1. E-learning as a key component of the Medical Education
Reform in the Kyrgyz Republic
A. Mambetova, N. Tentiev, A. Azimova, R. Bikulova, Ch. Akhmedakunova, G. Orozalieva , L.Loutan
Background
Introduction
Kyrgyzstan is located in Central Asia, where mountains represent major obstacles to easy travel and access to medical services and training of health professional. As in many countries, there is a high concentration of doctors in the capital city Bishkek and in Osh, the second largest city in the country. While the majority of the population lives in rural areas, their source of income being agriculture and livestock raising very few doctors are ready to practice in the regions.
Access to the internet is quite broad in Kyrgyzstan with an estimated 2,493,400 Internet users as of Dec/2017 with 40.7% penetration, per ITU. There are also 360,000 Facebook subscribers on June/2017, 5.9% penetration. The vast majority of medical facilities have access to the internet, allowing on line training programs to be generated.
As part of a Swiss Development Cooperation funded project on Medical Education Reform several mechanisms have been developed to encourage young doctors to train and practice in the regions. One of them is a distance-learning program to facilitate access to training courses. These weekly e-learning courses have been produced during a two year period in the central province (Oblast) of Naryn. This program is recognized as a part of the continuing medical education and provide also post-graduate regular training.
Total population: 6,
Kyrgyzstan is located in Central Asia, bordering Kazakhstan, Uzbekistan, Tajikistan and China
Capital - Bishkek c.
Language - Kyrgyz, Russian
Religion - 80% Islam, 15% Russian Orthodoxy
Medical staff in the health sector ( )
2009
2010
2011
2012
2013
2014
2015
2016
2017
Medical doctors
12 488
12 685
12 954
12 718
12 961
12 934
13 099
13 432
13 484
GP/FM
1 833
1 818
1 750
1 729
1 706
1 707
1 633
1 640
1 586
Nursing personnel
28 201
28 570
30 148
31 081
31 928
32 440
33 187
33 788
33 958
Relevance
Strength
Notification of the upcoming courses (When? Where? Topic)
Access to the past courses 24/7
Forum for discussing the professional issues and interesting topics
Feedback on the lectures can be provided
Expanding the program to all regions can be implemented at low cost.
Weakness
Inadequate awareness of doctors, students, residents, medical workers about the online training
Some sites do not have free access to internet
Planning and coordination are critical
Insufficient level of computer skills and conservatism in academic circles
Objectives
The objective was to test the feasibility of weekly e-learning training sessions in remote medical facilities linking academic institutions with regional hospitals and family medicine centers; develop a standard format of presentation using low internet capacity and measure the level of satisfaction of participants.
Methods
Implementation of weekly distance –learning sessions. Development of a standard presentation format based on clinical vignettes and defined learning objectives. Training of trainers in academic institutions to produce training contents adapted to the needs of the local practitioners and residents. Regular evaluation of the level of satisfaction of the participants has been monitored. Regular interviews of the providers and of the participants to identify strength and weaknesses of the program were collected.
Kyrgyz Health Network (KHN)
To facilitate access to all the courses and learning documents produced from the different academic institutions a platform has been created by the Kyrgyz educational institutions and the MER project.
It provides:
Direct link to the portal, where they can listen or read this lecture
A forum where experts discuss professional issues and new ideas
Access is open to physicians, health care workers, students, residents 24/7
Results
A total of 77 sessions have been organized from October 2015 till April 2017 in the 3 main Naryn Oblast hospitals and family medicine centers. Altogether 2614 participants, young post-graduate residents, practicing family medicine doctors and nurses have taken these courses. Minimal training of a local technical coordinator to prepare on time the equipment, remind local physicians of the sessions and insure that the connection is adequate. Simultaneously at central level a program coordinator is maintaining proper coordination, contact the professors to produce the courses according to the agreed format and deliver the course on time. Each course should end with three questions as quizzes in relation with the topic of the course. A validation system is being put in place, so participants can register on line and benefit from CME credit points. These courses can be used both for post-graduate weekly training of residents and for continuing medical education (CME) for practitioners. The level of satisfaction is good: overall satisfaction on the quality of course was 88.9%, on the content 82.5%, on exchanges with the tutors 63.5%, on the quality of presentations 90.5% and 87.3% consider that the program facilitates the learning process. This model of distance learning, including several academic institutions, challenges the professors, not used to the technology and to this new way of teaching. Academic professors encounter some difficulties to adapt their courses to the needs of the practitioners and following the required format of the courses. Often the courses are too theoretical and not enough oriented towards clinical decision making . Courses using clinical vignettes were well appreciated by participants.   
Conclusions
Distance learning both for post-graduate and CME purposes can be implemented at low cost in regional medical facilities. Accrediting these training courses with CME credits provides an additional incentive for the participants. The program is progressively being expanded to other provinces. Expanding teaching and training activities via distance learning supports contribute to modify the practice of medical education, linking academic institutions with the rural areas and facilitating the implementation of policies aimed at encouraging more doctors to practice in the regions, where the shortage of practitionners in critical.