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.

Depression and perceived stress among the medical residents under the / 中南大学学报(医学版)

OBJECTIVES@#It is an important reform for medical education in China to combine professional postgraduate training with standardized resident training. This study aims to evaluate the depression and perceived stress in postgraduate students of clinical medicine and residents from society and to determine the relation between depression and perceived stress in medical residents.@*METHODS@#Chinese Perceived Stress Scale (CPSS) and Self-Rating Depression Scale (SDS) were applied to 330 residents (including 235 postgraduate students of clinical medicine and 95 residents from society) from a Class-A Grade-3 genernal hospital in Hunan Province to evaluate and compare the depression and perceived stress in postgraduate students of clinical medicine and residents from society. Pearson correlation analysis was performed to assess the association between depression and perceived stress. Stress resources between 2 groups of residents were observed and compared.@*RESULTS@#Of the 235 postgraduate students of clinical medicine, 148 (63.0%) showed depression and 162 (68.9%) showed elevated perceived stress. Main stress resources were academic pressure, scientific research pressure, and employment pressure. Of the 95 residents from society, 52 (54.7%) showed depression and 58 (61.1%) showed elevated perceived stress. Main stress resources were economic stress, employment pressure, and academic pressure. The scores of CPSS and SDS were significantly higher in postgraduate students of clinical medicine than those in residents from society (@*CONCLUSIONS@#Residents (including postgraduate students of clinical medicine and residents from society) possess depression and elevated perceived stress with positive correlation. The postgraduate students of clinical medicine show higher level of depression and perceived stress than the residents from society under the "unified double-track" training system.

Development and psychometric properties of the Subtle Gender-Based Violence Among Medical Residents Assessment Scale (SGEVRA) / Desarrollo y propiedades psicométricas de la Escala de Violencia Sutil de Género en Médicos Residentes (SGEVRA)

Abstract Introduction Medical residents (MR) are an important pillar for a future effective health system. As such, it is important to study all the factors throughout their training that may influence their professional development, like gender-based violence (GV). Objetive To design and evaluate the psychometric proprieties of subtle GV among medical residents' assessment scale (SGEVRA). Method The design was carried out in two phases: (1) in the qualitative phase, three focus groups were interviewed to obtain information about GV during medical training; and (2) in the quantitative phase, the information was incorporated into the instrument and the psychometric properties were tested. Results A total of 1,645 medical residents (MRs) completed the instrument. Exploratory factor analysis led to a final two factor model comprised of 31 items that explained 74.9% of the variance. The factors were labelled as gender discrimination (factor 1) and sexual violence (factor 2); both demonstrated high internal consistency using Cronbach's alpha (factor 1: .987; factor 2: .935). Discussion and conclusion The SGEVRA is a brief, valid, and reliable instrument for assessing subtle GV among MR.

Resumen Introducción Los residentes médicos (MR) son un pilar importante para un futuro sistema de salud efectivo. Por ello, es importante estudiar todos los factores a lo largo de su capacitación que puedan influir en su desarrollo profesional, como la violencia de género (GV). Objetivo Diseñar y evaluar las propiedades psicométricas de la Escala de Violencia Sutil de Género en médicos residentes (SGEVRA, por sus siglas en inglés). Método El diseño se realizó en dos fases: (1) cualitativa: se entrevistó a tres grupos focales para obtener información sobre la VG durante la capacitación médica; y (2) cuantitativa, donde la información se incorporó al instrumento y se evaluaron las propiedades psicométricas. Resultados 1,645 residentes médicos (MR) completaron el instrumento. El análisis factorial exploratorio condujo a un modelo final de dos factores compuesto por 31 reactivos que explicaron el 74.9% de la varianza. Los factores fueron etiquetados como discriminación de género (factor 1) y violencia sexual (factor 2); ambos demostraron una alta consistencia interna con el alfa de Cronbach (factor 1: .987; factor 2: .935). Discusión y conclusión SGEVRA es un instrumento breve, válido y confiable para evaluar GV en MR.

Psychological stress among post-graduate medical resident doctors: A cross-sectional study in a tertiary care hospital in Central India

Background: Medical residents are exposed to numerous stressors during their post-graduate training which affects them both physically and emotionally. This stress can have a profound impact on the resident’s ability to work and perform activities of daily living. Objectives: The goals of this study are to (1) estimate the psychological stress in medical post-graduate doctors and (2) study the sociodemographic factors associated with stress in post-graduate doctors. Materials and Methods: This was a cross-sectional study of resident doctors in a tertiary care hospital in Central India. A total of 130 medical residents at a tertiary hospital in Central India were surveyed anonymously using the Kessler psychological distress reporting scale questionnaire (K10) + self-reporting measure. Descriptive statistics as well as Pearson’s Chi-square test (χ2) and odds ratios were used to quantify the associations between categorical variables using SPSS v24.0 software. P < 0.05 was considered statistically significant. Results: A total of 131 (of 138, with a response rate of 95%) medical post-graduate residents were participated in this study. The mean age of study participants was 27 years. The results showed that there was no statistical gender difference when it came to reports of stress among the residents. Moderate amounts of stress were reported by the residents, with some of this stress requiring time off from the residency and/or medical care. Conclusions: This study has shown that postgraduate medical residents at a tertiary care hospital in Central India experience increased amounts of stress during their residency training.

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.

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.

Estrategias de afrontamiento y su relación con depresión y ansiedad en residentes de pediatría en un hospital de tercer nivel / Coping strategies and their relation with depression and anxiety in pediatric residents in a third level pediatric hospital

Introducción. La depresión y la ansiedad son comunes entre los residentes. Las estrategias de afrontamiento son esfuerzos cognitivos y conductuales encaminados a manejar el estrés. El empleo de estas estrategias de tipo activo está asociado con la menor frecuencia de depresión y ansiedad. El objetivo del presente trabajo fue identificar si existe una relación entre la depresión y la ansiedad y las estrategias de afrontamiento empleadas por los médicos residentes. Métodos. Previo consentimiento de los médicos residentes, se aplicaron los inventarios de depresión y ansiedad de Beck y el de estrategias de afrontamiento. Los datos se analizaron mediante la prueba de χ². Resultados. Se incluyeron en el estudio 112 sujetos. Se identificó depresión en 39.6%, ansiedad en 25.6% y ambas coexistieron en 21.4%. Se encontró asociación entre la ansiedad y el tipo y grado de la residencia. Dos de las subescalas de afrontamiento pasivas se asociaron con depresión y tres de ellas con ansiedad. Conclusiones. La presencia de síntomas depresivos y ansiosos es frecuente entre los residentes. Las estrategias de afrontamiento más empleadas son de predominio mixto. El empleo de estrategias de afrontamiento pasivas se asocia con la depresión y ansiedad.

Background. Depression and anxiety are common among medical residents. Coping strategies are cognitive and conductual efforts in order to manage stress and specific individual demands. The use of active strategies has been associated with a lower frequency of anxiety and depression. Our objective was to determine if there is an association between depression and anxiety and the coping strategies used by medical residents. Methods. Previous consent, Beck anxiety and depression inventory and coping strategies inventory were completed. Data were analyzed using χ2 test. Results. A total of 112 residents were included. Depressive symptoms were identified in 39.6% and anxiety in 25.6%, with coexistence of both symptoms in 21.4%. Anxiety was associated with the type and year of residence. Two of the passive subscales of coping strategies were associated with depression and three with anxiety. Conclusions. Depressive and anxiety symptoms are frequent among medical residents. Mixed coping strategies are most commonly used. Passive coping strategies are associated with depression and anxiety.

Burnout e pensamentos suicidas em médicos residentes de hospital universitário / Burnout and suicidal thoughts in medical residents at a university hospital

Este estudo objetivou descrever e analisar a prevalência de burnout e pensamentos suicidas em médicos residentes de um hospital público de Goiânia e verificar se há correlação entre os dois. Foi realizada uma investigação por meio de um estudo analítico-descritivo em corte transversal em 72 residentes através do MBI (Malasch Burnout Inventory) e do questionário de suicídio de Paykel. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa do Hospital das Clínicas da Universidade Federal de Goiás sob o Parecer nº 052/2009. Resultados indicam a prevalência de burnout em 18,05% da amostra. Dentre os 13 sujeitos com manifestação de burnout, 61,53% já apresentaram pensamentos suicidas. Dentre os 42 sujeitos com baixo risco para manifestação de burnout, 28,57% já apresentaram pensamentos suicidas. Evidenciou-se correlação entre burnout e pensamentos suicidas, o que torna preciso elaborar programas de prevenção do burnout. Pesquisas nesta área são necessárias para a compreensão do burnout e sua correlação com pensamentos suicidas e outros distúrbios psiquiátricos.

This study aimed to analyze the prevalence of burnout and suicidal thoughts in residents of a public hospital in Goiania and to verify if there is any correlation between the two. An investigation was conducted using an analytic-descriptive cross-sectional study among 72 residents using the MBI (Malasch Burnout Inventory) and the Paykel's suicide questionnaire. This study was approved by the Ethics Committee of the Hospital das Clínicas of GoiásFederal University, under registration number 052/2009. The results show the prevalence of burnout in 18.05% of the sample. Among the 13 subjects who displayed 'burnout', 61.53% have had suicidal thoughts. Among the other 42 with low risk for manifestation of 'burnout', 28.57% have had suicidal thoughts. This study revealed a correlation between 'burnout' and suicidal thoughts, making it necessary to draw up burnout prevention programs. Research hasbecome necessary for the understanding of burnout and its correlation tosuicidal thoughts and other psychiatric disorders.

Conhecimento e atitudes sobre genética entre médicos residentes / Knowledge and attitudes on genetics among a group of medical residents

O objetivo deste trabalho foi estudar o conhecimento, as crenças e opiniões sobre Genética em um grupo de médicos residentes. Foi utilizada a técnica de grupos focais com 12 residentes de Pediatria em seu primeiro mês de curso, divididos em quatro grupos. Para a análise do material, foi escolhida a técnica da leitura isotópica. Os participantes demonstraram pouco interesse pelo assunto, mas tinham um grau razoável de conhecimento. Este conhecimento, entretanto, era pouco vinculado à prática clínica, sugerindo a necessidade de reformulação da formação médica. Os grupos mostraram consciência da alta prevalência e da grande morbidade das doenças genéticas, sinalizando que a nova geração de médicos pode ser mais sensível à questão da inserção da Genética na saúde pública. O Brasil está passando por um momento de transição epidemiológica, com o aumento proporcional das doenças de etiologia genética como causas de morbi-mortalidade, tornando necessária a inclusão dessas condições no planejamento para a gestão da saúde pública.

This article focuses on knowledge, beliefs, and opinions related to genetics among a group of medical residents. Twelve residents in pediatrics, divided into four focus groups, were interviewed during their first month of residency. The material was analyzed using the isotopic reading technique. Participants showed little interest in the topic, despite having a reasonably good level of knowledge, which bore little relationship to their clinical practice, suggesting the need to reformulate medical education. The groups were aware of the high prevalence and morbidity of genetic disorders, thus signaling that the new generation of physicians may be more sensitive to the need to include medical genetics in public health. Brazil is currently experiencing an epidemiological transition, with a proportional increase in genetic disorders as a cause of morbidity and mortality, thus requiring such inclusion in public health planning.

O encontro com a morte: à procura do mestre Quíron na formação médica / Facing death: the search for Quiron in medical education

Este estudo tem como objetivo compreender como a formação médica lida com o processo de morte de um paciente, e o que os estudantes desejam e sugerem em relação ao tema. Trata-se de estudo qualitativo, baseado na narrativa de estudantes e residentes de Medicina da Universidade Federal do Rio Grande do Norte. A Fenomenologia Existencial, a Hermenêutica Gadameriana e a Teoria da Ação Comunicativa, de Habermas, constituem a base filosófica do trabalho de produção e interpretação das narrativas. Foram combinadas duas estratégias tecno-metodológicas: entrevistas em profundidade e oficinas com utilização de "cenas" projetivas. Os estudantes e residentes transitam entre escassos modelos e poucas experiências pessoais no lidar com a morte de pacientes. O mito de Quíron traduz a procura dos entrevistados por modelos conceituais capazes de ajudá-los a manejar suas vulnerabilidades e desenvolver seus potenciais.

The current study aimed to shed light on how medical education deals with end-of-life issues and death, and on students' related concerns and suggestions. This qualitative study was based on the narratives of medical students and medical residents at the Federal University in Rio Grande do Norte, Brazil. Existential phenomenology, Gadamer's Hermeneutics, and Habermas' Theory of Communicative Action provided the philosophical basis for the narratives' production and interpretation. Two methodological strategies were combined: in-depth interviews and workshops using projective role-playing activities. Students and residents reported a scarcity of models and poor personal experience in coping with the death of patients. The ancient Greek myth of Quiron expresses the participants' search for conceptual models to help them deal with their vulnerabilities and increase their own potential.

Conocimientos acerca del trastorno de ansiedad generalizada y el trastorno de pánico con y sin agorafobia entre médicos residentes de medicina en entrenamiento durante el año 2009 / Knowledge of generalized anxiety disorder and panic disorder with and without agoraphobia among medical residents training during 2009

Objetivos: Estimar el grado de conocimiento que los médicos residentes de dos hospitales públicos tienen acerca del diagnóstico y tratamiento del trastorno de ansiedad generalizada (TAG) y el trastorno de pánico (TP). Material y Métodos: Se diseñó y validó, mediante revisión por jueces y un estudio piloto con médicos generales, un instrumento para evaluar conocimientos acerca del diagnóstico y manejo del TAG y el TP, el cual se aplicó a 70 médicos residentes de medicina de los Hospitales Cayetano Heredia y Arzobispo Loayza en enero del 2009. Resultados: El 22,9% de los participantes diagnosticó correctamente el TAG; 70%, el TP; y 20%, la agorafobia. Los psicofármacos mencionados como tratamiento de primera línea fueron las benzodiazepinas (78,5% para el TAG y 71,4% para el TP), seguidos de los antidepresivos, siendo los más comunes, fluoxetina (21,4% para el TAG y 20% para el TP) y sertralina (20% para el TAG y 17,1% para el TP). El 51,9% y el 52,4% de los participantes indicarían sólo benzodiazepinas para el TAG y el TP, respectivamente. El 80% y 88,6% de médicos residentes transferirían al Servicio de Psiquiatría los pacientes con TAG y TP, respectivamente. Conclusiones: Los médicos residentes diagnostican mejor el TP que el TAG o la agorafobia. Asimismo, en general consideran que estos trastornos requieren tratamiento farmacológico y tratarían a pacientes con estos cuadros si acudieran a su consulta; sin embargo, no indicarían un adecuado tratamiento. Por lo tanto, se debe mejorar la enseñanza sobre estos trastornos en el pregrado y la residencia.

Objective: To estimate the knowledge about diagnosis and management of generalized anxiety disorder (GAD) and panic disorder (PD) among medical residents from two public hospitals. Material and Methods: An instrument to evaluate knowledge about diagnosis and management of GAD and PD was designed and validated by means of expertsÆ review and pilot study with general practitioners. This instrument was administered to medical residents from Cayetano Heredia and Arzobispo Loayza Hospitals (Lima, Perú) during January 2009. Results: Twenty- three percent of participants correctly diagnosed GAD; 70%, PD; and 20%, agoraphobia. Psychotropic drugs considered as first line treatment were benzodiazepines (78.5% for GAD and 71.4% for PD) followed by antidepressant drugs, the commonest being fluoxetine (21.4% for GAD and 20% for PD) and sertraline (20% for GAD and 17.1% for PD); 51.9% and 52.4% of participants would prescribe benzodiazepines as monotherapy for GAD and PD, respectively. Eighty percent and 88.6% of medical residents would refer to a psychiatry service the patients with GAD and PD, respectively. Conclusions: Medical residents diagnose better PD than GAD or agoraphobia. In addition, generally they consider that these disorders require pharmacological treatment and would manage patients with these illnesses if they sought help in their office; however, there are deficiencies in the treatment that they would prescribe. Therefore, it is necessary to improve the education about these disorders in medical students and residents.

Prevalencia del síndrome de desgaste profesional en médicos residentes de un hospital pediátrico en el Estado de Sonora / Prevalence of Burnout syndrome in medical residents from a pediatric hospital in Sonora, México

Introducción. El síndrome de desgaste profesional (SDP) o síndrome de Burnout (SB) es un problema de salud en la población médica. En México se desconoce con precisión la prevalencia del evento. Factores como estrés laboral, carga asistencial y largas jornadas de trabajo se asocian a su ocurrencia. Objetivo: Determinar la prevalencia del SDP en médicos residentes de pediatría del Hospital Infantil del Estado de Sonora (HIES). Métodos. Se efectuó un estudio transversal en el año 2008. Para evaluar el SDP, se aplicó el cuestionario Mashlach Burnout Inventory (MBI). Las diferencias observadas fueron evaluadas mediante la prueba de Kruskal-Wallis. Resultados. Se encontró que 100% (n =58) de los residentes presentaron SDP, 27.5% en grado severo, 44.8% en moderado, y 27.5% en leve (P<0.03); el grupo más afectado fue el de los residentes de 3º año de pediatría, con los mayores niveles de cansancio emocional (P <0.025) y despersonalización (P <0.005). Conclusiones. El SDP es un problema de salud entre los residentes del HIES, que se agudiza conforme avanzan en su grado jerárquico. Es conveniente iniciar medidas preventivas que disminuyan la prevalencia del síndrome entre médicos residentes del HIES.

Background. Burnout syndrome (BS) refers to an arising health problem among medical professionals, particularly in medical residents who perform their duties under stressful scenarios. Several factors such as job stress, length of duties, and working environment have been associated with its occurrence. Accuracy of the prevalence of BS in Mexico is unknown. We undertook this study to determine the prevalence of BS in medical students of a pediatric service from the Hospital Infantil del Estado de Sonora (HIES). Methods. A cross-sectional study was carried out in the year 2008. To evaluate BS, the Maslach Burnout Inventory scale was applied to 58 residents. Differences in scores were assessed using the Kruskal-Wallis test. Results. All study subjects were classified as having some degree of BS; 27.5% were categorized as severe, 44.8% as moderate, and 27.5% as mild (p <0.03). Higher levels of emotional exhaustion (p <0.025) and impersonalization (p <0.005) were observed among third-year residents. Conclusion. BS is a health problem among pediatric residents in the HIES. It is appropriate to design supportive and preventive strategies to ameliorate the negative impact of BS.

Working Conditions of Medical Residents in Ontario, Canada / 医学教育

1) In Canada, the working conditions of medical residents are negotiated on a province-by-province basis between provincial associations of residents and their respective employers. This paper focuses on the role of the Professional Association of Interns and Residents of Ontario (PAIRO).2) PAIRO negotiates working conditions with the Council of Academic Hospitals of Ontario and has obtained for its members a monthly salary of approximately 390,000 yen for first-year residents (the salary increases with each year of residency), a restriction of on-call duties to 7 of 28 days, and 4 weeks of paid vacation per year.3) In Japan, consideration should be given to the development of guidelines for the working conditions and salaries of residents based on the realities of each specialty and on local needs. To establish and enforce such guidelines, public funding and a third-party agency are necessary.