98

p It would be no exaggeration to say that the training of a vast army of highly-skilled medical specialists and junior medical workers and auxiliary personnel is one of the greatest achievements of the Soviet public health system, which reflects the immense successes scored by Soviet economy, science and culture. It may even be asserted that medical education was built up and doctors and other medical specialists trained at a rate which outstripped the development of the overall material and technical base of public health.

p Indeed, as has already been noted, in 1913, before the October Revolution, there were only 28,000 doctors and some 46,000 junior medical workers in all of Russia, whereas today there are more than 20 times as many doctors and more than 40 times as many junior medical workers. During the same period, the number of beds in medical institutions has increased 12-fold.

p The following table gives some idea of the number of doctors per 10,000 population in the USSR and in five economically developed capitalist countries. (See p. 99.)

p According to these figures, one doctor serves some 400 people in the Soviet Union, i.e., far fewer than in the USA, FRG, France, Britain and Japan.

Development of a new system of medical education began in the very first days of the October Revolution, despite the adverse conditions of economic dislocation and the Civil War. Between 1918-1922, as many as 16 new medical faculties were opened, many of them in formerly outlying national areas of the tsarist empire, in Tashkent, Baku, Yerevan and Minsk, as well as in Omsk, Irkutsk and other distant regions.

99 Table 11 Number of doctors of all specialities in the USSR and five capitalist countries  [99•*  (exclusive of army doctors) Countries Years Number of doctors per 10,000 population USSR 1970 27.6 USA 1969 19.2 FRG 1968 19.8 France 1967 16.8 Britain 1965 15.2 Japan 1968 14.4 Even during this first decade of Soviet power, the medical colleges of the young Soviet Republic turned out several times as many doctors in a year as had all the medical faculties before the Revolution. In 1928, for example, they turned out more than 6,000 doctors, i.e., nearly 7 times as many as graduated in 1913. By 1930 the USSR already had 40 medical colleges, and in 1940, on the eve of the Great Patriotic War, 72. By that time there was not a single Union Republic without its own higher medical school where specialists were trained for the national public health system.

p Before the Revolution, Russia’s ten medical faculties of universities, the so-called higher women’s courses in Moscow, Kiev, and Odessa, and the women’s medical institutes in Petrograd and Kharkov all trained general medical practitioners without any primary specialisation; in Soviet time the principle of medical education was modified.

p In 1930, the medical faculties of universities were reorganised into independent medical colleges, in which therapeutic, sanitary and hygienic, pediatric and stomatological faculties were established. At the same time, institutes and faculties were organised for training pharmaceutists. Thus, in addition to general practitioners the medical institutes began to train specialists in the major branches of medicine. Their subsequent specialisation usually took place in clinics and large hospitals, as well as through a combined system of postgraduate study, internship and advanced training. Already before the Great Patriotic War scientific and 100 technical progress necessitated an increase in the term of study in medical colleges, which at that time was 5 years. The Government passed a special decision to extend the course of training in therapeutic, pediatric and sanitary and hygiene faculties to six years, in the stomatological faculties to five years, and in the pharmaceutical institutes and faculties to 4 years 6 months.

p But this length of training, which met the high international standards of medical education, had to be abandoned during the war, because both the front and rear needed a large number of medical specialists for treating the sick and wounded servicemen and civilians. The medical colleges, a large number of which had been evacuated to the country’s eastern regions, speeded up the training of doctors, the course having been cut to four years. After the war many of these graduates went back to medical colleges to complete their training.

p The Soviet system of medical education has continually striven to find the most rational forms and methods of training. Particular attention has been devoted to specialisation during training, i.e., to a deeper study of the future narrow speciality to be practised professionally. Considerable importance has also been attached to the rational combination of the theoretical or, as they are also called, medico- biological, clinical and social disciplines. Already in early 1920s the curricula of medical schools gave prominence to subjects and disciplines giving the students a correct understanding of the significance of social conditions in the origin and development of disease, and teaching them to devote special attention to prophylactic measures. In other words, the higher medical school began to adapt itself to the social- andprophylactic trend, which had by then emerged as the leading one in Soviet health protection. The departments of social hygiene organised in medical colleges in the 1920s, together with the departments of social sciences—philosophy and sociology, helped to instil in students the materialist world outlook and give them an understanding of the paramount importance of the social environment in health protection.

p Today students of medical colleges are given general, preclinical, as it were, training during their first three years. They study medico-biological subjects, morphology, physiology, pathology, medical microbiology, and the natural 101 sciences—physics, chemistry and general biology. In the fourth year, and for general surgery and the clinic of internal diseases even in the third year, the students receive primary clinical training, i.e., they are taught the fundamentals of various clinical subjects. About this time, depending on the faculty, students undergo their primary specialisation. Today primary clinical specialisation is given additional emphasis. Senior students of medical colleges are given every chance to acquire additional knowledge in one of the major medical specialities—internal diseases, surgery, obstetrics and gynecology, etc. Specialisation within such a broad speciality as pediatrics is, as has already been noted, effected in special pediatric faculties or pediatric colleges of which the Soviet Union now has over 30.

p The vast amount of scientific and technical information to be coped with, and the need to further improve the training of doctors have necessitated the decision to extend the course of training in medical colleges by an extra year. Now the course at Soviet medical colleges lasts for 7 years, which includes 5 years of training in pre-clinical and main clinical subjects, as well as primary specialisation. The first year of specialisation (the sixth year of training) takes place in the medical college, i.e., in its clinics and laboratories where the students work as interns. They actually perform the duties of hospital doctors under the supervision of experienced specialists, usually instructors of medical colleges. However, internship does not cover all, but only a few major medical specialities, namely, internal diseases, surgery, obstetrics and gynecology. During the sixth year at pediatric faculties, training continues in the general branch of medicine chosen, with elements of primary specialisation (child surgery, pediatrics) introduced. In sanitary and hygienic faculties ( colleges) senior students also specialise in the main hygienic subjects (communal hygiene, educational hygiene, occupational hygiene, nutritional hygiene, etc.). In the seventh year students work as interns in large hospitals under the supervision of their more experienced colleagues. After the sixth year students take their state examinations which cover the most important theoretical and clinical subjects. However, those who have successfully passed their examinations are not immediately given their doctor’s diplomas, but must, as we already noted, serve as interns in a hospital for a period of one year. Only after successfully completing their probation 102 do they get their diplomas and, with them, the right to independent work.

p Of course, this system does not as yet solve all the problems of specialisation because in present-day conditions it takes a much longer time to master the basic medical skills of any one branch of medicine. This is why considerable importance is still being attached to institutes of advanced medical training. In these institutes doctors of various specialities take courses for a period of 2 to 5 months or longer in accordance with special programmes. In some branches of medicine correspondence courses are available, but in any case, those enrolled in them must take examinations in conclusion. More than 35,000 doctors a year attend institutes and faculties of advanced medical training.

p Internship in a clinic and post-graduate training are other ways of improving the doctors’ professional knowledge in their chosen specialities. Internship takes 2 years and postgraduate course, 3. At the end of post-graduate course the physician must successfully defend a thesis in order to be awarded the degree of Candidate of Medical Science. To improve their professional skill, doctors are also commonly sent for various periods to the largest medical institutions specialising in a particular branch of medicine. Students’ scientific groups and societies organised in the chairs and clinics of medical colleges initiate students into medical research. They not only test their abilities in research, but can also acquire additional special knowledge in a particular field.

p New faculties have of late begun to function in a number of institutes. Prominent among them are medico-biological faculties, intended for training specialists in associated fields, medical biophysics and biochemistry. Young specialists in these fields are now trained at the medico-biological faculty of the N. I. Pirogov 2nd Moscow Medical Institute and at the Kaunas Medical Institute. Naturally, this form of specialisation requires the knowledge not only of the fundamentals of medical subjects, including clinical ones, but also of biology, mathematics, chemistry, physics and other sciences.

p The country’s 77 medical colleges, 5 pharmaceutical institutes and 9 medical faculties at universities, enrolling the total of over 250,000 students, turn out annually some 30,000 doctors and pharmaceutists.

103

The increase in the total number of doctors, including specialists in different branches of medicine is shown in table 12.

Table 12 Number of doctors in major specialities  [103•*  1940 1950 I960 1970 Total Per 10,000 population Total including: 155,323 265,031 413,752 668,400 27.4 internists 42,564 55,940 96,208 134,588 5.5 surgeons 12,564 22,501 44,460 67,182 2.8 obstetricians and gy- necologists 10,620 16,624 28,663 41,400 1.7 pediatricians 19,358 32,105 58,908 80,811 3.3 neuropathologists 3,213 5,118 10,543 18,108 0.7 psychiatrists 2,408 3,119 6,389 14,502 0.6 ophthalmologists 3,625 5,661 10,481 15,952 0.7 otolaryngologists 2,641 4,543 9,632 15,792 0.6 dermato-venereolo- gists 4,807 9,216 9,355 12,431 0.5 sanitary doctors 12,527 21,926 31,454 40,474 1.7

p There is no need to cite the number of doctors in the different Soviet Republics; it is enough to mention that in 1970, the RSFSR had 378,400 doctors, the Ukrainian SSR— 131,000, the Byelorussian SSR—more than 23,000, the Uzbek SSR—more than 24,000, the Kazakh SSR—almost 29,000, and the Georgian SSR—more than 17,000. The republics which formerly were nearly deprived of medical aid, in particular the Central Asian Republics, now have large numbers of highly-skilled specialists. For instance, the Tajik and the Turkmen Republics have 4,700 doctors each, the Kirghiz SSR—more than 6,000, etc. In some of the republics the ratio of doctors to the population is greater than in the Soviet Union as a whole.

p The system of training junior medical workers has also changed in Soviet times. Before the October Revolution the 104 country had, as has already been noted, only 46,000 nurses and other junior medical personnel, whereas today the number of junior medical personnel has exceeded 2 million. This means that there are 78.6 (in 1967) junior medical workers per 10,000 population. They include surgeons’ assistants, midwivcs, assistant sanitary inspectors, trained nurses, various laboratory and X-ray technicians, dental mechanics, disinscctors and disinfectors, etc.

The increase in the numbers of junior medical personnel may be judged from the following table.

Table 1 Number of junior medical personnel in the USSR  [104•*  1067 1940 1950 I’.IGO Per 10,000 Total population Total including: 472,000 719,400 1,388,300 1,860,700 78.6 surgcons’assistants 82,200 160,000 334,700 417,400 17.6 women surgeons’assis- tants and midwivcs 12 -SOO 42,000 76,200 82,100 3.5 midwivcs 68,100 66,700 139,300 184,800 7.8 trained nurses 227,700 325,000 623,500 892 600 37.7 laboratory technicians 11,700 25,300 52,500 71,700 3.0

p In 1970 there were 87 junior medical workers per 10,000 population (a total of 2,123,000).

p An equally good rate of growth in the number of all categories of junior medical workers can be found in all the Soviet Republics. Thus, for example, in 1940 the RSFSR had 290,400 junior medical workers, and by 1970 this number had increased to 1,212,300. In the Ukraine during the same period there was an increase from just over 100,000 to 411,500, in the Kazakh SSR, from 11,900 to 104,800, in the Kirghiz SSR, from 2,600 to 21,600, in the Tajik SSR, from 2,700 to 15,400, etc.

p The rapid increase in the number of the junior medical personnel has been made possible by the organisation of a large number of secondary medical schools, of which there jrkcrs 105 were 666 in 1970. Today the total enrolment of these schools amounts to more than 410,000, with more than 100,000 graduating every year. The secondary medical schools admit young people with 10 or 8 years of general schooling. In the former case the course of training is 2 years and in the latter case, 4, since in addition to studying special medical subjects, those who have not completed their secondary education must do so while in the secondary medical schools. The curriculum of secondary medical schools includes all the major medical subjects, but not surprisingly, particular attention is given to teaching the students practical skills in the care of the sick.

p In addition to doctors and junior medical personnel the country’s medical institutions also employ a large technical personnel. The total number of people employed in the public health system now exceeds 4.5 million, which equals 2 per cent of the entire population or 4 per cent of the working population of the USSR.

Among this group, one of the largest professional groups in the Soviet population, there are thousands of outstanding physicians, world-famed scientists and well-known public health workers. Many thousands of them have been decorated with orders and medals, more than 10,000 doctors have been awarded the title of Honoured Physician of the Republic for their contributions to public health, and some 100,000 medical workers have been decorated with the honorary Outstanding Public Health Worker badge. For their great contributions to the development of heaith protection and medical science more than 100 scientists and 70 practicing physicians have been awarded the honorary title of Hero of Socialist Labour.