Becas para la formación de médicos especialistas académicos del Hospital Clínico de la Universidad de Chile / Academic residents fellowship program at the University of Chile Clinical Hospital

The mission of the University of Chile Clinical Hospital is to be the main University Hospital in the country. Along with training of health professionals in clinical practice and research, the Hospital provides comprehensive health solutions to the community. Since its foundation, it played an important role in the training of health professionals and specialists. To fulfill this mission, it is important to have outstanding academics and a system that allows their renewal and replacement. From January 25, 2001, the University of Chile approved the regulations that rule the Residents Program Fellowship, aimed to train the new generations of clinical academics. These regulations allow the financing of training programs in basic or primary specialties (such as internal medicine, surgery, obstetrics and gynecology, among others) or in specialties derived from them (such as cardiology, gastroenterology and reproductive medicine, among others.) The different clinical departments and the Hospital Direction define each year how many places will be offered and in which specialties. The Faculty of Medicine Graduate School carries out the formal selection of the applicants. This article reviews the results of this program between 2013 and 2021, analyzing in detail the traceability of each graduate over the years.

Estimating the cost of training an ophthalmologist in Brazil / Estimativa do custo para formação de um oftalmologista no Brasil

ABSTRACT Introduction: It is estimated that 23% of the Brazilian population does not have access to an ophthalmologist, mainly because of the irregular geographical distribution of experts. It may be expensive to train ophthalmologists in Brazil. Objective: To estimate the cost of training an ophthalmologist and the labor market conditions so that the provider recovers the investment. Methods: Epidemiological study in databases from governmental sources and institutions related to the eye health system regulation. Results: The cost for training an ophthalmologist would be equal to R$ 592.272,00. After specialization, if the provider pledged all his/her income to recover the amount spent on training, it would take 5.2 years to reach the point of equilibrium. Conclusion: Young doctors from families unable to afford the cost of their education and support for at least 14 years after the beginning of the undergraduate course will hardly be able to specialize in Ophthalmology if they are unable to carry out their studies in public educational institutions. And those who can specialize are likely to choose to practice their profession in large urban centers, where most of the job opportunities are available, to at least recover the financial investment in training in the medium term.

RESUMO Introdução: Estima-se que 23% da população brasileira não tenha acesso ao oftalmologista, devido, principalmente, à falta de recursos do Sistema Público de Saúde e à distribuição geográfica irregular dos especialistas. É possível que seja caro formar oftalmologistas no Brasil. Assim, é compreensível que a maioria dos profissionais optem para ficar próximos dos grandes centros consumidores, onde estão as melhores remunerações. Objetivo: Estimar o custo para a formação de um oftalmologista e as condições do mercado de trabalho para que ele recupere o investimento. Métodos: estudo epidemiológico em bases de dados de fontes governamentais e de instituições relacionadas à regulamentação do sistema de saúde ocular. Resultados: Estimou-se que o custo para formação de um oftalmologista seja de R$ 592.272,00. Após a especialização, caso ele empenhe todo seu rendimento para reaver o valor gasto em sua formação, precisaria de 5,2 anos para atingir o ponto de equilíbrio. Conclusão: Jovens médicos oriundos de famílias incapazes de arcar com o custo de sua formação e de seu sustento, por pelo menos 14 anos após o início da graduação, dificilmente conseguirão se especializar em Oftalmologia, se não conseguirem realizar seus estudos em instituições públicas de ensino. E aqueles que conseguem se especializar, provavelmente optem por exercer a profissão em grandes centros urbanos, onde está a maior parte das oportunidades de trabalho, a fim de, a médio prazo, conseguir, pelo menos, recuperar o investimento financeiro na formação.

Low cost simulator for heart surgery training

Abstract Objective: Introduce the low-cost and easy to purchase simulator without biological material so that any institution may promote extensive cardiovascular surgery training both in a hospital setting and at home without large budgets. Methods: A transparent plastic box is placed in a wooden frame, which is held by the edges using elastic bands, with the bottom turned upwards, where an oval opening is made, "simulating" a thoracotomy. For basic exercises in the aorta, the model presented by our service in the 2015 Brazilian Congress of Cardiovascular Surgery: a silicone ice tray, where one can train to make aortic purse-string suture, aortotomy, aortorrhaphy and proximal and distal anastomoses. Simulators for the training of valve replacement and valvoplasty, atrial septal defect repair and aortic diseases were added. These simulators are based on sewage pipes obtained in construction material stores and the silicone trays and ethyl vinyl acetate tissue were obtained in utility stores, all of them at a very low cost. Results: The models were manufactured using inert materials easily found in regular stores and do not present contamination risk. They may be used in any environment and maybe stored without any difficulties. This training enabled young surgeons to familiarize and train different surgical techniques, including procedures for aortic diseases. In a subjective assessment, these surgeons reported that the training period led to improved surgical techniques in the surgical field. Conclusion: The model described in this protocol is effective and low-cost when compared to existing simulators, enabling a large array of cardiovascular surgery training.

Assessment form - new improvement of actions: concentration and research areas / curriculum structure / fundraising / Ficha de avaliação - novas ações de aperfeiçoamento: áreas de concentração e linhas de pesquisa / estrutura curricular / captação de recursos

Objective: This review aims to develop a critical and current analysis of the basic structure of a Postgraduate program for proposing improvement actions and new evaluation criteria. Method: To examine the items that are areas of concentration (AC), research lines (LP), research projects (PP), curricular structure and fundraising were consulted the Area Document, the 2013 Evaluation Report and the Assessment Sheets of Medicine III programs, evaluated in the 2010-2012 period. Results: Consistency is recommended especially among AC, LP and PP, with genuine link between activities and permanent teachers skills and based on structured curriculum in the education of the student. The Program Proposal interfere, and much, in qualifying a program. The curriculum should provide subsidy to the formation of the researcher, through the core subjects, and development of PP, being the concept of disciplines to support lines and research projects. Fundraise should be set out in research projects and in the CV-Lattes. The area recommended that at least 40-50% of permanent teachers present fundraising and the minimum 20-25% of these teachers to have productivity scholarship PQ / CNPq during the triennium. Conclusion: It is necessary to promote wide discussion and find a consensus denominator for these issues. The actions should contribute to the improvement of evaluation forms and certainly for the qualification of the programs but graduate.

Objetivo: Essa revisão tem como objetivo elaborar uma análise crítica e atual da estrutura básica de um programa de Pós-Graduação para a proposição de ações de aperfeiçoamento e novos critérios de avaliação. Método: Para analisarem-se os itens áreas de concentração (AC), linhas de pesquisa (LP), projetos de pesquisa (PP), estrutura curricular e captação de recursos/fomentos foram consultados o documento de área, o relatório de avaliação 2013 e as fichas de avaliação dos programas da Medicina III, avaliados no triênio 2010-2012. Resultados: A coerência é recomendada especialmente entre AC, LP e PP, com substancial vínculo entre atividades e competências do corpo de docentes permanentes e embasamento da grade curricular na formação do aluno. A Proposta do Programa interfere, e muito, na qualificação de um programa. A estrutura curricular deverá dar subsídio à formação do pesquisador, por meio das disciplinas nucleares, e ao desenvolvimento dos PP, de competência das disciplinas de apoio às linhas e aos projetos de pesquisa. Os fomentos devem ser indicados nos projetos de pesquisa e no CV-Lattes dos beneficiados/responsáveis pelos projetos. A área recomenda que, no mínimo, 40 a 50% dos docentes permanentes apresentem captação de recursos e que o mínimo de 20 a 25% desses docentes tenham bolsa de produtividade PQ/CNPq durante o triênio. Conclusão: Há que se promover ampla discussão e encontrar um denominador de consenso para essas questões. As ações deverão contribuir para o aprimoramento das fichas de avaliação e, certamente, para a qualificação dos programas de pós-graduação.

Financial support of graduate programs in Brazil: quo vadis?

Graduate programs provide the highest level of formal education and thus are crucial for the development of any country. However, official Brazilian data clearly show a dramatic decrease in the number and values of scholarships available to graduate programs in Brazil over the last few years, despite the importance and growth of such programs. Between 1995 and 2004, investment by the Coordenadoria de Aperfeiçoamento de Pessoal do Ensino Superior (CAPES, subordinate to the Ministry of Education and Culture) in funding scholarships, corrected for inflation in the period, actually decreased by 51 percent. In addition, during the period between 1994 and 2004, there was a loss of about 60 percent in the purchasing power of the graduate scholarships provided by CAPES and the National Council for Science and Technology (CNPq). To reverse this trend, we propose the development of sectorial funding for Brazilian graduate programs to guarantee the availability and continuity of financial support for this strategic activity.

Cost of producing a medical doctor at Chulalongkorn University.

To illustrate the cost of producing a medical doctor through a 6-year curriculum and the analysis of the cost components of the Faculty of Medicine, could be used as key data for future planning, budgeting and preparation for the autonomous university. The cost centers were categorized to be executive, education support and education unit. The simultaneous equation method was employed to allocate all costs from other associated cost centers to the education unit. The unit cost per enrolled student was 2,161,124 baht and 8,217 Baht/Student Credit Hour (SCH), while the unit cost per graduate was 2,174,091 baht and 8,267 Baht/SCH. The labor cost accounted for 69.46 per cent, capital cost, 26.42 per cent and material cost, 4.12 per cent of the total medical doctor production cost. The three most costly departments were,: Department of Medicine (13.24%), Department of Obstetrics and Gynecology (11.73%) and Department of Paediatrics (9.87%). The cost-fee ratio (cost/fee) was 95:5 which suggested that medical students obtain 95 per cent subsidy from the government budget or the society. If the University becomes autonomous and less dependent on public budget, the fee may have to be adjusted higher to cover the cost. The percentage of drop out and repeat students was 0.00-0.88 per cent with a delay duration of about 6 months to one year only. The opportunity cost of six years' study for a student attending the medical school was 544,956 baht which raised the total cost per graduate to 2,719,047 baht from student/societal perspective.

Consideraçöes sobre a pós-graduaçäo stricto sensu em medicina / Stricto sensu graduation in medicine

Durante os últimos trinta anos, o curso de pós-graduaçao stricto sensu alcançou sua maturidade. O objetivo principal desse curso é formar docentes universitários, atualizando-os em áreas específicas do conhecimento e ensinando-os a produzir trabalhos científicos. Os limites do curso estao relacionados aos poucos orientadores, ao reduzido apoio financeiro e à falta de integraçao com outros cursos e instituiçoes. Os limites relacionados ao corpo discente sao sua disparidade, seu afastamento das atividades profissionais e seu isolamento em um ambiente estranho. Entretanto, as vantagens trazidas por esse curso justificam os investimentos em seu crescimento e conseqüente desenvolvimento da universidade.

El financiamiento del postítulo: una revisón indispensable en la modernización de la educación superior universitaria en salud / Postgraduate training financing: an essential review in the modernization of university health teaching

Due to social and economical changes in the chilean university and health systems in the last decades, the traditional financing model of the Faculty of Medicine and postgraduate training programs became obsolete. The progressive reduction of the fiscal budget has forced the search of alternate financing sources. The payment of specialization is, at the present moment, an obliged, inappropiate and without compensation subsidy of the universities to the public and private health system, that profite of training professionals and to the specialists that acquire skills that will increase their earnings. Equable financing systems should be stablished in which the direct beneficiaries, institutions or individuals, would pay the expense. A national schoolarship fund or deferred credits seem reasonable alternatives that should be promply established to allow the survival of university postgraduate training programs

Costo beneficio de una residencia / Cost/Benefit of Residence Program

El costo de las acciones relacionadas con cualquier emprendimiento constituye un factor fundamental en la toma de decisiones. Los ,costos de la salud y de la educación han aumentado aceleradamente, haciendo racional exigir el uso eficiente de los fondos. Los estudios Costo/Beneficio son adecuados para esta misión. Se estudió un programa de Residencia de Clínica Quirúrgica, dependiente de la Provincia de Buenos Aires. El costo por Residente con programa completo se elevó a $50.674. Las residencias son programas de alto costo. Los innegables beneficios de la Residencia, se refieren a la consecución de los objetivos docentes propuestos. Se refieren a la formación de profesionales técnicamente idóneos, con sólida formación en los planos ético, moral y social, capaces de proveer óptima promoción, protección y rehabilitación de la salud, contemplando la prevalecia lesional como uno de sus pilares fundamentales. La medida objetiva de los beneficios es casi imposible de concretar, debiendo definir instrumentos de evaluación que permitan expresarlos. Defender la Residencia como sistema debe ser más que una expresión de deseo. Implica un compromiso racional y creativo, para evitar cristalizaciones definitivas en un mundo donde la inestabilidad y el cambio permanentes obligan a hombres e instituciones a adaptarse para sobrevivir. El análisis Costo/Beneficio provee una medida de la realidad que permite sugerir ajustes y proponer nuevas soluciones