Tendencia en el estudiante de medicina a ejercer como médico general o especialista / Trends among medical students towards general practice or specialization

Background: A 60/40 ratio has been estimated as a country's ideal proportion between general practitioners and specialists. In Chile this proportion was 36/ 64 in 2004, exactly the opposite of the ideal. Trends towards specialization or general practice among medical students have not been thoughtfully studied. Aim: To assess trends among medical students towards becoming general practitioners or specialists, exploring associated factors. Material and methods: Descriptive survey of 822 first to seventh year medical students at the University of Chile, School of Medicine. Desired activity to pursue (general practice or specialization) after graduation and general orientations within clinical practice were explored. Results: Fifty three percent of students desired to enter a specialization program. Only 20 percent would work as a general practitioner (27 percent were still indecisive). Furthermore, a trend in early years of medical training towards an integral medicine is gradually reversed within later years. Seventh year students give significantly more importance to specialization than to integral medicine (p <0.01). Ten percent of this opinion change is related to the emphasis given to specialized medicine in the teaching environment. Conclusions: Most students prefer to enter a specialization program immediately after finishing medical school. Moreover, there is a social trend, at least within the teacher-attending environment, promoting not only the desire to specialize, but a pro-specialist culture.

Formación valórica del estudiante de medicina: de lo integral a lo especializado / Formation valorica of medicine student: of the integral to the specialist

The dehumanization of medicine is a well-known phenomenon, negatively evaluated by patients, physicians and community as a whole. Health authorities and Medical Education Center have responded by declaring the chilean Ministry's 'New Attention Model' and by implementing ethical-humanistic within the medical formation curriculum. The impact of these initiatives is informally considered as insufficient. Part of the problem consists in the difficulty of objectively evaluate the same aspects that are tried to be modified. We present the psychological model of the 'Social Representations', as a solution, that allows a valid and objective method for values and other non-cognitive aspect analysis. In this paper, we implement this methodology by evaluating values and non-cognitive aspects in the Medical student throughout his formation. (Third to Seventh grade Universidad de Chile's Medical student). We demonstrated an undesired outcome in medical formation, reaffirming the 'dehumanization' in students: as time passes by, interest or and integral care is lost, while specialty-focused care receives a higher priority. This process reaches a critical impact during clerkship, when students are deeper exposed to clinical practice. We comment associated factors and propose a value management intervention model, as a development respond to the present situation.

La deshumanización de la medicina es un fenómeno conocido, evaluado negativamente por pacientes, médicos y toda la comunidad. Como respuesta, autoridades en salud y centros de educación médica intentan promover un cambio cultural, a través del 'nuevo modelo de atención' del Ministerio de Salud e implementando asignaturas ético-humanistas dentro de la formación médica. El impacto de estas iniciativas es considerado informalmente como insuficiente. Parte del problema consiste en la dificultad de evaluar objetivamente los aspectos que se intentan modificar. Presentamos como solución el modelo psicológico de las representaciones sociales, que permiten analizar aspectos valóricos y no-cognitivos con gran validez y objetividad. En el presente trabajo, utilizamos dicha metodología al evaluar aspectos valóricos del estudiante de medicina a lo largo de su formación. (Alumnos de tercero a séptimo año de la Universidad de Chile, Área Occidente). Evidenciamos un efecto contrario al perseguido por la universidad reafirmando la 'deshumanización' los estudiantes: a medida que el estudiante avanza en la carrera, pierde interés por la medicina de orientación integral y cobra prioridad la atención fraccionada en especialidades. Esto se acentúa durante el período de internado, al entrar el estudiante en contacto directo con la práctica médica. Comentamos factores asociados y proponemos un modelo de intervención y gestión en valores, como respuesta a esta situación.