Study tour to Switzerland

This week, from 5 to 8 June 2023, Basel (Switzerland) hosted a study visit to the Swiss model of university hospitals, which we organized for our medical staff and representatives of government and medical institutions. Together, we studied the Swiss healthcare and medical education systems, making Switzerland a benchmark in these areas.

Our group of experts is leaders and educators in the healthcare sector. Among them are Serhiy Dubrov, Deputy Minister of Health of Ukraine, representatives of the National Health Service of Ukraine, Bogomolets National Medical University, Danylo Halytskyi Lviv National Medical University, Health Department of Lviv Regional State Administration, Yuriy Semeniuk Rivne Regional Clinical Hospital and Dobrobut Medical Network.

Below, we share some interesting facts and opinions about the trip. 

Interesting facts about the healthcare system and medical education in Switzerland:

• Switzerland has the most decentralized and extensive network of family doctors and nurses. This allows them to respond quickly to challenges in the healthcare system;
• Medical professions, from doctors to chiropractors, are regulated by the federal law on medical professions;
• Educational programs in the medical professions, both undergraduate and postgraduate, are subject to accreditation.

The first day of the educational tour

The professionals visited the Swiss Institute of Tropical and Public Health (Swiss TPH) on the first day of the visit. It is a leading institution in health research, training, and services and the implementer of the Ukrainian-Swiss Medical Education Development project. It employs more than 900 people from 80 countries.

“For us, such study tours are an important contribution to shaping the future of healthcare in Ukraine. Once upon a time, Switzerland relied on the experience of Canada, some US medical schools, and Maastricht University, and today, we have the opportunity to study the Swiss experience. Studying the Swiss healthcare system and medical education will help us introduce modern approaches to training, particularly within university hospitals, which will help improve the competencies of doctors and nurses who will provide quality medical care to patients. The leadership of motivated professionals ready to advocate and implement changes at the country level and the level of each university is crucial in this process,” summarises the first day Olha Korolenko, coordinator of the Ukrainian-Swiss project “Medical Education Development.

The second day of the educational tour

A group of experts visited the University Hospital Basel to learn about the institution’s structure and effective management. The University Hospital Basel has three governing bodies:

• The Steering Medical Board – Steuerungsausschuss Medizin SAM, which includes the directors of the health departments of the two cantons and two members from higher education institutions;
• The Medical Coordinating Committee – the Dean and Head of the Faculty, the Director of the ULB, and two members of the Rectorate;
• University Council: 5 members from the cantons of Basel-city and Basel region plus one representative from the university.

The University Hospital Basel is directly managed by the Executive Director and his secretariat, the Medical Director, the Chief Academic Officer, the Chief Financial Officer, and the Chief Human Resources Officer. Together, they make up the Board of the University Hospital Basel.

“Today, our focus was on university hospitals. We discussed administration, explored the process of acquiring clinical skills, and even visited a simulation center. Despite the different institutional features, it turned out that we have many common problems and possible successful solutions that we will implement,” shares impressions Mykhailo Ryabinchuk, Chief Professional Development Specialist at the Professional Development Department of the Public Health Centre.

In addition, our team got acquainted with the didactic concept and the Teach the Teacher program at the Faculty of Medicine of the University of Basel and the University Hospital of Basel.

The program has six modules, from which teachers can choose the ones they need for their professional development. The modules and topics cover various aspects of work: didactics, tutor training, teaching at the patient’s bedside, objective structured clinical examination, curriculum development, mentoring, and feedback.

For a teacher to successfully start working at a medical school or hospital, they must

• Complete three training courses and receive a “Certificate in Higher Education Didactics”;
• Conduct a test lecture within the educational program, which must be positively evaluated by the students (at least 20 positive feedbacks from students with a minimum score of 7.5 out of 10);
• Present a teaching portfolio (at least 42 academic hours following the requirements of the faculty).

The third day of the educational tour

We continue to delve into the internal workings of the University Hospital Basel; in particular, we learned more about the Swiss system of postgraduate medical education and continuing professional development.

The key event of the day was an introduction to integrating medical students into the hospital’s routine work during their studies. A great emphasis was placed on practice to consolidate theoretical knowledge and give confidence to specialists from the first days of working with actual patients. We had a chance to talk to students and resident doctors and ask them in detail about learning and professional development in Swiss healthcare.

Both undergraduate and postgraduate students undergo an internship at the hospital, depending on their year of study:

• The purpose of the internship in the first year of a bachelor’s degree is the so-called “introduction to medicine,” the first contact with patients, the first impression of the doctor-patient relationship, the first experience in a multidisciplinary team,
• In the third year of the bachelor’s degree and the first year of the master’s degree, students spend more time in the hospital, at least 2 hours a week, where they conduct clinical examinations and get acquainted with medical histories in small groups of 4-5 people under the supervision of a supervisor,
• In the second or third year of the master’s program, the internship takes the form of employment for 2-4 months. The student works 50 hours a week at the hospital, of which 5.5 hours are spent studying there. Once a month, they are on duty from Friday to Sunday, have two days of leave per month, and receive a monthly salary of CHF 1,200. This internship consists of several rotations in hospital departments.

Each healthcare and medical education institution promotes lifelong learning, focusing on providing the clinical skills needed in the here and now and ensuring that doctors continue to develop and learn throughout their careers. This approach promotes adaptability and continuous improvement and helps maintain high healthcare standards.

The Swiss Institute for Postgraduate and Continuing Medical Education (SIWF) is responsible for the quality of postgraduate education and CPD.

It is made up of medical societies/associations, representatives of medical education institutions, healthcare institutions, and the federal healthcare administration. The main task of the SIWF is to formulate requirements for the content of postgraduate education programs and accredit centers of such education, which can be hospitals, departments, or private practice. Today, there are about 1,500 accredited training centers in Switzerland.

The fourth day of the educational tour

Our group traveled from Basel to St. Gallen to learn about the experience of the cantonal hospital.

In contrast to the University Hospital Basel, the Cantonal Hospital St. Gallen is an affiliated hospital that provides medical education in cooperation with the Universities of St. Gallen and Zurich.

Here’s what a week of formal and informal education at St. Gallen looks like:

1. Monday: general rounds with the chief and senior doctors.
2. Tuesday: X-ray presentation with discussion and explanation of diagnostic criteria. There is also a journal club where participants present and collectively discuss relevant articles, their study design, and results.
3. Wednesday: X-ray presentation with discussion and explanation of diagnostic criteria; interactive discussion of short clinical cases and a broader discussion of the clinical case of the week.
4. Thursday: specialized lecture, general rounds with chief and senior doctors, infectious diseases.
5. Friday: presentation of an X-ray with discussion and explanation of diagnostic criteria; practical seminar on work organization, use of medical protocols; cardiology.

Each Friday ends with case presentations by senior doctors, and once a month, there is an interdisciplinary tumor board, other interdisciplinary boards, or special reports on narrow specialties.

We also discussed the organization of postgraduate specialized training (PUST) at the Cantonal Hospital of St Gallen. Switzerland has a smooth transition from university to specialized training thanks to a cohesive and comprehensive approach to medical education.

Our group of experts met with Dr Raphael Stoltz, Vice President of the Swiss Institute for Medical Education (SIWF), responsible for continuing medical education. He gave us a presentation about the SIWF and its key role in the Swiss medical education system.

In particular, the institute is responsible for:

• Changes in programs and names of specialties;
• Creation of new specialized programs (must be approved by the government);
• Changes and/or creation of new qualification certificates and centers;
• Accreditation of educational institutions (in universities, hospitals and doctor’s offices);
• Training of teachers;
• Jointly with specialized organizations for continuing professional development activities.

Yuriy Ordynskyi, Medical Director of Surgery at Rivne Regional Clinical Hospital, was among the team of participants who took part in the study tour in Basel.

Yuriy shared with us his impressions and reflections on the trip.

“The first thing you notice is that the educational process is not focused on the number of medical degrees obtained but on the quality of training of doctors throughout the entire educational process.

The number of masters is many times less than in Ukraine, but the level of training is much higher. And the main advantage of this is the work of teachers with groups of 5-6 students. Students are involved in the hospital from the first year of study and gain practical skills.

Practitioners from universities are fully involved in the medical process and are employed in hospitals accredited to train students.”

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“I was also very impressed that there is a form of public-private partnership: an attestation organization, which includes representatives of hospitals, universities, and healthcare authorities. The main goal is for the state to delegate to this organization the ability to certify undergraduate education, postgraduate education, and all continuing education courses for doctors and teachers.”

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“Postgraduate education is regulated. Programs and work schedules for young doctors are prescribed. Training on a practical basis takes place in small groups with many theoretical and practical classes. The duration of such training is up to 6 years.”

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What would you like to implement in our healthcare facilities?

• Establish more evident cooperation with the university to conduct cycles of theoretical training at clinical sites.
• Group interns and assign them to specific supervisors who will accompany and train them. If necessary, increase the number of doctors who will teach.
• Conduct training for doctors who will be teaching interns.
• And the key thing for all participants in the training of doctors should be to take responsibility for those who, how, and what we train young doctors.

This concludes the visit to Switzerland that we organized for our doctors and representatives of governmental and medical institutions.

This is the end of the visit to Switzerland that we organized for our doctors and representatives of governmental and medical institutions. We sincerely thank all the specialists and institutions that made this trip possible. For several days, we studied the Swiss healthcare and medical education systems to implement the best practices in Ukraine.