Faina Filina— Advisor to the General Director, Director for External Communications of the International Foundation
International Medical Cluster (MMK)- medical, educational and scientificplatform created by the Moscow government. MMK's goals are to attract the world's best medical practices and educational technologies to Russia. In 2016, a capsule was laid for the construction of the first building of the cluster. In September 2017, the first agreement on participation in the project was signed with the Israeli clinic Hadassah. According to the creators, the cluster should unite branches of the best foreign clinics, educational and research institutions, where doctors can exchange experiences and patients can receive medical care according to world standards.
Patients are not experimental
- According to official plans, until 2029, about 20 foreign clinics will operate at MMK. Will our citizens be able to take advantage of the medical assistance of these organizations for compulsory medical insurance?
- No, participating clinics do not work on compulsory medical insurance. But it is possible to serve patients according to VHI, private payments and referrals from charitable organizations. This approach is related to laws: FZ-160 gives the cluster clinics a unique opportunity to work with their equipment and doctors according to foreign protocols, as well as use drugs that are not registered in Russia but officially recognized in OECD countries (Organization for Economic Cooperation and Development - High Tech )
- Paid medical care implieshigh quality. But if students work in the cluster’s clinics, and the patients actually become “experimental”, can we talk about a decent level of medical care?
— Only the best become members of the clusterclinics of the OECD - countries with high quality of medical care. Each participant must be approved by two-level control - an expert council, which includes leading Russian and foreign medical specialists, as well as a supervisory board.
For effective work, familiarization with Russiandoctors with treatment protocols in the institutions will be attended by doctors from the head clinic. They will work side by side with our specialists and share their skills with them. And in the clinics will work Russian doctors who speak foreign languages, supporters of evidence-based medicine, ready to accept the new. All specialists have long-term internships in maternal hospitals, so there is no reason to talk about the low quality of staff training.
One of the tasks of the cluster is to give patients access tohigh-quality, highly effective and, of course, safe medicine. The development and research of the biomedical technology park are carefully selected for further use in practice. The quality of such an analysis is significantly different from the procedure for domestic drugs to enter the Russian market, which, for example, does not require any international certification. MMK's developments will necessarily have data confirming effectiveness and safety.
“The doctor and patient must be partners”
- It is planned to create in the medical clustera medical university operated by a foreign educational operator. Does this mean that the university will issue diplomas recognized both in Russia and in the world?
- Getting a medical education withThe award of an internationally recognized diploma is under active discussion. The operator will enter into the necessary partnerships with MMK participants and Russian educational and medical centers. Then he will independently build his activities: he will staff the international staff, determine the format and training program. In addition to organizing seminars and master classes, the operator will conduct continuing education programs.
At MMK, lectures andmaster classes with the participation of foreign and Russian experts. Intensives were organized with lecturers from the Netherlands on cooperation in the field of quality management and a system of indicators of the quality of medical care. Together with Johns Hopkins Hospital, we held a seminar “International Experience of Simulation Centers”, a meeting for managers dedicated to the development of medical tourism in Russia. Also, on the example of the work of the Israeli nursing service, a school of nurses was opened to expand the functionality and more actively engage in the medical process.
The medical cluster hosts weekly lectures by Israeli doctors who come to receive patients at the Hadassah Medical.
- Due to the size of the country, transporting a specialist toStudying in Moscow is often quite expensive. Will the cluster provide for the possibility of distance theoretical training with the development of practical skills in regional medical centers?
- If we talk about seminars and conferences, then weregularly arrange a live broadcast, which anyone can join. If we are talking about master classes, then, of course, the maximum result from the event can be obtained with a personal presence. But at the same time, telemedicine provides more and more opportunities: after the adoption of the corresponding law, the development of the industry has accelerated significantly. Now the direction “doctor-doctor" is actively developing, allowing, among other things, to undergo television training and virtually attend the operations of recognized industry experts. That is, to participate in educational activities from anywhere in the world.
According to the Federal State Statistics Service, the average salary of doctors in Russia in January-September 2019 increased by 7% and amounted to 79 thousand rubles. By region, it varies from 43.4 thousand rubles to 187.9 thousand rubles.
- In Russia, due to the low level of salaries and high workload, there is a decrease in the number of teachers in medical schools. Will the medical cluster open its training programs for doctors from all over the country?
- All lectures and seminars held at MMK,are free. If the specialist does not have the opportunity to attend the event in person, then videos from some events, reports can be found on our YouTube channel or website.
In addition, doctors can remotely receiveadditional education and learn more about innovative foreign practices in a simulation center equipped with equipment to create conditions as close as possible to real operations. For example, the robots that are used in the center look almost like real patients. Doctors can practice laparoscopic, cardiological and other operations on them, train to administer anesthesia. At the same time, computers located nearby tell the specialist what to do next. After the operation, you can summarize, see the statistics of your progress and deal with the teacher all the actions and errors.
Another skills training device thatcan be found in our center, - a hysteroscopy simulator, but in the future its functionality is planned to be expanded. Soon, both gynecologists and urologists will be able to study here. Doctors have the opportunity to work in a one-day hospital mode: to train simple surgical interventions. An important part of the training is teamwork skills, which are given considerable attention in the simulation center.
- Management training for medicine is a separate area of study. By what standards will specialists in this field be trained at MMK?
- Initially, there was no Russian healthcareunderstanding that a medical institution should be managed by a person who understands how it functions and has project management skills. Even having gathered the best doctors under one roof, it is impossible to achieve the most effective work without a competent manager. MMK regularly conducts training courses and intensives for senior staff.
International experts leading workshops andseminars, not only share their experience in building a quality management system, but also analyze the situation in Russia, its features, existing cases and ways to solve the problems facing managers. It is important that this is not just a theory, but material analyzed from the point of view of Russian realities. This is done to obtain the maximum result from training and the effective use of the information received in practice. Doctor and patient must be partners.
In 2015, the All-Russian program ontraining and professional development of managers responsible for the financial and economic activities of medical organizations. Its goal was to increase the professional level of managerial personnel: chief physicians and their deputies responsible for drug provision and financial and economic management.
In recent years, a new healthcare concept - 4P medicine - has become a priority in Russia. It is based on four principles starting with the letter P:
- prediction (warning);
- prevention (preventiveness);
- personalization
- participation (patient involvement in the treatment process).
So different medicine
- How can a doctor who has undergone advanced training in a medical cluster be able to apply the acquired skills by returning to the "native" hospital, which provides medical care in the old-fashioned way?
- A different situation develops regularly: there is high-quality new equipment, but no one knows how to use it. Specialists are not trained to work with him, and it is easier for them to work with old proven methods than to spend time understanding the device and the functions of this or that device.
The question here is not only about using the latestequipment, but also in the approach itself. In Russian institutions, the service component is poorly developed; there is no understanding of the importance of organizing work in accordance with international standards. With the help of clearly defined actions, it is possible to make staff work more efficient and safe, and patients can be given the opportunity to feel comfortable within the hospital, which also affects the speed of recovery. Returning to the hospital after working with foreign doctors, meeting with otherwise organized medical processes, specialists will share this experience with their colleagues, motivate them to introduce new solutions, because it’s more convenient and safer to work this way.
- The medicine of the future implies the participation of patients. How difficult will it be to change the psychology of Russian doctors accustomed to a fairly authoritarian style of treatment?
— Yes, participation is an important part4P-medicine, based on an individual approach and maximum participation in the treatment process of both the doctor and the patient. Today, patients are becoming more and more informed thanks to Internet technologies; it is no longer enough for them to follow the doctor’s authoritarian orders, but it is important to understand why treatment occurs in this way. And here it is necessary to move to a partnership model, when the doctor discusses possible treatment options with the patient, and they make a decision together.
In Russia, components are still being heavily introduced4P-medicine. Doctors cannot imagine a patient not in the role of a person who came for help and will follow the instructions implicitly, but in the role of a partner with whom one can and should discuss how treatment will be carried out, tell what other options are and what is better than the other. It is very important to introduce this into Russian healthcare. Due to the participative nature and other components of 4P medicine, the patient’s level of trust in treatment and the improvement of clinical outcomes increase.
Us and they
- How interesting are foreign specialists to work in Russia? Do we have any unique experience that foreign doctors can draw here?
- They come to Russia with great pleasure. First, like any professionals, it is important for them to get acquainted with the experience of other countries, share their knowledge and thus create a more complete picture of the world. Secondly, this desire to help people is what originally led them to medicine. The ability to help more people, train other doctors to achieve better results in treatment motivates specialists to regularly visit other countries and share experiences with colleagues.
There are a lot of talented doctors in Russia, whosenames are known all over the world. They perform complex operations, achieve unique survival results and, of course, they have something to learn. Even if we talk about average Russian doctors, it’s still an interesting experience - to look at another healthcare system not from the side, but to immerse yourself in it completely, to understand the weak and strong points of both systems.
Russian doctors who have earned recognition not only at home, but around the world
- Leonid Mikhailovich Roshal- pediatrician, surgeon, doctor of medical sciences, professor, president and director of the Research Institute of Emergency Pediatric Surgery and Traumatology.
- Alexander Georgievich Aganesov- traumatologist-orthopedist of the highest category, doctormedical sciences, professor. Heads the Department of Spine Surgery at the Russian Scientific Center for Surgery named after Academician B.V. Petrovsky, founded the first vertebrology course in Moscow at the I.M. Sechenov Faculty of Postgraduate Medical Academy. He was the first in the world to sew a spine.
- Renat Suleymanovich Akchurin- cardiac surgeon, Honored Academician of the Russian Academy of Medical Sciences and the Russian Academy of Sciences.Heads the Department of Cardiovascular Surgery at the A. L. Myasnikov Institute of Clinical Cardiology of the Russian Cardiology Research and Production Center of the Russian Academy of Medical Sciences. Author of the world's first methods for heart transplantation and the heart-lung complex.
- Margarita Beniaminovna Anshina— Vice-President of the Russian Association of Human Reproduction.
- Leo Antonovich Boqueria- cardiac surgeon, inventor, professor, academician of the Russian Academy of Sciences and the Russian Academy of Medical Sciences and member of the Presidium of the Russian Academy of Medical Sciences. Chief cardiac surgeon of the Ministry of Health of the Russian Federation and president of the National Health League.
- Julia Dmitrievna Vuchenovich— obstetrician-gynecologist, deputy chief physician for obstetrics and gynecology of the Perinatal Medical Center.
- Sergey Vladimirovich Gauthier- surgeon and transplantologist, academician of the Russian Academy of Sciences, Russian Academy of Medical Sciences.He is the director of the National Medical Research Center for Transplantology and Artificial Organs named after Academician V.I. Shumakov and the chief transplantologist of the Ministry of Health of the Russian Federation.
- Sergey Leonidovich Dzemeshkevich- cardiac surgeon, doctor of medical sciences,professor, author of 27 patents and discoveries, board member of the Association of Cardiovascular Surgery of Russia, director of the Russian Scientific Center for Surgery named after B.V. Petrovsky of the Russian Academy of Medical Sciences.
- What if the modern treatment methods used by foreign specialists contradict Russian legislation?
- If we are talking about the territory of MMK, then thanksfederal law No. 160-FZ cluster members can use in their clinics drugs that are not registered in Russia. It is important to note here that only clinics from OECD countries - developed countries with a very high level of health care, where the effectiveness and safety of the drugs used are carefully monitored, can become cluster members.
If we talk about the use of drugs in Russia,which are not available in other countries, it is necessary to focus not on illicit drugs, but on drugs whose effectiveness has not been proven. If you look at the rating of drugs by sales in Russia, then almost all the positions in the top are drugs whose effectiveness has not been proven by randomized clinical trials. In Europe or the USA it is impossible to imagine such a situation.
According to the DSM Group agency, in 2019 the following drugs were most actively sold in Russia:
18.3%- for the digestive tract and metabolism;
14.8%— for the cardiovascular system;
12.4%— for the respiratory system;
11.5%- for the nervous system;
8.4%- for the musculoskeletal system.
In 2018, the Russians bought the most: Nurofen, Xarelto, Detralex, Kagocel, Concor, Cardiomagnyl, Ingavirin, Actovegin, Miramistin, Mexidol.