MEDICAL EDUCATION IN RUSSIA

Medical education in this country dates back to the eleventh century, however regular
training courses in medicine  were initiated only in the second founding of Moscow
University in 1755 and with the medical Faculty created in 1764. Early medical training
was similar to that adopted in Germany and the Netherlands. At the beginning of the
XXth century there were 16 Medical Faculties and by 1935 55 medical institutes
(schools).
In 1930, Medical Faculties were separated from universities,  renamed Medical
Institutes, and given independent status under the supervision of the Health Ministry.
This step was taken to bring medical education closer to governmental bodies of the
same profile and for better integration with health services. Systems of Medical
Institutes for both undergraduate and postgraduate levels were established.
Medical education in  this country is under the auspices of institutes of education
responsible to the Ministry of Health.

UNDEGRADUATE MEDICAL EDUCATION
Basic medical education requires six years training that usually starts at age 17.
Training of doctors and pharmacists in Russian is provided in 48 higher medical and
pharmaceutical institutions.
Medical education mainly is subsidized by the state and planned to correspond to the
country’s needs for medical personnel.  Funds for higher medical institutions  are
allocated from  the state budget. The Ministry of Health coordinates educational,
methodological, and organizational work conducted at the medical establishments,
plans the medical institution networks and determines the number of applicants
admitted.


The planning and management function at all levels ensures the operation of the
system and its relevance to health care services and  the educational needs of the
medical profession. It is a continuous process. In Russia the organization responsible
for development and review of professional standards also undertakes the design of
instructional programs for undergraduate medical schools responsible for national
health care manpower production, the development of high-quality specialty and
professional standards for educational institutions that provide medical specialization,
and compulsory Continuing  Medical  Education (CME) with the necessary periodic
certifications. The regular evaluation of skills, knowledge and attitudes, and problem
definition is another complex, continuous function that is undertaken at different
levels and at specified intervals by different institutions. This is done in the context of
legal requirements to determine all the different dimensions of CME.
Medical and pharmaceutical institutions are open to applicants who have completed
general secondary and/or nursing schools. The admission examinations cover biology,
physics, chemistry and language and it should be  mentioned that medical  institute
admission is highly competitive.
Higher medical institutions are organized in five separate Faculties: Faculty of Curative
Medicine (a six-year course, specialty-general medicine); Faculty of Hygiene (a six-year
course, specialty-sanitary hygiene); Faculty of Stomatology (a five-year course,
specialty-stomatology); Institute or Faculty of Pharmacy (a four-live year course,
specialty-pharmacist)


The curriculum for the first two years is the same at all Faculties. It includes preclinical
and fundamental medical sciences that are the essential basis for any medical
specialty. Medical specialization starts at the third year of studies; the curriculum
includes propedeutics, biochemistry and pathology (pathological anatomy and
pathological physiology) clinical and special subjects, depending on the orientation.
The principal feature of the curricula for both the Faculties of curative medicine and
pediatrics is the introduction of a new approach to the training of internists and
pediatricians that implies a two-year continuing primary specialization, one year while
at the institution and the other year after graduation.
The curriculum at these Faculties is designed to cover all the general medical
education within five years. During the third, fourth, and fifth years, students perform
clinical work as nurses, feldshers, and clinical assistants. In the sixth year, medical
students take their primary specialization in one of the following clinical subjects:
Faculty of Curative Medicine (surgery, obstetrics, and gynecology) of Faculty of
Pediatrics (pediatrics, including child infectious diseases, and pediatric surgery,
including orthopedics). Sub specialization in clinical areas is not an option during the
undergraduate program, as profound knowledge of the main clinical subjects is
believed to be fundamental for adequate training of doctors.
After primary specialization in their sixth year, students pass a state examination
according to the curriculum, obtain a Doctor’s Diploma, and complete a one year
internship in medical units under the supervision of specialists. Instruction in
ophthalmology, otolaryngology, dietology, climatotherapy, endocrinology, clinical
biochemistry, physiotherapy, and such aspects of surgery as  oncology  and
neurosurgery is provided by the appropriate departments. The instructional
methodology in higher medical institutions includes lectures by the leading specialists
and regular practical classes throughout the course of studies.
Training programs at medical institutes are adjusted to the needs of population in
accordance with health priorities. Thus, when  in  the 1950s the non-communicable
diseases became a real health  problem; these subjects were  strengthened and
introduced more widely into curricula. When the role of primary health care became
more evident in the 1970s, the training programs were adapted to this target-problem.
Following annual examinations at the end of the fourth and fifth years, senior students
of all Faculties usually spend the breaks between semesters in professional training.
Students are taught to use their knowledge, develop their professional skills, master
up-to-date methods of diagnostics and treatment, and become familiar with all other
work they will do in the future. It should be emphasized that at least 25 percent of the
time within the training programme of all specialties is devoted to practice at the
primary health care level.
Finally, students must pass state examinations in general and special medical subjects
(depending on the orientation of a particular Faculty) to receive a diploma as physician
of general medicine at the Faculty of Curative Medicine (VRAC), as pediatrician at the
Faculty of Pediatrics, as sanitary officer at the Faculty of Hygiene, as stomatologist at
the Faculty of Stomatology, or as pharmacist at the pharmaceutical institution or
faculty.
Annually, about 60,000 students graduate from higher medical institutions.