Reforms in medical education: lessons learnt from Kyrgyzstan

Figures & data

Table 1. Elements needed for education reform [18]

Element	Definition
Setting the direction	Communicating the overall goal of what will be achieved
Building a consensus	‘Strategic leadership’ Development of consensus through regular interactions with stakeholders Consultations with local partners
Engaging stakeholders in the process of the reforms	Regular interactions Trust building Keeping an open dialogue
Pilot projects and evaluation	Using pilot projects to build consensus Review and evaluate processes
Capacity building	Strengthening capacity
Timing	Importance of the ‘timing’ of the reforms
Key partners	Key institutions and groups of individuals necessary for successful reforms

Table 2. Summary of lessons learnt

Element	Lesson(s) learnt	Persisting challenges
Setting the direction	System-wide changes in the health system with a focus on FM and PHC; focus on health needs of the population; adapt medical education and capacity building within the environment and culture of Kyrgyzstan as much as possible; strong role of Ministry of Health; role of donor in assisting with setting the direction; development of communication strategy	Strengthen focus on role of Ministry of Education in medical education reforms; link between medical education and health system reforms with Ministry of Health; challenge with the perceptions of roles of doctors and nurses and specialists versus FM; Financing mechanisms of UGME and PGME
Building a consensus	Champions; involving a wide range of stakeholders; fostering interactions; catalytic and facilitating role of the project; many consultations with stakeholders; need for coordinated leadership between Ministry of Health and Ministry of Education	Need to consider financial interests, especially those of medical faculties that might be counter to the reform process, for example their role in PGME. Make institutions self-appropriate the reforms made
Engaging stakeholders in the process of the reforms	Importance of international support; engaging stakeholders in the different regions; development of relationships and trust between a wide range of stakeholders; study tours; additional activities in clinical training to foster engagement and interactions; Knowledge and understanding of context (top down regulations and approaches and cultural sensitivities (e.g. managing hierarchy)	Engaging non-health actors, especially Ministry of Education; coordination at different levels of medical and nursing education as well as health system; Involving the PHC and FM stakeholders in academic processes
Pilot projects and evaluation	Use of pilot projects to show the feasibility of certain changes as well as using this experience to further influence changes in reforms; use of research activities to help inform and direct the process of reforms	Resources are significant for the implementation and adequate documentation of pilot projects to then be used in reform process and further integration into the system
Capacity building	Mix of activities to increase clinical competencies; institutional capacity, including formal trainings, workshops, conferences	Evolving needs as project advances.
Timing	Wide ranging changes in the health system	Alignment has occurred for PGME and CME and to a certain extent nursing, but not for UGME, with the needs of the health system
Key partners	Partners from different organizations (Ministry of Health; Actors beyond the health and education sectors; high-level central government officials; and representatives from the regions and clinical practice)	Regular changes in key positions

Figure 1. Summary of key components of reform process

Ministry of Health of the Kyrgyz Republic. Den Sooluk National Health Reform Program in the Kyrgyz Republic for 2012–2016. Bishkek: Ministry of Health of the Kyrgyz Republic; 2012.

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