Historical Inequities in Medical Education - Commitment to Opportunity, Diversity, and Equity at the University of Hawai'i School of Medicine.

Medical education in the US has contributed to institutionalized racism through historically exclusionary practices, which has led to health disparities and inequities in health care today. The 1910 Flexner report, which favored schools with greater resources, led to the closure of nearly half of medical schools in the Us, which were mostly small schools located in rural communities that served economically disadvantaged, ethnic minority, and female populations. Closing these schools ultimately limited the availability of physicians willing to serve disadvantaged and minority populations in impoverished and underserved communities. In order to transform medical education to be more equitable, medical schools must be proactive in opportunity, diversity, and equity efforts. This not only includes efforts in admissions and faculty hiring, but also curricula related to social and health disparities, interracial interactions between students and faculty, and service learning activities that engage and work with marginalized communities. The University of Hawai'i John A. Burns School of Medicine has a longstanding commitment to diversity, which is integral to the school's mission. Providing opportunities to underserved populations has been a priority since establishment of the school. As one of the most diverse univeristies in the US, the school of medicine continues to focus on opportunity, diversity, and equity priorities in both its strategic planning and overall mission.

The Critical Need for Disaster Medicine in Modern Medical Education.

Current escalation of natural disasters, pandemics, and humanitarian crises underscores the pressing need for inclusion of disaster medicine in medical education frameworks. Conventional medical training often lacks adequate focus on the complexities and unique challenges inherent in such emergencies. This discourse advocates for the integration of disaster medicine into medical curricula, highlighting the imperative to prepare health-care professionals for an effective response in challenging environments. These competencies encompass understanding mass casualty management, ethical decision-making amidst resource constraints, and adapting health-care practices to varied emergency contexts. Therefore, we posit that equipping medical students with these specialized skills and knowledge is vital for health-care delivery in the face of global health emergencies.

[State of the art: Simulation in US]. / State of the art: Simulation in der Ultraschallausbildung.

Technical simulation of diagnostic and therapeutic procedures is of growing relevance for student education and advanced medical training and has already been introduced in the field of ultrasound. This review gives a broad overview on different levels of simulation for ultrasound diagnostics and highlights the technical background of the methodology. A critical review of the literature reveals recommendations for implementing simulation techniques in medical studies and professional ultrasound training. An analysis of strengths and weaknesses shows the advantages of simulation especially in the context of individual learning situations and COVID-19-related restrictions for personal interaction. However, simulation techniques cannot replace the experiences of complex clinical examinations with direct interaction to real patients. Therefore, future applications may focus on repetition and assessment of achieved competencies by using standardized feedback mechanisms in order to preserve the limited resources for practical medical training.

Guía en redes sociales de radiología. ¿Hacia un nuevo paradigma en educación médica? / Social networks in radiology: Toward a new paradigm in medical education?

El sistema universalmente aceptado para la transmisión del conocimiento científico en medicina se basa desde hace mucho en las publicaciones científicas. Las redes sociales (RRSS) son una alternativa o complemento que puede ser útil. Las RRSS (Twitter, Instagram, Facebook, LinkedIn, YouTube, TikTok) tienen generadores de contenidos educativos que pueden proporcionar formación de calidad, a pesar de su informalidad. Cada una tiene sus puntos fuertes y sus debilidades, que conviene conocer. Son gratuitas y permiten discutir en vivo, incorporar contenidos ágilmente y contactar directamente con expertos o fuentes de conocimiento. Las editoriales son conscientes de su influencia y han incorporado métricas que miden el impacto en ellas de los artículos (Altmetrics). La estrategia formativa de cualquier servicio debe incorporarlas ya. Sin embargo, navegar en ellas es complejo y el sistema de búsqueda, basado en hashtags, es ineficiente, por lo que su uso en educación sigue siendo cosa de excéntricos. El conocimiento generado en las RRSS, a pesar de su informalidad, es una fuente cada vez más importante de conocimiento. Los servicios de radiología deben definir una estrategia de RRSS, no con fines de propaganda, sino educativos, creando grupos focales bien formados que busquen contenidos mediante revisión sistemática y filtros, repositorios digitales y sesiones de revisión y los compartan dentro y fuera del servicio. Igualmente, debe ser implementada una estrategia de comunicación a través de redes.(AU)

The universally accepted system for the transmission of scientific knowledge in the field of medicine has long been grounded in scientific publications. Social networks can be a useful alternative or complementary method of transmitting this knowledge. Social networks (e.g., Twitter, Instagram, Facebook, LinkedIn, YouTube, and TikTok) generate educational contents that enable quality training, despite their informality. Each of these networks has strengths and weaknesses that users should know about. These platforms are free and allow for real-time discussion. They make it easy to incorporate content and to contact experts or access sources of knowledge directly. Aware of their influence, publishers have incorporated metrics to measure the impact of their articles in social networks (Altmetrics). These networks should be incorporated into departmental training programs immediately. Nevertheless, navigating through social networks is complex, and the hashtag-based system of searching is inefficient, limiting their use in education. Despite the informality of the knowledge generated on social networks, the importance of these networks as a source of knowledge is growing. Radiology departments must design a strategy for using social networks for education rather than for propaganda, creating well-organized focal groups that search for contents through systematic, filtered review of information, digital repositories, and review sessions and for sharing this knowledge both inside and outside the department. Departments must also implement a strategy for communicating through these networks.(AU)

A Call to Action: Urgently Strengthening the Future Physician-Scientist Workforce in Infectious Diseases.

Infectious diseases (ID) research is vital for global public health, typically led by physician-scientists. This Perspective addresses challenges in the ID workforce and suggests solutions. Physician-scientists have made key discoveries that have significantly impacted human health. The importance of ID research in understanding diseases, leading to treatments and vaccines, is emphasized, along with the need to address persistent and new infections, antimicrobial resistance, and threats like HIV and influenza. The paper analyzes the physician-scientist workforce's struggles, including funding, training, and research-practice integration gaps. We suggest increased funding, better training, and mentorship, more collaborative and interdisciplinary research, and improved recognition systems. The article stresses the urgency of supporting physician-scientists in ID, advocating for proactive prevention and preparedness, and calls for immediate action to enhance ID research and care.

The Case for Advocacy Curricula and Opportunities in Medical Education: Past Examples to Inform Future Instruction.

ABSTRACT: With recent advances in understanding racial, socioeconomic, and mental health issues in medicine and their relation to policy and legislation, medical professionals are increasingly involved in local and national advocacy efforts. At the frontlines of these initiatives are medical students who, in addition to completing required coursework and clinical training, devote themselves to serving patients through civic participation. The burgeoning evidence concerning health care disparities and inequity, along with greater awareness of racial and socioeconomic discrimination, have made advocacy an essential aspect of many students' medical training. Every year, thousands of medical students join national medical advocacy organizations, in addition to regional, state, and local groups. Despite the rich history of medical student involvement in advocacy, there remains much speculation and skepticism about the practice as an essential component of the medical profession. From early initiatives pushing for national health insurance after World War II to encouraging antidiscrimination policies and practices, medical students have been collectively working to create change for themselves and their patients. Through efforts such as banning smoking on airplanes, creating safe syringe programs, and protesting against police brutality, many medical students work tirelessly in advocacy despite minimal educational support or guidance about the advocacy process. Given that medical student advocacy continues to grow and has shown measurable successes in the past, the authors believe that these efforts should be rewarded and expanded upon. The authors examine historical examples of medical student advocacy to suggest ways in which advocacy can be integrated into core medical school curricula and activities. They call attention to opportunities to support students' development of knowledge and skills to facilitate legislative change, expansion of interprofessional collaborations and credit, and curricular updates to promote social and health equity.

Chat GPT: origen, evolución, retos e impactos en la educación / Chat GPT: Origen, Evolution, Challenges and Impacts on Education

Introducción: Los avances de unas tecnologías y la obsolescencia de otras marchan a una velocidad inimaginable, especialmente en este siglo xxi. En los últimos meses de 2022 y primeros meses de 2023 muchas incógnitas y controversias en diferentes campos han surgido en torno a los Chat GPS, una innovación que presenta desafíos nunca pensados para la sociedad actual, así como nuevos retos que impactarán de manera directa en la formación y/o desempeño de profesores, estudiantes, profesionales de la salud, juristas, políticos, informáticos, bibliotecarios, científicos y cualquier ciudadano. Objetivo: Identificar algunas características del chat GPT y su posible impacto en el educación. Posicionamiento de los autores: Se leen en las noticias y reportajes valoraciones de especialistas; se han realizado encuentros virtuales y exposiciones; y están disponibles diversos artículos y videos sobre este tema, algunos llegan a ser elaborados con el propio asistente. Por la novedad del tema, la reciente incorporación como herramienta para el desarrollo profesional, así como por el interés mostrado en los últimos días por la comunidad de profesores de las ciencias médicas cubanas, y considerando que esta herramienta es resultado del desarrollo de la inteligencia artificial, cabe preguntarse: ¿en qué consiste? y ¿cuáles son sus perspectivas? Conclusiones: Resulta oportuno acercarse al tema desde las posibilidades y los retos que abre a la educación y el aprendizaje, en particular a la docencia médica(AU)

Introduction: The advances of some technologies and the obsolescence of others are marching at an unimaginable speed, especially in this twenty-first century. In the last months of 2022 and first months of 2023, many questions and controversies in different fields have arisen with respect to Chat GPT, an innovation that presents challenges never thought of before for today's society, as well as new challenges that will have a direct impact on the training and/or performance of professors, students, health professionals, law practitioners, politicians, computer scientists, librarians, scientists and any citizen. Objective: To identify some technological characteristics of Chat GPT. Positioning of the authors: In news and reports, assessments by specialists are read; virtual meetings and presentations have been held; and several articles and videos on this topic are available, some of them even elaborated by the assistant itself. Due to the novelty of the subject, its recent assimilation as a tool for professional development, as well as the interest shown in recent days by the community of professors of Cuban medical sciences and considering that this tool is the result of the development of artificial intelligence, it is worth wondering what it consists in and what its prospects are. Conclusions: It is appropriate to approach the subject with a focus on the possibilities and challenges that it opens to education and learning (AU)

Propuesta de modificaciones a la tecnología para la determinación de problemas y potencialidades / A Proposal of Modifications to the Technology for Determining Problems and Potentialities

Introducción: Para el desarrollo de la investigación científica, la educación médica ha asumido supuestos que conforman la Teoría de la Educación Avanzada, entre los que se encuentran la Tecnología para la determinación de problemas y potencialidades, descrita por reconocidos pedagogos cubanos. Objetivo: Proponer modificaciones a la Tecnología para la determinación de problemas y potencialidades. Métodos: Se utilizaron métodos teóricos: sistematización, histórico-lógico, sistémico estructural, funcional, análisis documental, concreción-abstracción y modelación. Resultados: Los autores realizaron modificaciones a la Tecnología para la determinación de problemas y potencialidades en el primer, quinto, sexto y séptimo pasos, con dos acercamientos al objeto de estudio desde lo genérico y holístico a lo particular, de la aproximación al análisis profundo. Se introdujo en la práctica mediante su utilización en una tesis, defendida en 2021, para optar por el título de Doctor en Ciencias de la Educación Médica. Conclusiones: La Tecnología para la determinación de problemas y potencialidades con modificaciones demuestra la flexibilidad y posibilidad de aplicación de la tecnología inicial en otras ciencias, a partir de modificaciones que pudieran introducirse de acuerdo con sus particularidades y complejidades. Esta innovación tecnológica se propone para el desarrollo de la investigación científica en las ciencias de la educación médica con vista a abordar, con un enfoque holístico, sus objetos de estudio y campos de acción(AU)

Introduction: For the development of scientific research, medical education has taken assumptions that make up the theory of advanced education, among which is the technology for determining problems and potentialities, described by renowned Cuban pedagogues. Objective: To propose modifications to the technology for determining problems and potentialities. Methods: Theoretical methods were used: systematization, historical-logical, structural-systemic, functional, documentary analysis, concretion-abstraction, and modeling. Results: The authors made modifications to the technology for determining problems and potentialities in the first, fifth, sixth and seventh steps, with two approaches to the object of study from the generic and holistic to the particular, from approximation to profound analysis. It was introduced into practice through its use in a thesis, defended in 2021, to opt for the degree of doctor of Medical Education Sciences. Conclusions: The technology for determining problems and potentialities with modifications shows the flexibility and possibility of application of the initial technology into other sciences, from modifications that could be introduced according to their particularities and complexities. This technological innovation is proposed for the development of scientific research in the sciences of medical education, in view of approaching, with a holistic perspective, its objects of study and fields of action(AU)

Universidad latinoamericana y el derecho social a la salud / The Latin-American University and the Social Right to Health

Este artículo se presenta en la sección de Conferencias Magistrales por ser el texto de una conferencia dictada en la IV Conferencia Internacional Educación Médica en el Siglo xxi durante la IV Convención Internacional de Salud, La Habana, octubre de 2022. Se ha mantenido su carácter de discurso oral. Se aborda el tema universidad latinoamericana y el derecho social a la salud, al considerar la relevancia de la salud en el desarrollo social y económico de la población y al tomar en cuenta la importancia de formar recursos humanos comprometidos con la salud como un derecho social, un bien público y una responsabilidad del Estado. Esto permite analizar críticamente el espacio de la salud pública y la formación de los recursos humanos en el siglo xx y el inicio del siglo xxi para aportar a la demanda de una nueva dimensión estratégica que responda, de forma comprometida, a las necesidades y prioridades de salud de nuestras poblaciones(AU)

This article is presented in the Keynote Lectures section because it is the text of a lecture given at the IV International Conference on Medical Education in the 21st Century during the IV International Health Convention, Havana, October 2022. It has been kept as an oral text. The topic on the Latin-American university and the social right to health is addressed, considering the relevance of health in the social and economic development of the population, as well as taking into account the importance of training human resources committed to health as a social right, a public good, and a responsibility of the State. This allows to analyze critically the public health space and the training of human resources in the twentieth century and the beginning of the twenty-first century, in order to contribute to the demand for a new strategic dimension that responds, in a committed manner, to the health needs and priorities of our populations(AU)

It is not about the destination but the journey: A dive into student-staff partnership processes.

Student-staff partnership advocates the active involvement of students' voices in the design of education. Although the concept of student-staff partnership is rapidly gaining momentum in health professions education, the current practices are more outcome-focused and pay less attention to the partnership process itself. Students' involvement in most of the claimed partnerships has been viewed as input information to the educational design process rather than inviting them to the more pronounced role as partners. In this commentary, we elaborate on different levels of students' involvement in educational design, before highlighting the possible dynamics between students and staff in partnership. We propose five key features of dynamics involved in the process of real student-staff partnerships and a Process-Outcome Model for Student-staff Partnership. We advocate that moving beyond outcomes and diving deeper into the partnership processes is the way forward to establishing true student-staff partnerships.

Salud comunitaria. Innovando en la formación de residentes de medicina familiar y comunitaria / Community health. Innovating in the training of family and community medicine residents

Objetivo: Conocer las opiniones de los agentes implicados en la formación de residentes de medicina familiar y comunitaria para mejorar el proceso formativo del «Proyecto de Apoyo a la Revitalización de la Atención Primaria; Activos para la Salud Comunitaria» (PARAC) teniendo en cuenta su adecuación, contextualización y las metodologías utilizadas.Método: Estudio cualitativo interpretativo-explicativo de orientación fenomenológica, multinivel y multicéntrico, en el que se analiza la opinión de las personas participantes. Entre 2018 y 2020 se realizaron 12 grupos focales y 24 entrevistas semiestructuradas, participando 67 profesionales pertenecientes a seis distritos sanitarios de Andalucía, que estuvieron implicados/as en el proceso formativo PARAC.Resultados: Las personas participantes consideran necesario ampliar la formación en salud comunitaria de los/las residentes. Para ello, creen necesario realizar cambios en el plan formativo de la especialidad, otorgando mayor protagonismo a la atención primaria de salud que a las rotaciones hospitalarias. Valoran positivamente las metodologías utilizadas en el proceso formativo PARAC, que consideran «novedosas», y la elección de docentes jóvenes que sirvan como referentes. Para que sus intervenciones en el territorio se realicen con calidad y seguridad para la población, piden que se garanticen unos tiempos y unos espacios específicos para la salud comunitaria, así como una adecuada supervisión que ayude a asegurar la coherencia y la continuidad de sus intervenciones.Conclusiones: La formación en salud comunitaria de los/las residentes de medicina familiar y comunitaria requiere un esfuerzo pedagógico, didáctico y curricular que los/las prepare para el trabajo con la comunidad, así como la garantía de unas condiciones organizativas que permitan este trabajo.(AU)

Objective: To know the opinions of the agents involved in the training of family and community medicine residents in order to improve the training process of the «Project to Support the Revitalization of Primary Care; Assets for Community Health» (PARAC) taking into account its adequacy, contextualization and the methodologies used.Method: Qualitative interpretative-explanatory study of phenomenological orientation, multilevel and multicenter, in which the opinion of the participants is analyzed. Between 2018 and 2020, 12 focus groups and 24 semi-structured interviews were carried out, with the participation of sixty-seven professionals from six health districts of Andalusia (Spain), who were involved in the PARAC training process.Results: The participants consider it necessary to broaden training in community health for residents. To this end, they consider it necessary to make changes in the training plan of the specialty, giving more importance to primary health care than to hospital rotations. They value positively the methodologies used in the PARAC training process, which they consider «novel», and the choice of young teachers to serve as references. In order for their interventions in the territory to be carried out with quality and safety for the population, they ask that specific times and spaces be guaranteed for community health, as well as adequate supervision to help ensure the coherence and continuity of their interventions.Conclusions: Training in community health for family and community medicine residents requires a pedagogical, didactic and curricular effort that prepares them for work with the community, as well as the guarantee of organizational conditions that allow this work.(AU)