Process and outcome indicators to monitor salutogenic training in health promotion within the medical degree program

Health promotion training in medical school has traditionally been anchored in risk and deficit approaches. Salutogenesis proposes an epistemological shift focused on health assets; however, there are no validated indicator systems to monitor this training at the undergraduate level. Objective: To design a set of process and outcome indicators to monitor salutogenic health promotion training within the medical program. Methodology: A sequential, mixed-methods study, developed in three phases: (1) systematic literature review (2019-2024) and theoretical mapping; (2) participatory construction of indicators with 24 experts (faculty, researchers, and advanced students); (3) validation by expert judges (n=15) using Kendall's coefficient of concordance and feasibility analysis. Results: Eight process indicators were obtained (curricular relevance, didactic coherence, teacher training, use of community assets, hours of salutogenic practice, student output, interdisciplinary integration, and accessibility to resources), along with six outcome indicators (change in coherence, competence in asset identification, quality of community projects, self-efficacy in health promotion, transfer to professional practice, and satisfaction with training). Inter-rater agreement was high (W=0.84; p<0.001). Discussion: The proposed indicators overcome the limitations of traditional evaluation approaches, aligning with the Sense of Coherence (SOC) theory of health resources and competency-based formative monitoring models. Their applicability in resource-limited settings and their potential for curriculum feedback are discussed. Conclusions: The indicator system constitutes a valid, feasible, and theoretically sound tool for monitoring the processes and outcomes of salutogenic training in Medicine. Pilot testing in at least three faculties in Latin America is recommended.