In January 2026, the President of Kyrgyzstan, Sadyr Japarov, signed a law tightening the requirements for medical education and scientific activities in healthcare. This document changes the approaches to accreditation, licensing, and quality control of medical specialists' training.
Some key provisions of the new law include:
Mandatory state accreditation of all educational programs in medicine and pharmacy at all levels: from secondary to continuing education. Educational institutions that do not pass accreditation will not be able to accept students or issue state diplomas.
Creation of a state franchise system. Private medical educational institutions must operate through an accredited state university, which implies the use of state educational programs and materials, as well as oversight by the basic structure.
Strengthening control over the quality of medical personnel training. The relevant health authority will be responsible for monitoring, supervision, and evaluation.
Clarification of the procedure for internship and residency: programs will only be implemented in accredited educational institutions and clinics.
In this regard, the following questions remain important:
How will the actual level of training of specialists, especially in the field of cardiovascular medicine, be determined?
Who will be able to conduct training in accordance with modern international standards (not at the level of reports, but in practice through lectures, seminars, clinical sessions, and training)?
To assess the scale of the problem of training highly qualified personnel, one can refer to the document "2025 ACC/AHA/ASE/ASNC/SCCT/SCMR Advanced Training Statement on Advanced Cardiovascular Imaging," prepared by six professional organizations involved in training physicians in cardiovascular medicine. This document clearly outlines the requirements for the experience of physicians engaged in the visualization of the heart and vessels:
Specialists must:
Know the normal ranges of sizes and functional characteristics of heart chambers, taking into account demographic data (age, gender, race).
Know the physiology of the heart and the pathophysiology of cardiovascular diseases.
Know the anatomy of the cardiovascular system in 2D and 3D, its functional characteristics, and adjacent structures, as well as imaging methods.
Know the importance of clinical diagnosis of normal and pathological anatomy in extracardiac imaging.
Know the physics and basic principles of image acquisition, formation, and reconstruction for each method of cardiovascular imaging.
Know methods for optimizing spatial and temporal resolution for various imaging techniques.
Know the causes of image distortion and ways to eliminate them, as well as the application of artificial intelligence and machine learning.
Know the risks and procedures for their reduction for patients and medical personnel.
Know the contraindications for each imaging method and the optimal method depending on the patient's needs.
Know the basics of radiation safety and methods for reducing radiation exposure for all participants in the process.
Know the pharmacokinetics and pharmacodynamics of contrast agents and methods for managing side effects.
Know the indications and contraindications for imaging during pregnancy, including the safety of drugs and radiation doses.
Know the risks and complications associated with physical activity and pharmacological stress tests.
Know the principles of hemodynamics of the heart in normal and pathological conditions.
Know the indications, methods, and limitations of imaging for assessing hemodynamics.
Know the relationship between the results of cardiovascular hemodynamic imaging and invasive methods.
Know the indications and methods for assessing the structural and functional characteristics of the ventricles.
Know the methods for differential diagnosis of cardiomyopathies.
Know the indications and methods for assessing heart valve defects.
Know the data on normal and pathological valves for all imaging methods.
Have an understanding of the normal and pathological structure of valve prostheses.
Know the indications and methods for assessing infections related to cardiac devices.
Know the indications and methods for assessing coronary diseases.
Know the indications for physical exercises and stress tests for each imaging method.
Know the principles of combining imaging results with preliminary testing to assess the probability of cardiovascular diseases.
Know how to manage complications during stress testing.
Know the criteria for stopping physical activity and stress tests.
Know the advantages and limitations of stress testing compared to anatomical imaging.
Know pharmacological stress agents and methods for monitoring patients.
Know the indications and limitations of imaging methods for assessing pericardial diseases.
Know the anatomy and functions of the pericardium for each imaging method.
Know the indications for assessing the condition of the aorta and pulmonary arteries.
Have an understanding of diseases of the aorta and pulmonary arteries.
Know the imaging methods for the atria and their functions.
Know the methods for assessing systemic and pulmonary veins.
Know the indications and methods for assessing congenital heart defects.
Know the anatomy of congenital defects and their clinical significance.
Know the indications for assessing the condition of critically ill patients.
Know the results of imaging mechanical support devices.
Know the methods for working with imaging results to optimize device settings.
Know the imaging methods for cardiovascular diseases related to cancer.
Know the features of assessing cardiovascular diseases based on gender.
Know the assessment of cardiovascular diseases before, during, and after pregnancy.
Know the features of assessing cardiovascular diseases in autoimmune diseases.
Know the approaches to assessing cardiovascular indicators in athletes.
The requirements are specified depending on the specialization of the physician using various imaging methods. Training in modern imaging methods in cardiovascular medicine requires high medical knowledge and proficiency in all four imaging techniques. Competency-based practice includes various tools for assessing progress in training.
In such a complex field as cardiovascular imaging, the level of competency depends on both the quality and volume of training. Creating a quality educational experience includes theoretical classes, self-study, mentorship, and interaction with diverse clinical cases. The volume, though less significant, can be measured by the number and variety of studies conducted by trainees. However, mere volume is insufficient to guarantee full competency achievement. Competency in cardiovascular imaging is based on the successful completion of all training requirements and positive evaluation from the leadership.
The minimum volume of procedures proposed in this document is defined as necessary for familiarization with the diversity of clinical cases and provides an opportunity to assess the competency level of each trainee. The document specifies the procedures necessary to achieve competency, while the true assessment may require more than stated in the requirements.
Flexibility is provided in this concept, and programs should establish checkpoints for acquiring various competencies during the training process. Achieving absolute mastery in all aspects of cardiovascular imaging may be challenging if based solely on internships.
In the case of routine procedures, a high level of mastery may be achieved, but for complex or rare cases, graduates may possess a lower level of qualification. Complete mastery of advanced techniques is only possible after years of independent practice and clinical experience.
The minimum volume of procedures for cardiovascular imaging specialists is presented in the table below:
| All specialists in cardiovascular imaging | Specializing in a specific area of cardiovascular imaging | ||
| Interpretation of multi-slice CT results | 250 | 450 | Includes various types of MSCT, such as coronary artery MSCT and others (e.g., heart valve defects, formations in the heart and pulmonary veins). Archived cases may be used to ensure adequate representation but should not be the primary data source. In some studies, more than one type of MSCT may be considered. |
| CT studies with direct involvement in patient preparation, data collection, and interpretation | 65 | 150 | These examinations are included in the total number of interpreted MSCTs. Trainees must participate in patient preparation, selection of imaging acquisition parameters, and reconstruction. |
| Total number of interpreted MRI cases | 200 | 350 | Includes various types of MRI and covers a wide range of pathologies, including 15 cases of ischemic cardiomyopathy and others. Archived cases may be used for adequate representation but should not be the primary source. Studies may include more than one type of MRI. |
| MRI studies with direct involvement in patient preparation, data collection, interpretation | 100 | 150 | These examinations relate to the total number of interpreted MRI studies. Includes participation in studies such as cine imaging, non-contrast blood imaging, and coronary imaging. Advanced methods should be used in specialization. |
| Total number of interpreted echocardiographic examinations | 475 | 1100 | Includes a set of studies described below and assumes that the performed echocardiograms are included in the number interpreted. |
| Total number of interpretations of cardiac nuclear tomography | 300 | 575 | Includes various studies (SPECT or PET). |
Thus, for the successful development of medicine, it is necessary to understand who, when, and where will be able to train high-class specialists. Without this, patients will be forced to seek alternative solutions to their health problems.
