Latin american residents' surgical education after the pandemic: what strategies have emerged for adapting to this new era? / Pandemia de covid-19 e educação cirúrgica de residentes da américa latina. que estratégias surgiram para se adaptar a esta nova era?

ABSTRACT BACKGROUND: The COVID-19 pandemic has had a negative effect on surgical education in Latin America, decreasing residents' surgical training and supervised clinical practice. AIMS: This study aimed to identify strategies that have been proposed or implemented to adapt surgical training and supervised clinical practice to COVID-19-related limitations in Latin America. METHOD: A literature review was performed between April and May 2021, divided into two searches. The first one sought to identify adaptation strategies in Latin America for surgical training and supervised clinical practice. The second one was carried out as a complement to identify methodologies proposed in the rest of the world. RESULTS: In the first search, 16 of 715 articles were selected. In the second one, 41 of 1,637 articles were selected. Adaptive strategies proposed in Latin America focused on videoconferencing and simulation. In the rest of the world, remote critical analysis of recorded/live surgeries, intrasurgical tele-mentoring, and surgery recording with postoperative feedback were suggested. CONCLUSIONS: Multiple adaptation strategies for surgical education during the COVID-19 pandemic have been proposed in Latin America and the rest of the world. There is an opportunity to implement new strategies in the long term for surgical training and supervised clinical practice, although more prospective studies are required to generate evidence-based recommendations.

RESUMO RACIONAL: A pandemia de COVID-19 teve um efeito negativo na educação cirúrgica na América Latina, diminuindo o treinamento cirúrgico dos residentes e a prática clínica supervisionada. OBJETIVOS: Identificar estratégias que foram propostas ou implementadas para adaptar o treinamento cirúrgico e a prática clínica supervisionada às limitações relacionadas ao COVID-19 na América Latina. MÉTODOS: Foi realizada revisão de literatura entre abril-maio de 2021, dividida em duas buscas. O primeiro procurou identificar estratégias de adaptação em América Latina para treinamento cirúrgico e prática clínica supervisionada. A segunda foi realizada como complemento para identificar metodologias propostas no resto do mundo. RESULTADOS: Na primeira busca, foram selecionados 16 dos 715 artigos. Na segunda, foram selecionados 41 dos 1.637 artigos. Estratégias adaptativas propostas na América Latina com foco em videoconferência e simulação. No resto do mundo, foram sugeridas análises críticas remotas de cirurgias gravadas/ao vivo, tele-mentoria intra-cirúrgica e gravação de cirurgia com feedback pós-operatório. CONCLUSÕES: Múltiplas estratégias de adaptação para educação cirúrgica durante a pandemia de COVID-19 foram propostas na América Latina e no resto do mundo. Há uma oportunidade de implementar novas estratégias a longo prazo para treinamento cirúrgico e prática clínica supervisionada, embora mais estudos prospectivos sejam necessários para gerar recomendações baseadas em evidências.

Primary care performance in Dominica / Desempeño de la atención primaria en Dominica

Objective. To document the structure and functions of primary care (PC) in the country of Dominica using the Primary Care Assessment Tools (PCAT), a set of questionnaires that evaluate PC functions. Methods. This cross-sectional study combined data from two surveys. The systems PCAT (S-PCAT) survey gathered national-level data from key informants about health system characteristics and PC performance. The provider version (P-PCAT) survey collected data on PC performance from health providers (nurses and physicians) at all PC facilities in the country. Provider-level data were aggregated to obtain national and district-level results for PC domains scored from 0.00 (worst) to 1.00 (best). Results. From the systems perspective, results showed several knowledge gaps in PC policy, financing, and structure. Key informants gave “Good” (adequate) ratings for “first-contact” care (0.74), continuity of care (0.77), comprehensive care (0.70), and coordinated care (0.78); middling scores for family-centered care and community-oriented care (0.65); and low scores for access to care (0.57). PC providers assessed access to care (which included “first-contact” care, in the P-PCAT surveys) (0.84), continuity of care (0.86), information systems (0.84), family-centered care (0.92), and community-oriented care (0.85) as “Very Good”; comprehensive care as “Good” (0.79); and coordinated care as “Reasonable” (0.68). Overall, the scores for the country's health districts were good, although the ratings varied by specific PC domain. Conclusions. The assessments described here were carried out with relatively little expense and have provided important inputs into strategic planning, strategies for improving PC, and identification of priority areas for further investigation. This two-staged approach could be adapted and used in other countries.

Objetivo. Documentar la estructura y las funciones de la atención primaria (AP) en la república insular de Dominica con los cuestionarios PCAT (Primary Care Assessment Tools o instrumentos para evaluar la atención primaria), un conjunto de cuestionarios que evalúan las funciones de la AP. Métodos. En este estudio transversal se combinaron los datos de dos series de encuestas. La realizada con los PCAT sobre los sistemas (S-PCAT) recopiló, a partir de informadores relevantes, datos de ámbito nacional sobre las características del sistema sanitario y el desempeño de la AP. La versión para profesionales (P-PCAT) recopiló datos sobre el desempeño de la AP a partir de los profesionales sanitarios (enfermeras y médicos) en todos los centros de AP del país. Se combinaron los datos relativos a los profesionales para obtener resultados correspondientes a los niveles de distrito y del país sobre los dominios de la AP calificados con una puntuación de entre 0,00 (peor) y 1,00 (mejor). Resultados. Desde la perspectiva de los sistemas, los resultados demostraron varias brechas en el conocimiento de las políticas, el financiamiento y la estructura de la AP. Los informantes clave otorgaron puntuaciones “buenas” (suficientes) a la atención durante el “primer contacto” (0,74), a la continuidad de la atención (0,77), a la atención integral (0,70) y a la atención coordinada (0,78); puntuaciones medias a la atención centrada en la familia y orientada a la comunidad (0,65); y puntuaciones bajas al acceso a la atención (0,57). Los profesionales consideraron que el acceso a la atención (incluida la de “primer contacto”, en las encuestas P-PCAT) (0,84), la continuidad de la atención (0,86), los sistemas de información (0,84), la atención centrada en la familia (0,92) y la atención orientada a la comunidad (0,85) son “muy buenos”; que la atención integral es “buena” (0,79); y que la atención coordinada es “correcta” (0,68). En general, las puntuaciones relativas a los distritos sanitarios del país son buenas, aunque las puntuaciones varían según el dominio de la AP. Conclusiones. Las evaluaciones descritas, que conllevaron un gasto relativamente bajo, constituyen un aporte importante a la planificación estratégica, las estrategias para mejorar la AP y la identificación de áreas prioritarias para ulteriores investigaciones. El enfoque en dos etapas podría adaptarse y aplicarse en otros países.