Česky
What does getting accredited mean for your department?
It is worthwhile for the department and the hospital to educate our own physicians, and I am glad that we were able to regain accreditation by changing the education ordinance. We are allowed to have our own specialist training for internal medicine, i.e. internal medicine.
Can you give us an overview of how postgraduate medical education works?
A doctor doesn't become fully qualified until he or she is around 30 to 32 years old. It used to be called the attestation exam. The post-graduation period for each doctor is 6 years in total. It starts with the so-called basic strain, for which we have a five-year accreditation. A candidate who opts for the internal medicine strain enters the training program for 30 months and, with the exception of a two-month internship in surgery and the ER, works primarily at the bedside. He or she always has a supervisor, a senior physician with experience and specialty training. In addition to the bedside, he also practices in outpatient clinics, under supervision, of course. We also have a number of outpatient clinics in our country, such as cardiology, diabetes, gastroenterology and endocrinology.
What happens after the 30 months when the doctor completes the compulsory internship and practice in the department?
After this period, he or she applies to the medical faculty for a week-long training camp, which ends with an examination. This is proof that he or she has moved up a level in qualification. Not only economically, but also in responsibility. He is not yet a doctor who is certified, so he still has a supervisor. In this period, after the basic training, the doctors, future specialists, go for shorter or longer internships at highly specialised faculty or regional centres. We have an agreement with the Prague teaching hospitals where we send our doctors for post- and pre-service training. The lengths of these stays are specified by a decree of the Ministry of Health. As a rule, they start with cardiology, but gradually the doctors visit other clinics such as gastroenterology, endocrinology, nephrology, pneumology and so on.
What advantage can smaller hospitals gain when their doctors leave to practice in big cities? Do they come back?
In the years I've been here, I've been very positive about that. It should be stressed that these doctors are still our employees even when they are on their internships. Their salaries are paid by our hospital. According to the current decree of the Ministry of Health, the duration of these internships has been shortened, but we are still missing these doctors in the internal medicine department for months at a time. And specialised training lasts 30 months. The advantage, however, is undoubtedly that they gain valuable practical experience and knowledge, as well as personal contacts with specialists at the clinics, which is then beneficial for consultation activities and for the eventual hospitalisation of our patients.
Does it happen that your doctors do not return after training?
It is typical of our field that many women work in it. They go not only on maternity leave, but also to GP surgeries where they have a daily routine. Over the past few years, we have thus trained GPs in Beroun and throughout the district, who have replaced the older set of doctors who retired. Also, some doctors prefer to work in specialised outpatient clinics, especially in Prague, where they have a daily regime of work without weekend and night services.
"The advantage of internships in specialist clinics is that our doctors gain valuable experience and contacts."
You have been working in Beroun since 1994. Do you see any differences between young doctors then and now?
There are a lot of medics studying 4th and 5th years of medicine and 6th years before the state exams. They stay here for 2 to 6 weeks and usually have a completely different idea of life than to start working in a hospital right after their residency. Their outlook is more practical for life unlike my generation. We didn't have a lot of options. Our main purpose was to get qualified, to get knowledge, practical skills. Today I see in young people that they are undoubtedly interested, but thanks to modern technology they are much more able to acquire new knowledge, absorb it and test it.
How challenging was it to get accreditation? According to some doctors, accreditation is mainly a lot of paperwork...
I don't want to complain, but it was mainly paperwork. The department is supposed to have not only technical equipment but also personnel. The commission then checks it on the basis of the documents submitted. You have to give a list of doctors, and for each one you have to prove what qualifications, experience and so on. And then the accreditation commission comes and checks the equipment of each department, including the physical presence of the staff.
Unfortunately, this is also medicine today. It's all about paperwork. There's never been so much paperwork within a single patient just in the reception area. I know we have to protect not only the patients, but ourselves. In the event of a complaint or request for an investigation, what is not written is not given. And if any record is missing, it casts a bad light on the whole department. Even though we have computers, paper is still the most important thing. I'm glad we have an IT department that works closely and successfully with us.
For example, what innovations have you introduced with the help of IT?
We discussed with them, for example, how to make rounds easier, how they could help us streamline processes. As a result, we now have a tablet the size of a mobile phone in the rounds. With this, the doctor scans the barcode and has up-to-date complete results for each patient. This is a very sophisticated system that makes our job easier.
What about the future of the department?
Personally, I see that we still have room for improvement. We doctors can't do much about it ourselves, the IT professional needs suggestions from us. We have already come up with some and I believe the future will bring improvements and a lot of paperwork will fall away. The outlook is that paper documentation will be a thing of the past and everything within technology will be digital.
The reconstruction of the reception area of the internal department is also in the pipeline, and I personally have high hopes for this. The modern concept of the new emergency room under the leadership of Dr. Zajac should thus be suitable for a few years into the future.
"The advantage of internships at specialist clinics is that our doctors gain valuable experience and contacts."
