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SPECIALTY TRAINING IN RESPIRATORY MEDICINE IN TURKEY

SPECIALTY TRAINING IN RESPIRATORY MEDICINE IN TURKEY. Ali Kocabaş, Oya İtil, Can Sevinç,Hacer Arı, Eyüp Sabri Uçan,Numan Ekim. Specialty Training in Medicine.

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SPECIALTY TRAINING IN RESPIRATORY MEDICINE IN TURKEY

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  1. SPECIALTY TRAINING IN RESPIRATORY MEDICINE IN TURKEY Ali Kocabaş, Oya İtil, Can Sevinç,Hacer Arı, Eyüp Sabri Uçan,Numan Ekim

  2. Specialty Training in Medicine • Specialty training is an organized educational training program presented to the medical student / assistant under guidance and supervision. • During this process, while safe and appropriate health service is offered to the patients, occupational, ethical and personal development is provided for the assistants. • Qualities of education and patient care are related with each other and should be balanced.

  3. Specialty training ServiceEducation National Standards and extrencic control International Standards

  4. Problems in European Specialty Training • Exposure of assistants excessively long working hours without regarding their educational needs. • Inadequate financial support of the governments • Inadequate training planning on the basis of institution that give the training and the person who takes it. • Absence of pedagogic sufficiency of the trainers • Organization disorders of the education system. *Borman E, O’Grandy P. Postgraduate training. Medical Education. 1997,31:3-8

  5. Assistants and Their Problems

  6. Trainer Trainee Training institution Standards

  7. FEATURES OF TRAINING INSTITUTIONS • Should have infrastructural facilities (Completely equipped hospital) • enough bed capacity • a determinate number of patients (In-patient / outpatient) • a determinate number of interventions (Operation / Application) • Education / Investigation/Service should be the targets • Sufficient man power • Should have an educational program in the related branches.

  8. Structure and organization of specialty training in our country has been given to the Ministry of Health with the law numerated as 1219 in April 11,1928. • 1949 : Tuberculosis Specialty • 1960: Respiratory Medicine and Tuberculosis Specialty • 2002: Respiratory Medicine Specialty

  9. Turkish Board in Pneumology was established in 2000 in order to provide standardization and to increase the quality of Specialty Training in Respiratory Medicine. • Board exams were started to be carried out since 2002.

  10. However,the Specialty Training Program prepared in 2002 by the Turkish Board in Pneumology couldn’t be realized. • It’s always recognized that there is no standardization among the institutions giving Respiratory Medicine Specialty training in Turkey and this is not been supported by scientific data till now.

  11. Aim • The aim of the present study conducted by Turkish Respiratory Medicine Board is to form and realize the specialty education program by detection of the current state and problems of institutions in Turkey giving Respiratory Medicine Specialty Training.

  12. Method • June-July 2005: Preparation of a questionnaire including 89 items by the Executive Committee of the Board. • July- September 2005: Sending and collection of the questionnaires to all university departments of Respiratory Medicine and to government training hospitals of the Health Ministry. • October-November 2005:Analysis of all data

  13. Content of the questionnaire • Physical infrastructure • Health staff capacity • Functional capacity • Educational infrastructure

  14. Results • 41 university Respiratory Medicine Departments and 9 government training hospitals of the Health Ministry enrolled the study. • Some questions were incompletely answered by some of the Heads of the university Chest Departments and Clinical Chiefs of the Government Hospitals.

  15. Institutions Giving Respiratory Medicine Specialty Training • A. University Respiratory Medicine Departments:41 - Ankara,İstanbul,İzmir:11 - Anatolia:30(2 of the universities have no assistants) • B. Health Ministry Government Training Hospitals or clinics:9 Training Hospital:5 Respiratory Clinic:4

  16. Physical Infrastructure Feature University Big city (n= 11) University Anatolia (n= 30) Training Hospitals N= 9 In the central hospital Bed number Total Bed Number 6 (% 54.5) 71 (26-147) 638 29 (% 96.7) 26 (4-83) 473 3 (% 33.3) 258 (15-873) 2319 Total number of beds in the university chest clinics: 1381 Total number of beds in government chest clinics: 2319 Total: 3700

  17. Are there the following branches in your hospital ?

  18. Official Scientific Branches 20 18 Central Univ. 18 Peripheral Univ. 16 Training Hosp. 14 13 12 10 9 8 6 3,3 4 2 0 Allergy Intensive Oncology care

  19. Evaluation I • In 50 institutions offering Respiratory Medicine Specialty Training in Turkey there are 3700 beds and 63 % of these are in the government training hospitals • Some clinics required for specialty training are absent in training • Units like intensive care, allergy and oncology are being established recently.

  20. B. Health Staff Capacity 90 83 University Big City (n=11) 80 University Anatolia (n=30) Training Hospital (n=9) 70 60 54 55 50 38 40 34 35 30 30 25 20 9 10 0 Professor Assoc.Prof. Assist.Prof. Chief Assistant Chief Head assist.

  21. B. Number of assistants 200 189 University Big City (n= 11) 180 University Anatolia (n=30) 160 Training hospital (n=9) 140 116 120 107 100 80 55 60 37 40 34 31 27 17 14,5 20 10,7 6,5 0 Mean Total (412) Number of new assistants (2005) (119) Number of specialists (2005) (82)

  22. B. Other Health Staff 300 Üniversity Big City(n= 11) 263 University Anatolia (n=30) 250 Training Hospital (n=9) 216 207 200 158 150 124 99 100 48 50 29 27 25 13 11 5 4 3 3 2 1 1 1 0 Other Secretary Technician Nurse Library Officer Other health staff Physiotherapistt

  23. Evaluation II • 363 trainers are giving specialty training and 147 (41% ) of them are in training hospitals. • 28% of 412 assistants are in the training hospitals. • A trainer has 1.3 assistants in the universities , but the same rate is 0.8 in the training hospitals.

  24. C. Functional Capacity

  25. Outpatient and In-patient Clinical Activities 250 University N= 41 216 Training Hospital N=9 200 150 92 100 67 37 50 20 20 10 6 4 2,5 0 Outpatient room Daily Daily number Bed fullness Mean duration patient of hospitalization number of patients rate number hospitalized

  26. Intensive Care Units and Sleep Laboratories 80% University Big city (n= 11) 67 % University Anatolia (n=30) 64 % 64 % 70% Training Hospital (n=9) 60% 44 % 50% 40 % 40 % 40% 30% 20% 10% 0% With intensive care unit With sleep laboratories

  27. Intensive Care units

  28. Sleep Laboratories

  29. Lung Cancer Chemotherapy Unit 50% University N= 41 44% 44% 45% Training hospital N=9 40% 37% 37% 35% 30% 25% 20% 15% 12% 10% 10% 10% 5% 5% 0% A room referred A special unit A special unit General clinic Daily Care İn the outpatient clinic İn the out patient clinic İn the clinic unit

  30. Tuberculosis Clinic 60% University N= 41 56% Training hospital N=9 49% 50% 40% 33% 31% 30% 20% 11% 10% 10% 5% 0% With tuberculosis clinic No, referred to the dispensary No, referred to the infection clinic Other

  31. Units 100% 90% 89% 89% 87% 90% 80% 70% 60% University N= 41 50% 46% Training Hospital N=9 44% 44% 39% 40% 33% 33% 33% 28% 30% 22% 22% 21% 21% 18% 20% 16% 10% 10% 0% Rehabiltation uniti Asthma outpatient clinic PFT laboratoryı Allergy laboratoryı Bronchoscopy unit Smoking cessation outpatient clinic Oncology outpatient clinici Allegy outpatient clinici COPD outpatient clinici Interventional bronchoscopy uniti Medical thoracoscopy uniti

  32. Absent equipments-1 120% 100% 100% 87% 87% 81% 78% 80% 67% 64% University N= 41 56% 56% 56% 56% 60% 51% Training Hospital N=9 44% 44% 44% 36% 40% 22% 20% 11% 10% 3% 0% Cryotherapyi CO diffusion Exercise test Spirometry Electrocother Plethysmography Rigid brnchoscopyi Bronchoscopic laser Bronchoprovocation medical thoracoscopy Autofluorscein bronchoscopy Fiberoptic bronchoscopy

  33. Equipments-2 80% University N= 41 70% Training Hospital N=9 67% 60% 57% 56% 50% 44% 40% 33% 31% 30% 23% 22% 22% 20% 15% 15% 13% 11% 11% 11% 11% 11% 8% 10% 5% 5% 5% 3% 3% 3% 3% 0% NIMV Bactec Spiral CT TB resistance-culture Ultrasonography Polisomnography BT venogaphyi Computerized tomography Allergic skin test Mechanic ventilator V/Q scan Sputum ARB smear D-dimer

  34. Evaluation III • Of the total of 845 thousand 68 % of 50 institutions giving specialty training administered to the training hospitals. • 56 % of 65 thousand patients hospitalized in these institutions in 2004 were in training hospitals. • Some differences are not observed between university and training hospitals regarding technical infrastructure.

  35. D. Educational Infrastructure 60% University N= 41 Training Hospital N=9 49% 50% 40% 33% 30% 22% 22% 20% 17% 15% 11% 11% 10% 10% 5% 5% 0% No specialty 0-5 years 6-20 years 21-50 years > 50 years Unresponded training

  36. Educational Infrastructure 90% University N= 39 82% 80% Training Hospital N=9 70% 67% 67% 60% 56% 50% 41% 40% 30% 22% 22% 20% 15% 10% 0% With adaptation With a written With an assistant Making an assistant program specialty education program exam during the education program

  37. Educational infrastructure 120% University N= 39 Training Hospital N=9 98% 100% 93% 93% 90% 89% 80% 80% 76% 80% 68% 67% 67% 67% 67% 67% 59% 56% 56% 60% 51% 44% 40% 33% 20% 0% Overhead Notebook TV-video Barcovision Slide machine Meeting room Desktop computer Internet open to everyone A working photocopy With a library open to everyone

  38. Educational activities not done 90% University N= 39 78% 80% Training Hospital N=9 68% 70% 67% 67% 61% 60% 56% 56% 54% 50% 44% 44% 40% 30% 20% 20% 12% 10% 7% 5% 0% Case presentation Asistant seminary Education member Mortality Literature hour Multidisciplinary committee Feedback from the seminar meeting assistants about education

  39. Assistant Work load 30 27,5 University N= 39 Training hospital N=9 25 21,7 20 15 11,5 10 8,2 5 0 Mean number of patients an assistant is responsible in the in-patient clinic Mean number of patients an assistant examines a patient in the outpatient clinic

  40. Duty Status of The Assistants 10 University N= 39 8,6 9 Training Hospital N=9 8 7 6,7 7 5,8 6 5,4 5,4 4,7 5 3,7 4 3,4 3 2,5 2 1 0 First year Second year Third year Fourth year Fifth year assistant assistant assistant assistant assistant

  41. Rotation status 120% University N= 39 100% 100% Training Hospital N=9 100% 93% 90% 89% 85% 80% 66% 60% 56% 56% 49% 40% 33% 32% 22% 17% 20% 11% 11% 10% 10% 0% Other Radiology Internal Medicine Cardiology Intensive care Thoracic surgery Dispensary TB Hospital Emergency service Infectious diseases

  42. Whose picture is this in your opinion ? An educational member ? Head of a department ? Assistant ?

  43. Scientific activities(2004) 25 University N= 39 21,4 20,8 Training Hospital N=9 20 15 13,6 10 8,8 7,4 7 6,7 5,9 5,5 5,3 5 3 1,9 1,2 1 0 International National article International National National Health staff International Congress presentation speaker speaker Sent abroad article Congress presentation for education İn the last 5 years

  44. Assistant activities in specialty training University N= 41 Training hospital N=9 Followed patient and epicrisis (35/7) Thoracenthesis (37/8) Pleural biopsy(37/8) Bronchoskopy (37/8) PFT (32/7) Allergic skin test (30/6) Patient follow-up at Mechanic vent. (29/5) Patient follow-up at NIMV(35/7) Patient follow-up in sleep lab.(18/4) Pleurodesis (30/6) Transthoracic needle aspiration (21/7) Central venous catheter (19/4) Pulmonary arterial catheterization(8/3) 543 (80-3000) 151 (30-500) 38 (3-250) 113 (20-500) 187 (0-1000) 78 (0-500) 58 (0-200) 75 (3-300) 26 (0-180) 12 (0-50) 13 (0-30) 10 (0-40) 4 (0-15) 1242 (400-2500) 208 (50-320) 54 (25-100) 143 (40-250) 138 (0-400) 68 (0-200) 88 (5-400) 84 (10-400) 24 (0-50) 8 (0-20) 21 (0-50) 4 (0-15) 2 (0-5)

  45. Evaluation IV • There are deficiencies in training hospitals regarding educational infrastructure and activities. • Work load and practical applications of the assistants in training hospitals is more in training hospitals. • No significant difference was detected in scientific activities between the university and the training hospitals.

  46. Society Memberships 600 University N= 41 526 Training Hospital N=9 500 437 400 300 233 193 200 137 119 114 85 100 75 60 38 22 20 12 12 8 5 0 TB dispensary ERS ATS ACCP Other Turkish Thoracic TÜSAD TABİB Other Society ODASI

  47. Conclusions-I • In Turkey, specialty education is offered to 412 assistants with 363 trainers in 48 institutions. • There are deficiencies in training hospitals regarding educational infrastructure and activities , but the practical appliacations of the assistants working in these hospitals are more.

  48. Conclusions-II • Standardization and accreditation have not been realized in specialty training in Respiratory Medicine yet. • In parallel to European and Health Ministry work, specialty training program is targeted to be finished at the end of 2006 and accreditation will be at the end of 2007 • A new organization is needed for specialty training in which universities and training hospitals will work together.

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