Preferencia de especialidades médicas en estudiantes de medicina de una universidad chilena / Preference of medical specialties among medical students in a Chilean university

En este trabajo se describen las preferencias de elección de especialidad médica que manifiestan los estudiantes de la carrera de medicina de una universidad regional del norte de Chile. Se trata de un estudio descriptivo basado en información primaria con una muestra de 266 respuestas válidas, con una tasa de respuesta de 58,7%. La información se recogió a través de un cuestionario disponible en Google Forms, previo consentimiento voluntario de participación, durante los meses de mayo a julio de 2022. Se encontró que las especialidades médicas preferidas por los estudiantes de la Universidad Católica del Norte fueron las especialidades clínicas como medicina interna y las médico-quirúrgicas como medicina de urgencias y ginecología-obstetricia. Además, existen especialidades con un claro predominio femenino como psiquiatría infanto-adolescente, ginecología-obstetricia, cirugía pediátrica, pediatría y medicina familiar, mientras que el predominio masculino destaca en radiología y anestesiología, ambas asociadas a un trato indirecto con el paciente. Se observó que las especialidades quirúrgicas, tradicionalmente preferidas por hombres, podrían estar en proceso de cambio generacional, aumentando la presencia femenina en ellas, sobre todo en cirugía general.

This study describes medical specialty preferences expressed by medical students at a regional university in northern Chile. This descriptive study is based on primary information with a sample of 266 valid responses and a response rate of 58.7%. The information was collected through a Google Forms questionnaire before voluntary consent of participation from May to July 2022. We found that the medical specialties preferred by the Universidad Católica del Norte students were clinical specialties, including internal medicine, and medical-surgical specialties, including emergency medicine and gynecology-obstetrics. Women markedly predominated in child and adolescent psychiatry, gynecology-obstetrics, pediatric surgery, pediatrics, and family medicine, while men predominated in radiology and anesthesiology, both associated with indirect patient interaction. We also found that surgical specialties, traditionally preferred by men, could be in the process of generational change, as there is an increase in the presence of women, especially in general surgery.

Variables, indicadores y criterios de evaluación del servicio médico como escenario de formación de especialistas

La calidad de la educación de posgrado concebida estratégicamente como la integración de la pertinencia social y la excelencia académica, deviene esencial en la gestión de las instituciones docente-asistenciales del sector salud. Sus múltiples dimensiones deben ser contextualizadas y son susceptibles de análisis y perfeccionamiento en cada servicio médico donde se desarrolla el proceso de formación de especialistas. Se utilizaron métodos teóricos y empíricos, para la identificación de las dificultades y la elaboración de la nueva propuesta. Se obtuvieron criterios sobre los servicios médicos como escenarios de formación, en los que se identificaron los problemas relativos a la actividad de posgrado. La propuesta consideró las directrices estratégicas, la población objeto de atención y los diferentes ámbitos temporales y espaciales identificados, con lo que pretende el fortalecimiento y desarrollo de la formación de posgrado en las Universidades de Ciencias Médicas en Cuba.

The quality of postgraduate education, strategically conceived as the integration of social relevance and academic excellence, becomes essential in the management of teaching-assistance institutions in the health sector. Its multiple dimensions must be contextualized and are susceptible to analysis and improvement in each medical service where the specialist formation process takes place. Theoretical and empirical methods were used, for the identification of the difficulties and the elaboration of the new proposal. Criteria on medical services were obtained as training scenarios, in which problems related to postgraduate activity were identified. The objective of the work is to expose a proposal of variables, indicators and evaluation criteria in the service as a scenario the specialist's formation. The proposal was considered the strategic guidelines, the target population and the different temporal and spatial areas identified, with which it intends to strengthen and develop postgraduate training in the Medical Sciences Universities in Cuba.

Propuesta de competencias profesionales específicas para la formación de los especialistas en gastroenterología / A proposal of specific professional competences for the training of gastroenterology specialists

Introducción: La formación con calidad del capital humano en el sector salud constituye un reto para la educación médica cubana contemporánea. La formación académica, en particular la especialidad, tiene el cometido de formar un profesional con alta competencia y avanzadas capacidades para el desempeño especializado, solidez de los principios ético-morales y elevada calificación científico-técnica, por lo que el desarrollo de competencias profesionales resulta una prioridad para la formación de los especialistas biomédicos. Objetivo: Elaborar una propuesta de competencias profesionales específicas para la formación de los especialistas en gastroenterología. Métodos: Se realizó un estudio educacional, de investigación aplicativa, bajo el enfoque general dialéctico-materialista, con fundamento en teorías y enfoques filosóficos, psicológicos y legales de las leyes de la educación, y de la educación médica en particular. Asimismo, se utilizaron métodos teóricos, empíricos y estadístico-matemáticos. Resultados: Se elaboró una definición operativa de competencias profesionales específicas en gastroenterología, a partir del estudio del sistema de competencias y de la sistematización de los documentos rectores en dicha formación. También se identificaron y definieron las competencias profesionales específicas en las áreas asistencial, docente, investigativa y de dirección, que posibilitaron la mejora en el desempeño profesional de los futuros especialistas. Conclusiones: La formación basada en el desarrollo de competencias profesionales específicas constituye una prioridad para la educación médica y la salud pública cubana contemporánea, en aras de elevar la calidad del proceso formativo en la especialidad de gastroenterología y la atención médica que brindan estos galenos en los niveles de atención en salud(AU)

Introduction: The quality training of human capital in the health sector is a challenge for contemporary Cuban medical education. Academic training, particularly the residence, has the task of training a professional with high competence and advanced capabilities for specialized performance, solid ethical-moral principles and high scientific-technical qualification; therefore, the development of professional competences is a priority for the training of biomedical specialists. Objective: To elaborate a proposal of specific professional competences for the training of gastroenterology specialists. Methods: An educational study of applicative research was carried out under the general dialectical-materialistic approach and based on philosophical, psychological and legal theories and approaches of the laws of education and, particularly, of medical education. Theoretical, empirical and statistical-mathematical methods were also used. Results: An operational definition of specific professional competences in gastroenterology was elaborated, based on the study of the system of competences and the systematization of the guiding documents for such training. Specific professional competences were also identified and defined in the care, teaching, research and management areas, which allowed to improve the professional performance of future specialists. Conclusions: Training based on the development of specific professional competences is a priority for contemporary Cuban public health and medical education, in view of raising the quality of the training process in the specialty of gastroenterology and the medical care provided by these physicians at the levels of healthcare(AU)

Intenções de graduandos de Medicina em face dos preditores de fixação: Programa Mais Médicos na Bahia / Medicine graduates intentions in the face of establishment predictors: Bahia's Mais Médicos Program

Resumo: Introdução: O déficit quantitativo e as desigualdades na distribuição de médicos agravam a crise global da força de trabalho em saúde. Muitas políticas têm sido adotadas para enfrentamento do problema, destacando-se pela sua abrangência o Programa Mais Médicos. Objetivo: Este estudo objetivou caracterizar, entre graduandos de Medicina do estado da Bahia, as intenções de especialidade médica futura e de fixação em áreas prioritárias definidas pelo Programa Mais Médicos, conforme os preditores apontados na literatura. Método: Trata-se de um estudo de corte transversal com caráter exploratório, realizado com estudantes dos cursos de Medicina de quatro universidades federais da Bahia. Resultado: Predominaram estudantes de 20 a 24 anos, com perfil socioeconômico mais baixo em relação aos estudos anteriores, naturais dos pequenos e médios municípios baianos, que afirmaram, em sua maioria, a opção pela residência médica em especialidades de outras áreas, que não as áreas básicas, após a graduação. Verificou-se uma disparidade entre o percentual de estudantes com intenção de trabalhar na atenção primária à saúde e aqueles que desejaram especialidades básicas, sendo ainda consideravelmente menor a opção pela medicina de família e comunidade. As estudantes do sexo feminino predominaram de modo evidente entre aqueles que desejaram as especialidades de áreas básicas e que vislumbraram um futuro trabalho na atenção primária à saúde, nesse estado. De modo contrário, os estudantes do sexo masculino escolheram, na sua maioria, especialidades de outras áreas, especialmente aqueles que tiveram os aspectos financeiros como motivação principal para escolha de carreira. Conclusão: O estudo acrescentou conhecimento ao corpo de literatura sobre as mudanças na formação médica no país e os efeitos de políticas indutoras de um perfil profissional generalista que atenda às necessidades sociais da população.

Abstract: Introduction: The quantitative deficit and inequalities in the distribution of doctors exacerbate the global health workforce crisis. Many policies have been adopted to face the problem, with the 'Mais Médicos' Program standing out due to its scope. Objective: This study aimed to characterize, among undergraduate medical students in the state of Bahia, the intentions of future medical specialty and professional retention in priority areas defined by the More Doctors Program (PMM), according to the predictors indicated in the literature. Methods: This is a cross-sectional exploratory study conducted with medical students from four federal universities in the state of Bahia. Results: The study predominantly included students aged 20 to 24 years, with a lower socioeconomic profile in relation to previous studies, born in small and medium-sized municipalities in the state of Bahia, who mostly stated their option for medical residency in specialties other than the basic areas after graduation. An inequality was observed between the percentage of students who intended to work in Primary Care and those who wanted basic specialties, with the option for Family and Community Medicine being even lower. Female students clearly predominated among those who desired basic specialties and who envisioned a future employment in Primary Care in this state. Conversely, male students mostly chose specialties in other areas, especially those who had financial aspects as the main motivation for career choice. Final considerations: The study added knowledge to the body of literature on changes in medical training in the country and the effects of policies leading to a generalist professional profile that meets the social needs of the population.

Modelo de atención integral en el segundo nivel: Experiencia de la Unidad de Especialidades Médicas / Care models at the second level: Experience of the Medical Specialties Unit

Resumen Objetivo: Reportar la implementación y los beneficios del Modelo de atención integral en el segundo nivel: Experiencia de la Unidad de Especialidades Médicas, su utilidad en el manejo y seguimiento de los pacientes con enfermedades crónicas. Material y métodos: Se lograron implementar 9 consultorios de atención médica de la siguiente forma, 2 de Endocrinología, 3 consultorios de Clínica de Enfermedades Crónicas, uno de educación en diabetes e hipertensión, así como 3 de apoyo nutricional. Se midió valores absolutos del número de consultas durante los años 2017, 2018, 2019 y parte del 2020. Así mismo se buscó identificar las patologías más prevalentes con la idea en tener un mejor control y seguimiento de los pacientes, con una mejor organización de personal de atención médico y de enfermería. Resultados y discusión: Se lograron incrementar los números de consulta, con un control y seguimiento más estricto de los pacientes, además de los beneficios en cuanto a la formación y capacitación de médicos residentes, generales tanto militares como profesionales de la salud civiles para enfrentar estos padecimientos prevalentes en nuestro país.

Abstract Objective: To report the implementation as well as the benefits of the Comprehensive Care Model at the second level: Experience of the Medical Specialties Unit, and assess its usefulness in the management and monitoring of patients with chronic diseases. Material and methods: 9 medical care clinics were implemented as follows, 2 for Endocrinology, 3 Clinics for Chronic Diseases, one for education in diabetes and hypertension, as well as 3 for nutritional support. Absolute values of the number of consultations were measured during the years 2017, 2018, 2019 and part of 2020. Likewise, it was sought to identify the most prevalent pathologies with the idea of having a better control and monitoring of patients, with a better organization of medical and nursing care personnel. Results and discussion: It was possible to increase the consultation numbers, with a stricter control and monitoring of patients, in addition to the benefits in terms of training and training of resident doctors, both military generals and civilian health professionals to face these prevalent conditions in our country.

Valoraciones sobre el procesamiento de información en investigaciones asociadas a especialidades médicas / Assessments on the processing of information in research associated with medical specialties

RESUMEN El presente trabajo tiene como objetivo valorar las regularidades de los principales problemas que se evidencian en el uso y empleo de la dinámica del procesamiento de la información en investigaciones asociadas a especialidades médicas, a partir de una selección de tesis vinculadas a la especialidad de Medicina General Integral y de otras especialidades médicas defendidas en los últimos 5 años en la Universidad de Ciencias Médicas de Camagüey. Los principales resultados de la revisión documental se centran en deficiencias en la presentación e interpretación de la naturaleza de las relaciones entre las variables del diseño metodológico y las técnicas estadísticas que se utilizan desde el diseño, ejecución y presentación del resultado científico.

SUMMARY The present work aims to assess the regularities of the main problems that are evidenced in the use and employment of the dynamics of information processing in research associated with medical specialties, from a selection of theses linked to the specialty of Comprehensive General Medicine and other medical specialties defended in the last 5 years at the University of Medical Sciences of Camagüey. The main results of the documentary review focus on deficiencies in the presentation and interpretation of the nature of the relationships between the variables of the methodological design and the statistical techniques that are used from the design, execution and presentation of the scientific result.

Posicionamiento conceptual metodológico para el examen estatal en anatomía humana / A conceptual-methodological stance for the state examination of human anatomy

Introducción: El examen estatal en las especialidades médicas cubanas es un garante de calidad en las competencias y el desempeño profesional. Su calidad técnica y metodológica debe ser objeto de perfeccionamiento permanente como acción responsable hacia la excelencia académica. Objetivo: Promover un posicionamiento conceptual metodológico para el perfeccionamiento del examen teórico práctico de la especialidad anatomía humana. Métodos: Se emplearon el analítico sintético, la observación participativa y la revisión documental. Resultados: Se obtuvo una propuesta valorativa en el contexto de la especialización en anatomía humana, con acciones específicas para el perfeccionamiento del examen práctico y teórico de esta especialidad. Conclusiones: Los fundamentos teóricos y prácticos presentados son pertinentes para superar debilidades en los exámenes estatales anteriores, y favorecer en el residente de anatomía humana el desarrollo de un pensamiento holístico durante su proceso de formación, con beneficio de mayores competencias y mejor desempeño docente e investigativo(AU)

Introduction: The state examination in Cuban medical specialties ensure quality in competences and professional performance. Its technical and methodological quality should be subjected to permanent improvement as a responsible action towards academic excellence. Objective: To promote a conceptual-methodological stance for the improvement of the practical-theoretical examination of the Human Anatomy specialty. Methods: The methods of analysis-synthesis, participative observation and documental review were used. Results: An assessment proposal was obtained in the context of the specialization in Human Anatomy, with specific actions for the improvement of the practical and theoretical examination of this specialty. Conclusions: The theoretical and practical foundations presented are pertinent to overcome weaknesses of previous state examinations, as well as to favor, in the Human Anatomy resident, the development of a holistic thinking during her or his training process, with the benefit of greater competences and better teaching and research performance(AU)

Actitudes ante la muerte en cirujanos e internistas

RESUMEN Introducción: La muerte en el contexto hospitalario, es un estresor crítico que para el médico en su asistencia es parte del rol profesional, lo cual produce diferentes actitudes de afrontamiento. Objetivo: Comparar las actitudes ante la muerte en médicos cirujanos e internistas de un hospital clínico quirúrgico. Método: Investigación cuantitativa, descriptiva y transversal, realizada en agosto del 2019, en una muestra intencional de 30 cirujanos y 33 internistas. Se empleó el Cuestionario de Actitudes ante la Muerte - 2, compuesto por 32 ítems distribuidos en 6 subescalas. Resultados: Hubo desacuerdos con tener actitudes religiosas tanto en cirujanos como en internistas. No se manifestaron actitudes de ansiedad ante la muerte ni actitudes proeutanasia. Se identificaron posiciones no definidas con relación a las actitudes de distanciamiento profesional. Se mostró ambigüedad con respecto a las actitudes de vulnerabilidad afectiva y de evasión ante la muerte. No hubo asociación entre la edad y la experiencia profesional con respecto a las actitudes caracterizadas. Conclusiones: Las actitudes ante la muerte entre internistas y cirujanos se caracterizaron por ser predominantemente homogéneas. No se halla ningún tipo de relación entre las variables sociodemográficas edad y experiencia laboral, con respecto a las actitudes ante la muerte.

ABSTRACT Introduction: Death in the hospital context is a critical stressor; for the doctor in his care, is part of the professional role, producing different coping attitudes. Objective: To compare the attitudes to death in surgeons and internists of clinical-surgical hospital. Methods: Quantitative, descriptive and cross-sectional research conducted in August 2019, in an intentional sample of 30 surgeons and 33 internists. The Attitudes to Death Questionnare-2 was used, composed of 32 items distributed in 6 subscales. Results: There were disagreements with having religious attitudes both surgeons and internists. There were no anxiety attitudes towards death as well as pro-euthanasia attitudes. Undefined positions were identified in relation to professional distancing attitudes. There was ambiguity regarding attitudes of affective vulnerability and evasion before death. There was no association between age and professional experience with respect to the attitudes characterized. Conclusions: The attitudes to death between surgeons and internists were characterized by being predominantly homogeneous. No type of relationship was found between the sociodemographic variables age and work experience with respect to attitudes towards death.

Relação médico-paciente nas especialidades médicas: um breve panorama da realidade brasileira / Doctor-patient relationship in medical specialties: a brief overview of the Brazilian reality

Introdução: A humanização do cuidado responde por um grande ganho à saúde do enfermo, haja vista que a relação médico-paciente, quando bem estabelecida, favorece a aceitação do tratamento pelo doente. Apesar disso, observa-se uma variação de postura entre os médicos generalistas e os especialistas, no tocante à priorização da empatia ao longo das atividades. Dessa forma, o presente artigo busca apresentar uma breve descrição a respeito da relevância da relação médico-paciente junto da prática clínica e abordar diferenças de conduta profissional identificadas entre médicos generalistas e especialistas no quesito empatia. Métodos: Foram colhidos dados secundários obtidos de uma revisão bibliográfica de caráter qualitativo, na qual foram incluídos oito trabalhos científicos publicados entre 2008 e 2018 em plataformas digitais, no idioma português. Resultados: O estudo acerca do tema permitiu observar a existência de falhas no exercício da relação médico-paciente tanto entre médicos generalistas quanto entre especialistas, o que pode ser explicado pela influência da formação acadêmica, bem como pelos entraves estruturais e administrativos incidentes sobre a atuação médica; a respeito das variações de conduta analisadas entre médicos especialistas, a busca pareceu indicar que a prática clínica se aproxima mais do processo de humanização em comparação à prática cirúrgica. Conclusão: Portanto, tem-se que a relação médico-paciente consiste em uma prática indispensável na assistência ao enfermo, principalmente no que concerne ao tratamento integrativo; ao mesmo tempo, são necessários mais estudos que delimitem perfis de comportamento dentro de cada especialidade médica.

Introduction: The humanization of care accounts for a great gain in patient health, given that the doctor-patient relationship, when well established, favors the acceptance of treatment by the patient. Nevertheless, there is a variation in attitude between general practitioners and specialists regarding the prioritization of empathy throughout the activities. Thus, this article seeks to present a brief description of the relevance of the doctor-patient relationship in clinical practice and to address differences in professional conduct identified between general practitioners and specialists in terms of empathy. Method: Secondary data were collected from a qualitative literature review, which included 8 scientific papers published between 2008 and 2018 on digital platforms, in Portuguese. Results: The study on the subject allowed observing the existence of flaws in the exercise of the doctor-patient relationship, both among general practitioners and among specialists, which can be explained by the influence of academic training, as well as by the structural and administrative obstacles inherent in the doctor's activity; regarding the variations in conduct analyzed among specialist physicians, the search seemed to indicate that clinical practice is closer to the humanization process as compared to surgical practice. Conclusion: Therefore, the doctor-patient relationship is an indispensable practice in the care of the sick, especially with regard to integrative treatment; at the same time, further studies are needed to define behavior profiles within each medical specialty.

Effects of the COVID-19 on the public interest in medical specialties in Brazil

SUMMARY OBJECTIVE: The aim of this study was to evaluate the effects of the COVID-19 pandemic and the social isolation on the interest rates of different medical specialties in Brazil. METHODS: The research was performed using the terms "Médico" (Doctor), "Infectologista" (Infectologist), "Cirurgião" (Surgeon), "Geriatra" (Geriatrician), "Otorrinolaringologista" (Otolaryngologist), and "Oftalmologista" (Ophthalmologist), related to several medical specialties, and "COVID-19," which represented the public interest for the disease, utilizing the Brazilian version of Google Trends, where the data were acquired. The time range of this analysis was from 29 September, 2019 to 20 September, 2020. The data were tabulated in Microsoft Excel, exported to the Statistical Package for the Social Sciences software, and correlated with searches for the term "COVID-19" using Pearson's correlation. 95% confidence interval was used for all analyses. RESULTS: "Geriatra" (72.26±16.42) and "Cirurgião" (72.15±12.53) remained with the higher means among the evaluated specialties. In terms of standard deviation, "Oftalmologista" (64.71±16.72) and "Infectologista" (22.03±16.60) presented the most significant changes. After utilizing the Pearson's analysis to identify the correlation between each medical specialty and the term "COVID-19," all the evaluated specialties presented significant statistical correlations. "Oftalmologista" (r= -0.607) was notoriously the most negatively affected, while "Infectologista" (r=0.504) was pointed to have the highest positive correlation with the term. CONCLUSIONS: Several changes in the interest rates of different medical specialties in Brazil were found during the time range of the COVID-19 pandemic.

COVID-19 pandemic in São Paulo: a quantitative study on clinical practice and mental health among medical residency specialties

ABSTRACT BACKGROUND: 2020 was a challenging year for all healthcare professionals worldwide. In São Paulo, Brazil, the virus SARS-CoV-2 took 47,222 lives up to December 29, 2020. The front line of medical professionals in São Paulo was composed of many residents, who were transferred from their rotations to cover the needs of the pandemic. OBJECTIVE: To identify medical residents' mental health and clinical issues, regarding symptoms of burnout, depression and anxiety during the pandemic, and to compare them among specialties. DESIGN AND SETTING: Quantitative study using a convenience sample of medical resident volunteers who responded to an anonymous online survey that was available during April 2020. METHODS: This investigation collected sociodemographic information and used the Oldenburg Burnout Inventory (OLBI) to measure burnout, the Patient Health Questionnaire (PHQ-9) to measure depression and the General Anxiety Disorder (GAD-7) scale to measure anxiety symptoms. This study also developed a COVID-19 Impact Questionnaire (CIQ-19) to assess the residents' beliefs and clinical practices relating to COVID-19 patients. RESULTS: The sample comprised 1,392 medical residents in São Paulo, Brazil. Clinical specialty physicians showed the highest rates of anxiety symptoms (52.6%) and burnout (51.2%), among the specialties. CONCLUSION: Clinical specialty residents are at higher risk of anxiety, depression and burnout. The symptoms of anxiety and depression have worsened during the COVID-19 pandemic. There is a general need for mental health support interventions for medical resident physicians, which requires reinforcement during this worldwide crisis.

Desarrollo histórico de la evaluación del impacto de la formación de especialidades médicas en Cuba / Develop historical of the evaluation of the impact in the formation of the medical specialties in Cuba

RESUMEN La evaluación en la formación surgió en el siglo XVII, buscando dar juicios de valor a las acciones y actitudes de los estudiantes, a la determinación sistemática del mérito, valor y significado del aspecto a evaluar en función de criterios y normas establecidas en aquella época. Su evolución desde lo conceptual y lo procesual tuvo la influencia de los paradigmas investigativos. Muchos han sido los modelos propuestos en el ámbito internacional para perfeccionar el proceso de evaluación de la calidad en la educación. Actualmente, se asocia el término "evaluación" con el término "impacto", usado con frecuencia como expresión del efecto de una acción determinada, con cambios o transformaciones generadas en las personas, organizaciones, procesos o productos. En Cuba, este proceso ha tenido diferentes etapas, pero no es hasta el siglo XXI que comienza a implementarse en el Sistema Universitario de Programas de Acreditación, actual Sistema de Evaluación y Acreditación de la Educación Superior, con el objetivo de lograr una mejora continua en la formación, acorde a los principios y exigencias de la sociedad socialista. Dentro del mismo, el Sistema de Evaluación y Acreditación de Especialidades de Posgrado desempeña un papel fundamental en el desarrollo de dicha figura del posgrado, teniendo una repercusión notable en el desarrollo de las ciencias médicas. Este artículo expone la evolución histórica de la evaluación de la calidad y su impacto en el proceso de formación de especialidades médicas en el país, como referente para futuras investigaciones (AU).

ABSTRACT Training assessment emerged in the 17 century, in search for giving value judgment to the students' actions and behavior, for systematic determining the worth, value and significance of the aspect to assess according to criteria and norms established at that time. Its evolution, from the point of view of the conceptual and process, received the influence of research paradigms. Many models have been proposed around the world to improve the process of quality assessing in the educational field. Currently, the term 'assessment' is associated to the term 'impact', frequently used as an expression of a determinate action's effect on changes or transformations in people, organizations, processes or products. This process has had different stages in Cuba, but only in the 21 century, the University System of Accreditation Programs (SUPRA by its acronym in Spanish) -currently known as Accreditation and Assessment System of High Education (SEAES by its acronym in Spanish)- has begun to be implemented, with the objective of achieving a better continuous training, according to the principles and demands of the socialist society. Among it, the Accreditation and Assessment System of Post-grade Specialties (SEA-EP by its acronym in Spanish), play an important role in the development of the post-grade figure, having a remarkable repercussion in the medical sciences. This article exposes the historical evolution of the quality assessment and its impact in the medical sciences training process in the country as a referent for subsequent researches (AU).

Patient's perception of the communication of clinical doctors and surgeons in a university hospital / Percepção de pacientes sobre a comunicação de médicos clínicos e cirurgiões em hospital universitário

Abstract: Introduction: The way information is transmitted is of crucial importance in the doctor-patient relationship, as good communication reduces complaints about inadequate practices and patient concerns and improves treatment adherence and health recovery. However, patient dissatisfaction on this subject is not unusual. Objectives: The objective of this work was to evaluate the perception of patients admitted to a Hospital Complex about the communication of clinical doctors and surgeons during the hospitalization period. Method: Cross-sectional, descriptive, analytical inquiry study, with the application of a questionnaire with questions about physicians' general communication. The instrument was built by the researchers and was answered by 120 adult patients. The sample was defined by convenience and stratified by medical and surgical clinic. Frequency and statistical analyses were performed on the obtained results. Results: Of 120 patients, 53.33%(n=64) were admitted to the Surgical Clinic and 46.67%(n=56) to the Medical Clinic. Of this total, 57.5%(n=69) had high school to college/university education. Patients reported more negative than positive responses to the following questions: information about the side effects of medications (66%), advice on post-surgical procedures (68.75%) and information on health promotion and prevention in the hospital environment (63.33%). The surgical clinic had significantly lower proportions of positive responses for: The doctor said their name (p <0.01; crude OR: 0.33; 95% CI 0.15-0.76); The patient was informed about how their treatment would be conducted (p=0.02; crude OR: 0.38; 95% CI 0.17-0.87); and the patient was informed about the need to undergo tests (p=0.02; crude OR 0.40; 95% CI 0.18-0.90), which remained significant after adjustment for certain confounding factors. There were no significant differences regarding the other questions. When analyzing the question: "What grade would you give to the doctor's general communication?" a significantly higher value (p=0.007) was given to the Medical Clinic (average 4.46±0.76) when compared to the Surgical Clinic (average 4±1.19). Conclusion: The doctor-patient communication showed significant deficits. Therefore, it is necessary for medical schools to offer students the development of this competence. Additionally, for an adequate generalization of the obtained results, new studies need to be carried out at different levels of medical care.

Resumo: Introdução: A maneira de transmitir informações é essencial na relação médico-paciente, pois a boa comunicação reduz queixas por práticas inadequadas e preocupações dos pacientes, e melhora a adesão aos tratamentos e a recuperação da saúde. Porém, não são raras as insatisfações dos pacientes sobre esse assunto. Objetivo: O objetivo deste trabalho foi avaliar a percepção dos pacientes internados em um complexo hospitalar sobre a comunicação de médicos clínicos e cirurgiões durante o período de internação. Método: Trata-se de estudo transversal, descritivo e analítico, do tipo inquérito, com aplicação de um questionário com perguntas sobre a comunicação geral do médico. O instrumento foi construído pelos pesquisadores e respondido por 120 pacientes adultos. A amostra foi definida por conveniência, estratificada por clínica médica e cirúrgica. Realizaram-se análises de frequência e estatística dos resultados encontrados. Resultados: Dos 120 pacientes, 53,33% (n = 64) foram internados na clínica cirúrgica e 46,67% (n = 56) na clínica médica. Desse total, 57,5% (n = 69) tinham escolaridade que variava de ensino médio a superior. Os pacientes relataram respostas mais negativas do que positivas em questões referentes a: informações sobre os efeitos colaterais dos medicamentos (66%), orientações de procedimentos pós-cirúrgicos (68,75%) e informações sobre promoção e prevenção da saúde no ambiente hospitalar (63,33%). A clínica cirúrgica teve proporções de respostas positivas significativamente menores para: "O médico disse o nome dele" (p < 0,01; OR bruta 0,33; IC95% 0,15-0,76); "O paciente foi informado sobre como será seu tratamento" (p = 0,02; OR bruta 0,38; IC95% 0,17-0,87); e "O paciente foi informado sobre a necessidade de realizar exames" (p = 0,02; OR bruta 0,40; IC95% 0,18-0,90), que se mantiveram significativas após o ajuste por determinados fatores intervenientes. Não se observaram diferenças significativas para as demais questões. Na análise da questão "Que nota você daria para a comunicação geral do médico? ", verificou-se valor significativamente maior (p = 0,007) para a clínica médica (média 4,46 ± 0,76) quando comparada à clínica cirúrgica (média 4 ± 1,19). Conclusão: A comunicação médico-paciente apresentou déficits significativos. Por isso, é necessário que as escolas médicas ofereçam para os discentes o desenvolvimento dessa competência. Além disso, para uma generalização adequada dos resultados encontrados, novos estudos precisam ser realizados em níveis diferentes do cuidado médico.

Factors associated with the choice of a second specialty among internal medicine residency graduates / Fatores associados à escolha da segunda especialidade entre concluintes da residência em clínica médica

Abstract: Introduction: After the residency in Internal Medicine, most graduates choose to undergo a new selection process to obtain a second specialty. The phenomenon of early specialization is encouraged as early as in the undergraduate course. Despite this, the demand for general practitioners is growing. Objective: To investigate the factors that lead the newly graduated clinician to undertake a new residency. Method: This is a cross-sectional study that analyzes the responses of Internal Medicine residency graduates from the state of Pernambuco in 2020, through a questionnaire available online by Google Forms, containing questions about social aspects, undergraduate medical course, Medical Residency and intentions for the future career. Results: There were 81 responses of the 104 possible participants (77.88%). Most of these were female (66.67%), graduated from public universities (69.14%) and had already started the Internal Medicine residency shortly after graduation (50.62%). Regarding the specialty choice, 51.85% answered they had decided in the second year of residency, and 80.25% stated that they had undergone the selection process for the second specialty shortly after completing the Internal Medicine residency. The most often chosen career was Cardiology (20%). The factors most often associated with the choice of specialty were, according to the means on the Likert scale, "work in an outpatient setting", "long-term patient follow-up", and "more contact with patients". Conclusion: As far as it could be investigated in the literature, this was the first Brazilian study on specialty choices after the Internal Medicine residency. It was possible to identify the most important reasons for choosing a second specialty among the graduates of this Medical Residency program in Pernambuco in 2020. More studies are needed to establish correlations between the factors of choice with the chosen specialty.

Resumo: Introdução: Após a residência em clínica médica, a maioria dos concluintes opta por se submeter a um novo processo seletivo para obter uma segunda especialidade. O fenômeno da especialização precoce é incentivado já na graduação. Apesar disso, a demanda por médicos generalistas está em crescimento. Objetivo: Este estudo teve como objetivo investigar os fatores que levam o clínico recém-formado a realizar uma nova residência. Método: Trata-se de um estudo transversal que analisou as respostas dos concluintes do Programa de Residência Médica em Clínica Médica (PRM-CM) realizado em 2020 no estado de Pernambuco. Os concluintes do PRM-CM, por meio de um questionário disponibilizado de forma on-line pelo Google Forms, responderam a perguntas sobre aspectos sociais, a graduação, a residência médica e intenções para a carreira futura. Resultado: Dos 104 participantes possíveis, houve 81 respostas (77,88%). Desse total final, 66,67% eram do sexo feminino, 69,14% tinham se graduado em universidades públicas, e 50,62% já haviam iniciado o PRM-CM logo após a graduação. Quanto à escolha de especialidade, 51,85% responderam ter decidido no segundo ano de residência, e 80,25% afirmaram ter se submetido ao processo seletivo para a segunda especialidade logo após o PRM-CM. A carreira mais escolhida foi cardiologia (20%). Os fatores mais associados à escolha de especialidade foram, de acordo com as médias na escala de Likert, "trabalho em ambiente ambulatorial", "acompanhamento de pacientes por longo período" e "mais contato com pacientes". Conclusão: Até onde se pôde investigar na literatura, este é o primeiro estudo brasileiro a abordar as escolhas de especialidade após o PRM-CM. Foi possível identificar os motivos mais importantes para escolher uma segunda especialidade entre os concluintes desse PRM em Pernambuco, em 2020. Mais estudos são necessários para tecer correlações entre os fatores de escolha com a especialidade escolhida.

Vascular surgery in the most populous state in the Amazon: socio-professional profile and aspirations of the specialty / A cirurgia vascular no estado mais populoso da Amazônia: perfil socioprofissional e anseios da especialidade

Abstract Background There is a dearth of studies conducted to understand the socio-professional profile of the vascular surgery specialty and the population demands of specific regions, which are needed to support creation of care policies and direct infrastructure improvements in healthcare. Objectives The purpose of this study was to describe the socio-professional profile of vascular surgeons in the state of Pará, Brazil, to guide creation of tools for professional improvement. Methods A cross-sectional, self-report survey was conducted in Pará using a questionnaire comprising 30 questions covering six main topics. Results All vascular surgeons actively practicing in the state participated in this study. The total number of specialists was 59, with 71.2% working in the greater Belém area and 16.9% exclusively practicing in the interior of the state. The mean age of these professionals was 48 ± 11.1 years, 86.4% of respondents were men, 64.4% of surgeons had completed medical residency, and 96.6% (n=57) of the surgeons would like to improve their skills in venous surgery, echo-guided vascular access, and endovascular surgery. The method of professional improvement of greatest interest was simulation courses (hands-on), endorsed by 93% of the participants. Conclusions Pará has 59 vascular surgeons. These professionals mainly work in the greater Belém (71.2%), in hospitals (100%) or in private clinics or offices (94.9%), performing a wide range of procedures, including venous and arterial surgery, amputations, and provision of hemodialysis access. More than 90% of these surgeons were satisfied professionally and reported that they would choose the specialty again. However, 22% had a pessimistic view of the specialty's future. The vast majority of professionals (96.6%) consider that training or a continuing education program are necessary.

Resumo Contexto Há uma falta de estudos necessários para entender o perfil socioprofissional da especialidade e as demandas específicas da população de uma região específica, a fim de subsidiar a criação de políticas assistenciais e a melhoria na infraestrutura da assistência à saúde. Objetivos O objetivo deste estudo foi descrever o perfil socioprofissional de cirurgiões vasculares no Pará para orientar a criação de ferramentas de melhoria profissional. Métodos Foi realizado um levantamento transversal no Pará utilizando um questionário com 30 questões que envolvia seis temas principais. Resultados Todos os cirurgiões vasculares ativos participaram deste estudo. O número total de especialistas foi de 59, dos quais 71,2% trabalhavam na grande Belém e 16,9% exclusivamente no interior do estado. A idade média dos profissionais foi de 48 ± 11,1 anos, e 86,4% dos entrevistados eram homens. Além disso, 64,4% dos cirurgiões haviam completado a residência médica, e 96,6% (n = 57) deles gostariam de ter melhorias em cirurgia venosa, acesso vascular ecoguiado e cirurgia endovascular. As áreas de maior interesse para melhorias são cursos de simulação (práticos), com 93% dos participantes interessados. Conclusões O Pará tem 59 cirurgiões vasculares, os quais trabalham principalmente na grande Belém (71,2%) em hospitais (100%) ou em clínicas privadas ou consultórios (94,9%) e realizam uma ampla gama de procedimentos, incluindo cirurgias venosas e arteriais, amputações e acessos para hemodiálise. Mais de 90% dos cirurgiões estavam satisfeitos e relataram que escolheriam a especialidade novamente; entretanto, 22% tinham uma visão pessimista do futuro da especialidade. A grande maioria dos profissionais (96,6%) considera a necessidade de qualificação ou de um programa de educação continuada.

Presencia de burnout en estudiantes de postgrado de medicina de la Universidad Católica del Maule / Presence of burnout in medical graduate students from the Catholic University of Maule

Burnout is a psychological syndrome generated as a consequence of prolonged exposure to interpersonal stressors at work. Maslach and Jackson (1976) defined it as a syndrome of emotional exhaustion, depersonalization and low personal fulfillment; that occurs in individuals who work with people, damaging their quality of life and worsening their care work. There is growing concern about the presence of this syndrome in educational environment of medical schools. Given this reality, it was decided to make a diagnosis of the current situation of our residents of the Faculty of Medicine of the Catholic University of Maule (UCM). A validated and anonymous survey is carried out to all graduate students of different medical specialties to determine the presence of this syndrome. The results showed that burnout is present in 14% of our graduate students. Furthermore, it was observed that a high percentage of them manifest isolated characteristics of this syndrome; which leads us to conclude that we must work urgently to improve educational environments in our clinical field at Hospital Regional de Talca.

Opportunities in the teaching of medical specialties, regarding influenza and COVID-19 / Oportunidades perdidas en la enseñanza de especialidades médicas, a propósito de la influenza y COVID-19

Abstract Medical specialties’ teaching is an area of health systems that deserves special consideration in light of the lessons learned from influenza and COVID-19; educational programs and implementation of the training strategies that are used must be reevaluated, since the level of training of most specialty students does not allow to consider them as personnel who can face these global problems. The number of specialization courses has exponentially grown, and their main threat is the cancellation or partial execution of their academic programs as a consequence of not implementing functional operational strategies during a contingency.

Resumen La enseñanza en las especialidades médicas es un rubro de los sistemas de salud que merece consideraciones especiales de acuerdo con las lecciones aprendidas de la influenza y COVID-19. Deben reevaluarse los programas educativos y las estrategias de capacitación implementadas, ya que la preparación escolar de la mayoría de los alumnos no les permite ser considerados como personal que pueda enfrentar esos problemas globales. Los cursos de especialización han crecido en número, pero su principal amenaza es la suspensión de los programas académicos o que sean parcialmente cubiertos como consecuencia de no implementar estrategias operativas funcionales durante una contingencia.

A qualitative and quantitative comparison of adverse drug reaction data of anti-epileptic drugs in various sources of drug information

Background: It is essential to spread awareness about known adverse drug reactions (ADRs) for identification, prevention and their proper management. The aim of this study is to assess disparities in documented ADRS of antiepileptic drugs in various sources of drug information.Methods: An observational, cross sectional study was done to compare different drug information sources for ADRs. Six sources of information namely: National Formulary India (2011), Drug Today (2018), Current index of medical specialties (CIMS), and some textbooks like Lippincott’s illustrated reviews: Pharmacology (2012), Brenner and Stevens' Pharmacology (2018) and George and Goodman and Gilman's (GG): The pharmacological basis of therapeutics (2018) were critically analysed for ADRs of a total of 34 drugs. Prototype drugs and most commonly prescribed antiepileptic drugs, were chosen for study. They were categorized according to therapeutic classification and guidelines by Indian Society of Epilepsy. ADRs were categorized according to various body systems, and serious and life threatening ADRs, then were tabulated and compared. Qualitative and quantitative analysis of this data was also done.Results: None of analysed sources mentioned all antiepileptic drugs. GG contained information for maximum number of drugs studied (76.4%) and National Formulary of India gave information for (52.9%) drugs only. There was wide variability among various resources while listing ADRs. CIMS listed maximum number of ADRs (85.5%) while minimum was included in Brenner and Stevens' Pharmacology (13%) for all antiepileptic drugs. The quality of data though limited was relatively better in CIMS, but none of sources studied were found to be complete.Conclusions: No source of information provided complete information about adverse effects of all 34 anti-epileptic drugs. Academicians and policymakers can work towards providing complete ADR information in all sources of information and updating it from time to time. Thus, making drug use safer in patients of epilepsy.

Metodología para monitoreo del impacto de la formación de especialistas en la Universidad Médica matancera / Methodology for monitoring the impact of specialists training in the University of Medical Sciences of Matanzas

RESUMEN Introducción: el impacto de un programa de formación de posgrado con enfoque profesional puede ser definido como su repercusión en cambios favorables en los niveles de competencia de los estudiantes, su desempeño en el puesto de trabajo, la eficiencia y la competitividad de las organizaciones y sus efectos en el entorno interno y externo. No siempre las instituciones educativas cuentan con los instrumentos adecuados para la evaluación de estos impactos, aspecto que resulta medular para valorar la pertinencia y el impacto social de los programas de formación. Objetivo: elaborar una metodología para la evaluación del monitoreo del impacto de la formación en las especialidades médicas. Material y Método: la metodología elaborada se fundamenta en el Subsistema de Evaluación y Acreditación de Especialidades de Posgrado (SEA-EP) y el análisis de los modelos de evaluación del impacto de la formación existentes, la cual incluye un instrumento propio para evaluar el impacto de dicha formación, el cual se apoya esencialmente en un grupo de encuestas y entrevistas. Resultados: se muestra una contribución a la evaluación sistémica e integradora del proceso de formación, demostrando la pertinencia de la metodología diseñada, con la inclusión del instrumento propio. Conclusión: La metodología propuesta se concibió con una visión integral, sistémica y abarcadora de la formación. Los cuestionarios diseñados recogen gran cantidad de información, alineados al Patrón de Calidad del SEA-EP, por lo que son más eficaces para valorar su impacto, la calidad intrínseca del proceso formativo y determinar oportunidades de mejora en el mismo (AU).

SUMMARY Introduction: The impact of a program of postgraduate training with professional view could be defined as its repercussion in favorable changes in the students´ competence levels, their performance in their work places, the efficiency and competitiveness of the organizations and their effectiveness in the internal and external environment. The educative institutions do not always have the effective instruments for evaluating these impacts, important aspect to assess the pertinence and the social impact of the training programs. Objective: to elaborate a methodology for evaluating the monitoring of the training impact in medical specialties. Materials and methods: the elaborated methodology is based on the Subsystem of Evaluation and Accreditation of Postgraduate Specialties [Subsistema de Evaluación y Acreditación de Especialidades de Posgrado (SEA-EP) en español] and the analysis of the patterns of evaluating the impact of the existent training which includes a proper tool to evaluate the impact of that training, based mainly in a group of enquiries and interviews. Results: it confirms a contribution to the systemic and integrative evaluation of the training process, showing the pertinence of the designed methodology, with the inclusion of a proper instrument. Conclusion: the proposed methodology was conceived with an integrative, systemic and comprehensive point of view of the training. The designed questionnaires gather great quantity of information, according to the Quality Pattern of SEA-EP, being therefore more efficacious to assess its impact, the intrinsic quality of the training process and to determine opportunities of improvement in it (AU).

Experiencias en la formación de médicos familiares en la modalidad a distancia y virtual: una posibilidad para el sistema de salud colombiano / Experiencies in training family physicians through both virtual and distance-learning modes: a possibility for Colombia ́s health system / Experiências na formação de médicos familiares à distância e virtual: uma possibilidade para o sistema de saúde colombiano

Introducción. Mediante la Resolución 429 de 2016, Colombia adoptó el modelo de Atención Primaria en Salud como una política de atención integral en salud. Los médicos familiares son un elemento fundamental para su desarrollo. Para 2014, se estimó que en Colombia había poco más de 1,2 médicos familiares por 100.000 habitantes y solo siete programas de formación de posgrado presencial en todo el país, concentrados en las ciudades más desarrolladas. Por este motivo, el Ministerio de Educación y el Ministerio de Salud y Protección Social buscan incrementar la formación de especialistas en Medicina Familiar. Brasil, India, México, Paraguay y Sudan, entre otros países, exploraron la educación virtual y a distancia como una opción de formación médica para esta especialidad. Por lo anterior, los investigadores se preguntaron si las características que permitieron el desarrollo de estas experiencias en otros países podrían servir para orientar la creación de un programa similar en Colombia. Objetivo. Hacer una descripción detallada de las características que permitieron el desarrollo de experiencias de formación a distancia y virtual para médicos familiares en el mundo y, a partir de su análisis, encontrar bases que puedan servir para el desarrollo de un programa similar en Colombia. Metodología. Se trata de un estudio cualitativo, hermenéutico, basado en la recopilación y el análisis documentales. La búsqueda se hizo en Pub-med, ProQuest, Embase, Lilacs, Bireme, Springer Link, PlosOne y World Library of Science, utilizando los términos "distance learning", "family practice", "e-learning", "education B-learning", "ICT learning", "computer-assisted instruction", "educación a distancia", "educación virtual", y "medicina familiar y comunitaria". Resultados. Se seleccionaron 71 artículos de 23 países. Se señalaron las características comunes en los programas de educación virtual y a distancia, mediante una matriz de fortalezas, oportunidades, debilidades y amenazas, y se reseñaron los rasgos políticos, económicos, sociales, y tecnológicos del contexto colombiano que pudieren favorecer o no el desarrollo de un programa similar. Conclusiones. La educación de posgrado a distancia para médicos familiares ha sido posible en diferentes países. En Colombia, deben desarrollarse ajustes políticos, económicos, tecnológicos y legales para que un programa de estas características tenga un impacto significativo en el desarrollo de la especialidad.

Overview: Through Resolution 429 promulgated in 2016, Colombia adopts Primary Care model as comprehensive health service policy and family physicians have been essential for such model adoption. According to different sources, in 2014 there was an estimated 1.2 family physicians per 100.000 in-habitants and only 7 Family Medicine postgraduate programs throughout the country. Consequently, Colombia ́s National Health Ministry sought to increase training of Family Physicians. Countries such as Brazil, India, México, Paraguay y Sudan looked into virtual and distance- learning strategies as options for family physicians training. This led researchers to inquire whether such education options could allow the implementation of similar experiences in ColombiaObjective: Conducting a thorough description of features involved in the development of distance-learning and virtual education strategies for family physician training worldwide. Such description aimed as a means to develop a similar program in Colombia. Methodology: Qualitative-hermeneutic study based on data collection and analysis. Search was conducted through the following web search engines: PubMed, ProQuest, Embase, Lilacs, Bireme, Springer Link, Plos One and World library Of Science. Search terms included: "distance learning", "family practice", "e-learning", "education B-learning", "ICT learning", "computer-assisted instruction", " distance-learning education", "on -line education" and "family and community medicine." Results: 71 articles from 23 countries around the world were selected. Commonalities amongst on line education and distance-learning programs were drawn through the use of SWOT analysis that included social, political, economic and technological contextual features that may favor or hinder the development of a similar program in Colombian Conclusions: Graduate distance learning for Family Physicians has been successful in various countries. Colombia ought to implement political, economic, technological and legal adjustments to allow for the development of such an educational program and its significant impact for this medical specialty.

Introdução. Em 2016 mediante a Resolução 429, a Colômbia adotou o modelo de Atenção primária em Saúde (APS) como uma política de atenção integral em saúde (PAIS), os médicos familiares são um elemento fundamental para seu desenvolvimento. Para 2014 foi estimado no país mais do que 1,2 médicos familiares por cada 100.000 habitantes e somente 7 programas de formação de Pós-Graduação presencial no país todo, concentrados nas principais cidades. Os Ministérios de Educação e de Saúde e proteção Social procuram incrementar a formação de especialistas em Medicina Familiar. Brasil, India, México, Paraguay e Sudán, são entre outros países, exploraram a educação virtual e a distância como uma opção de formação médica para esta especialidade. Pelo anterior, os pesquisadores questionam sobre se as características que permitiram o desenvolvimento dessa experiência nesses países, servem para orientar a criação de um programa semelhante na Colômbia. Objetivo. Descrever detalhadamente as características que permitiram o desenvolvimento de experiências de formação à distância e virtual para médicos familiares no mundo, para buscar alternativas de desenvolvimento de um programa semelhante na Colômbia.Metodologia. estudo qualitativo, hermético, baseado na colheita e análise documental. A busca bibliográfica foi realizada nas bases de dados especializadas (Pubmed, ProQuest, Embase, Lilacs, Bireme, Springer Link, Plos One y World library Of Science) usando os térmos "distance learning", "family practi-ce", "e-learning", "education B-learning", "ICT learning", "computer-assisted instruction", "educación a distancia", "educación virtual" e "medicina familiar y comunitaria". Resultados. Foram selecionados 71 artigos de 23 países para identificar características comuns dos programas de educação virtual e a distância, com fortalezas, oportunidades, fraquezas e ameaças, sendo também resenhados os atributos políticos, econômicos, sociais e tecnológicos do contexto colombiano. Conclusões. A educação de Pós-graduação a distância para médicos familiares tem sido possível em vários países. Na Colômbia podem ser desenvolvidos ajustes para gerar as condições que favoreçam a realização de um programa como esse com alto impacto significativo.