psychiatric training in russia: challenges and perspectives alexey pavlichenko, md, phd moscow state...
TRANSCRIPT
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Psychiatric training in Russia: challenges and perspectives
Alexey Pavlichenko, MD, PhD
Moscow State University Russian Society
Of Medicine and Dentistry of Psychiatrists
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Comparison of “psychiatric myths” among medical students and population in Russia
Psychiatric myths First-year students
Final-year students
Population
People become psychiatric patients by chance
36% 31% 33%
Mental illness is a result of lack of will
20% 13% 72%
Hex may result in any mental disorder 20% 16% 32%
Mental disorders are recompenses for one’s sins
24% 20% 17%
Mental disorders are communicable 12% 11% 13%
- Medical students’ opinions of psychiatry reflect the prevailing views in society rather than training in the specialty
Ruzhenkov V., Moskvitina U. Rus. Psychiatr. J. 2010; 4:34-38
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Differences between training curricula on paper and in practice in Europe
- There are significant differences in content and quality of training curricula across Europe
- In only 7 countries (24%) the curriculum was in line with training conditions in practice
- The most problematic issues of curriculum: psychotherapy, research and addictions
- The most common difficulties in the implementation of the psychiatric curriculum: lack of time; lack of appropriate rewards for trainers; lack of quality control measure; a shortage of supervisors
- Quality control measures in the most countries are absent or consist of formal questionnaires
Kuzman M. et al. World Psychiatry. 2012; 2:135
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Medical education in Russia
Undergraduate higher education (6 years) including psychiatric training (144 hours)
Postgraduate education
Compulsory Extended
Clinical residency
(the so-called
ordinatura): 2 year
Residencyship (the so-called
internatura): 1 year
Retrainer course:
500 hours
Refresher course:
1 time per 5 years: 144 h.
Postgraduate studies (the so-called
aspirantura): 3 years (PhD program)
Doctoral studies (the so-called
doctorantura): 5 years (Doctor of Science)
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Levels of psychiatric training
-First level
Medical school: course in psychiatry during fourth year of training
– 3 weeks (144 h.)
-Second level
Residencyship (the so-called internatura) – 1 year (1728 h.)
Clinical residency (the so-called ordinatura)- 2 years (3456 h.)
- Third level (Research)
Postgraduate studies (the so-called aspirantura): 3 years (PhD)
Doctoral studies (the so-called doctorantura): 5 years (Dr.Sci.)
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Challenges of psychiatric training at medical school
- Gap between content and quality of training curricula
and modern knowledge in psychiatry
- Insufficient duration of training (144 hours)
- Difficulties to provide training conditions in
psychotherapy, addiction and child psychiatry
- Teaching of psychiatry before other clinical disciplines
- Methods of assessment of knowledge is associated
with memorizing rather than understanding underlying
theories
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Teaching on psychiatric clinic
-Formal ward rounds (examine the patients, bedside
manner, “tricky” cases)
-Attending other hospital departments including
addiction’s, children’s, eating disorders’ ones
-Psychiatric interview: ask students to write down their
observations and discuss with a clinician afterwards
-Encourage self-directed learning: student’s clinical case
report, allow see “tricky” cases on their own, making
presentation Adapted from El-Sayeh et al. Adv. Psychiatr.treat. 2006; 12:182-192
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Additional forms of teaching
- Attending scientific conferences and congresses
- Duty at the admission department together with
clinicians
- Working in a psychiatric hospital as a medical staff
- Using modern technologies: teleconferences, webinars,
E-learning (“virtual learning environment”)
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Critical problems of teachers
- “Self-stigmatization” of psychiatrists
- Uncertainty of lecturer’ position (clinician, teacher or
researcher?)
- Low wages (two-three times less than the salary of adult
psychiatrists )
- Lack of motivation to improve the qualification
- “Burn out syndrome”: late for work, detachment, lack
of motivation, decline in the quality of teaching
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Perspectives of psychiatric training at medical school
- Combine psychiatry and psychology into a single discipline
- To focus on the psychosocial aspects of medicine and on non-pathological experience in the beginning of training
- Offering students an experience in other psychiatric settings including inpatient and outpatient services
- Methods of assessment of knowledge should be focused on understanding rather than memorizing
- To attract new technologies including E-learning
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Challenges of postgraduate educationMethodological
- Lack of quality control measures
- Disintegration of educational institution
- A general shortage of supervisors
- Lack of uniform standards of training curricula
- A shortage of teaching materials
Social and economic
- Reduction of state-funded
places
- Low material and technical
recourses
- Low wages for trainers and
supervisors
- Low motivation to conti-
nuous medical education
- Inappropriate clinical settings
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Supervision
NOW- One supervisor is
responsible for 5-10 trainees
- Lack of individual
approach- Only one theoretical
practice per two weeks- Control measures:
Pass/fail grading test -1 year
Certification exam – 2 year
POSSIBLE VARIANT
- Weekly individual
practice during 1 hour- Not more than 4 trainees
per a supervisor- Control measures:
Formal (training curricula,
exam, trainees’ diary)
Informal (privately,
academic background)Robertson J Adv. Psychiatr.treat. 2007
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Professional Examination
NOW- Computerized test (out of
date)- Oral interview with a
professor (quite a subjective opinion)
POSSIBLE VARIANT- Updated computerized test
in line with modern knowledge in psychiatry
- Oral interview including solution of clinical descriptions. Formalized criteria of assessment are required
- A certificate of Continuous medical education
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Continuous Medical Education
- Full-time/distance learning: lectures, webinars,
teleconferences, thematic improvement, forum
- Attending Scientific Conferences and Congresses
- Participating in case conferences
- Self-directed learning: self-education, research,
publications
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Challenges of postgraduate studies
-Absence of standardized training curricula for future
researchers
-Low technical resources (fMRI, medications)
-Low quality of PhD thesis in psychiatry
-Most of psychiatric research does not meet the
principles of evidence based medicine
-Absence of demand for future researchers
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Perspectives of postgraduate education- Harmonization of training curricula with the Directives
of the European Union of Medical Specialties (UEMS)- Increasing of duration of psychiatric training up to 3
(4) years- Reforming of postgraduate studies’ institutions (the so
called “aspirantura” and “doctorantura”)- Improvement of training conditions in practice
(material and technical resources)- Implementation of Continuous medical education’s
system
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The role of Russian Society of Psychiatrists in psychiatric training
NOW- The section on
Education of RSP - The traditional school
for ECPs each 2 years- Educational module for
specialists at the RSP’
website
FUTURE- Create of continuous
medical education’s system- Sign up the agreement to
WPA granted credits for CME
activities
-Provide mutual recognition
of psychiatric certificates - Motivate to continuing
education (grants, scholarship)
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Training in psychiatry in the EU and Russia: similarities and differences
Similarities1. Theoretical training (except for such issue as research methodology and
leadership)
2. Training in biological psychiatry 3. Training of old age psychiatry4. Supervision in psychiatry5. Quality assurance in specialist training in psychiatry
Differences 1. Training in psychotherapy (incl. individual supervision)2. Training in community psychiatry3. Lack of training in forensic psychiatry , addictive disorders and sexual disorders (subspecialities in Russia)
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Psychiatric training in Russia: perspectives
Compulsory postgraduate educationclinical residency in psychiatry (3 years and more)+
additional training in subspecialties (psychotherapy, narcology)
Continuous Medical Educationtraining and self-education
Medical College clinical psychology, psychiatry, pharmacology,
neurology, physiology, anatomy, pathology
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Conclusions
- Views of future doctors on psychiatry and mentally ill
people are wrong- Insufficient duration of training, outdated training
curricula and absence of CME are the main challenges of
psychiatric education in Russia- Postgraduates studies (PhD program) should be
reformed- The role of Russian Society of Psychiatrists should be
increased at all levels of psychiatric training