Monitoreo del impacto en la formación de especialistas en Medicina Intensiva y Emergencias en Matanzas / Monitoring the impact in the formation of specialist in intensive medicine and emergencies, Matanzas

Introducción: la evaluación y acreditación de la calidad en la formación de las especialidades médicas en Cuba, conceptualiza el monitoreo del impacto como el proceso dirigido a evaluar la correspondencia entre los objetivos del programa y los resultados alcanzados por sus participantes en el entorno social donde se desarrollan profesionalmente. Objetivo: aplicar la metodología diseñada para el monitoreo del impacto en la formación de las especialidades médicas en el Programa de Medicina Intensiva y Emergencias. Materiales y métodos: se realizó un estudio de corte pedagógico donde se aplicó la metodología diseñada en la Universidad de Ciencias Médicas de Matanzas, para monitorear el impacto en la formación de la especialidad de Medicina Intensiva y Emergencias, desarrollado en el Hospital Universitario Comandante Faustino Pérez Hernández. Participaron 6 egresados, 11 profesores, 8 tutores y 4 directivos de la última edición concluida (octubre de 2016 a noviembre de 2019). Resultados: se observó un alto impacto en la institución y mediano en el individuo, con contraste entre el diagnóstico inicial y durante la formación: de excelencia en el 100 % de los residentes, pero un diagnóstico final con 33,3 % excelente y 66,6 % bien. No se evaluó la etapa de transferencia o impacto en la sociedad, por el corto de tiempo de experiencia laboral de los egresados. Conclusiones:la metodología aplicada permitió conocer un mediano impacto en la formación de los egresados de Medicina Intensiva y Emergencias, por contrastación entre el diagnóstico inicial y durante la formación, de excelente con un diagnóstico final de bien (AU).

Introduction: the evaluation of the quality in the formation of the medical specialties in Cuba, conceptualize the monitored of the impact like the process directed to evaluate the correspondence among the objectives of the program and the results reached by their participants in the social environment where they are developed professionally, guaranteeing the relevancy of the program. Objective: to apply the methodology designed for the monitored of the impact in the formation of the medical specialties in the program of intensive Medicine and emergencies. Materials and methods: carried out a study of pedagogic court where the methodology was applied designed in the Medical University of Matanzas, for the monitored of the impact in the formation of the specialty of intensive Medicine and emergencies, developed in the university hospital "Faustino Pérez Hernández." They participated six graduate, four directives, 11 professors and tutors of the last concluded edition, from October of the 2016 to November of the one 2019. Results: a high impact was observed in the institution and medium in the individual, with a contrast among the initial diagnosis and during for formation of excellence in 100% of the residents, with a final diagnosis of 33,3% excellent and 66,6% well. It was not evaluated the transfer stage or impact in the society, for the short of time of labor experience of the graduate. Conclusions: the applied methodology allowed to know the medium impact in the formation of graduate in Intensive Medicine and Emergencies in Matanzas, for a contrast among the initial diagnosis and during the formation of excellent with the final diagnosis of well (AU).

Desarrollo histórico de la evaluación del impacto de la formación de especialidades médicas en Cuba / Develop historical of the evaluation of the impact in the formation of the medical specialties in Cuba

RESUMEN La evaluación en la formación surgió en el siglo XVII, buscando dar juicios de valor a las acciones y actitudes de los estudiantes, a la determinación sistemática del mérito, valor y significado del aspecto a evaluar en función de criterios y normas establecidas en aquella época. Su evolución desde lo conceptual y lo procesual tuvo la influencia de los paradigmas investigativos. Muchos han sido los modelos propuestos en el ámbito internacional para perfeccionar el proceso de evaluación de la calidad en la educación. Actualmente, se asocia el término "evaluación" con el término "impacto", usado con frecuencia como expresión del efecto de una acción determinada, con cambios o transformaciones generadas en las personas, organizaciones, procesos o productos. En Cuba, este proceso ha tenido diferentes etapas, pero no es hasta el siglo XXI que comienza a implementarse en el Sistema Universitario de Programas de Acreditación, actual Sistema de Evaluación y Acreditación de la Educación Superior, con el objetivo de lograr una mejora continua en la formación, acorde a los principios y exigencias de la sociedad socialista. Dentro del mismo, el Sistema de Evaluación y Acreditación de Especialidades de Posgrado desempeña un papel fundamental en el desarrollo de dicha figura del posgrado, teniendo una repercusión notable en el desarrollo de las ciencias médicas. Este artículo expone la evolución histórica de la evaluación de la calidad y su impacto en el proceso de formación de especialidades médicas en el país, como referente para futuras investigaciones (AU).

ABSTRACT Training assessment emerged in the 17 century, in search for giving value judgment to the students' actions and behavior, for systematic determining the worth, value and significance of the aspect to assess according to criteria and norms established at that time. Its evolution, from the point of view of the conceptual and process, received the influence of research paradigms. Many models have been proposed around the world to improve the process of quality assessing in the educational field. Currently, the term 'assessment' is associated to the term 'impact', frequently used as an expression of a determinate action's effect on changes or transformations in people, organizations, processes or products. This process has had different stages in Cuba, but only in the 21 century, the University System of Accreditation Programs (SUPRA by its acronym in Spanish) -currently known as Accreditation and Assessment System of High Education (SEAES by its acronym in Spanish)- has begun to be implemented, with the objective of achieving a better continuous training, according to the principles and demands of the socialist society. Among it, the Accreditation and Assessment System of Post-grade Specialties (SEA-EP by its acronym in Spanish), play an important role in the development of the post-grade figure, having a remarkable repercussion in the medical sciences. This article exposes the historical evolution of the quality assessment and its impact in the medical sciences training process in the country as a referent for subsequent researches (AU).

Comportamiento del proceso de evaluación externa de las especialidades médicas en la Universidad de Matanzas / Behavior of the external evaluation process of medical specialties at the University of Matanzas

RESUMEN Introducción: la acreditación en las especialidades de posgrado es la expresión de la calidad de un programa educativo. Establece entre sus procedimientos la autoevaluación de los propios ejecutores del programa y la evaluación externa, con vistas a la acreditación. Objetivo: describir según el patrón de calidad de El Sistema de Evaluación y Acreditación de las Especialidades de Posgrado, el comportamiento del proceso de evaluación externa para la acreditación de las especialidades médicas en la Universidad de Ciencias Médicas de Matanzas, en el 2018-2019. Materiales y métodos: se realizó un estudio de carácter exploratorio descriptivo, predominantemente cualitativo para describir el comportamiento de la evaluación externa de los programas de Formación de las Especialidades Médicas en la Universidad de Ciencias Médicas de Matanzas. Se aplicaron métodos teóricos como el análitico-sintético, inductivo-deductivo e histórico-lógico; así como empíricos y el de revisión documental. Resultados: se constató insuficiencias relacionadas con la obtención de grados científicos, bajo índice de publicaciones del claustro, insuficiente publicación de los resultados científicos de los estudiantes. Se evidenció que los indicadores evaluados se aproximan a los estándares establecidos por la metodología empleada. Conclusiones: durante el proceso de autoevaluación se identificaron fortalezas y debilidades de la universidad, para enfrentar el proceso de acreditación de las especialidades de posgrado. La elaboración del plan de mejora y su control suelen ser las vías idóneas para asegurar la gestión de la calidad y el resultado final obtenido (AU).

ABSTRACT Introduction: the accreditation of postgraduate specialties is the expression of quality of an educative program. Among its procedures, it establishes the auto-evaluation by the proper program executors and the external evaluation with a view to accreditation. Objective: to describe, according to the quality pattern on The System of Evaluation and Accreditation of Postgraduate Specialties, the behavior of the external evaluation process for the accreditation of medical specialties in the University of Medical Sciences of Matanzas, in 2018-2019. Materials and methods: a descriptive exploratory, predominantly qualitative study to describe the behavior of the external evaluation of the programs of Training Medical Specialties in the University of Medical Sciences of Matanzas. The used theoretical methods were the analytic-synthetic one, the inductive-deductive, and the historical-logical; empiric methods and documental reviewing were also used. Results: Insufficiencies were found related to obtaining scientific degrees, low publication rates of the training staff and poor publication of the students' scientific results. It was evidenced that the evaluated indicators were close to the standards set up for the used methodology. Conclusions: several strengths and weaknesses of the university to affront the accreditation process of the postgraduate specialties were found during the process of auto evaluation. The elaboration of the improvement plan and its control are usually the suitable ways to achieve the quality management and the final result (AU).

Modelo médico hegemónico: tendencias posibles y tendencias más o menos imaginarias / Hegemonic medical model: Possible trends, and more or less imaginary trends

RESUMEN El objetivo de este texto es analizar la posibilidad futura de que el modelo médico hegemónico siga perpetuándose o se generen cambios significativos. Para ello, se parte de las características y funciones actuales del modelo médico hegemónico y se las observa a través de algunos de los aportes de la inteligencia artificial, de las investigaciones genéticas y de la robótica, referidas a procesos de salud-enfermedad-atención-prevención, entre los que se analizan las posibilidades de fuertes incrementos en la esperanza de vida, las necesidades de "curar la senectud", así como los procesos que están modificando la relación médico-paciente, llegando a la conclusión de que si bien se observan algunas modificaciones sustantivas, las características y funciones del modelo médico hegemónico siguen siendo las mismas.

ABSTRACT The purpose of this article is to analyze the possibilities that the hegemonic medical model will continue to prevail in the future or if significant changes will take place. The discussion will take as a starting point the characteristics and current functions of the hegemonic medical model, and reexamine them through a look at advancements in artificial intelligence, genetic research, and robotics in health-illness-care-prevention processes. The analysis takes on issues such as possible increases in life expectancy, what is needed to "cure old age," as well as processes that are modifying the doctor-patient relationship. It is concluded that although significant changes are taking place, the characteristics and functions of the hegemonic medical model remain unmoved.

Salud e Internet: nuevo escenario para la práctica médica / Health and Internet: a new setting for clinical practice

El autor desarrolla y reflexiona sobre el uso de Internet como fuente de información médica, analizando los beneficios y potenciales perjuicios de este nuevo escenario de práctica médica al que nos enfrentamos los profesionales de la salud. (AU)

The author develops and reflects on the use of the Internet as a source of medical information, analyzing the benefits and potential harms of this new setting of medical practice that we face as health professionals. (AU)

El cambiante escenario de la práctica de la medicina y su impacto sobre la salud mental de los médicos: alarmantes señales para los cardiólogos / The changing scenario of the practice of medicine and its impact on the physicians mental health: alarming signs for cardiologists

The introduction of digital technology in Medicine has brought enormous diagnostic and therapeutic advances but also has impacted the practitioner's welfare and important aspects of practice such as patient-physician relations. It has been alarming the increasing reports of physicians and nurse's burnout and associated mental disturbances such as depression and suicidal ideation. Increasing administrative burden brought to the practitioners by the need to document by digital technology patients' encounters has reduced the time of patient-physician relation and substituted by a longer time spend by the provider interacting with a computer. This represents probably one of the major causes of frustration and burnout consequences among health providers, as reported by a recent National Academy of Medicine review, a Mayo Clinic Proceedings study published in 2019, several recent Medscapes physicians surveys and by a panel discussion in the 2018 European Congress of Cardiology among many other publications. Many factors are indeed at play in this complex scenario such as government, payers, hospital facilities rules and regulations, and the way to modify them to create a more provider friendly environment may be long and difficult. Nevertheless, a first step to be considered is to reduce the administrative burden of the providers to free more time for them with their patients The future role of using diagnostic and therapeutic algorithms, some of them already available, to develop platforms of patient management with a reduced or minimal medical provider force is still uncertain and likely subject to controversial value and ethical considerations.

O vitalismo hipocrático de Canguilhem / Canguilhem's Hippocratic vitalism

Resumo O vitalismo canguilhemiano não é evidente, tampouco é uma forma mais conhecida desse tipo de pensamento; não nasce das antigas diatribes que, do século XVIII, invadiram as polêmicas do XIX. Canguilhem reabilita o vitalismo a partir de uma abordagem ontológica única, para a qual ele não hesita em referenciar-se nos antigos e, de modo geral, num Hipócrates que, lido sobretudo por meio da história escrita por Charles Singer, traz à tona outros temas, como a crítica ao conceito de homeostase revivido e nomeado por Walter Cannon. Canguilhem redimensiona a homeostase hipocrática que Cannon cientificizou, dando-lhe uma mobilidade que lhe é conceitualmente essencial, e redesenha o projeto do vitalismo, recusando-lhe a antítese do mecanicismo. Dessa forma, Canguilhem foi buscar ou se respaldar num Hipócrates lido pelos historiadores da medicina (e das ciências biomédicas). Este artigo procurou mapear a contribuição de longa duração de Georges Canguilhem para o discurso médico, bem como seu papel fundador de uma nova concepção de normalidade a partir da sua concepção de vitalismo, que, para ele, é herdeira de um "espírito hipocrático".

Abstract Canguilhem's vitalism is not obvious, neither does is consist of a more known form of this type of thinking; it does not come from the old diatribes that, coming from the 19th century, are still relevant to the 20th century's discussions. Canguilhem reclaims vitalism from a unique ontological approach, and does not hesitate to allude to the classics and, most of all, to a Hippocrates that, read mainly through the perspective of the history written by Charles Singer, brings to light other themes such as the critic to the concept of homeostasis revitalized and named by Walter Cannon. Canguilhem gives another perspective to Hippocrates' homeostasis, that was "scientified" by Cannon, giving it mobility that is considered essential to its concept and redraws the vitalism project, rejecting the place of mechanism antithesis. This paper aimed to map Canguilhem's longue durée contribution to the medical discourse, as well as his funding role of a new conception of normality formulated from his own interpretation of a vitalism that, in his point of view, comes from a "Hippocratic spirit".

Medicina evolucionista en terapia intensiva: un nuevo paradigma / (Evolutionary medicine in critical care: a new paradigm)

Resumen Los avances tecnológicos han permitido la supervivencia de pacientes críticamente enfermos que hubieran fallecido de manera inevitable. No obstante, muchas de las medidas de este tratamiento intensivo son riesgosas y con un alto costo material y de esfuerzo humano. La medicina evolucionista es una tendencia mundial que propone que un alto número de alteraciones del paciente corresponden a respuestas de adaptación con el objetivo de la supervivencia y no requieren obligatoriamente de su normalización. En el caso del paciente críticamente enfermo, este enfoque es innovador y podría conducir a una medicina crítica orientada al reconocimiento de estas respuestas adaptativas y su modulación. Esta nueva forma de interpretar las manifestaciones de la enfermedad puede tener importantes repercusiones en su tratamiento y una utilización más racional de los recursos. La aplicación de este paradigma puede mejorar los resultados hasta ahora no óptimos, en condiciones como shock séptico, en las que medidas consideradas como lógicas o racionales han sido inefectivas. Se presenta una revisión sobre los principios de esta tendencia, evidencia que la apoya, algunas hipótesis sobre su aplicación en casos concretos y sus limitaciones.

Abstract Technological advances have allowed the survival of critically ill patients who otherwise would have inevitably died. However, many of the measures of this intensive treatment are risky and with a high material cost and human effort. Evolutionary medicine is a worldwide trend that proposes that a high number of patient alterations correspond to adaptation responses with the aim of survival and do not necessarily require their normalization. In the case of the critically ill patient, this approach is innovative and could lead to a critical medicine aimed at the recognition of these adaptive responses and their modulation. This new way of interpreting the manifestations of the disease can have important repercussions in its treatment and a more rational use of resources. The application of this paradigm can improve the results so far not optimal, in conditions such as septic shock, in which measures considered logical or rational have been ineffective. This review presents the principles of this trend, the supporting evidence, some hypotheses about its application in specific cases as well as its limitations.

Uma categorização analítica para estudo e comparação de práticas clínicas em distintas racionalidades médicas / An analytical categorization for the study and comparison of clinical practices in distinct medical rationalities

Resumo Este artigo apresenta uma categorização analítica de encontros clínicos para investigações comparativas de práticas clínicas em diferentes sistemas médicos, de forma equidistante deles. Ela foi concebida como um tipo ideal weberiano e norteada pela dinâmica da eficácia simbólica proposta por Lévi-Strauss. Postularam-se seis movimentos como constituintes dos encontros clínicos em geral: (1) acolhida do usuário; (2) escuta das demandas; (3) investigação do problema; (4) elaboração da interpretação diagnóstica; (5) socialização do diagnóstico; e (6) elaboração, consensuação e execução da terapêutica. Tais movimentos podem ser associados com as dimensões das racionalidades médicas, conforme Madel Luz (cosmologia, doutrina, fisiologia, morfologia, sistemas diagnóstico e terapêutico), e permitem descrição, análise e comparação de práticas clínicas norteadas por uma racionalidade médica. Assim, este instrumento analítico pode facilitar a investigação e compreensão das abordagens de distintos sistemas médicos, contribuindo para a compreensão e comparabilidade das suas práticas clínicas e de sua eficácia.

Abstract This article presents an analytical categorization of clinical encounters for comparative equidistant investigations of clinical practice in different medical systems. This categorization was conceived as an ideal Weberian type, guided by Levi-Strauss's dynamics of symbolic effectiveness. We conceptualized six constituent movements of clinical encounters: (1) user's acceptance; (2) demand listening; (3) problem investigation; (4) diagnosis elaboration and interpretation; (5) socialization of interpretation; and (6) therapy elaboration, agreement and implementation. These constituent movements can be associated with Madel Luz's medical rationality dimensions (cosmology, doctrine, physiology, morphology, diagnostic and therapeutic systems), allowing the description, analysis and comparison of various clinical practices, guided by one or more medical rationalities. Therefore, this analytical instrument could facilitate the investigation and understanding of clinical practices within different medical systems, contributing to both comparability of different medical practices and to its general effectiveness.

Percepção de docentes e de estudantes sobre a presença dos determinantes sociais de saúde no currículo de uma escola de medicina / Students ' and professors ' perception of the presence of social determinants of health in the curriculum of a medical school

Num panorama de desigualdade e iniquidade sociais crescentes, considerar a saúde como sendo um direito fundamental e buscar o idealizado bem-estar físico, mental e social passa por decisões relacionadas às esferas governamentais, institucionais e da comunidade, que tem influência direta dos determinantes sociais da saúde (DSS). Pensando-se no papel das instituições de educação superior e o processo de formação do médico, sua complexidade exige estratégias diversas para que esse profissional possa trazer melhores respostas às necessidades de saúde da população. Para tanto, tenta-se intervir em diversos eixos, tanto em relação à legislação, adaptando os currículos às Diretrizes Curriculares Nacionais, quanto por meio de novas pedagogias de aprendizado, que via problematização fazem uma aproximação teórico-prática. O estudante passa a ter oportunidade de aprender sobre os determinantes sociais de saúde, saindo-se de um modelo de formação puramente biomédica, para uma visão crítica, reflexiva e associada à responsabilidade social. As experiências curriculares podem trazer respostas enriquecedoras condizentes com o ideal de saúde proposto. Utilizando-se a Escola Superior de Ciências da Saúde (ESCS) de Brasília, com seu cenário de ensino na atenção primária, desenvolvida no eixo Interação Ensino Serviço e Comunidade (IESC), buscou-se compreender a percepção sobre a presença do tema dos determinantes sociais de saúde sob a ótica dos estudantes e docentes do curso de medicina dessa instituição. Realizou-se uma pesquisa qualitativa, com análise documental do Projeto político-pedagógico da escola e dos manuais do IESC, além de análise de conteúdo de entrevistas semiestruturadas, com foco na percepção dos docentes e discentes. Frente a experiências curriculares que buscam o foco no desenvolvimento de responsabilidade social da instituição, bem como com a inserção dos temas dos determinantes sociais de saúde, encontrou-se nos documentos uma necessidade de aprofundamento teórico e uma melhor correlação teórico-prática das atividades. Frente às percepções dos docentes e estudantes, identificou-se como fortalezas o cenário de atenção primária e sua complexidade como ideal para desenvolver-se o conhecimento sobre os DSS. A diversidade de cenários propicia um aprendizado significativo para além dos conteúdos puramente biomédicos, desenvolvendo empatia e visão mais integrada e ampla sobre o papel do médico e a necessidade da interprofissionalidade para a oferta de cuidados de qualidade em saúde. Como aspectos a serem melhorados, foram pontuados a necessidade de melhor correlação teórico-prática ao longo do currículo e de outros eixos, a melhor capacitação docente e o aproveitamento de temas correlacionados como a violência e a desigualdade, vivenciadas nas visitas domiciliares, mas ainda com sistematização e uniformidade necessárias para qualificar o aprendizado e a formação médica. O estudo deixa ainda como sugestão de abordagem futura a inclusão da percepção da comunidade e de outros profissionais de saúde. Esta dissertação espera trazer elementos que colaborem com o desenvolvimento de um currículo de medicina voltado para a maior responsabilidade social

In an increasingly socially unequal and inequitable context, considering health as an essential right and pursuing the idealized physical, mental and social welfare involve governmental, institutional and communal decisions, and the community is directly influenced by Social Determinants of Health (SDH). Considering the role of higher education institutions and the doctor education process, its complexity requires several strategies so that these professionals can further address the population's health needs. In order to do so, there is an attempt to intervene in several levels, regarding both legislation, through the adaptation of the curricula to the National Curriculum Guidelines, and new learning pedagogical methods, which make a theoretical-practical approach through problematization. Students then have the opportunity to learn about the social determinants of health, emerging from a purely biomedical education into a critical, reflective perspective, connected with social responsibility. Curricular experiences can bring enriching answers consistent with the health ideal proposed. This work was developed at Escola Superior de Ciências da Saúde (ESCS), an institution located in Brasília and whose teaching background is centered on the primary care, developed on the Education-Service-Community Interaction (IESC) level, and its objective was to understand the perception on the theme of social determinants of health held by medicine students and professors from the aforementioned institution. A qualitative research was developed with the documental analysis of the institution's political-pedagogical Project and IESC's guidebooks, in addition to content analysis of semi-structured interviews focused on students' and professors' perception. In view of curricular experiences that intend to address the institution's development of social responsibilities, as well as the inclusion of the theme of social determinants of health, a need for a deeper theoretical development and a better correlation between theory and practice in the activities was observed in the documents. After analyzing the perceptions of students and professors, the primary care setting and its complexity as an ideal to broaden knowledge on SDH were identified as strong points. The diversity of settings offers a significant learning experience that goes beyond purely biomedical contents, developing empathy and a more integrated and broader perspective on the role of doctors and the need for interprofessionality in order to provide high-quality healthcare. The following elements were identified as improvement points: the need for a better correlation between theory and practice throughout the curriculum and other levels, a better teacher training and the exploration of correlated themes such as violence and inequality, experienced in home visits, although it still needs systematization and uniformity to qualify the learning and the medical education. The study also suggests the inclusion of the community's and other healthcare professionals' perception in a future approach. This essay aims to contribute to a social responsibility driven medical curriculum development

Desarrollo de la Gastroenterología en Matanzas / Development of the Gastroenterology in Matanzas

El origen e historia de los hechos, son olvidados en ocasiones con el desarrollo vertiginoso de la sociedad, que se desarrolla progresivamente, sin pensar que ese desarrollo es producto de una correcta planificación de los recursos humanos y materiales por aquellos que dedicaron su vida, con esperanza y afán, al ejercicio de una profesión que requiere de tanto humanismo y sensibilidad como es la Medicina. Con este trabajo se pretendió exponer brevemente el desarrollo de la Gastroenterología en Matanzas y de esta manera rendir merecido homenaje a especialistas que, aunque muchos ya no están físicamente o simplemente no forman parte de los colectivos de trabajo que hoy continúan sus obras, merecen ser nombrados por su destacada labor en el desarrollo de esta especialidad en la provincia con el respeto que se han ganado (AU).

The origin and history of the events are occasionally forgotten due to the vertiginous development of the society that develops progressively without discerning that development is the product of the correct materials and human resources planning made by those who devoted their lives, with hope and eagerness, to a profession requiring so much humanism and sensibility as Medicine. This work was aimed to shortly expose the development of Gastroenterology in Matanzas, and that way to render homage to those specialists, that even if they are not already alive, or at the present are not part of the working collectives that today continue their work, deserve to be remembered because of their important contribution to the development of this specialty in the province (AU).

Ángel Florencio Duque Pérez, microbiólogo colombino / Ángel Florencio Duque Pérez, a Colombinan microbiologist

Muchos han sido los médicos cubanos que se han dedicado al estudio de la microbiología médica, entre ellos algunos muy conocidos como el matancero Juan Guiteras Gener. Con este trabajo los autores pretendieron resaltar la figura del microbiólogo colombino Ángel Florencio Duque Pérez, primer microbiólogo matancero formado por la revolución y con una esmerada labor. Fallecido hace varios años, este excelente profesional es poco conocido y prácticamente ha quedado en el olvido. Para todos aquellos que lo conocieron y para los que no tuvieron ese enorme placer se les hace llegar esta síntesis biográfica (AU).

There have been many Cuban doctors who have devoted themselves to the study of Medical Microbiology, including well-known ones as the Matanzasan Juan Guiteras Gener. With this work the authors pretended to highlight the figure of the Colombinan microbiologist Florencio Angel Duque Pérez, the first microbiologist trained after the Revolution, with an important work. Deceased several years ago, this excellent professional is scarcely known and has been virtually forgotten. This biography is intended to all those who knew him and to all those who did not have that great pleasure (AU).

Usos diversos de los epónimos en Medicina / Various uses of eponyms in Medicine

Los epónimos vienen siendo utilizados desde hace siglos. Su uso habitual constituye una de las características del lenguaje de las ciencias médicas y está extendido a todas las especialidades, formando parte de su cultura y de la historia de la Medicina. Se abordan los epónimos en el campo de varias especialidades médicas, así como el debate científico a favor y en contra de su uso, considerando que no son pocas las voces que apoyan su erradicación total; esto es algo que todavía resulta difícil pensar, ya que se cree que los epónimos aportan más de lo que podrían ofrecer otros recursos lingüísticos. Se reconoce la existencia de epónimos cubanos, que no se han estudiado lo suficiente (AU).

Eponyms have been used during centuries. Their common use is one of the characteristics of the medical sciences language, reaches all the specialties, and is part of the Medicine culture and history. The use of eponyms in the field of several medical specialties is approached and also the scientific dispute in favor or against their use, taking into consideration that no few voices back their total eradication; it is still something difficult to understand because it is believed that eponyms are more fruitful than what is offered by other linguistic resources. The existence of Cuban eponyms that are still not sufficiently studied is recognized (AU).

¿Tiene cabida, hoy, el "privilegio terapéutico"? / Does therapeutic privilege have a place in modern medicine?

During the last years, bioethical discussion has highlighted the role of the patients' autonomy, being informed consent its particular expression, about decisions that they should make about their own health. The Hippocratic tradition, the deontological positions of the Geneva Declaration of the World Medical Association and numerous codes of ethics in various countries, require that the physician, above all, should ensure patients' health. In this context the discussion on pros and cons for the so-called "therapeutic privilege" are discussed. The "therapeutic privilege" refers to the withholding of information by the clinician during the consent process in the belief that disclosure of this information would lead to harm or suffering of the patient. The circumstances and conditions in which this privilege can become valid are discussed. Special reference is made in order to respect multiculturalism and to the possibility of obtaining advice from health care ethics committees. The role of prudence in the doctor-patient relation must be highlighted. Disclosure of information should be subordinated and oriented to the integral well-being of the patient.

Procesos de Acreditación de la Formación de Posgrado de Carreras de Salud en Argentina. Hacia la Consolidación de un Sistema Articulado / Accreditation Processes of Postgraduate Training Health Careers in Argentina. Towards the Consolidation of an Articulated System

Introducción: El título de grado de médico es habilitante para el ejercicio de la profesión en cualquier especialidad. No obstante, la mayoría de los médicos egresados eligen continuar su formación de posgrado. La misma incluye las carreras de especialidades, maestrías y doctorados, dependientes de Educación, y las Residencias, dependientes de Salud. Existen carreras de especialista universitario que están asociadas a residencias. Algunas debieron pasar por un doble proceso de evaluación, tanto por parte de la CONEAU, como por parte del SNARES. Estas situaciones evidencian la necesidad de consolidar un sistema integrado de acreditación para la formación de médicos especialistas, que se oriente a alcanzar similares estándares de calidad en la formación. Objetivo: Establecer los procesos necesarios para la construcción de un sistema de acreditación conjunta de las Carreras de posgrado de Especialista Universitario en el campo de la salud que funcionan en asociación con una Residencia del Sistema Nacional de Residencias de Equipo de Salud. Metodología: La presente investigación se planteó como un estudio de implementación, de diseño cualitativo, en el que utilizaron una variedad de técnicas de recolección de datos. Se analizó la normativa y los procesos de acreditación llevados adelante por el SNARES, sobre las residencias, como por la CONEAU, sobre las carreras de especialista universitario, en todo el ámbito nacional. El análisis empírico de casos en donde tuvo lugar un doble proceso de acreditación por estar asociada una carrera a una Residencia, se realizó sobre una muestra definida en relación con los hallazgos de la primera etapa del estudio. Resultados y conclusiones: Pensar en un sistema de acreditación integrado requiere revisar los procesos de definición de una política de formación de especialistas médicos que garantice criterios de equidad y de calidad en todo el territorio. La cantidad de carreras de especialización universitaria asociadas a Residencias es aun marginal en relación con la cantidad de sedes de Residencia a nivel nacional. Se visualiza como el requisito fundamental la necesidad de consolidar políticas a nivel del Estado. En la evaluación de las formaciones se evidenció la posibilidad de unificar los procedimientos para las evaluaciones. Y la necesidad de consensuar estándares diferenciados por especialidad.(AU)

Background: A degree of medical doctor authorizes professional practice. However, most physicians choose to continue their post graduate training through residencies or university specialist careers. There are specialist careers associated to residencies which undergo a double evaluation process before certification entities of both systems (CONEAU and SNARES). The need to investigate if it is possible to count with a certification integrated system for them is shown. Purpose: To establish the processes for developing a joint certification system of both university specialist careers and medical residencies. Methods: qualitative design, implementation research. A variety of data collection techniques and interviews to key informants were used. Regulation was analyzed, the universe of specialist careers and medical residencies as well as certification processes performed on associated training were surveyed. Results: Characteristics of both certification systems are linked to the origin of each training system. The development degree of the regulation is consistent with the age of each certification system. The number of university specialization careers associated to residencies is marginal as regards the number of residencies at a national level. There is wide consensus among actors about the need and possibility to articulate both systems. Certification analysis showed the technical feasibility to join evaluation procedures progressively and the need to develop common standards for each specialty. Conclusions: The analysis regarding an integrated certification system leads to review the creation processes of medical specialist training policies, with equity, quality and territorial criteria as well as the importance of building consensus among training actors.(AU)