KZrez

JOINT REPORT ABOUT POST-GRADUATE PROFESSIONAL RESIDENCY

PROGRAMME OF UNIVERSITY OF LATVIA

(University of Latvia Institute of Postgraduate Medical Education)

We, Prof. Thomas Kenner (Karl-Franzens-University of Graz, Austria), Prof.

O.Ya.Marga (Medical Academy of Latvia), Prof.A.Krisciunas (Kaunas Medical

University of Medicine, Lithuania), Ass.Prof.J.Stanaitis (Medicine Faculty of Vilnius

University, Lithuania), visited University of Latvia, Institute of Postgraduate Medical

Education as members of the joint Evaluation Comission for the post-graduate professional residency programme. We have read the written report on self-evaluation about residency programme, visited University of Latvia and few university hospitals and clinical centres, which are basic institutions for residence training. In these institutions we had the possibility to discuss this programme and residence with supervisors of residence, teaching doctors. We have also seen methodological provision: classrooms, lectures rooms, reading halls, electronic documents etc.

The impression from the discussion with residents complies with the report on the selfevaluation. The residents are motivated for their work. Their suggestion in the report

(page 11 and 12) to introduce some additional classes or lectures on issues as psychology, economics, management and interpersonal relationships should be well considered. In addition, the residents appear interested to discuss problems of medical ethics and psychosomatic aspects of diseases with the teachin doctors. Our discussions with teaching doctors support the mentioned opinion, particularly about the high motivation.

General impression: the post-graduate educational residency programme consists of 34 sub-programmes of medical specialities and sub-specialities.

Residency programme is created for postgraduate medical education and basically corresponds with European Union of professional studies in medicine.

The theoretical and practical skills acquired in comparison to other Baltic States residency programmes are basically the same.

Equipment and resources which we could see in hospitals and in the Institute are adequate to excellent.

Quality of teaching process is tolerable, because University teaching staff (most of them has scientific degree) and practical doctors, who are skilful in their speciality are involved in this process. The teaching process is related with the organisation. There is a practice in medical schools that after undergraduate studies there follows a one-year primary residency programme (internship). In the Latvian residency programme there is no this part of training. Knowledge and skills acquired in the internship programme are included in main speciality programmes. An important issue is that each teaching doctor can be responsible for only one resident.

The study period for the residency programme is 48 (44) weeks a year with 40 hours a week, giving one credit point. Of these hours mentioned, 32 hours (12 contact-hours) are spent in practice (about 80%) by the resident at a (out-patient clinic or hospital) teaching medical institution under supervision of a teaching doctor, and 8 hours (4 contact-hours) are spent in furthering theoretical knowledge, independent work with literature, acquiring clinical research work skills and writing the final residency report.

Basically duration of training courses in the main specialities is sufficient for acquiring professional skills.

Some additional remarks concerning the educational process and assessment.

The high proportion of practical education and training (around 80% according to the self evaluation report – actually even more) appears quite adequate to fulfill the goal of the Study Program.

As far as we have learned from presentations and reports, the learning process required for obtaining credit points (“participation at seminars and lectures, passing practical training at the teaching medical institution”) and the corresponding examinations are useful and accepted by residents and teachers.

With respect to the involvement of residents in research it should be noted that learning the method of scientific thought and reasoning is important even for a medical practitioner and a family doctor. It is the same process which is used to find a diagnosis in a patient. Besides that, the performance of a “final report”

strengthens the cooperation between teacher and resident and permits a more continuous evaluation.

Concerning Quality Assurance and Feedback, it seems appropriate, that evaluation of the Study Programmes from the point of view of residents, as well as from the point of view from the teachers, should be carried out at regular intervals – at least once a year. The information can be used for improvements

– if necessary.

Part of residency in the form of short courses within the training programmes for basic specialities is recommended to be taken outside Riga, according to recommendations of professional associations.

In the text we noticed that the same main programmes are confused with subspecialities programmes. We think that in the main speciality in surgery there are: general surgery and traumatology & orthopaedics, cardio-vascular surgery, thoracic surgery, urology, neurosurgery, transplantation are sub-specialities. It is written that a resident before this education must finish two years postgraduate education in general surgery.

In future we recommend to integrate the tranplantology programme within urology or cardiovascular surgery according to recommendations of professional associations.

The same situation is also found with the transfusiology programme. An important issue is to convert this speciality in a sub-speciality with one-year training programme for residents after covering 2 or3 years programme in some of the main specialities.

Certain problems are caused to the residency programme due to the small number of residents in each specific speciality, except for family medicine.

Programmes amalgamation – few programmes can be included in one basic programme:

-We recommend to integrate therapeutic radiology programme as a subspeciality to oncology programme according to recommendations of professional associations.

The residency programme of physical medicine is very narrow. This speciality comes from Soviet Union times. The study programme may be included in the Rehabilitology programme.

The residency programm of sports medicine covers four years. Many courses (internal medicine, infectious diseases, obstertics and gynaecology, ophthalmology , dermavenerology) repeat undergraduate medical education. We recommen to designate this programme for three years.

Another point, which merits attention, is the language. Contacts between patients and doctors must be in the patients native language, but international contacts between doctors should be in English. We recommended that final residency papers on clinical research might be written in English.

Final conclusion:

The post-graduate professional residency education programme of University of Latvia complies with the requirements of the European Union Directives on medical professions.

Our commission members unanimously recommend that University of Latvia Institute of

Postgraduate Medical Education profesional residency programme be given accreditation for 6 years.

Prof. Thomas Kenner

Prof. O.Ya.Marga

Prof.A.Krisciunas

Ass.Prof.J.Stanaitis

Riga. 2001.05.29.

Individual report about Allergology Residency Programme

1.

Goals and aims:

To train highly skilled specialists in diagnostics, treatment, prophylactics and rehabilitation of patients with various allergic diseases. The basic residency programme gives 96 credits.

2. Structure and Division

A two-year full time training. The first year – immunological mechanisms (cells, mediators, etc.) special methods of diagnostics, practice in clinics (allergology, pneumonology). The second year – practice in hospitals and out-patient units

(allergology, pathology of upper airways, dermatology) .

3.

Educational process and assessment

Lectures and seminars comprise about 25%, while practical work – 75% (1/3 in hospitals,

2/3 in out-patient units) of teaching hours. The practical work is performed under supervision of teaching doctors – certified specialists in the respective discipline

(allergology, pneumonology, dermatology, functional diagnostics, etc.).

4.

Research, involvement of residents

Final report - theoretical and practical, well documented report about one aspect of diagnostics method or treatment of selected lung disease or allergic manifestations of other diseases.

5.

Quality assurance, feedback

Quality assurance systems are introduced in teaching institutions –Stradin's Clinical

Hospital, Children’s Clinical University Hospital, several out-patient units (“Rūpes”, dermatology).

Recommendation: accreditation for 6 years.

Prof. Dr.hab.med. Olgerts Marga

Medical Academy of Latvia

Individual report about quality of the ANAESTHESIOLOGY&REANIMATION

Residency Programme

1.

Goals and aims: the programme encompasses 176 credit points covering 4 years of study. The programme contains all courses in accordance with the recommendations of the European Union. It is a good approach, that 80% of these hours are spent in practice by the residents under supervision of a teaching doctors according to the principle "one resident – one supervisor".

I agree with this programme and have no comments, excluding terminology. It must be same between European states. The term "reanimation" must be changed by

"Intensive care".

My final advice would be to give accreditation for 6 years

Juozas Stanaitis, M.D., Ph.D.

Head of General Surgery Clinic

Vilnius University

Lithuania

Individual report about quality of the CARDIO-VASCULAR SURGERY Residency

Programme

1.

Goals and aims: the programme encompasses 132 credit points covering 3 years of study. This programme is like sub-speciality in surgery, because a resident gets into this speciality after finishing two years postgraduate education in general surgery (88 credit points). The programme contains all courses in accordance with recommendations of the European Union. It is a good approach, that 80% of these hours are spent in practice by the residents under supervision of a teaching doctors according to the principle "one resident – one supervisor".

2.

Structure and division: this programme contains knowledge in emergency and elective surgery, but they are not being distinguished for residents. Hours, which are spent in different courses are enough for acquisition of practical skills

3.

Educational process and assessment: resident's participation at seminars, lectures and their final report is arranged in a proper way. I think, that the contact with a patient must be in state language level, but final report must be written in English, as it is the so-called "international doctors" language. Training in English is necessary. Another points which merits attention is the minimum requirement list of surgical procedures.

It is difficult to understand what a resident must perform selfdependent in cardiac surgery, invasive methods of treatment etc.

4.

Research, involvement of residents: residents of the last year are sufficiently involved in a research process. It is reflected and documented in the resident's final report.

5.

Quality assurance, feedback: quality assurance systems and their realization introduced in departments and units that are basic training places for residents in surgery.


Juozas Stanaitis, M.D.,Ph.D.


Vilnius University

Lithuania

Individual report about Cardiology Residency Programme

1. Goals and aims

To educate physicians to master methods and techniques in diagnostics and treatment of cardiologic diseases.

2.

Structure and Division

The programm endures for two years (88 credits). The course programm envisages coronary disease, cardiac failure, arrithmies, cardiac hypertension, miocardiopathy, rheumatism, functional diagnostics. The structure of the programm is well-designed.

3.


Studies are arranged in the form of theoretical courses, practical classes for improvimg skills in cardiology.

4.

Research, involvment of residents

Clinical research working skills are acquired while working on the final residency paper, working with literature and carrying out scientific research.

5.


Each subject has its own assessment requirements: short tests, colloquims,exams

Conclusion:

For the programm I recommend accreditation for 6 years.

Dr. habil. med., Professor Aleksandras Kriščiūnas,

Head Clinic of Rehabilitation

Kaunas University of Medicine

2001.05.29.

Individual report about Dermato-venerology Residency Programme

1. Goals and aims

A well described speciality (3 years)

2.


Psychosomatic diseases of skin are frequent. In some countries AIDS patients are treated in Dermatology.

3.


Additional practical training in the field of Geriatry and Palliative Medicine seems advisable.

4.


See: General Statements

5.



Univ.-Prof. Dr.Dr.h.c. Thomas Kenner

Karl-Franzens Universitaet Graz

2001.05.29.

Individual report about Endocrinology Residency Programme

1.

Goals and aims:

To train specialists with the higher qualifications in diagnostics, treatment, prophylactics and rehabilitation of endocrinologic diseases. The basic programme encompasses 96 credits.


A two-year full time training. In the first year: laboratory, instrumental methods, radiology, morphological examination, histology, cytology, ophthalmology, clinical endocrinology, children’s endocrinology. The second year includes continuation of training in clinical endocrinology, diabetes and its complications, education of patients and their ambulatory care.

3.


Lectures, seminars, practical training at the teaching medical institutions: Stradin’s

Clinical Hospital, Hospital “Gaiļezers”, sanatorium “Rīgas Jūrmala”, intensive care units in city hospitals. About 80% of teaching time is spent on practical work under supervision of a teaching doctor – certified specialist in the respective discipline.

4.


Involvement in research: writing a final report in the resident’s speciality which mainly contains survey of literature and little clinical part with the analysis of several contingents of selected patient groups.

5.


The quality assurance basically meets the regulations of the Council of European Medical

Specialist Unions from 1995 with the same amount of theoretical knowledge and practical skills to be acquired during the total residency time.




2001.05.29.

Individual report about Family Medicine Residency Programme

1.

Goals and aims

After graduation residents acquire the right to start an independent GP practice; to provide primary health care, to run individual or group familiy doctor’s practice.

2.


The programm gives 144 credit points and includes three years education. The structure of the programm is well-designed, and it is logically stated and easy to follow. The course includes theoretical and practical subjects; familiy medicine, internal medicine; mother and child care, public health, emergency aid and surgery.

3.


Training used in education of residents: lectures, seminars, problem discussions and situation analysis, patient demonstrations. The section on acquiring practical skills includes diagnostic, therapeutical methods and manipulation, practical medical activities

(out-patient clinics and hospitals).

4.



5.


Each subject has its own assessment requirements: short tests, colloquims,exams

Conclusion:

The programm is well-designed and similar to other programs of GP applied in the

European Union.

I recommend the accreditation for 6 years.




2001.05.29.

Individual report about Gastroenterology Residency Programme

1.

Goals and aims:

To train highly skilled specialists in diagnostics, treatment, prophylactics and rehabilitation of gastroenterologic diseases. The basic programme gives 144 credits.


A three-year full time residency. 1 st

year – rotation in internal clinics (diagnostic methods of gastroenterologic diseases) the 2 nd year – endoscopy, radiology (CT, USG, scintigraphy) abdominal surgery, infectology, oncology and pathology. The 3 rd

year – practical work in a clinic, and twice a week – in an out-patient unit under supervision of a teaching doctor.

3. Educational process and assessment

Lectures and seminars comprise about 20%, while practical work – 80% of teaching hours. The programme contains the list of compulsory required procedures and manipulations [endoscopy, liver biopsy, intestinal intubations, polypectomy (stomach, colon), sclerotisation of veins of oesophogus]

4.


Writing a final report on one of gastrointestinal diseases with survey of literature, analysis of a group of patients, their diagnosis and treatment results.

5.


Quality assurance systems are introduced in teaching institutions – mainly in Stradin's

Clinical Hospital. The training programme meets the recommendations of “Specialist

Training in Gastroenterology in the European Union” (The care for European Boards,

1994).




2001.05.29.

Individual Report by Prof. Dr. Thomas Kenner Riga, 29. 5. 2001

General remarks

1) Self-evaluation report

The impression from the discussion with residents agrees well with the report on the self-evaluation. The residents are motivated for their work. Their suggestion in the report (page 11 and 12) to introduce some additional lectures and classes on issues as psychology, economics, management and interpersonal relationships should be well considered. In addition, the residents appear interested to discuss problems of medical ethics and psychosomatic aspects of diseases, with the teachers.

2) Equipment and ressources which we could see in the hospital and in the institute are adequate to excellent.

3) The discussions with teachers support the above mentioned opinion.

4) I propose an accreditation for 6 years.

Statement concering Education, Research and Quality Assurance – valid for all Specialities and Subspecialities on which I report.

Ad 1: Goals and aims:

The following are well defined “classical” Specialities:

Pediatrics, Neurology, Dermatology, Ophthalmology and Pathology.

A new Speciality, the scope of which is rapidly growing, is Laboratory

Medicine. The course contents must have some flexibility.

There are in my list the following Subspecialities:

Neonatology, Hematology and Nephrology.

Ad 2: Structure and division of the program:

With respect to this issue, some additional topics are mentioned and proposed in the questionnaire.

Ad 3: Educational process and assessment.

The high weight on practical education and training (around 80% according to the self evaluation report – actually even more) seems to me quite adequate to fulfill the goal of the Study Program.

As far as we have learned from presentations and reports, the learning process required for obtaining credit points (“participation at seminars and lectures, getting through practical training at the teaching medical institution”) and the corresponding examinations are useful and accepted by residents and teachers.

Ad 4: Research involvement of residents.

In my opinion, learning the method of scientific thought and reasoning is important even for a medical practitioner and family doctor. It is the same process which is used to find a diagnosis in a patient. Besides that, the performance of a “final report” strengthens the cooperation between teacher and resident and permits a more continuous evaluation. In consequence, inspite of the possible abjection, that the training of medical practice would not need learning of research, I am very much in favour of such a procedure. This is also in agreement with the discussion with the residents.

I would popose to make the choice of language of the final report paper

(Latvian or English) optional.

Ad 5: Quality Assurance and Feedback

I propose, that evaluation of the Study Program as well from the point of view of residents as from the point of view from the teachers, should be carried out in regular intervals – ar least once a year. The information can be used for improvements – if necessary.

In the questionnaires concerning the above mentioned Specialities and Sub-

Specialities I have mentioned in addition several suggestions for modifications or additions in the program.

In summary I agree with the positive conclusions of the joint report and I express my hope, that the Study project will successfully continue.

Prof. Dr.Thomas Kenner

Attached: 10 questionnaires

Individual report about quality of the GENERAL SURGERY Residency Programme

1.

Goals and aims: the basic programme encompasses 240 credit points covering 5 years of study. The programme contains all courses in accordance with recommendations of the European Union. It is a good approach, that 80% of these hours are spent in practice by the residents under supervision of a teaching doctors according to the principle "one resident – one supervisor".

2.

Structure and division: this programme contains knowledge in emergency and elective surgery, but they are not being distinguished for residents. Hours, which are spent in different courses are enough for acquisition practical skills

3.

Educational process and assessment: resident's participation at seminars, lectures and their final report is arranged in a proper way. I think, that contact with patient must be in state language level, but final report must be written in English, as it is the socalled "international doctors" language. Training in English is necessary. Another points which merits attention is the minimum requirement list of surgical procedures in each kind of surgery. In the few courses (pediatric surgery, traumatology and orthopaedics) this list is written in a very indefinite way.

4.

Research, involvement of residents: residents of the last year are sufficiently involved in research process. It is reflected and documented in the resident's final reports.

Noteworthy, that few residents have published their research works in scientific journals or presented their investigation data in different scientific meetings

5.

Quality assurance, feedback: quality assurance systems and their realization introduced in departments and units which are basic training places for residents in general surgery.




Vilnius University

Lithuania

Individual report about quality of the GYNAECOLOGY & OBSTETRICS Residency

Programme

1.

Goals and aims: the basic programme encompasses 176 credit points covering 4 years of study. The programme contains all courses in accordance with recommendations of the European Union. It is a good approach, that 80% of these hours are spent in practice by the residents under supervision of a teaching doctors according to principle "one resident – one supervisor".

2.

Structure and division: this programme contains knowledge in emergency and elective gynaecology also. Hours, which are spent in different courses are enough for acquisition practical skills

3.

Educational process and assessment: resident's participation at seminars, lectures and their final report is arranged in a proper way. Training in English is necessary.

Another points which merits attention is the minimum requirement list of interventional procedures in gynaecology. I was impressed by listing of these procedures in this residency programme.

4.



5.

Quality assurance, feedback: quality assurance systems and their realization introduced in departments and units which are basic training places for residents in gynaecology & obstetrics.




Vilnius University

Lithuania

Individual report about Haematology Residency Programme

1.

Goals and aims

A subspeciality to Internal Medicine (3+3 years residency).

2.


In the description of course BM-transplantation and stem-cell therapy should be mentioned.

3.


In addition to anatomy and patho-physiology also patho-histology should mentioned.

There is some overlapping to transfusology.

4.



5.





2001.05.29.

Individual report about Internal Medicine Residency Programme

1.

Goals and aims

The aim of the program is to train specialists within the boundaries of postgraduate professional residency to furnish professional skills to display knowledge on the diagnostics of internal diseases in their medical treatment, prevention and rehabilitation.

The goals and aims of the education are very well described.

2.


The program consists of 144 credits. The structure of the program is well-designed. The course program envisages the knowledge on ethiology, pathogenesis, sympathomatology diagnostics, differential diagnostics, treatment, prophylactics and rehabilitation of internal diseases.

3.


Training used for education of residents: lectures, seminars, clinical practice, individual research projects. The section on acquiring practical skills includes diagnostic, therapeutical methods and manipulation under the supervision of a teaching doctor.

4.



5.


Each subject has its own assessment requirements: short tests, colloquims, exams

Conclusion:

The program is very serious and professional which will play a significant role in the educational system, preparing highly-professional internists. I recommend accreditation for 6 years.




2001.05.29.

Individual report about Laboratory Diagnostics Residency Programme

1.

Goals and aims

Laboratory Diagnostics is a speciality which encompasses an ever-growing field (3 years).

2.


The structure should be flexible for new developments (like genetic techniques, new cytological techniques, e.g. FACS, etc.)

3.


The field may include diagnostics for certain tropical diseases and overlaps with transfusology.

4.



5.





2001.05.29.

Individual report about Neonatology Residency Programme

1.

Goals and aims

A subspeciality to Paediatrics (4+2 years)

2.


There is certainly co-operation with obstetrics and gynaecology necessary (in utero diagnosis)

3.


If not already included, a practical training in dietetics seems important.

4.



5.





Individual report about Nephrology Residency Programme

1.

Goals and aims

A subspeciality of Internal Medicine.

3+2 years residency.

Aims: well defined.

(Basic training in Internal Medicine is only 3 years?)

2.


Considering the possibility of allergic diseases (mentioned) and transplantation, the course should contain immunology.

3.


Additional training in dietics can be recommended.

4.


See General Statement.

5.


See General Statement.



2001.05.29.

Individual report about quality of the NEUROLOGICAL SURGERY Residency

Programme

1.

Goals and aims: the programme encompasses 176 credit points covering 4 years of study and 2 years postgraduate education in general surgery. Totally duration of this residency programme is 6 years. The programme contains all courses in accordance with recommendations of the European Union. It is a good approach, that 80% of these hours are spent in practice by the residents under supervision of a teaching doctor according to the principle "one resident – one supervisor".

2.

Structure and division: this programme contains knowledge in emergency and elective surgery, but they are not being distinguished for residents. Hours, which are spent in different courses are enough for acquisition practical skills

3.


Another points which merits attention is the minimum requirement list of surgical procedures.

4.

Research, involvement of residents: residents of the last year are sufficiently involved in research process. It is reflected and documented in the resident's final report.


5.

Quality assurance, feedback: quality assurance systems and their realization introduced in departments and units which are basic training places for residents in surgery.




Vilnius University

Lithuania

Individual report about Neurology Residency Programme

1.

Goals and aims

A well defined speciality, closely related to Internal Medicine and Psychiatry (4 years)

2.


Not mentioned in the list of topics: brain imaging, age-dependent diseases (especially

Geriatric), genetic diseases.

3.


The importance of rehabilitation should be considered, furthermore – prophylaxis, like e.g. stroke prevention.

In addition: Palliative Care

4.



5.





2001.05.29.

Individual report about Occupational Medicine Residency Programme

1.

Goals and aims

The aim of the programme is to train specialists able to carry out independent medical practice in occupational medicine.

2.


The programme consists of 132 credits. The programme envisages the knowledge on occupational medicine, epidemiology, physiology, sociology, psychology, ergonomic and internal medicine. The structure of the programme is well-designed.

3. Educational process and assessment

Training used in education of residents: lectures, seminars, clinical practice, individual research projects.

4.


Every resident has individual research project. They defend the residency thesis/

5.


During the study process an orientational system of evaluation is used, ensuring the feedback, information on study process. Independent work in the study of scientific literature improves the study process.

Conclusion:

I recommend accreditation for 6 years.




2001.05.29.

Individual report about Oncology Residency Programme

1.

Goals and aims:

The programme contains the training of theoretical knowledge and practical skills in aetiology, pathogenesis, clinics, diagnosis, treatment, rehabilitation and prevention of oncologic diseases. The basic programme gives 144 credits.


A three-year full time residency contains courses in: medical services, documentation, statistics, oncosurgery, radiation therapy, chemotherapy; oncogynaecology, oncourology, clinical, X-ray, morphological and immunological diagnostic methods, palliative care, out-patient treatment.

3.


The programme contains the entire amount of teaching hours in each course divided in lectures/ seminars (25%) and practical work (75%). Each course has the list of minimum required manipulations and operations (a resident must know the basic principles of these manipulations/operations or perform these manipulations under supervision of a teaching doctor (biopsies, cytological; and histological examinations, etc.)).

4.


In accordance with the Regulations on Residency Programmes, each resident may workout an abstract/survey of scientific literature. and write a final report on the chosen topic with the analysis of literature and selected patients in line with the chosen topic.

5.


Quality assurance meets the EEC Directive documents of Basic Medical Education

“Content of Cancer in specific Training for General Practice”, 1990, Directive

86/457/EEC. The training is performed in Latvian Centre of Oncology, both – in clinic and in out-patient department, as well as in the department of therapeutic radiology.




2001.05.29.

Individual report about Ophthalmology Residency Programme

1.

Goals and aims

A well defined speciality (3 years).

2.


It is not clear how much additional training time the description of “courses in clinical histology, internal medicine” indicates (last sentence).

3.


Special ophthalmologic problems in early childhood in paediatric patients should be considered.

4.



5.





2001.05.29.

Individual report about Pathology Residency Programme

1.

Goals and aims

A well defined speciality (3 years)

2.


In the course content not only patho-morphology, but also patho-physiology should be mentioned.

3.


There are relations to forensic medicine in certain unexplained death cases. Training in co-operation with surgery (quick intraoperative diagnosis) is important.

4.



5.





Individual report about Pediatry Residency Programme

1.

Goals and aims

I propose that the aim should include children and adolescents (4 years).

2.


Although the course has already a rather long list of topics, I consider as important: traumatology, logopedics, adolescents and drug problem (included in social paediatrics?)

3.


Some experience in adult Internal Medicine would be useful. Some training of interaction with parents is recommended. Further topic: prevention of accidents.

4.



5.





2001.05.29.

Individual report about Phthisiopulmonology Residency Programme

1.

Goals and aims:

To acquire theoretical knowledge and practical skills in diagnostics, treatment, prophylactics and rehabilitation of congenital and acquired pulmonary diseases and chest injuries. The basic residency programme encompasses 96 credits.


A two-year full time training. First year is spent in acquiring theoretical knowledge and practical skills in special methods for diagnosing pathology of lungs and pleura, chest radiology. The second year includes clinical practice in pulmonology and TB clinic, outpatient treatment, bronchology, functional diagnostics, rehabilitology.

3.


Lectures and seminars comprise 23% of total teaching hours, while practical training –

77% (60% of then in hospitals, 28% in out-patient treatment and 12% - for writing the final research report). The practical work in clinics and out-patient departments is performed under supervision of a certified specialist in the respective discipline. List of compulsory minimum of diagnostic procedures!

4.


2 residents during the last years participated in preparing poster presentations on ERS congresses in Florence and Berlin.

Final reports including survey of literature and clinical analysis of patients with pulmonary pathology.

5.


Quality assurance systems are introduced in teaching institutions and units – Stradin's

Clinical Hospital, Clinical Hospital “Gaiļezers”, State Centre of Tuberculosis and Lungs

Diseases. In general they correspond to the quality recommendations of EU (European

Medical Specialist Union – EMSU) from 1995.


Prof. Dr.hab.med. Olgerts Marga


2001.05.29.

Individual report about Physical Medicine Residency Programme

1.

Goals and aims

The aim of the programme is to educate doctors of physical medicine who are able to master methods and techniques, the instruments, devices and equipment used in physical medicine.

2.


The program consists of 132 credits. The course includes physical medicine, physical therapy, ergotherapy, X-ray and radiology.

3.


Training used for education of residents: lectures, seminars, problem discussions. The section on acquiring practical skills includes knowledge in diagnostics of diseases, their practical treatment, prevention and rehabilitation.

4.


Each resident has an individual research project. They defend residency thesis.

5.


The assessment methods used during the study process: tests, exams.

Conclusion:

The program is very narrow. The whole study programme may be included in the study programme for Rehabilitologists.




2001.05.29.

Individual report about Radiology Residency Programme

1.

Goals and aims:

The aim of the programme is to provide theoretical knowledge and practical skills of diagnostic methods in conventional radiology, computer tomography, mammography, ultrasonoscopy, magnetic resonance and invasive radiology. The basic programme gives

180 credits.

2.


A four-year full time residency including the following courses: conventional radiology, skeleton radiology, chest radiology, diagnostic ultrasonoscopy, children radiology, urogenital radiology, radionuclear diagnostics, radiation and dosimetry, protection against radiation. Lectures/seminars comprise 25%, while practical works – 75% of teaching hours.

3.


The programme is divided into 4 parts; the first and the second years contain 10 courses each, the third year is spent on work in a multi-profile hospital and diagnostic radiology/ ultrasonoscopy, the fourth year is devoted to the work in a chosen branch/speciality of radiology. Each part of the programme contains the list of required minimum compulsory methods and manipulations/practical skills. The programme requires knowledge of spoken and written English and German, as well as computer skills.

4.


Writing of a final report on the selected topic of radiology, specialities (abstract/survey of literature, analysis of diagnostic procedures in certain diseases, etc.).

5.


Quality assurance systems are implemented in teaching institutions – Institute of

Diagnostic Radiology of Stradin's Clinic University Hospital, units of diagnostic radiology of Stradin’s Clinic Hospital, State Centre of Tuberculosis and Lung Diseases,

Hospital of Traumathology and Orthopaedics.




2001.05.29.

Individual report about Rehabilitation Residency Programme

1.

Goals and aims

The goal of the program is to train specialists able to carry-out independent medical practice in rehabilitation.

2.


The program consists of 176 credits. The contents of the course includes: physiology, biomechanics, social sciences, functional diagnostics, theoretical rehabilitology and practice in internal medicine, paediatrics, orthopedy, surgery, neurosurgery, neurology.

3.


Training used for education of residents: lectures and seminars, passing a practical training at the teaching medical institution.

4.


Every resident has an individual research project. They defend the residency thesis.

5.


Assessment methods used during the study process: tests, exams.

Conclusion:

The program is very well designed. I recommend accreditation for 6 years.




2001.05.29.

Individual report about Rheumatology Residency Programme

1. Goals and aims To provide in-depth acquisition of theoretical knowledge and practical skills in the diagnostics of rheumatological diseases and their medical treatment

, prophylactics and rehabilitation.

2.

Structure and division

The contents of the course include clinical rheumatology, immunology, traumatology and ortopedy, physical medicine, radiology, children dermatology, adult dermatology. The program endures three-years (144 credits). Course of cardiology is not included in the program.

3.


Studies is arranged in the form of theoretical courses, practical classes for improving skills in rheumatology.

4.


Every resident has individual research project. The final result level of the clinical research in controlled by a collective evaluation form - depending on residency's thesis.

5. Quality assurance, feedback

Each subject has its own assessment requirements: short tests, exams. Reports on practical training submitted to teaching doctors, activities, at seminars and problem discussions, ensuring feedback information on the study process.

Conclusion: The programm is well designed. I recommend accreditation for 6 years.

2001. 05. 29.

Dr.habil. med., professor Aleksandras Kriščiūnas

Head clinic of Rehabilitation


Individual report about Sports Medicine Residency Programme

1.

Goals and aims

The aim of the program is to educate sports doctors able to assess the patient’s physical status, to help a patient to make the choice for achievement of better performance of physical, mental and social activities; to be able to diagnose diseases linked with sports activities and provide treatment.

2.


The program consists of 176 credits. The structure of the program is well-designed, the programme endures for four years. The course includes internal medicine, infectious diseases, general surgery, obstetrics and gynaecology, ophthalmology, dermatovenerology, neurology. All these courses repeat undergraduate medical education.

3.


Training used for education of residents: lectures, seminars, clinical practice, individual research projects.

4.


Every resident has individual research project.

5.


Each subject has its own assessment requirements: tests, exams ensuring feedback information on the study process.

Conclusion:

The program is too long. A lot of courses repeat undergraduate medical education. I recommend accreditation for 2 years.




2001.05.29.

Individual report about Therapeutical Radiology Residency Programme

1.

Goals and aims:

To provide theoretical knowledge and practical skills in diagnostics and treatment of oncologic diseases, principles and methods of radiation therapy in oncology and methods of rehabilitation of cancer patients. The basic residency programme gives 132 credits.


A three-year full time residency covers the following courses: cancer classification, diagnostics, immunology, radiobiology, radiological therapy in oncologic and nononcologic diseases; X-ray therapy methods and equipment, side effects and complications of X-ray therapy. Lectures/seminars comprise 20%, while practical training – 80% of total teaching hours.

2.


The programme is divided in five main courses: diagnostics and classification; cancer immunology, radiobiology; radiological therapy (oncologic and non-oncologic patients);

X-ray therapy – equipment, apparatus, therapy planning; side effects and complications; rehabilitation of cancer patients.

3.


Writing a final residency paper with its public presentation and discussing. The topic of final residency paper can be selected from various clinical, diagnostic or technical aspects of radiological therapy.

4.


Quality assurance is introduced in teaching institutions – Latvian Centre of Oncology

(clinic, out-patient division, centre of palliative care, unit of dosimetry and radiation security), Clinical Hospital “Gaiļezers”, Clinic of Traumatology, Clinical Hospital

“Linezers”, Cancer Register of Latvia.

NB!

The programme contains many topics and courses in diagnostics and treatment of cancer patients, which are essential parts of residency programme in oncology (about 35-

40%). In this respect I would suggest in future to integrate this programme in the programme “Oncology” – therapeutic radiology may be as a subspeciality in oncology; as there exists “Oncologic Chemotherapy”, why not “Oncologic radiotherapy”?




2001.05.29.

Individual report about quality of the THORACIC surgery Residency Programme

1.

Goals and aims: the programme encompasses 144 credit points covering 3 years of study. It is a good approach, that 80% of these hours are spent in practice by the residents under supervision of a teaching doctors according to the principle "one resident – one supervisor".

2.

Structure and division: Hours, which are spent in different courses, are aim for discussion. I think, that 16 credit points (4 months) for rentgenology is too much. For

thoracic surgery 48 credit points plus 42 credit points for practical skills are fixed. I can't found minimum requirement list of surgical procedures in thoracic surgery.

Vague meaning for final production – it will be thoracic surgeon or pulmonologist after graduation this residency programme? I think, that this course must be shorter: 2 years in general surgery + 2 years in thoracic surgery = totally 4 years

3.

Educational process and assessment: resident's participation at seminars, lectures and their final report is arranged in a proper way. I think, that contact with patient must be in state language level, but final report must be written in English.

4.

Research, involvement of residents: residents of the last year are involved sufficiently in research process. It is reflected and documented in the resident's final reports.


5.



Juozas Stanaitis, M.D., Ph.D.


Vilnius University

Lithuania

Individual report about Transfusiology Residency Programme

1.

Goals and aims:

Acquisition of theoretical knowledge and practical skills in transfusiology, its diagnostics and medical methods, blood preparations and their application in practical medicine. The teaching programme gives 96 credits.


A two-year full time residency contains courses in: haematology, surgery and intensive care, neonatology, emergency and accident medicine, immunology, blood transmission infections. Lectures/seminars comprise 25%, while practical works – 75% of teaching hours.

2.


The first year: organisation of blood donors’ services (compiling, selection, documentation); blood preparations, cytapheresis and plasmapheresis, HLA system, immuno-haemotology; quality control. The second year: practical work in haematology , transfusiology in surgery, intensive care, traumatology, cardiosurgery, neonatology, transplantology, haemodialysis, immunology; blood transmissive diseases.

3.


Writing a final research work or a survey/abstract of literature on the chosen topic in transfusiology.

4.


Quality assurance systems are implemented in teaching institutions – Stradin's Clinic

University Hospital, Centre of Emergency and Accidental Medicine, Centre of

Haematology (Linezers Clinic Hospital), State Centre of Infectology). Proposal – in future to integrate this programme as a subspeciality in anaesthesiology and reanimation residency programme.



Medical Academy of Latvia

2001.05.29.

Individual report about quality of the TRANSPLANTATION Residency Programme

1.


2.

Structure and division: this programme contains mostly knowledge and skills in kidney transplantation. I recommend that this subspeciality should be integrated in

Urology programme. Hours, which are spent in different courses are enough for acquisition practical skills.

3.

Educational process and assessment: resident's participation at the seminars, lectures and their final report is arranged in a proper way. Training in English is necessary.

Another points which merit attention is the minimum requirement list of surgical procedures. I can`t understand how many kidney transplantations during 3 years are obligatory to be performed personally by residents.

4.


Noteworthy, that few residents have published their research works in scientific journals or presented their investigation data in different scientific meetings.

5.

Quality assurance, feedback: quality assurance systems and their realisation introduced in departments and units which are basic training places for residents in surgery.




Vilnius University

Lithuania

Individual report about quality of the TRAUMATOLOGY AND ORTHOPAEDICS

Residency Programme

1.

Goals and aims: the basic programme encompasses 192 credit points covering 4 years of study. The programme contains all courses in accordance with recommendations of the European Union. It is a good approach, that 80% of these hours are spent in practice by the residents under supervision of a teaching doctor according to the principle "one resident – one supervisor".

2.

Structure and division: Hours, which are spent in different courses, are subject to discussion. I think, that 12 credit points (3 months) for abdominal surgery + thoracic surgery + urology is not enough for acquisition practical skills, especially in emergency situations. Trauma is birch of our century and I have missed more attention in this way. I think, that too many hours are allocated for microsurgery and corrective surgery.

3.

Educational process and assessment: resident's participation at seminars, lectures and their final report is arranged in a proper way. I think, that contact with patient must be in state language level, but final report must be written in English. Training in

English is necessary. Another points which merit attention is the minimum requirement list of surgical procedures in each kind of surgery. In the few courses

(pediatric surgery, traumatology and orthopaedics) this list is written in a very indefinite way.

4.



5.





Vilnius University

Lithuania

Individual report about quality of the UROLOGY Residency Programme

1.


2.

Structure and division: this programme contains knowledge in emergency and elective surgery, but they are not being distinguished for residents. Hours, which are spent in different courses are enough for acquisition of practical skills

3.


Another point which merits attention is the minimum requirement list of surgical procedures.

4.

Research, involvement of residents: residents of the last year are sufficiently involved in research process. It is reflected and documented in the resident's final report.


5.





Vilnius University

Lithuania

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