RESUMO
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.
RESUMO
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.