title: Service, training, mentorship: first report of an innovative education-support program to revitalize primary care social service in Chiapas, Mexico.
abstract: BACKGROUND
  The Mexican mandatory year of social service following medical school, or pasantía, is designed to provide a safety net for the underserved. However, social service physicians (pasantes) are typically unpracticed, unsupervised, and unsupported. Significant demotivation, absenteeism, and underperformance typically plague the social service year.
  
  
  OBJECTIVE
  Compañeros en Salud (CES) aimed to create an education-support package to turn the pasantía into a transformative learning experience.
  
  
  METHODS
  CES recruited pasantes to complete their pasantía in CES-supported Ministry of Health clinics in rural Chiapas. The program aims to: 1) train pasantes to more effectively deliver primary care, 2) expose pasantes to central concepts of global health and social medicine, and 3) foster career development of pasantes. Program components include supportive supervision, on-site mentorship, clinical information resources, monthly interactive seminars, and improved clinic function. We report quantitative and qualitative pasante survey data collected from February 2012 to August 2013 to discuss strengths and weaknesses of this program and its implications for the pasante workforce in Mexico.
  
  
  RESULTS
  Pasantes reported that their medical knowledge, and clinical and leadership skills all improved during the CES education-support program. Most pasantes felt the program had an overall positive effect on their career goals and plans, although their self-report of preparedness for the Mexican residency entrance exam (ENARM) decreased during the social service year. One hundred percent reported they were satisfied with the CES-supported pasantía experience and wished to help the poor and underserved in their careers.
  
  
  CONCLUSIONS
  Education-support programs similar to the CES program may encourage graduating medical students to complete their social service in underserved areas, improve the quality of care provided by pasantes, and address many of the known shortcomings of the pasantía. Additional efforts should focus on developing a strategy to expand this education-support model so that more pasantes throughout Mexico can experience a transformative, career-building, social service year.
authors.affiliation: Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Van Wieren
authors.affiliation: Partners in Health/Compañeros en Salud, Boston, MA, USA.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Palazuelos
authors.affiliation: Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Partners in Health/Compañeros en Salud, Boston, MA, USA.
authors.forename: Patrick F
authors.initials: PF
authors.lastname: Elliott
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
authors.forename: Jafet
authors.initials: J
authors.lastname: Arrieta
authors.affiliation: Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Partners in Health/Compañeros en Salud, Boston, MA, USA.
authors.forename: Hugo
authors.initials: H
authors.lastname: Flores
authors.affiliation: Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Partners in Health/Compañeros en Salud, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; dpalazuelos@pih.org.
authors.forename: Daniel
authors.initials: D
authors.lastname: Palazuelos
mesh_terms: D004503:Education, Medical, Graduate / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008611:Mentors; D008800:Mexico; D010820:Physicians / Q000523:psychology*; D011320:Primary Health Care / Q000458:organization & administration*; D012947:Social Work / Q000193:education*
keywords: Latin America; Mexico; global health; health systems strengthening; medical education; primary care; social service; underserved