Consideraciones sobre el proceso de formación de especialistas en Organización y Administración de Salud / Considerations on the training process of specialists in Health Organization and Management

La lectura del artículo A propósito de nuevos especialistas en Organización y Administración de Salud publicado en la Revista Cubana de Salud Pública (2020;46(2):e1349), me motivó a hacer un comentario sobre la indudable necesidad de la formación de personal especializado con dedicación a tareas de gestión para su desempeño en el Sistema Nacional de Salud. Soy graduado en Administración y Organización de Salud Pública en el inolvidable Instituto de Desarrollo de la Salud, identificado como IDS. Este instituto contaba con un calificado y exigente claustro de profesores con probada experticia nacional e internacional. Estos profesores fueron garantes, en cada graduado, del sentimiento de la responsabilidad de asumir las tareas como verdaderos salubristas cubanos, con desempeño internacional muchos de ellos, por lo que merecieron ese honroso calificativo con profesionalidad y orgullo para seguir haciendo más. En nuestra etapa de formación en el IDS se realizaban frecuentes actividades investigativas en la práctica docente, en áreas asistenciales y de servicios, mediante encuestas, trabajos prácticos y evaluaciones de procesos. Se utilizaban herramientas de la investigación científica, algunas construidas por nosotros, específicamente para un objetivo demandado por alguna entidad que solicitara colaboración al prestigioso y experimentado IDS y su colectivo profesoral. Lo que comprometía a los educandos a tener una participación responsable desde la especialización, además los imbuía una elevada motivación al apreciar que el producto de ese ejercicio producía algún impacto en el área de atención del solicitante. Éramos consciente de que esto ampliaba nuestro acervo profesional porque nos permitía apreciar las consecuencias de su realización con hechos reales de gestión en áreas de la dirección de salud pública. La acertada renovación de la formación de estos especialistas demanda de una adecuada selección de profesionales comprometidos, que evite una rápida hipoteca de la inversión requerida. Por esa razón, deseo compartir la opción de valorar si sería oportuno seleccionar candidatos en otras categorías profesionales del país; por supuesto, con prioridad en las propias del sector y que pudieran ser formados para desempeñar las funciones de gestión en la administración pública para salud. Además, que incluyera en sus diseños curriculares, desempeños temporales en las futuras y perspectivas áreas de su ámbito administrativo, compartidos con profesionales de la salud con experticia asistencial y docente, delimitando cada campo de acción dentro del objetivo común de las nuevas formas de dirección de la economía, donde la salud pública cubana tiene que seguir aprendiendo. Durante algunos cursos de mi etapa de formación como especialista en administración, el entonces director del Instituto de Desarrollo de la Salud me instó a redactar una propuesta para el desarrollo de la especialidad gerencial en el sistema de salud, a partir de un trabajo de campo que habíamos efectuado, al parecer con resultados muy favorables. Como era habitual, un plazo coordinado para pensar y elaborar, y una entrega con cuartillas bien definidas que evitara pérdida de tiempo, un claro mensaje para evitar costos irreversibles. En aquel momento, experiencias compartidas como parte de tareas docentes ya expresadas en párrafos anteriores, me animó a que, en una de las propuestas, se analizara lo que denominé proceso hipotecario del recurso salubrista. Me refería a la facilidad para designar a autoridades médicas de reconocido prestigio en su especialización y desempeño, para asumir responsabilidades de dirección en la asistencia, administración, docencia e incluso, de servicios; que no dudo que en esos momentos fuera necesario. Pero estas decisiones provocaban, en la mayoría de los casos, la separación y abandono de su práctica profesional, con el consiguiente deterioro de habilidades por las que, en muchos casos, habían sido el motivo de su selección. Con el paso del tiempo se asumió esa práctica, ya probada, de manera habitual, y se aceptó como natural. Lo mismo ocurre en la actualidad, que no permite su formación como parte activa de los procesos en los que deben convertirse en verdaderos líderes, esencia fundamental para ejercer su responsabilidad con una mayor capacidad de autoridad, de mando, pues gestionarían los procesos que comparten con sus propios subordinados. Creo es importante hoy enfatizar en esta actividad para modificar esa hipoteca, teniendo en cuenta el potencial actual de cuadros y reservas en el país. En la actualidad, con el capital humano que dispone la salud pública cubana, a pesar de que alguna personas e instituciones no lo reconozcan, y de su reconocimiento internacional más que destacado, con equipos de dirección entrenados a todos los niveles del sistema de salud, existen condiciones para que directivos médicos o estomatólogos de salud puedan cumplir tareas sin la pérdida de su desempeño profesional. Serían mucho más hábil asumir la responsabilidad donde actúan, y las acciones derivadas de su responsabilidad cumplimentarían una mejor adecuación del ejercicio de su autoridad, es decir, en sus estilos de mandar u ordenar ante los colectivos donde honrarían con su trabajo la gestión comprometida. Poseer responsabilidades es también saber distribuir las tareas, distinguir lo emergente de lo urgente, lo delegable de lo que no lo es. Además, se puede y se deben delegar las tareas, en virtud de la preparación de la reserva, aunque esta no siempre sea su propio relevo, como parte de la realidad objetiva del diario desempeño profesional de un gestor salubrista con deseos de hacer y hacer bien, parafraseando una frase martiana. Comparto esta inquietud, seguro de que los graduados de antes y después del prolongado periodo sin formar nuevos especialistas (ya superado), podrán gestar un espacio adecuado para intercambiar sobre las experiencias acumuladas en entorno a su deber salubrista, a fin de continuar avanzando como país, con la fortaleza demostrada y reconocida de la salud pública en Cuba(AU)

COVID-19: ensuring safe clinical teaching at university optometry schools.

The COVID-19 pandemic has been spreading across the globe for several months. The nature of the virus (SARS-CoV-2) with easy person-to-person transmissions and the severe clinical course observed in some people necessitated unprecedented modifications of everyday social interactions. These included the temporary suspension of considerable elements of clinical teaching at optometry schools worldwide. This article describes the challenges optometry schools were facing in early to mid 2020. The paper highlights the experiences of six universities in five countries on four continents. Strategies to minimise the risk of virus transmission, to ensure safe clinical optometric teaching and how to overcome the challenges presented by COVID-19 are described. An outlook on opportunities to further improve optometric education is provided.

COVID-19 Planning Among Radiologic Science Programs: Response Mitigation Activities.

PURPOSE: To examine radiologic science programs' mitigation activities and educators' experiences related to coronavirus disease 2019 (COVID-19) response planning. METHODS: Using a mixed-methods approach, educators in magnetic resonance, medical dosimetry, radiation therapy, and radiography programs were surveyed to capture their experiences and mitigation strategies related to COVID-19 response planning. Quantitative data were summarized using descriptive statistics and percentages. Thematic analyses were performed on the qualitative responses. RESULTS: A total of 274 educators responded. Educators reported being somewhat comfortable with modifying clinical experiences (79, 28.8%), moderately comfortable with adjusting assessment procedures (112, 40.9%), and extremely comfortable with changing delivery of didactic content (115, 42%). Incidentally, 220 (80.3%) educators thought adjusting to a new course delivery approach (eg, face-to-face to online format) was the greatest challenge for faculty during the pandemic. Notably, half of the educators in this study questioned the quality of online (remote) learning. Specific to program policies, educators indicated that access restrictions to campus buildings (263, 96%) and removal of students from clinical sites (254, 92.7%) were implemented during the pandemic. DISCUSSION: Educators self-reported a moderate to strong comfort level with curricular modification. The area of modification that yielded the most uncertainty arose from alterations of clinical experiences. Thematic analyses revealed concerns related to personal protective equipment procurement and clinical sites prohibiting students from completing rotations. However, educators created innovative alternatives to enhance clinical education by providing simulations, case study analyses, and virtual tours of facilities during the pandemic. Securing educational technology resources, such as lockdown browser software, and working with institutional instructional designers might provide some resolution to educators' concerns regarding the quality of online (remote) learning. CONCLUSION: Archiving radiologic science programs' COVID-19 response efforts is important. The compilation of mitigation strategies will inform and guide programs on contingency planning for future pandemic and emergent conditions.

Assessment of Climate-Health Curricula at International Health Professions Schools.

Importance: Researchers have published surveys on health professionals' perceptions of the possible association between climate change and health (climate-health) and assessed climate-health or planetary health curricula in medical schools. However, curricula on climate-health are still lacking and gaps in knowledge persist. Objective: To understand the state of climate-health curricula among health professions institutions internationally. Design, Setting, and Participants: A survey of 160 institutional members of the Global Consortium on Climate and Health Education, which includes international health professions schools and programs, was conducted from August 3, 2017, to March 1, 2018. The survey, hosted by Columbia University Mailman School of Public Health, used an online survey tool for data collection. Main Outcomes and Measures: The survey assessed climate-health curricular offerings across health professions institutions internationally, including existing climate-health educational offerings, method of teaching climate-health education, whether institutions are considering adding climate-health education, whether institutions received a positive response to adding climate-health curricula and/or encountered challenges in adding curricula, and opportunities to advance climate-health education. Results: Overall response rate to the survey was 53%, with 84 of 160 institutional responses collected; 59 of the responses (70%) were from schools/programs of public health, health sciences, or health professions; 15 (18%) were from medicine; 9 (11%) were from nursing; and 1 (1%) was from another type of health profession institution. Among respondents, 53 (63%) institutions offer climate-health education, most commonly as part of a required core course (41 [76%]). Sixty-one of 82 respondents (74%) reported that climate-health offerings are under discussion to add, 42 of 59 respondents (71%) encountered some challenges trying to institute the curriculum, and most respondents have received a positive response to adding content, mainly from students (39 of 58 [67%]), faculty (35 of 58 [60%]), and administration (23 of 58 [40%]). Conclusions and Relevance: Current climate-health educational offerings appear to vary considerably among health professions institutions. Students, faculty, and administration are important groups to engage when instituting curricula, and awareness, support, and resources may be able to assist in this effort.

Research Success in Schools of Allied Health Professions.

Although the value of research within schools of allied health professions is widely accepted, its practice is limited, and the means of achieving success is poorly understood. This project aimed to characterize schools that have achieved research success, to explore the activities that allow schools to become successful, and to evaluate the metrics by which research success may be monitored. Using data from the 2016 ASAHP Institutional Survey (n=83 schools) and interviews with leadership at top-funded schools, we examined the relationships between external research funding, publications, and program rank for ASAHP member schools and explored the characteristics of well-funded schools. The hallmarks of success include high and clear expectations of faculty, significant levels of institutional investment in research infrastructure, and protected time for faculty research. Institutional support for publishing, including support for pilot studies, statistical analysis, and writing, may be important first steps in achieving research success. While average program rank is higher among schools with research funding than schools without it, program standing alone is not highly correlated with overall research success among ASAHP member institutions.

Faculty Mentorship in Allied Health Schools: A Program Evaluation of a Mentorship Initiative.

Mentorship is an important career development resource for junior faculty and one that may be particularly important for those who begin their career as allied health clinicians before transitioning to academia. To support junior faculty at an allied health school, a formal mentoring program was established within a rehabilitation and counseling department. The program was started in response to a school-wide effort to promote faculty development and increase scholarly productivity. A committee was convened and tasked with matching junior faculty members with experienced mentors. After the mentoring relationships had time to mature, mentors and protégés were surveyed to determine successes as well as drawbacks of the mentoring initiative. Thematic analysis of survey responses indicated that most protégés and mentors had a positive response to the mentoring initiative. Protégés benefitted from receiving support and structure that promoted accountability. They also identified skill development related to teaching and scholarship as a valuable outcome. Mentors described contributing to the growth of protégés as a rewarding experience. While very few negative aspects of the mentoring initiative were identified, lack of time and difficulty coordinating schedules were cited by some respondents. Suggestions for how to improve the mentoring experience were also shared.

Development of a Novel Pathways Program for Pre-Health Students by a Private Four-Year University and a Private Health Professions University.

Education in the health professions occurs at the graduate level, increasing the barriers to underrepresented and first-generation students. Some programs attempt to alleviate these barriers by streamlining passage from the undergraduate campus to the medical campus within a university or by accelerating entry to the professions by bypassing the bachelor's degree. These solutions each have their own limitations for students, including added pressure to maintain grades and a limited ability to explore multiple professions. The Alliance for Health Sciences, a partnership between DePaul University and Rosalind Franklin University of Medicine and Science (RFUMS), was formed to address these issues and has created the Pathways Honors program. Through this program, current DePaul students may apply for an early admission decision to one of 6 of RFUMS's programs and, if qualified, pursue an accelerated entry. They have the option to apply for early decision at any time during their undergraduate career to encourage exploration of career options and to allow students to adjust to college rigor with lower stakes. In addition, collaborative, innovative advising contributes to creating well-rounded students and admissions committee decisions not dictated solely by test metrics. The Pathways Honors program has continued to attract a diverse student pool to DePaul, and early indications are that many of these students are making a successful transition to professional programs. Currently, we have data on our first cohort of students. Continued development of this program will be necessary to ensure that it is preparing students for rigorous graduate programs and helping to diversify the health care workforce.

Similarities and Differences Between Physician Assistant Program and Medical School Mission Statement Themes.

PURPOSE: The purpose of this study was to examine the concordance of US physician assistant (PA) program mission statements with those of US public- and private-sponsored medical schools. With the exception of a broader medical school focus on research, the authors hypothesized that little difference in mission statement congruence would be found in a comparison of medical schools and PA programs. METHODS: Mission statements of 209 of the 210 accredited US PA programs as of May 2016 were obtained and analyzed. Keywords and phrases were identified, coded, and analyzed using NVivo. Themes that previously reported medical school mission statement analyses (including education, research, service, primary care, diversity, prevention, provider distribution, and cost control) were examined. Additional themes of evidence-based medicine (EBM), interprofessional care, patient safety, and quality improvement were included in the analyses. RESULTS: Analyses revealed similar emphasis in both PA programs and medical schools on themes of education, prevention, and cost control, with dissimilar emphases on themes of research, service, primary care, diversity, and provider distribution. Physician assistant programs were more likely to emphasize interprofessional care than EBM, patient safety, or quality improvement. CONCLUSIONS: In the comparison of mission statements of medical schools and PA programs, much less congruence was found than had been hypothesized. Although this study examined the similarities and differences between the mission statements of US medical schools and PA programs, it did not examine the extent to which programs succeeded in meeting the stated missions. Additional research is necessary to understand the factors that determine whether mission statements are actualized in measurable deliverables.

A Program's Analysis of Communication Methods With Clinical Preceptors.

PURPOSE: Preceptors value communication with physician assistant (PA) educational programs. This study describes preceptors' perspectives about one PA program's established and new communication strategies to promote preceptor development and retention. METHODS: An electronic survey of preceptors was conducted in December 2014. Quantitative and qualitative data were analyzed using descriptive statistics. RESULTS: Eighty-eight of 209 preceptors completed the survey (42% response rate). Preceptors reported satisfaction with communication frequency and quality. The most preferred topics were preceptor benefits, teaching strategies, feedback about students' performance, and program policy updates. Many preceptors reported not receiving communications sent by mail. A majority of preceptors preferred site visits at least once per year and in person. CONCLUSIONS: Understanding preceptors' preferred topics helped the study program increase its emphasis on those topics. Knowledge that many preceptors do not receive mailed communications has prompted the program to use electronic communication for all communication types. The results reinforced the program's approach to site visits.

Key Factors Leading to Program Selection: A Survey of Physician Assistant Program Interviewees.

PURPOSE: The purpose of this study was to determine which factors had the greatest influence on physician assistant (PA) interviewees' decision to choose a PA program to attend. The information in this article may assist PA programs in making their program more attractive to potential applicants and also may help applicants identify programs that will best fit their needs. METHODS: Applicants who interviewed with a PA program were asked to rate 33 different influential factors when choosing a program to attend. RESULTS: Respondents most highly endorsed quality of faculty and staff, first-time Physician Assistant National Certifying Examination pass rates, and morale of faculty and staff. Results varied by demographics, including marital status, age, and sex of respondent. Results also varied from pre-PA students. CONCLUSIONS: Although there are numerous factors involved in program selection, PA programs may want to focus on the quality and morale of their faculty and staff to help improve the likelihood of attracting and retaining the highest quality applicants.

A community-based strategy in medical education of the university of the philippines manila-school of health sciences - Lessons from innovations in human resources for health development in a developing country.

Background: After nearly four decades of testing an innovative model for training health workers for marginalized communities, the evidence base for the impact of University of the Philippines Manila-School of Health Sciences (UPM-SHS) medical program needs to address important gaps. Has it succeeded in contributing toward socially accountable medical education where medical schools will be evaluated in terms of their contribution to society's health outcomes? To answer this question, this study examined human resources for health (HRH) inequity in the Philippines and reviewed the medical school's performance in terms of addressing HRH distribution. Methods: The evaluation of the school's performance was done through two phases. Phase 1 involved generating HRH inequity metrics for the Philippines through secondary data. Phase 2 involved gathering primary data and generating performance metrics for UPM-SHS. Results: We found challenges that UPM-SHS needs to address based on the analysis of its student admissions from 1976 to 2011: targeting the right underserved communities, especially at the municipal level; addressing issues of high leakage and undercoverage rates in the program; ensuring mechanisms for return service are in place at the community level; and tracking and measuring program outputs and impact on community health outcomes. Discussion: Given this study on the performance of UPM-SHS to produce a broad range of health workforce to address the needs of marginalized communities in the Philippines and in similarly situated countries, there is a need to reassess its HRH development strategy. If it wants to build a critical mass of transformational health leaders to meet the needs of poor communities as part of its social accountability mandate, it needs to accelerate this development process.

Time for action: key considerations for implementing social accountability in the education of health professionals.

Within health professional education around the world, there exists a growing awareness of the professional duty to be socially responsible, being attentive to the needs of all members of communities, regions, and nations, especially those who disproportionately suffer from the adverse influence of social determinants. However, much work still remains to progress beyond such good intentions. Moving from contemplation to action means embracing social accountability as a key guiding principle for change. Social accountability means that health institutions attend to improving the performance of individual practitioners and health systems by directing educational and practice interventions to promote the health of all the public and assessing the systemic effects of these interventions. In this Reflection, the authors (1) review the reasons why health professional schools and their governing bodies should codify, in both curricular and accreditation standards, norms of excellence in social accountability, (2) present four considerations crucial to successfully implementing this codification, and (3) discuss the challenges such changes might entail. The authors conclude by noting that in adopting socially accountable criteria, schools will need to expand their philosophical scope to recognize social accountability as a vitally important part of their institutional professional identity.

[Acupuncture schools in the Republic of China].

The materials of 48 acupuncture schools in the Republic of China were collected. Their features were analyzed in terms of school running, students enrolling, curriculum setting and course contents, etc. The acupuncture schools at that time were established by private organizations, and opened up correspondence education. These schools mainly relied on advertisements to enroll students, and partially got government supports. The students were on different levels. They emphasized systematic acupuncture curriculum and clinical practice. Most schools absorbed western contents into courses, while few schools taught traditional acupuncture theories. The education model of acupuncture school during the Republic of China was continued after the foundation of the nation, especially laying the foundation for the establishment of department of acupuncture.

Crafting a Profession: Moving From Innovative Model Programs to a Successful National Profession.

The authors review the historical underpinnings of the physician assistant (PA) profession and the tumultuous social context at the time the PA profession was born. They explore the creation of "model" PA programs and the subsequent crafting of the PA profession through 2 distinct "quality control" procedures: the credentialing of PA programs (accreditation) and the credentialing of PA graduates (certification). These pillars of PA education and PA practice brought credibility to a fledgling profession in its early years and stand today as examples of the creative thinking and courage of the architects of a profession that, for the first time in American medical history, allowed someone, other than physicians, to practice medicine.