1. THE ROLE OF LATVIAN MEDICAL ASSOCIATION IN SERTIFICATION AND REGULATION PHYSICIANS IEVIŅA ALKA LATVIAN MEDICAL ASSOCIATION VILNIUS 26 – 27 SEPTEMBER 2005

2. Regulation No.431 of the Cabinet of Ministers Rules of Procedure of the Certification of Medical Practitioners Certification – award of certificates by evaluating and certifying with a certain degree of probability theoretical knowledge and professional skills of a medical practitioner in a primary speciality, sub-specialty, additional specialty or skills of a medical practitioner within relevant speciality to employ specific treatment or diagnostic method

3. The Cabinet of Ministers of the Republic of Latvia Riga, 23 December 1997 Regulation No.431 Rules of Procedure of the Certification of Medical Practitioners Certification is granted in speciality according to the classification of specialities of medical practitioners listed on the Index of Professions in the Republic of Latvia and division of specialities of medical practitioners into primary specialties, sub-specialties and additional specialties by the Ministry of Health as well as within speciality in order to evaluate the skills of medical practitioner in application of specific treatment and diagnostic methods Re-certification is granted by the certification institution after reviewing the report of a certified person on his professional career and activities undertaken for raising his qualification during the validity of his certificate according to the requirements of the rules of the respective speciality

4. Certification of Doctors 1990 Associations Certification Commissions Rules of Specialities Rules of Certification. Lists of primary specialties, sub-specialties and additional specialties, treatment and diagnostic methods liable to certification

5. The Ministry of Welfare of the Republic of Latvia Riga, 13 March 1998 Ordinance No.63 Rules on the Procedure for Approving the Rules of Certification of Medical Practitioners

6. The Ministry of Welfare of the Republic of Latvia Riga, 13 March 1998 Ordinance No.63 Certification institution shall ensure the accessibility of the services connected with the certification without limitation for all medical practitioners undergoing certification or re-certification according to the principle of the neutral third party involvement that is independent of health care provider and the provider of postgraduate training services, pursuant to the standard LVS EN 45013“General Criteria of Personnel Certification Institutions”, Regulation of the Cabinet of Ministers No.431 of 23.12.1997., and the procedures set forth in the present Rules.

7. Certification institution shall establish Certification Council with the term of office of 2 years. The Certification Council shall be a collegiate body that co-ordinates and adopts decisions on the issues connected with certification and re-certification in the Certification institution. The Ministry of Welfare of the Republic of Latvia Riga, 13 March 1998 Ordinance No.63

8. The Certification Institution shall perform the following functions: Coordinate the uniform evaluation procedure of theoretical knowledge and professional skills of medical practitioners in the Certification Institution Supervises the conformity of the operation of certification exam commissions to the requirements of the Regulation No.431 of the Cabinet of Ministers of 23.12.97., these rules and the decisions of the Certification Council.

9. The Ministry of Welfare of the Republic of Latvia Riga, 13 March 1998 Ordinance No.63 Certification Council has the right by a reasoned decision to suspend the operation of a certification exam commission before the expiry of its term of office should the Certification Council find that the activity of the exam commission fails to conform to the requirements of Regulation of the Cabinet of Ministers of the Republic of Latvia No.431 of 23.12.97., these rules and the decisions of the Certification Council.

10. The Certification Exam Commission performs the following functions: Drafts and approves the examination programme and the questions for the theoretical part of an exam for the relevant speciality in conformity to the requirements of the Rules of that speciality. Informs the person undergoing certification about requirements of certification, examination programmes and questions as well as about evaluation system. It assesses reports on the previous professional activity and other documents submitted by the persons undergoing certification as stipulated in Articles 15-16 of the Regulation of the Cabinet of Ministers of the Republic of Latvia titled `Rules of procedure for certification of medical practitioners` of 23.12.97. Ensures the availability of the requirements of certification, examination programmes and questions to the persons undergoing certification.

11. Certification Council functions pursuant its rules and determines: Uniform procedure for the review of professional activities Uniform procedure for certification and recertification Constitutes and approves commissions of specialities and certification commissions as well as carries out the supervision of their activities to ensure the compliance of their activities with certification rules

12. Certification Commission for each speciality develops and with a special decision decides the following matters: Rules for certification and re-certification procedure Examination programme in the form of multi-choice questions, including questions on emergency medicine programme Consults the Certification Board of Latvian Medical Association as to the content of the programme The scope of questions to be included in the programme that are in the field of competence of related specialities according to their speciality rules The criteria for control of professional activities

13. Regulation No.431 of the Cabinet of Ministers Rules of Procedure of the Certification of Medical Practitioners Certification exam may be taken by doctors, nurses, midwives, doctor’s assistants, laboratory technicians, dentist technicians, hygenists, physiotherapists and ergotherapists that after obtaining of an appropriate medical education have supplemented their knowledge in specialty and acquired skills during specified time period in accordance with a rules of relevant specialty as approved by the Ministry of Welfare.

14. Procedure for taking Certification Examination Exam consists of filling out a multi- choice questionnaire. The physician taking an exam answers the questions, the minimum number being 100, whereas the maximum number is 250. The physician undergoing certification is awarded certification diploma only if the proportion of correct answers reaches 75%

15. Updating the Rules of Operation of The Certification Council of the Latvian Medical Association  Head specialists of the Ministry of Health or Directors of a specialised centres  Sub-speciality may be represented by the representative of the primary speciality  Certification Council of the Latvian Medical Association is entitled to delegate its representative to sessions of any certification commission of any association where he can participate with rights of a commission member

16. The rights of a medical practitioner undergoing certification Receive certification examination programme Receive the information on the rules of procedure of the examination Take a repeated certification exam after one year To be informed about the composition of the examination commission and to submit an opposition against the inclusion of individual members in the examination commission

17. FINANCIAL BASIS OF CERTIFICATION  Certification is financed on the account of a physician undergoing certification Specialist Associations use the received money to finance:  Drafting of Certification and re-certification programme that is to be completed by 31.12.1994., and drafting multi-choice questions for exams. The number of the questions shall be no more than 3000, but not less than 2000 (in 1993-1994 temporary questions were prepared depending on the number of persons undergoing certification)  Prepares and distributes the multi-choice examination programme and eventual questions to physicians taking exam no later than 2 months before exam (since 31.06.1994.)

18. Primary specialty – an area of medicine in which a medical practitioner has acquired a professional medical postgraduate training the length of which is specified in a rules of specialty and cannot be shorter than 3 years Criteria for primary specialty – this is a wide area of medicine in which a medical practitioner acquires a professional medical (postgraduate) training pursuing the plan of education either of a type of residentship training or courses that is specified in the rules of specialty and the length of which cannot be shorter than 3 years The Certification Council have adopted specialty definitions and criteria enabling a drawing up of a classification of specialties

19. Sub-specialty – narrower area of the primary specialty for mastering of which (specialization) previous primary specialty is required Criteria for Sub-specialty – this is a narrower area of the primary specialty that can be mastered by a medical practitioner only upon the completion of the residentship training programme (or training cycle) and for which a plan of residentship education programme (or of postgraduate training) is specified as defined in the rules of the relevant subspecialty and according to which the length of education period cannot be shorter than 2 years

20. Supplementary specialty - narrower area of the primary specialty that is a shared competence of two or more primary specialties and for mastering of which (specialization) previous training in one of the relevant primary specialties Criteria for supplementary specialty – this is a narrower area of several primary specialties that can be mastered by a medical practitioner only after completion of residentship training programme (or training cycle) of some primary specialty (that is connected with this supplementary specialty) and has a defined plan of residentship training (or postgraduate education plan) that is specified in a rules of relevanat supplementary specialty and whose length of training cannot be shorter than 2 years. The Certification Council have adopted specialty definitions and criteria enabling a drawing up of a classification of specialties

21. Latvian Medical Association Structures and forms of co-operation involved in the process of postgraduate education Structures Professional Associations I Commissions and Councils II

22. Latvian Medical Association Structures and forms of co-operation involved in the process of postgraduate education Structures Professional Associations I Commissions and Councils II

23. Professional Associations I Without cooperation partnersWith cooperation partners Latvia University Riga Stradina University, Department of Postgraduate Education Riga International School of Economics and Business Administration State Agency of Medicines Health Statistics and Medical Technologies State Agency Major Latvian Hospitals etc.

24. Commissions and Councils II Commission of doctors with teaching rights Selection of doctors for award of teaching rights is done according to the criteria set by the Latvian Medical Association Selection and assessment of facilities available for training of resident doctors Certification Council Complaints Commission Professional Court

25. Forms of Action and Cooperation for LMA I In international context UEMS – cooperation commenced Organization of professional congresses, conferences and postgraduate training courses Cooperation with international professional associations Cooperation with the WHO World Congress of Latvian Physicians

26. Forms of Action and Cooperation for LMA II On a national level Congresses of physicians, conferences and seminars for different specialties In cooperation with Pharmaceutical companies Seminars Conferences Residentship education

27. Not only Residentship, but also Retraining of Doctors from Other Related Specialities Emergency Medicine doctor Family doctor ( GP ) The goal is the execution of state procurement for the implementation of the Master Plan and maintenance of human resources.

28. Regulation No.315 of the Cabinet of Ministers of 23 July 2002 Minimum requirements for educational programmes for obtaining professional qualification of medical doctors 1. Regulation sets out the basic requirements for educational programmes for obtaining a professional qualification of medical doctor in the Republic of Latvia in order for it to be recognised abroad. 2. For mastering residentship programme full-time training is required.

29. Courses of Action of the Certification Council 1. Draft the rules of evaluation of theoretical knowledge and professional skills during certification and re-certification for all specialities that would conform to uniform basic criteria 2. Revive the co-operation with the Ministry of Health, including co- operation through the Consultative Council of Head Specialists and special centres 3. Include in the activities of the Certification Council all the delegated functions of the Latvian Medical Association that are concerned with the recognition of the professional qualification in doctors` profession 4. Update the rules of procedure of the Certification Council integrating all accumulated information and Europe opinion

30. Doctors` Specialities and Number of Sertificated Doctors (01.09.2005) NoCodePrimary SpecialityCodeSub-speciality 1.P01Internist903A011Cardiologist231 A012Rheumatologist27 A013Phthysiopulmonologist180 A014Endocrinologist82 A015Nephrologist41 A016Gastroenterologist44 2.P02Family doctor (general practitioner) 1397 3.P03Surgeon78 4.P04Neurosugreon48 5.P05Thorasic Surgeon20 6.P06Heart Surgeon15 7.P07Vascular Surgeon18 8.P08Urologist59 9.9.P09Plastic Surgeon21 10.P10Transplantologist7 11.P11Outpatient Surgeon-

31. Doctors` Specialities and Number of Sertificated Doctors (01.09.2005) NoCodePrimary SpecialityCodeSub-speciality 12.P12Paediatric Surgeon54 13.P13Traumatologist/Orthopaedic Surgeon 173 14.P14Gynaecologist/Obstetrician492A141Paediatric Gynaecologist- 15.P15Paediatrician913A151Neonatologist106 A152Paediatric Infectologist34 A153Paediatric Cardiologist9 A154Paediatric Rheumatologist10 A155Paediatric Pneumonologist18 A156Paediatric Endocrinilogist4 A157Paediatric Neprologist- A158Paediatric Gastroenterologist8 A159Paediatric Haematho- oncologist 5 A1510Paediatric Allergologist11 16.P16Oncologist73A161Oncologist chemiotherapist16 A162Oncologic Surgeon25 A163Oncologic Gynaecologist15

32. Doctors` Specialities and Number of Sertificated Doctors (01.09.2005) NoCodePrimary SpecialityCodeSub-speciality 17.P17Haemothologist21 18.P18Anaesthesologist, reanimathologist 404 19.P19Psychiatrist359 20.P20Neurologist282 21P21Paediatric Neurologist47 22P22Ophthalmologist253 23P23Othorhinolaryngologist185A231Phoniatrist- A232Paediatric Audologist- 24P24Infectologist64 25P25Dentist1563A251Orthodontist15 A252Paradonstist- A253Paediatric Dentist11 A254Dental Prothesist6 26.P26Mouth, Face and Jaw Surgeon37 27.P27Dermathologist, venerologist155 28.P28Narcologist101

33. Doctors` Specialities and Number of Sertificated Doctors ( 01.09.2005) NoCodePrimary SpecialityCodeSub-speciality 29.P29Laboratory Doctor194A291Parasithologist- A292Microbiologist69 A293Cytologist- 30.P30Hygenist68 31.P31Radiology therapist27 32P32Radiology diagnostician269 33.P33Pathologist48 34P34Forensic Doctor31 35P35Occupational Health Doctor399 36P36Sports Doctor48 37.P37Rehabilitologist62A371Doctor of Physical Rehabilitation 7 38.P38Doctor of Physical Medicine75 39.P39Emergency Medicine Doctors179

34. Doctors` Specialities and Number of Sertificated Doctors (01.09.2005) NoCodePrimary Speciality Code Sub-speciality 40.P40Disaster Medicine Doctor- 41.P41Health Care doctor5 42.P42Psychotherapist39 43.P43Epidemiologist66 44.P44Genetic18 45.P45Transfusiologist84 46.P46Health Care Manager208 Σ 1- 46 9562 974

35. Doctors` Specialities and Number of Sertificated Doctors NoCodeSupplementary speciality 47.PP01Alergologist24 48.PP02Hepatologist18 49.PP03Immunologist19 50.PP04Homeopath117 51PP05Cosmethologist33 52.PP06Dietician21 53.PP07Acupuncture Doctor144 54.PP08Military Medicine Doctor- 55.PP09Doctor of Occupational Health31 56.PP10Prosthetic Orthopaedist- 57.PP11 Sexologist, sexopathologist 44 58.PP12 Child Psychiatrist 46 59.PP13 Expert 154 60.PP14 Intensive Care Doctor - 61.PP15 Hypnotherapist 29 62.PP16 Algologist - 63.PP17 Osteopath 7 64.PP18 Flebologist 13 Σ47-64 700 (01.09.2005)

36. Diagn. and Treat. Methods and Nr. of Sertificated Doctors Nr.Nr.CodeMethod 1.M01Iridodiagnostics3 2.M02Electroacupuncture diagnostics according Voller method22 3.M03Electroacupuncture and electroacupuncture therapy10 4.M04Auriculoacupuncture2121 5.M05Laser acupuncture8 6.M06Medical bioesthesia7 7.M07Nonverbal hypnosis2 8.M08Qi-Gong5 9.M09Su-Jok17 10.M10Bioresonance therapy5 11.M12Hyperbaric oxygenation- 12.M16Laser therapy27 13.M17Gastrointestinal endoscopy60 14.M18Medical chlamydiology12 15.M19Electrocardiography77 16.M20Exercise testing with ECG72

37. Diagn. and Treat. Methods and Nr. of Sertificated Doctors Nr.Nr.CodeMethod 17.M21Echocardiography55 18.M22Manual diagnostics and manual therapy29 19.M23Electroencephalography22 20.M24Neuro-ultrasonography26 21.M33Ultrasonography of superficial abdominal blood vessels89 22.M34Ultrasonography in gynaecology and obstetrics125 23.M35Electro cardio stimulation and invasive correction of arrhythmias 8 24.M36Counter pulsation with intra aortal balloon and ancillary circulation methods - 25.M37Electro physiological diagnostics1 26.M39Ultrasound Dopplerography of vessels19 27.M40Angioplasty of peripheral vessels1 28.M43Plasmopheresis- 29.M45Treatment, prevention and diagnostics of fungal diseases13 30.M46Methods for analysis of presence of alcohol, narcotics and psychotropic substances -

38. Diagnostic and Treatment Methods and Number of Sertificated Doctors Nr.Nr.CodeMethod 31.M48Percuatneous coronary angioplasty for treatment purposes 7 32.M49Diagnostic catheterisation of heart and major vessels, incl. coronary angiography 13 33.M50Ostheopathy- 34.M51Ostheorephlexotherapy17 35.M52Bronchoscopy11 36.M53Electromyography7 37.M54Neurosonography of children and infants26 38.M55Neurological Diagnostics according Vojt method - Σ1 – 38 817

39. Courses of Action of the Certification Council 1. Draft the rules of evaluation of theoretical knowledge and professional skills during certification and re-certification for all specialities that would conform to uniform basic criteria 2. Revive the co-operation with the Ministry of Health, including co- operation through the Consultative Council of Head Specialists and special centres 3. Include in the activities of the Certification Council all the delegated functions of the Latvian Medical Association that are concerned with the recognition of the professional qualification in doctors` profession 4. Update the rules of procedure of the Certification Council integrating all accumulated information and Europe opinion

40. WE DO HOPE WE ARE NOT PUTTING TOOMUCH TROUBLE TO LATVIAN DOCTORS BECOMING MORE BELIEVE IN GOD THAN POPE WE DO HOPE WE ARE NOT PUTTING TOO MUCH TROUBLE TO LATVIAN DOCTORS BECOMING MORE BELIEVE IN GOD THAN POPE

41. Thank you for your attention!