Fellowship training of family medicine in the United States and its implications for China / 中华全科医师杂志

The study utilized a cross-sectional design. Data was retrieved from the American Academy of Family Physicians fellowship training directory, including program names, areas of focus, program length, and program descriptions. The collected data was categorized and analyzed based on areas of focus and training duration. The program descriptions were also analyzed qualitatively using Nvivo12 software. A total of 532 programs were included in the study:295 programs (55.5%) were ACGME-certified, while 237 programs (44.5%) were not. The majority of programs, 468 (87.9%), were clinically oriented, while 64 programs (12.1%) were non-clinical. Among ACGME-certified programs, the largest number of programs were in sports medicine (121 programs), followed by geriatrics (52 programs). Among non-certified programs, the largest number of programs was in obstetrics (66 programs), accounting for 27.8% of all non-certified programs. Qualitative research found that fellowship programs were diverse, reflecting the societal demands of healthcare service. Moreover, a significant emphasis was placed on empowering teaching and research abilities.The family medicine fellowship programs in the United States cover a wide range of disciplines and meet both the professional interests of doctors and the needs of patients. As China continues to implement its tiered medical system, it can learn from the experience of the United States and develop general practice subspecialty training programs, thereby improving the service capacity of general practitioners and improve the quality of healthcare.

Conhecimento de Alunos de Medicina do Centro Universitário do Estado do Pará sobre a Residência Médica / Knowledge about the Medical Residency among students of the Centro Universitário do Estado do Pará

RESUMO A residência médica (RM) é um curso de pós-graduação cujo ensino se baseia principalmente na prática voltada a determinada especialidade. Ao decidir se especializar, o acadêmico de Medicina precisa entender como funciona o processo de seleção, o número de vagas, as fases, a necessidade de se matricular em um curso preparatório para residência, quais as especialidades de cada serviço, seus pontos negativos e positivos, entre outros aspectos. Dessa forma, este estudo tem como objetivo identificar o conhecimento de alunos de Medicina do Centro Universitário do Estado do Pará (CESUPA) sobre a residência médica, as principais fontes de informação a respeito do assunto e as lacunas nesse conhecimento. Foi realizado um estudo observacional do tipo transversal, exploratório, de caráter descritivo e analítico, com uso de um questionário próprio, com 259 acadêmicos do curso de Medicina do CESUPA. Observou-se que 99,6% dos participantes desejam cursar residência médica, tendo a maioria se declarado com baixo e médio conhecimento sobre o tema (49% e 42%, respectivamente). Mais de 60% já realizaram algum tipo de pesquisa sobre o assunto, sendo a internet a fonte de informações mais utilizada. Foi identificado que apenas 6,6% dos participantes sabem corretamente o número de fases obrigatórias do processo seletivo e 89,6% acham necessária a realização de curso preparatório. Conclui-se que ainda existem lacunas no conhecimento dos acadêmicos de Medicina a respeito dos programas de residência médica, devendo este assunto ser mais explorado no meio acadêmico mediante intervenções que possam ampliar os horizontes dos alunos, deixando-os mais aptos e críticos no momento de decidir onde irão fazer a residência médica e como irão se preparar para ela.

ABSTRACT Medical residency (MR) is a postgraduate course in which learning is based mainly on practice focused on a particular medical specialty. Once the medical student decides to become a specialist, it is important to understand how the selection process works, the number of vacancies available, the steps they need to go through, whether they need to enroll in a preparatory course for the residency, which specialties exist in each service, and the negative and positive aspects of each one, among other inherent aspects. This study aims to identify the knowledge of MR among medical students of the Centro Universitário do Estado do Pará (CESUPA), the main sources of information available on the subject, and their gaps in this knowledge. An observational cross-sectional, exploratory, descriptive, analytical study was carried out with 259 students of the Cesupa medical school. It was observed that 99.6% of the participants hoped to enroll in a medical residency, with the majority stating that they have low and medium knowledge about the subject (49% and 42% respectively). More than 60% had already done some research on the topic, the Internet being the most used source of information. Only 6.6% of participants correctly knew the number of mandatory steps in the selection process, and 89.6% considered it necessary to take a preparatory course. It is concluded there are still gaps in medical students' knowledge about medical residency programs, and this subject should be further explored in the academic environment, through interventions that will broaden students' horizons, enabling them to become more apt and critical when it comes to deciding where to take the MR, and how to prepare for it.

Predictors for choosing the specialty of Family Medicine from undergraduate knowledge and attitudes / Preditores da escolha da especialidade Medicina de Família a partir de competências e atitudes de alunos de graduação

ABSTRACT: CONTEXT AND OBJECTIVE: A cold climate towards primary care (PC) within medical academia could form a barrier against choosing family medicine (FM) as a career option. This study was designed to determine whether medical students' knowledge of and attitudes towards FM predicted their career choice. DESIGN AND SETTING: Cohort study conducted at two different medical schools. METHODS: After completing a PC course at the Albacete Medical School in 2005-2006, 81 second-year students were asked to give responses to a questionnaire. In their sixth year (2009-2010), 79 students in Albacete and 42 in Seville (taken as an unexposed cohort) were asked to give responses too. Their choice of specialty was investigated in 2011. RESULTS: In Albacete, the questionnaire was answered by 79 second-year and 76 sixth-year students; in Seville, it was answered by 26 sixth-year students. After completing the PC course, 69.3% said they would like to become a family doctor. This percentage decreased to 40.3% at the end of the undergraduate course (P < 0.0001). In the sixth year, the attitudes towards FM worsened, yet these were significantly more favorable than those in Seville. Only 12 students chose FM; they obtained significantly worse scores in their specialty selection examination than their peers (P < 0.0001). CONCLUSION: In the Albacete Medical School, the students' opinion about FM worsened over the undergraduate course, although it was still better than the Seville students' stance. In any case, FM was seen to be a minority option.

RESUMO CONTEXTO E OBJETIVO: Um clima frio para a atenção primária na academia médica constitui uma barreira para escolher Medicina de Família (MF) como opção de carreira. Este estudo foi concebido para determinar se o conhecimento e as atitudes dos estudantes de medicina em relação à MF predizem a escolha da carreira. TIPO DE ESTUDO E LOCAL: Estudo de coorte realizado em duas faculdades de medicina. MÉTODOS: Depois de terem completado um curso de Cuidados Primários na Faculdade de Medicina de Albacete, em 2005-2006, 81 alunos do segundo ano foram convidados a responder a um questionário. No seu sexto ano (2009-2010), 79 estudantes de Albacete assim como 42 de Sevilha, tomados como coorte não exposta, foram convidados a responder também. Todos eles foram investigados sobre a escolha da especialidade em 2011. RESULTADOS: Em Albacete, 79 e 76 estudantes responderam no segundo e sexto anos, respectivamente, e 26 em Sevilha. Depois de terem concluído o curso de cuidados primários, 69,3% disseram que gostariam de se tornar médicos de família. Esta percentagem diminuiu para 40,3% no final da graduação (P < 0,0001). No sexto ano, as atitudes com relação à MF pioraram, mas estas foram significativamente mais favoráveis do que as de Sevilla. Apenas 12 alunos escolheram a MF; eles obtiveram pontuação significativamente piores no exame do que seus pares (P < 0,0001). CONCLUSÃO: Na Faculdade de Medicina de Albacete, a opinião dos alunos sobre a MF ao longo da graduação piorou; contudo ainda era melhor que as dos estudantes de Sevilha. Em qualquer caso, MF foi opção minoritária.

Acupuntura: motivações de médicos para a procura de especialização / Physicians' reasons for specializing in acupuncture

Este estudo quanti-qualitativo objetivou identificar concepções sobre Medicina Convencional e Acu puntura que contribuem para entender os motivos que levam médicos a procurarem conhecer ou se especializar em Acupuntura. Foram pesquisados 175 médicos do Curso de Desenvolvimento em Me dicina Chinesa − Acupuntura, do Center-AO − Centro de Pesquisa e Estudo da Medicina Chinesa e Universidade Federal de São Paulo − Escola Paulista de Medicina (Unifesp - EPM), com questio nário composto por perguntas abertas e fechadas. Os dados obtidos foram analisados estatisticamente, e as respostas foram analisadas com a técnica de análise de conteúdo, buscando desvelar unidades de significado. A partir disso, foram estabelecidas categorias gerais e específicas, que passaram a dar significado aos discursos. Dessa forma, foram obtidos três grupos categoriais: "aprimoramento profis sional", "ampliar seu próprio horizonte de vida" e "compreender o paciente em uma dimensão mais abrangente". Nossos dados revelaram que os médicos desejam exercer a Acupuntura de forma inte grada à Medicina Convencional, no bojo da qual a Acupuntura vem se firmando como especialidade médica.

This aim of this quantitative and qualitative study was to identify concepts of conventional medicine and acupuncture that contribute to the understanding of motives leading physicians to learn about or specialize in acupuncture. We interviewed 175 physicians from the Course in Chinese Medicine and Acupuncture administered by the Research Center on Chinese Medicine at the School of Medicine of the Federal University in São Paulo (UNIFESP/EPM), using questionnaires consisting of open and closed questions. The resulting data were submitted to statistical analysis, and the answers were analyzed using the content analysis technique, seeking to unveil units of meaning. This process ena bled establishing general and specific categories that lent meaning to the discourses. Three categorical groups were obtained: "professional enhancement", "expanding one's life horizons", and "understan ding the patient in a more comprehensive dimension". Our data also showed that physicians wish to integrate acupuncture with their practice of conventional medicine, within which acupuncture has been consolidated as a medical specialty.