Residências em saúde em hospital universitário: cenário potente de formação para a prática colaborativa interprofissional / Health residency programs in a university hospital: a potent training setting for interprofessional collaborative practice / Residencias sanitarias en un hospital universitario: un potente escenario de formación para la práctica colaborativa interprofesional

Resumo Este estudo tem por objetivo compreender a experiência de residentes sobre a Prática Colaborativa Interprofissional (PCI) em um hospital universitário (HU) do estado de São Paulo. É uma pesquisa qualitativa realizada por meio de entrevistas semiestruturadas com base na Técnica do Incidente Crítico, com 14 residentes de programas de residência uni e multiprofissionais, analisadas pela análise temática de Bardin. O HU mostrou-se potente para efetivação da PCI por proporcionar interações entre profissionais de diferentes áreas e níveis de formação. A qualidade das interações entre trabalhadores, residentes, usuários e família foi determinante para o desenvolvimento da PCI. Foram identificadas barreiras como ausência de estruturação organizacional, sobrecarga dos profissionais, fragilidade na oferta de Educação Permanente relacionada à educação interprofissional e predomínio do modelo biomédico de Atenção à Saúde. As ações colaborativas mediadas pela comunicação informal constituem o dispositivo mais utilizado para os atendimentos compartilhados.(AU)

Abstract The aim of this study was to explore residents' experiences of interprofessional collaborative practice (ICP) in a university hospital (UH) in São Paulo. We conducted a qualitative study with 14 residents undertaking uniprofessional and multiprofessional residency programs. The data were collected using critical incident technique-based semi-structured interviews and analyzed using thematic analysis as proposed by Bardin. The UH was shown to be a potent training setting for ICP, promoting interactions between professionals from a range of areas and with varying levels of qualification. The quality of interactions between workers, residents and patients and their families was a determining factor for the development of ICP. Barriers to ICP included lack of organizational structure, excessive workload, weaknesses in the provision of permanent training in ICP and the predominance of the biomedical model of health care. Collaborative actions mediated by informal communication were the most common mechanism used for providing shared consultations.(AU)

Resumen Este estudio reta comprender la experiencia de los residentes sobre la Práctica Colaborativa Interprofesional (PCI) en un hospital universitario (HU) en el estado de São Paulo. Investigación cualitativa a través de entrevistas semiestructuradas basadas en la Técnica del Incidente Crítico con 14 residentes de programas de residencia uni y multiprofesionales, analizadas por análisis temático de Bardin. El HU demostró ser potente para la implementación de la PCI al propiciar interacciones entre profesionales de diferentes áreas y niveles de formación. La calidad de las interacciones entre trabajadores, residentes, usuarios y familiares fue crucial para el desarrollo de la PCI. Se identificaron barreras como falta de estructura organizacional, sobrecarga de profesionales, debilidad en la provisión de educación permanente interprofesional y predominio del modelo biomédico de atención. Las acciones colaborativas mediadas por comunicación informal son el dispositivo más utilizado para el cuidado compartido.(AU)

Efectos de la pandemia en los programas de formación en cirugía: problemas y soluciones / Effects of pandemic on training programs in surgery: problems and solutions

Resumen La pandemia por el virus SARS-CoV-2 ha afectado fuertemente los programas de educación quirúrgica. El Capítulo Chileno del American College of Surgeons realizó un webinar para evaluar y discutir los efectos de la pandemia en la educación quirúrgica. Este evento contó con la asistencia de 450 personas de 17 países, incluyendo la participación de destacados docentes del área quirúrgica. Las principales conclusiones de este webinar fueron que la pandemia alteró considerablemente los programas de educación quirúrgica. Un 26% de los residentes se contagiaron, pero la mayoría no precisó cuidados especiales. Las intervenciones quirúrgicas disminuyeron hasta en un 90% en algunos programas. Los residentes debieron asumir el cuidado de pacientes COVID-19. Se han implementado sistemas de enseñanza virtual, como seminarios en línea o webinars, discusión de casos clínicos, videos y simulación. Dichas actividades teóricas, al igual que la simulación quirúrgica fueron evaluadas, mayoritariamente, vía web. Las sociedades científicas han tenido un importante rol en estas actividades. En el futuro, los programas universitarios enfrentarán escenarios con menos pacientes y una reducción de las oportunidades de enseñanza para residentes. Las actividades en línea y simulación adquirirán mayor relevancia. Es posible superar esta crisis como lo han hecho los países desarrollados, comparados con ellos, carecemos de un plan nacional de emergencia en salud, en el que los estudiantes y personal sanitario tengan un rol definido en áreas específicas, con metas concretas. El retorno a la "nueva normalidad" estará lleno de desafíos.

The SARS-CoV-2 pandemic has had an impact in surgical residency programs. The Chilean chapter of the American College of Surgeons organized a webinar to discuss and address the effects of this pandemic on surgical education. This meeting had a virtual attendance of 450 people from 17 countries, including the participation of surgical educators. Conclusions of this webinar were that COVID-19 has strongly affected surgical education programs. Twenty six per cent of residents were infected. Most of them did not need special care. Surgical opportunities have decreased up to 90% in some programs. Residents have had to be involved in managing COVID-19 patients. Changes in surgical education, led to a virtual instruction which includes seminars, webinars, case discussion, videos and simulation. Assessment has been performed of theoretical activities, via web. Simulation tasks also have been evaluated. Scientific societies had a very important role in these activities. In the near future, university programs will face different scenarios in hospitals and clinical centers, with fewer patients and reduced clinical instruction for residents. Online activities and simulation will increase in relevance in years to come. It is possible to overcome this crisis, as some developed countries have already done, compared to them, we lack a national emergency health plan in which medical students, residents, doctors, and all health care providers have a designated role in specific areas with clear goals. The return to "the new normal" will be filled with challenges.

Transition experience to professional nurse: A phenomenological approach

Purpose@#Transition programs have been adopted by many healthcare institutions to assist the new graduate nurse as they adjust to the work environment. The use of structured residency programs and prolonged orientations are considered best practices to ease the new graduate nurse into their role. This study aims to describe the lived experience of new graduate registered nurses as they enter the workforce.@*Design@#Using a qualitative research design, Van Manen's phenomenological inquiry, study participants were selected using non-probability purposive sampling. Data were collected between December 2018- September 2019 with in-depth interviews using semi-structured questionnaires. The sample (N=7) consisted of participants born between the years 1986-1996, graduated within three years of the study, and practice in the northeastern region of the United States.@*Method@#Amodified Colaizzi approach allowed the researchers to return to the study participants to validate themes.@*Findings@#The experience and perceptions of new graduate registered nurses are unified in two major themes discussed within this article: emotional ambivalence and the need to escape.@*Conclusion@#New graduate nurses continue to feel overwhelmed and need structured guidance during their professional transition training programs. In the absence of strong support by the institution, new graduates leave the bedside.

Proceso de acreditación de residencias de Pediatría por el Consejo de Acreditación de Espacios de Formación / Pediatric residency program accreditation process by the Council for the Accreditation of Education Institutions

Introducción. La formación médica de posgrado en un sistema de residencias constituye el mejor modelo para la formación de especialistas. La acreditación de residencias implica un proceso de armonización y normalización de criterios. Establece una base común y reproducible, que asegura una formación de calidad y con lineamientos curriculares universales.Objetivo. Describir el proceso de acreditación de residencias de Pediatría por el Consejo de Acreditación de Espacios de Formación entre enero de 2011 y julio de 2017.Métodos. El proceso de acreditación se desarrolló acorde al marco de referencia, que definía 6 dominios y 28 ítems. De acuerdo con su cumplimiento, se especificaron 3 categorías de acreditación. El análisis de las residencias acreditadas se categorizó en tres regiones geográficas: provincia de Buenos Aires, Ciudad Autónoma de Buenos Aires (CABA) y otras regiones. Se dicotomizó cada ítem evaluado en no cumplimiento y cumplimiento parcial o total. Las variables categóricas se expresaron en números totales y porcentajes.Resultados. Se evaluaron 94 programas de residencia de Pediatría: 34 (el 36 %) correspondieron a provincia de Buenos Aires; 25 (el 27 %), a CABA, y 35 (el 37 %), a otras regiones. Pertenecían a la gestión pública 79 (el 85 %). Alcanzaron la máxima categoría de acreditación 35 (el 37 %). No fueron acreditadas 4 (el 4 %). El cumplimiento de la mayoría de los ítems pertenecientes a los 6 dominios evaluados fue superior al 80 %.Conclusión. La mayoría de las residencias evaluadas fueron acreditadas y cumplieron con los estándares de referencia

Introduction. Postgraduate medical education as part of a residency system is the best model for specialist training. The accreditation of residency programs entails a harmonization and standardization process. It defines a common and reproducible basis to ensure high-quality training and universal curricular guidelines.Objective. To describe the pediatric residency program accreditation process by the Council for the Accreditation of Education Institutions between January 2011 and July 2017.Methods. The accreditation process was developed according to a reference framework that defined 6 domains and 28 items. Based on compliance, 3 accreditation categories were established. The analysis of accredited residency programs was categorized into 3 geographic regions: province of Buenos Aires, Autonomous City of Buenos Aires (CABA), and other regions. Each analyzed item was dichotomized into non-compliance and partial or total compliance. Categorical outcome measures were expressed in absolute numbers and percentage.Results. Ninety-four pediatric residency programs were assessed: 34 (36%) corresponded to the province of Buenos Aires; 25 (27 %), to CABA; and 35 (37 %), to other regions. In total, 79 (85 %) were in the public sector. The maximum accreditation category was achieved by 35 (37 %). Four (4 %) were not accredited. Compliance for most items corresponding to the 6 domains was over 80 %.Conclusion. Most assessed residency programs were accredited and complied with the reference standards

Encontros de aprendizagem e projetos pedagógicos singulares nas residências em Saúde / Encuentros de aprendizaje y proyectos pedagógicos singulares en las residencias de Salud / Learning meetings and singular pedagogical projects in health residency programs

São apresentados os conceitos de "encontros de aprendizagem" e de "projetos pedagógicos singulares", ambos resultantes do estudo sobre o ensino da saúde em programas de residência. O primeiro refere-se à ética do acompanhamento e ao acoplamento educação-trabalho; o segundo, à constituição de currículos singulares em substituição a currículos conservadores. A metodologia do estudo foi designada como "pesquisar com Alice" (Alice no País das Maravilhas), usando a multiplicidade de comunicações sistemáticas (convite à conversa) e assistemáticas (escutas em cenas de debate) proporcionadas por um Encontro Nacional de Residências em Saúde, diante das palavras ensino e aprendizado. Pode-se compreender que os aprendizados da prática são resultantes de exposições e apreensões afetivas, e que um currículo se faz pela capacidade de se apreenderem perguntas e dar-lhes lugar, não à curricularização escolar daquilo que há por aprender, especialmente quando a educação ocorre em serviço.(AU)

Se presentan los conceptos de "encuentros de aprendizaje" y de "proyectos pedagógicos singulares", ambos resultantes del estudio sobre la enseñanza de la salud en programas de residencia. El primero se refiere a la ética del acompañamiento y al acoplamiento educación-trabajo, el segundo a la constitución de currículos singulares en substitución a los currículos conservadores. La metodología del estudio se designó como "investigar con Alicia" (Alicia en el país de las maravillas), utilizándose la multiplicidad de comunicaciones sistemáticas (invitación a la conversación) y asistemáticas (escuchas en escenas de debate) proporcionadas por un Encuentro Nacional de Residencias de Salud, ante las palabras enseñanza y aprendizaje. Es posible comprender que los aprendizajes de la práctica resultan de exposiciones y captaciones afectivas y que un currículo se realiza por medio de la capacidad de captar preguntas y darles espacio, no por la colocación en currículo escolar de lo que se debe aprender, especialmente cuando la educación se realiza durante el trabajo.(AU)

This is a presentation of the concepts of "learning meetings" and "singular pedagogical projects", both resulting from a study on health education in residency programs. The first concept refers to follow-up ethics and the educationwork pair, whereas the second refers to the constitution of singular syllabuses in replacement of conservative syllabuses. The methodology was designed as "researching with Alice" (Alice in Wonderland), making use of the multiplicity of systematic (invitation to dialogue) and nonsystematic communication (hearings in debate scenes) provided in a in a Health Residency Programs National Meeting, in light of the words teaching and learning. It is understood that practical learning results from emotional exposure and apprehensions, and that a syllabus is made up of the possibility to apprehend questions and contextualize them, rather than creating a school syllabus based on what will be learned, especially when it comes to in-service education.(AU)

Residency programs and the outlook for occupational and environmental medicine in Korea

OBJECTIVES: This study investigated the implementation of training courses and the overall outlook for occupational and environmental medicine (OEM) in Korea. We described the problems facing OEM residency programs in Korea, and reviewed studies dealing with the specialty of occupational health in developed countries in order to suggest directions of improvement for the OEM training courses. METHODS: We surveyed 125 OEM residents using a questionnaire in August 2012. A total of 23 questions about the training environment, residency programs, preferred institutions for post-licensure employment, and the outlook for OEM specialists were included in the questionnaire and analyzed according to the type of training institution and residency year. Responses from 88 residents (70.4 %) were analyzed. RESULTS: The major responsibilities of OEM residents were found to vary depending on whether they were trained in research institutes or in hospitals. OEM residents had a lower level of satisfaction with the following training programs: toxicology practice (measurements of biological markers, metabolites, and working environments), and OEM practice (environmental diseases and clinical training involving surgery). When asked about their eventual place of employment, OEM residents preferred institutions providing special health examinations or health management services. OEM residents reported a positive outlook for OEM over the next 5 years, but a negative outlook for the next 10 years. CONCLUSIONS: Although a standardized training curriculum for OEM residents exists, this study found differences in the actual training courses depending on the training institution. We plan to standardize OEM training by holding a regional conference and introducing open training methods, such as an open hospital system. Use of Korean-language OEM textbook may also reduce differences in the educational programs of each training institution. Toxicology practice, environmental diseases, and clinical training in surgery are areas that particularly need improvement in OEM residency training programs.

Core procedure of family medicine residency programs

BACKGROUND: There has been no systematic investigation of the necessary core procedures in primary care in Korea. The purpose of this study is to examine the core procedures necessary in primary care and to have the results reflected in residency programs. METHODS: A mail survey was conducted fram May 2, to August 20, 1997 among 478 physicians who qualified as a family physician specialist since 1989. The contents of the questionnaire included 1) sex, age, locatian and size of the hospital 2) of the 93 procedures that should be taught during residency pragrams as suggested by the [American Academy of Family Physicians] and the [Korean Academy of Family Physicians a) procedures taught in residency programs, b) procedures performed by practicing family physicians, and, c) procedures considered as necessary in primary care. RESULTS: 1) Of the 93 procedures, 78 were taught in residency programs, 35 were performed by practicing family physicians, and 77 were considered necessary in primary care. 2) All of the 35 procedures performed by family physicians were taught in the residency programs. Of the 77 procedures considered necessary in primary care, 71 were taught but the remaining 6 were infrequently taught. 3) 7 procedures were taught but was considered unnecessary ; Procedures taught but not actually performed amounted to a total of 43. 4) 42 procedures were considered necessary but not performed. 5) More procedures were performed by male doctors(p<0.05). Surgical procedures were performed more often in regional hospitals than those in Seoul and in the larger cities(p<0.05), and more were performed in private practice(p<0.05). CONCLUSIONS: Although almost all of the procedures considered necessary in primary care were taught in residency programs, many procedure's were not being performed in current medical practice. We suggest that it would be more effective to intensively train the core procedures than to provide exposure to a wide array of procedures. As the procedures performed were found to vary in relat