Training and Regulation of Health Professionals In Lithuania

1
Training and Regulation of Health Professionals
In Lithuania

• Algimantas Tamelis
• Centre for Postgraduate Education
• Kaunas University of Medicine

2
Challenge

• COUNCIL DIRECTIVE 93/16/EEC To facilitate the
  free movement of doctors and the mutual
  recognition of their diplomas, certificates and
  other evidence of formal qualifications

3
State Regulated Professions

• Medicine
• Odontology
• Nursing
• Pharmacy
• Public Health non regulated

4
Basic Principles of Education

• Law of High Education
• Three levels of education
• Principles and basic structure of undergraduate
  education
• Internship and Residency training

5
Regulation of Postgraduate Training

• Decisions of the Government
• Training of Doctors
• Training of Odontologists
• Structure of training
• Undergraduate studies 6 (5) years
• Internship 1 year
• Residency training
• Regulations
• Duration

6
Medical (Odontology) Education
Specialist
General (Family)
Medicine 3 years
3 - 6 years
Internship 1 year
Basic
Medical
Education
Undergraduate studies 6 (5) years
7
Requirements For the Training

• Order of Ministers of Health Care and Education
  and Science
• Minimal requirements for the training of
  doctors, odontologists, nurses, midwifes and
  pharmacists
• Duration
• Structure
• Principles
• CPD
• Transposition of EU directives

8
Undergraduate Training

• Universities
• Kaunas University of Medicine
• Vilnius University
• Programs in High Education
• Medicine 6 years
• Odontology 5 years
• Pharmacy 5 years
• Nursing 4 2 years
• Public Health 4 2 years
• Colleges
• Nursing
• Midwifery
• Other

9
Reform of Postgraduate Studies

• Structure more streamline
• Duration according EU directive
• Programs
• Structure
• Training log-book

10
Medicine - Internship

• Established since 1993
• Regulated by Universities
• Clinical experience in regional hospitals and
  out-patient departments selected by University
• Internal medicine
• Surgery
• Obstetrics
• Paediatrics

11
Medicine - Internship

• Program ending University Examination
• Professional Qualification Medical Doctor
• Possibility to get Licence of Medical Doctor
  right for limited Independent Practice
• Emergency Room
• Ambulance

12
Odontology - Internship

• University regulated
• 1 year
• Clinical experience under supervision in settings
  selected by University
• University examination
• Professional qualification Odontologist
• Licence for independent practice

13
Residency training

• Established since 1990
• University and University Hospitals based
• Duration
• 6 years 3 programs (paediatrics)
• 5 years 18 programs
• 4 years 26 programs
• 3 years 13 programs (incl. Family doctor)

14
Medicine - Residency training

• Final university examination
• Professional qualification - specialist in
  medicine
• Possibility to get Licence for independent
  practice

15
Accreditation

• Provided by Centre For Quality Assessment In
  Higher Education
• External evaluation
• Medicine
• Odontology
• Public health

16
Licensing

• Law On Practice In Medicine
• Law On Practice In Odontology
• Law On Practice In Nursing
• Law On Practice In Pharmacy
• Law On Public Health Care

17
License

• Medicine, Odontology, Nursing, Pharmacy
• Obligatory licence
• Termless
• Obligation for CPD
• Control
• Public Health
• For certain practices (decision of Government)

18
Licensing Body

• Ministry of Health Care
• State Agency Of Accreditation For Health Care
  Practice
• Commission of specialists
• State Agency for Public Health
• State Medicines Control Agency
• Chamber of Odontologists
• Non governmental professional organisation
• Obligatory participation

19
Types of Doctors Licenses

• License of medical doctor
• Medical diploma
• Certificate of internship
• Evidence of satisfactory health
• Limited independent practise

• Full License
• Medical diploma
• Certificate of internship
• Certificate of specialist (residency) training
• Evidence of satisfactory health

20
Registers

• Ministry of Health Care
• State Agency Of Accreditation For Health Care
  Practice
• Register of licensed Doctors
• Register of licensed Nurses
• State Agency for Public Health
• State Medicines Control Agency
• Chamber of Odontologists

21
Re-licensing

• Formally non exist
• Informally requirement to prove obligatory CPD

22
CPD

• Law On Practice In Medicine
• Law On Practice In Odontology
• Law On Practice In Nursing
• Law On Practice In Pharmacy
• Law On Public Health Care

23
CPD

• Decision of Minister of Health Care
• Principles of Organisation
• Forms
• Financing - partially (75) financed by
  government

24
CPD - Forms

• Updating courses and traineeship
• Conferences and seminars
• Participation
• Presentations
• National - under supervision of Universities
• Articles in journals
• Subscription of journals
• Other

25
CPD - Volume

• Doctors 200 hours per 5 years, incl. 120 hours
  in University settings
• Nurses 100 hours
• Pharmacists 1 20 hours
• Odontologists 120 hours (Chamber of
  Odontologists)
• Public Health not established

26
Problems

• Internship
• Residency training
• CPD
• Professional organisations

27
Internship

• Still under debate
• Is it necessary at all?
• Duration?
• Undergraduate training?
• Postgraduate training?

28
Residency training

• Status of resident
• Student
• Limited responsibility
• Insurance
• Duration of training
• Only minimal requirements of directives

29
CPD

• More CME than CPD
• Concernment of
• Employer
• Financial
• Organisational
• Employee
• Interest
• Activity
• Audit

30
Professional organisations

• Chamber of Odontologists
• Lithuanian Association of Doctors
• Chamber of Doctors?
• Functions
• Rationality?
• Obligatory participation?
• Fees?

31
Conclusions

• System of under and post graduate education
• Minimal requirements of EU directives followed
• Licensing and regulation practice functioning
• Many unsolved questions