Second degree: A Challenge for the specialty of Comprehensive General Medicine


Second degree: A Challenge for the specialty of Comprehensive General Medicine


Segundo Grado: un reto para la especialidad de Medicina General Integral



Mariela Rosa Oropesa Molerio¹, Tamara Guevara de León², Jesús Yasoda Endo Milán³

1 University of Medical Sciences of Villa Clara. Cuba. Email:
2 University of Medical Sciences of Villa Clara. Cuba. Email:
3 University of Medical Sciences of Villa Clara. Cuba. Email:




The specialty of the Second Degree is considered in the universities of medical sciences as a higher qualitative phase in the preparation of specialists and given to those whose scientific, research and improvement trajectory distinguishes them from the rest of the professional requirements set out in the Resolution 132/2009. This work aims to characterize the behavior of this category in the specialty of Comprehensive General Medicine. Second Grade category in this field has low behavior in Villa Clara, so existing strategies need to be strengthened and become a challenge to complete the work of managers of the process, both teachers and administrative staff.

MeSH: Professional development, upgrading courses, general practitioners/education, education, medical.


La especialidad de Segundo Grado es considerada en las universidades de ciencias médicas como una fase cualitativa superior en la preparación de sus especialistas y se les otorga a aquellos cuya trayectoria científica, investigativa y de superación los distinga del resto de los profesionales, requisitos que se recogen en la Resolución 132/2009. Este trabajo tiene como objetivo: caracterizar el comportamiento de esta categoría en la especialidad de Medicina General Integral. En la provincia de Villa Clara se manifiesta con índices bajos, por lo cual deben reforzarse las estrategias existentes y convertirse en un reto a cumplimentar en el trabajo de directivos del proceso, tanto docentes como administrativos.

DeCS: Superación profesional, posgrado, médicos generales, educación médica.



The Cuban Universities of Medical Sciences have a well defined social commitment, expressed in the formation of health professionals, doctors, odontologists, bachelors in nursing, and technologists that society needs, with a higher scientific-technical preparation and capable of a steady updating in the evolution of the medical sciences and the like, with high ethical, political and moral values, committed to satisfy the demands and necessities of the branch mainly by means of the primary health care strategy, that is expressed through a high system of convictions with a high orienting tendency of personality towards the profession.1

Currently, medical practice worldwide is facing multiple challenges and to address them the professionals of this branch must possess:

  • Effective professional updated knowledge, to enable them to exercise medicine at the level of current standards competence.
  • Skills for continuous and lifelong learning.
  • Ability to provide comprehensive health care in health promotion, combining with preventive, curative and rehabilitative actions to transform the existing health situation.
  • Commitment to apply the professional values, with appropriate ethical, social and moral behavior.
  • Scientific and critical thinking in their professional activities.
  • Optimum management capacity for the organization of their working position and performance of their professional duties.

About this problem Castro Ruz2 has insisted: "For a doctor who graduates today and not study anymore, within ten years is a dangerous practical physician, an ignorant practicing physician, (...), therefore, study and work with the doctor, it requires of a steady education (...). Just look out at the gates of contemporary technology and science to ask whether it is possible to live and know that future world without an enormous amount of preparation and knowledge".

Post graduate specialty provides updating, deepening, improvement or expansion of labor skills for professional performance required for a job, or family of jobs-, in line with the needs of economic, social and cultural development.3

The specialty of the Second Degree, considered at the universities of medical sciences as a higher qualitative phase in the preparation of its specialists, it is given to those whose scientific, research and work improvement distinguishes them from other professionals. It is obtained from the specialty of First Degree and for this they must gather a group of requirements set out in 132/2009 Resolution.4 They can get it in their specialty or another where doctors demonstrate their preparation in a period not less than 5 years.

The Second Degree is permanent. In the regulations of the Ministry of Higher Education for the career accreditation, masters courses and specialties, professionals who possess it are equal to Ph D. at the time of evaluating the teaching staff in the categories of ratified and certified; they are also part of examining boards for master´s courses, changes of teaching ranks and it is considered, by its steady updating scientific career, giving prestige to their specialty and offer a higher quality service. It is not needed a teaching rank to aspire to this specialty; it is only related to work.

Villa Clara University of Medical Sciences has designed strategies for obtaining the Second Degree, which have been met but still they have not achieved the expected results and this has allowed reflecting on the knowledge the professionals really have on this resolution and it is containing headings to guide their work, either improvement and research in such achievement.

The Comprehensive General Medicine is the integrating discipline in the improvement of the curriculum of the medical career; it is present in every year in a greater or lesser extent. This is present in the 1st. 2nd. and 5th. years in the 5 subjects and in 6th. in the rotating internship by rotating 7 weeks. Although it has clinical aspects of care for healthy and sick individuals, their fundamental goals are closely linked to the activities of public health. That is a characteristic of the Medical and the Family Nurse Program in Cuba.5,6

The professionals responsible for carrying it out must have high educational and research prestige that allows them to motivate his disciples since the early years of their training so that they understand the need and importance that family medicine has in medical care, assistance problems they can solve for addressing a small population group whom they know and have controlled and that in the Cuban context is the easiest way to solve them.

Villa Clara University of Medical Sciences had at the end of January 2016 a total of 508 professionals with the Second Degree; of them, 454 are doctors, 52 dentists and 2 nursing specialists. The specialty in General Medicine has 61 Second Degree specialists representing 3,3 % of the total and 13,7 % of professionals of all specialties in the province who have that rank.

There are 20 specialists in Comprehensive General Medicine who obtained the rank of Second Degree in another specialty, Health Administration is the largest number. According to job placement, most located in Santa Clara municipality and the University of Medical Sciences; in 8 of the 13 municipalities of the province there is no professional in this specialty with that rank.

According to the function they perform 12 occupy management posts in the specialty teaching process, 6 are administrative, 8 are currently serving international missions and 35 perform some other activities.

Obtaining the Second Degree in the General Medicine specialty has low behaviors due to the high number of professionals who graduate as First Grade specialists, being of mandatory implementation once they graduate as general practitioners, and due to poor publicity 132/20094 resolution has by managers at the base. This situation also occurs in other provinces,7 however, professionals who remain for years in the field with the purposes to continue practicing the profession should be a priority to achieve this level; therefore it is considered necessary to strengthen strategies and it is a challenge to complete the work of managers of both teaching and administrative process.


Declaration of conflict of interest

The authors declare that they don´t have conflicts of interest



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2. Castro Ruz F. Discurso clausura Cuarto Congreso de Educación Superior, el 6 de febrero de 2004. La Habana: Oficina de Publicaciones del Consejo de Estado; 2004.

3. Ministerio de Educación Superior. Reglamento de la Educación de Posgrado de la República de Cuba. Resolución No. 132/04. La Habana: MES; 2004.

4. Ministerio de Salud Pública. Reglamento para la obtención del Segundo Grado de las especialidades en Ciencias de la Salud. Resolución Ministerial No. 132. La Habana: MES; 2009.

5. Ministerio de Salud Pública. Programa del Médico y la Enfermera de la Familia. La Habana: Minsap; 2004.

6. Vela Valdés J, Fernández Sacasas JA, Álvarez Sintes R. Política de formación médica para la atención primaria de salud y el papel de la asignatura Medicina General Integral en el currículo. Educ Med Super [Internet]. 2012 [citado 25 Ago 2016];26(2):[aprox. 12 p.]. Disponible en:



Submitted: November, 2 2016.
Accepted: November, 29 2016.



Mariela Rosa Oropesa Molerio. University of Medical Sciences of Villa Clara. Cuba. Email:

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