La evaluación final en la especialidad Medicina Interna: propuesta de adecuaciones / Final evaluation in Internal Medicine specialty: proposal of adjustments

Introducción: La evaluación de graduación constituye el examen de culminación de los estudios de la especialización, correspondiente a la enseñanza de posgrado. Objetivo: Proponer y fundamentar la realización de modificaciones en la evaluación de graduación de la especialidad Medicina Interna, en nuestro contexto. Método: Investigación sustentada en el análisis de documentos metodológicos y en una reflexión crítica de la praxis, para la construcción teórica de la propuesta de modificaciones. Resultados: A partir de la identificación de puntos de mejoría y guiados por una serie de principios, se proponen los siguientes cambios: 1) readecuación en la secuencia de los ejercicios teóricos y prácticos que conforman el examen estatal, 2) mayor peso de las actividades prácticas en la evaluación, tanto por aumento del número de actividades como por el tiempo destinado a las ejecuciones, 3) representación más amplia de la diversidad de habilidades y competencias objetivo de aprendizaje en la residencia, y 4) una mirada más exigente y valorizada de las competencias investigativas en general, y del trabajo de terminación de la especialidad en particular. Conclusiones: Mediante los cambios que se proponen se logra una certificación más real y objetiva de las competencias profesionales de los educandos para el cumplimiento del encargo social, y contribuye al mejoramiento de la calidad del profesional egresado, al estimular un proceso formativo dirigido a garantizar la aplicación de los conocimientos(AU)

Introduction: The graduation evaluation constitute the final assessment of the specializing studies, corresponding to postgraduate education. Objective: To propose and to substantiate the conduction of modifications in the graduation evaluation of Internal Medicine specialty, in our context. Method: A research based on the analysis of methodological documents and on praxis critical reflection was carried out for the theoretical construction of the proposed modifications. Results: From the identification of çimprovement points and guided by a series of principles, the following changes are proposed: 1) Readjusting the sequence of theoretical and practical exercises that make up the state exams, 2) Providing greater importance of practical activities in the assessment, both due to the increase in the number of activities and the time allocated to performing, 3) Bringing broader representation of the diversity of skills and competencies which are learning objective in the residence, and 4) Demanding and measuring more the research competences in general, and of the completion paper of the specialty in particular. Conclusions: These proposed changes result in more real and objective certification of the professional competences of the students for achieving the fulfillment of the social mandate. These changes improve the quality of the professional, by stimulating a training process aimed at guaranteeing the application of knowledge(AU)

Fundamentos para la clasificación de los programas de médico especialista en un marco de cualificaciones nacional / Foundations for the classification of medical specialist programs in a national qualifications framework

Qualification of learning outcomes in terms of knowledge, skills, responsibility and autonomy provided by medical specialist programs is of interest to State authorities, educational service providers, employers, and specialists. Countries that are signatories to the Bologna Process and others outside Europe, established that the guaranteed primary degree for medical studies is the Master in Medicine (second cycle). There is agreement that medical specialist programs are more advanced than a Master of Medicine but are different from the Doctor of Medicine (third cycle) in their clinical orientation. These programs usually do not have research components and occasionally they are not carried out in the higher education system. However, the level of qualification of medical specialist programs has not been established due to lack of consensus. In Chile, this decision becomes even more complicated due to the certification of "licenciatura" (first cycle) that medical schools provide. There are also gaps in the educational classification procedure employed by the country. However, the review of national qualification frameworks and government acts shows that some countries have validated these certifications as third cycle. Medical specialties certainly do not correspond to PhD programs and the eligibility of the qualification level must be guaranteed to all stakeholders, who require an agreement on the specific national framework of learning outcomes and competencies.

El proceso de acreditación de Especialistas en Pediatría en Chile / Accreditation process of pediatric healthcare professionals in Chile

In Chile since 1984, the Autonomous Corporation for Certification of Medical Specialties (CONACEM) has certified 12,294 medical specialists. The Pediatrics discipline began its certification processes in 1984; it had certified 1,329 specialists by December, 2012. There are three possible ways to get certified: a) to have passed the Training Graduate Degree Program, taken by 57% of the applicants; b) to meet the requirements for Training in Practice for 5 years, achieved by 39% of applicants; c) to have been trained oversees according to validated programs. There are 11 accredited 3-year long university programs, which take place in Santiago and Provinces with a total annual capacity of 96 students. With the exception of doctors approved by accredited medical university programs, the rest of the applicants must pass a practical examination. A written examination has been added since 2002, whose approval is required to take the practical examination, which has proven to have good discrimination (22% average rejection in 11 years). The certifications granted today are good for 10 years and recertification is good for 7 years. The expiration of the certification process is related to recertification. This review discusses the reasons behind it and discusses the requirements and a table of credits to complete. Current legislation requires the action of at least one certification body, a condition that has been legally and uniquely granted by the Ministry of Health to CONACEM since 2/11/2014.

Desde 1984 la Corporación Autónoma de Certificación de Especialidades Médicas (CONACEM) ha certificado 12.294 especialistas médicos en Chile. La disciplina de Pediatría inició su certificación en 1984, habiendo certificado hasta Diciembre 2012 a 1.329 especialistas. Para la certificación existen tres vías posibles: a) haber aprobado un Programa de Formación Universitario Acreditado, lo que hizo el 57% de los postulantes; b) cumplir los requisitos de Adiestramiento en Práctica durante 5 años, como sucedió con el 39% de los postulantes; c) haber sido formado en el extranjero de acuerdo a programas convalidados. Existen 11 programas universitarios acreditados, de 3 años de duración, con un cupo total anual de 96 alumnos que se desarrollan en Santiago y Provincias. Salvo los médicos aprobados en los Programas Universitarios acreditados, el resto de los postulantes aprobar un examen práctico; desde 2002 se ha agregado un examen escrito, cuya aprobación es requisito para dar el práctico, y que ha resultado tener buena discriminación (22% de rechazo promedio en el período de 11 años). Las certificaciones dadas hoy, tienen una duración de 10 años al inicio y serán de 7 años en la recertificación. La caducidad de las certificaciones está aparejada al proceso de recertificación, de lo cual se discuten las razones que lo avalan; se presentan los requisitos y una tabla de créditos a cumplir, elaboradas por CONACEM. La legislación vigente y en proceso, requiere la actuación de al menos una entidad certificadora, condición que ha sido otorgada legalmente en forma única por el Ministerio de Salud a CONACEM a partir del 11/02/2014.

Programa de ensino de facoemulsificação CBO/ALCON: resultados do Hospital de Olhos do Paraná / CBO/ALCON teaching method of phacoemulsification: results of Hospital de Olhos do Paraná

Objetivo: Analisar os resultados obtidos com a aplicação do programa de ensino de facoemulsificação CBO/ALCON no curso de especialização em oftalmologia do Hospital de Olhos do Paraná. Métodos: Realizou-se um estudo retrospectivo analítico dos resultados das cirurgias de catarata realizadas pelo programa de ensino de facoemulsificação CBO/ALCON que utiliza o método "reverso" em pacientes provenientes do ambulatório do SUS do Hospital de Olhos do Paraná. O programa consta da progressão dos alunos por cinco etapas chamadas de "check points", sendo analisadas as intercorrências per-operatórias em cada um deles, bem como as pós-operatórias. Resultados: Do total de 84 olhos operados, 77 (91,67 por cento) apresentaram acuidade visual (AV) final de 20/40 ou melhor. Entre as intercorrências, a principal delas foi a rotura de cápsula posterior (RCP) e ocorreu em 11 (13,09 por cento) dos 13 (15,48 por cento) olhos que apresentaram algum tipo de complicação. Conclusão: O método "reverso" proposto para o ensino de facoemulsificação pelo programa CBO/ALCON se mostra uma forma de ensino adequada, para o médico residente e seu instrutor, e principalmente para o paciente, devido ao baixo índice de complicações.

Purpose: To analyze the results obtained with a new phacoemulsification teaching method in the specialization course of Hospital de Olhos do Paraná. Methods: A retrospective study evaluated the results of a "reversal" method used in the CBO/ALCON teaching program at the Hospital de Olhos do Paraná. The method is based on the student progression through five checkpoints starting from the end of the surgery towards the beginning and analysis of intra- and postoperative complications at each one of the checkpoints. Results: Of 84 operated eyes, 77 (91.67 percent) presented final visual acuity of 20/40 or better. Among the complications, the main one was the posterior capsular rupture and occurred in 11 (13.09 percent) of 13 (15.48 percent) eyes with complications. Conclusion: The "reversal" teatching method used in the CBO/ALCON teaching program is appropriate to the student, his instructor, as well as to the patient.

Evaluación de los Programas de Formación en Cirugía General: encuesta a los alumnos de postítulo / Resident evaluation of general surgery training programs

Background: The profile of the general surgeon has changed, aiming to incorporate new skills and to develop new specialties. Aim: To assess the quality of postgraduate General Surgery training programs given by Chilean universities, the satisfaction of students and their preferences after finishing the training period. Material and methods: A survey with multiple choice and Likert type questions was designed and applied to 77 surgery residents, corresponding to 59 percent of all residents of general surgery specialization programs of Chilean universities. Results: Fifty five per cent of residents financed with their own resources the specialization program. Thirty nine percent disagreed partially or totally with the objectives and rotations of programs. The opportunity to perform surgical interventions and the support by teachers was well evaluated. However, 23 percent revealed teacher maltreatment. Fifty six percent performed research activities, 73 percent expected to continue training in a derived specialty and 69 percent was satisfied with the training program. Conclusions: Residents considered that the quality and dedication of professors and financing of programs are issues that must be improved. The opportunity to perform surgical interventions, obtaining a salary for their work and teacher support is considered of utmost importance.

A especialização profissional / The professional specialization in cardiology

A especialização médica tornou-se necessária em decorrência dos inúmeros avanços no conhecimento das doenças e da aquisição de novas técnicas, o que repercute tanto no diagnóstico como na terapêutica. Entretanto, o tempo monstrou que não se pode deixar de lado a formação básica, e que a capacitação profissional deve ser encarada de forma séria e continuada. O título de especialista é fornecido seguindo regras explícitas dos Conselhos Regional e Federal de Medicina, por meio da Associação Médica Brasileira, esta vinculadas às sociedades de especialidades. Serve como comprovação para a sociedade civil da qualificação do profissional médico em determinada especilidade sendo válido apenas quando registrado no Conselho Regional de Medicina. A revalidação do título de especilista é um tema atual, tendo como finalidade o estímulo à educação continuada sendo uma ferramenta de comprovação do esforço desse profissional para mater-se atualizado e, portanto, preparado para oferecer a seus pacientes o que a medicina tem de mais atual.

Defesa profissional nas sociedades de especialidades médicas / Medical specialist association and professional defense

Honorários justos e condições adequados para o exercício da medicina são apenas duas das vertentes da Defesa Profissional.Estar vigilante quanto às pressões que ferem a autonomia profissional, organizar serviços jurídicos contra a indústria do erro médico e lutar por justiça tributária, pela regulamentação da profissão e por recursos para a saúde também são pontos fundamentais à defesa do médico.