Knowledge, attitude, and practice regarding COVID-19 skin manifestations among doctors working at Khartoum dermatology and venereology teaching Hospital, 2021

Background: COVID-19 is a global pandemic caused by SARS_COV2. The symptoms of covid-19 include: fever, dyspnea, fatigue, a recent loss of smell and taste, sore throat, cough, and cutaneous lesions. In addition, some skin manifestations were reported to be associated with COVID-19. Methods: The study design is a descriptive cross-sectional hospital-based study. The study aimed to evaluate the level of knowledge and practice about skin manifestations of COVID-19 among doctors working at Khartoum dermatology and venereology teaching hospital. A self-administrated questionnaire was used for data collection after an informed consent was taken. Results: Among 140 doctors working in the dermatology and venereology teaching hospital, 75.7% of the doctors had knowledge that COVID-19 can present with skin manifestations. The study results showed that about half of the participants have poor knowledge about COVID-19 skin manifestations while 25% have no knowledge, and that 35 (25%) doctors have good knowledge. From a total of 140 doctors; 46.4% reported that when patients present with COVID-19 skin lesions, they will isolate them in separate rooms and call the epidemiology center, whereas, 61 doctors (43.6%) did not know if they have a protocol for COVID-19 suspected cases. This study reported a significant association between job category and level of knowledge toward COVID-19 skin manifestations measured by Chi-square test, the P-value was 0.003 (significant at 0.05), and the same significant association was found between the year of rotation and knowledge. Conclusion: Half of the doctors covered by this study had poor knowledge about COVID-19 skin manifestations, and therefore, educating doctors in dermatology hospitals about skin manifestations of COVID-19 is recommended, besides clear and precise guidelines and protocols for diagnosis and management.

Evolución y desafíos en la formación médica de posgrado en Brasil / Evolution and challenges in postgraduate medical training in Brazil

La especialización médica es un gran desafío porque necesita preparar un profesional recién egresado en el especialista que la po-blación quiere y necesita para asegurar mejores condiciones de atención a la salud. La construcción de un sistema para la capacitación de estos profesionales es un gran desafío dada la característica de la formación en servicio, es decir, los profesionales en formación trabajan directamente en la asistencia, dependiendo de instalaciones adecuadas, aparatos, tutores médicos y un programa teórico que garantice el desarrollo del aprendizaje según los parámetros técnicos más actuales. Un desafío adicional es la cantidad y diversidad de instituciones involucradas, desde hospitales universitarios con tradición docente hasta hospitales privados donde el desempeño se limita a la prestación de servicios. En este artículo, buscamos mostrar la trayectoria de la construcción de este sistema en Brasil, que desde hace cerca de 40 años se ha mejorado y ampliado ante la creciente demanda de atención de calidad por parte de la población.

Medical specialization is a challenge because it needs to prepare a newly graduated professional as the specialist that the population wants to ensure better conditions in health care. The construction of a system for training these professionals is a challenging given the characteristic of in-service training where professionals work directly with patients, depending on adequate facilities, equipment, medical tutors, and theoretical programs that guarantee the development of learning within the most current technical parameters. An additional challenge is the number and diversity of institutions involved, including university hospitals that have a tradition of teaching and private hospitals where the performance is based on practice. We seek to show in this article the trajectory of the construction of this system in Brazil, which for about 40 years has been improving and expanding to fulfill the population ́s growing demand for quality care.

Reforma da Atenção Hospitalar para modelo de saúde baseada em valor e especialidades multifocais / Remodeling hospital care - an account of experiences in the Federal District of Brazil

Resumo A saúde pública em Brasília sofreu diversas melhorias desde sua implementação devido à mudança do perfil econômico, social e de escolaridade da população. Foi realizada uma reforma na Atenção Hospitalar por gestão baseada em evidências, através de um conjunto normativo que estabeleceu o ordenamento dos Serviços Hospitalares de Emergência, Atenção Ambulatorial Secundária, Regulação de Serviços de Saúde e modelagem organizacional da Secretária de Saúde do Distrito Federal. Tais mudanças permitiram que os profissionais nos seus diferentes níveis de atenção estejam interligados. Ou seja, os profissionais passam a prestar um serviço de saúde de forma contínua para a população, proporcionando um cuidado de saúde integral ao paciente. Essa abordagem garante ganho de eficiência no tratamento do paciente, pois os profissionais multifocais e focais trabalham de maneira integrada. Com a implementação da gestão da organização por processos de trabalho e o planejamento adequado, foi possível redesenhar o modelo assistencial utilizado nos dias atuais, permitindo através da gestão do conhecimento a ampliação do acesso e da interatividade, proporcionado ao cidadão através do modelo de gestão em saúde que agregue valor.

Abstract Since its creation in 1988, major changes have been made to Brazil's public health system in response to the epidemiological transition and the country's changing economic context and demographics. This article describes the recent healthcare reform implemented in the federal district's public hospital system. Guided by evidence-based management and a series of regulatory instruments, the reform organized hospital emergency services and secondary outpatient care, regulated health services, and remodeled the organizational structure of the Department of Health. These changes were aimed at promoting integration between health professionals across different levels of care and ensuring the provision of continuing comprehensive care. This approach guarantees efficiency gains in patient treatment, since multifocal and focal professionals work in an integrated manner. By reorganizing work processes and ensuring adequate planning, it was possible to redesign the care model to promote knowledge management and improve access to information and interactivity, thus helping to ensure the provision of quality, value-added care.

Formación elegida por médicos que aprobaron el examen único de residencias y no accedieron al cargo / Training chosen by physicians who passed the single examination for medical residency and did not occupy the position

INTRODUCCIÓN: se observa una tendencia creciente a no cubrir los cargos de residencias médicas ofrecidas en el Examen Único (EU) del Ministerio de Salud de la Nación para ciertas especialidades y regiones del país. Se desconocen las opcionesformativas que adoptan quienes deciden no acceder al cargo. OBJETIVOS: Indagar y describir las alternativas de formación elegidaspor médicos que, tras haber aprobado el EU en 2013, no asumen un cargo y determinar sus motivaciones, expectativas y representacionesen torno a la formación en residencias. MÉTODOS: Se diseñó un estudio cuanti-cualitativo. Inicialmente se efectuó un estudio de corte transversal, aplicando un cuestionario cerrado a una muestraintencional integrada por postulantes de las provincias de Santa Fe, Neuquén, Salta y San Juan. Luego se realizó un estudio cualitativo mediante entrevistas semiestructuradas, que abordaron los motivos de la decisión. RESULTADOS: Las razones que llevaron a rechazar el cargo fueron una opción formativa diferente a la obtenida en el EU (58%), así como otras expectativas respecto del estilo de vida (28%) y sobre la calidad de la formación y la salida laboral (14%). Al elegir el lugar para formarse, priorizaron el prestigio de la institución y la cercanía con sus vínculos afectivos. CONCLUSIONES: La residencia es la opción preferida para la especialización médica. Dada laoferta suficiente de cargos, el desafío radica en hacer confluir las expectativas personales con las necesidades sanitarias.

INTRODUCTION: there is an increasing trend not to accept the medical residency positions offered by the Single Examination of the Argentine Ministry of Health for certain specialtiesand regions of the country. It is unknown which training options arechosen by those who do not accept such positions. OBJECTIVES: To recognize the alternatives of training chosen by physicians who, after having passed the Single Examination in 2013, decided not to accept the position, determining their motivations, expectations and representations regarding residency training. METHODS: A qualitative-quantitative design was used. Initially, a cross-sectional study was performed, applying a closed questionnaire to anintentional sample composed by applicants from the provinces of Santa Fe, Neuquén, Salta and San Juan. That was followed by a qualitative study through semi-structured interviews, which looked at the reasons of the decision. RESULTS: The positions were rejected due to: training option different from the one obtained by the Single Examination (58%) as well as other expectations regarding lifestyle(28%) and quality of training and job prospects (14%). The training place was chosen considering, above all, the institutional reputation and being close to beloved people. CONCLUSIONS: The medical residency is the preferred option for medical specialization. Giventhat enough jobs are offered, the challenge is how to bring togetherpersonal expectations and sanitary needs.

A Multicenter Study Investigating Empathy and Burnout Characteristics in Medical Residents with Various Specialties

We assessed empathy in medical residents, including factors modifying empathy and the relationship between empathy and burnout. Participants (n = 317 residents, response rate = 42%) from 4 university hospitals completed a socio-demographic questionnaire, the Jefferson Scale of Empathy (Health Professional version, Korean edition), and the Maslach Burnout Inventory (MBI). Participants were classified by medical specialty: “people-oriented specialty” (POS group) or “technology-oriented specialty” (TOS group), with more women in the POS than in the TOS group, χ2 = 14.12, P < 0.001. Being female, married, and having children were factors related to higher empathy (gender, t = -2.129, P = 0.034; marriage, t = -2.078, P = 0.038; children, t = 2.86, P = 0.005). Within specialty group, POS residents showed higher empathy scores in the fourth as compared to the first year, F = 3.166, P = 0.026. Comparing POS and TOS groups by year, fourth year POS residents had significantly higher scores than did fourth year TOS residents, t = 3.349, P = 0.002. There were negative correlations between empathy scores and 2 MBI subscales, emotional exhaustion (EE) and depersonalization (DP). Additionally, first year POS residents had higher DP scores than did first year TOS residents, t = 2.183, P = 0.031. We suggest that factors important for empathy are type of medical specialty, marriage, siblings, and children. Burnout state may be related to decreasing empathy.