PEDIATRIC EDUCATION IN LATIN AMERICA
Authors: Wegman Myron E. , Hughes James G. , Puffer Ruth R. 
Published: December 2021

Medical care of infants and children profoundly influences the health status of a large segment of the population, of particular importance in areas like Latin America where high birth and death rates result in a relatively young population. Pediatric education of high quality not only means better care of children but may foster sound attitudes towards prevention throughout the medical curriculum. For these reasons the Pan American Sanitary Bureau, Regional Office of the World Health Organization, undertook this survey in the Americas, excluding the U.S.A. and Canada, basing the technique on surveys previously carried out in these two and other countries of the world.

Objectives were to assemble a clear picture of present-day pediatric education, ascertain gaps and needs, provide an instrument for self-evaluation, help schools learn from each other, and bring pediatric education closer to the community.

The investigation was carried out through obtaining written information from every school, complemented by personal visits to a substantial number.

Information was received from all of the 79 medical schools in Latin America in 1956, some of which do not teach pediatrics because they are either new or provide pediatric work at another university. Data were available from the others, 69, which, because of the existence of several chairs in some universities, included 74 chairs of pediatrics.

Analysis indicates extraordinary variation in every topic analyzed. On the one hand, great progress in education is being made in many of the countries surveyed. A few schools have really excellent facilities and programs. Some of the new medical schools and hospitals are outstanding, and most professors and staffs are capable and conscientious. On the other, serious defects which merit prompt attention and correction are apparent in a great many institutions.

In 1956, 6,573 students were being taught pediatrics in these schools, usually in 1 year, the last of the medical curriculum. In proportion to national population, variation was from 8.0 to 0.6 pediatric students per 100,000, but evaluation of these figures in relation to each country's needs requires consideration of several factors, including premedical training, number of existing physicians, and number studying abroad. Individual schools varied in size from 720 to 6 students. Seven schools, 10% of the total, had 47% of all the students.

Excessively large student bodies were related to unselected admissions and frequent disregard of the school's resources in faculty and facilities. Many schools graduate fewer than 50% of the students admitted, but even though the number has been reduced by the final year there are still many schools in which the size of class makes sound pediatric instruction impossible. Emphasis needs to be placed, as recommended by the Seminars on Teaching of Preventive Medicine, on careful selection of that number of students which the school can properly teach.

At the other end of the scale, one-quarter of the schools had 22 students or less, raising problems of high cost per student trained. In these schools classes were frequently so small that it was difficult to have all the resources necessary for a complete and balanced pediatric course.

Total hours of instruction in pediatrics received by the individual student varied from over 400 to 72, with a median of 225 hours. Although it is difficult to set an optimum number, the WHO Study Group on Pediatric Education suggested 300 hours as a minimum; 65% of the cátedras were below this figure.

Cátedras with more total hours tended to devote a much higher proportion of the time to practical work, while those having the most inadequate number of teaching hours usually devoted most of their time to large group instruction, i.e., to academic or clinical lectures. Furthermore, in 16 cátedras, constituting more than 20% of the total, no individual work with patients was carried on by students in hospital or outpatient department. In an additional 11 cátedras, only hospital experience was provided, indicating that in almost 40% no individual work was done with outpatients, a most essential part of pediatric instruction.

Information on the relationship of pediatric hours to total hours of instruction in the entire medical curriculum was available from 47 cátedras. Among these the proportion ranged from 6.9% to 1.5% with a median of 4.3% Almost all schools with percentages over 5 had more than 300 hours devoted to pediatrics.

Distribution of hospital beds showed in general an adequate supply of clinical material, although four cátedras with 820 students reported no hospital beds at all. The highest figure was 690, and some schools had so many beds to take care of that the burden may distract necessary attention from educational matters.

Infectious disease beds were generally available, but differentiation needs to be made by type of infection. In some hospitals placement of children on general infectious disease wards resulted in neglect of the pediatric aspects of the disease process and of the child as a growing person.

In general, more attention needs to be given to the emotional problems of the hospitalized child.

Hospital records were frequently inadequate and laboratory services insufficient.

Relatively few centers carry out modern fluid and electrolyte therapy with high efficiency.

Newborn nurseries varied from very good to very poor, and there is an unfortunate tendency to have nurseries supplant the existing traditional plan of "rooming-in."

More than 50% of faculty members devoted less than one-quarter of their time to teaching activities. Only two schools had full-time teachers in pediatrics. Proportion of full-time teachers needed will vary with many factors, but it appears impossible to carry on a proper modern program without at least one full-time person to give continuity to instruction.

Analysis of teaching time showed enormous variation in the proportion of teaching hours to student body. A ratio was derived by totaling all the hours devoted to the school by the faculty members listed and dividing this by the number of students in the class. Variation existed from more than 224 faculty hours per student to 1. In general, there was serious lack of faculty time.

Definition of the term "cátedra," or chair, varies from one country to another, in some representing a single course and in others an entire department. In some schools clinical pediatrics of older infants and children is separated from puericulture, which usually deals with normal growth and development, child hygiene, and diseases of infancy. There are many advantages to teaching pediatrics as a whole, correlating growth and care of the normal child with problems of disease throughout this entire period.

Increased attention to research is essential to develop high level teaching programs.

Analysis of procedures carried out by students indicated that most of them had experience with history taking, physical examination, and observation of treatment and operations. A large gap existed in laboratory procedures, which were included as a student exercise in pediatrics in less than half the cátedras.

Investigation of certain key subjects for instruction disclosed a considerable gap in teaching about child health services, crippled children, and children with psychologic and psychiatric problems. Twenty-five cátedras made use of child health centers to some extent for instruction, but only five schools made any attempt to use school health services, a rich source of clinical material. A small number of schools made use of data supplied by public health nurses and social workers, although the majority of these used social workers rather than public health nurses.

As emphasized in the objectives, the survey will have accomplished one of its major goals if this description of the actual situation, with both favorable and unfavorable aspects, is a stimulus to critical self-evaluation and a determined effort for lasting improvement.