Accreditation of medical education in Brazil: an evaluation of seventy-six medical schools.

BACKGROUND: We present the first results of the Accreditation System of Medical Schools (Sistema de Acreditação de Escolas Médicas - SAEME) in Brazil. METHODS: We evaluated the results of the accreditation of medical schools from 2015 to 2023. The self-evaluation form of the SAEME is specific for medical education programs and has eighty domains, which results in final decisions that are sufficient or insufficient for each domain. We evaluated the results of the first seventy-six medical schools evaluated by the SAEME. RESULTS: Fifty-five medical schools (72.4%) were accredited, and 21 (27.6%) were not. Seventy-two (94.7%) medical schools were considered sufficient in social accountability, 93.4% in integration with the family health program, 75.0% in faculty development programs and 78.9% in environmental sustainability. There was an emphasis on SAEME in student well-being, with seventeen domains in this area, and 71.7% of these domains were sufficient. The areas with the lowest levels of sufficiency were interprofessional education, mentoring programs, student assessment and weekly distribution of educational activities. CONCLUSION: Medical schools in Brazil are strongly committed to social accountability, integration with the national health system, environmental sustainability and student well-being programs. SAEME is moving from episodic evaluations of medical schools to continuous quality improvement policies.

Community-oriented primary care footprinting: An undergraduate programme experience.

The Nelson Mandela Fidel Castro (NMFC) programme, a government initiative to address healthcare inequities in South Africa, focuses on the training of indigenous students to become competent healthcare practitioners. A collaboration combining training in a Cuban primary care, preventative system with integration in a South African institution within a quadruple disease burdened healthcare system. This article reflects on integration experience at the University of Witwatersrand, a programme pedagogically positioned within a workplace-based, situated learning framework. Since 2022, community-oriented primary care (COPC) projects became part of the integrated primary care and family medicine learning objectives. This article summarises the experience of the 2021-2022 cohort and calls for the strengthening of undergraduate medical education curricula with learning objectives reflective of social accountability.Contribution: This article spotlights work in the undergraduate space around teaching and experiential learning of community-oriented primary care in line with the journal's scope.

Posta las lilas: A model of integral commitment to the community.

Background: The Posta Sanitaria Las Lilas (La Posta) is a health promotion project of the medical school. Its purpose is to improve the health of individuals and the society by fostering qualitative changes in people's attitudes and habits in relation to every aspect of their health. The project serves a population of 25,000 inhabitants that live in conditions of vulnerability and poverty. It is based on a specific approach to social commitment and accountability that integrates teaching, research, and care with the whole community. Activities: The project activities are oriented toward key dimensions for each person and the community. There are two programs: health and education that involve physicians, students, residents, teachers, volunteers, and community members. Outcomes: The project has increased the number of medical appointments, medical records, and workshop participants. It is difficult to establish objective indicators that may reflect the changes in the life of the community members. In this article, findings of an impact evaluation study are presented. We also describe unexpected results for those who participated in the project. Conclusion: La Posta is part of the University's agenda and a place of meaningful and formative learning. All program activities are implemented with the support and resources of the institution. A network of various organizations cooperates with La Posta in order to help promote the welfare of the community. They are all committed to contributing to the development of project participants' personal resources rather than merely addressing their unmet needs. This requires thinking about people in all dimensions (biological, psychological, social, and spiritual).

COVID-19 challenge with regard to medical schools social responsibility: new professional and human perspectives.

Medical schools play a central role in the compilation and development of professional knowledge, which is why they have privileges and resources that are justified only to the extent that they use them to serve the community, particularly those who are most in need. Medical schools social accountability focuses on the training, healthcare provision and research services they offer. The principles of medical education and the structure proposed by the Flexner Report are in crisis due to the COVID-19 pandemic, and redefinition of the social contract is required. This document offers a proposal for medical schools social accountability that includes anticipation of the needs of the community, patient-centered inter-professional care, training of people in the area of health and collaboration between institutions. It highlights the need for a conscious institution that finds new training spaces other than hospitals, where each patient is cared for in a personalized way, with inter-professional training models that consider the student as a person who takes care of him/herself in open collaboration with organizations. Leaders must act now because it is their social accountability and because it is the right thing to do.

Las escuelas de medicina desempeñan un papel central en la acumulación y desarrollo del conocimiento profesional, por lo cual poseen privilegios y recursos que se justifican solo en la medida en que los retribuyan a la comunidad, en particular a los más necesitados. La responsabilidad social de las escuelas de medicina se centra en los servicios formativos, asistenciales y de investigación que ofrecen. Los principios de la educación médica y la estructura propuesta por el Informe Flexner están en crisis debido a la pandemia de COVID-19 y se requiere la redefinición del contrato social. El presente documento ofrece una propuesta de responsabilidad social de las escuelas de medicina que incluye previsión de las necesidades de la comunidad, atención interprofesional centrada en el paciente, formación de profesionales en el área de salud y colaboración entre instituciones. Resalta la necesidad de una institución consciente que encuentre nuevos espacios de entrenamiento diferentes al hospitalario, donde se atienda a cada paciente de forma personalizada, con modelos formativos interprofesionales que consideren al alumno como persona que cuida de sí misma en colaboración abierta con las organizaciones. Los líderes deben actuar ya porque es su responsabilidad social y porque es lo correcto.

COVID-19 challenge with regard to medical schools social accountability: new professional and human perspectives / El reto de COVID-19 respecto a la responsabilidad social de las escuelas de medicina: nuevas perspectivas profesionales y humanas

Abstract Medical schools play a central role in the compilation and development of professional knowledge, which is why they have privileges and resources that are justified only to the extent that they use them to serve the community, particularly those who are most in need. Medical schools social accountability focuses on the training, healthcare provision and research services they offer. The principles of medical education and the structure proposed by the Flexner Report are in crisis due to the COVID-19 pandemic, and redefinition of the social contract is required. This document offers a proposal for medical schools social accountability that includes anticipation of the needs of the community, patient-centered inter-professional care, training of people in the area of health and collaboration between institutions. It highlights the need for a conscious institution that finds new training spaces other than hospitals, where each patient is cared for in a personalized way, with inter-professional training models that consider the student as a person who takes care of him/herself in open collaboration with organizations. Leaders must act now because it is their social responsibility and because it is the right thing to do.

Resumen Las escuelas de medicina desempeñan un papel central en la acumulación y desarrollo del conocimiento profesional, por lo cual poseen privilegios y recursos que se justifican solo en la medida en que los retribuyan a la comunidad, en particular a los más necesitados. La responsabilidad social de las escuelas de medicina se centra en los servicios formativos, asistenciales y de investigación que ofrecen. Los principios de la educación médica y la estructura propuesta por el Informe Flexner están en crisis debido a la pandemia de COVID-19 y se requiere la redefinición del contrato social. El presente documento ofrece una propuesta de responsabilidad social de las escuelas de medicina que incluye previsión de las necesidades de la comunidad, atención interprofesional centrada en el paciente, formación de profesionales en el área de salud y colaboración entre instituciones. Resalta la necesidad de una institución consciente que encuentre nuevos espacios de entrenamiento diferentes al hospitalario, donde se atienda a cada paciente de forma personalizada, con modelos formativos interprofesionales que consideren al alumno como persona que cuida de sí misma en colaboración abierta con las organizaciones. Los líderes deben actuar ya porque es su responsabilidad social y porque es lo correcto.

Insulados e não democráticos: a (im)possibilidade do exercício da social accountability nos Tribunais de Contas brasileiros / Aislados y antidemocráticos: la (im)posibilidad de ejercer la social accountability en los tribunales de cuentas brasileños / Insulated and undemocratic: the (im)possibility of social accountability in Brazilian courts of accounts

Resumo Este artigo tem por objetivo analisar a permeabilidade dos Tribunais de Contas (TCs) brasileiros à sociedade, por meio de 3 perspectivas: a) transparência dos portais; b) transparência da atividade de fiscalização; e c) participação cidadã. Para tanto, foi estruturado um roteiro de observações, a partir de recomendações de organismos internacionais, e foram coletadas informações dos 32 TCss existentes no Brasil. Em seguida, foram elaborados mapas perceptuais para cada uma das perspectivas analisadas, por meio da técnica de escalonamento multidimensional. As evidências sugerem que os TCs não são transparentes, o que limita a social accountability, e são muito resistentes à participação social, limitando-se a disponibilizar os mecanismos de ouvidoria, portal da transparência e serviço de atendimento ao cidadão. Essas práticas evidenciam que os TCs são, ainda, muito insulados, burocratizados e, apesar de terem um relevante papel no contexto republicano, pouco democráticos. Identificou-se, entretanto, forte influência da Lei de Responsabilidade Fiscal (LRF) e da Lei de Acesso à Informação (LAI) sobre os TCs. Isso pode significar futuras mudanças, ainda que incrementais, na direção da atuação dos TCs como fortes aliados para o aprimoramento da accountability vertical.

Resumen Este artículo examina la permeabilidad de los tribunales decCuentas (TC) brasileños a la sociedad, y si dichos tribunales han actuado de forma que facilite el ejercicio del control social sobre la administración pública. La técnica de escalonamiento multidimensional se utilizó para la construcción de mapas perceptuales en tres dimensiones, elaborados a partir de informaciones recolectadas de los 32 TC existentes en Brasil. Las evidencias sugieren que los TC son todavía poco permeables a la sociedad y poseen pocos mecanismos para auxiliar o facilitar el control ciudadano. Se constató, además, una limitación de medios para la participación social, que se reducen, básicamente, a la oidoría, al portal de transparencia y al servicio de atención al ciudadano. Se identificó, sin embargo, una fuerte influencia de la Ley de Responsabilidad Fiscal y de la Ley de Acceso a la Información sobre los TC. Esto puede significar cambios futuros, aunque incrementales, en la dirección de la actuación de los TC como fuertes aliados para el perfeccionamiento de la accountability vertical.

Abstract This article examines the transparency of the Brazilian Courts of Accounts to citizens, andwhether these Courts have acted in a way that facilitates social accountability over public administration. The multidimensional scaling technique was used to determine the integrity of the 32 Courts of Accounts in Brazil. Evidence suggests that Brazilian Courts of Accounts are still not transparent to society and count on few mechanisms to help and facilitate citizen control. Evidence also shows that the means of social participation is limited, and represented by the Ombudsman, the Transparency Web Portal, and the Citizen Assistance Service. However, this study identified that the Fiscal Responsibility Law (LRF) and the Access to Information Law (LAI) had a strong influence on the Courts of Accounts. Although gradual, these elements can lead to future changes in terms of an increasingly prominent role of the Courts of Accounts as strong allies in the process of enhancing vertical accountability.

Speaking Truth to Power: Twitter Reactions to the Panama Papers.

The current study examines the micro-linguistic details of Twitter responses to the whistleblower-initiated publication of the Panama Papers. The leaked documents contained the micro-details of tax avoidance, tax evasion, and wealth accumulation schemes used by business elites, politicians, and government bureaucrats. The public release of the documents on April 4, 2016 resulted in a groundswell of Twitter and other social media activity throughout the world, including 161,036 Spanish-language tweets in the subsequent 5-month period. The findings illustrate that the responses were polyvocal, consisting a collection of overlapping speech genres with varied thematic topics and linguistic styles, as well as differing degrees of calls for action and varying amounts of illocutionary force. The analysis also illustrates that, while the illocutionary force of tweets is somewhat associated with the adoption of a prosaic and vernacular ethical stance as well as with demands for action, these types of voicing behaviors were not present in the majority of the tweets. These results suggest that, while social media platforms are a popular site for collective forms of voicing activities, it is less certain that these collective stakeholder voices necessarily result in forceful accountability demands that spill out of the communication medium and thus serve as an impulse for positive social change.

Association of mother's handwashing practices and pediatric diarrhea: evidence from a multi-country study on community oriented interventions.

INTRODUCTION: Improved hand hygiene in contexts with high levels of diarrheal diseases has shown to reduce diarrheal episodes in children under five years. A quasi-experimental multi-country study with matched comparisons was conducted in four rural districts/sub districts in Cambodia, Guatemala, Kenya and Zambia. METHODS: Community oriented interventions including health promotion for appropriate hand washing was implemented in the intervention sites, through community health workers (CHW) and social accountability mechanisms. Community councils were strengthened/established in all study sites. Using household surveys, information on mother's handwashing practices and diarrhea incidence of children 2 weeks preceding the study was obtained. RESULTS AND CONCLUSION: Access to safe drinking water was reportedly higher for communities in Guatemala and Zambia (> 80%), than those in Cambodia and Kenya (< 63%), with significantly higher levels in intervention sites for Guatemala and Kenya. Improved sanitation was low (< 10%), for Kenya and Zambia, compared to Cambodia and Guatemala (> 40%); intervention sites reporting significantly higher levels, except for Zambia. Hand washing index; hand washing before food preparation, after defecation, attending to a child after defecation, and before feeding children was significantly higher for intervention sites in Cambodia, Guatemala and Kenya (Cambodia, 2.4 vs 2.2, p < 0.001, Guatemala, 3.0 vs 2.5, p < 0.001, Kenya, 2.6 vs 2.3, p < 0.001). Factors significantly associated with lower odds of diarrhea were; mother's marital status, higher educational status, one or more handwashing practices, wealthier quintiles, older (> 24 m), and female children. The findings suggest that caretaker handwashing with soap or ash has a protective effect on prevalence of diarrhea in children.

Learning by teaching basic life support: a non-randomized controlled trial with medical students.

BACKGROUND: Cardiopulmonary resuscitation is usually taught in universities through theoretical lectures and simulations on mannequins with low retention of knowledge and skills. New teaching methodologies have been used to improve the learning, placing the student at the center of the process. Likewise, the outside community knows next to nothing about cardiopulmonary resuscitation. Patients who have an out-of-hospital cardiac arrest will die if the effective maneuvers are not promptly done. Learning by teaching could be a way to answer both requirements. It was therefore decided to evaluate whether the medical students' cardiopulmonary resuscitation performance would improve when they teach other people, and if those people could learn with them effectively. METHODS: A non-randomized controlled trial was designed to assess whether teaching Basic Life Support would increase students' learning. Socially engaged, seeking to disseminate knowledge, 92 medical students were trained in Basic Life Support and who subsequently trained 240 community health professionals. The students performed theoretical and practical pre- and post-tests whereas the health professionals performed theoretical pre- and post-tests and one practical test. In order to assess the impact of teaching on students' learning, they were divided into two groups: a case group, with 53 students, reassessed after teaching health professionals, and a control group, with 39 students, reassessed before teaching. RESULTS: The practical students' performance of the case group went from 13.3 ± 2.1 to 15.3 ± 1.2 (maximum = 17, p < 0.001) and theoretical from 10.1 ± 3.0 to 16.4 ± 1.7 (maximum = 20, p < 0.001) while the performance of the control group went from 14.4 ± 1.6 to 14.4 ± 1.4 (p = 0.877) and from 11.2 ± 2.6 to 15.0 ± 2.3 (p < 0.001), respectively. The theoretical performance of the health professionals changed from 7.9 ± 3.6 to 13.3 ± 3.2 (p < 0.001) and the practical performance was 11.7 ± 3.2. CONCLUSIONS: The students who passed through the teaching activity had a theoretical and practical performance superior to that of the control group. The community was able to learn from the students. The study demonstrated that the didactic activity can be an effective methodology of learning, besides allowing the dissemination of knowledge. The University, going beyond its academic boundaries, performs its social responsibility.

The role of civil society in strengthening intercultural maternal health care in local health facilities: Puno, Peru.

BACKGROUND AND OBJECTIVE: Peru's Ministry of Health has made efforts to increase the cultural inclusiveness of maternal health services. In 2005, the Ministry adopted an intercultural birthing policy (IBP) that authorizes and encourages the use of culturally acceptable birthing practices in government-run health facilities. However, studies suggest that indigenous women may receive inconsistent benefits from these kinds of policies. This article examines whether a grassroots accountability initiative based on citizen monitoring of local health facilities by indigenous women can help to promote the objectives of the IBP and improve intercultural maternal health care. DESIGN: Findings are drawn from a larger qualitative research study completed in 2015 that included fieldwork done between 2010 and 2011. Semi-structured interviews were conducted with 23 women working as citizen monitors in local health facilities in Puno and 30 key informants, including frontline health workers, health officials, and civil society actors in Puno and Lima, and human rights lawyers from the Defensoría del Pueblo Office in Puno. RESULTS: Monitors confirmed from their own personal experiences in the 1990s and early 2000s that respect for intercultural aspects of maternal health care, including traditional indigenous birthing practices, were not readily accepted in publicly funded health facilities. It was also common for indigenous women to face discrimination when seeking health service provided by the state. Although the government's adoption of the IBP in 2005 was a positive step, considerable efforts are still needed to ensure high-quality, culturally appropriate maternal health care is consistently available in local health facilities. CONCLUSIONS: Despite important progress in the past two decades, policies aimed at improving intercultural maternal health care are unevenly implemented in local health facilities. Civil society, in particular indigenous women themselves, can play an important role in holding the state accountable for quality care.