The End of Mandatory Internships for Doctors? "Will Lower Knowledge Levels Even Further"
- KRAUM Chairman Prof. Wojciech Załuska emphasizes in an interview with Rynek Zdrowia that "maintaining the postgraduate internship in its current form is no longer substantively justified."
- - Verification of practical skills is ensured by the objective OSCE (Objective Structured Clinical Examination) and learning in medical simulation centers - says the expert
- This is, in fact, a return to the concept from a dozen or so years ago, but - according to the rectors - the concerns that accompanied it at that time have lost their relevance.
- However, residents have a different view and set a condition
The idea of eliminating postgraduate internships for doctors has resurfaced. Medical professionals and policymakers alike revisit the idea every few years. A proposal was once successfully pushed through, but before it could be tested, the next Ministry of Health administration reinstated the internship. Now, the rectors themselves have proposed its abolition in talks with Minister Jolanta Sobierańska-Grenda .
Prof. Wojciech Załuska, Chairman of the Conference of Rectors of Academic Medical Universities (KRAUM) and Rector of the Medical University of Lublin, emphasizes in an interview with Rynek Zdrowia that "maintaining the postgraduate internship in its current form is no longer substantively justified."
- Verification of practical skills is ensured by the objective OSCE (Objective Structured Clinical Examination) and learning in medical simulation centers, which guarantee uniform and safe clinical training - he emphasizes.
Therefore, in the opinion of the rectors, the abolition of the internship should take place in parallel with the full implementation of the new clinical education program and the OSCE examination at all universities.
The first cohort to be no longer covered would be graduates who started their studies in the 2024/2025 academic year, according to the new standards of the Ministry of Education and Science.
The change would be a consequence of the curriculum reform, which transfers full responsibility for education and competence assessment to medical universities.
- This is a step towards a modern, European model of medical education, which will increase the efficiency of the system, accelerate the entry of young doctors into the profession and improve the rationality of spending public funds - argues the Rector of the Medical University of Lublin.
The Ministry of Health covers the internship fee. It also provides funds to the marshal's offices for organizing the internship, which are then distributed to hospitals and clinics.
When asked about the elimination of postgraduate internships, the Ministry of Health admitted that the proposal was raised during talks with the Presidium of the National Medical College (KRAUM), but no decision has yet been made. "The issue is being analyzed," added the Ministry of Health's Communications Office.
The abolition of mandatory internships for doctors is a return to a concept from over a decade ago.
The Ministry of Health, under the leadership of Ewa Kopacz, had already attempted this solution, abolishing it in 2011 through an amendment to the Act on the Medical and Dental Professions (the last internship for dentists was to begin in 2016, and for physicians in 2017). The internship was then to be replaced by a two-semester practical training program during the final year of studies. However, this move was met with harsh criticism, and Minister Konstanty Radziwiłł reinstated this form of training at the last minute.
The Ministry of Health, under the leadership of subsequent ministers, returned to the topic in 2021 and 2023. However, each time it sparked heated discussions.
Four years ago, some in the medical community sharply criticized the idea. After medical school rectors passed a resolution abolishing the mandatory one-year postgraduate internship, and the Ministry of Health embraced the idea, the proposal was protested by, among others, the Supreme Medical Council.
The Presidium of the NRL justified in its position that "a postgraduate internship is an element necessary to ensure the appropriate level of education of doctors and dentists at the stage of preparation for independent practice of the profession and a guarantee of the implementation of the patient's right to health services of appropriate quality."
The Presidium also took the position that "it is the best way for university graduates to acquire the qualifications to independently practice their profession."
Doctors argued that it is also "a necessary supplement to the knowledge, and especially the practical skills, acquired during studies."
In a survey for doctors conducted by konsylium24.pl at the time, as many as 84% of respondents were in favor of maintaining the current solution, and only 9% of those surveyed believed that the internship should be abolished (7% had no opinion on this matter).
77% of respondents believed that the elimination of internships would make it more difficult for doctors to prepare practically for their profession.
71% indicated that it would make it more difficult to make informed choices about specialization, and 62% feared it would lower the quality of education (each respondent could choose the three most plausible justifications). However, doctors agreed that the education system requires change.
Today, this idea is also receiving critical reviews. According to the OZZL Residents' Agreement, it is simply unacceptable in the current situation.
"In recent years, we have witnessed a rapid increase in the number of places in medical programs. As a result, there are currently nearly 11,000 first-year students. This has come at the expense of the quality of education, as the Ministry of Science and Higher Education publicly acknowledged several months ago, recommending that places be awarded to universities that do not meet any educational standards," the residents' organization states in its official statement.
He also notes that the opening of new medical programs has reduced the availability of teaching staff. "In such a situation, shortening the training by a year will further reduce the level of knowledge among young doctors, especially their practical skills," residents fear.
Therefore, as they point out, "a necessary condition for initiating any discussions about eliminating the internship should be the introduction of a mandatory sixth year at all universities, conducted in two-person clinical groups at the patient's bedside." This, young doctors believe, is unrealistic given the current situation of academic teachers.
Currently, in some Western countries, such as France, Germany, the Netherlands, and Spain, postgraduate training is not required. It is assumed that clinical training sufficiently prepares physicians for professional work.
In Norway, the internship lasts 12 months in a hospital and six months in a clinic. In Portugal, doctors complete a year of additional training in internal medicine, surgery, pediatrics, and family medicine. In the UK, it lasts up to two years, with the second year allowing them to see patients independently.
The entire conversation with Professor Wojciech Załuska on the abolition of mandatory postgraduate internships for doctors will be available tomorrow at Rynek Zdrowia.
Copyrighted material - reprint rules are specified in the regulations .
rynekzdrowia
