Propiedad intelectual y derecho de la competencia en el sector farmacéutico durante la pandemia de COVID-19

La pandemia de COVID-19 demostró que las políticas públicas relacionadas con la propiedad intelectual y el derecho de la competencia no fueron adecuadas o suficientemente articuladas para permitir el acceso oportuno de la población a las vacunas de manera equitativa, debido a distorsiones en su fabricación, distribución y venta cuando éstas estuvieron disponibles durante la pandemia. Esta investigación tiene como objetivo analizar, desde una perspectiva jurídica, si los problemas observados se originan en una inadecuada aplicación de la legislación que regula la propiedad intelectual y su relación con otras políticas públicas vinculadas a la competencia, o, eventualmente, en el ejercicio abusivo de tales derechos, y que, como consecuencia, distorsionaría el proceso de competencia en los mercados nacionales y regionales.

The COVID 19 pandemic demonstrated that public policies related to intellectual property and competition law were not adequate or sufficiently articulated to allow timely access to vaccines in an equitable manner, due to distortions in the manufacture, distribution, and sale of COVID-19 vaccines when they were available during the pandemic. This research aims to analyze, from a legal perspective, whether the observed problems originate in an inadequate application of intellectual property legislation and its relationship with other public policies related to competition, or, eventually, in the abusive exercise of such rights, which, as a consequence, would distort the process of competition in national and regional markets.

A pandemia de COVID 19 demostrou que as políticas públicas relacionadas com a propriedade intelectual e o direito de competência não foram adequados ou suficientemente articulados para permitir o acesso oportuno da população às vacinas de maneira equitativa, devido a distorções na fabricação, distribuição e venda de vacinas COVID-19, quando estavam disponíveis durante a pandemia. Esta investigação tem como objetivo analizar, desde uma perspectiva jurídica, se os problemas observados se originam em uma inadequada aplicação da legislação que regula a propriedade intelectual e sua relação com outras políticas públicas vinculadas à competência ou, eventualmente, no exercício abusivo de tais direitos, e que, como consequência, distorceria o processo de competência nos mercados nacionais e regionais.

[Translated article] Pharmaceutical care in respiratory diseases: Current situation and opportunities for hospital pharmacy in Spain.

OBJECTIVE: Respiratory diseases present a challenge for the healthcare system due to their prevalence and clinical impact. The aim of this study was to explore the current situation of hospital pharmacy in the field of respiratory diseases. METHOD: Observational, cross-sectional study, with a national scope, divided into 2 parts. In an initial phase, the activity and level of pharmaceutical care in respiratory diseases was evaluated through an online questionnaire using REDCap. The survey was addressed to department chiefs and consisted of 17 items, divided into 2 modules: general data and general activity. The second phase was open to hospital pharmacists, with the aim of exploring their opinion on care, training, and improvement needs. The number of items in this phase was 19, divided into 5 modules: general data, pharmaceutical care, competencies, training, and degree of satisfaction. RESULTS: In the first phase, 23 hospitals were included. Most of them (n=20) had a pharmacist in charge of respiratory diseases. However, a large proportion of them dedicated less than 40% of their working day to this activity. The pharmacist's activity occurred at the level of external patients (n=21), hospitalised patients (n=16), and secondarily in management (n=8). Integration is greater in pathologies such as asthma, IPF, pulmonary hypertension, and bronchiectasis. Participation in committees was present in 15 hospitals, with variability in pathologies and degree of involvement. In the second phase, 164 pharmacists participated, who considered pharmaceutical care in cystic fibrosis, asthma, and lung transplant as a priority. 51% considered integration to be adequate and 91% considered it necessary to implement prioritisation criteria. Professional competencies ranged from 6.5 to 6.9 out of 10 points. Only 45% of participants had received specific training in the last 4 years, indicating greater priority for asthma, pulmonary hypertension, and IPF. CONCLUSIONS: Most centers have pharmacists specialised in respiratory diseases. However, there is room for improvement in terms of subspecialisation, participation in multidisciplinary committees, implementation of prioritisation criteria, diversification in pathologies treated, as well as greater specific training in this area.

Competências do enfermeiro no cuidado a pacientes com acidente vascular cerebral elegíveis à terapia trombolítica / Competencias de enfermería en el cuidado de personas con accidente cerebrovascular elegibles para terapia trombolítica / Nursing competencies in the care of patients with stroke who are eligible for thrombolytic therapy

Resumo Introdução: O acidente vascular cerebral isquêmico tem como tratamento a terapia trombolítica, aplicada ainda na fase aguda, promovendo melhora importante nas sequelas acarretadas por este agravo. Considerando a complexidade da terapia trombolítica, torna-se necessário que os enfermeiros compreendam suas competências para auxiliar no cuidado. Objetivo: Identificar evidências científicas acerca das competências do enfermeiro no cuidado a pacientes com acidente vascular cerebral elegíveis à terapia trombolítica. Metodologia: Revisão integrativa composta por seis etapas em seis etapas (elaboração da questão, busca na literatura, coleta de dados, análise, discussão e apresentação da revisão), realizada nas bases de dados MEDLINE, LILACS, BDENF, IBECS, PubMed, Scopus, Web of Science, Embase e CINAHL. A busca foi realizada entre agosto e setembro de 2022 adotando como critérios de inclusão estudos primários; gratuitos, disponíveis eletronicamente na íntegra; nos idiomas inglês, português e espanhol. Foram obtidos inicialmente 2.830 estudos, os quais passaram por uma seleção, onde foram incluídos aqueles que atendiam os critérios previamente estabelecidos. Resultados: Com base nos doze estudos incluídos nesta revisão identificaram-se competências voltadas à três atividades do cuidado: gestão do cuidado como trabalho em equipe, códigos, fluxos e protocolos, assistência ao paciente antes, durante e após a utilização da terapia trombolítica e educação em saúde para equipe, pacientes e familiares. Conclusão: Os achados desta revisão puderam evidenciar as competências do enfermeiro no cuidado aos pacientes elegíveis a terapia trombolítica, as quais perpassam diferentes áreas de atuação do enfermeiro. Para este estudo prevaleceram as competências assistências, seguida por competências gerenciais.

Resumen Introducción: El accidente cerebrovascular isquémico se trata con terapia trombolítica, aplicada incluso en la fase aguda, que promueve una mejoría significativa de las secuelas provocadas por este padecimiento. Considerando la complejidad de la terapia trombolítica, es necesario que las personas profesionales de enfermería comprendan sus competencias para ayudar en el cuidado. Objetivo: Identificar evidencias científicas sobre las competencias del personal de enfermería en el cuidado de pacientes con accidente cerebrovascular elegibles para terapia trombolítica. Metodología: Revisión integradora que consta de seis etapas (elaboración de la pregunta, búsqueda bibliográfica, recolección de datos, análisis, discusión y presentación de la revisión), realizada en las bases de dados MEDLINE, LILACS, BDENF, IBECS, PubMed, Scopus, Web of Science, Embase y CINAHL. La búsqueda se realizó entre agosto y septiembre de 2022. Los criterio de inclusión fueron: estudios primarios, gratuito, disponible electrónicamente en su totalidad, en inglés, portugués y español. Inicialmente se obtuvieron 2830 estudios, los cuales fueron sometidos a un proceso de selección, que incluyó aquellos que cumplían con los criterios previamente establecidos. Resultados: A partir de los doce estudios incluidos en esta revisión, se identificaron competencias centradas en tres actividades asistenciales: gestión del cuidado como trabajo en equipo, códigos, flujos y protocolos, atención a pacientes antes, durante y después del uso de la terapia trombolítica y educación en salud para personal, pacientes y familias. Conclusión: Los hallazgos de esta revisión pudieron resaltar las competencias de las personas profesionales en enfermería en el cuidado de personas elegibles para terapia trombolítica, que abarcan diferentes áreas de actuación del personal de enfermería. Para este estudio, prevalecieron las habilidades asistenciales, seguidas de las competencias gerenciales.

ABSTRACT Introduction: Ischemic stroke is treated with thrombolytic therapy, applied even in the acute phase, promoting a significant improvement in the after-effects caused by this condition. Considering the complexity of thrombolytic therapy, it is necessary for nurses to understand the skills required to assist in care. Objective: To identify scientific evidence about the competencies of nurses in the care of patients with stroke who are eligible for thrombolytic therapy. Methodology: An integrative review consisting of six stages (elaboration of the question, literature review, data collection, analysis, discussion, and presentation), conducted in MEDLINE, LILACS, BDENF, IBECS, PubMed, Scopus, Web of Science, Embase, and CINAHL databases. The search was carried out between August and September 2022 using primary studies as the inclusion criteria: free of charge, fully available electronically, published in English, Portuguese, or Spanish. Initially, 2.830 studies were obtained, which underwent a selection process that included only those studies that met the previously established criteria. Results: Based on the twelve studies included in this review, competencies focused on three care activities were identified: care management such as teamwork; codes; flows and protocols; patient care before, during, and after the use of thrombolytic therapy; and education health education for staff, patients, and families. Conclusion: The findings of this review highlighted the nurses' competencies in the care of patients eligible for thrombolytic therapy, which encompass different areas of the nurse's work. For this study, assistance competencies prevailed, followed by management competencies.

Pharmaceutical care in respiratory diseases: Current situation and opportunities for Hospital Pharmacy in Spain. / Atención farmacéutica en enfermedades respiratorias: situación y oportunidades de la farmacia hospitalaria en España.

OBJECTIVE: Respiratory diseases present a challenge for the healthcare system due to their prevalence and clinical impact. The aim of this study was to explore the current situation of hospital pharmacy in the field of respiratory diseases. METHOD: Observational, cross-sectional study, with a national scope, divided into 2 parts. In an initial phase, the activity and level of pharmaceutical care in respiratory diseases was evaluated through an online questionnaire using REDCap. The survey was addressed to department chiefs and consisted of 17 items, divided into 2 modules: general data and general activity. The second phase was open to hospital pharmacists, with the aim of exploring their opinion on care, training, and improvement needs. The number of items in this phase was 19, divided into 5 modules: general data, pharmaceutical care, competencies, training and degree of satisfaction. RESULTS: In the first phase, 23 hospitals were included. Most of them (n=20) had a pharmacist in charge of respiratory diseases. However, a large proportion of them dedicated less than 40% of their working day to this activity. The pharmacist's activity occurred at the level of external patients (n=20), hospitalized patients (n=16), and secondarily in management (n=8). Integration is greater in pathologies such as asthma, IPF, pulmonary hypertension, and bronchiectasis. Participation in committees was present in 15 hospitals, with variability in pathologies and degree of involvement. In the second phase, 164 pharmacists participated, who considered pharmaceutical care in cystic fibrosis, asthma and lung transplant as a priority. Fifty-one percent considered integration to be adequate and 91% considered it necessary to implement prioritization criteria. Professional competencies ranged from 6.5-6.9 out of 10 points. Only 45% of participants had received specific training in the last four years, indicating greater priority for asthma, pulmonary hypertension and IPF. CONCLUSIONS: Most centers have pharmacists specialized in respiratory diseases. However, there is room for improvement in terms of sub specialization, participation in multidisciplinary committees, implementation of prioritization criteria, diversification in pathologies treated, as well as greater specific training in this area.

Construction and validation of an Entrepreneurship Measurement Instrument for nursing students / Construcción y validación de un Instrumento de Medición Emprendedora para estudiantes de enfermería / Construção e validação de Instrumento de Medição Empreendedora para estudantes de enfermagem

Objective. To develop a valid and reliable scale to measure entrepreneurship competences of nursing students, by assessing the level of development of diverse entrepreneurship dimensions. Methods. An Entrepreneurship Measurement Instrument, Catalonia (IME.Cat) was constructed, by adapting two existing instruments, and a psychometric study was performed to address the validity of the content and the construct, and the reliability. The internal consistency and the discrimination capacity of the instrument's items were examined. Results. The IME.Cat scale showed a high reliability (α=0.89) for the complete set of items. The Cronbach's α value of the individual dimensions were: Problem management=0.78; Creativity=0.76; Personal confidence =0.64; and Risk acceptance =0.46. The corrected homogeneity indices for each of the item in the instrument were high (>0.40). The Confirmatory Factorial Analysis validated the proposed structure of the items according to dimension. Conclusion. The IME.Cat scale showed solid psychometric values for assessing the entrepreneurship competences of nursing students within its dimensions, which are fundamental for the professional development of nursing.

Objetivo. Desarrollar una escala válida y fiable para medir competencias emprendedoras para estudiantes de enfermería, evaluando el nivel de desarrollo en diversas dimensiones del emprendimiento. Métodos. Se construyó el Instrumento de Medición Emprendedora Cataluña (IME.Cat) adaptando dos instrumentos existentes y se llevó a cabo un estudio psicométrico que abordó la validez de contenido, de constructo y la fiabilidad. Se examinaron la consistencia interna y la capacidad de discriminación de los ítems del instrumento. Resultados. La escala IME.Cat mostró una alta fiabilidad (α=0.89) para el conjunto completo de 25 ítems. Los valores del α de Cronbach de las dimensiones individuales fueron: Manejo de problemas=0.78; Creatividad=0.76; Seguridad personal=0.64; y Aceptación del riesgo=0.46. Los índices de homogeneidad corregidos para cada ítem del instrumento fueron elevados (>0.40). El Análisis Factorial Confirmatorio validó la estructura propuesta de ítems por dimensión. Conclusión. La escala IME.Cat mostró valores psicométricos sólidos para evaluar competencias emprendedoras en estudiantes de enfermería en sus dimensiones, las cuales son fundamentales en el desarrollo profesional de la enfermería.

Objetivo. Desenvolver uma escala válida e confiável para medir as competências empreendedoras dos alunos de enfermagem, avaliando o nível de desenvolvimento em várias dimensões do empreendedorismo. Métodos. O Instrumento de Medição de Empreendedorismo da Catalunha (IME.Cat) foi construído com a adaptação de dois instrumentos existentes, e um estudo psicométrico foi realizado para abordar a validade de conteúdo, a validade de construção e a confiabilidade. A consistência interna e a capacidade discriminatória dos itens do instrumento foram examinadas. Resultados. A escala IME.cat apresentou alta confiabilidade (α=0.89) para o conjunto completo de 25 itens. Os valores de α de Cronbach para as dimensões individuais foram: Tratamento de problemas=0.78; Criatividade=0.76; Segurança pessoal=0.64; e Aceitação de riscos=0.46. Os índices de homogeneidade corrigidos para cada item do instrumento foram altos (>0.40). A análise fatorial confirmatória validou a estrutura de itens proposta por dimensão. Conclusões. A escala IME.Cat apresentou bons valores psicométricos para avaliar as competências empreendedoras dos estudantes de enfermagem em suas dimensões, que são fundamentais para o desenvolvimento profissional da enfermagem.

Competências para o atendimento multiprofissional da PCR em pediatria: percepções da equipe de enfermagem / Skills for multiprofissional care for cardiorespiratory arrests in pediatrics: perceptions of the nursing team / Habilidades para el cuidadod multiprofesional de las paradas cardiorrespiratorias en pediatria: percepciones del equipo de enfermería

Estudo exploratório descritivo, quantitativo, realizado em um hospital pediátrico filantrópico, com objetivo de compreender as competências profissionais da enfermagem no atendimento da parada cardiorrespiratória em pediatria, além de investigar suas percepções. Participaram 30 profissionais da equipe de enfermagem e a coleta de dados foi realizada por meio de um questionário fechado. Os resultados, analisados por meio de estatística descritiva, mostraram que os profissionais de enfermagem, em sua maioria, apresentaram conhecimento sobre o atendimento da emergência investigada. Em relação às suas percepções sobre as habilidades técnicas necessárias, notou-se que a maioria dos participantes se perceberam seguros para as manobras de ressuscitação e para a administração de medicações durante o atendimento; contudo, ao abordar o manuseio do desfibrilador e a realização de punção venosa, a maior parte da amostra afirmou não se sentir totalmente segura para estas atividades. Concluiu-se que a maioria dos participantes apresentam conhecimento teórico-prático para a execução do atendimento.

Descriptive, quantitative exploratory study, carried out in a philanthropic pediatric hospital, with the objective of understanding the nursing professional competencies in the care of cardiorespiratory arrests in pediatrics, besides investigating. 30 professionals from the nursing team participated and data was collected using a closed questionnaire. The results, analyzed using descriptive statistics, showed that the majority of nursing professionals had knowledge about the care of the investigated emergency. In relation to their perceptions about the necessary technical skills, the majority of participants perceived themselves to be confident in resuscitation maneuvers and the administration of medications during care. However, when approaching the handling of the defibrillator and performing a venipuncture, most of the sample stated that they did not feel complete confidence for these activities. Study concluded that the majority of participants had theoretical-practical knowledge to perform the service.

Estudio exploratorio descriptivo, cuantitativo, realizado en un hospital pediátrico filantrópico, con el objetivo de comprender las competencias profesionales de enfermería en el cuidado de la parada cardiorrespiratoria en pediatría, además de investigar sus percepciones. Participaron 30 profesionales del equipo de enfermería y la recolección de datos se realizó mediante cuestionario cerrado. Los resultados, analizados mediante estadística descriptiva, mostraron que la mayoría de los profesionales de enfermeira tenían conocimiento sobre la atención de la emergencia investigada. En relación a sus percepciones sobre las habilidades técnicas necesarias, se observa que la mayoría de los participantes se observó que la mayoría de los participantes se percibió confiada en las maniobras de reanimación y la administración de medicamentos durante la atención. Sin embargo, al abordar el manejo del desfibrilador y realizar una punción venosa, la mayoría de la muestra manifestó no sentirse completamente segura para estas actividades. Estudio concluyó que la mayoría de los participantes presentó conocimientos teórico-prácticos para realizar el servicio.

Fundamentos teóricos de una investigación sobre competencia profesional comunicativa en el docente de la educación médica superior

La competencia profesional comunicativa resulta una necesidad para el logro del desarrollo discursivo en las ciencias médicas, pero sucede que en numerosos casos se adolece de preparación didáctica por desconocimiento sobre competencia comunicativa. Es propósito de este texto fundamentar los presupuestos teóricos que sustentan los estudios sobre el desarrollo de la competencia comunicativa para el desempeño profesional del docente de la educación médica superior. El texto constituye una salida del proyecto de investigación no asociado al programa Perfeccionamiento de competencias profesionales en el contexto de la salud que lidera el Centro de Desarrollo de las Ciencias Sociales y Humanísticas en Salud. Se efectúo la búsqueda en bibliografía impresa y digital certificada, se consultaron bases de datos como SciELOCuba, SciELO Regional, los sitios web Organización Panamericana de la Salud, Organización Mundial de la Salud. El estudio de documentos propició la determinación de los presupuestos teóricos que sustentan el estudio que se desarrolló desde enero de 2021 a diciembre de 2023.

The talkative professional competition is vital in the educational one that imparts the subject History of Cuba in the Medical Sciences, but, it happens that in numerous cases didactic preparation suffers due to lack of knobbledge and communicative competence. It is purpose of this text to substantiate the theoretical assumptions that support studies on the development communicative for the professional performance of Cuban history teachers. It not belongs to the project associated to program: Improvement of professional competitions in the context of the health that leads the Center of Development of the Social and Humanistic Sciences in Health 2021-2023. You makes the search scientifically in certified printed and digital bibliography, databases like SciELOCuba are consulted, Regional SciELO, the places web Pan-American Organization of the Health, World Organization of the Health. The study of documents propitiated the elements to apply for the professors of the subject to reach the professional competition in the formative process.

Paediatric interventional radiology: it's not child's play.

Pediatric interventional radiology is a dynamic and growing subspecialty. The new training pathways in interventional radiology, the maintenance of skills with a small volume of cases or complex procedures, the limited availability of specific pediatric equipment and materials pose significant challenges and opportunities.

Anaesthesia training designs across Europe: A survey-based study from the trainees committee of the European Society of Anaesthesiology and Intensive Care.

BACKGROUND: Anaesthesiology training programs in Europe vary in duration, content, and requirements for completion. This survey-based study conducted by the Trainees Committee of the European Society of Anaesthesiology and Intensive Care explores current anaesthesia training designs across Europe. METHODS: Between May and July 2018, we sent a 41-item online questionnaire to all National Trainee Representatives, members of the National Anaesthesiologists Societies Committee, and Council Representatives of the European Society of Anaesthesiology and Intensive Care (ESAIC) of all member countries. We cross-validated inconsistent data with different country representatives. RESULTS: Forty-three anaesthesiologists from all 39 associated ESAIC countries completed the questionnaire. Results showed considerable variability in teaching formats, frequency of teaching sessions during training, and differences in assessments made during and at the end of training. The reported duration of training was 60 months in 59% (n = 23) of participating countries, ranging from 24 months in Russia and Ukraine to 84 months in the UK. CONCLUSION: This study shows the significant differences in anaesthesiology training formats across Europe, and highlights the importance of developing standardised training programs to ensure a consistent level of training and to improve patient safety. This study provides valuable insights into European anaesthesia training, and underlines the need for further research and collaboration to improve requirements.

[Human resources in the National Health System. Medical education. SESPAS Report 2024]. / Recursos humanos del Sistema Nacional de Salud. Formación. Informe SESPAS 2024.

The problems posed by medical education in Spain are diverse. This paper analyzes the system currently used to select candidates who will be admitted to a public faculty of medicine in Spain and some issues arising from the unprecedented increase in both public and private medical schools in our country. The importance of generic competencies in today's medicine and the need to return to a core design in specialist training are other aspects that are discussed. The degree of development of advanced accreditation diplomas and areas of specific competence is also subject to analysis. Finally, the authors emphasize the importance of continuous professional development and the idea of professional recertification as a system that guarantees patients the quality of the care they receive.

Radiología intervencionista en pediatría: no es un juego de niños / Pediatric interventional radiology: It's not a child's play

La radiología intervencionista pediátrica es una subespecialidad dinámica y en crecimiento. Las nuevas vías de formación en radiología intervencionista, el mantenimiento de las competencias con un pequeño volumen de casos o procedimientos complejos, la disponibilidad limitada de equipos y material pediátrico específico, los efectos de la sedación o de la anestesia sobre el neurodesarrollo y la protección radiológica suponen importantes retos y oportunidades.(AU)

Pediatric interventional radiology is a dynamic and growing subspecialty. The new training pathways in interventional radiology, the maintenance of skills with a small volume of cases or complex procedures, the limited availability of specific pediatric equipment and materials, the effects of sedation or anesthesia on neurodevelopment or radiological on neurodevelopment or radiation protection pose significant challenges and opportunities.(AU)

Definición, Dimensiones y Atributos del Profesionalismo en Odontología para el Contexto Chileno

El profesionalismo ha tomado gran relevancia en la educación para profesionales de la salud, debido a que existe evidencia de su impacto en la calidad de atención a los pacientes. Se ha reportado que las prácticas poco profesionales incurridas por estudiantes tienden a repetirse posteriormente en su actividad profesional. El profesionalismo es un constructo que refleja valores, cultura, idioma y acuerdos sociales, por lo cual no se sugiere extrapolar una definición desde un contexto a otro. Por ello, un punto de partida es obtener una definición de profesionalismo adaptada culturalmente al contexto donde se encuentra inmersa. El objetivo de este estudio fue obtener una definición de profesionalismo en odontología, sus dimensiones y atributos consensuados por representantes de distintos programas de odontología de universidades chilenas. Se utilizó una metodología mixta en dos fases. En la fase 1 el diseño cualitativo exploratorio tuvo una aproximación por Teoría Fundamentada, donde se desarrollaron dos grupos focales (docentes y estudiantes de odontología) y se analizó la data con método de comparación constante y codificación abierta. En la fase 2 se realizó una consulta a expertos utilizando un diseño explicativo secuencial, a través de un Panel Delphi y un cuestionario con preguntas cerradas y abiertas, donde se realizó análisis de contenido. Se obtuvo una definición de profesionalismo en odontología, consensuada, transversal y adaptada al contexto nacional, con cinco dimensiones (contextual, formativa, personal, interpersonal y social) y trece atributos. El profesionalismo es un constructo complejo, por lo que se hace necesario obtener una definición común que guíe la incorporación de sus dimensiones y atributos en los procesos educacionales de las instituciones formadoras de cirujanos dentistas, de tal manera que ellos/ ellas puedan cumplir su rol social desde la excelencia contribuyendo a mejorar la calidad de atención en salud.

Professionalism has become highly relevant in health professional education since there is evidence of its impact on the quality of patient care. It has been reported that unprofessional practices incurred by students tend to be repeated later in their professional activities. Professionalism is a construct that reflects values, culture, language and social arrangements; therefore, it is not suggested to extrapolate a definition from one context to another. Thus, a starting point is to obtain a definition of professionalism culturally adapted to the context in which it is embedded. The aim of the study was to obtain a definition of professionalism in dentistry, its dimensions and attributes agreed upon by stakeholders of different dentistry programs of Chilean universities. A mixed methodology was used in two phases. In phase 1, an exploratory qualitative design with a Grounded Theory approach, two focus groups were developed (dental teachers and students), and the data was analyzed using a constant comparison method and open coding. In phase 2, an expert consultation was carried out using a sequential explanatory design through a Delphi Panel (consensus method) and a questionnaire with closed and open questions, where content analysis was conducted. A consensus definition of professionalism in dentistry was obtained, transversal and adapted to the national context, with five dimensions (contextual, formative, personal, interpersonal and social) and thirteen attributes. Professionalism is a complex construct, requiring a common definition to guide the incorporation of its dimensions and attributes in the educational processes of dental education institutions, enabling them to play their social role with excellence, contributing to improving the quality of health care.

The effectiveness of a blended-learning training methodology on the dialysis nurse’s perception of competence. Quasi-experimental study / Efetividade de um programa de formação b-learning na perceção de competência do enfermeiro de diálise. Estudo quase-experimental

Introdução:Os enfermeiros que prestam cuidados à pessoa com doença renal crónica em hemodiálise devem ter formação específica em técnicas dialíticas. Assim, os Enfermeiros de Diálise deverão desenvolver competências específicas e diferenciadas ao longo do seu percurso profissional. O b-learning desempenha um papel fundamental na modernização do ensino, tornando-o mais acessível, flexível e adaptado às necessidades dos enfermeiros. Oferece oportunidades para melhorar a quali-dade da aprendizagem e promover a colaboração e a inovação no processo educativo.Objetivos:Os objetivos do estudo foram: avaliar a influência das variáveis sociodemográficas (idade e habilitações literárias) e da formação adquirida (frequência e duração) no perfil de competências e avaliar a eficácia de um programa de formação em técnicas de HD, na perceção de competência do Enfermeiro de Diálise. Material e Métodos:Estudo quase-experimental, pré e pós-teste, sem grupo controle. Resultados:A idade, a frequência e a duração da formação influenciam a perceção de competência do enfermeiro de diálise. Os participantes apresentaram uma melhoria significativa em alguns domínios da perceção de competência do Enfermeiro de Diálise após a implementação de um programa de formação em técnicas de HD. Conclusões:A existência de um programa de formação para Enfermeiros de Diálise, devidamente estruturado e padronizado, é uma mais-valia na aquisição, consolidação e atualização de conhecimentos. (AU)

Introduction: Nurses providing care to individuals with chronic kidney disease undergoing hemodialysis must have specific training in dialysis techniques. Therefore, Dialysis Nurses should develop specific and differentiated competencies throughout their professional career. Blended learning plays a fundamental role in modernizing education, making it more accessible, flexible, and tailored to the needs of nurses. It offers opportunities to improve the quality of learning and promote collaboration and innovation in the educational process. Objectives: The study’s objectives were to assess the influence of sociodemographic variables (age and education) and acquired training (frequency and duration) on the competence profile and to evaluate the effectiveness of a training program in HD techniques on the perception of competence of Dialysis Nurses. Material and Methods: Quasi-experimental, pre and post-test study without a control group. Results: Age, frequency, and duration of training influence dialysis nurses’ perceptions of competence. Participants showed a significant improvement in some domains of dialysis nurses’ perceptions of competence after the implementation of a training program in HD techniques. Conclusions: A properly structured and standardized training program for dialysis nurses is an asset in acquiring, consolidating, and updating knowledge. (AU)

Toma de decisiones de encomienda y evaluación de las actividades profesionales confiables en la educación médica basada en competencias: una revisión de alcance y análisis temático / Entrustment decision-making and evaluation of entrustable professional activities in the competency- based medical education: a scoping review and thematic analysis

Introducción: La evaluación de las actividades profesionales confiables implica que el tutor tome decisiones de encomienda que posibiliten el desarrollo de competencias adecuadas de los futuros especialistas. Objetivo. El objetivo es conocer los componentes que sustentan la toma de decisiones de encomienda como herramienta de evaluación efectiva, segura y eficaz de las actividades profesionales confiables en la educación médica basada en competencias. Materiales y métodos: Se realizó una revisión sistemática en las bases de datos PubMed, BIREME-BVS y Web of Science. Se procedió al análisis y síntesis de los artículos, de acuerdo con la metodología JBI para las revisiones de alcance; el análisis se profundizó en otros artículos de revistas especializadas y citas bibliográficas relacionadas; y el manuscrito final se efectuó con base en las recomendaciones PRISMA-ScR. Resultados: La toma de decisiones de encomienda se centra en la relación tutor-estudiante, con base principalmente en la proactividad, la integridad, la capacidad y la humildad del estudiante, que confluyen en la confianza del tutor para sobrepasar la ‘zona de desarrollo próximo’ y alcanzar un siguiente nivel. Aunque eso signifique un determinado riesgo inicial sobre la seguridad de la atención médica, permite gradualmente generar la autonomía del estudiante. Conclusiones: No cabe duda de que la toma de decisiones de encomienda se basa en la confianza, la encomienda, la supervisión y la autonomía. Una escala retrospectiva-prospectiva que incluya la confianza-encomienda-supervisión-autonomía permite una adecuada evaluación de las actividades profesionales confiables y, por ende, la evaluación de las competencias.(AU)

Introduction: The evaluation of entrustable professional activities implies that the tutor makes assignment decisions that enable the development of appropriate competencies of future specialists. Aim. The aim of this work is to recognize the components that support entrustment decision making as an effective, safe and efficient evaluation tool of entrustable professional activities, in competency-based medical education. Materials and methods: A systematic review was carried out in the PubMed, BIREME-BVS and Web of Science databases. The analysis and synthesis of the articles was carried out in accordance with the JBI methodology for scoping reviews; and was further conducted including other articles from specialized journals and related bibliographic citations. The final manuscript was prepared based on the PRISMA-ScR recommendations.Results: Entrustment decision-making focuses on the tutor-student relationship, based mainly on the student’s proactivity, integrity, ability and humility, which converge in the tutor’s confidence to surpass the ‘zone of proximal development’ and reach the next level. Although this means a certain initial risk to the safety of medical care, it gradually generates the student’s autonomy. Conclusions: There is no doubt that entrustment decision-making is based on trust, entrustment, supervision and autonomy. A retrospective-prospective scale that includes trust-entrustment-supervision-autonomy allows for an adequate evaluation of entrustable professional activities and, therefore, the evaluation of competencies.(AU)

La investigación en las escuelas de las ciencias de la salud / Research in schools of health sciences

RESUMEN La investigación se erige como un pilar fundamental que distingue a la universidad como una entidad de relevancia institucional y social. Esta afirmación es particularmente verídica en el ámbito de las ciencias de la salud, donde no solo se espera que las instituciones educativas generen conocimiento en beneficio de la sociedad, sino que también moldeen individuos capacitados para sumergirse en la investigación y fortalecer esta premisa vital. En este contexto, emergen conceptos intrincados que delinean la naturaleza y el propósito de la investigación en el ámbito académico. La investigación científica, por un lado, se alza como el motor principal que impulsa el avance del conocimiento, y pone énfasis en el método riguroso y sistemático para desentrañar los misterios de la realidad. Por otro lado, la formación para la investigación se erige como un vehículo educativo primordial para cultivar mentes analíticas y curiosas, que dota a los futuros profesionales con las herramientas necesarias para indagar y contribuir al progreso científico. Asimismo, la investigación formativa, si bien menos conocida, desempeña un rol crucial al integrar la investigación en la experiencia de aprendizaje, lo cual fomenta habilidades de pensamiento crítico y resolución de problemas desde etapas tempranas. En esta travesía educativa e investigativa, diversos actores y componentes adquieren protagonismo. Los institutos de investigación se presentan como pilares fundamentales, ya que proporcionan el ambiente propicio para la colaboración interdisciplinaria y el florecimiento de ideas innovadoras. Los docentes, por su parte, ejercen un rol de guías y mentores, transmitiendo su experiencia y conocimientos a las nuevas generaciones de profesionales. Además, las actividades extracurriculares o extraprogramáticas en el área de la investigación surgen como terrenos fértiles para la expansión de horizontes intelectuales, que ofrecen espacios para la exploración creativa y la aplicación práctica de los conocimientos adquiridos por los alumnos. No obstante, estos conceptos y componentes no están exentos de desafíos y controversias en su integración dentro de los programas académicos. La implementación de estos enfoques en los niveles de pregrado y posgrado requiere un análisis profundo de sus objetivos y metas específicas. Las discusiones en torno a la ponderación del tiempo y los recursos dedicados a la investigación frente a otros aspectos curriculares son una constante. La presente revisión se propone delinear y definir de manera precisa los conceptos de investigación científica, formación para la investigación e investigación formativa, así como subrayar el papel cardinal que desempeñan los institutos de investigación, los docentes y las actividades extracurriculares en la configuración de programas académicos en el ámbito de las ciencias de la salud.

ABSTRACT Research stands as a fundamental pillar that recognizes the university as an entity of institutional and social relevance. This statement is particularly true in the field of health sciences, where educational institutions are expected not only to generate knowledge for the benefit of society but also to shape individuals capable of immersing themselves in research and strengthening this vital premise. In this context, intricate concepts that outline the nature and purpose of research in the academia emerge. Scientific research, on the one hand, arises as the driving force behind the advancement of knowledge, emphasizing rigorous and systematic methods to unravel the mysteries of reality. On the other hand, research training stands as a pivotal educational vehicle for nurturing analytical and curious minds, providing future professionals with the necessary tools to inquire and contribute to scientific progress. Similarly, formative research, although less known, plays a crucial role in integrating research into the learning experience, which fosters critical thinking skills and problem-solving abilities from early stages. In this educational and research journey, various actors and components take center stage. Research centers arise as fundamental pillars, as they provide the conducive environment to interdisciplinary collaboration and development of innovative ideas. Educators, on their part, play the role of counselors and mentors by sharing their experience and knowledge with the new generations of professionals. Furthermore, extracurricular or nonacademic activities in the area of research emerge as fertile grounds for the expansion of intellectual horizons, offering spaces for creative exploration and practical application of the knowledge acquired by students. However, these concepts and components are not free of challenges and controversies when integrating into the academic programs. Implementing these approaches at the undergraduate and graduate levels requires an in-depth analysis of their specific objectives and goals. Discussions regarding the balance of time and resources devoted to research versus other curricular aspects remain a constant. This review aims to accurately outline and define the concepts of scientific research, research training and formative research, as well as to highlight the leading role played by research centers, educators and extracurricular activities in shaping academic programs in the field of health sciences.

Terapeutas ocupacionales novatos en unidades de cuidados críticos: ¿qué estrategias educativas de rehabilitación y cuidados se implementan en su formación? / Terapeutas ocupacionais novatos em unidades de cuidados críticos: quais estratégias educativas de reabilitação e cuidados são implementadas em sua formação? / Novice occupational therapists in critical care units: what rehabilitation and care educational strategies are implemented in their training?

Resumen Introducción La formación práctica de terapeutas ocupacionales en unidades de cuidados críticos, es esencial para el desempeño profesional en áreas de rehabilitación y cuidados clínicos. Objetivo Analizar el uso de estrategias educativas utilizadas en unidades de cuidados críticos y su incorporación en los procesos de formación profesional en terapeutas ocupacionales novatos. Metodología Se realizó una investigación cualitativa, con enfoque fenomenológico y diseño descriptivo. Se empleó un muestreo intencional. Los datos se obtuvieron a través de la aplicación de entrevistas semiestructuradas, observación directa y revisión documental. Participaron 4 terapeutas ocupacionales que se desempeñan en un hospital de alta complejidad de Santiago, Chile. Los datos fueron codificados en temas, categorías y subcategorías para su análisis, considerando las unidades de significado presentes en los mensajes desde una perspectiva hermenéutica. Resultados Se destaca la necesaria imbricación teórica-práctica que debe existir en el desarrollo de competencias profesionales de calidad en los entornos de cuidados críticos. Se consideran estrategias educativas efectivas en la formación de terapeutas ocupacionales novatos, sistemáticas tutorías, participación en equipos interdisciplinarios y la retroalimentación constante en las experiencias en medicina intensiva. Conclusión Se enfatiza la importancia de lograr formación profesional de calidad en terapeutas ocupacionales, mediante la implementación de estrategias de colaboración interdisciplinaria, reconociéndose la importancia de afianzar habilidades de comunicación efectiva entre terapeuta ocupacional y paciente crítico. Se identifica la necesidad de consolidar un campo de formación específica en estrategias educativas para el desarrollo de competencias profesionales en terapeutas ocupacionales novatos.

Resumo Introdução A formação prática de terapeutas ocupacionais em unidades de cuidados críticos é essencial para o desempenho profissional em áreas de reabilitação e cuidados clínicos. Objetivo Analisar o uso de estratégias educativas utilizadas em unidades de cuidados críticos e sua incorporação nos processos de formação profissional de terapeutas ocupacionais novatos. Método Foi realizada uma pesquisa qualitativa, com abordagem fenomenológica e design descritivo. Foi utilizado uma amostragem intencional. Os dados foram obtidos por meio de entrevistas semiestruturadas, observação direta e revisão documental. Participaram quatro terapeutas ocupacionais que trabalham em um hospital de alta complexidade em Santiago, Chile. Os dados foram codificados em temas, categorias e subcategorias para análise, considerando as unidades de significado presentes nas mensagens a partir de uma perspectiva hermenêutica. Resultados Destaca-se a necessária imbricação teórico-prática que deve existir no desenvolvimento de competências profissionais de qualidade nos ambientes de cuidados críticos. São consideradas estratégias educativas eficazes na formação de terapeutas ocupacionais novatos, como tutorias sistemáticas, participação em equipes interdisciplinares e feedback constante nas experiências em medicina intensiva. Conclusão Enfatiza-se a importância de alcançar formação profissional de qualidade entre terapeutas ocupacionais, por meio da implementação de estratégias de colaboração interdisciplinar, reconhecendo a importância de fortalecer habilidades de comunicação efetiva entre terapeuta ocupacional e paciente crítico. Identifica-se a necessidade de consolidar um campo de formação específico em estratégias educativas para o desenvolvimento de competências profissionais em terapeutas ocupacionais novatos.

Abstract Introduction Practical training for occupational therapists in critical care units is essential for professional performance in rehabilitation and clinical care areas. Objective To analyze the use of educational strategies employed in critical care units and their integration into the professional development process for novice occupational therapists. Methodology A qualitative research with a phenomenological approach and descriptive design was conducted. Intentional sampling was employed. Data was obtained through the application of semi-structured interviews, direct observation, and documentary review. Four occupational therapists working in a high-complexity hospital in Santiago, Chile, participated. The data was coded into themes, categories, and subcategories for analysis, considering the units of meaning present in the messages from a hermeneutic perspective. Results The necessary theoretical-practical integration required for the development of high-quality professional competencies in critical care environments is emphasized. Effective educational strategies for novice occupational therapists are considered, including systematic mentoring, participation in interdisciplinary teams, and ongoing feedback from experiences in intensive medicine. Conclusion The importance of achieving high-quality professional training for occupational therapists is emphasized through the implementation of interdisciplinary collaboration strategies, recognizing the significance of strengthening effective communication skills between occupational therapists and critical care patients. The need to establish a specific training field for educational strategies in the development of professional competencies for novice occupational therapists is identified.

Insuficiencias en proyectos de investigación de residentes de Estomatología General Integral: alerta necesaria

Fundamento: los proyectos de tesis de los residentes representan una de las actividades fundamentales en su desarrollo científico. Objetivo: describir las principales dificultades encontradas en los proyectos de investigación de los residentes de Estomatología General Integral. Métodos: se realizó un estudio observacional descriptivo retrospectivo en la Facultad de Ciencias Médicas de Sagua la Grande en el periodo 2014-2022. Se utilizaron métodos teóricos y empíricos para la fundamentación de la investigación y recogida de información. Se confeccionó un modelo para la recogida de datos extraídos de los proyectos, y se elaboró una base de datos para su almacenamiento. Resultados: las principales dificultades constatadas fueron: no sustentar adecuadamente la investigación, dificultades en la redacción del problema científico, específicamente en la relación entre el problema y el tipo de investigación, la conceptualización y/o operacionalización de las variables, la selección y elaboración de los métodos, técnicas e instrumentos para la recogida de la información y la acotación de la bibliografía por normas de Vancouver. Conclusiones: se constataron las principales dificultades en los proyectos de investigación de los residentes de Estomatología General Integral por la necesidad de que desarrollen habilidades investigativas desde el primer año de formación, para un mejor desempeño profesional, a partir de la aplicación del método científico en la solución de los problemas de salud bucal que se presenten en su quehacer diario.

Background: residents' thesis projects represent one of the fundamental activities in their scientific development. Objective: to describe the main difficulties found in the research projects of Comprehensive General dentistry residents. Methods: a retrospective descriptive observational study was carried out at Sagua la Grande Faculty of Medical Sciences from 2014 to 2022. Theoretical and empirical methods were used to support the research and collect information. A model was created for data collection extracted from the projects, and a database was created for its storage. Results: the main difficulties found were: not adequately supporting the research, difficulties in writing the scientific problem, specifically in the relationship between the problem and the type of research, the conceptualization and/or operationalization of the variables, the selection and preparation of the methods, techniques and instruments for collecting information and delimiting the bibliography according to Vancouver standards. Conclusions: the main difficulties were confirmed in the research projects of the residents of Comprehensive General Dentistry due to the need for them to develop research skills from the first year of training, for better professional performance, based on the application of the scientific method in the solution to oral health problems that arise in everyday life.

Efectividad del procedimiento para la formación del proyecto de vida profesional en estudiantes de Medicina

Fundamento: el proyecto de vida profesional constituye una formación psicológica compleja que debe ser desarrollada y evaluada durante las acciones que se realizan en los procesos sustantivos universitarios: formación, investigación y extensión universitaria. Objetivo: evaluar la efectividad del procedimiento para la formación del proyecto de vida profesional en estudiantes de Medicina. Métodos: se realizó una investigación cualitativa de tipo prexperimental en la Universidad de Ciencias Médicas de Holguín, Facultad de Ciencias Médicas "Mariana Grajales Coello", desde enero 2021 hasta diciembre 2022. Se utilizaron como métodos teóricos el análisis-síntesis, la inducción-deducción y la modelación. Los métodos empíricos aplicados fueron la observación y el instrumento Exploración del proyecto de vida profesional; así como el prexperimento para evaluar su efectividad. Resultados: se aportó un procedimiento para la formación del proyecto de vida profesional en estudiantes de la carrera Medicina a implementarse durante los procesos sustantivos universitarios. El prexperimento mostró su efectividad para alcanzar el objetivo. Conclusiones: el procedimiento presentado incrementa la calidad de la formación inicial de estudiantes de la carrera Medicina. A través de su evaluación se constató que perfecciona el proceso pedagógico y favorece el proyecto de vida profesional.

Background: the professional life project constitutes a complex psychological training that must be developed and evaluated during the actions carried out through core university processes: training, research and university extension. Objective: to evaluate the effectiveness of the procedure for the formation of the professional life project in medical students. Methods: a pre-experimental quantitative research was carried out at "Mariana Grajales Coello" University of Medical Sciences from Holguín, Faculty of Medical Sciences, from January 2021 to December 2022. Analysis-synthesis, induction-deduction were used as theoretical methods. The empirical methods applied were observation, the Exploration of the professional life project instrument; as well as the pre-test, post test and modeling to evaluate its effectiveness. Results: a procedure was provided for the formation of the professional life project in Medicine students to be implemented trough core university processes. The pre-test and post test showed its effectiveness in achieving the objective. Conclusions: the procedure presented increases the quality of the initial training of medical students. Through its evaluation, it was found that it improves the pedagogical process and favors the professional life project.

Modelo para perfeccionar la redacción de textos científicos en la educación superior

Fundamento: la misión fundamental de las instituciones de educación superior es la formación de profesionales capaces de responder con eficiencia y efectividad a los requerimientos de la sociedad y ponerse a tono con las exigencias sociales del tiempo histórico. Objetivo: evaluar los resultados del sustento práctico del modelo para el perfeccionamiento de la redacción de textos científicos en docentes de la Universidad "José Martí Pérez" de Sancti Spíritus. Métodos: se realizó una investigación experimental con enfoque cuanticualitativo en la Universidad de Sancti Spíritus del 2014 al 2020. Se utilizaron métodos teóricos: análisis-síntesis, inductivo-deductivo, histórico-lógico, sistémico-estructural, la modelación; empíricos: análisis documental, la observación científica, cuestionario a docentes, entrevista grupal a directivos y docentes, estudio de los productos de la actividad de los docentes, prexperimento pedagógico; y matemático-estadísticos. Resultados: se evidenció un cambio de actitud en el proceso de redacción de textos, demostrado en mayor interés e implicación para la adquisición de conocimientos teóricos y prácticos, se logró un mejoramiento en el total de errores por docente y en cuanto al total de docentes por error; además de tendencias de cambio en la divulgación. Conclusiones: la evaluación de los resultados exhibidos demostró la significancia del sustento práctico del modelo desde la dinámica formativa como forma de compartir saberes, ampliar, adquirir y perfeccionar los conocimientos, habilidades y actitudes desde exigencias en el proceso enseñanza aprendizaje para la redacción de textos científicos, al lograr tendencias de cambio en el proceso de escritura de docentes y mejorías en el proceso de divulgación precedente.

Background: the fundamental mission of higher education institutions is the training of professionals capable of responding efficiently and effectively to the requirements of society and coping with the social demands of historical time. Objective: to evaluate the results of the practical support of the model for the improvement of the writing of scientific texts in professors of the "José Martí Pérez" University of Sancti Spíritus. Methods: an experimental research with a quantitative-qualitative approach was carried out at Sancti Spíritus University of from 2014 to 2020. Theoretical methods were used: analysis-synthesis, inductive-deductive, historical-logical, systemic-structural, modeling; empirical: documentary analysis, scientific observation, questionnaire for teachers, group interview with managers and professors, study of the products of professors' activity, pedagogical pre-experiment; and mathematical-statistical Results: a change in attitude was evident in the process of writing texts, demonstrated in greater interest and involvement in the acquisition of theoretical and practical knowledge, an improvement was achieved in the total errors per professors and in the total number of professors per error; in addition to changing trends in disclosure. Conclusions: the evaluation of the results shown demonstrated the significance of the practical support of the model from the formative dynamics as a way of sharing knowledge, expanding, acquiring and perfecting knowledge, skills and attitudes from demands in the teaching-learning process for writing scientific texts. , by achieving trends of change in the professors' writing process and improvements in the preceding dissemination process.

Competências para a produção do cuidado integral: análise dos processos avaliativos no internato de Medicina da Universidade Federal Fluminense / Competencias para la producción de cuidados integrales: análisis de los procesos de evaluación en el internado de Medicina de la Universidad Federal Fluminense / Competencies for the production of comprehensive health care: analysis of the assessment processes in Medicine Internship at Fluminense Federal University

O objetivo deste estudo foi analisar a priorização e valorização de competências para a produção do cuidado integral no internato obrigatório (IO) da faculdade de Medicina da Universidade Federal Fluminense. O percurso metodológico contou com análise documental das competências para o IO e suas formas de avaliação, seguido de entrevistas remotas com docentes. A análise de conteúdo categorizou unidades temáticas de acordo com o momento da produção do cuidado integral no encontro com o paciente e nos demais encontros ocorridos para além deste. Foram evidenciadas priorização e valorização da integração de habilidades de comunicação e de técnicas semióticas; e raciocínio clínico com atitudes éticas e humanísticas e de competências relacionadas ao trabalho em equipe; participação em espaços coletivos de discussão; gestão do cuidado; abordagem comunitária; e processo de produção do conhecimento baseado nos signos do "ser médico(a)".

El objetivo de este estudio es analizar la priorización y valorización de las competencias para la producción de cuidados integrales en el Internado Obligatorio de la Facultad de Medicina de la Universidad Federal Fluminense. La metodologia incluye análisis documental y entrevistas con profesores. El análisis de contenido fue categorizado en unidades temáticas según el momento de producción de la atención integral: en el encuentro y en los encuentros necessários a partir de este encuentro com el paciente. Em el encuentro, se priorizó la integración de habilidades comunicativas y técnicas semióticas y de razonamiento clínico con actitudes éticas y humanísticas, y en los demás encuentros, las habilidades relacionadas con el trabajo en equipo, participación en espacios colectivos de discusión, gestión del cuidado, enfoque comunitario, además del propio proceso de producción de conocimiento, todos basado en la idea de lo que significa ser médico.

The objective of this study is to analyze the prioritization and valorization of competences within the production of comprehensive care at Mandatory Internship at the Faculty of Medicine at Fluminense Federal University. The methologic included analysis of the documents that contained the competencies and its forms of assessment at the Mandatory Internship, and remote interviews with professors. The analysis of the content was categorized into thematic units according to the moment of the production of comprehensive care: in the encounter with patient and beyond others encounters needed after this first one. By the encounter, there was a prioritization of the integration of communication skills and semiotic techniques and clinical reasoning with ethical and humanistic attitudes, and in the second one the competencies related to teamwork, participation in collective spaces for discussion, care management, community approach, in addition of the knowledge production process itself, based on the idea of being a doctor.