The Latin American School of Medicine (Elam): Admissions, Academics and Attitudes

IntroductionCuba's health status has grown in the last few decades following the expansion of their acclaimed medical schools, to welcome a growing number of international students. In 1999, the Latin American School of Medicine (Spanish - Escuela Latinoamericana de Medicina (ELAM)) was founded by the Cuban government to train international students in the field of medicine (Castro 1999). It now has 10,000 students from 124 countries (Porter 2012), primarily those from Latin America and the Caribbean, with smaller numbers from Africa and Asia. With all students at the school on full scholarships, inclusive of room, board, and a small monthly stipend, admission to the school is widely viewed as a prestigious opportunity to learn in one of the most innovative and sophisticated healthcare systems in the world (Tandon et al. 2000). In particular, Cuba's approach to healthcare is famed for its medical internationalism and its public health strategies which have resulted in health statistics paralleling those in the developed world. With such a heavy focus on health governance, the underlying processes in creating these doctors have often been overlooked. This article examines the available literature to describe and analyse the teaching methods, curriculum structure and student experience at ELAM.BackgroundUnder General Batista's rule (1952-59), pre-revolutionary healthcare in Cuba was private, with a fee-for-service system in place. This catered mainly for the elite and was neither universal nor equally accessible. While charity hospitals were available to those who could not afford private healthcare, there was still a significant number of Cubans who were unable to access healthcare or whom were denied care (Choonara 2010). A significant number of Cubans lived in rural communities, whereas most hospitals and doctors were located in the capital, Havana (Keck and Reed 2012). Wages differed according to location, and with lower wages in rural areas, doctors in these areas were usually less qualified or experienced than those in the cities (Choonara 2010). As a result, infant mortality in the area was as high as 100 per 1,000 births - statistics that paint today's picture of Mali or Somalia (World Health Organization 2016b).Following the revolution in 1959, Che Guevara outlined his aims for healthcare in Cuba, in his speech on Revolutionary Medicine. The speech declared,The work that today is entrusted to the Ministry of Health and similar organisations is to provide public health services to the greatest possible number of persons, institute a program of preventative medicine and orient the public to the performance of hygienic practices. (Guevara 1960 in Guevara 1971)Acting on these words, Fidel Castro, Cuba's new leader, began a programme of reform which involved the construction of new hospitals, decentralised the Cuban healthcare system, and began a programme of nationalisation and regionalisadon. The medical school in Havana, which had been closed following protests under General Batista's rule, was reopened. Tuition for students was now free, and students from rural areas were more numerous. For the first time, practical skills teaching was included in the curriculum alongside social medicine.In 1960, Law 717 created the Ministry of Public Health (MINSAP - Ministerio de Salud Publica) and Law 723 established the Rural Medical Service (RMS; Fitz 2016). In practice, the laws resulted in two major changes:i. Making Rural Medicine a PriorityStudents in their final year of medical school, formed an initiative detailing the need for them to work in the Cuban countryside, where they were most needed. The Ministry of Public Health responded by creating 318 jobs for students in rural communities (Del et al. 2008), creating the RMS (Spanish, El Servicio Medico Rural) in 1960. RMS aimed to provide 'disease prevention and health revitalisation services for those most in need, whether they are poor, in precarious health or live far from urban centres' (Gorry 2012b). …