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Psychiatric training in Russia: challenges and perspectives

Alexey Pavlichenko, MD, PhD

Moscow State University Russian Society

Of Medicine and Dentistry of Psychiatrists

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Comparison of “psychiatric myths” among medical students and population in Russia

Psychiatric myths First-year students

Final-year students

Population

People become psychiatric patients by chance

36% 31% 33%

Mental illness is a result of lack of will

20% 13% 72%

Hex may result in any mental disorder 20% 16% 32%

Mental disorders are recompenses for one’s sins

24% 20% 17%

Mental disorders are communicable 12% 11% 13%

- Medical students’ opinions of psychiatry reflect the prevailing views in society rather than training in the specialty

Ruzhenkov V., Moskvitina U. Rus. Psychiatr. J. 2010; 4:34-38

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Differences between training curricula on paper and in practice in Europe

- There are significant differences in content and quality of training curricula across Europe

- In only 7 countries (24%) the curriculum was in line with training conditions in practice

- The most problematic issues of curriculum: psychotherapy, research and addictions

- The most common difficulties in the implementation of the psychiatric curriculum: lack of time; lack of appropriate rewards for trainers; lack of quality control measure; a shortage of supervisors

- Quality control measures in the most countries are absent or consist of formal questionnaires

Kuzman M. et al. World Psychiatry. 2012; 2:135

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Medical education in Russia

Undergraduate higher education (6 years) including psychiatric training (144 hours)

Postgraduate education

Compulsory Extended

Clinical residency

(the so-called

ordinatura): 2 year

Residencyship (the so-called

internatura): 1 year

Retrainer course:

500 hours

Refresher course:

1 time per 5 years: 144 h.

Postgraduate studies (the so-called

aspirantura): 3 years (PhD program)

Doctoral studies (the so-called

doctorantura): 5 years (Doctor of Science)

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Levels of psychiatric training

-First level

Medical school: course in psychiatry during fourth year of training

– 3 weeks (144 h.)

-Second level

Residencyship (the so-called internatura) – 1 year (1728 h.)

Clinical residency (the so-called ordinatura)- 2 years (3456 h.)

- Third level (Research)

Postgraduate studies (the so-called aspirantura): 3 years (PhD)

Doctoral studies (the so-called doctorantura): 5 years (Dr.Sci.)

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Challenges of psychiatric training at medical school

- Gap between content and quality of training curricula

and modern knowledge in psychiatry

- Insufficient duration of training (144 hours)

- Difficulties to provide training conditions in

psychotherapy, addiction and child psychiatry

- Teaching of psychiatry before other clinical disciplines

- Methods of assessment of knowledge is associated

with memorizing rather than understanding underlying

theories

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Teaching on psychiatric clinic

-Formal ward rounds (examine the patients, bedside

manner, “tricky” cases)

-Attending other hospital departments including

addiction’s, children’s, eating disorders’ ones

-Psychiatric interview: ask students to write down their

observations and discuss with a clinician afterwards

-Encourage self-directed learning: student’s clinical case

report, allow see “tricky” cases on their own, making

presentation Adapted from El-Sayeh et al. Adv. Psychiatr.treat. 2006; 12:182-192

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Additional forms of teaching

- Attending scientific conferences and congresses

- Duty at the admission department together with

clinicians

- Working in a psychiatric hospital as a medical staff

- Using modern technologies: teleconferences, webinars,

E-learning (“virtual learning environment”)

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Critical problems of teachers

- “Self-stigmatization” of psychiatrists

- Uncertainty of lecturer’ position (clinician, teacher or

researcher?)

- Low wages (two-three times less than the salary of adult

psychiatrists )

- Lack of motivation to improve the qualification

- “Burn out syndrome”: late for work, detachment, lack

of motivation, decline in the quality of teaching

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Perspectives of psychiatric training at medical school

- Combine psychiatry and psychology into a single discipline

- To focus on the psychosocial aspects of medicine and on non-pathological experience in the beginning of training

- Offering students an experience in other psychiatric settings including inpatient and outpatient services

- Methods of assessment of knowledge should be focused on understanding rather than memorizing

- To attract new technologies including E-learning

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Challenges of postgraduate educationMethodological

- Lack of quality control measures

- Disintegration of educational institution

- A general shortage of supervisors

- Lack of uniform standards of training curricula

- A shortage of teaching materials

Social and economic

- Reduction of state-funded

places

- Low material and technical

recourses

- Low wages for trainers and

supervisors

- Low motivation to conti-

nuous medical education

- Inappropriate clinical settings

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Supervision

NOW- One supervisor is

responsible for 5-10 trainees

- Lack of individual

approach- Only one theoretical

practice per two weeks- Control measures:

Pass/fail grading test -1 year

Certification exam – 2 year

POSSIBLE VARIANT

- Weekly individual

practice during 1 hour- Not more than 4 trainees

per a supervisor- Control measures:

Formal (training curricula,

exam, trainees’ diary)

Informal (privately,

academic background)Robertson J Adv. Psychiatr.treat. 2007

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Professional Examination

NOW- Computerized test (out of

date)- Oral interview with a

professor (quite a subjective opinion)

POSSIBLE VARIANT- Updated computerized test

in line with modern knowledge in psychiatry

- Oral interview including solution of clinical descriptions. Formalized criteria of assessment are required

- A certificate of Continuous medical education

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Continuous Medical Education

- Full-time/distance learning: lectures, webinars,

teleconferences, thematic improvement, forum

- Attending Scientific Conferences and Congresses

- Participating in case conferences

- Self-directed learning: self-education, research,

publications

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Challenges of postgraduate studies

-Absence of standardized training curricula for future

researchers

-Low technical resources (fMRI, medications)

-Low quality of PhD thesis in psychiatry

-Most of psychiatric research does not meet the

principles of evidence based medicine

-Absence of demand for future researchers

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Perspectives of postgraduate education- Harmonization of training curricula with the Directives

of the European Union of Medical Specialties (UEMS)- Increasing of duration of psychiatric training up to 3

(4) years- Reforming of postgraduate studies’ institutions (the so

called “aspirantura” and “doctorantura”)- Improvement of training conditions in practice

(material and technical resources)- Implementation of Continuous medical education’s

system

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The role of Russian Society of Psychiatrists in psychiatric training

NOW- The section on

Education of RSP - The traditional school

for ECPs each 2 years- Educational module for

specialists at the RSP’

website

FUTURE- Create of continuous

medical education’s system- Sign up the agreement to

WPA granted credits for CME

activities 

-Provide mutual recognition

of psychiatric certificates - Motivate to continuing

education (grants, scholarship)

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Training in psychiatry in the EU and Russia: similarities and differences

Similarities1. Theoretical training (except for such issue as research methodology and

leadership)

2. Training in biological psychiatry 3. Training of old age psychiatry4. Supervision in psychiatry5. Quality assurance in specialist training in psychiatry

Differences 1. Training in psychotherapy (incl. individual supervision)2. Training in community psychiatry3. Lack of training in forensic psychiatry , addictive disorders and sexual disorders (subspecialities in Russia)

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Psychiatric training in Russia: perspectives

Compulsory postgraduate educationclinical residency in psychiatry (3 years and more)+

additional training in subspecialties (psychotherapy, narcology)

Continuous Medical Educationtraining and self-education

Medical College clinical psychology, psychiatry, pharmacology,

neurology, physiology, anatomy, pathology

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Conclusions

- Views of future doctors on psychiatry and mentally ill

people are wrong- Insufficient duration of training, outdated training

curricula and absence of CME are the main challenges of

psychiatric education in Russia- Postgraduates studies (PhD program) should be

reformed- The role of Russian Society of Psychiatrists should be

increased at all levels of psychiatric training