Experiencia docente en un programa de formación de Medicina Familiar y General a distancia / Teaching experience in a distance learning program for Family and General Medicine

La distribución inequitativa del talento humano en salud afecta la capacidad de los sistemas de ofrecer servicios esenciales. En la provincia de Córdoba, el primer nivel de atención es responsabilidad de los municipios, pero el nivel provincial procura sostener la rectoría y ser garante del derecho a la salud. En ese marco, se desarrolló un programa para reducir las brechas en la distribución de médicos: el Plan Cordobés de Médicos del Interior. Acompañando ese plan se ejecutó un convenio específico con la Universidad Nacional de Córdoba para garantizar la formación en la especialidad de Medicina Familiar y General. Ingresaron al programa 170 personas, y hoy contamos con 98 médicos en formación o seguimiento. En este artículo damos cuenta de la experiencia docente, los desafíos y dificultades que supuso afrontar una formación en lugares de práctica variados, y con el aporte de las tecnologías de la información y comunicación. Esperamos que la experiencia sirva para transmitir los aprendizajes de nuestra práctica (AU)

The inequitable distribution of human talent in health affects the capacity of systems to offer essential services. In the province of Córdoba, the primary level of care is the responsibility of municipalities, but the provincial level aims to maintain leadership and guarantee the right to health. Within this framework, a program was developed to reduce gaps in the distribution of physicians: the Cordobés Plan for Interior Physicians. Accompanying this plan, a specific agreement was executed with the National University of Córdoba to ensure training in the specialty of Family and General Medicine. 170 individuals entered the program, and today we have 98 physicians in training or under supervision. In this article, we give an account of the teaching experience, the challenges, and difficulties involved in facing training in various practice settings, along with the contribution of information and communication technologies. We hope that this experience serves to transmit the lessons learned from our practice (AU)

Reflexões e propostas para a estruturação de programas de Mestrado em Medicina de Família e Comunidade no Brasil / Reflections and proposals for the establishment of Family and Community Medicine Master's Programs in Brazil

Resumo Embora a atenção primária à saúde (APS) e a medicina de família e comunidade (MFC) tenham aumentado seu espaço e relevância no cenário assistencial e nos cursos de graduação médica, não há cursos de pós-graduação "stricto sensu" em MFC no Brasil. Neste artigo, analisamos alguns aspectos do campo da saúde pública brasileira e da própria estruturação da pós-graduação "stricto sensu" nacional que podem ajudar a explicar este panorama. Como uma contribuição para o debate neste tema, também reunimos informações de experiências internacionais em pós-graduação e pesquisa em MFC e elaboramos uma proposta de currículo para futuros cursos nacionais de mestrado em MFC. Ao final discutimos algumas estratégias fundamentais para o surgimento de cursos de pós-graduação "stricto sensu" nesta área no Brasil, destacando o potencial desses cursos para a avaliação e a qualificação dos serviços de atenção primária, em especial a Estratégia Saúde da Família, e para a formação de profissionais especializados em APS necessários para a consolidação do Sistema Único de Saúde como sistema acessível, abrangente e equitativo para a população brasileira.

Abstract While Primary Health Care (PHC) and Family and Community Medicine (FCM) have expanded their space and relevance in health care and undergraduate medical courses, Brazil has no stricto sensu FCM postgraduate programs. In this paper, we analyze some aspects of the Brazilian public health field and the national stricto sensu postgraduate system that can help to explain this scenario. As a contribution to the debate on this topic, we also gathered information from international postgraduate and research experiences in FCM and devised a curriculum proposal for future national FCM master's courses. In the end, we discussed some key strategies for the emergence of stricto sensu postgraduate courses in this discipline in Brazil, highlighting the potential of these programs for evaluation and qualification of primary care services, especially the Family Health Strategy, and the training of PHC specialists required for the consolidation of the Unified Health System (SUS) as an accessible, comprehensive and equitable health system for the Brazilian population.

Programa mais médicos dois anos: mais saúde para os brasileiros / More Doctors Program two years: more health for Brazilians / Programa Más Médicos dos años: más salud para los brasileños

Saúde pública, universal e gratuita para mais de 200 milhões de brasileirosnão é desafio que se supera sozinho. A constituição brasileira repartiu asresponsabilidades entre as três esferas de governo e assim, há 27 anos, seguimosconstruindo o Sistema Único de Saúde. Talvez a mais importante de todas as etapasdessa construção, a Atenção Básica, justamente aquela que está mais próximada população, é a que mais exige integração entre União, estados e municípios.É no atendimento básico, na Estratégia da Saúde de Família, que se solucionamcerca de 80% dos problemas de saúde da população. Respeitando aautonomia de cada ente, o governo federal, com os estados e municípios, decidiureforçar esse pilar tão importante da saúde pública. Lançado o desafio de atendera uma demanda histórica por mais médicos nas Unidades Básicas de Saúde, oMinistério da Saúde começou a reunir parceiros dentro e fora do governo paratransformar em realidade o Programa Mais Médicos para o Brasil...

Knowledge, attitudes and practices related to healthcare ethics among medical and dental postgraduate students in south India.

Background: Conventional medical training offers students little help in resolving the ethical dilemmas they will encounter as healthcare professionals.

A degree in bioethics: an "introspective" analysis from Pakistan.

The success of degree-level bioethics programmes, a recent development across the world, is generally evaluated on the basis of their quantifiable impact; for instance, the number of publications graduates produce. The author conducted a study of Pakistani graduates who had pursueda higher qualification in bioethics, and on the basis of the respondents' written and verbal narratives, this paper presents an analysis of their perceptions of the internal impact of bioethics degree programmes. Using these narratives, the paper also analyses the reactions of their colleagues to their new qualification.

Is there need for a transformational change to overcome the current problems with postgraduate medical education in India.

In spite of the existence of a dual system of postgraduation, one under the Medical Council of India (MCI) and the other on a parallel track under the National Board of Examinations, postgraduate medical education in India is beset with several problems. For example, the curriculum has not been revised comprehensively for several decades. The diploma course under the MCI has become unpopular and is largely a temporary refuge for those who do not get admission to degree courses. The level of skills of the outgoing graduate is falling and the increase in the number of seats is taking place in a haphazard manner, without reference to the needs. In spite of increase in seats, there is a shortage of specialists at the secondary and tertiary care levels, especially in medical colleges, to share teaching responsibilities. Further, the distribution of specialists is skewed, with some states having far more than others. To remedy these ills and fulfil the requirements of the country over the next two decades, a working group appointed by the erstwhile governors of the MCI was asked to suggest suitable modifications to the existing postgraduate system. After an extensive review of the lacunae in the present system, the needs at various levels and the pattern of postgraduate education in other countries, it was felt that a competency-based model of a 2-year postgraduate course across all specialties, the use of offsite facilities for training and a criterion-based evaluation system entailing continuous monitoring would go a long way to correct some of the deficiencies of the existing system. The details of the proposal and its merits are outlined for wider discussion and to serve as a feedback to the regulatory agencies engaged in the task of improving the medical education system in India. We feel that the adoption of the proposed system would go a long way in improving career options, increasing the availability of teachers and dissemination of specialists to the secondary and primary levels, and improving the quality of outgoing postgraduates.

Caracterización del claustro que imparte los diplomados de Dirección en Salud / Characterization of the professors who teach health management diploma's courses

OBJETIVOS: Describir las características científicas y docentes del claustro que imparte los diplomados de Dirección en Salud y su proceso de superación en el período 2008-2009 en Cuba. MÉTODOS: Se aplicó un cuestionario a 27 profesores a tiempo completo correspondiente a 14 centros provinciales de la ENSAP. La información obtenida se organizó en tablas. RESULTADOS: Los médicos representan el 51,8 por ciento, los Licenciados en Enfermería el 11,1 por ciento, los estomatólogos el 3,7 por ciento y los licenciados en otras profesiones el 33,3 por ciento. Los instructores constituyen el 25,9 por ciento del total, los asistentes el 22,2 por ciento, los profesores auxiliares el 44,4 por ciento y los titulares el 7,4 por ciento. El 59,2 por ciento es máster y un 3,7 por ciento representa al doctorado. Recibieron los diplomados en Dirección en Salud el 92,6 por ciento. El 77,7 por ciento respondió que la superación recibida les ha solucionado aspectos relativos a lo personal o profesional. Sobre las dificultades presentadas para realizar el proceso de superación: los problemas con el tiempo significaron el 33,3 por ciento, la falta de computadoras el 25,9 por ciento y los problemas con la conectividad el 40,7 por ciento. CONCLUSIONES: La composición del claustro es heterogénea, existe desbalance en la disposición por categorías docentes y grados científicos. El proceso de superación debe diseñarse atendiendo a la formación básica, especializada y a la experticia individual de cada profesor. Los docentes reconocen la utilidad de la superación para el perfeccionamiento del proceso de enseñanza aprendizaje.

OBJECTIVES: To describe the scientific and teaching characteristics of the faculty in the health management diplomaïs courses and of the upgrading process in the 2008-2009 period in Cuba. METHODS: A questionnaire was administered to 27 full-time professors from 14 provincial centers of the National School of Public Health. The collected data was organized in tables. RESULTS: The physicians accounted for 51,8 percent, Bachelors of Nursing represented 11,1 percent; dentists, 3,7 percent and Bachelors of other professions, 33,3 percent. The instructors were 25,9 percent of the total amount, assistant professors, 22,2 percent, associate professors, 44,4 percent and full professors, 7,4 percent. The master's degree was held by 59,2 percent of the participants and 3,7 percent had PhD title. Of the total amount, 92,6 percent graduated from diploma's courses in health management. Of the participants, 77,7 percent responded that upgrading allowed them to solve some difficult aspects in their personal or professional life. Regarding the difficulties in the upgrading process, the lack of time accounted for 33,3 percent, the non-availability of computers, 25,9 percent and the connection problems represented 40,7 percent. CONCLUSIONS: The composition of the faculty is heterogeneous; there is imbalance between teaching categories and scientific degrees. The upgrading process should be designed according to the basic and specialized formations as well as the individual expertise of each professor. The teaching staff acknowledged the usefulness of the upgrading for the improvement of the teaching-learning process.

Entrenamiento en equipos automatizados de laboratorio clínico de los Centros de alta tecnología en Venezuela: I Fundamentación / Training in automated equipment of clinical laboratory of high technology center in Venezuela: I Basis

Los Laboratorios Clínicos de los Centros Médicos Diagnósticos de Alta Tecnología (CMDAT) en Venezuela han sido dotados de tecnologías de punta las cuales no están todavía difundidas en Cuba, por lo que no contamos con suficientes profesionales debidamente entrenados. OBJETIVOS: identificar las necesidades de aprendizaje de los médicos Especialistas y Licenciados de Laboratorio Clínico para el manejo de los equipos de tecnología de punta de los Centros Médicos Diagnósticos de alta tecnología. Elaborar un programa de entrenamiento para los profesionales del Laboratorio Clínico para la correcta explotación de los equipos de alta tecnología. MÉTODOS: se realizó el análisis de un grupo de documentos rectores de la educación de posgrado en Cuba. Fue administrada una encuesta a 34 profesionales. RESULTADOS: entre el 60 y el 86 por ciento de los profesionales destinados a los CMDAT no conocían estas tecnologías. La proporción de profesionales que no habían tenido experiencias prácticas previas se encontró siempre por encima del 76 por ciento en las cuatro tecnologías. CONCLUSIONES: se diseñó un entrenamiento en equipos automatizados de laboratorio clínico de los Centros Médicos Diagnósticos de Alta Tecnología con un enfoque contextualizado y una estructuración metodológica que asume al proceso de asimilación relacionado directamente con la propia realidad profesional de los implicados. Su aplicación contribuirá al logro de una explotación más efectiva de las tecnologías de punta de los laboratorios clínicos de los CMDAT.

Clinical Laboratories of the Diagnostic Medical Centers of High Technology (DMCHT) in Venezuela have point technology, which are not very diffused in Cuba, thus we count on enough professional very well trained. OBJECTIVE: To identify the learning needs of physicians specialists and bachelors in Clinical Laboratory to management of point technology equipments from the high technology Diagnostic Medical Centers.To the correct exploitation of high technology equipments authors draw out a training program for professionals from clinical laboratories was draw out. METHODS: Authors made an analysis of important documents related to postgraduate education in Cuba. A survey was applied to 34 professionals. RESULTS: Between the 60 percent and the 86 percent of professionals appointed to DMCHTs failed to recognize these technologies. The ratio of professional without previous practical experiences was always above the 76 percent in the four technologies. CONCLUSIONS: A training program on automated equipments of clinical laboratories of high technology Diagnostic Medical Centers with a contextualized approach and a methodological structuring assuming the assimilation process related directly to own professional reality of the participants. Its application will allows the achievement of a more effective exploitation of point technologies of clinical laboratories from DMCHts.

A residência médica: articulações entre a prática e o ensino / Medical residence: articulations between practice and teaching

O objetivo desta tese de doutorado é o estudo da residência médica e de suas articulações com o campo educacional e o da saúde. Propõe-se uma análise histórico - dialética, tomando como ponto de partida a articulação da medicina e da educação na estrutura social. Parte-se da concepção segundo a qual a prática e o saber no campo educacional e na saúde estão ligados à transformação histórica do processo de produção econômica. Essa compreensão remete à chamada determinação em última instância: a estrutura econômica determina o lugar e a forma de articulação da medicina e da educação na estrutura social. Para compreender as peculiaridades do ensino e da residência médica no Brasil faz-se uma caracterização da assistência médica, sobretudo do papel assumido pelo Estado na configuração do campo: primeiro, a adoção de um sistema em que compete ao Estado a responsabilidade pela universalização da atenção básica, através de serviços próprios ou em parceria com organizações não governamentais; segundo, a atenção especializada, com maior incorporação tecnológica, seria prestada pelo setor privado, mediante incentivos concedidos pelo Estado. Dessa divisão, resulta, no desenho atual, ao invés de um único sistema, a conformação de dois ou mais sistemas de saúde, em que a segmentação da assistência implica em práticas diferenciadas. O efeito desta divisão no mercado de trabalho repercute na escola e na residência médicas. A residência, em particular, por suas características de treinamento em serviço, responde diretamente aos condicionantes do mundo do trabalho, reproduzindo o modelo de prática hegemônica.

Providing a setup and opportunities for better training of postdoctoral research fellows in an academic environment.

Thousands of young researchers come from different parts of the world every year to take up postdoctoral (postdoc) research fellowship positions in the developed countries. In the US alone, there were 48,601 postdocs in the year 2005 working in different labs in the fields of science, health and engineering. Many pursue this option for lack of other alternatives. Expectedly, these individuals face a lot of difficulties in making this transition from being a student to becoming an employee of an institution. Many institutions are prepared to make this transition and period of stay easy for their fellows while others are not equipped at all. The presence of a postdoc office (established by an institution) or an association (formed by the fellows) can be of immense help to postdocs. Additionally, the availability of institutional professional development and leadership programs can also help to nurture and polish postdoc fellows into future faculty members and valuable members of the community at large. To name a few, these professional development programs can focus on communication and presentation skills, medical education, teaching and learning, bioethics and mentorship. There is an urgent need to address some or all of these issues so that better training environment and opportunities are available to this group of postdoc fellows.

Study skills course in medical education for postgraduate residents.

The learners have to take active parts in the teaching learning activities. To make them aware and to help them develop the skills required, the need of the study skills course in medical education early in the part of their training has been realized for the postgraduate residents. The important areas of the study skills course focusing in the requirement of clinical components of the postgraduate residents are 1) Interpersonal and communications skills, 2) Teaching, learning and presentation skills, 3) Language, reading and computer use, 4) Evidence based medicine and diagnosis and management, 5) Assessment principles and strategies, 6) Time management strategies to get the best out of the training, 7) Reflection, portfolio and self-directed lifelong learning, and 8) Follow-up presentation. The methodologies that could be used in such study skills course are interactive lectures, brainstorming, presentations by the trainees, demonstration to and by the trainees, small group discussion, group work and presentation, group and individual feedback, practice sessions, role play, short relevant video movies, video recording of the trainees and viewing with feedback. With their already tight training schedule and posting and other similar other mandatory courses required for the postgraduate residents, much time cannot be allocated for the study skills course in medical education alone. Similar study skills course in medical education may need to be arranged for the undergraduate medical students as well.

Restructuring medical education.

This article explores instances of dysfunctional behaviour in resident doctors and examines the causes. It looks at the cultural competency training procedures for doctors in some institutions. There is a need for greater competency and diversity training of resident doctors. Counselling services also must be in place for addressing stress issues of doctors. These are important attributes looked for by WHO for accreditation.

Changing the research culture at the section of psychiatry, the University of the West Indies, Mona / Cambiando la cultura de la investigación en el Departamento de Psiquiatría de la Universidad de West Indies, Mona

OBJECTIVE: To compare the medical research output of the Section of Psychiatry, The University of the West Indies (UWI), Mona, before and after the implementation of strategies aimed at stimulating research. METHOD: Specific strategies such as weekly research and journal club meetings, with an emphasis on team activities and the establishment of bi-annual targets for submission of research papers were instituted in 2000. All research outputs from the Section of Psychiatry over the period 1995 to 2005 were identified from the Departmental Reports of the University of the West Indies and the published abstracts of the UWI Faculty of Medical Sciences and the Caribbean Health Research Council annual research conferences. A number of variables were extracted from each paper and comparisons made between the five-year period before and the five-year period after the implementation of the research enhancing strategies. Statistical analyses were performed with the Statistical Package for the Social Sciences (SPSS; version 11.5) and included chi-squared and Mann Whitney U tests. RESULTS: One-hundred and sixty-two items of research output were identified for the entire period under study. In the period after the implementation of the research enhancing strategies, there were significant increases in the total research output (p = 0.008) and refereed publications (p = 0.016). CONCLUSIONS: There were considerable increases in the overall research output of the department as well as in many sub-categories of output. These strategies are presented as a model to other departments seeking to augment their output of research.

OBJETIVO: Comparar la producción médico-investigativa del Departamento de Psiquiatría de la Universidad de West Indies (UWI), Mona, antes y después de la implementación de las estrategias encaminadas a estimular la investigación. MÉTODO: En el año 200, se instituyeron estrategias específicas, tales como reuniones semanales del club de investigación y publicaciones, con énfasis en las actividades en equipo y el establecimiento de objetivos semestrales para la presentación de trabajos de investigación. Todas las producciones investigativas del Departamento de Psiquiatría durante el periodo de 1995 al 2005, fueron identificadas a partir de los informes Departamentales de la Universidad de West Indies y los resúmenes publicados por las conferencias anuales de la Facultad de Ciencias Médicas de UWI y el Consejo Caribeño de Investigaciones de la Salud. Se extrajeron un número de variables de cada trabajo y se hicieron comparaciones entre el quinquenio anterior y el posterior a la implementación de las estrategias del perfeccionamiento de las investigaciones. Se realizaron análisis estadísticos con el Paquete Estadístico para las Ciencias Sociales (SPSS; versión 11.5) y se incluyeron pruebas U de Mann-Whitney y Chi-cuadrado. RESULTADOS: Se identificaron ciento sesenta y dos ítems de output investigativo para todo el periodo en estudio. En el periodo posterior a la implementación de las estrategias de perfeccionamiento de las investigaciones, hubo aumentos significativos en la producción investigativa total (p = 0.008) y en las publicaciones referenciadas (p = 0.016). CONCLUSIONES: Hubo aumentos considerables en la producción investigativa general del departamento, así como en muchas subcategorías de producción. Estas estrategias se presentan como un modelo para otros departamentos que buscan aumentar su producción investigativa.

Pattern of postgraduate specialization of Kuwaiti medical graduates throughout the last 30 years

The study examines postgraduate specialty training of Kuwaiti medical graduates during the period 1968 to 1999, identifies their attained professional qualifications in order to reveal scarcity in some specialties. A survey was carried out involving review of the records maintained at the Kuwait Institute for Medical Specialization [KIMS] and Ministry of Health for all the trainees who were enrolled in higher training programs for specialization during the study. Information obtained from the records were ascertained through matching with the doctors' career destinations and employment in the recruitment departments of the health sector. Ascertained data included gender, year and awarding country, level of attained qualifications [medium: Diploma and M.Sc.; higher clinical: fellowship/membership: MRCP, FRCS, MRCOG, Boards of Kuwait, Canada, USA, Germany; and higher academic qualification: Ph.D.]. A total of 679 [363 males, 316 females] Kuwaiti medical graduates attained their higher postgraduate qualifications until year 1999. There was an excess of female postgraduates since 1993, and a drop in 1991 due to the Gulf War. Specialty differed according to gender males mostly opted for medicine and surgery, while females mainly chose obstetrics and gynecology, pediatrics and family medicine. The nature of postgraduate qualifications differed according to gender, fewer females undertook academic qualifications. Also, the awarding country differed according to gender: females obtained their qualifications mostly from Kuwait or UK, while males were mainly awarded by Canadian, American or German universities. Scarcity in some clinical specialities was apparent: subspecialities in surgery [vascular, pediatric, h and, chest, laparoscopic, neurosurgery and oncology]; pediatric [nephrology, respiratory, cardiology, and neonatology]; psychiatry, occupational medicine, and immunology. The number of Kuwaiti medical graduates with higher professional qualifications significantly increased after 1985 due to the establishment of KIMS and Kuwait Faculty of Medicine. Excess of female postgraduates since 1993 was due to the social and cultural transitions witnessed by Kuwait resulting in rapid urbanization, changing the structure and content of education, increasing the numbers of females employed, professional redistribution in social dimensions, and modification in life style. Gender significantly affected the nature of postgraduate studies, the awarding countries and the choice of specialty. The pattern of preference of Kuwaiti graduates to specialties was consistent with other parts of the world; males opted mainly to internal medicine and surgery, while females preferred obstetrics and gynecology, pediatrics and family medicine. Scarcity in some specialties has been revealed and needs to be adjusted

Development of the family practice specialty training program over a 20-year period [1983-2002] in Kuwait

The study examined the evolution of the Family Practice Post graduate Training Program [FPSTP] in Kuwait during the period 1983 to 2002 and identified the main changes and achievements as well as limitations in order to identify ways to improve the program for the future. In a review of the main records of the FPSTP and manpower statistics in Qadsia, Kuwait Institute for Medical Specialization [KIMS] and Ministry of Health [MOH] covering the last 20 years, three years were selected for observational comparisons. These were 1987, the year of graduation of the first batch of Family Medicine Graduates [FMG], 1995 when the program was reactivated after the Iraqi invasion, and 2002. Data reviewed included numbers of graduates, year of graduation, sex and nationality. The study showed that the number of FMG has increased tremendously over the 20 year period, from 13 in 1987 to 152 in 2002, with the percentages of Kuwaitis increasing from 7.7% to 77%. The percentage of females also changed from 38.5% to 62%. This increase was also accompanied by the loss of FMG to attachments or posts other than clinical general primary care work. Steps have been taken to make the program local, with decreasing Royal College of General Practitioners [RCGP] participation in the courses and examinations. Training centers, however, have not increased since 1995, despite the rise in the numbers of trainers and examiners. The study revealed that FPSTP has exp and ed, with an increase in the number of FMG, in spite of the substantial shift away from family practice as a career for some graduates. There have also been improvements and additions to the curriculum in conformity with international postgraduate [PG] programs