Correspondence
A new era for medical
education in Colombia
During Nov 1–3, 2017, most of the
Deans of Medicine who belong to the
Colombian Association of Faculties of
Medicine (ASCOFAME)—a nationwide
network of higher education insti­
tutions or universities with medical
faculties—met in Monteria, Colombia.
Their objective was to develop a
consensus on medical education.1
Since 1965, there has been no
comprehensive meeting and agreement
for the transformation of medical
education across Colombia. More than
a century ago, a series of studies about
the education of health professionals,
led by the 1910 Flexner report, sparked
ground-breaking reforms.2 However,
in countries such as Colombia and
others in Latin America, further social
issues have occurred and some are still
ongoing. These include substantial
inequities in health, complex health
systems, an uneven distribution
of health-care workers across the
territories, and the need to enhance
efforts to address deficiencies.
Beyond the Flexner proposal,
which built a way to move from an
empirical education to education
oriented around the scientific method
of natural sciences, a redesign of
medical education is necessary, which
considers not only the integration
of the biomedical sciences and
basic clinical medicine, but also social
medicine in the curriculum.³ It is
important to encourage discussion
about these issues for the health of
people in relation to their behaviour
in social groups, the care of individual
patients as a family member and
member of other important groups in
everyday life, and the health of these
groups and the whole community.⁴ In
medicine, it is not enough to interpret
the behaviour of patients as a strictly
individual matter. In light of the most
recent knowledge provided by the
social sciences, researchers now know
that people constitute themselves
as such in specific social groups.
www.thelancet.com Vol 391 January 20, 2018 201
Therefore, they should not be isolated
conceptually from their networks of
social relations, which explain the social
cause of diseases. In Latin American
countries, such as Colombia, with
emerging infectious, environmental,
and behavioural risks as well as rapid
demographic and epidemiological
transitions threatening health security
of all, the integration of biomedical,
clinical, and social sciences is of utmost
importance.²–⁴
The Monteria consensus1 could
provide an opportunity for integration
and other aspects required for a new
era of medical education in Colombia.
Without necessarily being the only
answer, the Monteria consensus is a call
for reflection of the medical curricula.
Specifically, this agreement from
almost 50 medical schools1 includes
information about the creation of a
general council of education, definition
of a national profile for applications
to medical schools, and initiation of
a comprehensive reform of curricula
promoting early clinical and community
contact and integration of basic, clinical,
social, and public health aspects as part
of the professional, scientific, critical,
and civilian skills. The consensus
also includes a definition of a core
curriculum shared by the schools (skills
based), and contents and minimum
required medical procedures record.
Finally, it promotes ASCOFAME as the
leader of such processes.1
Fulfilling the aspirations of the
agreement will likely face multiple
challenges, including acceptance by the
Ministries of Education and Health,5
but they could also renew the hopes of
the medical community in Colombia to
build a new era of medical education.
We declare no competing interests.
*Alfonso J Rodríguez-Morales,
Carlos J González-Colonia,
Julio C Gutiérrez-Segura,
Eduardo Ramírez-Vallejo,
Guillermo J Lagos-Grisales
arodriguezm@utp.edu.co
Departments of Community Medicine (AJR-M,
CJG-C, JCG-S , GJL-G) and Clinical Sciences (JCG-S,
ER-V), School of Medicine, Faculty of Health
Sciences, Universidad Tecnológica de Pereira, Pereira
660003, Risaralda, Colombia
1 ASCOFAME. Consenso de Montería sobre
Educación Médica. November, 2017. http://
ascofame.org.co/web/wp-content/
uploads/2017/11/Consenso-de-Monteria-
ASCOFAME.pdf (accessed Nov 10, 2017;
in Spanish).
2 Frenk J, Chen L, Bhutta ZA, et al. Health
professionals for a new century: transforming
education to strengthen health systems in an
interdependent world. Lancet 2010;
376: 1923–58.
3 Mullan F, Chen C, Petterson S, Kolsky G,
Spagnola M. The social mission of medical
education: ranking the schools.
Ann Intern Med 2010; 152: 804–11.
4 Porta M. A dictionary of epidemiology, 6th
edn. New York: Oxford University Press, 2014.
5 Ministerio de Educación y Ministerio de Salud
de Colombia. Documento de
recomendaciones para la transformación de
la educación médica en Colombia. 2017.
http://www.sociedadescientificas.com/
userfiles/file/2017/MARZO/Documento%20
Final%20Comision.pdf (accessed Aug 31,
2017; in Spanish).
A public health approach
to opioid addiction in
North America
GIPhotostock/Science Photo Library
Keith Humphreys’ Comment in
The Lancet (July 29, 2017, p 437)1
describes the main drivers of the
opioid crisis in the USA and advocates
for global restriction of prescription
opioids as an effective public health
response to addressing the overdose
epidemic. We argue that although
the dominant narrative about the
opioid crisis circulating around
careless prescribing and unscrupulous
pharmaceutical companies has some
merit, it does not tell the whole story
of the epidemic of opioid addiction in
North America because it occurs among
medical and non-medical opioid users.2
We agree that restricting access
to prescription opioids for opioid-
naive populations should be included
in the primary strategies needed
to address the epidemic. However,
this single restrictive strategy
could potentiality lead to a surge in
fatal overdoses in people who are
already opioid dependent and at Submissions should be
made via our electronic
risk of exposure to the toxic opioid submission system at
medications (eg, fentanyl-adulterated http://ees.elsevier.com/
drugs), if they are not provided thelancet/