National School of Public Health, Havana, Cuba.
MEDICC Rev. 2008 Oct;10(4):35-42. doi: 10.37757/MR2008.V10.N4.8.
Introduction Through the 1990s, wide disparities in health status were recorded in Venezuela, a mirror of poor social conditions, decreasing investment in the public health sector and a health workforce distribution unable to meet population health needs or to staff effective, accessible public health services. Venezuelans' health status deteriorated as a result. In 2003-2004, the Venezuelan government launched Barrio Adentro, a new national public health model aimed at assuring primary health care coverage for the entire population of an estimated 26 million. Cuban physicians staff Barrio Adentro clinics, mainly in poor neighborhoods, until enough Venezuelan physicians can be trained to fill the posts. Intervention Cuban experience with community-oriented medical education and global health cooperation was drawn upon to develop curriculum and provide faculty for the new National Training Program for Comprehensive Community Physicians, begun in 2005 in cooperation with six Venezuelan universities. The program differs from previous Venezuelan medical education models by adopting a stated goal of training physicians for public service, recruiting students who had no previous opportunity for university-level education, and concentrating the weight of their training on a service- and community-based model of education, relying on practicing physician-tutors. Results Over 20,000 students have been enrolled in three years. The six-year program has been extended to all 24 Venezuelan states, relying mainly on Cuban faculty who are practicing Barrio Adentro doctors and who receive postgraduate training in medical education. This "university without walls" has accredited 5,131 Barrio Adentro clinics as teaching institutions; its infrastructure includes other health care delivery facilities plus 855 multipurpose classrooms throughout the country. For the 2006-2007 academic year, the pass rate was 82% for first-year students and 94% for second-year students. Some difficulties persist in student selection, pre-medical preparation, and achieving optimum use of existing resources. Academic, institutional, and external evaluations are ongoing. Conclusion This is the most ambitious example of scaling up of physician training in a single country. The program has been made possible by considerable political will from the Venezuelan and Cuban governments; by the experience acquired through development of the Cuban health system and medical education programs; by the individual commitment of Cuban curriculum developers and physician-tutors; and by ever-more-organized Venezuelan communities. The size of the undertaking, coupled with significant innovations in curriculum, present challenges. The Venezuelan experience - emphasis on training physicians for a revitalized public health sector, accompanied by a paradigm shift in primary care - warrants attention from the international community in the context of the global shortage of health workers and efforts to achieve a more equitable distribution of health services worldwide.
引言
20 世纪 90 年代，委内瑞拉的健康状况存在着广泛的差异，这反映了其社会条件较差、对公共卫生部门的投资减少以及卫生人员配置无法满足人口健康需求或为有效的、可及的公共卫生服务提供人员。委内瑞拉人的健康状况因此而恶化。2003-2004 年，委内瑞拉政府发起了“巴里奥阿迪斯特”（Barrio Adentro），这是一个新的国家公共卫生模式，旨在为估计有 2600 万人口提供全民初级卫生保健。古巴医生在巴里奥阿迪斯特诊所工作，主要在贫困社区，直到有足够的委内瑞拉医生接受培训来填补这些职位。
干预措施
为了制定新的国家综合社区医生培训方案，并为该方案提供师资，从 2005 年开始，委内瑞拉与六所大学合作，借鉴了古巴社区导向医学教育和全球卫生合作的经验。该方案与以往的委内瑞拉医学教育模式不同，它明确规定了培训为公众服务的医生的目标，招收以前没有机会接受大学教育的学生，并将培训的重点放在以服务和社区为基础的教育模式上，依靠实习医生导师。
结果
三年来，已有 2 万多名学生入学。该六年制方案已扩展到委内瑞拉的 24 个州，主要依靠古巴教员，他们是在巴里奥阿迪斯特行医的医生，并接受医学教育的研究生培训。这个“没有围墙的大学”已将 5131 家巴里奥阿迪斯特诊所认可为教学机构；其基础设施包括其他医疗保健提供设施和全国 855 间多功能教室。在 2006-2007 学年，一年级学生的通过率为 82%，二年级学生的通过率为 94%。在学生选拔、医学预科准备和最佳利用现有资源方面仍存在一些困难。学术、机构和外部评估正在进行中。
结论
这是一国范围内扩大医生培训规模的最雄心勃勃的例子。委内瑞拉和古巴政府具有相当大的政治意愿；通过开发古巴卫生系统和医学教育方案所获得的经验；通过古巴课程制定者和实习医生导师的个人承诺；以及越来越有组织的委内瑞拉社区，使该方案成为可能。这项工作的规模，加上课程的重大创新，带来了挑战。委内瑞拉的经验——强调为振兴公共卫生部门培训医生，并伴随初级保健方面的范式转变——值得国际社会关注，因为全球卫生工作者短缺，努力在全球范围内更公平地分配卫生服务。
