[Teaching assistants in Argentina have greater intentions to migrate abroad as physicians than other medical students] / Los ayudantes de cátedra en Argentina tienen mayores intenciones de migrar al extranjero como médicos que otros estudiantes de Medicina.

Introduction: The brain drain of physicians from lower-middle-income countries to high-income countries is a growing phenomenon that contributes to global health inequalities. Retention strategies are difficult to implement locally and to specifically target the population at risk of migrating. We hypothesize that medical students who are teaching assistants have greater intentions to migrate to practice Medicine abroad. Methods: Medical students from Argentina were invited to an online survey of 22 multiple-choice questions based on the LIRHUS Network survey, previously used in Latin America. Results: 2,301 medical students were enrolled. Most were young (23 [20-25] years old), single (90%), and female (79%). The majority studied at public universities (87%). The intention to migrate to practice Medicine abroad was more frequent among teaching assistants (36% vs 31%; χ2 = 4.4982; p = 0.0339). After adjusting for sex and age, being a teaching assistant was associated with the intention to migrate to practice Medicine abroad (OR = 1.26; 95% CI 1.02 - 1.55; p = 0.002). Conclusions: Argentine teaching assistants have a greater risk of migrating to practice Medicine abroad. Given their high academic profile, these are valuable human resources trained using the public financing of low-middle-income countries. The loss of these resources could contribute to health inequalities. This is an easily identifiable and accessible subgroup toward which local retention policies could be directed.

Introducción: La fuga de cerebros de médicos de países de ingresos medianos- bajos a países de ingresos altos es un fenómeno creciente que contribuye a las desigualdades mundiales en salud. Las estrategias de retención son difíciles de implementar localmente y de dirigir específicamente a la población en riesgo de migrar. Hipotetizamos que los estudiantes de Medicina que son ayudantes tienen mayores intenciones de migrar para ejercer la Medicina en el extranjero. Métodos: Estudiantes de Medicina de Argentina fueron invitados a una encuesta online de 22 preguntas de opción múltiple basada en la encuesta de la Red LIRHUS, previamente utilizada en América Latina. Resultados: Se enrolaron 2.301 estudiantes de Medicina. La mayoría eran jóvenes (23 [20-25] años), solteras (90%) y mujeres (79%). La mayoría estudiaba en universidades públicas (87%). La intención de migrar para ejercer la Medicina en el extranjero fue más frecuente entre los ayudantes (36% vs 31%; χ2 = 4,4982; p = 0,0339). Después de ajustar por sexo y edad, ser ayudante se asoció con la intención de migrar para ejercer la Medicina (OR = 1,26; IC 95% 1,02 - 1,55; p = 0,002). Conclusiones: Los ayudantes argentinos tienen mayor riesgo de migrar para ejercer la Medicina en el exterior. Dado su alto perfil académico, se trata de recursos humanos valiosos formados con la financiación pública de un país de ingresos medianos-bajos, cuya pérdida puede contribuir a las desigualdades en salud. Es un subgrupo fácilmente identificable y accesible hacia el que se pueden dirigir políticas de retención locales.

International Medical Graduates in US Orthopedic Residency Programs: A Comprehensive Analysis.

BACKGROUND: This study aims to provide insight regarding the different qualities of international medical graduates (IMGs) involved in US orthopedic residency programs. METHODS: Orthopedic residency programs accredited by the ACGME and listed in the AMA database were screened. Data on program size and location, IMG year of training, the geographic region of IMG's medical schools, their research experiences and number of gap years were included. RESULTS: A total of 167(80.3%) orthopedic residency programs were included. A total of 3838 residents were identified, of which 44 (1.15%) were IMGs. The United Kingdom and Ireland had the highest number of matched IMGs with four (9.1%) each. Massachusetts was the state with the highest number of enrolled IMGs. On average, IMGs had 26.3 publications and joined US orthopedic residency 4.66 years following medical school graduation. CONCLUSION: Despite the many hurdles experienced by IMGs, a decent number succeeds in matching into US orthopedic residency programs each year.

Professional experiences in the transition of Cuban-trained South African medical graduates.

BACKGROUND: Medical educators have been tasked to provide Cuban-trained Foreign Medical Graduates (FMGs) with adequate learning exposures to become integrated into the South African healthcare workforce. International research suggests that FMGs face multiple challenges during the transition from practising medicine in countries other than where they had been trained. The transitional experiences of international FMGs are well documented, but little is known about the challenges faced by Cuban-trained graduates upon reintegration into South Africa. An improved understanding of the challenges will provide insight into how medical educators can best support Cuban trained graduates in their final phase of training in the South African context.This study explored the challenges experienced during the professional transition of Cuban-trained FMGs with reference to Schlossberg's transitional theory. METHODS: A qualitative case study was used to interview a purposive sample of 20 Cuban-trained FMGs who studied between January 1997 and December 2007. Data were collected through audio-recorded, semi-structured interviews, which were analysed thematically. RESULTS: The findings indicate that FMGs' experienced educational and social stress, which was linked to the transitional situation itself. Challenges during reintegration included bias and discrimination, language, educational differences, and becoming familiar with patients from diverse educational and cultural backgrounds. They drew on peer and institutional support that was mainly informal and varied across disciplines and the medical schools. CONCLUSION: Recommendations include a national multidisciplinary consolidated approach to provide personal and professional support at national, institutional, and departmental levels. The creation of mentoring networks will optimise Cuban-trained FMGs' transitional experiences for returning students.

Recomendação nº 018, de 05 de agosto de 2021 Recomenda a prorrogação, em caráter de urgência, dos prazos de atuação dos médicos no Programa Mais Médicos, especialmente no contexto de pandemia da Covid-19 / Recommendation No. 018, of August 5, 2021 Recommends the urgent extension of the deadlines for the performance of physicians in the Mais Médicos Program, especially in the context of the Covid-19 pandemic

Recomenda ad referendum do Pleno do Conselho Nacional de Saúde aos Deputados Federais e Senadores da República: I - O encaminhamento de projeto de lei, em caráter de urgência, para a retirada do prazo de vigência da dispensa de revalidação do diploma para atuação no âmbito do Programa Mais Médicos e seus desdobramentos previsto no caput do art. 16 da Lei Federal nº 12.871, de 22 de outubro de 2013, alterado posteriormente pela Lei Federal nº 13.333, de 12 de setembro de 2016; II - A adequação de ofertas sucessivas de atividades de aperfeiçoamento, conforme previsto no art. 14 da Lei Federal nº 12.871, de 22 de outubro de 2013, e a prorrogação da vigência para emissão de visto de permanência aos profissionais estrangeiros, conforme previsto no art. 18 da mesma lei, permitindo a permanência dos profissionais vinculados ao Programa e sua atualização ao longo do tempo, em particular durante o período de enfrentamento à pandemia de COVID-19 e a organização de linhas de cuidado para o seu enfrentamento. Aos Ministérios da Saúde e da Educação: I - A organização da oferta de programas de aperfeiçoamento regulares e automáticos, conforme previsto no art. 14 da Lei Federal nº 12.871, de 22 de outubro de 2013, para a continuidade do Programa Mais Médicos, assim como providências administrativas e formais para garantir a permanência dos profissionais vinculados e a incorporação de novos, prioritariamente em áreas de maior necessidade social e dificuldade de fixação de profissionais e equipes, em colaboração com os gestores estaduais e municipais do SUS. Ao Ministério da Saúde:I - A restauração do Programa Mais Médicos, nos moldes previstos na Lei nº 12.871, de 22 de outubro de 2013; II - A reincorporação dos médicos brasileiros formados no exterior, ex-participantes do Programa Mais Médicos, que foram desligados do referido programa desde 2016; III - A reincorporação dos médicos cubanos desligados do Programa, mas que permaneceram no Brasil, por razões diversas; IV - O imediato chamamento de médicos recém-formados no exterior, aptos a participar dos próximos editais do Programa Mais Médicos; e V - A expansão de vagas de residência em área profissional da saúde e outras modalidades de formação especializada para profissionais de saúde atuarem na atenção básica e em áreas de maior vulnerabilidade, em trabalho colaborativo com os gestores estaduais e municipais, para expandir o acesso e qualificar a atenção à saúde oferecida pelo SUS às pessoas e coletividades no território brasileiro, em especial nas regiões com maior dificuldade de acesso da população aos cuidados em saúde e fixação desses profissionais.

Preconceito e Identidade Patriótica face à Imigração de Médicos / Prejudice and Patriotic Identity face to Immigration of Physicians / Prejuicio e Identidad Patriótica frente a la Inmigración de Médicos

Este artigo analisa o papel do preconceito e de fatores identitários na oposição à contratação de médicos estrangeiros. Utilizou-se o Programa Mais Médicos (PMM) como cenário para testar a hipótese de que a oposição à contratação de médicos estrangeiros varia consoante a nacionalidade do médico e é motivada pelo preconceito e necessidade de manter a identidade patriótica. Realizamos dois estudos entre estudantes de uma universidade pública brasileira (N= 236 e N=176), nos quais colocamos em saliência a origem nacional dos médicos e avaliamos a oposição à sua contratação. Os resultados indicaram que a influência da origem dos imigrantes na oposição à sua contratação pelo PMM ocorre somente nos participantes mais preconceituosos e esse efeito é maior entre os participantes com níveis mais elevado da identidade patriótica. Em conjunto, os resultados indicam a importância de investigar o papel do preconceito juntamente com diferentes dimensões da identidade social no posicionamento frente a imigração de profissionais qualificados. (AU)

This article examines the role of prejudice and identity factors in opposition to hiring foreigner physicians. Used the More Doctors Program as a backdrop to test the hypothesis that opposition to hiring foreign doctors varies according to the origin of the doctor and is motivated by prejudice and the need to maintain the patriotic identity. We conducted two studies among students of a Brazilian public university (N = 236 and N = 176), in which it was highlighted the national origin of doctors and evaluated the opposition to their hiring. The results indicated that the influence of the origin of immigrants in opposition to their hiring by the Program occurs only in the most prejudiced participants and this effect is greater among participants with higher levels of patriotic identity. Together, the results indicate the importance of investigating the role of prejudice together with different dimensions of social identity in the positioning against the immigration of qualified professionals. (AU)

Este artículo analiza el papel del prejuicio y de factores identitarios en la oposición a la contratación de médicos extranjeros. Se utilizó el Programa Mais Médicos (PMM) como base para testar la hipótesis de que la oposición a la contratación de médicos extranjeros varía según el origen del médico y está motivada por el prejuicio y la identidad patriótica. Realizamos dos estudios entre los estudiantes de una universidad pública brasileña (N = 236 y N = 176), en los que destacamos el origen nacional de los médicos y evaluamos la oposición a su contratación. Los resultados indican que la influencia del origen de los inmigrantes sobre la oposición a su contratación por el PMM ocurre solamente en los participantes más prejuiciosos y este efecto es más importante entre los participantes que tienen niveles más altos de identidad patriótica. En conjunto, los resultados indican la importancia de investigar el papel del prejuicio junto con diversas dimensiones de la identidad social en el posicionamiento frente a la inmigración de profesionales calificados. (AU)

Eight Years of the Pediatric Orthopaedic Fellowship Match: What Have We Learned?

BACKGROUND: Pediatric orthopaedic surgery fellowships in North America have been organized, assigned, and administered through the San Francisco Match Program since 2011. However, trends in application numbers and match rates have not been assessed to this point. The purpose of this study is to describe these trends and applicants' perspective of the fellowship match. METHODS: The San Francisco Match databank was queried for program and applicant data from 2011 to 2018. Specifically, we obtained data regarding the number of applicants, programs, match rates, and match results. Each year, applicants also completed an anonymous post-match survey administered by the Pediatric Orthopaedic Society of North America fellowship committee, which included information on the number of applications, interview process, estimated costs, and suggested changes. Descriptive statistics were used to summarize the data, and univariate statistics were used to assess differences in categorical and continuous variables. RESULTS: From 2011 to 2018, 524 applicants participated in the pediatric orthopaedic fellowship match, and the mean number of annual applicants was 66 (range, 55 to 76). The mean number of fellowship programs and available positions during the same time period was 43 (range, 40 to 47) and 69 (range, 63 to 74), respectively. Each fellowship interview was estimated by the applicant to cost a mean of $458 (range, $372 to $566), and annual application costs across all applicants were extrapolated to be over $200,000/year. The mean overall match rate was 81% (range, 74% to 91%). The mean match rate for North American applicants was 98.7% and international applicants were 40.9% (P<0.01). Approximately, 93% of applicants obtained one of their top 5 choices of fellowship program (range, 78% to 100%), and 50% of matched applicants obtained their top choice each year (range, 43% to 56%). CONCLUSION: In the pediatric orthopaedic fellowship match, the number of applicants and fellowship programs has remained relatively stable over the study period, and the majority of applicants match one of their top choices for fellowship. Proposed changes to the match should focus on decreasing the financial burden on applicants. LEVEL OF EVIDENCE: Level II.

Profissionalismo e negociações identitárias de médicos no contexto do programa Mais Médicos / Professionalism and identity negotiations of health professionals in the context of the Mais Médicos program

Resumo Como a chegada de profissionais médicos estrangeiros a postos de saúde brasileiros, no contexto de implantação e vigência do programa Mais Médicos, tensiona os discursos de profissionalismo, e quais os efeitos desse contato para as identificações profissionais desses médicos? Diferentes tipos de formação profissional dentro de uma mesma profissão produzem discursos de profissionalismo concorrentes em posições equivalentes? Neste artigo, buscamos compreender como os médicos constroem suas identidades e negociam o profissionalismo cotidianamente, como se posicionam nesse debate e como lidam com a diferenciação introduzida pela política pública. A metodologia combina técnicas qualitativas, observação direta e entrevistas com médicos estrangeiros e brasileiros. Isso permitiu compreender como se dão os processos de negociação dos discursos identitários, e como eles aparecem e são difundidos na fala dos médicos de um município localizado na região metropolitana de São Paulo. O resultado encontrado foi que não há um sentido fixo e singular para o profissionalismo, cujo significado é objeto de disputa visando a legitimação das perspectivas e das identidades desses sujeitos. Essa negociação se dá a partir das experiências em contexto, mas é recortada pela atuação na medicina de família em contraste com as especializações focais.

Abstract How has the arrival of foreign health professionals to work mainly in health posts with Brazilian physicians caused tension in the discourses of professionalism in the context of the implementation and validity of the "Mais Médicos" program and what are the effects of this contact in their professional identities? Do different types of professional training within the same profession produce competitive discourses of professionalism when in the same work position? This paper analyzes how physicians build their own identities and negotiate their professionalism daily, how they have positioned themselves in this debate, and how they deal with the differentiation introduced by public policies. The methodology adopted combines qualitative techniques, direct observation and in-depth interviews with Brazilian and foreign professionals. Such fieldwork clarified the processes of negotiation related to identity-based discourses and how they appear and are disseminated in the discourse of professionals working in a municipality situated in the metropolitan region of São Paulo. The results show that there is no single, fixed meaning to professionalism, whose meaning is still discussed in order to legitimate subject identities and perspectives. This kind of negotiation is defined by their contextual experiences, but it is intertwined by the practice in family medicine as opposed to focal specializations.

Saúde e empoderamento das mulheres: estudo de caso do Programa Mais Médicos em municípios com presença de médicos cubanos / Women's health and empowerment: a case study of the More Doctors Program in municipalities with Cuban physicians / Salud y empoderamiento de las mujeres: estudio de caso del programa Mais Médicos en municipios con presencia de médicos cubanos

Objetivo. Descrever as representações de ser mulher das usuárias do Programa Mais Médicos (PMM), com perspectiva de gênero e raça, e as mudanças que o PMM trouxe quanto ao empoderamento e cuidado da saúde. Métodos. Trata-se de um estudo de caso descritivo, de corte transversal. O trabalho de campo foi realizado mediante entrevistas semiestruturadas, aplicação de uma técnica evocativa de associação de palavras e grupos focais em municípios com médicos cubanos, com amostras de tipo nominal para escolha dos municípios e de tipo intencional para a escolha de participantes. O tamanho das amostras foi definido em campo com base na técnica da saturação teórica. Os dados foram analisados por meio de análise de conteúdo e análise prototípica. Resultados. A cobertura da atenção básica foi fortalecida com os aportes do programa, segundo os quatro gestores entrevistados. As mulheres (103 na técnica evocativa e 120 nos grupos focais) relataram mudanças no modelo de atendimento, que se tornou mais humanizado, com impacto sobre sua percepção sobre os serviços de saúde, sobre a consulta médica, sobre os médicos e sobre a imagem de si mesmas e, em menor medida, sobre as práticas de cuidado da saúde. Conclusões. O PMM trouxe ganhos no empoderamento individual das mulheres, com reflexos potencialmente positivos para os comportamentos em saúde.(AU)

Objective. To describe the representations of being a woman by users of the More Doctors Program (Programa Mais Médicos, PMM) in Brazil, exploring the perspectives of gender and race, and the changes produced by PMM in terms of empowerment and health care. Methods. This is a descriptive, cross-sectional study. The field work was performed using semi-structured interviews, with application of an evocative word technique and focal groups in municipalities with Cuban physicians, with nominal selection of municipalities and intentional selection of participants. The size of the sample was defined in the field based on saturation. The data were analyzed by content and prototypical analyses. Results. Primary health care coverage was strengthened by the PMM, according to the four municipal health secretaries interviewed. Participants (103 in the evocative technique and 120 from focal groups) reported changes in the model of care, which became more humanized, with impact on their perception of health care services, medical consultations, and physicians, on the image they had of themselves and, to a lesser extent, on their health care practices. Conclusions. PMM produced individual empowerment gains for study participants, with potentially positive impacts on health care behaviors.(AU)

Objetivo. Describir las representaciones de la condición de ser mujer hechas por las usuarias del programa Mais Médicos, con una perspectiva de género y raza, y los cambios producidos por este programa en materia de empoderamiento y cuidado de la salud. Métodos. Se trata de un estudio de caso descriptivo y transversal. El trabajo de campo se realizó mediante entrevistas semiestructuradas, con aplicación de una técnica evocadora de asociación de palabras y grupos focales en municipios con presencia de médicos cubanos, con muestras de tipo nominal para la selección de los municipios y de tipo intencional para la selección de las participantes. El tamaño de las muestras se definió sobre el terreno con base en la técnica de la saturación teórica. Los datos se sometieron a análisis prototípico y de contenido. Resultados. Los aportes del programa fortalecieron la cobertura de la atención básica, según lo expresado por los cuatro gestores entrevistados. Las mujeres (103 de las entrevistadas con la técnica evocadora y 120 de los grupos focales) relataron cambios en los modelos de atención que hicieron que la atención se torne más humanizada y que incidieron en su percepción de los servicios de salud, las consultas médicas, los médicos, la imagen de sí mismas y, en menor grado, las prácticas de cuidado de la salud. Conclusiones. El programa Mais Médicos implicó adelantos en materia de empoderamiento individual de las mujeres, con repercusiones potencialmente favorables en los patrones de comportamiento relacionados con la salud.(AU)

Where are they working? A case study of twenty Cuban-trained South African doctors.

BACKGROUND: The year 2017 marked the 21st anniversary of the South African Cuban Medical Collaboration (SACMC) programme that offers disadvantaged South African (SA) students an opportunity for medical training in Cuba. Graduates are expected to return to practice at a primary care level in rural communities; however, little is known about the professional trajectories and career choices of graduates from the programme. AIM: This study explored the reasons why students enrolled in the programme, their professional and career choices as graduates and their career intentions. SETTING: The study setting was the whole of SA although participants were primarily drawn from KwaZulu-Natal. METHODS: An exploratory, qualitative case study used a purposive sampling strategy to gather data through semi-structured interviews from participants. RESULTS: Graduates (N = 20) of the SACMC programme were all practicing in local SA settings. Participants preferred the SACMC programme as it offered them a full scholarship for medical training. Nineteen doctors had fulfilled their obligation to work in rural areas. Thirteen doctors are engaged in primary healthcare practice, either as private practice generalists or as public service medical officers. Three doctors had completed specialty training: one doctor was training towards specialisation, one doctor was employed at national government and two doctors were employed as medical managers. At the time of the study, 11 doctors were practicing in rural locations and 19 had indicated a long-term intention to work and live within South Africa. CONCLUSION: The participants of this study who graduated from the SACMC programme are fulfilling their obligations in rural communities. They all intend to contribute to the SA medical workforce in the long-term.

Ata da tricentésima décima nona reunião ordinária do Conselho Nacional de Saúde - CNS / Minutes of the 319th regular meeting of the National Health Council

Aos onze e doze dias do mês de julho de 2019, no Plenário do Conselho Nacional de Saúde "Omilton Visconde", Ministério da Saúde, Esplanada dos Ministérios, Bloco G, Anexo B, 1º andar, Brasília/DF, realizou-se a Tricentésima Décima Nona Reunião Ordinária do CNS. Estabelecido o quórum, o conselheiro Fernando Zasso Pigatto, Presidente do CNS, iniciou a sessão, com saudações aos presentes e aos internautas que acompanhavam a reunião em tempo real. Em seguida, apresentou os objetivos da 319ª RO: 1) Socializar os informes e apreciar as indicações. 2) Assistir e apreciar o tema do Radar que abordará "As conquistas e desafios no Sistema Único de Saúde, para consolidar a política nacional de saúde integral da população LGBT". 3) Aprofundar o debate sobre os efeitos da Desvinculação de Receita da União para o SUS. 4) Conhecer e debater a Proposta de Emenda Constitucional - PEC n°. 39/2019. 5) Atualizar e articular ações da Comissão Nacional de Ética em Pesquisa ­ CONEP/CNS. 6) Contribuir e deliberar sobre invisibilidade da mulher com deficiência. 7) Analisar e deliberar sobre as demandas da Comissão Intersetorial de Recursos Humanos e Relações de Trabalho ­ CIRHRT e discutir o contexto atual do Exame Nacional de Revalidação de Diplomas Médicos expedidos por Instituição de Educação Superior Estrangeira ­ REVALIDA. 8) Conhecer e debater as perspectivas da implementação da Política Nacional de Vigilância em Saúde no Brasil. 9) Apreciar e deliberar as demandas da Comissão Intersetorial de Orçamento e Financiamento ­ COFIN. 10) Apresentar e apreciar as questões da 6ª Conferência Nacional de Saúde Indígena e da 16ª Conferência Nacional de Saúde. 11) Socializar e deliberar as demandas das Comissões Intersetoriais, Câmaras Técnicas, Grupos de Trabalho, Coordenação de Plenárias dos Conselhos de Saúde e encaminhamentos do Pleno.

Resumo executivo da tricentésima décima nona reunião ordinária do Conselho Nacional de Saúde - CNS / Executive summary of 319th regular meeting of the National Health Council

Objetivos da 319ª reunião ordinária: 1. Socializar os informes e apreciar as indicações. 2. Assistir e apreciar o tema do Radar que abordará "As conquistas e desafios no Sistema Único de Saúde, para consolidar a política nacional de saúde integral da população LGBT" 3. Aprofundar o debate sobre os Efeitos da Desvinculação de Receita da União para o SUS. 4. Conhecer e debater sobre a PEC 39/2019. 5. Atualizar e articular ações da Comissão Nacional de Ética em Pesquisa ­ CONEP. 6. Contribuir e deliberar acerca da Invisibilidade da Mulher Com Deficiência 7. Analisar, deliberar as demandas da Comissão Intersetorial de Recursos Humanos e Relações de Trabalho ­ CIRHRT e discutir o contexto atual do Exame Nacional de Revalidação de Diplomas Médicos expedidos por Instituição de Educação Superior Estrangeira ­ REVALIDA. 8. Conhecer e debater as Perspectivas da Implementação da Política Nacional de Vigilância em Saúde no Brasil. 9. Apreciar e deliberar as demandas da Comissão Intersetorial de Orçamento e Financiamento ­ COFIN. 10. Apresentar e apreciar as questões da 6ª Conferência Nacional de Saúde Indígena a da 16ª Conferência Nacional de Saúde. 11. Socializar e deliberar as demandas das Comissões Intersetoriais, Câmaras Técnicas, Grupos de Trabalho, Coordenação de Plenárias dos Conselhos de Saúde e encaminhamentos do Pleno.

Pauta da trecentésima décima nona reunião ordinária do Conselho Nacional de Saúde / Agenda for the 319th regular meeting of the National Health Council

Objetivos da 319ª reunião ordinária: 1. Socializar os informes e apreciar as indicações. 2. Assistir e apreciar o tema do Radar que abordará "As conquistas e desafios no Sistema Único de Saúde, para consolidar a política nacional de saúde integral da população LGBT" 3. Aprofundar o debate sobre os Efeitos da Desvinculação de Receita da União para o SUS. 4. Conhecer e debater sobre a PEC 39/2019. 5. Atualizar e articular ações da Comissão Nacional de Ética em Pesquisa ­ CONEP. 6. Contribuir e deliberar acerca da Invisibilidade da Mulher Com Deficiência 7. Analisar, deliberar as demandas da Comissão Intersetorial de Recursos Humanos e Relações de Trabalho ­ CIRHRT e discutir o contexto atual do Exame Nacional de Revalidação de Diplomas Médicos expedidos por Instituição de Educação Superior Estrangeira ­ REVALIDA. 8. Conhecer e debater as Perspectivas da Implementação da Política Nacional de Vigilância em Saúde no Brasil. 9. Apreciar e deliberar as demandas da Comissão Intersetorial de Orçamento e Financiamento ­ COFIN. 10. Apresentar e apreciar as questões da 6ª Conferência Nacional de Saúde Indígena a da 16ª Conferência Nacional de Saúde. 11. Socializar e deliberar as demandas das Comissões Intersetoriais, Câmaras Técnicas, Grupos de Trabalho, Coordenação de Plenárias dos Conselhos de Saúde e encaminhamentos do Pleno.

Cuban medical training for South African students: a mixed methods study.

BACKGROUND: Achieving universal health care coverage will require greater investment in primary health care, particularly in rural and underserved populations in low and middle-income countries. South Africa has invested in training black students from disadvantaged backgrounds in Cuba and large numbers of these Cuban-trained students are now returning for final year and internship training in South Africa. There is controversy about the scheme, the quality and relevance of training received and the place of Cuban-trained doctors in the health care system. Exploring the experiences of Cuban- and South African-trained students, recent graduates and medical school faculty may help understand and resolve the current controversy. METHODS: Using a mixed methods approach, in-depth interviews and a focus group discussion were held with deans of medical schools, senior faculty, and Cuban-trained and South African-trained students and recent graduates. An online structured questionnaire, adapted from the USA medical student survey, was developed and administered to Cuban- and South African-trained students and recent graduates. RESULTS: South African students trained in Cuba have had beneficial experiences which orientate them towards primary health care and prevention. Their subsequent training in South Africa is intended to fill skill gaps related to TB, HIV and major trauma. However this training is ad hoc and variable in duration and demoralizing for some students. Cuban-trained students have stronger aspirations than those trained in South Africa to work in rural and underserved communities from which many of them are drawn. CONCLUSION: Attempts to assimilate returning Cuban-trained students will require a reframing of the current negative narrative by focusing on positive aspects of their training, orientation towards primary care and public health, and their aspirations to work in rural and under-served urban areas. Cuban-trained doctors could be part of the solution to South Africa's health workforce problems.

Una diáspora bienvenida a Venezuela: los médicos vascos exilados hace ochenta años / A diaspora welcome to Venezuela: basque doctors exiled eighty years ago

En unos tiempos de éxodo de los médicos venezolanos, cabe recordar a la favorable acogida recibida en Venezuela por los médicos vascos exilados al terminar la Guerra Civil Española (1936-1939). Los médicos que prestaron servicios en Sanidad Militar de la región autónoma de Euzkadi fueron destituidos de sus cargos en los hospitales vascos y fueron desterrados a Francia. Un convenio oficial del gobierno venezolano les concedió asilo y se les destinó en mayoría a medicaturas rurales. Se describen las trayectorias de los médicos procedentes del Hospital Civil de Bilbao. Algunos se destacaron por sus contribuciones notables a la comunidad medica de su tierra de adopción en campos de clínica, de docencia y de salud publica(AU)

In an era of medical exodus from Venezuela, it seems of interest to recall the favorable welcome received by Basque medical doctors exiled after the Spanish Civil War (1936-1939). The medical doctors who had cooperated with the Military Health Services of the autonomous Basque Country (Euzkadi) were expelled from the hospitals and had to leave to France in exile. An official agreement from the government of Venezuela allowed them to come legally and be offered a position as doctors in small rural communities in the interior of the country. The professional paths of those doctors excluded from the Civil Hospital of Bilbao are described, some of which made substantial contributions to clinical medicine, academic teaching and public health in their new land of adoption(AU)

Interacciones socioculturales de los médicos cubanos participantes del Programa Más Médicos en Brasil / Sociocultural interactions of Cuban doctors participating in the More Doctors Program in Brazil

El Programa Más Médicos (PMM) fue creado en Brasil, en 2013, en el contexto de la necesidad de ampliar y garantizar el acceso y la cobertura de los cuidados básicos de salud, principalmente para la población con mayor vulnerabilidad social. Se trata de una iniciativa de carácter holístico, creada no sólo para resolver el problema de la escasez de médicos en el país, sino también para asegurar el desarrollo de las capacidades para la atención básica, además de invertir en la infraestructura necesaria y en la formación del personal de la salud, tanto en cantidad como en calidad. Finalmente, el reclutamiento de médicos tiene carácter de emergencial, pues pretende llenar vacíos de cobertura en municipios carentes. El PMM trajo impactos desde su inicio, percibido de forma positiva por las poblaciones objetivo, permitiendo así superar las fuertes críticas que recibió de algunos segmentos de la sociedad, incluso de la corporación médica. El hecho es que actualmente este programa se identifca como auténtica «marca¼ de salud pública, en términos de satisfacción de usuarios y gestores y de resolución de problemas de salud para la población brasileña. Este libro presenta una nueva visión sobre el PMM, aún poco explorada, al ingresar en los escenarios de práctica para responder preguntas importantes acerca de las interacciones socioculturales de los médicos cubanos reclutados, con el objetivo declarado de producir conocimiento, pero además para promover mejoras en la participación de extranjeros en la atención primaria que el SUS ofrece a la población, aún limitada. Su lectura presentará percepciones, memorias e incluso explicaciones para quien, de una forma u otra, está asociado con el desarrollo del PMM, particularmente aquellos en una posición comprometida con la salud y con el reconocimiento de los cuidados primarios de la salud como el verdadero camino para el desarrollo del sistema de salud.

Global Health Education at Home: Canadian Medical Students' Perspectives After Learning Alongside Haitian Peers.

PURPOSE: To explore how host medical students learn from visiting foreign students, by reporting on a global health program that has invited two or three Haitian medical students each year since 2013 to a Canadian medical school for a summer anatomy program. METHOD: In 2017, the authors conducted a qualitative descriptive study that collected data through one-on-one, semistructured interviews with 10 Canadian students, who participated in the Université Quisqueya-McGill University collaborative, a bidirectional global health education initiative, 2013-2016. The authors' critical constructivist thematic analysis, while exploratory, was sensitized by their knowledge of contemporary frameworks of global health competencies, a postcolonial understanding of power relations, and three key concepts (agency, cultural humility, and reflexivity). RESULTS: The authors found two phenomena related to bidirectional exchange: the nature of the relationship between Canadian and Haitian students, and elements of the learning experience that facilitated transformation and growth. There were three important components to the nature of the relationship between Canadian and Haitian students-reflection on practices and privilege, negotiation of power dynamics, and perception of Haitian students as agents-and three components of the learning experience that facilitated transformation and growth-working in groups, common learning objectives, and informal social gatherings. CONCLUSIONS: Bidirectional programs may have implications for Canadian students' perception of the agency of international medical learners and may prompt self-reflection that manifests in a range of ways, including an experience of culture shock at home. These tensions seemed to create space to practice reflexivity and cultural humility.

[A collaborative objective structured clinical examination for title revalidation by foreign medical graduates in Chile]. / Revalidación de títulos médicos extranjeros: eficacia y eficiencia de un examen colaborativo y estandarizado.

BACKGROUND: Title revalidation of foreign medical graduates to practice medicine in Chile is a complex and expensive process. According to the legislation they are required to approve the Unique National Exam of Medical Knowledge (EUNACOM), which has a theoretical and a practical section. AIM: To demonstrate that a collaborative and standardized examination of the practical section of EUNACOM is more effective and efficient than traditional practical examinations. MATERIAL AND METHODS: The faculties of Medicine of the Catholic University of Chile, University of Chile and University of Concepción were associated to implement an examination proposal, framed in the legislation. The EUNACOM board supported and funded the initiative which consisted in the implementation of Objective Structured Clinical Examination (OSCE) for each basic specialty of medicine, applied to 40 designated candidates. This format was selected because of the wide experience and evidence at the international level in the certification of medical professionals. RESULTS: A collaborative and standardized OSCE reduces to less than half the time spent by examiners, providing more evidence of validity, reliability and objectivity. It also allows to visualize the real costs per applicant, which proved to be higher than those currently charged by EUNACOM, but comparatively lower than the examination used in the United States. CONCLUSIONS: A collaborative OSCE responds to the ethical principle of justice by being more valid, reliable, objective and cost efficient.