HOW THE COMPETENT DOCTORS TEACH IN UKRAINE

22.01.2018

Higher education in Ukraine already faces the certain problems – they are the obsolete methodologies, obsolete technologies, insufficient financing. If we compare the “old school” and new European methodologies – what is the difference?

Professor, rector of O.O. Bogomolets National Medical University Kateryna Amosova answered these and other questions on air in “Time. Online” in the “5th Channel”.

“Now the society is interested in medical and educational reforms. And we are at the junction – doctors and educators. Historically it happened that the teachers at higher medical schools are namely the doctors and not educators. Without formalities and trainings. Our team now catches up namely this. The problems of Ukrainian medical education are already of 100 years old – firstly “bloodletting” Ukrainian intellectuals after revolution, then – the life behind “iron curtain”. No matter how we would like, we could not significantly change this for 25 years. But we shall do it”, – is sure professor.

ABOUT OBSOLETENESS OF EDUCATIONAL METHODOLOGY

According to the arrangement of curriculum itself, we have German system from the times of one hundred years, where they taught due to ribbon, in parallel, per 10-15 subjects per semester. The whole world has already re-arranged to units with better integration across.

For example, we have the course in anatomy: firstly – all bones, then – all muscles, then – vessels, etc. it is very difficult to collect thus together, to integrate, how it works in general. And the world already studies it with separate units. For example, the head – starting from bones and ending with nerves. Although there are no scientific researches in the sphere of pedagogy of higher medical education, which would show the significant advantages in learning and applying the material in practice. For the present we do not plan to implement this. Firstly, all Ukrainian higher schools are bound due to one principle, the students are transferred, so, they have the right in mobility. We cannot just change the program separately. Secondly, this is a very large link, which may cause harm for a certain period of time.

The communication is the thing that also differ the Western education from national one. There is the real course of communicative skills, which have only implemented. The communicative competence is one from the main landmarks for medical education, about which Ukraine in general heard few. This is what we implement now.

ABOUT DIFFERENCE OF EDUCATION IN THE USA AND EUROPE

The best medical education is in the USA. It is better than European one. That’s why Bologna Declaration and Bologna Process have appeared – this was the desire to improve European education, so that it would not behind American one. But American education is very expensive, European one is significantly cheaper.

Though, there is no principal difference between them. The modern education is based on the result. The result is the competency. It is similar for doctor everywhere.

The licensing assessment of future doctors all over the world is based on tests with clinical cases, pursuant to clinical situations that enable checking the ability to synthesis and analysis and not only memory. And OSCE (Objective Structured Clinical Exam) – on standard patients, on “phantoms”, with assessment on competency of practical skills as well. Thus, the USA has some centers of OSCE; this 4-6 hours exam costs USD 1.5 thousands per each student. The indicator of “check list” for actions of student is patient. This is actor, it is very hard to train them and this costs money. European model is significantly cheaper, works at each higher school. The teachers and not actors check. This example is rather good illustration along both sides of the Atlantic.

The USA went by way of simulation study. Some clinical states of human and their measures may be reproduced. The second example: it is possible to make the measure – whether a student presses on the breast rather strongly while making the closed-chest cardiac massage. And there is the complete list of the simplest and cheapest equipment, “phantom” mannequins, more acceptable for our budget.

ABOUT REFORMS

The idea and strategy, which university implements together with the students – the modernization and harmonization of medical education, with its approach to international samples. It is absolutely real to implement certain best educational practices. Secondly, we planned for ourselves so that the society and students would see the first results already in a year. And thirdly: we do not wait for the money from the state. There is the war in the state, there are families, and there are pensioners. We earn money with educational services; we are the higher school No 1 due to admission of students – in particular, foreign ones. This year we had the record breaking admission, although we made stricter criteria for admission. This was the risk but it was justified as we have the real brand.

Студенти Національного медичного університету ім. Богомольця

ABOUT FOREIGN STUDENTS

We have the contingent of students, who could not enter to free higher schools in their countries. This relates both developed countries, such as India, and those ones that lacked the courage or money to go to study in the West.

Now at us No 1 is Hindu, No 2 – Arabic students. But 46 countries are represented; there are people with passports of the Great Britain and USA.

ABOUT INTERNATIONAL EDUCATION

The diploma of Ukrainian higher school in all countries shall be confirmed, for that it is necessary to pass through licensing exams. Such system is in India, Germany, and Poland. The strictest system is in the USA. But to pass through this control after graduation from higher school even in Germany or Britain is absolutely real.

One of the parts in our project is to pass to teaching due to basic English speaking textbooks. By the way, we have almost 2 thousands foreign persons, this year we admitted 1 thousand – 80% among them are English speaking. This develops teachers very much. Earlier all higher schools translated these textbooks in English for foreign students. Earlier we made it to a limited extent and now we just put the textbooks to open access. In their turn, Ukrainian has the possibility to write essays and the teachers make the notes about text so that everyone would understand.

ABOUT ENGLISH LANGUAGE

I would not tell about high level in English at least in most students, Kyivans at the university are only 20%, we have the whole Ukraine. Even when we started teaching using original American tests, there appeared the complaints – and even in the website of university trade union – that we infringe their rights, providing with texts in English. Unfortunately, the school education in countryside is not rather good. But the significant portion of students communicates in English. We performed the students’ scientific conference in English – all actions and events during two days. English speakers came to us.

ABOUT COOPERATION WITH MINISTRY OF HEALTH

The ministry launched very serious changes in the system for rendering the medical aid. But to orient the whole country from Soviet system to western one is a business of not one year. The medical community was in a certain transitional period for five years more. During recent year the team of Ministry of Health at the head with Uliana Suprun made two serious things.

  1. The project with testing of our interns and students-graduates of the sixth course due to licensing American tests in translation – without influence on the mark, for comparison of results. It took place in May, 2017 and was voluntary. This was so interesting for students and teachers that we bought the books in Amazon and started the trainings due to American principles. This is qualitatively new tests, which are used not only for control and assessment but for study. “Testing for learning” – this is what the team of Mrs. Suprun made. We will gladly continue such contacts and would be glad in general to pass to these tests.
  2. The recommendation of Ministry of Health about improvement in minimum of scores up to 150 in discipline “Biology” for entrants to medical higher schools. The educators accepted this initiative ambiguously but potentially this may significantly reduce the number of entrants, especially to contractual form of study. But NMU supported this initiative from MH and approved the entry standard in “Biology” at the level of 140. We are the first such higher school in Ukraine, this was risky but we have the complete set. And hereby – students with the highest scores. So, this is so edgy and unpopular decision but it has the advantages. And already next year Ministry of Health officially set the requirement of 150 minimum scores for two from three disciplines. Thus, the medical higher schools will significantly lose in the number of contract students but we are ready to do it.

Студенти Національного медичного університету ім. Богомольця

ABOUT TEXTBOOKS

Textbooks are very important. But now in the epoch of the internet, Google, millenials – they are already less important for education. There is the colossal number of very laconic information in any issue. According to the survey, which we performed two years ago among the students of the fourth course “What do you use while preparing for practical classes?”, less than 50% use the textbooks, and lectures – in general 20%. And this is two years ago. Taking into consideration the low quality of national textbooks, we plan to pass to international textbooks. We have the intent to address to the Ministry of Health to seek for aid.

Besides, there is the issue about protocol. And this is the third position of cooperation with MH, to a certain extent revolutionary – to pass to treatment due to international protocols in English.

ABOUT ASSESSMENT OF OSCE

The licensing exams are in medical schools all over the world. As I told, the most complex system is in the USA. The exams are performed in pairs – in the middle of study, before graduation and at the end of internship or residency, when a specialist receives a permit for practice. The diploma without internship does not entitle to practice. And our graduates have 2-3 years (depending on specialty) to work at clinics and only then to pass through exams. Such system is in the world but we have the shortest period of medical study. In America it is 10-12 years – for us this is very expensive, some day or other we will come to this.

Thus, there is the pair. Firstly – the test exam with clinically significant questions. And in parallel there are the objective structured clinical exams. Using the standard patients – they are the imitators-students or actors or “phantoms” – demonstrate the manual skills, abilities to behave in concrete situations. The teacher hereby does not put any questions, does not communicate. He/she has the check list, the previous author’s team, according to educational purposes, marked the most important steps, which a student shall demonstrate. And according to this list they define, which percentage of those steps was demonstrated. This provides with the objectivity, which is important both for student and society. At present moment we do not have it, so, there is the distrust of society, the dissatisfaction of teachers. But we have been working on such format of exam.

ABOUT PRACTICE AND UNIVERSITY CLINICS

Here, perhaps, is the largest problem, which impedes to internationalize the medical education. What cannot be made by efforts of higher school is to establish the university clinics. The unique model was implemented in Ukraine during Soviet times: the higher schools only teach but practically make no science. Science relates to scientific research institutes (SRI), and the treatment of patients relates to municipal hospitals or special SRI.

Now the law about autonomation of medical health care facilities, which shall start acting, – solves the destiny, whether they would allow us continuing to perform the clinical study with our students. And the part of departments may be “invited to leave” – this relates the whole Ukraine. Now there is the situation when we have to receive the support from the state or to return to the world system of university clinics. And we are glad that the Prime Minister Volodymyr Hroisman in his speech in December also mentioned that medical higher schools shall have the university clinics.

Студенти Національного медичного університету ім. Богомольця

ABOUT EDUCATION FOR TEACHERS

For the first time in Ukraine we launched the center of constant, continuing education for teachers. Since this academic year we actively perform the system of trainings for teachers due to western format in small groups using all internet resources. The clinical doctors learn better to teach and not only to think that if you are a doctor – you may work as a teacher by default. We can suggest this model to all higher schools in Ukraine.

ABOUT GRANTING THE LICENSES

American and European practice – after graduation from internship or residency a doctor receives the license. As a variant for Ukraine – the license is important. In order it will be such one as in the West, the extraordinary adherence to principle is necessary. Here is the problem as the occupational associations issue the license in developed countries – and they are very principle in this issue as they are responsible to society for a new young doctor. The establishment of these associations is only in germ at us. Many “pocket”, named after one professor, who wants to have such imaginary crown, were established for recent 20 years. Only some specialties – for example, anesthesiologists or cardiologists – have the uniform Ukrainian associations. Thus, now we cannot implement such model.

Source: 5th Channel