THE PROGRAM OF MEDICAL AND PSYCHOLOGICAL SUPPORT OF THE PROCESS OF MEDICAL COLLEGE STUDENTS ADAPTATION TO WORK IN PRIMARY POSITIONS

Relevance. The current period of Ukraine development is characterized by a number of socially conditioned stressors, which result in a significant increase in the number of cases of short-term, and most often, long-term stress. In particular, the duration of verbal and non-verbal communication with patients, their relatives, junior nurses (nurses, paramedics, midwives) is longer than in doctors, thus the psychological stress, which is also associated with maintaining their physical health, is much greater. The consequence of this is professional exhaustion, development of psychosomatic pathology, change of place of work. Objective of the work was to compile and propose a program of medical and psychological support for the process of medical college students adaptation to primary positions in treatment and prevention facilities. Methods. Students of the Kharkiv Regional Medical College and the Dnipro Basic Medical College took part in the study. The experimental group consisted of students in the number of 100 people aged 17.5±1.5 years. The control group (n=45) consisted of individuals 16.5±2.5. The research was conducted without gender. To assess the tasks Author’s questionnaires were used: «Means of adaptation of students to study in a medical university of I-III levels of accreditation», and individually typological questionnaire LM Sobchik. The data validity test for the Individual Typological Questionnaire was conducted to determine the validity and reliability of the answers in the categories «False» and «Aggravation». Statistical methods were used: middle and outward correlation analysis according to the criteria of Spirman and Pirson, Student’s criterion. Results. The importance of medical and psychological support of the process of adaptation of junior medical specialists was studied, an original program was developed, which is an integrated structural procedural model of adaptation of medical college students to primary positions. After the introduction of the correctional program for working with students, the average level of student motivation increased by 17%, which was confirmed by the data of statistical analysis before and after the experiment. The results were also obtained: the average level of students’ adaptive capabilities increased by 2 times. Conclusions. The program introduced into the educational process will allow for a short period of time to adapt them to work in primary positions, form the need for continuous education and adherence to the principles of a healthy lifestyle. It will allow you to consolidate a positive coping strategy not only in a work environment, but also in everyday life.

Relevance. The current period of Ukraine's development is characterized by a number of socially conditioned stressors, which result in a significant increase in cases of short-term, and most often, long-term stress. Military events, COVID-19 give medical personnel an additional reason to worry about their physical and psychological condition.
The duration of verbal and non-verbal communication with patients, their relatives, junior nurses (nurses, paramedics, midwives) is longer than in doctors, thus the psychological stress, which is also associated with maintaining their physical health, is much greater. Very often powerful emotional outbursts or emotional exhaustion can be traced. All this leads to persistent anxiety, stress and, as a consequence, psychosomatization and even the desire to change jobs, possibly the direction of professional activity.
From the perspective of medical management, there is one more problem in the work and social attitude to this category of specialists -material and moral satisfaction and public recognition of the importance of the work of nurses, paramedics and midwives.
It would be possible to simplify this problem by increasing wages (material motivation), but this is a tempo-rary measure which will not solve the problem, because the absence of certain individual-typological features of the subject in the presence of a stress factor does not allow to qualitatively master professional skills and perform them, especially in difficult critical conditions [1].
In psychology, the term "adaptation" refers to restructuring of the individual's psyche under the influence of objective environmental factors, as well as the ability of man to adapt to different environmental requirements without feeling internal discomfort and without conflict with the environment. Shafazhinskaya NE revealed the procedural side of the phenomenon of adaptation in contrast to the adaptation of animals, adaptation as a process of formation of certain, professional, personality traits.
Within the sociological approach, "adaptation" was identified as "socialization", so the problem of compliance with the forms of individual behavior, the basic rules and requirements for the performance of social functions. The sociological approach interprets adaptation as a process of "entry" of the individual into new social roles, and the essence of this process is a meaningful, creative adaptation of the individual to the conditions of life. In this context, psychocorrection of personality maladaptation can be used the concept of psychosynthesis by R. Assadjola. At the same time there is achievement of harmonious internal integration, comprehension of the true "I" and formation of the correct relations with other people [2].
In the theory of evolutionary development of living beings and substantiation of physiological adaptation I.P. Pavlov noted that the psychological state of man, his «heavy feelings» arising in the course of various adaptive processes when changing the usual way of life, when terminating normal activities, when losing loved ones, not to mention mental crises and breaking beliefs, have their physiological basis [3]. A detailed analysis of the concept of «adaptation» is given in the work of Konstantinov V.V. [4].
Very often when talking about adaptation to work, we do not pay attention to the general adaptation to daily changes in personal and social life during which a person is behind the walls of his workplace.
This fact is very important and we must understand that the same applies to impaired adaptation. The inability to relax and change social roles also leads to maladaptation. We can observe various negative emotions -from dissatisfaction to depression, which in the end will lead to a situation that a person will not be able to effectively adapt to work or, being already trained by a specialist to change jobs. To prepare a new specialist, you need to spend an average of 6 to 12 months.
The structure of the adaptation process has several components: 1. Psychophysiological stage, which includes the regime and rhythm of working hours, working conditions and the state of the workplace, physical and psychological stress.
2. Social stage: the organizational structure of the company, including traditions and norms of behavior and as a consequence -the relationship in the team.
3. Stage of professional realization: realization of professional skills and abilities, advanced training, application of criteria for evaluation of work results and temporary responsibilities.
4. Organizational stage: the status and value of the position they hold. The importance of the unit in which a person works, or will work. Adaptation can be seen as a technique or task that aims to effectively attract a new employee to the company. As for students, in a short time we have the opportunity to train a qualified specialist, as well as to develop or develop personal qualities that would help this person feel confident in the workplace. In solving the problem of adaptation, first of all, the author of the article proposes to change the system of selection of future students of medical schools at the initial stage, using diagnostic methods of medical psychology. These studies should be aimed at the rapid identification of individual-typological features of personality, which will allow you to quickly adapt to the peculiarities of training and work in the medical field.
For the formation or greater development of innate useful skills it is necessary on the personal example of the teaching staff of a medical institution throughout the educational process to form and educate the personal qualities of students that are characteristic of the medical profession.
All these features of the educational process contribute to the effective adaptation of the medical student to work in the primary position in the treatment and prevention institution [6][7][8][9][10].
The objective of the work was to compile and propose a program of medical and psychological support for the process of adaptation of medical college students to primary positions in treatment and prevention facilities (PHC). Task: 1. Analyze the cause of maladaptation. 2. On the basis of the conducted researches to make a technique of correction of maladaptation.
3. Evaluate the results of the implemented methodology.
Hypothesis: introduction into the educational process of a comprehensive correctional program of medical and psychological support of the adaptation process of medical college students will allow in a short period of time to adapt them to work in primary positions, will form the need for continuing education and healthy living. The process of psychoeducation will become an important part of their professional responsibilities.

METHODS
Students of the Kharkiv Regional Medical College and the Dnipro Basic Medical College took part in the study. The experimental group consisted of students in the number of 100 people aged 17.5±1.5 years. The control group consisted of individuals n=45 16.5±2.5. The samples can be considered representative, they reflect the situation with age, gender, level of education. The research was conducted without gender.
To assess the tasks were used: Author's questionnaires were used for the initial assessment of the motive for choosing the profession of a medical worker and to identify individual psychological features of the personality: «Means of adaptation of students to study in a medical university of I-III levels of accreditation», and individually -typological questionnaire LM Sobchik [11]. The data validity test for the Individual Typological Questionnaire was conducted to determine the validity and reliability of the answers in the categories «False» and «Aggravation».
Based on the methods: system approach, content analysis and concept analysis, the importance of medical and psychological support of the process of adaptation of junior medical specialists was studied, an original program was developed, which is an integrated structural procedural model of adaptation of medical college students to primary positions. These studies will help to correctly arrange personnel and prevent professional burnout of employees, which will save time and material costs for the search and training of new personnel.
The results of the preliminaries on the basis of foreign statistical methods: middle and outward correlation analysis according to the criteria of Spirman and Pirson, Student's criterion.

RESULTS AND DISCUSSION
Indications for medical and psychological correction may be: the presence of difficulties in the process of adaptation to study in a medical institution and adaptation to a primary position in a medical institution, informed consent to psychodiagnosis and psychological intervention, manifestations of psychological maladaptation and the need for psychiatric intervention (medical psychologist). Thus, the purpose of the correctional program is to determine the possibilities of adaptation and specialization of the future medical worker before starting his work in the primary position in the treatment and prevention facility Task: -study of the motive for which the profession of medical worker was chosen and to establish compliance with the possibility and degree of adaptation of respondents to the chosen profession -normalization of psycho-emotional state and formation of skills of its self-regulation; -awareness of the role of personalities for the formation of positive adaptation to primary positions; -harmonization of personal characteristics through the formation of positive coping strategies.
Based on this, the developed program consists of successive stages (table 1).
The first stage contains three components: informative, motivational, forming an alliance of the doctor-psychologist and client. Neurolinguistic programming methods are effective.
The second stage of the psychocorrection program consisted of 2 parts: differentiated and general psychocorrection. Differentiated approach was used to clarify the causes of maladaptation and selection of tactics and methods that stabilize the psycho-emotional state of man and the correction of personalities. After the first part, general psychocorrection is used. We offer methods of psychosynthesis [2], neurolinguistic programming [3], fairy tale therapy [4], arrangement by the method of Bert Hellinger [5]. Due to the fact that they are aimed at determining (self-assessment) or diagnosis (medical psychologist, psychotherapist) negative coping -behaviors that improve it. These methods are aimed at identifying or diagnosing, psychotherapist) negative coping behavior, improve it, meet the methods of science and practical psychotherapeutic correction.
The third stage aims to consolidate the positive effect and prevention: emotional burnout, formation of ineffective models of coping -behavior. At this stage, it is appropriate to use methods of work in the paradigm of psychosynthesis, cognitive-behavioral psychotherapy [12], because according to the literature and personal experience of practical work as a medical psychologist, psychotherapist, author of the program Medical and psychological support of medical college students contribute to the development of innate and the formation of new individual personality traits. During the first week of training, 2 studies were conducted: Table 1 The program of medical and psychological support of the process of adaptation of medical college students to work in primary positions

Goal Method Means
The first stage -Psychodiagnosis Formation of effective models of coping, optimization of social interaction and system of motivations Informing, explaining, developing self-help skills, supporting regular visits to a psychologist -with the help of the author's questionnaire, the motives for choosing the profession of a medical worker were determined, which allowed to predict the presence of external / internal motivation. The received information gives an understanding in which direction it is necessary to direct correctional work; -questionnaire LM Sobchyk found the presence of characterological features in relation to the general characteristics of typological personality traits. 100 people were elected to the reference group. The general training helped to identify groups with problems: 1. communicative nature; 2. moral-ethical; 3. volitional nature.
Comparing the results of the observation with the test results, groups for group work and students who needed individual work were formed.
This gradation was caused both by the individual characteristics of the respondents and the nature of the problem.
The author's questionnaire «Means of adaptation of students to study at the medical university of I-III levels of accreditation» was used after the first month of study at the college to obtain information about the reference environment of the respondents.
Our results when comparing the scales of the questionnaire LM Sobchyk and the author's questionnaires gave positive results and were determined by statistical evaluation.
When using the author's questionnaire «Means of adaptation of students to study at a medical university of I-III levels of accreditation» was carried out on the basis of tracking the dynamics of changes in the number of positive answers before and after the experiment, paired, average and general correlation analysis according to the Spearman and Pearson criteria. The results were obtained: the average level of students' adaptation methods increased 2 times.
The results of the questionnaire LM Sobchyk: «Anxiety» changed from 6.8 to 8.6 points. This can be seen as an increase in responsibility, a sense of action. And it can be assessed as a meaningful uncertainty. The lability index changed from 5.4 to 6.2 points. On the scale «Extraversion» we observe an increase in indicators from 5.7 to 6.2 points. «Aggression»: indicators decreased from 6.2 to 4.1 points. Indicators on the scale «Rigidity» changed from 6.7 to 4.8 points. The score on the «introversion» scale turned out to be interesting: it decreased from 4.2 to 3.2. It can be interpreted as shifting the focus of attention from oneself to the environment, including patients. But the scale of «Sensitivity» remained almost unchanged: 7.2-7.1 points. In our opinion, this is a typical feature of the personality of a health worker.
So, speaking about the results obtained before and after the experiments, we can say that we have received positive changes in the personality of students, future health workers. The results of the general correlation analysis according to Spearman's criteria (before the experiment r=0.13, after -r=0.17) and Pearson (r=0.08) before and after the experiment coincide. The questionnaire is valid and its results are reliable.
In order to assess the effectiveness of the proposed program of medical and psychological correction of the process of adaptation of medical college students to primary positions, it was proposed to re-test and interview students of experimental and control groups with the help of author questionnaires: «Means of adaptation of students to medical institutions Motives for choosing the profession of a medical worker» and individual -typological questionnaire LM Sobchik. After the introduction of a correctional program to work with students, the average level of student motivation increased by 17%.
In the process of providing psychological assistance and/or support, the students formed a positive attitude to medical and psychological measures as a form of correctional care. A comparative analysis of studies of adaptation of students of higher medical educational institutions to study and further work revealed: 1. Such studies of medical college students have not been conducted by anyone other than the author of the article.
2. Students of medical universities were tested for adaptation to learning. The characteristics and parameters that the researchers were interested in were: emotions, including anxiety, and the correctness of the educational process [13,14].
3. Some foreign scientists took into account the psychological characteristics of the respondents when assessing adaptation [15].
The author of the article did not find a comprehensive study of the problems of adaptation of medical students and the influence of their individual characteristics on the process of adaptation to work.

CONCLUSIONS
The gradual use of principles and methods of psycho-therapeutic correction in the educational process, group and individual work, leads to the rapid adaptation of students of higher medical educational institutions to work in primary positions through the formation of effective coping behavior. In the process of providing students with psychological assistance / support, they form a positive attitude to medical and psychological measures as a form of correctional care.