Competencias profesionales en especialistas en cirugía general

Introducción: el nivel de competencias de los profesionales ha constituido una preocupación de los sistemas de salud para incrementar la calidad de los servicios. Las funciones y acciones de los cirujanos generales son de vital importancia, por lo que resulta imprescindible que el capital humano que se desempeña en esta actividad posea las competencias requeridas. Esto motivó la realización de una tesis doctoral, que tiene como objetivo la elaboración de una metodología para la formación y desarrollo de las competencias profesionales en los especialistas en cirugía general. La investigación, cuyos resultados preliminares constituyen el presente trabajo, se realizó en el Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas. Objetivo: caracterizar el estado actual de las competencias profesionales en los especialistas en cirugía general. Materiales y métodos: del nivel teórico, se utilizaron: análisis documental, análisis sintético, análisis histórico-lógico, sistematización, inducción-deducción, modelación y enfoque de sistema. Del nivel empírico, la encuesta. Resultados: se mostraron algunas deficiencias en las competencias profesionales e insatisfacciones que afectan la cultura organizacional. Conclusiones: el proceso realizado, combinado con los fundamentos teóricos, ratificó la necesidad de la elaboración de una metodología para la formación y desarrollo de competencias profesionales en los especialistas en cirugía general, como alternativa de las ciencias de la educación médica para resolver las dificultades encontradas.

Introduction: the professionals' level of competences has been a concern of health systems to increase the quality of the services. The functions and actions of general surgeons are of vital importance, so it is essential for the human capital that carries out this activity, to have the required competences. This motivated the completion of a doctoral thesis which aims to the realization of a methodology for training and developing professional competences in general surgery specialists. The research, whose preliminary results are the present work, was carried out in the Clinical Surgical University Hospital Comandante Faustino Perez Hernandez, in Matanzas. Objective: to characterize the current state of professional competences in general surgery specialists. Materials and methods: from the theoretical level, the following methods were used: documental analysis, synthetic analysis, historic logical analysis, systematization, induction-deduction, modeling and system approach. From the empiric level, the survey was used. Results: some deficiencies in the professional competences and in satisfactions that affect the organizational culture were shown. Conclusions: the process carried out, combined with theoretical fundaments, ratified the need of elaborating a methodology for training and developing professional competences in general surgery specialists, as alternative to the medical education sciences for solving the difficulties found.

Expectativas y realización profesional en Cirugía General y subespecialidades quirúrgicas: situación actual de los cirujanos jóvenes en Córdoba / Expectations and professional fulfillment in general surgery and surgical sub-specialties: current situation of young surgeons in Cordoba

RESUMEN Antecedentes: en la Argentina, la especialidad Cirugía General se encuentra en crisis y esta situación alarmante se halla vinculada a las malas condiciones laborales del cirujano general. Objetivo: describir la percepción que el cirujano joven tiene al terminar su programa de formación, en relación con su perspectiva laboral, actividad quirúrgica y académica. Material y métodos: estudio transversal basado en una encuesta dirigida a cirujanos jóvenes en Córdoba, Argentina. Resultados: participaron 53 encuestados. El 58% eran hombres y la mediana de edad fue 32 años. El 72% ejercía Cirugía General y el 55% trabajaba en el sector privado. El 34% pertenecía a la Asociación de Cirugía de Córdoba y el 23% a la Asociación Argentina de Cirugía. En cuanto a la experiencia profesional, el 53,1% eran cirujanos junior y el 64% eran competentes para realizar procedimientos de baja o mediana complejidad. En relación con la perspectiva laboral, el 89% consideró que el cirujano joven no consigue salida laboral rápida y el 96,2% refirió que sus prácticas no eran bien remuneradas. Respecto de la calidad de vida personal y laboral, el 57% manifestó frustración e incertidumbre económica. En cuanto a las cirujanas, la tasa de inequidades de género y hostigamiento sexual en el ámbito laboral fue del 73% y 50%, respectivamente. Conclusión: encontramos la percepción de un bajo nivel de competencia para las cirugías de mayor complejidad y una baja tasa de adherencia a sociedades quirúrgicas. Debido a la escasa oferta laboral existe gran frustración e incertidumbre económica. Actualmente, predomina y persiste el maltrato y hostigamiento hacia las cirujanas.

ABSTRACT Background: In Argentina, the specialty of general surgery is in crisis, and this alarming situation is associated with the poor working conditions of general surgeons. Objective: The aim of this study is to describe the perception of young surgeons at the end of their training program, in relation to their job prospects, surgical and academic activity. Material and methods: We conducted a cross-sectional study based on a survey responded by young surgeons in Cordoba, Argentina. Results: The survey was responded by 53 young surgeons; 58% were men and median age was 32 years. Seventy-two percent practiced general surgery and 55% worked in the private setting. Thirtyfour percent were members of Asociación de Cirugía de Córdoba and 23% belonged to Asociación Argentina de Cirugía. As for professional experience, 53.1% were junior surgeons and 64% were capable of performing low or medium complexity procedures. Eighty-nine percent considered that young surgeons do not get a job quickly and 96.2% reported that they were not well paid for their practice. When asked about their personal and professional quality of life, 57% expressed frustration and economic uncertainty. Among women surgeons, 73% reported gender inequities and 50% reported sexual harassment in the workplace. Conclusion: Young surgeons perceived they had low level of competencies for high complexity surgical procedures and reported low rate of membership in surgical societies. Most of them feel frustrated due to scarce job opportunities and expressed economic uncertainty. Nowadays, abuse and harassment of women surgeons still prevails and persists.

Síndrome de burnout en cirujanos generales en tiempos de la pandemia COVID-19

Objetivo: Evaluar el síndrome de burnout (SB) en cirujanos generales. Material y Método: Se realizó un estudio de corte transversal en nuestro centro hospitalario, en agosto de 2021. La muestra estuvo formada por 56 profesionales de la salud que incluyeron a residentes y especialistas en cirugia general quienes prestaron servicio en el contexto de la COVID-19. Resultados: La prevalencia del burnout fue del 71%, la edad media fue de 34 años y los residentes fueron los más afectados (62,5%). La distribución por sexo fue de 82,5% en masculinos y 17,5% en el sexo femenino. Del total de evaluados, 23 son casados y 17 solteros, predominando los cirujanos con hijos (60%). Discusión: Entre los pocos estudios publicados sobre el SB en trabajadores de la salud en tiempos de COVID-19 se ubican como posibles factores predisponentes: a las privaciones de sueño, el riesgo biológico ocupacional intrínseco, la cuarentena obligada a la que tienen que someterse los trabajadores de la salud fuera de casa y los dilemas éticos en la toma de decisiones de atención a pacientes. Sin embargo, un estudio ha mostrado que los estresores vinculados al SB más importantes son la falta de equipo de protección personal, el miedo al contagio de COVID-19 y el miedo de contagiar a los familiares. Conclusión: Existe una alta prevalencia del SB en cirujanos generales en el contexto de la pandemia COVID-19. Los más afectados fueron residentes jóvenes de sexo masculino, casados, con hijos y con bajos ingresos económicos.

Objective: To evaluate the burnout syndrome (BS) in general surgeons. Material and Method: A cross-sectional study was carried out in our hospital in August 2021. The sample consisted of 56 health professionals that included residents and specialists in general surgery who provided service in the context of COVID-19 Results: The prevalence of burnout was 71%, the mean age was 34 years and the residents were the most affected (62.5%). Sex was 82.5% in males and 17.5% in females. Of the total evaluated, 23 are married and 17 are single, with a predominance of surgeons with children (60%). Discussion: Among the few studies published on BS in health workers in times of COVID-19, the following are located as possible predisposing factors: sleep deprivation, intrinsic occupational biological risk, the forced quarantine that patients have to undergo. out-of-home health workers and ethical dilemmas in patient care decision-making. However, a study has shown that the most important stressors linked to BS are the lack of personal protective equipment, the fear of contagion of COVID-19 and the fear of infecting family members. Conclusion: There is a high prevalence of BS in general surgeons in the context of the COVID-19 pandemic. The most affected were young male residents, married, with children and with low income.

A new biomarker in severe pneumonia associated with coronavirus disease 2019: hypoalbuminemia. A prospective study

ABSTRACT BACKGROUND: Effective triage and early detection are very important for controlling and treating coronavirus disease 2019 (COVID-19). Thus, the relationships between hypoalbuminemia and other acute-phase reactants in such cases need to be evaluated. OBJECTIVES: To investigate the importance of albumin levels in cases of severe pneumonia due to COVID-19. DESIGN AND SETTING: Prospective study conducted in Ankara City Hospital (a stage 3 hospital), Turkey. METHODS: Data from 122 patients diagnosed with pneumonia due to COVID-19 who were admitted to this hospital were analyzed statistically in comparison with date from 60 healthy controls. Three groups were established: healthy controls, intubated patients and non-intubated patients. Lung tomography scans from the patients were examined one-by-one. Real-time polymerase chain reaction (RT-PCR) test results were recorded. RESULTS: Albumin levels were statistically significantly lower in the intubated and non-intubated groups than in the control group, in comparing the three groups (P < 0.01). The other acute-phase reactants, i.e. neutrophil-to-lymphocyte ratio and C-reactive protein levels, were significantly higher in the intubated and non-intubated groups than in the control group (P < 0.05). Albumin levels were also significantly lower in the intubated group than in the non-intubated group (P = 0.02). No differences were detected with regard to other parameters (P > 0.05). CONCLUSIONS: Hypoalbuminemia may constitute a biomarker indicating the severity of pneumonia due to COVID-19.

Inserción laboral del cirujano joven en la Ciudad de Buenos Aires. Necesidad de reestructuración del sistema de formación del cirujano general / Young surgeons entering the workforce in the City of Buenos Aires. Need for restructuring of the general surgery training system

RESUMEN Antecedentes: la formación en cirugía se mantuvo uniforme desde la instauración del modelo de re sidencias. El avance de la ciencia ha llevado a la superespecialización y un 70% de los cirujanos conti núan en formación con una especialidad posbásica. Objetivos: identificar la proporción de cirujanos que derivan horas a otra actividad y analizar la inser ción laboral del cirujano. Material y métodos: estudio prospectivo, descriptivo, de corte transversal. 1) Encuesta, 2) Registros de la Dirección General de Docencia e Investigación, 3) Concursos y Perfiles profesionales de acceso público. Resultados: sobre 435 encuestados, al finalizar la residencia, un 73,3% continuó su formación en una posbásica. Solamente un 24,7% se insertó inmediatamente en el mercado como cirujano general. En cuanto a la inserción laboral actual de aquellos que finalizaron la formación como cirujano general, apenas un 17,4% se desempeña de manera exclusiva como cirujano general. Conclusiones: la falta de confianza para actuar de manera independiente y la necesidad de completar 4 años de formación para ingresar en el campo de interés aparecen como las problemáticas para resol ver. Se propone un programa de 5 años con formato 2+3. El período de formación básica abordará en 24 meses las generalidades de la práctica quirúrgica. El segundo, de formación avanzada, desarrollará en profundidad la subespecialidad elegida. El quinto año otorgará a todos la posibilidad de actuar a modo de cirujano independiente. Planteada como una subespecialidad, la Cirugía General volvería a ser un fin en sí misma y no un medio para llegar a una subespecialidad.

ABSTRACT Background: Training in surgery has remained relatively uniform since the residency programs were introduced. The continuous advances in science have led to the progressive super-specialization of surgeons; 70% of them continue their training with a subspecialty. Objectives: The aim of this study was to identify the proportion of surgeons who dedicate hours of their practice in another activity and to analyze how surgeons enter the workforce. Material and methods: We conducted a prospective and descriptive cross-sectional study with data from a survey, records of the General Directorate of Teaching and Research, and records of competitive selection processes and professional profiles available online. Results: Of 435 survey respondents, 73.3% of the resident graduates continued postresidency training in a surgical subspecialty. Only 24.7% immediately started working in general surgery. Among the graduate trainees in general surgery, only 17.4% were exclusively dedicated to general surgery. Conclusions: The lack of confidence to perform procedures independently and the need for completing 4 years of training in the residency program in general surgery to start training in the professional field of interest, appear as the issued to be solved. We propose a 5-year program with a 2+3 model. The initial period comprises 24 months of basic training covering the general aspects of surgical practice. The second period of advanced training will provide thorough training in the subspecialty chosen. In the last year of the 5-year program trainees will have the opportunity to act as attending surgeons. General surgery, conceived as a subspecialty, would regain its status as an objective and no longer a pathway to become a subspecialist.

Did general surgeons surgical spectrum changed over time? A retrospective comparative study in a South Indian tertiary care centre between 2009 and 2018

Background: General surgery discipline has fragmented into several subspecialties over the past. This division has affected the surgical spectrum of general surgeons. Studies comparing the changes in the general surgeon's work spectrum were done in the ’90s but not in the recent past. Our study aims to compare the surgical spectrum of general surgeons between two time periods in our institute.Methods: We performed a retrospective study comparing the elective surgeries performed by general surgeons in the year 2009 and 2018 in an academic tertiary care centre.Results: There was a 28.9% rise in the total number of elective surgeries (1567 vs. 2020) in our study. There was a significant rise in the mean age of surgical patients (39.7 years vs. 41.9 years) but with no change in M: F ratio (1.7: 1). There was a significant rise in Hernia surgeries and Varicose veins surgeries (p<0.001) along with a rise in anal surgeries (p=0.018). There was a significant decrease in Breast surgeries (p=0.02) and Thyroid surgeries (p<0.001). There was a dramatic rise in the laparoscopic cholecystectomy rate (23.2% vs. 52%) and a fall in the laparoscopic appendectomy rate (26.3% vs. 8%). Open inguinal hernia surgeries were the most common surgeries performed in both the years.Conclusions: There was an increase in the surgical volume for general surgeons but the surgical spectrum has narrowed. We recommend conducting periodic surgical audits in institutions to monitor and maintain the standards of surgeries performed by general surgeons.

Conferencia Dr. Hernán Alessandri R. 2011: historia del cáncer pulmonar: otro monstruo creado por el hombre / Hernán Alessandri lecture 2011: history of lung cancer: another monster created by mankind

In Profesor Alessandri's days lung cancer cases in Chile and all over the world were very few. In German medical papers in the third decade of XXth century some relationship between lung cancer and smoking habits was reported but only in the middle of the century medical literature reported evidences about this relationship. Smoking habit become universal in the XXth century. Medical community and public opinion were formally informed about the danger of smoking, for the first time in USA, in 1964 in the first Report of General Surgeon. Nowadays lung cancer is the cause of death of2,500 Chileans a year and over one million all over the world. Thoracic X rays and rigid bronchoscopy were for long time the only diagnostic methods in lung cancer. Today we have a lot of sophisticated tools that are mentioned in this paper. Surgery was and continues being the principal therapeutic weapon against the disease. The first surgical intervention performed was a pneumonectomy whose history is related in this review. Several other therapies are available in our days for the disease. A section of this paper is reserved to analyse patients and the disease. A very touching testimony of a poet written when he suffered from the disease is quoted in the text. The paper finishes with a light of hope based on the new immunological and molecular methods for treatment and the radiological approaches for early diagnosis that are available today.

En los tiempos del Prof. Alessandri los casos de cáncer pulmonar eran muy pocos en Chile y en el resto del mundo. La literatura médica alemana de la tercera década del siglo XX, observó cierta relación entre el hábito tabáquico y el cáncer pulmonar, pero sólo 20 años después la literatura médica evidenció esta relación. El hábito tabáquico se hizo universal en el siglo XX. La comunidad médica y el público general fueron advertidos por primera vez del peligro del tabaquismo en 1964 en el primer informe para el Cirujano General de EE.UU. Hoy día mueren al año 2.500 chilenos y 1 millón de personas en el mundo por la enfermedad. La radiografía de tórax y la broncoscopía rígida fueron por largo tiempo los únicos métodos diagnósticos en cáncer pulmonar. Hoy tenemos muchos métodos diagnósticos sofisticados que se revisan en este artículo. La cirugía era y continúa siendo la principal arma terapéutica contra la enfermedad. La primera intervención quirúrgica fue la neumonectomía cuya historia es relatada en esta publicación. Hoy día tenemos muchas otras armas terapéuticas disponibles. En el artículo se reserva una sección para analizar los pacientes y la enfermedad. Se cita un conmovedor testimonio de un poeta que lo escribió mientras sufría de la enfermedad. El artículo termina con una luz de esperanza en relación a nuevos métodos inmunológicos y moleculares de diagnóstico y radiológicos de diagnóstico precoz, disponibles hoy en día.

The Role of General Surgeon in Gynecologic Oncology Surgery

PURPOSE: Resection of the bowel or solid organs may be required for pelvic tumor surgery. The present study was performed to assess combined surgical procedures and determine the role of the general surgeon in gynecologic oncology surgery METHODS: We performed a retrospective study of 135 patients with gynecologic malignancy who underwent a combined operation with a general surgeon between January 2000 and December 2005 at Asan Medical Center. The purpose of the combined operation was categorized into 3 groups: a tumor debulking operation, a resolution of intraoperative complications by a gynecologic surgeon, or an intraoperative diagnostic change. RESULTS: The incidence of combined operations for debulking, resolution of intraoperative complications, and intraoperative diagnostic changes were 103 cases (76.3%), 22 cases (16.3%), and 10 cases (7.4%), respectively. Ovarian cancer was the most common gynecologic malignancy (74.1%) and the rate of a combined operation with a general surgeon in ovarian cancer was 18.5% during the time period. Colorectal resection was the most common procedure by a colorectal surgeon (61.5%). Twenty four patients (17.8%) experienced postoperative complications, including ileus, wound infection, pancreas leakage, and stomal necrosis, with no significant differences according to the purpose of combined operation, pathologic diagnosis, or bowel preparation. The rate of a preoperative consultation to a general surgeon by gynecologic surgeons in cases with colorectal or solid organ invasion preoperatively was 53.2%. CONCLUSION: A general surgeon is an important consultant in a debulking operation of gynecologic malignancies, especially ovarian cancer, or treatment of complications. Thorough preoperative evaluation, bowel preparation, and preoperative consultation to a general surgeon is important in gynecologic oncology surgery.