Public Health in Croatia
“It is more important to educate the people than to pass new laws.”
One of Andrija Štampar’s “10 principles of public health and social medicine” (1926)
Croatian Section of Medical Residents in Public Health (Hrvatska sekcija specijalizanata javnog zdravstva; CSMRPH / HSSJZ) was founded in 2014 and operates as a section of the Croatian Public Health Association (Hrvatskog društvo za javno zdravstvo; HDJZ). HDJZ is a professional medical society under the Croatian Medical Association (Hrvatski liječnički zbor, HLZ).
CSMRPH’s vision is the affirmation of public health with the following missions:
- to promote adequate residency education among public health residents and
- to work with young physicians by
- increasing visibility and popularity of public health as a career choice.
Section’s goals are:
- assurance, monitoring and improvement of the public health residency programme in line with relevant legal acts and strategies as well as offering opinions and suggestions for modifications and improvements,
- monitoring and suggesting improvements to the postgraduate education related to the public health residency programme,
- networking and collaboration,
- increase of professional and scientific activities (projects, public health scientific papers, research, organization of workshops, forums, meetings, etc.)
All public health residents, doing their residency in Croatia, are eligible for full membership in CSMRPH. Residents of other specialties (including epidemiology) as well as non-medical public health professionals are eligible for the status of Section’s associated members.
If you have any question, don’t hesitate to contact the CSMRPH / EuroNet Croatia Team: euronetmrphcroatia@gmail.com
Information about residency program
“Everyone, regardless of position, should participate in issues of public health and work to improve it.”
Again, one of Andrija Štampar’s 10 principles
Pre-training requirements
Only graduates of the integrated (undergraduate and graduate) study of medicine are eligible to start the residency programme. The studies last for 6 years followed by a mandatory 5 month internship which consists of clinical rotations with different specialties and is followed by a professional board exam.
Prospective residents must apply for the specialization through public tenders published by different public health institutions in Croatia. The selection of the resident to the specialization is determined by an interview and based on a number of criteria (interview score, grade average, participation in additional training or publications during and post-graduation, etc.)
Duration of training
Following the 2011 harmonisation with European Union of Medical Specialists (UEMS) standards, the residency programme was extended to 48 months (previously 36 months). Most of the residency training takes place in different healthcare institutions (29 months) and for the purpose of obtaining practical experience in the “base” institution (10 months). Rest of the programme takes place in “other institutions related to public health” (mostly Ministry of Health and Health Insurance Fund) and for doing a residency-related scientific project (3 months).
Residency programme plans for both general and specific competences to be acquired during the 4-year programme. General competencies are the same for all medical specialties and include communication and teamwork skills, courses on ethics as well as Evidence-based Medicine. Competencies specific for the public health residency are divided into several categories:
- Disease prevention;
- Health promotion;
- Population health management;
- Organisation and quality of the healthcare system;
- Health policy development and implementation and
- Strategic planning and management.
Each resident is assigned mentors at two levels of mentorship whose jobs are to assure that resident does all the rounds and acquires all the required skills and competencies.
Residency programme evaluation
At the end of the residency programme, the resident takes an oral exam in from of an expert panel of senior public health professionals and professors, after which he/she becomes a specialist of public health. Informally, in the last couple of years, the final exam also includes a presentation of a personal residency work portfolio by the resident.
Residency programme history
Public health residency programmes have a long history in Croatia, starting with the work of the, above quotes, Andrija Štampar - one of the pioneers of public health in Croatia and one of the WHO’s founders. For a long time, the residency programme was called “social medicine and the organisation of the health care system”. In 1992. the residency programme was renamed “public health” and finally, after complying with the UEMS standards, since 2011. it has been called “public health medicine”.
Other related public health residency programmes
Besides public health, Croatian medical specialisations landscape also has a long history of other public health-related residencies - mainly epidemiology, school medicine and occupational medicine. These have, throughout the years, undergone a series of “reforms”, rendering their work more or less related to preventive and public health medicine. Thanks to “close-knit” relationships between different specialists, the cooperation between different professionals working in the public health “arena” has been satisfactory.
Post-training careers
After completing the residency programme and becoming a public health specialists, most residents, partly due to unfavourable contractual obligations, stay and work for the institution they have started their residency for. These are almost exclusively national and regional public health institutes, health insurance funds (national and regional offices), Ministry of Health and rarely - other healthcare institutions. Placements in clinical institutions are not common for public health specialists.