La experiencia de quince años en la acreditación de centros formadores de especialistas médicos / The experience of 15 years in accreditation of training centers of medical specialists

The National Committee of the Association of Medical Schools for the Accreditation of Medical Centers to train specialists is active since 1979. At the present time, 1547 postgraduate medical students are engaged in training programs lasting 2 to 3 years. During the period in which the Committee has operated, 591 centers were assessed. Sixty percent were approved but the deficient academic or technical facilities for clinical practice or teaching motivated the rejection of 14 percent. During these years, several problems were detected such as the support given by the authorities of medical schools to accretitation, the instability and shortage of teaching faculty, the persistence of training programs in rejected centers, the excessive number of students for the capacity of the teaching center, the faculty integration between Medical Schools and the National Health Service and the increasing competition of scientific societies and private health institutions with medical schools in teaching activities. These issues must be appraised both at medical schools and the National Health Services

La anemia de la glomerulonefritis aguda post-estreptocócica / Anemia associated to acute post streptococcal glomerulonephritis

Thirty-three children with post-streptococcal acute glomerulonephritis, age x:8.3 years (range 6-12) were studied prospectively. Mean initial hematocrit (Hct) was 31.6 percent with 90 percent showing Hct under the normal lower limit for this age group. Reticulocyte index (RI) was <0.5 in half of the cases. Serum iron concentration, total iron binding capacity (TIBC) and percentaje of transferrin saturation were normal for this age group although 75 percent of the children had increased serum ferritin levels. At the time of discharge, Hct increased to 35.1 percent but 44 percent still had anemia. Hct increased spontaneously for 105 days stabilizing at 38 percent. Based on Hct changes, 3 groups were defined: Group I (3 individuals): normal upon discharge; Group II (19): partial recovery at discharge, slow recovery stabilizing after 105 days; Group III (11): lower Hct, slower recovery but with RI significantly higher than group II (0.96 vs 0.45 p<0.01). Our data suggest that although hemodilution is present in all, it may be considered the solely factor only in 3 cases (Group I). In group II, evidence of bone marrow depression was indicated by the low RI. On the other hand, the intense anemia that could not be justified only by hemodilution and marrow depression in group II, suggest other pathogenic factors

La certificación de especialistas y su formación fuera del marco universitario / Certification of medical specialists and training outside the university environment

El proceso de certificación de especialistas iniciado en Chile en 1984 por la Corporación Nacional de Certificación de Especialidades Médicas ha permitido caracterizar mejor la formación de especialistas en Chile. Un aspecto especialmente trascendente para la calidad de la capacitación es el representado por los numerosos programas que se llevan a cabo al margen de la tuición universitaria. El registro de los primeros 4.500 especialistas certificados por CONACEM revela la existencia de 338 médicos (7,5% de todos los postulantes y 24,8% de los que postulan por programas oficiales) que habrían recibido entrenamiento en 137 programas extrauniversitarios. Los contenidos, dedicación y experiencias comprendidas en ellos es variable y muy diverso, también, el respaldo académico, tecnológico y la calidad de los campos clínicos en que se llevan a cabo. Sin duda su proliferación obedece a legítimas demandas de especialización que superan la capacidad formadora de las Universidades y esto hace necesario prever alguna forma de discriminación y control sobre tales programas para lograr mejorar su calidad o desincentivar a los que no alcanzan un determinado nivel de eficiencia