Postgraduate training in Latvia

Background Up until 2009, Latvia’s postgraduate training centre for health professionals, which fell under the responsibility of the Ministry of Health, was dedicated to organizing postgraduate training and specialization programmes in medical care, including continuing professional education. In 2009, the centre was reorganized and some of its functions were taken over by the Ministry of Health, such as the coordination of resident training (financed through the state budget). The planning and organization of further education for medical practitioners would be financed by the European Social Fund (ESF). At present, postgraduate speciality training is available in Latvia for medical and dental graduates (medical residency), emergency-care physician assistants and nurses. There are 87 physician specialities, 5 dentistry specialities, 2 physician- assistant specialities and 13 nursing specialities. Any medical practitioner with more than 5 years’ experience and a certified speciality can train residents in medical institutions that have accredited residency educational programmes. A certain number of state-funded places are available each year (in 2020, 996 places are available). Nurse specialities can be obtained through a 1–2 year study in a second-level higher vocational education programme (professional bachelor) after acquisition of a first-level higher vocational education (3 years of college education). Specialization as an emergency-doctor’s assistant takes 1 year; entry into training requires completion of a 3-year first-level college programme. Specialization as an ambulatory-care doctor’s assistant can be achieved through non-formal programmes organized by both educational institutions and the private sector. Participation in these programmes is covered by the participants themselves or their employers (medical treatment institution), or from an ESF funding project administered by the Ministry of Health In Latvia, postgraduate medical training varies in content, according to profession. Residency programmes are available for doctors and dentists; for nursing specialities, there are programmes leading to professional bachelor’s degrees. Delivery Currently, Latvian graduates can undertake postgraduate training only in Latvia. The country’s higher-education institutions can provide the necessary training and, so far, there has not been a need to collaborate with other countries in this connection.The European Community Action Scheme for the Mobility of University Students (ERASMUS) is open to medical residents as well. Postgraduate training in Latvia To improve the organization and delivery of postgraduate training in Latvia, the 3 most important measures would be to: 1. enhance the residency-monitoring process, specifically that related to post-residency work in hospitals and regional areas; 2. continue to evaluate the list of doctors’ specialities and duration of related studies (Ministry of Health and Latvian Medical Association); 3. before the end of 2022, adjust the regulatory framework for entry into the nursing profession to reflect the transformation of the profession into general-care nursing and the requirement of a bachelor’s degree. Until the beginning of 2020, obtaining a nursing education was possible through both college and undergraduate programmes. On 29 October 2019, the Latvian Government approved a conceptual report on the future development of the nursing profession. As a result, the beginning of 2020 saw a clear description of nursing competences, as a result of which college training is not considered sufficient to achieve all nursing competencies, and college-educated nurses are required to continue their studies at the undergraduate level. The report also introduced a training programme, which leads to a professional bachelor’s degree in nursing. The conceptual report: (i) defines the new standard for the nursing profession (general care), including new and improved competences, thus extending the right to practise; (ii) introduces a new approach to speciality nursing training, making it possible to specialize through a professional development programme rather than an institute for higher education; and (iii) eliminates the certification process and replaces nursing specialities with specialization in specific care areas. It aims at reducing the shortage of nurses in the country by encouraging those working in non-health sectors to return to nursing and promoting nursing in line with the changing demands of the labour market. In Latvia, there is a need to include transversal competences (such as those required for surgery, internal medicine and outpatient care) in basic nursing education. This currently calls for an additional year of university education. Initiatives Latvia participates in EU-funded activities related to the development of health-care professionals. The following areas have benefitted from EU support. © W H O Postgraduate training in Latvia • Professional development of health-care professionals This project involves 79 non-formal education programmes, 2 programmes for the professional development of nurses (new treatment and diagnostic methods), and 1 first-level higher-education programme, which allows medical assistants to qualify as emergency medical assistants. A total of 1370 medical practitioners and pharmacists benefitted from these activities, 77 of whom have qualified as medical assistants. • Resettlement compensation Within one of the EU projects, which will run until 30 September 2023, medical personnel who move to work in regions outside Riga are provided with a one- off resettlement compensation and a fixed monthly reimbursement of accommodation costs. The selection of applicants for EU funds was started in May 2018. Work under the European Social Fund (ESF) (funding projects on the regional attraction of health-care professionals) has included 552 applications for compensation and 402 compensation contracts (with 48 doctors, 81 medical assistants, 62 nurses, 208 nursing assistants, 8 physiotherapists, 7 midwives and 2 ergotherapists). Data In Latvia, only data on doctors and dentists trained through state-financed residency programmes are available. These are used to monitor adherence to the compulsory condition of providing health services in national health-care institutions for a period of 3 years after completion of residency programmes. Universities have private residency programmes in connection with which data on resident specialities (start/ completion of programme, location of employment after residency) are available. Latvia would like to improve the selection, collection, storage and analysis of data on postgraduate education (which fall under the responsibility of the Ministry of Health). It would also be valuable for Latvia to gather qualitative data on the health professional’s perspective of postgraduate training (quality, availability, and adequacy). Role of postgraduate training in reducing brain drain To attract human resources to the national health-care system and reduce brain drain, several state-funded postgraduate- training programmes for physicians have been established; an average of 220 physicians are enrolled in these programmes each year. State-funded training programmes provide a sufficiently wide choice of medical speciality. In Latvia, there are 45 state- funded basic-speciality training programmes, 17 subspeciality programmes and 9 additional speciality programmes. Students who undertake state-funded postgraduate education in Latvia must commit to working for at least 3 years in a state-run medical institution after graduation. The salaries of doctors, nurses and other health professionals in Latvia are among the lowest in the country. The need to increase the remuneration of health-care workers, including those who undertake postgraduate training in Latvia, is a government priority. Challenges and enablers The insufficient availability of human resources is a challenge to the health-care system. This is related to a number of issues, including the need to ensure (in the face of low public funding for the health sector) adequate remuneration of health-care personnel working in the public sector, especially in inpatient settings, and an educational process (duration of study, content, including sufficient clinical practice, state-funded study places, etc.) that is as easy and accessible as possible. The administrative capacity available to address these issues, in both the Ministry of Health and its subordinate institutions and hospitals, represents a challenge. Good cooperation with nongovernmental medical organizations and the willingness of the Ministry of Health to implement the necessary reforms are important drivers of improvement. Cross-country collaboration Latvia would be interested in collaborating with other countries on the training of medical specialists. WHO support needed Latvia would appreciate WHO support in understanding how to measure the level of knowledge among health professionals and determine what kind of skills should be acquired through postgraduate training. Further discussion is needed on other forms of support that may be appropriate. Advice/how to improve postgraduate training Collaboration with other countries on finding solutions to the need for different postgraduate training programmes is important. For example, seeking the views of the relevant medical professionals and listening to their problems and concerns would be very valuable. © World Health Organization 2020. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license. WHO/EURO:2020-1304-41054-55734