Reforms on medical education: the case of Kyrgyzystan.
INTRODUCTION: The Central Asian republics of the former Soviet Union gained their independence in 1991. Soon after this event, reforms in health care were planned in many of these countries. In Kyrgyzistan, the reforms included a mandatory health insurance system, a new provider payment system, licensing and accreditation, a national drug policy and rationalization of ambulatory services. Multi-profile policlinics, or family medicine group practices were established. Reforms in health care are not always accompanied by changes in medical education, and so medical knowledge may lag behind that in other countries. This is especially prominent in rural areas, where new practices and regulations may arrive late, and are often misunderstood. The reforms in Kyrgyzistan necessitated a change in undergraduate medical education. The educational reform consisted of a unification of the separate tracks for pediatrics, medicine and public health into one track of general medicine; the introduction of teaching of patho-physiology according to body systems; the establishment of clinical clerkships; and a proposal for rotating internship. METHODS: World Health Organisation sent teams to Kyrgyzistan to work with the local committees as facilitators for the implementation of the health-care reform. This paper is based on the experience of the authors in conducting two such missions directed at the synergistic reform in medical education. RESULTS: VISIT 1: Changes to the curriculum were suggested. It was decided not to recommend teaching in rural primary care settings at that stage, due to logistical difficulties. This subject was to be addressed at a later stage because medical services in rural areas were scarce. VISIT 2: Among other interventions, the encouragement of doctors to practice in rural areas was discussed in detail, but the teachers of the medical school were not receptive to the idea of sending medical students to rural clinics. This was to be addressed at some time in the future. CONCLUSION: The changes were aimed at facilitating the introduction of family medicine as a specialty and strengthenning primary care, although measures to incorporate rural practice in the reform proved difficult to achieve. Reform in medical education can only be justified if it will contribute to the improvement of the health of the population. In order to achieve this goal, the production of better physicians must be assured. In Kyrgyzistan, it was hoped that improved graduates would be the resource for the development of family medicine as a recognized specialty, with the potential to improve the health status of the whole population.