Internship: A time to prioritise

Medical internship is a yearlong experience that is physically, mentally, and emotionally exhausting. After five years as students, the interns finally get close to achieving what they have always dreamt of. Most of the fundamental clinical knowledge and skills that a student learns are acquired during their internship. For the first time, students gain financial freedom, recognise the importance of a white coat, and are recognised as doctors. Internship helps a student to realise the mechanics of how a hospital operates, how patients are treated, how crises are managed, and most crucially, how to think and work productively in a chaotic yet effective atmosphere. Each obstacle encountered serves as a training ground. The key dilemmas are whether to prioritise learning clinical skills or study for the post-graduation entrance examinations, and which specialty to opt for. Conscientious mentors are vital to this whole process.

The electronic media and the study profile of the surgical resident / A mídia eletrônica e o perfil de estudo do residente em cirurgia

ABSTRACT Objective: this study analyzed the surgical resident's study profile by assessing the use of electronic media. 44.76% of the physicians agreed on participating. Methods: observational, cross-sectional non-controlled study. Statistical analysis was performed using Pearson's correlation coefficient and the significance level for the statistical tests was p <0.001. Results: 87.2% of the residents believed that it is interesting to use e-learning together with the classical theoretic classes. 45% of the interviewed claimed to spend more than 3 hours on the Internet daily. Conclusion: residents recognize the importance of technology for education, but not as a way of replacing the traditional teaching methods.

RESUMO Objetivo: este trabalho analisou o perfil de estudo dos residentes em Cirurgia, caracterizando o uso das mídias eletrônicas, por meio de questionário padronizado, com índice de resposta de 44,76%. Métodos: estudo descritivo, observacional transversal, sem grupo controle. O coeficiente de correlação de Pearson foi usado para a análise estatística e o nível de significância adotado foi de p <0,001. Resultados: observou-se que 87,2% dos residentes julgaram interessante associar o e-learning às aulas teóricas. Sobre o tempo despendido no uso de tecnologia, 45% referiram usar internet mais de 3 horas por dia. Conclusão: a partir dessa pesquisa, pode-se observar que os residentes atribuem importância à tecnologia em sua formação, todavia sem substituir o ensino tradicional.

Impacto de pandemia COVID-19 en la formación de residentes: análisis de una encuesta nacional a residentes de otorrinolaringología en Chile / How the COVID-19 pandemic affects specialty training: An analysis of a nationwide survey among otolaryngology residents in Chile

Introducción La enfermedad por coronavirus 2019, o COVID-19, se ha convertido en una pandemia. Dada que la mayor carga viral de coronavirus de tipo 2 causante del síndrome respiratorio agudo severo (SARS-CoV-2) se encuentra en la vía aérea, los otorrinolaringólogos tienen un elevado riesgo de infección. Múltiples recomendaciones han surgido con respecto a las medidas de protección, incluidos la suspensión de procedimientos y cirugías electivas. Objetivos Evaluar el impacto de la pandemia de COVID-19 en los programas de formación de otorrinolaringología a nivel nacional. Métodos Estudio transversal de encuesta en línea a residentes de otorrinolaringología realizado durante abril de 2020. Se analizaron datos demográficos, actividades clínicas, turnos de llamado, infección por COVID-19, exposición a pacientes COVID-19 positivos, despliegue a otras especialidades, procedimientos y cirugías realizadas. Se utilizaron los portafolios quirúrgicos de años previos para comparar los resultados. Resultados Completaron la encuesta 47 residentes, con 84% de tasa de respuesta; el 64% refirió haber acudido a su centro asistencial 10 días o menos durante el mes de abril de 2020. Con relación a procedimientos frecuentes tales como nasofibroscopía, endoscopia nasal rígida y drenaje de absceso periamigdalino, no fueron realizados por más del 40% de los residentes en el mes. Solo el 38% participó en cirugías, con un promedio de 0,6 procedimientos como primer cirujano; se constata una drástica disminución al comparar los registros de años anteriores. La mayoría de los residentes refieren estas medidas educativas complementarias: videoconferencias bibliográficas (87%), seminarios de casos clínicos en línea (60%), revisión de artículos (38%), entre otros. Conclusiones La formación clínica y quirúrgica disminuyó drásticamente durante abril de 2020. Se deben considerar ajustes a los planes de estudio para disminuir el impacto negativo de la pandemia en la formación de los residentes.

Introduction Coronavirus disease 2019, or COVID-19, has become a global pandemic. Given that the highest viral load of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is found in the airway, otolaryngologists are at high risk of infection. As a result, multiple recommendations have emerged regarding protective measures for surgical teams, including suspending non-urgent procedures and surgeries. Objectives To evaluate the impact of the COVID-19 pandemic on otolaryngology residency training programs nationwide. Methods A cross-sectional survey-based study was completed in April 2020. The participants were recruited through an online survey, sent by email to all Chilean otolaryngology residents. Demographics, clinical activities, on-call shifts, COVID-19 infection status, exposure to COVID-19 patients, deployment to other specialties, diagnostic/therapeutic procedures, and surgeries performed were analyzed. Self-reported surgical data logs from previous years were used to compare results. Results Forty-seven residents completed the survey (84% response rate); 64% of residents refer seeing patients ten days or less during April 2020. Commonly performed procedures such as flexible nasolaryngoscopy, rigid nasal endoscopy, and peritonsillar abscess drainage were not performed by over 40% of the residents in that month. Only 38% participated in surgeries, with an average of 0.6 surgeries as a first surgeon, a dramatic decrease in surgical exposure when comparing the data logs from previous years. Most residents refer the following measures taken by their residency program to improve residency training: bibliographic videoconferences (87%), online clinical case seminars (60%), weekly journal clubs (38%), among others. Conclusions Clinical and surgical opportunities decreased dramatically during April 2020. Adjustments to the regular academic curricula should be considered to decrease the negative impact of this pandemic on residency training.

Single-Incision, Two-Port Laparoscopic Appendectomy as an Alternative to Transumbilical Single-Port Laparoscopic Appendectomy

PURPOSE: We designed a modified technique to perform an advanced procedure using conventional instruments and did not employ specialized single-incision laparoscopic surgery (SILS) port equipment. We compared postoperative results for transumbilical, single-port laparoscopic appendectomy (TUSPLA) and single-incision, 2-port laparoscopic appendectomy (SITPLA). METHODS: This retrospective study enrolled 77 patients who underwent TUSPLA or SITPLA to provide more minimally invasive surgery between May 2017 and April 2018. TUSPLA was performed in 39 patients and 38 underwent SITPLA. In the SITPLA group, two 5-mm trocars were inserted through the umbilicus and an extra puncture site was used for a left-handed instrument. Demographic characteristics, operative data, and postoperative outcomes were collected and compared between the groups. RESULTS: The mean total operative time in the SITPLA group was shorter than in the TUSPLA group (p=0.003). The mean laparoscopic instrumental time was also shorter (p<0.001) in the SITPLA. The number of postoperative analgesics in the SITPLA group was less than in the TUSPLA group (p=0.002). The length of hospital day after surgery was shorter in the SITPLA group than in the TUSPLA group (p=0.008). There were no other significant differences between the groups. CONCLUSION: SITPLA had a shorter operative time, required less pain management, and had a similar cosmetic outcome when compared with TUSPLA.

Teaching skills for medical residents: are these important? A narrative review of the literature

ABSTRACT BACKGROUND: There is extensive evidence, mainly from the United States and Canada, that points towards the need to train medical residents in teaching skills. Much of the "informal curriculum", including professional values, is taught by residents when consultants are not around. Furthermore, data from the 1960s show the importance of acquiring these skills, not only for residents but also for all doctors. ­Teaching moments can be identified in simple daily situations, like discussing a clinical situation with patients and their families, planning patients' care with the healthcare team or teaching peers and medical students. The aim here was to examine the significance of resident teaching courses and estimate the effectiveness of these courses and the state of the art in Brazil. METHODS: We conducted a review of the literature, using the MEDLINE, PubMed, SciELO and LILACS databases to extract relevant articles describing residents-as-teachers (RaT) programs and the importance of teaching skills for medical residents. This review formed part of the development of a doctoral project on medical education. RESULTS: Original articles, reviews and systematic reviews were used to produce this paper as part of a doctoral project. CONCLUSIONS: RaT programs are important in clinical practice and as role models for junior learners. ­Moreover, these educational programs improve residents' self-assessed teaching behaviors and teaching confidence. On the other hand, RaT program curricula are limited by both the number of studies and their methodologies. In Brazil, there is no such experience, according to the data gathered here, except for one master's thesis.

A comparison of perspectives on costs in emergency care among emergency department patients and residents / 世界急诊医学杂志（英文）

@#BACKGROUND: Costs of care are increasingly important in healthcare policy and, more recently, in clinical care in the emergency department (ED). We compare ED resident and patient perspectives surrounding costs in emergency care. METHODS: We conducted a mixed methods study using surveys and qualitative interviews at a single, academic ED in the United States. The two study populations were a convenience sample of adult ED patients (>17 years of age) and ED residents training at the same institution. Participants answered open- and closed-ended questions on costs, medical decision making, cost-related compliance, and communication about costs. Closed-ended data were tabulated and described using standard statistics while open-ended responses were analyzed using grounded theory. RESULTS: Thirty ED patients and 24 ED residents participated in the study. Both patients and residents generally did not have knowledge of medical costs. Patients were comfortable discussing costs while residents were less comfortable. Residents agreed that doctors should consider costs when making medical decisions whereas patients somewhat disagreed. Additionally, residents generally took costs into consideration during clinical decision-making, yet nearly all residents agreed that they had too little education on costs. CONCLUSION: There were several notable differences in ED patient and resident perspectives on costs in this U.S. sample. While patients somewhat disagree that cost should factor into decision making, generally they are comfortable discussing costs yet report having insufficient knowledge of what care costs. Conversely, ED residents view costs as important and agree that cost should factor into decision making but lack education on what emergency care costs.

Razones, retos y aportaciones del programa de la especialidad de medicina familiar y comunitaria en España / Razões, desafios e contribuições do programa da especialidade de Medicina de Família e Comunidade na Espanha / Reasons, challenges and contributions of the specialty training programme in family and community medicine in Spain

El sistema de formación especializada, mediante residencia, ha sido, indudablemente, en estos 30 años uno de los motores que ha contribuido a elevar de forma homogénea la calidad asistencial y la seguridad de los pacientes, alcanzando de forma eficiente importantes resultados en salud en España, en relación a los países de nuestro entorno. La especialidad de Medicina Familiar y Comunitaria (MFyC) es una de las 44 especialidades médicas vía residencia. Se desarrolla en 97 Unidades Docentes que cuentan con 887 Centros de Salud y 212 hospitales acreditados y forma en torno a 1800 residentes/año. El programa de la especialidad, actualmente vigente, de 4 años, es un programa orientado por competencias, donde la flexibilidad, la pluripotencialidad, el eje tutor-residente y la evaluación formativa son sus características claves. Nace de la firme voluntad de actualizar y consolidar el cuerpo doctrinal y los valores de la MFyC y de un profundo compromiso con la formación y con el Sistema Nacional de Salud. Se sustenta en la evidencia de que un sistema sanitario para ser equitativo, efectivo, eficiente y viable debe contar con una Atención Primaria potente y resolutiva, la cual debe ser proporcionada por médicos bien formados y entrenados en su práctica. Por todo ello, es clave que los Ministerios y Organismos responsables de los sistemas sanitario y educativo de los países, consideren, como objetivo imprescindible, valorizar, con financiación adecuada y "empowerment", a la Atención Primaria como función central del sistema sanitario y a la MFyC como disciplina, especialidad y profesión sanitaria.

O sistema de formação especializada em medicina mediante residência tem sido, sem dúvida, nestes 30 anos, um dos elementos que contribuíram para aumentar a homogeneidade da qualidade assistencial e a segurança dos pacientes, atingindo eficientemente importantes resultados na saúde espanhola, com relação aos países vizinhos. A especialidade de Medicina de Família e Comunidade (MFC) é uma das 44 especialidades médicas existentes por meio de residência. É desenvolvida em 97 Unidades Docentes (UUDD) que contam com 887 Centros de Saúde e com 212 hospitais credenciados que formam cerca de 1800 residentes/ano. O programa da especialidade, que atualmente é de quatro anos, é orientado por competências em que a flexibilidade, o pluralismo na potencialidade, o eixo preceptor-residente, e a avaliação, são características principais. O programa nasce da vontade de atualizar e consolidar as doutrinas e os valores da MFC e de um profundo compromisso com a formação e com o Sistema Nacional de Saúde. É sustentado na evidência de que um sistema de saúde para ser equitativo, eficiente e viável precisa contar com uma Atenção Primária contundente e resolutiva, que deve vir com médicos bem formados e treinados. Por isso, é fundamental que os ministérios e os órgãos responsáveis pelos sistemas de saúde e educação dos diferentes países, levem em conta como objetivo imprescindível, a valorização, com um financiamento adequado e o empowerment necessário, da Atenção Primária como eixo central do sistema de saúde, e a MFC como disciplina, especialidade e profissão para a área da saúde.

In the past 30 years, specialty training in medicine, by means of residency programmes, has undoubtedly been one of the instruments that helped raise care quality and patient safety homogenously across the country, efficiently achieving important health outcomes in Spain in relation to surrounding countries. The specialty of Family and Community Medicine (FCM) is one of 44 medical specialties which require a residency training programme. It is developed in 97 teaching units that count on 887 health centres and 212 accredited hospitals, and train approximately 1800 residents per year. Currently, the specialty programme in FCM lasts four years and it is a competency-oriented programme whose key elements encompass flexibility, pluripotency, a resident-preceptor axe, and formative assessment. It originates from the firm will to update and consolidate the doctrines and values of FCM, as well as from a deep commitment to education and the National Health System. It is based on the evidence that an equitable, efficient and viable health care system must rely on a forceful and resolute Primary Care, which should provide well-prepared and trained physicians. Therefore, it is critical that the Ministries (and other organisations responsible for the health and educational systems of different countries) regard the provision of adequate funding and empowerment as an essential objective, so that primary care services can play a central role within the Health System and FCM can be seen as a discipline, specialty and health profession.

Reflexiones sobre la experiencia en el programa de residencia en Medicina Familiar y Comunitaria en España / Reflexões sobre a experiência no programa de residência em Medicina de Família e Comunidade na Espanha / Reflections on the experience in the Family and Community Medicine residency programme in Spain

En este artículo se relata la experiencia de una médica de familia a su paso por la Universidad, por el examen Médico Interno Residente (MIR) y por el programa de residencia en Medicina Familiar y Comunitaria, así como expectativas laborales, y su visión de futuro de la Atención Primaria.

Este artigo relata a experiência de uma médica de família em sua trajetória pela universidade, o exame Médico Interno Residente (MIR) e sua vivência no programa de residência em Medicina de Família e Comunidade, assim como as expectativas laborais e sua visão de futuro da Atenção Primaria.

This article describes the experience of a family physician in her university trajectory, the Physician Internship Resident exam (MIR), and her experience in the Family and Community Medicine residence programme as well as the career prospects and her vision on the future of primary care.

Pharmaceutical industry support for junior residency education in Japan : a national survey of program directors / 医学教育

  To examine the status of pharmaceutical industry support for junior residency education in Japan, we performed a questionnaire survey of 445 residency program directors （response rate, 76%）.<br>1） Fifty-one percent of respondents thought that industry support was necessary for education, and 28% did not believe that industry support negatively affects residents’ prescribing behaviors.<br>2） Twelve percent said their institutions had a curriculum for physician-industry relationships. Ten percent prohibit residents from meeting with pharmaceutical representatives, and 30% ban gifts from industry.<br>3） Fifty-one percent reported that they had pharmaceutical industry-sponsored in-hospital educational events for residents, and 73% reported that they had industry-sponsored in-hospital educational events which residents were allowed to attend.<br>4） Program directors’ belief that industry support was necessary for education predicted that programs would receive such support.