Certificación y recertificación de especialistas en anestesiología: una mirada desde CONACEM / Certification and recertification specialist anesthesiology: a look from CONACEM

Desde 1984 la Corporación Autónoma de Certificación de Especialidades Médicas (CONACEM) ha certificado 12.294 especialistas médicos en Chile. La disciplina de Anestesiología inició su certificación en 1985, habiendo reconocido hasta diciembre de 2012 a 716 especialistas. Para la certificación existen tres vías posibles: a) haber aprobado un Programa de Formación Universitario Acreditado, lo que hizo el 53 por ciento de los postulantes; b) cumplir los requisitos de Adiestramiento en Práctica durante 5 años, lo que hizo un 41 por ciento de los postulantes. c) haber sido formado en el extranjero de acuerdo a programas convalidados. Existen 7 programas universitarios acreditados, de 3 años de duración, con un cupo total anual de 39 alumnos que se desarrollan en Santiago y provincias. Salvo los médicos aprobados en los Programas Universitarios acreditados, el resto de los postulantes requieren dar un examen práctico; desde 2002 se ha agregado un examen escrito, cuya aprobación es requisito para dar el práctico, y que ha resultado tener buena discriminación (49 por ciento de rechazo promedio en el período de 11 años de existencia). Las certificaciones dadas hoy, tienen una duración de 10 años al inicio y serán de 7 años en la recertificación. La caducidad de las certificaciones está aparejada al proceso de recertificación, de lo cual se discuten las razones que lo avalan; se presentan los requisitos y tabla de créditos a cumplir, elaborada por CONACEM. La legislación vigente y en proceso, requiere la actuación de al menos una entidad certificadora, condición que ha sido otorgada legalmente en forma única por el Ministerio de Salud a CONACEM a partir del 11/02/2014...

Since 1984, 12.294 different medical specialists have been certified in Chile by the Corporación Autónoma de Certificación de Especialidades Médicas (CONACEM). The certification in Anestesiology specialty was initiated in 1985 reaching 716 candidates approved until December 2012. Three ways are available to achieve certification: a) to be approved by a reputable university program in the specialization; this way has been used by 53 percent of postulants; b) to fulfill the requirements of a 5 years practical training program, as 41 percent of postulants did; c) to have passed a training program abroad, similar to those in force in Chile (< 5 percent). There are 7, three-year-long reputable university programs with a total annual capacity of 39 students; half of it is for programs developed in provinces. With the exception of doctors completing reputable university programs, others postulants are require to pass a five days practical examination. Since 2002 a written test has been added, which must be taken and approved as a condition of the practical examination. Written examinations have demonstrated good discriminative capacity (52 percent average approval in 11 years). Extended certifications currently have a 10 years duration for the first time and 7 years for subsequent recertification. Revocation of certification involves installing a recertification mechanism. The reasons that support the recertification are analyzed, and also present the requirements to obtaining it. Current legislation requires that certification and recertification are done by accrediting entities. CONACEM has been legally recognized by de Ministery of Health since February 2014 as the unique entity to perform that labor...

Certificación y Recertificación de Especialistas en Psiquiatría de Adultos: Una mirada desde CONACEM / Certification and recertification of specialists in Adult Psychiatry: Aview from CONACEM

Since 1984, 12.265 different medical specialists have been certified in Chile by the Corporación Autónoma de Certificación de Especialidades Médicas (CONACEM). The certification in Psychiatry specialty was initiated in 1984 reaching504 candidates approved until December 2013. Three ways are available to achieve certification: a) to be approved by a reputable university program in the specialization; this way has been used by 42% of postulants; b) to fulfill the requirements of a 5 years practical training program, as 50% of postulants did; c) to have passed a training program abroad, similar to those in force in Chile (8%). There are 9, three-year-long reputable university programs with a total annual capacity of 46 students; almost half of it is for programs developed in provinces. With the exception of doctors completing reputable university programs, others postulants are require to pass a five days practical examination. Since 2002 a written test has been added, which must be taken and approved as a condition of the practical examination. Written examinations have demonstrated good discriminative capacity (82% average approval in 12 years). Extended certifications currently have a 10 years duration for the first time and 7 years for subsequent recertification. Revocation of certification involves installing a recertification mechanism. The reasons that support the recertification are analyzed, and also present the requirements to obtaining it. Current legislation requires that certification and recertification are done by accrediting entities. CONACEM has been legally recognized by de Ministery of Health since February 2014 as the unique entity to perform that labor.

Desde 1984 la Corporación Autónoma de Certificación de Especialidades Médicas (CONACEM) ha certificado 12.665 especialistas médicos en Chile. La disciplina de Psiquiatría inició su certificación en 1986, habiendo certificado hasta diciembre de 2013 a 504 especialistas. Para la certificación existen tres vías posibles: a) haber aprobado un Programa de Formación Universitario Acreditado, lo que hizo el 42% de los postulantes; b) cumplir los requisitos de Adiestramiento en Práctica durante 5 años, como sucedió con el 50% de los postulantes; c) haber sido formado en el extranjero de acuerdo a programas convalidados. Existen 9 programas universitarios acreditados, de 3 años de duración, con un cupo total anual de 46 alumnos que se desarrollan en Santiago (n: 5) y Provincias (n: 4). Salvo los médicos aprobados en los Programas Universitarios acreditados, el resto de los postulantes requirió aprobar un examen práctico, y desde 2002, además, un examen escrito, como requisito para dar el práctico, y que ha resultado tener buena discriminación (18% de rechazo promedio en el período de 12 años). Las certificaciones dadas hoy, tienen una duración de 10 años al inicio y serán de 7 años en la recertificación. La caducidad de las certificaciones está aparejada al proceso de recertificación, de lo cual se discuten las razones que lo avalan; se presentan los requisitos y una tabla de créditos a cumplir, elaboradas por CONACEM. La legislación vigente y en proceso, requiere la actuación de al menos una entidad certificadora, condición que ha sido otorgada legalmente en forma única por el Ministerio de Salud a CONACEM a partir del 11/02/2014.

Certificación y recertificación de especialistas en cirugía general: una mirada desde CONACEM / Certification of surgery specialists in Chile by the autonomous corporation for certification of medical specialties

Since 1984, 12.294 different medical specialists have been certified in Chile by the Autonomous Corporation for Certification of Medical Specialties (whose Spanish acronym is CONACEM). General Surgery certification started in 1984, approving 1.088 candidates thus far. Certification can be obtained in three ways. Seventy-two percent of applicants were approved by a reputable university specialization program. Twenty-three percent of applicants fulfilled the requirements of a five years practical training program and 5 percent were approved in a training program from another country which was validated in Chile. There are 13 university training programs for surgery specialty, lasting three years each. These programs can receive a total of 223 students per year. Thirty-one percent of these programs are not carried out in Santiago. Applicants, who have not completed a certified university training program, must go through a five days practical examination. Since 2002 a written test was added, whose approval is a requisite to gain access to the practical examination. Eighty-nine percent of applicants have approved the theoretical test. Certifications last 10 years initially and seven years, thereafter. When certifications expire, a recertification mechanism is required, whose requirements are informed. According to the current legislation, certifications must be done by recognized accrediting agencies. CONACEM has been accepted by the authority and its definitive legal recognition should be a reality soon...

Desde 1984 la Corporación Autónoma de Certificación de Especialidades Médicas (CONACEM) ha certificado 12.294 especialistas médicos en Chile. La disciplina de Cirugía General inició su certificación en 1984, habiendo reconocido hasta la fecha a 1.088 especialistas. Para la certificación existen tres vías posibles: a) haber aprobado un Programa de Formación Universitario Acreditado, lo que hizo el 72 por ciento de los postulantes; b) cumplir los requisitos de Adiestramiento en Práctica durante 5 años, lo que hizo un 23 por ciento de los postulantes. c) haber sido formado en el extranjero de acuerdo a programas convalidados. Existen 13 programas universitarios acreditados de 3 años de duración, con un cupo total anual de 223 alumnos, de los cuales el 69 por ciento se desarrolla en Santiago y el resto en provincias. Salvo los médicos aprobados en los Programas Universitarios acreditados, los postulantes requieren dar un examen práctico; desde 2002 se ha agregado un examen escrito, cuya aprobación es requisito para dar el práctico, y que ha resultado tener buena discriminación (11 por ciento de rechazo en el período de 11 años de existencia). Las certificaciones dadas hoy, tienen una duración de 10 años al inicio y de 7 años posteriormente. La caducidad de las certificaciones está aparejada al proceso de recertificación, para lo cual se discuten las razones que lo avalan; se presentan los requisitos y tabla de créditos a cumplir, elaboradas por CONACEM. La legislación vigente y en proceso, requiere el reconocimiento de entidades certificadoras, concurso en el cual ha sido aceptado CONACEM, esperando la sanción legal definitiva...

Hiperparatiroidismo primario con normocalcemia, una asociación de diagnóstico complejo: a propósito de un caso clínico / Normocalcemic hyperparathyroidism: report of one case

We report a 59 years old female with a history of nephrolithiasis and progressive worsening of her bone mineral density. High serum PTH levels were detected, with normal serum calcium. Causes of secondary hyperparathyroidism were discarded. The patient was followed during six years, period in which she maintained elevated serum PTH and normal serum calcium. During the second year of follow up, hydrochlorothiazide was indicated. Serum calcium raised progressively and after six years, it became abnormally high. The patient was subjected to a total left lobe and subtotal right lobe thyroidectomy. The surgeon found a 1.6 mm diameter left parathyroid nodule. After surgery the patient is asymptomatic and is receiving levothyroxine supplementation.

Amenorrea hipotalámica: consideraciones etiológicas y clínicas a raíz de una paciente / Hypothalamic amenorrhea: report of one case

Hypothalamic amenorrhea is secondary to the dysfunction of the hypothalamic pacemaker that regulates the pulsatile secretion of gonadotropin releasing hormone (GnRH). We report a 21 years old female with an isolated and persistent hypogonadotropic hypogonadism probably of congenital origin. The patient had a good olfactory function, did not have anatomical alterations and two GnRH stimulation tests showed a pre puberal pattern. Hormone replacement therapy allowed her to complete her puberal development.

Radioterapia como indicación post operatoria en macroadenomas hipofisiarios no funcionantes: a propósito de un caso / Surgical treatment of a non functioning pituitary macroadenoma without postoperative radiotherapy: report of one case

We report a 45 years old female that consulted for amenorrhea and galactorrhea after discontinuing oral contraceptives, that she used for several years. The patient had hyperprolactinemia, a hypogonadotrophic hypogonadism and a primary hypothyroidism. Sella turcica magnetic resonance showed a pituitary macroadenoma with a diameter of 23 mm and supraselar extension. The patient was subjected to a transsphenoidal excision of the tumor with good clinical and surgical results. Therefore radiotherapy was not used for the treatment of the tumor.

Neuropatía óptica distiroidea como manifestación de orbitopatía de Graves / Dysthyroid optic neuropathy: report of one case

Dysthyroid optic neuropathy is an uncommon and severe form of presentation of Graves ophtalmopathy, caused by compression and elongation of the optic nerve. Use of high dose steroids is the treatment of choice. Decompressive surgery is reserved for refractory cases. We report a 41 years old female with a dysthyroid optic neuropathy that appeared 18 years after the diagnosis of Graves disease, manifested by a marked reduction in visual acuity. Orbit CAT scan did not show compression or elongation of optic nerve. She was treated with prednisone 60 mg per day, obtaining a complete remission after 19 days of treatment. After 90 days of follow up with low doses of steroids, the patient remains asymptomatic.

Timo persistente y su implicancia en el seguimiento del cáncer diferenciado del tiroides / Abnormal mediastinal radioiodine uptake due to persistent thymus: report of one case

We report a 37 years old female operated for a multifocal papillarythyroid carcinoma. During her follow up, mediastinal uptake of radioiodine due to a persistent thymus, was detected. Thisis a situation may cause a false positive uptake of radioiodine that may be interpreted as a tumor relapse or metastasis.

Hiperparatiroidismo normocalcémico asociado a hipovitaminosis D, hipercalciuria renal y nódulo paratiroideo: caso clínico / Normocalcemic hyperparathyroidism secondary to vitamin D deficiency and renal hypercalciuria: report of one case

We report a 77 years old woman with osteoporosis in whom a hyperparathyroidism secondary vitaminD deficiency and renal hypercalciuria was diagnosed. Serum calcium was normal. During the diagnostic work up, a parathyroid nodule was discovered and subjected to a fine needle aspiration biopsy, that showed normal parathyroid cells. The patient was treated with calcitriol, cholecalciferol, hydrochlorothiazide and intravenous zolendronic acid. There was a reduction in urinary calcium and serum PTH levels and improvement of serum 25 hydroxy vitamin D levels.

Análisis de un Programa Universitario de Formación de Postgrado en Endocrinología, luego de 24 años de su inicio / Analysis of a university training program in endocrinology

The Pontificia Universidad Católica de Chile has a two decades experience in training endocrinology specialists. This communication explains the operation of the training program and the results of a survey, answered by 90 percent of Endocrinologists that were trained at the center. This survey covers different aspects of the program such as the strengths and weaknesses of the academic teaching and the present position of the trainees. Questions about the working environment and the relationship with their teachers during the application of the program are also included. These results can be useful for other University centers that are planning a training program in endocrinology and for those physicians that are planning to become endocrinologists.

¿Pseudohipoparatiroidismo o déficit de vitamina D? / Pseudohypoparathyroidism or vitamin D deficiency? Report of one case

Pseudohypoparathyroidism is characterized by a resistance to parathormone, with variable phenotypical and biochemical manifestations. Its diagnosis is difficult. We report a 28 years old male presenting with a hypokalemic periodic paralysis. His serum PTH was elevated to 1,343 and 1,101 pg/ml with concomitant hypocalcemia of 7.9 and 6.7 mg/dl. Twenty four hour urinary calcium and serum 25 hydroxy vitamin D were normal. Bone mineral density was normal. The patient was managed with calcitriol in doses of 1 to 2 µg/d, associated to calcium 2 g/day. Serum calcium levels and PTH normalized after two months and six months of treatment respectively.