Family and Community Medicine in Uruguay from 1997 to 2019: how many kilometers will it take to reach that town? / La Medicina Familiar y Comunitaria en Uruguay de 1997 a 2019: ¿cuántos kilómetros faltarán para llegar al pueblo aquel?

The Family and Community Medicine Residency started in Uruguay in 1997. Through a self-managed process, the first generations were molded into training that integrated hospital knowledge and experience with territorial praxis in a community-based health service with a population of reference. The academic recognition of the specialty and the installation of the institutional areas for its management were achievements parallel to that process in the first decade. The second decade was marked by the territorial teaching-assistance expansion in the country, university decentralization and the active participation of Family and Community Medicine in the Health Reform, and the country's rights agenda. The third decade of the specialty begins with a crisis triggered by the sustained decline in the aspiration for residency. An initial approach to explanations reflects on the possibility of facing a more profound crisis and the need to find the keys to a 21st century Medicine that allows us to achieve the principles of Alma-Ata that are still current.

La residencia de medicina familiar y comunitaria comenzó en Uruguay en el año 1997. A través de un proceso autogestionado, las primeras generaciones se moldearon en una formación que integraba en ellos el conocimiento y la experiencia hospitalarios junto con la praxis territorial en un servicio de salud de base comunitaria con población de referencia. El reconocimiento académico de la especialidad y la instalación de los ámbitos institucionales para su gestión fueron conquistas paralelas a ese proceso en la primera década. La segunda década estuvo marcada por la expansión territorial de la estructura docente-asistencial, la descentralización de la universidad y la participación activa de la medicina familiar y comunitaria en la reforma de la salud y la agenda de derechos. La tercera década de la especialidad se presenta en su inicio como crisis dada por la caída sostenida en la aspiración a la residencia. Desde una aproximación inicial a las explicaciones, se reflexiona sobre la posibilidad de estar frente a una crisis más profunda y la necesidad de encontrar las claves de una medicina del siglo XXI que permita alcanzar los principios de Alma Ata, siempre vigentes.

La Medicina Familiar y Comunitaria en Uruguay de 1997 a 2019: ¿cuántos kilómetros faltarán para llegar al pueblo aquel? / Family and Community Medicine in Uruguay from 1997 to 2019: how many kilometers will it take to reach that town?

Resumen La residencia de medicina familiar y comunitaria comenzó en Uruguay en el año 1997. A través de un proceso autogestionado, las primeras generaciones se moldearon en una formación que integraba en ellos el conocimiento y la experiencia hospitalarios junto con la praxis territorial en un servicio de salud de base comunitaria con población de referencia. El reconocimiento académico de la especialidad y la instalación de los ámbitos institucionales para su gestión fueron conquistas paralelas a ese proceso en la primera década. La segunda década estuvo marcada por la expansión territorial de la estructura docente-asistencial, la descentralización de la universidad y la participación activa de la medicina familiar y comunitaria en la reforma de la salud y la agenda de derechos. La tercera década de la especialidad se presenta en su inicio como crisis dada por la caída sostenida en la aspiración a la residencia. Desde una aproximación inicial a las explicaciones, se reflexiona sobre la posibilidad de estar frente a una crisis más profunda y la necesidad de encontrar las claves de una medicina del siglo XXI que permita alcanzar los principios de Alma Ata, siempre vigentes.

Abstract The Family and Community Medicine Residency started in Uruguay in 1997. Through a self-managed process, the first generations were molded into training that integrated hospital knowledge and experience with territorial praxis in a community-based health service with a population of reference. The academic recognition of the specialty and the installation of the institutional areas for its management were achievements parallel to that process in the first decade. The second decade was marked by the territorial teaching-assistance expansion in the country, university decentralization and the active participation of Family and Community Medicine in the Health Reform, and the country's rights agenda. The third decade of the specialty begins with a crisis triggered by the sustained decline in the aspiration for residency. An initial approach to explanations reflects on the possibility of facing a more profound crisis and the need to find the keys to a 21st century Medicine that allows us to achieve the principles of Alma-Ata that are still current.

[The history of the decree on the Department of ambulatory care and community medicine]. / La Policlinique médicale universitaire de Lausanne : aperçu historiquede son cadre législatif et politique.

In 1957 the Grand Council of Vaud adopted a decree aiming to clarify the administrative situation of the Department of ambulatory care and community medicine created in 1887 under the name of central dispensary. The new decree confirms the special status of the Department of ambulatory care and community medicine, which becomes a public-law institution. This article reviews the context and the stakes of this legal evolution.

C'est en 1957 que le Grand Conseil vaudois adopte un décret visant à clarifier la situation administrative de la Policlinique médicale universitaire, créée en 1887 sous le nom de dispensaire central. Le nouveau décret entérine le statut particulier de la Policlinique qui devient un établissement de droit public. Cet article revient sur le contexte et les enjeux de cette évolution juridique.

25 Años de comunicación y salud / No disponible

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Centros de Saúde: ciência e ideologia na reordenação da saúde pública no século XX / Health Centers: science and ideology in the re-organization of public health in the twentieth century

Os Centros de Saúde surgem nos EUA em torno de 1910, com caráter de assistência social adida a algum serviço médico. Sua separação inicial entre medicina preventiva e curativa foi superada pela medicina integral na década de 1940, quando o discurso dos Centros de Saúde se insere na educação médica. Nos anos 1960 a visão de combate à pobreza daria ensejo à medicina comunitária. No Brasil este ideário foi difundido desde a década de 1920 e fortalecido pela política varguista de construção nacional. Mas foi o Serviço Especial de Saúde Pública o maior responsável por lhe conferir forma prática e conceitual no país.

Health Centers appeared in the United States around 1910. They provided social assistance in conjunction with some type of medical care. Their original separation between preventive and curative medicine was superseded by the concept of whole health in the 1940s, when Health Center discourse became part of medical education. In the 1960s, the notion of community medicine arose out of the war on poverty. These ideas spread through Brazil in the 1920s and were strengthened under the Vargas policy of national construction, but it was the Serviço Especial de Saúde Pública (Special Public Health Service) that was primarily responsible for lending them their practical and conceptual shape in this country.

Centros de Saúde: ciência e ideologia na reordenação da saúde pública no século XX / Health Centers: science and ideology in the re-organization of public health in the twentieth century

Os Centros de Saúde surgem nos EUA em torno de 1910, com caráter de assistência social adida a algum serviço médico. Sua separação inicial entre medicina preventiva e curativa foi superada pela medicina integral na década de 1940, quando o discurso dos Centros de Saúde se insere na educação médica. Nos anos 1960 a visão de combate à pobreza daria ensejo à medicina comunitária. No Brasil este ideário foi difundido desde a década de 1920 e fortalecido pela política varguista de construção nacional. Mas foi o Serviço Especial de Saúde Pública o maior responsável por lhe conferir forma prática e conceitual no país. (AU)

Movimentos de mudança na formação em saúde: da medicina comunitária às diretrizes curriculares / Changing movements in health higher education: from community medicine to the activators course

Este ensaio busca refletir as diversas iniciativas pró-mudança na formação superior em saúde implantadas no Brasil. Esta análise histórica faz-se necessária tendo em vista a importância da sistematização e difusão das experiências anteriores para o auxilio na construção das novas propostas pró-mudança. Estamos hoje refletindo sobre processos ativos de ensino-aprendizagem por termos vivenciado propostas como a da Medicina Comunitária, o Projeto de Integração Docente Assistencial, o Programa UNI, o movimento da Rede UNIDA, a Lei de Diretrizes Curriculares, Educação Permanente em Saúde e o Curso de Ativadores. Avançamos a partir da construção da tentativa anterior. Não é necessária a descoberta da roda a todo momento. Ela pode ser adaptada e voltar a girar. O olhar para as experiências do passado e para as necessidades do presente ajuda na construção do futuro almejado.

This paper aims to ponder over the various pro-change initiatives in health higher education in Brazil. A historical analysis is needed since prior experiences systematization and diffusion are important on attempting to build new pro-change proposals. Today we are pondering over active processes of teaching-learning because we have experienced proposals such as Community Medicine, the Professor Integrative Assistence Project, the PROUNI Program, the Rede UNIDA movement, the Curricular Guideline Law, Permanent Education in Health and the Activators' course. There is no need to discover the wheel all the time. It can be adapted and start to spin again. Taking a look into the past experiences and into the present needs helps in building a desirable future.

[N. I. Teziakov's contribution to the development of community medicine and sanitation in the Saratov Province (on the occasion of the 150th anniversary of his birth)].

The paper provides N. I. Tezyakov's concise biographical and historical data pertaining to a sanitary service in the Saratov Province. It shows his scientific contribution to the development of community medicine and sanitation in Russia.

La formación del especialista en medicina familiar y comunitaria y los niveles de responsabilidad para gestionar emergencias / No disponible

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O processo do trabalho do agente comunitário de saúde e a construção da integralidade: histórico e a política nacional de atenção básica / The process of the work of the communitarian agent of health and the construction of the completeness: description and the national policy of basic attention

Busca realizar dois movimentos: o primeiro seria um resgate histórico do trabalho e formação dos agentes comunitários e o outro seria, a partir da leitura da nova Política de Atenção Básica, fazer algumas considerações sobre o processo de trabalho do Agente Comunitário de Saúde (ACS) na Equipe de Saúde da Família (ESF), sob a perspectiva da construção da integralidade. Enfatiza que o objetivo principal é contribuir para o debate sobre a formação técnica dos Agentes Comunitários de Saúde no Brasil.

O processo do trabalho do agente comunitário de saúde e a construção da integralidade: histórico e a política nacional de atenção básica / The process of the work of the communitarian agent of health and the construction of the completeness: description and the national policy of basic attention

Busca realizar dois movimentos: o primeiro seria um resgate histórico do trabalho e formação dos agentes comunitários e o outro seria, a partir da leitura da nova Política de Atenção Básica, fazer algumas considerações sobre o processo de trabalho do Agente Comunitário de Saúde (ACS) na Equipe de Saúde da Família (ESF), sob a perspectiva da construção da integralidade. Enfatiza que o objetivo principal é contribuir para o debate sobre a formação técnica dos Agentes Comunitários de Saúde no Brasil (AU)

Teaching community, occupational and family medicine at the National University of Singapore: past, present and future.

INTRODUCTION: We describe how the curriculum of community, occupational and family medicine (COFM) has evolved in response to social and educational forces and local health needs. Challenges in the teaching of the curriculum are also discussed. CURRICULUM: The COFM Department aims to produce medical undergraduates and graduates with the skills to critically appraise evidence, prevent and manage diseases, and promote health in the community and primary healthcare setting. Its teaching programmes consist of the medical undergraduate programme and the Master of Medicine programmes in Occupational Medicine, Public Health and Family Medicine. The undergraduate modules consist of evidence-based medicine, public health in the community, disease prevention and control, occupational medicine practice, health promotion and behaviour, and communication with patients. The university's first completely online module on SARS was jointly implemented by the Department and the Centre for Instructional Technology for the entire student population last year. The COFM curriculum has shifted from giving students factual information through lectures to developing students' critical thinking and problem-solving skills through small group teaching, case studies and community health projects. Innovative assessment methods such as open-book examinations; objective structured communication stations with simulated patients; and evaluation of students' participation in group work are used to assess students' skills in problem-solving, communication and teamwork respectively. CONCLUSION: While the Department has made significant progress in developing a relevant and updated curriculum based on appropriate learning and assessment approaches, it will strive to do more to develop students' critical thinking skills by using newer approaches.