Flaws in the design of the Examen Nacional para Aspirantes a Residencias Médicas produce inequity / Fallas en el diseño del Examen Nacional para Aspirantes a Residencias Médicas generan inequidad

Abstract: Objective: To assess the assumption of 'equity' of Mexico's resident-selection assessment tool, the Examen Nacional para Aspirantes a Residencias Médicas (ENARM). Materials and methods: Official ENARM-2016 and -2017 databases were analyzed. Differences in the absolute number of correct answers (multivariable linear regression) and the number of applicants reaching their specialty minimum score (SMS) per test day (odds ratio [OR]) were calculated. Applicants affected by test-day inequity were estimated. Results: There were 36 114 applicants in 2016, and 38 380 in 2017. In 2016, day-2 applicants had significantly higher scores and more reached the SMS than on days 1-3-4 (OR 1.55), and 5 (OR 3.8); 3 565 non-passing applicants were affected by inequity (equivalent to 44.64% of those selected). In 2017, day-1 and -2 applicants had significantly higher scores and more reached the SMS than on days 3-4 (OR 1.85), and 5 (OR 4.04); 3,155 non-passing applicants were affected by inequity (37.2% of those selected). Conclusion: Analysis of official ENARM databases does not support the official attribution of equity, suggesting the test should be redesigned.

Resumen_ Objetivo: Evaluar el atributo de "equidad" asignado al Examen Nacional para Aspirantes a Residencias Médicas (ENARM). Material y métodos: Se analizaron las bases de datos oficiales del ENARM 2016 y 2017. Se compararon las diferencias inter-día de respuestas correctas (regresión linear multivariable) y de sustentantes que alcanzaron el puntaje mínimo de su especialidad (PME) (razón de momios [RM]). Se estimó a los afectados por la inequidad. Resultados: Hubo 36 114 sustentantes en 2016 y 38 380 en 2017. Los días 2 (ENARM-2016) y 1-2 (ENARM-2017) registraron puntajes significativamente más altos, y más sustentantes alcanzaron el PME que en los días 1-3-4 (RM 1.55) y 5 (RM 3.8) en 2016, y los días 3-4 (RM 1.85) y 5 (RM 4.04) en 2017. Se estimó que cuatro de cada diez sustentantes que aprobaron el ENARM no lo hubieran hecho si el examen fuera equitativo. Conclusión: Los resultados sugieren que el atributo de equidad del ENARM está en duda.

Changes in operative experience after the introduction of residency: an objective comparison of surgical and endoscopic volumes

<p><b>INTRODUCTION</b>The SingHealth Residency General Surgery Programme replaced the basic and advanced specialist training (AST) system in Singapore in 2010. The relative merits of both systems continue to be debated, especially the operational readiness of graduating residents. We set out to compare the operative and endoscopic volumes of graduates from the AST system with those from the first graduating batch of the residency programme during their registrar (or equivalent) years, as a reflection of procedural experience gained during traineeship.</p><p><b>METHODS</b>Operative and endoscopic records of four graduating residents and seven AST system trainees were extracted from the cluster-wide Operating Theatre Management system and compared. Surgeries were analysed as registrar-level operations and their corresponding subspecialties.</p><p><b>RESULTS</b>Registrars and senior residents performed a mean of 1,182 and 533 general surgical operations, respectively. Median percentage loss in operative volume was 50.6% (range 9.6%-75.5%). The mean number of total gastroscopies and colonoscopies performed by registrars (total gastroscopy, n = 819; total colonoscopy, n = 743) and senior residents (total gastroscopy, n = 376; total colonoscopy, n = 412) indicated a mean loss of 54.1% and 44.6%, respectively, in gastroscopic and colonoscopic experience.</p><p><b>CONCLUSION</b>The residency programme aims to provide robust and complete surgical training. The operational readiness of its graduates is often scrutinised against that from the old system. Although a significant difference in surgical and endoscopic volumes was observed between the two trainee groups, this is only one marker of surgical experience and technical competence.</p>

Ensino em serviço de enfermeiras obstétricas na modalidade de residência: o papel da preceptoria / Residency in-service education for nurse-midwives: the role of preceptorship

O objeto da pesquisa é o papel da preceptoria no ensino em serviço de enfermeiras obstétricas na modalidade de residência. No ensino de enfermagem obstétrica, pode se aplicar os conceitos pedagógicos de Paulo Freire, visto que o ensino deve capacitar enfermeiras com competências técnico-profissionais e conscientes do contexto sanitário, sociopolítico, organizacional, econômico, do trabalho em saúde da mulher e da própria profissão, para que sejam capazes de participar ativamente na mudança do modelo hegemônico e de implementar as práticas humanizadas e voltadas para as necessidades da mulher. Os objetivos da pesquisa foram: analisar como ocorre o ensino em serviço da preceptoria da residência em enfermagem obstétrica nos cenários da prática hospitalar; identificar as estratégias pedagógicas adotadas pela preceptoria durante esta formação; discutir as potencialidades e os limites do ensino em serviço para a formação de enfermeiras obstétricas capazes de atuar na mudança do modelo assistencial medicalizado. Para alcançá-los, optou-se pela pesquisa de abordagem qualitativa e do tipo descritiva. Os cenários foram quatro maternidades públicas municipais onde são desenvolvidas as atividades práticas dos programas de residência de enfermagem obstétrica, com coordenação pedagógica da Faculdade de Enfermagem da Universidade do Estado do Rio Janeiro (UERJ), onde foram entrevistadas dezesseis enfermeiras obstétricas preceptoras, por atuarem diretamente na formação das residentes de enfermagem obstétrica. A análise foi guiada pela hermenêutica-dialética. Foram construídas duas categorias: a) O ensino em serviço da preceptoria ocorre segundo a rotina assistencial e apresenta contradições entre a teoria e a prática; b) O papel da preceptora no ensino em serviço: ênfase nas práticas humanizadas, mas limitado pela organização do ensino e do trabalho da enfermeira obstétrica no hospital. Os resultados demonstram que o ensino em serviço ocorre segundo a rotina assistencial com valorização da unidade teórico-prática, possibilitando a integração de teoria, vivência e trabalho, defendida por Paulo Freire. Visa ao modelo humanizado, baseado nas individualidades de cada mulher, porém sua efetivação é prejudicada por fatores relacionados à organização do processo formativo, que exige a constituição de um elo de comunicação entre universidade e serviço. As preceptoras utilizam estratégias de ensino, como a discussão de casos, leitura de artigos científicos e questionamentos acerca da prática. Contudo, não estimulam o pensamento crítico sobre os conflitos e as resistências do contexto assistencial em que a residência se efetiva. Elas dão ênfase para a realização de procedimentos técnicos, almejando o aprendizado de habilidades e destrezas. Espera-se que este estudo contribua para a melhora desta formação. Recomenda-se que seja estimulada a comunicação entre academia e os campos de prática, e que esta aproximação também seja próspera para as preceptoras, promovendo a expansão de seu conhecimento didático-pedagógico e, consequentemente, favorecendo sua prática como preceptoras.

The object of this research is the role of preceptorship in the in-service training of nurse-midwives in residency programs. Paulo Freire's pedagogical concepts can be applied to the teaching of nurse-midwifery, since education should capacitate nurses with technical and professional competencies and make them aware of the healthcare, sociopolitical, organizational and economic contexts, as well as the work in the area of women's healthcare and their own profession, so they will be able to actively participate in changing the hegemonic model and to implement humanized practices focused on women's needs. The objectives of the research were: to analyze how the nurse-midwifery residency preceptorship in-service teaching occurs in the scenarios of hospital practice; to identify the pedagogical strategies adopted by the preceptorship during this training process; to discuss the potentialities and limits of in-service education for the training of nurse-midwives capable of contributing to the change of the medicalized health care model. A qualitative and descriptive approach was chosen in order to achieve these objectives. The scenarios were four public maternity hospitals, where the practical activities of nurse-midwifery residency programs are carried out under the pedagogical coordination of the School of Nursing of the State University of Rio de Janeiro (UERJ), where sixteen preceptors of nurse-midwifery were interviewed, since they directly participate in the training process of the residents of the nurse- midwifery program. The analysis was conducted based on the dialectical hermeneutics method. Two categories were built: a) The preceptorship in-service teaching occurs according to the care routine and presents contradictions between theory and practice; b) The preceptor's role in the in-service training: oriented to humanized practices, but constrained by the organization of the nurse-midwives' training and work load dynamics in the hospital. The results showed that the in-service training takes place according to the care routine with and that it values the unity of theory and practice, which enables the integration of theory, work and experience, as advocated by Paulo Freire. It aims for the humanized model, based on the individuality of each woman, but its effectiveness is hampered by factors related to the organization of the training process, which requires the establishment of a communication link between the university and the scenarios for practice. The preceptors use teaching strategies such as case discussions, reading of scientific papers and questions regarding the practice. However, they do not stimulate critical thinking about the conflicts and the resistance in the care context in which the residency program occurs. They emphasize the performance of technical procedures, aiming at the learning of abilities and skills. It is expected that this study will further contribute to the improvement of residency training. It is recommended that the communication between the academy and practice fields be stimulated, and that this proximity may also be thriving for preceptors, promoting the expansion of their pedagogical and didactic knowledge, consequently favoring their practice as preceptors.

Expectativas, motivações e percepções das enfermeiras sobre a especialização em enfermagem obstétrica na modalidade residência / Expectations, motivations and perceptions of nurses on the nurse-midwifery specialization course in the residence modality / Expectativas, motivaciones y percepciones de las enfermeras sobre la especialización en enfermeríaobstétrica en la modalidad de residencia

Objetivo: Identificar as motivações e expectativas das enfermeiras que optaram pelo curso de especialização em enfermagem obstétrica na modalidade residência e descrever as percepções, destas enfermeiras, sobre esta modalidade de pós-graduação lato sensu. Métodos: Pesquisa descritiva de abordagem qualitativa, que entrevistou as enfermeiras residentes de dois programas de residência em enfermagem obstétrica do Município do Rio de Janeiro. Utilizou-se a técnica da análise de conteúdo temática. Resultados: A escolha pela residência é motivada pela ênfase nas experiências práticas; identificação com a área da saúde da mulher; obtenção de bolsa-auxílio durante o curso e credenciais profissionais para o mercado de trabalho. O aprendizado prático é satisfatório, contudo com limitações nos setores de internação hospitalar e na integração entre teoria e prática. Conclusão: A Universidade e o serviço precisam trabalhar de forma mais integrada para melhoria do processo pedagógico na residência.

Objective: To identify the motivations and expectations of nurses who opted for the nurse-midwifery specialization course inthe residence modality and describe the perceptions of these nurses on this modality of lato sensu Post-graduate education.Methods: Qualitative descriptive study, in which the nurse residents of two nurse-midwifery residency programs in the city of Riode Janeiro were interviewed. We used the thematic content analysis technique. Results: The choice of the residency program ismotivated by an emphasis on practical experience; preference for women's health area; obtaining financial aid during the courseand professional credentials for the job market. Practical learning is satisfactory, but with limitations in the hospital sectors andintegration of theory and practice. Conclusion: The university and service need towork in a more integrated way to improve theeducational process in the residency program.

Objetivo: Identificar motivaciones y expectativas de enfermeras que optaron por el curso de especialización en enfermeríaobstétrica en la modalidad de residencia y describir las percepciones de ellas sobre el postgrado lato sensu. Métodos: Estudiodescriptivo de enfoque cualitativo. Fueron entrevistadas enfermeras residentes de dos programas de residencia en enfermeríaobstétrica en la ciudad de Rio de Janeiro. Se utilizó la técnica de Análisis de Contenido Temático. Resultados: La opción por laresidencia es motivada por su énfasis en la experiencia práctica; identificación con el área de la salud de la mujer; obtención deauxilio financiero durante el curso y credenciales profesionales para el mercado de trabajo. El aprendizaje práctico es satisfactorio,pero hay limitaciones en las áreas de hospitalización y en la integración de la teoría con la práctica. Conclusión: La universidady el servicio deben trabajar de manera más integrada para mejorar el proceso educativo en la residencia.

Consumo de tabaco en médicos residentes de pediatría en la Argentina: Prevalencia actual y tendencia en los últimos diez años / Tobacco consumption among pediatric residents in Argentina: Current prevalence and trend over the past 10 years

Introducción. Los pediatras se encuentran en una posición estratégica para actuar en la prevención del tabaquismo. Objetivos. Estimar la prevalencia del tabaquismo en residentes de pediatría, analizar los factores asociados, describir su conducta preventiva y evaluar las diferencias en la última década. Métodos. Estudio transversal, por encuesta anónima, autoadministrada, que incluyó a residentes de pediatría de ocho hospitales de la Argentina. Se evaluaron el hábito de fumar, los factores asociados, la actitud hacia el consumo de tabaco de los pacientes o los padres, y se compararon los resultados con los de 2002. Resultados. De 448 encuestados, 20,1% fumaban. No hubo diferencias signifcativas entre fumadores y no fumadores respecto del sexo, los hijos, el número de guardias y el tener un jefe fumador. El padre fumador fue un factor de riesgo para tabaquismo solo en las mujeres (OR 1,98; IC 95% 1,09 a 3,61; p= 0,01). Los que vivían en pareja fumaban menos (OR 0,57; IC 95% 0,34 a 0,96; p= 0,03). Solo 18,1% refrieron tener una conducta activa frente al tabaquismo de los pacientes, sin diferencias entre fumadores y no fumadores. No hubo diferencia con la prevalencia del tabaquismo de 2002, pero sí mayor proporción de residentes que aconsejaban (32,4% contra 26,1%; p <0,01) y advertían a sus pacientes (37,7% contra 18,6%; p <0,01), y que recibieron información durante su formación (63,6% contra 39,8%; p <0,01). Conclusiones. El 20,1% de los médicos residentes de pediatría eran fumadores, siendo más frecuente en las mujeres con un padre fumador. La conducta activa frente al tabaquismo de los pacientes o sus padres fue muy baja. Pese a las políticas ofciales, el tabaquismo en este grupo no se ha modifcado en la última década, aunque aumentó la proporción de quienes recibieron información durante su formación, y aconsejan y advierten a los pacientes sobre sus riesgos.

Introduction. Pediatricians are in a strategic position to prevent smoking. Objectives. To estimate the prevalence of smoking among pediatric residents, analyze associated factors, describe preventive actions, and assess the differences observed over the past decade. Methods. Cross-sectional study with a self-administered, anonymous survey conducted among pediatric residents from eight Argentine hospitals. Smoking habit, associated factors, and attitude towards patients' or their parents' smoking were evaluated; results were compared to those obtained in 2002. Results. Out of 448 surveyed physicians, 20.1% smoked. There were no signifcant differences between smokers and non-smokers in terms of gender, having children, number of on-call shifts, and having a supervisor who smokes. Having a parent who smoked was a risk factor for tobacco use only among women (OR: 1.98; 95% CI: 1.09-3.61; p = 0.01). Surveyed residents living with a couple had a lower smoking rate (OR: 0.57; 95% CI: 0.34-0.96; p = 0.03). Only 18.1% referred having an active behavior towards smoking patients, no differences were observed between smokers and non-smokers. In addition, there were no differences in smoking prevalence from 2002, but there was a higher rate of residents who advised their patients (32.4% versus 26.1%; p < 0.01) and warned them against smoking (37.7% versus 18.6%; p < 0.01), and of those who received information on this topic during their training (63.6% versus 39.8%; p < 0.01). Conclusions. Among resident pediatricians, 20.1% were smokers, with a higher prevalence among women with a father or mother who is a smoker. The rate of active behavior regarding patients or parents who smoke was very low. In spite of offcial policies, tobacco use in this group has not changed over the past decade, but there was an increase in the rate of those who received information during their training and of those who advised their patients of smoking risks.