Um programa de mentoria para estudantes de Medicina de uma universidade do Centro-Oeste brasileiro / A mentoring program for medicine students at a University inthe Midwest of Brazil

Resumo: Introdução: Neste artigo, fazemos um relato de experiência da implantação e do funcionamento de um programa de mentoria aplicado a estudantes de graduação do curso de Medicina de uma universidade do Centro-Oeste brasileiro. É consenso que a pressão dos cursos de Medicina provoca sobrecarga emocional e afeta negativamente os estudantes, e é preciso que medidas de apoio sejam implementadas. Relato de experiência: O programa de mentoria da Faculdade de Medicina da Universidade Federal de Goiás teve um processo de construção lógico. Foi criado no início de 2015, pelo reconhecimento da necessidade da instituição em apoiar os acadêmicos durante sua graduação, fato evidenciado a partir do atendimento psicológico ao aluno e de uma pesquisa in loco. Os seguintes aspectos-chave caracterizam o programa: é oferecido como uma disciplina eletiva, pode ser feito até cinco vezes e,além de um encontro mensal com o mentor, o estudante escolhe as oficinas de que deseja participar, diversificando assim sua formação. Após 12 semestres de funcionamento, sintetizamos neste artigo uma parte de nossos resultados e algumas reflexões sobre o que queremos para o futuro do programa. Discussão: A implementação da mentoria e suas adequações foram resultados de pesquisa, capacitação, discussões dos docentes e avaliação periódica pelos mentorados. As mudanças procuraram atender às expectativas e sugestões dos estudantes, objetivando atrair a atenção e satisfazer aos anseios dos discentes. Ao longo dos 12 semestres de funcionamento do programa, o interesse dos alunos pela matrícula na disciplina cresceu, com forte avaliação positiva, especialmente pela livre escolha e diversidade de oficinas, e pelo envolvimento do tutor. Conclusão: As instituições de ensino devem estimular a criação de programas de mentoria. O programa relatado neste artigo tem tido boa aceitação por parte dos alunos e nos aponta bons resultados.

Abstract: Introduction: This article reports on the experience of implementing and running a mentoring program for medical school students at a Brazilian university in the Midwest region. It is widely accepted that the pressure at medical school is detrimental to the students and often leads to emotional overload. Therefore, supporting mechanisms must be implemented. Experience report: The mentoring program at the Federal University of Goiás had a logical beginning. It was created in early 2015, after psychotherapy services offered to the students led to an in loco research study, which in turn pointed out the need to provide support to students throughout their undergraduate studies. There are some key characteristic aspects of the program: it's an elective course, which can be taken up to 5 times, and the students can choose the workshops they want to attend in addition to the monthly meeting with the mentor, which allows for diverse paths to be followed. After twelve semesters in existence, this article presents a summary of some of the results obtained and reflections on the future of this program. Discussion: The implementation of the program and its adaptations resulted from research, professional development, discussions among professors and regular assessments by the mentees. Changes were made according to the expectations and suggestions of participating students, aiming to effectively meet their needs and represent a desirable course. Since its inception, the program has attracted increasingly more students, and enjoyed a strong positive evaluation, mainly due to the various workshops to choose from and engagement with the mentor. Conclusion: Universities should support the creation of such mentoring programs. The program discussed in this article has been well received and points towards positive outcomes.

Surgery course load in Brazilian medical schools / Carga horária de cirurgia em escolas médicas do Brasil

Abstract: Introduction: Surgery is an important curricular component of undergraduate medical courses. This study was conducted because the surgery course load in Brazilian medical has not been systematically explored at the national level. Objective: To analyze the surgery course load in Brazilian medical schools. Method: A cross-sectional, descriptive study was carried out with Brazilian medical schools acknowledged by the Ministry of Education, which had begun their activities prior to December 31, 2017 and, as of September 2018, had their curriculum matrix and/or political-pedagogical project with the surgery course load available on the internet. The variables studied were total medical curriculum course load and surgery course load before and during clerkship, as well as the schools' geographic region and fee status. Data analysis was performed using descriptive statistic Student t-test, analysis of variance, and Mann-Whitney U and Kruskal-Wallis tests, with the null hypothesis rejected for p < .05. Results: The study included 205 of the country's 323 existing medical schools, of which 175 had available information on the surgery course load during the clerkship, 157 before the clerkship, and 129 had information on course load before and after the clerkship. The median total surgery course load in hours was 815.0 (P25 - 75 = 677.5 - 992.0; minimum = 340.0 h; maximum =1,665.0), while the mean surgery course load before clerkship in hours was 268.7 (SD = 140.3; minimum = 32.0; maximum = 780.0), with no difference between geographic regions or fee status. During the clerkship, the median course load was 540.0 hours (P25 - 75 = 400.0 - 712.0; minimum = 170.0 h; maximum = 1,410.0), with no difference between geographic regions, but with higher values in medical schools with no tuition fees. Regarding the total curriculum course load, the mean percentage of the surgery course load before clerkship was 3.2% (SD = 1.7), the median percentage during the clerkship was 6.4% (P25 - 75 = 5.0 - 8.2), the median percentage of the total surgery course load was 6.4% (P25 - 75 = 5.0 - 8.2%, and the median percentage of surgery course load (both periods) was 9.7% (P25 - 75 = 8.3 - 11.8%). Conclusions: Despite the considerable variation in the surgery course load limits, the median of total surgery and the mean of surgery course load before clerkship were similar across geographic regions and fee statuses. The median surgery course load during clerkship was also similar across regions but higher in tuition-free medical schools. The values found in this study can help schools' administrators to assess and plan the surgery course load in their institutions.

Resumo: Introdução: A cirurgia é um importante componente dos currículos dos cursos de graduação em Medicina. Este estudo foi realizado por não se conhecer a carga horária de cirurgia nas escolas médicas brasileiras. Objetivo: Analisar a carga horária de cirurgia de escolas médicas brasileiras. Método: Este estudo foi transversal e descritivo, realizado em escolas médicas brasileiras reconhecidas pelo Ministério da Educação que iniciaram atividades até 31 de dezembro de 2017 e disponibilizavam matriz curricular e/ou projeto político-pedagógico com carga horária de cirurgia na internet até setembro de 2018. As variáveis estudadas foram carga horária total e de cirurgia antes do internato e durante esse período, região geográfica e gratuidade das escolas. Os dados foram analisados por meio de estatística descritiva, teste t de Student, análise de variância e testes U de Mann-Whitney e de Kruskal-Wallis, rejeitando-se a hipótese nula quando p < 0,05. Resultados: Foram incluídas 205 das 323 escolas médicas existentes, das quais 175 disponibilizavam carga horária de cirurgia no internato; 157, antes do internato; e 129, disponibilizavam ambas as cargas horárias. A mediana da carga horária total de cirurgia foi de 815,0 horas (P25 - 75 = 677,5 - 992,0; limites: 340,0 - 1.665,0 horas), e a carga horária média antes do internato foi de 268,7 horas (desvio padrão = 140,3; limites: 32,0 - 780,0), ambas sem diferença estatística por região geográfica ou gratuidade da escola. A mediana da carga horária do internato foi de 540,0 horas (P25 - 75 = 400,0 - 712,0; limites: 170,0 - 1.410,0), sem diferença estatística por região geográfica, mas maior nas escolas gratuitas. Em relação à carga horária total do currículo do curso, a porcentagem média da carga horária de cirurgia antes do internato foi 3,2% (desvio padrão = 1,7); a porcentagem mediana da carga horária de cirurgia no internato, 6,4% (P25 - 75 = 5,0 - 8,2); e a porcentagem mediana da carga horária de ambos os períodos foi de, 9,7% (P25 - 75 = 8,3 - 11,8). Conclusões: Apesar da variação nos limites extremos da carga horária de cirurgia, a mediana de seu total e sua média antes do internato são semelhantes por região geográfica e gratuidade da escola, e sua mediana no internato é também semelhante por região, mas maior em escolas médicas gratuitas. Os valores encontrados neste estudo podem ajudar os gestores na avaliação e no planejamento da carga horária de cirurgia em suas escolas.

Statistics for N = 1: a non-parametric Bayesian approach / Estatística para N = 1: uma abordagem Bayesiana não paramétrica

Research in education is often associated with comparing group averages and linear relations in sufficiently large samples and evidence-based practice is about using the outcomes of that research in the practice of education. However, there are questions that are important for the practice of education that cannot really be addressed by comparisons of group averages and linear relations, no matter how large the samples. Besides, different types of constraints including logistic, financial, and ethical ones may make larger-sample research unfeasible or at least questionable. What has remained less known in many fields is that there are study designs and statistical methods for research involving small samples or even individuals that allow us to address questions of importance for the practice of education. This article discusses one type of such situations and provides a simple coherent statistical approach that provides point and interval estimates of differences of interest regardless of the type of the outcome variable and that is of use in other types of studies involving large samples, small samples, and single individuals.

A pesquisa em educação é frequentemente associada à comparação de médias de grupo e relações lineares em amostras suficientemente grandes, e a prática baseada em evidências trata do uso dos resultados dessa pesquisa na prática educacional. No entanto, há questões importantes para a prática da educação que não podem ser realmente abordadas por comparações de médias de grupo e relações lineares, por maiores que sejam as amostras. Além disso, diferentes tipos de restrições, incluindo as logísticas, financeiras e éticas, podem tornar a pesquisa com amostras maiores inviável ou, pelo menos, questionável. O que tem ficado menos conhecido em muitos campos é que existem desenhos de estudos e métodos estatísticos para pesquisas envolvendo pequenas amostras ou mesmo indivíduos que nos permitem abordar questões de importância para a prática da educação. Este artigo discute um tipo de tais situações e fornece uma abordagem estatística coerente simples que fornece estimativas de ponto e intervalo de diferenças de interesse, independentemente do tipo de variável de resultado e que é útil em outros tipos de estudos envolvendo grandes amostras, pequenas amostras, e indivíduos solteiros.

Avaliação da Síndrome de Burnout entre estudantes do último ano de um curso de medicina do Brasil / Evaluation of Burnout Syndrome in senior students from a brazilian medical school

Introdução: Estudantes de medicina estão cada vez mais suscetíveis ao desenvolvimento de agravos relacionados à saúde mental. Um importante agravo que deve ser investigado durante a formação médica é a Síndrome de Burnout. Sintomas próprios da síndrome, como a exaustão emocional, muita das vezes não são reconhecidos com tal, podendo agravar o quadro já instalado no estudante. Objetivo:Avaliar a ocorrência da Síndrome de Burnout no período de formação profissional dos graduandos do último ano de um curso de medicina. Casuística e Métodos: Trata-se de um estudo transversal analítico com abordagem quantitativa realizada por meio de questionário sociodemográfico e pelo Instrumento de avaliação de Burnout "Maslach Burnout Inventory for students (MBI-SS)", aplicados aos acadêmicos do último ano de um curso de medicina da cidade de Goiânia, Goiás, Brasil. Foi confeccionado um banco de dados, sendo realizadas análises descritivas, teste t de Student e o teste de análise de variância (ANOVA). Resultados: Foram pesquisados 81 estudantes do último ano do curso de medicina, sendo 42% do sexo masculino e 58% do sexo feminino. Um total de 67,9% tinha idade entre 21 e 25 anos, eram solteiros (95,1%), com baixo envolvimento religioso (38,3%) e praticavam atividade física regularmente (71,6%). Os escores da escala MBI-SS foram respectivamente: exaustão emocional (4,21±1,063), descrença (3,02±1,402) e satisfação pessoal (4,28±0,885). As análises demonstraram que aqueles que participaram de iniciação científica tiveram uma melhor satisfação pessoal (4,73±0,78) e menor escore em relação à descrença (3,43±1,27). Aqueles que tiveram experiência de doença grave pessoal apresentaram escore mais alto em exaustão (4,50±0,71). Conclusão: Os alunos pesquisados não apresentaram escores que indicam a ocorrência da Síndrome de Burnout. Os escores apresentaram-se moderados em exaustão emocional e descrença, mas altos em satisfação pessoal, não caracterizando assim a síndrome neste grupo de alunos. Diante da relevância dos resultados apresentados, é importante que as instituições de ensino voltem sua atenção à questão da prevalência da Síndrome de Burnout em acadêmicos de medicina.

Introduction: Medical students are increasingly susceptible to the development of mental health problems. An important issue that must be investigated during medical training is Burnout Syndrome. Symptoms typical of the syndrome, such as emotional exhaustion, are often not recognized with such, and may aggravate the picture already installed in the student. Objective: To evaluate the Burnout Syndrome occurrence in the final-year medical undergraduate students during their period of professional training. Patients and Methods: This is a cross-sectional, analytical study with a quantitative approach using a sociodemographic questionnaire and the Burnout Assessment Instrument "Maslach Burnout Inventory for students (MBI-SS)", applied to the final-year medical undergraduate students in the city of Goiânia, Goiás, Brazil. A database was prepared, descriptive analyzes, Student's t-test and analysis of variance (ANOVA) were performed. Results: Study sample was composed of 81 final-year medical undergraduate students, 42% male and 58% female. Age of the interviewed students ranged from 21 to 25 years (67.9%), 95.1% were single, 38.3% had low religious involvement, and 71.6% were engaged in regular physical activity. MBI-SS scores were: emotional exhaustion (4.21 ± 1.063), disbelief (3.02 ± 1.402), and personal satisfaction (4.28 ± 0.885). The analyzes showed that students who participated in scientific initiation had a better personal satisfaction (4.73 ± 0.78) and a lower score about disbelief (3.43 ± 1.27). Students who had experience of severe personal disease had a higher score on exhaustion (4.50 ± 0.71). Conclusion: The students did not present scores indicating the burnout syndrome occurrence. The scores were moderated in Emotional Exhaustion and Disbelief, but high in Personal Satisfaction. Thus, we could not characterize the syndrome in this group of students. Given the relevance of the presented results, it is important that the institutions of education turn their attention to the question of the prevalence of the Burnout Syndrome among medical students.

Treinamento teórico-prático de equipe multidisciplinar para atendimento de parada cardiorrespiratória em enfermaria / Theoretical and practical training of multidisciplinary team for cardiac arrest care in a ward

Objetivo: Avaliar se o treinamento teórico-prático integrado de médicos e enfermeiros traz melhorias ao atendimento no caso de parada cardiorrespiratória em enfermaria. Métodos: Trata-se de estudo prospectivo quase-experimental por meio da análise de questionários pré e pós-capacitação. Os participantes foram médicos, enfermeiros e técnicos de enfermagem que atuavam nas alas de enfermaria de um hospital em Belo Horizonte (MG), submetidos a um questionário pré-curso. Em seguida, eles participaram do curso de capacitação. Após o treinamento, foi respondido novo questionário. Os resultados pré e pós-curso foram comparados. Resultados: Nas questões objetivas, houve aumento de acertos no questionário pré-capacitação de 68,1% para 85,6% no questionário pós-capacitação, com diferença estatística significante (p<0,001). Nas questões subjetivas, também houve aumento de acertos de respostas positivas no questionário pré-capacitação de 45,3% para 73,3% na pós-capacitação, com diferença estatística significante (p<0,001). Conclusão: Ao se compararem os dois questionários, constataram-se mudanças estatisticamente significantes nas respostas dos participantes após a capacitação, o que reflete o potencial de melhoria no atendimento à parada cardiorrespiratória na enfermaria do hospital avaliado. (AU)

Objective: To evaluate whether an integrated theoretical -practical training of physicians and nurses improves medical care of cardiac arrest at an inpatient ward. Methods: This is a prospective quasi-experimental study through the analysis of pre- and post-training questionnaires. Participants included physicians, nurses, and nursing technicians who worked in the inpatient wards of a hospital in the city of Belo Horizonte, state of Minas Gerais. They responded a pre-training questionnaire. Afterwards, they participated in training course. Following training, they answered a new questionnaire. Pre- and post-training results were compared. Results: In the multiple-choice questions. the correct answers improved from 68.1% in the pre-qualification questionnaire to 85.6% in the post-qualification questionnaire, with a statistically significant difference (p<0.001). in the subjective questions, there was also an improvement of positive answers from 45.3% in the pre-qualification questionnaire to 73.3% in post-qualification questionnaire, with a statistically significant difference (p<0.001). Conclusion: When comparing the two questionnaires, statistically significant changes were observed in participants' responses after the training, reflecting improvement potential in care for cardiorespiratory arrest in the ward of the hospital evaluated. (AU)

Aspectos psicológicos e qualidade de vida na Residência Médica / Psychological aspects and quality of life in Medical Residency

RESUMO Objetivo: avaliar a percepção de qualidade de vida entre residentes no primeiro ano de Residência Médica em relação aos residentes de outros anos, dada a importância dessa questão na saúde. Métodos: estudo comparativo, transversal e analítico realizado no período de fevereiro a abril de 2016, realizado em um hospital de trauma terciário de referência do Brasil. Médicos residentes foram submetidos voluntariamente ao questionário validado da Organização Mundial de Saúde (OMS) sobre qualidade de vida, o WHOQOL-BREF, com preenchimento online. Os residentes foram divididos em dois grupos: primeiro ano de residência (R1) e outros anos de residência. Resultados: noventa e sete residentes de diversas especialidades médicas responderam ao questionário. Desses, 59 eram homens e 38, mulheres. A média de idade foi de 27,7 anos. Residentes do primeiro ano representaram 49,5% dos entrevistados. A qualidade de vida de maneira global foi considerada regular em ambos os grupos. Em relação ao domínio psicológico, houve diferença significativa entre o R1 (este, com piores escores neste domínio) e os demais anos de residência (p<0,0000001). Conclusão: a qualidade de vida dos residentes do primeiro ano é pior em relação aos demais, tendo uma variação significativa de sentimento positivo, capacidade de aprender, memória, pensamento e concentração, autoestima, imagem corporal e aparência e sentimentos negativos em relação aos médicos residentes dos outros anos.

ABSTRACT Objective: to evaluate the perception of quality of life among residents in the first year of Medical Residency compared to the one among residents in other years of training, given the importance of this issue in health. Methods: a comparative and cross-sectional analytical study performed from February to April 2016 in a reference tertiary trauma hospital in Brazil. Resident physicians were voluntarily submitted to an online questionnaire on quality of life (called WHOQOL-BREF), validated by World Health Organization (WHO). They were divided into two groups: first year of residency (R1) and other years of residency. Results: ninety-seven residents of several medical specialties answered the questionnaire. Of these, 59 were men and 38 were women. The mean age was 27.7 years. First-year residents accounted for 49.5% of the interviewees. Overall, quality of life was considered regular in both groups. In relation to psychological domain, there was a significant difference between the R1 group (with worse scores in this domain) and the non-R1 group (p<0.0000001). Conclusion: first-year residents' quality of life is worse than the one of the residents from other years, having a significant variation of positive feelings, learning capacity, memory, thought and concentration, self-esteem, body image and appearance, and negative feelings.

Brazilian More Doctors Program: assessing the implementation of the Education Axis from 2013 to 2015 / Programa Mais Médicos: avaliando a implantação do Eixo Formação de 2013 a 2015 / Programa Más Médicos: evaluación de la implantación del Eje Formación de 2013 a 2015

Abstract The More Doctors Program (PMM) was created in 2013. Guided by social needs, it set a new regulatory framework for medical education and residency in Brazil. This study is based on public policies and their actions aimed at implementing changes in medical education in PMM, as well as their results until 2015, by analyzing documents from official sources and the literature. The following results were identified: decrease in regional inequalities in the distribution of undergraduate course seats; education internalization; increase in medical residency seats specialized in Family and Community Medicine; expansion of preceptorship qualification; and creation of the National Registration of Specialists. The challenges faced by PMM to effectively achieve its goals, the need for State commitment and the current threats to this vital dimension of the program (ensure the right to health) are pointed out.(AU)

Resumo O Programa Mais Médicos (PMM), criado em 2013, estabeleceu novo marco regulatório para a graduação médica e a residência médica no Brasil, tendo a necessidade social como orientadora do processo. A presente reflexão pauta as políticas públicas e suas ações direcionadas à implementação de mudanças na formação médica no PMM e seus resultados até 2015, por meio de análise documental de fontes oficiais e literatura. Identificou-se: redução nas desigualdades regionais na distribuição de vagas de graduação; interiorização da formação; expansão de vagas de residência médica com enfoque na medicina de família e comunidade; expansão da qualificação da preceptoria; e criação do Cadastro Nacional de Especialistas. São apontados desafios enfrentados pelo PMM para alcançar efetivamente seus objetivos, a necessidade de comprometimento do Estado e as atuais ameaças a essa dimensão vital do programa, que busca a garantia do direito à saúde.(AU)

Resumen El Programa Más Médicos fue creado en 2013 y estableció un nuevo marco regulador para la formación y residencia médica en Brasil. En este artículo se han realizado análisis documentales, análisis de bases de datos oficiales y revisión de literatura, buscando estudiar los cambios en la formación médica y sus resultados hasta 2015. Se han identificado avances importantes en la distribución de plazas de graduación entre las diferentes regiones del país; en la interiorización de la formación; en la creación de cursos de medicina que sigan la regulación estatal; en la regulación de las plazas de residencia médica con enfoque en medicina de familia y comunidad; en la cualificación de la preceptoría; y en la creación del Catastro Nacional de Especialistas. En la conclusión se señalan los desafíos que ha enfrentado para alcanzar efectivamente sus objetivos.(AU)

Los desafíos en la formación de los futuros médicos / Challenges in the training of future doctors

En este artículo, el autor reflexiona sobre sobre el presente y el futuro de la educación médica en el contexto de las tecnologías de la información y de la convivencia de nuestro trabajo con los dispositivos de inteligencia artificial, de los nuevos contenidos de genética y neurociencias, del trabajo en equipo y de la necesaria resignifificación de los términos "cura" y "cuidado". Se pregunta además si estamos en condiciones de encarar dicho desafío y de estar a la altura de las necesidades educativas de las próximas (y la actual) generación/es de médicos. (AU)

In this article, the author reflects on the present and the future of medical education in the context of information technologies and the coexistence of our work with artificial intelligence devices, the new contents of genetics and neurosciences, about team work and the necessary resignification of the terms "cure" and "care". He also wonders if we are able to face this challenge and to deal with the educational needs of the next (and the current) generation/s of doctors. (AU)

¿Cuál es la relación entre el síndrome de burnout, el sentido de la vida y el proyecto de vida laboral en los médicos residentes?: una perspectiva logoterapéutica / What is the relationship between burnout syndrome, the meaning of life and the project of working life in resident physicians ?: a logotherapeutic perspective

Introducción: el síndrome de burnout (BO) suele afectar a médicos residentes, debido al estrés laboral crónico. Desde un marco logoterapéutico, la pérdida de un sentido de la vida (SV) es el denominador más común de todas las formas de perturbación emocional, y el BO podría enmarcarse dentro de un proyecto de vida laboral (PVL) con enrolamiento enajenante. El objetivo principal del trabajo es evaluar la relación entre el BO, el SV y el PVL, en los programas de residencia del Hospital Italiano de Buenos Aires. Población y métodos: se evaluaron residentes de 6 programas de residencia del Hospital Italiano de Buenos Aires, a través de un cuestionario. El BO se midió con el "Maslach Burnout Inventory" (MBI). El SV se midió con el "Purpose in Life Test" (PIL Test). El PVL se midió con la Escala de PVL de la Dra. Isabel Pérez Jáuregui. Resultados: participaron 104 residentes. El 28,8% de los evaluados mostraron BO, el 18,3% falta de SV y el 30,8% un PVL inauténtico con sobreadaptación. Tanto la falta de SV como el PVL inauténtico con sobreadaptación se asociaron en forma estadísticamente significativa con BO (p < 0,01), y la presencia de cualquiera de estas alteraciones aumentó en casi 18 veces (odds ratio [OR] crudo) la probabilidad de presentar el síndrome. Los OR ajustados de falta de SV (6,28) y PVL inauténtico (9,57) para la presencia de BO continuaron siendo estadísticamente significativos. Por último, en esta investigación pudimos determinar que las subescalas del MBI agotamiento y despersonalización se correlacionaron negativamente con el PIL Test (r=-0,41 y r=-0,53, respectivamente) y la Escala de PVL (r=-0,45 y r=-0,42, respectivamente), mientras que la subescala de realización se correlacionó positivamente en forma significativa con estas dos últimas (r=0,63 y r=0,61, respectivamente). Conclusiones: se encontró una relación estadísticamente significativa entre BO, falta de SV y PVL inauténtico, en la residencia. (AU)

Introduction: The Burnout Syndrome (BO) usually affects medical residents because they are exposed to chronic labour stress. From a logotherapeutic view, the loss of meaning and purpose in life (ML) is the common denominator of all types of emotional distress, and the BO could belong to an altered labour life project (LLP) with overadaptation. The objective of this study was to evaluate the relationship between the BO, the ML, and the LLP, in residency programs at a university hospital. Population and methods: residents from six programs at Hospital Italiano de Buenos Aires were evaluated. The BO was measured with the Maslach Burnout Inventory (MBI). The ML was measured with the Purpose in Life Test (Pil Test). The LLP was measured with the LLP Scale created by Doctor Isabel Pérez Jáuregui. Results: one hundred and four residents participated. Out of the evaluated residentes, 28.8% showed BO. The loss of ML was observed in 18.3%, and an altered LLP with overadaptation affected the 30.8% of the sample. Loss of ML and altered LLP with overadaptation were associated in a statistically significant way with BO (p<0.01), and the presence of any of this alterations increased the odds ratio almost 18 times to suffer BO. The adjusted odds ratio of loss of ML (6.28) and altered LLP (9.57) to suffer BO, were also statistically significant. Finally, a negative correlation was observed between exhaustion and despersonalization (MBI) and the Pil Test (r=-0.41 and r=-0.53, respectively) and the LLP Scale (r=-0.45 and r=-0.42, respectively), while a positive significant correlation was observed between the personal accomplishment (MBI) and the Pil Test and LLP Scale (r=0.63 and r=0.61, respectively). Conclusions: in the residency, we found a statistically significant relationship between BO, loss of ML and altered LLP. (AU)

Apreciación de los médicos residentes acerca de la supervisión de sus tareas por médicos mayores / Appreciation of resident doctors about the supervision of their tasks by senior doctors

Introducción. La educación en residencias médicas, tiene como objetivo el desarrollo de competencias. Para que esto ocurra los tutores deben reflexionar sobre su propia actividad docente. El objetivo de este trabajo es conocer qué piensan los residentes del Servicio de Obstetricia del Hospital Italiano de Buenos Aires (HIBA) respecto de la supervisión que reciben. Material y métodos. Se realizó un cuestionario abierto no estandarizado sobre aspectos relevantes de la supervisión de los residentes. Las preguntas se enfocaron en la supervisión en general que reciben. Resultados. Se analizaron 14 cuestionarios. La supervisión en general, (11/14) fue considerada "adecuada", (refiriéndose a la posibilidad de consulta, supervisión constante en cirugías y buen clima de aprendizaje). Observaron falencias en la supervisión en guardia (5/14). Perciben un buen equilibrio entre autonomía alcanzada y la posibilidad de consulta. Sobre las devoluciones, todos consideran que deben ser oportunas (cercanas a la situación que está siendo evaluada), y destacan que no siempre es así (6/14). Las evaluaciones formativas son consideradas suficientes para valorar el desempeño de los residentes (8/14). La mayoría (9/14) proponen actividades de simulación y talleres de casos clínicos y temas básicos de obstetricia (5/14). Comentarios. La realización de este cuestionario permitió conocer la opinión de los residentes sobre aspectos relevantes de la enseñanza clínica y de la supervisión que reciben. Los resultados muestran que la supervisión en general ha sido considerada como positiva y que existe un buen clima de aprendizaje. (AU)

Introduction. The ultimate goal of medical education during residency is skill development. In order for this to occur, tutors must often reflect on their own teaching activity and experiences. The aim of this study was to evaluate how the residents of the Obstetrics Department of the Hospital Italiano of Buenos Aires (HIBA) perceive the supervision they receive from their elder staff. Materials and Methods. We developed an open non-standardized questionnaire detailing relevant aspects of resident supervision. The questions were specifically oriented towards the global aspects of the supervision process. Results. Fourteen questionnaires were analyzed. In general, 11 out of 14 described their supervision as "adequate" in terms of availability of advisory and consultation opportunities, constant supervision during surgical procedures and an encouraging learning environment. Several weaknesses were observed regarding supervision during active call duty (5/14). In general, a favorable balance is noted between resident autonomy and senior availability for consult. With regards to feedback, they all concur in saying that timing is key (ideally feedback should be offered in close proximity to the activity that is being supervised) and point out that this is not always the case (6/14). Formative assessments are globally considered adequate for resident evaluation (8/14). Most surveys suggest use of simulation activities and clinical case workshops regarding basic obstetric practice scenarios (9/14). Comments. The development of this questionnaire has given us great insight towards our residents' thoughts regarding clinical teaching and supervision. Results show that supervision is in general regarded as a positive experience and the learning environment is perceived as pleasant and nurturing. (AU)

Sistema de tareas docentes interdisciplinarias para contribuir al aprendizaje de los métodos estadísticos / System of interdisciplinary educational tasks to contribute to the learning of the statistical methods

Fundamento: El desempeño profesional de excelencia requiere, en gran medida, la práctica de la medicina basada en evidencias, así como egresar desde la enseñanza superior, personal de salud capaz de utilizar la estadística en la investigación científica como herramienta que permita elevar la calidad del proceso. Objetivo: Proponer un sistema de tareas docentes interdisciplinarias para contribuir al aprendizaje de métodos estadísticos en las investigaciones, actuando como consumidor y reproductor de información biomédica. Metodología: Investigación pedagógica realizada en la Filial Universitaria de Cabaiguán. Se emplearon los métodos histórico-lógico, el análisis-síntesis, sistémico, el criterio de expertos, hipotético-deductivo e inductivo-deductivo. Resultados: Un sistema de tareas para la búsqueda de información y solución a problemas que se presentan en la etapa estudiantil y profesional, adquisición de conocimientos y comparación de resultados obtenidos en sus investigaciones con los de otros autores. Conclusiones: El sistema de tareas docentes interdisciplinarias propuesto, además de estar fundamentado teóricamente, tiene potencialidades para incentivar la motivación del estudiante y resulta factible su aplicación en el contexto formativo actual.

Background: The professional acting of excellence requires, in great measure, the practice of the medicine based on evidences, as well as graduate from the higher education, personal of health able to use the statistic in the scientific investigation as a tool that allows to elevate the quality of the proces. Objective: To propose a system of interdisciplinary educational tasks to contribute to the learning of statistical methods in the investigations, acting as consumer and reproducer of biomedical informatio. Methodology: Pedagogic investigation carried out in the University Branch of Cabaiguán. The historical-logical, the analysis-synthesis, systemic, the approach of experts, hypothetical-deductive and inductive-deductive methods were used. Results: A system of tasks for the search of information and solution to problems that are presented in the student and professional stage, acquisition of knowledge and comparison of results obtained in their investigations with those of other authors. Conclusions: The proposed system of interdisciplinary educational tasks, besides being based theoretically, has potentialities to incentive the student's motivation and it is feasible its application in the current formative context.

Initial results of a doctorate in medical sciences program at a regional university / Resultados iniciales de un programa de doctorado en ciencias médicas de una universidad

The number of doctoral programs in the biomedical field has risen in recent decades, but with a concentration in Santiago and little expansion into the provinces. The aim of this article is to describe the initial results obtained by the Doctorate in Medical Sciences program of the Universidad de La Frontera, Chile. Observational study, conducted in the Department of Surgery at the Universidad de La Frontera, Chile. All cohorts in the program from 2008 to 2015 were included. The outcome variables were: Graduation rate and scientific productivity of the graduates (WoS and SciELO publications). Other variables of interest were: academic faculty productivity (WoS and SciELO publications), and characteristics of students who entered the program (age, sex, origin, profession, previous graduate training and number of years of formal university education). Descriptive statistics were applied. During the evaluation period, of a total of 17 qualified, 8 doctorates have been granted (1.6 per year), a graduation rate of 47.1 %. The research productivity for 2010-2015 was 14.1 publications per graduate (8.4 WoS and 5.7 SciELO) and 43.8 publications per academic (41.2 WoS and 2.6 SciELO). In the period, 55 professionals applied and 27 were accepted (49.1 % rate acceptance). Initial results of the Doctorate in Medical Sciences program of the Universidad de La Frontera, Chile are presented.

El número de programas de doctorado en el área biomédica ha crecido en las últimas décadas, aunque la mayoría se concentra en Santiago, con un escaso desarrollo en regiones. El objetivo de este artículo es describir los resultados iniciales obtenidos por el programa de Doctorado en Ciencias Médicas de la Universidad de La Frontera. Estudio observacional, descriptivo; realizado en el Departamento de Cirugía de la Universidad de La Frontera. Se incluyeron la totalidad de las cohortes que han ingresado al programa, desde 2008 a 2015. Las variables de los resultados fueron: Tasa de graduación y productividad de los graduados (publicaciones WoS y SciELO). Otras variables de interés fueron: productividad del Claustro (publicaciones WoS y SciELO); y características de los alumnos que ingresaron al programa (edad, sexo, origen, profesión, formación de postgrado previa y número de años de formación universitaria formal). Se aplicó estadística descriptiva. Durante el período evaluado, de un total de 17 habilitados, se graduaron 8 doctores (1,6 por año), tasa de graduación de 47,1 %. La productividad para el período 2010-2015 fue de 14,1 publicaciones por graduado (8,4 WoS y 5,7 SciELO); y 43,8 publicaciones por miembro del Claustro (41,2 WoS y 2,6 SciELO). En el período analizado postularon 55 profesionales, siendo aceptados un total de 27 (49,1 % de aceptación). Se presentan los resultados iniciales del programa de Doctorado en Ciencias Médicas de la Universidad de La Frontera.

Mistreatment in an academic setting and medical students' perceptions about their course in São Paulo, Brazil: a cross-sectional study / Maus-tratos em um ambiente acadêmico e percepção sobre o curso entre estudantes de medicina em São Paulo, Brasil: um estudo transversal

ABSTRACT: CONTEXT AND OBJECTIVE: High prevalence of mistreatment among medical students has been described in the worldwide literature since the 1980s. However, studies addressing the severity and recurrence of victimization and its effects on students' perceptions of their medical course are scarce. This study had the aim of estimating the prevalence of exposure to mistreatment that was considered to be severe and recurrent and its association with medical students' perceptions about their medical course. METHODS: A cross-sectional study was conducted in a medical school in São Paulo, Brazil. Three hundred and seventeen students from the first to the sixth year answered the online questionnaire. RESULTS: High prevalence of mistreatment during the course was found. Two thirds of the students considered the episodes to be severe, and around one third reported experiencing recurrent victimization. Occurences of mistreatment that the students considered to be severe were correlated with feeling overloaded and wanting to abandon the medical course. CONCLUSIONS: Occurrences of mistreatment within the academic environment are frequent in Brazil. The results suggest that mistreatment that was considered to be severe might negatively affect students' perceptions about their course.

RESUMO CONTEXTO E OBJETIVO: Altas prevalências de maus-tratos entre estudantes de medicina vêm sendo descritas na literatura internacional desde a década de 1980. Estudos sobre a gravidade e recorrência da vitimização e seus efeitos na percepção dos alunos sobre o curso médico são escassos. Este estudo tem por objetivo estimar a prevalência de exposição a maus-tratos considerados graves e recorrentes e sua associação com a percepção dos estudantes de medicina sobre o curso médico. MÉTODOS: Estudo transversal realizado em uma escola médica em São Paulo, Brasil. Trezentos e dezessete estudantes do primeiro ao sexto ano responderam ao questionário online . RESULTADOS: Foram encontradas altas prevalências de maus-tratos durante o curso. Dois terços dos estudantes consideraram os maus-tratos graves e cerca de um terço referiu vitimização recorrente. A ocorrência de maus-tratos considerados graves pelos estudantes esteve associada a sentimento de sobrecarga e desejo de abandonar o curso médico. CONCLUSÃO: A ocorrência de maus-tratos no ambiente acadêmico é frequente no Brasil. Os resultados sugerem que os maus-tratos percebidos como graves podem afetar negativamente a percepção dos estudantes sobre o curso.

La atención de la salud en Argentina: Al gran pueblo argentino... ¿Salud? -Tercera entrega: formación médica en Argentina ­ flojos de papeles / Health care in Argentina: To the great Argentine people ... Health? -Third issue: medical training in Argentina

En una serie de entregas relacionadas, el autor describe mediante la utilización de viñetas utilizadas a modo de ejemplo, los diferentes factores que hacen de la administración de salud argentina una "tragedia". En esta entrega se describe la deficiencia de la formación médica y la falta de exámenes periódicos de certificación y recertificación como factores determinantes de un nivel de formación deficiente en la Argentina. (AU)

In a series of related articles, the author describes, through vignettes utilized as examples, the different factors that turns the Argentinian health administration into a "tragedy". This issue is oriented toward description of the deficiency in medical training and the lack of certification tests as determinant factors of a very poor medical formation in Argentina. (AU)

Factores asociados con el éxito académico de los estudiantes de medicina de la Universidad de Buenos Aires

El objetivo fue identificar los factores asociados al éxito académico de los estudiantes de medicina distinguidos con diploma de honor por la Universidad de Buenos Aires. En 2011 se aplicó un cuestionario a 142 graduados con esta distinción en el 2006 que incluyó 59 preguntas sobre aspectos sociodemográficos, condiciones de vida e integración social, motivación para el estudio, capacidad de aprendizaje y estado de salud durante la carrera. En comparación con los demás alumnos, los exitosos habitaban más frecuentemente en la ciudad, provenían de escuelas medias privadas o universitarias, tenían menor necesidad de trabajar para financiarse, casi todos eran solteros y sin hijos, una proporción mayor vivía lejos de su familia, tenían más progenitores profesionales y eran financiados por ellos; nunca consideraron la salida laboral para elegir la carrera, para ellos era importante alcanzar el éxito y éste dependía principalmente del esfuerzo propio; solían manejar la ansiedad, eran sociables aunque independientes y preferían la experiencia concreta a la conceptualización abstracta para adquirir información. Con el actual sistema de ingreso, estos resultados sirven para cuantificar los mecanismos latentes de autoselección durante la carrera o en un régimen restrictivo, para seleccionar los candidatos a alcanzar el éxito académico. El análisis de los factores demográficos indica algún grado de inequidad para los estudiantes menos favorecidos socialmente. Quizás, un sistema de ingreso basado solo en las capacidades intelectuales, ayudaría a individualizar y apoyar a los mejores candidatos, independientemente de su contexto social.

The aim of this study was to identify common factors relating to the academic success of medical students who were distinguished with honors at the Buenos Aires University. In 2011, 142 graduates were surveyed; the questionnaire included 59 questions on their sociodemographic environment, living conditions and social integration, motivation to study, learning capacity and health quality during their career. Compared to other students, these distinguished students more often lived in the city, far from their families; had been educated at private or universitary high schools, their economic needs were financed by their parents, who were on the whole professionals. Most of them were single and childless. The possibility of future employment oportunities (work) did not influence their choice of a medical career, academic success was important to them and they believed that success depended largely on personal effort; they knew how to handle anxiety, were sociable but independent and preferred solid experience to abstract conceptuality in order to obtain information. Our conclusion, within the current system of candidate selection, these results serve to calculate the covert self-selection mechanisms during the career, or in a more restrictive regime, to select those likely to reach academic success due to their privileged ambience. The analysis of demographic factors indicates some degree of inequality for socially disadvantaged students. Perhaps, a selection system based only on intellectual abilities would help identify and support the best candidates regardless of their social context.

Aprendizaje autodirigido en estudiantes de primer año de medicina de la Universidad de Concepción y su relación con el perfil sociodemográfico y académico / Association between self-directed learning behaviors, socio-demographic and academic variables among medical students

Medical education must encourage autonomous learning behaviors among students. However the great income profile disparity among university students may influence their capacity to acquire such skills. Aim: To assess the association between self-directed learning, socio-demographic and academic variables. Material and Methods: The self-directed learning readiness scale was applied to 202 medical students aged between 17 and 25 years (64% males). Simultaneously information about each surveyed participant was obtained from the databases of the medical school. Results: There is an association between socio-demographic and academic variables with the general scale of self-directed learning and the subscales learning planning and willingness to learn. Participants coming from municipal schools have a greater willingness to learn than their counterparts coming from subsidized and private schools. High school grades are related to self-directed learning and the subscales learning planning and self-assessment. Conclusions: Among the surveyed medical students, there is a relationship between self-directed learning behaviors, the type of school where they come from and the grades that they obtained during high school.

Perfil do cirurgião plástico paranaense / Profile of plastic surgeons in the state of Paraná, Brazil

INTRODUÇÃO: Esta pesquisa tem por objetivo traçar o perfil do cirurgião plástico do estado do Paraná. É um projeto inicial que não tem a pretensão de indicar respostas, mas sim de entender o que pensa, quais os anseios e objetivos na profissão e como atua o profissional dessa especialidade. MÉTODO: Foi idealizada uma pesquisa com 37 perguntas de múltipla escolha, em sua maioria com foco no mercado de trabalho. Ela foi enviada por e-mail aos 263 membros da Sociedade Brasileira de Cirurgia Plástica - Regional Paraná (SBCP-PR), sob forma de um link que dava acesso ao questionário. O link também estava disponível no website da SBCP-PR, com um banner em sua página inicial. O tempo médio para preenchimento do questionário variou de 3 minutos a 5 minutos. RESULTADOS: O índice de resposta foi de 40,5%. A maioria dos entrevistados atua apenas em uma cidade, e mais da metade atende apenas convênios e particulares. Metade dos participantes considera o mercado extremamente competitivo e procura várias alternativas para se manter, entre elas: aumentar parcelamento, baixar preços e atuar em outros locais. Uma parcela significativa acredita ter perdido mais de 30 pacientes por preço no último ano e faz, em média, 10 a 20 cirurgias mensais. A maioria dos participantes não opera com auxiliar cirurgião plástico, pois consideram que aumenta o custo ou que instrumentadoras podem fazer a mesma função. A maioria dos participantes acredita que o número de residentes formados no estado é excessivo. CONCLUSÕES: O cirurgião plástico no Paraná está muito preocupado com o mercado de trabalho e procura alternativas para se manter competitivo.

INTRODUCTION: In the present study, we aimed to outline the overall practice profile of plastic surgeons in the state of Paraná. It represents an initial project that aimed not to provide generalizations but to understand how plastic surgeons think and their professional aspirations, goals, and performance. METHODS: A survey was conducted using a questionnaire consisting of 37 multiple-choice questions, mostly focusing on the current job market for plastic surgeons. The link to the online questionnaire was e-mailed to 263 members of the Brazilian Society of Plastic Surgery-Regional Paraná (SBCP-PR), which was also accessible via the SBCP-PR website, through a banner on its home page. The overall time to complete the questionnaire ranged from 3 to 5 minutes. RESULTS: The response rate was 40.5%. Most interviewees operated only in one city, and more than half provided services only through health-care insurance plans and private practice. Half of the participants considered the market as extremely competitive and searched for several alternatives for self-maintenance, including increasing installment payment terms, lowering prices, and working at other locations. A significant proportion of the respondents believed that they lost more than 30 patients owing to pricing in the previous year and performed 10-20 surgeries per month on average. Most of the surgeons did not operate with an auxiliary plastic surgeon because this would increase their operational cost or because technologists could perform this function. Most participants believe that the number of trained residents in the state of Paraná is excessive. CONCLUSIONS: In Paraná, plastic surgeons are concerned about the job market and therefore search for alternatives to remain competitive.

Burnout Syndrome and associated factors among medical students: a cross-sectional study

OBJECTIVES: To assess the prevalence and levels of burnout syndrome among medical students at the Universidade Federal de Sergipe-Brazil and to identify associated factors. METHODS: A cross-sectional study was performed with randomly selected students in 2009. The Maslach Burnout Inventory/Student Survey (MBI-SS) and a structured questionnaire on socio-demographic characteristics, the educational process, and individual aspects were used. Statistical evaluation of multiple variables was performed through backward stepwise logistic regression analysis. RESULTS: The prevalence of burnout was 10.3% (n = 369). The prevalence was higher among those who did not have confidence in their clinical skills (Odds Ratio-OR = 6.47), those who felt uncomfortable with course activities (OR = 5.76), and those who did not see the coursework as a source of pleasure (OR = 4.68). CONCLUSION: There was a significant prevalence of burnout among the medical students studied. Three variables, in particular, were associated with burnout and were directly related to the medical education process. Preventive and intervention measures must be adopted, and longitudinal studies should be conducted.