Cancellation of internship - details of the medical education reform. Residency: what is it, study or work, how long does it last?

After graduating from a medical or pharmaceutical university, a graduate cannot immediately begin to independently treat patients. After passing the diploma, he must undergo postgraduate residency training and only after that he has the right to begin independent medical practice.

What is residency, how long does this additional training last and what are its features?

Residency training – what is it?

Residency courses are a form of education and primary training after graduating from a medical or pharmaceutical university, as well as medical faculties at a state university.

The main goal is an in-depth study of the fundamentals of medical sciences, gaining experience in independent treatment and obtaining highly qualified medical specialists for independent work in government agencies or private healthcare organizations.

Residency training is also required to gain skills, knowledge and experience in dentistry. Dental students undergo a course of lectures according to an in-depth program and practice their acquired knowledge.

After completing training, young dentists are issued certificates that allow them to work in government agencies or private dentistry, or open their own personal dental office.

Residency and internship

After graduation, residents and interns take additional courses to improve their knowledge and skills. But what is the difference between residency and internship?

The main difference is the duration of training. Interns study for only 1 year, and residents - 2 years, and for some specialties the study can last for 5 years.

Residency over a longer period is considered more complex and complete.

Residency and internship in medicine is a desirable step for graduates of medical universities. On initial stages During training, the intern and resident can only listen to the doctor and answer his questions.

In the future, they may be allowed to collect tests or perform other manipulations with patients, and only at the end of their studies can the doctor prescribe the management and treatment of the patient, but with mandatory supervision and consultation with experienced specialists.

Another difference is the level of knowledge. It is difficult to absorb everything in one year, so residency in medicine is preferable. Also, sometimes completing one internship is not enough to obtain a high position or academic degree.

Important! To obtain a complex specialization, for example, cardiac surgeon, neurosurgeon and others, a one-year internship is not enough.

Is such training required?

Residency in medicine – what is it?

Medical or clinical residency training is not required component higher education doctors, pharmacists and other healthcare workers.

It serves to gain experience, in-depth knowledge and improve the professional qualities of a doctor. You can take residency courses at medical universities or medical faculties of universities, as well as at advanced training institutes.

This form of education is an independent, conscious choice that a graduate can make to improve their own knowledge or become familiar with new treatment technologies.

The residency form of study was approved in 1994; pharmacists, doctors, dentists and pharmacists can enroll in it. Admission is on a competitive basis, so not everyone will be able to get into the group.

The duration of education for full-time residency courses in medicine is two years. But in some cases, residents can study for 5 or more years.

This takes into account seniority medical worker for as long as the residency lasted. But in practice this is rarely used, even with the possibility of early retirement.

Do I have to pay for residency?

The first question that worries a graduate of a medical institution before entering a residency is whether it is paid or not. There is paid and free residency training.

Paid - study under a contract, free - budget funding based on competitive admission to the university. Students are paid a fixed stipend from the institution where they are studying.

Until mid-2017, free education was accompanied by mandatory residency training government agency, after which students were released from such an obligation, regardless of whether their studies were paid or not.

Important! If a student enrolled on a budget basis and then left for personal reasons, in the future he will be able to enroll again only on a paid basis.

What is the difference between residency training for pharmacists and pharmacists? Pharmacists have a higher pharmaceutical education, unlike an ordinary pharmacist with a secondary specialized education. In 2017, pharmacists entering residency training will study on an equal basis with doctors - 2 years.

This is due to changes in federal standards public education, to deepen the knowledge of pharmacists and improve their qualifications. However, the period of study after 2018 may again be changed - shortened.

An important feature of resident training is that it exists only in Russian Federation and in the countries of the former Soviet Union. Therefore, it is not possible to become a resident outside the CIS countries.

However, abroad you can take a course of study after graduation in an in-depth program. The graduate will be able to enroll in advanced training courses or become a medical assistant and gain experience in theoretical and practical knowledge.

Residency programs abroad differ from Russian ones. For example, Italian higher educational establishments They train specialists for 2–6 years, while they have a permanent medical practice. And in Germany, the status of an assistant can be changed to a doctor only after successfully passing the exam. All these criteria apply to future dentists.

Is residency a study or a job?

Residency in medicine takes place on the basis of universities, and you need to enroll in it on a competitive basis. When continuing education in order to improve knowledge or qualifications, the knowledge of resident students is monitored.

Training is carried out according to individual plan, it is compiled by a leader - an experienced medical worker.

The residency program includes lectures on general and advanced disciplines, seminars and practical lessons, as well as attending conferences with reports.

In addition, students have the opportunity to conduct rounds of patients under the guidance of an experienced health worker, carry out simple manipulations and prescribe treatment after consultation with the attending physician.

But the main thing is: is residency a study or a job? Despite all the educational training, it is work. It is worth remembering that the health worker’s work experience during this period is entered in the work book.

In addition to gaining additional in-depth knowledge of their medical specialty, residents have a number of other advantages:

1. After completing their studies, graduates are given a certificate that confirms completion of their studies.
2. The resident receives a certificate based on the results of the certification.
3. A student who entered on a competitive basis will be able to find a job independently in the future.
4. The resident receives a stipend during training, as well as an additional bonus upon entering the place of work.
5. Resident students have vacations; their duration is equal to a doctor's vacation.
6. Housing is provided for those who come to study from other cities or countries.
7. You can complete your studies earlier if you complete the curriculum correctly and successfully.
8. Students are allowed to take academic leave.

Useful video

Let's sum it up

Enrolling in residency courses is a conscious choice for medical graduates. This necessary step to improve their own knowledge and skills, as well as to learn new treatment methods or modern computer technologies.

Students of this form of education receive work experience and extensive work experience. Unlike an internship, residents study for two years, after which they can receive a certificate of completion and a certificate of qualifications.

The education system is moving forward every year. If previously new developments affected secondary educational institutions, then in the future they will also affect medical universities. Mostly new developments will follow during the internship. It is planned to be canceled in 2016. Instead, students will take exams according to the state federal standard.

The planned innovation is assessed by medical specialists in two ways. For example, some of them believe that such an approach to direct higher education will negatively affect the level of training of future doctors. Others, on the contrary, argue that the planned changes will certainly lead to an improvement in the receipt of medical services by patients in general. How this will actually happen is impossible to decide at the present time. But the problem of whether the internship will be canceled from 2016 excites many future healers in snow-white coats.

After certain studies and analyses, scientists came to the correct conclusion that today the level of training of young specialists is at lowest level. In this case, the data is submitted for the period until the planned changes have been introduced.

If the internship is canceled in 2016, it turns out that after graduating from a certain higher educational institution of a medical profile, young specialists will have to begin directly performing personal work responsibilities. If previously, after graduating from university, they became interns and continued to receive the qualifications they needed, but now, after students leave the doors of these institutions, they must immediately sit in the offices of medical institutions.

Among other things, experts in the above-mentioned service sector argue that obtaining a higher education diploma alone will not be enough to work in clinics. The question of the quality and effectiveness of medical services remains open. Will yesterday's students be able to provide effective assistance to injured or sick people? In order to slightly counteract the new products of next year, enhanced training lessons have been introduced into specialized medical education, allowing young personnel to become more qualified and prepared. Among other things, the new standards indicate that future specialists will need to undergo additional advanced training once every 5 years, followed by passing the required exams.

Residency question

When the internship cancellation occurs in 2016, the law states that it will continue to do so. What does it mean?

A student who has received a higher education in the relevant field has the right to go to work in any medical institution, and then undergo important residency training in his field of work. Currently, the number of years a young doctor must work after graduating from university is 3 years. This amount of time is not indicated in any valid document, but this figure is verbally discussed. After working the required amount of time in a medical institution, a young specialist has the right to enter residency training. The period of pre-graduation practice in case of admission to residency increases to 5 years.

What will happen after changes in the medical structure?

It is planned that after the cancellation of the internship in 2016, there will be a massive problem with personnel in medical structures in a positive way allowed. But this medal has 2 mandatory sides.

At a glance, young professionals will fill vacancies in medical institutions. On the other hand, poorly trained specialists will not be able to answer all their patients’ personal questions.

The only good thing is that gradually the young specialist will receive practical life experience. Accordingly, with each subsequent year of work he will gain more life skills. Another advantage is that once every 5 years, a medical specialist will need to confirm his qualifications and improve his knowledge with the help of relevant courses. All this will ensure improved quality of medical services.

According to senior specialists and scientific experts in the field medical technologies, the abolition of internship will radically change the specifics of medicine. The new changes will affect not only higher educational institutions, but also secondary schools and medical schools.

Future doctors themselves do not yet appreciate the problem. Young people also have different opinions. For example, some young specialists are happy to begin direct practice after receiving the appropriate education. Others, on the contrary, want to thoroughly prepare themselves in medical theory in order to subsequently provide decent medical care.

Quality medical education and services have always been the subject of close attention and complaints from citizens, which forced the government to undertake deep reforms of the healthcare system. Direct measures also affected the educational process, most affecting the stage of postgraduate education - internship, which was previously considered mandatory for graduates of medical universities.

Many people involved in this field, and especially future medical graduates, are passionate about the question of whether changes to the internship will occur in 2018-2019.

Reason for change

Innovations in the structure of education of medical specialists were planned back in 2011. During this period, a new Federal Education Standard was approved at the government level. In accordance with this standard, the requirements that bring the level of education closer are brought to the fore. Russian doctors to the global one.

The main positions that are being implemented in educational process:

• Previously, the years of study at the university were fully devoted to studying the theoretical component of the sciences, and only during the internship did students acquire practical skills. Now the approach is radically changing: all stages of training, starting with applicants, are full of practical exercises and the acquisition of skills through experience. Scientific research activities now occupies integral part educational process.
• The new scheme involves working with patients at universities and within medical institutions. This is important from the point of view of constant observations, conclusions, and analysis against the background of direct contact with the patient. All these stages will be supervised by qualified personnel with a high professional and pedagogical level.
• Most of the learning process is devoted to simulation methods, which have been widely used abroad for last decades and are recognized as highly effective. For this purpose, special phantoms and simulators are used, which allow students to try their hand in conditions close to practice, after theoretical part has already been mastered, but practical training has not yet begun. In this case, simulators become a buffer for acquiring and consolidating skills.

All these measures imply a huge amount of work, which this moment carried over educational program. Full-scale replacement of benefits and development of new mechanisms are required, and all these processes will take place during 2018-2019.

Starting in 2018, internships are no longer valid for doctors of all specializations, since their training before receiving a diploma fully corresponds to the level at which they can successfully work with patients. That is, doctors will be able to begin full-fledged practice immediately after graduating from university.

How does cancellation work?

The widespread process of abolishing internships takes place in three stages:

• fall 2016 – cancellation of internship for dentists and pharmacists;
• autumn 2017 – for therapists and pediatricians;
• 2018 – for the remaining specialties.

After the complete cancellation of the internship, the residency will remain unchanged. This type of postgraduate training is often confused with internship, but their functions are different. Residency is needed for doctors with a narrow focus, such as surgeons, gynecologists, neonatologists, neurologists, etc. This form of training during the transition to new system remains in its original form and will take 2 years, after which the specialist will be issued a certificate allowing the doctor to practice independently.

Pros and cons of cancellation

Radical change educational system received medical specialists mixed reviews. This reform has both strengths and weaknesses.

The advantages include the following:

• students will be able to start their studies earlier labor activity and perform paid work;
• since doctors will start treatment earlier independent activity, this will improve the staffing picture, since at the moment many clinics lack qualified, highly specialized medical staff;
• working in clinics during training will allow you to prepare in detail for a wide variety of situations and study the dynamics of pathologies in practice, which forms more constructive medical thinking in each student;
• simulation techniques make it possible to work out treatment algorithms without the risk of harming the patient, which allows the student to act more calmly and without unnecessary stress;
• The abolition of internships will reduce training time, but at the same time increase the qualifications and level of training of university graduates.

Along with these positive factors, there are also negative ones:

• to expand the practical part of the program, the theoretical component will be significantly reduced, some topics and subjects will be transformed into a shortened course without in-depth;
• simulation does not provide the full effect of treating patients and deprives the student of mastering the psychological aspects of interaction between a doctor and a patient;
• On the part of patients, it is possible to display great mistrust and reluctance to be treated by an inexperienced doctor who has not completed an internship.

What will replace certification?

After completing the internship course, students received a confirming certificate, which indicated the appropriate level of the young doctor. This document became permissible independent work for a beginner specialist. Certification had to be repeated throughout the practice at intervals of 5 years, which gave the right to obtain a higher qualification.

Now certification is being transformed into accreditation. Without it, a doctor cannot be allowed to practice independently.

Accreditation involves collecting the required number of points, which are calculated for:

• participation in seminars, conferences and other similar medical events;
• edition scientific works in the form of books or articles;
• successful performance of complex medical procedures or successful application of complex integrated treatment regimens in severe cases.

The accreditation mechanism will be launched for the first time in 2021. Doctors still have many questions about this:

• which party will pay for travel and accommodation at the accreditation site;
• How will the patient appointment time change based on the additional requirements for writing scientific and research work, as well as attending seminars and conferences;
• will accreditation be affected by daily practice and patient reviews, etc.

The Ministry replies that over the coming period all these issues will be finalized and clearly regulated, so the refusal of internship will take place calmly and in an orderly manner. This reform is aimed at improving the level of young specialists and competitiveness Russian doctors on the world market.

Video about cancellation of internship:

Russia is undergoing a full-scale reform of the healthcare system. One of its components is university and postgraduate training of qualified specialists. The essence of the changes concerns the issues of internship and residency, advanced training, replacement of certificates with accreditation sheets, approval educational standards training of future doctors.

2014 - the beginning of reforms in medical education

The essence of change is standardization. According to the plans of the Ministry of Health of the Russian Federation, training, postgraduate training, specialization, advanced training of doctors, treatment, rehabilitation - everything related to medicine must fit within the framework of specially developed standards. For this purpose, in 2014, Order of the Ministry of Economic Development of Russia dated May 30, 2014 N 326 was adopted (as amended on March 17, 2017). It regulated the transition to a standardization system in the training of doctors and was supposed to become the basis of the Federal State General Education Standard for Higher Education in the Field of Medicine (FSES). Almost all higher education institutions in the country operate by these standards. However, its final version has not yet been developed in medicine. Medicine is facing constant changes: the cancellation or abandonment of internship or residency, how to issue accreditation certificates, how to improve the qualifications of experienced doctors, etc.

Training of doctors until 2016

Each medical school graduate with 6 years of theory and a diploma in General Medicine or Pediatrics could choose how to develop and where to work.

In order to independently treat patients and gain practical skills, he was obliged to enter an internship in a general specialty (therapy, surgery, obstetrics and gynecology) or on a competitive basis to a residency in one of the narrow specialties of his choice (neonatology, dermatology, cardiac surgery, etc.) .d.). From college it was possible to enter graduate school to continue scientific work.

The internship involved a year of practice under the guidance of an experienced supervisor, residency - two, postgraduate study - three.

If during the course of work (more than 5 years of experience) a desire arose to acquire a narrow specialty, the doctor could take advanced training courses (from 3 months to a year) and receive the right to independently manage patients according to the acquired profile in a clinic or hospital.

This system was, is, and will be in effect until approximately 2021 for doctors who graduated from university before 2015 inclusive.

2016 - cancellation of internship

In 2016, Order No. 127n dated February 25, 2016 was adopted, according to which Internships will be phased out from 2016. At the first stage - for pharmacists and dentists; on the second - for doctors of therapeutic specialties and then for surgeons. It was planned that university graduates, along with their diploma, would now be required to instead of a certificate, receive an accreditation sheet, giving the right to work independently from a student's bench at an appointment in a clinic or outpatient clinic as a general practitioner, therapist or pediatrician. Only after a year of such work is the aspiring doctor allowed to take residency exams. These innovations have affected applicants to medical schools since 2013.

Practical skills in working with patients at the institute are acquired during subordination - the sixth year of study, when students undergo practical training in clinics under the guidance of curators. It was planned that from 2016 upon graduation they would confirm these skills in simulation centers, of which there are about 70 open in the country.

The simulation center is equipped with dummies, mannequins, computer programs and medical equipment qualification units for testing.

On their basis, the practical skills of a doctor must be confirmed in order to obtain or renew accreditation (every 5 years).

According to the plan of the Ministry of Health of the Russian Federation until 2018, everything medical workers were required to confirm professional suitability in simulation centers according to special clinical protocols. To date, these plans have not been fully realized. At the same time, over the past two years there have been some changes in the procedure for obtaining accreditation sheets. Now it is planned to receive them not along with a diploma, but after a year of practical work.

2018 - start of postgraduate education reform

There are no internships since 2018. There is a residency program, but to enter you need to obtain accreditation. It was planned that accreditation and narrow specialization could be obtained only after a year of work as a pediatrician, therapist, clinician, dentist, hygienist, epidemiologist or pharmacist. In this way, the Ministry of Health wanted to fill the primary clinic with specialists.

However, in July 2018 it looks different. Young doctors receive accreditation along with their diploma, which allows you to work in a clinic as a therapist, pediatrician, general practitioner or emergency room.

You can also immediately enter residency and no need work for a year.

Accreditation

Without accreditation it is impossible to work as a doctor. This is the main innovation in the system of postgraduate training. All graduates are eligible for accreditation.

Accreditation consists of three stages:

• Testing according to a special program.
• Exam.
• Interview.

Level of the accreditation commission - Doctor of Medical Sciences, Professor. The essence of the event is to allow doctors with a good practical base to obtain a narrow specialty.

As a result, in order to receive accreditation, everyone fulfills the requirements and goes to work in a clinic or emergency room, but only a few remain there, since the prospects for working in such primary care are not the most promising.

Residency

All graduates after graduation have the right to enter residency on a competitive basis. Paid or free.

Only 5% of places left for free residency

At the same time, it is possible to enroll in residency at any time, the main thing is to obtain graduation accreditation and accumulate the points necessary to win the competition. You can save them from your student days. The bigger, the better. Residential minimum – 50 points. But both paid and free residency is a competition. The winner is the one who managed to distinguish himself at the student bench or at the workplace.

Residency scores are calculated as follows:

The accumulated points are especially important for the free competition. However, the competition is also held on a paid basis on general terms. Therefore, it is better to think about a career from your student days.

In July 2018 You can enroll in residency at the request of the chief physician the medical organization (MO) where the graduate works, if there is an urgent need for a specialized specialist. In this case, the Moscow Region will pay for the resident, he will be included in the 5% budget places, but under the contract he will be required to work in the Ministry of Defense that sent him for three to five years. Add in residency training for two to five years, and the prospect of becoming a specialized specialist becomes even more tempting.

In such conditions, residency becomes virtually unattainable for most. Paid is too expensive (the cost of training is three times more than for a year at a university), only 5% is left for free, which includes targeted areas. Usually, “targets” are secretly distributed among graduates. The young doctor signs a contract along with receiving a diploma and accreditation and knows where, by whom and how long he will work before and after residency. Exceptions for foreigners have been eliminated.

After residency, another accreditation is issued, this time to a narrow specialist.

Final testing in residency

Testing is part of checking the readiness of a young doctor to work independently. The test is aimed at assessing the general level of knowledge, and not just in a narrow specialty. In 60 minutes you will have to answer 60 questions selected automatically. The results are assessed by leading experts in each field, professors, and candidates of science.

Postgraduate education at the moment

• Obtaining a diploma and accreditation for the right to work in primary care.
• Residency or continued work in a clinic or emergency room.
• Annual study for a week to obtain modern knowledge and skills in their field of medicine (36 points), participation in scientific and practical conferences in their specialty (14 points), a total of 50 points is the minimum that gives a doctor the right to treat people. It should be noted that each scientific and practical conference has its own point value. Minimum – 10 points. This means that the doctor needs to visit 2 CPD per year.

This got the name MNO – medical continuing education. Doctors who still have valid certificates are required to study once every five years, but within a month. Advanced training courses have been abolished. The Ministry of Health of the Russian Federation plans to oblige doctors to undergo retraining courses at universities every five years (4-5 months) or remotely on the portal for continuing medical education. And only after that re-accreditation.

edu.rosminzdrav.ru - on the site you can take online courses for medical workers.

Opinions on the reform

Here is what Alexey Starchenko, a member of the Expert Council under Roszdravnadzor, Doctor of Medical Sciences, says about this:

We continue to keep our finger on the pulse of reform. The article will be updated.

Medicine has always been considered one of the most important areas of social security for the population. In our country, representatives of this profession are treated with great respect, because everyone knows that the health of citizens largely depends on people in white coats.

In order to obtain the right to personal practice, any physician has to overcome difficult path training. Only after acquiring in-depth knowledge and the necessary experience can a novice doctor make a diagnosis, prescribe procedures and medications, while simultaneously taking on full responsibility for the patient's health condition.

Due to the specifics of the profession, it is customary to pay increased attention to medical education. Healthcare is one of those areas where, in addition to maintaining established traditions, it is also necessary to encourage innovation.

The need for changes in the healthcare system

Almost every day, the scientific community produces new methods for treating diseases and develops unique drug formulas in order to more effectively cope with various types of diseases.

Knowledge provided in medical universities just a couple of decades ago, they can no longer form the necessary basis for a modern professional. The government understands this and is trying to modernize this area of ​​education, although this is achieved with great difficulty.

Every year, officials from the relevant ministry strive to implement dramatic changes into the educational process of novice doctors, now called current system morally outdated and requiring global reform.

Another reason to think about qualitative changes in the healthcare system was the systematic complaints of citizens dissatisfied with the quality of medical care and the level of training of young specialists.

As it became known from official sources, it will bring long-awaited changes to medicine. They will affect every link in the industry, from education to reception and patient care.

The most unexpected innovations will be in the segment of postgraduate education – internship. A widespread practice, without which previously a physician could not obtain the right to practical activities, may very soon become history.

Reasons for canceling an internship

The reform of the medical sector began back in 2011, when a new federal standard education. In accordance with this document, it is planned to gradually modernize the training system for domestic healthcare workers.

If previously, during the years spent at the university, students studied mostly the theory of medical sciences, and acquired practical skills during the internship, now the approach to this concept is changing radically.

According to the new standards, young people who enter a specialized university will acquire all the necessary knowledge, starting from the first year. This will be achieved through a complete restructuring of the training system, focusing primarily on practice.

Scientific and research activities will now become an integral part of the educational process. Students will carry out practical training with real patients directly in their universities or city medical institutions.

This is extremely important in terms of developing a highly qualified specialist who is able to most effectively implement the acquired knowledge in direct contact with the patient.

Each lesson will be held under the strict guidance of teaching staff with a high professional and pedagogical level.

Steps to cancel an internship

According to the government's plan for reforming the field of medical education, the abolition of internship will take place in three stages.

Students of dental and pharmaceutical specialties will be the first to benefit from the innovation: they will be relieved of the need to undergo postgraduate practice in the first fall of 2016.

Pediatricians and therapists will be second in line: the reform will affect them in 2017. The final stage The internship will be canceled in 2018, and all remaining specialists will fall under it.

These changes will not affect . This practicum is often confused with an internship, although their functions are slightly different.

Residency is needed primarily for specialists with a narrow focus, such as surgeons, neurologists, dermatologists or gynecologists.

Young doctors who choose this specialization will continue to prove their professional suitability for two years and only after this period will be able to receive a special certificate allowing them to practice independently.

Advantages of changes in the system of training doctors

Such radical changes in the system of training medical specialists have received rather mixed reviews. As it turned out, people were able to find both advantages and disadvantages in such an innovation, although there were many times more positive ones.

The main advantages of the changes are:

• reduction of specialist training time (students can start working much earlier without wasting time on additional education);
• getting rid of the shortage of personnel in medical institutions (since medical universities will train doctors faster, the labor market will quickly fill up);
• increasing the level of knowledge of a young doctor (by relying on practice, the university will be able to provide more deep knowledge student during classes).

By introducing such changes, the government will be able to simultaneously speed up the production of ready-made medical personnel and increase its professional level, which is what is required domestic system healthcare.

Video news

The article was written specifically for the website “2019 Year of the Pig”: https://site/