Postgraduate Specialist Training Research Articles

ОПЫТ РЕАЛИЗАЦИИ ПИЛОТНОГО ПРОЕКТА «ГРОДНЕНСКАЯ УНИВЕРСИТЕТСКАЯ КЛИНИКА» В АСПЕКТЕ ЭФФЕКТИВНОСТИ ПРАКТИКООРИЕНТИРОВАННОЙ ПОДГОТОВКИ МЕДИЦИНСКИХ КАДРОВ

The training of highly professional medical staff with minimal need in their further workplace adjustment is an important current problem facing health care and medical higher education institutions authorities. To a large extent, existing clinical healthcare organizations, which are an example of cooperative relationships are serving this purpose. At the same time, the existing practice of their functioning indicates an insufficient degree of integration of the academic environment and practical healthcare. The purpose of this publication is to summarize the experience of the pilot project “Grodno University Clinic” implementation regarding the efficiency of practice-oriented training of medical staff. The integration of academic medicine and practical healthcare in a university clinic allows solving a number of important problems. Maximum involvement of teaching staff in medical activities allows maintaining and improvement of their professional competencies. The logical consequence of this process is the improvement of the quality of practice-oriented undergraduate and postgraduate training of medical specialists. Participation of the students in the diagnostic and treatment process as both active observers and direct participants to an even greater extent contributes to a quality learning experience and a conscious approach to choosing their future specialization.

Roles and competencies of the clinical psychologist in adult diabetes care-A consensus report.

Psychological care is recognised as an integral part of quality diabetes care. We set out to describe the roles and competencies of the clinical psychologist as a member of the multidisciplinary adult diabetes care team, focused on secondary care. The authors are clinically experienced psychologists involved in adult diabetes care, from Australia, Europe and North America, and active members of the international psychosocial aspects of diabetes study group. Consensus was reached as a group on the roles and competencies of the clinical psychologist working in adult diabetes secondary care, building both on expert opinion and a selective review and discussion of the literature on psychological care in diabetes, clinical guidelines and competency frameworks. The clinical psychologist fulfils multiple roles: (1) as a clinician (psychological assessment and therapy), (2) as advisor to the healthcare team (training, consulting), (3) as a communicator and promotor of person-centred care initiatives and (4) as a researcher. Four competencies that are key to successfully fulfilling the above-mentioned roles in a diabetes setting are as follows: (a) specialised knowledge, (b) teamwork and advice, (c) assessment, (d) psychotherapy (referred to as STAP framework). The roles and competencies of clinical psychologists working in diabetes extend beyond the requirements of most university and post-graduate curricula. There is a need for a comprehensive, accredited specialist post-graduate training for clinical psychologists working in diabetes care, building on the proposed STAP framework. This calls for a collaborative effort involving diabetes organisations, clinical psychology societies and diabetes psychology interest groups.

REFORMING THE MANAGEMENT OF THE SYSTEM OF CONTINUOUS MEDICAL EDUCATION

The article examines the continuous professional development of specialists in the field of health care as a gradual, cyclical, long-term process of updating professional knowledge, improving the professional competencies of medical specialists, which requires reforming its management. It was revealed that the integration of Ukraine into the European and world scientific and educational space involves the internationalization of education, which is actively discussed in scientific circles. Directions, goals, tasks, strategies, mechanisms of postgraduate education are defined. The essence, purpose, content and main tasks of postgraduate education are defined. The importance of ensuring the availability of post-graduate education for all applicants, regardless of their socioeconomic status, is substantiated. Measures for the stable development of postgraduate education are considered, the success of which depends on the solution of a number of problems, in particular such as: regulatory and legal support of the postgraduate education system; updating the content, forms, methods, technologies of education; optimization of the informatization process of postgraduate education; creation of a mechanism for stimulating specialists to continuous professional improvement of their knowledge and skills throughout their lives. The best practical models of medical education in Europe are characterized in order to clarify the issues of developing a strategy for the development of postgraduate education in Ukraine. It is substantiated that a reasonable step for raising the quality of post-graduate training of health care specialists is: carrying out systemic changes in postgraduate education that will meet modern global and European recommendations; coordination of activities with the main directives of the European Union and the World Federation of Medical Education; modernization of the material and technical base of educational institutions and internship bases; improvement of university hospitals. It was concluded that the development of the system of continuous professional training is a priority direction of state policy and it is important to provide high-quality and affordable education for everyone, oriented to the needs of the labor market and society.

An 8-year retrospective study of fixed prosthodontics clinical unit completions in a postgraduate prosthodontics program.

The range of aesthetic fixed prosthodontics materials utilizing digital manufacturing techniques has expanded in recent years ostensibly replacing traditional laboratory techniques and materials. This retrospective study conducted over eight consecutive years aimed to analyze the types of laboratory fabricated fixed prosthodontics clinical units completed in a postgraduate prosthodontics specialist training program and determine meaningful trends. The logbooks of eight postgraduate prosthodontics completions from 2014 to 2021 were reviewed and the different types of laboratory fabricated fixed prosthodontics units and total number of fixed prosthodontics units completed were recorded. The data was categorized and presented in tabulated and chart form using Microsoft Excel software (version 2016). Paired t-tests and Mann-Kendall trend tests were performed to analyze for statistical significance between the different restoration types across the program completions. Porcelain bonded to metal (PBM) crowns represented 42.05% of all fixed prosthodontics units completed over all study years followed by all-ceramic crowns (ACC) (18.14%) and full gold crowns (FGC) (10.70%). Jointly, PBM, ACC and FGC's encompassed 70.88% of all fixed prosthodontics units. Over the 8-year study period, there were observed trends of reduced use of PBM's, increased use of ACC's, statistically significant reduced use of FGC's (p = 0.035) and a statistically significant difference in the use of complete and partial coverage restorations (p < 0.001). PBM crowns were the dominant laboratory fabricated fixed prosthodontic clinical unit across postgraduate prosthodontics program completions. The trend in later years indicating ACC as the dominant crown type warrants further investigation.

Mistakes in planning a dissertation research by graduate students of clinical departments

The postgraduate specialist training program contains a scientific component (own research, preparation of publications based on the results, certification based on its findings). Its success depends on how the work is planned from a scientific, legal and ethical positions. The ethics committee of a scientific organization that trains a specialist in postgraduate studies is obliged to conduct an ethical review of scientific projects and guarantee the public that the author's research complies with ethical standards and does not violate the law. The purpose of this work is to analyze the quality of packages of documents for planned studies submitted by postgraduate students of Kazan State Medical University to the ethics committee of the university in 20192022. 260works were analyzed, of which 70had no comments, 138had errors that were eliminated without changing the design of the study, 52required significant revision, 5researchers applied after the completion of the study, 1project was not approved. The work done revealed defects in the planning of research work, the analysis of which was carried out. The main comments concerned the substantiation of the number of study participants, the formation of comparison groups, the writing of the protocol and the patient's informed consent sheet for participation in the study, knowledge of the legislation of the Russian Federation. The author analyzes in detail the situations when and from whom consent to medical intervention should be obtained, based on current international and ethical documents. According to the shortcomings identified, recommendations are presented that, in the author's opinion, will be useful both for researchers and their leaders, and will serve to improve the quality of the planned work.

Creation and implementation of a progressive model of medical staff training in the Republican Medical College of the Ministry of Health of the Udmurt Republic

The article presents the experience of the Autonomous Professional Educational Institution of the Udmurt Republic «Republican Medical College named after the Hero of the Soviet Union F. A. Pushina of the Ministry of Health of the Udmurt Republic» (hereinafter — APEI UR «RMC of the MOH UR») to improve the efficiency of training specialists with secondary medical education. Aim. To study the experience of the APEI UR «RMC of the MOH UR» in improving the efficiency of training specialists with secondary medical education from the stage of pre-professional training of high school students of general educational organizations to postgraduate education. Results. The analysis showed an increase in the number of students trained in the main vocational training programs in the medical field as part of the implementation of the republican project «Medical Classes» for the period from 2019 to 2022, as well as an increase in the number of applicants to medical educational organizations from among them, which indicates a high effectiveness of pre-professional medical training. Individual work with senior students, aimed at getting acquainted with the working conditions in medical organizations of the republic, can increase the motivation of graduates to find employment in a specific workplace and prevent the phenomenon of «early disappointment in the profession». In modern conditions, there is a high need for the implementation of continuous professional programs in forms that allow minimizing the distraction of specialists from the labor process during the training period. The change in the needs of medical organizations in the types and forms of postgraduate training of specialists led to a change in the structure of the State assignment of the APEI UR «RMC of the MOH UR» for the provision of educational services, the need to improve part-time and distance forms of implementing programs using e-learning and distance learning technologies. Conclusion. The results of the analysis indicate the need to improve the system of medical education in terms of expanding the coverage of long-term (at least a year) career guidance projects for high-school students of general education schools; to more actively involve healthcare professionals in the educational process as mentors, internship supervisors, field practice leaders, etc.; to focus on practice orientation of continuous professional education and development of distance learning technologies.

Systematic Review of Work-life Balance among Early Career Doctors

Background: Early Career Doctors (ECDs) are medical doctors who are in their internship, postgraduate specialist training and medical/dental officers below the rank of principal medical/dental officers. The long hours of work, staff-shortage and various expectations at this formative stage expose ECDs to potential negative outcomes including poor work-life balance.&#x0D; Methods: This systematic review included all available original articles on the work-life balance among ECDs world-wide between 2006 and 2020. PubMED, Google Scholar and African Journals Online (AJOL) databases were searched, and the review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.&#x0D; Results: The literature search yielded 145 articles, and after screening 33 articles were included in this review. Twenty (87.9%) of the studies were cross sectional studies, 5 (15.2%) were prospective cohort studies and 1 (3%) was an interventional study, sample size ranged from 21 to 4,581 ECDs with a mean age range 24-35±7yrs. Positive work-life balance was reported among ECDs in 4.7% Karachi, 21% Ireland, 23% USA, 27% Australia; major determining factors include work-load and burn-out, female gender, specialty and location of practice, flexibility of work schedule; and the impacts are burn-out and reduced career satisfaction.&#x0D; Interpretation: Work-life balance among ECDs is poor worldwide, and is worse amongst the more junior cadre and female gender. It is recommended that reduction in work hours, improved wages, social and organizational support could improve the quality of work-life balance among ECDs.

Higher Library Education in the Countries of Latin America

The purpose of the article is look into historical features and to determine the formation stages and the current state of the library specialists’ education system and its level in Latin American countries.&#x0D; The methodology. There were used historical-genetic and systemic-structural approaches. It made it possible to establish the main stages periodization of the higher education levels in Library Studies’ origin and development in the leading countries of Latin America. The study proved the influence of North American and European traditions on the development of the training of highly qualified library personnel system in the founding countries of graduate library education on the continent. A comparative and content analysis of the bachelor’s, master’s and Doctoral Degrees’ educational programs in the specialty “Library and Information Sciences” provided by leading universities in Argentina, Brazil, and Mexico, made it possible to determine the general and specific aspects of the specialists training for the information industry, to establish the peculiarities of cognitive and institutional components of bachelor’s and master’s educational programs, justify the objective necessity of strengthening their interdisciplinarity and flexibility.&#x0D; The results. It has been established that Argentina was the first among Latin American countries to establish a training school for librarians in the structure of the Philosophy and Literature Faculty of the University of Buenos Aires back in 1922. In the 1940s and 1950s, universities opened Library Studies (Schools) in Panama (1941), Brazil (1942), Peru (1943), Uruguay (1943), Mexico (1945, 1956), Chile (1949), Costa Rica (1950) and Colombia (1956). The system of post-graduate library education began to take shape in the 1970s, when in 1972 the first post-graduate program in the field of “Library and Information Science” was opened in Brazil at the School of Communication and Arts of the University of São Paulo, and in 1980 — the doctoral program as well. Currently, in the countries of Latin America, only the leading metropolitan universities have educational programs of master’s and Doctoral levels. It is due to the low scientific qualification of graduate departments and the insufficient number of professors who can carry out qualified supervision of master’s and Doctoral thesis research.&#x0D; The current state of the library and information education system development on the Latin American continent is demonstrated by the following statistics: Brazil has 47 universities with their structure including schools or departments for the library specialists training, Argentina has 16 of such universities, Mexico — 13, Colombia — 6, Chile — 4, Cuba — 3, Costa Rica, El Salvador, Peru, Venezuela — 2 universities each, Bolivia, Ecuador, Panama, Paraguay, Uruguay, Jamaica — 1 university each.&#x0D; The scientific topicality. The formation of the higher library education levels system on the Latin American continent took place in several stages: the genesis stage (1920–1930s), the stage of active development (1940–1960s), the stage of starting post-graduate training of library specialists at the postgraduate level, and later — master’s and Doctoral studies (1970–1990s); the stage of strengthening the interdisciplinary integration of educational program profiles (2000 — present). The results of the educational programs (EPs) content analysis of various levels of training in the specialty “Library and Information Sciences” made it possible to establish a certain conservatism of their profiling, to determine that the promising directions for their modernization are interdisciplinary and strengthening of the digital and information and communication components with, for example, such relevant EPs as “Communication, organization, management of information and knowledge”, “Sociocultural, political and economic configurations of information”.&#x0D; The practical significance. The research results can be used by Ukrainian institutions of higher education in the process of improving master’s and Doctoral educational programs in the specialty 029 “Information, Library and Archival Affairs”. The introduction of the best foreign training practices of library specialists will improve their quality and competitiveness at the global information market.

Priorities of Professional Postgraduate Specialist Training

Priorities of professional postgraduate specialist training

Contemporary androgogical approaches in doctor training

The paper presents andragogical approaches in postgraduate training of medical specialists, continuing medical education, primary specialized and periodic accreditation. Individual approaches to learning are described, taking into account the initial level of knowledge, motivation, psychophysiological and age characteristics, and information literacy. The features of training medical specialists in the fight against Covid-19 are presented.

Implementation of competence committees during the transition to CBME in Canada: A national fidelity-focused evaluation

Purpose This study evaluated the fidelity of competence committee (CC) implementation in Canadian postgraduate specialist training programs during the transition to competency-based medical education (CBME). Methods A national survey of CC chairs was distributed to all CBME training programs in November 2019. Survey questions were derived from guiding documents published by the Royal College of Physicians and Surgeons of Canada reflecting intended processes and design. Results Response rate was 39% (113/293) with representation from all eligible disciplines. Committee size ranged from 3 to 20 members, 42% of programs included external members, and 20% included a resident representative. Most programs (72%) reported that a primary review and synthesis of resident assessment data occurs prior to the meeting, with some data reviewed collectively during meetings. When determining entrustable professional activity (EPA) achievement, most programs followed the national specialty guidelines closely with some exceptions (53%). Documented concerns about professionalism, EPA narrative comments, and EPA entrustment scores were most highly weighted when determining resident progress decisions. Conclusions Heterogeneity in CC implementation likely reflects local adaptations, but may also explain some of the variable challenges faced by programs during the transition to CBME. Our results offer educational leaders important fidelity data that can help inform the larger evaluation and transformation of CBME.

Последипломная подготовка специалистов как важное условие и составляющая создания и развития системы паллиативной и хосписной помощи

Актуальность. Согласно международным стандартам и подходами, адекватное кадровое обеспечение является обязательным условием и составляющей создания и успешного развития системы паллиативной и хосписной помощи (ПХП) в любой стране. Одной из основных задач современной профессиональной подготовки медицинских работников (М/Р), которые привлекаются к оказанию ПХП населению, является формирование у них осознания пациент-семья-ориентированной парадигмы, навыков мультидисциплинарной (МД)/командной, межведомственной и межсекторальной координации и сотрудничества. Также важно обеспечить тщательный отбор и соответствующую мотивацию кадров. Поскольку в основе современной системы ПХП лежит МД, межведомственный и межсекторальный подход к оказанию ПХП после соответствующей профессиональной подготовки могут привлекаться врачи любой специальности, младшие медицинские специалисты, а также психологи, социальные работники, юристы и священнослужители, волонтеры, представители местных общин и частных структур, а также сами паллиативные пациенты (ПП) и члены их семей или опекуны. Цель: научное обоснование профессиональной последипломной подготовки специалистов), которые привлекаются к оказанию ПХП населению. Материалы и методы. Нормативно-правовые документы Украины и авторитетных международных профессиональных организаций; отечественные и зарубежные литературные источники с использованием поисковых систем JAMA, Scholar и PubMed; данные официальной статистики; результаты социологического исследования; методы исследования: системного подхода и системного анализа, библиосемантичний, социологический (анкетный опрос) и общепринятые медико-статистические методы. Результаты. Анализ национальных и международных нормативно-правовых документов свидетельствует о важном медико-социальном значении создания и развития системы ПХП населению. Показана роль профессиональной подготовки специалистов по вопросам ПХП. Результаты социологического исследования позволили определить: расчетную потребность населения в ПХП в Украине; состояние службы ПХП и недостаточный уровень знаний и настоятельную потребность М/Р в специальных знаниях по вопросам ПХП. Выводы. Мультидисциплинарная профессиональная подготовка специалистов имеет большое значение для создания системы и повышения доступности, качества и эффективности ПХП. Это позволит М/Р вместе с психологами, социальными работниками, волонтерами, священнослужителями обеспечить комплексную ПХП ПП и членам их семей, включая медицинскую, психологическую, социальную и духовную/ религиозную составляющую.

Postgraduate education of ophthalmologists on the basis of the state autonomous health institution "Republican Clinical Ophthalmological Hospital of the Ministry of Health of the Republic of Tatarstan named after Professor Emilian Valentyevich Adamyuk"

The State Autonomous Healthcare Institution "Republican Clinical Ophthalmological Hospital of the Ministry of Health of the Republic of Tatarstan named after Professor Emilian Valentyevich Adamyuk" (hereinafter - RKOB) is a training base for postgraduate training and advanced training of specialists in the field of "Ophthalmology". The study of the specifics of the organization of additional professional training for specialists in the field of "Ophthalmology" at the RSCS became possible after obtaining a license to conduct educational activities in 2019. Educational activities in the RCCH are carried out not only in the form of organizing thematic advanced training courses for ophthalmologists, but also in organizing educational events, each of which is accredited in the CME system. The formation on the basis of the RKOB of a modern educational area of ​​activity with a highly qualified teaching staff and an educational and clinical complex ensures high-quality training of students in advanced training cycles in the system of additional professional education, which is confirmed by the results of final certification and positive feedback from students and employers.

ORGANIZATION OF POSTGRADUATE TRAINING OF CIRCULAR ECONOMY SPECIALISTS IN THE REPUBLIC OF POLAND (ON THE EXAMPLE OF SILESIAN POLYTECHNICS)

The article is devoted to the analysis of the organization and content of postgraduate training of specialists in circular economics in the Republic of Poland on the example of Silesian Polytechnic. It is emphasized that the Republic of Poland is taking significant steps in the development of the circular economy and the training of specialists to implement its ideas. Based on the analysis of postgraduate education programs «Circular Economics and Cleaner Production in Practice» and «Cyclic Engineering» in the Silesian Polytechnic, the article reveals the requirements the requirements, rights and responsibilities of postgraduate students are revealed; knowledge, skills and competencies that they acquire in the process of training in circular economics programs; forms of education and the content of diplomas that students receive after training, as well as areas of possible employment. It is emphasized that in the system of postgraduate education of Silesian Polytechnic there are programs both directly from the circular economy and from certain problems that relate to the scope of such specialists and contribute to the development of a circular economy. It is proved that the training of specialists in circular economics in postgraduate studies acquires a systemic character in terms of coverage of the content of those problems that relate to the professional activities of specialists in circular economics. The indisputable value of such educational programs is to involve in their development and determine the content of training not only teachers of higher education institutions, but also public and professional societies that care for the environment, waste recycling and more. Educational programs on circular economics at Silesian Polytechnic are practice-oriented, they include consultations in circular production companies, trainings on business practice, as well as the development of an implementation project under the guidance of experts.

Internship Experience in Orthopaedics and Traumatology and its Impact on Becoming a Specialist.

The German practical year is the last clinical placement period during Medical School. However, it remains unclear how medical students evaluate the practical year in orthopaedics and traumatology (Orthopädie und Unfallchirurgie; O & U) and whether it has an impact on becoming an O & U specialist. We analysed data of 146 medical students (46,7% female) who completed the placement in O & U. From the evaluation, 37 items were included in the analyses. Participants who could imagine becoming an O & U specialist (O & U-Ja) following graduation were statistically compared to those who could not (O & U-Nein). Overall 123 (83.7%) trainees indicated that they would like to become an O & U specialist (O & U-Ja), 18 (12.8%) negated (O & U-Nein) and 6 (4.1%) were undecided. Groups did not differ for sex and age (sex: Chi² = 2.50, p = 0.114; age: F [1.93] < 1, p = 0.764). Group differences were found for practical orientation, independency, acquisition of anamnesis and diagnostics skills and problem-solving expertise with students who could imagine becoming an O & U specialist (O & U-Ja) giving the highest ratings. Evaluations of the last medical year are essential in order to continuously improve the internship experience and to attract students towards a certain medical field and, moreover, to post-graduate specialist training. Clinics and institutions who already emphasize on the factors derived from this evaluation, or are continuously working on improvement, might be more able to attract young professionals, since personnel acquisition is starting early in the medical field.

Review of the European standard for postgraduate training of medical specialists in internal medicine and prospects for implementation in Russian Federation

Relevance. Residency remains an integral part of quality postgraduate education in Russia. Improving the education system of medical workers and creating a system of motivation for their quality work is one of the priority tasks implemented within the framework of the Concept of development of the healthcare system in the Russian Federation until 2020. Objective. Comparison of the European standard of postgraduate training of medical specialists in the field of “internal diseases” with the existing training system in the Russian Federation. Results. The residency program of the Russian Federation pursues a similar aim to the European standard — the training of a qualified general practitioner. The program is based on a modular system and includes the study of various disciplines, an extensive practice program and state final certification. An analysis of the content of the work programs of the disciplines indicates that the training is aimed at the formation of both universal (general cultural) competencies, which are essentially similar to CanMEDS, and professional competencies. There is no significant difference between the list of knowledge, skills and practical skills that a general practitioner must possess after graduation from residency in Europe and Russian Federation. However, the development of a similar program in the Russian Federation takes much less time (2 years or 4,320 hours), which raises a logical question about the quality of training. Conclusion. Despite the diff erence in the programs for postgraduate training of internist (primarily in terms of hours), the learning goal is the formation of similar competencies. It should also be noted a well-structured control system, which makes it possible to objectively evaluate the acquired competencies and adjust the individual learning process.

Moving beyond the technical skills and promoting professionalism-the experience of the College of Anaesthesiologists of Ireland with incorporating the Medical Council Eight Domains of Good Professional Practice into Entrustable Professional Activities.

The goal of the College of Anaesthesiologists of Ireland (CAI) is to train qualified anaesthesiologists who embody all aspects of professionalism. The Medical Council of Ireland has identified Eight Domains of Good Professional Practice which guide the standards for postgraduate specialist training, including within the CAI. Entrustable Professional Activities (EPAs) were adopted as the organising framework for a competency-based programme within CAI. The aims were (i) to ensure that the EPA-integrated competencies from across the full range of domains and (ii) to design workplace-based assessment which fosters a culture and practice of feedback above and beyond technical skills. Four core EPAs were developed for trialling; competencies were tagged to the eight domains in an iterative development process. Feedback Reports were devised as tools for workplace-based assessment. Analysis of the Feedback Report data revealed how well the content reflected the full range of domains. 'Clinical Skills' is the domain to which most competencies within the EPAs were tagged. Analysis of the content of Feedback Reports also revealed an overrepresentation of that domain. This highlighted the apparent preference of consultants and trainees for selecting clinical aspects of an EPA to provide and receive feedback on, rather than professionalism or any of the other non-technical domains. We advocate and make recommendations for more effective incorporation of the non-technical domains of professional practice in the processes of curriculum development, teaching, learning, feedback and assessment.

NATIONAL AND INTERNATIONAL EXPERIENCE OF INTEGRATION PALLIATIVE AND HOSPICE CARE ISSUES INTO EDUCATION OF SOCIAL WORKERS AND NURSES

The article presents a brief analysis of the legal framework for social work in the field of palliative and hospice care – comprehensive medical, psycho-social and spiritual support of patients and their families facing the problem associated with life-threatening illnesses. This problem is relevant for Ukraine, as there are up to 2 million people who are seriously ill and their family members who need this type of care.National and international educational programs and currucula for undergraduate and postgraduate training of social work specialists and nurses were analyzed in the article. It was found out that, according to the Law of Ukraine “On Social Work with Families, Children and Youth”, palliative and hospice care can be provided by social workers. Social, psychological, clinical issues of palliative and hospice care are partially included in the University social work and social pedagogy training programs and curricula. At the same time, issues of social work are not included in the educational training of nurses in Ukraine. The study of international experience shows that the issues of palliative and hospice care are included in the undergraduate and postgraduate educational training of social workers and nurses, and meet the needs of beneficiaries. A common feature of training of social workers and nurses in Ukraine and abroad in the context of palliative and hospice care is that at the undergraduate level the study of palliative and hospice care issues is introductory. The difference is that abroad there is a wide range of postgraduate training on this issue. In Ukraine, relevant postgraduate training for social workers and nurses on issues of palliative and hospice care is absent. The adequacy of the social workers' training to the needs of beneficiaries in other countries is evidenced by the fact that in the first weeks of the Covid-19, many professional associations issued detailed recommendations, guidelines, manuals, etc., with instructions on specifics of palliative and hospice care in time of epidemics.

Microbiology capacity building in the Asia-Pacific region

Microbiology capacity is limited in low-middle income countries in the Asia Pacific with insufficient laboratories to meet the needs of the population. Diagnostic capacity is limited with shortages in skilled scientists, pathologists, functional equipment, weak procurement systems and substandard facility infrastructure. Laboratories are underutilised with low specimen numbers, often of low quality. High rates of antimicrobial resistance is in part related to diagnostic uncertainty and resultant inappropriate antimicrobial therapy. There is a need to strengthen microbiology capacity for improved patient care, surveillance and global health security. Capacity strengthening requires recognition of the importance of microbiology across all levels of health care. Development of skilled scientists is best served by standardised undergraduate training programs, with specialist postgraduate training in microbiology. Mentoring is a successful method for improving knowledge and allows for development of essential relationships that are necessary to effect change. Implementation of contextually appropriate standard operating procedures, international standards for susceptibility testing, quality control and external quality assurance are required. Mass clinician understanding is necessary for pre and postanalytical quality. Systematic collection of quality specimens is essential for development of national and regional surveillance systems. Increased donor support, including provision to purchase and maintain essential equipment and consumables, is required.

Global Medicine, Parasites, and Tasmania.

Until the 1970s, infectious disease training in most medical schools was limited to those diseases common in the area of instruction. Those wishing to explore a more globalised curriculum were encouraged to undertake specialist postgraduate training at schools or institutes of tropical medicine. However, the increase in global trade and travel from the 1970s onward led to dramatic changes in the likelihood of returning travellers and new immigrants presenting with tropical infections in temperate regions. Furthermore, population growth and the changing relationships between animals, the environment, and man in agriculture accentuated the importance of a wider understanding of emerging infectious diseases, zoonotic diseases and parasitic infections. These epidemiological facts were not adequately reflected in the medical literature or medical curriculum at the time. The orientation on tropical infections needed specialised attention, including instruction on diagnosis and treatment of such infections. We describe key global health events and how the changing field of global medicine, from the 1970s to early 2000, impacted on medical education and research. We describe the impact of global health changes in the Tasmanian context, a temperate island state of Australia. We retrospectively analysed data of patients diagnosed with parasites and present a list of endemic and non-endemic parasites reported during this period. Finally, we reflect on the new approaches to the changing needs of global health and challenges that medical programmes, learners and educators face today.