Medicine/13. Preparation of medical workers in universities

Voloshyna Karina Viktorovna

The Kharkov medical academy of postgraduate education

Modern medical education in Ukraine

Preparation of medical personnel, without doubts, is a weak point in Ukrainian public health system. In European countries, for instance, health manpower resources are considered as the most expensive element of public health. And the cost of medical staff increases depending on the level of professionalism and experience of the workers.

A university education plays the leading part in the medical professional training.

What do we have today?

Nowadays training lasts for 6 years today at a medical university in Ukraine. After a successful graduation a former student receives a diploma in medicine. A career of a doctor in a large city can ensure a stable income for a young specialist. Of course, a doctor’s salary is not too big in Ukraine, but nevertheless this salary is guaranteed firmly. In emerging and unstable Ukrainian economy, in conditions of high level of unemployment, even such low paid work turns out to be in demand. Besides, due to a great level of corruption and poor working legal institutes in Ukraine, doctors often have a chance to receive illegal incomes: although the law tells about free health services in Ukraine, doctors actually have no responsibility for their actions, so many of them are used to demanding money for doing doctor’s work properly. Especially in large Ukrainian cities doctors receive unofficial incomes that many times more than a doctor’s official salary. All these facts make the doctor’s profession prestigious and so available mainly for the people of relatively higher social status and for those, who have contacts in medical circles. To become a student of medical university it is often necessary to pay an informal payment or to use relationships. And graduating student of medical university can hardly get a place of a doctor, especially in a city without relationships or bribe. So it happens, that a lot of modern entrants choose medical universities not because of their calling for medicine, but because they have relatives among doctors and medical administration, or because entrants belong to rich families. An inaccessibility of doctor's career for many talented people from poor families deprives the Ukrainian public health system of really good professionals.

Today doctoral career is available for those, who have high social status and difficult of access for those, who don’t belong to rich stratum. And the majority of Ukrainian people live in poverty. The number of badly prepared and less gifted students is increasing constantly, while a quantity of gifted and talented students in medical universities is dwindling. Many students enter medical universities only because of a prestigious of doctor’s profession, because their parents insisted or because they had chances to use connections in medical circles. Such students don’t have real calling for medicine and don’t really appreciate studying in medical university. Consequently a potential of educational groups in medical universities is reducing.

Of course, inaccessibility of doctor's career for a great number of talented people, who really have calling for medicine, is a fault not only of medical universities. The problem is in deep society stagnation and perversions of moral principles. But such stagnation, no doubt, affects the quality of medical education in Ukraine.

Because a common potential of medical students is decreasing, the demands for educational and professional level of students are lowering too. The best working places come to privileged students, despite of their results in education. Having no need to study hard, these privileged students don’t always do their best in education. Knowing about a little role of education achievements for distribution of working places and about students’ career predestination, professors and tutors often perform formally their duties. Printing paper works and essays from internet instead of writing by oneself became a usual evident for students, which is often accepted by tutors. Truancy and bribes for good marks became usual too. Some tutors even demand money from students for good marks, and student’s, who can’t pay receive bad marks. It sometimes happen, that in a group consisting of 15 students, only 5 persons regularly visit lectures and learn all educational material. According to author’s personal survey not more than 30% of students in medical university really want to become doctors and actually comprehend the full responsibility of this profession. After all the main rule of medicine is not to do harm! And what with the remained 70% of the future doctors? Certainly, during training a little part of them is used to being eliminated because of completely awful study results. Sometimes students leave university, understanding that they will be responsible for human life, knowing that this profession doesn’t suit their abilities. But the larger part of these 70% students stay at the university. They continue studying medicine indifferently and graduate together with those of 30% of diligent students. These 70% not best students even succeed to get high marks due to belonging to high stratum, bribery and relationships, despite of really poor knowledge. And later due to the same reasons they receive places in best medical institutions. The last is impossible for the above mentioned 30% of diligent students which have no relationships with medical administration or money to ‘buy’ job position in state medical institution. It's a pity that corruption and bribery prosper in our country.

But let’s return to medical education. Why is formation in Ukraine worse, than in the European countries? It is true that Ukrainian medical universities have good staff of professors. But here comes another problem of Ukrainian medical universities: poor equipment and congestion of study groups.

It is necessary to notice that a group of 15 students is numerous enough for studying medicine. The fact is that this science assumes not only theoretical but also solid practical training. And it is hardly possible to master training in overcrowded group having little teaching hours.

Usage of multimedia and communication technologies in medical education, for example, would provide the possibility to transmit video from the operational rooms (from external cameras located within an operational field). So an interactive participation of students would be provided. The European students have already been studying with the help of such systems for many years, and here in Ukraine, such systems are only a dream.

After graduation of medical university a student receives the diploma of medical doctor. The next step is internship. In Ukraine the duration of internship is 1.5-3 years depending on the speciality. During this period former medical student, and now the doctor-intern, gets to other environment, different from a university. Intern moves to a medical institution where he should learn in practice all the theoretical knowledge, he has received in the university. He should get practice of real work, for example through assistance in surgical operation.

Certainly, nobody would allow an intern to approach the operational room if he didn’t prove to be ready for it. To do this an intern should show himself from the best side: he should stay in hospital days and nights, evince his striving and deep interest in medicine, and also he should spend a lot of time helping his doctors-colleagues with registration and medical documentation (paper work in Ukraine occupies 30-40% of doctor’s working time, although in Europe this documentation is used to being processed by the paramedical personnel with the help of computers). So, if the doctor-intern has shown all his best qualities, he gets to operational room where he at first watches surgical operations, and then gets a chance to assist on some of them. But once again, this difficult way of internship concerns mainly those students who really have a calling for medicine and those, who can’t rely on money or relationships in order to get a good job. Many privileged students of the high stratum, whose careers are predefined, regard internship as formality like they considered education. Some interns pass internship and become surgeons in best state clinics having never assisted at the surgical operation.

It is necessary to notice that in contrast to European countries, the preparation of the doctor-surgeon in Ukraine lasts for 9 years. Why in Europe it takes 12-13 years? It occurs so because the European countries have insurance medicine. In case of doctor’s mistake a hospital pays a large sum of compensation. And also the hospital loses its reputation, which is important because of competition among private medical institutions. Therefore they do their best to prepare excellent doctors in Europe. In Ukraine we have neither insurance medicine nor well developed sector of private medicine. Most medical services are provided by state hospitals and policlinics which in addition are insufficiently funded by government. So it is hardly possible to get compensation for doctor’s mistake from Ukrainian medical institutions. Patients pay with their own money and health for doctor’s mistake in Ukraine. Thus we have poor public health and bad medical education.

In Ukraine those, who are going to become doctors and get profitable job position know that they will get it despite of poor results in university and in internship. And professors know this too. Doctor’s career in a city is available mainly for privileged people, remaining no chance for others. Lack of competition to get good doctor's job allows these ‘privileged people’ not to be zealous in studying. Medical education turned into a formality on the way to well paid job for the privileged group of people. It seems that really qualified doctors are not needed in Ukraine and good medical education is not necessary too.