All medical schools in our country agree that the graduate profile to which their respective study plans are oriented is that of a “general practitioner”. It is hoped that this professional has the appropriate clinical criteria to diagnose and treat the prevalent pathologies in our environment or eventually refer the patient in a timely manner to a specialist. It is also expected to be involved in preventive medicine and ultimately to be an effective effector of primary health care.
At this point, the plant generator of this article is the following: graduates of medical schools are not in a position to practice –without supervision– as general practitioners as enabled by their immediate enrollment upon completion of their studies. When I ask sixth-year students or recent graduates of different medical schools regarding this topic, the coincidence is unanimous: they do not feel in a position to practice medicine autonomously. When I ask them how to overcome this situation, the answer is also unanimous: they all aspire to enter a medical residency to complete their training (regardless of the specialty they choose).
The problem is that this is not only the opinion of the students of the last year or recent graduates, but also that of all the university professors of Medicine from different universities with whom I have dealt with this subject. The conclusion is clear: this requires an urgent review.
It is unanimous opinion in the world of contemporary medicine that the best postgraduate training system is medical residency. It is essentially a training in the real care scenario of the profession, which is carried out in a supervised manner (under the control of professionals with experience and teaching vocation) and following a rigorous training plan, meeting objectives and skills of increasing complexity. It is also a paid and full-time activity. Not just any healthcare institution can host a residence. You have to meet strict requirements to ensure proper planned training and qualify as “accredited medical residency.”
At this point of analysis the proposal that I imagine is the following: why not incorporate an education and training regimen with the characteristics of a medical residency in the final years of the Medicine degree program? It would be a general practitioner undergraduate university residence in charge of each Faculty of Medicine in accredited healthcare centers associated with each university. It would obviously be mandatory to obtain the qualifying license (as part of the career program). All of us involved in medical education agree that completing an accredited residency is when you are truly in a position to practice medicine unsupervised.
Let us remember at this point that the degrees awarded by the universities in our country are enabling. As Tauro, Manterola and Echenique point out very well in the excellent work Policies in education and health (El Guion Ediciones, Buenos Aires, 2021), “the higher education law (LES) No. 24,521, of 1995, determined that officially recognized titles certify the academic training received and qualify for professional practice throughout the national territory without to the detriment of the police power that corresponds to the provinces (which often delegate this power to professional associations)”. “This responds to the model of countries with a Latin tradition (such as France), but in Anglo-Saxon countries, such as the United States, academic training is clearly separated from professional qualification. The latter is under an extra-university orbit”.
There is a not minor medical-legal aspect and it is the limitation that Medicine students have to carry out certain assistance practices, lacking qualifying registration. An alternative would be to consider granting the medical student, when entering the final cycle of his career, a registration for restricted and supervised exercise of the profession for the sole purpose of the activity in the general practitioner undergraduate medical residency.
In function of the concepts explained Previously, the proposal is to remodel the Medicine degree in three stages in which the theoretical and practical components vary in the opposite direction: 1) an initial two-year cycle exclusively of basic and humanistic sciences, with a first contact with the care setting; 2) a two-year intermediate cycle with basic clinical and surgical subjects (the time of interaction with the healthcare setting is increasing); 3) a final three-year cycle consisting of a general practitioner undergraduate residency (full-time, supervised care activity) continuing simultaneously with the other clinical and surgical subjects (specialties), but integrated with the care training of the undergraduate residency.
The last year of this undergraduate residency it is proposed that it be rented as consideration for the assistance tasks that are allowed according to the plan of the residence. In summary, this proposal determines a total duration of the degree of seven years. Currently, in most universities it is six years.
The general practitioner undergraduate residency cycle of the last three years of the degree It would replace the current practices or rotating internships that are carried out in the last year of the degree, while the teachers who were in charge of those would be the natural ones in charge, due to their experience, of supervising this final cycle.
Advantages of the proposal: 1) the graduate will really be able to practice medicine as a general practitioner. 2) Well-trained general practitioners would be generated who would cover the needs of primary health care professionals in the country. Let us remember that many graduates, for various reasons, do not complete a residency. This only reinforces the importance of achieving high quality training in our graduates.
It is timely to highlight some phrases of the remembered teacher Dr. Alberto Agrest on the subject at hand: “Medical knowledge is knowledge integrated with doing, it is not scholarly knowledge in which knowledge is an end in itself.” “You don’t have medical training when you only have information.” “The mission of the faculties is to provide the population with responsible and reliable graduates in knowledge and attitudes” (Agrest, A., More inaccurate musings from a medical observerAventis, Buenos Aires, 2002).
In conclusion: we must review the Medicine career, given that university teachers are guarantors before society of the training of our graduates. It is our essential ethical commitment.
Associate Professor of the Chair of Ophthalmology at the Faculty of Medicine of the University of Buenos Aires (UBA). Doctor of Medicine (UBA)
