UNIVERSITY OF PENNSYLVANIA - ST. PETERSBURG
MEDICAL UNIVERSITY AFFILIATION



The Penn-Pavlov Agreement (dogovor) was established in 1992 between the University of Pennsylvania Medical Center and the St. Petersburg Medical Institute (the Pavlov). The agreement followed immediately upon the issuance of a new "charter" to the Pavlov Medical Institute from Moscow to move ahead quickly into the post-Soviet era of Russian medicine.

Essentially, we at Penn were invited to work with the Pavlov Medical Institute to help build a model academic medical center which would reflect some characteristics of Western academic medicine. The First St. Petersburg Medical Institute became the St. Petersburg (Pavlov) Medical University in March 1995.

Through initial discussions with the Rector of the Pavlov Institute, we set up six "categorical areas" in which we might develop the affiliation. Called the "Rector's Priorities", they were the following:

1. Library Resources and Services
2. Medical Student Education
3. Communications and Information Management
4. Medical Pedagogy
5. Faculty and Scientific Exchanges
6. Organization and Management

1. The medical library at the Pavlov Medical University was the Rector's top priority. With the dedicated cooperation of the National Library of Medicine in Bethesda, we quickly set up the Pavlov Library's ability to access MEDLARS, and worked out methods for supplying to them documents identified in their searches of the medical literature.

In 1994 the Library was equipped with a CD-ROM capability through the Soros Foundation program.
In June 1995 the Pavlov connected with the INTERNET, which made it possible for us to install ARIEL™ software for document transmission.
Since September 1995, an addition to the Pavlov medical school curriculum includes a requirement for instruction of all students in library searching methods. Our Biomedical Library provided the Pavlov library staff with the instructional methodology.
In 1999, as part of the Open Society Institute's Russian Internet Program the Pavlov Office became the INTERNET Center for medical institutions of St. Petersburg and of the Leningrad Region.
We have determined what we need to accomplish in terms of further staff and faculty education, and in the ultimate building of appropriate library resources for this modern age of medical communications and literature.

Three major outstanding tasks are:

1) supply of documents - expensive even through the Ariel program;
2) training of staff - especially in their role as "trainers" of users;
3) development of a St. Petersburg biomedical library network

2. The students:

We have established a 2-month preceptorship program for the Pavlov 6th year students. The 9th group arrived in July 2000.
Our faculty have been most impressed with the ability and the competence of these young people. We anticipate the role they will play as the young Pavlov faculty of the future. Eventually, our planned overall program for the medical students will involve 5% of each class (about 25 students per year).
These student "clerkships" have been in many departments at Penn. The students have two kinds of educational objectives: "individual" ->i.e., what each student wants to learn; and "institutional" ->i.e., systems information, useful to the Pavlov and the Pavlov-Penn affiliation. Thus, the very first student studied echocardiography for his individual objective, AND became a student librarian for his institutional objective - making trips to the National Library of Medicine and taking home to Petersburg the computer program to connect directly with MEDLARS.
Financial support for the Pavlov-Penn student program has come from Wyeth-Ayerst Pharmaceutical Laboratories.

3. The information management program has grown rapidly because of the commitment made to computer-based communications by the faculty and administration of the Pavlov. They have proceeded with hard-wiring of the campus, established access to the INTERNET, which allowed installation of the ARIEL™ software for receipt and transmission of library documents.

The Director of the Computer Center has made visits to the States to study our medical informatics systems, and has done an excellent job in pushing this field forward at the Pavlov. He has been appointed to GOSSTANDART in Moscow, and in August '98 was the Russian representative to the ISO-TC meeting in the States.
The Pavlov has recently (Dec.1998) received a grant from the SOROS Foundation to establish the INTERNET Center for the medical institutions of the Leningrad region.

4. The area of medical pedagogy as such is of critical importance to the Pavlov and to our program. The Rector and faculty established the "Penn-Pavlov Learning Center" in April 1994. That has given us the organizational and administrative base from which we can carry out appropriate programs in evaluation and teaching. Dr. Silberberg and Dr. Storey of our Office are both on the Governing Council (Obschestvennii soviet) of the Pavlov Learning Center, and are directly and immediately involved in its activity and in planning for its future programs.

There are two major parts of the Center's activity:
1) evaluation of the existing curriculum as measured by student performance on standardized examinations; and
2) preparation of selected students to take the United States Medical Licensure examinations. (USMLE).
A major donation of review textbooks was made to the Pavlov-Penn Learning Center by Waverly International Publishing House (300 volumes). The Pavlov graduates have done well in taking the ECFMG administered USMLE exams. It has been interesting to see the subject matter areas in which they do well and those in which have had difficulties.

5. In terms of faculty exchange and the development of joint research and teaching efforts, we have identified a number of the Pavlov faculty and determined how they might fit into the Penn-Pavlov program. Senior and junior faculty have come to Penn. We have a special focus on the "35-year old" group - those who have made it on to the faculty and still have "30 years to go under the Penn-Pavlov affiliation!"

Faculty in Surgery, Obstetrics-Gynecology (Women's Health), and Urology have come to Penn. Three courses in Maxillo-facial and Plastic Surgery have been given at the Pavlov. Because of the expanding epidemic of drug addiction, with the concomitant devastation of HIV/AIDS, sexually transmitted diseases, the spread of TB-ADR (all-drug-resistant), and Hepatitis C, we have developed a special approach to this current disaster in Russian health care.
Further and more rapid implementation of the faculty exchange category will depend on our ability to find outside financial support.

6. The final category, that of organization and management was established to facilitate change in the Russian health services system and development of its academic support base. Russia, St. Petersburg, and the Pavlov Medical University continue to deal with the problems of reorganization from a centrally managed government-run nation-wide network for health care to a more decentralized approach based to an ever greater degree on local determinants, market forces, and the emergence of a non-governmental insurance industry.

In 1993 the Pavlov established a "practice plan" called the "Delor Medical Center of the St. Petersburg Pavlov Medical University" ("delor" is an acronym from the Russian words for "délovaya organizátsia" = "business organization") Contracts are made with insurance companies, with enterprises which maintain their own employee health facilities, and with other outside agencies. Individual patient access on a fee-for-service basis is administered by DELOR.
One of our proposals is the creation of a "Department of Health Care Management." This department would be modeled on the Leonard Davis Institute for Health Economics of the University of Pennsylvania which is a joint effort between the Wharton School of Finance and the Medical School at Penn.. The plan includes the essential concepts for the "managed care" era of health services, and is as important for Russia in its new orientation to decentralized services as it is for the United States. Such a department would be an important educational resource for Russian physicians, nurses, and health service managers from around the country.
Some "joint ventures" presently under consideration include: development of a joint Pavlov-Penn Program in Andrology and Women's Health. A new building is under construction, external funding has been obtained, and faculty and students from the Pavlov have been to the Penn program.
Four areas of special joint effort are presently under development:

These descriptions provide a brief account of the programs and the ideas which have been developed jointly with our St. Petersburg colleagues.