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UDC 378
THE TENDENCIES OF DEVELOPMENT, MODELS AND STANDARDS OF LEARNING IN THE RUSSIAN UNIVERSITY MEDICAL HIGH EDUCATION (19 — 21 CENTURIES)
R.Yu.Zalilov
Yaroslav-the-Wise Novgorod State University, Rinat.Zalilov@novsu.ru
The authors of article highlights stages of establishing the university system for training of the medical personnel in Russia in 19 — 21 centuries, the tendencies of its development, the forms of the organization, standards and models of learning.
Keywords: the tendencies of development, models and standards of learning
Авторами статьи рассматриваются этапы становления университетской системы подготовки медицинских кадров в России в 19 — 21 вв., тенденции ее развития, формы организации, стандарты и модели обучения.
Ключевые слова: тенденции развития, модели и стандарты обучения
The domestic system of training of the medical staff has a long history and conducts the readout from the moment of acceptance of university charters in 1804 (more in detail see tab., a line 1). They planned the general principles of medical education in the country, set the educational standards, corresponding to requirements of time; determined number of faculties, etc. [1].
During this period the state system of training of the medical staff has been initially focused on training of doctors at public expense. The basic customers of medical experts were military and sea departments, and also civil where physicians have consisted on public service as officials. At this time in Russian empire did not exist public health services, connected to rendering of medical aid to the population.
It was possible to allocate three types of the state high medical educational formation into first third XIX century: medical faculties of universities, medical surgical academies and medical institutes at medical faculties of universities (tab., a line 2) [2].
In the beginning of 30th years of 19 century in Russia there was a process of reforming of national education system, result of that becomes development and acceptance in 1835 of the new University charter (tab., a line 3), which have predetermined the further development the medical education as complete system.
Is conventional, that the first decade after introduction of this charter was rather fruitful as from the point of view of the organization of university educational process and training of the professorial staff, as well in the matter for development of university sciences. However subsequently it became clear, that the system of the high medical education demands the further updating and reforming.
During development of basic directions of reform of the high medical education, two approaches, so-called «German and Russian models» have distinctly come to light. Within the framework of the first concept it was planned to strengthen considerably a medical component of training of the doctor and it is especial its clinical part and it was offered to refuse teaching general educational sciences completely.
The second point of view — «the Russian model» — determined that general educational disciplines at medical faculties are necessary for keeping [3] at the expense of increasing of the process of training up to six years.
The conciliatory proposal of the given question was the statement in 1846 program for medical faculty of the Moscow University (tab., a line 4). Within the framework of this program the general quantity of the hours which were let off on teaching humanitarian subjects was sharply reduced [4], at the same time all five years of study at medical faculties were densely filled with especially medical subjects.
TENDENCIES, STANDARDS AND MODELS OF LEARNING
№№ The period Tendencies of becoming and development Normative documents/the form of the organization of training Model and specificity of learning
1. The first decade of 19 century Development of legal bases for becoming and developments of the state high medical education, introduction of educational standards, an establishment of number of faculties The university charter 1804/ Medical faculties of universities, Medical surgical academies «One-step model» training of physicians (scientific-theoretical training on medical disciplines and simultaneously clinical training of students)
2. Since 20th of 19 century Creation of medical institutes for the accelerated training of medical officials and «state» doctors Medical institutes at medical faculties of the Russian universities. The special curriculum on which the first year is allocated on general educational and natural-science training, other three years — studying of actually medical disciplines with accent on a clinical component of education
3. 30th 19 century Transition to five years' education at medical faculty, increase in duration of clinical occupations since one year up to two, the right on independent medical practice on the termination of university, integration of university professorial corporations into the Russian state system The university charter 1835 The first uniform curriculum, course system of training, sequence in studying by students of a course of medical sciences, a natural-science orientation of medical education
4. 40th 19 century Expansion of a quantity of university clinics, creation of the first hospital clinics, a clinical orientation of training. Domination of actually medical disciplines. Universities began concentrating spiritual unity of professorate and students The additional decision about medical faculty of Imperial Moscow university. The base program for medical faculty of the Moscow university and provincial medical faculties The compromise between the «German» and «Russian» models, term of training - five years, the increased number of the week hours allocated on studying (since the first course) medical subjects, refusal of auxiliary humanitarian subjects for the benefit of medical, reduction of hours on natural-science and general educational disciplines
5. 60th 19 century. Increase in quantity of laboratories and clinics, prevalence of practical classes {occupations} over theoretical readings. Support of theoretical courses by practical demonstrations Renewal of practice of foreign business trips The university charter 1863, combining the European university traditions, the Russian creative operating time and the state leadership A wide university autonomy (the opportunity is given to medical department to solve questions on change of structure, opening of new departments, etc.)
6. 80th 19 century Increase and a deepening of the general medical course. Change of structure of medical faculties (23 departments) University charter 1884 Qualitative changes in character of teaching (a combination of theoretical, practical and clinical knowledge and skills) at professional growth of the faculty
7. 30th 20 century Transformation of medical faculties of universities to the independent specialized high schools — medical institutes Orientation of educational process on a medical component of training, easing of connection between medical education / science and technical and natural-science schools
8. 90th 20 century. - p/t Revival of classical type universities with obligatory medical faculty University level of general scientific and humanitarian training of the future medical experts, introduction in medical education of hi-tech, innovative approaches
9. 1994 — 1996 Adaptation of the high professional training under a new socioeconomic structure SES HPT of the first generation An obligatory minimum of contents of BEP; the maximal volume of an academic load of trainees; requirements to a level of training of graduates
10. 1996 — 2000 Expansion of academic freedom of high schools in formation of educational programs (up to 30% from general labour input BEP) The federal law «About the high and postgraduate professional training» / SES HPT of the second generation Information-knowledge model of the high professional training
11. 2007 — p/t Granting to universities of the greater degree of freedom (up to 50% from general labour input BEP), introduction of the level high vocational training SES HPT of the third generation Competence the approach; connection of education and scientific researches
Thus, reforming of the high medical education in 1840th years «focused» educational process on domination of actually medical disciplines, and also increased a clinical orientation of training, to that promoted both expansion of a network of university clinics, and creation of the first hospital clinics.
In 1860th years in St.-Petersburg and Moscow universities the works on preparation of the project of the new university charter were being carried out. By development of a medical component of the university charter the experience of the European universities was taken into account. So, for example, from the French charters, state and end-of-year examinations, compulsion of curricula have been borrowed.
Characteristic feature of the 1863-years charter was a wide university autonomy which gave an opportunity to medical faculties independently to solve structural and organizational questions (tab., a line 5).
By 80-th years of 19 century in Russia a national medicine had formed both as practical, and as scientific. In sphere of training of the medical staff and scientific activity Russia becomes at one level with the countries of the Western Europe [1].
The results of the gone way in matter of development of the high medical education have been reflected in new university charter, accepted in 1884 (tab., a line 6).
Let's note, that to 1914 in Russia there was an extensive system of training of the medical staff, including both state, public and private educational institutions.
The First World War and then October revolution have suspended realization of many perspective projects directed on reforming of the state high medical schools.
During Soviet time (thirties) there was a process of transformation of medical faculties of universities in the independent specialized high schools — medical institutes. This reorganization had both positive and negative consequences. Concentration of high school activity on training of the medical staff only it's an obvious plus, that allowed to strengthen a medical part of education. On the other hand, formed «insularity» of medical school put obstacles in the way of integration processes, broke connection between medical education / sciences and technical and natural-science schools. And it somewhat slowed down introduction of scientific and technical achievements in medical sphere.
In the 90s of 20 century, in Russia backward processes are taking place, namely: integration of separate high schools and formation on their basis of new educational structure - university of classical type. In structure of such formation the medical faculty is necessarily created/revived. This, as professor V.Veber has noted, has allowed to realize the new concept of a professional training and scientific research in medicine, to provide a university level of general scientific and humanitarian training of the future doctors, pharmacists, stomatologists and medical managers [5].
In 1994 — 1996 years the first generation of the state educational standards of the high professional training (SES HPT) is developed and commissioned, called to adapt the high professional training under a new socioeconomic structure.
The standard regulated an obligatory minimum of the contents of basic educational programs (BEP); the
maximal volume of an academic load of trainees; requirements to a level of training of graduates.
The first generation of SES HPT was developed during stagnation of economy and, in the overwhelming majority, was guided by requirements of the academic communities. Thus the best traditions of the Soviet education — fundamentality and breadth of preparation were kept.
In 1992 the training of bachelors and masters was established by the departmental act in Russian Federation, which actively took root in high schools according to the decision of an academic council.
In 1996 the Federal law «About the high and postgraduate professional education» has been accepted, according to which the federal components SES HPT should include the following: the common requirements to the basic educational programs; requirements to an obligatory minimum of BEP contents, to conditions of their realization, including to educational and an industrial practice, to final certification of graduates, a level of training of graduates, terms of development of BEP; the maximal volume of an academic load of students.
In 2000 according to the given law the Federal state educational standards HPT of the second generation have been commissioned.
In spite of the fact that SES HPT both the first, and the second generations have considerably expanded academic freedom of high schools in formation of educational programs (from 10% in 1988 up to 30% in 2000), they have not changed principals of designing the contents of higher education to the full extent. Conceptually they have been focused on information-knowledge model of the high professional training, in which basic emphasis is put on an establishment of the list of disciplines, their volumes and the contents. While the purposes of training is creation/achievement of a high level of mastering of a teaching material, formation of professional competences at high school graduates, inculcation of research skills.
The competence approach is a fundamental ideology of the third generation standard.
Other actual feature of the new standard - it will regulate only 50% of the general labour input of educational program, and 50% of it university fills independently. Thus the larger degree of freedom is given to universities.
And the last, transition on level (bachelor, master, specialist degree) the high professional training in view of requirements of a labour market and the international tendencies of development of higher education.
Let's note, that by present time in Russia there is formed system of the high professional training which consists of two educational subsystems: it is continuous training of diploma experts (term of training, as a rule, 5 years), and level, providing realization of educational programs on steps of the HPT with assignment to the graduate of a «bachelor» degree (term of 4 year training) and «master» (term of 6 year training).
Training on a medical direction because of the specificity is not yet covered by level system. Though, if we address to world experience, such examples are available. So, in Massachusetts University there are both bachelor and master degrees of medicine, with that only the requirement, that the student of medical department
already should have a degree of the bachelor in any field. Due to this students of the high medical school the USA have training only on disciplines of a medical field. And this, as rector NovSU V.Veber has emphasized, is constructive and in the future can have application to the medical education of Russian universities.
Summing up, we shall note, the domestic system of the high university medical education is historically developed and has been constantly evolving during centuries the educational structure; it has the tendency to the strengthening of medical constituent of the doctor training, and especially, its clinical part. The important branch of this system is maintenance of a university level of general scientific and humanitarian training of the future doctors. Its modern direction of evolution is wide application on the basis of classical model of teaching about innovative technologies and the techniques, providing higher level of training of experts.
Let's note as well, that the Russian university education has been always aspiring to the greater degree of academic freedom in teaching that found its embodiment in the positions of the University charter of 1863, and now in new FSES HPT the third generation, and on this
way it had to overcome «severe» administrative supervision from the state structures.
1. Zimin I.V. Training of the medical staff in Russia (XIX — the beginning XX Centuries) / I.V.Zimin. SPb., 2004. The monography. 367 p.
2. Stochik A.M. Medical institutes at the Russian universities — a special (third) type of the high medical educational institutions of Russia of the first third XIX century / A.M.Stochik, S.N.Zatravkin, E.Ju.Astakhov // Problems of social hygiene, public health services and a history of medicine. 2001. N°3. P.35-40.
3. Stochik A.M. From a history of creation of « the Additional decision about medical faculty of Imperial Moscow university. 1845. / A.M.Stochik, etc. // Problems of social hygiene, public health services and a history of medicine. 2002. №4. P.61-64.
4. Stochik A.M. The change in the organization and the contents of educational process in connection with acceptance « the Additional decision about medical faculty of Imperial Moscow university » / A.M.Stochik, etc. // Problems of social hygiene, public health services and a history of medicine. 2001. №1. P.44-47.
5. Veber V.R. Medical education in Velikiy Novgorod (Events and people) / V.R.Veber. Velikiy Novgorod, 2003. 146 p.
