Valoración de la docencia de pregrado de urología por docentes y alumnos en el nuevo escenario hospitalario (autogestionado en red) / The effects of a new model of hospital management on undergraduate teaching of urology

Background: Since January 2005, a new model for hospital coordinated assistance was implanted in Chile, denominated “Self Managed Hospitals in net”, to improve resource use effectiveness and effciency. This new design changed health care and teaching models. Aim: To analyze, understand and to refect on how teachers and students of the Urology Unit of the Eastern Campus of the Faculty of Medicine in the University of Chile, perceive learning in this new hospital scenario. Material and Methods: A qualitative methodology was used, including semi-structured interviews to chief teachers and focal groups of teachers and students. Also, a written structured questionnaire was answered by a group of 5th year students and interns. Results: University teachers perceive that undergraduate learning is affected in the new hospital scenario. Students think that they have less opportunities to directly interact with patients, and therefore have fewer possibilities to take medical histories, perform physical examinations, and fewer occasions to discuss cases with their tutors. Conclusions: The new health system that runs hospitals under a network could jeopardize undergraduate teaching. This is the case for the Urology Service at Hospital and the corresponding Department of Specialties, where the dominant perception of teachers and a number of students is that their clinical learning is endangered by these innovations. To obtain the learning objectives of the undergraduate program in this subject, reorientation of their ambulatory practice and derivation skills must be rationally elaborated to improve student’s accomplishment.

Dimensiones del profesionalismo médico: Proyecciones para el siglo XXI / Dimensions of medical professionalism: Perspectives for the twenty-first century

Medicine is progressively loosing its prestige and efficacy and needs to rebuild the moral values that maintain the tacit social contract subscribed between doctors and patients. This altruistic commitment to serve people has been devaluated by changes in health systems, by advances in knowledge and by social and economical changes. The perspective with which humanity faces its future, harmed by radical environmental transformations also has contributed to this devaluation. Notwithstanding, requirements to provide high quality health care and demands to reinstall those fundamental attributes of professional work, commit us to introduce or increase the selective learning of those competences to health professionals. This new, or renewed form of improving the teaching of health sciences, seems to be the unique way to stop the reduction on health care professional effectiveness, to maintain quality of care and to accomplish the goal of medical profession to serve and take care of humankind health.

La globalización en la educación superior europea. Pródromos para nuestra educación médica: The precursor of changes in Chilean medical education / Globalization of higher education in Europe. The precursor of changes in Chilean medical education

At the present time, higher education is a central process shaping the society of knowledge. The mutual strength of society and education influence worldwide changes. Globalization, that mainly embraces politics and commerce, is also promoting changes in professional training, modifying programs, structures and the organization of superior education. The European example is attractive and has a great projection. It will cause a profound impact in culture, development and life of Europeans. Universities in Latin America, in an attempt to achieve the same objectives than their European counterparts, are experiencing premonitory changes, that will have the same effects as in Europe. In the medical area, several changes will occur and we will have to provide initiatives to facilitate these changes in a timely manner. The revision of the model in its inception, is convenient to assimilate changes in our culture.

Aspectos bioéticos en la Reforma de la Atención de Salud en Chile: II Discriminación, libre elección y consentimiento informado / Bioethical aspects of health care reform in Chile: II Discrimination, free election and informed consent

Bioethical issues emerge each time health care reform projects are discussed. These affect diverse moral values and principles and have an impact on cultural, social and political areas. Thus, they demand more than just organizational, financial or administrative solutions. This review analyses discrimination, free election of professionals and informed consent. All three concepts are alluded in the legislative debate raised upon the actual process for health reform. Having clear ideas about these subjects is crucial to foresee the reactions expected to arise among physicians and the general public, when confronting the proposed changes (Rev Méd Chile 2003; 131: 1329-36).