[Putting freelancing in the medical profession to the test]. / Der Freie Beruf auf dem Prüfstand.

Hallmarks of freelancing in the medical profession include special professional qualifications or expertise. Identification with the activity is also reflected in a physician's responsibility for patients that goes beyond a mere business relationship. At the same time, this responsibility requires that a physician can act independently of economic aspects. Privileges of self-employed are, in addition to a fee schedule, the possibility to establish one's own pension fund and to exercise self-governance in medical associations. An important aspect of being self-employed is self-governance. The goal of the independence of those who are self-employed is to avoid the social and irresolvable conflict of values in state- or market-based systems. Physicians work in a field of tension between an empathetic, time-taking medical activity and a fast "economically sensible, expedient and necessary" medicine. Enduring this dilemma is the original task of the liberal profession.

Psychiatry training in 42 European countries: A comparative analysis.

Psychiatry qualifications are automatically recognized among European Union (EU) countries despite differences in national training programs. A widening gap between the number of psychiatrists, their competencies and the growing burden of mental illnesses in Europe has renewed calls for international standardization of training. Comprehensive information about training programs is missing, which limits thorough comparisons and undermines development of an actionable strategy to improve and harmonize psychiatry training. This study describes and compares the existing postgraduate psychiatry programs in 42 countries in the European region. Representatives of national psychiatry associations completed a semi-structured, 58-item questionnaire. Training structure and working conditions of each country were compared with population needs calculated by the World Health Organization to determine the European mean and contrasted among pre-2004 and post-2004 EU members and countries with unrecognized qualifications. Differences were tested with nonparametric (Wilcoxon) and parametric (Anova) tests. Median training duration was 60 months, significantly shorter in countries with unrecognized qualifications (48 months, χ²16.5, p < 0.001). In 80% of the countries, placement in a non-psychiatric specialty such as neurology or internal medicine was mandatory. Only 17 countries (40%) stipulated a one-month rotation in substance abuse and 11 (26%) in old-age psychiatry. The overall deficit of training versus population need was 22% for substance abuse and 15% for old-age psychiatry. Salaries were significantly higher in pre-2004 EU members (χ²22.9, p < 0.001) with the highest in Switzerland (€5,000). Significant variations in curricula, training structure and salaries exist in Europe. Harmonization of training standards could offer significant benefits for improving mental healthcare.

A proposed Common Training Framework for Specialists in Laboratory Medicine under EU Directive 2013/55/EC (The Recognition of Professional Qualifications).

European Union (EU) Directive 2013/55/EC (The Recognition of Professional Qualifications) allows Member States to decide on a common set of minimum knowledge, skills and competences that are needed to pursue a given profession through a Common Training Framework. To be adopted the framework must combine the knowledge, skills and competences of at least one third of the Member States. Professionals who have gained their qualifications under a Common Training Framework will be able to have these recognised automatically within the Union. The backbone of the European Federation of Clinical Chemistry and Laboratory Medicine's (EFLM) proposed Common Training Framework for non-medical Specialists in Laboratory Medicine is outlined here. It is based on an Equivalence of Standards in education, training, qualifications, knowledge, skills, competences and the professional conduct associated with specialist practice. In proposing the recognition of specialist practice EFLM has identified 15 EU Member States able to meet Equivalence and in whom the profession and/or its training is regulated (an additional EU Commission requirement). The framework supports and contributes to the Directive's enabling goals for increasing professional mobility, safeguarding consumers and ensuring a more equitable distribution of skills and expertise across the Member States. It represents EFLM's position statement and provides a template for professional societies and/or competent authorities to engage with the EU Commission.

Medical Biochemistry as Subdiscipline of Laboratory Medicine in Serbia.

Medical biochemistry is the usual name for clinical biochemistry or clinical chemistry in Serbia, and medical biochemist is the official name for the clinical chemist (or clinical biochemist). This is the largest sub-discipline of the laboratory medicine in Serbia. It includes all aspects of clinical chemistry, and also laboratory hematology with coagulation, immunology, etc. Medical biochemistry laboratories in Serbia and medical biochemists as a profession are part of Health Care System and their activities are regulated through: the Health Care Law and rules issued by the Chamber of Medical Biochemists of Serbia. The first continuous and organized education for Medical Biochemists (Clinical Chemists) in Serbia dates from 1945, when the Department of Medical Biochemistry was established at the Pharmaceutical Faculty in Belgrade. In 1987 at the same Faculty a five years undergraduate study program was established, educating Medical Biochemists under a special program. Since the academic year 2006/2007 the new five year undergraduate (according to Bologna Declaration) and four-year postgraduate program according to EC4 European Syllabus for Postgraduate Training in Clinical Chemistry and Laboratory Medicine has been established. The Ministry of Education and Ministry of Public Health accredited these programs. There are four requirements for practicing medical biochemistry in the Health Care System: University Diploma of the Faculty of Pharmacy (Study of Medical Biochemistry), successful completion of the professional exam at the Ministry of Health after completion of one additional year of obligatory practical training in the medical biochemistry laboratories, membership in the Serbian Chamber of Medical Biochemists and licence for skilled work issued by the Serbian Chamber of Medical Biochemists. In order to present laboratory medical biochemistry practice in Serbia this paper will be focused on the following: Serbian national legislation, healthcare services organization, sub-disciplines of laboratory medicine and medical biochemistry as the most significant, education in medical biochemistry, conditions for professional practice in medical biochemistry, continuous quality improvement, and accreditation. Serbian healthcare is based on fundamental principles of universal health coverage and solidarity between all citizens.

La evaluación psicológica en contextos educativos: aciertos del pasado, errores del presente y propuestas de futuro / Psychological assessment in educational contexts: Past successes, mistakes of the present and future proposals

Con este artículo se pretende un doble objetivo. En primer lugar, evidenciar el progreso de la evaluación psicológica mediante el relato de determinados hitos del pasado y los actuales avances en producción, tecnología e investigación, progreso que no se ha producido a nivel aplicado en uno de los ámbitos más importantes, desde la antigüedad, de la evaluación psicológica en España, que es la evaluación en contextos educativos. Este hecho se debe a los errores legislativos de la Administración Educativa que ha permitido que profesionales sin la debida cualificación realicen estas funciones, por lo que es necesario que académicos, colegios profesionales y asociaciones científicas aúnen esfuerzos y establezcan directrices sobre las normas de uso de los test, la formación del evaluador y el control del intrusismo profesional. En segundo lugar se propone un modelo para la evaluación diagnóstica en contextos educativos, el "Modelo Integrador", en el que el psicólogo educativo no sólo recogerá información relevante del alumno sino también del contexto familiar y escolar.(AU)

This article will develop two objectives. The first is to highlight the progress of psychological evaluation through the consideration of important achievements of the past and current developments in production, technology and research, detailing the reasons why evaluation has not progressed in the applied level of educational contexts (one of the most important areas since the beginning of the psychological evaluation history in Spain). This non-progress is a result of legislative mistakes of the Educational Administration, which has allowed professionals without proper qualifications to perform those functions. It is necessary that university teachers, professional and scientific associations join force in order to establish guidelines of test usage, qualifications of evaluators and professional intrusion control. The second objective is to propose a model for diagnostic evaluation in educational contexts, the "Integrator Model", in which educational psychologists will collect relevant information not only about the student but also about the family and school context.(AU)

La evaluación psicológica en contextos educativos: aciertos del pasado, errores del presente y propuestas de futuro / Psychological assessment in educational contexts: Past successes, mistakes of the present and future proposals

Con este artículo se pretende un doble objetivo. En primer lugar, evidenciar el progreso de la evaluación psicológica mediante el relato de determinados hitos del pasado y los actuales avances en producción, tecnología e investigación, progreso que no se ha producido a nivel aplicado en uno de los ámbitos más importantes, desde la antigüedad, de la evaluación psicológica en España, que es la evaluación en contextos educativos. Este hecho se debe a los errores legislativos de la Administración Educativa que ha permitido que profesionales sin la debida cualificación realicen estas funciones, por lo que es necesario que académicos, colegios profesionales y asociaciones científicas aúnen esfuerzos y establezcan directrices sobre las normas de uso de los test, la formación del evaluador y el control del intrusismo profesional. En segundo lugar se propone un modelo para la evaluación diagnóstica en contextos educativos, el "Modelo Integrador", en el que el psicólogo educativo no sólo recogerá información relevante del alumno sino también del contexto familiar y escolar.

This article will develop two objectives. The first is to highlight the progress of psychological evaluation through the consideration of important achievements of the past and current developments in production, technology and research, detailing the reasons why evaluation has not progressed in the applied level of educational contexts (one of the most important areas since the beginning of the psychological evaluation history in Spain). This non-progress is a result of legislative mistakes of the Educational Administration, which has allowed professionals without proper qualifications to perform those functions. It is necessary that university teachers, professional and scientific associations join force in order to establish guidelines of test usage, qualifications of evaluators and professional intrusion control. The second objective is to propose a model for diagnostic evaluation in educational contexts, the "Integrator Model", in which educational psychologists will collect relevant information not only about the student but also about the family and school context.

Deciding when physicians are unfit to practise: an analysis of responsibilities, policy and practice in 11 European Union member states.

In 1974, the European Economic Community established mutual recognition of medical qualifications obtained in any of its member states. Subsequently, a series of directives has elaborated on the initial provisions, with the most recent enacted in 2013. However, greater movement of physicians across borders and some high-profile scandals have raised questions about how to prevent a physician sanctioned in one country from simply moving to another, without undermining the principle of free movement. A survey of key informants in 11 European Union (EU) member states was supplemented by a review of peer-reviewed and grey literature, with the results validated by independent reviewers. It examined processes, adjudicative and disciplinary measures that are in place to evaluate physicians about whom concerns arise, and related sanctions, along with other aspects of professional standards and regulation. Overall, responses varied greatly between participating countries, with respect to the institutions responsible for the regulation of medical professions, the investigation processes in place, and the terminology used in each member state. While the types of sanction (removal from the register of medical professionals and/or licence revocation, suspension, dismissal, reprimand, warnings, fines, as well as additional education and training) applied are similar, both the roles of the individuals involved and the level of public disclosure of information vary considerably. However, some key features, such as the involvement of professional peers in disciplinary panels and the involvement of courts in criminal cases, are similar in most member states studied. Given the variation in the regulatory context, individuals and processes involved that is illustrated by our findings, a common understanding of definitions of what constitutes competence to practise, its impairment and its potential impact on patient safety becomes particularly important. Public disclosure of disciplinary outcomes is already applied by some member states, but additional measures should be considered to protect medical professionals from undue consequences.

Citotécnico: análise do processo de trabalho em laboratórios de citopatologia e anatomopatologia no Estado do Rio de Janeiro / Cytology: analysis of the work process in cytopathology and pathology laboratories in the State of Rio de Janeiro

INTRODUÇÃO: Trata-se de um estudo sobre o processo de trabalho dos citotécnicos que atuam em laboratórios de Anatomopatologia e Citopatologia no Estado do Rio de Janeiro. OBJETIVOS: objetivo geral é: analisar a percepção dos citotécnicos sobre as competências necessárias à execução de sua atividade laboral; e específicos: (1) descrever a atividade laboral do citotécnico; (2) identificar o modo de produção da atividade por meio das inter-relações de trabalho; (3) conhecer e compreender as implicações do trabalho do citotécnico nas ações de controle do câncer. MATERIAL E MÉTODO: A investigação foi de abordagem qualitativa, de natureza descritiva e social, realizada em três laboratórios de Anatomopatologia e Citopatologia no Estado do Rio de Janeiro, com a participação de 33 citotécnicos. Os dados foram obtidos pela técnica de entrevista semiestruturada, aplicação de questionário, e grupo focal, no período de janeiro a agosto de 2014, e analisados com base na Análise de Conteúdo de Bardin, tendo como unidade de registro o tema. RESULTADOS: Os resultados revelaram: dos 33 citotécnicos, 73% são do sexo feminino; 34% estão distribuídos em igual percentual para as faixas etárias entre 41 a 50 anos e 51 a 60 anos. Com relação à variável do grau de escolaridade, 43% possuem especialização e 24% concluíram o curso superior. Em relação ao cargo exercido, 73% atuam como citotécnicos e 70% são funcionários públicos. O trabalho do citotécnico tem especificidade única desse trabalhador de nível técnico, que é a realização da primeira análise do exame citopatológico, com ações articuladas e complementares de natureza técnica, de gestão, e educativas vinculadas à equipe, com ênfase nos princípios de prevenção e promoção da saúde. Por meio da escala de avaliação do contexto de trabalho, foram avaliadas as condições físicas, materiais e organizacionais do processo de trabalho. O quesito clareza, na definição das tarefas, foi o maior valorado com 4,7% de média, seguido das relações socioprofissionais com média de 4,0%. Os resultados da análise de conteúdo revelaram: na trajetória da atividade laboral, emergiram quatro categorias associadas à motivação e ao ingresso na ocupação por pessoas de referência na formação, acesso ao mercado de trabalho, busca pelo aperfeiçoamento profissional e aprendizagem prática no trabalho; no conceito de modo de produção, emergiram cinco categorias: responsabilidade de salvar vidas, crítica em relação ao próprio trabalho com qualidade, características físicas, atividades distintas do citotécnico e do histotécnico, visão do trabalho com otimismo; nas condições de trabalho, emergiram quatro categorias: trabalho em equipe e responsabilidade individual, ambiguidade em relação à autonomia, precarização do trabalho, esperança no reconhecimento da profissão. CONCLUSÃO: O trabalho do citotécnico é uma ocupação fracamente regulamentada, que se caracteriza por ausência de perfil profissional específico compatível com o escopo de prática real observada no trabalho levando a condições de trabalho precário. O reconhecimento ocorre entre os próprios trabalhadores que se valorizam por serem responsáveis pela promoção da saúde tornando seu trabalho socialmente útil.

INTRODUCTION: This study examines the work processes of cytotechnicians employed in Anatomic Pathology and Cytopathology laboratories in Rio de Janeiro State, Brazil. OBJECTIVES: general purpose is: to analyze perceptions among cytotechnicians of the skills needed to perform their jobs; and more specifically: (1) to describe the work activities of cytotechnicians; (2) to identify activity production modes through workplace relationships; and (3) to explore and understand the implications of the work of cytotechnicians on cancer control actions. MATERIAL AND METHODS: Conducted at three Anatomic Pathology and Cytopathology laboratories in Rio de Janeiro State, this qualitative, descriptive and social research project involved 33 cytotechnicians. Obtained between January and August 2014 through semi-structured interviews, questionnaires and focus groups, the data were subsequently analyzed through the Bardin Content Analysis technique, with the theme constituting the record unit. RESULTS: The findings showed that 73% of these 33 cytotechnicians were women and 34% were split equally between two age brackets: 41  50 years old and 51  60 years old. For the education variable, 43% held specialty qualifications and 24% were university graduates. In terms of their positions, 73% worked as cytotechnicians while 70% were civil servants. The work of the cytotechnician has a specific characteristic that is unique to these technical level employees: they handle the initial analyses of cytopathologic tests through tight-knit team-based complementary actions involving technical, administrative and educational aspects, grounded on health promotion and disease prevention principles. The physical, material and organizational conditions of their work processes were assessed on a work-place rating scale. The issue of task definition clarity ranked highest with a 4.7% mean score, followed by social and professional relationships at a 4.0% mean score. The Content Analysis findings showed that four categories appeared for their work-place activities, associated with: motivation and career choices steered by persons of influence while studying; access to the job market; quest for professional enhancement; and on-the-job training using a hands-on approach. CONCLUSION: The production mode concept gave rise to five categories: responsibility for saving lives; criticism of their own work and quality; physical characteristics; activities specific to cytotechnicians and histotechnicians; and positive views of their jobs. Their working conditions resulted in four categories: teamwork and individual responsibilities; ambiguity about autonomy; weak job security; and hope for better professional acknowledgment. The work of cytotechnicians is covered by lax labor regulations, undermining the presence of a specific professional profile compatible with the scope of their actual job routines as observed and resulting in poor working conditions. They affirm they see themselves as buttressing health promotion, appreciatively aware that their work is useful to society.

Medical migration within Europe: opportunities and challenges.

The free movement of European citizens to live and work within the European Union (EU) is one of the fundamental pillars of the European single market. Recent EU legislation on the recognition of professional qualifications (to take effect January 2016) updates the framework within which doctors and others can migrate freely between EU member states to practise their profession. UK organisations lobbied extensively to change aspects of the original proposals, in particular those that threatened to 'water down' public protection in the interest of free movement. The legislation finally adopted significantly increases safeguards for patients and the public. The revised law covers the rules to be applied by regulators on (for example) assuring language competence, warning 'blacklists' of practitioners subject to sanctions, 'fast track' registration based on mutual recognition of professional qualifications, agreed minimum education and training requirements for mutual recognition, and encouragement of continuing professional development. Drafting of detailed secondary legislation is ongoing and poses opportunities and challenges for patient safety, quality of care and transparency.

O desafio da implementação da educação permanente na gestão da educação na saúde / The challenge of implementing continuing education in health education management / El reto de implementar la educación permanente en la gestión de la educación en salud

O caminho utilizado neste estudo foi a revisão sistemática de literatura da produção científica e do marco normativo, com o objetivo de identificar as principais concepções teórico-conceituais referentes à gestão da educação na saúde no Brasil no período de 2003 a 2009. A gestão do Sistema Único de Saúde aponta para a necessidade de qualificação de gestores e profissionais para atuar no setor desde a graduação, incluindo a integração ensino-serviço e a formação profissional no ambiente de trabalho. Após a aplicação de critérios de inclusão, 16 artigos e seis portarias foram incluídos na revisão. No âmbito da gestão da educação na saúde, o debate gira em torno de duas principais concepções, a educação continuada e a educação permanente, centradas respectivamente no modelo acadêmico e na aprendizagem em equipe, inerente aos grupos de trabalhadores. A análise da produção científica e do marco normativo sugere que as transformações conceituais desafiam todos os atores da saúde a realizarem uma ruptura teórico-conceitual e de posicionamento subjetivo, superando uma posição de 'recurso humano', realizador de tarefas, para a de sujeito capaz de refletir sobre os processos de trabalho.

This study undertook a systematic review of the scientific literature and of the regulatory framework to pinpoint key theoretical and conceptual ideas on health education management in Brazil in the period of 20032009. The management of the National Health System points to the need of training managers and professionals to work in the industry from the moment they graduate, including teaching-service integration and professional training in the workplace. After applying the inclusion criteria, 16 articles and six ordinances were included in the review. Insofar as health education management is concerned, the debate revolves around two main concepts, permanent education and continuing education centered, respectively, on the academic model and in team learning, inherent to the groups of workers. The analysis of the scientific literature and of the regulatory framework suggests that conceptual transformations challenge all players in health to a theoretical-conceptual break away and subjective stance, extending beyond a position of 'human resource,' undertaker of tasks, and reaching a subject capable of reflecting on the work processes.

El camino utilizado en este estudio fue la revisión sistemática de literatura de la producción científica y del marco normativo, con el fin de identificar las principales ideas teóricas y conceptuales referidas a la gestión de la educación en salud en Brasil, en el período de 2003 a 2009. La gestión del Sistema Único de Salud señala la necesidad de capacitación de gestores y profesionales para trabajar en el sector desde su graduación, incluyendo la integración entre enseñanza y servicio, y la formación profesional en el ambiente de trabajo. Después de aplicar los criterios de inclusión, 16 artículos y seis ordenanzas fueron incorporados a la revisión. En el ámbito de la gestión de la educación en salud, el debate gira en torno a dos principales concepciones, la educación continua y la educación permanente, centradas respectivamente en el modelo académico y en el aprendizaje en equipo, inherente a los grupos de trabajadores. El análisis de la producción científica y del marco normativo sugiere que las transformaciones conceptuales desafían a todos los actores de la salud para llevar a cabo una ruptura teórica y conceptual, y posicionamiento subjetivo, superando una condición de 'recurso humano', realizador de tareas para un sujeto capaz de reflexionar sobre los procesos de trabajo.

Licensing procedures and registration of medical doctors in the European Union.

The current proposals to update the European Union (EU) directive on professional qualifications will have potentially important implications for health professions. Yet those discussing it will struggle to find basic information on key issues such as licensing and registration of physicians in different countries. A survey was conducted among national experts in 14 EU member states, supplemented by literature and independent expert review. The questionnaire covered five components of licensing and registration: (1) definitions, (2) regulatory basis, (3) governance, (4) the process of registration and (5) flow and quantity of applications. We identify seven areas of concern: (1) the meaning of terminology, which is inconsistent; (2) the role of language assessments and the responsibility for them; (3) whether approval to practise should be lifelong or time limited, subject to periodic assessment; (4) the need for improved systems to identify those deemed no longer fit to practise in one member state; (5) the complexity of processes for graduates from non-EU/European Economic Area (EAA) countries; (6) public access to registers; and (7) transparency of systems of governance. The systems of licensing and registration of doctors in Europe have developed within specific national contexts and vary widely. This creates inevitable problems in the context of free movement of professionals and increasing mobility.

Avaliação de competências profissionais e formação de psicólogos / Professional skills assessment and the training of psychologists

Esta pesquisa teve como objetivo avaliar o desenvolvimento de competências profissionais relacionadas ao processo de formação em Psicologia e ao campo de trabalho do psicólogo. Foi construído um inventário de competências profissionais de psicólogos e graus de importância a elas atribuído, composto por 132 itens organizados em 16 categorias e aferidos por meio de uma escala ordinal de cinco pontos, submetido antes de sua aplicação a um processo de validação semântica e de conteúdo. Participaram 102 sujeitos (21 a 64 anos), sendo 71,6 por cento do sexo feminino, dentre professores, estagiários e psicólogos egressos de um curso de Psicologia da região Sul do Brasil. Destacaram-se como competências essenciais para a atuação profissional dos psicólogos: manter sigilo dos dados fornecidos pelo seu cliente, atuar em equipes multiprofissionais e assumir responsabilidade pelos resultados do seu trabalho. De uma forma geral, as competências imprescindíveis à atuação do psicólogo mostram-se relacionadas à dimensão ética profissional, à comunicação e ao relacionamento social e profissional(AU)

This research aimed to evaluate professional skills related to the education process in Psychology and the psychologist's work field. An inventory of the psychologists' professional qualifications and their levels of importance were constructed, involving 16 categories, 132 items and an ordinal scale of five points. This inventory was submitted to a process of semantic and content validation. The sample consisted of 102 individuals (21 to 64 years old), 71.6 percent of which were females, and was made up of professors, interns and psychologists that attended an undergraduate Psychology course in a Brazilian Southern institution. The qualifications that stood out among the ones that were considered essential for the psychologists' work are: to maintain secrecy about the information given by the clients, to be part of multiprofessional staffs, and to take responsibility for their work results. In general, the qualifications that are indispensable for the psychologist's work proved to be related to the professional ethics dimension, to the communication contexts and to the social and professional relations(AU)