Guía para evaluar el desarrollo de las habilidades profesionales del residente de Medicina General Integral en la atención ginecobstétrica / Guide to evaluate professional skills development of Comprehensive General Medicine resident in gynecobstetric care

RESUMEN Fundamento: la diversidad de actividades que realiza el médico de familia, la heterogeneidad de los profesores que los evalúan y las diferentes fases en que se puede encontrar este médico, entre otras circunstancias, hacen que su evaluación en el contexto asistencial esté plegada de innumerables criterios subjetivos y que no exista uniformidad. Objetivo: elaborar una guía para evaluar, bajo observación directa, el desarrollo de las habilidades clínicas del residente de Medicina General Integral en la atención ginecobstétrica. Métodos: se realizó la investigación con el uso de métodos teóricos y empíricos. Para el desarrollo de la priorización de las habilidades clínicas se partió de los problemas identificados. Se practicó la observación directa del comportamiento del residente en sus encuentros reales con pacientes ambulatorios. Los profesores de Medicina General Integral realizaron la observación del desempeño mientras ocurría la atención de una paciente. Sobre la base de los principales problemas identificados en el desempeño del residente se elaboró la guía y se sometió a criterio de expertos para su aprobación. Resultados: la guía incluye la evaluación de las siguientes habilidades clínicas: examen físico obstétrico, auscultación de la frecuencia cardiaca fetal, examen físico de la puérpera, examen físico de las mamas, colocación y extracción de dispositivo intrauterino, prueba citológica, cepillado de canal y realización de test de Schiller. Conclusiones: la guía es de fácil aplicación y permite identificar las dificultades que presenta el residente durante la ejecución del procedimiento. Su implementación sistemática contribuye al diagnóstico de las necesidades de aprendizaje.

ABSTRACT Foundation: diversity of activities carried out by the family doctor, heterogeneity of teachers who evaluate them and different phases in which this doctor can be found, among other circumstances, cause his evaluation in the healthcare context to be riddled by innumerable subjective criteria and that there is no uniformity. Objective: to design an evaluation guide, for direct observation of clinical skills development of the Comprehensive General Medicine resident in gynecobstetric care. Methods: this research was carried out by using theoretical and empirical methods. Clinical skills prioritization was developed on the basis of the identified problems. Direct observation of the resident's behavior was done in their actual outpatient appointments. Professors of Comprehensive General Medicine observed the performance while patient´s assistance. Based on the main problems identified in the resident's performance, the guide was prepared and submitted to expert judgment for approval. Results: the guide includes the evaluation of the following clinical skills: physical obstetric examination, auscultation of the fetal heart rate, physical examination of the postpartum woman, physical examination of the breasts, placement and removal of intrauterine device, cytological test, canal brushing and Schiller test. Conclusion: the guide is easy to apply and allows identifying the resident´s difficulties during the execution of the procedure. Its systematic implementation contributes to the diagnosis of learning needs.

Patología vulvar en niñas y adolescentes / Vulvar disordes during childhood and adolescence

RESUMEN Introducción: El aparato genital de la niña sufre modificaciones en las diferentes etapas de la vida desde el nacimiento hasta la pubertad. Los motivos de consulta y la frecuencia de patologías vulvares varían según las distintas etapas de la vida. El diagnóstico correcto favorece el tratamiento y seguimiento adecuados.Objetivo: Identificar las patologías vulvares en niñas y adolescentes que asisten a un consultorio especializado.Materiales y Métodos: Diseño observacional, descriptivo, retrospectivo, de corte transversal. Población de estudio: niñas y adolescentes con diagnóstico de patologías vulvares que consultaron en el Departamento Infanto-Juvenil del Centro Materno Infantil de la Cátedra de Clínica Gineco-obstétrica del Hospital de Clínicas, Universidad Nacional de Asunción, en período enero 2005-diciembre 2009.Resultados: Se estudió a 132 pacientes. El 62% corresponde a la primera y segunda infancia, 12% a adolescencia temprana, 6% a adolescencia media, 22% a adolescencia tardía. Los motivos de consulta más frecuentes en la primera y segunda infancia fueron la falta de apertura vaginal (40%), sangrado vaginal premenárquico, dolor abdominal y vulvar (10%). En la adolescencia temprana fue el dolor vulvar (44%), en la adolescencia media dolor y tumor vulvar (75%), en la adolescencia tardía el tumor vulvar (21%). Los diagnósticos más frecuentes en la primera y segunda infancia fueron coalescencia de labios menores (44%) y vulvitis (24%), en la adolescencia temprana las malformaciones genitales (63%), en la adolescencia media y tardía los condilomas gnitales (38%) y bartolinitis (20%). El 79% de las pacientes recibió tratamiento médico.Conclusión: la edad es un factor importante que determina el tipo y frecuencia de las patologías vulvares. El motivo de consulta y los síntomas presentes son parámetros fundamentales para guiar el diagnóstico. Las patologías inherentes al hipoestrogenismo son más frecuentes en la infancia y adolescencia temprana. Las infecciones o tumores debidos a enfermedades de transmisión sexual son característicos en la adolescencia media y tardía. El tratamiento en la mayoría de los casos es médico.

ABSTRACT Introduction: Children’s genitalia undergo changes throughout the different stages of life, from birth to puberty. The chief complaint and the frequency of the vulvar disorders vary according to the different stages of life. The correct diagnosis guarantees a correct treatment and follow up.Objective: To identify the vulvar disorders in girls and teenagers that consult at speciality offices.Materials and Methods: Design: Retrospective, descriptive, analytic, cross-sectional. Population: girls and teenagers with vulvar disorder diagnosis that attended the Child and Adolescent department at the Centro Materno Infantil, Hospital de Clinicas, during the period of January 2005 to December 2009.Results: 132 patients were studied. 62% (80/132) correspond to early childhood, 12 %( 16/132) early teenage years, 6 %( 8/132) middle teenage years, 22 %( 28/132) late teenage years. The most frequent chief complaint in early childhood were: the lack of vaginal opening (40%), vaginal bleeding before the menarche, abdominal and vulvar pain (10%). In early teenage years was: vulvar pain (44%), in middle teenage years were: vulvar pain and tumor (75%), and in the late teenage years: vulvar tumor (21%). The most frequent diagnose in early childhood were: labia minor coalescence (44%) and vulvitis (24%), in early teenage years, genital malformations (63%), in middle and late teenage years, genital condilomas (38%) and bartholinitis (20%). 79% of the patients received medical treatment. Conclusion: The patient´s age is an important factor that determines the type and the frequency of the vulvar disorders. The chief complaint and the symptoms are fundamental guidelines to the diagnosis. The hypoestrogenism related disorders are more frequent during chilhood and the early teenage years. The sexually transmitted infections and tumors are found in middle and late teenage years. In most cases there is a medical treatment.

Certificação de especialização em Ginecologia e Obstetrícia por egressos da Universidade de Brasília / Specialty certification in Obstetrics and Gynecology by graduates of a medical school

Objetivo. Análise de fatores associados à obtenção do título de especialista em Ginecologia e Obstetrícia por egressos da Universidade de Brasília. Métodos. O estudo incluiu os 55 egressos que se inscreveram para residência médica em Ginecologia e Obstetrícia, dentre 645 médicos formados de 1994 a 2004 na Instituição. Os dados abrangeram descritores demográficos, índices de interesse na especialidade e de rendimento acadêmico durante a graduação, inscrição para residência e indicação de adesão à especialidade, bem como registro de aprovação para obter o título. Análises estatísticas de contingência, correlação e regressão logística foram realizadas. Resultados. A análise dos dados mostrou que 24 egressos, dentre cinquenta inclusos no acompanhamento, obtiveram o título no intervalo de 1996 a 2008, a maioria graduada a partir do semestre 2/99. Os fatores significantemente associados à obtenção foram: rendimento global, e nas disciplinas da área, mais elevados, bem como faixa etária mais jovem na graduação. Sexo e índice de interesse na especialidade durante a graduação mostraram relação insignificante. O modelo de regressão logística classificou corretamente 76% dos casos, com variabilidade significantemente atribuível a dois fatores preditivos: rendimento global e interação faixa etária por época de graduação. Conclusões. O perfil predominante dos egressos que obtiveram o título caracterizou-se por rendimento acadêmico superior e faixa etária mais jovem no período recente de graduação. Os achados sugerem a tendência crescente nabusca de reconhecimento da identidade profissional - propiciada pela obtenção do título de especialista - notadamente entre profissionais mais jovens e de maior aptidão acadêmica.

Objective. Analysis of undergraduate features that relate to earning a specialty title in Obstetrics and Gynecology among University of Brasilia graduates. Methods. The study included the 55 graduates who applied for a medical residency program in Obstetrics and Gynecology among the 645 physicians who earned the degree at that university from 1994 to 2004. Data included demographic features, an index of interest in Obstetrics and Gynecology, measures of academic achievement, application for residency and the title certification. Analyses of contingency, correlation and logistic regression were done. Results. The findings showed that 24 (48%) among the 50 follow-up participants earned the title by 2008 and most of them graduated since 1999. The features associated with the outcome were younger age-bracket at graduation and higher scores both in the overall cumulative achievement index and in the Obstetrics and Gynecology marks. Sex and the previous index of interest in the specialty were unrelated to that outcome. A logistic regression model classified correctly 76% of cases and two predictive factors accounted for the variability: the cumulative academic achievementand the age-bracket by graduation-time interaction. Conclusion. Higher academic achievement and younger age-bracket in the recent graduation timeframe were key features of the predominant profile of the graduates who earned the specialty certification in Obstetrics and Gynecology. The findings suggest a growing trend in the search for the recognition of the professional identity - provided by earning the specialty certification - especially among younger professionals with greater academic aptitude.