Apuntes históricos sobre del proceso de formación del médico general integral en Cuba / Historical notes on the training process of the comprehensive general doctor in Cuba

La salud pública cubana se sustenta en la Atención Primaria de Salud y, con ello, la instauración de la especialidad de medicina general integral en 1985, con cambios sustanciales hasta la actualidad, ha dado un importante paso de avance en la accesibilidad y calidad en los servicios médicos; transformación necesaria en el Sistema Nacional de Salud. Teniendo en cuenta lo anterior se realizó el presente estudio con vistas a profundizar en las tendencias históricas por las que ha transitado el proceso de formación del médico general integral en Cuba. Se concluye que dicho proceso ha tenido transformaciones que obedecen a las necesidades nacionales e internacionales, donde todas las versiones del programa consideran la educación en el trabajo como protagonista en los servicios de salud.

The Cuban public health is sustained in the Primary Health Care which improvement has been favored with the establishment of the comprehensive general medicine specialty in 1985, with substantial changes until the present time that have propitiated a step of important advance in the accessibility and quality in the medical services. Taking into account the above-mentioned the present study was carried out aimed at deepening in the historical tendencies that the training process of the comprehensive general doctor in Cuba has gone through. It was concluded that this process has had transformations that obey the national and international necessities, where all the versions of the program consider the education at work as main character in health services.

Aproximación histórica tendencial a la superación bioética del médico general integral para la práctica pediátrica

RESUMEN El desarrollo histórico supone la evolución de los procesos de superación del médico general integral e implica considerar los saberes bioéticos en beneficio de un mejor desempeño en la atención a niños y adolescentes en el contexto comunitario. El trabajo tuvo el objetivo de exponer los elementos teórico-prácticos que conforman una aproximación histórica-tendencial a la superación bioética del médico general integral para la práctica pediátrica, en el periodo de 1984 al 2020. Se utilizaron métodos teóricos: análisis-síntesis, histórico-lógico y hermenéutico. Se revisaron normativas, indicaciones y resoluciones relacionadas con la docencia médica y la superación. El estudio evidenció un desarrollo progresivo de acciones y estrategias que conciben la integración de contenidos bioético-pediátricos en la superación del médico general integral. Se identificaron aspectos didáctico-metodológicos que advierten sobre las posibilidades de continuar perfeccionando la preparación del profesional a partir de propuestas didácticas que favorezcan la apropiación de saberes integrados.

ABSTRACT The historical development supports the evolution of the improvement processes of comprehensive general doctor and implies considering bioethical knowledge in benefit of a better performance in the care of children and adolescents in the comunity context. The objective of this work dealt with the practical-theoretical elements that make up a historical trend approach to the bioethical improvement of the comprehensive general doctor for the pediatric practice at the period from 1984 to 2020. Analysis-synthesis, historical-logical and hermeneutical were the theoretical methods used. Regulations, indications and resolutions related to medical teaching and improvement were reviewed. The study showed a progressive development of actions and strategies that conceive the integration of pediatric bioethics content in the improvement of the comprehensive general doctor. Didactic-methodological aspects were identified that warn about the possibilities to continue improving the professional preparation based on didactic proposals that favor the appropriation of integrated knowledge.

Una mirada crítica sobre la reacción situacional en la atención primaria de salud / A critical glance on the situational reaction in primary health care

La enfermedad situacional es una categoría nosográfica poco analizada en la bibliografía médica. En este artículo se abordan aspectos importantes relacionados con su valor clasificatorio y práctico, así como la importancia que reviste en el plan de formación del médico general integral, debido a las potencialidades de desarrollo en la comunidad. Además, se enfatiza en las posibilidades prácticas de aplicar los procedimientos psicoterapéuticos de apoyo, que son oportunos y facilitadores para evitar la sobresaturación de la demanda asistencial secundaria, resultante del envío o remisión

The situational disease is a nosographic category little analyzed in the medical literature. In this work important aspects related to its classificatory and practical value are approached, as well as the importance that it has in the training plan of the comprehensive general doctor, due to the development potentialities in the community. It is also emphasized on the practical possibilities of implementing the support psychotherapeutic procedures that are opportune and facilitators to avoid the overflood of secondary assistance demand, resulting from referral.

Among adults with epilepsy reporting recent seizures, one of four on antiseizure medication and three of four not on medication had not seen a neurologist/epilepsy specialist within the last year, the 2010 and 2013 US National Health Interview Surveys.

We combined 2010 and 2013 National Health Interview Survey (NHIS) data to examine the prevalence of seeing a neurologist/epilepsy specialist and/or a general doctor among US adults with active epilepsy who either took antiseizure medications or had at least one seizure in the past 12months. Among adults with recent seizures, about 76% of adults who did not take antiseizure medication (including 55% of those who saw only a general doctor and 21% of those who saw neither a specialist nor a general doctor) and 26% of those who took medication (including 23% of those who saw only a general doctor and 3% of those who saw neither a specialist nor a general doctor) had not seen a specialist within the past year-indicating gaps in quality care putting patients with uncontrolled seizures at risk of negative outcomes. The US Healthy People 2020 objectives call for increasing the proportion of people with epilepsy and uncontrolled seizures who receive appropriate medical care. Epilepsy stakeholders can work with community services/organizations to improve provider education about epilepsy, eliminate barriers to specialized care, and promote self-management support to reduce the burden of uncontrolled seizures in people with epilepsy.

Reformation of the Medical Educational Institutes and Training of General Doctors during the Early Period of Japanese Rule / 의사학

The Japanese government downgraded a Korean medical college being attached to the Daehan hospital to a medical training center blaming upon a lack of education in Korea. But the actual curriculum and the years required for completing a course of study in the Korean medical college were equivalent to those of the Japanese medical college. Furthermore, the Japanese government discarded the financial support for medical school students. So they should pay their tuitions and other stipends by themselves. The Japanese government forced a private institute to establish an endowed school by the legal act of college. It enabled to classify a medical education system with the judicial support. For the example of Severance Medical School, it reformed faculty, curriculum and facility according to the legal standard of a college act. Therefore, Severance Medical School was able to be upgraded to a medical college. But there was a limitation even for the government schools under the colonial era. It was not possible to train important medical human resource who enabled to supervise the modern medical system in Korea. On one hand, almost every important medical human resource such as a military doctor, and a professor, who should have trained in Korea in the Great Han Period, was trained in Japan. On the other hand, fostering general doctors, who practiced medicine with hands-on experience, was the purpose of medical education in Korea whether the medical school was governmental or private. Since the purpose of Severance Medical College was to foster general doctors, it was able to grow within the colonial medical system. The purpose of medical missionaries, who promoted the spread of gospel with the western medical support, enforced the Japanese colonial logics that the Japanese government could educate and develop Korea with the introduction of western civilization. Although it was later comparing to the government medical school, Severance Medical College enabled to certify the medical license automatically to the graduates from the school. The reason that the Japanese government allowed for Severance Medical College to issue the automatic medical license was to keep the colonial structure of Japanese in Korea.