[HOLDING OBJECTIVE STRUCTURED CLINICAL EXAMINATIONS FOR ANESTHESIOLOGY AND INTENSIVE CARE CLINICAL RESIDENCY IN STATE GRADUATES CERTIFICATION].

The modern system of medical education requires objective methods to assess clinical competence of medical specialists. Application of objective structured clinical examination (OSCE) during the final certification of graduates of clinical residency allows to evaluate the theoretical knowledge, manual skills. Enabling simulation scenarios in the program makes it possible to objectively evaluate the important non-technical skills of anesthesiologists, identify gaps in the system of training and modify it. The experience of the objective structured clinical examination as part of the state certification of graduates of clinical residency of the Department ofAnesthesiology and Intensive Care, Military MedicalAcademy after C M Kirov allows us to consider this technique in an objective way a comprehensive assessment of the competence of health professionals. Students confirmed its highly realistic, they have revealed the presence of emotional stress during the simulation sessions, the majority agreed that the simulation session increased the level of their readiness to address these situations in clinical practice. Staff of the department is planning to testing and introduction rating scales into a system of assessment, to improved exam program, increasing the number of clinical scenarios for simulation sessions.

[Characteristics of hemodynamic reactions during various endoscopic surgeries for cholelithiasis in patients with concurrent cardiovascular pathologies]. / Osobennosti gemodinamicheskikh reaktsii pri razlichnykh variantakh éndovideokhirurgicheskogo lecheniia zhelchnokamennoi bolezni u patsientov s soputstvuiushchimi zabolevaniiami serdechno-sosudistoi sistemy.

A prospective study of 170 patients with concurrent cardiac pathology, who had underwent the laparoscopic cholecystectomy under the conditions of a tense carboxyperitomium, led to isolating two groups of patients with high-risk of intra- and postoperative unfavorable cardiac-vascular responses: an original high risk degree (III-IV classes according to ASA), a high value of cardiac risk indices according to Goldman (III-IV classes) and according to Detsky (II-III classes), a hypodynamic blood circulation regimen under rest conditions, and ejection fraction (according to echocardiography) amounting below 50%. Such patients are recommended to be operated on by laparolifting or by low-gas laparoscopy with a local lifting, i.e. by using the surgical techniques free of any negative effects produced on the carboxyperitomium hemodynamics, while all positive features of small-invasion surgery remain intact.