Cuban medical education: aiming for the six-star doctor.

Profound changes are under way in Cuban medical education. Some aspects of this transformation represent radical shifts, others a deepening of processes already in motion. Together, these changes reflect a progressive sense of urgency over the last four decades to: 1) scale up physician training to meet the needs of the whole population; 2) recruit and train scientifically prepared and socially committed students; and 3) match competencies, knowledge base, and scope of responsibilities to the concrete health needs of people in Cuba and other countries where these future physicians may serve. These three goals have guided successive innovations in Cuban medical education since the early 1960s, when the University of Havana Medical School was left with only 23 of its 161 professors - the rest either emigrating or in disagreement with academic and health care reforms designed to guarantee the right to health care. From a fee-for-service model catering mainly to individual patients, health care was being transformed into a universal public health system. This required decentralization of medical services - first to the rural areas of the country, which had essentially gone without - followed by development of a nationwide primary health care network. Thus, from the beginning, there was an urgent need to train many more physicians and to train physicians prepared for, and committed to, this new vision.