Sergei V. Jargin

The aim of this preprint was to overview some aspects of medical education and postgraduate training in Russia during the last 5 decades. Apart from review of literature, it is based on observations of the author since the 1970s. After the 6-year undergraduate medical education, to become a specialist in any field of medicine, a 2-year postgraduate program (ordinatura) without a preceding internship has been the usual way. In 2016 the internship was abolished; so that the postgraduate training has on average become shorter. Less common is a 3-year program (aspirantura) that includes research for a candidate's thesis. Previously, certificates of medical specialists could be obtained after a 1-year internship. Insufficient quality of training was pointed out by several experts. After completion of the postgraduate training, medical specialists must go every 5 years on a continuing education course up to one month long. Last time, many online courses have been developed; while their quality is improving thanks to the availability of foreign literature on the Internet and advances of health information technology. Several specific drawbacks of medical education and postgraduate training are discussed. More cooperation with the international professional community is needed. Without profound restructuring, the system of postgraduate training in Russia can be adapted to the international standards if its options (2and 3-year programs) would be transformed into consecutive steps. The total postgraduate training time would thus amount to 5 years, include preparation of a thesis and examinations to be awarded a degree equivalent to M.D. and a specialist certificate. Physicians not interested in research could prepare a thesis in a form of a literature review. Curricula including rotation should be modernized and adjusted to the corresponding fields of medicine. With time, the above-mentioned components of the training can be amalgamated in a unified system. In conclusion, the medical postgraduate training in Russia must be prolonged, intensified and better organized.

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Anti-religious propaganda in the former Soviet Union was efficient; with a majority of young people being nonbelievers. Atheism was easily accepted after the 1917 revolution because religiosity was not as deeply ingrained as it is sometimes supposed. A commentary on the politicization of religion in Russia in the context of the war in Ukraine is provided here. The hypothesis is proposed that a majority of today’s churchgoers, priests and church officials in Russia are atheists or agnostics, habitually following prescribed ideologies. Selected psychological and healthcare-related aspects are discussed. The Ukraine war, having thwarted the internationally agreed status quo, has triggered conflicts in different parts of the world. An optimal solution would be a global leadership, centered in most developed parts of the world, based on the principles of mercy and mutual help. This might be the last opportunity to avoid a major catastrophe.

The conflict in Ukraine and ensuing energetic crisis has hindered environmental policies in Europe and elsewhere. The war itself has severe environmental implications. The conflict between two major agricultural countries has negative impact on the global food supply. As food prices rise, some nations are likely to cope by converting forests and grasslands to fields. International tensions and conflicts are among reasons to boost childbearing in Russia and some other countries. There are inter-ethnic differences in the birthrate within Russia and worldwide. The necessity of birth control has been obfuscated by conflicting national and global interests, the population growth being regarded as a tool helping to the national sovereignty and defense. The pro-natalist policy is counterproductive in view of the global overpopulation. The ecological damage is generally proportional to the population density. The demographic growth contributes to the scarcity of energy and food in many regions. The energy could be supplied by nuclear power plants (NPPs). Well-managed NPPs pose less of a risk than those running on fossil fuels. The nuclear facilities practically do not emit greenhouse gases. Obviously, a lasting peace is needed, since NPPs are potential targets. By analogy with the Chernobyl accident, the war damage and shutdown of the Zaporozhie NPP (the largest NPP in Europe) will enhance demands for fossil fuels. In the past, the overpopulation was counteracted by wars, pestilence and famine. Today, scientifically based humane methods can be used to regulate the population size taking account of ecological and economical conditions in different regions. Large projects could be accomplished to improve the quality of life all over the world: irrigation systems, nuclear and other energy sources instead of fossil fuels. Hydroelectric power plants can be built on large rivers to produce hydrogen as eco-friendly energy carrier. Such projects would create many jobs, being a reasonable alternative to hostilities and excessive military expenditures. Not only durable peace but also mutual trust is required for that. Ukraine should become a testing ground for the international trust and cooperation.

Paranoid individuals have restricted abilities to test their beliefs for reality. Among them are writers touting mysterious theories. Certain war instigators are paranoid in their tendency to present themselves as liberators, world saviors etc. Paranoiacs may be aggressive against delusional goals. Some mentally healthy people are susceptible to paranoid appeals, a predisposing condition being fear of strangers and projection of hatred upon them. The projection mechanism in some individuals is the aberration of shame. Being unable to tolerate shame, they project it onto others. Repressed shame may cause aggression. This review applies the above considerations to the conflict in Ukraine. Among others, the lack of knowledge about other countries, misleading propaganda, suppressed envy and shame contribute to hostility against welfare states. Some topics discussed here are associated with shame, reflected by the comparatively low life expectancy and world highest abortion rate in Russia. In this connection, drawbacks of the healthcare are discussed here. If the global power shifts to Russia, it will come along with losses of certain values. The quality of many services, products and foodstuffs will decline. Autocratic management style will spread also in the healthcare and science. If the world is becoming multicentric, armed conflicts of various magnitudes may become permanent. There would be a vicious circle of overpopulation and homicide. International tensions provide motives for birth rate elevation: the demographic growth is believed to strengthen defenses and sovereignty. Environmental damage and exhaustion of non-renewable resources are proportional to the population size. The only thinkable alternative is a global leadership centered in most developed parts of the world. Among advantages of globalization are the ecological and demographic management, prevention of conflicts and warfare. Large projects could be accomplished by the globalized humankind to improve the life quality of billions, creating many jobs, being a reasonable alternative to excessive military expenditures. Confidence-building measures, international trust and reliability are needed. Instead of machismo and militarism, propaganda should popularize the image of scrupulous and hardworking people. Ukraine must become a testing ground for the international cooperation.

Sergei V. Jargin