Defensa de los derechos adquiridos: luchas y albures del ejercicio de la homeopatía en Colombia (1905-1950) / Defending entitlement: struggles and fate of the practice of homeopathy in Colombia (1905-1950)

Resumen El artículo analiza la práctica y el estatuto profesional de los homeópatas colombianos en el siglo XX, según las solicitudes de licencia de la serie "Teguas" del Archivo General de la Nación. Desde el contexto histórico del ejercicio de la medicina en Colombia, se estudia la práctica homeopática en su inserción en el debate entre medicina diplomada y medicina permitida. Ahí aparece la homeopatía como un campo subordinado a la medicina universitaria y los homeópatas como conjunto de practicantes no homogéneo ni organizado, pero caracterizado por compartir la lucha por el "derecho adquirido" a ejercer y por la defensa de un estatuto profesional mediante la judicialización constante de la reprobación oficial.

Abstract This article analyzes the practice and professional status of Colombian homeopaths in the twentieth century, based on applications for licenses in the "Teguas" series in the Archivo General de la Nación. Within the historical context of the practice of medicine in Colombia, it studies homeopathic practice within the framework of the debate between licensed and permitted medicine. In that context, the field of homeopathy was subordinate to university medicine and homeopaths were a group of practitioners who were neither homogeneous nor organized, but characterized by their shared struggle to become "entitled" to practice, and their advocacy of professional status through constant litigation against official reprimands.

George Deacon and the circulation of homeopathic therapies in Lima (1880-1915) / George Deacon e a circulação de tratamentos homeopáticos em Lima (1880-1915)

Abstract Homeopathy arrived from the United States to Peruvian soil in the last decades of the nineteenth century, broadening the repertoire of existing medical knowledge, which included an emerging medical profession, Chinese herbalists, and indigenous practitioners. This article examines the circulation and use of homeopathic therapies and medicines in Lima from the time when the American homeopath George Deacon initiated his practice, in the 1880s, until his death, in 1915. Although homeopathy was not the most widely used medical therapy in the country, it nevertheless posed a threat to professional medicine and the School of Medicine's desired monopoly of the field of medicine.

Resumo A homeopatia originária dos EUA adentrou solo peruano nas últimas décadas do século XIX, ampliando o repertório de conhecimento médico existente até então, o qual incluía uma profissão médica em ascensão, herbolários chineses e médicos locais. Este artigo analisa a circulação e o uso de tratamentos e medicamentos homeopáticos em Lima desde o período em que o homeopata norte-americano George Deacon iniciou sua prática, nos anos 1880, até sua morte, em 1915. Embora a homeopatia não fosse o tratamento médico mais disseminada no país, ela representou uma ameaça à medicina profissional e ao monopólio do campo da medicina almejado pela escola tradicional.

Breaking the boundaries of professional regulation: medical licensing, foreign influence, and the consolidation of homeopathy in Mexico / Rompendo as barreiras da regulamentação profissional: licenciamento médico, influência estrangeira e consolidação da homeopatia no México

Abstract As doctors sought state support to regulate professional training and practice after Independence, Mexicans also developed different attitudes toward foreign ideas, influences, and professionals. Leveraging the allure of the foreign among Mexicans, homeopaths strategically used work, products, and organizations from abroad to establish their practices and fight changing professional policies in the country that threatened homeopathic institutions. Homeopaths inhabited the blurry and shifting boundary between professional and lay medical practice during the early Republican period, the Porfiriato, and the post-revolutionary era, and used the ambivalent feelings about medical licensing, and foreign influence in Mexican society to consolidate their position.

Resumo Após a independência do país, enquanto os médicos buscavam apoio do Estado para regulamentar o treinamento e a prática profissionais, os mexicanos desenvolveram atitudes diferentes em relação a ideias, influências e profissionais estrangeiros. Aproveitando o encanto dos mexicanos com o estrangeiro, os homeopatas usaram estrategicamente o trabalho, os produtos e as organizações de fora do país para implantar suas práticas e combater as políticas que ameaçavam as instituições ligadas à homeopatia. Os homeopatas ocuparam a barreira nebulosa entre as práticas médicas profissional e leiga no início do período republicano, no Porfiriato e na era pós-revolucionária, usando sentimentos ambivalentes sobre licenciamento médico e influência estrangeira para consolidar sua posição.

Perspectivas de la certificación profesional en salud en el Perú / Perspectives of professional certification in health in Peru

Certificación periódica, es el reconocimiento público y temporal realizado a profesionales que demuestran un desempeño competente. Es certificación de tercera parte, diferente de certificación que otorgan las instituciones formadoras y también de colegiación que es requisito obligatorio en Perú para ejercer profesiones de salud. Colegio médico fue pionero de certificación a través del Sistema de Certificación y Recertificación Médica, basado en educación médica continua. Desde 2006 en que se creó el sistema de evaluación, acreditación y certificación de la calidad educativa, y su reglamentación en 2008, se establece que la certificación se basa en competencias, es temporal y obligatoria para profesiones de salud, educación y derecho, y solo puede ser realizada por el Colegio Profesional correspondiente. Luego de 7 años de implementación, es pertinente preguntarse ¿dónde va la certificación profesional en salud? La estrategia implementada fue inducción de demanda a través de colegios profesionales, con un esquema rígido de certificación. Entre 2011 y 2017 se han certificado 6354 profesionales de salud, con predominio de enfermería con 58.14%. Cabe precisar que Colegio Médico implementa dos esquemas de certificación, uno basado en educación médica continua (se han certificado 18333 médicos) y otro basado en competencias autorizado por Sineace, con muy poca cobertura. Resultados hacen suponer que estrategia implementada ha resultado insuficiente y se proponen nuevos caminos que incluyan: certificación voluntaria como "sello de calidad", diversificación de la oferta, especialización y pluralidad metodológica, flexibilidad en esquemas de certificación..(AU)

Periodic certification is the public and temporary recognition of professionals who demonstrate competent performance. It is a third-party certification, different from certification granted by the training institutions and also of membership that is a mandatory requirement in Peru to practice health professions. Medical College was a pioneer of certification through the Medical Certification and Recertification System, based on continuing medical education. Since 2006, when the Educational Quality Assessment, Accreditation and Certification System was created, and its regulations in 2008, it is established that certification is competency-based, temporary and compulsory for health, education and law professions, and only It can be done by the corresponding Professional Association. After 7 years of implementation, it is pertinent to ask: where is the professional certification in health? The strategy implemented was induction of demand through professional associations, with a rigid certification scheme. Between 2011 and 2017, 6354 health professionals were certified, with a predominance of nursing with 58.14%. It should be noted that Medical College implements two certification schemes, one based on continuing medical education (18333 doctors have been certified) and another based on competencies authorized by Sineace, with very little coverage. Results suggest that the strategy implemented has been insufficient and new paths are proposed that include: voluntary certification as a "seal of quality", diversification of the offer, specialization and methodological plurality, flexibility in certification schemes..(AU)

Calidad de vida del personal de salud y su relación con el ausentismo / Quality of life of health personnel and their relationship to absenteeism

OBJETIVO: Evaluar la relación entre la calidad de vida del personal de salud y el ausentismo en un hospital de Chile. MÉTODOS: Estudio de corte transversal. La población de estudio corresponde a funcionarios del Hospital de Nueva Imperial. Se aplicó el instrumento de Calidad de Vida Profesional (CVP-35) y se recolectaron características demográficas, condiciones de empleo e índices de ausentismo por licencias médicas. Se realizó un modelo logístico para identificar qué factores se asocian al ausentismo. Un modelo de binomial negativo cero inflado para evaluar factores asociados con la frecuencia de licencias médicas y al número de días generados. Los modelos se ajustaron por sexo y edad, y las dimensiones del CVP- 35. RESULTADOS: El porcentaje de respuesta del CVP-35 fue de 63,6%. Un 67,4% corresponde a mujeres con edad media de 39,1 años. De los 352 trabajadores, 149 presentaron ausentismo por licencia médica. La mediana en los días de ausentismo es de 15 días. Presentar bastante o mucha carga de trabajo aumenta la chance de ausentarse, OR 1,29 IC95% (1,01-1,64). La edad es un factor que se encuentra asociado a los tres índices de ausentismo evaluados, aumentando sus resultados. DISCUSIÓN Y CONCLUSIONES: Existe una relación entre la calidad de vida del personal de salud y el ausentismo. El ausentismo laboral es un claro síntoma de problemas en la gestión de los recursos humanos dentro de una organización.

OBJECTIVE: To evaluate the relationship between the quality of life of health personnel and absenteeism in a hospital in Chile. METHODS: Cross-sectional study. The population corresponds to health person nel of the Hospital of Nueva Imperial. The instrument of Quality of Professional Life (CVP-35) was applied and demographic character istics, employment conditions and absenteeism indexes for medical licenses were collected. A logistic model was developed to identify which factors are associated with absenteeism. A zero-inflated nega tive binomial model to evaluate factors associated with the fre quency of medical licenses and the number of days generated. The models were adjusted by sex and age, and the dimensions of the CVP-35. RESULTS: The response rate of CVP-35 was 63.6%. 67.4% were women with a mean age of 39.1 years. Of the 352 workers, 149 were absent from medical leave. The median on absentee days is 15 days. Presenting a lot or a lot of workload increases the chance of being absent, OR 1.29 95% CI (1.01-1.64)". Age is a factor that is associated with the three absenteeism indices evaluated, increasing their results. DISCUSSION AND CONCLUSIONS: There is a relationship between the quality of life of health personnel and absenteeism. Absenteeism at work is a clear symptom of problems in the manage ment of human resources within an organization.

Consultorios adyacentes a farmacias privadas en México: infraestructura y características del personal médico y su remuneración / Clinics adjacent to private pharmacies in Mexico: infrastructure and characteristics of the physicians and their remuneration

Objetivo. Analizar las características del personal médico y su remuneración, así como la infraestructura, apego a la regulación y servicios ofrecidos en consultorios adyacentes a farmacias (CAF), y compararlos con consultorios médicos independientes (CMI). Material y métodos. Cuestionario aplicado a 239 médicos generales en 18 entidades federativas, incluido el Distrito Federal, en México en 2012. Resultados. Los médicos en CAF tenían menor experiencia profesional (5 vs 12 años), menos estudios de posgrado (61.2% vs 81.8%) y menor salario base promedio mensual (MXN 5500 vs MXN 8500) que en CMI. En CAF hubo menor cumplimiento de la regulación en relación con la historia clínica y la receta médica. Conclusiones. Los aspectos laborales explorados de médicos en CAF son más precarios que en CMI. Es necesario fortalecer la aplicación de la regulación vigente para consultorios y generar políticas a partir del monitoreo de su funcionamiento, particularmente, pero no de forma exclusiva, en CAF.

Objective. To analyze and compare the physicians' characteristics, their remuneration, the compliance with regulation and the services offered between clinics adjacent to pharmacies (CAF) and independent medical clinics (CMI). Materials and methods. Questionnaire applied to 239 physicians in 18 states including the Federal District, in Mexico in 2012. Results. Physicians in CAF had less professional experience (5 versus 12 years), less postgraduate studies (61.2 versus 81.8%) and lower average monthly salaries (USD 418 versus USD 672) than their peers in CMI. In CAF there was less compliance in relation to medical record keeping and prescribing. Conclusions. The employment situation of physicians in CAF is more precarious than in CMI. It is necessary to strengthen the enforcement of existing regulations and develop policies according to the monitoring of its performance, particularly, but not exclusively, in CAF.

Challenges in the coordination of children's healthcare / Desafios à coordenação na atenção primária à saúde da criança

This is a qualitative survey with a hermeneutic-dialectic frame of reference, designed to identify how parents and caregivers see the attribute 'coordination' in children's healthcare, in terms of resolving problems in children's health. The interview was held with 16 people responsible for care of children under one year of age, served in Emergency Care Units of a municipality in the south of Brazil, in 2010. With the thematic analysis, the central category was identified as: Effects and results of fragile coordination in Children's Primary Health Care, with the following themes: Divergences between different health units in the organization of care; functional barriers and delays obstructing access to technologies; absence of effective communication; absence of medical transport; need for healthcare on an individual basis; and coordination involving management of healthcare. It was concluded that the absence of coordination results in the absence of a solution-based approach in healthcare for children under one year old, showing gaps in the organization of the services and in health management, since communication, access to technologies, referral and counter-referral systems, and secure transport become essential for organizing primary care services and offering fully rounded care to the child.

Com o objetivo de identificar o atributo coordenação na Atenção Primária à Saúde, na visão de pais e cuidadores, para a resolução dos problemas de saúde das crianças, desenvolveu-se uma pesquisa qualitativa baseada no referencial da hermenêutica-dialética. A entrevista foi feita com16 cuidadores de crianças menores de um ano, atendidas em Unidades de Pronto Atendimento de um município sul brasileiro, em 2010. Com a análise temática, identificou-se como categoria central: repercussões da frágil coordenação na Atenção Primária à Saúde da criança, representadas pelos temas divergências na organização do atendimento entre unidades de saúde; barreiras funcionais e morosidade dificultando o acesso às tecnologias; ausência de comunicação efetiva; ausência de transporte sanitário; busca por atenção à saúde individual; e, coordenação envolvendo gestão da atenção à saúde. Concluiu-se que a ausência da coordenação levou à falta de resolutividade na atenção à saúde da criança menor de um ano, demonstrando lacunas na organização dos serviços e na gestão em saúde, uma vez que, comunicação, acesso às tecnologias, sistemas de referência e contrarreferência e transporte seguro tornam-se essenciais para organizar os serviços de atenção primária e oferecer o cuidado integral à criança.

Perceptions on item disclosure for the Korean medical licensing examination / 한국의학교육

PURPOSE: This study analyzed the perceptions of medical students and faculty regarding disclosure of test items on the Korean medical licensing examination. METHODS: I conducted a survey of medical students from medical colleges and professional medical schools nationwide. Responses were analyzed from 718 participants as well as 69 faculty members who participated in creating the medical licensing examination item sets. Data were analyzed using descriptive statistics and the chi-square test. RESULTS: It is important to maintain test quality and to keep the test items unavailable to the public. There are also concerns among students that disclosure of test items would prompt increasing difficulty of test items (48.3%). Further, few students found it desirable to disclose test items regardless of any considerations (28.5%). The professors, who had experience in designing the test items, also expressed their opposition to test item disclosure (60.9%). CONCLUSION: It is desirable not to disclose the test items of the Korean medical licensing examination to the public on the condition that students are provided with a sufficient amount of information regarding the examination. This is so that the exam can appropriately identify candidates with the required qualifications.

Best fit model of exploratory and confirmatory factor analysis to the 2010 Medical Council of Canada's Qualifying Examination Part I clinical decision making cases / 보건의료교육평가

PURPOSE: This study aims to assess the fit of a number of exploratory and confirmatory factor analysis models to the 2010 Medical Council of Canada's Qualifying Examination Part I (MCCQE1) clinical decision making cases (CDM). The outcomes of this study have important implications for a number of activities, including scoring and test development. METHODS: Candidates included all first-time Canadian medical graduates and international Medical graduates who completed either the spring or fall 2010 test form of the MCCQE1. The fit of one- to five-factor exploratory models was assessed for the 2010 CDM cases item response matrix. Five confirmatory factor analytic models were also examined with the same CDM response matrix. The structural equation modeling software program, Mplus(R) was used for all analyses. RESULTS: Out of five exploratory factor analytic models, a three-factor model provided the best fit. Factor 1 loaded on 3 medicine cases, 2 obstetrics and gynecology cases, and 2 orthopedic surgery cases. Factor 2 corresponded to a pediatrics factor whereas the third factor loads on psychiatry CDM cases. Among the five confirmatory factor analysis models examined in this study, three- and four-factor lifespan period models and the five factor discipline models provided the best fit. CONCLUSION: Above results suggest that broad discipline domains best account for performance on CDM cases. In test development, particular effort should be placed on developing CDM cases according to broad discipline and patient age domains; CDM testlets should be assembled largely using these two constraints i.e. discipline and age.

History of the medical licensing examination (uieop) in Korea's Goryeo Dynasty (918-1392) / 보건의료교육평가

This article aims to describe the training and medical licensing system (uieop) for becoming a physician officer (uigwan) during Korea's Goryeo Dynasty (918-1392). In the Goryeo Dynasty, although no license was necessary to provide medical services to the common people, there was a licensing examination to become a physician officer. No other national licensing system for healthcare professionals existed in Korea at that time. The medical licensing examination was administered beginning in 958. Physician officers who passed the medical licensing examination worked in two main healthcare institutions: the Government Hospital (Taeuigam) and Pharmacy for the King (Sangyakguk). The promotion and expansion of medical education differed depending on the historical period. Until the reign of King Munjong (1046-1083), medical education as a path to licensure was encouraged in order to increase the number of physician officers qualifying for licensure by examination; thus, the number of applicants sitting for the examination increased. However, in the late Goryeo Dynasty, after the officer class of the local authorities (hyangri) showed a tendency to monopolize the examination, the Goryeo government limited the examination applications by this group. The medical licensing examination was divided into two parts: medicine and 'feeling the pulse and acupuncture' (jugeumeop). The Goryeo Dynasty followed the Chinese Dang Dynasty's medical system while also taking a strong interest in the Chinese Song Dynasty's ideas about medicine.

Changes in medical students' patient-centeredness attitudes by implementation of clinical performance examination / 한국의학교육

PURPOSE: From 2009, the Korean Medical Licensure Exam implemented a clinical performance examination (CPX) that highlighted the importance of good patient-physician relationships in medical education. This study aimed to examine changes in medical students' attitudes before and after implementation of the CPX in their medical education curriculum. METHODS: In 2006 and 2009, 236 fourth-year medial students of C College of Medicine took the Patient Practitioner Orientation Scale (PPOS) by Krupet et al. (2000), which measures patient-centered attitudes in patient-physician relationships. The data were analyzed by independent t-test and two-way analysis of variance using SPSS 21.0. RESULTS: The PPOS scores of year 2006 students were 3.88+/-0.25 for males and 3.98+/-0.38 for females. For year 2009 students, males scored 3.81+/-0.42 and females scored 4.01+/-0.48. All students had higher Care scores than Share scores (2006: Share, 3.67+/-0.47 vs. Care, 4.19+/-0.51; 2009: Share, 3.56+/-0.34 vs. Care, 4.18+/-0.53). There were significant differences in PPOS and Share scores by gender before and after the CPX. With regard to Care scores, female students' scores tended to rise and males' scores declined over time. CONCLUSION: An educational program is needed for students to foster patient-centered attitudes, but gender differences should be taken into account.

Can a medical regulatory system be implemented in Korea?

The International Association of Medical Regulatory Authorities has suggested three roles for a country's medical regulatory authority: first, it should provide the graduates of medical schools and immigrant physicians licenses to practice in the country; second, it should provide high-quality educational and training programs to promote and maintain the health and safety of the public and ensure professionalism; third, it should resolve public complaints regarding medical practice so as to increase rapport between professionals and the public. In Korea, the first function has been performed by the National Health Personnel Licensing Examination Board. The second function has been executed by the Korean Medical Association as required by medical law since 2012. No authority has been designated to deal with the third function, so this role has been ceded to the legal market. There are three major reasons that the time has come to establish medical regulatory authority in Korea. First, to assure a minimum quality of medical service, more vigorous continuing medical education must be required for licensure. Second, specific and comprehensive preparation should be made available for medical professionals who immigrate, including physicians from North Korea. Third, the establishment of a regulatory authority is the easiest and most reasonable way to establish and promote a level of professionalism that is respected by the public. To establish a medical regulatory authority in Korea, not only physicians but also the government and the public should participate in discussions of this topic. The medical societies should lead the process of discussion, and the societies' agreement with any regulatory outcomes should be obtained.

Overview of medical student assessment: why, what, who, and how

The paper discusses various issues related to assessment in the context of the Arab world and focusing on 2 forms of assessment: multiple choice questions [MCQs] and objective structured clinical examinations [OSCEs]. The appropriate assessment system is determined by the content and method of teaching as well as the expected knowledge and skills of the final product, the health professional. Assessment motivates students to study hard. It is also used to make decisions on promotion of students. A good assessment system cannot be imported; it must be home grown taking into consideration the cultural, linguistic, and educational background of the students. Centralized assessment not under the immediate control of teachers in contact with the students is appropriate for standardized examinations like the United States Medical Licensure Examination [USMLE] but is associated with many challenges in internal examinations within the teaching institution: complicated logistics, marginalization of the teachers, and the injustice of treating un-equals as equals. Assessment covers the two components of medicine: the science and the art The MCQ format assesses knowledge and its applications. The OSCE format assesses practical skills. Writing good MCQ items takes a lot of effort and time to review but is easy to administer and score. The OSCE based on simulated patients [SP] has ably replaced the traditional long and short clinical cases but penalizes the advanced candidate who asks the SP questions off the script. I propose using SPs who actually had personal experience of the condition being tested. I also propose some items in the OSCE that are of critical knowledge for professionals and which should have higher scores assigned to them. Students should be failed in the whole examination if they do not know some of these critical items

U. S. acupuncturists qualification tests of clean needle technique (CNT) examination / 中国针灸

Clean needle technique (CNT) examination is required for all applicants seeking National Certification Commission for Acupuncture and Oriental Medicines' (NCCAOM) certification. CNT examination is one of compulsory subjects of certification of professional competence to practice acupuncture safely and effectively for the sake of the health and safety of the public, which is developed by the Council of Colleges of Acupuncture and Oriental Medicine (CCAOM). The uniform standard of practice for acupuncture, the content of CNT course, application procedure and the requirements of CNT examination are introduced in this paper.

Comparison of performance of graduates in traditional curriculum and graduates in an organ system integrated curriculum from the same medical school on the physician licensure examinations

Objective. To compare the performance of graduates in a traditional curriculum and graduates in an organ system integrated curriculum from the same school on the national medical licensure examination. Methods. The scores of graduates of the University of the Philippines Manila College of Medicine in 2008, taught in the traditional medical curriculum were compared with those of the scores of graduates in 2009, taught under the organ system integrated curriculum, on the Physicians Licensure Examination (PLE) conducted by the Professional Regulation Commission (PRC). Average scores, and scores per subject were compared using t-test. Results. The graduates of the organ system integrated curriculum (2009) had higher average scores than the graduates of the traditional curriculum (2008). The former also had higher scores in Physiology, Legal Medicine, Pathology, Surgery, Obstetrics and Gynecology, and Pediatrics. The scores of the 2 groups were not significantly different in Biochemistry, Anatomy, Pharmacology and Medicine. The graduates of the traditional curriculum had higher scores in Microbiology and Preventive Medicine. Conclusion. The graduates of the organ system integrated curriculum (2009) had better over all performance in the physician licensure examinations than the graduates of the traditional curriculum (2008).

Medical Council of India : the rot within.

The Medical Council of India is a statutory national agency charged with several responsibilities. Sadly, it is plagued by inefficiency, arbitrariness and lack of transparency. It has been functioning for some years as the fiefdom of one person - Dr Ketan Desai. He has been re-elected president of the council despite strictures against him by the High Court of New Delhi. This essay provides data that may help the reader identify the rot within the Council. Permitted optimism, we may hope that this essay and similar observations by others will prompt a change for the better.

The Relationship between Senior Year Examinations at a Medical School and the Korean Medical Licensing Examination / 한국의학교육

PURPOSE: Most medical schools prepare for the Korean medical licensing examination (KMLE) with various tests. By assessing the degree to which these exams and the KMLE are related, students, professors, and institutions can be well prepared and some schools use these exams as predictive tools for KMLE scores. Therefore, we determined the relevance of KMLE results to midterm exams and the objective structured clinical examination (OSCE), administered to senior students at a medical school. METHODS: From 2002 to 2004, KMLE results were compared with midterm examinations, the KMLE, and the OSCE. The total score, or T-score, of the KMLE was used, as was a pass or nonpass score. Windows SPSS 14.0 and MedCalc 9.0 were used for statistical analysis. RESULTS: The yearly correlation coefficient of the KMLE and school exams was highest for the midterm exams in 2002 and the KMLE in 2003 and 2004. The correlation coefficient of midterm exams and the KMLE were related to a high degree, yet the values were as low as that of the OSCE. Compared with the KMLE results, the sensitivity and specificity of the average midterm exam were 100.0% and 93.8%, and the sensitivity and specificity of the average trial exams were 100.0% and 95.8%, respectively. CONCLUSION: In conclusion, the KMLE results have a strong relationship with midterm exams, trial exams, and the combination of midterm and trial exams, but not with the OSCE. Thus, we believe that using both midterm exams and trial exams to predict KMLE results is superior to the use of only one type of school exam.