Understanding Mexico’s Social Service Year From Physicians’ Perspectives: A Mixed Methods Study in Rural Chiapas

Abstract

Every year in Mexico, the state deploys 8,000 medical students to increase health coverage in primary care clinics in rural areas as part of a mandatory social service year called the pasantía. These social service year physicians better known as pasantes solely staff about one-third of state clinics in Mexico during their last year of medical school, without another graduated physician supporting them. Pasantes are sent remotely to work with few supplies, limited training in primary health care, and little or no mentorship or supervision. Absenteeism, demotivation, underperformance, fear and frustration are common features among the pasantes. The qualitative study revealed that pasantes experienced a lack of educational and professional support from their medical schools and the MOH, as well as a lack of meaningful connection with members of their assigned communities. The institutional detachment led to pasantes feeling frustrated with the health system and dissatisfied with the medical profession. The social service year contributed to an improved understanding of social barriers faced by patients while trying to access health care. Experiences in rural communities encouraged empathy for patients and a focus on the social determinants of health, especially when there was support provided to pasantes in remote areas. The quantitative study showed that an education-support program for pasantes can lead to perceived overall improvement in clinical preparedness and understanding of the health system organization; and an increased willingness to choose a career in primary health care and work for poor or marginalized communities after completing the social service year.