To the Editors: In her MEDICC Review article earlier this year, Ponce-Laguardia emphasized the need for integrating social and psychological support in efforts to improve quality of life (QoL) for older Cuban adults.[1] With global life expectancy on the rise, health professions education should emphasize the importance of active aging and stress appropriate preparation of […]

Meningitis, neuropathy, HIV, dengue—since the 1960s, Cuba has faced its share of epidemics. More recently, Cuban health professionals tackled domestic outbreaks of H1N1 (2009) and Zika (2016), and worked alongside colleagues from around the world to stem Ebola in West Africa; all three were categorized by WHO as public health emergencies of international concern. In […]

Joan O’Connell MHSc PhD, Ana María Gálvez-González PhD, Jean Scandlyn PhD, María Rosa Sala-Adam MS DDS, Xiomara Martín-Linares MS

In 2011, the US Department of the Treasury changed its regulations to allow US students to participate in short-term education programs in Cuba. Beginning in 2012, and each year thereafter, Cuba’s National School of Public Health and the Colorado School of Public Health have jointly taught a class on the Cuban public health system. The program goals are to provide US students with an opportunity to learn about the Cuban national health system’s focus on 1) prevention and primary health care services; 2) financial and geographic access to services and health equity; 3) continuum of care across the home, family doctor-and-nurse offices, polyclinics and hospitals; 4) data collection at all levels to understand health risks, including outbreaks, and to guide resource allocation; 5) assessing patients’ health and risks using a comprehensive definition of health; 6) multisectoral collaborations between the Ministry of Public Health and other Cuban agencies and organizations to address population health risks; 7) disaster preparedness, response and recovery; and 8) provision of international health assistance. The class incorporates information about health systems in Latin American and other Caribbean countries to provide context for understanding the Cuban health system.

The course includes: 1) seminars, online readings and discussions before travel to Cuba; 2) seminars at Cuba’s National School of Public Health, visits to Cuban national health institutions at all levels, from community-based family doctor-and-nurse offices and multispecialty clinics (polyclinics) to internationally recognized national health institutions, and guided visits and activities about Cuban culture and history during their 12 days in Cuba; and 3) followup course work upon return to the USA in which students integrate what they learned into their final class reports and presentations. During time spent planning, implementing and revising the program, both institutions have learned from each other about global health teaching methodologies and have laid a foundation for future teaching and research collaborations. To date, 49 individuals have participated in the program.

KEYWORDS Medical education, public health system, collaboration, Cuba, USA

On the 40th anniversary of the Alma Ata Declaration that affirmed health for all a right and primary health care the route to guarantee that right, WHO and PAHO have issued a call to action to convert universal health into reality for the nearly four billion people worldwide lacking full coverage of essential health services. There is some urgency to this movement: WHO estimates the health workforce shortage of nearly 8 million could reach almost 13 million by 2035. And the USA is not exempt: medical associations and special commissions set up to investigate the shortage of primary care physicians, especially “under-represented minority” doctors, have issued report after report on this growing health care emergency. The biggest question looming is: where will the health care providers come from, especially well-trained primary care doctors who want to work for those who need them most?

Part of the answer may be found in Cuba and its Latin American School of Medicine (ELAM), which has graduated some 28,500 MDs from 103 countries since its first class of 2005­­—including nearly 200 from the USA. Graduates, most from low-income families, are not only admitted for their intellect and academic records, but also for their social commitment.

MEDICC Review looked to a group of these US graduates to better understand their decision to study medicine in Cuba and how they faced the resulting challenges, as well as the relevance of their Cuban education to their current practice.

Leadership is the perception or acceptance by members of a group of their superior’s ability to inspire, influence and motivate them to meet their goals and contribute to the achievement of shared objectives.

This article analyzes the characteristics of bioethics and the profile of the bioethicist in relation to the comprehensive development required of health leaders. We address this relationship in the areas of research and clinical practice; intersectoral activity; health sciences education; bioethicist’s profile; and influence on organizational structures, functioning and decisionmaking, with particular reference to development and current situation of these aspects in Cuba.

KEYWORDS Bioethics, leadership, medical education, health professional education, health, values, workplace stress, Cuba

In the 20th century, the basic biomedical sciences (particularly anatomy, histology, embryology, physiology and biochemistry) were taught predominantly in the first semesters of Cuban medical education, with differing curricular connections between these and the clinical sciences. Establishment of the University Polyclinic Program in 2004 laid the foundation for integration of basic biomedical sciences into a transdisciplinary unit designated morphophysiology.

This paper argues for improvements in this curricular unit and in its coordination with family medicine in the first semesters of medical training, complemented by integration of basic biomedical sciences into family medicine clinical courses throughout the remainder of the six-year curriculum.

KEYWORDS Medical laboratory science, medical clinical science, medical education, curriculum, biological science disciplines, interdisciplinary communication, transfer of learning, Cuba

INTRODUCTION One reason given by the South African government for establishing a physician training agreement with Cuba is that the ethical, humanistic and solidarity principles promoted in Cuban medical education are difficult to acquire in other settings. However, Cuba’s general medical training program does not provide all skills needed by a general practitioner in South Africa: other competencies are required, such as management of general and gynecological or obstetrical surgical emergencies, administration of anesthesia and nursing procedures. As long as the desired humanistic values were assured, South African authorities have preferred to complement these competencies. Thus, since 2003, the Medical University of Villa Clara has applied a curricular strategy of 12 complementary courses to develop the requested additional skills, but results have not met expectations.

OBJECTIVE Determine why the complementary curricular strategy has not been entirely successful and identify possible courses of action for improvement.

METHODS A document review was conducted of the curricular strategy applied and of minutes of meetings between Cuban and South African counterparts to identify correspondence between requested professional skills and actions to develop them. In addition, South African students were surveyed and Cuban professors were interviewed in depth. Senior university administrators and key informants were also interviewed. Variables assessed were course quality and satisfaction of students and professors.

RESULTS Some actions originally included in the curricular strategy were not implemented and there were structural weaknesses in complementary courses, primarily in objectives, teaching strategy and evaluation. Students reported insufficient practical activities and lack of relationship between content and the health situation in South Africa. Professors were dissatisfied with student levels of motivation and ability to manage their own learning. Other influencing factors were insufficient academic management and professors’ lack of knowledge about the context where these future professionals would eventually practice.

CONCLUSIONS Curricular strategy deficiencies detected are primarily in academic management; overcoming them could facilitate action in specific directions identified to improve the requested skill levels.

KEYWORDS Evaluation, qualitative evaluation, curriculum, competency-based education, professional competence, medical education, clinical skills, international educational exchange, Cuba, South Africa

The shortage of health professionals in developing countries and especially in their poorest regions imperils the vision of health for all. New training policies and strategies are needed urgently to address these shortages. The Gambia’s new Community-Based Medical Programme is one such strategy.

KEYWORDS Medical education, access to health care, healthcare disparities, health manpower, rural health, developing countries, The Gambia

Introduction Through the 1990s, wide disparities in health status were recorded in Venezuela, a mirror of poor social conditions, decreasing investment in the public health sector and a health workforce distribution unable to meet population health needs or to staff effective, accessible public health services. Venezuelans’ health status deteriorated as a result. In 2003-2004, the Venezuelan government launched Barrio Adentro, a new national public health model aimed at assuring primary health care coverage for the entire population of an estimated 26 million. Cuban physicians staff Barrio Adentro clinics, mainly in poor neighborhoods, until enough Venezuelan physicians can be trained to fill the posts.

Intervention Cuban experience with community-oriented medical education and global health cooperation was drawn upon to develop curriculum and provide faculty for the new National Training Program for Comprehensive Community Physicians, begun in 2005 in cooperation with six Venezuelan universities. The program differs from previous Venezuelan medical education models by adopting a stated goal of training physicians for public service, recruiting students who had no previous opportunity for university-level education, and concentrating the weight of their training on a service- and community-based model of education, relying on practicing physician-tutors.

Results Over 20,000 students have been enrolled in three years. The six-year program has been extended to all 24 Venezuelan states, relying mainly on Cuban faculty who are practicing Barrio Adentro doctors and who receive postgraduate training in medical education. This “university without walls” has accredited 5,131 Barrio Adentro clinics as teaching institutions; its infrastructure includes other health care delivery facilities plus 855 multipurpose classrooms throughout the country. For the 2006-2007 academic year, the pass rate was 82% for first-year students and 94% for second-year students. Some difficulties persist in student selection, pre-medical preparation, and achieving optimum use of existing resources. Academic, institutional, and external evaluations are ongoing.

Conclusion This is the most ambitious example of scaling up of physician training in a single country. The program has been made possible by considerable political will from the Venezuelan and Cuban governments; by the experience acquired through development of the Cuban health system and medical education programs; by the individual commitment of Cuban curriculum developers and physician-tutors; and by ever-more-organized Venezuelan communities. The size of the undertaking, coupled with significant innovations in curriculum, present challenges. The Venezuelan experience — emphasis on training physicians for a revitalized public health sector, accompanied by a paradigm shift in primary care — warrants attention from the international community in the context of the global shortage of health workers and efforts to achieve a more equitable distribution of health services worldwide.

Keywords medical education, human resources for health, community-based medical education, primary care, health equity, Venezuela

This paper describes Cuba’s experience with the Virtual Health University (VHU) as a strategic project of INFOMED, promoting creation of an open teaching-learning environment for health sciences education, through intensive and creative use of Information and Communication Technologies (ICTs) and a network approach to learning.

An analysis of the VHU’s main antecedents in its different stages of development provides insight into the strategic reasons that led to the establishment of a virtual university in the national health system during Cuba’s so-called Special Period of economic crisis.

Using the general objectives of creating, sharing, and collaborating which define the VHU’s conceptual-operative framework, the three essential components (subsystems) are described: pedagogical, technological, and managerial, as well as the operative stages of educational design, technological implementation, and teaching-administrative management system.

Each component of the model is analyzed in the context of global, modern university trends, towards integration of the face-to-face and distance education approaches and the creation of virtual institutions that assume the technological and pedagogical changes demanded by eLearning.

Keywords TIC; eLearning; telehealth; medical education; INFOMED