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.

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.

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.

Dialogues between the Astana Declaration, the Right to Health and Family and Community Medicine training in Rio de Janeiro, Brazil. / Interlocuções entre a Declaração de Astana, o Direito à Saúde e a formação em Medicina de Família e Comunidade no Rio de Janeiro, Brasil.

This paper discusses and fosters concerns in light of the repercussions of both the 40th anniversary of the Alma-Ata Declaration and the Astana Declaration, discussing the possible influence on Family and Community Medicine training, as per the lenses of two Residency Programs of three public institutions, namely, State University of Rio de Janeiro, Federal University of Rio de Janeiro, and the Oswaldo Cruz Foundation. These are inserted in a historical and social context, between the world of work, public policies, international organizations, the population and subjects involved in the construction, maintenance, and consolidation of the Brazilian PHC. Thus, in a brief historical revival, we contextualized which Primary Care was a practice setting and where we might be headed. We concluded that the willingness to ensure the Right to Health would be threatened by the concept of Universal Coverage, advocated by the Astana Declaration, which leads to essential discussions: ensuring state-provided services, advocating for equity and integrality of actions, reaffirming the risk of generating inequality by creating multiple service offerings for different segments of the population, reiterating the relevance of access to health, and valuation of territorialization.

Este artigo discute e promove inquietações à luz da repercussão dos 40 anos da Declaração de Alma-Ata e também da Declaração de Astana, discutindo os possíveis impactos na formação em Medicina de Família e Comunidade, segundo o olhar de 2 Programas de Residência de 3 instituições públicas: a Universidade do Estado do Rio de Janeiro, a Universidade Federal do Rio de Janeiro e a Fundação Oswaldo Cruz. Estes estão inseridos em um contexto histórico e social, entre o mundo do trabalho, as políticas públicas, os organismos internacionais, a população e os sujeitos envolvidos na construção, manutenção e consolidação da Atenção Primária no Brasil. Assim, em um breve resgate histórico, contextualizamos qual Atenção Primária era cenário de prática e para onde, possivelmente, estaríamos nos deslocando. Conclui que a garantia do Direito à Saúde, estaria ameaçada pelo conceito de Cobertura Universal, preconizado pela Declaração de Astana; o que provoca importantes discussões: garantia de ofertas de serviços providos pelo estado, defesa da equidade e integralidade das ações. Reafirmação sobre o risco de gerar desigualdade ao se criar múltiplas ofertas de serviços para diferentes segmentos da população, reiteração sobre a importância do acesso às Unidades de Saúde, valorização da territorialização.

Reflections and proposals for the establishment of Family and Community Medicine Master's Programs in Brazil. / Reflexões e propostas para a estruturação de programas de Mestrado em Medicina de Família e Comunidade no Brasil.

While Primary Health Care (PHC) and Family and Community Medicine (FCM) have expanded their space and relevance in health care and undergraduate medical courses, Brazil has no stricto sensu FCM postgraduate programs. In this paper, we analyze some aspects of the Brazilian public health field and the national stricto sensu postgraduate system that can help to explain this scenario. As a contribution to the debate on this topic, we also gathered information from international postgraduate and research experiences in FCM and devised a curriculum proposal for future national FCM master's courses. In the end, we discussed some key strategies for the emergence of stricto sensu postgraduate courses in this discipline in Brazil, highlighting the potential of these programs for evaluation and qualification of primary care services, especially the Family Health Strategy, and the training of PHC specialists required for the consolidation of the Unified Health System (SUS) as an accessible, comprehensive and equitable health system for the Brazilian population.

Embora a atenção primária à saúde (APS) e a medicina de família e comunidade (MFC) tenham aumentado seu espaço e relevância no cenário assistencial e nos cursos de graduação médica, não há cursos de pós-graduação "stricto sensu" em MFC no Brasil. Neste artigo, analisamos alguns aspectos do campo da saúde pública brasileira e da própria estruturação da pós-graduação "stricto sensu" nacional que podem ajudar a explicar este panorama. Como uma contribuição para o debate neste tema, também reunimos informações de experiências internacionais em pós-graduação e pesquisa em MFC e elaboramos uma proposta de currículo para futuros cursos nacionais de mestrado em MFC. Ao final discutimos algumas estratégias fundamentais para o surgimento de cursos de pós-graduação "stricto sensu" nesta área no Brasil, destacando o potencial desses cursos para a avaliação e a qualificação dos serviços de atenção primária, em especial a Estratégia Saúde da Família, e para a formação de profissionais especializados em APS necessários para a consolidação do Sistema Único de Saúde como sistema acessível, abrangente e equitativo para a população brasileira.

Interlocuções entre a Declaração de Astana, o Direito à Saúde e a formação em Medicina de Família e Comunidade no Rio de Janeiro, Brasil / Dialogues between the Astana Declaration, the Right to Health and Family and Community Medicine training in Rio de Janeiro, Brazil

Resumo Este artigo discute e promove inquietações à luz da repercussão dos 40 anos da Declaração de Alma-Ata e também da Declaração de Astana, discutindo os possíveis impactos na formação em Medicina de Família e Comunidade, segundo o olhar de 2 Programas de Residência de 3 instituições públicas: a Universidade do Estado do Rio de Janeiro, a Universidade Federal do Rio de Janeiro e a Fundação Oswaldo Cruz. Estes estão inseridos em um contexto histórico e social, entre o mundo do trabalho, as políticas públicas, os organismos internacionais, a população e os sujeitos envolvidos na construção, manutenção e consolidação da Atenção Primária no Brasil. Assim, em um breve resgate histórico, contextualizamos qual Atenção Primária era cenário de prática e para onde, possivelmente, estaríamos nos deslocando. Conclui que a garantia do Direito à Saúde, estaria ameaçada pelo conceito de Cobertura Universal, preconizado pela Declaração de Astana; o que provoca importantes discussões: garantia de ofertas de serviços providos pelo estado, defesa da equidade e integralidade das ações. Reafirmação sobre o risco de gerar desigualdade ao se criar múltiplas ofertas de serviços para diferentes segmentos da população, reiteração sobre a importância do acesso às Unidades de Saúde, valorização da territorialização.

Abstract This paper discusses and fosters concerns in light of the repercussions of both the 40th anniversary of the Alma-Ata Declaration and the Astana Declaration, discussing the possible influence on Family and Community Medicine training, as per the lenses of two Residency Programs of three public institutions, namely, State University of Rio de Janeiro, Federal University of Rio de Janeiro, and the Oswaldo Cruz Foundation. These are inserted in a historical and social context, between the world of work, public policies, international organizations, the population and subjects involved in the construction, maintenance, and consolidation of the Brazilian PHC. Thus, in a brief historical revival, we contextualized which Primary Care was a practice setting and where we might be headed. We concluded that the willingness to ensure the Right to Health would be threatened by the concept of Universal Coverage, advocated by the Astana Declaration, which leads to essential discussions: ensuring state-provided services, advocating for equity and integrality of actions, reaffirming the risk of generating inequality by creating multiple service offerings for different segments of the population, reiterating the relevance of access to health, and valuation of territorialization.

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.

Reflexões e propostas para a estruturação de programas de Mestrado em Medicina de Família e Comunidade no Brasil / Reflections and proposals for the establishment of Family and Community Medicine Master's Programs in Brazil

Resumo Embora a atenção primária à saúde (APS) e a medicina de família e comunidade (MFC) tenham aumentado seu espaço e relevância no cenário assistencial e nos cursos de graduação médica, não há cursos de pós-graduação "stricto sensu" em MFC no Brasil. Neste artigo, analisamos alguns aspectos do campo da saúde pública brasileira e da própria estruturação da pós-graduação "stricto sensu" nacional que podem ajudar a explicar este panorama. Como uma contribuição para o debate neste tema, também reunimos informações de experiências internacionais em pós-graduação e pesquisa em MFC e elaboramos uma proposta de currículo para futuros cursos nacionais de mestrado em MFC. Ao final discutimos algumas estratégias fundamentais para o surgimento de cursos de pós-graduação "stricto sensu" nesta área no Brasil, destacando o potencial desses cursos para a avaliação e a qualificação dos serviços de atenção primária, em especial a Estratégia Saúde da Família, e para a formação de profissionais especializados em APS necessários para a consolidação do Sistema Único de Saúde como sistema acessível, abrangente e equitativo para a população brasileira.

Abstract While Primary Health Care (PHC) and Family and Community Medicine (FCM) have expanded their space and relevance in health care and undergraduate medical courses, Brazil has no stricto sensu FCM postgraduate programs. In this paper, we analyze some aspects of the Brazilian public health field and the national stricto sensu postgraduate system that can help to explain this scenario. As a contribution to the debate on this topic, we also gathered information from international postgraduate and research experiences in FCM and devised a curriculum proposal for future national FCM master's courses. In the end, we discussed some key strategies for the emergence of stricto sensu postgraduate courses in this discipline in Brazil, highlighting the potential of these programs for evaluation and qualification of primary care services, especially the Family Health Strategy, and the training of PHC specialists required for the consolidation of the Unified Health System (SUS) as an accessible, comprehensive and equitable health system for the Brazilian population.

Guía didáctica para la educación en el trabajo desde la asignatura Medicina Comunitaria / Didactic guide for the education in the work from the Community Medicine subject

Introducción: La educación en el trabajo es la forma fundamental del proceso docente educativo en las carreras de las ciencias médicas y en específico para la asignatura de Medicina Comunitaria de la carrera de Medicina. Objetivo:Exponer elementos referidos a una guía didáctica para la educación en el trabajo de la asignatura Medicina Comunitaria. Método: Se diseñó una guía didáctica para la educación en el trabajo, desde la asignatura Medicina Comunitaria. Se interactuó con estudiantes de segundo año de la carrera de Medicina, la cuak abarcó 4 etapas. Resultados: Se ofrecen las tareas con sus objetivos y acciones a cumplimentar por los estudiantes, amparados por la guía actual de confección del Análisis de la Situación de Salud. Conclusiones: La guía constituye una herramienta que posibilita la realización de las actividades de la educación en el trabajo a la vez que permite el logro de competencias profesionales(AU)

Introduction: The education in the work is the fundamental form of the educational teaching process in the careers of the medical sciences and in specific for the subject of Community Medicine of the career of Medicine. Objective: To exhibit elements referred to a didactic guide for the education in the work of the Community Medicine subject. Method: A didactic guide was designed for the education in the work, from the Community Medicine subject. It was interacted with students of the second year of the career of Medicine, which included 4 stages. Results: The tasks are offered with their objectives and actions to complete for the students protected by the current guide of preparation of the Analysis of the Situation of Health. Conclusions: The guide constitutes a tool that makes possible the achievement of the activities of the education in the work, simultaneously it allows the achievement of professional competitions(AU)

Requerimientos didácticos y organizativos del Trabajo Comunitario Integrado en la formación del estudiante de Medicina / Didactic and organizational requirements of Integrated Community Work to Medical Education

El trabajo responde al desarrollo del Programa Nacional Formación Médica Integral Comunitaria (PNFMIC), dada la necesidad de consolidar el proceso formativo desde las potencialidades que brinda el trabajo comunitario integrado. Se reflexionó desde el tratamiento teórico metodológico en aspectos epistemológicos del tema, sus relaciones, que desde la acción práctico transformadora puede y debe lograr la entrada en las áreas de residencias de colectivos humanos identificados ya por estilos y formas de vida, por costumbres y cultura autóctonas. El objetivo está dirigido a establecer una aproximación a la problemática del trabajo comunitario integrado como escenario para fortalecer lo formativo, en tanto se resalta la importancia de reconstruir una comunidad y esbozar aspectos metodológicos para la acción concreta de transformación que garantiza su estabilidad y sostenibilidad y por tanto, dirigida a establecerse como tecnología social orientada a demostrar su impacto social y científico desde las condiciones de la construcción de una sociedad diferente(AU)

The work answers to the development of the National Program Community Integral Medical Education (PNFMIC), considering the need to consolidate the formative process from the potentialities that offers the integrated community work. It was reflected from the methodological theoretical treatment in epistemological aspects of the topic, its relations, that from the practical transforming action can and must achieve the entry in the areas of residences of human groups identified already by styles and forms of life, by native customs and culture. The objective is directed to establish an approach to the problems of the integrated community work like stage to strengthen the formative, meanwhile it is highlighted the importance of reconstructing a community and of outlining methodological aspects for the concrete action of transformation that guarantees its stability and sustainability and therefore, directed to settle like social technology faced to demonstrate its social and scientific impact from the conditions of the construction of a different society(AU)

The pursuit of healthier communities through a community health medical education program.

BACKGROUND: Distinct periods in the community health undergraduate medical program at the University of La Sabana (Colombia) were identified in its evolution from 1999 to 2013. We describe each period and explain the succesion of changes toward improvement. METHODS: An ordered review of the community health program was constructed based on the retrospective recollection, classification, and analysis of information from document archives and interviews with participants. The review of the experience reconstructs periods of the program, organizing the evolution of its learned lessons and identified changes across the development of community health projects (CHPs) and the phases followed in their implementation. RESULTS: Two principal stages were identified, the first when students' CHPs involved only schools, and the second when students worked in a broader array of community settings. Identified phases of the community health cycle leading to identifying changes across the program timeline were focus of the community-campus partnership; development of relationships among participants; health and health determinants' assessment; defining project goals and objectives; devising a project activity plan; implementing and gathering results; disseminating project achievements; and building sustainability of program activities. Periods were bounded by important new characteristics introduced in the pursuit of healthier communities. DISCUSSION: Understanding the evolution of the program revealed the key concepts and practices in setting community health apprenticeship scenarios for the various participants. Overall, trust and commitment from stakeholders requires competent facilitators able to build meaningful and sustainable collaborations that can translate the purpose of community health practice into an effective teaching-learning experience. Institutional capacity building and collaborative practice contribute to improvements in the community health program and its ability to be flexible to adapt to different contexts. Periods reflecting improvement in this school's programs over time can help others identify key elements that need to be integrated into a community health medical education program.

Preceptorship in Family and Community Medicine: challenges and achievements in a Primary Health Care in progress. / Preceptoria em Medicina de Família e Comunidade: desafios e realizações em uma Atenção Primária à Saúde em construção.

Strengthening Primary Health Care (PHC) relies directly on training medical specialists in primary care. This text aims to report the Family Medicine training experiences in Rio de Janeiro between 2008 and 2016. It brings to reflection the development of preceptors in medical specialization through an experience report on three Family Medicine medical residency programs, namely, the Municipal Health Secretariat program, the Federal University of Rio de Janeiro program and the National School of Public Health program. The PHC reform in Rio de Janeiro created a demand for medical specialists working in networks, leading to the expansion of already established medical residency programs and the establishment of a new program sponsored by the Municipal Health Secretariat, providing new teaching positions in several health facilities within the municipal network. These three residency programs progressed through different paths to provide training to their preceptors, offering permanent courses and local actions seeking higher professional qualification and better balance between care and education responsibilities. Permanent investments to strengthen medical residency programs and preceptors training are essential to consolidate the PHC reform nationwide.

Adecuaciones de las asignaturas de formación general del plan de estudios de Medicina cubano para la República Popular de Angola / Adaptation of general training subjects from the Cuban Medicine syllabus for the Republic of Angola

Introducción : el aporte a la salud de la misión médica cubana en la República Popular de Angola ha contribuido al mejoramiento del estado de salud de la población, fundamentada en la Medicina Comunitaria. Debido a ello se solicitó por parte de la Secretaría de Estado del Ministerio de Educación Superior de este país, la implementación del plan de estudios cubano para la carrera de Medicina adecuado a las condiciones angolanas en sentido general, donde se incluyó las asignaturas de formación general: idioma Inglés, Educación Física e Informática Médica en estrecha vinculación con la Medicina Comunitaria I y II.Objetivo : adecuar las asignaturas de formación general del plan de Estudios de la carrera de Medicina de Cuba a las condiciones de la República Popular de Angola.Métodos: se realizó una investigación de desarrollo tecnológico basado en el marco contextual y regulatorio del entorno angolano, a través del análisis documental, entrevistas a autoridades y grupos focales con criterios de expertos en estos temas.Resultados: fueron analizadas las asignaturas de formación general en sus ejes transversales y verticales, así como, se realizó el diseño de las disciplinas de Informática Médica, Educación Física e Idioma Inglés e integradas al Plan de estudio de Medicina.Conclusión: la proyección comunitaria está presente a lo largo de toda la carrera de Medicina e integra las disciplinas de formación general, lo cual permite que los futuros profesionales consoliden los conocimientos y las habilidades para el desarrollo de la misma(AU)

Introduction: The Cuban medical mission to the Republic of Angola has contributed to the improvement of that population's health, based on community medicine. Therefore, the Secretariat of State of the Ministry of Higher Education of this country requested the implementation of the Cuban Medicine major syllabus adapted the overall Angolan conditions. The general training subjects included were English Language, Physical Education and Medical Informatics, in close relation with Community Medicine I and II.Objective: To adapt the general training subjects of the Cuban Medicine major syllabus to the conditions of the Republic of Angola.Methods: A research about technological development was carried out, based on the contextual and regulatory features of the Angolan environment, by means of documental analysis, interviews to the authorities and focal groups with criteria by experts in these topics.Results: The general training subjects were analyzed in their traverse and vertical axes, and the design of the disciplines Medical Informatics, Physical Education and English Language was carried out and integrated to the Medicine syllabusConclusion: Community projection is present throughout the whole Medicine major and integrates the general training disciplines, which allows for the future professional to consolidate his/her knowledge and the abilities for the development of their carreer(AU)

Adecuaciones de las asignaturas de formación general del plan de estudios de medicina cubano para la República Popular de Angola / Adaptation of general training subjects from the Cuban Medicine syllabus for the Republic of Angola

INTRODUCCIÓN: el aporte a la salud de la misión médica cubana en la República Popular de Angola ha contribuido al mejoramiento del estado de salud de la población, fundamentada en la Medicina Comunitaria. Debido a ello se solicitó por parte de la Secretaría de Estado del Ministerio de Educación Superior de este país, la implementación del plan de estudios cubano para la carrera de Medicina adecuado a las condiciones angolanas en sentido general, donde se incluyó las asignaturas de formación general: idioma Inglés, Educación Física e Informática Médica en estrecha vinculación con la Medicina Comunitaria I y II. OBJETIVO: adecuar las asignaturas de formación general del plan de Estudios de la carrera de Medicina de Cuba a las condiciones de la República Popular de Angola. MÉTODOS: se realizó una investigación de desarrollo tecnológico basado en el marco contextual y regulatorio del entorno angolano, a través del análisis documental, entrevistas a autoridades y grupos focales con criterios de expertos en estos temas. RESULTADOS: fueron analizadas las asignaturas de formación general en sus ejes transversales y verticales, así como, se realizó el diseño de las disciplinas de Informática Médica, Educación Física e Idioma Inglés e integradas al Plan de estudio de Medicina. CONCLUSIÓN: la proyección comunitaria está presente a lo largo de toda la carrera de Medicina e integra las disciplinas de formación general, lo cual permite que los futuros profesionales consoliden los conocimientos y las habilidades para el desarrollo de la misma.

INTRODUCTION: The Cuban medical mission to the Republic of Angola has contributed to the improvement of that population's health, based on community medicine. Therefore, the Secretariat of State of the Ministry of Higher Education of this country requested the implementation of the Cuban Medicine major syllabus adapted the overall Angolan conditions. The general training subjects included were English Language, Physical Education and Medical Informatics, in close relation with Community Medicine I and II. OBJECTIVE: To adapt the general training subjects of the Cuban Medicine major syllabus to the conditions of the Republic of Angola. METHODS: A research about technological development was carried out, based on the contextual and regulatory features of the Angolan environment, by means of documental analysis, interviews to the authorities and focal groups with criteria by experts in these topics. RESULTS: The general training subjects were analyzed in their traverse and vertical axes, and the design of the disciplines Medical Informatics, Physical Education and English Language was carried out and integrated to the Medicine syllabus CONCLUSION: Community projection is present throughout the whole Medicine major and integrates the general training disciplines, which allows for the future professional to consolidate his/her knowledge and the abilities for the development of their carreer.

Implementation of the Residency Program in Family and Community Medicine of the Rio de Janeiro Municipal Health Department, Brazil. / Implantação do Programa de Residência em Medicina de Família e Comunidade da Secretaria Municipal de Saúde do Rio de Janeiro, Brasil.

The reform of Primary Healthcare in the city of Rio de Janeiro created various needs for improvement of the network, one of which was professional training/qualification of doctors to practice at this level of care. To respond to this the Municipal Health Department took the initiative of structuring the Residency Program in Family and Community Medicine. This paper aims to describe the experience of implementation of this program in the context of the reform of primary healthcare. It also reports on the process of structuring of the program to meet the objectives proposed by the reform, and how this is reflected in the network, and suggests investments in studies that can indicate impacts generated by the Program.

Implantação do Programa de Residência em Medicina de Família e Comunidade da Secretaria Municipal de Saúde do Rio de Janeiro, Brasil / Implementation of the Residency Program in Family and Community Medicine of the Rio de Janeiro Municipal Health Department, Brazil

Resumo A reforma da Atenção Primária à Saúde na cidade do Rio de Janeiro gerou diversas necessidades de melhoria da rede, em uma delas está a qualificação profissional de médicos para atuar neste nível. Desta forma, foi estruturado o Programa de Residência em Medicina de Família e Comunidade pela própria Secretaria Municipal de Saúde. Este artigo tem como objetivo descrever a experiência da implantação desse Programa no contexto da reforma da Atenção Primária à Saúde. Além disso, demonstrar a estruturação do Programa para atingir os objetivos propostos pela reforma e como isso se reflete na rede e sugere investimentos em estudos que possam sinalizar os impactos gerados pelo Programa.

Abstract The reform of Primary Healthcare in the city of Rio de Janeiro created various needs for improvement of the network, one of which was professional training/qualification of doctors to practice at this level of care. To respond to this the Municipal Health Department took the initiative of structuring the Residency Program in Family and Community Medicine. This paper aims to describe the experience of implementation of this program in the context of the reform of primary healthcare. It also reports on the process of structuring of the program to meet the objectives proposed by the reform, and how this is reflected in the network, and suggests investments in studies that can indicate impacts generated by the Program.

Eight years' experience with a Medical Education Journal Club in Mexico: a quasi-experimental one-group study.

BACKGROUND: A time-honored strategy for keeping up to date in medicine and improving critical appraisal skills is the Journal Club (JC). There are several reports of its use in medicine and allied health sciences but almost no reports of JC focused on medical education. The purpose of the study is to describe and evaluate an eight years' experience with a medical education Journal Club (MEJC). METHODS: We started a monthly medical education JC in 2006 at UNAM Faculty of Medicine in Mexico City. Its goal is to provide faculty with continuing professional development in medical education. A discussion guide and a published paper were sent 2 weeks before sessions. We reviewed the themes and publication types of the papers used in the sessions, and in June-July 2014 administered a retrospective post-then-pre evaluation questionnaire to current participants that had been regular attendees to the JC for more than 2 years. The retrospective post-then-pre comparisons were analyzed with Wilcoxon signed-rank test. Effect sizes were calculated for the pre-post comparisons with Cohen's r. RESULTS: There have been 94 MEJC sessions until July 2014. Average attendance is 20 persons, a mix of clinicians, educators, psychologists and a sociologist. The articles were published in 32 different journals, and covered several medical education themes (curriculum, faculty development, educational research methodology, learning methods, assessment, residency education). 22 Attendees answered the evaluation instrument. The MEJC had a positive evaluation from good to excellent, and there was an improvement in self-reported competencies in medical education literature critical appraisal and behaviors related to the use of evidence in educational practice, with a median effect size higher than 0.5. The evaluation instrument had a Cronbach's alpha of 0.96. CONCLUSIONS: A periodic Medical Education Journal Club can improve critical appraisal of the literature, and be maintained long-term using evidence-based strategies. This activity is a useful adjunct to the scholarship of teaching.

Breve historia de la formación de recursos humanos / Brief history of the formation of human resources

Se realizó una investigación de carácter histórico cuyo objetivo fue relatar el desarrollo del proceso de formación y superación de los colaboradores cubanos en la misión y del Nuevo Programa de Formación de los médicos integrales comunitarios en Portuguesa, estado llanero de la República Bolivariana de Venezuela en el marco de Misión Médica cubana. Se utilizaron métodos como el análisis y síntesis de la literatura consultada, histórico-lógico y genético así como la entrevista y la revisión de documentos e informes estadísticos. Se relata cómo y cuándo comenzó la docencia para los colaboradores cubanos, destacándose, en el posgrado, la formación de especialistas de MGI, EGI tanto cubanos como venezolanos así como la formación de másteres. En el pregrado se destacó la formación de médicos para el fortalecimiento de la salud pública en Venezuela, el nacimiento del Programa Nacional de Formación en Medicina Integral Comunitaria, en 2011 se graduó la primera cohorte con 311 nuevos profesionales que brindan servicio en el sistema público de esa nación(AU)

A historical research study was conducted to present the development of the process of formation and upgrading of Cuban cooperators in the Cuban Medical Mission and of the New Program for the Formation of Community-based Integral Physicians in Portuguesa state of the Bolivarian Republic of Venezuela. The methods used in the study were analysis and summarizing of consulted literature, historical-logical and genetic analysis as well as interviews and reviews of documents and statistical reports. The study set forth how and when teaching activity started for the Cuban cooperators, making emphasis on the post-graduate education, the formation of General Integral Medicine specialists both Cubans and Venezuelans and the formation of Masters . In the undergraduate education, the study underlined the formation of physicians for the strengthening of the public health in Venezuela and the inception of the national program of community-based integral medicine formation from which the first cohort of 311 new professionals graduated in 2011, who render service in the public health system of that nation(AU)

Breve historia de la formación de recursos humanos / Brief history of the formation of human resources

Se realizó una investigación de carácter histórico cuyo objetivo fue relatar el desarrollo del proceso de formación y superación de los colaboradores cubanos en la misión y del Nuevo Programa de Formación de los médicos integrales comunitarios en Portuguesa, estado llanero de la República Bolivariana de Venezuela en el marco de Misión Médica cubana. Se utilizaron métodos como el análisis y síntesis de la literatura consultada, histórico-lógico y genético así como la entrevista y la revisión de documentos e informes estadísticos. Se relata cómo y cuándo comenzó la docencia para los colaboradores cubanos, destacándose, en el posgrado, la formación de especialistas de MGI, EGI tanto cubanos como venezolanos así como la formación de másteres. En el pregrado se destacó la formación de médicos para el fortalecimiento de la salud pública en Venezuela, el nacimiento del Programa Nacional de Formación en Medicina Integral Comunitaria, en 2011 se graduó la primera cohorte con 311 nuevos profesionales que brindan servicio en el sistema público de esa nación.

A historical research study was conducted to present the development of the process of formation and upgrading of Cuban cooperators in the Cuban Medical Mission and of the New Program for the Formation of Community-based Integral Physicians in Portuguesa state of the Bolivarian Republic of Venezuela. The methods used in the study were analysis and summarizing of consulted literature, historical-logical and genetic analysis as well as interviews and reviews of documents and statistical reports. The study set forth how and when teaching activity started for the Cuban cooperators, making emphasis on the post-graduate education, the formation of General Integral Medicine specialists both Cubans and Venezuelans and the formation of Masters . In the undergraduate education, the study underlined the formation of physicians for the strengthening of the public health in Venezuela and the inception of the national program of community-based integral medicine formation from which the first cohort of 311 new professionals graduated in 2011, who render service in the public health system of that nation.