Conflictos del cirujano: ¿La vocación quirúrgica está en crisis? / Conflicts of surgeons: is surgical vocation in crisis?

RESUMEN Introducción: En los últimos años vemos un aumento de bibliografía que se refiere a problemas perso nales y psicológicos del cirujano, a la deserción en residencias de cirugía y a la falta de especialización de individuos jóvenes. Este aumento se observa sobre todo en revistas de jerarquía como Lancet o JAMA. ¿Pero cuál es la situación en la Argentina? ¿Consideramos que nos están pagando adecua damente por nuestra práctica? ¿Pensamos en abandonar nuestra especialidad? ¿Cuántos conflictos tenemos con pacientes por mes? Estimamos necesaria la realización de un trabajo regional que lo plasme. Objetivo: conocer la situación socioeconómica actual de los cirujanos. Material y métodos: estudio de corte transversal. Resultados: de 73 cirujanos encuestados de la provincia de Santa Fe, se recibió respuesta en un 57,5 %. El 87,8 % fueron hombres y 56,1% estaba dentro del grupo de edad adulto intermedio/mayor al momento del estudio. El 97,6 % de los cirujanos concordó en que sus ingresos no se corresponden con el tiempo invertido en la práctica. Consideraron abandonar su práctica diaria en el último año en un 26,2 %; la causa económica es el principal problema para el 72,7%. Discusión: la incomodidad del cirujano frente a su salario (97,6 %), la discrepancia de porcentajes en tre cirujanos y cirujanas (87,8% vs. 12,2%), la falta de cirujanos jóvenes (43,9%) y la alarmante cifra de cirujanos graduados por año (35 por año) son cuatro puntos clave que consideramos deberían abordar de manera urgente los entes políticos y, sobre todo, las Asociaciones de Cirugía.

ABSTRACT Background: In recent years we have witnessed more publications about personal and psychological issues affecting surgeons, residents quitting surgery residencies, and lack of specialization of young in dividuals. This growth can be observed especially in high-impact journals such as The Lancet or JAMA. But what is the situation in Argentina? Do we think that we are receiving adequate payment for our practice? Do we consider quitting our specialty? How many conflicts do we have with patients each month? We think that a regional work is necessary to reflect this situation. Objective: The aim of this study is to determine the current socioeconomic situation of surgeons. Material and methods: We conducted a cross-sectional study. Results: A total of 73 surgeons from the province of Santa Fe were contacted and 42 answers were received (response rate 57.5%): 87.8% were men and 56.1% corresponded to middle/older adulthood. Almost all surgeons (97.6%) agreed that their income did not reflect the time spent in practice. Up to 26.2% of survey respondents considered quitting their daily practice in the last year due to eco nomic reasons, which is the main problem for 72.7% of them. Discussion: Surgeons' discomfort with their salaries (97.6%), the discrepancy in percentages between male and female surgeons (87.8% vs. 12.2%), the lack of young surgeons (43.9%) and the alarming number of surgeons graduated per year (35 per year) are 4 key issues which we believe should be urgently addressed by political bodies and, especially, by surgery associations.

Attitudes and experiences during training and professional expectations in generation-y surgical residents

SUMMARY BACKGROUND: Residency programs, especially in surgery, have been undergoing constant changes. The profile of residents in surgical fields is changing too since residents are now part of the Generation Y (Millenials). This change in profile mandates a re-evaluation to adapt surgical residency programs. Six years ago, we carried out a study evaluating attitudes and experiences during training, and the professional expectations of residents. This study aims to survey surgical residents to evaluate current attitudes, experiences, and expectations. METHODS: We surveyed 50 residents to determine professional satisfaction, residency-program satisfaction, future expectations, financial expectations, and correct attitude towards patients. RESULTS: Our results show that half of the residents are satisfied with the residency program. However, dissatisfaction reaches 40% on surgical volume and 80% on mentorship; 62% of the residents are not confident to perform operations after the residency, the majority believes a specialization is necessary; most residents believe financial compensation will decrease with time, but concerns with reimbursement are low; and most residents are worried about injuring patients, but only two thirds are satisfied working with patients. CONCLUSIONS: Current residents present lower job satisfaction and more criticism of teaching techniques. These changes compared to previous results match the profile of Generation Y, who is more iconoclastic when compared to previous generations.

RESUMO INTRODUÇÃO: Os programas de residência, especialmente em cirurgia, estão em constante mudança. O perfil dos residentes nos campos cirúrgicos também vem mudando, dado que atuais residentes fazem parte da Geração Y (Millennials). Essa mudança de perfil demanda uma reavaliação para adaptar os programas de residência. Este estudo tem como objetivo entrevistar os residentes de áreas cirúrgicas para avaliar suas atuais atitudes, experiência e expectativas. MÉTODOS: Entrevistamos 50 residentes para determinar satisfação profissional, expectativas em relação ao futuro, expectativas financeiras e atitude correta em relação aos pacientes. RESULTADOS: A insatisfação com o volume cirúrgico chega a 40% e a 80% com a preceptoria; 62% dos residentes não se sentem confiantes para realizar procedimentos sozinhos após o fim do programa e a maioria acredita que uma especialização cirúrgica é necessária; a maioria dos residentes acredita que os ganhos monetários diminuirão com o tempo. CONCLUSÃO: Os atuais residentes apresentam menor satisfação com o trabalho quando comparados com os antigos, e são mais críticos quanto ao ambiente de ensino. Essas mudanças seguem as premissas da Geração Y, cujos participantes são mais iconoclastas quando comparados a gerações passadas.

TRENDS AND ATTITUDES TOWARD ONCOPLASTICS TRAINING IN MASTOLOGY IN BRAZIL / Tendências e atitudes para o treinamento oncoplástico em Mastologia no Brasil

Introduction: There is a growing interest in, and an increasing demand for, oncoplastic (OP) and reconstructive surgery training by breast surgeons. However, until now there has been a lack of a specific model for training in this field in most countries and no data with respect to learning curves. Mastology has been a medical specialty in Brazil since 1978. It is fully dedicated to studying, preventing, diagnosing, and managing all diseases of the breast. Incorporation of OP and reconstructive surgery in Mastology presents a number of challenges, and there are some controversial issues to overcome. Objective: The purpose of this study, therefore, was to analyze how OP and reconstructive techniques are being incorporated into surgical training in Mastology in Brazil. Methods: A specific survey was designed to cover all surgical residents who concluded their regular program in Mastology in Brazil in 2015 and 2016. Results: One hundred twenty-four residents from 49 breast units were included, with the majority having their training for all 2 years of their residence, as recommended by the Brazilian Society of Mastology. In addition, most of the respondents were able to perform partial breast reconstructions and reconstructions using expanders and implants, but 20% of them had a lack of specific training in these techniques. Conclusion: As adequate local control of disease and quality of life are related to surgical decisions, it is expected that breast surgeons expand their limits and responsibilities in order improve the reality of most breast cancer patients.

Introdução: Existe um interesse e uma demanda crescente de treinamento oncoplástico (OP) e cirurgia reconstrutiva por cirurgiões de mama. No entanto, até agora tem faltado um modelo específico de treinamento neste campo na maioria dos países, sem dados com relação à curva de aprendizado. A Mastologia tem sido uma especialidade médica no Brasil desde 1978. É totalmente dedicada a estudar, prevenir, diagnosticar e gerenciar todas as doenças da mama. A incorporação de OP e cirurgia reconstrutiva na Mastologia apresenta uma série de desafios, e há algumas questões controversas a serem superadas. Objetivo: O objetivo deste estudo, portanto, foi analisar como a OP e as técnicas reconstrutivas estão sendo incorporadas no treinamento cirúrgico em Mastologia no Brasil. Métodos: uma pesquisa específica foi projetada para cobrir todos os residentes cirúrgicos que concluíram seu programa regular em Mastologia no Brasil em 2015 e 2016. Resultados: Foram incluídos 124 residentes de 49 unidades mamárias, com a maioria treinada durante todos os 2 anos de residência, conforme recomendado pela Sociedade Brasileira de Mastologia. Além disso, a maioria dos entrevistados foi capaz de realizar reconstruções e reconstruções mamárias parciais usando expansores e implantes. Mas ainda 20% deles apresentaram falta de treinamento específico nestas técnicas. Conclusão: uma vez que o controle local adequado da doença e da qualidade de vida está relacionado às decisões cirúrgicas, espera-se que os cirurgiões de mama ampliem seus limites e responsabilidades para melhorar a realidade da maioria dos pacientes com câncer de mama.

Exploration of the management of surgical internship for foreign medical students / 中华医学教育探索杂志

Clinical intemship is an important part of medical education.Medical eduezlion for foreign individuals in China has been initiated for a few years.Given the cultural and language background of foreign medical students,It is necessary to study and accumulate experience in developing an effective systern to manage their clinical intemship.We are here to present our approaches,such as teaching with both Chinese and English,arranging for Chinese students and foreign students to work together,to impmve surgical internship for foreign medical students in West China Medical School

Laparoscopic Appendectomy: A Safe Procedure that can be Performed by Surgical Residents

PURPOSE: Although laparoscopic surgery has many advantages and has become popular in various disease settings, surgical residents do not yet have sufficient opportunity to perform laparoscopic surgery. Appendectomies are the most common procedures performed by surgical residents, and they may be suitable for gaining them laparoscopic experience. We had our residents perform laparoscopic appendectomies and analyzed clinical outcomes to verify the utility of this procedure in providing laparoscopy education. METHODS: Between September 2006 and December 2007, 384 patients with a preoperative diagnosis of acute appendicitis underwent laparoscopic appendectomy (n=191, LA) or open appendectomy (n=193, OA). Patient demographic data and outcomes for the two groups were compared. In the LA group, cases performed by surgical residents were compared against those performed by surgical specialists. RESULTS: Both groups of patients were comparable demographically. The incidence of complicated appendicitis in the LA group was 19.4% and that in the OA group was 25.9% (P=0.126). Operative time was similar between the two groups. Postoperatively, recovery time was shorter in the LA group than in the OA group, especially for patients with non-complicated appendicitis. LA performed by surgical residents showed similar outcomes, including operative time and postoperative recovery parameters. CONCLUSION: Laparoscopic appendectomy appears to have many advantages, such as less pain, rapid postoperative recovery, and more economic differential diagnosis. This procedure can be performed safely by surgical residents. Thus, laparoscopic appendectomy is a suitable procedure for laparoscopic surgery education for surgical residents.