Spotlight
Medical Education:
Training Cuba’s Family Doctors

Compiled by MEDICC Review Editorial Staff

The Cuban Family Doctor and Nurse Program was conceived as a team approach, where the two professions work in tandem, responsible for the health of a neighborhood, some 700-800 people. The family is the hub of medical care, but actions are also directed at individuals within the family and towards the community at large. This program required by definition the training of a new kind of health professional in a new medical field: what the Cuban health system has called “comprehensive general medicine” or family medicine of a new type.

Students enter medical school directly upon graduation from high school, and they graduate as “general comprehensive physicians” (general practitioners) upon completion of a six-year medical curriculum. Since the curriculum reform of 1984, students spend at least 18% of their training in the community itself, as follows:

The percentage of time in the community, where training is carried out by professors at the polyclinics, may rise significantly if a pilot program introduced in the 2004-2005 academic year is extended throughout the country in the years to come. Under this proposed curriculum reform, students will spend their entire 6 th year in the community, with professors of internal medicine, pediatrics, ob-gyn, psychology, and a mentor in family medicine, all members of a Basic Work Team at the local polyclinic. Students will continue to receive training at other sites, including hospitals.

Residency in Comprehensive General Medicine (Family Medicine)

The training of the 1 st Degree Specialist in Comprehensive General Medicine is designed to build on the previous years, to produce a broadly prepared specialist, with the skills, knowledge base and approach that meet the demands and development perspectives of Cuban society. Thus, the specialty of family medicine has become the basis for all other specialization, whether clinical or surgical, and recent graduates carry out their family medicine residency before opting for a second residency in any other field.

The family medicine residency is two years, and begins full-time in the community, mainly at a family doctor’s office, although other academic sites are also included. The academic program includes theoretical as well as practical material, in settings where knowledge and skills are both tested, complemented by a series of courses and rotations.

In order to pass from one year to the next, residents must pass their annual theoretical exam. In order to complete their residency, they must also pass a practical exam, presenting research results related to a health problem identified in their community, through the Community Health Diagnosis, which each resident is required to carry out.

Figure 1: Training Sites for Cuban Family Physicians

During this process, and in the practice of family medicine, family doctors must fulfill four main functions in the community:

• Medical Care
• Teaching/learning
• Research
• Management

Post-Graduate Opportunities for Cuban Family Physicians

Once a physician completes his/her residency, they become a 1 st Degree Specialist in Comprehensive General Medicine (Family Medicine). They then have the following opportunities for further advancement, some of which may be pursued simultaneously:

• Continue their family medicine practice until they reach the level of 2 nd Degree Specialist, with possibilities for a Master’s Degree and Doctoral Degree in the field.
• Complete a residency in a second field.
• Enter teaching, by advancing along the established categories: instructor, assistant professor, associate professor and full professor.
• Continue post-graduate work through Master’s Degree courses, short courses and specific practicum.
• Obtain a research category.
• Occupy management or academic positions at any level in the health system (hospital or polyclinic director; dean, vice-dean, etc. of medical schools, etc.).

Cuba’s 2 nd Degree Specialists in Comprehensive General Medicine

On the cutting edge of the future of family medicine in Cuba are the following 53 physicians who are bringing new depth to theory and practice in the field, by becoming 2 nd Degree Specialists - the top rung in the Cuban ladder of specialization. Among them are two PhDs in family medicine. All are being looked to for deepening reflections on these 20 years of accumulated experience, with their own practice and study at the core of the growing body of constituted science in Cuban community-oriented primary care.