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Asociación PanAmericana Académica de Medicina de Família
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Apamefa > Publicações > Volume 1/2005
  • Capa
  • Prólogo
  • Capítulos
    • Promoviendo Liderazgos En Medicina De Familia: Una Reflexión Vital
      The introspective approach adopted by Family Medicine, although is not exclusive of this specialty, is its strength. The philosophical professional – the reflective practitioner – of family medicine attempts to integrate medical knowledge, care for people, and development of leaders with true wisdom. When you attempt to turn wrongs into rights, remember that reformation begins first and foremost within. To fight for an ideal without self-examination is perilous! Our goal is to establish leadership, pursue excellence in education, and provide viable role models. To achieve this goal, we must contend with what, at first, appear to be competing demands:On the one hand, there is the ethereal realm of principles, vision, motivation, and inward enrichment. On the other, the pragmatic considerations of caring, daily routine, consistency, and making a measurable difference in people’s lives. On closer inspection, however, these spheres are intimately related, with each one encompassing the other, like two faces of the same coin. It requires constant vigilance to strike this difficult yet necessary balance to attain practical idealism, in the day by day construction.

    • Compartilhando Histórias
      Narrative therapy is a psychotherapy technique created in Australia and New Zealand in 1980”s. Family physicians and all health professionals who emphasize the importance of a good patient relationship employ elements of this technique, although sometimes in an intuitive way. Patients’ narratives are more than mere stories where the facts are told one after another in a longitudinal and finite sequence; actually narratives go beyond our conventional clinical stories. In the narratives, the feelings behind the events are more important than the concrete events. Paying attention to the patients’ stories, not only to what is communicated verbally, but also to what is transmitted between the lines, in a subliminal language, the professionals can help their patients to find solutions for difficult situations, solutions that the patients, when immersed in a universe of problems, can’t see by themselves. This is the great challenge nowadays: learn how to practice medicine as Science and as an Art!

    • As Expectativas Dos Estudantes De Medicina Em Relação À Medicina De Família
      The proposal of workshop carried through in the IX congress of Family Medicine with medical students, was to evaluate which are the real expectations of these students about Family Medicine. The main goals aim to evaluate three important questions. The first one, to know if the medical students really knows what is Family Medicine; the second one, if they consider as a specialty, with specific issues; and finally, to appraise the real interest the students have to be a family physician as their future career choice. The workshop run in a interactive way, the medical students were deeply involved and had the opportunity to inquire and clarify doubts, and to share their reflections related to the Family Medicine option. The teachers facilitated the students´ involvement as observing participators. The discussion brings up family medicine identity as one of the main issues. This include not just the attendants´ opinion but the usual consensus medical students have regarding family medicine in the several cultures, as an “informal curriculum”. This is what really matters, as reflect the real perspectives medical students have, and to promote family medicine among them we need to know what they really think and expect about the specialty.

    • As Atividades Da Sobramfa: Variações Educacionais Na Procura Da Excelência
      The activities of SOBRAMFA – Brazilian Society of Family Medicine - are here presented framed in a journalistic report, in which the several fields of Sobramfa´s action are visited: student learning scenario, resident-training programs, doctors in CME, and the Family Medicine professors teaching environment. The SOBRAMFA directors are invited, one by one, to interact with the attendance to explain each program. Educational activities aim to incorporate the principles of Family Medicine as an Academic Discipline. That is the most important SOBRAMFA´s goal: to be a respected and competent Family Medicine Professors School. Finally, it was presented APAMEFA – Pan American Academic Association for Family Medicine – just founded in a meeting during the IX Sobramfa Meeting, with 15 attendants, real leaderships in their own countries. The Act of Constitution of APAMEFA was signed during the meeting and the Association gained strength, decided about the goals and paths needed to foster Family Medicine as an Academic Discipline throughout the American continent.

    • Reflexões Sobre O Programa De Residência Em Medicina De Família Como O Programa Fitness Mudou Minha Vida?
      The Fitness Program is the Family Medicine Residency Program run by Sobramfa. Reflections gathered here were provided by the residents –fitness fellows- during the IX Sobramfa Meeting in order to an informal appraise of the Fitness Program. The residents stress, the simultaneous learning of clinical skills and competencies with the professional development as the most important accomplishment in their training. Taking care of patients in the real world and being satisfied and happy as family doctors, growing up in a familiar learning scenario, in which fostering reflection, updating knowledge and lifelong learning with personal supervision are quoted as standards of excellence.

    • Promoviendo La Educación, Apoyando Nuevos Liderazgos
      Aiming to promote educational values and to identify and support new Latin American leadership the APAMEFA (Pan-American Academic Association of Family Medicine) runs the International Fitness Program, which includes rotations and 4-8 week fellowship training for family medicine residents. With the International Fitness Program APAMEFA strengthens educational links and promote Latin America leadership for improving patient and community health in order to achieve the “ health for All” accepted principle.

    • Comunicação Do Diagnóstico De Doença Grave (Câncer) Ao Paciente: Quem? Quando? Como? Por Que?
      Despite of development of science and health technology, cancer is still connected to death and physical and psychological pain. Culture and social level, sex and age are some factors that influence the impact of cancer diagnosis on patients. Should patient know all about all his disease? Are the physicians receiving adequate training in communicating bad news, social and psychological baseline to this delicate face of their profession? How to explain still today a patient get into mutilant surgery ignore his diagnosis and the possible results of the surgeon’s treatment choices? There are divergences related to the management information. Some physicians think that patient must know everything about his disease, and prognostic; others disclose the diagnosis eventually or just for relatives. Only two to four percent of patients refuse information about diagnosis, even so, until 1993, about 60% of Europeans gastroenterologists didn’t diclose the diagnosis, when patients didn´t ask. In spite of the advances on oncology, cancer clinicians do not receive routine in the psychosocial aspects of patient care such as how to communicate bad news or respond to patients who have unrealistic expectation of cure. The physicians depend on their own judgement in make decisions on when, who and how disclosure the cancer diagnosis. The communication skills are needed.

    • Módulo Relação Médico Paciente

    • Spirituality And Medicine

    • Aptitud Clínica Sobre La Disfunción Familiar En Médicos Familiares Mexicanos

    • Conhecendo E Respondendo Ao Sofrimento Humano Na Situação De Doença: A Experiência De Estudantes De Enfermagem

    • Family Medicine In Honduras: Initial Consultation Report
      La Medicina de Familia es un nuevo concepto en Honduras donde la Universidad Nacional Autónoma de Honduras ( U.N.A.H ) es responsable de la educación de profesionales de la salud tanto a nivel de pre grado como de pos grado. La educación medica de post grado depende directamente de la dirección general de estudios de post grado. La mayoría de graduados de la escuela de medicina se dedican a la práctica de la medicina general y un número reducido obtiene acceso a educación médica de post grado en el Hospital
      Escuela y en el extranjero. Actualmente hay siete médicos de familia en Honduras. Ninguno esta envuelto en academia pero algunos tienen interés en desarrollo de programas y participación en academia en el futuro. Dos iniciativas previas para el desarrollo de un programa de residencia en medicina de familia en Honduras no fueron logradas. Las razones expuestas para que estas iniciativas no fueran exitosas incluyen falta de recursos financieros, insuficiente información presentada a las autoridades de educación pertinentes así como un sistema no listo para la innovación. Este artículo resume el proceso inicial de consulta para el desarrollo de un programa de residencia en medicina de familia dirigido por el departamento de Medicina de Familia de la escuela de medicina de la Universidad de Indiana.


    • La Narrativa Del Paciente Como Herramienta Terapéutica
      Patients may be seen for years without truly knowing their life history even when being aware of the history of their sicknesses. An on-time and a high medical-quality service may be provided without realizing what the fears, joys and other feelings of our patients are. A preventive health program may be adequately fulfilled without knowing the person. The same could happen in a familiar dimension. Only medicine centered in the person accomplishes these tasks and simultaneously gets to know the emotional history of the patient – his/ her fears, goals, wishes, etc. Narrative is the doorway for entering this process which does not end until the very doctor-patient relationship ceases. Certain techniques and will from both parts is needed so that the narrative of the patient’s life becomes a therapeutic tool itself. When making good use of the patient’s narrative to comprehend and accept his/her emotions the physician becomes- in Michel Balint’s words- the best drug.

    • Patient’s Narrative As A Therapeutic Tool
      Se puede “dar consulta” por años a un paciente sin conocer su historia de vida a pesar de conocer la historia de sus enfermedades. Se puede “dar un servicio” puntual y de buena calidad técnico-médica sin saber cuales son los temores, alegrías y demás sentimientos de nuestros pacientes. Se puede cumplir adecuadamente con un programa preventivo de salud sin conocer a la persona. Lo mismo podría ocurrir en la dimensión familiar. Sólo la medicina centrada en la persona cumple con las tareas anteriores y al mismo tiempo conoce su historia emocional –sus temores, aspiraciones, deseos etcétera-. La narrativa es la puerta de entrada en este proceso, que no termina sino hasta que la relación médico-paciente cesa. Para que la narrativa de vida del paciente se convierta en herramienta terapéutica se requiere de ciertas técnicas y disposición de ambas partes. Cuando se aprovecha la narrativa del paciente para comprender y aceptar sus emociones el médico se convierte –en palabras de Michel Balint- en el mejor medicamento.

    • Copc In Family Medicine Residencies: A Literature Review

    • Copc En Residencias De Medicina Familiar: Una Revisión De La Literatura

    • Using The Acgme Core Competencies To Assess Family Medicine Residents
      La certificación por El Consejo de la Acreditación sobre Educación Médica Posgraduada (ACGME) es solicitada a los residentes de medicina familiar y a los residentes de todas las especialices médicas en los Estados Unidos de Norteamérica (EEUU). La evaluación se realiza fundamentalmente por medio de seis principales categorías referidas como “Competencias obligatorias” estas competencias han sido propuestas como marco de referencia en las escuelas de medicina sobre todo en cuanto a la enseñanza, evaluación de los residentes y la valoración de la excelencia de los programas de las propias escuelas. En consecuencia la ACGME requiere del desarrollo de una innovación curricular y la evaluación de métodos. Los programas de entrenamiento en la especialidad de medicina familiar de otros países podrían adaptar estas competencias obligatorias para enriquecer la enseñanza, desarrollar sus programas curriculares y evaluar integralmente sus programas de residencia.

    • Proposta Do Sistema Médico Familiar No México: 1953-1971

    • Índice Simplificado De Pobreza Familiar: Proposta Para Uma Previsão Ponderada
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APAMEFA - Asociación PanAmericana Académica de Medicina de Família
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