Factores que influyen en la elección de la especialidad de Medicina Familiar y Comunitaria / Elements influencing the election of Family and Community Medicine

Objetivo: Analizar las percepciones, motivaciones y razones que influyen al elegir la especialidad de Medicina Familiar y Comunitaria (MFyC), y explorar posibles propuestas de cambio sobre el modelo sanitario y la formación universitaria. Diseño: Estudio cualitativo descriptivo-interpretativo de perspectiva socioconstructivista. Emplazamiento: Unidades docentes del Área Metropolitana de Barcelona. Participantes y contexto: Se contactó con 55 residentes de primer año de MFyC pertenecientes a la U.D. MFyC Barcelona Ciutat ICS vía telefónica, y se reclutaron 25 participantes que fueron segmentadas en dos grupos según hubieran escogido MFyC como primera opción o no. Mediante muestreo en bola de nieve, se reclutaron once residentes de primer año de otras especialidades. Método: Constitución de tres grupos focales: (a) MFyC como primera opción, (b) no como primera opción y (c) otras especialidades. Desarrollo de entrevistas grupales semiestructuradas de dos horas de duración. Codificación inductiva con una primera triangulación intra-grupo y una segunda triangulación inter-grupo, posterior análisis de contenido temático. Resultados: La elección de plaza MIR representa un gran hito académico y es pensado como determinante para el futuro tanto profesional como personal. Así, se dibuja como resultado de una compleja trama de elementos influyentes, destacando la formación universitaria, el modelo sanitario, las expectativas laborales y la valoración social de la especialidad. Poniendo en relación los diferentes factores, se pone de manifiesto el fenómeno llamado desprestigio de la AP. Conclusión: La especialidad de MFyC no será atractiva en un sistema sanitario y formativo hospitalo-céntrico que no apuesta por la AP organizativa ni económicamente.(AU)

Aim: To analyze the perceptions, motives and reasons that influence the election of Family and Community Medicine (FCM) speciality, thus exploring possible proposals for change in the health system model and university training. Design: Descriptive–interpretative qualitative research from a socio-constructivist perspective. Emplacement: Medical speciality training departments in the Metropolitan Area of Barcelona. Participants and context: 55 first year junior doctors belonging to the FCM Barcelona Ciutat ICS training department were contacted; 25 agreed to participate. They were segmented into two groups depending on if the choice of FCM had been their first option or not. Through snowball sampling 11 more junior doctors from other specialities were recruited. Method: Three focus groups were formed: (a) first choice FCM, (b) not first choice FCM and (c) other specialities. Semi-structured 2-h long interviews took place with each of the groups. Literal transcription and inductive codification with a first triangulation within each group and a second one between the three of them and thematic content analyses. Results: The choice of speciality is lived as an academic milestone and is thought determining professional and personally. It is a complex weave of influencing elements but some of main factors were university training, health system model, professional prospects and the social appreciation of the speciality. Analyzing the relation between these elements puts light on a phenomena we have called “the discredit of Primary Care (PC)”. Conclusion: The FCM specialty will not be attractive in a hospital-centric health and training system that does not bet on PC organizationally or economically.(AU)

[Elements influencing the election of Family and Community Medicine]. / Factores que influyen en la elección de la especialidad de Medicina Familiar y Comunitaria.

AIM: To analyze the perceptions, motives and reasons that influence the election of Family and Community Medicine (FCM) speciality, thus exploring possible proposals for change in the health system model and university training. DESIGN: Descriptive-interpretative qualitative research from a socio-constructivist perspective. EMPLACEMENT: Medical speciality training departments in the Metropolitan Area of Barcelona. PARTICIPANTS AND CONTEXT: 55 first year junior doctors belonging to the FCM Barcelona Ciutat ICS training department were contacted; 25 agreed to participate. They were segmented into two groups depending on if the choice of FCM had been their first option or not. Through snowball sampling 11 more junior doctors from other specialities were recruited. METHOD: Three focus groups were formed: (a) first choice FCM, (b) not first choice FCM and (c) other specialities. Semi-structured 2-h long interviews took place with each of the groups. Literal transcription and inductive codification with a first triangulation within each group and a second one between the three of them and thematic content analyses. RESULTS: The choice of speciality is lived as an academic milestone and is thought determining professional and personally. It is a complex weave of influencing elements but some of main factors were university training, health system model, professional prospects and the social appreciation of the speciality. Analyzing the relation between these elements puts light on a phenomena we have called "the discredit of Primary Care (PC)". CONCLUSION: The FCM specialty will not be attractive in a hospital-centric health and training system that does not bet on PC organizationally or economically.

[Public participation in research projects: ways of creating collective knowledge in health]. / Participación pública en los proyectos de investigación: formas de crear conocimiento colectivo en salud.

Public participation in research projects is an emerging area in Spain and Latin American countries. There are five types of projects according to the degree of involvement that the participants have in the processes: contributory, collaborative, co-created, contractual and independent. In order to promote public participation in health research teams, their practices and competencies need to be redefined. To this end, it may be useful to ask questions in the different phases of the research, as well as to develop strategies that include audiences that have fewer channels of participation in favour of favouring equity in health. This way of doing science allows gathering experience and expertise prioritizing and adapting the research to the needs of the population, which increases its transforming capacity and the social impact of its results.