The problem of the synthesis of pedagogical strategy and moral practice in modern medical education (aspects of integrating international experience) O problema da síntese da estratégia pedagógica e da prática moral na educação médica moderna (aspectos da integração da experiência internacional) El problema de la síntesis de la estrategia pedagógica y la práctica moral en la educación médica moderna (aspectos de la integración de la experiencia internacional)

The article is devoted to the phenomenon of "medical humanities" as an independent interdisciplinary area of research, formed on the basis of the international experience integration as a reality. Тhe phenomenon is comprehended simultaneously in the field of Russian patristic tradition and medicine, since it focuses pedagogical strategy and moral practice. In the Russian spiritual tradition, it fits into the processes of educating humanity, which receives a modern consideration both in moral and religious categories, and in the categories of natural science, which are significant for medicine. Spirituality is the category of thinking that changes the idea of a person in the existing reductionist approach to his integrity in medicine. The action of the worldview of the individual is considered as a mandatory constant, which acts as a constructive mechanism for the transformation of the value foundations of thinking and ethical reflection. The fundamentals of spiritual and moral education and patristic experience make complex conditions for the restoration of humanitarian culture in medicine. The purpose of the process is to qualitatively change its anthropological, ethical and psychological components. Systemic humanitarian knowledge is main


RESUMEN
Aquí se considera el fenómeno de ciencias medicinales humanitarias como un campo interdisciplinario autónomo formado como una realidad por medio de integrar experiencias internacionales. Este fenómeno se comprende simultáneamente a través de la tradición de los Padres de Iglesia Ortodoxa Rusa y de la tradición medicinal rusa porque se enfoque en la estrategia pedagógica y la ética práctica. En la tradición de la espiritualidad rusa se inserta el fenómeno en la pedagogía del humanismo que se interpreta de modo moderno tanto en los términos de ética y religión como en las categorías de ciencias naturales que tienen un sentido particular para la páctica medicinal. En la tradición citada la espiritualidad es la categoría axial que cambia la idea del ser humano en el enfoque reduccionista a la dirección de integridad. Ademas de eso, se ve como una constante obligatoria el efecto de la visión del mundo del individuo, que juega el papel del mecanismo diseñador en la transformación de las bases valorativas del pensamiento. En la capacitación universitaria de médicos las bases de la educación ética y espiritual y la experiencia de los Padres de la Iglesia creen condiciones integrales para restaurar la cultura humanitaria e importancia del enfoque humanitario en el campo de medicina. El proceso tiene por objetivo hacer cambios esenciales en los componentes antropológico y ético-psicológico de medicina. El conocimiento humanitario sistémico en la capacitación medicinal se vuelva una práctica ética instrumental según el estándar mundial WFME que es una visión del mundo sobre el fondo. Se revela la importancia de la convergencia positiva de humanidades para la teoria y práctica de medicina y su función valorativa y de diseño ontológico para el individuo. A causa de este

INTRODUCTION
The key functions of humanitarian knowledge in medicine are onto-projecting, value-based, pedagogical. Тhey form the cognitive meta-frames of the diagnostic process. Within the framework of tradition, the fabric of the spiritual sphere is constantly being formed, within which the transition of philosophical categories to metaphysics and self-knowledge takes place, and the concept of spirituality modulates into medicine, uniting the foundations of the humanities. It is necessary to include the foundations of spiritual education in the complex training of doctors in modern medical education. The doctor is an integral part of a particular medical school, from where he draws forms of ideas about reality. The chain of deployment of medical truth as a correct knowledge about the body has the form: "illness-patient-doctor-school of medicine" and is oriented towards tradition. The periodic change of paradigms in medicine is interpreted as a prerequisite for the ability to actualize the effectiveness of the impact by a word, and the totality of various areas of medicine is interpreted as a single metadirection of medicine, which is formed by the humanities. The result of the work is a synthetic model of practice-oriented quanta of the humanities as an educational and applied integrity in the medical knowledge.
A study of the essence of social transformations (Eldin et al., 2016;Sidorov, 2018;Kortunov, 2014) demonstrates modifications of the Russian spiritual tradition in the context of selfdetermination (Ibid.) and the integrative role of religious categories in these processes. The paradigmatic rethinking of religious experience has actualized a new reading of the term "Russian spiritual tradition," which is based on the phenomenon of spirituality (Ibid.). Spiritual tradition is a way of realizing the social inheritance of the positive experience of past generations and reality, objectified in subject and linguistic forms and cultural values (esotskaya,2019). At the same time, both the religious and secular spheres of society existence is implicitly inherent in the appeal to spirituality as an axial category, which is increasingly used in humanitarian knowledge and philosophy. The inner world of a person becomes the seat of this spirituality. Modulation of the concept in medicine as a part of social culture occurs through its philosophical foundations, which combine the principles and approaches of ideological, methodological and socio-historical content. In the field of medicine they condition the existence of its ideological and methodological structure.
In modern times, the study of personality and its health in conjunction with the complexity of human substratum and subjectivity is impracticable without the humanities. Medical practice, based on a synthetic worldview base, has an onto-projecting effect that originates in medical education, ethical regulations. The purpose of the study is to apply the concept of spiritual tradition in a meta-analysis of the significance of humanitarian knowledge in medicine and training of a doctor, and to justify the inclusion of humanitarianism in professional competencies. So, the aims of this research are: to develop a synthetic model of practice-oriented quanta of the humanities as an educational and applied integrity in the system of medical knowledge; to demonstrate through modulation of the concepts of spirituality and tradition in medicine, the integrative role of the foundations of the humanities in the professional development of a doctor.

METHODOLOGY
The appeal to the macrometaphysical foundations of philosophical anthropology and their concepts as universal elements characterizing a person in general from an epistemological standpoint made it possible to integrate the results obtained in the study of aspects of international experience on the problem of synthesizing pedagogical strategy with moral practice in teaching doctors.
The method of transdisciplinary synthesis of concepts and epistemic constructions from theoretical medicine, philosophical theory of knowledge. The method of reflection of medical reality, the peculiarities of the organization of health care and human life in the light of the introduction of high technologies merges with the position of the "inner man" in the Russian philosophy. Medical reality reflects the worldview of society, acting as an actual process and a result at the same time. The principles of human dimension and human-centrism serve as a general methodology for studying the constructive foundations of the organization of medicine.
Historical and religious-moral foundations of humanitarian knowledge with their initial ontological relationship with the professional mentality, as well as tradition itself as a method of forming a doctor's thinking, are regarded as a method of cognition.
The representation at a specific stage of the development of science of its interacting individual (specialized in the field of medicine), and general (philosophical) levels as a hierarchy of control programs, correlates with the integration of theoretical and experimental bases. On the basis of the concept of multi-level by the method of substratum unification of cognitive structures, a unified regulatory metasystem of the organism with the key role of professional worldview is presented.
The method of onto-gnoseological work was used to include the concept of spirituality in the field of analysis, which expresses the worldview choice of a person's own image and destiny, which is valuable for individual health; ethical reflection in the Russian spiritual tradition, associated with the archetypal basis of mentality, the humanistic principle as a toolkit for balancing the excessive "manufacturability" of doctors.

RESULTS
The questions of the causality of diseases and psychosomatic chains requires a rethinking of the humanitarian basis for training doctors. During the period of dominance of the limited reductionist paradigm of biology and medicine (Khomutova & Mikhailova, 2019), the complexity of the fruitful understanding of information flows and their use remains. In such a situation, there is no place for the transdisciplinary direction, the humanities as a synthetic ideological base (Tilburt & Geller, 2007) of professional medical activity.
"Medical humanities" became the resulting reform of the foundations of medical education in medical practice in the US and Europe (Frank, 2012) based on the integration of biomedical ethics and humanitarian knowledge. Moral and practical aspects of international experience exchange (Kutac et al., 2016) are addressed to tradition and its values. With the understanding of the mission of the humanities in medicine, the concept of medical reality arises as the existence of medicine itself with its ontological status, subject and object.
It manifests itself in tradition, and through it, within the framework of the fields of medicine. In the depths of tradition, a spiritual sphere is formed, where philosophical categories move to deep metaphysics. The concept of medical reality is also associated with the concept of a doctor's thinking style, his spiritual potential and values. It synthesizes pedagogical strategy and moral practice in medical education. Knowledge is achieved by the spiritual abilities of a person, in terms of content, dimension, always greater than science, which does not have such abilities. "This is primarily intuition, that is, a direct sense of truth…" (Science and religion, 2001). Besides, the human ability to visualize the spiritual has led to the emergence of long-term worldview systems in cognitive evolution. The latter combines the individual sensory world of the individual with his rational logical thinking as the ability to transform realities through value cognition. Intuition, occupying more attention of philosophy, leads to another, higher area of the spirit -to religion. Religious philosophy proceeds from ideological premises, methodologically using the terminology and language of theology. As a result it develops morality, a system of values, feelings and social assessments, so important for healing.
Our proposed method is an interdisciplinary analysis of sociality, through which modern science deciphers the basis of the effects of spiritual activity, informational in nature. The latter acts as a special way of constituting the being of a person. In the "constant interaction of spirit and flesh": (Luka, 2016) personality changes.
The destructiveness on the part of the technical and technological environment is increasing in relation to real historical knowledge and sociocultural experience, which becomes secondarily significant in comparison with the technologically implemented image of the world. An existential threat is posed by a violation of the system-forming effect of the "mechanisms of personality reflection" (Zhukova, 2014;Meshcheryakova, 2011). Violation of spiritual regulation associated with the archetypal foundations of the personality, with the technological transformation of a person, is an existential problem. Preservation of archetypal foundations in the light of the relations of modernization (Sidorov, 2018) becomes a condition for strengthening the models of spiritual development. The scientific and epistemological basis of archetypization is the provision on the "inner man" in the Russian philosophy (Luka, 2016).
With Hi-Tech and Hi-Hume technologies development, the violation of spiritual regulation affects the archetypal foundations of the personality with the transformation of human nature into a technosystem. Preservation of these foundations is possible with the preservation of tradition as a way of realizing the social inheritance of the experience of generations. The actual ontological transformation of man is the essence of the process that followed the cybernetization of social reality (Khomutova & Mikhailova, 2019). Human perceptions change depending on the influence of anthropo-technological practices and the transformative potential of the virtual environment. The analysis of the influences of virtual reality, modifying the forms of culture, life rhythm, way of life, and through them the spiritual foundations of the personality and its biosocial essence, is an analysis of the influence of constantly acting factors of virtual being. The priority of environmental friendliness, safety for a person and his health as values of modern times extends to the requirements for the social individual and the organization of health care, his life. The effect of medicine and its influence on the personality is understood as the influence of a controlled factor that forms the worldview and the metaphysical world of the individual.
The organization of medicine on the principles of human dimension and humancenteredness is a constructive basis for organizing a health safety strategy. The preservation of the sociality of an individual depends on the constructive role of his reflexive mechanisms and spirituality. Therefore, the mission of the humanities in medicine helps to get answers to technical and technological challenges.
The analysis by the authors of the philosophical and worldview basis of medicine and its instrumentality (Pesotskaya, 2017) made it possible to predict the state of the body in the light of medical technologies in medical students teaching. Thus, the worldview in the course of medical training becomes the basis for the formation of the principle of "methodological confidence" of a doctor. The principle serves as an important qualification characteristic. The mission of "professional dedication of a practitioner" (Fujino, 2015) is, at the same time, actualized by the intrinsic value of humanitarian knowledge in medicine.
Thus, in the structure of medical education, two circumstances have developed: the specificity of the role of methodology in the process of doctor's training, and the peculiarities of the historical stage of the evolution of the methodology itself. Methodological disciplines teaching to medical students forms thinking, a sense of conviction as a key characteristic of professional qualification. Humanitarian knowledge analyses the epistemological and praxeological aspects of medical theories and methodologies, which are combined contradictory. In teaching doctors, methodology should be transformed into ideology, since ideology as a form of non-alternative worldview is the basis for the formation of confident medical action.
The formation of the professionalism of doctors in the context of the humanization of medicine proceeds through the phenomenon of "medical humanities" and the allocation of an independent interdisciplinary research. Medical humanities are part of basic medical education (Gordon, 2019;Feilchenfeld et al., 2017;Wald et al., 2019) and the subject of medicine. The field of medical humanities is directed to the education of spirituality, love, compassion and moral qualities in the personality of a doctor. On the paths of technologization of medicine, medical humanitarian sciences aim to educate humanity through medical practice and contemplation, empathy for patients, through understanding of the mutual healing power of human relations (Mukhamedova & Umirzakova, 2019). Humanistic principles instrumentally balance the excessive "manufacturability" in the training of physicians.
The question of the historical basis of humanitarian knowledge gains its relevance in the 20th century, when history becomes its epistemological environment. This leads to the emergence of new social and humanitarian sciences, actively forming the cognitive contours of transdisciplinarity. History is "the foundation of humanitarian and even all scientific knowledge, because the foundation is often sought in the past" (Vyshegorodtseva & Schastlivtsev, 2007). As a special sociohumanitarian science, it is history that contains two types of objectivity: social and humanitarian, exploring society through textual sources. Awareness of the problems of responsibility, reflexive attitude to value systems has become an interdisciplinary problem.
The construction of humanitarian knowledge on the principle of concrete historicality of knowledge and understanding has its own foundations and potential, requiring self-reflection (Selbstbsinnung) in terms of its language and transformativeness. Continuing the tradition of Kant's positive assessment of the Endilichkeit (finitude) of human existence (Kant, 1994), it accumulates methodological tools for assessing and analysing its ontological status and values. The presence of faith inside a person at a creative moment is based on consciousness, values. Values are understood as a single regulatory complex that guides the processes of information nature.
The humanistic matrix aims at changing reality and one's own essence. Therefore, the discussion of the meta-frames of medicine, built on the basis of humanitarization, the deepening of which is indicated in the World Standard WFME (International standarts in medical education: assessment and accreditation of medical scool's, 2020), is a priority task of our time. Professional worldview and reflection are associated with spiritual activity as a movement towards truth. The process is an instrumental moral practice, effective in the presence of a systemic humanitarian component of medical education, that is historically associated with traditional medicine.
Thus, the research results are: 1. A theoretical analysis of the humanitarian component of medical education, which is the worldview of a doctor, is given. It is the worldview that has a healing function and is a sufficient condition for a positive effect of treatment, regardless of medicinal and surgical effects.
2. The physician's worldview is presented in qualitative terms through humanitarianism as an invariant of communication with the patient, causing the patient's optimism, and the latent or explicit placebo effect in treatment.
3. Tradition is substantiated as a form of ethnopsychology and a linguistic form of the effectiveness of influence on ethno-thinking, through which the patient's immune system is influenced, stimulating its excessive energy and information. Therefore, the form of the philosophical and pedagogical, psychological, ethical, communication foundations of medicine is the form of professional competencies proper.
The problem of the synthesis of pedagogical strategy and moral practice in modern medical education…

DISCUSSION
Тhe study of the problems of cognitive activity in medicine and medical education, its method, structures, characteristics of clinical thinking, the cognitive specifics of medical diagnostics, intuitive cognition takes its roots in the works of V. P. Petlenko (1982), Slesarev V. O. (1998), Stepanov M. A. (1997, united by the search for a common terminology, descriptions of reflexive processes, their basis and potential of human integrity, its subjective and objective components (Davydova, 2008). The research lacks uniform metatheoretical language for the procedural description of the relationship between the body and the spiritual, which is relevant for medicine. Its formation is impossible without referring to the complex of the humanities.
The cultural-semantic and social orientation of the considering interdisciplinarity is to create a conceptual field that plays an adaptive role through two epistemological constants -adaptive attitudes and value dominants. The first is a theoretical and methodological toolkit for cognition and ideas about truth, the second is values and dominants that form orienting ideal constructs of an interdisciplinary field. The first and second constants are related as a mode of action, and as a goal of action. The essentially ideational recognition of the value of the supersensible cognitive principle, which forms the metaphysical perception of the world, is the ideological foundation of interdisciplinary research. Its contact with religious knowledge and spiritual practices is the intrinsic value of the connecting link. In the humanities, the procedural aspect of the influence of this foundation on the effectiveness of cognitive structures, studied in in sociology by P. A. Sorokin, is continued in social philosophy (Sorokin, 2008).
The socio-anthropological understanding of spirituality is expressed in interconnection with the choice of one's own image, which should be designated as ethical reflection, a way of organizing a person's worldview and activities through language and culture. The patristic tradition (Kargamanova, 2016) points to the formation of spirituality through a practice that recognizes the primacy of the properties of Divine love. Thanks to it, the spiritual spheres, which are basic for the healing power of human relations and healing, are transformed, as an invariant of communication that causes optimism. According to the Russian surgeon, Archbishop, scientist and priest Luka Voino-Yasenetsky, "Love cannot be contained in itself, because its main property is the need to pour out on someone and on something ..." (Zhukova, 2014). The period of active development of the educational approach and Orthodox enlightenment enriched the patristic heritage with spiritual creations from the second half of the 18th century. A special place among them was occupied by the works of the Greek and Russian scientist-theologian, archpastor Nikifor Theotokis (Theotokios), who reveals through exact sciences the essence of the virtuous life of man and virtues. "Virtues are both the deeds of man and the gift of God" (Archbishop Nikifor Theotokis, 2006). Reflecting on the causality of events, Luka (Voino-Yasenetsky) pointed out that "there is no eternal matter, but only energy appears in the form of matter. During atomic disintegration, more subtle energies are released, approaching something immaterial ... "," God is spirit, God is love ... Love creates "( Way of the Cross of St. Luka, 2018). This is how the essence of everything reflected and unreflected by a person is formulated; spirituality. In search of moral and religious-spiritual meaning in science, exploring human ontos and mental activity through cognition, he generalizes the works of I. P. Pavlov: ... "Our spirit always participates in acts and states of consciousness, defining and guiding them. The spirit grows and changes from the activity of consciousness, from its individual acts and states" (Popovsky, 2003). Not the mind, but the spirit becomes the subject of self-knowledge, "... for the mind is only a part of the spirit, and not the whole spirit ..." (Ibid.,428). The cognitive process is associated with the work of the spirit. In the scientific analysis of the correspondence between the sensory and the spiritual, the phenomenal space between them, which does not contradict religious ideas about the composition of a person, a substratum approach is used as a general methodological one. This is expressed in the study of a person through the cultural environment, where language, religious, scientific knowledge and philosophy act as objectivations. The latter transition to deep metaphysics, faith, implicitly includes the category of "all-embracing" -Umgreifende, and relies entirely on it as an integrator of man with the world and as a religious foundation of humanitarian knowledge in medicine.
The substratum approach in the humanistic scientific tradition has become an enduring basis for studying the question of the influence of the mental, the ideal on the physiological, the material. The essence of influence lies in the control role of the mental. As realities of a spiritual nature, one's own thoughts and feelings are perceived by a person from within his own ontos. The carrier of processes in the hierarchical structure of the brain is a word, the meaning of which is fixed by subjective experience (Pesotskaya, 2015). Synergetic ideas are available for the development of ideas about information in diagnostics as a value-semantic constant, initial for medical knowledge, parametric aspects of its research. Reasoning about the "inner" (transcendental) person and metapsychic phenomena (Science and religion, 2001;Luka, 2016), Archbishop Luka assigns a special place to the self-organizing role of the primacy of the ideal organism in nature, the truth of spiritual knowledge in terms of tradition.
Humanitarian and social knowledge has concepts and abstractions that successfully capture the value components of knowledge; such elements of the structure of the worldview as human value orientations are included in the theory and methodology of socio-humanitarian, naturalscientific knowledge and medicine. History as an integrative foundation of the humanities forms their special "environment" that determines the space-time framework of the place in culture. Medical science borrows the principle of value as a methodological basis for the study of man.
The historically accumulated empirical material of medicine in the field of the influence of the cognitive and psychogenic in general on the human body has undoubted relevance. The study of this issue is of practical importance, since this effect realizes a significant proportion of the positive effect of any act of therapy (regardless of the essence of the applied health-improving method). Psychosomatic effects have been and still are a significant part in the positive therapeutic effect of any method of treatment. The Russian spiritual tradition, based on the phenomenon of spirituality, acts here as a method of cognition and an unusual method for analytical thinking for social transmission of the positive experience of spiritual practices and professional reflection in medicine. Diagnostic systems have always been an attribute of medical systems and a condition for the development of medical knowledge, in which multivariate cognition of the characteristics of personality reflection and its value potential takes place.
In the structure of the diagnostic system, two phases of procedural interaction are distinguished (Pesotskaya, 2019). The first phase takes place before the diagnostician and outside his value-reflective processes, forming in a particular society and the system of medicine as a whole; the second is associated with the activities of a specific professional specialist: a linguistic form of effective influence on ethnic thinking is used, through which the patient's immune system is influenced, stimulating its excess energy and information. During the formation of the first phase of the system, the involvement of subjects in a specific social structure through the substantiality of the schemes means a certain activity of the psychosomatic type.
The principle of cyclical causality becomes an attribute of the classical functional model of the organization of complex systems (Anokhin, 1962) and the philosophy of interpersonal communication associated with it in the twentieth century. This means the inclusion of a general scientific synergetic model and the principle of causality in the study of the functional foundations of communication. In this case, the model is extrapolated to the humanity of the process. Only individual order parameters, and some associated opportunities for the implementation of certain states, reflect the situation in complex open systems (for example, in the system of interaction between communicants and parties in the diagnostic process). From the standpoint of the functional approach, order parameters in combination with cyclic processes become a way of building language and communication as a self-organizing system. Their manifestation is the The problem of the synthesis of pedagogical strategy and moral practice in modern medical education… essence of the second phase of the diagnostic system, formed by a specific specialist within the framework of a separate medical school or tradition.
The communicative relationship between the doctor and the patient is part of social communication. Its new aspect has already been described -the correlation of consciousness and social processes, which gives access to a new space for researching the social role of consciousness (Pesotsky & Zhebit, 2018), referred to as quantum. Its phenomenon is important at the beginning of the diagnosis. Empirical statements of the observed nonlinear effects in society (Vyshegorodtseva & Schastlivtsev, 2007) contrast with synergetic methodology, which gives a level understanding of a person as a substrate integrity, therefore, his psychophysical contour connections as a systemic component of diagnostic constructs. The latter's connection with therapeutic practices, which is built through and based on a worldview, is obvious.

CONCLUSION
The key functions of humanitarian knowledge in medicine are onto-projecting, value-based, pedagogical. Тhey form the cognitive meta-frames of the diagnostic process. Within the framework of tradition, the fabric of the spiritual sphere is constantly being formed, within which the transition of philosophical categories to metaphysics and self-knowledge takes place, and the concept of spirituality modulates into medicine, uniting the foundations of the humanities. It is necessary to include the foundations of spiritual education in the complex training of doctors in modern medical education. The doctor is an integral part of a particular medical school, from where he draws forms of ideas about reality. The chain of deployment of medical truth as a correct knowledge about the body has the form: "illness-patient-doctor-school of medicine" and is oriented towards tradition. The periodic change of paradigms in medicine is interpreted as a prerequisite for the ability to actualize the effectiveness of the impact by a word, and the totality of various areas of medicine is interpreted as a single metadirection of medicine, which is formed by the humanities. The result of the work is a synthetic model of practice-oriented quanta of the humanities as an educational and applied integrity in the medical knowledge.