Critical Health Situation Research Articles

Institutional Deficiencies and the Rationing of Access to Health Services in Developing Countries: Markers and Challenges (Carences institutionnelles et rationnement de l'acces a la sante dans les pays en developpement: Reperes et enjeux)

The economic analysis of the links between institutions and development is crucial with regard to the socio-economic and human challenges linked to the health situation and the conditions of the access to health services in developing countries. This paper tries to put emphasis on the major role of institutional deficiencies in explaining the persistence of the critical health situation of populations in disadvantaged countries. First, we analyze the causes and features of internal deficiencies within the developing countries themselves as well as those characterizing donator countries and multilateral organizations. We then examine the challenges implied by the remedy of these deficiencies, and draw some possible paths for the emergence and the sustainability of the institutional changes that could be envisaged.

EDUCACIÓN MÉDICA: NUEVAS TENDENCIAS, DESAFÍOS Y OPORTUNIDADES

El presente artículo trata sobre las pautas que deben tener en cuenta las escuelas de Medicina para responder a los desafíos y nuevas tendencias de la sociedad actual. En este contexto se valora la Educación Basada en Competencias (EBC), que es considerada como el modelo educativo predominante en las escuelas de Medicina del mundo y a su vez la revolución más importante en la educación médica para el siglo XXI. Los nuevos médicos deberían tener las siguientes características: una formación integral comprometida con la recuperación y promoción de la salud, una concepción integral del hombre y la salud, una sólida formación científica, estar preparado para liderar y trabajar en equipos multidisciplinarios, poseer habilidades directivas y de gestión, entre otras; para lograr ello se requieren de nuevas metodologías educativas como la Educación Basada en Problemas. Por ello en el Perú es necesario tomar en cuenta estos criterios para formar a médicos capaces de resolver la situación crítica de salud de la población, este compromiso inspiró a la creación de la Escuela de Medicina de la Universidad Peruana de Ciencias Aplicadas (UPC).

Narratives in needs assessment to improve first aid curriculum

Context and setting Communication skills are largely acknowledged as a core component of health care providers' competence. Over the past 20 years, many medical schools have included them in their curricula. Among health care providers, first aid professionals have a pivotal impact on society and individuals due to their daily involvement in critical health situations. However, few studies have assessed first aid curricula with regard to communication skills. Why the idea was necessary Italian first aid professionals receive only a technical training. Communication skills are not part of the curricula. Our work represents the first attempt to assess first aid professionals' educational needs in order to improve their curriculum. What was done A research intervention was carried out with all the team leaders of a first aid association in Milan, with the 2-fold objective of performing a needs assessment and offering participants an opportunity to reflect on their experiences in a supportive environment. In-depth interviews regarding a first aid situation that struck the participants were collected. The interviews followed a simplified version of debriefing in order to offer participants an opportunity to process their experiences. Facts, emotions and thoughts were solicited. One week after the interviews, participants were given a telephone questionnaire which included questions to be answered on a 5-point Likert scale on ease of narrating, well-being after the narration and how positive the narrative experience was, as well as an open-ended question. Interview transcripts were analysed through content analysis. Upon completion of analysis, a 2-hour meeting with all participants was organised. Selected quotes from interviews were presented by theme for group discussion. This helped participants become more aware of their strengths as well as the areas in which they needed to improve and allowed for the building of a shared map of educational needs. Evaluation of results and impact Of the 30 team leaders approached, 27 volunteered to participate in the project. The content analysis highlighted a sense of inadequacy in 2 areas: communication with patients and management of emotions. Communication with the patient or family was described as among the most difficult aspects of dealing with an emergency. The need to acquire skills for managing difficult conversations with patients and their families emerged. Strong personal emotions were also perceived as a source of difficulty because of the lack of tools with which to manage them. The need to manage personal emotions during an emergency in order to be fully present and provide competent first aid was identified. The need to process those emotions after the emergency was described as a ‘matter of surviving’. So far, this need has been met by discussing the medical aspects of the intervention with the team or by talking with friends and family. Questionnaire results showed that the narrative experience was perceived on average as being very positive, but not easy (ease 2.9 points, well-being 3.5, positivity 4.2). In the open-ended question, 9 respondents described the interview as providing relief and as useful for organising feelings and thoughts; 8 expressed a generally positive opinion; 5 underlined the difficulty of narrating; 3 addressed the interview's educational value, and 2 underlined the pleasure of being listened to. The positive evaluation of the research intervention might be due to the fact that the intervention fulfilled the participants' needs to process difficult experiences. Results call for the development of a first aid curriculum that includes training in communication skills and emotion management.