Res Medica, Volume 268, Issue 1, 2004
Page 1 of 3
West of the Andes - Undergraduate Medical Teaching
in Chile, South America
David Apps
Reader in Biomedical Sciences
School of Biomedical & Clinical Laboratory Sciences,
Abstract
Wrenching myself away from Edinburgh in winter. I made two working visits of 2-3 weeks each to the
University of Concepcion, in central Chile, at the invitation of Drs Carlos Gonzalez and Mario Munoz, the
vice-deans of Science and Medicine respectively. My remit was to meet with undergraduate course organizers
and comment on their plans for a new medical curriculum, in the light of my experience as the first course
director of Year 1 of Edinburgh’s new curriculum, and as module organizer for Nutrition and Digestion, one of
the six modules that make up the Biomedical Science component of this first year. Edinburgh’s new course,
which originally had the slightly embarrassing title ‘Vision 2000’ , was implemented in October 1998, and has
been extensively revised for the new semester system. In Concepcion the new medical curriculum was
introduced in February of this year.
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Res Medica, Volume 268, Issue 1, 2004: 7-8
doi:10.2218/resmedica.v268i1.1014
Apps, D, West of the Andes - Undergraduate Medical Teaching in Chile, South America.,
Res Medica, Volume 268, Issue 1 2004, pp.7-8
doi:10.2218/resmedica.v268i1.1014
W est of the Andes - Undergraduate Medical Teaching in Chile,
South America.
DAVID APPS
Reader in Biomedical Sciences
S c h o o l o f B i o m e d i c a l & C li n ic a l L a b o r a t o r y S c ie n c e s , H u g h R o b s o n B u ild in g , G e o r g e S q u a r e , E D I N B U R G H , E H 8 9 X D
W re n ch in g m y s e lf aw ay fr o m Edi nb urgh in w inter. I made t w o w o r k i n g
c u r ric u lu m reform.
visi ts o f 2-3 weeks each to the U n i v e r s i t y o f C once pci on , in central
Org anization, the re m it o f w h ic h was to oversee c u r ric u lu m development,
Chile, at the invitatio n o f Drs Carlos Gonzalez and M a r i o M u n o z , the
to m a i n t a i n a b a la nce b e tw e e n the c o n t r i b u t i o n s o f the d i f f e r e n t
Th is led to the creation o f the M e d ic a l Teaching
vice-deans o f Science and M e d ic in e respectively. M y remit was to meet
Departments or disciplines, to develop case-based learning so as to integrate
w i t h undergraduate course organizers and com men t on their plans fo r a
scientific, clinic al, sociolo gical and ethical approaches to cases, to oversee
new medical curriculu m , in the lig h t o f m y experience as the first course
s tu d e n ts’
director o f Year 1 o f E d inbu rg h’s new curric ulum , and as module organizer
c o m m unica ti on and consultation skills ), and to coo rdinate assessment
fo r N u tr it io n and Digestion, one o f the six mo du les that make up the
th roughou t the curriculu m . O u r experience was that the creation o f the
Biomed ic al Science compone nt o f this first year. E d inbu rg h’s ne w course,
M T O , w i t h its o w n budget f o r the d e liv e ry o f medical teaching, was very
personal
an d
p ro fe s s io n a l
de velo p m e n t
(in c lu d in g
w h ic h o r ig i n a l l y had the slig h tl y embarrassing title ‘ V isio n 2 0 0 0 ’ , was
he lpful in ove rc om in g c onflicts between departments.
imple mented in Octobe r 1998, and has been exte nsively revised fo r the
creation o f several new posts, although some m embers o f the M T O were
new semester system.
e x i s t i n g s ta ff, seco nd ed f r o m th e i r d e p a rt m e n t a l jo b s .
In Concepcion the new medical cu rri cu lu m was
introduced in February o f this year.
It involv e d the
Acade m ic
departments remain the basic organizational units in Concepcion; on the
other hand there is a real appetite fo r m o dern iz ation among the teaching
Concepcion lies some 500 k m south o f Santiago, close to the coast, on the
s ta f f - the pharmacologists, in particular, have been enthusiastic users o f
estuary o f the B ío - B ío river. N o-o ne w o u ld call it a be autifu l c ity - it was
case-based teaching methods fo r some years, and in the new course medical
almost com ple te ly razed by an earthquake in 1960, and has been reb uilt
m i c r o b i o l o g y is ta ugh t in the same way. T h is is a v e r y pr og re ssiv e
in a rather u n if o rm , uti litarian style, but it has a v i s ito r- frie n d ly layout o f
de velopment that w i l l ce rtainly be taken further, even tho ugh it puts a big
broad, leafy streets, b u il t to a gr id -p la n around the central square, the
demand on s ta f f time. M a n y E din bu rg h students w i l l have encountered
P la za d e la Indepencia. H e r e in 1818 ‘ El Libe rador', B e rn a rd o O 'H ig g in s ,
Drs Ma riana Do m in gue z and M a rc elo Fasce, colleagues fr o m Concepcion
pr oclaim ed the independence o f Chile, and n o w the Penquistas (natives
w h o have a pa rticular interest in course development, and w h o visited us
o f C oncepcion) sit there listenin g to music or po lit ic a l speeches, eating
in the autumn o f 2003 and attended ma ny practical and C B L sessions in
ice-cream, ha ving th eir shoes polished or u n in h ib ite d ly expressing their
years 1 and 2 o f the Edinbu rgh course.
aff ecti on fo r each other.
Th e U n i v e r s i ty o f C on ce pc ion is the th ird-
oldest in C hile, and one o f the largest; it has a ma rin e b i o l o g y un it in
I was rather surprised not to fi nd mu ch human nu tr it io n in the course -
nearby D ichato, and other out-stations fu rthe r south in Lo s Angeles and
this is an impo rta nt topic that is easy fo r students to com prehend in the
C hilian.
It is partially governmen t-funde d, un lik e the private Cath olic
con text o f basic medical sciences. N o r was there any early teaching o f
un iversity on the outskirts o f the city. The spacious ma in campus, just
basic clinic al skills, such as blood-pressure measurement and respiratory
a f e w m i n u t e s ' w a l k f r o m the centre, has m a n y m o d e rn b u il d i n g s
fu n ctio n testing, or even first aid and resuscitation. Teaching o f simple
surrou nding a broad central plaza, and its handsome w h ite cam panile (no
clinic al skills fr o m the be ginn in g o f the course helps student morale, as
longer open to visitors, after several unfortunate events in recent years) is
w i th o u t it they can easily lose sight o f their educational aims; further more
a local landmark. A small lake is home to a f a m i ly o f black-necked swans,
mu c h o f this teaching can be done by nurses and first-aid instructors, and
some o f w h ic h were rum ou re d to have been caught and eaten by hu ng ry
w hen students eventua lly arrive in clinics they are equipped w ith some
students. I was struck by the relaxed but (the swans no tw iths tanding )
useful skills. I suspect that arranging such sessions is a d m in is tra tiv ely
respectful atmosphere - there were no g r a ffiti or litter, but ple n ty o f
d i f f i c u lt in Chile, wher e a great deal o f me dicine is conducted privately.
students sitting on the grass or under the trees, reading and talking . Behind
H o w e ve r the fra m e w o r k o f the new course is in place, and given the
the lake is a monu ment to the ma ny s ta f f and students w h o disappeared
enthusiasm and vision o f the s ta f f I met, there are certain to be further
du ring the p o lit ic a l violence f o l l o w i n g the m i l i ta r y coup in 1973.
developments in the c o m in g years. There is already a mo ve to de liver
parts o f the cu rri cu lu m elect ronically: medical students have their o w n
The previous medical cu rri cu lu m was in m any w a y like E d in b u rg h ’s, pre-
w ell equipped co mpu te r lab, presided over by a c o m p u ti n g o ff ic e r whose
1998, in that it was discipline-based, relied extensively on didactic teaching,
console shows every screen on the room
and was sharply d iv id e d into c lin ic a l and pr e- cl inic al phases.
surfers beware.
These
features have largely disappeared fro m the new curriculu m : biom edical
sciences are n o w taught thro ug h a series o f integrated, system-based
modules, w h ic h are spread over f iv e semesters and include contributions
f r o m th e d e p a r t m e n t s o f p h y s i o l o g y , p h a r m a c o l o g y , p a t h o l o g y ,
b io c h e m is tr y and m ic ro b io lo g y .
A n a t o m y stands p a rtl y outside this
plan, and some o f it is still taught in separate modules: this perhaps
reflects the contin ue d existence o f academic departments, some w ith
p o w e rfu l and con servat ive heads. A n o th e r feature that I notic ed and
commented on was the relative lack o f ‘ social m e dicine' and pu blic health
in the f i r s t th re e years o f te a c h in g , and the la ck o f e m phas is on
c o m m u n i c a t i o n s k ills , eth ic al awareness, personal and p rofe s sion al
de velopm ent and so on, in the fo rm al c urriculu m . In E dinb urgh w e found
that conflicts between co m pe ting ‘ k in g d o m s ’ were cou nter-productive,
in that each discipline insisted on de fin in g its o w n inpu t to the cur ricu lum ,
resulting in far more detail than the students cou ld reasonably be expected
to assimilate; ‘ info rm atio n o v e r- loa d’ , as was recognized (and castigated)
by the G M C in ‘ T o m o r r o w ’s D o c to rs ’ , one o f the d r iv i n g forces fo r
Plaza d e la Indepencia, C oncepcion
7 • RES M E D IC A C CLXVIII (I)
M y overw helm ing im pression o f C hile w as o f the w arm th and kindness
o f the people. A s I cleared custom s in Santiago a cab driver grabbed my
bag; w hen I explained I w as ju st changing planes he let it go, shook my
hand and w elcom ed me to Chile. T his w as typical - encounters in shops
and restaurants w ere invariably friendly, and I w as entertained and show n
around not ju s t by C arlos and M ario, but by m any kind people, especially
Sergio M ancinelli, the genial D ean o f Science. He took m e on several
tours by car, and also invited me for a w eekend at his sm all fruit farm in
T ucapel. a village in the foothills o f the C ordillera, w here I w as treated to
an asado (large-sized barbecue). A fter dinner w e took to the fields w ith a
bottle o f pisco (the C hilean national drink, a bit like grappa) to look at the
stars - I could ju st about pick out the Southern C ross, but C arlos the
freem ason w as able to nam e them all.
A rco Universidad de Concepcion - T he University Campus
T here w ere som e other aspects o f teaching that I w ould have liked to have
exp lo red , but did not have the opportunity. F or exam ple, there w ere
form al classes in E nglish, and the students that I spoke w ith all spoke
g o o d E n g lis h ( o th e r w is e th e r e w o u ld h a v e b e e n p r e c io u s little
com m unication b etw een us), but I did not com e across any teaching that
is co n d u cted in E nglish, and rem ain uncertain w hether that w ould be
desirable. T he indigenous p opulation o f Chile is relatively sm all, unlike
those in B olivia or Peru, but C hileans com e from a great range o f ethnic
b ack g ro u n d s, and I w o u ld h ave liked know to w h at ex ten t cu ltu ral
d ifferences w ould have a bearing on patient care, or w hether this is given
m uch consideration in the course. Finally, because o f m y own background
as a non-clinical teach er and also because o f the tim e o f m y visits, both o f
w hich w ere during the C hilean sum m er vacation, I w as not able to sit in
on any classes; nor w as I able to speak to m any clinicians or discuss the
clinical part o f the course.
M y visits w ere enorm ously enjoyable - I hope that m y advice and the
report I w rote w ere also o f som e use to m y hosts. S om e o f the problem s
they face with their new curriculum , both financial and political (university
politics, that is) are daunting. I w ould certainly recom m end C hile as a
destination for any student seeking an elective attachm ent in a fascinating,
beautiful and friendly country. M ore sta ff visits are planned, in both
directions. Will I go back? C ertainly, if I'm invited - and, as my granny
used to say, if I'm spared.
M y tim etable left m y quite a lot o f free tim e betw een m eetings, w hich I
used to explore the city. C hile is the m ost developed country in South
A m erica, and Concepcion one o f its m ost industrialised cities; nevertheless
it seem ed to m e quite exotic. Som e o f the streets around the Plaza are
barred to traffic, and in the evenings these are filled w ith m usicians,
haw kers and stalls offering everything from cherries or plum s to copper
plates depicting Salvador A llende, Che G uevara or even G eneral Pinochet;
or for a hundred pesos you can view the m oon through a large telescope.
I w as content to sit in one o f the outdoor cafes and w atch the parade o f
passers-by. T alcahuano, the adjoining port, is C h ile’s largest naval base.
H ere one can see and visit the Huascar, a veteran ironclad w ar-ship that
w as built in B irkenhead for the Peruvian navy and used during the w ar
w ith C hile (1 8 7 9 ), w hen it w as lured into a trap by several C hilean
vessels and ev entually taken. I w as even m ore interested in the m any sea­
food restaurants in nearby Lenga, som e o f w hich w ere set up in governm ent
job-creatio n schem es - their empanadas mariscos (little pies containing
shellfish in a sauce) w ere indescribably delicious. A lunch bill o f four
thousand pesos ($4,000.00) looks alarm ing, but is less than £4.
Sem ester
1
2
3
4
5
6
7
8
9
10
Introduction to m edicine
Introduction to biom edical
sciences 1
Introduction to biom edical
sciences 2
N euroscience
Haem atology
Internal m edicine 1
Internal m edicine 2
O rientation and
basic inform ation
O rientation for
m edical studies
Evidence-based
m edicine
Endocrine system
Renal system
Surgery 1
Surgery 2
O bstetrics & gynaecology
O bstetrics & gynaecology
Paediatrics
Student Life on Campus
G eneral and organic
chem istry
Introduction to
m edicine
G eneral anatom y
English
General and topographical
anatom y
M edical
anthropology
C ardiovascular system
Infection
General pathology
Public health
Public health
R espiratory system
M edical psychology
Digestive system
M edical law
M ental health
M ental health
O u tlin e pla n of the undergraduate m ed ic a l course at the U niversity of C oncepcion
8 • RES M EDICA CCLXVIII (I)