Remote education: doctors will be banned from teaching remotely
This week, the State Duma will consider a bill aimed at improving the quality of medical care, the chairman of the lower house of parliament, Vyacheslav Volodin, said. The bill was developed back in the summer of 2024, but it has reached the first reading only now. The document establishes a ban on full distance learning of medics, and standardizes the improvement of their qualifications. What is the situation with the quality of medical education and how lawmakers are going to solve the issue of its improvement - in the material "Izvestia".
What the bill is about
The document was submitted to the lower house of Parliament on June 25, 2024, but after the government's review with critical comments, it was sent for revision. The new version of the bill was approved by Duma committees on January 15 and, according to Vyacheslav Volodin, will be considered at the plenary session of the Duma this week.
According to him, one of the problems that the document solves is the unregulated issues of advanced training of medical personnel, which in most cases is carried out by "commercial organizations that do not have the necessary infrastructure, certified teachers and clinical base for training". Medical personnel receive diplomas and certificates of retraining "practically without leaving home," writes the Duma speaker.
Therefore, it is proposed to assign to the Ministry of Health the development and approval of standard additional professional programs of medical education - no one else will have such powers. In addition, educational organizations will be obliged to obtain the conclusions of Roszdravnadzor to conduct training of medical professionals. Also, the State Duma will establish a ban on the use of exclusively electronic and distance learning in the implementation of basic programs of secondary medical and pharmaceutical education.
Why the law is needed
First Deputy Chairman of the State Duma Committee on Health Protection Badma Bashankaev explained to Izvestia that now the greatest concerns about the quality of medical education are related to additional training programs.
- Today, about 10,000 institutions offer services in this area. Alas, there are many among them who act irresponsibly ," he said. - The flow of complaints to the Health Protection Committee shows that there are too many examples of doctors receiving documents of dubious origin. Checks show that they are often issued by organizations that have neither a serious reputation, nor the necessary material and technical equipment, nor experienced teachers, nor clinical bases for practical training of students.
According to him, training there is reduced to distance courses, and sometimes certificates "are simply sold on sites like marketplaces". For a patient, a doctor with a certificate purchased in this way can be simply dangerous, Badma Bashankayev said.
- Atthe same time, the existing licensing system is unable to ensure quality control of additional medical education," he says. - Therefore, we believe it is important to give the Ministry of Health the right to develop and approve standard additional professional programs, as well as to tighten the requirements for educational institutions in health care. The licensing procedure should include a mandatory conclusion from Roszdravnadzor.
Bashankaev also calls it important to prohibit completely distance learning in the medical field, because a doctor needs "constant practice to become a real professional".
Anatoly Domnikov, chairman of the Russian Health Care Workers' Trade Union, while agreeing with the proposed ideas, nevertheless believes that, for example, distance learning could be allowed in pharmaceutical specialties. In other cases this is unacceptable, he points out, although he adds that he has not encountered situations where a medical specialist was trained exclusively through distance technologies.
Yan Vlasov, co-chairman of the All-Russian Patients' Union, notes that everything related to medical practice does not lend itself to distance education.
-The specialized medical schools do not practice online training, but we know of cases when organizations of additional education offer doctors to improve their qualifications without their personal presence, " he told Izvestia. - Doctors need to improve their qualifications throughout their lives, and for this they should come to a place that guarantees quality.
What is the situation with the quality of medical training
Experts also have questions about the quality of professional higher medical education.
The explanatory note to the bill states that 127 universities in Russia train medical professionals, of which 49 are subordinate to the Ministry of Health, 56 are subordinate to the Ministry of Science and Higher Education, three are subordinate to the Ministry of Education, three are subordinate to local governments, two are subordinate to the Russian government, and 14 more are private. Anatoly Domnikov notes that the approaches to education of these universities may differ quite seriously, especially where medical faculties are opened at universities. Not everyone can provide the quality of education that medical universities traditionally have, says the union chairman. According to him, in this sense, the state's desire to bring all medical education to common requirements is legitimate.
-Many non-core universities with medical faculties do not have their own clinical base, laboratories, anatomy rooms, " says Yan Vlasov. - But it is extremely important to have all this in order to train a qualified specialist capable of taking responsibility for the life and health of a patient. The abolition of internship also has a negative impact.
Yan Vlasov adds that the quality of training also raises questions, especially given the reduction in the number of teachers at universities.
The Higher School of Health Care Organization and Management (HSEOM) conducted research on higher medical education in Russia in 2021 and 2023. The authors of the work concluded that the quality of training of medical students requires significant improvement. This is evidenced, in particular, by the results of independent testing, which is conducted in Moscow: more than 20% of candidates do not pass the exam for the right to work as a doctor in the capital from the first time.
Moreover, according to the results of the examination of the quality of medical care conducted in the MHI system, the share of serious violations is a quarter of all inspections.
The authors of the study also point out that despite the presence of more than 2.6 thousand articles published on this topic over the past 10 years, the issue of the quality of medical education is not sufficiently studied. Thus, there are no scientific publications on the strategic development of higher medical education, on forecasting the need for personnel and the sufficiency of financing of universities. Most of the articles do not contain quantitative analysis, for example, what should be the remuneration of a university teacher or his/her maximum workload. Nevertheless, these scientific publications make a number of conclusions: for example, it is indicated that distance learning is optimal only in emergency conditions, and in a normal situation it is better to teach medical students at least in combination with a face-to-face format. Another important conclusion of the available studies is that university professors in 20% of cases "would like to improve their financial situation".
The HSEPS study also points out that the average remuneration of the teaching staff of medical universities is now equal to that of practicing doctors and, if compared, is 2.5 times lower than in Soviet times, and also 2.5 times lower by region.
- Young people are not very eager to teach now," emphasized Dr. Guzel Ulumbekova, Head of the Higher School of Medical Education, in a conversation with Izvestia. - In Soviet times, a teacher at a medical school was a very prestigious profession, and the best staff went there. Today, unfortunately, they often go there on a leftover principle.
At the same time, the number of students is growing, commercial enrollment is increasing, and at the same time the load on teachers is increasing, says Guzel Ulumbekova. For example, today the working hours of teaching staff at medical schools are much higher than the normative one, which should be no more than 36 hours. In addition, it is 20% higher than in Soviet times, when there were only nine students per teacher. In additional medical education the situation with the load on teachers is no better, but the current bill will at least remove frankly fraudulent organizations from the market, the expert noted.
There are also other problems. For example, according to the head of the Higher School of Education, schoolchildren are provided with textbooks 2.5 times better than medical students per one consumer. In addition, not all universities have clinical bases. By the way, the explanatory note to the draft law also says the same thing: "educational activities for both basic and additional educational programs are carried out by organizations that do not have the necessary educational infrastructure, clinical base for practical training and qualified staff".
-At the same time, compared to developed countries, Russia has one of the shortest terms of higher professional medical education - six years, while they have 7-8 years, - said Guzel Ulumbekova. - Moreover, we need to establish unified for the country target indicators of the quality of medical education, each region and higher education institution does it differently. The quality of education, including additional education, determines the result of medical care.
