CC BY
49
МЕДИЦИНСКОЕ И ФАРМАЦЕВТИЧЕСКОЕ ОБРАЗОВАНИЕ
D. M. Kulmirzayeva, D. S. Zharlyganova, V. V. Koykov, O. T. Zhuzzhanov
DIFFERENCES AND SIMILARITIES OF CONTINUING MEDICAL EDUCATION IN SOME COUNTRIES OF EUROPE, NORTH AMERICA AND ASIA
Nowadays a public health services system develops very fast, new modern technologies of diagnostics and treatment appears, the information volume increases which leads to increasing necessity of continuous professional education of medical specialists [7].
Continuous Medical Education (CME) is one of the most important tools in ongoing development: it helps physicians to maintain and improve their professional competence and skills, to broaden their professional outlook and to keep abreast of relevant developments, thus providing patients with up-to-date high quality healthcare.
In many countries the corresponding legislation works and fixes the requirements of a CME, which should be observed if someone want to be engaged in professional work. Concrete requirements differ from country to country, and concerning to various medical trades [1, 3].
For example, in United Kingdom postgraduate education includes the individual program of preparation under the control of the consulting physician with obligatory working on manual skills. For specialization and possibility to practice it is necessary for young doctor to train within 1-3 years in specialized hospitals. At this stage after a passing examinations and passage of manual skills the trainee can become "general practitioner" (GP). The majority of doctors in Great Britain work as general practitioners [2, 5, 6, 7].
Participation in CME is a hiring clause in national health services (NHS), and since recent time -for acknowledgement of membership in Royal boards which play a key role in the organization of doctors training [18].
In the UK, the general medical council has proposed that physicians would have to prove their fitness to practice. The Chief medical officer of England initiated a public consultation on several options for revalidation [27]. He proposed that revalidation should be broken down into two requirements - relicensure to permit practice as a medical practitioner, and in addition, recertification to practice as a GP or specialists [19]. Relicensure would take place every five years, based on a revised model of appraisal used in the NHS, but applied to all doctors wherever they work, incorporating the GMC's generic and specialty standards as well as views of patients and colleagues (360-degree feedback exercise). Recertification would be according to procedures developed by each royal college. Physicians who fail in either process would spend a period of time in supervised practice [17]. Evidence to support recertification can come from
various sources (depending on specialty), including clinical audit, knowledge tests, patient feedback, employer appraisal, continuing professional development or observation of practice [20].
In Belgium, GPs and specialists are legally obliged to comply with certain standards and have financial incentives to pursue further accreditation. Licences to practice are granted by the Minister of Public Health, and GPs must fulfill specific criteria, such as maintaining patient files, participating in the local oncall service, ensuring continuity of care, undertaking at least 500 consultations each year, and regularly developing and maintaining their knowledge, skills and medical performance [10]. Accreditation can serve as proof of this last criterion; alternatively, the doctor must provide evidence of 20 hours of CME per year, recognized by the Licensing Committee of general practitioners. Specialists must preserve and develop their competence through practical and scientific activities throughout their career [11].
Accreditation is granted by the INAMI/RIZIV if the physician meets additional requirements, including participation in CME and peer review. While accreditation is not required, it enables physicians to charge higher reimbursable fees to patients, boosting a physician's annual salary by about 4%. Accreditation lasts for a period of three years. To renew accreditation, specialists and GPs must obtain 200 CME credits and participate in at least two peer reviews per year. Hospital physicians are required to participate in the peer-review process, regardless of whether they seek accreditation [14].
In Austria the program of continuous medical training for the licensed doctors (Diplom -Fortbildungs-Programm) has been approved in December, 2001 and gives the certificate of three-year cycles passage. Through this programme, physicians are encouraged to acquire 150 CME credits every three years. Within this total, a minimum of 120 points have to be acquired through specialty-related, certified CME programmes, with a minimum of 40 points in the physician's particular specialty. CME points can also be accumulated for undergoing peer review. Since 2001 a new medical law has made participation in CME mandatory, with legal responsibility residing with the Austrian medical chamber [21]. The Austrian academy of physicians advises the medical chamber on content and methods of the CME system [24].
In Europe the definitions and mechanisms of revalidation vary significantly across member states. While some countries, eg Austria, Germany and Spain, look to continuing medical education as a means to promote recertification and quality of care, other countries, eg Belgium, France and the Netherlands, also incorporate peer review. In the UK the proposed revalidation scheme would include elements of relicensure through appraisal and feedback as well as physician recertification. Divergence between countries also exists in monitoring and enforcement. The European Commission should ex-
plore the implications for professional mobility of the diversity in the regulation of the medical profession [25].
In Canada after the graduation the medical school the canadian medical students pass the state examinations in Medical license council which carries out their admission to practical activities. Starting practical work, the young doctor is obliged to confirm the knowledge on the commission of colleagues in the hospital where the he is going to work.
Certification of doctors is carried by Canada Royal corporation of therapists and surgeons (CRCTS) and College of family physicians of Canada (CFPC). CRCTS is responsible for working out and realization of all certified examinations in each speciality, except for family medicine. Doctors-experts who join CRCTS as grant-aided students keep the knowledge, skills, competence by participating in the program certification maintenance. During a five years cycle, doctors are obliged to collect 400 credits, at least 40 credits during one year. CFPC claims 250 credits during a five years cycle, 50 credits each year. If a student wants to get the stipend in college, it is necessary to collect additional 24 credits per year. Thus, each province and territory demands the documentation of current continuous medical training for license acknowledgement [12].
Each doctor obligatory must join the professional organization according to the specialization -national, provincial or associations which are engaged in the organization of continuous education and certification of doctors every 10 years , financed by the professional organizations, hospitals, medical schools and sometimes pharmaceutical firms and the firms which produce medical equipment [16, 26].
CME in USA is necessary for the majority of doctors as a part of requirements for revalidation of license. The medical license is the legal requirement which gives the right for medical practice, while the certification received from a council of speciality, is facultative [13]. Now renewal of certificates is required each 7-10 years, depending on a speciality [15]. In the USA the state and national instances are engaged in licensing of doctors.
In USA the law requires a physician applying for license renewal to have completed at least 50 contact hours of continuing education during the previous 24 months. A "contact hour" means a minimum of 50 minutes of continuing education activity. It must (1) be in the physician's practice area; (2) reflect the physician's professional needs in order to meet the public's health care needs; and (3) include at least one contact hour of training or education in each of the following topics: (a) infectious diseases (e. g. , AIDS, HIV), (b) risk management, (c) sexual assault, and (d) domestic violence. Under the law, acceptable continuing medical education includes courses offered or approved by the American Medical Association, American Osteopathic Medical Association, Connecticut Hospital Association, Connecticut State Medical Society, county medical societies
or equivalent bodies in other jurisdictions; education sponsored by hospitals and other health institutions; and courses offered by regionally accredited academic institutions, or a state or local health department [23].
In USA separate states do not recognize medical certificates of other states and demand the repeating examinations [4]. For example, in Arizona it is necessary to collect in average 40 credits during 2 years, in California - 100 credits during 4 years, in Kansas, Massachusetts, Washington - 50 credits for 1 year, in Texas - 24 credits for 1 year, and in New York credits are not required
In Singapore all fully and conditionally registered doctors renewing their practicing certificates (PCs) are required to meet the compulsory CME requirements for their CME qualifying period(s) before their PCs are renewed.
The Singapore Medical Council (SMC) accredits CME activities and reviews CME policies and programmes. The CME qualifying period for doctors is 2 calendar years, during which they must obtain a minimum total of 50 CME points within the CME qualifying period (the preceding 2 years), of which 20% or 10 points shall be core points before their PCs can be renewed. Similary, doctors holding a 1-year PC must obtain a minimum total of 25 points within the CME qualifying period (the preceding 1 year), of which 5 must be core points before their PCs can be renewed. There are 4 types of medical registration (excluding specialist registration) for doctors who wish to practice medicine in Singa-pore:full registration, temporary registration, conditional registration, provisional registration. Registration of medical practitioners in Singapore is governed by the Medical registration Act. Application for medical registration must be submitted through a local employer in Singapore. However, satisfaction of the criteria for medical registration does not mean automatic approval for registration. Each application for medical registration will be considered on its own merits. All renewals of PC are subject to compliance with compulsory CME requirements; i.e. the doctor must obtain the required number of CME points, including core points, within the CME qualifying period for renewal of his PC.
In Singapore there are different categories of CME activities and different credits claims. The maximum number of CME points that doctors can claim for participation in SMC-accredited CME activities are as follows: 1A category - Pre-approved established programmes, 1B - Local events (e.g. scientific meetings, conferences, workshops, etc.), 1C - Overseas events (e.g. scientific meetings, conferences, workshops, etc.), with maximum point in 2 years PC - 50 credits, 2 - Publication /editorial work/ presentation of original paper or poster, with maximum point in 2 years PC - 40 credits, 3A - Self-study (e.g. reading of refereed journals listed in PubMed or MOH Clinical practice guidelines), 3B - Accredited distance-learning programmes with verifiable self-assessment (e.g. Medscape), with maximum point in 2 years PC
- 50 credits, All - CME with 5 points per year. Doctors can claim points for attending accredited local and overseas CME events; for the publication of original papers in refereed medical journals; for the presentation of original papers /posters; for the reading refereed medical journals/ MOH CPG and for participating in accredited distance-learning programmes.
As for Kazakhstan, the main forms of preparation of specialists and improvement of professional skill are cycles of specialization (retraining), the general and thematic improvement.
The specialist certificate of different categories (second, first, higher) is valid within 5 years. The specialist can be supposed to next category after 3 years from the date of a definite category reception [8]. The skill level of specialists is defined by following categories:
The second qualifying category is given to specialists with a higher education, with work experience of 3 and more years by speciality, with an improvement of professional skill on total volume 108216 hours for the last 5 years confirmed by special certificates.
The first qualifying category is given to specialists with a higher education, with work experience of 9 and more years by speciality, with an improvement of professional skill on total volume 216-288 hours for the last 5 years confirmed by special certificates and presence at least three publications for the last 5 years, published in the official publications recommended by Committee on supervision and certification in a sphere of education and science of the Ministry of Education and Science of the Republic of Kazakhstan.
Within the programs of professional skill improvement and retraining activities master classes, trainings, self-education, training in practice (training on a workplace) can also be carried out. The programs of continuons education are conducted out, at the work place.
Qualification improvement and retraining of staff can be carried out both in Republic of Kazakhstan, including invitation of foreign specialists, which can contain from 144 to 1440 academic hours [9].
The comparative analysis of continuons medical education in a number of countries of Western Europe, the USA, Canada, Singapore shows various approaches to it. But in common, many countries have the credit system assuming an obligatory set of certain quantity of credits-hours a year, allowing constantly continuous professional development, and also the system of revalidation including reli-censing and recertification for acknowledgement of the right to practical activities.
LIST OF LITERATURE
1. Аканов А. А. «Медицинское образование в США: опыт для Казахстана» /А. А. Аканов, Н. К. Хамзина, А. С. Чукмаитов. - Астана., 2005. - С. 26
- 27.
2. Горбунов С. Н. Нужна ли нам аккредитация медицинских учреждений или достаточно лицен-
зирования медицинской деятельности /С. Н. Горбунов, П. А. Воробьев //Проблемы стандартизации в здравоохранении. - 2004. - №1 - С. 8 -122.
3. Каверина Э. Ю. Высшие учебные заведения США: структура и классификация //США - Канада: Экономика. Политика. Культура., 2004. - №7. - 14 с.
4. Каирбекова С. З. Методологические основы и организационно - управленческие технологии реформирования дополнительного профессионального медицинского образования в Республике Казахстан. - Астана., 2006 - 41 c.
5. Лисицын Ю. П. Общественное здоровье и здравоохранение /Ю. П. Лисицын, Н. В. Полунина //Учебник для медицинских ВУЗов. - М.: Медицина., 2002. - 382 с.
6. Овчаров В. К. Аккредитация и оценка качества деятельности медицинских учреждений // Проблемы социальной гигиены и история медицины. - 1995. - №4. - С. 25 - 35.
7. Проблемы развития последипломного образования специалистов здравоохранения //Л. К. Мошетова, Ф. Е. Вартанян, Ю. Н. Касаткин и др. -М., 2000. - С. 9 - 17.
8. Приказ МЗ РК от 6 ноября 2009 года №661 «Об утверждении Правил проведения квалификационных экзаменов в области здравоохранения».
9. Приказ МЗ РК от 11 ноября 2009 года №691 «Об утверждении Правил повышения квалификации и переподготовки медицинских и фармацевтических кадров».
10. Arrete ministeriel fixant les criteres generaux d'agreation des medecins specialistes, des maоtres de stage et des services de stage art (30 April 1999). - 31 p.
11. Arr^ minis^riel fixant les critwes d'agrnment des mйdecins gйnйralistes (21 February 2006). - 37 p.
12. Assessment of specialists in cardiovascular practice /K. Ahmed, H. Ashrafian, GB. Hanna et al. (Oct 2009). Nature Rev Cardiol. - 178 p.
13. Cassel C. Professional standards in the USA: overview and new developments /C. Cassel, E. S. Holmboe //Clinical. Medicine. - 2006. - №6. - P. 363 - 367.
14. Continuing medical education and continuing professional development: international comparisons /C. Peck, M. McCall, B. McLaren, T. Rotem //B. M. J., 2000. - 432 p.
15. Dauphinee W. D. Self regulation must be made to work. British Medical Journal., 2005. - P. 1385 -1387.
16. Deber R. B. Restructuring Canada's health worker as the cornerstone of the primary health care model /R. B. Deber, G .G. Thompson //Social Science and Medicine., 1987. - P. 515 - 528.
17. Department of Health. Trust, assurance and safety - the regulation of health professionals in the 21st century //London. - DH. - 2007. - 106 p.
18. Department of Health. White paper: trust, as-
surance and safety - the regulation of health professionals in the 21st century //London. The Stationery Office., 2007. - 106 p.
19. Donaldson L. Good doctors, safer patients: proposals to strengthen the system to assure and improve the performance of doctors and to protect the safety of patients //London. - Department of Health., 2006. - 378 p.
20. General Medical Council. Revalidation. GMC today., 2007. - P. 8 - 9.
21. Guideline of the Austrian Medical Chamber on CME //Vienna. - Austrian. - Medical Chamber., 2004. - 208 p.
22. Hayes J. Implementing accreditation systems / J. Hayes, C. And Shaw //International Journal of Quality in Health Care, 1995. - №7. - P. 72 - 165.
23. Kasprak John Continuing Education Require-
ments for Physicians.Location: Occupational safety; Physicians. - October 10 2008. - 573 p. 10.
24. Osterreichischen Ärztekammer. Guideline of the Austrian Medical Chamber on CME. - Vienna. - OAK. - 2004. - 413 p.
25. Physician revalidation in Europe. Sherry Merkur, Elias Mossialos, Morgan Long, Martin McKee. - Clinical Medicine., 2008. - №8. - 211 p.
26. Rachlis M. Strong Medicine: How to save Canada's Health Care System /M. Rachlis, C. Kushner // Toronto: Harper-Collins., 1994. - 421 p.
27. Royal College of Physicians. Doctors in society: medical professionalism in a changing world. Report of a Working Party of the Royal College of Physicians of London //London. - RCP., 2005. - 217 p.
Поступила 12.04.10
Д. М. Кульмирзаева, Д. С. Жарлыганова, В. В. Койков, О. Т. Жузжанов
СХОДСТВА И РАЗЛИЧИЯ НЕРПЕРЫВНОГО МЕДИЦИНСКОГО ОБРАЗОВАНИЯ В НЕКОТОРЫХ
СТРАНАХ ЕВРОПЫ, СЕВЕРНОЙ АМЕРИКИ И АЗИИ
Авторы приводят данные о непрерывном медицинском образовании в зарубежных странах. Д. М. Кулмирзаева, Д. С. Жарль^анова, В. В. Койков, О. Т. Жузжанов
ЕВРОПАНЫЦ, СОЛТУСТЖ АМЕРИКАНЬЩ ЖЭНЕ АЗИЯНЬЩ Б1РЦАТАР ЕЛДЕР1НДЕГ1 УЗД1КС1З МЕДИЦИНАЛЬЩ Б1Л1М БЕРУДЩ ¥КСАСТЬЩТАРЫ МЕН АЙЫРМАШЫЛЫЦТАРЫ
Авторлар макалада шетелдердеп Yздiксiз медициналык б^м берудщ жай-жапсары туралы салыстырмалы мэлiметтер кел^рген.
А. Я. Долгоаршинных, А. Г. Молдажанова, М. К. Мусулманбекова, Г. Е. Богданова, Н. А. Никурашина
ПРИМЕНЕНИЕ ИННОВАЦИОННЫХ ТЕХНОЛОГИЙ КАК СРЕДСТВА АКТИВАЦИИ ОБУЧЕНИЯ
Кафедра стоматологии ФНПР Карагандинского государственного медицинского университета
Одним из требований к образовательной среде дополнительного медицинского и фармацевтического образования является проведение учебных занятий на циклах повышения квалификации и переподготовки с использованием инновационных технологий и интерактивных методов обучения (ГСДО РК специальности стоматология, пункт 9,7, Астана, 2009).
Выбор наиболее эффективных методов и средств для какого-либо конкретного занятия представляется для кафедры стоматологии ФНПР одним из важных моментов процесса обучения. Анализируя методы и средства обучения, необходимо учитывать их постоянное совершенствование. При использовании методов и средств мы учитываем то обстоятельство, что одни и те же методы или средства могут быть эффективными при одних условиях и совершенно неприемлемы при других.
У нас на кафедре в учебный процесс внедрены следующие инновационные и интерактив-
ные методики преподавания: проблемный метод обучения, творческие задания, обсуждение сложных и дискуссионных вопросов и проблем, использование сети Интернет.
Важное место в изучении материала занимает лекция, представляющая собой способ изложения объемного теоретического материала, систематизирующего состояние и перспективы развития изучаемой проблемы.
Однако традиционная лекция имеет ряд недостатков, которые обусловлены следующим: приучает к пассивному восприятию чужих мнений, тормозит самостоятельное мышление обучающихся; отбивает стремление к самостоятельным занятиям; лекции нужны, если нет учебников или их мало;
Одни слушатели успевают осмыслить, другие - только механически записать слова лектора. Это противоречит принципу индивидуализации обучения.
Указанные недостатки в значительной степени могут быть преодолены с внедрением в учебный процесс проблемных лекций, позволяющих провести всесторонний анализ проблемы, научный поиск истины. Вместо того, чтобы «транслировать» слушателям факты и их взаимосвязь, проводится анализ ситуации (проблемы) и поиск путей изменения данной ситуации к лучшему. Проблемная ситуация - это сложная противоречивая обстановка, создаваемая на занятиях путем постановки проблемных вопросов
