The logic of the MED project architecture: the framework – all comprising umbrella for all project activities
Groups of institutions – key collaborators of the MED project:
А. higher medical education institutions (HEIs - Autonomous university, academy) who create human resources for health care; the Project is guided by the Capacity building approach here that comprise various components of medical education – it represents a system thinking and student/graduate-centred approach;
B. health care facilities (mostly primary health care - PHCs), where medical university, medical academy graduates are working, as employees they are improving their competencies (also at the universities, its post-graduate departments) and provide the services to people (the latter are always in the centre of the healthcare system);
C. national and regional governing bodies – Ministry of Health of Ukraine, National Agency for educational quality assurance, Ministry of Education and Science of Ukraine, National Health Service of Ukraine – they develop policies and create the rules for A. and B., enhance conducive for the development environment etc.
What are the agents (groups of professionals) at HEIs:
- Educators who should demonstrate teaching excellency, disseminate good practices (e.g. in Peer groups), implement better skills-focused trainings for students
- Management / administration aiming at (a) monitoring, dissemination of values that lead to education development, i.e. academic integrity, transparency, respect etc. vs corruption), that is incredibly important for good learning environment where new professionals are growing and obtaining their competencies (knowledge, skills and attitude); (b) prioritization of the problems and practice efficient resource allocation, including the areas related to human resource management, finances, educational process management and digitalization of the processes
- Additionally, specialists (e.g. IT, of educational departments, skill labs assistance) should understand the key principles of education and be competent enough to facilitate implementation of innovations in the facility. The MED project does not focus its activities on this group, but we involve them in joint activities with educators and/or administration when relevant
- Students should also be active actors while educational processes and products are designed (that is a student-oriented approach), however now students' involvement is minimal as well as their needs are not always integrated in the educational policies and practices. Although the project underlines the competencies of educators and administration that has an essential impact on the students (and are sustainable), still the physical students' spaces as a part of the learning environment (included in the international accreditation criteria as campus) is almost the only activity where the primary target audience is students.
What are the key areas of collaboration at HEIs:
- The overall capacity building approach has been outlined by the project in January 2020 – after the first year of the project, when multiple challenging / problematic areas were identified. It is based on system thinking and student/graduate centred approach which underline the complexity of the system (instead of focusing on one-two areas, it is important to intervene several areas simultaneously for sustainable development)
- Competence – based education is the main guiding principle in educational practices, is has been introduced more than a decade ago, still its potential is not recognized by the Ukrainian educators, administration of the universities, academies. The key messages of the competence – based education are (a) the competences obtained on the graduation should be clearly outlined, they should be measurable and translated in the curricula; (b) the learning objectives should be consistent with the teaching mode and with the assessment criteria. This alignment has a critical impact on the quality of education.
- Learning environment is also an important concept that assists better understanding of gaps, needs, achievements, e.g., curriculum, teaching practices, campus etc. This concept is integrated into the M&E of the project, the indicators are based on the measures of learning environments in pilot and non-pilot institutions
- Educational institutions rarely think in terms of good managerial / governance practices as they focus mostly on education and research. Still, financial, human, informational resources should be efficiently and transparently managed to assure good outcomes (graduates with standard competences who are willing to become a medical doctor, nurse etc.)
- It is not only education, but research and practice that core ground of university.
Health care facilities are seen as collaborators of the project in the following areas – groups of professionals:
- Health care managers should have managerial competencies for better and more efficient allocation of human, financial and information resources. Thus we (with partners – UCU, UHC) develop courses, programs, events for their development
- Nurses should be involved in the process of service provision, should have their career trajectories and should continue their professional development as medical doctors. For this we implement an “Advanced practice nurse in primary care” project.
- Family doctors and other primary health care providers need reliable sources of information for their professional development as well as community building for professional exchange and assuring ‘family medicine’ is highly appreciated and recognized in the society.
National and regional bodies are considered in the project as those who create the rules, policies and environment for the universities, academies, health care facilities, who monitor their principles and practices while providing services etc. Depending on the quality and relevance of these rules, policies, the final consumer, client (patient, student, state) receives the product with characteristics which reflect the expectations / frameworks given by the governors. Hence, the project collaborates, supports, and creates partnership with the national and regional bodies aiming at better policies, an environment where autonomous health care facilities and educational institutions could develop needed for society value (products, knowledge, health etc.). For example, the MED project initiate involvement of professionals of the National agency for education quality assurance in promotion of competence-based approach and explanations of the principles of new autonomous status of institutions. The Ministry of Health of Ukraine (beneficiary of the Project) also should create policies for better arrangements of internatura, CPD of the human resources in health, hence the project supports it with the expertise, events etc.
The operations of autonomous facilities have different layers of transformation depending on their development. At the moment, the MED project’s experts underline the importance of (a) educational standards of good quality for educational process, (b) enrollment criteria to assure that the motivated and with good knowledge enrollees will have scholarships for their medical studies, and (c) the exams – assessment of the competencies of medical school graduates are not aligned to the list of competencies (defined in the recently approved educational standard). Thes principles/areas are elaborated by the national regulators together with medical educational representatives, discussed by the civil society and medical professionals.
Similarly, (a) occupational standards, (b) financial stimuli, and (c) guidelines are important to be elaborated as the framework for the health care facilities’ good practices, communicated and implemented.
Certainly, more actors and principles are or should be outlined in the education – profession – regulation scheme, e.g. hubs that provide certain products, expertise for the mentioned organizations. Still, with this picture we try to emphasize the largest components and linkages between them.
Note: the framework is outlined as picture by the MED project team in January 2022 for better visibility and communication of the project architecture. It is seen as a base for Phase 2 elaboration where we plan to put more emphasis on the bridging education and practice, on the key principles (development, implementation and communication with the A., B., and C), e.g. educational and occupational standards, measurable criteria of the effectiveness of educational interventions.