The administration of knowledge. The biological and the social in the training of health personnel in Latin America

The article starts with the concept of the management of knowledge, a component of the mission of PAHO as formulated in 1982. The purpose of the article is to consider what ideas have been formulated on the biological and social elements in medicine and how, and to what extent, they have been put into practice. The first part of the document discusses the theory of medicine and the social sciences, and the biological and social nature of the health-disease process. The second part traces the historical development of the biological and social approaches in relation to the degree to which these elements have been isolated and integrated in instruction. The first stage, the decade of the fifties, was characterized by the influence of the Flexner Report: instruction was organized in a cycle of the basic and clinical sciences; there was almost complete separation between medicine and society, and seminars in the Hemisphere proposed the inclusion of an integrated approach. The second stage, the decade of the sixties, was one of the great advances in theory and practice. Hemispheric meetings among health authorities, professional associations and groups of social scientists, physicians, and educators explicitly expounded the need for integration of the social and biological elements into medical education. The biological basis of study plans was reinforced as well. The third stage, the decade of the seventies, was one of consolidation of social medicine in the profession and the intensification of studies in that discipline. The idea then emerged of interdependence between medical education, medical practice, and the organization of health services in a social context. The authors examine the years of the eighties as an unfinished stage of culmination of the integration of the social and biological elements in medicine with inclusion of the idea of the physician's commitment to society.