Alkan M L, Oztek Z, Akylbekov I K
Rural Remote Health. 2002 Jan-Dec;2(1):127. Epub 2002 Sep 2.
The Central Asian republics of the former Soviet Union gained their independence in 1991. Soon after this event, reforms in health care were planned in many of these countries. In Kyrgyzistan, the reforms included a mandatory health insurance system, a new provider payment system, licensing and accreditation, a national drug policy and rationalization of ambulatory services. Multi-profile policlinics, or family medicine group practices were established. Reforms in health care are not always accompanied by changes in medical education, and so medical knowledge may lag behind that in other countries. This is especially prominent in rural areas, where new practices and regulations may arrive late, and are often misunderstood. The reforms in Kyrgyzistan necessitated a change in undergraduate medical education. The educational reform consisted of a unification of the separate tracks for pediatrics, medicine and public health into one track of general medicine; the introduction of teaching of patho-physiology according to body systems; the establishment of clinical clerkships; and a proposal for rotating internship.
World Health Organisation sent teams to Kyrgyzistan to work with the local committees as facilitators for the implementation of the health-care reform. This paper is based on the experience of the authors in conducting two such missions directed at the synergistic reform in medical education.
VISIT 1: Changes to the curriculum were suggested. It was decided not to recommend teaching in rural primary care settings at that stage, due to logistical difficulties. This subject was to be addressed at a later stage because medical services in rural areas were scarce. VISIT 2: Among other interventions, the encouragement of doctors to practice in rural areas was discussed in detail, but the teachers of the medical school were not receptive to the idea of sending medical students to rural clinics. This was to be addressed at some time in the future.
The changes were aimed at facilitating the introduction of family medicine as a specialty and strengthenning primary care, although measures to incorporate rural practice in the reform proved difficult to achieve. Reform in medical education can only be justified if it will contribute to the improvement of the health of the population. In order to achieve this goal, the production of better physicians must be assured. In Kyrgyzistan, it was hoped that improved graduates would be the resource for the development of family medicine as a recognized specialty, with the potential to improve the health status of the whole population.
前苏联的中亚各共和国于1991年获得独立。这一事件后不久，其中许多国家都规划了医疗保健改革。在吉尔吉斯斯坦，改革包括强制性医疗保险制度、新的提供者支付系统、许可和认证、国家药物政策以及门诊服务合理化。设立了多科综合门诊部或家庭医学团体诊所。医疗保健改革并不总是伴随着医学教育的变革，因此医学知识可能会落后于其他国家。这在农村地区尤为突出，新的做法和规定可能来得很晚，而且常常被误解。吉尔吉斯斯坦的改革需要改变本科医学教育。教育改革包括将儿科学、医学和公共卫生的单独轨道统一为一个普通医学轨道；根据身体系统引入病理生理学教学；建立临床实习；以及提出轮转实习的建议。
世界卫生组织派遣团队前往吉尔吉斯斯坦，与当地委员会合作，作为医疗保健改革实施的促进者。本文基于作者执行两项此类任务的经验，这些任务旨在推动医学教育的协同改革。
访问1：建议对课程进行修改。由于后勤困难，当时决定不建议在农村初级保健机构进行教学。由于农村地区医疗服务匮乏，这个问题将在稍后阶段解决。访问2：在其他干预措施中，详细讨论了鼓励医生到农村地区执业的问题，但医学院的教师不接受将医学生送到农村诊所的想法。这将在未来某个时候解决。
这些变革旨在促进将家庭医学作为一个专业引入并加强初级保健，尽管将农村实践纳入改革的措施难以实现。只有当医学教育改革有助于改善民众健康时，才是合理的。为了实现这一目标，必须确保培养出更优秀的医生。在吉尔吉斯斯坦，人们希望培养出更好的毕业生将成为发展作为公认专业的家庭医学的资源，有潜力改善全体民众的健康状况。
