The global challenges of the present and the new wave of reforms of healthcare, education and social policy add to the urgency of the health preservation problems.

The priority factors fostering health preservation and healthy lifestyle among students are regulations supporting the state policy aimed at the maintenance and improvement of the health of students, development of the respective educational system in educational establishments, as well as promotion of a favorable atmosphere there and in the families of students.

Health-oriented pedagogy rests on the foundation of health saving techniques part of the educational process; such techniques are described in the "Concept of Implementation of the National Goals in the Field of Science and Higher Education until 2030" [1].

As stipulated by the Russian Federation strategic development tasks and national goals (Decree of the President of the Russian Federation № 204 of May 7, 2018), many federal projects in the fields of healthcare, education and social policy seek to solve the problems of public health improvement and preservation, organization of the learning processes and digital educational environment, creation of the new opportunities for everyone and "social elevators", etc. [2].

Young people in general and students in particular play a special role in the life of society because they possess a significant social, demographic, industrial, intellectual and reproductive potential. The state of health of students reflects the level of socio-economic and cultural development of the state [3].

The current Federal State Higher Education Standard effective since 2020 regulates training of medical personnel; the Standard guides medical students to develop both universal competencies (UC) and general professional competencies (GPC) in the context of the General Medicine and Pediatrics specializations. In particular, there are following sets of competencies: UC 7, aimed at self-organization and self-development (health preservation); UC 8, enabling to create and maintain safe conditions in everyday and professional lives; GPC 2, aimed at establishment of control of effectiveness of the public prevention measures, healthy lifestyle and sanitary/hygienic education efforts; GPC 10, guiding to search for solutions to the standard professional problems using information and communication technologies while accounting for the basic information security requirements [4, 5] .

Currently, against the background of the experience of the pandemic and distance learning [6] coupled with insufficiency of the students' health preservation competencies [7], the task set before the higher education and professional medical training establishments prescribes mastering (by students) of a number of competencies significant from the point of view of their future profession and social life, as well as skills allowing to preserve and improve health and apply the innovative health saving techniques. Therefore, this review aims to analyze the experience of developing health preservation competencies of medical students in the context of blended learning, and learning the universal competencies in the broader sense.

Materials and methods

Observing the principles of scientific objectivity and complexity, we analyzed the prospective studies and major achievements in the field of development of health preservation competencies of doctors-to-be, such development being a current task in curricula of the medical universities. We considered the papers published in periodic research and practical publications between 1 January, 2000 and 31 December, 2022, accessible in the Russian and foreign databases (RSCI and PubMed).

Health preservation as a multifactorial and multicomponent construct in the system of organization of educational activities

Analysis of the notional, conceptual aspects of health preservation yielded identification of the problems embedded in the very definition of health (its two polar states and the many transitional conditions between "well" and "sick"), various systemic levels (health of an individual, group, population), various conceptual models of health (biological, medical, biomedical, biosocial, value-social) [8]. Moreover, the concept of health is dynamic, it changes over time and reflects the shifts in epidemiological situation, dubbed "epidemiological revolutions"; in this connection, the content of the "quality of life" indicator was reinvented to better show the possibility of an individual to realize his/her potential (including individuals with special educational needs) and not simply the capability to recover from the diseases, i.e., be at a given health state level [9].

One of the obstacles on the path of development and introduction of health preservation into the curricula is terminology, namely, the discrepancies therein. There is no single definition of "health preservation" and "healthy lifestyle", the concept and notion behind them are fuzzy, which inevitably complicates understanding of the respective terminological construct and its practical application in educational activities [10].

Most researchers addressing the problem define "health preservation" as activity aimed at maintaining health, interconnected and unified at all levels of human life. The said researchers also underscore the fact that the construct is not used as much as it should be in real-life practice [8–11].

Some theoretical studies and practical systems promote "health preservation" as an interconnected set of measures that raise awareness of people about health saving and improving practices; in other words, such measures foster taking health as something of value [12].

Considering health preservation through the lens of the systematic approach, it is important to factor in not only environmental influences but also the individual personal characteristics of the student, since the success and effectiveness of the educational effort depends on them.

The tiered approach implies management of external and internal factors, as well as the conditions of health preservation. There are different factors and conditions peculiar to different tiers of health (individual, group, population). While at the tier of an individual the assessment of health relies on physical, physiological, biochemical, clinical and other indicators, at the level of population "health" is a socio-economic category with procreation, duration and quality of life at its base [8].

The different characteristics of health at the tiers of an individual and population require considering health preservation as a multidimensional discipline, and plan appropriate vectors of activity aimed at protecting health of students in the educational, medical, psychological, social and other aspects.

The vectors support health maintenance and extension of active years of life, professional activities of people, their social and spiritual development, efforts contributing to building and reinforcing a healthy family [13].

In addition, the term "health preservation" is often used s a generalized concept of "healthy lifestyle" as a special case of "lifestyle", which encompasses physical training activities, principles of rational nutrition, work and rest, psychohygiene, spiritual culture as protection from the stressful impact of intellectual and emotional psycho-traumatic factors of society, all of which are necessary for the psychosocial development of the individual and formation of his/her moral ideals and a habit of healthy lifestyle [11–14].

The term "health saving educational technology" has  broader sense behind it. There is more to it that just a qualitative characteristic of the respective method of teaching, its "safe for health" certificate [15].

Depending on the goal and focus of the application, health saving educational technologies affect different factors and ultimately harmonize and transform the the environment around students into a health saving one, subsequently promoting formation of a health preservation space at a given tier (individual, group or population). The resulting health saving effect relies on wide range of techniques, methods and means, including traditional and innovative technologies of education and upbringing.

Below, we contemplate some technologies through the lens of their impact on the most significant factors and different levels of health.

Health preservation technologies and their impact factors

Educational factor and its components

Jointly with family and society, higher education establishments play an important part in the student healthcare system. The health saving aspects of the establishment's curriculum, in addition to being designed to teach professional competencies, include a wide range of environmental influences that create conditions for development of the student in the intellectual, information and communication, object-spatial, recreational and other areas [16].

Learning the "ready-made knowledge" from textbooks does not guarantee that the student evolves into a person capable of professional activity, continuous self-education and self-development. It is very important to teach students how to effectively search for the necessary information, comprehend it, formulate a problem, analyze ways to solve it, get a reliable result and reasonably prove the correctness of their point of view. Thus, introduction of active learning methods into the higher education system and integration of innovative technologies with the educational process seek to optimize the learning routine, form a value-driven attitude in students in the context of their professional development as doctors-to-be, and, consequently, promote health preservation [16, 17].

Such technologies, applied in the form of a productive discussion of creative, original, non-standard issues, can evoke an emotional response and trigger a keen interest in the problem; they enable development of the ability to think, process information (analyze, structure, evaluate, etc.), creatively solve theoretical and practical problems, give feedback (reflect), convey ideas, formulate and express thoughts.

Current research confirms there is a link between academic performance, learning motivation and development of the emotional intelligence [:lit_18–:lit_;21;]. A high emotional intelligence supports effective metacognitive decision-making strategies applied in learning [22], good self-regulation abilities [23] and the creative thinking ability, all of which contribute to success in studying [24]. Students with high emotional intelligence adapt better and enjoy harmony in their study/life balance [25].

Interactive classes have an especially valuable aspect: students actively participate in the teaching process, which ensures effectiveness of learning; they interact, work in groups and realize their potential. Thus, students learn to establish social contacts, overcome self-doubt and fears, creatively approach certain problems that are interesting for them and can actually be solved by them, and they also learn to set priorities and take responsibility for the results of educational activities [16, 26, 27]. All this directly or indirectly contributes to the improvement of health on the levels of an individual and the group.

Infrastructural factor (exemplified on the students with special educational needs)

Teaching healthy lifestyle to students with special educational needs is an interdisciplinary problem.

For students with special educational needs, it is essential to have access to various educational, informational systems, work opportunities, societal activities on the same level as their fellow students without such needs. Currently, there is a sufficient choice of resources enabling education of students with special educational needs without any harm to their health. According to S.G. Serikov, they can be divided into procedural, related to the educational process itself, and environmental or accompanying, i.e., related to setting up conditions favorable for studying and a health preserving space. Rational organization of studying, harmonization of the associated load, personalization of the schedule to effectively combine learning and task solving, mixing mental and physical activities, practicing the student-centered approach, etc. All of these are procedural health saving resources [28, 29]. As for the environmental or accompanying resources, these include material and technical means, sanitary and hygienic conditions, favorable psychological climate, information support for health preservation [28–30].

Distance learning technology and special teaching aids enable successful development of universal competencies in students with special educational needs in the context of their professional training [31].

Facilitation of the educational process for children with special educational needs should start at preschool age and continue through the general educational institutions, thus ensuring the possibility of professional self-fulfillment for such children when they grow to be young adults [32].

For young people with special educational needs, who are learning new trades, the health saving educational process should be designed to eliminate the obstacles or maximize social adaptation, since training can expose them to the factors associated with the industrial environment and labor process that affect the body [33, 34].

Medical treatment and prevention factor and components thereof

To form the health preservation competencies in future doctors, it is also necessary to purposefully teach hygiene, psychology and pedagogy, with the respective curriculum including health-improving, sport, creative and educational activities revolving about health [35].

In addition to teaching universal and general professional competencies, following health preservation techniques are successfully used at the levels of an individual and a group for the purpose of hygienic education of medical students: rational nutrition checklists, physical activity, etc. [36, 37], successful development of communication skills, managerial decision-making, interpersonal relationships, adequate self-esteem, self-respect that aid socio-psychological adaptation as, in particular, a factor in effective interaction between a doctor and a patient. The effectiveness of interaction is one of the tools enabling relevant clinical decisions that factor in the opinion of the patient, thus making the medical consultation patient-oriented [38].

There are various types of positive social activity (needs promotional support in the form of social ads) that are the opposite of the unhealthy lifestyle. Such activity, involving the youth, offers alternative forms of leisure time, such as sports, travel, creative and research activities; the purpose is to convey information about the positive effect of healthy lifestyle through the media (social networks, television, radio, newspapers). Such programs, being part of a higher educational establishment's educational policy, are implemented as various student events teaching healthy lifestyle and behavior; they make their impact at the group and population health tiers [14, 35].

Psychological and social factors

Positive emotions and development of the emotional intellect in general, their impact on health and life, management of emotions and navigation through stressful situations, are very important in the context of receiving an education. A student's academic performance and emotional state are strongly influenced by the system of relationships that student is a part of, namely, the relations with fellow students and teachers, as they affect the manifested behavioral patterns inherent in a particular person, i.e. in the types of interpersonal relationships. Therefore, teaching students to be aware of and control emotions, switch them from one modality to another without resorting to various forms of self-destructive behavior, helps increase their efficiency, competence, self-esteem, develop the ability to consciously pursue a healthy lifestyle and resist bad habits, especially in the context of distance learning [39].

Along with AI technology, improvement of health of an individual requires betterment of human qualities relying on the achievements of neuroscience, positive psychology, evolutionary biology, together with clinical practices, behavioral therapy etc. Individual abilities, capabilities and personal qualities of a student are growing more and more important, since they, in the first place, require understanding at the level of thinking, beliefs, worldview and decision-making, and, most  importantly, at the level of emotions, motivation and ability to act, as well as the ability to increase energy potential and stress resistance resources using innovative health-saving techniques.

The educational process should be completed with the current knowledge about thinking (as a process), psychology of consciousness, neuroplasticity and learning the skills needed to manage emotions, resist stress, self-help to increase energy balance, foster emotional stability, immunity and vitality.

This is especially relevant for medical students and people in other helping professions. For them, it is especially important to be able (taught) to seek assistance in difficult life situations, understand and name feelings of other people, understand the cause-and-effect relationships between one’s actions and responses, be friendly, appropriate and observant, control attention.

Learning innovative health preservation techniques and methods, mastering the step-by-step instructions (checklists) enabling recognition and neutralization of cognitive distortions, limiting beliefs, fears, etc., can help reduce anxiety, the effects of stress, disappointment in everyday life and difficult life situations.

It is the teacher's duty and responsibility to create a favorable climate in the group of students and in the context of teacher-student interactions. At the group health tier, these goals require that the teacher had the knowledge and the experience in the field of personality psychology and group work, psychology of communication with students and application of the innovative health preservation techniques. It is important to use training regimens, programs aimed at improving interaction between teachers and students. To create a favorable psychological climate in a group of students, it is necessary to teach them to recognize non-verbal communication mechanisms, form certain behavioral strategies that stem from personal experience, actively involve students themselves in various simulated situations having them formulate personal attitudes to their lifestyle [16, 27] .

A multifactorial and multicomponent systemic approach to the concept of teaching health preservation as a universal competence has proven to be the most promising, since the effectiveness of such an approach directly depends on the number of components it includes, and the greater the amount of such components is, the more reliable and universal the system is [31, 40].

Conclusion

Analysis of the experience of forming health preservation competencies in medical students allowed concluding that health preservation techniques that affect certain factors, external or internal, create favorable conditions for a health-saving environment and shape the needed health-saving space. Depending on the goal and the focus, a health preservation technique affects health on a certain tier (individual, group or population) directly and throughout indirectly. Thus, we can control the health preservation process: improving individual health, we improve health of a group, which, in turn, has a beneficial effect at the tier of population and betters the quality of life in general.

Economic, political, social, demographic and other challenges and life realities manifesting at the population tier force young people to compete fiercely and struggle for a successful career and personal development. Introduction of the health preservation techniques to the educational process and daily routines of students can help offset the impact of negative factors, optimize the process of learning, mitigate the risks of health disorders, reduce fatigue, with one of the positive factors in this context being the habit of a healthy lifestyle, independent health monitoring and control. The curricula should be extended with the theoretical knowledge about the work of thinking, psychology of consciousness, decision-making, as well as practical skills in occupational health, emotion management and conflict resolution, communication skills that improve health on both individual and group levels.

Adding the health preservation components to the educational process with the help of innovative techniques and student education patterns, coupled with optimization of the learning load resulting from application of health saving pedagogical techniques in an active sensory-developing environment (including for young people with special educational needs), will assist conscious formation of a culture of health that medical students can rely on in their future professional lives.