ACCREDITATION
OF FURTHER EDUCATION FOR HEALTH PROFESSIONALS

Contents
INTRODUCTION02	Certification		
		study programmes	12	
FOR HEALTH				
PROFESSIONALS	02	Continuing education study programmes	13	
				
PLURALITY		Application for accreditation	13	
OF FURTHER EDUCATION				
FOR HEALTH		Project contents		14	
PROFESSIONALS	03			
		Pedagogical documentation....	15	
ACCREDITED		Procedure		
AND NON-ACCREDITED		for processing applications	16	
EDUCATIONAL ACTIVITIES	04			
		Application Evaluation principles 		
ACCREDITATION		used by the Accreditation		
COMMISSION OF THE MHSR	05	commission	16	
Standardisation 		07	Documentation about the study		20	
Accreditation -		Documents issued by		
Evaluation of competence		08	the educational institution		21	
Other		08	■     FINANCING		
		OF FURTHER EDUCATION	21	
Commission meetings	09			
		Amount of settlement		
Results of the present		of the health		
activity of the Commission	10	professional	22	
Results		European Union Funds	23	
of standardisation activity		10			
		State contributions	24	
Results of the 				
accreditation activity		11	■     EVALUATION		
		OF THE QUALITY OF EDUCATION	25	
Iné	11			
		■     SOURCES	27	
CONDITIONS OF  ACCREDITATION   aAAACCREDITATIONACCREDITATION	11			
Specialised		Annexes	28	
study programmes	12			

© 2006 MHSR

Introduction

The strategic importance of education for the development of society was confirmed by representatives of the European Union in Lisbon on 23–24 March 2000 at the meeting of the European Council. One of their conclusions
was that the styles of education, life and work change constantly and Europe has moved to an “Era of knowledge”.

Also, documents from February 2005 for a new beginning of the Lisbon Strategy claim that knowledge may be the key factor through which Europe will keep its international comparative advantage.

For the implementation of lifelong learning, the European Commission has adopted documents which it summarised in 2000 in its Memorandum on lifelong learning. 

In the Slovak Republic, lifelong learning in the field of education was treated in several conceptual materials of the Ministry of Education. For example, the Concept of Further Education in the Slovak Republic approved by the government in the year 2002 contained the characteristics of the present state of further education and the basic preconditions for its development until the year 2010.

Further education of health professionals in the Slovak Republic takes place within the context of these European and Slovak strategic and conceptual materials.

Authors

The publication contains the sequence of steps leading to the acquisition of accreditation of the corresponding study programme from the Ministry of Health.

Lifelong learning of health professionals

A duty of health professionals is to systematically study, increase or deepen their professional competence and continuously renew their acquired professional competence.  This is so that, throughout their career, they keep up with the development of practice and science in the relevant field. Lifelong learning is important mainly for ensuring the necessary quality of health care provision and the protection of a citizen or patient from the inadequate provision of health care.
Further education of health professionals represents the part of their lifelong learning after they have obtained professional competence to pursue professional working activities.

According to government ordinance No. 322/2006 Coll. concerning further education methods for health professionals, the system of specialisation and the system of certified working activities, further education of health professionals may be categorised as

•	specialised study
•	certification training or
•	continuous education activities, such as conferences, seminars, workshops and courses, professional internships, lecturing, pedagogical, publishing and scientific-research activity and the like.

The first two methods are developed in an institutionalised form of further education, the latter can also take place outside of an institution. Professional medical practice also plays an important role in lifelong learning of health professionals.

Plurality of further education of health professionals

Act No.528/2003 Coll. amending and supplementing Act No.131/2002 Coll. on Higher Education as well as Act No.277/1994 Coll. on Health Care then in force introduced plurality in the provision of further education of health professionals for the first time in the history of the Slovak Republic.

This means that, after more than fifty years, during which time a single educational institution had a monopoly on further education in the health system within the Slovak Republic, legal regulations created space that abolished this monopoly. This allowed other educational institutions (including institutions with international characteristics) to apply for the accreditation of further education of health professionals.

The Slovak Medical University of Bratislava was created from the Slovak Postgraduate Medicine Institute and, mainly, from the former Institute for Further Education of Doctors and Pharmacists and from the Institute for Further Education of Middle Health Professionals. It was the only institution within the Slovak Republic to have the right to offer further education for health professionals and to issue health professionals with further education certificates of participation that had national validity.

From the entry into force of the above-mentioned Act on 1st January 2004, the legal regulation that opened the way for other educational institutions became available. Reform acts of the health department from the year 2005 have confirmed this trend in the system of further education of health professionals.

Scheme 1
Lifelong learning of health professionals

Continuous

seminars, conference, workshops, courses, professional internships, lecturing, pedagogical, publishing and scientific-research activity

seminars

Certification training

												

Specialised study

								

Acquisition of professional competence for the pursuit of a health profession at university or secondary health school 

Pursuit of a medical profession (professional, specialised or certified working activities)

Further education of a health professional
							
Lifelong learning of a health professional

		main process
		parallel process
Accredited and non accredited educational activities

According to Act No. 578/2004 Coll. on Healthcare Providers, Healthcare Workers, Professional Healthcare Organisations and on the Amendment and Supplementation of Certain Acts as amended (Article 40 and following), it is possible to differentiate between educational activities dedicated to health professionals that must be subject to the Ministry of Health of the Slovak Republic's accreditation process, and educational activities that may be realised without the Ministry's accreditation.

Accreditation is mandatory for each natural or legal person who wishes to undertake:

•	specialised study programme,
•	certification study programme, or
•	study programme of continuing education (that does not repeat a previous educational activity)

dedicated to health professionals.

Accreditation of a specialised study programme dedicated to health professionals with university education may only be requested by a university (Article 46 of the Act on Universities). A university may file an application only if it provides education for students in the same medical profession in which it requests the specialised study programme (Article 40 par. 3(a) of the Act on providers).

Accreditation of a specialised study programme dedicated to health professionals with secondary education may be requested by a secondary health school for medical assistants, if it provides education for students in the same medical profession in which it requests the realisation of a specialised study programme (Article 40 par. 3(a)
of the Act on Providers).

Accreditation of specialised study programmes for other health professionals may only be demanded by a university that prepares health professionals for the pursuit of a health profession within one of the fields in the number 7 Health Service.

Accreditation of a certification study programme or a study programme of continuing education dedicated to health professionals may be requested by the Ministry of Health for any natural or legal person:
 
•	for whom education is their main activity,
•	who has ensured the services of the lecturing team responsible for the study programme for which it requires accreditation or
•	at least five years before the submission of the application performed health care provision.

The opinion of the relevant chamber on the performance of the study programme of continuing education for which it requests accreditation should be attached to the submitted study programmes of continuing education. According to the quoted Act No. 578/2004 Coll., continuing education is handled by the corresponding chamber that helds the register of health professionals performing the corresponding health profession.

Scheme 2
Educational activities of continuing education of health professionals

Non accredited by the Ministry of Health

unrepeated  
(with a changing programme - content)

(e.g. hospital, district, regional, national and international seminars and conferences, internships on the premises of  health facilities, pedagogical activity, publication activity, scientific-research activity)

i.e. study material - in this case the programme of the activity can differ from case to case, and it varies over time

Accredited by the Ministry of Health

repeated
(with the same content)

(e.g. additional - educational courses or skills in emergency health services, training of psychotherapists)

i.e. study material is standard and is taught repeatedly

After five years from the day that a health professional is registered in the chamber the corresponding chamber (except for emergency medical services, where the evaluation is carried out annually by the employer) evaluates whether the health professional obtained the determined number of credits in the specified period (doctor 250, dental doctor 250, pharmacist 100, nurse 100, etc.)

Credits corresponding to a definite educational activity of continuing education are laid down by the Regulation of the MHSR No.366/2005 Coll. on the criteria and method of evaluating the continuing education of a health professional, as amended by the Regulation of the MHSR No. 187/2006 Coll.

Accreditation Commission of the MHSR

The Accreditation Commission of the MHSR for further education of health professionals is, according to the mentioned Act on Providers, the advisory body of the Ministry of Health of the Slovak Republic for the area of accreditation for further education of health professionals.

The accreditation Commission of the MHSR for further education of health professional is composed of experts with long-term professional health and pedagogical practice in individual health professions. It is designed so that each category of health professionals - doctors, dental practitioners, pharmacists, nurses, midwives, laboratory technicians, assistants, technicians and other health professionals, are represented in it. At the beginning of its activity in December 2004, the Commission had 12 members and the first president of the commission became Dr. Juraj Pechan, CSc.

Within the meaning of the statute of the commission issued by the Ministry of Health, for the fulfilment of its specific duties and for the preparation of its meetings it obligatorily establishes the following workgroups:
a) workgroup for the accreditation of specialised study programmes and certification study programmes in the category of “doctor”,
b) workgroup for the accreditation of specialised study programmes and certification study programmes in the category of “dental practitioner”,
c) workgroup for the accreditation of specialised study programmes and certification study programmes in the category of “pharmacist”,
d) workgroup for the accreditation of specialised study programmes and certification study programmes in the category of “nurse”,
e) workgroup for the accreditation of specialised study programmes and certification study programmes in the category of “midwife”,
f) workgroup for the accreditation of specialised study programmes and certification study programmes in the category of “laboratory technician”,
g) workgroup for the accreditation of specialised study programmes and certification study programmes in the category of “assistant”,
h) workgroup for the accreditation of specialised study programmes and certification study programmes in the category of “technician”,
i) workgroup for the accreditation of specialised study programmes and certification study programmes in the category of “other health professional”, for health professionals categorised as physiotherapists,
j) workgroup for the accreditation of specialised study programmes and certification study programmes in the category of “other health professional” for health professionals categorised as psychologists, logopaedists, and therapeutic pedagogues and special pedagogues,
k) workgroup for the accreditation of specialised study programmes and certification study programmes in the category of “other health professional” for health professionals who are not listed under letter a) to j).

Workgroups deal with study programmes in the corresponding category of health professionals in the corresponding professions according the Regulation of the Government of the Slovak Republic No. 322/2006 Coll.

Each of the current members of the commission is also the president of one of the listed workgroups of the commission one member is the president of two workgroups at the same time (for the “assistant” category and for the “other health professional” category in the “physiotherapist” profession). The commission has the option to invite external experts to their discussions.

The commission may also have associate members, employed by the Ministry with a scope of employment particularly necessary for the work of the commission or a person who is an important figure in the field of further education of health professionals. At present the associate members of the commission appointed by the Minister of Health are the Director General of the Section of Health of the MHSR and the Director of the Department of Health Education. 

An overview of full and associate members of the Accreditation Commission of the MHSR is listed in Annex 1.

The commission has at its disposal two secretaries who are employees of the Ministry and one administrator. The secretaries focus on the activities of the commission and its workgroups following individual categories of health professionals, while the administrator prepares the meetings of the commission from the technical-administrative aspect.

In order to ensure professional evaluation of study programmes that individual organisations in the Slovak Republic intend to develop, the Accreditation commission of the Ministry of Health of the Slovak Republic for further education of health professionals was established and began operating activity on 2 December 2004.

Tasks of the Commission

Standardisation
The Accreditation Commission of the MHSR elaborates and proposes to the Ministry for approval

•	the minimum standards of specialised study programmes in the corresponding fields of specialisation stated in the Regulation of the Government of the Slovak Republic No. 743/2004 on the Method of Further Education of Health Professionals, the System of Fields of Specialisation and the System of Certified Working Activities as amended by the Regulation No.179/2005 Coll.

•	the minimum standards of certification study programmes of certified working activities stated in the quoted government regulation as amended, and possibly

•	also the minimum standards of cyclical study programmes of continuing education

in the form of model study programmes (Article 4 and Article 5 of the government regulation).

The commission ensures compliance of the proposed minimum standards with the requirements of the bodies of the European Union updates them regularly and helds an integrated database on the approved minimum standards, which is accessible to public.

The model study programmes for the specialised study, certification training or continuing education of health professionals are published regularly in the Official Journal of the MHSR (see special issue from 30.7.2005, 13.2.2006, 1.3.2006 and 30.5.2006; others are in the process of treatment).

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Scheme 3
Standardisation of study programmes of further education of health professionals
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Standardisation
                         initiative

1. Alternative: MHSR or the Accreditation Commission of the MHSR discovers the absence of and need for a model specialised study programme in the corresponding field of specialisation, a model certification study programme in the corresponding certified working activity and announces the call for submission of a model programme by a potential submitter – via internet or alternative method.
2. Alternative: a natural or legal person expresses interest in the preparation and submission of the proposal of a model (specialised, certification, continuing education) study programme – through the mail room of the MHSR

                     
Control of compliance of requisites and content of the proposal of a model study programme with the requirements of the legal regulations (Act on Providers, government regulations on professional competence of health professionals and on their further education, system of trade unions, etc.)

						

Department of Health Education of the MHSR

                     
Assignment to the corresponding workgroup of the AC MHSR and determination of external cooperators

President of the AC MHSR

       Wide discussion, public opposition, internal opposition
											
Wide discussion, public opposition, internal opposition

						
Workgroup of the AC MHSR, Accreditation Commission of the MHSR, 
various educational institutions, MHSR

  Evaluation and processing of remarks, summary

Wide discussion, public opposition, internal opposition

Accreditation Commission of the MHSR and the Department of Health Education of the MHSR

       Model study programme

Wide discussion, public opposition, internal opposition

						Accreditation Commission of the MHSR

       Approval by the Ministry				

Wide discussion, public opposition, internal opposition

						
						Panel meeting of the Minister of Health

Publication (Official Journal MHSR) and implementation (educational institutions)

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Accreditation – evaluation of competence

The MHSR Accreditation Commission also evaluates the ability of the educational institution to conduct the specialised study programme, certification study programme or a study programme of continuing education for health professionals and submits to the Ministry a proposal to issue a decision on accreditation.

The evaluation of the educational institution's competence  also includes ensuring that relevant personnel and material-technical conditions for the theoretical and practical components of education are met in accordance with the requirements stated in the minimum standards (model study programmes).

The commission systematically follows and independently evaluates the pedagogical, professional, material-technical and moral competence of educational institutions that have obtained the accreditation for a study programme for the further education of health professionals.

It evaluates in detail the conditions and quality of the education provided, provides recommendations for improvement in the quality of their work and, if necessary, it submits to the Ministry a proposal for cancelling the decision on accreditation.

Other

The commission carries out also other activities in the field of accreditation for further education of health professionals, if so instructed by the Ministry of Health. For example, it gives accreditation to study programmes of continuing education, helds the records and single issuance of documentary evidence for further education according to a regulation in force from the Slovak government regarding methods for further education of health professionals certified working activities and, in cases of duplicity, it proposes and ensures corrective measures.

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Scheme 4
Process for accreditation of study programmes for the further education of health professionals
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Submission of applications

Wide discussion, public opposition, internal opposition

							Mail room of the MHSR

       Control of the integrity of the content and form 
of the application				

Wide discussion, public opposition, internal opposition

Department of Health Education of the MHSR and Legal Section of the MHSR

Assignment to the corresponding workgroup of the AC MHSR
of the application

Wide discussion, public opposition, internal opposition

							President of the AC MHSR

Comparison with the model study programme. Evaluation of an expert guarantor and the lecturing team for the theoretical and practical components of education

Wide discussion, public opposition, internal opposition

Workgroup of the AC MHSR

							

Evaluation of material-technical equipment for carrying out the practical portion of the course (most frequently an inspection at the educational institution and at the health care provider)

Wide discussion, public opposition, internal opposition

Members of the workgroup, members of the Commission, invited experts (in particular the primary MHSR experts) with relevant professional expertise

Opinion of the Accreditation Commission of the MHSR

							Accreditation Commission of the MHSR

Elaboration of a proposal to grant or refuse accreditation

							Legal Section and Department of Health Education

Granting or refusing an accreditation

Wide discussion, public opposition, internal opposition

							Minister of Health of the Slovak Republic

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Meetings of the Commission

Under the meaning of the statute, the Accreditation Commission of the MHSR for further education of health professionals shall meet approximately once every two months, but at least four times a year.
 
Due to the amount of work that needs to be done to properly introduce plurality to the further education of health professionals, for over a year the commission has been holding meetings at an average of one a month. In addition, workgroups of the commission, together with external invited experts, hold meetings in the period between meetings.

From the beginning of its activity until 31 March 2006 15 regular and 2 extraordinary sessions of the Accreditation Commission of the MHSR took place in total, in addition to four external work meetings with the purpose of evaluating the competence of the educational institutions to conduct the corresponding specialised programmes, and 51 meetings of its workgroups, which took place at the MHSR (72 meetings in total). Moreover, ad hoc meetings of workgroups outside the MHSR also took place, for which the MHSR has no particular records.

The communication and coordination of the activities of experts are ensured by the Ministry of Health of the Slovak Republic.
Ministerstvo zdravotníctva
Slovenskej republiky
Sekcia zdravotníckeho vzdelávania Odbor riadenia zdravotníckeho vzdelávania
Limbová 2, 837 57 Bratislava tel.: 02/593 73 171, 02/593 73 373, fax: 02/593 73 400
e-mail: 	monika.hozlarova@health.gov.sk
	zuzana.slezakova@health.gov.sk

Results of current Commission activities

Results of standardization activity

The first basis for the elaboration of model specialised programmes in the corresponding fields of specialisation and model certification programmes for further education of health professionals were the proposals from the Slovak Medical University in Bratislava.

In the period between January 2004 and December 2004 they passed through the opponency of other universities preparing for the pursuit of medical professions, professional companies and other interested institutions so that they were available at the start of the Accreditation Commission of the MHSR's activities on December 2004. During the period between 2.12.2004 and 31.3.2006, the Commission adapted and proposed to the Ministry of Health 104 model education programmes for approval.

With regard to the list of all fields of specialisation and certified working activities contained for all the categories of health professionals in the Regulation of the Government of the Slovak Republic No 743/2004 on the Method of Further Education of Health Professionals, the System of Fields of Specialisation and the System of Certified Working Activities as amended by the Regulation No.179/2005, the Accreditation Commission of the MHSR has 201 model programmes left for elaboration or processing before the next period, the majority of which are missing model certification study programmes. This number does not include model study programmes of continuing education where the initiative is left entirely to potential education institutions.

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Scheme  5
Model specialised programme versus accredited specialised study programmes
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Accredited specialised study programme

Model specialised study programme

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Results of accreditation activity

The Ministry will issue a certificate of accreditation in the form of a decision to the educational institution. This fulfils the conditions of accreditation laid down by the Act No.578/20004 Coll. and for which the Commission has issued a positive opinion on granting accreditation.

The Ministry of Health of the Slovak Republic issued its first accreditation decisions for specialised study programmes in the “doctor” category to the Jessenius Faculty of Medicine of the Comenius University in Martin and to the Pavol Jozef Šafárik University in Košice, as well as to specialised study programmes in the category dentist in March 2006. As a result, the monopoly in further education of health professionals was effectively ended.

The list of accreditation decisions is listed in Annex 5. In case the Slovak Medical University in Bratislava does not request accreditation in these fields of specialisation from the MHSR nor obtain it by the end of the year 2006, it shall not proceed further with the non accredited study (Article 101 par. a) of the Act on Providers).

Other

In November 2005 the “Principles of Accreditation of Study Programmes for Further Education of Health Professionals” was published in the Official Journal of the MHSR. It was evaluated by the Accreditation Commission of the MHSR and proposed for approval to the Ministry of Health. The principles are the working instrument of the Commission in the process of accreditation for ensuring objective evaluation of applications.

In the next period the Commission will probably focus on the elaboration of the Quality Indicators for Further Education of Health Professionals and the methodology of control of the fulfilment of the conditions of accreditation.

Conditions of accreditation

The Ministry of Health of the Slovak Republic decides on the accreditation of 

•	specialised study programmes, 
•	certification study programmes and 
•	study programmes for continuing education that are cyclical in nature and are aimed at refreshing and maintaining theoretical knowledge, practical skills and experiencies among various categories of health professionals.

Accreditation applies to specialised study programmes in certain fields of specialisation that are, within the directives of the European Union, recognised automatically, but also specialised study programmes in fields of specialisation that are not recognised within the European Union but are desirable in terms of health protection requirements and the quality of health care in the Slovak Republic (see Annex 2).

Each of the specialised study programmes has a detailed level of theoretical knowledge and practical skills which the health professional must master in order to obtain a diploma in the corresponding field of specialization so that he or she can begin to carry out specialised working activities independently.

These standards are outlined by special editions of the Official Journal of the Ministry of Health of the Slovak Republic in which model specialised study programmes and model certification study programmes for individual categories of health professionals are defined.

When the university or other educational institution applies for the accreditation of a specialised study programme or a certification study programme, it is desirable that the applicant meets the given standard. In order to raise the interest of candidates it is also appreciated if the applicant offers practical skills and experience which the health professional may acquire from him or her and become a specialist in the given area.

As we have mentioned, the minimum standards of theoretical knowledge and practical skills are also outlined for certification study programmes that are focused on narrowly specific activities that the health professional should master.

Standards for programmes of continuing education are not expressly determined for the moment, as they are dedicated to various issues in individual categories of health professionals.

Specialised study programmes

Accreditation of a specialised study programme dedicated to health professionals with university education may only be requested by a university that:

•	has educational activity for students and it educates students in the corresponding medical profession in which it requests the specialised study program,
•	has outlined a project and pedagogical documentation according to the principles approved by the Ministry of Health, 
•	provided for the relevant lecturing team and material-technical conditions for the specialized study programme.

If the specialised study programme also includes the acquisition of practical skills that the educational institution cannot ensure on its own premises, another condition of accreditation is the submission of an agreement between the educational institution and another institution – mainly the provider of health care – to ensure the corresponding

•	material-technical and
•	personnel conditions

for the acquisition of the practical skills necessary for the pursuit of specialised activities for each participant of the specialised study programme according to the pedagogical documentation.

Accreditation of a specialised study programme dedicated to health professionals with secondary education may be requested by an educational institution – such as a secondary health school, which has:

•	educational activities and educates students in the corresponding medical profession in which it requests the creation of a specialised study program,
•	elaborated a project and pedagogical documentation according to the principles approved by the Ministry of Health,
•	provided for the relevant lecturing team and material-technical conditions for the specialised study programme.

If the specialised study programme also includes the acquisition of practical skills that the educational institution cannot guarantee on its own premises, another condition of accreditation is the submission of an agreement between the educational institution and another institution ensuring the material-technical and personnel conditions  for the acquisition of the necessary practical skills for the pursuit of specialised working activities for each participant of the specialised study programme according to the pedagogical documentation.

Certification study programmes

Accreditation of a certification study programme dedicated to the education of health professionals may be requested by an educational institution (university, secondary health school) that fulfils the conditions stated in the chapter entitled. Specialised study programmes.

Accreditation of a certification study programme for a certified working activity dedicated to the education of health professionals may also be requested by a health care provider, professional company or professional health organisation or another natural or legal person who has education in its subject of activity, provided that:

•	for a period of at least five years before the submission of the application it has carried out the provision of health care and has ensured the corresponding lecturing team for the creation of a certification study programme,

•	has outlined a project and pedagogical documentation for the certification study programme,
and 
•	has ensured the corresponding material-technical conditions for the certification study programme.

If the certification study programme also includes the acquisition of practical skills that the applicant cannot ensure in his own premises, another condition of accreditation is the submission of an agreement between the applicant and another institution to ensure the corresponding material-technical and personnel conditions for the acquisition of the necessary practical skills for the pursuit of certified working activities for each participant of the certification study programme according to the pedagogical documentation.

Study programmes for continuing education

Accreditation of a study programme for continuing education dedicated to health professionals (if it is an educational activity that will have the same content repeated at least once a year) may be requested from the Ministry of Health by any natural or legal person who has: 

•	educational activity or for a period of at least five years before the submission of the application has provided health care,
•	provided for the corresponding lecturing team for the  study programme for the continuing education that it is requesting accreditation for,
•	outlined a project and pedagogical documentation of the study programme for continuing education,
•	outlined the corresponding material-technical conditions for the study programme for continuing education.
If the study programme for continuing education also includes the acquisition of practical skills that the applicant cannot ensure on their own premises, another accreditation condition will be the submission of an agreement between the applicant and another institution that ensures the material-technical and personnel conditions necessary for the acquisition of  practical skills required for the pursuit of activities for each participant of the study programme of continuing education according to the pedagogical documentation.

It is recommended that the organiser attaches to the study programme a written statement of the corresponding professional organisation. In the health system these are: the Slovak Medical Chamber, Slovak Chamber of Dentists, Slovak Chamber of Pharmacists, Slovak Chamber of Nurses and Midwives, the Slovak Chamber of Laboratory technicians, Assistants and Technicians, the Slovak Chamber of Physiotherapists, the Slovak Chamber of Dental technicians, the Slovak Chamber of Orthopedic technicians, the Slovak Chamber of other Health Professionals and the Slovak Chamber of Psychologists.

This procedure is advisable in order to fulfil the provisions of Article 42 par. 3 of the Act on Providers. According to these provisions, continuing education of a health professional is ensured by the chamber that helds the register of health professionals in the corresponding medical profession.

As mentioned with regard to certification study programmes, accreditation of a study programme of continuing education of health professionals may also be requested by a university, secondary health school, health care provider, professional company, professional health organisations, etc.

Application for accreditation

The educational institution applies for the accreditation of each study programme separately.

On each submitted application it states

•	the name, registered office and legal form of the educational institution,
•	brief details of the activity of the educational institution with focus on the premises in which practical skills and experience will be ensured in a specialised study programme, certification study programme or a study programme for continuing education.

It attaches to the application:

•	the project, 
•	the pedagogical documentation of the study programme in question in accordance with the principles of accreditation,
•	the designation of the expert guarantor of the study programme and the certificates of professional competence of the expert guarantor of the study programme for the specialised working activities:
-	professional competence for the specialised activities is proved by a certificate of having attained the required degree of education in the appropriate field of study in the appropriate category of health professionals and a diploma on the specialisation in that field of specialization for which the educational institution demands accreditation, as well as with professional medical practice,
-	professional competence for the pursuit of certified activities is proved by having attained the required degree of education in the appropriate field of study in the appropriate category of health professionals and a certificate for the certified working activity,
•	a statement from the expert guarantor about the expert guarantor of a single study programme and a single educational institution.-	a list of the members of the lecturing team for the theoretical part of the course,
•	a list of the members of the lecturing team for the practical part of the course,
•	certificates of professional competence for the members of the lecturing team,
•	evidence of their consent to membership in the lecturing team,
•	documentary evidence of the age of the members of the lecturing team,
•	relevant documentary evidence that the educational institution has the necessary material-technical securing for the study programme or
•	an agreement between the educational institution and the provider of health care that the necessary specialised or certified working activities desirable for the pursuit of the accredited specialised study programme in the appropriate field of specialisation or for the pursuit of the certified working activity in the appropriate accredited certification study programme will be acquired,
•	documentary evidence of the pursuit of pedagogical activity by the expert guarantor and the members of the lecturing team,
•	agreements on the pursuit of pedagogical activity for members of the lecturing team carrying out the practical portion of the course, if they are the employees of the health care provider,
•	documentary evidence of labour or other professional relationships of the expert guarantor and members of the lecturing team with the educational institution and with the health care provider,
•	a statement of the expected number of applicants for the specialised study in the corresponding field,
•	a statement of the number of applicants within the competence of each member (supervisor) of the lecturing team for the practical part of the educational programme.

Content of the project

Name of the project – state the name of the study programme for which the accreditation is requested.

Person managing the project – state the name, registered office and legal form of the educational institution.

Objective of the project - why the stated programme of education should be created.

Expert guarantor

Description of the project:

•	characteristics of the field of specialisation, the duration,
•	the degree of education, the duration and content of professional medical practice necessary for the engagement in a specialised study in the field of specialisation,
•	the extent of theoretical knowledge, practical skills and experience that the health professional acquires by graduating from the accredited study programme. In this part we recommend stating and accentuating the knowledge,  practical skills and experience in the appropriate field of specialisation that the health professional will gain in the educational institution as compared to the minimum standard stated in the model specialisation programme,
•	the organisational form of the specialised study. In this part it is necessary to state, apart from the minimum standards stated in the model programme, how the educational institution will organise the specialised study, 

and the following details: opening of specialised study, information on the organisation, the study plan – time-table of the courses, location, evaluation of  acquired knowledge and practical skills, study texts, study literature, possibility of study texts on the web site of the educational institution, method of final evaluation, comments on the level and organisation of modules, courses in the form of an anonymous inquiry and similar,
•	the extent and aims of professional medical practice within individual departments of the facilities, their minimum duration and schedule,
•	the current state of specialists in the appropriate field of specialisation in the region,
•	expected sources of financing for the study and their relative proportions.

Pedagogical documentation

Apart from the project, the pedagogical documentation also includes the following:

•	the study plan for the duration of the specialised study (the study plan shall be elaborated depending on the duration, e.g. if the study lasts four years, it is necessary to state in which courses and seminars the trainee shall participate and how often during the four years),
•	the time-table including the specification of the subject matter within the programme according to Table 1,
•	overview of the qualification of the lecturers for the theoretical and practical portions of the education, supported by verified certificates of education,
•	protocols of evaluation of the knowledge and skills that the health professional acquire within the study programme,
•	index of proficiency,
•	record of health services and other professional activities,
•	composition of the examination Commission appointed by the statutory representative of the educational institution. The composition of the Commission shall observe Article 41 section 2 of Act No. 578/2004 Coll. on Providers. This means that it shall be composed of representatives of educational institutions offering the accredited specialised study programme in the appropriate field of specialisation. The recommended number of members of the Commission is seven. For the certification study programme for continuing education, the Commission is composed of representatives of the educational institution.

Within the study department of the educational institution, it is appropriate to separate the administrative employees who held and processthe administrative agenda for the further education of health professionals, i.e. for the specialised study, certification training or for the programmes of continuing education.

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Table no.1
Study plan for the specialised study programme

Field of specialisation		
Academic/school year		
Practical skills ensured by the department: 
Responsible person:		
Time-table: (State the number of semesters in which the subject matter shall be taught, the duration and the subject or syllabus)		
Responsible for observing  the subject matter:	    (lecturer)                                         (theme):	
Method of evaluation in the course of study (for participation, written tests, practical demonstrations of health services and similar)		
Literature
		
Procedure for processing the application

•	The application signed by the statutory representative of the educational institution shall be sent by registered mail to:
Ministry of Health of the Slovak Republic:
Sekcia zdravotníckeho vzdelávania Odbor riadenia zdravotníckeho vzdelávania
Limbová 2, 837 57 Bratislava

alternatively, it may be submitted to the mail room of the Ministry of Health of the Slovak Republic which is situated on the ground floor. It must be received, by either method by 31 March for the corresponding academic year.
•	Control of the fulfilment of the formal requirements of the application follows within 30 days from the submission. In the case of incompleteness a written notice for the completion of the missing data or documents within a reasonable time is produced for the applicant.
•	If the application is complete, an immediate submission to the president of the Accreditation Commission of the MHSR for further education of healthcare professionals will follow.
•	Evaluation by the corresponding workgroup and Accreditation Commission (immediately after establishing the completeness of the submitted materials). 
•	The proposal of an opinion of the Accreditation Comittee to grant or refuse a certificate of accreditation and submission of the opinion to the Minister of Health.
•	The proposal of a decision by the Minister of Health on accreditation or dismissal of the application or suspension of proceedings.
•	Sending the decision to the participants of the proceedings.

Principles of evaluation of the application by the Accreditation Commission

When exercising its activity the Accreditation Commission evaluates projects according to the principles approved by the Ministry of Health SR.

The principles of accreditation apply to:

•	the educational institution and its department ensuring the creation of a specialised study program, certification study programme or a study programme of continuing education,
•	the particular specialised study programme, certification study programme or the study programme of continuing education.

During evaluation the Accreditation Commission uses general principles common for all the evaluated study programmes (specialised, certification and  continuing education programmes) and special principles specific to the corresponding field. The principles are developed into individual criteria. The result of the evaluation following individual criteria is a verbal evaluation of “fulfilled” or “did not fulfil” and the justification for such evaluation.

A. General principles

Principle no. 1 (P1)
The submitted programme shall be in compliance with the model study programme.

•	Criteria P1 – 1 Compliance of the programme with the Regulation of the Government of the Slovak Republic No. 734/2004 Coll.
•	Criteria P1 – 2 Compliance of the structure of the programme with Article 4 section 4 or Article 5 section 5 of the Regulation of the Government of the Slovak Republic No.743/2004 Coll. 
•	Criteria P1 – 3 Compliance of the length of study with the specified length of study. 
•	Criteria P1 – 4 Compliance of the minimum content of theoretical knowledge and practical skill with the model study programme.
The Principle P1 is fulfilled if all the criteria are evaluated as “fulfilled”. 

Principle no.2 (P2) 
The submitted programme shall be guaranteed and realised by the appropriate lecturing team.

•	Criteria P2 – 1 The expert guarantor of the programme has:
- subcriteria P2-1/1 the highest possible qualification which can be attained in the given field
- subcriteria P2-1/2 at least 5 years of professional medical practice in the working activities the
   shall be taught in the study programme
- subcriteria P2-1/3 at least 5 years of pedagogical practice
- subcriteria P2-1/4 labour or other similar relationship with the educational institution
- subcriteria P2-1/5 a maximum age of 65 years
- subcriteria P2-1/6 expert guarantor in a single educational institution
- subcriteria P2-1/7 experience as an expert guarantor in a single specialised programme
(subcriteria P2-1/6 and subcriteria P2-1/7 must be fulfilled simultaneously) 

Criteria P2-1 is fulfilled if all the subcriteria are evaluated as “fulfilled".

•	Criteria P2-2 Lecturing team
- subcriteria P2-2/1
Members of the lecturing team for the theoretical part of the educational programme are university educators with a qualification in the corresponding field of specialisation or certified working activity in the corresponding area of study  (this condition does not apply to certification programmes and programmes of continuing education).
- subcriteria P2-2/2
The members of the lecturing team for the practical part of the educational programme have at least three years of professional medical practice in the relevant field.
- subcriteria P2-2/3
The proportion of members of the lecturing team for the theoretical part and the members of the lecturing team for the practical part is in favour of the practical part.
- subcriteria P2-2/4 at least 50% of members of the lecturing team are between 41 and 59 years old or younger (this subcriteria shall not apply to programmes of continuing education).
- subcriteria P2-2/5
The number of applicants falling within the competence of one member of the lecturing team (trainer) of the lecturing team for the practical part of the educational programme is a maximum of 1 for dentists, 2 for doctors, 2 for nurses, 1 for midwives, 2 for laboratory technicians, assistants and technicians, 2 for physiotherapists, 1 for psychologists, logopaedists and therapeutic instructors (this subcriteria shall not apply to programmes of continuing education).
- subcriteria P2-2/6
Except for the applicants under subcriteria P2-2/5, no more students from other educational programmes fall within the competence of one member of the lecturing team (trainer) on the same day for the practical part of the educational programme (this subcriteria shall not apply to programmes of continuing education)

The criteria P2—2 is fulfilled if all the subcriteria are evaluated as“fulfilled".

The Principle P2 is fulfilled if all the criteria (P2 -1 and P2 – 2) are evaluated as “fulfilled”.

Principle no.3 (P3)
The submitted programme shall be realised by the appropriate material-technical equipment (only the ensuring of the practical part of education is evaluated).

•	Criteria P3-1 Compliance of the personnel and material-technical equipment of the health care provider where the educational programme shall take place, with regulation of the minimum personnel and material-technical equipment of health facilities in relation to the submitted study programme.
•	Criteria P3-2 Creation of premises, material-technical and information equipment dedicated for the realisation of the educational programme following the fulfilment of the requirements defined in Criteria P3—1 (classrooms, didactic technique – kind, number of didactic tools and instrument technique,
•	concrete data on providing education of study literature and study materials, direct access of students to professional literature, textbooks, technical papers, Internet, foreign consulting). 
•	Criteria P3-3 Equipment under criteria P3-1 and P3-2 is functional and effective in relation to the study programme.
•	Criteria P3-4 Performance of health sevices in order to acquire practical skills that shall be acquired from the provider during the two preceding years at least (statistically proved for the last 2 years) and guarantee of a minimum ability to perform the procedures declared in the study programmes
•	Criteria P3-5 Documentary evidence of having provided medical instruments including special medical material for the practical part of the course according to the study programme (health services) for each applicant of the study programme.
•	Criteria P3-6 Evidence of having created conditions for the fulfilment of psychohygienic requirements with regard to the protection of health for the trainers and the applicants.

The Principle P3 is fulfilled if all the criteria (P3 -1 to P3 – 6) are evaluated as “fulfilled”.

B. Specific principles

If necessary, the Accreditation Commission of the MHSR for further education of health professionals elaborates and submits for approval to the Ministry of Health specific principles for the corresponding fields that will be regularly published on the Internet site www.health.gov.sk.

Accreditation and what next?

The Ministry will issue a certificate of accreditation valid for five years to educational institutions that fulfil the conditions of accreditation laid down by Act No.578/20004 Coll. on Healthcare Providers, Healthcare Workers, Professional Healthcare Organisations and on Amendment and Supplementation of Certain Acts, to which the Commission has issued a positive opinion for granting accreditation for 5 years.

The educational institution that obtains the decision on admission the right to perform the specialised study programme, certification study programme or the study programme of continuing education is obliged to:

•	perform the accredited specialised study programme, certification study programme or study programme of continuing education within the conditions under which the Ministry of Health has issued the decision of accreditation, i.e. in accordance with the approved pedagogical documentation,
•	submit all the changes concerning the accredited programme to the Accreditation Commission for approval,
•	handle an administrative agenda on the realization of the accredited programme including the list of participants and the list of graduates of the accredited programme in the corresponding academic year or school year or in the corresponding education cycle,
•	handle a list of issued diplomas of specialisation, a list of issued certificates or a list of issued confirmations (Article 41 section 1 of the Act) following the day of their issuance,
•	inform the data from the lists following the letters to the chamber responsible for handling the register of health professionals (hereinafter referred to as the  “register”) (Article 62 sections 2 to 6 of the Act) and for the purposes of national statistical findings to the National Health Information Centre (formerly the Institute of Health Information and Statistics) and also to the Ministry of Health SR, the data from the list of issued diplomas should also be sent to the Slovak Medical University,
•	inform the data from the list of participants of the accredited certification study programme, upon request, to another educational institution that offers a specialised study programme in the appropriate field of specialisation or a certification study programme in the appropriate certification training,
•	submit to the Accreditation Commission for approval, upon its request, the schedule, location of the accredited programme and the list of participants in the accredited programme,
•	notify the Accreditation Commission of any change of data under Article 40 section 7 letters a) and b) of the Act,
•	ensure that the participants in the accredited specialised study programme studied only one field of specialisation at a time (Article 40 section 11 of the Act) and 
•	after proper graduation, issue a diploma of specialisation according to Article 41 of the Act (a model diploma of specialisation and certificate are annexes to this publication and are also published in the Official Journal of the MHSR from 18.2.2005).

Such certificates are non-transferable and do not pass to the legal successor. The educational institution issues a diploma of specialisation to the graduate of an accredited specialised study programme, a certificate to the graduate of a certification study programme, or a confirmation to the graduate of an accredited study programme of continuing education.  This right expires after the expiry of the certificate of accreditation's validity.

The Ministry of Health of the SR cancels the certificate of accreditation if the educational institution requests it, if it has acquired the certificate of accreditation on the basis of false information or if it carries out a study programme for which it did not acquire a certificate of accreditation.

The Ministry of Health of the SR may cancel a certificate of accreditation if the educational institution breaches one of the duties laid down in Article 40 Section 10 and 11 of the Act.

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Scheme 6
The procedures of the educational institution in the creation of a specialised course of study
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Proposal for engagement in specialised study

The employer submits to the educational institution; for health self-employed professionals the proposal is submitted by the self-governing region; for health professional without employment the application is submitted by the health professional.

Control of the integrity of the content and the form of the proposal

The educational institution in cooperation with the Slovak Medical University Bratislava Article 7 of regulation No. 743/2004 Coll.) + it shall ensure that the health professional is educated in only one field of specialisation at a time.

Inclusion into the specialised study and sending of the index of proficiency and the record of procedures to the educational institution

							

							Slovak Medical University Bratislava

Conclusion of an agreement with a health professional (model in Annex no.7)

							Educational institution

Elaboration of the individual schedule of the study and its submission to the interested parties (health professional, person who submitted the proposal for the engagement in the study 
(employer, self-governing region and similar), lecturers, health care provider responsible for the practical section of the course)

								Educational institution

Realization and control of the specialised study

Educational institution, if necessary in consultation with 
the Accreditation Commission of the MHSR

Specialisation examination and issuance or non issuance of a diploma of specialisation

Educational institution (establishes a Commission composed of the representatives of all educational institutions carrying out the programme in the relevant field)

Registration on the list of issued diplomas of specialisation and notification of the data to the Slovak Medical University of Bratislava, the relevant chamber and the MHSR

							

								Educational institution

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Documentation on the study

The documents of further education serve the health professional for the purposes of recording all forms of further education.

According to the Regulation of the Government of the Slovak Republic No. 322/2006 Coll. on Methods of Further Education of Health Professionals, the System of Fields of Specialisation and the System of Certified Working Activities, the documents of further education of the health professionals are the index of proficiency and the record of health services and other professional activities (the “logbook”).

These documents are issued by the Slovak Medical University in Bratislava. During inclusion into the specialised study and when issuing of documents it proceeds in accordance with Scheme 6 and helds evidence of the issued documents.

These documents are issued by the Slovak Medical University in Bratislava. During engagement in a specialised study and in the issuance of documents it proceeds in accordance with Scheme 6 and handles evidence of the issued documents.

The educational institution records the following in the index of proficiency of the health professional:

•	the course of specialised study, recorded by the trainer on the basis of a commission from the educational institution within the framework of the relevant specialised study programme
•	accomplishment of the specialised study, i.e. specialisation examination with the signatures of the members of the examination Commission, on the basis of which the diploma is awarded
•	inclusion into the certification training
•	course of certification training, recorded by the trainer on the basis of a commission from the educational institution within the framework of the relevant certification study programme
•	termination of the certified working activity, i.e. examination with the signatures of the members of the examination Commission, on the basis of which the certificate is acquired
•	retraining for the pursuit of professional working activities, specialised working activities that will be carried out by a respected health professional
•	course of the continuing education, this activity may be recorded also by the chambers, the Slovak Medical Company and the departments of the facilities
•	for other health professionals, training and participation in training for the pursuit of work in the health service of other health professionals.

In the record of health services and other professional activities in particular, the following information is recorded in chronological order:

•	the number of health services and other professional activities
•	the frequency of health services and other professional activities
•	the extent of health services and other professional activities carried out personally by the health professional within the specialised study or certification training.

Every record shall be acknowledged to the health professional by the trainer if the health services have been undertaken to the extent of records made in the health documentation, or in accordance with accounting documents confirming that such professional specialised or certified working activities did take place in accordance with the accredited study programme. Other professional activities shall be acknowledged by the trainer based on the submission of documentary evidence.

Documents issued by the educational institution

After successfully passing the examination within further education, the educational institution issues:

•	a diploma of specialisation to the graduate of an accredited specialised study programme after passing the specialisation examination. If certified working activities are also part of the accredited specialised programme within the meaning of the Government Regulation No. 322/2006 Coll. in force, the educational institution will also issue the certificate for the corresponding certified working activity after passing the prescribed practical procedures (Annex 8)
•	a certificate to the graduate of an accredited certification study programme after successful graduation (Annex 9)
•	confirmation of graduation from an accredited study programme for continuing education after successful graduation, to the graduate of the accredited study programme of continuing education (Annex 10). 

Financing of further education

Further financing of health professionals in the department may come from, for example:

•	the resources of employers
•	the resources of self-governing regions or municipalities
•	the resources of health insurance companies
•	the settlements of the health professionals, who participate in further education
•	state budget resources
•	the resources of foundations and other legal persons and natural persons
•	other sources, such as from the funds of the European Union for projects dedicated to further education in the department of health system.

The financing appears to be several times lower than that of developed EU countries. This requires a special analysis of the current state, a financing strategy and a coordinated approach from all the interested parties.

The state budgetary organisation and state contributing organisation plan to contribute financial resources for further education of their own employees for the calendar year directly in their budget. These resources will be used
in accordance with the education plan for the employees. If these organisations acquire additional financing resources, they will finance education from these resources as well.

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Scheme 7
Co-financing of further education of health professionals
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Settlement of the employer´provide of health care who proposed the engagement of the health professional in a specialised study (financial and non financial contributions)

Settlement of a health professional for further education

Contribution of a region, town or village for further education of a health professional

Cost of the specialised study 
of a health professional

Contribution/subsidy from the state 
(refundable or non-refundable)

Contribution/subsidy from EU funds
(refundable or non-refundable)

Contribution/subsidy from a health insurance company

Contribution/subsidy from sponsors

Amount of settlement of a health professional

This is governed by the legislation in force. In individual categories of health professionals for further education, it is the following:

•	The settlement amount for a doctor, dentist and pharmacist for further education from specialised study for the pursuit of specialised working activities (further referred to as “specialised study”) for the entire study is 10% of the economically justified costs for the educational activity, to a maximum of 40,000 SKK.
•	The settlement amount for a doctor, dentist and pharmacist for further education from a specialised study in a field of specialisation which follows after the termination of the specialisation in any of the fields of specialisation for the entire course of study is 10% of the economically justified costs for the educational activity, to a maximum of 30,000 SKK.
•	The settlement amount for further education from certification training for the pursuit of certified working activities for the entire training is 10% of the economically justified costs for the educational activity, to a maximum of 20,000 SKK.
•	The settlement amount for specialised study for a nurse, midwife, assistant, laboratory technician, technician or other health professionals, for the entire course of study is 10% of the economically justified costs for the educational activity, to a maximum of 7,000 SKK.
•	The settlement amount for certification training for the pursuit of certified working activities for a nurse, midwife, assistant, laboratory technician, technician and other health professionals for the entire training is 10% of the economically justified costs for the educational activity, to a maximum of:
a) 7,000 SKK if the health professional has already acquired grade II university education,
b) 4,000 SKK if the health professional has already acquired grade I university education or advanced vocational training,
c) 2,000 SKK if the health professional has already acquired a complete secondary vocational training,
d) 500 SKK if the health professional has already acquired secondary vocational training.

The settlement amount according to letters form a) to d) is determined on the basis of the highest acquired degree of education of the health professional in the relevant medical profession.

•	The settlement amount for the participation of a health professional in one educational activity within the framework of continuing education, except the settlement under the paragraphs in the left column, is as follows: 
a)	for health professionals who pursue a health profession in a labour relationship, it is 50% of the economically justified costs for the educational activity, but a maximum of 1,500 SKK,
b)	for health professionals who do not pursue a medical profession in a labour relationship, it is 100% of the economically justified costs for the educational activity.
•	The settlement amount for training for the pursuit of work in the health service for other health professionals, for the entire training is 10% of the economically justified costs for the educational activity, to a maximum of 3,000 SKK.
•	Economically justified costs are those that are proved with accounting documents, calculations of costs, billing or tax documents, in particular
a) costs related to the use of tangible and intangible property necessary for the realisation of the educational activity,
b) benefits, travel, accommodation and other costs related to the activities of an expert guarantor, lecturer, trainer or member of the lecturing team or supervisor of the educational activity,
c) postal costs, costs for the use of telecommunication and electronic means for ensuring the educational activity, and
d) labour costs and other administrative costs related to the educational activity, which means costs related to the engagement of the health professional in further education, the accomplishment of further education and the issuance of the diploma of specialisation, certificate or certificate of training for the pursuit of work in the health service.

The settlement amount of a health professional engaged in a specialised study in the corresponding field of specialisation at his or her own expense is determined by the cost of the specialised study.

European Union Funds

In accordance with the Lisbon Strategy, the Slovak Republic shall support educational programmes oriented towards the improvement, adjustment and renewal of qualifications of health professionals according to the requirements and rules of the European Union, with the objective of ensuring the quality of the provided health services and the competitiveness of the Slovak health system in the European community.

In May 2006 a process of approval of the National Strategic Reference Framework 2007 – 2013 took place at the governmental level. This represented an elaboration of the Lisbon Strategy from the perspective of financial support of the development of Slovakia from European structural and cohesion funds for the given years. The intention of the health system was to obtain its own operational programme, which would also include financial support for the development of the system of education of health professionals. Further education of health professionals will eventually be supported by the Operation Programme Education, the managing authority of which is the Ministry of Education of the SR. The MHSR should be a cooperating authority.

Until then it is possible to submit projects for drawing resources from present community funds with the purpose of supporting education. This shall continue simultaneously with the possibilities mentioned above, such as the Leonardo da Vinci Programme. Under this programme, resources can be obtained for projects aimed at the creation and transfer of innovations, improvement of the quality of education and training and use of communication technologies in vocational training, and also for the creation of supranational networks of open and distance education, or for testing new approaches to vocational training connected with new conditions in the work process. A new programme known as the Erasmus Mundus Programme, is available and is oriented towards the support of university education.

There are also funds available that are not primarily dedicated to the support of education but for which the support of education is an integral part. For example the Matra project, programmes of bilateral cooperation with Norway, Netherlands and the like, and also the Public Health Programme.

Information on the possibilities of drawing from European funds are regularly published on the web sites of the relevant institutions, in particular at www.health.gov.sk, www.saaic.sk and also www.build.gov.sk, because the Ministry of Construction and Regional Development of the Slovak Republic was the managing authority for the Operational “Basic Infrastructure” Programme of the structural funds of the European Union which were available for 2004-2006. Instructions and manuals for the submission of projects can be found, for example at www.eeagrants.sk.

State Contributions

Until now, state resources dedicated to further education of health professionals was only given to the Slovak Medical University Bratislava. After introducing plurality in the system of further education of health professionals, transparent conditions should be created. Upon fulfilment of these, other educational institutions that have obtained Ministry of Health accreditation for study programmes of further education of health professionals should also have the ability to apply for these resources.

For this purpose space has been created in the Decree of the Ministry of Health of the Slovak Republic No, 07440/2006-SL from 17 March 2006 establishing the extent, method and other conditions of the provision of subsidies under the auspices of the Ministry of the Slovak Republic According to Article 1 section (b) of the quoted decree, published in the Official Journal of the MHSR part 17-23 from 1.4.2006, a  Ministry of Health subsidy may also be provided to an applicant who is a natural or legal person for the support of activities in the area of education of health professionals. The decree was registered in the Collection of Laws under No. 164/2006 Coll. and has become generally binding.

It is assumed that after obtaining resources, the educational institutions from the chapter of the MHSR will only be able to draw on and dispose of the resources on the basis of a precisely defined contract concluded with the Ministry of Health of the Slovak Republic.

When allocating the resources, the declared priorities of the department will be determined by the relevant strategic materials. A previous example of this was the development of emergency medical services and therefore the support for education of qualified health professionals for emergency medical services, the elaboration of the national plan for the support of mental health and therefore the education of professionals in the field of mental heath, oncological programmes and the education of professionals specialised in carcinogenic oncological diseases, Cardio-vascular programmes – education of professionals on the diagnostics and treatment of cardio-vascular diseases, etc.
With regard to the limited resources which are currently available in the state budget, it is necessary to focus on wider possibilities offered by the structural and other funds of the European Union (see European Union Funds chapter).

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Table 2 
Financial plan of study of a health professional (title, full name)

Year	2006	2007	2008	2009	2010	
Overall Costs	
						
Justifiable Costs	
EU Funds						
State Contribution						
Health Insurance Companies						
Employer						
Municipalities						
Participant						

Evaluation of the quality of education

In the field of further education, no effective system currently exists for the evaluation of quality. At present, the elaboration of framework standards is finalised in the Department of Health system, determining the minimum basic requirements for the corresponding fields of specialisation in individual categories of health professionals. The verification of the quality of further education in the department is handled in the form of accreditation according to the law. Each educational institution that wants to carry out further education of health professionals has to request accreditation of the educational activity.

It will also be necessary to develop the connection of further education of health professionals on the prepared Single European Qualification Framework of education (as well a application of the credit system on education in the specialised and certification education of health professionals).

In this respect it is necessary to point out the newly created term of “educational accountability”.

Educational accountability represents the direct responsibility of the educational institution for the quality of the services provided and the results of the education, as well as for the consequences of its approach and procedure in the legal framework against participants of education and other engaged parties. It is expressed financially in order to proves the adequacy of the provided resources for controllable target procedures. 

It is also important to control target procedures because, in the member states of the European Union, four basic freedoms are guaranteed: free movement of goods, capital, services and persons. This guarantees the right to live, study and work in another member state under the same conditions as citizens of the member state. This is a right of individuals and it may be considered as the foundation of European citizenship.

At present the freedom of movement of persons relates to the 25 member states of the European Union (from 1 January 2007 this also includes Romania and Bulgaria), states of the European Free Trade Association – EFTA (Norway, Lichtenstein, Iceland) and Switzerland which is involved on the basis of separate agreements.

A prerequisite for free movement of labour is the necessity to introduce a mutually recognised system for the recognition of documentary evidence of education. . For this purpose, the so-called “minimum standards” for the content and extent of acquired education were set out, in order to guarantee the same quality to the greatest extent possible.
For doctors, dentists, pharmacists, nurses and midwives, the member countries managed by means of the EU sector directives to reach an agreement and define a single framework minimum criteria for the content and extent of the quality of the educational process in the qualifications for doctors and dentists, as well as a framework for the quality of the educational process in the system of further education for selected specialisations.

On the day of the Slovak Republic's accession to the EU, 
SR guaranteed, as one of the member states of the EU, 
by transposing the sector directives in the legal regulations 
of the Slovak Republic, that these minimum 
requirements for the content and extent 
of the acquired education would also be observed 
and fulfilled within Slovak territory.

The Council Directive 93/16/EEC introduced the system of mutual automatic recognition of specialised diplomas in 52 medical specialisations for which each member state guarantees that 

•	such education was acquired after the successful completion of a six-year university study, during which time the graduates have gained appropriate knowledge of general medicine; 
•	the requirements include the following: It shall comprise both theoretical and practical training;
•	it shall be a course of full-time study under the supervision of competent authorities or organisations;•	
•	it shall take place in a university centre, university hospital and, if appropriate, in a healthcare facility approved with this objective by the competent authorities or organisations (i.e. accredited educational institutions);
•	it shall include full-time personal participation (in SR represented by the defined weekly working time) on specialised study, activities and responsibility of the relevant facilities; in the case of part-time study, the length of study shall be accordingly extended so that the determined number of hours and procedures is fulfilled in order to allow an independent pursuit of specialised working activities; 
•	the minimum duration of the specialised study shall not be less than the duration of the training determined by Annex C of the stated directive;
•	the acquired specialisation diplomas in individual fields correspond to the designation of the diplomas listed in Annexes B and C of the stated directive.

The Council Directives 78/686/EEC and 78/687/EEC introduced the system of mutual automatic recognition of specialised diplomas in two dental specialisations for which each member state guarantees that

•	such study was acquired after completion of at least a five-yearfull-time university study course comprising both theoretical and practical study;
•	it shall comprise both theoretical and practical training;
•	it is a full-time course of study lasting at least three years and carried out under the supervision of competent authorities or bodies;
•	it is carried out in a university facility, a facility conducting treatment, education and scientific-research activity or, if appropriate, in a healthcare facility approved for this purpose by the competent authorities or bodies (i.e. accredited educational institutions);
•	it shall include the full-time personal participation (in SR represented by the defined weekly working time) of a practising dentist, educated in the activities and duties carried out in the given educational facility and, in the case of part-time study, the length of study shall be accordingly extended so that the determined number of hours and procedures is fulfilled in order to allow an independent pursuit of s activities;
•	the minimum duration of the specialised study shall not be less than the duration of the training determined by Annex B of the directive 78/686/EEC. 

If the abovementioned conditions are met, it is possible to refer to automatic and unconditional mutual recognition of qualifications. The member states mutually guarantee, on a long-term basis through the executive power of their authorities, the same quality of education. . In the case of the Slovak Republic, the relevant authority for the area of further education of health professionals is the Ministry of Health of the SR which builds on the competences in the area of formal education of health professionals under the competence of the Ministry of Education of the SR.
Besides the 52 medical and two dental specialisations, another member state may recognise the education and confer the right to pursue the activity of a doctor and dentist for persons who are not holders of documentary evidence of qualification, do not fall within the system of mutual recognition of qualifications and grant them the same right to operation on its territory. A member state may therefore also recognise fewer specialisation diplomas, not included in the annexes of the stated directives, which also applies to the documentary evidence of further education of pharmacists, nurses, midwives and other health professionals for which no consensus has been achieved concerning the creation of a system of automatic recognition of documentary evidence of further education.

From the point of view of the Slovak Republic and its membership in the European Union, it is therefore also necessary to mention that in the second year (2005) of the membership of the SR in the EU, the application and improvement of the system of mutual recognition of medical qualifications continued to contribute significantly to the fulfilment of one of the basic rights of the citizens of the member states of the European Union - the free movement of persons. The system was still differentiated into the automatic recognition of qualification of doctors, dentists, nurses and midwives and to a semi-automatic recognition of qualifications of other medical professions following a general system of recognition of qualifications.
The issue of acknowledging the equality of acquired education became significant for the health system, as it was a necessary condition for the recognition of qualifications acquired in SR and in the former Czechoslovakia in other member states. The MHSR assumed responsibility for acknowledging the quality of acquired education in relation to other member states, and therefore guaranteeing high professional qualifications of SR health professionals, which also required certain changes in the system of medical education in the SR.
An important milestone, reached in 2005 in the area of qualification recognition was the adoption of a new Directive of the European Parliament and of the Council no. 20005/36/EC on the recognition of qualifications which which was classified according to individual professions, more transparent.  However, the classification of automatic and semi-automatic recognition of qualifications will be preserved. . The adoption of the new directive and the obligation of all member states to implement the content of its provisions in their legal regulations by October 2007 at the lates modifications and amendments to the SR legal regulations.  AIt will also increase the necessity for closer cooperation, in particular with the SR Ministry of Education, but also with other departments at national level as well as t, will again require international cooperation with the relevant authorities of other member states and the European Commission.

Sources
•	Beňušová, K.: Vzájomné uznávanie dokladov o odborných kvalifikáciách v členských a pridružených štátoch EÚ. In: Slovenský lekár v európskej únii. Vrútky: Raabe, s. r. o., o. z., 2004, ISBN 80-968206-1-1.
•	Act No. 131/2002 Coll. on Universities and on amendments to certain Acts
•	Act No 578/2004 Coll. on Healthcare Providers, Health Professionals, Professional Healthcare Organisations and on amendments to certain Acts
•	Regulation of the Government of the Slovak Republic No. 742/2004 Coll. on Professional Competence for the Pursuit of Medical Professions as amended
•	Regulation of the Government of the Slovak Republic No. 324/2006 Coll. amending the Regulation of the Government of the Slovak Republic No. 742/2004 Coll. on Professional Competence for the Pursuit of Medical Profession
•	Regulation of the Government of the Slovak Republic No. 743/2004 Coll. on the Method of Further Education of Health Professionals, the System of Fields of Specialisation and the System of Certified Working Activities
•	Regulation of the Government of the Slovak Republic No. 179/2005 Coll. amending the Regulation of the Government of the Slovak Republic No. 743/2004 Coll.on the Method of Further Education of Health Professionals, the System of Fields of Specialisation and the System of Certified Working Activities
•	Decree of the MHSR No. 366/2005 Coll. on the Criteria and Method of Evaluation of the Continuing Education of Health Professionals.•	-Decree of the MHSR No. 187/2006 Coll. amending Decree of the MHSR No. 366/2005 on the Criteria and Method of Evaluation of the Continuing Education of Health Professionals
•	Decree of the MHSR No. 31/2006 Coll. on the Settlement Amount of a Health Professional for Further Education
•	Decree of the Ministry of Health of the Slovak Republic No. 07440/2006-SL of 17 March 2006 establishing the Extent, Method and Other Conditions of the Provision of Subsidies in the Competence of the Ministry of Health of the the Slovak Republic 
•	Regulation of the Government of the Slovak Republic No. 322/2006 Coll. on the Method of Further Education of Health Professionals, the System of Fields of Specialisation and the System of Certified Working Activities.•	-National Strategic Reference Framework for the years 2007 – 2013 (online). Meeting of the SR government, session from 17. 06. 2006, point 35 (quoted22. 5. 2006), available on the internet: http://www.government.gov.sk

Annexes

Annex 1
Accreditation Commission of the MHSR for further education of healthcare professionals	29

Annex 2
Fields of specialisation for individual categories of health professionals (extract from Government Regulation No. 322/2006 Coll.as amended)	30

Annex 3
Certification training for individual categories of health professionals (extract from Government Regulation No.322/2006 Coll.as amended)	36

Annex 4 
Fields of specialisation dedicated to the management and organisation of the health system (extract from Government Regulation No.322/2006 Coll.as amended)	39

Annex 5
List of issued decisions on accreditation	40

Annex 6
Model of the contract of an educational institution with a health professionalon study	41

Annex 7
Example of groups of questions for the questionnaire for evaluating the educational activity by the health professional	44

Annex 8
Model diploma of specialisation 	45

Annex 9
Model certificate 	46

Annex 10
Model confirmation from an educationalactivity of continuing education 	47

Annex 1
Accreditation Commission 
of the MHSR for further
education of health professionals

•	President:•	prof. MUDr. Juraj Pechan, CSc.

•	Vice-president:
prof. MUDr. Peter Šimko, CSc.

•	Members:
prof. MUDr. Marián Mokáň , DrSc.
prof. MUDr. Anton Kohút, DrSc. 
prof. MUDr. Vladimír Javorka, CSc. 
doc. RNDr. Silvia Szücsová, CSc.
PhDr. Ľubica Derň árová, PhD., MPH 
PhDr. Adriána Repková, PhD.
PhDr. Dagmar Komačeková
RNDr. Eva Mistríková
dipl. dental technician Jaroslav Šaár
Ing. Michal Farkaš
prof. PhDr. Teodor Kollárik, DrSc.

•	Secretaries:
Mgr. Monika Hozlárová
PhDr. Zuzana Slezáková, PhD., MPH

•	Associate members:
MUDr. Mario Mikloši, PhD.
PhDr. Kvetoslava Beň ušová, MPH

Annex 2
Fields of specialisation for individual categories of health professionals (extract from Government Regulation No. 322/2006 Coll. as amended)

A. Doctor
Fields of specialisation that are automatically recognised by individual EU member countries within the meaning of the applicable directives if the name and the minimum duration of a specialised course of study, as specified by the directives, are observed:

•	Anaesthesiology and intensive medicine
•	Vascular surgery
•	Dermatovenerology
•	Paediatric surgery
•	Paediatric psychiatry
•	Endocrinology
•	Physiatry, balneology and therapeutic rehabilitation
•	Gastro-enterology
•	Gastro-enterological surgery
•	Geriatrics
•	Gynaecology and obstetrics
•	Haematology and transfusiology
•	Thoracic surgery
•	Surgery
•	Communicable diseases
•	Cardiac surgery
•	Cardiology
•	Clinical biological chemistry
•	Clinical pharmacology
•	CIinical immunology and allergology
•	Clinical microbiology-bacteriology
•	Clinical oncology
•	Laboratory medicine
•	Medical genetics
•	Maxillo-facial surgery
•	Renal diseases
•	Neurological surgery
•	Neurology
•	Neuro-psychiatry
•	Nuclear medicine
•	Ophthalmology
•	Orthopaedics
•	Otorhinolaryngology
•	Pathological anatomy
•	Paediatrics
•	Plastic surgery
•	Respiratory medicine and phtisiology
•	Occupational medicine
•	Psychiatry
•	Radiotherapy
•	Radiology
•	Rheumatology
•	Tropical medicine
•	Accident medicine
•	Emergency medicine
•	Urology
•	Public health
•	Internal medicine
•	General medicine

Fields of specialisation which may be recognised by an individual member state of the European Union after comparison of the study contents and duration with a comparable specialised course of study in the corresponding member state:

•	Algesiology
•	Acupuncture
•	Andrology
•	Angiology
•	Diabetology, metabolic and nutritic disorders
•	Epidemiology
•	Phoniatrics
•	Gerontopsychiatry
•	Gynaecologic sexology
•	Gynaecologic urology
•	Hepatology
•	Infant and juvenile hygiene
•	Nutritional hygiene
•	Environmental hygiene
•	Clinical occupational medicine and clinical toxicology
•	Aviation medicine
•	Mammology
•	Maternal-foetal medicine
•	Drug addiction medicine
•	Medical informatics and Biological statistics
•	Neonatology
•	Health protection from ionising radiation
•	Oncology in gynaecology
•	Oncology in surgery
•	Oncology in urology
•	Orthopaedic prosthetics
•	Palliative medicine
•	Paediatric anaesthesiology
•	Paediatric endocrinology
•	Paediatric gastro-enterology, Hepatology and nutrition
•	Paediatric gynaecology
•	Paediatric haematology and oncology
•	Paediatric immunology and allergology
•	Infant communicable diseases
•	Paediatric intensive medicine
•	Paediatric cardiology
•	Infant renal diseases
•	Paediatric neurology
•	Paediatric ophthalmology
•	Paediatric orthopaedics
•	Paediatric oto rhino laryngology
•	Paediatric respiratory Medicine and ftizeology
•	Paediatric rheumatology
•	Paediatric emergency medicine
•	Paediatric urology
•	Assessment medicine
•	Preventive occupational medicine and toxicology
•	Psychiatric sexology
•	Reproduction medicine
•	Revision medicine
•	Occupational health services
•	Forensic medicine
•	Sports medicine
•	Ultrasound in gynaecology and obstetrics
•	General care of infants and juveniles
•	Health edification
•	Health ecology

The majority of these fields of specialisation can only be obtained after completing the specialisation in some of fields of specialisation listed in the first group. Accordingly, they are also called "sub-specialisations".

B. Dental practitioner category

Fields of specialisation that are automatically recognised by member states of the European Union, if such study follows the acquisition of a university Doctoral Degree in the stomatology field of study under the new study programmes:

•	Maxillo-facial surgery
•	Orthodontics

The following field of specialisation with at least three years of specialised study for doctors who have acquired or shall acquire a university Doctoral Degree in the stomatology field under the list of study programmes valid until 2009 is not automatically recognised by the member states of European Union, Norway, Lichtenstein, Iceland or Switzerland:

•	Stomatology

In the Slovak Republic the following sub-specialisations are also applicable to dental practitioners with specialised study of at least two years, the study of which may be started only upon completion of specialisationin any of the fields of specialisation and which are not recognized automatically by the member states of the European Union, Norway, Lichtenstein, Iceland or Switzerland:

•	Paediatric stomatology
•	Revision stomatology

C. Pharmacist category
The EU directive does not regulate which fields of specialisation are automatically recognised in the member states. In many cases, in the recognition of education, the specialised study may be replaced by appropriate professional medical practice of a pharmacist. However, in Slovakia the following apply:

•	Pharmaceutical inspection and medicinal product quality assurance;
•	Pharmaceutical technology
•	Pharmacology

The following are sub-specialisations, the study of which may be started only upon completion of a specialisation in any of the fields of specialisation listed above:

•	Clinical pharmacy
•	Revision pharmacology
•	Radio-pharmaceutical agent technology

The list of specialisations for pharmacists in the Slovak Republic was significantly reduced after entry to the European Union after the European Union advised that the Slovak Republic provides education in a specialised form of study for the pursuit of such working activities which a graduate of a pharmaceutical faculty shall be able to carry out independently after proper completion of university study in the field of pharmaceutics.

D. Nurse category
Fields of specialisation following the completion of a university Master’s Degree:

•	Occupational health nursing
•	Revision nursing

Fields of specialisation following the completion of a university Master’s Degree or Bachelor’s Degree, or higher vocational education:

•	Anaesthesiology and intensive care
•	Rescue health service operating centre
•	Intensive nursing care of adults
•	Paediatric intensive nursing care
•	Neonatal intensive nursing care
•	Surgery instrumentation
•	Nursing careof dialysed patients
•	Nursing care in fields of internal medicine
•	Nursing care in fields of surgery
•	Paediatric nursing care
•	Psychiatric nursing care
•	Community nursing care
•	Oncological nursing care
•	Specialised emergency care
•	Health edification
•	Medical informatics

E. Midwife category 

Fields of specialisation following the completion of a university Bachelor’s Degree higher vocational education:
 
•	Intensive care in gynaecology and obstetrics
•	Surgery instrumentation in gynaecology and obstetrics
•	Midwifery and nursing of women in the family and community
•	Health edification 
•	Medical informatics

F. Laboratory technician category

Fields of specialisation following the completion of a university education in laboratory examination methods:

•	Laboratory medicine

Fields of specialisation following completion of higher vocational education in certified medical and technological laboratory technician studies or full secondary education in the medical laboratory technician field:

•	Laboratory medicine
•	Examination methods in hygiene Chemical and physical analysis
•	Examination methods in microbiology and environmental biology
•	Examination methods in clinical cytology
•	Examination methods in toxicology and pharmacology
•	Examination methods in histopathology
•	Examination methods in health protection from ionising radiation

Fields of specialisation following the accomplishment of full secondary education in the pharmaceutical laboratory technician field:
•	Pharmaceutical inspection
•	Laboratory methods in medicinal Product and xenobiotic toxicology
•	Pharmacology
•	Medicinal product preparation technology
•	Therapeutic instruments

G. Assistant category

Fields of specialisation following completion of a university Master’s Degree education in public health:

•	Epidemiology
•	Infant and juvenile hygiene
•	Nutritional hygiene
•	Environmental hygiene
•	Health protection from ionising radiation
•	Health edification 
•	Occupational health
•	Medical informatics and biological statistics

Fields of specialisation following the completion of a university Bachelor’s Degree in public health or higher vocational education in the certified hygiene and epidemiology assistant fields:

•	Epidemiology
•	Infant and juvenile hygiene
•	Nutritional hygiene
•	Environmental hygiene health protection from ionising radiation
•	Health edification 
•	Occupational health
•	Medical informatics

Fields of specialisation following the completion of higher vocational education in the radiological assistant field:

•	Nuclear medicine
•	Radiotherapy
•	Special radiology

Fields of specialisation following the completion of higher vocational education in the certified medical rescuer field:

•	Rescue health service operating centre
•	Specialised emergency care

Fields of specialisation following the completion of full secondary education in the nutrition assistant field:

•	Therapeutic nutrition

Fields of specialisation following the completion of full secondary education in the medical assistant field:

•	Care of seniors

H. Technician category

Fields of specialisation following completion of higher vocational education in the certified optometrist or certified dental technician fields:

•	Medical informatics

l. Other health professional category

Fields of specialisation following the completion of a Master’s Degree in physiotherapy:

•	Physiotherapy of psychomotoric development disorders
•	Physiotherapy of functional and structural motor system disorders
•	Physiotherapy of CNS disorders
•	Physiotherapy in sports and physical education
•	Ergonomics and rehabilitation engineering

Fields of specialisation following the completion of a Master’s Degree or a Bachelor’s Degree in physiotherapy, and/or after higher vocational education in the certified physiotherapist field:

•	Physiotherapy of selected motor system diseases
•	Physiotherapy of respiratory diseases
•	Physiotherapy of psychosomatic and Civilisation diseases
•	Ergotherapy

Fields of specialisation following the completion of a Master’s Degree in psychology:

•	Clinical psychology
•	Counselling psychology
•	Occupational and organisational psychology
•	School psychology

Fields of specialisation following the completion of a Master’s Degree in logopaedics:

•	Clinical logopaedics

Fields of specialisation following the completion of a Master’s Degree in therapeutic pedagogy and special pedagogy: 

•	Therapeutic pedagogy
•	Special pedagogy

Fields of specialisation following the completion of a Master’s Degree university in social work:

•	Social work in the health service

Fields of specialisation following the completion of a Master’s Degree in a subject other than those referred to above:

•	Environmental hygiene
•	Occupational environmental hygiene
•	Infant and juvenile environmental hygiene
•	Clinical physics
•	Laboratory medicine
•	Examination methods in pathology and forensic medicine
•	Examination methods in preventive Occupational medicine and toxicology
•	Examination methods in microbiology and environmental biology
•	Examination methods in Environmental hygiene
•	Examination methods in health protection from ionising radiation
•	Medical informatics

Fields of specialisation following the completion of full secondary education:

•	Health protection from ionising radiation
•	Examination methods in clinical biochemistry
•	Examination methods in clinical microbiology
•	Examination methods in hygiene chemical and physical analysis
•	Examination methods in toxicology an dpharmacology

Annex 3
Certification training for individual categories of health professionals (extract from Government Regulation No. 322/2006 Coll. as amended)

A. Certified working activities for doctors (some are part of model specialised programmes in their relevant fields of specialisation): 

•	Adult abdominal ultrasonography – part of the specialised study programme for internal medicine 
•	Diagnostic and intervention esophago-gastroduodenoscopy – part of the specialised study programme within the field of internal medicine, gastroenterology, 
•	Audio-prosthetics
•	Diagnostic and intervention colonoscopy - part of the specialised study programme for internal medicine, gastroenterology 
•	Diagnostics and treatment of immuno-pathological gynaecologic status
•	Endoscopic retrograde Cholangiopancreatography – part of the specialised study programme for internal medicine, gastroenterology 
•	Respiratory endoscopy – part of the specialised study programme for respiratory medicine and phtisiology
•	Pharmaco-economics
•	Functional diagnostics
•	Chemotherapy of infectious diseases
•	Tumoral chemotherapy
•	Intensive care in internal medicine
•	Intervention radiology - part of the specialised study programme for radiology
•	Intervention ultrasonography in urology – part of the specialised study programme for urology
•	Clinical medicine testing
•	Mammo-diagnostics in gynaecology
•	Mammo-diagnostics in radiology
•	Eye microsurgery
•	Paediatric radiology
•	Perfusiology
•	Assessment medicine
•	Psychotherapy
•	Infant rehabilitation
•	Rehabilitation in gynaecology
•	Rehabilitation in obstetrics
•	Spondylosurgery
•	Examination methods in genetics
•	Examination methods in cardiology
•	Clinical psychophysiology (neurofeedback and biofeedback)

B. Certified working activities for dental practitioners in certified working activities (mostly part of model specialised programmes within the appropriate fields of specialisation): 

•	Dentoalveolar surgery
•	Oral mucosa diseases
•	Implantology
•	Paediatric surgery

C. Certified working activities for pharmacists:

•	In-vitro medical and diagnostic devices
•	Pharmaco-economics
•	Clinical product and medicine testing
•	Preparation of cytostatic agents
•	Quality assurance of transfusion medicinal products
D.Certified working activities for nurses:

•	Audiometry
•	Endoscopic examination methods in different fields
•	Functional examination methods
•	Invasive and intervention diagnostic and therapeutic procedures
•	Vaccination against TB
•	Cardiologic examination methods
•	Nursing care of diabetic Patients
•	Multicultural communities nursing care
•	Organisation and techniques in tissue banks
•	Organisation and management of care for medical devices
•	Care of drug addicts
•	Psychotherapy
•	Examination methods in clinical neurophysiology and neurodiagnostics

E.Certified working activities for midwives:

•	Family planning and contraception
•	Physiological preparation for labour

F.Certified working activities following the completion of university education in the laboratory examination methods field of study:

•	CIinical immunology and allergology
•	Medical genetics

G.Certified working activity following the completion of full secondary education in the pharmaceutical laboratory technician field of study:

•	Digital Subtraction Angiography – DSA
•	Mammography
•	Computer tomography – CT

H. Certified working activities for technicians:

I. Certified working activities for other health professionals:

-	for physiotherapists

•	Mobilisation techniques
•	Dr. Vojta’s reflexive therapy method 
•	Lymphoedema therapy techniques
•	Clinical psychophysiology (neurofeedback and biofeedback)

-	for clinical logopaedists:

•	Aphasiology
•	Clinical psychophysiology (neurofeedback and biofeedback)

-	for clinical, consultant, occupational and school psychologists:

•	Drug addictions
•	Psychotherapy
•	Traffic psychology
•	Clinical psychophysiology
•	(neurofeedback and biofeedback)

-	for therapeutic instructors  and special instructors

•	Drug addictions
•	Psychotherapy
•	Traffic psychology
•	Clinical psychophysiology (neurofeedback and biofeedback)

-	for social workers in the health service:

•	Drug addictions
•	Psychotherapy
•	Clinical psychophysiology (neurofeedback and biofeedback)

For each category there may be changes in the structure of specialised and certified working activities. Ttherefore, it is advised to follow the actual legal regulations.

Annex 4 
Fields of specialisation dedicated to the management and organisation of the health system (extract from Government Regulation No.322/2006 Coll. as amended)

•	Doctor and dental practitioner categories
- Health service management and finance
- Social medicine and health service organisation
- Military health service organisation.

•	Pharmacist category
-	Social pharmacy and health service organisation

•	Nurse category
a) Following the completion of a Master’s Degree
- Health service management and finance
- Social medicine and health service organisation
b) Following the completion of a Bachelor’s Degree and higher vocational education:
- Management in nursing

•	Midwife category
Following the completion of a Bachelor’s Degree and higher vocational education:
- Management in midwifery

•	Laboratory technician, assistant, technician category 
Following the completion of university education and higher vocational education:
-	Management in the appropriate field

•	Other health professional category
Following the completion of university education:
- Management in the appropriate field
- Health service management and finance

•	Common studies for all health professional categories with a university education
-	Master of public health

Annex 5
List of issued decisions on accreditation

As of academic year 2006/2007, these educational institutions are allowed to offer the study programmes accredited by the Ministry of Health of Slovak Republic which are dedicated to the further education of health professionals:

Name of Educational Institution	Name of accredited specialised study programme	Category of health professionals	
Commenius University in Bratislava, Jessenius Faculty of Medicine of Martin	Internal medicine	Doctor	
	Diabetology, disorders of metabolism and nutrition	Doctor	
	respiratory medicine and phtisiology	Doctor	
	Urology	Doctor	
	Surgery	Doctor	
	Hematology and transfusiology	Doctor	
	Neurology	Doctor	
	Gynaecology and obstetrics	Doctor	
	Paediatrics	Doctor	
	Dermatovenerology	Doctor	
	Communicable diseases	Doctor	
Commenius University in Bratislava, Faculty of Medicine	Neurology	Doctor	
	Gynaecology and obstetrics	Doctor	
	Ophthalmology	Doctor	
University of Pavel Jozef Šafárik in Košice, Faculty of Medicine	Maxillo-facial surgery	Doctor	
	Maxillo-facial surgery	Dental practitioner	
	Stomatology	Dental practitioner	
	Surgery	Doctor	
	Accident medicine	Doctor	
	Gastro-enterological surgery	Doctor	
	Occupational medicine	Doctor	
	Endocrinology	Doctor	
	Diabetology, disorders of metabolism and nutrition	Doctor	
	Dermatovenerology	Doctor	
	Internal medicine	Doctor	
	Neurology	Doctor	
	Gynaecology and obstetrics	Doctor	
	Ophtalmology	Doctor	

Annex 6
Model of the agreement of an educational institution with a health professional on study

--------------------------------------------------------------------------------------------------------------------------------------------

MODEL
Contract on the creation of a specialised study in the field of specialisation
........................................

1.	Contracting parties:
1.1.	Supplier:	(name of educational institution)
	Registered office address
ID No.:
Represented by: (statutory body)

1.2. Customer: (student of specialised study)
	Title, Full Name:	 .................................................... 
	Personal Identification Number	....................................................................... 
	Permanent address/telephone number	................................................................

2.	 Subject of the contract
2.1.	Specialised study of a health professional in the accredited study programme in the field of .......................... dedicated to the ................... category of health professionals  to the total extent of............ hours. (A copy of the lawful decision of the MHSR on accreditation is attached to this contract)

2.2.	This contract covers the realization of specialised working activities under the responsibility of the health professional with appropriate professional competence in the premises of the health professional's employer that represent an integral part of this specialised study and may only be realised after the statement and upon prior consent of the educational institution.

3.	Obligations of the supplier - educational institution
3.1.	Provide to the health professional ............ hours of specialised study in the field of  ............., consisting of theoretical and practical components to the extent of the specialised study programme accredited by the Ministry of Health of the Slovak Republic in accordance with a study plan elaborated in advance (attached to this agreement) which is in compliance with the requirements for the accredited programme set out in the applicable legal regulations so that the health professional, following graduation, is professionally capable of independently pursuing appropriate specialised working activities. Ensure that the practical component of the course prevails within the specialised study; for this purpose the educational institution concludes agreements to secure the practical component of the specialised study in the appropriate premises of the health care providers so that the health professional has the opportunity to acquire all the practical knowledge and skills contained in the accredited study programme. The educational institution, at the beginning of the study and during its course updates and notifies to the health professional information regarding the extent of the concluded agreements.
3.2.	To carry out the specialised study between ............ years1)  of the signature of this contract at the earliest, and .........years at the latest.
3.3.	At the beginning of the course, deliver to the health professional the index of proficiency and the record of procedures for the course records.
3.4.	After completion of the course and passing of the examination before the examination Commission, composed of the representatives of the educational institutions delivering the course, in the same field of specialisation within the Slovak Republic, within the meaning of the applicable legal regulations2), issue to the health professional a diploma of specialisation if he or has fulfilled the conditions determined for its acquisition.
3.5.	Ensure the delivery of the programme under an expert guarantee and by a lecturing team approved by the Ministry of Health within the framework of the accreditation granted for the purposes of delivering the programme (point 2.1) and on premises evaluated by the Ministry.
3.6.	Ensure the fulfilment of ethical standards when dealing with personal data of the health professional, even after expiration of this contract.
4.	Obligations of the customer - health professional
4.1.	 The health professional initiates the specialised study with the intention to pass the entire specialised study programme within the number of …….. hours, as stated above, and  within the determined weekly working time. For a time shorter than the established weekly working time the duration of the specialised study shall be proportionately extended, while healthcare must be provided to the extent of at least half the weekly working time and involve sufficient theoretical and practical lessons in order to assure proper training for autonomous provision of specialised healthcare.3)
4.2.	The health professional attempts to accomplish the study within ........... from the signature of this contract.
4.3.	If, due to serious circumstances, the health professional cannot participate in the course, he or she will, as soon as possible, inform the teacher appointed by the educational institution in the study plan (point 3.1 or management of the educational institution).
4.4.	In the case of an absence exceeding more than ….. hours in one year, he or she shall replace the missed programme and health services in the following year. The total absence for ..... years of the specialised study shall not exceed ....... hours. If this happens the health professional shall discuss with the teacher or the teaching team in the case of several teachers the possibility of replacement of the absence, repetition of the year or another solution.
4.5.	 The health professional engages to fulfil other conditions for the accomplishment of the specialised study, including:
- Completion and submission of written papers as part of the final evaluation for the corresponding year,
- Participation in seminars and conferences on the subject of specialised working activities which are the subject of the specialised study according to the recommendation of the teacher, at least in the amount of ….. hours for each calendar year,
- Internship at a workplace recommended by the educational institution,
- Independent performance of at least …… health services under the supervision of the trainer, etc.
4.6.	The health professional initiates the study of his or her own will and is prepared for active cooperation in order to transform and extend his or her human and therapeutic potential. In this respect he will be at the disposal of the other health professionals of the accredited specialised study programme.

5.	Determination of the cost of the specialised study
5.1.	The cost of the specialised study for the entire specialised study is determined so that it covers the expected expenses, mostly according to the economic analysis of the previous year. The health professional will cover 10 % of the economically justified costs to the educational institution for the entire period of study, to a maximum of 40,000 Slovak Crowns4). The balance will be covered from the contribution of the employer who proposed the health professional's involvement in the specialised study5), which represents  .... SKK for the entire course; the contribution of the state, which represents……. SKK for the entire course; the contribution from the funds of the European Union, which represents ……………… SKK for the entire course of the health professional; the contribution of health insurance company, which represents …………… SKK for the entire course , and the contributions from any sponsors, amounting to …… SKK. The contribution of the employer may also be deductible from the total price of the study in the form of quantification of study leave and other personal and material-technical costs incurred by the employer for the health professional in relation to the completion of the course.
5.2.	The educational institution agrees to ensure and cover from the stated financial resources the activity of the lecturing team and teachers with appropriate professional competence health professional6) from the educational institution and other organisations participating in the health professional's studies, mostly special medical material and instruments, etc; in addition, the costs for securing the index of proficiency and the recorder of procedures of the health professional, costs for the supervisor, necessary training courses and internships and providing the examination Commission will be met by the educational institution.
5.3.	The health professional agrees to settle a proportional part of his or her contribution for the corresponding year before the beginning of each academic year, i.e. at the latest within ….. of the corresponding calendar year. The settlement may also be paid by instalments upon agreement with the management of the educational institution.
5.3.	The employer of the health professional engages to spend the expenses for the specialised study of the health professional continually, from ............... until …. (at the latest) and inform the educational institution regularly of these amounts of expenses to the defined extent and intervals.
5.4.	The health professional, considering the contribution of the employer under points 5.1 and 5.3, agrees to complete the study and work for at least 5 years of professional medical practice in their respective field of specialisation on the employer's premises or other premises determined by the employer following an agreement - otherwise he or she engages to reimburse to the employer the value of the costs incurred by the employer for his or her study to the extent quantified by the employer, unless they agree otherwise.
5.5.	The contribution of the sponsor represents ….. SKK and the sponsors reserve …. . The contribution of the health insurance company represents ……. SKK and the health insurance company reserves ……. The contribution of the state and from the funds of the European Union are governed by a separate agreement.
5.6.	f the health professional and other contributors under this contract pay for the specialised study and the health professional does not then commence the study, the aliquot part of his or her contribution will be returned to him or her after deducting a 5 % cancellation fee.
5.7.	Accommodation and food during the study is not covered in this contract.

6.	Validity of the contract
6.1.	The contract enters into force on the date of signature by both contracting parties.
6.2.	The contract is made in two copies, each one having the value of the original and each contracting party will receive one copy.
6.3.	The contract terminates:
1.	on the moment that a diploma of specialisation is issued
2.	on the date the health professional quits the specialised study
3.	with the non-fulfilment of the obligations defined in the contract
4.	upon agreement of both contracting parties
5.	with the termination of the training by the supplier (see Art. 7.2)

7.	Special provisions
7.1.	The health professional shall notify unconditionally to the management of the educational institution any health difficulties which could affect the performance of specialised working activities and the completion of the specialised study, including mental diseases or disorders which required or require professional assistance before and during the course. The eventual failure of notification may be a reason for withdrawal from the contract.
7.2.	The educational institution reserves the right to terminate the specialised study of the health professional before fulfilment of the contract if the team of trainers (the lecturing team) comes to the conclusion that further continuation in the specialised study would represent a threat to the health professional as a student or a threat to his or her current or future patients or if it comes to the conclusion that it has discovered the health professional shows other contrary indications of an independent pursuit of specialised working activities which are the subject of the study.
7.3 The contract may be amended only after the agreement of both contractual parties. 

The contract is governed by the regulations contained in the Civil Code. 

In ...................... on ....................

..........................................................	..........................................................
(educational institution) supplier	(health professional) customer

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1) See minimum length of the specialised study in the corresponding field of specialisation in the Annexes to Government Regulation No.743/2004 Coll. as amended by Government Regulation No.179/2005Coll.
2) Article 41 of the Act No 578/2004 Coll. on Healthcare Providers, Health Professionals, Professional Organisations in the Health Service, and on amendments to certain Acts.
3) Article 6 of Government Regulation No.743/2004 Coll. as amended
4) Decree of the MHSR No. 31/2006 Coll. on the Settlement Amount of the Health Professional for Further Education
5) Article 7 of Government Regulation No.743/2004 Coll. as amended by  Government Regulation No.179/2005 Coll.
6) Article 6 of Government Regulation No.742/2004 Coll. and 743/2004 Coll. as amended-----------------------------------------------------------------------------------------------------------
Authors' note: The model of the contract can also be used as a model for the creation of certification training or a programme of continuing education

Annex 7
Example of groups of questions for the guestionnaire for evaluating the eduactional activities by the health professional

•	Questions about the evaluation of the educational activity

•	Questions about the form of the educational activity

•	Questions about the theme of the educational activity

•	Questions about the content of the educational activity

•	Questions about the structure (number of lectures, proportion of lectures versus practical     
     demonstrations of procedures and the like)

•	Questions about the duration of the educational activity

•	Questions about the number of trainers

•	Questions about the length of discussion

•	Questions about the evaluation of the contribution

Annex 8
Model diploma of specialisation

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MODEL

SLOVAK REPUBLIC

SLOVAK MEDICAL UNIVERSITY
Bratislava
Faculty of Medical Specialty Studies

Number: B. 123456

DIPLOMA
of specialisation

MUDr. Alena Nová
born on June 20, 1954

acquired in accordance with the Act of the NC SR No. 578/2004 Coll. on Healthcare Providers, Health Professionals, HealthCare Professional Associations and on the amendment and supplements to certain Acts, Government Regulation of the Slovak Republic No.322/2006 Coll. on the Method of Further Education of Health Professionals, the System of Fields of Specialisation and the System of Certified Working Activities on ................... competence to pursue specialized working activities

in the field of specialisation
INTERNAL MEDICINE

The specialisation is in accordance with Annex C of Council Directive 93/16/EEC as amended by later legal act of the European Communities.

.............................................
Prof. Dr. Ján Štencl, CSc. 
Rector

...............................................		.................................... 
Prof. MUDr. Milan Pavlovič, CSc.	Dr. Alojz Rakús
President of the Examination 	CommissionFaculty Dean

Bratislava, on.....................

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Approved as a model by the SR Ministry of Health under no. 10714-3/2004-ORL on May 5, 2004.
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Annex 9
Model certificate

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MODEL

SLOVAK REPUBLIC
SLOVAK MEDICAL UNIVERSITY
in Bratislava
Faculty of Medical Specialty Studies

Number: C. 432

CERTIFICATE

MUDr. Alena Nová 
born on June 20,1954

acquired in accordance with the Act  of the NC SR No. 578/2004 Coll. on Healthcare Providers, Health Professionals, HealthCare Professional Associations and on the amendment and supplements to certain Acts,  Government Regulation of the Slovak Republic
No. 322/2006 Coll. on the Method of Further Education of Health Professional, the System of Fields of Specialisation and the System of Certified Working Activities
on ................... competence to pursue 

certified working activity in the field of
PHARMACO-ECONOMICS

............................................. 
Prof. MUDr. Ján Štencl, CSc. 
Rector

...............................................		.................................... 
Prof. MUDr. Milan Pavlovič, CSc.	Dr. Alojz Rakús
President of the Examination 	CommissionFaculty Dean

Bratislava, on.....................

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Approved as a model by the SR Ministry of Health under no. 10714-3/2004-ORLon May 5, 2004.
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Annex 10
Model confirmation from an educational activity for continuing education

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MODEL

Slovak Psychotherapeutic Company confirms that

Dr. Alena Nová, born on June 20, 1954
registration number from the chamber register ..............*

has participated during .................. 
on a three day international conference 
on the “Systemic Structure of Symptoms”
held in Bratislava

in the amount of  ............... hours,

of which ....................... hours were spent actively
(lecture on the theme “............................................”,
poster on the theme “.....................................................................” and
participation in the panel discussion on the theme “....................................”).

signatures of authorized members
of the Slovak Psychotherapeutic Company

stamp

Information of the organizer:
Within the meaning of MHSR Decree No.366/2005 Coll. on the Criteria and Method of Evaluation of Continuing Education of Health Professionals, as amended by Decree No.187/2006 Coll., the participant shall be awarded 15 credits for this educational activity for participation in the entire conference plus 15 credits for the lecture (authorship) plus 5 credits for the posting (co-authorship) and 5 credits for participation in the panel discussion) – a total of 40 credits.

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* Author's Note: the registration number is not obligatory

•	Accreditation of further education of health professionals
Compiled by and the collective of authors led by:
PhDr. Kvetoslava Beň ušová, MPH

•	Authors:
Mgr. Monika Hozlárová 
Mgr. Zuzana Menďanová 
Mgr. Marián Nagy
PhDr. Zuzana Slezáková, PhD., MPH 
Doc. PhDr. Vlasta Závodná, PhD

•	Manuscript reviewed by:
Prof. MUDr. Juraj Pechan, CSc., 
President of the Accreditation Commission of the MHSR for further education of healthcare professionalsRudolf Zajac,
Minister of Health of the Slovak Republic

•	Published by the Ministry of Health of the SR in the year 2006
•	1st edition, 10 000 copies, 56 pages

All rights reserved.
This work or any of its parts may not be reproduced without the consent of the owner of the rights.

ISBN 978-80-969507-7-5