Riesgos psicosociales e integración profesional de médicos extranjeros: Un estudio sobre el manejo del conflicto en Chile / Psychosocial risks and professional integration of foreign physicians: a study on conflict management in Chile

Background: The way in which communicative conflicts are confronted, as part of the acculturation process, can constitute a psychosocial risk factor that may affect the effectiveness of health care delivery. Aim: To describe the levels of dominance, adaptability and evasion as indicators of the way in which conflict situations are faced in the workplace by foreign physicians in the management of communicative conflicts. Materials and Methods: A self-report questionnaire was answered by 51 foreign physicians (63% women, 76% Venezuelans, 64% aged between 31 and 40 years old) who work in public healthcare institutions in a southern region of Chile. Results: The highest scores were recorded for the adaptable style of conflict management (69%), while the lowest scores were recorded for the evasive style (6%). Higher levels of dominance were identified for women than for men. There was a positive association between dominance and time progression, where the level of dominance increased as participants gained greater professional experience and workplace seniority. Conclusions: The foreign physicians who participated in this study have a clear constructive attitude towards the negotiation of conflicts. However, this effort to adapt can also become a psychosocial risk factor that affects professional integration in intercultural workplace contexts.

Thai medical graduates in the United States residency training programs: 1988-2003.

In the past 2 decades, international medical graduates (IMG) were needed to fill graduate medical education (GME) positions in the United States (U.S.). The author built a database of Thai medical graduates in accredited U.S. residency systems between 1988-2003, and analyzed the trend and opportunity for Thai IMG. During the 16-year study period, there were 281 Thai medical graduates who successfully entered residency in the U.S., with a rising trend that reached a peak between 1993-1994, and subsequently declined to about 10-15 per year Thai physicians entered U.S. residency program 4.2 +/- 3.3 years after medical school graduation. Thai IMGs were mostly in internal medicine (N=153, 54.4%) and pediatric residency programs (N=76, 27.1%), with much fewer in psychiatry (N=10), surgery (N=9), neurology (N=8), anesthesiology (N=7), and other specialties (N=18). Thai medical graduates tended to be clustered in a few residency programs. Half of the Thai graduates in the U.S. internal medicine residency were accepted in 9 programs; the largest were Texas Tech (Lubbock, N=18), Albert Einstein University (Philadelphia, N=14), and University of Hawaii (Honolulu, N=13). For pediatric residency, about half of the Thai graduates (56.6%) were in 6 programs; the largest were Christ Hospital (Oaklawn, N=11), University of Illinois at Chicago (N=11), and Jersey City Medical Center (N=9). After residency training, most Thais (94.5%) chose to do subspecialty training. The most popular medical subspecialties were cardiology, nephrology, and hematology-oncology. The most popular pediatric subspecialties were allergy-immunology, endocrinology, and cardiology. In conclusion, there are too few Thais in the U.S. residency system. This information may be helpful for Thai medical graduates who seek residency abroad.

Geographic origin of Nepali doctors.

Though the history of in-country training of doctors in Nepal is not long, Nepal had started training doctors in abroad long ago. This is probably the first paper of its kind to correlate the developmental and ecological region to the country of training of Nepali doctors. This retrospective analysis reveals that nearly 38% doctors are trained in India, 22% each from former USSR and Nepal, 10% from Bangladesh, and 2.5% from Pakistan. Other countries contribute very few in the list. Nearly 2/3rd of the doctors represent the central developmental region and most of them are from Kathmandu valley. Ecologically mountain and hills are in great minority compared to Kathmandu valley and Terai. Interestingly training in former USSR shows a bit wider base regarding the origin in terms of developmental region. And Nepal has a clear broad base both in terms of developmental and ecological regions. As most of the doctors among Nepal trained ones are from IOM, the role of IOM way of selecting medical students need a deeper look into it.

Número de médicos en Chile: estimaciones, proyecciones y comparación internacional / Number of physicians in Chile: current and prospective estimate and international comparison

Background: In the last decades, the number of Universities with medical schools has increased dramatically in our country. Aim: To introduce a conceptual model to estimate the number of physicians that are incorporated to the profession in Chile every year as well as the cumulative number of active physicians in specific time frame. To provide information about the number of available physicians in the country and compare it with the international context. Material and methods: This model includes information about the number of students that are admitted in all medical schools of the country, the dropout rate, the number of immigrant physicians from other countries, and the cumulative number of active physicians in the previous period. Results: There is an increased number of new medical students starting in 1994 that will produce, starting in 2001, a significant increased in the number of new physicians graduated from Chilean Universities. Meanwhile the increased number of new physicians in recent years is mainly explained by a significant increase in immigrant physicians. The number of active physicians estimated by the year 2000 is 18,549 and this number will be 25,704 by the year 2007. With these estimated numbers, we introduce a qualitative model that allowed us to compare the current number of active physicians in Chile with other countries, especially those with a comparable degree of development. This model uses first The Human Development Index and later the per capita income of different countries adjusted by purchasing power in USA. According to these calculations, Chile has a lower number of physicians than similar countries, and this difference will persist, even after the significant increase in the new physicians expected for the new future. Conclusions: Chile continues to have a lower number of physicians than countries with similar human development indices

Autorización para el ejercicio profesional médico en Chile: experiencia de la comisión de reválida de la Escuela de Medicina de la Universidad de Chile período 1984-1999 / Medical practice licensing in Chile: experience of the re-valuation committee of the medical school of Universidad de Chile, 1984-1999

We report the experience of the re-valuation committee of the University of Chile Medical School, in the period 1984-1999. This experience is relevant to the licensing processes in Latin America. We report the political, legal and regulatory backup and the academic criteria used to esatblish different evaluation methodologies. We also communicate the main results obtained. Factors such as the country and University conferring a title, nationality and length of service of the applicant, influence in the percentage of licensure exammination approval. Some modifications to the licensure process should be incorporated but, the overall results obtained, fully justify the existence of this licensure committee

Certificación como especialistas clínicos de médicos con formación de pre y post título en el extranjero: experiencia de la Corporación Nacional Autónoma de Certificación de Especialidades Médicas / Certification as clinical specialists of physicians with pre and post grade education at foreign countries: experience of the CONACEM

Materials and methods:The certification process for 90 physicians (38 Chilean and 52 foreing) with studies abroad is reported. Criteria for certification of specialties were the same used for physicians with studies in Chile and results were compared with those obtained by the latter. Results: Physicians with studies abroad required additional evaluations with a greater frequency than local physicians, due to the fact that foreign training programs are not well known by CONACEM members. Eighty five percent of foreighn physicians required those further evaluations, compared with 66.6 percent of all physicians certified bu the commission. Fifty five percent of Chilean physicians with studies abroad did not accept this additional assessment. Aplications for specialties of physicians with studies abroad, were rejected with a greeater frequency than those of Chilean psysicians (31 percent and 13 percent, respectively). Conclusions: Physicians with studies abroad applying for certification of medical specialties required more evaluations and were rejected with a greater frequency than Chilean physicians