Eduardo Rosselot J

Reivindicando la medicina como profesión científico-humanista

There is an urgent need, in our society, to recover the real meaning of medicine as a complex of science and humanistic values committed to persons health care. Following the initiative of the American Board of Internal Medicine, the American College of Physicians and the American Society of Internal Medicine (ACP-ASIM) and the European Federation of Internal Medicine, the Medical Professionalism Project has launched a comprehensive declaration to rephrase the social contract between medicine and the society, emphasising the principles and responsibilities that must orient the thoughts and actions of the good physician. The importance, soundness and opportunity of this chart, stimulates an ample dissemination of these concepts and to incorporate them as moral assets, integrating the quality, as experts on a scientific discipline, with the humanistic values provided in these era of increasing bioethical demands (Rev Med Chile 2003; 131: 454-5).

Dimensiones del profesionalismo médico: Proyecciones para el siglo XXI

Medicine is progressively loosing its prestige and efficacy andneeds to rebuild the moral values that maintain the tacit social contract subscribed betweendoctors and patients. This altruistic commitment to serve people has been devaluated by changesin health systems, by advances in knowledge and by social and economical changes. Theperspective with which humanity faces its future, harmed by radical environmentaltransformations also has contributed to this devaluation. Notwithstanding, requirements toprovide high quality health care and demands to reinstall those fundamental attributes ofprofessional work, commit us to introduce or increase the selective learning of thosecompetences to health professionals. This new, or renewed form of improving the teaching ofhealth sciences, seems to be the unique way to stop the reduction on health care professionaleffectiveness, to maintain quality of care and to accomplish the goal of medical profession toserve and take care of humankind health (Rev Med Chile 2006; 134: 657-664).(Medicine is progressively loosing its prestige and efficacy and needs to rebuild the moral values that maintain the tacit social contract subscribed between doctors and patients. This altruistic commitment to serve people has been devaluated by changes in health systems, by advances in knowledge and by social and economical changes. The perspective with which humanity faces its future, harmed by radical environmental transformations also has contributed to this devaluation. Notwithstanding, requirements to provide high quality health care and demands to reinstall those fundamental attributes of professional work, commit us to introduce or increase the selective learning of those competences to health professionals. This new, or renewed form of improving the teaching of health sciences, seems to be the unique way to stop the reduction on health care professional effectiveness, to maintain quality of care and to accomplish the goal of medical profession to serve and take care of humankind health.

Aspectos bioéticos en la Reforma de la Atención de Salud en Chile: II. Discriminación, libre elección y consentimiento informado

Bioethical issues emerge each time health care reform projects are discussed. These affect diverse moral values and principles and have an impact on cultural, social and political areas. Thus, they demand more than just organizational, financial or administrative solutions. This review analyses discrimination, free election of professionals and informed consent. All three concepts are alluded in the legislative debate raised upon the actual process for health reform. Having clear ideas about these subjects is crucial to foresee the reactions expected to arise among physicians and the general public, when confronting the proposed changes (Rev Med Chile 2003; 131: 1329-36). (Key Words: Ethics, medical; Health care economics and administration; Health care reform)

Acreditación de Escuelas de Medicina.: Trabajando para la calidad y la confiabilidad pública

Important advances in the accreditation of higher education institutions and programs have occurred in Chile. A definite step forward had been the accreditation of three of the six Medical Schools, considered in the agreement subscribed between the Chilean Medical Faculties Association and the National Committee for Undergraduate Program Accreditation (CNAP). According to this understanding, educational quality was evaluated using international standards and its improvement was encouraged. The accreditation procedure carried out at the University of Chile Medical School is described. Its observation has revealed the difficulties of accreditation procedures and the early benefits obtained after they have been completed. The careful observation of the evaluation procedure will help to improve the used model and to design an effective accreditation instrument that will ultimately improve undergraduate teaching programs.

Planificando la educación médica para las próximas décadas

Accelerated changes in source and contents of knowledge, methodologies and scenarios used in learning, and in the meaning and goals of the educational process, are typical of these times. To characterize future needs, roles and expectations of the various actors involved, is also very unreliable and unpredictable. Performing reiterative strategic analysis, monitoring procedures, doing continuous assessment of results and making permanent adaptations in the educational process to the environmental conditions, are unavoidable means to get secure and pertinent effects from the implemented actions. From this perspective, the University of Chile Faculty of Medicine is formulating its proposals to innovate in curriculum, and strengthen its academic resources and students development (Rev Med Chile 2001; 129: 1473-8)

Hacia el médico que nuestros países necesitan: Emphasis on communications and training of academics

Changes in physicians education and practice induce, nowadays persistent modifications in programs curricula and contents and in learning methodologies, in almost all medical schools and countries. In many of these, and in Chile, this process shows some peculiarities due to the unusual proliferation of medical schools and their differing proposals about the profile of the professional training based on epidemiological considerations and teaching resources. The institutional initiatives leading to reforms, have defined quality and pertinence of these programs and profiles, as it has been the case of the curricular renewal in the University of Chile School of Medicine. Relevant to this reform have been: 1) the introduction of communication skills, pursuing to increase humanistic contents, to improve patient doctor relationship and to accomplish the actual goals of medicine, and 2) capacitating the faculty in the proper disciplines and competencies, for better application of new knowledge and teaching tools to improve learning of the health professionals. Prospective evaluation of these changes will allow us to assess, with best evidence, its definitive role, that is momentarily availed by students satisfaction.

El derecho a una atenccición médica de buena calidad

Quality has a central role in medical care. The satisfaction of the rights of people to medical care, presupposes good quality medical acts. The meaning of quality goes further than a good attention based on scientific evidence and with competent skills. It comprises patient-physician relationship where professional behavior is evaluated, based on the fundamental principles of bioethics. These principles sustain the measures to control quality of medical actions, to comply with the rights of patients to have access to a good professional care (Rev Med Chile 2000; 128: 1385-88).

Errores en Medicina

Untoward effects can result from the various procedures involved in patients care. Because of its risks and consequences it is very important to determine the causal factors of these events to improve the procedures at stake and be sure to obtain from them the results to be expected. Several recent and somehow disturbing reports about the magnitude and type of these said medical errors, have raised interest to review the subject and phase this problem under the scope of a quality control system, as to prevent its occurrence or mitigate its effects when there is no chance to avoid them properly (Rev Med Chile 2001; 129: 1455-8)

Aspectos bioéticos comprendidos en la Reforma de la Atención de Salud en Chile: Los problemas del acceso y el costo de los recursos

During the process of health reforms there is always the concernthat patients rights might be harmed. The bill that is being discussed in the Chilean Parliamentcontains an special issue dedicated to patient’s obligations and rights. However, on the author’sopinion, the best protection for patient rights rests on adequate financing and access to areasonably, good and qualified health care. A thorough revision of the proposals contained inthe reform will allow an objective assessment of the eventual ethical problems that it mightimply (Rev Med Chile 2003; 131: 1079-86).(

Formación profesional y su acreditación en medicina, un paradigma en garantía de la fe pública

Sustaining quality control of learning programs for health professions has become a central issue in university systems, under the pressure of an unexpected merging of new medical schools in Chile, during the last decade, and the massive arrival of other Latin American physicians. Accreditation of institutions and programs represents valid safeguards used in most countries where professional training processes take place. Due guarantee of its quality is required to assure proper health care to people. The authors provide specific arguments to support systematic evaluation and accreditation processes, as those introduced in our country to fulfill the requirements of a high level medical practice (Rev Med Chile 2002; 130: 585-89)