[The new program of the Family and Community Medicine specialty: An opportunity not to be missed]. / El nuevo programa de la especialidad de medicina familiar y comunitaria: una oportunidad que no se debe perder.

The training program for the Family and Community Medicine specialty (MFyC), which has been in effect since 2005, is currently undergoing a review and update process. This article proposes contributions to deepen the specific contents of the specialty in order to guide towards a more significant competency development. To carry out values-oriented training, it is suggested to deploy the values function and promote the creation of care spaces where the daily experience of those values is possible. It is proposed to establish a scale of values where the two essential values of the family physician are, in this order, a commitment to the individual person, and a commitment to the group of people under their care. Additionally, it is proposed to reorganize the competency map around five competency integrators or meta-competencies: patient-centered clinical method, population-based clinical governance, primary care oriented to the community, health promotion or community health based on assets, and research in the family and community field.

Scaling up family medicine training in Gezira, Sudan - a 2-year in-service master programme using modern information and communication technology: a survey study.

BACKGROUND: In 2010 the Gezira Family Medicine Project (GFMP) was initiated in Gezira state, Sudan, designed as an in-service training model. The project is a collaboration project between the University of Gezira, which aims to provide a 2-year master's programme in family medicine for practicing doctors, and the Ministry of Health, which facilitates service provision and funds the training programme. This paper presents the programme, the teaching environment, and the first batch of candidates enrolled. METHODS: In this study a self-administered questionnaire was used to collect baseline data at the start of the project from doctors who joined the programme. A checklist was also used to assess the health centres where they work. A total of 188 out of 207 doctors responded (91%), while data were gathered from all 158 health centres (100%) staffed by the programme candidates. RESULTS: The Gezira model of in-service family medicine training has succeeded in recruiting 207 candidates in its first batch, providing health services in 158 centres, of which 84 had never been served by a doctor before. The curriculum is community oriented. The mean age of doctors was 32.5 years, 57% were males, and 32% were graduates from the University of Gezira. Respondents stated high confidence in practicing some skills such as asthma management and post-abortion uterine evacuation. They were least confident in other skills such as managing depression or inserting an intrauterine device. The majority of health centres was poorly equipped for management of noncommunicable diseases, as only 10% had an electrocardiography machine (ECG), 5% had spirometer, and 1% had a defibrillator. CONCLUSIONS: The Gezira model has responded to local health system needs. Use of modern information and communication technology is used to facilitate both health service provision and training. The GFMP represents an example of a large-volume scaling-up programme of family medicine in Africa.

Family and Community Medicine Residency Programs for training the health workforce: what do municipal health managers think? / Residência em Medicina de Família e Comunidade para a formação de recursos humanos: o que pensam gestores municipais?

The training, recruitment and retention of primary care professionals is a constant challenge in Brazil. The recent expansion of family and community medicine residency programs in the country coexists with gaps in the literature on the effects of this process. This article explores municipal health managers' understanding of these programs and the role they play in professional training and improving the quality of health care. We conducted a quantitative and qualitative analysis of the responses to questionnaires answered by 48 health managers working in municipal health services affiliated to residency programs. A descriptive statistical analysis of the quantitative data was performed and the qualitative data were analyzed using thematic analysis. The findings show that efforts were made to incorporate family and community doctors into the health care network and that managers recognized the potential residency program have to improve the quality of care and enhance professional training. Weaknesses were found in actions to improve infrastructure and facilities and the organization of the services affiliated to the programs. This study highlights the potential of residency programs for addressing longstanding problems in primary health care in Brazil when combined with actions to strengthen services, human resources and the programs.

Treinamento especializado, provimento e fixação de profissionais na Atenção Primária à Saúde são desafios prementes no Brasil. A recente expansão dos Programas de Residência em Medicina de Família e Comunidade coexiste com lacunas na literatura sobre o efeito deste processo. O objetivo do trabalho é explorar a perspectiva do gestor municipal de saúde acerca das estratégias para o fortalecimento das residências e do papel destas na formação profissional e na qualificação da atenção. Trata-se de um estudo de análise quantitativa e qualitativa, com aplicação de questionário a gestores de municípios cenários destes programas. As respostas de 48 sujeitos foram submetidas a estatística descritiva e análise de conteúdo. Os resultados revelam um esforço em incorporar o Médico de Família e Comunidade na rede de atenção à saúde, uma percepção do potencial das residências no incremento da qualidade da atenção e da formação profissional e fragilidades nas ações para melhoria da estrutura e organização dos serviços com residentes. Vislumbra-se assim o potencial das residências para a superação de problemas históricos da Atenção Primária à Saúde brasileira, se atrelada a ações de fortalecimento do serviço, dos recursos humanos e do próprio programa.

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

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

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

[Profile of the Family Doctor who gains access to positions with teaching tutorship of Family and Community Medicine by means of relocation examination in Galicia]. / Perfil del médico de familia que accede a plazas con tutoría docente de Medicina Familiar y Comunitaria mediante concurso de traslados en Galicia.

OBJECTIVE: To analyse the profile of Family Doctors who gain access to positions, both to the general quota, as well those reserved for teaching tutors of Family and Community Medicine, by means of a relocation competition. MATERIAL AND METHODS: A descriptive observational study was conducted in which 2 comparison groups were established: A Non-Teaching group that did not include Family Doctors who did not request or gain access to tutor positions, and a Teaching group with those that gained access to positions reserved for tutors. The information was obtained from the marks of the relocation competition carried out in Galicia in 2018. A total of 426 General Practitioners that entered the examination were included, of which 301 were female (70.7%) and 125 (29.3%) males. The variables were the obtaining of a position reserved for tutor, gender, and the merits considered in the competition: professional experience, training, scientific publications, and Galician language. The non-parametric statistics tests of Mann-Whitney and Kruskal-Wallis were used, after checking for non-normal distribution. RESULTS: Statistically significant differences were found in the distribution by gender in favour of males in the Teaching group compared to the Non-Teaching group (P<.01). The Teaching group obtained better results in training and publications. The females obtained statistically significant results in their favour in the training variable, and the males in experience. CONCLUSIONS: For the choice of teaching places in relocation interviews and examinations, publications and training had an important weighting; but, taking the gender perspective into account, a lower percentage of women had gained access to teaching positions due to having lower score in the experience category.

Programa educativo sobre cáncer de mama para mujeres del Consultorio Médico 028-2. Manicaragua / Educational program on breast cancer for women of the Doctor´s Office 028-2. Manicaragua, Cuba

Fundamento: el cáncer de mama representa un problema sanitario mundial por su alta incidencia; en la actualidad este es el de tipo de cáncer más frecuente en las mujeres. Objetivo: desarrollar un programa educativo sobre el cáncer de mama dirigido a las mujeres del Consultorio Médico 028-2, del Policlínico Docente "50 Aniversario", en Manicaragua. Métodos: se desarrolló un estudio prexperimental de intervención educativa evaluado por especialistas, en el Consultorio Médico 028-2, del Policlínico Docente "50 Aniversario" del municipio Manicaragua, entre enero 2021-enero 2022. Se utilizaron métodos teóricos: análisis-síntesis, inductivo-deductivo e histórico-lógico; empírico: análisis documental, encuesta y matemático-estadísticos para el análisis de los datos investigados. Resultados: predominaron las edades de 45 a 54 años, la mayoría no tenían antecedentes patológicos personales y sus conocimientos sobre cómo prevenir la enfermedad eran insuficientes, por lo que se diseñó un programa educativo, el cual fue valorado por criterios de especialistas. Conclusiones: después de ser valorado como adecuado, fue aplicado con muy buenos resultados entre las féminas; este programa se alerta sobre la necesidad de intensificar la labor educativa del médico y demás personal involucrado en la atención a las mujeres para que desarrollen conciencia sobre la importancia de la detección temprana de esta neoplasia.

Background: breast cancer represents a global health problem due to its high incidence; at present this is the most frequent type of cancer in women. Objective: to develop an educational program on breast cancer aimed at the women of the Doctor´Office 028-2, of the "50th Anniversary" Teaching Polyclinic, in Manicaragua. Methods: a pre-experimental study of educational intervention was developed, evaluated by specialists, in the Medical Office 028-2, of the "50 Aniversario" Teaching Polyclinic of the Manicaragua municipality, from January 2021 to January 2022. Theoretical methods were used: analysis-synthesis, inductive -deductive and historical-logical; Empirical ones: documentary, survey and mathematical-statistical for the analysis of the investigated data. Results: the ages of 45 to 54 years predominated, the majority had no past medical history and their knowledge on how to prevent the disease was insufficient, for which an educational program was designed, which was assessed by specialist criteria. Conclusions: after being evaluated as adequate, it was applied with very good results among the females; the need to intensify the educational work of the physician and other personnel involved in caring for women is alerted so that they develop awareness of the importance of early detection of this neoplasm.

Dr. Serafín Ruiz de Zárate Ruiz: aportes al ideal médico social desde su gestión ministerial / MD. Serafín Ruiz de Zárate Ruiz: contributions to the social medical ideal from his ministerial management

Fundamento: los años 1959 y 1960 fueron decisivos en las proyecciones y concreción del ideal médico social, como proceso iniciado, a establecerse en Cuba. Objetivo: identificar los aportes más relevantes del Dr. Serafín Ruiz de Zárate Ruiz, en su gestión como ministro de salud pública a la conformación del ideal médico social cubano en la década del sesenta del siglo XX. Métodos: se realizó una investigación documental de corte histórico en el año 2022. Se aplicaron métodos teóricos que permitieron analizar el objetivo de estudio, basado en la interacción de lo histórico y lo lógico y desde las dimensiones temporal y espacial; y empíricos: análisis de contenido y la consulta bibliográfica para procesar en conjunto el producto resultante, se empleó la triangulación para mejorar la validez y confiabilidad de los datos obtenidos. Resultados: la designación y actuación del Dr. Ruiz de Zárate frente al Ministerio de Salud Pública sentó las bases y logró avanzar, bajo una aguda lucha de clases, en el camino de modificar las condiciones higiénico-sanitarias de la población, posible solo por los cambios de concepciones médicas de lo asistencial curativo a lo social. Conclusiones: el Dr. Ruiz de Zárate en su gestión como ministro hizo relevantes aportes a la conformación del ideal médico social. Diversas y amplias fueron las acciones encaminadas para materializarlo, expresadas concretamente en políticas, leyes, planes, medidas, entre otras, que fueron superadas y fortalecidas con el mismo objetivo por el Dr. José Ramón Machado Ventura.

Background: the years 1959 and 1960 were decisive in the projections and concretion of the social medical ideal, as an initiated process, to be established in Cuba. Objective: to identify the most relevant contributions of MD. Serafín Ruiz de Zárate Ruiz, as Minister of Public Health, to the conformation of the Cuban social medical ideal in the sixties of the 20th century. Methods: a historical documentary research was carried out in the year 2022. Theoretical methods were applied that allowed us to analyze the objective of the study, based on the interaction of the historical and the logical and from the temporal and spatial dimensions; and empirical ones: content analysis and bibliographic consultation to jointly process the resulting product, sources contrasting was used to improve the validity and reliability of the data obtained. Results: the appointment and action of MD. Ruiz de Zárate in front of the Ministry of Public Health laid the foundations and managed to advance, under an acute class struggle, in the path of modifying the hygienic-sanitary conditions of the population, possible only because of the Changes in medical conceptions from curative care to social. Conclusions: MD. Ruiz de Zárate as minister of public health made relevant contributions to the conformation of the social medical ideal. Diverse and extensive were the actions aimed at materializing it, specifically expressed in policies, laws, plans, measures, among others, which were overcome and strengthened with the same objective by MD. José Ramón Machado Ventura.

Ambiente escolar: una necesidad de aprendizaje por el médico de familia / School environment: a learning need for the family doctor

El Ministerio de Salud Pública cubano tiene orientada la realización de los controles médicos a los estudiantes y trabajadores que en su centro no cuentan con equipo básico de salud, en el consultorio médico de la comunidad. En el presente artículo los autores se proponen compartir con la comunidad científica los basamentos teóricos concernientes al proceso de superación, el cual responde a las necesidades de aprendizaje y constituye una vía primordial para que, gradualmente, los médicos de familia coadyuven a la solución de las insuficiencias académicas en determinados temas relacionados con el ambiente escolar y favorezcan el bienestar social desde su desempeño profesional y humano.

The Cuban Ministry of Public Health is oriented to carry out medical controls for students and workers who do not have basic health equipment in their center, in the community doctor's office. In this article the authors intend to share with the scientific community the theoretical foundations concerning the improvement process, which responds to the learning needs and constitutes a primary way for Gps to gradually contribute to the solution of the academic insufficiencies in certain topics related to the school environment and favor social well-being from their professional and human performance.

Competencias profesionales del Equipo Básico de Salud en prevención de violencia intrafamiliar / Professional competencies of the Basic Health Team in the prevention of intra-family violence

Fundamento: la violencia intrafamiliar representa un problema de salud y los profesionales de estas ciencias deben reconocer su existencia y estar debidamente preparados para prevenirla. Objetivo: identificar el nivel de competencia de los equipos básicos de salud en el manejo contra la violencia intrafamiliar en la edad pediátrica desde la atención primaria de salud. Métodos: se realizó un estudio descriptivo transversal en el Policlínico Universitario "Mártires del 10 de Abril", municipio Corralillo de enero a abril de 2021. Se utilizaron métodos teóricos y empíricos; para recogida de información se empleó el análisis de documentos y examen de competencia a profesionales de salud. Las variables en estudio fueron: categoría ocupacional, años de graduado, dimensiones cognitivas, procedimentales y actitudinales; y competencias profesionales en la prevención contra la violencia intrafamiliar. Resultados: El 52,94 % de los profesionales encuestados tenía más de 5 años de graduados, hubo predominio de residentes de MGI y licenciados en enfermería, respectivamente 44,12 % y 35,29 %. Las dimensiones de competencias en prevención contra la violencia intrafamiliar fueron evaluadas de medianamente adecuadas: la cognitiva en 18 (52,94 %), la procedimental en 21 (61,76 %) y la actitudinal en 24 (70,59 %). Conclusiones: el nivel de desarrollo de competencias profesionales resultó ser medianamente adecuado, como promedio. El diagnóstico realizado evidenció la necesidad de desarrollar competencias profesionales para la prevención contra la violencia intrafamiliar en edad pediátrica.

Background: intra-family violence represents a health problem and professionals in these sciences must recognize its existence and be properly prepared to prevent it. Objective: to identify the level of competence of the basic health team in the management of intra-family violence in the pediatric age. Methods: a cross-sectional descriptive study was carried out at the "Mártires del 10 de Abril" University Polyclinic, Corralillo municipality from January to April 2021. Theoretical and empirical methods were used; For the collection of information, the analysis of documents and the examination of the competence of health professionals were used. The variables under study were: occupational category, years of graduation, cognitive, procedural and attitudinal dimensions; and professional skills in the prevention of intra-family violence. Results: 52.94% of the surveyed professionals had more than 5 years working experience, there was a predominance of comprehensive General Medicine residents and nursing graduates, respectively 44.12% and 35.29%. The dimensions of competencies in intra-family violence prevention were evaluated as moderately adequate: cognitive in 18 (52.94%), procedural in 21 (61.76%), and attitudinal in 24 (70.59%). Conclusions: the level of development of professional skills turned out to be moderately adequate, on average. The diagnosis made showed the need to develop professional skills for the prevention of intra-family violence in children.

Superación del médico general para la atención integral a niños con necesidades educativas especiales / Knowledge improvement of the general practitioner for comprehensive care for children with special educational needs

Fundamento: la superación especializada del médico general integral debe de estar encaminada a elevar su nivel profesional en la atención primaria de salud, particularizando en las características individuales de cada paciente. Objetivo: diagnosticar el estado actual de preparación de los médicos generales de la atención primaria de salud en cuanto al conocimiento para brindar atención integral y especializada a los niños con necesidades educativas especiales, pertenecientes al Policlínico Universitario "Ignacio Agramonte", de Camagüey. Métodos: se realizó un estudio descriptivo transversal entre los meses septiembre-diciembre de 2021. Se aplicaron métodos teóricos: histórico-lógico, análisis-síntesis e inducción-deducción; y empíricos, revisión documental y cuestionario a los médicos que laboran en los consultorios médicos del área. Resultados: el diagnóstico realizado permitió identificar falencias en la formación profesional del médico general desde su programa de formación en la especialidad Medicina General Integral, las que dificultan el trabajo exitoso en cuanto a la atención integral a niños con necesidades especiales, en aras de promover su inclusión social y el beneficio de su desarrollo individual. Conclusiones: las deficiencias encontradas ratifican la necesidad de implementar una estrategia de superación en cuanto al tema para perfeccionar el distintivo trabajo comunitario del médico general integral.

Background: the specialized improvement of the comprehensive general practitioner must be aimed at raising their professional level in primary health care, particularizing the individual characteristics of each patient. Objective: to diagnose the current state of preparation of general practitioners in primary health care in terms of knowledge to provide comprehensive and specialized care to children with special educational needs, belonging to the "Ignacio Agramonte" University Polyclinic in Camagüey. Methods: a cross-sectional descriptive study was carried out between from September to December 2021. Theoretical methods were applied: historical-logical, analysis-synthesis and induction-deduction; and empirical ones, documentary review and questionnaire to the doctors who work in the doctor´s offices of the area. Results: the diagnosis made possible to identify shortcomings in the professional training of the general practitioner from his training program in the Comprehensive General Medicine specialty, which hinder successful work in terms of comprehensive care for children with special needs, in order to promote their social inclusion and the benefit of their individual development. Conclusions: the deficiencies found ratify the need to implement an improvement strategy regarding the subject to improve the distinctive community work of the comprehensive general practitioner.

Avaliação do internato médico rural em Medicina de Família e Comunidade da Universidade de Caxias do Sul: reflexões para a educação médica e políticas de saúde / Evaluation of the rural medical internship in Family and Community Medicine at the Universidade de Caxias do Sul: reflections on medical education and health policies

A educação médica passou por transformações constantes ao longo da História e no Brasil assume características específicas. Recentemente, entre outros aspectos, têm-se debatido sobre a importância da variedade de cenários de ensino e de uma abordagem integral e generalista para o desenho de um perfil de egresso mais próximo às necessidades de saúde da população. Este estudo apresenta uma avaliação qualitativa e quantitativa da experiência de acadêmicos de Medicina, professores e profissionais de saúde envolvidos no internato médico rural em Medicina de Família e Comunidade da Universidade de Caxias do Sul, estado do Rio Grande do Sul, Brasil. Perfis dos participantes, motivadores de estágio, influências sobre opções de trabalho futuro, impacto nas equipes de saúde e aspectos positivos e negativos da experiência são apresentados e discutidos à luz da literatura internacional no tema. O internato rural aparece como uma experiência positiva na formação médica, com potencial agregador qualitativo para os envolvidos e influência na opção futura de trabalho, ajudando a reduzir a defasagem de recursos humanos em áreas rurais. O diálogo entre as comunidades, equipes de saúde, universidade e gestores locais é essencial para a superação dos desafios cotidianos e para a manutenção das atividades, assim como o suporte institucional aos alunos e qualificação do corpo docente. Sugestões de futuras linhas de pesquisa na área são apresentadas.

Medical education has undergone constant transformations throughout history and in Brazil it takes on specific characteristics. Recently, among other aspects, there has been debate about the importance of the variety of teaching scenarios and of an integral and generalist approach to the design of an egress profile closer to the population's health needs. This study presents a qualitative and quantitative evaluation of the experience of medical students, professors and health professionals involved in the rural medical internship in Family and Community Medicine at the Universidade de Caxias do Sul, Rio Grande do Sul state, Brazil. Profile of participants, internship motivators, influences on work options future, impact on health teams and positive and negative aspects of the experience are presented and discussed in the light of international literature on the subject. The rural internship appears as a positive experience in medical training, with qualitative aggregating potential for those involved and influence on the future work option, helping to reduce the gap in human resources in rural areas. Dialogue between communities, health teams, universities and local managers is essential to overcome daily challenges and to maintain activities, as well as institutional support for students and qualification of the teaching staff. Suggestions for future lines of research in the area are presented.

Community Paramedicine Initiative: Transforming Paramedicine in British Columbia.

British Columbia's health care system is facing challenges related to rural access to care and an ever increasing demand for services. These variables are compounded by the anticipated needs of an aging population that can expect to live several of their golden years with a chronic illness. The introduction of community paramedicine in BC allows for a care delivery model that expands the role of qualified paramedics to include the delivery of prevention, health promotion and primary care services in the community. The implementation of the Community Paramedicine Initiative in rural and remote BC highlights a transformational approach to health care delivery empowered by a technology enabled perspective of community needs.

Estágio de internato médico em medicina da família e comunidade no programa mais médicos: relato de experiência / Internship in family and community medicine within the more doctors program: experience report / Internado en medicina familiar y comunitaria dentro del programa más médicos: relato de experiencia

Um dos objetivos do Programa Mais Médicos (PMM) é proporcionar o provimento de médicos para o atendimento da população usuária do Sistema Único de Saúde (SUS) por meio do aumento da quantidade de vagas para a graduação em medicina, associado ao aumento da carga horária do graduando e atividades relacionadas ao ensino na comunidade. Este trabalho tem por objetivo descrever a experiência de estágio de estudantes de medicina nas unidades de saúde que atuam com estratégia de saúde da família (ESF) nas quais atuam médicos do PMM. Foram avaliados dados qualitativos referentes a aspectos objetivos e subjetivos envolvendo dimensões didáticas, cognitivas, comportamentais e assistenciais vivenciadas na relação estudante-médico-comunidade. Os estagiários não apresentaram dificuldade significativa quanto à adaptação ao modelo assistencial do PMM, relacionando-se de maneira harmoniosa com a equipe da unidade e com a comunidade atendida, alcançando, assim, os objetivos didáticos e formativos esperados. Nossa experiência do estágio de internato médico dentro do Programa Mais Médicos tem se mostrado exitosa.

One main objective of the More Doctors Program (PMM) is to supply physicians to serve the Brazilian Unified Health System (SUS) user population by increasing the number of vacancies for medical courses, associated with an increased course load and activities in the community. Given this context, this experience report focuses on internships developed in Family Health Strategy (ESF) units, served by PMM physicians. Data on objective and subjective aspects involving didactic, cognitive, behavioral and care dimensions experienced in the student ­ doctor ­ community relationship were qualitatively evaluated. The interns presented no significant difficulties in adapting to the PMM care model, establishing a harmonious relationship with the unit's team and the community served, thus achieving the expected didactic and training objectives. In conclusion, the medical internship within the More Doctors Program has been successful.

Uno de los objetivos del Programa Más Médicos (PMM) es proporcionar la provisión de médicos para la atención de la población usuaria del Sistema Único de Salud (SUS) mediante el aumento del número de vacantes para cursos de graduación en medicina, asociado al aumento de la carga de trabajo del estudiante en actividades relacionadas a la enseñanza en la comunidad. Este estudio tiene como objetivo describir la experiencia de la pasantía de estudiantes de medicina en una unidad de salud que actúan con estrategia de salud familiar (ESF), atendida por un médico del PMM. Los datos fueron evaluados cualitativamente, referidos a aspectos objetivos y subjetivos que involucran dimensiones didácticas, cognitivas, conductuales y asistenciales vivenciadas en la relación estudiante-médico-comunidad. Los internos no tuvieron dificultades significativas para adaptarse al modelo de atención del PMM, presentando una relación armoniosa con el equipo de la unidad y con la comunidad atendida, y logrando los objetivos didácticos y formativos esperados. Nuestra experiencia de la pasantía en el internado médico dentro del programa más médicos ha sido exitosa.

Residência em Medicina de Família e Comunidade para a formação de recursos humanos: o que pensam gestores municipais? / Family and Community Medicine Residency Programs for training the health workforce: what do municipal health managers think?

Resumo Treinamento especializado, provimento e fixação de profissionais na Atenção Primária à Saúde são desafios prementes no Brasil. A recente expansão dos Programas de Residência em Medicina de Família e Comunidade coexiste com lacunas na literatura sobre o efeito deste processo. O objetivo do trabalho é explorar a perspectiva do gestor municipal de saúde acerca das estratégias para o fortalecimento das residências e do papel destas na formação profissional e na qualificação da atenção. Trata-se de um estudo de análise quantitativa e qualitativa, com aplicação de questionário a gestores de municípios cenários destes programas. As respostas de 48 sujeitos foram submetidas a estatística descritiva e análise de conteúdo. Os resultados revelam um esforço em incorporar o Médico de Família e Comunidade na rede de atenção à saúde, uma percepção do potencial das residências no incremento da qualidade da atenção e da formação profissional e fragilidades nas ações para melhoria da estrutura e organização dos serviços com residentes. Vislumbra-se assim o potencial das residências para a superação de problemas históricos da Atenção Primária à Saúde brasileira, se atrelada a ações de fortalecimento do serviço, dos recursos humanos e do próprio programa.

Abstract The training, recruitment and retention of primary care professionals is a constant challenge in Brazil. The recent expansion of family and community medicine residency programs in the country coexists with gaps in the literature on the effects of this process. This article explores municipal health managers' understanding of these programs and the role they play in professional training and improving the quality of health care. We conducted a quantitative and qualitative analysis of the responses to questionnaires answered by 48 health managers working in municipal health services affiliated to residency programs. A descriptive statistical analysis of the quantitative data was performed and the qualitative data were analyzed using thematic analysis. The findings show that efforts were made to incorporate family and community doctors into the health care network and that managers recognized the potential residency program have to improve the quality of care and enhance professional training. Weaknesses were found in actions to improve infrastructure and facilities and the organization of the services affiliated to the programs. This study highlights the potential of residency programs for addressing longstanding problems in primary health care in Brazil when combined with actions to strengthen services, human resources and the programs.

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

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

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

Recruiting community faculty.

The success of community-based resident education depends on a partnership between a residency program and a variety of individuals, physician and nonphysician, in the community. The process of recruiting community faculty in the education of pediatric residents begins with selection of learning objectives. Next, characteristics of effective teachers and teaching sites should be listed so that appropriate faculty may be identified and recruited. A residency program's existing physician network of both referring physicians and graduates of the residency is a good beginning point for making contacts. Selection of specific educational goals, objectives, and activities will lead to identification of potential nonphysician participants. Understanding why community colleagues might want to become part of the training program leads to techniques for contacting and recruiting them.