How to pass the accreditation of a doctor in a year. Instruction: mandatory accreditation of health workers

Since 2016, Russian doctors are waiting for big changes: certification and advanced training cycles once every 5 years will become a thing of the past. Instead, there will be accreditation and a new system of continuing medical education. What exactly will change for doctors, and how innovations will be introduced, said a member of the Coordinating Council for the Development of Continuous Medical and Pharmaceutical Education of the Russian Ministry of Health Zalim Balkizov.

How will doctors be accredited from 2016?

According to federal law No. 323-FZ "On the fundamentals of protecting the health of citizens in the Russian Federation", from January 1, 2016, certification of medical workers will be replaced by accreditation. The certificate of accreditation will be an admission to medical and pharmaceutical activities. Newly minted dentists and pharmacists - graduates of medical universities in 2016 will be the first to receive it. And since 2017, accreditation has been waiting for all other graduates.

The procedure will include three stages: testing, assessment of competencies on simulation equipment, solving clinical problems. Moreover, the tasks for the first stage are already known: 3,500 tests in dentistry and 3,200 tests in pharmacy have been published on the websites of the Ministry of Health of Russia (www.rosminzdrav.ru) and the Methodological Accreditation Center (www.ffos.ru). These questions will form individual sets of tasks for the exam - it can be "rehearsed" online. In the preparation mode, the system will offer 60 tasks with four answer options and give 90 minutes to solve them.

How will accreditation of medical workers be implemented?

Everything, but not immediately

Medical accreditation will be introduced in stages. So while a work permit can still be obtained "in the old fashioned way". Certificates for specialists already working in the healthcare system will continue to be issued until 2021, and they will be valid until 2026.

Upgrading in a new way

Another important reform in 2016 is the introduction of a new model of continuing medical education (CME). Doctors and nurses will now improve their qualifications not once every 5 years, but constantly. “The established practice, when a health worker improves his qualifications once every five years, is outdated long ago,” Zalim Balkizov is sure. - With such a system of additional professional education (AVE), the doctor's knowledge is updated more slowly than medicine itself. Science does not stand still: modern methods of treatment and diagnostics are constantly being introduced, new drugs are entering the market. And some familiar drugs, on the contrary, go out of circulation because serious side effects have been discovered, or the medicine has become useless. It is unlikely that a doctor will know all this, studying once every 5 years. Moreover, advanced training cycles often come down to repeating what was studied in the 6th year of a medical university.”

How will the additional education of health workers change?

It is assumed that the new model of continuous medical education will help streamline the "loose" system of APE. How will the new NMO model be fundamentally different from the old one? Instead of 144 hours of advanced training every 5 years, which fit in 4 weeks, doctors will have 250 hours of training over 5 years. For a year, a health worker is required to gain at least 50 hours (or points) of educational activity. “It is not necessary to receive points at a time,” explains Zalim Balkizov. - A doctor can go through short training cycles of 18 hours, attend a conference, study electronic educational modules remotely, etc.

Where to improve knowledge - at conferences, simulation trainings, master classes or the usual cycles of advanced training - the specialist decides for himself. But you can choose the types of educational activity only from those approved by the Coordinating Council of the Russian Ministry of Health for Lifelong Education. There are already plenty of such materials on the site. edu. rosminzdrav. en. Everyone who enters the system of continuing medical education will have to register here. After that, you can create your own training plan, choose electronic materials and activities, and keep track of the accumulated points. “For 5 years, a health worker needs to score 250 points and confirm this with a report,” continues Zalim Balkizov. “Moreover, most of all points (from 70%) must be obtained precisely in your specialty, and not in related ones.”

Then a special commission will check the report. If there are no complaints, the physician will be admitted to accreditation. Those who pass it successfully will be able to continue working and accumulate points for the next upgrade or confirmation of qualification.

No points - no accreditation?

The CME system, as well as the accreditation of health workers, will be introduced in stages. Starting from 2016, those who will be accredited for the first time or receive a certificate for the last time will be included in continuing education. Since 2017 - the next "batch". Every year, 120-150 thousand doctors will enter the CME system, and in the end it will affect everyone.

- Without a portfolio on the CME portal, no doctor will be admitted to primary or re-accreditation. Therefore, he will not be able to continue working, - emphasizes Balkizov. - Here is my surgeon's certificate valid until 2017. Next year, I will go through the certification cycle for the last time and immediately enter the NMO system. If I accumulate 250 points by 2022, I will be able to re-accredit and get the right to work as a surgeon.

But what if, for some reason, the specialist does not have time to score the coveted points? The expert of the Coordinating Council is reassuring: “We will look for some way out. We will give an additional period for the health worker to complete intensive courses and get the missing points. This is how it is done in most developed countries. We focused on them, changing the system of continuous medical education. CME in Europe has long been implemented according to these principles: 250 hours - in 5 years and at least 50 hours - per year.

Pitfalls of the new system

True, in order to switch to European standards, a lot needs to be changed in the Russian system of medical APE. The notorious 250 hours of training in 5 years is a completely new system for medical universities. This means that curricula need to be changed and coordinated with the expert commission of the Ministry of Health. “The ministry is now working on a new form of training - 18 hours a day, i.e. only two days, - says Zalim Balkizov. - During this time, the doctor can attend a simulation course, seminar or master class, study part of the educational materials at home. If all 250 hours of training are broken down into such “segments”, employers will not need to let the doctor go for as much as 4 weeks, looking for a replacement specialist. This will be more convenient for managers, but the health workers themselves may not like this system. After all, many people regard advanced training cycles as an additional vacation and do not want to lose it.”

However, the leaders themselves are still reluctant to let doctors go even to one-day conferences. In confirmation of this, there are the first results of the NMO pilot project, which started in Russia at the end of 2013 and will last until 2020. As part of the project, 569 district therapists, general practitioners and pediatricians from 15 regions of the country began to improve their skills in a new way. And then they faced difficulties: the heads of medical institutions are not allowed to go to educational events. Thus, only three of the 20 Moscow doctors participating in the pilot project were able to attend the Congress of the Union of Pediatricians.

There is another problem: not all doctors are good at computers and the Internet. And without these skills, it will be difficult to join the CME system. About 30% of the pilot participants have already admitted that working with an electronic portfolio is difficult for them. “Participation in the pilot project encouraged many professionals to learn how to work on the Internet,” comments Zalim Balkizov. - As a result, some doctors began to use the Internet more actively, someone bought a laptop. People had a need to acquire such skills, and they mastered them. In the meantime, a doctor visits educational cycles once every 5 years, he does not need the Internet.”

Anastasia Lemenkova

In an unfinished form and in inept hands, accreditation is a dubious, unexpected and even dangerous undertaking.

Do we need it?

Yes, if we consider it as a universal, fair and adequate assessment of the professional suitability of a doctor. No, if it turns out to be insolvent within 3 years.

What are her advantages? In my opinion, there are two.

A unified approach to assessing knowledge and skills.

The universality of accreditation lies in the fact that every graduate must pass it. Moreover, there is no difference whether he plans to continue his education in residency or goes to the primary link. In both cases, this cannot be avoided: for the primary it is a green light on the way to independent work, for residency and the main exam at all (imagine, for this you just need to learn the answers to the test and voila - welcome to any department any licensed institution! Nightmare!). At the same time, everyone rents essentially the same thing under the same conditions. As a result, it seems that the assessment is objectified.

The opportunity for yesterday's graduate to quickly become a practicing doctor and find a job immediately after the procedure.

In 2017, according to the Minister of Health of the Russian Federation Veronika Skvortsova, 15.4% of medical university graduates, having passed the primary accreditation procedure, came to work in primary care. In general, not bad statistics for a project that has just begun its journey - especially given the fact that there is a shortage of personnel and demand for specialists everywhere. In addition, as they say, for example, in Moscow, wages are kept at the level of 70-100 thousand rubles, which, if true, is completely excellent. Thus, the principle “graduated from a university - came to work” showed its relevance, people turned on (although we will keep silent about the workload for now - as well as how many of these 15.4% are not averse to changing their current occupation).

But, of course, where there are pluses, there are also minuses. And, alas, they are much more significant.

The lack of experience of independent work, coupled with the lack of a mentor at the beginning of medical activity, turns into a stressful and disorganizing situation for the doctor, and for the patient - the risk of encountering a medical error. None of those who have just come to the clinic often knows how to work in EMIAS, how to understand what is happening at least in their own head (and even more so with the patient) within the prescribed time limit. There are few doctors nearby and they are all busy, and you, since you have passed accreditation, it means that you are fit for work. Here, work. Don't know how? It's good if senior comrades come to the rescue, but this is far from a fact. As a result, lacking the confidence and resource of time, the young doctor misses seemingly minor complaints and symptoms. This is especially true for complex and multicomponent diseases - autoimmune, oncological, mental, as well as conditions requiring urgent surgical intervention. For example, when there is a picture of renal colic, and it is an inflamed appendix located atypically, or there is a manifestation of bacterial meningitis, which has common features with a hypertensive crisis.

In general, the refusal of a senior doctor to help a younger one, in my opinion, is irresponsible and fundamentally wrong. Medicine is one of the exceptional areas where knowledge must be transferred from teacher to student, where experience is very important. There are mistakes that you should know about in advance and avoid them. Help teach! No one guarantees you, old and wise, that if you get sick, you will fall into the reliable hands of a professor (well, who is really a professor, and not like now, when the list of regalia is on A4, but in fact common phrases and homeopathy).

Accreditation is designed to establish the degree of compliance of the person being accredited with the requirements for the qualification of a medical/pharmaceutical worker. But how can this be determined if for two of the three stages of the procedure it is enough to learn the bank of answers attached to the bank of questions? In addition, the available official answers for the situational tasks of the third stage are rather controversial. Diagnostic search in them is often carried out either along the path of frank evidence (which in itself is a good option, but not very correctly interpreted in practice), or by methods of exclusion and exaggerated overdiagnosis. Perhaps the situation would have been less deplorable if the testing of the first stage had not been a direct stage for residency, which, for a moment, is a specialist, but more on that another time.

The only, perhaps, rational grain of the new system is the stage of handing over practical skills, since in simulated situations, in the vast majority of cases, clear algorithms should really be followed. However, there are shortcomings here as well. For example, for the specialty "General Medicine", algorithms are provided for examining only the cardiovascular and respiratory systems, conducting cardiopulmonary resuscitation, providing emergency care and performing intravenous injection. It is clear that the selection proceeded from the most necessary skills and the percentage of prevalence of diseases. But is it possible to cross out everything else that the propaedeutic of internal diseases prescribes to the doctor to know? In a word, if any sane physician accepts today's accreditation system, he will not understand it due to the fact that medicine is not a set of standards and it is impossible to cure a patient by simply applying a clinical protocol.

Accreditation is considered an objective method for assessing knowledge and skills, which, according to the facts described above, is, of course, not at all the case. Which, however, is understandable: any innovation is initially imperfect and needs to be improved. In medical terms, it is too early to judge the effectiveness and safety. Whether primary accreditation will justify itself is a matter of time. The main thing is not to miss it in vain.

In accordance with Part 1 and Part 2 of Article 69 of Federal Law No. 323-F3 dated November 21, 2011 “On the Basics of Protecting the Health of Citizens in the Russian Federation”, persons who have received medical or pharmaceutical education in the Russian Federation have the right to carry out medical or pharmaceutical activities in the Russian Federation. Federation in accordance with federal state educational standards and having a certificate of accreditation of a specialist.

In accordance with according to the provisions of Order No. 127, and at present, the specialist accreditation procedure has been passed by persons who, after January 1, 2017, received higher education in basic educational programs in accordance with federal state educational standards in the direction of training "Health care and medical sciences" (specialist level).

These persons who have successfully passed the specialist accreditation procedure, in accordance with Part I and Part 2 of Article 69 of Federal Law No. 323-FZ, are allowed to carry out medical or pharmaceutical activities in the Russian Federation.

An accredited person, recognized as having passed or not passed the accreditation of a specialist, within 3 days from the date of signing the minutes of the meeting of the accreditation commission by the executive secretary of the accreditation commission, is issued an extract from the minutes of the meeting of the accreditation commission containing the relevant decisions.

A certificate of accreditation of a specialist is issued to a person recognized by the accreditation commission as having passed the specialist accreditation procedure no later than 30 calendar days from the date of signing the minutes of the meeting of the accreditation commission.

Based on the foregoing, at present, in healthcare organizations, regardless of their form of ownership and departmental affiliation, they can carry out medical activities in the following positions: “Dentist” (specialty “General Dentistry”), “District Therapist” (specialty “General Medicine”), “District Pediatrician” (specialty “Pediatrics”), “Doctor of Clinical Laboratory Diagnostics” (specialty “Medical Biochemistry”), “Doctor of Functional Diagnostics” (specialty “Medical Biophysics”), “Statistician "(specialty "Medical Cybernetics"), "Physician-Epidemiologist" and "Physician in General Hygiene" (specialty "Medical Preventive Business") or pharmaceutical activities in the positions: "Pharmacist" and "Pharmacist-Technologist" (specialty "Pharmacy"), specialists who successfully passed the procedure of primary accreditation of specialists in 2017, have an extract from the protocol of the accreditation commission and have not yet received a certificate of specialist accreditation.

These specialists are admitted to the implementation of medical or pharmaceutical activities.

Accreditation of medical workers is a procedure established by law that makes it possible to establish whether a specialist who has received a medical education meets the requirements established for the conduct of medical activities.

When is accreditation carried out?

Questions and the algorithm for conducting are determined by the Law of November 21, 2011 No. 323-FZ. It allows in article 100 to conduct medical activities only for those who have studied under higher or secondary education programs and have a specialist certificate. The same law in article 73 obliges physicians to improve the level of existing professional knowledge by studying additional programs.

The first document that answered the question of why medical workers need accreditation, what kind of procedure it is and who goes through it, was the Order of the Ministry of Health of February 25, 2016 No. 127n. Primary accreditation of a number of specialties (physicians, pediatricians, dentists) was carried out in accordance with this administrative act.

Since January 2019, a new Order of the Ministry of Health - 898n dated 12/21/2018 (amended Order 1043n) came into force, in which the issues of accreditation of paramedical workers related to the timing and stages have changed. The document explains in detail what the accreditation of medical workers consists of, new conditions for admission to the specialty are indicated in it.

The planned transition to the accreditation algorithm will take a long period from 01/01/2016 to 12/31/2025.


	higher education (programs "Health care and medical sciences", the level of specialist); secondary vocational education in accordance with the Federal State Educational Standard.
	Specialists who received after the specified date: higher education (resident);
	Specialists who received after the specified date: medical or pharmaceutical education outside the country; other higher education; higher education in accordance with the Federal State Educational Standard of the program "Health and medical sciences" (bachelor, master, resident); additional vocational education under vocational retraining programs.
	The rest of the people who did not undergo the procedure.

Types of accreditation

The accreditation algorithm is determined by the Order of the Ministry of Health of the Russian Federation dated 02.06.2016 No. 334n.

Test questions

The issues of accreditation of medical workers depend on the specialty and qualifications. For example, pharmacists in the framework of primary accreditation are asked about the effect of drugs, chemical groups, documents that regulate the work with drugs.

You can find verification questions on the official website of the Methodological Accreditation Center. We have collected questions for 2018 in the table.

To find questions on the website of the Methodological Center, select the type of test, then the specialty and Test tasks. You can download only tests for the last year, but they will also help you prepare. There is an opportunity to pass a rehearsal exam.

Accreditation commissions

The accreditation procedure is carried out by specially created commissions in the buildings of educational or scientific institutions that implement medical and pharmaceutical education programs. The commission is created by the Order of the Ministry of Health for those specialties for which accreditation is carried out (non-profit institutions mentioned in Article 76 323-FZ also participate). The commission includes:

chairman,
vice-chairman,
committee members,
secretary.

In addition to them, the commission should include representatives of:

professional NGOs (organizations that meet the criteria of Article 76 323-FZ);
health authorities or trade unions;
institutions implementing medical and pharmaceutical education programs.

There are a number of requirements for the composition of the commission. For individuals from its composition:

there should be no conflict of interest during the procedure;
there must be a higher or secondary vocational education in accordance with the specialty for which accreditation is underway, and more than 5 years of experience in this area (except for the chairman).

The format of the work is a meeting, held after each stage of the process. The Commission is competent provided that all its members are present at a particular stage. According to the results, a protocol is drawn up. The document is signed by all participants at the end of the procedure.

The protocols are filed into books that are sent to the Ministry of Health, in whose archive the documents are stored for 6 years.

Accreditation procedure

The regulation on the accreditation of specialists was approved by the Order of the Ministry of Health of the Russian Federation dated June 2, 2016 No. 334n.

The algorithm is this:

The accredited person submits a package of documents to the commission.
The secretary records in the register the fact of receipt of papers against receipt.
Not later than 7 calendar days, the secretary transfers the package to the commission.
Not later than 10 calendar days from the date of registration, the commission holds a meeting, deciding whether the applicant can be admitted to the procedure and its timing.

Stages of implementation:

Primary and primary specialized
Testing		Formed automatically by random selection of 60 tasks. You can find them on the official website of the Methodological Center for Accreditation (paramedical workers and all others). You have 1 hour to complete.
Practical skills in special conditions	Can be organized with the use of special equipment (simulators, mannequins, attracted patients)	5 practical tasks generated automatically (to help - the official website for the accreditation of medical workers in 2019). You have 10 minutes to complete each task. The evaluation is given by the commission by filling in evaluation sheets. The result is generated automatically based on the analysis of the completed assessment sheets, similar to stage 1.
Situational tasks	Applicant's answers to tasks	Formation of a set of tasks on an automatic basis. You need to answer 5 questions included in each of the 3 tasks. 1 hour to prepare answers. The assessment is carried out by 3 members of the commission. Based on the results, the commission decides: passed - with more than 10 correct answers, not passed - less than 9.
periodic
Portfolio evaluation	Document review	The decision is made by the commission. Passed or not passed - according to the results of the applicant's compliance with the established requirements for qualifications and skills.
Testing	Using Test Items	Formed automatically by random selection of 60 tasks. They are contained on the official website of the methodological center for accreditation (paramedical workers, other workers). You have 1 hour to complete. The result is considered automatically: passed - when more than 70% of correct answers are received, not passed - less than 69%.

During the procedure, you can not use the means of communication. The auditorium is audio and video recorded.

Accreditation results

Each stage of the procedure is reflected in the protocol of the commission meeting and is subject to posting on the official website and information stands of the institution no later than 2 working days from the date of signing the protocol.

The applicant has passed accreditation, if each stage is assessed as passed, the decision is reflected in the protocol no later than 2 days from the date of the last stage and no later than 5 days sent by the secretary to the Ministry of Health. The applicant is not accredited if:

he didn't show up;
stages are rated as not passed;
used technical means in the process.

In any case, the specialist receives no later than 3 days from the date of formation of the protocol an extract from it with a specific decision.

Information about an accredited person is included in the Federal Register of Health Workers. Not later than 30 days after signing the protocol, the specialist receives a certificate of accreditation (Order of the Ministry of Health of 06.06.2016 No. 352n). The document is valid for 5 years after the date of formation of the protocol, then the validity period of the certificate is extended subject to the passage of the next accreditation.

If the stage is not passed, the person has the right, by submitting an application, to go through it again. If 3 unsuccessful attempts are made, accreditation is not passed. The right to retry will arise after 11 months.

Those who have not passed the procedure have the right to appeal the decision to the Appeals Commission no later than 2 working days after the placement of the results of the stage. The decisions of both commissions can be appealed to the Ministry of Health.

What do you need to qualify for a category?

To pass the primary specialized accreditation, you must personally submit a package of documents to the commission:

an application with a request to allow admission to the procedure (indicate information on the development of the educational program of higher, secondary vocational education, the specialty in which the intention to conduct medical or pharmaceutical activities is expressed);
copies of documents on higher education, qualifications (with attachments) or secondary vocational education (with attachments) or an extract from the minutes of the meeting of the state examination commission;
copy of SNILS (if available).

To undergo periodic accreditation, you must personally submit (or send by registered mail with notification) to the commission a package of documents:

statement;
a copy of an identity document;
portfolio
a copy of the specialist's certificate or certificate of accreditation of the specialist (if any);
copies of documents on higher education and qualifications (with attachments) or on secondary vocational education (with attachments) or an extract from the minutes of the meeting of the state examination commission;
a copy of the work book (if available);
copy of SNILS (if available).

Portfolio is information about the activities of a professional nature for the previous 5 years, including information about:

about the professional achievements of a particular specialist;
on the completion of professional development programs.

The document is drawn up independently, and information about educational programs must be confirmed in the form of documents on their passage.

Sample application for certification

Certification or accreditation

A number of doctors have a question: do they have the opportunity to obtain a certificate without an accreditation procedure. The answer depends on what kind of certification is needed:

Planned (according to Federal Law No. 323) - it is necessary to improve the level of qualification every 5 years.
Unscheduled - refers to those who complete residency, retraining courses.

Planned already has a set deadline for accreditation. If an employee received a certificate before 01/01/2016, he has the right to undergo another certification. If the document is received later than 01/01/2016, the next process for a person will be accreditation. Residents, as well as persons who completed professional retraining courses after 01/01/2019, must also undergo accreditation.

Planned certification (do I need to join the NMO)

CME (for paramedical workers, other specialists) is a new option for advanced training based on continuity, a personalized learning algorithm that allows you to gain knowledge in accordance with your needs. Doubts related to the need to register on the NMO website are related to Order No. 66n dated 03.08.2012. The fact is that the Ministry of Health intended to amend this document, which regulates the improvement of knowledge by physicians. In accordance with them, the physician will have the opportunity to choose: to take advanced training courses annually or to attend a course of 150 academic hours or more. There is no clear answer to the question yet. But the doctor will not lose anything by connecting to the site and completing the training. Why? Everything is simple. The portfolio, being one of the elements of accreditation, contains information about the certificates received for training, and such information will allow you to successfully complete the procedure.

Do I need certification for those who are retraining?

Order No. 1043 dated December 22, 2017 established that certificates must be received before December 31, 2018. Those who complete their professional retraining courses after 01/01/2019 will already be taking a multi-stage exam.

Responsibility

If the employee does not have a valid certificate, both the organization and the employee can be punished. Articles 19.20, 14.1 of the Code of Administrative Offenses of the Russian Federation establish the following amounts:

With regard to employees, the situation is as follows: if there is an established fact of guilt related to the fact that the doctor did not take into account the employer's order on the need to improve their qualifications by taking appropriate courses, the latter has the right to:

suspension from work for up to 2 months;
transfer to another position that does not require a certificate;
terminate the employment contract.

Ask questions, and we will supplement the article with answers and explanations!

About accreditation of medical workers and the new CME system Since 2016, Russian doctors are waiting for big changes: certification and professional development cycles once every 5 years will become a thing of the past. Instead, there will be accreditation and a new system of continuing medical education. What exactly will change for doctors, and how innovations will be introduced, said Zalim Balkizov, a member of the Coordinating Council for the development of continuing medical and pharmaceutical education of the Russian Ministry of Health. How will doctors be accredited from 2016? According to federal law No. 323-FZ "On the fundamentals of protecting the health of citizens in the Russian Federation", from January 1, 2016, certification of medical workers will be replaced by accreditation. The certificate of accreditation will be an admission to medical and pharmaceutical activities. Newly minted dentists and pharmacists, graduates of medical universities in 2016, will be the first to receive it. And since 2017, accreditation has been waiting for all other graduates. The procedure will include three stages: testing, assessment of competencies on simulation equipment, and solving clinical problems. Moreover, the tasks for the first stage are already known: on the websites of the Ministry of Health of Russia ( www.rosminzdrav.ru) and the Methodological Accreditation Center ( www.ffos.ru ) published 3500 tests in dentistry and 3200 in pharmacy. These questions will form individual sets of tasks for the exam - it can be "rehearsed" online. In the preparation mode, the system will offer 60 tasks with four answer options and give 90 minutes to solve them. Everything, but not immediately Medical accreditation will be introduced in stages. So while a work permit can still be obtained "in the old fashioned way". Certificates for specialists already working in the healthcare system will continue to be issued until 2021, and they will be valid until 2026. Upgrading in a new way Another important reform in 2016 is the introduction of a new model of continuing medical education (CME). Doctors and nurses will now improve their qualifications not once every 5 years, but constantly. “The established practice, when a health worker improves his qualifications once every five years, is outdated long ago,” Zalim Balkizov is sure. - With such a system of additional professional education (AVE), the doctor's knowledge is updated more slowly than medicine itself. Science does not stand still: modern methods of treatment and diagnostics are constantly being introduced, new drugs are entering the market. And some familiar drugs, on the contrary, go out of circulation because serious side effects have been discovered, or the medicine has become useless. It is unlikely that a doctor will know all this, studying once every 5 years. Moreover, advanced training cycles often come down to repeating what was studied in the 6th year of a medical university.” How will the additional education of health workers change? It is assumed that the new model of continuous medical education will help streamline the "loose" system of APE. How will the new NMO model be fundamentally different from the old one? Instead of 144 hours of advanced training every 5 years, which fit in 4 weeks, doctors will have 250 hours of training over 5 years. For a year, a health worker is required to gain at least 50 hours (or points) of educational activity. “It is not necessary to receive points at a time,” explains Zalim Balkizov. – A doctor can go through short training cycles of 18 hours, attend a conference, study electronic educational modules remotely, etc. Where to improve knowledge - at conferences, simulation trainings, master classes or the usual cycles of advanced training - the specialist decides for himself. But you can choose the types of educational activity only from those approved by the Coordinating Council of the Russian Ministry of Health for Lifelong Education. There are already plenty of such materials on the site. edu.rosminzdrav.ru . Everyone who enters the system of continuing medical education will have to register here. After that, you can create your own training plan, choose electronic materials and activities, and keep track of the accumulated points. “For 5 years, a health worker needs to score 250 points and confirm this with a report,” continues Zalim Balkizov. “Moreover, most of all points (from 70%) must be obtained precisely in your specialty, and not in related ones.” Then a special commission will check the report. If there are no complaints, the physician will be admitted to accreditation. Those who pass it successfully will be able to continue working and accumulate points for the next upgrade or confirmation of qualification. No points - no accreditation? The CME system, as well as the accreditation of health workers, will be introduced in stages. Starting from 2016, those who will be accredited for the first time or receive a certificate for the last time will be included in continuing education. Since 2017 - the next "party". Every year, 120-150 thousand doctors will enter the CME system, and in the end it will affect everyone. – Without a portfolio on the CME portal, no doctor will be admitted to primary or re-accreditation. Therefore, he will not be able to continue working, - emphasizes Balkizov. – Here is my surgeon's certificate valid until 2017. Next year, I will go through the certification cycle for the last time and immediately enter the NMO system. If I accumulate 250 points by 2022, I will be able to re-accredit and get the right to work as a surgeon. But what if, for some reason, the specialist does not have time to score the coveted points? The expert of the Coordinating Council is reassuring: “We will look for some way out. We will give an additional period for the health worker to complete intensive courses and get the missing points. This is how it is done in most developed countries. We focused on them, changing the system of continuous medical education. CME in Europe has long been implemented according to these principles: 250 hours in 5 years and at least 50 hours a year.” Pitfalls of the new system True, in order to switch to European standards, a lot of changes must be made in the Russian system of medical AVE. The notorious 250 hours of training in 5 years is a completely new system for medical universities. This means that curricula need to be changed and coordinated with the expert commission of the Ministry of Health. “The ministry is now working on a new form of training – 18 hours a day, i.e. only two days, - says Zalim Balkizov. – During this time, the doctor can attend a simulation course, seminar or master class, study part of the educational materials at home. If all 250 hours of training are broken down into such “segments”, employers will not need to let the doctor go for as much as 4 weeks, looking for a replacement specialist. This will be more convenient for managers, but the health workers themselves may not like this system. After all, many people regard advanced training cycles as an additional vacation and do not want to lose it.” However, the leaders themselves are still reluctant to let doctors go even to one-day conferences. This is confirmed by the first results of the NMO pilot project, which started in Russia at the end of 2013 and will last until 2020. As part of the project, 569 district therapists, general practitioners and pediatricians from 15 regions of the country began to improve their skills in a new way. And then they faced difficulties: the heads of medical institutions are not allowed to go to educational events. Thus, only three of the 20 Moscow doctors participating in the pilot project were able to attend the Congress of the Union of Pediatricians. There is another problem: not all doctors are good at computers and the Internet. And without these skills, it will be difficult to join the CME system. About 30% of the pilot participants have already admitted that working with an electronic portfolio is difficult for them. “Participation in the pilot project encouraged many professionals to learn how to work on the Internet,” comments Zalim Balkizov. - As a result, some doctors began to use the Internet more actively, someone bought a laptop. People had a need to acquire such skills, and they mastered them. In the meantime, a doctor visits educational cycles once every 5 years, he does not need the Internet.”