The course of specialization in public health in Rio de Janeiro, Brazil, from 1926 to 2006: lessons and challenges

<p>Abstract</p> <p>Background</p> <p>Public health, as a field of knowledge, depends on its professionals. Their education and training, therefore, is considered to be an important factor for the quality of health services. In Brazil, the Course of Specialization in Public Health of the National School of Public Health is one of the oldest in the country. The course has existed for over 80 years, during which it has had an eventful history, with modifications in its organization, interruptions in its delivery, threats to its survival and changes in the institutions hosting it, reflecting the wider transformation in Brazilian society and public life over that period.</p> <p>Methods</p> <p>In this article we analyse this course via its history, disciplines, organization and characteristics of the student body.</p> <p>Results</p> <p>Insights were gained into the advancement of public health in Brazil and the progress of education for professionals in this field was highlighted. The course has formed nearly 2000 specialists in public health.</p> <p>Conclusions</p> <p>An analysis of the course's history provides valuable lessons for other schools of public health trying to train professionals in developing countries.</p

Professionalism and Evolving Concepts of Quality

For much of the twentieth century, quality of care was defined specifically in terms of physician characteristics and behaviors. High-quality physicians were well trained, knowledgeable, skillful, and compassionate. More recently, quality of care has been defined in terms of systems of care. High-quality organizations develop and adopt practices to reduce adverse events and optimize outcomes. This essay discusses this transformation from physician-based to organization-based concepts of quality and the consequences for patient care and medical professionalism

Medical students' learning of the consultation and the patient-doctor relationship

Background: In medical education, learning about the consultation and the patient-doctor relationship is nowadays highly recommended. However, research from educational practice from students’ perspective is needed to facilitate a better understanding of students’ learning. The thesis is based on four studies. Aims: The overall aims were to study and analyse medical students’ learning of the consultation and patient-doctor relationship. Specific aims were to analyse students’ descriptive evaluations of a Consultation skills course and course development over five years (I), to explore final-year students’ abilities to communicate with patients (II), to analyse final-year students’ written reflective accounts of a memorable consultation (III), to assess students’ patient-centred attitudes at various stages of undergraduate medical education and to explore the association between patient-centred attitudes and gender, age and work experience in health care (IV). Method: A qualitative content analysis method was used in studies I-III, covering term 5 and term 10 (T5, T10). T5 students’ descriptive evaluations and teachers’ documentation were analysed 1995-1999. Experienced supervisors assessed T10 students’ communication abilities in video consultations with patients and supervisors’ focus group meetings were analysed. T10 students’ written reflective accounts of a memorable consultation were analysed. A cross-sectional study of students’ patient-centred attitudes was performed across the curriculum by an internationally validated instrument (Patient-Practitioner Orientation Scale, PPOS). Students’ gender, age and earlier work experience in health care were also collected and analysed statistically. Results: Learning of the consultation was facilitated when the T5 student was active in practice and could have a choice, by a link between explicit learning goals, learning activities and an examination in practice including feedback. Students’ descriptions of awareness and confidence corresponded to a strengthened relation with the facilitator and reflection. In exploring T10 students’ video consultations, an instrumental strategy was suggested as a stage in students’ consultation training. However, analysis of T10 students’ written reflective accounts of a memorable consultation displayed a view of the patient as a person beyond symptoms, an insight into the complexity of medical work and students’ search for a professional role. In contrast to previous reports, no decline of students’ patient-centred attitudes at the end of education was found. Independent of age or work experience in health care, female students had higher PPOS scores compared to men. Female students also had significantly more work experience in health care. Conclusions: Students’ learning of the skills and attitudes needed for the consultation and the patient-doctor relationship is complex. Senior students display patient-centeredness in writing but might have difficulties in integrating their know-how with the performance of physician’s clinical tasks. Learning the consultation and the patient –doctor relationship is suggested to benefit from integrating a patient-centred perspective in a student-centred learning relationship through clinical education; and by adopting a process-oriented and experience-based model including feedback and reflection