Community Medicine Training Research Articles

Family and Community Medicine Training: Challenges and Innovation in the Wake of COVID-19

Family and Community Medicine Training: Challenges and Innovation in the Wake of COVID-19

The Effect of the COVID-19 Pandemic on the Family and Community Medicine Residency Training Program: The Philippine Experience.

The COVID-19 pandemic had a profound impact on medical education, particularly in Family and Community Medicine training programs. This study aimed to assess the impact in the Philippines by comparing the number of cases and procedures before and during the pandemic, as well as the adaptations made by these programs. The objective of this study was to determine the effect of the COVID-19 pandemic on Family and Community Medicine training in the Philippines by comparing the average number of cases and procedures done before and during the pandemic and the changes implemented by the different accredited training programs. A cross-sectional study utilizing an explanatory sequential mixed methods approach was undertaken. The quantitative portion collected data on cases and procedures from the participating institutions' residents using the standardized checklist of the Philippine Academy of Family Physicians. The qualitative portion was done through a focused group discussion (FGD) following a prepared set of FGD questions. Analysis of variation (ANOVA) was used to compare the average cases seen and procedures across the four years and content analysis for the qualitative data. There was a significant decrease in the average number of adult and pediatric cases during the pandemic years (2020-2021) compared to before (2018-2019). Various organ systems cases such as neurology, ophthalmology, dermatology, and gastrointestinal, showed significant differences (p-value <0.05) in the average number of pediatric cases. For adult cases, significant differences (p-value <0.05) were found for several organ system cases when comparing the years before (2018-2019) and during the pandemic (2020-2021), including neurology, ophthalmology, ENT, dermatology, cardiology, gastrointestinal, genitourinary, reproductive health, musculoskeletal, and endocrinology cases. The trainers adjusted training activities to support the hospital's COVID-19 response and that prompted an abrupt shift to online strategies for patient consultations, teaching sessions, and examinations. The COVID-19 pandemic led to a reduction in the variety of cases and procedures in Family and Community Medicine training, impacting the fulfillment of specialty training requirements. However, it also drove innovation through the integration of technology, including online teaching methods. These experiences underscore the importance of resilience and adaptability in medical education and offer valuable lessons for future training programs, potentially leading to improvements in training and patient care through innovative methodologies.

FOFA da residência em medicina de família e comunidade no estado de São Paulo

Abstract Introduction: Medical residency is the gold standard for training in Family and Community Medicine. In the last decade there has been a significant increase in vacancies without evaluating quality of the programs. Objective: To observe and qualify the perception of the residency preceptors in this area. Methodology: Application of a quali-quantitative questionnaire in the state of São Paulo, with descriptive statistical analysis and use of the SWOT matrix associated with the Donabedian Triad based on Content Analysis of the interviewees. Results: The sample consisted of 64 preceptors in 27 programs, with a median age of 37 years, consisting of 52% women. The most prevalent distribution is 2 residents per preceptor and 67% also work with undergraduate students. Of the sample, 56.7% have medical residency and 13.4% have degrees, in addition to 82% courses in preceptorship. The qualitative analysis indicates training in preceptorship and the increase in specialists as relevant points, but there is still difficulty with the organization of services and low support from municipal management. Conclusion: Although there are preceptors with adequate training, it is still necessary to increase their number considering the disproportionate increase in the number of vacancies to the installed capacity. Improvement of structural conditions and greater support from municipalities will be necessary, according to the perception of preceptors in family and community medicine.

Programa Médicos pelo Brasil: primeiros resultados

Abstract Access to medical care is essential to achieve quality primary health care (PHC). In Brazil, access difficulties still persist. The Doctors for Brazil Program (PMpB in Portuguese) aims to expand the offer of medical services in places of difficult provision or high vulnerability. It innovates insofar as it prioritizes smaller and rather isolated cities, by selecting professionals through an isonomic process, offering them training in Family and Community Medicine and a chance to build their first federal medical career in PHC. The program offers competitive salaries, progression and financial incentives that value long-term commitment and performance. The PMpB is rolled out by the Agency for the Development of Primary Health Care (Adaps), which allows better management of public policies. The first nine months of the program showed promising results, as approximately 23,000 candidates seeking to join the program through its selection process, i.e., 97.1% vacancies were filled and retention rate after admittance was 95.4%. These results show to what extent PMpB has improved in quality compared to previous policies, as well as how essential it is to keep implementing the program so that it may reach its full PHC coverage potential within the Brazilian public health system.

Doctors for Brazil Program: first results.

Access to medical care is essential to achieve quality primary health care (PHC). In Brazil, access difficulties still persist. The Doctors for Brazil Program (PMpB in Portuguese) aims to expand the offer of medical services in places of difficult provision or high vulnerability. It innovates insofar as it prioritizes smaller and rather isolated cities, by selecting professionals through an isonomic process, offering them training in Family and Community Medicine and a chance to build their first federal medical career in PHC. The program offers competitive salaries, progression and financial incentives that value long-term commitment and performance. The PMpB is rolled out by the Agency for the Development of Primary Health Care (Adaps), which allows better management of public policies. The first nine months of the program showed promising results, as approximately 23,000 candidates seeking to join the program through its selection process, i.e., 97.1% vacancies were filled and retention rate after admittance was 95.4%. These results show to what extent PMpB has improved in quality compared to previous policies, as well as how essential it is to keep implementing the program so that it may reach its full PHC coverage potential within the Brazilian public health system.

Training items for trainee residents in community medicine in rural areas

ObjectiveTo examine the significant events experienced by initial trainees during community medicine training, evaluate their impact on community medicine practice, and support improvements in rural community medicine training.ResultsThree faculty teachers independently evaluated the reports of 25 residents who had completed a four-week community medicine training in a rural area to analyze major events. The reports were analyzed using topics from the Model Core Curriculum for Medical Education that relate to rural medicine. The most frequently reported items were identified as follows: Primary care: 9 (36.0%); integrated community care systems: 8 (32.0%); medical care in the local community: 7 (28.0%); home health care and systems, patient-physician relationship, and end-of-life medical treatment and care: 6 each (24.0%). Reports from residents describing events related to home health care and systems and end-of-life medical treatment and care were related to more than one item.

Key factors influencing public health students and curricula in India: Recommendations from a mixed methods analysis.

Building on a distinguished history of community medicine training, public health programs have been expanding in India in recent years. The COVID-19 pandemic has brought additional attention to the importance of public health programs and the need for a strong workforce. This paper aims to assess the current capacity for public health education and training in India and provide recommendations for improved approaches to meet current and future public health needs. We conducted a desk review of public health training programs via extensive internet searches, literature reviews, and expert faculty consultations. Among those programs, we purposively selected faculty members to participate in in-depth interviews. We developed summary statistics based on the desk review. For qualitative analysis, we utilized a combination of deductive and inductive coding to identify key themes and systematically reviewed the strengths and weaknesses of each theme. The desk review captured 59 institutions offering public health training across India. The majority of training programs were graduate level degrees including Master of Public Health and Master of Science degrees. Key factors impacting these programs included collaborations, mentorship, curriculum standardization, tuition and funding, and student demand for public health education and careers. Collaborations and mentorship were highly valued but varied in quality across institutions. Curricula lacked standardization but also contained substantial flexibility and innovation as a result. Public sector programs were perceived to be affordable though fees and stipends varied across institutions. Further development of career opportunities in public health is needed. Public health education and training in India have a strong foothold. There are numerous opportunities for continued expansion and strengthening of this field, to support a robust multi-disciplinary public health workforce that will contribute towards achieving the sustainable development goals.

Impact of general practice / family medicine training on Japanese junior residents:a descriptive study.

Despite international recognition of the impact of general practice / family medicine training on postgraduate training outcomes, there have been few reports from Japan. Junior residents who participated in community medicine training for one month between 2019 and 2022 were enrolled in the study. The settings were five medical institutions (one hospital and four clinics) that had full-time family doctors. The junior residents were assigned to one of these institutions. The training content mainly consisted of general ambulatory care, home medical care, community-based care, and reflection. The junior residents evaluated themselves at the beginning and end of their training, and the family doctors evaluated the junior residents at the end. The evaluation items were 36 items in 10 areas, based on the objectives outlined in the Guidelines for Residency Training - 2020 Edition, and were rated on a 10-point Likert scale. In the statistical analysis, Wilcoxon signed rank test of two related groups was performed to analyze changes between pre and post self-evaluation, and the effect size r was calculated. Ninety-one junior residents completed the study. Their self-evaluations showed statistically significant increases in all 36 items. The effect size was large in 33 items. The family doctors' evaluation was 8-9 points for all 36 items. General practice / family medicine training may greatly contribute to the acquisition of various required clinical abilities in postgraduate training even in Japan.

Entrustable professional activities for Junior Brazilian Medical Students in community medicine

BackgroundEntrustable professional activities (EPAs) have been defined to promote the workplace participation of undergraduate medical students, generally in the context of high-income countries with a focus on the secondary and tertiary health care sectors. These EPAs have limited applicability to training and health care contexts in low- to middle-income countries that have a focus on primary health care, for instance, the context of community medicine. The purpose of this article is to report the process and results of defining EPAs for undergraduate medical training in a community health care setting.MethodsA modified Delphi study was performed to develop EPAs for the training of medical students in community medicine during their first and second years of education at the Marília Medical School (FAMEMA), Brazil. The supervision level was operationalized in terms of a student’s ability to perform the EPA autonomously in an effective and safe manner with supervision readily available on request. Panellists (9 physicians and 6 nurses) rated the completeness of the proposed list of EPAs and EPA categories on four-point Likert scales. The threshold for consensus among panellists was a mean content validity index of at least 80%.ResultsConsensus was reached after two Delphi rounds, resulting in 11 EPAs for undergraduate medical education and training in community medicine. These EPAs were organized into three overarching EPA domains: integrality of care for individual health needs in all phases of the life cycle (5 EPAs), integrality of care for family health needs (3 EPAs), and integrality of care for community health needs (3 EPAs). For each EPA, descriptions of the following categories were created: title; specifications and limitations; conditions and implications of the entrustment decision; knowledge, skills, and attitudes; links to competencies; and assessment sources.ConclusionThe resulting 11 EPAs for training medical students in community medicine expand the application of the EPA framework to both early undergraduate medical education and the context of primary health care. This report can support and guide other medical schools in their attempts to train students in primary health care contexts and to incorporate EPAs into their curricula.

4. Benefits of Community Medicine Training as an Internal Medicine Residency

4. Benefits of Community Medicine Training as an Internal Medicine Residency

Outpatient regulation in Primary Care in the municipality of Rio de Janeiro, Brazil, based on the local regulatory doctors.

The scope of the article was to characterize the process of regulation of care in Primary Health Care units in the city of Rio de Janeiro, with an emphasis on the outpatient dimension. A cross-sectional study was carried out in 2019, by means of a survey, with the participation of 114 local regulatory physicians. With respect to the profile of local regulators, there is a high percentage with training in Family and Community Medicine and the length of service of these professionals in the units is relatively satisfactory. For 52.6%, the infrastructure for regulation is adequate, but connectivity frequently presents problems. In the regulation system, the mechanisms and schedules for making vacancies available and accessing them elicit competition between the regulators of the units, with work overload and associated access inequities. There was major involvement of local regulators in activities of evaluation and management of waiting times. The majority reported that there was little or no interaction with specialized care. Although the decentralized regulation process still has some shortcomings, the study points to the feasibility and contribution of more intense participation of Primary Care in the regulation of access.

Questionnaire for Community Medicine Training in Family Medicine Training Program and Rural Health Center Training Program

&lt;p&gt;目的：根據衛生福利部調查醫療區域醫師人力密度，部份次醫療區域醫師人力仍低於世界衛生組織所定最低醫療基本需求之每萬人口醫師數10位，因此衛生福利部提出優化偏鄉醫療精進計畫，其中教育方面規範家庭醫學科於專科訓練期間得前往偏遠地區衛生所進行輪訓。為完善規劃偏遠衛生所輪訓試辦之事宜，因此進行本研究。&lt;/p&gt; &lt;p&gt;方法：於2020年6月對全台68所符合家庭醫學科訓練資格醫院之部科主任或家庭醫學專科醫師訓練計畫主持人行問卷調查，後續召集有參加試辦計畫意願之醫療院所進行會談與二次調查。&lt;/p&gt; &lt;p&gt;結果：問卷回收率100%。全台約60.3%之教學訓練醫院有大於一個月以上的衛生所訓練計畫，且大部分的訓練醫院同意衛生所是具備教學功能之院外基層醫療訓練場所。然而安排偏遠地區衛生所訓練的主要障礙是工作分配困難與和不符合醫院組織的方向與需求，此外工作場所安全、學習和工作間的平衡也是一大考量。儘管如此，多數醫院仍認為偏遠地區衛生所之訓練能有助住院醫師的責任感訓練及不同制度下之工作與溝通訓練。&lt;/p&gt; &lt;p&gt;結論：此計畫執行立意良善，然衛福部需考慮增加家庭醫學科總訓練容額、補助交通經費、補助相關保險、偏遠執業風險及教學訓練之平衡。以期於住院醫師訓練、醫療院所家庭醫學科成長及國家偏遠醫療精進之間達成多贏局面。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Purpose: According to a MOHW (the Ministry of Health and Welfare) survey, several sub-regions (mainly rural and remote areas) in Taiwan fail to meet the WHO minimum requirement for health workforce (ten physicians per ten thousands residents). The MOHW had accordingly developed and implemented a program requiring all family medicine doctors-in-training to spend a part of their residency at rural health centers (RHCs). To promote the quality and efficacy of the training program and the safety of the training environment, the following research was conducted.&lt;/p&gt; &lt;p&gt;Methods: A questionnaire was issued in June 2020 to the branch chiefs and training program organizers of the 68 hospitals qualified for family medicine training in Taiwan. A symposium was subsequently held and a survey conducted to learn and analyze the responses of all the participating hospitals and public health centers.&lt;/p&gt; &lt;p&gt;Results: The response rate of the questionnaire was 100%. Around 63% of the responding hospitals had a RHC training program more than one month long, and most of the hospitals found public health center a good training venue. A major difficulty was that sending residents specializing in family medicine to RHCs seldom met the needs and goals of those hospitals. In addition, safety of the working environment and balance between learning and working were identified as issues demanding further consideration. Nevertheless, most participating hospitals believed that training at RHCs did help promote residents&amp;rsquo; sense of responsibility, as well as their ability to work under different systems.&lt;/p&gt; &lt;p&gt;Discussion: The program has great humanitarian potential. However, the MOHW may need to consider increasing the allowed number of trainees in family medicine each year, subsidizing trainee&amp;rsquo;s travel and insurance expenses, and assessing and addressing the risks of practicing in remote and rural areas so both the quality and efficacy of the training program can be improved to create win-win outcomes for all parties involved.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Residência de Medicina de Família e Comunidade: percepções de egressos sobre sua formação e processo de trabalho

The article analyzed how the Residency in Family and Community Medicine (RFCM) in a capital of the Northern region of Brazil contributed to the formation and development of the current work process of its graduates. This is an exploratory, descriptive and cross-sectional study, with a qualitative approach focused on 31 graduates, through electronic questionnaires with open questions. The answers were interpreted based on the Content Analysis Thematic technique, constituting four empirical categories: training in Family and Community Medicine (FCM) in the graduate’s work process; recognition and application of the attributes of Primary Health Care (PHC); potentials of the FCM training and the challenges of the specialty. The analyzed data show that the studied Programs contribute to the education for professional practice and the profile of its graduates through the strengthening and implementation of the Primary Health Care (PHC) attributes, also extending beyond the specialty.

English

BACKGROUND India has been facing various challenges in the past decade, which include outbreaks of different communicable diseases and the rising of slow pandemics of non-communicable diseases. The current COVID 19 pandemic brings to light the need to revamp the training in public health during the internship. A standardized and outcome-based approach to internship training is the need of the hour for the Indian medical graduate (IMG). The internship program in community medicine should train the Indian medical graduate to develop patient management and administrative skills to promote health care through a health facility. The training provided is not standardized or evaluated across the medical colleges. Hence, it was aimed to study the effectiveness of educational interventions on internship training during the posting at the rural training health centre (RTHC). METHODS A quasi-experimental study was conducted among the interns posted in the rural training health centre using a validated semi-structured questionnaire as a pretest followed by a post-test after two weeks of training on the primary health care system. The perception of the students towards the training was assessed using the Likert 5 point scale. RESULTS The pre-test score was 5.30 (SD 2.105) and the post-test mean score was 9.35 (SD 2.033) [P &lt; 0.01]. The gender-based analysis also showed significance within genders. Student perception revealed 80 % found the training useful, 90 % agreed that the guidance provided by the field staff helped them and 90 % agreed that the intervention changed their outlook towards the internship training in community medicine. CONCLUSIONS The study has brought a positive outlook towards giving adequate guidance to acquire knowledge and skills to interns by the active involvement of faculty. Rethinking and re-implementation of the existing internship training in the community is the need of the hour. KEYWORDS Internship Training, Community Medicine, Medical Education, Kerala, GMR 2019

Consultas virtuales en Traumatología y Cirugía Ortopédica

ObjectiveThe objective of this study is to analyse the current system of virtual consultations between the levels of Primary and Specialised Care in the field of Traumatology and Orthopaedic Surgery (TOS) in our healthcare area. Material and methodA retrospective observational study was carried out on 90 consecutive patients who had a non-face-to-face consultation between 3 January 2017 and 10 February 2017 and subsequently a face-to-face consultation. All the patients belonged to the same healthcare area attached to the Nuestra Señora de Candelaria University Hospital. The data on the diagnostic orientation, medical history provided and complementary tests were evaluated by 2 observers, one with training in Family and Community Medicine and the other with specialised training in TOS, and compared with those obtained in the final face-to-face assessment. ResultsThe results showed a low inter-judge agreement regarding the diagnostic orientation, anamnesis, exploration and complementary tests provided in the virtual consultation request. It was considered that only 59% for one observer (Family and Community Medicine) and 47.7% for the other (specialised care) had sufficient information for decision-making. Furthermore, 35.2% required more than one face-to-face assessment consultation until diagnosis and in 45.5% it was necessary to request new complementary tests. In 30.7%, there was no concordance in the suggested and final diagnosis. In 51.9%, no therapeutic action other than that carried out by Primary Care was carried out and 34.1% of the patients were referred to the Rehabilitation department. ConclusionsThe current model of virtual consultations in TOS does not seem adequate to respond to this new healthcare model. The number of unnecessary referrals is very high despite the previous virtual assessment by a specialist in TOS. The Family and Community Medicine specialist should have more diagnostic resources and coordination between Primary and Specialised Care is necessary to determine, in the area of TOS, the type of consultations and conditions for which this system should be implemented to obtain adequate coordination and improve communication between both levels of care.

Impact of a Residential Rural Community-Based Training Program for Medical Students on Cognitive and Affective Domains of Learning in Community Medicine: A Mixed Methods Study.

Introduction:As part of undergraduate training in community medicine, students of 1st-year MBBS at our medical college in South India undergo rural residential community-based training called Rural Orientation Program (ROP).Objective:The objective was to study the impact of ROP at a medical college in South India.Methodology:Short-term impact was studied immediately before and after ROP using a 30-item questionnaire administered to 142 students. Medium-term impact was studied among 23 students in 2nd-year MBBS. Quantitative component consisted of objective structured practical examination scores and qualitative component documented reflections on learnings. Long-term impact was studied by surveying 287 alumni (batches of 1979 onward) to explore the impact of ROP on their career.Results:We found a significant (P < 0.001) improvement in the median posttest score (21, interquartile range [IQR]: 20–23) when compared to pretest (12, IQR: 10–16). The mean OSPE score was 19.34 ± 3.19 (maximum score = 25) with 54.55% obtaining a score ≥20. Thematic analysis of reflections depicted that students gained insights on factors influencing health and social organizations in rural areas. ROP helped develop empathy toward patients and a holistic approach toward health, in understanding rural dynamics and improved communication skills.Conclusion:ROP increases subject knowledge and plays a role in molding attitudes of students toward the care of people in rural areas and improves communication skills. This time-tested model can be replicated in other medical colleges across the country.

Postgraduate training in community medicine in India in the era of COVID-19: challenges and remedies

The recent months have witnessed an unprecedented disruption in the processes and methods of training post-graduate students.1 The residents who are currently enrolled in post-graduate programs must be equipped with the necessary know-how to become competent specialists in the future. Therefore, the challenges facing these programs in India need to be identified and the necessary remedial measures must be swiftly put in place. In this article, we attempt to identify the most pertinent challenges facing the post-graduate students in community medicine, from their perspective, and also provide individually tailored recommendations to overcome them.

Professor Sandip Kumar Ray

Professor Sandip Kumar Ray, a brilliant, highly committed, renowned Community Medicine teacher and distinguished public health expert and researcher left for his heavenly abode on 17th July 2020.Prof. Ray had dedicated his entire professional career to public health teaching, training and research. He had brought about a radical change in Community Medicine training by orienting it more towards practical approach i.e. field based training.Prof. Ray was the elder son of Prof. Bidhu Sekhar Ray, an eminent medical teacher and former Principal of R.G.Kar Medical College, Calcutta. He was born on 28th April 1947. He passed MBBS from R.G. Kar Medical College in the year 1971 and joined “Kadambini” Primary Health Centre, Monteswar, Burdwan as Medical Officer in 1973. He attained Post Graduate degree in Community Medicine from Benaras Hindu University in the year in 1979. After that he joined as faculty in Community Medicine Department of Burdwan Medical College and attained the post of Professor and Head of the department. During his tenure, the department flourished under his able leadership and the teaching and training modalities of Community Medicine was strengthened as well. In 1994 he joined Medical College, Kolkata as Professor and Head and continued his term till his superannuation from West Bengal Medical Education Services. Thereafter he continued to render his expertise as senior faculty/ HoD of Community Medicine in several Medical Colleges of West Bengal, Karnataka and also in Nepal. He was Guest Professor at Indian Institute of Social Welfare and Business Management, Kolkata. He was also program coordinator of PGDMCH course of IGNOU study centre at Medical College, Kolkata. He had a pleasant personality with an ever smiling face and was the loving ‘dada’ and an ideal role model for the junior colleagues. His passion for the discipline and his dedication towards teaching inspired thousands of undergraduate, post graduate and PhD students.

Cuidado compartilhado de pessoas vivendo com HIV/AIDS na Atenção Primária

Introdução: Buscando instituir ações para prevenir e reduzir a transmissão, melhorar o acesso ao tratamento e a qualidade de vida das pessoas vivendo com HIV/AIDS (PVHIV), a rede municipal de saúde de Florianópolis implantou entre 2015 e 2016 uma nova forma de suporte em Infectologia para a Atenção Primária a Saúde (APS). Objetivo: Descrever os resultados encontrados no município no processo de descentralização e cuidado compartilhado de pessoas vivendo com HIV/AIDS (PVHIV) com a APS de Florianópolis. Métodos: Trata-se de um estudo observacional, transversal e descritivo. Os dados foram obtidos de relatórios do prontuário eletrônico local e a partir de questionário estruturado aplicado junto aos médicos da APS de Florianópolis. Resultados: Entre 2014 e 2018, o número de atendimentos na APS relacionados ao cuidado de PVHIV teve um aumento expressivo, sobretudo após 2016, acompanhado de uma redução de 45,7% na proporção de encaminhamentos para infectologia após a implantação do apoio matricial em infectologia. Aliada à redução da taxa de encaminhamento evidenciou-se a habilidade na prescrição de Terapia Antirretroviral (TARV) por 100% dos médicos da APS entrevistados. Em relação à situação de acompanhamento de PVHIV, exclusivamente sob cuidados da APS, foi encontrada diferença estatisticamente significante entre os médicos que fazem preceptoria em ensino na graduação e residência e os que são residentes ou tem formação específica em medicina de família e comunidade (MFC) em relação aos médicos sem formação específica. A proporção de médicos que se sentem seguros e confiantes em realizar esse tipo de atendimento na APS também foi significativamente maior entre os médicos que fazem preceptoria e são médicos de família e comunidade. Conclusões: A implantação do Apoio Matricial da Infectologia para a APS trouxe grande avanço para o município de Florianópolis, no que tange ao acesso e qualificação do cuidado das pessoas vivendo com HIV/AIDS. Os resultados foram mais significativos para os profissionais envolvidos com atividades de preceptoria e formação específica em MFC, o que reforça o papel da educação permanente na qualificação da coordenação do cuidado pela APS.

Dialogues between the Astana Declaration, the Right to Health and Family and Community Medicine training in Rio de Janeiro, Brazil.

This paper discusses and fosters concerns in light of the repercussions of both the 40th anniversary of the Alma-Ata Declaration and the Astana Declaration, discussing the possible influence on Family and Community Medicine training, as per the lenses of two Residency Programs of three public institutions, namely, State University of Rio de Janeiro, Federal University of Rio de Janeiro, and the Oswaldo Cruz Foundation. These are inserted in a historical and social context, between the world of work, public policies, international organizations, the population and subjects involved in the construction, maintenance, and consolidation of the Brazilian PHC. Thus, in a brief historical revival, we contextualized which Primary Care was a practice setting and where we might be headed. We concluded that the willingness to ensure the Right to Health would be threatened by the concept of Universal Coverage, advocated by the Astana Declaration, which leads to essential discussions: ensuring state-provided services, advocating for equity and integrality of actions, reaffirming the risk of generating inequality by creating multiple service offerings for different segments of the population, reiterating the relevance of access to health, and valuation of territorialization.