PhD Training in Clinical Medicine Vilnius University

PhD Training in Clinical Medicine at the Faculty of Medicine, Vilnius University, Lithuania

Zita Auörelė Kučinskienė, prof., M.D., Ph.D., Habil. Dr.

Dean of Medical Faculty, Vilnius University,

Head of the Department of Physiology, Biochemistry and Laboratory Medicine

Janina Tutkuvienė, assoc.prof., M.D., Ph.D.

Vice-Dean of Medical Faculty for Research and Doctoral Studies, Head of the Department of Anatomy, Histology and Anthropology, Faculty of Medicine, Vilnius University, Ciurlionio street 21, LT-03101 Vilnius, LITHUANIA, http://www.mf.vu.lt

 

Introduction

Vilnius University (the oldest high school of Eastern part of Europe) was established in 1579, and the Faculty of Medicine was founded in 1781, – since then the foundations for fundamental and clinical sciences were laid. At present time the Faculty of Medicine consists of over 20 subdivisions (http://www.vu.lt/en/): four Departments (mostly for Preclinical Sciences), three Institutes (Institute of Public Health, Institute of Odontology, Institute of Rehabilitation, Sportís Medicine and Nursing), twelve University Clinics, that incorporate over 50 different Clinical Centres and Laboratories, distributed in several University Hospitals (in total five hospitals in Vilnius hold the status of University Clinical Hospital).

Currently the Faculty of Medicine is carrying out scientific investigations in five main research trends (most of clinical research is carried out within the third and fifth research trend, though certain interface with clinical medicine is characteristic for the other trends as well): 1. Human Genome Diversity, Its Origin and Phenotypic Realisation. 2. Human and Public Health, Quality of Life and Environment: Scientific and Applied Research. 3. Health of Mother and Child: Physiological and Social Aspects and Research on Natural Development of an Individual. 4. Bioethics, Health Politics, Application of New Technologies. 5. Etiopathogenesis, Diagnostics, Treatment, Rehabilitation and Prevention of Diseases: Fundamental and Clinical Research.

Recently Clinical Medicine and other Biomedical sciences at Vilnius University were integrated into several International programs (http://www.vu.lt/en/research/): FP5, FP 6, GROWTH, QUALITY OF LIFE, BRIMHEALTH, CEECFOODS, EURAP, EUNOMIA, EURECA, EURETHNET, BIT NET, PECO, STOPII, AGIS. During the years 2003-2006 the Faculty of Medicine participated in over 70 international projects and programmes. The dynamics of International projects was as follows: 2003 ñ 28, 2004 ñ 31, 2005 ñ 29, 2006 ñ 25. The number of scientific congresses, conferences, symposiums, and practical seminars during the last few years was (Local/International): in 2003 ñ 39/15, 2004 ñ 54/28, 2005 ñ 88/14, o 2006 ñ 67/20. The Faculty of Medicine collaborates with major Universities in neighbouring and other countries: Austria, Czech Republic, Denmark, France, Germany, Italy, Japan, Norway, Poland, Russia, Spain, Sweden, Taiwan, The Netherlands, United Kingdom, USA. Two thirds of different International projects and scientific research is in Clinical Medicine. PhD students are enrolled and participate in all research programmes, projects and scientific events of the Faculty.

PhD studies in Biomedical Sciences and Clinical Medicine

At present time doctoral studies, also PhD studies in Clinical Medicine, at the Faculty of Medicine are organized according to the general regulations approved by Vilnius University (http: www.vu.lt). The Faculty of Medicine has PhD programmes in two main scientific directions (sub-areas) that belong to the scientific area of Biomedical Science: 1. Medicine. 2. Public health. At present time (August of 2007) there are 73 full-time doctoral students at the Medicine and 10 students ñ at the Public health sub-area (in total, over 1300 students are studying within the different under-graduating programmes of Faculty of Medicine, and there are over 600 residency students at present time). The dynamics of general number of PhD students at the Faculty of Medicine during 2003-2006 was (Medicine/Public health): 2003 ñ 35/4, 2004 ñ 44/9 2005 ñ 44/12, 68/10, 2006 ñ 73/10. Each year Vilnius University enrols about 15-18 doctoral students to the sub-area of Medicine and 2-3 doctoral students ñ to Public health sub-area. Besides, 10-15 dissertations per year are prepared and defended by different specialists of Clinical Medicine in an extramural manner (by extern) under the supervision of the scientists from Vilnius University, or the other research institutions in Lithuania, or foreign countries. The dynamics of defended PhD thesis at the Faculty of Medicine in 2003-2006 was as follows:

Year

Total:

MEDICINE

PUBLIC HEALTH

PhD studies

By extern

Total

PhD studies

By extern

Total

2003*

46

9

35

44

2

2

2004

11

3

7

10

1

1

2005

22

7

12

19

2

1

3

2006

20

7

11

18

2

2

* the rules and requirements for PhD studies and thesis after joining the EU were revised

Most of the Clinical Research is carried out in Medicine sub-area, though some Clinical Studies are pursued within the Public Health as well. In general, the proportion between the research works in Preclinical (basic) Sciences and Clinical Medicine is approximately 1/3 and 2/3 (accordingly): for example, during the 2003-2006 in total 91 dissertations were defended in Medicine sub-area, and amongst them 28 were dealing more with the problems of Preclinical (basic) Sciences, while from 10 theses defended in Public Health sub-area 3 were analysing different questions of Clinical Medicine as well. Recently interdisciplinary scientific investigation becomeS more and more relevant, therefore, PhD training, for example, in clinical genetics, clinical biology, clinical anthropology, clinical biochemistry, clinical physics and radiology is impossible without the interface between theoretical, fundamental sciences and clinical research.

In general, PhD thesis is mandatory in a scientific carrier, but for clinical practitioners PhD is also desirable and has an advantage. In accordance with the Regulations on Awarding Scientific PhD is mandatory also in receiving academic title.

Description of PhD studies in Clinical Medicine

Candidates (medical students) eligible for doctoral studies in clinical medicine should have obtained a Diploma of Higher Education (after six year of studies). Only students after the residency (the duration ñ 4-6 years), or solely during the residency (very motivated and research active students) could be admitted for PhD studies in certain field of Clinical Medicine. The admission to different PhD programmes is carried out on a competitive basis within the frame of Medical Faculty and different Departments of the Faculty. Students have to pass the entrance exams according to the chosen scientific branch of Clinical Medicine. The examinations are held under supervision of an Examination Commission organised by the Faculty of Medicine and validated by the Rector of Vilnius University.

The classification of fields, areas and branches of different sciences (also Clinical Medicine) was approved in 1998 by the Lithuanian Government, and at present time differs from the other countries (http://uais.cr.ktu.lt/lkkadocs/moksloklasifikacija.htm). The main branches of Clinical Medicine are: endocrinology, haematology, immunology, serology, transplantology, infections, cardiovascular system, respiratory system, gastroenterology, urology, nephrology, obstetrics, gynaecology, andrology, reproductive system, skeletal system, muscular system, joints, anaesthesiology, intensive care, surgery, orthopaedics, traumathology, otorhinolaryngology, audiology, speech, ophthalmology, dermatology, sexually transmitted disease, neurology, neuropsychology, neurophysiology, psychiatrics, clinical psychology, paediatrics, gerontology, rehabilitation, kinesitherapy, oncology, forensic medicine, diagnostic methods and instruments, general practise. Nevertheless, recently more and more research projects in Clinical Medicine are carried out together with scientists of adjacent Preclinical (basic) Sciences or other branches of Biomedical sciences, such as follows: general pathology, clinical cytology and cell biology, clinical and medical genetics, clinical and medical biology, clinical chemistry, clinical physics, radiology, clinical microbiology, clinical anatomy and histology, human development, clinical embryology, clinical anthropology, clinical physiology, clinical biochemistry, also epidemiology, environmental health, social medicine, occupational medicine, preventive medicine, psychosocial care, nutrition, dietetics, bioinformatics, biostatistics, biometry.

The duration of PhD studies is four years, but for doctoral studies in Clinical Medicine the longer term usually is eligible. There are two stages of PhD training in Clinical Medicine: the first stage ñ theoretical studies of the selected subjects and examinations; the second stage ñ the arrangement and defending of a doctoral thesis. Theoretical studies usually follow on the first 1-2 years, but the preparing of the thesis in most cases is going in parallel. The doctoral student must take up at least three subjects (courses) from the selected area of research (at least one subject should be from adjacent area of science). Total studies consist at least from 20 credits (one credit compounds about 40 hours of lectures, seminars, individual consultations, hands-on works). Every subject is completed by an examination.

It is not an easy task for young medical doctor to combine PhD studies and clinical specialization or clinical practice. Mostly our PhD students have started their research work before entering the doctoral studies at the Faculty of Medicine: in most cases they were active as young scientists while being students or during their residency. An individual study and scientific research program is composed for every doctoral student. A wide range of various subjects is lectured within the frame of Medical Faculty at present time (http://www.vu.lt/lt/studijos/doktorantams/dokt_biomedicinos/): in total about 200 different courses in Medicine and 20 courses in Public health sub-area cover the all main branches of general and clinical medicine, as well as Public health sciences (very often clinical researchers are interested also in Public Health subjects also). Those programmes and courses were prepared and approved by the Scientific Council of the Faculty of Medicine in 2003. The experience of nearly four years shows the necessity of several courses obligatory for all students: for example, Biostatistics, also Basics of Scientific Research could be mandatory for all PhD students in Clinical Medicine. However, the methods of theoretical PhD studies, the courses and subjects of Clinical Medicine, the proportion of elective and obligatory courses, the arrangement of the courses (the proportion of lectures, seminars, self-dependent work, etc.) is under discussion: certain variety between Universities is necessary in order to keep the particularity and oneness, but some harmonisation of PhD studies in Europe could help to equalize the scientific level of doctoral studies, also in Clinical Medicine.

Doctoral students in Clinical Medicine have an opportunity to develop their research skills by continuing their doctoral studies at foreign universities or carrying out integrated, joint research projects. Doctoral supervisory committees may accept relevant examinations (not more than two) passed while following a doctoral programme at certain foreign university. More affinity, conformity and interface between the programmes and subjects of PhD studies in different European universities could help to enhance the mobility of PhD students as well.

The supervision of doctoral studies and the defence of PhD thesis

The responsibility for doctoral studies at Vilnius University is taken by different Departments of Medical Faculty and the official Supervisors. Certain qualifications, defined by the Government are mandatory for the Supervisors: at least 5 peer-reviewed research articles of specific scientific branch must be published during the last 5 years, and at least PhD doctorate degree obtained in the Republic of Lithuania or equivalent degree obtained abroad is obligatory. The Supervisor of the doctoral student controls the doctoral studies and scientific research as well as accepts the students' reports. The official Supervisor, if his/her qualification satisfies mentioned above requirements, could be also from the other University of Lithuania or from abroad.

More cooperation and experience exchange of supervision in PhD studies could enhance better and closer collaboration between different European Universities in general, and could help to develop join research field. Nevertheless, the requirements for the PhD Supervisorís qualification differ and vary between European Universities widely. The question, which qualification for PhD Supervisor is mandatory and whether the requirements should be similar in all European countries, is complicated and covers many adjacent questions: for example, the kind of publication (only the scientific article, or scientific monograph, textbook, or other scientific issue could be suitable), the quality of publication (peer-reviewed article, or other reviewed scientific issue could also satisfy the requirements), the data basis for publication (ISI Web of Science, Thompson ISI, MEDLINE, Index Copernicus, or other data basis could be proper and presentable), citation records, etc.

The doctoral theses in Clinical Medicine, as PhD thesis in Preclinical or other scientific fields, are defended publicly at the meeting of specially compiled Doctoral Defence Board (the board is compiled pro tempore for the period of defence of certain doctoral thesis). The Board consists of 5 members (chairperson and 4 members), that should have no common publications with doctoral student. At least two members of the Board should be from the other institutions (extramural of Vilnius University). Scientists from foreign Universities (mostly scientists from Latvia, Estonia, Poland, Russia, also ñ from Germany, United Kingdom, USA, or other countries) sometimes are invited to the defence Board. Board Members have to satisfy certain qualifications defined by the Government of the Republic of Lithuania: at least 5 peer-reviewed research articles of certain scientific branch must be published during the last 5 years, and at least PhD doctorate degree obtained in the Republic of Lithuania or equivalent degree obtained abroad is obligatory. But recent experience shows that the large Doctoral Defence Board, compiled for certain period and constantly renewable, consisting of more than 5 scientists of the specific field, area or branch of science would be eligible for more objective evaluation of the scientific level of PhD thesis. Moreover, the question about the establishment of joint for several countries or even European Doctoral Defence Boards or Committees for different fields and branches of Biomedical sciences should be discussed, though it is also related with other problems, especially with the financial resources.

Conclusions

The harmonisation of PhD training in Biomedical and Health Science in Europe should start from the unification of the classification of the fields, areas, sub-areas and branches of different Biomedical and Health Sciences. The duration of PhD training, the courses of PhD studies (number of subjects, credits), the requirements for doctoral thesis (volume, structure), the number and quality of publications for PhD student (and the rating of scientific journals), also the rules and requirements for supervision and for the qualification of PhD Supervisors and the members of Defence Board/Commission, the procedure of defending thesis in Biomedical Sciences should be discussed between the different European countries in order to reach more or less the same quality and scientific level of PhD training.

References:

1. A. Bumblauskas et al. Universitas Vilnensis 2004 (in English). Vilnius, 2004.

2. Faculty of Medicine at Vilnius University in 1781-2006: Itís modern everyday life (publication dedicated to 225th Anniversary Year). Vilnius University, 2006.

3. Z.Lackovic, J.Bozikov. European PhD programmes in Biomedicine and Health sciences. ñ Proceedings of the Second European Conference on harmonization PhD programmes in Biomedical and Health Sciences. University of Zagreb, Medical School, Zagreb, Croatia, April 22-24th, 2005 (http://bio.mef.hr/conference).

4. OPPHEUS (Organization for PhD education in Biomedicine and Health Sciences in the European System): Internet database of European PhD programmes in Biomedicine and Health Sciences. Available on website of OPPHEUS: (http://www.orpheus-med.org/index.php?option=com_bookmarks&Itemid=37)

5. Vilnius University. Research. (http://www.vu.lt/en/research/)

6. Vilnius University. For doctoral students. Biomedicine. (http://www.vu.lt/lt/studijos/doktorantams/dokt_biomedicinos/)