DEVELOPMENT OF POSTGRADUATE MEDICAL EDUCATION IN UKRAINE

Background. WHO experts note that there is no generally accepted approach to continuing medical education in Europe today, but there is a general opinion that the quality of medical services depends directly on continuous developing and evaluating professional competencies by medical doctors in their advanced training. Special attention has always been placed in insuring (and constant improving) academic level of education services providers or training programs, on the basis of which medical doctors coordinate their own plans for obtaining the necessary professional knowledge and skills. The most important precondition for ensuring advanced training is the creation of a unified accreditation system for education services providers or training programs, as well as the "collective responsibility" of all participants in medical education settings. The purpose was to investigate the development of medical postgraduate and continuing education system in Ukraine on the example of the leading national postgraduate education establishment, Shupyk National Medical Academy of Postgraduate Education. Materials and methods. Archival materials. We used the general (universal) method, historical and logical methods in researching. Results. According to the definition of the World Federation of Medical Education (WFME), postgraduate medical education is the phase of medical education in which medical doctors develop their competences after completion of their basic medical qualification. This education phase is carried out in accordance with specific rules and instructions. Postgraduate medical education includes preparation for certification and/or licensure, industrial/professional training, specialization and narrow specialization, as well as other formalized training programs for developing certain expert functions. Being a part of the continuum of medical education postgraduate education is included in continuing medical education (CME) or continuing professional development (CPD). According to the WFME definition, CPD refers to training medical doctors, which begins after completion of their basic and postgraduate medical education and continues thereafter throughout the professional life of each medical doctor. Modern medicine development is currently going on at an extremely rapid pace, and medical doctors’ skills and knowledge are rapidly becoming obsolete. The article traces the introduction of postgraduate medical training in Ukraine on the example of the National Medical Academy of Postgraduate Education (NMAPE). Conclusions. The introduction of postgraduate training for medical doctors in Ukraine is studied on the example of more than 100 years of NMAPE activity, which allows to state that combining research & innovation, training and medical practice enabled the education establishment to become an example to follow and the role model in educational & methodical activity in postgraduate medical and pharmaceutical education settings.


Introduction
In the context of modern rapid and constant changes in the world of new technologies, there is a constant need for improving postgraduate education system bearing in mind the concept of lifelong learning.
WHO experts note that today in Europe there is no generally accepted approach to continuing medical education, but there is a general opinion that the quality of medical services depends directly on continuous develop-ing and evaluating professional competencies by medical doctors in their advanced training. The most important precondition for ensuring continuous professional development is the creation of a unified accreditation system for education services providers and training programs, as well as the "collective responsibility" of all participants in medical education settings.
The most important prerequisite for ensuring advanced training is the creation of a unified accreditation system Медицина / Медицина / Medicine of educational services providers or training programs, as well as the "collective responsibility" of all participants in the system of medical training.
The purpose was to investigate the development of medical postgraduate and continuing education system in Ukraine on the example of the leading national institution of postgraduate education, Shupyk National Medical Academy of Postgraduate Education.

Materials and methods
Archival materials. We used the general philosophical (universal) method, historical and logical methods in researching. General philosophical (universal) method is used in the study of all areas of reality and at all stages of each specific cognitive process. The historical method involves considering the objective process of the object's development, its real history with all its peculiarities. This implies reproducing in thinking the historical process in its chronological sequence and specificity. The logical method is a reflection of the historical process in abstract and theoretical sequential form. That is, the logical is in essence also historical, but free from coincidences, details, zigzags. Historical and logical research methods are unified, as they study the same object, the genesis of its origin and development [1].

Results and discussion
Recently, economically developed countries have begun to rely on education in their development strategies. Among fundamental principles of forming a world unified research & education space, continuing professional deve lopment (CPD) system occupies a specific place and creates the most favorable conditions for increasing the duration of active life and maximum, effective use of human experience and intelligence.
According to the definition of the World Federation of Medical Education (WFME), postgraduate medical education is the phase of medical training during which medical doctors gain experience after completion their basic medical qualification. This professional training phase is carried out in accordance with specific rules and instructions. Postgraduate medical education includes preparation for certification and/or licensure, industrial/professional training, specialization and narrow specialization, as well as other formalized training programs aimed at development of certain expert functions. Postgraduate medical education includes preparation for official registration, industrial / professional training, specialization and narrow specialization, as well as other formalized training programs appropriate to the performance of certain expert functions. According to the WFME definition, CPD refers to medical doctors training, which begins after their completion of basic medical education and postgraduate training, and continues thereafter throughout the professional life of each medical doctor.
Modern medicine is advancing at an extremely rapid pace, and society has begun to make higher demands on practitioners' ability to prove their compliance with accep ted professional standards. With that end in view, in many countries of the world medical doctors are required to participate in lifelong learning programs that are based on two key aspects -a) maintaining the level of professional expertise through lifelong learning and professional development, b) further testing of acquired skills and knowledge using different evaluation and feedback mechanisms (recertification or revalidation) [2].
The first attempts to introduce postgraduate training for medical doctors in Ukraine date back to the late 80s of the XIX century and are related to the activity of the Kharkiv Medical Society (1861), when in 1889 Professor V. Krylov organized Repeating and Demonstrative Courses" in Bacteriology on the basis of the Pasteur Station and the Kharkiv Bacteriological Institute. Less than ten years later, in Kyiv, Professor V. Vysokovych also organized systematic courses in theoretical and practical Bacteriology in 1897 on the basis of the Bacteriological Institute, and in 1901 the first in the Russian Empire courses in Pathological Anatomy.
Thus, at the outset of postgraduate medical education stood scientists of medical faculties of the Kharkiv and Kyiv universities, however, the establishment of a specialized edu cational establishment -at present Shupyk National Medical Academy of Postgraduate Education -became possible only during the Ukrainian statehood (1917)(1918)(1919), during the revival of Ukrainian education, science and culture.
The creation of such a specialized institution was attri buted to socio-political processes that took place in Ukraine during 1917-1918. This short historical period was marked by the revival of Ukrainian culture and education, inclu ding medical education. On October 5, 1917, the Ukrainian People's University was founded in Kyiv as the initial form of laying the foundations of the national Ukrainian higher school, including its medical faculty, which coexisted with the medical faculty of St. Volodymyr's University, in November 1918 the first and new for Ukraine (in St. Petersburg in 1885) the type of higher educational institution was created -the Clinical Institute of Advanced Training for Medical Doctors (hereinafterthe Institute).
It is significant that the at the origins of its creation were the medical community -the Trade Union of Kyiv Doctors, whose leading representatives, graduates of the Medical Faculty of St. Volodymyr University M. Levitsky, O. Laza riev, E. Sklovsky, G. Bykhovsky, I. Frumin and others became the founders of a new type of establishment and its first professors.
The mission of the establishment was clearly defined in its first Statute: "1) The vision of the Clinical Institute: Clinical Institute of the Kyiv Union of Doctors is a research & trai ning establishment, the purpose of which is medical specialty training in practical and theoretical medicine for medical doctors, organizing repeated courses aimed at supplementing and refreshing medical doctors' know ledge, and finally, organizing research work for medical doctors in their chosen fields" [3].
According to archival materials, in May 1918 at the ge neral meeting of the Union of Kyiv Doctors, on behalf Медицина / Медицина / Medicine of one of the city patrons N. Uvarova, doctor M. Kiselevich proposed "to transfer the building of the liquidated Consolidated Red Cross Infirmary named after F. Tereshchenko at the corner of Bibikovsky Boulevard and Tereshchenko Street, 13/7, together with some medical supplies and household equipment for the use by the Clinical Institute", which was the beginning of the creation of the Institute training venue [4].
Professor M. Levitsky (1918)(1919)(1920)(1921)(1922) became the first Chairman of the Board. Among the main tasks of the Institute, Professor M. Levitsky defined: "... training medical doctors in the field of theoretical and practical medicine, replenishing and refreshing knowledge of young medical doctors, to achieve this goal periodic repeated courses by all specialties are organized, as well as practical scientific work is conducted, it results in improving medical care for the broad population of Kyiv and its outskirts..." [4].
At the beginning of its activity training process for medical doctors at the Clinical Institute involved practical work in medical institutions and evening lectures, systematic classes began in the autumn semester of 1920, when 117 medical doctors became the first learners of "newly opened repetitive courses".
During Summing up the Institute's achievements for the first 10 years of its activity, noting its role and place in the health care system and outlining the perspective, its Director Professor O. Bernstein in 1928 emphasized: "... among the devastation, hunger, epidemics in the first days of the revolutionary era, this cultural center was created -one of the stages of Soviet medicine development ... In 10 years the Institute became a large research & training institution, which strengthened the knowledge of more than 2,500 medical doctors, which was more than 1/4 of all medical doctors in Ukraine ..." [5].
The beginning of the 1930s was marked by the completion of a radical reorganization of the higher medical school of Ukraine. According to the new Statute (1931), the duties of learners were defined for the first time: " After graduation all learners of institutes of advanced training were obliged to work in positions assigned by the NCHC at the rate of 1-1.5 months of service for 1 month training, but not less than one year" [6]. And in 1938, the Government Decree "On Strengthening the Rural Site" for the first time established a mandatory -once for every three years -referral to training courses for medical doctors from rural areas, and once every five years for medical doctors from urban sites.
During this period, the Institute was managed by di- In the late 1950s, the Institute was headed by Professor M. Umovist, who held this position for 25 years . This period was marked by important events in the life of the Institute, which left an imprint on all its further activity. They are related, firstly, with a significant increase in the number of departments to meet the needs of practical health care, which since the early 60's has taken the direction in expanding, improving and enhancing the specialized care quality. Second, from 1965 onwards for more than a quarter of a century (until 1991), the Institute was subordinated to the Ministry of Health of the USSR, which gave it a new "international" status, as learners came from all the republics of the USSR, although medical doctors from Ukraine always accounted for almost half of the entire contingent of learners.
By 1991, the Institute became one of the largest in the USSR and the most powerful educational institu- In commemoration of the 80th anniversary of the Academy, according to the Resolution of the Cabinet of Ministers of Ukraine № 513 of April 20, 1998 "On Perpetuation of the Memory of P. Shupyk", the establishment was named after a prominent statesman and scientist Professor Platon Lukych Shupyk (1907 -1986), who held the post of the Minister of Health of Ukraine twice (1952)(1953)(1954)(1956)(1957)(1958)(1959)(1960)(1961)(1962)(1963)(1964)(1965)(1966)(1967)(1968)(1969), made a significant contribution to the development of educational, research and material capacity of the Academy, and for 14 years (1965)(1966)(1967)(1968)(1969)(1970)(1971)(1972)(1973)(1974)(1975)(1976)(1977)(1978)(1979)  The Academy is the leading center in Ukraine in postgraduate settings for teaching & methodological work for medical doctors and pharmacists, which is entrusted by the Ministry of Health of Ukraine to develop the most standard training programs for specialization, and internship, computer attestation programs used by all institutions and faculties of postgraduate education.
Every year the Academy develops and updates more than 100 curricula and programs of training courses, publishes more than 60 educational & methodical publications (textbooks, training manuals, reference books) and conducts more than 1.5 thousand training courses for more than 3 thousand interns and more than 25 thousand medical doctors and pharmacists.
The Academy scientists' research developments are appreciated both in Ukraine and in the world. Research outcomes by the Academy research & academic staff members for the last twenty years have been reflected in more than 500 monographs, 130 textbooks, 600 manuals, 190 reference books, 950 methodical recommendations and information letters, 640 patents. Over the past 35 years, the Academy scientists have received more than 560 copyright certificates for inventions, some of which are patented in the United States, Italy and other countries [7].
One of the priorities of the Academy is the continuity of scientific knowledge. Currently, the Academy has 11 Specialized Academic Councils for the defense of Central Credit Register (CCR). This gives the Academy the opportunity to be a recipient for grants from the US Congress and the US National Institutes of Health. Since 2008 NMAPE has been a collective member of the European Academy of Natural Sciences. A significant event was signing in 2016 a cooperation agreement between NMAPE and the leader of the European medical educational Karolinska Institutet (Sweden). Since 2017, the Academy has been a member of the Magna Charta Universitatum. In 2018, the Academy became a member of the Organisation for PhD Education in Biomedicine and Health Sciences in the European System (ORPHEUS) and received the Recognized for Excellence 5 Stars certificate in the EFQM excellence system.
Awarding honorary titles (Doctor Honoris Causa and Professor Honoris Causa) to famous world scientists is traditionally practised. Doctors Honoris Causa of the Academy are Professor Theodor Helbrugge (Germany), Professor Albert Schinzel (Switzerland), Professors Honoris Causa are the Alternative Nobel Prize laureate George Vitulkas (Greece), Professor Hubertus von Foss (Germany), Professor Ktibor Weiss (Austria), Professor Maciej Smetanski (Poland). The Academy is a co-organizer of the Association "Medical Informatics" with offices in Canada, USA, Germany, Vietnam, China, Bulgaria [5].
Today NMAPE has taken the next step in the second century of its existence. Prospects for the development of NMAPE are defined in the basic documents: Strategy and Development Program, and the main strategic task is to form a model of NMAPE based on combining education, research, medical practice and innovation, integrating into international research and educational space and carrying out the necessary preparatory activities for obtaining the status of a research university by NMAPE.
At all stages of the Academy's activity, research & academic staff has made a significant contribution to the treasury of Ukrainian medicine and education, thereby helping health care and higher medical education reforming in Ukraine.

Conclusions
The introduction of postgraduate training for doctors and pharmacists in Ukraine is studied on the example of more than 100 years of NMAPE activity and it allows to state that on the basis of combination of education, research, medical practice and innovations in Ukraine, the center has become an example to follow and a model of educational & methodological work in postgraduate medical and pharmaceutical education settings.

Conflicts of interests.
Authors declare the absence of any conflicts of interests and their own financial interest that might be construed to influence the results or interpretation of their manuscript.