Scientific Grounds for Improving the System of Training Mid-Level Medical Personnel in the Republic of Armenia

The dissertation is devoted to the scientific substantiation of improving the system of training mid-level medical personnel in the Republic of Armenia in the context of health care reform. The research analyzes trends in the provision of curative and preventive institutions of the Republic of Armenia with mid-level medical personnel during the socio-economic reforms of the 1990s, as well as examines the educational-pedagogical process in medical colleges of the republic. The work presents a comprehensive analysis of the dynamics of the health care personnel potential, and a comparative evaluation of the curricula and programs of basic mid-level medical education in Armenia and the Russian Federation.

The research includes studying the relationship between attendance at practical classes and academic performance of students, analyzing socio-hygienic factors of lifestyle and morbidity of students, as well as the motivation of applicants to enter medical college. Data were obtained on students' attitudes toward the organization of the educational-pedagogical process and the level of graduate preparation. Based on the conducted analysis, practical recommendations were developed for improving the educational process and enhancing the material and technical base of medical colleges of the Republic of Armenia.

Relevance of the Research Topic. In the protection of public health, an important role belongs to mid-level medical personnel. Their qualifications, their compliance with high deontological requirements, largely determine the quality of medical care and the effectiveness of the activities of various curative and preventive institutions. In the contemporary development of medical science and medical technology, the significance of the work of the physician's closest assistant of any specialty — his or her nurse — can hardly be overestimated. It is precisely the nurse, working together with the physician, who is called upon to free the physician from the most routine, unskilled work not commensurate with the physician's qualification, and thereby increase the efficiency and rationality of the use of highly qualified specialists. Moreover, a qualified mid-level medical worker is capable of successfully replacing a physician in a whole range of procedures and manipulations, thereby increasing the labor productivity of higher-category medical workers — physicians — and reducing the need for their training. At the same time, training physicians who meet contemporary requirements is a rather costly and lengthy process, which explains the necessity of the subsequent rational use of physicians' labor.

Despite the importance of the labor of mid-level medical personnel, their material remuneration remains quite low, and the prestige of the profession under conditions of heavy and responsible work and low pay is declining. In the context of changes in the public order, fundamental reform of health care during the 1990s of the twentieth century, questions of training and placement of mid-level medical personnel have received altogether insufficient attention. Meanwhile, the very course of health care reforms and their primary goal — improving the quality and accessibility of medical care for the population — are largely determined by the quality of training mid-level medical personnel, their sufficient provision to medical institutions, and the optimal ratio of physicians and mid-level medical personnel.

In recent years, a sufficient number of studies on questions of training medical personnel have appeared. However, these studies concern either the problems of higher nursing education (Zadvornaya O. L., 1995; Kirguev P. D., 1997) or continuous postgraduate education (Baskakova S. A., Gracheva I. G., 1999; Semenkov N. N., 1995; Shamshurina N. G., 1998). Therefore, research devoted to questions of improving the educational-pedagogical process in a medical college under contemporary conditions is, without doubt, relevant.

The goal of the research is to find ways of improving the educational-pedagogical process in a medical college under contemporary conditions of health care reform in the Republic of Armenia.

The tasks of the research:

1. Analysis of the dynamics of the personnel potential of health care in the Republic of Armenia in the 1990s of the twentieth century.

2. Conducting a comparative analysis of curricula and programs for training mid-level medical personnel in the Republic of Armenia and the Russian Federation.

3. Studying the relationship between attendance at practical classes and academic performance of students.

4. Studying the socio-hygienic factors of lifestyle and morbidity of students.

5. Studying the motivation of applicants to enter a medical college.

6. Studying the attitudes of students toward studying in a medical college and their opinions on the organization of the educational-pedagogical process.

7. Developing proposals for improving the educational-pedagogical process in the training of mid-level medical personnel in the Republic of Armenia.

The scientific novelty of the work is due to the fact that, for the first time, an analysis of trends in the provision of curative and preventive institutions of the Republic of Armenia with mid-level medical personnel during the socio-economic reforms in the republic and the reform of health care was conducted. A new element is the conducting of a comparative analysis of curricula and programs of basic professional education of mid-level medical personnel in the Republic of Armenia and the Russian Federation. For the first time, the motives of applicants' admission to a medical college and the plans of graduates for professional activity after completing the college were compared. The scientific novelty of the research consists in the fact that, for the first time, the educational-pedagogical process in a medical college was studied in a complex with an in-depth analysis of the socio-hygienic aspects of the daily life, studies, and health of students.

The practical significance of the research lies in proving the high identity of curricula and programs of basic mid-level medical education in the Republic of Armenia and the Russian Federation, which allows considering the corresponding diplomas valid in both countries. A certain practical significance has the revealed violations among students of a healthy lifestyle and the resulting recommendations for strengthening hygienic education and upbringing of future professional workers of health care.

Great practical significance has the evaluation by students of the educational-pedagogical process in the college, which makes it possible to develop specific proposals for improving the material and technical base of the college, as well as for improving curricula in disciplines for which students experience the greatest difficulties in studying or which hold no interest for them.

The results of the research are used in the work of medical colleges: the Yerevan Basic College, the State Medical College "Erebuni," the medical college of the city of Gyumri of the Republic of Armenia, as well as in delivering lectures devoted to problems of training and placement of mid-level medical personnel at the departments of public health and health care of Saint Petersburg State Medical University named after academician I. P. Pavlov and Yerevan State Medical University named after Mkh. Heratsi.

Testing of the Work. The main results of the research were reported at the scientific-practical conference of medical workers of the Armavir district of the Republic of Armenia (city of Armavir, RA, 14.11.02), a meeting of directors of medical colleges and the collegium of RA (Yerevan, 10.01.03), at sessions of the problem commission "Hygiene and Organization of Health Care" of Saint Petersburg State Medical University named after academician I. P. Pavlov (21.03.03), and the department of public health and health care of Yerevan State Medical University named after Mkh. Heratsi. The results of the research are presented in 4 printed works.

The main provisions of the dissertation to be defended:

1. The unfavorable nature of trends in the training and placement of mid-level medical personnel in the Republic of Armenia in the 1990s of the twentieth century.

2. The socio-hygienic characteristics of students of a medical college.

3. Studying the opinions of students of a medical college on the organization of the educational-pedagogical process and the level of preparation of graduates for independent professional activity in the theoretical and practical directions.