of competent teaching staff, etc.
Unlike internship, residency training specializes in graduating doctors individual practice. Such doctors open their own highly specialized clinics and treat people in practice instead of reading medical literature and delving into theoretical knowledge.
What changes are expected in 2017
Already in 2017, significant changes can be expected in residency training. For certain specialties, training will last one year. However, during this time, the medical university student will gain practical knowledge, experience and test his skills and strengths as a competent medical staff.
Changes in residency since 2017 will closely affect the knowledge base of graduates. The training program for the training of medical specialists will be tough and complex. However, as experts say, in this way you will achieve a catastrophic shortage of doctors in various specialties.
Changes in residency will affect quick preparation doctors Now eternal students will become practitioners and learn to provide first aid medical care. However, from 2017, residency training will become modular. For neurosurgeons, cardiac surgeons and plastic specialists, the training period will be up to five years.
Graduates of medical universities in St. Petersburg have passed state exams and are preparing for three-stage primary accreditation. Those who successfully pass it will receive a certificate of accreditation - a document with which they can get a job as a local therapist or pediatrician in a clinic starting from August 1.
Graduates have two options: someone will be able to enter residency, this is about 40-45% of total number 6th year students, the rest will go to work for us in primary care,” Chairman of the Health Care Committee Valery Kolabutin reported at a meeting of the St. Petersburg government. According to him, thanks to the innovation from the Ministry of Health, a double increase in young specialists is expected in clinics.
Let us remind you that in the midst of state exams Ministry of Health No. 212n “On approval of the Procedure for admission to training in educational programs higher education" Graduates regarded it as an obstacle to entering residency. On the one hand, they heard that there will be changes this year, but they only found out what changes now. In accordance with the order, their fate will largely be determined by a single test within the framework of accreditation. But in addition to testing, achievements for all previous years of study will be taken into account, each of which is assessed in points. Yesterday's student receives the largest number of points for medical experience acquired during or after training. For those who do not achieve the required number of points, but receive accreditation, the direct path is to local therapists or pediatricians. Moreover, the number of “free” budget places in universities has been sharply reduced: it is assumed that mainly “target students” will study at state expense, since there is a shortage of doctors with “narrow” specialization in the regions. IN major cities In rural areas, on the contrary, there is a shortage of therapists.
When the order came out, everyone was nervous and worried, it caused a resonance in the student community, say graduates of First Honey. - Now everyone is calming down, looking for ways out of the situation. Of course, residency training is mostly done for commerce. But there are few places there either. The rest are forced to either change their chosen specialty, become therapists, or leave medicine. And many, probably 25-30%, are inclined to choose the latter option.
Repay
The system proposed by the Russian Ministry of Health will be tested for the first time this year. This is an attempt to fill the shortage of doctors in primary care. For a long time, the Ministry of Medical University Graduates has been trying to solve this problem.
To distribution from the Soviet medical system high school V pure form We couldn't go back - it would be illegal. Although there was logic in it - if you are studying at state expense, be so kind as to repay the debt to the state, and then do what you want. The same logic works in the current situation, when, says the Vice-Rector for educational work First St. Petersburg Medical University
Of course, the Ministry of Health does not force graduates into clinics. But against the backdrop of a reduction in budget places for residency and changes in the rules for admission to it, the choice for many becomes obvious. 6th year student of the Faculty of Medicine, PSPbSMU named after. Pavlova Elena Artemyeva wanted to continue her residency training and become an otolaryngologist. According to the new rules for admission to residency, she has all the advantages for admission - a diploma with honors, participation in scientific and social activities, experience working in a medical organization. However, there are simply no budget places in her specialty based on the general competition at First Med. All of them are distributed between target audiences and “payers”. Target direction The girl was unable to obtain, despite appeals to medical institutions and authorities:
The fate of those who are not ready to pay for residency has been determined - let’s go work in local therapy,” says Elena Artemyeva, she has already come to terms with future work in the clinic.
Andrei Yaremenko does not see anything unusual in the fact that the state is reducing opportunities for doctors to obtain a narrow specialization every year:
Every person wants to be unique and get a lot of money. But the state needs doctors with minimal qualifications in maximum quantity and with a minimum wage. This is an eternal conflict between man and state, and not only in Russia. For example, if you want to become a professional, you need to go through a huge and difficult path and invest a lot of money in your education. If you are ready to be a general practitioner, then simply write an application and they will immediately send you to work somewhere in Oklahoma, notes the vice-rector.
Future doctors are most frightened by patients
The trouble is that many schoolchildren, when choosing a profession, do not go into medicine, but into prestigious university. They study well and, as a rule, receive diplomas with high scores and go into the industry. Then there is a meeting with the patient and it turns out that the dad who can “resolve the issues” is not around, but there is a patient who was dissatisfied with the quality of treatment and has complaints. Meeting a patient face to face can be very dramatic. Unfortunately, not everyone is ready for it, just as they are not always ready for small initial salaries. These people leave healthcare almost immediately.
Therefore, for the chief therapist of St. Petersburg, Vadim Mazurov, the admission of graduates to work in clinics raises many questions.
They will have to immediately plunge into real life and work. It is not yet clear how ready they are for this,” says Vadim Mazurov. - Is the graduate’s level of training sufficient to prescribe instrumental and laboratory examinations? Will he be able to maintain documentation, engage in prevention, medical examination? Will be able to prescribe drug therapy to the patient, choose between the original drug and the generic, evaluate possible side effects? Of course, prepared by leading specialists, which the therapist uses in his work. But when patients with ARVI, coronary heart disease, irritable bowel syndrome come to him within an hour... You immediately need to have a whole library on the table in order to take advantage of the opportunities clinical recommendations. This type of work is a huge burden that requires serious preparation. I worry about these children.
According to Vadim Mazurov, administrations of institutions have not yet encountered such young and inexperienced specialists, so this year they will also need special attention and patience. After all, even after residency training, only a few young specialists came to work in clinics, and the personnel shortage was solved mainly by doctors from other regions of the country who already had work experience. According to him, for a graduate to feel at least relatively comfortable in a new position, it will take at least two years of work. “These guys will need help, identify mentors and prepare all the conditions for work,” says Vadim Mazurov.
The graduates themselves also count on support:
Of course, all students worry whether they will cope with the work. Perhaps at first we will be in the same office with a more experienced doctor,” says student Elena Artemyeva. - But we still have the skills - the last practice after the fifth year was at the clinic, the new educational standard prepared us for the work of a local therapist. And for depth of knowledge there is always a reference manual - it is not prohibited to use it.
At PSPbSMU named after. Pavlova note that they are ready to help their students - for this there is a Center for Interaction with Alumni and the possibility of telemedicine consultations:
They always have the opportunity to talk with a university representative if any problems arise. What's the worst thing? When a sick person comes to you, and you don’t understand what’s wrong with him, says Andrei Yaremenko and asks to treat graduates with trust. - Every year during the flu epidemic we send 6th year students to work in clinics. And we receive a lot of grateful feedback; they are attentive, intelligent, and will listen and help.
At the same time, Andrei Yaremenko admits that it is still difficult to call a graduate a full-fledged doctor who can carry out the entire scope of diagnostic and therapeutic measures.
It seems to me that there should be some kind of intermediate position between the exit of the future doctor from the university and the beginning of his wide professional activity. When in Germany a person receives driver license, he must drive for some time in the presence of a more experienced driver. Something similar should be here. At one time there was a wonderful position - a trainee doctor. It was created for doctors who had a break from work for more than 5 years. They received a salary, but worked with a mentor. Only after this did they go full-time. There is also some kind of internship abroad: a young specialist has a mentor, he works in a team, absorbs medical traditions, and this is how he develops as a doctor, says Andrey Yaremenko.
Forecast: Those who came to medicine “for love” will remain
To find a place in the district clinic, First Med graduates can use a specially created database of vacancies. The number of proposals, according to Andrei Yaremenko, is sufficient for everyone. But the problem is that many of the graduates do not need these jobs - they simply do not want to go work as local therapists.
Everyone has a dream. Let’s say a student dreamed of becoming the director of an aviation medicine clinic. The first goal on the way to his dream is to get into a clinical residency in extreme medicine. And now he has been given a serious barrier in the form of working in a clinic. And if he doesn’t want to work as a local therapist, he won’t do it,” notes Andrey Yaremenko.
According to Vadim Mazurov, even those students who go to work in clinics, “not out of love,” but out of despair, are unlikely to remain in primary care for a long time. This threatens clinics with staff turnover - young doctors will work for a certain period of time and again try to get into residency in their favorite specialty.
- This is another one possible problem for the heads of the institution - they trained a young specialist, created comfortable conditions for his work. And after a couple of years the person thanks them and says goodbye. But, on the other hand, there is no other way out of the current situation with the shortage of doctors in clinics. Maybe not everyone will run away in the end. When I see a young therapist while conducting certification, I usually ask why he works in primary care. Many answer that they simply liked it here and wanted to stay, says Vadim Mazurov.
At the same time, the chief therapist of St. Petersburg asks patients not to be afraid of young doctors:
“I think this still will not affect the level of examination and treatment of patients. After all, it depends not only on the therapist. Subspecialty specialists will also take part in the treatment. But there is also a catch here - the main thing is that a medical school graduate does not become a dispatcher, redirecting his patients to other doctors for backup. With this approach, we will not prepare a good specialist.
Katerina Reznikova
Doctor Peter
According to the new standards, get additional specialties doctors will be able to do residency after undergoing accreditation in a special center.
(Kazan, July 8, Tatar-inform, Nadezhda Gordeeva). In Russia, starting from this year, internships for graduates of medical universities are cancelled. In 2017, former students will begin to “emerge” from universities as local therapists and pediatricians. The rector of KSMU, Alexey Sozinov, announced this in an interview with Tatar-inform news agency.
As the agency’s interlocutor clarified, to receive additional medical specialties Residency training will be required, lasting from one to five years. As well as obtaining accreditation. Special attention will be given practical classes and visiting medical simulation centers.
“At the stage of an objective-structured clinical exam, a young doctor performs a certain type of task related, for example, to providing emergency care to a person. Assignments are formed depending on the specialty. And this is controlled by all accreditation commissions, the composition of which is approved by the Russian Ministry of Health. The commission includes representatives of professional associations, the university community, and employers. After passing these stages, you can receive personal accreditation to work at the level of a general dentist, pharmacist, or general practitioner,” he said.
After a certain period of training, an aspiring doctor will be able to obtain accreditation for new specialties. “Accreditation is one of the new products that appear in the system of admitting doctors to professional activities,” noted the rector of KSMU, adding that it applies to all medical workers who will thus confirm their qualifications.
A. Sozinov said that a federal methodological center for professional accreditation has been created in Moscow. “This year, dentists and pharmacists received accreditation. Nurses will appear in this system from 2018. Only from the methodological center can you receive an assignment. Each accredited person registers with the federal center and receives access and assignments from Moscow. At the first stage, testing takes place online. One of the principles is minimal human participation, everything is automatic. About 5 thousand have been trained for dentists. test tasks, for pharmacists - more than 3 thousand. They are in the public domain, you can study and prepare. If you score less than 70 out of 100 points, you just don’t get further,” he said.
A. Sozinov recalled that previously working doctors and nurses had to “go through a cycle of improvement” once every five years - pass an exam and receive a certificate. "Now, by new system, a doctor must continuously complete 50 credits of educational activity each year. WITH in English"credit" is translated as "trust". That is, in fact, a person should devote one hour a week to learning something new. You need to earn at least 50 credits a year, and 250 in five years. If you don’t score, you won’t be allowed to be accredited,” he explained.
Existing specialists will need to improve their skills in educational organization, attend trainings, conferences, seminars, etc. “It is necessary to prepare abstracts for symposia, conferences, and seminars held by public and professional medical organizations accredited at the federal level, not for profit. Training in educational interactive modules on the Internet is necessary; a special website has been created for this,” noted the rector of the university. “The completion of this system and admission to the next cycle is personal accreditation.”
“The new system is based on the ideology of quality. We proceed from the fact that the doctor must meet the requirements - professional standards. If you don’t comply, it means you can do more harm than good,” he believes.
According to the representative of the medical university, as a result, an account of the quantitative and qualitative training of specialists will be formed, and there will be an opportunity to develop in the direction necessary for Russian healthcare. “If a doctor does not meet the requirements, then his work experience and experience may not be in demand,” he assured.
A working doctor, according to him, needs to compile a so-called “portfolio” within five years - “treatment results, characteristics from the place of work, reviews from patients,” etc. “At the same time, testing and interviews will remain. But instead of simulators there will be real life"- emphasized A. Sozinov.
He also clarified that five years will pass between initial and repeated accreditation, but during this period it is possible to undergo initial specialized accreditation. “A doctor can acquire fundamentally new competencies and master new technologies,” concluded the rector of KSMU.