industry-sponsored postgraduate medical education: russian experience boleslav lichterman institute...
DESCRIPTION
Higher Medical Education in Russia six years at medical school (medical, paediatric or sanitary faculty of medical university) internatura - specialization for one year in a big hospital in one of three major fields: internal medicine, surgery or obstetrics and gynecology and/or ordinatura – a two year subspecialization ( in neurology, cardiac surgery, ophthalmology etc.) (optional) followed by aspirantura - a three year PhD program, academic degree (kandidat meditsynskikh nauk) after completion kandidatskaya dissertation (optional) doctorantura – a program for completion of second doctorskaya dissertation for getting highest academic degree (doctor meditsynskikh nauk) and becoming a professorTRANSCRIPT
Industry-sponsored postgraduate medical education: Russian
experience
Boleslav LichtermanInstitute for the History of Medicine, Russian
Academy of Medical Sciences, Moscow, Russia
Outline of presentation
• A system of postgraduate medical education in Russia, its benefits and pitfalls.
• A case of Russian Postgraduate Medical Academy.
• Suggested reforms and introduction of credit system.
• The impact of industry on continuing medical education and clinical practice.
Higher Medical Education in Russia
• six years at medical school (medical, paediatric or sanitary faculty of medical university)
• internatura - specialization for one year in a big hospital in one of three major fields: internal medicine, surgery or obstetrics and gynecology
• and/or ordinatura – a two year subspecialization ( in neurology, cardiac surgery, ophthalmology etc.) (optional)
• followed by aspirantura - a three year PhD program, academic degree (kandidat meditsynskikh nauk) after completion kandidatskaya dissertation (optional)
• doctorantura – a program for completion of second doctorskaya dissertation for getting highest academic degree (doctor meditsynskikh nauk) and becoming a professor
СТРУКТУРА МЕДИЦИНСКОГО ОБРАЗОВАНИЯ В РФ
БАЗОВОЕ ОБРАЗОВАНИЕ (6 ЛЕТ)
КУРСЫ ПОВЫШЕНИЯ КВАЛИФИКАЦИИ – 1 РАЗ
В 5 ЛЕТ ~ 144 ЧАСОВ
КУРСЫ ПЕРЕПОДГОТОВКИ> 500 ЧАСОВ
ИНТЕРНАТУРА – 1 ГОД (ПЕРВИЧНАЯ ПОСЛЕВУЗОВСКАЯ ПОДГОТОВКА)
ИЛИ ОРДИНАТУРА – 2 ГОДАИЛИ АСПИРАНТУРА – 3 ГОДА
МЕДИЦИНСКОЕ ОБРАЗОВАНИЕ В РФ
ОБЯЗАТЕЛЬНОЕ ПОСЛЕВУЗОВСКОЕ ОБРАЗОВАНИЕ
ДОПОЛНИТЕЛЬНОЕ ОБРАЗОВАНИЕ
ПОСЛЕДИПЛОМНОЕ (ПОСЛЕВУЗОВСКОЕ) ОБРАЗОВАНИЕ
Russian/Soviet system of postgraduate medical education is
• highly centralized • unified • state-controlled • state-sponsored
Refreshment courses (1-2 months, min. 144 hours) every five years at an institute (academy, faculty) of postgraduate medical education.
A Historical Outline• 1885 - Imperatorsky Klinichesky Institut (The Imperial
Clinical Institute) of the Grand Duchess Elena Pavlovna was founded in St.Petersburg
• 1920s - 16 postgraduate medical institutes were opened in former USSR
• 1930 – Central Postgraduate Medical Institute was established in Moscow ( now Russian Postgraduate Medical Academy)
• Currently there are more than 70 institutes and faculties for postgraduate medical education in Russia. 161.300 physicians studied there in 2000. The overall number of physicians in Russia is about 700.000.
Russian Postgraduate Medical Academy
• seven faculties • 112 chairs (departments)• research centre• publishing house, • three hostels • more than 2000 employees • the annual number of specialists who
refresh their knowledge exceeds 30.000.
Problems of postgraduate medical education
• standards of education are non-existent • the number of medical specialties (92 in
Russia (33 main and 59 additional specialties) vs 52 in Western Europe) is excessive
• qualification criteria are blurred • certificates are given automatically • postgraduate medical institutions do not
have their clinics
How to achieve the goals of CME?How to achieve the goals of CME?
Modernize normative base:- modernization of federal education standards, programs and tests- introduction of system CME credits- credits should be taken into consideration for certification of a specialist- and for licensing of healthcare institutions- regulation of CME procedures
Provide material base:— at medical universities (modern technical equipment and libraries, infrastructure for distance learning)— at healthcare institutions (access to modern sources of information, computerization, electronic libraries, internet etc.)
What is necessary for practical What is necessary for practical implementation of CME?implementation of CME?
Provide sufficient funding:— from federal sources (computerization of healthcare institutions, creation of National electronic medical library, equipment for university libraries, probation at foreign centers)— from regional sources ( creation of regional libraries, financing of conferences and seminars etc.)— from local sources (money for postgraduate training of healthcare providers, probations, participation in conferences, introduction of standards, creation of medical libraries)Motivate healthcare providers:—CME should have an impact on salary— compilation and publication of ratings ( of physicians and of HMO)— quality control of medical care
SuggestionsSuggestions
Healthcare providers should continuously improve their qualification and annually report their acquired creditsPrograms of postgraduate education should be updated according to modern requirements (distance learning, modern methods of education, good content, tests etc. )Overall volume of education activity should increase from 144 hours to 216 (288?) hours due to independent learning of healthcare providers (including learning at workplaces) and evenly distributed within 5 year period
In search of a compromise• “Introduction of Western model of postgraduate
medical education is unacceptable in Russian realities because it would destroy our system of education” (Romanyuk PF, 2004).
• How to accumulate credits? 2/3 might be provided by on-site education at
postgraduate medical institutions and 1/3 - by extramural education (attending conferences and seminars, writing of scientific papers, reading of medical journals and manuals followed by testing etc.).
In search of funding
• federal funding for CME is insufficient• education facilities are outdated• teachers’ salaries are low
Industry-sponsored postgraduate medical education
• At conferences and symposia• Via medical representatives• Sponsoring lecturers and opinion leaders• Conflicts of interest are often ignored
Problems• How many Russian physicians join international
meetings?• How often an ordinary physician purchase
medical literature or subscribe a specialized periodical?
• Are there many Russian physicians who have an access to reliable sources of information, systematic reviews and meta-analyses
• Do they have chances to use electronic databases or internet?
Russian pharmaceutical market
• Ca.17.000 different drugs are registered• More than half of then are imported• More than 90% of Russian drugs are simple pharmaceuticals or
generics• More than 400 pharma companies are working in Russia• Each medical representative has 1200 information contacts annually• Physicians put visits of medical representatives as the third
information source (after reference manuals and specialized medical periodicals) (a sample of 1298 physicians)
“Medical representative is fighting not for a market share but for the place in physician’s mind” (Budarina TN,2008)
Positive effects of relationship between physicians and pharmaceutical business
• Doctors are informed about the newest drugs
• Facilitation of getting these drugs• Possibility of additional professional
advancement and active participation in the life of scientific community
Negative possibilities of relationship between physicians and pharmaceutical
business
• Prescription of unnecessary drugs• Prescription of more expensive drugs• Possible mistrust of patients
“None of these normative documents [Russian laws and instructions] regulate relationship between a physician and medical representative of a pharmaceutical company. Interestingly, it cannot be the case because such regulation would contradict principles of the market economy” [Budarina TN, 2008]
A case of “Pfizer”
• In 2005 “Pfizer” was concerned by decrease of sales of Diflucan in Volgograd region. For promotion this drug local company representatives organized a boat trip on Volga river for medical doctors. The program included a round table discussion, dinner, handing drug samples to the participants (400 were invited, 600 arrived). After the event 6-month stock of Diflucan in pharmacies of the city and the region was sold within one week. (Budarina TN, 2008)
Johnson & Johnson education centers worldwide
Country USA Germany China (2 centers)
India(3 centers)
Russia and CIS
Year of foundation 1992 1991 2005 2005 2008
Territory (sq.m.) 4600 5000 5000 3000 3 000
Annual number of trained specialists
6000 14 000 10 000 10 000 3 000
Kazan Teaching Center of High Medical Technologies
Launched by the Ministry of Health in 2008with support of Tatarstan government and Johnson & Johnson company
Aim: to train qualified physicians for increasing availability of modern medical technologies for Russian population
Up to 3000 physicians might be trained annuallyTraining course lasts for 9 days (72 hours)
On course completion an official certificate is given
The lack of trained specialists in Russia
700
Orthopedic surgeons implanting joints
Endoscopic surgeons
Interventional neuroradiologists
220
1 100
3 000
2 400
13 500
Needed number
in RussiaSpecialists
Number of specialists
using high-tech methods
5 000 30 000Physicians 600.000
Surgeons 90.000
Education activitySince 2008 specialists are trained in:
Endoscopic surgery
Interventional radiology
Starting from 2009 training in:
electrophysiology
oncology
hematology
pharmacoeconomics
healthcare organization
Johnson & Jonhson plans to invest 10 million USD within a five year period for purchase of training equipment ( phantoms etc.) and teaching programs
Facilities of the Kazan CenterTerritory: 3 000 м2
Facilities:
• Seminar rooms with live translations from operative theatres in Russia and abroad
• Reading hall equipped with PC’s with access to internet
• Laboratories for training on stimulators • Operating room (dry-lab) for work on live
tissues • Conference-hall for 250 seats
“The problem is not in opinionated specialists but in the lack of common ethical space”
(Budarina TN, 2008)