Dr Roman Ciubara
I am a final-year medical resident specializing in Anaesthesia and Intensive Care in the Republic of Moldova, a country whose beauty is exceeded only by its poverty. I am writing this letter in order to share certain thoughts raised from my training experience, or better said, to tell about certain problems we face during our residency.
In the Republic of Moldova the anaesthesia residency duration is 4 years of training, hard work, night shifts, exams, powerful impressions, but also disappointment. Apparently, 4 years of residency after 6 years of medical studies seems to be a lot. But, in reality, our training lasts (by excluding annual additional modules and other time spent outside the clinic) only 2 years and 7 months. Is it enough?
The question is: Are there any means to improve efficiency and performance in these “4 years” of training? Could an increase in duration of residency help? And, maybe, a decent salary would keep the resident in the hospital and not looking for an additional job in order to survive.
From my perspective, program directors should allow senior residents to stay by themselves on nights shifts, guided by the on call attending physician. This would allow the resident to accumulate experience, would motivate him/her to read more, will give self-confidence, and probably would provide a supplementary income too. This practice exists in Moldova, but it is rather an exception than a general rule.
The existential question of the Anesthesia and ICU resident, as well as of all residents from other specialties in my country, is a rhetorical one. By the government’s decision – the minimum wage in Moldova is 2100 MDL per month (about 105 €) for 169 worked hours. The monthly income of a resident is 2,800 MDL, or about 131 €/month for 210-220 worked hours, including night shifts. The average age of residents is 25-29 years. Usually, he/she has a family and children. This situation obliges the resident to look for an additional job. Something even more unpleasant happens when the resident finds this in a different professional area, with a higher salary that invites him/her to abandon the medical field. In this way many doctors fall out of the healthcare system. In my opinion something is wrong here. After 8-10 years of training and substantial resource investments in professional development, the outcome is zero.
Let’s admit that for professional development the resident should also read and learn. Let’s take a look through the list of recommended literature for an exam (e.g., EDAIC). I would like to pick up two books: P. Barash – Clinical Anesthesia and J. Vincent – Textbook of Critical Care. On the web one could see that the first book has a price of 145 € and the second one 260 €. How much should the resident be motivated to make this kind of sacrifice and purchase both textbooks?!
At the end of the third year residency we have to pass the European Diploma in Anesthesiology and Intensive Care Part I Exam (EDAIC). Apparently this is a mandatory and scheduled exam, but in practice it is an absolutely optional exam.
We are not sufficiently familiar with the details of the EDAIC Part I and not sufficiently prepared for such an examination after three years of residency. We could not dedicate enough time to prepare ourselves for the exam. In the end, the passing rate for Moldova is one successful case in the last five years!
Usually the conception about EDAIC Part I, among residents, is:
- you have to lose a beautiful Saturday day;
- there are two textbooks somewhere that are too complicated to purchase and to waste time reading and learning their content.
I tried to take the EDAIC Part 1 and I failed. I didn’t have enough knowledge and I didn’t spend enough time preparing myself for this event. But even the attempt to pass it was useful for me, because by learning and studying I received answers to many questions, I perceived and understood many things, and I improved my clinical critical thinking.
My proposal is that the EDAIC Part I should be recognized as a national residency exam. It could serve as a filter for the incompetent residents, who are too often promoted for “idiopathic” reasons.
Obviously, a certain amount of time is necessary for preparation for the exam. Besides, we need mentors or a workgroup (physicians, resident alumni – who have accumulated experience in this direction) that would guide and help us to prepare for this exam. This is the only way to get good results and avoid creating incompetent specialists.
I believe that while these problems are not solved, good and competent anaesthesia specialists will be an exception in my country and not a rule.
Despite of all the above, there are a lot of positive things in our daily activity. I am firmly convinced that I have chosen the best specialty and I am taking this opportunity to thank everyone who took part in my training as a physician, and they are many.