Health Professions Education in Slovenia

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Health Professions Education in Slovenia

• A new challenge to overcome a quality gap

The people who deliver care are the health
systems most important resource
Andrej Robida, MD, PhD, FACC Professor of
Paediatrics
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Content

• A need for different curriculum for health
  professions
• education
• Current status of undergraduate, graduate
  education of
• health professions and renewal of licences in
  Slovenia
• Thoughts for reflection and discussion in the
  group on
• health professions education

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National policy for the development of quality
in health care
One of the recommendations was focused on
preparing health care professionals to acquire
new skills.
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Quality is a system property
Trying harder will not work
Changing current curriculum with the
development of new competencies for the future
and current health care professionals is one of
the first steps towards
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Aims for improvement of health care system

• Effectiveness - do our interventions improve
  patient health status?
• Safety - will we harm a patient?
• Timeliness - how long does a patient have to
  wait?
• Efficiency - can we render a service with fewer
  costs
• and with equal results?
• Equity - is there discrimination on the basis of
  sex,
• age or social status?
• Patient-centred care - do we treat all patients
  as we
• would treat our own children?

Crossing the quality chasm, 2001 National policy
for the development of quality in health care,
2006
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Qality gaps
Percentage of patients with thromboprophylaxis
after abdominal surgery (2006)
Hospitals
Underuse
Percentage
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Qality gaps
Percentage
Overuse
Hospitals
Percentage of inappropriate admissions blue
columns - 21 criteria red columns - 18 criteria.
(Maruic, D., Ceglar, J. Neustrezni sprejemi
(Inappropriate admissions). Ljubljana, 23 April
2003).
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Patient Safety
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Building new professional competences
The concept of professional competence has
evolved over the last 30 years from a
one-dimensional construct representing
specialized knowledge to a more global one
which includes the application of specialized
knowledge.
Epstein R, Hundert E. JAMA. 2002287226-35.
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Building new professional competences
Professional competence is the habitual and
judicious use of

• communication,
• knowledge,
• technical skills,
• clinical reasoning,
• emotions,
• values,
• reflection

What individual need to know and do to carry out
the activity regardless of who performs it.
in daily practice
for the benefit of the individual and community
being served
Epstein R, Hundert E. JAMA. 2002287226-35.
www.skillsforhealth.org.uk (May 2008)
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New knowledge skills required
Competent clinicians

• Partnerships with patients carers
• Teamwork
• Risk communication
• Data collection
• Patient safety
• Professional responsibility
• Professional accountability

• Deliver patient centred care
• Member of multidisciplinary teams
• Use evidenced based ethical practice
• Use quality improvement approaches
• Use information technology

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Traditionally, educators relied on role
modelling. Professional behaviours will be
learned from attending physicians, residents, and
fellow students in the clinical setting
And the present level of competencies will
continue
Hatem C. Teaching approaches that reflect
professionalism. Acad Med. 200378709-713.
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Health care educational facillities in Slovenia
Hungary
Austria
Italy
Croatia
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Slovenia
Aim

• To look at the state of the art on quality and
  safety education in
• colleges and faculties for health care
  professions
• institutions for specializations
• licensure bodies

Methods

• A survey among health care educational colleges
  and faculties was
• conducted regarding quality and safety
  education in undergraduate and
• graduate levels
• Questions
• Stand alone subject
• Integrated into other subjects
• Contents of the subject
• Planning of curriculum for individual
  professions or integrated teaching

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Slovenia
Methods

• All 51 programmes of specializations in medicine,
  pharmacology,
• and laboratory medicine were screened for
  content of specialization regarding

• Quality in health care
• Patient safety
• Evidence based medicine
• Teamwork
• IT

• Rules for licensure of health care professionals
  were reviewed

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Slovenia
Results
1. Questionnaires were returned from 4 of 8 (50)
educational institutions
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Slovenia
Results
1. Undergraduate, graduate studies
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Slovenia
Results
2. Programmes of specializations (51)
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Slovenia
Results
3. To renew a license every 7 years a continuous
medical education by gathering credit
points is mandatory for physicians, dentist,
specialists in laboratory medicine, and
nursing profession. Performance of individual
health care professional is not a part of credit
points.
Professional competencies in nursing and
midwifery, 2008
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Conclusions
Slovenia

• Tradition, particularly medical education is on
  teaching core knowledge
• with basic mechanisms of disease and
  pathophysiology and not other
• competences
• Only 13 of specialization programmes includes
  quality, safety,
• EBM, teamwork and IT
• Nursing schools are ahead of medical schools
• Nursing profession has just published
  professional competencies
• in nursing and midwifery
• Teaching competencies regarding quality, safety,
  teamwork, EBM and IT
• in education of physicians are almost non
  existing
• Requirements for the renewal of licences do not
  include performance

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Thoughts for reflection - obstacles

• Lack of funding to review curricula and
  teaching methods
• Lack of faculty development for new content of
  teaching
• Decentralized departments in medical faculties
• Lack of integration of common subjects for all
  health care professions
• No coordinated oversight across continuum of
  education and
• fragmentation
• Responsibilities for undergraduate and graduate
  education and
• licensing not clear
• Difficulty assessing the impact of change in
  curriculum and teaching
• methods
• Ignoring the reality of change in health care

Regan- Smith , 1998 Ludmerer, 1999 Griner,
Danoff, 2000 Robida 2008.
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Thoughts for reflection - questions

• 1.How can new health professionals learn most
  effectively
• the basic skills related to
• Patient safety
• Patient centred care
• Quality of care
• Evidence based practice
• System thinking
• IT

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Thoughts for reflection - questions
2. How can these skills be further developed in
graduate studies? 3. How they be relayed to
professionals already in practice?
4. What will be the implication of change in
clinical education for the health care
organisations?
5. What will be the implication of change in
education for licensing? 6. What will be the
implication of change in education for funding?
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Thank you

• e-mail andrej.robida_at_guest.arnes.si

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