Especialidades derivadas de la cirugía general: revisión de brechas e intención de residentes de la especialidad en Chile / Gaps between country needs and intentions to obtain a subspecialty among general surgery trainees in Chile

The fragmentation of a general specialty in subspecialties or derived specialties is a widely spread reality. Chilean health care system is becoming more complex, requiring more specialists. On the other hand, doctors in specialty training increasingly choose a subspecialty to continue their training and professional development. This contrasts with the growing need for well-trained general surgeons. We aimed to compare the evidence about the needs for general surgeons and the perspectives of Chilean physicians about their specialty training. A literature review about the intention of specialization in Chilean general surgery residents and the gaps in the Chilean health system, was performed. As of December 2016, there were 2,103 general surgeons in Chile, of whom 598 (28%) also have a subspecialty. Among the latter, 49% are plastic or vascular surgeons, which are also the specialties with the greatest demand in the public system. According to estimates of the Chilean Ministry of Health, on that year there was a deficit of 285 general surgeons and 142 subspecialists. These figures correspond to 18.5% and 23.8% of the existing resources. A survey published in 2009 reported that 78% of trainees in general surgery would prefer to continue studying a subspecialty, following the trend observed in the USA and Europe. Therefore, there is a disproportion between the intentions of general surgery trainees and the needs for these professionals in Chile.

Aproximando saberes e experiências à distância: relato da tutoria de um curso de especialização / Approaching knowledge and experiences at a distance: report of the tutoring of a specialization course / Aproximando saberes y experiencias a distancia: relato de la tutoría de un curso de especialización

RESUMO Este relato busca descrever a experiência do processo de tutoria a distância do Curso de Especialização Multiprofissional na Atenção Básica no Brasil, realizado nos estados de Santa Catarina e Paraná. O curso teve como público profissionais de saúde, entre esses: médicos, enfermeiros e dentistas, vinculados ao "Programa de Valorização da Atenção Básica" e ao "Programa Mais Médicos no Brasil", totalizando 1 600 profissionais. O curso foi estruturado a partir de três eixos teóricos e com mediação pedagógica realizada por uma equipe de tutoria. A metodologia adotada foi a problematizadora, desenvolvida a partir de uma postura crítica sobre a realidade, no processo de ensino aprendizagem. Os tutores realizaram orientação pedagógica, apoio ao uso das mídias e tecnologias e avaliação das atividades didáticas realizadas no curso. Os alunos avaliaram positivamente, a didática e conteúdo programático do curso e o desempenho dos tutores. Almeja-se que esta experiência possa ser vista como possibilidade de impulsionar outras experiências na formação em saúde.(AU)

ABSTRACT This report aims to describe the experience of tutoring process in distance learning of the Multidisciplinary Specialization Course in Primary Care in Brazil, in the states of Santa Catarina and Paraná. Course participants were physicians, dentists and nurses included in the "Program for the Valorization of Primary Health Care" and the "More Doctors Program in Brazil", a total of 1 600 professionals. The course was structured from three theoretical axes and pedagogical mediation conducted by a team of tutoring. . It was adopted problematization methodology, developed from a critical view of reality in the teaching and learning process. The tutors worked in pedagogical orientation, supporting use of media and technology and evaluation of educational activities in the course. The students evaluated positively the didactic and the course design and performance of the tutors. One hopes that this experience can be seen as a possibility to boost other experiences in health education.(AU)

RESUMEN Este relato busca describir la experiencia del proceso de tutoría a distancia del Curso de Especialización Multiprofesional en la Atención Básica en Brasil, realizado en los Estados de Santa Catarina y Paraná. El curso tuvo como público a profesionales de salud médicos, enfermeros y odontólogos; todos vinculados al "Programa de Valorización de la Atención Básica" y al "Programa Más Médicos en Brasil", 1 600 profesionales en total. El curso fue estructurado a partir de tres ejes teóricos y con mediación pedagógica realizada por un equipo de tutoría. La metodología adoptada fue la problematizadora, desarrollada a partir de una postura crítica sobre la realidad, en el proceso de enseñanza aprendizaje. Los tutores realizaron orientación pedagógica, apoyo al uso de los medios y tecnologías, y evaluación de las actividades didácticas realizadas en el curso. Los alumnos evaluaron positivamente la didáctica y el contenido programático del curso y el desempeño de los tutores. Se anhela que esta experiencia pueda ser vista como una posibilidad para impulsar otras experiencias en la formación en salud.(AU)

Cursos de especialização ofertados no âmbito do Mais Médicos: análise documental na perspectiva da Educação Interprofissional / Specialization courses offered in the scope of the More Doctors Program: documentary analysis from the perspective of Interprofessional Education

Trata-se de estudo de abordagem qualitativa e caráter exploratório, que buscou analisar os projetos políticos pedagógicos (PPP) dos cursos de especialização em Saúde da Família ofertados no âmbito do Programa Mais Médicos (PMM) como possibilidade para adoção dos elementos teóricos e metodológicos da Educação Interprofissional (EIP). Foi empreendida análise documental de nove PPP, cujos resultados demonstram que tais documentos não trazem explicitamente a intencionalidade de adoção dos marcos teórico-conceituais e metodológicos da EIP, mas se mostram potentes para a adoção dessa abordagem, na medida em que valorizam estratégias pedagógicas reflexivas; reconhecem a necessidade de desenvolvimento de competências específicas, comuns e colaborativas; e buscam adotar uma perspectiva processual da avaliação. Dessa forma, os cursos analisados representam uma oportunidade para aplicação dos pressupostos da EIP, subsidiando o desenvolvimento de competências para as práticas colaborativas.(AU)

Se trata de un estudio de abordaje cualitativa y carácter exploratorio que buscó analizar los proyectos políticos pedagógicos (PPP) de los cursos de especialización en Salud de la Familia ofrecidos en el ámbito del programa Más Médicos (PMM), como posibilidad para adopción de los elementos teóricos y metodológicos de la Educación Interprofesional (EIP). Se emprendió un análisis documental de nueve PPP cuyos resultados demostraron que tales documentos no proporcionan explícitamente la intencionalidad de adopción de los marcos teórico-conceptuales y metodológicos de la EIP, pero se muestran potentes para la adopción de tal abordaje en la medida en que valoran estrategias pedagógicas relflexivas, reconocen la necessidad de desarollo de competencias específicas, comunes y colaborativas y buscan adoptar una perspectiva procesual de la evalución. De esa forma, los cursos analizados representan una oportunidad para la aplicación de los supuestos de la EIP, subsidiando el desarrollo de competencias para las prácticas colaborativas.(AU)

This qualitative and exploratory study aimed to analyze the pedagogical-political projects (PPP) of the specialization courses in Family Health offered under the More Doctors Program (PMM) to verify if it is possible to adopt the theoretical and methodological elements of Interprofessional Education in the courses. A documentary analysis of nine PPPs was carried out. Results show that these documents do not mention explicitly the intention of adopting the theoretical-conceptual and methodological frameworks of Interprofessional Education, but they are fit for the adoption of this approach, as they value reflective pedagogical strategies, recognize the need to develop specific, common and colaborative competencies, and seek to adopt a process-based perspective of assessment. Thus, the analyzed courses represent an opportunity to apply the presuppositions of Interprofessional Education, subsidizing the development of competencies for collaborative practice.(AU)

Expectativas profesionales del alumnado de enfermería desde un enfoque de género / Professional Nursing Student Expectations From Gender

Las expectativas sociales y profesionales están imbuidas de los roles de género. Hacen referencia a las creencias, actitudes y conductas que la sociedad asigna a hombres y mujeres. Los roles se integran en todos los quehaceres de la vida cotidiana y generan sesgos en las valoraciones de las prácticas profesionales. La disciplina de Enfermería, ha sido objeto de una visión estereotipada de la que no está ajena el alumnado. En este sentido, nuestro objetivo es aportar una mirada de género a las motivaciones y expectativas profesionales que describe el alumnado de Enfermería. Revisión bibliográfica en bases de datos nacionales e internacionales entre octubre de 2012 y febrero de 2013, priorizados en función del factor de repercusión inmediato y/o factor de impacto medidos por WOK, Cuiden y Scopus. Se utilizaron los descriptores de ciencias de la salud (DECS) y términos Medical Subject Headings (MESH). Se han analizado 26 artículos que cumplían los criterios de inclusión establecidos. Y se han categorizado en relación a las expectativas de género relacionadas con la profesionalización, especialización y movilidad laboral. La disciplina enfermera es una carrera de perfil eminentemente femenino, con una visión estereotipada que puede influir en las expectativas laborales postgrado, por lo que ahora podría ser el momento de trabajar para fijar estrategias que consigan minimizar los estereotipos de género(AU)

Gender roles condition social and professional expectations. These make references to beliefs, attitudes and behaviors that society assigns to men and women. Roles are integrated into all the chores of daily life and they create biases in valuations of professional practices. Nursing has received a stereotyped vision that includes at the student. In this way, we aim to bring a gender perspective to the professional motivations and expectations that describe nursing students. A primary, secondary and tertiary inspection of the literature was conducted in both national and international databases between October 2012 and February 2013. The articles were prioritized in based on the immediately impact factor and/or impact factor measured by WOK, Cuiden and Scopus. Descriptors of Health Sciences (DECS) and terms of Medical Subject Headings (MESH) were used. The total number of articles reviewed was 26, fulfilling the inclusion criteria established. They have been categorized in relationship to gender expectations associated with professionalism, specialization and labor mobility. Nursing is a career with a feminine profile and this stereotypical view may influence graduate job prospects. Therefore might be the moment to work setting strategies to break gender stereotypes(AU)

A cirurgia de mão como uma área de atuação dos cirurgiões plásticos / Hand surgery as a working area of plastic surgeons

INTRODUÇÃO: Estudos prévios têm revelado que o público tem conhecimentos equivocados sobre a atuação dos cirurgiões plásticos em cirurgia da mão. No entanto, não existem dados específicos na literatura científica brasileira. O objetivo deste estudo foi avaliar as percepções do público sobre o papel dos cirurgiões plásticos no campo de cirurgia da mão no Brasil. MÉTODOS: Membros do público brasileiro escolheram um ou dois especialistas que eles acreditassem serem experts para oito cenários relacionados à cirurgia de mão. Os padrões de respostas foram distribuídos como "cirurgiões plásticos" ou "não cirurgiões plásticos". RESULTADOS: "Não cirurgiões plásticos" foram significativamente (p < 0,05 para todas as comparações) mais reconhecidos como experts que "cirurgiões plásticos" em todos os cenários relacionados à cirurgia de mão. CONCLUSÃO: Os conhecimentos e as percepções do público brasileiro sobre o trabalho realizado por cirurgiões plásticos no campo cirurgia da mão são limitados.

INTRODUCTION: Previous studies have shown that the public has misconceptions about the work of plastic surgeons in hand surgery. However, no specific Brazilian data on this issue are available. The objective of this study was to evaluate the public perceptions about the role of plastic surgeons in the field of hand surgery in Brazil. METHODS: Members of the Brazilian public chose one or two specialists whom they believed to be experts in eight scenarios related to hand surgery. The patterns of the responses were distributed into "plastic surgeons" or "non-plastic surgeons." RESULTS: Non-plastic surgeons were significantly (p < 0.05 for all comparisons) more recognized as experts than plastic surgeons in all scenarios related to hand surgery. CONCLUSION: The knowledge and perceptions of the Brazilian public about the work performed by plastic surgeons in the field of hand surgery are limited.

Necesidad de reconocer a la "Medicina del Quemado" como una nueva e independiente especialidad / The need to consider the "Burned Patient Medicine" as a new and independent medical specialty

La frecuente observación, aún en nuestros días, de pacientes con graves quemaduras atendidos en lugares no apropiados, que no cuentan con los recursos humanos y físicos necesarios para afrontar el tratamiento que tal patología requiere, ha motivado la presentación de este artículo. En el texto de esta nota se hace referencia a una frase de Dupuytren (prestigioso cirujano francés) del año 1839 que decía que “el tratamiento de las quemaduras ha sido objeto en todos los tiempos de las tentativas más bizarras (extravagantes) del empirismo” resultando incomprensible que 175 años después siga teniendo vigencia. Se deja constancia de que los cirujanos plásticos han sido los que desde comienzos del Siglo XX se han ocupado del tratamiento local y han aportado el recurso del autoinjerto de piel para la reposición cutánea, pero para atender a los pacientes graves, la necesidad del tratamiento integral demostró que esta situación excede los alcances de la Cirugía Plástica y, por lo tanto, han debido convocar a médicos clínicos (actualmente a terapistas intensivos) para que tomen a su cargo la corrección de las alteraciones generales (pulmonares, renales, inmunológicas e infecciones) y las desviaciones metabólicas que ocasionan las quemaduras graves. También, se recomienda actualmente en diversas publicaciones, la asistencia integral por un “grupo interdisciplinario” pero no se aclara quién debe coordinarlo y qué conocimientos debe tener el coordinador. Su presencia es indispensable para lograr la armónica acción del conjunto. Como medio para corregir estas deficiencias, se recuerda que: a) se ha solicitado al Ministerio de Salud de la Nación el reconocimiento de la “Medicina del Quemado” como Especialidad Básica; b) que desde el año 2006 se dicta una Diplomatura sobre “Fisiopatología, Clínica y Tratamiento Integral de las Quemaduras”...

The frequent observation, even in our days, of severely burned patients admitted in inappropriate places which lack the necessary human and physical resources to face the treatment of this pathology motivated the present article. Dupuytren, the renowned French surgeon, affirmed in 1839 that “the treatment of burns has always been subject to the most extravagant attempts of empiricism”. It is difficult to understand how this assertion maintains its validity 175 years later. In this work we refer to the fact that since the beginning of the 19th Century plastic surgeons have dealt with local treatment and implemented the procedure of the skin graft; however, in the case of severely burned patients requiring an integral treatment, plastic surgery proved to be insufficient. Clinicians (as well as intensive care professionals) were required to deal with the general disorders (lung, kidney and immunological disorders and infections) and the metabolic alterations produced by severe burns. In different works integral assistance by an “interdisciplinary group” is also recommended, but who should hire its services or the kind of knowledge required to do it is not clearly specified. The presence of a coordinator is vital to ensure a harmonious action of the group. As a means to correct these deficiencies, it is important to remember that: a) it has been requested to the Ministerio de Salud de la Nación the recognition of the “Burned Patient Medicine” as a basic specialty; b) a two-year Diploma in “Physiopathology, Clinic and Integral Treatment of Burns” is delivered since 1996; c) the creation of a four-year residency for the recent graduates is suggested; d) postgraduate courses are offered to those who will integrate the interdisciplinary groups of attendance of the burned patient, in order to obtain what the Ministerio de Salud de la Nación considers “additional capacities”...

Career in pediatrics as a specialty among students in two Iraqi medical colleges

Limited knowledge is present on career in pediatrics among Iraqi medical students. The objective of this study was to figure out how pediatrics is popular among Iraqi medical students to be pursued as a future career as well as to define factors associated with the decline to pursue such specialty, if any. During the academic year 2010-2011, a questionnaire survey was employed to the final-year students from two medical colleges in Baghdad. The questionnaire included the variables of participant's gender, the option to participate in the study, the intention to pursue pediatrics career and, finally the reason stand behind rejecting that career, if any. Descriptive statistics was used to address data. Three hundred and thirty five students were asked to participate in this study and 271 have proved to take part in it with a response of 81%. Pediatrics was chosen as a career in 42.1% of the participants while 57.9% rejected it. Males were more attracted to pediatrics than females with a rejection percentage of 41.5% compared with 5 8.5% for females. Among factors stand behind not to pursue pediatrics were lacking of intellectual interest [79.6%] and deficient pediatric clinical training and skills [10.2%]. Other factors such as sparse promotional academic opportunities, lacking of anticipated higher financial rewards, and unfavorable prestige were at low percentages [5.1%, 3.2%, and 1.9% respectively]. In comparison with previous Iraqi studies, medical students were more enthusiastic towards pursing pediatrics as a career. This trend is anticipated to ensure the adequacy of pediatricians' workforce and healthcare. It should be continuously promoted necessitating the attention of policy makers and medical educators

Tendencia en el estudiante de medicina a ejercer como médico general o especialista / Trends among medical students towards general practice or specialization

Background: A 60/40 ratio has been estimated as a country's ideal proportion between general practitioners and specialists. In Chile this proportion was 36/ 64 in 2004, exactly the opposite of the ideal. Trends towards specialization or general practice among medical students have not been thoughtfully studied. Aim: To assess trends among medical students towards becoming general practitioners or specialists, exploring associated factors. Material and methods: Descriptive survey of 822 first to seventh year medical students at the University of Chile, School of Medicine. Desired activity to pursue (general practice or specialization) after graduation and general orientations within clinical practice were explored. Results: Fifty three percent of students desired to enter a specialization program. Only 20 percent would work as a general practitioner (27 percent were still indecisive). Furthermore, a trend in early years of medical training towards an integral medicine is gradually reversed within later years. Seventh year students give significantly more importance to specialization than to integral medicine (p <0.01). Ten percent of this opinion change is related to the emphasis given to specialized medicine in the teaching environment. Conclusions: Most students prefer to enter a specialization program immediately after finishing medical school. Moreover, there is a social trend, at least within the teacher-attending environment, promoting not only the desire to specialize, but a pro-specialist culture.

Correlación clínico-patológica en entidades dermatológicas. Clínica Ces Medellín 1995-1997 / Clinic-patological correlation in dermatologicals diseases: Clinica Ces Medellin 1995-1997

A diario el dermatólogo se enfrenta con la tarea de hacer un buen diagnostico clínico, pero ¿cuántos de éstos se correlacionan en una forma adecuada con el estudio anatomopatológico? Para evaluar dicha concordancia se planteó este estudio, además se buscaba comparar el acierto de los dermatólogos con los de los médicos de otras especialidades. El presente es un estudio analítico buscando la correlación entre los diagnósticos clínicos y los de anatomía - patológica de todas las biopsias procesadas en la Clínica CES durante el período comprendido entre enero de 1995 y mayo de 1997. Para tal fin se revisaron todas las órdenes de solicitud de biopsias y los informes de patología respectivos. En total se tabularon 1198 muestras. La concordancia diagnóstica de los clínicos con los diagnósticos realizados mediante patología fue de 72,3% para los dermatólogos, 11% para los cirujanos plásticos y 16,7% para el grupo de otros médicos. En los tumores benignos no hubo diferencia significativa en la coincidencia diagnóstica entre las diferentes especialidades. La coincidencia entre dermatólogos y otros en los tumores benignos es muy semejante (55,9% y 53,2%); en las entidades infecciosas el grupo de otros médicos tuvo mejor correlación que los dermatólogos. Sería interesante realizar un trabajo por diagnósticos específicos y comparar con otros médicos, para evaluar la causa real de la poca correlación de los dermatólogos y el mejor desempeño de otros especialistas en entidades infecciosas y tumorales.

Everyday the dermatologist faces the responsibility of making a good clinical diagnosis, but how many of these are appropriately correlated with the anatomopathological studies? This study was made to evaluate such correlation, and to see how good are the diagnosis made by dermatologists compared to other specialists. This descriptive study is looking for the concordance between clinical diagnoses and the anatomy – pathology biopsies processed at the CES Clinic during the period between January 1995 and May 997. For such aim all the biopsy requests and the respective information of pathology were reviewed. 1198 samples were tabulated. The concordance viewed between clinical diagnoses and those made through pathology was of 72.3% for the dermatologists, 11% for plastic surgeons and 16.7% for the group of other physicians. In the benign tumors there was no significant difference in the diagnostic concordance among the different specialties. The coincidence between dermatologists and others in the benign tumors is very similar with 55.9% and 53.2%, respectively; in the infectious entities the group of other doctors had better correlation than the dermatologists. It would be interesting to conduct a specific diagnostic research and compare with other physicians, to assess the real cause of the low correlation of dermatologists and better perform of other specialistsin infectious and tumor entibies.

Formación de médicos dermatólogos en Argentina / Training for dermatology specialists in Argentina

En los últimos veinticinco años se han producido cambios en la política de salud y desde diferentes Organizaciones (oficiales y profesionales) ha surgido la necesidad de analizar la composición, capacitación y distribución del recurso humano para lograr la mejor salud de los argentinos. Frente a esta necesidad se ha trabajado en el presente estudio con el objetivo de conocer las alternativas de formación de los médicos especialistas en Dermatología. Se identificaron 63 centros de formación de posgrado en Dermatología, distribuidos en: Ciudad Autónoma de Buenos Aires 29 (46 por ciento), provincia de Buenos Aires 14 (22,2 por ciento), Santa Fe 5 (7,9 por ciento), Tucumán 2 (3,2 por ciento), Córdoba 6 (9,5 por ciento), Salta 3 (4,8 por ciento), Mendoza 2 (3,2 por ciento), Entre Ríos 1 (1,6 ciento) y Chaco 1 (1,6 por ciento). El 46 por ciento de los centros formadores se localizan en la CABA, y el 22,2 por ciento en la provincia de Buenos Aires. De la totalidad de los 63 centros formadores, el 73 por ciento corresponde al sector público y el 27 por ciento al sector privado. En su totalidad estos centros ofrecen un total de 283 vacantes anuales para la formación.

During the last twenty-five years changes in health policy have taken place and from different Organizations (public and professional) the need of analyzing the composition, qualification and distribution of human resources has arisen, in order to obtain better health care for the Argentine people. This research was carried out with the aim of knowing the training choices for dermatology specialists. Sixty three postgraduate training centers in dermatology were found: 29 in: Buenos Aires City (46 per cent), 14 in Buenos Aires Province (22.2 per cent), 5 in Santa Fe (7.9 per cent), 2 in Tucumán (3.2 per cent), 6 in Córdoba (9.5 per cent), 3 in Salta (4.8 per cent), 2 in Mendoza (3.2 per cent), 1 in Entre Ríos (1.6 per cent) and 1 in Chaco (1.6 per cent). Most of these training centers (68.2 per cent) are located in Buenos Aires City and in Buenos Aires Province. Of these 63 training centers, 73 per cent belong to government operated centers and 27 per cent to the private sector. Altogether, there is an annual offer of 283 places for dermatology training candidates.

Perfil epidemiológico del médico especialista en dermatología en la República Argentina 2008 / Epidemiological study of the dermatology specialist in the Argentine Rpublic 2008

En los últimos 25 años se han producido cambios en la política de salud desde diferentes Organizaciones (oficiales y profesionales) ha surgido la necesidad de analizar la composición, capacitación y distribución del recurso humano. El presente estudio tiene como objetivo conocer la distribución de los médicos especialistas en Dermatología, según jurisdicción e identificar información general de los especialistas. Como resultado fueron identificados 2750 profesionales relacionados con la especialidad y con residencia en el país; el 66 por ciento (1820) se corresponden con el criterio de inclusión tener título habilitante de especialista; el 15.7 por ciento (431) se encuentra cursando la especialidad; el 18 por ciento (494) fueron invitados por distintos mecanismos (Web, e-mails, notas) no pudiendo obtener su adhesión. De este 18 por ciento el 3.4 por ciento (95) no aceptaron participar; el 11 por ciento (296) no respondieron; el 2.9 por ciento (81) al momento de ser visitados se contató cambio de domicilio; el 0.8 por ciento (22) son médicos de otras especialidades que prestan servicios dermatológicos, tres manifestaron estar jubilados y dos habían fallecido. En el estudio se observa que el 78.5 por ciento son del sexo femenino; que el promedio de edad es de 47.4 años de edad, (26 años - 86 años), con una mediana de 48 años. La distribución no es uniforme en las diferentes jurisdicciones. La tasa general de profesionales proyectada es de 7.13/100000 habitantes.

In the last twenty-five years changes in health policy have taken place and from different organizations (officials and professionals) the necessity to analyze the composition, qualification and distribution of the human resource has arisen. The objective of this study is to know the distribution of the dermatology's specialist by jurisdiction and identify their characteristics. As a result were identified 2750 professionals related to the specialty and with residence in the country, 66 per cent (1820) meet the inclusion criteria "to have qualifying title of specialist", 15.7 per cent (431) is attending the specialty, 18 per cent (494) were invited by different mechanisms (Web, emails, notes) not being able to obtain their adhesion. Of this one 18 per cent, 3,4 per cent (95) did not accept to participate, 11 per cent (296) did not respond, 2,9 per cent (81) at the time of being visited was stated change of address, 0,8 per cent (22) are doctors of other specialties that serve dermatological, three declared to be retired and two had passed away. In the study it has been observed that 78,5 per cent are female, the average age of 47,4 years of age (26 years - 86 years). The medium is 48 years. The distribution is not uniform in all jurisdictions. The general rate of professionals projected is 7.13 / 100.000 inhabitants.

Cuenta esta leyenda. O de la dificultad de la cancerología) / It counts this legend. Or of the difficulty of the cancer research)

Se intenta poner de manifiesto la dificultad de ser cancerólogo, una profesión muy difícil de ejercer. Por otra parte, se intenta también destacar cuándo "dedicarse a la profesión" puede constituir una posición narcisista, con sacrificio de su entorno afectivo.