First Deputy Minister of Health of Ukraine Serhii Dubrov Discussed Internship-Related Issues with TNMU Students

On March 29, 2024, the First Deputy Minister of Health of Ukraine, Serhii Dubrov, visited Ternopil National Medical University on a working visit in order to meet with students of graduation courses to discuss with them the changes in the assignment to the internship, its completion and further plans of the Ministry of Health.

Serhii Dubrov told that the Ministry of Health had planned to implement electronic distribution of internships from 2024. For this, all the technical components are already ready, but the full operation of the program can be expected at the beginning of June. Accordingly, in order for the internship distribution process in 2024 to take place on time, the Ministry of Health decided to postpone the electronic distribution to next year.

Serhii Dubrov started the meeting with an analysis of the shortcomings of the internship distribution system, including:

1. Inadequacy of the number of places offered for internships by specialty to the real personnel need. So far, according to Serhii Dubrov, health care institutions have sent proposals not because of a real need for specialists, but because they want to train intern doctors at their facilities. This does not guarantee the further employment of young specialists in these institutions.
2. Lack of a mechanism for academic mobility of interns within Ukraine and abroad to acquire the necessary competencies and practical skills.
3. Absence of an English-language form of internship training for foreigners. India is making such demands today.
4. Lack of arrangement of the features of internship admission for demobilized servicemen, persons who underwent internship in temporarily occupied territories.
5. The need to review the list of internship specialties and the duration of training for individual specialties, etc.

Serhii Dubrov drew attention to the fact that in 2024, the list of health care institutions, in which employment and practical training of interns can be provided, is planned to be expanded. “We consider it necessary, as shown by European and world practice, that after completing internship training, a young doctor should be able to remain at work at the health care institution in which he completed internship training, if they wish.

The first deputy minister of health care said that for health care institutions of communal and state ownership, which are providers of medical services under the medical guarantee program and in which there are positions of intern doctors, the conclusion of a contract is a mandatory condition with National Health Care Service under the package “Ensuring the personnel potential of the health care system by organizing the provision of medical care with the involvement of intern doctors.”

A medical specialist who has completed an internship training program funded by the state is provided with a job in the relevant specialty at the health care institution they have chosen according to the rating distribution. “I want to draw attention to the fact that today no one forces anyone to serve a certain number of years. Each graduate of the state and contract form of education, according to their personal rating of academic success, the main part of which is the result of the “KROK 2″ exam, chooses the specialty in which they want to work or the region where they want to get a job. If the graduate has the highest rating, they can choose their dream specialty and health care institution. This year, the geography of distribution by each institution of higher education is preserved. Next year, with the start of the electronic distribution system for internships, a graduate of any higher education institution will be able to choose any institution of higher education for the full-time part of the internship and any health care institution, specialty or vacant position,” Serhii Dubrov said.

The request of TNMU graduates regarding the geographical distribution of internships based on the results of a survey of students.

The request of TNMU graduates regarding the desired specialty based on the results of a survey of students.

If there is no possibility of employment after the internship at the selected health care institution (reorganization of the institution, reduction of the position), the health care department of the local state administration is obliged to provide employment for a vacant position in another health care institution.

Algorithm of rating distribution in 2024:

– in February, the Ministry of Health provides the health care departments with the planned number of vacant positions of intern doctors;

– in March, health departments provide the Ministry of Health with information on vacant positions of intern doctors, determined in accordance with the personnel needs of the health care sector in the regions, taking into account the available vacant positions of specialist doctors;

– in May, the Ministry of Health provides higher medical education institutions with information on vacant positions of intern doctors in relevant specialties in health care institutions in the relevant regions and to which institutions of higher education can assign graduates;

–rating distribution for internships is carried out by the commission of the higher education institution for graduates whose studies were funded by the state and at the expense of natural (legal) persons.

Serhii Dubrov answered a number of questions from students of Ternopil National Medical University.

I want to ask a question about various categories of students, because not everything is clear there: for example, those who have a disability, whose parents are disabled, who have children and are pregnant. That is, will these categories somehow affect the distribution?

Thank you for the question. In Order No. 367 it was written and it was the basis. I support that the presence of small children, the disability of the graduate, the disability of first-line relatives should be taken into account. Please, write this proposal in the form of a public comment and we will support it as it was in Order No. 367, which was cancelled in 2022.

Is it possible for a student whose studies are funded by the state to refuse an internship altogether and will the state need to compensate for the study funds?

Of course, it’s a pity that these six years of study will be a waste of time. There is no refund mechanism. Even if a higher education institution wants to sue you, you will definitely win. You do not have to compensate for tuition fees.

If the student whose studies are funded by the state during the distribution chose the place of internship at the proposal of the Ministry of Health and during the signing of the agreement with the hospital, will the terms of this agreement include mandatory work for 3 years?

I will say right away that the hospital cannot demand such a thing. For now, we ask medical institutions to provide the possibility of further employment of intern doctors, but there is no mandatory training. Every reasonable manager of a health care facility is interested in keeping a young, able-bodied doctor. Recently, we were in a hospital in the Volyn region. This is the Volodymyr Territorial Medical Association. This institution is headed by a young manager, Tetiana Vashchuk (a 2012 graduate of TNMU). Over the course of 3 years, she made it many times better than private healthcare facilities in Kyiv or abroad. This is a fully capable hospital with 25 packages of NHCS, and the doctor’s salary is 50-60 thousand hryvnias. She is a great manager. Considering that she is also your graduate, this once again confirms that Ternopil National Medical University is the best in Ukraine for many years. I graduated from NMU, but TNMU was ahead of our university in the rankings. As for the quality of education, no one will argue that you are the best.

How do you determine the needs in certain specialties?

We collect information about vacant positions in health care institutions and, thus. determine the need for a particular specialty. I did not like the information provided last year, as it was more a desire to teach interns than a reflection of the real situation. Today we are talking about real vacancies. In Ukraine, a portal for medical staff vacancies is being launched, so we will clearly see where and which specialist a medical institution needs.

According to what principle are vacant places in internships distributed among universities?

We collected questionnaire data from all students of graduation courses in Ukraine. We will take them into account. The commission will evaluate the available vacant positions, take into account wishes regarding geography and specialties. If you look again at the chart of graduates of Ternopil Medical University, all needs seem realistic and can be satisfied.

Will institutions from the National Academy of Medical Sciences provide information on vacant positions at the same level as communal institutions?

From 2025, all institutions of the Ministry of Health and the National Academy of Medical Sciences will be transformed into state non-profit enterprises. We will conduct negotiations with research institutes. If they are willing to provide places and pay the salary of an intern doctor, then why not. So far they have not provided information about vacant positions, but we can contact them.

Can graduates of the contract form of study in Medicine choose an internship in paediatrics?

There is a very big academic difference between specialties 222 and 228. If there is no big academic difference in some specialties, then there will be no problem. For certain paediatric specialties, graduates of specialty 222 Medicine can go on an internship.

As for specialty 228 Paediatrics, the Ministry of Education and Science wanted to withdraw this specialty this year. So far, we have defended it, but the European integration process is ongoing in our country, and in Europe there are no paediatric faculties, but purely medical faculties, so sooner or later there will be no paediatrics faculties in Ukraine, but only those of general training in medicine. Accordingly, the situation will also change with regard to applications to internships. If someone really wants to be a specialist in the field of paediatrics, after an internship in general practice – family medicine, internal medicine, they can get a specialization in paediatrics.

If a student is considering admission to the Military Medical Academy, then they refuse to be assigned to an internship. But entrance tests in the Military Medical Academy take place several months later than the internship start. What does that applicant have to do: refuse to be assigned to an internship, and in case of unsuccessful admission, take part in the next year’s assignment?

I will say unequivocally that we will create all the conditions so that everyone willing will enter the Military Medical Academy. You have a choice: agree to the place of internship, enter the Military Medical Academy and, in the event of admission, refuse the internship, or refuse during the placement and, in case of unsuccessful admission, take part in the next year’s placement.

Does the Ministry of Health plan to introduce a residency in neurosurgery this year?

This year, we planned to introduce residency in three specialties – neurosurgery, cardiac surgery, thoracic surgery. However, this year a residency will be introduced only in neurosurgery and the duration of training in it will last 3 years after a 3-year internship in surgery. There are GPA requirements and others. We need 4-5 neurosurgeons per year, so the demands will be high. We wanted to set a payment of 40,000 hryvnias for a neurosurgeon resident, but the Ministry of Finance has not yet confirmed this, but we will continue to work in this direction. The department of neurosurgery will be responsible for entering the residency, and perhaps in three years it will be the bodies of medical self-government. In 2025, we plan to start implementation of a residency for thoracic surgery and cardiac surgery. First, let’s see how this year’s admission to residency in neurosurgery will take place.

In India, one of the main requirements is to receive a certificate after completing the internship, which is identical to the certificate of the resident country where they are doing the internship, but according to the regulations, they do not have the right to work in Ukraine. On the basis of what do they get the right to undergo an internship?

On the basis of confirmation of the diploma in one’s country. We spoke with representatives of the Indian embassy in Ukraine, where they confirmed that it is important for graduates from India to have a certificate of practical training. We can also offer an English-language internship with the completion of Krok 3 in English. There are no problems with this, because they take “Krok 1” and “Krok 2” in English, so for “Krok 3” you can also make an English-language tests, but with mandatory internship training for 2 years. Indian students do not want to study for 2 years in an internship, so we offered a compromise option of one year of study according to the requirements of the Indian curriculum with obtaining a certificate of general medical practice. And it will be unfair to Ukrainians who undergo a full internship if we give them the right to work in Ukraine after a one-year internship. I suggest that this item be submitted to the public discussion, and after discussion with lawyers, we will make an appropriate decision.

TNMU Press Secretary, Yanina Chaikivska.

Photographs by Mykola Vasylechko.