The relationship between teaching and service

On the last 1st of July, the National Government issued Decree 2376, which defines the following: «Through which the Teaching-Service Relationship is regulated for Human Talent training programs in the Health field. One of the main objectives of this measure is to update the norms regulating the relationships of the multiple educational programs in the area of health with the different healthcare service provider institutions, for the purpose of achieving adequate development of the activity in the so-called formative practice.»

It is worth noting that the dispositions of this Decree are aimed at replacing and complementing the dispositions contained in Decree 190 of 1996, which during this period of time regulated the relationships between institutions in charge of training health personnel and the healthcare service providers; all of this based on the premise of «Teaching-Healthcare providing Integration» a situation persisting in the nation since several decades ago.

The aforementioned situation, associated to the proliferation of Medical Faculties and formation of different Healthcare professionals triggered economic and commercial interest of the «practice scenarios», which significantly affected the quality of the formation of medical personnel at the undergraduate and graduate levels, advancing in such a manner that effective norms were sought to regulate it through the approval of Legislation 1164.

The concept of the «Teaching-Service Relationship» implies a commitment in implementing an integral program dealing with providing ethical, suitable, timely, effective, and qualified services, as well as permitting the formation, development, and training of healthcare personnel, which is evident in an important number of educational and healthcare institutions, but which does not necessarily imply its acceptance and application inSciELO all of these.

Decree 2376 does not specifically contemplate this integration and suggests the implementation of two different sets of actions, which should perform separately, registering on one side educational, formative and training responsibilities, and on the other suggesting responsibilities for healthcare providers, which implies a step back in all the mechanisms previously used in the different Teaching-Healthcare providing agreements.

Upon the application of this Decree, there are certain conceptual restrictions significantly affecting the organization and development of multiple education activities, which must be carried out by the different entities committed with formation and training of healthcare personnel. Likewise, it can be seen that there is no specific differentiation between undergraduate students and resident students in different medical and surgery specializations; thereby, perpetuating the denomination of these as graduate students, without favoring them with the diverse prerogatives deserved through the labor rights registered in the current legislation.

It is also important to manifest that the hiring of healthcare professionals by different healthcare providers includes within their obligations to perform «teaching activities», this Decree does register that personnel from different healthcare institutions must have recognition and training in the field of education, which should be properly registered and documented. Educational institutions must be present in different practice scenarios with faculty staff along with education, formation, and training of healthcare personnel and workers and of those they assign to teaching functions and activities.

Attention should also be paid to the issue of interpretation and to the concept of what a University Hospital should be, given that the denomination «University» demands a set of requirements, personnel, and infrastructure, which are contemplated and defined by Legislation 1164. Similarly, along with the prior factors being contemplated, the complete follow up and control mechanism is defined; all with the purpose of offering quality in the service, as well as in the training of the healthcare personnel.

Compliance with the requirements from this documentary point of view does not necessarily guarantee the quality and suitability of teaching centers and education in the healthcare field. Authorizing a program for a seven-year period demands a follow up and control program to respond to the needs of the educational institutions; such program should be complemented and implemented as a State policy.

It is also important to keep in mind that the ten-year period contemplated in this Decree, to allow institutions to make adjustments in their organization, implement and initiate the actions that should guarantee optimal conditions to establish adequate development of high-quality educational programs; while assuring that undergraduate students and resident students comply with the objectives of a program, which is adapting to new requirements, would significantly affect the quality of said program because the students have to endure this situation’s restrictions and inherent changes for a minimum of ten cohorts.

It is important to design an adequate and effective follow up and control mechanism, which has the participation of all the parties in the process and where changes can be introduced in timely and opportune manner without affecting the quality of the service and the academic level of the different undergraduate and graduate educational programs. It is also worth reviewing the institutional policy regarding residents, who are specially deserving of being hired by institutions that guarantee their rights and duties.

Ricardo Salazar-López, MD
e-mail: risalazarl@gmail.com
Education Commission
Academia Nacional de Medicina