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19METHODOLOGICAL WORK AND PRACTICAL TRAINING OF FUTURE MEDICAL
SPECIALISTS
Rusina S.,
Candidate of Medical Sciences, Associate Professor of the Department of Nervous Diseases, Psychiatry and Medical Psychology named after S. M. Savenko, Higher educational institution of Ukraine "Bukovynian State
Medical University", Chernivtsi, Ukraine
Nikoryak R.
Ph.D. student of the National Medical Academy of Postgraduate Education named after P.L. Shupyk,
Kyiv, Ukraine
ABSTRACT
Methodological work and practical training of intern doctors in the higher educational institution Bukovynian State Medical University is carried out by the educational-scientific institute of postgraduate education.
Theoretical training of intern doctors in the discipline "Psychiatry" with 1.5 years of study is carried out at the Department of Nervous Diseases, Psychiatry and Medical Psychology (psychiatry and medical psychology course) in the process of teaching professional and professionally-oriented disciplines during the full-time cycle. Practical training of future medical specialists in psychiatry is carried out partly on a full-time and, mainly, on a part-time cycle based on the regional psychiatric hospital. Educational and practical work is based on the advanced achievements of modern medical science.
Keywords: methodological work, practical training, psychiatry, intern doctors.
Problem formulation. The quality of teaching and methodological work and practical training of competitive medical specialists fully depends on the head of the full-time cycle, his/ her theoretical training, pedagogical skills, and the head of the part-time cycle at the internship place. To improve the professional training of future intern-doctors experienced associate professors and practitioners of the highest category work with them.
Analysis of recent research and publications.
Ensuring the effective social and economic development of our country and a high level of medical care necessitates the training of specialists of a fundamentally new formation [2]. An important stage of training in medicine is postgraduate training - internship, the purpose of which is to deepen theoretical knowledge, acquire and improve practical skills in a particular specialty, train doctors (pharmacists) for independent professional and service activities. Internship for intern-doctors is the first step in postgraduate education.
Particular attention is paid to the algorithmization of diagnostics, treatment and prevention of the most common diseases. The introduction of new computer technologies has significantly expanded and improved the opportunities for theoretical training of intern doctors. But in addition to the theoretical training of young professionals, special attention during internship should be paid to the issues of practical training of young professionals. As assigned in the Program of primary specialization (internship), "the main purpose of the internship is to increase the level of practical training of interns in their professional readiness for independent medical work" [1].
The purpose of internship: to help an intern doctor to master the basics of professional activity, consolidate and improve the acquired professional skills, systematize and deepen special knowledge of basic and related disciplines and prepare for certification to determine the knowledge and practical skills of a specialist. The main methodological principle of internship training is
the development of doctors' activity and control of their independence. According to the Regulations on internships, internships are conducted in the form of full-time and part-time education at the departments of higher medical educational institutions of III-IV levels of accreditation, institutions of postgraduate education and internships in basic health care institutions [3].
According to the Law of Ukraine "On Higher Education", the order of the Ministry of Health of Ukraine dated 19.09.1996 № 291 "Regulations on specialization (internship) of graduates of medical and pharmaceutical educational institutions of III-IV levels of accreditation" specialization of intern doctors is a mandatory form of postgraduate education completion of the qualification "specialist doctor".
Specialization (internship) involves mastering by a doctor one of the nomenclature medical specialties, approved by the order of the Ministry of Health of Ukraine from 21.11.2005 № 621 "On amendments to the order № 81 from 23.02.2005" List of specialties and terms of internship graduates institutions, medical and pharmaceutical faculties of universities ". Training of intern doctors in psychiatry at the department is carried out according to the Curriculum and the program of specialization (internship) of graduates of higher medical educational institutions of III-IV levels of accreditation in the specialty "Psychiatry", approved by the Ministry of Health of Ukraine.
The purpose of the article. The purpose of the article is to highlight the improved system of methodological work and practical training of future specialists in psychiatry.
Highlighting previously unresolved issues. Modern challenges: armed conflicts in which both military and civilians suffer and the coronavirus pandemic pose a psychological threat to humanity. Therefore, medical science, based on the principles of physical and mental health of citizens, should respond primarily by making adjustments to the curriculum in the training of intern doctors, including psychiatry.
Presenting main material. Training of intern doctors is carried out on the basis of the standard curriculum and the training program of specialization (internship). At the course of psychiatry, there have been developed reference books (syllabuses), which correspond to the training program and are available to every intern doctor. Each intern works according to the program of "Individual plan-schedule", which is drawn up and approved for each academic year. The content of the curriculum, which is included in the syllabus, namely: the thematic plan of lectures, seminars, practical classes and independent work of an intern doctor, is determined by the state standard of professional training for a postgraduate with higher methodological education in a particular specialty while maintaining the number classroom and extracurricular hours (according to the curriculum). According to the training program, an intern doctor has to master a list of specific necessary practical skills, abilities and emergencies that meet the requirements of the qualification characteristics of the specialist during the internship.
During the face-to-face cycle with intern doctors, practical classes are conducted with obligatory micro supervision of patients. During the quarantine period, video supervision is also carried out in part. However, the main purpose of the supervisions is the work of an intern doctor to diagnose mental disorders, namely -differentiating of a psychopathological syndrome, syndrome differential diagnostics, stating the diagnosis, and prescribing treatment. Rehabilitation and examination (labor, military, forensic) of mentally ill people are also resolved with intern doctors. A significant share of examination questions (in hourly equivalent) is devoted to seminars and self-study.
During the part-time cycle, intern doctors of the discipline "Psychiatry", working in different departments, supervise patients under the surveillance of the head of the department or an experienced doctor. Intern doctors take part in daily morning rounds of patients, report about the patients who are treated by them independently or under the guidance of a doctor. They participate in the discussion of patient complaints, clinical diagnosis statements and treatment prescribing. An important component is to include the intern in the practical work of the department. They study current orders on psychiatric care with the head of the part-time cycle at seminars. The knowledge gained by an intern during the part-time cycle cannot be compensated only by studying the theory.
Supportive outpatient treatment plays a particularly important role in the lives of our patients and is aimed at their re-socialization (full, partial) in society. A significant number of specialists work in inpatient and outpatient psychiatric services after the internship. They are also involved in labor expertise, preparing documents for submission to MSEC, or working in these commissions. Some intern doctors continue to work as military experts, being members of district, city and regional medical commissions at military enlistment offices. A forensic examination is the recognition of an illegal action of a patient as one that is recognized by the court as sane or insane and, accordingly, com-
pulsory treatment is prescribed. Therefore, in the process of training, interns must go through all stages of providing psychiatric care to citizens and, coming to the main place of work, be competent in solving the tasks.
Intern doctors master practical skills while working under the guidance of teachers in psychiatric wards. Also, practical training of future specialists in psychiatry takes place during hospital shifts (2 shifts per month), consultations, mortality tests, clinical examinations (once a week under the guidance of an associate professor of the department responsible for medical work) and other medical and educational activities such as, performance and presentation of research works of students, methodological work with teachers, etc., which are carried out during the full-time and part-time cycles. An important component in the formation of a psychiatrist is to master the professional skills of a clinician. Therefore, the availability of practical skills is assessed at all stages of intern preparation: basic, intermediate and final computer test control, abstracts, speeches at scientific conferences of intern doctors, semi-annual, annual certifications at the end of the first full-time cycle and final certification at the end of the second full-time cycle with a test on practical skills.
The above stages in the theoretical and practical training of an intern doctor in psychiatry will create conditions for improving the technology of postgraduate education and provide an appropriate level of training for young professionals, improving the experience of the Department of Nervous Diseases, Psychiatry and Medical Psychology to introduce new technologies for intern doctors.
So that teaching and methodological work in higher educational institution encourage each intern doctor to increase his/ her professional level, contribute to the personal enrichment with medical findings, allow young doctors to learn clinical skills from experienced teachers and professional clinicians, provide supporting the spirit of creativity and desire for research in the medical environment, it must be skillfully managed.
Therefore, the educational - scientific institute of postgraduate education carefully monitors the work of intern doctors by attending classes on a full-time basis online (joining the links of the seminar or practical lesson, monitoring the answers of interns and their evaluation by the teacher).
To obtain the professional skills by intern doctors at the Bukovina State Medical University, the educational and scientific institute of postgraduate education applies the following forms of methodological work:
a) scientific-practical conferences of teachers responsible for the full-time cycle and heads of the parttime cycle on the problems of implementation and improvement of the concept of continuing professional education (from theory to practice), scientific and methodological principles of training future medical professionals;
b) general conferences of pedagogical workers with a discussion of the educational process state in the higher educational institution, and prospects for the development of the chosen profession of an intern doctor, in particular - a psychiatrist;
c) meetings of small and large academic councils of the institution, which analyze in detail the level of professional training of intern doctors, the state of educational work based on internships, discuss and approve a long-term plan of higher education on emerging issues. During the training, psychiatric interns are involved in the "deontology" program, which is mandatory in the work with patients in psychiatric clinics using psychotherapeutic approaches in the treatment and diagnostic process. An important role is also given to the educational process, as the future medical specialist is the bearer of politeness and intelligence; high morality and spirituality; ethics and aesthetics, especially if it is a psychiatrist or a medical psychologist.
Conclusions and offers. Thus, the ultimate goal of the internship is to increase the level of practical
training of graduates, their professional readiness for independent medical activity in the basic specialty "Psychiatry".
References
1. Bezzubko L.V., Chernysh O.I., Sokolova L.S. Development of the education system in modern conditions. Makiiivka, 2005. 132 p.
2. Higher Education of Ukraine and the Bologna Process / Textbook (edited by V.G. Kremen). Ternopil, 2004. 384 p.
3. Lukina T. Monitoring the quality of education: Theory and practice. M.: Publishing House "Shkilnyi svit", 2006. 128 p
ПСИХОСОМАТИЧЕСКИЕ КОНЦЕПЦИИ КАК ПРЕДПОСЫЛКИ КОНЦЕПЦИИ «НЕПСИХИАТРИЧЕСКОЙ ПСИХИАТРИИ»: СОВРЕМЕННЫЕ ПОДХОДЫ. ЧАСТЬ 3.
Сукиасян С.Г.
доктор медицинских наук, профессор Медицинский реабилитационный центр АРТМЕД, отделение реабилитации психического здоровья СТРЕСС Армянский медицинский институт, кафедра психиатрии и психического здоровья Арманский государственный педагогический университет им. X Абовяна,
кафедра прикладной психoлoгии
PSYCHOSOMATIC CONCEPTION AS A BACKGROUND OF «NON-PSYCHIATRIC PSYCHIATRY»: MODERN APPROACH. PART 3.
Sukiasyan S.
MD
Mental Health Rehabilitation "Stress"Medical rehabilitation center "Artmed" Department of Mental Health and Psychiatry of the Armenian Medical Institute Department of Applied Psychology and the Armenian State Pedagogical University after Abovyan
АННОТАЦИЯ
В настоящем обзоре представлен анализ ситуации, которая сложилась в медицинской науке после бурного развития психосоматической медицины и ее очевидных притязаний на общемедицинскую парадигму. История исследования психосоматической проблемы не внесла ясности в вопросы понимания этио-патогенеза и клиники психосоматических болезней. Проблема в том, что понятие «дихотомия» ввело исследователей в заблуждение - это две противоположности или две части целого. Показано, что налицо существенный казус в истории психосоматической психиатрии: говорили о единстве психики и тела, а в реальности эти категории практически во всех психосоматических концепциях разделялись.
Современные нейровизуализационные и тонкие лабораторные исследования показали, что соматические и психические расстройства, проявляющиеся функционально-соматическими, соматоформными, психовегетатичными, сенестопатическими симптомами, ипохондрическми, тревожными, депрессивными проявлениями, соматическими и органными симптомами, опосредованы близкими изменениями в головном мозге: изменения структуры, активности и объема в гиппокампе, миндалине, префронтальной коре; снижение уровня кортизола, альдостерона; активация инфламаторных процессов; повышение уровня про-воспалительных цитокинов, которые могут объяснить взаимодействие между эндокринной, иммунной, вегетативной, центральной нервной систем с психологическими расстройствами.
Это позволяет нам говорить не о психических и соматических синдромах, а о едином церебро-сома-тическом синдроме - базисном синдроме непсихиатрической психиатрии. Концепция «непсихиатрической психиатрии» строится на положении, что психические и соматические болезни имеют единый «корень» -головной мозг, который является не только основным нервным «ганглием» в организме, но и самой большой железой внутренней секреции, координирующей, регулирующей и контролирующей все жизненные функции организма и поведение человека, то есть является не только органом психическим, но и органом соматическим.
