Geneva Health Forum Archive

Browse and download abstracts, posters, documents and videos from past editions of the GHF

Making profession of family doctors attractive for future doctors: Kyrgyzstan

Author(s) Salima Sydykova1, Nurlan Brimkulov2.
Affiliation(s) 1Hospitral Therapy, Kyrgyz State Medical Academy I.K. Akhunbaev, Bishkek, Kyrgyzstan, 2Department of Hospital Therapy, Kyrgyz State Medical Academy I.K. Akhunbaev, Bishkek, Kyrgyzstan.
Country - ies of focus Kyrgyzstan
Relevant to the conference tracks Education and Research
Summary One of the main current healthcare problems is a shortage of family doctors/general practitioners, especially in rural areas. Medical students are not motivated to choose the specialty of family medicine because they don't find it prestigious. The community also has disrespectful and discriminating feelings about this specialty.
The Kyrgyz State Medical Academy has the very challenging task of re-orienting the training in order to find a training approach that would change this situation. This abstract is about one of the new teaching modules, “Human, Society and Health”. Its primary goal is to set a positive “pro-family medicine” attitude from the beginning of the undergraduate training.
What challenges does your project address and why is it of importance? The burning problem of health education and the healthcare system is a dramatic lack of general practitioners/family doctors in the field, particularly in rural areas. Many villages do not have even a single medical professional however it is considered that  the number of medical students in Kyrgyzstan is sufficient. Another figure is the low number of students who have their post-graduate education in family medicine as opposed to the giant number of residents who do their post-graduate education in the field of surgery, gynecology, cardiology and other narrow specialties. The major reason why students are not motivated to become a general practitioner/family doctor is a negative and disrespectful image of this specialty in the eyes of the community as undertrained and poorly qualified doctors.
Kyrgyz traditional health education system, both at undergraduate and post-graduate levels, is based on a curriculum with longitudinal disciplines that are taught separately and in isolation. The teachers of different departments are used to focusing on the narrow competencies of their discipline without knowing the general goal of the curriculum.
How have you addressed these challenges? Do you see a solution? KSMA is the largest medical educational institution that provides undergraduate and post-graduate and continuous medical education. To meet the needs of the healthcare system and to help to overcome the crisis in family medicine, the KSMA started working actively to change the curriculum and to change the whole approach to teaching the curriculum. The working groups of KSMA realized that the current curriculum needs one main goal that would connect and link all teaching units. The main task and challenge was to introduce the integration principle, so called vertical and horizontal integration, and build the curriculum around the core competencies to provide the country with well-prepared and motivated general practitioners.
After setting the main teaching goal as producing well-prepared General Practitioners/Family Doctors, the Department of the training, organizational and methodic work (DTOMW) has assigned working groups consisting of the representatives of each teaching Department/Chair to revise the existing modules and training programs.
Current modules were revised and some new integrated modules were developed in place of the longitudinal isolated disciplines.
One of the new modules was module “Human, Society and Health” for the 1st year of medical study. It involves the following disciplines: public health, psychology, philosophy, anatomy and physiology, biology and physics and clinical component. The revolutionary piece of the module is bringing the students to a real clinical environment, in the setting of a family medicine at a primary health organization. The module has a dual goal: the first is technical and the second is “ideological”. All the disciplines of the module built their teaching around these two goals. The first goal is to introduce a new medical student into the specialty of General Practice/Family Medicine, to orient medical students towards the specialty of general practice/family medicine and make them comfortable and aware about the goals of the undergraduate training. The second goal is to set a positive attitude towards the specialty of family medicine and help students understand the challenges and advantages of this specialty. The module explains the most important yet challenging role of the family doctors especially in neglected rural areas and the key role of primary health professionals in sustaining the health of the nation.
How do you know whether you have made a difference? Students are trained in the module “Human, Society and Health” in the beginning of their 1st year of study. To test the effectiveness of the module and our success in achieving our “ideological” goal each student was asked to make a visual presentation in any format to describe his vision and feelings about being a family doctor. Different formats were proposed: Power Point presentation, video, illustrated personal story, poster. Students were encouraged to work in groups. The idea behind the group work was to facilitate discussions and enhance creativity.
At the end of the module we conducted an anonymous survey among the students to assess the organizational and methodological aspects of the new module.
The students worked really hard on their projects and created motivational presentations and videos describing the challenging but fascinating work of a family doctor. All of them acknowledged that it is one of the most difficult jobs and admitted that their vision about the image and perspectives of a family doctor has been changed in the process of the training.
The anonymous survey of 221 first year medical students showed that 96% of the students found visiting doctor’s office interesting and helpful. 88% of the students found it the most interesting and motivational part of the training which allowed them to understand this profession better.
At the first meeting with students, each student was informally asked about future career plans and very few students had plans to become a family doctor, which was very shocking. A question about the choice of the profession was included into the survey.
25% of students responded that they “would like to work as family doctors in future”, 48% - “don’t know yet”, 27% - “would not like to work as family doctor” (explaining that they would like to become narrow specialists such as neurosurgeons, cardiologists, gynecologists, etc.).
48% of students who don’t know yet whether they would become a family doctor illustrates the possibility of using the 6-year training process to further encourage family doctor as a career choice. All the teachers of the KSMA have to be dedicated to the idea behind all the teaching units which is to build a positive and respectful attitude towards family medicine in our future doctors.
Our module allows us to understand the feelings and career plans of our future doctors, orient them into family medicine, and form positive attitudes to the primary healthcare professions.
Have you or the project mobilized others and if so, who, why and how? The disciplines were mobilized to form the working group and elaborate the training plan for the module “Human, Society and Health”. The most difficult part of the work was to re-orient the teaching staff into the integration mode. Traditionally every department would teach the discipline in isolation with its own competencies not being linked with the core global competencies of the whole master curriculum. Teachers of various departments had difficulty discussing the general training plan of the module and finding links to their discipline. They would tend to develop their part of the module without considering integration and interrelation with the other parts of the module. The coordinator of the module (the author of this abstract) took over the role of ensuring the integrity of the module and interconnection of the various disciplines and maintaining regular communication between the departments.
Now that the module is developed it is important to motivate the departments to continue collaboration and monitor the effectiveness of the new module in order to provide dynamic development and yearly improvement of the module.
If considered successful by the Main Training and Methodic Committee of KSMA, this module will be recommended to other medical schools in Kyrgyzstan.
When your donor funding runs out how will your idea continue to live? Our activity is not funded externally or internally. It is an internal initiative within the frames of the current health education reform which was started several years ago to meet the needs of the Kyrgyz health care system. To help with the revisions of the overall health education strategy and re-shaping the curriculum the KSMA has been granted funding for technical support by the health education experts of the Faculty of Medicine of Geneva University. They have provided field trainings for the KSMA leaders and faculty about the integration principles, competencies-based teaching and teamwork.
The reform at the KSMA is impeded by the lack of motivation of the faculty staff because their extra work is not funded and the only motivation to change is professional interest.
We need to discover other opportunities to motivate the faculty staff to improve their performance, to be engaged actively in this challenging but fascinating process in order to improve the training of future doctors!

Finding an integrated solution for tobacco use prevention: Kyrgyzstan.

Author(s) Anara Kalieva1, Salima Sydykova2, Nurlan Brimkulov3, Asel Burzhubaeva 4
Affiliation(s) 1Project "Community-based action against smoking in Chui Oblast KR 2011-2013", Project "Community-based action against smoking in Chui Oblast KR 2011-2013", Bishkek, Kyrgyzstan, 2Department of Hospital Therapy, Kyrgyz State Medical Academy I.K. Akhunbaev, Bishkek, Kyrgyzstan, 3Department of Hospital Therapy, Kyrgyz State Medical Academy I.K. Akhunbaev, Bishkek, Kyrgyzstan, 4Department of Hospital Therapy, Kyrgyz State Medical Academy I.K. Akhunbaev, Bishkek, Kyrgyzstan.
Country - ies of focus Kyrgyzstan
Relevant to the conference tracks Advocacy and Communication
Summary The current escalation in tobacco use and tobacco-related death and disease can be reversed only by integrated tobacco control strategies. Like other low-income countries Kyrgyzstan is facing massive challenges in this respect. The main idea of this project is to integrate a public health and health systems approach in tobacco control by implementing intensified community-based actions in one of the seven regions of the country in 2011-2013. Through activation of village health committees, primary health care, schools, medical schools and mass media the project strives to reach better understanding of the health hazards of smoking, and make changes in social norms of the community.
What challenges does your project address and why is it of importance? Kyrgyz Republic (KR) is a developing country in phase II of the tobacco epidemic, with a very high and growing prevalence of smoking in males and less in females. One of the dramatic facts that confirm the urgency of the tobacco use problem is high mortality from chronic respiratory diseases which is the highest among Eurasian countries. The problem requires integration of the various layers of the community, and active actions to build of supportive environments for the non-initiation and cessation of smoking.
One of the problems is the lack of data including data about actual smoking and attitude of the different layers of society towards smoking. Up to 80% of smokers acquire tobacco dependence before the age of 18. That is why it is so important to conduct intervention activities before this age when they are young and not dependent. Unfortunately our country does not have up-to-date and detailed data on the prevalence of active and passive smoking in various age groups. This deficiency of information hampers tobacco control, in particularly prevention activities for the reduction of smoking prevalence. The data available is not complete, but even this confirms the importance and urgency of the tobacco problem in our country.
How have you addressed these challenges? Do you see a solution? We see the solution in integration. If we want to change social norms, change the behavior and mentality of the community, the only way to go is integration of the players, because only the combination of all the available forces can beat the tobacco monster.
The pilot phase of the project was conducted during 2011-2013 in Chui Oblast. In 2015 monitoring will be conducted for the evaluation of the long-term effects of the activities.
The project combines efforts of the Ministry of Education, Ministry of Health and Republican Health Promotion Center to coordinate the integration process and enforce the project. The project integrates Village Health Committees, local authorities, school teachers, primary care professionals, health curriculum developers and mass media. They, in their turn work with various layers of the community: adult village population (smoking and non-smoking), drivers of public transport, school children, households, patients (smoking and non-smoking), medical students and interns, doctors, and newspaper readers.
VHC is a union of volunteer members who are active villagers wanting to advocate healthier lives and raise awareness of the community on various health issues. VHCs are trained by the Health Promotion Unit (HPU) specialists of the Family Medicine Centers (FMC).
The main components of our pilot project include: 1) Building the capacity of VHC in tobacco use prevention and activization and empowerment of local authorities; 2) Implementation of the modern teaching modules on healthy life style into school curriculum; 3) Systematization of the activity of the primary health organizations in tobacco use prevention; 4) Development and implementation of anti-smoking programs in the health curriculum at undergraduate and post-graduate levels.
Indicators were developed for each component and regular monitoring of the qualitative and quantitative indicators was performed.
We expected to reach the following outcomes:
• Increase awareness of the community in the health area.
• Establish skills on tobacco use prevention at a personal and community levels.
• Increase the number of patients visiting doctors for tobacco cessation.
• Establish healthy life-style behavior and tobacco-free attitude in children.
• Reinforce inter-sectoral cooperation at regional and smaller levels on tobacco use prevention.
• Elaborate of the model of the program on tobacco use prevention among the general population.
How do you know whether you have made a difference? The pilot phase of the project was conducted during 2011-2013 in Chui Oblast.
First of all a communication strategy was developed for community involvement in tobacco prevention activity in the Chui region and implementation of guidelines for the members of the VHC and HPU specialists. Authorities of the villages of Chui region approved the campaign and showed commitment to providing support to the village health committees.
The central part of the campaign are VHC members who are coordinated by the HPU specialists of the FMC. The project ensured the training of the HPU specialists and VHC members.
HPU specialists ensured that the local newspapers publish success stories and other positive information on tobacco use prevention.
The first task of the VHC members and schools was to increase awareness of the community about harmful effects of active and passive smoking on human body, especially in children. The second task of the VHC members and schools was the establishment of the negative attitude to tobacco smoking.
The survey of the Chui population shows that in 2011 34% of the population in Chui Oblast regarded smoking as very harmful to health whereas in 2013 the result was 49% (+15% increase). The awareness of impact of passive smoking on health increased from 29% to 49% (+20% increase).
In 2011 66% of the population was aware of the existence of national tobacco legislation. In 2013 this number was 85% (+19% increase). The number of smokers indicating that they would like to quit increased from 33% to 72% during the project (+39% increase).
600 teachers from the 296 schools in the Oblast have been trained during the project resulting in improved knowledge (37% -> 91%) about tobacco control issues by the teachers.
The teachers were provided with hand-outs containing description of lessons plans on smoking prevention for their students, text of the tobacco control law and the video “Tobacco or health!”.
Selective interviews of the family doctors within the report period revealed improvement of the situation in providing support to those who are willing to quit. Elements of anti-smoking programs are included in the curriculum of under-graduate and post-graduate levels in the training programs of Kyrgyz State Medical Academy.
Have you or the project mobilized others and if so, who, why and how? The project is realized by the partners: Finnish Lung Health Association (FILHA), Finnish ASH and Republican Health Promotion Center of the Ministry of Health of Kyrgyz Republic (KR), training center of Practical Approach to Lung Health Strategy under the Kyrgyz State Medical Institution of Continuous Medical Education and Ministry of Education of KR.
The partners have signed an agreement that was signed and approved by the Ministry of Health of KR and Ministry of Health and Education of KR.
The key partners were identified because of the expertise they have in the field of tobacco control, or the role they play in public health and the communication of the health messages with the community, or their role in coordination and reinforcement of the orders and regulations related to tobacco use prevention. All of the partners have past experience in tobacco control activities and showed their commitment through the whole period of project realization.
When your donor funding runs out how will your idea continue to live? From the very beginning of the project the project team was employed sustainable ideas that would survive long after the funding runs out. The key authority partners, such as Ministry of Health and Ministry of Education, were involved for the sake of sustainability. The project made sure that all the documents and orders that legalized project activities (such as including lessons into school curriculum for the 5-7 form school students, including the tobacco problem into the agenda of village authority meetings, the inclusion of tobacco control problems into the curriculum of KSMA at undergraduate and post-graduate levels and the systematizing of the tobacco prevention activities in the Family Medicine Centers) would be sustainable and institutionalized.