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MEDICAL EDUCATION IN LITHUANIA. Algimantas Tamelis Faculty (School) of Medicine Kaunas University of Medicine. Lithuania. Membership: EU ( 1 May 2004 ) , NATO ( 29 March 2004 ) Capital: Vilnius Language: Lithuanian Population: 3,39 mln. Area: 65,300 km²

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MEDICAL EDUCATION IN LITHUANIA

Algimantas Tamelis

Faculty (School) of Medicine

Kaunas University of Medicine


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Lithuania

  • Membership:

    • EU (1 May 2004),

    • NATO (29 March 2004)

  • Capital: Vilnius

  • Language: Lithuanian

  • Population: 3,39 mln.

  • Area: 65,300 km²

  • Political system: Parliamentarydemocracy


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Largest cities:

Vilnius (553,200),

Kaunas (373,700),

Klaipėda (191,600),

Šiauliai (132,700),

Panevėžys (118,800).

Ethnic composition:

Lithuanians: 83.5%,

Poles: 6.7%,

Russians: 6.3%,

Belorussians: 1.2%,

other: 2.3%.

Lithuania


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ACADEMIC COUNCIL

SENATE

STUDENTS COUNCIL

GENERALINFRASTRUCTURE

SERVICES

GENERAL SERVICES FOR

EDUCATION AND RESEARCH

RECTOR’S OFFICE

UNIVERSITY HOSPITAL COUNCILS

FACULTIES’ COUNCILS

RESEARCH INSTITUTES’ COUNCILS

  • UNIVERSITY HOSPITAL

  • DIRECTOR GENERAL

  • OBSERVER’S COUNCIL

  • MEDICAL COUNCIL

  • NURSING COUNCIL

  • FACULTIES

  • MEDICINE

  • ODONTOLOGY

  • PHARMACY

  • NURSING

  • PUBLIC HEALTH

  • RESEARCH INSTITUTES

  • BIOMEDICAL RESEARCH

  • CARDIOLOGY

  • ENDOCRINOLOGY

  • PSYCHOPHYSIOLOGY &

    REHABILITATION

UNIVERSITY

HOSPITAL

OF

ONCOLOGY

  • DEPARTMENTS

  • UNITS

  • THEORETICAL AND CLINICAL DEPARTMENTS

LABORATORIES




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Pedagogic Units

10 theoretical departments

30 clinical departments

Administrative staff

Dean

3 Vice Deans

2 Dean Assistants

3 Technical personnel

School of Medicine: Human Resources



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Challenge

  • COUNCIL DIRECTIVE 93/16/EEC “To facilitate the free movement of doctors and the mutual recognition of their diplomas, certificates and other evidence of formal qualifications”


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Basic Principles of Education

  • State regulated profession

  • Law of High Education

    • Three levels (cycles) of education

      • Bachelour

      • Master

      • Doctor

    • Principles and basic structure of undergraduate education

    • Internship and Residency training


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Regulation of Postgraduate Training

  • Decision of the Government

    • Training of Doctors

    • Structure of training

      • Undergraduate studies 6 years

        • Internship – 1 year

      • Residency training

        • Regulations

        • Duration


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Medical Education

Specialist

General (Family)

3 - 6 years

Medicine 3 years

Internship 1 year

Basic

Medical

Education

Undergraduate studies 6 years


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Enrolment

  • Completed secondary education

  • No entrance examinations

  • Concerted enrolment procedure:

    • Ranking on Matura examinations

      • school-level

      • national-level (National Examination Centre)

  • This year – joined 310 students


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Requirements For the Training

  • Order of Ministers of Health Care and Education and Science:

    • “Minimal requirements for the training of doctors, odontologists, nurses, midwifes and pharmacists”

      • Duration

      • Structure

      • Principles

      • CPD

    • Transposition of EU directives


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Requirements for the medical training

  • 6 years or at least 5 500 hours of teaching:

    • adequate knowledge of the sciences on which medicine is based and a good understanding of the scientific methods including the principles of measuring biological functions, the evaluation of scientifically established facts and the analysis of data;

    • sufficient understanding of the structure, functions and behaviour of healthy and sick persons, as well as relations between the state of health and physical and social surroundings of the human being;


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Requirements for the medical training

  • adequate knowledge of clinical disciplines and practices, providing him with a coherent picture of mental and physical diseases, of medicine from the points of view of prophylaxis, diagnosis and therapy and of human reproduction;

  • suitable clinical experience in hospitals under appropriate supervision.


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Undergraduate Training

  • Universities

    • Kaunas University of Medicine

    • Vilnius University

      • Programs in High (University) Education

        • “Medicine” – 6 years

        • “Odontology” – 5 years

        • “Pharmacy” – 5 years

        • “Nursing” – 4 + 2 years

        • “Public Health” – 4 + 2 years


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Study credit

  • To measure student workload

    • 1 week – 40 hours

    • Every activity to achieve learning outcomes

      • Lectures

      • Classes

      • Laboratory

      • Practical training

      • Library

      • At home

      • Ets.


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KMU Curriculum

  • 6 years (12 semesters)

  • 240 national credits – 360 ECTS credits

    • contact time – 6965 hours (72,5 % of study time)

    • independent studies – 2635 hours (27,5 %)

  • 62 subjects

    • 52 compulsory

    • 10 elective (could be chosen from the list of more than 60 subject).


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KMU Curriculum

  • Study blocks (according Lithuanian law):

    • university background knowledge

      • 34 credits (14,2%)

    • program basis

      • 60 credits (25%)

    • special medicine subjects

      • 146 credits (60,8%)

  • Elective courses – 38 credits (15,8%) – through all blocks


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Traditional curriculum

  • 1st and 2nd years

    • Courses in the university background knowledge and the programs basis

  • 3rd year

    • Courses in special medicine are started

  • 4th, 5th and 6th years

    • Courses in special medicine prevails

    • Some courses in university background knowledge


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Teaching Methods

  • Proportion of lectures (overall) – 20%

    • Variations according subject

  • Practical clinical training

    • Contact with the patient

      • The first - the 1st year – “Fundamentals and Practice of Nursing”

      • As a doctor – the 3rd year – “Basics of Medical Diagnosis” and “Basics of General Surgery”

    • All working day in the clinical department

    • Small groups

    • Bedside teaching


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Student Assessment

  • Study results – discussed every semester

    • Dean office

    • Rector Board

  • Percentage of failing students per teaching year

    • Temporary – 5 – 20 %

      • Repeated studies

      • Delays

    • Drop outs – 1 – 2


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Survey

Anonymous

Conducted every second year.

Special questionnaire

Effectiveness of course unites,

Value of lectures and practical classes,

Aspects of teachers’ work and other.

Results of survey

by the Office of Students Representatives and administration of the Faculty

Discussed at:

Faculty Council,

University commission on Study quality assurance

Rector Board.

Are presented to the all subdivisions of the Faculty

Quality Assessment


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Development

  • Problem based learning – from academic year 2006/2007

  • Support from EU structural funds


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Problem based curriculum

  • 1st year – traditional studies

    • Main principles of cell and tissue structure (Citology, Histology)

    • Main principles of human anatomy

    • Related courses

      • Physiscs

      • Chemistry

      • Informatics

      • Etc.


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Problem based curriculum

  • 2nd and 3rd year – problem based learning

    • According to main functions of human body

      • Homeostasis

      • Respiration

      • Blood circulation

      • Sensation and consciousness

      • Infection

      • Immune responce

      • Ets.

    • Preclinical and clinical departments involved

    • 6 problems per module

    • 2 turorial seminars per problem


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Problem based curriculum

  • 4 – 5 year

    • Integrated clinical trainig(internal medicine, surgery, radiology, biochemistry, rehabilitation)

      • Cardiovascular system

      • Chest and lungs

      • Gastrointestinal disorders

      • Kidneys and urinary tract

      • Endocrine

      • Etc.


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Problem based curriculum

  • 6 year

    • Reseach project

    • Elective couses

    • Practical placement in regional hospitals

      • Internal medicine

      • Surgery

      • Obstetrics

      • Pediatry

    • Final examination

      • Practical

      • Theoretical


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SOCRATES / ERASMUS PARTNERS

Lulea

Oulu

Kuopio

Tampere

Kotka

Bergen

Helsinki

Tartu

Linkoping

Riga

Vaxjo

Aarhus

Kristianstad

Naestved

Gdansk

Groningen

Greifswald

Kiel

Cardiff

Berlin

Magdeburg

Leipzig

Gent

Halle

Wroclav

HradekKralove

Praha

Lille

Brno

Rennes

Lyon

Geneve

Grenoble

Santiago de

Compostela

Parma

Oviedo

Montpellier

Perugia

Plovdiv

Porto

Dicle

Roma

Lleida

Madrid

Coimbra

Beja




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Reform of Postgraduate Studies

  • Structure – more streamline

  • Duration – according EU directive

  • Programs

    • Structure

    • Training log-book


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Medicine - Internship

  • Established since 1993

  • Regulated by Universities

  • Clinical experience in regional hospitals and out-patient departments selected by University

    • Internal medicine

    • Surgery

    • Obstetrics

    • Paediatrics


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Medicine - Internship

  • Program ending – University Examination

  • Professional Qualification – Medical Doctor

  • Possibility to get Licence of Medical Doctor

    • Assistant physician

    • Limited independent practice

      • Emergency Room

      • Ambulance

      • Nursery


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Residency training

  • Established since 1990

  • University and University Hospitals based

  • Duration

    • 6 years – 3 programs (paediatrics)

    • 5 years – 18 programs

    • 4 years – 26 programs

    • 3 years – 13 programs (incl. Family doctor)


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Medicine - Residency training

  • Final university examination

  • Professional qualification - specialist in medicine

  • Possibility to get Licence for independent practice


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License

  • Medicine, Odontology, Nursing, Pharmacy

    • Obligatory licence

    • Termless

      • Obligation for CPD

      • Control

  • Public Health

    • For certain practices (decision of Government)


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Licensing Body

  • Ministry of Health Care

    • State Agency Of Accreditation For Health Care Practice

      • Commission of specialists

  • Chamber of Odontologists

    • Non governmental professional organisation

    • Obligatory participation


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License of Medical Doctor

Medical diploma

Certificate of internship

Evidence of satisfactory health

Limited independent practise

Full License (Specialist)

Medical diploma

Certificate of internship

Certificate of specialist (residency) training

Evidence of satisfactory health

Types of Doctors’ Licenses


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Re-licensing

  • Formally – non exists

  • Informally – requirement to prove obligatory CPD


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CPD

  • Law On Practice In Medicine

  • Decision of Minister of Health Care

    • Principles of Organisation

    • Forms

    • Financing - partially (75%) financed by government


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CPD - Forms

  • Updating courses and traineeship

  • Conferences and seminars

    • Participation

    • Presentations

    • National - under supervision of Universities

  • Articles in journals

  • Subscription of journals

  • Other


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CPD - Volume

  • Doctors – 120 hours per 5 years, incl. 70 hours in University settings

  • Nurses – 100 hours

  • Pharmacists – 120 hours

  • Odontologists – 120 hours (Chamber of Odontologists)


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Conclusions

  • System of under and post graduate education

  • Minimal requirements of EU directives followed

  • Licensing and regulation practice functioning

  • Still many unsolved questions


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