Postgraduate medical education (PME) is the phase of medical education in which physicians develop competencies under supervision following completion of their basic medical training. PME in the Baltic countries has experienced a great deal of criticism but, to date, there have been no studies that have analysed PME in the Baltic countries by applying scientific methods. The aim of the study is to analyse how PME is organised in the Baltic states (Estonia, Latvia, and Lithuania) – to identify strengths, weaknesses and opportunities and to accelerate the improvement of PME. For this purpose, the assessment is conducted to evaluate to what extent PME in the Baltic states meets international standards. The study could be regarded as the first-ever systematic mapping of PME in the Baltic countries.
The study utilises the WFME (World Federation for Medical Education) Global Standards for Quality Improvement: Postgraduate Medical Education as a framework to analyse the current situation of PME in the Baltic countries. From the original 254 WFME standards, a more compact version consisting of 56 standards was designed in relation to the context of the Baltic countries.
The research was conducted in the period of 2016-2018. Quantitative and qualitative methodologies were combined in order to produce a richer and more comprehensive understanding of the subject under observation. The study, conducted in three selected countries (Estonia, Latvia and Lithuania) involved four main phases: (1) desk research, (2) field data collection and analysis, (3) assessment of standards, (4) development of policy briefs and recommendations.
The main results show that practices differ across countries, institutions and departments. Only in a few cases does PME in the respective countries fully meet the international standard. On average, the situation in the Baltic countries could be characterised as ‘conflicting evidence that PME meets the standard’. The major concerns pertain to improper application of regulations regarding PME, inconsistency in the quality of supervision, lack of assessment of competencies, no systematic approach towards teaching soft skills or skills of scientific reasoning and methodology, little and not constant or timely appraisal, and absence of a comprehensive feedback system. Key policy recommendations to improve the current situation in PME in Estonia, Latvia and Lithuania were developed and proposed.
The analysis was commissioned by the Estonian Junior Doctors Association as part of the project ‘Becoming a Doctor in Baltic Sea Region – empowering junior doctors in the Baltics’ (financed partly by Nordplus Horizontal programme and partly by Estonian Junior Doctors Association, Estonian Ministry of Social Affairs, Tartu University Hospital and East Tallinn Central Hospital).