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.

Effectiveness of a Mindfulness and Self-Compassion Standard Training Program versus an Abbreviated Training Program on Stress in Tutors and Resident Intern Specialists of Family and Community Medicine and Nursing in Spain.

Stress is one of the most common problems among healthcare professionals, as they are exposed to potentially stressful and emotionally challenging situations in the workplace. Mindfulness-based stress reduction (MBSR) training programs have been shown to decrease stress. The objective of this study was to compare the effectiveness of an abbreviated 4-weeks MBSR training program in relation to a standard 8-weeks one on the stress levels. A controlled and randomized clinical trial was designed, in which 112 tutors and resident intern specialists in Family and Community Medicine and Nursing of six Spanish National Health System teaching units (TUs) participated. Participants included in the experimental groups (EGs) received a MBRS training program (standard or abbreviated), while control group (CG) participants did not receive any intervention. The stress levels were assessed by the Perceived Stress Questionnaire (PSQ) in three different moments during the study: before, immediately after, and 3 months after the intervention. Adjusted covariance analysis (ANCOVA), using pretest scores as the covariate, showed a significant reduction in stress (F(2,91) = 5.165; p = 0.008; η2 = 0.102) in the post-test visit, attributable to the implementation of the standard training program, but without the maintenance of its effects over time. No significant impact of the abbreviated training program on stress levels was observed in the intergroup comparison. A standard 8-weeks MBSR training program aimed at tutors and resident intern specialists in Family and Community Medicine and Nursing produces significant improvements in stress levels compared with the abbreviated intervention and no intervention. New studies about abbreviated training programs are needed to provide effective treatments which improve well-being of these professionals.

Comparison of the Effectiveness of an Abbreviated Program versus a Standard Program in Mindfulness, Self-Compassion and Self-Perceived Empathy in Tutors and Resident Intern Specialists of Family and Community Medicine and Nursing in Spain.

Health professionals are among the most vulnerable to work stress and emotional exhaustion problems. These health professionals include tutors and resident intern specialists, due to the growing demand for the former and the high work overload of the latter. Mindfulness training programs can support these professionals during times of crisis, such as the current global pandemic caused by the coronavirus-19 disease. The objective of this study was to compare the effectiveness of an abbreviated Mindfulness-Based Stress Reduction (MBSR) and Mindful Self-Compassion (MSC) training program in relation to a standard training program on the levels of mindfulness, self-compassion, and self-perceived empathy in tutors and resident intern specialists of Family and Community Medicine and Nursing. A total of 112 professionals attached to six Spanish National Health System teaching units (TUs) participated in this randomized and controlled clinical trial. Experimental Group (GE) participants were included in the standard or abbreviated MBSR programs. The Five Facet Mindfulness Questionnaire (FFMQ), the Self-Compassion Scale short form (SCS-SF), and the Jefferson Scale of Physician Empathy (JSPE) were administered three times during the study: before, immediately after, and 3 months after the intervention. Adjusted covariance analysis (ANCOVA), using pretest scores as the covariate, showed a significant increase in mindfulness (F(2,91) = 3.271; p = 0.042; η2 = 0.067) and self-compassion (F(2,91) = 6.046; p = 0.003; η2 = 0.117) in the post-test visit, and in self-compassion (F(2,79) = 3.880; p = 0.025; η2 = 0.089) in the follow-up visit, attributable to the implementation of the standard training program. The standard MBSR and MSC training program improves levels of mindfulness and self-compassion, and promotes long-lasting effects in tutors and resident intern specialists. New studies are needed to demonstrate the effectiveness of abbreviated training programs.

Internal Medicine Residency Program Responses to the Increase of Residency Applications: Differences by Program Type and Characteristics.

BACKGROUND: Over the past decade, the number of residency applications has increased substantially, causing many residency programs to change their recruitment practices. OBJECTIVE: We determined how internal medicine (IM) residency programs have responded to increased applications by program type (community-based, community-based/university-affiliated, and university-based) and characteristics (percentage of international medical graduates, program size, and program director [PD] tenure). METHODS: The Association of Program Directors in Internal Medicine conducted a national survey of 363 IM PDs in 2017. Five questions assessed IM program responses to the increased number of residency applications in 3 areas: changes in recruitment strategies, impact on ability to perform holistic review, and interest in 5 potential solutions. We performed a subgroup analysis to measure differences by program type and characteristics. RESULTS: The response rate was 64% (233 of 363). There were no differences by program type or characteristics for experiencing an increase in the number of applicants, altering recruitment practices, or conducting holistic reviews. There were moderate differences in alterations of recruitment practices by program characteristics and moderate differences in interest in proposed solutions by program type. Community-based programs had the greatest interest in a program-specific statement (59%, P = .032) and the lowest percentage in a national database of matched applicants (44%, P = .034). CONCLUSIONS: IM residency programs are experiencing an increasing number of applications and are accommodating by adjusting recruitment practices in a variety of ways. A majority of IM PDs supported 4 of the 5 solutions, although the level of interest differed by program type.

Profiling the best-performing community medicine distributors for mass drug administration: a comprehensive, data-driven analysis of treatment for schistosomiasis, lymphatic filariasis, and soil-transmitted helminths in Uganda.

BACKGROUND: The most prevalent neglected tropical diseases are treated through blanket drug distribution that is reliant on lay community medicine distributors (CMDs). Yet, treatment rates achieved by CMDs vary widely and it is not known which CMDs treat the most people. METHODS: In Mayuge District, Uganda, we tracked 6779 individuals (aged 1+ years) in 1238 households across 31 villages. Routine, community-based mass drug administration (MDA) was implemented for schistosomiasis, lymphatic filariasis, and soil-transmitted helminths. For each CMD, the percentage of eligible individuals treated (offered and ingested medicines) with at least one drug of praziquantel, albendazole, or ivermectin was examined. CMD attributes (more than 25) were measured, ranging from altruistic tendencies to socioeconomic characteristics to MDA-specific variables. The predictors of treatment rates achieved by CMDs were selected with least absolute shrinkage and selection operators and then analyzed in ordinary least squares regression with standard errors clustered by village. The influences of participant compliance and the ordering of drugs offered also were examined for the treatment rates achieved by CMDs. RESULTS: Overall, only 44.89% (3043/6779) of eligible individuals were treated with at least one drug. Treatment rates varied amongst CMDs from 0% to 84.25%. Treatment rate increases were associated (p value< 0.05) with CMDs who displayed altruistic biases towards their friends (13.88%), had friends who helped with MDA (8.43%), were male (11.96%), worked as fishermen/fishmongers (14.93%), and used protected drinking water sources (13.43%). Only 0.24% (16/6779) of all eligible individuals were noncompliant by refusing to ingest all offered drugs. Distributing praziquantel first was strongly, positively correlated (p value < 0.0001) with treatment rates for albendazole and ivermectin. CONCLUSIONS: These findings profile CMDs who treat the most people during routine MDA. Criteria currently used to select CMDs-community-wide meetings, educational attainment, age, years as a CMD, etc.-were uninformative. Participant noncompliance and the provision of praziquantel before albendazole and ivermectin did not negatively impact treatment rates achieved by CMDs. Engaging CMD friend groups with MDA, selecting CMDs who practise good preventative health behaviours, and including CMDs with high-risk occupations for endemic infections may improve MDA treatment rates. Evidence-based guidelines are needed to improve the monitoring, selection, and replacement of CMDs during MDA.

Developing a community-based nursing and midwifery career pathway - A narrative systematic review.

INTRODUCTION: Community nursing and midwifery is changing in response to a shift in care from hospital to home, brought about by increasing costs to care because of an aging population and increasing chronicity. Until now, community nursing positions and scope of practice has been dependent on service focus and location, which has led to the role being unclearly defined. Lack of appeal for a career in community practice and a looming workforce shortage necessitates a review into how community nursing and midwifery transition to practice is supported. METHODS: This review sought to identify, assess and summarize available evidence relating to transitioning into community nursing and midwifery practice as a speciality. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach. A narrative synthesis was then undertaken on papers that examined community nursing and midwifery pathway perspectives which define, and enable or inhibit a contemporary pathway. Thematic analysis used a theoretical framework developed for early career and rapid transition to nursing specialty practice. RESULTS: There is a paucity of research that identifies community nursing and midwifery as a discreet scope of practice. Twelve papers were eventually included in the review. Verbatim findings were extracted from the papers and clustered into categories based on the chosen theoretical framework. Major themes were 'the self' (professional and personal); 'transition processes'; and, a 'sense of belonging'. Sub themes included narrative identifying inhibitors and enablers in each theme. DISCUSSION: No definition of community practice or pathway was identified in nursing, although midwifery was clearly defined. Community nursing practice was described as generalist in nature although specialist knowledge is required. Being part of the community in the professional sense and personal sense was considered important. The importance of transition was identified where pre-entry exposure to community practice was seen as important. Stages in transition to practice were recognised as pre-entry; incomer; insider; and, a sense of belonging. The process of transition should be planned and individualised acknowledging past experience whilst acknowledging the specialist nature of community-based practice.

Controlled clinical trial comparing the effectiveness of a mindfulness and self-compassion 4-session programme versus an 8-session programme to reduce work stress and burnout in family and community medicine physicians and nurses: MINDUUDD study protocol.

BACKGROUND: Health personnel are susceptible to high levels of work stress and burnout due to the psychological and emotional demands of their work, as well as to other aspects related to the organisation of that work. This paper describes the rationale and design of the MINDUUDD study, the aim of which is to evaluate the effectiveness of a mindfulness and self-compassion 4-session programme versus the standard 8-session programme to reduce work stress and burnout in Family and Community Medicine and Nursing tutors and residents. METHODS: The MINDUDD study is a multicentre cluster randomised controlled trial with three parallel arms. Six Teaching Units will be randomised to one of the three study groups: 1) Experimental Group-8 (EG8); 2) Experimental Group-4 (EG4) Control group (CG). At least 132 subjects will participate (66 tutors/66 residents), 44 in the EG8, 44 in the EG4, and 44 in the CG. Interventions will be based on the Mindfulness-Based Stress Reduction (MBSR) program, including some self-compassion practices of the Mindful Self-Compassion (MSC) programme. The EG8 intervention will be implemented during 8 weekly face-to-face sessions of 2.5 h each, while the EG4 intervention will consist of 4 sessions of 2.5 h each. The participants will have to practice at home for 30 min/day in the EG8 and 15 min/day in the EG4. The Five Facet Mindfulness Questionnaire (FFMQ), Self-Compassion Scale (SCS), Perceived Stress Questionnaire (PSQ), Maslach Burnout Inventory (MBI), Jefferson Scale of Physician Empathy (JSPE), and Goldberg Anxiety-Depression Scale (GADS) will be administered. Measurements will be taken at baseline, at the end of the programs, and at three months after completion. The effect of the interventions will be evaluated by bivariate and multivariate analyses (Multiple Linear Regression). DISCUSSION: If the abbreviated mindfulness programme is at least as effective as the standard program, its incorporation into the curriculum and training plans will be easier and more appropriate. It will also be more easily applied and accepted by primary care professionals because of the reduced resources and means required for its implementation, and it may also extend beyond care settings to academic and teaching environments as well. TRIAL REGISTRATION: The study has been registered at ClinicalTrials.gov ( NCT03629457 ; date of registration: 13.08.2018).

老年人整合照护：针对老年人内在能力减退的社区干预措施指南 [Integrated care for older people: guidelines on community-level interventions to manage declines in intrinsic capacity]

世界卫生组织老年人整合照护指南（ICOPE）在预防、延缓和逆转身体机能和脑力下降方面，向卫生保健专业人员就提供了以实证为基础的建议。这些建议需要国家将老年人的需要和偏好置于中心位置，并依此协调照护资源。实施ICOPE指南有利于国家改善老年人的健康和福祉，进一步达成所有年龄群体的全民健康覆盖。

Bioética para la comunidad: identificación y transmisión de nociones relevantes de bioética para la comunidad / Bioethics for the community: identification and transmission of relevant notions of bioethics for the community / Bioètica per a la comunitat: identificació i transmissió de nocions rellevants de bioètica per a la comunitat

Se presenta el marco, desarrollo y resultados de un estudio en el que se concluye que los asuntos bioéticos pueden ser tratados con interés y aprovechamiento (con las adaptaciones y metodologías adecuadas) en actividades comunitarias. Se concluye también que la bioética debe impulsar y permear una acción comunitaria desde los centros de atención primaria, imbricada con la atención individual, promotora de la participación y el empoderamiento ciudadano, integrada intersectorialmente con otros sistemas en el territorio y comprometida con la justicia

The article presents the framework, development and results of a study which concludes that bioethical issues can be treated with interest and profit (with appropriate adaptations and methodologies) in community activities. Above all, bioethics must promote and permeate a community action developed by primary care centres, imbricated with individual attention, promoting participation and citizen empowerment, integrated intersectorally with other systems in the territory and committed to justice

Es presenta el marc, el desenvolupament i els resultats d'un estudi en el qual es conclou que els temes bioètics poden ser tractats amb interès i aprofitament (amb les adaptacions i metodologies adequades) en activitats comunitàries. Es conclou que la bioètica ha d'impulsar i transcendir a una acció comunitària des dels centres d'atenció primària, imbricada amb l'atenció individual, promotora de la participació i l'empoderament del ciutadà, integrada intersectorialment amb altres sistemes al territori i compromesa amb la justícia

The Family Medicine Integrated Clinical Pathways Project (FM ICliP): Methods of development and implementation

Continuing care in family and community medicine is a dynamic process that requires regular patient assessments and adjustments of treatment strategies as the patient goes through the wellness and disease process. Family and community physicians need to be aware of any changes in the patient's clinical condition and re-assess therapeutic interventions when such changes occur. The use of clinical pathways can optimize the management of patients with a given disorder in our setting. The overall goal of the project is to improve the quality of health care in Philippine family and community medicine practice.Clinical pathway is defined as a "tool to guide family and community medicine practitioners to implement evidence- based care and holistic interventions to specific group of patients and populations within a specific timeframe adjusted for acceptable variations that may be due to patient and practice setting characteristics designed to achieve optimum health outcome for the patient and community and efficient use of health care resources." In this definition, holistic interventions refer to interventions directed to the individual patient within the context of the family and community. In this context the PAFP Clinical Pathways Project will be developed to promote and implement the clinical pathways in family and community medicine. The PAFP Clinical Pathways Project will be implemented by a group who will review published medical literature to identify, summarize and operationalize the clinical content of diagnostics, interventions and clinical indicators or outcomes to develop an evidence-based clinical pathway in family medicine practice. The group will also identify processes and indicators to measure the effect of implementation of clinical pathways. Linear time-related representations of patient care processes, in terms of assessments, pharmacologic and non-pharmacologic interventions as well as social and community strategies to prevent complications and maintain wellness will be developed. The clinical pathways will be disseminated to the general PAFP membership and other stakeholders for consensus development. We hope that with this process, family and community medicine practitioners will be dedicated to a common goal and overcome organizational, personal, and professional perspectives barriers to the implementation of the clinical pathway.The implementation of the clinical pathways to be adopted by the PAFP will include a nation-wide dissemination, education, quality improvement initiatives and feedback. Dissemination will be in a form of publication in the Family Filipino Physician Journal, conference presentations and focused group discussions. Quality improvement activities will be in a form of patient record reviews, audit and feedback. Audit standards will be the assessment and intervention recommendations in the clinical pathway. Variations will be discussed in focused group meeting and feedback sessions. The clinical pathways recommendations may also be revised if the variations are justified. Quality improvement activities will also be used to identify barriers in the implementation of clinical pathway. An electronic medical information system may also be used to facilitate the implementation.To monitor the implementation of clinical pathways the PAFP need to select, define and use outcomes and impact to monitor the success of implementation. Outcomes and impact will be at the practice level and the organizational level. Practice level can be a simple count of family and community medicine practice using and applying the clinical pathways. Patient outcomes will also be measured based on quality improvement reports. Organizational outcomes can be activities of the PAFP devoted to the promotion, development, dissemination and implementation of clinical pathways.

The Family Medicine Integrated Clinical Pathways Project (FM ICliP): Methods of development and implementation

@#<p style="text-align: justify;">Continuing care in family and community medicine is a dynamic process that requires regular patient assessments and adjustments of treatment strategies as the patient goes through the wellness and disease process. Family and community physicians need to be aware of any changes in the patient's clinical condition and re-assess therapeutic interventions when such changes occur. The use of clinical pathways can optimize the management of patients with a given disorder in our setting. The overall goal of the project is to improve the quality of health care in Philippine family and community medicine practice.<br />Clinical pathway is defined as a "tool to guide family and community medicine practitioners to implement evidence- based care and holistic interventions to specific group of patients and populations within a specific timeframe adjusted for acceptable variations that may be due to patient and practice setting characteristics designed to achieve optimum health outcome for the patient and community and efficient use of health care resources." In this definition, holistic interventions refer to interventions directed to the individual patient within the context of the family and community. In this context the PAFP Clinical Pathways Project will be developed to promote and implement the clinical pathways in family and community medicine. The PAFP Clinical Pathways Project will be implemented by a group who will review published medical literature to identify, summarize and operationalize the clinical content of diagnostics, interventions and clinical indicators or outcomes to develop an evidence-based clinical pathway in family medicine practice. The group will also identify processes and indicators to measure the effect of implementation of clinical pathways. Linear time-related representations of patient care processes, in terms of assessments, pharmacologic and non-pharmacologic interventions as well as social and community strategies to prevent complications and maintain wellness will be developed. The clinical pathways will be disseminated to the general PAFP membership and other stakeholders for consensus development. We hope that with this process, family and community medicine practitioners will be dedicated to a common goal and overcome organizational, personal, and professional perspectives barriers to the implementation of the clinical pathway.<br />The implementation of the clinical pathways to be adopted by the PAFP will include a nation-wide dissemination, education, quality improvement initiatives and feedback. Dissemination will be in a form of publication in the Family Filipino Physician Journal, conference presentations and focused group discussions. Quality improvement activities will be in a form of patient record reviews, audit and feedback. Audit standards will be the assessment and intervention recommendations in the clinical pathway. Variations will be discussed in focused group meeting and feedback sessions. The clinical pathways recommendations may also be revised if the variations are justified. Quality improvement activities will also be used to identify barriers in the implementation of clinical pathway. An electronic medical information system may also be used to facilitate the implementation.<br />To monitor the implementation of clinical pathways the PAFP need to select, define and use outcomes and impact to monitor the success of implementation. Outcomes and impact will be at the practice level and the organizational level. Practice level can be a simple count of family and community medicine practice using and applying the clinical pathways. Patient outcomes will also be measured based on quality improvement reports. Organizational outcomes can be activities of the PAFP devoted to the promotion, development, dissemination and implementation of clinical pathways.</p>

Cambridge community Optometry Glaucoma Scheme.

BACKGROUND: With a higher life expectancy, there is an increased demand for hospital glaucoma services in the United Kingdom. DESIGN: The Cambridge community Optometry Glaucoma Scheme (COGS) was initiated in 2010, where new referrals for suspected glaucoma are evaluated by community optometrists with a special interest in glaucoma, with virtual electronic review and validation by a consultant ophthalmologist with special interest in glaucoma. PARTICIPANTS: 1733 patients were evaluated by this scheme between 2010 and 2013. METHODS: Clinical assessment is performed by the optometrist at a remote site. Goldmann applanation tonometry, pachymetry, monoscopic colour optic disc photographs and automated Humphrey visual field testing are performed. A clinical decision is made as to whether a patient has glaucoma or is a suspect, and referred on or discharged as a false positive referral. The clinical findings, optic disc photographs and visual field test results are transmitted electronically for virtual review by a consultant ophthalmologist. MAIN OUTCOME MEASURES: The number of false positive referrals from initial referral into the scheme. RESULTS: Of the patients, 46.6% were discharged at assessment and a further 5.7% were discharged following virtual review. Of the patients initially discharged, 2.8% were recalled following virtual review. Following assessment at the hospital, a further 10.5% were discharged after a single visit. CONCLUSIONS: The COGS community-based glaucoma screening programme is a safe and effective way of evaluating glaucoma referrals in the community and reducing false-positive referrals for glaucoma into the hospital system.

Percepções de estudantes de medicina sobre a experiência de aprendizado na comunidade dentro do programa mais médicos: análise de um grupo focal / Medical student’s perceptions of community-based learning experience in a primary care medical program: a focus-group analysis / Percepciones de estudiantes de medicina en la experiencia de aprendizaje en la comunidad en el programa más médicos: análisis de un grupo de enfoque

O ensino médico orientado para a comunidade constitui um dos fundamentos do preparo de futuros profissionais para o trabalho nos serviços de saúde e permite formação ampla para atendimento nos diversos níveis de cuidado. A instituição do programa mais médicos permitiu distribuição de profissionais em regiões com maior necessidade e mudanças nos processos de trabalhos na atenção básica. O curso de medicina da Universidade Federal do Amapá (UNIFAP) iniciou em 2015 atividades de inserção de alunos nas equipes de saúde com profissionais do programa. Este estudo visou identificar as percepções dos acadêmicos de medicina sobre a experiência de aprendizado na comunidade durante acompanhamento de equipes de saúde da família do programa mais médicos. Realizou-se estudo qualitativo através da técnica do grupo focal com voluntários da quarta série de graduação de medicina. O estudo constatou que alunos tiveram percepções positivas sobre a atuação dos médicos acompanhados, principalmente pela valorização da relação médico paciente e atendimento holístico. Entretanto, houve identificação de necessidade de atualização dos protocolos brasileiros de atendimento na atenção primária. Os discentes mudaram visão preconcebida sobre a baixa qualidade profissional do programa e passaram a aceitar melhor a experiência. A observação da realidade estrutural de postos de saúde foi considerada causa importante para que médicos evitem trabalhar no interior ou regiões isoladas. Os achados auxiliam no aprofundamento das discussões sobre políticas de provimento de médicos e sua interação com o ensino, ainda assim novos estudos precisam ser estimulados para avaliar outros aspectos e impactos ocasionados por esse tipo de programa.

: Community-based learning is one of the foundations of preparing future professionals to work in health services and allows extensive training to act in various levels of health care. In Brazil, The establishment of the “Mais Médicos” Program allowed distribution of professionals in areas with greater need and changes in primary care work processes. In 2015, the course of medicine at the Federal University of Amapá (UNIFAP) started students insertion activities in health teams with professionals of the Program. This study aimed to identify the perceptions of medical students on the learning experience in the community while following-up family health teams of the Program. A qualitative research was conducted through focus-group technique with fourth graders volunteers from medical school. Students had positive perceptions about the performance of doctors, mainly reagarding the doctor-patient relationship and holistic care. However, it was identified the need to update primary care to brazilian protocols. Students had their preconceived view of the low professional quality of the program changed and began to best accept the experience. The observation of the structural reality of health centers was considered an important cause to make doctors avoid working in the coutryside or isolated regions. These findings help to deepen the discussions on medical provision policies and their interaction with teaching. Neverthless, further studies need to be encouraged to evaluate other aspects and impacts caused by this type of program.

La educación médica orientada a comunidad es uno del fundamentos de preparación de futuros profesionales que trabajan en servicios de salud y permite una amplia formación para satisfacer diversos niveles de atención. El establecimiento del Programa Más Médicos permitido profesionales de distribución en zonas con mayor necesidad y cambios en procesos de trabajo en atención primaria. El curso de medicina en Universidad Federal de Amapá (UNIFAP) inició en 2015 actividades de inserción estudiantes en equipos de salud con profesionales del programa. Este estudio tuvo como objetivo identificar percepciones de estudiantes de medicina en la experiencia de aprendizaje en comunidad durante el seguimiento de equipos de salud de familia de programa más médico. Se realizó una investigación cualitativa mediante técnica de grupos focales con los voluntarios de la cuarta serie de graduación médica. El estudio encontró que los estudiantes tenían percepciones positivas sobre el desempeño de médicos acompañados principalmente por apreciación de relación médico paciente y servicio integral. Sin embargo, se reconoció la necesidad de actualizar los protocolos de brasileños de atención en atención primaria. Los estudiantes cambiaron visión preconcebida de baja calidad profesional del programa y comenzaron a aceptar la mejor experiencia. La observación de realidad estructural de centros de salud se consideró importante causa de que médicos evitan trabajar dentro o regiones aisladas. Los resultados ayudan a profundizar las discusiones sobre provisión médica de políticas y su interacción con la enseñanza aún, más estudios necesitan ser alentados a evaluar otros aspectos e impactos causados por este tipo de programas.

Comprehensive Healthcare module: medical and pharmacy students' shared learning experiences.

INTRODUCTION: The Comprehensive Healthcare (CHC) module was developed to introduce pre-clinical medical and pharmacy students to the concept of comprehensive healthcare. This study aims to explore their shared learning experiences within this module. METHODOLOGY: During this module, medical and pharmacy students conducted visits to patients' homes and to related community-based organisations in small groups. They were required to write a reflective journal on their experiences regarding working with other professions as part of their module assessment. Highly scored reflective journals written by students from the 2011/2012 academic session were selected for analysis. Their shared learning experiences were identified via thematic analysis. We also analysed students' feedback regarding the module. RESULTS: Analysis of 25 selected reflective journals revealed several important themes: 'Understanding of impact of illness and its relation to holistic care', 'Awareness of the role of various healthcare professions' and 'Generic or soft skills for inter-professional collaboration'. Although the primary objective of the module was to expose students to comprehensive healthcare, the students learnt skills required for future collaborative practice from their experiences. DISCUSSION: The CHC module provided early clinical exposure to community-based health issues and incorporated some elements of inter-professional education. The students learnt about the roles of other healthcare professions and acquired soft skills required for future collaborative practice during this module.

Saberes e práticas fitoterápicas de médicos na estratégia saúde da família / Herbal knowledge and practice of physicians in the family health strategy / Conocimientos y prácticas fitoterápicas de médicos en la estrategia salud familiar

Este artigo analisa o conhecimento e o emprego de fitoterápicos por médicos na Estratégia Saúde da Família de Caicó, Rio Grande do Norte. Tratase de pesquisa descritiva com abordagem qualitativa desenvolvida com nove médicos, em janeiro e fevereiro de 2011, na qual se utilizaram entrevistas semiestruturadas. Os dados foram submetidos à análise temática de conteúdo: perfil dos entrevistados; conhecimento dos médicos sobre fitoterápicos; e emprego de fitoterápicos por médicos. A maioria dos entrevistados (77%) referiu conhecer fitoterápicos e recomendálos aos usuários da Estratégia, no entanto, o saber sobre essa temática era limitado. Foram mencionados 16 fitoterápicos, com maior índice de aplicabilidade para o Ansiopax e o Calman, indicados para problemas de ansiedade e insônia. Evidenciaram-se a importância da abordagem de práticas integrativas e complementares nos cursos de graduação da área da saúde e a necessidade de investimento na formação de recursos humanos, com a oferta de educação permanente em saúde e a garantia de um suporte básico (físico e estrutural) para implantação, manutenção e consolidação da Política Nacional de Plantas Medicinais e Fitoterápicos.

This article examines the knowledge and use of herbal medicines by physicians in the Family Health Strategy at Caicó, state of Rio Grande do Norte (Northeast Brazil). This is a descriptive study with a qualitative approach carried out with nine physicians in January and February 2011 using semistructured interviews. The data were subjected to thematic content analyses: the respondents' profiles; the physicians' knowledge about herbal medicines, and the use such physicians made of herbal medicines. Most respondents (77%) reported knowing herbal medications and recommend them to Strategy users; however, knowledge on this topic was limited. Sixteen herbal medicines were mentioned, with the highest applicability rate for Ansiopax and Calman, prescribed for anxiety disorders and insomnia. The importance of having integrative, complementary practice approaches in place in undergraduate healthcare courses was evident, as was the need for investments in training human resources, by offering continuing education in health and ensuring basic support (physical and structural) for the deployment, maintenance, and consolidation of the National Policy for Medicinal and Herbal Plants.

Este artículo examina el conocimiento y el uso de fitoterápicos por parte de médicos en la Estrategia Salud Familiar de Caicó, Rio Grande do Norte (Noreste de Brasil). Se trata de una investigación descriptiva, con enfoque cualitativo, desarrollada con nueve médicos, en enero y febrero de 2011, en la que se utilizan entrevistas semiestructuradas. Los datos fueron sometidos al análisis temático de contenido: perfil de los entrevistados, conocimiento de los médicos sobre fitoterápicos y empleo de fitoterápicos por médicos. La mayoría de los encuestados (77%) dijeron conocer fitoterápicos y recomendarlos a los usuarios de la Estrategia, sin embargo, el conocimiento sobre este tema era limitado. Se mencionaron 16 fitoterápicos, con mayor índice de aplicabilidad para Ansiopax y Calman, indicados para trastornos de ansiedad e insomnio. Se puso de relieve la importancia del enfoque de prácticas integrativas y complementarias en los cursos de pregrado del área de la salud y la necesidad de invertir en la formación de recursos humanos, con oferta de educación permanente en salud y la garantía de un soporte básico (físico y estructural) para implantación, mantenimiento y consolidación de la Política Nacional de Plantas Medicinales y Fitoterápicos.