Original article

Education for the prevention of adolescent pregnancy in the physician resident's training

Raúl Evaristo Silva Silva^{1  *} 
http://orcid.org/0000-0002-0905-0114

Yolanda Cruz Proenza Garrido¹ 
http://orcid.org/0000-0001-8156-2555

Luis Manuel Leyva Leyva¹ 
http://orcid.org/0000-0002-9529-6857

¹Universidad de Holguín. Holguín.

ABSTRACTS

The article shows a method and its procedures for the dynamics of preconception multidisciplinary teams in the various health areas where adolescents attend for education in pregnancy prevention, involving health specialists, education, sociologists and psychologists. The research perspective of the guiding role in the training of Gynecology and Obstetrics physician residents in these scenarios and formative spaces for adolescents in the communities is favored by the use of the proposed method, whose evidence in the "César Forné Frutos" health area of Banes supports its relevance.

Keywords: Permanent training in health; Pregnancy prevention education; Adolescents; Interactive methods

Introduction

The proposal of this method responds to the social, medical and educational demands assigned to the Maternal and Child Care Program (PAMI) in the training of physicians resident in Gynecology and Obstetrics. It is a theoretical approach where the medical, teaching and research aspects are integrated since it favors the study of the relationships of the content of teenage pregnancy prevention in primary health care (PHC) from the projection of the (PAMI), as an appropriate scenario for action, which has the task of identifying, understanding, transforming and socializing the different problematic situations that occur in the health areas.

The conformation of the method enriches the proposal of methods carried out by other researchers such as: ^{Pérez (2007}); ^{Aguilera (2008}); ^{Leyva (2012}); ^{Batista (2013}), who have made incursions into the problematic of medical personnel training and especially those considered from the developmental and professional approach. Their argumentation is based on the assumptions stated in the work and with the aim of promoting knowledge and a reflective and critical attitude in the training of Gynecology and Obstetrics physician residents in the face of the situations experienced from the diagnosis of the community and in particular of adolescents in the health areas in which they interact with the General Practitioner (GP).

In general, they consider the method as a mediating instrument provided by culture, with which the subject operates for the transformation of reality both externally (tools) and internally (signs). For this study, the project method and the method for the construction of learning strategies support the proposal of a new method that meets these requirements for the prevention of adolescent pregnancy as content in the Gynecology and Obstetrics physician residents' training.

Development

The method has its origin in the integrative logic of PAMI (^{PAMI, 2011}) for the training of physician residents in Gynecology and Obstetrics in their various training contexts. Its objective is to serve as a basis and foundation for the structuring of a system of procedures to guide the dynamics of PHC and secondary health care (SSA) for education in the prevention of teenage pregnancy, which favors the participation of the multidisciplinary team led by the Gynecology and Obstetrics specialists and the GP, in such a way as to verify the transformations and thus innovative decision making on the problem under study.

Its specificity is acquired by the system of relationships it achieves when processing the information (theoretical, practical and experiential) being studied; Therefore, its degree of uniqueness is achieved in the dynamics of the process itself in the health areas and depends on the positive disposition of the participating adolescents and the multidisciplinary team, in order to reach qualitatively higher levels in the prevention of teenage pregnancy and to have a favorable impact on avoiding behaviors in general and on sexual and reductive health in particular, which will lead to detecting the potentialities and insufficiencies of the context, the families and the adolescents.

The applicability of this Method of appropriation of pregnancy prevention for the interactive dynamics with the specialist in (GP) in (PHC) is in correspondence with: the requirements of (PAMI) in the training of physician residents in Gynecology and Obstetrics and (GP), the characteristics of the health areas related to the professionals in training and, the depth in the knowledge of teenage pregnancy prevention to transform (mitigate or solve) the problems from (PHC).

The significance of the method is given because it is based on updated information in the health areas of the municipalities, especially in each health area involved in the training of professionals in these specialties and coherence in the integration of actions of different natures that have as a starting point the preparation of contents and contexts, in connection with the reality to be transformed.

The essential means in the use of the proposed method are the contextual diversity of the training of the physician residents of the Gynecology and Obstetrics and General Integral Medicine (GP) specialties from the Education at work (^{González, 2017}) as an essential form of organization of this process and the prevention of teenage pregnancy in their health areas, through an educational, preventive, investigative process of observation-indagation-explanation-argumentation of these realities.

From the gnoseological point of view (^{Amarillo & González, 2008}), the method makes it possible to understand the various ways to address the prevention of teenage pregnancy in the training of these specialists and the need to establish relationships between their contexts in order to achieve transformations, in constant improvement and evolution. On the technical side, the method assumes interactivity and action research as practical ways.

Methodologically, the method is made up of procedures aimed at training these specialists in the prevention of adolescent pregnancy, as a unique, diverse and self-developing process for the participating multidisciplinary teams.

This method of an educational-research nature orients, from the knowledge associated with the prevention of teenage pregnancy, ways and means to generate coordinated actions to transform reality from PHC, the procedures that make it feasible reveal its practical value and constitute its operational structure.

The Method of appropriation of pregnancy prevention for the interactive dynamics with the specialist in (GP) in (PHC) is defined, then, as a way to identify, delimit, organize and systematize the knowledge, skills and attitudes about the prevention of teenage pregnancy, the particularities to the health areas of the municipality and the potentialities of practical actions contextualized to the community realities according to the Cuban health policy. Whose demonstrations promote a positive attitude towards the profession in the different training contexts of the physician residents of Gynecology and Obstetrics and (GP).

For the concretion of the Method of appropriation of pregnancy prevention for the interactive dynamics with the specialist in (GP) in the (PHC), methodological procedures are proposed. The methodological procedures (^{Antuan, 2014}) that materialize the method allow the logic, which is assumed, of pregnancy prevention as formative content of the physician residents in Gynecology and Obstetrics to be made viable and express the relationships established between the functions and directions of this process. The actors responsible for the execution are the multidisciplinary teams, led or guided by the specialists of Gynecology and Obstetrics and GP).

The proposal of the method, from its dynamizing function, fulfills the theoretical and methodological functions of the remaining components of the model. From its conception, a theoretical-practical platform is achieved that favors the conception of the assimilation of teenage pregnancy prevention as a formative content in the referents of the (PAMI), as a hallmark of a comprehensive, developmental and from a professional approach, an aspiration that contributes to realize the aspirations of the training of physician residents in Gynecology and Obstetrics and (GP) more scientific and identified with human and solidarity values that distinguish Cuban medicine.

The Method of appropriation of pregnancy prevention for the interactive dynamics with the specialist in (GP) in (PHC), is revealed as a quality in the interactive dynamics for the prevention of adolescent pregnancy. To the extent that the specialist appropriates the knowledge that allows him/her to recognize, understand, explain and apply the prevention of adolescent pregnancy in his/her professional dynamics from PHC and SSA as a concretization of the PAMI, he/she is in a position to contribute to the solution or mitigation of this problem and to comply with indicators and goals that humanize health.

The argumentation of the Education Model for the prevention of adolescent pregnancy in the training of Gynecology and Obstetrics physician residents, from the analysis of its relationships and nexus, reveals as a resulting quality the coherence between the reproductive quality of life and the sexual health, understood as the relationship between a pregnancy at optimal ages of reproductive life, in adequate biopsychosocial conditions and with a happy outcome; this is achieved to the extent that preventive educational actions for vulnerable segments (women at extreme ages of reproductive life) are efficient and involve these segments emotionally in their strategies, from a multidisciplinary approach.

Justification of procedures for the contextualization of the method to the dynamics in the health areas.

The term procedure is defined and used by several authors, it is derived from the Latin "processus", which means progress, march or development. By assuming the proposal of (^{Chávez, 2017}, p. 76), they are a set of ordered and sequenced steps that lead to an end or purpose, so these steps can be manifested in the form of actions and operations between which there must be a systemic relationship.

The authors agree on the structure and rationale, which is taken into account for the preparation of this proposal. The specific objective of the procedures is the orientation of the methodological procedure to be followed, in order to achieve a significant collective construction of knowledge about this problem; as well as, from the complexity of what is evaluated, to enhance the self-development of the participants.

They are conceived for the training of specialists in Gynecology and Obstetrics in connection with the (GP), they are:

1. Inquiry of the assimilation of the contents of teenage pregnancy prevention in the training of the physician resident in Gynecology and Obstetrics and (MGI).

2. Approach to the practice of (PAMI) in (PHC).

3. Contextual explanatory of practical situations of pregnancy prevention in (PHC) and (SSA).

Each of them is argued below in actions and operations.

Inquiry into the assimilation of the contents of teenage pregnancy prevention in the training of Gynecology and Obstetrics physician residents and (GPs).

This procedure is based on the key assumption of the necessary preparation in the content of teenage pregnancy prevention from the medical, psychological, sociocultural, educational and individual perspectives in the training of specialists in Gynecology and Obstetrics and (GP). Its investigative nature is aimed at the in-depth search for information on knowledge about the problem, in order to support the intervention in practice. Its essence lies in the subject/outcome relationship of the activity.

Action #1:

Diagnosis of the training of physician residents in Gynecology and Obstetrics and (GP). Objective: Determination of the level of knowledge, skills and attitudes necessary for education in the prevention of adolescent pregnancy from the application of the (PAMI) in (PHC). It is suggested to apply techniques such as: document review, surveys, interviews and observation guides. This action is intended to determine the disposition towards the subject matter, the level of knowledge. It includes the following operations:

1. Identify gaps in theoretical knowledge and beliefs about adolescent pregnancy prevention.

2. Conduct professional discussions and socialization activities about teenage pregnancy prevention, (PAMI) and (PHC) and (SSA), in terms of preparedness.

3. Design and execute professional tasks that place physician residents in training in diverse and complex socio-community situations, leading them to assume a position on the matter and offer alternative solutions.

Action #2: Actions aimed at a first approach to adolescent pregnancy prevention education in PHC and SSA. Objective: To organize and discuss specific contextual situations of the work in the community or health care centers in which the physician residents in training participate for a gradual approach to real situations of their medical practice, of the subject matter, for which they should carry out the following Operations:

1. Identify what is primary, secondary and tertiary prevention of adolescent pregnancy.

2. To specify its essential features.

3. Identification of multidisciplinary team interventions.

4. Analysis of the regularities of the proposed solutions and specification of the nuances of risks and vulnerability detected.

5. Approach to the practice of (PAMI) in (PHC)

This procedure contributes to solve in practice the predominance of the assessment of indicators for the fulfillment of (PAMI) and (PHC) objectives. It is directed to preventive work as the essence of the work in PHC and later in education in SSA, and is conceived from the systematization of the information obtained from the intervention in the health areas, community schools framed in the popular councils. Towards the analysis, interpretation and search for regularities, not of numerical data, but of the particularities of adolescents who live or study in these contexts and who are at ages with vulnerable situations. Its essence is in the relationship subjects/contexts/outcome of the activity.

Action #1:

Management and organization of information on the subjects and processes involved in the evaluation. Its objective is derived from field work in the real scenarios of the (PHC) in the health areas involved to obtain information on the emotional, psychological, social and biological status of the adolescents who belong to it.

Operations:

1. Application of instruments elaborated for obtaining the information.

2. Classification of the information derived from the application of the instruments.

3. Synthesize the information and, based on its richness, delimit the relevant aspects.

4. Drawing up inferences from the processing of the information obtained.

5. Contextual explanatory of practical situations of pregnancy prevention in the (PHC) and (SSA).

This procedure is conceived based on the actual knowledge of the particularities of the scenarios in which the multidisciplinary group works, guided by the physician resident in Gynecology and Obstetrics and (GP) in charge of carrying out prevention actions and the results derived from their application. It is aimed at explaining the particularities derived from the scenarios or contexts; the knowledge of which will make possible the projection of solutions or mitigations according to the particularities of the adolescents involved. Its essence lies in the contexts/subjects/transformation relationship.

Action # 1:

Contrast the results of the information obtained. Its central objective is the search for solutions to the demands presented by the adolescents or mitigate problems that occur in the different contexts and whose solutions do not depend on (PHC) or (SSA); check the physical, mental, sexual, reproductive health of the adolescents involved in the study. Operations:

1. Compare the initial state (subjects and processes) involved with the behavior obtained derived from the application of the instrumentation defined for the identified object.

2. To elaborate information based on the inferences obtained from the evaluation of the results. 3.

3. Generate conclusions that gather essential relationships that determine possible generalizations.

4. Verify the conclusions with the educational reality and assess the need to improve or not the result of the educational scientific activity studied.

In summary, it is significant to recognize the transcendence of the training of physician residents in Gynecology and Obstetrics for the work of education in the prevention of adolescent pregnancy, which together with the (GP The need to provide the conditions to train these professionals with high human and scientific values is highlighted; therefore, in this training, the preparation in the preventive educational order in segments of vulnerable women, such as adolescents, becomes relevant.

Conclusions

The proposal of a method and its procedures for interaction in the communities located in the health areas is an alternative solution to the social problem of the increase in teenage pregnancy. This is a challenge that the country systematically controls as part of the health policy and the goals of the 2030 agenda.

The implementation in Cuba of the PAMI and the counseling from the National Center for Sexual Education (Cenesex), attached to the Ministry of Public Health, show the priorities that are considered in the country regarding this problem; however, the current protocols and the training of specialists such as Gynecology and Obstetrics and (MGI) with a Master's degree in genetic counseling show that the theoretical and methodological foundations that support the scientific training of these specialists for PHC work are still insufficient. Therefore, it is intended to improve the training process of the physician residents in Gynecology and Obstetrics and ( (GP) from didactic, sociocultural, legal, educational and medical (biological) positions.

The methodological procedures for the materialization of the Method of appropriation of teenage pregnancy prevention from the (PHC) constitute a way that makes feasible the preparation in the training process; they are also an expression of the dialectic between possibility and reality

Referencias bibliográficas

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Received: March 25, 2022; Accepted: August 12, 2022

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