Elmer Huerta | Peruvian medical education is in a serious crisis: what is happening with the national medicine exam | ENAM | Public and private universities | Health | COVID-19 | Coronavirus | TECHNOLOGY

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a recent Original articlepeer-reviewed, published in “Acta Médica Peruana”, whose main author is Dr. Giuston Mendoza-Chuctaya of the National University of San Antonio Abad of Cusco, has caused enormous commotion in the academic circles of the peruvian medicine.

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In it, the results of the academic evaluation of the students of the last year of the medical schools of Peru, and, incredible as it may seem, 43% of the doctors who took the exam failed it.

The national exam medicine (ENAM) is a written test of 200 multiple choice questions, 30% of which are general medicine, 15% general surgery, 18% pediatrics, 17% obstetrics and gynecology, 10% public health and management, and 10% basic sciences.

In the words of Dr. Raúl Urquizo, dean of the Medical College of Peru (CMP), the exam is nothing to write home about and should be passed without much effort by any student in the last year of Medicine. This is assuming that the Faculty of Medicine in which the student studied has properly instructed him, and that he has dedicated himself to studying.

Although the comparisons are odious, a similar test in the US. it is only disapproved by 3.7% of the students. How is it interpreted, then, that such a high proportion of recently graduated doctors cannot pass an exam that they are supposed to pass without much difficulty?

The study

The research was relatively simple and consisted of tabulating the grades obtained by 30,750 students in the last year of Medicine, who took the exam between 2009 and 2019. The results were disaggregated according to the type of medical school they came from: private, state, and foreign schools. The exam is a requirement to access a place in the Marginal Urban Rural Health Service (Serums).

The 30,750 doctors were from 36 Peruvian universities (17 public and 19 private), of which 9,087 were from public universities, 17,607 from private ones, and 4,056 graduates from abroad.

“Unlike many countries, in Peru the approval of a similar exam is not a mandatory requirement to practice the career.”

Results

The analysis of the average grades revealed that 42.8% disapproved. According to the university of origin, it was found that 31.3% of graduates from public universities disapproved, as well as 33.9% of graduates from private universities. Of the foreign graduates, 79% failed.

The state university with the fewest disapproved was San Marcos (6.6%). With more than 40% of disapproved are the national universities Federico Villarreal, Ucayali, San Luis Gonzaga and the Universidad del Altiplano. The National University of the Amazon had the worst record, with 55.1% disapproved.

For their part, the private universities with less than 10% disapproval were Católica Santo Toribio, Unión, UPC, Cayetano Heredia, Andina del Cusco and Continental.

The private ones with more than 60% disapproval were Peruana Los Andes, from Chiclayo, San Juan Bautista and San Pedro. The highest percentage of disapproval was held by César Vallejo, with 70.5%. Of the foreign graduates, it is noteworthy that, compared to Peruvians, those from Cuba had 845% more chances of failing the exam.

It is not a requirement to practice medicine.

Unlike many countries, In Peru, passing a similar exam is not a mandatory requirement to practice the degree. That means that all those young doctors – unable to pass a theoretical knowledge test – are right now seeing patients somewhere in Peru, which, according to many observers, endangers the health of their patients.

The CMP established in 2019 the obligation to approve the ENAM for the practice of medicine. This initiative was appealed to Indecopi which, in the resolution 0555-2021/SEL-INDECOPIsigned by Gilmer Paredes Castro, ruled that “The requirement to prove having passed the ENAM with a minimum passing grade of eleven (11) for registration in the CMP Registration Registry constitutes a bureaucratic barrier, since the CMP has exceeded its powers.”

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The United States experience

At the beginning of the 20th century, the educationalist Abraham Flexner, with the Carnegie Foundation, published the Flexner Reporta document that is considered as the germ of the high quality of the medical schools current US

The report described turn-of-the-century medical education as being made up of for-profit corporations that produced a surplus of poorly trained physicians, and concluded that, due to low admissions standards, poor laboratories, and inadequate clinical teaching, most medical schools in the US they were considered deficient.

Medical schools were classified into three groups: of good quality, poor but salvageable, and of such poor quality (30%) that they had to be closed.

The medical education in Peru it is in crisis and the country urgently needs a “Flexner Report”. The first provision should be that students who do not pass the ENAM cannot work as doctors.

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