Community-based Medicine

From Classrooms to Neighborhoods -- A Reality Students Must Be Prepared For

Alejandro Avelino Bonilla

In recent decades, medical education has been changing around the world in an effort to improve quality, equity, and relevance among other characteristics. A good example for this is the accreditation process of many medical institutions around the world. Besides this, institutions are also aiming to reach what has been defined as social accountability, and it is the main topic of the must-read, “Global Consensus for Social Accountability of Medical Schools.” ¹ Both topics have been widely explored by The Network: TUFH and its members during the last years and are reflected on The Fortaleza Declaration (2014)² and the Tunis Declaration (2017)³ seeking global learning objectives for health professionals and to enhance health and social justice in the social accountability context respectively.  

Accreditation and social accountability are topics that deserve their own review and discussion, but both are related to an issue I want to highlight, the disparity between what is taught and learned during the undergraduate period and what is really useful and needed to work with, and in, communities. From the accreditation perspective, standards are given in order to develop programs and activities in the communities (depending on the national standard that is widely used), meaning that students will, for sure, be in touch with the communities and their surroundings in non-clinical or outreach activities. On the other hand, social accountability has a much bigger picture of the community and includes relevance, quality, cost-effectiveness, and equity to the activities developed in the community.^4,5 

We, as health educators, talk about the relevance of community-based practices and that students must be in touch with the community (even though some students and even teachers may be slightly against it), but community-based practices are not the same as socially accountable actions, neither being a social accountability program. Therefore, students are being taken to communities to perform activities, within accreditation standards, but they might not be socially accountable and it endangers the development of health care students and the reason is quite simple, during and around four to seven years, health care education institutions train students to face and treat health issues in a clinical context (of course this does not apply to all medical institutions but for most it does), and then, they are taken to a more social context where they do not have the tools and environment they are used to, so they must face a completely new reality. This situation can be so deeply entrenched that even the country's health system is not designed to respond to the needs of the community outside the hospital, so what do we expect from students when it comes to commitment and delivery within the community? Why do we proudly say that our students perform activities in the community when we are not really having the desired effect on them nor on the community? Or at least in most communities because even faced with these difficulties, some students actually “fall in love” with the community’s health and that’s what brings us to this discussion. 

Recently in Latin America there was a debate about the voluntary interruption of pregnancy as a right, Argentina⁶ and Colombia⁷ just to cite some examples, and many institutions refused to train their students about this type of care. In the specific case of Colombia when the students where asked, many reported that they received little or almost no training about the topic. If this happens with a subject that is specific, what might be happening when we try to teach and inform students around health in the communities, and even more complex, social accountability issues?

Now, from the community context, are they involved in the planning, execution, and follow up of these community-based practices or social accountable activities? Do we even ask them what they need and what is a priority for them? Or do we just assume that we know what is best because we are the health professionals? A highly involved and active community is not a common thing but is not impossible to find or to nurture. Yet it does require time and work and once it is archived, it can basically guarantee the sustainability part of the impact of the intervention. This brings us to the “the elephant in the room,” are we involving the community? Are we working for the community, in the community, or with the community? Most of the community-based activities tend to be focused on building capacities for the students, but not all of them aim for building capacities for the community as well. These activities ended up being used as a means to reach the objectives with the students, instead of being the end itself and forming students along the way.

So, if we combine these factors, students are being formed on a clinical level and then taken to perform community-based practices that do not meet the needs of the community, ultimately we will have newly graduated doctors that do not possess the theoretical and practical knowledge to answer a community’s health needs, and additionally, communities that do not feel like they can identify with these newly graduated doctors. Isn’t this a problem we are facing worldwide? Of course, it has other contributing causes, but this is one we can face now.

The solution can be found in the problem itself once we face it. Building programs and curriculums around the needs of the community -- with the community -- will allow students to face these needs in a much more real scenario, while during classes students will receive education in primary health care. This is a solution that does not require additional funding, it requires a restructuring and prioritization, something that is extensively addressed during the actions of primary health care and community-based primary health care.

There are many programs and institutions that are changing the health related education paradigm and that we all can meet in the next The Network: TUFH Social Accountability: From Evidence to Action Conference in Darwin, Australia, which demands that institutions, teachers, students, and policymakers among others participate in this must attend event.

This is just a short reflection on a subject that requires a wide and rich debate with different perspectives to support primary health care as a reality that will last over time and that will deliver the impact we are looking for -- education and health promotion, disease prevention, early detection and treatment, and the improvement of the quality of life of the entire population. It may sound idealistic, but Ayn Rand stated it best, “Anyone who fights for the future, lives in it today.”


Works Cited

• Abdalla, Mohamed Elhassan, y Charles Boelen. “Social Accountability of Medical Schools: The New Frontier For Development”, 2012, 7–31.
• Awases, Magdalena, Rebecca Bailey, Charles Boelen, y Mario Dal Poz. “Global consensus on social accountability of medical schools”. Sante publique (Vandoeuvre-les-Nancy, France) 23, núm. 3 (2010): 247–50. www.ncbi.nlm.nih.gov/pubmed/21896218.
• Boelen, Charles, Jeffery E Heck, y World Health Organization. Division of Development of Human Resources for Health. “Defining and measuring the social accountability of medical schools”, 1995. apps.who.int//iris/handle/10665/59441.
• Cañón, Laura Natalia Cruz. “Facultades de medicina, reprobadas en Interrupción Voluntaria del Embarazo”. El Espectador. 2019. www.elespectador.com/noticias/salud/.
• Garcia, Glenn. “Abortion in Argentina”. The Lancet 393, núm. 10173 (2019): 744. doi.org/10.1016/s0140-6736(18)32767-3.
• Goñi, Uki. “‘Thousands’ of young girls denied abortion after rape in Argentina”. THe Guardian, 2019. www.theguardian.com/global-development/.
• Members of The Network; TUFH. “The Fortaleza Declaration”. Fortaleza, Brasil, 2014. thenetworktufh.org/declarations/.
• ———. “Tunis Declaration”. Hammamet, Tunisia, 2017. thenetworktufh.org/declarations/.

 
 
 
Footnotes

 

• ¹ Magdalena Awases et al., “Global consensus on social accountability of medical schools”, Sante publique (Vandoeuvre-les-Nancy, France) 23, núm. 3 (2010): 247–50, www.ncbi.nlm.nih.gov/pubmed/21896218.
• ² Members of The Network; TUFH, “The Fortaleza Declaration” (Fortaleza, Brasil, 2014), thenetworktufh.org/declarations/.
• ³ Members of The Network; TUFH, “Tunis Declaration” (Hammamet, Tunisia, 2017), thenetworktufh.org/declarations/.
• ⁴ Charles Boelen, Jeffery E Heck, y World Health Organization. Division of Development of Human Resources for Health, “Defining and measuring the social accountability of medical schools”, 1995, apps.who.int//iris/handle/10665/59441.
• ⁵ Mohamed Elhassan Abdalla y Charles Boelen, “Social Accountability of Medical Schools: The New Frontier For Development”, 2012, 7–31.
• ⁶ Glenn Garcia, “Abortion in Argentina”, The Lancet 393, núm. 10173 (2019): 744, https://doi.org/10.1016/s0140-6736(18)32767-3; Uki Goñi, “‘Thousands’ of young girls denied abortion after rape in Argentina”, THe Guardian, 2019, www.theguardian.com/global-development/2019/mar/05/.
• ⁷ Laura Natalia Cruz Cañón, “Facultades de medicina, reprobadas en Interrupción Voluntaria del Embarazo”, El Espectador, 2019, www.elespectador.com/noticias/salud/.

* Alejandro Avelino Bonilla is a physician and epidemiology postgraduate student from Juan N. Corpas University in Bogotá, Colombia. He is a National Research Leader in the Colombian Medical Student Association ACOME and member of the advisory board of The Network: TUFH. For more than three years he was a student representative for his University, as well as founder and co-president of the Colombian Association of Students Representatives of Higher Education ACREES. Alejandro also previously served as a Latin Americas´ representative and president of SNO.

Programa Médicos pelo Brasil

NOTA AOS MÉDICOS E À SOCIEDADE

 

 

O Conselho Federal de Medicina (CFM) foi surpreendido com a nota divulgada pela imprensa informando que o relatório da Comissão Mista do Congresso Nacional que discute a Medida Provisória nº 890/2019, que cria o Programa Médicos pelo Brasil, deve prever a inclusão de 1.800 médicos cubanos, além da permissão de que médicos brasileiros formados no exterior que não foram aprovados no Exame Nacional de Revalidação de Diplomas Médicos Expedidos por Instituições de Educação Superior Estrangeiras (Revalida) tenham o direito de prestar a prova para ingressar no Programa, mesmo sem registro em Conselho Regional de Medicina (CRM).

 

Essa notícia surpreende e decepciona, pois não corresponde à proposta apresentada pelo Ministério da Saúde ao CFM por ocasião do planejamento do Programa Médicos pelo Brasil.

 

O CFM tem posicionamento público em relação a essa questão e é inflexível quanto à obrigatoriedade de que qualquer médico, para exercer sua profissão no Brasil, tenha de ter diploma revalidado, estar registrado nos Conselhos de Medicina e ser portador de inscrição no CRM. Não há exceções a essas normas. O CFM não admite nenhum tipo de flexibilização dessas obrigações legais, que garantem qualidade e segurança no atendimento à população, realizado por profissionais qualificados.

 

O CFM solicita que o relator da proposta na Comissão Mista do Congresso Nacional, o senador e médico Confúcio Moura (MDB-RO), como profissional da medicina e conhecedor da catástrofe que é o atendimento da população por médicos desqualificados, resista à pressão de setores interessados em que o Revalida não seja aplicado aos intercambistas cubanos e aos brasileiros formados no exterior, o que contraria promessa de campanha do presidente Jair Bolsonaro, e mantenha em seu relatório a obrigatoriedade de que todos os médicos que pleiteiam entrar no Programa Médicos pelo Brasil sejam portadores de inscrição no CRM, em obediência à lei e pela segurança da assistência médica a todos os brasileiros.

 

O CFM, em passado recente, sob outros governos, sempre atuou contra medidas que ameaçavam a qualidade e a segurança da boa assistência à população brasileira, e novamente o fará caso essas propostas equivocadas sejam aprovadas, desvirtuando e contaminando o Programa Médicos pelo Brasil.

 

 

 

Brasília, 17 de setembro de 2019.

 

CONSELHO FEDERAL DE MEDICINA

Internacionalização

UEM é selecionada a participar de programa de internacionalização

Tereza Parizotto

 

Foram apenas três universidades brasileiras escolhidas para formação pelo American Council on Education que visa fomentar o desenvolvimento de planos estratégicos de internacionalização

 

A UEM (Universidade Estadual de Maringá) está entre as três instituições brasileiras de ensino superior selecionadas pela Capes (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior) para participar do American Council on Education (ACE), Laboratório de Internacionalização, que será realizado em Washington. As Universidades Federais do Pará e de Goiás completam o trio.

O objetivo do projeto, que abrange um ano e meio de formação e tutoria, é ajudar as instituições participantes a desenvolverem planos abrangentes e estratégicos de internacionalização, definindo áreas prioritárias, objetivos, metas e ações. Além dos encontros em Washington, estão previstas reuniões em Brasília e visitas da comitiva americana à UEM.

A assessora de cooperação internacional, Sandra Schiavi (foto acima), e o diretor de pesquisa da UEM, Luiz Fernando Cótica (foto abaixo), representam a Universidade nesta iniciativa, que teve início no começo deste mês.

Sandra Schiavi comenta que a UEM já tem um processo de internacionalização estruturado e que a busca atual é agregar ações isoladas em um projeto mais abrangente e institucionalizado, capaz de elevar o patamar da Universidade nesta área, possibilitando, inclusive, que ela se torne referência em modelo de internacionalização no Paraná. “Neste sentido o curso a participação no ACE será um importante impulsionador”, opina a assessora.

Para Schiavi é necessário ir além dos acordos de cooperação e programas de mobilidade com instituições estrangeiras. O processo de internalização deve permear, ainda segundo a assessora, o ensino, a pesquisa, a extensão e os currículos de docentes, discentes e agentes universitários, a comunicação e tantas outras áreas.  São qualificações que precisam ser feitas até como contrapartida na participação no programa americano.

A seleção da UEM ao American Council on Education tem uma relação direta com o resultado alcançado no último edital do Programa Institucional de Internacionalização (PrInt). É o que pensa Sandra Schiavi.

Criado pela Capes, o PrInt visa a fomentar o desenvolvimento de planos estratégicos de internacionalização como meio de melhorar a qualidade dos cursos de pós-graduação nacionais e de conferir maior visibilidade internacional à pesquisa científica realizada no Brasil. A assessora de cooperação internacional lembra que apesar de não ter seu projeto contemplado no programa, a UEM chegou “quase lá” o que contribuiu para carimbar seu passaporte rumo a formação oferecida pelo ACE

Instituições participantes

Além das três universidades brasileiras também participam do programa as seguintes instituições: Bethany College (WV), California State University, San Bernardino, Loyola Marymount University (CA), Mercer University (GA), Purdue University Northwest, Rhodes College (TN), Sinclair College (OH), Southern Illinois University, SUNY - The College of Brockport, University of California San Diego, University of Delaware, University of Missouri, Kansas City, University of Nebraska-Lincoln, University of North Georgia e York College of Pennsylvania.

Gamification

Startup “gamifica” o aprendizado de alunos de medicina

O biólogo Vinicius Gusmão e o engenheiro de automação Sandro Nhaia decidiram, em 2016, que era o momento de unir suas áreas de competência em um empreendimento: a MedRoom. A startup surgiu com o objetivo de utilizar a modelagem 3D para auxiliar professores de medicina a ensinarem por meio da realidade virtual (RV). Com a premissa de potencializar o aprendizado dos alunos, desenvolvendo um ambiente imersivo dentro dos óculos de RV, a startup dialoga com as duas pontas do setor da saúde para fazer o seu negócio crescer: as universidades, onde apresenta sua solução para o corpo docente e procura gerar novas funcionalidades para sua tecnologia; e os hospitais, com o objetivo de validar cientificamente cada aspecto médico das aulas que cria dentro da sua ferramenta. Para saber mais, não perca o novo episódio do Terra Inovação!