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THE STATE OF HIGH MEDICAL EDUCATION IN RUSSIA WITH THE ASPECT OF
GLOBALIZATION
Stepanova I.
Omsk State Medical University, the head of chemistry department
Kryukova N.
Omsk State Medical University, the interpreter of International department
Pisclakova S.
Omsk State Medical University, the head of International department
Maksimenko L.
Omsk State Medical University, the head of philosophy and social science department
Myalkin Y.
Omsk State Medical University, the student
ABSTRACT
Nowadays medical education in Russia is undergoing serious and systemic changes, gradually adapting to new educational standards. In the article it was analyzed state of high medical education organization in Russia in the paradigm approaches and standards of Association for Excellence in Medical Education.
While analyzing Omsk State Medical University it became apparent that the university curriculum in high medical schools in Russia needs to move from a teacher-centered strategy to one that is student-centered.
Keywords: medical education, curriculum development, teaching, learning, educational strategies, teaching methods.
Introduction. Life and health are the key values in medicine. It is difficult to disagree with Arthur Schopenhauer that health is recognized as an enduring value only when an individual loses it: "Health far outweighs all the other blessings of life, that in reality, a healthy beggar is happier than a sick king." A doctor must be a qualified specialist, an altruistic professional, with high spiritual motivation and endless desire for professional growth, with whom a patient can entrust their life and health.
With rapid changes in society, educational systems are doing their best to keep up. After the introduction of the 2012 Federal Law "On Education in the Russian Federation," universities in Russia are undergoing serious and systemic changes, gradually adapting to new educational standards.
These changes are largely related to global trends, especially with the process of globalization, in which a single global financial and economic space is being formed and developed. In the 21st century, the world is more and more like a giant market, which involves modern education, medical science and health care.
The reform of the Russian educational system is defined by the tasks of improving the quality of education, international cooperation, promoting the mobility of highly qualified personnel, increasing the competitiveness of specialists in the global labor market, which implies compliance of the specialist's qualification with international standards. These goals form the basis of the 21st century vocational education model.
The medical education in Russia has been changing towards competency-based approach. Its appearance "on the market of ideas" is characterized as a change in the educational paradigm: from knowledge and skills to competencies. Nowadays the need for competency-based medical education is widely recognized, however, it has been poorly documented. The term "competency-based education" refers to an effective system model, where teaching and learning are designed to ensure that students are becoming proficient in respective fields of study.
Competency-based education approach not only standardizes the outcome and general competencies, it also allows students to move forwards based on their ability to master a discipline at their own learning rate, regardless of external factors. This approach solves the complex problem of preparing a competent doctor to willingly apply their acquired knowledge and skills to their profession [1].
Competency-based medical education has been implemented in foreign countries for decades. Different innovations in the sphere of medical education have been discussed in such authoritative organizations as
the World Federation of Medical Education, the Association for Medical Education in Europe, which is a global educational association of doctors and teachers, International Association of Medical Science Educators, Asian Medical Education Association, and Association for Excellence in Medical Education. These organizations develop international standards promoting the integration of medical education in different countries into the global educational landscape. The study of international experience in the development of training programs, their implementation and quality assessment provides additional opportunities for optimizing Russian medical education.
The purpose of the study is to analyze high medical education organization and state in Russia in the paradigm approaches and standards of Association for Excellence in Medical Education.
Materials and methods. The object of the study is the high medical educational process based on the curriculum at Omsk State Medical University as one of the typical medical schools in Russia. Critically analyzing the present state of medical education, we are reflecting on "whether the intended transformation towards competency-based education has or has not been completed?"
Results. Discussing the medical education, we should look at a curriculum planning. The term "curriculum" means "a sophisticated blend of educational strategies, course content, learning outcomes, educational experiences, assessment, the educational environment, the individual students' learning style, personal timetable and programmer of work" [2]. A competency-based curriculum "defines a comprehensive set of competency requirements that all graduates are expected to attain" [3]. An effective curriculum is an essential tool for a quality medical education. "The development of medical school curricula must be informed by medical students, doctors in training, educators, employers, other health and social care professionals as well as patients, families and carers" [4]. It should be noted that since the ways of forming competencies are not rigidly set by standards, universities have the opportunity to maintain autonomy in curriculum planning.
The curriculum for a primary care physician in Omsk State Medical University is currently changing to adapt new educational standards. Therefore, there is no need to create a curriculum from scratch. The current curriculum resembles the SPICES model, although it is not fully realized. SPICES, an acronym, stands for the educational strategies: student-centric, problematic, integrated and interprofessional, community-based, elective driven and systematic [5].The SPICES model allows reviewing an existing curriculum to determine
the areas where the improvements can be made, and helps to decide on what teaching methods to use on a course and what assessment it should undergo.
When looking at the SPICES model, we can say, that the student-centered strategy is not fully realized in our university. This approach may be characterized as organized learning, depending on students' abilities and a content of a course, based upon agreed outcomes. In contrast to a teacher-centric approach, a student-centric one concentrates on students' learning, which is more active rather than passive. As for our university, our system is more teacher-centric; where students can select suitable learning resources to achieve their objectives, but unfortunately, they are not able to choose their own learning objectives, decide on the sequence, or the pace of their own learning. Students must attend all lectures and classes in accordance to a department syllabus, therefore, teachers are responsible for assessing students' achievements, and a student-centric strategy is not fully implemented.
Our university doesn't provide an adequate number of options for students to personalize their learning experience, even though it is an important component in determining success of personal development. The current curriculum does not allow for a personal educational path that focuses on student-centered learning; therefore, the individual educational trajectories, which are designed to meet different learning abilities aren't fulfilled. Some students, who don't fit into the standards of the "average one", are undeservingly deprived of an individual learning approach. Gifted students need a curriculum that is focused more on adaptive learning since such individuals can quickly master the necessary competencies and they can spend more time on research instead of classroom work.
In contrast to a curriculum oriented towards gifted students, an inclusive education for persons with disabilities is provided. In other words, individuals with disabilities, who aspire to become doctors, will be able to receive an education at our university. Even though an educational environment for people with disabilities is available, other forms of adaptive learning could be improved, currently this process is underway.
Another SPICES strategy is problematic, which is based upon real clinical, community, and scientific life issues. It can be used for students to discover gaps in their knowledge [5]. The problematic strategy falls under active learning, the solution of practice-oriented tasks stimulates students' cognitive activity and internal motivation for a careful study of a discipline, as well as awareness of the connection of this discipline with the ones that follow. A teacher must think about how to evaluate students' answers. The problem-based strategy provides shared learning and competitive peer assessment, improves life and communication skills, lifelong learning, and allows peer-teach. Within our university this strategy has been widely implemented and has been proven effective in helping students understand the areas of their learning that could be improved, whether it is through classwork or clinical practice.
An integrated and interprofessional strategy of the SPICES model is an essential point of a curriculum de-
sign, aimed to remove barriers between basic and clinical sciences. As one moves up the integration ladder, the role of the disciplines in curriculum organizational structure changes and staffs' discussion on curriculum planning becomes more important [6].
A "spiral integration" is the most ideal form, which represents a combination of both a horizontal and vertical forms, combining them across both time and disciplines. Such model has recently been defined as a curriculum involving learning both basic and clinical sciences across both time and subject matter [7].
The curriculum in our university contains a horizontal as well as a vertical integration. For example, chemistry has a horizontal integration with physics and biology, and is vertically integrated with biochemistry, physiology, pathology, and pharmacology. But such a model cannot be defined as a "spiral integration." Selecting content and failure to successfully integrate across both disciplines and time to achieve good learning outcomes is an actual problem at our university.
When it comes to a community-based strategy, it has helped tear down the "ivory tower" that the hospital based approach helped foster in. The students under the hospital based approach have little contact with the community that they are training to serve. Due to the hospital based approach, primary care has been perceived as a weak link in healthcare. Over the years many countries around the world have been adapting more of a community based approach when training future doctors [5]. If community-based medical education is realized by a medical course, it will be able to solve some ills of the clinical culture and large community staff will be successful in delivering effective learning [8]. Over the last several years, our university has been working hard at developing a community based rural curriculum that helps future doctors develop their interpersonal communication skills.
The elective driven strategy of the SPICES model is integrated into our curriculum as the "students' selected components". They can perhaps be regarded as one of the more essential innovations of our medical curriculum. Currently our university allows for "students selected components" to take up 10% of the total curriculum time, based on the current recommendations. They provide students with a significant element of choice and depth of study in a curriculum that prepares students for the "long term intellectual and attitu-dinal demands of a professional life that will be constantly challenged by the growth of knowledge and change of circumstances" [9].
The systematic strategy approach was developed in order to incorporate the experiences that the traditional model was unable to provide. The curriculum at our university has followed the systematic strategy in developing a programme that is designed to cover all aspects necessary for students' training. Systematic approach gives a golden opportunity for students to "rotate specialties and work a number of fields within health care delivery system" [5]. Thanks to this approach our students have a vast knowledge of practices in a medical field and are able to choose a specialty based on their experiences.
The principle for improving the education in Omsk State Medical University rests on the idea that a teacher should be FAIR (Feedback, Activities, Individ-ualization and Relevance) to students [10]. Feedback is a process of finding out the results of the learning outcomes, and the transmission of information to students with the intent to help modify their thinking and behavior in order to improve their learning. Good students' achievements are enhanced by numerous feedback.
Feedback is widely applied at our university through an annual survey on students' satisfaction with the current educational process in each department. Besides the annual survey, there is an online survey, to which students have open access, this includes feedback for specific departments, and if they would like they are able to provide feedback to the rector of the university. Unfortunately, the methods of providing feedback are not always properly organized. There are multiple ways of improving the quality of feedback, this includes providing feedback that is more than just a grade, it is timely, specific and can be exploratory. In other words, the best feedback is actually "feed-forward". This way the information that is provided, could be used by the university as a guide to further studies or enhance learning strategies.
As for the activities principle, there is a great amount of attention devoted to this at our university. Through activities we are able to enhance and create excellent learning outcomes. Using meaningful experiential methods by varying activities, we can renew attention and develop an interest in learning. Using such activities as case studies, problem-solving, questions, discussions, experiments, games, TEL, e-learning, simulations, and reflective portfolios. Active learning builds on what students already know, and tests their understanding of the material, therefore, active methods of teaching should be used more often, in order to stimulate the learning process. For example, in the skills center, our university has provided multiple opportunities for students and young doctors to train and enhance their skills. Using equipment such as an ambulance equipped with everything necessary for practice, Cardio-Pulmonary Resuscitation manikins, birthing manikins, other helpful simulators are available. However, there are other methods of active learning that our university uses less frequently since they are only provided in certain settings, such as surgeries, or master classes.
Our curriculum attaches great importance to self-learning, which is one of the necessary forms of educational activities aimed at achieving students' ambitions. Students' professional competences and skills of self-educational activity, self-organization, responsibility, creative initiative and research skills are developed through purposeful, systematic and organized self-learning. According to the learning standards, the share of curricular self-learning will be not less than one-third of the time scheduled for a discipline. As for our curriculum, it is set at about 50%.
Currently, with an increased amount of emphasis on self-learning the amount of time spent on lectures is decreasing. Lectures can be as effective as other methods of teaching, especially when using active methods
of learning. The essential components of explaining the lecture material are clarity, interest, and persuasion [11]. As the educational system evolves, the way that lectures are conducted is changing, now lecturers can use TEL, e-learning, and other forms of active learning to ensure that the lecture is efficient. As a rule, a lecturer presents the medical and biological significance of a discipline, highlights the structure of each topic and gives the informational resources, including internet-resources. Instead of a detailed presentation of material, they discuss any difficult issues that students may struggle to understand.
Such FAIR principles as individualization depend on the individual student's requirements ('Just for You' education). Individualization provides students with a great opportunity to experience student-centric learning. Individualization also provides students with the power to set a convenient time ('Just-in-Time' education). The student-centric strategy approach is determined by prior experiences and education; prior knowledge, skills, and attitudes; aims and goals; learning preferences and strategies; learning opportunities available; ability ('Suits-my-Style' education). These three paths of individualization have not yet been addressed at my university.
The last FAIR principle is relevance. Relevance is a necessity of a purpose for any learning, it must be explicit. If students do not see a purpose in the material that is being covered then they will lose interest, in order for the learning process to be efficient students must understand the relevance of a subject at hand. Teachers at our university tend to give material relevant to forming the required competency, therefore, students don't have a problem understanding the purpose of the work assigned to them.
The new model of educational strategy in curriculum development, such as the CRISIS criteria is partially used by curricular planners. CRISIS, an acronym, stands for the educational principles: convenience, relevance, individualization, self-assessment, interest, speculation and systematic [12]. The CRISIS criteria are similar to educational principles described in the FAIR criteria.
Assessment is considered a distinctive feature in "up to date" education. Assessment is the process of gathering and judging personal achievements and outcomes of each student [13]. Assessment is characterized by two closely related trends. On one hand, assessment is a tool to ensure the quality of the training programmes, motivate students and help guide their learning process, on the other hand, assessment is a base for curriculum development. It is distinguished as assessment OF, FOR and AS. Assessment OF assesses the students' achievement compared to learning outcomes and the standards. Assessment FOR informs and improves the instructors teaching as well as the students' learning. Assessment AS involves students reflecting on their learning, consolidating their understanding and succeeding in learning aims [14]. Sometimes the preferred assessment method isn't incorporated with the assessed learning outcome.
In our university, assessments receive a considerable amount of attention. Learning outcomes and general competencies are standardized and most graduates from our university successfully pass a final certification. The most widely applied summative assessment is the multiple choice questionnaire, this variety is reliable, discriminatory, reproducible and cost-effective. It tests a set of skills in addition to recalling factual knowledge. Now the multiple true/false questionnaires can be recommended for formative assessment but not for summative examinations [15].
It is known that the most effective medical education is characterized by a combination of a good educational programme and a good teacher. The role of the medical teacher is difficult to overestimate because they perform several functions. A teacher is an information provider, educational planner, facilitator, assessor, learning resource developer and plays a role model [16].
The teachers of our university are excellent at providing the required information. The teachers help students to seek information by asking the right questions, discussing where to find the right answers and how to evaluate those answers. However, not all teachers are able to fulfill the listed functions; it is extremely difficult for any individual to fulfill all of those functions. Our teachers are constantly working to improve themselves and every three years undergo an assessment of their qualifications, everyone is required to undergo training that helps facilitate the continuing development of their qualifications. Besides raising their qualifications, teachers have to undergo an assessment of their soft skills (behavior, ethics, values, etc.) as well as knowledge.
Discussion. After analyzing the present state of the medical education in Omsk State Medical University, there are four ways in which I feel the medical education could be improved on. Some of the improvements have been partially implemented but there is always more to be done. We should continue to use the SPICES model when making improvements to our curriculum. The FAIR principles must be implied in order to increase the level of student' learning. There needs to be an improvement in the way assessments are conducted. Finally, we should put more emphasis on a good teacher' training.
While analyzing our university it became apparent that the university curriculum needs to move from a teacher-centered strategy to one that is student-centered. More options must be provided for students with different learning abilities, we must use the SPICES model to help personalize their learning experience and create individual learning trajectories. The curriculum must work with different learning styles of students and promote an individual learning approach to "gifted" students who are able to rapidly excel in their fields of study. Even though our current curriculum does not provide an opportunity for gifted students to excel past their groupmates, it is however set up to help individuals who have disabilities. It is wonderful that the university provides an option for disabled students to become doctors, however there are still many opportuni-
ties to improve the programme. A curriculum that focuses on the individual learning trajectory would create new methods of learning, such as various new ways for conducting classes. These methods would include new ways of using modern technologies, making it possible for disabled people to have access to the learning material without having to leave their home. The use of such technologies would also enhance the learning process of average students by granting them the ability to review the learning material as needed. Changing the ways that classes are conducted would also create a new opportunity for gifted students who would finally have a chance to excel past their peers. The reason for these changes is to encourage average students to adapt to a learning style that works for them and provides the specialized adaptive disciplines that would be needed for certain disabled individuals. The current curriculum allows the training period of students with disabilities to be increased by no more than a year, but with the mentioned changes, perhaps that need for extra time would be reduced. The university could also be more inclusive with disabled students by helping them deal with problems that they have in their everyday life, by providing them with an opportunity to live in dorms, provide some financial assistance to help make sure that a lack of certain funds doesn't inhibit their learning process, and finally by assisting them with post-graduation employment. All these changes would benefit the university, and create an adaptive learning process for our students. The SPICES model makes it easier to implement some of these changes by editing the current curriculum.
Implementing the FAIR principles would be of great benefit to our teachers and our students. With the improvement of feedback, we will increase the amount of communication between students and teachers, therefore helping eliminate some of confusions that may arise in students learning process. Harden once wrote that "good students' achievement is enhanced by excel numerous feedback," therefor, theoretically, if our teachers improve the quality and the amount of feedback they provide, then they should see an improvement in students' performance, therefore they have enhanced students learning process.
The activity principle of FAIR has been implemented at our university with facilities like the skills center which allows students and young doctors to use a number of different manikins and equipment with the intention of perfecting their skills or perhaps even gaining new knowledge, even though we already apply some of the ideas under the active principle, there is room for improvement. There are disciplines such as pathological anatomy and topographical anatomy that would tremendously benefit from using the principle of active learning, using materials such as TEL and e-learning enhances the learning process for students by improving their understanding of the material through practical application. Using such methods keeps the students interested in what they are learning and increases the amount of knowledge they are able to obtain through the process of active learning. These methods not only help them with their studies, but with the prac-
tical skills as well. They create the opportunity for students to participate in teamwork. Through teamwork students are able to improve their discussion skills, and learn taking on different roles in different situations [17]. With teamwork there's a multitude of benefits, but one of the biggest ones is the effect it has on a student's self-learning process, and their ability to adapt to new learning processes. Without active learning students would study lots of theory and gain little practice, so the biggest benefit of active learning is the training of a well-balanced doctor, who will have as much experience in practice as he has theoretical knowledge.
The quality of the education at Omsk State Medical University could be improved through reconsidering of the assessment process. As Race said, "we assess far too much, but do it not very well!" and that is certainly the case at our university. Currently our university uses selected tests that are valid, reliable, and practical, based on teachers' reports and students' portfolios. We must use multiple methods of assessment, overcoming many limitations of individual tests. One of the opportunities to improve the quality of assessment is to have them be conducted anonymously, so that students will have confidence that they will not receive repercussions for their answers.
Another way is to use the "lie scale" in order to filter out the incorrect answers due to the possibility of students' excessive desire for social desirability in terms of norms, rules, and values of a society. There are some questions used as a lie marker, for example, "Do you always tell the truth, even when it is completely unprofitable for you?" (Answers: yes; no). It is believed that an honest individual will admit lying sometimes, while a dishonest one will answer that they never lie.
One possibility to assess progress of students in their learning process is through the innovative portfolio that strives to balance a personalized assessment and teachers' assessment. Evidence of learning achievement (papers, video or audio recordings, photographs) is gathered together and possibly presented to another person for review. By focusing on a student-centered aspect, a student portfolio ensures a student's active role in assessing their own learning process. A portfolio maintains competences, keeps up to date with professional practice, fitness for practice and more, and reflects student's occurring work overtime which may provide evidence for learning progress towards the educational and professional outcomes [18].
The method for conducting a pre-graduation assessment of the general practice physicians is the Objective Structured Clinical Examination. It can capture professional competencies in a simulated situation or clinical practice. Objective Structured Clinical Examination is useful for assessment OF and FOR learning [14]. Currently this assessment is not properly conducted. There is lack of the recommended amount of stations which causes the results of the assessment to be not valid. As of right now, one of the main focuses of our university should be to bring the amount of stations to the recommended level. The number of Objective Structured Clinical Examination stations reflects the reliability of this test. If the Objective Structured Clinical Examination test is carried out correctly, it is well validated.
Finally, one of the most important improvements that could be made when it comes to the medical education at Omsk State Medical University is the amount of emphasis put on a good teacher's training. There is a whole scientific approach to train a good teacher. Good teaching can be calculated by a formula; it is directly proportional to technical competencies, approaches to teaching, and personal approaches. One of the keys to an effective improvement of medical education is to coordinate the staff for rethinking how we educate doctors and exchanging staffs' knowledge and staffs' experience about teaching and learning.
A teacher is an information provider, educational planner, facilitator, assessor, learning resource developer and plays a role model [16]. A teacher must ask the right question because the control questions serve as a guideline toward reviewing informational sources. When students prepare answers to questions for discussions in class, a teacher must be the guide to finding the necessary information for a student to achieve their learning outcome. Recommended literature helps students "to not get lost" in the plethora of information, a good teacher should be able to provide literature in multiple forms, including specific presentations of lectures, textbooks and other sources of information. This allows students to efficiently spend their time, successfully cope with all types of verbal and written class tasks, as well as help reduce the amount of questions a teacher may have to answer. During problem solving tasks, if a teacher provides quality educational material that is assigned to a specific topic then students develop a multitude of skills which in the end will result in students passing their exams. Teachers have many roles that they must fulfill especially when it comes to teaching and training future doctors. Luckily in our university teachers are wonderful at providing the required information and at guiding students towards achieving their desired learning outcomes.
When summing up the state of medical education at Omsk State Medical University, even though this school is regarded as one of the top ten medical universities in the Russian Federation, there is still a lot to be done. In order to train a competent doctor, we should continue to make improvements to our curriculum using the modern educational strategies, principles and methods and put more emphasis on good teachers' training.
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POSITION OF ART, TRADITIONS, CULTURE IN MODERN WORLD
Maltseva L.
Doctor of Education, Professor Kuban State University, Krasnodar
Snaksarev P.
Undergraduate Kuban State University, Krasnodar
ABSTRACT
Traditions, culture, customs begin where a person creates, and for a child this measurement is revealed through figurative thinking and mastery of creativity. Mastery of this measure is the essential sign of culture. The familiarization of young people with traditions, culture, and customs is the teaching of art and history. Keywords: culture, traditions, customs, upbringing, art, Cossacks, youth, thinking.
In history, a person has always played a huge role, and a person's personality will play. Pushed to the front line, she can, without fear, of any negative consequences, take full responsibility. Artists, poets, theorists and practitioners of space flight, large production managers and many simple workers in the village know how to work efficiently, beautifully and harmoniously. And be personalities.
So, the ongoing restructuring in education is justified by the data of recent psychological studies, which indicate that based on an objective consideration of age-related opportunities and finding the most optimal psychological conditions for teaching and upbringing, art can significantly improve the quality of knowledge, skills and teaching effectiveness. The psychological patterns of creating works of art are studied. The features of artistic thinking, the development of artistic perception are studied, and the task is to reveal the laws of the impact of a work of art on personality formation.
Fine art, fraught with special opportunities for the development of creative imagination and intuition, for a sense of joy. It opens up many possibilities. With the help of these materials, spatial thinking, imagination develops. They feel the material, representing themselves as creators and are capable of expressing their attitude to the world in the creation of specific objects.
Man lives by feelings, and feelings are an integral part of our ability to perceive the world, comprehend it, live in it, dream about the future, and therefore create it. Huge experience has been accumulated and using this experience, it is possible to educate the younger generation [6].
Artistic works answer not only questions of life, but also social, political, moral, that is, visual art should be a universal, multi-valued spiritual phenomenon. At the same time, the worldview in this process becomes not only a rational concept, but also a worldview, an organic manifestation of the personality. It is associated
