Industrysponsored postgraduate medical education: Russian experience

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Industry-sponsored postgraduate medical
education Russian experience

• Boleslav Lichterman
• Institute for the History of Medicine, Russian
  Academy of Medical Sciences, Moscow, Russia
• lichterman_at_hotmail.com

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Outline of presentation

• A system of postgraduate medical education in
  Russia, its benefits and pitfalls.
• A case of Russian Postgraduate Medical Academy.
• Suggested reforms and introduction of credit
  system.
• The impact of industry on continuing medical
  education and clinical practice.

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Higher Medical Education in Russia

• six years at medical school (medical, paediatric
  or sanitary faculty of medical university)
• internatura - specialization for one year in a
  big hospital in one of three major fields
  internal medicine, surgery or obstetrics and
  gynecology
• and/or ordinatura a two year subspecialization
  ( in neurology, cardiac surgery, ophthalmology
  etc.) (optional)
• followed by aspirantura - a three year PhD
  program, academic degree (kandidat meditsynskikh
  nauk) after completion kandidatskaya dissertation
  (optional)
• doctorantura a program for completion of second
  doctorskaya dissertation for getting highest
  academic degree (doctor meditsynskikh nauk) and
  becoming a professor

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Russian/Soviet system of postgraduate medical
education is

• highly centralized
• unified
• state-controlled
• state-sponsored
• Refreshment courses (1-2 months, min. 144 hours)
  every five years at an institute (academy,
  faculty) of postgraduate medical education.

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A Historical Outline

• 1885 - Imperatorsky Klinichesky Institut (The
  Imperial Clinical Institute) of the Grand Duchess
  Elena Pavlovna was founded in St.Petersburg
• 1920s - 16 postgraduate medical institutes were
  opened in former USSR
• 1930 Central Postgraduate Medical Institute
  was established in Moscow ( now Russian
  Postgraduate Medical Academy)
• Currently there are more than 70 institutes and
  faculties for postgraduate medical education in
  Russia. 161.300 physicians studied there in
  2000. The overall number of physicians in Russia
  is about 700.000.

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Russian Postgraduate Medical Academy

• seven faculties
• 112 chairs (departments)
• research centre
• publishing house,
• three hostels
• more than 2000 employees
• the annual number of specialists who refresh
  their knowledge exceeds 30.000.

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Problems of postgraduate medical education

• standards of education are non-existent
• the number of medical specialties (92 in Russia
  (33 main and 59 additional specialties) vs 52 in
  Western Europe) is excessive
• qualification criteria are blurred
• certificates are given automatically
• postgraduate medical institutions do not have
  their clinics

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How to achieve the goals of CME?

• Modernize normative base
• - modernization of federal education standards,
  programs and tests
• - introduction of system CME credits
• credits should be taken into consideration for
  certification of a specialist
• and for licensing of healthcare institutions
• - regulation of CME procedures
• Provide material base
• at medical universities (modern technical
  equipment and libraries, infrastructure for
  distance learning)
• at healthcare institutions (access to modern
  sources of information, computerization,
  electronic libraries, internet etc.)

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What is necessary for practical implementation of
CME?
Provide sufficient funding from federal
sources (computerization of healthcare
institutions, creation of National electronic
medical library, equipment for university
libraries, probation at foreign centers) from
regional sources ( creation of regional
libraries, financing of conferences and seminars
etc.) from local sources (money for
postgraduate training of healthcare providers,
probations, participation in conferences,
introduction of standards, creation of medical
libraries) Motivate healthcare providers CME
should have an impact on salary compilation and
publication of ratings ( of physicians and of
HMO) quality control of medical care
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Suggestions
Healthcare providers should continuously improve
their qualification and annually report their
acquired credits Programs of postgraduate
education should be updated according to modern
requirements (distance learning, modern methods
of education, good content, tests etc. ) Overall
volume of education activity should increase from
144 hours to 216 (288?) hours due to independent
learning of healthcare providers (including
learning at workplaces) and evenly distributed
within 5 year period
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In search of a compromise

• Introduction of Western model of postgraduate
  medical education is unacceptable in Russian
  realities because it would destroy our system of
  education (Romanyuk PF, 2004).
• How to accumulate credits?
• 2/3 might be provided by on-site education at
  postgraduate medical institutions and 1/3 - by
  extramural education (attending conferences and
  seminars, writing of scientific papers, reading
  of medical journals and manuals followed by
  testing etc.).

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In search of funding

• federal funding for CME is insufficient
• education facilities are outdated
• teachers salaries are low

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Industry-sponsored postgraduate medical education

• At conferences and symposia
• Via medical representatives
• Sponsoring lecturers and opinion leaders
• Conflicts of interest are often ignored

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Problems

• How many Russian physicians join international
  meetings?
• How often an ordinary physician purchase medical
  literature or subscribe a specialized periodical?
• Are there many Russian physicians who have an
  access to reliable sources of information,
  systematic reviews and meta-analyses
• Do they have chances to use electronic databases
  or internet?

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Russian pharmaceutical market

• Ca.17.000 different drugs are registered
• More than half of then are imported
• More than 90 of Russian drugs are simple
  pharmaceuticals or generics
• More than 400 pharma companies are working in
  Russia
• Each medical representative has 1200 information
  contacts annually
• Physicians put visits of medical representatives
  as the third information source (after reference
  manuals and specialized medical periodicals) (a
  sample of 1298 physicians)
• Medical representative is fighting not for a
  market share but for the place in physicians
  mind (Budarina TN,2008)

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Positive effects of relationship between
physicians and pharmaceutical business

• Doctors are informed about the newest drugs
• Facilitation of getting these drugs
• Possibility of additional professional
  advancement and active participation in the life
  of scientific community

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Negative possibilities of relationship between
physicians and pharmaceutical business

• Prescription of unnecessary drugs
• Prescription of more expensive drugs
• Possible mistrust of patients

None of these normative documents Russian laws
and instructions regulate relationship between a
physician and medical representative of a
pharmaceutical company. Interestingly, it cannot
be the case because such regulation would
contradict principles of the market economy
Budarina TN, 2008
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A case of Pfizer

• In 2005 Pfizer was concerned by decrease of
  sales of Diflucan in Volgograd region. For
  promotion this drug local company representatives
  organized a boat trip on Volga river for medical
  doctors. The program included a round table
  discussion, dinner, handing drug samples to the
  participants (400 were invited, 600 arrived).
  After the event 6-month stock of Diflucan in
  pharmacies of the city and the region was sold
  within one week. (Budarina TN, 2008)

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Johnson Johnson education centers worldwide
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Kazan Teaching Center of High Medical Technologies
Launched by the Ministry of Health in 2008 with
support of Tatarstan government and Johnson
Johnson company Aim to train qualified
physicians for increasing availability of modern
medical technologies for Russian population Up
to 3000 physicians might be trained
annually Training course lasts for 9 days (72
hours) On course completion an official
certificate is given
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The lack of trained specialists in Russia
Number of specialists using high-tech methods
Needed number in Russia
Specialists
30 000
5 000
Physicians 600.000
Surgeons 90.000
3 000
700
Interventional neuroradiologists
Orthopedic surgeons implanting joints
2 400
220
13 500
Endoscopic surgeons
1 100
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Education activity

• Since 2008 specialists are trained in
• Endoscopic surgery
• Interventional radiology
• Starting from 2009 training in
• electrophysiology
• oncology
• hematology
• pharmacoeconomics
• healthcare organization
• Johnson Jonhson plans to invest 10 million USD
  within a five year period for purchase of
  training equipment ( phantoms etc.) and teaching
  programs

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Facilities of the Kazan Center
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The problem is not in opinionated specialists
but in the lack of common ethical space
(Budarina TN, 2008)
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