Why does the undergraduate education in Ecuador fall short to train skills for rural health? A qualitative study

Galo Sánchez del Hierro, Roy Remmen, Susana Alvear Durán, Paul Van Royen, Kristin Hendrickx

Resumen


Background and Objectives

Since 1970, Ecuador establishes mandatory rural health service as a requirement for licensing work. Medical education is based in the hospital with little contact with rural areas. There is little information on the training and skills needs of recent graduated doctors. The research focuses on the perceptions of rural doctors on obstetric skills needed in rural areas. The aim of our study was to describe how the basic doctor in rural areas addresses training and teaching in obstetric skills needed in rural areas during undergraduate medical education.

Methods

A qualitative research project was performed using focus group discussions involving 23 rural doctors who work in rural and marginal urban areas in Southern Ecuador.  We identified themes that came from the data collected in the focus group and we selected those which are of interest for the readers in a detailed analysis. Rural doctors responded the following question: How do you feel with obstetric skills training at the University where you studied? 

Results

The majority of participants describe two predominant themes: the undergraduate theoretical teaching process of obstetrical skills and the practice experiences during the clinical attachment. Not all required skills are taught and internalize during undergraduate rotations including internship.

Discussion

There is no definition of the recent graduate profile that determines a standard for medical education. Rural doctors expressed lack of knowledge and practice for the obstetrical skills that they were required to perform. There is an urgent need to identify a baseline undergraduate curriculum that meets the country needs.


Palabras clave


Clinical Competence; Medical Education; Obstetrics; Rural Health Services; Undergraduate

Texto completo:

VER EN LINEA

Referencias


Decreto Supremo No 44. Registro Oficial Nro 13 Ecuador; 1970.

Cavender A, Albán M. Compulsory medical service in Ecuador: the physician’s perspective. Social Science & Medicine [Internet]. 1998 Dec;47(12):1937–46. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0277953698003359

Hunsaker M, Glasser M, Neilsen K, Lipsky M. Medical students’assessments of skill development in rural primary care clinics. Rural and Remote Health [Internet]. 2006;6(616). Available from: http://www.rrh.org.au/publishedarticles/article_print_616.pdf

College of Family Physicians of Canada, Society of Rural Physicians of Canada, Society of Obstetricians and Gynaecologists of Canada. Joint position paper on training for rural family practitioners in advanced maternity skills and cesarean section. Canadian family physician Médecin de famille canadien [Internet]. 1999;45:2416–22, 2426–32. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2328629&tool=pmcentrez&rendertype=abstract

Strasser R, Neusy A-J. Context counts: training health workers in and for rural and remote areas. Bulletin of the World Health Organization [Internet]. 2010 Oct 1;88(10):777–82. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2947041&tool=pmcentrez&rendertype=abstract

Gaus D, Herrera D, Heisler M, Cline BL, Richmond J. Making secondary care a primary concern: the rural hospital in Ecuador. Revista Panamericana de Salud Pública [Internet]. 2008 Mar;23(3):212–7. Available from: http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008000300013

Reglamento de profesionales en el año de servicios de medicina rural. Registro Oficial Ecuador; 2001.

Ley Orgánica de Salud. Registro Oficial. 2006;Nro 423.

Frehywot S, Mullan F, Payne PW, Ross H. Compulsory service programmes for recruiting health workers in remote and rural areas: do they work? Bulletin of the World Health Organization [Internet]. 2010;88(5):364–70. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2865657&tool=pmcentrez&rendertype=abstract

Borrell RM. La educación médica en América Latina: debates centrales sobre los paradigmas científicos y epistemológicos. In: UNR Editora, editor. Proceso de transformación Curricular: otro paradigma es posible. Rosario, Argentina: Universidad Nacional de Rosario; 2005. p. 1–32.

Villanueva RMT, Tapia RMN, Syr R, Perea S. El internado médico de pregrado y las competencias clínicas . México en el contexto latinoamericano. Educación Médica Superior [Internet]. 2007;21(4):1–10. Available from: http://scielo.sld.cu/pdf/ems/v21n4/ems05407.pdf

Carrillo J, Delgado B, Kosik RO, Huang L, Zhao X, Su T-P, et al. Medical education in Ecuador. Medical Teacher [Internet]. 2013;35(12):979–84. Available from: http://www.tandfonline.com/doi/full/10.3109/0142159X.2013.826789

Sánchez del Hierro G, Remmen R, Verhoeven V, Van Royen P, Hendrickx K. Are recent graduates enough prepared to perform obstetric skills in their rural and compulsory year? A study from Ecuador. BMJ Open [Internet]. 2014 Jul;4(7):e005759. Available from: http://bmjopen.bmj.com/cgi/content/long/4/7/e005759

Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology [Internet]. 2006 Jan;3(2):77–101. Available from: http://www.tandfonline.com/doi/abs/10.1191/1478088706qp063oa

Sandelowski M. Whatever happened to qualitative description? Research in Nursing & Health [Internet]. 2000 Aug;23(4):334–40. Available from: http://doi.wiley.com/10.1002/1098-240X(200008)23:4%3C334::AID-NUR9%3E3.0.CO;2-G

Remmen R, Derese A, Scherpbier A, Denekens J, Hermann I, Van der Vleuten C, et al. Can medical schools rely on clerkships to train students in basic clinical skills? Medical Education [Internet]. 1999;33(8):600–5. Available from: http://doi.wiley.com/10.1046/j.1365-2923.1999.00467.x

Hannon FB. A national medical education needs’ assessment of interns and the development of an intern education and training programme. Medical education. 2000 Apr;34(4):275–84.

Instituto Nacional de Estadísticas y Censos. Ecuador en Cifras [Internet]. 2015. Available from: http://www.ecuadorencifras.gob.ec/

Frank JR, Snell LS, Cate O Ten, Holmboe ES, Carraccio C, Swing SR, et al. Competency-based medical education: theory to practice. Medical teacher [Internet]. 2010 Jan;32(8):638–45. Available from: http://www.tandfonline.com/doi/full/10.3109/0142159X.2010.501190

Frank J (Ed). The CanMEDS 2005 physician competency framework. Better standards. Better physicians. Better care. [Internet]. Ottawa: The Royal College of Physicians and Surgeons of Canada; 2005. Available from: http://meds.queensu.ca/medicine/obgyn/pdf/CanMEDS2005.booklet.pdf

Rourke J, Frank JR. Implementing the CanMEDS physician roles in rural specialist education: the multi-specialty community training network. Education for health (Abingdon, England) [Internet]. 2005 Nov;18(3):368–78. Available from: http://old.educationforhealth.net/EfHArticleArchive/1357-6283_v18n3s6_727315619.pdf

Bell E, Walker J, Allen R, MacCarrick G, Albert E. Non clinical rural and remote competencies : can they be defined ? Focus on Health Professional Education: A Multi-Disciplinary Journal [Internet]. 2010;11(2):28–41. Available from: http://epubs.rcsi.ie/cgi/viewcontent.cgi?article=1004&context=mededart

Lyss-Lerman P, Teherani A, Aagaard E, Loeser H, Cooke M, Harper GM. What training is needed in the fourth year of medical school? Views of residency program directors. Academic medicine : journal of the Association of American Medical Colleges. 2009 Jul;84(7):823–9.

Eyal L, Cohen R. Preparation for clinical practice: a survey of medical students’ and graduates’ perceptions of the effectiveness of their medical school curriculum. Medical teacher [Internet]. 2006 Sep;28(6):e162-70. Available from: http://informahealthcare.com/doi/abs/10.1080/01421590600776578

Russell G, Ng A. Taking time to watch: observation and learning in family practice. Canadian family physician Médecin de famille canadien [Internet]. 2009 Sep;55(9):948–50. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2743595/pdf/0550948.pdf

Ríos V, Gasca A, Urbina R, Flores R, Lloret A. Nuevos modelos educativos en el internado médico de pregrado. La participación de la Universidad. Reencuentro [Internet]. 2005;42:0. Available from: http://www.redalyc.org/articulo.oa?id=34004217

Sánchez A, Flores R, Urbina R, Lara N. Expectativas y realidades del internado médico de pregrado . Un estudio cualitativo. Investigación en Salud [Internet]. 2008;X(3):14–21. Available from: http://www.redalyc.org/articulo.oa?id=14219995004

Universidad Técnica Particular de Loja. Malla titulación de la carrera de medicina [Internet]. Loja, Ecuador; 2013. Available from: http://www.utpl.edu.ec/medicina/files/malla-titulacion-medicina.pdf




DOI: http://dx.doi.org/10.23936/pfr.v0i5.175

DOI (VER EN LINEA): http://dx.doi.org/10.23936/pfr.v0i5.175.g233

Enlaces refback

  • No hay ningún enlace refback.


Licencia de Creative Commons
Este obra está bajo una licencia de Creative Commons Reconocimiento-CompartirIgual 4.0 Internacional.