Factors affecting willingness to practice medicine in underserved areas: a survey of Argentine medical students.

INTRODUCTION: Previous research has explored the effect of motivations, incentives and working conditions on willingness to accept jobs in rural and remote areas. These studies demonstrated that difficult working conditions, low job satisfaction and remuneration, and poor security, predisposed new medical graduates to select cities instead of rural districts. Since Argentina has a critical shortage of health staff in rural and low-income marginal suburban settings, and limited qualitative and quantitative local research has been done to address this issue, the present study was developed to assess the factors associated with the willingness of medical students to work in low-resource underprivileged areas of the country after graduation. METHODS: A cross-sectional descriptive design was used with data collected from a self-administered questionnaire and using quantitative analysis methods. A total of 400 eligible second-year medical students were invited to participate in a survey focused on sociodemographic characteristics, incentives and working conditions expected in deprived areas, extrinsic and intrinsic motivations, university medical education and government promotion policies. RESULTS: Twenty-one per cent of medical students showed a strong willingness to work in a deprived area, 57.3% manifested weak willingness and 21.5% unwillingness to work in a low-resource setting. Being female, of older age, not having a university-trained professional parent, previous exposure or service in a poor area, choice of pediatrics as a specialty and strong altruistic motivations were highly associated with the willingness to practice medicine in rural or underprivileged areas. Only 21.5% of respondents considered that medical schools encourage the practice of medicine in poor deprived regions. Likewise, only 6.2% of students considered that national public health authorities suitably stimulate physician distribution in poorer districts. CONCLUSIONS: One-third of students expressed high altruistic motivations and should therefore be encouraged during their careers. Better remuneration and the assurance of a position at an urban hospital in the future may tip the choice in favor of underprivileged regions. Since most respondents said that neither government nor medical schools sufficiently encourage the practice of medicine in poor deprived regions, government policy-makers should recommend changes in resource allocation to better promote official proposals and opportunities to work.

Diferencias en los estilos de aprendizaje desde la escuela primaria hasta el posgrado en medicina / Learning styles preferences from elementary school to medical postgraduate

Objetivos: Describir los estilos de aprendizaje de estudiantes de medicina al ingreso y en el posgrado inmediato, de acuerdo con las modalidades preferidas para usar la información, y comparar estos resultados con los estilos de alumnos de la escuela primaria, a fin de hallar diferencias generacionales. Sujetos y métodos: Se administró el cuestionario VARK a 73 alumnos de séptimo grado de una escuela primaria, 113 estudiantes de primer año de medicina y 141 residentes. Se realizó un análisis exploratorio para determinar conjuntos con características afines (análisis de conglomerados). El conteo y suma de los resultados de cada individuo representó el estilo preponderante de cada grupo, definiéndose como dominante cuando se elegía en más del 50% de las respuestas. Resultados: Los estilos preponderantes en los tres grupos fueron cinestésico (27,5%) y bimodal (37,3%), mientras que el lectoescritor creció desde la escuela primaria hasta el posgrado (1,4% a 10,7%; p = 0.037), con una tendencia de la caída del estilo auditivo desde la primaria hasta la universidad y posgrado (19,2% a 12,2%; p = 0.269). Para el estilo bimodal, la combinación preponderante fue auditivo-cinestésica, que disminuyó desde la primaria hasta el posgrado (65% a 31%; p = 0,002). Conclusiones: El análisis de correspondencia mostró que los alumnos de la escuela primaria preferían el estilo auditivo, los universitarios se acercaban al cinestésico y los de posgrado tenían una preferencia intermedia entre el visual y el lectoescritor. Este último perfil creció significativamente desde la escuela primaria hasta el posgrado, con una tendencia inversa del estilo auditivo y del bimodal auditivo-cinestésico entre los mismos grupos

Aims: To describe learning styles observed in first-year medical students and in postgraduates, regarding sensory preferences to use information, and to compare the results with the learning styles of last-year elementary school pupils, in order to find out generational differences. Subjects and methods:The VARK questionnaire was administered to 73 last-year elementary school pupils, 113 first-year medical students and 141 residents of cardiology (postgraduate). The questionnaire consists of 16 questions and each answer was associated to a particular learning style, corresponding to visual, aural, reading/writing or kinaesthetic. Results: Most common styles were kinaesthetic (27.5%) and bimodal (37.3%) in the three groups, with some differences in reading/writing profile that increased from elementary school up to postgraduate (1.4% to 10.7%; p = 0.037), and a slight tendency to decrease aural style from that educational level to the university and the postgraduate (19.2% to 12.2%; p = 0.269). Within bimodal styles, the most common combination was aural-kinaesthetic, that decreased from the elementary school to the postgraduate (65% to 31%; p = 0.002). Conclusions: Correspondence analysis showed last-year elementary school pupils preferred aural style, medical students were nearer to kinaesthetic mode, and postgraduates had an intermediate preference between visual and reading/writing styles. The last profile significantly increased from elementary school to postgraduate, with an inverse tendency of aural and aural-kinaesthetic bimodal styles among the two same levels

Desarrollo de competencias de prevención primaria cardiovascular en el pregrado: una forma de integración vertical de la fisiología / Developing Skills in Cardiovascular Primary Prevention in Undergraduate Education for a Vertical Integration of Physiology

La Fisiología es una disciplina con un papel clave en la integración básico-clínica. El conocimiento y la comprensión de los mecanismos de adaptación del organismo a los diferentes escenarios fisiológicos y fisiopatológicos resultan fundamentales para la construcción del pensamiento clínico. La creciente brecha entre las disciplinas básicas y las clínicas, en especial en los currículos orientados por disciplinas, ha generado la necesidad de utilizar herramientas didácticas con el fin de contextualizar, integrar, motivar y fomentar en los alumnos el aprendizaje activo de los conceptos más relevantes de la práctica profesional. Se diseñó un curso para la adquisición de competencias de Prevención Primaria Cardiovascular que les permita a los alumnos de pregrado calcular el riesgo cardiovascular en pacientes sanos e inducir modificaciones en sus hábitos y al mismo tiempo contextualizar los conocimientos fisiológicos. Se reclutaron 100 alumnos de Fisiología de 2.º año de Medicina de la Universidad de Buenos Aires y 11 ex alumnos cursantes de los dos primeros cursos realizados con pacientes reales que fueron entrenados en una escuela fundamentada en los lineamientos OSCE (examen clínico objetivo estructurado). En seis encuentros de 150 minutos se intentó reflejar la actividad médica cotidiana: consultorio (50 min) y ateneo-debate (100 min). Los alumnos expusieron oralmente las conclusiones del encuentro, integrando los pacientes vistos en el consultorio con la bibliografía. La evaluación en consultorio fue con lista de cotejo de 33 ítems y con un escrito de 16 preguntas. El entrenamiento siguió la lista de cotejo para cada caso (hipertensión, hipercolesterolemia, tabaquismo, diabetes, síndrome metabólico). Noventa y seis alumnos completaron la regularidad. Se calculó la diferencia preprueba-posprueba del puntaje obtenido en las listas de cotejo (0 a 10) utilizando la prueba de la t para datos apareados, que mostró una diferencia significativa a favor de la posprueba [3,80 ± 2,08 vs. 9,60 ± 0,58, diferencia preprueba-posprueba de -5,69 (IC 95% -6,11, -5,277; p < 0,001]. El presente curso y la escuela permitieron la incorporación de las primeras destrezas médicas en alumnos con escasa o ninguna experiencia clínica en un área de mucha significación en salud pública.

Physiology is a discipline that plays a key role in the integration of basic and clinical science. Knowing and understanding the adaptive mechanisms of the body to the different physiological and pathophysiological scenarios are essential for clinical thinking. The growing gap between basic and clinical disciplines, particularly in discipline-oriented curriculum, has generated the need for educational tools in order to contextualise, integrate, motivate and encourage students in the active learning of the most relevant concepts of professional practice. We designed a course for developing skills in cardiovascular primary prevention that would allow undergraduates to calculate the cardiovascular risk in healthy patients, induce changes in their habits, and, at the same time, contextuali-zing the physiological knowledge. A total of 100 second year medical students were recruited from the chair of Physiology of the University of Buenos Aires Medicine School, together with 11 ex-students who took the first two courses with real patients in an school based on the OSCE (Objective Structured Clinical Evaluation) guidelines. The course consisted on six encounters lasting 150 minutes reflecting routine medical activity: physician office practice (50 min) and seminar-debate (100 min). The students presented oral conclusions of the encounter, integrating the patients seen in the office with the bibliography. The evaluation of physician office practice was made with a checklist of 33 items and a document of 16 questions. Training followed the checklist for each case (hypertension, hypercholesterolemia, smoking habits, metabolic syndrome). The course was completed by 96 students. The difference between the pre-test and post-test scores obtained in the checklists (0 to 10) was calculated using the paired t test; showing a significant difference in the post-test score [3.80±2.08 vs. 9.60±0.58, pre-test - post-test difference -5.69 (95% CI -6.11, -5.277; p <0.001]. The present course and the school allowed incorporating the first medical skills in students without or with a little clinical experience in a significant area of public health.