The ties that bind: Social network analysis describes the social element of medical workforce recruitment to rural/remote Australia.

We present the argument that medical recruitment to a previously under-recruited remote town was effected through what Social Network Analysis (SNA) measures as "brokerage" which operates amidst "structural holes". We proposed that medical graduates being generated by the national Rural Health School movement in Australia were particularly affected by the combined effect of workforce lacks (structural holes) and strong social commitments (brokerage) - all key SNA concepts. We therefore chose SNA to assess whether the characteristics of RCS-related rural recruitment had feature that SNA might be able to identify, as operantly measured using the industry-standard UCINET's suite of statistical and graphical tools. The result was clear. Graphical output from the UCINET editor showed one individual as being central to all recently recruited doctors to one rural town with recruitment issues like all the others. The statistical outputs from UCINET characterised this person as the single point of most connections. The real-world engagements of this central doctor were in accord with the description of brokerage, a core SNA construct, relationship with reported the reason for these new graduates both coming and staying in town. SNA thus proved fruitful in this first quantification of the role of social networks in drawing new medical recruits to particular rural towns. It allowed description at the level of individual actors with a potent influence on recruitment to rural Australia. We propose these measures could be helpful as key performance indicators for the national Rural Clinical School programme that is generating and distributing a large workforce in Australia, which appears from this work to have a strong social basis. This redistribution of medical workforce from urban to rural is needed internationally.

Análise situacional de uma clínica-escola de Fonoaudiologia de uma universidade federal da Bahia: um enfoque sobre os problemas / Situational analysis of a Speech, Hearing and Language clinical school at a federal university in Bahia: a focus on problems

Resumo Trata-se de uma análise situacional de uma clínica-escola de Fonoaudiologia de uma universidade federal da Bahia no que tange ao seu funcionamento e à articulação com a rede municipal de saúde de Salvador-BA. Estudo de caso descritivo, cuja estratégia metodológica foi baseada no Enfoque por Problemas na perspectiva do Planejamento Estratégico Situacional (PES), de Carlos Matus. A investigação empregou como estratégia metodológica a análise documental, a observação participante, entrevistas semiestruturadas e grupo focal com os atores institucionais. Os resultados apontaram fragilidades em quatro das cinco categorias de análise, quais sejam: infraestrutura, financiamento, organização e gestão, o que remete a fragilidades no processo de formação dos discentes e na integração da Instituição com a rede municipal de saúde. Dos vinte problemas identificados, dez encontram-se dentro da capacidade de governo e dentro da governabilidade dos atores institucionais, ou seja, são passíveis de intervenção pelos atores institucionais. Conclui-se que a clínica-escola deve institucionalizar a prática do planejamento estratégico situacional para combater a improvisação de ações e conseguir cumprir com efetividade suas duas importantes funções: ensino e atenção à saúde.

Abstract This work describes a situational analysis of a Speech, Hearing and Language clinical school at a federal university in Bahia, examining how it functions and coordinates with the municipal health system in Salvador, Bahia. It is a descriptive case study, whose methodological strategy is based on Carlos Matus' Situational Strategic Planning (Planejamento Estratégico Situacional: PES) with a Focus on Problems. Our methodological strategy employed document analysis, participant observation, semi-structured interviews and a focus group with institutional actors. The results indicate weaknesses in four of the five categories of analysis, which were: infrastructure, funding, organization, and management. These have led to failings in student training and in the institution's integration with the municipal health system. Of the twenty identified problems, ten related to the institutional actors' capacity for both governance and governability, in other words, problems that are amenable to intervention. We conclude that the clinical school must institutionalize the practice of situational strategic planning to combat improvisational practices and enable it to effectively fulfil its two important functions: teaching and healthcare.

Consultas Terapêuticas com pais e filhos: o espaço potencial em reconstrução / Consultas Terapéuticas con padres y hijos: el espacio potencial para la reconstrucción / Therapeutic Consultations with parents and children: the potential space reconstruction / Consultations thérapeutiques avec les parents et les enfants: l'espace potentiel pour la reconstruction

O pedido dos pais por atendimento psicológico do filho tem sido estudado por diversos autores da psicanálise. A ênfase do presente artigo é na teoria do relacionamento paterno-infantil, conforme construída por Winnicott. Segundo o autor, condições favoráveis apresentadas pelo ambiente serão facilitadoras para que a criança possa se desenvolver de acordo com o seu potencial na direção do seu amadurecimento emocional, desde que haja uma sustentação favorável dos pais. O estudo teve objetivo principal verificar se as Consultas Terapêuticas com pais e filhos, desenvolvidas em um Serviço Escola, são um método eficaz para investigar e compreender os mecanismos psíquicos envolvidos na interrupção do percurso de amadurecimento da criança. Nos dois casos analisados, foi possível ter essa compreensão. O método empregado nas intervenções promoveu o resgate da comunicação entre os pais e as crianças, a partir da reinclusão dos pais no papel de sustentação do processo de amadurecimento da criança, cumprindo o complemento da nossa proposta.

La solicitud de los padres de atención psicológica para sus hijos ha sido estudiada por varios autores de psicoanálisis. El énfasis de este artículo está en la teoría de la relación paterno-infantil, construida por Winnicott (1979). Según este autor, las condiciones favorables que presenta el entorno facilitarán que el niño se desarrolle de acuerdo con su potencial hacia su madurez emocional, siempre que haya un apoyo favorable de los padres. Este artículo tiene como objetivo presentar consultas terapéuticas con padres e hijos, realizadas en un Servicio de la Escuela de Psicología, como un método eficaz para investigar y comprender los bloqueos que determinaron la suspensión del camino de maduración del niño y la promoción del rescate de la comunicación entre los padres y los hijos. En los dos casos analizados fue posible tener este entendimiento. El método utilizado en las intervenciones promovió el rescate de la comunicación entre padres e hijos, a partir de la reincorporación de los padres en el rol de apoyo al proceso de maduración del niño, cumpliendo el complemento de nuestra propuesta.

The parents' request for psychological care of the child has been studied by several authors of psychoanalysis. The emphasis of this article is on the paternal-child relationship theory, as constructed by Winnicott (1979). According to this author, favorable conditions presented by the environment will be facilitating so that the child can develop according to his potential in the direction of his emotional maturation provided for a favorable support from the parents. This article aims to present therapeutic consultations with parents and children performed on a Serviço Escola of Psychology as an effective method to investigate and understand the blockages that have determined the suspension of the maturation path of the child and the promotion of the rescue of the communication between the parents and the children. In the two cases analyzed, it was possible to have this understanding. The method used in the interventions promoted the rescue of communication between parents and children, starting from the re-inclusion of parents in the role of supporting the child's maturation process, fulfilling the complement of our proposal.

La demande des parents pour une prise en charge psychologique de leur enfant a été étudiée par plusieurs auteurs de psychanalyse. Le présent article met l'accent sur la théorie de la relation paternelle-enfant, telle que construite par Winnicott. Selon l'auteur, les conditions favorables présentées par l'environnement permettront à l'enfant de se développer plus facilement en fonction de son potentiel vers sa maturité affective, à condition qu'il y ait un soutien favorable des parents. L'objectif principal de l'étude était de vérifier si les consultations thérapeutiques avec les parents et les enfants, développées dans un service scolaire, sont une méthode efficace pour enquêter et comprendre les mécanismes psychiques impliqués dans l'interruption du cours de maturation de l'enfant. Dans les deux cas analysés, il a été possible d'avoir cette compréhension. La méthode utilisée dans les interventions a favorisé le sauvetage de la communication entre parents et enfants, à partir de la réintégration des parents dans le rôle de soutien au processus de maturation de l'enfant, en remplissant le complément de notre proposition.

Undergraduate nursing student and preceptors' experiences of clinical placement through an innovative clinical school supervision model.

This study explores final year undergraduate nursing and midwifery students and their preceptors' experiences of a newly introduced Clinical School Supervision (CSS) model, which was implemented to reduce a perceived disconnect between theory and practice. A descriptive design was used with qualitative data collected through open-ended survey questions. Respondents included 43 undergraduate nursing and midwifery students involved in the final year and 13 clinical preceptors from a large metropolitan tertiary health service in Victoria, Australia. Qualitative data were analysed using thematic analysis. Students described the CSS as a favoured supervision model with students being able to take advantage of support from both the academic supervisor and nursing staff in the clinical setting, a model which also supported student's sense of belonging. Students experiences indicated the CSS model facilitated consolidation of knowledge, reflective practice and transition to graduate nursing. The preceptors described a commitment to and preparedness for the role, although they found they had little break from teaching and their rosters did not always align with their students'. Preceptors also shared experiences of unfulfilled expectations, lack of recognition and incentives for supervising students. Further studies are needed to identify effective ways to support preceptors in their roles.

Factors associated with medical students' interest in remote and very remote practice in Australia: A national study.

OBJECTIVE: To investigate the factors that are associated with medical student interest in remote and very remote practice in Australia. DESIGN: Aggregated data of an annual cross-sectional survey from 2013 to 2017. SETTING: Australia. PARTICIPANTS: Medical students from 17 medical schools, at the point of finishing one year of clinical training in a rural or remote location in Australia. MAIN OUTCOME MEASURES: Intention for working in a remote or very remote location as a doctor. RESULTS: Responses were analysed from 3328 medical students. From this cohort, 37.6%, 54.0% and 7.0% of students reported future career intent in capital or major cities; regional Australia; and remote or very remote Australia respectively. Multivariable analysis indicated students interested in remote and very remote practice compared to those interested in regional practice were more likely to be from a rural background, have prior generalist intentions, felt as though their rural clinical school (RCS) experience increased interest in remote and very remote practice, and had higher rural practice self-efficacy. Odds ratios were larger for these factors when students interested in remote or very remote practice were compared with students interested in practicing in capital or major cities. CONCLUSIONS: Rural background, prior generalist intentions, rural practice self-efficacy and the overall influence of the RCS experience are associated with interest in remote and very remote practice.

Gender equity at last: a national study of medical students considering a career in rural medicine.

BACKGROUND: The rural medical workforce internationally suffers from a significant imbalance between male- and female- identifying practitioners. Not only do male doctors outnumber female doctors, but additionally female doctors work fewer hours than their male counterparts. This has health implications for rural communities. In response, In Australia, Rural Clinical Schools (RCSs) are a national training strategy to increase the number of graduates entering the rural medical workforce. It has been observed that RCSs attract a greater number of female students than male students. However, the future work intentions of male versus female RCS students is not known. This paper therefore asked whether male and female RCS students have equivalent intent for future rural practice. METHODS: Participants were all students who attended RCSs from 2015 to 2017, who completed an exit survey that gathered data on demographic, experiential and intentional variables. Univariate analyses examined differences between the sexes. A multivariate model was constructed to determine the independent predictors for rural intention. RESULTS: There were 2017 respondents across the 3 years, of whom 937 identified as male, and 1138 identified as female. In univariate analysis, female-identifying students had significantly higher rural intention than male-identifying students. There were no other sex-based differences in age, rural background, overall perception of support, and overall excellence of clinical education whilst in RCS. However, in multivariate analysis, sex was not a significant predictor for rural work intention, whereas older age, rural background, and first preference for RCS were all predictive of increased rural intent, as expected from the literature. There were no differences between male and female students in their perceptions of the overall support and the clinical education provided by RCS. CONCLUSION: We conclude from this national study that sex is not an independent predictor for future rural work intention among RCS students. Considering the disproportionate number of female students entering RCS, this is reassuring for ultimately achieving rural workforce gender equity.

[The Kazan therapist Nikolai Andreevich Vinogradov (1831-1886) and his role in becoming of therapeutic clinic in Russia].

The article highlights the course of life, scientific, pedagogical and social activities of Nikolai Andreevich Vinogradov, the eminent therapist of the XIX century and the disciple of S. P. Botkin.

Rural clinical school dental graduates views on rural and metropolitan employment.

INTRODUCTION: There is a maldistribution of dental professionals working in rural and remote regions of Australia. This study investigates dental graduates from a newly established rural clinical school (RCS) at Charles Sturt University (CSU), New South Wales, Australia, and records graduates' workforce locations and views on working in both metropolitan and rural practice. MATERIALS AND METHODS: In late 2015 to early 2016, CSU graduates of 2013 and 2014 were asked to complete a telephone interview related to their employment choices. Thirty-nine interviews (68% of contactable graduates) were completed. Qualitative framework analysis was applied to identify trends and themes. RESULTS: More than half of the graduates were working rurally, with 67% working full-time and 77% in private practice. Key influencing factors on graduates related to rural employment were as follows: family and personal relationships, developing clinical skills, rural community, lifestyle, professional support, mentorship, job availability, full-time employment and financial incentives. Key barriers to working rurally included leaving family and friends, small patient base, low salary, partner factors, and professional and personal isolation. CONCLUSION: More than half of the CSU graduates were working in rural communities, demonstrating initially positive rural workforce outcomes. Reasons for choosing to work rurally were complex and spanned a broad spectrum of social, personal, professional development and support, community, economic, environmental and lifestyle factors. Future workforce strategies should apply a broad multifactorial approach to consider the complex interrelated employment factors. Furthermore, increased evaluation is required of the CSU programme, with increased workforce outcomes and exploration of employment retention factors.

The workforce outcomes of dental graduates from a metropolitan school 'Rural Clinical Placement Program' versus a 'Rural Clinical School'.

INTRODUCTION: This study compares the workplace decisions from University of Sydney (USYD) dental graduates who participated in a 1-month voluntary Rural Clinical Placement Program (RCPP), USYD graduates who did not participate in the RCPP (non-RCPP), and with graduates who qualified from a dental Rural Clinical School (RCS) at Charles Sturt University (CSU). METHODOLOGY: From mid-2015, USYD students who graduated between 2009 and 2013, and CSU graduates from 2013 to 2014, were requested to complete a telephone interview related to employment choices. For USYD, 135 interviews were completed (63% of contactable graduates) and for CSU, 39 interviews (68%). Mixed methods were applied to analyse the data. RESULTS: For USYD, 33% of RCPP participants were working rurally compared with 18% of the non-RCPP, whilst 54% of CSU graduates were working rurally. For USYD, the self-reported influence of the RCPP on the graduates' employment decisions was a significant predictor of rural employment. For CSU, country of birth and employment status were weakly associated with rural employment. Across the three cohorts, key employment factors were as follows: job availability, family, personal relationships, good mentorship, clinical training, partner factor and lifestyle. In addition, both the RCPP and CSU graduates showed greater interest and awareness of rural employment than the non-RCPP. CONCLUSION: The CSU RCS and USYD RCPP are leading to positive rural employment outcomes, and it is clear that the provision of a rural experience is influencing graduates to work rurally. Further investigation of the CSU program is required to fully assess its impact and to provide longitudinal workforce information.

Atendimento psicológico e supervisão em terapia analítico-comportamental em um serviço-escola / Psychological care and supervision in analyticbehavior therapy in a school service

Este artigo tem como objetivo descrever o estágio de atendimento individual na abordagem analíticocomportamental, oferecido pelo Laboratório de Pesquisa de Intervenção Cognitivo-Comportamental - LaPICC-USP (CPA - Instituição da FFCLRP-USP). Serão descritos os procedimentos de atendimento e supervisão assim como dados clínicos referentes aos atendimentos realizados entre 2009 e 2016. Trata-se de uma pesquisa descritiva com metodologia documental. As variáveis consideradas foram sexo, idade, escolaridade, ocupação, estado civil, indicação de atendimento, demanda e encaminhamento. Os resultados quantitativos foram analisados a partir de estatística descritiva, sendo atendidos 24 pacientes, havendo prevalência na busca espontânea por atendimento (54,17%), por clientela na faixa dos 20-29 anos (66,67%), com ensino superior completo (54,17%), economicamente ativa (83,33%), solteira (54,17%) e do sexo feminino (75,00%). Os procedimentos específicos relativos à supervisão também foram descritos com detalhes.(AU)

This article aims to describe the stage of individual care in the analytical-behavioral approach offered by the Research Laboratory of Cognitive-Behavioral Intervention - LaPICC-USP (CPA - Institution of FFCLRP-USP). The procedures of care and supervision will be described as well as clinical data referring to the visits performed between 2009 and 2016. It is a descriptive research with documentary methodology. The variables considered were sex, age, schooling, occupation, marital status, indication of care, demand and referral. The quantitative results were analyzed from descriptive statistics, with 24 patients being attended, with prevalence in the spontaneous search for care (54.17%), by clientele in the 20-29 age group (66.67%), with complete higher education (54.17%), economically active (83.33%), single (54.17%) and female (75.00%). Specific oversight procedures have also been described in detail.(AU)

Este artículo tiene como objetivo describir la etapa de atención individual en el abordaje analítico-conductual, ofrecido por el Laboratorio de Investigación de Intervención Cognitiva-Conductual - LaPICC-USP (CPA - Institución de FFCLRP-USP). Se describen los procedimientos de atención y supervisión así como datos clínicos referentes a las atenciones realizadas entre 2009 y 2016. Se trata de una investigación descriptiva con metodología documental. Las variables consideradas fueron sexo, edad, escolaridad, ocupación, estado civil, indicación de atención, demanda y encaminamiento. Los resultados cuantitativos fueron analizados a partir de estadística descriptiva, atendiendo a 24 pacientes, habiendo prevalencia en la búsqueda espontánea por atención (54,17%), por clientela en la franja de los 20-29 años (66,67%), con enseñanza superior completa (54,17%), económicamente activa (83,33%), soltera (54,17%) y del sexo femenino (75,00%). Los procedimientos específicos relativos a la supervisión también se describen con detalle.(AU)

Survival analysis of Rural Clinical School of Western Australia graduates: the long-term work of building a long-term rural medical workforce.

BACKGROUND: Deficits in the rural medical workforce is an international issue. In Australia, The Rural Clinical School intervention is effective for initial recruitment of rural doctors. However, the extent of survival is not yet established. This paper summarises rural survival over a 10-year period. METHODS: Rural Clinical School graduates of Western Australia were surveyed annually, 2006-2015, and post Graduate Years (PGY) 3-12 included. Survival was described as "tours of service", where a tour was either a period of ≥1 year, or a period of ≥2 weeks, working rurally. A tour ended with a rural work gap of ≥52 weeks. Considering each exit from urban as an event, semi-parametric repeated measures survival models were fitted. RESULTS: Of 468 graduates, using the ≥2 weeks definition, 239 PGY3-12 graduates spent at least one tour rurally (average 61.1, CI 52.5-69.7 weeks), and a total length of 14,607 weeks. Based on the tour definition of ≥1 year, 120 graduates completed at least one tour (average 1.89, 1.69-2.10 years), and a total of 227 years' rural work. For both definitions, the number of tours increased from one to four by PGY10/11, giving 17,786 total weeks (342 years) across all PGYs for the ≥2 weeks tour definition, and 256 years total for ≥1 year. Significantly more graduates exited from urban work for the 2007-09 middle cohort compared with 2010-11 (HR 1.876, p = 0.022), but no significant difference between 2002 and 06 and 2010-11. Rural origin, age and gender were not statistically significant. CONCLUSIONS: PGY3-12 RCS graduates contributed substantially to the rural workforce: 51% did so by short rotations, while 26% contributed whole years of service. There was an apparent peak in entry and survival for the middle cohort and decline thereafter, likely attributable to lack of advanced/specialist vocational training. These data indicate a real commitment to rural practice by RCS graduates, and the need for rural vocational training as a key element of a successful rural survival strategy.

Screening for burn-out in Australian medical students undertaking a rural clinical placement.

OBJECTIVE: To investigate Australian medical student burn-out during rural clinical placement. Second, to examine the association between perceived burn-out and rural career intent at the time of finishing their rural placement. DESIGN, SETTINGS AND PARTICIPANTS: The 2016 Federation of Rural Australian Medical Educators evaluation survey is a cross-sectional study of medical students from 17 Australian universities. Specifically, those medical students who completed a full academic year or more at a Rural Clinical School (RCS). Responses from 638 medical students from regional Australia were analysed in the study of all eligible 756 medical students (response rate 84.3%). PRIMARY AND SECONDARY OUTCOME MEASURES: The primary objective was to determine self-reported burn-out (emotional exhaustion) in rural placements for medical students. Secondary outcome measures were designed to explore interactions with rural practice self-efficacy and rural intentions. Logistic regression models explored factors associated with burn-out. RESULTS: 26.5% of students reported experiencing burn-out during a rural placement. Factors associated with burn-out were female gender, rural origin, low preference for RCS, stress in the year prior to a rural clinical placement, perceived social isolation during rural placement and lower rural practice self-efficacy. Burn-out was not associated with rural career intentions. Social isolation and low rural self-efficacy were independently associated with burn-out during rural placement and together explained 10% of variance in burn-out (Model Nagelkerke R2=0.23). CONCLUSION: Burn-out during rural placement may be a consequence of stress prior to a medical school placement. Social isolation and rural self-efficacy are amendable factors to mitigate medical student burn-out during rural placements.

Social network analysis of rural medical networks after medical school immersion in a rural clinical school.

BACKGROUND: The impact of new medical graduates on the social dimensions of the rural medical workforce is yet to be examined. Social Network Analysis (SNA) is able to visualize and measure these dimensions. We apply this method to examine the workforce characteristics of graduates from a representative Australian Rural Clinical School. METHODS: Participants were medical graduates of the Rural Clinical School of Western Australia (RCSWA) from the 2001-2014 cohorts, identified as being in rural work in 2017 by the Australian Health Practitioner Regulation Agency. SNA was used to examine the relationships between site of origin and of work destination. Data were entered into UCInet 6 as tied pairs, and visualized using Netdraw. UCINet statistics relating to node centrality were obtained from the node editor. RESULTS: SNA measures showed that the 124 of 709 graduates in rural practice were distributed around Australia, and that their practice was strongly focused on the North, with a clear centre in the remote Western Australian town of Broome. Women were strongly recruited, and were widely distributed. CONCLUSIONS: RCSWA appears to be a "weak tie" according to SNA theory: the School attracts graduates to rural nodes where they had only passing prior contact. The multiple activities that comprise the social capital of the most attractive, remote, node demonstrate the clear workforce effects of being a "bridge, broker and boundary spanner" in SNA terms, and add new understanding about recruiting to the rural workforce.

The Australian Rural Clinical School (RCS) program supports rural medical workforce: evidence from a cross-sectional study of 12 RCSs.

INTRODUCTION: Many strategies have been implemented to address the shortage of medical practitioners in rural areas. One such strategy, the Rural Clinical School Program supporting 18 rural clinical schools (RCSs), represents a substantial financial investment by the Australian Government. This is the first collaborative RCS study summarising the rural work outcomes of multiple RCSs. The aim of this study was to combine data from all RCSs' 2011 graduating classes to determine the association between rural location of practice in 2017 and (i) extended rural clinical placement during medical school (at least 12 months training in a rural area) and (ii) having a rural background. METHODS: All medical schools funded under the RCS Program were contacted by email about participation in this study. De-identified data were supplied for domestic students about their gender, origin (rural background defined as having lived in an Australian Standard Geographic Classification-Remoteness Area (ASGC-RA) 2-5 area for at least 5 years since beginning primary school) and participation in extended rural clinical placement (attended an RCS for at least 1 year of their clinical training). The postcode of their practice location according to the publicly available Australian Health Practitioner Regulation Agency (AHPRA) register was collected (February to August 2017) and classified into rural and metropolitan areas using the ASGC 2006 and the more recent Modified Monash Model (MMM). The main outcome measure was whether graduates were working in a 'rural' area (ASGC categories RA2-5 or MMM categories 3-7) or 'metropolitan' area. Pearson's χ2 test was used to detect differences in gender, rural background and extended placement at an RCS between rural and metropolitan practice locations. Binary logistic regression was used to determine odds of rural practice and 95% confidence intervals (CIs) were calculated. RESULTS: Although data were received from 14 universities, two universities had not started collecting origin data at this point so were excluded from the analysis. The proportion of students with a rural background had a range of 12.3-76.6% and the proportion who had participated in extended RCS placement had a range of 13.7-74.6%. Almost 17% (16.6%) had a principal practice postcode in a rural area (according to ASGC), range 5.8-55.6%, and 8.3% had a principal practice postcode in rural areas (according to MMM 3-7), range 4.5-29.9%. After controlling for rural background, it was found that students who attended an RCS were 1.5 times more likely to be in rural practice (95%CI 1.2-2.1, p=0.004) using ASGC criteria. Using the MMM 3-7 criteria, students who participated in extended RCS placement were 2.6 times as likely to be practising in a rural location (95%CI 1.8-3.8, p<0.001) after controlling for rural background. Regardless of geographic classification system (ASGC, MMM) used for location of practice and of student background (metropolitan or rural), those students with an extended RCS had an increased chance of working rurally. CONCLUSION: Based on the combined data from three-quarters (12/16) of the Australian medical schools who had a graduating class in 2011, this suggests that the RCS initiative as a whole is having a significant positive effect on the regional medical workforce at 5 years post-graduation.

(Des)articulações e (im)possibilidades de uma clinica escola em rede: uma reflexão ética e política / (Dis)Joints and (Im)Possibilities of a Net School Clinic: An Ethical and Political Reflection

Esse artigo trata-se de um relato de pesquisa que objetivou-se investigar possibilidades de articulação entre a Clínica de Psicologia da Universidade Federal do Ceará - UFC e o trabalho em rede dos Centros de Atenção Psicossocial na Saúde Mental (CAPS) de Fortaleza, por meio da compreensão do trabalho em rede e do funcionamento dos serviços de saúde, principalmente na atenção secundária. e, por fim, a verificação se a Clínica Escola pode ser integrar a rede de saúde. Foram entrevistas a ex-coordenadora da Clínica Escola da UFC, a coordenadora atual da Clínica Escola da UFC e assessora da Célula de Atenção à Saúde Mental. Encontramos pontos importantes de reflexão, entre eles a relevância do buscar entendimento sobre o funcionamento da Clínica Escola de Psicologia da UFC e do trabalho em rede como chave para fortalecer as interações e propiciar um engajamento maior dos dispositivos de saúde, bem como, oportunizar a prestação de um atendimento mais qualificado e assertivo a sociedade. Todavia, ainda existe um longo caminho a percorrer que perpassa por ações e políticas públicas conjuntas, bem como, o esforço e interesse dos membros de ambas as instituições (prefeitura e SEP/clínicas-escolas) para que haja a inclusão destas na rede de saúde

This article is about a research report that aimed to investigate possibilities of articulation between the Psychology Clinic of the Federal University of Ceará (UFC) and the networking of the Centers for Psychosocial Attention in Mental Health (CAPS) in Fortaleza, for understanding of networking and the functioning of health services, especially in secondary care. and, finally, to verify if Clínica Escola can be integrated into the health network. The former coordinator of the UFC School Clinic, the current coordinator of the UFC School Clinic and an advisor to the Mental Health Care Cell were interviewed. We find important points of reflection, among them the relevance of seeking understanding about the functioning of the Clinical School of Psychology of the UFC and networking as a key to strengthen interactions and foster a greater engagement of health devices, as well as, of a more qualified and assertive service to society. However, there is still a long way to go that goes through joint actions and public policies, as well as the effort and interest of members of both institutions (city hall and SEP / clinics-schools) to include them in the health network

How does studying rurally affect peer networks and resilience? A social network analysis of rural- and urban-based students.

OBJECTIVE: To examine differences in peer networks between urban-based students and rural-stream students in an Australian medical school and to examine how characteristics of networks relate to resilience. DESIGN: Cross-sectional survey asking students to signify social, academic and support relationships with students in the same year and to complete a survey on their resilience. SETTING AND PARTICIPANTS: All second-, third- and fourth-year students at the Australian National University Medical School. MAIN OUTCOME MEASURES: Social network analysis comparing peer networks, t-test comparing mean resilience of urban and rural students. RESULTS: A visual analysis of the peer networks of year 2, 3 and 4 medical students suggests greater integration of rural-stream students within the year 2 and 4 urban cohorts. Resilience is similar between year 2 and 3 students in both urban and rural streams, but is significantly higher in year 4 rural-stream students, compared to their urban-based peers. Networks of rural-stream students suggest key differences between their period spent rurally and on their return and integration within the larger student cohort. Furthermore, rural students, once reintegrated, had larger and stronger social networks than their urban counterparts. CONCLUSION: The results of the study suggest that the rural experience can instruct support systems in urban settings. However, whether the rural placement creates a more resilient student or resilient students are selected for rural placement is unclear.

Das possibilidades de trabalho com a psicanálise no contexto de uma clínica-escola / Las posibilidades de trabajo con el psicoanálisis en el contexto de una clínica-escuela / The possibilities of working with the psychoanalysis in the school clinical

Este trabalho decorre da experiência docente e discente em relação à prática da psicanálise em uma clínica-escola de um curso de Psicologia. Situamos, primeiramente, a história da inclusão da psicanálise nos cursos de graduação de psicologia. Em seguida discutimos o ensino teórico e, sobretudo, os desafios que se impõem a uma prática de estágio em clínica psicanalítica frente às questões que circundam e regulamentam o próprio funcionamento da universidade. Nessa via, ressaltamos que a formação do analista não é acadêmica e as diferenças fundamentais entre psicanálise e psicoterapia. Assim, abrimos espaços para que sejam evidenciados os embaraços encontrados na experiência no que toca de perto o estágio em clínica psicanalítica, situado como uma das modalidades de formação em um curso de psicologia, apontando limites e possibilidades de um trabalho que possa se aproximar e abrir caminhos para os alunos que forem capturados pela psicanálise (AU).

This paper comes from professor and students' experience regarding the practice of psychoanalysis in a Clinical School of an undergraduation course of Psychology. First, we presented the history of the introduction of psychoanalysis in undergraduate psychology courses. After, we discussed the theoretical education, and mainly, the challenges to an internship practice in the psychoanalysis clinic facing questions that encompass and regulate the functioning of the University. Thus, we highlight that the psychoanalyst formation is not academic and the fundamental differences between Psychoanalysis and Psychotherapy. Therefore, we discuss the difficulties that are found in the experience related to the internship in psychoanalysis clinic, placed as one of the modalities of formation in a Psychology Course, indicating limits and possibilities of a work that can approximate and expand the minds students who are interested by the psychoanalysis (AU).

Este trabajo surge de la experiencia de docente y estudiantes en relación a la práctica del psicoanálisis en una Clínica Escuela del curso de Psicología. Situamos la historia de la inclusión del psicoanálisis en cursos de grado de psicología. Discutimos la enseñanza teórica y los retos a los que se enfrenta la práctica en una clínica psicoanalítica frente a las cuestiones que circundan y rigen el funcionamiento de la propia universidad. Destacamos que la formación del analista no es académica y las diferencias fundamentales entre el psicoanálisis y la psicoterapia. De esa forma, abrimos espacio para evidenciar los enredos que se encuentran en la experiencia que refieren a la práctica en clínica psicoanalítica, establecida como una de las modalidades de formación en un curso de psicología, señalando límites y posibilidades de un trabajo que pueda aproximar y abrir rutas de acceso para los estudiantes capturados por el psicoanálisis (AU).

[The School of S.P. Botkin: Vassili Nikolaievich Sirotinin (1855-1934)].

The article considers a number of characteristics of the scientific clinical school of S.P. Botkin. The exceptional significance of this school in the history of national medicine is emphasized. It is demonstrated that V.N. Sirotinin was the most outstanding of all his followers, the school leader and one of the leaders of the clinic of inner diseases in Russia during the first decades of XX century. The article presents the scientific biography of V.N. Sirotinin, including his emigration years. It is demonstrated that the issues of organization by V.N. Sirotinin of his own clinical school requires and additional investigation.

Factors related to doctors' choice of rural pathway in general practice specialty training.

OBJECTIVE: To investigate the factors eligible applicants consider in electing for a rural pathway into specialty training. DESIGN: Cohort study. SETTING: Australia. PARTICIPANTS: Applicants to the Australian General Practice Training program. MAIN OUTCOME MEASURES: Applicants' initial preference of either a general or rural pathway to undertake specialty training. RESULTS: Of the 2,221 applicants, 45% were Australian Medical Graduates (AMGs), 27% Foreign Graduates of Accredited Medical Schools (FGAMS) and 29% International Medical Graduates (IMGs). Through government regulation, two thirds (70%) were eligible to train on both general and rural pathways and a third (30%) were required to train rurally. For applicants eligible for general pathway (n = 1552), those with rural background [Odds Ratio (OR) = 3.7, 95% CI 2.7-5.2] and rural clinical school experience (OR = 2.0, 95% CI 1.5-2.8) were more likely to choose the rural pathway. In addition, FGAMS who were eligible for the general pathway were less likely to choose a rural pathway when compared with IMGs (OR = 0.33, 95%CI 0.1 = 0.7). In applicants who changed their training pathway from their initial to revised preference, lower Multiple-Mini-Interview (OR = 0.54, 95% CI 0.43-0.66) and Situational Judgement Test z-scores (OR = 0.68, 95% CI 0.56-0.83) were associated with a higher probability of changing from a general to rural pathway preference. CONCLUSION: For those eligible for a general or rural pathway, rural background and rural clinical school experience are associated with the decision to elect for rural training. Targeted support for international and foreign graduates of Australia/New Zealand schools may influence them to train rurally.

A construção do perfil da clientela numa clínica-escola / The profile construction of clientele in a school clinic

A caracterização da demanda na instituição de prestação de serviços é fundamental para a proposta de melhoria da qualidade desses serviços, em particular quando se aborda o trabalho desenvolvido nos Serviços Escola de Psicologia, voltados ao atendimento da população. Este trabalho faz uma análise sobre o processo de recepção a pacientes e apresenta o levantamento da demanda que chega ao Centro de Pesquisa e Psicologia Aplicada (CPPA) "Dra. Betti Katzenstein" da UNESP de Assis. Por meio de pesquisa documental, analisaram-se as fichas de triagem dos anos de 2008 a 2012 e foram tabuladas as variáveis sociodemográficas (sexo, idade, núcleo familiar), motivo da procura pelo serviço, segundo a faixa etária, constituição familiar das crianças, e profissão, nos adultos. O objetivo foi esboçar o perfil da clientela que busca auxílio no CPPA, compreender melhor a realidade dos conflitos que essa população enfrenta e, obtendo-se melhor compreensão da demanda, orientar ações no sentido de melhor atendê-la favorecendo a prevenção da saúde mental...

The demand characterization in service institutions is fundamental to improve their quality, particularly when discussing the work of Psychology School Services, focused on people's attendance. This paper makes an analysis on the process of patients' reception and shows the demand survey that arrives at Centro de Pesquisa e Psicologia Aplicada (CPPA)2 "Dr. Betti Katzenstein" at UNESP in Assis. Through documentary research, screening records from 2008 to 2012 were analyzed and sociodemographic variables (gender, age, household) were tabulated, as well as the reason for seeking treatment, age, children's family constitution, and profession in the case of adults. The objective was to outline the clientele profile who seeks for assistance in CPPA, to understand better the reality of conflicts those people face and, when better understanding of the demand is achieved, guide actions to serve them better, providing prevention to mental health...