Education of Public Health Specialists and relation with the practical sector of work
Once the activities within the Project TEMPUS in 2010 „Master Programmes in Public Health and Social Services” have been launched, it was created, in the State University of Medicine and Pharmacy (USMF) „Nicolae Testemitanu”, a Permanent Committee for Curricular Revising and Amendment of the Study Programme and Plans, both for the higher education, as well as for the postgraduate one. This committee is led by the project’s coordinator. The curricular committee’s members are the pro-dean of the No.1 Medicine Faculty – responsible for higher education at the specialty of public health, associate professors – heads of specialty chairs and university lecturers with didactic and practical experience. When necessary, the curricular committee consults the senior specialists of the public health area.
The main goal, when creating the curricular committee, was to delegate responsibilities and authority to plan and implement a curriculum complying with the current requirements, in order to ensure high educational results.
The curricular revising and amendment committee annually analyses the international trends in the medical education, especially the curriculum’s composition and duration, comparing the inter-discipline module curricula with the linear ones. Presently, it is planned to organise the self-assessment of the didactic process. As regards the curriculum’s optimisation, one of the activities of the curricular committee is represented by the advisory services in medical education provided by certain experts from other universities from the European Union.
The process of vocational training of doctors from the public health area differs as regards the form and length necessary for the vocational training of other categories of specialists (including clinical doctors), being composed of the higher stage (6 years) and the postgraduate one (2-year residency). Thus, pursuant to the normative provisions in force, the candidates’ admission to residency studies is done exclusively on the ground of a contract concluded with the Health Ministry, by which the public authority assumes the obligation to ensure all necessary teaching conditions and the doctors take the commitment to work, after they graduated the university, at least three years, in the settlements where they have been distributed.
The residency education in the Republic of Moldova has started in 1991, when the first six groups of resident physicians, from the rows of the best graduates of the university to three specialisations (general surgery, obstetrics and gynaecology, traumatology and orthopaedics) have been matriculated. The residency training at the public health specialty has been introduced as compulsory starting with 1996.
Presently, the medical postgraduate education, which ensures the formation of the specialist physician, is regulated by: • Decision of the Government of the Republic of Moldova no.502 from 15.07.1994; • Law on education no.547, art.28, paragraph 2, entered in force on 21.07.1995; • Decision of the Government of the Republic of Moldova no.18 from 15.01.1997; • Classifier of medical specialisations, approved by the Government of the Republic of Moldova in 2000; • Regulation on the postgraduate education via residency, approved by the Health Ministry, no.110-p§2 from 07.10.2003; • Regulation on the postgraduate education via clinical secondary studies, approved by the Health Ministry, no.110-p§2 approved on 07.10.2003; • Law on the state budget for 2005 no.373-XV from 11.11.2005 „About the residents’ scholarships”.
The postgraduate education via residency is organised by the USMF ”Nicolae Testemitanu” and is coordinated by the Health Ministry in compliance with the law, as regards the requirements related to the formation of a doctor specialist, set by the strategies of the national health programmes. The main grounds, for the practical training in residency of the public health specialists, are: the National Centre for Public Health and the Chisinau-based Centre of Public Health. Along those two years of study, the resident physicians make a three-month internship in the district public health centres. The main objective of the residency education is the vocational training of specialists in the public health sector, so that they could later put into practice, on their own, the gained knowledge.
The doctors’ postgraduate training is covered from the state budget. The residency is a mandatory form of postgraduate education, which is aimed at obtaining a specialisation by the physicians and pharmacists. • The annual number of places to residency is set by the Ministry of Health for each specialisation, depending on the needs. • In order to organise the postgraduate training, the didactic process is directed to acquisition of practical skills, stipulated in the Educational Standard and the analytical programme, which aims at preparing a competent specialist with an appropriate aesthetic behaviour.
Due to these reasons, the following objectives are achieved during the postgraduate training: • to implement new modern methodologies and techniques in order to ensure, optimise and assess the continuous training process; • to assess and improve the educational plans and programmes by observing the field of the specialisation; • to organically integrate the training to fundamental, clinical and preventive medical and biological subjects in compliance with the achievements got in science and medical practice; • to ensure the scientific and didactic information, with access to international values and achievements in the public health area; • to educate the specialist in line with the ethic and moral and deontological requirements; • to ensure the development of scientific researches and investigations and the cooperation with the specialised scientific institutions as artistic training, according to the scientific national and branch programmes; • to develop the inter-university relations as regards the organisation, management and evaluation of the process of postgraduate education.
Thus, according to the government’s decision, the Health Ministry is the institution responsible for the repartition of the licensed doctors in order to be employed, institution which also concludes contracts with the licensed doctors after the residency graduation.
In order to ensure the rural sector with qualified medical staff, already when carrying out their studies at the university and during the summer holidays, the students were distributed to carry out their internships mainly in the public health centres from the rural area, contributing to increase the activities promoting health and healthy life style. • The resident physicians are compulsory distributed, during the training period, to work in the district medical institutions, thus covering the needed number of doctors in districts. • Over the past year of study, the resident physicians were continuously informed about vacant positions, possibilities of employment and benefits they might benefit from. • There are organised meetings with the heads of the district medical institutions, with representatives of the local public administration and other decision-making factors interested in employing doctors. • The Health Ministry annually organises, in universities and with the relevant institution’s support, the repartition campaigns of licensed doctors in order to be employed, being created the necessary conditions for the participation of heads of the public medical-sanitary institutions and of representatives of the local public authorities.
The experience of the past years shows that the benefits offered to young doctors are not very attractive and, unfortunately, did not influence on the trends of employment after they obtain the licence, thing that demonstrates that the issue of attracting physicians in the rural area needs important involvement and joint efforts of the central and local public authorities, of the heads of the district public medical-sanitary institutions, as well as from the part of the civil society. The interventions shall be based on large-scale approaches, mainly focused on motivation and attraction, and less on constraint, they shall start up from recognition of the doctor’s statute and value, resulting from the state’s investments into this category of specialists, from the long-lasting period of education and sacrifices of people who have chosen this profession, of risks and responsibilities assumed.
Strenghts: • a Permanent Committee for Curricular Revising and Amendment of the Study Programme and Plans was created in the university; • the Permanent Committee for Curricular Revising and Amendment is composed of persons responsible with experience in the field; • the education criteria of the specialist doctors comply with the modern requirements, implemented by the economic advanced states; • responsibilities for planning and implementation of a curriculum appropriate to current requirements have been delegated; • the state ensures the graduates with jobs; • there is set a relation in higher and postgraduate education of specialist doctors with the medical experience and the health sector; • formula and possibility of continuous postgraduate education have been set.
Drawbacks: • poor involvement of representatives of the republican public health centres, of the Health Ministry, as well as of those outside Moldova in the curricular committee; • it was not worked out yet the possibility of continuous education of specialists in notorious medical specialised institutions abroad Moldova; • the distribution system to workplaces of young specialists is based on the authoritative administrative principle; • the principles of distribution of young specialists to workplaces are not enough motivated.