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0Синяченко О.В.
д. мед. н., профессор, член-корреспондент НАМН Украины, заведующий кафедрой внутренней медицины №1
Донецкий национальный медицинский университет (г. Лиман).
Егудина Е.Д.
к.мед.н., доцент, ассистент кафедры пропедевтики внутренней медицины ГУ «Днепропетровская медицинская академия» МОЗ Украины
Пасиешвили Л.М.
д. мед. н., профессор, заведующая кафедрой общей практики- cемейной медицины
Харьковский национальный медицинский университет
Ермолаева М.В.
д. мед. н., профессор, профессор кафедры внутренней медицины №1 Донецкий национальный медицинский университет (г. Лиман).
Ханюков А.А.
д. мед. н., доцент, заведующий кафедрой пропедевтики внутренней медицины ГУ «Днепропетровская медицинская академия» МОЗ Украины
АНАЛИЗ РЕЗУЛЬТАТОВ ПРЕПОДАВАНИЯ ПРЕДМЕТА «ОБЩАЯ ПРАКТИКА - СЕМЕЙНАЯ
МЕДИЦИНА» В ВЫСШЕМ УЧЕБНОМ ЗАВЕДЕНИИ
ANALYSIS OF THE RESULTS OF TEACHING THE SUBJECT "GENERAL PRACTICE - FAMILY
MEDICINE" IN THE UNIVERSITY
Syniachenko O. V.
DM, professor, corresponding member NAMS of Ukraine, head of the Department of Internal medicine №1
Donetsk National Medical University (Liman)
Iegudina Ye.D.
PhD, Associate professor of the Department of the Propedeutic of the internal medicine SE "Dnepropetrovsk Medical Academy" of Health Ministry of Ukraine
Pasiyeshvili L.M.
DM, Professor, head of the Department of General Practice - Family Medicine
Kharkiv National Medical University Yermolayeva M. V.
DM, Professor, professor of Department of Internal medicine №1 Donetsk National Medical University (Liman)
Khaniukov A.A.
DM, associate professor, head of the Department of the Propedeutic of the internal medicine SE "Dnepropetrovsk Medical Academy" of Health Ministry of Ukraine
АННОТАЦИЯ
Проанализированы результаты преподавания предмета «общая практика - семейная медицина» на VI курсе медицинского вуза IV уровня аккредитации, сравнивая успешность обучения по отдельным темам с характером оценок на III, IV, V курсах и прослежен уровень знаний врачей до и после интернатуры по семейной медицины. Как свидетельствуют данные анкетирования и тестового контроля на результаты подготовки врачей общей практики оказывает достоверное влияние форма обучения студентов (бюджетная, контрактная), выбранная специальность («лечебное дело», «медико-профилактическое дело») и постоянное место жительства (город, поселок, село). Сложными темами для усвоения студентами являются работа семейного врача в контексте установления временной и стойкой нетрудоспособности больных разного профиля, реабилитация особых групп населения (пожилой контингент, дети, подростки, беременные женщины). Основополагающим фактором в рамках качества подготовки соответствующих специалистов является желание студентов стать семейным врачом, что констатировано в разных группах в 30-50% от числа опрошенных лиц.
ABSTRACT
It was analyzed the results of teaching the subject "General Practice - Family Medicine" for the IVth year student of the medical university with the IVth accreditation's level. The success of the teaching in specific topics was compared with disposition marks of the IIId, IVth, Vth year students, and the knowledge of doctors before and after the internship in Family Medicine were traced. According to this survey and test control the outcome of training general practitioners are the likely impacted by the students' tuition (budgetary, contract), by chosen profession ("Medicine", "Medical Prevention speciality") and by permanent residence (city, town, village). Complicated topics for students' mastering are work by family doctor in the context of establishing a stable and temporary disability of different types of patients' diseases, rehabilitation special populations (elderly contingent, children, adolescents, pregnant women). The fundamental factor in the quality of the preparation
proper experts is students' wish to become a family doctor, that were established in different groups with 30 -50% of all surveyed individuals.
Ключевые слова: семейная медицина, преподавание, высшее учебное заведение. Keywords: family medicine, teaching, university.
Introduction. In our opinion [1, 2], the subject of "General practice - family medicine", as one of the youngest, but certainly leading discipline in the medical university, it requires special priority and should be constantly improved to enhance the quality of training of young physicians. In the United States was introduced the transition of triad purposes of general practitioners ( "knowledge + skill + attitude") to the pentad (added "job satisfaction + newfound confidence") [8]. While the concept of continuing medical education recognized everywhere, the actual conditions of the training for the general practitioners are not yet originated [6]. In this context, the comparative evaluation of the training of family doctors in medical higher educational institutions in different countries was held. It turned out that if in some universities the number of hours for the general practice of 1.5-2 decades has decreased slightly (e.g., Canada), in most of them increased, and by 15-20% [7].
In this regard, we note that some students from English-speaking countries expressed a negative attitude to learning the subject of "general practice" at pre-planned topics with a special pre-selection of patients, since the selectivity makes affectation of learning and tear from real-life conditions. More perspective they consider apprenticeship system in the conventional outpatient conditions [4, 5]. Training of family doctors in medical universities should not only provide the necessary knowledge, but also to prepare students for a future in their own ability to make better decisions and to act in difficult situations [3].
The purpose and objectives of the study: to analyze the quality of teaching of the subject "general practice - family medicine" in medical universities, to establish the factors that determine it in VIth year students and during learning the doctors in internship.
Material and methods. There was established the questioning of 614 VIth year students of medical university with the IVth accreditation's level, 420 of which were native and 194 foreign nationals (70.5% of the number of native students were taught in speciality «Medicine» and 29.5% in - «Medical Prevention speciality»). Students practical trainings in physical methods of examination of the patient were estimated by a teacher and carried out test control of knowledge before and after the series of lessons on the subject of "general practice - family medicine". Conventionally used a scale from "2" to "5" score ( "unsatisfactory", "satisfactory", "good", "excellent"). These marks were compared with those in the IIId, IVth, Vth years in propaedeutic, faculty, hospital therapy and during follow-up training of doctors-interns in "family medicine". Among the respondents were 50.8% men and
49.2% women aged 21-33 years (mean age 23.1 ± 0.07 years). 65.2% of the number of native students have the budget form of education, 34.8% - the contract, 84.3% before entering the University resided in cities, 12.9% - in towns, 2.9% - in villages.
Statistical analysis of the results carried out by computer variations, non-parametric, correlation, regression, single (ANOVA) and multivariate (ANOVA / MANOVA) analysis of variance (the program "Microsoft Excel" and "Statistica-Stat-Soft", USA). Estimate the average value, its standart deviations, the correlation coefficients, the regression, dispersion, Student, Wilcoxon-Rao, McNemar, Fisher criteria and the accuracy of the statistics.
Results and discussion. Established a direct highly significant correlation between the marks on the III-VI courses and internship. Registered increase in the average mark in townsmen and students with the budget form before and after teaching in the IVth year, villagers on the Vth year, learned in the "Medical Prevention speciality» in the IlIrd and IVth year. Before the cycle "General practice - family medicine" at the VIth year 42.4% of students relatively well oriented in the specifics of the family doctor occupation, 52.4% - had some idea, and 5.2% - had no idea. These students were divided into groups conventionally with evaluation at 2, 1 and 0 points. According to ANOVA, budgetary and contractual forms of education, progress in learning in previous years, as well as future specialty have a significant impact on these. According to the results of the analysis McNemar, Fisher, there are significant differences between the groups of students with the budgetary and contract forms of learning, as well as «Medicine» and «Medical Prevention speciality». The so-called "contract students" in 2,3 times, and "physisians" in 4.2 times more often oriented in the peculiarities of the general practitioner job.
It should be noted that only 30.5% of the number of native students expressed a desire to work as a family doctor by the VIth year, and by the end of university, after the cycle "General practice - family medicine" there are - 63.6%, i.e., obvious increase by 2.1 times. Accordingly, in the same period the number of students who were willing to work in the polyclinic, but not the family doctor, decreased from 40.5% to 21.0%. We think that such dynamics in students' expressed opinion refer to a positive influence of teacing in "General practice - family medicine" cycle, when there is seen positive trend of familiarization with future profession of the family doctor.
Scatterplot (Spreadsheetl.sta 100v*771c) NeWVar2 = 0,3616+0,8867*x
Scatterplot (Spreadsheetl.sta 100v*771c) NeWVar4 = 2,2315+0,2791*X
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/
2 3 4
Temporary disability
34
Temporary disability
Fig. 1. Correlation between the marks by the organization of home hospital and temporary disability of the patients among students who will (left) and unwill (right) become a family doctor
5
5
3
3
2
2
5
2
5
b
In a desire to work as a family doctor the age of the students and their place of permanent residence have the dispersion influence. In general, the profession of family doctor chose 33.3% of male students and 29.0% of women, 32.9% of the "budget students" and 26.0% "contract students", 28.4% of the number of "Medicine" and 35.5% of representatives of the "Medical Prevention speciality». If among the inhabitants of the cities as a family doctor was ready to work 29.1% of university graduates, among the rural population - 66.7%. 6.1% of urban residents, 11.1% of small towns, and 16.7% of villages wish to work as a family doctors.
Before the cycle "General practice - family medicine" representatives of the specialty "Medical Prevention speciality» had significantly lower marks in comparison with the "student-medical practice", in sections of auscultation patients, instrumental methods of diagnosis, diagnosis and treatment of emergency conditions. International students have lower marks in sections of questioning and examination of patients. It should be emphasized that according to the multivari-ate analysis Wilcoxon-Rao, form of training (budget, contract) of VI years students, future profession and desire (unwillingness) to become a family physician have a highly significant impact on integral marks in
course of disease diagnosis methods.
3D Surface Plot (Spreadsheet1.sta 100v*771c) NewVar3 = -4,4723+1,1336*X+2,4288Y0,1254*X*X-0,0317*XY0,2003Yy
3D Surface Plot (Spreadsheet1.sta 100v*771c) NewVar6 = 2,5293-0,6322*X+0,5874>0,0618*X*X+0,0484*XV0,0133*yy
Fig. 2. Integral marks histograms of willing (left) and unwilling (right) to become a family doctor students in
course of the diagnosis of diseases
According to ANOVA, after the cycle "General practice - family medicine" desire to become a family doctor was determined by the students marks on sections "percussion" and "palpation" of the patients, "treatment of emergency conditions", «principles of work of out-patient department and home care organization" the role of the general practitioner in the medi-cosocial assessment. There is a direct correlation between the marks on the organization of hospital at home and temporary disability of patients (Fig. 1), but only for those who were the VIth years students and prepare themselves for the work as a general practitioner. There have been marked differences of integrated students marks in methods of physical examination, laboratory and instrumental diagnostics, willing and unwilling to become a family doctor (Fig. 2).
Before the cycle "General practice - family medicine" the level of knowledge on the principles of primary health care of the population, its financing, evidence-based medicine and telemedicine aspects in
As can be seen from Fig. 3, the level of training of general practice interns on syndromology, estimated by special tests by the end of internship study is greatly increased in comparison with the baseline values. Also increased the number of quality marks on individual sections of general practice.
Attention is drawn by the following fact: if after the cycle "General practice - family medicine" integral level of knowledge of VIth-year students on the issue of sick-list, the medical advisory committee and medical-social expert commission work has increased from 69% to 90%, then a year later from the beginning of the training internship in family medicine, he was already 99%.
Conclusions:
1. According to the survey and test control of knowledge of the teaching of the subject "general practice - family medicine" at the VIth year of medical
the practice of the family doctor, the diagnosis and treatment of emergency conditions, sanatorium selection of patients, assessing the quality of life patients and promote a healthy lifestyle does not differ in different compared groups of VIth year students. However, the form of payment of tuition, student specialty, the number of quality assessments and the average marks on the previous courses, place of a summer medicine practice after the Vth year, desire (unwillingness) to work as a family doctor according to performed variance analysis depends on the preliminary exploration of issues of the general practitioner with special populations groups (geriatric contingent, children, adolescents, pregnant women) to assess patients disability temporary and permanent, for issuing sick leave, for psychosomatic and somatopsychic aspects in the daily activities of family physician. These data require a certain correction in the organization of the pedagogical process.
university IVth level of accreditation was significantly correlated with the success of training of selected topics in internal medicine at the III, IV, V years that are also directly related to the further evaluation of the training of doctors before and after the internship in family medicine.
2. On the results of the training of general practitioners has a significant impact form of student learning (budget, contract), the chosen specialty ("Medicine", "Medical Prevention speciality") and a permanent place of residence (city, town, village).
3. Complex themes for learning by students and medical interns are the work of the family doctor in the context of the rendering of medical and preventive care for patients with hematological, ophthalmic, otolaryngological and dermatological profile, with modern treatment of acute poisoning cases, in establishing temporary and permanent disability of
Fig. 3. The dynamics of the average marks of the test control of knowledge of university graduates in the diagnosis of major syndromes in the beginning (bottom bar) and at the end (top bar) training in internship on
the subject "General practice - family medicine". 1 - arterial hypertension, 2 - hypotension, 3 - bronchial obstruction, 4 - respiratory failure, 5 - pulmonary heart,
6 - acute heart failure, 7 - chronic heart failure, 8 - acute vascular insufficiency, 9 - liver failure, 10 - renal failure, 11 - joint syndrom, 12 - nephritic syndrom, 13 - nephrotic syndrom, 14 - hyperglycemic syndrom, 15 -hypoglycemic syndrom, 16 - hyperthyroid syndrom, 17 - hypothyroid syndrom.
patients with different profiles, the rehabilitation of specific populations (elderly contingent, children, adolescents, pregnant women).
4. The basic factor in the framework of the quality of training of professionals is the desire of students to become a family physician that stated in different groups in the 30-50% of the interviewed persons.
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