For family practices

Since the summer of 2011, the law has allowed a medical student who has completed at least the fourth year to take part in providing healthcare services as an assistant doctor, carrying out a doctor’s duties within the limits of their competence and skills, under the guidance and supervision of a responsible doctor, without holding a healthcare worker’s registration.

What does Estonian healthcare gain?

Delegating simpler tasks lets supervisors use their time more efficiently and reduces their workload.
As befits the medical profession, knowledge is passed on to the next generation.
In the longer run the quality of care improves, because future doctors can put what they learned at university into practice early, consolidate their knowledge and build experience.
Future doctors get to work in their chosen specialty in Estonia and to build professional ties, which over time helps ensure continuity in healthcare.

What do medical students gain?

Applying the skills and knowledge learned at university during their studies embeds the theory better.
The sense of responsibility that comes with being a doctor starts already as a student.
Clinical reasoning develops.
The student gains experience of working in a team and understands the role of the different healthcare workers in the system.
They gain a better understanding of how Estonian hospitals and family practices are organised.

What does the patient gain?

Sharing the doctor’s workload gives the doctor more time for each patient.
Patients’ trust in the institution rises when they see the family practice investing in young doctors.
With enough experience, a medical student helps reduce both workload and waiting times.

Where can a medical student be useful?

A student who has completed the fourth year has gained knowledge and skills in the following subjects:

Internal medicine: rheumatology, gastroenterology, haematology, endocrinology, cardiology, pulmonology and thoracic surgery, nephrology, infectious diseases, laboratory medicine, introductory geriatrics
Surgery: vascular surgery, general and abdominal surgery, traumatology and orthopaedics, paediatric surgery, urology, cardiac surgery
Anaesthesiology and intensive care
Oncology
Ophthalmology
Human molecular and clinical genetics (taken in the third year since 2021)
Military and disaster medicine
Clinical pharmacology
Clinical pathology I

A student who has completed the fifth year has additionally taken the following rotations:

Family medicine
Critical conditions in emergency medicine
Dermatology and venereology
Gynaecology and obstetrics
Paediatrics
Neurology and neurosurgery
Psychiatry
Ear, nose and throat diseases
Rehabilitation medicine
Forensic medicine
Clinical radiology
Clinical pathology II
Health service management and health economics

Obligations and area of responsibility

The medical student is part of the patient’s care team. They can handle diagnosing classic and common cases, prescribing treatment and explaining the treatment plan. Having just completed rigorous theoretical study, students can also help with questions of differential diagnosis. A student’s actual duties and area of responsibility develop out of the trust between them and their supervisor, and rest on that particular student’s experience and knowledge so far.

Possible tasks in a family practice

Taking the history
Examining the patient and describing objective findings
Making entries and drafting summaries and discharge letters
Following a child’s development and comparing it with age-appropriate norms
Ordering tests and investigations
Explaining results and tests to the patient
Establishing the initial diagnosis
Drawing up the initial treatment plan and adjusting an existing one
Writing referrals
Explaining the treatment and the illness to the patient
Counselling the patient and giving recommendations, including by phone and e-mail
Completing documents (e.g. various health certificates, sick leave)
Simpler procedures: blood pressure measurement, performing and interpreting an ECG, rhinoscopy, otoscopy, direct laryngoscopy, dressing and cleaning wounds, injections, blood glucose and INR measurement, urine dipstick analysis.
Various procedures after brief instruction: gynaecological examination and sampling, suturing wounds, ear irrigation, various punctures, intra-articular injections, opening and draining abscesses, removal of an ingrown nail, and so on.

The student’s obligations

The student undertakes to carry out the tasks assigned to them by agreement.
The student undertakes to be responsible for the quality with which those tasks are carried out.
If a problem or doubt arises, the student must turn to their supervisor. If the supervisor is unwilling to supervise the student or is unavailable, the supervisor is responsible.
Under the code of medical ethics the student is bound to confidentiality.

The employer’s obligations

The employer undertakes to conclude a written employment contract with the student.
The employer undertakes to assign the student a supervisor.
The employer undertakes to pay the student. Under the 2023–24 collective agreement the rate is at least 60% of the minimum wage of a doctor.
Under the amendment to the Health Services Organisation Act that came into force in March 2017, the employer undertakes to do everything in its power to give assistant doctors access to the e-Health information system and, where possible, to the prescription centre, including the ability to draft prescriptions from their own personal account.

The supervisor’s obligations

The supervisor undertakes to assign the student tasks they can manage.
The supervisor undertakes to give feedback on the student’s work.
The supervisor undertakes to be available to the student within a reasonable time, depending on the seriousness of the professional problem.