Análisis del conocimiento sobre los inhibidores selectivos de la recaptura de serotonina (ISRS) en el manejo de la depresión por médicos residentes y concurrentes de clínica médica de 5 hospitales de CABA / Review of the Knowledge on Selective Serotonin Reuptake Inhibitors (SSRIs) for Depression Management by Resident and Intern Physicians of the Medical Clinic of 5 Hospitals in CABA

Introducción: la depresión es un trastorno cada vez más prevalente alrededor del mundo. Los médicos generales son los profesionales de la salud más consultados por pacientes deprimidos. Más del 70% de los pacientes con depresión son vistos por médicos generales y no por especialistas en Psiquiatría. Según estudios realizados en Buenos Aires, más del 25% de los pacientes internados en Servicios de Clínica Médica en hospitales generales presenta depresión. Estos pacientes suelen ser atendidos y seguidos por médicos en formación, sean residentes o concurrentes de Clínica Médica. El objetivo del trabajo fue analizar el conocimiento sobre los inhibidores selectivos de la recaptura de serotonina (ISRS) que tienen los médicos residentes y concurrentes de Clínica Médica de 5 hospitales de la Ciudad Autónoma de Buenos Aires (CABA) y describir el tratamiento de un paciente depresivo por ellos. Material y métodos: se realizó un estudio descriptivo de corte transversal con un muestreo de tipo no probabilístico. Se utilizó como instrumento de medición un cuestionario semiestructurado organizado en dos secciones, una de datos demográficos que permiten caracterizar la muestra. La otra, de 15 ítems, explora los conocimientos sobre los ISRS y el tratamiento de la depresión. Dicho cuestionario fue revisado por 4 expertos. El instrumento es anónimo. Se aplicó a 59 médicos en formación en Clínica Médica, residentes y concurrentes, de 5 hospitales de la CABA, que participaron de forma voluntaria, durante el período agosto-septiembre de 2022. Resultados: la mayoría de los médicos en formación en Clínica Médica no tratan cuadros depresivos y, ante un paciente deprimido, solicitan la evaluación por un especialista en Salud Mental. Solo un 6,8% lo medica con un antidepresivo. Más del 75% de la muestra refiere recordar los conocimientos que tiene sobre de los ISRS de la cursada de Farmacología y un 13,6 de la cursada de Psiquiatría en la Facultad de Medicina. Conclusión: se observa un conocimiento deficitario sobre los ISRS en médicos residentes y concurrentes de Clínica Médica. Se considera necesario reforzar la formación sobre depresión y manejo de antidepresivos durante la residencia/concurrencia de Clínica Médica. (AU)

Introduction: depression is an increasingly common disorder around the world. General practitioners are the most frequently consulted health professionals by depressed patients. More than 70% of all depressed patients receive treatment by general practitioners and not by psychiatric specialists. According to studies conducted in Buenos Aires, more than 25% of all patients admitted to the Clinical Services in public hospitals present depression. These patients are usually under the care and follow-up of clinical trainee physicians, residents, or interns.This study aimed to analyze the knowledge about selective serotonin reuptake inhibitors (SSRIs) of clinical trainee residents and interns in five hospitals in the Ciudad Autónoma de Buenos Aires (CABA) and to describe their treatment of a depressive patient. Material and methods: we conducted a descriptive cross-sectional study with a non-probabilistic sampling. We used a semi-structured questionnaire arranged into two sections as a measuring tool. One, with demographic data to describe the sample. The other, with 15 items, explores respondents' knowledge of SSRIs and the treatment of depression. Four experts reviewed the questionnaire, which was anonymous. We applied it to 59 clinical medical trainees, residents, and interns from five CABA hospitals who volunteered to participate during August-September 2022. Results: most clinical trainees do not treat depressive conditions and, when confronted with a depressed patient, request an assessment by a Mental Health specialist. Only 6.8% medicate the patient with an antidepressant. More than 75% of the sample reported remembering their knowledge of SSRIs from the Pharmacology course and 13.6% from the Psychiatry course at the School of Medicine. Conclusion: there is a deficient knowledge about SSRIs in trainee residents and interns of Clínica Médica. We believe it is necessary to reinforce training on depression and management of antidepressants during residency/internship practice in Clínica Médica. (AU)

Factores psicosociales y sociodemográficos asociados con el desgaste profesional en médicos residentes de Sonora (México) / Psychosocial and Sociodemographic Factors Associated with Burnout among Medical Residents of Sonora ­ Mexico / Fatores psicossociais e sociodemográficos associados ao burnout em médicos residentes de Sonora, México

Introducción: la simultaneidad de actividades entre las exigencias académicas y el adiestramiento médico durante las residencias provoca un elevado riesgo de desarrollar un desgaste profesional (o síndrome de burnout [SB]) en los médicos residentes. El objetivo fue identificar los factores psicosociales y socio- demográficos asociados al SB en médicos residentes. Materiales y métodos: estudio transversal y correlacional. Participaron 47 médicos residentes de un hospital público. Se aplicaron la Escala de Desgaste Ocupacional (EDO), el Inventario Multifásico de la Personalidad Minnesota-2 Forma Reestructurada (MMPI2-Rf) y un cuestionario sociodemográfico. Los datos se analizaron mediante la prueba de correlación no paramétrica de Spearman. Resultados: el 25.6 % de los participantes mostró burnout alto, y el 51 %, un agotamiento emocional alto. Respecto a los factores de personalidad y sociodemográficos asociados, solo mostraron relación significativa (p < 0.05) la escala de impulsividad (r = 0.341, p = 0.019) y las horas de ejercicio en la semana (r = −0.414, p = 0.004). Al segmentar por sexo, solo en los hombres del estudio existió una relación entre SB y psicoticismo (r = 0.468, p = 0.018), la disminución de la actividad física (r = −0.620, p = 0.001) y primeros años de residencia (r = −0.396, p = 0.050). Conclusiones: el alto agotamiento emocional de los residentes está asociado con problemas en el manejo de impulsos, distorsiones de la realidad (debido al psicoticismo), pertenecer a los primeros años de residencia y falta de ejercicio físico. Se requiere especial atención a la salud física y mental de estos profesionales

Introduction: The simultaneity of activities between academic demands and medical training during residencies is a high risk of developing burnout syndrome (BS) among resident physicians, which decreases their quality of life. This study aimed to identify the psychosocial and sociodemographic factors associated with BS among resident physicians from a public hospital. Materials and methods: This cross-sectional and correlational study involved 47 resident physicians. The Occupational Burnout Scale (EDO), the Minnesota Multiphasic Personality Inventory-2 Restructured Form, and a sociodemographic questionnaire were applied. The data were analyzed by using nonparametric Spearman's correlation test. Results: We found that 25.6% of the participants had a high level of burnout, while 51% showed a high level of emotional exhaustion. Regarding personality and sociodemographic factors associated with BS, only the impulsivity scale (r = 0.341; p = 0.019) and the hours of exercise performed in a week (r = −0.414; p = 0.004) showed a significant relationship (p < 0.05). When segmented by sex, a relationship between BS and psychoticism (r = 0.468; p = 0.018), decreased physical activity (r = −0.620; p = 0.001), and first years of residence (r = −0.396; p = 0.050) were noted only in men. Conclusions: A high level of emotional exhaustion was evidenced among the medical residents in relation to the development of their activities, which were associated with problems in the management of impulses, distortions of reality (due to psychoticism), belonging to the first years of residency, and the lack of physical exercise. Hence, special attention must be given to the physical and mental health of medical residents

Introdução: a simultaneidade de atividades entre as demandas acadêmicas e ao mesmo tempo a formação médica durante as residências acarreta alto risco de desenvolvimento da Síndrome de Burnout (SB) nos médicos residentes, diminuindo sua qualidade de vida. O objetivo da pesquisa foi identificar os fatores psicossociais e sociodemográficos associados à SB em médicos residentes. Materiais e métodos: estudo transversal e correlacional. Participaram 47 médicos residentes de um hospital público. Aplicou-se a Escala de Desgaste Ocupacional (EDO), o Inventário Multifásico da Personalidade Minnesota-2 Forma Reestruturada (MMPI2-Rf) e adicionalmente um questionário sociodemográfico. Os dados foram analisados por meio do teste de correlação não paramétrica de Spearman. Resultados: 25,6% dos participantes apresentaram alto burnout e 51% alto nível de exaustão emocional. Em relação aos fatores de personalidade e sociodemográficos associados à SB, apenas a escala de impulsividade (r = 0,341; p = 0,019) e as horas de exercício por semana (r = −0,414; p = 0.004) apresentaram relação significativa (p < 0,05). Quando segmentado por sexo, apenas nos homens do estudo houve relação entre SB e psicoticismo (r = 0,468; p = 0,018), diminuição da atividade física (r = −0,620; p = 0,001) e primeiros anos de residência (r = −0,396; p = 0,050). Conclusões: destaca-se o elevado desgaste emocional vivenciado pelos residentes no desenvolvimento das suas atividades, que se associa a problemas na gestão dos impulsos, distorções da realidade (devido ao psicoticismo), estar nos primeiros anos de residência e falta de exercício físico. É necessária atenção especial à saúde física e mental desses profissionais

Aproximación hacia la evaluación de la aptitud clínica en residentes de cardiología. Diseño multicéntrico / Approach to cardiology residents clinical aptitude evaluation. Multicenter design

Resumen Introducción: Hasta donde se tiene conocimiento, la investigación que se presenta constituye el primer trabajo multicéntrico en México que estudia el desarrollo de la aptitud clínica en unidades formadoras de cardiólogos. Objetivo: Determinar el grado de desarrollo de la aptitud clínica en residentes de cardiología en tres unidades médicas de alta especialidad. Métodos: Diseño transversal multicéntrico. Se analizaron todos los estudiantes del ciclo académico 2019-2020. Se construyó un instrumento que evaluó la aptitud clínica a partir de ocho indicadores y 170 ítems; la validez conceptual/de contenido y la confiabilidad fueron valoradas por cinco cardiólogos con experiencia docente y en investigación educativa. Resultados: Por indicador y año de residencia se observaron diferencias estadísticas significativas en la sede CMN20Nov; en HCSXXI e INCICh se observaron diferencias estadísticamente significativas en uno de ocho indicadores. Se estimaron diferencias entre residentes R1 (n = 41) de las tres sedes por indicador, con significación estadística en tres de ocho indicadores. El resultado fue semejante al comparar R2 (n = 35) y R3 (n = 43). Conclusiones: El grado de desarrollo de la aptitud clínica se puede considerar medio en las tres sedes académicas, probablemente debido a que el instrumento exploró situaciones clínicas problematizadas que exigieron del residente la reflexión crítica de su experiencia clínica.

Abstract Introduction: To the best of our knowledge, the research herein presented is the first multicenter study in Mexico to analyze the development of clinical aptitude in medical units that train cardiologists. Objective: To determine the degree of development of clinical aptitude in cardiology residents at three High Specialty Medical Units. Methods: Multicenter, cross-sectional design. All students of the 2019-2020 academic year were included in the study. An instrument was constructed that evaluated clinical aptitude based on eight indicators and 170 items; conceptual/content validity and reliability were assessed by five cardiologists with teaching and educational research experience. Results: By indicator and year of residence, significant statistical differences were observed in the CMN20Nov academic site. At HCSXXI and INCICh, statistically significant differences were observed in one of eight indicators. Differences between R1 residents (n = 41) of all three academic sites were estimated by indicator, with statistical significance being recorded in three of eight indicators. Between R2 (n = 35) and between R3 residents (n = 43), the result was similar. Conclusions: The degree of clinical aptitude development can be considered intermediate in all three academic sites, probably because the instrument explored problematized clinical situations that required the residents to critically reflect on their clinical experience.

Evaluación del estado nutricional, los patrones de alimentación y realización de actividad física de los médicos residentes del Hospital General de Luque del año 2020

RESUMEN Los médicos residentes enfrentan cambios en el estilo de vida, adquisición de hábitos alimenticios inadecuados, influencia de modas, publicidad y necesidad de pertenecer a un grupo social, por lo cual se encuentran en riesgo de padecer sobrepeso y obesidad. Nuestro objetivo fue determinar el estado nutricional, los patrones de alimentación y la realización de actividad física de los médicos residentes del Hospital General de Luque del año 2019. Se realizó un estudio descriptivo, observacional de corte transversal en el que se evaluaron variables sociodemográficas, antropométricas, estado nutricional, patrón alimentario y actividad física. Se incluyó un total de 58 médicos residentes de los cuales 66% fueron del sexo femenino, y la edad promedio fue de 28,12 años. Según el IMC, la mayoría presentó sobrepeso (34,5%). En cuanto a los patrones de alimentación, la mayoría no cumplía con las recomendaciones de las Guías Alimentarias del Paraguay de consumir 3 frutas por día ni de evitar alimentos ricos en grasas, sodio y altos en calorías como lo son las comidas rápidas. Se observó que 49% no realizaba actividad física. Los médicos residentes del Hospital General de Luque presentaron en su mayoría exceso de peso, tenían un patrón alimentario inadecuado y no realizaban actividad física.

ABSTRACT Resident physicians face changes in lifestyle, acquisition of inappropriate eating habits, influence of fashions, advertising and the need to belong to a social group, which is why they are at risk of being overweight and obese. Our objective was to determine the nutritional status, eating patterns and physical activity of the resident doctors of the General Hospital of Luque in 2019. A descriptive, observational cross-sectional study was carried out in which sociodemographic variables, anthropometric, nutritional status, eating pattern and physical activity were evaluated. A total of 58 resident physicians were included, of which 66% was female, and the average age was 28.12 years. According to the BMI, the majority were overweight (34.5%). Regarding eating patterns, most did not comply with the recommendations of the Paraguayan Dietary Guidelines of consuming 3 fruits per day or avoiding foods rich in fat, sodium and high in calories such as fast foods. It was observed that 49% did not perform physical activity. The resident physicians of the General Hospital of Luque were mostly overweight, had an inadequate eating pattern and did not perform physical activity.

A construção da Identidade Médica na concepção de médicos recém-graduados / The construction of Medical Identity in the conception of newly graduated physicians

A Identidade Médica (IM) é uma contrução social dinâmica e é influenciada por fatores relacionados ao estudante, ao docente/preceptor e à sociedade, além de moldar a forma como o futuro médico exercerá sua profissão. O objetivo desta tese é analisar a construção da IM e os fatores que a influenciam a partir das percepções de médicos recém-graduados, além de realizar uma revisão da literatura atual, pesquisar os fatores intrínsecos e extrínsecos formadores da IM, a influência dos primeiros anos do exercício profissional e das Diretrizes Curriculares Nacionais (DCN) no perfil e na consolidação da IM. Estudo observacional de corte transversal de caráter qualitativo realizado com médicos-residentes de um hospital universitário de um grande centro urbano brasileiro. Os dados foram coletados por meio de doze entrevistas virtuais no período de setembro a novembro de 2021 e três grupos focais presenciais, com seis participantes cada, em agosto de 2022. O material produzido foi submetido à análise de conteúdo, seguindo os seguintes passos: leitura e releitura flutuante, busca de semelhanças e divergências, classificação em categorias temáticas, contextualização espaço-social-temporal, discussão com a literatura científica e síntese interpretativa. Além disso, foram pesquisadas as bases de dados PubMed®/MEDLINE, SciELO, LILACS, Cochrane Library e BVS para realização da revisão da literatura. Para a revisão, estruturação da fundamentação teórica e discussão dos dados da pesquisa, foram estudados, na íntegra, os 154 artigos encontrados. Pouco mais da metade (51%) dos artigos trata-se de pesquisas empíricas que possuem como foco um dos três eixos formadores da IM (estudante / docente / sociedade), enquanto 40% são revisões da literatura e 9% são editoriais. A maioria das pesquisas (73%) foi desenvolvida no eixo América do Norte / Europa. Apesar disso, o Brasil configura-se como o 5º país em número de publicações. O material produzido no campo revelou que as expectativas dos estudantes com relação ao médico que imaginam se tornar, a influência de docentes e preceptores e o perfil de médico exigido pela sociedade moldam a IM dos participantes. Os primeiros anos da carreira profissional constituem um período de turbulência e de conflitos identitários que são suavizados durante a Residência Médica, quando esta se configura como um ambiente de prática e de ensino-aprendizagem salutar. Os médicos-residentes desconhecem as DCN e isso impacta negativamente na forma que vivenciam as expectativas da sociedade traduzidas pelas Diretrizes. Na percepção dos médicos recém-graduados, há uma incongruência entre o que é preconizado nas DCN, a formação que é efetivamente oferecida nos cursos de medicina e o mercado de trabalho que eles encontram após estarem habilitados a exercer a profissão. Essa incongruência gera uma IM pouco saudável que é prejudicial ao exercício qualificado da profissão e gera sofrimento e insatisfação nos novos médicos. Os resultados desse estudo podem contribuir com o trabalho daqueles envolvidos no processo de formação identitária dos médicos, auxiliando-os a empreender ações que favoreçam a formação de uma IM mais saudável em benefício dos atuais e futuros médicos e da população por eles assistida.(AU)

The Medical Identity (MI) is a dynamic social construction and is influenced by factors related to the student, the professor/preceptor and society, in addition to shaping the way the future physician will exercise his profession. The objective of this thesis is to analyze the construction of MI and the factors that influence it based on the perceptions of newly graduated physicians, in addition to carrying out a review of the current literature, researching the intrinsic and extrinsic factors that form MI, the influence of the first years of professional practice and the National Curriculum Guidelines (NCG) for Brazilian Medicine courses in the profile and consolidation of MI. A qualitative, cross-sectional observational study carried out with resident physicians at a university hospital in a large Brazilian urban center. Data were collected through twelve virtual interviews from September to November 2021 and three face-to-face focus groups, with six participants each, in August 2022. The material produced was subjected to content analysis, following the steps below: reading and fluctuating rereading, search for similarities and divergences, classification into thematic categories, spatio-social-temporal contextualization, discussion with the scientific literature and interpretative synthesis. In addition, the PubMed®/MEDLINE, SciELO, LILACS, Cochrane Library and BVS databases were searched to carry out the literature review. For the review, structuring of the theoretical foundation and discussion of the research data, the 154 articles found were studied in full. A little more than half (51%) of the articles are empirical research that focus on one of the three axes that form MI (student / teacher / society), while 40% are literature reviews and 9% are editorials. Most of the surveys (73%) were developed in the North America / Europe axis. Despite this, Brazil ranks 5th in number of publications. The material produced in the field revealed that the students' expectations regarding the doctor they imagine becoming, the influence of professors and preceptors and the profile of a doctor required by society shape the participants' MI. The first years of the professional career constitute a period of turbulence and identity conflicts that are softened during the Medical Residency Program, when it is configured as an environment of practice and healthy teaching-learning. Medical residents are unaware of the NCG and this negatively impacts the way they experience society's expectations translated by the Guidelines. In the perception of newly graduated physicians, there is an inconsistency between what is recommended in the NCG, the training that is effectively offered in medical courses and the job market that they find after being qualified to practice the profession. This incongruity generates an unhealthy MI that is harmful to the qualified exercise of the profession and generates suffering and dissatisfaction in new physicians. The results of this study can contribute to the work of those involved in the physicians' identity formation process, helping them to undertake actions that favor the formation of a healthier MI for the benefit of current and future physicians and the population they assist.(AU)

Burnout Syndrome: an analysis of the mental health of medical residents in a teaching hospital / Síndrome de Burnout: uma análise da saúde mental dos residentes médicos de um Hospital Escola

Abstract: Introduction: Medical residency can cause burnout syndrome, a physical, emotional and mental state of extreme exhaustion. Objective: This research sought to describe and analyze the prevalence of burnout in resident physicians linked to a teaching Hospital and to verify whether there is a correlation with sociodemographic and socioeconomic data. Method: This is an analytical, cross-sectional and quantitative study using the MBI (Malasch Burnout Inventory) version HSS (Human Services Survey), the Brazilian Economic Classification Criterion (CCEB) of ABEP and sociodemographic questions. Result: Of the enrolled residents, 102 participated in the survey. Of these, 76.47% showed a high level in at least one of the three domains of the burnout index and 21.57% of the residents showed a high level of burnout. There was a significant relationship between a larger number of children and the presence of emotional exhaustion (P=0.047), a higher frequency of depersonalization for surgical area residents (P=0.013) and reduced professional accomplishment, with an average income of R$ 2,965.69 and R$ 10,386.52 (P=0.006). No significant relationship was found between burnout and sociodemographic and socioeconomic variables. Conclusion: The results show that resident physicians are exposed to situations that contribute to high levels of stress and distress. Further studies on the subject are still necessary.

Resumo: Introdução: A residência médica pode causar a síndrome de burnout, um estado físico, emocional e mental de exaustão extrema. Objetivo: Buscou-se com esta pesquisa descrever e analisar a prevalência de burnout em médicos residentes vinculados a um hospital-escola e verificar se há correlação com dados sociodemográficos e socioeconômicos. Método: Este é um estudo analítico, transversal e quantitativo realizado por meio do Maslach Burnout Inventory (MBI) versão Human Services Survey (HSS), do Critério de Classificação Econômica Brasil (CCEB) da Abep e de perguntas sociodemográficas. Resultado: Dos 221 residentes matriculados, 102 participaram da pesquisa. Destes, 76,47% apresentaram alto nível em pelo menos um dos três domínios do índice de burnout e 21,57% dos residentes exibiram alto nível de burnout. Houve relação significativa entre maior número de filhos e presença de exaustão emocional (p = 0,047), maior frequência de despersonalização para residentes da área cirúrgica (p = 0,013) e reduzida realização profissional com a renda média de R$ 2.965,69 e R$ 10.386,52 (p = 0,006). Não foi encontrada relação significativa entre burnout e as variáveis sociodemográficas e socioeconômicas. Conclusão: Os resultados evidenciam que os médicos residentes estão expostos a situações que contribuem para os altos níveis de estresse e angústia. Ainda são necessários mais estudos sobre o tema.

Síndrome de desgaste profesional en médicos residentes de cuatro hospitales pediátricos de La Habana / Professional burnout syndrome in resident doctors from four pediatric hospitals in Havana

Introducción: La residencia médica constituye una etapa de formación que genera gran estrés, dicha situación puede coadyuvar a la génesis del síndrome de burnout, sin embargo, a pesar de su importancia, ha sido poco investigado en los educandos aspirante a la especialidad de Pediatría. Objetivo: Describir la frecuencia y características del síndrome de desgaste profesional entre residentes de cuatro hospitales pediátricos. Métodos: Estudio descriptivo y transversal realizado en cuatro hospitales pediátricos de la ciudad de La Habana en diciembre del año 2019. Se aplicó el cuestionario validado de Maslach Bournout Inventory. Para el análisis estadístico se definió la presencia del síndrome en tres dimensiones, si el puntaje correspondiente era alto; en situación de presentar en alguna dimensión moderado o bajo fue clasificado como propenso. Los datos cuantitativos de las variables se examinaron a través de medidas de tendencia central y variabilidad. Resultados: La caracterización de la muestra arrojó que el sexo femenino se observó en 91,0 por ciento con edad 33,4 por ciento menor de 30 años y el 66,6 por ciento eran solteros; 36,3 por ciento en los residentes eran del primer y segundo año y 35,5 por ciento de tercero. El síndrome se observó en 6 por ciento de los encuestados y clasificaron como propensos el 84,4 por ciento de la población. Conclusiones: El síndrome de desgaste profesional se observó con poca frecuencia, pero con una gran tendencia a presentarse como propenso entre los residentes de pediatría(AU)

Introduction: Medical residency is a stress-generating training stage. This situation can contribute to the genesis of burnout syndrome; however, despite its importance it has been poorly researched in the students aiming to be Pediatrics specialists. Objective: Describe the frequency and characteristics of professional burnout syndrome among residents of four pediatric hospitals. Methods: Descriptive and cross-sectional study carried out in four pediatric hospitals in Havana city in December, 2019. The validated Maslach Bournout Inventory questionnaire was applied. For statistical analysis, the presence of the syndrome was defined in three dimensions, if the corresponding score was high; or if presenting some moderate or low dimension, it was classified as prone. Quantitative data on variables were examined through central trend measures and variability. Results: The sample characterization showed that the female sex was observed in 91.0 percent with ages 33.4 percent under the age of 30 and 66.6 percent were single; 36.3 percent of the residents were in the first and second year and 35.5 percent in the third year. The syndrome was observed in 6 percent of respondents and 84.4 percent of the population was classified as prone. Conclusions: Professional burnout was observed infrequently, but with a strong tendency to present as prone among pediatric residents(AU)

Evaluación del proceso de lavado de manos en el personal médico en formación del posgrado de puericultura y pediatría HUPAZ. Lara

Con el objetivo de evaluar el proceso de lavado de manos en el personal médico en formación del Posgrado de Puericultura y Pediatría que labora en el Hospital Universitario de Pediatría Dr. Agustín Zubillaga, se realizó un estudio descriptivo transversal, tomando como población 67 residentes cuyo promedio de edad fue de 28,57±2,42 años, con predomino del sexo femenino (79,10 %), de los cuales 40,30 % eran cursantes del primer año y 22,39 % laboran en el Servicio de Atención Médica Inmediata. Se aplicó la guía observacional diseñada y validada por Mora y Salazar (2015), obteniendo como resultados que el lavado de manos es beneficioso para los médicos (83,6 %) y para el paciente (86,6 %), a pesar de que no cumplen a cabalidad los cinco momentos y los 11 pasos del lavado de manos. Los factores que influyen en el proceso de lavado de manos son: estructura inadecuada, falta de lavabos cómodos y accesibles (73,1 %), falta de dispensadores de jabón y toallas de papel (88,1 %); además, la institución no cuenta con presupuesto (86,6 %) no realiza capacitaciones sobre higiene de manos, ni cuenta con material gráfico sobre el mismo (91 % y 79,1 %, respectivamente). Los residentes manifestaron que no se realizan evaluaciones (98,5 %), capacitaciones (94 %) y no existen normas escritas y difundidas en los servicios (83,6 %); sin registros e instrumentos de evaluación (98,5 %) y sistema de monitoreo permanente (98,5 %). Se concluye de manera global que casi la totalidad de los residentes del Posgrado de Puericultura y Pediatría afirman que no existe eficiencia y efectividad en el proceso del lavado de manos.

With the objective of evaluating the hand-washing process in the medical personnel in training of the Postgraduate Course of Pediatric and Childhood that works in the University Hospital of Pediatrics Dr. Agustin Zubillaga, a transversal descriptive study was carried out, taking as a population 67 residents whose average of age was 28.57 ± 2.42 years, with predominance of females (79.10 %), of which 40.30 % were students of the first year and 22.39 % work in the Immediate Medical Care Service. The observational guide designed and validated by Mora and Salazar (2015) was applied, obtaining as results that hand washing is beneficial for physicians (83.6 %) and for the patient (86.6 %), despite the fact that they do not fully comply with the five moments and the 11 steps of hand washing. The factors that influence the handwashing process are: inadequate structure, lack of comfortable and accessible toilets (73.1 %), lack of soap dispensers and paper towels (88.1 %); In addition, the institution does not have a budget (86.6 %) does not carry out training on hand hygiene, nor does it have graphic material on it (91 % and 79.1 %, respectively). The residents stated that there are no evaluations (98.5 %), training (94 %) and there are no written rules and disseminated in the services (83.6 %); without records and evaluation instruments (98.5 %) and permanent monitoring system (98.5 %). It is concluded in a global way that almost all the residents of the Postgraduate Course in Child Care and Pediatrics affirm that there is no efficiency and effectiveness in the hand washing process.

Encuesta de Percepción en Capacidad Instalada para la Formación de Médicos Residentes en Ortopedia (Traumatología) y Necesidades de la Atención en Patología Musculoesquelética Aguda y Crónica en México. Primera Parte / Installed Capacity Perception Survey for the Training of Resident's Program in Orthopedics and Care Needs in Acute and Chronic Musculoskeletal Pathology in Mexico

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Abstract: Introduction: It is essential that orthopaedic resident physicians be highly proficient in all aspects, considering the balance between supply, demand, need and context. Fundamental to identify the capacity and quality installed for their training in Mexico. Material and methods: Observational Study, transverse, non-probabilistic sampling-conglomerates, in two phases. The instrument has 8 domains, 57 variables and 4,867 items. 60 graduate professors of 20 states, 50 hospital sites, 22 university programs. Results: 1,038 years of experience (collective intelligence), 17 years of experience/teacher (01 to 50 years). Identified: acute pathology 30 (2 to 90%), chronic pathology 30 (5 to 96%), patients ˂ 15 years, 10 (3 to 30%), patients between 15 and 65 years, 47 (2 to 78%), patients ˃ 65 years, 20 (2 to 60%), number of beds/seat 20 (2 to 510), number of clinics 3 (1 to 48), number of surgical procedures/headquarters per year at the national level, was 960 (50 to 24,650). The national average per resident doctor is 362 surgeries/year with 1,450 surgical times/year. Conclusions: The needs and resources for the training of physicians specializing in orthopedics/traumatology are highly heterogeneous, so it should be adapted to the epidemiological needs of the region of influence, in an area of epidemiological transition. 62.2% expressed not having or have bad academic and scientific infrastructure at its headquarters, more than 50% without rotation overseas and ˃ 90% without regular scientific production.

Avaliação da Empatia nos Médicos Residentes do Hospital Universitário Alzira Velano em Alfenas, Minas Gerais / Evaluation of Empathy in Medical Residents of Alzira Velano University Hospital in Alfenas, Minas Gerais

RESUMO INTRODUÇÃO Muito se discute a importância da empatia na relação médico-paciente. Poucos estudos avaliaram essa habilidade em médicos residentes (MR). OBJETIVO Avaliar a empatia dos MR do Hospital Universitário Alzira Velano (Huav) por meio da Escala Jefferson de Empatia Médica (Ejem), que fornece quatro tipos de escores: empatia geral (EG); tomada de perspectiva do doente (TP); compaixão (CP) e capacidade de colocar-se no lugar do outro (LO). MÉTODOS A Ejem e um questionário sociodemográfico foram aplicados em 36 MR do Huav no início do segundo semestre de 2016 após assinatura do Termo de Consentimento Livre e Esclarecido. RESULTADOS A análise estatística mostrou que os escores de empatia apresentaram associação em relação às variáveis: sexo, área de atuação (clínica ou cirúrgica) e período da residência em curso. Para a variável sexo, os seguintes achados foram encontrados: MR do sexo feminino do 1° ano apresentaram escores de EG e TP maiores que as MR no ≥ 2°ano (p = 0,01) e (0,03), respectivamente. Em relação à área de atuação, foi encontrado: (a) os escores de EG dos MR do 1° ano eram maiores, comparados aos dos MR no ≥ 2° ano, tanto para a área clínica (p = 0,03) como para a cirúrgica (p = 0,02); (b) MR da área cirúrgica apresentaram escores TP mais elevados no 1° ano em relação aos MR no ≥ 2° ano (p = 0,01). Nenhuma associação aos fatores estudados foi observada para os escores CP e LO. CONCLUSÃO Os dados demonstram que os escores de empatia dos MR dos anos finais são menores em relação aos dos MR do primeiro ano, fato verificado também para MR do sexo feminino. Nossos dados concordam com as observações da literatura e evidenciam a importância do desenvolvimento de estratégias instrucionais para o ensino da empatia entre médicos residentes.

ABSTRACT INTRODUCTION Much is discussed about the importance of empathy in the patient-physician relationship. Few studies have evaluated this ability in resident physicians (RPs). OBJECTIVE To evaluate the empathy of the resident physicians of the University Hospital Alzira Velano (HUAV), through the Jefferson Scale of Empathy (JSE), which provides 4 types of scores: General Empathy (GE); Perspective Taking (PT); Compassionate Care (CC) and Standing in Patient's Shoes (SP). METHODS The JSE and a sociodemographic questionnaire were applied to 36 RPs of the HUAV at the beginning of the second semester of 2016, after they signed the informed consent form. RESULTS Statistical analysis by the Mann-Whitney test showed that empathy scores were associated with variables: gender, area of performance (clinical or surgical) and period of residence in progress. For the variable gender, the following findings were observed: 1) Female RPs of the 1st year had higher GE scores than the RPs in the ≥ 2nd year (p = 0.01) and (0.03), respectively; 2) female RP's of 1st year had higher TP scores than RPs of ≥ 2nd year (p = 0.03). Regarding the area of performance, 1) the GE scores of the 1st year RPs were higher when compared to the RPs in the ≥ 2nd year, both for the clinical (p = 0.03) and for the surgical area (p = 0.02); 2) RPs of the surgical area had higher PT scores in the 1st year compared to RPs in the ≥ 2nd year (p = 0.01). No association was observed between the studied factors and CC and SP scores. CONCLUSION The data show that the empathy scores of the RPs of the final years are lower in relation to the RPs of the 1 st year, a fact also verified for female RPs. Our data are in agreement with the observations of the literature and show the importance of the development of instructional strategies for the teaching of empathy among resident physicians.

El proceso de enfermar de los médicos y sus consecuencias en el profesionalismo / The process of physicians falling ill and consequences for their professionalism / O processo de adoecimento dos médicos e as suas consequências acerca do profissionalismo

Resumen: La idiosincrasia de la profesión médica, los rasgos de personalidad característicos del médico y la falta de formación específica para reconocer y tratar adecuadamente la propia vulnerabilidad, predisponen a este colectivo a padecer más patología mental y, probablemente, un deficiente tratamiento de otras enfermedades. La mayoría de los estudios realizados hasta el momento se centran en la patología mental y adictiva del médico, desde el punto de vista del riesgo para la mala praxis y la seguridad de sus pacientes. La revisión narrativa de la literatura científica realizada (MEDLINE, EMBASE e IME 1985-2016) ha mostrado que, en el entorno hispanoparlante, apenas disponemos de información actualizada sobre el médico como paciente, a pesar de ser un tema de indudable relevancia desde el punto de vista de la seguridad asistencial, del profesionalismo y del propio bienestar de los profesionales. La situación del médico que enferma es compleja y poco conocida, con conflicto de roles y con repercusiones en la ética profesional y la calidad asistencial.

Abstract: The idiosyncrasy of the medical profession, the characteristic personality traits of the physician and the lack of specific training to properly recognize and treat one's own vulnerability dispose this group to suffer more mental pathology and probably worse control of other medical diseases. Most of the studies promoted so far focus on the psychiatric and addictive concerns of the physician, from the point of view of the sick doctor as being at risk for malpractice and to guarantee the safety of their patients. The narrative review of scientific literature (MEDLINE, EMBASE and IME 1985-2016) has shown that we do not have in the Spanish-speaking environment updated information about the doctor as a patient, despite being a topic of incipient media repercussion and undoubtedly relevant from the point of view of patient safety, professionalism and medical ethics and as well as the welfare of professionals. The characteristic of a sick doctor are more complex than the rest of patients with a conflict of roles and repercussions on professional ethics and the quality of care.

Resumo: A idiossincrasia da profissão médica, as características de personalidade característica do médico e a falta de formação específica para reconhecer e, corretamente, tratar a própria vulnerabilidade, predispõem esse grupo a sofrer mais patologias mentais, e provavelmente tratamento deficiente de outras doenças. A maioria dos estudos realizados até agora tem como foco a patologia mental e o comportamento aditivo do médico, do ponto de vista do risco por negligência e segurança de seus pacientes. A revisão narrativa da literatura científica realizada (MEDLINE, EMBASE e IME 1985-2016) tem mostrado que no ambiente de idioma hispânico temos apenas informações atualizadas sobre o médico como paciente, apesar de ser uma questão de relevância inquestionável do ponto de vista da segurança assistencial, do profissionalismo e do próprio bem-estar dos profissionais. A situação do médico enfermo é complexa e pouco conhecida, com conflito de papéis e impacto sobre a ética profissional e a qualidade dos cuidados médicos. São necessários mais estudos, tanto quantitativos como qualitativos, que permitam compreender o processo do adoecimento dos médicos em cada um dos seus estágios profissionais (desde a graduação até a aposentadoria) para ser capaz de considerar estratégias para a melhoria na atenção da saúde desses profissionais.

Conocimientos acerca del insomnio de médicos residentes en Paraguay / Knowledge about insomnia of medical residents in Paraguay

El insomnio es un trastorno que puede presentarse en cualquier edad y hasta un 30% de la población mundial lo padece en algún momento; puede ser síntoma de un sinnúmero de patologías médicas que incluye muchos trastornos psiquiátricos. El objetivo de este estudio observacional analítico de corte transversal fue determinar el grado de conocimiento sobre insomnio en médicos residentes de Asunción-Paraguay; se incluyeron 54 médicos residentes entre 26-39 años de edad de las Cátedras de Medicina Interna (26), Medicina Familiar (11) y Psiquiatría (17). Significativamente mayor proporción de residentes de Psiquiatría (47,1%) y de Medicina Familiar (45,5%) tuvieron buen conocimiento comparado a los de Medicina Interna (7,7%). El 59,3% de los residentes (Psiquiatría: 58,8%, Medicina Familiar: 75,0% y Medicina Interna: 53,8%) había diagnosticado alguna vez insomnio primario y la mayoría de ellos registra ≤20% de los pacientes con insomnio en las historias clínicas. Sobre el tratamiento instaurado, el 57,4% utiliza medidas farmacológicas, el 55,5% medidas de higiene del sueño, mientras que 18,5% recomienda actividad física. Entre los grupos farmacológicos que conocen para el tratamiento del insomnio, el 72,2% de los residentes citó a las benzodiacepinas; hipnóticos no benzodiacepínicos (16,7%); antipsicóticos (35,2%); antihistamínicos (9,3%) y otras medicaciones (27,8%). Los conocimientos de los residentes respecto a la terapéutica del insomnio son suficientes, pero no del nivel deseable. Esto resalta la necesidad de establecer oportunidades educativas sobre el manejo y tratamiento del insomnio y mayor profundización de la teoría y la práctica de la medicina del sueño en estudiantes de grado y posgrado

Insomnia is a global distribution disorder that may occur at any age and up to 30% of the world's population suffers from insomnia at some point in their lives. Insomnia presents the peculiarity of being a symptom of a number of medical pathologies among which are many psychiatric disorders. The objective of this cross-sectional, observational study was to determine the knowledge on insomnia in medical residents in Asunción, Paraguay. The study includes 54 medical residents between 26 and 39 years of age, from the Departments of Internal Medicine (26), Family Medicine (11) and Psychiatry (17). A higher proportion of residents of Psychiatry (47.1%) and Family Medicine (45.5%) had a good knowledge of insomnia compared to Internal Medicine residents (7.7%); 59.3% of residents (Psychiatry: 58.8%, Family Medicine: 75.0% and Internal Medicine: 53,8%) had ever diagnosed primary insomnia and the majority of them recorded ≤20% of the patients with an insomnia diagnosis in the medical records. About the treatment established, 57.4% used pharmacological measures, 55.5% sleep hygiene measures, while 18.5% recommended physical activity. Among the pharmacological groups known for the treatment of insomnia, 72.2% of residents cited benzodiazepines; non-benzodiazepine hypnotics (16.7%); antipsychotics (35.2%); antihistamines (9.3%) and, other medications (27.8%). Residents' knowledge of insomnia therapy is sufficient, but not at the desirable level. This highlights the need to establish educational opportunities on the management and treatment of insomnia and further deepening the theory and practice of sleep medicine in undergraduate and postgraduate students

Conocimientos sobre reanimación cardiopulmonar básica y avanzada de adultos de médicos residentes de un hospital de tercer nivel en Paraguay / Knowledge of adult basic and advanced cardiopulmonary resuscitation of medical residents at a third level in Paraguay

El objetivo de este trabajo consistió en determinar el nivel de conocimiento que tienen los médicos residentes del Hospital Nacional de Itauguá sobre reanimación cardiopulmonar básica y avanzada en adultos. Estudio observacional, descriptivo, de corte transverso, con muestreo no probabilístico de casos consecutivos que incluyó a médicos residentes del Hospital Nacional de Itauguá, de distintas especialidades. Los participantes completaron un cuestionario de 20 preguntas seleccionadas del banco de preguntas de las guías de Soporte Vital Básico para profesionales de la salud (BLS) y Soporte Vital Avanzado en Adultos (ACLS) de la American Heart Association, actualización del 2010. Participaron del estudio 135 médicos, de los cuales 76 (56,3%) fueron del sexo masculino y 59 (43,7%) del sexo femenino. La edad media de los participantes fue de 27,57 ± 4 años, estando 92 (68,1%) médicos con edades comprendidas entre los 26 y 31 años. En cuanto al conocimiento de los participantes sobre la reanimación cardiopulmonar de adultos, 113 (83,7%) presentaron un nivel no satisfactorio, al responder menos de 17 preguntas del cuestionario de manera correcta. La evidente deficiencia que mostraron los médicos residentes participantes de este estudio en sus conocimientos sobre reanimación cardiopulmonar, nos hace plantear la necesidad de insistir que todas las Facultades de Medicina del país incorporen un mejor y mayor enfoque teórico y práctico de los contenidos sobre reanimación cardiopulmonar dentro de sus planes de estudio e implementen estrategias de capacitación continua en esta área

The objective of this study was to determine the level of knowledge of adult basic and advanced cardiopulmonary resuscitation of medical residents at the National Hospital of Itauguá. Observational, descriptive and cross-sectional study with a nonprobabilistic sampling of consecutive cases. The study participants were medical residents of the National Hospital of Itauguá, from different specialties, who completed a questionnaire of 20 questions selected from the Basic Life Support for Health Professionals (BLS) and Advanced Cardiovascular Life Support in Adults (ACLS) of the American Heart Association guides, 2010 update. The study included 135 physicians, of which 76 (56.3%) were men and 59 (43.7%) were women. The mean age of participants was 27.57 ± 4 years and 92 (68.1%) were physicians between 26 and 31 years of age. Regarding the participants' knowledge about cardiopulmonary resuscitation, 113 (83.7%) presented an unsatisfactory level, by answering less than 17 questions of the questionnaire correctly. The evident deficiency shown by the medical residents in their knowledge of cardiopulmonary resuscitation makes it necessary to insist on incorporating a better and greater theoretical and practical approach of the contents on cardiopulmonary resuscitation within the curricula of all the Medical Schools of the country, and they should implement continuous training strategies in this area.

Conocimientos, actitudes y prácticas sobre depresión mayor en médicos residentes de un hospital de tercer nivel de atención en Lima, Perú / Knowledge, attitudes and practices about major depression in medical residents of a reference hospital in Lima, Peru

La depresión es el trastorno mental más frecuente a nivel mundial y nacional. Sin embargo, en servicios de atención primaria, solo 50 a 70% de pacientes con este cuadro son apropiadamente diagnosticados. Objetivos: Identificar el nivel de conocimientos, actitudes y prácticas sobre depresión mayor en médicos residentes de un hospital general en Lima, Perú, evaluados durante un periodo de 30 días. Material y métodos: Estudio descriptivo, correlacional, de corte transversal. Se encuestó a médicos residentes de todos los años y de diferentes especialidades. Resultados: De un total de 113 residentes (56,64% varones), solo el 5,31% había recibido durante el residentado un curso de psiquiatría y salud mental. El 15,93% demostró conocimiento insuficiente, 73,45% conocimiento moderado, y 10,62% conocimiento suficiente sobre depresión. No hubo asociación estadísticamente significativa entre el puntaje total de conocimiento y confianza en su capacidad para diagnosticar depresión. Aunque el 88,5% consideró que la depresión es una enfermedad, solo el 55,75% del grupo encuestado opinó que todos los médicos deben ser capaces de detectar e iniciar tratamiento de un caso de depresión. Conclusiones: El conocimiento sobre depresión, entre los médicos residentes evaluados en este estudio dista de ser óptimo. Un porcentaje pequeño pero significativo de los participantes mostró persistentes actitudes negativas hacia la valoración de la depresión como enfermedad mental y menos de la mitad están correctamente informados acerca de aspectos relevantes del tratamiento. La necesidad de corregir estas deficiencias es perentoria.

Depression is the most common mental disorder worldwide and in our country. However, only 50 to 70% of patients with depression are diagnosed in primary care settings. Objectives: To identify levels of knowledge, attitudes and practices about major depression in medical residents of the Cayetano Heredia National Hospital in Lima, Peru during a 30-day period. Material and methods: Cross-sectional, descriptive, correlational study. Medical residents of all training years and of different specialties were surveyed. Results: From a total of 113 medical residents (56.64% males), 5.31% had received teaching about psychiatry and mental health during the residency training, 15.93% demonstrated insufficient knowledge, 73.45% moderate knowledge, and only 10.62% showed sufficient knowledge about depression. There was no statistically significant association between total knowledge score and confidence in their ability to diagnose depression. Although 88.5% consider that depression is a disease, only 55.75% opined that all physicians should be able to detect and start the treatment of a case of depression. Conclusions: The medical residents' knowledge of major depression is far from optimal. A small but significant percentage of the participants showed persistently negative attitudes toward the assessment of depression as a mental illness, and less than half appeared to be well informed about relevant treatment aspects. The need to correct these deficiencies is indeed perentory.

Engagement no Trabalho em Residentes Médicos de Pediatria / Work Engagement Among Pediatric Physician Residents

RESUMO Objetivos Avaliar os índices de engagement no trabalho em residentes médicos de Pediatria. Métodos Amostra composta por 36 profissionais matriculados no programa de residência médica em Pediatria da Faculdade de Medicina de São José do Rio Preto no ano de 2013. Os dados foram coletados de setembro de 2013 a fevereiro de 2014, utilizando-se a Utrecht Work Engagement Scale (Uwes) – Escala Utrecht de Engajamento no Trabalho –, composta por 17 itens de autoavaliação com três dimensões, Vigor, Dedicação e Absorção, além de um escore geral do constructo. Resultados 91,67% eram do sexo feminino; a idade mediana foi de 28 anos (mínimo: 25; máximo: 34); 86,11% eram solteiros; 33,33% tinham renda familiar de 2 a 5 salários, e 44,44%, mais de 10 salários mínimos; 88,89% estavam satisfeitos com o trabalho; e 52,78% já pensaram em desistir do programa. Os índices de engagement variaram de 3,56 a 4,28. A dimensão Dedicação obteve índice alto (4,28±1,12), e as dimensões Absorção, Vigor e Engagement, médios (3,58±1,00; 3,56±0,98; 3,78±0,96). Quanto ao desejo de desistir do programa, ambos os grupos apresentaram índices médios para as dimensões Absorção e Vigor; nas dimensões Dedicação e Engagement, índices médios para os que já pensaram em desistir do programa e altos para aqueles que nunca pensaram em desistir. Sobre a satisfação com o programa, na dimensão Dedicação, os índices foram: alto para os satisfeitos e médio para os não satisfeitos (4,49 e 2,6); as dimensões Absorção, Vigor e Engagement apresentaram índices médios para ambos os grupos – 3,66, 3,68 e 3,92 entre os satisfeitos e 2,95, 2,54 e 2,7 para os não satisfeitos, respectivamente. Conclusão Os residentes em Pediatria da Faculdade de Medicina de São José do Rio Preto apresentaram bons índices de engagement, principalmente no domínio Dedicação. Há um baixo percentual de profissionais com baixo índice de engagement em todos os domínios da Uwes.

ABSTRACT Objectives To evaluate work engagement rates among medical residents in pediatrics. Methods Data was collected from a sample of 36 professionals enrolled in residency programs in pediatrics at the Medical School of São José do Rio Preto from September 2013 to February 2014, using the Utrecht Work Engagement Scale (Uwes), featuring seventeen items for self assessment and three dimensions: vigor, dedication, and absorption, and an overall score for the construct. Results 91.67% were female, the median age was 28 years (minimum: 25, maximum: 34), 86.11% single, 33.33% had a family income of 2-5 monthly wages and 44.44% over 10 minimum wages, 88.89% were satisfied with their work and 52.78% were considering quitting the program. The engagement of the indexes ranged from 3.56 to 4.28. Dedication was high (4.28 ± 1.12), while Absorption, Vigor, and Engagement, were medium (3.58 ± 1.00, 3.56 ± 0.98 and 3.78 ± 0.96). Regarding the desire to withdraw from the program, both groups revealed average rates for Absorption and Vigor; while Dedication and Engagement rates were average among those to have considered quitting the program, and high among those who had never thought about quitting. In terms of satisfaction with the program, Dedication indexes were high for those happy on the residency and medium for those not satisfied (4.49 and 2.6). Absorption, Vigor, and Engagement rates were average for both groups – 3.66, 3.68, and 3.92 among satisfied residents and 2.95, 2.54, and 2.7 among those not satisfied, respectively. Conclusion Pediatrics residents at the Medical School of São José do Rio Preto revealed sound levels of engagement, particularly in terms of Dedication. A low percentage of professionals was revealed to have low engagement rates across all areas of the Uwes.

Programa de prevención del suicidio, tratamiento de trastornos mentales y promoción de la salud mental para médicos residentes / Program for suicidal prevention, mental disorder treatment, and mental health development for resident doctors

La elevada demanda asistencial aunada a la carga académica de los cursos de especialización en medicina afecta la salud mental de los médicos residentes produciendo manifestaciones que van desde el simple malestar emocional hasta el desarrollo de trastornos afectivos en personas predispuestas. El suicidio de médicos ha generado programas para su atención en algunos países. Presentamos la primera clínica de salud mental para médicos residentes de un hospital de alta especialidad en México, centrada en la prevención del suicidio y depresión, tratamiento de trastornos mentales y promoción de la salud mental. A diferencia de los reportes de baja tasa de respuesta en otros países, hemos conseguido una participación mayor al 95%, proporcionamos tratamiento oportuno y seguimiento a los residentes identificados con trastorno mental, y no se han presentado suicidios consumados. Suponemos que la utilización de diferentes estrategias (escrutinio, adaptación de modelos de prevención del suicidio como entrenamiento por pares y entrenamiento gatekeeper, sesiones informativas de desestigmatización y promoción de la salud mental, intervenciones dirigidas a individuos y grupos con conflictos) ha sido de utilidad contra las barreras que impiden que los médicos identifiquen los signos de alarma de riesgo de suicidio, busquen ayuda por la presencia de trastorno mental y procuren mejorar su salud mental

High demand of care and the academic burden of courses of specialization in medicine affect the mental health of medical residents with events ranging from simple emotional discomfort to development of affective disorders in susceptible individuals. The suicide of physicians has produced programs for their attention in some countries. We present the fi rst mental health clinic for residents of a high specialty hospital in Mexico, focused on the prevention of suicide and depression, treatment of mental disorders and mental health promotion. Unlike the reports of other countries, we get participation of more than 95%, we provide appropriate treatment and follow-up to residents with mental disorder, and there has not been a consummate suicide. We assume that the use of different strategies (scrutiny, adapting models of prevention of suicide as a peer and gatekeeper training, informative sessions of mental health promotion and stigma, interventions targeted at individuals and groups with confl icts) has been useful against barriers that do not allow doctors to identify the risk of suicide warning signs, seek help for mental disorder, and seek to improve their mental health.

Actitudes y desafíos percibidos de médicos residentes de medicina familiar hacia la investigación: un estudio piloto de Paraguay, 2016 / Attitudes and perceived challenges towards research of medical residents of family medicine: a pilot study from Paraguay, 2016

Las competencias en investigación han sido reconocidas como parte esencial de la educación médica en el postgrado. El objetivo de este estudio piloto fue evaluar las actitudes y desafíos percibidos de médicos residentes de Medicina Familiar hacia la investigación. Estudio piloto, observacional, descriptivo, de corte transverso y muestreo no probabilístico, en el que se incluyeron 20 médicos residentes. Se utilizó un cuestionario sobre actitudes y desafíos percibidos sobre la investigación. Se realizó estadística descriptiva para todas las variables. Los resultados se expresaron en frecuencias, porcentajes, medias y desvíos estándar. Del total de participantes, sólo 7 (35%) participaron en algún proyecto de investigación durante la residencia, principalmente, en estudios descriptivos (30%) y reportes de casos (15%). El 60% respondió que en la residencia no desarrollaban un programa específico de formación en investigación, aunque la mayoría estuvo de acuerdo con que la investigación es esencial para el desarrollo de una carrera académica (95%), que mejora la atención sanitaria del paciente (75%) y que su estudio debe ser obligatorio en el currículo académico (70%). Los médicos residentes paraguayos presentan actitudes positivas y reconocen la importancia de la investigación, no obstante, sólo el 35% ha realizado investigaciones durante su programa de residencia, siendo el principal desafío al que se enfrentan, la falta detiempo protegido. Se considera necesario el rediseño del currículo del programa de residencia en Medicina Familiar de la Universidad Nacional de Asunción a fin de incluir de manera trasversal la formación en investigación de médicos residentes.

Research skills have been recognized as an essential part of medical education at thepostgraduate level. The objective of this pilot study was to evaluate the attitudes andperceived challenges of family medicine residents toward research. This was anobservational, descriptive and cross-sectional pilot study, of non-probabilistic sampling, which included 20 medical residents. A questionnaire on attitudes and perceived challengeson research was used. Descriptive statistics were performed for all variables. The resultswere expressed as frequencies, percentages, means and standard deviations. Of the totalparticipants, only 7 (35%) participated in a research project during residency, mainly indescriptive studies (30%) and case reports (15%). Sixty percent of participants respondedthat their residency did not develop a specific program of research training, although mostagreed that research was essential for the development of an academic career (95%),improved patient healthcare (75%) and that the study of research techniques should bemandatory in the academic curriculum (70%). Paraguayan medical residents have positiveattitudes and recognize the importance of research. However, only 35% have conductedresearch during their residency program; being the main challenge they face, the need for aprotected time for research. It is considered necessary to redesign the curriculum of theFamily Medicine residency program of the National University of Asuncion, in order toinclude research training in a transversal way.

Estrés laboral en médicos residentes de los Hospitales públicos de Managua. Abril a mayo 2016

Estudio observacional, correlacional y de corte transversal. Se basó en la percepción de estrés de los médicos residentes utilizando el cuestionario de Wolfgang, la encuesta se realizó en línea, utilizando la aplicación de Google Drive, el universo lo constituyeron 540 residentes a los que se les envió la encuesta, la muestra fue de 73 residentes que respondieron la encuesta en el período comprendido del 17 de abril al 8 de mayo. Se encontró que el nivel de estrés referido por los médicos residentes fue alto en el 49% y muy alto en el 8%, el 40% refirió estrés moderado y sólo el 3% refirieron estrés mínimo. No se encontró asociación entre los factores socio demográficos y el nivel de estrés de los residentes. No se encontró relación entre la jornada laboral y el nivel de estrés de los médicos residentes. Si se encontró relación estadísticamente significativa (p=0.000), entre la percepción de estrés por tener tanto trabajo que no todo queda bien hecho con el nivel de estrés en los médicos residentes. No se encontró asociación entre el tipo de especialidad y el nivel de estrés en los médicos residentes. La relación entre conflictos con supervisores, médicos especialistas, residentes de mayor, igual y menor jerarquía y el nivel de estrés de los médicos residentes fue estadísticamente significativa (p=0.000 y 0.01)

Niveles de ansiedad de médicos residentes / Anxiety levels in medical residents

Introducción: La residencia médica es un período de riesgo para el desarrollo de problemas de salud mental. Los estudios de ansiedad en residentesson contrastantes; sin embargo, se cree que los niveles de ansiedad son altos ya que los programas se desarrollan en hospitales nacionales que carecende recursos fsicos, materiales y humanos. El objetvo del presente estudio es determinar los niveles de ansiedad en médicos residentes en diferentesespecialidades empleando el cuestonario inventario de la ansiedad rasgo-estado (IDARE).Métodos: Se administró una encuesta electrónica para determinar el nivel de ansiedad en médicos residentes en diferentes especialidades del HospitalGeneral San Juan de Dios.Resultados: Se obtuvieron 132 encuestas para el análisis. La mayoría de los médicos encuestados son hombres (59%), solteros (83%) que no tenendependientes (79%), cursan residencia de cirugía o medicina interna (54%), trabajan más de 80 horas por semana (85%) y viajan menos de una horapara llegar al lugar de residencia (67%). El promedio del nivel de ansiedad-estado de los médicos residentes fue 46.94 puntos, mientras que el nivelpromedio de ansiedad-rasgo fue de 42.77 puntos. El 35% de los residentes poseen niveles de ansiedad medio y 59% altos en el momento de responderla encuesta; y el 56% posee niveles de ansiedad medio y 37% alto generalmente. No se encontró diferencia estadístcamente signifcatva en los nivelesde ansiedad en base a género, estado civil, tpo de residencia, dependientes y horas de tráfco. La única variable asociada con ansiedad fue la cantdadde horas de trabajo por semana.Conclusiones: La mayoría de los residentes encuestados poseen niveles de ansiedad medio-altos, la única variable asociada con niveles de ansiedadfue la cantdad de horas de trabajo por semana.

Background: Medical residency is a risky period for the development of mental health problems. Although anxiety studies in medical residents areinconclusive; we hypothesize anxiety levels in residents are high, since residency programs are developed in community hospitals that lack material andhuman resources. The aim of this study is to determine the levels of anxiety in medical residents of diferent specialtes using the State Trait-AnxietyInventary (STAI).Methods: An electronic poll with STAI was administered to medical residents of diferent specialtes of a tertary referral hospital.Results: We received 132 questonnaires for analysis. Most of the respondents are men (59%), single (83%), without dependents (79%), belong tosurgical or internal medicine residency (54%), work more than 80 hours per week (85%) and travel less than an hour to get to the hospital (67%). Theaverage level of state anxiety of the residents was 46.94 points, while the average level of trait anxiety was 42.77 points. Thirty fve percent of theresidents have medium anxiety levels and 59% high anxiety levels at the tme they answered the inventory; and 56% have medium anxiety levels and37% have high anxiety levels as a trait. We did not found a statstcal diference in anxiety levels based on gender, marital status, and type of residency,number of dependents or number of hours spent in trafc. The only variable that was associated with anxiety was the amount of work hours per week.Conclusions: Most of the residents have medium-high levels of anxiety; the only variable associated with anxiety levels was the amount of work hoursper week

Modelo anatômico de ventriculomegalia para treinamento neuroendoscópico / Ventriculomegaly anatomical models for neuroendoscopy training

OBJETIVO: Desenvolver peças anatômicas que simulem uma condição real de ventriculomegalia para serem utilizadas como uma ferramenta no treinamento dos neurocirurgiões nas técnicas de neuroendoscopia e viabilizar estudo anatômico dos ventrículos. MÉTODO: Foram utilizadas vinte peças anatômicas de encéfalo de cadáveres de indigentes, com a aprovação do Comitê de Ética em pesquisa da FMUSP sob o número 046/10. As peças foram retiradas da base do crânio com a persistência da superfície óssea (parte da calvária) para serem submetidas aos seguintes procedimentos: canulação do IV ventrículo por meio da abertura mediana do IV ventrículo (forame de Magendie); tomografias pré-experimento e injeção de água destilada no sistema ventricular. A água injetada estava à temperatura ambiente e os cérebros foram resfriados até 4º C e, após 12 horas, foram congelados a uma temperatura de 0º C (no estado sólido) por 24 horas. Esses procedimentos foram realizados na frequência de três vezes. Após o experimento, foram realizadas tomografias pós-experimento e procedimentos neuroendoscópicos ventriculares. Foram excluídos encéfalos com lesões traumáticas ou antecedentes de enfermidades transmissíveis. Não foram critérios de exclusão o sexo e a idade. Foram avaliadas, nas imagens tomográficas, a variação pré e pós-experimento dos seguintes parâmetros: coeficiente corno frontal/diâmetro interno; índice de Evan; e tamanho do corno temporal. As análises estatísticas foram realizadas no programa SPSS (Statistical Package for the Social Sciences) versão 13, para ambos os grupos. RESULTADOS: A avaliação da relação Corno frontal/Diâmetro interno, antes e pós-experimento apresentou média de 11,98% e 19,46%, respectivamente. Estudo estatístico (t Student) mostrou diferença estatística (t= -5142, gl =19; p < 0,01). O Índice de Evan também apresentou diferença significativa (t = -5,172, gl = 9; p < 0,01) entre os resultados antes (média de 10,86%) e após experimento (média de 18,35%). A análise...

PURPOSE: To develop anatomical models which simulate real conditions of ventriculomegaly and to use them as tools to train neuroendoscopic techniques and allow the study of the ventricles. METHODS: A total of twenty brains, with the approval of the Ethics in Research Committee from FMUSP (046/10) were used to perform this research. The brains were separated from the skull base, but keeping part of the calvaria, and then underwent the following procedures: cannulation of the fourth ventricle through the median open of the fourth ventricle (foramen of Magendie); CT scans performed before the experiment; and then injection of distilled water into the ventricular system. The water was injected at room temperature, and then the brains were cooled to 4ºC. After 12 hours, they were then frozen at 0ºC for 24 hours.These procedures were repeated three times. After the experiment,CT scans were performed after the injections and neuroendoscopic procedures. Brains, which had traumatic injuries or history of infectious diseases, were excluded. Gender and age were not exclusion criteria. The statistical analysis was performed with the SPSS program (Statistical Package for the Social Sciences) version 13, for both groups. To assess the variation of the frontal horn (FH)/internal diameter (ID) coefficient, such as Evan's index's variation, and to analyze the temporal horn (TH) size, thet-Student test was used. RESULTS: The results of the t-Student test showed that the FH/ID, with an average of 11.98% before the experiment, had significant difference (t = -5.142, gl = 19; p < 0.01) after the experiment, with an average of19.46%. The Evan's index also showed a significant difference (t = -5.172, gl = 9; p < 0,01) with an initial average of 10.86% and a final average of 18.35%. The analysis of the temporal horn size showed a significant difference between the size before and after the experiment (t = -2.297, gl = 9; p < 0.01), indicating the significant increase of the temporal...