Resumen Introducción: De acuerdo con lo sostenido por entidades internacionales la estrategia de Atención Primaria en Salud (APS) es un eje central para mejorar la salud de la población. Al respecto, Chile se ha adscrito al objetivo de fomentar la educación médica orientada hacia la atención primaria. Sin embargo, la evidencia académica muestra una formación con enfoque predominantemente hospitalocéntrico y orientado hacia la especialidad médica. Se desconocen los efectos que tienen los espacios formativos de y en APS sobre los estudiantes. Objetivo: Explorar, desde una perspectiva fenomenológica, las percepciones de los/as internos/as respecto de las modificaciones que advierten durante el internado de APS y la valoración de la experiencia vivida como factor de cambio de sus expectativas laborales o su visión del ejercicio profesional. Método: Estudio cualitativo con enfoque fenomenológico. Se realizaron 15 entrevistas semiestructuradas a internos/as de medicina y profesionales médicos/as recientemente egresados/as que trabajan en APS. Análisis de contenido con triangulación entre investigadores apoyado con software NVivo. Resultados: Las opiniones expresadas por los/as participantes se condicen con lo descrito en la literatura, con importante componente de currículum oculto y modelaje docente que reproduce el paradigma imperante. Se describen una serie de variables que fomentan la percepción del ejercicio en APS como una etapa de transición a la especialidad, a lo que se suma la invisibilización de la medicina familiar como especialidad. Conclusiones: Si bien el internado de APS no logra cambiar las expectativas laborales a largo plazo, puede influir efectivamente en las de corto plazo. Además, permite generar un pensamiento crítico respecto a los lineamientos actuales en educación médica y la estrategia de APS, promotores esenciales para un cambio de paradigma.

Abstract Introduction: According to international institutions, Primary Health Care (PHC) strategy is the central axis to improve the population’s health. In this regard, Chile ascribes to promote medical education guided toward primary care. However, the facts show ME with a hospital-centered focus and oriented to specialty. The effects of formative instances about and in PHC on medical students are unknown. Objective: To explore from a phenomenological perspective the intern’s perception regarding the changes that occur during the PHC internship and the assessment of the experience as a change factor of their job expectation or the professional exercise view. Method: Qualitative research with phenomenological approach. 15 semi-structured interviews were performed to interns who approved PCH internship and recently graduated physicians working in primary care centers. Therefore, information was analyzed with investigator triangulation strategy using NVivo software. Results: The opinions presented by the participants coincide with the literature showing the presence of hidden curriculum and role modeling which reproduces the prevailing paradigm. A series of variables that promote the practice in primary care perception as a transition to the specialty are described, including the invisibility of family medicine as a specialty. Conclusions: Even though the PHC internship does not change the long-term professional expectations, it could influence the short-term expectations. Besides, it allows to generate critical thinking about the ongoing guidelines on medical education and the PHC strategy, being these essential promoters for a paradigm change.

Resumo A América Latina tornou-se um dos epicentros da pandemia de Covid-19, com uma crise sanitária e humanitária. O objetivo do artigo é analisar as estratégias implementadas por países da Região para enfrentar a pandemia e o papel da Atenção Primária à Saúde, ponderando obstáculos e potencialidades. Foram analisados os casos de Bolívia, Brasil, Chile, Colômbia, Cuba, Uruguai e Venezuela. Os sete países adotaram estratégias de distanciamento social diversas com diferentes graus de sustentabilidade. As respostas enfatizaram mais a assistência hospitalar do que a vigilância, a identificação de casos, o rastreamento dos contatos e a viabilização de condições adequadas para isolamento. Em quase todos os casos estudados, foi subestimada a capacidade dos serviços de atenção primária no território. Ainda assim, iniciativas de atenção primária com enfoque territorial e comunitário buscaram integrar a vigilância à saúde com a promoção, prevenção e cuidado, apesar de implantação parcial. Nesse contexto, uma atenção primária integral e integrada adquire novo significado e requisita novos desenvolvimentos de forma a contribuir para a recuperação do equilíbrio entre a sociedade e o meio ambiente. A pandemia mostrou a necessidade de repensar os sistemas de atenção à saúde e a importância da atenção primária à saúde integral e integrada.

Abstract Latin America has become one of the epicenters of the COVID-19 pandemic, with a health and humanitarian crisis. The objective of the article is to analyze the strategies implemented by countries in the Region to face the pandemic and the role of Primary Health Care, considering obstacles and potential. The cases of Bolivia, Brazil, Chile, Colombia, Cuba, Uruguay and Venezuela were analyzed. The seven countries have adopted diverse social distancing strategies with varying degrees of sustainability. The responses emphasized hospital care more than surveillance, case identification, contact tracking, and enabling adequate conditions for isolation. In almost all cases studied, the capacity of primary care services in the territory was underestimated. Even so, primary care initiatives with a territorial and community focus sought to integrate health surveillance with promotion, prevention and care, despite partial implementation. In this context, comprehensive and integrated primary care takes on new meaning and requires new developments in order to contribute to the recovery of the balance between society and the environment. The pandemic showed the need to rethink health care systems and the importance of primary care for comprehensive and integrated health.

Resumen América Latina se ha convertido en uno de los epicentros de la pandemia de Covid-19, con una crisis sanitaria y humanitaria. El objetivo del artículo es analizar las medidas para enfrentar la pandemia en países de la Región y el rol de la Atención Primaria de Salud, discutiendo obstáculos y potencialidades. Son analizados los casos de Bolivia, Brasil, Chile, Colombia, Cuba, Uruguay y Venezuela. Los siete países adoptaran medidas de aislamiento social de diferentes alcances, con grados distintos de sostenibilidad. El énfasis de las respuestas estuvo más en la atención hospitalaria que en la vigilancia de la salud, identificación de casos y contactos y disposición de condiciones adecuadas para el confinamiento. En casi todos los países, se subestimó la capacidad de los servicios de atención primária en el territorio. No obstante, iniciativas de enfoque territorial y comunitario buscaron integrar la vigilancia de la salud con actividades de promoción, prevención y cuidado, aunque con alcance parcial. En este contexto la Atención Primaria Integral e integrada toma nuevo sentido y reclama desarrollos que contribuyan a recobrar el equilibrio entre sociedad y medio ambiente. Es necesario repensar los sistemas de salud y la importancia de la atención primaria de salud integrada e integral.

Background: It is unknown if medical education is preparing physicians to successfully work at primary health care settings. Aim: To explore what are the perceptions of faculty members and students about the type of physician needed and if medical education is coherent with the practice of primary health care. Material and Methods: Fifteen semi-structured interviews to key informants from faculty members and ten focus groups with students were carried out. Results: Important influences of role modelling and hidden curriculum were found, especially in relation to the type of physician needed, generalist or specialist, and in relation to the places where the clinical practices were done. Although primary health care was declared in the profiles, most of clinical practices were done at hospitals and supervised by specialists. Working at primary health care is seen as a temporary work, not valued by professionals nor by the society. Conclusions: Medical Schools are not preparing professionals for primary health care but for hospital care and specialized medicine.