From the left: Prof. Dalius Jatužis, Prof. Harm Peters, Prof. Janusz Janczukowicz / © MF archive
This year's December 15th saw the occurrence of the conference on the competencies and qualifications improvement project for Vilnius University (VU) doctors (Project No. 09.4.2-ESFA-V-715-06-0001) – 'Changes in Residency Training Systems: Challenges and Opportunities of Competency Integration.' The conference mainly addressed the integration of stepwise competency concepts (Entrustable Professional Activities, EPA) into residency training programs.
The goal of the conference was to bring together representatives from the Ministry of Health, foreign medical education experts, and Vilnius University to discuss implemented activities, celebrate achievements, acknowledge challenges overcome, outline future priorities, and address mistakes while seeking alternatives and solutions in improving physician training programs and defining the needs for stepwise competencies.
The event was initiated by opening remarks from the Dean of VU's Faculty of Medicine, Prof. Dalius Jatužis, the Vice-Dean of Subsidiary Studies, Prof. Vytautas Kasiulevičius, VU's Vice-Rector for Studies, Assoc. Prof. Valdas Jaskūnas, and the Vice-Rector of the Lithuanian University of Health Sciences (LSMU), Prof. Kęstutis Petrikonis.
Prof. Dalius Jatužis / © MF archive
'It is a great honor and joy to participate in this conference. Residency lives as much as our contemporary Lithuanian independence. The period from 1990 to 1993 was a time when we transitioned from the previous doctor training system to an entirely new qualitative stage. Times were changing, medicine advanced in diagnostics, treatment, and prevention. Education and physician training could not stand still, not with time moving forward. The greatest asset of the healthcare system is not iron, not just equipment, drugs, but the people working in the system. This conference is an excellent opportunity to hear where we are now, what we have achieved during this project, and what steps are planned for the future,' said Prof. Dalius Jatužis.
'Over the past 10 years, the Faculty of Medicine at Vilnius University has made a significant change by restructuring 63 residency programs and introducing EPA. I believe this change will have a long-term impact on both the education process and the early stages of medical careers. The development of medical residency education is of exceptional and even strategic importance to Vilnius University as an institution responsible for the future of the country's health, healthcare system, and education in this field,' stated VU's Vice-Rector for Studies, Assoc. Prof. Valdas Jaskūnas, at the beginning of the conference.
From the left: Prof. Vytautas Kasiulevičius, Prof. Harm Peters, Prof. Janusz Janczukowicz, Prof. Olle ten Cate, Prof. Dalius Jatužis / © MF archive
The conference participants listened to presentations by Prof. Dalius Jatužis and invited lecturers: Prof. Olle ten Cate (Utrecht University, Netherlands), Prof. Harm Peters (Charité – Universitätsmedizin Berlin, Germany), and Prof. Janusz Janczukowicz (University of Lodz, Poland).
The first presentation was by Prof. Dalius Jatužis titled 'Presentation of the Main Project Activities and Results: Challenges and Triumphs.' The Dean of the Faculty of Medicine reviewed the results of the mentioned project initiated in 2018: the update of 63 residency study programs by the Medical Faculty Council based on the new stepwise competency implementation model – EPA; acquisition of new simulators for the Medical Science Center for 1 million euros; remote training conducted by Prof. Peter Harms for residency study coordinators, project experts, and residents (training over 3500 doctors); completion of the development and implementation of a new residency study monitoring and administration system, including the electronic residency portfolio; residents working in regional healthcare institutions; changes in the legal basis of healthcare, approval of new lists of competency for residency studies, and more. 'The competency-based model of undergraduate and postgraduate studies is a system that ensures that a resident has sufficient qualifications upon completion of studies. The competency-based model functions in medical and dental practice. Is there a difference between stepwise competencies and EPA? Yes: in legal acts, stepwise competency does not reflect professional activity, the resident's ability to engage in practical professional activities. This made us rethink whether the concept of stepwise competencies is suitable for us,' said the Dean of the Faculty of Medicine in his presentation.
Prof. Olle ten Cate / © MF archive
Prof. Olle ten Cate began his presentation, 'The Purpose of an EPA-based Residency Program and Addressing the Challenges of its Implementation,' by asking, 'Would you entrust the health of your family members to all graduates? Perhaps you have had to approve the completion of a program or rotation even though you were not entirely sure that the student had achieved the set standards?' The professor invited the audience to consider a serious issue: whether all individuals completing residency studies are truly prepared to practice their profession. 'In many cases, there are people who have completed their studies with high results and are ready to practice. Then there are those with lower grades who may not be ready to practice – this is completely understandable. There may also be cases where a person has lower results but is ready to practice. However, the most dangerous situation is when individuals complete their studies with high results but are clearly not ready to practice,' said Professor Olle ten Cate. According to him, competency-based preparation for the medical profession requires standardization of practical skills for all individuals completing residency. 'It is necessary to standardize the competencies that a practicing doctor must have, what a truly good specialist must be able to do. Only in this way can we reduce falsely positive assessments of skills,' the professor emphasized.
Prof. Harm Peters / © MF archive
'While the idea of EPA did not originate in academic societies, they have always played a significant historical role in the fields of professional education and training. Academic societies establish standards and practices, collaborate with healthcare institutions and regulatory bodies. Therefore, I am very pleased that today's conference theme, not limited to just EPA, is about what it means to be well-prepared for professional medical practice,' said Prof. Harm Peters, President of the Association of Medical Schools in Europe (AMSE), in his presentation 'Role of Academic Societies in EPA Development and Implementation.' According to him, an academic society is a natural environment for medical schools to exchange experiences in education, research, management, and patient care, find future concepts, and define what medical education should be like. Academic society meetings are expert groups that can be approached, and on a national scale, they form EPA standards, actively participating in the activities of institutions (organizing various workshops, webinars, information campaigns, conferences, etc.). 'Of course, let's not forget the challenges that academic societies face. One of them is that standards can be established, but each medical school, organization, or other institution is very different, with its own people, local thinking, and traditions. Therefore, despite the need for standardization, these factors must also be taken into account,' Professor Harm Peters said.
Prof. Janusz Janczukowicz / © MF archive
Prof. Janusz Janczukowicz presented the lecture 'New Health Workforce Competences Responding to Rapidly Changing Permacrisis Landscape.' 'Today, we are experiencing a permacrisis. We did not expect climate change, pandemics, or wars. We live in a post-COVID era, and it somewhat worries me that we are urged to 'return to how it was.' This is undoubtedly a wrong direction. We need competencies on how to deal with such critical situations. We need competencies on how to act in the face of uncertainty,' said the professor. Addressing the politicians present at the conference, Prof. Janusz Janczukowicz emphasized that education for those working in the field of healthcare is expensive but the best investment that can be made. 'We have many examples of how excessive focus on return on investment had disastrous consequences. Therefore, we must focus on the quality of education. Whatever you plan to implement, it must be related to both the education of people working in the field of healthcare and patients themselves. Education experts should be involved in every major project. We must focus on interprofessional education, move away from this hierarchical perspective where the doctor is important, and representatives of other professions are less important. We are one team, working together for the same success,' concluded the professor.
After the presentations, conference participants were invited to join workshops led by the speakers: Prof. Harm Peters – to discuss the development of EPA-based training programs, Prof. Olle ten Cate – to consider EPA assessment strategies, Prof. Vytautas Kasiulevičius – to discuss changes in the faculty community when implementing the stepwise competency concept, and Prof. Janusz Janczukowicz – to discuss new necessary competencies in responding to extreme situations.