Surgical complications in the first and second semesters of the general surgery medical residence. A study of 14063 cases

Abstract Objective: To evaluate whether the rate of surgical complications is higher during the first semester of the General Surgery residency in the largest hospital complex in Latin America. During this period, students are expected to have less experience in carrying out procedures. Methods: During a period of two years, all General Surgery resident doctors at the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo, made a notification of all the procedures they performed (n = 14.063), containing information such as name of the procedure, date, who participated, complications, among others. These data were analyzed with the purpose of evaluating the variation in the rate of complications throughout the year. Results: There was a 52 % increase in the rate of complications in the first academic semester when compared to the second semester. This phenomenon was observed in resident doctors in the first and second years of residency. Furthermore, it was observed that second-year residents remain with high rates of complications, in some procedures, for a longer time than first-year residents. Furthermore, the first three months (March, April and May) seem to have the highest complication rates of the entire year. Conclusion The impact of these complications can affect several health services and the increase in surgical complications in the first half of the year must be monitored by institutions, in order to control this phenomenon.

Escala del ambiente de enseñanza-aprendizaje de especialistas médico-quirúrgicos en formación / A scale for the teaching-learning environment of medical-surgical specialists in training

Introducción: La formación de los especialistas médico-quirúrgicos (residentes) se lleva a cabo en hospitales donde confluyen actividades asistenciales y de enseñanza-aprendizaje. El conocimiento sobre este ambiente dual es fundamental para identificar oportunidades para optimizar la calidad y efectividad de ambas actividades. Objetivo: Construir una escala para medir la percepción del ambiente de enseñanza-aprendizaje en la práctica clínica de los residentes en formación en Colombia. Métodos: Se diseñó una escala tipo Likert, que adaptó la guía de la Association for Medical Education in Europe Developing Questionnaires For Educational Research, con los siguientes pasos: revisión de literatura, revisión de la normatividad colombiana con respecto a los hospitales universitarios, síntesis de la evidencia, desarrollo de los ítems, validación de apariencia por expertos y aplicación del cuestionario a residentes. Resultados: Se construyó la escala de Ambiente de la Práctica Clínica (EAPRAC) sobre la base de la teoría educativa de la actividad y del aprendizaje situado en el lugar de trabajo. Inicialmente, se definieron 46 preguntas y, posterior a la validación de apariencia, se conformaron 39 ítems distribuidos en siete dominios: procesos académicos, docentes, convenios docencia-servicio, bienestar, infraestructura académica, infraestructura asistencial y organización y gestión. La aplicación de esta escala a residentes no mostró problemas de comprensión, motivo por el cual no fue necesario depurar la cantidad ni el contenido de los ítems. Conclusiones: La escala construida tiene validez de apariencia por los pares expertos y los residentes, lo que permite que en una fase posterior se le realice la validez de contenido y reproducibilidad(AU)

Introduction: The training of medical-surgical specialists (residents) takes place in hospitals where healthcare and teaching-learning activities converge. Knowledge about this dual setting is essential for identifying opportunities to optimize the quality and effectiveness of both activities. Objective: To construct a scale for measuring the perception about the teaching-learning environment in the clinical practice of residents who receive training in Colombia. Methods: A Likert-type scale was designed as an adapted form of the guide Developing Questionnaires for Educational Research, presented by the Association for Medical Education in Europe, with the following steps: literature review, review of Colombian regulations regarding university hospitals, synthesis of evidence, development of items, validation of appearance by experts, and questionnaire application to residents. Results: A clinical practice environment scale was constructed on the basis of the educational theory of activity and learning situated in the workplace. Initially, 46 questions were defined and, after the validation of appearance, 39 items distributed in seven domains were created: academic processes, teaching processes, teaching-service agreements, welfare, academic infrastructure, care infrastructure, and management and organization. The application of this scale to residents showed no comprehension problems; therefore, it was not necessary to refine the number or content of the items. Conclusions: The scale constructed has validity of appearance by expert peers and residents, which allows, in further stages, to carry out content validity and reproducibility(AU)

El mal en Jean Jacques Rousseau: sobre el ser humano y el conocimiento de sí / The evil in Jean Jacques Rousseau: on the human being and the knowledge of himself

Este artículo se ocupa del mal en Rousseau, recurriendo a cuatro imágenes, a saber: la vida social (socie-dad) y el hombre social (homme de l ́homme), en contraste con el estado de naturaleza (état de nature) y el hombre natural (homme naturel). Imágenes de orden lógico, esto es, filosófico argumentativas, que exponen la tensión y el alejamiento del hombre con respecto a su naturaleza. El supuesto indica que este alejamiento se eleva como la imposibilidad del conocimiento pleno de sí; convierte al ser humano en alguien extraño para sí que hipostasia su concepto en las determinaciones de la vida social. El método utilizado se desprende de la filosofía misma de Rousseau. El procedimiento se organiza con la identificación y presen-tación de un supuesto y su desarrollo lógico mediante argumentos que requieren la selección, organización y sistematización de fuentes encaminadas a exponer el supuesto en toda su complejidad

This article deals with evil in Rousseau, resorting to four images, namely. Social life (society) and social man (Homme de l'homme) are in contrast to (contrast with)) the state of nature (état de nature) and the natural man (Homme naturel). Images of logical order, that is, argumentative philosophical, which expose the tension and distance of man from his nature. The assumption indicates that this estrangement rises as the impossibility of full self-knowledge; it turns the human being into someone foreign to himself who hypostasia his concept in the determinations of social life. The method used follows from Rousseau's philosophy. The procedure is organized with the identification and presentation of an assumption and its logical development through arguments that require the selection, organization, and systematization of sources aimed at exposing the assumption in all its complexity.

Autoeficácia, habilidades sociais e clima escolar de estudantes do ensino fundamental / Self-efficacy, social skills and school climate of elementary school students / Autoeficacia, habilidades sociales y clima escolar de estudiantes de la enseñanza fundamental

O estudo comparou a autoeficácia acadêmica, as habilidades sociais e o clima escolar de estudantes do final do Ensino Fundamental, considerando diferenças por sexo e a influência do histórico de reprovação escolar, a partir da Teoria Social Cognitiva. Participaram 491 alunos (idade de 11 a 16 anos), selecionados por conveniência, de ambos os sexos, que frequentavam os três últimos anos do Ensino Fundamental de escolas públicas e particulares de uma cidade do Estado de Minas Gerais. Os participantes responderam ao Inventário de Habilidades Sociais para Adolescentes, ao Children's Self-Efficacy Scale, ao Questionário de Clima Escolar e ao Questionário com informações demográficas. Os resultados indicaram que as meninas apresentaram mais autoeficácia para atividades extracurriculares/lazer e social e mais empatia e assertividade do que os meninos. Os alunos apresentaram mais habilidades sociais de abordagem social/sexual e perceberam mais o clima escolar acerca do relacionamento entre estudantes. Estudantes com histórico de reprovação escolar tiveram menor autoeficácia e clima escolar positivo. Os dados evidenciaram as influências dos papéis de gênero e da reprovação escolar sobre as relações interpessoais e o desempenho escolar dos estudantes ao final do Ensino Fundamental, destacando a necessidade de se fomentar programas de intervenção com alunos e professores.

The present study aimed to compare academic self-efficacy, social skills and the school climate of students in the last years of Middle School, considering differences by sex and influences school failure, based on the Social Cognitive Theory. Participated 491 students aged between 11 and 16 years old, selected by convenience, of both sexes who attended the last three years of middle school in a city in the state of Minas Gerais. Participants answered Social Skills Inventory for Adolescents, Children's Self-Efficacy Scale, School Climate Questionnaire, and Socio-economic Demographic Questionnaire. The results indicated that girls showed more self-efficacy for extracurricular/leisure and social activities and more empathy and assertiveness than boys. The students presented more social skills of social/sexual approach and perceived more the school atmosphere about the relationship between students. Students with a history of school failure had lower self-efficacy and a positive school climate. The data evidenced the influence of gender roles and school failure on interpersonal relationships and school performance of students at the end of Elementary School, highlighting the need to promote intervention programs with students and teachers.

El estudio comparó la autoeficacia académica, habilidades sociales y el clima escolar de estudiantes del final de la Enseñanza Fundamental, considerando diferencias por sexo e influencias del histórico de reprobación escolar, basado en la Teoría Social Cognitiva. Participaron 491 alumnos (edad de 11 a 16 años), seleccionados por conveniencia, de ambos sexos que frecuentaban los tres últimos años de la Enseñanza Fundamental de escuelas públicas y particulares de una ciudad del Estado de Minas Gerais. Los participantes respondieron al Inventario de Habilidades Sociales para Adolescentes, al Children's Self-Efficacy Scale, al Cuestionario de Clima Escolar y al Cuestionario con informaciones demográficas. Los resultados indicaron que las niñas presentaron más autoeficacia para actividades extracurriculares/ocio y social y más empatía y asertividad que los niños. Los alumnos presentaron más habilidades sociales de abordaje social/sexual y percibieron más el clima escolar acerca de la relación entre estudiantes. Los estudiantes con historial de reprobación escolar presentaron menor autoeficacia y clima escolar positivo. Los datos evidenciaron las influencias de los papeles de género y de la reprobación escolar sobre las relaciones interpersonales y el desempeño escolar de los estudiantes al final de la Enseñanza Fundamental, destacando la necesidad de fomentar programas de intervención con alumnos y profesores.

"Cesárea? Não, Obrigada!": ativismo em uma comunidade online na busca pelo parto normal no Brasil / "C-section? Thanks, But No Thanks!": activism in an online community in quest for normal childbirth in Brazil / "¿Cesárea? ¡No, Gracias!": activismo en una comunidad en línea en la búsqueda de parto natural en Brasil

Resumo: Este artigo visa a compreender a organização de uma comunidade online cujo objetivo é contribuir para a conquista do parto normal e humanizado entre mulheres de camadas médias. Realizou-se uma netnografia na comunidade Cesárea? Não, Obrigada! na rede social Facebook, cujas participantes são de diferentes partes do país. A análise enfoca a troca de saberes, apoio mútuo entre as participantes sobre o que denominam de processo de "empoderamento" e mudanças na relação médico/paciente. Categorizou-se quatro perfis de participantes: não iniciadas, iniciadas, paciente informada e profissional de saúde. Nas razões das usuárias para a busca de informações online alinham-se interesse pela autonomia de decisão, cuidado e humanização da assistência. A comunidade contribui para esse processo ao organizar, educar e fornecer ferramentas para transformar as participantes em pacientes informadas.

Abstract: The aim of this paper is to comprehend the organisation of an online community which supports middle-class women from different parts of Brazil in the process of achieving humanized care in childbirth. A netnography has been performed in the community C-section? Thanks, But No Thanks! on Facebook. The analysis focuses on knowledge exchange, mutual support among participants on what they call empowerment process and changes in physician-patient relationship. Four profiles have been categorized: uninitiated, initiated, informed patient and healthcare professional. The reasons why users search for online information encompass interest in decision-making autonomy, care and humanization of childbirth. The community contributes to this process as it organizes, educates and provides tools for participants transformation into informed patients.

Resumen: El propósito de este artículo es comprender la organización de una comunidad en línea cuyo objetivo es contribuir a la conquista del parto normal y humanizado entre mujeres de clase media. Se realizó una netnografia en la comunidad ¿Cesárea? ¡No, Gracias! en la red social Facebook, cuyas participantes son de distintas partes de Brasil. El análisis enfoca el intercambio de saberes, apoyo mutuo entre las participantes sobre lo que denominan proceso de "empoderamiento" y cambios en la relación médico-paciente. Se categorizó cuatro perfiles de participantes: no iniciadas, iniciadas, paciente informada y profesional de salud. En las razones de las usuarias para la búsqueda de información en línea se incluye el interés por la autonomía de decisión, cuidado y humanización de la asistencia. La comunidad contribuye a ese proceso al organizar, educar y proporcionar herramientas para convertir a las participantes en pacientes informadas.

Hacia una educación de excelencia: el rediseño curricular de medicina aprobado en 2017 genera nuevos cambios / Towards an education of excellence: the curricular redesign of medicine approved in 2017 generates new changes

Contexto: El presente trabajo describe el proceso de rediseño curricular de la Carrera de Medicina de la Universidad Central del Ecuador. Discusión: se desarrolló conforme a las disposiciones y lineamientos del Reglamento de Régimen Académico (RRA), con base al análisis de mallas curriculares de Medicina a nivel regional y mundial; sumado a estudios de documentos de pertinencia, prospectiva, empleo; y talleres de consenso y mesas de discusión en la que intervinieron: docentes, estudiantes y otros actores involucrados con la formación médica. Se reformuló el objeto de estudio de la Medicina y sus núcleos problémicos; se adaptó el perfil de egreso de la carrera, lo que propició la inclusión de nuevas asignaturas y la reforma de las existentes, mejorando la interrelación e integración mesocurricular. Resultados: el producto obtenido es una malla curricular con 72 asignaturas que se cursan en 12 semestres. Este proceso fue una oportunidad para innovar y debatir la matriz curricular de la carrera. Conclusión: el rediseño curricular aprobado, con un adecuado ajuste microcurricular horizontal y vertical, lo eleva a categoría cinco en la escala de Harden, es decir, es un diseño curricular de enseñanza integrada que favorece la coordinación metodológica de las asignaturas, visionando en el mediano plazo a lograr un programa de aproximación transdisciplinar o nivel once de Harden, donde se reemplazan las asignaturas por constructos de ideas que llegan a ser parte de la experiencia real y globalizada del estudiante, a través de tareas concretas y tangibles que las aplica en el mundo real y capaz de resolver problemas del entorno. (AU)

Context: The present work is a description of the curricular redesign process that the Medicine Career of the UCE. Discussion: it was developed according to the dispositions and guidelines of the Regulation of Academic Regime (RRA), based on the analysis of curricular meshes of Medicine worldwide; studies of relevance, prospective, employment documents; and consensus workshops of discussion groups in which they took part: teachers, students and other actors involved with medical training. the object of study of Medicine and its problem nuclei was reformulated; the graduate profile of the career was adapted, which led to the inclusion of new subjects and the reform of existing ones, improving the interrelation and meso-curricular integration. Results: the obtained product is a curricular mesh with 72 subjects that are studied in 6 years. This process was an opportunity to innovate and debate the curricular matrix of the career.Conclusion: : the curricular redesign transforms the old curriculum into a Transdisciplinary Approach Program, or level eleven of Harden, where the subjects are replaced by constructs of ideas that become part of the student's real and globalized experience, through specific tasks and tangible that applies them in the real world and capable of solving environmental problems. (AU)

Specialty Training System and Postgraduate Education in Japan / 医学教育

Medical education towards a specialty is a core stage of training for medical doctors. The specialty training system in Japan was initially organized by various academic societies and was recently integrated under Japan Medical Specialty Board, which was established in 2014. From April 2018, a revised specialty training system will begin and be based on new program guidelines. Its main concepts are professional autonomy, quality assurance of the medical specialty board and trustworthy medical consultation. As with undergraduate education, global standards are recently required in postgraduate education. Consistent outcome policy throughout undergraduate and postgraduate education and workplace-based assessment can hopefully be established.

Specialty Training System and Postgraduate Education in Japan / 医学教育

Medical education towards a specialty is a core stage of training for medical doctors. The specialty training system in Japan was initially organized by various academic societies and was recently integrated under Japan Medical Specialty Board, which was established in 2014. From April 2018, a revised specialty training system will begin and be based on new program guidelines. Its main concepts are professional autonomy, quality assurance of the medical specialty board and trustworthy medical consultation. As with undergraduate education, global standards are recently required in postgraduate education. Consistent outcome policy throughout undergraduate and postgraduate education and workplace-based assessment can hopefully be established.

Present undergraduate medical education with connection to Postgraduate education / 医学教育

Medical education at college is the very first step of life-long learning as a medical doctor. Curricular reforms in Japan took place in the early 21st century, and can be exampled by the development of a model core curriculum, the emergence of the CAT (common achievement test) examination, the development of clinical clerkship and so on. The International accreditation of medical schools has just started spring of 2017. It highlights outcome-based education, which accelerates the connection of undergraduate education with postgraduate training.

Autoevaluación institucional. Una herramienta indispensable en la calidad de los procesos universitarios / Institutional Self-assessment. An Essential Tool for Quality of University Processes

La autoevaluación se identifica, con mucha frecuencia, con el paso previo para la realización del proceso de acreditación universitaria, lo que reduce su verdadero significado para el mejoramiento de la calidad de una institución de educación superior. Se desarrolla el presente trabajo con el objetivo de contribuir a la actualización de los profesores, estudiantes y directivos de la Universidad de Ciencias Médicas de Cienfuegos en los preceptos teóricos de la evaluación institucional, así como destacar la importancia de la autoevaluación como herramienta indispensable en la calidad de los procesos universitarios. Se hace referencia a la importancia y necesidad que en la actualidad se le confiere a la autoevaluación en las universidades para el mejoramiento de su quehacer institucional. Se presenta una síntesis de las tendencias y enfoques que abordan la autoevaluación, con énfasis en las diferentes modalidades evaluativas. Se concluye que es necesario involucrar responsablemente a toda la comunidad universitaria en el desarrollo de la autoevaluación creando una verdadera cultura de calidad en nuestras instituciones, que permita no solo estar listos para una evaluación externa sino para cumplir con calidad nuestro encargo social.

Self-assessment is usually identified with the step prior to the university accreditation process, which reduces its true significance for quality improvement in a higher education institution. This paper aims at updating teachers, students and administrators of the University of Medical Sciences of Cienfuegos on the theoretical precepts of institutional evaluation and highlighting the importance of self-assessment as an essential tool for quality of university processes. The current importance and need for self-assessment to improve the work performed by universities is discussed. A summary of trends and approaches to self-assessment is presented, with emphasis on the different self-assessment methods. It is concluded that it is necessary to responsibly engage all the university community in the development of self-assessment by creating a true culture on quality in our institutions, which would not only contribute to being ready for an external evaluation, but also allow us to meet our social mission.

O perfil dos ingressantes de um programa de educação física para idosos e os motivos da adesão inicial / The profile of the initiators in a physical education program for elderly and the reasons for the initial adherence

Numa sociedade em pleno envelhecimento, a Educação Física deverá desempenhar um importante papel. A cada ano, cresce a procura por programas supervisionados, como é o caso do Programa Autonomia para Atividade Física do Idoso - PAAF. Conhecer o idoso é fundamental para orientar as ações pedagógicas e atender suas expectativas. Assim, este trabalho destina-se a conhecer o perfil sócio-demográfico, a atividade física pregressa, verificar a saúde percebida e entender quais foram os motivos de adesão ao programa. Participaram desse estudo 54 pessoas (14 homens e 40 mulheres), com idade acima de 60 anos (66,45 ± 5,176 anos de idade), que ingressaram no PAAF-2002. Foram utilizados questionários, em que foram consideradas as seguintes variáveis: gênero, idade, nível de escolaridade, estado civil; saúde percebida do ingressante; a atividade profissional e a atividade física pregressa e o nível sócio-econômico. Para verificar os motivos da adesão inicial utilizamos tabela tipo Liekert e aplicamos o Índice de Consistência Interna de Liekert. Utilizamos o Coeficiente de Concordância de Kendall (W) e o Teste de Friedman (Xr²), com nível de significância (p = 0,05). A maioria dos alunos tinha entre 60 a 70 anos de idade, pertencia aos níveis sócio-econômico A e B e possuía alto nível de escolaridade. A maioria tinha pelo menos uma doença, porém, a saúde percebida era positiva. Os motivos de adesão relatados foram: aprender fazer exercícios físicos, melhorar condicionamento físico e prevenir problemas de saúde. Já, ocupar o tempo livre e fazer amigos foram motivos considerados menos importantes...

In an aging society, Physical Education has paramount importance. Each year the search for supervised programs expends, as in the Elderly Physical Activity Autonomy Program (PAAP) case. Understanding the elderly is important to orientate the pedagogic actions and to attend participants' needs. Therefore, the purpose of this study was to determine the social demographic characteristics, previous physical activity, perceived health of the elderly and to understand the reasons for their adherence in the PAAP. Fifty four individuals (14 male and 40 female, 66,45 ± 5,176 years old) that went into PAAP took part in this study. Questionnaires were used with the following variables: type, age, education level, marital status, perceived health, previous professional activity, previous physical activity and social-economic level. To check the reasons for the first adherence, we used the Liekert table and the Liekert Internal Consistence Index. To confirm the results, we applied the Kendall Concordance Coefficient (W) and the Friedman test (Xr²), adopting p = 0.05 as the significance level. The majority of the participants belonged to the A and B socio-economical classes and had a bachelor's degree. The majority had, at least, one disease, but the perceived health was positive. The adherence reasons reported were: learn how to perform physical exercises, to improve physical condition and to prevent health problems. Further, take up free time and to make friends were considered the less important reasons...

Serviço e comunidade, vetores para a formação em saúde: o curso de medicina da Uniderp / The health system and the community as vectors for the preparation of health professionals: the medical course at Uniderp

Este trabalho registra o processo de concepção, implantação e implementação do Programa Interinstitucional de Interação de Ensino, Serviço, Comunidade (Pinesc), uma parceria entre a universidade e a Prefeitura Municipal de Campo Grande, visando à realização de módulos curriculares longitudinais de ensino baseado na comunidade, desenvolvidos em oito semestres letivos do curso de medicina da Universidade para o Desenvolvimento do Estado e da Região do Pantanal (Uniderp, Anhanguera, MS). O relato inlcui o histórico, com seus pontos fortes e dificuldades, além de desdobramentos ão previstos, bem como aspectos operacionais do programa.

This paper relates the planning, implantation and implementation process of the Inter-institutional Program for University-Health Service-Community Interaction (Pinesc), a partnership between the university, the city council of Campo Grande and the Local Health System aimed at producing a longitudinal curriculum module of community based education (CBE and Come), developed over eight semesters of the medical course of the Universidade para o Desenvolvimento do Estado e da Região do Pantanal (Uniderp, Anhanguera, MS, Brazil). This report tells the history of the implementation of the program, its strengths, difficulties and unforeseen developments besides approaching some operational aspects.

Los grandes paradigmas de la educación médica en Latinoamérica / The big paradigms of the medical education in latin american countries

La educación médica ha sido y será un tema de preocupación para todas las generaciones en cualquier parte del mundo ya que de ello depende en parte el progreso de las sociedades y de nuestra profesión, necesaria en el Estado. En este artículo trataré de realizar un recuento histórico de los procesos que se han llevado a cabo en la educación médica en el mundo y en especial en los países de América Latina, tomando como puntos de referencia los dos paradigmas más importantes hasta el momento como son el paradigma "flexneriano" y el paradigma "crítico". También enuncio los inconvenientes y algunas reformas educacionales que ha tenido que pasar la mayoría de las naciones frente a la adversidad del contexto socioeconómico que los rodea. Además de ello hago un esbozo de un tercer paradigma en gestación generado por la introducción de un nuevo personaje en la educación médica: la tecnología.

The medical education has been and will continue to be a subject of concern to all generations anywhere in the world because it depends in part on the progress of societies and our profession; so necessary in the state. The objective of this article is to try to conduct a historical review of the processes that have taken place in medical education in the world and especially in Latin America; taking as a benchmark the two paradigms most important so far as the "Flexner" paradigm and the "critical" paradigm. I’ll also try to show the disadvantages and some educational reforms that most of the nations have faced, related to adversity in the socio-economic context that surrounds them. Besides that, I make an outline of a third emerging paradigm generated by the introduction of a new character in medical education: Technology.

Practice and Effect on the Plan of Three Early Educations in Medical Teaching Reform in our University / 中华医学教育探索杂志

The plan of three early educations is based on our real education condition, which builds a bridge between the traditional education and advanced education as a balance and breakthrough. It means the early involvement of clinic, the early involvement of scientific research and the early involvement of social practice.