Estudio del cambio de perfil del médico interno residente en un período de cuatro años en un hospital de tercer nivel / Profile changes of medical postgraduate residents. A 4-year study in a tertiary hospital

Introducción: Los recientes cambios socioeconómicos pueden modificar las características de los residentes que se incorporen a la formación sanitaria especializada (FSE), por lo que es oportuno, como punto de partida, estudiar algunas de sus particularidades en estos últimos años, incluida la incidencia de la denominada 'recirculación' dentro de la FSE. Sujetos y métodos: Se analizaron los datos demográficos, número obtenido en la convocatoria y otras características de todos los médicos internos residentes (MIR) que accedieron al Hospital Universitario Virgen de la Arrixaca (Murcia) durante el periodo 2009-2012. El estudio de la recirculación se limitó a los MIR ingresados en 2011 y 2012. Resultados: De los 226 MIR, 55% de sexo femenino, 73% de nacionalidad española, edad mediana de 25 años (rango intercuartílico: 25-28), la elección más frecuente es una especialidad clínica, y la mediana del número de acceso MIR, de 2.413 (rango intercuartílico: 1.305-3.425). El número de acceso es mejor en los varones que en las mujeres y en especialidades quirúrgicas respecto a médicas. La proporción de mujeres y de MIR de nacionalidad no española no ha cambiado significativamente durante los cuatro años. La recirculación se evidenció en el 17,1% (9,9% por segunda especialización y 7,2% por cambio de especialidad o con titulación fuera de la FSE antes de su conclusión). Conclusiones: Nuestros MIR en un hospital de tercer nivel son mujeres en mayor proporción. Un mejor número de acceso al examen MIR se asocia a varones y especialidades quirúrgicas. La tasa de recirculación en el periodo 2011-2012 no es desdeñable, predominando la reespecialización

Introduction: Recent economic and social changes may result in changes in the profile of our Residents currently admitted to postgraduate medical training (PMT) programs. Therefore, it seemed appropriate to study the current profile of trainees and proportion of residents retraining within our PMT programs to know the extent of these changes. Subjects and methods. We analyzed the demographic, examination score and other trainee data of 226 residents admitted to PMT programs in a tertiary hospital (Hospital Universitario Virgen de la Arrixaca, Murcia) during the 2009-2012 period. The study of retraining was limited to years 2011 and 2012. Results: Among 226 residents, females accounted for 55%, median age was 25 years (interquartile range: 25-28), they more frequently chose a clinical specialty, their median score in the national examination was 2,413 (interquartile range: 1,305-3,425) and there was no change in the proportion of foreign residents during the study. Male gender and the option for a surgical specialty were associated with a better examination score. Retraining accounted for 17.1% of our residents: 9.9% entered the PMT system to carry out a second specialty and 7.2 % after a previously unfinished specialty. Conclusions: The residents' profile in a tertiary hospital has remained unchanged during the last four years apart from a higher proportion of females. A higher score in the PTM examination was associated with male gender and the option for a surgical specialty. The proportion of foreign trainees did not change. The retraining rate among our residents was not negligible and was mostly due to respecialization

[Hospital resources and myocardial infarction case fatality. The IBERICA study]. / Recursos hospitalarios y letalidad por infarto de miocardio. Estudio IBERICA.

INTRODUCTION AND OBJECTIVES: To determine the proportion of patients with myocardial infarction (MI) not admitted to a coronary care unit (CCU), the variables associated with admission into a CCU, and whether admission to a CCU, and the availability of coronary angiography in the same hospital, were associated with 28-day case fatality. PATIENTS AND METHOD: Population-based registry of MI in patients 25 to 74 years of age, admitted during 1996-1998. Demographic and clinical characteristics were recorded, as well as management, clinical course and survival after 28 days. Hospitals were classified according to the availability of a CCU and catheterization laboratory (advanced hospital), CCU only (intermediate hospital) or neither (basic hospital). Admission to the CCU was also recorded. RESULTS: In all, 9046 cases of MI were recorded; in 11.3% the patient was not admitted to a CCU. Age, smoking (OR=1.33; 95% CI, 1.08-1.64), non-Q MI (OR=0.62; 95% CI, 0.49-0.78) or undetermined location of MI (OR=0.34; 95% CI, 0.23-0.50), Killip 4 score on admission (OR=0.63; 95% CI, 0.40-1.00) and delay in arrival at the hospital >6 h were associated with CCU admission. Patients admitted to a CCU showed a lower case fatality in the first 24 h (4.2% vs 23.5%), which was independent of comorbidity, severity and treatment. The 24-hour survivors admitted to a basic hospital had higher case fatality (17.3% vs 7.8%) than other groups, which was related to differences in treatment. CONCLUSIONS: CCU admission is associated with a lower case fatality in the first 24 h. Admission to a basic hospital is associated with a higher 28-day case fatality even in patients who survive 24 h.