St Petersburg University is increasingly asserting itself as a modern institution of higher education engaged in teaching and research in the field of medicine and health.
Thus, for instance, the University has received megagrants of the Russian Government to develop medical science in the field of autoimmunity and creation of targeted drugs. There is also a resource centre at SPbU involved in nuclear medicine development. Translational biomedicine is being actively developed as well. It is an interdisciplinary field combining the achievements of clinical medicine and cutting-edge inventions in biology, genetics, chemistry, and physics.
A clinical complex detached from the N. I. Pirogov National Medical and Surgical Centre became affiliated with St Petersburg University — since the start of 2018 a medical clinic has been part of the University. It receives patients and conducts research focused on practical results that can be applied in medical treatment. St Petersburg University continues networking with clinical facilities — medical organisations of St Petersburg and Leningrad Oblast where SPbU students and clinical residents have practical training during the academic year.
To date, about 90 contracts have been signed with these facilities to provide practical training for the students of the "General Medicine" programme; about 20 contracts have been signed for the "Dental Medicine" programme. One of the areas that caused the need to update all the work in recent years was the transition to the system of continuing medical education (CME).
What is CME?
The community of doctors refers to continuing medical education as a procedure for the doctor's professional formation. In other words, CME is a new form of continuing training for medical workers in Russia (including professional development). It differs from the old system primarily by its continuity; another new thing is the use of cutting-edge technologies including electronic, remote and simulation ones. It is also important that the CME model participants build their own track of training, that enabling them to obtain the knowledge and competencies they personally require. Meeting the general workload requirements is an important prerequisite for participation in the model: regardless of his/her individual curriculum, the participant has to complete 250 academic hours (credit points of the workload) in the five years of training, the annual workload being 50 hours or more with 36 hours allocated to educational programmes, and the remaining 14 — to scientific and educational events such as conferences and seminars. As a result, doctors are provided an opportunity to be educated and improve their knowledge and skills, while the healthcare system is staffed with competent medical personnel, and patients receive — as a result — high-quality treatment.
Admission to work
Since the beginning of 2016, the doctor's certification procedure has been replaced in Russia by a new procedure for admission to professional activity — specialist accreditation. It is gradually being implemented now. Its four transition stages will last until 2025. Young doctors undergo their first accreditation when graduating from universities. SPbU graduates in the main field of study "General Medicine" passed the primary specialist accreditation in 2017 and were granted five years' admission to professional activity. SPbU graduates in the main field of study "Dental Medicine" received accreditation for the second time in the recent two years. Starting from the next year, students of the middle level professional educational programme "Nursing" will have to pass accreditation, too.
To pass it successfully, one usually needs to go through three stages:
- a computer test;
- demonstration of practical skills on phantoms (special simulators) at several "stations"
- passing an interview and being able to solve certain interdisciplinary situational clinical problems
Examination boards formed by the Russian Ministry of Health annually include independent experts in various fields of medicine — heads of medical organisations, heads of departments, doctors practicing at hospitals, polyclinics and medical centres. The boards are formed in such a manner as to ensure complete impartiality and independence in assessing the quality of university graduates' training.
Yet accreditation includes admitting to work not only young specialists who have just finished their studies. Throughout his or her professional career, any doctor will, every five years, have to undergo tests designed to prove the level of competence allowing the doctor to work with patients using up-to-date scientific knowledge and modern technologies. The moment of successfully passing the first (or yet another) accreditation is the moment of entering a five-year cycle of continuing medical education. For each doctor an individual plan will be drawn up: enrollment on additional educational programmes as well as participation in conferences, seminars, master classes and webinars.
Training SPbU students
As one of the largest educational and research centres in Russia St Petersburg University is working on the introduction of the CME model in several areas, all of that being duly documented by the Rector's orders. Thus, the educational and methodological support of the programmes in the main fields of study "General Medicine" and "Dental Medicine" as well as "Nursing" is being gradually developed and constantly updated. The contents and requirements of these programmes allow the students to be well-trained for accreditation by the time of graduation. This work is also supported informationally. The information on SPbU's educational programmes and activities is published on the official website of CME. New educational programmes for doctors and other specialists are developed, too, while the existing ones are upgraded.
It is important to note that SPbU's educational programme "General Medicine" has several important features, including the fundamental and — which is also significant — interdisciplinary character of training. The humanities and natural science disciplines are taught by lecturers belonging to various research teams, institutions and faculties. For example, students of medical programmes learn foreign languages until their proficiency reaches the B2 level of the Common European Framework of Reference and are instructed by teachers of linguistics. The same approach is used in training dentists.
It is significant that medical training is practice-oriented: in addition to practicums and work placements throughout the whole period of study, the graduation year is devoted to a multidisciplinary pre-graduate internship that includes disciplines in surgery, therapy, obstetrics, gynaecology and paediatrics. In addition, the clinical training of SPbU students is efficient due to the application of modern technologies including interactive, remote, and simulator-based training. All that allows the students to approach graduation being confident in their knowledge and skills and become full-fledged participants of the CME model.
The goal of the CME transition is to make university-based medical education meet the modern requirements of the medical profession and science.
Marina Lavrikova, SPbU Vice Rector for Academic Affairs and Methodological Support
Our objective is to contribute to the development of the health sector. This includes, among other things, training personnel possessing the required competencies. In our case CME is a tool of "watches synchronisation", an indicator of how well we meet modern requirements," noted Marina Lavrikova, SPbU Vice Rector for Academic Affairs and Methodological Support. She also highlighted that today education, science and practical activities are inseparable and that is a requirement of modern time dictates: science must develop for the sake of medicine development.
Professional development and retraining
Today, St Petersburg University offers many additional educational programmes that are part of the CME cycle, including "Modern Approaches to Primary and Secondary Prevention of Cardiovascular Diseases", "Correction of Dyslipidemia Under Conditions of Resistance and Poor Tolerance of Lipid Lowering Therapy", "Computer Tomography in Diagnostics of Rounded Formations in the Lungs. " These SPbU programmes and many more aimed at professional development and retraining can be found on the Internet portal for continuing medical education, a website making it possible to systemise information on educational organisations and professional communities offering their programmes throughout Russia.
"SPbU programmes are actively featured on this portal, as well as programmes offered by hundreds of other organisations, very small and very big. The filtering system allows the user to choose a particular institution, for example SPbU, and see all the courses that we offer, or to indicate a specialty — and then other universities will be listed, and you will be able to compare the dates, tuition fees and other conditions. The availability of SPbU programmes on the portal gives the University an opportunity to participate in the implementation of programmes that are funded by the MMIF (Mandatory Medical Insurance Fund)," said Elena Tregubova, Deputy Director for Academic Affairs and Research at the SPbU Institute of Osteopathy, Secretary General of the Russian Osteopathic Association.
"The CME portal does provide for individual organisation and recording of the educational activity of medical workers. Our Centre for Additional Educational Programmes in Medicine, Medical Technologies and Dentistry promptly publishes new educational programmes on the portal, tracks user interest in them and invites doctors to undergo further training at St Petersburg University," noted Sergey Podsadny, Director of the SPbU Centre for Additional Educational Programmes in Medicine.
The CME model provides for the introduction of the most up-to-date educational technologies, i. e. various forms of distance education and simulator-based training. Much attention is paid to organising webinars, recording of lectures, making up electronic tests and applying other Internet technologies, because, according to the professional community, the situation with doctors is still difficult in the remote locations of the country — often the trip to the place of training takes more time and effort than the educational process itself. This helps in two ways: the educational institutions receive a large audience, while the doctors shorten their period of off-the-job training.
As to simulator-based technologies, they are aimed at doctors' improving not only their theoretical knowledge, but also practicing a lot. Thus, in the case of paramedics' training, the case study method is used, involving discussion of all stages of ambulance services provision, its varieties and justification for a particular method of intensive care. "When implementing the professional development programmes in functional diagnostics, direct work of students with those programmes for processing functional research data they have to use in real life, for example, daily monitoring of ECG — the students decode real patients' monitors. This training option is available both in full-time and distance mode," said Valeriya Shurygina, Deputy Head for Academic Affairs at the Research Clinical and Educational Centre "Cardiology" of the SPbU Institute of High Medical Technologies.
There is a simulation centre at SPbU. Training is provided here using special-purpose simulators called phantoms, making it possible to simulate the types of medical care provided to the patient. According to experts, such practical classes are necessary for any doctor improving his or her professional skills regardless of the competence — even if you are an outstanding cardiologist with thirty years of experience, it is vital to practice the skills acquired when you were a student, so that these skills could not be lost.
The future of the CME model
Despite the fact that educational organisations and professional communities are actively involved in the CME, it has already become evident at this stage that the system is developing in the real time mode and therefore requires further enhancement. First of all, according to experts, it is necessary to develop a regulatory framework that regulates the policy of implementing the model of continuous medical education. Today Order No 66n of the Russian Ministry of Health is in effect regulating improvement of professional knowledge and skills by medical and pharmaceutical workers. It was adopted in 2012 and since then many amendments have been made to it.
"Whichever CME model we will have in a day, in a month, or in six months is difficult to visualise," Elena Tregubova believes. "Yet we know: in order to be competitive, to offer our products to doctors, the University needs to adequately present its educational products everywhere, including the portal for continuing medical education. As an institution involved both in undergraduate and postgraduate education and in professional development, St Petersburg University is interested in the transition to CME and is taking certain steps to implement this model."