Merja Toivonen, University of Tampere, 3.6.2016, Practical issues for integration into Finnish healthcare system

1. THL 2.6.16

2. Licensing process for imigrating
doctors graduated outside the
EU-countries
Merja Toivonen 3.6.16 THL
GP, Clinical teacher in general medicine, University of Tampere
Project manager, University of Tampere

4. Diploma evaluation by Valvira
• Requiered before any other actions towards licencing
• The original diblomas needed
• The process takes more than 4 months
• One must use the form for the application, provided at Valviras
website
• A lot of attachments needed
• Apostille or Grand Legalisation procedure used when evaluating the
diploma´s origin

5. Practice in hospitals or in health centers in
the muncipalities
• Duration 6 months minimum for doctors, can be collected from
several employers
• Salaries according to bargaining agreement (FMA or SLL) as an
assistant doctor (amanuenssi)
• For dentists practicing of three months at Turku univercity´s dental
clinicis needed
• The supervision of a senior doctor is mandatory

6. Language test in Finnish or Swedish
• The language test´s lewel of YKI 3 (official Finnish language
assessment system) is mandatory to get access to the examinations
• The lewel might be raising to YKI 4 –lewel in the future
• It has been investigated that YKI 3-level is not sufficient for the
written exams (Tervola M., Mattila K., Duodecim 2015;131(4):339-46)

7. Written clinical examination (KLI)
• At Tampere university four times a year
• Six clinical cases to be solved
• Evaluation criterions
• Clinical skills and central knowledge of medicin needed in general practice
• Familiarity with the Finnish healthcare systems
• Finnish clinical pathways used in decisions
• Can be re-tested nine times
Sufficient Finnish language is needed, but language is not a criterion in
evaluation of the test
• After aproved exam Valvira gives a restricted lisence for practising in
general hospitals under supervision of a licensed doctor

8. Finnish heath care examination (STH)
• At Tampere University four times a year
• Divided in three parts:
1. Diciplinary of the recipies (reseptioppi)
2. Forensic medicine (oikeuslääketiede)
3. National health care system in Finland (suomalainen
terveydenhuoltojärjestelmä)
• Can be made separately, like three different exams
• Can be re-tested nine times
• Lower price for the re-test if only one part is tested
• After approved exam Valvira gives a restricted lisence for practising
also in heath care centers under supervision of a licensed doctor

10. Clinical skills assessment (POT)
1. Three videofilmed patient appointments for normal/actual patients
in heath care center under control of an experienced GP
• A normal patient appointment includeing:
• patient interviewing and clinical status,
• care planning, prescriptions ect. according to Finnish guidelines
• patient indormation
• The patient is asked for an assessment of the appointment (was
he/she understood properly)
2. Testing of X-ray diagnosis acquirements
Assessment of the videos are done by one professor (general medicine)
and two clinical teachers at Tampere University
After approved test Valvira gives a full lisence

11. The tariff of Tampere-exams
• KLI (Clinical exam) 500 €
• STH (Finnish heath care) 500 €
• STH re-test, 1 part 250 €
• POT(Patient exam) 1400 €
• Payment for a certificate 20 €

12. Statistics
• Every year Valvira gives permission for an examination process to
about 50 new doctors outside EU countries
• About 35-40 approved clinical evaluations per year
• In year 2015
• KLI of 132 accepted 62 (47%)
• STH of 112 accepted 58 (52%)
• POT of 46 accepted 36 (78%)
Waiting times for Clinical assessments has been long, but this year
Tampere University has put extra resources for the process and now
there are no more rows to the test

13. The most common countries of the diploma
between the years 1994-2015
• Russia 532 (26 of 36 in the year 2015)
• Ukraina 36
• Irak 18
• Egypt 17
• Afganistan 11
• America 20 (including North and South)
• Estonia 129 (joined EU)

14. Dentists´ lisencing process at Turku and Helsinki
University (present system from 1.1.16)
• Diploma evaluation by Valvira
• Three months´ training at Turku University´s dentist clinic (four places
at a time)
• The theory test once a year in January-February (in Helsinki and
Turku)
• The practical test once a year in March-April
• Administration and radiation laws and practices tested once a year
during every spring

15. Project to develop training and
qualification process for doctors´ and
dentists´ coming outside EU- and ETA-
countries in 2015-16
Merja Toivonen
GP, Clinical teacher in Tampere University
Project manager
3.6.16

16. Lääkäriksi/hammaslääkäriksi Suomeen
-valmennusmalli EU-/ETA-alueen
ulkopuolella lääkärin tutkinnon
suorittaneille

17. The objectives of our project
• To evaluate the exisiting system
• To create a new way to evaluate and a new educational process,
similar for doctors and denstists
• Education system based on different modules with professional
contents and language learning (WP1 and WP2)
• Part of the language modules and professional modules will be mixed

18. Financing and partners of the project
• The Ministry of Education and Culture (OKM) gave financing
• The Ministry of Social affairs and Health (STM), Ministry of
Employment and the Economy (TEM) are also connected
• Tampere University is the main operator
• Jukka Mäkinen (project chief)
• Anneli Sorkio (project manager, language skills, WP2) -> Taina Pitkänen
• Merja Toivonen (project manager, professional skills, WP1)
• Partners: University of Turku, University of Joensuu, University of
Helsinki, Duodecim, City of Tampere, (Mediverkko, no more)
• Assessment: University of Jyväskylä (language)

19. The big picture in the future
• The rules of the licencing process will remain mostly the same
• More professional language skills can be reached during the modules
• YKI 4 lewel in language might be demanded
• For dentists a similar process than the doctors have (1.1.16, new rules)
• New rules for contents of the practicing period of 6 (doctors) or 3 (dentists)
months
• Personal objectives, guidance, duration of one period minimum x months
• Info for the employers
• Co-ordination of the process from diploma evaluation untill the lisence

20. Ei läpäise lähtötasotestiä. Palaute
ja ohjausta lisäopintoihin
Lääketieteellinen osaaminen ja
suomen kielen taito riittävällä
tasolla:
valitsee moduulit vapaasti tai
menee suoraan
laillistamiskokeeseen
1. Alkuarviointi
Ammatillinen osaaminen ja suomen kielen taito/B1-taso
Moduulit: 1. Suomalainen terveydenhuoltojärjestelmä ja
a) Kieli, oppiminen ja oppija
2. Moduuli
Perusterveydenhuollon
episodiluonteiset hoitopolut
3. Moduuli
Pitkäaikaissairaan hoito/polku
4. Moduuli
Terveyden edistäminen
5. Moduuli
Lääkärin toiminta
terveydenhuoltojärjestelmässämme
6. Moduuli
Tutkimukset ja toimenpiteet
Moduuli b) Kielen oppiminen
työpaikalla
Moduuli c) Viestintä
työyhteisössä
Moduuli d)
Vuorovaikutus potilastyössä
Moduuli e) Itseohjautuva
kielenopiskelu
2. Kliininen kuulustelu
3. Suomalainen terveydenhuolto-
kuulustelu
4. Potilastentti
Puutteita lääketieteellisessä osaamisessa Puutteita suomen kielen taidossa
Lääkärin/hammaslääkärin tavoitteellinen työharjoittelu
Kielitesti YKI-4
12kk

21. Assessment of professional skills and language
Modules : 1. The Finnish heath care system and
a) Language , learning and learner

22. The first module for doctors and
dentists begins 25.8.16
• 25.8.-23.9.16
• Registration before 25.7.16
• 15-20 persons according to the assessment (1.8. Tampere and
Helsinki)
• The Finnish language level B1 required (The European Frame of Reference)
• Basic professional skills are sufficient
• Eight days at Tampere (4x thu-fri)
• Learning language is Finnish!
• Price 700 €

23. Thank you! Any questions?