Awareness And Legal Aspects Of Medical Students’ Possible Access To Medical Practice

Abstract

The article considers the issue of regulatory law which is concerned with medical practice and possibility to obtain an access to implement professional performance by undergraduates and to work as nursing staff without completion of the educational program of higher and post-secondary professional establishments. The purpose is to study the awareness of students of a higher medical educational institution for the possibility of obtaining access to engage in medical activities during the period of study. A sociological survey of 634 students of a medical university was carried out. Data processing was carried out by methods of descriptive and nonparametric statistics. Awareness of possibility, specifics and reasons for obtaining access to carry out medical activities by the students has been analyzed. 59.3% of the respondents consider themselves informed about the possibility of obtaining access to medical or pharmaceutical practice in the positions of nursing or secondary pharmaceutical personnel. 69.9% of respondents have no idea about the specifics of the procedure for obtaining a permit. 74.3% of the respondents would like to obtain access without completing their studies in the program of higher medical or higher pharmaceutical education. It has been stated that students do not have sufficient information on the possibility to obtain an access to medical practice and to work as nurses.

Keywords: Access, medical, nursing, practice, regulatory law problem, staff

Introduction

The main issues in the healthcare system of the Russian Federation have been relevant for a long period of time. They include efficiency and disproportion in the structure of medical staff due to unsatisfactory working conditions and irrational allocation of the workforce, low wages, obstacles to professional adaptation and consolidation of young specialists, a low training level of graduates that does not correspond to the employer's requests, insufficient motivation and interest in professional activity. Annually the number of admissions to the higher and post-secondary professional medical educational institutions is increasing. Nevertheless, the problem of shortage of medical staff in the healthcare system has become important. The reasons of this antinomy have been studied and analyzed by a number of authors revealing the factors that explain unfavorable conditions and suggest variants of solution (Fadeeva, 2020; Molchanov, 2020; Sheyman & Sazhina, 2018). Obviously one of the effective measures to solve the staff problem in the system of healthcare is to improve the legal framework, responsible for all the activities in the healthcare system: governing bodies, educational and medical institutions and medical staff.

In the conditions of significant shortage of nursing staff, “The procedure for admission of persons who have not completed the educational programmes of higher medical or higher pharmaceutical education, as well as persons with higher medical or higher pharmaceutical education to carry out medical or pharmaceutical activities in the positions of nursing professionals or secondary pharmaceutical personnel” (came into force on July 27, 2016 No. 419n by the Ministry of Health of the Russian Federation) was approved according to the Federal Law No. 323 of November 21, 2011 “On the Fundamentals of Health Protection of Citizens in the Russian Federation”, Federal Law No. 273 of December 29, 2012 "On Education in the Russian Federation" and Order of the Ministry of Education and Science of Russia No. 1061 of September 12, 2013 "On approval of the lists of specialties and areas of training for higher education" (On the Fundamentals of Health Protection …, 2011; On Education in the Russian Federation, 2012; On the approval of the lists of specialties …, 2013; The procedure for admission of persons …) thereby canceling the previously valid regulatory document – Procedure for admitting the specified category of persons to carry out medical activities in the positions of nursing staff, (came into force on March 19, 2012 No. 239n by the Ministry of Health of the Russian Federation). However, the regulatory document has not undergone significant changes. The updated document contains all the necessary information about the requirements for the applicant, about the conditions and content of examination tests. Thus, students who have not completed the educational programs of higher medical education can be admitted to work as nurses under certain conditions. It is mandatory to provide an academic certificate of training and an extract from the protocol on the successful passing of the exam. The exam is organized by the educational organization of secondary vocational education (medical college) with the participation of a special commission. The exam includes sequential passage of three stages: testing, interview and assessment of practical skills necessary for practical activity in accordance with the main educational program of higher professional education.

Consequently, this regulatory law is determined on the change of quantitative indices – number of medical workers, staffing level, ratio of medical personnel. However, to date in Russian scientific literature and periodicals, there is significant lack of information on the change in the unfavorable personnel position of the health care system caused by the coming into operation of the Order of the Ministry of Health of Russia dated June 27, 2016 No. 419n.

At the same time the promulgation of the law provides the solution of urgent problems under discussion such as the formation of professional commitment and professional development of young specialists – medical professionals, doctors. Early professional immersion into the practice enables the growth of possible formation of professional orientation among young specialists and successful adaptation in the professional sphere.

The analysis of the foreign authors’ research results on the professional activities of medical students working as nursing assistants showed that attracting students to practical work contributes to gaining practical experience, developing a sense of belonging to the professional environment, increasing motivation either to future work activities or to the educational process. According to students, work experience in departments of medical organizations provides an opportunity to strengthen and develop their personal and professional qualities, to work out and acquire new professional competencies, communication and teamwork skills, to form a professional identity (Davison & Lindqvist, 2020; McGettigan & McKendree, 2015; Smith et al., 2013; Walker et al., 2017).

Problem Statement

The problem of regulatory law of medical activity is of special interest within the ranges of medical society. Besides it serves as a subject for modern research. The consideration of the problem of admission to medical practice of undergraduates of higher medical schools demands special attention and solution of national health care issues concerned with staff strengthening and professional development of young specialists.

Research Questions

The research subject comprises the awareness of undergraduates of medical university about possible access to medical practice as nursing professionals before the completion of the programme of higher professional education.

Purpose of the Study

The research purpose isto study the awareness of undergraduates of higher medical educational institutions about possible medical practice during the period of studies.

Research Methods

Social survey which includes anonymous questionnaire (Ʃ = 634) has been carried out among the students of Saratov Medical University for the period between February 2021 and March 2021. The course of studies at medical university by the completion of which students may receive an access to medical practice, including pharmaceutical activity and not being graduated from medical or pharmaceutical institutions of higher education, is considered as a criterion of the research. The research has included third-year students of pediatric and medical faculties (45.4 and 32.6 % of respondents respectively), fourth-year students of stomatological faculty (9.8 of respondents), pharmaceutical faculty (5.2 % of respondents) and medical prophylactic faculty (2.2 % of respondents) and second-year bachelors of Institute of Nursing (4.7 % of respondents). The number of female interviewees was prevailed. Mean age was 19.7±0.044 years.

To the moment of the survey 3.8 % of all the respondents have already obtained post-secondary medical education. 5.8 % of respondents have announced the fact that they received another post-secondary professional/higher education. Practical experience in the healthcare sphere has been found out in 12.6 % of respondents. 2.1 % of respondents work in the healthcare system, of which 1.1 % – as nursing personnel, 0.5 % – as medical receptionists and 0.2 % – as pharmacists.

Quantitative data generalization was performed by the methods of descriptive statistics (calculation of the relative, the mean and errors of the mean). Pearson's chi-squared test χ² was applied for the summarization of characteristics measured in terms of category (qualitative). Data processing was carried out using SPSS statistics 22.

Findings

About half of all the respondents (59.3 %) have stated the fact that they are informed on the possibility to receive an access to implementation of medical or pharmaceutical practice as nursing professionals or secondary pharmaceutical workers without completion of the basic educational programme of higher medical or higher pharmaceutical education (further – access). The information becomes more often available for the students of pharmaceutical and medical prophylactic faculties (87.9 and 78.6 % of respondents of the given faculties respectively) as compared to other faculties (62.1 % – pediatric faculty, 57.5 % – medical faculty, 53.3 % – nursing faculty, 35.5 % – stomatological faculty). Variability was investigated by Pearson's correlation coefficient χ2 (χ2 = 29.589; p ˂ 0.001).

69.9% of all the respondents have not been aware of specifics to obtain an access. The rest 30.1 % of respondents have been informed about the particular details in the procedure of obtaining access. Among the respondents who were aware of specific access procedure, the majority were informed about the possibility how to obtain an access in comparison to other respondents (89.6 and 46.2 % respectively; opinion variability was investigated by Pearson's correlation coefficient χ2 (χ2 = 104.610; p< 0.001)).

74.3% of respondents would like to obtain an access without the completion of the educational programme of higher medical or pharmaceutical institutions. One fourth of all the interviewees (25.7 %) responded negatively. Most of them were students of pediatric and medical faculties (41.1 and 32.5 % of respondents respectively). 68.71 % of respondents were not aware of possible access obtaining therefore they were not prone to have an access. 30.8 % of respondents were likely to have an access but they were not informed about the possibility to obtain an access. Variability was investigated by Pearson's correlation coefficient χ2 (χ2 = 72.260; p ˂ 0.001).

Respondents were intended to obtain an access without the completion of educational programme of higher medical or higher pharmaceutical schools. The reasons were explained by the following facts: to get working experience for further professional practice or for residency admission (52.2 %) as well as intention to apply/work out the acquired competencies during the real practice (42.3 %). Financial benefit has served as a reason to obtain the access for 36.3 % of respondents. Strong feelings about full engagement into future professional work have been identified as the motive for 25.7 % of respondents. It should be underlined that such motives as “intention to apply/work out the acquired competencies on real practice” and “full engagement into future professional work” have become more significant for students of pediatric faculty than for students from other faculties. “Intention to apply/work out the acquired competencies on real practice” as a motive comprised 50 % of the respondents of pediatric faculty and 38.0 % of respondents of other faculties. Variability was investigated by Pearson's correlation coefficient χ2 (χ2 = 8.110; p=0.005). “Full engagement into future professional work” as a motive was estimated by 31.3 % of the respondents of pediatric faculty and 21.0 % of respondents of other faculties. Variability was investigated by Pearson's correlation coefficient χ2 (χ2 = 8.481; p = 0.004).

The majority of the respondents (32.6 %) having obtained the access would like to work as a nursing assistant while 25.6 % – as a practice nurse. Particular attention should be paid to the fact that in some cases students who have already obtained the access except bachelors of Nursing Institute applied for the jobs not relevant to their specialty or professional area. For instance, students of stomatological faculty were prone to take the job of a pharmacist (6.4 %). Students of pediatric and medical faculties matched the work placements of a pharmacist (11.1 and 10.1 % of respondents respectively), an assistant of epidemiologist / assistant of entomologist (5.2 and 5.3 % of respondents respectively) and a dental hygienist (3.8 % and 3.4 % of respondents respectively). Pharmaceutical faculty students chose the work placements of a receptionist (6.1 %), a nurse of accident and emergency department (3.0 %) and a practice nurse (3.0 %). Students of medical prophylactic faculty pointed to such jobs as a pharmacist (7.1 %) and a dental hygienist (14.3 %).

The majority of the interviewed (86.3 %) are convinced on the access importance as it helps solve the staff problems occurred in the healthcare system (improvement of the situation concerned with nursing staff shortage). Otherwise, the number of students of stomatological and pharmaceutical faculties reacted to the concern is slightly decreased (80.6 and 81.8 % respectively) than the number of students of other faculties (88.2 % – pediatric faculty, 84.5 % – medical faculty, 90.0 % – Institute of Nursing, 100 % – medical prophylactic faculty). Though the significance of variability data was not defined.

Conclusion

Active development and promulgation of the regulatory law responsible for the solution of staff problems should contribute to the improvement of national healthcare.

Staff shortage problems play a crucial role in the Russian as well as in European system of healthcare. To overcome the situations with staffing shortage in healthcare and to improve medical service availability, such countries as Poland and the Czech Republic suggest the model for professional training of nursing staff in short-term period, a four-year educational programme (Lorkovsky & Yugovich, 2021).

Currently, there is a dynamics of indicators characterizing the personnel situation in the Russian health care. At the same time, it can be argued that the ongoing changes are not always due to the optimization of the normative regulation of the system's activities. The measures proposed to solve personnel problems are often implemented slowly and not fully. When developing the main provisions of the concept of personnel policy, healthcare management authorities, among other things, need to focus on professional requests, social and economic needs of medical workers and directly the young generation of future doctors, which plays a significant role in the socio-economic, cultural and other transformations of the industry.

The survey has showed that the majority of undergraduates are informed about the possible access to medical or pharmaceutical performance and are intended to work as nurses or pharmacists without completion of educational programme of medical or pharmaceutical schools of higher education. In most cases respondents were motivated by the possible opportunity to obtain practical skills and to work out professional competencies performing real medical tasks. However, the interviewed were not aware of the fact that the choice of the job might not correspond to the standards set in order No. 419n by the Russian Healthcare, July 27, 2016.

Awareness of students has proved the effectiveness of educational process and professional orientation programmes realized within the period of studies. Consequently, it enables young specialists to be involved into healthcare hierarchy. It is necessary to provide awareness of undergraduates about possible practical experience and to point out the significance of young specialists in solution of healthcare staff issues.

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