# Presentation: 218533

## Planned Government’s Steps in Specialized Education of Health Care Professionals

- Eva Prošková
- Ministry of Health
- Department of Education and Science

## Situation Before the Reform of the Education System – before 2004

**Centralized role of Government (Ministry of Heath) by means of directly controlled organizations (IPVZ – for doctors, dentists and pharmacists; NCO NZO – for paramedical professions)**
- Regulatory function
- Exclusive role in pursuing of specialization
- Individual health care facilities had been participating only as contractual workplace/department of IPVZ
- All financial sources only by way of state subsidy to these organizations
- Beginning specialization without approval of employer was impossible

## Beginning of the Reform

**2004 – Act No. 95/2004 Col. (on medical professions) and Act No. 96/2004 Col. (on paramedical professions)**
- Specializations of the I. and II. level were voided
- Separation of medical and paramedical professions according to principle of  self-rule (professionals chambers]
- Juridical disjunction the regulatory state role of realization specialized education by accredited facilities– formal liberalization of specialized education
- Accredited facilities are: HC facilities, universities and still directly controlled organizations
- Financing continues without changes

## System of education of Physicians, Dentists and Pharmacists

- Professional qualification
- of doctor

- Specialized education
- – independent
- pursuing of profession

- Professional qualification
- of dentist – independent
- pursuing of profession

- Specialized education
- – optional

- Professional qualification
- of pharmacist – independent
- pursuing of profession

- Specialized education
- –  optional

- Practice due to edu-
- cational program

- Practice due to edu-
- cational program

- Practice due to edu-
- cational program

- MoEdu

- MoH

- Lifelong education

## System of Education of Paramedical Professions 

- Master’s degree
-  health care programs
-  others +

- Specialized education
- independent pursuing
-  of profession

- Bachelor’s degree
-  health care programs
-  others +

- Specialized education
- - optional

- Secondary level or

- Specialized education
- - optional

**Accredited **
**qualification **
**course**

- MoEdu

- MoH

- Lifelong education

**Accredited **
**qualification **
**course**

**Accredited**** **
**qualification **
**course**

## Evaluation of Current Situation 

**Strengths**
** **Definitions of HC professions,  professional titles, conditions for obtaining of prof. and specialized qualification = regulation of profession
-  Beginning of specialized education as a distributed system
- Stronger role of universities
-  Enactment of obligatory lifelong education
-  Enactment of activities – only paramedical workers

**Weaknesses**
-  Unfair transition of “old” medical specializations
-  Complicated accreditation for the whole educational program (medical professions)
-  Missing discrimination between  accredited facilities due to types
-  Too many fields of medical specializations (doctors)
-  Unequal position of accredited facilities  (unequal financing, conflict of interest)
-  Unclear activities of medical workers

## Solution of Problems

**Amendments of laws **
- Included in implementation of new directive on recognition of qualifications – part 2 and 3 of the amendment of Act on recognition of qualifications (parliamentary No. 361)
- MoH has planned enacting of financing in an independent amendment, now is approved in suggestion of MPs
**Revision of decrees, new decrees**
- Activities of medical workers
- Transformation of specializations
**3) Revision of educational programs**
- Common parts – “trunks” – improving of permeability
- Requirements for accredited facilities higher and lower level
- Requirements for all parts of programs (personal, material, scope of HC)

## Amendment of Acts on HC Workers

**Structure of specialized education of doctors**
-  After completing the “trunk” – independent activities (as former attestation of I. level]
- Specialized qualification -  condition for independent practice, for supervisors, for heads of wards
- Certified courses – over then 1 year, (parallel to specializations, as the former  advanced specializations)
- Lifelong education – without changes

## Amendment of Acts on HC Workers

**Regulation of specialized education – responsibility of government (MoH)**
- Enactment of specializations, approving of educational programs, accreditation
- Supervision: enrollment, pursuing (check up of accredited facilities), output (check up of fulfillment of ed. programs by participants, performance of  in-specialization examinations)
- Delegated power – to universities, other subjects (directly controlled organizations) – MoH decides in dubiousness
- Assistant's role  – EU project E-health (interface between registers of HC workers, accredited facilitates, schools, authorities – access to information, evidence)

## Amendment of Acts on HC Workers

**Realization  -  Accreditation of facilities**
- Possible for part of educational program or as contractual facilities
- Decision on accreditation enacts  precisely scope of accreditation
- Change of legal form - continuing accreditation for 2 years
- Consequence of breach of obligations - possibility of sanctions (fine, seizing of accreditation)

## Amendment of Acts on HC Workers

**Financing of specialized education**
- MoH declares each year resident's workplaces for individual specializations, with individual financial contribution for the time of duration the whole program
- Number of resident’s workplaces will correspond to numbers of graduates of medicine
- the total sum may be about 500 mil/year, the support would be different according to needs in individuals specializations
- Accredited facilities will have a right to apply for residential facilities

## Amendment of Acts on HC Workers

**Financing of specialized education**
- Paramedical workers – applicants may be also unaccredited HC facilities
- Residential facilities are obliged to ensure the whole program for theirs residents
- Selections of applicants pursue accreditation commissions (as advisory body of MoH), primarily according to regional lack of specialists
- Residential facilities announce public competitive hiring procedure
- MoH publishes all announced residential workplaces
- MoH enters into contract with prospective resident – determination of duties

## Amendment of Acts on HC Workers

**Resident’s duties **
- Fulfilling all requirements of educational program
- Passing the in-specialization exam in time of duration extended by 3 years
- Pursuing his/her profession in the field of a specialization at least 5 years in the Czech republic
- Returning the adequate part of a subvention in case of breach of contract
- The Ministry decides to refrain from fining to the extent that there were any  unpredictable obstruction or difficulty

## New Decrees

**Activities of doctors, dentists and pharmacists **
- Activities of medical professions are not now enacted – there is only general definition in the law, scope of activities may be deduced from the educational programs (they are not legal rules)
- Consequence – legal uncertainty, uncertain common fields of activity between specializations, potential legal problems
- Enactment of common activities after the common “trunk”
- - possibility of legal partial independency
- - possibility of common emergency for similar specializations

## Conclusion

**We succeed to reach a significant consensus of professionals:**
**The reform is supported by**
-  Universities (all deans of medicine faculties)
- The Czech Pharmaceutical Chamber, the Czech Chamber of Dentists
- Professional organization of nurses, HC Unions
- Under reservation due to the most of goals also the Czech medical Chamber

- Thank you