American Nursing Education System. Medical education in the USA: universities, exams, rules for foreigners. Tuition fees and scholarships

Admission to medical schools for an international student is not an easy task. First, because less than half of all US medical schools accept students from overseas. And even they accept very few foreigners, giving preference to local students. Secondly, because of the high entrance requirements.

The financial issue also plays an important role here. Medical programs in all countries of the world are one of the most expensive, as they require a lot of laboratory studies, clinical practice, and almost constant participation of a scientific supervisor. In addition, US medical education is the most expensive in the world.

Tuition fees and scholarships

Medical training takes 11 to 15 years, including a bachelor's degree, and prices at American medical schools are rising every year. So, over the past 10 years, the cost of medical programs has increased by more than 40%. On average, you should focus on the cost of $ 40'000-50'000 and above.

Foreign students in medical schools hardly have to rely on scholarships - although there are rare exceptions to this rule. But given the highest competition, in order to receive a scholarship, you need to have really outstanding knowledge, academic and life achievements, have excellent recommendations, and write exceptional motivation letters.

General requirements for applicants to medical schools

The general requirements of medical schools for applicants are as follows:

• Bachelor's degree with compulsory study of biology and chemistry. Some schools also require hours in some liberal arts, English, mathematics, science.
• Good MCAT scores - a required test for admission to US medical schools. If necessary / desired, the results of other standard tests are indicated - GRE, GMAT, LSAT.
• Good results on the test of knowledge of English - TOEFL, IELTS or other.

In addition, the applicant must carefully read all the requirements of the university, which will often differ from the standard ones. Additional tests, exams and interviews may be required, which will be conducted directly by representatives of the university.

Application submission and admission

International students apply uniform applications to all US medical schools through the AMCAS - American Medical College Application Service. The application system is administered by the Association of American Medical Colleges.

The applicant fills out a standard form that includes personal information about him and his family, all educational institutions that he attended, subjects studied, assessments, activities directly related to medicine, letters of recommendation available.

Then the applicant indicates the medical universities to which he plans to send the application. After that, he adds motivational essays - from one to three, depending on the program and level of study. Applicants to M.D. or Ph.D required: personal motivational essay - Personal Comments Essay, master's or doctoral essay - M.D./ Ph.D. essay, as well as an essay describing the student's research experience - Significant Research Experience essay.

Education

Study at the US medical school lasts 4 years, continuing with residency training from 3 to 7 years. After that, for those wishing to expand or deepen their specialization, to strengthen their practical skills, there are additional programs that last from one to four years and do not lead to the award of degrees. Students must be prepared for huge and diverse loads - hours of study in classrooms, laboratories and anatomical theater, practice in clinics.

To obtain a medical diploma, students must pass the United States Medical Licensing Examination (USMLE), or Board exam, which consists of three stages:

1. The first exam is taken at the end of the second year of medical school,
2. The second - during the fourth year of study,
3. The third - after the first year of residency.

These exams vary in structure and content, but collectively they ensure that the young professional's knowledge and skills meet the standards of American medical education.

Degrees

Graduates of US medical schools are awarded the following degrees: Doctor of Medicine, M.D., Doctor of Osteopathic Medicine D.O., Ph.D.

Medical education in the United States and the educational system are incomparable with the curriculum of Russian universities. American education is considered one of the best, after the UK and Canada. There are more than 120 medical educational institutions in America that are ready to accept not only their applicants, but also foreign applicants. At the same time, the competitive basis for the selection of students is the same for everyone. Only an applicant with high academic performance can be admitted. For foreigners, the requirements are even higher, it is necessary to take language courses, pass a language exam, be tested and only then submit documents to the university of interest.

Today, the most highly qualified universities with promising employment opportunities are:

● University of Rochester;

● University of Washington;

● Oregon University of Medicine and Science;

● University of Iowa;

● University of Minnesota;

● University of California at San Diego.

Requirements for admission

To enter a medical university, Russian applicants must pass the MCAT test and provide documents with academic grades. In order to take the test, you must contact a special center (not available in Russia). "Exam" is paid - $ 270. Lasts about 6 hours. The test program includes: an essay, an interview and answer questions in biology and physics.

On a note! Average cost of medical education from $ 100,000.

Education system

Complete medical education in the USA includes: university, medical school and residency:

● Studying at the university takes about 4 years;

● The passage of medical school takes at least 4 years, while students listen to lectures and perform laboratory work for 2 years, then clinical practice begins;

● Residency - from 3 to 5 years.

Traditional curriculum:

1. In the first year, students receive a general education program.

2. Second year - the following subjects are studied in detail: anatomy, pathology, pharmacology, physiology, biochemistry. Students are given practical laboratory work in the anatomical laboratory.

3. Third year - clinical practice, where a student, under the supervision of an experienced doctor, consults patients. At the same time, the practice is conducted in several departments of the hospital: therapy, pediatrics, obstetrics and others. The student's work includes the collection of data (history) and the proposed treatment plan.

4. Fourth year - deepening of clinical practice. Having tried himself in each department, the student can choose one direction and intern for a month.

After graduating from medical school and passing state exams, the university, based on the results of final certification, distributes graduates to residency, the so-called postgraduate hospital training. It must be compulsory for 3 to 8 years. At the same time, the competition for admission to residency is extremely high. The selection committee selects the best students who have distinguished themselves during their studies or participated in volunteer programs.

Upon completion of education, the educational institution issues a diploma - MD. Some schools have an innovative system of "double degree" - MD and Ph.D. (MD / RhD). To obtain this type of diploma, it is necessary to undergo training for 7-8 years. According to statistics, 90% of students receive a single diploma, on the awarding of the title of Doctor of Medicine. After completing all stages of training, you can officially work as a doctor in the United States.

Employment issue

Higher medical education in the United States provides its students with work without fail. The so-called ORT program is a professional production practice. It should be noted that this is a temporary job. The term of practice is a year. After graduation, the student is offered the following opportunities:

● Obtain citizenship and get a job in the United States;

● Complete training at another university in a new specialty;

● Leave the country within 60 days after ORT.

According to forecasts of American researchers, in the next ten years, unemployment will bypass the following industries - medicine, engineering, education. Statistics and polls also show positive results: unemployment among young professionals - 4%, among experienced doctors - about 2%. The salary is one of the highest from $ 48,000 to $ 64,000 per year. Therefore, we can safely say that large and small universities provide work for each student in the medical field, since the demand for specialists is growing exponentially every year.

Long way to a diploma

There are about 120 medical schools or medical universities in the United States, as Russia would say. Let me remind you that only students with the best grades are admitted to medical schools.

Each of them sets its own standards and selection procedure. The Medical School Admission Requirements directory is published annually, containing a set of requirements for admission to each of the medical schools and statistics on the results of the entrance exams last year. But the MCAT entrance test, developed by the AAMC in collaboration with the medical schools of America and Canada, awaits all applicants equally. We have already spoken about him.

Some schools have an MD / PhD (Doctor of Medicine / Doctor of Philisophy) dual degree program. However, about 98% of all medical graduates receive one diploma - MD. There is also an MD / MBA (Doctor of Medicine / Master of Business Administration) diploma - medicine plus business, but this is even less common. The duration of study for MD / PhD is 7-8 years, which is approximately twice as long as for MD.

The best medical universities in the United States are:

• University of Washington;
• Oregon University of Medicine and Science;
• University of Minnesota;
• Michigan State University College of Osteopathic Medicine;
• University of California, San Diego;
• University of Wisconsin;
• University of New Mexico;
• University of Rochester;
• University of Iowa.

Traditionally, training in medical school lasts 4 years, half of which is lectures and laboratory work. Then - the same amount of clinical practice.

The first 2 years are studied anatomy, biochemistry, pathology, physiology, pharmacology, histology and microbiology. The most impressive at this time was the first experience of working in an anatomical laboratory.

In the third year, in the course of clinical practice, the student encounters a patient for the first time.

The year is usually divided into several periods: the student visits the departments of pediatrics, therapy, surgery, obstetrics and gynecology, psychiatry and family medicine. Each period lasts 6-8 weeks, and each student under the supervision of doctors treats hospitalized patients. The work includes taking anamnesis, examining and compiling a list of possible diagnoses and treatment plans.

During the fourth year, the student has an increase in the volume of practice, he is given more responsibility towards the patient and works in a series of monthly courses in the areas of greatest interest. For example, a student with an interest in pediatrics might spend one month studying in a pediatric cardiology department.

Some medical schools do not follow such a traditional plan and have a more integrated learning process. Students begin clinical practice much earlier, studying and attending lectures for all four years.

8 years after graduation from High School, the time for residency comes. After receiving a diploma, students take the state exam - USMLE. According to its results, they are assigned to residency - an analogue of the Russian residency, only taking more years. Residency in the USA - postgraduate hospital training of doctors, providing for specialization for one year as an intern and for 3 to 8 years as a resident.

For example, students interested in pediatrics apply for residency at children's hospitals, and those wishing to become surgeons - in the surgical departments of university hospitals. Admission to residency, like medical school, is a highly competitive process. Admissions committees select students with the best grades and also favor those who have volunteered and helped others who did research and who performed well during interviews.

During the residency, the young specialist is hired by the hospital, receives a salary, works about 60-80 hours a week and provides assistance to both hospitalized and outpatients, but under the guidance of a more qualified doctor.

A resident may be the first doctor in contact with a patient, however, before starting treatment, he seeks advice from a more experienced colleague.

Upon completion of this level of specialization, the graduate becomes a fully licensed physician. He can work as a therapist and provide assistance in private practice. For example, a pediatric residency graduate might work as a pediatrician in a clinic as part of a pediatrician team. An alternative may be to receive additional, highly specialized education in a specific field. Then it is called "fellowship" and includes training for another 3-6 years. For example, after completing a residency in pediatrics, a young doctor may choose an additional four-year training to become a gastroenterologist.

The general picture of obtaining a permit for independent practice is approximately the following. If you are going to work in an ambulance, it will take 3-4 years; go into family practice or pediatrics - 3 years. Gynecology and Psychiatry will take 4 additional years. Urology and general surgery - 5 years each. Specialized surgery, including plastic surgery - 5-6 years (depending on the specialization). And if you dream of becoming, for example, a cardiologist surgeon, add 7 years, and a neurosurgeon - 8 years.

After this stage comes the "last battle". He is, accordingly, "the most difficult". The doctor passes a difficult exam and finally receives the degree of Doctor of Medicine - MD (Medical Doctor). After that, you can work as a doctor in the United States.

An Important Difference in the American Medical Tradition

I would like to draw the attention of Russian readers to the fact that in the United States there is a practice when not an entire person is treated, but individual organs. Treatment is outsourced to "narrow" specialists who pay attention only to what is the object of their professional qualifications, not noticing the rest of the body.

A distinctive feature of American medicine is the special personal relationship between doctor and patient. The patient is considered a partner of the doctor, the patient is explained in detail his condition and his opinion is listened to when choosing treatment tactics. The opinion of the patient in assessing the quality of medical care is given great, sometimes excessive importance. This situation, according to a number of experts, leads to a distortion of the assessment, since the patient is always subjective and is far from always able to objectively assess the quality of service. This state of affairs is most likely due to the fear of lawsuits.

Paul Frumkin, USA
(to be continued)

The high level of teaching achieved by the domestic higher education is well known. According to the UNESCO rating, some of the Russian medical universities are among the best medical schools in the world. Since no national authority awards any international qualifications, the alleged inconvertibility of a Soviet or Russian medical diploma is just a myth inherited from the times when this false idea was specially supported by the propaganda machine to limit the outflow of domestic medical personnel abroad.

The prestige of a medical university is created not so much by high-profile names and orders, as by its practicing graduates. Only by being constantly present in the market of higher medical education in developed countries can you "keep your brand". Under US law, in particular, graduates with diplomas of any medical university registered by WHO and the IMED-FAIMER agency authorized by the government of this country are equal and, after testing their individual level of knowledge, can apply for medical practice, regardless of whether they graduated from medical school in New York, Paris, St. Petersburg or Yoshkar-Ola. The personal ability and knowledge of the holder of the diploma is critical. However, listing in the WHO list is mandatory: without being mentioned in the WHO World Directory of Medical Schools and in the broader Avicenna Catalog (2007) created by WHO in collaboration with the University of Copenhagen, listing not only medical, but also other universities that train workers the health care system, the school loses its attractiveness for a foreign applicant, and the diplomas received there cannot claim legitimacy. WHO, IMED-FAIMER and the Avicenna Catalog automatically register universities, which are officially reported by the authorized authority - the Ministry of Health of a particular country (for IMED-FAIMER, a letter from the national ministry of education is also acceptable). But how slow this procedure can be is shown by the example of the Faculty of Medicine of St.

As a community group, medical professionals have achieved their greatest prosperity in the United States, and this dictates the restrictive class policy of the American Medical Association (AMA), therefore, very high prices in the American market for medical services and medical education. It is no coincidence that in 2009, immediately after coming to power, the new US President Barack Obama raised the issue of health care reform and the transition to more affordable medicine. In the USA and Canada, the cost of training in the specialty "General Medicine" is many times higher than the cost of obtaining a specialty of a pharmacist or dentist, which is not justified by fundamental differences in the level of costs of universities and differs from the situation in developing countries and most European countries. Even low-profile American universities, which occupy low places in the national rankings of universities, charge a tuition fee for a doctor of at least 50-70 thousand US dollars a year. In addition, there are simply few medical schools in the United States. And the path to a medical specialty for a young American takes much longer than for a young Russian due to differences in the organization of education (Fig. 1).

Therefore, obtaining medical education abroad is becoming more and more popular in the United States and other developed countries. One in ten of Canada's medical students study abroad. Even small Cyprus, Grenada and Jamaica are taught by hundreds of medical students from the United States. Universities in the Czech Republic, Poland, Hungary, Romania and the Philippines earn significant funds through English-language training programs for medical students from developed countries, Russian medical universities teach in English citizens of third world countries, mainly from South Asia. But so far in the medical universities of the CIS, there are practically no students from the G7 countries - the most medically developed states (except for a small number of children of naturalized emigrants from our country). Why are our medical universities with their enormous potential and classical traditions not participating in the development of these areas of the medical educational market?

The first reason is the objectively existing differences in the volume, nature and duration of education required for admission to the medical faculty in Russia and in English-speaking countries, so a huge part of potential applicants is cut off from Russian medical schools (Fig. 1). The point is in the difference between the systems and traditions of the continuity of school, general university and professional higher education. In Russia, since 2009, there have been provisions unified for all state medical universities, according to which any seventeen-year-old schoolchild who received a certificate of maturity for completing a full secondary school (eleven-year) can become a first-year student, if he has successfully passed the competitive entrance exams (in 5 leading medical universities of the country, including - at the medical faculty of St. Petersburg State University) or passed the competition for the results of the exam (in other medical universities).

Figure 1. The path to a medical diploma and a typical situation with the employment of a doctor in Russia and the United States. Let us clarify that the WHO for 2007 registered 63 Russian medical universities, training physicians and pediatricians.

In the USA, Canada and many other English-speaking countries, it is simply impossible to enter the Medical School (the equivalent of a medical school) at such an early age and with such preliminary education. The fact is that non-medical and general education disciplines, which, according to the current State Standard, make up the lion's share of the curriculum of the first and second years of Russian medical universities, are not taught at the Medical School at all. This is not at all due to the dislike of the local doctors for chemistry, physics, general biology, languages, philosophy and other subjects necessary for a highly qualified specialist, but because the Medical School in the USA is a professional school. General university education is not provided by it, but by a special link between the full secondary school (which in the United States is twelve years old) and medical universities. This link is absent in the Russian system. It's called College.

Here, perhaps, a semantic digression from the main topic, outlining some of the philological difficulties, will be useful. These difficulties look speculative, but when comparing documents on qualifications and education obtained in Russia and English-speaking countries, they give rise to quite real misunderstandings and can be a source of errors and mutual grief (Fig. 2). Many misunderstandings occur due to the fact that in Russia the name “college” is legally used by many secondary vocational educational institutions. Because of this, many domestic students and even professionals of the university system are in the erroneous belief that American College is also a secondary educational institution, something like a technical school or medical school (Medical College). But in fact, College in the United States is a higher educational institution that performs the functions of a university-wide education.

The term of study in most colleges is four years, and they award a Bachelor of Science degree, which literally corresponds to paragraph 4 of Art. 6 of the Russian Law on Higher and Postgraduate Vocational Education, which requires this term for a bachelor's degree.

By the way, answering the question of how medical education and the universal European two-degree system "bachelor - master" are related, we note that, from our point of view, there is no place in the medical education system for a mechanical transition to the mentioned gradations. For doctors, the undergraduate level corresponds to secondary specialized medical education and the qualifications of a paramedic. Therefore, in fact, our Russian bachelors in medicine are graduates of medical schools with medical assistant diplomas. The established practice provides that a domestic medical student reaches the qualifications of a paramedic by the fourth year of a medical university. This is confirmed by the presence in our curricula of industrial practice as a doctor's assistant, to which the medical student is just allowed after the fourth year. Moreover, medical and prophylactic institutions employ (with the permission of the dean's office) in the evening, concurrently with studies, as nurses for students who have completed at least four courses. In our opinion, it would be better to designate graduates of medical schools with the qualifications of a paramedic as bachelors of medicine and offer them more broadly, upon admission to a medical university, individual curricula taking into account not only nursing and paramedic practice (which is being done now), but also that part of the theoretical course that coincides with a program studied in a medical school. Within the framework of such a classical university as St. Petersburg State University, the Faculty of Medicine, which trains doctors, and the Medical College, which trains nurses, coexist in the structure of a single Medical Center of St. Petersburg State University, which can facilitate such integration.

As for a medical university, its graduate is not a master's degree, but a doctor of medicine. This qualification definition exists in most European countries and in North America. It is understood that both the duration and the richness of the six-year education of a graduate of a medical university is greater than that provided for by master's programs in non-medical specialties. A doctor is an "integrated", that is, immediately after graduating from a medical university, a master who is capable of applied professional activity. Only Great Britain and some of its former colonies call a graduate of the medical school "BBSM" - that is, a bachelor of medicine.

The question "who are they: Russian medical bachelors?" not the only status-philological obstacle on the way of international medical education programs. In fig. 2 lists some of these semantic pitfalls.

Russia is a country of boundless popular respect for scholarship and scientists. Obviously, this is the legacy of the reforms of the founder of our university, city and empire - Peter the Great. The name Academy is surrounded in our country (as, indeed, in France) with sacred honor, and its use is limited by law (see "Law on Education", article 9, clause 3 and the current special decree of the President of the Russian Federation regarding the use of this term). In the developed countries of the West, any public organization is free to call itself Academy. And this does not lead to any automatic conclusions about the intellectual level of its members. Many such organizations even do business by selling membership degrees to countries where the Member of Academy is traditionally regarded as an honorary academic title. The word “institute” sounds very solid to the Russian ear (and this is supported by paragraph 4 of the article cited above of the Russian Law on Higher Education and the Law on Science) and is completely incomparable with the Russian reputation of the term “college”. However, when dealing with American and Western European educational organizations, it should be remembered that in a number of countries the Institute stands for only an "institution", and thus there is no legal obstacle for an office of several resourceful businessmen to officially be called "Institute of Global Affairs and Human Resources. "Or something even more impressive for the Russian ear. But Сollege has the right to exist in the United States only if it provides training for bachelors.

A person engaged in international educational programs reluctantly pays tribute to the depth and sagacity of the philosophy of positivism, according to which many, if not all, troubles arise from different understandings of the same words and the same meaning attached to different terms. In Russia, a graduate of a medical institute is awarded the qualification of a doctor. This neutral formulation, preserved from Soviet times, emphasizes the narrowly professional, service aspect of higher medical education (engineer, technologist, doctor, teacher ...) and deliberately excludes any title and status: the future district therapist or pediatrician had no time for university robes and hats. Moreover, this formulation was introduced by the People's Commissariat for Health and the People's Commissariat for Education in the very years when medical faculties were taken out of the Soviet universities (1930) and made independent medical universities.

In our opinion, this decision was an attempt to take away from the doctor a part of public trust and prestige. In Soviet society, the authorities could not reconcile themselves to the fact that a clergyman or servant of Asclepius enjoyed more trust and respect from people than a party worker and a government official. Therefore, they deprived the medical diploma of the aura of status, expelling the university formulation from it and replacing it with a narrowly professional one. No degrees of dedication or sacraments - just a doctor, a repairman for living equipment. In the USA (as, by the way, in Russian diplomas intended for foreign graduates) there is not “Qualified as a physician”, but “awarded the title (conferred upon the Degree) of Doctor of Medicine”, that is, literally “awarded the title or the degree of doctor of medicine ", which, you see, is perceived completely differently, although in fact it refers to persons of the same qualifications! Likewise, the majestic letters R.N. after the surname of an American colleague means the qualification of a “registered nurse,” and a Russian paramedic, no matter how fresh it sounds, is a bachelor of medicine in terms of qualifications, although in our country he is not called. This difference in perception and interpretation of the same qualifications is profoundly symptomatic.

Beginning with the famous decree on the withdrawal of higher medical schools from universities, the USSR pursued a policy of eliminating the estate spirit of the medical profession and lowering the social status of intellectuals in general and doctors in particular. And we are reaping the benefits of this. The prestige of the Russian word "doctor" at the time of A.P. Chekhov was much taller. But in the United States, perhaps even now there is no more honorable and prestigious title than M.D. If a physician from the United States, possessing a number of honorary titles and scientific titles, like ours - "professor", "assistant professor", candidate of medical sciences or doctor of medical sciences, briefly introduces himself, he will omit all his regalia, but he will definitely mention: "Dr ... Smith ". Have you met the stars of Russian medical science who, in a similar situation, would have limited themselves in an official document with a signature like “Ivanov, doctor”?

In the USSR, a country of powerful science, a scientific career was for many more prestigious than a medical one. For the United States, it’s the other way around, and it’s not just about money. Lawyers earn even more money there than doctors, but public opinion traditionally trusts a doctor rather than a lawyer. In a letter from America, addressed to a domestic physician - a member of several academies, it may simply be: "Doctor so-and-so." And this is not a sign of disrespect, but quite the opposite. Such are the differences in mentality in our Eurasian country and in the United States, which did not survive either feudalism or communism and were created by immigrants, for the most part far from the classical European university traditions.

The use of the abbreviation M.D. in the United States it is regulated by law. In Russia, the word "doctor" is legally present in the diploma of any medical faculty. In the USA, only a post-residency doctor's manual (the equivalent of our internship) can be titled M.D. Graduates of Schools of Public Health and Preventive Medicine (the equivalent of our hygiene departments) receive the M.P.H. - Master of Public Health or D.M. It would seem that nothing changes from the rearrangement of the letters. In fact, M.D. and D.M. a completely different legal status. This detail is purely overseas. Currently, St. Petersburg State University has also started (in partnership with Yale University in the USA) training in the Master of Public Health specialty in the second higher education mode, primarily for specialists with non-medical diplomas. However, it is also open to doctors.

In Russia, future dentists, therapists, pediatricians are all medical students. In American university practice, the term Medical Students does not apply to dentists. Moreover, the everyday term Medical Doctors, which for Americans does not contain any tautology and is translated not as "medical doctors", but rather as "allopathic doctors" or "medical doctors". The fact is that we traditionally have a holistic approach to the patient's body, to the disease and to medicine itself. Therefore, according to Russian law, a number of medical specialties can be obtained in domestic medical universities only on the basis of postgraduate specialization, already having at least a diploma in general practitioner. This applies to manual therapy, homeopathy, osteopathy, orthopedics and its various subspecialties and areas. In the USA and Canada, some countries of Western Europe and the Third World, for historical reasons, a reductionist approach to the issues of delineating medical specialties and powers has been preserved. This led to a peculiar system of early specialization and isolation of some branches of medicine to the status of their complete delineation. Let us explain this with examples.

After the joint study of basic and biomedical disciplines at the college, its graduates, who, as a rule, are at least 22-23 years old, enter a four-year study at the Professional School. This can be a Medical School (medical faculty), after which the specialist receives an M.D. and becomes a medical doctor. After spending four years at the Dental School (Faculty of Dentistry), one can obtain a diploma and a D.D.S. (dentist). After studying for four years at the School of Podiatry (podiatric faculty - not to be confused with pediatric, preparing pediatric doctors), the graduate becomes a D.P.M. - a certified specialist in the treatment of diseases of the lower extremities (!!!). One can argue about the legitimacy of such a diploma specialization: in the skits of domestic medical students, brought up in a holistic spirit and confident that it is not the arm, leg or heart that is sick, but the whole organism, there are many jokes about "specialists in the treatment of the right ear." However, D.P.M. - an important and full-fledged element of the historically established Western market and health insurance system. His qualifications are controlled by a nationwide standard, and he does not sit without work. But a pediatrician in Western Europe and in the United States, unlike Russia, can only become within the framework of postgraduate specialization, already having an M.D.

After a four-year School of Optometry, one can become an O.D. and have the right to treat exclusively a number of eye diseases, moreover, only non-invasively. As a result, a graduate of the Medical School in the United States, unlike his Russian counterpart, cannot be required to be able to choose glasses - this is not his specialty. At the same time, consider the following: An optometrist in the United States is a university degree.

The School of Chiropractic, which should be most accurately translated as the Faculty of Manual Therapy, gives after four years of study with the number of standard hours practically equal to the Medical School, the degree of Doctor of Manual Therapy (D.C.). The term “chiropractic” is unknown in Russia and is a novelty in most European countries, except France and Scandinavian ones (for many years, for the Russian reader, almost the only source of information about this part of the American health care system was the caustic satirical book of the Finnish writer Matti Larni “The Fourth Vertebra "). In addition, in consonance this term resembles the “palmistry” negatively perceived by many, with which, of course, it has nothing in common. Therefore, it seems to us that manual therapy is a more adequate translation. Unfortunately, here too there is a basis for semantic problems, since in Russia, legalized chiropractors are, exclusively, doctors who specialized after a diploma.

In the United States, the total length of study after high school in manual therapy is 6-8 years, as is the case for a general practitioner. D.C. specialize in non-invasive non-drug methods of treating diseases of the spine and back, have fundamental training in these sections of orthopedics and related fields, they are well oriented in certain parts of the course of internal medicine, neurology, laboratory and instrumental diagnostics, but their training does not include surgical disciplines and pharmacology, and the law does not permit them to use invasive manipulation. The circle of D.C. drugs are limited to a narrow list of analgesics, vitamins and minerals. At the same time M.D. with this system, he does not have in-depth training in the sections reserved for D.C., and, as a rule, does not treat diseases of the back and spine.

After four years of study at the School of Osteopathy, the graduate receives a D.O. and the right to treat patients with various diseases in accordance with this peculiar isolated doctrine, in many ways an alternative to both allopathic medicine and manual therapy. The Institute of Osteopathy is currently operating within the Medical Center of St. Petersburg State University, which provides postgraduate training for doctors in this area.

For all six of the above branches of medicine in the United States there is an isomorphic system of state certification, licensing and quality control of knowledge.

These issues, as well as the frequency of retraining and improvement of senior medical professionals, are overseen by appropriate commissions at the state level. Specialists of each profile are united in specialized national associations. In the conditions of insurance medicine, especially during the years of the Clinton health care reform, among all these profiles were M.D., who have a multivolume list of appointments, services and procedures paid from the compulsory health insurance system. The same D.C. it fits into a thin brochure. This makes the circle of their permanent patients narrower, and their income is significantly lower than that of M.D., given the formally equal status of education and comparable curricula. Therefore, a significant number of American doctors - representatives of the narrow specialties listed above - would like to retrain as general practitioners. Such a situation is fundamentally unthinkable in Russia, where specialization is possible mainly after graduate training and where only postgraduate training strengthens the professional status and economic position of a doctor! We think that few domestic homeopaths or chiropractors would prefer to return to the position of a general practitioner again. But their colleagues from the United States proceed from the fact that M.D. - a more promising profession on the market.

They often prefer to retrain abroad, since the relationship between the AMA, which controls medical schools, and representatives of their specialties are rather cold and, in many ways, poisoned by competition for patients and insurance funds. All these are people with a strong socio-economic position and solid incomes, and it is they who could become motivated, prepared and financially wealthy commercial students of Russian medical universities.

And here we must return to the main subject of this article - the reasons for the absence of medical students from developed foreign countries in the Russian Federation. American schoolchildren simply cannot think of entering a Russian medical school, since secondary school graduates, in the American sense of the word, do not enter medical schools, and there is no equivalent of American university colleges and schools of basic biomedical sciences in Russia. Consequently, the main contingent of potential students could be mature specialists who receive medical education as a second higher education with already acquired bachelor's, master's and / or doctor's degrees in one of the narrow specialties. But the barrier here is that Russian universities typically offer a standard program consisting of a year of studying Russian in the preparatory department and six years of study together with yesterday's students. For a medical specialist aged 26-30 years or even older (12 years at school + 4 years of college + 4 years of higher professional school + some work experience in the specialty, which made it possible to make sure of the need for retraining), this is unacceptable. Let's not forget that the equivalent of our residency - Clinical Residency - abroad is much longer (three to five years instead of two) and immeasurably richer in terms of work and study load.

Among our students in the first English-language medical program in Russia, successfully implemented in 1993-1998 at the Pediatric Academy in St. Petersburg (see below) was the oldest graduate of this university, Randolph Oswald Dordon-Berezovsky, who received a Russian doctor's diploma at the age of 64 ( !).

Art. 11, clause 7 of the Law on Higher and Postgraduate Vocational Education in the Russian Federation provides academic councils of universities with the right to make decisions on training in accelerated and reduced programs for persons whose previous education level and abilities are sufficient grounds for this. However, in practice, this right is very rarely used in medical education, since this form of work requires significant independent efforts of universities to create and implement individualized curricula, and the autonomy of universities in our country was restored only relatively recently by the law of 1995. At the same time, in the United States and other developed countries, the so-called advanced standing degree Programs are a common routine practice that allows for a flexible and cost-effective retraining system. In addition, in these countries, a significantly larger part of the curriculum of a medical student falls on electives than in Russia, being non-standard.

The standard practice of teaching foreign students available in our universities is convenient when working with people from developing countries, where the quality of school education is significantly lower. But it cuts off significant groups of potential students from developed countries from Russian universities.

Real educational integration with Europe is also constrained by the fact that Russia is not a member of the European Union, and therefore, Russian doctors do not enjoy full freedom of employment in the European Union, no matter how adapt the wording in the diplomas to the European standard. However, with a good knowledge of the national language in the country of residence, a Russian medical diploma is not an obstacle, but a help for practicing in a specialty.

At the same time, the American standard of higher medical education does not require a student to study medicine in the United States in English. It is necessary to complete the program in any medical institution in the world, registered by WHO and mentioned in the IMED-FAIMER list. The program must have a duration of at least four years (according to Texas law - 42 months). Education in basic life sciences should generally take at least 18 months and include at least 1,600 classroom hours. Independent work of students outside the classroom is not taken into account by American transcripts (in Russian curricula, this is a mandatory component). A minimum of 80 academic weeks of clinical disciplines are required. Throughout North America and Western Europe, academic time is recorded in semester hours (credits), not in academic hours, as we do. Typical Russian curricula are adequate to foreign requirements for all these positions. However, some details of typical Russian programs do not meet foreign standards or are falsely perceived as inadequate for formal reasons. Thus, according to the American standard, at least 60-hour course "Basic & Professional Cardiopulmonary Resque - CPR" is taught to all doctors, the content of which is much wider than the course of first aid and which pursues tasks other than the Russian course of resuscitation. Programs without this course can be formally regarded as inadequate. In general, a unified centralized state certification of university educational programs, familiar to the USSR and Russia, is a novelty in many foreign countries with their centuries of history of higher education. So, in Holland it was introduced only in 2003 - in connection with the directive of the European Union. Until then, for centuries, the Dutch monarch and government reasonably assumed that professors in Leiden and other universities knew what they were teaching.

The names of a number of courses and departments, which are mandatory for Russian medical universities, cannot be literally translated into English, since the unique Pirogov three-stage system of teaching clinical medicine (propedeutics - faculty course - hospital course) has never been practiced in the West. Instead, there is the practice of an introductory course and subsequent "Clinical Сlerckships". In American medical schools, the equivalent of propaedeutics is traditionally represented by two courses at once: "Introduction into Internal Medicine" and "Laboratory & Instrumental Diagnosis". Foreign graduates of Russian medical universities are sometimes forced to endure inconvenience due to the fact that their transcripts contain something incomprehensible to some professionals of the medical licensing and nostrification system in the West or literally scalped from Russian “Propedeutics of Internal Diseases”, “Hospital Surgery”, “Faculty Therapy”, which for the reader of the diploma looks meaningless. In this regard, we note that medicine is the only one of the most important sciences, in which the task of creating a single professional language has not yet been solved. Doctors in different countries call the same terms different, and different - the same concepts. Even in the same country, physicians of different specialties sometimes use different terms to refer to the same thing. What is a white blood clot for a Russian and a German is a platelet plug for an Englishman and an American (literally "platelet nail"). This does not mean that doctors are better educated on one side of the English Channel (or perhaps the English Channel?) Than on the other. But alas, this means that their thesaurus does not match. The same "named" diseases, syndromes, methods, phenomena (and there are more than 9 thousand!) In the medical community of different countries is historically customary to name in honor of different doctors. For example, Americans call sideropenic laryngopharyngoesophagitis Plummer-Vinson syndrome, the British call the same disease Patterson-Kelly syndrome, and Scandinavians call Waldenstrom-Kjelberg syndrome. Diffuse toxic goiter in German and Russian-speaking countries is von Basedow's disease, in Italians - Flayani's disease, in Ireland - Parry's disease, and in England and all its former colonies - Graves' disease. This situation, unthinkable in physics, chemistry, mathematics and most of the humanities, makes teaching and learning difficult in international medical programs. Education - both fundamental and applied - is, first of all, the inculcation of a certain professional thinking. Language is a tool of thinking. Therefore, the problem requires solutions. To help solve such problems, we are currently working on the "Explanatory Illustrated Dictionary of Eponyms and Figurative Expressions in Pathology" and "Comprehensive Explanatory Dictionary of Biomedical Sciences", which will be published in 2009-2010. In the meantime, terminological discrepancies remain.

So, in most Western European and Japanese universities and in all North American there are departments of pathology, combining both the course of pathophysiology and the course of pathological anatomy. In the USSR, these two nursing branches of theoretical medicine, representing the study of the same subject - the causes and mechanisms of diseases, but in different ways (by the method of intravital experiments and functional tests - pathophysiology and the method of postmortem observations and biopsies - pathological anatomy) - were artificially divorced according to different departments and placed in different lines of curricula and transcripts in 1925-1926. This separated the pathophysiology from the pathological anatomy course. Despite the existence of such an objective prerequisite for separation as the increased methodological arsenal of these disciplines, this organizational decision was largely subjective and responded to the directive imposed by the then authorities - to take medical education outside the framework of universities, which happened in 1930. Abroad, the principle of joint teaching of these sciences has been preserved to this day. Russian transcripts of medical students, where these disciplines stand apart, look inadequate for this position. Moreover, in the West, including in Great Britain, a pathologist, a doctor engaged in functional tests, and an interpreter of laboratory tests are considered a clinical pathologist. In Russia, however, the qualification "clinical pathology" for some reason is monopolistically assigned by ministerial lists to representatives of pathological anatomy, which is absolutely archaic and, in our opinion, is subject to immediate correction. Physicians of functional diagnostics offices and doctors-laboratory assistants are not formally considered clinical pathologists, although they actually are. Separate departments of pathophysiology and pathological anatomy exist everywhere in China and in some universities in Germany (Jena), Eastern Europe, and Italy.

The Bologna process requires the unification of wording and terms in curricula and transcripts, in the list of specializations. Modern possibilities of non-invasive examination of patients have expanded to the level of molecular genetic research in the course of the treatment and diagnostic process. This allows both pathophysiology and pathological anatomy to be considered clinical sciences, creates a basis for the reintegration of their teaching. Unlike other Russian medical universities, since 1997 at the Faculty of Medicine of St. Petersburg State University there is a Department of Pathology, where teaching is of an interdisciplinary integrative nature.

Education is also about exams. In a foreign medical school, there is a cult of objective methods for assessing knowledge, which resulted in a tendency to eliminate the personality of the examiner from the control procedure. The exam in our Russian form, like a live interview of a student with a professor or a commission of teachers on ticket topics with a demonstration of practical skills, is universally excluded from the life of American medical schools and from the practice of many European medical universities. It has been replaced by a computer or multiple choice test. Being in the grip of legal control and legal fetishism, our American colleagues were forced to go to such surreal exotic as an exam on healthy actors depicting illness. The classical technology of knowledge control, adopted in the medical universities of our country, is unusual for foreign students. The objective economic complexity of organizing the training of students from developed countries in Russia is associated with the fact that in the United States and many European countries it is customary to study on preferential loans provided by banks to medical students under the relevant law. These loans are available only to medical schools that are officially approved by the state medical councils. The approval procedure ("Approval", or equating to local schools) is formal, but complex, it requires the qualified filling of multi-page documents, the acceptance of a state commission on the ground and a significant contribution of the medical school to the state treasury. In the state of New York, for example, in 1995, of all foreign medical universities in the world, only two faculties were officially equated to local ones - in Jerusalem and in Beirut, although the socio-political situation in the area where these medical universities are located cannot be called more stable. than in St. Petersburg or Moscow. The level of teaching in the best universities of both Russian capitals can successfully compete with the above-mentioned schools. But, of course, the strong positions of the Jewish and Arab diasporas of New York, which welcome the idea of ​​educating young people in their historical homeland, had an effect. Without going through the equalization procedure, the Russian medical school can only rely on those students who do not use preferential loans for studies.

In addition, American law and the laws of many other countries protect patients from all contact with doctors who are not licensed to practice in the country where the examination or treatment is taking place. It is this circumstance that prevents the establishment of a wide exchange of senior medical students and clinical teachers between the United States, other Western countries and Russia. In the exchange of theorists and students studying non-clinical disciplines, such problems are much less. For example, a medical student of our faculty can already take an internship in biochemistry at the Karolinska Institute in Stockholm or an internship in pathophysiology at Kyushu University in Fukuoka, but there are some legal barriers to full-fledged practice in therapy or surgery. But the same circumstance increases the competitiveness of Russian medical universities in the international market of educational services: after all, in our country, in clinical hospitals of medical universities since the time of N.I. Pirogov, early contact of students with patients, even their participation in surgical operations, is practiced, and students are admitted to clinics for classes, regardless of their citizenship.

Taking into account all these difficulties, solving the problem of creating a competitive training program for students from developed countries of the world in Russian medical universities, specialists from St. I.P. Pavlova, with the participation of the Health Committee of the City Hall of St. Petersburg, back in 1993, created a curriculum specifically designed for the education in Russia of American students who had previously received degrees of Bachelor (Master) of Science and Doctor of Chiropractic.

In 1993-1998, this program was implemented, and for the first time in the history of domestic higher medical education, 10 American citizens, having completed the curriculum and passed state exams, received Russian medical diplomas (see photo). Despite the many difficulties and costs inherent in any difficult and new business that does not fit into the usual standard framework of routine functioning, the program left a good mark. The high level of teaching, provided during its implementation by the teaching staff of St. Petersburg State Medical Academy and St. Petersburg State Medical University, was repeatedly noted by American students in their written and oral responses as "unparalleled in all their previous student experience." The New York State Senate noted this with special honorary diplomas, which Federal Senator Kenneth Laval presented to representatives of the universities organizing the program in recognition of its high level. At present, its graduates (among them one of the authors of this article), after successfully passing the national licensing exams, work as doctors in the USA and Ireland, and the experience gained during its implementation, documents, human resources are currently used by St. Petersburg universities in their English-speaking medical programs. This pilot program has already become history. Nowadays in Russia, medicine is taught in English at many universities: MMA im. THEM. Sechenov, RUDN them. P. Lumumba, medical universities of Nizhny Novgorod, Kursk, Jewish Academy named after Maimonides, St. Petersburg State University, St. Petersburg State Medical Academy, St. Petersburg State Medical Academy, St. Petersburg State Medical University and many others.

The most acute problems arising during the implementation of these programs, in addition to those noted above, are as follows. An English-language program is not only a Shakespeare-speaking teacher, but also an English-speaking learning environment. However, the university's administrative and educational support personnel - from the librarian to the dormitory commandant - with rare exceptions, do not speak English. In the libraries of Russian medical universities, there are very few English-language medical textbooks accepted in foreign practice. Most of the typical Russian textbooks for medical students have not been translated into English, and those that have been translated and published have long been sold out. Russian publishers are not very interested in publishing Western medical textbooks or translating domestic ones - due to the limited effective demand for them in our medical community. Let's say a publishing house has decided to give the Russian reader a textbook of pathology by Robbins, Cotran and Kumar, which is used to study in English-speaking countries. A book of comparable volume and printing quality will cost about 3,000 rubles in Russia without store markups, which, in turn, will be close to 100 percent. How many Russian doctors - students and non-students - will be ready to buy it with all their will? In the course of the program, teachers themselves create English and bilingual teaching aids, but this does not solve all the problems. Currently, based on the sublanguage of therapy and pathology, we are developing an audio-video-text textbook "English for Physicians", which will be released in 2010.

Clinical studies of a medical student are held in hospitals and clinics, where the student must examine Russian-speaking patients and get acquainted with Russian case histories, maintain medical records, interact with nursing staff and laboratory staff, who for the most part do not speak English. The activities of healthcare institutions in the Russian Federation are free from subordination to supranational medical standards. The Russian doctor is less than his foreign counterpart looking back at the standards of evidence-based medicine, working in line with the creative adherence to authoritative recommendations. Even the nomenclature of diagnoses made, as our specialists were convinced, trying to unite the clinical bases of the Medical Center of St. From our point of view, the path of authoritative standardization of the doctor's actions, which is sometimes popularized as "the last word in evidence-based medicine", leads to a dead end. He expels authorship from medicine and would transform the work of a doctor from a professional mental work into a service and service performance: as, for example, with postal workers. It contradicts the basic principle of the Russian clinical school: to treat not a disease, but a patient. A doctor will always be sinful; it will not work to make him infallible through evidence-based medicine. It will turn out differently: to expand the famous "Do not harm!" to the vulgar "Don't hurt ... yourself!" Therefore, medical students in the 21st century (if they are lucky with teachers) will study author's medicine, and not stereotyped. This means that the role of foreign students learning the language of the country of study will only grow. And students of the English-language program of the Faculty of Medicine of St. Petersburg State University study the Russian language, as well as our national culture and history. Despite the fact that all academic hours in the program are taught in English, on the territory of Russia, according to the provisions of the Ministry of Health, only a physician who is sufficiently fluent in Russian can obtain a doctor's diploma and practice medicine. Otherwise, direct contact with the patient, penetration into the thesaurus of the Russian medical community, work with domestic medical documentation is impossible.

It is worth thinking about modifying the system, traditional for our universities, inherited from the USSR, in which foreign students have their own dean's office. There is nothing like this in foreign universities, where the dean's office is one for everyone, regardless of citizenship. This issue is closely related to the need to comply with visa laws. Russia is one of the few European countries that maintain a visa regime in relations with the overwhelming majority of states. And this circumstance (as well as the fact that most of our, even the largest, universities have no permanent representative offices in non-CIS countries) works against the equal competition of domestic universities in the international market. Finnish or Swedish students living at a distance of three hours by car or forty-five minutes of flight from St. Petersburg could become a permanent contingent in our universities. But this will happen only when they can travel to their parents for the weekend without visa formalities. In the meantime, they choose universities in Europe: albeit less prestigious than the legendary St. Petersburg State University, and often located geographically further from home, but accessible without visas. Let's hope that the practice of agreements on the liberalization of the visa regime for students and teachers, concluded by Russia not so long ago with Italy, France, Poland, Germany and a number of other countries, will be significantly expanded.

Since the 19th century, two different approaches to medical education can be distinguished. In France, the basic principle of training future doctors has become hospital, when students from the first to the last year consistently mastered the skills and abilities of an orderly, nurse, paramedic and doctor's assistant in a hospital setting. The main method was practical, theoretical lectures only generalized knowledge about the forms of diseases seen. The significant predominance of learning through action led to serious gaps in the student's theoretical baggage. On the contrary, higher medical educational institutions in Germany in the 19th century focused on the theoretical aspects of healing, which inevitably led to the emergence of equally serious gaps, but already in the development of practical skills. In Russian medical universities of the 19th century, teaching methods depended, first of all, on the belonging of teachers to a particular school. Moscow therapist G.A. Zakharyin, defining approaches to treatment, focused on the doctor's actions based on positive clinical experience: systemic examination of the patient, the ability to collect anamnesis, taking into account the patient's psychology, and developing intuition. The value of teaching through direct practical action was also emphasized by the St. Petersburg surgeon N.I. Pirogov. The head of the St. Petersburg therapeutic school S.P. Botkin gave preference to instrumental diagnostics and laboratory studies, on the results of which the treatment itself was based. At the same time, M. Ya. Mudrov, not satisfied with the practical training of doctors at Moscow University, wrote with bitterness: "We learned to dance without seeing how they dance!" - and chose St. Petersburg for the postgraduate course.

The twentieth century did not lead to a common understanding of the specifics of approaches in medical education either in Russia or in Europe. Perhaps this is due to the fact that, like a century earlier, he was influenced by two opposite powerful tendencies. The first, leading to the predominance of the "French" version, stems from a large number of bloody wars on a local and global scale in the last century. Indeed, a doctor in a front-line hospital has no time for theorizing and speculations about the philosophy of medicine. Another trend is associated with the rapid development of natural science, which began at the turn of the century, including the scientific basis of public health. Over the course of twenty to thirty years, such branches of science as genetics, biochemistry, biophysics, immunology, endocrinology, virology, later (molecular biology and molecular genetics, genetic engineering and biotechnology, developmental biology, biomedical cybernetics, and later on proteomics, liponomics, before our eyes now - autoimmunomics, etc. Understanding the importance of mastering new theoretical and experimental data of these sciences for health care and their application in clinical practice led to the shift to the forefront of the "German" version. The situation was complicated by social and economic problems, which it was necessary to decide first of all.

As for our country, let us pay attention, for example, to the fact that already in 1919 the government of Soviet Russia set the task of providing qualified medical care to every member of society, regardless of his social status, material wealth, and place of residence. It should be noted that by 1917, all higher medical educational institutions in the country graduated about 1000 specialists per year for the 150 millionth power, which occupies a sixth of the Earth. Of course, it is safer to carry out extensive ways of providing the population with medical care according to the "French" version, since, thanks to this, it is easier to solve urgent problems of combating mass morbidity. Having successfully solved them, the medical education system of the USSR tended to the "German" version, since it is impossible to live only today. Then the change in the situation threw the pendulum back. For example, a significant increase in the population of the USSR by the 70s - 80s (up to 270 million), the emergence of new settlements and cities in Siberia, Central Asia, in the Far North required a corresponding increase in the number of health workers. In 1990, the annual release of doctors in the USSR reached 60 thousand people. But the rapid development of natural science in the second half of the last century led to the fact that medicine began to lag behind the fundamental sciences. Gradually, the methodological arsenal of medical experimentalists began to differ more and more from the equipment used in routine clinical, since the health care of the USSR was financed on a leftover basis, and significant attention was paid to fundamental science at the state level. To remedy the situation, a palliative decision was made in the 1960s: to start training medical researchers. In 1963, the first medical and biological department in the USSR was opened at the 2nd MMI, which became a faculty three years later. At the same time, a department of biophysics was created at the Kaunas Medical Institute, the Faculty of Medicine and Biology (in Tomsk, and at the end of the 90s - a similar department at the Faculty of Natural Sciences of Novosibirsk State University. The problem, however, was that the graduates of these faculties, having a good natural science training, did not have the right to therapeutic activity, since the actual clinical training here did not correspond to the accepted norms at all, due to a lack of study time. researcher) was not widespread in our country and due to the fact that the main task (deep mastering of fundamental sciences and the acquisition of experimental skills by doctors (was never solved. Moreover, not having a holistic, systemic understanding of the disease, which is given only by clinical thinking, in fundamental medicine they were often inferior to graduates of ordinary good medical universities. After all, the classic of Russian therapy N.Ya. Chistovich emphasized (1918) that medical thinking is not replaced by scientific thinking, and the diagnostic and treatment process as a cultural phenomenon is broader and richer than scientific and cognitive. One might think, however, that in XX century Russia the Franco-German pendulum, violating the laws of physics, nevertheless was more often and longer “on the French side”.

At present, both approaches coexist in the system of domestic higher medical education. Relatively speaking, the "French" version is closer to the traditional training system in specialized medical universities. At the same time, the main attention in teaching students is paid to developing the skills of a future doctor in treatment-and-prophylactic, diagnostic, sanitary-educational and other areas of his activity. A physician who has received a traditional medical education must fully meet the needs of practical health care with his professional competence. The advantages of the existing medical universities here are undeniable: they successfully cope with the tasks set by the state educational standard in the field of training graduates of various medical specialties. The "German" version is closer to the education that the medical faculties of classical universities provide. It allows, if not completely to remove, then at least smooth out the emerging contradictions between the established traditional narrow-disciplinary approaches to higher medical education and the time-dictated need to ensure a holistic, systemic educational process of the formation of a modern doctor. For graduates of the university's medical faculty, possession of the latest achievements in clinical medicine and the practical skills of a doctor should be combined with fundamental training in the entire spectrum of natural sciences. At the same time, theoretical natural science knowledge has not only a practical medical focus, but also an independent value in the development of professional thinking. It is important that the "university" approach does not exclude or reject the existence of traditional medical education, it only complements and expands it. The actual medical training in both types of educational institutions should be at the same high level. But what concerns natural science training does not have to be the same. The natural science training of a doctor in two types of medical educational institutions can be different, namely: in classical universities - a deeper one. In these conditions, the third-year disciplines play a special role, and among them are propaedeutics, pharmacology, pathophysiology and pathological anatomy, which integrate basic and clinical knowledge. They must provide a bridge between scientific and clinical thinking, become, in the words of S.P. Botkin, "natural science at the patient's bed." That is why the teaching of clinical pathology at the Faculty of Medicine of St.

In a reasonable combination of fundamental, general professional and special components of the content of higher medical education, it is necessary to look for the key to international integration. Only the health care system is national. Medicine as a science is supranational. A doctor in any corner of the world, measuring a patient's blood pressure, uses an Italian Riva-Rocci tonometer and a Frenchman Laennec's stethoscope, listening to the tones of the Russian Korotkov. Dr. Joseph Goebbels talked about "Aryan" and "non-Aryan" physics, but we are closer to Dr. Anton Chekhov, who argued that national science is as funny as the national multiplication table.

The essence of the Bologna Process is not in the renaming of academic subjects and degrees, not in the redesign of curricula. All this must be done very carefully and carefully, so as not to "brush off the table" the unique organizational and methodological achievements of the domestic higher medical school, which for a long time ensured its unparalleled effectiveness - that is, a high level of qualifications and efficiency of medical personnel with extremely limited funding. The essence of the process is to create organizational, economic and legal prerequisites for the free movement of all carriers of academic values ​​- students, teachers, researchers - within the common educational space. The Russian medical school is worth it.

This is how Stephen Glen Honeycutt, an American doctor with a Russian diploma, head of the emergency department from Michigan sees it now, ten years after graduation:

“Whenever I look back and remember the work done, I cannot help but draw comparisons between American teachers and their Russian colleagues. Personally, I got the impression that Russian teachers have much deeper knowledge in their particular field. They are much more concerned with your truly mastering the art of medicine, and if you have difficulties, they study with you until you succeed. It seems to me that Russian teachers are much more devoted to their profession. They certainly show much more interest in the personality of the student. Russian law, it seems to me, also gives students more opportunities for clinical practice than US law. In addition to me, three other graduates of Russian medical schools participated in the program of the [postgraduate] practical course in Michigan. All of them received the highest marks for their knowledge and professional skills. They took their work seriously and worked significantly more than American students without expressing any displeasure.

I sincerely believe that both the United States and Russia provide quality medical education. And for me there is not a shadow of a doubt that a graduate of a Russian medical school is at least equal to his American counterpart, moreover, I believe that a Russian graduate is even better prepared than an American one.

I am very proud to have studied in Russia and would like as many American students as possible to be able to do the same.

... I will always be grateful for the fact that I received an education and found friends in your beautiful country.

God bless you all. "

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