Can medical residency keep young specialists in the place where they graduate? Cross-sectional and exploratory study of the first seven years after implementation of medical residency programs in the State of Tocantins, Brazil

ABSTRACT BACKGROUND: New medical schools and new medical residencies in Brazil, mainly in its interior, were opened under the justification of collaborating towards distribution of these healthcare professionals and specialist doctors across the national territory. However, this proposal did not guarantee that medical practitioners would become established in the place where they graduated and specialized. OBJECTIVE: To calculate, through interviews, how many specialists who graduated in the state of Tocantins stayed there after finishing their medical residency; and to analyze the factors that made them stay or leave the place. DESIGN AND SETTING: Cross-sectional exploratory study conducted at a Brazilian federal public higher education institution. METHODS: All graduates from medical residencies in Tocantins, who graduated between 2013 and 2019, were contacted by telephone and, after obtaining consent, an interview was conducted. The interviews took place between June 2020 and January 2021. RESULTS: The permanence of medical residency graduates in the state increased from 50% in an earlier study to 55.8% in the current study, thus showing a situation of stability. In addition, we detected some reasons for staying or not. In a multivariate analysis, only working in the state capital was related to staying in the state of Tocantins, showing a 5.6 times greater chance. CONCLUSIONS: The percentage of those who remained was just over 50%, even some years after implementation of the first programs. Most specialists remained working for the state health department, with a smaller proportion in municipal health departments, and were concentrated in the state capital.

Aquisição de habilidades em cirurgia videolaparoscópica por residentes em cirurgia geral após treinamento em um simulador de alta fidelidade / Acquisition of skills in videolaparoscopic surgery by residents in general surgery after training in a high fidelity simulator

OBJETIVOS: Observar a aquisição de habilidades em cirurgia videolaparoscópica em um grupo de residentes de cirurgia geral após o treinamento em simulador de alta fidelidade. MÉTODOS: Série de casos com abordagem qualitativa, descritiva e aplicada. Os participantes foram residentes de cirurgia geral que já haviam cursado o módulo de técnicas cirúrgicas e realizado o treinamento em um simulador de videolaparoscopia de alta fidelidade. A coleta de dados foi realizada por meio de um questionário semiestruturado aplicado aos residentes após o treinamento e de entrevistas com os preceptores cirurgiões, gravadas entre um ano e um ano e meio após o treinamento, quando os residentes já estavam realizando o procedimento em pacientes reais. RESULTADOS: De acordo com os critérios de inclusão, foram analisadas as respostas de sete residentes de cirurgia geral. Após o treinamento em simulador os residentes relataram adquirir habilidades em procedimentos videolaparoscópicos. Dois dos residentes entrevistados mencionaram que tiveram dificuldades na execução das tarefas devido à alta sensibilidade exigida pelo simulador em alguns procedimentos. A metodologia dos "seis passos", utilizada durante o treinamento no simulador, foi bem aceita pelos residentes. Foi apontada a importância da presença de um tutor durante o uso do simulador. Os preceptores de cirurgia videolaparoscópica relataram que as habilidades adquiridas pelos residentes após o treinamento no simulador de alta fidelidade foram transferidas para o mesmo procedimento em pacientes reais. CONCLUSÕES: O presente estudo permite concluir que, de acordo com a percepção técnica e críticas dos residentes e dos preceptores do programa de residência médica em cirurgia geral, o treinamento padronizado utilizando o simulador de cirurgia videolaparoscópica de alta fidelidade mostrou-se eficiente para aquisição de habilidades por esse grupo de residentes, inclusive em posteriores procedimentos cirúrgicos em pacientes reais.

AIMS: To observe the acquisition of skills in videolaparoscopic surgery in a group of residents of general surgery, after training in a high fidelity simulator. METHODS: Case series with a qualitative, descriptive and applied approach. The participants were residents of general surgery who had already completed the surgical techniques module and accomplished the training in a high-fidelity simulator of videolaparoscopy. Data were collected through a semi-structured questionnaire applied to the residents after the training and interviews with the preceptors surgeons, recorded between one year and a year and a half after the training, when the residents were already performing the procedure in real patients. RESULTS: According to the inclusion criteria, the responses of seven general surgery residents were analyzed. After simulator training, they reported to have acquired skills in videolaparoscopic procedures. Two among the interviewed residents mentioned that they have had difficulties in performing the tasks due to the high sensitivity required by the simulator in some procedures. The "Six-Steps" methodology used during simulator training was well accepted by the residents. The importance of the presence of a tutor during the use of the simulator was pointed out. The videolaparoscopic surgery preceptors reported that skills acquired by the residents after training in the high-fidelity simulator were transferred to the same procedure in real patients. CONCLUSIONS: The present study allows to conclude that, according to the technical perception and criticals of residents and preceptors of the medical residency program in general surgery, the standardized training using the high-fidelity videolaparoscopic surgery simulator has proved to be effective for skills acquisition by this group of residents, including future surgical procedures in real patients.

Maximizing HIV Partner Notification Opportunities for Index Patients and their Sexual Partners in Malawi

Background. HIV testing and counselling (HTC) is important to effect positive sexual behaviour change and is an entry point to treatment; care; and psychosocial support. One of the most practical initiatives to increase HTC is to encourage sexual partners of HIV-infected persons to test for HIV. However; partner notification strategies must be feasible in the healthcare setting and acceptable to the population. Methods.We conducted a qualitative study during the pilot phase of an HIV partner notification trial to complement its assessment of feasibility and acceptability of methods of partner notification. We performed in-depth interviews with 16 consecutive HIV-positive index participants who consented and their 12 identifiable sexual partners. We also conducted two focus group discussions with healthcare workers to supplement the patient perspectives. In the main study; newly diagnosed HIV cases (index cases) were randomized to one of three methods of partner notification: passive; contract; and provider referral. Clients in the passive referral group were responsible for notifying their sexual partners themselves. Individuals in the contract referral group were given seven days to notify their partners; after which a healthcare provider contacted partners who had not reported for counselling and testing. In the provider group; a healthcare provider notified partners directly. Results.Although most index participants and partners expressed a preference for passive notification; they also highlighted benefits for provider-assisted notification and the universal right for all HIV-exposed persons to know their HIV exposure and benefit from HIV testing and access antiretroviral treatment. Several participants mentioned couples counselling as a way to diffuse tension and get accurate information. All mentioned benefits to HIV testing; including the opportunity to change behaviour. Conclusions. Provider-assisted partner notification is not preferred; but it is acceptable and may complement the passive method of notification. Couples counselling should also be encouraged

Prevalência e fatores agravantes do sintoma de refluxo gastroesofágico em estudantes de medicina da Universida de Federal do Tocantins / Prevalence and aggravating factors of symptom of gastroesophageal reflux in medical students of the Federal University of Tocantins

Objetivos: Avaliar a prevalência e fatores agravantes do sintoma de pirose possivelmente associado a refluxo gastroesofágico, em estudantesde medicina da Universidade Federal do Tocantins (UFT).Métodos: Um estudo transversal avaliou questionários aplicados a estudantes do Curso de Medicina da Universidade Federal do Tocantinsentre 23/09/2013 e 04/10/2013. As variáveis analisadas foram faixa etária, sexo, índice de massa corporal, frequência de ocorrência dossintomas, percepção de fatores que agravam o sintoma de pirose, tabagismo e uso de medicamentos para aliviar sintomas de pirose. Paracalcular a prevalência, foi considerado como sintoma de refluxo gastroesofágico a ocorrência de pirose mais de uma vez por semana, mas osfatores agravantes foram pesquisados nos indivíduos que referiam ter tido o sintoma pelo menos uma vez na vida. A análise estatística incluiuas frequências absolutas e relativas das variáveis, bem como os intervalos de confiança de 95%.Resultados: Foram avaliados 186 estudantes, sendo que 160 (86,0%) referiram ter tido pirose em alguma ocasião. Naqueles que referiramtal sintoma, a faixa etária predominante foi de 21 a 25 anos (65,0%), sendo 51,3% do sexo masculino. O sintoma de pirose ocorrendo pelomenos uma vez por semana foi referido por 88 (47,3%) dos entrevistados, sendo uma vez por semana por 53 (28,5%) e mais de uma vez porsemana por 35 (18,8%). Considerando todos os 160 estudantes que referiam ter tido pirose em alguma ocasião, constatou-se piora do sintomana presença de alterações emocionais (67,5%), ingestão de alimentos gordurosos ou condimentados (63,7%) e bebidas alcoólicas (60,6%).Conclusões: Os estudantes de medicina em estudo apresentaram uma alta prevalência do sintoma pirose. O sintoma era agravado por ingestãode alimentos gordurosos ou condimentados, alterações emocionais e bebidas alcoólicas.

Aims: To evaluate the prevalence and aggravating factors of heartburn symptom possibly associated with gastroesophageal reflux in medicalstudents of the Federal University of Tocantins.Methods: A cross-sectional study evaluated questionnaires given to students of the Medical School of the Federal University of Tocantinsbetween 09/23/2013 and 10/04/2013. The analyzed variables were age, sex, body mass index, frequency of occurrence of symptoms, perceptionof factors that aggravate the symptom of heartburn, smoking, and use of drugs to relieve symptoms of heartburn. To calculate the prevalence,occurrence of heartburn more than once a week was considered as a symptom of gastroesophageal reflux, but the aggravating factors wereinvestigated in subjects who reported having had this symptom at least once in life. Statistical analysis included absolute and relative frequenciesof the variables as well as the confidence intervals of 95%.Results: At all 186 students were evaluated, of which 160 reported heartburn at some time. In those who reported such symptom, thepredominant age group was 21-25 years (65.0%), and 51.3% were male. The symptom of heartburn occurring at least once a week was reportedfor 88 (47.3%) of respondents, being 53 (28.5%) for once a week and 35 (18.8 %) for more than once a week. Considering all the 160 studentswho reported having had heartburn at some time, there was a worsening of symptoms in the presence of emotional disorders (67.5%), eatingfatty foods (63.7%) and alcoholic beverages (60.6% ).Conclusions: Medical students in the study showed a high prevalence of heartburn. This symptom was aggravated in most interviewees byintake of fatty or spicy foods, emotional changes, and alcoholic beverages.

Exploring the Feasibility of Engaging Traditional Birth Attendants in a Prevention of Mother to Child HIV Transmission Program in Lilongwe; Malawi

Objective:To investigate the willingness of Traditional Birth Attendants (TBAs) to provide single dose antiretroviral prophylaxis to infants born to mothers with HIV and the feasibility of providing the TBAs with antiretroviral medication. Design 2 focus groups with a total of 17 registered TBAs. Setting Lilongwe; Malawi Methods TBAs were recruited by local health workers and participated in focus groups assessing their attitudes towards participation in a PMTCT program. Results TBAs were willing to participate in this prevention of mother-to-child HIV transmission (PMTCT) program and helped identify barriers to their participation. Conclusions:Given appropriate support and training; TBAs' participation in PMTCT programs could be an additional way to deliver medication to mothers and neonates who might otherwise miss crucial doses of medication

Utilization of Family Members to Provide Hospital Care in Malawi: the Role of Hospital Guardians

Aim :Like most of sub-Saharan Africa; Malawi suffers from a paucity of human resources in the health sector. With an average of one physician for every 50;000 persons; and a health care professional to in-patient population ratio of 1:277; patient care suffers. At Kamuzu Central Hospital (KCH) of Lilongwe; Malawi; family members; termed Hospital Guardians; are utilized to provide basic care for patients. The aim of our study is to characterize this population and explore their role in the health care system of KCH. Methods Seventy three semi-qualitative surveys and nineteen in-depth interviews were conducted with hospital administrators; Guardians; nurses; and physicians from these wards. The results were analyzed using descriptive analysis and emergent coding. ResultsIt was found that Hospital Guardians were primarily female family members of patients and have a low literacy rate. They performed a wide range of daily tasks in patient care from wound care to advocacy. Despite their essential role in the health care system; the Guardians were provided with little support from the hospital. There was often conflict between the Guardians and hospital personnel due to overcrowding with more than one Guardian per patient; a lack of understanding of hospital rules and regulations; and a lack of respect for the Guardian role by hospital staff.Conclusions :Until their role can be reduced by additional trained health care professionals; patient care could be improved by institutional support including a clarification of the role of the Hospital Guardians. Recommendations include a one-patient one-guardian policy; Guardian education; and enhancing Guardian resources

Hepatectomia central: relato de caso / Central hepatectomy: case report

A ressecção hepática é o tratamento apropriado para uma variedade de lesões benignas e malignas primárias e secundárias. Quando essas lesões estão localizadas nos segmentos IV, V e VIII,o problema persiste. A hepatectomia central é uma forma de minimizar o volume de fígado ressecado e evitar a insuficiência hepática pósoperatória. O objetivo do presente estudo é registrar um caso de hepatectomia central. Paciente do sexo masculino,40 anos, apresentava dor abdominal, perda de peso e saciedade precoce. A tomografia computadorizada mostrou múltiplos cistos na localização correspondente aos segmentos IV, V e VIII do fígado. A ressecçãoda região central do fígado foi realizada, preservando os segmentos I, li, 111, VI e VII e a recuperação ocorreu sem intercorrências. Os autores concluem que a hepatectomia central deve ser considerada como alternativa para ressecçõesem pacientes selecionados com lesões primárias ou secundárias localizadas na região central do fígado.

Hepatectomia central / Mesohepatectomy

A ressecção hepática é o tratamento apropriado para uma variedade de lesões benignas e malignas, primárias e secundárias. Quando estas lesões são localizadas na região central o problema persiste. A hepatectomia central é uma forma de minimizar o volume de fígado ressecado e evitar a insuficiência hepática pós-operatória. Objetivo - o presente estudo é registrar um caso de hepatectomia central / Hepatic resection is appropriate treatment for a variety of benign and primary or secondary malignant lesions. Centrally located lesions remains problematic. Mesohepatectomy is one way to minimize the volume of liver resected and in preventing postoperative liver failure. Objective - the aim of the present study is to report a case of mesohepatectomy...

Carcinoma hepatocelular apresentado por metástase óssea / Hepatocellular carcinoma presented with bone metastasis

Patients with hepatocellular carcinoma usually present with signs of liver disease, but bone metastasis at the initial presentation is a rare condition. We report a case of bone metastasis at the initial presentation in a patient with hepatocellular carcinoma. A 39 years old man complained of abdominal pain, fever, and weight loss. Computed tomography revealed osteolytic lesions in the body of the lumbar vertebra. Histological examination of the liver showed to be hepatocellular carcinoma. The authors believe that hepatocellular carcinoma should be included in the protocols in patients with clinical manifestations of bone disease.