Challenges in internship practical training

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Challenges in internship practical training

Vysochyna Iryna Leonidivna D.Med.Sc., Professor, Head of the Department; Kramarchuk Volodymyr Viktorovych Assistant Professor of the Department; Yashkina Tetiana Olegivna Assistant Professor of the Department of Family Medicine at the Faculty of Postgraduate Education and Propaedeutics of Internal Medicine, Dnipro State Medical University

Abstract

The demanding landscape of the healthcare job market compels young doctors during their internship to acquire all necessary competencies and be prepared for intense competition to secure respectable employment. This is intricately tied to the substantial reform of the educational component and a focus on acquiring relevant evidence-based knowledge and skills. In Ukraine, the training period for medical interns in specialized departments has been shortened, with the practical training aspect now fully delegated to internship bases. The provisions regarding internship and the criteria of the National Health Service of Ukraine (NHSU) package for "Ensuring the human resource potential of the healthcare system through the involvement of medical interns" concerning the suitability of medical facilities for internship requirements remain at a low level, given the current state of affairs preventing substantial enhancement. In response to these changes, higher medical education institutions have initiated the establishment of university clinics, yet this has led to significant legal and financial barriers. At this stage, we have examined the progress of intern doctors in acquiring essential skills during the internship period and their self-assessment levels of professional competencies, aiming to identify obstacles faced by future specialists. Objective: to analyze the information provided by junior doctors in the field of General Practice and Family Medicine and assess the quality of their practical training at internship bases, in order to develop effective mechanisms and strategies to enhance the training of family doctors. Materials and Methods. Following the acquisition of the specialist doctor certificate, 27 respondents specializing in "General Practice - Family Medicine" who completed a two-year internship anonymously participated in a survey. The questionnaire comprised 14 questions. Likert scale responses were employed: unsatisfactory, satisfactory, mediocre, good, excellent for quality, and did not perform, 1-5, 6-10, 11-30, more than 30 for the quantity of skills performed within the specialty. Results and Discussion. According to the obtained results, the average self-assessment score of young doctors' practical training proved to be lower than the scores achieved during certification. Skills such as "Pap smear", "intraocular pressure measurement" and "spirometry/peakflowmetry" remained inadequately practiced. These skills require equipment (gynecological chair, ocular tonometer, spirometer, or peak flow meter). The factors leading to this outcome require further analysis and investigation involving the supervisors of intern doctors' training bases. Conclusions. Young specialists are not inclined to overestimate their own achievements. Only 18% of the respondents rated the quality of practical skills training at internship bases as excellent. The quantitative measurement of practiced practical skills during the internship period does not meet the needs of future specialists. Predictive factors for junior doctors' self-assessment of practical training levels were identified as follows: lack of willingness to change the internship base, the number of performed otoscopies, and the presence of rotation cycles at the internship base.

Keywords: internship bases, medical interns, general practice - family medicine, practical training, self-assessment.

Анотація

Виклики практичної підготовки в інтернатурі

Височина Ірина Леонідівна професор, доктор медичних наук, завідувач кафедри; Крамарчук Володимир Вікторович асистент кафедри; Яшкіна Тетяна Олегівна асистент кафедри сімейної медицини ФПО та пропедевтики внутрішньої медицини, Дніпропетровський державний медичний університет

Високі вимоги на ринку праці охорони здоров'я змушують молодих лікарів на етапі інтернатури опановувати всі необхідні компетенції та бути готовим до умов жорсткої конкуренції заради гідного працевлаштування. Це нерозривно пов'язано з масштабним реформуванням освітянського компоненту та концентрацією на отриманні релевантних знань та вмінь, заснованих на доказах. В Україні запровадили скорочення строків підготовки лікарів-інтернів на профільних кафедрах, а забезпечення відпрацювання практичного компоненту в повному обсязі передано на бази стажування. Положення про інтернатуру та критерії пакету НСЗУ «Забезпечення кадрового потенціалу системи охорони здоров'я, шляхом організації надання медичної допомоги із залученням лікарів-інтернів» щодо відповідності медичного закладу вимогам бази стажування залишаються на низькому рівні, оскільки нинішній стан справ не дозволяє зробити його більш високим.

Навздогін цим змінам, заклади вищої медичної освіти почали створювати університетські клініки, проте це породило велику кількість юридичних та фінансових бар'єрів. На даному етапі ми проаналізували стан відпрацювання лікарями-інтернами базових навичок за період інтернатури та рівень самооцінки щодо їх володіння професійними компетенціями, аби виявити бар'єри, що виникають на шляху майбутнього спеціаліста. Мета: проаналізувати інформацію, надану лікарями-інтернами за фахом ЗПСМ та оцінити якість їх практичної підготовки на базах стажування, що дозволить розробити дієві механізми та сценарії покращення підготовки сімейних лікарів. Матеріали і методи. Після отримання сертифікату лікаря-спеціаліста пройшли анонімне анкетування 27 респондентів за фахом «Загальна практика - сімейна медицина», які закінчили дворічне навчання в інтернатурі. Опитник містив 14 запитань. Для відповідей використовувалась шкала. Лайкерта: незадовільно, задовільно, посередньо, добре, відмінно щодо якості та не проводив/ла, 1-5, 6-10, 11-30, більше 30 щодо кількості виконаних навичок за спеціальністю. Результати і обговорення. Згідно з отриманими результатами середній бал самооцінки практичної підготовки молодих лікарів виявився нижчим за отримані за час атестації оцінки.

Недостатньо відпрацьованими залишилися навички «взяття мазків у жінки на онкоцитологію», «вимірювання внутрішньоочного тиску» та «проведення спірометрії/пікфлуометрії». Тобто ті навички, які потребують обладнання (гінекологічне крісло, очний тонометр, спірометр чи пікфлуометр). Фактори, які призвели до цього, потребують подальшого аналізу та вивчення з залученням керівників баз стажування лікарів-інтернів. Висновки. Молоді спеціалісти не схильні завищувати власні досягнення. Тільки 18% респондентів оцінили рівень якості навчання практичним навичкам на базах стажування як відмінний. Кількісний вимір відпрацьованих практичних навичок за час перебування на базах стажування не задовольняє потреби майбутніх спеціалістів. Прогностичними факторами самооцінки лікарів-інтернів щодо рівня практичної підготовки виявилися: відсутність бажання змінити базу стажування, кількість проведених отоскопій та наявність ротації циклів на базі стажування.

Ключові слова: бази стажування, лікарі-інтерни, загальна практика - сімейна медицина, практична підготовка, самооцінка.

Introduction

In order to bridge the gaps between the job market and the educational environment, as well as to enhance the competitiveness of young professionals, the competency-based approach is increasingly being adopted in the educational process. [1] Unlike the traditional approach, this direction focuses not only on acquiring professional knowledge and skills but also aims to meet the demands of the modern world by fostering critical thinking and the ability to act in the face of potential or existing risks. [2] Competencies encompass clear, measurable, transferable learning objectives that enable learners to understand the expectations placed upon them in the future. Unlike a fragmented set of knowledge formed in conditions of insufficient systematization, competencies can be objectively assessed. [3]

Within such a learning framework, self-assessment is not considered sufficient to validate the quality of acquired professional competencies, yet it reflects the level of satisfaction and has the potential to enhance the assimilation of new information. [4,5] Given the context of shortened training periods for medical interns in specialized departments and the transfer of practical education components to internship bases, studying and analyzing the progress of basic skills acquisition during the internship period and the self-assessment of young doctors regarding their professional competencies will help identify barriers that emerge on the path of future qualified specialists towards self-improvement. [6]

Objective: to analyze the information provided by medical interns specializing in General Practice - Family Medicine (GP/FM) and evaluate the quality of their practical training at internship bases, aiming to develop effective mechanisms and scenarios for improving the preparation of family doctors.

Materials and Methods

After obtaining the specialist doctor certificate, an anonymous survey was conducted with 27 doctors specializing in General Practice- Family Medicine who completed a two-year internship. The questionnaire consisted of 14 questions, including possibilities for open-ended responses, 11 closed-ended questions, and 3 open-ended questions. The creation of the custom questionnaire was carried out within a focus group of instructors from the Department of Family Medicine at the Faculty of Postgraduate Education and Propaedeutics of Internal Medicine at Dnipro State Medical University. The questions pertained to self-assessment of the quality of practical skills training during the period spent at the remote bases.

According to the training program, medical interns underwent a 2-year internship in GP/FM, including 10 months at the department, 12 months at the internship bases, and 1 month of leave. Likert scale responses were used for answers: unsatisfactory, satisfactory, mediocre, good, excellent for quality, and did not perform, 1-5, 6-10, 11-30, more than 30 times for the quantity of skills performed within the specialty.

For the purpose of comparing self-assessment of basic competency mastery with the objective level, we utilized the database of assessments obtained by medical interns during certification for the title of "specialist doctor" in the field of General Practice - Family Medicine.

Statistical data analysis and presentation of results were carried out using Microsoft Excel and SPSS v29 trial. The critical threshold for statistical significance was assessed at the level of p<0.05.

Results and Discussion

The actual study involved 3 male doctors (11%) and 24 female doctors (89%). The average age of survey participants was 25 years. Responses from the respondents revealed that 26 participants (96%) had the opportunity and conditions to independently examine and treat patients during their training at internship bases, while 1 junior doctor did not have such an opportunity (4%).

The average level of acquired preparation, rated on a scale from "unsatisfactory" - 1 point to "excellent" - 5 points, was evaluated by young professionals at 3.85 (SD = 0.93). Importantly, none of the survey participants considered their level of practical training to be unsatisfactory. To obtain more objective information, achieved through the comparison of data regarding the quality of the professional component from different sources, we conducted a comparison between the self-assessment of family doctors and the assessments given by medical interns during certification for the title of "specialist doctor". The average certification score for practical skill performance according to state data was 4.18 (SD = 0.47), and was significantly higher than the self-assessment score of junior family doctors (Figure 1).

Fig. 1. Comparison of average self-assessment scores ofpractical skill levels and scores obtained in certification for practical skill demonstration (95% CI for the mean)

Diagram 1. Self-assessment of practical training level by junior doctors specializing in "General Practice - Family Medicine"

The distribution of scores obtained by medical interns during certification for the title of "specialist doctor" is presented in Diagram 2.

Diagram 2. The scores obtained by medical interns during certification for the title of "specialist doctor"

The average level of practical skills training quality at internship bases was 3.88 (SD =0.87), which corresponded to the range between "mediocre" and "good" (Diagram 3).

The next section of the survey was dedicated to the number of core competency practical skills performed at the internship bases. (Table 1)

Diagram 3 The level of quality in practical skills training at the internship bases for medical interns

Table 1. Average score of competency practical skills performed at the internship bases, where 1 point - did not perform, 5 - performed more than 30 times