Las enfermeras como nodrizas de un consultor de Ética Clínica
Autores/as
- Miguel Ángel Bedolla-González <p>University of Texas at San Antonio, Policy Studies Center, UTSA Pathway to the Health Professions. San Antonio, Texas,</p> http://orcid.org/0000-0001-8135-1029
Palabras clave:
Ética, Ética en enfermería, Ética médica, Ética clínicaResumen
En su magistral libro sobre la relación médico-enfermo, Don Pedro Laín Entralgo señala que el médico, y por extensión todo profesional de la salud, debe tener dos amores: el amor a su profesión, y lo llama philotekhnia y el amor al enfermo y lo llama philanthropia.
Me he pasado muchos años como profesor en varias escuelas de medicina y creo que pocas veces he sido testigo de la philanthropia entre mis colegas del profesorado y los estudiantes que he tenido. Cuando he tratado de entender el por qué, la respuesta casi siempre es la misma: ante el enfermo hay que ser objetivo, y al amarlo se pierde la objetividad.
Biografía del autor/a
-
Miguel Ángel Bedolla-González, <p>University of Texas at San Antonio, Policy Studies Center, UTSA Pathway to the Health Professions. San Antonio, Texas,</p>
NAME: Miguel Bedolla
POSITION TITLE: Director of the UTSA Pathway to the Health Professions
EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, include postdoctoral training and residency training if applicable. Add/delete rows as necessary.)
INSTITUTION AND LOCATION
DEGREE
(if applicable)
Completion Date
MM/YYYY
FIELD OF STUDY
St. Mary’s University, San Antonio, Texas
Universidad de Nuevo León, Monterrey, México
The Ohio State University 1985
The University of Texas, SPH Houston, Texas
BA
MD
PhD
MPH
06/1962
06/1971
05/1985
05/1995
History
Medicine
Ed Policy & Leadership
Community Health
A. Personal Statement
Presently I am the Director of the HRSA funded Health Careers Opportunities Program (HCOP), nicknamed The UTSA Pathway to the Health Professions where I work with students from Bexar County and surrounding areas, that are economically disadvantaged. The Pathway is a 5-year, academic enrichment, program designed to assist the students in becoming competitive health professional school applicants. The Pathway takes the economically disadvantaged students, from their junior year in high school through graduation, and into college until the moment that they are competitive applicants and apply to the health professional school of their choice.
I also consider that the programs that I led while in the faculty of the Medical School of the University of Texas Health Science Center in San Antonio have enabled me to be ready to play a significant role in the present project. Please see under Research Support.
B. Positions and Honors
Academic
2015
Program Director
San Antonio Pathway to the Health Professions
2013-2015
Program Coordinator
Policy Studies Center of the University of Texas in San Antonio
1994-2006
Associate Professor –Tenured
The University of Texas Health Science Center in San Antonio– Department of Family Medicine
1988-1994
Assistant Professor
The University of Texas Health Science Center in San Antonio Department of Family Medicine
1984-1986
Professor of Education
Universidad de Monterrey
1978-1979
Instructor of Nursing
Faculty of Nursing of the U de Nuevo Leon
1975
Lecturer in Anthropology
National Institute of Anthropology and History –
1972-1975
Research Professor
Faculty of Medicine of the National U of Mexico
1968-1971
Instructor
Faculty of Nursing of the U de Nuevo Leon
1974
Science Teacher
Natalia Independent School District – Natalia TX
Administrative
2009
Consultant
Vida y Salud Health Systems – Crystal City TX
2005-2006
Associate Director
AmeriCorps Program
University of Texas Health Science Center San Antonio
1985-1986
1982-1986
Consultant
Dean
Ministry of Health of the State of Nuevo Leon, Mexico
Medical School Universidad de Monterrey
1982-1984
Director/Manager of Education and Services
Hospital, Clínica y Maternidad Conchita of Monterrey, México (Alfa Industrial Consortium)
1981-1982
1978-1981
Manager of Project’ Development
Dean
Nova Clinic of the Alfa Industrial Consortium of
Monterrey, Mexico
Medical School of Monterrey Tec
1972-1975
Program manager
Experimental Medical Curriculum (A-36) of the Faculty of Medicine of the National Autonomous University, Mexico City
Outstanding Awards
2000 Outstanding Teacher Award, College of Education-Dean’s Roundtable, Texas A&M University
1998 Lifetime Achievement Award from the Center for Hispanic Studies of the UTSA
C. Contributions to Science
- The design of an experimental medical curriculum at the Medical School of the National University of Mexico.
- I had to go to medical school in Monterrey Mexico because I could not enroll in a Texas medical school because I was born in Mexico City. When I was a upper level medical student I was acutely aware that the curriculum was educating me as a hospital-clinical lab-dependent physician that would be unable to take care of the healthy segment of any population and of those whose diseases were vague, non-life-threatening or at an early stage of their natural history. This awareness was fostered by the two courses in Epidemiology and Public Health that the medical school required for graduation. This was one of the reasons why I decided to become an expert in medical education rather than a hospital-based specialist. Almost immediately after graduation I was invited to join the faculty of the medical school of the brand new Universidad de Monterrey where I was put in charge of the multidisciplinary laboratories. This gave me the opportunity to begin reading everything I could read on medical education. Since I was working in Mexico I was especially interested in understanding what the best type of medical education for a developing nation was. I soon encountered a number of ideas that “radicalized” me especially the well-documented idea that is now called the Iceberg Phenomenon that basically demonstrates that only see in their offices a very small minority of the people of the community, the overwhelming majority of whom are healthy and receive no care to stay healthy. As this was happening, at the National University of Mexico, in Mexico City, the Dean of the Medical School, Dr. Jose Laguna, had put together a group of experts in medical education and tasked it with designing an entirely new medical curriculum. After a long period of deliberations, led by Dr. Laguna himself, the group came up with a unique curricular design; perhaps the best way to describe it is to say that it transformed the traditional “Flexnerian” curriculum into a multidisciplinary residency in Community and Family Medicine. The students would spend two years in a community health center and the community itself, seeing patients with the physicians there and working with a number of families each had been assigned to work with much as a community health worker and ensure that everyone was receiving the appropriate health care. After those two years the students would go through the usual hospital-based clinical rotations and then a one year pre-degree internship before graduating.
- Specific role: Toward the end of the curriculum design process Dr. Laguna invited me to join the group and eventually appointed me to what was in effect the project Manager. I was tasked to create what I will call a proof of concept demonstration to show that the educational materials for the new curriculum could be developed and that all student activities of the first two years could be scheduled in order for the students to achieve the objectives of learning. I was able to complete these two tasks and was in charge of developing all materials and schedules for the first two years of program implementation along with being a faculty in one of the learning modules that we built in four underserved communities around Mexico City.
- The central finding was that such a radical curriculum could be implemented. These findings were published in the PanAmerican Health Organization’s health education journal: Educacion Medica y Salud, [Experimental study plan of general medicine (Plan A-36)]. Laguna García J, Alvarez Manilla J, Barrios de la Rosa A, Bedolla M, Beltrán F, Benavides I, Brust H, De la Fuente R, García Alonso H, Guzmán García J, Hernández J, Lujan H, Pucheu C, Rodriguez Dominguez J, Vasconcelos R. Educ Med Salud. 1974 Apr;8(2):205-25. Spanish. No abstract available.
- The influence of the finding(s): the findings mainly influenced the thinking of those Mexican public universities that did not have a medical school and were located in the less developed states such as Campeche and Chiapas. It also influenced the design of the curriculum of the about to be founded medical school of the University of New Mexico, and countless other medical schools throughout Latin America and even the Middle East since it became something of a showcase through which the PanAmerican Health Organization promoted the changes they thought should be introduced into medical education.
- The introduction of Problem Based Learning into Mexican Medical Schools
- The historical background that frames the scientific problem; Early in the 1970’s, people like myself, who are interested in medical education, were introduced to the idea of writing educational objectives that were stated on the basis of the outcomes of the learning process, not the teaching process as it was usual, and that were “measureable.” And people were also introduced to Bloom’s Taxonomy of educational objectives. It was also around this time that the Association of American Medical Colleges (AAMC) began to disseminate the doctrine that physicians ought to be self-directed, life-long learners. The people that first published on how to write educational objectives in accordance with Bloom’s Taxonomy were mainly elementary educator. And the application of their ideas produced strange results in the medical educational environment. I once met a medical educator who had written approximately 270 learning objectives for a one-hour presentation. At this time I was at the National University of Mexico studying the history and structure of the doctor-patient relationship and his lectures, along with my reading of Bernard Lonergan’s “Insight: a study of human understanding” led me to think that the most important thing we do in education is to help the student learn to use his/her mind, and in this case, how to use his/her mind as a responsible and loving physician. Meanwhile, the work of Dr. Larry Weed on the Problem Oriented Medical Record led me to believe there was a small core of objectives of learning for a medical school curriculum.
- Central Finding: I returned to the United States and enrolled at The Ohio State University where I completed a PhD in educational policy and leadership while devoting my time to understanding the manner in which good physicians use their minds and wrote a dissertation: The Development of an Undergraduate Medical Curriculum Following a Core of Behaviors Approach: a Philosophical Analysis. University Microfilms, Ann Arbor. 1985, in which I propose that there is a small core of mind operations that ought to be the focus of medical education and, ultimately, professional education.
- Specific role: While working on my dissertation in 1978, I was invited to come to come to Monterrey Tec (Instituto Tecnológico y de Estudios Superiores de Monterrey/ITESM ), where the President appointed me the sole member of the Curriculum Committee of its brand new medical school.
- Influence of the findings: I used my ongoing dissertation work to design a Problem Based Learning curriculum that was the first in Latin America (1979) and may have been the third in the world (after the curricula at McMasters and Michigan State. To this day, Monterrey Tec’s med school is a leader in medical education and recently hosted a national conference on Problem Based Learning that is now the trend for all Mexican medical schools.
D. Additional Information: Research Support and/or Scholastic Performance
Research Support- Office of the Health Professions of the Health Resources and Services Administration. From 9/15-8/18. Direct Cost $1,860,000. Dr. Roger Enriquez is the PI. Director.
- Google: The Structure of Medical Data (Dr. Graciela Gonzalez Farias was PI). From 10/06-09/06. Direct Cost $60,000
- Agency of Health Research Quality: Decision Making at the End of Life in Mexican American Elderly. From 01/06 to 12/08 Direct cost $250,000.
- Office of the Surgeon General of the United States. Texas Medical Rangers. From 11/03 through 10/06. Direct Cost $150,000. Dr. Harold Timboe was PI.
- Department of Health and Human Services, Health Resources and Services Administration, Health Careers Opportunities Program. From 09/1/99 through 08/31/04. Direct Cost $2,500,000. Director
- Association of American Medical Colleges Health Professions Partnership Initiative. From 06/98 through 05/2003. Direct Cost $350,000. Director
- Office of Border Health of the Health Resources and Services Administration of the US Department of Health and Human Services. From 09/01/97 to 12/31/98. Direct Cost $60,000. Principal Investigator
- Department of Health and Human Services, Health Resources and Services Administration. Medical Hispanic Center of Excellence. From 09/01/91/ through 08/31/93. Direct Cost $284,132. Director
- Department of Health and Human Services, Health Resources and Services Administration. Medical Hispanic Center of Excellence. From 09/1/93 through 08/31/96. Direct Cost $1,398,000 Director.
- Department of Health and Human Services, Health Resources and Services Administration. Medical Hispanic Center of Excellence. From 09/1/96 to 08/31/99. Direct Cost $1,500,000 Principal Investigator and Director
- Department of Health and Human Services, Health Resources and Services Administration. Health Careers Opportunities Program. From 09/1/93 through 08/31/96. Direct Cost $900,000 Director
- Department of Health and Human Services, Health Resources and Services Administration. Health Careers Opportunities Program. From 09/1/96 through 08/31/99. Direct Cost $900,000.
- Department of Health and Human Services, Health Resources and Services Administration. South Texas-Border Partnership for Health Professions Education. From 10/1/96 through 09/31/99. Direct Cost $800,000 Principal Investigator and Director
- Department of Health and Human Services, Health Resources and Services Administration. Hispanic Healthy Aging Center. From 09/01/93 through 08/31/96. Direct cost $900,000. Director of Evaluation
Referencias
Ninguna
