Health Professions Education in Slovenia

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					       Health Professions
      Education in Slovenia
      A new challenge to overcome a
               quality gap
          The people who deliver care
are the health system’s most important resource

                   Andrej Robida, MD, PhD, FACC   1
                    Professor of Paediatrics
                       Content

 A need for different curriculum for health professions
  education
 Current status of undergraduate, graduate education of
  health professions and renewal of licences in Slovenia
 Thoughts for reflection and discussion in the group on
  health professions education




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               Kranjska Gora, 6th June 2008
National policy for the development
      of quality in health care

       One of the recommendations was focused
       on preparing health care professionals to
       acquire new skills.




                                              3
       Quality is a system property
            Trying harder will not work

       Changing current curriculum with the
development of new competencies for the future and
 current health care professionals is one of the first
                   steps towards




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      Aims for improvement of health care system
 Effectiveness - do our interventions improve patient
  health status?
 Safety - will we harm a patient?
 Timeliness - how long does a patient have to wait?
 Efficiency - can we render a service with fewer costs
  and with equal results?
 Equity - is there discrimination on the basis of sex,
  age or social status?
 Patient-centred care - do we treat all patients as we
  would treat our own children?
Crossing the quality chasm, 2001
National policy for the development of quality in health care, 2006

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                                       Qality gaps
            Percentage of patients with thromboprophylaxis after abdominal surgery (2006)
Hospitals




                                                                Underuse




                             Percentage

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                                                          Qality gaps
                                                                                                            31
                                                                                                       30
       Percentage




                                                                                                  19

                                                                                             14

                                                                              10                                 9
                                                                                    8                        9
                                                              6              7
                                                                  6   6

                                   2      2
                                              4
                                                  5   4   5
                                                                                                                     Overuse
                       0   0   0




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                                                      Hospitals

Percentage of inappropriate admissions; blue columns - 21 criteria; red columns - 18
criteria. (Marušič, D., Ceglar, J. Neustrezni sprejemi (Inappropriate admissions). Ljubljana, 23 April 2003).



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            Patient Safety

18
16
14                                      USA 3.7%
12                                      Australia 16.6%
10                                      England 10.8%
                                        Denmark 9%
8
                                        New Zealand 12.9%
6
                                        Canada 7.5%
4                                       Japan 11%
2
0
     % of acute admissions


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          Building new professional competences

         The concept of professional competence has evolved
         over the last 30 years from a one-dimensional construct
         representing “specialized knowledge” to a more
         global one which includes the application of
         specialized knowledge.




Epstein R, Hundert E. JAMA. 2002;287:226-35.



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          Building new professional competences
    Professional competence is the habitual and judicious use of
     communication,          What individual need to know and do
     knowledge,              to carry out the activity regardless of who
                              performs it.
     technical skills,
     clinical reasoning,       in daily practice
     emotions,
     values,
     reflection
     for the benefit of the individual and community being served
Epstein R, Hundert E. JAMA. 2002;287:226-35.

 www.skillsforhealth.org.uk (May 2008)

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    New knowledge                            Competent clinicians
    & skills required


                                         Deliver patient centred care
 Partnerships with patients & carers    Member of multidisciplinary
 Teamwork                                teams
 Risk communication                     Use evidenced based & ethical
 Data collection                         practice
 Patient safety                         Use quality improvement
 Professional responsibility             approaches
 Professional accountability            Use information technology




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      Traditionally, educators relied on
      role modelling.
      Professional behaviours will be
      learned from attending physicians,
      residents, and fellow students in
      the clinical setting


      And… the present level of competencies will continue


Hatem C. Teaching approaches that reflect professionalism. Acad Med. 2003;78:709-713.



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          Health care educational
          facillities in Slovenia
                                                 Hungary
                   Austria




Italy
                                       Croatia



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   Slovenia                                                        Aim
To look at the state of the art on quality and safety education in
 colleges and faculties for health care professions
 institutions for specializations                              Methods
 licensure bodies
  1. A survey among health care educational colleges and faculties was
     conducted regarding quality and safety education in undergraduate and
     graduate levels
  Questions
   Stand alone subject
   Integrated into other subjects
   Contents of the subject
   Planning of curriculum for individual professions or integrated teaching




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Slovenia                                                        Methods
2. All 51 programmes of specializations in medicine, pharmacology,
   and laboratory medicine were screened for content of specialization regarding
 Quality in health care
 Patient safety
 Evidence based medicine
 Teamwork
 IT


3. Rules for licensure of health care professionals were reviewed




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Slovenia                                                            Results
1. Questionnaires were returned from 4 of 8 (50%)     educational institutions

Institution

Medical Faculty, University of Ljubljana
Medical Faculty University of Maribor
Faculty of Pharnacy
Faculty for Health Sciences, University of Maribor
University College of Health Studies, University of
Ljubljana
College of Nursing Jesenice
College of Health Care Novo Mesto
College of Health Care, University of Primorska


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         Slovenia                                                                Results
        1. Undergraduate, graduate studies

Institution   Stand    Integrated   Plan to introduce                      Plan to introduce
              alone    into                                                integrated study
              ECTS     another                                             for all health care
                       subject                                             professions
                       ECTS
              U   G    U     G
UM MF         0   0    0,4   0,04   2-3 years, integrated into another     -
                                    subject (internal medicine, surgery,
                                    family medicine)
UM FHS        0   15   NA    NA     NA                                     Integrated
ULFP          0   0    Yes   Yes    -                                      No
CNJ           5   8    NA    NA     NA                                     Integrated



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Slovenia                                                  Results
2. Programmes of specializations (51)

Content              Number                 % of all
                                            specialties
Quality              11                     22
Patient safety       3                      6
EBM                  4                      8
Teamwork             6                      12

IT                   9                      18


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Slovenia                                                       Results
3. To renew a license every 7 years a continuous medical education by
   gathering credit points is mandatory for physicians, dentist,
   specialists in laboratory medicine, and nursing profession.

Performance of individual health care professional is not a part
of credit points.


    Professional competencies in nursing and midwifery, 2008




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                                                             Conclusions
    Slovenia
   Tradition, particularly medical education is on teaching core knowledge
    with basic mechanisms of disease and pathophysiology and not other
    competences
   Only 13% of specialization programmes includes quality, safety,
    EBM, teamwork and IT
   Nursing schools are ahead of medical schools
   Nursing profession has just published professional competencies
    in nursing and midwifery
   Teaching competencies regarding quality, safety, teamwork, EBM and IT
    in education of physicians are almost non existing
   Requirements for the renewal of licences do not include performance


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              Thoughts for reflection - obstacles
 Lack of funding to review curricula and teaching methods
 Lack of faculty development for new content of teaching
 Decentralized departments in medical faculties
 Lack of integration of common subjects for all health care professions
 No coordinated oversight across continuum of education and
  fragmentation
 Responsibilities for undergraduate and graduate education and
 licensing not clear
 Difficulty assessing the impact of change in curriculum and teaching
 methods
 Ignoring the reality of change in health care


Regan- Smith , 1998; Ludmerer, 1999; Griner, Danoff, 2000; Robida 2008.


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           Thoughts for reflection - questions
1.How can new health professionals learn most effectively
 the basic skills related to
    Patient safety
    Patient centred care
    Quality of care
    Evidence based practice
    System thinking
    IT




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            Thoughts for reflection - questions
2. How can these skills be further developed in graduate studies?
3. How they be relayed to professionals already in practice?

4. What will be the implication of change in clinical education
  for the health care organisations?
5. What will be the implication of change in education for licensing?
6. What will be the implication of change in education for funding?




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               Thank you
e-mail: andrej.robida@guest.arnes.si




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