Palliative Care in Cuban Medical Training: Analysis of Study Plan E vs. International Standards

Abstract

Introduction: The World Health Organization recommends integrating palliative care as a routine element in undergraduate medical education. In Cuba, the aging population (27% of adults are over 60 years old) and the epidemiological transition toward chronic non-communicable diseases make this training imperative, especially for general practitioners who lead Primary Health Care. However, the Curriculum E in effect since 2019 presents structural limitations in this area.

Objective: To justify the need for an integrated curriculum model for palliative care training in Cuban undergraduate medical education, comparing it with the international standards of the European Association for Palliative Care (EAPC) and the EDUPALL curriculum.

Authors' Position: The authors identify structural deficiencies: fragmented content without pedagogical sequence, absence of a specific required course, lack of supervised clinical practice in palliative care units, lack of specific competency assessment, and disconnection from the multidisciplinary approach. Contrast this with international standards that recommend a spiral approach, mandatory training, progression in complexity, and systematic evaluation. They point out that only 18% of European countries have mandatory training, demonstrating that the problem is not unique to Cuba. They highlight Latin American experiences (Colombia, Brazil, Chile) as viable models.

Conclusions: Study Plan E maintains a biomedical model that obscures palliative care, which constitutes a training weakness with direct consequences for the quality of care. It is imperative to move towards an integrated model with a spiral structure, supervised practice, and validated evaluation tools, leveraging the strengths of the Cuban system (work-based learning, community-based approach).