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Effective Advocacy for Health in Europe. Medical Education in European Integration context : new challenges for accession countries Emanuil Grigore Stoicescu College of Physicians, Bucharest Riga, Latvia 3 – 5 April, 2003. Medical Education. Wh y it is important :

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Effective advocacy for health in europe l.jpg

Effective Advocacyfor Health in Europe

Medical Education in European Integration context : new challenges for accession countries

Emanuil Grigore Stoicescu

College of Physicians, Bucharest

Riga, Latvia

3 – 5 April, 2003


Medical education l.jpg
Medical Education

  • Why it is important :

  • free movement of health professionals

    • EU requirements

  • development of medical science and technology

  • rationalization of resources

  • social factors

  • quality of medical care


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Medical Education

  • The purpose is:

  • “to train physicians that are authorized (licensed), according to their preparation, to practice the medicine without limitation”

    (The international Medical Association and the International Association of Medical Education)


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Undergraduate Medical Training

EU recommendations

Directives 73/362, 75/363, 93/16

Standing Committee of Europeans Doctors

European Union of Medical Specialists

  • Duration of training

    • 6 years (5500 hours)

    • any student, before getting the degree, must perform at least one year of clinical practice

    • teaching resources


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Undergraduate Medical Training

EU recommendations

  • Curricula

    • biological and behavioral science

    • socio-economic aspects of medical services

    • ethical principles


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Undergraduate Medical Training

  • Romania

    • appropriate length of training

    • 13 medical schools

      • 3 private

      • 7 created after 1989

  • Negatives

    • exaggerated development of theoretical component

    • no respond to the social needs

      • health promotion,recovery, responsibilities

    • hospital based training

    • no cooperation between education managers and health authorities

    • no “numerus clausus”


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Postgraduate training - specialization

  • Directives 93/16 and 2001/19

    • 14 medical specialties recognize in all member states

    • 36 specialties recognize in al least 2 member states

    • Duration of training

    • Excessive specialization

      • increase inequality in distribution of health services

    • Too many specialists

      • competition for a job

      • great offer of medical services

        • Increase the number of referrals to specialists

        • Increase the number of procedures


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Postgraduate training - specialization

  • Too many rigidly delimited specialties

    • difficult to plan the number of doctors needed

    • inequities in distribution

  • Romania

    • 53 medical specialties (2 for dentists)

    • duration of training – 3 to 7 years

    • “common trunk” principle

    • Quality of training programme

      • Insufficient clinical problem solving capability


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    Training General Practitioners

    Directive 2001/19

    • 3 years of training

      • at least 6 months in hospitals

      • minimum 6 months in a general medical practice

      • maximum 6 month in other health establishments

    • Romania

      • the specialty was introduced in 1990

      • residency programme since 1993

      • chairs within medical schools – 1997

      • general practitioners represent 43% of the total number

        • Bucharest – 10%


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    Continuing Medical Education / Continuing Professional Development

    • “formal and informal activities undertaken by doctors in order to maintain,update and develop their competence”

    • importance

      • meet the real demands

      • meet the needs of patients

      • determined by day to day practice

      • recertification


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    Continuing Medical Education / Continuing Professional Development

    • Romania

      • CME organized by the College of Physicians

      • recertification of physicians based on CME credits – minimum 200 CME credits for 5 years

      • CME providers accredited by the College


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    Continuing Medical Education / Continuing Professional Development

    • College of Physicians

      • professional organization (NGO)

      • special law

      • membership mandatory

      • organized at the national and district level

        • elections each 4 years

      • attributions

        • certification/recertification

        • medical ethics/judicial problems

        • guidelines

        • quality of care


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    Number of Doctors Development

    • Standing Committee of European Doctors

      • 1982 - Concern about the uncontrolled development of the number of physicians

      • Negative impact

        • quality of training

        • free circulation

        • mutual recognition of degrees

        • waste of economical resources

      • 1986 – asked for

        • “numerus clausus” in member states

        • ratio inhabitants/doctor kept constant

        • number of students regarding training capacities

      • 1989 – 200 000 unemployed doctors in UE


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    Number of Doctors Development

    • Romania

      • geographic misdistribution

      • ¾ of the counties are below the country average

      • 86% of physicians practice in urban areas

      • 14% - provide health care for 47% of the population in rural areas

      • Bucharest – almost 25% of the romanian doctors

      • no real medical unemployment

        • jobs available

      • no significant loses during the medical school

      • more than 30% of graduates abandon the system



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    Doctors / Development100000 population

    Romania (1999)……191.4

    Europa (1996) …... 297.5

    CEE (1996) ……311.1


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    Doctors’ Ratio in Romania DevelopmentSource: National Commission for Statistics, 2000


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    Medical Schools Development


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    Conclusions Development

    • Romania needs 14,000-15,000 doctors to reach the EU average

    • Keep a level of 2,500 entries in medical schools for the next 5 years

    • Cooperation - health care authorities / education institutions

    • Revise that number in 2008-2012 regarding the economical evolution

    • Merging some medical specialties and maintain the list stable minimum 5 years


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    Conclusions Development

    • Number of residents by specialty be stable at least for 5 years

    • Emphasize the role of general practitioners

    • Training programmes more practical and oriented toward

      • common medical problems

      • socio-medical aspects

      • public health


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