Aim This article analyses the institutional practices that shape socio-health care for cancer along the disease trajectory—from screening to survivorship—in five countries with the highest cancer survival rates: Australia, Belgium, Canada, Costa Rica, and Japan. Methods: Drawing on social practice theory, the study applies a critical documentary analysis of 115 institutional and scientific sources, including national cancer plans, legislation, and clinical guidelines, to examine how material elements, practical knowledge, and shared meanings are articulated in policy and practice. Results: Findings reveal consistent patterns across the five high-survival countries, including the strong institutionalisation of screening programmes, continuous strengthening of diagnostic infrastructure, and establishment of interdisciplinary teams. However, significant challenges persist in addressing territorial inequalities, ensuring equitable access, and protecting patients from out-of-pocket costs associated with innovative therapies. Japan is distinguished by its population-based endoscopic screening for gastric cancer, while Australia and Canada lead in culturally adapted, community-based approaches. Costa Rica shows partial implementation through regional pilots, and Belgium displays high diagnostic and therapeutic integration with European networks. Psychosocial, financial, and legal support emerge as indispensable dimensions for achieving equitable and comprehensive cancer care. Non-governmental organisations and community networks play a central role in providing counselling, subsidies, and reintegration support, although their reach varies across contexts. Overall, the study underscores that biomedical innovation alone is insufficient: cancer survival depends on the effective coordination of biomedical, social, cultural, and legal policies within integrated socio-health care systems that prioritise equity and quality of life as key pillars of public cancer policy. In high-performing systems, survivorship is not merely the result of clinical coverage but emerges from an institutional ecosystem that bridges biological recovery and social citizenship.

Objective The rapid growth in the cancer survivor population in Chile and Latin America raises new challenges in addressing their care needs. This study assesses the health status and compares the quality of care and quality of life in cancer survivors at a primary care network and a private cancer centre in Santiago, Chile. Design Retrospective cohort study. Setting Three primary care clinics and one cancer centre in Chile. Participants All breast and colorectal cancer patients identified from a primary care retrospective cohort of 61 174 were followed from 2018 to 2023 and compared with an equivalent sample of patients from a university cancer centre identified during the same period. Outcome measures Quality of care was assessed based on American Cancer Society standards, while quality of life was measured using the EuroQol 5 Dimensions-5 Levels survey instrument. Results A total of 420 cancer survivors participated in the study; 208 from primary care and 212 from the cancer centre. All participants received substandard care. Patients in primary care had lower educational levels and higher rates of comorbidity. They reported a lower quality of life score (72.22 vs 78.43, p<0.001), a higher prevalence of chronic pain (37.02% vs 25.6%, p=0.016) and more severe mental health symptoms (19.89% vs 10.05%, p=0.03). Differences in educational level and cancer stage at diagnosis explained the observed disparities in chronic pain and mental health disorders between the two populations. Primary care patients received more psychosocial care (OR=2.29; 95% CI: 1.55 to 3.39), cardiovascular assessment (OR=2.66; 95% CI:2.17 to 3.26) and psychosocial evaluations (OR: 9.07; 95% CI:4.75 to 17.32). Conclusion Cancer survivors face a significant disease burden and receive substandard care in Chile. As the primary source of care for this population, primary care is challenged to better integrate with speciality care to develop an effective shared care model for cancer survivors.

BACKGROUND:Cancer is a major global cause of death, and primary care is crucial for cancer prevention and early detection. However, there is conflicting information on the effectiveness, implementation, and sustainability of cancer control interventions in primary care. OBJECTIVE:This study aimed to summarize the evidence for cancer control in primary care, focussing on identifying relevant factors for implementation and sustainability. STUDY SETTING AND DESIGN:We conducted a narrative, mixed-methods review of systematic reviews, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Four databases were screened, and two independent reviewers selected studies reporting on cancer prevention, screening, or early detection in primary or community settings. We analysed findings using the extended Reach-Effectiveness-Adopt-Implementation-Maintenance (RE-AIM) Framework. PRINCIPAL FINDINGS:From the 37 reviews that met the inclusion criteria, 6 focussed on primary prevention, 23 on screening, and 12 on early detection. Most reviews (78%) addressed intervention effectiveness, such as HPV vaccination, tobacco cessation, and cervical, breast, and colorectal screening. One-third of the reviews mentioned adoption and implementation factors, including barriers and facilitators to the implementation of cancer screening programs. Only one review addressed maintenance and sustainability factors, exploring continuous resources and funding strategies. CONCLUSION:While numerous interventions are effective for cancer prevention and detection in primary care, literature on implementation and sustainability strategies is lacking. Focusing on continuous resources and funding for cancer strategies in primary care may aid sustainability. Future research should prioritize reporting on implementation and sustainability factors to enhance cancer prevention and control in primary care settings.

Background Cancer is a growing global health issue, particularly in middle- and high-income countries. National Cancer Control Plans (NCCPs) have emerged as a strategic response to reduce this burden. Primary care plays a crucial role across the cancer care continuum, yet its systematic inclusion in NCCPs remains unclear—especially in countries facing significant epidemiological challenges. Methods This study employed a systematic qualitative design based on document analysis. Using the READ (Ready material, Extract data, Analyze, Distil) model, we examined the integration of primary care policies and practices in eight NCCPs: four from non-Latin American high-income countries (NLAHIc—Australia, Canada, the United States, and the United Kingdom) and four from Latin American middle-income countries (LATAMc—Argentina, Colombia, Chile, and Mexico). Covidence software facilitated the systematic text review, and a set of evidence-based key performance indicators (KPIs) was developed to guide the analysis. Results Primary care integration varied across countries. LATAMc NCCPs showed greater inclusion of primary care than NLAHIc. Health promotion strategies were more consistently present in NLAHIc, while LATAMc better integrated primary prevention into primary care. However, only 50 % of KPIs for secondary prevention and 15 % for survivorship care were included in LATAMc. Palliative care was more consistently integrated in LATAMc (75 %) than in NLAHIc (33 %).Policy SummaryThis is the first study to benchmark NCCPs from Latin American and high-income countries using evidence-based KPIs to assess primary care involvement in cancer control. Findings highlight an urgent need to strengthen primary care integration. LATAMc should improve secondary prevention and survivorship care, while NLAHIc need to better incorporate primary prevention and palliative care into their NCCPs.

BackgroundMedical professionalism is an essential characteristic of excellent physicians and in most need of training. It should involve areas not included in traditional frameworks, such as physicians’ self-care and social accountability. This study aims to develop a comprehensive self-assessment instrument to improve medical professionalism training in medical students.MethodsMixed-methods design that integrated a scoping review, a qualitative framework method, and a cross-sectional design. The qualitative phase included focus groups with 19 medical students and 9 in-depth interviews with clinician educators. The quantitative phase included descriptive and exploratory factor analysis of 112 interviews to fifth-year medical students at the Catholic University in Chile.ResultsIn the scoping review, 290 articles were screened. The Professionalism Mini-Evaluation Exercise (P-MEX) instrument was selected as the reference instrument. The qualitative phase generated 188 open codes and 468 quotes, which were analyzed using the Atlas-ti 8.0 software®. Three levels of professional assessment emerged. The micro level included self-reflection and self-care skills; the meso level included doctor–patient relationship, team interaction, and management skills; and the macro level included social accountability skills. The new adapted instrument (P-MEX-LA) contained 30 items and achieved high reliability and internal consistency (Omega 0.86; Cronbach’s alpha 0.82). Self-care and social accountability skills were the areas with the lowest level of achievement by students.DiscussionA Latin American self-assessment version of the P-MEX instrument (P-MEX-LA) that included self-care and social accountability skills achieved high content validity, internal consistency, and reliability. It could contribute to improving medical professionalism training among medical students.

Introduction: The global cancer burden is increasing. Current global evidence indicates there will be a 47% rise of cancer cases for the period 2020-2040. The cancer rate differential also is evident within countries and regions. Efforts have been used to reduce the health disparities; however, the inequity prevails. One potential way to help reduce the disparity is through advocacy by physicians. Methods: Two recent systematic review articles on advocacy among physicians note that physicians are unlikely to be taught advocacy in medical education, and also note there are no advocacy competencies or skill sets that are either taught or valued in medical education. We explore literature and develop a model to understand the components of advocacy in medical education, specifically in resident training. We follow the model's main components by examining principles of advocacy, relevant domains of advocacy, and competencies and values for advocacy education. Results: Four ethical principles of advocacy education are identified: beneficence, non-maleficence, autonomy, and justice. These principles must be applied in meaningful, culturally sensitive, respectful, and promotion of the well-being ways. Three domains are identified: the practice domain (provider-patient interaction), the community domain (provider-community collaboration), and the health policy domain (the larger social environment). Advocacy occurs differently within each domain. Finally, competencies in the form of knowledge, skills, and values are described. We present a table noting where each competency occurs (by domain) as well as the value of each knowledge and skill. Policy summary: The significance of including advocacy instruction in medical education requires a change in the current medical education field. Besides valuing the concept of including advocacy, principles, domains, and competencies of inclusion are critical. In summary, we encourage the inclusion of advocacy education in resident medical programs so physicians become competent medical providers at diverse levels of society.

PurposeProfessional Identity Formation is the dynamic evolution to “think, act and feel” to become part of a professional community. This document presents the development and the study that aimed to assess the usability of a m-Learning Identity App (MLIA) focused on the formation of professional identity among undergraduate medical students.Design/methodology/approachMLIA development included four phases: Conceptual, prototype, pilot and implementation, before further deployment. The conceptual model was designed by eight faculty members from three Latin American universities. The prototype was developed and tested with stakeholders. The pilot was performed during 5 weeks before the implementation. Cross-sectional data collected during implementation from 138 medical students who completed a survey to assess the usability of MLIA are presented. During deployment, 977 posts were made on Professional Identity Formation, and examples of these posts are presented.FindingsThe prototype and pilot phases demanded improvements. The survey explored (1) Familiarity, (2) Perceived ease of use, (3) Perceived usefulness for Professional Identity Formation, (4) Satisfaction, (5) Intention to reuse (6) Digital aesthetics and (7) Safety. Results from the usability assessment suggest that students perceived MLIA as a secure space with positive aesthetics and ease of use.Research limitations/implicationsImportant limitations of the present study include, firstly, that it does not provide information on the effectiveness of the MLIA in shaping professional identity in medical students, it focuses exclusively on its development (conceptual model, prototype, pilot and implementation) and usability. Secondly, the study design did not consider a control group and, therefore, does not provide information on how the App compares with other strategies addressing self-reflection and sharing of meaningful experiences related to professional identity.Originality/valueMLIA introduces a different approach to education, simulating a secure, easy-to-use, social media with a friendly interface in a safe environment to share academic and motivational moments, transitioning from being to becoming a professional.

Objective: The goal of this study was to report on the development and early usability of a new interactive mHealth app for reducing cardiovascular risk in primary care patients of low socioeconomic status attending clinics in Chile. Design: Mixed-methods design with qualitative and quantitative components. Setting: Three Chilean primary care clinics located in one urban (Santiago) and two rural areas (San Clemente and Chiguayante). Each clinic serves a population of about 24,000 people of generally low socioeconomic status with an average of 8.5 years of education. Methods: A qualitative co-design participatory framework was used to develop the Mi Salud-APS mHealth app. Three iterations of virtual workshops were held with healthcare providers and patient participants to develop the new app. Once developed, the usability phase identified, invited and followed up for 3 months a sample of primary care patients with moderate ( N = 119) or high ( N = 329) cardiovascular risk. Results: A total of 24 healthcare providers and 24 patients participated in the developmental workshops. Three emergent categories represented the core attributes for the mHealth app design: ‘Friendly’, ‘Interactive’ and ‘Pertinent’. In the usability phase of the sample of 448 patients, 98% downloaded the app, and 64.6% of them logged in and used it for an average of 1.46 (0.5–10) times weekly. Conclusion: Findings suggest that patient and healthcare provider contributions to the development of the mHealth app accurately reflect the interests and experiences of both groups and together helped achieve the high usability levels observed among primary care patients enrolled in clinics in underserved communities.

Objectives The burden of cancer is increasing rapidly in Latin America. Primary care has an essential role in cancer prevention, but implementation levels of prevention practices are not well known. This study evaluated implementation levels and associated factors of cancer preventive practices in primary care over time. Study design The study incorporated a retrospective multicentre cohort study. Methods A population of 59,949 patients registered at three primary care clinics was followed from January 2018 to December 2022 in Santiago, Chile. We studied human papillomavirus (HPV) and hepatitis B virus (HBV) immunisation, brief counselling for smoking cessation and alcohol consumption, and cervical and breast cancer screening practices. Standardised electronic medical records were utilised as the source of information. Social, clinical, and organisational factors associated with prevention practices were studied. Results The cohort attrition level was 17.1%. Most of the population was of a low socioeconomic status, and 70% visited a primary health centre yearly. Implementation rates of immunisation practices were 90.84% for HPV and 80.94% for HBV in 2022. In contrast, brief counselling for smoking and alcohol consumption was below 20% during the study period. Cervical cancer screening decreased by 25.58% between 2018 and 2022, whereas breast cancer screening reached only 41.71% of the target population. Opportunistic medical visits were strongly associated with brief counselling and breast cancer screening. Conclusion Implementation practices for cancer prevention in a Chilean primary care cohort are high for immunisation and very low for brief counselling and screening practices. A comprehensive non-medical-based model is needed to improve cancer prevention in primary care.

Introduction: There is evidence of burnout experienced by faculty due to the overload involved in combining the academic and research roles and the practice with patients. It is interesting to generate knowledge on initiatives that favor learning individual and institutional self-care strategies. The study aims to examine the implementation of the program "Scientific Basis of Well-Being and Self-Care Tools for Health Professionals" through burnout and well-being indicators. Material and methods: One hundred twenty participants from two cohorts completed questionnaires. Burnout, Mindfulness, Psychosocial Well-being, Vitality, and Affectivity indicators were measured. The quantitative study compared the measurements in two moments. Change t1-t2 was analyzed with W Wilcoxon-test and U Mann-Whitney-test. Cronbach's and McDonald's tests were used to analyze the instruments' reliability. Results: A five-week online program was implemented in the Moodle platform. Asynchronous individual activities and learning assessments were incorporated. Six tutors were trained in wellbeing and self-compassion. Levels of wellbeing and burnout changed post-program favorably (p-value < 0.01). The change is maintained when analyzing the variables separated by sex, profession, and cohort, except the depersonalization, personal accomplishment, and positive affectivity variables. Questionnaires achieved reliability > 0.7. Conclusion: A five-week self-care online program effectively reduced emotional exhaustion and promoted strategies that enhanced dispositional mindfulness and self-regulation. Short online courses that encourage learning self-care strategies could be part of programs that develop teaching competencies in health professionals. (c) 2023 The Author(s). Published by Elsevier Espa & ntilde;a, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Background: Breast cancer is the leading cause of death from cancer among women in Latin America. Most Latin American countries started national mammogram screening programs a decade ago. The implementation level and effects of screening programs in Latin America have not been evaluated. Aim: To evaluate the association between screening programs implementation and breast cancer mortality in selected North American and European countries compared to a group of Latin American countries with national screening programs. Methods: The study applied an ecological design with secondary data from official national and international sources. Join point regression analysis was conducted to describe the trends in mortality rates in a group of five Latin American countries (Brazil, Chile, Colombia, Costa Rica and Mexico) with five Non-Latin American countries (Canada, Spain, Sweden, United Kingdom and the United States of America). The association between screening and mortality rates was explored using correlation and linear regression. National cancer plans were assessed to describe screening strategies among selected countries. Results: A significant reduction in standardized breast cancer mortality rates was observed in all Non-Latin American countries with an Average Annual Percent Change (AAPC) of -2.00 (p<.05, 95%CI [-3.33, -0.70]) for the period 2010-2020. In contrast, Latin American countries reported a significant increase in the AAPC of +1.38 (p<.05, 95%CI [0.86,1.76]) in breast cancer mortality rates for the period 2010-2020. For Latin American countries, with screening rates below 50%, there was no correlation between screening and mortality rates for the period 1985-2020 (r = -0.17, p = .78). For non-Latin American countries, with screening rates over 70%, the linear regression model explained significantly 55% of the variance in mortality rates (R2aj =.55, F (5,14) = 5.69, p = .005), with a negative and significant effect of mammogram screening on mortality rates (β = -0.14, p = .01). The National Plans analysis revealed an opportunistic screening model for Latin American countries and an organized-systematic model in Non-Latin American countries. Conclusion: There is an association between the level of implementation of screening programs and mortality rates from breast cancer. Latin American countries should transform their opportunistic strategy into an organized-systematic model.

PurposeLatin American reports on genetic cancer risk assessments are scarce. In Chile, current breast cancer (BC) guidelines do not define strategies for germline genetic testing. Our study sought to quantify the disparities in access to genetic testing in Chilean BC patients, according to international standards and their clinical characteristics to explore improvement strategies.MethodsRetrospective analysis of invasive BC databases including patients treated in a Public Hospital (PH) and in an Academic Private Center (AC) in Santiago, Chile between 2012 and 2021.ResultsOf 5438 BC patients, 3955 had enough data for National Comprehensive Cancer Network (NCCN) categorization. From these, 1911 (48.3%) fulfilled NCCN criteria for germline testing, of whom, 300 were tested for germline mutations and 268 with multigene panels. A total of 65 pathogenic variants were found in this subset. As expected, BRCA1/2 mutations were the most frequent (17.7%). Access to genetic testing was higher in AC versus PH (19.6% vs. 10.3%, p = 0.0001). Other variables associated with germline genetic testing were BC diagnosis after 2018, being 45 years old or younger at diagnosis, BC family history (FH), FH of ovarian cancer, non-metastatic disease, and triple-negative subtype.ConclusionIn our cohort, 15% of BC patients who met NCCN criteria for germline testing were effectively tested. This percentage was even lower at the PH. Current recommendations encourage universal genetic testing for BC patients; however, our findings suggest that Chile is far from reaching such a goal and national guidelines in this regard are urgently needed. To our knowledge, this is the first study of its kind in Chile and Latin America.

Antecedentes: El autocuidado aparece como elemento central en la formación de estudiantes de la salud. La falta de estrategias efectivas para desarrollarlo se asocia con una prevalencia del 50% de burnout en esta población. Objetivo: Identificar y analizar estrategias efectivas de valoración e intervención de autocuidado en estudiantes de la salud. Metodología: Se realizó una revisión sistematizada de alcance (scoping review) utilizando métodos estandarizados para valorar la calidad mediante la Scale for the Assessment of Narrative Review Articles. Para el análisis temático de contenido se utilizó el Critical Appraisal Skills Programme. Se revisaron 4 bases de datos que incluyeron Pubmed, Google Scholar, Epistemónikos y Lilacs además de literatura gris. Dos revisores independientes analizaron cada publicación y un experto definió controversias. Resultados: Se identificaron 1682 artículos de los cuales 32 fueron seleccionados. La calidad promedio de los artículos revisados fue de 13 puntos [6 – 14]. El análisis temático identificó dos grupos. Primero, estudios de valoración de autocuidado (N = 12) destacando el World Health Organization Quality-of-Life Scale (WHOQOL-BREF) y el Health Promoting Lifestyle Profile II (HPLP-II); y segundo, estudios de intervenciones efectivas destacando cuatro estrategias: mindfulness (N = 14); intervenciones grupales (N = 8); mentorías (N = 2); e intervenciones curriculares (N = 4). Conclusión. Existe una variedad de estrategias efectivas para valorar y promover el autocuidado en estudiantes de la salud. Los estudios encontrados destacan por ser de buena calidad y aplicables a los diferentes planes de estudio.

Background Cardiovascular disease is a leading cause of death in Latin America. Internationally, low medication adherence is associated with 15% to 40% of excess cardiovascular deaths. In Latin America, the magnitude of low medication adherence and the factors associated with it, are not well known, especially among socially vulnerable populations. The aim of this study is to estimate the magnitude and associated factors of low medication adherence in a socially vulnerable population with high cardiovascular risk in Chile. Methods The study is based on a mixed-methods design. It included a multicenter cross-sectional design of a randomly selected clinical population of 900 participants, and a qualitative design based on the analytical framework model, that included patients and health team members, from three primary care clinics in Chile. Results Only 24.6% from the 886 (out of 900) patients who completed the study had “high” medication adherence, 24.9% had “regular,” and 50.4% had “low” adherence. Depression was the main factor associated with regular and low adherence combined (OR: 2.12; 95%CI:1.55-2.89). Confusion and tiredness were identified as barriers for adherence. Main facilitators reported by patients included better understanding of the medications, and availability of reminders. Clearer information and family support were identified by team members as initiators for improving adherence. Conclusion Low medication adherence is highly prevalent among patients with high cardiovascular risk in a low-income population in Chile. Quantitatively, depression was a significant risk factor for regular and low adherence; qualitatively, confusion and tiredness were identified as barriers. Clearer information and family support are identified as potential facilitators. What is new? What are de clinical implications? ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial Cllinicaltrials.gov Prococol Registration [NCT05395806][1] ### Funding Statement This project is funded by the Chilean National Agency for Research and Development (ANID) (SA20I0001) ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The project was reviewed and approved by the Institutional Review Boards at the Faculty of Medicine Pontificia Universidad Católica de Chile as well as Servicio de Salud Concepción and Servicio de Salud del Maule, Chile (CI200117003). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as [ClinicalTrials.gov][2]. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data referred to in the manuscript is availability. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT05395806&atom=%2Fmedrxiv%2Fearly%2F2023%2F03%2F31%2F2023.03.30.23287988.atom [2]: http://ClinicalTrials.gov

Resumen: Introducción: existe evidencia sobre el desgaste profesional experimentado por el profesorado del área de la salud producto de la sobrecarga que implica la combinación de los roles académico, investigador y asistencial. Es mandatorio generar conocimiento sobre iniciativas que promuevan su autocuidado a nivel individual e institucional. El objetivo del estudio es examinar a través de indicadores de desgaste profesional y bienestar subjetivo la implementación del programa «Bases científicas del bienestar y herramientas de autocuidado para profesionales de la salud». Material y métodos: se evaluó el síndrome de desgaste profesional, atención plena, bienestar psicosocial, vitalidad y afectividad de 120 participantes de 2 cohortes. El estudio cuantitativo comparó las mediciones en 2 tiempos. El cambio se analizó mediante las pruebas de Wilcoxon y Mann-Whitney. Cronbach y McDonald se utilizaron para evaluar la confiabilidad de los instrumentos. Resultados: se implementó un programa de 5 semanas que incluyó actividades individuales preferentemente asincrónicas, retroalimentación y evaluación sumativa. Seis tutores recibieron entrenamiento en bienestar y autocompasión. Los indicadores de bienestar y desgaste profesional cambiaron favorablemente al término del programa (valor p < 0,01). El cambio se mantuvo al analizar los indicadores separados por sexo, cohorte y carrera, excepto en despersonalización, realización personal y afectividad positiva. Los instrumentos alcanzaron una confiabilidad > 0,7. Conclusión: el programa de autocuidado fue efectivo para reducir el agotamiento emocional y promover las estrategias que mejoran la atención plena y la autorregulación. Cursos a distancia acotados que promuevan el aprendizaje de estrategias de autocuidado podrían formar parte de programas de desarrollo de las competencias docentes para profesionales de la salud. Abstract: Introduction: There is evidence of burnout experienced by faculty due to the overload involved in combining the academic and research roles and the practice with patients. It is interesting to generate knowledge on initiatives that favor learning individual and institutional self-care strategies. The study aims to examine the implementation of the program ''Scientific Basis of Well-Being and Self-Care Tools for Health Professionals'' through burnout and well-being indicators. Material and methods: One hundred twenty participants from two cohorts completed questionnaires. Burnout, Mindfulness, Psychosocial Well-being, Vitality, and Affectivity indicators were measured. The quantitative study compared the measurements in two moments. Change t1-t2 was analyzed with W Wilcoxon-test and U Mann-Whitney-test. Cronbach's and McDonald's tests were used to analyze the instruments’ reliability. Results: A five-week online program was implemented in the Moodle platform. Asynchronous individual activities and learning assessments were incorporated. Six tutors were trained in well-being and self-compassion. Levels of wellbeing and burnout changed post-program favorably (p-value < 0.01). The change is maintained when analyzing the variables separated by sex, profession, and cohort, except the depersonalization, personal accomplishment, and positive affectivity variables. Questionnaires achieved reliability > 0.7. Conclusion: A five-week self-care online program effectively reduced emotional exhaustion and promoted strategies that enhanced dispositional mindfulness and self-regulation. Short online courses that encourage learning self-care strategies could be part of programs that develop teaching competencies in health professionals.

BACKGROUND:Self-care is a central element in the training of health students. The lack of effective strategies to develop it is associated with a 50% prevalence of burnout in this population. AIM:Identify and analyze effective strategies for self-care assessment and intervention in health students. METHODOLOGY:We developed a systematized scoping review using standardized methods to assess quality using the Scale for the Assessment of Narrative Review Articles. The Critical Appraisal Skills Programme was used for the thematic analysis. Four sources of information were explored including Pubmed, Google Scholar, Epistemónikos and Lilacs as well as gray literature. Two independent reviewers reviewed each publication and one expert defined controversies. RESULTS:A total of 1682 articles were identified, of which 33 were selected. The average quality of the reviewed articles was 13 points [6-14]. The thematic analysis identified two groups. First, self-care assessment studies (N = 12) highlighting the World Health Organization Quality-of-Life Scale (WHOQOL-BREF) and the Health Promoting Lifestyle Profile II (HPLP-II); and second effective intervention study highlighting four strategies: mindfulness (N = 14); group interventions (N = 8); mentoring (N = 2); and curricular interventions (N = 4). CONCLUSION:There are a variety of effective strategies to assess and promote self-care in health students. The studies we found stand out for being of good quality and applicable to the different study plans.

La Dra. Philippa Moore, académica del Departamento de Medicina Familiar de la Universidad Católica de Chile, ha dejado una profunda huella por su aporte esencial en el desarrollo de la medicina familiar y también por su gran contribución en la educación médica en la Universidad Católica y en Chile.

Introducción: la educación médica basada en competencias (CBME) se ha ido adoptando ampliamente; en esta, las competencias se originan de las necesidades sociales de atención de salud y están articuladas en un marco claramente definido. El Royal College de Canadá (RCPSC) ha desarrollado el marco CanMEDS, que ha sido ampliamente utilizado en formación de especialistas. Métodos: la Dirección de Postgrado de la Pontificia Universidad Católica de Chile (DPG-UC) decidió adoptar el modelo CanMEDS de CBME, y se planteó la meta de integrarlo a nivel institucional y en sus programas de especialización médica. Se utilizó el modelo de Kotter de liderazgo en gestión del cambio para describir el proceso. Resultados: comenzamos estableciendo un sentido de urgencia de realizar el cambio, y se constituyó un equipo directivo sólido para liderar el proceso. Definimos nuestra visión: consolidar un Postgrado con estándares internacionales, y aportar especialistas de excelencia a la sociedad; diseminamos la visión con jefes de programas, docentes de primera línea y residentes, usando variadas estrategias para empoderarlos. Se fijaron metas: en DPG-UC se actualizaron procesos según estándares institucionales internacionales del RCPSC; y a nivel de programas, post mapeo curricular, estos se reescribieron por competencias, y se consolidó la enseñanza y evaluación de roles. El 2016, la UC logró el hito histórico de ser la primera institución no canadiense, acreditada por RCPSC. Discusión y conclusiones: preparar la acreditación internacional resultó un motor para impulsar cambios. formamos una comunidad de práctica UC-RCPSC, aprendimos a incorporar la mirada internacional del RCPSC, aplicada a nuestra realidad local. Nuestro desafío es mantener estándares internacionales, y seguir aportando especialistas de excelencia que aseguren una atención integral, experta y comprometida con la sociedad y nuestros pacientes.

Latin American (LA) studies on triple-negative breast cancer (TNBC) and their characteristics are scarce. This forces physicians to make clinical decisions based on data obtained from studies that include non-Hispanic patients. Our study sought to obtain local epidemiological data, including risk factors and clinical outcomes from a Chilean BC registry. This was a retrospective population-cohort study that included patients treated at a community hospital (mid-low income) or an academic private center (high income), in the 2010–2021 period. Univariate and multivariate analyses were performed to identify prognostic factors associated with survival. 647 out of 5,806 BC patients (11.1

Chile has one of the highest rates of breast cancer in Latin America. Mammography rates among women, especially those of low socioeconomic status (SES), are thought to contribute to high breast cancer morbidity and mortality. A successful randomized controlled trial among women aged 50 to 70 in a low-SES primary care clinic in Chile led to a significant increase in mammography screening rates in a two-year intervention trial. This study assesses the sustainability of the intervention after ten years and identifies factors that might have been associated with a long-term effect using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. The mammography rates among women aged 50 to 70 in the low-SES intervention clinic were compared to two populations of women aged 50 to 70 from middle-SES clinics and to national data. Qualitative data were used to answer questions of adoption, implementation, and maintenance, while quantitative data assessed the reach and effectiveness. After ten years, low-SES women at the intervention clinic maintained significantly higher mammography screening rates vs. middle-SES women at the comparison clinics (36.2% vs. 30.1% and 19.4% p < 0.0001). Women of a low SES at the intervention clinic also had significantly higher screening rates compared to women of a low SES at a national level (44.2% vs. 34.2% p < 0.0001). RE-AIM factors contributed to understanding the long-term difference in rates. Mailed contact, outreach interventions, and the integration of health promoters as part of the Community Advisory Board were important factors associated with the effects observed. This study provides information on factors that could contribute to reducing the social gap on breast cancer screening.